|Year : 2021 | Volume
| Issue : 1 | Page : 4-8
General dental practitioners knowledge of dental radiography among dentist in Chennai, India
Praveen, L Jailance
SRM Dental College, Kattankulathur, Tamil Nadu, India
|Date of Submission||06-Oct-2021|
|Date of Acceptance||06-Oct-2021|
|Date of Web Publication||29-Nov-2021|
Dr. L Jailance
Assistant Professor, SRM Dental College, Kattankulathur, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Introduction: Dental radiographs are one of the principal diagnostic methods used in dentistry. The safe and effective use of X-ray equipment is important to the protection of the patient and members of the dental team. The aim of this research is to evaluate the general dental practitioner's knowledge of dental radiography. Materials and Methods: The data were collected from fifty general dental practitioners at self-convenience using a structured questionnaire consisting of 9-item questionnaire. The sample was selected based on inclusion criteria and exclusion criteria. Inclusion criteria include undergraduate, postgraduate, and Chennai dental practitioners. The exclusion criteria include the students and dental radiograph assistants. In the questionnaire, details were asked about the age of the intraoral radiographic unit, kVp and mA of the equipment, the type of timer on the machine and about the geometry of the machine, and the geometric technique used for intraoral radiography. Furthermore, the questionnaire contained questions about the type of intraoral detectors that were used and whether the dentists were also using panoramic machines and, if so, which type of detector they had. Among the possible answers, one option was “no idea.” The data thus obtained were subjected to statistical evaluation. Results: 80% (40 dentist) of the equipment used in South Chennai dentist was reported to operate between 60 and 70 kVp, whereas 20% (10 dentist) claimed to be working at a tube voltage of 50 kVp. Conclusion: The results of this study showed that the knowledge of dentist in South Chennai regarding dentomaxillofacial radiology is excellent. The level of awareness of practitioners regarding radiation hazards and safety was found to be acceptable.
Keywords: Exposure, general practitioners, knowledge, radiation protection, radiology
|How to cite this article:|
Praveen, Jailance L. General dental practitioners knowledge of dental radiography among dentist in Chennai, India. Int J Soc Rehabil 2021;6:4-8
| Introduction|| |
As a dental professional, the utilization of radiograph for finding and further treatment is significantly more regular than different fields of medicine. It is accounted for that around 45% of dental patients require radiographs for determination. Dental radiographs is one of the essential demonstrative techniques utilized as a part of dentistry. Intraoral and extraoral radiographs are two sorts of radiographs available. The sheltered and powerful utilization of x-beam hardware is imperative to the assurance of the patient and individuals from the dental team. Its assumes a critical part in the identification of oral disease. Exposure to such radiation is related with an expanded hazard in the long haul of threatening sickness in those persons. Furthermore, it is accepted that the likelihood of event of these antagonistic impacts is straightforwardly corresponding to the level of presentation, with no measurements threshold. The dangers related with the vital introduction to ionizing radiation might be generous and must be limited through careful adherence to great practice.
Specialized advances in radiological equipment significantly affect lessening of radiation dosages to patients during intraoral and extraoral radiographs. During extraoral radiography, the utilization of uncommon earth escalating screens has diminished the radiation presentation significantly.,, Although the quantity of radiographs taken every day in essential dental care is over the top, the most serious hazard emerges when there is proof of poor picture quality or nondiagnostic images inferable from poor specialized information and the insufficient handling of films.,,,, It has been evaluated that the disposal of nonbeneficial examinations could prompt a 30% lessening in the aggregate populace measurements, got from medical radiology. Dental hygienists assume an imperative part in handling and they should accept the accountability for poor preparing rehearses, the majority of which concern not supplanting preparing arrangements as oftentimes as required, overdeveloping and overfixing. Accordingly, numerous dental practitioners tend to build the presentation time to make up for the disgraceful preparing, therefore expanding the radiation measurements to patients.
