Management of Traumatic Dental Injuries among Otolaryngologists in Southwestern Mainland China: a cross-sectional observational survey

Management of Traumatic Dental Injuries among Otolaryngologists in Southwestern Mainland China: a cross-sectional observational survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Management of Traumatic Dental Injuries among Otolaryngologists in Southwestern Mainland China: a cross-sectional observational survey Zhongjing Pan, Qinghan Zeng, Tianpei Ma, Yuanyuan Peng, Jinyi Zhang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4248219/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Apr, 2025 Read the published version in BMC Oral Health → Version 1 posted 4 You are reading this latest preprint version Abstract Background This study aimed to examine otolaryngologists' attitudes and knowledge regarding the management of traumatic dental injuries (TDIs) encountered when patients present at the emergency department or during procedures such as tonsillectomy,adenoidectomy and suspension laryngoscopic surgery, as well as their motivation for pursuing additional education in this area. Methods A cross-sectional observational survey involving otolaryngologists selected from multiple hospitals across Sichuan Province was carried out in this study. The questionnaire, consisting of 31 questions, was segmented into three sections: demographic data (10 items), knowledge about the management of TDI (17 items), and attitudes toward acquiring dental trauma education (4 items). Descriptive analysis, the Kruskal–Wallis test, the Mann–Whitney U test and ANOVA were used for statistical analysis. Results In the analysis, a total of 214 surveys were included, with over half of the participants (60.3%) having experienced at least one TDI case in their practice, while four in ten (39.7%) reported never encountering any cases. Participants who had a longer duration of practice were more likely to have a large caseload on the TDI (χ2 = 29.44, p < 0.001). Seventy-one percent of participants experienced TDI during the perioperative period; however, only 6/214 participants (2.8%) responded correctly to all three questions about emergency management of TDI, and nearly all participants (98.1%) chose to refer TDI patients to a dentist. The majority of participants (91.1%) stated that they had not received any training on TDI, and 94.4% were willing to receive TDI-related education. Conclusions The findings of this study highlight the inadequate knowledge of otolaryngologists in southwestern mainland China regarding the management of TDI. Furthermore, the results indicate a strong interest among otolaryngologists in pursuing further training, which could help meet the educational needs necessary for providing appropriate management of TDI patients. Hence, it is imperative to provide targeted training courses to ensure prompt and appropriate TDI treatment, thereby minimizing the associated medical and societal costs. Traumatic dental injuries oral health care otolaryngologists knowledge skills Figures Figure 1 Figure 2 INTRODUCTION Traumatic dental injury (TDI) is a broader concept that is classified by the World Health Organization (WHO) as damage to oral tissues, including teeth, periodontal tissues, supporting bone, gingiva and oral mucosa. Encountering these lesions is one of the most common dental health complications and can result in functional, aesthetic, financial, and psychological consequences for patients and their families 1,2 . In recent decades, TDI has been acknowledged as a significant global public dental health issue, ranking as the 5th most prevalent condition 3,4 and accounting for 85% of injuries to the oral region 5 . Indeed, reports indicate that as many as 66% of all emergency department visits related to dental problems are specifically for the management of TDI 6 . Because traumatic injuries in permanent dentition peak between the ages of 10 and 12 and existing data show that TDIs are more common in permanent dentition than in primary dentition 7,8 , with significant consequences for quality of life, the impact of dental traumas may last a lifetime. Previous studies have indicated that the most common etiologies of TDI are accidental falls and injury during sports activities 7 . In most cases, dentists and emergency physicians will complete the first intervention for patients with TDI. Nevertheless, a small but significant proportion of patients with TDI (between 2.9% and 11%) and accompanying orofacial injuries are referred to the Otorhinolaryngology department 9,10 . For this reason, treatment planning often involves multidisciplinary specialists 7 . Furthermore, with the advancement of medical technology and an increasing number of surgical procedures, iatrogenic trauma has also attracted the attention of some scholars. During a tonsillectomy, traumatic dental injuries (TDIs) involving the rupture, dislocation, or avulsion of dental elements can occur 11 . Jens et al investigated 339 patients who underwent suspension laryngoscopy in Cologne and Germany and reported that TDI occurred in 6.5% of all patients 12 . Therefore, not only dentists and emergency physicians but also otolaryngologists should have basic knowledge of the emergency management of TDIs. The majority of practicing otolaryngologists do not routinely perform this procedure, and the prognosis for traumatized teeth heavily relies on immediate and appropriate emergency management of the injured tissues 13 . Therefore, timely and accurate assessment, diagnosis, and treatment can help improve the prognosis and reduce adverse outcomes for affected patients, particularly pediatric patients. Recent studies conducted in several countries have evaluated the knowledge level regarding the emergency management of TDI among physicians specializing in various fields. Studies investigating the knowledge and management of TDI among otolaryngologists professionals were published in 2021 by Üstün et al 9 . The findings showed that 44.38% of the participants answered the questions incorrectly, and 97.7% of the participants indicated that they had not received any education regarding TDI. Similar studies have also demonstrated that medical professionals, such as general practitioners 14 , emergency medicine physicians 10,15,16 , and pediatricians 17 , have insufficient knowledge regarding the management of TDI. To the best of our knowledge, there is limited literature available on the understanding and initial assessment of TDI among otolaryngologists. Furthermore, no studies have been published that specifically concentrate on the knowledge, practices, and attitudes of otolaryngologists regarding TDI in China. This study aimed to ( 1 ) assess the current knowledge level of Chinese otolaryngologists regarding the management of patients with TDI, ( 2 ) explore their attitudes toward dental trauma education, and ( 3 ) determine potential factors that affect their knowledge. MATERIALS AND METHODS This study was a questionnaire-based cross-sectional survey of otolaryngologists from southwestern mainland China. Ethical approval was obtained from the Institutional Review Board of West China Hospital, Sichuan University (2022.1588). All participants voluntarily participated in the study, and their information was kept confidential. Questionnaire The original version of the questionnaire was created by an investigation team based on previous counterpart studies and dental trauma guidelines 18,19 . Prior to data collection, three otolaryngologists and two dentists, each with a minimum of five years of practice and research