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ORIGINAL ARTICLE
Year : 2015  |  Volume : 5  |  Issue : 3  |  Page : 171-176

Endodontic radiology, practice, and knowledge of radiation biology, hazard, and protection among clinical dental students and interns


Department of Restorative Dentistry, University of Benin Teaching Hospital, Benin City, Edo, Nigeria

Date of Web Publication26-Aug-2015

Correspondence Address:
Joan Emien Enabulele
Department of Restorative Dentistry, University of Benin Teaching Hospital, Benin City, Edo State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-5984.163634

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  Abstract 

Objective: To evaluate the practice and knowledge of endodontic radiology as well as assess the knowledge of radiation biology, hazard, and protection among clinical dental students and interns.
Materials and Methods: Cross-sectional study of clinical dental students and interns at University of Benin and University of Benin Teaching hospital respectively. Data was collected using a questionnaire which covered practice and knowledge of endodontic radiography, knowledge of radiation biology, hazard, and protection. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 17.0.
Result: Seventy participants were included in the study, 40% were final year students and 24.3% house officers. Majority (95.7%) agreed that they exposed radiographs as part of endodontic treatment. Only 18.6% knew that the apices of teeth should be 3mm from the border of the X-ray film, while 24.3% knew that 3mm of periapical bone should be visible on X-ray. Less than half (31.4%) knew that paralleling technique was the technique of choice for endodontic radiography and this was statistically Significant in relationship to the status of the of the respondents. A few (4.3%) of the respondents had knowledge of new horizons in endodontic imaging. Half of the respondents knew that damage by X-rays is mainly due to formation of free radicals. The most frequently reported radiation hazards was reduced salivary flow, while the least reported was rampant caries. Most knew how to protect patients, themselves, and other persons while exposing radiographs.
Conclusion: There is need for inclusion of endodontic radiography in the undergraduate curriculum to ensure proper and correct radiographs during endodontic procedure.

Keywords: Dental students, dental intern, endodontic radiology, knowledge


How to cite this article:
Enabulele JE, Itimi E. Endodontic radiology, practice, and knowledge of radiation biology, hazard, and protection among clinical dental students and interns. Saudi Endod J 2015;5:171-6

How to cite this URL:
Enabulele JE, Itimi E. Endodontic radiology, practice, and knowledge of radiation biology, hazard, and protection among clinical dental students and interns. Saudi Endod J [serial online] 2015 [cited 2021 Sep 25];5:171-6. Available from: https://www.saudiendodj.com/text.asp?2015/5/3/171/163634


  Introduction Top


Endodontics has been defined as the aspect of dentistry which involves the treatment or precautions taken to maintain the vital tooth, the moribund tooth, or the Non vital tooth in the dental arch.[1] Most structures of concern during endodontic therapy are not visible to the naked eyes, hence, they cannot be directly observed.[2],[3] It is imperative therefore that an imaging process be employed to aid in visualization leading to a considerable dependence on radiographs.[3]

Although radiation doses in dental radiography are low and may not present any risks, exposure to radiation should be minimized where practicable.[4][5][6] There should be a reasonable expectation of gaining information from the radiograph that is not available from any other reasonably available safer method,[4],[7] which is applicable in endodontics.

Since no amount of radiation is safe, the basic goal of radiation protection is to prevent exposures that cause deterministic effects and reduce the potential for stochastic effects.[4] It is important that the As Low as Reasonably Achievable (ALARA) principle is followed to minimize patient's exposure. The information gotten from the radiograph must be necessary for the diagnosis or treatment and must be obtained using the least number of radiographs required and made with the smallest amount of radiation consistent with producing radiographs of acceptable diagnostic quality.

Protective measures need to be taken to safeguard the patient, the operator, and others from the harmful effect of radiation. The use of faster film speed have been found to result in up to a 50% decrease in exposure to the patient without compromising diagnostic quality.[4],[8] Film holders that align the film precisely with collimated beam are recommended for periapical and bitewing radiographs.[8] Leaded aprons and thyroid shields that contain lead or other materials are patient-protective equipment that minimize the exposure to scattered radiation.[4],[7] Operator protection measures include education, implementation of a radiation protection program, and annual and life time limits of exposure to ionizing radiation. As well as recommendations for personal dosimeters and the use of barrier shielding.[8]

In Nigeria, endodontics is not one of the recognized dental specialties that postgraduate training is undertaken. Endodontics is part of restorative dentistry with restorative dentist teaching endodontics at the undergraduate and postgraduate levels. During undergraduate and postgraduate training, students are expected to perform endodontic procedures which involve endodontic radiography. Student feedback is a fundamental part of the assessment and/or evaluation of teaching processes.[9] It gives students the opportunity to express their views and provide valuable information about their learning.[10],[11]

Many studies on the knowledge of ionizing radiation of patients, medical students, and physicians who requested radiographs and even radiologists,[12][13][14][15][16][17] revealed poor knowledge among these groups of people. However, only a few studies were found among dental students and interns[18],[19] with none assessing knowledge and practice regarding endodontic radiography.

