Knowledge, Awareness and Attitude towards Prosthodontic Rehabilitation among the General Population in Bengaluru City - A Cross-Sectional Survey

Introduction

Edentulism remains a major form of disease worldwide leading to functional limitation and also physical, psychological and social disability. Various prosthetic treatment modalities are available for the patients to replace their missing teeth that includes removable partial dentures or fixed partial dentures, complete dentures, implants etc.^1,2 Understanding the mind-set of the general population for the replacement of the missing teeth, further acknowledgment and attending to the needs, play an important role in their acceptance of the prosthetic rehabilitation.³ Involvement of a broader range of individuals in the evaluation of prosthodontic rehabilitation is very important and hence the attitude of not just patients visiting the dental practitioners, but also the entire general population is required. An analysis of the attitude towards prosthodontic rehabilitation of the entire community provides us the valuable insights that are not ordinarily gained in dental practice, and also, such a study tells us what people know about certain things, how they feel and how they behave towards it.^{4- 9} Literature search reveals that there is no documented evidence regarding the prosthodontic health status and prosthetic rehabilitation needs of the Bengaluru general population.¹⁰ Hence the present survey was undertaken to explore the knowledge, awareness and attitude towards prosthodontic rehabilitation among the general population in Bengaluru city.

Methods

Sample size calculation

N= (4Pq/ L2) D

Where,

P=prevalence value=55.7% (17)

L= Allowable error = 5% of p value= 2.8

D= Design effect = 2, q= (1-P) = 44

Therefore, N= (4×56×44×2) / (2.8× 2.8) = 2514 Approximated to 2516.

A total of 2516 subjects gave their consent (Annexure1) and participated in the survey. A self-made questionnaire (Annexure-II) which was written either in English/ Kannada language was given to the participants. The self-made questionnaire had two parts. Part 1 had the provision to collect the socio-demographic data, while Part 2 had sixteen closed ended questions (out of which six were awareness based, five were knowledge based and five were attitude based). Strategies for coding were developed and applied in the questionnaire for the purpose of statistical analysis.

Bengaluru city was arbitrarily divided into four zones namely, North, South, East and West for administrative purposes. From each zone, 629 participants were selected using multistage random sampling technique.

The above diagram represents how the multi-stage random sampling was done in one zone and the same methodology was applied in all the four zones in order to arrive at the sample size of 2516.

Stage 1: One Corporation Ward in each zone was randomly selected (From four zones, we will have four corporate wards).

Stage 2: From each ward four localities were sampled randomly (Four localities from each ward amounts to sixteen localities).

Stage 3: Four lanes from each locality were randomly selected (Four lanes from each locality and sixteen localities out of four wards amounts to sixty-four lanes).

Stage 4: Eligible participants in the households from one end of the lane to another end were surveyed. Selection criteria

Inclusion criteria

Subjects belonging to the age group of 35-74 years, both males and females.

Exclusion criteria

 Participants with psychological disorders were excluded

 Participants who were unable to comprehend and respond to the questions were excluded

 The persons associated with dentistry were excluded from the study.

Statistical analysis: The responses from all the questionnaires containing 16 closed ended questions were analysed for descriptive statistics using SPSS software (Version-22). The level of significance was kept at 5%. The interpretation of the statistical analysis of the compiled data is as follows.

Results

Among 2516 subjects, 70.3% (1768) subjects belonged to the age group 35 to 55 years and 29.7% (748) belonged to the age group 55 to 74 years.

Among 2516 subjects, 51% were male and 49% were female participants.

Among the 2516 subjects, 11.6% visited the dentist once in 6 months, 11.2% visited once in 12 months and 77.2% visited only when there was a problem.

45.5% of subjects had got their missing teeth replaced, 54.4% had not got their missing teeth replaced. 71.3% of subjects were aware that the missing teeth had to be replaced, whereas 28.7% were unaware of it.

78.5% of subjects left it to their respective dentists to decide regarding their prosthetic treatment; 15.4% would decide themselves regarding their prosthetic treatment, 6.1% of the subjects did not know.

After the prosthetic treatment, 73.4% thought that quality of life will improve, 5.4% thought it will not improve and 21.3% did not know if there would be any changes in their general wellbeing.

