ORIGINAL Menezes ARTICLE et al
Knowledge of Dentists on the Management of Tooth Avulsion Injuries in Rio de Janeiro, Brazil Mariana Cezário Menezesa/Ricardo G. Carvalhob/Thais Accorsi-Mendonçab/ Gustavo De-Deusc/Edson J.L. Moreirad/Emmanuel J.N.L. Silvae Purpose: To evaluate dentists’ professional experience and knowledge of emergency management of tooth avulsion injuries in Rio de Janeiro, Brazil. Materials and Methods: A total of 100 questionnaires were evaluated. The first part of the questionnaire consisted of questions regarding personal information. The second part evaluated dentists’ knowledge of emergency management in cases of dental avulsion. The responses for each question were counted and expressed as percentages. Results: All dentists had a college degree or above. Only three dentists had a Master’s or PhD degree. Most of the dentists (94.5%) considered time and storage media important for the prognosis of avulsed teeth. However, the dentists did not show consistent responses about the adequate time and ideal storage media to transport avulsed teeth. Conclusion: The study highlighted Brazilian dentists’ need for continuing education in order to improve current knowledge in emergency management of avulsed teeth. Key words: dental trauma, emergency, tooth avulsion Oral Health Prev Dent 2015;13:457-460 doi: 10.3290/j.ohpd.a33923
T
raumatic dental injuries are frequent, widespread and represent a serious public dental health problem.3-5 Epidemiological studies have revealed prevalence rates of traumatic dental injuries to be between 4.9% to 37%.5,9,11,17-19 One of the most serious traumatic dental injuries is avulsion, a condition in which one or more teeth are com-
a
Dentist, Endodontics Department, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil. Performed the experiments in partial fulfillment of requirements for DDS degree.
b
Professor, Endodontics Department, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil. Idea, hypothesis, experimental design.
c
Professor, Endodontics Department, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil. Wrote and proofread the manuscript.
d
Professor, Endodontics Department, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil. Consulted on and performed statistical evaluation.
e
Professor, Endodontics Department, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil. Idea, wrote and proofread manuscript.
Correspondence: Emmanuel João Nogueira Leal Silva, Rua Herotides de Oliveira, 61/902 – Icaraí, Niterói, RJ, Brazil. Tel: +55-21-98357-5757. Email: [email protected]
Vol 13, No 5, 2015
Submitted for publication: 25.04.13; accepted for publication: 10.10.13
pletely knocked out of their alveolar sockets.3,4,17,18 Traumatic tooth avulsion comprises 0.5%–16% of traumatic injuries in the permanent dentition and 7%–13% in the primary dentition.5,9,11,17-19 The tooth most commonly avulsed in both the primary and permanent dentition is the maxillary central incisor. Although avulsion may occur at any age, the most common age for avulsion of permanent dentition is between 8 and 12 years of age, a time when the loosely structured periodontal ligament surrounding erupting teeth provides only minimal resistance to an extrusive force.3 Prompt and appropriate emergency management is exceedingly important for the best long-term prognosis of teeth affected by avulsion, especially in young children.2 Ideally, an avulsed tooth should be immediately replanted in its socket in order to avoid further damage to the periodontal membrane.3 The prognosis of a replanted tooth depends on the period of time elapsed between trauma and replantation, the type and condition of storage medium, the stage of root formation, and the presence of contamination.3,4 Dentists’ knowledge in this field has a very important role. Furthermore,
457
Menezes et al
Table 1 Demographic characteristics of respondents (n=74) Demographic Data Age Mean ± SD Range
Number (%) 28.9 ± 9.6 years 21–71 years
Years since graduation 1–5 years 6–10 years 11–15 years > 16 years
41 (55.5%) 20 (27.0%) 10 (13.5%) 03 (4.0%)
Sex Male Female
31 (41.8%) 43 (58.2%)
Identity Graduate Specialist Master’s degree PhD degree
36 (49.3%) 34 (46.6%) 2 (2.7%) 1 (1.4%)
there are little published data from Brazilian dentists in this area. Brazil is a large developing country, and certain differences exist among different regions in terms of living conditions and levels of medical treatment available. Therefore, the purpose of this study was to evaluate the professional experience and knowledge of tooth avulsion emergency management of dentists in Rio de Janeiro, Brazil.
