|Year : 2019 | Volume
| Issue : 2 | Page : 108-113
Special care dentistry: Knowledge and attitudes among Indian dental students
Shivam Kapoor1, Puneet Chahar2, Vikrant Mohanty1, Aswini Y Balappanavar1
1 Department of Public Health Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi, India
2 Department of Public Health Dentistry, Manav Rachna Dental College, Faridabad, Haryana, India
|Date of Submission||30-Oct-2018|
|Date of Acceptance||08-Apr-2019|
|Date of Web Publication||20-Jun-2019|
Dr. Shivam Kapoor
Room No. 604, Maulana Azad Institute of Dental Sciences, MAMC Complex, BSZ Marg, New Delhi - 110 002
Source of Support: None, Conflict of Interest: None
Background: Special care dentistry (SCD) includes the provision of oral care for individuals with any disability or impairment. Published studies have reported poor oral health and quality of life. Providing quality treatment to the disabled population requires essential knowledge acquired by additional training. Objectives: The study aimed to explore the preparedness of dental students in Delhi to manage patients with special needs. Material and Methods: A cross-sectional survey was carried out in December 2017, among 117 students of a tertiary care government dental hospital in Delhi. A questionnaire was developed using literature and previously administered surveys to assess knowledge, attitude, and institutional provisions pertaining to special care patients. Validity and reliability testing was carried out. Data were subjected to appropriate statistical measures and analyzed using SPSS version 22 (P < 0.05). Results: The study sample included postgraduate students (28.3%), undergraduate students (47.8%), and interns (23.9%). All of them felt that some special precautions are to be taken while treating a patient with special needs, whereas only half considered SCD as a different specialty. The majority (60%) were unaware regarding the availability of any special equipment for the disabled. However, they had some idea regarding the institutional provisions for special care patients. Conclusions: This survey reported positive attitude and comfort levels among dental students toward special care patients. However, there is an urgent need for professional associations to reorient dental curriculum with regard to SCD and train students appropriately.
Keywords: Dental education, dentistry for disabled, disabled persons, India, oral health
|How to cite this article:|
Kapoor S, Chahar P, Mohanty V, Balappanavar AY. Special care dentistry: Knowledge and attitudes among Indian dental students. J Indian Assoc Public Health Dent 2019;17:108-13
|How to cite this URL:|
Kapoor S, Chahar P, Mohanty V, Balappanavar AY. Special care dentistry: Knowledge and attitudes among Indian dental students. J Indian Assoc Public Health Dent [serial online] 2019 [cited 2019 Sep 23];17:108-13. Available from: http://www.jiaphd.org/text.asp?2019/17/2/108/260872
| Introduction|| |
Special health care needs (SHCN) include any physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health-care intervention, and/or use of specialized services or programs. Special care dentistry (SCD) deals with the provision of oral care for individuals with impairment or disability, such as physical, sensory, intellectual, mental, medical, emotional, social, or any combination. It mostly refers to patients with mental or developmental disabilities. Broadly, SCD includes individuals: (a) where an impairment of oral structure or function leads to disability, (b) with conditions that directly or indirectly influence oral health, and (c) who are affected by “environmental factors” that impact oral status.,
Disability is complex, dynamic, multidimensional, and contested. The individuals with disabilities may have the same health needs as nondisabled people, but they may experience a narrower margin of health and have greater unmet needs (World Health Organization [WHO], 2011). They are more likely to be restricted by problems in communication, motility, and therefore, are more susceptible to poorer oral health than the rest.
It has been estimated in the last population census that there are over 26 million people with disability in India, accounting for 2% of the overall country. The recent evidence confirms poor oral health in this group of population and encounters problems in availing dental treatment due to direct and indirect effects of their disabilities. This necessitates oral health professionals to be compassionate, patient, and empathetic individuals with a constant desire to be successful in treating this population.,,,, Upholding those values remains a challenge and demands extraordinary training during the building years it self.
