Document Type : Original Article

Authors

1 Dental Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran

2 Department of Orthodontics, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran

3 Gastrointestinal Cancer Research Center, Cancer Research Institute, Mazandaran University of Medical Sciences, Sari, Iran

4 Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran

Abstract

Introduction: Orthodontics is defined as a branch of dentistry that deals with the correction of malocclusion. In this regard, determining the most appropriate time for orthodontic treatment is of utmost importance. General dental practitioners (GDPs) are normally the first link of the treatment chain of patients needing orthodontic treatments. The present study aimed to determine the GDPs’ knowledge of appropriate timing of orthodontic treatments in Sari, Iran. 
Material and methods: This descriptive, analytical and cross-sectional study was performed on GDPs working in Sari in 2019. The statistical population included 380 GDPs, 186 of whom were selected. Data were collected using a 24-item questionnaire is applied to evaluate the GDPs’ knowledge level of the appropriate timing of orthodontic treatments. Data analysis was performed in SPSS version 19.
Results: In total, 142 out of 186 GDPs participated in the study with a mean age of 36.12±10.15 years. 86 subjects (59.9%) had less than 10 years of work experience. Total mean (±SD) knowledge level of the GDPs was estimated at a moderate level (14.13±3.79). Percentage of the knowledge levels of poor, moderate and good was 12, 70, and 18, respectively. There was significant relationship between knowledge level and gender (P=0.013). Meanwhile, no association was observed between the work experience of the participants and their level of knowledge (P=0.393). 
Conclusions: According to the results of the present study, the total mean score of GDPs’ knowledge of appropriate timing of orthodontic treatments in Sari was moderate, and only 12% of the participants had poor knowledge level in this regard. It is notable that male subjects had a significantly higher knowledge level, and another analysis demonstrated the lack of effectiveness of work experience on the knowledge level of individuals. 

Keywords

Main Subjects

A malocclusion is defined as an irregularity of the teeth or a malrelationship of the dental arches beyond the range of what is accepted as normal, which affects the jaws, tongue and facial muscles (1, 2). Malocclusions are one of the major oral health problems ranking third after dental caries and periodontal disease (3). Even though malocclusion is not a pathological disease, it can negatively affect the quality of life due to causing difficulty in speech, mastication, and swallowing, and increasing a person's susceptibility to periodontal disease and dental traumatic injuries (4). It is notable that attempts to correct this disorder date back to at least 1000 before Christ (5).

Orthodontics is defined as a branch of dentistry that deals with the correction of malocclusion to achieve optimal functional occlusion and dental and facial aesthetics. In fact, orthodontic treatment is performed to correct the malocclusion. Possible disadvantages of malocclusion for individuals will affect their long-term health in three areas of dental, mental, and social health (6). In this regard, determining the most appropriate time for orthodontic treatment is of utmost importance. Some researchers believe that both effectiveness and efficiency of treatment depend on determining the best treatment time (7, 8).

General dental practitioners (GDPs) are normally the first link of the treatment chain of patients needing orthodontic treatments. Therefore, having knowledge of the appropriate time to initiate orthodontic procedures for referring to the relevant specialists seems necessary (9, 10). Providing timely treatment for patients in need of early management can prevent unsuitable and irreversible changes in soft and bone tissues and provide a proper environment for following dental growth (11). On the other hand, delayed treatment due to inadequate knowledge of dentists can have adverse effects such as complicated treatment, increased costs for patients, and the need for complex surgical treatments when a simple growth therapy would have sufficed (12). In addition, if treatment is started too early, there may be issues such as prolonged treatment or maintenance, tiredness, and lack of cooperation. Furthermore, very early treatment initiation can be associated with complications such as prolonged treatment or recovery period, treatment fatigue and lack of cooperation of patients (13).

Therefore, since most previous studies have evaluated the knowledge of diagnostic and treatment issues and few researches have focused on the proper timing of treatment, the present study aimed to determine the GDPs’ knowledge about appropriate timing of orthodontic treatments in Sari, Iran. 

 

Materials and Methods

This descriptive, analytical and cross-sectional study was performed on GDPs working in Sari in 2019. The statistical population included 380 GDPs, 186 of whom were selected by simple sampling based on the Morgan’s table. The research was conducted after receiving approvals from the ethics committee of biomedical research of Mazandaran University of Medical Sciences (Code: IR.MAZUMS.REC.1398.653). The subjects were entered into the study after obtaining a written informed consent. Notably, the participants were ensured of the confidentiality terms regarding their personal information. Data were collected using a questionnaire by Omrani et al. (2018) (6), the reliability of which were confirmed at the Cronbach’s alpha of 0.78. This 24-item questionnaire is applied to evaluate the GDPs’ knowledge level about appropriate timing of orthodontic treatments. A score of one is given to correct answers while incorrect answers are allocated zero points. Therefore, the score range considered for each person is 0-24, classified into three categories of low (1-8), moderate (9-16), and good (17-24) knowledge level (13). Moreover, information such as age, gender and work experience were recorded by the researcher. 

