Volume 7, Issue 11, November – 2022 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Assessment of Knowledge and Attitude about

Principles and Practices of Orthodontic Treatment
among Dentists and Non-Orthodontic Specialists
in Karnataka: A Questionnaire Study
Sharath Kumar Shetty1, Mahesh Kumar Y.2, Harish Gowda K.3
Professor & HOD1, Professor 2, Post Graduate Student3
Department of Orthodontics & Dentofacial Orthopaedics,
K.V.G Dental College & Hospital, Sullia, Karnataka, India

Abstract:- Temporomandibular disorders, 68% (n=246) thought

Introduction: General practitioner dentists and non- that retainers should be worn for 12 months after
orthodontic specialties should have the knowledge of the orthodontic therapy, 58% (n=208) believed that
basic principles and practices of orthodontics in order to orthodontic treatment can be given in periodontally
educate the patients, diagnose their problems correctly compromised patients, 86% (n=309) believed
and for proper referral. orthodontic treatment can be delivered even if the
molars were missing, 96% (n=343) considered calling
Many times, patient might present with a chief an orthodontist for opinion, 87% (n=311) answered
complaint that he/she would not be able to correlate with that they carry out diagnostic orthodontic procedures,
an underlying malocclusion. In that case, it is imperative 84% (n=300) believed orthodontic treatment can be
for the dentist to identify and diagnose the chief cause started before the eruption of all permanent teeth, 88%
which may be an orthodontic cause and then plan a (n=316) said that they will look for malocclusions even
proper referral if the patient presented with some other chief
complaint, 70% (n=250) considered doing orthognathic
Aim:- The objective of the present study is to assess the surgery at patient’s convenience place.
Knowledge and Attitude about Principles and Practices
of Orthodontic Treatment among Dentists and Non- Conclusion:- This study showed that there is good
Orthodontic Specialists in Karnataka. knowledge and Attitude about Principles and Practices
of Orthodontic Treatment among Dentists and Non-
Method:- This study was performed by presenting a Orthodontic Specialists in Karnataka. However, there is
closed questionnaire to a total of 359 participants who a need to increase the knowledge about few things like
were general dental practitioners and non-orthodontic retention after orthodontic treatment and regarding the
specialists. A self-developed questionnaire was requirement of extraction for particular orthodontic
distributed through personal contact and e-mail.The treatment and hence there is a need for an increased
questionnaire survey included a total number of 17 clinically oriented education in the undergraduate
questions out of which 12 questions were formulated to courses and a multi-disciplinary inter department
study the knowledge and 5 questions were formulated to seminar presentations and forums set up for the post-
study the attitude towards orthodontic treatment graduation courses for them to understand the scope of
principles and practices. each other’s specialties.
Result:- Among 359 responders, 74% (n=267) knew that Keywords:- assessment; attitude; knowledge; orthodontic
ideal period to start orthodontic treatment was by treatment.
assessing the Growth period and treating accordingly,
88% (n=316) knew that malocclusions can be treated I. INTRODUCTION
during mixed dentition stage, 94%(n=337) were aware
of functional therapy,75%(n=267) knew that functional Malocclusion has a variety of causes but the outcomes
appliances were best advised during peak of pubertal are quite common including unesthetic appearance, patient
growth period, 94%(n=337) considered functional discomfort, gingival and periodontal problems, difficulty in
therapy as a part of orthodontic treatment when a chewing, speech problems, and etc.1So, a multidisciplinary
patient complains of incompetent lips and proclined approach of patient education is required for them to
teeth, 87%(n=312) were not sure whether extraction of understand the need of orthodontic treatment. Thus, general
teeth during orthodontic treatment, 96% (n=346) practitioner dentists and non-orthodontic specialties ought to
believed habits like mouth breathing or thumb-sucking have the knowledge of the basic principles and practices of
have an effect on the alignment of anterior teeth, 89% orthodontics in order to educate the patients.2Many times
(n=321) believed correcting the malocclusion patient might present with a chief complaint that he/she
influences healthy social living,94% (n=339) believed would not be able to correlate with an underlying
orthodontic therapy can be a part of management of malocclusion. In that case, it is imperative for the dentist to

