|Year : 2019 | Volume
| Issue : 3 | Page : 226-231
Knowledge, attitude, and practice of general dentists toward cone-beam computed tomography and dental radiology
Aditi Thakkar, Amit Reche, Shivangi Srivastava, Nandini Nade, Sukeshani Jagtap, Gargi Nimbulakar
Department of Public Health Dentistry, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
|Date of Submission||15-Jul-2019|
|Date of Decision||22-Jul-2019|
|Date of Acceptance||20-Aug-2019|
|Date of Web Publication||2-May-2020|
Dr. Amit Reche
Department of Public Health Dentistry, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences, Wardha, Wardha, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Oral cavity is a sort of “No Man's Land” to the general practitioners of medicine and dentistry. As dentistry moves into medical and wellness model, the incorporation and proper utilization of advanced diagnostic technologies is essential. Diagnostics have a decisive impact of continuum of care and this early diagnosis help in disease prevention, knowing early disease stage when symptoms are just beginning to appear. The introduction of cone-beam computed tomography (CBCT) heralds true paradigm shift from two-dimensional to three-dimensional approach to data acquisition and image reconstruction. Aim: The aim of this study was to evaluate’ knowledge, attitude, and practice of general dentists toward CBCT and dental radiology. Objectives: This study was conducted to assess the knowledge, attitude, and practice of general dentist toward CBCT and dental radiology. Materials and Methods: A questionnaire survey dealing with knowledge, attitude, and practice used in dental radiology was conducted among 250 dental practitioners in Sharad Pawar Dental College, Sawangi (Meghe), Wardha and private dental clinics of Vidharbha region of Central India. Furthermore, written consent was taken from each individual who were willing to participate in the study. A total of 250 dentists participated in the survey, including Master of Dental Surgery (MDS) and Bachelor of Dental Surgery (BDS), working as a faculty and/or general practitioner, intern, and postgraduate. The questionnaire consisted of two principle parts – the first part requested the demographic details of respondents. In the second part, they were questioned about the clinical method relating to the use of CBCT, the type of radiography they use, the guidelines they follow, and the technologies they prefer. The analysis was done using SPSS version 16.0. Results: There were 63.6% of BDS practitioners and about 35.7% MDS practitioners; it was observed that more than 63% of the practitioners had advised their patients for CBCT scan. Furthermore, around 81.6% of practitioners were satisfied with the use of CBCT and 72% of them had the view that it should be used for selected dental applications in the future as well. There were 88.8% of the practitioners who believed that there should be regular training or hands-on courses or evaluation o CBCT scan. Around 41.2% of participants opiated that workshop will help enhance the knowledge concerned with CBCT. Conclusion: Therefore, the present study showed better awareness of CBCT among dental practitioners and it also highlighted that majority of participants believed that CBCT was an ultimate diagnostic tool in dentistry and research.
Keywords: Computed tomography, cone-beam computed tomography, X-ray
|How to cite this article:|
Thakkar A, Reche A, Srivastava S, Nade N, Jagtap S, Nimbulakar G. Knowledge, attitude, and practice of general dentists toward cone-beam computed tomography and dental radiology. J Datta Meghe Inst Med Sci Univ 2019;14:226-31
|How to cite this URL:|
Thakkar A, Reche A, Srivastava S, Nade N, Jagtap S, Nimbulakar G. Knowledge, attitude, and practice of general dentists toward cone-beam computed tomography and dental radiology. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2020 May 28];14:226-31. Available from: http://www.journaldmims.com/text.asp?2019/14/3/226/283583
| Introduction|| |
Oral cavity is a sort of “No Man's Land” to the general practitioner of medicine and dentistry. As dentistry moves into medical and wellness model, the incorporation and proper utilization of advanced diagnostic technologies is essential. Diagnostics have a decisive impact on continuum of care and this early diagnosis helps in disease prevention, knowing prior disease stage when symptoms are just starting to appear. It also helps to know the outcome (prognosis) of disease and management of cases such as oral squamous cell carcinoma, to know whether disease is curable, to decide the line of treatment, to prescribe medicine, to select potency of medicine, and to evaluate the new symptoms. The present-day technology gives doctors many choices to diagnose the patient condition. Diagnostic radiology uses various noninvasive routes. Examples of it include ultrasound, CT scans, magnetic resonance imaging (MRI), and nuclear medicine scans. Dental radiographs are known as X-rays. All these possess major disadvantage of higher doses of radiation and two-dimensional (2D) approach to data acquisition and image reconstruction. Hence, cone-beam computed tomography (CBCT) can be new mechanics in modern dentistry and can be preferred imaging modality up to the minute, which can provide higher definition of images for local surgeries that will not take long time without any advance appointment.
