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 Table of Contents  
Year : 2019  |  Volume : 16  |  Issue : 2  |  Page : 88-93

Knowledge of Turkish general dentists about traumatic dental injuries

Department of Endodontics, Faculty of Dentistry, Zonguldak Bülent Ecevit University, Zonguldak, Turkey

Date of Submission04-Feb-2019
Date of Acceptance21-Apr-2019
Date of Web Publication23-Sep-2019

Correspondence Address:
Olcay Ozdemir
Department of Endodontics, Faculty of Dentistry, Zonguldak Bülent Ecevit University, Zonguldak
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tdj.tdj_11_19

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The purpose of this study was to evaluate the knowledge of Turkish dentists on different scenarios in dental traumatology.
Materials and methods
A two-part online questionnaire was used to collect data. The first part included questions about practitioners' demographics, their meeting frequency for trauma cases, their self-evaluated knowledge, educational information about dentistry. The second part included multiple-choice for 10 clinical scenarios about a variety of dental trauma cases and their complications.
A total of 472 questionnaires returned. 55.5% of participants were general dentists. Overall, 7.8% reported extensive and comprehensive knowledge about dental trauma, 55.3% considered their dental traumatology knowledge to be sufficient, but incomplete, and 36.9% self-evaluated their knowledge as insufficient. 40.9% of participants refer their patients for diagnosis and treatment mostly to endodontists, pediatric dentists, and oral and maxillofacial surgeons. In questionnaire 2, overall the correct answer average was 5.79 based on 10 clinical scenarios. The average of correct answer in 1–5 years experience group was significantly higher than the groups having experience over 10 years.
Turkish general dentists demonstrated insufficient knowledge regarding the management of traumatized teeth. Informing the students during their undergraduate education and encouraging the clinicians to follow the updates in trauma guidelines may be beneficial for a higher success in trauma cases.

Keywords: dental trauma, knowledge of trauma, trauma guide

How to cite this article:
Sevencan GC, Ozdemir O, Kocak MM, Saglam BC, Kocak S, Bodrumlu E. Knowledge of Turkish general dentists about traumatic dental injuries. Tanta Dent J 2019;16:88-93

How to cite this URL:
Sevencan GC, Ozdemir O, Kocak MM, Saglam BC, Kocak S, Bodrumlu E. Knowledge of Turkish general dentists about traumatic dental injuries. Tanta Dent J [serial online] 2019 [cited 2020 Feb 17];16:88-93. Available from: http://www.tmj.eg.net/text.asp?2019/16/2/88/267561

  Introduction Top

A common serious oral health problem among children and adolescents is traumatic injuries of dentoalveolar tissues. Twenty-five percent of school-age children and 33% of adults have a history of traumatic injury in their permanent teeth, most of them before the age of 19 [1].

Traumatic dental injuries are difficult situation for dental practitioners. Therefore, a correct diagnosis, treatment planning, and follow-ups are crucial for a successful prognosis. Delay in treatment planning often results in a lower success rate for prognosis of the patient's involved tooth/teeth [2]. The prognosis of such treatments was associated with the type and severity of the traumatic injury, the stage of root development, the time which elapsed since the trauma occurred and the dentist's knowledge and experience [3],[4],[5]. The guidelines for treating dental traumatic injuries have changed over recent years due to the developments in dental technology. In addition to these changes, the obtaining knowledge has become more reachable and interactive. A series of guidelines for the management of traumatic dental injuries were published by the International Association for Dental Traumatology (IADT).

Recent studies evaluated the knowledge of various professional groups such as physicians, school teachers, dental students, and dentists regarding the emergency management of traumatic injuries [6],[7],[8],[9],[10]. Most of these studies pointed out the need of a better communication between the dental professionals and individuals with limited knowledge [11],[12]. However, the knowledge levels of dentists and their experiences on traumatic injuries are of top priority. Dental trauma knowledge may be associated with the dentists ages, their practices, locations and their own self-evaluations. It is also important to evaluate the compatibility of clinicians self-evaluation with the actual dental knowledge [3].

The purpose of this study was to evaluate the demographic characteristics and the knowledge of Turkish general dentists on different scenarios in dental traumatology, as well as their treatment choices.

