Stabilization and Treatment of Dental Avulsions and Fractures by Emergency Physicians Using Just-in-Time Training
Received 25 September 2008; received in revised form 13 April 2009 and 3 June 2009; accepted 24 June 2009. published online 24 August 2009.
Study objective
The objective of this investigation is to use a dental simulation model to compare splinting and bandaging methods for managing tooth avulsions and fractures, as measured by dentist evaluators for quality and time to complete each stabilization procedure.
Methods
This was a randomized crossover study comparing 3 splinting techniques for managing a traumatically avulsed tooth (periodontal pack, wire, and bondable reinforcement ribbon) and 2 bandage techniques for managing a fractured tooth (calcium hydroxide paste and light-cured composite). After viewing a Just-in-Time training video, a convenience sample of emergency physicians performed the 5 stabilization techniques on dental models containing extracted teeth embedded in clay to simulate a segment of the human dentition. Data collected included time to complete each procedure, the evaluation of dentists about whether the procedure was performed satisfactorily or unsatisfactorily, and the ranking of dentists' and participants' preferred technique.
Results
Twenty-five emergency physicians participated in the study: 17 residents, 2 pediatric emergency medicine fellows, and 6 attending physicians. Reported median time, as well as minimum and maximum times to complete each splinting technique for an avulsed tooth, was as follows: periodontal pack 4.4 minutes (2.5 to 6.5 minutes), wire 8.6 minutes (5.8 to 12.9 minutes), and bondable reinforcement ribbon 8.9 minutes (5.6 to 15 minutes). Median time (and minimum and maximum times) to complete each protective bandaging technique for a fractured tooth was calcium hydroxide paste 4.6 minutes (3 to 9.6 minutes) and light-cured composite 7.1 minutes (5.5 to 14.1 minutes). When asked to choose a preferred splinting and bandaging technique according to the performance of the physicians, the dentists chose the bondable reinforcement ribbon 96% (24/25) and the light-cured composite 100% (25/25) of the time. Study participants had no measurable or agreeable preference for a particular splinting or bandaging technique.
Conclusion
The results of this study suggest that of the stabilization procedures completed by emergency physicians, dentists preferred the bondable reinforcement ribbon for managing an avulsed tooth and the light-cured composite technique for managing a fractured tooth over the commonly taught and more frequently used procedures in emergency medicine.
aDepartment of Emergency Medicine, University of Florida Health Science Center Jacksonville, Jacksonville, FL
bDental Programs, Florida Community College at Jacksonville, Jacksonville, FL
Address for correspondence: Mark S. McIntosh, MD, MPH, Department of Emergency Medicine, University of Florida Health Science Center Jacksonville, 655 West 8th Street Box C506, Jacksonville, FL 32209; 904-244-4934, fax 904-244-4077
Supervising editors: Robert D. Welch, MD, MS; Judd E. Hollander, MD
Author contributions: MSM and CJK were responsible for protocol development and general supervision of the study. MSM, JK, CJK, TW, AK, and MM-J were responsible for simulation models and data collection. JS and HS performed ratings of effectiveness. RLW conducted statistical analysis. MSM, JK, RLW, JS, HS, CJK, TW, AK, and MM-J were responsible for article writing and editing. MSM takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. We claim no conflict of interest with any of the industries that manufacture the materials that we used. All materials were selected and purchased independently by funds allocated by our University of Florida and Shands/Jacksonville emergency department. Researchers had no previous opinion about which procedure would perform best.
Publication date: Available online August 24, 2009.
ABSTRACT