KNOWLEDGE AND ACCEPTANCE OF DENTAL IMPLANT TREATMENT IN GENERAL PUBLIC IN DELHI POPULATION

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WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES Himanshu et al. SJIF Impact Factor 6.

1 WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES Himanshu et al. SJIF Impact Factor Volume 6, Issue 9, Research Article ISSN KNOWLEDGE AND ACCEPTANCE OF DENTAL IMPLANT TREATMENT IN GENERAL PUBLIC IN DELHI POPULATION Anubhav Sharma 1, Narender Singh 2, Suman Yadav 3, Megha Kiran 4, Nitin Tyagi 5 and Himanshu Thukral* 6 1 Senior Lecturer, Department of Public Health Dentistry, I.T.S Dental College, Muradnagar, Ghaziabad, U.P. 2 Assistant Professor & Head, Department of Dentistry, RNT Medical College and MB Govt Hospital, Udaipur, MDS(Oral and Maxillofacial Surgery). 3 MDS, Oral & Maxillofacial Surgeon, Azamgarh, UP. 4 MDS 3 YR, Shree Bankey Bihari Dental College, Ghazibad. 5 MBBS, MD (Post Graduate Student) Vardhman Mahavir Medical College, New Delhi. 6 Oral & Maxillofacial Surgeon, CEO Sarita Dental Care, Delhi. Article Received on 16 July 2017, Revised on 06 August 2017, Accepted on 26 August 2017, DOI: /wjpps *Corresponding Author Dr. Himanshu Thukral Oral & Maxillofacial Surgeon, CEO Sarita Dental Care, Delhi. ABSTRACT Aims: Due to the high success rates and predictability of dental implants, their usage in the rehabilitation of partially dentate and edentulous patients is increasing year by years. The aim of the survey was to assess the patient awareness, source of information and acceptance of dental implants as a treatment modality for replacement of missing teeth among the Delhi population. Materials and Methods: A survey was conducted among the patients visiting various private dental clinics using a self-explanatory questionnaire. The questionnaires were prepared in English and Hindi language to enable better understanding and completion. Results: Among the 1013 response retrieved, 772 were aware of dental implant treatment. Among the 81% of the respondents who knew dental implants can be used to replace missing teeth, 19.5% opted not to receive dental implant treatment. About 81.8% of the respondents expressed that dental implant treatment was unaffordable. The cost and associated surgery was a major disadvantage and deterrent to this modality. The dentists were the main source of information regarding the dental implant treatment modality, followed by friends and electronic media. Conclusion: The survey concluded that 76.2% of the Delhi population was aware of dental implant treatment in delhi, Vol 6, Issue 9,

2 mainly from dentists. Having dental insurance would most definitely raise the willingness of respondents for receiving dental implant treatment. INTRODUCTION Implant dentistry has become increasingly important in oral reconstruction since the intraoral use of titanium implants was suggested in the late 1950s. [1-2] The majority of patients treated with implant-supported prosthesis have reported improvement in their quality of life and self-confidence. [3] Advantages of implant-supported restorations include psychological benefits and tooth structure conservation adjacent to the teeth to be replaced. [4] Due to high success rates and predictability of dental implants, the prevalence of dental implant therapy in partially dentate and edentulous patients is increasing year by year. [5] According to Narby et al., a previous study conducted based on two questionnaires, in Sweden, there was, over the course of a decade, a dramatic escalation in interest of implant treatment. At the time of the second survey (1999), 95% of participants expressed a desire for implant treatment in comparison with 32% in the first survey (1989). [6-7] For professionals, it is vital to assess their level of knowledge with regards to dental implants and whether their perception of dental implants does in fact reflect reality. [8-9] Replacement of missing or lost teeth with dental prostheses supported by implants has been accepted and rated as a positive experience by patients who have undergone implant treatment. [9-10] Many studies have been carried out in different parts of the world with regards to the awareness of dental implants as a treatment option. The overwhelming majority of patients with severely compromised local host bone can be offered implant-supported rehabilitation with a very good prognosis. [11-17] A nationwide survey from a representative sample of the general Delhi population is therefore needed to assess public awareness and understanding of oral implants as a treatment option. AIMS AND OBJECTIVES To evaluate the level of knowledge amongst the populations with regards to dental implants. To evaluate the sources of information regarding dental implant treatment. To evaluate the level of acceptance of dental implants as a treatment option compared to other conventional treatment modalities. Vol 6, Issue 9,

