| Abstract|| |
Background: Dentists have a unique potential of preparing a future generation ready to accept the preventive services. To keep the clinical practice in pace with the advancing dental sciences, the practitioner's knowledge and skills toward preventive care options need to improve.
Aim: To evaluate the knowledge attitude and practice toward preventive dental care among the dental professionals in Chennai.
Materials and Methods: A cross-sectional study conducted among dental professionals in Chennai. Knowledge, attitude and practice toward preventive dental care were assessed using a pretested, structured and validated questionnaire that was administrated to 142 dental professionals.
Results: A total of 142 dental professionals participated in this questionnaire study, of which, 95 (66.9%) were males and 47 (33.1%) were females. In the present study, more than 80% respondents agreed to the fact that preventive services can decrease the prevalence of dental caries. Results of the present study reveal that the majority (86%) of the dentists believe that pit and fissure sealants are effective in preventing dental caries in children. The fact is that 72% of dentists in Chennai were aware of atraumatic restorative treatment is a positive finding.
Conclusions: Dentists' knowledge of and attitudes toward prevention should be improved and updated to enable and encourage them to provide their patients with preventive care. Greater effort should be made by the professional organization and governmental agencies to inform patients of the benefits of sealants.
Keywords: Dental care, dental education, preventive dentistry
|How to cite this article:|
Premnath P, John J. Knowledge attitude and practice toward preventive dental care among dental professionals in Chennai. J Educ Ethics Dent 2015;5:20-4
|How to cite this URL:|
Premnath P, John J. Knowledge attitude and practice toward preventive dental care among dental professionals in Chennai. J Educ Ethics Dent [serial online] 2015 [cited 2019 Oct 16];5:20-4. Available from: http://www.jeed.in/text.asp?2015/5/1/20/178023
| Introduction|| |
One of the most common pandemic diseases that affect mankind is dental caries. Dental caries is a microbial disease that forms through a complex interaction over time between acid-producing bacteria and fermentable carbohydrate, and many host factors including teeth and saliva.  Dental diseases are not directly life-threatening but have a detrimental effect on quality of life. 
The prevalence and severity of dental caries in industrialized countries have decreased in the last three decades, but improvements have now halted in younger age groups. In developingcountries where fluoride is not available and populations have more opportunity to consume free sugars and other fermentable carbohydrates, the prevalence of decay is increasing. 
Changes in diagnostic criteria and preventive and curative efforts by dental health services have certainly been parallel factors for the caries decline. Dentists are the professionals who educate the public about oral health care, they influence their patient's oral health related behavior.  Dentist's knowledge attitude and practice toward oral health care provide the framework for their professional work.  But there seems to be a lack of knowledge about the preventive services provided in our country. Lack of public knowledge and believe in the efficacy of these dental products also influence parental acceptance of these materials for their children. Continuing education has been proposed as a method of increasing sealant and varnish utilization among practicing dentists. 
Oral health is not only important to your appearance and sense of well-being, but also to your overall health. The preventive approach in dental practice has been cited as a reason for caries decline in recent decades,  and as a predominant part of the service-mix of dental practices in the future.  The re-orientation of oral health services toward prevention and health promotion is one of WHO's priority action areas for the continuous improvement of oral health.  The knowledge, attitude and practice of dental professionals need to follow this reorientation.
To keep the clinical practice in pace with the advancing dental sciences, the practitioner's knowledge and skills toward care options need to improve. Thus increasing the oral health knowledge of the dentist provides an opportunity to educate an important segment of the public that has to access to the large population of the young people. 
Dentists have a unique potential of preparing a future generation ready to accept the preventive services. Although dentists generally seem to be knowledgeable of preventive matters,  and have positive attitude toward prevention, , deficiencies in their knowledge have been reported.  So the present study was carried out to evaluate the knowledge attitude and practices toward preventive dental care.
| Materials and Methods|| |
The present study was conducted in Tamil Nadu; India. A list of dentists practicing in Chennai registered with Dental Council of India was obtained. Among the total number of dentists practising in Chennai 142 dental professionals were selected. Dentists who are not willing to participate in the study and dentists who were unavailable even after three consecutive visits to their clinics/hospitals were excluded from the study.
