|Year : 2022 | Volume
| Issue : 2 | Page : 174-179
Awareness, Knowledge and Attitude of Teledentistry Among Dentists in Kanchipuram District – A Cross-Sectional Survey
R Kamalakannan1, C Nagappan1, M Krishnaveni1, NC Arun Prasad1, S Vinoth Kumar1, J Mahesh2
1 Department of Prosthodontics and Crown and Bridge, Karpaga Vinayaga Institute of Dental Sciences, Madhuranthagam, Chengalpattu, Tamil Nadu, India
2 Public Health Dentistry, Karpaga Vinayaga Institute of Dental Sciences, Madhuranthagam, Chengalpattu, Tamil Nadu, India
|Date of Submission||22-Oct-2021|
|Date of Decision||28-Jan-2022|
|Date of Acceptance||17-Feb-2022|
|Date of Web Publication||13-May-2022|
Karpaga Vinayaga Institute of Dental Sciences, Madhuranthagam, Chengalpattu - 603 308, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Introduction: A highly infectious and life-threatening novel coronavirus Corona Virus Disease (COVID-19) has been spreading worldwide, causing severe medical complications and practising dentistry is becoming difficult. To reduce the risk of spread of coronavirus infection between dentist and patient, teledentistry, an innovative digital tool, has the potential to reach patients straightforward without direct contact. Materials and Methods: A self-structured standard questionnaire was framed and distributed among dentists from July 2021 to August 2021. The survey consisted of 15 closed-ended and multiple-choice questions related to awareness, knowledge and attitude of teledentistry during this COVID 19 pandemic. After proper validation of the questionnaire from the experts and evaluating reliability, the survey was conducted by forwarding the link of the Google Form through social media. Totally 520 participants responded to the survey. The statistical analysis was performed using SPSS statistical software version 21. All statistical analyses were carried out at a significance level of P < 0.05. The descriptive data were analysed and compared using the Chi-square test. Results: Among specialists, general practitioners, postgraduate students and undergraduate students, specialists have better awareness, knowledge and attitude of teledentistry. Almost all participants have 50% knowledge about teledentistry and have a high (80%) attitude towards teledentistry. Conclusion: From this study, it is clearly understood that it is high time to increase the use of teledentistry practice by spreading knowledge among dentists and dental students. It is potentially an innovative digital tool in this new era of dentistry. It is an effective tool not only in the current pandemic situation but also in emergencies. Thus, teledentistry is a satisfied boon in the field of dentistry through the use of digital technology.
Keywords: Communication, Corona Virus Disease 19, digital tool, pandemic, teledentistry
|How to cite this article:|
Kamalakannan R, Nagappan C, Krishnaveni M, Arun Prasad N C, Kumar S V, Mahesh J. Awareness, Knowledge and Attitude of Teledentistry Among Dentists in Kanchipuram District – A Cross-Sectional Survey. Adv Hum Biol 2022;12:174-9
|How to cite this URL:|
Kamalakannan R, Nagappan C, Krishnaveni M, Arun Prasad N C, Kumar S V, Mahesh J. Awareness, Knowledge and Attitude of Teledentistry Among Dentists in Kanchipuram District – A Cross-Sectional Survey. Adv Hum Biol [serial online] 2022 [cited 2022 May 25];12:174-9. Available from: https://www.aihbonline.com/text.asp?2022/12/2/174/345210
| Introduction|| |
A highly infectious and life-threatening novel coronavirus Corona Virus Disease (COVID-19) has been spreading worldwide from Wuhan, China, since 12th December 2019, causing severe medical complications. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a single-chain ribonucleic acid virus that is the cause of novel coronavirus disease known as COVID-19. Some evidence suggests that the pathogen of COVID-19 originated in some species of bats first, and it was then spread to intermediate hosts such as wild dogs, snakes and pangolins. It started to spread among humans via contaminated meat products from the traditional wildlife market in Wuhan.