experience, were asked to individually review the preliminary questionnaire. The questionnaire items were adjusted based on the feedback and suggestions from the reviewers. Subsequently, a second questionnaire survey was distributed to 15 otolaryngologists for completion, aiming to gather additional feedback on the clarity of the instructions and wording. The questionnaire was reviewed and finalized by the project team. The questionnaire comprised 31 questions categorized into three sections: demographic data, knowledge about the management of TDI, and attitudes toward acquiring dental trauma education. Participants This study specifically targeted certified otolaryngologists from southwestern mainland China. Individuals who were illiterate or unwilling to participate were not included. During the data screening process, the inclusion criterion included Chinese residents aged 18 years or older who volunteered to participate and were capable of understanding the questionnaire. Those who declined to participate, provided inconsistent or factual responses, or completed the questionnaire in less than 180 seconds were excluded. All participants were practicing in the otolaryngology department between December 20th, 2022, and June 20th, 2023. Data collection and analysis The electronic questionnaire was distributed to otolaryngologists online through Wenjuanxing, a widely utilized platform for conducting survey studies. This was accompanied by a brief introduction outlining the study's nature and objectives, emphasizing its voluntary nature. The principal investigator was in charge of verifying the collected data from Wenjuanxing. Statistical analysis was performed with IBM SPSS Statistics for Mac (version 26.0) and GraphPad Prism 8 (San Diego, CA, USA). A statistically significant alpha was considered at p < 0.05. Descriptive analysis was conducted, which included calculating the mean, median, standard deviation, minimum, and maximum values. The Mann‒Whitney U test was used to compare two independent groups, while the Kruskal‒Wallis test was used for comparisons involving more than two groups. The statistical significance level of alpha was set at p < 0.05. RESULTS This study recruited 214 otolaryngologists, mainly from the southwestern mainland of China (95.40%), comprising 122 males and 92 females aged between 23 and 60 years (mean ± SD = 39.0 years ± 8.57). The educational and professional backgrounds revealed that the majority of participants held a bachelor's degree (68.2%) and were attending physicians (41.6%). They had practiced as otolaryngologists for one to forty years (mean = 15.0 years, SD = 9.38). The majority of the medical institutions in which the participants worked were public hospitals (93.0%), teaching hospitals (70.1%), and tertiary hospitals (77.1%). Moreover, 91.6% of them reported that their hospital had a dental department. Among the surgeries performed in hospitals, supported laryngoscopy, transoral tonsil/adenoidectomy, and oropharyngeal mass removal were performed on more than nine in ten patients. Only eight otolaryngologists reported that none of them had performed in their hospital (3.7%). Management of dental trauma When asked about their knowledge of dental trauma, 75.3% of the participants said they had "heard of it, but do not know about it" or "know a little about it". Only 3.7% reported knowing a lot about it (n = 8), and 13.1% reported that they had not heard of it (n = 28). Regarding the caseload of TDI they had encountered, four in ten participants reported that they had never encountered it (39.7%), and 41.1% reported that they had encountered 1–5 cases of TDI (41.1%). Furthermore, there were significant differences in the caseload of TDI among the various practiced duration groups (χ2 = 29.44, p 5 cases n % n % n % < 5 years 22 25.9 7 8.0 1 2.5 10 years 46 54.1 75 85.2 37 90.2 Almost all otolaryngologists informed patients about the risk of dental injuries before surgical intervention (98.1%) and checked patients' teeth conditions before starting a transoral surgical procedure (96.7%). A total of 71.0% of the participants experienced TDI during the perioperative period (n = 152). During the surgical procedure, more than ninety percent of otolaryngologists provided additional items to protect the teeth (93.9%), with gauze being the most common choice (n = 97, 92.1%). In addition, a suction tube and a rubber tube were also used to protect the teeth. A small number of participants also reported that they usually used appropriate items for additional protection, such as customized dental protectors, adhesive pads, suction devices, oxygen tubes, and other plastic cannulas. Regarding knowledge of TDI, 69.6% of otolaryngologists stated their ability to differentiate between permanent and deciduous teeth, whereas only 128 participants (59.8%) could accurately define complete tooth luxation. A total of 179 participants reported that patients with TDI require emergency treatment (83.6%), and 35 patients had negative responses (16.4%). When asked if your patient presented with a complete luxation of permanent teeth, nearly all participants chose to refer him/her to a dentist (n = 210, 98.1%). During the perioperative period, only 36.9% of participants (n = 135) expressed their willingness to independently reposition the tooth back into the alveolar socket when confronted with a patient experiencing TDI. Further questions and concrete statistics about the refusal reasons and knowledge about the management of TDI are shown in Table 2 . Figure 2 illustrates the percentage of otolaryngologists who provided accurate responses to three knowledge-based questions. Among these emergency management questions, only 6/214 participants had 3/3 correct answers, while 22 participants failed to answer any right one. Table 2 Questions about the management of TDI Questions Answer Number (%) The reason why not you put a complete luxation of permanent teeth back directly? (Multiple choices) TDI should be treated by dentists 42 31.1 I worried that inappropriate management would delay the condition of TDI 39 28.9 I don’t know the exact procedure of emergency management of TDIs 32 23.7 I have insufficient confidence to manage the patient with TDI 9 6.7 Other 9 6.7 I worried the condition of TDI beyond my professional scope of medical Practice. 4 3.0 What do you think is the correct way to hold a luxated/avulsed teeth? Teeth crown 177 82.7 I do not know about it 22 10.3 Teeth root 11 5.1 Both crown and root of the teeth are harmless 4 1.9 If a complete luxation of permanent teeth falls to the floor and becomes stained with dirt, mud and other stains before the treatment, which of the following do you think is the most appropriate practice? Rinse the tooth slowly with running water 137 64.0 Spray alcohol/disinfectant on the teeth 39 18.2 Gently wipe off the stains attached to the teeth with your hand or paper towel 16 7.5 I do not know about it 14 6.5 Gently scrub the teeth with a toothbrush 6 2.8 Put the tooth directly back into the socket without any interventions 2 0.9 Which of the following do you think would be the most ideal dental storage media for maintaining periodontal cells’ activity of a complete luxation of permanent teeth before arriving the hospital༟ Isotone saline solution 132 61.7 Wrap with gauze/paper towel 27 12.6 Clean ice water 21 9.8 I do not know about it 14 6.5 Saliva 12 5.6 Milk 8 3.7 Disinfectant solution 0 - Alcohol 0 - Attitudes toward acquiring knowledge about traumatic dental trauma Although the majority of participants indicated that they had not received any training or education on