MATERIALS AND METHODS A questionnaire was developed and distributed to 100 dentists selected from the city of Rio de Janeiro, Brazil. The survey was carried out between April and July 2011. Questionnaires were given to participants under the supervision of the authors and were collected immediately after the participants had answered (when participants agreed to answer). Confidentiality was assured as no names or phone numbers were required. The questionnaire was divided into two parts and the questions were closedended (multiple choice questions). The first part was designed to gather dentists’ personal and professional data, such as years of practice after graduation and educational level. The second part evaluated dentists’ knowledge of emergency management in dental avulsion. The responses for each question were counted and expressed as percentages.
458
Table 2 Trauma knowledge of the respondents (n = 74) Trauma information
Number (%)
Information about trauma Graduation Post-graduate course Journal Educational campaign
47 (64.4%) 20 (27.4%) 4 (5.5%) 2 (2.7%)
Previous experience in trauma Yes No
44 (60.3%) 30 (39.7%)
Are time and storage media important for the prognosis? Yes No
70 (94.5%) 4 (5.5%)
Extra-alveolar time 30 min 1 hour 2 hours 4 hours 12 hours Indifferent
11 (14.8%) 24 (32.3%) 22 (30.0%) 13 (17.5%) 3 (4.1%) 1 (1.3%)
Storage medium Water Milk Saline solution Saliva Dry Hanks’ balanced salt solution Indifferent Others
31 (42.4%) 30 (41.1%) 8 (11%) 0 (0%) 0 (0%) 0 (0%) 5 (5.5%) 0 (0%)
RESULTS Questionnaires were returned by 74 of 100 dentists (74%). The demographic characteristics of the participants are summarised in Table 1. For about half (52.5%) of the dentists, less than five years had passed since graduation. Table 2 shows the knowledge of participants about tooth avulsion. Among the dentists, about two-thirds (60.3%) reported that they had previously witnessed a tooth avulsion injury, while 39.7% reported that they had not witnessed a tooth avulsion before. Most of the dentists (94.5%) considered time and storage media important for the prognosis of avulsed teeth. However, the dentists did not show consistent responses regarding the adequate time and ideal storage media to transport avulsed teeth.
DISCUSSION This study focused on the knowledge of the treatment of avulsed teeth and demonstrated that the
Oral Health & Preventive Dentistry
Menezes et al
level of knowledge regarding critical time for treatment and the adequate storage medium was not satisfactory. In this survey, we preferred to directly supervise the questionnaire process. In the survey reported by Holan and Shmueli,13 the questionnaire forms were mailed to the participants. When using the latter method, Abu-Dawoud1 suggested that there is a risk that the participants’ responses may be compromised. One of the most important factors in treatment of dental avulsion is the extra-alveolar time before re-implantation. The longer the time lapse between tooth avulsion and re-implantation, the greater the risk of replacement resorption and inflammatory root resorption.1 Although 94.5% of the participants recognised that extra-alveolar period and storage media are critical factors to be considered for optimal healing of avulsed teeth,4 only 11 (15.1%) of the dentists knew that 30 min is a critical time and that an avulsed tooth should be replaced within this time. This is a very startling fact, especially because 44 (60.3%) of the dentists answered that they have already had some trauma experience in the office and demonstrated a lack of knowledge regarding the extra-alveolar time before the re-implant. Although immediate replantation is the treatment of choice,10 clinical experience has shown that most avulsed teeth are replanted only after an extended extra-alveolar time.4,10 Depending on the extra-alveolar time and the storage/transport medium, pulp necrosis and degeneration of the cementum and periodontal ligament (PDL) cells may occur. This may lead to inflammatory root resorption and replacement resorption, which are the major causes of tooth loss.6,12 It is necessary to choose a suitable storage medium for maintaining the viability of periodontal ligament cells, thus avoiding further damage to the tooth. However, no dentist said that they would use Hanks’ balanced salt solution (HBSS), which is recommended by the International Association of Dental Traumatology guidelines.6,10 HBSS is a standard saline solution that is widely used in biomedical research to support the growth of many cell types. HBSS is commercially available as Save-A-Tooth (Save-A-Tooth; Pottstown, PA, USA) as a storage medium for avulsed teeth, although it is not yet widely available in pharmacies or drugstores around the world. Milk is regarded as a convenient storage medium for an avulsed tooth because it is easy to obtain in the event of an accident and it can maintain PDL cells.10,15 Although 30 (41.1%) of the dentists rec-