The officials announced that the coronavirus (COVID-19) had been announced as the causative pathogen of the disease in January 2020. This novel viral pneumonia was named '(COVID-19)' by the World Health Organisation (WHO). 'SARS CoV-2' was also the given name for this novel coronavirus by the International Committee on Taxonomy of Viruses. Soon, it turned into worldwide public health challenges, having spread in over 200 countries across the globe. The WHO declared the COVID-19 as a public health emergency on an international scale on 30 January 2020.
On 30th January 2020, the first SARS-CoV-2 positive case was reported in the state of Kerala, India. Subsequently, the number of cases drastically rose.
During the initial period of the COVID-19 pandemic, it was assumed that lack of oral involvement was a differentiating feature of COVID-19. Later, the officials found the presence of SARS-CoV-2 in the saliva of the patients, and it has been demonstrated that reverse transcriptase-polymerase chain reaction from saliva is a more sensitive test than a nasopharyngeal test. Moreover, Angiotensin-Converting Enzyme 2 is also found in oral mucosa, with more density on the dorsum of the tongue and salivary glands relative to buccal mucosa or palates. Dysgeusia is the first recognised oral symptom of COVID-19 reported in 38% of patients, mostly in North Americans and Europeans, females, and patients with mild-moderate disease severity. This virus transmits through cough, sneeze, inhalation of virus-containing droplets. It also transmits via coming in contact with oral, nasal and eye mucous membranes.
Many studies indicate that this harmful virus may spread airborne during aerosol procedures in dental set-up. Aerosol containing viruses can stay in the air for a long period and enter the human body via inhalation. The aerosol present on the surfaces of the dental surgery and instruments will result in cross-contamination between the dentist and patient.
Its incubation period can vary from 7 to 24 days without any clinical symptoms. Furthermore, frequent contamination with saliva, blood, body fluids of symptomatic and asymptomatic patients and the sharp, rotary instruments used to treat infected patients can increase the risk of spread of infection in dental practices. This coronavirus is affecting the public physically and psychologically. Oral manifestations. and cutaneous lesions associated with COVID-19 have been reported in adults and, more recently, children.
This pandemic is not likely to end soon, and in-office dental check-ups will be difficult, and there is no solution to avoid face-to-face communication between dentist and patient. Dentists and patients are looking for an effective solution to communicate with each other. Now, it is time to use an innovative, fresh digital tool to continue dental practice during the COVID 19 pandemic and in the future. 'Teledentistry' plays an important role and has the potential to reach patients directly without contact.
Teledentistry is a developing tool in dentistry that bridges dentists to their patients. Cook defined teledentistry as 'the practice of using videoconferencing technologies to diagnose and provide advice about treatment over a distance.' Teledentistry works under two methods: (a) Real-time consultation and (b) Store and Forward Method. Real-Time consultation helps in communication between dentists and patients from different locations through video – conferencing. Store and Forward Method helps the dental practitioner to store the clinical examination records and images of the patient and also helps in transferring the records and images to the specialist for consultation and treatment planning.
Teledentistry is not a substitute for physical dental consultation, but it is an alternative to dental service during this COVID 19 pandemic.
The purpose of this study was to evaluate the awareness, knowledge and attitude of teledentistry among dentists and dental students.
| Materials and Methods|| |
This descriptive cross-sectional study was done among specialists, general practitioners, postgraduate students and undergraduate students. Dental students were included for educational purposes and awareness of teledentistry. A total of 520 participants participated in this study.
Sample size/study subject
The estimated sample size on statistical analysis was found to be 484 in Morgan's table, but the response received was 520.
A survey was conducted by framing 15 self-structured standard questionnaires to assess the awareness, knowledge, attitude of teledentistry among dentists and dental students. The questions were close-ended, multiple-choice and were prepared in the English language.
