Knowledge, Awareness, and Attitude among Practicing Orthodontist on Teledentistry during COVID Pandemic in Kerala: A Cross-Sectional Survey.

BACKGROUND: Considering the gravity of coronavirus disease 2019 (COVID-19) and its potential to unfold within the dental workplace or institutions, a shift from traditional dental practice to a newer method is needed. Teledentistry is widely being practiced in this pandemic era for the diagnosis and to give instructions to the patients. Hence, an attempt has been made to explore the knowledge, attitude, and awareness of practicing orthodontists regarding the usage of teledentistry during COVID lockdown, in Kerala.
MATERIALS AND METHODS: A cross-sectional, descriptive study was done on about 150 orthodontic professionals. A pretested, self-organized, close-ended survey was managed through online stages that comprised of 15 questions. The information gathered was assembled in a systematic way and investigated regarding recurrence and Chi-square test was utilized for the examination of frequencies.
RESULTS: It was observed that 93.3% orthodontic practitioners had knowledge regarding teledentistry and a positive attitude toward teledentistry was shown by younger age group practitioners and those who were working in institutions (P < 0.05). 77.3% believed that teledentistry can save dentist's time and 71.3% responded that the new technology can be helpful in reducing the cost of treatment for patients.
CONCLUSION: The knowledge, awareness, and attitudes were discovered to be acceptable among the orthodontic practitioners. Younger practitioners had more positive attitude toward teledentistry, and there was an overall positive attitude for using teledentistry as a temporary alternate for direct patient contact in COVID-19 pandemic time. Copyright:

INTRODUCTION

Coronavirus disease 2019 (COVID-19) is a contagion caused by severe acute respiratory syndrome coronavirus which affects largely the vulnerable population together with older folks with compromised immunity and comorbidities such as coronary heart diseases, diabetes mellitus, and hypertension. It is transmitted through oral or nasal secretions once an infected individual sneezes or coughs. The pandemic eruption of (COVID-19) has become a major public health burden globally. Considering the gravity of COVID-19 and its potential to unfold within the dental workplace or institutions, a shift from traditional dental practice to a newer method is needed.[1]

Teledentistry is a field that has arisen with the beginning of data technology.[2] It is outlined as “the phase of the science of telemedicine involved with dentistry that deals with the whole method of networking, sharing digital information, distant consultations, workup, and analysis.”[3] Teledentistry uses two approaches: Real-time and store-and-forward strategies.[4] Real-time consultation includes a videoconference during which dental experts and their patients, at entirely unexpected areas, may see, hear, and speak with one another really utilizing progressed data innovation and super high transfer speed network communications.[567] Store-and-forward alludes to the social affair and secure transmission of encoded data along with understanding reports and pictures (intraoral photographs, radiographs, and extraoral photographs) which are used for review by the dental professional or expert sometime in the not too distant future for discussion and treatment designing.[5678]

In India, there is no documented information on teledentistry per se from any of the 29 states, six union territories and one national capital region. Three states are specifically operating within the field of teleconsultation, of which Maharashtra has implemented teleconsultation for dental-related issues as well.[9] In Kerala state, The “Tele-Oncology Network” was the primary telemedicine service developed for early detection, follow-up, and pain relief for cancer patients from the rural areas.[10] There is moderately less independent foundations for teledentistry. As of now, these administrations work underneath the umbrella of telemedicine services in Bharat.[11]

Teledentistry tools can be used for remote specialist superintendence of orthodontic treatments and interventions undertaken by native dentists, and studies have proven that it is a helpful approach.[12] While there is no chance for face-to-face consultations, professionals and patients have the opportunity to use technology to supply and receive virtual help, using photo, video, or video call applications, thereby permitting the orthodontist to judge the requirement to be seen at dental workplace.[1314] Hence, an attempt has been made to explore the knowledge, attitude, and awareness of practicing orthodontists regarding the usage of teledentistry during COVID lockdown in South Kerala.

Objective

To assess the knowledge, awareness, and attitudes of orthodontic practitioners on using teledentistry in COVID pandemic time.

STUDY DESIGN AND STUDY POPULATION

The current investigation is a clear cross-sectional survey. A pretested, self-directed, close-ended questionnaire comprising of 15 inquiries were incorporated to assess knowledge, attitudes, and awareness among the orthodontic practitioners. A structured online questionnaire along with informed consent was prepared and sent through social media platforms to practicing orthodontist. The study population comprised of 150 practicing orthodontist in Kerala.

Inclusion and exclusion criteria

All the practicing orthodontists willing to participate in the study were considered in the inclusion criteria. The exclusion criteria included were orthodontists who are not practicing and who were above 60 years.