IJISRT22NOV174 www.ijisrt.com 412

Volume 7, Issue 11, November – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
identify and diagnose the chief cause which may be an 4. Functional appliances are best advised in which
orthodontic cause and then plan a proper referral. 3This study growth stage?
is done with an objectiveto assess the Knowledge and a. Pre pubertal
Attitude about Principles and Practices of Orthodontic b. Peak of pubertal growth
Treatment among Dentists and Non-Orthodontic Specialists c. Post pubertal growth
in Karnataka. d. Growth stage doesn’t matter
5. Do you consider functional therapy as a part of
II. METHODS orthodontic treatment when a patient complains of
incompetent lips and proclined teeth?
A self-developed questionnaire was distributed to a. Yes
general dental practitioners and non-orthodontic specialists b. No
in the state of Karnataka through personal contact and e- 6. Does orthodontic treatment require extraction?
mail. The Ethical approval was obtained from the Ethical a. Yes
committee KVG dental college Sullia, Dakshina Kannada. b. No
To maintain the utmost confidentiality, the personal details c. May be, Sometimes
are not disclosed or circulated anywhere except for between 7. Do habits like mouth breathing or thumb-sucking
the researchers and so the names of the participants are not have an effect on the alignment of anterior teeth?
disclosed in the final report. The inclusion criteria included a. Yes
general practitioner dentists who have completed their b. No
bachelor degree and the Dental specialists other than the 8. Do you believe correcting the malocclusion
orthodontists in the state of Karnataka. Exclusion criteria influences healthy social living?
included dental practitioners who are not currently a. Yes
practicing anywhere. b. No
A sample size of 359 was taken using the following 9. Can orthodontic therapy be a part of management
formula of Temporomandibular disorders?
a. Yes
n= (Z1-α/2) 2 SD2 b. No
10. What is the time duration that retainers should be
d2 worn after orthodontic treatment?
a. 6 months
where, Sd= Standard Devation= 1.87 b. 12 months
c. 24 months
Z1-α/2 = 1.96 at 95% Confidence Interval d. Life long
11. Is orthodontic treatment recommended for patients
d = Absolute Error or Precision- 0.20, having periodontal problems?
Substitutingthe Values, We Get n = 335.75 a. Yes
b. No
To compensate for any possible errors’, the sample c. May be
size was increased to 359 12. Do you deny orthodontic treatment for patients
with missing molar?
The questionnaire survey included a total number of a. Yes
17 questions out of which 12 questions were formulated to b. No
study the knowledge and 5 questions were formulated to 13. Do you call specialist (orthodontist) for an opinion?
study the attitude towards orthodontic treatment principles a. Yes b. No
and practices. 14. Do you carry out diagnostic orthodontic
procedures?
Following were the components of the questionnaire a. Yes
1. What is the ideal period to start orthodontic b. No
treatment? 15. Do you tell your patients to come for orthodontic
a. Mixed dentition period treatment only after eruption of all permanent
b. Permanent dentition period teeth?
c. After all the 3rd Molars are erupted a. Yes
d. To assess the Growth period and treat b. No
accordingly 16. Do you always look for malocclusions on clinical
2. Can malocclusions be treated during mixed examination when patients report with any other
dentition stage? complaint?
a. Yes a. Yes
b. No b. No
3. Are you aware of functional therapy as a part of
Orthodontic treatment?
a. Yes
b. No

IJISRT22NOV174 www.ijisrt.com 413

Volume 7, Issue 11, November – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
17. Where do you refer a patient for orthognathic III. RESULTS
surgery?
a. Perform at own clinic The study included 359 participants and there were 17
b. Refer to dental college questions the results of the study is as follows.
c. Refer to medical college
d. Refer to multispeciality clinic When asked about ideal period to start orthodontic
e. According to patient’s convenience treatment 267(74.4%) answered as by assessing the growth
period and treat accordingly whereas 59 (16.4%) believed
during mixed dentition stage, 25thought during permanent
dentition stage and 8 participants thought after all 3rd molars
are erupted.

Fig. 1: Showing distribution of results for question 1

When asked about can we treat malocclusion during mixed dentition perio

316(88%) answered yes, we can and 43(12%) answered we cannot.

Fig. 2: Showing distribution of results for question 2

337(93.9%) were aware that functional therapy was part of orthodontic treatment 22(6.1%) were not aware of functional therapy.

Fig. 3: Showing distribution of results for question 3

IJISRT22NOV174 www.ijisrt.com 414

Volume 7, Issue 11, November – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
267 answered that functional appliances work best during peak of pubertal growth spurt whereas 71 believed during
prepubertal period 15 believed during post pubertal period and 6 participants believed that growth doesn’t matter.