Method of assessment
The questionnaire was pretested to check the validity and reliability. Validation of the questionnaire was done with five subject experts (1 Public Health Dentist, 2 Prosthodontists and 2 General Practitioners) in terms of clarity, simplicity, objectivity and ambiguity. According to their feedback, questions were corrected. Content validity was checked, and the chronic venous insufficiency score was 0.8.
The reliability was done on ten dentists who were not included in the sample. The responses were collected twice from the participants in 1-h intervals. The reliability was checked, and the reliability coefficient (α) of 0.911 was considered adequate and satisfactory. The reliability of these questions was tested using Cronbach's alpha analysis. A Cronbach's alpha value of 0.911 indicated a good internal consistency and validity.
The protocol for the survey was submitted to the Institutional Ethical Committee, and ethical approval (IEC No: KIDS/009/2021/II) was obtained.
Method of the survey conducted
The survey was conducted by forwarding the Google Form link to a maximum number of participants by the mode of social media such as WhatsApp, Instagram and Facebook from July 2021 to August 2021. The participants were encouraged to share the survey with their contacts to increase the number of participation and response rate of the questionnaire. All responses of the participants were recorded, analysed and checked for completeness.
After the collection of data, the statistical analysis was done using the Statistical Packages for the Social Sciences (SPSS), Chicago software version 2. All statistical analyses were carried out at a significance level of P < 0.05. The descriptive data were analysed and compared using the Chi-square test.
| Results|| |
A total of 520 participants participated in this study. Of which, 71 (13.7%) were specialists, 111 (21.3%) were general practitioners, 73 (14%) were postgraduates and 265 (51%) were undergraduates. A maximum number of responses were from undergraduates, followed by general practitioners, postgraduates and specialists [Table 1].
[Table 2] shows that 46.4% of myelodysplastic syndrome (MDS), 52.0% of postgraduate students feel moderately difficult, and 41.4% of general practitioners, 40.3% of undergraduate students feel difficult to practice dentistry during the COVID pandemic. It is statistically significant.
[Table 3] shows that 73.2% of MDS were aware of the term teledentistry, followed by postgraduate students, general practitioners and undergraduate students. Only 20.7% of undergraduate students were aware of the term teledentistry. The majority of MDS, general practitioners, postgraduate students and undergraduate students had knowledge that teledentistry is a virtual interaction between dentist and patient, and it helps in consulting, diagnosing, e-prescribing the patient via video conferencing. About 50.7% of MDS, 59.4% of general practitioners, 43.0% of undergraduate students selected mobile as the most preferred electronic gadget for teledentistry. The majority of general practitioners, postgraduate students and undergraduate students said that teledentistry would be effective to some extent during this COVID pandemic. The majority of general practitioners, postgraduate students and undergraduate students said that the time required for dental examination via teledentistry could not be judged, while most of the MDS said that it is a time-saving tool when compared to physical dental examination.
[Table 4] shows that the majority of respondents had the opinion that teledentistry will be useful in any emergencies and agreed on teledentistry to become a part of dental education. More than half of the respondents said that the use of teledentistry is limited because of low socioeconomic status people, people living in remote areas and mass media usage. 77.1% of respondents were ready to practice teledentistry. About 59.6% of respondents said that teledentistry gives them satisfaction. About 87.8% of respondents said that teledentistry is a boon in the field of dentistry.
[Graph 1] clearly states that:
- MDS have better awareness, knowledge and attitude of teledentistry compared to postgraduate students, general practitioners and undergraduate students, which is statistically significant
- General practitioners and undergraduate students have less awareness compared to postgraduate students
- MDS, general practitioners, postgraduate and undergraduate students almost have equivalent and 50% knowledge about teledentistry
- MDS, general practitioners, postgraduate and undergraduate students have equivalent and high (80%) attitudes towards teledentistry.
| Discussion|| |
Teledentistry is a combination of technology and dentistry. It is a form of home care for patients. The word 'tele' means 'distant,' and therefore practising teledentistry satisfies the social distancing criteria in this COVID pandemic. Teledentistry helps in assisting general dentists in improving services to people in rural areas who cannot access the internet. Teledentistry can be incorporated into routine dental practice as it offers a wide range of subunits such as teleconsultation, telediagnosis, teletriage and telemonitoring. Like various subunits, teledentistry is very useful in each field of dentistry. Teledentistry is of different types like it can be a patient-dentist, dentist–specialist, dentist–data storage bank, students–dental education, and dentist–research centre.
