This topic has not been submitted to any other academic institution or non-academic institution for any qualification. In the event that my dissertation be found to violate the conditions mentioned above, I voluntarily waive the right of conferment of my degree and agree be subjected to disciplinary rules and regulation of MAHSA University.
Acknowledgement
In the name of Allah, the most Merciful and the most Beneficent.
It is with the deepest senses gratitude of the almighty that gives strength and ability to complete this research thesis successfully. First and foremost, I would like to dedicate my sincere appreciation to my supervisor Ms Noreen Che Khalin. Thank you for the continuous support, constant encouragement, invaluable advice and immense knowledge. Her guidance helped me in all the time of research and writing this proposal. I would like to thank the head of department Madam Chan Lai Kuan for her unconditional support, advise and co-guidance. I wish to thank the lecturers of Medical Imaging Department, Mahsa University for motivation and advice in the process of writing this dissertation.
I would like to thank my loving family especially my parents, for their endless love, prayers, support, motivation and spiritually throughout my life. I will always make you proud. Last but certainly not least, my special thanks also extend to my beloved siblings and my friends for their continual support and encouragement. I offer my special thanks to all Dentistry students who took time off their busy schedule to participate in this survey. This research dissertation would not be possible without the help from all of them.
Abstract
Introduction: Dental radiography play an important role in the detection and management of oral diseases.
Although radiation exposure in dental setting is relatively low, it is one of most frequently undertaken radiographic procedures and also repeated several times during childhood and adolescence. Objectives: This research sought to assess the level of knowledge and radiation protection awareness on dental radiology among Mahsa University Final Year Dentistry Students. Methodology: A descriptive research design conducted by using convenience sampling. Total of 70 questionnaires was distributed to dentistry final year students of MAHSA University.
A few days period were given to the students to fill and return the questionnaires. The data collected was analyzed using SPSS version 23, Descriptive analysis were used to the obtain the results. Results: A response rate of 89.2% (n=65) was obtained. The study revealed that most of the students had moderate knowledge with the mean percentage score is 52.13% (M 0.5213) and standard deviation of 12.33 which reflect the knowledge of dental radiology.
In part of awareness, there is favourable results the mean percentage score is 50.10% (M 0.5010) and standard deviation of 9.968 towards radiation protection awareness of dental radiology Conclusion: A moderate knowledge of dental radiology and also inadequate knowledge about radiation protection awareness was found among Dentistry Final Year students in MAHSA University.
Introduction
Dental radiographs are important tools in the diagnosis of oral diseases. It helps the dentist to employ appropriate treatment regimen for patient’s dental conditions and plays a continual important role in dental practice. Radiation dosage from such dental radiographs are low and are thought to present minimal risk CITATION joa13 l 1033 (Enabulele & Igbinedion, 2013) The radiation protection is the science and art of protecting people and environment from the harmful effects of ionizing radiation. It is also described as all activities directed towards minimizing radiation exposure of patients and personnel during x-ray exposure CITATION ran15 l 1033 (Ahmed, Elamin, M, & Hassan, 2015) An evaluation study done by Somayyeh Azimi, (2016) stated that radiographic evaluation along with clinical examination is necessary for the diagnosis of lesions. Radiography can help clinicians to detect lesions such as primary tumors, before their clinical appearance, and is also used to evaluate the size and extension of lesions, in the development of treatment plans.
However, one of the major limitations of radiography is that it depends on the individual’s skills and ability in interpreting radiography consideration the responsibilities of dental students in providing community oral health, it is essential to be aware or radiographic interpretation of oral lesions.
Statement of Problem
This study is done to examine the level of knowledge regarding radiation protection awareness on Dental radiology among Final Year Dentistry Student in Mahsa University. According to Enabulele ; Igbinedion (2013) there is poor knowledge among dental students and dentists. The radiation protection knowledge and practice of dental radiography by dentists is consequently crucial. Unfortunately, proper radiation protection practice by dentists is inadequate.
Justification of Study
A study done by Awooda (2016) mention that dentists or dental students as health care providers are responsible for prescribing and exposing patients to dental radiographs. Since dental radiographic examination is widely used in dentistry, public health concern should be given to its hazardous effects. Therefore, they should be knowledgeable about x-ray exposure and be strictly following the ALARA principle as to protect the patient from any unnecessary radiation exposure that may lead to irreversible damage.
Research Questions
Does Mahsa University Final Year Dentistry Students have knowledge on Dental radiology? Does Mahsa University Final Year Dentistry Students aware regarding on radiation protection of Dental radiology? OBJECTIVES 1.4.1 MAIN OBJECTIVES To evaluate the level of knowledge and radiation protection awareness on Dental radiology among Mahsa University Final Year Dentistry Students. 1.4.2 GENERAL OBJECTIVES To assess the knowledge of Dental radiology among Mahsa University Final Year Dentistry Students. To assess the radiation protection awareness of Dental radiology among Mahsa University Final Year Dentistry Students.
Literature Review
Introduction
This chapter covers the theoretical background of the main areas of research the first section discusses the concept of dental radiology, the second presents the knowledge of dental radiology, while the last section discusses radiation protection awareness of dental radiology.
Dental Radiology
In dentistry, radiographs are very helpful in detecting oral diseases, cavities, bone related problems, treatment planning. And it should be clinically justified to obtain maximum benefit and reduce further effects. CITATION rou16 l 1033 (Awooda, 2016) Dental radiation is considered of small dose, however cumulative exposures may lead to irreversible damage, it is also an integral part of clinical dentistry.
As a result, radiographs are often referred as the clinician’s main diagnostic aid. Despite it carries a potential harm and the exposure to dental radiation should be minimized where practicable CITATION son16 l 1033 (Behal, 2016). An official document done by IADMFR (International Association of Dentomaxillofacial Radiology) Association (2007) stated that: it is widely accepted that dental practitioners and dental radiography operators should not carry out a diagnostic x-ray exposure without having adequate training. Dental practitioners and dental radiography operators should complete training, including theoretical knowledge and practical experience in: Radiation production, radiation protection and statutory obligations relating to ionizing radiation as a relevant to their functions as a practitioners or operator and; Diagnostic radiology as significant to the specific area of practice.
