Microsoft Word - 60 2017.docx   Vol  5,  No  1  (2017)   ISSN  2167-­‐8677  (online)   DOI  10.5195/d3000.2017.60           http://dentistry3000.pitt.edu     New  articles  in  this  journal  are  licensed  under  a  Creative  Commons  Attribution  4.0  United  States  License.     This  journal  is  published  by  the  University  Library  System,  University  of  Pittsburgh  as  part  of  its  D-­‐Scribe  Digital  Publishing  Program  and  is  cosponored   by  the  University  of  Pittsburgh  Press.     Assessment  of  knowledge  among  public  and  private  elementary   school  teachers  in  dental  trauma  management   Merve  Bayram1,  Mine  Koruyucu2,  Figen  Seymen2      1Istanbul  Medipol  University,  School  of  Den3stry,  Department  of  Pedodon3cs,  Istanbul,  Turkey   2Istanbul  University,  Faculty  of  Den6stry,  Department  of  Pedodon6cs,  Istanbul,  Turkey Abstract   Purpose:  Trauma&c  dental  injuries,  majority  of  which  occur  at  school  and  primary  care  given  by  teacher,  should  man-­‐ aged  as   soon  as  possible.  The  knowledge  and  a2tudes  of   teachers   is   cri8cal   for   the  best  prognosis  of   trauma8zed   teeth.   The   purpose   of   this   study   was   to   evaluate   knowledge   and   a7tudes   among   elementary   public   and   private   school   teachers   in  dental   trauma  management.  Materials  and  Methods:  A  modified   three-­‐part  ques*onnaire  com-­‐ prised  of  ques,ons  regarding  demographic  data,  a5tude  and  knowledge  about  dental  trauma  was  distributed  to  328   teachers  (public  schools:164/private  schools:164).  The  results  of  the  ques:onnaire  were  expressed  as  frequency  dis-­‐ tribu&ons.  Sta&s&cal  analysis  was  performed  by  version  20.0  of  the  SPSS  sta&s&cs  so15     4.  Do  you  have  kids?         Yes     No   5.  Have  you  had  first  aid  training  in  your  own  organization?   Yes     No   6.  Have  you  had  first  aid  training  in  another  organization?   Yes     No   7.  If  you  did,  have  it  included  dental  trauma  first  aid?   Yes     No   8.  Did  you  have  personal  experience  (yourself/your  student)  in  dental  trauma?        Yes     No       Part  II   1.  Self  assessed  knowledge  in  dental  trauma  management:   a-­‐none     b-­‐little     c-­‐moderate     d-­‐high   2.  Satisfaction  with  self  assessed  knowledge:   a-­‐very  low                      b-­‐low     c-­‐moderate     d-­‐high:     3.  Enthusiasm  for  more  education  in  the  subject:   a-­‐not  interested   b-­‐little  interested   c-­‐very  interested:       Part  III   1.  An  8  year  old  boy  was  hit  in  the  face  with  a  football  during  the  school  time  and  his  upper  front  tooth  was   broken.  He  was  otherwise  unhurt  and  didn’t  lose  consciousness.     1(a)  Is  the  damaged  front  tooth  likely  to  be  primary  or  permanent?     a.Primary     b.Permanent   1(b)  Which  of  the  following  actions  would  you  considered  as  the  most  appropriate?   1. a.A$er  class,  contact  his  parents  to  explain  what  had  happened.   2. b.Give  him  a  warm  drink  and  contact  his  parents   3. c.Send  him  immediately  to  the  doctors  or  infirmary   4. d.Send  him  immediately  to  the  den/st   5.   6. 2.  A  12  year  old  girl  fell  from  the  stairs  and  hit  in  the  mouth  during  the  school  0me.  Her  mouth  is  bleeding  and   an  upper  front  tooth  is  found  to  be  missing.     7.   8. 2(a)  Which  of  the  following  would  you  do?   9. a.Sideline  the  injured  girl,  ge1ng  her  to  bite  on  a  hankerchief  to  control  the  bleeding.   