Turkish Pediatricians’ Competence Concerning Children’s Oral and Dental HealthABSTRACT
Objective: To assess Turkish pediatricians' knowledge, perceptions, and educational levels regarding oral and dental health, particularly in light of the high prevalence of dental caries among children.
Material and Methods: A cross-sectional study involved 323 practicing Turkish pediatricians utilizing Google Forms for data collection between December 2021 and November 2023. A structured questionnaire examined sociodemographic and clinical characteristics and employed scales to evaluate pediatricians' knowledge, attitudes, and self-perceptions concerning childhood oral health.
Results: The study included 323 pediatrician participants, with a mean age of 37.15 ± 7.92 years, with a majority being female (65%). Academic staff demonstrated superior knowledge, positive attitudes, and higher self-perception scores than research assistants and specialists. Significant correlations were observed between age and years of service with attitudes and self-perceptions, while knowledge scores showed no such correlations. Pediatricians without formal dental education exhibited lower attitude and self-perception scores related to oral health.
Conclusion: The study emphasizes the critical need for targeted education to enhance Turkish pediatricians' grasp of oral health. Strengthening their knowledge and attitudes is essential to advancing dental care, improving children's outcomes, and addressing dental caries effectively.
Keywords:
Pediatricians; Oral Health; Health Education, Dental; Knowledge
Introduction
Oral and dental health in children is a crucial aspect of pediatric healthcare, with significant implications for overall well-being and quality of life. Pediatricians play a central role in promoting and safeguarding children's oral health through their knowledge, perceptions, and educational practices [1-7]. Understanding the oral health needs of children is essential due to the potential long-term impact on their physical, psychological, and social development. Poor oral health in childhood can lead to various adverse outcomes, including dental caries, periodontal diseases, malocclusion, and impaired growth and development. Furthermore, oral health problems in children are associated with pain, discomfort, difficulty eating and speaking, and diminished self-esteem and quality of life [8]. As primary healthcare providers for children, pediatricians are ideally positioned to address oral health issues and promote preventive measures early on. However, the extent of their knowledge, perceptions, and educational preparedness regarding oral and dental health in children may vary, influencing their ability to manage and prevent oral health problems effectively [6,9].
Pediatricians' knowledge of oral and dental health encompasses various aspects, including the etiology, epidemiology, prevention, diagnosis, and management of oral diseases in children. It involves understanding the role of diet, oral hygiene practices, fluoride exposure, and socioeconomic determinants in oral health outcomes. Additionally, pediatricians must know the importance of early dental visits, anticipatory guidance, and timely referral to dental specialists for comprehensive care [1-7].
Perceptions refer to pediatricians' attitudes, beliefs, and opinions regarding oral and dental health in children. These perceptions may influence their priorities, practices, and communication with patients and families regarding oral health promotion and disease prevention. Positive perceptions can lead to proactive engagement in oral health promotion activities, whereas negative perceptions or misconceptions may hinder effective intervention and collaboration with dental professionals [1,8].
Educational levels encompass the formal training, continuing education, and professional development opportunities available to pediatricians regarding oral and dental health. Pediatric residency programs and medical school curricula may vary in the extent of oral health education provided, leading to differences in knowledge and preparedness among pediatricians. Furthermore, ongoing education through conferences, workshops, and online resources can enhance pediatricians' competence and confidence in addressing oral health issues [6,8].
The current study aims to explore Turkish Pediatricians' knowledge, perception, and educational levels regarding oral and dental health, considering the introductory context and the high prevalence of dental caries (tooth decay) in both primary and permanent teeth.
Material and Methods
Study Design, Participants, and Ethical Clearance
The population for this cross-sectional study included all practicing pediatricians in Turkey, irrespective of age or gender. Ethical approval was obtained from the Clinical Research Ethics Committee of Bursa Uludag University, Faculty of Medicine (Date: 30/09/2020; Approval No.: 2020-17/11).
