Knowledge and Self-Reported Practice of Iranian Elementary School Students Towards Traumatic Dental Injuries
Abstract
Introduction: Traumatic dental injuries (TDIs) are common among school-aged children and often require immediate and appropriate first-aid management to improve treatment outcomes. However, evidence regarding children’s knowledge and intended responses to TDIs in Iran remains limited. This study aimed to assess the knowledge and self-reported practice of Iranian elementary school students regarding the emergency management of TDIs and to identify associated factors. Materials and Methods: A descriptive-analytical cross-sectional study was conducted among 487 students aged 10–13 years from four public elementary schools in Tehran, Iran. Participants completed a structured self-administered questionnaire comprising demographic characteristics, 10 knowledge items, and 5 scenario-based self-reported practice items related to TDI management. Knowledge and practice scores were converted to percentages, with higher scores indicating better performance. Data were analyzed using descriptive statistics, Pearson’s correlation coefficient, and multiple linear regression analysis. Results: The mean age of participants was 10.73 ± 0.85 years, and 57.1% were female. The mean knowledge score was 64.83 ± 9.54, while the mean self-reported practice score was 80.89 ± 16.30. Although most students recognized the importance of seeking immediate dental care after tooth mobility (82.1%), only 6.6% knew that an avulsed permanent tooth could be replanted. Knowledge regarding the critical extra-alveolar time and appropriate storage media for avulsed teeth was also low. Only 4.5% of participants selected immediate replantation as the correct management of an avulsed tooth, and 17.7% identified milk as an appropriate storage medium. Regression analysis showed that knowledge scores were positively associated with previous TDI training (β = 0.15, p = 0.001) and negatively associated with age (β = −0.10, p = 0.03). Self-reported practice scores were associated with gender (β = 0.19, p < 0.001), while an unexpected inverse association was observed with previous training (β = −0.15, p = 0.001). Conclusion: Elementary school students demonstrated inadequate knowledge regarding the emergency management of TDIs, particularly tooth avulsion. School-based educational interventions are needed to improve emergency preparedness and evidence-based responses to dental trauma. Keywords: Tooth injuries; Knowledge; Practice; Students; Child; Adolescent.
1. Glendor U. Epidemiology of traumatic dental injuries–a 12 year review of the literature. Dent Trauma. 2008;24(6):603-11.
2. Azami-Aghdash S, Azar FE, Azar FP, Rezapour A, Moradi-Joo M, Moosavi A, et al. Prevalence, etiology, and types of dental trauma in children and adolescents: systematic review and meta-analysis. Med J Islam Repub Iran. 2015;29(4):234.
3. Aminu K, Kanmodi KK, Amzat J, Salami AA, Uwambaye P. School-based interventions on dental trauma: a scoping review of empirical evidence. Children (Basel). 2023;10(5):797.
4. Petti S, Glendor U, Andersson L. World traumatic dental injury prevalence and incidence, a meta‐analysis—One billion living people have had traumatic dental injuries. Dent Trauma. 2018;34(2):71-86.
5. Lam R. Epidemiology and outcomes of traumatic dental injuries: a review of the literature. Aust Dent J. 2016;61:4-20.
6. Khoshnevisan M, Ghasemianpour M, Samadzadeh H, Baez R. Oral health status and healthcare system in IR Iran. J Contemp Med Sci. 2018;4(3):107-18.
7. Nowosielska M, Bagińska J, Kobus A, Kierklo A. How to Educate the Public about Dental Trauma—A Scoping Review. Int J Environ Res Public Health. 2022;19(4):2479.
8. Hashim R, Luke AM, Salah A, Mathew S. Traumatic dental injuries in permanent teeth among Arab children: prevalence, and associated risk factors—a systematic review and meta-analysis. PeerJ. 2024;12:e18366.
9. Antunes LS, Debossan PF, Bohrer LS, Abreu FV, Quintanilha LELP, Antunes LAA. Impact of traumatic dental injury on the quality-of-life of children and adolescents: a case-control study. Acta Odontol Scand. 2013;71(5):1123-8.
10. El-Kalla IH, Shalan HM, Bakr RA. Impact of dental trauma on quality of life among 11–14 years schoolchildren. Contemp Clin Dent. 2017;8(4):538-44.
11. Milani AJ, Castilho T, Assaf AV, Antunes LS, Antunes LAA. Impact of traumatic dental injury treatment on the oral health‐related quality of life of children, adolescents, and their family: systematic review and meta‐analysis. Dent Trauma. 2021;37(6):735-48.