CBCT has been available to dentists since 1990s and is an important diagnostic adjunct now with its most recent applications in radiotherapy guidance and mammography. The introduction of CBCT has led to a shift from 2D to three-dimensional (3D) approach, which is groundbreaking since the process of decision-making has become simpler and it has given an opportunity to the clinician to examine oral and maxillofacial region without superimposition and distortion of images. It has various advantages as it is less expensive and involves a smaller system, requires less space, has rapid scan time, lowers the radiation doses, and has exclusive display modes that offer maxillofacial imaging.,,, The disadvantages include scattered radiation, limited soft-tissue contrast, and limited contrast resolution. Indications for CBCT in dentistry include detection of missed canals and root perforation in endodontics, localizing the impacted teeth, detection of position and effects of supernumerary teeth on the surrounding dentition, evaluation of mandibular nerve position, presurgical evaluation of maxillary sinus, analysis of temporomandibular joint (TMJ) and its disorders associated with degenerative pathologies or abnormalities in the bony structures of condyles, glenoid fossa, and articular eminence, implant planning, for the measurement of bone architecture in putative implant sites to be made,, assessment of bone for signs of infections, cysts or tumors.
Hence, CBCT is a widely accepted imaging tool for variety of dental and nondental applications. Notwithstanding the fact that dental CBCT has advanced appreciably over the last decade, there is yet lot of scope for optimization of this modality. In this perspective, the present study aims to assess the knowledge, attitude, and practice of general dentists toward CBCT and dental radiology, which will give an outline of CBCT device, its applications, and help in understanding the underlying technology. Furthermore, it also focuses on its “emerging” role in dentistry.
| Materials and Methods|| |
A questionnaire survey dealing with knowledge, attitude, and practice used in dental radiology was conducted among 250 dental practitioners working in private dental clinics and clinicians of Vidharbha region of Central India. Furthermore, written consent was taken from each individual who was willing to participate in the study. A total of 250 dentists participated in the survey, including Master of Dental Surgery (MDS) from all specialties of dentistry and Bachelor of Dental Surgery (BDS), working as a faculty and/or general practitioners, intern, and postgraduate (PG).
The questionnaire consisted of two principal parts. The first part requested the personal details of the respondents regarding qualification, years of practicing etc., without asking names to ensure anonymity of responses [Questionnaire 1].
In the second part, the respondents were questioned about the clinical methods relating to the use of CBCT, the types of radiography they use, the guidelines they follow, and the technologies they prefer.
The data were assessed using SPSS version 16 software developed by IBM, Chicago, Illinois, USA.
| Observations and Results|| |
The pro forma consisted of questions which were divided into knowledge based, attitude and practice based, and attitude based. The questions were not designed to test the knowledge of the clinician but also muster the opinion about augmentation required for increasing awareness toward the use of CBCT.
Respondent and practice profile
The distribution of respondents according to qualification is as follows: 63.6% practitioners are BDS and about 35.7% practitioners are MDS.
[Table 1] shows the distribution of respondents according to the category: 21.2% of practitioners are PGs, majority of them (48.4%) are interns, and about 11.6% and 18.8% of them are general practitioners and faculties, respectively.
On analysis among study population related to years of practicing, it was found that 71.2% have <5 years of experience, whereas 12.8%, 8.0%, and 7.6% have 5–10 years, 11–15 years, and >15 years of experience, respectively [Table 2].
Analysis of data in accordance with knowledge, attitude, and practice
[Graph 1] shows that approximately 62.8% of practitioners have obtained their knowledge via lectures, 22.0% by way of CDE, 14.4% through internet source, and 0.8% by other means. Furthermore, 77.20% of them believed that CBCT has low radiation dose, whereas 11.20% believed that it has same radiation dose as of computed tomography (CT) and the remaining 1.6% believed that CBCT has higher radiation dose than that of CT. About 54.8% of dental practitioners assumed that the radiations used in CBCT are nonionizing, whereas 44.4% assumed it as ionizing. Panoramic radiographs were favored by 19.2% of the dental population for digital imaging, whereas 8.8% preferred cephalometric and periapical type of radiography, 5.6% of them considered posteroanterior radiograph as the suitable one, and, surprisingly, 57.6% were of opinion that digital imaging is relevant in all types of above-mentioned radiographs. As seen from the results, CBCT was the imaging method of choice among the participants with the highest percentage (47.20%), followed by MRI (27.60%), CT (17.20%), and conventional radiography (8.0%). Furthermore, maximum participants (72.0%) said that they will use CBCT for selected dental applications in future, whereas 11.6% of them said that they will not use it and the rest (16.4%) have no idea about it [Graph 2]. It was found that approximately 97.60% of dentists have heard about CBCT, whereas 2.40% have not [Table 3].
