= 1. = INTRODUCTION

= <= /p>

= Dental avulsion is a serious traumatic injury characterized by the complete expulsion of the tooth out of the alveolar socket, the tooth’s supportive structure. The hard-dental tissue, especially the cement, the alveolar bone and gums can also be affected, and the blood vessels and nerves torn up and ruptured at the apex, what almost always lea= ds to pulpal necrosis (Banchs & Trope, 2004; Flores et al., 2007; Soares, Go= mes, Zaia, Ferraz, & de Souza-Filho, 2008; Yanpiset & Trope, 2000). According to researches, dental avulsion represents between 1 to 11% of all dental injuries, and the teeth most affected are the upper central incisors (= Trope, 2002; Tzigkounakis, Merglová, Hecová, & Netolický, 2008; Zhang & Go= ng, 2011)(= Tzigkounakis et al., 2008; Zhang & Gong,= 2011) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"76gs4Vbe","properties":{"= formattedCitation":"(Kargul & Welbury, 2009; Trope, 2002)","plainCitation":"(Ka= rgul & Welbury, 2009; Trope, 2002)","noteIndex":0},"citationItems":[{"id&q= uot;:"xjdZYJIE/GiIdYAlW","uris":["http://zotero.or= g/users/4995460/items/4S752A4G"],"uri":["http://zotero.= org/users/4995460/items/4S752A4G"],"itemData":{"id"= ;:696,"type":"article-journal","title":"= Avulsion and replantation","container-title":"Refu'at Ha-Peh Veha-Shinayim (1993)","page":"6-15, 76","volume":"19","issue":"2",= "source":"PubMed","abstract":"The reported incidence of tooth avulsion ranges from 1% to 11% of all traumatic injuries to the permanent dentition. The maxillary central incisor is the m= ost frequently avulsed tooth in the permanent dentition, and the most frequently involved age group is 7-10 years. This article reviews the present day knowledge on avulsion and replantation of permanent teeth. Treatment object= ives are explained, and clinical management outside and inside the dental office= are discussed. Detailed treatment protocols are provided considering the extrao= ral time and the degree of apical closure.","ISSN":"0792-99= 35","note":"PMID: 12055711","journalAbbreviation":"Refuat Hapeh Vehashina= yim (1993)","language":"eng","author":[{&quo= t;family":"Trope","given":"= M."}],"issued":{"date-parts":[["2002"]]}= }},{"id":"xjdZYJIE/YAh5YzmR","uris":["ht= tp://zotero.org/users/4995460/items/KQJRZ7ET"],"uri":["= http://zotero.org/users/4995460/items/KQJRZ7ET"],"itemData":= {"id":702,"type":"article-journal","titl= e":"An audit of the time to initial treatment in avulsion injuries","container-title":"Dental Traumatology: Offic= ial Publication of International Association for Dental Traumatology","page":"123-125","volume":= "25","issue":"1","source":"Pub= Med","abstract":"The prognosis of avulsed teeth depends on prompt and appropriate treatment. Good outcome requires education of the general public and non-dental professionals.\nAIM: Retrospective observational survey of case records of avulsion injuries attending a(= Kargul & Welbury, 2009; Trope, 2002) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"RH2CSLoM","properties":{"= formattedCitation":"(B\\uc0\\u252{}ren, Krastl, K\\uc0\\u252{}hl, & Filippi, 2013)","plainCitation&qu= ot;:"(Büren, Krastl, Kühl, & Filippi, 2013)","noteIndex":0},"cit= ationItems":[{"id":"xjdZYJIE/mi5iXbW0","uris&= quot;:["http://zotero.org/users/4995460/items/Q4N9RTV6"],"ur= i":["http://zotero.org/users/4995460/items/Q4N9RTV6"],"= itemData":{"id":733,"type":"article-journal&q= uot;,"title":"Management of avulsions in Switzerland 2007–2010","container-title":"Dental Traumatology","page":"176-181","volume":= "30","issue":"3","source":"Wil= ey Online Library","abstract":"Introduction More than 50% = of all European children suffer a dental injury (DI), for which the emergency treatment is usually carried out by a general dentist. The aim of this surv= ey was to assess the management of avulsions in Switzerland as the common treatment procedures used by Swiss dentists in such cases. As yet there are= no published data on the treatment of DI in Switzerland. Materials and methods= A 15-item questionnaire was distributed to all members of the Swiss Dental Society containing questions about the dentists' profile, the distribution = of dental injuries they had encountered affecting permanent teeth, especially avulsions, the number of treated avulsions and questions about how the dent= ists had treated an avulsion in the past 3 years. Results The response rate was 41% (n =3D 1350= ). On average, two avulsions per practitioner had been seen in the past 3 years. = The dental practitioners who encountered cases of tooth avulsion treated an ave= rage of 2.8 avulsions in that time frame. Most dentists applied conventional intraoral root canal treatment, which= was performed on average 9 days after replantation. As the intracanal dressing, calcium hydroxide was used by 69.8% and Ledermix® by 49.3%, while Asphaline® was used by only 1.8% (multiple answers were possible). Seventy-eight perce= nt (78.1%) of the respondents had received postgraduate dental trauma educatio= n. Dentists with such an education used Ledermix® significantly more often (P = =3D 0.002), and the time until pulp extirpation was significantly shorter (P &l= t; 0.001). The favorite splint after replantation was the Titanium Trauma Spli= nt®, followed by the wire composite splint and the bracket splint, while the ali= gner was used very rarely. The average splinting time was 11.2 days. Eighty-one percent (81.1%) of the respondents had a tooth rescue box in their office, 41.1% had Emdogain®, 25.9% had tetracycline for local application, and 14.7% had steroids for local application available. Conclusion Although only a few patients with avulsions had presented in Swiss dental offices in the past 3 years, their treatment was closely aligned to current guidelines.",&qu= ot;DOI":"10.1111/edt.12080","ISSN":"1600-9657= ","language":"en","author":[{"famil= y":"Büren","given":"Anja","dropping= -particle":"von"},{"family":"Krastl",&qu= ot;given":"Gabriel"},{"family":"Kühl",&q= uot;given":"Sebastian"},{"family":"Filippi&qu= ot;,"given":"Andreas"}],"issued":{"date-= parts":[["2013"]]}}}],"schema":"https://githu= b.com/citation-style-language/schema/raw/master/csl-citation.json"} (= von Büren, Krastl, Kühl, & Filippi, 2013) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"2gJFZvEi","properties":{"= formattedCitation":"(Sharma & Duggal, 1994)","plainCitation":"(Sharma & Dug= gal, 1994)","noteIndex":0},"citationItems":[{"id&q= uot;:"xjdZYJIE/7RuIU8tx","uris":["http://zotero.or= g/users/4995460/items/GABNZCMC"],"uri":["http://zotero.