10. b.Look  for  the  tooth,  wash  it  and  give  it  to  the  girl  to  take  home.   11. c.Look  for  the  tooth  and  put  it  back  into  the  socket.   12. d.Put  the  tooth  in  liquid  and  send  the  girl  home  straight  away.   13. e.Find  the  tooth  and  put  it  in  liquid  and  send  the  girl  to  the  nearest  den.st.   14. 2(b)  In  case  of  this  condi.on,  which  would  be  the  first  place  you  would  contact  to?   15. a.Doctor   b.Den&st   c.Hospital   d.  I  would  tried  to  treat   16. 2(c)  In  case  of  this  condi.on,  how  urgent  do  you  think  it  is  to  seek  professional  help?   17. a.  Immediately  -­‐  Within  30  min   b.  Within  1  hour   18. c.  Within  a  few  hours       d.  Within  1  day     3.Would  you  replant  the  primary  tooth  that  has  been  knocked  out?   a.Yes     b.No     4.Would  you  replant  the  permanent  tooth  back  into  socket  yourself?   a.Yes,  I  would     b.No,  I  would  get  professional  help     4(a)  If  your  answer  is  “Yes”,  when  you  get  the  tooth  from  the  ground  you  saw  the  tooth  was  dirty  what  would   you  do?   a.Scrub  the  tooth  gently  with  a  toothbrush.   b.Rinse  the  tooth  under  tap  water.   c.Put  the  tooth  straight  back  into  the  socket  without  any  pretreatment.   d.Rinse  the  tooth  with  detergant  or  soap.       4(b)If  your  answer  is  “No”,  how  would  you  transport  the  tooth  to  the  dentist?   a.in  Tap  water         b.in  milk       c.in  alcohol     d.in  physiologic  water  (saline)   e.in  paper  tissue     f.in  ice       5.Would  you  search  for  if  the  child  had  tetanus  vaccine?   a.Yes     b.No     Assessment  of  knowledge  among  public  and  private  elementary  school  teachers  in  dental  trauma  management   Vol  5,  No  1  (2017)        DOI  10.5195/d3000.2017.60    http://dentistry3000.pitt.edu   the  questionnaire  were  expressed   as  frequency  distributions.  Statis-­‐ tical  analysis  was  performed  using   chi-­‐square  test  with  a  significance               level  of  .05  by  version  20.0   of  the  SPSS  statistics  software.   Results   The  results  from  part  I  on   teachers’  from  public  and  private   schools  demographic  information   are  shown  in  Table  2.     In  part  II,  while  138   (84.5%)  teachers  in  public  school,   129  (79%)  teachers  in  private   school  claimed  they  have  poor   knowledge  of  the  subject;  and   139  (85%)  teachers  in  public   school,  124  (76%)  teachers  in  pri-­‐ vate  school  were  low  satisfied   with  their  knowledge  only  33   (20%)  were  interested  to  learn   more  in  both  school  type.  Teach-­‐ ers  specified  that  the  main  source   for  information  was  a  dentist.   Part  III  of  the  question-­‐ naire  was  evaluated  the   knowledge  of  elementary  school   teachers  about  dental  trauma   management.  The  average  score   for  all  respondents  was  4.96  (of   10).  Two  groups  significantly  im-­‐ proved  the  respondents’   knowledge:  being  above  50  year   old  age  group  (p=0.001)  and  hav-­‐ ing  teaching  experience  above  15   years  (p<0.001).     Table  3  summarizes  the   following  data:  For  question  1(a),   54.9%  public  school  teachers,   69.5%  private  school  teachers  rec-­‐ ognized  that  the  upper  incisor  is  a   permanent  tooth  in  an  8-­‐year-­‐old   child.  There  was  a  significantly  as-­‐ sociation  between  public  and  pri-­‐ vate  schoolteachers  knowledge   (p=0.003).  For  case  1(b)  52.4%   public  school  teachers,  39.6%  pri-­‐ vate  school  teachers  would  ur-­‐ gently  take  her  to  the  dentist.   