Objective: The objective of the present study was to assess the perception and practice of Saudi towards accidental dental trauma and Avulsed Tooth.

Methodology: In this is a cross sectional study, collected data obtained from 350 Saudi volunteers living in three cities of the Kingdom of Saudi Arabia (KSA) including; Hail (Northern KSA), Jeddah (Western KSA) and Riyadh (Capital KSA).

Results: Of the 350 participants, 150/350(43%) were males and 200/350(57%) were females. Of the respondents 36.4% were have experienced dental trauma of whom 40/148(27%) were males and the remaining 84/197(42.6%) were females.

Conclusion: This study proves an insufficient knowledge regarding dental trauma management amongst general Saudi population. There is an urgent need to expand the knowledge of general Saudi population in this context using a variety of educational methods.

Keywords: Dental trauma; Avulsed tooth; Saudi Arabia

Accidental traumatic damages to the teeth and their supporting tissues are frequent seen particularly among children. These dental injuries as well as, tooth avulsion lead to major functional and esthetic troubles for patients and parents of children [1]. The common tooth injuries among children happen between the ages 8 and 11 years; falling accidents are more frequent in school environment which is the main cause of dental trauma [2]. Epidemiological studies indicated that about 11.6% to 33.0% of all boys and about 3.6% to 19.3% of all girls experience dental trauma of varying severity earlier than the age of 12 years [3,4]. Numerous studies have been published throughout the earlier decades showing a lack of care of traumatic dental injuries as well as dentists and lay people having inadequate knowledge on how to manage traumatic dental injuries. These circumstances could extremely upset the outcome of traumatic dental injuries, particularly complicated traumatic dental injuries [5]. Therefore, education of caregivers and lay people is a playing field where much remains to be targeted. Avulsion which is displacement of a tooth from its socket in alveolar bone represents the most harmful form of dental trauma. Several studies have evaluated the knowledge of avulsed teeth in children among parents, school teachers, and general dentists, and have accentuated the need of education to avoid and increase the prognosis of avulsed teeth [6,7]. The management of the avulsion of deciduous and permanent teeth in children is well defined in the guidelines of the International Association of Dental Traumatology [8]. The prevalence of dental trauma in 354 Saudi boys aged 5-6 years was 33%. The most frequent form of dental trauma was fracture of enamel (71%) followed by loss of tooth due to trauma (13%), fracture into enamel and dentine (7%), discoloration (5%), pulp involvement (4%). However, the prevalence rates of dental trauma in 5-6- and 12-14-year-old boys are greater than those reported in studies from United Kingdom Children's Dental Health Survey of the same age groups [9]. Such high percentages of dental trauma in KSA require high levels of knowledge and better practice, therefore, the aims of the present study was to assess the Perception and Practice of Saudi towards accidental dental trauma and Avulsed Tooth.

In this is a cross sectional study, collected data obtained from 350 Saudi volunteers living in three cities of the Kingdom of Saudi Arabia (KSA) including; Hail (Northern KSA), Jeddah (Western KSA) and Riyadh (Capital KSA). Purposeful questionnaire was designed and used for collection of the required data. The following information were obtained from each participant: age, sex, level of education, did your child ever experienced dental trauma?, what would you do if the tooth was in child's mouth, however, out of place?, did you seek professional treatment, when did you visit the dentist for the treatment after the trauma, what would you do with tooth that is knocked of the socked?, how did you carry the tooth.

 Statistical Package for Social Sciences (version 16) was used for analysis and to perform Pearson Chi-square test for statistical significance (P value). The 95% confidence level and confidence intervals were used. P value less than 0.05 was considered statistically significant.

Ethical consent

Each participant was asked to sign a written ethical consent during the questionnaire’s interview. The informed ethical consent form was designed and approved by the ethical committee of the College of Medicine (University of Hail, KSA) Research Board.