3 MATERIALS AND METHODS The survey was conducted through printed and online questionnaire composing of six questions with the intention of evaluating dental implant awareness among the Delhi population in 2017 (January to March). A random sampling method with convenient sample size was used. Questionnaire was prepared both in English to enable completion and to improve the respondents understanding of the questions. Most of the hospitals with a dental outpatient department and private dental clinics were included in the study. The questionnaires were handed to the patients during their regular dental visits. All the respondents were informed about the aims and objectives of the study. Those who were not willing to give informed consent were excluded from the study. Hence, out of 1300, only 980 respondents agreed to participate in the survey with the non response rate 32.46%. For the purpose of the study, the Delhi population was grouped according to: Gender: Male/female Age: 20 years and below, years, years, years, 81 years and above. Education: Up to high school Up to college Up to university and above. Vol 6, Issue 9,

4 Figure 1 depicts the survey form which included self-explanatory questions which were in correspondence to previous studies conducted Chowdhary et al. [9] and Berge. [18] Figure 1: Survey form. RESULTS Based on the 980 responses retrieved, 772 (76.2%) respondents were aware of dental implants treatment in Delhi. Non response rate of the survey was 487 (32.46%). Table 1 depicts the characteristics of respondents who have heard of dental implants based on their gender, age and education levels. Respondents with age group of years were most wellinformed regarding dental implants. Vol 6, Issue 9,

5 Table 1: Characteristics of respondents who were aware of dental implants n (%) GENDER Male 306 (39.6) Female 466 (60.4) Age (years) < (24.7) (54.5) (16.5) (3.8) >81 4 (0.5) Education Up to high school 113 (14.6) Up to college 178 (23.1) University and above 481 (62.3) Alternatives for replacing missing teeth Among the 980 respondents, most were aware of complete dentures (59%), followed closely by implant-supported denture (56%) and partial dentures (55%) as an alternative for the replacement of missing teeth. 113 respondents were not aware of any alternatives given [Table 2]. Table 2: Alternatives for replacing missing teeth n (%) Implant-supported dentures/bridges 571 (56) Partial dentures 562 (55) Complete dentures 599 (59) Bridges (fixed partial dentures) 432 (43) None of the above 113 (11) Source of information regarding dental implants Among the 772 respondents who were aware of dental implants, most stated their dentist (53.6%), followed by friend, relatives, internet, magazine and newspapers as the various source of information regarding dental implants [Table 3]. Table 3: Source of information regarding dental implants Source n (%) Newspaper/magazine 233 (30.2) Television/radio 73 (9.5) Internet 267 (34.6) Dentist 414 (53.6) Relatives/friends 350 (45.3) Someone who received an implant 259 (33.5) Vol 6, Issue 9,

6 Willingness to consider dental implant treatment if needed About 80.5% of the respondents were willing to consider dental implant treatment if needed whereas 19.5% refused for it as shown in Table 4. Table 4: Willingness to consider dental implant treatment Yes 816 (80.5) No 197 (19.5) Reasons for refusing implant treatment Most respondents stated high costs (81.8%), followed by need of surgery and inadequate knowledge as the main limitations of dental implant treatment and the major reasons for refusing such treatment options [Table 5]. Dental insurance Table 5: Reasons for refusing dental implant treatment n (%) High costs 130 (81.8) Lack of knowledge 45 (28.3) Need of surgery 48 (30.2) Long treatment time 32 (20.1) Among the 980 respondents, 788 (81%) thought that dental insurance coverage was needed in the country for dental implant treatment as the cost of the treatment is high, whereas 19% did not support insurance coverage [Table 6]. Table 6: Need for dental insurance coverage is needed in our country n (%) Yes 788 (81) No 192 (19) DISCUSSION Among the 980 respondents, only 739 people (76.2%) had heard of dental implants in Delhi. This is a slightly higher finding than a study done in a Norwegian population [18] that showed 70% of respondents had heard of dental implants. Majority of thosewho had heard of dental implants were among the year s age group (54.5%). This can be attributed to the increased interest in dental treatment among the younger generation and changing attitudes towards the advancements in medical and dental technology. [9] Vol 6, Issue 9,

