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- DOI 10.18231/j.ijodr.2022.017
-
CrossMark
- Citation
Awareness about minimally invasive dentistry among dental under graduates & Interns: A cross-sectional study
- Author Details:
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Shreya Rani
-
Soni Patel
-
Nilotpol Kashyap *
-
Aparna Dey
-
Nishi Singh
Introduction
Minimally Invasive Dentistry (MID) is a modern concept that attempts to keep teeth functional for life. It is the management of caries with biological approach rather than traditional surgical approach. It is a concept that focus on a new dimension for caries management mainly on early diagnosis, risk assessment, prevention, and control.[1] It is to leave the traditional GV Black concept of ‘Extension for Prevention’ behind. Now, the present-day principle is ‘Constriction with Conservation’. Irrespective of the growing evidence and emphasis on MID practice, limited data is available to evaluate the knowledge and attitude towards MID practice among the dental students.[2] So, this has been noticed that the concept of MID is still very unclear to the practicing dentists & even to the undergraduates.
Aim
Firstly, to assess the knowledge about MID technique among the undergraduate students and interns from the institution.
Secondly, to also investigate whether the knowledge acquired by the students reflects in the form of a positive attitude towards practice of MID principles.
Materials and Methods
Study design
It was a study having a cross-sectional design.
Study population
The study population of 50 both male & female dental students and interns belonging from the institution.
Study tool
Close ended questionnaire-based online survey.
Sample size
Purposive sample of about 50 dental students & interns were taken from the institution.
Inclusion criteria
Dental interns and final year students in clinical training years.
Data collection procedure
A pre-validated questionnaire [3], [4], [5] consisting of questions on knowledge and attitude toward MID practice was employed. The questionnaire was circulated online among the dental students and interns. The first section is to assess the demography of the respondents – year of study. The second part of the questionnaire consisted of 10 questions. Three questions assessed the knowledge, 3 questions assessed the attitude and 4 questions assessed the practice- based on screening, prevention and curative measures.
Data analysis
The data obtained were subjected to statistical analysis using Statistical Package for the Social Sciences (SPSS Version 23; Chicago Inc., IL, USA). Data comparison was done by applying specific statistical tests to find out the statistical significance of the comparisons. To test for awareness regarding MID among dental students, Kolmogorov –Smirnov and Shapiro Wilk tests were performed to determine the normality of the data.
Validation of questionnaire
A 10 variable, close ended questionnaire was developed elaborating various information regarding knowledge, techniques and procedures of MID.
Result
About knowledge regarding MID among dental students & interns ([Table 1]).
When the intern & final yr. student were asked whet which was fluoride is an essential agent in tooth remineralisation process, out of 25 final yr. student 13 (52%) strongly agreed about it while none of the intern or final yr. student disagree. P value was 0.868 which was found to be non-significant.
When asked whether caries risk assessment should be conducted with all patients 56% (14) of final year student strongly agreed while 76% (19) intern also did the same. 8% of final yr. student disagree while none of the intern disagreed. P value 0.6628 while was non-significant.
When asked whether cavity design like tunnel & box preparation were effective 20% (5) of final yr. strongly agree & 16% (4) disagree while 52% of intern agree & 4% disagree. P value was 0.0445 while was found to be signification.
Knowledge regarding instrument used in MID among dental students & interns ([Table 2])
For sharp explorer 48% of FYS said sometimes while 8% said never while 60% of intern said sometimes & 32% said never. P value was 0.006 & was significant.
For radiograph 56% FYS said sometimes & 12% said never while 32% of interns said sometimes & 4% said never while 64% said always. P value was 0.7054 & was non-significant.
When asked about never method of caries detection 32% of FYS said sometimes 12% said always and 56% said never while among the interns 48% said sometimes 18% said always & 34% said never. P value 0.0045 & was found too significant.
When asked about the effectiveness of various MID techniques. ([Table 3])
ART -88% of final year students found it effective & 12% found it effective while 96% of interns found it effective & 8% did not. P value 1.087 was on significant.
Sandwich technique- 56% final year students found it effective & 44% found it effective & 72% intern found it effective while 28% didn’t P value was 0.624 non-significant.
When asked about the effectiveness of remineralisation with high concentration fluoride toothpaste at home. 84% of final year students found it effective while 56% said it effective & 84% of interns found it effective & 16% found it be effective. P value 0.0072 which is significant.
Hall’s technique was found to be ineffective according to the final years 52% while 84% of the interns found the technique to be effective.
