Knowledge and attitudes of Jordanian and Polish dental interns towards cone beam CT imaging

INTRODUCTION

Today in dental office, digital radiography is a widely used radiographic modality due to its’ advantages, such as time saving, reduction of amount of radiation, removal of imaging errors, image enhancement, data storage, communication with other practitioners, and easier viewing of patients’ images on a monitor [1]. Cone beam computed tomography (CBCT) is an advanced digital imaging modality that operates by focusing a cone-shaped X-ray beam on a two-dimensional (2D) detector that rotates 360° or less around the patient’s head, to produce a sequence of 2D images. A cone beam encryption is then applied to this data set, allowing the operator to extract planar and curved reconstructions of variable thicknesses in any orientation, and create accurate three-dimensional (3D) bone and soft-tissue surface images [2]. Three-dimensional data of dental structures and related anatomy without superimpositions help dentists to diagnose complex cases and plan desirable treatments more reliably. Knowledge of the advantages and implementation of this method create a tendency among dental staff to use CBCT imaging according to the exact needs. However, since the technology is relatively new, more time may be needed to achieve an adequate and suitable role for this technic to be implemented in dental office [3].
Despite the ample benefits, information obtained from CBCT requires considerable experience in the interpretation of images; untrained dentists may present high error rates in interpretation of CBCT images. Knowledge of CBCT is therefore an essential need [4]. There are many studies evaluating the current experience and attitudes of general practitioners and dental interns in the assessment and use of CBCT [1-5]. However, to the authors’ knowledge, there is no study, which investigated dental interns in different educational structures with different curriculums. Therefore, the aim of the present study was to assess and compare knowledge and attitudes of Jordanian and Polish dental interns towards CBCT.

OBJECTIVES

The aim of this study was to assess and compare knowledge and attitudes of Jordanian and Polish dental interns towards CBCT.

MATERIAL AND METHODS

A total of 192 questionnaires were distributed to 89 Jordanian and 103 Polish dental interns. In addition to demographic data, including age, gender, and years of professional experience, participants were requested to answer 17 multiple-choice questions related to CBCT (Appendix 1). First 9 questions were about general awareness and attitudes towards CBCT, and remaining 8 questions were to assess and compare CBCT basic knowledge among participants. All procedures were followed in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) as well as with the Helsinki Declaration of 1964 and subsequent versions. Data were analyzed using IBM SPSS statistics v. 21 (SPSS Inc., Chicago, IL, USA). Descriptive statistical methods (frequency, percent, valid percent, and cumulative percent) were applied to evaluate data. Multi-response method was used to describe multi-answer questions. 2 test was performed to compare qualitative data. P-value < 0.05 was considered significant.

RESULTS

The study included 192 respondents, of which 89 were Jordanians and 103 Polish interns’ volunteers, who responded to the questionnaire. Two-third of them were in their twenties, and about the same portion were females. Regarding their experience, more than half of the respondents presented over 9 months’ of experience compared with 40% of the respondents between 5 to 8 months of experience (less than 10% with less than 3 months of experience) (Table 1). Among all the respondents, lecture was the most reliable source of knowledge, with 38.3% (Table 2). Only 27.1% of the respondents attended workshops regarding cone beam computed tomography, but 38% were willing to attend if they have a chance (Table 3). Regarding indications for referring patients for CBCT, low radiation dose and rapid scanning time were the main ones (Table 4). The majority of participants (63%) said they have referred or told their patients about CBCT imaging (Table 5). More than half of the participants believed that the cost for one CBCT image was between 50 to 100 Jordanian dinars (Table 6). Table 7 illustrates responses to the question on cases, in which CBCT was used. More than half of the respondents (52.6%) believed that CBCT would be used in all areas of dentistry in the near future (Table 8). In the question regarding the stage of education, at which lectures about CBCT should be included, 56.3% of the participants declared clinical phase, and both pre-clinical and doctoral phase scored 43.2% and 3.1% answers, respectively; there was no answer for ‘There is no need’ (Table 9). Seventy-six percent felt satisfied with the use of CBCT at their workplace (Table 10). Among questions related to CBCT basic knowledge (if this technique offers enhanced diagnosis at lower dose than CT), more than 80% indicated the right answer, which meant absolutely correct. When the participants were asked about principal difference between CBCT and CT, 55.2% of them correctly answered that CT shows more radiation compared with CBCT. When questioned about “The radiation dose and risk from CBCT is generally higher than the conventional dental radiography (IOPA, intra-oral peri-apical radiograph, panoramic) but lower than conventional CT scans”, which was true, around 80% correctly answered the question. Moreover, 58.9% of the participants correctly answered the question that CBCT cannot be considered a replacement for standard digital radiographs (panoramic, periapical), which was true. As much as 94.3% of the participants answered that CBCT contains more detailed information of maxillofacial region than other 2D images, which was also true. Only 6.8% of the respondents gave the wrong answer for the fact that CBCT is considered useful in evaluation of hard tissue pathology. Around two-third of the participants confirmed the fact that CBCT is not useful in evaluating soft tissue pathology. Also, as few as 6.8% of the participants did not now that CBCT cannot be ordered before taking history and clinical examination (Table 11).
When comparing between Jordanian and Polish interns’ basic knowledge about CBCT, out of eight questions, Polish interns answered six questions with higher scores, out of which four showed statistically significant difference. Jordanian interns presented higher scores in two questions, where only one question displayed statistically significant difference (Table 12).

