Awareness among general public of Srikakulam in regards to periodontics, as a speciality in dentistry—a cross-sectional survey

Introduction

Periodontics is one of the most important and versatile branches of dentistry which deals with the tissues surrounding the teeth. Because of its multifactorial origin, with bulk plaque and calculus containing many bacteria make it a tough task to treat (1). Many treatment strategies like surgical (periodontal flap, bone grafts, guided tissue regeneration, platelet concentrates) and non-surgical periodontal therapy (scaling and root planing, local drug delivery etc.) have been developed to treat periodontitis. Periodontitis is a painless disease and by the time pain is felt maximum bone loss would already took place (2). Most people will not visit a dentist until it is of utmost important. There is always a lack of awareness among the population regarding the dental specialities (3). Medical awareness was of much greater pace because of increasing diseases and availability of treatment strategies and emergencies. Because of single individual clinical practice of dentistry with no multidisciplinary approaches general population lack awareness regarding, which speciality they need to visit for their problems. Moreover single practitioner does all the speciality treatments also led to this situation (4).

In the present scenario because of dental camps, some awareness was created for treating dental caries, teeth replacement etc. Hence, people know some things regarding the root canal treatments, implants and other treatment modalities (5). Like other dental specialities periodontology lacks this kind of awareness because of its painless situation and patients also neglect the bleeding gums by leaving them as it is or use the home remedies. Hence people were not much aware of who a periodontist is, what he does (6).

Most of the studies (6,7) were performed regarding the knowledge and awareness of periodontal disease systemic links, regarding general and oral health comparisons in medical and dental professionals. Where they concluded that it is the practitioners and patient responsibility to communicate regarding the oral and systemic links and educate regarding the global burden of oral disease by conducting awareness camps. Apart from this, it is important to address health education, patient-doctor interaction and a multidisciplinary collaboration of identifying and treating a disease (8). But no study was performed to find awareness regarding periodontics speciality as a separate branch of dentistry. Because of this prevailing confused state, present study aimed to evaluate the awareness of general public of Srikakulam district regarding periodontics as a speciality in dentistry, who a periodontist is and what he does. We present this article in accordance with the STROBE reporting checklist (available at https://amj.amegroups.com/article/view/10.21037/amj-23-211/rc).

Methods

Sample size estimation, study design and patient enrolment

Present study used systematic random type of sampling. It was a close ended, validated, self-administered, cross-sectional questionnaire survey. Study was performed during January 1st 2023 to June 31st 2023. Sample size estimation was done using the formula n= (Z_α + Z_1-β )² pq/d² where Z_α value was 1.96, Z_1-β value was 0.84, P value was 55.3, q value was 44.7 and d value was 2.84. Thus a total sample of 2,392 was obtained after utilizing the formula and it was rounded to 2,400. A total of 2,400 questionnaires were gathered, out of which 342 were excluded because of incomplete filling and irrelevant answering of questionnaires. So a total of 2,058 samples [females of 1,134 (55.1%) and males of 924 (44.9%)] were finalized with mean age of 28.3±10.3 years. Based on calculated sample size, 14 questionnaires were distributed per day for 6 months. First person randomly included into the study and afterwards every 21^st person attending the institute was included in the study. Patients and their attendants who were visiting dental college were considered and questionnaires were randomly distributed.

Inclusion and exclusion criteria

Subjects aged >20 years who visited dental college for treatments, subject’s attendants who came along with them and interested to take part in the survey were included in the study while subjects who were not willing to participate, subjects who gave irrelevant and irresponsible answers were excluded. Dentists, all speciality dental practitioners, students pursuing dentistry as profession, dental hygienists and dental health care workers were also excluded from the study.

Questionnaire proforma

Development of questionnaire was done in the following way, initially 15 questions were generated by doing literature review, expert opinion and based on existing similar questionnaires. Out of 15 questions, 13 were considered and 2 were eliminated because of their ambiguity. Further during the validation process, 3 more questions were eliminated (Figure 1). Finally, this self-administered (which means a respondent was required to complete the questionnaire by him/herself) questionnaire consists of 10 questions with demographic data, questions 1, 2, 3, 4, 5, 7 and 8 depicts the awareness and remaining questions show the knowledge regarding the bleeding gums, visiting the periodontist and reason for not visiting (Figure 2). Out of these 10 questions, question 1 to 5 have binary responses (yes/no) for which score 1 was given for yes and 0 for no. Question 1 has four options correct response was given a score of 1 and wrong response was given as 0. Further for question 8—dental implant placement is done by whom? The responses were periodontist/prosthodontist/oral surgeon/general dentist was given a weightage score of 1 while all the above option was given a weightage score of 5. When added the scores of questions 1, 2, 3, 4, 5, 7 and 8, the overall range of score is 1–11 which were categorized as follows—≤4= lower awareness; 5–8= medium and 9–11= higher awareness. Internal consistency of questionnaire was good with a Cronbach alpha value of 0.84. Test re-test reliability was found to be 0.75. Fake and content validity of the questionnaires were checked with the help of experts.