In this study a total of 350 individuals were assessed in regard to their knowledge and practice towards dental trauma. Of the 350 participants, 150/350 (43%) were males and 200/350 (57%) were females giving males’ females’ ratio of 1.00: 1.33 and their ages ranging from 16 to 62 years. The great majority of the participants were in age range 21-25 years representing 115/350 (33%), followed by age ranges 26-30, both 31-35 & 41+, 15-20 and 36-40 constituting 75/350 (22%), 46/350 (13%), 39/350 (11%) and 29/350(8%), respectively. The distribution of males and females was relatively similar with exception of age group 21-25 years, the number of females was 78/115 (68%) compared to 37/115 (32%) of the males, as indicated in Table1 & Figure 1, On asking the participants whether their children have experienced dental trauma, 124/341 (36.4%) answered yes of whom 40/148 (27%) were males and the remaining 84/197 (42.6%) were females. When asking them what will do if the tooth is displaced?, 159/343 (46.4%) of the respondents will discard it completely, 106/343 (30%) will Put it back in the aveolus and 78/343 (22.6%) will remove it from child’s mouth. In regard to the sex the practice was relatively similar with exception of “Put it back in the aveolus”, 40% of females agreed compared to 22.6% of males (Figure 2). On asking them whether they seek out professional treatment when they experienced dental trauma; 219/334 (65.6%) of the respondents seek out professional treatment of whom 98/142(69%) were males and 121/193 (62.7%) were females, as indicated in (Table 2,3 ) & (Figure 2). Summarizes the distribution of the study population by gradual response to the dental trauma. On asking them when will you visit the dentist after trauma; 238/346 (68.8%) of the respondents indicated immediate response, 55/346 (16%) after some time and 53/346 (15%) next day. In regard to the proportions were relatively similar in respect to the number in each group, as shown in Figure 3. On asking them what will they do with the tooth that is knocked out of the socket; 196/346 (56.6%) will Knocked it out of the socket and 149/346 (43%) will save it. The males and females proportions is shown in Figure 3. On asking them how will you carry the tooth; 123/341 (36%), 83/341 (24.3%), 69/341 (20%) and 66/341 (19.4%) will carry it in cloth, water, milk and other materials, respectively. The males and females proportions are shown in Figure 3 in respect to the number in each group. In regard to the relationship between age and immediate response to the dental trauma, of the 124 individuals who experienced dental trauma, 13, 35, 19, 22, 15, and 20 were experienced among age groups, 15-20, 21-25, 26-30, 31-35, 36-40 and 41+, in this order as indicated in Table 4. The responses to the questions; what will you do if the tooth is displaced and did you seek professional treatment were also summarized in Table 4. However, the percentage of the responses for these questions greatly vary when calculating the percentage within the entire age group, as shown in Figure 4. Table 5 summarizes the distribution of the study population by gradual response to the dental trauma and age. When asking them “when will you visit the dentist after trauma”, the highest number for immediate visit to dentist after trauma was among age range 21-25 years, followed by 26-30 and 31-35, constituting 75, 53, and 35, respectively. For after some time, the highest number was among age range 21-25 years, followed by 41+ and 26-30, constituting 23, 7, and 6, respectively. For the next day, the highest number was among age range 21-25 years, followed by 26-30 and 15-20, constituting 16, 15, and 10, respectively. When asking them “What will you do with the tooth that is knocked out of the socket”, the highest number was among age range 21-25 years, followed by 26-30 and 31-35, constituting 53, 27, and 17, respectively. When asking them “How did you carry the tooth”, the highest number for those who place it in water was among age range 21-25 years, followed by 26-30 constituting 23, 22, respectively. For milk, the highest number was among age range 21-25 years, followed by 31-35, constituting 29 and 15, respectively. For cloth, the highest number was among age range 21-25 years, followed by 26-30, constituting 39 and 35, respectively. Table 6 summarizes the distribution of the study population by response to the dental trauma and education. It is observed that in this Table, the majority of positive responses for all variables were among individuals with university level of education followed by secondary school.

Figure1: Study population by demographical characteristics.

Figure 2: Description of the study population by immediate response to the dental trauma.

Figure 3: Description of the study population by gradual response to the dental trauma.

Figure 4: Description of the study population by immediate response to the dental trauma and age.