Vol 13, No 5, 2015
ommended milk as an ideal storage media, most of the dentists (53.5%) preferred water or saline solution in which to store the tooth, despite substantial numbers of studies showing that milk is superior to saline in maintaining vitality, both in vitro and in vivo.6,8,12,15,16,20 Again, the results demonstrated that Brazilian dentists had little knowledge regarding the ideal storage media for avulsed teeth. Above all, the results revealed poor knowledge among dentists regarding the management of avulsed teeth. This is in agreement with the findings of previous studies, which demonstrated that the great majority of professionals would not intervene in avulsed teeth.7,14 Zhao and Gong21 suggest that the lack of standardisation in treatment techniques and standard protocols may be one of the reasons, neglect of continuing education may be another, and the third reason may be that updating textbooks is slow and cannot keep up with the progress in international research in recent years.
CONCLUSION This survey demonstrated generally poor knowledge among the dentists on how to treat patients with dental traumatic injuries. It highlights the need to develop strategies to improve the knowledge of dentists to provide emergency diagnosis and treatment for patients with tooth avulsion.
REFERENCES 1. Abu-Dawoud M, Al-Enezi B, Andersson L. Knowledge of emergency management of avulsed teeth among young physicians and dentists. Dent Traumatol 2007;23:348–355. 2. Al-Jundi SH, Al-Waeili H, Khairalah K. Knowledge and attitude of Jordanian School Health teachers with regards to emergency management of dental trauma. Dent Traumatol 2005;21:183–187. 3. Andreasen JO, Andreasen FM, Andersson L, editors. Textbook and color atlas of traumatic injuries to the teeth, ed 4. Oxford: Blackwell, 2007. 4. Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 avulsed permanent incisors. Factors related to periodontal ligament healing. Endod Dent Traumatol 1995;11:76–89. 5. Borssen A, Holm AK. Traumatic dental injuries in a cohort of 16-years-olds in northern Sweden. Endod Dent Traumatol 1997;13:276–280. 6. Chamorro MM, Regan JD, Opperman LA, Kramer PR. Effect of storage media on human periodontal ligament cell apoptosis. Dent Traumatol 2008;24:11–16. 7. de França RI, Traebert J, de Lacerda JT. Brazilian dentists’ knowledge regarding immediate treatment of traumatic dental injuries. Dent Traumatol 2007;23:287–290.
459
Menezes et al 8. dos Santos CL, Sonoda CK, Poi WR, Panzarini SR, Sundefeld ML, Negri MR. Delayed replantation of rat teeth after use of reconstituted powdered milk as a storage medium. Dent Traumatol 2009;25:51–57. 9. Eyuboglu O, Yilmaz Y, Zehir C, Sahin H. A 6-year investigation into types of dental trauma treated in a paediatric dentistry clinic in eastern Anatolia region, Turkey. Dent Traumatol 2009;25:110–114. 10. Flores MT, Andersson L, Andreasen JO, Bakland LK, Malmgren B, Barnett F et al. International Association of Dental Traumatology. Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth. Dent Traumatol 2007;23:130–136. 11. Gelbier S. Injured anterior teeth in children: A preliminary discussion. Br Dent J 1967;123:331–335. 12. Gjertsen AW, Stothz KA, Neiva KG, Pileggi R. Effect of propolis on proliferation and apoptosis of periodontal ligament fibroblasts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:843–848. 13. Holan G, Shmueli Y. Knowledge of physicians in hospital emergency rooms in Israel on their role in cases of avulsion of permanent incisors. Inter J Paediatric Dent 2003;13:13–19. 14. Hu LW, Prisco CR, Bombana AC. Knowledge of Brazilian general dentists and endodontists about the emergency management of dento-alveolar trauma. Dent Traumatol 2006;22:113–117.