Fig. 4: Showing distribution of results for question 4

338(94.2%) answered that they consider functional therapy as a part of orthodontic treatment when a patient complains of
incompetent lips and proclined teeth whereas 21 (5.8%) answered they won’t consider.

Fig. 5: Showing distribution of results for question 5

When asked about requirement of extraction during orthodontic treatment 312 (86.9%) answered sometimes its required
sometimes its not required, 32(8.9%) believed extraction is required and 15(4.2%) participants believed extraction is not required.

Fig. 6: Showing distribution of results for question 6

346(96.4%) answered mouth breathing or thumb-sucking have an effect on the alignment of anterior teeth whereas
remaining 13 marked that it has no effect

IJISRT22NOV174 www.ijisrt.com 415

Volume 7, Issue 11, November – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

Fig. 7: Showing distribution of results for question 7

321 believed that correcting the malocclusion influences healthy social living,

Fig. 8: Showing distribution of results for question 8

339 (94%) believed orthodontic therapy can be a part of management of Temporomandibular disorders

Fig. 9: Showing distribution of results for question 9

246 (68% ) thought that retainers should be worn for 12 months after orthodontic therapy, 52(15%) believed that it should
be worn for 6 months, 36(10%) believed it should be worn for 24 months only 25(7%) participants answered that it should be
worn for life long.

IJISRT22NOV174 www.ijisrt.com 416

Volume 7, Issue 11, November – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

Fig. 10: Showing distribution of results for question 10

208 (58%)believed that orthodontic treatment can be given in periodontally compromised patients, 80 (22.3%) believed
they cannot be treated whereas 71(20%) participants answered that they may be treated depending on the severity of
periodontal problem they are having.

Fig. 11: Showing distribution of results for question 11

309 (86%) answered that orthodontic treatment can be delivered even if the molars were missing, but 50 (14%) believed
that orthodontic treatment cannot be given if molars are missing.

Fig. 12: Showing distribution of results for question 12

343 (96%)considered calling an orthodontist for opinion, whereas remaining 4% participants dint bother to call an
orthodontist for opinion.

IJISRT22NOV174 www.ijisrt.com 417

Volume 7, Issue 11, November – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

Fig. 13: Showing distribution of results for question 13

311 (87%)answered that they carry out diagnostic orthodontic procedures,

Fig. 14 : Showing distribution of results for question 14

300 (84%) believed that orthodontic treatment can be started before the eruption of all permanent teeth whereas
remaining 59 (16%) believed that orthodontic treatment should be started only after all permanent teeth are erupted.

Fig. 15: Showing distribution of results for question 15

316 (88%)said that they will look for malocclusions even if the patient presented with some other chief complaint

IJISRT22NOV174 www.ijisrt.com 418

Volume 7, Issue 11, November – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

Fig. 16: Showing distribution of results for question 16

250 (70%) considered doing orthognathic surgery at patient’s convenience place, whereas 71 (20%) consider referring
patient to a dental college, 17 (5%) referred to a multispeciality clinic, 13(3.6%) referred to medical college and 8 (2%)
participants believed that they can do it at their own clinic.

Fig. 17: Showing distribution of results for question 17

IV. DISCUSSION 1716 participants in Saudi Arabia showed similar results of

knowledge and attitude amongst the general practitioner
Malocclusion is a common dental problem running at dentists and specialists.7Many other studies have also been
second number after the dental caries worldwide. 4 Dental done on the knowledge of key parameters of malocclusion
malocclusion can have a plethora of implications and the in many parts of the world.8,9 Many of these studies support
most common being on facial aesthetics. Many associated the fact that dental graduates do not have an ample
problems also include periodontal problems, difficulty in knowledge of basic malocclusion concept. 10 A unique study
mastication, speech, swallowing, TMJ problems, associated was done in Ireland in which a survey was done among the
habit development, etc.5 Many a times, patients come to the dental practitioners about the undergraduate orthodontic
dentists with one of the associated problems as the chief training that they have had and the extent to which they
complaint and at that time, it is imperative for the dentist to apply it in their practice. The results showed a 54% of
recognize the key cause and understand the need for positive response about the academic knowledge. About
orthodontic treatment.6The present study focuses on the 60% of them said they could handle orthodontic
knowledge of dental practitioners both general and non- emergencies. And 70% aspired to go for higher education in
orthodontic specialties towards the basic principles and this field.11The present study is just the first step towards a
practices of orthodontic treatment. Our study shows that bigger question. The end goal is to make sure the dental
there is better understanding about orthodontic basic graduates have enough knowledge so that a proper referral
principles and practices among the general dental of such cases can be made to an orthodontist in time.
practitioners and non -orthodontic specialists. But still there However, the limitation of this study is the geographic area
is a need to understand basic of orthodontics among many covered and the sample as it was a convenient sample. More
dentists who are lacking basic knowledge even to diagnose studies done in this niche would potentiate the findings and
an orthodontic problem.In a study done by Alnusayri on help in acquiring better evidence-based conclusion.

