Microsoft Word - 189 2022.docx The Effect of Using an Educa3onal Poster on Mothers’ Knowledge of Emergency Management of Dental Avulsion Vol 10 No 1 (2022) DOI 10.5195/d3000.2022.189 h#p://den*stry3000.pi#.edu The Effect of Using an Educational Poster on Mothers’ Knowledge of Emergency Management of Dental Avulsion Seyedeh Hediyeh Daneshvar1, Melika Khaef2 1 Assistant Professor, Dental Sciences Research Center, Department of Dentistry, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran 2 Dentist, Private Practice Abstract INTRODUCTION: Mothers are commonly the first ones who encounter the dental avulsion in children. High knowledge of them could greatly affect the success rate of treatment. The purpose of this study was to evaluate the effect of educa3onal poster on the mother’s knowledge about management of dental avulsion. MATERIALS AND METHODS: This study was conducted at the Department of Pediatric Den3stry, Guilan University of Medical Sciences from November 2020 to February 2021. ANer obtaining the informed consent, a ques3onnaire containing the mothers’ socio- demographic informa3on and 8 ques3ons regarding knowledge about dental avulsion was responded alone by 262 mothers (131 in the study group and 131 in control group) before educa3onal poster presenta3on in the study group. ANer three months, the par3cipants of both groups were re-evaluated using the same ques3onnaire. McNemar’s test and Generalized Es3ma3ng Equa3ons (GEE) was used to analyze the data. Results with P < 0.05 were considered sta3s3cally significant. RESULTS: Use of an educa3onal poster improved the knowledge of par3cipants of study group about dental avulsion, although this improvement was sta3s3cally significant in ques3ons regarding immediate emergency ac3on (P=0.003), appropriate 3me for replanta3on (P<0.001), cleaning before replanta3on of a dirty tooth(P=0.022) and suitable storage medium for transferring an avulsed tooth (P<0.001). It was found that variables like age, level of educa3on, employment status and previous training had no significant effect on par3cipants knowledge(P>0.05). CONCLUSION: Results showed that the use of posters as an educa3onal method can effec3vely improve mothers’ knowledge about management of children’s dental avulsion. KEYWORDS: Tooth Avulsion; Knowledge; Pediatric Den3stry Cita9on: Daneshvar, SH et al. (2022) The Effect of Using an Educa9onal Poster on Mothers’ Knowledge of Emergency Management of Dental Avulsion Den9stry 3000. 1:a001 doi:10.5195/d3000.2022.189 Received: May 28, 2021 Accepted: September 13, 2021 Published: May 9, 2022 Copyright: ©2022 Daneshvar SH et al. This is an open access ar9cle licensed under a Crea9ve Commons AXribu9on Work 4.0 United States License. Email: hedyehdaneshvar@gmail.com Introduction Traumatic dental injury (TDI) is an important global oral health concern in childhood that causes functional, psychological and esthetic problems [1]. TDIs affect teeth, their supporting structures, and adjacent soft tissue and range from minor enamel cracking to extensive maxillofacial injury [2-4]. Parents of the children are usually the first ones to report dental trauma to dentists; therefore, the parents’ awareness of emergency management is important [5,6]. Unfortunately, the children are often referred to a dentist without any emergency management at the accident site that results in irreversible consequences such as tooth loss and aesthetic problems in anterior region [7]. Frequency of tooth avulsion in permanent and in primary dentition is 0.5%–16% and 7–13%, respectively [3]. Avulsion of permanent anterior teeth with delayed reimplantation and unphysiological storage lead to dehydration of the root surface and decrease the survival rate of The Effect of Using an Educa3onal Poster on Mothers’ Knowledge of Emergency Management of Dental Avulsion Vol 10 No 1 (2022) DOI 10.5195/d3000.2022.189 h#p://den*stry3000.pi#.edu reimplanted tooth [8,9]. With appropriate emergency treatment, the prognosis of the traumatic dental injury can be improved and ultimately preserve the smile of the child [10]. Educational programs and training are needed to improve proper management of dental avulsion by mothers. Educational posters and pamphlets can be used to