Original Article

Knowledge, attitude, and perception of mothers

towards emergency management of dental trauma in
Salem district, Tamil Nadu: A questionnaire study
Kruthika Murali, Ramesh Krishnan, Suresh Kumar V., Shankar Shanmugam1, Prakash Rajasundharam2
Department of Pedodontics and Preventive Dentistry, Vinayaka Mission Sankarachariyar Dental College, Ariyanoor, Salem,
1
Departments of Public Health Dentistry, J. K. K. Nattraja Dental College and Hospital, Komarapalayam, 2Public Health Dentistry,
K. S. Rangasamy Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, India

ABSTRACT
Background: Dental trauma is one of the main oral
health problems in childhood, and can cause pain and
distress. It is important to provide emergency care to
combat the aftermaths of trauma. Aim: The aim of
the study is to assess the knowledge and attitude of
mothers regarding dental trauma and its management.
Materials and Methods: A questionnaire consisting
of 33 closed-ended questions were used to interview
150 mothers who participated in the study. The
questions assessed the knowledge and attitude of
mothers towards their childs dental visit, dental
trauma, and its management. Statistical analysis was
performed using Statistical Package for Social Sciences
(SPSS) version 17.0. Results: Mothers previous
experience of dental trauma when associated with
the preservation of avulsed tooth of the child, those
mothers who had the experience of dental trauma
reported that they would discard the tooth which was
found to be statistically significant (P < 0.05) when
compared to the mothers with no experience of trauma.
The education status of the study population when
associated with the knowledge variables of avulsion,
it was found that most of the variables had statistically
significant association with P < 0.05. Conclusion: This
study reveals that there is a lack of awareness among
the mothers regarding the emergency management of
dental trauma. This warrants the need of an effective
communication between dental professionals and
mothers for better handling of dental emergencies.

KEYWORDS: Attitude, dental trauma, management,

knowledge

Introduction
Dental trauma during childhood leads to present and
future oral health problems, which can cause pain
and distress. Children encounter with many accidents

Address for correspondence:

Dr. Kruthika Murali,
Department of Pedodontics and Preventive dentistry,
Vinayaka Mission Sankarachariyar Dental College,
Ariyanoor, Salem - 636 308, Tamil Nadu, India.
E-mail: smilekruthika@gmail.com
Access this article online
Quick response code

Website:
www.jisppd.com
DOI:
10.4103/0970-4388.135825
PMID:
******

in their routine activities, such as running, skating,

and cycle riding. Thus, it is important to provide
immediate first class emergency care to reduce the
possible outcomes.[1,2]
The prognosis of some of the dental injuries is
highly dependent on correct and prompt emergency
management and proper advice. This may frequently
be the responsibility of the lay people available at the
accident site, which proved lacking in many reports.[3-5]
Tooth loss in children commonly occur due to dental
trauma, which may be caused by violence, accidents,
falls, and sport-related activities.[6]
Epidemiological studies indicate that dental trauma
is a significant problem in young people, and that in
the near future, the incidence of trauma will exceed
that of dental caries and periodontal disease in young
population.[7] According to Andreasen and Andreasen,
oral injuries are the fourth most common bodily
injuries among the 7-30 year age group.[8,9] Traumatic
injuries can thus have a significant effect on a childs
quality of life.[10]

Journal of Indian Society of Pedodontics and Preventive Dentistry | Jul-Sep 2014 | Vol 32| Issue 3 |

202

Kruthika, et al.: Knowledge, attitude and perception of dental trauma among mothers

High percentage of children with dental trauma

present late for treatment, possibly because of lack
of awareness and knowledge among related adults,
resulting in unfavorable long-term prognosis. Mother
plays a significant role in a childs life, as they are
the primary source of information to impart their
knowledge. Forty-one percent of dental injuries occur
at home,[5] so mothers play an important role for
appropriate decision making.[11]
Despite the importance of this problem, there is
no study available in the literature in the state of
Tamil Nadu to assess the knowledge among mothers
towards the emergency management of dental trauma.
Hence, the aim of the present study was to assess the
knowledge and attitude of mothers in the emergency
management of dental trauma.

