article_Bologa-Stoleriu-2020
CARIOLOGY www.stomaeduj.com
KNOWLEDGE ABOUT DENTIN HYPERSENSITIVITY:
Original Articles
A QUESTIONNAIRE-BASED SURVEY AMONG DENTAL
STUDENTS AND YOUNG DENTISTS
Emilia Bologa1a , Simona Stoleriu1b* , Angela Cristina Ghiorghe1c , Galina Pancu1d , Irina Nica1e , Sorin Andrian1f
1
Department of Odontology, Periodontology and Fixed Prosthodontics, Faculty of Dental Medicine, Grigore T. Popa University of Medicine and Pharmacy
of Jassy, Jassy, Romania
a
DDS, PhD Student; e-mail: bologa.emilia@umfiasi.ro; ORCIDiD: https://orcid.org/0000-0002-0091-8765
b
DDS, PhD, Associate Professor; e-mail: stoleriu_simona@yahoo.com; ORCIDiD: https://orcid.org/0000-0001-5427-6027
c
DDS, PhD, Lecturer; e-mail: cristina.ghiorghe@umfiasi.ro; ORCIDiD: https://orcid.org0000-0002-1636-6686
d
DDS, PhD, Lecturer; e-mail: galina.pancu@umfasi.ro; ORCIDiD: https://orcid.org/0000-0001-9593-1884
e
DDS, PhD, Assistant Professor; e-mail: irina.nica@umfiasi.ro; ORCIDiD: https://orcid.org/0000-0003-1189-0785
f
DDS, PhD, Professor; e-mail: sorin.andrian@umfiasi.ro; ORCIDiD: https://orcid.org/0000-0002-9271-6123
ABSTRACT https://doi.org/10.25241/stomaeduj.2020.7(3).art.3
Introduction Continued education is a fundamental characteristic of one’s working life, especially in the
medical field. Keeping up to date should be a mandatory element of dental practice. Dentin hypersensitivity
(DH) has been a long-term significant challenge for practitioners due to the uncertainties around its diagnosis
and treatment. The aim of this study is to assess the knowledge of senior dental students and young doctors
with respect to this dental pathology.
Methodology A total of 632 self-administered questionnaire were distributed to dental students and
doctors for data collection. The 10 questions investigated the knowledge about the description of pain
in DH, triggering and predisposing factors, treatment strategies, preventive and treatment measures,
remineralization products, etiological factors of dental wear, and main characteristics of DH. The data were
analyzed using SPSS 20.0. Standard descriptive statistics were computed and analytical statistical analysis
was performed using Pearson’s chi-square test.
Results The response rate for dental students was 87.87% and 10.2% for young doctors. Most respondents
revealed a good level of knowledge regarding pain characterization, triggering factors, and predisposing
factors of dentin hypersensitivity, and a satisfactory level for the disease management strategies. The average
score of the questionnaire recorded at group level was 42.253.
Conclusion Young dentists had better knowledge of DH compared to 6th-year dental students. The
information obtained from this study revealed that there is a need to provide better theoretical but also
clinical teaching opportunities to students, as well as continued educational programs to young doctors.
KEYWORDS
Dentin Hypersensitivity; Knowledge; Dental Students; Dentists; Questionnaire.
1. INTRODUCTION is exposed to different stimuli (typically thermal,
evaporative, tactile, osmotic or chemical) and the
Dentin hypersensitivity (DH) is a condition that has pain cannot be ascribed to any other form of dental
often been encountered in dental practice in recent defect or disease. The prevalence of DH ranges from
decades [1–3], however, the historical reporting 1.34% to 92.1% in the adult population [1–4,7–11].
of this symptomatology goes as far back as the This discrepancy occurs due to the differences in
16th century [4,5]. Holland et al. [6] described this the methods used for diagnosis and in the selection
pathology as a short, sharp pain arising when dentin criteria of the subjects.
OPEN ACCESS This is an Open Access article under the CC BY-NC 4.0 license.
Peer-Reviewed Article
Citation: Bologa E, Stoleriu S, Ghiorghe AC, Pancu G, Nica I, Andrian S. Knowledge about dentin hypersensitivity: a questionnaire-based survey
among dental students and young dentists. Stoma Edu J. 2020;7(3):175-183.