Although the Dental Council of India (DCI) has revised the course regulations, there is no mention regarding the minimum number of working hours to be devoted for SCD., If the dental graduate does not ensure sensitization to the disabled, it risks becoming an elitist professional that is less likely to have empathy. The current status of dental education in India, with a massive production of new graduates each year, has some serious challenges that call for such modification., Keeping all this in mind, the new dental graduates are more likely to witness a considerable number of patients requiring SCD in the course of their professional careers. The purpose of this study was to assess the current knowledge and attitude of the dental students in Delhi, India, toward those with special needs.
| Material and Methods|| |
A cross-sectional study was conducted among all the final-year dental undergraduates (UGs), interns (I), and postgraduate (PG) students in a tertiary care government dental hospital in Delhi. Approval was granted from the head of the institution, and ethical clearance was obtained from the Institutional Review Board (IRB) for the delivery of a 43-item survey (MAIDS/2017/4095). Since it was a census approach, the study population comprised all the dental students who were present at the day of the study and those who consented. The study was conducted in two phases (survey tool development and data collection) for 1 month (December 2017).
Survey tool development
A thorough literature search was done, and the survey tool was drafted based on previously used questionnaires and instruments.,,, A preliminary 63-item questionnaire was devised and screened for face validity. An expert committee consisting of three public health dentists and one community medicine expert carried out the content validation using Lawshe approach. The questions that were graded as essential were further validated using Aiken's VIndex. A high level of agreement (V > 0.7) was considered for inclusion of survey items in the study tool. This resulted in a 43-item questionnaire, with adequate reliability (Intra Class Correlation (ICC) = 0.76). Furthermore, pilot testing for reliability on a sample of 15 dental interns was also assessed, within 15-day interval (test–retest reliability, r = 0.83).
The survey tool consisted of three sections. The first section focused on the students' background such as age, gender, and marital status, and professional year was collected. The next part (11 items) probed into the student's knowledge regarding patients with special needs and SCD. Questions in the last section were a measure of the students' general attitude toward patients with special needs. The items were taken from the previously tested Dental Student Attitude Toward the Handicapped Scale (DSATHS),, wherein “handicapped” was reinstated as “special care patients” and “handicapping conditions” with “special needs.” These factors were assessed using a 5-point Likert-scale: strongly agree (SA = 5) to strongly disagree (SD = 1). Further analysis of the attitude was done by grouping the items into two factors as those concerned with the students' educational experiences and perception of instructors (Factor 1, 22 items) and interpersonal and future interactions with special care patients (Factor 2, 10 items).
The survey was administered to the dental UG immediately after their lecture classes while the dental PG and I were approached in their respective specialty departments. An introduction to the survey explained the study rationale and concealment of anonymity. The survey tool had the following opening statement: “This survey evaluates attitudes of dental students towards patients with disability. It includes patients with physical, mental or any such disability, etc.”
Data were collected and stored in compliance with IRB standards and analyzed using the Statistical Package for the Social Sciences software version 22.0 (SPSS Inc., Chicago, IL, USA). The students' knowledge and attitude were expressed in proportions. The 5-point Likert scale was adapted to a 3-point scale for the ease of the analysis (SA and agree taken as agreement, whereas SD and disagree as disagreement). The scores were reversed for the items with a negative slant. The responses according to gender and qualifying year were tested for a significant difference using Mann–Whitney and Kruskal–Wallis. A statistical significance level of 0.05 was used for all analyses.
| Results|| |
Of 131 students, 117 (total clinical students in the tertiary care dental hospital) were subjected to the survey, for a response rate of 89.3%. However, only 113 students answered the entire survey completely so that the valid response rate was 86.3%. Majority of the survey respondents were unmarried female UG students [Table 1].
While all of them felt special precautions are to be taken while treating a patient with special needs, only half considered SCD as a different specialty and majority of them (60%) were unaware of any special equipment available for these patients [Table 2]. Most of the respondents were aware for the provision of wheelchairs (88.5%) and wheelchair lifts (80.5%) in the institute [Table 3].
|Table 3: Knowledge responses concerning institutional provision for special care patients (n=113)|
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More than half of the respondents showed disagreement to the statements: “My education/educational experiences/training helped me to... enjoy/empathize/positive attitude.with special care patients.” Every nine out of ten respondents expressed care toward dental needs of patients with special needs. However, one-third of them found it hard to respond to such patients while providing dental treatment [Table 4]. Female students, as compared to the males (P < 0.05), showed a positive attitude and liked working more with such patients [Figure 1]. Similarly, among the clinical students, dental interns emerged with an upbeat attitude toward working and setting up a separate waiting room (P < 0.05) [Figure 2].
|Table 4: Repartition of the respondents' self-declared frequency of attitude toward special care patients (n=113)|
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|Figure 2: Comparison of mean ranks of attitude as per the qualifying year|
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| Discussion|| |
The current study presented an insight into preparedness (knowledge and attitude) of the clinical dental students and institutional provision for special care patients. Other than this, the attitudinal impact on the students regarding individuals needing special care was evaluated. Since the survey tool was validated and reliability was tested, it might be a valuable tool for conducting further research in India.
