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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 10  |  Issue : 4  |  Page : 178-182

Attitude of general dental practitioners to pediatric patients and preventive dentistry


Department of Pediatric Dentistry, Faculty of Dentistry, Harran University, Sanliurfa, Turkey

Date of Submission16-Oct-2019
Date of Acceptance20-Nov-2019
Date of Web Publication22-Jan-2020

Correspondence Address:
Dr. Ahmet Aras
Department of Pediatric Dentistry, Faculty of Dentistry, Harran University, Sanliurfa
Turkey
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DOI: 10.4103/srmjrds.srmjrds_71_19

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  Abstract 

Background: Dental education shapes the attitudes and professional behavior of dentists when treating pediatric patients. We evaluated the extent to which general dental practitioners (GDPs) in private and public hospitals were willing to treat pediatric patients as well as their attitude to preventive dentistry. Materials and Methods: A web-based questionnaire comprising 18 questions was E-mailed to 600 GDPs across Turkey. Descriptive statistics and the Pearson Chi-squared test were used for statistical analysis. Results: The response rate was 63.6% (n = 382). Of the 382 GDPs, 40 were unwilling to treat pediatric patients, whereas 74 stated that they treated such patients rarely. The GDPs were most unwilling to treat pediatric patients under 4 years of age (35.1%). The most frequent reason cited for unwillingness to treat was the uncooperative behavior of pediatric patients (77.2%). Of the GDPs, 51.6% and 56.8% preferred topical fluoride and fissure sealant, respectively, as preventive measures. Conclusions: GDPs are unwilling to treat pediatric patients due to their lack of cooperation. To overcome this, theoretical and practical training in pediatric dentistry behavior management techniques should be promoted.

Keywords: Cooperation, dental education, preventive dentistry, primary tooth


How to cite this article:
Aras A, Dogan MS. Attitude of general dental practitioners to pediatric patients and preventive dentistry. SRM J Res Dent Sci 2019;10:178-82

How to cite this URL:
Aras A, Dogan MS. Attitude of general dental practitioners to pediatric patients and preventive dentistry. SRM J Res Dent Sci [serial online] 2019 [cited 2020 May 25];10:178-82. Available from: http://www.srmjrds.in/text.asp?2019/10/4/178/276376


  Introduction Top


The demand for basic dental care is increasing. Tooth decay adversely affects children in terms of food intake and preferences, sleep habit, and quality of life.[1] Various interventions (e.g., promotion of healthy nutrition, toothbrushing, fissure sealant, and fluoride) are used to prevent tooth decay.[2] Although preventing tooth decay is easy and relatively inexpensive, its treatment can be problematic.[3]

Despite the development of new treatment methods for pediatric dentistry, uncooperative pediatric patients remain a challenge.[4] General dental practitioners (GDPs) who find a patient uncooperative typically refer that patient to a pedodontist. However, the number of pedodontists is insufficient, necessitating treatment of pediatric patients by GDPs. Unfortunately, some GDPs are unwilling to treat pediatric patients, particularly those of preschool age, and instead refer them to pedodontists.[5] Dental education shapes the attitudes and professional behavior of dentists in terms of the treatment of pediatric patients. Dentists who received a sufficient undergraduate education are well prepared to treat children or adults who require special care.[6]

We evaluated the willingness of GDPs in the private and public sectors to treat pediatric patients as well as their attitude toward preventive dentistry.


  Materials and Methods Top


Ethics approval for this study was obtained from the Harran University Faculty of Medicine Ethics Committee (HRU-190608). A web-based questionnaire survey consisting of 18 questions was designed and reviewed by a statistician at the University of Harran and evaluated by five GDPs. The questionnaire was modified according to their comments; most of the changes were in the form of rewording to aid clarify. In Turkey, 34,045 GDPs were active in 2018. The sample size was determined on the basis of that deemed to be required to obtain reliable results (>380). An invitation to participate in this survey was E-mailed to 600 GDPs across Turkey.

The questionnaire consists of four parts. The first part concerns demographic characteristics and professional experience. The second part comprises questions related to the willingness to treat pediatric patients. The third part contains questions about attitudes toward preventive dentistry. The fourth part comprises questions designed to determine the sufficiency of education in preventive dentistry.

