Knowledge, attitude, and practice of feeding plate obturators among dental practitioners

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1 Research Article Knowledge, attitude, and practice of feeding plate obturators among dental practitioners Y. Sivanagini 1, Dhanraj Ganapathy 2, Ashish R. Jain 2 * ABSTRACT Background: Every infant should receive a comprehensive health-care risk assessment irrespective of their circumstances. Numerous reports have shown association between orofacial cleft and weight loss, feeding disability. The purpose of this study was to understand the anxiety and depression among mothers and knowledge, attitude, and practice skills of feeding plate obturators among dental practitioners. Aim: The aim of the study is to evaluate the knowledge, attitude, and practice of feeding plate obturators among dental practitioners. Materials and Methods: The study involved a survey of private dental practitioners all among India. The pre-tested questionnaire on the awareness and fabrication of feeding plate obturators among the dental practitioners was used to collect the data related. The data collected were subjected to statistical analysis using frequency of responses and standard deviation. Results: The data acquired from this survey exhibited that 85% of dentists receive a frequency of cases with orofacial clefts of around /6 months, though these patients require a multidisciplinary approach through various phases of their growth, parents bother about their feeding disabilities, as 7% of patients age approaching clinic was around days. Hence, the primary treatment approach could be a feeding plate obturator which helps them in feeding and swallowing. Whereas 55% of clinicians fabricate feeding plate obturators on their own and % depends on other clinicians for such cases. Usually, the obturators were been delivered in 1 or 2 days (8%). The hospital anxiety and depression scale has been recorded by clinicians (75%) before and after the fabrication of obturators. Whereas, 8% out of the above reveals that the anxiety and depression among mothers have been reduced after the treatment. Conclusion: The findings of this survey with dental practitioners showed that management of feeding difficulties among orofacial cleft infants with feeding plate obturators still presents some deviations from scientific literature recommendations, indicating the need to update these health-care professionals to establish guidelines for postnatal dental care. KEY WORDS: Cleft lip, Cleft palate, Dental practitioners, Feeding plate obturators, Orofacial cleft INTRODUCTION Overall, the prevalence rate for live births with cleft lip, cleft palate, or both was 1.39/ live births stated by Dr. F. Al Omari and Al-Omari. [1] Mossey et al. in his study stated that a combination cleft palate, alveolus, and lip was the most common variant in Caucasian patients. [2] % of the clefts identified affected the lip, 22% affected the palate, and 48% involved both lip and palate. The child oral and orofacial conditions have a pervasive impact on mothers and also an entire family. [3] Orofacial clefts were found to be common craniofacial anomaly. It requires a complex multi-disciplinary Access this article online Website: jprsolutions.info ISSN: treatment. It was a multi-factorial disorder including genetical and environmental as major factors. [4] Studies states that the mutations in interferon regulatory factor-6 were responsible for Van der Woude syndrome, poliovirus receptor-related-1 gene was responsible for autosomal recessive ectodermal dysplasia syndrome which is also responsible for orofacial clefting. [5] On the other hand, many other studies stated that environmental factor also plays a major role in the early stages of embryonic development. The orofacial clefts fell into a common group of congenital malformations, so were more likely will be encountered in general practice. [6] Parents and healthcare workers will identify this in a cosmetic view and sometimes they will fail to understand the complexity of the condition, which results in impairment of the child s health. [7] 1 Department of Prosthodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India, 2 Department of Prosthodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India *Corresponding author: Dr. Ashish R. Jain, Department of Prosthodontics, Saveetha Dental College and Hospital, Saveetha University, Poonamallee High Road, Chennai 6 127, Tamil Nadu, India. Phone: dr.ashishjain_r@yahoo.com Received on: ; Revised on: ; Accepted on:

2 It is important for the dental practitioners to have basic knowledge on the holistic management of these patients. [8] The dentists should play a major role in explaining the patient about what to expect, which motivates them toward the treatment protocol. In this article, we aim to determine the role of general dental practitioner, in approaching the patients effectively despite extent of their role. MATERIALS AND METHODS The study involved a survey of private dental practitioners all among India. The questionnaire consisted of closed-ended questions. We used a simple randomized sampling method to survey. The questionnaire was prepared in such a way to know the knowledge of dental practitioners about the orofacial clefts, its management protocol and fabrication of feeding plate obturators as well as to evaluate the anxiety levels among the mothers of those infants. [9] The study was conducted in the month of January 18. The participants were private dental practitioners, who are practicing all over India with an experience of minimum years. We have contacted the participants mostly in personnel, and others through s, and phone contacts. The questionnaire form was send to doctors through online google forms. The time period for them to fill the questionnaire was about 3 5 min. The questionnaire extracts the information of their perception toward cleft patients, approach toward the treatment, and their concern about mothers anxiety and depression scores. The anxiety and depression among mothers have been recorded in pre- and post-operative treatment phases. Hospital anxiety and depression scale (HADS) has been used to record mothers anxiety and depression before and after the fabrication of feeding plate obturator. [] HADS was originally developed. [11] This is commonly used by clinical practitioners to determine the patient s anxiety and depression levels. It was hoped to determine the people physical health problems. The pre-tested questionnaire on the awareness and fabrication of feeding plate obturators among the dental practitioners were used to collect the data related and were analyzed with SPSS version 3.. The data collected were subjected to statistical analysis using frequency of responses and standard deviation. KAP Survey on Feeding Plate Obturators 1. How frequently do you face the infants with feeding difficulties due to cleft lip/palate at your clinic per 6 months? a. 1 b. 2 c. 3 d. 4 e. 5 f. 6 g. 7 h. 8 i. 9 j. k. More than 2. Who are all the concerned clinicians in the team for multidisciplinary treatment of a child with an orofacial cleft? a. Pediatrician b. Plastic surgeon c. Pediatric dentist d. Otolaryngologist e. Geneticist f. Genetic counselor g. Speech pathologist h. Orthodontist i. Prosthodontist j. Maxillofacial surgeon k. Psychologist l. All the above 3. What are all the treatment modalities for a cleft patient to follow? a. Feeding and swallowing b. Surgical intervention c. Physical management d. Speech therapy e. Palatal repair f. Audiological care g. All the above 4. What is the chief complaint of mothers of such infants attending your OPD? a. Difficulty in feeding and swallowing b. Difficulty in suckling c. Regurgitation d. Poor nourishment e. Poor weight gain of infants f. Esthetics g. All the above 5. What is the age of infant usually that approaches you in need of treatment with cleft lip/palate? a. < days b. 15 days c. 15 days d. 6 days e. 6 9 days f. >9 days 6. What is your primary treatment approach toward patients with cleft lip/palate? a. Feeding and swallowing b. Surgical intervention c. Physical management 1958