Materials and Methods

(53.3%) were from rural area [Table 1]. Amongst the

respondent mothers, 65 (43.3%) were graduates, 57
(38%) had their schooling till higher secondary, and 27
(18%) were illiterate [Table 2].
When the education status of the study population
was associated with the knowledge variables related to
avulsion, it was found that the degree holders showed
preference in visiting a dentist (49.2%) immediately
(48.8%), with the saved tooth (58.2%) wrapped in paper
(58.2%) when compared to that of other groups, which
was found to be statistically significant (P < 0.05).
When previous maternal experience to dental trauma
was associated with the place for seeking treatment for
avulsion, it was found that the mother who had dental
trauma significantly (P < 0.05) preferred to visit the
hospital or physicians office when compared to those
who had no previous experience of dental trauma
[Table 3].

A questionnaire was designed and one-to-one interview

was done among 150 mothers of children attending
the Outpatient Department (OPD) of Department of
Pedodontics and Preventive Dentistry of VMS Dental
College from December 2012 to February 2013.

When previous maternal experience to dental trauma

was associated with the preservation of the avulsed
tooth (i.e., if they find the avulsed tooth outside the
mouth), it was found that the mothers who had no
previous experience of dental trauma responded that

The questionnaire contained 33 closed-ended questions

for the assessment of mothers knowledge and attitude
towards their childs dental visit, dental trauma, and
its emergency management. The questionnaire was
prepared in both English and vernacular language
(Tamil). The questionnaire was checked for the
content validity by two professors in the Department
of Pediatric Dentistry and it was also checked for
construct validity using test-retest method following
which Cronbachs alpha was calculated.

Table 1: Frequency distribution of mothers age

and place of residence

The institutional ethical committee clearance was

obtained prior to the study and those mothers who
were willing to participate in the study only were
interviewed.
Statistical analysis was performed using Statistical
Package for Social Sciences (SPSS) version
17.0. Frequency distribution which includes number
and percentage were calculated for the demographic
variables like mothers age, place of residence, and
educational status of mother. Chi-square analysis
was used to test the influence of previous experience
of dental trauma on the knowledge, attitude, and
perception of the participants. The level of significance
was set at P < 0.05.

Age of mother
21-30
31-40
41-50
51-60
Place of residence
Urban
Semiurban
Rural

5 (3.3)
65 (43.3)
80 (53.3)

Table 2: Frequency distribution of mothers

educational status
Education
Illiterate
Primary education
Middle school
High and higher secondary
Degree
Professional degree

N (%)
27 (18)
24 (16)
20 (13.3)
13 (8.7)
65 (43.3)
1 (0.7)

Table 3: Association between maternal experience

to dental trauma and place for seeking treatment

Results

Previous maternal
experience to dental
trauma

The number of participants in this survey included

150 mothers, of which five (3.3%) were from urban
area, 65 (43.3%) were from semiurban area, and 80

Yes
No
P-value

203

N (%)
77 (51.3)
53 (35.3)
15 (10)
5 (3.3)

Place for seeking treatment for avulsion

Hospital or physicians
office N (%)
3 (33.3)
14 (10.1)
<0.05

Dental
clinic N (%)
6 (66.7)
125 (89.9)
<0.05

Journal of Indian Society of Pedodontics and Preventive Dentistry | Jul-Sep 2014 | Vol 32| Issue 3 |

Kruthika, et al.: Knowledge, attitude and perception of dental trauma among mothers

High percentage of children with dental trauma

present late for treatment, possibly because of lack
of awareness and knowledge among related adults,
resulting in unfavorable long-term prognosis. Mother
plays a significant role in a childs life, as they are
the primary source of information to impart their
knowledge. Forty-one percent of dental injuries occur
at home,[5] so mothers play an important role for
appropriate decision making.[11]
Despite the importance of this problem, there is
no study available in the literature in the state of
Tamil Nadu to assess the knowledge among mothers
towards the emergency management of dental trauma.
Hence, the aim of the present study was to assess the
knowledge and attitude of mothers in the emergency
management of dental trauma.

