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ORIGINAL ARTICLE
Year : 2020  |  Volume : 18  |  Issue : 3  |  Page : 240-245

Knowledge, attitude, and practices of dentists of aligarh and mathura regarding shortened dental arch therapy in elderly: A questionnaire study


Department of Periodontics and Community Dentistry, Dr. Z.A. Dental College, AMU, Aligarh, Uttar Pradesh, India

Date of Submission14-Dec-2019
Date of Decision01-Jan-2020
Date of Acceptance24-Sep-2020
Date of Web Publication24-Oct-2020

Correspondence Address:
Neha Agrawal
Department of Periodontics and Community Dentistry, Dr. Z.A. Dental College, AMU, Aligarh, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_128_19

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  Abstract 


Background: There is an escalating demand for geriatric oral health care in all developed and developing countries including India. Dental caries and periodontal diseases are the most common dental disorders, which cause loss of teeth, mostly molars among elderly, creating high unmet needs. A complete dental arch is usually wanted, though not affordable, nor always achievable, especially in old age dental patients with compromised general health. Aim: The aim of the present study was to assess the knowledge, attitude, and practices (KAP) toward shortened dental arch (SDA) concept among dentists of Aligarh and Mathura (Uttar Pradesh, India). Subjects and Methods: A cross-sectional study was conducted among 307 dentists working as academicians or clinicians or both in Aligarh and Mathura. KAP of dentists regarding SDA concept was assessed using a pretested structured self-administered questionnaires. Data were analyzed using the Statistical Package for the Social Sciences software, version 16.0 (SPSS Inc., Chicago, IL, USA). Chi-square test was employed. P < 0.05 was considered statistically significant. Results: Of the 307 dentists, only 294 dentists responded to the questionnaire, generating the response rate of 95.76%. Only 64 (21.8%) had knowledge about this concept and had positive attitude regarding the concept. A great majority of MDS 20 (31.25%) in comparison of BDS 6 (9.3%) applied this concept but only in <10% of their patients. This difference was statistically significant (P < 0.05). Conclusions: Most of the dentists did not know SDA concept but had positive attitude about this concept and only few dentists practiced it. It is essential to raise the SDA understanding as well as its application clinically, which can prove to be a practical and cost-effective approach in providing care to geriatrics.

Keywords: Awareness, dentists, geriatrics, knowledge, shortened dental arch


How to cite this article:
Agrawal N. Knowledge, attitude, and practices of dentists of aligarh and mathura regarding shortened dental arch therapy in elderly: A questionnaire study. J Indian Assoc Public Health Dent 2020;18:240-5

How to cite this URL:
Agrawal N. Knowledge, attitude, and practices of dentists of aligarh and mathura regarding shortened dental arch therapy in elderly: A questionnaire study. J Indian Assoc Public Health Dent [serial online] 2020 [cited 2020 Nov 29];18:240-5. Available from: https://www.jiaphd.org/text.asp?2020/18/3/240/298999




  Introduction Top


The aging phenomenon has come out as an important health issue all across the globe. The present world is witnessing increase in the number and proportion of older persons 60 years and above due to the collective effect of declining fertility and increased longevity.[1] In India, elderly persons (60 years and above) constitute 8.6% of the total population,[2] which is projected to reach 19% by 2050.[3]

There is a growing demand for geriatric oral health care in all developed and developing countries including India as two-thirds of the world's elderly live in developing countries.[4] Conventionally, dentistry stressed upon the prerequisite of a restoration of the entire dentition in order to maintain complete dental arches. Due to inherent limitations of this strategy, a different way of planning in dental care, the “Problem-Oriented Approach,” has been proposed. This problem-oriented approach is the basis for the shortened dental arch (SDA) concept. The SDA concept refers to the reduction of complicated restorative treatment in the molar area. It can be applied either actively or passively.[5] “SDA” is mainly based on the research by Käyser, who refuted the prevailing belief that any missing tooth should be replaced and gave the concept of acceptable oral function with partial dentition.[6] The SDA concept is based on WHO goal for oral health according to which, the presence of not <20 natural, functional, and esthetic dentition throughout life does not require prosthesis. This denotes a complete turnover from the traditional treatment approach of restoration of complete dentition.[7]