= org/users/4995460/items/GABNZCMC"],"itemData":{"id"= ;:705,"type":"article-journal","title":"= Replantation in general dental practice","container-title":"British Dental Journal","page":"147-151","volume":"= ;176","issue":"4","source":"PubMed&= quot;,"abstract":"This paper presents a comparison of the outcome of two cases where teeth, avulse= d in sporting accidents, were replanted in general dental practice and have been reviewed for 5 years. Avulsed teeth which were stored dry, had a long extra-alveolar period and were splinted for a longer period of time, ultima= tely underwent replacement root resorption (case 1). There was no evidence of resorption, after 5 years, in the tooth that was stored in the patient's own saliva and was replanted within 45 minutes of being avulsed (case 2). The replantation procedure for these two cases was based on recent literature, which is also reviewed in this paper, and a protocol for the management of avulsed teeth is suggested.","ISSN":"0007-0610","note":&q= uot;PMID: 8123319","journalAbbreviation":"Br Dent J","language":"eng","author":[{"fam= ily":"Sharma","given":"N. K."},{"family":"Duggal","given":"M.= S."}],"issued":{"date-parts":[["1994"]]= }}}],"schema":"https://github.com/citation-style-language/sc= hema/raw/master/csl-citation.json"} (= Sharma & Duggal, 1994). The main cause of dental avulsion is of traumatic origin such as falling off bikes, falling to the ground or stairs, criminal acts, traffic, sports and game accidents (= Tzigkounakis et al., 2008; Zhang & Gong,= 2011) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"li7sifF5","properties":{"= formattedCitation":"(Soares et al., 2008; Traebert, Lacerda, Foster Page, Thomson, & Bortoluzzi, 2012)","plainCitation":"(Soares et al., 2008; Traebert, Lacerda, Foster Page, Thomson, & Bortoluzzi, 2012)","noteInde= x":0},"citationItems":[{"id":"xjdZYJIE/8nM2XQ= M4","uris":["http://zotero.org/users/4995460/items/FTWW= HQU7"],"uri":["http://zotero.org/users/4995460/items/FT= WWHQU7"],"itemData":{"id":689,"type":&qu= ot;article-journal","title":"Relationship between clinical-radiographic evaluation and outcome of teeth replantation","container-title":"Dental Traumatology: Official Publication of International Association for Dental Traumatology","page":"183-188","volume":= "24","issue":"2","source":"Pub= Med","abstract":"The aim of this retrospective study was to evaluate clinical and radiographic results related to avulsed and replanted teeth in patients who sought treat= ment at the Dental Trauma Center of the Dental School of Piracicaba, State University of Campinas, Piracicaba, SP, Brazil. One hundred replanted teeth were studied from 48 individuals (18 females and 30 males, with a mean age = of 15 years and 9 months). Post-replantation factors (clinical and radiographi= c) were observed. The clinical aspects evaluated were crown discoloration, pulp necrosis, mobility changes, presence of fistulae and tooth infra-position. Radiographic examination aimed to identify replacement and inflammatory root resorptions, pulp canal obliteration and the presence of radiolucent areas. Depending on clinical and radiographic findings, results were classified as: complete success, acceptable success, uncertain success or failure. During anamnesis, other factors such as stage of root formation, period extra-alveolar, storage medium, type of splintation, and period after replantation time were recorded. The data obtained were statistically analy= zed in order to determine the relationship between the post-replantation factors and outcome of teeth replantation. Linear logistic regression revealed that= the majority of replanted teeth were associated with root resorptions and its occurrence duplicated proportionally as the time after replantation increas= ed. Based on these findings, replantation procedures must be submitted to an accurate follow-up, as the success of replanted teeth, which already tends = to be limited, may be even more jeopardized if cases are not controlled.","DOI":"10.1111/j.1600-9657.2007.00528.x&qu= ot;,"ISSN":"1600-9657","note":"PMID: 18352921","journalAbbreviation":"Dent Traumatol","language":"eng","author":[{&= quot;family":"Soares","given":"Adriana de Jesus"},{"family":"Gomes","given":"= Brenda Paula Figueiredo de Almeida"},{"family":"Zaia",&qu= ot;given":"Alexandre Augusto"},{"family":"Ferraz","given":&qu= ot;Caio Cezar Randi"},{"family":"Souza-Filho","given":= "Francisco José","non-dropping-particle":"de"}],"issued&= quot;:{"date-parts":[["2008"]]}}},{"id":"= ;xjdZYJIE/FQhSsTuV","uris":["http://zotero.org/users/49= 95460/items/AE9ME79C"],"uri":["http://zotero.org/users/= 4995460/items/AE9ME79C"],"itemData":{"id":707,&quo= t;type":"article-journal","title":"Impact of traumatic dental injuries on the quality of life of schoolchildren","container-title":"Dental Traumatology: Official Publication of International Association for Dental Traumatology&q= uot;,"page":"423-428","volume":"28"= ,"issue":"6","source":"PubMed",&quo= t;abstract":"BACKGROUND: Knowledge of the impact of traumatic dental injuries (TDI) on children's quality of life is sparse.\nAIM: To determine the association between TDI a= nd oral health-related quality of life (OHRQoL) among schoolchildren aged 11-14 years.\nMATERIAL AND METHODS: A cross-sectional study was carri= ed out involving a representative sample of 409 schoolchildren from 13 municipalities in the Midwest Region of the Brazilian Southern State of San= ta Catarina. Clinical examination included the presence and type of TDI and the treatment provided (or needed) according to criteria used in the UK Childre= n's Dental Health Survey. Dental caries in anterior teeth and malocclusion stat= us were also collected according to WHO criteria. OHRQoL= was assessed using the short form of the Child Perceptions Questionnaire (CPQ11-14), and the outcome was the prevalence of one or more adverse impac= ts on quality of life occurring often/very often.\nRESULTS: The prevalence of = TDI was 16.6% (95% CI 13.0-20.2). The prevalence of one or more adverse impacts occurring often/very often was 46.6% (95% CI 41.7-51.5). Logistic regression modeling for the outcome indicated an independent and significant associati= on between the prevalence of one or more adverse impacts occurring often/very often and the presence of TDI even after adjustment for gender, presence of dental caries in anterior teeth and malocclusion. A prevalence ratio of 1.79 (95% CI 1.16-2.76) of one or more adverse impacts occurring often/very ofte= n in schoolchildren with TDI was found, compared to those without TDI.