|Year : 2016 | Volume
| Issue : 2 | Page : 57-61
Knowledge, attitude, and awareness regarding dental implants among patients visiting a university hospital and its teaching districts
Pramita Suwal1, Bishal Babu Basnet1, Bidhan Shrestha2, Prakash Kumar Parajuli1, Raj Kumar Singh1
1 Department of Prosthodontics and Crown-bridge, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
2 Department of Prosthodontics, Kantipur Dental College and Hospital, Kathmandu, Nepal
|Date of Web Publication||15-Mar-2017|
Bishal Babu Basnet
Department of Prosthodontics and Crown-Bridge, B. P. Koirala Institute of Health Sciences, Dharan
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: Dental implants are considered one of the best treatment options for completely or partially edentulous patients. But due to lack of knowledge and education many patients especially in the region of underdeveloped or developing countries do not opt for this. In current study the knowledge, attitude and awareness about dental implants was studied in a referral center and its outreach centers in Nepal.
Purpose: To determine the status of knowledge, attitude and awareness about dental implants in a tertiary care hospital and its outreach centers.
Materials and Methods: 192 patients were asked about dental implants using a standard questionnaire. Their response were recorded and analyzed statistically.
Results: Among the respondents 52.6% were aware of implant therapy, however in specific knowledge only 24.5% could attribute the jaw as site for implant placement. It was also found that rather than dental professionals (17.7%), friends and acquaintances (30.2%) play a role in awareness.
Conclusion: Within the limitations of this study limited knowledge and awareness about dental implants was noticed and role of dentists for the information is lacking in our part of world.
Keywords: Attitude, awareness, dental implants, knowledge
|How to cite this article:|
Suwal P, Basnet BB, Shrestha B, Parajuli PK, Singh RK. Knowledge, attitude, and awareness regarding dental implants among patients visiting a university hospital and its teaching districts. J Dent Implant 2016;6:57-61
|How to cite this URL:|
Suwal P, Basnet BB, Shrestha B, Parajuli PK, Singh RK. Knowledge, attitude, and awareness regarding dental implants among patients visiting a university hospital and its teaching districts. J Dent Implant [serial online] 2016 [cited 2018 Jan 21];6:57-61. Available from: http://www.jdionline.org/text.asp?2016/6/2/57/202157
| Introduction|| |
Oral diseases are not cured by means of prosthodontics treatment. Instead, the principal purpose of prosthodontics is rehabilitation of teeth and oral function. However, there are no generally accepted rules about how to estimate need, demand, or utilization of prosthodontics services in most situations since individual preferences play a very important role.,
In spite of improvement in oral health promotion and restorative techniques, tooth loss is still a reality in old age, and there is widespread need for the replacement of teeth in the elderly population. It has been estimated that more than half of the Canadians over the age of 65 years are missing all their teeth. Furthermore, several European countries, The United Kingdom (46%), The Netherlands (65%), and Iceland (69%) have high prevalence of edentulism. However, the prevalence of dental implants in the elderly, especially in the very old, and institutionalized population is very low.,
Many factors are involved in choosing the restorative options for edentulism. Individuals with less education and low income tend to have poor dental status, in part because of poor finances, and edentulism is often associated with poverty and deprivation. Similarly, the older patients who are accustomed to wearing dentures have little or no interest in implant treatment. In a Swedish study, cost was the main factor for refusing hypothetical implant treatment, followed by fear of surgical procedure. In a qualitative approach, fear of pain, complication, and social embarrassment were revealed as factors explaining refusal of implant by elderly patients.
The awareness about dental implants has been studied in America showing very high awareness. The awareness rate in Australia was 72%, and the source of information was media rather than dentists. In an Indian study, 23.24% of people considered dental implants as a replacement for lost teeth and their information source was from dentists.
Although implant can be the best treatment choice for the partially or completely edentulous patients, there is limited availability of implant therapy in our part of the world. Identifying barriers could help improve patient's awareness; acceptance and usefulness of implant therapy in this region. There is unavailability of published information regarding the knowledge, awareness, and attitude of Nepalese population regarding dental implants. Hence, the present study will evaluate the knowledge, attitude, and awareness of the people toward dental implants and will identify the barriers such as education, economic status, and general health circumstances.
| Materials and Methods|| |
This descriptive, cross-sectional study was conducted in College of Dental Surgery, B. P. Koirala Institute of Health Sciences (BPKIHS), and its teaching districts with primary objective to determine the awareness toward dental implants among completely or partially edentulous patients visiting BPKIHS and its teaching districts. The ethical approval was obtained from the Institutional Review Committee (109/071/072-IRC). The secondary objectives were to determine knowledge among patients visiting various hospitals in Eastern Nepal, to determine attitude toward dental implants, and to identify various constraints in implant therapy in Nepal. A total of 192 people were asked using a standard questionnaire. The adult patients who were requiring prosthetic rehabilitation in any or both of their jaws were recruited in the study. The exclusion criteria for the study were as follows:
- Patients not indicated for any prosthetic rehabilitation
- Patients who have received dental implants already
- Patients with professional dental knowledge
- Patients not willing to participate in the study.
