The Experience and Knowledge of Traumatic Dental Injuries among Pediatric Physicians

The Experience and Knowledge of Traumatic Dental Injuries among Pediatric Physicians | 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 The Experience and Knowledge of Traumatic Dental Injuries among Pediatric Physicians Andrea Dora Schachter, Nata Kaplan, Sigalit Blumer, Gisela Berenstein Ajzman, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4298093/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To assess the knowledge and attitude of pediatric physicians towards management of permanent and primary avulsed teeth. Materials and Methods: Pediatric physicians filled out a questionnaire. A total of 133 physicians agreed to participate. The questionnaire surveyed the physician's background, knowledge, and approach to managing tooth avulsion. Results: Only 27.1% of the physicians underwent dental trauma training. Most of the physicians (74%) prefer to refer avulsed tooth cases to a dentist immediately. Only 3% would put the tooth back into the socket. When the participants were asked about storing the avulsed tooth, 38.3% correctly said they would advise keeping the tooth in milk. Most of the physicians (67%) answered that primary teeth should not be replanted. Conclusions: The pediatric physicians’ knowledge about tooth avulsion is fair Clinical Relevance: Educational training programs should be developed and conducted in order to improve awareness of emergency management strategies in such cases. Traumatic Dental Injuries Avulsion Pediatric Physicians Knowledge Figures Figure 1 Figure 2 Introduction The oral region comprises only 1% of the body, but accounts for 5% of all injuries across all age groups. [ 1 ] Intrusion and avulsion pose the greatest danger to the develop-ment of permanent teeth. [ 2 ] Dental avulsion is defined as the complete displacement of a tooth out of its socket, along with a severed periodontal ligament, with or without fracture of the alveolar bone. Avulsion is the most serious form of dental trauma and also occurs quite frequently, with an incidence of 0.5%-3% of all traumatic injuries to the permanent dentition. The tooth most commonly involved is the maxillary central incisor, [ 3 ] which has minimal resistance to frontal impact among children ages 7–9, due to the periodontal ligament’s low resiliency and the surrounding bone’s low mineralization. [ 4 ] Since many incidents occur at home or at school, the participation of parents and schoolteachers in the emergency situation is fundamental to providing proper care for the injured child. [ 5 ] As the time factor is crucial for optimal healing, acute replantation ap-proach is required. [ 6 ] The patient should visit a dental emergency service as soon as pos-sible. Reimplantation of the avulsed tooth is considered the best treatment modality be-cause of its biological and psychological advantages. If replantation is not possible, the tooth should be placed, as soon as possible, in a storage or transport medium that is im-mediately available at the emergency site. This should be done quickly to avoid dehydra-tion of the root surface, which starts to happen in a matter of a few minutes. In descending order of preference, milk, HBSS, saliva (after spitting into a glass for instance), or saline are suitable and convenient storage mediums. [ 7 ] By contrast, replantation after a prolonged dried extra-alveolar period results in poor prognosis, with possible ankylosis (replacement resorption) development. [ 8 ] Dental avulsion has aesthetic, functional, and psychological consequences, both on the child and the parents. [ 3 ] Avulsions were found to be the most common type of dental injury rec-orded for children under 15 years of age seeking treatment in hospital emergency rooms. Under these circumstances, it is reasonable to expect health care providers to know how to manage avulsed teeth. [ 9 ] Many studies conducted in several countries have showed that medical physicians lack adequate knowledge about the emergency management of avulsion. [ 8 , 10 , 11 ] In a lo-cal study, only 5.9% of all physicians stated they received education regarding dental trauma and only 4% would provide appropriate initial treatment. [ 12 , 13 ] The purpose of this study is to assess the knowledge of first aid dental treatment among pediatric physicians. Materials and Methods In the present study, a survey was conducted from January to March 2020. The study was approved by the ethical committee of the Tel Aviv University (IRB), and was targeted at pediatric physicians (i.e. specialist, interns and non-specialists). A questionnaire was sent by email to pediatric physicians on three different occasions, the email address were given to us by the Israel Pediatric Association. In addition, the questionnaire was handed out at a major conference of the Pediatrics association. The first part of the questionnaire included demographic details, such as occupation, education, place of work and experience. The second part of the questionnaire includes enquiries about formal dental trauma training and past experience with treating an avulsed tooth. The third part of the questionnaire contains questions regarding dental avulsion and its management was comprised of three close-ended questions modified from previous studies. [ 4 , 10 , 13 ] Statistical Analysis The statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS Incorporated, Chicago, Illinois, Version 25.0, USA). The chi-square test was applied in order to investigate the significance of the data on physician knowledge of the correct treatment. Results One hundred thirty-three pediatric physicians completed the questionnaire, ninety out of about 300 physicians responded in the conference and the rest by email. Table 1 summarizes the main demographic data. Fifty-seven percent of the physicians are wom-en. The mean age of the physicians is 47 ± 14.2 years. Seventy percent of the responders are pediatric specialists. More than Eighty-five percent of the responders completed their in-ternship locally. Most of the physicians (53.4%) work at health maintenance organizations (HMOs) and have more than 15 years of experience (54.9%). Table 1 Demographic data Number % Gender Female 76 57.1 Male 57 42.9 Experience Level (occupation) Specialist 93 69.9 Intern 27 20.3 General practitioner 13 9.8 Location of medical school Local 83 62.4 West Europe 26 19.5 East Europe 11 8.3 North America 2 1.5 Other 11 8.3 Place of internship Local 114 85.7 West Europe 9 6.8 East Europe 5 3.8 North America 4 3.0 Other 1 .8 Place of work Hospital 53 39.8 Private clinic 8 6.0 HMO 71 53.4 Other 1 .8 Years of practice 15 73 54.9 Previous knowledge and experience with dental trauma Table 2 summarizes the dental trauma training and experience with treating an avulsed tooth. Almost two-thirds (64.7%) of the responders estimated their subjective dental trauma knowledge as low or very low, whereas only 27.1% had undergone official dental trauma training. Dental knowledge was gained mainly through lectures (33.3%), the other sources were pediatric internship, medical