Knowledge, attitude, and practice regarding prosthodontic rehabilitation and factors affecting the patients visiting private clinics in Riyadh, Saudi Arabia: A cross-sectional study.

BACKGROUND: Prosthodontic rehabilitation maintains the esthetics, functional support, and the masticatory function of the oral cavity. The main aim of the present study was to explore the knowledge, attitude, and practice towards prosthodontic rehabilitation and factors affecting the KAP of patients.
MATERIALS AND METHODS: The present research is a cross-sectional descriptive questionnaire study conducted among the patients visiting private hospitals in Riyadh City, Saudi Arabia. The city was divided into five directions; south, north, east, west, and central. From each direction, one hospital was included randomly with more than 50 patients in OPD per day. The interview was conducted among 121 patients from each hospital which made the sample size of 605.
RESULTS: Among all study participants in the present study, majority (252 [41.67%]) of them were more than 50 years of age. Female study participants (318 [52.57%]) were more than (287 [47.43%]) the male participants. It was reported that 458 (75.70%) of the study participants have missing teeth ranging from 6 to 10. The main reason reported for absence of prosthesis was money constraints among the 121 (38.90%) study participants. Inadequate knowledge regarding prosthodontic rehabilitation was significantly associated (P-value ≤ 0.05*) with attitude and practice of the study participants.
CONCLUSION: It was concluded that financial constraints were the major factors for not availing prosthodontic rehabilitation. Moreover, inadequate knowledge regarding prosthodontic rehabilitation significantly affects the attitude and practice of the study participants. Copyright:

Introduction

According to the American Dental Association “Prosthodontics”, which is also known as dental prosthetics or prosthetic dentistry, is the area of dentistry pertaining to the diagnosis, treatment, planning, rehabilitation, and maintenance of the oral function, comfort, appearance, and health of patients with clinical conditions associated with missing, or deficient teeth, or oral and maxillofacial tissues using biocompatible substitutes.[1]

In the past few years with the rapid improvement in oral health and the reduction of edentulism in many countries, increasing numbers of people are retaining more teeth later in their life.[2] However, with increase in age, patients’ need more prosthodontic rehabilitation, particularly in patients with poor oral wellbeing and loss of teeth, complete misfortune or edentulism, is proportionate to dental death.[3] Thus, tooth misfortune causes leftover edge resorption prompting diminished masticatory capacity influencing the dietary admission, nutritional status, and feeling of seniority along these lines trading off the general wellbeing. In substitution of missing teeth different factors, for example, esthetics and utilitarian solace are viewed as increasingly significant while endeavoring to supplant missing teeth.[456] If the teeth are replaced at the proper time it will prevent nutritional deficiencies, motivation for phonetics, and many more psychological problems associated with it, which can be considered as a type of primary prevention for subsequent problems after the loss of teeth.

The three principle factors that decide the agreeableness and achievement of prosthetic treatments are comfort, function, and esthetics. Mechanical and organic elements decide solace and functional ability. The patient's acknowledgment of tasteful angle is dictated by social impacts and frame of mind and conviction of a person.[7] The requirement for dental prosthesis shifts from patient to patient contingent upon their age, sex, occupation, financial foundation, and education. Rehabilitative treatment is fruitful just when patients are inspired and are made mindful of different prosthodontic treatments accessible, its utilization, and maintenance.[8]

In a study conducted by Reddy et al.[9] among Jazan population in the southern region of Saudi Arabia, it was reported that complete dentures were related with lower anticipated results, compounded by insufficient information and lack of motivation for the same. Therefore, the main aim of the present study was to explore the knowledge, attitude, and practice towards prosthodontic rehabilitation and factors affecting the KAP of patients visiting a clinic in Riyadh, Saudi Arabia.

