Emergency management of avulsed permanent teeth: a national study of knowledge gaps among dentists and predictors informing an intervention framework

Tooth avulsion is a severe traumatic dental injury where prognosis depends on immediate management and adherence to guidelines. No nationwide assessment of Sri Lankan dentists’ knowledge on management of avulsed teeth has been reported. The study assessed knowledge of avulsion management among Sri Lankan dentists and identified demographic factors associated with knowledge scores. A nationwide cross-sectional analytical study (January 2021–April 2022) was conducted encompassing all nine provinces of Sri Lanka using a validated 21-item questionnaire based on IADT 2020 guidelines. Stratified random sampling identified 750 eligible dentists; 256 participated (response rate 34.1%). Knowledge was assessed in emergency and intermediate management domains. Analyses included descriptive statistics, nonparametric tests, Spearman correlation, and multivariable regression with robust errors. Participants included 163 female (63.7%) and 93 male (36.3%) dentists, with a mean professional service duration of 11.65 ± 8.97 years. The proportion of correct responses were low for accident-site management (44.92%) and storage media order (44.53%), but higher for tooth handling (99.61%) and splinting time (71.88%). Mean scores: knowledge 2.38 ± 1.0, management 3.00 ± 0.9, grand total 5.38 ± 1.6 (range 0–9). Only 0.8% achieved full scores. Knowledge was negatively associated with years of service ( ρ = − 0.18, p = 0.0045). Multivariable regression showed that postgraduate trainees scored on average 1.62 points higher (95% CI: 1.04–2.19), senior academics 1.48 points higher (95% CI: 0.54–2.41), and diploma holders 1.18 points higher (95% CI: 0.65–1.70) than dentists, while each additional year of service was associated with a modest − 0.07‑point decrease (95% CI: − 0.10 to − 0.04). Years of service alone explained ~ 3% of score variance (R 2 = 0.033), whereas the multivariable model including professional role and gender explained ~ 32% (R 2 = 0.32). Remarkably, even experienced dentists exhibit notable deficiencies in managing tooth avulsion. Consequently, implementing targeted continuing professional development and systematic integration of training aligned with IADT guidelines is imperative to optimize clinical outcomes.