|Year : 2019 | Volume
| Issue : 1 | Page : 6-11
Knowledge and perceived adequacy of information regarding the applications of lasers in dentistry among dental interns in India
Sini T Damodar, Rucha Shah, Raison Thomas, Triveni Mavinkote Gowda, Dhoom S Mehta
Department of Periodontology, Bapuji Dental College and Hospital, Davangere, Karnataka, India
|Date of Web Publication||24-Jul-2019|
Dr. Sini T Damodar
Department of Periodontology, Bapuji Dental College and Hospital, Davangere 577004, Karnataka
Source of Support: None, Conflict of Interest: None
Aim: Laser dentistry is one of the latest, precise, and minimally invasive tools being explored in dentistry. The objective of the study was to determine the knowledge and perceived adequacy of information of lasers in dentistry among the dental interns in Karnataka, India. Materials and Methods: A survey was conducted in Karnataka among the dental students who were in their fifth year of the course. The questionnaire consisted of two main parts: first part included use and applications of dental lasers, and second part included source and need of information regarding the laser. Total of 1000 questionnaires were distributed among the students, and finally, 727 completely filled questionnaires were considered for the study. Results: A majority of the students (79%) were not provided with adequate knowledge during their Bachelor of Dental Surgery (BDS) curriculum and 53% of the students were interested in procuring the additional information about lasers. It was found that the knowledge regarding lasers was satisfactory only regarding the types and benefits of lasers. The knowledge regarding applications of lasers in various fields of dentistry was below satisfactory. Conclusion: The dental interns of Karnataka feel that the laser education provided to them during their BDS course was insufficient. Most of the surveyed interns were found to be having either insufficient knowledge or incorrect notion about lasers.
Keywords: Dental interns dental laser, laser dentistry
|How to cite this article:|
Damodar ST, Shah R, Thomas R, Gowda TM, Mehta DS. Knowledge and perceived adequacy of information regarding the applications of lasers in dentistry among dental interns in India. J Dent Lasers 2019;13:6-11
|How to cite this URL:|
Damodar ST, Shah R, Thomas R, Gowda TM, Mehta DS. Knowledge and perceived adequacy of information regarding the applications of lasers in dentistry among dental interns in India. J Dent Lasers [serial online] 2019 [cited 2020 Apr 4];13:6-11. Available from: http://www.jdentlasers.org/text.asp?2019/13/1/6/263345
| Introduction|| |
The field of dentistry is constantly changing to best suit patient needs. Techincal advancements in the field of science and technology often finding their way into patient care. One such advancement that has made dentistry progress by leaps and bounds is that of lasers. Since the discovery of laser by Maiman in the 1960s, the applications of lasers in medicine have increased tremendously. It was Stern, Sognnaes, and Goldman who reported the first laser applications in dentistry in the year 1964. Lasers have been referred to as “scalpels of light” and they can be used alone or in combination with various surgical procedures.
In the field of dentistry, lasers are increasingly being used for various dental procedures, including oral and maxillofacial surgery, pedodontics, periodontics, implant dentistry, conservative dentistry and endodontics, and prosthodontics.,,,,,,, With the advent of these advances, it is of pertinent importance that dental graduate be abreast with theoretical and practical knowledge regarding lasers. Recently, a cross-sectional descriptive study was carried out among 94 final year dental students in Riyadh to assess the knowledge and level of education regarding the applications of lasers. The authors concluded by saying that the students had inadequate education and insufficient knowledge in regard to lasers. Also, they emphasized the fact that more education about lasers was required to be added to the undergraduate curriculum.
Hence, the awareness, safety, and applications of laser physics in dentistry should be adequate for students to practice laser and to motivate patients for the different laser treatments. Hence, the aim of our study was to assess the knowledge and perceived adequacy of information regarding the lasers in dentistry among the dental interns in Karnataka, India.
| Materials and Methods|| |
This study was designed to be a descriptive cross-sectional survey and was carried out among dental interns in India. The study protocol was approved by the IRB before the commencement of study. Students who were pursuing their internship (students who were in their fifth clinical year of undergraduate curriculum dentistry) were included in this study. Students not willing to participate or who submitted incompletely filled questionnaires were excluded from the study. A list of dental institutions in the state of Karnataka was obtained from the website of Dental Council of India (January 12, 2016) for the year 2014–2015. After tabulation of the retrieved data, a list of 46 colleges in the state of Karnataka was obtained. The total number of seats for BDS curriculum for the year 2014–2015 was found to be 3260. Using these data, sample size for the current study was estimated to be 690. To obtain a heterogeneous sample, we divided the state of Karnataka into three approximately equal zones of north, middle, and south. From each zone, we selected four to five colleges for our study.
