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ORIGINAL ARTICLE
Year : 2021  |  Volume : 19  |  Issue : 3  |  Page : 206-211

Management of extracted human teeth by dental students in East Coastal Region of India


1 Department of Public Health Dentistry, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
2 Department of Public Health Dentistry, Dr Syamala Reddy Dental College Hospital and Research Centre, Bengaluru, Karnataka, India

Date of Submission11-Jan-2021
Date of Decision01-Feb-2021
Date of Acceptance14-Sep-2021
Date of Web Publication15-Oct-2021

Correspondence Address:
Parveen Sultana Shaik
Department of Public Health Dentistry, Sibar Institute of Dental Sciences, Takkellapadu, Guntur - 522 509, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_1_21

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  Abstract 


Background: Dental students practice on extracted human teeth (EHT) in their preclinical to learn professional and technical skills before performing dental procedures on patients. Aim: The aim of the present investigation was to assess the management of EHT among dental students in the east coastal region of India. Materials and Methods: A cross-sectional study was conducted on II, III, and IV Bachelor of Dental Surgery (BDS) students from five dental colleges in India's east coastal region, which were chosen using the fishbowl technique. Data was collected using a pretested, validated self-administered questionnaire and analysed using the Chi-square test, Mann–Whitney test, Kruskal–Wallis test, and linear regression. Results: A total of 649 students participated from five dental colleges, among them, 43.6% (283) were II BDS, 29.6% (192) were III BDS, and 26.8% (174) were IV BDS. About 66% of the participants do not know that the EHT are a source of infection; 22% of them noted that there was an incidence of infection with the use of EHT; 81.5% do not know that guidelines have to be given by the regulatory body/institution to handle EHT. Only 2% of the people think it was necessary to disinfect/sterilize EHT before use, while 33% of the study population felt that there was a need to wear mouth masks and gloves while working on EHT. In the study group, only 43% know that formalin was used as a storage/disinfecting medium for EHT and 80% of them experienced hazards due to chemicals used for storage/disinfecting medium of EHT. Conclusion: The results of this investigation stipulated that awareness, attitude, and practices of undergraduate students in relation to the handling of EHT were poor. However, deficiencies were observed in relation to teaching the materials and methods suitable for the management of EHT which reveals the need to incorporate the guidelines in their curriculum.

Keywords: Awareness, dental student, disinfection extracted human teeth, dental, practice management


How to cite this article:
Shaik PS, Yaddanapalli SC, Ravoori S, Pachava S, Lodagala A, Pavani NP. Management of extracted human teeth by dental students in East Coastal Region of India. J Indian Assoc Public Health Dent 2021;19:206-11

How to cite this URL:
Shaik PS, Yaddanapalli SC, Ravoori S, Pachava S, Lodagala A, Pavani NP. Management of extracted human teeth by dental students in East Coastal Region of India. J Indian Assoc Public Health Dent [serial online] 2021 [cited 2021 Dec 7];19:206-11. Available from: https://www.jiaphd.org/text.asp?2021/19/3/206/328266




  Introduction Top


Unblemished extracted human teeth (EHT) are utilized by dental graduates to create and hone their clinical abilities for treating patients. EHT are utilized for different purposes, for instance, like preparing ground sections to study histology of teeth, for learning endodontic procedures such as cavity preparation and root canal treatment, for learning crown preparation, and to evaluate microleakage of the restorative material and marginal integrity in crown preparation techniques.[1]

Nowadays, typodont models are used as practical learning aids for dental students for dental students, permitting them to exercise certain dental procedures on the plastic teeth of a model before really playing out the systems on live patients. Working on the extracted teeth results in achieving the same tactile sensation as like operating on the live case scenario. In middle- and low-income nations like India where the per capita income is less, extricated human teeth serve a low spending substitute to typodont that permits the students to utilize them for training.[2]

