ORIGINAL ARTICLE

PATIENTS’ KNOWLEDGE AND AWARENESS LEVELS FORIMPLANT-SUPPORTED DENTAL PROSTHESES AT A TEACHINGDENTAL HOSPITAL.

INTRODUCTION

oth patients and dentists have accepted implant-supported dental prostheses as a viable and predictable

treatment option for restoring partial and completeedentulism.1-2 It has now been proposed that dental implantseducation and training should become an integral part ofthe undergraduate dental curriculum and that dental implanttherapy needs to be an essential part of every prosthodontictreatment plan.3 This is because patients have given veryhigh rating and recognition of approval for implant-supported dental prostheses in terms of raising their self-confidence.4 It has also been shown that those having hadthe experience of dental implant prostheses, many of themwould again like going through such treatment procedures.4,5

Asmany as 98% patients have felt general improvementin their oral health status consequent to implant-supportedprostheses.4 There is no doubt that an exhaustive researchliterature on the basic and clinical dental implant relatedaspects exists, it has yet to consider issues on patient

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OBJECTIVE: To assess knowledge and awareness levels fordental implant-supported prostheses (ISPs) as optionsforreplacing teeth, amongst patients ata Teaching Dental Hospital in Islamabad.Study Design, Place & Duration: Questionnaire based, Cross-sectional, Prosthodontics Department, IslamicInternational Dental College, Hospital, Islamabad ,1st Dec 2011-30th Mar 2012.METHODOLOGY: Withconvenience sampling, 210 patients participated in the study. The method of directinterview and a pre-structured questionnaire with nine questionswere used for collecting data of each patientincluding knowledge,level of awareness, acceptance and perceived cost of ISPs. SPSS version 17.0, was used toanalyze data.RESULTS: Only 35 (16.6%) patientshad prior knowledge of ISPs.Majority (83.4%) did not know about ISPs. Ofthe 35 patients having prior knowledge and awareness, only one had actually received ISP. Of the 175 out of210(83.4%) patients having no prior knowledge of ISPs, 161 (92%) showed interest after receiving explanationand information aboutthem. Many patients (N=196, 93.3%) indicated interest in ISPs upon knowing about them.Many patients (N=188, 89.5%) rejected conventional removable prosthesis.Those who believed ISPas the bestchoice for replacing missing teeth were 115 (54.7%) but 85% of themindicated their high cost as a barrier to havingISPs.CONCLUSION: Patients’ knowledge and awareness about ISPs was found poor. However,upon introduction aboutISPs, many showed interest in them. Many would still refrain from getting ISPs because of their high cost. Dentalpractitioners should include information about ISPswhen explaining prosthodonticoptions for replacing missingteeth.KEY WORDS: Implant-supported prostheses, Awareness to dental implant prostheses, Options for replacingmissing teeth, Informed consent .Prosthodontictreatment.How to cite this article: Ghani F, Moeen F, Nisar S. Patients’ Knowledge and Awareness Levels for Implant-Supported Dental Prostheses at a Teaching Dental Hospital.J Pak Dent Assoc 2013;22(2):78-83.

B

Fazal Ghani1

Faisal Moeen2

Saleha Nisar3

1. Head of Department of Prosthodontics, Khyber Collegeof Dentistry, University Campus, Peshawar 25120 (Pakistan).

2. Associate Professor of Dental Materials,IslamicInternational Dental College, 7th Avenue, G-7/4, Islamabad (Pakistan).

3. Lecturer, Department of Prosthodontics, Islamic International Dental College, 7th Avenue, G-7/4, Islamabad (Pakistan).

Correspondence: Fazal Ghani<fazalg55@hotmail.com> Mobile : +92-301-594 3425

BSc, BDS, MSc, CMP, PhD, FDSRCPSBDS, MScBDS

feedback and awareness regarding dental implant treatment.6

The level of awareness of dental implant treatmentvaries among several studies from different countries.7-14

In a US based survey of 120 subjects, public awarenessand acceptance of dental implants was not only high butit also showed a generally positive attitude among patientsof that study toward dental implants.7 They furtherconsidered implant-supported rehabilitations estheticallymore attractive than removable prostheses by rating thisaspect of implant therapy as a major advantage over theother prosthodontic treatment options.