This study was designed therefore to evaluate the Practice and knowledge of endodontic radiology and knowledge of radiation biology, hazards, and protection among clinical dental students and interns.


  Materials and Methods Top


This was a cross-sectional study of clinical dental students and interns at the University of Benin and University of Benin Teaching Hospital, respectively. The target population was all the clinical dental students (68) and interns (17) who expose radiographs for patients undergoing endodontic treatment giving a total of 85 participants. Ethical approval was obtained for this study from the College Ethics and Research Committee, College of Medical Sciences, University of Benin, Benin city, Edo state. Informed consent was sought from all the participants in this study.

The data collection instrument was a pretested, self-administered questionnaire which was atfirst developed from reviewed literatures and modified based on the authors' observations and knowledge. The pretesting was done using seven volunteering dental students who were excluded from the final study. The questionnaire was further developed into the final form which was administered after a departmental seminar at which all interns and students were expected to attend. The questionnaire's Flesch Reading Ease was 52.2 and Flesch-Kincaid grade level was 8.3. There was no prior notice or lecture on the topic given to the participants by the researchers and all the questionnaires were picked and dropped at a designated point in the department. The questionnaire consisted of five sections. Thefirst section being sociodemographic data, second section practice of endodontic radiography, third section knowledge of radiation biology, fourth section knowledge of radiation hazards, and fifth section knowledge of radiation protection. There was no student/intern identifier in the questionnaires. Correct responses were allocated 1 mark, while wrong response received no mark. No point was subtracted for wrong responses.

Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 17 (Chicago, IL). The analysis was done using frequency distribution and cross tabulations. Pearson's coefficient correlation analysis was performed to establish relationship between various variables with the significant level set at 5%.


  Results Top


Eighty-five questionnaires were administered to all the clinical dental students and interns, 70 questionnaires were returned and used for the study giving a response rate of 82.4%. Majority (70%) were in the 25–30 years age group with only a few (12.9%) married. Students (penultimate class 35.7%; final year class 40%) made up majority of the respondents [Table 1]. Majority (95.7%) agreed that they exposed radiographs as part of endodontic treatment. Most (95.7%) of the respondents reported that they exposed radiographs for preoperative evaluation of patients; while 67.1 and 70.0% exposed radiographs during endodontic treatment for verification of the procedure and postoperatively to evaluate treatment outcome, respectively [Table 2]. There was statistically significant association between status of the respondents and exposing radiographs for preoperative evaluation of patients (P = 0.001) as well as with exposing radiographs postoperatively to evaluate treatment outcome (P = 0.03) with an increase in such radiographic exposures as the status of the respondent increased.
Table 1: Sociodemographic characteristics of the respondents


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Table 2: Responses to the questionnaire section 2 (Endodontic radiography)


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Majority (77.1%) knew that film holders could be used during endodontic radiographic exposure, while less than half (31.4%) knew that paralleling technique was the technique of choice for endodontic radiography [Table 2] and this was statistically significant in relation to the status of the respondents (P = 0.0001) with more respondents knowledgeable as their status increased. Only 18.6% knew that the apices of teeth should be 3 mm from the border of the X-ray film, while 24.3% knew that 3 mm of periapical bone should be visible on X-ray. There was no statistically significant association with the status of the respondents. Few (4.3%) of the respondents had knowledge of new horizons in endodontic imaging.

Half of the respondents knew that damage by X-rays is mainly due to formation of free radical [Table 3] and this was statistically significant with status of the respondents (P = 0.01) with increase in knowledge as status increased. Majority (84.3%) reported that radiation could induce changes in the oral cavity. Varying responses with regards to induction of changes in the oral organs by radiation was reported as follows: Taste buds (70.0%), salivary glands (87.1%), teeth (51.4%), and bone (84.3%). The most frequently reported radiation hazards were reduced salivary flow (78.6%) and osteoradionecrosis (72.9%), while the least reported were rampant caries (38.6%) and acidic saliva (38.6%). Loss of taste, mucositis, secondary infection, fibroatrophy of the pulp, and malformation of the teeth were reported as radiation hazards by 64.3%, 50.0%, 52.9%, 54.3% and 51.4%, respectively. There was statistically significant association between knowledge of osteoradionecrosis as a radiation hazard and status of the respondents (P = 0.03) with increase in knowledge as status increased. Majority of those who recognized mucositis as a radiation hazard were penultimate students and interns, and this was statistically significant (P = 0.04). Only 18.6% knew what ALARA meant; the lower the status of the respondents, the less the idea of what ALARA meant; and this was statistically significant. Most knew how to protect patients, themselves, and other persons while exposing radiographs [Table 4]. However, use of cone-shaped X-ray tube device and standing 6 feet away from primary X-ray beam was reported as a means of radiation protection more by penultimate students and interns, and this was statistically significant (P = 0.001 and 0.002, respectively).
Table 3: Responses to section 3 of the questionnaire (Radiation Biology)


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Table 4: Responses to the questions on radiation protection