There  was  a  significantly  associa-­‐ tion  between  public  and  private   schoolteachers  knowledge   (p=0.01).  For  case  2(a)  54,9%  pub-­‐ lic  schoolteachers  and  51,8%  pri-­‐ vate  schoolteachers  would  find   the  tooth  and  put  it  in  liquid  and   send  the  girl  to  the  nearest  den-­‐ tist.  For  question  2(b)  79.3%  public   schoolteachers  and  67.7%  private   schoolteachers  knew  that  in  case   of  dental  trauma,  first  place  of   contact  is  a  dentist.  For  question   2(c)  only  5%  public  schoolteachers   and  10.9%  private  schoolteachers   were  aware  of  getting  early  pro-­‐ fessional  help.  Private  school-­‐ teachers  statistically  had  more   correct  answers  on  ideal  replanta-­‐ tion  time  than  public  schoolteach-­‐ ers  (p=0.02).  For  question  3,  100%   public  schoolteachers  and  93.3%   private  schoolteachers  chose  that   replantation  of  primary  tooth  is   not  recommended.  There  was  a   significantly  association  between   public  and  private  schoolteachers   knowledge  (p=0.001).   Private  schoolteachers  had   significantly  more  correct  answers   on  trauma  management  of   avulsed  teeth  than  public  school-­‐ teachers  (p=0.01).   Discussion   Table   2.   Demographic   characteristics   of   15   randomly   chosen   public   and  private  elementary  school  teachers     Demographic  characterictics   Public   Private   n   %   n   %   Gender             Male   76   46.3   46   28.0     Female   88   53.7   118   72.0   Age             20-­‐34   72   43.9   80   48.8     35-­‐49   61   37.2   67   40.9     ≥50   31   18.9   17   10.4   Length  of  teaching  experience   (year)             <1     5   3.0   2   1.2     1-­‐5   24   14.6   36   22.0     5-­‐10   32   19.5   58   35.4     10-­‐15   23   14.0   26   15.9     >15   80   48.8   42   25.6   Having  children             Yes   109   66.5   94   57.3     No   55   33.5   70   42.7   Received  first  aid  training  in  own   organization             Yes   50   30.5   23   14.0     No   114   69.5   141   86.0   Received  first  aid  training  in   another  organization             Yes   61   37.2   53   32.3     No   97   59.1   108   65.9                              No  answer   6     3     Content  of  first  aid  training     (including  dental  trauma)               Yes   8   5   3   1,8     No   120   73.2   108   65.9   No  answer   36     53     Dental  trauma  experience   (yourself/  your  student)             Yes   40   24.4   29   17.7     No   118   72.0   128   78.0   No  answer   6     7     Assessment  of  knowledge  among  public  and  private  elementary  school  teachers  in  dental  trauma  management   Vol  5,  No  1  (2017)        DOI  10.5195/d3000.2017.60    http://dentistry3000.pitt.edu   The  level  of  knowledge  of   dental  trauma  management  as   found  in  this  survey  was  low,  av-­‐ erage  score  being  4.96  of  10;  Fux-­‐ Noy  et  al  found  similar  results   (4.59)  [25].  In  addition,  only  20%   were  interested  in  additional   training  to  dental  trauma  man-­‐ agement.  These  results  show  the   lack  of  awareness  among  teachers   to  the  importance  of  immediate   and  optimum  treatment  of  dental   injuries.     Teachers  who  were  above   50  year  old  had  better  knowledge   about  the  subject.  It  is  a  fact  that   this  age  group  had  more  experi-­‐ ence  than  the  younger  age  groups.   Having  teaching  experience  above   15  years  was  also  found  to  be  a   related  factor  to  better   knowledge  on  the  subject  (Ta-­‐ ble  2).   Private  school  teachers   aren’t  good  at  referring  an  8-­‐ year-­‐old  child  with  broken  up-­‐ per  incisor  tooth  get  suitable   health  service.  