Perception, Awareness, and Practice about Missing Teeth, Prosthetic Options, and Knowledge about Dental Implants as a Treatment Modality in the Adult Population of Jharkhand State: A Hospital-Based Study.

Context: Several options to restore the missing teeth are currently available; however, minimal information is there regarding the tooth loss consequences and knowledge of the various prosthetic options in the Indian population. Aim: The aim of this study was to investigate the perception, awareness, and practice about missing teeth, prosthetic options, and knowledge about dental implants among the adult population of Jharkhand state. Materials and
Methods: A questionnaire-based cross-sectional study was carried out on 400 participants. The questionnaire was divided into two sections, i.e., perception awareness and practice about missing teeth, its consequences, and prosthetic options and the second part was about the knowledge of dental implants. Statistical Analysis: Chi-square test was applied for comparison, and P < 0.05 was considered statistically significant.
Results: Maximum numbers of people 178 (44.5%) were interested to get their teeth replaced as a definite requirement. Loss of esthetics as a consequence after tooth loss was known to 72.5% followed by tilting of adjacent teeth (47%). Awareness for prosthetic options available after tooth loss was highest (71.5%) for fixed partial denture's (Bridge). Sixty-three percentage of the studied population had not replaced their missing teeth with any dental prosthesis. Knowledge about dental implants was restricted to a meager of 84 (21%) of the participants. Dentist was the main source of information for dental implants, followed by media.
Conclusion: Awareness of patients toward missing teeth and its consequences requires more emphasis. Special effort is needed to improve the knowledge of dental implants among the less educated population of this region. Copyright:

INTRODUCTION

Rehabilitation of missing teeth is the prime goal of dentists to restore function, speech, esthetics, and psychological morbidity of the patient since antiquity.[1] Several options to restore the missing teeth are currently available including complete and partial removable prosthesis, fixed partial dentures (FPD), dental implants, and overdentures.[2]

Emergence of dental implants has shown promising results in fulfilling completely or partially edentulous patient's desires of function, esthetic, speech, and self-esteem.[3] Fixed prosthesis has outweighed the removable prosthesis as a choice for tooth replacement due to its fixed and esthetic nature, despite the main disadvantage of sacrificing the adjacent tooth.[4] Dental implants have shown immense durability with enhanced efficacy in function compared to FPD's and dentures.[5] Many studies have proved that dental implant prosthesis has dramatically improved the mechanical factors such as retention, stability, and support of the denture giving functional satisfaction and a boost in quality of life.[67] They also have resolved the problem of adjacent tooth destruction but the disadvantage of a surgical approach is evident in implants. Despite several advantages of dental implants, they still are not the primary choice of majority of patients for missing tooth replacement due to minimal knowledge.[8] Therefore, this study aims to investigate the perception, awareness, and practice about missing teeth, prosthetic options, and knowledge about dental implants as a treatment modality among the adult population of Jharkhand state.

MATERIALS AND METHODS

A questionnaire-based cross-sectional study was carried out among the patients attending the outpatient department of our institute. In this study, 400 participants were enrolled, out of which 234 were males and 166 were females with mean age of 38.6 years. Informed consent was obtained from the patients who agreed to participate in the study. The study was approved by the institutional ethical committee. The questionnaire was explained to every patient in their own language. The questionnaire was divided into two sections, i.e., perception awareness and practice about missing teeth, and its consequences with their various mode of rehabilitation and the second part was about the knowledge of dental implants. The inclusion criteria comprised patients who presented with partially edentulous arches within the age group of 18–65 years and those who had replacement of missing tooth. Full information about dental implant procedure its advantages and disadvantages were deliberately rendered to all participants, and then, their willingness was also assessed whether they will opt for implant in the future. The gathered data were entered in an Excel sheet and analyzed using the Statistical Package for the Social Sciences (SPSS Inc., Chicago. IL, USA) software to obtain the results. The categorical variables were presented as numbers and percentages. Chi-square test was applied for comparison, and P < 0.05 was considered statistically significant.

RESULTS

Perception of our study group toward reason for replacement of missing teeth showed that maximum numbers of people, 178 (44.5%) were interested to get their missing teeth replaced as a definite requirement. One hundred and fifty six (39%) subjects stressed on function while 76 (19%) participants weighed esthetic over other reasons as a need for replacement of teeth. Only 6% of the surveyed population said not to replace teeth if there is no problem. Gender wise males stressed on the importance of function and females laid stressed on esthetics. Education-wise undergraduates were keener on function.

On evaluating awareness of our study group for consequences of missing teeth, maximum number of patients 290 (72.5%) reported loss of esthetics with no significant variation gender- and education-wise. One hundred and eighty-eight (47%) subjects knew tilting of teeth as a consequence after tooth loss of which 85% were undergraduates and 15% were graduates or above. Supra eruption as a consequence of tooth loss was known to 14.5% of participants, speech to 34.5% of the participants, while 26% of our studied group knew no consequences of missing teeth.

