|Year : 2023 | Volume
| Issue : 1 | Page : 36-43
Assessment of quality of life among dental practitioners using magnification devices during nonsurgical root canal treatment in the Kingdom of Saudi Arabia: A cross-sectional study
Nezar Mohammed Boreak, Afnan Yahya Shabi, Hamed Ahmed Ali Alshawkani, Walaa Aqeel Ageeli, Zainab Mousa Madhhali, Abdulrahman Saeed Al Juman, Ahmed Ali Shibli, Hussain Hassan Najmi
Department of Restorative Dentistry, College of Dentistry, Jazan University, Jizan, Kingdom of Saudi Arabia
|Date of Submission||10-May-2022|
|Date of Decision||19-Jul-2022|
|Date of Acceptance||21-Jul-2022|
|Date of Web Publication||11-Jan-2023|
Dr. Nezar Mohammed Boreak
Department of Restorative Dentistry, College of Dentistry, Jazan University, Jizan
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Introduction: This study was conducted to assess the effect of magnification devices (MDs) during nonsurgical root canal treatment (RCT) on quality of life (QOL) among dental professionals of the Kingdom of Saudi Arabia. The dental practitioners performing endodontic treatment were evaluated for ergonomic, postural, psychological, and financial issues associated with and without the use of MDs.
Materials and Methodology: A total of 1650 dental professionals (general dentists and endodontists) were recruited from public and private sectors of Saudi Arabia from October 2021 to December 2021. The World Health Organization's QOL assessment questionnaire (WHOQOL-BREF) was administered to conduct the study. The questionnaire addressed four domains of QOL which included physical, psychological, procedural, and financial. Statistical analysis was done by SPSS software® version 23.0. Descriptive analysis, ANOVA test, and unpaired t-test were used.
Results: All dental professionals completed the survey. 41.5% reported the use of MDs out of which dental loupe was most commonly used. Work-related musculoskeletal disorders were the most frequent physical difficulty which was faced by 61.5% of dental practitioners while performing RCT. 80% of DPs revealed that MDs improve manual abilities while performing RCT. MDs also relieved psychological, physical, and postural stress by 49.2%, 64.6%, and 63%, respectively. Further 72% of the dental professionals reported improved quality of work after the usage of MD.
Conclusion: MDs are commonly used by dental professionals during RCT in Saudi Arabia. It is believed that its use can lead to a better ergonomic, postural, and psychological state of these dental professionals.
Keywords: Dental practitioners, endodontists, magnification devices, quality of life, root canal treatment
|How to cite this article:|
Boreak NM, Shabi AY, Alshawkani HA, Ageeli WA, Madhhali ZM, Al Juman AS, Shibli AA, Najmi HH. Assessment of quality of life among dental practitioners using magnification devices during nonsurgical root canal treatment in the Kingdom of Saudi Arabia: A cross-sectional study. Saudi Endod J 2023;13:36-43
|How to cite this URL:|
Boreak NM, Shabi AY, Alshawkani HA, Ageeli WA, Madhhali ZM, Al Juman AS, Shibli AA, Najmi HH. Assessment of quality of life among dental practitioners using magnification devices during nonsurgical root canal treatment in the Kingdom of Saudi Arabia: A cross-sectional study. Saudi Endod J [serial online] 2023 [cited 2023 Feb 1];13:36-43. Available from: https://www.saudiendodj.com/text.asp?2023/13/1/36/367522
| Introduction|| |
Root canal treatment (RCT) is an age-old treatment practiced by dental professionals. Obturation is one of the most crucial steps during this procedure where gutta-percha was used as an obturating material since 1847 till date.
A successful RCT requires expertise in the clinical steps involved in the treatment. Critical visual assessment of minute details during the procedure is also considered essential for favorable prognosis. However, this critical assessment is not possible without MD. These MDs act to bridge the gap between the naked eye and microscope. This not only aids to enhance the dental professional's visualization but is also known to improve their working posture as well.
