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Table of Contents   
EPIDEMIOLOGICAL WORK  
Year : 2019  |  Volume : 30  |  Issue : 5  |  Page : 794-797
Knowledge, attitude, and practice of senior dental students toward management of complications in exodontia


1 Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
2 Department of Oral and Maxillofacial Pathology, Sri Venkateswara Dental College and Hospital, Chennai, Tamil Nadu, India
3 Department of Periodontia, Sri Venkateswara Dental College and Hospital, Chennai, Tamil Nadu, India
4 Department of Orthodontia, Sri Venkateswara Dental College and Hospital, Chennai, Tamil Nadu, India

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Date of Submission14-Sep-2017
Date of Decision16-Nov-2017
Date of Acceptance11-Dec-2017
Date of Web Publication18-Dec-2019
 

   Abstract 


Introduction: Dental graduates have a professional responsibility of being competent in managing the complications in exodontia, a very commonly performed procedure. Aim: The aim of this paper was to assess the knowledge, attitude, and practice of senior dental students toward the management of complications in exodontia. Materials and Methods: Four hundred dental students participated in the study voluntarily. Verbal consent was obtained after elaborating the purpose of the study. A short validated questionnaire consisting of 12 close-ended multiple choice questions was distributed to all the students. The questionnaires were collected back and results from fully filled questionnaires were tabulated in Microsoft Excel 2007. Results: Nearly 93.4% of the students perform extractions in their practice on a routine basis. Among those 32.5% of the students have encountered complications, out of which only 20% of the students are confident in managing them. The remaining 64.8% of students who have not encountered complications are not confident in managing the same. Conclusion: This study revealed the need for increase in cases which will in turn help the students to transfer their theoretical knowledge into professional skills.

Keywords: Complications, dental students, extraction

How to cite this article:
Prasad T S, Sujatha G, Priya R S, Ramasamy M. Knowledge, attitude, and practice of senior dental students toward management of complications in exodontia. Indian J Dent Res 2019;30:794-7

How to cite this URL:
Prasad T S, Sujatha G, Priya R S, Ramasamy M. Knowledge, attitude, and practice of senior dental students toward management of complications in exodontia. Indian J Dent Res [serial online] 2019 [cited 2020 Apr 1];30:794-7. Available from: http://www.ijdr.in/text.asp?2019/30/5/794/273429



   Introduction Top


Complications in exodontia are not always avoidable. Exodontia is the painless removal of whole tooth or tooth root with minimal trauma to the investing tissues with uneventful wound healing, thus ensuring no postoperative prosthetic problems.[1] Although the definition of exodontia by Howe[1] gives a picture of ideal tooth extraction procedure, encountering complications in exodontia is not very rare. It is therefore imperative and desirable for the dental student to arm themselves with the knowledge and skills for managing the complications of exodontia. The aim of the oral and maxillofacial surgery course at the undergraduate level is to produce a graduate who is competent in performing extraction of teeth under both local and general anesthesia as well as prevent and manage related complications. The statement is a direct lift from the syllabus prescribed by the Dental Council of India.[2] Whether it is to prevent or manage a complication, what becomes the acme of necessity is adequate knowledge on the spectrum of complications in exodontia.[3]

Starting from simple complications such as dry socket or tooth root fractures, the severity can even escalate to morbid sequelae where the tooth can get displaced to adjacent anatomic spaces.[4],[5],[6],[7] Furthermore, the systemic health status of the patient can also influence the occurrence of a complication during or after tooth extraction. Patients on anti-platelet therapy, hemophiliacs, pregnant women, etc., are examples where the occurrence of a complication is more likely and hence are to be cautiously treated.[3] Thus, a thorough history is very important before commencing with extractions so that necessary precautions can be taken in advance. The knowledge on these basic skills among dental students should be assessed to identify lacunae if any in managing extraction complications.