Prior to the start of the study ethical clearance was obtained from the Institutional Ethics Committee, Saveetha University. Written informed consent was obtained from the study participants. The sample size was calculated based on the study done by Rafi; 2010 N = 142 (90% power @ 5% alpha).
A pretested, structured and validated questionnaire was adapted from questionnaires used previously in studies done by Hadi et al.  and Rafi. 
The survey tool consisted of several parts. The first section collected demographic information of the participants such as age, gender, highest level of education and number of years of experience in clinical practice. The second part assessed the participant's levels of knowledge regarding preventive dental care. The third section of the questionnaire assessed participant's attitudes toward the preventive dental care. The last section of the questionnaire assessed the practices of dentists regarding preventive dental care. The questionnaire was assessed based on a five point Likert scale (strongly agree, agree, neutral, disagree, and strongly disagree)
Questionnaires were distributed to the dentists and filled questionnaires were collected. The duration of the study was 1-month (September 2013). Only completely filled forms were considered for analysis.
Data were entered in Microsoft Excel spreadsheet and descriptive data were analyzed using SPSS software (Version 17.0) developed by IBM Corporation. One way ANOVA and Independent t test were used to compare the mean scores. Tukeys HSD Post Hoc test was done for the attitude score since it was found to statistically significant in one way ANOVA. Pearsons correlation was done to assess the correlation between the variables value ≤0.05 is considered as statistically significant. For test, a P < 0.05 is considered as statistically significant.
| Results|| |
[Figure 1] depicts the distribution of study subjects. The study sample consisted of 142 subjects of which 95 (67%) were males and 47 (33%) were females.
In the 21-30 years age group, 72 (75.8%) were males; 37 (78.7%) were females. In 31-40 years of age group, 21 (22.1%) were males; 7 (15%) were females. In >40 years of age group, 2 (2.1%) were males; 3 (6.3%) were females.
[Figure 2] shows the distribution of study subjects based on level of education. Among the 142 study subjects, 17 (12%) had completed under graduation, 125 (88%) had completed post-graduation.
[Table 1] shows the comparison of mean scores of knowledge, attitude and practice between the different age groups.
|Table 1: Comparison of mean scores of knowledge, attitude and practice between age groups|
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The mean score for knowledge was found to be more in 21-30 years of age group (0.110 ± 0.44) followed by 31-40 years (0.321 ± 0.611). However, statistical analysis showed no significant difference in the mean knowledge score to different age groups (P = 0.086).
The mean score for attitude was found to be more in 21-30 years of age group (1.724 ± 0.770) followed by 31-40 years (2.214 ± 0.74) and >40 years (1.800 ± 0.45). The association between the mean attitude score and age groups was statistically significant (P = 0.011).
The mean score for practice was found to be more in 21-30 years of age group (2.330 ± 1.312) followed by 31-40 years (2.285 ± 1.272) and >40 years of age group (2.800 ± 0.830). P value was not found to be statistically significant (P = 0.710).
[Table 2] depicts the comparison of mean differences in attitude scores at various age groups.
|Table 2: Comparison of mean differences in attitude scores at various age groups|
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Post-hoc analysis showed a significant difference in attitude score between 21-30 years and 31-40 years of age group (P = 0.007).
The mean differences in attitude scores at 21-30 years and >40 years (P = 0.974), 31-40 years and >40 years (P = 0.497) was found to be not statistically significant.
[Table 3] shows mean scores of knowledge attitude and practice between the genders.
|Table 3: Comparison of mean scores of knowledge, attitude and practice between genders|
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The mean knowledge score of male (0.180 ± 0.545) and female (0.080 ± 0.282) gender was not found to be statistically significant (P = 0.179).
The mean attitude score of male (1.800 ± 0.860) and female (1.872 ± 0.575) was not found to be significant (P = 0.553).
The mean practice score of male (2.505 ± 1.210) and female (2.000 ± 1.383) was found to be significant (P = 0.0270).