Received: June 25, 2020; Revised: July 13, 2020; Accepted: July 20, 2020; Published: July 22, 2020
*Corresponding author: Simona Stoleriu; Address: 16 Universității Str., RO-700115 Jassy, Romania;
Tel.: 0040745106066; Fax: +40.232.211.820; e-mail: stoleriu_simona@yahoo.com;
Copyright: © 2020 the Editorial Council for the Stomatology Edu Journal.
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Original Articles
Figure 1. Sample of the
questionnaire used in the
present study.
Patients with sensitive teeth experience discomfort questionnaires, providing descriptive data on
while eating, drinking, and brushing their teeth, all the entire population being studied. In scientific
of them being considered activities that affect the literature, several self-reported questionnaire studies
quality of life [2,12]. The academic curricula include assess students’ or dentists’ knowledge about dentin
clinical training for students to diagnose and to hypersensitivity [1–4,8,9,14,15].
treat patients with different dental diseases under Those surveys evaluated the clinical practice of the
supervision, and therefore they are expected to have subjects in patients with DH and did not assess the
adequate knowledge about these conditions. Dental theoretical knowledge that they possess about this
students and beginner young dentists that no longer disease.
have a supervisor to check their work quality must The theoretical educational processes represent
be acquainted with DH and must have the skills to the base for developing clinical skills. For this
correctly manage the disease [3,9]. reason, we conducted a study to evaluate the
There are limited data available regarding dental knowledge of dental students and young dentists
students’ and young dentists’ understanding of DH, about dentin hypersensitivity regarding pain
especially in Romania, where no studies have been description, triggering factors, predisposing factors,
conducted on this topic. diagnosis, preventive and treatment measures. The
Questionnaires are objective tools that researchers null hypothesis of the present study is that there
can use to collect information about people’s are no differences in the evaluation of the level of
knowledge, beliefs, attitudes, and behavior knowledge between young dentists and dental
[13]. Cross-sectional studies can be based on students.
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Original Articles
Figure 3. The distribution of scores obtained by students and dentists
for Q2 (regarding the triggering factors of DH).
Figure 2. The distribution of scores obtained by students and dentists
for Q1 (regarding the pain characteristics of DH).
Figure 5. The distribution of scores obtained by students and dentists
for Q5 (regarding the preventive measures of DH).
Figure 4. The distribution of scores obtained by students and dentists
for Q3 (regarding the predisposing factors of DH).
two dental students were asked to respond to the
self-administered questionnaire at the end of their
Cariology classes. Also, 500 young dentists were
randomly chosen from the alumni database and
received the questionnaire online. No reminder was
given to those participants who did not return the
questionnaire.
A literature search was performed on readily available
questionnaires that measure the knowledge of
dental students and young dentists about dentin
hypersensitivity. None of them met the criteria to be
followed in this study, so a new questionnaire was
developed.
Figure 6. The distribution of scores obtained by students and dentists
The process of developing the new questionnaire
for Q6 (regarding the treatment of DH). followed the recommendations of Tsang et al. [16].
The first step was to establish the expert committee,
2. MATERIAL AND METHODS that was comprised of cariology professors, and
then identify the dimensionality of the construct.
This cross-sectional study was conducted since It was decided that the questionnaire will be self-
November 2018 till May 2019. A total of 632 questio- administered because in this way the respondents
nnaires were distributed among senior dental will answer more truthfully.
students (6th year of study) at the Faculty of Dental The items used specific medical terminology because
Medicine - “Grigore T. Popa” University of Medicine all the participants were trained in the dentistry field,
and Pharmacy Iași, Romania, and among alumni hence being familiar with such terms. The questio-
who graduated in the last five years. nnaire was constructed based on nine close-ended
All participants were informed about the purpose questions (seven multiple choice questions, one
and the objective of this study and signed a true/false question, one matrix question) and one
consent form of agreement. One hundred thirty- open-ended item (Fig. 1).
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Original Articles Table 1. The qualitative assessment for the 7 multiple choice questions.