Astudy from Finland by Solonen8 reported very lowlevel of awareness (29%) to implant procedures ascompared to an Australian based study that showed veryhigh level of awareness (64%).9 The findings of anothersurvey6 reportedeven more higher rate of awareness (72%)about implant procedures. However, more interesting wasthe negative response of some 42 % to the question whetherthey were informed by their dentists regarding dentalimplant therapy. The figure for those well-informed aboutimplant therapy was extremely low (4%).Similar work ofthe kind from Saudi Arabia and India also show greatlyvarying figures for the level of knowledge and awarenessof patients towards dental implant prostheses.11-14 All thesehave shown socio-economic status, level of education,working status and area where the patients lived as theinfluencing variables related to patients.

Information about dental implants can be provided byvarious means. Conflicting role of both the dentists andmedia in bringing awareness to implant therapy amongpatients has been reported in the literature.7, 9, 15-16 In somecountries media has been reported to have played a majorrole in educating public about dental health and dentaltreatments and for bringing an increased level of awarenessabout dental implants.7, 15 In USA and Japan, media hasbeen the main source of information for the very high levelof awareness among patients about dental implant therapy.7,

15 It has been shown that US dentists have contributed littlein bringing awareness about dental implants.7 Similarly,In Japan, a study showed that dentists provided no morethan 20% of the information about dental implants.15

Reports have also shown that dentists have proved to bethe main source of education and awareness regardingimplants in a great majority (68%) patients who knewabout dental implant therapy as compared to print mediain 23% patients and acquaintance from friends in 22%patients.9,16 Berge observed that mass media includingperiodicals, television, and broadcasts as the main sourcesof mostly negative information about dental implants.16

Of particular concern in the media reporting about dentalimplant therapy were the creation of both fear amongpatients by showing and reporting dental implantscomplications and misinformation about implant prosthesesto be lasting for a life-time. Tepperet al6found that 34%of a sample of general Austrian population thought implantsto be lasting for lifetime. They noted this as misinformationor incomplete information provided to the public eitherby the dentists or marketing sources. Another study foundsome 28% believing that their implants would be lastingforever.10

Considering these varying levels of knowledge andawareness among patients from countries of both thedeveloped and developing world and the non availabilityof such information relating to our local patients, this studyaims for a survey of the kind to assess the knowledge andawareness level, belief, sources, and need for informationabout dental implants among a selected sample of dentalpatients presenting, for prosthodontic therapy, at a teachinghospital in Islamabad, Pakistan.

METHODOLOGY:

During the period of 4-months, from 1st December 2011to 30th March 2012), patients presenting at the ProsthodonticDepartment of the Islamic International Dental Hospitaldemanding for replacing their missing teeth were invitedto participate in this study. Male and female adult patientswho were willing and cooperative for participation in thestudy were considered. They were to be over the age of18 yearsand had to have edentulous areas ranging fromone to all missing teeth. Those having only missing thirdmolars were not considered.

A pre-structured questionnaire used previously byTepperet al6 was adapted for this study. Apilot study wasalso conducted on 15 dentate patients to see the problemsand to find ways to overcome them if any before theinitiation of main study. Approval of the study byInstitutional Research & Ethics Board (IREB) and informedconsent for the study were obtained. Assurance ofmaintaining the confidentiality of personal data toparticipating patients was done before recording of thebasic knowledge, awareness, acceptance and reservationsof patients regarding dental implants as a treatment modalityfor the replacement of missing teeth through answers ofeach patient to the nine questions (Table 1). Each question,translated into local language was read out in front of eachpatient seated in the dental chair with further explanationgiven if necessary. Data collected so were computed for

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Ghani F, Moeen F, Nisar S. Patients’ Knowledge and Awareness for Implants

descriptive statistics, using the SPSS software version 17.