school, or literature, articles and me-dia. Out of all the responders, 41.4% were asked to provide first aid in a case of tooth avul-sion during their career. Most of them (73.7%) chose to refer the patient to a dentist. Table 2 Dental trauma training and experience with treating an avulsed tooth % How would you rate your knowledge of dental trauma Very good 18.0 Good 17.3 Low 48.9 Very low 15.8 Dental trauma training Yes 27.1 No 72.9 Place of dental trauma training Medical school 16.7 Pediatric Internship 19.4 Lecture 33.3 Literature 27.8 Other 2.8 Have you come across an accident where a tooth was ‘knocked out’ (Avulsed) Yes 41.4 No 58.6 If yes, what did you do? Treated him myself 3.5 Referred to hospital 22.8 Referred the child immediately to the dentist 73.7 Knowledge about management of avulsed teeth Table 3 summarizes the answers to the questions regarding dental avulsion and its management. Only one third (32.3%) correctly answered that the proper procedure for a permanent avulsed tooth is an immediate replantation. More than half would refer the child to a dental office. The three most common storage medium answers were milk, sa-line, and ice (38.3%, 30.8%, 21.8% respectively). Almost two-thirds (65.4%) correctly an-swered that the proper procedure for an avulsed primary tooth is “not to re-implant the tooth.” Table 3 Knowledge about management of avulsed teeth Question Answers % What is the most appropriate action when a tooth is avulsed? Refer the patient to a dental clinic 51.1 Refer the patient to Emergency Room 15.8 Wash the tooth and Put back the teeth back into the socket 32.3 How would you keep the tooth until you get help? Alcohol 1.5% Saline 30.8% Milk 38.3% Ice 21.8% Dry gauze 1.5% Other 6% Should an avulsed upper primary tooth be replanted? Yes 34.6% If the patient’s parents ask. 0% No 65.4% Only 2.4% answered all of the questions according to the appropriate initial treatment /common protocol (IADT-International Association of Dental Traumatology). Almost half (46%) answered two out of the three questions correctly, 39% answered one question cor-rectly, and 13% answered none of the questions correctly (Fig. 1 ). Table 4 summarizes the relationship between the statistical significant answers to the questions regarding dental avulsion management to different parameters. Statistically significance was found between physicians who answered the first question correctly to ‘Experience level’ (p = 0.016), ‘Years of practice’ (p = 0.025), ‘Dental trauma training’ (p = 0.002), to physicians who had come across avulsion cases in the past (p = 0.049) and with previous dental trauma training (p = 0.031). There was a statistical significance be-tween physicians who answered Question 2 (Storage medium) correctly to ‘Dental trauma training’ (p = 0.031) and with ‘Self-estimated level of knowledge of dental trauma’ (p < 0.0001). No correlation was found with relation to Question 3 (Treating a primary avulsed tooth). Table 4 The relationship between Knowledge about management of avulsed teeth to different parameters Category Correct Answer Wrong Answer P value Question 1 Experience Level Specialist 37 56 0.016 Intern 5 22 General Practitioner 1 12 Years of practice ≤ 10 years 10 39 0.025 > 10 years 33 51 Dental trauma training Yes 19 17 0.002 No 24 73 Physicians who came across an accident where a tooth was ‘knocked out’ (Avulsed) Yes 23 32 0.049 No 20 58 Question 2 Dental trauma training Yes 30 6 0.031 No 62 35 Self-estimated level of knowledge of dental trauma Very good 19 5 < 0.0001 Good 2 21 Low 23 42 Very low 3 18 Discussion Dental avulsion has long-term physical, economic, social, and psychological conse-quences. The prevalence of traumatic dental injuries (TDI’s) is high worldwide. In the lit-erature, a few studies have assessed the incidence of TDI’s occurring from birth to age 14, demonstrating that 30% of the children considered had sustained injuries to the primary dentition and 22% to the permanent dentition. Altogether, every other child had sustained a TDI by the age of 14. [ 14 ] Locally, about one third of the youth population has sustained a dental injury, mostly because of falls (64%), followed by sport activities (23.2%), street-fights (7.2%), and car accidents (5.6%). [ 15 ] Boys are impacted almost twice as often as girls. The peak incidence of dental injuries is at 2–4 and 8–10 years of age. Numerous studies have been conducted to evaluate the knowledge of dental trauma management by dentists, [ 5 , 11 ] health professionals, [ 4 , 8 , 10 , 11 , 13 , 16 ] teachers, [ 17 , 18 ] and lay persons [ 19 , 20 ] in various countries. The main findings show that the majority of the physicians lack the knowledge needed to manage avulsion cases. [ 4 , 8 , 10 , 21 ] The medical team, in general, and of the pediatric physicians, in particular, is chal-lenged with treating all sorts of injuries, including dental injuries. While the majority of TDI’s such as crown fractures can be postponed, the importance of treating an avulsed teeth as soon as possible has a crucial impact on the success of the treatment. [ 13 , 14 ] This study provides a baseline of information about the current level of pediatric physicians knowledge about dental trauma. Like other countries, medical school is sepa-rated from dental school. The knowledge in the field of dentistry for medical students is minimal, and amounts to several hours of teaching. Although 41.4% of the participants had come across avulsion cases, 72.9% of them had no previous knowledge about avulsion management. This result confirmed the find-ings of several previous surveys among medical doctors in Saudi Arabia and Nepal (45.9% and 21.1% respectively). [ 4 , 22 ] The ideal treatment of tooth avulsion, which determines long-term success, is immediate replantation. Almost one third (32.3%) thought it was possible to replant the avulsed tooth, but most of the responders (73.7%) would refer to a dentist and only 3.5% would treat the child themselves. Bahamman's cross-sectional survey of emergency physicians was conducted in emergency rooms at eight hospitals in Jeddah. He found that 79.5% of the physicians thought it was possible to replant the avulsed tooth but only 49.4% would do it themselves. [ 4 ] Our findings were similar to Hashim's result, an email questionnaire that was sent out to physicians working in private practices. He found that none of the responders preferred to put the tooth back. [ 21 ] When dealing with a case of an avulsed permanent tooth, the role of the pediatric physi-cians is divided to two scenarios: Providing instructions over the phone in order to enable the best prognosis. The pa-tient/ parent / adult in charge should be instructed to look for the tooth at the accident site, and to hold it by the crown and to replant it immediately. If the tooth is contaminated, rinse it with cold tap water prior to the replantation. The tooth should be held in place by biting on a handkerchief. The child should see a dentist immediately. If replanting of the tooth cannot be accomplished, The child should see a dentist immediately, and the tooth should be placed in