Journal of Dental Research and Review

ORIGINAL ARTICLE
Year
: 2022  |  Volume : 9  |  Issue : 2  |  Page : 104--110

Evaluation of knowledge, awareness, and perception toward the application of teledentistry on managing early childhood caries during COVID-19 among dental professionals in Kolkata, West Bengal


Topi Nyodu, PN Nanmaran, Khooshbu Gayen, Subir Sarkar, Somen Roychowdhury 
 Department of Pedodontics and Preventive Dentistry, Dr. R Ahmed Dental College and Hospital, Kolkata, West Bengal, India

Correspondence Address:
P N Nanmaran
Department of Pedodontics, 2C, Dr. R. Ahmed Dental College and Hospital, Kolkata - 700 014, West Bengal
India

Abstract

Background: Teledentistry concerns with the utilization of telecommunication technology to provide clinical information, dental consultation, and treatment planning while avoiding direct personal contact with the patients. Its application is already established within the disciplines of oral medicine, orthodontic consultations, and early detection of caries.[1] Objective: The present study aims to evaluate the relevancy of teledentistry on managing early childhood caries (ECC) during the COVID-19 pandemic among dentists residing in Kolkata, West Bengal. Materials and Methods: This descriptive cross-sectional study using a 22-item prestructured, closed-ended questionnaire was conducted among dental professionals in Kolkata, West Bengal, to evaluate their knowledge on their thought that whether teledentistry can be implemented in the effective management of ECC. Results: A total of 108 participants responded to the survey. Knowledge and awareness regarding teledentistry and its use toward managing ECC is found to be high among postgraduates followed by Post Graduate Trainees (PGTs). The majority of the participants think teledentistry can increase the availability of specialists to rural and undeserving communities, where ECC is more prevalent (88%) and 73% of dentists are willing to practice teledentistry to bridge the gap of lack of health-care facilities to rural and undeserving communities for their dental needs. Conclusion: The majority of the BDS graduates and dentists doing private practice surveyed have less knowledge about teledentistry and awareness of ECC is less among dentists doing private practice. Education about teledentistry and ECC should be considered so that dentists can provide better oral health care.



How to cite this article:
Nyodu T, Nanmaran P N, Gayen K, Sarkar S, Roychowdhury S. Evaluation of knowledge, awareness, and perception toward the application of teledentistry on managing early childhood caries during COVID-19 among dental professionals in Kolkata, West Bengal.J Dent Res Rev 2022;9:104-110


How to cite this URL:
Nyodu T, Nanmaran P N, Gayen K, Sarkar S, Roychowdhury S. Evaluation of knowledge, awareness, and perception toward the application of teledentistry on managing early childhood caries during COVID-19 among dental professionals in Kolkata, West Bengal. J Dent Res Rev [serial online] 2022 [cited 2022 Dec 8 ];9:104-110
Available from: https://www.jdrr.org/text.asp?2022/9/2/104/354196


Full Text



 Introduction



Coronavirus/COVID-19/SARS-CoV-2 was declared a public health emergency of global concern by the World Health Organization in late January 2020.[2]

On March 16, 2020, the American Dental Academy (ADA) nation's largest dental association recommended that dental practices should be postponed and only elective dental procedures should be carried out until April 6, 2020, provided only emergency dental services to help keep patients from burdening hospital emergency departments.[1] In the context of this ongoing pandemic, as the country has been hit by the second wave from June 12, 2021, putting immense social and economic implications, imposing an extra burden on the health-care system, to reduce the burden on frontline workers, and to flatten the curve of coronavirus disease, guidelines have been issued by the ADA, to utilize teledentistry as it offers key advantages in the dental management of patients without involving risks from the possible sources of nosocomial spread in health-care setups like dental operatory and through respiratory droplets of infected patients as dental treatments are aerosols generating procedures and pose a high risk to practitioners as there is a strong possibility of cross-infection and them acquiring the disease or becoming potential carriers.

Teledentistry offers integrating a dental component with the technical component which may further improve the early intervention mechanism, thus expanding school and pediatric care centers to meet children's oral care needs, educating parents/guardians on the importance of seeking early treatments for children with signs of early childhood caries (ECC), as oral health is a part of systemic health. ECC is a global public health burden affecting children under 6 years of age and represents a major public health issue among children worldwide. The global burden of disease study 2015 has stated that the dental caries of the primary dentition as the 12th most prevalent disease in all ages combined.[3]

Bearing in mind the prevalence of ECC and how it impacts the day-to-day life of children and their families, this present study is carried out among the dental professionals and graduates residing in Kolkata to assess their knowledge to ponder upon the thought that whether teledentistry can be implemented in the effective management of ECC as a part of pediatric oral care.

