E-scooter-related dental injuries: a two-year retrospective review

Introduction In June 2020, the United Kingdom (UK) published guidance on electric scooter (e-scooter) use to ease transport congestion and reduce pollution. This study aims to examine dental injuries sustained during the two years following initiation of the trial.Methods The research was conducted at a UK, Level 1, supra-regional major trauma centre. All eligible patient records were analysed to identify e-scooter-related dental injuries to the following regions: teeth, periodontium, alveolus, palate, tongue, floor of mouth, frenum, buccal mucosa and lips. To assess significant associations between recorded variables, a Pearson's chi-square test was utilised.Results Of the 32 patients who experienced a total of 71 dental injuries, 46.5% (n = 33) affected teeth, predominantly upper central incisors (n = 17). 'Lacerations' (n = 32) and 'lips' (n = 30) were the most common type and site of soft tissue injuries, respectively. Unprovoked falls by riders accounted for 53.1% (n = 17) of the injuries. There was an overall increase in e-scooter-related dental injuries throughout the two-year period.Conclusion E-scooters have introduced an additional source of dental trauma. It is imperative health care professionals can also identify signs of head and non-dental injuries when managing such patients. Further studies are warranted allowing for better informed and optimised dental public health interventions.

Evaluation of the knowledge level of pediatricians on dental trauma and their awareness of the ToothSOS mobile application: A cross sectional study

BACKGROUND/AIM

Pediatricians play an essential role in managing pediatric oral emergencies; hence, they should have accurate information on dental injuries. This study aimed to assess the knowledge level of pediatricians regarding traumatic dental injuries (TDI) and their awareness of the ToothSOS mobile application.

MATERIALS AND METHODS

A survey comprising 10 questions was created on Google forms, and the links were sent to the participants via electronic mail and a mobile application. The demographic characteristics and the knowledge level of pediatricians about TDI and their awareness of the ToothSOS mobile application were evaluated. The questions were prepared by following similar studies and the current guidelines of the International Association of Dental Traumatology.

RESULTS

A total of 229 pediatricians (74.2% female) participated in this study. The correct answer rates revealed statistical differences in terms of profession and experience on the following issues: the most frequently traumatized tooth, the preference of the antibiotic agent, and the management of avulsed primary tooth (p < .05). The decision to consult a dentist revealed statistical differences in the profession (p = .001). The correct answers on the correlation between the age group and dental trauma accompanied by soft tissue injuries showed statistical differences in experience (p = .005). Although none of the participants knew the ToothSOS application, 91.7% of them preferred using this tool in future practices. This rate was statistically higher in participants with an experience of more than 10 years (p = .013).

CONCLUSIONS

The knowledge level of pediatricians regarding dental trauma was found to be sufficient, except for the questions on avulsion injuries. However, the fact that the participants were unaware of the ToothSOS mobile application was the most considerable result of the study, and this finding highlighted the importance of informing pediatricians dealing with oral injuries regarding the latest updates on dental traumatology.

Perceptions of general practitioners towards managing dental presentations in Australia: a qualitative study

Background Patients presenting with dental pain are common in general practice, despite dental infections being most appropriately managed with dental treatment to address the cause of the infection. Although antibiotics are not appropriate for the management of localised toothache without signs of systemic spread, general practitioners (GPs) often prescribe antibiotics and analgesics for the management of dental pain. The aim of this study was to explore GPs' perceptions and management of dental presentations in Australia. Methods Twelve semi-structured interviews were conducted with GPs across Victoria, Australia, between October 2022 and January 2023. Data were thematically analysed. Results The study found that dental pain was the most common presenting complaint for patients attending general practice with a dental problem. Five major themes were identified in this study: knowledge, beliefs about capabilities, emotion, environmental context and resources, and social influences/social professional role and identity. In terms of knowledge and capabilities, GPs would advise patients to seek dental care, as they are aware that antibiotics would not resolve the underlying issue. Challenges for GPs included limited training in oral and dental treatment, as well as emotions, such as patient anxiety and phobia resulting in patients seeking dental care through a GP rather than a dentist. Barriers due to the context, such as access to dental care, long waiting lists within the public dental system and cost, were some of the reasons patients present to general practice rather than a seeing a dentist. Furthermore, issues that influenced GPs' antibiotic prescribing included patients' expectations for antibiotics to treat their dental pain, as well as dentists advising their patients to attend their GP for antibiotics prior to dental treatment. Conclusions This study identified factors that influenced GPs' management of patients with dental conditions. To address these issues, it is imperative to develop interventions addressing patients' knowledge around oral health, as well as providing improved access to dental care for these patients.

