|Year : 2020 | Volume
| Issue : 1 | Page : 24-29
General dentists' knowledge, attitude, and practice guidelines toward pediatric dentistry
Thabitha S Rani1, E Rajendra Reddy2, Kiranmayi Merum3, MP Srujana4, S Srikanth Raju4, Manitha Pershad Seth5
1 Professor, Department of Pedodontics and Preventive Dentistry, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda District, Telangana, India
2 Professor and HOD, Department of Pedodontics and Preventive Dentistry, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda District, Telangana, India
3 Reader, Department of Pedodontics and Preventive Dentistry, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda District, Telangana, India
4 Sr. Lecturer, Department of Pedodontics and Preventive Dentistry, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda District, Telangana, India
5 Postgraduate, Department of Pedodontics and Preventive Dentistry, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda District, Telangana, India
|Date of Submission||22-Jan-2019|
|Date of Decision||01-Sep-2019|
|Date of Acceptance||09-Sep-2019|
|Date of Web Publication||19-Jun-2020|
Manitha Pershad Seth
Department of Pedodontics and Preventive Dentistry, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda District, Telangana State - 508254
Source of Support: None, Conflict of Interest: None
Introduction: Pediatric dentists play an important role in treating primary teeth and providing oral health care needs for children. The prevention for diseases of the oral cavity, namely early childhood caries (ECC), abnormal oral habits, etc., at primary level is of great need in young children. General dentists also share an equal responsibility toward early screening, educating parents, and treating and referring the patient to the pediatric dentist whenever required. Aim: The aim of this study was to determine the knowledge, attitude, and practice guidelines among general dentists in Hyderabad, Telangana, India, toward various treatment modalities in the pediatric dentistry using a questionnaire survey. Materials and Methods: A structured 25-item questionnaire was formulated in English and was distributed among 200 general dentists. The filled questionnaire survey was analyzed using the SPSS. Results: Among the respondents, the knowledge regarding treatment modalities in children was 59% said that pulpectomy is the first line of treatment for pulpal exposure, 66.5% said that crowns are necessary after pulpectomy, and 76% of general dentists said that they refer the special child to the pedodontist for the treatment. Among the respondents, 61.5% of the general dentists said that they can treat the patients with ECC with behavior management on the dental chair, and 32% had said that they can deal children with fear following tell-show-do technique. Conclusion: General dentists in Hyderabad city have got good knowledge toward various treatment modalities in preventive dentistry. The attitude is highly commendable, but in practice, patient's referral to the respectful profession is the utmost important step for the complete oral care.
Keywords: Fluorides, general dentists, pulp therapies, space maintainers
|How to cite this article:|
Rani TS, Reddy E R, Merum K, Srujana M P, Raju S S, Seth MP. General dentists' knowledge, attitude, and practice guidelines toward pediatric dentistry. CHRISMED J Health Res 2020;7:24-9
|How to cite this URL:|
Rani TS, Reddy E R, Merum K, Srujana M P, Raju S S, Seth MP. General dentists' knowledge, attitude, and practice guidelines toward pediatric dentistry. CHRISMED J Health Res [serial online] 2020 [cited 2021 Mar 3];7:24-9. Available from: https://www.cjhr.org/text.asp?2020/7/1/24/286876
| Introduction|| |
Pediatric dentistry is considered to be the most needed, yet neglected area of all the services performed by the dental surgeons. Consequently, clinical reference must be balanced with the clinicians' professional proficiency and the patient's preference. Every dentist must deliver the highest quality of treatment to individual pediatric patients and apply advances in science and technology to continually improve oral health.
Dental surgeons should be encouraged to increase and update their clinical skills and knowledge in behavior guidance techniques. The establishment of a good relationship between dentist and the child has been shown to increase the success of treatment in terms of the child's cooperation during the treatment or advice for prevention.