TDI (n = 195, 91.1%), they all regarded its necessity as quite important (Fig. 2 ). Overall, there is a strong willingness to receive continuous education on TDI management. The attitudes of otolaryngologists toward acquiring knowledge about TDI are shown in Table 2 . Several participants reported that they would not attend the training because these lesions were beyond their professional scope and lacked time. Table 3 Emergency management of dental trauma among otolaryngologists Questions n % Have you had any training on TDI? Yes 19 8.9 No 195 91.1 If there was a training/conference/seminar for otolaryngologists about TDI, would you attend? Yes 202 94.4 No 12 5.6 The reasons why not you attend the training on TDI? (Multiple choices) Patients with TDI should be treated by dentists, and thus making a referral is appropriate 8 66.7 I am busy at work and have no time to participate 5 41.7 Others 2 16.7 Few caseload of patients with TDI during the clinical practiced duration 1 8.3 I am not interested in this field 1 8.3 DISCUSSION As a worldwide public dental health problem, TDI can occur at any age and represents approximately 5% of all injuries among children and young adults. DiPaolo et al 18 revealed that tooth avulsion had an average direct cost of $ 1619 USD, and patients had an average of 9.5 follow-up visits after the avulsion. The treatment outcome of TDI is strongly related to the timeliness of the intervention and the knowledge and skills of emergency personnel 13 . Therefore, proper and immediate management can improve patient prognosis, minimize undesired consequences and reduce patient costs. The objective of this study was to evaluate the ability of otolaryngologists to handle common traumatic dental injuries in emergency situations. TDI is primarily managed by dentists and emergency physicians. However, with the increasing use of intraoral examinations and surgeries, as well as referrals for orofacial injuries accompanied by TDI, the probability of encountering TDI has significantly increased for otolaryngologists. In contrast to Üstün et al.’s study 9 , where 96.9% of participants had faced at least one case during their clinical experience. In this study, 60.3% of participants had encountered at least one case. Under these conditions, all otolaryngologists should receive basic training on how to manage TDI. Otolaryngologists had a low level of knowledge about TDI. In this study, only a small percentage of individuals (8.9%) had received formal education on the relevant knowledge, and the majority of them (97.2%) were unable to answer all three questions correctly regarding the emergency management of TDI. A low level of knowledge is also evident in questions 12 and 16, where 39.7% of the respondents answered "0" to "What caseload of patients with dislocated teeth have you ever met at work?" Moreover, 71% of the respondents answered "Yes" to "Did your patient have any traumatic dental injuries during the perioperative period?" This indicates that the respondents were not familiar with the definition of TDI. This is also demonstrated in other similar articles; emergency physicians 10 , pediatricians 17 , and otolaryngologists 9 exhibit low levels of knowledge in regard to TDI. In the research of Parisay et al. 19 In Mashhad and Iran, compared to residents in emergency medicine and otolaryngology, those in maxillofacial surgery exhibited the highest level of proficiency in handling traumatic dental injuries. For surgeons, it is essential to master both preventive and treatment methods for TDI. In this study, almost all participants (98.1%) were aware that TDI is one of the surgical risks, and they would inform patients about this risk. The majority of participants will take a series of measures to prevent TDI, including examining the teeth and using gauze to protect them. Managing luxation injuries in TDI entails repositioning the affected tooth within the alveolar socket and applying gentle pressure 17 . Although participants were aware of the need for immediate intervention when TDI occurs, 63.1% of the otolaryngologists indicated that they would not undertake reimplantation of the avulsed teeth. This is closely related to the high referral rate and the lack of knowledge and confidence among participants in dealing with dental issues. These results are highly consistent with the studies conducted by scholars such as Üstün et al. 9 and Nikolic et al. 17 Among the three issues in scoring, “the correct way to hold an avulsed tooth” and “the most appropriate practice to deal with stained teeth” achieved an accuracy rate of more than 50% for these two issues. The condition of periodontal ligament (PDL) cells depends on both the storage medium and the duration that the tooth is out of the mouth, which will impact the selection of treatment. After being allowed to dry for 60 minutes or longer, all PDL cells became nonviable. In the event of a tooth avulsion, the most effective initial response is to prompt the patient to reinsert the tooth and bite down on a handkerchief to secure it in place. If this is not possible, placing the tooth in a glass of milk or another osmolality-balanced storage medium is necessary 7,20 . However, in regard to preserving an avulsed tooth, 61.7% of otolaryngologists would place the tooth in saline, 12.6% would wrap it with gauze or a paper towel, and only 3.7% would use milk as a storage medium. These results are unsatisfactory, particularly compared to those of Üstün et al.'s study, in which 12.5% of participants stored their teeth in milk. Most of them (99.5%) considered that acquiring knowledge related to TDI is important. However, similar to the research conducted by Abu-Dawoud et al. 21 and Manochehrifar et al. 22 The majority of nondental healthcare professionals (96.6%, 90.7%, respectively) do not receive specialized education on the management of TDI. Consistent with previous research 10,16,17,21,23,24 , almost all otolaryngologists had positive attitudes and were willing to undergo further education to enhance their professional competence. Bruno et al. 25 and Parisay et al. 19 Both demonstrated that educational interventions resulted in a notable increase in correct responses concerning the actions to be taken in cases of tooth avulsion. However, Bruno et al. 25 reported that the professionals’ knowledge level decreased slightly six months after the lecture but still remained high. However, participants' confidence in their ability to perform replantation significantly decreased. Therefore, regular knowledge education and skill training for nondental medical professionals is needed. Limitations The present study shares limitations common to all cross-sectional studies. First, there may be selection bias among participants due to the lack of randomization, which is attributed to limited objective conditions. Individuals interested in TDIs or those with prior experience in such cases were more likely to respond to the questionnaire. Second, the majority of the data were collected from multiple centers in southwestern mainland China, potentially limiting the generalizability of the results to the broader population. In future studies, we aim to develop more deeply into dental issues that are closely associated with orofacial concerns. Furthermore, we propose stratifying clinicians based on their practice characteristics to ensure that the analysis yields a more objective and representative conclusion. CONCLUSIONS The current study indicated that more than half of the otolaryngologists in southwestern mainland China had experienced TDI, which is insufficient for managing TDI. Educational campaigns must be undertaken to improve the knowledge of otolaryngologists regarding the emergency management of TDI. A significant proportion of otolaryngologists have expressed a keen interest in receiving education on TDI. Leveraging new multimedia approaches to provide TDI knowledge in a more convenient manner could be a promising strategy for enhancing TDI management practices among otolaryngologists and increasing their awareness of TDI. Declarations Ethics approval and consent to participate Ethnic approval was obtained from the Sichuan University West China Hospital Institutional Review Board (2022.1588). All participants voluntarily participated, and their information was kept confidential. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors have no conflicts of interest relevant to this article to disclose. Funding Not applicable Authors' contributions Dr. Dan Lu and Dr. Jue Xu conceptualized and designed the study, Zhongjing Pan, Yuanyuan Peng and Jinyi Zhang acquired the data, Zhongjing Pan conducted the data analyses, and Zhongjing Pan and Qinghan Zeng created the manuscript. Tianpei Ma reviewed the statistical outcomes and directed the improvement. All authors provided critical revision of the manuscript for important intellectual content. Acknowledgments Not applicable References Chopra A, Lakhanpal M, Rao N, Gupta N, Vashisth S. Traumatic Dental Injuries Among Twelve to Fifteen Years Old School Children in Panchkula. Arch Trauma Res. 2014;3(1). 10.5812/atr.18127 . Fakhruddin KS, Lawrence HP, Kenny DJ, Locker D. Impact of treated and untreated dental injuries on the quality of life of Ontario school children. Dent Traumatol. 2008;24(3):309–13. 10.1111/j.1600-9657.2007.00547.x . Petti S, Glendor U, Andersson L. 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Effect of an Educational Programme on the Knowledge Level Among an Emergency Service Medical Team Regarding Tooth Avulsion. Oral Health Prev Dentistry. 2016;14(3):259–66. 10.3290/j.ohpd.a35615 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 10 Apr, 2025 Read the published version in BMC Oral Health → Version 1 posted Editorial decision: Revision requested 28 May, 2024 Submission checks completed at journal 24 May, 2024 Editor assigned by journal 24 May, 2024 First submitted to journal 10 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4248219","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":307669008,"identity":"6b98f133-48d3-4cf4-925a-8b9ee2b8708e","order_by":0,"name":"Zhongjing Pan","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Zhongjing","middleName":"","lastName":"Pan","suffix":""},{"id":307669009,"identity":"1c5846da-9826-46f7-a3d1-5d7d2d217d9a","order_by":1,"name":"Qinghan Zeng","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Qinghan","middleName":"","lastName":"Zeng","suffix":""},{"id":307669013,"identity":"128be240-5513-4e29-a579-15f94ef4a05e","order_by":2,"name":"Tianpei Ma","email":"","orcid":"","institution":"Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Tianpei","middleName":"","lastName":"Ma","suffix":""},{"id":307669015,"identity":"711c643c-7c52-4b54-bd5c-25cf68843b5d","order_by":3,"name":"Yuanyuan Peng","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Yuanyuan","middleName":"","lastName":"Peng","suffix":""},{"id":307669016,"identity":"fe5fef3a-4d85-475b-aa37-e084846bc480","order_by":4,"name":"Jinyi Zhang","email":"","orcid":"","institution":"chengdu jincheng","correspondingAuthor":false,"prefix":"","firstName":"Jinyi","middleName":"","lastName":"Zhang","suffix":""},{"id":307669017,"identity":"be658d17-c78c-489b-8f33-614fd80db5f4","order_by":5,"name":"Jue Xu","email":"","orcid":"","institution":"Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Jue","middleName":"","lastName":"Xu","suffix":""},{"id":307669018,"identity":"5ec028e6-7f21-4453-95ae-3327d93fd3a8","order_by":6,"name":"Dan Lu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIie3PIQ+CQBTA8efYjsKg3m1Ov8I5N/Xj3CWLbkaCUxkOguf8KkQjFinnrEQsWCw2bHIUG2Bz8/7phffb3gPQ6X6xGBAwCwMyOl7G3OUXxDF9n2by3JKoiEgCctsazcJOkjzLupMeTXng8g0CJ9yxWkLkbEzLw4aKpPzYBSwvUS2h8QzhkvCoIhIBxfMGcr3niqwVWfDAaEFSNlKEEXEKoBUh6aMig4Pp+ZjJs9X4i32d5uQlVn1kmLdn4S57TrivJ1Ud8Zmt5vWqouWeTqfT/Wdv5ApMaLMD9kgAAAAASUVORK5CYII=","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":true,"prefix":"","firstName":"Dan","middleName":"","lastName":"Lu","suffix":""}],"badges":[],"createdAt":"2024-04-10 15:32:02","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4248219/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4248219/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12903-025-05683-2","type":"published","date":"2025-04-10T16:05:54+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":58144015,"identity":"8000f5e7-3c4d-436f-b687-c38450697455","added_by":"auto","created_at":"2024-06-11 18:22:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":35605,"visible":true,"origin":"","legend":"\u003cp\u003eThe distribution of correct answers to three questions about the management of TDI (Q25-Q27)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4248219/v1/e9b5e7fe9eec8a7e20273e4e.png"},{"id":58144016,"identity":"3e413b18-83b2-44df-a29f-513f7510e95d","added_by":"auto","created_at":"2024-06-11 18:22:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":41631,"visible":true,"origin":"","legend":"\u003cp\u003eNecessity of acquiring knowledge about TDI among otolaryngologists\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4248219/v1/c96b6df9a9286a918d26f30a.png"},{"id":80558750,"identity":"b888613b-490e-46a4-83c9-2ccb035fbc8d","added_by":"auto","created_at":"2025-04-14 16:16:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":800883,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4248219/v1/f1d4e3bd-7bdc-478a-b4df-069b003b68f7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Management of Traumatic Dental Injuries among Otolaryngologists in Southwestern Mainland China: a cross-sectional observational survey","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eTraumatic dental injury (TDI) is a broader concept that is classified by the World Health Organization (WHO) as damage to oral tissues, including teeth, periodontal tissues, supporting bone, gingiva and oral mucosa. Encountering these lesions is one of the most common dental health complications and can result in functional, aesthetic, financial, and psychological consequences for patients and their families\u003csup\u003e1,2\u003c/sup\u003e. In recent decades, TDI has been acknowledged as a significant global public dental health issue, ranking as the 5th most prevalent condition\u003csup\u003e3,4\u003c/sup\u003e and accounting for 85% of injuries to the oral region\u003csup\u003e5\u003c/sup\u003e. Indeed, reports indicate that as many as 66% of all emergency department visits related to dental problems are specifically for the management of TDI\u003csup\u003e6\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBecause traumatic injuries in permanent dentition peak between the ages of 10 and 12 and existing data show that TDIs are more common in permanent dentition than in primary dentition\u003csup\u003e7,8\u003c/sup\u003e, with significant consequences for quality of life, the impact of dental traumas may last a lifetime.