Individuals handling EHT for preclinical training or clinical assignments must be conscious of the potential exposure to the blood-borne pathogens acquired from the extricated human teeth. Therefore, individuals who collect extracted teeth must decontaminate before using them. Various solutions have been used to store and transport extracted teeth. Of all the media, the most common ones are formalin, saline, hydrogen peroxide, and sodium hypochlorite. Since these liquids are easily available in dental clinics, they have become the obvious choice to store extracted teeth.[3]

The Occupational Safety and Health Administration Blood-borne Pathogens Standard considers human teeth used for research and teaching purposes as a potential source of blood-borne pathogens.[4] Since extracted teeth form a part of the human body before they are extracted, they are an obvious source of infection, and the Center for Disease Control (CDC) also recommends that the extracted teeth be treated as potential blood-borne pathogens. The CDC and prevention have adopted guidelines for infection control of extracted teeth used for research and teaching, requiring that teeth be sterilized before use, to minimize the risk of transmission of blood-borne pathogens.[5],[6]

While there are studies on the effectiveness of disinfectants, assessment of knowledge, attitude, and practice regarding the handling of extracted teeth among dental students are limited. Hence, this study was conceived with the intention to assess the knowledge, attitude, and practice regarding the handling of extracted teeth among the students of the dental colleges in the east coastal region of newly formed state of India.


  Materials and Methods Top


A cross-sectional study was carried out on the II, III, and IV bachelor of dental surgery (BDS) dental students among five dental colleges located in the east coastal region of Andhra Pradesh, India [Image 1]. There are 16 dental colleges in the state of Andhra Pradesh out of which 13 colleges are located in the east coast region where five colleges were selected randomly using the fishbowl technique.



A pretested, validated, self-administered questionnaire which was taken from the previous study was used to test the knowledge, attitudes, and practices of students regarding the handling of EHT.[3] Questionnaires were anonymous and filling the questionnaire was completely voluntary where consent was taken prior to the start of the study. The questionnaire was distributed and collected by a single investigator. The goal of the study was explained and students were left alone to fill the questionnaire. Ethical approval was obtained from the Institutional Review Board (IRB) with reference number 39/IRB/SIBAR/2019.

The questionnaire consisted of four sections, where the first section consists of demographic details and II, III, and IV sections include knowledge, attitude, and practice-based questions on the management of EHT.

Data were collected and statistically analyzed using Statistical Package for the Social Sciences (SPSS) version 25 (IBM, Chicago Inc., IL, USA). Descriptives, Chi-square test, Mann–Whitney test, Kruskal–Wallis test, and linear regression were done where P ≤ 0.05 was considered as statistically significant.


  Results Top


[Figure 1] shows the distribution of study participants in accordance to their academic year. Total study population were 649 students, among them 43.6% (283) were II BDS, 29.6% (192) were III BDS, and 26.8% (174) were IV BDS. [Table 1] describes all knowledge, attitude, and practices in handling of EHT. Most of the study participants (66%) do not know that the EHT are a source of infection. About 22% of the participants noted that there was an incidence of infections such as respiratory problems, eye and skin irritation was reported with the use of EHT for educational purpose. Almost 81.5% do not know that guidelines are necessary to be given by regulatory body/institution to handle EHT. Only 36% of the students are aware of guidelines by a regulatory body regarding the handling of EHT and only 2% of the people think it was necessary to disinfect/sterilize EHT before use. Nearly 33% of the study population felt that there was a need to wear mouth mask and gloves while working on EHT. In the study group, only 43% know that formalin was used as storage/disinfecting medium for EHT and 80% of them experienced hazards due to chemicals used for storage/disinfecting medium of EHT. Merely 11.5% of the participants referred to any published scientific literature regarding the use of an appropriate medium for storage/disinfection of EHT and 52.5% have noticed some changes in surface characteristics such as a change of color and surface texture of the EHT samples after storage in a disinfectant medium.
Figure 1: Distribution of participants according to their academic year