For dispensing with unnecessary X-beam examinations, each expert who works X-beams ought to be appropriately prepared as per the Ionizing Radiation Medical Exposure Regulations 2000. We live in an ocean of radiations. We are constantly exposed to naturally occurring ionizing radiation, i.e., background radiation and furthermore presented to ionizing radiation from manmade sources, for the most part through medical procedures. On an average, doses from a diagnostic X-ray are much lesser, in dose effective terms, than the natural background radiation. Radiation has turned into a part of present day living, achieving each section of our general public. The essential hazard from dental radiography is radiation actuated malignancy. The writing on conceivable destructive impacts of expert analytic presentation for dental specialists is not steady. The hazard required with dental radiography is surely little in the correlation with numerous different dangers that are a typical piece of regular daily existence. In any case, no premise exists to accept that it is zero. Similarly, the biologic impacts of ionizing radiation ingested during dental radiography are questionable. The radiographic examination utilized as a part of all fields of medicinal administrations and adds to the advancement of the well-being, both separately and broadly. Radiographic examination has a basic impact of dental practice. Certain measure of radiation is unavoidably conveyed to patients, it ought to be as low as reasonably achievable (ALARA). International Commission for Radiation Protection is the administrative body which sets down standards for radiation security at the universal level. In India, it is the Atomic Energy Regulatory Board (AERB) which gives the standards to radiation assurance.
AERB prescribes standards for reasonable dosages of radiation from X-beam tubes, the protecting required for the dividers of an X-beam tube room, the lead equal protecting attire to be worn by radiation specialists and sets down safe measurements limits for radiation laborers and for the overall population. Before undertaking any radiological examination, it is important that the provider comprehends the potential dangers and the advantages of radiation. The dangers can be stochastic (of which likelihood increments with dosage) and deterministic (of which severe increments with measurement). Cancer induction and hereditary effects are stochastic impacts and blood dyscrasias, cataracts, and impaired fertility are cases of deterministic effects. Biological effects of ionizing radiation are gathered into stochastic and deterministic effects. Over a specific decided dosage of radiation organic harm starts to show up, this is called as deterministic impact. Stochastic impact is that in which there is no specific dosage level above which natural change happens in the body.
Ionizing radiation causes both the impacts relying on radiation doses and body's reaction to these radiations. Dental practitioners and in addition patients are more inclined to the danger of stochastic effects because of its lack of a dose threshold limit. The positive parts of diagnosis of disease and detection of disease should be considered while assessing the risk of impacts of radiation. It is essential for dental practitioner to refresh their insight about new patterns in analytic strategies, protective measures, etc. This can be accomplished by methods for proceeding with training, continuing education, journals, workshops, and other media. In India, diagnostic radiation facilities are administered by AERB. The role of the AERB is to guarantee that utilization of ionizing radiation and atomic vitality in India does not make undue hazard the well-being of individuals and the environment. It is required to enlist all diagnostic radiation facilities in e-Licensing of Radiation Application (eLORA) system of AERB. From December first, 2013, it is mandatory for dental specialists and dental institutions to enroll in eLORA and get a license to operate dental X-ray units, panaromic machines, and cone-beam computed tomography. It is additionally essential for manufacturers of X-ray machines to get a license available to be purchased in India by AERB.
The current radiation protection standards are based on three principles: justification of a practice, optimization, and dose limitation. In spite of the fact that the radiation dosage levels in dental practice are generally low, one ought to think about the combined impact of repeated exposures. There ought to be a making progress toward radiation assurance measures in the private dental offices. There is an association between knowledge and the use of low-dose techniques and attitudes toward risks. A dental professional should always be prepared to improve his or her knowledge through continuous education, it is a well-known fact that this is more likely to occur if the continued education is mandatory for all dental professionals, for whatever local or federal reasons.
The reason for performing this study was to alert the dental professional societies that more attention should be paid to radiation protection in dentistry in our country. The aim of this research is to evaluate the general dental practitioners knowledge of dental radiography.
| Materials and Methods|| |
Data was collected from 50 general dental practitioners using a structured questionnaire consisting of 9 item questionnaire [refer [Figure 1]]. The sample was selected based on certain inclusion and exclusion criteria.
- Chennai dental practitioners.
- Dental radiograph assistants.