|
Variables |
Strongly agree N(%) |
Agree N(%) |
Neutral N(%) |
Disagree N(%) |
Total N(%) |
Chi- Square statistic |
P value |
|
Fluoride is an essential agent in the tooth remineralisation process |
|||||||
|
Final years |
13(S2.0) |
8 (32.0) |
4 (16.0) |
0 (0.0) |
25(100) |
|
|
|
Interns |
19 (76.0) |
6 (24.0) |
0 (0.0) |
0 (0.0) |
25( l00) |
0.9718 |
0.808(NS) |
|
Total |
32 (64.0) |
14 (28.0) |
4 (8.0) |
0 (0.0) |
50(100.0) |
|
|
|
Caries risk assessment should be conducted with all patients |
|||||||
|
Final years |
14 (S6.0) |
7 (28.0) |
1 (4.0) |
2 (8.0) |
2S (100) |
|
|
|
Interns |
19 (76.0) |
5 (20.0) |
1(4.0) |
0 (0.0) |
25 (100) |
l.7386 |
0.6628(NS) |
|
Total |
33(66.0) |
12 (24.0) |
2 (4.0) |
2 (4.0) |
50 (100.0) |
|
|
|
Conservative cavity designs like tunnel and box p1·eparations are effective |
|||||||
|
Final years |
5 (20.0) |
11 (44.0) |
5 (20.0) |
4 (16.0) |
25 (100) |
|
|
|
Interns |
13(52.0) |
10 (40.0) |
1 (4.0) |
1 (4.0) |
25(100) |
8.0698 |
0.0445* |
|
Total |
18(36.0) |
21(42.0) |
6 (8.0) |
5 (10.0) |
50(100.0) |
|
|
|
Variables |
Sometimes N(%) |
Always N(%) |
Never N(%) |
Total N(%) |
Chi - Square statistic |
P value |
|
Use of a sharp explorer |
||||||
|
Final years |
12 (48.0) |
11 (44.0) |
2(8.0) |
25(100) |
10.1641 |
0.006* |
|
Interns |
15(60.0) |
2 (8.0) |
8(32.0) |
25(100) |
||
|
Total |
27 (54.0) |
13(26.0) |
10(20.0) |
50(100.0) |
||
|
Use of radiographs |
||||||
|
Final years |
14 (56.0) |
8 (32.0) |
3(12.0) |
25(100) |
5.3.3 |
0.7054(NS) |
|
Interns |
8 (32.0) |
16(64.0) |
1(4.0) |
25(100) |
||
|
Total |
22 (44.0) |
24(48.0) |
4(8.0) |
50(100.0) |
||
|
Use of newer methods like (ECM- Electronic Caries Monitor, QLF-Quantitative Light-induced Fluorescence. IRLF- infrared laser fluorescence, FOTI- Fibre-Optic Trans-Illumination |
||||||
|
Final years |
8 (32.0) |
3(12.0) |
14 (56.0) |
25 (100) |
10.784 |
0.0045* |
|
Interns |
16 (64.0) |
6 (24.0) |
3 (12.0) |
25(100) |
||
|
Total |
24 (48.0) |
9 (18.0) |
17 (34.0) |
50 (100.0) |
|
Variables |
Effective N(%) |
Ineffective (N%) |
Total N(%) |
Chi - Square statistic |
P value |
|
A traumatic restorative technique |
|||||
|
Final years |
22 (88.0) |
3 (12.0) |
25(100) |
1.087 |
0.2971(NS) |
|
Interns |
24 (96.0) |
1 (4.0) |
25(100) |
||
|
Total |
46 (92.0) |
4 (8.0) |
50<100.01 |
||
|
Sandwich technique |
|||||
|
Final years |
14 (56.0) |
11(44.0) |
25(100) |
0.624 |
0.4295(NS) |
|
Interns |
18 (72.0) |
7 (28.0) |
25(100) |
||
|
Total |
32 (64.0) |
18 (36.0) |
50<100.0) |
||
|
Remineralization with high concentration fluoride toothpaste at home (Duraphat 2800/5000 ppm F) |
|||||
|
Final years |
11 (44.0) |
14 (56.0) |
25<100) |
10.7843 |
0.0010* |
|
Interns |
22 (88.0) |
3 (12.0) |
25(100) |
||
|
Total |
33(66.0) |
17(34.0) |
50(100.0) |
||
|
Halls technique |
|||||
|
Final years |
12 (48.0) |
13(52.0) |
25<100) |
7.2 193 |
0.0072* |
|
Interns |
2 1 (84.0) |
4 (16.0) |
25(100) |
||
|
Total |
33(66.0) |
17(34.0) |
50<100.0) |
Discussion
The MID focuses on the preventive aspect of caries management dissociating from the traditional concept of "drill and fill" to a more conservative holistic and biological concept of “seal and heal”.[6]
Regarding knowledge about MID among dental students & interns, In the study it was found that 52% of final year students strongly agreed & 32% agreed about the remineralization potential of fluoride while 76% of interns strongly agreed & 24% agreed & none of the final year students & interns disagreed about it. This is in accordance to a study conducted in Chennai by Natarajan K, 2019 where 73% of participants agreed about the remineralization potential of fluoride. [5] So, in the study it was found that 56% of final year & 76% of interns strongly agreed with the importance of performing caries risk assessment in all patients this confirms with the study done by Nagraj A in Jaipur 2015.[7] Majority of the interns 52% strongly agreed to the use of conservative techniques like tunnel and box preparation while only 20% of final year strongly agreed to the same. Although the use of tunnel preparation is widely used in the management of proximal caries, study conducted by Kinomoto Y, 2004 found no significant advantage over conventional restoration. [8]
Knowledge regarding instruments used in MID among dental students & interns.
In the study it was found that only 44% of final yrs. & 8% of interns agreed on the use of a sharp explorer to detect caries, this is contradictory to the evidence of the use of sharp instruments as caries diagnostic tools as shown in a study done by Pitts NB, 2001.[9] And the similar observation was made in a study conducted amongst general dental practitioners of Saudi Arabia wherein 79.5% participants still use sharp explorer for caries detection and this study was done by Shah AH in 2016. [10] In the present study 32% of final yrs., and 64% of interns were in the favour of taking radiographs for caries detection and was compliant with the finding of Pitts NB. In this study it was also found that newer methods of caries detection were better known to interns (64%) than final year counterparts (32%).
Conclusion
In this study it was found that interns had greater knowledge of MID than final years as they had greater clinical exposure. It was also found that there is a need to introduce evidence-based dentistry in the dental curriculum as well as establish guidelines for caries detection, diagnosis, treatment discussion & treatment performance.
Conflict of Interest
The authors declare no relevant conflicts of interest.
Source of Funding
None.
References
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