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Knowledge about permanent tooth avulsion and its management among dentists in Riyadh, Saudi Arabia

  • Yousra Hussain AlJazairy1, 2,
  • Hassan Suliman Halawany2, 3Email author,
  • Nassr AlMaflehi2, 3,
  • Nawaf Sulaiman Alhussainan2, 4,
  • Nimmi Biju Abraham2 and
  • Vimal Jacob2
BMC Oral Health201515:135

https://doi.org/10.1186/s12903-015-0126-3

Received: 11 May 2015

Accepted: 23 October 2015

Published: 2 November 2015

Abstract

Background

There is a lack of adequate information on dentists’ knowledge about tooth avulsion and its management in Saudi Arabia. The aim of this study was to evaluate the level of knowledge about permanent tooth avulsion and its management among dentists working in Riyadh, Saudi Arabia.

Methods

A total of 550 dentists were contacted to request their participation in this 19-item questionnaire survey over a three-month period starting in January 2015 using convenience sampling methodology. A questionnaire consisting of demographic items and multiple-choice questions regarding knowledge of avulsion and its management was used. The level of knowledge was assessed using a scoring system that assigned one point for each correct answer and zero points for wrong answers, with a maximum possible score of ten points. An independent t-test was used to compare the level of knowledge (mean score) based on particular variables, such as sex, nationality, type of practice, current employment, working hours and whether the respondents had attended a continuing dental education (CDE) programme on avulsion management. The level of significance was set at P< 0.05.

Results

A total of 470 completed questionnaires were collected with data suitable for statistical analysis. The majority of the respondents were Saudi (n = 331; 72.1 %) and general practitioners (n = 278; 59.3 %). Most of the participants correctly responded to the knowledge-based questions, except the questions regarding the best storage medium (milk: 24.1 %) and the duration of follow-up by clinical and radiographic examination (5 years: 15.6 %). The mean knowledge score was 5.94 ± 1.57. Gender (P = 0.001), current employment (P = 0.045) and working hours per day (P = 0.020) had a significant effect on the mean knowledge score.

Conclusions

The surveyed dentists were found to have a moderate knowledge of avulsion and its management, although a relative lack of knowledge was observed regarding the duration of follow-up after replantation.

Keywords

Knowledge Avulsion Dentists

Background

Permanent tooth avulsion occurs in 0.5–3 % of all dental injuries [1], which are reportedly the most common cause of all cases of facial trauma. The prognosis of an avulsed tooth is essentially dependent on its extra-alveolar time and the procedures performed at the time of the avulsion injury. In cases where these factors are unfavourable, pulp necrosis and degeneration of periodontal ligament (PDL) cells may ensue, resulting in inflammatory/replacement root resorption or ankylosis of the tooth, eventually leading to tooth loss [1, 2]. Immediate replantation is the treatment of choice for an avulsed tooth, although it is not always possible to perform this treatment [1]. Replantation success depends on the maintenance of PDL cell vitality [3].

A higher prevalence of dental trauma in 12- to 14-year-old boys (prevalence of avulsion: 6.4 per thousand permanent maxillary central incisors) was reported in a Saudi Arabian study [4] compared with that found in an age-matched United Kingdom Children’s Dental Health Survey (prevalence of avulsion: 3.0 and 0.8 per thousand permanent maxillary central incisors for 12- and 14-year-old boys, respectively) [5]. A considerably higher prevalence of maxillary central incisor trauma (31.4 %) was reported among 12- to 15-year-old Saudi girls in another study [6].

Comparatively few Saudi studies have investigated knowledge of tooth avulsion and its management across various professions that are either directly or indirectly involved in emergency dental trauma care. A recent survey performed by Halawany et al. [7] reported that the educational qualifications of dental assistants had a significant effect on their level of knowledge regarding tooth avulsion and its management. However, there is a lack of sufficient information regarding dentists’ knowledge about tooth avulsion and its management in Saudi Arabia. Consequently, the aim of this study was to evaluate the knowledge of dentists working in private and governmental hospitals, clinics, polyclinics (large dental health care facilities that provide a wider range of service than a standard general dental practitioner’s office) and dental schools in Riyadh, Saudi Arabia, concerning permanent tooth avulsion and its management.