Magnification can aid in the visualization of fractured root or residual pulp tissue which is considered the sole cause of lingering tooth pain during an endodontic procedure. It is of interest to note that MDs are widely used by the dental professionals these days because of its potential ergonomic benefits., Further various researchers have also studied the role of MDs for promoting good posture and reduction in musculoskeletal stress among dental professionals. This perception has been a prominent marketing strategy for the manufacturers of these MDs for endodontic use.,, These devices include dental operating microscope, loupes, and endoscopes. Owing to visual enhancement offered by these devices, their use has been advocated by recent studies in literature.,
It is of interest to note that literature reveals variable opinion on the usage of MDs.,,,, On the one hand, the dental professionals of the United States and the United Kingdom reveal raised trend of the usage of these devices during endodontic treatment;, however, on the other hand, Turkish dental practitioners were resistant toward their use., Some researchers have also postulated few factors which encourage the dental professionals for the use of MDs. These factors include exposure to MDs in a conference, peer influence, and awareness about the recent advancements/benefits of such devices. However, increased treatment time, steep learning curve, problems during infection, and postural difficulties were considered the factors which discouraged the dentists from the usage of these devices.
Apart from the fact that the literature is flooded with the perception of benefits of MDs in endodontics, there is still scarcity of well-designed and scientifically sound articles which highlight the effect of these on the QOL of dentists performing the procedure.,, Most of the studies address QOL in terms of patient-centric dental care; however, the success of the treatment is actually dependent on the dental professionals. This necessitates the fact that QOL of dental professionals is also necessary. This QOL can be evaluated with several indicators such as improvement in quality of treatment as well as raised postural/physical and psychological comfort. This may further include reduced visual stress as well as reduced musculoskeletal injury. Henceforth, the aim of this study was to assess the effect of using MDs while performing nonsurgical RCT on the QOL of dental professionals of the Kingdom of Saudi Arabia.
| Materials and Methodology|| |
A multicenter cross-sectional study was conducted on dental professionals including general dental practitioners and endodontists of either sex to evaluate QOL among them while using MDs during nonsurgical RCT. The study protocol was approved by the Scientific Research Unit of Jazan University with approval number CODJU-2110F. The research was conducted according to the Helsinki Declaration.
One thousand six hundred and fifty dental professionals were selected by conservative sampling technique from five different study centers in the Kingdom of Saudi Arabia including College of Dentistry of King Abdulaziz, Taibah and Jazan University, Buraidah College of Pharmacy and Dentistry (Private Institute), and Al Hijra Multispecialty Dental Clinics in Al Madina Al Monawara.
Dental professionals performing nonsurgical RCT and practicing in the Kingdom of Saudi Arabia with a valid registration number were included regardless of the fact, whether RCT was done in single or multiple sittings. Immature teeth and dental professionals who do not practice endodontic treatment were excluded from the study.
The World Health Organization's quality of life (QOL) assessment questionnaire (WHOQOL-BREF) was administered to study participants recruited. The questionnaire was modified and was in English language and was distributed in person to the selected dental professionals by the investigators. Participation in the study was voluntary. Written informed consent was obtained from each participant before filling the questionnaire. All the participants were ensured about the confidentiality of their responses.
The first part of the questionnaire (demographic) included general information of dental practitioners such as age, gender, nationality, and years of practice, and the second part addressed four domains of QOL which included physical (ergonomic), procedural, psychological, and financial issues [Supplementary material: Questionnaire].
Pretesting of the questionnaire
WHOQOL-BREF questionnaire was pretested among a small sample of 25 dentists. This aided to evaluate approximate time to fill the questionnaire by the respondents. This also helped to relate any problems associated with the formulation of questions. The reliability of the questionnaire was also evaluated on another group of dental professionals. The intra-observer agreement was good (κ = 0.952).
Participants were instructed to mark their responses on a 3-point scale on the basis of their level of agreement with proposed management. The total score of RCT difficulty was calculated by assigning 0 for “never” and 2 for “regularly” for all the 8 RCT difficulty items [Graph 1]. Hence, a maximum 16 score was possible. The total gained score was the sum of all item scores of RCT difficulty. For overall summary of various components of magnification device (MD) use, the scoring method was used with scoring criteria as follows: regularly (yes) = 2, sometimes (to some extent) = 1, and never = 0.