Materials and Methods

(53.3%) were from rural area [Table 1]. Amongst the

respondent mothers, 65 (43.3%) were graduates, 57
(38%) had their schooling till higher secondary, and 27
(18%) were illiterate [Table 2].
When the education status of the study population
was associated with the knowledge variables related to
avulsion, it was found that the degree holders showed
preference in visiting a dentist (49.2%) immediately
(48.8%), with the saved tooth (58.2%) wrapped in paper
(58.2%) when compared to that of other groups, which
was found to be statistically significant (P < 0.05).
When previous maternal experience to dental trauma
was associated with the place for seeking treatment for
avulsion, it was found that the mother who had dental
trauma significantly (P < 0.05) preferred to visit the
hospital or physicians office when compared to those
who had no previous experience of dental trauma
[Table 3].

A questionnaire was designed and one-to-one interview

was done among 150 mothers of children attending
the Outpatient Department (OPD) of Department of
Pedodontics and Preventive Dentistry of VMS Dental
College from December 2012 to February 2013.

When previous maternal experience to dental trauma

was associated with the preservation of the avulsed
tooth (i.e., if they find the avulsed tooth outside the
mouth), it was found that the mothers who had no
previous experience of dental trauma responded that

The questionnaire contained 33 closed-ended questions

for the assessment of mothers knowledge and attitude
towards their childs dental visit, dental trauma, and
its emergency management. The questionnaire was
prepared in both English and vernacular language
(Tamil). The questionnaire was checked for the
content validity by two professors in the Department
of Pediatric Dentistry and it was also checked for
construct validity using test-retest method following
which Cronbachs alpha was calculated.

Table 1: Frequency distribution of mothers age

and place of residence

The institutional ethical committee clearance was

obtained prior to the study and those mothers who
were willing to participate in the study only were
interviewed.
Statistical analysis was performed using Statistical
Package for Social Sciences (SPSS) version
17.0. Frequency distribution which includes number
and percentage were calculated for the demographic
variables like mothers age, place of residence, and
educational status of mother. Chi-square analysis
was used to test the influence of previous experience
of dental trauma on the knowledge, attitude, and
perception of the participants. The level of significance
was set at P < 0.05.

Age of mother
21-30
31-40
41-50
51-60
Place of residence
Urban
Semiurban
Rural

5 (3.3)
65 (43.3)
80 (53.3)

Table 2: Frequency distribution of mothers

educational status
Education
Illiterate
Primary education
Middle school
High and higher secondary
Degree
Professional degree

N (%)
27 (18)
24 (16)
20 (13.3)
13 (8.7)
65 (43.3)
1 (0.7)

Table 3: Association between maternal experience

to dental trauma and place for seeking treatment

Results

Previous maternal
experience to dental
trauma

The number of participants in this survey included

150 mothers, of which five (3.3%) were from urban
area, 65 (43.3%) were from semiurban area, and 80

Yes
No
P-value

203

N (%)
77 (51.3)
53 (35.3)
15 (10)
5 (3.3)

Place for seeking treatment for avulsion

Hospital or physicians
office N (%)
3 (33.3)
14 (10.1)
<0.05

Dental
clinic N (%)
6 (66.7)
125 (89.9)
<0.05

Journal of Indian Society of Pedodontics and Preventive Dentistry | Jul-Sep 2014 | Vol 32| Issue 3 |

Kruthika, et al.: Knowledge, attitude and perception of dental trauma among mothers

they would save the tooth, when compared to those

mothers who had previous experience of dental
trauma which was significant with P < 0.05 [Table 4].

Table 4: Association between maternal

experience of dental trauma and preservation to
the avulsed tooth

When the childs previous experience of dental trauma

was associated with different variables related to
knowledge on avulsed tooth, none was found to be
statistically significant.