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  Discussion Top


Radiographs are an important adjunct for successful endodontic treatment. As part of undergraduate training, dental students in Nigeria are expected to undertake simple endodontic procedures so it is not surprising that in this study majority of the respondents exposed radiographs as part of endodontic treatment. The role of radiographs has been well-emphasized with it being necessary for preoperative evaluation of patients as well as for verification of the procedure, evaluation of quality of root canal obturation,[20] and postoperative evaluation of treatment outcome. The respondents in this study tend to pay more attention to radiographic preoperative assessment compared with radiographic verification of the procedure and postoperative treatment outcome evaluation with an increase in such radiographic exposures as the status of the respondents increased. This is probably because without preoperative assessment, students cannot undertake endodontic procedure. In addition, the students may be involved in the initial preoperative assessment, but may not have the competence to continue endodontic management, thereby, reducing their chances of exposing the other radiographs. Radiographic verification of the procedure and evaluation of postoperative treatment outcome are very important for successful endodontic treatment, therefore, there is need for emphasis on these aspects of endodontic radiography in the undergraduate curriculum.

It has been recommended that a periapical radiograph intended for endodontic use must include the entire area of interest with the apices of the teeth at least 3 mm away from the border of the radiograph.[21] The technique of choice for endodontic radiography is the long cone paralleling technique due to its projection of an accurate radiograph with minimal dimensional distortion[22] as well as a high level of reproducibility.[23] Radiographs may not always determine the correct morphology when only a buccolingual view is exposed. Two or more periapical radiographs exposed at different angulations have been said to be mandatory for better evaluation.[24] It has been demonstrated that a single radiograph may show an apparently well-accomplished treatment. However, when retaken from a second or third viewpoint may demonstrate an important discrepancy relative to thefirst view.[25] In this study there was an obvious gap in knowledge with regards to the specifications of endodontic radiograph to ensure good quality radiographs.

It has been observed that conventional radiographs used for endodontics yield limited information because of the two-dimensional nature of images produced, geometric distortion, and anatomical noise. This led to the introduction of three-dimensional imaging techniques as adjuncts to conventional radiographs. These include tuned aperture computed tomography, magnetic resonance imaging, ultrasound, computed tomography, and cone beam computed tomography (CBCT).[26],[27] The respondents in this study seem not to be conversant with the new horizons in endodontic radiography. There is need to update the dental curriculum in line with recent research findings.

Generally, there was better practice as status increased lending credence to the role of clinical experience in rendering improved care. Knowledge and practice of radiation biology and protection seem to be better than that of endodontic radiology among the respondents. This suggests that general dental radiology is more entrenched in the curriculum, especially as radiographs are also exposed in other specialties.


  Conclusion Top


There is a need for inclusion of specific endodontic radiography with emphasis on the ideal requirements of an endodontic radiograph in the undergraduate curriculum. This is to ensure appropriate and accurate radiographs are exposed during endodontic procedure.

 
  References Top

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9.
Martini RC, Seijo MO, Ferreira EF, Paiva SM, Sobrinho AP. Dental students' perceptions about the endodontic treatments performed using NiTi rotary instruments and hand stainless steel files. Braz Dent J 2012;26:729-36.  Back to cited text no. 9
    
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Oliver R, Kersten H, Vinkka-Puhakkz H, Alpasan G, Bearn D, Cema I, et al. Curriculum structure: Principles and strategy. Eur J Dent Educ 2008;12:74-84.  Back to cited text no. 11
    
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13.
Zewdneh D, Dellie ST, Ayele T. A study of knowledge and awareness of medical doctors towards radiation exposurenrisk at Tikur Anbessa specialized referral and teaching hospital, Addis Ababa, Ethiopia. J Pharm Biol Sci 2012;2:1-5.  Back to cited text no. 13
    
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Mubeen SM, Abbas Q, Nighat N. Knowledge about ionizing and non-ionising radiation among medical students. J Ayub Med Coll Abbottabad 2008;20:118-21.  Back to cited text no. 14
    
15.
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Soye JA, Paterson A. A survey of awareness of radiation dose among health professionals in Northern Ireland. Br J Radiol 2008;81:725-9.  Back to cited text no. 16
    
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Lee CI, Haims AH, Monica EP, Brink JA, Forman HP. Diagnostic CT scans: Assessment of patient, physician and radiologist awareness of radiation dose and possible risks. Radiol 2004;231:393-8.  Back to cited text no. 17
    
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Prabhat MP, Sudhakar S, Kumar BP, Ramaraju. Knowledge, attitude and perception of dental undergraduates and interns on radiographic protection- A questionnaire based cross-sectional study. J Adv Oral Res 2011;2:45-50.  Back to cited text no. 18
    
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Enabulele JE, Igbinedion BO. An assessment of dental students' knowledge of radiation protection and practice. J Educ Ethics Dent 2013;3:54-9.  Back to cited text no. 19
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20.
Obeidat RS, Abdallah H. Radiographic evaluation of the quality of root canal obturation of single-matched cone guttapercha root canal filling versus hot lateral technique. Saudi Endod J 2014;4:58-63.  Back to cited text no. 20
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21.
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Alothmani OS, Friedlander LT, Chandler NP. Radiographic assessment of endodontic working length. Saudi Endod J 2013;3:57-64.  Back to cited text no. 22
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24.
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27.
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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