[Graph 2] shows that about 74.8% of the participants were aware of the fact that CBCT could be advised for endodontic purpose for single tooth, whereas 25.2% of them were not. In the study conducted, it was also seen that 41.2% of the dental practitioners obtained their knowledge; 36.0%, 14.0%, and 7.6% reported of obtaining the same by the means of lectures, seminars, and symposiums, respectively. It was also seen that around 1.2% were not interested. Majority of the participants (88.8%) affirmed that there should be regular training or hands-on course for the evaluation of CBCT scan, whereas the rest (11.2%) did not find any need for such. Approximately 97.2% of the dental professionals favored that CDE should be held to enhance knowledge about advanced digital imaging, whereas 2.8% did not approve the same. Among the study population, the dominant 81.6% insisted that all the CBCT scans should be interpreted by an oral radiologist and pressed the need to sign all the reports by them only, whereas the minority (17.6%) thought that it was not necessary. On analyzing the level of satisfaction, it was found that majority of the participants (81.6%) were satisfied with the use of CBCT, whereas the rest of them (17.60%) were not.
[Graph 3] shows that among the participants in the survey conducted, 95.2% agreed that CBCT can be used for dental imaging, whereas 8.4% of them did not think so. Despite the various advantages of the CBCT technique, many practitioners admitted of not using it as an imaging modality in their clinical practice and blaming lack of awareness as the major reason (77.2%). Around 15.2% indicated that the procedure is tough to perform, and the remaining 3.2% feel that lack of knowledge and availability is the reason for not using it. Maximum percentage (73.2%) of the professionals have reported advising their patients for CBCT scan, whereas only 25.6% reported of never doing so. Approximately 73.2% of the dental professionals follow the guidelines when performing CBCT scan, whereas 25.6% admitted of not following the guidelines. In accordance with the results, CBCT is considered highly safe for patients with implants (49.20%), followed by pregnant women (27.2%) and patients with cardiac pacemakers (12.0%), and is considered least safe for children (11.6%). Furthermore, maximum participants (72.0%) said that they will use CBCT for selected dental applications in future, whereas 11.6% of them said that they will not use it and the rest (16.4%) have no idea about it [Graph 3]. Analysis of the results also concluded that 88.8% of the dentists thought that CBCT is an expensive technique, 5.6% felt that the imaging is of poor quality, around 3.20% found the image area in CBCT to be insufficiently wide, and the rest (2.0%) did not have necessary equipment to perform the same [Table 4].
| Discussion|| |
Imaging is a remarkable diagnostic inclusion to the clinical evaluation of dental patients. Commencement of CBCT to imaging of maxillofacial region is an astute as it has led to revolution in maxillofacial radiology aiding in the transition of 2D to 3D approach. CBCT is swiftly replacing conventional tomography because of its applications and benefits from viewing thin sections through the field of view without superimposition and distortion of images.
The study has attempted to grasp how dentists follow the principles and practices of customary and contemporary radiology. Category wise, it was found that maximum participants (97.6%) heard about CBCT and 77.2% of them used in their clinical practice. The findings were homogenous with the study conducted by Rai et al. who found in their study that CBCT was extensively used in their clinical practice because of high awareness with reference to use of CBCT among dental practitioners. This finding was also analogous with the study conducted by Balabaskaran and Srinivasan.
Among the 250 dental practitioners, approximately more than half of our sample (68.2%) got to know about CBCT through lectures, 22.0% via CDE, 14.40% via internet sources, and 0.8% via other means. These findings were comparable with the study conducted by Rai et al. and Balabaskaran and Srinivasan. This finding was also analogous with the study conducted by Cesur et al., Turkey, 2016. This may be because at university level, interaction with oral radiologists (via lectures, CDEs, etc.,) is easier and universities are the usual centers of “leading edge” technology. Furthermore, theoretical education is highly supplemented at the institutions. Second, methods of study at different places differ such as different regions of India (Western and South India) and different countries (Turkey).