Possible  reason  –   we  concluded  subjectively  due   to  oral  discussions  -­‐  for  this  dif-­‐ ference  can  be  the  fact  that  pri-­‐ vate  schools  have  their  own   school  doctors  and  they  choose   to  take  the  child  to  the  school   doctor  in  case  of  dental  trauma.     Primary  teeth  may  also   be  avulsed,  but  they  should  not   be  replanted  because  this  ma-­‐ nipulation  may  result  in  injury   to  the  underlying  permanent   teeth  germ  [1].     In  this  survey,  only  5.1%   teachers  replant  the  tooth   themselves.  While  Chan  et  al.   [26]  and  Fux-­‐Noy  et  al.  [25]   found  similar  results;  Hamilton  et   al.  [27]  and  Pacheco  et  al.  [28]   found  higher  percentage.  More   than  94%  of  teachers  did  not  feel   the  capable  of  performing  tooth   replantation.  Other  studies  have   reported  70%  to  80%  respondents   wouldn’t  replant  the  tooth  or   wouldn’t  be  comfortable  to  do  so   [29-­‐31].   An  avulsed  tooth  should  be   replanted  in  its  socket  as  soon  as   possible  to  avoid  further  damage   to  the  periodontal  membrane  [32-­‐ 35].  Before  replantation,  the  tooth   should  be  cleaned  with  saline  so-­‐ lution  if  the  tooth  would  be  ob-­‐ served  dirty  [28,34].  The  replanta-­‐ tion  procedure  of  the  avulsed   teeth  has  been  recommended  to   be  performed  immediately  -­‐  with-­‐ in  30  minutes  after  trauma   [26,30,36].  If  the  tooth  can’t  be   replanted,  until  replantation  time,   the  teeth  must  be  kept  in  a  proper   media  [30].  Hank‘s  Balanced  Salt   Solution  (HBSS)  has  been  especial-­‐ ly  developed  for  cell  maintenance   and  thus,  theoretically,  it  allows  a   better  conservation  of  tissues  for   long  time  periods.  It  has  been   widely  employed  as  a  reference   solution  in  studies  on  dental  avul-­‐ sion  as  it  has  the  ideal  osmolality   and  pH  for  preserving  the  vitality   of  cells  [37].   Milk  has  a  favorable  osmo-­‐ lality  and  composition  for  the  via-­‐ bility  of  periodontal  ligament  cells   and  has  therefore  been  widely   recommended  to  dentists  and   general  population  for  keeping   avulsed  teeth  to  be  replanted,  be-­‐ ing  the  second  or  third  best  trans-­‐ portation  media  for  avulsed  teeth   include  (in  order  of  preference),   after  Viaspan®  and/or  Hank’s  Bal-­‐ anced  Salt  Solution®,  according  to   the  International  Association  of   Dental  Traumatology  [19],  and  the   American  Academy  of  Pediatric   Dentistry  [38]  due  to  its  beneficial   effects  and  characteristics,  and  its   ease  of  access  at  the  moment  of   trauma  [37].   While  53.3%  teachers   choose  to  put  the  avulsed  tooth  in   liquid,  only  14.9%  teachers  knew   that  the  proper  media  is  milk.  Sim-­‐ ilar  results  were  found  in  other   studies  among  teachers  [25-­‐ 27,36].  The  popular  wrong  an-­‐ swers  are  paper  tissue,  ice  and  tap   water  respectively.  Private  school   Table   3.   Assessment   of   teachers’   knowledge   on   dental   trauma   management   in   15   randomly   chosen   elementary   schools   compared   by  school  type.   