CLASS LICENSE UNDER ACT 304 FOR DENTAL PRACTITIONERS
According to obtain class license under the Atomic Energy Licensing Act (ACT 304) from the Ministry of Health Malaysia, stated that person who operates the apparatus should be: A qualified radiographer, full time or part time. An x-ray operator currently employed in the clinics & has trained in the orientation programme conducted by college of general practitioner’s society of Malaysia. He/she be restricted to procedures he/she has been trained to be; or A medical or dental practitioner.
Knowledge of Dental Radiology
According to survey done by de-Azevedo-Vaz, et.al, (2013) on dental undergraduate’s knowledge of dental radiology, the obtained results demonstrated that Third and Fourth-year students showed less knowledge of the interpretation domain. These students are closest to entering the professional field and this lower knowledge should concern the clinical practice because a thorough knowledge of various available radiographic modalities, their application and accurate interpretation of the images and obtained data is necessary for the ethical and efficient practice of dentistry.
An evaluation study done by S & A (2014) it shows that 5th year students have high percentage 73.9% of correct answers and possible explanation for this might be that they have been practicing three years on clinical field, so they obtained the fair amount of knowledge and experience of identifying the anatomical landmark such as maxillary sinus. In contrast, the 4th year students demonstrated that they have low percentage 63.6% than 5th year of correct answers although they have more experience in dental practicing than 3rd year. The errors in periapical radiographs can be categorized into the followings: x-ray equipment, the image receptor, processing the patient, the operator and the radiographic technique. The most frequent errors were processing errors (23.5%), cone cut (20.2%) & incorrect vertical angulation (15.1%). The processing errors revealed 9.6% in 4th year & 43.7% in 5th year.
A possible explanation for this might be a lack of adequate knowledge about the basic of processing. In addition, the 5th year students have a lot of clinical requirements to be finished. Therefore, they might attempt to finish the processing in hurry. On the other hand, crown not shown was found 0.8% in 5th year while 14.4% in 4th year. Therefore, it seems possible that these results are due to the 4th year students have less experience in radiographic practice CITATION Abd14 l 1033 (Almogbel, 2014) Aydin Ü, (20014) revealed incorrect angulation done by under graduate students was most frequent in the maxillary molar region followed by maxillary premolar, maxillary anterior regions.
Also, a study done by Almogbel, (2014) stated that same thing the incorrect vertical angulations were mostly detected in maxillary anterior (35.7%) followed mandibular premolar (27.8%) the possible explanation for high percentage at maxillary anterior is the anatomical angulation of jaw. A study done by Scott McNab, (2015) stated that contrary to predictions, graduate dentists scored significantly higher than undergraduate dentists in the identification of pathology on panoramic radiographs (PRs), as mean score shows 4.7/10 vs 3.5/10. The result may indicate an area of the undergraduate curriculum that requires additional attention. Even though there are no comparative studies that have directly examined the ability of students or graduate dentists to diagnose pathology on panoramic radiographs. According a study done by S.
Elangovan, (2016) that there is reduction of improper vertical angulation (39%), film position error (33.4%) and improper horizontal angulation (27.6%) in taking and processing errors. As compared among 4th year and 5th year students, it shows that 5th year students (37.3%) outperformed than 4th year (13.2%). This clearly indicates that experience reduces the error occurrence frequency among students. Whereby a study done by Patel JR, (1986) seems opposite about the study, as he stated that the incorrect film placement followed by incorrect vertical angulation and cone cutting were most common errors in paralleling technique.
Radiation Protection Awareness
Radiation protection is to provide an appropriate level of protection for humans without unduly limiting the beneficial actions giving rise to radiation exposure.
It is also to prevent the occurrence of harmful deterministic effects and to reduce the probability of occurrence of stochastic effect. (HORNER, 1994) As stated by Swapna, et al., (2017) that there are guiding principles in radiation protection. Firstly, the principle of justification, in making dental radiographs this principle obligates the dentist to do more good than harm. Secondly guiding rule is the principle of optimization, this principle holds that dentists should use every means to reduce unnecessary exposure to their patient and themselves. Thirdly the principle is dose limitation, dose limits are used for occupational and public exposures to ensure that no individual are exposed to unacceptably high dose. According to a study done by Enabulele & Igbinedion (2013) stated poor knowledge of meaning of ALARA principle was observed as only 17.9% of the students knew what the acronyms meant.
It can be deduced that these students who were unfamiliar with the term may not be able to apply the principle of ALARA in practice. Consequently, patients may receive unnecessary radiation dose if ALARA principle is not put into practice. Furthermore, none of the students knew the annual radiation dose limit for dentist. According to a study done by Reddy, Krishnan, Ramesh, Krishna, & Praveen, (2017) the percentage of dental students that always wore lead apron was 20% which is good increase compared to study carried out by Jacobs, Vanderstappen, & Gijbels, (2004) where by only 12% of dental students wore lead apron while operating an x-ray unit.
The reason for not wearing a lead apron among dental undergraduate students might be attributed to the non-availability of lead apron and increased weight of the apron CITATION son16 l 1033 (Behal, 2016) The American Dental Association (ADA) , American Board of Oral & Maxillofacial Radiology (ABOMR) & North Carolina Regulations for Protection against Radiation (NCAC) recommend dentists perform radiographic examinations using optimal radiographic techniques to achieve radiation safety & diagnostic image quality. ADA guidelines consider the dentist’s responsibility to follow the ” as low as reasonably achievable principle for radiographic practice (ALARA) prior to making the decision to obtain radiographic. Jayasilan, (2015) conducted a survey in 2015 to access th knowledge of undergraduate dental students on radiation protection: 44% of students are not aware of ALARA. It shows that students are not well aware of radiation and it’s harmful effects and have not been implementing the safety precautions in practice.