Dental graduates have a professional responsibility of being competent in managing the complications in exodontia, a procedure very commonly performed. Obarisiagbon et al.[8] in a study identifying anxiety-provoking situations for dental students ranks encountering complications in exodontia as one of the top reasons. Assessing the current scenario on the knowledge among dental students in managing complications is essential to bring about changes in curriculum for improving their confidence levels in handling what is thought as appalling situations.[9] Therefore, the aim of this present study is to assess the knowledge, attitude, and practice of senior dental students toward the management of complications in exodontia.


   Materials and Methods Top


The study was designed as a questionnaire-based survey to assess the knowledge, attitude, and practice of senior dental students toward the management of complications in exodontia. The study sample consisted of dental housemen from various dental colleges in Chennai. Four hundred dental students participated in the study voluntarily. Verbal consent was obtained after elaborating the purpose of the study. The study was conducted in the academic year 2016–2017 from the month of December 2016 to February 2017. Students who were absent on those days when the study was conducted were excluded from the study.

A short validated questionnaire consisting of 12 close-ended multiple choice questions was distributed to all the students. The questionnaires were collected back, and only the results of fully filled questionnaires were tabulated in Microsoft Excel 2007. The data collected was then subjected to statistical analysis.


   Results Top


List 1 contains the 12 close-ended questions framed to assess the knowledge, attitude, and practice of dental students toward managing complications in exodontia. A total of 400 dental students participated and the response rate was 100%.

[Figure 1] shows the graphical representation of the responses given by the students. About 93.4% of the students perform extractions in their practice on a routine basis. Among those, 32.5% of the students have encountered complications, out of which only 20% of the students are confident in managing them. The remaining 64.8% of students who have not encountered complications are not confident in managing the same. Nearly 48.3% of the students feel that they have adequate knowledge on complications of exodontia and 32.1% of them believe that they lack the required knowledge whereas 19.7% of the students are not sure. Majority of the students (73.7%) require the presence of an oral surgeon for managing complications. Nearly 54.8% of the students have the habit of referring the patient to an oral surgeon or a nearby hospital if they encountered any complications. Nearly 63.7% of the students think it is best to refer to a specialist rather than manage a complication on their own. Nearly 53.4% of the students feel that they can predict whether a case would go for a complication or not. A greater part of the study group (93.8%) feels that they need more training in handling complications.
Figure 1: Graphical representation of response of students

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   Discussion Top


Forceps exodontia is a basic and relatively simple procedure. Although complications are undesirable, it cannot be completely evaded. The senior dental students are expected to be competent in carrying out extractions as well as manage complications at least to a certain degree.[10] They should perform independently and safely while having sufficient knowledge to manage a contingency without fear.[11] The academic years include an annual assessment of the students' skills to identify their competencies in carrying out exodontia and related procedures. This is done either by a longitudinal assessment or a clinical objective test.[12],[13],[14],[15] However, it is important to know the self-perception of the students on their technical skills in dentistry at the end of their graduation or immediately after graduation. This is desirable as it will help us bring reformations in the dental curricula to address and suit the needs of the future clinicians.[16],[17],[18],[19] To comprehend the needs of the students when it comes to handling the complications in exodontia, the following study was carried out among senior dental students in Chennai city.

According to a study done by Baniwal et al.[20] the prevalence of complications in exodontia is <2%. Although complications are a rarity, the results of the current study reveal that around 32% of the students have encountered complications in exodontia. This percentage is slightly greater than that shown in a study done by Santhoshkumar and Lavanya.[9] The reason could probably be the increased size and heterogeneity of the sample included in this study. Majority of the students require assistance from an expert in the field to manage complications. An overwhelming number of students voted affirmatively for a training program in managing the complications. This is in congruence with the studies of Santhoshkumar et al.,[21] Shah et al.[22] and van Diermen et al.[23] where participants felt the need to be educated about evidence-based guidelines for carrying out exodontia in patients on antiplatelet therapy.

