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Knowledge, practice and attitude on management of diastema among dental students

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  • Saveetha Institute of Medical and Technical Sciences

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Introduction: Diastema is a term used in dentistry which refers to a gap between the teeth. This condition is both common in children as well as in adults. These gaps can be an aesthetic issue for individuals when they are highly noticeable. The causes for diastema can be several reasons like size of teeth, size of jaw bone etc. Treatment of diastema varies from individual to individual based on the cause of the condition. Aim: The aim of the study is to determine the knowledge, attitude and practice about management of diastema among the dental students. Materials and methods: Self-administered questionnaire was prepared based on diastema and distributed among dental students through an online survey link. The sample size was about 113 undergraduate dental students. The data was statistically analysed with the SPSS software. Results and Discussion: In the study, 94.7% of the population were aware about the term diastema and 5.3% of the population were not aware about the term diastema. 13.3% % of the participants responded that transient malocclusion is the cause for diastema, 14.2% responded midline pathology, 7% responded proclination and 65.5% responded as all of the above.
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How to Cite:
Kamalli, M., Deepak, S., & Sandeep, A. H. (2022). Knowledge, practice and attitude on management
of diastema among dental students. International Journal of Health Sciences, 6(S1), 50175032.
https://doi.org/10.53730/ijhs.v6nS1.5972
International Journal of Health Sciences ISSN 2550-6978 E-ISSN 2550-696X © 2022.
Corresponding author: Deepak, S.; Email: deepaks.sdc@saveetha.com
Manuscript submitted: 27 Feb 2022, Manuscript revised: 18 March 2022, Accepted for publication: 09 April 2022
5017
Knowledge, practice and attitude on
management of diastema among dental
students
Kamalli. M
Graduate, Saveetha Dental College and Hospitals, Saveetha Institute of Medical
and Technical Sciences, Saveetha University, Chennai-600077, Tamil Nadu,
India.
Email: 151901007.sdc@saveetha.com
Dr. Deepak. S
Senior Lecturer, Department of Conservative dentistry and Endodontics, Saveetha
Dental College and Hospitals, Saveetha Institute of Medical and Technical
Sciences, Saveetha University, Chennai-600077, Tamil Nadu, India.
Email: deepaks.sdc@saveetha.com
Dr Adimulapu Hima Sandeep
Senior lecturer, Department of Conservative Dentistry and Endodontics, Saveetha
Dental College, Saveetha Institute of Medical and Technical Sciences (SIMATS),
Chennai, Tamilnadu, India.
Email: himas.sdc@saveetha.com
Abstract---Introduction: Diastema is a term used in dentistry which
refers to a gap between the teeth. This condition is both common in
children as well as in adults. These gaps can be an aesthetic issue for
individuals when they are highly noticeable. The causes for diastema
can be several reasons like size of teeth, size of jaw bone etc.
Treatment of diastema varies from individual to individual based on
the cause of the condition. Aim: The aim of the study is to determine
the knowledge, attitude and practice about management of diastema
among the dental students. Materials and methods: Self-administered
questionnaire was prepared based on diastema and distributed among
dental students through an online survey link. The sample size was
about 113 undergraduate dental students. The data was statistically
analysed with the SPSS software. Results and Discussion: In the
study, 94.7% of the population were aware about the term diastema
and 5.3% of the population were not aware about the term diastema.
13.3% % of the participants responded that transient malocclusion is
the cause for diastema, 14.2% responded midline pathology, 7%
responded proclination and 65.5% responded as all of the above.
5018
Conclusion: The present study concludes that the knowledge, attitude
and practice about management of diastema among the dental
students was satisfactory yet more education regarding the recent
advances is necessary.
Keywords---Knowledge, practice, diastema, dental students,
Innovative technique.
Introduction
Diastema is a term used in dentistry which refers to a gap between the teeth. This
condition is both common in children as well as in adults. These gaps can be an
aesthetic issue for individuals when they are highly noticeable. The causes for
diastema can be several reasons like size of teeth, size of jaw bone etc. Certain
oral habits also influence diastema. It is also known that diastema can develop
from periodontal diseases. The inflammation progression affects the gums and
tissue supporting the teeth which eventually leads to loss of teeth. Treatment of
diastema varies from individual to individual based on the cause of the condition.
Diastema is generally aren't preventable but there are possibilities to reduce the
risk of developing diastema.Prevention of habits like thumb sucking, tongue
thrusting, improper swallowing and biting and poor oral hygiene can reduce the
possibility of diastema. Midline diastema is the most common type occurring both
in adults and children (1). Sometimes there can be iatrogenic causes for the
condition. Fixed appliances play a major role in the rapid correction of diastema
by incorporating elastics and springs (2). Retention of midline diastema is often
difficult as there is a feasibility of formation of gaps again (3). The midline
diastema is often influenced by genetic and environmental factors mainly in
primary and mixed dentition period (4) (5). Hereditary relations and patterns also
have their own correlation with midline diastema (6).