3 d. Speech therapy e. Language intervention f. Palatal repair g. Audiologic care 7. Do you know the method of fabrication of feeding plate obturator, if not what do you prefer to do? a. Yes, I know to fabricate b. No, I will refer the case to other practitioner c. No, I will not take up such cases d. I will not usually get such cases e. I will call a consultant for such cases. 8. How long will you take to fabricate single feeding plate obturator? a. 1 day b. 2 days c. 3 days d. 4 days e. 5 days f. 6 days g. 1 week 9. Do you usually record anxiety and depression levels (HADS) in mothers of such cases in your clinical to assess their psychological health? a. Very often b. Not regularly c. Rarely d. Never used.. Is your treatment helps in reducing the anxiety and depression levels of mothers of infants with orofacial clefts? a. Reduced for all the mothers b. Reduced, but not for all of them c. It is not helpful in reducing their anxiety and depression d. Not recorded. DISCUSSION Dentist had a potential role both in post- and preoperative phases of management depending on the patient needs. [12] In the pre-operative phase a dentist should be able to mold the deformity to a position that is better suited for surgical repair. [13] Pure dental problems are more common in this population, so there is a need for routine dental assessment. It is very difficult for the practitioners to judge the timing of these interventions. The multidisciplinary approach toward the defect yields better results. The multidisciplinary team includes ENT Surgeon, Genetic scientist, plastic and oral surgeon, orthodontist, prosthodontist, pediatric dentist, ophthalmologist, psychiatrist, speech therapist, nursing support, and social worker. [14] Usually, this defect could be seen immediately after childbirth. A dentist can play a role in fulfilling the initial requirements of the patients. [15] Parents initially bother about their nourishment and health as infants with this defect could not be able to take food as per their usual requirements. The primary support for the infants could be to accomplish the needs of feeding and swallowing. [16] The role of the rest of the team members in the multidisciplinary team comes later. The feeding plate obturator was a prosthetic work which was usually fabricated by a prosthodontist or general dentist or a plastic surgeon. [16] Usually, a patient in their own prospective tends to consult a general physician for the solution. As the treatment was a team effort by a group of doctors, patients should be explained about the treatment cycle and stepwise procedure. [17] Then, they will be knowing the treatment plan and helps in consulting a proper clinician at that particular time. Patients and their parents should also be given psychological support to face all the barriers in the treatment cycle. [18] When a question raises about how far a dental practitioner was aware of orofacial cleft defects and their management, we took a role in evaluating the knowledge, attitude, and practice of dental practitioners toward orofacial defects and their management. [19] Usually, maxillofacial surgeons play a major role in treating any kind of defects related to head and neck. When it comes to an infant, the care should be more subtle and cautious. Infants with orofacial defects require special feeding techniques (feeding in upright techniques and special feeding bottles), since they cannot create an effective negative sucking pressure leads to regurgitation. [] Treatment should be started as early as possible to help them in feeding initially, which helps them to maintain normal weight to their age. [21] Parents, as well as medical professional, should try for the fulfillment of child unexpressed needs. [22] The questionnaire in this survey was formulated in such a way that the first two questions are regarding the general information about cleft patients and the frequency of incoming patients with such problems. The third question was related to general treatment modalities of cleft patients. Other questions were related to treatment modalities for those patients, chief complaint of mothers when they approach the OPD, age of the children, method of fabrication, and anxiety and depression level of mothers of those patients. All the questions were formulated in such a way that to evaluate the knowledge and interest of dentists in treating such cases. The role of a dentist should not be enclosed within the mouth but can progress in all possible ways. HADS has been used since 1983 to determine the patient s psychological well-being. It has been developed. [23] The HADS contains 14 item scale that 1959

4 yields ordinal data. HADS is commonly used by doctors to determine patient s anxiety and depression levels that they are experiencing. The questionnaire on this scale contains items that yield general information of the patients which, in turn, related to their psychological problem and their behavior toward the problem. Scoring the questionnaire is for each item the score ranges from to 3, and hence a person can score from to 21 for either anxiety or depression. Hence, the data returned from the HADS scale are ordinal. In general, when the caseness of anxiety and depression was calculated based on many studies the specificity and sensitivity of each were as follows; (HADS-A) specificity -.78 and sensitivity -.9, whereas for (HADS-D) specificity -.79 and sensitivity There are many studies supporting its unidimensional measure of psychological distress. Calculating the preoperative and post-operative anxiety and depression score among the mothers of infants with orofacial cleft defects found mandatory after looking into its score. [24] A subtle approach of the clinician toward the patient defects yields better results Frequency of cases with patients with cleft lip and palte that a clinician face in his practice > Graph 1: Frequency of cases you face with orofacial clefts the multidisciplinary team involved in the management of oro-facial clefts Pediatrician plastic surgeon pedodontist otolaryngologist geneticist genetic counsellor speech pathologist orthodontist prosthodontist oral and maxillo facial surgeon psychologist all the above what are all the treatment modalities of patients with oro-facial clefts Graph 2: Multidisciplinary team involved in the orofacial cleft treatment 196

5 Graph 3: What are all the general treatment modalities for orofacial cleft patients chief complaint of mothers a ending OPD difficulty in feeding and swallowing suckling difficulty regurgita on poor nourishment poor weight gain of infants aesthe cs all the above Graph 4: Chief complaint of mothers attending OPD RESULTS < days -15 days15- days-6 days 6-9 days >9 days Graph 5: Age of the infant attending the OPD The data acquired from this survey have been represented by descriptive analysis and were shown in bar graphs. The survey exhibited that 85% of dentists receive a frequency of cases with orofacial clefts of around /6 months, though these patients require a multidisciplinary approach through various phases of their growth, parents bother about their feeding disabilities, as 7% of patients age approaching clinic was around days. Hence, the primary treatment approach could be a feeding plate obturator which helps them in feeding and swallowing. Whereas 55% of clinicians fabricate feeding plate obturators on their own and % depends on other clinicians for such cases. Usually, the obturators were been delivered in 1 or 2 days (8%). The HADS has been recorded by clinicians (75%) before and after the fabrication of obturators. Whereas, 8% out of the above reveals that the anxiety and depression among mothers have been reduced after the treatment. Graph 1 represents the frequency of cases that a dentist would face with an orofacial cleft in a period of 6 months. In India, the total number of births with orofacial clefts was found to be 28,6 as per 17 census. Here, in our survey, doctors are facing at around a minimum of cases in 6 months duration. Graph 2 represents about concerned clinicians in a team of multidisciplinary approach toward orofacial 1961