The following study is conducted among dentists who are practicing in Kolkata either in the private or government sector. This is a unique study as there is not much literature has been found involving both teledentistry and management of ECC, especially literature pertaining to studies done in Kolkata city of West Bengal.

By this study, we can educate the practicing dentists about the prevention of ECC by utilizing teledentistry, so they can create awareness among the general population at the same time they do not have to worry about the risk of getting exposed, especially during this ongoing COVID-19 pandemic.

 Materials and Methods



This descriptive cross-sectional study using a 22-item prestructured, closed-ended questionnaire was conducted among dental professionals in Kolkata, West Bengal, to evaluate their knowledge on their thought that whether teledentistry can be implemented in the effective management of ECC; duration of this study is 1 month done in June 2021.

Ethical clearance was obtained from the Institutional Review Board of Dr. R. Ahmed Dental College and Hospital (Memo No. 2294 Dated November 16, 2021).

The questionnaire was divided into two domains:

Section A assessed the demographic details of the respondents – age, gender, qualification and type, and sector of practiceSection B consisted of 22 closed-ended questions aimed at evaluating the knowledge regarding teledentistry, awareness of the devastating effect of ECC and role of teledentistry in its management, and the perception of the participating dentist in the utilization of teledentistry for pediatric oral care.

The questionnaire was validated by two experienced academicians with sound knowledge of teledentistry in the management of ECC. Reliability was verified using Cronbach's alpha coefficient and was found to be 0.76, signifying acceptable internal reliability for the questionnaire. The study was approved by the Institutional Ethics Committee.

The questionnaire was configured online using the Google Survey Forms and the link was circulated among the 150 registered dental professionals and graduates practicing in Kolkata, West Bengal, either in a private clinic or government sectors, the list of which was obtained from the local branch of Indian Dental Association, to complete the survey.

A total of 108 responses were obtained, which was confirmed for adequacy of sample size, and it was concluded that the sample size was adequate with acceptable error margin and power based on the target population.

All the data were entered and tabulated into Microsoft Excel (version 2019). Frequency and percentage were used to describe the categorical data.

 Results



Characteristics of participating dentists

A total of 108 dentists from Kolkata, West Bengal, have responded to this survey. The majority of the responders were above the age of 26 (61.7%). Among the participants, only 7 (6.4%) have completed their postgraduation, 18 (16.6%) carrying out private practice, whereas 33 (30.5%) were PGT, and the majority 50 (46.3%) have completed their graduation only [Table 1].{Table 1}

Knowledge regarding teledentistry among participants

The majority of the participating dentists are well aware [Figure 1] that teledentistry is a telecommunication technology to diagnose and give advice regarding treatment over distance. Moreover, more than half of the population believes that it is a beneficial tool in the current scenario of the COVID 19 pandemic to improve access to patient's oral health by prioritizing risk reduction for both dentists and patients [Table 2].{Table 2}{Figure 1}

Awareness regarding the effect of early childhood caries and utilization of teledentistry for its management

Most of the participating dentists consider ECC an existing social burden and more than half of them think that the COVID-19 pandemic has a negative impact on the prevalence of ECC as it has altered the preventive health-care delivery system, 75.6% dentists are willing to provide both elective as well as preventive measures during this pandemic [Figure 2]. About 77.6% of dentists agree that teledentistry inflicts a positive attitude in pediatric patients. Eighty-six percent of dentists are aware of the major preventive measures of ECC such as monitoring feeding patterns and diet, fluoride therapy, and creating awareness among parents about deleterious habits [Figure 3] and 87% of dentists are willing to guide the parents with both diet counseling and proper supervision on oral hygiene maintenance through teledentistry in preventing ECC [Table 3].{Figure 2}{Figure 3}{Table 3}

To evaluate the perception and opinion of the participating dentist in the utilization of teledentistry for pediatric oral care

The majority of the dentists want to create awareness among parents to provide adequate guidance to maintain oral health. 89% of the dentists think that teledentistry can increase the availability of dentists in rural and underserved communities where ECC is more prevalent and 74% of participating dentists are willing to practice teledentistry to bridge this gap of lack of health-care facilities to rural, underserved communities for their dental needs [Table 4].{Table 4}

 Discussion



Optimal oral health-care benefits from the detection of early changes in the oral cavity, and for ECC, the best approach from a preventive perspective is identifying risk factors, presence and absence of protective factors, and practice of proper oral hygiene. However, with the rise in COVID-19 cases in the country, access to dental health is compromised, so keeping in mind the potential of teledentistry to provide preventive dental care, it is the need of the hour to integrate teledentistry as a tool to expand the capacity of the school and pediatric care centers to meet oral health-care needs for children.

