Assessment of Knowledge, Attitude and Practice Regarding Effectiveness of Probiotics among General Dentists and Postgraduates: A Cross-sectional Study

Introduction

Probiotics are defined as, 'living microorganisms, principally bacteria, that are safe for human consumption and when ingested in sufficient quantities, have a beneficial effect on human health beyond basic nutrition' which has been approved by the United Nations This work is licensed under a Creative Commons Attribution-NonCommercial 4.0. Food and Agriculture Organization and World Health Organization. They are also referred as 'good bacteria' or 'supporting bacteria.¹

The World Health Organization has defined probiotics as, “Live microorganisms which when administered in adequate amounts confer a health benefit on the host.”²

These microorganisms belong to the natural human flora to survive in the acid environment during transit to the intestines. The probiotic organisms, which have been proven to be beneficial include Lactobacillus species, Bifidibacterium species, etc. The bacterial strains most widely used as probiotics belong to the species of Lactobacillus and the species reuteri is the most potent among all.

Lactobacillus reuteri is also known to have an immunomodulatory effect on the biofilm by suppressing human TNF production by lipopolysaccharide-activated monocytoid cells. The strains of Lactobacillus reuteri synthesize an anti-microbial compound named ‘reuterin’ (beta-hydroxypropionaldehyde) which has the ability to inhibit both gram negative and gram positive bacteria, along with other fungi and protozoal infections. Periodontitis is denoted by overt inflammation of gingiva along with loss of clinical attachment and most importantly resorption of alveolar bone. The main etiology for initiation of periodontitis is attributed to the presence of pathogenic bacteria that induce connective tissue changes to further set in the extensive progression of periodontal disease.³

Materials and Methods

This cross-sectional study was conducted among two hundred subjects. Ethical clearance for the study was obtained from the Institutional Review board of Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bangalore. A questionnaire was prepared and sent to all the participants as online google form. The questionnaire consisted of 15 questions among which five questions were related to knowledge, five questions were related to attitude and remaining five questions were related to practice.

The questionnaire was designed to asses the knowledge, attitude and practice regarding the effectiveness of probiotics among general practitioners and postgraduates. The google form questionnaire was distributed among general practitioners and postgraduates and the responses were collected.

Statistical analysis

Statistical Package for Social Sciences (SPSS) for Windows Version 22.0 (Released 2013, Armonk, NY: IBM Corp.,) was used to perform statistical analyses.

Descriptive statistics

Descriptive analysis of all the explanatory and outcome parameters was conducted using mean and standard deviation for quantitative variables, frequency and proportions for categorical variables.

Inferential statistics

Chi square Goodness of Fit test was used to compare the distribution of responses towards knowledge and awareness on probiotics in the treatment of periodontitis among the study subjects.

Chi square test was used to compare the responses between postgraduates and general practitioners towards knowledge and awareness on probiotics in the treatment of periodontitis.

The level of significance (P value) was set at P <0.05.

Results

A total of two hundred subjects participated in the study, among which 115 were general practitioners and 85 were postgraduate students (Table 1).

Majority of the participants in the study demonstrated good knowledge (Table 2), attitude (Table 3) and practice (Table 4) towards probiotics as there was statistical significance between the responses given by the study group.

Both the general practitioners and postgraduate students had good knowledge about the probiotics. However, on comparison, there was a statistical significant difference in the knowledge between general practitioners and postgraduates (Table 5).

General practitioners and postgraduate students showed better practice regarding probiotics, but on comparison, there was no statistical significant difference between them (Table 7).

The mean knowledge scores amongst general practitioners and postgraduate students were 2.99±1.673 and 3.32±1.5, respectively. On comparison between the groups, there was no statistical significant difference. The mean attitude scores amongst general practitioners and postgraduates were 2.28±1.6 and 2.29±1.5, respectively. On comparison, no statistical significant difference was found between the groups. The mean practice score values among general practitioners and postgraduate students were 2.83±1.3 and 3.16±1.35, respectively. On comparison between the groups, there was no statistical significant difference (Table 8).

Discussion

A recent study proposed that dental practitioners should be aware of the applications of probiotics in dentistry and their role in the treatment of oral diseases. Probiotics are living microbes that beneficially influence the host health and their uses are said to be an imperative aspect in dentistry which helps in circumvention and periodontal therapy.

The studies conducted by Fijan et al., and Ramah et al., reported that Bifidobacterium and Lactobacillus were the most identifiable genes of bacteria containing probiotic strains. Lactobacillus acidophilus, Bifidobacterium bifidum, and Lactobacillus rhamnosus are the most commonly used bacterial genera in the prevention of oral diseases.⁴

In the present study, 86.5% of participants were aware of the term probiotics, which is similar to the study conducted by Krishnan et al., where 86% showed awareness regarding the term probiotics.²

In this study, 45% of the postgraduate students were aware of the beneficial effects of Streptococcus strains as probiotics to oral health. However, in a study conducted by Patait et al., 94.1% of dental postgraduates were aware of beneficial effects of Streptococcus strain as probiotics.⁵

Around 76.5% of the participants reported to be willing to use probiotics if prescribed by a dentist, which is similar to the findings of Sunayana et al.,⁶ where 84% of the participants were ready to use probiotics if prescribed by a practitioner and in a study conducted by Krishnan et al., 44.8% of the participants were willing to use probiotics.²

In the present study, 64.5% of the participants had knowledge regarding food supplements being the source of probiotics. Krishnan et al., reported that 73.2% of the participants were aware of the same.² Patait et al., stated that 67.6% of the postgraduates were aware that food supplements can be the source for probiotics.⁵

Krishnan et al., reported that 66.5% of the participants had knowledge regarding the advantages of probiotics and similar result has been observed in the present study with 58% participants being aware of the probiotics.² In a study conducted by Sam Prasad et al., 4% of the general practitioners opined that probiotics can cause adverse effects, while in the present study, 27% of general practitioners agreed with the same.⁷

In our study, 27.8% of general practitioners expressed their opinion that probiotics can replace antibiotics, while in a study conducted by Sam Prasad et al., 79% of the general practitioners opined that probiotics can overcome the side effects of antibiotics.⁷

About 64.5% participants accepted that probiotics are helpful in providing quality oral care to the patients. Almost similar results were reported by Krishnan et al., where 71.2% participants accepted that probiotics are available to address the issues of oral health.² Patait et al., reported that 76.5% of the postgraduates agreed that probiotics help in the improvement of oral health, while 67.1% of postgraduates conceded that probiotics are beneficial in providing oral care.⁵

Conclusion

General practitioners and postgraduate students have sufficient awareness regarding probiotics. Though not statistically significant, postgraduate students were found to have better knowledge, attitude and practice levels compared to general practitioners.

Financial support and sponsorship

Nil

Conflict of interest

Nil