The data were entered into Microsoft Excel and analyzed using SPSS 11.5 version (Chicago: SPSS Inc.).
| Results|| |
Among 192 patients, 49.47% were female and 50.53% were male. The average age of the participants was 43.5 years.
Among the respondents, only 12% were aware about different ways of replacing teeth and 71.4% of respondents knew from the dentists about treatment modalities. The source of knowledge was newspaper for 7.3% and friends for 17.7%. While asking the information about dental implant, it was found that 52.6% of respondents were aware of it. Among them, 30.2% attributed friends for their source of knowledge, 17.7% from dentists, and 1.6% from newspapers.
A good portion of participants (58.9%) think that implant survives for whole life. While asked about constraints for implant treatment, 60.4% consider high cost as main barrier, followed by surgical procedure (26%) and long duration of treatment (13.5%).
The attitude of respondents toward dental implant was found positive as 91.1% of them were curious about dental implant and 85.4% want to get information from dentists only. Regarding the cost, most (39.6%) would like to opt implant therapy if the price were 10,000 NRs (93.87 US$).
Among the respondents, 31.3% think that hygiene care should be more than the natural teeth, and 10.9% think that it will require less. Almost same fraction of respondents think that specialist (31.8%) or general dentists (33.3%) can perform implant treatment.
Regarding fixed prosthesis in contrast to removable prosthesis, many consider fixed therapy comfortable in mouth (38%) whereas many (33.3%) also attribute esthetics as an important factor to choose fixed therapy.
In terms of objective knowledge, major fraction (65.1% of respondents) do not know where implant is kept. Only 24.5% replied alveolar bone as the implant recipient site. Very few consider gingiva (8.9%) and neighboring teeth (1.6%) as the implant placement site.
The results of the study are tabulated in [Table 1],[Table 2],[Table 3].
| Discussion|| |
The prevalence of dental implants in today's dental practice is increasing. Among various alternatives to replace missing teeth, 52.6% of respondents in our study heard about dental implants. In a study done by Pommer et al., the prevalence of patients knowing about dental implants was 74%. The awareness rate about dental implants was found to be less than that of Australian population (72%), Saudi Arabian population (66.4%), Swiss population (70.7%), Norwegian population (70.1%), and Sudanese population (68.5%). However, it is found higher than some studies in India (23.24% and 33.3% aware about dental implants).,
Compared with an old American study conducted in 1992, we are still far behind with awareness level of 77% in the USA in that era.
The level of subjective and objective information was not closely matching as half of the respondents said that they knew about implants, but when they were asked objectively regarding implant recipient site, only 24.5% quoted jawbone as the site. Similar finding was present in a study done by Awooda et al., with 25.5% patients quoting jawbone as the site for surgery. This objective knowledge was found higher in Austrian population (65% citing the jawbone), Turkish (52.6% quoting jawbone), and Saudi Arabian population (49.9% quoting jawbone).
It was found that there is poor public relation of dentists in terms of implant knowledge as very less (17.7% of total respondents) patients said that they had gotten information from dentists, rather many (30.2%) attributed friends as their source of information which is closely matching to another Asian study conducted in Saudi Arabia with similar results (28.3% via dentists and 31.5% via relatives and friends). In the present study, newspaper was quoted as another source of information about dental implants by 1.6% of the respondents. This finding is in contrast to the Austrian study where dentists were major source of information, followed by friends and printed media. The reason may be inadequate emphasis given to dental implants in the printed and electronic media in our country. Rustemeyer and Bremerich found that family dentists were primary source of information (41% of patients) in German patients, followed by the internet (25% of patients). Our findings correlate to a very old study, in which media and friends accounted for major source of information (77%) in contrast to dentists (17%). In Norwegian study, the newspaper, TV, and radio constituted highest share for providing the information about implants, which country like ours is not well-acquainted with. On the contrary, social environment (52.3%) and dentists (40%) are leading factors in developed countries in providing information about implants. This would suggest that there is need of strong efforts from multiple stakeholders alongside dentists to raise awareness about dental implants in general population.
Regarding the constraints of implant therapy, 60.4% were quoting high cost as main barrier, followed by surgical procedures (26%) and long duration of treatment (13.5%). It is in agreement with other studies by Narby, Bhat, and Prashanti. However, the findings of multicenter study done by Ellis  had outlined fear of pain of surgery as the main barrier for implant therapy. Furthermore, the cost was not any concern in European study for major portion of respondents. The cost seems a major setback for implant treatment in many studies including ours largely connected to economic conditions of society in contrast to many other studies in the Western world.
Asked about care and maintenance, 31.3% of respondents in our study think that implants need more care than natural teeth and 10.9% think that it requires less care. It is closely matched to the findings of the study done by Rustemeyer and Bremerich.
