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ORIGINAL ARTICLE
Year : 2019  |  Volume : 22  |  Issue : 1  |  Page : 24-33

Acquaintance of dental implants as a treatment modality in edentulous states among health workers in Aseer Province, KSA


Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia

Date of Acceptance31-Oct-2018
Date of Web Publication21-Jan-2019

Correspondence Address:
Dr. S Chaturvedi
Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_469_18

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   Abstract 


Purpose: To identify the acquaintance of dental implant (DI) as a treatment modality in edentulous states among health workers in the Aseer region and also to assess the level of understanding about DI among them. Materials and Methods: A questionnaire set of 18 questions was used for 500 health workers from the concerned area about DI. Questionnaire set basically consists of questions to assess the attitude, perception, and knowledge among them about DI. The data collected and association with the factors were tested for significance using the Chi-square test and P < 0.05 was considered statistically significant. Results: The response rate was 89%. More than 75% were aware of DI, but only 50% of the total respondents were knowing about the difference between the DI, fixed prosthesis, and removable prosthesis. Of the latter, 47.4% have suggested implants for patients and about 55% respondents were agreeing to get DI done for themselves. Dental health care workers have more knowledge than the medical health workers, and the difference was found to be statistically significant. Of respondents, >90% were willing to know more about DI. Conclusion: The practice of implant dentistry is growing in the Aseer region. However, general health workers are not fully aware of proper DI information. In addition, all the efforts should be made to include basic implant education in all the branches of health sciences and the CDE program should be conducted regularly to enhance the knowledge, so that correct information can be channelized to the patients.

Keywords: Dental implant, dental practitioners, medical practitioners, questionnaire


How to cite this article:
Chaturvedi S, Ahmed A R, Hussain M W, Alshehre A S, Abdullah M A. Acquaintance of dental implants as a treatment modality in edentulous states among health workers in Aseer Province, KSA. Niger J Clin Pract 2019;22:24-33

How to cite this URL:
Chaturvedi S, Ahmed A R, Hussain M W, Alshehre A S, Abdullah M A. Acquaintance of dental implants as a treatment modality in edentulous states among health workers in Aseer Province, KSA. Niger J Clin Pract [serial online] 2019 [cited 2022 Dec 10];22:24-33. Available from: https://www.njcponline.com/text.asp?2019/22/1/24/250521




   Introduction Top


Oral rehabilitation by means of dental implants (DI) has developed as an important treatment option and is developing with a high speed.[1],[2] Unanimously, DI replaces the missing teeth both esthetically and functionally[1],[3] and are proven as extremely expectable. It is documented and proved that overall 5-year implant survival rate ranges from 93% to 97%.[4] Overall long-term reported failure rates are 10% for fixed partial dentures (FPD),[5] 19% for resin-bonded bridges,[6] 13% for hemisection and root amputation,[7] 15% for endodontic therapy,[8] and 34% for endodontic retreatment,[9],[10] thus implant therapy has overruled the conventional method of restoration and this is also proved by various clinical researches.[11],[12],[13],[14]

DI have reformed the treatment of edentulous patients and improved deciding factors of denture success such as stability, retention, functional efficiency, and quality of life.[11],[12],[13],[14],[15],[16] At present, DI are one of the commonly accepted treatment modality of completely or partially edentulous patients[17],[18] within the dental fraternity.

Several studies on patient acceptance and satisfaction have shown encouraging results regarding DI treatment. Pommer et al. reported 79% of the Austrian population expressed desire for implant treatment.[19] Grogono et al. (1989) found in his study that self-confidence of the patients increased after DI treatment in 88%, 89% were ready for DI again if needed, and 98% reported improvement in their oral health.[20] A survey, in Riyadh, about the level of satisfaction of Saudi nationals after DI treatment revealed that 71% were highly satisfied with the esthetic results, 78% function, 76% were willing to undergo the same procedure again, and 79% recommend it to others.[21] Sweden population showed histrionic rise in interest of implant treatment to 95% over a period of 10 years.[22],[23],[24] The literature search of reports on DI, roughly 6000 citations were found, which reflect the extensive basic and clinical research on a wide spectrum of aspects,[25] however, still in our society in the Aseer region, incomplete knowledge, cost of treatment, and improper motivation of patients about DI have limited the choice of DI for replacing missing teeth.[6],[7]