Innovative treatment for diastema has been developed in order to restore the
aesthetics which are from procedures like composite build up, frenectomy etc. (7).
This condition requires immediate treatment after observation as they can be
treated and restored easily at the earliest (8). In previous studies it was mentioned
that diastema closure in anterior teeth using recontour of gingiva and composite
restoration was successful (9). There are many advances in treatment for
diastema which enable much easier restoration (4).
Our team has extensive knowledge and research experience that has translate
into high quality publications (1019),(2023),(2428) (29). The aim of this study
is to determine the knowledge, attitude and practice about management of
diastema among the dental students.
Materials and Methods
This was a survey conducted among dental students. Self administered
questionnaire was taken based on management of diastema. The questionnaire
(close ended questions) was circulated through an online survey link. The
questionnaire included demographic data also. SPSS software was used to obtain
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statistical results. Pearson chi square test was done to find the correlation
between year of study and knowledge about diastema. The method of
representation of results was presented by pie charts and bar diagrams.
Results
Figure 1: Pie chart showing the responses for gender of participants where blue
denotes female and green denotes male. 68.14% of the participants were female
and 31.9% were male.
5020
Figure 2: Pie chart showing the responses for the year of study of participants
where blue denotes female and green denotes male. 33.63% of the participants
were from second year, 29.20% were from third year, 18.58% were from fourth
year, 9.73% from first year and 8.85% were interns.
Figure 3: Pie chart showing the responses for the awareness about diastema
where blue denotes no and green denotes yes. 94.69% of the participants were
aware about the term diastema.
5021
Figure-4: Pie chart showing the responses for the main cause for diastema where
blue denotes all of the above, green denotes midline pathology, beige denotes
proclination and purple denotes transient malocclusion. 65.49% of the
participants responded to all of the above.
Figure-5: Pie chart showing the responses for the best radiograph to identify the
etiology of diastema where blue denotes bitewing radiograph, green denotes
5022
intraoral radiograph and beige denotes periapical radiograph. 46.02% of the
participants responded periapical radiograph.
Figure 6: Pie chart showing the responses for the awareness about phases of
treatment for diastema where blue denotes no and green denotes yes. 76.99% of
the participants were aware about the phases of treatment for diastema.
Figure-7: Pie chart showing the responses for the use of fixed appliances in
treatment for diastema where blue denotes no and green denotes yes. 80.53% of
the participants responded that fixed appliances help in treatment for diastema.
5023
Figure 8: Pie chart showing the responses for the awareness about recent
advances in treatment of diastema where blue denotes no and green denotes yes.
59.29% of the participants were aware about the recent advances in treatment for
diastema.
Figure-9: Pie chart showing the responses for the awareness about composite
buildup where blue denotes no and green denotes yes. 50.44% of the participants
5024
responded that composite build up acts as efficient treatment for midline
diastema.
Figure 10: Pie chart showing the responses for the awareness about time taken
for treatment of diastema where blue denotes no and green denotes yes. 68.14%
of the participants responded that treatment for diastema takes a prolonged time.
Figure 11: Pie chart showing the responses for the variation in treatment for
diastema where blue denotes no and green denotes yes. 95.58% of the
participants responded that treatment for diastema varies from individual to
individual.
5025
Figure-12: Bar graph depicting the association between year of study and
knowledge about the main cause of diastema. X-axis represents the year of study
and Y-axis represents the number of participants. The colour blue denotes all of
the above, green denotes midline pathology, beige denotes proclination and purple
denotes transient malocclusion. (Pearson Chi square value-24.711, P-value-
0.016[<0.05]-statistically significant). Out of 113 participants, 6 participants from
the first year, 22 participants from second year, 20 participants from third year,
16 participants from fourth year and 10 participants from interns responded to
all of the above.
5026
Figure-13: Bar graph depicting the association between year of study and
knowledge about the use of fixed appliances in treatment for diastema. X-axis
represents the year of study and Y-axis represents the number of participants.
The colour blue denotes no and green denotes yes. (Pearson Chi square value-
63.150, P-value-0.00[<0.05]-statistically significant). Out of 113 participants, 27
participants from second year, 33 participants from third year, 21 participants
from fourth year and 10 participants from interns responded that fixed appliances
help in treatment for diastema.
5027
Figure-14: Bar graph depicting the association between year of study and
knowledge about the use of composite in treatment for diastema. X-axis
represents the year of study and Y-axis represents the number of participants.
