title: Stabilization and treatment of dental avulsions and fractures by emergency physicians using just-in-time training.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, University of Florida Health Science Center Jacksonville, Jacksonville, FL 32209, USA. mark.mcintosh@jax.ufl.edu
authors.forename: Mark S
authors.initials: MS
authors.lastname: McIntosh
authors.forename: Jason
authors.initials: J
authors.lastname: Konzelmann
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Smith
authors.forename: Colleen J
authors.initials: CJ
authors.lastname: Kalynych
authors.forename: Robert L
authors.initials: RL
authors.lastname: Wears
authors.forename: Howard
authors.initials: H
authors.lastname: Schneider
authors.forename: Todd
authors.initials: T
authors.lastname: Wylie
authors.forename: Anne
authors.initials: A
authors.lastname: Kaminski
authors.forename: Madeline
authors.initials: M
authors.lastname: Matar-Joseph
mesh_terms: D002983:Clinical Competence; D003194:Computer-Assisted Instruction; D003794:Dental Restoration, Temporary / Q000379:methods; D004497:Education, Dental / Q000379:methods*; D004521:Educational Measurement; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital; D006801:Humans; D007318:Inservice Training; D003765:Models, Dental; D014084:Tooth Avulsion / Q000628:therapy*; D014082:Tooth Fractures / Q000628:therapy*; D014090:Tooth Replantation / Q000379:methods