cap of fresh, cold milk, which is the most available liquid. Replanting the tooth in case of dealing with a case of an avulsed tooth in the clinic. The pediatrician should implement the same basic guidelines and refer to the dentist as soon as possible. [ 13 , 14 , 23 ] The most important factor in the success of replantation is the viability of the periodontal ligament. If replantation is not feasible, the avulsed tooth must not be allowed to dry and should be placed in a storage or transport medium as soon as possible until it can be re-planted. An appropriate storage medium ensures the viability of the PDL cells present on the root surface of the avulsed tooth. [ 23 ] Studies have recommended storing the tooth in Hank’s balanced salt solution (HBSS), milk, saliva, or saline. Milk was the most recom-mended storage medium followed by HBSS. [ 23 ] In our study, 38.3% of the responders chose milk as the best medium for storing the tooth followed by saline (30%). This finding is similar to Bahammam's finding where 31.1% of the physicians preferred milk as a storage medium. [ 4 ] In this survey, only 27.1% of the physicians had undergone dental trauma training. The low percentage of training is similar to other worldwide studies. Hashim found that 19.2% of the physicians had dental trauma education. [ 21 ] In Kuwait, 16.7% physicians had received information about tooth avulsion. [ 11 ] This study shows that physicians who had undergone dental trauma training exhibit significantly better results in the avul-sion management questionnaire. This may emphasize the need for formal dental trauma management in medical schools and in the pediatric sociality programs. Holan & Shmueli found that 55% of the physicians in hospital emergency rooms had never received any basic dental trauma education. [ 13 ] Likewise, Lin et al found that only 5.9% of military physicians and emergency medical technicians had received education regarding dental trauma during their military service. [ 12 ] These findings can be attribut-ed to the diversity of physician specialties, while our research focused on pediatric physi-cians. In this study, 65.4% answered that a primary tooth should not be replanted. In other re-search, Dali et al found that 45.6% would consider whether the tooth was primary or permanent. [ 22 ] According to the IADT protocol, it is not recommended to replant avulsed primary teeth. Replantation of a primary tooth may cause gingival abscess or extraction of the replanted tooth due to gingival abscess, root resorption. In addition, it may cause dis-coloration of the permanent incisor and Turner’s hypoplasia of the permanent tooth. [ 24 ] This finding emphasizes the lack of knowledge about primary dental trauma. In the current study, the study population consisted of 133 physicians due to lack of cooperation, but similar to other studies; this was a convenient sample of physicians. Since the number of participants could limit the possibility of generalization to other pop-ulation groups, further research is needed. However, despite the limitations of the present study, the data emphasize a need for further dental health education and training for physicians, especially in the pediatrics field both locally and worldwide. Another recom-mendation would be supplying the physician with pediatric dentist contact information if a dentist is not available, and a flowchart that can help them manage such cases on their own (Fig. 2 ). Furthermore, the International Association of Dental Traumatology (IADT) launched the ToothSOS App. The purpose of the App is to provide information about TDI’s to the general public and dental professionals. [25] Conclusions The study findings showed that majority of respondents did not have the knowledge or skills to manage avulsion cases. Pediatric physicians should get the relevant education to improve their knowledge and ability to deal with the diagnosis and treatment of dental trauma. Declarations Acknowledgment The authors wish to thank Dr. Taylor Johnston-Levy for the assistance in the editing of the manuscript. Ethical Approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Funding This research received no external funding. Availability of data and materials The data that support the findings of this study are available from the authors but restrictions apply to the availability of these data, due to ethical confidentiality. Conflict of interest The authors declare that there is no conflict of interest regarding the publication of this article. Author Contribution Conceptualization, T.R. and A.D.S; methodology, T.R. and A.D.S.; software, T.S.T; validation, N.D., M.D. and E.D.; formal analysis, A.L and T.S.T.; investigation, N.K and J.B.A.; data curation, A.L.; writing—original draft preparation, T.R, A.D.S and N.K.; writing—review and editing, S.B, J.B.A, A.L and T.S.T.; supervision T.R.; project administration, S.B.; All authors have read and agreed to the published version of the manuscript. References Petti S, Glendor U, Andersson L (2018) World traumatic dental injury prevalence and incidence, a meta-analysis-One billion living people have had traumatic dental injuries. Dent Traumatol 34:71–86 de Amorim Lde F, Estrela C, da Costa LR (2011) Effects of traumatic dental injuries to primary teeth on permanent teeth–a clinical follow-up study. 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Dent Traumatol 22:124–126 Holan G, Shmueli Y (2003) Knowledge of physicians in hospital emergency rooms in Israel on their role in cases of avulsion of permanent incisors. Int J Paediatr Dent 13:13–19 Andreasen JO, Andreasen FM, Andersson L (2018) Textbook and color atlas of traumatic dental injuries to the teeth, 5th edn. Wiley-Blackwell, Oxford, pp 486–520 Levin L, Samorodnitzky GR, Schwartz-Arad D, Geiger SB (2007) Dental and oral trauma during childhood and adolescence in Israel: occurrence, causes, and outcomes. Dent Traumatol 23:356–359 Nikolic H, Ivancic Jokic N, Bakarcic D, Hrvatin S, Jakljevic N (2018) Knowledge about emergency procedure in case of dental trauma among paediatricians in Croatia. Eur J Paediatr Dent 19:277–281 Blakytny C, Surbuts C, Thomas A, Hunter ML (2001) Avulsed permanent incisors: knowledge and attitudes of primary school teachers with regard to emergency management. Int J Paediatr Dent 11:327–332 Sae-Lim V, Lim LP (2001) Dental trauma management awareness of Singapore pre-school teachers. Dent Traumatol 17:71–76 Quaranta A, De Giglio O, Trerotoli P et al (2016) Knowledge, attitudes, and behavior concerning dental trauma among parents of children attending primary school. Ann Ig 28:450–459 Sae-Lim V, Chulaluk K, Lim LP (1999) Patient and parental awareness of the importance of immediate management of traumatised teeth. Endod Dent Traumatol 15:37–41 Hashim R (2012) Physicians’ knowledge and experience regarding the management of avulsed teeth in United Arab Emirates. J Int Dent Med Resh 5:91–95 Dali M, Naulakha D, Rajbanshi L (2014) Knowledge, attitude and practice in emergency management of avulsed tooth among medical doctors in Nobel Medical College, Biratnagar, Nepal: A cross sectional survey. Int J Dent Heal Sci 1:3–12 Adnan S, Lone MM, Khan FR, Hussain SM, Nagi SE (2018) Which is the most recommended medium for the storage and transport of avulsed teeth? A systematic review. Dent Traumatol 34:59–70 Zamon EL, Kenny DJ (2001) Replantation of Avulsed Primary Incisors: A Risk–Benefit Assessment. J Can Dent Assoc 67:386 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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. We do this by developing innovative software and high quality services for the global research community. 