|Year : 2016 | Volume
| Issue : 2 | Page : 81-86
Extent of periodontal awareness and its treatment modalities among medical interns and postgraduates: A questionnaire study
Veena Kalburgi1, Shefali Jain1, Sandhya Raghuwanshi1, Shailendra Dass2
1 Department of Periodontology, People's Dental Academy, Bhopal, India
2 Department of Periodontology, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India
|Date of Web Publication||6-Jan-2017|
Department of Periodontology, People's Dental Academy, Bhanpura - 462 038, Bhopal, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
Aim: The aim of this study was to assess the awareness of oral hygiene, periodontal disease, and availability of treatment techniques among medical professionals.
Materials and Methods: A cross-sectional study was conducted on 150 medical professionals randomly selected. Those interviewed included an equal number of medical interns and postgraduates. Each participant was given a self-administered, pretested, multiple choice questionnaire to solve on the spot. The questionnaire is based on information about different terminologies, periodontal diseases their cause, its systemic effects, different treatment techniques used, and newer treatment modalities. The questionnaire consists of 12 questions which are divided under headings such as (1) knowledge about periodontal diseases, (2) knowledge about its association and etiology, (3) awareness about treatment availability.
Results: Positive attitude toward periodontal diseases was observed. The level of awareness was marginally higher with postgraduates. The difference was statistically significant among two groups except in case of treatment modality awareness. The obtained data were analyzed using SPSS version 15 for windows.
Conclusion: Awareness about periodontal diseases, its etiology and association between systemic diseases were observed. However, awareness about periodontal therapy and newer treatment modalities was poor.
Keywords: Attitude; awareness; health-care professionals; periodontal health; treatment modalities
|How to cite this article:|
Kalburgi V, Jain S, Raghuwanshi S, Dass S. Extent of periodontal awareness and its treatment modalities among medical interns and postgraduates: A questionnaire study. Indian J Multidiscip Dent 2016;6:81-6
|How to cite this URL:|
Kalburgi V, Jain S, Raghuwanshi S, Dass S. Extent of periodontal awareness and its treatment modalities among medical interns and postgraduates: A questionnaire study. Indian J Multidiscip Dent [serial online] 2016 [cited 2019 Sep 22];6:81-6. Available from: http://www.ijmdent.com/text.asp?2016/6/2/81/197760
| Introduction|| |
Periodontology is one of the fast growing dental specialties. Its services not only cover preventive and curative aspects of oral health but also offer cosmetic flare and regenerative health programs.  Periodontal diseases is multifactorial in nature. If left untreated, can lead to advanced destruction.  The bacterial plaque is the main etiology of periodontal diseases while many other factors such as hormonal changes, diabetes, poor nutrition, and smoking may affect the initiation and progression of gingival and periodontal diseases.  Bad breath is a widespread but still largely taboo problem. The dentist is often the first point of contact for affected patients. Initially, the diagnosis and quantification of halitosis provide objective evidence and help find the underlying causes, but it is equally important for monitoring the treatment progress. Most often, halitosis is caused intraorally; thus, the dentist will also be responsible for initiating an appropriate treatment. 
The influence of diabetes on the periodontium has been thoroughly investigated and periodontitis is considered a sixth complication of diabetes. A variety of changes have been described, including a tendency toward enlarged gingiva, sessile or pedunculated gingival polyps, polypoid gingival proliferations, shifting abscess formation, periodontitis, and loosened teeth. Perhaps, the most striking changes in uncontrolled diabetes are reduced in defense mechanisms and the increased susceptibility to infections leading to destructive periodontal disease [Graph 1 [Additional file 1] ].
In the hyperglycemic state, numerous proteins and matrix molecules undergo a nonenzymatic glycosylation, resulting in advanced glycation end products (AGEs). The formation of AGES can occur at normal glucose levels; however, in hyperglycemic environments, AGE formation is excessive. AGE formation cross-links collagen, making it less soluble and less likely to be normally repaired or replaced. As a result, collagen in the tissues of poorly controlled diabetics is AGES and more susceptible to breakdown. 
The association between periodontal diseases and adverse pregnancy outcomes such as preterm low birth weight (PTLBW) babies (gestational age <37 weeks and weight <2500 g) and premature labor are evident. Periodontal disease is known as a risk factor for preterm birth or low birth weight because the bacterial migration from periodontal tissues into blood circulation may stimulate the production of inflammatory mediators responsible for the onset of delivery. According to Hunter's theory, bacteria and their products from local infections could be disseminated throughout the body and cause diseases in other organs and remote or microbial toxins entering the uterine cavity during pregnancy and then interact, leading to prostaglandins production which have several systematic effects on the host. 