Poor knowledge of meaning of ALARA was observed, it can be deduced that these students who were unfamiliar with term may not be able to apply the principle of ALARA in practice. A study done by Byung-Do Lee, (2013) showed that only 21.7% of dentists draped lead apron or thyroid collar cover patients, to point that a relatively high percentage of dentists were unaware of potential of thyroid exposure. Considering every reasonable precaution should be taken to minimize radiation exposure, protective thyroid collars and aprons should be used whenever needed. As stated by R Jacobs, (2004) that the practitioner stands on average at 2.2m distance from the patient while taking radiographs, which seems to be a safe distance. However, there are strong variation with 8% of dentists holding the film inside the patient’s mouth, staying next to the patient. Most of these dentists (88%) do not wear lead apron, so there are risks of both primary radiation to dentist’s finger and secondary radiation caused by patient’s body.
Research Methology
Introduction
This chapter presents overview of the method used in this study, which is presents an overview of method used in this study include study design, study location, research instruments, ethical considerations, data collection and data analysis. 3.2 RESEARCH DESIGN In this study the descriptive research design was used to present and describes the correlation between the level of knowledge with radiation protection awareness on Dental radiology. Based on Helen L. Dulock, (1993) the research design is a plan specifically created to answer the research question and to control variance.
Overall this research is quantitative research, which involves 2 parts of questions. 3.3 RESEARCH LOCATION The research was focused on a single centre and it was conducted in the dentistry department of Mahsa University. Mahsa University is one of the biggest private university in Malaysia for Medical and Allied Health Sciences. This study was designed to collect and analyze data to determine the level of knowledge and radiation protection awareness on dental radiology among Mahsa University Final Year Dentistry Students.
3.4 RESEARCH SAMPLE3.4.1 SAMPLE SIZE Study sample were obtained from all Final Year Dentistry students and included a total of 70 students in Mahsa University. A sample of about 65 responded to participate to this study. 3.4.2 INCLUSION CRITERIA Final Year students who have been experienced clinical practicing. 3.4.3 EXCLUSION CRITERIA Students from year 1st to year 4th Dentists and the radiographers who are working in MAHSA dental clinic. 3.5 RESEARCH INSTRUMENT 3.5.1 QUESTIONNAIRE The structured questionnaire used in this study was adapted from an instrument validated in another study by de-Azevedo-Vaz, et al., (2013).
The questionnaire consisted of two parts, where the first part will be questions focused on demographic characteristics of dental students which includes gender and age. The second part was divided into three constructs that measured the knowledge and radiation awareness of dental radiology. The first part of second section is about the general principles of dental radiography, second part describes about the technique/interpretation of dental radiography and the last part describes of radioprotection of dental radiography. The questionnaire consists of 23 questions which were answered by respondents. The answer were recorded on four-point Likert-style scale which consisted of the following ranked from 1-5 respectively: strongly disagree, disagree, neutral, agree and strongly agree.
The questions to asses the level of knowledge and radiation protection awareness on dental radiology were conducted by author. The author were emailed to seek permission. A copy of email is attached in the appendices section of this thesis. 3.5.2 PILOT STUDY The questionnaire use for this research, were validated through pilot study. The questionnaire was reviewed by the researcher ‘supervisor. This was done to ensure the questions were easy to understand and significant to measure objectives of the research.
This pilot study was conducted by using 5 of dental fifth year students, from this study validity and quality were justified. Pilot study is a small-scale preliminary study that is helpful in process of designing and executing a large-scale research project CITATION Mub10 l 1033 (Mubashir Arain, 2010) The Cronbach’s alpha of 0.808 were obtained, the Cronbach’s alpha achieved for the 5 items are tabulated below; Reliability Statistics Cronbach’s Alpha No of Items .804 10 Table 3.1: Cronbach’s Alpha for 5 items 3.6 ETHICAL CONSIDERATION This research study is associate with Mahsa university. The research was approved by the Faculty of Health & Sports Science Research Review Committee (FRCC), Mahsa University. All the data collected from this study were used solely for this dissertation and access to the data were only given to the researcher, as well as the Research Review Committee. Moreover, the data were reported in a collective manner with no reference to an individual thus the confidentiality of participant were ensured throughout this research study.
The participants for this research were given an information sheet and informed consent sheet to obtain the consent. The participant has full right to accept or to decline to be part of the study and as for better understanding for the participant to answer the questions. A sample of the information sheet and consent sheet is attached in the appendices section of this paper. Throughout the study confidentiality of participant was protected, the data collected was used for this research only. The primary data obtained was for the duration of research and only was accessible to the researcher and FRCC of MAHSA University. The data was destroyed once the research was completed.
DATA COLLECTION
The questionnaire which relates the knowledge and awareness radiation protection in Dental radiography among Dentistry Final Year Students were distributed among students. The main objective of the research was explained to the students and informed consent was acquired from each participant before participation. A few days period were given to the students to fill and return the questionnaires. Then the data will be analyzed in descriptive statistics including frequency distribution were used to evaluate the knowledge and awareness radiation protection on dental radiography.
DATA ANALYSIS
The data collect will be analyzed be using the Statistical Package for Social Sciences (SPSS). Data will be analyzed through Descriptive statistic in the form of frequencies and percentages to identify the responses of Final Year Dentistry students towards the Likert scale statements which were regarding their knowledge of Dental radiology and radiation protection awareness on Dental radiology.
SUMMARY
1524000121285 Determine sample size 00 Determine sample size center10414000 center6350Ethical approval from MAHSA Faculty of Health & Sports Science Research Review 00Ethical approval from MAHSA Faculty of Health & Sports Science Research Review 288607522733000 center129540Distribute the questionnaire 00Distribute the questionnaire 287655024574400 center138430Data collection 00Data collection center21717000 center138430Analyzed data using IBM SPSS version 23.0 00Analyzed data using IBM SPSS version 23.0 Figure 3.1: summary of research methodology work flow
CHAPTER
RESULTS
Introduction
This chapter presents results and their interpretation which are based on the self-assessment questionnaire distributed among Dentistry students in MAHSA University, Kuala Lumpur. The data are analysed by Statistical Package for Social Science (SPSS Version 23.0 IBM, New York, NY USA) which involve the use of descriptive analysis to describe the final results. 4.2 Response Rate A total of 70 questionnaire were distributed to Final Year Dentistry Students of MAHSA University. 65 of questionnaire were returned after few days, whereby 5 students don’t want to answer the questionnaire. The non-response rate are of significance as it can affect the sample size. 4.3 Participants’ Demographic Information Table 4.1: Demographic characteristic details of Final Year Dentistry Students in MAHSA University (n=65).