\nCONCLUSI= ONS: Traumatic dental injuries appear to affect schoolchildren's OHRQoL.","DOI":"10.1111/j.1600-9657.2012.01114.x",= "ISSN":"1600-9657","note":"PMID: 22276554","journalAbbreviation":"Dent Traumatol","language":"eng","author":[{&= quot;family":"Traebert","given":"Jefferson&qu= ot;},{"family":"Lacerda","given":"Josima= ri Telino","dropping-particle":"de"},{"family&qu= ot;:"Foster Page","given":"Lyndie A."},{"family":"Thomson","given":"W= illiam M."},{"family":"Bortoluzzi","given":&quo= t;Marcelo Carlos"}],"issued":{"date-parts":[["2012"= ;]]}}}],"schema":"https://github.com/citation-style-language= /schema/raw/master/csl-citation.json"} (= Soares et al., 2008; Traebert, Lacerda, Foster Page, Thomson, & Bortoluzzi, 2012)Although being a situation that has a great emotio= nal impact on the person involved as well as those with them, a reimplantation = that is immediately performed is considered the most important factor in its success, because if it is done after a period greater than 5 minutes, it is considered a late reimplantation, succeeding in preserving only 24% of the periodontal ligament cells. Other variables that influence the prognosis include the degree of root development, the mode of transport and the extra oral period (= Andreasen, Borum, Jacobsen, & Andreasen, 1995) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"6ifpHgQh","properties":{"= formattedCitation":"(Andersson et al., 2012)","plainCitation":"(Andersson et al., 2012)","noteIndex":0},"citationItems":[{"id&q= uot;:"xjdZYJIE/fDsRHqt1","uris":["http://zotero.or= g/users/4995460/items/HAG3BZP7"],"uri":["http://zotero.= org/users/4995460/items/HAG3BZP7"],"itemData":{"id"= ;:688,"type":"article-journal","title":"= Guidelines for the Management of Traumatic Dental Injuries: 2. Avulsion of Permanent T= eeth","container-title":"Dental Traumatology","page":"8","volume":"= 39","issue":"6","source":"Zotero&qu= ot;,"language":"en","author":[{"family&q= uot;:"Andersson","given":"Lars"},{"famil= y":"Andreasen","given":"Jens O"},{"family":"Day","given":"Peter&= quot;},{"family":"Heithersay","given":"G= eoffrey"},{"family":"Trope","given":&quo= t;Martin"},{"family":"DiAngelis","given"= :"Anthony J"},{"family":"Kenny","given":"David J"},{"family":"Sigurdsson","given":"= ;Asgeir"},{"family":"Bourguignon","given"= ;:"Cecilia"},{"family":"Flores","given&q= uot;:"Marie Therese"},{"family":"Hicks","given":&quo= t;Morris Lamar"},{"family":"Lenzi","given":"= Antonio R"},{"family":"Malmgren","given":"B= arbro"},{"family":"Moule","given":"= J"},{"family":"Tsukiboshi","given":"= ;Mitsuhiro"}],"issued":{"date-parts":[["2012&= quot;]]}}}],"schema":"https://github.com/citation-style-lang= uage/schema/raw/master/csl-citation.json"} (= Andersson et al., 2012)For the above-mentioned reasons, it is very import= ant that the health staff such as nurses and medical doctor are prepared to bri= ng the first aids and that the dentist is prepared to treat this trauma. Studi= es regarding the knowledge of the first aid of trauma cases found an appropria= te level of knowledge of tooth avulsion in the population of nurses working at schools in Bialystok, Poland (= Baginska & Wilczynska‐Borawska, 2011) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"7QQoJODV","properties":{"= formattedCitation":"(Subhashraj, 2009)","plainCitation":"(Subhashraj, 2009)","= noteIndex":0},"citationItems":[{"id":"xjdZYJI= E/8aZeznIx","uris":["http://zotero.org/users/4995460/it= ems/765V8IFR"],"uri":["http://zotero.org/users/4995460/= items/765V8IFR"],"itemData":{"id":717,"type&q= uot;:"article-journal","title":"Awareness of management of dental trauma among medical professionals in Pondicherry, India","container-title":"Dental Traumatology: Official Publication of International Association for Dental Traumatology","page":"92-94","volume":&q= uot;25","issue":"1","source":"PubMe= d","abstract":"The aim of the study was to establish the level of knowledge on the management = of dental trauma among physicians at Pondicherry, India. A questionnaire was designed and was given to physicians working in medical colleges or as residents in advanced training programs in medicine in Pondicherry, India. = The questionnaire contained a clinical situation of tooth avulsion and various treatment options. Only 5.5% of the medical professionals knew about reimplantation and none knew that the patients' mouth was the best transport medium. 90% of them accepted that they had no knowledge on dental trauma management. As the physicians get an opportunity to attend a case of dental trauma in emergency or private practice, it is vital that they possess sufficient knowledge on primary management of tooth avulsion, before referr= ing to dentists.","DOI":"10.1111/j.1600-9657.2008.00714.x&q= uot;,"ISSN":"1600-9657","note":"PMID: 19208018","journalAbbreviation":"Dent Traumatol","language":"eng","author":[{&= quot;family":"Subhashraj","given":"Krishnaraj= "}],"issued":{"date-parts":[["2009"]]}}}= ],"schema":"https://github.com/citation-style-language/schem= a/raw/master/csl-citation.json"} (= Subhashraj, 2009)(= Zhao & Gong, 2010). In Norway, all Norwegian dentists study the treatment of dental trauma and the knowledge among dentist is in general go= od with some exceptions, but more information for diagnostic of external root resting is needed (= Skaare & Jacobsen, 2005). In Lithuania, general dentists have insufficient dental traumatology knowledge (= Zaleckienė et al., 2018) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"CwOJei3R","properties":{"= formattedCitation":"(Baginska & Wilczynska\\uc0\\u8208{}Borawska, 2011; de Fran\\uc0\\u231{}a, Traebe= rt, & de Lacerda, 2007; Skaare & Jacobsen, 2005; Zaleckien\\uc0\\u279{}= et al., 2018; Zhao & Gong, 2010)","plainCitation":"(Ba= ginska & Wilczynska‐Borawska, 2011; de França, Traebert, & de Lacerd= a, 2007; Skaare & Jacobsen, 2005; Zaleckienė et al., 2018; Zhao & Gong, 2010)","noteIndex":0},"citationItems":[{"id&q= uot;:"xjdZYJIE/6ADxmZO5","uris":["http://zotero.or= g/users/4995460/items/YECLBC4E"],"uri":["http://zotero.