A Survey on Hong Kong Secondary School Students’ Knowledge of Emergency Management of Dental Trauma

A Survey on Hong Kong Secondary School Students’
Knowledge of Emergency Management of Dental
Trauma
Cecilia Young1
*, Kin Yau Wong2
, Lim K. Cheung3,4
1 Private Practice, Hong Kong, 2 Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America, 3 BDS
(Glasgow), FFDRCS (Ireland), FDSRCPS (Glasgow), FRACDS (Australia), FRACDS (OMS) (Australia), PhD (HK), Hon FDSRCS (Edin), FHKAM (Dental Surgery), FCDSHK (Oral and
Maxillofacial Surgery), 4 Chair Professor, Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong
Abstract
Objectives: To investigate Hong Kong secondaryschool students’ knowledge of emergency management of dental trauma.
Method: A questionnaire survey on randomly selected secondary school students using cluster sampling.
Results: Only 36.6% (209/571) of the respondents were able to correctly identify the appropriate place for treatment of
dental injury. 55.2% of the respondents knew the suitable time for treatment. Only 24.7% of the respondents possessed the
knowledge of how to correctly manage fractured teeth. Only 23.6% of them knew how to manage displaced teeth. 62.5% of
them correctly answered that knocked-out deciduous teeth should not be replanted to the original position, but few of
them (23.6%) knew that permanent teeth should be replanted. Moreover, 37.1% of the respondents correctly identified at
least one of the appropriate media for storing a knocked-out tooth. First-aid training and acquisition of dental injury
information from other sources were significant factors that positive responses from these questions would lead to higher
scores.
Conclusion: Hong Kong secondary school students’ knowledge of emergency management of dental trauma is considered
insufficient. An educational campaign in secondary schools dedicated to students is recommended. Prior first-aid training
and acquisition of dental injury information from other sources positively relate to the level of knowledge. Dental trauma
emergency management is recommended to be added to first-aid publications and be taught to students and health
professionals.
Trial Registration: Hong Kong Clinical Trial Centre HKCTR-1344
Citation: Young C,Wong KY,Cheung LK(2014) A Survey on Hong Kong Secondary School Students’ Knowledge of Emergency Management of Dental Trauma.
PLoSONE9(1): e84406.doi:10.1371/journal.pone.0084406
Editor: Steve Milanese, University of South Australia, Australia
Received February 28, 2013; Accepted November 14, 2013; Published January 6, 2014
Copyright: © 2014 Young et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: There is no external funding for thisstudy.
Competing Interests: The authors have declared that no competing interests exist.
* E-mail: ceciliatyp@yahoo.com.hk
Introduction
The consequences of traumatic dental injuries range from tooth
fractures to avulsion of the whole tooth. The prognosis of some of
the dental injuries, especially avulsion, depends on early manage-
ment [1].
Surveys on children and adolescents have shown that falls [2–
14], sports activities [2,3,5,7,9,12–14], collisions [3,9,11,12],
physical leisure activities [3,7,11–13], being struck by an object
[4,6,11,12] and traffic accidents [2,5] are the major causes of
traumatic dental injuries. Among them, fall is the main cause of
traumatic dental injuries [4,6–14].
Home [6,7,9–12] and school [6,7,9–11] are the most common
places where traumatic dental injuries occur. If the patient or
persons nearby can perform immediate management at the site of
injury, the level of harm can be reduced.
It is important to study whether students know how to perform
simple but essential emergency procedures before a patient
suffering dental trauma reaches professional care. Evaluating the
corresponding knowledge level of students is important for
understanding the need for educational campaigns. This informa-
tion can also assist health promoters in requesting additional
resources.
Searching for the keywords ‘‘knowledge’’ and (‘‘dental trauma’’
or ‘‘dental injur*’’ or ‘‘traumatic dental injur*’’) on Pubmed and
Ovid Medline prior to the present study only resulted in three
papers on children and youngster which are related to knowledge
of dental trauma [15–17]. The results were the same up to Aug 27,
2013. Among the three papers, Castilho et al. studied sixth grade
primary school children [15]. Andersson et al. interviewed 7- to
15-year-old school children [16]. Biagi et al. studied an 8- to 15-
year-old group [17]. These authors concluded that these children
and youngsters’ knowledge of dental trauma was insufficient. No
such information on students’ knowledge of emergency manage-
ment of dental trauma in Hong Kong was available.
PLOSONE| www.plosone.org 1 January 2014 | Volume 9 | Issue1 | e84406

There were 663 secondary schools with a total of 454,244
students in Hong Kong in 2011. Children aged around 6 years
enter primary schools from Primary 1 to Primary 6 (US Grade 1–
6). Then, they attend secondary schools from Form 1 at around
age 12 to Form 7 (US Grade 7–12 plus 1 year). We chose the
secondary school students from Form 1 to Form 7 because they
should be able to comprehend written questionnaires.
Objectives
1. To investigate Hong Kong secondary school students’
knowledge of emergency management of dental trauma.
2. To investigate whether the secondary school students consider
themselves capable of distinguishing between permanent and
deciduous teeth.
Methods
Ethical approval
The Institutional Review Board of the University of Hong Kong
and Hospital Authority Hong Kong West Cluster approved this
research project (UW11- 186, HKCTR-1344), which complied
with the Declaration of Helsinki and ICH GCP guidelines. The
protocol for this study is available as supporting information; see
attached Protocol S1.
Subjects
The target group of this study was secondary school students
from Form 1 to Form 7 (US Grade 7–12 plus 1 year) in Hong
Kong who read Chinese orEnglish.