In this study, most of the respondents said that teledentistry is a virtual interaction between dentist and patient. But teledentistry also facilitates communication between a specialist and laboratory technician, which will be helpful in resolving any existing discrepancies or doubts regarding a prosthesis, subsequently providing a good quality prosthesis. Telecommunication-aided overdenture fabrication showed superior quality when compared to conventional fabrication. The majority of the respondents said that video conferencing is the most preferred method of practising teledentistry which is not in accordance with the study done by Khalifa et al., stated that video conferencing is the least chosen communication method.
In this study, as mobile has been selected as the most commonly preferred electronic gadget, teledentistry can get access into mobile by creating apps. eDantSeva is a web-based mobile app created for the National Oral Health Programme by the Centre for Dental Education and Research supported by the Ministry of Health, Government of India. It has many distinct features, including 'Find a Dental Facility,' which locates and maps dental facilities around the geographical location.
About 48.07% of respondents said the time required for dental examination via teledentistry could not be judged, which is not in accordance with the study done by Ata SO and Ozkan S in Turkey found that it is a time-saving tool. But, the limitations of teledentistry use should be noticed in this study. Besides such limitations, more than half of the respondents showed a bright outlook on teledentistry as they are willing to practice it.
In this study, postgraduate students and undergraduate students have equivalent and 50% knowledge about teledentistry, whereas, in a study done by Boringi et al., the knowledge and awareness about teledentistry were very low among postgraduates and undergraduates.
As postgraduate and undergraduate students are budding dentists, teledentistry can be made as a part of dental education which will be helpful in gaining knowledge, and they can be trained to practice teledentistry. As respondents have shown much positive behaviour in practising teledentistry in the future, a number of teledentistry centres can be implemented in India. There is no formal regulation or licencing required for practising teledentistry in India. So far, three states are specifically working in the field of teleconsultation, of which Maharashtra has implemented teleconsultation for dental-related problems. CollabDDS (Collaborative Digital Diagnosis System) is a unique software developed in India to practice teledentistry by accomplishing teleconsultation, diagnosis and education in rural/remote areas. This digital system can visualise medical and dental images for diagnosis and treatment planning. The first version of the CollabDDS v1.0 was released in July 2012 and has undergone development based on feedback from experts, and the latest version, 2.4 was released in August 2018. CollabDDS allows real-time collaboration at two or more remote locations.
| Conclusion|| |
From this study, it is clearly understood that it is high time to increase the use of teledentistry practice by spreading knowledge among dental professionals and dental students. It is potentially an innovative digital tool in this new era of dentistry. Such applications make it an effective tool not only in the current pandemic situation but also in emergencies. Thus, teledentistry is a satisfied boon in the field of dentistry through the use of digital technology.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Guo YR, Cao QD, Hong ZS, Tan YY, Chen SD, Jin HJ, et al.
The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak – An update on the status. Mil Med Res 2020;7:11.
Barabari P, Moharamzadeh K. Novel coronavirus (COVID-19) and dentistry – A comprehensive review of literature. Dent J (Basel) 2020;8:53.
Zhang T, Wu Q, Zhang Z. Pangolin homology associated with 2019-nCoV. bioRxiv 2020. [doi: 10.1101/2020.02.19.950253].
Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al.
A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020;579:270-3.
Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al.
Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020;382:1199-207.