Materials and Methods

The present research is a cross-sectional descriptive questionnaire study that was conducted to determine knowledge, attitude, and practice of patients visiting physician's clinic for general health check-up, regarding prosthodontic rehabilitation and factors affecting the KAP of patients. The present study is conducted among patients visiting private hospitals in the Riyadh city of Saudi Arabia. Ethical clearance was obtained from the ethical committee of the ELM university for post graduation and scientific research on 17th April 2019. Permission was availed from the head of the hospital to conduct the interview.

The city was divided into five directions, namely, south, north, east, west, and central. From each direction, one hospital was included randomly with more than 50 patients in OPD per day. In each hospital, survey was conducted for 7 days by a single investigator. The interview was conducted among those patients and people accompanying the patients who had one or more teeth missing and who had given their informed consent to be included in the study. A total of 121 patients were interviewed from each hospital which made the sample size of 605.

Before the main survey, a pilot survey was conducted on 10% of study participants to test the validity and reliability of questionnaire. The reliability of the questionnaire was determined by using test-retest method and the values measured Kappa (k) = 0.76 and weighted Kappa (k) = 0.67. Internal consistency of questionnaires were measured by applying Cronbach's-Alpha (α) where the value of α = 0.71.

A close-ended interview schedule was prepared which consisted of four parts. The first part consisted of demographic details and socio-economic status by Kuppuswamy scale.[10] The second part consisted of five knowledge questions: Is teeth in humans replaceable by artificial teeth? Can a prosthesis be fixed, removable, or both? Missing teeth for long time effects gums and bone? and so on. The attitude part had eight questions: removal of missing teeth is not necessary, removal of missing teeth by implants is best, missing teeth affects the appearance the most, missing teeth for long time does not affect the mouthparts like gums or bones, and so on. The practice part included six questions: I had taken treatment for my missing teeth; I had replaced my missing teeth by removal prosthesis; I had replaced my missing teeth by fixed prosthesis; I had availed treatment from specialist only and so on.

The questions included in attitude were assessed on a five-point Likert scale: Definitely Yes to Definitely No. The range of possible scores for knowledge, attitude, and practice were 0–5, 8–40, and 6–12, respectively. Correct answers for knowledge questions were given a score of “1” and wrong answers were given a score of “0” while the attitude scores ranged from 5 (definitely yes) to 1 (definitely no) and practice scores ranged from 2 (always) to 1 (never).

Statistical analysis

Demographic details, prosthodontic status, knowledge, attitude, and practice scores regarding prosthodontic rehabilitation among the study subjects were determined by applying descriptive analysis. Correlation analysis was used to determine association between knowledge, attitude, and behavior towards prosthodontic rehabilitation among the study subjects. Similarly, Chi-square test was used to determine association between knowledge, attitude, and practice scores regarding prosthodontic rehabilitation among the study subjects and their demographic details and prosthodontic details.

Results

Among all study participants, majority ((252 [41.67%]) of them were more than 50 years of age. Female study participants (318 [52.57%]) were more than (287 [47.43%]) the male participants. Maximum study participants (189 [31.23%]) belonged to lower-middle-class of socio-economic status [Table 1].

Table 1

Demographic details of study participants (n=605)

Demographic variables		Number (n)	Percentage (%)
Age in years	21–30	68	11.23
	31–40	131	21.65
	41–50	154	25.45
	More than 50	252	41.67
	Total	605	100%
Gender	Male	287	47.43
	Female	318	52.57
Socio-economic status	Upper class	59	9.75
	Upper middle class	153	25.28
	Lower middle class	189	31.23
	Upper lower class	110	18.18
	Lower class	94	15.56
	Total	605	100%

Table 2 shows the prosthodontic status of the study participants. It was reported that 458 (75.70%) of study participants have missing teeth ranging from 6 to 10. Among all, 311 (51.41%) study participants had no prosthesis in their oral cavity while those having it, majority (121 [41.15%]) of them, had fixed partial prosthesis. Among the 121 (38.90%) study participants, not having any prosthesis besides absent teeth, the main reason for the absence of prosthesis was money constraints.