Sample size calculation
For the calculation of sample size for the estimation of the
proportion of students having score higher than a certain threshold
level, we used a 95% confidence level with 10% precision. As the
population variance was unknown, we adopted P = 50% to allow
for the greatest variance. Assuming an infinite population size, we
needed a sample size of 97. To account for the cluster sampling
design, we multiplied a design effect of 1+(m21) r, with m being
the cluster size and r being the intracluster correlation (ICC). We
set the cluster size to be 40 and assumed an ICC of 0.1. No
published data on ICC under this setting could be found.
However, in general practice studies, ICC takes values commonly
between 0.01 and 0.05 [18], so 0.1 is a conservative estimate. We
needed a sample size of 476, or a total of 12 schools. To account
for possible blank or incomplete returned questionnaires, we
aimed at recruiting an extra 20%, which resulted in 15 schools or
600 students.
Questionnaire design
Chinese and English questionnaires were constructed. The
questionnaire consisted of 2 sections with a total of 14 questions.
The first section included basic demographic information, whether
the respondents had received formal first-aid training and
acquired dental trauma information and whether they considered
themselves capable of distinguishing between permanent or
deciduous teeth. The second part consisted of 6 questions
concerning the knowledge of dental traumatic injuries. The same
set of questions on dental knowledge was used in the survey for
primary and secondary school teachers in Hong Kong from the
same series of studies[19].
The questionnaire is provided as supporting information. For
Q9 to Q13, 1 mark would be given for a correct answer, no mark
would be given for ‘‘do not know’’ and 1 mark would be deducted
for an incorrect answer. If multiple answers were chosen, 1 mark
would be deducted for that question if an incorrect answer was
chosen. There were three correct answers for Q14 as the media for
storing avulsed teeth. As avulsion is the most serious dental
trauma, it is necessary to manage the emergency correctly right at
the scene in order to save the avulsed teeth. The more storing
media a person is aware of, the more likely he/she would be able
to find one in time for keeping the vitality of the periodontal cells
on the root surface of an avulsed tooth, thus improving the
prognosis. Therefore, 1 mark would be given for a correct answer
but 1 mark would be deducted for an incorrect answer. Multiple
answers were allowed.
Validity and reliability of questionnaire
The questionnaire was pilot tested with 59 students. Face
validity was established by expert opinion; length and whether
secondary school students could comprehend it were pre-tested
before adoption.
In the reliability test, a group of 39 students from a local
secondary school was recruited, and each was asked to complete
the questionnaire. After two weeks, the group was asked to
complete the same questionnaire again. All students returned the
second questionnaire.
To assess the test-retest reliability, paired t-tests were conducted.
For each question, the null hypothesis was that there was no
significant difference between the scores of the first and second
questionnaires. The level of significance was 5%. The Pearson’s
product moment correlation coefficient was also calculated for
each question. A correlation coefficient closer to 1 indicates a
higher reliability, as it represents a higher correlation between the
scores of the first and second questionnaires. The results are
presented in Table 1.
All differences of the scores were not significantly different from
zero at 5% significance as all the 95% confidence intervals
included 0. However, the confidence interval for the total score did
not include zero. The correlations were generally high, at levels
around 0.9.
Recruitment andimplementation
We sent invitations to schools in batches starting on May 13,
2011 until the desired sample size was reached. Each batch
consisted of 15 schools (5 for Forms 1–3, 5 for Forms 4 – 5 and 5
for Forms 6 – 7), which were randomly selected from the list of
secondary schools obtained from the Educational Bureau using
simple random sampling. An invitation pack sent to each selected
school included the invitation letter, a school consent form, 50
individual guardian’s consent forms, and 50 questionnaires.
After four batches of mailings, adding up to 60 schools, were
sent, 14 schools returned the school consent forms, individual
guardian’s consent forms and the filled questionnaires. Invitation
packs were sent to another 2 schools. On Oct 10, 2011, one more
school returned the filled materials.
We requested each school to invite one or more classes with at
least 40 students. We asked them to photocopy the guardian’s
consent forms and questionnaires if necessary. A teacher in charge
from each school was responsible for obtaining consent forms and
the distribution, supervision and collection of questionnaires. The
teacher in charge made clear that the whole procedure was a
survey instead of an examination and that there should be no
discussion on the questionnaire.
The participating students could withdraw from the study at any
time. This was mentioned in the invitation letter and in both
consent forms.
Students’ Knowledge on Dental Trauma

Statistical analysis
For each question concerning knowledge of dental trauma, the
number and proportion of respondents who chose the correct
answer(s) are reported.
To investigate the effects of the demographic and education
backgrounds on the knowledge, a multiple linear regression on the
total score was conducted, with independent variables (fixed
effects) gender, age, form, receipt of first-aid training, dental injury
content in first-aid training, confidence in distinguishing the type
of teeth and acquisition of dental injury information from other
sources. The school effect was considered as a random effect,
which acted addictively to the total score. The school-specific
random effect was normally distributed with zero mean and
unknown variance.
The two variables, receipt of first-aid training and the dental
injury content in first-aid training, were jointly represented by two
dummy variables, X5 and X6. The definitions were: X5 = 1 if the
respondent received first-aid training without dental injury
Table 1. Test-Retest Results.
