Traumatic dental injuries occur frequently in children and adolescents cross the world with a wide prevalence rate ranging between 4.9 and 37% (Ozer et al. 2012). Permanent tooth avulsion: complete detachment of tooth from the socket is the most complicated and serious type of dental trauma (Andreasen et al. 2019). It comprises 1–16% of dental injuries, with peak incidence in 7–11-year-old children affecting mainly the maxillary central incisors (Andreasen et al. 2019).

Prompt and appropriate onsite intervention of avulsed teeth is crucial for the success and survival of affected teeth. Ideally, an avulsed tooth should be immediately replanted into its socket to avoid further damage to the periodontal ligament cells (Fouad et al. 2020). Studies have shown that the prognosis of avulsed teeth depends on many factors including time elapsed between trauma and replantation, the type and condition of storage medium, the stage of root formation and the presence of contamination (Santos et al. 2009). Andreasen et al. (2019) reported that survival rates of avulsed teeth range between 39 and 89% with higher success rates of teeth managed appropriately especially at the site of injury.

Storage media have a critical role in the survival of periodontal ligament cells (Fouad et al. 2020). While dry storage causes an irreversible injury to the periodontal ligament cells, resulting in loss of the replanted tooth over time, wet media differ in their role. Milk, which is readily available and accessible at the place of injury, has a favourable osmolality and composition for the viability of periodontal ligament cells, therefore, has been recommended for temporary storage of avulsed teeth (Blomlöf 1981; Blomlöf et al. 1983). While water is not recommended, as a result of its low osmolality, the use of patient’s own saliva could be used for short storage periods (Cvek et al. 1974; Andreasen 1981; Andreasen et al. 1995). The use of especially composed cell culture media has been recommended in the literature; however, such media are seldom accessible at the place of accident (Andreasen et al. 1995; Chappuis and von Arx 2005; Andreasen et al. 2019).

Parents are usually present at the site of injury; therefore, understanding their level of knowledge on the appropriate management of avulsed teeth and their willingness to replant these teeth in a timely manner are of great importance in improving the long-term prognosis of avulsed teeth. Such area has never been assessed in the State of Qatar where the culture and sociodemographic structure are unique and different to that of neighbouring and international countries. Therefore, the aim of this study was to elucidate the level of parental knowledge with respect to the management of avulsed teeth and willingness to replant them in the State of Qatar. Furthermore, parent’s preference of the means of obtaining such knowledge has been assessed.

The study was presented in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement (STROBE).

This was a cross-sectional study where ethical approval was obtained from the Medical Research Center (MRC) at Hamad Medical Corporation (HMC), Doha, Qatar (MRC-01-19-086).

Parents of children attending the paediatric dental department at Hamad Dental Centre, Hamad Medical Corporation, Doha, Qatar, for their children’s routine dental appointments were invited to take part in this study. Parents, able to read and write Arabic, were consecutively recruited by approaching them to take part in this study. Informed consent was obtained prior to asking the participants to complete the anonymous study questionnaire while waiting for their child’s appointment. Data collection was performed between April 2019 and February 2020.

The primary outcome of this study was the level of parental knowledge with respect to the management of avulsed teeth. Sociodemographic variables were considered predictors (independent variables), which included gender, age, education level, and income. Parents willingness to replant avulsed teeth at the site of injury and their preference on the method of obtaining appropriate management information were also sought as secondary outcomes.

A 16-item hard copy questionnaire was constructed based on previous studies that investigated parental previous experiences and awareness of different aspects of the emergency management of avulsed permanent teeth (Al-Jame et al. 2007; Santos et al. 2009; Jain et al. 2017; Li et al. 2018). The questionnaire consisted of four distinct sections as follows:

The first section aimed at acquiring sociodemographic characteristics namely; age, gender, educational level, and monthly income. Age was categorised into “20–30”, “31–40”, “41–50”, and “ > 50 years”; while educational level was categorised into primary, preparatory, high school, university, and higher education.

The second section aimed at acquiring information related to parents’ prior knowledge on the management of avulsion, the source of such information, and whether parents were previously directly involved in the management of an avulsion case.

The third section aimed at acquiring information related to parents’ willingness on replanting avulsed teeth at the site of injury and knowledge of different aspects of the emergency management of avulsed permanent teeth. The questions included the ability to differentiate between primary and permanent dentition, the possibility of reinsertion of avulsed teeth, the correct timing to reinsert the tooth, the preferred tooth cleaning options and transportation media, and the best timing and location for seeking professional help. The fourth section aimed at obtaining parents’ opinion as to the best format for future parental education on the management of dental trauma.

Bilingual independent Arabic/English language speakers were involved in forward and backward translations of the original English questions (Hambleton and Zenisky 2010). Furthermore, the questionnaire was piloted on 25 participants to evaluate ease of understanding and appropriateness of the questions. The participants from the pilot study were excluded from the main study sample.

Based on the literature, parental knowledge with respect to emergency management of avulsed permanent teeth in children and adolescents is highly variable ranging from 25 to 60% (Al-Jame et al. 2007; Hashim 2012; Ozer et al. 2012; Alyahya et al. 2018; Alharbi et al. 2020). Therefore, assuming that our cohort had 40% of knowledge with precision of estimate (margin of error) of 5% and 95% level of confidence, a sample size calculation resulted in the need for 370 participants to achieve the objectives of this study. However, the sample size was increased to 400 to account for different subgroup analysis.

The following formula was used in calculating sample size:

n 1⁄4 [Z21–α/2 P(1–P) / d2], where n 1⁄4 sample size, Z 1⁄4 Z statistic for a level of confidence (for the level of confidence of 95%, which is conventional, Z value is 1.96), P 1⁄4 expected prevalence or proportion. d 1⁄4 precision (in proportion of one; if 5%, d 1⁄4 0.05).

Descriptive and analytical statistics were conducted. With respect to descriptive statistics, frequency of distribution in relation to demographic data and responses to items of the questionnaire were presented. For analytical statistics, univariate and multivariate logistic regressions were employed to assess the association between the independent variables (sociodemographic status) and knowledge in the management of avulsion. The scoring of knowledge in the management of avulsion was based on the percentage of the correct answers (favourable answers). The percentage of correct answers was calculated by dividing the number of correct answers to the maximum possible number of correct answers multiplied by 100. A percentage of 49 or below was considered poor, 50–69 fair, and > 70 good. To facilitate the regression analyses, the outcomes were dichotomized to either favourable (≥ 50%) or unfavourable answers (˂50%). Independent variables which were significantly associated in the unadjusted regression at (P = 0.2) were entered into a final multivariate logistic regression to evaluate their effects after adjustment. The p-value was set as 0.05 in the final model, and SPSS 22.0 software (SPSS Inc. Chicago, IL, USA) was used for analysis.