What is important to medical students' online learning of dental trauma in medical education

Traumatic dental injury (TDI), a topic not normally offered in the medical curriculum is made available through the medical school as an online learning course. Online learning provides an educational pathway for cross-disciplinary learning without any change to the existing curriculum. This research identified important key features that should be included in the design of an online course to provide a positive online learning experience for medical students. Ten important features were identified for medical educators to consider when they develop an online course to introduce dental trauma. These features are (1) prioritising information to TDI, (2) providing specific facts and information to TDI, (3) information must be easily retrieved, (4) providing career-related information, (5) promoting self-confidence, (6) promoting learning of new knowledge, (7) easy-to-understand content materials, (8) establishing a logical sequence of learning, (9) visual illustrations to complement written text and (10) promoting self-directed learning.

Perceptions of emergency department physicians regarding the management of traumatic dental injuries

BACKGROUND/AIM

The purpose of this study was to investigate the self-reported confidence level and education of Atlantic Canada emergency department physicians in the management of traumatic dental injuries and to assess the need for further education surrounding the management of dental trauma.

MATERIAL AND METHODS

An 18-item survey was developed and distributed electronically to physicians by their respective provincial medical associations.

RESULTS

Traumatic dental injuries were reported in the emergency department on a weekly basis (78%). Most respondents reported that they were somewhat confident (51%) or very confident (7%) in managing traumatic dental injuries. Physicians' years in practice correlated positively with self-reported confidence levels in managing dental trauma. Urban and rural emergency department physicians reported similar levels of access to general dentists (38% and 30%, respectively); however, urban emergency department physicians reported greater access to pediatric dental specialists (43%) and oral and maxillofacial surgeons (81%) than rural practicing colleagues (4% and 30%, respectively). Most emergency department physicians (85%) agreed that it was important to receive training on the management of traumatic dental injuries and reported that education on managing traumatic dental injuries during residency (37%) and access to a dental trauma decision-making pathway (30%) would be of most value.

CONCLUSIONS

This study highlights the role of emergency department physicians as first responders and demonstrates opportunities for improvement in the initial management of traumatic dental injuries. These implications can be achieved through the incorporation of further training in emergency medicine residency programs and through the implementation of decision-making pathways in emergency departments.

Management of traumatic dental injuries: a survey of paediatric emergency department health professionals

OBJECTIVE

To assess paediatric emergency department (PED) health professionals' confidence, experience and awareness in managing traumatic dental injuries (TDIs).

DESIGN

A cross-sectional online survey.

SETTING

PED at Alder Hey Children's Hospital and Birmingham Children's Hospital.

RESULTS

94 ED health professionals responded. One-third of responders (n=26) encounter children with dental trauma daily or weekly. TDI teaching during undergraduate training was received by 13% (n=12) of responders, and 32% (n=30) had never received training. Responders thought they would benefit from online resources and regular teaching on paediatric TDIs, in addition to an easy-to-use decision-making tool to signpost families.ED health professionals' confidence in giving advice to families following a TDI, and in recognising types of TDIs, was notably low; -79 and -76 Net Promotor Score, respectively.Responders' awareness of how to recognise and manage TDIs was varied. Majority were aware of the need to attempt to reimplant an avulsed permanent tooth, and the need to refer a child presenting with a complex permanent tooth injury to the oncall dentist. However, very few responders commented on the importance of follow-up. Responders also raised concerns about the lack of dental services to treat TDIs in children.

CONCLUSIONS

There is a need to enhance dental trauma teaching for all ED health professionals who encounter TDIs to increase their confidence and enable them to triage and advise patients appropriately. Additionally, increased signposting for families to the appropriate service could in turn improve outcomes and experience for children who experience a TDI.

The use of antibiotics in acute oral health patients presenting at public dental clinics in the Western Sydney region

BACKGROUND

There is a limited need for antibiotics when treating oral health problems, yet they are often prescribed, increasing risk of antimicrobial resistance (AMR). With AMR a threat to public health, the objectives of this study were to assess the frequency, suitability, and factors associated with antibiotic prescriptions for acute dental problems across Greater Western Sydney public dental clinics.

METHODS

Patients' reason for attending, details of any antibiotics use, and the treating dental practitioner's clinical examination and diagnosis were compared to current prescribing guidelines, and logistic regression was used to identify predictors of antibiotic prescription.

RESULTS

In all, 1,071 patients participated in the study, and 15.9% reported to using antibiotics for their dental problem. Over three-quarters obtained the antibiotics from their general medical practitioner (GMP). A high prevalence of antibiotics were not indicated for the patient's complaint (71.8%) including for those with a history of extraction, pain, or intraoral swelling, who had significantly higher odds of antibiotic prescription (OR > 9). The antibiotic type prescribed was generally suitable.

CONCLUSIONS

In summary, the data suggest that the majority of antibiotics were inappropriately prescribed for the patient's dental complaints and there is a need for interventions to improve compliance with antibiotic prescribing guidelines.