Smoking tobacco has been attributed to have a negative effect on the healing process of oral tissues after surgical and nonsurgical extractions, periodontal procedures, orthognathic surgeries, and implant therapies. One possible explanation is that the substances in tobacco and its smoke, particularly nicotine, cotinine, carbon monoxide, and hydrogen cyanide are cytotoxic to those cells that are involved in wound healing. Nicotine increases platelet adhesiveness, raising the risk of microvascular occlusion, and tissue ischemia. Smoking is associated with catecholamines release, resulting in vasoconstriction and decreased tissue perfusion. 
Pregnancy itself does not cause gingivitis. Gingivitis in pregnancy is caused by bacterial plaque, just as it is in nonpregnant individuals. Pregnancy accentuates the gingival response to plaque and modifies the resultant clinical picture. The aggravation of gingivitis in pregnancy has been attributed principally to the increased levels of progesterone, which produce dilation and tortuosity of the gingival microvasculature, circulatory stasis, and increased susceptibility to mechanical irritation, all of which favor leakage of fluid into the perivascular tissues. A marked increase in estrogen and progesterone occurs during pregnancy, with a reduction after parturition.  An interesting aspect of the angiogranuloma is its appearance during pregnancy and hence the terms of pregnancy epulis/tumor and granuloma gravidarum. These typically present during the second trimester. Most pregnancy epulides will resolve fully approximately 6 weeks postpartum or will reduce considerably in size and be much less hemorrhagic, thus permitting easier surgical excision [Graph 2 [Additional file 2] ].
In dentinal hypersensitivity, most pain-producing stimuli, especially the most problematic cold and evaporative stimuli, cause an outflow of dentinal fluid. This results in a pressure change to cause pain. In addition, the fluid movement in the tubules can cause an electrical discharge, known as "streaming potential," which may contribute by electrically stimulating a nerve response. By contrast, heat causes a relatively slow retreat of dentinal fluid, and the resultant pressure changes activate the nerve fiters in a less dramatic fashion. This is consistent with the fact that heat is generally a less painful stimulus than cold. 
The excessive gingival display when a patient smiles (from 4 mm or more), known as gummy smile, along with a short clinical crown of the maxillary anterior teeth characterizes esthetic problems. There are different etiologies of gummy smiles, such as excessive vertical bone growth, dentoalveolar extrusion, short upper lip, upper lip hyperactivity, altered passive eruption, and the combination of some of these factors. There is an adequate treatment for each kind of etiology and two or more techniques can be associated [Graph 3 [Additional file 3] ]. 
Lasers have photophysical characteristics and its irradiation exhibits strong ablation, hemostasis, detoxification, and bactericidal effects on the human body. Thus, in periodontal therapy, laser treatment may serve as an alternative or adjunctive therapy to mechanical approaches. The recently developed Erbium-doped (Er):yttrium aluminum garnet and Er, chromium: yttrium-scandium-gallium-garnet lasers, however, can ablate both soft and hard tissues safely with water irrigation and are applicable to periodontal treatments such as scaling, debridement, and bone surgery, and have minimal thermal effect [Graph 4 [Additional file 4] ]. 
Connective tissue graft is gold standard for treatment of gingival recession but the disadvantages are the second surgical site and inadequate graft availability. Hence, acellular dermal matrix graft (alloderm) is the most successful and predictable procedure in the management of gingival recession due to adequate root coverage and good color match, without the need for second surgical site [Graph 5 [Additional file 5] ]. 
The ultimate goal of dental implant therapy is to satisfy the patients desire to replace one or more missing teeth in an esthetic, secure, functional, and long-lasting manner.  The implants can be used in conjunction with natural teeth for the support of rigid prostheses [Graph 6 [Additional file 6] ].
Aim and objectives
- To assess the awareness of oral hygiene, periodontal disease, and availability of treatment techniques among medical professionals
- To assess the dental knowledge among medical interns and postgraduates
- To know their attitudes toward dental health
- To assess their awareness on systemic conditions related to oral health.
| Materials and Methods|| |
One hundred and fifty medical professionals from the Peoples Medical College and Gandhi Medical College, Bhopal, were interviewed through a questionnaire. Those interviewed included an equal number of medical interns, postgraduates. Among the 150 interviewed were interviewed on a single day at their workplace.
The questionnaire covered different areas such as understanding of the various terminologies, knowledge about cause and/or associations with periodontal disease, availability of treatment, their concepts, and awareness about different techniques used. The responses were compiled, computed, and analyzed for agreement or otherwise between and within the groups. 
The obtained data were analyzed using SPSS version 15 for Window (SPSS Inc., Chicago, USA). Data were described using frequency counts and percentages, and comparisons were made using the Chi-square analysis for different independent samples. The significance level was 70%.