The incidence and causes of dental trauma differs in different parts of the world. Falling down is the most frequent cause of mouth injuries particularly among younger age groups. The immediate action of response to dental trauma depends widely on an individual knowledge and consequent response. Since there is no established awareness and educational programs towards dental trauma and avulsed teeth in Saudi Arabia, the aim of the present study was to assess the existing knowledge and practice of Saudi towards accidental dental trauma and Avulsed Tooth. In the present study, 36.4% of the participants have experienced dental trauma (for themselves or their children) of whom 27% were males and 42.6% were females. However, relatively similar findings were previously reported. In a study assessed through a questionnaire the knowledge level of primary school teachers regarding dental trauma, they reported that 31.8% of the participants had faced a dental trauma in a child [10]. Another study reported that 42.8% of the school teachers had seen conditions where a child’s tooth was avulsed [11]. Nevertheless, there a lack of literature regarding the incidence of dental trauma and the most available studies were restricted to children, which isn’t the situation in the current study. In a study included 354 boys aged 5-6 years and 862 boys aged 12-14 years, joining 40 schools in Riyadh, the prevalence of dental trauma in 354 Saudi boys aged 5-6 years was 33% [12]. The prevalence reported in the present study was higher than several reports around the world [13]. The proportions of the males to females in the present study might be affected by the sample collection and response to the questionnaire. Otherwise similar studies among adults reported varying proportions of prevalence rates for men and women [14,15]. An appropriate immediate management is highly important to the success and best outcome of dental trauma. Suitable management in case of dental trauma can be achieved through knowledge of treatment guidelines [16]. In regard to the knowledge and practice about the immediate action that might be undertaken after having dental trauma, "when asking them what will do if the tooth is displaced?", 46.4% of the respondents will discard it completely, 30% will Put it back in the aveolus and 22.6% will remove it from child’s mouth. This finding indicates a low level of knowledge and misleading practice toward immediate management of dental trauma. Such insufficient knowledge and expected deceptive practice were previously reported from Saudi Arabia [17]. In a study to evaluate the knowledge level of a group of Saudi primary school teachers in the management of dental trauma, only 44.8% thought dental trauma emergency should be dealt with immediately [18]. On asking them whether they seek out professional treatment when they experienced dental trauma, 65.6% were positively responded. On asking them when you will visit the dentist after trauma; 68.8% of the respondents indicated immediate response, 16% after some time and 15% next day. All these parameters indicating the low levels of awareness and ignorance of information extracted from the treatment guidelines. In regard to the age most of the previous studies particularly from Saudi Arabia were restricting to younger age groups, hence the present study was a community base. However, there was no significant difference in relation to the association between age and level of knowledge or mean of practice. Consequently this may have two effects, the first one, such elder individuals might be more frequent exposed to traumatic accidents which may elevate the percentage of experienced dental trauma, and secondly, better level of knowledge acquired from the accumulated experiences was expected. In regard to the education, the great majority of the participants in the present study were with university level and this fact affect the generation of relatively specific findings. It was found that educational qualifications and preceding advice or education about tooth avulsion were positively correlated with the level of knowledge about tooth avulsion and its management [19]. However, a number of studies have been published during the recent years showing insufficiency of care of traumatic dental injuries which might be due to insufficient knowledge on how to manage dental trauma on community base. Since the great majority of these conditions happen way from professional personnel, more work should be done toward educating general population to reduce the burden of bad prognosis after dental trauma and achieve better complimentary outcomes. Many avulsed permanent teeth in school children can be kept back by replantation if school teachers know how to do that. Presentations followed by discussion can be an effective way to increase the knowledge level of teachers and other community members to deliver suitable dental first-aid measures [20]. The limitations of the present study include its cross-sectional settings, involving open age limits and the dependence on the questionnaire to generate certain clinical outcomes.

The conclusion derived from this study is that attention must be given to dental trauma care. This study proves an insufficient knowledge regarding dental trauma management amongst general Saudi population. There is an urgent need to expand the knowledge of general Saudi population in this context using a variety of educational methods.