Impact of Pediatric Dental Resident Availability in the Pediatric Emergency Department

OBJECTIVE

The purpose of this study is to describe the impact of Delaware's first pediatric dental residency program on treatment of patients presenting to the pediatric emergency department (PED).

METHODS

Charts were reviewed for patients presenting to the PED with a dental chief complaint over a 9-month period with a comparison period. Chief complaint, diagnosis, treatment interventions, disposition, and demographic information were included. χ 2 , Fisher exact, and Student t tests with a P value less than 0.05 were regarded as significant.

RESULTS

A total of 432 patients met inclusion criteria; 197 before dental residency commencement and 235 after residency commencement. Dental consultation significantly increased (56% vs 7%, P < 0.01) between the study periods. There were no statistically significant differences in sex, race, insurance type, admissions, or proportion of presentations of trauma or infection between the study periods. Dental residents provided in-person evaluation for 40% of patients. The proportion of patients receiving dental intervention increased significantly postresidency period (57% vs 47%, P = 0.04). Pediatric emergency department extractions and splints both occurred in a significantly larger portion of patients after the start of the residency program (17% vs 1% and 5% vs 0%, P < 0.01). A higher proportion of patients with dental complaints received procedural sedation in the PED after residency (13% vs 2%, P < 0.01).

CONCLUSIONS

Pediatric dental resident availability in the PED significantly increased dental consultation and intervention. A significantly higher percentage of PED patients received definitive treatment at point of service without requiring referral to another facility.

Knowledge and Attitudes of Saudi Medical Students about Emergency Management of Traumatic Dental Injuries

Several studies indicate that physicians lack emergency management knowledge concerning traumatic dental injuries (TDIs), emphasizing the fact that medical students are not taught about this topic. This study aimed to assess the basic knowledge and attitudes of medical students in Saudi Arabia about emergency TDI management. This cross-sectional study recruited a convenience sample of medical students in their clinical years through social networking sites and asked them to answer a pretested internationally accepted questionnaire that included demographic questions, two case scenarios about crown fractures and avulsion of permanent teeth, and self-assessment questions. The data were analyzed statistically using descriptive statistics and the chi-squared test (p < 0.05). A total of 761 medical students responded. Only 5.8% of the students reported receiving information about TDIs in their curriculum. Medical students, mainly those ready to graduate, were more knowledgeable of the emergency management of a crown fractured permanent tooth than an avulsed permanent tooth (p < 0.0001). However, more than half of the students were unable to differentiate between a primary versus permanent fractured tooth and would manage an avulsed primary or permanent tooth similarly. Regarding students' attitudes, less than one-quarter of the students (13.5%) were confident about diagnosing TDIs and/or providing emergency management when required (18.1%). Furthermore, only about one-tenth of the students (9.3%) were satisfied with their self-perceived knowledge, and most (71%) reported needing further education about the topic. Medical students in Saudi Arabia have insufficient knowledge about the emergency management of TDIs. Gaps in students' knowledge of emergency management of avulsion injury were identified in addition to their low confidence level to either diagnose or immediately treat TDIs if required. Students felt dissatisfied with their current knowledge level, this being most prominent among graduating students. There is a need to elaborate the undergraduate medical curriculum in Saudi Arabia to include emergency management of TDIs.

Traumatic and non-traumatic dental presentations to the paediatric emergency departments of two UK children's hospitals: A multi-centre evaluation

BACKGROUND

Dental attendances to paediatric emergency departments (PEDs) represent suboptimal use of resources of an unknown scale.

AIM

To evaluate dental attendances at two PEDs in the UK and compare traumatic dental injury (TDI) and non-traumatic dental conditions (NTDCs).

DESIGN

Retrospective data were collected for a 12-month period including demographics, attendance pattern, assessment, and management. Maxillofacial conditions were excluded, and attendances were grouped as TDI and NTDC.

RESULTS

Of 667 attendances, 35.1% (n = 234) were TDI and 64.9% (n = 433) NTDC. Nineteen children reattended. Proportionately, more TDI attenders were male, White British, of lower mean age, and resided in less deprived areas than NTDCs. Over half (52.3%, n = 339) of attendees resided in the 10% most deprived UK areas. Saturday and Monday were modal attendance days; attendance peaked in summer. Over half (56.4%, n = 376) attended out of hours. A majority (74.8%, n = 499) self-referred and half accessed no other service prior to PED attendance. No PED dental input was received for 38.7% (n = 258), and dental treatment was received for 12.4% (n = 83). Antibiotics were provided for 42.1% (n = 281), and 15.4% (n = 103) were admitted.

CONCLUSION

Dental abscesses and toothache accounted for half of attendances, many of these children may be managed in primary care. Improved signposting to alternative dental services for non-urgent conditions may better allocate resources to those with urgent need.

