Essay On The Attitude Of Private Dental Practitioners Towards Treatment And Management Of Children In Riyadh, Saudi Arabia
Hassan S. Halawany (BDS, MPH, MS, MHSA, DrPH); Sultan Abdurahman A. Al-Faridda (BDS); Bandar Hussain K, Al- Saeed (BDS) and Mansour Ali-Homaied (BDS).
Objective: The study conducted a survey among private dental practitioners in the Saudi Arabian City of Riyadh to investigate their attitudes towards children treatment, including the treatment of children with special care needs.
Methodology: The survey involved dentists working in Riyadh’s private dental clinics to undertake survey interviews inform of questionnaires. To describe the participants’ responses, the study used a 5 point Likert scale to rate participants’ responses regarding questions on adequacy of human resource training in the field, individual dentist preference behaviors and any modification techniques, barriers that prevented the dentists from treating young children, and suitable incentive programs that should be in place for them to continue treating children.
Results: The response rate of the respondents was 20.4%, corresponding to 204 returned questionnaires that provided valid and reliable information. The sample comprised 3.9% as Saudi dentists and 96.1% as non-Saudi dentists; 58.1% were male while 41.9 were female; 4.7%, 30.5% and 64.7% were consultants, specialists and general practitioners respectively. Results indicated that among the 204 respondents, 85% had treated children, 65.7% noted that financial loss and time consumption were the major barriers hindering them to treat young children, and 60.8% preferred the “tell-show-do” as a technique for managing dentists’ behaviors.Conclusions: The study revealed that the majority of individual dentists in private clinics had positive attitudes towards treating young children, but they were hampered with financial loss and time consumption to treat children, including those that require special care and attention.
Keywords: special care needs, pediatric patients, attitude, barriers.
Worldwide, fuelled by the increasing demand of basic dental care, dentistry profession is continuously experiencing growth. Over the years, since its beginning as a distinct profession, it has seen several revolutions on the perspective of treating young children. Among them have been the continued involvements of parents as important stakeholders in maintaining good dental care to their children (Massey, 2008). In this regard, dentists have been setting standard protocols of healthcare for them to follow at their consent. Seale and Casamassimo (2003) reported that despite the development in preventive services, as those that involve parents and emerging technologies that the dentistry profession has undergone, it is yet to claim grip on children’s dental health. Indeed this can be illustrated by the Oral Health America Report that has noted that cases of dental carries in primary dentions have not decreased in the last 10 years (Dao et al., 2005). Consequently, there have been reactionary views among leading academics and professionals in this field. However, the general consensus has been that when a child receives preventive oral care at his or her earlier age, he would have less risk of developing dental disease. In earlier studies, such as those done in the US, it has been revealed that the majority of dentistry professionals were willing to treat children, including those with special care needs. Although practitioners contended that their training was adequate to enable them to treat children and those with special needs effectively, others did not think so. A study conducted in Sweeden has revealed that lack of adequate training, experience and knowledge, too little time, general stress and constrained work environment are the major barriers why professional dentists could not attend to children with disabilities (Crossley & Joshi, 2002). Especially on the perspective of training, knowledge and experience, in some countries, like the UK, it has been noted that they are general dentists who form the majority of those that provide dental care to children (Massey, 2008). The UK situation was replicated in Nigeria when it was found in 2006 that the majority of dentists lacked adequate education, and thus, knowledge to manage children with special needs regardless of gender, age and place of practice. Even for those dentists who rated their knowledge and experience as adequate found themselves being challenged to meet the needs of such children. However, the dentists still indicated positive attitudes towards treating this kind of children (Oredugba & Sanu, 2006). A study done by Dailey and colleagues revealed that education and experience had positive contribution to the general dental practitioner (GDP)’s work (Dailey et al., 2007). In Saudi Arabia, although a recent study has explored parental attitudes towards techniques of managing behavior in pediatric dentistry, dentists’ attitudes regarding children treatment, including treatment of those with special needs and cares, have never been explored. Therefore, the aim of this study will be based on four sub-aims:
Investigating attitudes and willingness of dentists to treat children
Examining barriers faced by dentists to treat children and those with special needs
Getting opinions regarding parental accompaniment and involvement in dentistry operatory
Determining the influence of undergraduate management training programs on trainees to manage this kind of patients.
A random sample of dentists was obtained from dentists working in private clinics in Riyadh. The researchers obtained the names of the participants from the Ministry of Health, after a formal request had been sent. Further, an approval from the Ethical subcommittee of the College of Dentistry Research Centre (CDRC) was obtained before the study commenced. Before the actual study, the researchers carried out a pilot study to test the questionnaire’s effectiveness and efficiency as a measuring tool. The participants were also informed on the purpose of the study and the need of free consent to participate. The questions in the first part touched on demographic and professional data. In the second part, participants were asked on whether they involved in treating children or not, average number of children that they have treated, the number patients treated by them very week, and any barrier that they could face in their practice. Moreover, they were asked about any incentive that they could require enhancing their work in treating children effectively, advanced training in treating children and those with special needs, preference of parental involvement and behavior modification technique that could be suitable.