According to the practitioners, 77.20% of them believed that CBCT has low radiation dose, whereas 11.20% believed that it has the same radiation dose as of CT and the remaining 1.6% believed that CBCT has higher radiation dose than that of CT. The findings were identical with a study conducted by Rai et al. They reported that CBCT delivers lowest radiation dose to the organs, whereas CT delivers the highest. However, surprisingly, the findings were not similar with the study conducted by Balabaskaran and Srinivasan, where approximately 65.85% of dentists had no idea and only 14.63% of the participants are under the impression that less radiation dose is the potential difference between CT and CBCT.
On analyzing the level of satisfaction, it was found that majority of the participants (81.6%) were satisfied with the use of CBCT, whereas the rest of them (17.60%) were not. The results were analogous with a study conducted by Rai et al. Similar results were also obtained in the study conducted by Balabaskaran and Srinivasan, where maximum participants (95.12%) were satisfied with the use of CBCT. This could be due to preference for digital versus conventional radiographs with technological advances.
A high fraction (57.6%) of dentists preferred digital radiography for all types of analysis (panoramic, cephalometric, posteroanterior, and periapical). This was the case in the study conducted by Cesur et al., Turkey, 2016. The need for allocation of CBCT setup at dental institute to enhance the knowledge about it was mostly by the means of workshops (41.2%). The findings are in accordance with a study conducted by Rai et al. Approximately 95.2% of the practitioners agreed that CBCT can be used for dental imaging. The main reason for CBCT recommendation can be due to its use in implant assessment, TMJ analysis, as well as diagnosis of cysts and tumors, and the results of our study were supported by the findings from Dölekoǧlu et al., Turkey.
About 72.0% of practitioners said that they will use CBCT for selected dental applications. Whereas, in a similar study done by Shetty et al., Mangalore, approximately 41.5% of dentists considered its use in selected dental applications. Furthermore, in a study conducted by Balabaskaran and Srinivasan, only 7.32% of them believed that it will not be used all areas of dentistry in routine dental practice and will have its use in selected applications.
When asked about reasons for not using digital imaging, about 222 (88.8%) answered of being expensive. The results were in accordance with the study conducted by Shetty et al., Mangalore.
The study could also have been carried out in other regions of India involving large group of population where there are differences in the methods of study as well as no usage of CBCT and where people rely on conventional methods for radiographic techniques. This could give us large variation in results showing those people who have no idea about CBCT and its advantages which would help to create awareness in those areas.
| Conclusion|| |
To draw the conclusion, exact knowledge about CBCT and oral radiology in dental fraternity is of paramount importance due to its wide applications in future as well. Taking into account the results of the present study, it is endorsed that OMR departments should organize various courses to update the knowledge toward different imaging modalities. Dentists including the specialists must acquire more and more knowledge about indications and contraindications, its advantages and disadvantages for its precise diagnosis, and further its preferable management which will amplify patients safety and ameliorate the clinical outcomes significantly.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| Questionnaire|| |
Questionnaire 1: Survey of knowledge, attitude and practice of CBCT and dental radiology by general dentists
We request you to kindly take a few minutes and answer the following questionnaire of our study “KNOWLEDGE, ATTITUDE AND PRACTICE OF GENERAL DENTISTS TOWARDS DENTAL RADIOLOGY AND CBCT“. Your identity will not be revealed at any point of the study and this information will be used only for study purpose. To take part in our study, be completely honest in answering the questions. Thank you for your cooperation.
| Questionaire|| |
- Qualification: (a) BDS (b) MDS
- Category: (a) PG (b) Intern (c) General practitioner (d) Faculty/Researcher
- Years of practicing: (a) <5 years (b) 5–10 years (c) 11–15 years (d) >15 years
- Have you heard about CBCT? (a) Yes (b) No
- How did you obtain knowledge about CBCT?
(a) Lectures (b) CDE (c) Internet
- What is the potential difference between CT and CBCT?
(a) Low radiation dose (b) Same radiation dose as of CT (c) Higher radiation doses than CT.
- Can you use CBCT for dentofacial imaging? (a) Yes (b) No
- Are you aware that CBCT can be advised for Endodontic purpose for single tooth?
(a) Yes (b) No
- The radiations used in CBCT are: (a) Ionising (b) Nonionising
- Through what means would you like to enhance your knowledge concerned with CBCT?
(a) Lectures (b) Seminars (c) Workshops (d) Symposium (e) Not interested
- Should there be a regular training or hands-on course for evaluation of CBCT scan?
(a) Yes (b) No
- Do you think CDE should be conducted to enhance your knowledge about advanced digital imaging?