Statistical analysis was performed using SPSS software (version 24.0; SPSS Inc., Chicago, IL, USA). Descriptive statistics and the Pearson Chi-squared test were used to assess the significance of relationships between two variables (P ≤ 0.05).


  Results Top


A total of 382 (63.6%) GDPs completed and returned the surveys. Of them, 76.7% were working in public hospitals and 23.3% were employed in the private sector; 50.5% were female and 49.5% were male. Data on the demographic characteristics and professional experience of the GDPs are provided in [Table 1].
Table 1: Demographic characteristics and professional experience of the general dental practitioners

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To the question “Do you do restorative dental treatment for pediatric patients?,” 70.1%, 10.5%, and 19.4% of the GDPs responded yes, no, and rarely, respectively. Those who responded no or rarely were then asked “which age group are you most unwilling to treat?,” 35.1% responded under 4 years, 28.1% under 8 years, 21.1% under 12 years, and 15.7% under 16 years [Figure 1]. Regarding reasons for unwillingness to provide treatment, among the same GDPs, 77.2% stated that children were uncooperative, whereas 28% cited the difficulty of tooth restoration, 21% stated the performance system, and 6.1% stated insufficient education [Table 2].
Figure 1: Rate of unwillingness to provide treatment according to age group

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Table 2: Reason (s) cited by general dental practitioners for their unwillingness to treat pediatric patients

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There was a significant relationship between unwillingness to treat and the age of the GDP and the institution in which she/he worked (P < 0.05) [Table 3] and [Table 4]. No significant relationship was found between reluctance to treat and gender or years of professional experience (P > 0.05) [Table 5] and [Table 6].
Table 3: Willingness of general dental practitioners to treat pediatric patients by age

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Table 4: Willingness of general dental practitioners to treat pediatric patients by type of institution worked at

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Table 5: Willingness of general dental practitioners to treat pediatric patients by gender

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Table 6: Willingness of general dental practitioners to treat pediatric patients by experience

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Of the GDPs, 56.8%, 13.6%, and 29.6% stated that they did, did not, and rarely applied fissure sealant, respectively. Among the GDPs who did apply fissure sealant, 90.6% regarded it as beneficial, whereas 9.4% did not. Furthermore, 82.1% of the GDPs performed acid etching before applying fissure sealant, whereas 17.9% did not.

Of the GDPs, 51.6%, 18.6%, and 29.8% did, did not, and rarely applied topical fluoride, respectively. Among the GDPs who did apply fluoride, 48.2% responded that they did not perform surface cleaning before fluoride application, whereas 26.7%, 13.8%, and 9.3% stated that they carried out surface cleaning with a brush only, polyurethane paste, and pumice water, respectively [Figure 2]. Of the GDPs, 82.2% and 17.8% did and did not, respectively, regard topical fluoride application as beneficial. Among the GDPs, 55% stated that they applied fluoride for initial enamel lesions, whereas 39.8% used fluoride toothpaste, 16.7% tooth mousse, and 12.8% resin infiltration [Table 7]. Of the GDPs, 87.4%, 4.7%, and 7.9% stated that they did, did not, and rarely provided posttreatment motivational information to children about brushing and nutrition, respectively.{Figure 2}
Table 7: The general dental practitioners' preferred methods for treating initial enamel lesions

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To the question “Do you recommend the use of dental floss to pediatric patients?” 13.9%, 63.3%, and 22.8% of the GDPs responded yes, no, and rarely, respectively. Of the GDPs, 36.9% and 63.1% stated that their education in preventive dentistry was and was not, respectively, up-to-date and sufficient. To the question “On which subject would you most like to be educated in the field of pediatric dentistry?,” 47.3% of the GDPs indicated preventive dentistry, 46% behavior management techniques, 35.3% dental trauma, and 32.2% novel restorative materials [Table 8].
Table 8: Aspects of pediatric dentistry about which the general dental practitioners expressed the desire to be educated

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  Discussion Top


In studies conducted in the United States, the degree of willingness to treat pediatric patients was negatively associated with professional experience.[7],[8] Recently, qualified dentists (1–3 years) performed complex treatments (e.g., application of stainless steel crowns and space maintainers and endodontic treatment of primary or permanent teeth) more frequently and referred fewer patients to pedodontists than dentists with 10 years of experience.[5],[7] In this study, younger GDPs were significantly more willing to treat pediatric patients. However, there was no significant difference according to years of professional experience.