= org/users/4995460/items/YECLBC4E"],"itemData":{"id"= ;:738,"type":"article-journal","title":"= Knowledge of nurses working at schools in Bialystok, Poland, of tooth avulsion and its management","container-title":"Dental Traumatology","page":"314-319","volume":= "28","issue":"4","source":"Wil= ey Online Library","abstract":"– Aim: The purpose of this study was to evaluate the knowledge of first aid in tooth avulsion among nu= rses working at schools in Bialystok, Poland. A part of this population attended= a lecture on the management of dental trauma 2 years before. Methods: The sur= vey was conducted in September 2010 and covered 50 (96.15%) school nurses from Bialystok. Thirty-eight of them attended the dental trauma lecture conducte= d 2 years before the survey. They were asked to fill in an anonymous questionna= ire consisting of 20 cl= osed questions referring to demographic data, previous dental trauma experience,= and training. Seven questions referred directly to the knowledge of management = of dental avulsion and on that basis, the level of nurses’ knowledge was evaluated. The data were analyzed statistically using the Mann–Withney U-te= st with P < 0.05 to find factors influencing the level of knowledge. Result= s: The study showed that nurses’ knowledge about tooth avulsion was at an appropriate level. 86% of the participants chose the correct definition of = the term of replantation, 92% understood that the time is crucial for the resul= t of a replantation, 94% knew that an avulsed tooth should be held by the crown,= and 96% pointed the proper transport medium. A half of the surveyed nurses decl= ared that they would provide tooth replantation and another 16% would consult the procedures by calling a dentist. One statistically significant correlation between the level of knowledge and previous dental trauma training was reve= aled (P < 0.01). Conclusions: The lay knowledge of tooth avulsion in the population of nurses working at schools in Bialystok, Poland, was at an appropriate level. There was a strong correlation between this level and the participation in the lecture on the management of dental trauma conducted 2 years before.","DOI":"10.1111/j.1600-9657.2011.01084.x",= "ISSN":"1600-9657","language":"en",= "author":[{"family":"Baginska","given&qu= ot;:"Joanna"},{"family":"Wilczynska‐Borawska= ","given":"Magdalena"}],"issued":{"= date-parts":[["2011"]]}},"label":"page"}= ,{"id":"xjdZYJIE/mE7feicG","uris":["http= ://zotero.org/users/4995460/items/FXGTDR7Y"],"uri":["ht= tp://zotero.org/users/4995460/items/FXGTDR7Y"],"itemData":{&= quot;id":715,"type":"article-journal","title&= quot;:"Knowledge of emergency management of avulsed teeth: a survey of dentists in Beijing, China","container-title":"Dental Traumatology: Official Publication of International Association for Dental Traumatology",&quo= t;page":"281-284","volume":"26","is= sue":"3","source":"PubMed","abstrac= t":"OBJECTIVES: There is a high frequency of dental trauma cases in China, where tooth avul= sion is one of the most serious scenarios. The knowledge of how to take care of = an avulsion is of great importance to the outcome of such an injury. This knowledge among dentists in Beijing, China has never been tested before. The purpose of this study was to evaluate professional experience and knowledge= of emergency management of dentists working in urban and suburban areas of Beijing, China.\nMATERIAL AND METHODS: A two-part questionnaire was distrib= uted to 175 urban and 99 suburban dentists in Beijing. The first part contained personal and professional information of the participating dentists. The se= cond part evaluated dentists' knowledge about the emergency management of avulsed teeth. Data were entered into a SPSS database and analyzed using the chi-sq= uare test and Fisher's exact test for each question.\nRESULTS: All dentists had a college or above degree. Almost five times as many urban dentists compared = to suburban dentists presented with a Master or PhD degree. The knowledge leve= ls of the participants presenting with correct answer in the respective knowle= dge areas were; storage medium (15.8%) intra-canal medication (45.0%), type of splint (45.1%) and splinting period (10.2%). Significantly more urban denti= sts (50.6%) compared to suburban dentists (34.8%) (P =3D 0.016), used calcium hydroxide paste as an intracanal medicament, and significantly more urban dentists (51.3%) than suburban dentists (34.1%) chosed a flexible splint (P= =3D 0.008).\nCONCLUSION: The results revealed an uneven pattern of knowledge between urban and suburban dentists regarding the emergency management of avulsed teeth. The study highlighted Chinese dentists' need for continuing education in order to improve current knowledge in emergency management of avulsed teeth.","DOI":"10.1111/j.1600-9657.2010.00877.x",&= quot;ISSN":"1600-9657","note":"PMID: 20572844","shortTitle":"Knowledge of emergency manageme= nt of avulsed teeth","journalAbbreviation":"Dent Traumatol","language":"eng","author":[{&= quot;family":"Zhao","given":"Yanxiang"},= {"family":"Gong","given":"Yi"}],&qu= ot;issued":{"date-parts":[["2010"]]}},"label&= quot;:"page"},{"id":"xjdZYJIE/Qvm9e5oX","= ;uris":["http://zotero.org/users/4995460/items/T2YDG6LN"],&q= uot;uri":["http://zotero.org/users/4995460/items/T2YDG6LN"],= "itemData":{"id":736,"type":"article-jou= rnal","title":"Primary tooth injuries in Norwegian children (1–8 years)","container-title":"Dental Traumatology","page":"315-319","volume":= "21","issue":"6","source":"Wil= ey Online Library","abstract":"– This prospective study examined the yearly incidence of traumatic injuries to primary teeth. The a= im of the study was to find out more about dental injuries to primary teeth in Norwegian children. The study was performed in one county of Norway involvi= ng approximately 20 000 children in the age group 1–8 years. Twenty-seven publ= ic dental clinics and 42 dentists participated. The dentists attended informat= ion and calibration meetings and received illustrations of the classification of dental trauma as well as examples of how to fill in the forms correctly. Two hundred and sixty-six children were involved, including 447 primary teeth, recorded during a 1-year registration period (2003). The dental trauma incidence was 1.3% with 3.5-year old being the most accident-prone. Boys we= re significantly more often injured than girls, 164 versus 102 (P < 0.001).