12. Rouijel S, Bouchouk M, Zidane FE, Toure B. Awareness, knowledge and attitudes toward management of avulsed permanent incisors among primary school teachers. Clin Cosmet Investig Dent. 2024:267-72.
13. Tewari N, Goel S, Srivastav S, Mathur VP, Rahul M, Haldar P, et al. Global status of knowledge of parents for emergency management of traumatic dental injuries: a systematic review and meta-analysis. Evid Based Dent. 2023;24(2):91-.
14. Alshubat A, Bantan FS, AlNasser Y, Alhejji MT, Alsuwailem SH, Alibrahim MI, et al. Awareness and Knowledge of Tooth Reimplantation After Avulsion Among Dental and Non-dental Populations: A Systematic Review. Cureus. 2025;17(12).
15. Adekoya-Sofowora C, Oziegbe E, Ugboko V, Akinbade A. Knowledge of first aid measure of avulsion and replantation of teeth in Nigerian school children. Inter J Dent Sci. 2008;7(1):11-20.
16. Al Zaher N, Dashash M. An educational intervention for improving knowledge of Syrian school children about avulsion using the" save your tooth" poster. BMC Oral Health. 2021;21(1):1-6.
17. Castilho LR, Sundefeld MLMM, De Andrade DF, Panzarini SR, Poi WR. Evaluation of sixth grade primary schoolchildren’s knowledge about avulsion and dental reimplantation. Dent Trauma. 2009;25(4):429-32.
18. Rice SG, Medicine CoS, Fitness. Medical conditions affecting sports participation. Pediatrics. 2008;121(4):841-8.
19. Dhindsa A, Singh G, Garg S, Kour G, Kaur A, Loomba A, et al. Knowledge regarding avulsion, reimplantation and mouthguards in high school children: Organised sports-related orodental injuries. J Family Med Prim Care. 2019;8(11):3706-12.
20. Goswami M, Kumar P, Bhushan U. Evaluation of knowledge, awareness, and occurrence of dental injuries in participant children during sports in New Delhi: A pilot study. Int J Clin Pediatr Dent. 2017;10(4):373.
21. Shenoy N, Kaur S, Kini K S, Shetty N, Lakshmi R V. Knowledge, Attitude, and Awareness of Adolescents on the Emergency Management of Traumatic Dental Injuries. Dent J. 2026;14(3):182.
22. Spodzieja K, Mól W, Piekoszewska–Ziętek P, Studnicki M, Olczak-Kowalczyk D. Knowledge of first-aid management of traumatic dental injuries among secondary school students in Central Poland: a cross-sectional study. Saudi Dent J. 2026;38(2):15.
23. Young C, Wong KY, Cheung LK. A survey on Hong Kong secondary school students' knowledge of emergency management of dental trauma. PloS One. 2014;9(1):e84406.
24. Eigbobo JO, Etim SS. An Assessment of Emergency Care Following Tooth Avulsion among a selected population of Nigerian school children. Inter Ped Dent Open Acc J. 2020;3(5):265-70.
25. Andersson L, Al‐Asfour A, Al‐Jame Q. Knowledge of first‐aid measures of avulsion and replantation of teeth: an interview of 221 Kuwaiti schoolchildren. Dent Trauma. 2006;22(2):57-65.
2. Azami-Aghdash S, Azar FE, Azar FP, Rezapour A, Moradi-Joo M, Moosavi A, et al. Prevalence, etiology, and types of dental trauma in children and adolescents: systematic review and meta-analysis. Med J Islam Repub Iran. 2015;29(4):234.
3. Aminu K, Kanmodi KK, Amzat J, Salami AA, Uwambaye P. School-based interventions on dental trauma: a scoping review of empirical evidence. Children (Basel). 2023;10(5):797.
4. Petti S, Glendor U, Andersson L. World traumatic dental injury prevalence and incidence, a meta‐analysis—One billion living people have had traumatic dental injuries. Dent Trauma. 2018;34(2):71-86.
5. Lam R. Epidemiology and outcomes of traumatic dental injuries: a review of the literature. Aust Dent J. 2016;61:4-20.
6. Khoshnevisan M, Ghasemianpour M, Samadzadeh H, Baez R. Oral health status and healthcare system in IR Iran. J Contemp Med Sci. 2018;4(3):107-18.
7. Nowosielska M, Bagińska J, Kobus A, Kierklo A. How to Educate the Public about Dental Trauma—A Scoping Review. Int J Environ Res Public Health. 2022;19(4):2479.
8. Hashim R, Luke AM, Salah A, Mathew S. Traumatic dental injuries in permanent teeth among Arab children: prevalence, and associated risk factors—a systematic review and meta-analysis. PeerJ. 2024;12:e18366.