[Table 4] shows mean scores of knowledge attitude and practice between the years of experience.
|Table 4: Comparison of mean scores of knowledge attitude and practice between experience levels|
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The mean scores for knowledge were found to be more in <5 years of experience (0.125 ± 0.450) followed by >5 years of experience (0.233 ± 0.570). However, statistical analysis showed no significant difference in the mean attitude score to years of experience (P = 0.340).
The mean score for attitude was found to be more in <5 years (0.714 ± 0.764) followed by >5 years (2.233 ± 0.680). Statistical analysis showed a significant difference in the mean attitude score to years of experience (P = 0.001).
The mean score for practice was found to be more in <5 years of experience (2.232 ± 1.321) followed by >5 years of experience (2.733 ± 1.080). However, statistical analysis showed no significant difference in the mean practice score to years of experience (P = 0.058).
[Table 5] depicts the correlation between knowledge, attitude and practice toward preventive dental care. A statistically significant correlation was found in between the knowledge and practice score (-0.001). There is no statistical significant correlation found between knowledge and attitude (0.090); attitude and practice (0.032).
| Discussion|| |
Dental caries is a prevalent health problem and a leading cause of tooth loss among children, although the prevalence of dental caries has declined.  They represent a chronic, infectious, multifactorial disease that can occur throughout a person's lifetime. However, most of those could be prevented by the appropriate use of fluorides and pit and fissure sealants. To prevent dental caries, correct knowledge and positive attitudes about dental care are important, especially for dentists as leaders. 
As there is a paucity of literature regarding preventive dental care all over India, the current study was conducted to determine knowledge, attitude and practices of preventive dental care among dental professionals.
A total of 142 dental professionals participated in this questionnaire study, of which, 95 (66.9%) were males and 47 (33.1%) were females. Details on years of clinical experience and the associations with the knowledge, attitude and practice scores were determined. Only attitude scores had a statistically significant association with the years of clinical experience.
In the present study more than 80% respondents agreed to the fact that preventive services can decrease the prevalence of dental caries, this was in accordance with the study by Rafi (2010).  This accurate knowledge enables dentists to make appropriate decision on their patient's oral health. In the current study, deficiencies were evident in the dentist's knowledge regarding sugar, sealants and water fluoridation on dental caries.
Attitude are influenced by beliefs and values, personal needs and behavior. Accordingly, dentist's attitudes vary according to their background and professional factors. Results of the present study reveal that majority (86%) of the dentists believe that pit and fissure sealants are effective in preventing dental caries in children with accordance with the study conducted by Rafi (2010). Sealants applied to pits and fissures act as mechanical barriers between the enamel surface and the biofilm, and if retained completely, have been shown to be very effective in restricting the entry of bacteria. The studies of Handelman  from over 35 years ago and some later studies by Mertz-Fairhurst et al.  have shown that when caries lesions are sealed, the lesion does not progress. Until, the middle of 1980's sealants were generally applied in a preventive manner solely to intact, unstained fissures with no suspected enamel caries lesions. Accordingly, topical fluoride, pit and fissure applications should be included more effectively in the dental curriculum.
Atraumatic restorative treatment (ART) technique or approach uses manual excavation of dental caries, which eliminates the need for anesthesia and use of expensive equipment, and restores the cavity with glass ionomer cement, which demonstrates sustained fluoride release, pulpal biocompatibility, and chemical adhesion to the tooth structure.  This minimally-invasive procedure is largely pain-free and readily accepted by children. The fact that 72% of dentists in Chennai were aware of ART is a positive finding. In line with the findings from the study conducted by Rafi, the present study indicate that majority of the dental professionals that is, more than 70% were trained in the application of topical fluoride and pit and fissure sealants. The practice toward preventive dental care is much better among the dentists when compared to the knowledge. There is a negative correlation (r = -0.001) between knowledge and practice toward preventive dental care.