\u003c/p\u003e \u003cp\u003ePrevious studies have indicated that the most common etiologies of TDI are accidental falls and injury during sports activities\u003csup\u003e7\u003c/sup\u003e. In most cases, dentists and emergency physicians will complete the first intervention for patients with TDI. Nevertheless, a small but significant proportion of patients with TDI (between 2.9% and 11%) and accompanying orofacial injuries are referred to the Otorhinolaryngology department\u003csup\u003e9,10\u003c/sup\u003e. For this reason, treatment planning often involves multidisciplinary specialists\u003csup\u003e7\u003c/sup\u003e. Furthermore, with the advancement of medical technology and an increasing number of surgical procedures, iatrogenic trauma has also attracted the attention of some scholars. During a tonsillectomy, traumatic dental injuries (TDIs) involving the rupture, dislocation, or avulsion of dental elements can occur\u003csup\u003e11\u003c/sup\u003e. Jens et al investigated 339 patients who underwent suspension laryngoscopy in Cologne and Germany and reported that TDI occurred in 6.5% of all patients\u003csup\u003e12\u003c/sup\u003e. Therefore, not only dentists and emergency physicians but also otolaryngologists should have basic knowledge of the emergency management of TDIs.\u003c/p\u003e \u003cp\u003eThe majority of practicing otolaryngologists do not routinely perform this procedure, and the prognosis for traumatized teeth heavily relies on immediate and appropriate emergency management of the injured tissues\u003csup\u003e13\u003c/sup\u003e. Therefore, timely and accurate assessment, diagnosis, and treatment can help improve the prognosis and reduce adverse outcomes for affected patients, particularly pediatric patients.\u003c/p\u003e \u003cp\u003eRecent studies conducted in several countries have evaluated the knowledge level regarding the emergency management of TDI among physicians specializing in various fields. Studies investigating the knowledge and management of TDI among otolaryngologists professionals were published in 2021 by \u0026Uuml;st\u0026uuml;n et al\u003csup\u003e9\u003c/sup\u003e. The findings showed that 44.38% of the participants answered the questions incorrectly, and 97.7% of the participants indicated that they had not received any education regarding TDI. Similar studies have also demonstrated that medical professionals, such as general practitioners\u003csup\u003e14\u003c/sup\u003e, emergency medicine physicians\u003csup\u003e10,15,16\u003c/sup\u003e, and pediatricians\u003csup\u003e17\u003c/sup\u003e, have insufficient knowledge regarding the management of TDI.\u003c/p\u003e \u003cp\u003eTo the best of our knowledge, there is limited literature available on the understanding and initial assessment of TDI among otolaryngologists. Furthermore, no studies have been published that specifically concentrate on the knowledge, practices, and attitudes of otolaryngologists regarding TDI in China. This study aimed to (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) assess the current knowledge level of Chinese otolaryngologists regarding the management of patients with TDI, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) explore their attitudes toward dental trauma education, and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) determine potential factors that affect their knowledge.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eThis study was a questionnaire-based cross-sectional survey of otolaryngologists from southwestern mainland China. Ethical approval was obtained from the Institutional Review Board of West China Hospital, Sichuan University (2022.1588). All participants voluntarily participated in the study, and their information was kept confidential.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eQuestionnaire\u003c/h2\u003e \u003cp\u003eThe original version of the questionnaire was created by an investigation team based on previous counterpart studies and dental trauma guidelines\u003csup\u003e18,19\u003c/sup\u003e. Prior to data collection, three otolaryngologists and two dentists, each with a minimum of five years of practice and research experience, were asked to individually review the preliminary questionnaire. The questionnaire items were adjusted based on the feedback and suggestions from the reviewers. Subsequently, a second questionnaire survey was distributed to 15 otolaryngologists for completion, aiming to gather additional feedback on the clarity of the instructions and wording. The questionnaire was reviewed and finalized by the project team. The questionnaire comprised 31 questions categorized into three sections: demographic data, knowledge about the management of TDI, and attitudes toward acquiring dental trauma education.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThis study specifically targeted certified otolaryngologists from southwestern mainland China. Individuals who were illiterate or unwilling to participate were not included. During the data screening process, the inclusion criterion included Chinese residents aged 18 years or older who volunteered to participate and were capable of understanding the questionnaire. Those who declined to participate, provided inconsistent or factual responses, or completed the questionnaire in less than 180 seconds were excluded. All participants were practicing in the otolaryngology department between December 20th, 2022, and June 20th, 2023.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData collection and analysis\u003c/h2\u003e \u003cp\u003eThe electronic questionnaire was distributed to otolaryngologists online through Wenjuanxing, a widely utilized platform for conducting survey studies. This was accompanied by a brief introduction outlining the study's nature and objectives, emphasizing its voluntary nature. The principal investigator was in charge of verifying the collected data from Wenjuanxing. Statistical analysis was performed with IBM SPSS Statistics for Mac (version 26.0) and GraphPad Prism 8 (San Diego, CA, USA). A statistically significant alpha was considered at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Descriptive analysis was conducted, which included calculating the mean, median, standard deviation, minimum, and maximum values. The Mann‒Whitney U test was used to compare two independent groups, while the Kruskal‒Wallis test was used for comparisons involving more than two groups. The statistical significance level of alpha was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThis study recruited 214 otolaryngologists, mainly from the southwestern mainland of China (95.40%), comprising 122 males and 92 females aged between 23 and 60 years (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u0026thinsp;=\u0026thinsp;39.0 years\u0026thinsp;\u0026plusmn;\u0026thinsp;8.57). The educational and professional backgrounds revealed that the majority of participants held a bachelor's degree (68.2%) and were attending physicians (41.6%). They had practiced as otolaryngologists for one to forty years (mean\u0026thinsp;=\u0026thinsp;15.0 years, SD\u0026thinsp;=\u0026thinsp;9.38). The majority of the medical institutions in which the participants worked were public hospitals (93.0%), teaching hospitals (70.1%), and tertiary hospitals (77.1%). Moreover, 91.6% of them reported that their hospital had a dental department. Among the surgeries performed in hospitals, supported laryngoscopy, transoral tonsil/adenoidectomy, and oropharyngeal mass removal were performed on more than nine in ten patients. Only eight otolaryngologists reported that none of them had performed in their hospital (3.7%).