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ORIGINAL ARTICLE
Year : 2019  |  Volume : 17  |  Issue : 4  |  Page : 333-336

Awareness and approaches in treating patients with special needs among dental practitioners of Chennai City: A pilot study


Department of Public Health Dentistry, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India

Date of Submission20-Mar-2018
Date of Decision21-Sep-2019
Date of Acceptance01-Nov-2019
Date of Web Publication12-Dec-2019

Correspondence Address:
Dr. Krishnan Lakshmi
Department of Public Health Dentistry, Ragas Dental College and Hospital, SH109, ECR, Uthandi, Chennai - 600 119, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_69_18

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  Abstract 


Background: Special children are among the underserved dental patient groups around the globe, and their oral health care still remains an unmet challenge among the dental practitioners. One out of two persons with a disability cannot find an oral health professional resource to provide appropriate dental care. The identification of barriers can be the first step in addressing the deficiencies in dental care for such patients. Aim: The aim of the study is to assess the knowledge, attitude, and practices toward treating patients with special care need among private dental practitioners employed at a private dental teaching institution. Materials and Methods: A cross-sectional pilot study was conducted among a conveniently sampled 45 dental professionals from the same institution who were both private dental practitioners as well as academicians. The study was conducted between November 2017 and December 2017. Participants were interviewed through a validated questionnaire, which consisted of 14 items. The questionnaire comprised demographic details of the participants, their years of dental experience, disabled patients they had encountered so far in their practice, and questions related to their attitude, perception, and practice to provide oral health care for patients with special needs. Informed consent was obtained from the participants prior to the study. The data obtained were entered into Microsoft Excel 2010 and descriptive statistics was computed using the SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Results: A response of 71% was obtained. Majority of the dentists (65%) were unaware of the Right to Disability Act. Half of the dentists (50%) felt teledentistry would do more good to people with special needs. About (31.8%) of them felt inadequate training to handle patients with special needs as major barrier faced while treating them. Conclusion: Majority of the study participants felt inadequate training among the dental practitioners as barrier to treat special needs patients and hence suggested incorporation of special care dentistry into the dental curriculum.

Keywords: Awareness, disability, oral health care


How to cite this article:
Satish M, Iyer K, Lakshmi K, Neha S, Biju EA, Diwakar MK. Awareness and approaches in treating patients with special needs among dental practitioners of Chennai City: A pilot study. J Indian Assoc Public Health Dent 2019;17:333-6

How to cite this URL:
Satish M, Iyer K, Lakshmi K, Neha S, Biju EA, Diwakar MK. Awareness and approaches in treating patients with special needs among dental practitioners of Chennai City: A pilot study. J Indian Assoc Public Health Dent [serial online] 2019 [cited 2020 Nov 29];17:333-6. Available from: https://www.jiaphd.org/text.asp?2019/17/4/333/272792




  Introduction Top


According to the World Health Organization estimates, individuals with disabilities comprise 10% of the population in developed countries and 12% of the population in developing countries.[1] Disability is defined as “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.”[2]

Health-care structure in India is overburdened by an ever-increasing population. In India, 2.21% of the population, approximately 26.8 million people have some form of disability.[3] Health care for individuals with special needs requires specialized knowledge and additional training among the health professionals.[1] Numerous studies have repeatedly confirmed that the people with disability still face considerable difficulties and obstacles in accessing medical and dental care services despite the attempts of barrier-free environment to them at legal regulation.[4]

Dental care is found to be the most common unmet health-care need for the differently-abled children. Their oral health may be neglected because of focus on their disabling condition, other major diseases, or limited access to oral health care. Moreover, dental care is sought by them only on an emergency basis.[5] For children with disabilities, the effect of dental disease on their general health and function appears greater than for similar groups without a disability. They are at greater risk for poorer oral health than persons in the general population, due to more frequent oral infections and periodontal disease, enamel irregularities, moderate-to-severe malocclusion, and craniofacial birth defects.[6] The understanding of the barriers that prevent persons with a disability from seeking dental care is essential in designing remedies to overcome these barriers.[7]

The difficulty in access to dental health care is explained not only by their physical condition but also by the inadequacy of trained dentists to treat them and lack of awareness among parents or caretakers regarding oral health care.[8] This is broadly due to their attitudes and interest in acquiring knowledge in treating such patients. Although many of the barriers to dental care may not seem amenable to intervention, the attitude of a dentist to toward this population can be assessed as a first step to improve access to oral care among the disable population. Since there are only few studies that have assessed the attitude of dentist in treating children with special needs, this study was conducted to assess knowledge, attitude, and practices toward treating patients with special care needs among private dental practitioners employed at a private dental teaching institution.


