Assessment of School Teachers' Awareness about Dental Trauma in Children at Riyadh City: Survey Study

Introduction

Most facial injuries are caused by dental trauma, and avulsion happens in 1–16% of dental injuries. The treatment undertaken at the time of tooth avulsion and the period immediately following the incident determine the tooth's prognosis [1]. Approximately 25% of kids get dental injuries at school. Males are more likely than girls to be harmed than females are, and upper central incisors are the most often harmed teeth. TDIs are most often brought on by falls, sports, bicycling, and auto accidents. Youngsters with an inadequate lip that does not protect the upper front teeth, increased overjet, and Class II division 1 malocclusion are more susceptible to injury.

Most earlier investigations found that schoolteachers lacked proper expertise in TDI management [2].

The preservation of PDL cell vitality favors the success of tooth reimplantation. Replantation cannot always be done immediately, although it is the preferred treatment [3]. Very few injuries were documented, and the majority of permanent tooth injuries were reported as happening at schools. By the time they were 14, about 25% of kids had already had one or more of their permanent teeth damaged [4].

Many human behavioral variables, such as risk-taking recreational activities, vigorous involvement in sports without taking measures, or emotionally stressful situations, enhance the incidence of traumatic dental injuries (TDIs) in children in addition to oral and environmental factors [5, 6]. A Jeddah-based study found that children between 9 and 11 experienced dental injuries the most frequently. According to research, dental trauma affects 33% of Saudi schoolboys and 31.4% of Saudi schoolgirls. A better long-term prognosis requires prompt intervention at the injury scene [7].

Studies conducted in numerous nations (India, the United Arab Emirates, Brazil, and China) concluded that elementary school teachers are unprepared to handle dental injuries, particularly tooth avulsion [8].

In a study in Saudi Arabia, 66.3% of school personnel (67% and 66.3%, respectively) demonstrated a poor fundamental understanding of the significance of protecting the fractured portion of the tooth and recognizing the tooth involved in the trauma [9]. In a study at a Saudi primary school, findings revealed that most instructors were unaware of the best storage options for permanent teeth that had been avulsed. They concluded that the majority of Riyadh's Saudi elementary school teachers are ignorant of how to handle a youngster who has a dental injury [10].

The drying period after the tooth is removed from the oral cavity and the storage medium is crucial for successful replantation [11].

As prior research in Saudi Arabia concentrated mostly on tooth avulsion, our study aimed to gauge instructors' awareness of general dental damage in deciduous teeth. Our study aimed to test instructors' knowledge regarding common dental trauma, including concussion, subluxation, displacement fracture, and avulsion, since prior research in Saudi Arabia had mostly concentrated on tooth avulsion in children.

 The purpose of this study

Objectives of the study

1. Evaluate primary schoolteachers' understanding of traumatic dental injuries and how to manage them.
2. Assess how teachers' knowledge can be impacted by factors such as gender, nationality, marital status, school type, location, age group, education level, and years of experience.

Aim

To evaluate elementary school teachers' understanding of traumatic dental injuries and their treatment.

Objectives

1. To evaluate the potential effects of gender, nationality, marital status, school type, geography, age group, educational attainment, and years of experience on teachers' knowledge.
2. To assess knowledge of the treatment of various dental traumas

Study rationale

Children spend at least six hours a day in school. Moreover, younger kids are more likely to sustain traumatic injuries because they spend more time engaging in physical activity than older kids do. Therefore, the teachers are the ones who can provide them with the necessary management on an urgent basis.

Materials and Methods

Material and study design

This cross-sectional study was conducted among the schoolteachers of Riyadh using paper-based and online surveys after getting approval from the institutional review board (IRB), Riyadh Elm University, and the consent signed by the participant. Paper-based and online surveys were distributed. All data were collected with high confidentiality.

Study sample

Although the sample size calculations show 377 samples, we used 433 responses to improve the accuracy of the results.

The margin of error: 5%

Confidence level: 95%

Population size: 20000

Response distribution: 50%

Minimum sample size: 377

Study instrument

The online questionnaire consisted of questions including gender, nationality, marital status, school type, location, age group, education level, and years of experience. Questions about the management of concussion, subluxation, fracture, and avulsion were included in the questionnaire.

Instrument validity and reliability

Twenty participants were sent the survey as part of a pilot research, and the results were entered into SPSS version 22 to calculate the reliability using Cronbach's coefficient alpha. The questionnaire's validity was verified by distributing it to seasoned REU researchers, and modifications were made in response to their suggestions and criticisms. 