(a) Yes (b) No
- Do you think that all CBCT scan should be interpreted by an oral radiologist and all reports be signed by them only?
(a) Yes (b) No
- Do you use CBCT as an imaging modality in your clinical practice?
(a) Yes (b) No
-If NO, what is the reason for not using in clinical practice?
(a) Lack of awareness (b) Lack of knowledge (c) Lack of availability (d) Tough to perform
- Do you use digital imaging technique for obtaining radiographs?
a) Yes (b) No (If NO, then why?)
(a) Expensive (b) Poor image quality (c) I do not have the necessary equipment (d) Image area is insufficiently wide
- For which type of radiography do you use digital imaging?
(a) Panoramic (b) Cephalometric (c) Posteroanterior (d) Periapical (e) All
- Have you ever advised your patients for CBCT scan?
(a) Yes (b) No
- Do you follow the guidelines for.when or when not to take CBCT scan?
(a) Yes (b) No
- Which one do you favour when you need 3D imaging of head and neck region?
(a) CT (b) CBCT (c) MRI (d) Conventional radiography
- Which technology would you prefer when you need 3D imaging of neck and head region?
(a) Computerized Tomography (CT) (b) Dental Volumetric Tomography/CBCT
- Is CBCT safe for?
(a) Pregnant women (b) Children (c) Patient with cardiac pacemakers (d) Patient with implants
- Are you satisfied with the use of CBCT? (If you use it).
(a) Yes (b) No
- Will you use CBCT in routine dental practice in future also?
(a) I wonft use it (b) Selected dental applications (c) No idea
- Mention the reasons for using digital imaging technique (multiple selection is permissible)
(a) Reduced radiation dose (b) Less time consuming (c) Opportunity for instant assessment (d) Ease of image storage (e)
Images can be adjusted (f) Measurements can be performed on images (g) Environmental harm is reduced.
| References|| |
Shetty SR, Castelino RL, Babu SG, Prasanna LA, Rangare A, Roopashri K. Knowledge and attitude of dentists towards cone beam computed tomography in mangalore – A questionaire study. Austin J Radiol 2015;2:1016.
Cesur MG, Yilmaz A, Ozer T. Knowledge and attitudes towards digital radiography and CBCT among orthodontists. Biomed Res 2016;27:3.
Lohe B, Kadu R. Risk Factors in oral Cancer. Oral Cancer: Causes, Diagnosis treatment; 2011. p. 279-94.
Agrawal A, Sinha A. Lymphoma of frontotemporal region with massive bone destruction and intracranial and intraorbital extension. J Cancer Res Ther 2008;4:203-5.
Goel V, Parihar PS, Parihar A, Goel AK, Waghwani K, Gupta R, et al
. Accuracy of MRI in prediction of tumour thickness and nodal stage in oral tongue and gingivobuccal cancer with clinical correlation and staging. J Clin Diagn Res 2016;10:TC01-5.
Choudhary AB, Motwani MB, Degwekar SS, Bhowate RR, Banode PJ, Yadav AO, et al
. Utility of digital volume tomography in maxillofacial trauma. J Oral Maxillofac Surg 2011;69:e135-40.
Rai S, Misra D, Dhawan A, Tyagi K, Khatri M. Knowlwdge awarenessand aptitude of general dentists towards dental radiology and CBCT: A questionaire study. J Indian Academy Oral Med Radiol 2018;30:110-5.
Scarfe WC, Farman AG. What is cone-beam CT and how does it work? Dent Clin North Am 2008;52:707-30, v.
Kamburoglu K, Kursun S, Akarslan ZZ. Dental students’ knowledge and attitudes towards cone beam computed tomography in Turkey. Dentomaxillofac Radiol 2011;40:439-43.
Balabaskaran K, Srinivasan A. Awareness and attitude among dental professional towards CBCT. J Dent Med Sci 2013;10:55-9.
Dölekoǧlu S, Fişekçioǧlu E, İlgüy M, İlgüy D. The usage of digital radiography and cone beam computed tomography among Turkish dentists. Dentomaxillofac Radiol 2011;40:379-84.
Jain D, Chaudhary M, Patil S. Neurofibroma of the maxillary antrum: A rare case. Contemp Clin Dent 2014;5:115-8.
] [Full text]
Deore SS, Dandekar RC, Mahajan AM, Patil R, Prakash N. Plexiform unicystic ameloblastoma: A rare variant of ameloblastoma. Case Rep Dent 2014;2014. doi: 10.1155/2014/146989.
[Table 1], [Table 2], [Table 3], [Table 4]