Questions   Public  School   Private   School   P   value     n   %   n   %     Recognizing  that   the  upper  incisor  is   a  permanent  tooth   in  an  8-­‐year-­‐old   child   90   54.9   114   69.5   0.003   Suitable  approach   of  a  8-­‐year-­‐old   child  with  upper   incisor  tooth   broken   86   52.4   65   39.6   0.01   Suitable  direction   of  a  12-­‐year-­‐old   child  with  avulsed   teeth   90   54.9   85   51.8   >0.05   Suitable  affiliation   direction  in  case  of   dental  avulsion     130   79.3   111   67.7   >0.05   Right  answer  about   ideal  replantation   time   9   5   18   10.9   0.02   Suitable  approach   for  replantation  of   primary  tooth   164   100   153   93.3   0.001   Suitable  approach   for  trauma  mana-­‐ gement  of  avulsion   22   13.4   39   23.8   0.01   Remember  to   check  tetanus   vaccine  control   76   46.3   90   54.9   >0.05   Assessment  of  knowledge  among  public  and  private  elementary  school  teachers  in  dental  trauma  management   Vol  5,  No  1  (2017)        DOI  10.5195/d3000.2017.60    http://dentistry3000.pitt.edu   teachers  gave  better  answers   about  ‘suitable  approach  for   trauma  management  of  avulsion’   than  the  public  school  teachers.   In  case  of  dental  trauma   especially  intra-­‐oral  wounds  teta-­‐ nus  vaccine  is  necessary  to  be   checked  out  [39].  Half  of  both   public  and  private  school  teachers   knew  the  importance  of  tetanus   vaccine  control  in  dental  trauma.       Conclusion   The  level  of  knowledge  of   dental  trauma  management  both   public  and  private  school  teachers   from  Istanbul,  Turkey,  as  found  in   this  study  was  unsatisfying.  It  ap-­‐ pears  that  additional  education   programs  are  critical  to  improve   teachers’  awareness  of  the  im-­‐ portance  of  dental  trauma  man-­‐ agement  in  both  types  of  schools.   First  aid  training  should  involve   ‘dental  trauma  management’   courses  given  in  elementary   schools.     References   1. Andreasen  JO,  Andreasen   FM,  Andersson  L.  (2007)   Textbook  and  color  atlas   of  traumatic  injuries  to   the  teeth,  4th  edition.  Co-­‐ penhagen:  Munksgaard.   217–54  p,  444–88  p,  516– 41  p.   2. Traumatic  dental  injuries   in  children  presenting  for   treatment  at  the  Depart-­‐ ment  of  Pediatric  Den-­‐ tistry,  Faculty  of  Den-­‐ tistry,  University  of  Jor-­‐ dan,  1997–2000.  Rajab   LD.  Dent  Traumatol  2003;   Feb;19(1):6-­‐11.  PMID:   12656848   3. A  retrospective  study  of   dento-­‐alveolar  injuries  of   children  in  Ankara,  Tur-­‐ key.  Altay  N,  Güngör  HC.   Dent  Traumatol.  2001;   Oct;17(5):  201-­‐4.  PMID:   11678537   4. Traumatic  injuries  to   permanent  teeth  in  Turk-­‐ ish  children,  Ankara.  Dent   Traumatol.  Altun  C,  Ozen   B,  Esenlik  E,  Guven  G,   Gürbüz  T,  Acikel  C,  Basak   F,  Akbulut  E.  2009;  Jun;25   (3):  309-­‐13.  PMID:   19583580   5. Prevalence  of  traumatic   injuries  to  the  permanent   incisors  in  candidates  for   orthodontic  treatment.   Dent  Traumatol.  Bauss  O,   Röhling  J,  Schwestka-­‐ Polly  R.  2004;Apr  20(2):   61-­‐6.  PMID:15025687   6. Prevalence  and  handed-­‐ ness  correlates  of  trau-­‐ matic  injuries  to  the  per-­‐ manent  incisors  in  13-­‐17-­‐ year-­‐old  adolescents  in   Erzurum,  Turkey.  Canakci   V,  Akgül  HM,  Akgül  N,   Canakci  CF.  Dent  Trau-­‐ matol.  2003;  Oct  19(5):   248-­‐54.  PMID:14708648   7. Factors  associated  with   traumatic  dental  injuries   among  12-­‐year-­‐old   schoolchildren  in  South   India.  David  J,  Astrøm  AN,   Wang  NJ.  Dent  Traumatol.   2009;  Oct  25(5):  500-­‐5.   PMID:19614932   8. Fractured  permanent  in-­‐ cisors  among  Nigerian   school  children.  Falomo  B.   ASDC  J  Dent  Child.  1986;   Mar-­‐Apr  53(2):  119-­‐21.   PMID:3457032   9. Traumatic  dental  injuries   in  schoolchildren  from   Santo  Domingo.  Garcia-­‐ Godoy  F,  Morbán-­‐Laucer   F,  Corominas  LR,  Franjul   RA,  Noyola  M.  