Questionnaire for this study consisted of a total of 16 questions, which were divided in two main parts. The first part of the questionnaire consisted of nine questions regarding the uses and applications of dental lasers in different dental specialities. The second part enquired about their source of information and perceived need for more information regarding lasers in dentistry. Before data collection, a pilot study was carried out to validate the questionnaire. The validation of the questionnaire was done by means of face validation, reliability, and consistency tests. A pilot study was conducted on 20 students before the data collection and the value of Cohen’s kappa coefficient was estimated to be 0.925. Keeping in mind total number of nonresponders and who were not available, a total of 1000 questionnaires were posted to all the colleges. The prevalidated questionnaires were posted to different colleges. The entire sample consisted of 14 different dental colleges from the state of Karnataka.
In the first section, all the questions had the following responses: correct, incorrect, and do not know. The questions were scored as 2 for correct, –2 for incorrect, and 0 for the option of do not know. Overall scores for each student were calculated and divided by number of questions. The score was calculated overall and individually for each question. As previously described, a score of >1 was considered to be sufficient knowledge.
The data obtained were tabulated and analyzed using SPSS, version 17.0. Mean and standard deviation was calculated. A value of P < 0.05 was considered statistically significant.
| Results|| |
From the 1000 forms that we sent, we received 824 responses. Of these responses, 67 were incomplete and hence excluded from the study. Hence, a total of 757 completely filled questionnaires were included in the study. Among the responders, 545 (72%) were females and 212 (28%) were males. The responses for the first section of the questionnaire pertaining to the assessment of knowledge of dental laser among the students are presented in [Table 1].
|Table 1: Awareness of students regarding the dental laser and its applications|
Click here to view
The most known laser was Er:YAG with a correct response of 63.7%, whereas around 54% of the responders were not aware of Er,Cr:YSGG, and 11.7% of the students thought that diode laser was not a type of laser. When the type of lasers was asked, 79.8% were aware of soft tissue and 67.4% were aware of hard tissue lasers. Regarding the laser application in the different branches of dentistry, it was found that the applications of which the students were most aware were composite curing (72.9%), frenectomy (75.4%), and soft tissue curettage (70.3%). The applications for which the students had least knowledge were behavior management in children (14.6%) and periodontal pocket disinfection (30.8%). When calculated section wise [Figure 1], the adequacy of knowledge was least in the field of pediatric dentistry (0.3). In contrast, the students were most aware regarding the applications in oral surgery (0.8). The awareness regarding laser benefits and protection was above satisfactory (>1). When calculated student wise, sufficient knowledge about types of lasers and their benefits was found in around 82.4% and 83.5% of students, respectively. However, regarding the application of lasers in different fields of dentistry, it was found that the awareness was below sufficient for all the other subjects (<1).
|Figure 1: Mean knowledge score (calculated as an average of the responses in each section)|
Click here to view
The second section of the questionnaire dealt with the students’ perceived adequacy of the information about lasers and their desire to gain more knowledge [Table 2]. It was observed that 79% of students felt that they were not provided with sufficient information about laser during their course of dentistry, and about 48% of them were provided no information regarding lasers in their entire course. The majority of students (90%) said they had not observed, assisted, or performed any laser treatments. Around 53% of the students said they would like to get additional reliable information about dental lasers in the form of 1-year certificate or module-based courses conducted by college or trained experts.
| Discussion|| |
Laser technology has revolutionized various fields of medicine and is now set to change dentistry forever. Laser dentistry is an upcoming treatment modality with many advantages over the conventional procedures such as less time-consuming, bloodless, and painless.,,,,,,, A recent study showed that as many as 30.5% practitioners use lasers in their speciality periodontal practice. As the technology refines itself, we can expect the popularity of laser dentistry to increase in future. Knowledge about the applications of lasers will equip today’s dental surgeon to provide high-quality dental care to their patients with lasers as and when indicated.
