Effectiveness of educational poster on knowledge of emergency management of dental trauma part 2. rct

Effectiveness of Educational Poster on Knowledge
of Emergency Management of Dental Trauma – Part
2: Cluster Randomised Controlled Trial for
Secondary School Students
Cecilia Young1
*, Kin Yau Wong2
, Lim K. Cheung3
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
The University of Hong Kong, Hong Kong
Abstract
Objective: To investigate the effectiveness of educational poster on improving secondary school students’ knowledge
of emergency management of dental trauma.
Methods: A cluster randomised controlled trial was conducted. 16 schools with total 671 secondary students who can
read Chinese or English were randomised into intervention (poster, 8 schools, 364 students) and control groups (8
schools, 305 students) at the school level. Baseline knowledge of dental trauma was obtained by a questionnaire.
Poster containing information of dental trauma management was displayed in a classroom for 2 weeks in each school
in the intervention group whereas in the control group there was no display of such posters. Students of both groups
completed the same questionnarie after 2 weeks.
Results: Two-week display of posters improved the knowledge score by 1.25 (p-value = 0.0407) on average.
Conclusion: Educational poster on dental trauma management significantly improved the level of knowledge of
secondary school students in Hong Kong.
Trial Registration: HKClinicalTrial.com HKCTR-1343 ClinicalTrials.gov NCT01809457
Citation: Young C, Wong KY, Cheung LK (2014) Effectiveness of Educational Poster on Knowledge of Emergency Management of Dental Trauma - Part 2: Cluster
Randomised Controlled Trial for Secondary School Students. PLoS ONE 9(8): e101972. doi:10.1371/journal.pone.0101972
Editor: Michael Glogauer, University of Toronto, Canada
Received May 19, 2013; Accepted June 10, 2014; Published August 5, 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.
Data Availability: The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper and
its Supporting Information files.
Funding: The study is self-funded by the principal investigator.
Competing Interests: The authors have declared that no competing interests exist.
* Email: ceciliatyp@yahoo.com.hk

Introduction
Prevalence of traumatic dental injuries of primary and
permanent teeth is high throughout the world. Statistics from most
countries showed that one fourth of all school children and almost
one third of adults had suffered trauma to the permanent dentition,
with variations among and within countries [1].
Early management is crucial to the prognosis for some dental
injuries, especially avulsion [2]. However, most studies showed
that teachers or school staff [3–15], parents [15–21], nurses
[15,22,23], paramedics [23] and coaches [21] lacked the
knowledge to manage traumatic dental injuries appropriately
before the injured person reached dental professionals.
Since immediate management of traumatic dental injury does
not require special skill but only knowledge, it can be performed
by a lay person if one knows the procedures. The ideal situation is
that such knowledge becomes everyone’s basic practical knowl-
edge. The earlier one learns the appropriate procedure, the higher
chance one can save more traumatized teeth. In a literature search
conducted before the study and finalized on Sept 21, 2013, there
were only 4 studies investigating children’s and teenagers’
knowledge of traumatic dental injuries [24–27]. The results were
that the subjects did not possess adequate knowledge.
Literature search of published studies on education in traumatic
dental injuries prior to Sept 21, 2013 using keywords (‘‘promo-
tion*’’ or ‘‘intervention’’ or ‘‘education’’ or ‘‘knowledge’’ or
‘‘campaign’’ or ‘‘seminar’’ or ‘‘lecture’’ or ‘‘pamphlet’’ or
‘‘leaflet’’ or ‘‘banner’’ or ‘‘poster’’) and (‘‘dental injur*’’ or
‘‘traumatic dental injur*’’ or ‘‘dental trauma’’) on Pubmed, Ovid,
Web of Science and Cochrane Central Register of Controlled Trials
resulted in only 14 papers related to education [28–41]. All of them
targeted on adults, and there was no information about education
in dental trauma for children or teenagers.
All Hong Kong primary school students (US Grade 1–6) are
eligible to join the School Dental Care Service and most of them
joined voluntarily. Every participant received a handbook for
PLOS ONE | www.plosone.org 1 August 2014 | Volume 9 | Issue 8 | e101972

recording dental visits and it contained around 20 pages of dental
health information. Since 1994, the handbook contained one page
about avulsion and it mentioned that avulsed tooth should be put
back into the socket, stored in milk or in mouth. However, in 2011,
a survey about the level of knowledge of dental trauma revealed
that such knowledge of secondary school students (US Grade 7–12
plus 1 year) in Hong Kong was insufficient [27]. In that survey,
only a small portion of secondary school students knew that
avulsed permanent tooth should be replanted (23.6%), or stored in
cold milk (18.7%), physiological saline (24.2%) or saliva (6.7%),
even they were eligible to join the school dental service and
received the mentioned handbook in their primary education.
Educational campaign on dental trauma management was
recommended for secondary school students by the authors.
It is easy to implement poster campaign because of the low cost.
In the present study, the effectiveness of dental trauma educational
poster on level of knowledge was studied. Secondary school
students were chosen and the cluster design was adopted since it is
appropriate for the actual school environment as students might
discuss with and hence influence each other. Also, since students
in the same school may have some unique characteristics, e.g.
higher level of health consciousness, the study was randomised at
the school level to prevent contamination and improve on compara-
bility.
Methods
Ethical approval
The research project was approved by the Institutional Review
Board of the University of Hong Kong and Hospital Authority
Hong Kong West Cluster. (HKCTR-1343, ClinicalTrials.gov:
NCT01809457)
Subjects
The subjects were secondary school students (US Grade 7–12
plus 1 year) in Hong Kong, who can read Chinese or English. We
recruited the secondary schools as clusters. The protocol for this
trial and supporting CONSORT checklist are available as
supporting information; see Checklist S1 and Protocol S1.