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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-4298093","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":295207172,"identity":"bf8c41b1-1acb-4095-a190-6c192d635a45","order_by":0,"name":"Andrea Dora Schachter","email":"","orcid":"","institution":"Tel Aviv University","correspondingAuthor":false,"prefix":"","firstName":"Andrea","middleName":"Dora","lastName":"Schachter","suffix":""},{"id":295207173,"identity":"30f8ec23-afcb-45f7-ac7d-c1b92259c74b","order_by":1,"name":"Nata Kaplan","email":"","orcid":"","institution":"Tel Aviv University","correspondingAuthor":false,"prefix":"","firstName":"Nata","middleName":"","lastName":"Kaplan","suffix":""},{"id":295207175,"identity":"451a3e43-168f-4a2e-955f-fbfca644ae8e","order_by":2,"name":"Sigalit Blumer","email":"","orcid":"","institution":"Tel Aviv University","correspondingAuthor":false,"prefix":"","firstName":"Sigalit","middleName":"","lastName":"Blumer","suffix":""},{"id":295207177,"identity":"678b9309-ccb6-482c-93b3-20a58d27fdce","order_by":3,"name":"Gisela Berenstein Ajzman","email":"","orcid":"","institution":"Tel Aviv University","correspondingAuthor":false,"prefix":"","firstName":"Gisela","middleName":"Berenstein","lastName":"Ajzman","suffix":""},{"id":295207179,"identity":"1e2c7209-3131-4f4f-94b3-0fa093df576f","order_by":4,"name":"Tanya Sella Tunis","email":"","orcid":"","institution":"Tel Aviv University","correspondingAuthor":false,"prefix":"","firstName":"Tanya","middleName":"Sella","lastName":"Tunis","suffix":""},{"id":295207181,"identity":"b8c011be-9c19-450c-9678-5e4ba3aeb17f","order_by":5,"name":"Amir Laviv","email":"","orcid":"","institution":"Tel Aviv University","correspondingAuthor":false,"prefix":"","firstName":"Amir","middleName":"","lastName":"Laviv","suffix":""},{"id":295207182,"identity":"31a47634-eaf7-4fae-aa00-1852ddb334ca","order_by":6,"name":"Tal Ratson","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvklEQVRIiWNgGAWjYFAC5gYGHgZmORDzwANiNPAwMIK1GIO1JJCiJbEBxCNKiz37wbYPb3Os0+eHHX4ItMVOTreBkC08ic0z525Lz914O80AqCXZ2OwAQYclNjPzbjucu3F2AkjLgcRtBLXwPwRrSTecnf6BSC0SEFsS5KVziLXlxsNmRqBfDDdI5xQcSDAgwi/s/cmHGd5us5aXn52++cOHCjs5glrgwACs0oBY5SAg30CK6lEwCkbBKBhRAACaBETO5JMDnwAAAABJRU5ErkJggg==","orcid":"","institution":"Tel Aviv University","correspondingAuthor":true,"prefix":"","firstName":"Tal","middleName":"","lastName":"Ratson","suffix":""}],"badges":[],"createdAt":"2024-04-20 15:29:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4298093/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4298093/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55639358,"identity":"21985840-575a-4a1c-b835-d85ddfb2ce17","added_by":"auto","created_at":"2024-04-30 22:09:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":105644,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eNumber of correct answers from the physicians\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4298093/v1/c6280ba27b8c28fca6e9d805.png"},{"id":55639357,"identity":"6291b080-154e-411e-aab2-cbb7dfe8ca7a","added_by":"auto","created_at":"2024-04-30 22:09:34","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":49130,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBasic instructions: ‘What to do if a permanent tooth is knocked out?’\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4298093/v1/9669906b9839c4f2cb8d6ea6.png"},{"id":57552544,"identity":"3b7af766-f77b-49c3-bb07-a1e5c6389e95","added_by":"auto","created_at":"2024-06-01 19:01:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":801252,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4298093/v1/37c9f91b-0a0d-4a55-bd3e-b28b2c136ae0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Experience and Knowledge of Traumatic Dental Injuries among Pediatric Physicians","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe oral region comprises only 1% of the body, but accounts for 5% of all injuries across all age groups. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] Intrusion and avulsion pose the greatest danger to the develop-ment of permanent teeth. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Dental avulsion is defined as the complete displacement of a tooth out of its socket, along with a severed periodontal ligament, with or without fracture of the alveolar bone. Avulsion is the most serious form of dental trauma and also occurs quite frequently, with an incidence of 0.5%-3% of all traumatic injuries to the permanent dentition. The tooth most commonly involved is the maxillary central incisor, [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] which has minimal resistance to frontal impact among children ages 7\u0026ndash;9, due to the periodontal ligament\u0026rsquo;s low resiliency and the surrounding bone\u0026rsquo;s low mineralization. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eSince many incidents occur at home or at school, the participation of parents and schoolteachers in the emergency situation is fundamental to providing proper care for the injured child. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] As the time factor is crucial for optimal healing, acute replantation ap-proach is required. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] The patient should visit a dental emergency service as soon as pos-sible. Reimplantation of the avulsed tooth is considered the best treatment modality be-cause of its biological and psychological advantages. If replantation is not possible, the tooth should be placed, as soon as possible, in a storage or transport medium that is im-mediately available at the emergency site. This should be done quickly to avoid dehydra-tion of the root surface, which starts to happen in a matter of a few minutes. In descending order of preference, milk, HBSS, saliva (after spitting into a glass for instance), or saline are suitable and convenient storage mediums. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eBy contrast, replantation after a prolonged dried extra-alveolar period results in poor prognosis, with possible ankylosis (replacement resorption) development. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Dental avulsion has aesthetic, functional, and psychological consequences, both on the child and the parents. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] Avulsions were found to be the most common type of dental injury rec-orded for children under 15 years of age seeking treatment in hospital emergency rooms. Under these circumstances, it is reasonable to expect health care providers to know how to manage avulsed teeth. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eMany studies conducted in several countries have showed that medical physicians lack adequate knowledge about the emergency management of avulsion. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] In a lo-cal study, only 5.9% of all physicians stated they received education regarding dental trauma and only 4% would provide appropriate initial treatment. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe purpose of this study is to assess the knowledge of first aid dental treatment among pediatric physicians.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eIn the present study, a survey was conducted from January to March 2020. The study was approved by the ethical committee of the Tel Aviv University (IRB), and was targeted at pediatric physicians (i.e. specialist, interns and non-specialists). A questionnaire was sent by email to pediatric physicians on three different occasions, the email address were given to us by the Israel Pediatric Association. In addition, the questionnaire was handed out at a major conference of the Pediatrics association.\u003c/p\u003e \u003cp\u003eThe first part of the questionnaire included demographic details, such as occupation, education, place of work and experience. The second part of the questionnaire includes enquiries about formal dental trauma training and past experience with treating an avulsed tooth. The third part of the questionnaire contains questions regarding dental avulsion and its management was comprised of three close-ended questions modified from previous studies. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS Incorporated, Chicago, Illinois, Version 25.0, USA). The chi-square test was applied in order to investigate the significance of the data on physician knowledge of the correct treatment.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOne hundred thirty-three pediatric physicians completed the questionnaire, ninety out of about 300 physicians responded in the conference and the rest by email. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the main demographic data. Fifty-seven percent of the physicians are wom-en. The mean age of the physicians is 47\u0026thinsp;\u0026plusmn;\u0026thinsp;14.2 years. Seventy percent of the responders are pediatric specialists. More than Eighty-five percent of the responders completed their in-ternship locally. Most of the physicians (53.4%) work at health maintenance organizations (HMOs) and have more than 15 years of experience (54.9%).\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\u003eDemographic data\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eExperience Level (occupation)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecialist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e69.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral practitioner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eLocation of medical school\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLocal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWest Europe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEast Europe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNorth America\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003ePlace of internship\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLocal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWest Europe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEast Europe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNorth America\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003ePlace of work\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHMO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eYears of practice\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePrevious knowledge and experience with dental trauma\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes the dental trauma training and experience with treating an avulsed tooth. Almost two-thirds (64.7%) of the responders estimated their subjective dental trauma knowledge as low or very low, whereas only 27.1% had undergone official dental trauma training. Dental knowledge was gained mainly through lectures (33.3%), the other sources were pediatric internship, medical school, or literature, articles and me-dia. Out of all the responders, 41.4% were asked to provide first aid in a case of tooth avul-sion during their career. Most of them (73.7%) chose to refer the patient to a dentist.\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\u003eDental trauma training and experience with treating an avulsed tooth\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=\"left\" 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\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eHow would you rate your knowledge of dental trauma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery low\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDental trauma training\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003ePlace of dental trauma training\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical school\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=\"c2\"\u003e \u003cp\u003ePediatric Internship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLecture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiterature\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHave you come across an accident where a tooth was \u0026lsquo;knocked out\u0026rsquo; (Avulsed)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eIf yes, what did you do?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTreated him myself\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReferred to hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReferred the child immediately to the dentist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73.7\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=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge about management of avulsed teeth\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e summarizes the answers to the questions regarding dental avulsion and its management. Only one third (32.3%) correctly answered that the proper procedure for a permanent avulsed tooth is an immediate replantation. More than half would refer the child to a dental office. The three most common storage medium answers were milk, sa-line, and ice (38.3%, 30.8%, 21.8% respectively). Almost two-thirds (65.4%) correctly an-swered that the proper procedure for an avulsed primary tooth is \u0026ldquo;not to re-implant the tooth.\u0026rdquo;\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\u003eKnowledge about management of avulsed teeth\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=\"left\" 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\u003eQuestion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnswers\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\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eWhat is the most appropriate action when a tooth is avulsed?