Pilot study and pretesting of the questionnaire

The pilot study was directed among 10 orthodontic practitioners to decide the attainability of the investigation. Cronbach's coefficient was discovered to be 0.79 which implies an adequate inside unwavering quality of the survey. For testing the legitimacy, the substance legitimacy proportion was likewise determined by utilizing item-rated content validity indices. This was accomplished by taking the responses on the dichotomous scales where the academician showed whether a thing is favorable (score of +1) or unfavorable (score of 0). The content legitimacy proportion was discovered to be as 0.86 by the board of four academicians. Furthermore, there were no progressions needed in the survey because of pretest.

Ethical approval and informed consent

The protocol for the survey was approved by the Institutional Review Board, and ethical approval was obtained. An online consent form was also obtained from all the participants.

Data collection and analysis

The questionnaire was distributed through online portal. The questionnaire comprised of two parts which includes a first part which consists of sociodemographic details and the second part consists of questions to assess the knowledge, awareness, and attitudes of clinical practitioners on using teledentistry in COVID pandemic time. The study was conducted between the time period of May 2020 and July 2020. The data were assembled, organized, and arranged in a systematic manner and analyzed in terms of frequencies (yes/no), and Chi-square test was used for inferential statistics. Statistical analysis was done using the SPSS software version 17.0 (SPSS Inc., Chicago, IL, USA).

RESULTS

A total of 150 participants participated in the study. 42.6% participants were below 35 years of age, 38.6% between 35 and 45 years of age, and 18.6% was above 45 years of age. There were 108 males and 42 female orthodontists in the study. Majority of the participants were sole clinical practitioners (68.6%) and not into academics [Table 1].

Table 1

Sociodemographic characteristics

Parameter	Frequency (n=150), n (%)
Age
25-35	64 (42.66)
35-45	58 (38.66)
45-55	28 (18.66)
Sex
Males	108 (72)
Females	42 (28)
Mode of practice
Clinical practice only	103 (68.66)
Clinical practice and academics	47 (31.33)

93.3% heard of teledentistry while 82% felt that orthodontic diagnosis can be done through teledentistry. 83.3% think that the patient can share their radiographs digitally for diagnostic purpose. More than 50% responded positively for giving instructions for fixed and removable orthodontic appliance through teledentistry. 69.3% patients were willing to practice teledentistry in future also [Table 2].

Table 2

Responses in knowledge, awareness, and attitude-related questions

Knowledge, awareness and attitude related questions	Yes (%)	No (%)
Have you heard about teledentistry?	140 (93.3)	10 (6.6)
Is teledentistry about the practice of use of computers, Internet, and technologies to diagnosis and provide advice about treatment over a distance?	142 (94.6)	8 (5.3)
Does teledentistry helps patient for an orthodontic consultation and diagnosisin the COVID time?	123 (82)	27 (18)
Does teledentistry helps patient to share his/her radiograph for orthodontic diagnosis?	125 (83.3)	25 (16.6)
Do you think that teledentistry can help you deliver dental health education in an orthodontic patient?	138 (92)	12 (8)
Does teledentistry helps to monitor the fixed or removable orthodontic appliance?	113 (75.3)	37 (24.6)
Can teledentistry be used to instruct patient to activate removable orthodontic appliance? (expansion screw, hawleys appliance)	95 (63.3)	45 (30)
Can teledentistry be used to instruct patient to replace removable components (elastics) in fixed orthodontic treatment?	87 (58)	63 (42)
Can teledentistry be used to give instructions to help them fix a browken or damaged orthodontic appliance?	82 (54.6)	68 (45.3)
Does teledentistry can help in reducing costs for the dental practices?	107 (71.3)	43 (28.6)
Do you think that teledentistry saves time for the dentist?	116 (77.3)	36 (24)
Do you think that teledentistry can increase accessibility of the orthodontist to rural and underserved communities for their dental needs?	119 (79.3)	31 (20.6)
Can teledentistry be applied to any other branch of dentistry other than orthodontics?	135 (90)	15 (10)
Do you think that dental examinations are accurate via computers and intraoral camera as in the traditional office setting?	78 (52)	72 (48)
In the future, will you practice teledentistry?	104 (69.3)	46 (30.6)

COVID: Coronavirus disease

43.5% participants who responded positively were of the age group of 25–35 years. There was a statistically significant association between knowledge question with age group, P < 0.032 and mode of practice [Table 3]. There was no significant relation with knowledge question and gender.