Questionnaire
The questionnaire from a survey of the same series about
knowledge of dental trauma among the same target group was used
[27]. Chinese and English versions of the questionnaire were
constructed. There were 14 questions, divided into two sections.
The first section asked for basic demographic information, whether
the respondents had received formal first-aid training or acquired
dental trauma information and whether they considered themselves
able to distinguish between permanent and deciduous teeth. The
second part consisted of questions concerning knowledge of dental
traumatic injuries, which was for the assessment of dental
knowledge in this study. The questionnaire was pilot tested with 59
students. Face validity, length and comprehensibility by secondary
school students were pre-tested before the questionnaire was
finally adopted. Face validity was established by expert opinion,
and a test-retest reliability test indicated that the scores of the first
and second questionnaires were positively correlated.
The marking scheme is as follows: for Q9 to Q13, 1 mark would be
given for a correct answer, 0 would be given for ‘‘do not know’’ and 1
would be deducted for an incorrect answer. If multiple answers were
chosen, 1 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
Effectiveness of Educational Poster on Students
serious type of dental trauma, timely emergency management is
critical. Knowledge of more storing media raises the chance of a
student being able to find one soon enough to keep the vitality of
the periodontal cells on the root surface, which improves the
prognosis. Therefore, 1 mark would be given for each correct
answer but 1 mark would be deducted for each incorrect answer.
Multiple answers were allowed.
Poster
The educational poster was in A3 size, colourful and with
pictures. One side of the poster was written in Chinese and the other
side in English, The content was constructed by the authors using
two publications as reference [3,37]. This poster is the same as the
one used in another study for primary and secondary school
teachers of the same series [41]. Chinese and English educational
posters are available as supporting information S1 and S2.
Sample size calculation
In order to demonstrate a difference in score change of 2 marks
(variance 10) between the intervention group and the control group,
with a power of 90% and a statistical significance of 5%, 53
individuals are needed in each group under simple random
sampling. To account for the cluster design, we assume an
intracluster correlation (ICC) of 0.1. No published data on ICC
under this setting could be found. However, in general practice
studies, ICC takes value commonly between 0.01 and 0.05 [42], so
0.1 would be a conservative estimate. With an average of 40
students per school and a coefficient of variation of cluster size of
0.2 (after realizing that it was difficult in practice to recruit a
minimum cluster size of 40 as laid down in the original protocol,
we allowed clusters with size smaller than 40, but restricted the
coefficient of variation of cluster size to be 0.2), the adjusted
sample size is 7 schools, or 266 students, per group. To allow for
potential dropouts, we aimed to recruit extra 20% individuals per
group (this extra 20% was changed from 30% in the original
protocol), yielding a total of 8 schools, or 319 students, per group.
Recruitment
A staff of the principal investigator was invited to act as a
voluntary secretary for this study. She was responsible for all
mailings, information storage and co-ordination. She was informed
that the identities of the participating schools and students should
be blinded to all investigators, statistician and clerical staff at the
time of appointment. She was the only one who knew the identities
of the schools. She kept the information concealed and put them in
a locked drawer in her room.
The Education Bureau provided a list of secondary schools upon
request. There were a total of 663 schools. Special schools for
intellectually disabled students were included in the list. The
secretary sent invitation letters with school consent forms and
individual guardian consent forms to lots of 50 randomly selected
schools beginning on April 29, 2011. In each lot of invitation letters,
there were 17 letters for Form 1–3 (US Grade 7–9), 17 letters for
Form 4–5 (US Grade 10–11), and 16 letters of Form 6–7 (US Grade
12 plus 1 year). The contact information of the principal
investigator was given in the invitation letter.
The secretary followed up with telephone calls. 16 schools with
a total of 784 students joined the study after 200 invitations were
sent. They replied with both signed school and individual guardian
consent forms. The name and contact number of the teacher in
charge were given in the school consent form.

Randomisation and masking
The randomisation was performed after both school and
individual guardian consent forms were returned. The schools were
randomised to the intervention group and the control group at the
school level manually using sealed envelopes. The secretary put
two pieces of paper bearing the words ‘‘intervention group’’ and
‘‘control group’’ separately into two envelopes. She labelled the
sealed enveloped of intervention group as group A and the other as
group B. She verified that the envelope was opaque that the words
could not be seen through. An independent person who did not
know the details of this study were invited to assist the
randomisation. The secretary labelled 1 to 16 on separate sheets of
paper representing the 16 schools according to the order the
consent forms were received. She folded each piece of paper and
put it into an envelope and checked that the number could not be
seen through, and then put them inside a box.
The independent person, not knowing the identities of group A
and B, drew one envelope for group A and then one for group B
alternatively until all the envelopes were drawn. The secretary then
opened the envelopes and recorded the result of the randomisation.
The list was put in a locked drawer that only the secretary could
access.
Implementation of the trial
The schools, teachers in charge and students were not informed
of the identity of the group (intervention/control) they belonged to,
educational material that they would receive and the duration of the
trial. The letter of invitation and both consent forms only
mentioned that the students needed to fill out two questionnaires
(see protocol S1).
The trial began on May 5, 2011 and was completed on Nov 16,
2011. The first set of questionnaires was sent to both groups and
hard copies were distributed to the participating students by the
teachers in charge. All participating students were asked to fill out
the questionnaires and returned them to the corresponding teachers
in charge (in class), who then sent the completed questionnaires
back to the investigator in 1 week.
A large sealed envelope containing the educational poster along
with instructions was mailed to each intervention school. The
teacher in charge of each school displayed the educational posters
on the notice broad or at an area of similar function in the classroom.