= The upper central incisors were most involved (92%), with a non-significant difference between the right and left side. The minor periodontal injuries dominated (59%). Hard tissue injuries were far less frequent (13%). Avulsio= ns were observed in 6.5% and intrusions in 7.5% of the injured children, being 5.5% and 5% of the injured teeth. Most of the injuries occurred either at h= ome (38%) or at kindergarten (32%). Sixty-two percentage were falling accidents often sustained during children's play, and 25% were pure playing accidents. Conclusion: In Norwegian children aged 1–8 years, with a predominance of bo= ys, the most common primary tooth injuries were minor luxations of the maxillary central incisors, sustained at an age of 3.5 years. As the traumas often occurred during children's play and/or were the consequence of falls, these= are difficult to prevent. However, follow ups should be carried out to disclose pulpal or periodontal complications and/or developmental disturbances of the permanent successors.","DOI":"10.1111/j.1600-9657.2005.00362.x&qu= ot;,"ISSN":"1600-9657","language":"en&qu= ot;,"author":[{"family":"Skaare","given&= quot;:"Anne Berit"},{"family":"Jacobsen","given":&qu= ot;Ingeborg"}],"issued":{"date-parts":[["2005= "]]}},"label":"page"},{"id":"xjdZYJ= IE/okFKye5X","uris":["http://zotero.org/users/4995460/i= tems/7T56DSAW"],"uri":["http://zotero.org/users/4995460= /items/7T56DSAW"],"itemData":{"id":740,"type&= quot;:"article-journal","title":"Knowledge about traumatic dental injuries in the permanent dentition: A survey of Lithuanian dentists","container-title":"Dental Traumatology","page":"100-106","volume":= "34","issue":"2","source":"Wil= ey Online Library","abstract":"Background/Aims In Lithuani= a, dental trauma cases are often treated by general dentists, but it is unknown whether their age, self-evaluation of trauma knowledge and practice location can predict their actual knowledge and management of trauma cases. The aim = of this study was to evaluate whether these factors can be used to predict the actual knowledge and management of trauma cases. Methods A 2-part questionn= aire included 17 multiple-choice questions about practitionersʼ demographic= s, their self-evaluated knowledge and how frequently they treated traumatized permanent teeth as well as 13 clinical scenarios reflecting a variety of clinical trauma cases and their complications. A total of 980 randomly sele= cted general dentists, representing 5 Lithuanian counties, participated in the study. Results The response rate was 59.4% (n =3D 582). Overall, 82.3% of g= eneral dentists reported that they treated only a few dental trauma cases and 14.4% chose to refer their patients; 55.1% of dentists considered their dental traumatology knowledge to be sufficient but incomplete and 34.0% self-evalu= ated their knowledge as insufficient. The most knowledge (based on self-evaluati= on) was reported by the younger dentists (≤50 years; P =3D .004). The mean correct knowledge score was 7.6 ± 2.2 of the 13 clinical scenarios. Both bivariate and multivariate analyses showed that greater trauma-related knowledge was associated with a younger age. Better knowledge was observed amongst the dentists who self-evaluated their own knowledge as sufficient o= r as comprehensive. Conclusion Lithuanian general dentists have insufficient den= tal traumatology knowledge. Better knowledge was observed amongst younger denti= sts (≤50 years).","DOI":"10.1111/edt.12388",&quo= t;ISSN":"1600-9657","shortTitle":"Knowledge about traumatic dental injuries in the permanent dentition","language":"en","author":[{&q= uot;family":"Zaleckienė","given":"Vaida&= quot;},{"family":"Pečiulienė","given&quo= t;:"Vytautė"},{"family":"Brukienė",= "given":"Vilma"},{"family":"Jakaitien= 79;","given":"Audronė"},{"family":&= quot;Aleksejūnienė","given":"Jolanta"},{= "family":"Zaleckas","given":"Linas"= }],"issued":{"date-parts":[["2018"]]}},"= label":"page"},{"id":"xjdZYJIE/qsPphLqt"= ,"uris":["http://zotero.org/users/4995460/items/XAHNLLEM&quo= t;],"uri":["http://zotero.org/users/4995460/items/XAHNLLEM&q= uot;],"itemData":{"id":725,"type":"artic= le-journal","title":"Brazilian dentists' knowledge regarding immediate treatment of traumatic dental injuries","container-title":"Dental Traumatology: Offic= ial Publication of International Association for Dental Traumatology","page":"287-290","volume":= "23","issue":"5","source":"Pub= Med","abstract":"The objective of this study was to assess the knowledge of dentists working in = the city of Tubarăo, southern Brazil, about the immediate treatment of traumatic dental injuries. A cross-sectional study was carried out involving all dent= ists who were working in the city in 2004 (n =3D 108). Data were collected throu= gh self-applied questionnaires with questions about sex, time elapsed since graduation, whether the dentists had attended postgraduate courses and also four questions about traumatic dental injuries in which the dentists select= ed the best answer. The response rate was 86.1%. For the two questions related= to dental avulsion, 36.6% and 16.1% of professionals respectively, chose the correct answer according to the literature. For the question related to cor= onal fracture, 75.3% chose the correct answer. For the questions related to an incident without dental avulsion or fracture, 73.1% chose the correct answe= r. Time elapsed since graduation was the only variable statistically associated with the correct answer for the question related to coronal fracture. A significantly greater number of professionals with < or =3D 10 years of = experience chose the correct answer when compared with professionals with >10 years experience (P < 0.001). It can be concluded that the great majority of professionals would not intervene according to the literature in the cases = of avulsion. Less time elapsed since graduation was statistically associated w= ith the correct answer in the coronal fracture case.","DOI":"10.1111/j.1600-9657.2006.00444.x",&q= uot;ISSN":"1600-4469","note":"PMID: 17803485","journalAbbreviation":"Dent Traumatol","language":"eng","author":[{&= quot;family":"França","given":"Rossana India","non-dropping-particle":"de"},{"family= ":"Traebert","given":"Jefferson"},{"= ;family":"Lacerda","given":"Josimari Telino","non-dropping-particle":"de"}],"issue= d":{"date-parts":[["2007"]]}},"label":&q= uot;page"}],"schema":"https://github.com/citation-style= -language/schema/raw/master/csl-citation.json"} (Baginska & Wilczynska‐Borawska, 2011; França, Traebert, & de Lacerda, 2007; Skaare & Jacobsen, 2005; Zaleckienė et al., 2018; Zhao & Gong, 2010). <= /p>

The objective of this study was to examine the knowledge and management of dental avulsion among general and specialist dentists of the city of Cuenca, Ecuador, and to determine if they know the protocols recommended by the IADT for traumatic injury management.