Pediatricians' Knowledge of Emergency Management of Dental Injuries and Use of Mouthguards: A Cross-Sectional Survey

AIM

Dental injuries are one of the most frequent oral health problems in children and adolescents. This study aimed to evaluate Croatian pediatricians' knowledge and practice regarding dental injuries management and the use of mouthguards as means of protection against traumatic injuries.

MATERIALS AND METHODS

A questionnaire-based cross-sectional survey conducted among 186 pediatricians examined their demographic characteristics, knowledge and experience with dental injuries. Student t-test or one-way ANOVA, with Tukey's post-hoc were used to analyze obtained data (p ≤ 0.05).

RESULTS

The overall mean score of knowledge on the management of dental injuries was 3.6 ± 1.53 points. Male pediatricians (p = 0.016), those who witnessed dental injuries (p = 0.003), and those who had more than ten years of pediatric practice (p = 0.027) showed better knowledge. The results of multiple linear regression analysis demonstrated impact between pediatricians' knowledge in the emergency treatment of traumatic dental injuries concerning the level of health care (practice settings) (β = -0.254, p = 0.002) and the number of patients treated by a pediatrician per day (β = -0.187, p = 0.030).

CONCLUSION

Pediatricians have a low level of knowledge regarding the primary care of traumatic dental injuries. An additional course on dental injurie management should be recommended as part of the physician and pediatricians' educational training.

Knowledge and skills of emergency physicians in managing traumatic dental injuries

PURPOSE

Emergency departments are frequently confronted with traumatic dental injuries (TDIs). The prognosis of the injured tooth is related to early dental trauma management. For this reason, physicians must be familiar with the appropriate management of TDI. This study aimed to investigate the knowledge and skills of German emergency physicians regarding TDI.

METHODS

An electronic questionnaire was sent to 438 emergency departments throughout Germany. Four hundred and twenty seven questionnaires were evaluated and included in the analysis. The survey contained questions about physician characteristics and assessed their knowledge and skills of managing dental trauma. For statistical analysis, the Kruskal-Wallis, Mann-Whitney U test or ANOVA test was used as appropriate. Rank correlations were performed with the Spearman's rank correlation.

RESULTS

Out of 427 participants, 256 (59.95%) stated they had no or insufficient knowledge, and 266 (71.12%) stated they had no skills in dental trauma management. Almost 76% of the participants had no previous knowledge of dentistry. Only 7.28% knew the right procedure for replanting an avulsed tooth. Just 26.06% would choose the right medium for temporary tooth storage. Having a dentist in the family (p = 0.0074) or clinical exposure to patients with dental trauma (p = 0.0384) influenced the results of the knowledge score.

CONCLUSION

The knowledge and skills in dental trauma management among German emergency physicians are generally inadequate. Targeted training courses are necessary to ensure early and adequate TDI treatment to reduce the resulting medical and societal costs as much as possible.

Knowledge and attitudes of emergency medicine physicians and nurses regarding emergency management of dentofacial trauma in pediatric patients

OBJECTIVES

Considering that the first visit for dentofacial trauma is generally in emergency departments, the awareness and knowledge of the emergency medicine staff regarding the treatment of dentofacial injuries is very important for the prognosis. The aim of this study was to investigate the knowledge, education, and self-confidence levels of emergency medicine physicians and nurses concerning the diagnosis and treatment of dentofacial traumatic injuries in pediatric patients.

METHODS

This questionnaire-based, cross-sectional study included emergency medicine physicians and emergency medicine nurses. The survey contained questions and three sections on participants' general data, attitudes, basic knowledge, and confidence levels in managing dentofacial trauma.

RESULTS

A total of 407 participants (250 emergency medicine physicians and 157 emergency medicine nurses) were included in this study. There was a significant difference between the groups regarding the correct answers to the questions about trauma management and emergency management of crown fractures and avulsed permanent teeth (p <0.05).

CONCLUSION

Our findings show that there is a lack of information on dentofacial trauma for emergency medicine physicians and nurses. In order to increase knowledge in this area and to improve the diagnosis and management of dentofacial trauma, interdisciplinary seminars, case discussions, and continuing education programs should be held for emergency medicine staff.

Developing a prototype dental trauma e-learning course for medical education

This article aims to demonstrate how an expert feedback process was used to identify emerging issues within a prototype extracurricular course on dental trauma and show how the feedback was addressed prior to piloting the course more widely. Dowse's Design Research Model was adapted for the design and development of a prototype dental trauma e-learning course. This paper will focus on step five, gathering expert feedback and the evaluation process. Four critical features emerged from the feedback that ought to be incorporated into the e-learning course design, namely, 1) keep resources clinically relevant; 2) keep resources simple to learn; 3) make resources easy to understand; and 4) support self-learning. The results demonstrate the value of an expert feedback process for improving a prototype designed to address a major gap in knowledge among medical doctors identified in the literature.