460
15. Huang SC, Remeikis NA, Daniel JC. Effects of long-term exposure of human periodontal ligament cells milk and other solutions. J Endod 1996; 22:30–33. 16. Oikarinen KS, Seppa ST. Effect of preservation media on proliferation and collagen biosynthesis of periodontal ligament fibroblasts. Endod Dent Traumatol 1987;3:95–99. 17. Rajab LD. Traumatic dental injuries in children presenting for treatment at the department of pediatric dentistry, University of Jordan, 1997–2000. Dent Traumatol 2003;19:6–11. 18. Ravn JJ. Dental injuries in Copenhagen school children, school years 1967–1972. Community Dent Oral Epidemiol 1974;2:231–245. 19. Shashikiran ND, Reddy VVS, Nagaveni NB. Knowledge and attitude of 2,000 parents (urban and rural – 1,000 each) with regard to avulsed permanent incisors and their emergency management, in and around Davangere. J Indian Soc Pedod Prev Dent 2006;24:116–121. 20. Silva EJ, Rollemberg CB, Coutinho-Filho TS, Krebs RL, Zaia AA. Use of soymilk as a storage medium for avulsed teeth. Acta Odontol Scand 2013;71:1101–1104. 21. Zhao Y, Gong Y. Knowledge of emergency management of avulsed teeth: a survey of dentists in Beijing, China. Dent Traumatol 2010;26:281–284.
Oral Health & Preventive Dentistry
Knowledge of Dentists on the Management of Tooth Avulsion Injuries in Rio de Janeiro, Brazil Mariana Cezário Menezesa/Ricardo G. Carvalhob/Thais Accorsi-Mendonçab/ Gustavo De-Deusc/Edson J.L. Moreirad/Emmanuel J.N.L. Silvae Purpose: To evaluate dentists’ professional experience and knowledge of emergency management of tooth avulsion injuries in Rio de Janeiro, Brazil. Materials and Methods: A total of 100 questionnaires were evaluated. The first part of the questionnaire consisted of questions regarding personal information. The second part evaluated dentists’ knowledge of emergency management in cases of dental avulsion. The responses for each question were counted and expressed as percentages. Results: All dentists had a college degree or above. Only three dentists had a Master’s or PhD degree. Most of the dentists (94.5%) considered time and storage media important for the prognosis of avulsed teeth. However, the dentists did not show consistent responses about the adequate time and ideal storage media to transport avulsed teeth. Conclusion: The study highlighted Brazilian dentists’ need for continuing education in order to improve current knowledge in emergency management of avulsed teeth. Key words: dental trauma, emergency, tooth avulsion Oral Health Prev Dent 2015;13:457-460 doi: 10.3290/j.ohpd.a33923
T
raumatic dental injuries are frequent, widespread and represent a serious public dental health problem.3-5 Epidemiological studies have revealed prevalence rates of traumatic dental injuries to be between 4.9% to 37%.5,9,11,17-19 One of the most serious traumatic dental injuries is avulsion, a condition in which one or more teeth are com-
a
Dentist, Endodontics Department, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil. Performed the experiments in partial fulfillment of requirements for DDS degree.
b
Professor, Endodontics Department, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil. Idea, hypothesis, experimental design.
c
Professor, Endodontics Department, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil. Wrote and proofread the manuscript.
d
Professor, Endodontics Department, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil. Consulted on and performed statistical evaluation.
e
Professor, Endodontics Department, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil. Idea, wrote and proofread manuscript.