In the questionnaire, details were asked about the age of the intraoral radiographic unit, kVp and mAofthe equipment, the type of timer on the machine and about the geometry of the machine, and the geometric technique used for intraoral radiography. Furthermore, the questionnaire contained questions about the type of intraoral detectors that were used and whether the dentists were also using panoramic machines and, if so, which type of detector they had. Among the possible answers, one option was “no idea.” The data thus obtained were subjected to statistical evaluation.
| Results|| |
100% (50 dentist) claimed to be working with a digital exposure timer, whereas none said they were still working with a manual (clock-like) exposure timer. It was found that 94% (47 dentist) said that they were working with a short cone geometry, whereas 6% (3 dentist) claimed to be working with a long cone geometry (refer [Table 1]).
|Table 1: Responses from the study subjects to the questionnaire in percentage|
Click here to view
| Discussion|| |
As mentioned above, the data were collected from fifty general dental practitioners using a structured questionnaire consisting of 9-item questionnaire. The sample was selected based on certain inclusion criteria and exclusion criteria. Inclusion criteria which include the Chennai dental practitioners, undergraduates, postgraduates, and exclusion criteria include students and dental radiograph assistants. Regarding the age of the intraoral radiographic equipment used by the questioned population of Chennai dentists, it was found that almost 100% (50 dentist) were using radiographic machines for intraoral radiography equipment that was after 2000.
As the answers about the tube voltage of the intraoral equipment was mild difference, the answers were condensed into two groups. Therefore, tube voltage ranging from 60 to 70 kV was considered as one category. 80% (40 dentist) of the equipment used in South chennai dentist was reported to operate between 60 and 70 kVp., whereas 20%(10 dentist) claimed to be working at a tube voltage of 50 kVp.
The majority of the South Chennai dentists were using 4 or 8mA (easy to change) equipment for intraoral radiographs; 8%(4 dentist) claimed they not knew what they were working.
100% (50 dentist) claimed to be working with a digital exposure timer, whereas none said they were still working with a manual (clock-like) exposure timer.
It was found that 94% (47 dentist) said that they were working with a short cone geometry, whereas 6% (3 dentist) claimed to be working with a long cone geometry.
20% (10 dentist) said they were using a rectangular collimator. 80% (40 dentist) responded that they were using circular collimatior.
18% (9 dentists) claimed to be working with the parallel technique, whereas 82% (41dentist) said they were working with the bisecting angle technique.
76% (38 dentists) of the dentists in South Chennai were still using PSPP sensor films for intraoral radiography. 24% (12 dentists) had digitized to intraoral sensors as charge coupled device (CCD).
About 10% (5 dentists) of the dentists has no intention idea what sensor they using. 10% (5 dentists) of South Chennai dentist do not not possess a dental Panaromic machine. Others 80% use analogue films and 10% (5 dentists) use CCD technology.
A dental professional should know his or her equipment and it is expected to know the main guidelines on radiation protection. The overall conclusion of this study is that a great deal of work done to ameliorate the quality of radiographs and the knowledge and attitude of general dental practitioners regarding dentomaxillofacial radiology. This is a task for dentomaxillofacial radiology specialists, who will have to concentrate in the first place on undergraduate teaching and then on postgraduate teaching. The latter is not less important than the first as the working dentist population needs to change their attitude regarding radiation protection and dentomaxillofacial radiology general knowledge. This has also been stressed in other surveys. From the results, it is evident that continued education in dentomaxillofacial radiology is essential, especially when considering a change from analogue to digital radiology. That 92% (46 dentist) of the dentists in the present survey claimed to be working with a short cone radiographic machine is probably biased by the fact that they are not aware of the difference between a short cone and a short spacer cone, which is also called a beam indicating device or position indicating device. It can be assumed that dentists owning a machine with a short spacer cone, because the manufacturer positioned the focus near the rear end of the machine, gave the wrong answer. Therefore this result should be interpreted with care. The opposite for long cone could also be the case, of course.
The results are, therefore, excellent. This could mean, for instance, increased in the number of hours of under and/or postgraduate education. If this can be decided by the local authorities and enforced at university level, it had a chance of succeeding. However, at present, every university has its own curriculum. And as known from other studies, it is not always easy to change curricula and convince faculty staff colleagues of this issue.
