Orthodontic Treatment Knowledge among General Dentists and Non-orthodontic Specialists

Introduction: General dentists and specialists other than orthodontist may encounter patient requiring orthodontic treatment. For proper counseling and referral, it is important that general dentists and non-orthodontic specialists have adequate level of orthodontic knowledge. Objective: To assess the knowledge of orthodontic treatment among general dentists and non-orthodontic specialists and to compare the knowledge between the two groups. Materials & Method: A descriptive cross sectional study using questionnaire was performed among 185 actively practicing general dentists and non-orthodontic specialists of Nepal. The questionnaire comprised of three parts. The first part included demographic details, second part contained 5 multiple choice questions regarding orthodontic counseling and third part integrated 18 questions for evaluating knowledge of orthodontic treatment. Each correct answer was given score 1 and every incorrect answer was scored zero in the third part of the questionnaire. Result: Among total participants, 60.5% think first orthodontic evaluation of a child should be carried out within 7 to 8 years of age and 44.3% think orthodontic treatment can even be started after 40 years of age. Around 66% of the participants think that orthodontic treatment cannot be performed in periodontally compromised cases. No significant difference was found between the mean scores of knowledge among general dentists and non-orthodontic specialists (p=0.891), or among dentists with different years of experience (p=0.644). Conclusion: There is a need for more education of orthodontic treatment concepts to the dentists who do not belong to orthodontic field for proper counseling and referral.


INTRODUCTION
practitioners and other non-orthodontic specialists can play the role of orthodontic health educators. Possible differences in educational training, perception of orthodontic treatment need may differ by dentist group or specialty affiliation. 6,7 Sometimes, patient might present with complain that they cannot correlate with the underlying malocclusion. In such case, it is essential for a dentist to identify and diagnose the orthodontic cause and advice for a referral. 8 Therefore, there is a need to identify the knowledge level of general dental practitioners and nonorthodontist specialists with respect to the orthodontic treatment. The objective of the study was to assess the knowledge of orthodontic treatment among general dentists and non-orthodontic specialists and to compare the knowledge of orthodontic treatment between the two groups.

MATERIALS AND METHOD
Present study is a descriptive cross sectional study carried out among general dentists and non-orthodontic specialist working in different institutions and dental clinics of Nepal.
The ethical approval was taken from Institutional Review Committee of Kantipur Dental College. The study was carried out from January 2018 to March 2018. A written consent was taken from every participant of the study. This is a questionnaire based study. The questionnaire was developed with reference to different studies. 3,5,6,9 The questionnaire was first validated by pre-test. The questionnaire comprised of three parts with a total of twenty three questions. First part included demographic details, second part contained 5 multiple choice questions regarding orthodontic counseling and third part integrated 18 questions for evaluating knowledge on orthodontic treatment. The third part had yes or no as answers, each correct answer was scored 1 and every incorrect answer was scored zero. The individual scores were summed up to obtain the total score.
Dental surgeons and non-orthodontic specialists who are actively involved in providing oral health care in hospitals and private clinics were included in the study. Dentists who are not presently practicing dentistry were excluded from the study.
Questionnaire were distributed to 225 participants (approximately 25% of active dentist in Nepal). 10 The questionnaires was distributed proportionately among general dentists and non-orthodontic specialists into 2:1 ratio. Excluding non-respondents, total filled questionnaires collected was 185. The study group was then divided into two groups. Group I comprised of general dentists and Group II included non-orthodontic specialists with a master degree in any subject of dentistry other than orthodontics.
Statistical analysis was done using IBM SPSS software version 21. Mann-Whitney U test and Kruskal-Wallis test were performed as the data were not normally distributed.
Significance level was set at p≤ 0.05.

RESULT
The study population included 185 total participants out of which 124 were general dentists and 61 were nonorthodontic specialists. Among them 92 were male and 93 were female. 31% of the participants had experience of 2 years or less, 40% had experience of 2-6 years and 29% had greater than 6 years of experience. Frequency distribution of participants according to qualification is given in Figure 1.
While evaluating the knowledge on orthodontic treatment for counseling of the patients, 60.5% of the participants think first orthodontic evaluation of a child should be carried out within 7 to 8 years of age. 44.3% of the participants think that orthodontic treatment can be started after 40 years of age. 88.1% of the participants think that average duration of the orthodontic treatment is 2-3 years. 47% think that retainer should be worn for 6-12 months after orthodontic treatment. 83.2% participants think that only tipping movement can be achieved by the removable appliance (Table 1)

DISCUSSION
While evaluating the perception of the orthodontic treatment for the counseling of the patients, Table 1 shows that most of the general dentists and the nonorthodontic specialists were aware of the basic concept of the orthodontic treatment. However, around 40% of the participants aren't aware that first orthodontic evaluation should be done around 7-8 years and around 55% think that orthodontic treatment cannot be performed after 40 years. This lack of knowledge is very vital for the patient counseling and referral at the correct age for the optimal outcome of the orthodontic treatment. This shows the need for increased in clinically oriented education of practice and concepts of orthodontic treatment.
There was no significant difference between the mean score of knowledge among general dentists and nonorthodontic specialists (p=0.891). In a similar study done to assess the knowledge of principle and practice of orthodontic treatment among general dentists and nonorthodontics specialists, the mean score of knowledge Mean score of knowledge among general dentists was 13.74±2.32. Mean score of knowledge among non-orthodontic specialist was 13.87±1.75. There was no significant difference between the mean score of knowledge among general dentists and non-orthodontic specialists (p=0.891) ( Table 3).
In the present study, the mean score of knowledge was also evaluated by categorizing it in three grades. Mean score 0 to 6 was given poor, mean score 6.1 to 12 was given fair and mean score 12.1 to 18 was good. Distribution in different grades is given in Table 3.