Journal of International Oral Health

ORIGINAL RESEARCH
Year
: 2018  |  Volume : 10  |  Issue : 6  |  Page : 278--282

Knowledge, attitude, and awareness of patients regarding dental implants: A cross-sectional study


Aarti Ganesh Prabhu1, Mahesh Mundathaje2,  
1 Intern, Manipal College of Dental Sciences, Manipal, India
2 Associate Professor, Department of Prosthodontics and Crown and Bridge, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India

Correspondence Address:
Dr. Mahesh Mundathaje
Associate Professor, Department of Prosthodontics and Crown and Bridge, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal
India

Abstract

Aim: The aim of this study was to assess the knowledge, attitude, and awareness of the outpatients regarding dental implants. Objective: The objective of this study was to determine the reasons deterring a patient from choosing dental implants as a treatment modality inspite of its success rate and great clinical longevity. Materials and Methods: A self-administered questionnaire-based survey of 168 patients visiting the Clinic for replacement of teeth. The statistical analysis was done by the Chi-square test. Results: Females and volunteers of the age group of 15–30 years had the best oral hygiene. Lack of awareness followed by high cost was the main reason for not choosing dental implants. A significant number did not opt for implants because of its long waiting period. The dentist was the main source of knowledge, and most of the volunteers expected more information from the dentist. Conclusion: Based on the maintenance of oral hygiene, dental implants should be recommended to the age group of 15–30 years. Waiting period, high cost, and surgical procedures involved were all deterring factors for not choosing implant prosthesis. New developments should be made in the field of dental implants to eradicate these reasons. Electronic media should be used more effectively to improve awareness regarding dental implants.



How to cite this article:
Prabhu AG, Mundathaje M. Knowledge, attitude, and awareness of patients regarding dental implants: A cross-sectional study.J Int Oral Health 2018;10:278-282


How to cite this URL:
Prabhu AG, Mundathaje M. Knowledge, attitude, and awareness of patients regarding dental implants: A cross-sectional study. J Int Oral Health [serial online] 2018 [cited 2019 Jun 24 ];10:278-282
Available from: http://www.jioh.org/text.asp?2018/10/6/278/248427


Full Text

 Introduction



The oral condition of a patient is very important for social and psychological well-being of that patient. The presence of teeth in the oral cavity plays an important role in maintaining this well-being. The teeth are helpful in mastication and maintenance of esthetics. The loss of teeth may lead to impaired mastication, improper speech as well as social embarrassment. These are the main reasons as to why patients think of replacing or restoring the lost teeth.

Dental implant is an artificial root that is surgically inserted into the jaw bone to support a single tooth replacement (crown), fixed partial or complete denture or maxillofacial prosthesis. It can be used by people who have lost tooth or teeth due to injuries, periodontal diseases or because of endodontic failures. It can also be used for treatment with improved denture retention, stability, and functional efficiency[1] and thus, improving the quality of life of the patient.[2]

Implant supported prosthesis added more options to the functional rehabilitation of partially or completely edentulous patients. However, not many patients opt for this modality of treatment.

According to a survey,[3] 96.4% of participants had heard of dental implants, and 79.2% were willing to learn more about dental implants. More than 30% of the sample appeared to maintain dangerous misperceptions about dental implants.[4] Thus, we can see that dental implants are not one of the most preferred ways to restore lost teeth. This is mainly because of less awareness of patients regarding dental implants.

The awareness of the subjects toward dental implants will also be evaluated along with the current knowledge of dental implants of the patients, the source of knowledge, and knowledge of dental implants, per say. This study is being conducted to deduce the reason as to why dental implants are not being chosen in spite of their longevity and clinical performance.

 Materials and Methods



The study was done in accordance with the Declaration of Helsinki. The study was approved by the Institutional Ethics' Committee with Reference Number: 15006 an informed consent form was obtained from all the participants of the study.

The type of study is observational cross-sectional study.

A self-administered questionnaire-based survey was conducted. The questionnaire was prepared to include demographic details, and clinical examination was carried out according to the guidelines followed by authors of previous studies.[5],[6],[7],[8] Since patients in the required inclusion criteria were readily available, a pilot study was not conducted.

Selection of participants: the study period was from December 2014 to February 2015. Willing outpatients visiting the Department of Prosthodontics and Crown and Bridge were handed out the questionnaire.

Inclusion criteria

The inclusion criteria were outpatients visiting the Department of Prosthodontics and Crown and Bridge for replacement of teeth; the space between the missing tooth/teeth and adjacent teeth being adequate.

Exclusion criteria

Completely edentulous patients were excluded from the study.

The patients were grouped according to their gender, age group, occupation, and education. These groups were then evaluated based on their current oral hygiene and current dental knowledge about dental implants, source of knowledge, and expected source for further knowledge. We also evaluated their acceptance of surgical procedures and waiting period for placement of dental implants.