Original Retest Within person differences (Retest – Test) Correlation
Mean SD* Mean SD Mean (95% CI)
Q9 20.38 0.85 20.31 0.86 0.08 (20.04,0.19) 0.91
Q10 0.23 0.90 0.28 0.89 0.05 (20.05,0.16) 0.94
Q11 20.05 0.86 20.05 0.86 0 (0,0) 1
Q12 20.44 0.75 20.41 0.75 0.03 (20.03,0.08) 0.98
Q13 0.31 0.80 0.44 0.85 0.13 (20.004,0.26) 0.88
Q14 20.08 0.98 20.03 0.99 0.05 (20.02,0.12) 0.97
Total 20.41 2.12 20.08 2.08 0.33 (0.07, 0.59) 0.93
*SD= Standard Deviation.
doi:10.1371/journal.pone.0084406.t001
Table 2. Part 1 Demographics and characteristics of respondents.
No. of respondents (n = 571) Proportion of respondent (%)
Gender
Male 228 39.9
Female 343 60.1
Age
10 or below 1 0.2
11 –13 132 23.1
14 –16 308 53.9
17 –19 121 21.2
20 or above 9 1.6
Form
Form 1 – 3 249 43.6
Form 4 – 5 255 44.7
Form 6 – 7 67 11.7
Received First-aid Training
Yes 51 8.9
No 520 91.1
Learnt Dental Injury Management in First-aid Training
Yes 17 3.0
No 554 97.0
Confident in Distinguishing Type of Teeth
Yes 135 23.6
No 436 76.4
Read or heard dental injury information besides from First-aid Training
Yes 170 29.8
No 401 70.2

Table 3. Options chosen in knowledge section.
Proportion (%)*
Q9 Place for Treatment
Go to the casualty in the nearest hospital on foot or by any transport 25.4
Callan ambulance; go to the casualty in the nearest hospital 15.6
Go to the nearest private doctor 5.3
Go to the patient’s familydoctor 2.5
Go to a dentist 44.7
Treat it by self 4.2
Others 0.4
Don’t Know 14.7
Q10 Time for Treatment
At lunch or after school 1.8
After plenty of rest 2.8
Within 24 hours 7.7
Within 48 hours 1.8
When the parent or guardian is free to bring the patient for examination and treatment 2.5
Any time when the patient feels relax and want to have treatment 2.5
Within 4 hours 14
Immediately 57.1
Others 0.5
Don’t Know 14.2
Q11 Immediate Management of Fractured Teeth
The fractured part is useless, ignore it 2.3
Try to find the fractured time, wrap it with gauze or tissue and bring it for examination and treatment 44.5
Put it in liquid medium and bring it for examination and treatment [20,21] 24.7
Others 1.2
Don’t Know 27.5
Q12 Immediate Management of Displaced Teeth
Do not touch, let it remains its new position 47.5
Try to put back to the original position [22] 4.7
Ask the patient to carefully clench one’s teeth if possible [23] 19.6
Others 3.0
Don’t Know 25.9
Q13i Should knocked-out baby teeth be put back to original position
Yes 4.2
No [24–26] 62.5
Don’t Know 33.3
Q13ii Should knocked-out permanent teeth be put back to original position
Yes [21,24,25] 23.6
No 34.0
Don’t Know 42.4
Q14 Medium for storing knocked-out teeth
The tooth is useless, do not spend time to find it or to work on it 5.1
Gauze or tissue 33.1
Cold milk [21,24,25] 18.7
Physiological saline[21,24,25] 24.2
Patient’s saliva[21,24,25] 6.7
Tap water 5.4
Distilled water 17.5
A container or plastic bag in dry condition 6.1

content, and X5 = 0 if the respondent had not received first-aid
training. X6 = 1 if the respondent had received first-aid training
with dental injury content, and X6 = 0 if the respondent had not
received first-aid training.
The thresholds of all the statistical tests were set at 5% level of
significance. The statistical analyses were performed using a
computer programme (JMP version 9.0.2., SAS Institute Inc.,
USA).
Results
We collected 601 questionnaires between May 24 and Oct 10,
2011. After removing those with missing entries in the first section
of demographics and background information, 571 questionnaires
were left for statistical analysis. They were from 15 schools, with
each school having an average of 38 students. The summary
statistics of the respondents’ background information collected are
tabulated in Table 2. 60.1% of the respondents were female and
53.9% of them were within the age range 14 – 16. 43.6% were
from Form 1 – 3, 44.7% were from Form 4 – 5 and a small
percentage of 11.7% were from F.6 – 7. 8.9% had received first-
aid training, and only 3.0% (of the whole sample) had learnt about
management of dental injury in the training program. 23.6% of
the respondents considered themselves able to distinguish decid-
uous from permanent teeth. Finally, 29.8% of the respondents had
acquired information about dental injury management from other
sources besides from first-aid training program.
The percentages of responses to each question are tabulated in
Table 3. The correct answer(s) for each question is (are)
highlighted. Most of the questions were answered incorrectly,
which is also reflected in Table 4. 36.6% of the respondents were
able to identify the appropriate place for treatment of dental
injury. 55.2% of the respondents answered correctly the suitable
time for treatment. Only 24.7% of the respondents knew how to
correctly manage fractured teeth. Only 23.6% of the respondents
knew how to manage displaced teeth. 62.5% of the respondents
correctly answered that knocked-out deciduous teeth should not be
replanted to the original position, but only a comparatively much
smaller proportion of them (23.6%) knew that avulsed permanent
teeth should be replanted. Moreover, 37.1% of the respondents
correctly specified at least one of the appropriate media for storing
a knocked-out tooth.