74.9% of subjects thought that the cost of prosthesis is expensive, 23.3% thought that it was not expensive, 2.8% did not know if the prosthetic treatment is expensive or not.

64.9% of the participants had missing teeth and 35.1% of them had all the teeth present.

22.3% of subjects were edentulous for a duration of 0-6 months, 13.3% were edentulous for a duration of 6-12 months and 29.3% were edentulous for more than a year.

71.3% of the participants were aware that the missing teeth have to be replaced while the remaining 28.7% were not aware of the same.

The prime concern or expectation from prosthetic treatment in 11.6% subjects was speech, was functional purpose in 48.5% and appearance in about 10.1%. 19.4% were concerned about speech, function and appearance, while 10.4% were not interested in any of it.

8.2% of the subjects did not get the prosthetic treatment done with the fear of swallowing the prosthesis, 7.8% had a fear of dislodgement of prosthesis, 11.6% had a fear of gagging, 12.6% had a fear of discomfort, 9.5% had a fear of allergic reaction, 50.3% subjects did not respond as to why they did not take prosthetic treatment.

59.8% subjects felt that artificial teeth do help in reducing the problems caused by the missing teeth, 7.8% felt that artificial teeth do not help and 32.4% did not know if the artificial teeth will help improve their oral function.

59.4% would prefer to go to dental clinics for replacing their missing teeth, 29.3% would prefer to go to government hospitals, 10.2% prefer to go to dental colleges and 1.1% prefer other optional places for replacing their missing teeth.

38.2% knew about complete denture treatment, 14.9% knew about removable partial denture treatment, 15% knew about fixed partial denture, 11.4% knew about implants, 20.3% knew none of the treatments available and 0.2% knew all the treatments available for rehabilitation.

63.4% of subjects chose fixed prosthesis, 24.4% chose removable prosthesis and 12.2% did not know what type of prosthesis to choose.

34.9% of subjects thought implant is the best mode of treatment, 12.2% thought implant is not a better mode of treatment and 52.9% did not know if implant is better mode of treatment for replacing the missing teeth.

82.2% of subjects thought that prosthesis needs oral hygiene maintenance, 7.2% thought that prosthesis did not require oral hygiene maintenance and 10.6% did not know if the prosthesis required oral hygiene maintenance.

Discussion On analysing the responses of the subjects in Bengaluru city, it was found that restoring the function was the predominant reason to get prosthetic treatment which was same as in Jordan city (Edward Lynch, et al.).¹¹

Only 11.9% population in Bengaluru knew about dental implants whereas in entire South India about 17.8% population had knowledge about implants as reported by Mayya A, et al. ¹²

Around eighty two percent of the population in Bengaluru thought that oral hygiene maintenance of artificial prosthesis is a must, whereas in Jabalpur city it was 74.8% of population (Gupta S, et al.). In a study done by Al Quaran FA and his colleagues, about 60% of the population had good knowledge about the fixed prosthesis and 47.5% knew about removable partial dentures and 57% about dental implants. In Bengaluru city, 38.2% knew about complete denture treatment, 14.9% knew about removable partial denture treatment, 15% knew about fixed partial denture, 11.4% knew about implants, while 20.3% knew none of the treatments available and only 0.2% knew about all the treatments available for rehabilitation. However, the study by Al Quaran had only 200 participants.¹³

For prosthodontic rehabilitation, about 83.5% chose fixed partial denture as reported by Al Quaran FA and his colleagues while 63.4% of subjects chose fixed prosthesis in the present study.¹³

It was reported that 27.5% of people of Aseer region, Saudi Arabia were not aware that missing teeth has to be replaced, which is similar to the findings of present study where 28.7% were not aware of the same in Bengaluru city.¹⁴

In the present study, it was observed that 45.5% of the Bengaluru population had got their missing teeth replaced, whereas in Riyadh, Saudi Arabia, about 53.1% of people got their missing teeth replaced.¹⁵

Hence from the analysis, we can conclude that the knowledge, awareness and attitude levels can vary among the people due to various factors like age, gender, education, place etc. However, the subjects showed a positive attitude towards prosthetic treatment as it can restore normal function. It is hence important to develop practice guidelines and provide education and create awareness among the population for a better and healthy society.

Conflicts of Interest

None