Responses of the participants were rated on 5-point Likert Scale. Concerning their level of education, they were asked to indicate options as, “always”, “usually”, “sometimes”, “rarely” or “never”, depending on how education helped them to treat children. On barriers, they could indicate if they “highly agree”, “moderately agree”, “agree”, “moderately disagree” or “highly disagree” that certain barriers could prevent them to work effectively. Using Microsoft Excel, researchers carried out statistical analysis to classify resulting data and their frequencies.
The survey got a response rate of 20.4%, providing valid and usable information. This translated to 204 respondents, and it comprised 3.9% as Saudi dentists and 96.1% as non-Saudi dentists; 58.1% were male while 41.9 were female; 4.7%, 30.5% and 64.7% were consultants, specialists and general practitioners respectively. The percentages of participants with their countries of origin are stated as below in Table 1.
It is realizable that 85% of the dentist participants treated children; 68% treated 5 children or less within a week; 27% treated 6-20 children within a week; 5% of them treated more than 21 children within a week. On barriers, 65.7% indicated financial loss and time consumption as their major barrier in child treatment; 13.4% noted lack of training and experience as the major barrier; 10% indicated lack of interest to treat children; 5.2% of the respondents lacked tolerance on children; 5.3% had bad experience as a barrier to treat the children. This can be illustrated in the Figure 1 below.
On the question of whether they were enabled by their undergraduate studies to treat children effectively, 45% of them indicated “ sometimes”, 30% as “usually”, 16% as “always”, 5% as “rarely”, 4% as “never”. This is illustrated in the figure 2 below.
On parental participation in dental operatory, there was no overriding consensus on whether parents should be permitted to participate in children dentistry or not. 39.2% preferred that parents accompany their children; 48.5% preferred that parents escort them often; 11.7% disregarded the tendency of parental escort.
On the question of the method that would enhance behavior modification among them, the majority of participants (60.8%) preferred “tell-show-do”; general anesthesia was preferred the least. In treating children with special risks, the majority of the respondents, as 56.7%, reported having treated them. 73.3% of them had treated those with psychological problems. On referring to the better incentive technique for them to perform better, 94.9% indicated better training opportunities; 93.3% wanted professional social appreciation as the best; 76% wanted financial rewards.
Encouragingly, the findings have indicated that the majority, as 85%, of dentists treat children. It should also be noted that most of them were general practitioners at 60%. However, these percentage figures seem not agreeing with those of other studies. The Seale and Casamassim (2003) study had higher percentages. It indicated that over 90% of dentists treating younger children were general practitioners. Only 16% of the respondents indicated that quality training could enhance their performances at work. This shows that the country needs to consider the quality and the quantity of the kind of students that are currently studying dentistry. However, their opinions corroborate with those of Mouradian (2001), Edelstein (2001) and Cotton et al. (2011) who agreed that more training is needed to improve one’s practice in dentistry.
On barriers, however, Hallberg et al. (2004) has added that lack of access to dentistry services should also be considered as a barrier. The study findings agree with those of Tsai et al. (2007), who noted that financial endorsements and more training opportunities could be best rewards to improve the quality of treatment to children. Thus, from this study, social and professional appreciation, training opportunities and financial rewards have been seen as the best incentives organizations can advance to their dentists. Although the majority of the respondents did not like parental accompaniment to the child, due to the fear of being coerced to meet certain expectations, it should be noted that to build a good relationship with a child, his or her parent is a very important catalyst (Feigal, 2001). To modify their behaviors, the dentists preferred the “tell-show-do” technique and therefore their managers should avoid the “hand-over-mouth” technique, to reduce the possibility of non-compliance (Abushal & Adenubi, 2000).
The study also indicated that although over the majority as 56.7% treats children with special needs, only 8.6% of the respondents had attained special training for handling them. This results contrast those of Casamassimo et al. (2004), who differed that majority of dentists rarely treat children with psychological problems. The dominant theme in this case, is that services provided to children will depend on where the professional dentist got his education from (AlSarheed et al., 2001). Moreover, the study contrasts Casamassimo et al. (2004) by noting that although on-job training programs do not increase the number of people who want to join the profession, they can help to improve their skills and interactions at work.
Although the study is informative on dentists’ attitudes towards treating children, including those that are mentally sick, self reporting data may not be accurate. Moreover, one instance of cross-sectional data cannot be used to establish an effective cause-effect relationship. The study’s data are taken from those private dentists working in Riyadh only, but not from the whole of Saudi Arabia, and, hence, they cannot be used to generalize the whole country. However, there is a possibility that the low turnout and response rate could result from participant’s general lack of interest. By limiting responses to measure qualitative variables, it is possible that participants could have been barred from indicating their own opinions. Nevertheless, the study consisted of a large number of expatriate (foreign) dentists who are not Saudi Arabians; they may return in their home countries when permits expire.
The study has found that although the majority of private dentists would like to treat children, with positive attitudes, barriers such as lack of time and loss of finance could hinder them from rendering their services effectively. However, to alleviate some of the limitations noted above, the study need to be longitudinal to reveal the exact picture of the Saudi Arabian dentists in treating children. Policy makers and schools in dentistry education would also have to modify their curricula to include modules that impart knowledge and skills in handling young children and those with psychological problems (Thierer & Meyerowitz, 2005). This will overcome some of the barriers and increase dentist willingness to treat the children.
This study was sponsored by the Dental Caries Research Chair (DCRC), at the College of Dentistry, King Saud University, PO Box.60169, Riyadh 11545, Kingdom of Saudi Arabia.
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