At times of need for dental treatment, on usual basis patient seeks advise not only from the dental and medical professionals, but also suggestions are taken from the other health workers like nurses, dental therapists, dental technologists, laboratory staff, health attendants, and even from his family, friends, and relatives. Thus suitable understanding about the DI is of utmost importance at least for the health workers as they are the major guiding force accessible to patients. These health workers should emphasize the importance of DI to patients so a better long-lasting efficient treatment can be achieved by the patient.

Unfortunately, in area of our concern, still traditional/conventional methods of dental restoration [FPD, removable partial denture (RPD), and complete denture (CD)] are widely practiced rather than DI. The reason behind this may be the incomplete knowledge to health forces itself regarding the DI, due to deficiency in undergraduate curriculum. Also, unrealistic patient expectations due to deceitful claims and flyer by few like “implant forever” results in loss of trust in this treatment modality.[26],[27] This actually creates an impending requirement for the dental and medical practitioners along with entire health force to be well informed and understand all aspects of the DI.[28] When right kind of information is channelized to the patients and community, it will further help in promoting DI among the patients.[29] Definitely patients and public access health workers at an ease through formal or informal interactions. Through these collaborative sessions, they often play a role of health educators in their work places. Hence, it is important to evaluate their level of knowledge for DI and whether their awareness of DI does in fact reflect reality in order to guide patients who do not have the education or background understanding to make a cognizant choice among implant supported prosthesis and conventional prosthesis.[23],[24],[30],[31]

Hence, this study was intended to identify the acquaintance of DI as a treatment modality in edentulous states among health workers in the Aseer region and also to assess the level of understanding about DI among them.


   Materials and Methods Top


The current research was an observational cross-sectional type of study where the data were collected from the representative population at a specific time interval of 6 months. A quota sampling (non-probability sampling) technique was used with a sample size of 500 participants. These respondents were health workers in the Aseer Province, Saudi Arabia. Out of these 500 participants, 445 have given response. Thus, the study was included of 445 participants.

Ethical considerations

This study was conducted in compliance with the protocol; ethical approval was taken from the ethical committee of the institute. The subjects participating in the present study provided their informed consent. Participation was on a voluntary basis and there were no incentives. Data protection and anonymity were guaranteed.

The study was carried out with the help of 18 well-structured questionnaires [Appendix 1]. The questionnaire reliability was evaluated by four prosthodontists for vetting and remarks. The recommended modifications were implemented to ensure the cogency. Also, questionnaires were validated by doing a pilot study on 30 participants. It helped in assessing the knowledge, awareness, and attitude toward DI treatment among the participants. These questionnaires were given personally or e-mailed to the participants. Each participant's communication data were collected and coded. At an interval of 1 week, two times all the participants were reminded regarding returning of the questionnaire forms with response. Wherever essential, detailed explanation was provided regarding study and its use.

Questionnaire set basically consists of three sections. The first section determines participant's demographic and professional data; second section (first five questions) helped in assessing the knowledge regarding the modes of missing teeth replacement, where the participants have to answer the questions which were in the form of “Yes/No” and the multiple-choice questions. For analysis purpose the YES was coded as 1 and NO was coded as 2 and the third section (last 13 questions) was multiple-choice questions to determine the acquaintance (awareness and attitude) about DI among health workers, here the evaluation was done based on the responses given by the participants. However, no question on the source of their knowledge of implantology was included and, therefore, it was assumed that the Internet, journals, televisions, continuous education programs, and other personal efforts were the source of their knowledge.

Inclusion criteria, each participant should have finished undergraduate studies of their respective branch, must have completed 6–8 months in the same job (this is done to ensure that the participant is well versed with the job location, environment, and various treatment options available in his/her clinic), and exclusion criteria participants outside the Aseer region.

