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ORIGINAL ARTICLE
Year : 2021  |  Volume : 19  |  Issue : 3  |  Page : 212-216

Learning local anesthetic techniques in dental college of Purvanchal Region, India: A cross-sectional questionnaire study


1 Department of Dentistry, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
2 Department of Public Health Dentistry, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Date of Submission26-May-2020
Date of Acceptance08-Jul-2020
Date of Web Publication15-Oct-2021

Correspondence Address:
Keshav Kumar
Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_167_21

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  Abstract 


Introduction: Dentistry deals with teeth and related oral structures. Most of the procedure require anesthesia to make it painless. Objective: The objective of this study was (1) Recording the most frequently used local anesthetic techniques in our dental colleges and (2) satisfaction rate of dental students toward their curriculum of learning local anesthesia. Finally, we also wanted to formulate a research hypothesis, i.e., will artificial models be able to restitute conventional ways of learning local anesthesia in dental colleges. Materials and Methods: Prevalidated questions from published articles were picked and using Google Forms, an online survey platform was prepared, students who were the part of the study were asked to mark their response. Out of 90 students, 74 replied to the questionnaire. Response rate was 82.22%. This study was conducted between April and June 2019. Results: The survey results show that inferior alveolar nerve block and greater palatine were used very frequently (75.7% and 58.1%), respectively. Whereas, papillary (interdental) injection (PI) rarely (43.2%) or never (24.3%) and mental/incisive nerve block rarely (31.1%) or never (10.8%). Fifty-eight percent reported to learn local anesthesia on patient. Two-third (67.6%) of students was satisfied with their routine way of learning local anesthesia. Conclusion: Our study infers that, inferior alveolar nerve block is very frequently used nerve block. PI is rarely or never used block. Maxillary infiltration is marked as easy technique and can be performed without getting additional training. Two-third of students are satisfied with the present dental curriculum while one third wants a change.

Keywords: Dental schools, ethics, human cadaver, infiltration, local anesthesia, preclinical, skill lab


How to cite this article:
Kumar K, Kumar P G. Learning local anesthetic techniques in dental college of Purvanchal Region, India: A cross-sectional questionnaire study. J Indian Assoc Public Health Dent 2021;19:212-6

How to cite this URL:
Kumar K, Kumar P G. Learning local anesthetic techniques in dental college of Purvanchal Region, India: A cross-sectional questionnaire study. J Indian Assoc Public Health Dent [serial online] 2021 [cited 2021 Dec 7];19:212-6. Available from: https://www.jiaphd.org/text.asp?2021/19/3/212/328268




  Introduction Top


Dentistry is a branch of medicine that consists of study, diagnosis, prevention and treatment of diseases, disorders and conditions of oral cavity, and related structures and tissues. In day to day life, one or the other dental procedures result into pain, in order to have painless dental procedures one of the commonly used agent is local anesthesia which is most often used before any dental treatment except few cases. In the current scenario, the administration of local anesthesia is among the most commonly utilized skills in dentistry. To prevent patients from experiencing discomfort during invasive procedures and the dentist be able to work calmly with concentration and precision, local anesthesia must be performed.[1] Therefore, teaching about anesthetics and correct technique to deliver anesthetic injection is given prime importance in curriculum of dental colleges along with other important skills.[2] Teaching of local anesthesia is a comprehensive and multidisciplinary part of the dental college curriculum. Various modes of instruction are used to provide dental students with relevant didactic training in anatomy, neuroscience, physiology, and pharmacology, in addition to instruction in pain and anxiety management.[3] Recent dental colleges graduates have reported that the methods used to teach local anesthesia were not enough for them to deliver their first local anesthesia injection confidently, and they expressed insecurity in their ability to correctly administer anaesthesia. However, despite the critical importance of local anesthesia, there has been limited research on local anesthesia education.[1] Numerous dental students feel less confident for their first injection in a human. Knowledge of anatomy and complications of anesthetics have been mentioned frequently as areas in which students feel insufficiently prepared.[2]

Current techniques used in local anesthesia education include student-to-student injection, use of anatomic models, textbook instruction, and lecture hall learning. Anatomic models for local anesthesia education may simulate the mandible, soft-tissue structures, or the entire head and can be equipped with sensors to provide feedback on the student's technique. Preclinical use of human cadavers has also been suggested as a teaching aid for injection technique, but ethical objections have been raised about the use of cadavers.[1] Electronic training models that indicate the accurate site of injection have been available for three decades, but in India, most of the dental colleges do not use these models for training undergraduate students.[2] The objective of this study was (1) Recording the most frequently used local anesthetic techniques in our dental colleges and (2) Satisfaction rate of dental students toward their curriculum of learning local anesthesia. Finally, we wanted to formulate the Research hypothesis, i.e. Will artificial models be able to restitute conventional ways of learning local anesthesia in dental colleges.


