Artykuły w Czytelni Medycznej o SARS-CoV-2/Covid-19

Poniżej zamieściliśmy fragment artykułu. Informacja nt. dostępu do pełnej treści artykułu tutaj
© Borgis - New Medicine 2/2020, s. 51-59 | DOI: 10.25121/NewMed.2020.24.2.51
Maria Prokopczyk1, Zuzanna Piotrkowicz1, *Anna Turska-Szybka2
The attitude of polish dentists towards children treatment
Stosunek polskich dentystów do leczenia dzieci
1Students’ Scientific Group by Department of Pediatric Dentistry, Medical University of Warsaw, Poland
Tutor: Associate Professor Anna Turska-Szybka, DDS, PhD
2Department of Pediatric Dentistry, Medical University of Warsaw, Poland
Head of Department: Professor Dorota Olczak-Kowalczyk, PhD, DMD
Streszczenie
Wstęp. Stosunek dentysty do leczenia dzieci wpływa na powodzenie leczenia stomatologicznego i może być ukształtowany przez system opieki zdrowotnej, odpowiednie przygotowanie do leczenia młodych pacjentów oraz wykorzystanie różnych metod współpracy.
Cel pracy. Celem pracy było przedstawienie podejścia lekarzy dentystów do leczenia pacjentów nieletnich oraz omówienie wykonywanych procedur leczniczych i czynników wpływających na komunikację i planowanie leczenia.
Materiał i metody. Badaniem objęto 736 dentystów. Ankieta składała się z 46 pytań i poruszała tematy dotyczące: danych socjodemograficznych, ilości leczonych dzieci, premedykacji farmakologicznej, wizyt adaptacyjnych, leczenia zębów mlecznych i stałych niedojrzałych, metod behawioralnych kształtowania postawy dziecka, niewspółpracujących pacjentów oraz dentofobii.
Wyniki. Do ostatecznej analizy zakwalifikowano 577 ankiet. Kobiety stanowiły 85,4% badanych, mężczyźni – 14,6%. Średni wiek wynosił 33 ± 8,2 roku. Jedynie 17,9% respondentów posiadało specjalizację, w tym 24,3% z pedodoncji. Spośród ankietowanych 85,1% leczyło małe dzieci w wieku do lat 6. Leczenie zębów mlecznych bez znieczulenia miejscowego przeprowadzało 18,5% stomatologów. Według 84,9% respondentów możliwe było pokonanie dentofobii u dziecka dzięki wizytom adaptacyjnym. Zabiegi profilaktyczne wykonywało 98,0% lekarzy, premedykację farmakologiczną – 16,7%. Spośród dentystów 93,5% wykorzystywało cement szkło-jonomerowy do odbudowy zębów mlecznych. Dzieci niewspółpracujące kierowało na leczenie w znieczuleniu ogólnym 71,5% respondentów. Niepełnosprawnych pacjentów przyjmowało 60,5% ankietowanych. Z unieruchomienia dziecka korzystało 40,1%. Co szósty respondent wyrażał zainteresowanie kursami z zakresu pedodoncji.
Wnioski. Przeważająca ilość dentystów leczy dzieci, również najmłodsze do 6. roku życia oraz dzieci niepełnosprawne. Prawie każdy lekarz wykonuje zabiegi z zakresu profilaktyki. Istnieje silna korelacja pomiędzy wiekiem lekarza dentysty a rodzajem stosowanych metod leczenia. Niewspółpracujące dzieci kierowane są do leczenia w znieczuleniu ogólnym. Możliwe jest pokonanie dentofobii u młodych pacjentów dzięki odpowiednio zaplanowanym wizytom adaptacyjnym.
Summary
Introduction. The dentist’s attitude towards treating children influences the success of dental treatment and can be shaped by the healthcare system, appropriate preparation for treating young patients, and the use of various methods of cooperation.
Aim. The aim of the study was to present the dentists’ approach to the treatment of juvenile patients and to discuss treatment procedures and factors, which have an influence on communication and treatment planning.
Material and methods. The study included 736 dentists. The questionnaire consisted of 46 questions and covered topics related to socio-demographic data, number of treated children, pharmacological premedication, adaptation visits, treatment of deciduous and immature permanent teeth, behavioral methods of shaping the child’s attitude, non--cooperative patients as well as dentophobia.
Results. Amount of 577 questionnaires were qualified for the final analysis, women: 85.4%, men: 14.6%. The mean age was 33 ± 8.2 years. Only 17.9% of the respondents had a specialization, including 24.3% in pedodontics. Among the respondents, 85.1% treated young children up to the age of 6. Treatment of deciduous teeth without local anesthesia was performed by 18.5% of dentists. According to 84.9% of the respondents, it was possible to overcome the child’s dentophobia thanks to adaptation visits. Prophylactic procedures were performed by 98.0% of physicians, while pharmacological premedication was used by 16.7%. As much as 93.5% of dentists used glass ionomer cement to restore deciduous teeth. Non-cooperative children were referred to treatment under general anesthesia by 71.5% of the respondents. Disabled patients were treated by 60.5%. Every fourth dentist used child immobilization and every sixth expressed an interest in pedodontics courses.