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRefer the patient to a dental clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRefer the patient to Emergency Room\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWash the tooth and Put back the teeth back into the socket\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eHow would you keep the tooth until you get help?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSaline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMilk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIce\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDry gauze\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eShould an avulsed upper primary tooth be replanted?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIf the patient\u0026rsquo;s parents ask.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOnly 2.4% answered all of the questions according to the appropriate initial treatment /common protocol (IADT-International Association of Dental Traumatology). Almost half (46%) answered two out of the three questions correctly, 39% answered one question cor-rectly, and 13% answered none of the questions correctly (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e summarizes the relationship between the statistical significant answers to the questions regarding dental avulsion management to different parameters. Statistically significance was found between physicians who answered the first question correctly to \u0026lsquo;Experience level\u0026rsquo; (p\u0026thinsp;=\u0026thinsp;0.016), \u0026lsquo;Years of practice\u0026rsquo; (p\u0026thinsp;=\u0026thinsp;0.025), \u0026lsquo;Dental trauma training\u0026rsquo; (p\u0026thinsp;=\u0026thinsp;0.002), to physicians who had come across avulsion cases in the past (p\u0026thinsp;=\u0026thinsp;0.049) and with previous dental trauma training (p\u0026thinsp;=\u0026thinsp;0.031). There was a statistical significance be-tween physicians who answered Question 2 (Storage medium) correctly to \u0026lsquo;Dental trauma training\u0026rsquo; (p\u0026thinsp;=\u0026thinsp;0.031) and with \u0026lsquo;Self-estimated level of knowledge of dental trauma\u0026rsquo; (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). No correlation was found with relation to Question 3 (Treating a primary avulsed tooth).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe relationship between Knowledge about management of avulsed teeth to different parameters\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" 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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCorrect Answer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWrong Answer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003e\u003cb\u003eQuestion 1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eExperience Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpecialist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGeneral Practitioner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eYears of practice\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDental trauma training\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePhysicians who came across an accident where a tooth was \u0026lsquo;knocked out\u0026rsquo; (Avulsed)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eQuestion 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDental trauma training\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eSelf-estimated level of knowledge of dental trauma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVery good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVery low\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18\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\u003eDental avulsion has long-term physical, economic, social, and psychological conse-quences. The prevalence of traumatic dental injuries (TDI\u0026rsquo;s) is high worldwide. In the lit-erature, a few studies have assessed the incidence of TDI\u0026rsquo;s occurring from birth to age 14, demonstrating that 30% of the children considered had sustained injuries to the primary dentition and 22% to the permanent dentition. Altogether, every other child had sustained a TDI by the age of 14. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Locally, about one third of the youth population has sustained a dental injury, mostly because of falls (64%), followed by sport activities (23.2%), street-fights (7.2%), and car accidents (5.6%). [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] Boys are impacted almost twice as often as girls. The peak incidence of dental injuries is at 2\u0026ndash;4 and 8\u0026ndash;10 years of age.\u003c/p\u003e \u003cp\u003eNumerous studies have been conducted to evaluate the knowledge of dental trauma management by dentists, [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] health professionals, [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] teachers, [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and lay persons [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] in various countries. The main findings show that the majority of the physicians lack the knowledge needed to manage avulsion cases. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe medical team, in general, and of the pediatric physicians, in particular, is chal-lenged with treating all sorts of injuries, including dental injuries. While the majority of TDI\u0026rsquo;s such as crown fractures can be postponed, the importance of treating an avulsed teeth as soon as possible has a crucial impact on the success of the treatment. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThis study provides a baseline of information about the current level of pediatric physicians knowledge about dental trauma. Like other countries, medical school is sepa-rated from dental school. The knowledge in the field of dentistry for medical students is minimal, and amounts to several hours of teaching.\u003c/p\u003e \u003cp\u003eAlthough 41.4% of the participants had come across avulsion cases, 72.9% of them had no previous knowledge about avulsion management. This result confirmed the find-ings of several previous surveys among medical doctors in Saudi Arabia and Nepal (45.9% and 21.1% respectively). [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe ideal treatment of tooth avulsion, which determines long-term success, is immediate replantation. Almost one third (32.3%) thought it was possible to replant the avulsed tooth, but most of the responders (73.7%) would refer to a dentist and only 3.5% would treat the child themselves. Bahamman's cross-sectional survey of emergency physicians was conducted in emergency rooms at eight hospitals in Jeddah. He found that 79.5% of the physicians thought it was possible to replant the avulsed tooth but only 49.4% would do it themselves. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] Our findings were similar to Hashim's result, an email questionnaire that was sent out to physicians working in private practices. He found that none of the responders preferred to put the tooth back. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eWhen dealing with a case of an avulsed permanent tooth, the role of the pediatric physi-cians is divided to two scenarios:\u003c/p\u003e \u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eProviding instructions over the phone in order to enable the best prognosis. The pa-tient/ parent / adult in charge should be instructed to look for the tooth at the accident site, and to hold it by the crown and to replant it immediately. If the tooth is contaminated, rinse it with cold tap water prior to the replantation. The tooth should be held in place by biting on a handkerchief. The child should see a dentist immediately. If replanting of the tooth cannot be accomplished, The child should see a dentist immediately, and the tooth should be placed in cap of fresh, cold milk, which is the most available liquid.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eReplanting the tooth in case of dealing with a case of an avulsed tooth in the clinic. The pediatrician should implement the same basic guidelines and refer to the dentist as soon as possible. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e \u003cp\u003eThe most important factor in the success of replantation is the viability of the periodontal ligament. If replantation is not feasible, the avulsed tooth must not be allowed to dry and should be placed in a storage or transport medium as soon as possible until it can be re-planted. An appropriate storage medium ensures the viability of the PDL cells present on the root surface of the avulsed tooth. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] Studies have recommended storing the tooth in Hank\u0026rsquo;s balanced salt solution (HBSS), milk, saliva, or saline. Milk was the most recom-mended storage medium followed by HBSS. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] In our study, 38.3% of the responders chose milk as the best medium for storing the tooth followed by saline (30%). This finding is similar to Bahammam's finding where 31.1% of the physicians preferred milk as a storage medium. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn this survey, only 27.1% of the physicians had undergone dental trauma training. The low percentage of training is similar to other worldwide studies. Hashim found that 19.2% of the physicians had dental trauma education. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] In Kuwait, 16.7% physicians had received information about tooth avulsion. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] This study shows that physicians who had undergone dental trauma training exhibit significantly better results in the avul-sion management questionnaire. This may emphasize the need for formal dental trauma management in medical schools and in the pediatric sociality programs.\u003c/p\u003e \u003cp\u003eHolan \u0026amp; Shmueli found that 55% of the physicians in hospital emergency rooms had never received any basic dental trauma education. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] Likewise, Lin et al found that only 5.9% of military physicians and emergency medical technicians had received education regarding dental trauma during their military service. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] These findings can be attribut-ed to the diversity of physician specialties, while our research focused on pediatric physi-cians.\u003c/p\u003e \u003cp\u003eIn this study, 65.4% answered that a primary tooth should not be replanted. In other re-search, Dali et al found that 45.6% would consider whether the tooth was primary or permanent. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] According to the IADT protocol, it is not recommended to replant avulsed primary teeth. Replantation of a primary tooth may cause gingival abscess or extraction of the replanted tooth due to gingival abscess, root resorption. In addition, it may cause dis-coloration of the permanent incisor and Turner\u0026rsquo;s hypoplasia of the permanent tooth. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] This finding emphasizes the lack of knowledge about primary dental trauma.\u003c/p\u003e \u003cp\u003eIn the current study, the study population consisted of 133 physicians due to lack of cooperation, but similar to other studies; this was a convenient sample of physicians. Since the number of participants could limit the possibility of generalization to other pop-ulation groups, further research is needed. However, despite the limitations of the present study, the data emphasize a need for further dental health education and training for physicians, especially in the pediatrics field both locally and worldwide. Another recom-mendation would be supplying the physician with pediatric dentist contact information if a dentist is not available, and a flowchart that can help them manage such cases on their own (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Furthermore, the International Association of Dental Traumatology (IADT) launched the ToothSOS App. The purpose of the App is to provide information about TDI\u0026rsquo;s to the general public and dental professionals. [25]\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe study findings showed that majority of respondents did not have the knowledge or skills to manage avulsion cases.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePediatric physicians should get the relevant education to improve their knowledge and ability to deal with the diagnosis and treatment of dental trauma.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to thank Dr. Taylor Johnston-Levy for the assistance in the editing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the authors but restrictions apply to the availability of these data, due to ethical confidentiality.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no conflict of interest regarding the publication of this article.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization, T.R. and A.D.S; methodology, T.R. and A.D.S.; software, T.S.T; validation, N.D., M.D. and E.D.; formal analysis, A.L and T.S.T.; investigation, N.K and J.B.A.; data curation, A.L.; writing\u0026mdash;original draft preparation, T.R, A.D.S and N.K.; writing\u0026mdash;review and editing, S.B, J.B.A, A.L and T.S.T.; supervision T.R.; project administration, S.B.; All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePetti S, Glendor U, Andersson L (2018) World traumatic dental injury prevalence and incidence, a meta-analysis-One billion living people have had traumatic dental injuries. Dent Traumatol 34:71\u0026ndash;86\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Amorim Lde F, Estrela C, da Costa LR (2011) Effects of traumatic dental injuries to primary teeth on permanent teeth\u0026ndash;a clinical follow-up study. Dent Traumatol 27:117\u0026ndash;121\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoo TJ, Gurunathan D, Somasundaram S (2014) Knowledge and attitude of parents with regard to avulsed permanent tooth of their children and their emergency management\u0026ndash;Chennai. J Indian Soc Pedod Prev Dent 