Statistical analysis

The scores were calculated based on the responses given by the participants. The individual scores were summed up to get a total score. A principle investigator analyzed all returned questionnaires. A database was constructed using the Microsoft excel (Microsoft, Redmond, WA) and imported into the Statistical Package for Social Sciences (SPSS) version 20 (Chicago, Illinois, USA) for statistical analysis. Chi-square tests were used to compare the responses of participants for each question in regards to the response options. A P value <0.05 was considered statistically significant. The inferences so obtained was used to prepare the guideline for the program of study needed to increase the knowledge about DI treatment and its benefits among health workers, so that the right kind of information can be provided to the patients and community related to this superior treatment option of replacing missing teeth.


   Results Top


On the basis of the returned questionnaires, the overall response rate was 89%. Participants include – 190 of dental practitioners, 90 medical practitioners, and other auxiliary staff includes nurses, dental laboratory staff, medical laboratory staff, and health attendants [Figure 1]. The return forms were of mostly male responders 72.5% in comparison to female 27.5%, [Table 1] summarizes the demographic data of the sample.
Figure 1: Distribution of health workers included in the study

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Table 1: Demographic structure of the sample

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   Discussion Top


Various clinical and laboratory studies have been conducted following the evolution of DI and have confirmed the efficacy of implant therapy.[11],[12],[13],[14],[15] Currently, DI are largely accepted as an important prosthetic treatment option for dentulous or edentulous jaw.[17],[18] Studies have been conducted for determining the attitude, knowledge, and acceptance of DI treatment in patients and dentists, but very limited studies had been published till now to judge the DI in entire health care workers. On screening the PUBMED data base regarding the studies about attitude, knowledge, and acceptance of DI treatment in health care workers, only three closely related studies were found and no study was found in our area of concern. Thus, this study was of great importance as it helped in assessing the acquaintance of DI as a treatment option among entire health workers and also it recommended the sections of DI information which needs to be impressed to health workers, so they can guide the patients in a proper and correct manner. The importance of this study was more established by the results of Akagawa et al. (1988) study, in which they stated that most of the dentists do not provide >20% of the information about DI.[32] Around 82% of the dental patients interviewed in this study were willing to gain more information about DI, in addition more than three-fourth of them wished to have their dentists as the primary source of such information followed by the Internet. This indicates the actual prerequisite of precise realistic education about DI, especially dentist along with entire health workers so that the patients can develop confidence in them and best treatment can be rendered.

The demographic data of the present study showed more of male respondent which is in contrast to the study in Iran where Taghizadeh et al. (2008) evaluated the knowledge, attitude, and practice of Tabriz's school health workers about oral and dental health and found female respondents in the majority.[33] This indicated that males are coming up more in the health sector work in our area of concern and there is a need for more female health workers in this area.


   General Understanding Regarding Dental Implants Top


Questions related to oral hygiene shows that >90% participants recognize its importance. About 82% participants know various treatment options available to replace the missing teeth, but in that DI as an option scores just 24% compared to 76% of removable and fixed dental prosthesis together [Figure 2] and [Figure 3]. All health workers should understand that although initially DI were introduced to improve complete dentures,[34],[35] but now its use has been extended as an implant hybrid prosthesis and also for the replacement of single tooth and multiple teeth. It is also used in the palliative care following ablative surgery of the mandible and maxilla.[1],[2]
Figure 2: Importance of oral hygiene

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Figure 3: Treatment options to replace missing teeth

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   Awareness Toward Dental Implants Top


More than 75% of the participants were aware of DI and almost 65% know in detail or at least understand the difference between the FPD RPD, and DI. Even though there was a high level of awareness of DI, only 54% of those questioned correctly answered that DI is placed in or take anchorage from the jawbone, while 5–10% thought that it is placed in the gingiva/gums or teeth but a significant percentage of respondents 34% did not know where the DI are placed, which reveals incomplete or incorrect information about DI in spite of being aware of this treatment option. The question regarding the placement of DI in completely edentulous patient, 224 out of 445 said “Yes,” while 61 and 160 said “No” and “Do not Know,” respectively. Normally participants understand the fixed nature of DI but there was a doubt about the type of anesthesia used while placing DI and most of them thought that DI are only placed by a specialist. On analyzing the data it was revealed that mostly medical health workers were lacking in information about DI. This was ascertained by determining the association between the DI awareness and health workers (dental staff and medical staff), Chi-square test was performed. The calculated value of χ2 for various degree of freedom (df) at 5% level of significance was found to be statistically significant (P value <0.0001) indicating that dental health care workers were more aware compared to medical. Thus, there is compounding need to enrich the knowledge of medical sector health workers regarding DI [Figure 4] and [Table 2].
Figure 4: Awareness about dental implants