Regarding the knowledge of Chennai's general dental practitioners, there are various reasons for the results of this questionnaire being excellent. Perhaps the quality and quantity of the undergraduate education is good. However, it is the personal impression that, for many years, dentomaxillofacial radiology has been taught at every university in the country by medical radiologists or general dentists with specific dentomaxillofacial radiology training. The major problem with the undergraduate education is the number of hours that should be dedicated to dental radiology. The age of the dentists was not assessed and also the university where they had studied. Age was not considered an important question in this study, as the age of a dentist does not always reflect that person's knowledge of dental radiology. Furthermore, it is known that not every young dentist starts with new equipment and, vice versa, that not every “older” dentist is working with old equipment. Therefore, the age of the intraoral radiographic equipment was considered more important and more relevant as a question. The level of knowledge and the attitude of dentists regarding radiation safety will have a direct impact on patient exposure to radiation (Shahab et al. 2012). Many studies have been done to determine the knowledge and attitude of dentists regarding radiation safety.
Shahab et al. reported a study pertaining to radiation safety to assess the knowledge of dentists with regard to basic information in relation to radiation protection and methods of reducing the radiation dose to the patient. The majority of dentists did not employ appropriate procedures to decrease exposure to unwanted radiation.
Mutyabule and Whaites conducted a study to assess radiation protection measures in dental practices in Uganda. It was found that operators lacked sufficient knowledge regarding radiation safety protection measures.
Aps assessed dentists' knowledge regarding radiation safety. The dentists were asked about various methods of dose reduction to the patients. The results of the study highlighted the need to increase knowledge of dental practitioners regarding radiation safety and methods of dose reduction.
Lee and Ludlow assessed the attitude of dentists regarding radiation safety. The dentists were asked about primary knowledge of radiation safety and the method of reducing the dose to the patient such as speed of the film, collimation of the X-ray tube and the regular use of shielding. Results of the study confirmed that there is a demand to reinforce the dentist's working knowledge about the issue of radiation safety.
Math et al. assessed the understanding of dentists regarding radiation safety standards with regards to the X-ray machine, collimation of the tube, regular use of a film holder, shielding and the position of the operator during radiation exposure. The result of this study also highlights the need to increase the practitioner's awareness and attitude regarding radiation hazard and use of appropriate methods to reduce the radiation dose.
Jacobs et al. conducted a study regarding the perceptions of the dentists of radiation protection. The results of this study concluded that there was a need to apply strict guidelines toward radiation safety.
Majority of the practitioners still followed the position and distance rule, few were found to be using lead barriers while mere used lead aprons and some using a combination of various safety techniques. Distance in radiation protection refers to distance from the source and the individual. As the distance increases, radiation exposure reduces. Moreover, shieldingincludes both protective barriers such as lead shield and personnel protective measures such as lead apron. Ninety-eight percent reduction in scattered radiation and attenuate dose to 0.04 μR can be achieved using lead aprons. Patient should wear thyroid collar during radiation exposure as it reduces attenuation of scattered radiation to 92%(46 dentist). Proper shielding from radiation and by increasing the distance from source protect radiographer as well as patient for unnecessary exposure to radiation. According to position distance rule, radiographer position should be at least 6 feet from the source at an angle of 90 to 135° to the central ray of X-ray beam.
| Conclusion|| |
The results of this study showed that the knowledge of dentist in South Chennai regarding dentomaxillofacial radiology is excellent. This emphasizes that there is better under and postgraduate education in dentomaxillofacial radiology in Chennai. The present report is therefore an important statement for the dental professional society. The level of awareness of practitioners regarding radiation hazards and safety was found to be acceptable. However, implementation of their knowledge with respect to patient and personnel safety was found wanting. Insisting that they follow the protocols and take necessary safety measures by means of continuing medical education programs, pamphlets, articles, and workshops is strongly recommended. From the time of its discovery, X-rays have played a vital role in the field of medical and dental science. Ranging from diagnostic to therapeutic applications, the use of X-rays is manifold. Probably, the most widespread application is in the field of dentistry from the simple diagnosis of incipient caries, multiple fractures to aiding in more complex procedures such as precision implant planning. The modalities at the disposal of dentists range from intraoral radiography to cone beam computed tomography. During the course of their training, all health-care personnel are trained regarding radiation hazards and requisite safety measures. However, the sincerity with which the matter is considered needs to be assessed from time to time. In the present study, we attempt to evaluate the awarenessand validate the knowledge of radiograpy among general dental practitioners in Chennai, India. Protection of one's self and patient from all kinds of health hazards is the hallmark of concerned doctors. The AERB recommendations should reach out through the dentists' platform (e.g. IDA) to the dental practitioner. Better “safe than sorry” remains no more a virtue but a fundamental necessity.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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