Results

All the patients (N=210)responded completely to thequestionnaire giving a response rate of 100%. Of the totalsample,102 (48.16%) were males and 108 (51.14%) werefemales with a male to female ratio of 0.94. Nearly halfof the patients (45.7%) were in the age group of 20-39years. Those in the age group of 40-69 were 41.42%leaving only 9 patients (4.28%) who had their ages above70 years.

Patient occupation was classified based on their self-responses. Those having occupations like labourers,gardeners, mechanics etc. were placed in the non-

professional and unskilled groupwhile others working asengineers, doctors, inspectors were placed in theprofessional group. Majority of the patients belonged totheunskilled group (41.10%) with another 33 (15.7%) patientsbelonging to the unemployed group.

Patientswere also categorized with reference to theireducationallevels. There were 60 (28.6%) uneducatedpatients. Those having primary level education (5th class)were 33 (18.57%). Very few patients had post-graduation.Table 2 details the distribution of the patients in terms ofgender, age groups, occupational status and educationallevel.

Analyses of the data for the level of awareness to differenttreatment modalities for replacing missing teethrevealed;67.7% were aware about removable partial dentures, 70.2%about fixed partial dentures/ crowns and bridges but only35 patients (16.6%) knew about dental implants as anoption to replace their missing teeth. The patients whoknew about dental implants as a treatment option were alleducated and were either graduates (34.2%) or hadcompleted a post-graduate qualification (65.71%).

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Ghani F, Moeen F, Nisar S. Patients’ Knowledge and Awareness for Implants

Table 1: Questions included in the Questionnaire.

Table 2: Socio-demographics data of the patients (N = 210).

Of the 35 patients who already had some knowledgeregarding dental implants, relatives and friends were themain sources of information for 24 (68.57%) of themfollowed by dentis ts for the remaining 11(31.42%).Interestingly only one patient out of the 35 hadactually received dental implant therapy. The limitedinformation these patients possessed were based onexperiences from other sources such as relatives andfriends.

When subjects were asked about their knowledgeregarding the survival rate of dental implants, 3 patients(8.6%) said less than 5 years, 17 patients (48.5%) from 5to 10 years and the remaining 15 (43%) did not know.Five (14.2%) of the 35 subjects believed that implantfailure could be due to poor oral hygiene, 19 (54.2%) dueto the type of dental implant prostheses and 11 (31.4%)attributed implant failures to poor quality of treatmentprovided by the dentist. When asked about the ideal careand hygiene of dental implants, 12 (34.3%) said thatimplants should be cleaned similar to natural teeth. 21(60%) said they would need more care than natural teeth,while 2 (5.7%) said they need less care than natural teeth(Table 4).

All remaining 175 patients, who had no idea about theexistence of dental implants, were asked whether or notthey prefer to be introduced to the basic concepts of dentalimplant treatment. About 161 (92%) of these patientsindicated their interest in having more information, suchas predictability, modus operandi, costs etc associated withthe treatment while 14 (8%) were not interested at all.All161 patients who were interested in being introduced tothe idea of dental implant treatment believed that it shouldbe the dentist’s responsibility to provide both thisinformation and treatment option to them (Table 4).

After having been introduced to the basic concepts ofISPs,115 patients (54.7%) believed that dental implantscould be the best treatment choice in replacing missingteeth ascompared to 73 (34.7%)indicating tooth supportedfixed partial dentures as the best with only 22(10.4%)preferring removable dentures (Table 3).Tables 3 and 5 detail information related to participantsinterest, preferences and rejection of conventional and

dental implant prostheses. It can be seen that a fixedprosthesis was considered better than a removableprosthesisingiving a more comfortable feeling (43.7%),looking more natural (41.3%), better chewing capability(35.7%), and better speaking and pronouncing words with(25.4%). The idea of having a removable denture wasrejected by a total of 188 patients (89.5%) of the sampleif all other variables were kept aside. Having said this,these patients would go ahead with removable dentures if

they had no other choice. Table 5 details more informationabout patients’ interest in ISPs, reasons for refraining fromISPs and concerns related to ISPs.