Methods

The current study was registered with and approved by the College of Dentistry Research Center (CDRC: registration number FR 0211), and informed written consent was provided by each subject according to the ethical principles of the World Medical Association Declaration [8]. A 19-item English-language questionnaire, which was a modified version of the questionnaire used by Westphalen et al. [9], was developed and pretested in a group of ten Saudi and non-Saudi dentists. Potential difficulties were identified regarding the respondents’ comprehension of the questionnaire, which consisted of demographic items and multiple-choice questions regarding dental trauma and its management, and minor modifications were made according to these results. The final questionnaire consisted of 9 demographic items and 10 multiple-choice questions regarding dental trauma and its management. The survey was administered to dentists working in various private and governmental hospitals, clinics, polyclinics and dental schools in Riyadh, Saudi Arabia.

According to the Ministry of Health Statistics 2014, the total number of dentists working in Riyadh is 3597, of which 2929 work in the private sector, and 668 work in the government sector [10]. A total of 550 dentists, representing 15.3 % of all dentists working in Riyadh, were contacted to request their participation in this study over a period of three months starting in January 2015 using convenience sampling methodology. Two of the co-investigators participated in the data collection process and approached each of the prospective participants individually in person. The dentists’ willingness to participate in the study by completing the anonymous questionnaire was sought. No personal information on the dentists’ identities was required to be disclosed. Dentists who were willing to participate were given the questionnaire, and they completed and returned the questionnaire immediately to the co-investigators.

The data obtained from the survey were manually entered into a Statistical Package for the Social Sciences database (IBM, SPSS version 20, IL, USA) and analysed with a significance level established at P < 0.05. The respondents’ level of knowledge regarding tooth avulsion and its management was assessed using a scoring system that assigned one point for each correct answer and zero points for wrong answers, with a maximum possible score of ten points. An independent t-test was used to compare the level of knowledge (mean score) based on variables such as sex, nationality, type of practice, current employment, working hours, and whether the respondents had attended a continuing dental education (CDE) programme on avulsion management. Logistic regression was performed to assess the significance of each demographic variable (sex, nationality, type of practice, years of experience, current employment and working hours) and CDE programme attendance on avulsion management to explain their likelihood of correctly answering each of the knowledge-based questions.

Results

A total of 470 dentists, representing 13.1 % of the dentists working in Riyadh, completed the questionnaires with data that were suitable for statistical analysis. The mean age of the respondents was 35.89 ± 9.09 years. The majority of the respondents were Saudi (n = 331; 72.1 %) and general practitioners (n = 278; 59.3 %). The demographic characteristics of the study population are shown in Table 1.
Table 1

Demographic characteristics of the study population

Variables

Total N = 470, n (%)

Sexa

Male

220 (46.9)

Female

249 (53.1)

Nationalityb

Saudi

331 (72.1)

Non-Saudi

128 (27.9)

Educational qualificationsc

Bachelor’s Degree

269 (57.2)

Master’s Degree

174 (37.0)

Doctorate

24 (5.8)

Type of practice

General Practitioners

278 (59.3)

Endodontists

50 (10.6)

Orthodontists

35 (7.4)

Pedodontists

26 (5.5)

Oral and Maxillofacial Surgeons

21 (4.5)

Prosthodontists

18 (3.8)

Periodontists

16 (3.4)

Dental Public Health Specialists

11 (2.3)

Advanced General Dentists

6 (1.3)

Oral Biologists

4 (0.9)

Oral Medicine Specialists

3 (0.6)

Oral Pathologists

2 (0.4)

Years of experienced

<5 years

287 (62.5)

6 to 15 years

92 (20.0)

>16 years

80 (17.5)

Current employmente

Private

138 (30.5)

Public

315 (69.5)

Working hoursf

≤8 h

299 (66.6)

>8 h

150 (33.4)

Attended continuing dental education programme on the management of tooth avulsiong

Yes

195 (41.7)

No

273 (58.3)