Online dental trauma course for medical education

A literature review identified a knowledge deficit among medical doctors about dental trauma management. To overcome this knowledge gap, a proposal to integrate dental traumatology teaching into the medical curriculum was made to raise medical students' awareness of, and familiarity with managing dental injuries. Despite the challenges of teaching dental trauma, online courses are viewed as a practical learning approach for students to access course material during their busy university schedules. In focusing on the constructivist model, this article details the design and development of the online dental trauma course. It is an example of a learner-led, fully online course. The six steps involved in the course development were as follows: (1) structured order from preclinical to clinical topics; (2) content covering all essential information on TDI diagnosis and management; (3) illustrative materials to support engagement and motivation to complete the course; (4) feedback processes to evaluate the learning process; (5) interactions between peers, educators, and learning materials to help facilitate learning; and (6) content that encompasses mainly visual learning styles. The online dental trauma course has the potential to make important contributions to medical education.

Acute Vision Loss as an Ophthalmic Complication of Dental Procedures

Introduction: Acute vision loss has been previously described as a complication of dental procedures through a variety of mechanisms. The vision loss is typically transient, although permanent loss has been reported. Physicians, including ophthalmologists, typically lack formal education around dental procedures and may be uninformed about the risks to ocular or periocular structures as well as the types of complications that can arise. We aimed to summarize literature describing the various mechanisms by which dental procedures can lead to vision loss in order to equip physicians (primary care, emergency medicine, and ophthalmologists) with a better understanding of the mechanisms by which dental procedures can lead to acute vision loss. Methods: A literature search (1950 to 2020) identified articles discussing acute vision loss as a complication of dental procedures. Results: Dental procedures can result in a variety of ophthalmological conditions through ischemic, infectious, compressive, and anesthetic-related etiologies. Conclusions: While the majority of vision loss is transient and requires little management, there are vision and life-threatening complications that can arise and would require assessment and appropriate treatment.

A 3-Year retrospective study of traumatic dental Injuries to the primary dentition

BACKGROUND/AIMS

Traumatic dental injuries (TDIs) in the primary dentition are a significant public health problem, which has been neglected worldwide. Despite its high prevalence, limited studies address this injury. The aim of this study was to determine the characteristics and treatment modalities of TDIs affecting primary teeth, along with accompanying medical co-morbidities and attendance at follow-up appointments.

MATERIAL AND METHODS

This retrospective analysis included all TDIs affecting primary teeth from January 2014 to January 2017. Data abstraction included demographics, time lapse prior to arrival at hospital, trauma etiology, classification of TDIs, soft tissue and supporting bone injuries, medical co-morbidities, emergency treatment, follow-up appointments and prognosis.

RESULTS

Records of 283 children with 536 traumatized primary teeth were reviewed. The median age was 2 years and the maxillary right central incisor (35.1%) was the most frequently injured tooth. Almost half the patients, 46.3%, sought treatment after 24 h. Periodontal tissue injuries (97.2%) predominated TDIs for which fall accidents (82.0%) were the most encountered cause. Most patients (177/283) had accompanying soft tissue/supporting bone injuries and 67.2% had multiple traumatized teeth. Seventy percent of the patients were examined only or were prescribed medication. Survival time following TDIs was unknown in 67.7% of traumatized teeth due to non-attendance at follow-up appointments. Most patients (55.1%) did not attend the follow-up appointments.

CONCLUSIONS

TDIs occurred in the primary dentition with the predominance of periodontal tissue injuries. When TDI was the presenting problem to hospital, accompanying systemic injury was rare. Treatment modalities were mostly limited to examination or extraction. The follow-up appointments were poorly attended.

Best Splinting Methods in Case of Dental Injury-A Literature Review

The objective of this manuscript was to review the literature on dental trauma splints and discuss materials used for splinting injured teeth in terms of their properties and conditions that are required for optimal stabilization. A literature search was conducted in the PubMed database with the keywords: "trauma splints", "dental trauma" and "traumatic dental injuries". The search was limited to English language publications. 42 publications fulfilled the inclusion criteria and were in accordance with the current recommendations. Optimal splinting of the teeth after trauma is one of the main predictors for pulpal and periodontal healing. The splints stabilize and protect the teeth, creating favorable conditions for the regeneration of the supporting tissues. Their application and removal should be easy and fast without any additional irritating of the surrounding tissues. The materials used to stabilize the injured teeth should keep the tooth in the original position, allowing for its physiological mobility.

A proposal to introduce dental trauma into medical education: An insight

THE PROBLEM

This proposal aims to tackle the common poor management of traumatic dental injury (TDI) by medical doctors and subsequent poor healthcare outcomes for patients. The literature reports that most medical doctors, in either private practice or hospital emergency departments, lack the knowledge, skills, and confidence needed to adequately assess and manage victims of TDI. This is due to little or no clinical dentistry and dental trauma education being included in their medical studies.

