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ORIGINAL ARTICLE
Year : 2016  |  Volume : 6  |  Issue : 1  |  Page : 26-30

Confidence level in performing endodontic treatment among final year undergraduate dental students from the University of Medical Science and Technology, Sudan (2014)


1 Department of Endodontics, Faculty of Dentistry, University of Medical Sciences and Technology, Khartoum, 12810 Sudan, Sudan
2 Department of Endodontics, Faculty of Dentistry, University of Medical Sciences and Technology, Khartoum, Sudan

Date of Web Publication16-Dec-2015

Correspondence Address:
Elhadi Mohieldin Awooda
Department of Endodontics, Faculty of Dentistry, University of Medical Sciences and Technology, Khartoum, 12810 Sudan
Sudan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-5984.172000

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  Abstract 

Aim: This study is aimed to evaluate the confidence level of undergraduate final year dental students in performing root canal treatment (RCT) and how it may affect their performance and perception regarding endodontics. Materials and Methods: A self-administered questionnaire was distributed to the final year dental students, at the University of Medical Sciences and Technology, Khartoum, Sudan (2013–2014). A total of 21 students were requested to participate voluntary and were asked to score their level of confidence using a 5-point Likert's scale. Results: Response rate was 100%, all the students (100%) stated that the requirements set were enough, and 66.7% rated endodontic as average in terms of difficulty. When rating the mean of self-confidence for performing RCT in the dentition, maxillary teeth (2.43 ± 0.51) followed by mandibular teeth (2.71 ± 0.64) were higher, whereas the molars were the least. Higher scores of self-confidence were in administrating local anesthesia (4.24 ± 0.70), followed by root canal shaping by hand instrument (3.76 ± 0.54). No association was found between overall confidence level and the number of performed RCT (P = 0.721). No association was found between overall confidence level of students who were subjected to instrument fracture and their frequency of fracture (P = 0.507), supervisor' reaction (P = 0.587), and willingness to specialize in endodontics (P = 0.530). Conclusion: Students displayed high confidence in performing basic endodontic and treating single-rooted teeth. More exposure is recommended to enhance the students' self-confidence.

Keywords: Root canal treatment, self-confidence, undergraduate dental student


How to cite this article:
Awooda EM, Mudathir MS, Mahmoud SA. Confidence level in performing endodontic treatment among final year undergraduate dental students from the University of Medical Science and Technology, Sudan (2014). Saudi Endod J 2016;6:26-30

How to cite this URL:
Awooda EM, Mudathir MS, Mahmoud SA. Confidence level in performing endodontic treatment among final year undergraduate dental students from the University of Medical Science and Technology, Sudan (2014). Saudi Endod J [serial online] 2016 [cited 2019 Aug 25];6:26-30. Available from: http://www.saudiendodj.com/text.asp?2016/6/1/26/172000




  Introduction Top


With the new era of the ultimate conservation and preservation of tooth structure and the patients' awareness level increased, endodontic treatment stands as the core of conservative dentistry making the incidence of root canal therapy very high. That being said, students must have a full grasp of the fundamentals of endodontics to enable them to perform endodontic procedure independently.

A dental student, upon graduation, should have acquired the skills to make a sound diagnosis regarding endodontic cases, implement a reasonable treatment plan and carry out a qualified and safe endodontic treatment.[1] For students to reach such level of skill they must be exposed to enough number of cases of variable difficulty. Thus, the European Society of Endodontology (ESE) has advised the completion of 20 root canal treatments (RCTs) in 20 teeth including extracted teeth prior to graduation in the undergraduate curriculum guidelines and have competency of all the clinical procedures of performing RCT.[2]

Endodontic treatment can be one of the most difficult and stressful disciplines for undergraduate dental students and for general practitioners as well. This difficulty is thought to be due to its expansion in recent years in terms of clinical managements of the pulp and periapical diseases as well as the complex anatomical diversity and the huge number of developed instruments and materials used to perform the treatment along with the lack of self-confidence tends to make several students feel inadequately prepared to deal with endodontic treatment procedures.[3] Even though, several studies have established that general practitioners have got high confidence in performing root canal procedure.[4],[5] However, a number of recent studies have shown a high frequency of poorly executed RCTs with periradicular disease going apparently undetected and untreated.[6],[7],[8],[9] It is postulated that this may be because of a number of reasons including the difficulty of the technical procedures, lack of understanding of the principles and aims of treatment, poor remuneration for the time required and inadequate teaching at undergraduate level.[4] Thus, the later will inevitably lead the students to errors in judgment and technique.