= 2. = METHOD AND MATERIALS=

In October 2012, 183 dentists of the city of Cuenc= a, randomly selected from private dental practices, dental centers and hospita= ls, were subjected to a cross-sectional survey. The participating dentists were visited in their practice. The dentists’ knowledge about dental avulsion was tested by means of a questionnaire (= Zhao & Gong, 2010). The first part of the questionnaire was focused = on collecting general information of the participating dentists such as the le= vel of education, number of years of practical experience, whether they have had training in dental avulsion, and if they know the IADT[1]= protocols regarding dental trauma management. The second part of the questionnaire aimed at evaluating dentists’ knowledge ab= out the emergency management of avulsed teeth. Questions such as: Do you know the IADT guidelines for the management of traumatic injuries? What is dental avulsion? What is the ideal time for reimplantation of an avulsed tooth? How should the tooth be stored= and transported? During the treatment which type of medication should be used? = Is it necessary to splint after implantation? If your answer is affirmative, h= ow would you proceed? Would you reimplant an avulsed permanent tooth, in all cases? Would you reimplant a milk tooth? among other questions. All questions were multiple choice questions with multiple answers.

The survey was taken without giving any previous information to those being surveyed, so that the information obtained would= be as real as possible, as happens in emergency care situations. Once the surv= ey was finished, the envelopes were sealed. The researchers rated the response= s of each of the respondents. The sum of all the hits gave the score. The obtain= ed information was analyzed through descriptive (percentages) and inferential statistics (chi-square test). The data were analyzed using Epi Info 2008.

= 3. = RESULTS=

The first part of the questionnaire revealed that = 36% of the surveyed dentists have between five and ten years of experience, 33% less than 5 years and 26% more than 10 years. Figure 1 depicts the percenta= ge of respondents possessing a graduate degree (51.4%) and their specialty, covering different areas. The majority of the dentists possess a specialized degree in orthodontics (20%) and oral rehabilitation (15%). Regarding the question of having received dental trauma management training, only 42.6% of the surveyed population responded affirmative, and regarding knowledge of I= ADT protocols for trauma management only 19% expressed to be acquainted with th= ese protocols, indicating that familiarity with the IADT protocols is not a gen= eral phenomenon.

The second part of the questionnaire, that focused= on the probing of specific dental avulsion knowledge, 95.6% of the surveyed dentists expressed to know what dental avulsion is, and 52.4% of the respondents correctly indicated the ideal time for reimplantation. When ask= ed about the ideal storage medium 34.9% believe that placing the tooth in the mouth of the patient (saliva) is the best mode of transport, 22.4% think th= at it is saline solution, 19.1% fresh milk and only 18% chose Hank’s Balanced = Salt Solution (HBSS), which is the best option. Previous could be explained by t= he dentists’ lack of knowledge of its existence. 66.6% of those surveyed are c= lear that the objective of dental avulsion is to avoid necrosis of the periodont= al ligament cells. During the root canal treatment, which should be done after= a few days, 68.3% would use a medication with a calcium hydroxide base, while 8.74% consider that any medication = is necessary. With respect to the use of a splint or mouth guard, 97.8% consid= er it necessary to use one, however, 53.5% would choose a rigid splint, which = is not recommended in these cases; only 39.3% would use a flexible splint. The ideal amount of time to use the splint, which is up to two weeks, was chose= n by only 25.6%. We were also able to identify that 34.9% of the respondents correctly consider the dry extra alveolar time as the most important factor= in the treatment and prognosis of dental avulsion, while 24.5% consider it to = be the storage medium. Regarding the reimplantation of the tooth, 61.20% would= not reimplant in any case and 81.4% would not reimplant a temporary tooth.=

= 4. = DISCUSSION

Providing adequate treatment when presented with a case of dental avulsion, taking into account all possible variables, such as the degree of root development, the amount of time that has passed since the avulsion, the storage medium, etc., is a challenge for dentists that in gen= eral do not treat trauma cases often enough to be familiar with the proper procedures. As such, dentists should be knowledgeable of the protocols recommended by the organizations at the forefront of dental trauma manageme= nt on a world scale, one of them being the IADT. In our study, 74.8% of those surveyed are not familiar with the recommended IADT protocols, and only 43%= of those surveyed received some type of information regarding dental trauma management, which concurs with the results obtained by S= ubhashraj (2009)H= olan & Shmueli (2003) stated that less than half of the surveyed popula= tion of dentists said they had received information on dental avulsion treatment= .