9. Antunes LS, Debossan PF, Bohrer LS, Abreu FV, Quintanilha LELP, Antunes LAA. Impact of traumatic dental injury on the quality-of-life of children and adolescents: a case-control study. Acta Odontol Scand. 2013;71(5):1123-8.
10. El-Kalla IH, Shalan HM, Bakr RA. Impact of dental trauma on quality of life among 11–14 years schoolchildren. Contemp Clin Dent. 2017;8(4):538-44.
11. Milani AJ, Castilho T, Assaf AV, Antunes LS, Antunes LAA. Impact of traumatic dental injury treatment on the oral health‐related quality of life of children, adolescents, and their family: systematic review and meta‐analysis. Dent Trauma. 2021;37(6):735-48.
12. Rouijel S, Bouchouk M, Zidane FE, Toure B. Awareness, knowledge and attitudes toward management of avulsed permanent incisors among primary school teachers. Clin Cosmet Investig Dent. 2024:267-72.
13. Tewari N, Goel S, Srivastav S, Mathur VP, Rahul M, Haldar P, et al. Global status of knowledge of parents for emergency management of traumatic dental injuries: a systematic review and meta-analysis. Evid Based Dent. 2023;24(2):91-.
14. Alshubat A, Bantan FS, AlNasser Y, Alhejji MT, Alsuwailem SH, Alibrahim MI, et al. Awareness and Knowledge of Tooth Reimplantation After Avulsion Among Dental and Non-dental Populations: A Systematic Review. Cureus. 2025;17(12).
15. Adekoya-Sofowora C, Oziegbe E, Ugboko V, Akinbade A. Knowledge of first aid measure of avulsion and replantation of teeth in Nigerian school children. Inter J Dent Sci. 2008;7(1):11-20.
16. Al Zaher N, Dashash M. An educational intervention for improving knowledge of Syrian school children about avulsion using the" save your tooth" poster. BMC Oral Health. 2021;21(1):1-6.
17. Castilho LR, Sundefeld MLMM, De Andrade DF, Panzarini SR, Poi WR. Evaluation of sixth grade primary schoolchildren’s knowledge about avulsion and dental reimplantation. Dent Trauma. 2009;25(4):429-32.
18. Rice SG, Medicine CoS, Fitness. Medical conditions affecting sports participation. Pediatrics. 2008;121(4):841-8.
19. Dhindsa A, Singh G, Garg S, Kour G, Kaur A, Loomba A, et al. Knowledge regarding avulsion, reimplantation and mouthguards in high school children: Organised sports-related orodental injuries. J Family Med Prim Care. 2019;8(11):3706-12.
20. Goswami M, Kumar P, Bhushan U. Evaluation of knowledge, awareness, and occurrence of dental injuries in participant children during sports in New Delhi: A pilot study. Int J Clin Pediatr Dent. 2017;10(4):373.
21. Shenoy N, Kaur S, Kini K S, Shetty N, Lakshmi R V. Knowledge, Attitude, and Awareness of Adolescents on the Emergency Management of Traumatic Dental Injuries. Dent J. 2026;14(3):182.
22. Spodzieja K, Mól W, Piekoszewska–Ziętek P, Studnicki M, Olczak-Kowalczyk D. Knowledge of first-aid management of traumatic dental injuries among secondary school students in Central Poland: a cross-sectional study. Saudi Dent J. 2026;38(2):15.
23. Young C, Wong KY, Cheung LK. A survey on Hong Kong secondary school students' knowledge of emergency management of dental trauma. PloS One. 2014;9(1):e84406.
24. Eigbobo JO, Etim SS. An Assessment of Emergency Care Following Tooth Avulsion among a selected population of Nigerian school children. Inter Ped Dent Open Acc J. 2020;3(5):265-70.
25. Andersson L, Al‐Asfour A, Al‐Jame Q. Knowledge of first‐aid measures of avulsion and replantation of teeth: an interview of 221 Kuwaiti schoolchildren. Dent Trauma. 2006;22(2):57-65.
| Files | ||
| Issue | Vol 13, No 3 (Summer 2026) | |
| Section | Original Article(s) | |
| Keywords | ||
| Tooth injuries; Knowledge; Practice; Students; Child; Adolescent. | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Hosseinzadeh H, Mohebbi S, Kharazifard M, Razeghi S. Knowledge and Self-Reported Practice of Iranian Elementary School Students Towards Traumatic Dental Injuries. J Craniomaxillofac Res. 2026;13(3):327-337.
