Global status of knowledge for prevention and emergency management of traumatic dental injuries among school teachers: A systematic review and meta-analysis

Abstract

Background/aim: The majority of traumatic dental injuries (TDI) in childhood and adolescence occur in schools. Since school teachers are often the first responders, their knowledge about the emergency management of TDI needs to be adequate. The aim of this systematic review was to assess and analyse the global status of this knowledge as reported in previous studies and to provide recommendations for future research.

Methods: The protocol was designed as per PRISMA guidelines and registered in PROSPERO. A broad-based search using text-words and MeSH terms was performed in established databases as per a predefined strategy. Cohort-studies, cross-sectional, case-control studies and randomized/non-randomized trials without any distinction of language and year of publication were included while those without details of sampling strategy, validity and reliability were excluded. Data extraction was performed, risk of bias assessment was done by the Joanna-Briggs-Institute's critical appraisal checklist and meta-analysis was performed for four question stems using a random effects model.

Results: Twenty-three studies were included for qualitative analysis. Most of the studies had been conducted in Asia from 2009 to 2019. Ten studies used case-based questionnaires, mostly adapted from previous studies. Moderate to high risk of bias was observed in 14 studies. Less than 50% of teachers had witnessed a TDI in 8 studies and >75% desired to know more about TDI management in most studies. Less than 50% of teachers in 5 out of 6 studies knew about immediate replantation of avulsed permanent teeth, <25% knew about storage of an avulsed tooth in 16 studies and <50% knew about cleaning of a dirty avulsed tooth in 8 studies. Meta-analysis revealed I² values of >95% with 17% of teachers having previous dental-trauma first-aid training and 38% knowing about replantation within 30 minutes.

Conclusion: The awareness level in several areas of the world is unknown. Studies lacked well-designed questionnaires and teachers exhibited low self-belief and knowledge level in the majority of studies.

Keywords: awareness; replantation; systematic review; tooth avulsion; traumatic dental injuries.