Figure 1 The flow diagram of questionnaire preparation and finalizing of questions in the study.

Figure 2 The image of questions 1 to 10.

Ethical consideration

The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the institutional ethics committee of Sree Sai Dental College and Hospital Srikakulam, Andhra Pradesh, India (No. SSDCRI/IEC/2023/8/S2) and informed consent was taken from all individual participants.

Procedure

Patients and their attendants who have visited the dental college for treatments were considered and explained regarding the questionnaire. For interested people proforma’s were distributed and gave a time period of 10 minutes so that they will fill the forms. Further forms were collected and entire data was transferred to a Microsoft excel spread sheet and subjected to statistical analysis. Study was performed according to STROBE guidelines to as much extent as possible.

Statistical analysis

Data of analysis was performed on statistical package for social sciences (SPSS) version 22.0 (IBM Pvt Ltd., Chicago, IL, USA). Age was calculated and expressed in mean and standard deviations. Gender and awareness parameters were expressed in frequency distribution percentages. Fisher Exact test was applied to identify the association for identifying who the periodontist is and what he deals with. Chi-square test was performed to find out the association for gender and age wise awareness. Tests utilized in the study, were two sided and a P value of two sided <0.05 was considered statistically significant.

Results

Frequency distribution percentages of various age groups recruited in the study were depicted as follows: 402 (19.5%) were ≤20 years whereas 21–30 years were 1,154 (56.1%), 31–30 years [244 (11.9%)], 41–50 years [132 (6.4%)], 51–60 years [114 (5.5%)] and >60 years [12 (0.6%)]. For Question 6, regarding facing of gum problems 38.8% of study population face (opted yes) gum problems while 61.2% opted no and didn’t have any problems. Further regarding the level of awareness, 15.8% of study population showed higher level of awareness while 21.9% and 62.3% depicted the low and medium levels of awareness for periodontics as separate specialty, who a periodontist is and what he does. When significant comparisons were performed for question 3 and question 4, for knowing who a periodontist is, 59.1% revealed that periodontist does flap surgeries and implants and the value was statistically significant (P<0.001) whereas 40.9% also opted yes but reported a false answer of root canal treatment/extraction or none of the above.

Regarding (question 9) visit to a dentist or periodontist, 33.7% of study population never visited a dentist or a periodontist while 32.8% once, 22.9% twice and 10.5% visited thrice. Further when asked for a reason of not visiting a periodontist/dentist was 54.5% didn’t had any dental problems, 23.9% reported the costly dental procedures affected the visits, 3.5% reported the painful dental procedures, 0.9% reported due to intake of medicines problem got subsided so didn’t visit, 11.2% reported fear of dentistry and dental procedures and 6.1% had no interest for dental treatments.

Results were non-significant (P=0.20) regarding gender wise distribution to know the awareness regarding who a periodontist and what he does but numerically females (17.5%) have relatively higher awareness than males (13.9%) (Table 1). In the present study, comparing the levels of awareness among various age groups a significant (P<0.001) medium level of knowledge and awareness was reported. Higher level of awareness was reported for 21–30 years age group (19.9%) when compared to other age groups in high level column (Table 2).

When significant awareness comparisons were performed based on education level among study population, results were non-significant (P=0.17) and among high level awareness 16.5% were degree level educated, post graduates (PG) reported a 15.5% and inter/diploma people were about 6.4% but overall there was reported of greater medium level of awareness among study population (degree 62.4%, PG 62.6% and inter/diploma 59.6%) (Table 3).

When study population was divided into medical and non-medical individuals and compared for awareness, significant (P<0.001) higher level of awareness was recorded for medical individuals (24.8%) and non-medical individuals showed a percentage of 9.9. Medium level of awareness percentage was more in medical individuals than non-medical people. Further non-medical individuals has 29.1% lower awareness than medical individuals (10.9%) (Table 4).

Discussion

Tooth loss is a worldwide global burden, it is always necessary to take essential measures for controlling this with the use of newer treatment strategies both surgically and non-surgically (9). But for us to treat these disease conditions, patients should know regarding the disease which they were suffering from and to which type speciality of dentistry should they go. Medical practitioners lack sufficient knowledge regarding the oral and systemic health relations and if they identify any oral ailment they refer to a dentist in general (10). In the present scenario, interdisciplinary practice among specialized dentists is also lacking in-toto. Hence present cross-sectional survey tried to evaluate the awareness regarding periodontics as separate speciality in dentistry. As much number of studies were not performed regarding this, present study compared the results with the existing literature.