inform parents about guidelines on management of dental trauma [10]. The purpose of this study was to evaluate the effectiveness of using an educational poster to increase parents’ knowledge about management of dental avulsion. It is necessary to be aware of the knowledge level of parents to formulate a set of instructions to increase the parents’ knowledge and help them to properly manage an emergency case of dental avulsion. Material and Methods Ethical Aspects This cross-sectional descriptive analytical study was approved by Guilan University of Medical Sciences (IR.GUMS.REC.1399.311) in 2020/10/07. Sample This study was done on 262 mothers accompanying children between 4-12 years of age seeking dental treatment at the Department of Pediatric Dentistry, Guilan University of Medical Sciences from November 2020 to February 2021. Mothers between 20 and 60 years of age were included in the study. All participating subjects (n=262) were divided randomly into two groups (test- control), 131 mothers were allocated randomly to the test group and others to the control group. Questionnaire After explaining the nature and purpose of the study by a pedodontist to the mothers, subjects who agreed to participate, signed a statement of informed consent and filled out Questionnaire alone which assessed theirs' socio-demographic information and knowledge about dental avulsion. A total of 8 questions regarding identification of tooth type, how to clean an avulsed tooth, how to transfer an avulsed tooth (suitable storage medium) and appropriate time for referring for the problem- based section were included, in which the level of knowledge of respondents were assessed and classified into three groups, which are low (0-3), moderate (4-6) and high (7- 8). Validity of the questionnaire was checked by an expert panel of pediatric dentists and in a pilot study on 10 subjects, the reliability of the questionnaire was tested by a test- retest method. After filling the questionnaire, an educational poster was distributed among subjects of the study group. Three months later, the mothers’ knowledge was evaluated again in both groups using the same questionnaire. Educational poster The educational poster used in this study was designed at the Dental Research Center of Guilan University of Medical Sciences by a group of three pedodontists and included guidelines on emergency management of dental avulsion. In cases of primary dental avulsion, replantation is contraindicated but in permanent dental avulsion: • Hold the tooth by its crown, not by its root • Wash the tooth under a slow stream of cold water • Put the tooth in cold milk, saline or saliva • Replant the tooth in its socket • Visit a dengst immediately (within 30 min) [3] (Figure 1,2) Figure 1. Avulsion of the tooth Figure 2. Replantation of the teeth The Effect of Using an Educa3onal Poster on Mothers’ Knowledge of Emergency Management of Dental Avulsion Vol 10 No 1 (2022) DOI 10.5195/d3000.2022.189 h#p://den*stry3000.pi#.edu Statistical Analysis The data obtained on the questionnaires were analyzed with the aid of the Statistical Package for the Social Sciences (SPSS®, Version26.0, Chicago, IL, USA). McNemar’s test was used separately in both study and control groups for evaluating the changes of the percentage of correct answers after 3 months. Generalized Estimating Equations (GEE) was used to investigate the simultaneous effect of existing independent variables such as age, level of education, employment status and training history on participants knowledge. Results with P <0.05 were considered statistically significant. Results This cross-sectional descriptive study was conducted among 262 mothers. Socio-demographic characteristics of participants have been shown in Table 1. Knowledge level of participants in the study and control groups before intervention and 3 months later has been shown in Table 2. The percentage of the participants with low knowledge decreased and the percentage of participants with high knowledge increased in two groups but this change was greater in the study group. Table 3 shows the number and percentage of the participants who answered the questions correctly. Results showed that the use of an educational poster improved the