SDA concept should be considered specifically for the patients having SDA and on whom various fixed and removable prosthetic options such as removable partial dentures, fixed partial dentures, implants, and restorations are not suitable or justified. Thus, it can be considered as a less challenging, less time consuming, and less expensive treatment modality, which can improve the accessibility for socially and economically deprived, marginalized, and elderly communities.[7],[8]

It has been stated that no true objective or subjective patient treatment needs exists and demand for care is based upon the discussion between dentist and patient.[9] Moreover, the knowledge and understanding of a treatment modality outcome and the attitude of the clinician can affect their clinical conduct.[10] Therefore, the knowledge and attitude of a dentist toward a treatment option will have a crucial role in the decision-making regarding dental care for the elderly.

In various parts of the world including European countries, Nigeria,[11] and Saudi Arabia,[12] this concept appears to be widely accepted.[5] Though, many prosthodontic association members have positive attitude and have applied the concept, this therapy is not widely practiced.[13] In India, in a study conducted in Karnataka and Kerala,[14] it was found that the specialist prosthodontists had a positive attitude toward the SDA concept. However, they had reservations about the management outcome of SDA. There is scarcity of the reports regarding knowledge and attitude of general dentists regarding SDA concept in India. Therefore, the aim of this study was to determine the knowledge, attitudes and practices of dentists in Aligarh and Mathura city toward SDA therapy in elderly and to find out the association of knowledge, attitude, and practices (KAP) among dentists regarding SDA concept with qualification and years of experience.


  Subjects and Methods Top


A cross-sectional survey was carried out among the dentists working as academicians or clinicians or both in Aligarh and Mathura from January 2018 to August 2018. Convenient sampling method was utilized. List of all the registered dentists, registered at Chief Medical Office, District Hospital, Aligarh and Mathura, and the faculties working in two dental colleges and private practitioners was obtained from respective Institutions, hospitals, and Indian Dental Association and they were contacted to be the part of the study. Ethical approval was obtained from the institutional review board, and informed consent was obtained from all the study participants prior to the start of the study. Participation in the study was voluntary and confidentiality of data was maintained.

A pilot study was conducted among 34 dentists to estimate the sample size and to check for the feasibility of the study. The sample size was calculated using the following formula:



Where Z = 1.96, P = 16% = 0.16, Absolute level of precision (e) which specifies the width of the confidence interval was kept as 5. According to the above given formula, the final sample size obtained was 206. Considering nonresponse, the minimum sample size needed was increased to 250.

A questionnaire was designed for this cross-sectional survey based on the model used in a study by Witter et al. in 1997. It comprised of questions regarding knowledge and attitude of dentist about SDA concept, its application, and the benefits and drawbacks associated with it.[13] The questionnaire was modified according to the need of the study. The questionnaire consisted of three parts. The first part included the patients' demographic data and questions regarding years of experience and career prospective. The second section involved 13 KAP questions related to SDA concept. There were 7 knowledge, 3 attitude, and 3 practice related questions. In the last part of the questionnaire, the participants were asked to grade factors which are considered as important in decision making for SDA therapy, according to their clinical significance. The significance level scores ranged from 1 to 5, one being very insignificant and five being very significant (0–1: very insignificant, 1–2: insignificant, 2–3: neutral, 3–4: significant, 4–5: very significant). Later, the scores very insignificant and insignificant were combined as insignificant and scores significant and very significant were combined as significant for the ease for analysis. All the validities of the questionnaire including face validity were evaluated before the start of the main study on 34 (10% of the study sample) dentists who were not included in the main study. Reliability of the questionnaire was measured using test–retest, and internal consistency of the questionnaire was determined by using Cronbach's-alpha (α). Construct validity of the questionnaire was evaluated using Spearman's rank correlation between individual parameter and overall score of the construct. The questionnaire had good face validity and reliability with kappa statistics value found to be 0.89. Internal consistency calculated through Cronbach's -alpha (α) was found to range between 0.80 and 0.92. Construct validity was measured using Spearman's correlation coefficient which was found to be significant for KAP (P < 0.001).