DISCUSSION:

The present survey gives information about patientknowledge and their need for additional information relatedto dental implants as an option in replacing missing teeth,in a selected sample of dental patients in Islamabad,Pakistan. This specific sample of patients was selected forthe ease of access and to assess the basic level of awarenessamongst a particular patient population coming to theprosthodontic department of the Islamic InternationalDental College, Hospital for replacing their missing teeth.Out of 210 patients, only 35 (16.6%) had some basic, priorknowledge about dental implants as an option in replacingmissing teeth. This is significantly less than the results ina number of studies reporting the level of awareness as

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Table 3: Level of awareness of the various participantgroupsand their preferences for the treatment options.

Table 4: Data for information sources, survival, level ofcare and failure reasons for implants.

Table 5: Interest, Preference for and Reasons for rejectionof dental implants.

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77%, 70.1% and 72%, respectively.4, 9,10 Although thesubjective level of information about ISPs, out of the 35patients who knew about the concept of dental implants,all were educated and their main source of informationwere relatives and friends, followed by the dentists,newspaper, magazines, and lastly the internet. This resultis also different from a majority of western societies wheremedia is the main source of information to introduce andeducate patients about dental implants.6,9 It is pertinent tomention here that the number of patients who had priorknowledge about dental implants is significantly lesserthan similar studies done in other societies. This limitationrestricts the amount of information that can be extrapolatedfrom such a small sample size.

92% of the dental patients questioned in this surveywho had no prior knowledge about dental implants wereinterested in having some basic information about dentalimplants and all of them preferred to have their dentistsas the source of such information followed by other sources.This indicates the real need for dental education aboutdental implants.

Only 9.6% of the subjects chose removable prosthesisas the best treatment in replacing missing teeth, whichconfirms the fact that most patients do not prefer removableprosthesis in replacing their missing teeth regardless ofthe clinical situation they have. Most of the patients feltthat the fixed prosthesis would give a better feeling in themouth and would appear more natural. This result is similarto the general belief that a fixed prosthesis is estheticallymore attractive than removable prosthesis and less annoyingin the mouth.

In this survey, direct personal communication withpatients who had previously received dental implants isrestricted to only one case. This may reflect to the fact thatsubjects usually rely on the experience of exposed patientsto ISPs in making an opinion rather than the informationitself, or it could be that previously treated friends, relativescould be the only available source of information availablefor most of the subjects questioned.

When patients were asked about the factors that mayprevent them from choosing implants, the responses werehigh cost (80%), long treatment time and fear from surgery.Some patients believe that the implant placement is a majorsurgical procedure because of the use of the word surgery.This may explain the high fear rate (10%). These resultsare in agreement with the results of most of the previouslymentioned studies.7,10-11 Thepresent findings related topatients choices, concerns and fears regarding other optionsand dental implants, necessitate dental practitioners to

consider the recommended evidence available on theseaspects of dental implants before making informeddecisions.17-19

It is also important that further local work on theseaspects be conducted to better address the limitations ofthis study including; single tertiary care dental hospitalstudy with patients from one locality. A study representativeof the whole population by including a larger sample fromdifferent sects and regions of the country would providemore valid information on the topic.

CONCLUSION:

Within the limitations of this study, the following couldbe concluded:1. Generally subjects seeking prosthodontic treatments

were unaware about dental implants as an option in replacing missing teeth.

2. Many patients who were unaware about ISPs showedinterest in having education and information them.

3. Once a base-line information was provided to these patients many would prefer dental implant supported fixed prosthesis as the mainoption for replacing their missing teeth.

4. Nevertheless, dental implants being an expensive treatment modality was still not a viable option for many primarily due to the higher cost associated withthis therapy.

5. It is emphasized for all dental practitioners to considerinclusion of ISPs related education of their patients andalso to present ISPs among the treatment optionsto allprosthodontic patients so that patients are empoweredtoward making an informed choice regarding the replacement of their missing teeth.

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