In the current study, around 59% of students agreed that their curriculum includes lectures related to special care patients. These figures were higher than the findings reported in a study among Irish dental students (43%). Around one-third of the patients (34.5%) told that they have been trained in techniques to deal with the patient with special needs, which was in line with the previous study done in Irish students (41%). Only 53.1% were aware about SCD as a separate field, which was low as compared to a study done among Australian students (84.4%) and Malaysian students (96.9%). Faulks et al. mention the need for dentists to undergo special training to deal with patients with SHCN. Long back, Thompson et al. and Dougall et al. had taken it even further with the proposal of a well-structured curriculum for UGs in SCD. Considering today's changing demand for specialized dental care due to increased awareness and utilization, the inclusion of SCD in the training course is an optimistic conjecture. Unfortunately, until now, there is no such provision in our revised course regulations.,
Three-fourths of our study population were females, which matches with the feminization , of the profession presently but is contrary to the study among the Chinese students. There remained ambiguity in their awareness levels regarding the institutional provisions for the special care patients. It is only with the provision of such appropriate environment along with an optimally sensitized mindset toward SHCN, that the dental professional can treat special care patients with minimal inconveniences. This is one area that could be dealt with more sincerity under the DCI regulations for college establishment.
A study done among the Chinese students reported that 4th-year students had better attitude as compared to 3rd-year students; the results were significant for 14 items of DSATHS scale. In the present study, the mean rank score of interns was higher than UG students for five items (item 1, 4, 8, 12, and 27). This could be attributed to focused clinical exposure as per the internship program in India. On the other hand, a UG or PG student is found to channelize his/her efforts toward studying, and the clinical hours are sometimes perceived to achieve a fixed quota of patients, leading to stressful scenario.
The WHO has estimated that worldwide, there are over a billion people with disabilities. Of the total Indian population, 2% are reported to be disabled and 75% of them reside in rural India. The Indian dental students realize the equality of provision of care for patients requiring SCD – a significant proportion of the respondents strongly agreed that SCD should be part of the UG dental curriculum. An exclusive specialty in India at a PG level has also been recommended. Although the WHO and All India Institute of Medical Sciences, New Delhi, have recommended several actions to be taken by the government and nongovernmental sectors regarding the oral health care of disabled population; however, a formal organization addressing the oral health problems of this segment of population has not been organized. However, a formal organization addressing the oral health problems of this segment of population has not been organized.
Limitations of this study
As the respondents correspond to one Indian dental school with governmental health settings, survey responses might not showcase the entire picture. Although the uniform dental curriculum , and institutional requirement standards  for Indian dental institutes might counteract confounding, the patient inflow and other governing factors cannot be controlled.
A major limitation is that no reference was made in this study pertaining to the nature, area, and severity of disability. We had considered asking students to respond separately to categories such as “physical/mental/social/etc” and “mild/moderate/severe/etc.” adjective stimuli, but felt that this would reduce participation. Several respondents pointed out this problem while expressing that their responses would have varied according to the disability. The response bias could have been assessed by comparing the level of clinical exposure, which was assumed to be uniform for each level of clinical students.
| Conclusions|| |
This study found that the Indian students with more clinical exposure reported positive attitude, greater placatory levels, and higher anticipated comfort levels in treating special care patients in future practice. On these lines, we view revising our dental curriculum as the need of the hour. It is imperative for Indian dental schools to focus on specialized care with special attention to train our future-becoming dentists with theoretical knowledge and clinical expertise. Further research might employ a qualitative approach (involving focus group of students and faculty from each specialty) to provide greater insights regarding the motivating factors and opinions.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
American Academy of Pediatric Dentistry. Definition of special health care needs. Pediatr Dent 2016;38:16.
Valle-Jones R, Chandler D. Special care dentistry: Two sides of a coin. Br Dent J 2015;218:313-4.
