The status of knowledge, attitude and practice towards emergency management of avulsed tooth among dental students. a single center cross-sectional study

Objective: To evaluate the awareness of emergency trauma management and the potential role of dentists in handling tooth avulsion injuries. Method: The cross-sectional study was conducted at the Dental outpatients department of Jinnah Medical and Dental College, Karachi, from December 2020 to March 2021, and comprised dentists and final year dental students of either gender. Data was collected using a 17-item questionnaire to assess the awareness level regarding the knowledge of traumatic dental emergencies and the role of a dentist in handling a traumatic tooth injury. Data was analysed using SPSS 20. Result: Of the 170 subjects, 52(30.5%) were males and 118(69.4%) were females. Overall, 139(81.8%) subjects had prior knowledge regarding avulsion, 164(96.5 %) were aware of the term avulsed tooth, 106(62.4%) considered milk to be the best transport media for an avulsed tooth, 159(93.5%) knew the significance of extra-oral time, and all 170(100%) subjects said they wanted to study more about dental traumatic injuries. Conclusion: There was adequate knowledge about the term avulsion, transport media and extra-oral time, and there was evidence of interest about learning more among the subjects. Key Words: Avulsion, Emergency handling, Dental trauma, TDIs, Traumatic dental injuries, Knowledge, Appropriate management, Expert.

Clinical Management of Trauma to Primary Teeth and Delay in Eruption of Permanent Successor Tooth

Dental trauma is considered a complication in oral health, which has attracted the attention of researchers, as its prevalence has increased in recent years. Dental trauma in primary dentition can lead to early tooth loss and impairment of permanent successor teeth, depending on the stage of development of the tooth germ. The aim of the present study was to describe a clinical case of a 4-year-old child who was referred to a pediatric dentist after dental trauma and early loss of deciduous teeth. During the anamnesis, it was observed that the upper deciduous teeth (#51 and #61) were affected by successive traumas, resulting in the early loss of the affected teeth. Nance arch device with a tube-bar system was selected to restore function and aesthetics to the child, while the eruption of the successor permanent teeth was monitored. During the follow-up period, a delay in the eruption of #21 tooth was observed, and ulectomy of the region was indicated to allow the tooth eruption and the proper alignment of the central incisors, which occurred after 5 months of the surgical procedure. Through this report it was possible to conclude that the early diagnosis and the long-term periodic control of traumatic dental lesions in the primary dentition are of fundamental importance to prevent and minimize the damages that can occur to the permanent dentition. Keywords: Tooth Avulsion. Tooth, Deciduous. Dentition, Permanent. ResumoO traumatismo dentário é considerado uma complicação à saúde bucal que vem chamando a atenção de pesquisadores, pois sua prevalência tem aumentado nos últimos anos. O trauma dentário na dentição decídua pode ocasionar a perda precoce dos dentes, e comprometimento dos dentes sucessores permanentes, dependendo do estágio de desenvolvimento do germe dentário. O objetivo do presente estudo foi descrever um caso clínico de uma criança de 4 anos de idade que foi encaminhada ao odontopediatra após traumatismo dentário e perda precoce de dente decíduo. Durante a anamnese, foi observado que os dentes decíduos incisivos superiores (#51 e #61) foram afetados por sucessivos traumas, resultando na perda precoce dos dentes afetados. O dispositivo arco de Nance com sistema do tipo tubo-barra foi selecionado para devolver função e estética à criança, enquanto a irrupção dos dentes permanentes sucessores foi acompanhada. Durante consulta de controle, um atraso na erupção do dente #21 foi observado e a ulectomia da região foi indicada para permitir a irrupção do dente e o alinhamento adequado dos incisivos centrais, que ocorreu após 5 meses do procedimento cirúrgico. Por meio do presente relato foi possível concluir que o diagnóstico precoce e o controle periódico a longo prazo das lesões dentárias traumáticas na dentição decídua são de fundamental importância para prevenir e minimizar os prejuízos que podem ocorrer à dentição permanente. Palavras-chave: Avulsão Dentária. Dente Decíduo. Dentição Permanente.

Mediators involved in tooth resorption following delayed replantation: an experimental study

Inflammatory and replacement tooth resorption are common outcomes following tooth replantation, biological mediators involved in these processes are widely unknown. The aim study was to investigate molecules involved in tooth resorption following permanent tooth avulsion and delayed replantation. Dog premolars were extracted and kept dry for 20, 60 and 90 minutes (n= 30). The teeth were replanted, splinted. After 120 days, the animals were euthanized and tissues were removed for histological processing. Slides were stained for microscopic analysis, submitted to tartrate resistant acid phosphatase (TRAP) histoenzymology and immunostained for RANK, RANKL, OPG, alkaline phosphatase and periostin. Data obtained were submitted to statistical analysis using the chi-square, Fisher and one-way ANOVA tests (alpha= 0.05). In inflammatory resorption areas, TRAP + and RANK + osteoclasts surrounding the replanted teeth were identified, regardless of the extra-alveolar time. RANKL synthesis in this region was higher in longer extra-alveolar times and was more intense after keeping the tooth dry for 90 minutes compared to other periods. In the replacement reabsorption area, there was lower synthesis of periostin and higher alkaline phosphatase production. Inflammatory resorption was characterized by osteoclast recruitment and RANKL synthesis and replacement resorption was characterized by inhibition of periostin and alkaline phosphatase syntheses.