Missing values: a = 1; b = 11; c = 3; d = 11; e = 17; f = 21; g = 2

The percentage distribution of the responses to the questions regarding avulsion knowledge and management is shown in Table 2. Most of the participants correctly responded to the knowledge-based questions, except those regarding the best storage medium and the duration of follow-up by clinical and radiographic examination. Questions regarding factors that may affect the outcome of replantation of an avulsed tooth were correctly answered by the highest number of respondents (n = 415; 89.4 %), followed by questions regarding splinting duration (n = 389; 83.5 %).
Table 2

Distribution of the responses to questions about avulsion and its management

Questions about avulsion and its management

 

n (%)

1) Should an avulsed permanent tooth be replaced in its socket?a

Yes, in all cases

105 (22.6)

 

Not in all casesk

354 (76.3)

 

Never

5 (1.1)

2) Factors that may influence the outcome of replantation of the avulsed toothb

Extra-alveolar period

23 (5.0)

 

Storage medium

20 (4.3)

 

Injury to periodontal ligament

6 (1.3)

 

All of the abovek

415 (89.4)

3) Best storage mediumc

Patient’s saliva

121 (26.1)

 

Milkk

112 (24.1)

 

Physiological saline solution

22 (4.8)

 

Hank’s balanced salt solution

209 (45.0)

4) Ideal extra-alveolar periodd

<30 mink

318 (68.5)

 

30 minutes to 1 h

127 (27.4)

 

1 to 2 h

19 (4.1)

5) Tooth management before replantatione

Hold the crown and wash with any antiseptic solution

24 (5.2)

 

Hold the crown and wash with physiological saline solutionk

329 (70.9)

 

Hold the crown and wash with tap water

73 (15.7)

 

Hold the root and wash with physiological saline solution

38 (8.2)

6) Type of splintingf

Flexible splintsk

240 (51.6)

 

Rigid splints

215 (46.2)

 

No need for splinting

10 (2.2)

7) Splinting durationg

Less than 7 days

33 (7.1)

 

7 to 14 daysk

389 (83.5)

 

30 days

44 (9.4)

8) Endodontic treatmenth

Pulpectomy and root canal filling after 15 days

119 (25.6)

 

Depends on extra-alveolar period and stage of root formationk

287 (61.7)

 

Immediate pulpectomy and calcium hydroxide therapy

59 (12.7)

9) Systemic medicationi

Prescribe anti-inflammatory drugs only

101 (21.7)

 

Prescribe antibiotics, anti-inflammatory drugs and tetanus preventionk

274 (59.1)

 

No medication required

89 (19.2)

10) Follow-up by clinical and radiographic examination for:j

1 year

280 (59.8)

 

3 years

115 (24.6)

 

5 yearsk

73 (15.6)

Missing values: a = 6; b = 6; c = 6; d = 6; e = 6; f = 5; g = 4; h = 5; i = 6; j = 2

kBest answer from the choices provided

The mean knowledge score regarding tooth avulsion and its management according to demographic variables is shown in Table 3. The overall mean score was 5.94 ± 1.57. The mean knowledge score of female participants was significantly higher than that of male participants (P = 0.001). Furthermore, a significantly higher mean knowledge score was observed among respondents working in public clinics/hospitals compared with those working in private clinics/hospitals (P = 0.045) and among respondents working 8 h or fewer per day compared with those working more than 8 h per day (P = 0.020).
Table 3

Mean knowledge scores regarding avulsion and its management according to demographic variables

Demographic variable

 

Mean ± SD

P-value

Sex

Male

5.68 ± 1.54

0.001a

 

Female

6.17 ± 1.56

 

Nationality

Saudi

5.99 ± 1.53

0.648

 

Non-Saudi

5.91 ± 1.60

 

Type of practice

General practitioner

5.92 ± 1.44

0.783

 

Specialist

5.96 ± 1.77

 

Current employment

Private

5.72 ± 1.54

0.045a

 

Public

6.05 ± 1.59

 

Working hours

≤8 h

6.06 ± 1.52

0.020a

 

>8 h

5.69 ± 1.65

 

Attended continuing dental education programme on tooth avulsion management

Yes

5.89 ± 1.62

0.648

 

No

5.96 ± 1.53

 