32:97\u0026ndash;107\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBahammam LA (2018) Knowledge and attitude of emergency physician about the emergency management of tooth avulsion. BMC Oral Health 18:57\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTraebert J, Traiano ML, Arm\u0026ecirc;nio R, Barbieri DB, de Lacerda JT, Marcenes W (2009) Knowledge of lay people and dentists in emergency management of dental trauma. Dent Traumatol 25:277\u0026ndash;283\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAndreasen JO, Andreasen FM, Skeie A, Hj\u0026oslash;rting-Hansen E, Schwartz O (2002) Effect of treatment delay upon pulp and periodontal healing of traumatic dental injuries -- a review article. Dent Traumatol 18:116\u0026ndash;128\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdnan S, Lone MM, Khan FR, Hussain SM, Nagi SE (2018) Which is the most recommended medium for the storage and transport of avulsed teeth? A systematic review. Dent Traumatol 34:59\u0026ndash;70\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eD\u0026iacute;az J, Bustos L, Herrera S, Sepulveda J (2009) Knowledge of the management of paediatric dental traumas by non-dental professionals in emergency rooms in South Araucan\u0026iacute;a, Temuco, Chile. Dent Traumatol 25:611\u0026ndash;619\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhat M, Li S-H (1990) Consumer product-related tooth injuries treated in hospital emergency rooms: United States, 1979-87. Commun Dent Oral Epidemiol 18:133\u0026ndash;138\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSubhashraj K (2009) Awareness of management of dental trauma among medical professionals in Pondicherry, India. Dent Traumatol 25:92\u0026ndash;94\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbu Dawoud M, Al Enezi B, Andersson L (2007) Knowledge of emergency management of avulsed teeth among young physicians and dentists. Dent Traumatol 23:348\u0026ndash;355\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin S, Levin L, Emodi O, Fuss Z, Peled M (2006) Physician and emergency medical technicians\u0026rsquo; knowledge and experience regarding dental trauma. Dent Traumatol 22:124\u0026ndash;126\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolan G, Shmueli Y (2003) Knowledge of physicians in hospital emergency rooms in Israel on their role in cases of avulsion of permanent incisors. Int J Paediatr Dent 13:13\u0026ndash;19\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAndreasen JO, Andreasen FM, Andersson L (2018) Textbook and color atlas of traumatic dental injuries to the teeth, 5th edn. Wiley-Blackwell, Oxford, pp 486\u0026ndash;520\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLevin L, Samorodnitzky GR, Schwartz-Arad D, Geiger SB (2007) Dental and oral trauma during childhood and adolescence in Israel: occurrence, causes, and outcomes. Dent Traumatol 23:356\u0026ndash;359\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNikolic H, Ivancic Jokic N, Bakarcic D, Hrvatin S, Jakljevic N (2018) Knowledge about emergency procedure in case of dental trauma among paediatricians in Croatia. Eur J Paediatr Dent 19:277\u0026ndash;281\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlakytny C, Surbuts C, Thomas A, Hunter ML (2001) Avulsed permanent incisors: knowledge and attitudes of primary school teachers with regard to emergency management. Int J Paediatr Dent 11:327\u0026ndash;332\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSae-Lim V, Lim LP (2001) Dental trauma management awareness of Singapore pre-school teachers. Dent Traumatol 17:71\u0026ndash;76\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuaranta A, De Giglio O, Trerotoli P et al (2016) Knowledge, attitudes, and behavior concerning dental trauma among parents of children attending primary school. Ann Ig 28:450\u0026ndash;459\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSae-Lim V, Chulaluk K, Lim LP (1999) Patient and parental awareness of the importance of immediate management of traumatised teeth. Endod Dent Traumatol 15:37\u0026ndash;41\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHashim R (2012) Physicians\u0026rsquo; knowledge and experience regarding the management of avulsed teeth in United Arab Emirates. J Int Dent Med Resh 5:91\u0026ndash;95\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDali M, Naulakha D, Rajbanshi L (2014) Knowledge, attitude and practice in emergency management of avulsed tooth among medical doctors in Nobel Medical College, Biratnagar, Nepal: A cross sectional survey. Int J Dent Heal Sci 1:3\u0026ndash;12\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdnan S, Lone MM, Khan FR, Hussain SM, Nagi SE (2018) Which is the most recommended medium for the storage and transport of avulsed teeth? A systematic review. Dent Traumatol 34:59\u0026ndash;70\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZamon EL, Kenny DJ (2001) Replantation of Avulsed Primary Incisors: A Risk\u0026ndash;Benefit Assessment. J Can Dent Assoc 67:386\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Traumatic Dental Injuries, Avulsion, Pediatric Physicians, Knowledge","lastPublishedDoi":"10.21203/rs.3.rs-4298093/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4298093/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003eTo assess the knowledge and attitude of pediatric physicians towards management of permanent and primary avulsed teeth.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e Pediatric physicians filled out a questionnaire. A total of 133 physicians agreed to participate. The questionnaire surveyed the physician's background, knowledge, and approach to managing tooth avulsion.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Only 27.1% of the physicians underwent dental trauma training. Most of the physicians (74%) prefer to refer avulsed tooth cases to a dentist immediately. Only 3% would put the tooth back into the socket. When the participants were asked about storing the avulsed tooth, 38.3% correctly said they would advise keeping the tooth in milk. Most of the physicians (67%) answered that primary teeth should not be replanted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe pediatric physicians’ knowledge about tooth avulsion is fair\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Relevance:\u003c/strong\u003eEducational training programs should be developed and conducted in order to improve awareness of emergency management strategies in such cases.\u003c/p\u003e","manuscriptTitle":"The Experience and Knowledge of Traumatic Dental Injuries among Pediatric Physicians","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-30 22:09:30","doi":"10.21203/rs.3.rs-4298093/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c331129b-a12e-4e6e-a5a7-8b7a2dd6c730","owner":[],"postedDate":"April 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-27T08:23:25+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-30 22:09:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4298093","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4298093","identity":"rs-4298093","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}