Question Group Good Satisfactory Insufficient
Q1 - description of the students 67.2% 10.3% 22.4%*
pain in DH dentists 80.4% 11.8% 7.8%*
students 73.3%* 23.3%* 3.4%
Q2 - triggering factors
dentists 88.2%* 7.8%* 3.9%
students 65.5%* 16.4%* 18.1%
Q3 - predisposing factors
dentists 84.3%* 2.0%* 13.7%
students 32.8%* 32.8% 34.5%*
Q4 - treatment strategies
dentists 60.8%* 31.4% 7.8%*
Q5 - preventive students 43.1%* 37.9% 19.0%*
measures dentists 70.6%* 27.5% 2.0%*
students 22.4%* 69.0% 8.6%
Q6 - treatment measures
dentists 41.2%* 54.9% 3.9%
Q7 - remineralization students 12.9%* 57.8% 29.3%
products dentists 39.2%* 45.1% 15.7%
* statistically significant differences between students and dentists for each category
Table 2. The qualitative assessment for the 7 multiple choice questions.
Q4: therapeutic strategies
Pearson’s chi-square test= 16.720, Students Dentists Total
P = .010*
n % n % n %
0 37a 31.9%* 4b 7.8%* 41 24.6%
1 1a 0.9% 0a 0.0% 1 0.6%
2 2a 1.7% 0a 0.0% 2 1.2%
3 9a 7.8% 3a 5.9% 12 7.2%
4 29a 25.0% 13a 25.5% 42 25.1%
5 33a 28.4%* 26b 51.0%* 59 35.3%
6 5a 4.3% 5a 9.8% 10 6.0%
Total 116 100.0% 51 100.0% 167 100.0%
* statistically significant differences between students and dentists for each category
Items were simple, short, and written in the native 7 multiple choice questions about the description
language of the respondents. It was considered of the pain in DH, triggering factors, predisposing
that a 10-item questionnaire was short enough to factors, treatment strategies, preventive measures,
avoid respondents experiencing fatigue or loss of treatment measures, and remineralization products.
motivation during completion. The experts revie- The matrix question was about the etiological factors
wed the items in order to make sure they were of dental wear (abrasion, abfraction, and erosion),
accurate, free of item construction problems, and and the true/false question had subscales about the
grammatically correct. Minor modifications were main characteristics of DH.
made to the instrument to achieve the objectives of The open-ended question asked the participants to
the study. give an example of desensitizing toothpastes that
Content and face validation were obtained by participants may have knowledge of being efficient
circulating the questionnaire to 15 senior dental in DH treatment.
students and five young dentists (others than the We used a quantitative evaluation by scoring
ones we recruited for the study). They concluded each response between 0-6 points according to
that the questionnaire items were clear, easy, valid, the number of correct answers identified, first 7
and covered all the main subjects regarding the questions had between 2-4 correct answers (for each
knowledge of DH. incorrect answer given or correct answer missed 1
The survey instrument recorded the respondent’s point was deducted; a single answer given scored 0
gender and age. The subjects were asked to respond points). Question no.8 scored 0 or 6, for question
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Original Articles
Table 3. Results obtained by students and dentists at Q7.
Q7: Remineralization strategies
Pearson’s Chi-square Test = 39.981, Students Dentists Total
P = .000**
n % n % n %
0 31a 26.7%* 2b 3.9%* 33 19.8%
1 0a 0.0% 1a 2.0% 1 0.6%
2 3a 2.6% 5b 9.8% 8 4.8%
3 44a 37.9% 11b 21.6% 55 32.9%
4 23a 19.8% 12a 23.5% 35 21%
5 8a 6.9%* 19b 37.3%* 27 16.2%
6 7a 6.0% 15a 2.0% 8 4.8%
Total 116 100.0% 51 100.0% 167 100.0%
* statistically significant differences between students and dentists for each category
Table 4. Global score obtained of each group.