Statistical test: Independent T test

aSignificant

Logistic regression analyses for each of the knowledge-based questions according to the background characteristics of the respondents are shown in Table 4. The likelihood of correctly answering most of the knowledge-based questions was significantly higher among respondents working in public clinics/hospitals (7 of 10 questions) compared with those working in private clinics/hospitals, followed by female participants (6 of 10 questions) compared with male participants.
Table 4

Odds ratio based on maximum-likelihood estimates using logistic regression

Qsa

Sex (1)

Nat (1)

Prac (1)

Emp (1)

Hrs (1)

CDE (1)

1

1.90

1.77

1.03

3.07

0.76

0.67

 

(1.29–2.82)

(1.04–3.04)

(0.56–1.92)

(2.04–4.63)

(0.47–1.23)

(0.43–1.04)

2

2.71

2.49

0.95

3.81

1.03

1.95

 

(1.59–4.61)

(1.15–5.41)

(0.41–2.19)

(2.29–6.36)

(0.53–2.01)

(1.04–3.65)

3

0.95

0.59

0.55

0.36

0.72

0.86

 

(0.64–1.42)

(0.33–1.04)

(0.28–1.08)

(0.24–0.55)

(0.42–1.21)

(0.54–1.37)

4

1.61

1.52

1.65

1.66

0.63

0.82

 

(1.11–2.34)

(0.90–2.55)

(0.91–3.00)

(1.14–2.42)

(0.40–1.00)

(0.54–1.25)

5

1.27

1.78

1.22

3.05

1.03

0.66

 

(0.87–1.85)

(1.06–3.01)

(0.67–2.24)

(2.03–4.56)

(0.64–1.65)

(0.43–1.01)

6

1.18

0.75

2.09

0.99

0.65

1.68

 

(0.83–1.68)

(0.47–1.20)

(1.19–3.68)

(0.69–1.43)

(0.42–1.01)

(1.13–2.52)

7

2.56

1.92

0.66

2.61

1.11

3.44

 

(1.61–4.09)

(1.03–3.59)

(0.32–1.33)

(1.66–4.12)

(0.63–1.96)

(1.92–6.16)

8

1.67

0.59

0.79

1.38

0.86

1.26

 

(1.17–2.39)

(0.37–0.95)

(0.45–1.38)

(0.96–1.98)

(0.56–1.34)

(0.84–1.88)

9

1.37

1.32

1.07

1.25

1.01

0.88

 

(0.96–1.95)

(0.81–2.15)

(0.61–1.86)

(0.87–1.80)

(0.65–1.58)

(0.59–1.32)

10

0.51

0.69

2.19

0.30

0.62

0.45

 

(0.33–0.80)

(0.40–1.26)

(1.09–4.36)

(0.19–0.47)

(0.34–1.12)

(0.26–0.77)

Confidence interval (lower–upper) in parentheses. The variables with bold numbers were statistically significant (P < 0.05)

aQuestions 1 to 10 are provided in Table 2

Sex: (0) – Male, (1) – Female; Nationality (Nat): (0) – Saudi, (1) – Non-Saudi; Type of practice (Prac): (0) – General practitioner, (1) – Specialist; Current employment (Emp): (0) – Private, (1) – Public; Working hours (Hrs): (0) – ≤ 8 h, (1) – > 8 h; Attended continuing dental education programme on avulsion management (CDE): (0) – No, (1) – Yes

Discussion

Knowledge of avulsion, which is considered a dental emergency, and its management can reduce stress and anxiety for both patients and dentists [11]. Correct immediate post-traumatic management protocols have been reported to improve both the short- and long-term prognosis of the avulsed tooth [12]. Several studies have assessed dental trauma knowledge among dentists and reported that the surveyed dentists had insufficient knowledge to treat dental trauma [1315], had very little experience treating dental trauma to permanent incisors [16], and had a lack of confidence regarding the management of complex trauma cases [17]. The purpose of our cross-sectional study was to evaluate the level of knowledge about avulsion and its management among dentists working in Riyadh, Saudi Arabia.