Demographic Characteristic Details of Final Year Dentistry Students (n=65) Responses Variable Frequency Percentage (N) (%) Gender Female 41 63.0% Male 24 36.9% Age <20 0 0% 20-25 60 92.3% 25-28 5 7.7% Table 4.1 shows the demographic characteristic details for gender, age by Final Year Dentistry Students in MAHSA University. Based on the Table 4.1, about 41 (63%) female students and 24 (36.9%) male students had taken part in this research study. In terms of age, respondents between the ages 20-25 years old were the majority participants in the study with 60 (92.3%) respondents followed by those age between 25-28 years old with 5 (7.7%) respondents. 4.4 General principal of Dental Radiography Table 4.2: General Principal of Dental Radiography (n=65) Items 74295222250Strongly disagree 00Strongly disagree 144145327025Disagree 00Disagree 26670327025Neutral 00Neutral 70485326390Agree 00Agree 57150327025Strongly agree 00Strongly agree N (%) During examination, the x-ray operator must protect himself from the reflected rays. 0 20(30.8%) 5(7.7%) 15(23.1%) 25(38.5%) The x-ray machine must be turned off when not in use in order to avoid inadequate x-ray emission. 0 5(7.7%) 10(15.4%) 37(56.9%) 13(20.0%) It takes 5 seconds after an exposure for scatter radiation to dissipated.
0 20(40.0%) 23(35.4%) 10(15.4%) 6(9.2%) It is not possible to generate x-rays without power supply. 0 2(3.1%) 5(7.7%) 31(47.7%) 27(41.5%) The room must be immediately isolated if x-ray tube is broken. 1(1.5%) 5(7.7%) 40(61.5%) 11(16.5%) 8(12.3%) The first question was about the x-ray operator must protect himself from reflected rays during examination. From the result above, 20 (30.8%) students out of 65 disagreed about protecting themselves from reflected rays. While 5 (7.7%) students were chosen neutral, the remaining students 15 (23.11%) responded the scale of 4 which was agreed whereas 25 (38.5%) students responded the scale of 5 which they were strongly agreed about protecting themselves from reflected rays.
The mean score among Final Year Dentistry students is 3.69 along with SD of 1.274. Table 4.2 based on question two from the questionnaire, which is regarding inadequate x-ray emission. Among the 65 participants 5 (7.7%) students disagree to turn off the x-ray machine when not in use to avoid inadequate x-ray emission; 10 (15.7%) students were neutral while 37 (56.9%) students were agreeing to turn off the machine when not in use. With the remaining students, 13 of them which is 20.0% were strongly agreeing to turned off the x-ray machine when not in use to avoid inadequate x-ray emission.
The means score is 3.89. The SD for this question is .812. Majority of participants, 26 (40.0%) students were disagreed that it takes 5 seconds after an exposure for scatter radiation to dissipated. in the meantime, 23 (35.4%) out of 65 students were chosen neutral while 10 (15.4%) students were agreed. As the remaining students, 6 (9.2%) students were strongly agreed. The mean score of this question is 2.94 and the SD for question three in questionnaire was .966.
Based on the results obtained from question four concerning to generate x-rays without power supply is not possible, 2 (3.1%) students were disagreed, 5(7.7%) students were neutral, 31 (47.7%) students were agreed and finally 27 (41.5%) students were strongly agreed that it is not possible to generate x-rays without power supply. The mean is 4.28 and with a .740 SD. Table above shows regarding question five that 1 (1.5%) students were strongly disagreed, another 5 (7.7%) students were disagreed, 40 (61.5%) students were neutral, 11 (16.9%) were agreed with another 8 (12.3%) students was strongly agreed about isolating the room if x-ray tube is broken. The mean score of this question is 3.31 along with SD of .846.
Technique/Interpretation of Dental Radiography
Table 4.3: Technique/Interpretation of dental radiography (n=65) Items 172720149225Strongly disagree 00Strongly disagree 95885802640Disagree 00Disagree 965201050290Neutral 00Neutral 77470907415Agree 00Agree 48895631190Strongly agree 00Strongly agree N (%) Bite-wing radiographs are indicated to investigate dental decay. 0 2(3.1%) 0 43(66.2%) 20(30.8%) Occlusal radiographs are indicated to investigate Bucco-lingual bone expansion. 1(1.5%) 1(1.5%) 1(1.5%) 32(49.2%) 30(46.2%) Panoramic radiographs are indicated to investigate incipient caries lesion. 29(44.6%) 31(47.7%) 4(6.2%) 0 1(1.5%) A full- mouth series (FMX) is indicated if many teeth are absent during physical examination. 9(13.8%) 26(40.0%) 20(30.8%) 8(12.3%) 2(3.1%) An unerupted superior left-canine had dislocated coincidently with the x-ray tube in the Clark method. Therefore, it is localized in a palatal position.
0 1(1.5%) 34(52.3%) 20(30.8%) 10(15.4%) An elliptical radioluscence in the apex of vital lower pre-molars with intact lamina dura probably refers to the mentual foreman. 0 1(1.5%) 5(7.7%) 30(46.2%) 29(44.6%) A diffuse radiolucency in the mandibular body, apically to lower molars, may indicate an aggressive lesion. 0 27(41.5%) 12(18.5%) 23(35.4%) 3(4.6%) Multilocular ameloblastoma has a ground-glass appearance. 6(9.2%) 13(20.0%) 34(52.3%) 7(10.8%) 5(7.7%) Tooth displacement and bone expansion are typical of malignant lesions.