The patient selection bias was eradicated by 2 examinations done by 2 examiners with the same qualifications. The examiners were trained to judge the subjects based on similar criteria.

For the purpose of statistical analysis, the Chi-square test was done. The P value and degree of freedom were calculated. This was calculated using an interactive Chi-square calculator.[9]

 Results



The present survey was conducted to evaluate the knowledge, attitude, and awareness of patients regarding dental implants. Out of the 168 participating members [Table 1] in the study, 93 were male and 75 were female. Maximum number of participants belonged to the age group of 31–50 years. The volunteers were of different age groups and occupation to ensure a varied representation.{Table 1}

Statistical analysis was done with the Chi-square test, and the significance of the data collected was assessed.

The oral hygiene [Table 2] was assessed in terms of visible accumulation of debris, calculus, and stains. The results showed a significant association when it was compared to gender, age group, and occupation. Females had moderately better oral hygiene. Best oral hygiene was seen in the volunteer from the age group of 15–30 years. Most poor hygiene was seen in unskilled laborers. Best oral hygiene was seen in homemakers.{Table 2}

The prosthesis currently [Table 2] in use was evaluated next. The data when compared showed significant association with the occupation, educational levels, and age group of the volunteers. Fixed partial dentures (FPDs) were the most commonly used dental prosthesis. Removable partial denture was most commonly used by people who were currently unemployed. All the other categories mostly used FPD. The trend was, as the level of education increased, a fixed dental prosthesis was the preferred modality of treatment for replacement of missing teeth.

The reason for not choosing dental implants [Table 2] was assessed next. There was a significant association when there was comparison made between the age groups, educational statuses, and occupation of the volunteers. Lack of awareness of this modality of treatment followed by high cost was the reason for not choosing dental implants.

The awareness of the volunteers [Table 3] toward dental implants was determined next. There was a significant association when compared to the two genders and educational statuses of the volunteers. Males were more aware than females. It was noted that as the level of education increases, the level of awareness also increases.{Table 3}

The source of knowledge [Table 3] regarding dental implants was evaluated next. The dentist was the most common source of knowledge for the volunteers. This was followed by the friends and relatives of the volunteers and then electronic media. The students and businessmen had heard the most about dental implants from electronic media.

The knowledge about implant function, anchorage, and cost [Table 3] was analyzed. There was a significant association with the gender and age group of the volunteers. Females and volunteers in the age group of 30–50 years were most aware about the function, cost, and anchorage of dental implants.

Whether the volunteers found that the surgical procedure acceptable and understood the steps in the surgical placement of dental implants [Table 4] was examined next. The data showed significant association with respect to the gender, age group, and educational status of the individuals. Males were more understanding and accepting of the surgical procedures involved. We also found that as the level of education increases, the understanding and acceptance of the surgical procedures involved also increases. Volunteers in the age group of 30–50 years understood the surgical procedures better than other age groups.{Table 4}

The volunteers were then asked who they would expect further knowledge from [Table 4]. Most people said they expect to know more about dental implants from their dentist followed by media. It was also seen that older the age group, more the expectation from electronic media.

The other categories did not show a significant association.

 Discussion



The oral health of a person plays a crucial role in the social and psychological well-being of that person. The presence of teeth plays an important role in maintaining this well-being. Loss of teeth can lead to difficulty in mastication as well as compromised esthetics which greatly reduces the quality of life. The reasons for loss of teeth can range from poor oral hygiene progressing to periodontal diseases, to developmental disorders such as ectodermal dysplasia and Down 's syndrome. Teeth are usually replaced to meet the patient's functional and/or esthetic requirements.

In current times, there are many options available for the replacement of teeth. The options available are a removable dental prosthesis, fixed dental prosthesis, and dental implants. Out of these, dental implants are a relatively newer modality of treatment. According to the American Academy of Implant Dentistry, 3 million people already have dental implants. This number is usually higher in developed countries than developing countries. The reason can be availability of more resources, more income of the population, more concern about esthetics, and more awareness. This study was conducted to assess the awareness of dental implants and the knowledge of the participants regarding dental implants in an institutional setup.

A self-administered questionnaire was distributed to the patients visiting the Department of Prosthodontics and Crown and Bridge at the Manipal College of Dental Sciences, Mangalore. The questionnaire aimed at assessing the knowledge attitude and awareness of patients regarding dental implants. A total of 168 participants participated in the study. Out of these, 55.35% of the participants were male and 44.65% were female.

