|Year : 2017 | Volume
| Issue : 4 | Page : 291-295
Road blocks perceived by the dentists toward the treatment of early childhood caries in Chennai city – A cross-sectional study
Habibkhan Faizunisa1, Preetha Elizabeth Chaly1, Mohammed Junaid1, Selvaperumal Vaishnavi1, JE Nijesh1, Mohammed Musthafa2
1 Department of Public Health Dentistry, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India
2 Department of Oral Medicine and Radiology, Madha Dental College, Chennai, Tamil Nadu, India
|Date of Web Publication||15-Sep-2017|
No 6, HIG, TNHB, Avadi, Chennai - 600 054, Tamil Nadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: The problem of early childhood caries remains a worldwide public concern, as most of the caries remains untreated. Despite advances in dental care, most children fail to benefit from oral health-care services not only due to differences in attitudes in parents but also in oral health-care providers. Objectives: The objective of the study is to determine the road blocks perceived by the dentist in Chennai, toward the treatment of early childhood caries. Methods: Following a simple random sampling technique, a cross-sectional questionnaire study was conducted among general dentists (n = 50) and pediatric dentists (n = 50) in Chennai city. Each selected dentist was asked to complete the Barriers to Childhood Caries Treatment (BaCCT) questionnaire: a 29-item measure considering child, parent, dentist, and healthcare system factors. Results: The mean BaCCT score was found to be significantly higher among general dentists 2.68 ± 0.36 when compared to pediatric dentists 2.36 ± 0.45 (P = 0.0001). Similarly, mean BaCCT score was found to be significantly higher among general dentists in Domain-I (child coping abilities), Domain-II (dentist attitudes toward offering restorative treatment), and Domain-III (dentist attitudes toward restoring primary teeth) when compared to the pediatric dentists (P < 0.001). Conclusions: The general dentists exhibited inherent barriers in providing treatment for early childhood caries compared to pediatric dentists. Training in the field of pediatric dentistry enhances their ability to handle early child caries better.
Keywords: Barriers, dentists attitudes, early childhood caries, healthcare system
|How to cite this article:|
Faizunisa H, Chaly PE, Junaid M, Vaishnavi S, Nijesh J E, Musthafa M. Road blocks perceived by the dentists toward the treatment of early childhood caries in Chennai city – A cross-sectional study. J Indian Soc Pedod Prev Dent 2017;35:291-5
|How to cite this URL:|
Faizunisa H, Chaly PE, Junaid M, Vaishnavi S, Nijesh J E, Musthafa M. Road blocks perceived by the dentists toward the treatment of early childhood caries in Chennai city – A cross-sectional study. J Indian Soc Pedod Prev Dent [serial online] 2017 [cited 2018 Mar 23];35:291-5. Available from: http://www.jisppd.com/text.asp?2017/35/4/291/214912
| Introduction|| |
Early childhood caries is a serious public health problem in both developing and industrialized countries.,, Reviews have indicated that utilization of dental services among preschool children is not adequate.,, Empirical research in dentistry has adopted a broader view in which barriers are considered as factors preventing dentists from providing dental services. Understanding the attitudes of dentists is likely to have an implication in identifying potential barriers within oral health-care delivery system. This study is aimed to determine the road blocks perceived by the dentist in Chennai, toward the treatment of early childhood caries.
| Methods|| |
A cross-sectional survey was carried out among the general dentists and pediatric dentists in Chennai for the duration of 2 months (October–December 2016). The individuals who had given voluntary informed consent, registered general dental practitioner holding an undergraduate qualification alone, practicing in Chennai, and registered pediatric dentists practicing in Chennai were included in our study. The registered dentists who were not into clinical practice were excluded from the present study. The ethical clearance was obtained from the institutional review board of Meenakshi Academy of Higher Education and Research, Chennai (MADC/IRB-X/2016/198).
Following the pilot study, considering the mean difference in Domain-III between general and pediatric dentists, using sampling software G* power version 188.8.131.52 (Heinrich-Heine-Universtat Dusseldorf, Germany), a minimum sample of 94 was calculated which was raised to 100 (50 in each group) with α error of 5% and power of the study being 95%.
Selection of individuals in the present study was carried out using simple random sampling technique. General dentists were selected from the list of registered dentists as obtained from the Tamil Nadu Dental Council. Pediatric dentists in our study were recruited from the member list as obtained from Indian Society of Pediatric and Preventive Dentistry. The recruited individuals were asked to fill a pretested questionnaire at their work place.