Gorbalenya AE, Baker SC, Baric R, Groot RJ, Drosten C, Gulyaeva AA, et al
. Severe acute respiratory syndrome-related coronavirus: The species and its viruses–a statement of the Coronavirus Study Group. bioRxiv 2020.
Mahase E. China coronavirus: WHO declares international emergency as death toll exceeds 200. BMJ 2020;368:m408.
The Lancet. Emerging understandings of 2019-nCoV. Lancet 2020;395:311.
Kumar SU, Kumar DT, Christopher BP, Doss CGP. The rise and impact of COVID-19 in India. Front Med (Lausanne) 2020;7:250.
Iranmanesh B, Khalili M, Amiri R, Zartab H, Aflatoonian M. Oral manifestations of COVID-19 disease: A review article. Dermatol Ther 2021;34:e14578.
Ghani F. COVID-19 Outbreak – Immediate and long-term impacts on the dental profession. Pak J Med Sci 2020;36:S126-9.
Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect 2020;104:246-51.
Cleveland JL, Gray SK, Harte JA, Robison VA, Moorman AC, Gooch BF. Transmission of blood-borne pathogens in US dental health care settings: 2016 update. J Am Dent Assoc 2016;147:729-38.
Backer JA, Klinkenberg D, Wallinga J. Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20-28 January 2020. Euro Surveill 2020;25:2000062.
Wei J, Li Y. Airborne spread of infectious agents in the indoor environment. Am J Infect Control 2016;44:S102-8.
Chaux-Bodard AG, Deneuve S, Desoutter A. Oral manifestation of COVID-19 as an inaugural symptom? J Oral Med Oral Surg 2020;26:18.
Sachdeva M, Gianotti R, Shah M, Bradanini L, Tosi D, Veraldi S, et al.
Cutaneous manifestations of COVID-19: Report of three cases and a review of literature. J Dermatol Sci 2020;98:75-81.
Viner RM, Whittaker E. Kawasaki-like disease: Emerging complication during the COVID-19 pandemic. Lancet 2020;395:1741-3.
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al.
Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20.
Jampani ND, Nutalapati R, Dontula BS, Boyapati R. Applications of teledentistry: A literature review and update. J Int Soc Prev Community Dent 2011;1:37-44.
Chhabra N, Chhabra A, Jain R, Kaur H, Bansal S. Role of teledentistry in dental education: Need of the era. J Clin Diagn Res 2012;5:1486-8.
Ghai S. Teledentistry during COVID-19 pandemic. Diabetes Metab Syndr 2020;14:933-5.
Mariño R, Ghanim A. Teledentistry: A systematic review of the literature. J Telemed Telecare 2013;19:179-83.
Save SS, Singh SS, Kalra DD, Jhaveri ST, Avhad SK. An overview of teledentistry with a cross-sectional study on relevant knowledge and attitude of dentists in Mumbai. J Glob Oral Health 2020;3:101-9.
Al-Khalifa KS, AlSheikh R. Teledentistry awareness among dental professionals in Saudi Arabia. PLoS One 2020;15:e0240825.
Ata SO, Ozkan S. Information technology in oral health care: Attitudes of dental professionals on the use of teledentistry in turkey. Eur Mediterr Conf Inf Syst 2009;14:1-8.
Boringi M, Waghray S, Lavanya R, Babu DB, Badam RK, Harsha N, et al.
Knowledge and awareness of teledentistry among dental professionals – A cross sectional study. J Clin Diagn Res 2015;9:C41-4.
Kharbanda OP, Priya H, Balachandran R, Khurana C. Current scenario of teledentistry in public healthcare in India. J Int Soc Telemed eHealth 2019;7:e10-1.
Bhargava A, Sabbarwal B, Jaggi A, Chand S, Tandon S. Teledentistry: A literature review of evolution and ethicolegal aspects. J Glob Oral Health 2019;2:128-33.
[Table 1], [Table 2], [Table 3], [Table 4]