The current oral hygiene status of the participants was first evaluated. The grades were given based on the presence of plaque, calculus, and stains on the existing teeth. This gave us an idea of whether the patients were concerned and aware of the importance of maintenance of oral health. More than half of the participants that is 54. Seventy-six percent participants had moderate oral hygiene. According to studies,[3],[5] the female participants had better oral hygiene than the male participants and were more concerned about their oral hygiene. The same was reflected in this study too. Overall, females had better oral hygiene than males. We found that 82.35% people in the age group of 15–30 years had the best oral hygiene practices. We, thus, found that the younger generations' from the age group on 15–30 years had a more diligent attitude toward oral hygiene practices.

Next, the participants were asked which dental prosthesis is currently under use. Fixed partial dental prosthesis is more expensive than removable partial dental prosthesis. This would tell us how much the patient is willing to spend for replacement of missing teeth. We found that 70.23% people had fixed partial dental prosthesis and 29.76% people had a removable dental prosthesis. Thus, the results of the study proved that when given the necessary alternatives for replacing their missing teeth, patients do have a propensity to choose a replacement while not minding the cost of it.

The reason for not choosing dental implants was evaluated next. The most common reason for not choosing dental implants was the ignorance of patients toward this treatment modality. About 32.14% people were not aware about the existence of dental implants. This result was in contrast to many other studies such as Sharma et al.,[10] and Rani et al.,[11] where high cost was cited as the most common reason for not choosing dental implants. This showed that dental implants are not as popular as fixed dental prosthesis and removable dental prosthesis in this survey. About 24.4% did not choose dental implants because of the high cost. This was followed by 22.02% people not choosing dental implants because it was not suggested by dentists. Surprisingly, a whopping 86.48% people in the age group of 30–50 years did not choose dental implants because it was not suggested by their dentist. Dental implants should be suggested all the more to this age group because they are ideal in case of bone support and dental implant acceptance.

The next question was about the awareness of dental implants. We found that 73.8% of people were not aware of dental implants. This was expected because we were able to gauge from the former questions that fixed dental prosthesis and removable dental prosthesis were more commonly seen. This result was in sync with the study of Barot (2018)[5] and Santhosh (2016).[6] This must be mainly because of less popularity of dental implants in the participants of this study. The trend seen was more educated the participants were, more was their level of awareness about this treatment modality.

Source of knowledge of the participants was evaluated next. The dentist was the main source of knowledge for 66.66% of the participants. According to studies by Zimmer (1992)[12] and Berge (2000)[13] electronic media was responsible for the awareness of patients regarding dental implants. On the other hand, only 8.33% of the participants volunteering in this study had heard about dental implants from electronic media sources. Electronic media should be used to make people aware of dental implants on a greater platform and it can be a better source of information for patients. A survey[13] also indicates the lack of effort by the dentist and governing bodies regarding taking necessary steps for creating awareness among the population.

Next question was to evaluate the knowledge of patients regarding implant function, anchorage, and cost. Among the patients who participated in the survey, 63.09% of people were aware of the implants function, anchorage, and cost. Efforts should be taken to provide a better explanation to patients regarding dental implants. Patients should be made to understand all the limitations of dental implants due to insufficient bone structure required for anchorage.

Acceptance and understanding of surgical procedure were evaluated next. About 58.33% participants were ready to undergo the surgical procedures involved in the placement of dental implants. The trend was that more educated the volunteers were, more was their understanding of the surgical procedures involved. In retrospection, the reason for not accepting surgical procedures was not assessed. This was a shortcoming of this study. There can be a multitude of reasons for not accepting surgical procedures involved with dental implants. Some of them are high cost of surgeries, fear of surgical procedure, and host acceptance. Another study should be conducted to evaluate the same.

Acceptance of the patients toward the waiting period from implant placement to implant prosthesis was evaluated. We found that 69.04% participants considered the waiting period to be too long. This helped us understand that dentists should take active efforts in explaining to the patients the specifications and the surgical procedures involved in the placement of dental implants.

Next, the patients were asked about their preferred source to know more about dental implants. In conjunction with other similar studies,[13] 80.33% participants said they would prefer learning about dental implants from their respective dentists. Friends and relatives were the next preferred source for 13.09% people. Only 6.54% participants wanted to learn more about dental implants from electronic media. Patients can learn about dental implants from their friends and relatives if dental implants are popular. Electronic media should can prove to be a great platform for the same.

We can confidently say that the primary outcome of the study was achieved. We could isolate the exact reason for a patient not choosing dental implants as a replacement prosthesis. We found out that the general awareness and knowledge about implants were not up to the mark. The secondary outcome of the study was also achieved. Through this study, the age group wise acceptance toward dental implants was obtained. The participants in the younger age group were more accepting of dental implants as a treatment modality as compared to the participants in the older age group. We could conclude by saying that even though the majority of the patients liked the idea of dental implants, there was a multitude of deterring factors. The high cost, long waiting period and fear of surgical procedures are few of them. The information that patients expected the dentists to inform them about dental implants was also revealed on.