The total score of RCT difficulty was achieved by adding all the item scores of RCT difficulty component. The total score of MD importance [Graph 2], MD satisfaction [Graph 3], and improved quality of work [Graph 4] was also achieved by adding all the individual item scores, respectively. Similarly, the total score of “expenses” was achieved by adding all the item scores of expense component.
Data entry was made in Microsoft Office Excel software in codes and analysis was done by SPSS software® version 23.0. Descriptive statistical analysis, which included frequency, percentage, mean, and standard deviation, was used to characterize the data. ANOVA test was used to compare magnification component scores between multiple categories of various factors, while unpaired t-test was used to compare magnification component scores between exclusively two categories. P < 0.05 was considered statistically significant.
| Results|| |
All dental professionals completed the self-administered questionnaire survey. Most of the subjects were in the age range of 25–35 years (72.2%). Majority of them were males (77.6%) and Saudi residents (81.1%). Among them, 40.4% were using MDs, i.e., loupe, endoscope, or dental operating microscope. Most of them (53.0%) had clinical practice experience of <5 years [Table 2].
|Table 2: Distribution of subjects according to expenses of magnification use|
Click here to view
The perception of difficulties faced by the dental professionals during RCT is highlighted in [Graph 1]. The most frequent difficulty faced by the practitioners while performing RCT was work-related musculoskeletal disorders due to RCT for long hours with a 61.9% response rate on a regular level. 33.3% of the respondents have faced regular discomfort, aches, and numbness due to the procedure. The least frequent difficulty was tingling, burning sensation in arms and hands of the dental professionals which was regularly reported by 12.8% of the dental professionals. As far as the importance of MDs was concerned, 80.1% believed that these devices improved manual abilities and can pose as a better tool for RCT in terms of resolving certain complex clinical issues. 76.1% believed that MDs can enhance the accuracy of RCT. 64.4% even revealed that magnification should be considered by all the dentists for RCT [Graph 2].
[Graph 3] highlights the level of satisfaction among the practitioners regarding the use of MDs for RCT. 48.4% reveals a decrease in psychological stress, 64.4% highlighted decreased physical stress, while 62.7% revealed reduced postural stress with the use of MDs. The most common satisfaction item was “professional satisfaction” as responded by 73.0% of dental professionals followed by raised “personal satisfaction” as responded by 68.3% of dental professionals [Graph 3]. Quality of work was improved in 71.5% of DPs after magnification use [Graph 4]. However, 53.2% also responded that investment of time and expense is involved for learning the technique of using these devices. 45.4% of subjects responded that MDs are expensive; however, 29.6% were of the view to install economic MDs [Table 1].
The total score of RCT difficulty, MD importance, MD satisfaction, improvement in the quality of work, and expenses was shown by 52.19%, 83.89%, 75.18%, 66.65%, and 56.15% of dental professionals, respectively. Only “year of practice” showed a significant association with expense (P = 0.029). More score was observed for lesser year of practice.
The age, gender, and nationality of the respondents had a significant association with all the variables [P values highlighted in [Table 3]]. As for nationality was concerned, Saudi dental professionals scored significantly higher for RCT difficulty as compared to non-Saudi dental professionals (the higher score for Saudi group was >55 years, P < 0.001). Further, they scored less for MD importance, MD satisfaction as well as improvement in the quality of work (higher score for non-Saudi, P < 0.001). Saudi dental professionals considered MDs as expensive as compared to non-Saudi DPs (P = 0.004). Using any of the MD showed a significant association with MD importance (higher score for users, P < 0.001) and expense (higher score for nonusers, P = 0.004) [Table 3].