6 6 5 4 Graph 6: Primary treatment approach toward patients do you know the method of fabrication yes, I know to fabricate No, I will refer the case to other dentists No,I will not take up such cases I will not usually get such cases I will call the consultant for those cases Graph 7: Do you know the method of fabrication day 2days 3 days 4 days 5 days 6 days 7 days Graph 3 represents the various treatment modalities that should be followed that should be followed for a patient with orofacial clefts. They include feeding and swallowing, surgical intervention, physical management, psychological management, speech therapy, language intervention, palatal repair, and audiological care. Here, in this question, we aimed to know the doctor s knowledge about stepwise treatment plan for such cases. Graph 8: Time of fabrication feeding plate obturators cleft patients. This team includes various specialists such as pediatrician, plastic surgeon, pediatric dentist, otolaryngologist, geneticist, genetic counselor, speech pathologist, orthodontist, prosthodontist, maxillofacial surgeon, psychologist, and nursing team. Every specialist has to play their own role in treating the child, but their role varies at various phases of treatment. Graph 4 aims to know the mother s chief complaint of such infants for attending OPD. According to the age of infants obviously, the chief complaint would be difficulty feeding and swallowing, difficulty in suckling due to negative pressure, but they are also followed by many other difficulties such as regurgitation, poor nourishment, poor weight gain of infants, and their esthetic appearance. All together will bother mothers about their infants quality of life. Graph 5 represents about the age of infants usually that approaches a doctor in need of treatment with cleft lip/ 1962

7 do you record the HADS score in mothers very often not regularly rarely never Graph 9: Do you usually record hospital anxiety and depression scale score in mothers before and after the treatment is your treatment helps in reducing the anxiety and depression levels in mothers reduced for all mothers reduced, but not for all not helpful in reducing not recorded Graph : Is your treatment helps in reducing the anxiety and depression levels in mothers palate, and after looking into results, the majority of patients age was in between and 15 days. Graph 6 reveals the doctor knowledge about the primary treatment approach toward infantile patients with cleft lip/palate. More than 5% of the doctors mentioned that the feeding and swallowing were of the primary concern toward those patients. Graph 7 represents the knowledge and attitude of a dentist toward fabricating a feeding plate obturator, and the result shows that more than 5% of dentists knew how to fabricate feeding plate obturators and others would prefer to call for a consultant doctors regarding such cases. Graph 8 represents the time required for a dentist to fabricate and deliver a feeding plate obturator. More than 5% of dentist would deliver the obturator within a day and around 25% of dentists used to deliver the cases within 2 days. Graph 9 represents how frequently doctors used to record HADS among the mothers of such cases in preoperative and post-operative treatment phases. Very often doctors used to record the pre-operative and post-operative HADS score. Graph is all about how the treatment helps in reducing the anxiety and depression levels in mothers of infants with orofacial clefts. This has been evaluated all with the pre-operative and post-operative HADS score that they the dentists had recorded. As the basic needs of the infants are been fulfilled by fabricating feeding plate obturators, this has been reduced the anxiety levels of mothers. The results from this graph show that almost all mothers had reduced anxiety and depression levels. CONCLUSION The management of orofacial clefts represents a logistical challenge for the general medical profession. Several areas in the orofacial clefts might increase the quality of life through the role of the prosthesis and multidisciplinary management. REFERENCES 1. Al Omari F, Al-Omari IK. Cleft lip and palate in Jordan: Birth prevalence rate. Cleft Palate Craniofac J 4;41: Mossey PA, Little J, Munger RG, Dixon MJ, Shaw WC. Cleft lip and palate. Lancet 9;374: Turner SR, Rumsey N, Sandy JR. Psychological aspects of cleft lip and palate. Eur J Orthod 1998;: Dixon MJ, Marazita ML, Beaty TH, Murray JC. Cleft lip and palate: Understanding genetic and environmental influences. 1963

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