Correspondence: Emmanuel João Nogueira Leal Silva, Rua Herotides de Oliveira, 61/902 – Icaraí, Niterói, RJ, Brazil. Tel: +55-21-98357-5757. Email: [email protected]
Vol 13, No 5, 2015
Submitted for publication: 25.04.13; accepted for publication: 10.10.13
pletely knocked out of their alveolar sockets.3,4,17,18 Traumatic tooth avulsion comprises 0.5%–16% of traumatic injuries in the permanent dentition and 7%–13% in the primary dentition.5,9,11,17-19 The tooth most commonly avulsed in both the primary and permanent dentition is the maxillary central incisor. Although avulsion may occur at any age, the most common age for avulsion of permanent dentition is between 8 and 12 years of age, a time when the loosely structured periodontal ligament surrounding erupting teeth provides only minimal resistance to an extrusive force.3 Prompt and appropriate emergency management is exceedingly important for the best long-term prognosis of teeth affected by avulsion, especially in young children.2 Ideally, an avulsed tooth should be immediately replanted in its socket in order to avoid further damage to the periodontal membrane.3 The prognosis of a replanted tooth depends on the period of time elapsed between trauma and replantation, the type and condition of storage medium, the stage of root formation, and the presence of contamination.3,4 Dentists’ knowledge in this field has a very important role. Furthermore,
457
Menezes et al
Table 1 Demographic characteristics of respondents (n=74) Demographic Data Age Mean ± SD Range
Number (%) 28.9 ± 9.6 years 21–71 years
Years since graduation 1–5 years 6–10 years 11–15 years > 16 years
41 (55.5%) 20 (27.0%) 10 (13.5%) 03 (4.0%)
Sex Male Female
31 (41.8%) 43 (58.2%)
Identity Graduate Specialist Master’s degree PhD degree
36 (49.3%) 34 (46.6%) 2 (2.7%) 1 (1.4%)
there are little published data from Brazilian dentists in this area. Brazil is a large developing country, and certain differences exist among different regions in terms of living conditions and levels of medical treatment available. Therefore, the purpose of this study was to evaluate the professional experience and knowledge of tooth avulsion emergency management of dentists in Rio de Janeiro, Brazil.
MATERIALS AND METHODS A questionnaire was developed and distributed to 100 dentists selected from the city of Rio de Janeiro, Brazil. The survey was carried out between April and July 2011. Questionnaires were given to participants under the supervision of the authors and were collected immediately after the participants had answered (when participants agreed to answer). Confidentiality was assured as no names or phone numbers were required. The questionnaire was divided into two parts and the questions were closedended (multiple choice questions). The first part was designed to gather dentists’ personal and professional data, such as years of practice after graduation and educational level. The second part evaluated dentists’ knowledge of emergency management in dental avulsion. The responses for each question were counted and expressed as percentages.
458
Table 2 Trauma knowledge of the respondents (n = 74) Trauma information
Number (%)
Information about trauma Graduation Post-graduate course Journal Educational campaign
47 (64.4%) 20 (27.4%) 4 (5.5%) 2 (2.7%)
Previous experience in trauma Yes No
44 (60.3%) 30 (39.7%)
Are time and storage media important for the prognosis? Yes No
70 (94.5%) 4 (5.5%)
Extra-alveolar time 30 min 1 hour 2 hours 4 hours 12 hours Indifferent
11 (14.8%) 24 (32.3%) 22 (30.0%) 13 (17.5%) 3 (4.1%) 1 (1.3%)
Storage medium Water Milk Saline solution Saliva Dry Hanks’ balanced salt solution Indifferent Others
31 (42.4%) 30 (41.1%) 8 (11%) 0 (0%) 0 (0%) 0 (0%) 5 (5.5%) 0 (0%)
RESULTS Questionnaires were returned by 74 of 100 dentists (74%). The demographic characteristics of the participants are summarised in Table 1. For about half (52.5%) of the dentists, less than five years had passed since graduation. Table 2 shows the knowledge of participants about tooth avulsion. Among the dentists, about two-thirds (60.3%) reported that they had previously witnessed a tooth avulsion injury, while 39.7% reported that they had not witnessed a tooth avulsion before. Most of the dentists (94.5%) considered time and storage media important for the prognosis of avulsed teeth. However, the dentists did not show consistent responses regarding the adequate time and ideal storage media to transport avulsed teeth.