|Table 3: Association of magnification use components with baseline characteristics|
Click here to view
The type of MD use revealed a significant association of RCT difficulty (max score for loupe, P < 0.001). Most practitioners consider the endoscope as the most important MD (P = 0.005) which can lead to significant improvement in the quality of work (P < 0.001). However, MD satisfaction was most frequently reported for loupe (P < 0.001). Considering expense involved in purchasing the equipment, the endoscope was found to be most expensive MD (P < 0.001). Year of practice showed a significant association with RCT difficulty, MD importance, and MD satisfaction (max score for year of practice 5–10 years, P < 0.001). Expense was most significantly associated with the <5-year age group, while improvement in the quality of work with MD was significantly associated with >15 years of practice (P < 0.001) [Table 3].
| Discussion|| |
The scientific world, especially dental profession, has witnessed great revolutions and advancements in the past. Magnification is considered one such great advancement in dentistry which has actually led to raised precision of dental care, especially in endodontics. It was in 1970 when magnification was first utilized in dentistry in the form of operative microscope. Further, Dr. Gary Carr was the first person to use dental operating microscope in endodontics in the 1980s. He further revealed that magnification with illumination can aid in the increased success of endodontic treatment.
Literature also reveals the advantage of using MDs like dental operating microscope in carries diagnosis and excavation and for evaluation of margins of crown post placement. Further, evidence also exists regarding the use of MDs for surgical incisions, grafting procedures as well as perforation repair. Several researchers have advocated that MDs actually improve the quality of treatment along with reduction in visual stress experienced by the dental professionals. Dentists are prone to musculoskeletal pain and injuries owing to their posture during dental procedures. Implementation of MDs is even considered to reduce muscular pain associated with dental procedures since it aids in achieving better posture during dental practice.,,,,,,,,,, Tsesis et al. revealed that the therapeutic outcome of treatment can be significantly raised if MDs like microscopes are used. This extends high support to the fact that MDs should be considered a standard of care for endodontic treatment. Apart from the above-said fact, it is of importance to note that one Scottish study conducted in the year 1999 revealed that only 9% of general dental practices reported the regular use of dental MDs in their practice.
Although there is a scarce use of these devices, there is increased evidence of the use of dental loupes among general dental professionals (44%).,, Undergraduate students further used these devices in a reduced fashion. Henceforth, it was recommended that the importance of dental MDs is underscored or there is less awareness among dental students regarding the use of dental MDs in clinical practice, especially endodontics. A similar study also revealed that there was a significant improvement among dental undergraduate students in terms of the outcome of class II cavity preparation after using magnification loupes., Henceforth, this study was conducted to investigate and evaluate the ergonomic, procedural, postural, and psychological effects of performing RCT on dental professionals while using MDs in comparison to the professionals performing RCT without using these devices. To the best of our knowledge, this study was one of its type studies conducted among the DPs of Saudi Arabia.
The current study revealed that 40.4% of the enrolled dental professionals used MDs in RCT. This was little more than the result of a study conducted by Baharin et al. in 2021 where only 1/4th of the study participants used any form of MD. However, the results of the study done in the United Kingdom, the United States, Belgium, and South Africa were more. The present study also highlighted that male dental professionals used these MDs more frequently as compared to the female dental professionals. This was also reported by Bahrain et al. This can be explained by the fact that private practitioners are free to choose or adapt the use of MDs as a part of their clinical armament. However, on the contrary, the institutional practitioners or academicians are dependent upon the institutional resource allocation or purchasing procedures.
As far as the type of MD was concerned, dental loupe was used by most of the dental professionals enrolled followed by dental operating microscope. A very less number of dental professionals used endoscope. This was in accordance with the study done by Bahrain et al. This could be attributed due to affordability for loupes. Further, the level of magnification provided by the loupes is considered sufficient for dental practice including endodontics. However, greater magnification may be required to locate accessory canals so as to increase the treatment success.,
As far as the cost of MDs was concerned, in this study, 45.4% of the dental practitioners considered MDs as expensive. This was in accordance with the findings of Baharin et al. who revealed that expense of MD is considered the most common reason cited for not using these devices by 38.5% of the dental practitioners.