No poster was given to the control group.
The posters were removed by the teachers in charge after 2
weeks. The second set of questionnaires was then distributed to
schools of both groups and the students were asked to complete the
questionnaires in class. The teachers in charge then returned them
to the study secretary in 1 week using prepaid envelopes.
Educational posters were mailed to the control group after the
completion of the study. Every procedure followed that laid down
in the protocol after the trial commenced.
Withdrawal from the study
The participating schools or individual students could withdraw
from the study at any time, as mentioned in both consent forms. 39
students from the intervention group and 22 students from the
control group withdrew from the study by not returning either the
first or the second questionnaire.
Data processing
The data entry staff and the statistician were blinded to the group
randomisation. The statistician was instructed to analyse under the
labels ‘‘group A’’ and ‘‘group B’’ according to the
designed method in the protocol. The investigators were blinded to
the randomisation. Only after the completion of the whole
statistical report and the draft of the article, the study secretary
informed the principal investigator the identities of the groups. The
principal investigator then relabeled group A as intervention group
and group B as control group.
Data analysis
Individual level analysis was performed as our objective and
outcome measures pertain to individual level. Our objective is to
investigate the effects of the intervention, potentially controlled for
some baseline information, on the gain in knowledge. The
dependent variable is the score difference between the two
questionnaires. To account for potential correlation among students
from the same school, a linear mixed model was fitted with a
normally distributed random intercept for the school effect.
To select the most appropriate model, a backward elimination
method was adopted [43]. It started with including all covariates in
the model: group (intervention/control), the score of the first
questionnaire, gender, age, form, first-aid training, dental educa-
tion in first aid, confidence in distinguishing deciduous and
permanent teeth, and acquisition of dental injury information from
other sources. The covariate associated with the highest p-value
was eliminated in each iteration until all p-values were smaller than
a threshold value 0.1.
Due to the nature of the data collected and the collection process,
we anticipated that the proportion of missing data would not be
high. Therefore, we simply discarded subjects who did not provide
the demographic or personal information asked in the first section
of the questionnaire. Missing answers for questions in the second
section of the questionnaire were treated as ‘‘do not know’’, and
the total scores were accordingly calculated based on the marking
scheme given.
The thresholds of all the statistical tests were set at 5% level of
significance. The statistical analyses were performed using a
computer software (JMP version 9.0.0, SAS Institute Inc., USA).
Results
There was no unintended effect or harm reported through the
teachers in charge or directly to the principal investigator. After
removing participants with missing background information, there
were 364 individuals (8 schools) in the intervention group and 303
individuals (8 schools) in the control group available for analysis
(Figure 1). The basic information for both groups on the school
level and the individual level are given in Table 1. Statistical test
was not conducted to compare the baseline information of the two
groups [44].
The average scores of each question of both questionnaires,
along with the average difference in score of the two question-
naires for each group, are given in Table 2.
The result of the multiple linear regression is presented in Table
3. The covariates included in the final model were group
(intervention/control) and baseline score only.
From the regression analysis, the group effect is significant.
Given the same baseline score, individuals in intervention group
had on average a score difference 1.25 (p-value = 0.0407) higher
than that of individuals in control group. The baseline score effect
is also significant, which indicates that an increase in baseline score
of 1 mark would on average reduce the score difference by 0.40 (p-
value,0.0001).

Figure 1. Flowchart of the participants.
doi:10.1371/journal.pone.0101972.g001
Discussion
Effectiveness of educational poster on management of dental
trauma on secondary school students was studied. From the
statistical analysis, the group effect is significant. It means that the
two-week display of the poster improved the score with statistical
significance. Given the same baseline score, individuals in
intervention group had on average a score difference 1.25 (p-value
= 0.0407) higher than that of individuals in control group. However,
a score difference of 1.25 marks is smaller than our expectation.
Some questions were not answered any better in the interven-
tion group after the two-week display of poster. It may be that
students understood and/or remembered selective portion of the
information. Students may be more interested in reading certain
area of the poster and may not have gone through the entire poster.
This result reflects whether the students had read, understood
and remembered information on the poster. This is the first cluster
randomised controlled trial for investigating the effectiveness of
educational posters on dental trauma on this age group.
Since a model containing all relevant information collected in
the questionnaire is too large under the current sample size, which
would make the estimation unstable, we have chosen to adopt a
backward variable selection procedure. We are aware that such
method would possibly inflate type I error due to multiple testing,
and the significant factors remained in the model may just be
chosen by coincidence. It means that the p-values of the factors in
the model tend to be smaller and the confidence intervals tend to
be narrower than they, strictly speaking, should be. One should
bear that in mind when interpreting the results. However, under the
current setting, the major factor of interest is the intervention effect,
which would not be eliminated under the variable selection
procedure. The problem of concluding a significant intervention
effect by coincidence as a result of variable selection does not exist.
Also, besides intervention, there is only one factor remaining in the
model, namely the baseline score. Therefore, the inflation of Type
I error, if any, is minimal.
With the above being said, one may still be interested in the
estimated marginal effect of intervention. Fitting a linear mixed
model with only intervention group as independent variable, the
estimated effect is 1.26 (p-value = 0.0423), which means that on
average students from the intervention group had score improve-
ment of 1.26 more than that of students from the control group. It
is, though marginally, significant at 5% level of significance.
The immediate effect of two-week display of poster was
investigated, while long term effect is out of the scope of this study.
