Assessment of knowledge and attitude towards teledentistry during COVID pandemic among undergraduate dentistry students and interns of a private dental institute of Nagpur city

INTRODUCTION

A type of pneumonia started to spread in Wuhan, China, in 2019 which was named as coronavirus by the WHO.^[1] This led to a nationwide lockdown in India in March 2020.^[2] People were asked to postpone hospital and dental visits unless absolutely necessary.^[3]

Dentistry is considered high-risk profession during pandemic as cross-infection can occur through saliva or blood.^[4] Therefore, newer protocols in dentistry have been implemented for personal safety.^[5]

Today, with speed in connectivity and unlimited data connections, internet plays an important role to connect patient and dentist. With the usage of newer technological applications, performing “Teledentistry” is possible to provide dental care across distance.^[6] Teledentistry not only serves the purpose of consulting over distance but it also helps in providing services to the rural population over a distance through digital and online consultations.^[7,8] During the COVID pandemic, many countries allowed only emergency dental procedures, this can lead to neglect in oral care among the general population. Teledentistry can be a valuable tool in such situations.^[9,10]

For integrating practice of teledentistry in the future, it is essential to determine current level of dental students’ attitude and knowledge. Thus, we aimed to assess the knowledge and evaluate the attitude of undergraduate dentistry students and interns about teledentistry in Nagpur city.

MATERIALS AND METHODS

After obtaining ethical clearance from the IEC committee of VSPM Dental College & Research Centre (VSPM DC RC), Nagpur, we proceeded with this cross-sectional study among undergraduate dentistry students and interns of a private dental institute of Nagpur city (Maharashtra). A self-administered Google Forms is used in study. Questionnaire consisted of 12 questions which have been taken from previously conducted different studies.^[11-13] The combined questionnaire was got validated again. Out of 12 questions, questions 1–3 were knowledge based and 4–12 were attitude based.

The questionnaire was virtually distributed among the students and interns of VSPM DC and RC, Nagpur. The participants were told about the purpose of study. The inclusion criterion was entire willing students and interns. The participant who was not willing was the only exclusion criterion. The questionnaire was distributed anonymously; they were instructed not to discuss the questions among themselves. The data obtained from these responses were collected back and inserted in Excel sheet for analysis.

RESULTS

There were a total of 307 participants. Out of 307, 247 (81%) were female and 60 (19%) were male. Maximum responses were received from the 3^rd year, 127 (41%).

The distribution of students according to year of study is shown in [Table 1] and detailed result of every study year is given in [Table 2].

Among the study population of 307, majority of interns 22 (66%) and 3^rd year students 79 (62%) had heard the term called teledentistry while most of the I BDS 18 (55%) and IV BDS students 37 (49%) did not hear the term teledentistry. Teledentistry is consultation through only telephone was said by 12 (4%) students whereas 250 (81%) said that it is consultation through internet, telephone, and computer. The mode of consultation was not known to 45 (15%) students and interns.

Teledentistry can be applied in all branches of dentistry which was considered by 15 (45%) interns and 51 (40%) ^3rd year students while it was considered not applicable by 19 (47%) 2^nd year and 41 (55%) final year students.

Online dental examination is same and useful as the traditional office setting was said by 62 (20%) participants and opposite was considered by 246 (81%). Majority of III BDS students 66 (51%) and interns 19 (55%) felt that teledentistry is not as effective and useful as offline clinic setting.

Teledentistry can come handy in giving oral health and hygiene instructions for patients who were said by all the ^1st and 2^nd year participants but some 3^rd year students 12 (9%) did not feel that it is a good tool for instructions.

Teledentistry was considered a time saver by 227 (74%) participants majority of which were 29 (88%) interns and 97 (76%) 3^rd year students. The 1^st year 20 (62%) and final year students 17 (23%) were not sure about the opinion.

Teledentistry can minimize patient numbers for offline consultation by delaying non-emergency cases appointment which was agreed on by 258 (84%) participants whereas 39 (12%) disagreed and 10 (4%) were not sure.

Majority of the 3^rd year students 94 (74%) and all the 2^nd year students said that teledentistry can enhance the reach of oral health-care services but 12 (16%) final year and 5 (15%) interns disagreed.

Government initiative is a must for increasing reach of teledentistry which was felt necessary by 254 (83%) participants. Nine (3%) disagreed whereas 44 (14%) were not sure.

Ninety-nine (78%) 3^rd year students and 28 (85%) interns said that teledentistry can have a big role in the future practice, during the pandemic as well as after the pandemic but few 3 (9%) 1^st year and 4 (10%) 2^nd year students did not feel so. Teledentistry can be a preamble in robotic dentistry which was agreed on by 173 (56%) participants and disagreed by 23 (8%) participants whereas 111 (36%) were not sure.

Practicing teledentistry in clinical practice in the coming future was said yes by participants, most of which were interns 30 (91%) and 1^st year students 30 (90%). The detail result of study is given in [Table 3].

DISCUSSION

Teledentistry is a fascinating and upcoming field of practical dentistry that involves the application of internet for the diagnosis and treatment of the patient by the dental professional. Very limited data were available about this field as research in Nagpur. This study was undertaken to fill this gap as this will help to explore and assess the knowledge and evaluate the attitude toward teledentistry among undergraduate students and interns of dental colleges of Nagpur city.