Sampling
In determining the sample size for this study, an expected information adequacy rate of 50% and an acceptable margin of error of 6% were considered based on a total estimated population of 10,000 pediatricians in the country. Using Epi Info Version 7.2.5.0 software for population surveys, a sample size of 260 was calculated to achieve a 95% confidence level. To accommodate a potential 20% rate of missing or incorrectly filled responses, the minimum number of pediatricians included in the study was set at 312. Anticipating a 50% response rate, 624 pediatricians were invited to participate. The pediatricians were selected based on convenience sampling, with exclusion criteria applied to foreign national pediatricians.
Questionnaire Design
Explanations regarding the questions asked in the study and the scales were as follows:
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Socio-demographic and clinical variables: Age, gender, professional status (Research Assistant, Specialist, or Academic staff), years of practice, current workplace setting (State Hospital, Private Hospital/Consulting Room, University Hospital), medical specialization (Ministry of Health or University), presence of a dentist in their current workplace, attendance at any courses or educational programs, and regular provision of information about oral and dental health to their patients.
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Knowledge assessment questionnaire: Ozkaya et al. [10] devised a questionnaire to assess pediatricians' knowledge of childhood oral health, comprising ten items. Response options included "True," "False," and "I do not know." The evaluation involved calculating the total number of correct responses, with a higher score indicating a better level of knowledge among pediatricians regarding oral health in childhood.
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Seven-point semantic differential scale for attitude: Pediatricians' attitudes toward oral health in childhood were assessed using a seven-point semantic differential scale comprising eight attributes: costly to the pediatrician - beneficial to the pediatrician, useless to society - beneficial to society, not prestigious - prestigious, not necessary - necessary, difficult - simple, inefficient - efficient, unscientific - scientific, and worthless - valuable. Scores on the seven-point semantic differential scale ranged from 8 to 56, with a higher score indicating a more positive attitude toward oral health in childhood [11].
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Self-perception level scale: The scale comprised five items developed by the authors to assess pediatricians' self-perception levels regarding oral-dental health [10]. It utilized a 5-point Likert scale, with scores ranging from 0 to 20 points (0: Not competent; 1: Little competent; 2: Somewhat competent; 3: Competent; 4: Very competent). A higher score on this scale indicated a more positive self-perception level in oral-dental health.
Data Collection
Data were collected online using the Google Forms platform between December 2020 and November 2023. The initial section of the form began with an informative statement explaining that participation in the questionnaire was voluntary. It also assured participants that the collected data would be used solely for research purposes and would not be shared with other individuals or institutions. After reviewing this information, the questionnaire included a "yes/no" button to confirm participants' consent to the study. Pediatricians who selected "yes" completed the questionnaire and answered the questions.
Statistical Analysis
Data normality was assessed using the Shapiro-Wilk test. Results are presented as mean and standard deviation, median (25th-75th percentile), or frequency and percentage. Non-normally distributed data were analyzed using the Kruskal-Wallis and Mann-Whitney U tests. Multiple comparisons were conducted using the Bonferroni test. Categorical variables were compared using Pearson’s chi-square test or Fisher’s exact test as appropriate. Pearson correlation coefficients were used to examine correlations between variables, with partial correlation coefficients used to assess independent correlations after controlling for years in service. A significance level of p < 0.05 was applied. Statistical analyses were performed using IBM SPSS Version 28.0 (IBM Corp., Armonk, NY, USA).
Results
The study included 323 pediatrician participants, with a mean age of 37.15 ± 7.92 years. Two-thirds of the participants were female (65%). Among them, 21.4% were research assistants and 13.3% were academic staff. Table 1 summarizes the current workplace settings (State Hospital, Private Hospital/Consulting Room, University Hospital), medical specialization (Ministry of Health or University), presence of a dentist in their current workplace, and responses related to "tooth development, dental caries, and oral care..." and "routine information about oral and dental health patients" provided by pediatricians. No significant correlation was found between pediatricians' age or years of service and their scores on oral health knowledge (p > 0.05).
We examined the bivariate relationship between pediatricians' age, years in service, and scales. There was no statistically significant correlation between age (r=0.035; p=0.532), years of service (r=0.105; p=0.061), and knowledge scores. However, we observed a weak positive correlation between age and both attitude (r=0.209; p<0.001) and self-perception (r=0.233; p<0.001) scales. Similarly, we found a significant but very weak correlation between years of service and attitude (r=0.186; p<0.001) and self-perception (r=0.218; p<0.001) scales.