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Table 2: Association between the awareness toward dental implants among health workers (dental staff and medical staff)

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   Attitude Toward Dental Implants Top


Regarding the attitude toward DI, 45% were recommending DI for patients and 55% were enthusiastic to get treated with DI if needed. But a significant number, nearly 23–25% were neither recommending to patients nor willing to get treated with DI and almost identical number were not sure about recommending or getting treated as well. This may be due to less training, less knowledge, and ambiguity about the procedure of dental implantology among the health workers. This revealed that there is an immediate need to enhance the knowledge about DI procedure. Because in health care centers, where the dentists are not properly trained for DI or patients are not able to afford the cost for DI, generally do not explain appropriately on DI as a treatment choice. They opt for conventional simple economic prosthetic treatment options (FPD, RPD, and CD) which are less tasking and less challenging compared to DI.

While considering the association between the attitude of health workers (dental staff and medical staff) toward the DI (recommendation and getting it done for themselves), the χ2 calculated value for degree of freedom (df) 2 at 5% level of significance was 4.51 and 2.74, it was statistically not significant as P value >0.05. This shows that health care workers were recommending and willing to get DI for themselves. But still there was a group of health workers who were hesitant to DI [Table 3]. The reason may be many, either dentist themselves do not do implants or other health workers have less knowledge about it. To determine this, the participants were asked about the reasons for not recommending DI. High cost was the major factor inhibiting the explored subjects from recommending DI followed by complicated treatment, surgical risk, failure of implants in previously known patients, and others. [Figure 5] indicates percentage of each reason.
Table 3: Association between the attitude of health workers (dental staff and medical staff) toward the dental implants

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Figure 5: Reasons for not recommending dental implants

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   Understanding Benefits and Failures of Dental Implants Top


The aforementioned works and proven research had shown that the DI supported prostheses are functionally efficient, esthetically satisfactory conservative, and have good prognosis with a long-term success rate in uncomplicated cases. Ultimately, it improves the quality of life and self-confidence of the patient.[21],[36],[37],[38] In the present study, about 33% of those questioned believe function is the most important benefit of DI followed by esthetics 32%, avoidance of preparation of teeth 22%, and 13% do not know about its benefits [Figure 6]. This is in association with the studies of Giedre et al. (2009),[39] Chowdhary et al. (2010),[30] where they stated that DI improved oral functions in edentulous patients and received a wide acceptability due to its associated benefits. Conventional type dentures and bridges can be easily incorporated with implants in wide edentulous jaws and this leads to improved and sustained oral health.
Figure 6: Benefits of dental implants

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Among the surveyed participants, nearly 53% believed poor oral hygiene maintenance by patient as a main cause of DI failure and 85% suggested that there is a need for more dental implantologist [Figure 7]. It was very positive attitude of health workers both in dental and medical side that almost 90% were willing to gain more knowledge regarding the DI so that they can use it in their respective field and educate the patients. This was in accordance to the study done by Chowdhary et al.,[30] which also reported willingness of the clinicians to gain more knowledge regarding DI.
Figure 7: Understanding of dental implants