Conclusions. The vast majority of dentists treat children, including the youngest up to 6 years old, as well as disabled children. Almost every dentist performs preventive treatment. There is a strong correlation between the age of the dentist and the type of treatment used. Uncooperative children are referred for treatment under general anesthesia. It is possible to overcome dentophobia in young patients thanks to properly planned adaptation visits.
Introduction
Research conducted by the University of Warwick has shown that 81.0% of dentists see a child with neglected teeth at least once a week (1). The dentist’s attitude determines not only the final result of the treatment, but also whether the young patient agrees to any preventive or therapeutic procedure during the visit. The influence of the dentist is so strong that child’s memories and experiences from the office affect the frequency of brushing their teeth (2). According to Yamada et al. (3), there is a large group of cooperating patients with severe fear of visiting the office, as well as non-cooperative patients without dental anxiety. According to Swedish dentists, every second preschool patient cannot distinguish pain from discomfort (4). This shows the importance of dentist’s positive attitude towards the child, talking to the patient and making him aware of the type of stimuli experienced during dental treatment.
There are large statistical differences in the behavioral methods used by dentist depending on their age and gender (5). The method of contact and building the trust is a paramount element in establishing cooperation between the dentist, patient and parents.
Aim
The aim of the study was to present the attitude of dentists to the treatment of young patients, to discuss the way of performing dentals procedures and to point out the factors influencing methods of communication method and treatment planning.
Material and methods
The study included 736 dentists. A positive opinion was obtained from the Bioethics Committee of the Medical University of Warsaw, No. AKBE/74/2018. The responses were obtained voluntarily and anonymously on paper questionnaires and electronically within 8 months (April-November 2018). The survey consisted of 46 questions (3 open, 31 single choice, 12 multiple choice). The first part of the questionnaire included questions about socio-demographic data. The second part was only about dentists treating children and it discussed the topic of pharmacological premedication, adaptation and prophylactic visits, methods of dental treatment, influence on the child’s behavior in the office, behavioral methods of shaping the child’s attitude, working with a non-cooperative patient as well as dentophobia.
The criterion for qualifying the questionnaire for further analysis was all questions answered by the dentist.
The obtained data were analyzed using descriptive statistics and Spearman’s correlation for pairwise comparison, as well as a t-test to compare two groups (significance level 0.05). The analysis was performed in the Statistica 13 program.
Results
Amount of 577 surveys were qualified for the final analysis. The socio-demographic data of the surveyed dentists is presented in table 1.
Tab. 1. Socio-demographic data of the surveyed dentists
Parameters  n = 577
NumberPercentage
Gender Female49385.4
Male8414.6
Length of work (in years)1-1042373.3
11-208314.4
21-30579.9
> 30142.4
WorkplaceCity50387.2
Village366.2
Both386.6
Labor sectorPrivate office28148.7
Private office & National Health Service office27046.8
National Health Service office264.5
The surveyed dentists were aged from 23 to 72 years, the mean age was 33 ± 8.2 years, and the average period of professional work was 8.7 ± 8.4 years. Only 17.9% had specializations, including general dentistry (30.1%), pediatric dentistry (24.3%) and restorative dentistry with endodontics (17.5%).
Children up to 6 years old were treated by 85.1% of dentists. One of the most common reasons for treating children was a curative need for the treatment of children (66.6%) (tab. 2). Young children were not treated by 14.9% of dentists because: “they are difficult and non-cooperative patients” (69.8%), “children require more time” (50.0%) and because of “additional skills required in the treatment of children” (31.4%).
Tab. 2. Answers to selected survey questions
Parameters  n = 577
NumberPercentage
Reason for treating children Ability to work with children237/49148.3
Willingness to treat children142/49128.9
The curative need for treatment of children327/49166.6
Working with children was imposed to the dentist166/49133.8
Treatments performed on children with deciduous teethExtractions476/49196.9
Pulpotomy434/49188.4