  Materials and Methods Top


Design of study

Cross-sectional questionnaire study.

Prevalidated questions were selected from Brand et al. article. All the questions in the previous study were included in the present study. A set of six survey questions were uploaded over Google Forms an online platform for recording survey data, to make it environment friendly. The appropriate approval was taken from Dean Faculty of Dental Sciences (Institute of Medical Sciences, Banaras Hindu University) for conducting questionnaire-based survey in college. Investigator sent the online designed survey tool to Professor in-charge of Public Health Dentistry, from his office the online survey questionnaire was circulated among 3rd year, final year, interns and postgraduates, those exposed to local anesthetic techniques. First year and second year undergraduate students were not included in the study as they are not exposed of local anesthesia administration techniques. A total of 90 students were suitably matching criteria for this study are chosen.

Question one of the survey asked about demographic details that is gender, year of study and whether they were undergraduate or postgraduate student. Question two asked respondents to rate the frequency of utilization of various local anesthetic injections in their daily practises. Question three asked: “assuming you are trained only in inferior alveolar nerve block, how difficult is it for you to perform subsequent injections without additional training?” This question was meant to determine whether the students can apply skills gained from one type of injection in other similar circumstances. Question two and three responses were based on five-point Likert scale. Question four asked whether the students are satisfied with the routine way of learning local anesthesia. Question five was asked to evaluate the preference for learning local anesthesia administration. This question was designed to know whether student want to learn local anesthesia administration on patients, on artificial models having integrated sensors or on their peer partners. Question six was to know the opinion of respondents about the value of obtaining consent and ethics of administering local anesthesia to another student for the sole purpose of training.

Data collected and tabulated in Excel Spreadsheet; the data were statistically analyzed using the software package International Business Machines Corp. (IBM) Statistical Package for the Social Science (SPSS) statistics Version 17 registered worldwide for Windows10. Frequency tables were used for summarizing responses. Nonparametric statistical test applied for the data analysis. The Chi square test was used to analyze the association between gender, year of study, various nerve blocks used, satisfaction rate to curriculum, consent, and preference to learning local anesthetic techniques. P ≤ 0.05 was considered as statistically significant. This study was conducted between April and June 2019.


  Results Top


Out of 90 students, 74 students replied to the questionnaire. Response rate was 82.22%. Of the respondents, 19 (25.67%) were Interns undergraduate student, 34 (45.94%) were final year undergraduate, 10 (13.51%) were third year undergraduate, and 11 (14.86%) were postgraduate students. In percentage calculation, only two digits after decimal is considered, thus making it 99.98% while total sum of students responded questionnaire is still 74. Surprisingly, there was equal participation of male and female students' 50% each. The respondents reported using inferior alveolar nerve block (IA) and greater palatine (GP) very frequently 75.7% and 58.1%, respectively, or often 18.9% and 31.1%, respectively, in everyday practice. They reported using PI rarely 43.2% or never 24.3% and using mental/incisive nerve block (MIN) rarely 31.1% or never 10.8% [Figure 1].
Figure 1: Frequency of use of various types of injection in daily practises as perceived by respondents

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Assuming administration of the IA block would be the only local anesthesia technique taught to the students, opinions regarding applying the cognitive and clinical skills learned in that procedure to other type of injections varied widely among the respondents. They reported that injection techniques such as GP or maxillary infiltration (MI) were easy (40.5% and 36.5%, respectively) or very easy (5.4% and 6.8%, respectively) to learn without any specific training. However, they considered posterior superior alveolar (PSA), nasopalatine (NP) nerve block and infraorbital (IO) difficult or very difficult to learn without any additional training. The respondents were neutral regarding the learning of techniques of MIN and papillary (interdental) injection (PI) [Figure 2].
Figure 2: Graph of respondents perceived difficulty in performing various types of injection without getting additional training beyond that for inferior alveolar nerve block