The participants were briefed about the study, and the questionnaire was self-administered to all the dentists who consented to participate in the study. The dentists were approached either in the institutes or in their respective clinics. The dentists were requested to complete the questionnaire within 2 weeks and were telephonically reminded before the deadline.

Statistical analysis

The data were compiled and analyzed using Statistical Package for Social Sciences (SPSS) 16.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics and analytical tests, including mean, standard deviation, and Chi-square test were calculated.


  Results Top


Of the 307 dentists, 294 dentists responded to the questionnaire, generating the response rate of 95.76%. The study sample comprised of 146 (49.6%) males and 148 (50.4%) females. Most of the participants were having experience more than 5 years. Among the participants, 39.7% were academician, 36.9% were clinician and 23.4% were both [Table 1].
Table 1: Demographic characteristic of the study participants

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[Table 2] presents the response of the participants to the questionnaire. Out of 294 responding dentists, only 64 (21.8%) were aware about SDA concept and among 64 dentists 26 (40.6%) knew about this concept from more than 10 to 15 years and 24 (38.2%) were aware about this concept from 5 to 10 years.
Table 2: Response of dentists toward Shortened Dental Arch questionnaire

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More number of MDS dentists (49 [16.8]) in comparison to BDS (15 [5%]) were aware about this concept which was statistically significant (P < 0.05). There was no statistically significant difference among MDS and BDS regarding the most appropriate clinical situations for proposing SDA therapy to patients (P > 0.05). A great majority of MDS 20 (31.25%) in comparison of BDS 6 (9.3%) applied this concept but only in <10% of their patients. This difference was also statistically significant (P < 0.05). There was no statistically significant difference between the BDS and MDS participants in relation to factors such as effect of SDA therapy on chewing efficacy, temporomandibular joint (TMJ) health, appearance, tooth wear, and others.

It was found that dentists who had experience of 1–5 years were more aware (17.68%) about the SDA concept, had positive attitude, and applied this concept more commonly in their practices (21.45%) in comparison to others, which was statistically significant [Figure 1]. There was statistically significant difference among the three groups in relation to factors such as chewing efficacy, TMJ health, appearance, tooth wear, and others (P < 0.05). It was found that all the three groups (academician, clinician, and both) showed positive attitude regarding the SDA concept but did not use it frequently in their practice. There was no statistically significant difference among the three groups in relation to factors such as chewing efficacy, TMJ health, appearance, and tooth wear [Figure 2].
Figure 1: Distribution of dentists according to their years of experience and knowledge, attitude, and practices regarding shortened dental arch concept

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Figure 2: Distribution of academician, clinician, or both and their knowledge, attitude, and practices regarding shortened dental arch concept

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The average significance of decision making factors in SDA was calculated. Factors such as oral hygiene (OH) maintenance, chewing function, longevity of dentition, and cost were regarded as significant for decision making in SDA, with an average significance weightage (ASW) of 3.64, 3.45, 3.32, and 3.8, respectively [Table 3]. Other factors such as esthetics, temporomandibular disorder, tooth migration and wear, occlusal stability, and speech were regarded as insignificant for decision-making in SDA.
Table 3: Comparative significance of decision making factors in shortened dental arch