Post-traumatic treatment336/49168.4
Impregnation270/49155.0
Restorative treatment480/49197.6
Root canal treatment211/49143.0
Prophylaxis469/49195.5
Prophylactic treatmentHygiene instruction and recommendations467/48197.1
Fissure sealing441/48191.7
Scaling371/48177.1
Sandblasting122/48125.4
Fluoridation466/48196.9
Activities performed during prophylactic visitProphylactic treatment466/48196.9
Assessing oral hygiene indexes110/48122.9
Hygiene instruction417/48186.7
Delegating dental assistant to provide patient with hygiene instruction75/48115.6
Recommending appropriate hygiene tools344/48171.5
Motivation275/48157.2
Materials used for deciduous teeth reconstructionComposite377/49176.8
Stainless steel crowns15/4193.1
Glass-ionomer cement459/41993.5
Others e.g. ormocer, zincum oxide with eugenol4/4190.8
Compomer161/41932.8
Amalgam47/4199.5
Applying the amputation treatmentYes453/49192.3Vital pulpotomy309/45368.2
After devitalization291/45364.2
No38/491 7.7
Dentists treated an average of 14.2 ± 13.6 children per week. Dentists with specialization treated on average more children per week (19.7 ± 18.2) than dentists without specialization (13.3 ± 12.6). Pedodontists admitted 36.9 ± 17.3 children.
Among the respondents, 60.5% treated children with disabilities, 21.7% used nitrous oxide sedation, and 8.4% performed procedures under general anesthesia. The majority of dentists referred their patients to treat them under general anesthesia (69.8%). The correlation coefficient between these variables was 0.125 and was statistically significant. Pharmacological premedication was used by 16.7% of physicians who used hydroxyzine (74.4%) more often than midazolam (42.7%). Less than three-fourths of the respondents (70.5%) carried out independent adaptation visits. Almost all (98.0%) performed prophylactic procedures, more often together with treatment (59.5%) than as an independent preventive visit (40.5%).
Every second dentist assessed the risk of caries (47.3%), and 17.8% used additional caries risk assessment questionnaires, such as CAMBRA (Caries Management by Risk Assessment) and CAT (Caries-risk Assessment Tool). Every third dentist (34.6%) left deciduous teeth in the oral cavity with an open pulp chamber until the tooth was replaced. About 18.5% of the respondents did not anesthetize deciduous teeth for treatment, which was most often explained by the child’s greater fear of anesthesia than procedure, no need for anesthesia of the deciduous tooth and the patient’s lack of cooperation. Deciduous teeth were treated by root canal treatment in 41.3% of the subjects, and permanent teeth with incomplete root development by 65.4%. According to 42.8%, it took longer time for a child to perform the same procedure than for an adult.
The procedures with the highest frequency in children with primary dentition were extractions (96.9%), restorative treatment (97.6%) and prophylaxis (95.5%) (tab. 2). The most popular material for the reconstruction of deciduous teeth was glass-ionomer cement (93.5%). Amputation treatment was performed by almost all dentists (92.3%).
According to 12.4% of respondents, less interest in the specialization in pediatric dentistry was related to the limited number of places providing specialization courses. According to 10.8%, the number of trainings and courses which enable the development of knowledge in the field of pedodontics is insufficient, and 65.4% of dentists would be interested in such courses.
As many as 72.3% of dentists made their approach to children dependent on the parents’ upbringing style and on this basis, they selected methods of shaping the dental attitude. The respondents admitted that a dentist who treat children should be patient (93.1%), calm (87.8%) and empathetic (82.5%).
About 65% of dentists used behavioral methods of shaping child’s behavior, most often using the “tell-show-do” method (91.6%), then positive reinforcement (77.8%) and distraction (71.0%). The length of the dentist’s work experience was negatively correlated with the use of behavioral methods of shaping the child’s behavior, which was proved to be statistically significant.
Amount of 83.3% of dentists, including 52.0% of pediatric dentists, did not treat uncooperative young children and postponed the visit. When there was a need to immobilize the child, 4.5% of dentists asked for help from the dental assistant, and 35.6% from the parent. Instruments that prevent the child from closing mouth during the procedure were used by 28.5%. Non-cooperative children were referred for treatment under general anesthesia by 71.5% of dentists. The overwhelming majority (84.9%) considered it possible to cease dentophobia in young patients due to adaptation visits.