  Materials and Methods Top

The study was approved by the Zonguldak Bülent Ecevit University Clinical Research Ethics Committee (Protocol Number: 359/03.04.2018). Of the 610 questionnaires submitted, a total of 483 dentists replied the survey. The surveys which were not completely answered were excluded. Eventually, a total of 472 dentists participated in the present study. A two-part online questionnaire was used to collect data (https://docs.google.com/forms/). Questionnaire 1 consisted of seven demographic questions, including dentists' frequency of encountering trauma cases, self-evaluation of trauma knowledge, professional experience, education level, and profession [Table 1]. The participants were asked about their age. Participants over 20 years experience and older than 60 years old were not included. In questionnaire 2, there were 10 multiple-choice questions, including various dental trauma case scenarios [Table 2]. The questions were prepared by the authors with references to studies of Zaleckienė et al. [3], Krastl et al. [13], and IADT guidelines [14],[15].
Table 1: Demographic questions responses

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Table 2: The correct answers (in italics) and the percentages of all responses

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The participants reached the survey by clicking on the link via e-mail. The survey was available for about 3 weeks. The identity of the participants remained confidential. In the second part of the questionnaire, 1 point out of 10 was given for each correct answer. Statistical analyzes were performed with SPSS software (SPSS 19.0; IBM Corp., Armonk, New York, USA). Data were analyzed using Kruskal–Wallis, then Dunn test for post hoc. The χ2 test was used to determine the difference between groups for categorical variables. The level of significance was set at P value less than 0.05 [Table 3].
Table 3: The specialties and correct answer averages

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  Results Top

Questionnaire 1

A total of 472 questionnaires was collected. Up to 43% of the participants had professional experience between 1 and 5 years. The percentage of 20 years experience was recorded at 8%. The specialties and institutions of the participants were demonstrated in [Table 3] and [Figure 1].
Figure 1: Institutions of participants.

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55.5% of participants who answered the questionnaire had no additional expertise and 55.3% of them stated that they did not have extensive and comprehensive knowledge about dental trauma. Forty-two percent of the participants reported a very rare encounter with trauma cases and the percentage of 'never' option was recorded at 2%.

Of the 59.1% participants reported that they treat traumatic injuries. Overall, 40.9% of dentists reported that they refer trauma cases to a specialist. 7.8% stated that they have extensive knowledge about dental trauma, whereas 36.9% considered their knowledge to be sufficient but incomplete. Most referred specialties for dental trauma were endodontists, oral, and maxillofacial surgeons, and pediatric dentists.

Questionnaire 2

The average of the correct responses was recorded as 5.79 in 10 clinical scenarios. The correct answers and their percentages for each question were stated in [Table 2]. The relation between demographic information and answers was stated below:

  1. In terms of scores, the difference between dental faculty members (40%) and other institutions was significant (P < 0.05).
  2. The correct answers of practitioners with 1–5 years of experience was found to be significantly higher than 11–20 years and above 20 year groups (P < 0.05).
  3. The correct answers of dentists working at the Faculty of Dentistry were found to be significantly higher than the dentists working at Oral and Dental Health Center, Public Hospital and Private Clinics (P < 0.05).
  4. The highest rate of correct answer was recorded in question 8 about replantation time of an avulsed tooth (88.1%).
  5. The highest rate of wrong answer was recorded in question 7 about lateral luxation injury (81.6%).

  Discussion Top

An urgent and correct diagnosis and an appropriate treatment of the dental trauma are crucial factors for the successful treatment of traumatic injuries. In general, patients may refer to clinics with a delayed time after traumatic injury and dentists may have to make a decision urgently. Therefore, the level of knowledge during decision making in the dental trauma cases directly affects the prognosis. Thus, the present study evaluated the knowledge of Turkish dentists on different scenarios of dental trauma.

The present study consisted of two questionnaires and demographic information of participants was evaluated in questionnaire 1. The knowledge level of dentists who completed their undergraduate education 1–5 years ago, was found to be significantly higher than the clinicians with professional experience over 10 years (P < 0.05). A poor relation was recorded between the age and the knowledge scores. This finding might be related to possible attainability to the current developments and updates in dental education. Additionally, attendance for vocational courses and the access to Dental Trauma Guide on the internet may be more common in younger dentists. This finding also supported the findings of previously published reports evaluating the knowledge in different nations [13],[16].

In a similar study, the younger dentists demonstrated better knowledge of trauma cases [3]. However, the participants were not asked about their postgraduate education, institution, and year of experience which are also crucial for trauma knowledge and treatment. In the present questionnaire, the participants were expected to define the year of their clinical experience, institutions, and postgraduate education. The highest correct answer averages were recorded for participants working at universities, especially for the pediatric dentists and endodontists, who might be more frequently encountered with trauma cases. The lowest correct answer average was observed in the general dentists who did not experience any additional specialist training. The fact that the incidence of low frequency of encounter dental trauma cases among general dentists may explain this situation. The results of the present study supported the findings of Hu et al. [17], who reported that the dental trauma knowledge of endodontists were higher than the general dentists in Brazil.