Table 2

Prosthodontic status of study participants

Prosthodontic status		Number (n)	Percentage (%)
Number of missing teeth	1–5	31	5.12
	6–10	458	75.70
	More than 10	116	19.18
	Total	605	100%
Presence of prosthesis in oral cavity	Yes	294	48.59
	No	311	51.41
	Total	605	100%
Type of prosthesis present	Fixed partial	121	41.15
	Fixed complete	18	6.12
	Removable partial	23	7.82
	Removable complete	39	13.26
	Implant partial	62	21.08
	Implant complete	31	10.57
	Total	294	100%
Reason for not replacing the teeth	Financial constraints	121	38.90
	Inadequate knowledge	72	23.15
	Not motivated	19	6.10
	No time	48	15.46
	Scared of treatment	51	16.39
	Total	311	100%

Table 3 shows knowledge, attitude, and practice regarding prosthodontic rehabilitation among the study participants. It has been reported that knowledge of most of the study participants (286 [47.27%]) regarding prosthodontic rehabilitation was fair with scores ranging from 2 to 3. In relation with the attitude of the study participants (238 [39%]), most of them were having scores ranging from 17 to 28 which depicts a fair attitude. The practice of majority of the study participants was fair towards prosthodontic rehabilitation with 301 (49%) having a score ranging from 6 to 9.

Table 3

Knowledge, attitude, and practice scores regarding prosthodontic rehabilitation among study subjects

Variables	Number of subjects	Percentage of subjects n (%)
Knowledge	0–1 (poor)	154 (25.45%)
	2–3 (fair)	286 (47.27%)
	4–5 (good)	165 (27.28%)
	Total	605 (100%)
Attitude	8–16 (poor)	211 (34.87%)
	17–28 (fair)	238 (39%)
	29–40 (good)	156 (26.13%)
	Total	605 (100%)
Practice	Less than 6 (poor)	98 (16.19%)
	6–9 (fair)	301 (49.75%)
	10–12 (good)	206 (34.06%)
	Total	605 (100%)

Table 4 shows correlation analysis, which states that knowledge regarding prosthodontic rehabilitation had a significant correlation (P ≤ 0.05) with attitude, practice, and also the attitude of the study participants had significant correlation (P ≤ 0.05) with practice towards prosthodontic rehabilitation.

Table 4

Correlation analysis of knowledge, attitude, and behavior towards prosthodontic rehabilitation among study subjects by using Pearson’s correlation

	Knowledge		Attitude		Practice
	r	P	r	P	r	P
Knowledge	-	-
Attitude	0.122	0.01*	-	-	1.001	0.23
Practice	-0.002	0.00*	0.14	0.111	-	-

P value ≤0.05*

Table 5 shows the application of Chi-square test to determine association between demographic variables and prosthodontic status with knowledge, attitude, and behavior related to prosthodontic rehabilitation. It was stated that, age group (P-value ≤ 0.00***), socio-economic status (P-value ≤ 0.01**), and number of missing teeth (P-value ≤ 0.05**) were significantly associated with the knowledge of study participants regarding prosthodontic rehabilitation. The attitude of study participants was significantly associated (P-value ≤ 0.05**) with gender while practice regarding prosthodontic rehabilitation had a significant association with number of missing teeth (P-value ≤ 0.01**) and reason for not having prosthesis (P-value ≤ 0.00***).

Table 5

Correlation analysis of demographic variables and prosthodontic status with knowledge, attitude, and behavior about prosthodontic rehabilitation among study subjects by using x2 test

Demographic variables	Knowledge		Attitude		Practice
	Χ2	P	Χ2	P	Χ2	P
Age group	1.889	0.00***	1.900	1.56	5.111	0.78
Gender	3.901	1.22	0.344	0.05*	3.564	1.10
Socio-economic status	0.510	0.01**	5.138	1.12	0.206	0.31
Number of missing teeth	0.110	0.05*	2.321	0.98	2.181	0.01**
Presence of prosthesis in oral cavity	2.001	0.11	1.103	0.11	0.489	1.69
Type of prosthesis present	0.230	1.20	3.302	0.76	1.902	2.10
Reason for not having prosthesis	1.231	0.05*	2.651	0.101	2.403	0.00***