Therefore, an attempt was made to evaluate the knowledge level and attitude toward teledentistry among undergraduate students and interns of VSPM DC RC NGP-MS. A total of 307 students and interns participated in this study.

Out of total 307 participants, only 57% were aware of the term teledentistry. The percentage was more than study by Boringi et al. who found that 28% of participants were aware of the subject^[14] and also the study by Alipour et al. 38% were aware.^[15] Plaza-Ruíz et al. had findings that 88% of participants aware of the term teledentistry and 12% were unaware.^[9] In the present study, majority of interns 22 (66%) and III BDS students 79 (62%) had heard the term teledentistry while most of the I BDS 18 (56%) and IV BDS students 37 (49%) had not heard the term teledentistry.

When asked about the mode of consultation in teledentistry, telephone, internet, and other media were said by 72% I BDS, 80% by II BDS, 85% by III BDS, 80% by IV BDS, and 82% by interns whereas only telephone was said by the remaining. This was alike the study by Boringi et al., 92% I BDS, 86% II BDS, 82% III BDS, 95% IV BDS, and % interns said that it is the consultation through telephone and other media.^[14]

Teledentistry is considered applicable only for consultation services and imparting oral health-care advice to patient. When the participants were asked do they feel if teledentistry is applicable in all branches of dentistry, 35% said yes, 41% said no, while 23% said that they did not know. The results were nearly alike to a study by Nagarajappa et al. where 49% said yes, 23% said no, while 33% said that they did not know.^[11]

Online dental examination is similar and as useful as the normal offline clinic was said by 20% participants and it was considered not effective by 80%. It was similar to a study by Alipour et al. where 27% gave positive response.^[15] The study by Sen et al. showed contrasting results where 55% of participants considered it effective.^[12] Majority of III BDS students 66 (52%) and interns 19(57%) felt that teledentistry is not as effective as traditional dental office setting.

The fear of COVID-19 pandemic and increase in mucormycosis cases has forced people to stay indoors; hence, they are often reluctant to approach a dentist in person for an oral hygiene routine, which is an absolute necessity in current time. It was agreed on by most II BDS students 82% and interns 91% in our study whereas in a study by Boringi et al., most positive responses were from I BDS 79% and II BDS 71%,^[14] and in a study by Sen et al., they were also mostly from I and II BDS, 70%.^[12]

Teledentistry can act as a time saver for patients as well as that of consulting dental physician was agreed by 54% of participants in a study by Aboalshamat,^[13] and in our study by 74% participants, majority of which were interns 88% and III BDS 76%. Furthermore, a study by Alipour et al. had 77% of participants agreeing on this.^[15]

Most of the participants, 84%, said that teledentistry can lead to lesser number of non-urgent appointments, thus leading to decreased patient numbers. It can be seen that if online consultation is done, dentist can judge if patient needs prompt treatment or they are non-urgent.

Reach of oral care services in distant areas and also during pandemic can be improved by teledentistry which was agreed by 62% I BDS, 82% II BDS, 74% III BDS, 70% IV BDS, and 83% interns as compared to Sen et al. study showed that 66% I BDS, 26% II BDS, 33% III BDS, 67% IV BDS, and 50% interns agreed.^[12]

The study showed that 82% of participants felt that there is a need for government measures to increase the reach of teledentistry. Naragajappa et al. study showed the same 89% results.^[11]

Aboalshamat study found almost 50% of participants felt that teledentistry may have a huge role in future practice, during the pandemic as well as after the pandemic.^[13] The present study showed that 77% of participants felt this, most of which were interns 84%.

Khan and Omar, Bradley et al., and Brüllmann et al. said that the main techniques used in teledentistry are pixel images and computerized records.^[16-18] All these aims to bring improved quality of oral care also reduce the burden of oral disease. Thus, teledentistry can be a preamble in robotic dentistry which was agreed on by 173 (56%) participants and disagreed by 23 (8%) participants whereas 111 (36%) were not sure, same to a study by Boringi et al.^[14] and Sen et al.^[12] In our study, 83% said that they were interested to practice teledentistry in the future; most were I BDS 94% and interns 91%. In a study by Plaza-Ruíz et al., 60% were affirmative^[9] while in a study by Aboalshamat, 77% were affirmative.^[13]

As every coin has two sides, likewise, teledentistry also comes with its pros and cons. It can act handy in providing dental services to people in remote areas or also during pandemic where social distancing is to be maintained but at the same time, there are many challenges to the use of teledentistry which include network connectivity, technological illiteracy, and emergency cases which cannot be assessed online. Thus, teledentistry can be handy while diagnosing a case or giving online instructions but physical appointment is must for dental procedures.

CONCLUSION

The knowledge of participants concerning teledentistry was good. The attitude of participants toward teledentistry was found to be positive. Furthermore, there was keen interest in participants to practice teledentistry in the future. Promotion and motivation regarding teledentistry can be done through lectures and workshops.

There is a need for increasing the knowledge and expanding the reach of teledentistry in India. The current COVID pandemic tells us how disease transmission can be a rapid process. Thus, reducing the dental appointments and scheduling them through teledentistry can be a better option as it is safe for the dentist as well as the patients. The Government of India along with Indian Dental Association should look into the perks of teledentistry and make amendments in the current dental practice. This will act as a boost for the budding dentists to practice teledentistry in coming future.