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  Discussion Top


India has attained the tag of an aging nation,[15] and geriatric oral health concerns continue to be a challenge in our country as more people live longer. In the present study, only 21.8% of the dentists, including more number of MDS than BDS, were aware about SDA concept. These results were in line with studies conducted in the USA [12] and India.[16] This could be because SDA concept is not well known or may be due to inadequacy of present evidence-based treatment approaches. Even the result of systematic reviews found SDAs as an encouraging treatment option in terms of functioning, patient satisfaction, improved OH, comfort, and cost-effectiveness, but there has been lack of studies regarding the primary outcome of survival of the SDA, which might have weaken the recommendation of the SDA as a treatment option.[17],[18]

In this study, majority of MDS (20 [31.25%]) in comparison of BDS (6 [9.3%]) applied this concept but only in <10% of their patients, which was in accordance with the study conducted in Saudi Arabia.[19] Clinicians with 1–5 years of experience had positive attitude toward SDA concept but were not incorporating this concept in their clinical practice. SDA is based on conservative treatment provision, moreover, the cost was shown to be the most significant factor in the decision making of SDA therapy, which might have affected the choice of SDA as treatment modality.

In the present study, 25.4% of the dentists with knowledge regarding SDA concept, said initially their patients had objections but agreed after explanation regarding shortening of his/her dental arch for the treatment purpose. These results were similar to the study conducted by Vohra et al.[19] and Kumar and George.[14]

A large proportion of responding dentists showed a positive attitude toward SDA therapy, were also in agreement with this treatment choice, which was in line with other studies.[12],[16],[19],[20] No statistically significant difference could be found in relation to effect of SDA on various factors such as chewing efficacy, TMJ health, appearance, and tooth wear, neither among BDS or MDS nor among academician, clinician or both, which was similar to the results of study conducted in Syria [20] but different from study conducted in Saudi Arabia.[19] The typical SDA, comprising the anterior teeth and four occlusal units, usually four premolars, meets requirements for older adults with sufficient adaptive capacity.[6] Evidence suggests that patients with SDA have adequate masticatory function and satisfactory occlusal stability, simplification of OH maintenance, better prognosis of the remaining teeth, reduction in treatment cost, and preservation of oral tissues.[5],[12],[14],[19]

The most significant decision making factors for SDA therapy were treatment cost (ASW 3.8), OH maintenance (ASW 3.64), chewing function (ASW 3.45), and longevity of dentition (ASW 3.32). These findings are consistent with the advantages of SDA treatment as a conservative and cost-effective treatment option and are in line with other study.[19] In addition to that, increasing posterior occlusal units in an elderly patient increases the effort for OH maintenance as well as the overall treatment duration, difficulty, and cost.

The SDA approach offers an alternative of less treatment that is also less challenging, less time consuming, and less expensive.[21] It would therefore fit well in a worldwide perspective with widespread lack of dental and economic resources as indicated by the WHO.[22] The SDA concept may be of particular value in treatment plans for patients in the old age group having potential physical, sensory, and cognitive impairments.[23]

The SDA concept appears to be widely accepted among various countries including Saudi Arabia,[19] the USA,[12] the UK [11] and more widely among specialists (European Prosthodontic Association).[13] In the face of the advantages of SDA concept and economical concerns and other limitations (e.g., medical conditions), the teaching emphasis should be shifted toward the SDA for cases with compromised dentition in elderly. SDA concepts need to be promoted as this is relevant for many developing countries as it offers a functional approach at lesser cost.[8]

Limitations of the study were convenient sampling and poor generalizability of the results. Therefore, it is recommended that studies involving larger sample size should be carried out. SDA concept should be integrated into the undergraduate and postgraduate schools' curricula to understand the idea of preserving functionally strategic part of dentition and avoid overtreatment with all the associated cost and risk in older age group of dental patients.


  Conclusions Top


Majority of dentists were unaware of SDA concept and those who knew this concept had positive attitude but did not practiced it frequently. Therefore, it is very important to raise awareness, understanding of SDA concept, as well as enhancement of its application clinically, which can prove to be a practical and affordable care for socially and economically deprived elderly communities.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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