DISCUSSION This study focused on the knowledge of the treatment of avulsed teeth and demonstrated that the
Oral Health & Preventive Dentistry
Menezes et al
level of knowledge regarding critical time for treatment and the adequate storage medium was not satisfactory. In this survey, we preferred to directly supervise the questionnaire process. In the survey reported by Holan and Shmueli,13 the questionnaire forms were mailed to the participants. When using the latter method, Abu-Dawoud1 suggested that there is a risk that the participants’ responses may be compromised. One of the most important factors in treatment of dental avulsion is the extra-alveolar time before re-implantation. The longer the time lapse between tooth avulsion and re-implantation, the greater the risk of replacement resorption and inflammatory root resorption.1 Although 94.5% of the participants recognised that extra-alveolar period and storage media are critical factors to be considered for optimal healing of avulsed teeth,4 only 11 (15.1%) of the dentists knew that 30 min is a critical time and that an avulsed tooth should be replaced within this time. This is a very startling fact, especially because 44 (60.3%) of the dentists answered that they have already had some trauma experience in the office and demonstrated a lack of knowledge regarding the extra-alveolar time before the re-implant. Although immediate replantation is the treatment of choice,10 clinical experience has shown that most avulsed teeth are replanted only after an extended extra-alveolar time.4,10 Depending on the extra-alveolar time and the storage/transport medium, pulp necrosis and degeneration of the cementum and periodontal ligament (PDL) cells may occur. This may lead to inflammatory root resorption and replacement resorption, which are the major causes of tooth loss.6,12 It is necessary to choose a suitable storage medium for maintaining the viability of periodontal ligament cells, thus avoiding further damage to the tooth. However, no dentist said that they would use Hanks’ balanced salt solution (HBSS), which is recommended by the International Association of Dental Traumatology guidelines.6,10 HBSS is a standard saline solution that is widely used in biomedical research to support the growth of many cell types. HBSS is commercially available as Save-A-Tooth (Save-A-Tooth; Pottstown, PA, USA) as a storage medium for avulsed teeth, although it is not yet widely available in pharmacies or drugstores around the world. Milk is regarded as a convenient storage medium for an avulsed tooth because it is easy to obtain in the event of an accident and it can maintain PDL cells.10,15 Although 30 (41.1%) of the dentists rec-
Vol 13, No 5, 2015
ommended milk as an ideal storage media, most of the dentists (53.5%) preferred water or saline solution in which to store the tooth, despite substantial numbers of studies showing that milk is superior to saline in maintaining vitality, both in vitro and in vivo.6,8,12,15,16,20 Again, the results demonstrated that Brazilian dentists had little knowledge regarding the ideal storage media for avulsed teeth. Above all, the results revealed poor knowledge among dentists regarding the management of avulsed teeth. This is in agreement with the findings of previous studies, which demonstrated that the great majority of professionals would not intervene in avulsed teeth.7,14 Zhao and Gong21 suggest that the lack of standardisation in treatment techniques and standard protocols may be one of the reasons, neglect of continuing education may be another, and the third reason may be that updating textbooks is slow and cannot keep up with the progress in international research in recent years.
CONCLUSION This survey demonstrated generally poor knowledge among the dentists on how to treat patients with dental traumatic injuries. It highlights the need to develop strategies to improve the knowledge of dentists to provide emergency diagnosis and treatment for patients with tooth avulsion.