Almost half of the senior dental students who participated in this study agreed to have knowledge on the complications of exodontia. Venkateshwar et al.[3] concluded in their study that complications are more common with final year students than interns. This is because the senior dental students have a better experience than the final years and are hence able to carry out extractions smoothly.[3] This enforces the fact that they have adequate knowledge to avoid complications to a certain extent. Furthermore, the current study reveals that students think tooth fracture to be the most common complication. This is in harmony with the study result of Venkateshwar et al.[3] which concluded that the highest incidence of complication in exodontia is tooth fracture. Thus, it can be suggested that the senior dental students have adequate knowledge on the complications of exodontia. However, they lack the knowledge or skill in managing it.

This survey emphasizes the importance of prevention. Nearly 54% of respondents could predict the cases that might develop complications. Although the students admit that they are not adequately trained for handling major complications, their knowledge in the prediction of complications and prompt referral to surgical specialists (62.7% of respondents) indicate a healthy trend among the students. Only a small fragment (20%) of the study group is confident in managing complications in exodontia as per the results of the present study. The greatest handicap of the remaining 80% of the students is the lack of adequate caseload in the department. This gains importance as good exposure at the undergraduate level would reduce the case stress at the specialist level. Thus, the study indicated that the students have the necessary theoretical knowledge, but not enough practical skill exposure to successfully manage complications in exodontia.


   Conclusion Top


The survey has brought about interesting findings regarding the knowledge, attitude, and practice of dental undergraduates regarding exodontia. The obvious takeaway is that students need to have adequate caseloads to transform their theoretical knowledge into practical expertise. More exposure would increase their awareness on complications of exodontia, and help them to manage it successfully.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


   Questionaire Top


1. Do you perform extractions in clinical practice?

a. Yes b. No c. Cannot say

2. Do you think you have adequate knowledge regarding complications in exodontia?

a. Yes b. No c. Cannot say

3. Have you encountered any complications so far?

a. Yes b. No c. Cannot say

4. How confident are you in managing complications?

a. Very confident b. Not confident c. Cannot say

5. Should there be an oral surgeon to manage complications?

a. Yes b. No c. Cannot say

6. Do you usually refer the patient to an oral surgeon or to a nearby hospital?

a. Yes b. No c. Cannot say

7. Do you think it is right to refer it to another specialist?

a. Yes b. No c. Cannot say

8. Can you predict a case which would go for complication?

a. Yes b. No c. Cannot say

9. Which preoperative evaluation is important to avoid complications?

a. Clinical b. Radiographic c. Nothing specific

10. What do you think is the most common complication in exodontias?

a. Fracture of tooth b. Fracture of root c. Bleeding d. Dry socket

11. Do you think medically compromised patients are more prone to complications?

a. Yes b. No c. Cannot say

12. Do you think you need more training in handling these complications?

a. Yes b. No c. Cannot say



 
   References Top

1.
Howe GL. The Extraction of Teeth. 2nd ed. Mumbai, India: KM Verghese Company; 1970. p. 1.  Back to cited text no. 1
    
2.
Dental Council of India. Revised BDS Course Regulations. Available from: http://www.dciindia.org.in/rule_regulation/bds_course_regulation_2007_alongwith_amendments.pdf. [Last accessed on 2017 June 19].  Back to cited text no. 2
    
3.
Venkateshwar GP, Padhye MN, Khosla AR, Kakkar ST. Complications of exodontia: A retrospective study. Indian J Dent Res 2011;22:633-8.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Boulux GF, Steed MB, Percianccante VJ. Complications of third molar surgery. Oral Maxillofac Surg Clin North Am 2007;38:499-523.  Back to cited text no. 4
    
5.
Brauer HU. Unusual complications associated with third molar surgery: A systematic review. Quintessence Int 2009;40:565-72.  Back to cited text no. 5
    
6.
Osaki T, Nomura Y, Hirota J, Yoneda K. Infections in elderly patients associated with impacted third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;79:137-41.  Back to cited text no. 6
    