Previous maternal
Preservation of the avulsed tooth when
experience to
found outside the mouth
dental trauma
Dont know
Save N (%) Discard N (%)
what to do N (%)
Yes
0 (0)
9 (100)
0 (0)
No
67 (48.2)
66 (47.5)
6 (4.3)

The questions containing the dichotomized variable as

answers were analyzed separately, it was found that
significant number of respondent and their children
have not experienced dental trauma in their life with
P < 0.05. When asked about the treatment need for
avulsed teeth, almost 99% of the respondents said that
treatment is needed for avulsed tooth [Table 5].
When asked about the perception of mother about
their child who did not have any dental trauma and
pain, about 51.7% of mother responded no treatment
is required and it was found statistically significant
with other options like visiting a dentist, selfmedication, and taking them to general physician
with P < 0.05 [Table 6]. When asked about the time of
treatment required after dental trauma, about 61.6%
of respondent replied that they need it immediately
and was also found to be statistically significant with
P < 0.05 [Table 6].
On the contrary, the perception of mother whose child had
undergone a dental trauma and experienced pain, equal
amount of respondent replied that they had taken them to
dentist or did not undergo any treatment [Table 7].
When asked about the perception of mother towards
avulsed teeth, i.e., if they had found the avulsed tooth
inside the mouth about 91.2% of the mother responded
that they would remove the tooth from the mouth and
if found outside the mouth, about 50.7% of mother
responded that they would discard it. Both the answers
were statistically significant with P < 0.05 [Table 8].
When asked, what you will do with the avulsed
tooth about 58.2% of mother responded that they
would clean the tooth with water, about 20.9% of them
would not clean it and about 17.9% of them would
clean it with tissue paper. When asked about the
transport media for the avulsed tooth, about 94% of
mothers preferred carrying in paper or cloth and none
of the mothers were aware of the fact about carrying it
in mouth or milk, which was found to be statistically
significant with P < 0.05 [Table 9].

Discussion
The questionnaire used in the present survey was
short, with simple, direct, and closed-ended questions.
Similar studies reported in the literature surveyed the
knowledge of parents and teachers concerning the
management of avulsed teeth.[11-14]

P-value

<0.05

<0.05

<0.05

Table 5: Response to dichotomous variables

used in the study
Questions
Have you ever had
any dental trauma?
Did your child ever
have any dental
trauma?
Do you think
treatment is needed
for avulsed tooth?

141 (94)

2 value
22.162

P-value
0.002

7 (4.7)

143 (95.3)

26.349

0.006

148 (98.7)

2 (1.3)

17.392

0.001

Yes (%)

No (%)

9 (6)

Table 6: Response to perception of mother

whose child did not have dental trauma
Child has undergone a dental
trauma and doesnt experience
any pain
Visit a dentist
Will give self-medication
Visit a general physician
No treatment required
When do you think a professional
treatment is needed?
Immediately
Next day
After a week
Only if any pain or other
symptoms are noticed

N (%)

2 value

P-value

59 (41.3)
4 (2.8)
6 (4.2)
74 (51.7)

12.029

0.034

40 (61.6)
14 (21.5)
0 (0)
11 (16.9)

26.106

0.037

Table 7: Response to perception of mother

whose child had dental trauma
What did you do for the
trauma?
Went to the dentist
Took self-medication
Visited a general physician
Didnt undergone any
treatment
When did you go for the
treatment?
Immediately
Next day
Later
Only if any pain or other
symptoms are noticed

N (%)

2 value

P-value

3 (42.9)
0 (0)
1 (14.3)
3 (42.9)

13.477

0.019

3 (75.0)
1 (25.0)
0 (0)
0 (0)

24.796

0.021

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204

Kruthika, et al.: Knowledge, attitude and perception of dental trauma among mothers

Table 8: Response to perception of mothers

towards avulsion
What would you do if the
tooth was in childs mouth,
however, out of place?
Put the tooth back into the
socket
Leave the tooth inside the
mouth
Remove the tooth from the
mouth
Dont know
What will you do if you have
found the knocked out tooth
outside the mouth?
Save
Discard
Dont know what to do

N (%)

2 value

P-value

1 (7)

30.782

0.009

In the present study, only 7% of the mothers were aware

of the immediate reimplantation of an avulsed tooth,
similar to a study reported by Al-Jundi,[14] whereas, the
reports by Oliveira et al.,[15] (39%), Raphael and Gregory[3]
(66.6%), and Hegde et al.,[19] (66.5%) showed that some of
the mothers would reimplant the avulsed tooth, which
clearly indicates the insufficiency in the knowledge about
the immediate management of avulsed tooth. Therefore,
the mothers need to be educated more in this aspect.