Knowledge, rather than the management of traumatic dental injuries,
was tested because long term follow up is necessary for the latter. It is
not feasible to carry it out in Hong Kong because the number of cases
from the sampling frame may not be large enough to produce a sizable
sample that would produce statistically significant results. The list of
all primary and secondary schools was exhausted even for the series of
short term studies.

Table 1. Demographic information and characteristics of the both groups on cluster and individual levels.
School Level
Intervention group (n = 8) Control group (n = 8)
Cluster Size Mean = 45.5; Median = 45; Mean = 37.9; Median = 38.5;
Min = 8; Max = 74 Min = 26; Max = 48
Individual Level
Number (Percentage) Number (Percentage)
Gender
Male 122 (33.5) 113 (37.3)
Female 242 (66.5) 190 (62.7)
Age
10 or below 0 (0.0) 0 (0.0)
11–13 79 (21.7) 45 (14.9)
14–16 145 (39.8) 175 (57.8)
17–19 132 (36.3) 81 (26.7)
20 or above 8 (2.2) 2 (0.7)
Form
Form 1–3 220 (60.4) 111 (36.6)
Form 4–5 2 (0.5) 128 (42.2)
Form 6–7 142 (39.0) 64 (21.1)
Received First-Aid Training
Yes 28 (7.7) 49 (16.2)
No 336 (92.3) 254 (83.8)
Learnt Dental Injury Management in First-aid Training
Yes 4 (1.1) 10 (3.3)
No 360 (98.9) 293 (96.7)
Confident in Distinguishing Type of Teeth
Yes 83 (22.8) 90 (29.7)
No 281 (77.2) 213 (70.3)
Read or heard dental injury information besides from First-aid Training
Yes 101 (27.7) 91 (30.0)
No 263 (72.3) 212 (70.0)
No statistical test for comparison of baseline for both groups [43].
doi:10.1371/journal.pone.0101972.t001
From the 663 secondary schools in Hong Kong, with altogether
454244 students, the sample was randomly selected with only the
condition that the students were able to read Chinese or English.
The results apply to all these students. The generalizability of the
results to other countries is unclear since the culture, students’
workload, educational system, health consciousness, ability to
comprehend the study information and the importance students
placed on dental trauma material may differ.
As some schools display a lot of information to students and change
the notices or posters quite frequently, display time of longer than two
weeks may not be feasible. Classroom is the most suitable location for
effectively displaying information to students.
Though they are usable media for storage, Hank’s balanced salt
solution (or e.g. Save-A-Tooth), Viaspan, eagle’s medium and
propolis culture medium were not mentioned in the choices
explicitly in question 14 because these were not accessible to
students in Hong Kong. However, if students mentioned these in
the ‘‘others (please specify)’’ option, they would be considered
correct. Nevertheless, no student mentioned any of these solutions.
These media were not mentioned in the poster for the same reason.
The randomisation of this trial was blinded to the investigator,
data entry staff and the statistician. Only the secretary knew the
identities of group A and B, and this information was given to the
investigators only after the whole statistical report and the
manuscript were drafted. Other than relabeling ‘‘group A’’ and
‘‘group B’’ as ‘‘intervention group’’ and ‘‘control group’’,
respectively, no information on the figure or results was amended.
So doing was to minimize bias and to improve the representability
of the statistical analysis result.
Educational posters are relatively inexpensive and easy to
distribute. There is no temporal limitation and assembly of students
is not needed, as in the case of lectures and seminars. Displaying
educational posters in classrooms is practical and effective means
to improve students’ knowledge of dental trauma.

Table 2. Scores of both questionnaires of both groups.
Number (Percentage) Number (Percentage)
Baseline Score Q2 Score Baseline Score Q2 Score
Q9 Place for treatment
Correct 126 (34.6) 116 (31.9) 118 (38.9) 102 (33.7)
Incorrect 180 (49.5) 189 (51.9) 150 (49.5) 154 (50.8)
Do not know 58 (15.9) 59 (16.2) 35 (11.6) 47 (15.5)
Q10 Time for treatment
Correct 216 (59.3) 207 (56.9) 168 (55.4) 150 (49.5)
Incorrect 97 (26.6) 105 (28.8) 110 (36.3) 98 (32.3)
Do not know 51 (14.0) 52 (14.3) 25 (8.3) 55 (18.2)
Q11 Management of fractured teeth
Correct 99 (27.2) 146 (40.1) 90 (29.7) 92 (30.4)
Incorrect 177 (48.6) 131 (36.0) 137 (45.2) 119 (39.3)
Do not know 88 (24.2) 87 (23.9) 76 (25.1) 92 (30.4)
Q12 Management of displaced teeth
Correct 79 (21.7) 129 (35.4) 71 (23.4) 84 (27.7)
Incorrect 180 (49.5) 139 (38.2) 175 (57.8) 129 (42.6)
Do not know 105 (28.8) 96 (26.4) 57 (18.8) 90 (29.7)
Q13i Management of avulsed baby teeth
Correct 221 (60.7) 212 (58.2) 200 (66.0) 172 (56.8)
Incorrect 10 (2.7) 24 (6.6) 10 (3.3) 12 (4.0)
Do not know 133 (36.5) 128 (35.2) 93 (30.7) 119 (39.3)
Q13ii Management of avulsed permanent teeth
Correct 81 (22.3) 126 (34.6) 72 (23.8) 63 (20.8)
Incorrect 126 (34.6) 95 (26.1) 110 (36.3) 95 (31.4)
Do not know 157 (43.1) 143 (39.3) 121 (39.9) 145 (47.9)
Q14 Mediums for storage of avulsed teeth
Mean 20.352 0.310 20.330 20.261
Std. Dev. 1.117 1.466 1.155 1.077
Total Score
Mean 20.209 1.005 20.238 20.076
Std. Dev. 2.414 3.565 2.611 2.616
Change = 1.214 (SD = 3.447) Change = 0.162 (SD = 2.265)
For Question 9–13, 1 mark for each correct answer, 0 for don’t know, 21 if it is wrong or any wrong answer if chose more than 1. (26 to 6); For question 14, 1
for each correct answer, 0 for don’t know, 21 for each wrong answer (27 to 3); Range of total score of the whole questionnaire: 213 to 9.
doi:10.1371/journal.pone.0101972.t002
Table 3. Relationship between score change and intervention, baseline score.