5(7.7%) 18(27.7%) 10(15.4%) 25(38.5%) 7(10.8%) Based on table 4.3, Technique/Interpretation of dental radiography regarding first question from questionnaire about bite wing radiographs are indicated to investigate dental decay. Among these 65 dentistry students who participate in this research, a student 2 (3.1%) disagreed, whereby most of students 43 (66.2%) students were agreed and also 20 (30.8%) students was strongly agreed. The mean and SD of this question is 4.25 & .613. Based on the results obtained from question two shows 1 (1.5%) student choose strongly disagree, 1 (1.5%) student choose disagree and also 1 (1.5%) student choose neutral, while 32 (49.2%) agreed and lastly 30 (46.2%) students were strongly agreed that occlusal radiographs are indicated to investigate Bucco-lingual bone expansion.
The mean is 4.37. The SD for this question is .741. The third question was on dentistry students in panoramic radiographs are indicated to investigate incipient caries lesion. From the results above, 29 (44.6%) students of 65 strongly disagreed and also 31 (47.7%) students were disagreed. While 4 (6.2%) were chosen neutral. The remaining students, 1 (1.5%) responded the scale of 5 which was strongly agreed.
The mean score among Dentistry students is 1.66 along with SD of .735. Among these 65 Dentistry Final Year students who participate in this research, a student 9 (13.8%) were strongly agreed that a full-mouth series is indicated if many teeth are absent. 26 (40.0%) of the participants were also disagreed and 20 (30.8%) were chosen neutral. However, there were also a number of participants, approximately 8 (12.3%) students were agreed and 2 (3.1%) students was strongly agreed, the mean for this question is 2.51 and the SD is .986. Based on question five about an unerupted superior left-canine had dislocated coincidently with x-ray tube in the Clark method.
Most of respondent, 34 (52.3%) were chosen neutral, only 1 (1.5%) respondent choose disagree while 20 (30.8%) respondents were agreed and 10 (15.4%) were strongly agreed. The mean is 3.60 and SD is .766. Majority of participants, 30 (46.2%) students were agreed that an elliptical radioluscence in the apex of vital lower pre-molar with intact lamina dura, 1 (1.5%) out of 65 students was choose disagree while 5 (7.7%) students were neutral. As for the last 29 students (44.6%) were strongly agreed. The mean and SD for this question six in the questionnaire is 4.34 and .691.
According to question seven in questionnaire regarding Technique of dental radiography, most of respondents, 27 (41.5%) respondents were disagreed while 12 (18.5%) respondents were chosen neutral. 23 (35.4%) respondents were agreed and 3 (4.6%) respondents were strongly agreed that a diffuse radiolucency in mandibular body, apically to lower molars may indicate an aggressive lesion. The mean is 3.03 and with a .984 SD. Based on the results obtained question eight concerning multilocular ameloblastoma has aground glass appearance, 6 (9.2%) students were strongly disagreed, 13 (20.0%) students were disagreed while most of students 34 (52.3%) were chosen neutral, 7 (10.8%) students were agreed and lastly 5 (7.7%) students strongly agreed, the mean of this question is 2.88 with .992 SD. Most of respondents, 25 (31.5%) students were agreed that tooth displacement and bone expansion are typical of malignant lesions, 5 (7.7%) out of 65 students were strongly disagreed and 18 (27.7%) students were disagreed while 10 (15.4%) were chosen neutral. 7 (10.8%) students responded the scale of 5 which they were strongly agreed.
The mean score among Final Year Dentistry students is 3.17 along with SD of 1.18. 4.6 Radiation Protection of Dental Radiography Table 4.4: Radiation Protection of Dental Radiography (n=65) Items 207645215900Strongly disagree 00Strongly disagree 121920802640Disagree 00Disagree 552451049655Neutral 00Neutral 83820907415Agree 00Agree 64770631190Strongly agree 00Strongly agree N (%) Radiographic examination in pregnant women must be performed only in the second trimester of pregnancy in order to reduce the chance of harmful. 2(3.1%) 3(4.6%) 6(9.2%) 44(67.7%) 10(15.4%) Protecting gonads from radiation is not necessary, because dental radiographs are taken in the head and neck region. 4(6.2%) 8(12.3%) 5(7.7%) 37(56.9%) 11(16.9%) All human tissues have the same radio sensitivity. 15(23.1%) 46(70,8%) 0 3(4.6%) 1(1.5%) X-ray operators have minimal chance of somatic effects if they correctly adopt the radioprotection rules.
0 1(1.5%) 34(52.3%) 25(38.5%) 5(7.7%) Barriers like lead walls are mandatory to ensure adequate protection for the operator. 1(1.5%) 15(23.1%) 15(23.1%) 10(15.4%) 24(36.9%) An adequate maintenance of the x-ray machine results in better productivity, and protection for both operator and patient. 0 1(1.5%) 35(53.8%) 11(16.9%) 18(27.7%) Parents should hold films in children’s mouth if they do not cooperate during examination. 7(10.8%) 7(10.8%) 12(18.5%) 17(26.2%) 22(33.8%) Based on table 4.4, Radiation protection of dental radiography, majority of respondent 44 (67.7%) were agreed that radiographic examination in pregnant women must be performed only in second trimester of pregnancy to reduce the chance of harmful, 10 (15.4%) of respondents were strongly agreed while 6 (9.2%) of respondents were chosen neutral.
However, the remaining respondents 3 (4.6%) of respondents were disagreed and also 2 (3.1%) of respondents were strongly disagreed. The mean of this question is 3.88 with along .839 of SD. Based on these results regarding protecting gonads from radiation is not necessary, because dental radiographs are taken in head and neck region. Majority of students 44 (67.7%) were agreed and also 11 (16.9%) students were strongly while 5 (7.7%) students were chosen neutral, 8 (12.3%) students were disagreed, 4 (6.2%) was strongly disagreed. The mean is 3.66 and SD is 1.092. According to results in the above, relating question three in questionnaire discussing about radiation protection.
Majority of students 46 (70.8%) were chosen disagree that all human tissues have same radio sensitivity and also 15 (23.1%) students were strongly disagreed. The remaining students, 3 (4.6%) responded the scale of 4 which was agree and 1 (1.5%) responded the scale of 5 which was strongly agree. The mean of this question is 1.91 and SD is .744. 52.3% of participants (34 students) had chosen neutral that x-ray operators have minimal chance of somatic effects if they correctly adopt the radioprotection rules, 38.5% (25 students) were agreed and also 7.7% (5 students) were strongly agreed. In this result, only 1.5% (1 student) was totally disagreed in chance of somatic effects. Majority of participants 24 (36.0%) students were strongly agreed that barriers like lead walls are mandatory to ensure adequate protection for the operator.