7 Factors such as high level of education coupled with a reasonably higher income and age can influence the findings of this research. The Norwegian study that claimed people of ages 45 and above with a high level of education were well informed about dental implants, which is concurrent with the findings of Chowdharyet al., [9] that stated respondents in the age groups of with a college or university education were more aware of dental implants. Regarding the sources of information, 53.6% stated their dentist as their source of hearing about dental implants followed by relatives and friends, internet, someone who has received an implant, newspapers or magazines. This is in agreement with Pommer et al., [1] Chowdhary et al., [9] Satpathy et al. [16,19] Mukatash et al. [20] and Ravi Kumar et al. [21] all of which stated dentists as the main source of information. This finding is contrary to that reported by a study done in the USA, stating media as the main source. [18,22] Thus, it is important to promote dental implant treatment, most importantly by means of effective communication between patients and their dentists and other options such as highlighting the usage of dental implantsin health related articles in newspapers or health magazines. [23] Among the respondents who were aware of implants as a treatment modality for missing teeth, 19% refused for implant treatment if needed. Among them, 81.8% stated high costsas a limiting factor for dental implant treatment. This is in accordance to Zimmer et al. [10] and a Japanese study by Akagawa et al., [24] all of which showed that the most serious hindrance factor for obtaining dental implant treatment bypatients is the high cost. Thus, having dental insurance in Delhi would most definitely raise the willingness of respondents for receiving dental implant treatment. Eighty-one percent of respondents agreed for the need of insurance coverage for dental implants, whereas 19% do not agree to it. This is in accordance to Chowdhary et al. [9] in which 96.23% were in favor of dental insurance. Morewere in favor after learning that the cost of treatment is high. CONCLUSION Within the limitations of this study, it can be concluded that 76.2% of the population have heard of dental implant treatment in Delhi. This survey among patients attending dental hospitals and private dental clinics showed that the many of the patients were unaware about using dental implants as an option forreplacing missing teeth. Dentists were the main sources Vol 6, Issue 9,

8 of information regarding dental implants amongst the people. This clearly indicates the lack of efforts by dentists and the governing bodies regarding taking necessary steps for creating awareness amongst the people. The high cost of the implants is one of the major limiting factors working against the willingness of patients to undergo this treatment. It also shows that most patients found dental implants treatment to be expensive and unaffordable, but they were interested to know more about dental implants. Besides this, efforts should be made to reduce the cost of dental implants to a more affordable rate. The survey underlines the need for providing correct information through various means to the patients to improve awareness about this treatment modality. REFERENCES 1. Pommer B, Zechner W, Watzak G, Ulm C, Watzek G, Tepper G. Progress and trends in patients mindset on dental implants. I: Level of information, sources of information and need for patientinformation. Clin Oral Implants Res., 2011; 22: Lindh T, Gunne J, Tillberg A, Molin M. A meta-analysis of implants in partial edentulism. Clin Oral Implants Res., 1998; 9: Aglietta M, Siciliano VI, Zwahlen M, Brägger U, Pjetursson BE, Lang NP, et al. A systematic review of the survival and complication rates of implant supported fixed dental prostheses with cantilever extensions after an observation period of at least 5 years. Clin Oral Implants Res., 2009; 20: Den Hartog L, Slater JJ, Vissink A, Meijer HJ, Raghoebar GM. Treatment outcome of immediate, early and conventional single-tooth implants in the aesthetic zone: A systematic review to survival, bone level, soft-tissue, aesthetics and patient satisfaction. J Clin Periodontol, 2008; 35: Sonoyama W, Kuboki T, Okamoto S, Suzuki H, Arakawa H, Kanyama M, et al. Quality of life assessment in patients with implant-supported and resin-bonded fixed prosthesis for bounded edentulous spaces. Clin Oral Implants Res., 2002; 13: Narby B, Bagewitz IC, Soderfeldt B. Factors explaining desire for dental implant therapy: Analysis of the results from a longitudinal study. Int J Prosthodont, 2011; 24: Narby B, Kronström M, Söderfeldt B, Palmqvist S. Changes in attitudes toward desire for implant treatment: A longitudinal study of a middle-aged and older Swedish population. Int J Prosthodont, 2008; 21: Brunski JB. In vivo bone response to biomechanical loading at the bone/dental-implant interface. Adv Dent Res., 1999; 13: Vol 6, Issue 9,

