International Journal of Public Health Dentistry

Transcription

1 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 Porwal, Arin Bhattacharya, Pratap Kumar Sahu Abstract Background: There is lack of information regarding the patient s awareness of dental implants especially in eastern India. Objective(s): To assess the patient awareness, acceptance and perceived cost of dental Implants as a treatment modality for replacement of missing teeth in Bhubaneswar and Cuttack. Materials and Methods: A cross sectional survey was conducted among the patients visiting the various dental outpatient departments of hospitals and private dental clinics of Bhubaneswar and Cuttack using a self-explanatory questionnaire. Results: A total of 723 patients (aged years; mean age 39.25±14.02 years) participated in the survey. The results of this survey indicate that only 15.91% of the patients knew about dental implants. The patient s local dentist was the main source of information regarding the dental implant treatment modality followed by print and electronic media. About 71.23% patients disproved the removable prosthesis as replacement for missing teeth. A majority of them (60.44%) expressed that treatment was unaffordable. The cost and associated surgery was a major disadvantage and deterrent to this modality. However they were willing to know more about the dental implant treatment modality. Conclusion: The results of this survey among patients attending dental hospitals and private dental clinics showed that the majority of the patients were largely unaware about using dental implants as a treatment modality for replacing missing teeth in Bhubaneswar and Cuttack. Key Words: Dental Implants, Oral health awareness, Replacement of missing teeth, Patient perceived-cost. Received on: 7/02/2011 Accepted on: 8/03/2011 Introduction Eastern part of India and especially the state of Orissa is considered economically lacking. The literacy rate is comparatively low, with an average of 62%. Health care is not well organized and remote places have inadequate health care facilities. It is reported that the dental seeking behavior in the state was poor; 60% of elderly and 67% of adults had never received any dental care (1). The need to replace lost teeth with natural successors has encouraged rapid research and advancement in the field of dental implants. Currently, dental implants are widely accepted as a prosthetic treatment of completely or partially edentulous patients (2, 3). They are associated with improved denture retention, stability, functional efficiency, and quality of life (4). As implant therapy is an elective procedure in most of the patient cases (5) complete information on implant treatment and alternative therapies must be provided to guide the patient in the choice of the most appropriate option (6). However, little information is available to the patients regarding the procedure and its success. This problem is more magnified in developing nations where there is lack of education and awareness amongst people about dental implants as a dental treatment modality. Therefore the aim of the present study was to assess the patient awareness, acceptance and perceived cost of dental Implants as a treatment modality for replacement of missing teeth in Bhubaneswar and Cuttack. Material and methods A cross sectional survey was conducted among the patients visiting the dental outpatient departments of hospitals and private dental clinics of Bhubaneswar and Cuttack. The survey was conducted over a period of 6 months (August 2010 January 2011). A random sampling method with convenient sample was taken. All patients above 14 years of age and with at least one missing tooth (excluding third molars) were included in the survey. All hospitals with a dental outpatient department and all private dental clinics were included in the study. The information was collected using a self :2(1):1-7. Publishing Division, Celesta Software Private Limited