THE GAP IN THE LITERATURE

From a review of the literature, there is a clear lack of learning provision for medical students on the topic of dental anatomy and trauma. In addition, there appears to be no formal university theoretical and clinical training during medical school.

THE PRACTICAL IMPLICATIONS

The introduction of dental trauma into the medical curriculum will provide students with a better understanding of the importance of early management for better patient outcomes. Medical doctors competent in managing emergency dental trauma procedures will be able to provide a higher standard of care that could prevent potentially lifelong negative repercussions for the patient.

Physician Confidence in Dental Trauma Treatment and the Introduction of a Dental Trauma Decision-Making Pathway for the Pediatric Emergency Department

OBJECTIVES

The objectives of this study were to (1) survey and report the awareness and confidence of pediatric emergency medicine physicians in the management of dental trauma and (2) determine the prevalence of dental trauma decision-making pathway utilization in the pediatric emergency department.

METHODS

A survey was distributed through e-mail to the pediatric emergency medicine discussion list via Brown University LISTSERV. The survey study included 10 questions and was multiple-choice. The survey contained questions about physician confidence and their use of a dental trauma decision-making pathway.

RESULTS

A total of 285 individuals responded to the survey. Somewhat confident was the most common response (61%) followed by not confident (20%) and confident (19%) by respondents in treating dental trauma. Forty-one percent of respondents felt comfortable, 39% somewhat comfortable, 19% not comfortable, and 1% not sure in replanting an avulsed tooth. Only 6% of respondents reported that their pediatric emergency department always or sometimes uses a dental trauma decision-making pathway, whereas 78% of pediatric emergency departments do not.

CONCLUSIONS

We believe that the adoption of a decision-making pathway will provide timely management, improve emergency physician comfort, and enhance outcomes for pediatric patients presenting with a dental trauma. A future multicenter review will aim to evaluate these goals based on the utilization of our dental trauma decision-making pathway.

Dental Trauma in Children: A Quick Overview on Management

Traumatic dental injuries (TDI) or tooth trauma have a global prevalence of 10-15%. These are often the cause of first visit to emergency room. Prognosis of teeth after injury is dependent on type of TDI, emergency treatment and time elapsed till definitive care. The low level of awareness among general public and medical practitioners often leads to delay in seeking treatment which often leads to pain, severe symptoms and poor prognosis. Pediatricians can play a significant role in identification of TDI, health advise, emergency care and referral to dentists. This paper highlights the important features to be noted in children with history of TDI and the key steps which needs to be taken in these situations.

'He was distraught, I was distraught.' Parents' experiences of accessing emergency care following an avulsion injury to their child

Objective To explore how parents access emergency care for their children following avulsion of a permanent tooth.Method Semi-structured qualitative interviews were undertaken with parents of children who had suffered a tooth avulsion injury in the previous two years. The interviews were recorded and transcribed verbatim. Framework analysis was used to analyse the data and interpret the core concepts from the interviews. Results Nine parents participated in the study. None of the children received the appropriate emergency dental care within the timeframe identified by national and international guidelines. The core themes that emerged following the analysis were knowledge, access and emotion.Discussion & Conclusions The parents who were interviewed for this study had poor knowledge of what to do in the event of a tooth avulsion injury. This lack of knowledge directly impaired their ability to navigate emergency dental care for their child. They described their upset and distress following their child's injury, but also feelings of frustration and disappointment in relation to the emergency care their child received. There is a need to develop appropriate support and clinical pathways to enable parents to rapidly access appropriate and timely care for their child following a complex dental trauma.

The panoramic dental radiograph for emergency physicians

Dental emergencies are common reasons for presenting to hospital emergency departments. Here, we discuss the panoramic radiograph (orthopantomogram (OPG, OPT) as a diagnostic tool for the assessment of mandibular trauma and odontogenic infections. In this article, we review the radiographic principles of image acquisition, and how to conduct a systematic interpretation of represented maxillofacial anatomy. The aim is to equip the emergency physician with the skills to use the OPG radiograph when available, and to rapidly assess the image to expedite patient management. Included is a discussion of a number of cases seen in the emergency setting and some common errors in diagnosis.

A prototype mobile application for triaging dental emergencies

BACKGROUND

Evidence suggests that dental emergencies are likely to occur when preferred care is less accessible. Communication barriers often exist that cause patients to receive suboptimal treatment or experience discomfort for extended lengths of time. Furthermore, limitations in the conventional approach for managing dental emergencies prevent dentists from receiving critical information before patient visits.

METHODS

The authors developed a mobile application to mediate the uncertainty of dental emergencies. The development and study consisted of a needs analysis and quality assessment of intraoral images captured by smartphones, prototype development, refining the prototype through usability inspection methods, and formative evaluation through usability testing with prospective users.

RESULTS

The developed application successfully guided all users through a series of questions designed to capture clinically meaningful data by using familiar smartphone functions. All participants were able to complete a report within 4 minutes, and all clinical information was comprehended by the users.