Awareness toward alternatives for replacing missing teeth showed 71.5% of the surveyed population had awareness for FPD's (Bridge), 66.5% for removable partial denture (RPD's), 64.5% for CD, and only 21% had knowledge for dental implants. Fifty-two (13%) participants had no knowledge for any kind of replacement therapy, which was nonsignificant gender- and education-wise. Among 400 subjects, only 84 had awareness for dental implants, of which 60 (71.4%) were graduates or above. Similarly, for knowledge of FPD's, graduates or above had more information (63%) versus undergraduates (37%).

Practice toward prosthesis was checked, and we found 252 subjects (63%) had not replaced their missing teeth with any dental prosthesis. In this pool, 182 (72.2%) were undergraduates compared to 70 (27.8%) of graduates or above which was statistically significant. Ninety (22.5%) subjects had FPD's for their missing teeth, out of which 62 (69%) were graduates or above showing a statistically significance. RPDs were worn by 58 (14.5%) of population studied which was also highly significant for subjects who were graduates or above [Table 1].

Table 1

Practice toward prosthesis among patients according to education and gender level

	FPD (Bridge)	RPD	Not replaced	χ 2	Significance “P”
Education level
Under graduate	28	24	182	27.179	0.001 (HS)
Graduate or above	62	34	70
Gender
Male	56	40	158	0.440	0.802 (NS)
Female	34	18	94
Total	90	58	252

FPD: Fixed partial dentures, RPD: Removable partial denture, HS: Highly significance, NS: Not significance

Table 2 shows data for 252 subjects as their reason for not having replaced their missing teeth. We found that maximum number of subjects fell in the category of no problem so not replaced (46%) followed by cost (43.6%) as the factor for not replacing their missing teeth and it was found to be statistically highly significant for undergraduate group.

Table 2

Reason for not replacing missing teeth among patients according to education and gender level

	Not applicable	Not aware	No problem	Cost	Fear	χ 2	Significance “P”
Education level
Undergraduate	64	12	80	76	2	21.402	0.001 (HS)
Graduate or above	96	0	36	34	0
Gender
Male	102	10	70	72	0	3.100	0.541 (NS)
Female	58	2	46	38	2
Total	160	12	116	110	2

HS: Highly significance, NS: Not significance

Tables 3 and 4 show data about participants who knew about implants gender-wise and education-wise, respectively. Out of 400 participants, only 84 (21%) had some knowledge for dental implants and the rest of the questionnaire was targeted to them only. When asked about the advantages of implant, 46 (54.7%) participants knew their fixed nature and originality as the main advantage while 26 (30.9%) subjects knew that abutment cutting gets prevented. Sixty-four (76.1%) participants quoted high cost as the biggest disadvantage for dental implants. 54.7% of participants told dentist as their main source of information followed by media (33.3%) and this finding was highly significant for graduates and above category. Fifty (59.5%) of the participants had no idea whether implants require special care.

Table 3

Knowledge regarding dental implants among study subjects according to gender

Knowledge	Options	Male	Female	Total (%)
Q1. Aware about implant	Poorly	20	44	64 (16)
	Well	14	6	20 (5)
	No idea	140	176	316 (79)
Q2. Advantage of implant	Fixed	36	10	46 (54.7)
	Like original	24	22	46 (54.7)
	Prevent abutment cutting	14	12	26 (30.9)
	Can eat hard food	4	4	8 (9)
Q3. Disadvantage of implant	High cost	40	24	64 (76.1)
	Need surgery	20	10	30 (35.7)
	Long time	12	10	22 (26.1)
Knowledge	Options	Male	Female	Total	χ 2	Significance “P”
Q4. Source of information	Media	24	4	28	4.289	0.232 (NS)
	Dentist	28	18	46
	Friends	4	6	10
Q5. Implant require special care	No	6	2	8	0.517	0.915
	No idea	34	16	50
	Yes	16	10	26
Q6. Willingness for implant	Not sure	36	18	54	1.093	0.579 (NS)
	No	66	48	114
	Yes	152	80	232
Q7. If no-reason	Cost	50	44	94	3.829	0.281 (NS)
	Apprehension	14	4	18
	Others	2	0	2

NS: Not significance

Table 4

Knowledge regarding dental implants among study subjects according to education level