The total scores are shown in Table 5. The mean of thetotal
score was negative, with value 20.17. The median was 0. It
showed that secondary school students’ knowledge of dental injury
treatment was insufficient.
The regression results in Table 6 indicate that demographic
background including gender, age, and form did not have
significant effects on the knowledge of dental injury treatment.
X5 was significant, i.e., first-aid training without dental injury
treatment education would significantly increase the total score (p-
value = 0.0344). On the contrary, X6 was not significant, which
implied that students with first-aid training along with dental
injury management did not significantly respond to the questions
better than the rest. Confidence in distinguishing the type of teeth
was not significant. On the other hand, acquisition of dental injury
information from other sources was a significant factor that led to
higher scores (p-value = 0.0407).
Table 4. Scorefor each question in the knowledge section.
Correct Incorrect Do not know
n (%) n (%) n (%)
Q9 Place for treatment 209 (36.6) 276 (48.3) 86 (15.1)
Q10 Time for treatment 315 (55.2) 177 (31.0) 79 (13.8)
Q11 Management of fractured teeth 141 (24.7) 270 (47.3) 160 (28.0)
Q12 Management of displaced teeth 135 (23.6) 286 (50.1) 150 (26.3)
Q13i Management of avulsed baby teeth 357 (62.5) 24 (4.2) 190 (33.3)
Q13ii Management of avulsed permanent teeth 135 (23.6) 194 (34.0) 242 (42.4)
Q14 Medium for storage of avulsed teeth 212 (37.1) 188 (32.9) 171 (29.9)
For Q9–12, 13i &13ii, if more than one option, including an incorrect one, were chosen, the answer is considered asincorrect. For
Q14, 1 or more options could be chosen. If any incorrect option is chosen, the question is considered asincorrect.
Table 3. Cont.
Proportion (%)*
Disinfectan
t
solution 10.3
Others 1.1
Don’t Know 31.7
For Q9–12, 13i &13ii, respondents should choose 1 answer but some respondents chose more than 1. For
Q14, multiple options could be chosen.
*the sum of the proportions for aquestion may be larger than 1 asrespondents might have chosen more than one answer. The numbers in bracket indicate the
references.

Discussion
This survey recruited randomly selected secondary schools from
the list provided by the Educational Bureau. This should be the
most accurate and complete list of all secondary schools in Hong
Kong available. The School Dental Care Service has been
providing basic and preventive dental care to almost all primary
school children in Hong Kong since 1980 [27]. All local primary
students are eligible to join the School Dental Care Service. Most
of them join the School Dental Care Service with guardians’
consent. Students cease to be eligible for the School Dental Care
Service once they have entered secondary schools.
Since 1994, on signing up for the School Dental Care Service,
primary school students would receive a dental handbook, which
contains a page on immediate management of avulsion.
The results showed that the knowledge of emergency manage-
ment of dental trauma of secondary school students in Hong Kong
was less favourable than we would like it to be (Table 3, 4, 5). Such
results were similar to those of other studies, in which the
participants were children and youngsters [15–17]. Educational
campaign on emergency management of dental trauma can be
launched to increase the awareness and level of knowledge of the
topic.
A voluntary self-completed, individually responded to question-
naire survey was conducted in the same period of the present study
through the Hong Kong Professional Teachers’ Union. It showed
that primary and secondary school teachers in Hong Kong lacked
knowledge of management of traumatic dental injuries. Educa-
tional campaign for them was recommended [19].
In general, avulsed permanent teeth should be replanted
[21,24,25,28] or should be placed in milk, physiological saline or
saliva if immediate replantation is not possible [21,24,25,28].
Deciduous teeth should not be replanted [24–26,28]. In order to
carry out the most appropriate emergency management, it is
important that the persons at the scene of dental injury are able to
distinguish between deciduous and permanent teeth. Given that
76.4% (436/571) respondents stated that they could not distin-
guish between permanent and deciduous teeth (Table 2), future
education materials should include the instruction that an avulsed
permanent tooth should be replanted if one feels confident to do
so. Otherwise, simply immense the avulsed tooth in milk,
physiological saline or saliva if one is not sure about the tooth type
or is not confident with the procedure. This makes students be
more confident in managing traumatic dental injuries for patients
with deciduous, mixed or permanent dentition.
In the regression results shown in Table 6, the demographic
background including gender, age, form, and confidence in
distinguishing the type of teeth did not have significant effects on
the knowledge of dental injury management. X5 was significant,
suggesting that first-aid training that did not include dental injury
management would significantly increase the total score. Also,
prior acquisition of dental injury information from other sources
was a significant factor that positive response from these questions
would lead to higher scores. X6 was not significant, representing
that first-aid training with dental injury treatment education did
not significantly affect the total score. However, there were only 17
students who had received first-aid training with dental injury
content in the sample, which constituted only a very small
proportion. It is likely that this variable did not reach statistical
significance because of the small number of suchstudents.
Only 29.8% (170/594) of the students acquired dental injury
information from other sources (Table 2). Therefore, it is
beneficial to launch educational campaigns in secondary schools
to improve students’ knowledge of dentaltrauma.
Only 36.6% (209/571) of the respondents stated that it was
correct to go to dentists directly (Table 4) while most respondents
thought that doctors and nurses in casualty or in private sector
could help the patients (Table 3). Therefore, health educators and
doctors should inform students that patients should go to the
dentists immediately when they sustain dental injuries. It is also
recommended that the two local medical schools and the two
Table 6. Relationship between total score and the independentvariables.