\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eManagement of dental trauma\u003c/h2\u003e \u003cp\u003e When asked about their knowledge of dental trauma, 75.3% of the participants said they had \"heard of it, but do not know about it\" or \"know a little about it\". Only 3.7% reported knowing a lot about it (n\u0026thinsp;=\u0026thinsp;8), and 13.1% reported that they had not heard of it (n\u0026thinsp;=\u0026thinsp;28). Regarding the caseload of TDI they had encountered, four in ten participants reported that they had never encountered it (39.7%), and 41.1% reported that they had encountered 1\u0026ndash;5 cases of TDI (41.1%). Furthermore, there were significant differences in the caseload of TDI among the various practiced duration groups (χ2\u0026thinsp;=\u0026thinsp;29.44, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe caseload of TDI varied among the different practiced duration groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003eCaseload of TDI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" morerows=\"2\" nameend=\"c12\" namest=\"c10\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1\u0026ndash;5 cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 cases\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e7.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e85.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e90.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAlmost all otolaryngologists informed patients about the risk of dental injuries before surgical intervention (98.1%) and checked patients' teeth conditions before starting a transoral surgical procedure (96.7%). A total of 71.0% of the participants experienced TDI during the perioperative period (n\u0026thinsp;=\u0026thinsp;152). During the surgical procedure, more than ninety percent of otolaryngologists provided additional items to protect the teeth (93.9%), with gauze being the most common choice (n\u0026thinsp;=\u0026thinsp;97, 92.1%). In addition, a suction tube and a rubber tube were also used to protect the teeth. A small number of participants also reported that they usually used appropriate items for additional protection, such as customized dental protectors, adhesive pads, suction devices, oxygen tubes, and other plastic cannulas. Regarding knowledge of TDI, 69.6% of otolaryngologists stated their ability to differentiate between permanent and deciduous teeth, whereas only 128 participants (59.8%) could accurately define complete tooth luxation.\u003c/p\u003e \u003cp\u003eA total of 179 participants reported that patients with TDI require emergency treatment (83.6%), and 35 patients had negative responses (16.4%). When asked if your patient presented with a complete luxation of permanent teeth, nearly all participants chose to refer him/her to a dentist (n\u0026thinsp;=\u0026thinsp;210, 98.1%). During the perioperative period, only 36.9% of participants (n\u0026thinsp;=\u0026thinsp;135) expressed their willingness to independently reposition the tooth back into the alveolar socket when confronted with a patient experiencing TDI. Further questions and concrete statistics about the refusal reasons and knowledge about the management of TDI are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the percentage of otolaryngologists who provided accurate responses to three knowledge-based questions. Among these emergency management questions, only 6/214 participants had 3/3 correct answers, while 22 participants failed to answer any right one.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQuestions about the management of TDI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnswer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe reason why not you put a complete luxation of permanent teeth back directly? (Multiple choices)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTDI should be treated by dentists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI worried that inappropriate management would delay the condition of TDI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t know the exact procedure of emergency management of TDIs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have insufficient confidence to manage the patient with TDI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI worried the condition of TDI beyond my professional scope of medical\u003c/p\u003e \u003cp\u003ePractice.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat do you think is the correct way to hold a luxated/avulsed teeth?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTeeth crown\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e177\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e82.7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI do not know about it\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeeth root\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth crown and root of the teeth are harmless\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf a complete luxation of permanent teeth falls to the floor and becomes stained with dirt, mud and other stains before the treatment, which of the following do you think is the most appropriate practice?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRinse the tooth slowly with running water\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e137\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e64.0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpray alcohol/disinfectant on the teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGently wipe off the stains attached to the teeth with your hand or paper towel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI do not know about it\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGently scrub the teeth with a toothbrush\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePut the tooth directly back into the socket without any interventions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhich of the following do you think would be the most ideal dental storage media for maintaining periodontal cells\u0026rsquo; activity of a complete luxation of permanent teeth before arriving the hospital༟\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsotone saline solution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWrap with gauze/paper towel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClean ice water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI do not know about it\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSaliva\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMilk\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3.7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisinfectant solution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAttitudes toward acquiring knowledge about traumatic dental trauma\u003c/h2\u003e \u003cp\u003eAlthough the majority of participants indicated that they had not received any training or education on TDI (n\u0026thinsp;=\u0026thinsp;195, 91.1%), they all regarded its necessity as quite important (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Overall, there is a strong willingness to receive continuous education on TDI management. The attitudes of otolaryngologists toward acquiring knowledge about TDI are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Several participants reported that they would not attend the training because these lesions were beyond their professional scope and lacked time.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEmergency management of dental trauma among otolaryngologists\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave you had any training on TDI?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf there was a training/conference/seminar for otolaryngologists about TDI, would you attend?