DISCUSSION

The results of the study showed that most dental interns (range, 55.2-94.3%) correctly answered the questions related to CBCT knowledge, which reflects good level of knowledge among Jordanian and Polish dental interns and is in line with few studies conducted in India, Turkey, Iran, and Middle East [6-9]. In other previous studies [3-5, 10-15], the level of knowledge among dentists, interns, and specialists was inadequate and varying depending on several factors, such as age, years of experience, and specialty. Although all participants were non-specialist, they were young graduates, which can explain the good level of knowledge among them. Moreover, since CBCT technology was adopted 10 years ago in Jordan and Poland, it helped the participants to be introduced early to this method and to learn about CBCT technology during their undergraduate studies.
Third of our participants did not attend any workshop related to CBCT, which was expected, since they reported that lectures were the main source of knowledge on CBCT. Reading was the second source of learning about CBCT, which means that the participants preferred the non-paid way of learning. At the same time, more than third of them were willing to attend workshops related to CBCT, and this reflects their positive attitude towards CBCT.
The main advantages of CBCT over conventional CT scan include low radiation dose and short scanning time [16]; the participants were aware about these benefits, and around half of them referred patients having that in mind. Similarly, around half of them were also aware about the cost of single CBCT scan, which is around 100 US dollars. This can be considered expensive for some participants and patients [14, 17]; therefore, around one third of the participants have not referred their patients for CBCT scan due to high cost of the procedure. In agreement with Aditya and Kamburoğlu et al. [4, 6], participants referred patients mainly for implant planning, since implants are considered one of the most successful choice for replacing missing teeth [18]. Around two-third of them were satisfied with the use of CBCT, and referred different cases for CBCT. Again, this showed the positive attitude and high motivation towards CBCT technology, as shown in previous studies [5, 7, 11, 13]. Half of them thought that CBCT would be used routinely in all areas of dentistry, and one quarter believed that CBCT can be used in selected dental applications. This reflect why most of the respondents believed that CBCT education must be included in undergraduate studies, with slight tendency towards clinical education.
The last eight questions in the questionnaire were used to assess and compare basic CBCT knowledge among Jordanian and Polish interns. As mentioned earlier, the majority of dental interns (range, 55.2-94.3%) correctly answered the questions related to CBCT knowledge. According to clinical guidelines for using CBCT [19], CBCT is associated with higher dose in comparison with dental radiographs and lower dose in comparison with CT. CBCT contains more data than other 2D images, but cannot be used to replace them routinely. As other diagnostic tools, CBCT must be obtained after taking history and clinical examination, bearing in mind that its’ usefulness is confined to hard tissue pathology. Polish dental interns presented higher scores in 6 out of 8 questions. This can be attributed to the average teaching hours dedicated for teaching CBCT in dental schools. In Jordan, the average teaching hours is 2 compared with 4 hours dedicated for teaching CBCT in Poland.

CONCLUSIONS

In conclusion, both Jordanian and Polish dental interns present a good level of knowledge and positive attitudes towards CBCT. To enhance knowledge and attitudes among dental interns, dental faculties should provide more courses related to CBCT.

ACKNOWLEDGEMENT

The authors are thankful to all dental interns, who participated in this research.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

References