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In the answer toward the preference for learning local anesthesia administration, 58.1% respondents preferred to learn on the patient, 33.8% of respondents chose artificial models having integrated sensors, and 8.1% preferred to learn on student to student administration [Figure 3].
Figure 3: Pie chart showing respondents preference to learn local anesthesia administration

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Two-third (67.60%) of the respondents were satisfied with their current curriculum to teach local anesthesia administration, whereas one-third (32.40%) of the students were not satisfied with the existing curriculum [Figure 4].
Figure 4: Student satisfaction toward their existing curriculum to learn local anesthesia administration

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Of the respondents (97.3%) strongly agreed that prior to administering local anesthesia consent form should be must, while (2.7%) did not give importance to seeking consent prior to local anesthesia administration [Figure 5].
Figure 5: Importance of seeking consent prior to local anesthesia administration

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At this point, our survey results are bidirectional and not very affirmative to formulate a comprehensive hypothesis and we need further extensive surveys including more dental colleges to formulate appropriate hypothesis.


  Discussion Top


This survey was conducted to assess the various anesthetic techniques, satisfaction of dental students toward local anesthetic dental curriculum, and importance of seeking consent and ethics while learning local anesthesia administration techniques. Question one of the survey was about basic demographic information. Question two, frequency of utilization of various types of local anesthetic injection survey reflects that the inferior alveolar nerve block is very frequently used 75.7% and GP 58.1% in the present study. Survey done by university of California the inferior alveolar nerve block was reported as very frequently used with 88.2% which is connatural to our study except for percentage difference while the MI with 88.8% which is contradicting from our survey. This may signify that our respondents prefer block anesthesia despite local infiltration. On the other hand, in our study, the inferior alveolar nerve block and GP often used with 18.9% and 31.1%, respectively. Similar results were obtained in the University of California study but with percentage dipping.[1]

PI was rarely (43.2%) or never (24.3%) used and using MIN rarely (31.1%) or never (10.8%) while in University of California study result varies, that is IO nerve block rarely (34.2%) or never (44.7%) used and NP nerve block was rarely (32.9%) or never (12.5%) used. This result is contradicting from our study.[1]

Question Three was to assess the difficulty in performing various types of injection without getting additional training beyond that for inferior alveolar nerve block, in this study we observed that injection techniques such as GP or MI were easy (40.5% and 36.5%, respectively) or very easy (5.4% and 6.8%, respectively) to learn without any specific training, we found that injection techniques such as MI or PI were easy (37.5% and 32.9%, respectively) or very easy (36.2% and 30.3%, respectively). Above data infer that the MI is marked as easy technique and can be performed without getting additional training.

However, PSA, infraorbital (IO), and NP were difficult or very difficult to learn without any additional training. Dental college like University of California study indicated, the difficulty level of PSA, infraorbital (IO) were similar, but they reported GP as difficult or very difficult which is contradicting from our results.[1]

Question four was about satisfaction of students with their routine way of learning local anesthesia, for this question we found that in our survey two third (67.6%) of the students were satisfied with their routine way of learning still a considerable sum of students (32.4%) wanted change in their curriculum. However, we found that dental schools of Turkey reported 91% of the students were satisfied with their current local anesthetic curriculum, whereas 10% of them were planning a change in curriculum including preclinical training model.[4] Brand et al. Survey of European dental schools reported that 83% were satisfied with their local anesthetic curriculum; however, 43% are planning change to induct preclinical training models in a skill lab.[5] Preclinical use of human cadaver has been suggested as teaching method of local anesthesia which can teach point of insertion, depth and angle of injection, but no any European dental school use cadaver. Few European schools have preclinical training models.[5] A survey of dental schools of Pakistan reports that 50% of participants were satisfied with the quality of training models at undergraduate level while 30% were not satisfied.[6] We can clearly make out that none of two data is same which may indicate that there is difference in teaching methodology as well as the thinking pattern of humans. Survey result pointing that there is a need to revise the curriculum for teaching local anesthesia in dental colleges. Result may symbolize to address the most important aspect of local anesthesia which makes student less confident, i.e. Anatomy and complications of local anesthesia. There can be preclinical training session over artificial models having integrated sensors. This will help reduce the student anxiety over first local anesthesia administration.