CONCLUSIONS

Patient-provided information accompanied by high-resolution images may help dentists substantially in predicting urgency or preparing necessary treatment resources. The results illustrate the feasibility of patients using smartphone applications to report dental emergencies. This technology allows dentists to assess care remotely when direct patient contact is less practical.

PRACTICAL IMPLICATIONS

This study's results demonstrate that patients can use mobile applications to transmit clinical data to their dentists and suggest the possibility of expanding the use of mobile applications to enhance access to routine and emergency dental care. The authors addressed how to enable patients to communicate emergency needs directly to a dentist while obviating patient emergency department visits.

How Effective is a Dental Workshop at Improving the Knowledge and Confidence of Medical Students in the Management of Dental Emergencies?

The purpose of this study was to evaluate the effect of a three-hour hands-on workshop for medical students and residents on their pre- and postcourse knowledge and confidence in managing dental emergencies. A 1-hour lecture followed by four 20-minute "hands-on" skill stations on dental mannequins was administered to a group of 30 medical students and residents. Pre- and postworkshop questionnaire surveys were conducted. There was a significant increase in the percent of attendees who responded correctly to three of the four knowledge questions following the workshop (P-value < 0.005). Confidence, as expressed in various statements, about treating dental emergencies was significantly improved after the lecture for eight of the nine statements. These findings indicate that dental knowledge is generally not provided during medical training. Our interactive workshop appeared to be effective in increasing this knowledge and self-reported confidence in handling dental emergencies. These findings clearly indicate the need for additional dental education during medical school. The use of a hands-on workshop may be one model for achieving this goal.

General practitioners' attitudes towards the management of dental conditions and use of antibiotics in these consultations: a qualitative study

OBJECTIVES

This study aimed to produce an account of the attitudes of general practitioners (GPs) towards the management of dental conditions in general practice, and sought to explore how GPs use antibiotics in the treatment of dental problems.

DESIGN

Qualitative study employing semistructured telephone interviews and thematic analysis.

PARTICIPANTS

17 purposively sampled GPs working in Wales, of which 9 were male. The median number of years since graduation was 21. Maximum variation sampling techniques were used to ensure participants represented different Rural-Urban localities, worked in communities with varying levels of deprivation, and had differing lengths of practising career.

RESULTS

Most GPs reported regularly managing dental problems, with more socioeconomically deprived patients being particularly prone to consult. Participants recognised that dental problems are not optimally managed in general practice, but had sympathy with patients experiencing dental pain who reported difficulty obtaining an emergency dental consultation. Many GPs considered antibiotics an acceptable first-line treatment for acute dental problems and reported that patients often attended expecting to receive antibiotics. GPs who reported that their usual practice was to prescribe antibiotics were more likely to prioritise patients' immediate needs, whereas clinicians who reported rarely prescribing often did so to encourage patients to consult a dental professional.

CONCLUSIONS

The presentation of patients with dental problems presents challenges to GPs who report concerns about their ability to manage such conditions. Despite this, many reported frequently prescribing antibiotics for patients with dental conditions. This may contribute to both patient morbidity and the emergence of antimicrobial resistance. This research has identified the need for quantitative data on general practice consultations for dental problems and qualitative research exploring patient perspectives on reasons for consulting. The findings of these studies will inform the design of an intervention to support patients in accessing appropriate care when experiencing dental problems.

Knowledge and confidence of a convenience sample of australasian emergency doctors in managing dental emergencies: results of a survey

Background. We aimed to determine Australasian Specialist Emergency Physicians' and Emergency Physicians in Training (Trainees') level of knowledge of common dental emergencies. We also explored confidence in managing dental emergencies; predictors of confidence and knowledge; and preferences for further dental education. Methods. A questionnaire was distributed electronically (September 2011) and directly (November 2011) to Fellows and Trainees of the Australasian College for Emergency Medicine. It explored demographics, confidence, knowledge of dental emergencies, and educational preferences. Results. Response rate was 13.6% (464/3405) and college members were proportionally represented by region. Fewer than half (186/446; 42%) had received dental training. Sixty-two percent (244/391, 95% CI 57.5-67.1) passed (>50%) a knowledge test. More than 60% incorrectly answered questions on dental fracture, periodontal abscess, tooth eruption dates, and ulcerative gingivitis. Forty percent (166/416) incorrectly answered a question about Ludwig's Angina. Eighty-three percent (360/433) were confident in the pharmacological management of toothache but only 26% (112/434) confident in recognizing periodontal disease. Knowledge was correlated with confidence (r = 0.488). Interactive workshops were preferred by most (386/415, 93%). Conclusions. The knowledge and confidence of Australasian Emergency Physicians and Trainees in managing dental emergencies are varied, yet correlated. Interactive training sessions in dental emergencies are warranted.