Estimate Standard Error p-value
Intercept 20.9175 0.6355 0.1552
Gender (0 = Male, 1 = Female) 0.4448 0.2429 0.0677
Age** 20.2413 0.2709 0.3743
Form 0.5280 0.2939 0.0755
First-aid training and dental injury content
X5* (0 = No first-aid training, 1 = First-aid training without dental injury content) 0.9727 0.4586 0.0344
X6 (0 = No first-aid training, 1 = First-aid training with dental injury content) 20.2393 0.8119 0.7683
Ability to distinguish the type of teeth (0 = No, 1 = Yes) 0.4226 0.2732 0.1224
Receipt of dental injury management information from other sources
besides first-aid training* (0 = No, 1 = Yes)
0.5237 0.2553 0.0407
*the independent variable is significantly different from zero at 5% significance
**It is coded according to the categorization on the questionnaire, i.e. 1 for 10 or below, 2 for 11 – 13 etc.
Table 5. Summary statistics of the total score of the
respondents.
Minimum 29
Maximum 8
Mean 20.17
Median 0
Standard Deviation 2.75
From Question 9 – 13, 1 mark is awarded if only the correct answer was chosen,
0 for don’t know and 21 if any wrong answer was chosen (range: 26 to 6).
For question 14, 1 for each correct answer, 0 for don’t know, 21 for each
wrong answer (range: 27 to 3).
Rangeof total score of the whole questionnaire: 213 to 9.

universities should include basic management of dental trauma in
their undergraduate curricula and continuing professional devel-
opment programmes of medical and nursing courses.
In the sample, 15.6% of the students thought that it was correct
to call an ambulance (Table 3). This message should be conveyed
to the Fire Services Department and they should also be advised to
train the first aiders in emergency management of dental trauma.
Conclusion
Hong Kong secondary school students’ knowledge of emergen-
cy management of dental trauma is insufficient. First-aid training
and acquisition of dental injury information from other sources
positively correlate with the level of knowledge. Educational
campaign on dental trauma management is recommended for
secondary schools. We suggest that emergency management of
dental trauma should be added to first-aid publications and taught
to students and health professionals.
Follow up action
We prepared a dental trauma emergency management educa-
tional poster [29] with one side in Chinese and the other side in
English (see Chinese and English educational posters S1 and S2).
We have sent 22 copies of this poster to each secondary school in
Hong Kong. The poster emphasizes that an injured person should
go to a dentist directly. We advised the schools to display the
posters on the notice boards of classrooms and at medical rooms.
We have sent the posters to the fire service department, all
casualties and universities that provide medical and nursing
courses in Hong Kong. We have also sent letters to institutions
requesting the course coordinators to include emergency man-
agement of dental trauma in the undergraduate and the
continuing professional development programmes of healthcare
professionals.
Supporting Information
Protocol S1
(PDF)
Chinese Educational Poster S1.
(PDF)
English Educational Poster S2.
(PDF)
Acknowledgments
We thank all the schools and the students who returned the questionnaire.
Author Contributions
Conceived and designed the experiments: CY KYW LKC. Performed the
experiments: CY. Analyzed the data: CY KYW. Contributed reagents/
materials/analysis tools: CY KYW. Wrote the paper: CY KYW LKC.
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17. Biagi R, Cardarelli F, Butti AC, Salvato A (2010) Sports-related dental injuries:
knowledge of first aid and mouthguard use in a sample of Italian children and
youngsters. Eur J Paediatr Dent 11: 66–70.
18. Underwood M, Barnett A, Hajioff S (1998) Cluster randomization: a trap for the
unwary. Br J Gen Pract 48: 1089–1090.
19. Young C, Wong KY, Cheung LK (2012) Emergency management of dental
trauma: knowledge of Hong Kong Primary and Secondary School Teachers.
Hong Kong Medical J 18: 362–370.
20. Andreasen FM, Andreasen JO (2007) Crown fracture. In: Andreasen JO,
Andreasen FM, Andersson L, editors. Textbook and Colour Atlas of Traumatic
Injuries to the Teeth, 4th
edition. Blackwell Munksgaard. pp.290–296.
21. Flores MT (2007) Information to the Public, Patients and Emergency Services
on Traumatic Dental Injuries. In: Andreasen JO, Andreasen FM, Andersson L,
editors. Textbook and Colour Atlas of Traumatic Injuries to the Teeth, 4th
edition. Blackwell Munksgaard. pp. 869–875.
22. Andreasen FM, Andreasen JO (2007) Extrusive Luxation and Lateral Luxation.
In: Andreasen JO, Andreasen FM, Andersson L, editors. Textbook and Colour
Atlas of Traumatic Injuries to the Teeth, 4th
edition, Blackwell Munksgaard. pp.
411–427.
23. Lieger O, Graf C, El-Maaytah M, Von Arx T (2009) Impact of educational
posters on the lay knowledge of school teachers regarding emergency
management of dental injuries. Dent Traumatol 25: 406–412.
24. Andreasen JO, Andreasen FM (2007) Avulsion. In: Andreasen JO, Andreasen
FM, Andersson L, editors. Textbook and Colour Atlas of Traumatic Injuries to
the Teeth, 4th
edition. Blackwell Munksgaard. pp. 444–488.
25. Flores MT, Andersson L, Andreasen JO, Bakland LK, Malmgren B, et al. (2007)
Guidelines for the management of traumatic dental injuries. II. Avulsion of
permanent teeth. Dent Traumatol 23: 130–136.