Estimate Standard Error 95% Confidence Interval p-value
Intercept 1.34 0.38 0.59 2.09 0.0049
Group* (Intervention = 0, Control = 1) 21.25 0.54 22.30 20.19 0.0407
Baseline Score* 20.40 0.04 20.48 20.32 ,0.0001
Estimated ICC = 0.1193.
* the independent variable is significantly different from zero at 5%
significance. doi:10.1371/journal.pone.0101972.t003

Protocol S1
(PDF)
Acknowledgments
We thank all participating schools and students.
Author Contributions
Conceived and designed the experiments: CY KYW LKC. Performed the
experiments: CY. Analyzed the data: CY KYW LKC. Contributed
reagents/materials/analysis tools: CY KYW. Contributed to the writing of
the manuscript: CY KYW LKC. Wrote the paper: CY KYW LKC.
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30. Levin L, Jeffet U, Zadik Y (2010) The effect of short dental trauma lecture on
knowledge of high-risk population: an intervention study of 336 young adults.
31. Frujeri Mde L, Costa ED Jr (2009) Effect of a single dental health education on
the management of permanent avulsed teeth by different groups of professionals.
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single educational input given to school teachers on patient’s correct handling
after dental trauma. SADJ 56: 284–287.
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DOI: 10.1371/journal.pone.0101972

Effectiveness of Educational Poster on Knowledge of Emergency Management of Dental Trauma - Part 2: Cluster
Randomised Controlled Trial for Secondary School Students
Cecilia Young1*, Kin Yau Wong2, Lim K. Cheung3
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 The University of Hong Kong, Hong Kong
Abstract
Objective: To investigate the effectiveness of educational poster on improving secondary school students’ knowledge of emergency management of dental trauma.
Methods: A cluster randomised controlled trial was conducted. 16 schools with total 671 secondary students who can read Chinese or English were randomised into intervention (poster, 8 schools, 364 students) and control
groups (8 schools, 305 students) at the school level. Baseline knowledge of dental trauma was obtained by a questionnaire. Poster containing information of dental trauma management was displayed in a classroom for 2 weeks in
each school in the intervention group whereas in the control group there was no display of such posters. Students of both groups completed the same questionnarie after 2 weeks.
Results: Two-week display of posters improved the knowledge score by 1.25 (p-value = 0.0407) on average.
Conclusion: Educational poster on dental trauma management significantly improved the level of knowledge of secondary school students in Hong Kong.
Trial Registration: HKClinicalTrial.com HKCTR-1343 ClinicalTrials.gov NCT01809457
Citation: Young C, Wong KY, Cheung LK (2014) Effectiveness of Educational Poster on Knowledge of Emergency Management of Dental Trauma - Part 2: Cluster
Randomised Controlled Trial for Secondary School Students. PLoS ONE 9(8): e101972. doi:10.1371/journal.pone.0101972
Editor: Michael Glogauer, University of Toronto, Canada
Received May 19, 2013; Accepted June 10, 2014; Published August 5, 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.
Data Availability: The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper and its Supporting Information files.
Funding: The study is self-funded by the principal investigator.
Competing Interests: The authors have declared that no competing interests exist.
* Email: ceciliatyp@yahoo.com.hk
Introduction
Prevalence of traumatic dental injuries of primary and permanent teeth is high throughout the world. Statistics from most countries showed that one fourth of all school children and almost one third of adults had suffered trauma to the permanent dentition, with variations among and within countries [1].
Early management is crucial to the prognosis for some dental injuries, especially avulsion [2]. However, most studies showed that teachers or school staff [3–15], parents [15–21], nurses [15,22,23], paramedics [23] and coaches [21] lacked the knowledge to manage traumatic dental injuries appropriately before the injured
person reached dental professionals.
Since immediate management of traumatic dental injury does not require special skill but only knowledge, it can be performed by a lay person if one knows the procedures. The ideal situation is that such knowledge becomes everyone’s basic practical knowl-edge. The earlier one learns the appropriate procedure, the higher
chance one can save more traumatized teeth. In a literature search conducted before the study and finalized on Sept 21, 2013, there were only 4 studies investigating children’s and teenagers’ knowledge of traumatic dental injuries [24–27]. The results were that the subjects did not possess adequate knowledge.
Literature search of published studies on education in traumatic dental injuries prior to Sept 21, 2013 using keywords (‘‘promo-tion*’’ or ‘‘intervention’’ or ‘‘education’’ or ‘‘knowledge’’ or ‘‘campaign’’ or ‘‘seminar’’ or ‘‘lecture’’ or ‘‘pamphlet’’ or ‘‘leaflet’’ or ‘‘banner’’ or ‘‘poster’’) and (‘‘dental injur*’’ or ‘‘traumatic dental
injur*’’ or ‘‘dental trauma’’) on Pubmed, Ovid, Web of Science and Cochrane Central Register of Controlled Trials resulted in only 14 papers related to education [28–41]. All of them targeted on adults, and there was no information about education in dental trauma for children or teenagers.