No statistically significant differences were observed in knowledge, attitude, and self-perception scales based on gender (Table 2). However, all three scores showed statistical significance in staff comparison. In terms of knowledge scores, academic staff scored higher than specialists (Figure 1). Similarly, for attitude scores, academic staff scored higher than other staff categories (Figure 2). As for the self-perception scale, there was a significant difference among the three groups, with academic staff obtaining the highest score and research assistants the lowest (Figure 3).
Violin plots illustrating the knowledge scale for staff. The curved edges represent the volume distribution within the sample, while the box plots display the median and interquartile ranges.
Violin plots illustrating the attitude scale for staff. The curved edges represent the volume distribution within the sample, while the box plots display the median and interquartile ranges.
Violin plots illustrating the self-perception scale for staff. The curved edges represent the volume distribution within the sample, while the box plots display the median and interquartile ranges.
No statistically significant differences were observed when comparing the scores based on pediatricians' current institution and medical specialization conditions. However, the self-perception scale showed significance when comparing the scores to the responses regarding tooth development, dental caries, and oral care (p<0.001). In contrast, the other scores did not exhibit significance.
Pediatricians who responded with "I got no course/education, etc." had lower scores than others. When examining pediatricians' responses regarding routine information about oral and dental health patients, no difference was found in knowledge scores (p=0.166). However, there was a statistically significant difference in attitude (p<0.001) and self-perception scale (p<0.001). Those who answered with "I direct them to the dentist" had lower attitude scores than those who responded with "I give it without complaint/I give it without asking the patient."
Those who provided their answers were found to have higher scores. Concerning the self-perception scale, it was determined that the scores of individuals who responded with "I direct him/her to the dental specialist" were lower than those of others. Regarding attitude scores, respondents who chose "I direct them to the dentist" had lower scores than those who answered with "I give it without complaint/I give it without asking the patient." The self-perception scale revealed that individuals who opted for "I direct him/her to the dentist" had lower scores than others.
We examined the partial relationship between scores while controlling for years of service. The correlation between knowledge and self-perception scores (r = 0.272; p < 0.001) was identified as weakly positive, while the remaining correlations were statistically insignificant (Table 3).
Discussion
The study's sample size of 323 pediatricians provides a substantial dataset for analysis. However, the gender distribution imbalance, with two-thirds female, might introduce a potential bias in the findings. Research suggests that gender disparities exist in various aspects of healthcare, including attitudes, knowledge, and practices among healthcare providers. For instance, a study by Lim et al. [12] found that female healthcare providers tend to have higher levels of empathy and patient-centered communication than males. Therefore, further investigation into how gender influences pediatricians' attitudes and practices regarding oral and dental health could provide valuable insights.
The mean age of 37.15±7.92 years indicates that the sample comprises a relatively young to middle-aged group of pediatricians. This demographic characteristic may influence their experience level and exposure to continuing oral and dental health education. Pereira [13] emphasized the importance of continuing education in dental care for healthcare providers to improve patient outcomes. Therefore, it would be beneficial to explore how age and years of service correlate with pediatricians' knowledge and attitudes toward oral and dental health, as this could inform targeted educational interventions.
Regarding the distribution of pediatricians across different positions, the majority being specialists (65.3%), aligns with the hierarchical structure of healthcare systems. However, the relatively low percentage of academic staff (13.3%) raises questions about the involvement of educational institutions in oral health education and research. Clark et al. [14] emphasized the role of academic institutions in promoting oral health literacy among healthcare providers through interdisciplinary collaborations and curriculum development. Therefore, future research could explore the impact of academic affiliations on pediatricians' oral health knowledge and practices.