knowledge of mothers about dental avulsion, although this knowledge improvement was statistically significant in questions regarding immediate emergency action(P=0.003), appropriate time for replantation (P<0.001), cleaning before replantation of a dirty tooth(P=0.022) and suitable storage medium for transferring an avulsed tooth (P<0.001). Variables Study group(n=131) n(%) Control group(n=131) n(%) Age 33 years or younger 34 years or older 68(51.9 %) 63(48.1 %) 71 (54.1 %) 60(45.9 %) Educational level Diploma and associate’s degree Bachelor’s and master’s degree Doctorate degree 13(9.9 %) 105 (80.2 %) 13(9.9 %) 60(45.8 %) 71(54.2 %) 0(0%) Training history Yes No 8(6.2 %) 123(93.8 %) 4(3.1 %) 127(96.9 %) Employment status Yes No 63(48.1 %) 67(51.9 %) 51(38.9 %) 80(61.1 %) Variables Low knowledge n(%) Moderate knowledge n(%) High knowledge n(%) Study group Before intervention After 3 months 17(12.9%) 0(0%) 63(48.4%) 9(6.9 %) 51(38.7%) 122(93.1%) Control group Before intervention After 3 months 38(29%) 17(12.9%) 72(54.9 %) 84(64.1%) 21(16.1 %) 30(23%) Table 1: Participant’s socio-demographic characteristics Table 2: Knowledge level of participants in study and control groups before intervention and 3 months later The Effect of Using an Educa3onal Poster on Mothers’ Knowledge of Emergency Management of Dental Avulsion Vol 10 No 1 (2022) DOI 10.5195/d3000.2022.189 h#p://den*stry3000.pi#.edu Variables such as age (P = 0.564), level of education [diploma and associate’s degree (P = 0.091) bachelor’s and master’s degree (P = 0.330), doctorate degree (P = 0.357)], training history (P = 0.316) and employment status (P = 0.357) had no significant effect on knowledge of participants. Discussion Tooth avulsion is considered as one of the most detrimental traumatic dental injuries among children [3]. Mother’s high knowledge regarding the emergency management of tooth avulsion injury will help to reduce the time interval between avulsion and replantation. Immediate action may greatly affect the prognosis of the avulsed tooth and enhance the success rate of treatment [11]. The purpose of this study was to investigate the knowledge of mothers about the emergency management of dental avulsion before and after distribution of an educational poster. Present study revealed insufficient knowledge among mothers regarding emergency management of dental avulsion; the main reason is not having previous good training regarding dental avulsion. Although most studies conducted in different countries indicated that the level of knowledge regarding the management of avulsed permanent teeth is low [12], this finding is in accordance with other studies of parental knowledge performed in Singapore [13] and Kuwait [14]. Similar to the study by Murali et al [15], more than half of the mothers were not aware of immediate emergency action and reimplantation of the avulsed permanent tooth in children. Their first action after tooth avulsion injury was to only calm the Study group(n=131) Control group(n=131) Before intervention n (%) After 3 months n (%) P-Value* Before intervention n (%) After 3 months n (%) P-Value* Identification of permanent tooth 110(83.9%) 127(96.8%) 0.219 55(41.9%) 97(74.2%) 0.002 Immediate emergency action 80(61.3%) 127(96.8%) 0.003 46(35.5%) 63(48.4%) 0.219 Knowledge of holding the avulsed tooth by its crown, not by its root 114(87.1%) 122(93.5%) 0.687 114(87.1%) 122(93.5%) 0.500 Appropriate time for replantation 67(51.6%) 118(90.3%) <0.001 38(29%) 34(25.8%) 0.999 Cleaning before replantation of a dirty tooth 55(41.9%) 93(71%) 0.022 84(64.5%) 110(83.9%) 0.07 Suitable storage medium for transferring an avulsed tooth 21(16.1%) 101(77.4%) <0.001 21(16.1%) 21(16.1%) 0.999 Identification of primary tooth 118(90.3%) 131(100%) 0.25 93(71%) 97(74.2%) 0.999 Contraindication of primary tooth replantation 89(67.7%) 110(83.9%) 0.125 67(51.6%) 80(61.3%) 0.375 Table 3: Proportions of participating mothers who answered the questions correctly before intervention and three months later *P-value was based on McNemar Test (p<0.05) The Effect of Using an Educa3onal Poster on Mothers’ Knowledge of Emergency Management of Dental Avulsion Vol 10 No 1 (2022) DOI 10.5195/d3000.2022.189 h#p://den*stry3000.pi#.edu child down and compress the bleeding without searching for the avulsed tooth. Most parents didn’t pick up the avulsed tooth because they though it is an infected material and needs to be thrown out [15]. Avulsed permanent teeth should be cleaned with saline solution before replantation [12]. 