Dental anxiety and fear of dental treatment in children are considered to be the main reason for management problems and avoidance of dental care. These problems sometimes require the replacement of conventional treatment with more complicated alternatives such as sedation or general anesthesia (GA).
Shortcoming of most of the dental surgeons when treating children is their lack of knowledge, clinical skill, or attention to the vital performance of providing and assuring profound local anesthesia. Most of the dental surgeons felt uncomfortable with their clinical skills and avoid giving children local anesthesia. For this vision to become a reality, many more dental professionals will need to be aware of and skilled in the communication management methods advocated by the American Academy of Pediatric Dentistry (AAPD).
To execute a successful preventive practice, there is need of a better understanding of practice pattern that will help in targeting the continuing education by professional dental associations as well as encouraging evidence-based utilization of different preventive therapies.
| Materials and Methods|| |
A descriptive cross-sectional study was conducted in the Department of Pedodontics, Kamineni Institute of Dental Sciences, Narketpally, Shapelly, Telangana, India. The Institutional Ethical Committee clearance was obtained before the commencement of the study. General dental practitioners with a minimum of 2 years clinical experience and who were not attached to/working in any of the educational institutions were included in the study. Dentists who were specialized in pedodontics were excluded from the study. Informed consent was obtained from the participants. Around 200 private general dental practitioners of Hyderabad (within city limits) made up the sampling frame of the study.
A 25-item self-administered questionnaire was prepared which consisted of 10 questions on knowledge, 5 on attitude, and 8 on practice. Participants were asked several questions pertaining to the first dental visit, use of topical fluorides, early childhood caries (ECC), importance of space maintainers, and other preventive measures. In addition, demographic data, such as the practitioner's age, gender, qualification, and years of experience in clinical practice were also ascertained.
Questionnaire was distributed to the participants and collected on the same day. Responses were tabulated using the Microsoft Excel and SPSS version 19.0. Statistical analysis was performed for each of the 20 survey items, and for each of the three assessment domains (knowledge, attitude, and practice), a frequency and percentages were determined.
| Results|| |
The present study comprised 200 general dentists (private practitioners), with an experience level of 2–54 years (mean – 9.5 years). The descriptive analysis of the knowledge, attitude, and practice guidelines of general dentists providing treatment to the pediatric patient with 25 questions in the questionnaire, which was divided into three parts.
Knowledge of preventive and therapeutic approaches toward the management of dental conditions in children was assessed [Table 1]. Questions on preventive approach include child's first dental visit, fluoride content in the dentifrice, complications of premature loss of primary teeth, and the need for the space maintenance to maintain the integrity of the dental arch. When these questions were analyzed, only 32 (16%) of dentists responded correctly about child's first dental visit, i.e., at 1 year of age or when the first tooth erupts in the oral cavity as recommended by AAPD, and 71 (35.5%) of general dentists had the knowledge about the appropriate fluoride content being present in the toothpaste used for children. Almost 150 (75%) private practitioners have said that they have no idea about the complications due to premature extraction of primary teeth, and space maintainers were not provided by majority, i.e., 144 (72%) of them after early extractions. Questions on therapeutic approach include first line of treatment for primary teeth with pulpal exposure, various crowns used on primary teeth, intervention of oral habits, and difficulties faced during the management of children. The first line of treatment for deciduous tooth with pulpal exposure opted by general dentists was pulpectomy (118, 59%), medication (68, 34%), and extraction (9, 4.5%). Majority of the dentists (153, 66.5%) knew the importance of placing crown on endodontically treated primary tooth and the availability 118 (59%) of preformed stainless steel crowns (SSC). Treating the child patient with oral habits was done just by counseling 93 (46.5%) and rarely being referred to the pediatric dentist. Most of the practitioners have found difficulty in treating a special child 125 (62.5%) in their routine clinical practice.