7.
Migliorati CA, Siegel MA, Elting LS. Bisphosphonate-associated osteonecrosis: A long-term complication of bisphosphonate treatment. Lancet Oncol 2006;7:508-14.  Back to cited text no. 7
    
8.
Obarisiagbon A, Azodo C, Omoaregba J, James B. Do stages of dentistry training affect anxiety provoking situations? Ann Med Health Sci Res 2014;4:869-74.  Back to cited text no. 8
  [Full text]  
9.
Santhoshkumar MP, Lavanya. Knowledge about post extraction complications among undergraduate dental students. J Pharm Sci Res 2016;8:470-6.  Back to cited text no. 9
    
10.
Moore U, Durham J, Corbett I, Thomson P. The influence of staffing and timetabling on achieving competence in surgical extractions. Eur J Dent Educ 2009;13:15-9.  Back to cited text no. 10
    
11.
Chambers DW, Gerrow JD. Manual for developing and formatting competency statements. J Dent Educ 1994;58:361-6.  Back to cited text no. 11
    
12.
Low DS, Kalkwarf KL. Assessing continued competency: An approach for dentistry. J Am Dent Assoc 1996;127:383-8.  Back to cited text no. 12
    
13.
Macluskey M, Hanson C, Kershaw A, Wight AJ, Ogden GR. Development of a structured clinical operative test (SCOT) in the assessment of practical ability in the oral surgery undergraduate curriculum. Br Dent J 2004;196:225-8.  Back to cited text no. 13
    
14.
Yip HK, Smales RJ. Review of competency-based education in dentistry. Br Dent J 2000;189:324-6.  Back to cited text no. 14
    
15.
Prescott LE, Norcini JJ, McKinlay P, Rennie JS. Facing the challenges of competency-based assessment of postgraduate dental training: Longitudinal evaluation of performance (LEP). Med Educ 2002;36:92-7.  Back to cited text no. 15
    
16.
Holmes DC, Diaz-Arnold AM, Williams VD. Alumni self-perception of competence at time of dental school graduation. J Dent Educ 1997;61:465-72.  Back to cited text no. 16
    
17.
Greenwood LF, Lewis DW, Burgess RC. How competent do our graduates feel? J Dent Educ 1998;62:307-13.  Back to cited text no. 17
    
18.
Kiyak HA, Brudvik J. Dental students' self-assessed competence in geriatric dentistry. J Dent Educ 1992;56:728-34.  Back to cited text no. 18
    
19.
Stacey MA, Morgan MV, Wright C. The effect of clinical targets on productivity and perceptions of clinical competency. J Dent Educ 1998;62:409-14.  Back to cited text no. 19
    
20.
Baniwal S, Paudel KR, Pyakurel U, Bajracharya M, Niraula SR. Prevalence of complications of simple tooth extractions and its comparison between a tertiary center and peripheral centers: A study conducted over 8,455 tooth extractions. JNMA J Nepal Med Assoc 2007;46:20-4.  Back to cited text no. 20
    
21.
Santhoshkumar MP. Knowledge, attitude and practices of dental students toward dental management of patients on antiplatelet therapy. Asian J Pharm Clin Res 2016;9:270-6.  Back to cited text no. 21
    
22.
Shah AH, Khalil HS, Alshahrani FA, Khan SQ, AlQthani NR, Bukhari IA, et al. Knowledge of medical and dental practitioners towards dental management of patients on anticoagulant and/or antiplatelet therapy. Saudi J Dent Res 2015;6:91-7.  Back to cited text no. 22
    
23.
van Diermen DE, van der Waal I, Hoogvliets MW, Ong FN, Hoogstraten J. Survey response of oral and maxillofacial surgeons on invasive procedures in patients using antithromboftic medication. Int J Oral Maxillofac Surg 2013;42:502-7.  Back to cited text no. 23
    

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Correspondence Address:
Dr. T Srinivasa Prasad
Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.IJDR_508_17

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