Limitations of the present study were as follows. Present cross-sectional study had a good sample size, larger prospective field surveys were required for better outcomes, sample was also limited to a local area of Srikakulam. Type of answers delivered or depicted by the study population sometimes cannot be guaranteed and we tried to eliminate the flawed questionnaires to most extent. We had divided the sample into medical and non-medical individuals we couldn’t sub-classify them according to the speciality of education they belong to. This might help in better clarity of results. Apart from these limitations, as it is a hospital based study and included patients who have visited the dental college and hospital might have plausibility that the participants were already aware of or had inquired about dental services before the commencement of the study which might be an additional limitation of the study.

In the present study, 38.8% (opted yes) individuals has experienced gum problems, 61.2% subjects reports no bleeding of gums (opted no) this data coincides with meta-analysis done by Janakiram et al. (11) [2020] and study done by Penmetsa et al. (12) [2018] where they concluded that 42.3% and 51.5% of their study populations reported gingivitis. Thus it can be attributed that most of the Indian population were being experienced with some or the other periodontal disease. While coming to knowledge regarding periodontal speciality present study population reported minimal high level awareness of 15.8%. This is in harmony with a study done by Bhatia et al. (13) [2013], where they reported a poor awareness of periodontal disease in North Indian population. The similarity in both these studies might be due to lack of interest of taking good oral health care, increased use of tobacco products that alters the periodontal health, changed food patterns and lack of proper education regarding oral and systemic health.

While reporting the gender wise comparisons, present study population reported non-significant (P=0.20) high level of awareness in females (17.5%) when compared to males, this is in accordance with Hemalatha et al. (14) [2020] and Gupta et al. (15) [2016], stating females has more awareness. This might be attributed to greater aesthetic concern in females led to their timely visit to a dentist. Further in the present study Q3 and Q4 answers were controversial where 59.1% individuals has opted yes and 81.5% opted no with statistical significance (P<0.001) for who periodontal surgeon is and what they does. These variations might be due to irrelevant response of the study participant or genuinely they lack proper knowledge and awareness regarding who a periodontist is and what he does. Regarding age group variations, 21–30 years study population has about 20% of awareness in regards to periodontics as speciality. Similar results were reported by Penmetsa et al. (12) [2018] and contrast results were recorded with Hemalatha et al. (14) [2020], where 31–50 years individuals have higher awareness regarding the periodontal disease. This might be attributed to the change in educational environment, level of ads that were displayed socially and increased awareness of oral health camps to some extent. Further, 33.7% individuals never visited a dentist or periodontist and the reason was no dental problems (54.5%). This is in accordance with studies done by Shah (16) [2017] and Al-Hussaini et al. (17) [2003], where they recorded the percentage were 43%, 49% which indicates the lack of knowledge regarding the dental problems. Moreover periodontitis is a painless disease and this might be another reason for lack of attending a periodontist or dentist.

The level of education had showed an influence on data, high level of awareness was noted among university graduate (16.5% and 15.5%) was relatively lesser. This is in accordance with Hemalatha et al. (14) [2020], where they concluded that higher level of education helped in higher level of awareness; Dayakar et al. (18) [2016] and contrasted with Penmetsa et al. (12) [2018], where they concluded that lower economic status people with lower level of education had greater awareness regarding periodontal disease. These variations in the present study might be due to different population group, educated people’s active participation in the study, and greater levels of camps and awareness programs that are being conducted at a greater pace to educate the oral health problems. It was also evident from present study results that Medical fraternity has better understanding of dental specialities, when compared with non-medicos. Results were in contrast with Nagrik et al. (3) [2019], where they concluded that university students have poor awareness regarding the periodontal diseases and lack of proper knowledge regarding the conventional periodontal treatment influence on periodontal and systemic health. This can be indirectly attributed that as people are lacking awareness regarding the periodontal disease it is understood that they won’t have adequate knowledge regarding the periodontics speciality, who a periodontist was and what he does. Present study results regarding medical fraternity was also in contrast with recent study done by Gummaluri et al. (7) [2023] and Parveen et al. (19) [2023], where they concluded that medical professionals didn’t have adequate knowledge and awareness regarding relation between oral health and its relation to general health. This might be due to lack of educational camps and busy schedule of their clinical practice lack adequate knowledge, addiction to tobacco products was relatively higher in that area also caused such carelessness in their population. This was relatively lesser in the present study population.

Conclusions

Within limitations it can be concluded that there was a lack of higher level of awareness regarding periodontics as a separate speciality of dentistry, who a periodontist is and what he does. This indicates that general public of Srikakulam don’t have awareness regarding the periodontics subject as well as periodontal surgeon. It is our responsibility to educate the people by keeping field awareness camps. The amount of awareness that is being created in the present scenario is still lacking and much improvement should be done.

Acknowledgments

Funding: None.