Table 3

Association of knowledge and attitude-related question with baseline parameters

Parameter	Have you heard about teledentistry?		P
	Yes (n=140), n (%)	No (n=10), n (%)
Age group
25-35	61 (43.5)	3 (30)	<0.032*
35-45	52 (37.1)	6 (60)
45-55	27 (19.2)	1 (10)
Gender
Male	102 (72.8)	6 (60)	0.327
Female	38 (27.1)	4 (40)
Mode of practice
Clinical practice only	98 (70)	5 (50)	0.014*
Clinical practice and academics	42 (30)	5 (50)
Parameters	In the future, will you practice teledentistry?		P
	Yes (n=104), n (%)	No (n=46), n (%)
Age group
25-35	50 (48.07)	14 (30.4)	<0.002*
35-45	46 (44.2)	12 (26.08)
45-55	8 (7.6)	20 (43.47)
Gender
Male	85 (81.7)	23 (50)	0.327
Female	19 (18.2)	23 (50)
Mode of practice
Clinical practice only	71 (68.2)	32 (69.5)	0.014*
Clinical practice and academics	33 (31.7)	14 (30.4)

*Chi-square test P<0.05 considered as statistically significant

48.07% participants of age group of 25–35 years responded positively, whereas 43.47% responded negatively to the question “in the future, will you practice teledentistry?” There was a statistically significant relation between this question with age group P < 0.002 and mode of practice P < 0.014 [Table 3].

DISCUSSION

In the present study, the knowledge and awareness regarding teledentistry was assessed among 150 orthodontic practitioners. 93.3% of the study participants were aware about teledentistry. A similar study by Pradhan et al. on postgraduate students showed that there were 96.1% participants who were aware of teledentistry.[15] Knowledge level about the teledentistry approach was higher among younger practitioners than experienced practitioners in our present study and was statistically significant. Teledentistry is an ongoing origination and requires contraptions, for example, cell phones and media, which is clearly utilized more by younger generation in contrast with the older folks.[16171819]

Ninety-two percent participants had a positive attitude toward this method and believed it to be a decent apparatus for oral hygiene training in orthodontic patients. In addition, 71.3% respondents believed that teledentistry helps in reducing costs for the dental practices. A study done in Bristol highlighted that there is a significant reduction in travel expenses for dental treatment with the usage of teledentistry.[2021]

Most of the responses for consultation regarding instructions for patients on the usage and maintenance of removable and fixed orthodontic treatment were positive. 75.3% positively responded for the question “does teledentistry help to monitor the fixed or removable orthodontic appliance?” 63.3% responded on “teledentistry be used to instruct patient to activate removable orthodontic appliance? (expansion screw and Hawley appliance).” A low percentage of positive response was observed when it came to fixed orthodontic treatment and myofunctional appliances compared to the removable orthodontic appliance. Fifty-eight percent of the participants felt that teledentistry can be used to instruct patient to replace removable components (elastics) in fixed orthodontic treatment and 54.6% believed that teledentistry can be used to give instructions to help them fix a broken or damaged orthodontic appliance. A study by Saccomanno et al. on instructions for activation of expansion screw and monitoring of aligners showed a positive result and were considered time saving and economical for both dentists and patients.[22]

Is significant on the grounds that clinical dynamic through electronic methods may fall beneath set up principles of care dental assessments through PCs and intraoral camera when contrasted with the customary office setting.

The validity of telemedicine significant on the grounds that clinical dynamic through electronic methods may fall beneath set up principles of care. Furthermore, there is a lack of research investigating the validity of telemedicine applications.[2324] Only half of the population in our present study had doubt about the accuracy of the dental assessments through PCs and intraoral camera when contrasted with the customary office setting.

There was a statistically significant association between attitude with the age of the respondents and mode of practice. Positive attitude was seen in the practitioners of younger age group and in those who were working in teaching institutions. As mentioned before this may be due to an increased usage of electronic gadgets by younger practitioners.[16]

Although there are many merits associated with the usage of teledentistry, certain disadvantages do exist. It is a tedious procedure to ensure data security, collection, and storage. For instance, information encryption, password protection, and client access logs can help in preventing the greater part of individuals and in ensuring quiet privacy. Dental specialists should know about the legitimate necessities in their conditions of training and stay cautious about the parliamentary changes in this quickly creating field.

Limitations

In spite of receiving all the feasible strides to decrease predisposition, the investigation was as yet helpless to certain impediments. The significant impediment was brief length for information assortment which might have brought about more modest than anticipated example. Utilizing online media for information assortment would have wiped out the experts who were inexperienced with web-based media or the individuals who were caught up with dealing with individual issues. A few states or areas the nation over were more influenced than others which may impact the organization and medical care preventive estimates actualized by a specific state that could impact the result of the study.

CONCLUSION

The knowledge, awareness, and attitudes were discovered to be acceptable among the orthodontic practitioners. Younger practitioners had more positive attitude toward teledentistry, and there was an overall positive attitude for using teledentistry as a temporary alternate to avoid direct patient contact in COVID-19 pandemic time. There was no gender wise difference in knowledge, attitude, and awareness.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.