|Table 1: The descriptive analysis of the knowledge of dental surgeons providing treatment to pediatric patients (n=200)|
Click here to view
After assessing the questions included in the attitude session among general dentists, [Table 2] showed that general dentist talk to almost every parent about the child's first dental visit (41.5%). Majority of them (141, 71%) have said that preserving primary teeth is not as important as permanent teeth. For treating a malocclusion in a child of 12 years, 83 (41.5%) said that they refer the case to an orthodontist, 38% to pedodontists, and 15 (7.5%) said no treatment for 12 years old with malocclusion. Almost 154 (77%) general dentists do not treat a special child, and 152 (76%) referred the case to a pedodontist.
|Table 2: The descriptive analysis of the assessing attitude of dental surgeons providing treatment to pediatric patients|
Click here to view
By assessing the questions on clinical practice, they are related to behavior management, preventive measures, and management. Most of the general dentists have chosen to manage the child with fear by tell-show-do 64 (32%), voice control 56 (28%), and the least have used hand over mouth 6 (3%) and sedation 4 (2%). It was great to know that 103 (51.5%) dental surgeons have said that they use pit and fissure sealants in their daily clinical practice and followed by restoring them by glass-ionomer cement (70, 35%). When in need of fluoride supplementation, almost 112 (56%) have applied varnish and least prescribe in form of tablets 12 (6%). Of all the general practitioners, 134 (67%) never have given diet counseling to the patients and the parents; for treating a child with ECC on the dental chair, behavior management techniques (123, 61.5%) were applied. Few of the general dentists did counsel for brushing technique and of them 106 (53%) have shown Fone's technique to be used for brushing [Table 3].
|Table 3: The descriptive analysis of the practice guidelines of dental surgeons providing treatment to pediatric patients|
Click here to view
| Discussion|| |
Pediatric dentistry is considered to be the most needed, yet neglected area of all the services performed by the dental surgeons. The Third National Health and Nutrition Examination survey (1988–1994) showed that 1 in 5 children between the ages of 2 and 5 years had decayed teeth. Dental surgeons are expected to diagnose and manage effectively childhood dental diseases that are within the knowledge and skills acquired during dental education. This survey was planned to evaluate the knowledge, attitude, and practice guidelines of general dental practitioners in Hyderabad, Telangana, India, to ensure the preventive and interceptive benefits provided to children in the domain of oral health.
The first dental visit should be within 6 months of the eruption of the first teeth (AAPD 2014 and AAP). In the survey conducted, 32% have said that it is <1 year. Perception about the suitable age for the first dental visit throughout the world is remarkably diverse, and the most commonly reported age range is 2–5 years.,,,,,, Most of children in the current study visited dental clinics for the first time between the ages of 3 and 5 years. The longer a child's initial dental visit is delayed, the more likely he or she is to develop serious dental problems that could potentially deteriorate rapidly in the absence of proper care and treatment. Around 35.5% of the general dentists have told in this study that the fluoride content to be used in children is <550 ppm. In Chile, guidelines establish that F- toothpaste should not be used by children under 2 years of age. For children between 2 and 6 years of age, F- concentration must not be lower than 400 ppm and not higher than 500 ppm, and for children older than 6 years of age, F concentration must be between 1000 and 1500 ppm. Only 28% of the general dentists in this survey told that they provide space maintainer for the premature loss of the teeth. Talekar et al. reported that only half of their assessed population were treated with space maintainers.
In this survey, 59% of the general dentists were aware of the first line of treatment for the primary tooth with pulpal exposure is pulpectomy. The initial treatment phase should be restricted to the patient's ability to tolerate the treatment and desensitize the patient to the dental environment, helping to build trust with dental professional followed by more extensive or complex procedures in the later visits, such as tooth extraction or pulp therapies. None of the dentists recommended extraction as the first line of treatment. Of all the general dentists, just 4.5% have said that they would prefer extraction as a treatment plan for the primary teeth with pulpal exposure. This reflects the awareness among the dental practitioner about maintaining the primary tooth in the dental arch. SSC may be the best choice for the restoration of endodontically treated deciduous teeth. Around 66% of dentists in this survey say it is necessary to place a crown after pulpectomy. About 59% of general dentists know about preformed SSC and lack of placing crown is the cost factor. Blinkhorn and Zadeh-Kabir found that 88% of USA dentists would place a crown compared to 4% in the UK.