REFERENCES 1. Abu-Dawoud M, Al-Enezi B, Andersson L. Knowledge of emergency management of avulsed teeth among young physicians and dentists. Dent Traumatol 2007;23:348–355. 2. Al-Jundi SH, Al-Waeili H, Khairalah K. Knowledge and attitude of Jordanian School Health teachers with regards to emergency management of dental trauma. Dent Traumatol 2005;21:183–187. 3. Andreasen JO, Andreasen FM, Andersson L, editors. Textbook and color atlas of traumatic injuries to the teeth, ed 4. Oxford: Blackwell, 2007. 4. Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 avulsed permanent incisors. Factors related to periodontal ligament healing. Endod Dent Traumatol 1995;11:76–89. 5. Borssen A, Holm AK. Traumatic dental injuries in a cohort of 16-years-olds in northern Sweden. Endod Dent Traumatol 1997;13:276–280. 6. Chamorro MM, Regan JD, Opperman LA, Kramer PR. Effect of storage media on human periodontal ligament cell apoptosis. Dent Traumatol 2008;24:11–16. 7. de França RI, Traebert J, de Lacerda JT. Brazilian dentists’ knowledge regarding immediate treatment of traumatic dental injuries. Dent Traumatol 2007;23:287–290.
459
Menezes et al 8. dos Santos CL, Sonoda CK, Poi WR, Panzarini SR, Sundefeld ML, Negri MR. Delayed replantation of rat teeth after use of reconstituted powdered milk as a storage medium. Dent Traumatol 2009;25:51–57. 9. Eyuboglu O, Yilmaz Y, Zehir C, Sahin H. A 6-year investigation into types of dental trauma treated in a paediatric dentistry clinic in eastern Anatolia region, Turkey. Dent Traumatol 2009;25:110–114. 10. Flores MT, Andersson L, Andreasen JO, Bakland LK, Malmgren B, Barnett F et al. International Association of Dental Traumatology. Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth. Dent Traumatol 2007;23:130–136. 11. Gelbier S. Injured anterior teeth in children: A preliminary discussion. Br Dent J 1967;123:331–335. 12. Gjertsen AW, Stothz KA, Neiva KG, Pileggi R. Effect of propolis on proliferation and apoptosis of periodontal ligament fibroblasts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:843–848. 13. Holan G, Shmueli Y. Knowledge of physicians in hospital emergency rooms in Israel on their role in cases of avulsion of permanent incisors. Inter J Paediatric Dent 2003;13:13–19. 14. Hu LW, Prisco CR, Bombana AC. Knowledge of Brazilian general dentists and endodontists about the emergency management of dento-alveolar trauma. Dent Traumatol 2006;22:113–117.
460
15. Huang SC, Remeikis NA, Daniel JC. Effects of long-term exposure of human periodontal ligament cells milk and other solutions. J Endod 1996; 22:30–33. 16. Oikarinen KS, Seppa ST. Effect of preservation media on proliferation and collagen biosynthesis of periodontal ligament fibroblasts. Endod Dent Traumatol 1987;3:95–99. 17. Rajab LD. Traumatic dental injuries in children presenting for treatment at the department of pediatric dentistry, University of Jordan, 1997–2000. Dent Traumatol 2003;19:6–11. 18. Ravn JJ. Dental injuries in Copenhagen school children, school years 1967–1972. Community Dent Oral Epidemiol 1974;2:231–245. 19. Shashikiran ND, Reddy VVS, Nagaveni NB. Knowledge and attitude of 2,000 parents (urban and rural – 1,000 each) with regard to avulsed permanent incisors and their emergency management, in and around Davangere. J Indian Soc Pedod Prev Dent 2006;24:116–121. 20. Silva EJ, Rollemberg CB, Coutinho-Filho TS, Krebs RL, Zaia AA. Use of soymilk as a storage medium for avulsed teeth. Acta Odontol Scand 2013;71:1101–1104. 21. Zhao Y, Gong Y. Knowledge of emergency management of avulsed teeth: a survey of dentists in Beijing, China. Dent Traumatol 2010;26:281–284.
Oral Health & Preventive Dentistry