The lack of statistically significant correlation between age, years of service, and knowledge scores suggests that chronological age and professional experience may not directly influence pediatricians' knowledge of oral and dental health. However, the weak positive correlations between age and both attitude and self-perception scales, as well as between years of service and attitude and self-perception scales, indicate that there may be some association between these demographic factors and pediatricians' attitudes and self-perceived competence in oral and dental health. Recent research corroborates these findings to some extent in a study by Chala et al. [15] that explored the oral health knowledge, attitudes, and practices (KAP) of primary healthcare providers, including pediatricians, in low- and middle-income countries. While the study did not specifically examine the correlation between age or years of service and KAP scores, it found that attitudes toward oral health significantly influenced providers' practices, highlighting the importance of attitudes in shaping healthcare behaviors.
Another study investigated pediatric healthcare providers' oral health knowledge, attitudes, and practices in Saudi Arabia [16]. Although this study did not directly examine the correlation between age, years of service, and KAP scores, it found that attitudes toward oral health significantly influenced providers' knowledge and practices, underscoring the interplay between attitudes and professional behaviors.
The observed weak positive correlations between age, years of service, attitude, and self-perception scales in your study may be attributed to several factors. For instance, as healthcare providers gain more experience over time, they may develop more positive attitudes toward oral health due to increased exposure to oral health education and patient encounters. Additionally, older pediatricians or those with more years of service may perceive themselves as more competent in oral health due to accumulated experience and ongoing professional development activities.
However, the observed statistical significance in staff comparison suggests that differences in professional roles and responsibilities may influence pediatricians' knowledge, attitudes, and self-perceived competence in oral and dental health. This finding is consistent with existing literature highlighting the impact of professional experience and academic affiliation on healthcare providers' oral health knowledge and practices. For instance, a study by Yimenu et al. [17] explored the oral health knowledge and practices of healthcare professionals in community health centers and found that those with more years of experience and higher academic qualifications demonstrated better knowledge and confidence in providing oral healthcare services.
The higher knowledge and attitude scores among academic staff compared to specialists and other staff categories in the present study could be attributed to their involvement in teaching and research activities, which may enhance their exposure to oral health education and training opportunities. Similarly, the lower self-perception scores among research assistants may reflect their perceived lack of experience or confidence in providing oral health care services compared to academic staff and specialists.
The lack of statistically significant differences in scores based on current institution and medical specialization conditions suggests that these factors may not directly influence pediatricians' oral health knowledge, attitudes, and self-perception. However, the significance observed in the self-perception scale when comparing responses related to tooth development, dental caries, and oral care implies that pediatricians' perceptions of their competence in these specific areas vary significantly based on their responses. This finding aligns with existing literature on healthcare providers' self-perceived competence and its impact on patient care outcomes. A study by Elmanaseer et al. [18] explored the self-perceived competence of dental students in performing various dental procedures and found that their confidence levels varied depending on the procedure's complexity and training level. Furthermore, it was found that the self-perceived competence of medical students in providing oral health care and their confidence levels were influenced by their exposure to oral health education and training.
The significance observed in the self-perception scale, but not in knowledge and attitude scores, may reflect the subjective nature of self-perceived competence and its potential impact on healthcare providers' behaviors and practices. For instance, pediatricians who perceive themselves as less competent in addressing tooth development, dental caries, and oral care may be less likely to engage in preventive measures or refer patients to dental specialists, potentially impacting patient outcomes.
The findings regarding the influence of course or education attendance and responses regarding routine information about oral and dental health patients on pediatricians' scores underscore the importance of continuing education and the impact of attitudes on healthcare practices. The lower scores observed among pediatricians who reported not attending any courses or education sessions align with previous research highlighting the positive correlation between continuing education and healthcare providers' knowledge and competence in oral health. Nash et al. [19] investigated the impact of oral health education programs on healthcare professionals' knowledge, attitudes, and practices. They found that such programs significantly improved participants' knowledge and attitudes toward oral health.