In the current study, many respondents (58.9%) think that implant lasts forever. It is in contrast to the findings of Sudanese (19.3%) and Turkish (33%) studies. The attitude toward dental implant was found very high in our study with 91.1% showing interest to know more about implants. This is in agreement to Sudanese (93.2%) and slightly higher than that of Saudi Arabian (82.4%) and Turkish (68.3%) study. The comparison of various responses in different studies is depicted in [Table 4].
| Conclusions|| |
Within the limitations of the present study, it can be concluded that there are limited knowledge and awareness about dental implants in Eastern Nepal and role of dentists as a primary source of information has not been attained. The attitude of patients toward dental implants is appreciable, but there is need of strengthening education in young dentists to reinforce knowledge and awareness in public sectors. Similarly, cost seems to be major constraint for implant therapy in developing country like ours.
We would like to acknowledge the participants for their valuable time in our study, and also to the hospital staffs and dental interns for their support in collecting data from B. P. Koirala Institute of Health Sciences, Dharan, and its peripheral teaching district hospitals.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Narby B, Kronström M, Söderfeldt B, Palmqvist S. Prosthodontics and the patient: What is oral rehabilitation need? Conceptual analysis of need and demand for prosthodontic treatment. Part 1: A conceptual analysis. Int J Prosthodont 2005;18:75-9.
Beazoglou T, Brown LJ, Heffley D. Dental care utilization over time. Soc Sci Med 1993;37:1461-72.
Müller F, Naharro M, Carlsson GE. What are the prevalence and incidence of tooth loss in the adult and elderly population in Europe? Clin Oral Implants Res 2007;18 Suppl 3:2-14.
Awad MA, Lund JP, Shapiro SH, Locker D, Klemetti E, Chehade A, et al.
Oral health status and treatment satisfaction with mandibular implant overdentures and conventional dentures: A randomized clinical trial in a senior population. Int J Prosthodont 2003;16:390-6.
Visser A, de Baat C, Hoeksema AR, Vissink A. Oral implants in dependent elderly persons: Blessing or burden? Gerodontology 2011;28:76-80.
Zitzmann NU, Hagmann E, Weiger R. What is the prevalence of various types of prosthetic dental restorations in Europe? Clin Oral Implants Res 2007;18 Suppl 3:20-33.
Gratrix D, Holloway PJ. Factors of deprivation associated with dental caries in young children. Community Dent Health 1994;11:66-70.
Salonen MA. Assessment of states of dentures and interest in implant-retained prosthetic treatment in 55-year-old edentulous Finns. Community Dent Oral Epidemiol 1994;22:130-5.
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;21:481-5.
Ellis JS, Levine A, Bedos C, Mojon P, Rosberger Z, Feine J, et al.
Refusal of implant supported mandibular overdentures by elderly patients. Gerodontology 2011;28:62-8.
Zimmer CM, Zimmer WM, Williams J, Liesener J. Public awareness and acceptance of dental implants. Int J Oral Maxillofac Implants 1992;7:228-32.
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;14:621-33.
Chowdhary R, Mankani N, Chandraker NK. Awareness of dental implants as a treatment choice in urban Indian populations. Int J Oral Maxillofac Implants 2010;25:305-8.
Vasak C, Fiederer R, Watzek G. Current state of training for implant dentistry in Europe: A questionnaire-based survey. Clin Oral Implants Res 2007;18:xiii-xx.
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;22:223-9.
Al-Johany S, Al Zoman HA, Al Juhaini M, Al Refeai M. Dental patients' awareness and knowledge in using dental implants as an option in replacing missing teeth: A survey in Riyadh, Saudi Arabia. Saudi Dent J 2010;22:183-8.
Müller F, Salem K, Barbezat C, Herrmann FR, Schimmel M. Knowledge and attitude of elderly persons towards dental implants. Gerodontology 2012;29:e914-23.
Berge TI. Public awareness, information sources and evaluation of oral implant treatment in Norway. Clin Oral Implants Res 2000;11:401-8.
Awooda EM, Eltayeb AS, Hussein SA, Dayelnaiem ID, Abdelhamied MA, Mohamed LA, et al
. Knowledge, attitude and acceptance of dental implants among patients attending Khartoum dental teaching hospital. Int Organ Sci Res J Dent Med Sci 2014;13:19-23.
Suprakash B, Ahammed AR, Thareja A, Kandaswamy R, Nilesh K, Bhondwe Mahajan S. Knowledge and attitude of patients toward dental implants as an option for replacement of missing teeth. J Contemp Dent Pract 2013;14:115-8.
Ozçakir 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.
Rustemeyer J, Bremerich A. Patients' knowledge and expectations regarding dental implants: Assessment by questionnaire. Int J Oral Maxillofac Surg 2007;36:814-7.
Bhat AM, Prasad KD, Sharma D, Hegde R. Attitude toward desire for implant treatment in South Coastal Karnataka population: A short-term epidemiological survey. Int J Oral Implantol Clin Res 2012;3:63-6.
Prashanti E, Mohan M. Awareness of dental implants among undergraduate dental students at Mangalore, India. Indian J Appl Res 2013;3:1-2.
[Table 1], [Table 2], [Table 3], [Table 4]