Demographics

The level of knowledge of the surveyed sample of dentists was found to be moderate, with an overall mean knowledge score of 5.94 ± 1.57. The results of our study also revealed that gender, current employment and daily working hours had a significant effect on the mean knowledge score, whereas nationality, type of practice and history of attending CDE programmes on the management of tooth avulsion had no significant effect (Table 3). These findings were not consistent with the results obtained in previous studies [14, 18]; however, these studies used different questions to determine the knowledge score.

Most of our respondents (58.3 %) reported that they had not attended any CDE programme on tooth avulsion management, which is consistent with the findings reported by Zhao et al. [19] but not with those reported in other studies [9, 14]. Most of the respondents (60 %) in the study by Westphalen et al. [9] reported that they had participated in a CDE programme on dental trauma on their own initiative after graduation. The authors stated that the city where the study was performed had four dental schools; thus, the local dental practitioners had a higher probability of being presented with opportunities to attend these courses. Although Riyadh is the venue for the annual Saudi Dental Society International Dental Conference, and there are eight public and private dental schools within the city, fewer respondents had attended CDE programmes on this vital aspect of emergency dental care and management. This finding may be due to a lack of related course offerings, a lack of interest, or busy work schedules among these dentists. However, no significant difference (P = 0.648) in the mean knowledge score was observed between those who had and had not attended a CDE programme (Table 3). This result is not consistent with previous studies, which reported that dentists who attended dental trauma courses after graduation had higher knowledge scores [13], had more thorough [15] and better [14] knowledge of dental trauma management and had more confidence in managing these patients [17]. Some of the respondents who reported having attended CDE programmes on this topic may have done so a long time ago, and the information provided may now be outdated. This is a potential reason for the lack of a significant difference in the mean knowledge score between those who had and had not attended a CDE programme.

Clinical management

Approximately 76 % of our respondents reported that an avulsed permanent tooth should not be replanted in all cases, which is consistent with the results of previous studies [19, 20]. In cases of severe caries, periodontal disease, and medical conditions, such as immunosuppression or severe cardiac diseases, or in cases in which the patient is not cooperative, replantation of the avulsed permanent tooth is not indicated according to the International Association of Dental Traumatology (IADT) guidelines [1]. Most of our respondents (89.4 %) reported that the extra-oral period, storage medium and injury to the PDL are factors that may affect the outcome of replantation of the avulsed tooth, which is consistent with the results of a study by Westphalen et al. [9]. The extra-alveolar period has been recognized as the most critical factor for optimal periodontal healing [21, 22].

Saline, Hank’s balanced salt solution (HBSS), and milk are examples of osmolality-balanced media suitable for storing avulsed teeth [1]. The patient’s saliva, although readily available at the site of trauma, contains bacteria and their by-products [23]. Furthermore, several studies have reported that the vitality of PDL cells can be sustained for 30 min when immersed in the patient’s saliva, but it decreases remarkably after 60 min [21, 23, 24]. However, while milk may not be readily available at the site of trauma, storage of the avulsed tooth in milk at room temperature has been reported to preserve the viability of PDL cells for up to 60 min, whereas refrigerated milk preserves viability for an additional 45 min [25, 26]. HBSS, on the other hand, was not included by some authors as an option in their questionnaire concerning storage medium due to its lack of availability at trauma sites [27]. Physiological saline solution is more commonly available than HBSS but is less available than milk. Thus, for the purpose of scoring in this study, one point was assigned to the respondents who identified milk as the best storage medium. The highest percentage of our respondents (45 %) reported HBSS as the best storage medium, followed by the patient’s saliva (26.1 %) and milk (24.1 %). This finding was not consistent with the results of previous studies, in which most of the participants reported the patient’s saliva [9], saline [18], or milk [20, 28, 29] as the preferable or recommended storage medium.