Footnote

Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://amj.amegroups.com/article/view/10.21037/amj-23-211/rc

Data Sharing Statement: Available at https://amj.amegroups.com/article/view/10.21037/amj-23-211/dss

Peer Review File: Available at https://amj.amegroups.com/article/view/10.21037/amj-23-211/prf

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://amj.amegroups.com/article/view/10.21037/amj-23-211/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by institutional ethics committee of Sree Sai Dental College and Hospital Srikakulam, Andhra Pradesh, India (No. SSDCRI/IEC/2023/8/S2) and informed consent was taken from all individual participants.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Sobhana C, Vaid S, Singh M, et al. Kerala Dental Journal. Kerala Dent J 2012;5:1-66.
2. Gasner NS, Schure RS. Periodontal disease. StatPearls [Internet]: StatPearls Publishing; 2022.
3. Nagrik AP, Bhagat BA, Yemle SB, et al. Awareness of Specialties of Dentistry among Medical Trainees and Teaching Faculty of Medical College in the Central West India. J Int Soc Prev Community Dent 2019;9:269-74. [Crossref] [PubMed]
4. Sharma BS, Sharma J, Upadhyay M, et al. Knowledge and awareness about dentistry among medical students, residents, and medical practitioners in Bhairahawa city, Nepal. J Family Med Prim Care 2021;10:922-8. [Crossref] [PubMed]
5. Bansal R, Jain A. An insight into patient's perceptions regarding root canal treatment: A questionnaire-based survey. J Family Med Prim Care 2020;9:1020-7. [Crossref] [PubMed]
6. Alzammam N, Almalki A. Knowledge and awareness of periodontal diseases among Jordanian University students: A cross-sectional study. J Indian Soc Periodontol 2019;23:574-9. [Crossref] [PubMed]
7. Gummaluri SS, RG SM, Chaudhary B et al. Evaluation of Knowledge and Awareness of Periodontal Health and its relation to General Health among Medical Doctors-A Cross-Sectional Questionnaire Survey. EJ-Clinic Med 2023;4:1-6.
8. Akl S, Ranatunga M, Long S, et al. A systematic review investigating patient knowledge and awareness on the association between oral health and their systemic condition. BMC Public Health 2021;21:2077. [Crossref] [PubMed]
9. Manresa C, Sanz-Miralles EC, Twigg J, et al. Supportive periodontal therapy (SPT) for maintaining the dentition in adults treated for periodontitis. Cochrane Database Syst Rev 2018;1:CD009376. [Crossref] [PubMed]
10. Northridge ME, Kumar A, Kaur R. Disparities in Access to Oral Health Care. Annu Rev Public Health 2020;41:513-35. [Crossref] [PubMed]
11. Janakiram C, Mehta A, Venkitachalam R. Prevalence of periodontal disease among adults in India: A systematic review and meta-analysis. J Oral Biol Craniofac Res 2020;10:800-6. [Crossref] [PubMed]
12. Penmetsa GS, Meghana K, Bhavana P, et al. Awareness, Attitude and Knowledge Regarding Oral Health among Pregnant Women: A Comparative Study. Niger Med J 2018;59:70-3. [Crossref] [PubMed]
13. Bhatia A, Bains SK, Singh MP. To assess knowledge and awareness of North Indian population towards periodontal therapy and oral-systemic disease link: A cross-sectional survey. J Interdiscip Dentistry 2013;3:79-85. [Crossref]
14. Hemalatha DM, Melath A, Feroz M, et al. A survey on the awareness of interrelationship of periodontal disease and systemic health among Mahe population. J Indian Soc Periodontol 2020;24:271-5. [Crossref] [PubMed]
15. Gupta V, Singh A, Gupta B. Assessment of Oral Hygiene Practices and Awareness of Periodontal-Systemic Health Interrelationship Amongst the Local Population of Kanpur Region-A Cross Sectional Study. J Oral Health Comm Dent 2016;10:1-8. [Crossref]
16. Shah AG. Evaluation of oral hygiene awareness, oral health practices and dental health problems among the undergraduate medical students of India. Int J Prev Clin Dent Res 2017;4:109-13. [Crossref]
17. Al-Hussaini R, Al-Kandari M, Hamadi T, et al. Dental health knowledge, attitudes and behaviour among students at the Kuwait University Health Sciences Centre. Med Princ Pract 2003;12:260-5. [Crossref] [PubMed]
18. Dayakar MM, Kumar J, Pai GP, et al. A survey about awareness of periodontal health among the students of professional colleges in Dakshina Kannada District. J Indian Soc Periodontol 2016;20:67-71. [Crossref] [PubMed]
19. Parveen S, Al Qahtani AS, Halboub E, et al. Periodontal-Systemic Disease: A Study on Medical Practitioners’ Knowledge and Practice. Int Dent J 2023;73:854-61. [Crossref] [PubMed]