The majority of the general dentists are not advising patients to see the dentist by 1 year of age. Around 45% of general dentists talk about dental visit to parents every time they come. In the current survey, only 47% of general dentists always prefer talking to parents about the dental visit. There are about 41.5% of general dentists in the study done who said that they would refer the patient to an orthodontist rather than a pedodontist (38%). In the survey performed, treating a special child is difficult for most of the general dentists (62.5%). Seale and Casamassimo have proposed that the disproportionate lack of dental education regarding specific demographic populations such as infants and patients with special needs is a factor in the decreased care of young children by general dentists.
The current survey says tell-show-do (64%) followed by voice control (56%) is the most common techniques used for managing a child with fear and the least used techniques are music and video distraction (8%), hand over mouth (6%), and sedation (4%). The most popular technique for managing children was tell-show-do and was reported by 93% dental surgeons as their most commonly used behavioral management strategy, followed by 69% reported voice control.,, There were no differences in disruptive behaviors between music therapy and placebo. In the present survey, the treatment of patients with ECC is 78% prefer treating done on chair. More than 50% of the general dentists and 60% of the pediatric dental surgeons reported the use of GA.
According to the AAPD, 5% sodium fluoride varnish (NaF; 22,500 ppm F) and 1.23% acidulated phosphate fluoride (APF; 12,300 ppm F) are the most commonly used agents for professionally-applied fluoride treatments. In this study, 56% of the dentists prefer applying fluoride varnish as a supplement for fluoride preventive measure for caries control. Sharma et al. reported APF gels were the most preferred choice of topical fluoride application by the dental practitioners (71%) followed by varnish (13%) and fluoride mouthwash (10%). Bansal et al. stated that 66% of dentists preferred APF/NaF gel for their routine dental practice.
| Conclusion|| |
The general dentists in the survey that was conducted have got good knowledge toward various treatment modalities in preventive dentistry. Their attitude is highly commendable, but in practice, patient's referral to the respectful profession is the utmost important step for complete oral care.
The following measures will be taken to improve the general dentist's knowledge:
- More communication between the parent and the dentist
- Continued dental education programs for general dentists
- Establish dental home
- Referral of cases to pedodontist regularly
- Encourage group practice with pedodontists.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bimstein E, Azari AF, Riley JL 3rd
. Predoctoral and postdoctoral students' perspectives about pediatric dental behavior guidance. J Dent Educ 2011;75:616-25.
American Dental Association Council on Scientific Affairs. Professionally applied topical fluoride: Evidence-based clinical recommendations. J Am Dent Assoc 2006;137:1151-9.
Adair SM, Rockman RA, Schafer TE, Waller JL. Survey of behavior management teaching in pediatric dentistry advanced education programs. Pediatr Dent 2004;26:151-8.
Cotton KT, Seale NS, Kanellis MJ, Damiano PC, Bidaut-Russell M, McWhorter AG. Are general dentists' practice patterns and attitudes about treating medicaid-enrolled preschool age children related to dental school training? Pediatr Dent 2001;23:51-5.
Riley JL, Richman JS, Rindal DB, Fellows JL, Qvist V, Gilbert GH, et al.
Use of caries-preventive agents in children: Findings from the dental practice-based research network. Oral Health Prev Dent 2010;8:351-9.
American Academy of Pediatric Dentistry. Guideline on infant oral health care. Pediatr Dent 2014;36:1141-5.