The highest percentage of participants (68.5 %) reported the ideal extra-alveolar period as less than 30 min, which is consistent with the results of previous studies [9, 13, 19, 20]. Furthermore, approximately 71 % of our respondents reported holding the crown of the avulsed tooth and washing it with physiological saline solution prior to replantation, and 15.7 % of the respondents reported holding the crown and washing it with tap water. Westphalen et al. [9] reported that a significant number of the participating dentists in their study (40 %) used tap water to wash the avulsed tooth prior to replanting it during an office or hospital procedure. However, Baginska et al. [18] reported that most of their respondents (85 %) treated the contaminated avulsed tooth by gently rinsing it with saline under dental surgical conditions. The IADT recommends briefly washing the avulsed tooth (for a maximum of 10 s) under cold running water before repositioning it in the alveolar socket as a first-aid procedure at the accident site and cleaning the root surface and apical foramen with a stream of saline in cases in which the avulsed tooth has been kept in a physiological storage medium and/or the stored dry and extra-oral dry time was less than 60 min [1]. Because our questionnaire did not specify the clinical conditions (i.e., whether the procedures were performed at the accident site or whether the avulsed tooth was brought to the dental office in a suitable storage medium within 60 min), the results of this questionnaire should be cautiously interpreted.

The IADT recommends using a flexible splint for up to 14 days for an avulsed tooth [1]. Although more of our respondents suggested a flexible splint, the difference in the number of respondents suggesting flexible (51.6 %) compared with rigid (46.6 %) splints was not marked. However, a significantly higher number of respondents (83.5 %) reported the duration of splinting as 7 to 14 days. These results were not consistent with those obtained in previous studies. Hu et al. [14] reported that only 59.1 % of their participants knew that a flexible splint is indicated for 2 weeks in cases of avulsed teeth. Westphalen et al. [9] reported that most of their respondents (73 %) suggested a flexible splint and that 64 % of the dentists reported a splinting duration of more than 15 days. However, Zhao et al. [19] reported that more of their respondents suggested a rigid splint (49 %) than a flexible splint (45.1 %). Furthermore, a higher percentage of the respondents in this previous study suggested splinting for 30 days (40.6 %), whereas only 10.2 % suggested splinting for 2 weeks.

The IADT recommends root canal treatment if the dry time exceeds 60 min or for other reasons, such as the presence of non-viable cells and teeth with a closed apex [1]. A large percentage of our respondents (61.7 %) reported that the endodontic treatment is dependent on the extra-alveolar period and stage of root formation, which is consistent with the results obtained by Westphalen et al. [9]. Most participants in the study by Krastl et al. [27] reported that root canal treatment should be performed within 7 to 14 days for an avulsed tooth (with completed root apex formation) that has been replanted within 30 min. The IADT recommends prescribing systemic antibiotics and referring the patient to a physician to evaluate the need for a tetanus booster in cases in which the avulsed tooth has contacted soil or the tetanus coverage is uncertain [1]. A higher percentage of our respondents (59.1 %) suggested prescribing antibiotics, prescribing anti-inflammatory drugs and employing tetanus prevention strategies, which was consistent with the results obtained by Westphalen et al. [9]. Antibiotic treatment after replantation was also recommended by most of the participants in the study by de Vasconcellos et al. [28].

Follow-up

Follow-up treatment of replanted teeth via clinical and radiographic examination is recommended for a period of 5 years [22, 30]. However, more of our respondents suggested follow-up treatment by clinical and radiographic examination for 1 year (59.8 %), which was not consistent with the results of the study by de Vasconcellos et al. [28]. The highest percentage of the participants in that study (34.8 %) stated that the correct practice was follow-up treatment by clinical and radiographic examination for 2 or more years.

Study limitations

Specific limitations of this study should be noted when interpreting the results. A major limitation is the sampling methodology implemented in our study. A convenience sample may not sufficiently represent the entire population of dentists working in Riyadh. A direct comparison of our results with those of previous studies was not always possible due to differences in the questions and answer choices. Several studies used multiple-choice questions [1820, 28], open-ended questions [9] or scenario-based questions [14]. Furthermore, some studies determined the frequency distribution of the participants according to the questions [9, 20], whereas other studies used a scoring system [14, 18]. The basis for selecting the best storage medium (availability and maintaining the viability of PDL cells) was not explained in our questionnaire, which may have resulted in a higher number of respondents selecting HBSS instead of milk. The cross-sectional study design and lack of a control group should also be considered limitations.