2 explanatory questionnaire based on previous studies (7-8). Eighteen questions were chosen to assess patient awareness, acceptance and perceived cost of dental Implants as a treatment modality for replacement of missing teeth. Authors reviewed three successive revisions of the survey questionnaire and after piloting in an initial fifty six patients for its efficiency, sixteen questions were finalized. The questionnaire recorded the demographic information and the responses to questions. The nature and purpose of the survey was explained to the subjects and written consent was obtained. This protocol was approved by the Institutional Ethical Committee of Siksha O Anusandhan University, Bhubaneswar, India. The questionnaires were handed to the patients during their regular dental visits to various dental hospitals and private dental clinics in cities of Bhubaneswar and Cuttack. The content of the questionnaire was read out and explained in local language to those needing assistance. Descriptive statistics were generated to summarize the responses. Results The present survey gives information about patient s awareness, acceptance and their perceived-cost of dental Implants as a treatment modality for replacement of missing teeth in dental patients in the Bhubaneswar and Cuttack, Orissa, India. This study population (aged years; mean age 39.25±14.02 years) was selected for ease of access and to increase the response rate as they were dental patients who approached various dental hospitals and private dental clinics for their dental needs. In all 723 patients participated in the survey (M = 375(51.86%); F = 348(48.14%)). Table 1 summarizes the demographic data of the participating patients. Replacing missing teeth For the question on whether missing teeth should be replaced overall 63.49% were of the opinion that it was imperative to go for replacement of missing teeth in all cases while only 30.57% thought it was required only if it is aesthetically unpleasant (Table 2). A majority of surveyed population seemed to understand the need for replacement of missing teeth. Alternatives for replacing teeth Questioned about alternatives for replacing missing teeth, merely 15.91% patients were aware about implant-supported reconstructions. Most of the patients were equally aware of Fixed (46.89%) and removable partial (48.55%) and complete dentures (44.81%) as alternatives (Table 2) Level of information about dental implants. Demographic Data (n=723) Gender Male 375(51.86) Female 348(48.13) Age Groups (31.12) (51.17) > (17.7) Occupation Student(St) 23(3.18) Unemployed (Unemp) 20(2.76) Housewife (Hw) 36(4.97) Unskilled (Un) 422(58.36) Professional (Pro) 152(21.02) Business (Bus) 70(9.68) Education Uneducated (Uned) 22(3.04) Primary (Prim) 91(12.58) Secondary (Sec) 430(59.47) Graduate (Grad) 166(22.95) Postgraduate (PG) 14(1.93) Table1: Demographic data of the participating patients n (%) Majority (55.33%) of patients felt they were not at all informed about dental implants while 29.6% patients said they were poorly informed. Only 6.67 % patient population felt that they were adequately informed about dental implants (Table 2). Contentment with removable denture as replacement for missing teeth % of the total patients expressed discontent with a removable option as a replacement for missing teeth (Table 2). Disadvantage of dental implant-supported dentures / bridges High cost (58.79%) and need of surgery (43.99%) were seen as the main disadvantages of the dental implant treatment by most patients (Table 2). Biggest advantage of dental implant-supported dentures / bridges Fixed nature of dental implant treatment was seen as major advantage by 37.63% patients while 34.58% patients felt avoidance of grinding of natural teeth was the biggest advantage. Only 11.48% of patients thought that the functional improvement was a big advantage (Table 2) :2(1):1-7. Publishing Division, Celesta Software Private Limited

3 Table 2: Patient response to questions regarding awareness and knowledge of dental implants as a treatment modality for replacement of missing teeth like natural teeth, 23.24% did feel that they require more care than the natural teeth (Table 3). Source of information about dental implants and alternatives for replacing missing teeth For majority of patients (44.96%) it was their dentist from whom they got to know about dental implants while sizeable patients (31.54%) came to know about it from print and electronic media % patients were passed on this information from their friends and acquaintances (Table 3). Interested in knowing more about dental implants An overwhelming 89.35% expressed their desire to be informed and educated about dental implant treatment (Table 3). Opinion about dental implant option Most Patients were willing to opt for dental implants treatment (71.65%) while others (28.36%) wanted to go for the alternative options of replacing missing teeth. When asked about who should opt for this treatment modality 58.23% of the patients felt that it was an expensive treatment and only rich and affluent should opt for it (Table 3). Treatment charges involved in this procedure and major contributors to its cost Life span of dental implant treatment Most patients (59.62%) thought dental implants would last upto 5 years while 12.73% expected it to last for a lifetime (Table 3). Need for special care and hygiene While 39.29% felt dental implants needed less care in comparison to natural teeth and 37.49% felt they are cleaned just About 60.45% of the patients felt that the dental implants treatment option was not affordable while 57.27% felt that the cost of the dental implant itself was the reason for high treatment cost. However, 16.33% felt it was the surgical procedure which was mostly contributing to the cost. About 13.28% also felt that the dental practitioners were responsible :2(1):1-7. Publishing Division, Celesta Software Private Limited

4 for the overall high cost for this treatment (Table 3). Table 3: Patient response to questions regarding source of information, acceptance and perceived cost of dental implants as a treatment modality for replacement of missing teeth. Discussion Dental implant treatment has been at the forefront of clinical dental practice for over a decade and a half now. With increasing success rate of implant treatment more patients are opting for dental implants as premier choice for replacement of missing teeth. Rising awareness of an advanced treatment modality in the society paves way for its acceptability. However, advanced dental facilities are not in equal offering in all areas. In a time when metros and first tier cities boast of latest advancement and technology same is not true for the second tier cities and rural areas. Surveys conducted to collect to assess awareness level in patient population always come handy in deciding future approach. Although many surveys have been conducted on dental awareness there exists limited data on the patient awareness about dental implants in India. Bhubaneswar and Cuttack are two prominent cities of eastern India and with increasing dental activity over past few years. A survey of this kind provides data on patient s awareness level, knowledge, acceptance, and mindset towards a particular treatment modality. This data could be very well utilized to formulate patient education and motivation strategies, treatment policies, marketing strategies and guidelines for dental implants in this region. Conducting surveys for collection of information regarding dental implant is not uncommon and several researches have contributed in this field. Survey reports of :2(1):1-7. Publishing Division, Celesta Software Private Limited