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe reasons why not you attend the training on TDI? (Multiple choices)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients with TDI should be treated by dentists, and thus making a referral is appropriate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am busy at work and have no time to participate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFew caseload of patients with TDI during the clinical practiced duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am not interested in this field\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAs a worldwide public dental health problem, TDI can occur at any age and represents approximately 5% of all injuries among children and young adults. DiPaolo et al\u003csup\u003e18\u003c/sup\u003e revealed that tooth avulsion had an average direct cost of \u003cspan\u003e$\u003c/span\u003e1619 USD, and patients had an average of 9.5 follow-up visits after the avulsion. The treatment outcome of TDI is strongly related to the timeliness of the intervention and the knowledge and skills of emergency personnel\u003csup\u003e13\u003c/sup\u003e. Therefore, proper and immediate management can improve patient prognosis, minimize undesired consequences and reduce patient costs. The objective of this study was to evaluate the ability of otolaryngologists to handle common traumatic dental injuries in emergency situations.\u003c/p\u003e \u003cp\u003eTDI is primarily managed by dentists and emergency physicians. However, with the increasing use of intraoral examinations and surgeries, as well as referrals for orofacial injuries accompanied by TDI, the probability of encountering TDI has significantly increased for otolaryngologists. In contrast to \u0026Uuml;st\u0026uuml;n et al.\u0026rsquo;s study\u003csup\u003e9\u003c/sup\u003e, where 96.9% of participants had faced at least one case during their clinical experience. In this study, 60.3% of participants had encountered at least one case. Under these conditions, all otolaryngologists should receive basic training on how to manage TDI.\u003c/p\u003e \u003cp\u003eOtolaryngologists had a low level of knowledge about TDI. In this study, only a small percentage of individuals (8.9%) had received formal education on the relevant knowledge, and the majority of them (97.2%) were unable to answer all three questions correctly regarding the emergency management of TDI. A low level of knowledge is also evident in questions 12 and 16, where 39.7% of the respondents answered \"0\" to \"What caseload of patients with dislocated teeth have you ever met at work?\" Moreover, 71% of the respondents answered \"Yes\" to \"Did your patient have any traumatic dental injuries during the perioperative period?\" This indicates that the respondents were not familiar with the definition of TDI. This is also demonstrated in other similar articles; emergency physicians\u003csup\u003e10\u003c/sup\u003e, pediatricians\u003csup\u003e17\u003c/sup\u003e, and otolaryngologists\u003csup\u003e9\u003c/sup\u003e exhibit low levels of knowledge in regard to TDI. In the research of Parisay et al.\u003csup\u003e19\u003c/sup\u003e In Mashhad and Iran, compared to residents in emergency medicine and otolaryngology, those in maxillofacial surgery exhibited the highest level of proficiency in handling traumatic dental injuries.\u003c/p\u003e \u003cp\u003eFor surgeons, it is essential to master both preventive and treatment methods for TDI. In this study, almost all participants (98.1%) were aware that TDI is one of the surgical risks, and they would inform patients about this risk. The majority of participants will take a series of measures to prevent TDI, including examining the teeth and using gauze to protect them. Managing luxation injuries in TDI entails repositioning the affected tooth within the alveolar socket and applying gentle pressure\u003csup\u003e17\u003c/sup\u003e. Although participants were aware of the need for immediate intervention when TDI occurs, 63.1% of the otolaryngologists indicated that they would not undertake reimplantation of the avulsed teeth. This is closely related to the high referral rate and the lack of knowledge and confidence among participants in dealing with dental issues. These results are highly consistent with the studies conducted by scholars such as \u0026Uuml;st\u0026uuml;n et al.\u003csup\u003e9\u003c/sup\u003e and Nikolic et al.\u003csup\u003e17\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAmong the three issues in scoring, \u0026ldquo;the correct way to hold an avulsed tooth\u0026rdquo; and \u0026ldquo;the most appropriate practice to deal with stained teeth\u0026rdquo; achieved an accuracy rate of more than 50% for these two issues. The condition of periodontal ligament (PDL) cells depends on both the storage medium and the duration that the tooth is out of the mouth, which will impact the selection of treatment. After being allowed to dry for 60 minutes or longer, all PDL cells became nonviable. In the event of a tooth avulsion, the most effective initial response is to prompt the patient to reinsert the tooth and bite down on a handkerchief to secure it in place. If this is not possible, placing the tooth in a glass of milk or another osmolality-balanced storage medium is necessary\u003csup\u003e7,20\u003c/sup\u003e. However, in regard to preserving an avulsed tooth, 61.7% of otolaryngologists would place the tooth in saline, 12.6% would wrap it with gauze or a paper towel, and only 3.7% would use milk as a storage medium. These results are unsatisfactory, particularly compared to those of \u0026Uuml;st\u0026uuml;n et al.'s study, in which 12.5% of participants stored their teeth in milk.\u003c/p\u003e \u003cp\u003eMost of them (99.5%) considered that acquiring knowledge related to TDI is important. However, similar to the research conducted by Abu-Dawoud et al.\u003csup\u003e21\u003c/sup\u003e and Manochehrifar et al.\u003csup\u003e22\u003c/sup\u003e The majority of nondental healthcare professionals (96.6%, 90.7%, respectively) do not receive specialized education on the management of TDI. Consistent with previous research\u003csup\u003e10,16,17,21,23,24\u003c/sup\u003e, almost all otolaryngologists had positive attitudes and were willing to undergo further education to enhance their professional competence. Bruno et al.\u003csup\u003e25\u003c/sup\u003e and Parisay et al.\u003csup\u003e19\u003c/sup\u003e Both demonstrated that educational interventions resulted in a notable increase in correct responses concerning the actions to be taken in cases of tooth avulsion. However, Bruno et al.\u003csup\u003e25\u003c/sup\u003e reported that the professionals\u0026rsquo; knowledge level decreased slightly six months after the lecture but still remained high. However, participants' confidence in their ability to perform replantation significantly decreased. Therefore, regular knowledge education and skill training for nondental medical professionals is needed.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThe present study shares limitations common to all cross-sectional studies. First, there may be selection bias among participants due to the lack of randomization, which is attributed to limited objective conditions. Individuals interested in TDIs or those with prior experience in such cases were more likely to respond to the questionnaire. Second, the majority of the data were collected from multiple centers in southwestern mainland China, potentially limiting the generalizability of the results to the broader population.