In the meantime, 10 (15.4%) out of 65 students were agreed while 15 (23,1%) students were chosen neutral. As for last 16 students 15 (23.1%) of them were disagreed and another 1 (1.5%) were strongly disagreed, the mean is 3.63 with a long SD of 1.245. 53.8% of participants (35 students) were chosen neutral that an adequate maintenance of x-ray machine results in better productivity and protection for both operator and patient, 27.7% (18 students) were strongly agreed and also 16.9% (11 students) were agreed. Only 1.5% (1 student) were disagreed.
The mean of this question is 3.71 and SD of .897. Finally, majority of the respondents 22 (33.8%) students were strongly agreed that parents should hold films in children’s mouth if do not cooperate during examination and also 12 (18.5%) students were agreed, whilst 12 (18.5%) were chosen neutral. The remaining students 7 (10.8%) responded scale of 2 which was disagree and 7 (10.8%) students responded scale of 1 which was disagree. The mean was 3.62 and the SD was 1.343. In conclusion, the current study findings revealed that most of the students had moderate knowledge with the mean percentage score is 52.13% (M 0.5213) and standard deviation of 12.33 which reflect the knowledge of dental radiology.
In part of awareness, there is favourable results the mean percentage score is 50.10% (M 0.5010) and standard deviation of 9.968 towards radiation protection awareness of dental radiology.
DISCUSSION 5.1 INTRODUCTION
This research study is conducted to evaluate the level of knowledge and radiation protection awareness on Dental Radiology among MAHSA University Final Year Dentistry students, the results that was analyzed in chapter four will be further interpreted in this chapter. Therefore, in this chapter the results of the study was discussed in relation to the objectives and some comparisons were regarding with similar studies conducted in various places.
INTERPRETATION ON PARTICIPANTS’ DEMOGRAPHIC INFORMATION
This study includes 63% of female students and 36.9% male students, whereby female students are more than male students.
Among these 65 participants, majority of students age ranged from 20 to 25 years old. 5.3 KNOWLEDGE OF DENTAL RADIOLOGY While assessing the knowledge, the participants were asked whether they think that during examination the x-ray operator must protect himself from the reflected rays. Slightly more than half 61.6% of respondents agreed that x-ray operator must protect himself from reflected rays and a good number 30.8% of respondents disagreed and thought they don’t have to protect themselves from reflected rays, these result shows overall positive knowledge towards research. In comparison with Swapna, et al., (2017) showed that majority of students had the knowledge of harmful effects of dental radiation and they agreed that utmost care should be taken while handling diagnostic imaging in dental setup in which some of students agreed that x-ray cannot be reflected.
According a survey done by Brown, S (2017) stated that as the length of time a tech that being exposed increase, the dose received increases in direct proportion. The further a person is from the source the less the radiation source is, when the distance from the source is doubled the intensity at the new distance is only ¼ the original intensity. Majority of participants, 40% students were disagreed that it takes 5 seconds after an exposure for scatter radiation to dissipated. In the meantime, 35.4% of respondents took a neutral position they neither agree nor disagree. Surprisingly, a significant minority 24.6% of respondents portrayed positive respond.
The study done by Byung-Do Lee, (2013) showed that bitewing radiography is well known for high detectability of interproximal caries and is also useful for evaluating the periodontal condition and dental decay. According the results of his research showed 60% of respondents were aware of value and recommended frequency of bitewing radiographs. The majority of the students in this research 66.2% who participate in this study showed that they have knowledge of the use of bitewing radiographs. The results of this study shows that only 47.7% of respondents know that panoramic radiographs are not indicated to investigate incipient caries lesion, this shows that the knowledge gap about panoramic radiographs. Several research were done regarding panoramic radiographs use and there was evidence that the panoramic radiograph is not an effective method of approximal caries diagnosis and lesions located in anterior teeth are poorly demonstrated on panoramic films Molander B, (1993) the panoramic radiographs has been shown to be inferior to periapical and bitewing radiographs in the detection of approximal caries. (Horner, 1996) When considering localization, a palatal position, most of students 40.0% has no idea using the Clark method.
But the fact is the proper localization of unerupted canine plays a crucial role, it can help to recognize the tooth displacement in mixed dentition to prevent subsequent impaction. This statement was emphasized by the author Surubhi kumar, (2015) from the result of this research study, dentistry final year students 52.3% were uncertain about it, which seems they have moderate knowledge when it comes localization of palatal position. Ameloblastoma are benign epithelial neoplasms and represent about 10% of odontogenic tumors. Robert J. Scholl, (1999) ameloblastoma can vary in their radiographic appearance, some appear as well defined, unilocular, well-corticated, lucent lesion and also multilocular with internal septa and a honey comb appearance, V.J.
( 1990) a satisfactory number (52.3%) of the respondents answered neutral on the question about multilocular ameloblastoma has aground-glass appearance, whereby only 20% of respondents answered disagree. Similarly, only 48.5% of informants were agreed on the question that asked about “tooth displacement and bone expansion are typical of malignant lesion”. Jin-hyeok lee, (2014) as lesions grow, large lesions may cause cortical bone expansion, loss of bony continuity bone and root resorption of tooth. The fact that cortical bone expansion and loss of bony continuity are greater in odontogenic kerotocyst. This means that more than half of the respondents don’t know the main idea about odontogenic cystic lesions.
These results may have arisen the technique/interpretation domain needs to be reinforced throughout the course. As de-Azevedo-Vaz, et.al, (2013) concluded in the study regarding undergraduates’ knowledge of oral radiology as he; suggested that an active learner centered methodology be introduced in evaluated school in order to improve students.