The colour blue denotes no and green denotes yes. (Pearson Chi square value-
22.219, P-value-0.00[<0.05]-statistically significant). Out of 113 participants, 21
participants from second year, 14 participants from third year, 11 participants
from fourth year and 10 participants from interns responded that composite
build up acts as an efficient treatment for midline diastema.
68.14% of the participants were female and 31.9% were male (Figure-1). 33.63%
of the participants were from second year, 29.20% were from third year, 18.58%
were from fourth year, 9.73% from first year and 8.85% were interns (Figure-2).
94.69% of the participants were aware about the term diastema (Figure-3).
65.49% of the participants responded to all of the above (Figure-4). 46.02% of the
participants responded periapical radiograph (Figure-5). 76.99% of the
participants were aware about the phases of treatment for diastema (Figure-6).
80.53% of the participants responded that fixed appliances help in treatment for
diastema (Figure-7). 59.29% of the participants were aware about the recent
advances in treatment for diastema (Figure-8). 50.44% of the participants
5028
responded that composite build up acts as efficient treatment for midline
diastema (Figure-9). 68.14% of the participants responded that treatment for
diastema takes a prolonged time (Figure-10). 95.58% of the participants
responded that treatment for diastema varies from individual to individual
(Figure-11).
Discussion
In the present study, 68.14% of the participants were female and 31.86% of the
participants were male (Figure-1). 33.63% of the participants were from second
year, 29.20% were from third year, 18.58% were from fourth year, 9.73% from
first year and 8.85% were interns (Figure-2).
In the study by Patricia et al., due to increase in demand for facial aesthetics,
awareness about various dental trauma conditions is found to be prevalent
among patients (30). In the study, 94.69% of the population were aware about the
term diastema and 5.31% of the population were not aware about the term
diastema (Figure-3). 13.27% of the participants responded that transient
malocclusion is the cause for diastema, 14.16% responded to midline pathology,
7.08% responded to proclination and 65.49% responded as all of the above
(Figure-4). In the present study, 46.02% of the population answered that
periapical radiograph is the best radiograph to identify the etiology of diastema,
36.28% answered as bitewing radiograph and 17.70% answered as intraoral
radiograph (Figure-5).
76.99% of the population were aware and the remaining 23.01% of the population
were not aware about the phases of treatment of diastema (Figure-6). 80.53%
responded that fixed appliances help in treating diastema and the remaining
19.47% responded that fixed appliances do not help in treating diastema (Figure-
7). In the study by Wesley et al., the clinical report explained the use of computer-
aided design and computer-aided manufacturing (CAD-CAM) composite resin in
closure of a maxillary midline diastema (31). In this study, 59.29% were aware
about the recent advances in closure of midline diastema and 40.71% were not
aware (Figure-8). In the study by William et al., the use of a new silicone index
helped in diastema closure which improves gingival tissue health (32). In the
study by Edina et al., the application of direct restorations provided an excellent
treatment option for closure of diastemas (33).
50.44% of the participants responded that composite build up acts as an efficient
treatment and 49.56% of the participants responded that they are not efficient in
treatment (Figure-9).
In association with the time of treatment of diastema, 68.14% of the participants
answered that the treatment will take a long time and 31.86% of the participants
answered that the treatment will not take a prolonged time (Figure-10). 95.58% of
the participants responded that treatment for diastema varies from individual to
individual and the remaining 4.42% responded that it does not vary (Figure-11).
In the study by Ana et al., the case report showed minimally invasive diastema
treatment due to gingival trauma where it was evident that the cause for diastema
shows variations (34) .
5029
In the association between years of study and knowledge about the main cause of
diastema, out of 113 participants, the majority 22 participants from second year
responded all of the above (Figure-12). In the association between years of study
and knowledge about the use of fixed appliances in treatment for diastema, out of
113 participants, majority 33 participants from third year responded that fixed
appliances help in treatment for diastema (Figure-13). In the association between
years of study and knowledge about the use of composite in treatment for
diastema, out of 113 participants, majority 21 participants from second year
responded that composite build up acts as an efficient treatment for midline
diastema (Figure-14). The limitations of the study is that the survey was
conducted with a limited sample size. This survey can be used as a reference for
future studies with a wider range of population.
Conclusion
The present study concludes that the knowledge, attitude and practice about
management of diastema among the dental students was satisfactory yet more
education regarding the recent advances is necessary.
Acknowledgement
This research was done under the supervision of the Department of Research of
Saveetha Dental College and Hospitals. We sincerely show gratitude to the
corresponding guides who provided insight and expertise that greatly assisted the
research.