All Hong Kong primary school students (US Grade 1–6) are eligible to join the School Dental Care Service and most of them joined voluntarily. Every participant received a handbook for recording dental visits and it contained around 20 pages of dental health information. Since 1994, the handbook contained one page about
avulsion and it mentioned that avulsed tooth should be put back into the socket, stored in milk or in mouth.

However, in 2011, a survey about the level of knowledge of dental trauma revealed that such knowledge of secondary school students (US Grade 7–12 plus 1 year) in Hong Kong was insufficient [27]. In that survey, only a small portion of secondary school students knew that avulsed permanent tooth should be replanted
(23.6%), or stored in cold milk (18.7%), physiological saline (24.2%) or saliva (6.7%), even they were eligible to join the school dental service and received the mentioned handbook in their primary education. Educational campaign on dental trauma management was recommended for secondary school students by the authors.
It is easy to implement poster campaign because of the low cost. In the present study, the effectiveness of dental trauma educational poster on level of knowledge was studied. Secondary school students were chosen and the cluster design was adopted since it is appropriate for the actual school environment as students
might discuss with and hence influence each other. Also, since students in the same school may have some unique characteristics, e.g. higher level of health consciousness, the study was randomised at the school level to prevent contamination and improve on compara-bility.
Methods
Ethical approval
The research project was approved by the Institutional Review Board of the University of Hong Kong and Hospital Authority Hong Kong West Cluster. (HKCTR-1343, ClinicalTrials.gov: NCT01809457)
Subjects
The subjects were secondary school students (US Grade 7–12 plus 1 year) in Hong Kong, who can read Chinese or English. We recruited the secondary schools as clusters. The protocol for this trial and supporting CONSORT checklist are available as supporting information; see Checklist S1 and Protocol S1.
Questionnaire
The questionnaire from a survey of the same series about knowledge of dental trauma among the same target group was used [27]. Chinese and English versions of the questionnaire were constructed. There were 14 questions, divided into two sections. The first section asked for basic demographic information, whether the
respondents had received formal first-aid training or acquired dental trauma information and whether they considered themselves able to distinguish between permanent and deciduous teeth. The second part consisted of questions concerning knowledge of dental traumatic injuries, which was for the assessment of dental
knowledge in this study. The questionnaire was pilot tested with 59 students. Face validity, length and comprehensibility by secondary school students were pre-tested before the questionnaire was finally adopted. Face validity was established by expert opinion, and a test-retest reliability test indicated that the scores of the
first and second questionnaires were positively correlated.
The marking scheme is as follows: for Q9 to Q13, 1 mark would be given for a correct answer, 0 would be given for ‘‘do not know’’ and 1 would be deducted for an incorrect answer. If multiple answers were chosen, 1 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 type of dental trauma, timely emergency management is critical. Knowledge of more storing media raises the chance of a student being able to find one soon enough to keep the vitality of the periodontal cells on the root surface, which improves
the prognosis. Therefore, 1 mark would be given for each correct answer but 1 mark would be deducted for each incorrect answer. Multiple answers were allowed.
Poster
The educational poster was in A3 size, colourful and with pictures. One side of the poster was written in Chinese and the other side in English, The content was constructed by the authors using two publications as reference [3,37]. This poster is the same as the one used in another study for primary and secondary school
teachers of the same series [41]. Chinese and English educational posters are available as supporting information S1 and S2.
Sample size calculation
In order to demonstrate a difference in score change of 2 marks (variance 10) between the intervention group and the control group, with a power of 90% and a statistical significance of 5%, 53 individuals are needed in each group under simple random sampling. To account for the cluster design, we assume an intracluster
correlation (ICC) of 0.1. No published data on ICC under this setting could be found. However, in general practice studies, ICC takes value commonly between 0.01 and 0.05 [42], so 0.1 would be a conservative estimate. With an average of 40 students per school and a coefficient of variation of cluster size of 0.2 (after realizing
that it was difficult in practice to recruit a minimum cluster size of 40 as laid down in the original protocol, we allowed clusters with size smaller than 40, but restricted the coefficient of variation of cluster size to be 0.2), the adjusted sample size is 7 schools, or 266 students, per group. To allow for potential dropouts, we
aimed to recruit extra 20% individuals per group (this extra 20% was changed from 30% in the original protocol), yielding a total of 8 schools, or 319 students, per group.
Recruitment
A staff of the principal investigator was invited to act as a voluntary secretary for this study. She was responsible for all mailings, information storage and co-ordination. She was informed that the identities of the participating schools and students should be blinded to all investigators, statistician and clerical staff at the time
of appointment. She was the only one who knew the identities of the schools. She kept the information concealed and put them in a locked drawer in her room.
The Education Bureau provided a list of secondary schools upon request. There were a total of 663 schools. Special schools for intellectually disabled students were included in the list. The secretary sent invitation letters with school consent forms and individual guardian consent forms to lots of 50 randomly selected schools
beginning on April 29, 2011. In each lot of invitation letters, there were 17 letters for Form 1–3 (US Grade 7–9), 17 letters for Form 4–5 (US Grade 10–11), and 16 letters of Form 6–7 (US Grade 12 plus 1 year). The contact information of the principal investigator was given in the invitation letter.
The secretary followed up with telephone calls. 16 schools with a total of 784 students joined the study after 200 invitations were sent. They replied with both signed school and individual guardian consent forms. The name and contact number of the teacher in charge were given in the school consent form.