26. Flores MT, Malmgren B, Andersson L, Andreasen JO, Bakland LK, et al. (2007)
Guidelines for the management of traumatic dental injuries. III. Primary teeth.
27. Department of Health website. Available: http://www.dh.gov.hk/english/pub_
rec/pub_rec_ar/pdf/0607/Annual_Report/C4m_Dental_Service.pdf. Ac-
cessed 2012 Apr 30.
28. Andersson L, Andreasen JO, Day P, Heithersay G, Trope M, et al. (2012)
International Association of Dental Traumatology guidelines for the manage-
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29. Young C, Wong KY, Cheung LK (2013) Effectiveness of educational poster on
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randomised controlled trial for primary and secondary school teachers. PLoS
ONE 8: e74833. doi:10.1371/journal.pone.0074833.

DOI: 10.1371/journal.pone.0084406

楊幽幽牙科醫生
Dr. Cecilia Young Yau Yau
內容授權於原文醫藥人
以全篇原文為準
**以上內容已得病人同意使用作公共衛生教學用途
當中 "我們" 或 "示範中的方法" 指牙醫業內一般做法或其中一種做法
內容只作一般公共衛生教育用途，病人應該與醫生商量自己的處理方法。
所有牙醫均可進行公共口腔衛生教育，而公共衛生(Public Health )或社
會牙醫科
(Community Dentistry )更是牙科內的一個科目。
牙醫專業守則
1.6 牙科／口腔健康教育活動
1.6.1 牙醫可以參與真確的牙科／口腔健康教育活動，例如
演講及作專業發表..............
1.6.3 向公眾提供的資料應具權威性、合宜並與一般經驗相符。該等資
料應有事實根據、清楚易明及用詞淺白。
香港牙醫管理委員會香港牙醫專業守則
http://www.dchk.org.hk/docs/code_c.pdf

楊幽幽牙科醫生教育系列以下為公共口腔衛生教育系列關鍵字
嵌塞牙縫刷腎病致命牙齒脫位膿退縮戒煙骨質疏鬆腫脹四環素染色楊幽幽牙科醫生更薄的牙
齒刮舌板牙齒長出牙齒不可逆性牙髓炎水氟化 X光對生育期內婦女的影響, 什麼年紀最適合箍牙,
假牙, 傷口處理, 公共衛生教育, 剝牙, 副作用, 口腔種植, 成人矯齒成效如何, 止血, 正確刷牙及使用牙
線方法, 楊幽幽牙科醫生口腔教育系列注意事項, 洗牙流血點解, 活動假牙托, 流血不止, 滿口牙套可
以箍牙嗎, 漂牙, 牙周病, 牙周病患者是否可以箍牙. 透明牙箍有用嗎, 牙柱, 牙橋, 牙痛, 牙瘡, 牙肉流血,
牙醫, 牙骹, 種牙, 空姐接觸的宇宙射線會否影響胎兒, 笑容, 箍牙會唔會失敗, 脫牙, 蛀牙, 關節好唔好
以下為公共口腔衛生教育系列關鍵字, 阿士匹靈,抗血小板劑,抗凝血劑, 抗生素, 關節僵硬,銀粉, 矯正,
植牙, 膿腫, 研磨劑, 刷蝕牙齒, 態度, ,撕脫, 乳齒, 細菌, 口氣, 咬, 矯正器, 腦膿腫, 刷牙, 緩衝作用, 過
氧化尿素,齲齒,檢查,咀嚼, 複合, 牙套, 牙冠增長手術,
環孢素A, 失智症, 牙,科, 牙橋, 牙科疾病, 牙科脫牙,牙科問題, 牙髓, 牙周膜, 牙菌膜, 矯齒,根管治療,
洗牙齒表面, 微電測試牙髓, 預防性樹脂補牙, 玻璃離子, 牙腳尖, 二手煙, 敏感牙齒, 吸煙, 手術, 鑽洞測
試,水銀, 成功,牙齒氟化, 發炎, 淋巴核, 神經, 牙齒過度長出酸鹼值, 維他命C, 智慧齒,華法林, 牙膏, 牙
刷, 牙齒美白,牙齒漂白, 口氣, 失敗, 補牙, 牙線, 外觀, 咬合, 橋體, 牙冠,口腔種植周邊炎 , 含氟漱口水,
漱口水, 硝酸鉀, 口腔黏膜發炎, 尼古丁, 口腔疾病, 口腔感染, 預防, 牙袋, 家庭主婦, 感冒, 象牙質, 牙
齒創傷, 牙骨黏連, 牙周膜位置骨化, 磨蝕牙齒, 牙齒正畸, 氟素防蛀劑, 牙紋防蛀劑,鑲嵌物, 鑄造瓷貼
片, 酸蝕牙齒, 牙齒腫大, 漱口水, 肝素, 薄血藥, 維生素C,血栓栓塞, 國際標準化比值, 感染性心內膜炎,
琺瑯質, 局部麻醉劑, 三氯沙, 空間固定器, 進食次數,用餐次數, 全口假牙托、琺瑯質形狀缺陷,馬利蘭
牙橋, 咽喉炎, 食物與牙齒健康, 奶瓶齲齒, 鎮靜, 牙髓治療, 氟素凝膠, 牙腳斷裂, 牙腳吸收, 牙根整平術,
早期兒童蛀牙, 糖尿病, 效用, 測試, 牙齦, 牙齦組織, 牙齦出血, 雙氧水, 免疫抑制劑, 嵌塞, 牙縫刷, 腎
病, 致命,牙齒脫位, 膿, 退縮, 戒煙,骨質疏鬆, 腫脹, 四環素染色, 更薄的牙齒, 刮舌板, 牙齒長出, 牙齒
不可逆性牙髓炎, 水氟化X光對生育期內婦女的影響、什麼年紀最適合箍牙、假牙、傷口處理、公共
衛生教育、剝牙、副作用、口腔種植、成人矯齒成效如何、止血、正確刷牙及使用牙線方法、注意
事項、洗牙流血點解、活動假牙托、流血不止、滿口牙套可以箍牙嗎、漂牙、牙周病、牙周病患者
是否可以箍牙. 透明牙箍有用嗎、牙柱、牙橋、牙痛、牙瘡、牙肉流血、牙醫、牙骹、種牙、空姐接
觸的宇宙射線會否影響胎兒、笑容、箍牙會唔會失敗、脫牙、蛀牙、關節, 常見的牙患及預防方法,
蛀牙的成因及預防, 牙周病的成因及預防方法
