The attitudes and awareness of London based emergency department physicians towards the management of common dentofacial emergencies

Background Dentofacial emergencies which are a common presentation to the emergency department (ED)
and there is little data on how they are managed by non-dentally trained clinicians in the ED. Aims: To
investigate the attitudes and awareness of ED physicians towards four common aspects of dentofacial
emergencies and to explore potential barriers ED physicians may face in treating these emergencies. Methods
A questionnaire survey involving 103 ED physicians largely from around the London region was employed.
Results: The cohort included ED consultants (n=33), ED registrars (n=33) and ED juniors (n=37). 76.5%
reported as not having any formal training in managing these emergencies. The study found that the
percentage of participants who were confident in managing dental trauma was 20.4%, major facial trauma
(40.6%), interpreting facial x-rays (69.3%) and facial suturing (86.3%). A subgroup of the cohort (n=58) were
questioned on who they felt should manage maxillofacial and dental emergencies. 51.7% felt that dentists
should manage dental emergencies and 67.2% thought that maxillofacial surgeons should manage
maxillofacial emergencies in the ED. Only 12.1% and 22.4% felt that ED doctors should treat dental
emergencies and maxillofacial emergencies respectively. When asked who they would like to be treated by in
the event they presented to the ED with a traumatic dental injury (n=102) only 3.9% favoured ED as treating
speciality compared to 23.5% treatment by a dentist and 72.5% by a maxillofacial surgeon. None of the
participants opted treatment by an ENP. Discussion: Although based on a limited study sample the data
suggests that ED doctors do not feel confident in managing some dentofacial emergencies. This may be
attributed to a lack of training in this area as well as exposure to these types of emergencies. Furthermore the
confidence level reported may not reflect actual competence and there is a need for greater awareness,
validated guidelines and training resources for ED clinicians to treat dentofacial emergencies as well more research in this field of emergency medicine.