Agostini FG, Flaitz CM, Hicks MJ. Dental emergencies in a university-based pediatric dentistry postgraduate outpatient clinic: A retrospective study. ASDC J Dent Child 2001;68:316-21, 300-1.
Ismail AI, Sohn W. The impact of universal access to dental care on disparities in caries experience in children. J Am Dent Assoc 2001;132:295-303.
Nainar SM, Straffon LH. Targeting of the year one dental visit for United States children. Int J Paediatr Dent 2003;13:258-63.
Savage MF, Lee JY, Kotch JB, Vann WF Jr. Early preventive dental visits: Effects on subsequent utilization and costs. Pediatrics 2004;114:e418-23.
Mileva SP, Kondeva VK. Age at and reasons for the first dental visit. Folia Med (Plovdiv) 2010;52:56-61.
Farid H, Khan FR, Aman N. Knowledge, attitude and practice of mothers regarding their own and children's dental health – A tertiary care hospital based study. J Ayub Med Coll Abbottabad 2013;25:35-7.
Rodrigues Gomes SS, Barretobezerra AC, Maia Prado AC. Salivary biomarkers, vital signs and behaviour of pre-school children during their first dental visit. Eur J Paediatr Dent 2013;14:279-83.
Al-Shalan TA. Factors affecting Saudi parents' perception of their children's first dental visit. J Contemp Dent Pract 2003;4:54-66.
MINSAL. Regulation for the Use of Fluoride in Preventive Dentistry. Chile: Health Ministry; 2008.
Talekar BS, Rozier RG, Slade GD, Ennett ST. Parental perceptions of their preschool-aged children's oral health. J Am Dent Assoc 2005;136:364-72.
American Academy of Pediatric Dentistry, Clinical Affairs Committee – Restorative Dentistry Subcommittee. Guideline on pediatric restorative dentistry. Pediatr Dent 2012;34:173-80.
Blinkhorn A, Zadeh-Kabir R. Dental care of a child in pain – A comparison of treatment planning options offered by GDPs in California and the North-West of England. Int J Paediatr Dent 2003;13:165-71.
Brickhouse TH, Unkel JH, Kancitis I, Best AM, Davis RD. Infant oral health care: A survey of general dentists, pediatric dentists, and pediatricians in Virginia. Pediatr Dent 2008;30:147-53.
Seale NS, Casamassimo PS. Access to dental care for children in the United States: A survey of general practitioners. J Am Dent Assoc 2003;134:1630-40.
Lawrence SM, McTigue DJ, Wilson S, Odom JG, Waggoner WF, Fields HW Jr. Parental attitudes toward behavior management techniques used in pediatric dentistry. Pediatr Dent 1991;13:151-5.
McKnight-Hanes C, Myers DR, Dushku JC, Davis HC. The use of behavior management techniques by dentists across practitioner type, age, and geographic region. Pediatr Dent 1993;15:267-71.
Murphy MG, Fields HW Jr., Machen JB. Parental acceptance of pediatric dentistry behavior management techniques. Pediatr Dent 1984;6:193-8.
Filcheck HA, Allen KD, Ogren H, Darby JB, Holstein B, Hupp S. The use of choice-based distraction to decrease the distress of children at the dentist. Child Fam Behav Ther 2004;26:59-68.
Abushal MS, Adenubi JO. The use of behavior management techniques by dentists in Saudi Arabia: A survey. Saudi Dent J 2000;12:129-34.
American Academy of Pediatric Dentistry. Guidelines on Fluoride Therapy. American Academy of Pediatric Dentistry; 2014.
Sharma A, Chopra R, Sachdeva S, Sachdev V. Knowledge attitude and practice of Indian dentists on topical fluoride application in children. J Dent Specialities 2017;5:36-9.
Bansal R, Bolin KA, Abdellatif HM, Shulman JD. Knowledge, attitude and use of fluorides among dentists in texas. J Contemp Dent Pract 2012;13:371-5.
[Table 1], [Table 2], [Table 3]