RADIATION PROTECTION AWARENESS OF DENTAL RADIOLOGY
Participants’ knowledge on radiation protection awareness was general assessed. This was to determine the level of knowledge of Dentistry Final year students in MAHSA University, based on the findings in this study, majority of the students 74% were agreed on question about protecting gonads from radiation is not necessary because dental radiographs are taken in the head and neck region. This study is in consistent with a study conducted by Tsapaki, (2017 ) in Greece where 50.3% of students agreed that protecting gonads from radiation is not necessary, while 20.7% were uncertain about it. As the European guidelines report that there is no need to apply gonadal shielding and also UK guidance notes state that routine use of lead aprons in dental radiography is not justified.
Based on Seckinger, (1997) explanation about the biological effects and said that; during past decade scientific knowledge of somatic effects of radiation has increased substantially and it is now evident that certain transient somatic effects can be induced by relatively low doses of radiation; an evaluation study done by Silverstrim KJ, (2015) about knowledge of dental students stated that most of students were moderately have knowledge about radioprotection rules, thus chances of getting somatic effects. This study result show that half 52.3% of students were chosen neutral position regards the question of the minimal chance of somatic effect that x-ray operators can get if they correctly adopt the radioprotective rules. This shows that the students has moderate knowledge about somatic effects. I?lgu¨y, & Bay?rl?, (2005) carried out a study to determine the knowledge of dentists and dental students on radiation protection and quality of dental radiographic and they found that a considerable number of dental students in Turkey had knowledge of protective barriers and about 36%–60% acknowledged that the lead walls are essential to ensure adequate protection for the operator.
In this research study, most of students (52.4%) agreed that barriers like lead walls are mandatory to ensure adequate protection for the operator. Lead walls are protective barriers because they are designed to protect individuals located outside the x-ray rooms from unwanted radiation. The findings in this research study revealed that 53.8% of the students were unsure that an adequate maintenance of machine results in better protection and productive for both operator and patient. Conversely, 44.7% of the student were on the opinion that the adequate maintenance of x-ray machine results better productivity and protection. Similar to the present study Sutton D G,( 2012) found a significant number of students (37.8%) were unsure about adequate maintenance of x-ray machine. According to Kavita Madan, (2015) young children usually experience difficulty while taking a radiograph.
In such cases, it becomes necessary to take parental help in which the parent is asked to hold film or to hold both the child as well as the film. Majority of the students 60% who participate in this study agreed that parents should hold films in children’s mouth if they do not cooperate during examination.
LIMITATION OF STUDY
The study had several limitations rising due to the constraints, this research study was only done in MAHSA University and convenience sampling was used. Apart from this, another limitation that was considered during the study was the respondents might not honestly answer the questions and it may affects the finding and result of the research study.
CONCLUSION AND RECOMMENDATION
CONCLUSION
Dental Radiology is the specialty of dentistry and discipline of radiology concerned with production and interpretation of images and data produced by all modalities of radiant energy that are used for the diagnosis.
As a dental student who would eventually work in dental clinics are required to own a phenomenal knowledge and radiation protection awareness of dental radiology. This is because a dental practitioner are knowledgeable, clinically and technically competent, handling a variety of dental needs and also uses radiographs more often than any other health professionals. The aim of this research was to evaluate the level of knowledge and radiation protection awareness on dental radiology among MAHSA University Final Year Dentistry students. This study was across sectional and qualitative study conducted by using convenience sampling. Total of 70 questionnaires was distributed to dentistry final year students of MAHSA University during June 2018.
With an overall response rate of 89.2% the data collected was analyzed using SPSS version 23, Descriptive analysis were used to the obtain the results. Based on the result obtained, the majority of the respondents have moderate knowledge of dental radiology and also inadequate knowledge about radiation protection awareness, although they have been educated recently. Considering the responsibilities of dental students in providing oral health, it is essential to be acknowledgeable about dental radiology, as they are going to be future health professionals.
RECOMMENDATION
It is important for dentistry students to be knowledgeable about the dental radiology and to have a good radiation protection awareness in order to treat the patients effectively.
Therefore, based on findings of the study, it is suggested the following recommendation to be done. There is a need for students to be updated regularly with relevant dental radiology knowledge. After graduation dental students must update their knowledge by attending meetings and reading dental journals, receiving undergraduate radiological education is no guarantee of a lifetime’s professional competence. Since knowledge and education have strong direct effects on dentists. There is a need for students to improve their knowledge around radiation protection awareness and update them through growing their expertise. They as practitioners should remain informed about safety updates and the availability of new equipment’s and techniques that could further improve the diagnostic quality of radiograph and decrease radiation exposure as a radiation can cause cancer to patient.
More researches should be conduct in this field; besides that, this research can also be done in larger population.