Causes of primary tooth avulsion and replantation treatment

During primary dentition, the etiology changes by age group. For instance, traumas secondary to collisions and falls are attributable to early movement within the first six years, while accidents secondary to frequent playing are the main reason within the following nine years, and violence is the most common etiology until the age of 25 years old. Previous studies have estimated that traumas from falls, sporting activities, bicycling, traffic accidents, and violence were the most common causes of dental injuries in children. Iatrogenic causes also contribute to 0.04-12% of dental injuries, including avulsions. According to the current evidence, whether to use reimplantation or not is still controversial and further investigations are needed. Among the various case reports, damage to the permanent successors, root resorption, clot formation, and pulp necrosis were documented as potential complications and adverse events with intended reimplantation. However, many techniques were reported to overcome these problems. Besides, favorable outcomes following reimplantation could be hypothetically obtained as sound articulation, proper mastication, and proper dentition. Therefore, this encourages reimplantation, however, further evidence is still needed to validate the proposed advantages and disadvantages of the approach.

Implications of the use of Strontium Ranelate (SRAN) in periodontics, dental implantology, oral surgery, orthodontics and endodontics and its possibility of application as storage media for avulsed teeth

Dental avulsion is still public health problem and tooth replantation has important unsuccess rates due to root resorption. Strontium ranelate (SRAN) presents antiresorptive property on the bone tissue and stimulates bone formation. So we aimed to comprehensively review the literature to 1- understand the mechanism of action of SRAN regarding to its propaedeutic in periodontics, dental implantology, oral surgery, orthodontics and endodontics, 2- present the current scientific knowledge about the SRAN efficiency on tooth avulsion; 3- observe fails and gaps in the literature and open up for unexplored ideas for SRAN uses and applications. An electronic search was performed crossing the key words ‘strontium ranelate’, ‘periodontics’, ‘dental implantology’, ‘oral surgery’, ‘orthodontics’ and ‘endodontics’, PubMed/Medline, Lilacs and BBO electronic databases were searched for research articles, reviews of literature, animal laboratory studies and laboratory studies, which had been published in English until July 2020. Twenty-five articles fulfilled the inclusion and exclusion criteria. The available literature demonstrates that SRAN provides a really better propaedeutic on the bone tissue and that the topical applications show a lower risk of side effects. That open up new perspectives and for the use of SRAN as a potential storage media for avulsed teeth.

Evaluation of Placentrex as a novel storage medium for avulsions: an invitro study

ABSTRACT Tooth avulsion is one of the common traumatic injury results in complete extrarticulation of tooth from its socket since resulting in damage to the periodontal tissues. Maintaining viability of the periodontal cells remains a challenge to the clinician to reimplant the avulsed tooth. Since various avulsion media are used in dentistry a novel medium Placentrex derived from 0.1 gm. of fresh term, sterilized, infection-free human placenta which has unique pharmacological effects like enhancement of wound-healing, anti-inflammatory, antioxidant and analgesic effect is compared with HBSS and Propolis media in freshly extracted, non carious, non restored, periodontal diseases free human teeth which are indicated for orthodontic treatment purposes were used. The extracted teeth were placed in the enzyme solution to facilitate detachment of the cells and after ten minutes teeth were removed and 1 ml of solution were collected through micropipette and centrifuged. The stained cells were counted in Neubauer’s chamber under a light microscope at 10× magnification. Conclusion: Placentrex maintained PDL cell viability almost similar to Propolis and significantly better than HBSS. KEY WORDS : Avulsions, Avulsion media, HBSS, Reimplantation,

Construction and validation of a podcast for dental surgeons: timely conduction after tooth avulsion

Objective: Create and validate a podcast for dental surgeons as a guide after a dental avulsion. The validation was done through Google forms. Nine expert judges participated, following four aspects: characterization of the judges, content, functionality and appearance. The quantitative analysis was performed with Excel software to calculate the content validity index. Method: Methodological study with a quantitative and validation approach, carried out in three stages: integrative review of the literature; technology construction; validation of a post-avulsion podcast presented to nine expert judges. A Likert scale was used for data collection. For the analysis, a content validity index ≥ 0.75 was adopted. Results: The Content Validity Index presented values ​​of 0.84% ​​in its structure and presentation, 099% of high relevance for expert judges. Conclusion: The “Al Dente” podcast contains important information on dental reimplantation after an avulsion, resulting in preventive measures that directly influence health services.

Dental avulsion management by emergency professionals and efficacy of education

This intervention study evaluated knowledge of first responders regarding the emergency clinical protocol in cases of dental avulsions and impact of an informative campaign. A questionnaire was applied to evaluate effect of provided information on knowledge among emergency service professionals regarding the management of avulsion of teeth: before campaign (T0) and after campaign (T1). Participants were invited to attend the dental trauma awareness campaign that was carried out by the researchers. The campaign addressed main doubts and difficulties regarding emergency dental trauma care. Data were statistically analyzed (p <0.05). There was significant increasing in the knowledge of professionals regarding the possibility (from 74% to 88%) and ability (5% to 32%) of first responders perform tooth replantation; about the ideal time to perform the replantation (from 30% to 59%); about the correct handling (from 52% to 85%) and the need for cleaning (from 60% to 79%) of an avulsed tooth for replantation. It can be concluded there is a lack of knowledge of emergency service professionals about tooth avulsion management. The strong message is the importance not only of identifying the lack of knowledge of the professionals about tooth injuries, but also perform the education that can significantly improve the professional knowledge.