53.2% of participants selected saline solution whereas 41.5% of the participants of study by Jain A et al [12] chose saline as appropriate cleansing medium. Unfortunately in the studies by Abdellatif AM [8] and Al-Jame Q et al[16] lack of knowledge regarding cleansing medium was reported. In our study, 16.1% of participants chose milk as storage medium. The suitable storage medium should be capable of preserving cell vitality, clonogenic capacity and easily accessible at the site of the accident. Although Hank's Balanced Salt Solution (HBSS, Save-A-Tooth® ) has been proven to be the most effective storage media, low-fat milk is a good alternative to HBSS which is readily available and affordable[12]. In the study by Jain A et al [12] and Santos ME et al [17] as well, only 14.2 % and 3% of parents selected milk as suitable storage medium respectively. In the present study, most of the mothers were aware of not rubbing the root of tooth and holding the avulsed tooth by its crown. Whereas most of the participants of study by Oliveira TM et al [18] answered this question incorrectly. In the study by Abdellatif AM et al [8] most of the parents preferred holding the avulsed tooth from the crown. They were aware that holding the tooth from the root will disturb the viability of the periodontal ligament. In the study by Ozer S et al [19] more than half of the participants were aware of appropriate replantation time of an avulsed permanent tooth. In the present study, most mothers didn’t know that for optimal healing, professional help should be sought within 30 min and knowledge of study group regarding appropriate time for replantation was significantly improved after education using poster. Similar to our study, Abdellatif AM et al [8] reported that a few parents were willing to replantation of primary tooth which could be related to lack of knowledge about the hazards of replanting the primary teeth. Similar to the present study, Resmy N et al [5] concluded that the educational status of mothers was not playing a role in their knowledge regarding the management of avulsed teeth in children. Most studies [10,20,21] investigated the effect of educational poster on the knowledge of school teachers and students or fitness trainers but we studied the effect of educational poster on the knowledge of mothers. In the present study, educational poster effectively enhanced the knowledge of study group participants compared to control group. Lieger O et al [10] showed positive effect of educational poster on the knowledge of school teachers. In the study by Young C et al [20] educational poster significantly improved the level of knowledge of secondary school students in Hong Kong. Ramezani GH et al [21] concluded that educational pamphlets enhanced the knowledge level of fitness trainers, but the magnitude of this effect was not significant in their study. Conclusion Educational poster statistically significantly improves mothers' knowledge about management of children's dental avulsion, so intervention program by different means should be developed targeting parents. Acknowledgement We would like to thank Department of Pediatric Dentistry, School of Dentistry, Guilan University of Medical Sciences for their great support. References 1. Knowledge, awareness and a0tude towards emergency management of dental trauma among the parents of Kolkata-An ins=tu=onal study. Kaul R, Jain P, Angrish P, Saha S, Patra TK, Saha N, Mitra M. J Clin Diagn Res.2016 The Effect of Using an Educa3onal Poster on Mothers’ Knowledge of Emergency Management of Dental Avulsion Vol 10 No 1 (2022) DOI 10.5195/d3000.2022.189 h#p://den*stry3000.pi#.edu Jul;10(7):ZC95.doi:10.7860/JCDR /2016/20682.8208. 2. Awareness of emergency management of dental trauma. Namdev R, Jindal A, Bhargava S, Bakshi L, Verma R, Beniwal D. Contemp Clin Dent. 2014;5:507-13. doi: 10.4103/0976-237X.142820. 3. Textbook and Color Atlas of Trauma=c Injuries to the Teeth. 