Our results show that dentists with less than ten years of professional experience have the best understanding of dental avul= sion management, probably because young professionals have a greater ability to access sources of information. This conclusion coincides with the findings = of V= asconcellos et al. (2009) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"VLKIRced","properties":{"= formattedCitation":"(Krastl, Filippi, & Weiger, 2009)","plainCitation":"(Krastl, Filippi, & Weiger, 2009)","noteIndex":0},"citationItems":[{"id&q= uot;:"xjdZYJIE/3gpuO1XF","uris":["http://zotero.or= g/users/4995460/items/9C3TGQNQ"],"uri":["http://zotero.= org/users/4995460/items/9C3TGQNQ"],"itemData":{"id"= ;:723,"type":"article-journal","title":"= German general dentists' knowledge of dental trauma","container-title":"Dental Traumatology: Official Publication of International Association for Dental Traumatology","page":"88-91","volume":&q= uot;25","issue":"1","source":"PubMe= d","abstract":"The purpose of this study was to evaluate the knowledge of German general denti= sts on different scenarios in dental traumatology, as well as to analyse, wheth= er there was any correlation between practitioners' perceptions of their knowl= edge and their actual expertise. A questionnaire containing questions on demogra= phic data and knowledge was handed out to general dentists at the beginning of different lectures in dental traumatology given by the authors. A total num= ber of 181 questionnaires were evaluated. Sixty-three per cent of the dentists considered their knowledge as being sufficient or comprehensive, while only= 37% indicated to have fragmentary knowledge in dental traumatology. Irrespectiv= e of the self-assessment, 40% of the questions were answered correctly. Although= not statistically significant, there was a trend towards slightly better knowle= dge for dentists whose graduation was more recent. On the basis of the findings= of this study, it can be suggested that the level of knowledge among general dentists in Germany is rather poor on different scenarios regarding dental traumatology and their self-assessment is inaccurate.","DOI":"10.1111/j.1600-9657.2008.00706.x&qu= ot;,"ISSN":"1600-9657","note":"PMID: 19208017","journalAbbreviation":"Dent Traumatol","language":"eng","author":[{&= quot;family":"Krastl","given":"Gabriel"}= ,{"family":"Filippi","given":"Andreas&qu= ot;},{"family":"Weiger","given":"Roland&= quot;}],"issued":{"date-parts":[["2009"]]}}}]= ,"schema":"https://github.com/citation-style-language/schema= /raw/master/csl-citation.json"} K= rastl, Filippi, & Weiger (2009) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"wIFOmruw","properties":{"= formattedCitation":"(de Fran\\uc0\\u231{}a et al., 2007)","plainCitation":"(de = França et al., 2007)","noteIndex":0},"citationItems":[{"id&q= uot;:"xjdZYJIE/qsPphLqt","uris":["http://zotero.or= g/users/4995460/items/XAHNLLEM"],"uri":["http://zotero.= org/users/4995460/items/XAHNLLEM"],"itemData":{"id"= ;:725,"type":"article-journal","title":"= Brazilian dentists' knowledge regarding immediate treatment of traumatic dental injuries","container-title":"Dental Traumatology: Offic= ial Publication of International Association for Dental Traumatology","page":"287-290","volume":= "23","issue":"5","source":"Pub= Med","abstract":"The objective of this study was to assess the knowledge of dentists working in = the city of Tubarăo, southern Brazil, about the immediate treatment of traumatic dental injuries. A cross-sectional study was carried out involving all dent= ists who were working in the city in 2004 (n =3D 108). Data were collected throu= gh self-applied questionnaires with questions about sex, time elapsed since graduation, whether the dentists had attended postgraduate courses and also four questions about traumatic dental injuries in which the dentists select= ed the best answer. The response rate was 86.1%. For the two questions related= to dental avulsion, 36.6% and 16.1% of professionals respectively, chose the correct answer according to the literature. For the question related to cor= onal fracture, 75.3% chose the correct answer. For the questions related to an i= ncident without dental avulsion or fracture, 73.1% chose the correct answer. Time elapsed since graduation was the only variable statistically associated with the correct answer for the question related to coronal fracture. A significantly greater number of professionals with < or =3D 10 years of experience chose the correct answer when compared with professionals with >10 years experience (P < 0.001). It can be concluded that the great majority of professionals would not intervene according to the literature i= n the cases of avulsion. Less time elapsed since graduation was statistically associated with the correct answer in the coronal fracture case.","DOI":"10.1111/j.1600-9657.2006.00444.x",&q= uot;ISSN":"1600-4469","note":"PMID: 17803485","journalAbbreviation":"Dent Traumatol",&= quot;language":"eng","author":[{"family"= :"França","given":"Rossana India","non-dropping-particle":"de"},{"family= ":"Traebert","given":"Jefferson"},{"= ;family":"Lacerda","given":"Josimari Telino","non-dropping-particle":"de"}],"issue= d":{"date-parts":[["2007"]]}}}],"schema"= :"https://github.com/citation-style-language/schema/raw/master/csl-cit= ation.json"} F= rança et al. (2007)34% of those surveyed responded that the ideal transport medium is saliva, results that coincide with those obtained in previous investigations, aside from not being the ideal transport medium. O= nly 18% mentioned Hank’s Balanced Salt Solution as the ideal option, which we assume is due to the lack of knowledge about this substance in our field of dentists. Fortunately, no one of the surveyed population chose placing the tooth in water or paper, a strategy that is absolutely ill-advised. 66.66% = of those surveyed correctly stated that the purpose of the storage medium is to preserve the vitality of the periodontal ligament cells (= Tzigkounakis et al., 2008; Zhao & Gong, = 2010)97.81% of those surveyed accurately said that splinting the reimplanted tooth is necessary, unfortunately, the majority (53.55%) wrongly said that a rigid splint should be used, which coincides w= ith the results published by Z= hao & Gong (2010), but different from the findings of W= estphalen et al. (2007) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"567laeOw","properties":{"= formattedCitation":"(de Vasconcellos et al., 2009)","plainCitation":"(de Vasconcellos et al., 2009)","noteIndex":0},"citationItems":[{"id&q= uot;:"xjdZYJIE/86yCU39o","uris":["http://zotero.or= g/users/4995460/items/F8JF94UQ"],"uri":["http://zotero.