Knowledge	Options	UG	Graduate or above	Total (%)
Q1. Aware about implant	Poorly	24	40	64 (16)
	Well	6	14	20 (5)
	No idea	116	200	316 (79)
Q2. Advantage of implant	Fixed	22	24	46 (54.7)
	Looks like original	12	34	46 (54.7)
	Prevent abutment cutting	6	20	26 (30.9)
	Can eat hard food	2	6	8 (9)
Q3. Disadvantage of implant	High cost	20	44	64 (76.1)
	Need surgery	12	18	30 (35.7)
	Long time	4	18	22 (26.1)
Knowledge	Options	UG	Graduate or above	Total	χ 2	Significance “P”
Q4. Source of information	Media	4	24	28	53.138	0.001 (HS)
	Dentist	2	44	46
	Friends	2	8	10
Q5. Implant require special care	No	0	8	8	52.758	0.001
	No idea	6	44	50
	Yes	2	24	26
Q6. Willingness for implant	Not sure	42	12	54	45.216	0.001
	No	102	12	114
	Yes	90	142	232
Q7. If no-reason	Cost	86	08	94	32.134	0.001 (HS)
	Apprehension	14	04	18
	Others	2	0	2

HS: Highly significance

DISCUSSION

Interestingly, in our study, we only found 44.5% of the surveyed population perceived replacing their missing teeth as a definite need. This is in contrast with Siddique et al.[4] and Mayya et al.[1] wherein they found majority of their participants (84.4% and 78.1%, respectively) perception as a definite need. This contrast can be attributed to the difference in education level and awareness of our patients as well as designing of questionnaire where our format had multiple options rather than just opting for yes or no as in the mentioned studies. Esthetics was under weighed over function in our study. Only 19% of the participants laid stress on esthetics, whereas 39% laid importance to function as their perception toward replacement of missing teeth. In a similar study by Mayya et al.,[1] 21.9% of the participants said that the teeth should be replaced when gap is visible.

On evaluating the awareness of our patient pool for the consequences of missing teeth, 26% of the participants had no knowledge of any of the consequences given as options after tooth loss. Maximum (72.5%) reported loss of esthetics, followed by tilting of adjacent teeth (47%) as a known consequence after tooth loss. Difficulty in speech was known to 34.5%, whereas supra eruption was known to mere 14.5% of the participants. Apart from loss of esthetics, dentists must educate their patients of various other consequences of gaps left unattended for the entire stomatognathic system.

The subjective level of awareness of prosthetic alternatives available for replacement of missing teeth, it was found that knowledge about bridge was 71.5%, removable denture 66.5%, and complete denture was 64.5%. Interestingly, the knowledge of dental implants as an alternative for missing teeth was merely 21% in our studied population, and this agrees well with many Indian studies conducted by Gharpure et al.,[9] Venkata et al.,[10] and Satpathy et al.[11] which showed low level of awareness at 32%, 29%, and 16%, respectively. Our data for implant awareness are in stark contrast by many studies from western world reported by Zimmer et al.,[12] Berge[13] and Pommer et al.[14] who showed very high level of awareness toward dental implants to be 77%, 72%, and 71%, respectively. This contrast can be attributed to low education level of this part of our country compared from the western world.

Practice of our studied population for replacement of teeth by any type of dental prosthesis showed majority (63%) of the participants had not replaced their teeth by any kind of dental prosthesis and this finding was in congruence with the study of Mayya et al.[1] wherein 67.8% of participants had not replaced their teeth loss by any dental prosthesis. In this pool of our participants, 72% were undergraduates which were statistically significant finding indicating the importance of education of the practice of missing teeth replacement. When we checked for the reason for not having replaced their teeth among the pool of 252 (63%) patients, we found that 46% answered that they faced no problem because of tooth loss and 43.6% opted cost to be the factor.

Our second part of the questionnaire was specifically pertaining to dental implant knowledge and awareness regarding and our further questions were targeted only to 84 participants who had some knowledge for implants. The main advantage for dental implants was its fixed nature and originality which agrees well with the study of Saha et al.[7] The biggest disadvantage was high cost of dental implants which is in congruence with the study of Kohli et al.[15] followed by need of surgery and long time taken to fix implants. Regarding the source of information for most of the participants (54.7%), it was their dentist from whom they received the awareness about dental implants, followed by media (33.3%) and then relatives/friends (11.9%). This is in agreement with study of Chowdhary et al.,[16] and Mukatash et al.[2] which stated that dentists are the main source of information. A survey of Zimmer et al.[12] showed media to be the main source of information regarding dental implants, thus in accordance with the results of this survey apart from dentists, articles about dental implants should be published in magazines and newspapers to spread the awareness.

After completion of the questionnaire, we educated and motivated all our participants about the modality of fixed prosthesis dental implants. When asked about their willingness for dental implants after educating them, we found majority of 232 (58%) were now ready for implants in near future and this was statistically significant for graduates or above group. One hundred and fourteen (28.5%) participants were not willing to accept implant treatment and high cost was the major detriment reason and this was significant for undergraduate group. Thus, the levels of education have influenced the finding of this research.

CONCLUSION

The results of this survey among a selected sample indicated that perception and awareness of patients toward missing teeth and its consequences require better awareness and emphasis. It becomes thereby urgent and prudent for us as dental practitioners to increase the awareness about prosthetic dental treatment modalities, especially about dental implants, by implementing various public awareness campaigns, organizing dental camps, and establishing counseling centers.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.