The self-administered closed ended questionnaire used consists of five domains which cover potential barriers to dental care of children: Domain-I (six items were based on child coping abilities), Domain-II (7 items were based on dentist's own attitudes) Domain-III (seven items regarding dentists' beliefs on the need to restore primary teeth), Domain-IV (five items regarding parent expectations), and Domain-V (four items regarding the healthcare system). A total of 29 statements (items) were included in the measure. Dentists were asked to rate their level of agreement with each statement on a 5-point Likert scale (1, strongly disagree; 2, disagree; 3, neither agree nor disagree; 4, agree; 5, strongly agree), regarding dental care for preschool children (≤5 years old). To determine the barrier, several items were recoded to ensure that the direction of all items was the same as some items were deliberately constructed so that disagreement would represent a barrier, rather than agreement. Items with a value >3 considered barriers perceived by dentists. The data obtained was analyzed using SPSS V.16 (IBM Corp, Chicago, IL, USA). Student's t-test and Mann–Whitney test were used, and the significance level was set at P < 0.05.
| Results|| |
The overall Barriers to Childhood Caries Treatment (BaCCT) score across all domains was significantly higher among general dentists (2.68 ± 0.36) when compared to pediatric dentists (2.36 ± 0.45) (P = 0.0001). On evaluation of the overall mean BaCCT score of individual domains, it was noted that general dentists had significantly higher mean score when compared to pediatric dentists for Domains I, II, and III (P < 0.01). No significant difference in the mean BaCCT score observed between general dentists and pediatric dentists for Domains IV and V (P > 0.05) [Table 1].
|Table 1: Barriers perceived among the study individuals based on various domains|
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A greater percentage of general dentists exhibited inherent barrier in their attitude toward offering restorative treatment (28%) when compared to pediatric dentists (4%) (P = 0.001). However, no significant difference in percentage distribution of barriers was observed between the two groups when Domains I, III, IV, and V were considered (P > 0.05) [Table 1].
In Domain-I, the mean BaCCT scores were significantly higher among general dentists when compared to pediatric dentists, when it came to questions pertaining to their views on children not coping well with treatment, their inherent dislike to sit on the dental chair, and the child's lack of acceptance for dental treatment (P < 0.05) [Table 2].
In Domain-II, the mean BaCCT scores were significantly higher among general dentists when compared to pediatric dentists, when it came to questions pertaining to their attitudes on giving local anesthetic to children, prefer to refer children to be treated by other colleagues, find filling children's teeth stressful, rarely have enough time to spend with child patients, enjoy filling children's teeth, feel apprehensive to do a filling in a child, and in providing dental treatment for children as troublesome (P < 0.05) [Table 2].
In Domain-III, the mean BaCCT scores were significantly higher among general dentists when compared to pediatric dentists, when it came to questions pertaining to their attitudes toward the necessity of restoring a primary teeth, Like I feel there is no reason to fi ll primary teeth, if decayed primary molars not causing any symptom, they are best left untreated, and feel there is little point in fi lling primary teeth (P < 0.05) [Table 2].
In Domains IV and V, no significant difference in the mean BaCCT scores was observed among general dentists when compared to pediatric dentists, when it came to the questions pertaining to the parent's expectation toward the treatment of early childhood caries and their views toward the existing healthcare system (P > 0.05) [Table 2].
| Discussion|| |
This study reports the attitudes of dentists in Chennai city about managing and treating child patients in private dental clinic. Since dentists are the persons who convey evidence-based knowledge of oral health care to public, they also influence their patients' oral health-related behavior. Dentists' treatment decisions are influenced by their knowledge and attitudes toward care options, and assessing these is worthwhile. In the present study, child coping abilities (children get upset easily; most children are fearful; do not like the sound of the drill) were evident as barriers from general dentist's perspective. This was similar to the study conducted by Lee et al., in Hong Kong, in which child coping abilities were the barriers perceived by the general dentists.
In the present study, both the general dentists and pediatric dentists did not report time consumption as a barrier in treating children. Whereas in a study conducted by Mathews et al., in Kerala, reported time consumption as a major barrier in treating children. A study conducted by Halawany et al., in Saudi Arabia, reported the same. This could be due to the differences in attitudes between dentists in different countries probably caused by differences in the dental school training and curricula. The study conducted by Lee et al., in Hong Kong, reported no barrier was perceived by dentists in treating early childhood caries regarding the attitudes toward the necessity of restoring primary teeth. The result was in line with the current research.