Less knowledge of trauma may be explained by less interest of clinicians about this subject as a result of the low incidence of experiencing trauma cases in their daily practice. Similar results were also reported in a dental trauma survey among German general dentists [13].

When the average of the correct answers was evaluated, a correct answer average of 5.79 was given for 10 questions. A recently published survey, including 12 questions about dental trauma, evaluating the Brazilian dentists' dental trauma knowledge, reported a correct answer average of 5.87 [18]. In the questionnaire, the correct answer of a radiological periapical lesion after the luxation trauma was the microbial colonization of the root canal system. For question 7 in the second part of the survey, participants incorrectly with a ratio above 80%. This assumption may delay the endodontic treatment. In connection with this situation, the risk of external resorption arises as a result of luxation trauma increases. A high percentage of the Turkish dentists marked sterile necrosis as the main reason for apical periodontitis after a lateral luxation, similar to Lithuanian dentists. This incorrect knowledge was also found in the results of Krastl et al. [13], where more than half of the dentists considered sterile necrosis to be the primary cause of apical periodontitis.

The highest rates of incorrect answers were recorded in question 3 and question 7. We asked about the diagnosis of defined subluxation trauma and the treatment method. In this case, IADT states that no treatment is required and follow-up is required [14],[15]. Participants have marked the wrong option as 'Radiologically, there is usually an interval in the periodontal area.' This situation may be related to the difficulty to diagnose subluxation cases due to their clinical appearance. Turkish dentists owned insufficient knowledge with observance to the management of subluxation and the diagnosis of dental trauma-related complications.

The question about the time to have a critical prescription for the prognosis of an avulsion tooth demonstrated the highest correct response rate. In addition, the best storage media for an avulsed tooth demonstrated a high percentage of correct answers (76.7%). These findings were also similar to Brazilian dentist's survey [18]. This result reveals that participants have acceptable information about avulsion cases. Thus, the percentage of correct answers for avulsion cases, which have complicated treatment process and a high probability of poor prognosis, was found promising. On average, in the present study, endodontists and pediatric dentists answered more questions correctly similar to Brazilian dentists' survey [18]. The results of the present study demonstrated a correct answer average of 7.12 over 10 questions for Turkish Endodontists, which was also comparable to the Brazilian Endodontists whom demonstrated an average of 6.58. For both surveys, this finding could be associated with more experience in clinical practice and further information about the subject during their postgraduate education.

Studies evaluating a selected population may have several limitations. It should be noted that the English language skills of participants may limit their access to Dental Trauma Guide website. A possible elimination of this situation may be the translation of the guideline into different languages [18]. Additionally, variations such as; different curriculum of dental faculties, facilities of the institution which the participants employed, and government policies may be limitations of the present study.

  Conclusion Top

In conclusion, Turkish dentists demonstrated comparable results in knowledge of dental trauma. Pediatric dentists and endodontists who frequently examine trauma cases demonstrated sufficient knowledge score. Informing the students during their undergraduate education and encouraging the clinicians to follow the updates in trauma guidelines may be beneficial for a higher success in trauma cases during the clinical practice. The correct diagnosis and treatment of traumatized tooth may provide benefits for preventive dentistry by eliminating further interventional treatment procedures.

  Acknowledgements Top

The authors thank the voluntary and anonymous participation of the dentists.

Gulcin C. Sevencan, Olcay Ozdemir, Mustafa M. Kocak, Baran C. Saglam, Sibel Kocak, Emre Bodrumlu: concept and design of study.

Gulcin C. Sevencan, Olcay Ozdemir: survey of literature.

Gulcin C. Sevencan, Olcay Ozdemir, Mustafa M. Kocak, Baran C. Saglam, Sibel Kocak, Emre Bodrumlu: preparation of questionnaire.

Baran C. Saglam, Sibel Kocak: acquisition of data or analysis and interpretation of data.

Mustafa M. Kocak, Emre Bodrumlu: final approval of the version to be published.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Glendor U. Epidemiology of traumatic dental injuries – a 12 year review of the literature. Dent Traumatol 2008; 24:603–611.  Back to cited text no. 1
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Zaleckienė V, Pečiulienė V, Brukienė V, Jakaitienė A, Aleksejūnienė J, Zaleckas L. Knowledge about traumatic dental injuries in the permanent dentition: a survey of Lithuanian dentists. Dent Traumatol 2018; 34:100–106.  Back to cited text no. 3
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  [Figure 1]

  [Table 1], [Table 2], [Table 3]


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