P-value ≤0.05*, P value ≤0.01**, P value ≤0.00***

Discussion

Teeth are important to health and attitude, hence the practice to replace teeth depends on the knowledge of the individual about the available types and modes of artificial teeth replacement.[711]

In the present study, majority of the study participants (252 [41.67%]) were more than 50 years of age. Similar results were shown in a study conducted by Reddy et al.[9] and Shigli et al.[12] in which majority of the study participants were above 50 years of age. Contrasting results were shown in a study performed by Gupta et al.[13] wherein majority of study participants were between the age group of 41 to 50 years. The reasonable justification as portrayed by the creators were absence of data, portability issues, and misguided judgment about the estimation of dental consideration among geriatric patients.[14]

In the present study, females study participants (52.57%) were more as compared to male study participants (47.43%) which is in accordance with the study conducted by Shetty et al.[8] and Baqar et al[15]. On the other hand, contrasting results were reported by Reddy et al.,[9] Gupta[13] and Nirmal et al.[16] wherein male participants were more than the female participants.

In the present study, the majority of all study participants had missing teeth. Similar studies were reported by Nirmal et al.[16] where 84.3% of study participants had missing teeth; by Reddy et al.[9] where all study participants have missing teeth and by Shetty et al.[8] wherein 97.7% of study participants had missing teeth. As in the present study, only those participants were included who had one or more missing teeth.

In the present study, 311 (51.41%) of the study participants had no prosthesis in their oral cavity while majority (121 [41.15%]) of them had fixed partial prosthesis. Among the study participants, not having any prosthesis besides absent teeth, the main reason for the absence of prosthesis was money constraints. Comparable results were seen in a study by Nirmal et al.[16] wherein majority of the study participants wanted to replace the missing teeth by fixed partial prosthesis. In the same study, main reason for not going for prosthetic replacement was financial constraints. While in a study by Shetty et al.[8] main reason for not replacing the missing teeth was no felt needs of the participants to replace missing teeth. Contrasting results were reported in an earlier study conducted by Reddy et al.[9] in which financial constraints were the least common reason to replace missing teeth and inadequate knowledge was the most common reason for non-replacement. In a study by Shingli et al. 65.8% of study participants had prosthesis in their oral cavity which was not in accordance to the present study.

In the present study, it was reported that the study participants had fair knowledge, attitude, and practice towards prosthodontic replacement. While in another study by Reddy et al.[9] the knowledge regarding replacement of missing teeth was inadequate. Similar results were seen in a study by Gupta et al.[13]

In the present study, knowledge of the study participants regarding prosthodontic rehabilitation had a significant correlation (P ≤ 0.05) with attitude and practice.

Babar et al.[15] reported alike results in which low knowledge regarding replacement of missing teeth leads to unfavorable attitude and practice. Factors such as age, gender, socio-economic status, number of missing teeth, and reason for not having prosthesis were significantly (P-value ≤ 0.05*, P value ≤ 0.01**, P value ≤ 0.00***) associated with knowledge, attitude, and behavior about prosthodontic rehabilitation. In a study by Nirmal et al.[16] lower expected outcomes, cost-related issues, and lack of awareness were the major factors associated with KAP of the study participants.

Conclusion

In conclusion, knowledge, attitude, and practice regarding prosthodontic rehabilitation were fair among the study participants. Financial constraints were the main factors for not availing prosthodontic rehabilitation. Inadequate knowledge regarding prosthodontic rehabilitation significantly affects the attitude and practice of the study participants. Therefore, in the present study age, gender, socio-economic status, number of missing teeth, and reason for not having prosthesis of the study participants were significantly affecting KAP regarding prosthodontic rehabilitation.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.