Community   Dent  Oral  Epidemiol.   1985;  Jun  13(3):  177-­‐9.   PMID:3860343   10. Dental  trauma  in  children   and  young  adults  visiting   a  University  Dental  Clinic.   Ivancic  Jokic  N,  Bakarcic   D,  Fugosic  V,  Majstorovic   M,  Skrinjaric  I.  Dent   Traumatol.  2009;  Feb   25(1):  84-­‐7.   PMID:19208016   11. Epidemiologic  survey  of   traumatic  dental  injuries   in  children  seen  at  the   Federal  University  of  Rio   de  Janeiro,  Brazil.  Jesus   MA,  Antunes  LA,  Risso   Pde  A,  Freire  MV,  Maia  LC.   Braz  Oral  Res.  2010;Jan-­‐ Mar  24  (1):  89-­‐94.   PMID:20339720   12. Dental  trauma  in  Turkish   children,  Istanbul.  Kargul   B,  Cağlar  E,  Tanboga  I.   Dent  Traumatol.  2003;   Apr  19(2):  72-­‐5.   PMID:12656836   13. Prevalence  of  traumatic   injuries  to  maxillary  per-­‐ manent  teeth  in  9-­‐  to  14-­‐ year-­‐old  school  children   in  Yazd,  Iran.  Navabazam   A,  Farahani  SS.  Dent   Traumatol.  2010;Apr   26(2):  154-­‐7.   PMID:20089070   Assessment  of  knowledge  among  public  and  private  elementary  school  teachers  in  dental  trauma  management   Vol  5,  No  1  (2017)        DOI  10.5195/d3000.2017.60    http://dentistry3000.pitt.edu   14. Traumatic  injuries  to  the   anterior  teeth  among   South  Kanara  school  chil-­‐ dren-­‐-­‐a  prevalence  study.   Rai  SB,  Munshi  AK.  J  Indi-­‐ an  Soc  Pedod  Prev  Dent.   1998;  Jun  16(2):  44-­‐51.   PMID:11813754   15. Prevalence  and  risk  fac-­‐ tors  related  to  traumatic   dental  injuries  in  Brazili-­‐ an  schoolchildren.  So-­‐ riano  EP,  Caldas  Ade  F  Jr,   Diniz  De  Carvalho  MV,   Amorim  Filho  Hde  A.  Dent   Traumatol.  2007;Aug  23   (4):  232-­‐40.   PMID:17635357   16. Dental  trauma  in  school-­‐ children  six  to  twelve   years  of  age.  Zaragoza  AA,   Catalá  M,  Colmena  ML,   Valdemoro  C.  ASDC  J  Dent   Child.  1998;  Nov-­‐Dec  65   (6):  492-­‐4,  439.   PMID:9883326   17. The  caries  decline:  a  re-­‐ view  of  reviews.  Peters-­‐ son  GH,  Bratthall  D.  Eur  J   Oral  Sci.  1996;  Aug  104   (4):  436-­‐43.   PMID:8930595   18. Andreasen  JO,  Andreasen   FM,  Andersson  L.  (2007)   Socio-­‐psychological  as-­‐ pects  of  traumatic  dental   injuries.  In:  Textbook  and   color  atlas  of  traumatic   injuries  to  the  teeth.  4th   edition.  Copenhagen:   Munksgaard  pp  201.   19. Guidelines  for  the  man-­‐ agement  of  traumatic   dental  injuries.  II.  Avul-­‐ sion  of  permanent  teeth.   Flores  MT,  Andersson  L,   Andreasen  JO,  Bakland   LK,  Malmgren  B,  Barnett   F,  Bourguignon  C,  DiAnge-­‐ lis  A,  Hicks  L,  Sigurdsson   A,  Trope  M,  Tsukiboshi  M,   von  Arx  T.  Dent  Trau-­‐ matol  2007;  Jun  23(3):   130–6.  PMID:17511833   20. Tooth  avulsion  and  re-­‐ plantation  –  a  review.   Hammarström  L,  Pierce  A,   Blomlöf  L,  Feiglin  B,  Lind-­‐ skog  S.  Endod  Dent   Traumatol  1986;  Feb   2(1):  1–8.  PMID:3516666   21. Treatment  of  the  avulsed   tooth.  Trope  M.  Pediatr   Dent  2000;  Mar-­‐Apr   22(2):  145–7.   PMID:10769860   22. Oral  trauma  in  children:  a   hospital  survey.  O’Neil   DW,  Clark  MV,  Lowe  JW,   Harrington  MS.  Oral  Surg   Oral  Med  Oral  Pathol   1989;  Dec  68  (6):  691–6.   PMID:2574434   23. The  prevalence  of  trau-­‐ matic  injuries  treated  in   the  pedodontic  clinic  of   Ankara  University,  Tur-­‐ key,  during  18  months.   Saroğlu  I,  Sönmez  H.  Dent   Traumatol  2002;  Dec  18   (6):  299–303.   PMID:12656862   24. Knowledge  and  attitude   of  mothers  with  regards   to  emergency  manage-­‐ ment  of  dental  avulsion.   