= org/users/4995460/items/F8JF94UQ"],"itemData":{"id"= ;:721,"type":"article-journal","title":"= Knowledge of general dentists in the current guidelines for emergency treatment of avulsed teeth and dental trauma prevention","container-title":"Dental Traumatology: Official Publication of International Association for Dental Traumatology","page":"578-583","volume":= "25","issue":"6","source":"Pub= Med","abstract":"A high prevalence of dental trauma exists and its effects on function and esthetics deserve the attention of general dentists. The aim of this study = was to assess the level of general dental practitioners' (GDPs) knowledge about guidelines for dental avulsion and its prevention using a questionnaire. The 21-item questionnaire was distributed among 264 GDPs and the survey was realized between August-November 2006. The data obtained were statistically analyzed using descriptive analysis and Pearson's Chi-square test to determ= ine associations between knowledge regarding emergency treatment and dentists f= rom public or private dental schools and years of experience. The results showed that the participants exhibited appropriate knowledge concerning procedures= in cases of tooth avulsion and its prevention. The number of correct answers w= as low in relation to recommended treatment at the site of injury. Storage med= ium, preparation of the alveolus and splint time for receiving the avulsed tooth received a high number of correct answers. One statistically significant association between years of experience and recommended treatment at the si= te of the injury in the case an avulsed tooth (chi(2) =3D 9.384, P =3D 0.009).= In conclusion, this survey showed appropriate knowledge of dental avulsion management and its prevention among the surveyed dentists. The findings also showed that communication between dentists and the population is deficient, especially concerning practitioners of high risk and contact sports.","DOI":"10.1111/j.1600-9657.2009.00820.x",= "ISSN":"1600-9657","note":"PMID: 19788428","journalAbbreviation":"Dent Traumatol","language":"eng","author":[{&= quot;family":"Vasconcellos","given":"Luis Gustavo Oliveira","non-dropping-particle":"de"},{"fam= ily":"Brentel","given":"Aline Scalone"},{"family":"Vanderlei","given":= "Aleska Dias"},{"family":"Vasconcellos","given":= "Luana Marotta Reis","non-dropping-particle":"de"},{"family&= quot;:"Valera","given":"Márcia Carneiro"},{"family":"Araújo","given":&q= uot;Maria Amélia Máximo","non-dropping-particle":"de"}],"issue= d":{"date-parts":[["2009"]]}}}],"schema"= :"https://github.com/citation-style-language/schema/raw/master/csl-cit= ation.json"} V= asconcellos et al. (2009) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"za4yUxS0","properties":{"= formattedCitation":"(Zhao & Gong, 2010)","plainCitation":"(Zhao & Gong, 2010)","noteIndex":0},"citationItems":[{"id&q= uot;:"xjdZYJIE/mE7feicG","uris":["http://zotero.or= g/users/4995460/items/FXGTDR7Y"],"uri":["http://zotero.= org/users/4995460/items/FXGTDR7Y"],"itemData":{"id"= ;:715,"type":"article-journal","title":"= Knowledge of emergency management of avulsed teeth: a survey of dentists in Beijing, China","container-title":"Dental Traumatology: Official= Publication of International Association for Dental Traumatology","page":"281-284","volume":= "26","issue":"3","source":"Pub= Med","abstract":"OBJECTIVES: There is a high frequency of dental trauma cases in China, where tooth avul= sion is one of the most serious scenarios. The knowledge of how to take care of = an avulsion is of great importance to the outcome of such an injury. This knowledge among dentists in Beijing, China has never been tested before. The purpose of this study was to evaluate professional experience and knowledge= of emergency management of dentists working in urban and suburban areas of Beijing, China.\nMATERIAL AND METHODS: A two-part questionnaire was distrib= uted to 175 urban and 99 suburban dentists in Beijing. The first part contained = personal and professional information of the participating dentists. The second part evaluated dentists' knowledge about the emd teeth. Data were entered into a SPSS database and analyzed using the chi-square test and Fisher's exact test for each question.\nRESULTS: All dentists had a college or above degree. Almost five times as many urban dentists compared to suburban dentists presented with a Master or PhD degree. The knowledge levels of the participants presenting w= ith correct answer in the respective knowledge areas were; storage medium (15.8= %) intra-canal medication (45.0%), type of splint (45.1%) and splinting period (10.2%). Significantly more urban dentists (50.6%) compared to suburban dentists (34.8%) (P =3D 0.016), used calcium hydroxide paste as an intracan= al medicament, and significantly more urban dentists (51.3%) than suburban dentists (34.1%) chosed a flexible splint (P =3D 0.008).\nCONCLUSION: The r= esults revealed an uneven pattern of knowledge between urban and suburban dentists regarding the emergency management of avulsed teeth. The study highlighted Chinese dentists' need for continuing education in order to improve current knowledge in emergency management of avulsed teeth.","DOI":"10.1111/j.1600-9657.2010.00877.x",&= quot;ISSN":"1600-9657","note":"PMID: 20572844","shortTitle":"Knowledge of emergency manageme= nt of avulsed teeth","journalAbbreviation":"Dent Traumatol","language":"eng","author":[{&= quot;family":"Zhao","given":"Yanxiang"},= {"family":"Gong","given":"Yi"}],&qu= ot;issued":{"date-parts":[["2010"]]}}}],"sche= ma":"https://github.com/citation-style-language/schema/raw/master= /csl-citation.json"} Z= hao & Gong (2010) and W= estphalen et al. (2007)When knowledge of trauma was checked against the y= ears in the profession (see Table 1), a chi-sq value of 5.28 and p-value of 0.02 were obtained, a statistically significant value, that is, the fewer the ye= ars of experience, the better the management of trauma. This is contrary to the study of França et = al. (2007) who determined that those with more y= ears of experience have a better understanding of trauma management. 70.6% of general dentists do not have a good understanding of trauma, results that a= gree with the study conducted by K= rastl et al. (2009)c= hi-sq value was 11.71 with a p-value of 0.0006, indic= ating that there is a significant difference, that is to say, those that have a graduate education have a better understanding of trauma management.

From the study it can be concluded that the survey= ed dentists have a poor understanding of dental avulsion management and that t= he majority are not familiar with the recommended IADT protocols, which makes = the inclusion of dental trauma in the academic program of Ecuadoran university’s schools of dentistry of fundamental importance. Knowledge of trauma protoco= ls and its management should be made known to the greatest number possible of dentists and health professionals as well as to those that have constant contact with children, such as teachers, trainers, etc., through conference= s, workshops, short term academic courses, and the communication and dissemina= tion of information.

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Zhao, Y., & Gong, Y. (2010). Knowledge of emergency management of avulsed tee= th: A survey of dentists in Beijing, China. Dental Traumatology: Official Publication of International Association for Dental Traumatology, 26= (3), 281-284. https://doi.org/10.1111/j.1600-9657.2010.00877.x=