One-Sample Kolmogorov-Smirnov Test p = .000*
Mann-Whitney U = 1466.500, p = .000**
Standard
Standard
Group N Mean error of the Minimum Maximum
deviation
mean
student 116 40.471 7.8261 .7266 8.0 52.8
dentist 51 46.306 7.1557 1.0020 8.4 54.6
Total 167 42.253 8.0697 .6245 8.0 54.6
no.9 each correct association scored 2 points, and for The confidence interval was set to 95% and
question no.10 each correct answer scored 1.2 points. p-values less than 0.05 were considered statistically
The maximum overall score of the questionnaire significant.
was 60 points. For the qualitative assessment, each
response was evaluated as follows: 3. RESULTS
- from 0-2 points = Insufficient,
- 3-4 points = Satisfactory, The response rate for dental students was 87.87%
- 5-6 points = Good. (116 questionnaires returned from 132), and for
The participants’ overall knowledge was categorized young doctors this was 10.2% (51 questionnaires
using modified Bloom’s cut-off point, as good if the returned from 500). The mean age of the participants
score was between 80 and 100% (48–60 points), was 26.34 ± 3.635 years. Most participants were
satisfactory if the score was between 50 and 79% students (69.5%) and 30.5% were doctors. The re-
(30–47 points), and insufficient if the score was less sults showed that 61.1% were female participants
than 50% (< 30 points). and 38.9% males.
The qualitative assessment for the seven multiple
2.1 Statistical Analysis choice questions is presented in Table 1. The percen-
The data obtained were fed into Microsoft Excel tage of young doctors having a good level of
(Microsoft Inc., USA). The statistical software SPSS knowledge was statistically significantly higher than
20.0 (IBM Inc., USA) was used for data analysis. the one of dental students (Pearson’s Chi-square
The standard descriptive methods were applied Test, p<0.05).
to determine the characteristics of the sample. Regarding the characterization of dentin hyper-
Pearson’s Chi-square test was applied to compare sensitivity, 27 out of all subjects (16.2%) did not know
categorical variables between the groups. the correct answer, while the majority of subjects
We used nonparametric Mann-Whitney U and One- (105 subjects - 62.9%) obtained the maximum score.
Sample Kolmogorov-Smirnov tests to evaluate the The comparative study of the results obtained by
differences in the distribution of the age data set and students and doctors revealed statistically significant
data from the true/false question. differences (Pearson’s Chi-square Test, p = 0.001).
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The percentage of students who did not know value that proved subjects had average knowledge
Original Articles
how to characterize dentin hypersensitivity was of dentin hypersensitivity, as seen in Table 4. There
significantly higher than the doctors’ percentage as were statistically significant differences between
seen in Figure 2. the performances of doctors and students in this
For the question regarding the triggering factors questionnaire, indicating that doctors had a higher
of DH, 31.7% of all respondents obtained the maxi- level of knowledge than students on the investigated
mum score. There was a statistically significant diff- subject.
erence (Fig. 3) between the percentage of doctors
(45.1%) and that of students (25.9%) who obtained 4. DISCUSSION
a maximum score of 6 (Pearson’s Chi-square Test, p
= 0.032). The current research is one of the first studies that
The third question analyzed the knowledge of the aimed to establish whether the knowledge of young
predisposing factors that determine the appearance doctors differs from the knowledge of senior dental
of DH. Figure 4 shows that a significantly higher students regarding their theoretical information
percentage of doctors (37.7%) than of students about the dentin hypersensitivity. The high students’
(16.4%) scored a maximum of 6 points, while a response rate can be due to the setting in which
significantly higher percentage of students (12.1%) the questionnaires were collected, as soon as they
than of doctors scored 4 points. were filled. We observe a similar response rate (75.7
Table 2 shows the scores obtained by students and -78.7%) to the one reported in other studies that
dentists for question no.4 regarding the therapeutic analyzed dental students [3, 9]. The doctors’ response
strategies. rate was lower, mainly because the interaction with
The fifth item looked into the knowledge regarding the participants was on-line. Additionally, the lack of
the preventive measures for DH. The comparative knowledge and understanding of the subject might
evaluation of doctors and students showed have prevented them from filling in and returning
statistically significant differences (Pearson’s Chi- the questionnaire [17]. These data (response rate of
square Test, p = 0.001 – Fig. 5). 10.2% in the current study) are also in line with the
Analyzing the results of the sixth question regarding low response rate (7%) reported by the Canadian
the treatment measures of DH we identified Advisory Board on Dentin Hypersensitivity in a similar
statistically significant differences (Pearson’s chi- study regarding the practitioners’ understanding
square Test, p = 0.040) between the 5.9% of the and clinical management of DH [8].