甚麼是根管治療, 關於脫牙的事實, 銀汞合金安全嗎, 牙齒如何漂白, 需要矯齒的原因及準備, 牙齒創傷
即時處理及治療, 懷孕婦女需特別注重口腔健康, 如何除口氣, 骨質疏鬆與牙齒脫落的關係, 家長須助
孩子護理乳齒, 牙周病─治療方法探究篇, 牙患可以致命, 鑲補牙齒方法知多少, 假牙扥你們對我的期
望合理嗎, 牙菌膜可以使種牙鬆脫, 糖尿病與牙周病互相影響, 必先利其器口腔衛生用品知多少, 脫牙
前必須認真考慮, 預防蛀牙的方法氟素防蛀劑及牙紋防蛀劑, 漂白牙齒的各種方法, 細數牙周病各種病
徵, 用力刷牙≠清潔
使用漱口水是否好習慣, 吸煙與牙周病, 吸煙對治療牙周病的影響, 吸煙與口腔癌關係密切
戒煙為何與如何, 二手煙立法與自律, 乳齒對恆齒的影響, 公眾對洗牙的誤解調查, 兒童乳齒的根管治
療, 第一隻長出的恆齒, 換牙時需注意事項, 護理口腔第一步正確刷牙方法, 敏感牙齒成因及預防, 公眾
對洗牙的誤解應用篇, 如何保養活動假牙, 矯齒點滴, 矯齒前應注意的事項, 木糖醇對人有害嗎, 口腔穿
環的後遺問題, 牙周牙髓聯合症, 防敏感牙膏不適合長期使用, 頭頸部放射治療前後的口腔護理, 幫助
睡眠窒息症患者呼吸口腔矯治器, 根管治療時斷針是否失誤, 小朋友在牙科治療時不合作, 嚴重蛀牙幼
兒一次被脫8隻乳齒(上)
嚴重蛀牙幼兒一次被脫8隻乳齒(中), 嚴重蛀牙幼兒一次被脫8隻乳齒(下), 香港牙膏並未含有「二甘
醇」, 社會醫學研究電話調查, 小朋友不肯見牙醫怎辦？, 牙周病口瘡性潰痬與口腔癌牙齒創傷幸與
不幸, 智慧齒過度長出, 智慧齒過度長出引致的其他牙患, 矯齒替代鑲假牙, 矯齒替代鑲假牙(二), 善用
抗生素, 失去牙齒的其他後果, 一顆牙齒多個問題
根管治療後如何加上牙柱及牙套, 澳洲回顧研究漱口水內的酒精致口腔癌, 牙齒美容
牙齒美容(二), 牙齒美容(三), 常見牙齒問題酸蝕, 牙科治療為甚麼要磨蝕好的牙齒, 健康牙齒伴你一生,
淺談假牙的承扥問題, 腎病患者的口腔問題, 抗凝血劑抗血小板劑與脫牙

感染性心內膜炎與牙科治療, 二手煙對兒童牙齒的影響, 失智症(老人痴呆症)與口腔健康
如何保持牙齒清潔, 防敏感牙膏新資訊, 牙套內會不會蛀牙, 探討牙科內常用的局部麻醉
劑
孕婦及牙科常用藥物, 牙科病人與精神問題(上), 牙科病人與精神問題(下), 阻生智慧齒
殺菌劑三氯沙氾濫我們應否使用抗菌牙膏, 牙科病人的求診習慣, 診斷不同不知信那一個
什麼情況,什麼病人不宜脫牙, 關於植牙的種種迷恩, 如何處理長者的牙患, 預防牙患多角
度孕婦與胎兒母親與嬰幼兒, 牙周整形手術治敏感牙齒, 牙齦萎縮不能復原, 牙周組織再
生法, 植骨與植牙手術先植骨後植牙, 同時進行植骨與植牙, 口腔植體周邊組織炎, 牙冠
增長手術(上). 牙冠增長手術(下), 中小學教師與中學生對牙齒創傷認識不足, 牙齒各類創
傷與處理, 牙齒各類創傷與處理(2), 牙齒創傷當牙周膜死了, 牙齒創傷日後可能顯現的問
題
牙齒創傷後的治療個案, 假牙可以戴多久, 即時性假牙托, 假牙的種類和設計, 假牙的種類
和設計--種牙, 假牙的種類和設計--牙橋, 假牙的種類和設計--活動假牙托, 我的牙齒為什
麼不好, 由牙齒所引致的感染看似小事的牙瘡, 由牙齒所引致的感染看似皮膚問題的牙瘡
由牙齒所引致的感染細菌進入眼部, 由牙齒所引致的感染細菌入腦, 由牙齒所引致的感染
Ludwig氏咽峽炎阻塞氣道, 漱口水過酸易蛀牙, 食物與牙齒健康, 錯誤使用奶瓶餵飼幼兒
奶瓶齲齒, 兒童嚴重蛀牙的治療方法, 兒童嚴重蛀牙的治療方法--牙套, 牙齒咬合與移位
(上), 牙齒咬合與移位(下), 智障人士的牙患, 智障人士如何預防牙患, 正確使用氨素
氟素以外牙紋防蛀劑填補牙紋縫隙, 牙齒重疊最需要徹底清潔, 牙齒磨損, 對牙菌膜的監
測
簡介牙髓的各種測試, 淺談口腔以外的牙科X光, 口腔以內的牙科X光, 牙髓死亡, 淺析咬
合垂直距離, 牙痛, 到底哪裡痛, 能不能忍一時之痛, 活動假牙托下不應有壞牙腳, 氟斑齒
的處理方法注意有否刷蝕牙齒, 牙齒消炎丸到底是甚麼., 正確使用抗生素, 處理接近神經
線的阻生智慧齒, 脫牙流血不止, 正確清潔牙齒及牙肉邊緣, 牙科手術儀器的消毒程序, 牙
科用具其他消毒程序, 黏液囊腫, 看見和看不見的蛀牙, 切除部分牙腳手術, 切除部分牙腳
手術 2, 如何清潔牙腳分岔位上, 如何清潔牙腳分岔位下, 牙線功能成疑, 美白牙膏去牙
漬, 洗牙真的很痛嗎, 清刮牙腳, 再談清刮牙腳, 洗牙流血只因牙肉發炎口腔腫塊--牙齦瘤
口腔腫塊--乳突瘤, 口腔內的黑色素---牙齦的黑色素沉澱,G6PD缺乏症與牙科治療
頭頸癌放化治後牙科問題, 關愛基金改善政策使長者更受惠, 關愛基金改善政策使長者更
受惠, 磨去蛀牙

Dr. Cecilia Young Yau Yau Oral Health Education series key words
mellitus, diagnosis, early childhood caries, effectiveness, electric pulp test, enamel, erosion,
esthetics, examination, extraction, failure, fever, fillings, fissure sealant, flight attendant,
flossing, fluoride gel, fluorosis, gaps, gingiva, Gingival hypertrophy, gingival tissue, glass
ionomer, gum bleeding, gum disease, halitosis, Heparin, housewife, hydrogen peroxide,
hypoplasia, immunosuppressant, impaction, implant, infective endocarditis, inflammation,