Conclusions

Within the limitations of this study, the surveyed dentists’ knowledge regarding avulsion and its management was found to be moderate, although a relative lack of knowledge was observed regarding the duration of follow-up after replantation. While most of the respondents correctly answered most of the questions according to the IADT guidelines, a small but significant number of respondents answered the questions incorrectly. Future studies using clinical scenario-based questions related to permanent tooth avulsion and its management will enable more robust testing of dentists’ knowledge.

Abbreviations

PDL: 

Periodontal ligament

CDRC: 

College of Dentistry Research Center

SPSS: 

Statistical Package for the Social Sciences

CDE: 

Continuing dental education

ANOVA: 

Analysis of variance

IADT: 

International Association of Dental Traumatology

HBSS: 

Hank’s balanced salt solution

Declarations

Acknowledgements

The authors would like to extend their appreciation to King Saud University, Deanship of Scientific Research/Dental Caries Research Chair, for financially supporting the present study. The authors also wish to thank the dentists for their participation.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Department of Restorative Dentistry, College of Dentistry, King Saud University
(2)
Dental Caries Research Chair, College of Dentistry, King Saud University
(3)
Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University
(4)
Dental Health Department, Prince Sultan Military Medical City

References

  1. Andersson L, Andreasen JO, Day P, Heithersay G, Trope M, Diangelis AJ, et al. International association of dental traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol. 2012;28:88–96.View ArticlePubMedGoogle Scholar
  2. Soares Ade J, Gomes BP, Zaia AA, Ferraz CC, de Souza-Filho FJ. Relationship between clinical-radiographic evaluation and outcome of teeth replantation. Dent Traumatol. 2008;24:183–8.View ArticlePubMedGoogle Scholar
  3. Pileggi R, Dumsha TC, Nor JE. Assessment of post-traumatic PDL cells viability by a novel collagenase assay. Dent Traumatol. 2002;18:186–9.View ArticlePubMedGoogle Scholar
  4. Al-Majed I, Murray JJ, Maguire A. Prevalence of dental trauma in 5-6- and 12-14-year-old boys in Riyadh Saudi Arabia. Dent Traumatol. 2001;17:153–8.View ArticlePubMedGoogle Scholar
  5. O’Brien M. Children’s dental health in the United Kingdom 1993. London: HMSO; 1994.Google Scholar
  6. Al-Majed I. Dental trauma among 12–15 year-old schoolgirls in Riyadh Saudi Arabia. J Pak Dent Assoc. 2011;20:29–34.Google Scholar
  7. Halawany HS, AlJazairy YH, Alhussainan NS, AlMaflehi N, Jacob V, Abraham NB. Knowledge about tooth avulsion and its management among dental assistants in Riyadh Saudi Arabia. BMC Oral Health. 2014;14:46.View ArticlePubMedPubMed CentralGoogle Scholar
  8. World Medical Association. Declaration: WMA declaration of Helsinki-ethical principles for medical research involving human subjects. 2008. http://www.wma.net/en/30publications/10policies/b3/index.html. Accessed 23 Dec 2014.
  9. Westphalen VP, Martins WD, Deonizio MD, Da Silva Neto UX, Da Cunha CB, Fariniuk LF. Knowledge of general practitioners dentists about the emergency management of dental avulsion in Curitiba Brazil. Dent Traumatol. 2007;23:6–8.View ArticlePubMedGoogle Scholar
  10. Ministry of Health, Saudi Arabia. Ministry statistics and indicators. 2015. Statistical book for the year 1435.Google Scholar
  11. Robertson A, Norén JG. Knowledge-based system for structured examination, diagnosis and therapy in treatment of traumatised teeth. Dent Traumatol. 2001;17:5–9.View ArticlePubMedGoogle Scholar
  12. Flores MT, Andreasen JO, Bakland LK, Feiglin B, Gutmann JL, Oikarinen K, et al. Guidelines for the evaluation and management of traumatic dental injuries. Dent Traumatol. 2001;17:49–52.View ArticlePubMedGoogle Scholar