Conflicts of Interest
The authors declare that there are no conflicts of interest in the present study.
Source of funding
The present study is sponsored by
Molequle solutions
Saveetha Institute of Medical and Technical Sciences
Saveetha Dental College and Hospitals
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Dens invaginatus (DI) is a developmental anomaly resulting in a deepening or invagination of the enamel organ into the dental papilla prior to calcification of the dental tissues. Presence of DI is considered to increase the risk of caries and pulpal pathology, but they are often missed in the initial orthodontic assessment as they present with no clinical signs of an anomaly. In absence of adequate oral hygiene and maintenance, bacterial contamination of these malformations can lead to the development of early caries and consequent pulpal death. Early diagnosis of these lesions is critical as they can negatively impact any planned orthodontic treatment and assessment of the prognosis of these lesions is therefore necessary prior to the commencement of orthodontic treatment. In this article, we aim to illustrate the need for appropriate diagnosis and multidisciplinary approach in the management of DI in patients undergoing orthodontic treatment.
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Purpose: To study the dental caries experience among adolescent school children in Chennai city using the ICDAS-II scoring system. The secondary objective was to identify associated risk factors to different thresholds of dental caries defined by ICDAS. Material and methods: Two hundred and thirty-seven children (13-17 years) from five schools across Chennai city were included using simple random sampling. After obtaining assent to participate in the study and satisfying the selection criteria, 200 children were screened for dental caries using ICDAS-II. The population was assessed for the following risk factors: sociodemographic status, habits, diet, plaque and salivary parameters. Prevalence of dental caries was estimated at the following thresholds: normal (ICDAS-0/1), mild caries (ICDAS-2), moderate caries (ICDAS-3/4) and extensive caries (ICDAS-5/6). Backward logistic regression analysis was performed to identify risk factors at different thresholds and crude odds ratio was calculated for statistically significant risk factors. Results: The overall prevalence of dental caries (ICDAS 3-6) was 57.5% (95% CI 48-62%). The proportions of children at different caries thresholds were: ICDAS-2 - 55% (95% CI:48-62%), ICDAS-3/4 - 51% (95% CI:44-58%) and ICDAS-5/6 - 25% (95% CI:19-31%). Reduced pH was statistically significant for moderate and extensive caries (OR 6.24, 95% CI 1.18-32.78 and 1.73, 95% CI 1.18-1.92, respectively) and the quantity of saliva was statistically significant for mild and moderate caries (OR 4.48, 95% CI 2.94-8.23 and 3.97, 95% CI 2.65-7.03, respectively). Low buffering capacity was associated with mild caries OR 5.71, 95% CI 2.82-18.2). Interobserver correlation was 0.91. A non-statistically significant value using Hosmer-Lemeshow Goodness of Fit test indicated that all three models predict the true estimate of the population. Conclusion: The proportions of children with mild and moderate caries were high considering their age group. The risk factors associated with mild caries were different from those associated with moderate and extensive caries.
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Aim The purpose of this review was to determine the diagnostic accuracy of CBCT in detecting vertical root fracture in root filled teeth when compared to a reference standard (direct visualization). Methods Electronic searches were performed in Medline, Scopus, Cochrane and Grey Literature for English language articles till June 2020. Prospective and retrospective clinical studies using CBCT to diagnose VRF in root filled teeth were included. Case reports and in-vitro studies were excluded. Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess the risk of bias (RB) and applicability concerns. Meta-analysis was done using STATA 16.1 software via MIDAS 3.0 package and METANDI module. Publication bias was evaluated using Deeks funnel plot analysis. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was done to evaluate certainty of evidence. This systematic review was registered in the Open Science Framework (10.17605/OSF.IO/7JKE2). Results 8 articles were included in this systematic review and meta-analysis. RB assessment showed that 5 articles in the patient selection domain had low RB with low applicability concern. In the index test and reference standard domains, 7 articles had moderate RB with moderate applicability concern. 3 articles had high RB in the flow and timing domain. There was no publication bias. CBCT had pooled sensitivity and specificity of 0.78 (95% CI =0.64-0.88) and 0.80 (95% CI =0.63-0.91) respectively and accuracy of 0.86 (95% CI =0.83-0.89). CBCT also had pooled positive and negative likelihood ratios of 4 and 0.2 respectively. In GRADE analysis, the quality of evidence was low for sensitivity and moderate for specificity when CBCT was used for diagnosis of VRF. Conclusions Overall quality assessment of included articles showed that in patient selection domain, the risk of bias was low and it was moderate in index test and reference standard domains. Evidence from this updated systematic review and meta analysis indicates that CBCT is still not a good tool for diagnosing VRF in root filled teeth as compared to direct visualization.
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