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APPENDIX A 80654-109713MAHSA UNIVERSITY BE MORE Ref: MAHSA/FHSS+RRC/18(8) 27 April 2018 Student Researcher Name: HANA AHMED HASSAN Department of Medical Imaging, Faculty of Health & Sport Sciences Dear Student, Research proposal review (Ref no: FAHS/MI/18/UG08) Title: A Study on Dental Radiology Knowledge and Radiation Protection Awareness among Final Year Dentistry Students. The abovementioned project has been reviewed by the Faculty of Health & Sport Sciences Research Review Committee, MAHSA University (FRRC) on 9 March 2018. I am pleased to inform you that your project has been approved by the FRRCD 1161419787152623936810174378Since your research is approved, you may proceed with your research as planned in your research proposal. Assoc, Prof. Chan SOOÄ Dean, Faculty of Health & Sport Sciences Cc: Ms. Noreen Che Khalin Project Supervisor APPENDIX B Participant Information Sheet Study title: A Study on Dental Radiology Knowledge and Radiation Protection Awareness among Final Year Dentistry Students. Name of the Principal Investigator: Hana Ahmed Hassan Hand Phone Number: 0146317479 E-mail: [email protected] What is the study about? To evaluate the level of knowledge and radiation protection awareness on Dental radiology among Mahsa University Final Year Dentistry Students. Who is eligible to participate in this study? All Final Year Dentistry Students in Mahsa University. Place of research study: Faculty of Dentistry of Mahsa University. What will be the role of participants in this study? If you agree to take part in this study, you are required to fill up a questionnaire provided by the researcher. The participant will be required to answer questions on socio-demographic information, general principles dental radiography, technique/interpretation of dental radiography and radioprotection of dental radiography. Is there risk or side effect? There will be no risk or side effect. What benefit does this study provide? The questionnaire used in this study provide valuable information in evaluate the level of knowledge and radiation protection awareness on Dental radiology among Mahsa University Final Year Dentistry Students. The finding of this study will help final year dental students whom are going to be future dentists, to help them understanding importance of knowledge and radiation protection awareness on dental radiology. What will the data be used for? All data collected from this study will be analyzed and reported only for this thesis purposes. Access to the data is only given to the researcher and the Faculty of Health & Sports Science Research Review Committee of Mahsa University (FRRC). The data will be reported in a collective manner with no reference to any participants. Confidentiality of each participant will be protected throughout the course of the study. What will happen if I agree now and withdraw later from the study? Please note that this participation is of voluntary base. Therefore, by responding to the questionnaire, you acknowledge the purpose of this study. Participants are free to withdraw from the study at any time. Participants are in no way forced nor will any information or actions be held against them. All information and answer will be ensured of anonymity. Thank You APPENDIX C Consent Form Study title: A Study on Dental Radiology Knowledge and Radiation Protection Awareness among Final Year Dentistry Students. Name of the Principal Investigator: Hana Ahmed Hassan Please tick the box, if you agree with the statements given below: I have read and understood the information sheet provided by the researcher for this study. I have had the opportunity to ask questions about this study and these have been answered to my satisfaction. I understand that my participation is voluntary and that I can notify the examiner in writing and free to withdraw from the study at any point of time without my legal rights being affected. I understand that relevant sections of any of my medical notes and data collected during the study will be kept confidential and will only be used for the purpose of this study. I give my written consent to take part in this study. (If you haven’t ticked any of the boxes above, please do not sign this form) ……………………………………………………………………………… Name of the Participant Name of the Investigator Date: Date: APPENDIX D QUESTIONNAIRE The following questionnaire is based on the questions from de-Azevedo-Vaz, et al., (2013). Thank you for time PART 1: Background introduction This section of questionnaire seeks information about you. Please tick the box ?which you feel is appropriate: Gender: Male ? Female ? Age: ?<20 ?20 – 25 ? 25 – 28 PART 2: General principal, Technique/Interpretation and Radiation protection of dental radiography please indicate the extent of you agree or disagree with each statement by tricking the number on the scale that most closely corresponds to your opinion. Please tick one response for each statement. 1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree please indicate the extent of you agree or disagree with each statement by tricking the number on the scale that most closely corresponds to your opinion. Please tick one response for each statement. 1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree PART 2: A: General principal of dental radiography Strongly disagree (1) Disagree (2) Neutral (3) Agree (4) Strongly agree (5) 1. During examination, the x-ray operator must protect himself from the reflected rays. 2. The x-ray machine must be turned off when not in use in order to avoid inadequate x-ray emission. 3. It takes 5 seconds after an exposure for scatter radiation to dissipated. 4. It is not possible to generate x-rays without power supply. 5. The room must be immediately isolated if x-ray tube is broken. PART 2: B: Technique/Interpretation of dental radiography Strongly disagree (1) Disagree (2) Neutral (3) Agree (4) Strongly agree (5) 1. Bite-wing radiographs are indicated to investigate dental decay. 2. Occlusal radiographs are indicated to investigate Bucco-lingual bone expansion. 3. Panoramic radiographs are indicated to investigate incipient caries lesion. 4. A full- mouth series (FMX) is indicated if many teeth are absent during physical examination. 5. An unerupted superior left-canine had dislocated coincidently with the x-ray tube in the Clark method. Therefore, it is localized in a palatal position. 6. An elliptical radioluscence in the apex of vital lower pre-molars with intact lamina dura probably refers to the mentual foreman. 7. A diffuse radiolucency in the mandibular body, apically to lower molars, may indicate an aggressive lesion. 8. Multilocular ameloblastoma has a ground-glass appearance. 9. Tooth displacement and bone expansion are typical of malignant lesions. PART 2: C: Radiation protection of dental radiography Strongly disagree (1) Disagree (2) Neutral (3) Agree (4) Strongly agree (5) 1. Radiographic examination in pregnant women must be performed only in the second trimester of pregnancy in order to reduce the chance of harmful. 2. Protecting gonads from radiation is not necessary, because dental radiographs are taken in the head and neck region. 3. All human tissues have the same radio sensitivity. 4. X-ray operators have minimal chance of somatic effects if they correctly adopt the radioprotection rules. 5. Barriers like lead walls are mandatory to ensure adequate protection for the operator. 6. An adequate maintenance of the x-ray machine results in better productivity, and protection for both operator and patient. 7. Parents should hold films in children’s mouth if they do not cooperate during examination. APPENDIX E FACULTY OF ALLIED HEALTH SCIENCE DEPARTMENT OF MEDICAL IMAGING STUDENT SUPERVISOR’S PROGRESS REPORT FORM Name of Student: Hana Ahmed Hassan Student ID No.: BMI14091713 Program Code: RSP 2730 Name of Supervisor: MS Noreen Che Khalin Title of Thesis: A Study on Dental Radiology Knowledge and Radiation Protection among MAHSA University Final Year Dentistry students RECORDS OF SUPERVISORY MEETINGS MEETING DATE STUDENT SUPERVISOR PROGRESS REPORT COMMENT SIGNATURE 14/03/18 Rephrase Title rephrase questionnaire need to be revised 15/03/18 Discussion on research methodology Need to added pilot study 23/03/18 Questionnaire discussion Questionnaire to be corrected 28/03/18 Discussion on questionnaire and literature review Elaborate more on first three chapters 28/05/18 Discussion on the literature review Organize the arrangement of thesis content 12/06/18 Checking chapter 2 Please complete the chapter 1-3 30/06/18 Discussion on questionnaire Discussion on design of chapter 4 11/07/18 Discussion on results Need to do some corrections 16/07/18 Checking on chapter 4 discussion more on chapter 4 19/07/18 Discussion on chapter 5 Checking chapter 4-5 20/07/18 Discussion on conclusion Discussion overall the thesis APPENDIX F