Questions asked in survey
| Results|| |
82.43% of graduates and 93.42% of postgraduates responded that pyorrhea the same as gingivitis. Chi-square test showed a significant difference for response between graduate and postgraduates (χ2 = 4.287, P < 0.05). Significantly higher number of postgraduates than graduates said that pyorrhea the same as gingivitis.
Significantly higher number of postgraduates (92.11) than graduates (79.73%) said that halitosis is bad breath (χ2 = 4.769, P < 0.05).
Chi-square test showed a significant difference for response between graduate and postgraduates (χ2 = 5.645, P < 0.05). Significantly higher number of postgraduates than graduates said that periodontal disease can lead to PTLBW deliveries.
Chi-square test showed significant difference for response between graduate and postgraduates (χ2 = 4.982, P < 0.05). Significantly higher number of postgraduates than graduates said that smoking affects the healing of periodontal tissues.
Significantly higher number of postgraduates (90.79%) than graduates (77.03%) said that dentinal hypersensitivity is sensitivity to cold, heat, and sweets (χ2 = 5.284, P < 0.05).
Significantly higher number of postgraduates (93.42%) than graduates (74.32%) said that bleeding gums require visit the dentist (χ2 = 10.174, P < 0.01).
| Discussion|| |
To the questions pertaining to the various frequently used terminologies, nearly 50% of all the surveyed answered that pyorrhea and gingivitis are synonymous [Table 1]. Moreover, the majority of the participants knew the meanings of halitosis [Table 2] and dentinal hypersensitivity, [Table 3] and believed that periodontal disease is preventable, and for diabetes as a risk factor postgraduates were more aware than graduates [Table 4]. About the association between pregnancy and periodontal disease, the positive attitude was significant, be it its association with gingival hypertrophy [Table 5] or as a causative factor in delivery of preterm and low birth weight babies [Table 6]. This awareness among the health-care professionals augurs well for planning joint ventures in reducing low birth weight deliveries and perinatal morbidity.
|Table 1: Responses of participants for question whether pyorrhea the same as gingivitis |
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|Table 3: Responses of participants for question whether dentinal hypersensitivity is sensitivity to cold, heat, and sweets |
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|Table 4: Responses of participants for question whether diabetes is a risk factor for periodontal disease |
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|Table 5: Awareness of participants for gingival swellings which sometimes occur during pregnancy |
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|Table 6: Responses of participants for question whether periodontal disease can lead to preterm low birth weight deliveries |
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Responses regarding knowledge about treatment offered for gingival overgrowth and treatable periodontal problems such as gummy smile were poor suggesting that there is a need for awareness on these aspects [Table 7]. There were questions asked about the use in periodontal therapy of laser, alloderm. Awareness about these modalities in periodontal treatment was poorer in the interviewed interns [Table 8] and [Table 9]. The awareness level was marginally higher with postgraduates.
|Table 8: Awareness of participants for laser treatment of periodontal diseases |
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|Table 9: Responses of participants for question whether alloderm can be used in dentistry |
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Half of those interviewed did not know what dental implants mean. With implantology, coming up to be recognized as a subspecialty, it is necessary that information about implants be disseminated among the medical professionals [Table 10]. As far as the practice and attitude were concerned, it was good to know that most agreed with the impact of smoking on periodontal health [Table 11]. Similarly, most expressed belief that gum bleeding requires dental check [Table 12]. The vision on oral health is that physicians need to improve and impart oral health counseling, and serve as a guide in developing positive dental attitudes.
|Table 10: Awareness of participants whether dental implants can be used for replacement of natural teeth in the jaw bone |
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|Table 11: Responses of participants for question whether smoking affects the healing of periodontal tissues |
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|Table 12: Responses of participants for question whether bleeding gums require visit the dentist |
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For this, the physician needs to be well informed as to the need for dental care and treatments available, which calls for a joint advocacy between the two professions. This will enable the physicians to make appropriate referrals as and when required to address the serious problems of disparities in obtaining access to professional dental services. The information obtained from this knowledge, attitude, and practice survey should be utilized to bring change in lifestyle, to counsel, and to befriend dental clinics. Authors believe that the inputs of the survey will help the dental care providers to organize Periodontal Health Awareness Programs, structuring special clinics, and planning for joint ventures.
| Conclusion|| |
A positive attitude toward periodontal diseases, its etiology and association between systemic diseases were observed. However, awareness about periodontal therapy and newer treatment modalities were poor among those questioned. However, inputs from such surveys can be used in preventive periodontal programs. Periodontal health programs and joint ventures can be planned in future. Hence, physicians can provide oral health counseling and help install a positive dental attitude. Oral health education and training as part of the medical school curriculum are strongly recommended and interdisciplinary referrals should be made.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12]