  Materials and Methods Top


Study design and setting

A pilot study was conducted to assess the attitude and practices toward treating patients with special care need among 45 private dental practitioner also employed as academicians at a Private dental college. The study was approved by the Institutional Review Board (Ref no.-2017702). A verbal consent was obtained from the participants, and convenient sampling method was used to recruit participants for this study. The duration of the study spanned over a period of 1 month from November 2017 to December 2017; a validated questionnaire was administered to the practitioners by the two trained dental house surgeons.

Study instrument

A content validation and reliability analysis was done for the questionnaire. A Crohnbach's alpha value of 0.6 was obtained. The questionnaire was developed using Institute of Medicine model.[9] The questionnaire consisted of 14 items which had demographic details, and three domains on knowledge (4 questions), attitude (5 questions), and practice (2 questions) about treating patients with disabilities.

Study sample

Participants of this study were private dental practitioners who are currently working in private dental institution.

Inclusion criteria

Dental practitioners who had treated patients with special needs in their experience were only included. Participants who gave consent to take in the study were recruited.

Statistical analysis

The data were obtained and entered into a Microsoft Excel spreadsheet and analyzed using the IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY, USA: IBM Corp. Descriptive statistics (percentages and frequencies) was tabulated.


  Results Top


Among the 45 dental practitioners to whom the questionnaire was administered, 32 of them returned the paper-based survey which had a response rate of (71.1%).

The demographic data comprised of an equal number of male and female participants, and all of them held a minimum of postgraduation degree in dentistry. Majority of the dentists 18 (56%) had a private dental practice experience of <10 years, while 14 (44%) of them reported more than 10 years of private dental practice. When asked about the type of patients with special health care needs visiting their clinics, 18 (56%) of the dentist reported medically compromised were the type of patients they frequently encountered [Table 1].
Table 1: Demographic characteristics of the participants

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Majority of the participants 21 (65.6%) were unaware of the Right to Disability Act 2016.

More than half of the participants (81.3%) felt the need to incorporate special care dentistry as a part of the dental curriculum and about 16 (50%) of the participants felt that teledentistry would do more good to patients with special needs, as they were more cost-effective than regular dental examinations. Only 18 (65%) of the participants felt a need for the decrease in disparities between special needs patients and patients without special health care needs for access to oral health. Twenty-two (68.7%) of the participants felt inadequate training among the dental professionals as one of the major barrier in treating patients with special needs.

Around 3 (10%) of the participants did not feel the need of dental insurance for patients with special needs. When questioned about the treatment plan for these patients, 9 (28.3%) of the dental practitioners reported that they were comfortable in delivering simple dental procedures and 10 (31.3%) of them preferred treating the children under general anesthesia. Almost half of the participants had facilities like ramps/modified restrooms and lift facilities at their private dental clinics [Table 2].
Table 2: Responses of the participants to the questions

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  Discussion Top


The present study was conducted on 32 conveniently selected dental practitioners associated with academics working in the same dental college in Chennai, India, to determine their knowledge and attitude in providing optimal dental care for patients with special needs. The present study revealed that (70%) of the dentists reported that they had encountered <3 special needs patients every month in their practice, which was similar to the results of Adyanthaya et al. 2017.[8] The results showed that only (65%) of the practitioners wanted to eliminate the disparity in dental care delivered to children with and without special needs. This finding was similar to the conclusion made by Bindal et al.[10] in 2015. The majority of the professionals (68.7%) stated that the barrier faced in managing patients with special needs was inadequate training, which is in accordance with study done by Rao et al. in 2003[11] but was contrasting to the findings that (60%) of them reported to have adequate knowledge in managing these patients. These results reinforce the findings of Casamassimo et al. in 2012[12] who stated that dentists who had not been exposed to hands-on and lecture were less likely to care for these patients. Apart from inadequate training among dental practitioners, (3.10%) of the participants felt inadequately motivated caretakers to be a relevant barrier. This observation was similar to that of findings conducted by Vignehsa et al., in1991,[13] and it was higher (20.8%) in the study reported by Adyanthaya et al. 2017.[8]

Another interesting finding of our study was about (50%) of the practitioners reported that their dental clinics were barrier-free equipped with either ramp, lift or large waiting rooms, whereas in the study done by Venkatesh et al.[14] in 2017 stated that (40.6%) of dentists reported their dental clinics to be disable friendly.

