Correspondence Address:
Vishal Khandelwal
Department of Pedodontics and Preventive Dentistry, Modern Dental College and Research Centre, Gandhi Nagar, Airport Road, Indore, Madhya Pradesh - 453 112
India

Full Text

Sir,

Dental trauma is a common problem among children and adolescents throughout the world. [1] Among the different types of dental trauma, avulsion results in the greatest functional and aesthetic impairment due to its worse prognosis. [2] The prognosis of an avulsed tooth depends upon prompt care. Parents and school teachers often have the first opportunity to attend to a child with a tooth avulsion injury and the medical practitioners are frequently the first to actually provide primary treatment.

A study to evaluate the level of awareness and knowledge of regarding tooth avulsion among the primary contact doctors was conducted. A questionnaire was designed and was given to physicians, paediatricians and paediatric surgeons working in Indore. 32% of the practitioners had come across children with tooth avulsion. 52% of the practitioners wanted to seek a dentist's opinion immediately. 41% of the practitioners would advise to keep the tooth in normal saline, only 1.8% of them would advise to carry the tooth in the child's mouth and milk. 91% did not know the balanced solution as a transport medium. 90% of them accepted that they had no knowledge on dental trauma management. Only 16% of the practitioners received a professional advice earlier on the protocol about management of avulsed tooth. 93% of the practitioners were enthusiastic in attending an educational programme on the management of dental trauma.

With the advances in restorative dentistry and bonding techniques, re-attachment of the fractured crown portion should always be considered today. [1] The ideal transport media is patient's mouth (saliva), [3] though saline and milk are good medium of transport. The significance of the media is to preserve the vitality of the periodontal ligament. Furthermore, the economic value of retaining the tooth as a prosthetic replacement can prove to be considerable over the child's life time.

The primary contact doctors tend to look at the tooth avulsion more like a general trauma where they focus on the wound, bleeding and bony injury. As the pediatricians get an opportunity to attend a case of dental trauma in emergency, it is imperative that they hold sufficient knowledge on primary management of tooth avulsion, before referring to dentists. Collaborative actions between dental and medical professionals are needed in order to develop continued education programs. All members of the medical staff need to receive simple instructions about the management of dental trauma. The existing health education system should provide more courses on dental and dento-facial trauma management for physicians and medical residents. Just like the flow charts for the management of myocardial infarction, poisoning, animal bites etc., these guidelines should also be made as flow charts or posters and put up in all emergency departments. This would be very informative for the physicians and medical trainees in the emergency department to provide appropriate primary care to the child with dental trauma.

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