young doctors that obtained the maximum score Our study revealed that most participants knew that
compared with none of the students (Fig. 6). the short and sharp pain is characteristic for DH,
The results obtained for the seventh question about which is an important step in correctly diagnosing
remineralization strategies are shown in Table 3. this disease. The first clinical data that a practitioner
On the open-ended question, namely question must collect cover the history of the patient’s pain
eight, 160 participants (95.8%) were able to give [8,18].
examples of desensitizing toothpastes. There were In the present study, most participants had a good
no statistically significant differences (Pearson’s Chi- performance on the evaluation of all triggering
square Test, p = 0.340) between the answers given factors (thermal, tactile, evaporative, chemical
by the students compared with the doctors. stimuli) of DH, but young doctors had a significantly
Item number nine analyzed the knowledge about better performance than students. In other studies,
the etiology of different types of dental wear 92% of the surveyed dentist identified chemical and
(abrasion, abfraction, and erosion). Most participants thermal stimuli as the main triggering factors for DH
(63.5%) obtained the maximum score, and 7.8% of [2]. Amarasena et al. [19] observed that cold stimuli
the subjects failed to make any correct association. were the most frequently cited trigger of DH (67.5%).
There were no statistically significant differences An earlier study reported the participants’ lack of
(Pearson’s Chi-square Test, p = 0.052) between the knowledge because the doctors had identified
answers given by the students compared with the bruxism and malocclusion as triggers of DH even
doctors. though neither has been recognized as a major
The last question evaluated the knowledge of causative factor [8].
some of the main characteristics of the DH. The Most participants had a good performance when
average score recorded was 3.959 ± 1.2037, and asked to identify multiple predisposing factors
no statistically significant differences (One-Sample (tooth erosion, dentin exposure, gingival recession)
Kolmogorov-Smirnov Test p = .000*, Mann-Whitney of DH. Comparatively, young doctors performed
U = 2689.500, p = 0.328) were obtained between better than the senior dental students on this specific
students and doctors. item. The data are consistent with other studies that
The subjects’ answers to the questionnaire were have reported abrasion and gingival recession as the
also quantified using an overall score, with values most important predisposing factor for DH [1,19].
between 8 and 54.6. The average score recorded at The dental professional should identify and remove
the level of the whole group was 42.253 ± 8.0697 - a predisposing factors as a first step approach when
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treating patients with DH [18]. Less than half of the by the higher practical experience that doctors
Original Articles
respondents knew the therapeutic strategies for DH. accumulate in time, although dental students
One-third of the dental students and four doctors studied DH more recently. This demonstrates that
obtained a null score on this question, which means theoretical knowledge needs to be completed by
an insufficient level of knowledge. This question did practice and vice-versa.
not appear in other questionnaire-based studies Given the high prevalence of DH and its complexity,
that we found in our scientific literature search. the results of this study point to the stringent need to
The preventive measures were identified by two- provide better theoretical, but also clinical teaching
thirds of the young doctors and more than one- opportunities to students and good access to
third of the students, and half of all respondents continued educational programs to young doctors.
performed well on this item. This is in agreement These will contribute to a better quality of care for
with the studies of Benoist et al. [2] (where 78% of patients having this pathology. To date, there is
the dentists recognized the preventive measures) no evidence of such an observational study being
and Nazir et al. [3] where the most common undertaken in dentistry, but it is our belief that such
preventive strategy (74.1%) used by dental students a design would lead to interesting and significant
and interns was the proper education on tooth- insights for the field. The limitations of the study
brushing technique. are the decreased overall response rate obtained
As to identifying the correct treatment of DH, and the restricted population of undergraduate
the data revealed that less than one-third of all students belonging to the same university. Further
participants obtained a good performance score, multicenter studies are required in order to allow
most of them having only satisfactory results. The for these results to be confidently generalized into a
mostly recognized treatment strategies were the wider population of general dental practitioners and
correction of toothbrushing technique and the use senior dental students.
of desensitizing toothpastes, which is consistent
with other studies [2,3,9,19]. Less than ten percent of 5. CONCLUSION
all respondents failed to answer this item correctly.