Statistical analysis

Collected data was analyzed using SPSS version 22, where descriptive and inferential statistics were conducted. For comparisons, the T-test or chi-square test was used. Comparisons between groups were made with the value of significance kept under 0.05.

All data will be processed with confidentiality using the declaration of Helsinki.

Results and Discussion

Table 1. Demographics

Table 1 provides information about the demographic characteristics of a group of individuals. The table presents the percentages of respondents in different categories based on their gender, nationality, marital status, school type, location, age group, education, and experience.

The table shows that the group consists of slightly more females (51%) than males (49%). Most respondents (71%) are Saudi nationals, while 21% are non-Saudi. Most respondents (65.4%) are married, while 24% are single, 8.1% are divorced, and 2.1% are widowed.

In terms of age group, the most significant percentage of respondents (32.1%) fall in the 31-40-year-old category, followed by 20-30 years old (30.7%), 41-50 years old (26.8%), and above 50 (10.4%). As for education, most respondents (77.6%) have completed their graduate studies, while 15.2% have postgraduate degrees and 7.2% have only undergraduate degrees.

Table 2. Survey responses

Table 2 displays the responses to a survey related to dental trauma. The first question asks if the respondent has witnessed dental trauma in the past. Out of all the responses, 68.8% replied yes, while 31.2% replied no. The second question inquires if the respondent has attended a dental trauma training course, and only 21.2% replied yes, while 78.8% responded no.

For the sixth question, which asks about the action the respondent would take if there is mobility in the tooth immediately after the trauma, 68.3% said they would take the child straight to the dentist, and 22.3% said they would only watch the youngster. The seventh question inquires what the respondent would do if the tooth is displaced from its place, and 71.8% said they would take the child to the dentist, while only 14.6% said they would try to fix it with their finger.

In response to the eleventh question, which asked which kind of storage to use for the knocked-out tooth, 53.1% of respondents selected milk and just 8.8% selected tap water.

Table 3. Survey based on gender

Table 3 indicates no statistically significant difference in the replies of male and female participants to these questions, as shown by the multiple p-values in Table 3 that are larger than 0.5. The first question, "Have you witnessed dental trauma in the past?" shows a statistically significant difference between the replies of the male and female participants (p-value = 0.004).

The eleventh question, "If a 9-year-old child fell and broke his upper front tooth, which type of tooth it is most likely to be?" has a p-value of 0.013, indicating a statistically significant difference between the responses of male and female participants. The twelfth query,

In the table, some p-values indicate the statistical significance of the difference in responses between males and females for each question. Looking at the percentages where the p-value is significant, we can see that females are less likely to have witnessed dental trauma in the past compared to males (62.4% vs. 75.4%, p = 0.004). Additionally, females are more likely to have received information about dental trauma from a dentist compared to males (44.34% vs. 33.9%, p = 0.041).

Furthermore, females are more likely to correctly identify a permanent tooth as the one most likely to be broken in a 9-year-old child (46.21% vs. 32.54%, p = 0.013). Finally, females are less likely to want to receive information about dental trauma compared to males (75.56% vs. 89.15%, p < 0.001). These results indicate significant differences in knowledge and behavior related to dental trauma between males and females. The findings may help develop targeted educational interventions to improve knowledge and management of dental trauma in both males and females.

Table 4. Survey based on School type

In Table 4, among the various questions in the survey based on school type, only three questions have a p-value below 0.05, which suggests that they have statistical significance. One of the questions that had a statistically significant difference in responses between private and government school participants was, "Have you received information about dental trauma in the past?" The p-value for this question was 0.043, indicating that private school participants were more likely to receive information about dental trauma than government school participants. Another question with a significant difference in responses between private and government school participants was, "If there is bleeding from the gum after trauma, what will be your action?" In comparison to participants in government schools, parents of children attending private schools were more likely to take them to the dentist right away, as indicated by the p-value of 0.044 for this question.

On the other hand, for the question "Should the broken piece of the tooth be saved?" given that the p-value was 0.503, there was no statistically significant difference between the replies of individuals from government and private schools. Both private and government school participants had similar responses. For the question "Have you witnessed dental trauma in the past?", the p-value was 0.078, which was close to the significance level but not significant. This indicates that the difference in responses between private and government schools was not statistically significant and could have occurred by chance.

Similarly, for the questions "Have you ever attended a dental trauma training course?" and "If there is mobility in the tooth immediately after the trauma, what will be your action?" The p-values, which were not statistically significant, were 0.079 and 0.683, respectively. About the inquiries "If there is bleeding from the gum after Trauma, what will be your action?" and "If the tooth is displaced from its place, what will be your action?", there were significant differences in responses between private and government schools.

Table 5. Survey based on age group