  13. Hamilton FA, Hill FJ, Holloway PJ. An investigation of dento-alveolar trauma and its treatment in an adolescent population. Part 2: dentists’ knowledge of management methods and their perceptions of barriers to providing care. Br Dent J. 1997;182:129–33.View ArticlePubMedGoogle Scholar
  14. Hu LW, Prisco CR, Bombana AC. Knowledge of Brazilian general dentists and endodontists about the emergency management of dento-alveolar trauma. Dent Traumatol. 2006;22:113–7.View ArticlePubMedGoogle Scholar
  15. Kostopoulou MN, Duggal MS. A study into dentists’ knowledge of the treatment of traumatic injuries to young permanent incisors. Int J Paediatr Dent. 2005;15:10–9.View ArticlePubMedGoogle Scholar
  16. Stewart SM, Mackie IC. Establishment and evaluation of a trauma clinic based in a primary care setting. Int J Paediatr Dent. 2004;14:409–16.View ArticlePubMedGoogle Scholar
  17. Jackson NG, Waterhouse PJ, Maguire A. Management of dental trauma in primary care: a postal survey of general dental practitioners. Br Dent J. 2005;198:293–7.View ArticlePubMedGoogle Scholar
  18. Baginska J, Wilczynska-Borawska M. Continuing dental education in the treatment of dental avulsion: Polish dentists’ knowledge of the current IADT guidelines. Eur J Dent Educ. 2013;17:e88–92.View ArticlePubMedGoogle Scholar
  19. Zhao Y, Gong Y. Knowledge of emergency management of avulsed teeth: a survey of dentists in Beijing China. Dent Traumatol. 2010;26:281–4.View ArticlePubMedGoogle Scholar
  20. Cohenca N, Forrest JL, Rotstein I. Knowledge of oral health professionals of treatment of avulsed teeth. Dent Traumatol. 2006;22:296–301.View ArticlePubMedGoogle Scholar
  21. Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 avulsed permanent incisors. 4. Factors related to periodontal ligament healing. Endod Dent Traumatol. 1995;11:76–89.View ArticlePubMedGoogle Scholar
  22. Barrett EJ, Kenny DJ. Avulsed permanent teeth: a review of the literature and treatment guidelines. Endod Dent Traumatol. 1997;13:153–63.View ArticlePubMedGoogle Scholar
  23. Blomlöf L. Storage of human periodontal ligament cells in a combination of different media. J Dent Res. 1981;60:1904–6.View ArticlePubMedGoogle Scholar
  24. Andreasen JO. Effect of extra-alveolar period and storage media upon periodontal and pulpal healing after replantation of mature permanent incisors in monkeys. Int J Oral Surg. 1981;10:43–53.View ArticlePubMedGoogle Scholar
  25. Blomlöf L, Lindskog S, Hammarström L. Periodontal healing of exarticulated monkey teeth stored in milk or saliva. Scand J Dent Res. 1981;89:251–9.PubMedGoogle Scholar
  26. Lekic P, Kenny D, Moe HK, Barretti E, McCulloch CA. Relationship of clonogenic capacity to plating efficiency and vital dye staining of human periodontal ligament cells: implications for tooth replantation. J Periodontal Res. 1996;31:294–300.View ArticlePubMedGoogle Scholar
  27. Krastl G, Filippi A, Weiger R. German general dentists’ knowledge of dental trauma. Dent Traumatol. 2009;25:88–91.View ArticlePubMedGoogle Scholar
  28. de Vasconcellos LG, Brentel AS, Vanderlei AD, de Vasconcellos LM, Valera MC, de Araújo MA. Knowledge of general dentists in the current guidelines for emergency treatment of avulsed teeth and dental trauma prevention. Dent Traumatol. 2009;25:578–83.View ArticlePubMedGoogle Scholar
  29. Yeng T, Parashos P. An investigation into dentists’ management methods of dental trauma to maxillary permanent incisors in Victoria Australia. Dent Traumatol. 2008;24:443–8.View ArticlePubMedGoogle Scholar
  30. American Association of Endodontists. Recommended guidelines of the AAE for the treatment of traumatic dental injuries. 2013. http://www.aae.org/guidelines/. Accessed 28 Apr 2015.

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© AlJazairy et al. 2015

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