Powyżej zamieściliśmy fragment artykułu, do którego możesz uzyskać pełny dostęp.

Płatny dostęp tylko do jednego, POWYŻSZEGO artykułu w Czytelni Medycznej
(uzyskany kod musi być wprowadzony na stronie artykułu, do którego został wykupiony)

Aby uzyskać płatny dostęp do pełnej treści powyższego artykułu, należy wprowadzić kod:

Kod (cena 19 zł za 7 dni dostępu) mogą Państwo uzyskać, przechodząc na tę stronę.
Wprowadzając kod, akceptują Państwo treść Regulaminu oraz potwierdzają zapoznanie się z nim.

 

 

Płatny dostęp do wszystkich zasobów Czytelni Medycznej

Aby uzyskać płatny dostęp do pełnej treści powyższego artykułu oraz WSZYSTKICH około 7000 artykułów Czytelni, należy wprowadzić kod:

Kod (cena 49 zł za 30 dni dostępu) mogą Państwo uzyskać, przechodząc na tę stronę.
Wprowadzając kod, akceptują Państwo treść Regulaminu oraz potwierdzają zapoznanie się z nim.

Piśmiennictwo
1. Harris JC, Elcock C, Sidebotham PD, Welbury RR: Safeguarding children in dentistry: 2. Do paediatric dentists neglect child dental neglect? Br Dent J 2009; 206: 465-470.
2. Kowalczyk-Kustra O, Jarzębowska A, Zakrzewski J: Wpływ doświadczeń i emocji stomatologicznych rodzica na sposób kształtowania postawy stomatologicznej dziecka. Nowa Stomatol 2015; 2: 47-52.
3. Yamada MK, Tanabe Y, Sano T, Noda T: Cooperation during dental treatment: the Children’s Fear Survey Schedule in Japanese children. Int J Paediatr Dent 2002; 12: 404-409.
4. Wondimu B, Dahllöf G: Attitudes of Swedish dentists to pain and pain management during dental treatment of children and adolescents. Eur J Paediatr Dent 2005; 6(2): 66-72.
5. Adair SM, Schafer TE, Waller JL, Rockman RA: Age and gender differences in the use of behavior management techniques by pediatric dentists. Pediatr Dent 2007; 29(5): 403-408.
6. Olczak-Kowalczyk D, Mielczarek A, Kaczmarek U et al.: Stan zdrowia jamy ustnej i jego uwarunkowania u dzieci w wieku 6 lat. [W:] Olczak-Kowalczyk D (red.): Monitorowanie stanu zdrowia jamy ustnej populacji polskiej i jego uwarunkowań w latach 2016-2020. Ocena stanu zdrowia jamy ustnej i jego uwarunkowań w populacji polskiej w wieku 6, i 10 oraz 15 lat w 2018 roku. Oficyna Wydawnicza Warszawskiego Uniwersytetu Medycznego, 2019.
7. Oredugba FA, Sanu OO: Knowledge and behavior of Nigerian dentists concerning the treatment of children with special needs. BMC Oral Health 2006; 6: 9.
8. Abraham S, Yeroshalmi F, Margulis KS, Badner V: Attitude and willingness of pediatric dentists regarding dental care for children with developmental and intellectual disabilities. Spec Care Dentist 2019; 39(1): 20-27.
9. Dao LP, Zwetchkenbaum S, Inglehart MR: General Dentists and Special Needs Patients: Does Dental Education Matter? J Dent Educ 2005; 69(10): 1107-1115.
10. Kostopoulou MN, Duggal MS: A study into dentists’ knowledge of the treatment of traumatic injuries to young permanent incisors. Int J Paediatr Dent 2005; 15(1): 10-19.
