BACKGROUND

There is increasing demand for orthodontic treatment in society today.¹ This can be due to increasing awareness of malocclusion, treatment availability, importance given to aesthetics and facial appearance.² Orthodontic conditions are often considered to be of lesser importance by most health professionals, as they are not considered as life-threatening conditions.³ However, the early treatment of malocclusion is important, because it affects quality of life.⁴ Medical practitioners have an important role to play for patients with a vast majority of health-related complaints, as they are the primary caregivers. Involvement of medical practitioners in the process of screening, detection and referral of patients with oral health problems including malocclusion will be beneficial for the prevention and management of oral diseases and effective delivery of oral health care.⁵ Very few studies have been conducted to assess the medical students’ awareness of orthodontics. There have been no known studies to have compared the responses of a medical college attached with a dental college with a stand-alone medical college. Hence, it was considered pertinent to conduct this study. The objective of this study was to assess as to whether there would be any differences in attitudes and awareness of orthodontics between medical students with an attached dental college {A} and students in a stand-alone medical college {B}.

MATERIALS AND METHODS

This comparative cross-sectional study was conducted in Mangalore among 132 first year MBBS students at a medical college with a dental college {A} and 127 first year MBBS students in a standalone medical college {B}.

Sample size estimation was done based on the formula– (Z_α+Z_β)² (p₁q₁+p₂q₂)²/ (p₁₎-p₂)²

Based on previous studies and results of my pilot study, considering 50% awareness among medical students attached with a dental college and expecting a minimum difference of awareness 15% among medical students without a dental college, about 90 students were needed in each group at 95% confidence interval and 80% power of study.

All first year medical students who were present on the day of the study were included in the survey to assess their awareness.

Permission was sought from the principal of {A} medical college to conduct the survey at a time of convenience for the medical college students, preferably before or after their theory or a practical class, so as to cause minimum interference with their academics. Permission was granted to conduct the questionnaire survey after the anatomy practical class, so as to cause minimal disturbance to students.

A presentation was made before the Ethics Committee of {B} medical college. A protocol was submitted to the Ethics Committee, which permitted the questionnaire survey study to be conducted subject to registration at the Clinical Trial Registry of India (CTRI). The CTRI trial acknowledgement number was REF/2015/11010154. Finally, permission was sought from the Dean of {B} medical college to conduct the survey just after the anatomy theory class.

A pre-piloted, validated, self-administered questionnaire used by Al Shahrani et al⁵ (Table 1) was distributed among the students. Prior permission from the concerned authorities and informed consent from the participants was taken. The students were informed of the objective of the survey and were given instructions on how the forms were to be filled. Implied coercion was done away with as none of the authors were involved in classroom teaching. It was ensured for completeness of the questionnaire while collecting it back. The response rate was 100%. All forms were collected after 15 - 20 minutes.

Data collected was entered in Microsoft Excel. The statistical software package SPSS version 16.0 for Windows was employed for data analysis. Pearson’s Chi-square test was used and a p-value of less than 0.05 was considered statistically significant.

RESULTS

A total of 259 first year MBBS students participated in the survey. Of them, 132 were from a medical college attached with a dental college {A} and 127 from a stand-alone medical college {B}.

Among the 132 students of {A}, 55 were males and 77 were females. Among the 127 students {B}, 40 were males and 87 were females.

Descriptive statistics, i.e. number and percentage was used to describe the variables (Table 2 and Table 3). Comparison of the knowledge of orthodontics is described in Table 4.

Only 26% of the participants in {B} (n= 34) had visited a dentist in the last 6 months as compared to {A} where 40% of participants did visit a dentist (n= 53). This value was statistically significant (Graph 1).

75% respondents in {B} (n= 95) were familiar with the term Orthodontics as compared to {A} 80% (n= 106).

Only 61% (n= 77) students in {B} responded orthodontists correcting crooked teeth as compared to 74% (n= 98) in {A}. This value was statistically significant.

Close to 45% (n= 57) of the students in {B} felt mastication was most affected by malocclusion. This was followed by aesthetics 37% (n= 47) and speech 18% (n= 23). This is similar to the results from the study of {A} where the score for mastication was 48% (n= 63), aesthetics was 44% (n= 58) and speech was 8% (n= 11).

Treatment discomfort was a cause for concern for both groups, in {B} and {A}. 51% (n= 66) for {B} and 44% (n= 58) for {A}.

More students in {B} 45% (n= 57) would not refer Orthodontics as a career to their close relatives as compared to {A} respondents 30% (n= 40). This value was statistically significant (Graph 2).

There was a difference between male and female students’ awareness and their attitudes towards orthodontics (Table 5). There were significant differences in the attitudes and awareness of the subject of Orthodontics between those students studying in a medical college with an attached dental college (A) when compared with those medical students studying in a stand-alone medical college (B).

Medical College B (Without an Attached Dental College)

• Total males and females in both A and B medical colleges, 259.
• Total males in both A and B medical college, 95.
• Total females in both A and B medical college, 164.

*p < 0.05, significant

*p < 0.05, significant.

*p < 0.05, significant.

Graph 2. Would you suggest Orthodontics as a Career

DISCUSSION

The general purpose of the present study was to assess the differences in the attitudes and awareness of Orthodontics between first year MBBS medical college students studying in a medical college with an attached dental college and those students studying in a stand-alone medical college. A validated questionnaire was used. Medical College students’ exposure to the subject of dentistry is very minimal, let alone the field of Orthodontics. As tomorrow’s medical practitioners they would probably encounter patients with various malocclusions or dentofacial defects, who would not have an aesthetically pleasing profile. Hence, this study was conducted to assess the students.