To overcome the deficiency in the level of knowledge amongst dental professionals, continuing education programs are the need of the hour. However, as is usually a natural characteristic of questionnaire surveys, some over representation may occur because responding dentists tend to be more interested in the topics of the questionnaire and thus more confident and knowledgeable. The data being self-reported, and the subjects may have responded in a socially desirable manner. Future studies are required to investigate the knowledge, attitudes and practice toward preventive dental care.
| Conclusion|| |
Based on the findings of this study, it can be concluded that the dental professionals still lack sufficient knowledge regarding the preventive dental care, they also lack the attitudes toward this preventive dental aspects and lastly there is a lack in the practices of the dental professionals regarding the preventive dental care.
Our study raises the issue of lack of knowledge although almost all dental professionals believed that they had an important responsibility in preventing oral diseases. Dentists' knowledge of and attitudes toward prevention should be improved and updated to enable and encourage them to provide their patients with preventive care. Greater effort should be made by the professional organization and governmental agencies to inform patients of the benefits of sealants.
| References|| |
Selwitz RH, Ismail AI, Pitts NB. Dental caries. Lancet 2007;369:51-9.
Joshipura KJ, Willett WC, Douglass CW. The impact of edentulousness on food and nutrient intake. J Am Dent Assoc 1996;127:459-67.
Moynihan P, Petersen PE. Diet, nutrition and the prevention of dental diseases. Public Health Nutr 2004;7:201-26.
Eijkman MA, de With C. Answers from dentists, dental hygienists and dental assistants to questions asked by patients concerning preventive dental matters. Community Dent Oral Epidemiol 1980;8:339-46.
Murdoch-Kinch CA, McLean ME. Minimally invasive dentistry. J Am Dent Assoc 2003;134:87-95.
Petersson GH, Bratthall D. The caries decline: A review of reviews. Eur J Oral Sci 1996;104:436-43.
Eklund SA. Changing treatment patterns. J Am Dent Assoc 1999;130:1707-12.
Petersen PE, Estupinan-Day S, Ndiaye C. WHO′s action for continuous improvement in oral health. Bull World Health Organ 2005;83:642.
McGlone P, Watt R, Sheiham A. Evidence-based dentistry: An overview of the challenges in changing professional practice. Br Dent J 2001;190:636-9.
Gonzalez CD, Frazier PJ, Messer LB. Sealant knowledge and use by pediatric dentists: 1987 Minnesota survey. ASDC J Dent Child 1988;55:434-40.
Allard RH. Tobacco and oral health: Attitudes and opinions of European dentists; a report of the EU working group on tobacco and oral health. Int Dent J 2000;50:99-102.
Kujan O, Duxbury AJ, Glenny AM, Thakker NS, Sloan P. Opinions and attitudes of the UK′s GDPs and specialists in oral surgery, oral medicine and surgical dentistry on oral cancer screening. Oral Dis 2006;12:194-9.
Lewis DW, Main PA. Ontario dentists′ knowledge and beliefs about selected aspects of diagnosis, prevention and restorative dentistry. J Can Dent Assoc 1996;62:337-44.
Ghasemi H, Murtomaa H, Torabzadeh H, Vehkalahti MM. Knowledge of and attitudes towards preventive dental care among Iranian dentists. Eur J Dent 2007;1:222-9.
Tagoo RA. Dentists knowledge and expertise of preventive dental procedures in Saudi Arabia: A nation-wide cross-sectional survey. J Contemp Dent 2010;3:127-30.
Lin TH. Knowledge and practices of caries prevention among Taiwanese dentists attending a national conference. J Dent Sci 2010;5:229-36.
Handelman SL, Washburn F, Wopperer P. Two-year report of sealant effect on bacteria in dental caries. J Am Dent Assoc 1976;93:967-70.
Mertz-Fairhurst EJ, Curtis JW Jr, Ergle JW, Rueggeberg FA, Adair SM. Ultraconservative and cariostatic sealed restorations: Results at year 10. J Am Dent Assoc 1998;129:55-66.
Department of Public Health Dentistry, Saveetha Dental College and Hospital, No, 162, Poonamallee High Road, Vellapanchavadi, Chennai - 600 077, Tamil Nadu
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]