Majority of the practicing dentists (31.3%) preferred treating their patients with special health care needs under GA, which was higher when compared to the findings (17%) reported by Adyanthaya et al. in 2017.[8]

Limitations

The self-structured questionnaire developed was content validated and was subjected to assess the attitude, perception of the practitioners as a pilot study, the results of which are being published in this study. Based on the outcome, studies need to be carried out on a larger sample to generalize the results to the Indian population.

Recommendations

Based on the findings of this study, we recommend few potential strategies to combat the perceived barriers and help the professionals meet the treatment needs of children with special needs:

  • Training programs in special needs dentistry to enhance and improve the quality of patient care
  • To address the oral health-care needs from the elementary level, parents, caregivers, and teachers of these children should be adequately educated and trained about dental problems, oral hygiene instructions and dietary practice, prevention of orofacial trauma, and first aid
  • Since the location and equipment of the dental offices were found to be one of the major hindrances in accessing dental care for these children, barrier-free environments with suggested use of open space in clinic for maneuvering wheelchair, stabilizing devices, and disabled-friendly toilets and lifts are recommended.



  Conclusion Top


Despite certain limitations, this article reflects the knowledge and attitude of practicing dental practitioners who are academicians as well. Since inadequate training among the dentist is considered as major barrier in treating these patients, more training sessions must be conducted to modify the current dental curriculum at undergraduate level to increase the exposure of dental students to special cases at earlier stages of their career.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Altun C, Guven G, Akgun OM, Akkurt MD, Basak F, Akbulut E, et al. Oral health status of disabled individuals attending special schools. Eur J Dent 2010;4:361-6.  Back to cited text no. 1
    
2.
American Academy of pediatric Dentistry Council on Clinical Affairs. Definition of special health care needs (AAPDRM). Pediatr Dent 2014;40:237-42.  Back to cited text no. 2
    
3.
Hennequin M, Faulks D, Roux D. Accuracy of estimation of dental treatment need in special care patients. J Dent 2000;28:131-6.  Back to cited text no. 3
    
4.
American Academy of Pediatric Dentistry. Symposium on lifetime oral health care for patients with special needs. Pediatr Dent 2007;29:92-152.  Back to cited text no. 4
    
5.
Shawky S, Abalkhail B, Soliman N. An epidemiological study of childhood disability in Jeddah, Saudi Arabia. Paediatr Perinat Epidemiol 2002;16:61-6.  Back to cited text no. 5
    
6.
Smith G, Rooney Y, Nunn J. Provision of dental care for special care patients: The view of Irish dentists in the republic of Ireland. J Ir Dent Assoc 2010;56:80-4.  Back to cited text no. 6
    
7.
Salama FS, Kebriaei A, Durham T. Oral care for special needs patients: A survey of Nebraska general dentists. Pediatr Dent 2011;33:409-14.  Back to cited text no. 7
    
8.
Adyanthaya A, Sreelakshmi N, Ismail S, Raheema M. Barriers to dental care for children with special needs: General dentists' perception in Kerala, India. J Indian Soc Pedod Prev Dent 2017;35:216-22.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Meade MA, Mahmoudi E, Lee SY. The intersection of disability and healthcare disparities: A conceptual framework. Disabil Rehabil 2015;37:632-41.  Back to cited text no. 9
    
10.
Bindal P, Lin CW, Bindal U, Safi SZ, Zainuddin Z, Lionel A. Dental treatment and special needs patients (SNPs): Dentist's point of view in selected cities of Malaysia. Biomed Res 2015;26:152-6.  Back to cited text no. 10
    
11.
Rao D, Hegde A, Munshi AK. Periodontal status of disabled children in South Canara, Karnataka. J Indian Dent Assoc 2003;74:559-62.  Back to cited text no. 11
    
12.
Casamassimo PS, Seale NS, Ruehs K. General dentists' perceptions of educational and treatment issues affecting access to care for children with special health care needs. J Dent Educ 2004;68:23-8.  Back to cited text no. 12
    
13.
Vignehsa H, Soh G, Lo GL, Chellappah NK. Dental health of disabled children in Singapore. Aust Dent J 1991;36:151-6.  Back to cited text no. 13
    
14.
Venkatesh VG, Ravindranath NS, Raju R. Barrier free dental health care: A situation analysis of the dental care settings and provider's attitudes in private dental clinics for the movement disabled in Bengaluru city. J Indian Assoc Public Health Dent 2017;15:166-9.  Back to cited text no. 14
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