The number of children treated decreased as their age decreased, likely because the treatment of such patients is tiring and time-consuming for the practitioner, and has a low financial return; thus, GDPs often refer pediatric patients to pedodontists.[5],[9],[10] Furthermore, as age decreased the frequency of unwillingness to treat pediatric patients increased. The most frequent reason cited was a perception that children tend to be uncooperative, followed by the difficulty of achieving restoration in children, the performance evaluation system used in public hospitals, and time limitations.

Around 90% of all caries lesions are on the occlusal surface of the posterior teeth.[3] The application of fissure sealant to the permanent molars significantly reduced the incidence of caries. Furthermore, the use of fissure sealants has increased over time.[11],[12],[13] Although 90.6% of the GDPs in this study regarded fissure sealant as beneficial, only 56.8% applied fissure sealant and 29.6% applied it rarely. This may be due to its high cost for patients in the private sector and low income for GDPs in the public sector.

The application of fluoride reduces the solubility of enamel by converting hydroxyapatite to fluorapatites, promotes remineralization of demineralized enamel, and suppresses acid production by microorganisms.[3],[14],[15] Although 82.2% of the GDPs in this study regarded fluoride application as beneficial, only 51.6% applied fluoride and 29.8% applied it rarely. Cleaning the tooth surface reportedly enhances the efficacy of topical fluoride.[15] In this study, 48.2% of the GDPs did not perform surface cleaning before applying topical fluoride, likely because of inadequate education in the practical aspects of dentistry.

Although the success of preventive treatment methods depends, to a large extent, on the interest and cooperation of the patient, the dentists should inform their patients about the importance of these methods.[16] Studies of the effect of healthy nutrition on oral and dental health have shown that toothbrushing and dental flossing prevent cavities and periodontal disease.[17],[18],[19] Therefore, oral hygiene education should be provided to patients in addition to preventive treatment. Of the GDPs in this study, 87.4% provided posttreatment motivational information to pediatric patients about toothbrushing and nutrition, but only 13.9% recommended the use of dental floss. This is likely because the GDPs are unaware of the exact age of dental flossing.

Dentistry education is important in shaping the attitudes and professional behavior of dentists treating pediatric patients.[6],[7],[20] In 2005, Dao et al. reported a relationship between dentistry education and the willingness of dentists to treat patients requiring special care. They concluded that dentists who received a sufficient undergraduate education were well prepared to treat children or adults who needed special care.[6] Furthermore, dental education reportedly provides few opportunities to treat young or noncompliant patients, resulting in an unwillingness to treat such patients.[4],[21] Most of the GDPs (63%) in our study stated that they received insufficient preventive dentistry education, leading to incorrect or incomplete (or avoidance of) treatment.

In their response to the question “On which subjects would you like to receive education?” the GDPs cited preventive dentistry and behavior management techniques. This supports our finding that insufficient theoretical and practical education explains the unwillingness of many GDPs to treat pediatric patients.


  Conclusions Top


GDPs are frequently unwilling to treat pediatric patients because they lack sufficient theoretical and practical education in behavior management and preventive dentistry. In addition, due to the performance evaluation system used in public hospitals, and the perception that pediatric patients are uncooperative, GDPs concerned about time and cost tend to refer patients to pediatric dentistry clinics. This increases the workload of pediatric dentistry clinics, which often have an insufficient number of pedodontists.

To prevent such problems and improve the quality of preventive dentistry, sufficient theoretical education should be included in dentistry education programs, and GDPs should be provided with additional training, particularly in relation to uncooperative patients. The performance-based evacuation systems in public hospitals should be modified, and the application of restorative and preventive dentistry to pediatric patients should be encouraged. Moreover, the importance of dental flossing for preventing proximal caries and periodontal problems should be emphasized. In summary, more effective education for GDPs and their patients and relatives is needed to promote preventive dentistry.



Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Dhama K, Patthi B, Singla A. Topical Fluorides: A Literature Review. Hamburg: Anchor Academic Publishing; 2017.  Back to cited text no. 15
    
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    Figures

  [Figure 1], [Figure 9]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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