title: Socio-economic burden of permanent incisor replantation on children and parents.
abstract: This study describes the socio-economic burden and attitudes of children and their parents following replantation of avulsed incisors. Records of 80 patients with 99 avulsion injuries treated in a teaching hospital clinic from 1988 to 1999 were reviewed. Mean age at time of injury was 10.6 years (range = 6.6-17.7 years). Complete records for a minimum of 1 year were obtained for 43 patients with 60 replanted incisors. Mean treatment procedures provided during the first year included 5.5 diagnostic periapical radiographs, 1.9 occlusal radiographs, 1.3 pulpectomies, and 2.7 pulp medicament applications. The mean estimated treatment cost and direct time (dentist) for first-year post-trauma management was 1465 dollars CAD and 7.2 h, respectively. Treatment costs were significantly higher during the first year post-trauma for patients who had their incisors extracted (P = 0.04), but there was no significant difference in direct treatment time between the two groups (P = 0.19). Twenty-one patient-parent pairs were surveyed for a number of qualitative factors. Ninety per cent of patients and 86% of parents reported that school and work time was lost. Even after having gone through the painful experience of replantation, the demands of recall, and in some cases, extraction, the majority of patients (67%) and parents (81%) stated that they would have still made the same (replantation) decision. Patient and parent responses were not statistically different (P = 0.453). Almost half the parents stated they would be willing to pay over 2000 dollars CAD to save an incisor. Patients rated retention of an incisor as significantly more important than infraocclusion. This is the first study to quantify the treatment burden of replantation of avulsion injuries exclusively in the pediatric population. This study describes the socio-economic burden and responsibilities of patient/parent and dentist and their role in informed consent.
authors.affiliation: The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Phu-My T
authors.initials: PM
authors.lastname: Nguyen
authors.forename: David J
authors.initials: DJ
authors.lastname: Kenny
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Barrett
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D001294:Attitude to Health; D002648:Child; D002755:Choice Behavior; D017281:Cost of Illness; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D007180:Incisor / Q000293:injuries*; D008297:Male; D009864:Ontario; D010290:Parents / Q000523:psychology; D011670:Pulpectomy / Q000191:economics; D011861:Radiography, Dental / Q000191:economics; D012189:Retrospective Studies; D012390:Root Canal Therapy / Q000191:economics; D013997:Time Factors; D014084:Tooth Avulsion / Q000191:economics* / Q000523:psychology; D014081:Tooth Extraction / Q000191:economics; D014090:Tooth Replantation / Q000191:economics* / Q000523:psychology