5 several countries present different awareness levels. Our survey reports 15.91% awareness about dental implants which is quite low and in contrast to one of the earliest surveys conducted on this topic by Zimmer et.al (9) which investigated the public awareness and acceptance of dental implants in 120 American citizens and reported awareness as high as 77%. A recent study conducted in 1000 Austrian individuals by Pommer et al (10) also reports awareness of dental implants of 79% while a Norwegian survey (11) reported in 2001 reported dental awareness level of 70%. Our results were however lower than the reported awareness level of 23.24% in a survey conducted in Indian population by choudhary et al. (12). Such low awareness level may well be attributed to the lower socioeconomic and education levels of this region. Also, majority of the participating patients were unskilled workers and educated only till secondary school level or less. Majority (71.24%) of the patients were not content with a removable prosthesis as the treatment in replacing missing teeth, which confirms the fact that most patients prefer fixed prosthesis in replacing their missing teeth regardless of the clinical situation they have. This result was in accordance with those concluded by Tepper et al.(7), Zimmer et al. (9) and Pommer et al.(10). Also, a breakdown by age groups showed that a higher percentage of younger and middle aged patients rejected removable dentures. Patients of older age group were more willing to accept functionally poor dentures. This may be because of the fact that they tend to develop compensatory adaptive processes and to some extent unconsciously accept age-related losses of masticatory function (13). Our survey shows that most patients learnt about dental implants from their dentists followed by print and electronic media which is in contrast to that reported by earlier researchers. Studies by Berge (14), Best (15) and Zimmer et al. (9) reported media to be the main source of information. Our result however is consistent with a recent Indian survey (16) which reports 55.2% of people getting information from their dentist. The survey results reveal that patients in India get to know about the treatment modality only when they visit a dental office as compared to other countries where media plays a substantial role in educating general public about dental implants. It is interesting to note that a Norwegian study (14) found that electronic media broadcast provided more negative information by focusing on complications and treatment failures it also reported that magazines were found to be presenting facts after a research on the subject more carefully. In a recent study, 56% of the dentists expressed concern that patients are likely to misinterpret information on oral health gained from the Internet (17). Around 37% of patients found fixed nature of dental implants more advantageous. This finding is in accordance with the results revealed by clinical studies on implanted patients that patients already fitted with implants perceived no difference in chewing compared with natural teeth (18-20). Around 89% of the dental patients questioned in this survey were interested in having more information about dental implants. Breakup analysis shows that this was consistent across all gender, age groups, occupational and educational status. This outlines the yearning in dental patients for dental education about dental implants. Asked about the most major disadvantages of dental implant treatment modality, 58% of those interviewed mentioned high costs and 43% the need for stressful surgery. While middle and older age group patients found high cost to be a major deterrent to dental implants, younger patients wanted to avoid surgery. This is consistent with the American (9) and Japanese studies (21) where the cost factor and resentments regarding surgery were reported to be the major disadvantages of dental implants. This information indicates that dental surgeons need to allay the fear in patients regarding the dental implants treatment by explaining surgical procedure carefully and comprehensively. A pertinent observation was made when patients were asked about their expectation of life span of a dental implant, around 60% of the patients expected the life span to be within 5 years and 12.72% expected it to last for a life time. With highly unrealistic patient expectations the need for :2(1):1-7. Publishing Division, Celesta Software Private Limited