9 9. Chowdhary R, Mankani N, Chandraker NK. Awareness of dental implants as a treatment choice in urban Indian populations. Int J Oral Maxillofac Implants, 2010; 25: Zimmer CM, Zimmer WM, Williams J, Liesener J. Public awarenessand acceptance of dental implants. Int J Oral Maxillofac Implants, 1992; 7: de Bruyn H, Collaert B, Lindén U, Björn AL. Patient s opinion and treatment outcome of fixed rehabilitation on Brånemark implants. A 3-year follow-up study in private dental practices. Clin Oral Implants Res., 1997; 8: Adell R, Eriksson B, Lekholm U, Brånemark PI, Jemt T. Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws. Int J Oral Maxillofac Implants, 1990; 5: Bergendal T, Engquist B. Implant-supported overdentures: A longitudinal prospective study. Int J Oral Maxillofac Implants, 1998; 13: Friberg B, Gröndahl K, Lekholm U, Brånemark PI. Long-term follow-up of severely atrophic edentulous mandibles reconstructed with short Brånemark implants. Clin Implant Dent Relat Res., 2000; 2: van Steenberghe D, Quirynen M, Naert I, Maffei G, Jacobs R. Marginal bone loss around implants retaining hinging mandibular overdentures, at 4-, 8- and 12-years follow-up. J Clin Periodontol, 2001; 28: Satpathy A, Porwal A, Bhattacharya A, Sahu PK. Patient awareness, acceptance and perceived cost of dental implants as a treatment modality for replacement of missing teeth: A survey in Bhubaneshwar and Cuttack. Int J Public Health Dent, 2011; 2: Lambrecht JT, Cardone E, Kühl S. Status report on dental implantology in Switzerland in A cross-sectional survey. Eur J Oral Implantol, 2010; 3: Berge TI. Public awareness, information sources and evaluation of oral implant treatment in Norway. Clin Oral Implants Res., 2000; 11: Pommer B, Zechner W, Watzak G, Ulm C, Watzek G, Tepper G. Progress and trends in patients mindset on dental implants. II: Implant acceptance, patient-perceived costs and patient satisfaction. Clin Oral Implants Res., 2011; 22: Mukatash GN, Al-Rousan M, Al-Sakarna B. Needs and demands of prosthetic treatment among two groups of individuals. Indian J Dent Res., 2010; 21: Ravi Kumar C, Pratap KV, Venkateswararao G. Dental implants as an option in replacing missing teeth: A patient awareness survey in Khamman, Andhra Pradesh. Indian J of Dent Sci., 2011; 3: Vol 6, Issue 9,

10 22. Watzek G, Buser D, Neukmamm F. Eroffnungsanspracher community meeting of the German gesellchaft for implantology in dental, oral and maxillofacial region, Osterreichischen society of oral surgery and implantology and the Swiss society of oral implantology, risk in implantology Salzburg, 30 Nov-2 Dec Clin Oral Implants Res., 2003; 14: Tepper G, Haas R, Mailath G, Teller C, Zechner W, Watzak G, et al. Representative marketing-oriented study on implants in the Austrian population. I. Level of information, sources of information and need for patient information. Clin Oral Implants Res., 2003; 14: Akagawa Y, Rachi Y, Matsumoto T, Tsuru H. Attitudes of removable denture patients toward dental implants. J Prosthet Dent, 1988; 60: Vol 6, Issue 9,

International Journal of Public Health Dentistry

International Journal of Public Health Dentistry RESEARCH ARTICLE Patient awareness, acceptance and perceived cost of dental Implants as a treatment modality for replacement of missing teeth: A survey in Bhubaneswar and Cuttack Anurag Satpathy, Amit