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
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.
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.
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.
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.
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|
|Length of work (in years)||1-10||423||73.3|
|Labor sector||Private office||281||48.7|
|Private office & National Health Service office||270||46.8|
|National Health Service office||26||4.5|
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|
|Reason for treating children ||Ability to work with children||237/491||48.3|
|Willingness to treat children||142/491||28.9|
|The curative need for treatment of children||327/491||66.6|
|Working with children was imposed to the dentist||166/491||33.8|
|Treatments performed on children with deciduous teeth||Extractions||476/491||96.9|
|Root canal treatment||211/491||43.0|
|Prophylactic treatment||Hygiene instruction and recommendations||467/481||97.1|
|Activities performed during prophylactic visit||Prophylactic treatment||466/481||96.9|
|Assessing oral hygiene indexes||110/481||22.9|
|Delegating dental assistant to provide patient with hygiene instruction||75/481||15.6|
|Recommending appropriate hygiene tools||344/481||71.5|
|Materials used for deciduous teeth reconstruction||Composite||377/491||76.8|
|Stainless steel crowns||15/419||3.1|
|Others e.g. ormocer, zincum oxide with eugenol||4/419||0.8|
|Applying the amputation treatment||Yes||453/491||92.3||Vital pulpotomy||309/453||68.2|
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.
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