This survey was conducted in the state of Karnataka among the representative population of dental interns. The state of Karnataka was chosen for our study because it has maximum number of colleges (n = 46) among all the states in India (305 dental colleges). Dental interns are the upcoming new-generation dentists and as a doctor they should have a thorough knowledge about the latest techniques and advancements in their field including lasers. This would help them to practice lasers efficiently and safely and also to better educate and motivate the patients regarding the benefits of lasers. Hence, it becomes essential to gauge the awareness of laser applications and its benefits among the dental interns. Females constituted a predominant 72% of the surveyed population. This is attributed to the increasing trend of females in dentistry. Our study population is similar to those in previous studies.,
In our survey, the first half of the questionnaire was about the types of lasers and its applications in different fields of dentistry. A total of nine questions were asked with multiple subsets and options of correct, incorrect, or do not know. The question-wise average revealed that the students were well aware of types of lasers and their advantages (average score of ≥1). However, the students showed insufficient knowledge in all the other questions (average score of <1). This indicates that the students were not aware of the laser applications in the various fields of dentistry. Apart from that they also had wrong information or misconceptions regarding several aspects of laser applications. This observation is serious in nature and would limit the complete and correct utilization of the lasers for patients. Our findings are in agreement with a study conducted in Saudi Arabia among final year dental students where they found that 76% had insufficient knowledge regarding various applications of dental lasers.
The second set of questions was about the perceived adequacy of information about dental lasers. A majority of students (80%) felt that they were not provided with sufficient information about laser dentistry during their undergraduation. A large number of students (48%) were not provided with any information regarding lasers in the duration of the course. This observation is alarming and justifies the poor knowledge demonstrated by the students. Only 10% of them had assisted or performed laser treatments. This is in contrast with the results obtained in a survey conducted on the use of technology in the United states; it was observed that soft and hard tissue lasers were a part of the curriculum in 55% and 36% as clinical didactic and 39% and 12% as clinical experience level. Such low contact rate observed in our study shows that the students were not exposed to the laser treatments in their course even in form of observation.
Almost the entire studied population were willing to obtain more information about lasers. When asked about the source of information they would like to receive the information from, most of them felt that the ideal source would be in the form of short-term CDE programs, workshops, modules, or certificate courses conducted by the colleges. This is also in accordance with the Saudi Arabia study where it was observed that 91.5% of the surveyed population felt that they were provided insufficient knowledge at their undergraduate level.
In India, as per the Dental Council of India, even at the undergraduate level, the presence of a soft tissue laser unit is mandatory in the Department of Periodontics. However, the same is not mirrored in the undergraduate curriculum. The prescribed curriculum includes only an introduction to lasers in conservative and endodontic practice management regarding lasers at the undergraduate level. The last revision to the curriculum was made in 2007, and since then, the field of laser dentistry has expanded by leaps and bounds. A curriculum revision faces several challenges such as being exhaustive, expensive, the expected resistance from students and faculty, and large scope of advancements. However, it is essential for dentistry to provide the best possible care to the patients. The relatively low knowledge showed by students in this study is an indication that it is time that the curriculum be revised. Apart from several other things, laser dentistry should be incorporated both in theory and in practical.
Currently, laser education in India can mainly be acquired in one of the following ways. There are several diploma courses of 6-month duration comprising of three to four modules. These provide in-depth theoretical and practical hands-on knowledge. However, the intake is low (25–40) and the fee charged is quite high (USD1500–3000).,, Due to this, these courses are not very popular. The majority of people acquire knowledge through short-term (1–2 days) continuing dental education programs. These include lectures and hands-on training. This leaves the education in the hands of private companies and individual experts with primary commercial interests. This limits its impact on broader professional practice community.
In a survey by the American Dental Association, it was observed that 31% of patients consider it very important for a dental practitioner to have laser and 30% consider it important. In another study assessing patient responses to Er:YAG laser when used for conservative dentistry, it was observed once the patients fully understood the advantages of laser therapy, 100% had high satisfaction with laser therapy and 89% would choose laser in future. Keeping these findings in mind, to cope with the patient needs and expectations and also to be current with the latest technology, the best approach to laser education would be including it as a part of the curriculum.
In the United States, a Standard Proficiency level of competency as described in the Curriculum Guidelines and Standards for Dental Laser Education is recommended before a dentist starts lasers in his or her practice. In India, there are no set guidelines either for the course curriculum or for the minimum laser education required for dentists before using lasers in their practice. A dentist beginning laser practice more than often depends on the 1-hour demonstration provided by the company representatives. This limits the proper usage of lasers in practice. Similar guidelines concerning laser education and practice are required to be put in place to regularize the largely unregularized laser practice in India.
| Conclusion|| |
Hence, within the limitations of our study, it can be concluded that the dental interns of Karnataka feel that the laser education provided to them in their BDS curriculum is insufficient and they desire more knowledge. Most of the surveyed interns have either incomplete or wrong information regarding the applications of lasers in the various fields of dentistry. In the light of our current observations, we feel that it is the need of the hour to revise the BDS. curriculum appropriately to expose students to dental lasers procedures from the theoretical and practical perspectives.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Verma SK, Maheshwari S, Singh RK, Chaudhari PK. Laser in dentistry: An innovative tool in modern dental practice. Natl J Maxillofac Surg 2012;3:124-32.