Johnson I. Learning from a special care dentistry needs assessment. Prim Dent J 2015;4:61-6.
Faulks D, Hennequin M. Defining the population requiring special care dentistry using the International Classification of Functioning, Disability and Health – A personal view. J Disabil Oral Health 2006;7:143.
Balasubramanian R. Education and training in special care dentistry – A review. Med Res Chron 2014;1:183-9.
Shukla D, Bablani D, Chowdhry A, Jafri Z, Ahmad N, Mishra S. Oral health status and dental caries experience in mentally challenged individuals. Ann Public Health Res 2014;1:1008.
Mehta A, Gupta R, Mansoob S, Mansoori S. Assessment of oral health status of children with special needs in Delhi, India. Rev Sul Bras Odontol 2015;12:244-51.
Steinberg BJ. Issues and challenges in special care dentistry. J Dent Educ 2005;69:323-4.
Elangovan S, Allareddy V, Singh F, Taneja P, Karimbux N. Indian dental education in the new millennium: Challenges and opportunities. J Dent Educ 2010;74:1011-6.
Schwartz B, Bhan A. Professionalism and challenges in dental education in India. Indian J Med Ethics 2005;2:119-21.
Yeaton S, Moorthy A, Rice J, Coghlan D, O'Dwyer L, Green E, et al.
Special care dentistry: How prepared are we? Eur J Dent Educ 2016;20:9-13.
Vainio L, Krause M, Inglehart MR. Patients with special needs: Dental students' educational experiences, attitudes, and behavior. J Dent Educ 2011;75:13-22.
Parker SS, Hew JK. Attitudes towards treating individuals with disabilities: A survey of dental hygiene students and dental hygiene faculty. J Oral Hyg Health 2013;1:1-5.
Mac Giolla Phadraig C, Nunn JH, Tornsey O, Timms M. Does special care dentistry undergraduate teaching improve dental student attitudes towards people with disabilities? Eur J Dent Educ 2015;19:107-12.
Alkahtani ZM. A Comparative Study of the Attitudes of Dental Students in Saudi Arabia and the United States Towards Individuals with Developmental Disabilities. Tufts University School of Dental Medicine; 2013. Available from: https://www.dl.tufts.edu/catalog/tufts: 20204
. [Last accessed on 2019 Jan 31].
Lawshe CH. A quantitative approach to content validity. Pers Psychol 1975;28:563-75.
Aiken LR. Content validity and reliability of single items or questionnaires. Educ Psychol Meas 1980;40:955-9.
Ahmad MS, Razak IA, Borromeo GL. Undergraduate education in special needs dentistry in Malaysian and Australian dental schools. J Dent Educ 2014;78:1154-61.
Ahmad MS, Razak IA, Borromeo GL. Special needs dentistry: Perception, attitudes and educational experience of Malaysian dental students. Eur J Dent Educ 2015;19:44-52.
Faulks D, Freedman L, Thompson S, Sagheri D, Dougall A. The value of education in special care dentistry as a means of reducing inequalities in oral health. Eur J Dent Educ 2012;16:195-201.
Thompson S, Griffiths J, Hunter L, Jagger R, Korszun A, Mclaughlin W. Development of an undergraduate curriculum in special care dentistry. J Disabil Oral Health 2001;2:71-7.
Dougall A, Thompson SA, Faulks D, Ting G, Nunn J. Guidance for the core content of a curriculum in special care dentistry at the undergraduate level. Eur J Dent Educ 2014;18:39-43.
Dougall A, Thompson S. Guidance on the core content of an undergraduate curriculum in special care dentistry. Br Dent J 2013;215:349-50.
McKay JC, Quiñonez CR. The feminization of dentistry: Implications for the profession. J Can Dent Assoc 2012;78:c1.
Prasanna JS, Karunakar P, Sumadhura C, Aishwarya MD, Monica P, Sayed AS. Women dentists: Changing the face of dentistry. J Oral Res Rev 2015;7:69-73. [Full text]
Bedi R, Chan TS, O'Donnell D. Evaluation of attitudes of Chinese dental students toward dental care for patients with handicapping conditions. Spec Care Dentist 1986;6:29-32.
Levy H, Rotenberg LR. Tools and equipment for managing special care patients anywhere. Dent Clin North Am 2016;60:567-91.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]