The literature has got sufficient data regarding the quality of endodontic treatments performed by dental students. Davey et al.[10] reported that the majority of dental students lack self-confidence in performing root canal treatment, mainly due to the lack of clinical experience. In general, there is limited information regarding the way student's perceived endodontics and their level of self-confidence about various aspects of endodontic treatment with respect to their future practice, in Sudan no previous data tackling this issue. So, the aim of this study was to assess the level of confidence of final year dental students from University of Medical Science and Technology (UMST) in performing different endodontic procedure.


  Materials and Methods Top


A descriptive cross-sectional study was conducted during the last week of the academic year July 2014 in the Academy Dental Teaching Hospital through a self-administered questionnaire among 21 final year dental students attending UMST, Khartoum, Sudan.

The study was granted approval by the Ethical Committee of the University of Medical Sciences and Technology. Students had the freewill to participate in the survey and written consent was obtained. Data were kept confidential and used only for the purpose of this study.

The questionnaire consisted of 6 parts, part 1 included demographic data, part 2, 3, 4, and 5 were to assess their confidence in performing RCT in both single- and multi-rooted teeth and the standard procedures associated with carrying out a successful RCT. Students were asked about their future endodontic practice while working independently, whether they wish to perform all endodontic procedures by themselves or they would choose to refer the cases for a specialist whenever they felt necessary. They were also asked about their perception of endodontics in terms of difficulty and whether if they would choose endodontics as a line of specialty. In part 6 students were asked to report the most common mishaps they encountered, their supervisors' reaction to the incident and how would they carry on with the treatment after having such a mishap.

The students used the Lickert's scoring system from 1 to 5 to indicate their level of confidence as follows: 1 = Very little confidence, 2 = Little confidence 3 = Neutral 4 = Confident 5 = Very confident.

Data analysis

Data was cleaned, organized, and entered in a master sheet on a personal computer and analyzed using the Statistical Package for Social Sciences (SPSS) (version 17; SPSS Inc., Chicago, IL, USA). The descriptive statistics portion of the data was presented in the form of tables and figures using the Microsoft Excel program. Comparison between parametric data by using the t-test, and nonparametric data using Chi-square test with the level of statistical significance set at P ≤ 0.05.


  Results Top


The response rate of the survey was 100% with the majority of the students (66.7%) rated endodontic as average in terms of difficulty and all students (100%) stated the requirements set by the Department of Endodontics were enough.

Measuring working length by apex locator scored the lowest confidence rate; followed by management of root resorption and rubber dam placement. Higher scores of self-confidence were in administrating local anesthesia, followed by root canal shaping by hand instrument [Table 1].
Table 1: Students' self-confidence in performing different endodontic procedures

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When rating the self-confidence for performing RCT of different teeth on the dental arch, maxillary followed by mandibular molars are the teeth were the students felt the least confident treating [Table 2].
Table 2: Average scorings of students' self-Confidence level of performing the endodontic treatment of various teeth in the dental arch

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Results also revealed that the majority of the students (85.7%) would perform RCTs within their expertise limit in the future but would refer difficult cases to a specialist and only eight students (38.1%) wished to specialize in endodontics. No association was found between overall confidence level and the number of performed

RCTs, P = 0.721.

Sixteen students (76.2%) were subjected to the fractured instrument and (62.5%) had it once. The majority of these students (93.8%) reported completing the treatment after getting a fracture instrument, mostly by obturating to the level of the fractured instrument (75%). While only (6.3%) reported referring the patient to a specialist.

Half of the students (50%) who had an instrument fracture mentioned that the most commonly involved tooth in instrument fracture was the lower first molar particularly the mesio-buccal canal (43.8%); and the most common cause of instrument fracture is instrument overuse/fatigue (43.8%). Twelve of those students (75%) stated that their supervisor reaction in such situation (instrument fracture) was reassuring [Figure 1]. More than half (68.8%) of these students wish not to specialize in the endodontic field in the future.
Figure 1: Supervisor reaction when a student experienced a fractured instrument

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There is no significance association between overall confidence level of students who were subjected to instrument fracture and their frequency of fracture, supervisor reaction, and willingness to specialize in endodontics (P = 0.06)


  Discussion Top


Student surveys bridge between both students and the educationist and allows an insight into the educational process, a feedback which is important to provide updated curricula that aim to develop and refine both knowledge and practical skills and overcome hindrances that students face. Unfortunately, this received little attention in the educational planning of most dental schools.[11],[12]

The literature has got various studies that address the general clinical preparedness of the new graduate. However, very few studies have been specific to endodontics, especially regarding self-confidence level. Hence, this study is anticipated to provide insight to students' self-evaluation of themselves in a branch they will encounter very frequently in their daily practice.