6 patient education arises (7). Around 28% of Japanese subjects believed their implants would last forever (21). Such misconceptions point to misinformation or incomplete information of the public in terms of a major information gap (10). Conclusion In conclusion this survey among patients attending dental hospitals and private dental clinics showed that the majority of the patients were largely unaware about using dental implants as an option for replacing missing teeth. 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. The survey underlines the need for providing correct information through various means to the patients to improve awareness about this treatment modality. Affiliations of authors: 1. Dr. Anurag Satpathy, MDS, Reader, Department of Periodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan University, Sector 8, Kalinganagar, Ghatikia, Bhubaneswar, Orissa, 2.Dr. Amit Porwal, MDS, Reader, Department Prosthetic Dentistry, Pacific Dental College & Hospital, Udaipur, Rajasthan, 3.Mr. Arin Bhattacharya, B. Pharm, Postgraduate student, School of Pharmaceutical Sciences, 4. Dr. Pratap Kumar Sahu, Ph.D, Assistant Professor, School of Pharmaceutical Sciences, Siksha 'O' Anusandhan University, Sector 8, Kalinganagar, Ghatikia, Bhubaneswar, Orissa, India. Conflict of Interest: The author(s) declared no conflict of interests. Source of Funding: Nil References 1. Naseem Shah, Pandey RM, Duggal R, Mathur RM, Ranjan K. Oral Health in India: A report of the multi centric study, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India & World Health Organisation Collaborative Program, December Available at: _Oral_Health_In_India-Orissa.pdf. March Naert I, Koutsikakis G, Duyck J, Quirynen M, Jacobs R, van Steenberghe D. Biologic outcome of implant-supported restorations in the treatment of partial edentulism. part I: a longitudinal clinical evaluation. Clin Oral Implants Res. 2002;13(4): Naert I, Koutsikakis G, Quirynen M, Duyck J, van Steenberghe D, Jacobs R. Biologic outcome of implant-supported restorations in the treatment of partial edentulism. Part 2: a longitudinal radiographic study. Clin Oral Implants Res. 2002; 13(4): Jivraj S, Chee W. Rationale for dental implants. Br Dent J. 2006;200(12): Zitzmann NU, Sendi P, Marinello CP. An economic evaluation of implant treatment in edentulous patients-preliminary results. Int J Prosthodont. 2005;18(1): Guyatt GH, Cook DJ. Health status, quality of life, and the individual. J Am Med Assoc Aug 24-31;272(8): 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(5): Tepper G, Haas R, Mailath G, Teller C, Bernhart T, Monov G, et al. Representative marketing-oriented study on implants in the Austrian population. II. Implant acceptance, patient-perceived cost and patient satisfaction. Clin Oral Implants Res. 2003;14(5): Zimmer CM, Zimmer WM, Williams J, Liesener J. Public awareness and acceptance of dental implants. Int J Oral Maxillofac Implants. 1992; 7(2): 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 patient information. Clin Oral Implants Res. 2011;22(2): Berge TI. Public awareness, information sources and evaluation of oral implant treatment in Norway. Clin Oral Implants Res. 2000;11(5): 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(2): Muller F, Wahl G, Fuhr K. Age-related satisfaction with complete dentures, desire for improvement and attitudes to implant treatment. Gerodontology. 1994; 11(1): Berge TI. Public awareness, information sources and evaluation of oral implant treatment in Norway. Clin Oral Implants Res. 2000;11(5): Best HA. Awareness and needs of dental implants by patients in New South Wales. Aust. Prosthodont. J. 1993; 7: Pragati K, Mayank K. Awareness of dental implants as a treatment modality amongst people residing in Jaipur (Rajasthan). Journal of Clinical and Diagnostic Research [serial online] [cited: 2010 December 10]; 4(6): Available at: article_ fulltext.asp?issn= x&year= :2(1):1-7. Publishing Division, Celesta Software Private Limited

7 2010&volume=4&issue=6&page= & issn = x&id=1017. March Chestnutt IG, Reynolds K. Perceptions of how the Internet has impacted on dentistry. Br Dent J. 2006;200(3): Pjetursson BE, Karoussis I, Burgin W, Bragger U, Lang NP. Patients' satisfaction following implant therapy. A 10-year prospective cohort study. Clin Oral Implants Res. 2005;16(2): Zitzmann NU, Marinello CP. Treatment outcomes of fixed or removable implantsupported prostheses in the edentulous maxilla. Part I: patients' assessments. J Prosthet Dent. 2000;83(4): Vermylen K, Collaert B, Linden U, Bjorn AL, De Bruyn H. Patient satisfaction and quality of single-tooth restorations. Clin Oral Implants Res. 2003;14(1): Akagawa Y, Rachi Y, Matsumoto T, Tsuru H. Attitudes of removable denture patients toward dental implants. J Prosthet Dent. 1988; 60(3): Corresponding Author: Dr. Anurag Satpathy, MDS Reader, Department of Periodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan University, Sector 8, Kalinganagar, Ghatikia, Bhubaneswar Orissa, India Ph: a.satpathy@yahoo.com :2(1):1-7. Publishing Division, Celesta Software Private Limited