Children with a high risk of dental caries may be effectively screened for early presence of noncavitated lesions using telehealth technologies.[4] Caries on fissured surfaces account for over 80% of all caries on young permanent teeth.[5]

The prevalence of ECC varies from population to population. An ECC prevalence of 44% has been reported in India among 8–48 months old.[6] An high ECC prevalence rate has been reported in young children despite major progress seen in the field of caries control over the past, controlling the disease is a major societal concern and can be achieved if the population segments with greater needs are identified.[7],[8]

The American Dental Association (2017) in its statement on ECC recognizes that ECC is a significant public health problem in selected as well as general populations.[9]

This study shows that 86.9% of participating dentists believe in diet counseling and proper brushing to prevent caries which is similar to the study done by Bhardwaj et al., showing that 91.43% of the participating dentists think the same.[10] Another study by Ghasemi et al. also found that 71.3% of participating dentists think the same as above.[11]

The concept of risk assessment is seen as a significant step in the clinical decision-making process of managing the disease, as risk assessment aids in determining the likelihood of incidence of caries in the immediate future, and also aims to predict the rate of progression of existing noncavitated early lesions, and for teledentistry, caries risk assessment can effectively manage and triage patients for treatment planning, prevention, and establishing follow-up and recall times.[12]

A study was carried out in Rochester, NY, utilizing the Health-e-Access program, where elementary preschool children were screened using both the traditional method (Mouth mirror) and implying teledentistry by means of using an intraoral camera (Dr. Campscope). The result obtained by teledentistry examination states that almost half (more than the traditional method) of the children examined were diagnosed with ECC as multiple primary teeth were affected.[4] Kopycka and Billings in a follow-up study in the US concluded that teledentistry examinations were comparable to clinical examinations when screening for ECC.[13] Communication by teledentistry can be made via an application for instant message, video call, or via WhatsApp.[7]

This present study states that awareness regarding teledentistry is high among PGTs in comparison with BDS graduates and dentists doing private practice which is parallel with the study by Ata and Ozkan, which states that less awareness about teledentistry among general dentists in comparison with PGTs.[14] Another study by Devina Pradhan and Pratik Verma stated that the majority of the PGTs have knowledge and awareness about teledentistry.[15] Moreover, a similar study done by Balsaraf and Chloe showed that 85% of participating dentists were aware of teledentistry.[16]

A study by Mamata Boringi states that 50% of the participating dentists agree on promotion and implementation of health education by teledentistry,[17] which is similar to this study where 73.6% of participating dentists agree on utilizing teledentistry as well as to bridge this gap of health-care facilities to rural underserved communities for their dental needs.

This study shows that 89% of participating dentists think teledentistry will increase the availability of specialists to rural and undeserving communities which is similar to the study done by Al-Khalifa and AlSheikh who found that more than 70% of the practitioners of the study mentioned teledentistry would be beneficial for patients residing in rural or remote locations.[18] Moreover, a similar study was done by Purohit et al., shows that usage of teledentistry for the assessment of dental caries could provide the much-needed basic diagnostic care in remote and rural areas which might bridge the existing oral health disparities.[19] Moreover, another study by Nagarajappa R et al. showed 67.6% of participants think teledentistry can increase the accessibility of the specialists to rural and undeserving communities.[20] However, a study was done by Sen N et al. showed that only 52.5% of total participating dentists think like this.[21]

This current study shows that 82% of the total participants believe that it will be advantageous by using teledentistry to create awareness among parents about the children's oral health care. This is in accordance with the study done by Abdul et al., where 88.3% of the participants agreed that teledentistry helps to create awareness and educate patients about oral hygiene and prevention of early carious lesions.[22]

Despite good knowledge about teledentistry and ECC among dentists, responses show undergraduates and dentists doing private practice are less aware of both teledentistry and ECC among all the dentists responded, it maybe due to lack of knowledge so, proper training must be given so, that everybody can adopt this novel method of practice during the pandemic situation where in-person contact might put both dentists and patients at the risk of exposure.

 Conclusion



ECC is one of the highly prevalent diseases in the world. It has a major effect on the quality of life of parents and children. Managing ECC in this period of ongoing COVID-19 pandemic is difficult considering most of the population in the rural area have no access to dental care where ECC is highly prevalent. This present study shows that BDS graduates and dentists doing private practice have less knowledge about teledentistry and awareness of ECC is less among dentists doing private practice. The perception of the majority of the participating dentists shows that teledentistry can be used as a beneficial tool to prevent ECC, especially in rural and underserving communities where access to oral health care is difficult. In addition to these, education about teledentistry and ECC should be considered so that practicing dentists can create awareness among general population and at the same time they do not have to worry about the risk of getting exposed, especially during this ongoing COVID-19 pandemic.

Ethical clearance

Ethical clearance was obtained from the Institutional Review Board of Dr. R. Ahmed Dental College and Hospital (Memo No. 2294 Dated November 16, 2021).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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