11. Acharya S, Satpathy A, Prusty SN: Barriers in the Treatment of Early Childhood Caries among the General Dentists – A Cross Sectional Study in Bhubaneswar, Odisha, India. Pesq Bras Odontoped Clin Integr 2018; 18(1): e4489.
12. American Academy of Pediatric Dentistry: Guideline on periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents. Pediatr Dent 2013; 35(5): E148-156.
13. Kaczmarek U, Jackowska T, Mielnik-Błaszczak M et al.: Indywidualna profilaktyka fluorkowa u dzieci i młodzieży – rekomendacje polskich ekspertów. Nowa Stomatol 2019; 24(2): 70-85.
14. Garg S, Rubin T, Jasek J et al.: How willing are dentists to treat young children? A survey of dentists affiliated with Medicaid managed care in New York City, 2010. J Am Dent Assoc 2013; 144(4): 416-425.
15. Versloot J, Veerkamp JS, Hoogstraten J: Dental Discomfort Questionnaire: assessment of dental discomfort and/or pain in very young children. Community Dent Oral Epidemiol 2006; 34(1): 47-52.
16. Savage MF, Lee JY, Kotch JB, Vann WF Jr: Early preventive dental visits: effects on subsequent utilization and costs. Pediatrics 2004; 114(4): e418-e423.
17. Yokoyama Y, Kakudate N, Sumida F et al.: Dentists’ dietary perception and practice patterns in a dental practice-based research network. PLoS One 2013; 8(3): e59615.
18. Kaczmarek U, Majewska L, Olczak-Kowalczyk D: Postawa i wiedza stomatologów w zakresie profilaktyki fluorkowej. Nowa Stomatol 2015; 20(1): 23-28.
19. Riley JL 3rd, Qvist V, Fellows JL et al.: Dentists’ use of caries risk assessment in children: findings from the Dental Practice-Based Research Network. Gen Dent 2010; 58(3): 230-234.
20. Fellows JL, Gordan VV, Gilbert GH et al: Dentist and practice characteristics associated with restorative treatment of enamel caries in permanent teeth: multiple-regression modeling of observational clinical data from The National Dental PBRN. Am J Dent 2014; 27(2): 91-99.
21. Twetman S: Caries risk assessment in children: how accurate are we? Eur Arch Paediatr Dent 2016; 17(1): 27-32.
22. American Academy of Pediatric Dentistry: Clinical Affairs Committee-Behavior Management Subcommittee. Guideline on Behavior Guidance for the Pediatric Dental Patient. Pediatr Dent 2015; 37(5): 57-70.
23. Kaczmarek U, Grzesiak-Gasek I, Lisiecka K: Metody adaptacji dziecka do leczenia stomatologicznego stosowane przez stomatologów – doniesienie wstępne. Czas Stomat 2009; 62(1): 23-33.
24. Buchanan H, Niven N: Self-report treatment techniques used by dentists to treat dentally anxious children: a preliminary investigation. Int J Paediatr Dent 2003; 13(1): 9-12.
25. Brahm CO, Lundgren J, Carlsson SG et al.: Dentists’ skills with fearful patients: education and treatment. Eur J Oral Sci 2013; 121(3 Pt 2): 283-291.
26. Xia YH, Song YR: Usage of a Reward System for Dealing with Pediatric Dental Fear. Chin Med J (Engl) 2016; 20; 129(16): 1935-1938.