Very few studies have been conducted to assess the medical students’ awareness of orthodontics. There have been no known studies to have compared the responses of a medical college attached with a dental college with a stand-alone medical college.

In a study⁶ conducted in 2016 to assess the knowledge and attitudes towards orthodontics among paediatricians in Haryana, it was observed that there was a low level of awareness regarding orthodontics among paediatricians. The study concluded by saying that there was a necessity for education of paediatricians regarding orthodontics. This corroborates with the findings of our study

In our study we found more medical students in {A} visiting a dentist as compared to {B}. This could be due to the fact that the medical students in {A) have better access to dental treatment as compared to those in {B}.

A statistically significant number of medical students in {A} responded correctly that orthodontists were involved in correcting crooked teeth than those medical students in {B}. This could be due to more exposure of students in {A} to a dental college.

When it came to deterrence from advising or personally undergoing orthodontic treatment, the treatment discomfort scored over the cost or the time required for orthodontic treatment. This finding suggests that orthodontists can advise patients about the various appliances available for orthodontic treatment. Communication between the orthodontist and the patient regarding diagnosis and treatment planning is very important, as has been noted in an article⁷ which states that patients and parents are often amused to know that there is more than one proper treatment plan for any case. Another article⁸ suggests the importance of good communication between the orthodontist and the patient.

It was observed in our study that a statistically significant number of students in {B} would not refer Orthodontics as a career to their close relatives as compared to respondents in {A}. The study⁵ done in 2014 has mentioned the need for creating more orthodontic awareness among medical students. This is in concurrence with our study.

The findings of a study⁹ conducted to observe professional opinions on the advantages of orthodontic treatment also states that both general dentists and orthodontists rated the psychosocial gain from orthodontic treatment higher than the dental gain. They also felt that orthodontic treatment reduces the chances of dental disease. The data from our study also suggests that aesthetics may be a motivation for seeking treatment, especially for female patients.

There was a difference between male and female students’ awareness and their attitudes towards orthodontics. There was a difference among male and female students’ responses regarding which daily function would be most affected by malocclusion. 45.12% of the total number of females (n= 164) felt aesthetics as being most affected as compared to 32.63% in males (n= 95). This data suggests that the female participants consider aesthetics to be more affected than mastication or speech. These findings are similar to similar studies conducted in Nigeria³ and Saudi Arabia.⁵

67.07% of the females (n=164) would suggest orthodontics as a career as compared to 54.73% males (n=95).

It has been mentioned in various studies^10,11,12 that patients who have completed orthodontic treatment may benefit in their dental compliance and oral health indirectly by psychological factors.¹⁰ Also they have an improved oral health-related quality of life than did the untreated patients who were waiting for treatment.¹¹ The findings of our study suggest that it would benefit society at large if there was better awareness of Orthodontics among medical college students.

General dental practitioners are often the first dental professionals to suggest orthodontic treatment and to refer patients to orthodontic specialists. With the growing emphasis on cosmetic dentistry, more adults are likely to seek information regarding orthodontic surgery.¹³

The limitation of this present study was a limited sample size. There is a scope for further studies of similar nature to be conducted on a larger scale in future. In spite of the limitations of the present study, the findings are useful for the orthodontic profession and also the fact that this study facilitates for a debate in the medical community as to the amount of awareness the medical students must have about the sub-specialties of dentistry.

The findings of a study¹⁴ conducted in 2009 to assess the current evidence of the relationship between malocclusion/orthodontic treatment need and quality of life, mentions that there is a need for further studies so that outcomes are uniform and thus amenable to meta-analysis. Hence, better coordination between the medical and dental fraternity would lead to more awareness and better treatment outcomes.

CONCLUSION

Medical students who studied in an institution with an attached dental college had better awareness of the subject of orthodontics as compared to medical students of a stand-alone medical college.

Medical students who studied in a medical college without an attached dental college had average awareness of orthodontics as a sub-specialty of dentistry. A basic introduction to dental sub-specialties would help them identify dentofacial problems and make appropriate referrals.

Orthodontists can improve their communication skills and allay patient’s fears about treatment discomfort. Close contact with the orthodontist is a way to make patients aware of the importance of maintaining oral health.

ACKNOWLEDGEMENTS

Special thanks to Dr. Ibrahim Al Shahrani, Dean, King Khalid University, Saudi Arabia, for his permission to use the questionnaire.

The author would like to thank the A. B. Shetty Dental College Principal and Dean, Prof. Dr. U. S. Krishna Nayak; K. S. Hegde Medical College Dean, Dr. Satish Kumar Bhandary, the Head of Department of ENT; Dr. Martin Lucas, K. S. Hegde Medical College, the Head of Department of Anatomy; and all the first year MBBS students of K. S. Hegde Medical Academy, Nitte University, Mangalore for their participation in the study.

The author would like to thank the Fr. Muller Medical College administrator Rev. Fr. Rudolph Ravi D’Sa, the Dean Dr. J. P. Alva, the Chief of Medical Services Dr. Sanjeev Rai and the secretarial staff of Fr. Muller Medical College, Mangalore for their help. Thanks to Dr. Prakash Shetty, Head, Department of Anatomy, Fr. Muller Medical College, and to the 1st MBBS students for their participation in the study.