Furthermore, the significant differences in attitude and self-perception scores based on responses regarding routine information about oral and dental health patients suggest that attitudes toward patient care play a crucial role in pediatricians' perceptions of their competence and effectiveness in managing oral health issues. This finding is consistent with previous research demonstrating the influence of healthcare providers' attitudes on patient outcomes and satisfaction levels. Gaffar et al. [20] explored the association between healthcare providers' attitudes towards preventive oral health care and patient satisfaction. They found that positive attitudes were strongly correlated with higher patient satisfaction levels. The lower attitude scores observed among pediatricians who responded with "I direct them to the dentist" compared to those who answered with "I give it without complaint/I give it without asking the patient" may reflect differing approaches to patient care and communication styles. Healthcare providers who are more proactive in providing oral health information and support to patients may have more positive attitudes toward preventive care and may be perceived as more competent by their patients. Similarly, the lower self-perception scores among individuals who responded with "I direct him/her to the dental specialist" suggest that pediatricians who perceive themselves as less capable of managing oral health issues may have lower confidence levels in their abilities. This finding underscores the importance of addressing healthcare providers' self-perceived competence through targeted education and training programs to improve their confidence and skills in managing oral health issues within their scope of practice.
While controlling for years of service, the partial relationship between scores provides valuable insights into the interplay between different dimensions of pediatricians' perceptions and knowledge of oral health. The weakly positive correlation between knowledge and self-perception scores suggests that pediatricians who perceive themselves as more competent in oral health topics may also have higher levels of knowledge in this area. This finding is consistent with previous research demonstrating a positive association between healthcare providers' self-perceived competence and knowledge and skills in various clinical domains. For example, a study by Afnan and Tirupathi [21] investigated the relationship between self-perceived competence and actual performance in managing dental emergencies among medical students and found that students with higher self-perceived competence scores also demonstrated better clinical performance. Also, it explored the relationship between self-perceived competence and knowledge among dental students and found a positive correlation between self-perceived competence and knowledge scores.
However, it is noteworthy that the remaining correlations between knowledge and attitude and between attitude and self-perception were statistically insignificant. This suggests that while there may be some association between knowledge and self-perception, as indicated by the weakly positive correlation, other factors may influence pediatricians' attitudes toward oral health and their perceptions of competence in this area.
Several factors may contribute to the lack of significant correlations between knowledge, attitude, and self-perception scores. For instance, individual differences in educational background, professional experiences, and personal beliefs may influence pediatricians' attitudes toward oral health and their perceptions of competence. Additionally, contextual factors such as organizational culture, available resources, and patient population demographics may also impact healthcare providers' perceptions and practices related to oral health.
This study sheds light on factors influencing pediatricians' knowledge, attitudes, and self-perceived competence regarding oral and dental health. The substantial sample size of 323 pediatricians provided a robust dataset for analysis, offering valuable insights into the current landscape of pediatric oral healthcare in the study population. However, several limitations should be acknowledged.
Firstly, the gender distribution imbalance, with two-thirds of the participants being female, may introduce potential bias into the findings. Research indicates that gender disparities exist in healthcare, including attitudes, knowledge, and practices among healthcare providers. Further investigation into how gender influences pediatricians' attitudes and practices regarding oral and dental health could provide valuable insights.
Additionally, the sample's relatively young to middle-aged demographic profile may influence the findings' generalizability to older pediatricians. Further research exploring the impact of age and years of service on pediatricians' oral health knowledge and attitudes could provide a more comprehensive understanding of these dynamics.
Furthermore, the study's reliance on self-reported data may introduce response bias, as participants may provide socially desirable responses or inaccurately recall their educational experiences. Future research incorporating objective measures of knowledge and competence, such as clinical assessments or standardized tests, could provide more robust evidence.
Conclusion
The study highlights the importance of continuing education, attitudes toward patient care, and self-perceived competence in shaping pediatricians' oral and dental health practices. Healthcare organizations and policymakers can work towards improving pediatric oral healthcare delivery and outcomes by addressing these factors through targeted educational interventions and support programs.
While this study provides valuable insights into pediatricians' knowledge and attitudes toward oral and dental health, future research must address the limitations and further explore the complex interplay between demographic factors, educational experiences, and professional attitudes in shaping pediatric oral healthcare practices.
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Financial Support
None.
Data Availability
The data used to support the findings of this study can be made available upon request to the corresponding author.
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Edited by
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Academic Editor:
Catarina Ribeiro Barros Alencar