3rd ed. Andreasen JO, Andreasen FM. Copenhagen, Denmark: Munksgaard; 1994. p. 383-425. 4. Knowledge and a0tude of 2,000 parents (urban and rural—1,000 each) with regard to avulsed permanent incisors and their emergency management, in and around Davangere. Shashikiran ND, Reddy VV, Nagaveni NB. J Indian Soc Pedod Prev Dent. 2006;24:116-21. doi: 10.4103/0970-4388.27891. 5. Knowledge, a0tude, and awareness of mothers toward emergency management of dental trauma in high literacy popula=on. Resmy N, Parvathy K, Arun XM, Balagopal V. J Int Oral Health. 2019;11:287-92.doi:10.4103/jio h.jioh_59_19. 6. Knowledge, a0tude and prac=ce in emergency management of dental injury among physical educa=on teachers: A survey in Bangalore urban schools. Mohandas U, Chandan GD. J Indian Soc Pedod Prevent Dent. 2009;4:243-8. doi: 10.4103/0970-4388.57660. 7. Effec=veness of dental trauma educa=on for elementary school staff. McIntyre JD, Lee JY, Trope M, VannWF, Jr. Dent Traumatol. 2008 Apr;24(2):146-50. doi: 10.1111/j.1600- 9657.2008.00573.x. 8. Knowledge of emergency management of avulsed teeth among a sample of Egyp=an parents. Abdella=f AM, Salwa A. Hegazy. J Adv Res. 2011;2:157– 62. doi.org/10.1016/j.jare.2011.01.0 02. 9. Factors related to treatment and outcomes of avulsed teeth. Petrovic B, Marković D, Peric T, Blagojevic D. Dent Traumatol. 2010;26:52–9. doi: 10.1111/j.1600- 9657.2009.00836.x. 10. Impact of educa=onal posters on the lay knowledge of school teachers regarding emergency management of dental injuries. Lieger O, Graf C, El-Maaytah M, Von Arx T. Dent Traumatol. 2009;25:406–12. doi: 10.1111/j.1600- 9657.2009.00798.x. 11. Knowledge and a0tude of primary school teachers toward tooth avulsion and dental first aid in Davangere city: A cross- sec=onal survey. Prasanna S, Giriraju A, Narayan NL. Int J Clin Pediatr Dent. 2011 Sep;4(3):203- 6. doi: 10.5005/jp-journals- 10005-1110. 12. Knowledge and a0tude of parents towards avulsed permanent tooth of their children and its emergency management in Bhopal city. Jain A, Kulkarni P, Kumar S, Jain M. J Clin Diagn Res. 2017 May;11(5):ZC40.doi:10.7860/JCD R/2017/24953.9855. 13. Dental trauma management awareness of Singapore pre- school teachers. Sae-Lim V, Lim LP. Dent Traumatol. 2001 Apr;17(2):71-6. doi:10.1034/j.1600- 9657.2001.017002071.x. 14. The effect of a leaflet given to parents for first aid measures aoer tooth avulsion. Al-Asfour A, Andersson L. Dent Traumatol. 2008 Oct;24(5):515-21. doi: 10.1111/j.1600- 9657.2008.00651.x. 15. Knowledge, a0tude, and percep=on of mothers towards emergency management of dental trauma in Salem district, Tamil Nadu: A ques=onnaire study. Murali K, Krishnan R, Kumar VS, Shanmugam S, Rajasundharam P. J Indian Soc Pedod Prev Dent 2014;32:202- 6.doi: 10.4103/0970- 4388.135825. 16. Kuwai= parents’ knowledge of first-aid measures of avulsion and replanta=on of teeth. Al- Jame Q, Andersson L, Al-Asfour A. Med Princ Pract. 2007;16:274–79. doi: 10.1159/000102149. 17. Parent and caretaker knowledge about avulsion of permanent teeth. Santos ME, Habecost AP, Gomes FV, Weber JB, De Oliveira MG. Dent Traumatol. 2009 Apr;25(2):203- 8.doi.org/10.1111/j.1600.9657.2 008.00620.x. 18. Knowledge and a0tude of mothers with regards to emergency management of dental avulsion. Oliveira TM, Sakai VT, More0 AB, Silva TC, Santos CF, Machado MA. J Dent Child. 2007 Sep 15;74(3):200-2. PMID: 18482514. 19. Parental knowledge and a0tudes regarding the emergency treatment of avulsed permanent teeth. Ozer S, Yilmaz EI, Bayrak S, Tunc ES. Euro J Dent. 2012 Oct;6(4):370. PMID:23077415. 20. Effec=veness of educa=onal poster on knowledge of emergency management of dental trauma-Part 2: Cluster Randomised Controlled Trial for The Effect of Using an Educa3onal Poster on Mothers’ Knowledge of Emergency Management of Dental Avulsion Vol 10 No 1 (2022) DOI 10.5195/d3000.2022.189 h#p://den*stry3000.pi#.edu Secondary School Students. PloS one. Young C, Wong KY, Cheung LK. 2014 Aug 5;9(8):e101972. doi:10.1371/journal.pone.01019 72. 21. Effect of an Educa=onal Pamphlet on Knowledge and Performance of Fitness Trainers about Trauma=c Dental Injuries. Ramezani GH, Sohrabi M, Nasiri S, Kharazifard MJ, Ghadimi S, Seraj B. Front Dent. 2021;18:5. doi:10.18502/fid.v18i5.5648.