Randomisation and masking
The randomisation was performed after both school and individual guardian consent forms were returned. The schools were randomised to the intervention group and the control group at the school level manually using sealed envelopes. The secretary put two pieces of paper bearing the words ‘‘intervention group’’ and
‘‘control group’’ separately into two envelopes. She labelled the sealed enveloped of intervention group as group A and the other as group B. She verified that the envelope was opaque that the words could not be seen through. An independent person who did not know the details of this study were invited to assist the
randomisation. The secretary labelled 1 to 16 on separate sheets of paper representing the 16 schools according to the order the consent forms were received. She folded each piece of paper and put it into an envelope and checked that the number could not be seen through, and then put them inside a box.
The independent person, not knowing the identities of group A and B, drew one envelope for group A and then one for group B alternatively until all the envelopes were drawn. The secretary then opened the envelopes and recorded the result of the randomisation. The list was put in a locked drawer that only the secretary
could access.

Implementation of the trial
The schools, teachers in charge and students were not informed of the identity of the group (intervention/control) they belonged to, educational material that they would receive and the duration of the trial. The letter of invitation and both consent forms only mentioned that the students needed to fill out two
questionnaires (see protocol S1).
The trial began on May 5, 2011 and was completed on Nov 16, 2011. The first set of questionnaires was sent to both groups and hard copies were distributed to the participating students by the teachers in charge. All participating students were asked to fill out the questionnaires and returned them to the corresponding
teachers in charge (in class), who then sent the completed questionnaires back to the investigator in 1 week.
A large sealed envelope containing the educational poster along with instructions was mailed to each intervention school. The teacher in charge of each school displayed the educational posters on the notice broad or at an area of similar function in the classroom. No poster was given to the control group.
The posters were removed by the teachers in charge after 2 weeks. The second set of questionnaires was then distributed to schools of both groups and the students were asked to complete the questionnaires in class. The teachers in charge then returned them to the study secretary in 1 week using prepaid envelopes.
Educational posters were mailed to the control group after the completion of the study. Every procedure followed that laid down in the protocol after the trial commenced.
Withdrawal from the study
The participating schools or individual students could withdraw from the study at any time, as mentioned in both consent forms. 39 students from the intervention group and 22 students from the control group withdrew from the study by not returning either the first or the second questionnaire.
Data processing
The data entry staff and the statistician were blinded to the group randomisation. The statistician was instructed to analyse under the labels ‘‘group A’’ and ‘‘group B’’ according to the designed method in the protocol. The investigators were blinded to the randomisation. Only after the completion of the whole statistical
report and the draft of the article, the study secretary informed the principal investigator the identities of the groups. The principal investigator then relabeled group A as intervention group and group B as control group.
Data analysis
Individual level analysis was performed as our objective and outcome measures pertain to individual level. Our objective is to investigate the effects of the intervention, potentially controlled for some baseline information, on the gain in knowledge. The dependent variable is the score difference between the two
questionnaires. To account for potential correlation among students from the same school, a linear mixed model was fitted with a normally distributed random intercept for the school effect.
To select the most appropriate model, a backward elimination method was adopted [43]. It started with including all covariates in the model: group (intervention/control), the score of the first questionnaire, gender, age, form, first-aid training, dental educa-tion in first aid, confidence in distinguishing deciduous and
permanent teeth, and acquisition of dental injury information from other sources. The covariate associated with the highest p-value was eliminated in each iteration until all p-values were smaller than a threshold value 0.1.
Due to the nature of the data collected and the collection process, we anticipated that the proportion of missing data would not be high. Therefore, we simply discarded subjects who did not provide the demographic or personal information asked in the first section of the questionnaire. Missing answers for questions in the
second section of the questionnaire were treated as ‘‘do not know’’, and the total scores were accordingly calculated based on the marking scheme given.
The thresholds of all the statistical tests were set at 5% level of significance. The statistical analyses were performed using a computer software (JMP version 9.0.0, SAS Institute Inc., USA).
Results
There was no unintended effect or harm reported through the teachers in charge or directly to the principal investigator. After removing participants with missing background information, there were 364 individuals (8 schools) in the intervention group and 303 individuals (8 schools) in the control group available for analysis
(Figure 1). The basic information for both groups on the school level and the individual level are given in Table 1. Statistical test was not conducted to compare the baseline information of the two groups [44].
The average scores of each question of both questionnaires, along with the average difference in score of the two question-naires for each group, are given in Table 2.
The result of the multiple linear regression is presented in Table 3. The covariates included in the final model were group (intervention/control) and baseline score only.
From the regression analysis, the group effect is significant. Given the same baseline score, individuals in intervention group had on average a score difference 1.25 (p-value = 0.0407) higher than that of individuals in control group. The baseline score effect is also significant, which indicates that an increase in baseline score of
1 mark would on average reduce the score difference by 0.40 (p-value,0.0001).
Discussion
Effectiveness of educational poster on management of dental trauma on secondary school students was studied. From the statistical analysis, the group effect is significant. It means that the two-week display of the poster improved the score with statistical significance. Given the same baseline score, individuals in
intervention group had on average a score difference 1.25 (p-value = 0.0407) higher than that of individuals in control group. However, a score difference of 1.25 marks is smaller than our expectation.
Some questions were not answered any better in the interven-tion group after the two-week display of poster. It may be that students understood and/or remembered selective portion of the information. Students may be more interested in reading certain area of the poster and may not have gone through the entire poster.
This result reflects whether the students had read, understood and remembered information on the poster. This is the first cluster randomised controlled trial for investigating the effectiveness of educational posters on dental trauma on this age group.
Since a model containing all relevant information collected in the questionnaire is too large under the current sample size, which would make the estimation unstable, we have chosen to adopt a backward variable selection procedure. We are aware that such method would possibly inflate type I error due to multiple testing,
and the significant factors remained in the model may just be chosen by coincidence. It means that the p-values of the factors in the model tend to be smaller and the confidence intervals tend to be narrower than they, strictly speaking, should be.