Murray, et al.[13] Lynch, et al.[14] stated that insufficient clinical exposure during the undergraduate program limits confidence in performing clinical practices. Lynch, et al.[14] added limitations posed by the busy curriculum and lack of well-trained staff are major obstacles. However in this study, the above-mentioned factors are not contributing to lower confidence levels regarding various aspects of endodontic treatment. In UMST Faculty of Dentistry, School where this study was held, a very well balanced, sufficient dental curriculum that follows international guidelines such as ESE guidelines [2] for undergraduate students is set to joins both academic knowledge and practical clinical skills in order to graduate a well competent dentist. The entire last (final) semester is directed toward more clinical practice in all disciplines not only endodontics. A certain amount of clinical requirements is needed in order for the student to enter the final exam in each discipline. Moreover, a competency examination is held 1-month prior to the theoretical/written exam, a student is obliged to pass the competency examination in order to be eligible to sit for the final Bachelor of Dental Surgery written examination. The school has a well-qualified full-time teaching staff and each department is well equipped with sufficient dental units, and the school has a charity hospital policy just to keep a high patients flow rate, which all coincides with the European recommendations.[15] The entire study group responded that the requirements listed for them were satisfactory, a similar result which was obtained by Tanalp et al.[1] who stated that while it is true that students can make a better judgment of their clinical adequacy, there seems to be the necessity of very close and careful monitoring of each individual student and the development of an assessment strategy which is not dependent on numeracy basis only.

On analysis of the results of self-confidence performing certain endodontic procedures measuring working length by apex locator scored the lowest confidence rate; this is due to the unavailability of such a device in the department. The second lowest confidence level was the management of root resorption; this is likely that such cases are always unseen by the students or referred to a specialist as it is not one of the requirements. Rubber dam placement came third. This is because the student only starts working with rubber dam in their final year due to its unavailability, even though it is an indispensable element of contemporary endodontic practice. In contrast, Tanalp et al.[1] found that bleaching of endodontically treated teeth was the lowest confidence that the student felt followed by rubber dam and management of intra-appointment flare-up. This difference is related to the questions that they were asked.

As expected, multi-rooted teeth were the teeth were the students felt least confident treating, this is anticipated due to the complexity of root canal system and accessibility in the dental ach. A similar finding to other researches.[1],[10],[16],[17]

As stated by the majority (85.7%) of the students, they would perform RCTs within their expertise limit in the future which indicates a high confidence level, which is probably due to the high exposure level to endodontic cases, abundant and direct supervision. Similar findings were reported by Shetty et al.[18]

The lack of association between overall self-confidence and number of endodontic cases being treated was not as predicted. It might be due to the sense of lack of experience that the students have since they are only managing simple straight forward cases regardless of how many they are. Dummer [19] compared the endodontic teaching of undergraduate programs in the United Kingdom (UK) and in some dental schools in Europe and the United States (US). He reported a minor variation in the minimum number of teeth treated during the preclinical courses. The average number in the UK was 3–10 teeth (including simulated canals), 5–8 in European schools, and 4–9 in the US schools. Furthermore, he found that the number of treated cases increased twice during the clinical courses.

A separated instrument and perforation can be one of the most common complications to encounter during RCT.[1],[20],[21] Sixteen students (76.2%) were subjected to fractured instrument. This could be due to the use of excessive force or worn out and fatigued instruments. Majority of these students (93.8%) reported completing the treatment after getting a fracture instrument, this is probably due to the limited time they have in completing their requirements and starting a new case will take as much time, also it is due to the no referral policy of the department that student should mange such cases with direct supervision. Most of the students tried to retrieve the separated instrument, but because they lack the clinical experience and special instruments they completed the treatment by obturating to the level of the fractured instrument.