In the present study, no barrier was reported by the dentists regarding the parent's expectation from the dentists toward the treatment of early childhood caries. Whereas in a study conducted by Arheiam et al., in Libya, reported that dentists perceived barrier regarding the patient's poor knowledge of the potential of caries prevention among the patient-related barriers. This difference could be probably due to the presence of knowledge and awareness regarding the oral health care among the parents in the city.
In the present study, 46% of the dentists found barrier when it came to remuneration received for restorative care services rendered to patients. This is in accordance with the study conducted by Halawany et al., in Saudi Arabia, in which 65.7% of the dentists reported financial loss as a major barrier in treating children.
In the current study, no barrier perceived by the general dentist with regard to the payment received for providing preventive care was inadequate. This was in accordance with a study conducted by Arheiam et al., in Libya. In a present study, 72% of the general dentists and 44% of the pediatric dentists found barrier regarding the child coping ability. In a study conducted by Devendra Patil et al., in Mumbai, 41.6% of the dentists found difficulty in behavior management among the children.
In a current research, both the pediatric and the general dentists do not prefer to refer children to be treated by other colleagues. This was similar to the study conducted by Carole McKnight-Hanes et al., in the United States.
| Conclusion|| |
The present study reveals that certain barriers were perceived by the general dentists and pediatric dentists in treating early childhood caries. The general dentists found barrier with regard to child coping abilities domain, and pediatric dentists found barrier with regard to existing health-care system. Based on the findings of our study, we suggest that general dentists should be provided effective training in the basic concepts of pediatric oral care, so as to serve as efficient workforce. We also suggest that pediatric dentists should be involved at secondary and tertiary healthcare level, so as to encourage effective utilization of dental services by children to improve their oral and general health, respectively.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Colak H, Dülgergil CT, Dalli M, Hamidi MM. Early childhood caries update: A review of causes, diagnoses, and treatments. J Nat Sci Biol Med 2013;4:29-38.
Brown LJ, Wall TP, Lazar V. Trends in untreated caries in primary teeth of children 2 to 10 years old. J Am Dent Assoc 2000;131:93-100.
Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21st
century – The approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003;31 Suppl 1:3-23.
Lee GH, McGrath C, Yiu CK. Barriers to providing oral health care to pre-school children-differences between paediatric dentists' and general dental practitioners' beliefs. Community Dent Health 2015;32:32-8.
Beil H, Mayer M, Rozier RG. Dental care utilization and expenditures in children with special health care needs. J Am Dent Assoc 2009;140:1147-55.
Kim J, Kaste LM. Associations of the type of childcare with reported preventive medical and dental care utilization for 1- to 5-year-old children in the United States. Community Dent Oral Epidemiol 2013;41:432-40.
Pine CM, Adair PM, Burnside G, Nicoll AD, Gillett A, Borges-Yáñez SA, et al.
Barriers to the treatment of childhood caries perceived by dentists working in different countries. Community Dent Health 2004;21 1 Suppl:112-20.
Ghasemi H, Murtomaa H, Torabzadeh H, Vehkalahti MM. Knowledge of and attitudes towards preventive dental care among Iranian dentists. Eur J Dent 2007;1:222-9.
McGlone P, Watt R, Sheiham A. Evidence-based dentistry: An overview of the challenges in changing professional practice. Br Dent J 2001;190:636-9.
Brown G, Manogue M, Rohlin M. Assessing attitudes in dental education: Is it worthwhile? Br Dent J 2002;193:703-7.
Mathews S, Abraham K, Khosla E, James AR, Thenumkal E. Attitude of general dental practitioners towards child patients. Ann Essences Dent 2015;8: 1a-5a.
Halawany HS, Al-Fadda SA, Al-Saeed BH, Al-Homaied MA. The attitude of private dental practitioners towards treatment and management of children in Riyadh, Saudi Arabia. JPDA 2011;20:245-49.
Arheiam A, Masoud I, Bernabé E. Perceived barriers to preventive dental care among Libyan dentists. Libyan J Med 2014;9:24340.
Devendra Patil P, Farhin Katge A, Bhavesh Rusawat D. Knowledge and attitude of pediatric dentists, general dentists, postgraduates of pediatric dentistry, and dentists of other specialties toward the endodontic treatment of primary teeth. J Orofac Sci 2017;8:2.
McKnight-Hanes C, Myers DR, Dushku JC, Barenie JT. A comparison of general dentists' and pediatric dentists' treatment recommendations for primary teeth. Pediatr Dent 1991;13:344-8.
[Table 1], [Table 2]