27. Babaji P, Chauhan PP, Rathod V et al: Evaluation of child preference for dentist attire and usage of camouflage syringe in reduction of anxiety. Eur J Dent 2017; 11(4): 531-536.
28. Shamsa S, Soika I, Turska-Szybka A et al.: Determinants of the use of dental care of deciduous teeth in children – questionnaires. Nowa Stomatol 2019; 24(1): 13-19.
29. Sheller B: Challenges of managing child behavior in the 21st century dental setting. Pediatr Dent 2004; 26(2): 111-113.
30. Lee DW, Kim JG, Yang YM: The Influence of Parenting Style on Child Behavior and Dental Anxiety. Pediatr Dent 2018; 40(5): 327-333.
31. Bruzda-Zwiech A, Wochna-Sobańska M, Szydłowska-Walendowska B: Assessment of Dental Anxiety Level, Its Sources and Impact on Dentition Status in 18-Year-Olds from the Lodz Region. Dent Med Probl 2007; 44(3): 343-350.
32. Pine CM, Adair PM, Burnside G et al.: Barriers to the treatment of childhood caries perceived by dentists working in different countries. Community Dent Health 2004; 21: 112-120.
33. Galeotti A, Garret Bernardin A, D’Antò V et al.: Inhalation Conscious Sedation with Nitrous Oxide and Oxygen as Alternative to General Anesthesia in Precooperative, Fearful, and Disabled Pediatric Dental Patients: A Large Survey on 688 Working Sessions. Biomed Res Int 2016; 2016: 7289310.
34. Ridell K, Borgstrom M, Lager E et al.: Oral health-related quality-of-life in Swedish children before and after dental treatment under general anesthesia. Acta Odontol Scand 2015; 73(1): 1-7.
35. American Academy of Pediatric Dentistry: Clinical Affairs Committee – Restorative Dentistry Subcommittee. Guideline on pediatric restorative dentistry. Pediatr Dent 2012; 34(5): 173-180.
36. Burke FJ, McHugh S, Shaw L et al.: UK dentists’ attitudes and behaviour towards Atraumatic Restorative Treatment for primary teeth. Br Dent J 2005; 199(6): 365-372.
37. Kaczmarek U, Chłapowska J, Pawlaczyk K et al.: Wybór materiałów do wypełnien? zębów mlecznych przez polskich stomatologów. Czas Stomat 2007; 5: 289-298.
38. Rønneberg A, Strøm K, Skaare AB et al.: Dentists’ self-perceived stress and difficulties when performing restorative treatment in children. Eur Arch Paediatr Dent 2015; 16(4): 341-347.
39. Olczak-Kowalczyk D, Samul M, Góra J et al.: Ferric Sulfate and Formocresol pulpotomies in paediatric dental practice. A prospective-retrospective study. Eur J Paediatr Dent 2019; 20(1): 27-32.
40. Fukai K, Ohno H, Blinkhorn A: A cross-sectional survey investigating care of the primary dentition by paediatric dental specialists in Japan and the UK. Int Dent J 2012; 62(4): 203-207.
otrzymano: 2020-04-23
zaakceptowano do druku: 2020-05-14

Adres do korespondencji:
*Anna Turska-Szybka
Zakład Stomatologii Dziecięcej Warszawski Uniwersytet Medyczny
ul. Binieckiego 6, 02-097 Warszawa
tel.: +48 (22) 116-64-24
anna.turska-szybka@wum.edu.pl

New Medicine 2/2020
Strona internetowa czasopisma New Medicine