This is in agreement with the result obtained by The findings of this study indicate that dentists under
Cunha-Cruz et al. [20]. five-years’ working experience have significantly
Half of all participants had satisfactory knowledge better knowledge as compared to 6th-year dental
about the remineralization strategies used in the students. Both groups of participants were far
treatment of DH, but one-third of them did not know better informed regarding DH pain characterization,
the answer. triggering factors, and predisposing factors of this
Almost all of the participants had knowledge of and condition, and less about its treatment.
could mention at least one brand of desensitizing
toothpaste. That is in conformity with the findings CONFLICT OF INTEREST
of Benoist et al. [2], but as different from another The authors declare no conflict of interest.
study which has shown that fifty percent of
the dentists reported incorrectly that the most AUTHOR CONTRIBUTIONS
popular desensitizing ingredients in desensitizing
toothpastes are fluoride compounds [8]. EB: conception and design of the study, acquisition of data,
Almost two-thirds of the participants in our study analysis and interpretation of data, drafting the article, final
were able to recognize the etiology of different types approval of the version to be submitted. SS: drafting the article,
of dental wear (as abrasion, abfraction, and erosion). revising the article critically for important intellectual content.
Less than half of the young dentists and almost half AG: acquisition of data, analysis and interpretation of data.
of the dental students obtained a good result in IN: acquisition of data, analysis and interpretation of data.
identifying some of the main characteristics of DH. GP: acquisition of data, analysis and interpretation of data.
The mean global score of the questionnaire proved SA: conception and design of the study, revising the article
that subjects had an overall average level of critically for important intellectual content, final approval of the
knowledge of dentin hypersensitivity. No participant version to be submitted.
obtained the maximum score or a score zero.
The null-hypothesis was rejected. There were multiple ACKNOWLEDGMENTS
results with statistically significant differences (p <
0.05) between the two groups. This demonstrates The authors would like to thank all participants in the study who
that young dentists have a higher level of knowledge provided their fullest cooperation.
of DH when comparing to the students. We believe
that the differences between groups are explained
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Emilia BOLOGA
DDS, PhD Student
Department of Odontology Periodontology and Fixed Prosthodontics
Faculty of Dental Medicine
"Grigore T. Popa" University of Medicine and Pharmacy of Jassy
Jassy, Romania
CV
Emilia Bologa, DDS, received her degree in dentistry in 2014 from the „Gr. T. Popa” University of Medicine and Pharmacy, Jassy.
Dr. Bologa is currently a PhD student at the Department of Odontology, Periodontology and Fixed Prosthodontics, Faculty of
Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy of Jassy, Jassy, Romania. She is a young researcher
whose area of interest includes dentin hypersensitivity and remineralization strategies.
182 Stoma Edu J. 2020;7(3): 175-183 pISSN 2360-2406; eISSN 2502-0285
Knowledge about dentin hypersensitivity
www.stomaeduj.com
Questions
Original Articles
1. Dentin hypersensitivity is described as:
qa. A diffuse pain;
qb. A pulsating pain;
qc. A short, sharp pain;
qd. An aching pain.
2. Patients with sensitive teeth experience discomfort while:
qa. Flossing;
qb. Jogging;
qc. Sleeping;
qd. Brushing their teeth.
3. According to the results of this study, which percentage of participants have been able
to give examples of desensitizing toothpastes?
qa. 88.5%;
qb. 95.8%;
qc. 15.8%;
qd. None.
4. What did the mean global score of the questionnaire prove?
qa. Subjects had a very good level of knowledge;
qb. Subjects had a good level of knowledge;
qc. Subjects had an average level of knowledge;
qd. Subjects had an insufficient level of knowledge.
https://accademiaitalianadiconservativa.it/en/events/22nd-annual-congress-360-tooth-challange-crown-down-treatment-solutions/
Stoma Edu J. 2020;7(3): 175-183 pISSN 2360-2406; eISSN 2502-0285 183