Survey question five was for the choice over preference on ways of learning local anesthesia administration, 58.1% of students chose to learn over patient, 33.8% chose to learn over artificial model having integrated sensors, and 8.1% reported to learn over fellow dental students. However, in the United States, 97% of dental school students reported that initial injection are done on fellow students.[7] A study reports that dental students from UK, Ireland, Sweden, and Netherland learn their first injection on fellow students, whereas dental students from Italy, Slovenia, and Romania prefer their first injection on patient needing dental treatment.[7] A survey report figures that in Dental schools of Europe and Israel 61% students use first injection in a human or a fellow dental student.[5] Looking at the data from different countries our survey report result is contradicting, majority preferred to learn over patient needing dental treatment. The reason behind the variation is a subject for research which can be conducted and the result analysis will bring out a validated reason.

For question six, 97.3% of students agreed for taking consent and value ethics, when administering local anesthesia administration, but 2.7% disagreed for taking consent. However, study of university of California reports that 26.3% strongly agreed, 29.3% agreed, 22.4% were neutral, 11.8% disagreed, and 9.9% strongly disagreed.[3] We can see that our results have higher percentage of students agreeing over consenting for ethical clearance. This result may signify that the importance of ethical values is given prime importance during learning and patient treatment.

The results of the present study indicate that they were in opinion for conventional method of learning cannot be replaced by learning on artificial models. However, study on larger scale involving multiple dental colleges across the country would give better picture about this issue. In future, with the advancement in artificial models and college infrastructure, ways of learning local anesthesia may get modified. Artificial model may play a pivotal role in changing methodology of learning local anesthesia.

Our survey data have certain limitation as we were unable to consider other areas such as preclinical setup, workforce, instrument availability, treatment modalities, etc., for study. This study have limited data to comment on curriculum, secondly our survey was close ended gave less freedom to student for registering their opinion and suggestions. However, the local anesthesia teaching covers a vast area which is out of reach of this survey and this survey only focussed on the part of it. An elaborate study is needed over individual aspects part wise and the complete compilation of result will enable us to make a clearcut change or suggestions.


  Conclusion Top


However, this survey is unable to address the complete scenario of local anesthetic learning and teaching methodologies in Indian dental colleges, but this study has its own significance by illuminating the need to conduct such survey on larger scale in Indian dental colleges, as this is least touched topic and lack of available literature. Our study infers that, Inferior alveolar nerve block is very frequently used nerve Block. PI is rarely or never used block. MI is marked as easy technique and can be performed without getting additional training. Two-third of students are satisfied with the present dental curriculum while one third wants a change. There is room for research in this field for dental colleges to homogenise the dental teaching worldwide. This will remove the barrier of curriculum globally.

Acknowledgment

The author would like to thank dental school for giving permission to conduct survey, also grateful to the respondents for replying questionnaire.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kary AL, Gomez J, Raffaelli SD, Levine MH. Preclinical local anesthesia education in dental schools: A systematic review. J Dent Educ 2018;82:1059-64.  Back to cited text no. 1
    
2.
Brand HS, Baart JA, Maas NE, Bachet I. Effect of a training model in local anesthesia teaching. J Dent Educ 2010;74:876-9.  Back to cited text no. 2
    
3.
Hossaini M. Teaching local anesthesia in dental schools: Opinions about the student-to-student administration model. J Dent Educ 2011;75:1263-9.  Back to cited text no. 3
    
4.
Tomruk CÖ, Oktay İ, Sençift K. A survey of local anesthesia education in Turkish dental schools. J Dent Educ 2013;77:348-50.  Back to cited text no. 4
    
5.
Brand HS, Kuin D, Baart JA. A survey of local anaesthesia education in European dental schools. Eur J Dent Educ 2008;12:85-8.  Back to cited text no. 5
    
6.
Ashar A, Ataullah K, Raza AS, Javed I. Dentists' perceptions about practices, undergraduate training and training needs of local anesthesia. Pakistan Oral Dent J 2009;29:229-34.  Back to cited text no. 6
    
7.
Brand HS, Tan LL, van der Spek SJ, Baart JA. European dental students' opinions on their local anaesthesia education. Eur J Dent Educ 2011;15:47-52.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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