] [Full text]
Bhat MA, Hussain S, Imran M, Rehman S, Jan SM, Behal R. Application of lasers in periodontics: A review of the literature. Int J Rec Sci Res 2016;7:11924-9.
Awasthi PN. Dental Operating Room Assistant. 1st ed. New Delhi: Jaypee Medical; 2011.
Kathuria V, Dhillon JK, Kalra G. Low level laser therapy: A panacea for oral maladies. Laser Ther 2015;24:215-23.
Asma Al-Jobair. Dental laser education and knowledge among final year dental students at King Saud University in Riyadh, Saudi Arabia. Saudi J Dent Res 2014:5,98-103.
Gray R. Is this the end of stitches? Star Trek-style device uses lasers to close wounds in just 15 minutes and reduce scarring. Mailonline 2016. Available from: https://www.dailymail.co.uk/sciencetech/article-3437042/Is-end-stitches-Star-Trek-style-device-using-LASERS-heal-wounds-reduce-scarring.html. [Last accessed on 2016 Oct 26].
Nazemisalman B, Farsadeghi M, Sokhansanj M. Types of lasers and their applications in pediatric dentistry. J Lasers Med Sci 2015;6:96-101.
Asnaashari M, Zadsirjan S. Application of laser in oral surgery. J Lasers Med Sci 2014;5:97-107.
van As GA. Lasers in implant dentistry, Part 2. Dent Today. 2015;34:94, 96-9.
Jingarwar MM, Bajwa NK, Pathak A. Minimal intervention dentistry—A new frontier in clinical dentistry. J Clin Diagn Res 2014;8:ZE04-08.
Nalcaci R, Cokakoglu S. Lasers in orthodontics. Eur J Dent 2013;7:S119-25. [Full text]
Chaudhary S, Gowda TM, Kumar TA, Mehta DS. Knowledge and attitudes of dental interns in Karnataka state, India, regarding implants. J Dent Educ 2013;77:1365-70.
DCI. No of bds seats. Available from: http://dciindia.gov.in. [Last accessed on 2016 Oct 26].
Legres LG, Chamot C, Varna M, Janin A. The laser technology: New trends in biology and medicine. J Mod Phys 2014;5:267-79.
Patel AB, Matthews DC, Ghiabi E. Practice profile of periodontists in Canada: A national survey. J Can Dent Assoc 2016;82:g5.
American Academy of Periodontology statement on the efficacy of lasers in the non-surgical treatment of inflammatory periodontal disease. J Periodontol 2011;82:513-4.
Tandon S. Challenges to the oral health workforce in India. J Dent Educ 2004;68:28-33.
Brownstein SA, Murad A, Hunt RJ. Implementation of new technologies in U.S. dental school curricula. J Dent Educ 2015;79:259-64.
Dental Council of India. Revised BDS Course Regulations. New Delhi: Dental Council of India, The Gazette of India; 2007.
Society for Oral Laser Application. Available from: http://www.solaindia.org/laser-academy. [Last accessed on 2016 Oct 26].
Manipal College of Dental Sciences. Manipal. Available from: http://manipal.edu/mcodsmanipal/programs/program-list/pg-certificate-course-in-laser dentistry.html#.html. [Last accessed on 2016 October 26].
Sri Sai College of Dental Surgery. SSCDS Academy of Continuing Dental Education. Available from: http://www.sscds.edu.in/courses.html#laserdent. [Last accessed on 2016 Oct 26].
Dederich DN, Bushick RD; ADA Council of Scientific Affairs and Division of Science, Journal of the American Dental Association. Lasers in dentistry: Separating science from hype. J Am Dent Assoc 2004;135:204-12.
Fornaini C, Riceputi D, Lupi-Pegurier L, Rocca JP. Patient responses to Er:YAG laser when used for conservative dentistry. Lasers Med Sci 2012;27:1143-9.
Dansie CO, Park JH, Makin IR. Training and use of lasers in postgraduate orthodontic programs in the United States and Canada. J Dent Educ 2013;77:773-81.
White JM. Curriculum Guidelines and Standards for Dental Laser Education. Proceedings of lasers in Orthopedic, Dental, and Veterinary Medicine, II, SPIE, 1993;1880:88-99.
[Table 1], [Table 2]