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Table 1: Perceptions of the individuals regarding handling of extracted human teeth

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[Figure 2] explains that majority of the students (56%) used hydrogen peroxide (56%) followed by usage of both formalin and H2O2 (11%), while 9% of them are using formalin as a storage medium to store EHT. [Table 2] depicts the knowledge and attitudes of dental students in handling EHT according to their academic year. Second BDS (60.3%) and IV BDS (88.5%) students reported that they do not know that the EHT as a source of infection, while III BDS (78.2%) students did not consider them as an infectious source (P = 0.001). Second BDS (67.2%) and IV BDS (95.3%) students have disclosed that they were not aware of any guidelines by a regulatory body regarding the handling of EHT (P = 0.001); similarly, they have also proclaimed that they do not know whether it is necessary to disinfect/sterilize extracted teeth before use (72.4% and 100%, respectively, P = 0.001). Almost all the students of II BDS, III BDS, and IV BDS opted red color disposal bag to dispose EHT (P = 0.42).
Figure 2: Usage of various storage medium for extracted human teeth by the dental students

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Table 2: Awareness on handling of extracted human teeth by the dental students according to their academic years

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The highest percentage of the students among all the 3 year use hydrogen peroxide to store EHT and it is statistically significant (P = 0.005) [Figure 3]. [Table 3] elucidates that the mean rank of knowledge was more for females (310.07), while the mean rank of attitude (312.11) and practice (319.25) in participants were higher in males. Statistically significant results are seen in attitude (P = 0.004) between genders, but there was no statistical significance in knowledge (P = 0.194) and practice (P = 0.208). The mean rank of knowledge was higher in III BDS students (356.39) when compared to II BDS (294.94) and IV BDS (339.26) (P = 0.001), where the mean rank of attitude was observed to be more in II BDS students (357.60) followed by IV BDS (324.40) and III BDS (227.50) (P = 0.001), and the mean rank of practice score was more in IV BDS (348.02) compared to III BDS (335.36) and II BDS (303.82) which was statistically significant (P = 0.032).
Figure 3: Choice of storage medium for extracted human teeth according to academic year of the participants

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Table 3: Mean rank comparison of knowledge, attitude, and practice scores according to student's gender and academic year

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Knowledge and practice scores in dealing with EHT increase as the academic year progresses (B = 0.181, P = 0.004 and B = 0.589, P = 0.004, respectively), but attitude score showed an inverse relationship (B = -0.213, P = 0.002) [Table 4].
Table 4: Simple linear regression between the academic year of the dental students and knowledge, attitude, and practice scores in handling of extracted human teeth

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  Discussion Top


Extracted teeth contain virulent microorganisms capable of causing diseases such as hepatitis B virus (HBV) and human immunodeficiency virus (HIV).[4],[7],[8] Even after the complete removal of saliva and blood, HBV might remain contagious up to 6 months, while under the similar conditions, HIV can remain infectious for 4–8 weeks.[7],[9] Since EHT may harbor potential pathogens, proper handling of EHT in the preclinical's is important for educators and the students.

Developed countries such as Australia and the UK have legislation to limit the usage of EHT for the purpose of educational use with the help of the patient/legal guardians written consent, whereas in India, we do not have such legislation and acts to abide, while EHT were used for the educational purpose by horning their clinical skills rather disposing in the clinical waste.[10]

In the present study, 66% of the study participants do not know that EHT are a source of infection which is lower when compared to the other studies done by Kumar et al.[11] (97%), Hashemipour et al.[12] (95%), Deogade et al.[13] (90.2%), and Amith et al.[14] (88%), whereas it was higher when compared to studies done by Omar OM et al.[15] (55.6%) and Sethi et al.[16] (57.4%). This could be due to the fact that usage and handling of EHT was considered as a conventional practice while they are easily accessible, affordable while there were no guidelines framed in the curriculum on the management and utilization of EHT.