\u003c/p\u003e \u003cp\u003eIn future studies, we aim to develop more deeply into dental issues that are closely associated with orofacial concerns. Furthermore, we propose stratifying clinicians based on their practice characteristics to ensure that the analysis yields a more objective and representative conclusion.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThe current study indicated that more than half of the otolaryngologists in southwestern mainland China had experienced TDI, which is insufficient for managing TDI. Educational campaigns must be undertaken to improve the knowledge of otolaryngologists regarding the emergency management of TDI. A significant proportion of otolaryngologists have expressed a keen interest in receiving education on TDI. Leveraging new multimedia approaches to provide TDI knowledge in a more convenient manner could be a promising strategy for enhancing TDI management practices among otolaryngologists and increasing their awareness of TDI.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthnic approval was obtained from the Sichuan University West China Hospital Institutional Review Board (2022.1588). All participants voluntarily participated, and their information was kept confidential.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest relevant to this article to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr. Dan Lu and Dr.\u0026nbsp;Jue Xu\u0026nbsp;conceptualized and designed the study, Zhongjing Pan, Yuanyuan Peng and\u0026nbsp;Jinyi Zhang\u0026nbsp;acquired the data, Zhongjing Pan conducted the data analyses, and Zhongjing Pan and Qinghan Zeng created the manuscript. Tianpei Ma reviewed the statistical outcomes and directed the improvement. All authors provided critical revision of the manuscript for important intellectual content.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChopra A, Lakhanpal M, Rao N, Gupta N, Vashisth S. Traumatic Dental Injuries Among Twelve to Fifteen Years Old School Children in Panchkula. Arch Trauma Res. 2014;3(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5812/atr.18127\u003c/span\u003e\u003cspan address=\"10.5812/atr.18127\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFakhruddin KS, Lawrence HP, Kenny DJ, Locker D. Impact of treated and untreated dental injuries on the quality of life of Ontario school children. 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A Study of Physicians and Dentists in Kerman Province, Iran. J Dent Educ. 2013;77(4):494\u0026ndash;501. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/j.0022-0337.2013.77.4.tb05495.x\u003c/span\u003e\u003cspan address=\"10.1002/j.0022-0337.2013.77.4.tb05495.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBahammam LA. Knowledge and attitude of emergency physician about the emergency management of tooth avulsion. BMC Oral Health. 2018;18(1):57. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12903-018-0515-5\u003c/span\u003e\u003cspan address=\"10.1186/s12903-018-0515-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolan G, Shmueli Y. Knowledge of physicians in hospital emergency rooms in Israel on their role in cases of avulsion of permanent incisors. Int J Paed Dentistry. 2003;13(1):13\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1046/j.1365-263X.2003.00414.x\u003c/span\u003e\u003cspan address=\"10.1046/j.1365-263X.2003.00414.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEffect of an Educational Programme on the Knowledge Level Among an Emergency Service Medical Team Regarding Tooth Avulsion. Oral Health Prev Dentistry. 2016;14(3):259\u0026ndash;66. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3290/j.ohpd.a35615\u003c/span\u003e\u003cspan address=\"10.3290/j.ohpd.a35615\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Traumatic dental injuries, oral health care, otolaryngologists, knowledge, skills","lastPublishedDoi":"10.21203/rs.3.rs-4248219/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4248219/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThis study aimed to examine otolaryngologists' attitudes and knowledge regarding the management of traumatic dental injuries (TDIs) encountered when patients present at the emergency department or during procedures such as tonsillectomy,adenoidectomy and suspension laryngoscopic surgery, as well as their motivation for pursuing additional education in this area.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional observational survey involving otolaryngologists selected from multiple hospitals across Sichuan Province was carried out in this study. The questionnaire, consisting of 31 questions, was segmented into three sections: demographic data (10 items), knowledge about the management of TDI (17 items), and attitudes toward acquiring dental trauma education (4 items). Descriptive analysis, the Kruskal\u0026ndash;Wallis test, the Mann\u0026ndash;Whitney U test and ANOVA were used for statistical analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn the analysis, a total of 214 surveys were included, with over half of the participants (60.3%) having experienced at least one TDI case in their practice, while four in ten (39.7%) reported never encountering any cases. Participants who had a longer duration of practice were more likely to have a large caseload on the TDI (χ2\u0026thinsp;=\u0026thinsp;29.44, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Seventy-one percent of participants experienced TDI during the perioperative period; however, only 6/214 participants (2.8%) responded correctly to all three questions about emergency management of TDI, and nearly all participants (98.1%) chose to refer TDI patients to a dentist. The majority of participants (91.1%) stated that they had not received any training on TDI, and 94.4% were willing to receive TDI-related education.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe findings of this study highlight the inadequate knowledge of otolaryngologists in southwestern mainland China regarding the management of TDI. Furthermore, the results indicate a strong interest among otolaryngologists in pursuing further training, which could help meet the educational needs necessary for providing appropriate management of TDI patients. Hence, it is imperative to provide targeted training courses to ensure prompt and appropriate TDI treatment, thereby minimizing the associated medical and societal costs.\u003c/p\u003e","manuscriptTitle":"Management of Traumatic Dental Injuries among Otolaryngologists in Southwestern Mainland China: a cross-sectional observational survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-11 18:22:40","doi":"10.21203/rs.3.rs-4248219/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-28T10:45:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-25T02:48:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-25T02:48:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2024-04-10T15:30:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1d2fc732-0537-4f03-b669-53465b008510","owner":[],"postedDate":"June 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-14T16:11:44+00:00","versionOfRecord":{"articleIdentity":"rs-4248219","link":"https://doi.org/10.1186/s12903-025-05683-2","journal":{"identity":"bmc-oral-health","isVorOnly":false,"title":"BMC Oral Health"},"publishedOn":"2025-04-10 16:05:54","publishedOnDateReadable":"April 10th, 2025"},"versionCreatedAt":"2024-06-11 18:22:40","video":"","vorDoi":"10.1186/s12903-025-05683-2","vorDoiUrl":"https://doi.org/10.1186/s12903-025-05683-2","workflowStages":[]},"version":"v1","identity":"rs-4248219","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4248219","identity":"rs-4248219","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}