Alhekeir et al.[20] andBalto et al.[21] stated that mishaps, in general, occur in the posterior dentition. In the current study, separated instrument was found to be the only mishap reported. Also, it was found to be more common in the posterior dentition, most commonly in the lower first molar and more specific to the mesio-buccal canal. This is again due to difficulty of visibility and having to rely on the tactile sensation, a skill which is yet a student to develop over the years, and also the complexity of the multi-rooted teeth which contributes to the matter.[19]

A significant association was found between overall confidence level of students who were subjected to instrument fracture and the frequency of fracture, supervisor reaction, and willingness to specialize in endodontics. These results demonstrated how self-confidence can directly affect the students' performance in the present time and their perception of the subject in the future.

Unlike the study carried out by Murry et al.[16] and Shetty et al.[18] the vast majority of the students do not wish to specialize in the endodontic field in the future. This might be due to the fact that endodontics is one of the most difficult disciplines or simply a matter of personal preferences.


  Conclusion Top


This study is not a measure of competency for the students, but rather a self-assessment of competency for the students to give an insight to those standing in front of the blackboard. In general, students displayed high confidence in performing basic endodontic procedures. More similar studies are required to aid developing and refining the educational process.

Financial support and sponsorship

University of Medical Science and Technology, Sudan.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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European Society of Endodontology. Undergraduate curriculum guidelines for endodontology. Int Endod J 2001;34:574-80.  Back to cited text no. 2
    
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Rolland S, Hobson R, Hanwell S. Clinical competency exercises: Some student perceptions. Eur J Dent Educ 2007;11:184-91.  Back to cited text no. 3
    
4.
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5.
Saunders WP, Chestnutt IG, Saunders EM. Factors influencing the diagnosis and management of teeth with pulpal and periradicular disease by general dental practitioners. Part 1. Br Dent J 1999;187:492-7.  Back to cited text no. 5
    
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Weiger R, Hitzler S, Hermle G, Löst C. Periapical status, quality of root canal fillings and estimated endodontic treatment needs in an urban German population. Endod Dent Traumatol 1997;13:69-74.  Back to cited text no. 9
    
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Martins RC, Seijo MO, Ferreira EF, Paiva SM. Dental Students' Perceptions about the Endodontic Treatments Performed Using NiTi Rotary Instruments and Hand Stainless Steel Files. Braz Dent J 2012;23:729-36.  Back to cited text no. 10
    
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Oliver R, Kersten H, Vinkka-Puhakka H, Alpasan G, Bearn D, Cema I, et al. Curriculum structure: Principles and strategy. Eur J Dent Educ 2008;12 Suppl 1:74-84.  Back to cited text no. 11
    
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14.
Lynch CD, Ash PJ, Chadwick BL. Student perspectives and opinions on their experience at an undergraduate outreach dental teaching centre at Cardiff: A 5-year study. Eur J Dent Educ 2010;14:12-6.  Back to cited text no. 14
    
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De Moor R, Hülsmann M, Kirkevang LL, Tanalp J, Whitworth J. Undergraduate curriculum guidelines for endodontology. Int Endod J 2013;46:1105-14.  Back to cited text no. 15
    
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Murray CM, Chandler NP. Undergraduate endodontic teaching in New Zealand: Students' experience, perceptions and self-confidence levels. Aust Endod J 2014;40:116-22.  Back to cited text no. 16
    
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Arena G, Kruger E, Holley D, Millar S, Tennant M. Western Australian dental graduates' perception of preparedness to practice: A five-year follow-up. J Dent Educ 2007;71:1217-22.  Back to cited text no. 17
    
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Shetty N, Kundabala M, Shenoy R. Attitude and perception of undergraduate dental students toward endodontics as a specialty in India. J Educ Ethics Dent 2014;4:8-11.  Back to cited text no. 18
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Dummer PM. Comparison of undergraduate endodontic teaching programmes in the United Kingdom and in some dental schools in Europe and the United States. Int Endod J 1991;24:169-77.  Back to cited text no. 19
    
20.
Alhekeir DF, Al-Sarhan RA, Mokhlis HR, Al-Nazhan SA. Endodontic mishaps among undergraduate dental students attending King Saud University and Riyadh colleges of dentistry and pharmacy. Saudi Endod J 2013;3:25-30.  Back to cited text no. 20
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    Tables

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