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   Recommendation Top


This study showed that although most of the dental and medical practitioners have knowledge about DI and positive attitude, but still they are lacking in complete information. As a result DI therapy is often misunderstood by the health workers itself, and being the principal source in guiding patients for dental treatment, the key information about DI is missing at the community level. Therefore, it is essential to enhance the education level of health care community workers regarding the DI so that this treatment can be accepted and indorsed by most of them. This will improve their quality of life as well as of patients. In the present study, the sampled population believed that the knowledge regarding DI could be improved by incorporating the DI in course curriculum of all health sciences, followed by the Continuing Dental Education (CDE) Program and hands-on courses, articles in journals, and other means [Figure 8]. We are recommending the incorporation of basic DI topics in all syllabuses of health care workers with obligatory assessment of acquaintance before employment. All heath care centers must have a distinct DI help desk for guiding and educating the patients along with health workers. By this way, we can improve the oral health and ultimately general health with quality of life because healthy mouth is the mirror of healthy body.
Figure 8: Improvement in knowledge about dental implants

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   Limitations Top


As this study was carried out in a limited area and including limited health workers in that zone, further detailed survey including more number of questionnaires and more sample size should be carried out in a wide zone to generalize the results.


   Conclusion Top


Regardless whether the health workers are dealing with implants or not, it is necessary to have basic information about it, because patient most of the time takes opinion from them while selecting the treatment for missing teeth. In this study the acquaintance (knowledge, awareness, and attitude) of DI as a treatment for edentulous state were assessed among health workers and comparison was done between medical and dental health workers. It was revealed that even though in general health workers are aware of DI, but complete and proper information is lacking but dental health workers have more knowledge than the medical workers, and the difference was found to be statistically significant. This indicates the need for more education to health care workers about DI so that it can help in eliminating any negative image of the DI procedure in patient's mind due to lack of knowledge.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


   Appendix 1 Top


Questionnaire (Tick appropriate)

Job location ______________________________

Government sector ________________________

Private sector ________________________

Sex ________________________________

Male ________________ Female _________________________

Occupation _______________________________

Dental specialist (Please mention branch –)______________________________

General dentist _________________________

Medical doctor _________________________

Nurse _________________________

Dental therapists _________________________

Dental laboratory staff _________________________

Medical laboratory staff _________________________

Health attendants _________________________

Questions-

Q1. Do you know oral hygiene is important for good general health?

  1. Yes
  2. No


Q2. Do you know that improper oral hygiene may result in tooth loss?

  1. Yes
  2. No


Q3. Do you know various treatment options to replace missing teeth?

  1. Yes
  2. No


If yes – please mention –

  1. __________________
  2. __________________
  3. __________________


Q4 Are you aware of dental implants?

  1. Yes
  2. No


Q5. Do you know the difference between dental implants, fixed prosthesis, and removable prosthesis?

  1. Yes
  2. No
  3. Little


Q6. Dental implants take anchorage from

  1. Teeth
  2. Bone
  3. Gum
  4. Do not know


Q7. Can dental implants be used in patients without any teeth?

  1. Yes
  2. No


Q8. Is dental implant fixed or removable at patients' will?

  1. Fixed
  2. Removable


Q9. Dental implants are done by

  1. General dentist
  2. Specialist


Q10. Type of anesthesia used to do dental implants is-

  1. General
  2. Local


Q11. Do you recommend dental implants for patients?

  1. Yes
  2. No
  3. Not sure


Q12. Will you get dental implant done for yourself (if needed)?

  1. Yes
  2. No
  3. Not sure


Q13. What do you think benefits of dental implants?

  1. Esthetics
  2. Function
  3. Avoidance of preparation of natural teeth


Q.14. Reasons for not recommending dental implants

  1. Expensive
  2. Surgical risk
  3. Complicated treatment
  4. Lengthy treatment time
  5. Post-operative complications
  6. Failure of implants in previously known patient


Q.15 What do you think are cause of dental implant failure?

  1. Poor-quality treatment
  2. Poor oral hygiene maintenance by patient
  3. Do not know


Q.16 Do you think there is a need for more implant specialists?

  1. Yes
  2. No


Q.17 Do you like to know more about dental implants?

  1. Yes
  2. No


Q.18 Knowledge about dental implants can be increased by

  1. CDE Program
  2. Articles in journals
  3. Incorporation of dental implants in course curriculum
  4. Others




 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
    General Understa...
    Awareness Toward...
    Attitude Toward ...
    Understanding Be...
   Recommendation
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   Appendix 1
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