19.863

0.027

Cleaning of avulsed permanent teeth must be

performed with saline solution just when visible dirt is
observed. Unfortunately, about 20.9% of the mothers
in the present study answered that they will not clean
the avulsed tooth before going to the dentist and it was
found to be slightly less (31%) when compared with
the study by Oliveira et al.[15]

6 (4.1)
135 (91.2)
6 (4.1)

67 (45.3)
75 (50.7)
6 (4.1)

Table 9: Response to perception of mother

towards preservation and transport media for
avulsed tooth
What will you do with the
saved tooth?
Wash with water/other liquid
Clean it with a tissue or a paper
Dont clean it
Dont know what to do
How will you carry the tooth
to the dentist?
Wrap in paper or gauze
Ice
Water
Milk
In the mouth
Dont know what to do

N (%)

2 value

P-value

39 (58.2)
12 (17.9)
14 (20.9)
2 (3.0)

20.084

0.028

63 (94.0)
3 (4.5)
1 (1.5)
0 (0)
0 (0)
0 (0)

27.501

0.002

The present study was conducted in an interview

method as there was a lack of response in the selfreported questionnaire method in case of previous
studies.[15]
Many reports[11,12,16-18] indicate that there is a lack
of mothers knowledge regarding the immediate
management of dental trauma, which was a similar
finding in this study also.
The preference for seeking treatment for the avulsed
teeth by 90% of the mothers was dental office, which
was similar to study conducted by Oliveira et al.[15]
(93%).
The present study found that about 50% of the mothers
would discard an avulsed tooth, which was similar to
the study conducted by Hegde et al.,[19] (64.8%) and
was much higher than the study conducted by Oliveira
et al.,[15] (10%). This may be due to the fact that they
consider avulsed tooth as an infected material which
needs to be thrown out.
205

In the present study, only 4.1% of mother would leave the

avulsed tooth inside the mouth and it was much lesser
than the study conducted by Oliveira et al.,[15] (32%),
which indicates the lack of awareness among mothers.

When the immediate reimplantation is not performed,

storage mediums that can aid in pulpal and periodontal
healing are milk, sterile saline solution, saliva, etc. But
in the present study, most of the mothers responded
that they would wrap the avulsed tooth in the cloth
or paper (94%), which was found to be much higher
when compared to the studies reported by Oliveira
et al.,[15] (45%) and Hegde et al.[19] (35.8%).
The lack of experience and knowledge expressed by
the parents answering the questionnaire concerning
dental trauma reflects the need for more effective
communication between dental professionals and
parents to enable them to act correctly when facing
a case of dental avulsion. Additionally, educational
campaigns and preventive programs on dental trauma
must be organized to improve caregivers knowledge
on emergency management of dental avulsion.
The limitations of the present study are small sample
size and the trauma experienced individuals were
less; so, the significance obtained in the present study
cannot be extrapolated to the general population.

Conclusion
Within the limitations of the present study it can be
concluded that:
There is lack of knowledge regarding management
of dental trauma among mothers with or without
previous experience of dental trauma
Presence or absence of pain does not influence
the maternal perception of dental attendance for
traumatic dental injuries (TDIs).
The previous maternal experience of dental trauma
does not influence the preservation of an avulsed
tooth

Journal of Indian Society of Pedodontics and Preventive Dentistry | Jul-Sep 2014 | Vol 32| Issue 3 |

Kruthika, et al.: Knowledge, attitude and perception of dental trauma among mothers

Acknowledgments
I would like to acknowledge all the respondents who took
part in this study and my mother, Mrs Meena Murali who
helped a lot in giving moral support in conducting the study.

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How to cite this article: Murali K, Krishnan R, Kumar VS,

Shanmugam S, Rajasundharam P. Knowledge, attitude, and
perception of mothers towards emergency management of
dental trauma in Salem district, Tamil Nadu: A questionnaire
study. J Indian Soc Pedod Prev Dent 2014;32:202-6.
Source of Support: Nil, Conflict of Interest: None declared.

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