The study has made significant effects to recent clinical evidence. We have found out that the knowledge about implants is high among people who have heard about the implant prosthesis. Most patients are scared about surgical procedures involved. This can be eradicated by good patient management skills.

Thus, we can say that the two major controversies revealed by this study were the cost of the implant and the fear of surgical procedures. The former shortcoming, that is, of cost, can only be overcome after developmental strides in the field of implant technology. Fear of surgical procedures can be overcome developing a good rapport with the patients and being empathetic to their needs. The limitation of this study was that it was exclusively conducted in an institutional set-up. Similar studies can be conducted in other institutions, private practices, and satellite centers. The intergroup comparison can be done with post hoc Tukey's test to increase the scope of the study. Another limitation of this particular study design was that we could not evaluate if patients with previous fixed partial dental prosthesis were given an option of dental implants to replace existing teeth. We could not gauge the difficulties faced by the dentists' to not opt for a dental implant prosthesis.

Future prospects of this study can be grouping patients who are unaware and still, willing to know about dental implants. Such patients can be provided with an information brochure and audio-visual aids about dental implants followed by another questionnaire evaluating their refreshed knowledge and level of acceptance toward dental implants after reading about dental implants in the brochure. This method can also be an information tool for patients.

We can, thus, conclude by saying that dental implants are a relatively less popular modality of treatment. This can be changed if efforts are taken to make people more aware of the advantages of dental implants. Dentists are the major source of knowledge. Patients should be made to understand the minor surgical procedure involved and the benefits of dental implants. Electronic media can also be used to raise awareness on a greater platform. Newer developments should be brought about to eradicate the deterring factors for choosing dental implants.

 Conclusion



Based on the maintenance of oral hygiene, the age group of 15–30 years took the best care of their oral hygiene. Thus, dental implants should be advised to this age group. The high cost was a deterring factor for choosing dental implants. The long waiting period also discouraged patients from choosing dental implants to replace teeth. New developments should be made in the field of dental implants to eradicate these reasons. The dentist played a crucial role in advocating the use of and creating awareness about dental implants. They should explain well to the patients regarding the surgical procedures involved and why there is a long waiting period. Electronic media should be used more effectively to improve awareness regarding dental implants. Social awareness camps should be held to make the masses aware of this treatment modality.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Adell R, Lekholm U, Rockler B, Brånemark PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 1981;10:387-416.
2Gerritsen AE, Allen PF, Witter DJ, Bronkhorst EM, Creugers NH. Tooth loss and oral health-related quality of life: A systematic review and meta-analysis. Health Qual Life Outcomes 2010;8:126.
3Al-Musawi A, Sharma P, Maslamani M, Dashti M. Public awareness and perception of dental implants in randomly selected sample in Kuwait. J Med Implants Surg 2017;2:116.
4Yao J, Li M, Tang H, Wang PL, Zhao YX, McGrath C, et al. What do patients expect from treatment with dental implants? Perceptions, expectations and misconceptions: A multicenter study. Clin Oral Implants Res 2017;28:261-71.
5Barot K, Dave B, Patel J, Vaghasiya C, Brahmbhatt H. Awareness and attitude of patients regarding dental implants as a treatment modality, at Kalol Town, Gujarat. Int J Recent Sci Res 2018;7:13-5.
6Santhosh Kumar MP, Monika M, Gayathri J. Knowledge and awareness among patients about dental implants. J Pharm Sci Res 2016;8:351-4.
7Ozçakır Tomruk C, Ozkurt-Kayahan Z, Sençift K. Patients' knowledge and awareness of dental implants in a Turkish subpopulation. J Adv Prosthodont 2014;6:133-7.
8Radhika A, Daphne T, Shwetha P, Shetty G. Patient awareness and acceptance of dental implants as a treatment modality for the replacement of missing teeth. Int J Recent Sci Res 2018;7:74-8.
9Preacher KJ. Calculation for the Chi-Square Test: An Interactive Calculation Tool for Chi-Square tests of Goodness of fit and Independence; April, 2001. Available from: http://www.quantpsy.org. [Last accessed on 2018 Aug 23].
10Sharma A, Singh N, Yadav S, Kiran M, Tyagi N, Thukral H. Knowledge and Acceptance of Dental Implant Treatment in General Public in Delhi Population. WJPPS 2017;6:1727-36.
11Rani S, Singh RK, Kundra S. Quantitative estimation and evaluation of existing knowledge, attitude and awareness among patients about execution of dental implants: A questionnaire based original study, Amritsar. JADMS 2017;5:15-8.
12Zimmer CM, Zimmer WM, Williams J, Liesener J. Public awareness and acceptance of dental implants. Int J Oral Maxillofac Implants 1992;7:228-32.
13Berge TI. Public awareness, information sources and evaluation of oral implant treatment in Norway. Clin Oral Implants Res 2000;11:401-8.