In the current study, 81.5% do not know that guidelines are necessary by regulatory body/institution to handle EHT which is in contrast with the study done by Smitha et al.[3] (84.7%) and Sethi et al.[16] (83.3%), who reported that it is necessary to have guidelines by regulatory body/institution. In contrast to Smitha et al.[3] study, only a meager current study participants (36%) are aware of the guidelines on handling of EHT. (80.6%). In this study, 94% of the study participants do not know that it is necessary to disinfect the teeth which is in contrast with the studies done by Amith et al.[14] (93.2%), Deogade et al.[13] (91.5%), Smitha et al.[3] (90%), and Omar OM et al.[15] (87.9%) who reported that they know that it is necessary to disinfect the teeth.

About 56.5% of the current study participants do not know that there was a need to wear mouth masks and gloves while working on EHT where dissimilar results were observed in the studies done by Amith et al.[14] (90.7%), Deogade et al.[13] (95.3%), and Smitha et al.[3] (91.7%) which reveal that the study participants are had not kept themselves updated about the latest guidelines for safety. About 52.5% of the participants in the study have noticed some changes in surface characteristics after storing in the disinfectant medium, while similar results were found in the studies done by Smitha et al.[3] (42.7%) and Sethi et al.[16] (54.8%), this could be due to the fact that dentin hardness decreases as both organic and inorganic constituents are affected by the various disinfection methods.

Most of the study participants had used hydrogen peroxide (56%) and only 9% of them used formalin as a storage medium for EHT, comparable to the studies done by Amith et al.[14] (93.8%), Kumar[11] (81.7%), Deogade et al.[13] (57%), Smitha et al.[3] (42.2%), and Omar OM et al.[15] (18.8%). Despite the evidence demonstrated by numerous studies, students still use hydrogen peroxide because of its feasibility, availability, and cost-efficiency.

In the current study, 22% of them disclosed that they have experienced discomfort due to the usage of chemicals for storage/disinfection of EHT, whereas a higher percentage (61.1%) of them reported the same in the study done by Amith et al.[14] Exposure to EHT stored in formalin may cause irritation of the eyes, nose, and throat since they were absorbed through the epithelium due to the fact that tooth preserved in formalin releases toxic vapours that may cause local irritation, so when working with preserved EHT requires safety precautions such as wearing protective equipment and opening the container preserving EHT in a safe, well ventilated area.

Majority of the participants have disposed EHT in the red bin (66.1%) which was in contrast with the studies done by Omar OM et al.[15] (27.2%), Riswana[17] (10.9%), and Smitha et al.[3] (27.2%). Only 16% answered correctly that EHT have to be disposed in yellow color-coded bags which depicts a lack of knowledge among the dental students on disposal of EHT.

Almost 88.5% of the participants proclaimed that they have not referred to any published scientific literature regarding the use of an appropriate medium for storage/disinfection of EHT and similar results are observed in the studies done by Smitha et al.[3] (81.3%) and Omar OM et al.[15] (53.8%). As a source of knowledge, self-reading of articles and research papers was not so common in this sample community. This was demonstrated in their response and practice of using a suitable medium or procedure to sterilize/disinfect EHT. With this background, students need to be educated with the published literature. This often highlights incomplete knowledge in the dental curriculum on this subject that should be addressed in depth.


  Conclusion Top


Patient care is the very essence of what dentists do, and it is the way dental students truly learn to become dentists. The results of this investigation warranted that the awareness and knowledge of undergraduate dental students on the management of EHT were found to be deficient. However, proper teaching, training, and education are necessary to handle, storage, and practice of EHT for their educational purpose. The other safety measures such as the use of gloves, masks, and safety eyeglasses should be stressed while practicing preclinical work on these teeth. Incorporation of guidelines on disinfection, storage, usage, and disposal of EHT should be included in their curriculum.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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