Data analysis was performed in SPSS version 19 using Chi-square. It is notable that a P-value of less than 0.05 was considered statistically significant. 

 

Results

In total, 142 out of 186 GDPs (87 men and 55 women) participated in the study with a mean age of 36.12±10.15 years. According to the results, 86 subjects (59.9%) had less than 10 years of work experience while 56 participants (39.4%) had equal to and more than 11 years. In addition, the total mean (±SD) knowledge level of the GDPs was estimated at a moderate level (14.13±3.79). Moreover, the percentage of the knowledge level of poor, moderate and good was 12, 70, and 18, respectively. 

There was a significant relationship between knowledge level and gender (P=0.013). In addition, 7% of women and 10% of men had a poor knowledge level in this regard. However, the knowledge level of men was higher, compared to women (Table 1). Meanwhile, no association was observed between the work experience of the participants and their level of knowledge (P=0.393). In total, the number of subjects with a work experience below 10 years was higher, compared to other participants. The results demonstrated that the participants with a work experience below 10 years had a better knowledge level, compared to those with more than 11 years of experience (Table 2).

 

Table 1. Relationship between knowledge level of participants and the variables of gender and work experience

Knowledge Level

Gender

N (%)

Male

Female

Poor

10 (11.5)

7 (12.7)

Moderate

68 (78.2)

32 (58.2)

Good

9 (10.3)

16 (29.1)

P-Value

0.013

 

Table 2. Relationship between the knowledge level of participants and the variable of work experience

Knowledge Level

Work Experience

N (%)

Below 10 years

Above 11 years

Poor

8 (9.3)

9 (16.1)

Moderate

61 (70.9)

39 (69.6)

Good

17 (19.8)

8 (14.3)

P-Value

0.393

 

Discussion

According to the results of the study, the overall mean GDPs’ knowledge level of the appropriate timing of orthodontic treatments in Sari was moderate and only 12% of the participants had poor knowledge level in this regard. In the present study, male subjects had a significantly higher level of knowledge, and work experience had no impact on the knowledge level of GDPs. However, over the past years of graduation, the average score of GDPs’ knowledge of the appropriate timing of orthodontic treatments has diminished. This could be justified by obsolete content and staying away from educational environments, and lack of continuity in reading reference materials. In this context, our findings are in line with the results obtained by Jafari et al. (14), who marked that the knowledge level of dentists decreased as time passed since their graduation. Nonetheless, the mentioned researchers conducted a study on knowledge of the hold space, which is only one of the many treatments for the primary and complex dental courses.

In 2018, Omrani et al. evaluated the GDPs’ knowledge level of the appropriate timing of orthodontic treatments in Isfahan, Iran, reporting a mean score of 14.37 (out of 24 scores) in this regard. In the end, the knowledge level of the participants was estimated at a moderate level, which demonstrated the necessity for improving this factor among GDPs (6). In this respect, our findings are congruent with the results obtained by the aforementioned study, which might be due to similar educational curricula in different schools of universities of medical sciences in the country. Omrani et al. also reported that the information of graduates in the 80s was higher than other participants, followed by those graduated in the 70s and before the 70s, respectively. This decrease in the knowledge level of GDPs with increased time since graduation was observed in the present research as well. While the mentioned association was significant in the research by Omrani et al., it was insignificant in our study, one of the reasons of which could be the participation of an equal number of people with a high work experience and those graduated for less than 10 years in the mentioned study, compared to the current research. 

In 2017, Naseri et al. evaluated the GDPs’ views and knowledge of the proper timing of orthodontic patients in Bandar Abbas, Iran. According to their results, the participants had an acceptable knowledge level, in a way that their maximum score was 34. Moreover, the subjects’ mean score was estimated at 19.71, which was acceptable considering that more than half of the score could be acquired (15). Given that the score of 19 was in the middle third of the range of scores, the mean knowledge of the population under study was at a moderate level.

One of the major drawbacks of the study was the lack of cooperation of some GDPs regarding the completion and delivery of questionnaires. In addition, there was a limited number of similar studies on the knowledge of orthodontic treatment of those working in the field of oral therapy in the country and the region, which limited the generalizability of the final results. Therefore, it is recommended that similar studies be conducted at various levels to gain the necessary information and improve knowledge among the workforce of the field. 

 

Conclusion

According to the results of the present study, the total mean score of GDPs’ knowledge of appropriate timing of orthodontic treatments in Sari was moderate, and only 12% of the participants had poor knowledge level in this regard. It is notable that male subjects had a significantly higher knowledge level, and another analysis demonstrated the lack of effectiveness of work experience on the knowledge level of individuals.

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