Awareness of emergency management of dental trauma

AIM

Traumatic dental injuries frequently occur in society and may occur at home. The ultimate prognosis of an avulsed tooth occurring in a child may depend on the parents' knowledge of appropriate emergency measures. This study is aimed at evaluating the awareness level of a sample of Indian (Rohtak, Haryana) parents in the management of dental trauma.

MATERIALS AND METHODS

A total of 1500 parents were surveyed using a self-administered structured questionnaire. The questionnaire was divided into three parts. The tabulated data were statistically analyzed using the Chi-square test.

RESULT

This study indicated a low level of knowledge regarding tooth avulsion and replantation procedures to be followed in emergency. The residing area and age of parent did not affect the knowledge and awareness of parents. Moreover, well-educated parents also had very little or no information about dental trauma first-aid. The lack of significance in correct answers between those with and without such experience indicated that past experience did not seem to have increase the knowledge of the correct emergency procedures. Very little or no information about tooth avulsion and replantation had been given to most of them.

CONCLUSION

Dental injury prevention and management should be recognized as a major public health issue and adequate resources to be allocated for research in this area. Educational programs to improve the knowledge and awareness among the parents have to be implemented.

Planning the content of a brief educational course in maxillofacial emergencies for staff in accident and emergency departments: a modified Delphi study

It is well known that staff in accident and emergency (A&E) departments lack the knowledge and confidence needed to deal with maxillofacial emergencies, and that it is related to limited education at undergraduate and postgraduate levels. We therefore aimed to design a syllabus for a short course to educate staff about the most common emergencies. To find out which learning outcomes should be included and to reach a consensus, we did a 3-stage modified Delphi study of the opinions of members of the British Association of Oral and Maxillofacial Surgeons (BAOMS). Of a possible 890 members, 188 responded (21%) in the second round and 105 in the third (12%). Eighteen (37%) of the 49 proposed learning outcomes were rated very important and all of them were retained in the syllabus after the third round. Thirty (61%) items were retained with a consensus of 51% or above in the final round. The Delphi technique is a useful addition to the armamentarium of those involved in education, and has been used effectively in syllabus design. We achieved good consensus on the items to be included and the syllabus will be piloted locally.

Review article: Maxillofacial emergencies: Maxillofacial trauma

Fractures of the facial skeleton are a common reason for patients to present to EDs and general medical practice in Australia. Trauma to the maxillofacial region can lead to airway obstruction, intracranial injuries, loss of vision or long term cosmetic and functional deficits. This article focuses on the emergency assessment, triage and non-specialist management of traumatic injuries of the orbit and facial skeleton.

Massachusetts emergency departments' resources and physicians' knowledge of management of traumatic dental injuries

BACKGROUND

Hospital emergency departments (ED) are confronted with triaging and managing dental emergencies of both traumatic and non-traumatic origin. However, the literature suggests that there exists inadequate knowledge of the management of traumatic dental injuries (TDI) among medical professionals who must be knowledgeable and have the appropriate resources needed to triage or treat patients presenting with TDI.

AIM

The aims of this study were to (i) evaluate the resources of Massachusetts emergency departments (MEDs) for TDI, (ii) determine the knowledge of management of TDI among MED physicians, and (iii) investigate potential factors that affect their knowledge.

MATERIALS AND METHODS

Surveys were mailed to MED directors and their physicians. The director survey contained questions regarding institutional information for each emergency department (ED). The physician survey contained questions about physician characteristics and tested their knowledge of managing dental trauma.

RESULTS

A total of 72 surveys (16 MED directors and 56 physicians) were returned and included in the analysis. Only 50% of the MEDs had on-site dental coverage, 43.8% had 24-h off-site dental coverage, and none had a formal written dental trauma protocol. MED physician's knowledge of the appropriate management of luxations and avulsions was generally good, but poor for dental fractures. The MED physician's knowledge for the emergent nature of the various injuries was generally good with that of avulsions being the best. Physicians were more likely to have a better knowledge of managing dental trauma if they were specialists in pediatric emergency medicine (P = 0.001) or their hospitals had an academic affiliation (P = 0.05).

CONCLUSIONS

Based on the findings from this study, educational campaigns must be undertaken to improve both the resources available to the ED, and the knowledge of physicians regarding emergency management of TDI. In addition, efforts should be made by local dental organizations to provide ED with lists of dentists who are knowledgeable and willing to be available 24 h day⁻¹ to consult with and, if necessary, treat TDI. These efforts would enhance the long-term outcomes for patients sustaining dental trauma who present to hospital ED.

Dental and related infections

Emergency physicians should be comfortable treating most dental and related infections. In this article, we outline recommended techniques to perform a dental examination, explore common pathologies, recommend pain and antibiotic management strategies and review common pitfalls. How to avoid overprescribing opioid analgesics is discussed in depth, along with recent studies to support this strategy.