One should bear that in mind when interpreting the results. However, under the current setting, the major factor of interest is the intervention effect, which would not be eliminated under the variable selection procedure. The problem of concluding a significant intervention effect by coincidence as a result of variable
selection does not exist. Also, besides intervention, there is only one factor remaining in the model, namely the baseline score. Therefore, the inflation of Type I error, if any, is minimal.
With the above being said, one may still be interested in the estimated marginal effect of intervention. Fitting a linear mixed model with only intervention group as independent variable, the estimated effect is 1.26 (p-value = 0.0423), which means that on average students from the intervention group had score improve-ment
of 1.26 more than that of students from the control group. It is, though marginally, significant at 5% level of significance.
The immediate effect of two-week display of poster was investigated, while long term effect is out of the scope of this study. Knowledge, rather than the management of traumatic dental injuries, was tested because long term follow up is necessary for the latter. It is not feasible to carry it out in Hong Kong because the
number of cases from the sampling frame may not be large enough to produce a sizable sample that would produce statistically significant results. The list of all primary and secondary schools was exhausted even for the series of short term studies.
From the 663 secondary schools in Hong Kong, with altogether 454244 students, the sample was randomly selected with only the condition that the students were able to read Chinese or English. The results apply to all these students. The generalizability of the results to other countries is unclear since the culture, students’
workload, educational system, health consciousness, ability to comprehend the study information and the importance students placed on dental trauma material may differ.
As some schools display a lot of information to students and change the notices or posters quite frequently, display time of longer than two weeks may not be feasible. Classroom is the most suitable location for effectively displaying information to students.
Though they are usable media for storage, Hank’s balanced salt solution (or e.g. Save-A-Tooth), Viaspan, eagle’s medium and propolis culture medium were not mentioned in the choices explicitly in question 14 because these were not accessible to students in Hong Kong. However, if students mentioned these in the ‘‘others
(please specify)’’ option, they would be considered correct. Nevertheless, no student mentioned any of these solutions. These media were not mentioned in the poster for the same reason.
The randomisation of this trial was blinded to the investigator, data entry staff and the statistician. Only the secretary knew the identities of group A and B, and this information was given to the investigators only after the whole statistical report and the manuscript were drafted. Other than relabeling ‘‘group A’’ and ‘‘group B’’
as ‘‘intervention group’’ and ‘‘control group’’, respectively, no information on the figure or results was amended. So doing was to minimize bias and to improve the representability of the statistical analysis result.
Educational posters are relatively inexpensive and easy to distribute. There is no temporal limitation and assembly of students is not needed, as in the case of lectures and seminars. Displaying educational posters in classrooms is practical and effective means to improve students’ knowledge of dental trauma.
Conclusion
Educational poster statistically significantly improves the student’s knowledge of emergency management of dental trauma.
Supporting Information
Checklist S1
(DOCX)
Poster S1 Chinese Educational poster.
(PDF)
Poster S2 English Educational poster.
(PDF)
Protocol S1
(PDF)
Acknowledgments
We thank all participating schools and students.
Author Contributions
Conceived and designed the experiments: CY KYW LKC. Performed the experiments: CY. Analyzed the data: CY KYW LKC. Contributed reagents/materials/analysis tools: CY KYW. Contributed to the writing of the manuscript: CY KYW LKC. Wrote the paper: CY KYW LKC.

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34. Arikan V, Sonmez H (2012) Knowledge level of primary school teachers regarding traumatic dental injuries and their emergency management before and after receiving an informative leaflet. Dent Traumatol 28: 101–107.
35. Al-Asfour A, Andersson L (2008) The effect of a leaflet given to parents for first aid measures after tooth avulsion. Dent Traumatol 24: 515–521.
36. Mori GG, Castilho LR, Nunes DC, Turcio KH, Molina RO (2007) Avulsion of permanent teeth: analysis of the efficacy of an informative campaign for professionals from elementary schools. J Appl Oral Sci. 15: 534–538.
37. 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.
38. Skapetis T, Gerzina T, Hu W (2012) Managing dental emergencies: A descriptive study of the effects of a multimodal educational intervention for primary care providers at six months. BMC Med Educ 12: 103. doi: 10.1186/ 1472-6920-12-103
39. Skapetis T, Gerzina T, Hu W (2012) Can a four-hour interactive workshop on the management of dental emergencies be effective in improving self reported levels of clinician proficiency? Australas Emerg Nurs J. 15: 14–22.
40. Pujita C, Nuvvula S, Shilpa G, Nirmala S, Yamini V (2013) Informative promotional outcome on school teachers’ knowledge about emergency management of dental trauma. J Conserv Dent. 16: 21–27.
41. Young C, Wong KY, Cheung LK (2013) Effectiveness of Educational Poster on Knowledge of Emergency Management of Dental Trauma–Part 1. Cluster Randomised Controlled Trial for Primary and Secondary School Teachers. PLoS ONE 8(9): e74833. doi:10.1371/journal.pone.0074833
42. Underwood M, Barnett A, Hajioff S (1998) Cluster randomization: a trap for the unwary. Br J Gen Pract 48: 1089–1090.
43. Draper N, Smith H (1981) Applied Regression Analysis. New York: Wiley. Effectiveness of Educational Poster on Students
44. Froud R, Eldridge S, Diaz Ordaz K, Marinho VC, Donner A (2012) Quality of cluster randomized controlled trials in oral health: a systematic review of reports published between 2005 and 2009. Community Dent Oral Epidemiol 40 (Suppl 1) 3–14. doi: 10.1111/j.1600-0528.2011.00660

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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