inlay, interdental brushing, international normalizing ratio INR, Kidney disease, lethal, local
anaesthesia, look, luxation, lymph node, mechanical cleansing, mercury, mouthrinse,
mucositis, nerve, nicotine, number of meals, nursing bottle syndrome, occlusion, onlay, oral
disease, Oral Health Education, oral infection, orthodontic treatment, osteoporosis,
overeruption, peri-implantitis, periodontal disease, periodontal membrane, pH value,
plaque, pocket, pontic, porcelain veneer, post, post and core, potassium nitrate, prevention,
abrasion、abrasives、abscess、abutment tooth、aligners、amalgam、ankylosis、
antibiotics、anticoagulation、antiplatelet、aspirin、attitude、attrition、avulsion、baby
teeth、bacteria、bad breath、biting、bleaching、bleeding、bracing.., brain abscess、
bridge、brushing、buffering effect、carbamide peroxide、caries、check-up、chewing、
chlorhexidine、composite、crown、crown lengthening、cyclosporine A、dementia、
Dental、dental bridge、dental decay、dental disesase. dental extraction、dental problem、
dental pulp、dental scaling、dental trauma、dentine、denture、diabetes mellitus、
diagnosis、early childhood caries、effectiveness、electric pulp test、enamel、erosion、
esthetics、examination、extraction.. failure、fever、fillings、fissure sealant、flight
attendant、flossing、fluoride gel、fluorosis、gaps、gingiva、Gingival hypertrophy、
gingival tissue、glass ionomer、gum bleeding、gum disease、halitosis、Heparin、
housewife、hydrogen peroxide.. hypoplasia、immunosuppressant、impaction、implant、
infective endocarditis、inflammation、inlay、interdental brushing、international
normalizing ratio INR、Kidney disease、lethal、local anaesthesia、look、luxation、lymph
node、mechanical cleansing.. periodontal membrane、pH value、plaque、pocket、pontic、
porcelain veneer、post、post and core、potassium nitrate、prevention、preventive resin
restoration、pus、recession、removable appliance、removable denture、root apex..
Root Canal Treatment、root fracture、root planning、root resorption、scaling、second
hand smoking、sensitive teeth、side effect、smile、smoking、smoking cessation、
successful、surgery、swelling、test cavity、tetracycline staining、thinner teeth.
thromboembolism、tongue scrapper、tooth bleaching、Tooth bracing、tooth decay、
tooth eruption、tooth whitening、tooth. Irreversible pulpitis、toothache、toothbrush、
toothpaste、triclosan、vitamin C、warfarin、washing effect、water fluoridation.. wisdom
tooth、wound handling ,complete Denture, space maintainer, Maryland Bridge ,pharyngitis,
sedation , Pulpotomy. Small tooth, black tooth, damage tooth.

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A Survey on Hong Kong Secondary School Students’ Knowledge of Emergency Management of Dental Trauma