IJISRT22NOV174 www.ijisrt.com 419

Volume 7, Issue 11, November – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
V. CONCLUSIONS [9.] King GJ, McGorray SP, Wheeler TT, Dolce C,
Taylor M. Comparison of peer assessment ratings
This study showed that there is good knowledge and (PAR) from 1-phase and 2-phase treatments protocols
Attitude about Principles and Practices of Orthodontic of Class II malocclusion. Am J Orthod Dentofacial
Treatment among Dentists and Non-Orthodontic Specialists Orthop. 2003;123(5):489-96. [PubMed | Full Text |
in Karnataka. But still there is a need to understand basic of DOI]
orthodontics among many dentists who are lacking basic [10.] Koroluk LD, Tulloch JF, Phillips C. Incisor trauma
knowledge even to diagnose an orthodontic problem. and early treatment for Class II Division 1
However, there is a need to increase the knowledge about malocclusion. Am J Orthod Dentofacial Orthop.
few things like retention after orthodontic treatment and 2003;123(2):117-25. [PubMed | Full Text | DOI]
regarding the requirement of extraction for particular [11.] Fleming PS, Dowling PA. A survey of undergraduate
orthodontic treatment and hence there is a need for an orthodontic training and orthodontic practices by
increased clinically oriented education in the undergraduate general dental practitioners. J Ir Dent Assoc. 2005
courses and a multi-disciplinary inter department seminar Summer;51(2):68-72. [PubMed | Full Text]
presentations and forums set up for the post-graduation
courses for them to understand the scope of each other’s
specialties.

REFERENCES

[1.] Siddegowda R, Rani MS. An epidemiological survey

on awareness towards orthodontic treatment in South
Indian school children. Open J Dent Oral Med.
2013;1:5-8. [Full Text | DOI]
[2.] Sastri MR, Tanpure VR, Palagi FB, Shinde SK,
Ladhe K, Polepalle T. Study of the Knowledge and
Attitude about Principles and Practices of
Orthodontic Treatment among General Dental
Practitioners and Non-orthodontic Specialties. J Int
Oral Health. 2015;7(3):44–8. [PubMed]
[3.] Niveda S, Saravana D. A survey of the knowledge,
attitude and awareness of principles and practices in
orthodontics among general dentists and
nonorthodontic specialists. IOSR J Dent Med Sci.
2014;13(1):44–6. [Full Text]
[4.] Aldrees AM, Tashkandi NE, Al Wanis AA, Al
Sanouni MS, Al-Hamlan NH. Orthodontic treatment
and referral patterns: A survey of pediatric dentists,
general practitioners, and orthodontists. Saudi Dent J.
2015;27(1):30-9. [PubMed | DOI]
[5.] Dhanyasi AK, Mahobia Y, Agarwal APP, et al.
Orthodontic Treatment Provided by General Dentists
with Different Types of Appliances in Chattishgarh,
India. J Clin Diagn Res. 2015;9(6): ZC20–2.
[PubMed | Full Text | DOI]
[6.] Berk NW, Bush HD, Cavalier J, Kapur R, Studen-
Pavlovich D, Sciote J, et al. Perception of orthodontic
treatment need: opinion comparisons of orthodontists,
pediatric dentists, and general practitioners. J Orthod.
2002;29(4):287-91. [PubMed | Full Text | DOI]
[7.] Alnusayri MO, Alnezi KKK, Patil SR, Aeleni KR,
Rao KA. Knowledge and attitude regarding principles
and practices of orthodontic treatment among general
dental practitioners and nonorthodontic specialists of
Saudi Arabia: A preliminary study. J Res Med Dent
Sci. 2017;5(3):59-62. [Full Text | DOI]
[8.] Canavarro C. et al. Assessment of the orthodontic
knowledge demonstrated by dental school
undergraduates: recognizing the key features of
Angle Class II, Division 1 malocclusion. Dental Press
J Orthod. 2012 Jan-Feb;17(1):52.1-10. [Full Text
DOI]

IJISRT22NOV174 www.ijisrt.com 420