Oliveira  TM,  Sakai  VT,   Moretti  ABS,  Thiago  CS,   Santos  CF,  Machado  MA.  J   Dent  Child  2007  Sep-­‐Dec;   74  (3):  200-­‐2.   PMID:18482514   25. Knowledge  of  elementary   school  teachers  in  Tel-­‐ Aviv,  Isreal,  regarding   emergency  care  of  dental   injuries.  Fux-­‐Noy  A,  Sar-­‐ nat  H,  Amir  E.  Dent   Traumatol.  2011;  Aug   27(4):  252-­‐6.   PMID:21535404   26. Lay  knowledge  of  physi-­‐ cal  education  teachers   about  the  emergency   management  of  dental   trauma  in  Hong  Kong.   Chan  AWK,  Wong  TKS,   Cheung  GSP.  Dent  Trau-­‐ matol  2001;  Apr   17(2):77–85.   PMID:11475950   27. Investigation  of  lay   knowledge  of  the  man-­‐ agement  of  avulsed  per-­‐ manent  incisors.  Hamil-­‐ ton  FA,  Hill  FJ,  Mackie  IC.   Endod  Dent  Traumatol   1997;Feb.13(1):19-­‐23.   PMID:9206384   28. Evaluation  of  the   knowledge  of  the  treat-­‐ ment  of  avulsion  in  ele-­‐ mentary  school  teachers   in  Rio  de  Janeiro,  Brazil.   Pacheco  LF,  Filho  PFG,   Letra  A,  Menezes  R,  Vil-­‐ loria  GEM,  Ferreira  SM.   Dent  Traumatol  2003;Apr   19(2):  76–8.   PMID:12656837   29. Avulsed  permanent  inci-­‐ sors:  knowledge  and  atti-­‐ tudes  of  primary  school   teachers  with  regard  to   emergency  management.   Blakytny  C,  Surbuts  C,   Thomas  A,  Hunter  ML.  Int   J  Paediatr  Dent  2001;  Sep   11(5):  327–32.   PMID:11572262   Assessment  of  knowledge  among  public  and  private  elementary  school  teachers  in  dental  trauma  management   Vol  5,  No  1  (2017)        DOI  10.5195/d3000.2017.60    http://dentistry3000.pitt.edu   30. Tooth  reimplantation  af-­‐ ter  traumatic  avulsion:  A   report  of  10  cases.  Ki-­‐ noshita  S,  Kojima  R,   Taguchi  Y,  Noda  T.  Dent   Traumatol  2002;  Jun   18(3):  153-­‐6.   PMID:12154771   31. Elementary  school  staff   knowledge  about  dental   injury.  McIntyre  JD,  Lee   JY,  Trope  M,  Vann  WF.   Dent  Traumatol  2008;  Jun   24(3):  189–98.   PMID:18410391   32. American  Association  of   Endodontists.  Treatment   of  the  avulsed  permanent   tooth.  Recommended   guidelines  of  the  Ameri-­‐ can  Association  of  Endo-­‐ dontists.  Dent  Clin  North   Am  1995;  Jan  39(1):  221– 5.  PMID:7890106   33. Effects  of  treatment  delay   upon  pulp  and  periodon-­‐ tal  healing  of  traumatic   dental  injuries-­‐  a  review   article.  Andreasen  JO,  An-­‐ dreasen  FM,  Skeie  A,  Hjör-­‐ ting-­‐Hansen  E,  Schwartz   O.  Dent  Traumatol  2002;   Jun  18(3):  116–28.   PMID:12110104   34. Replantation  of  400   avulsed  permanent  inci-­‐ sors.  Part  1.  Diagnosis  of   healing  complications.   Andreasen  JO,  Borum  MK,   Jacobsen  HL,  Andreasen   FM.  Endod  Dent  Trau-­‐ matol  1995;Apr  11  (2):   51–8.  PMID:7641619   35. Avulsed  permanent  teeth:   a  review  of  literature  and   treatment  guidelines.   Barrett  EJ,  Kenny  DJ.  En-­‐ dod  Dent  Traumatol   1997;Aug  13(4):  153–63.   PMID:9550040   36. Dental  trauma  manage-­‐ ment  awareness  of  Singa-­‐ pore  pre-­‐school  teachers.   Sae-­‐Lim  V,  Lim  LP.  Dent   Traumatol  2001;Apr   17(2):  71–6.   PMID:11475949   37. Storage  media  for  avulsed   teeth:  a  literature  review.   Poi  WR,  Sonoda   CK,  Martins  CM,  Melo   ME,  Pellizzer  EP,  de  Men-­‐ donça  MR,  Panzarini  SR.   Braz  Dent  J  2013;Sep-­‐Oct   24(5):437-­‐45.   PMID:24474282   38. Guideline  on  Management   of  Acute  Dental  Trauma.   Pediatr  Dent.  2008-­‐ 2009;30(7):175-­‐83   PMID:19216418       39. Tetanus  prophylaxis  in  in-­‐ juries.  Guidelines  for  the   dental  practice.  Becking   AG.  Ned  Tijdschr   Tandheelkd  1995;Jul  102   (7):  266–8.   PMID:11837111