Work-related musculoskeletal disorders were experienced by almost all the dental professionals of this study, out of which 61.5% reported these disorders regularly during endodontic treatment. This was in contrast to the findings of Baharin et al. where reduced musculoskeletal strain was reported by 20.9% of the dental professionals after MD use. Further, burning sensation and tingling in the arms, decrease in range of motion, and loss of coordination were not reported by most of the dental professionals with 56.9% 46.2%, and 55.4% frequency, respectively. This was in accordance with the findings of a review done by Doppalapudi et al. which reveals that enhanced precision and an improved QOL can be achieved by reducing the unwanted stress on musculoskeletal system with the use of MDs while performing endodontic treatment. Henceforth, the use of MDs is advocated to prevent or reduce musculoskeletal disorders.
Literature reveals that the use of magnification is for enhancing visual capacity for better treatment planning.,, This paper also revealed that the use of MDs leads to raised manual ability as reported by 80% of the dental professionals. This was in accordance with the findings of systematic review conducted by Del Fabbro et al. where MDs were found to be advantageous in ergonomic, postural as well as therapeutic sectors.
Dental operating microscope was used by 41.6% of the practitioners in the study. This number is lesser as compared to the number of practitioners using loupes (50.5%). This was in accordance with the study done by Baharin et al. This can further be supported by the findings of Doppalapudi et al. as well as Del Fabbro et al. who revealed that loupes followed by dental operating microscopes offer a great advantage while performing RCT., This could be attributed to the fact that more complex cases require greater magnification powers.,
The current study also reveals that MDs raised professional satisfaction and quality of work in endodontics. 76.9% of dental professionals reported that the accuracy of RCT was enhanced due to MD use. This was in accordance with the other studies in literature which reveals that MDs enhance ergonomics.,, This can also be supported by the work of Meraner et al. which highlighted that the intuitive position and enhanced vision can lead to better endodontic therapy.
The large sample size and involvement of different study centers in Saudi Arabia can be considered the strength of this study. However, on the contrary, the usage of a self-assessment questionnaire with convenience sampling method can be considered limitation. Further, the data were collected from only five different study centers of four different cities of Saudi Arabia. Henceforth, the results do not possess external validity for the rest of Saudi Arabia. Further research considering factors such as workload and intensity can be considered the areas to be evaluated in endodontic treatment with MDs.
| Conclusion|| |
It can be concluded that the DPs considered MDs as an important tool to raise the quality of work in endodontics. It is believed that its use can lead to a better ergonomic, postural, and psychological state of the dental professionals.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Meraner M, Nase JB. Magnification in dental practice and education: Experience and attitudes of a dental school faculty. J Dent Educ 2008;72:698-706.
Baharin SA, Fay LJ, Mohd-Dom TN. A cross-sectional survey on the use of magnification device in mainstream dental practice. Teikyo Med J 2021;44:1983-91.
Farook SA, Stokes RJ, Davis AK, Sneddon K, Collyer J. Use of dental loupes among dental trainers and trainees in the UK. J Investig Clin Dent 2013;4:120-3.
Branson BG, Bray KK, Gadbury-Amyot C, Holt LA, Keselyak NJ, Mitchell TV, et al
. Effect of magnification lenses on student operator posture. J Dent Educ 2004;68:384-9.
Chang BJ. Ergonomic benefits of surgical telescope systems: Selection guidelines. J Calif Dent Assoc 2002;30:161-9.
Del Fabbro M, Taschieri S, Lodi G, Banfi G, Weinstein RL. Magnification devices for endodontic therapy. Cochrane Database Syst Rev 2015;12:CD005969.
Doppalapudi N, Burugapalli RK. Benefits of utilization of magnification in dentistry: A review. Dent Res Oral Health 2020;3:121-8.
Mines P, Loushine RJ, West LA, Liewehr FR, Zadinsky JR. Use of the microscope in endodontics: A report based on a questionnaire. J Endod 1999;25:755-8.
Kersten DD, Mines P, Sweet M. Use of the microscope in endodontics: Results of a questionnaire. J Endod 2008;34:804-7.
Alrayes N, Alshammary H, Alamoudi M, Alfardan B, Alhareky M, Nazir M. Evaluation of quality of life among dental professionals by using the WHOQOL-BREF instrument in eastern province of Saudi Arabia. ScientificWorldJournal 2020;2020:5654627.
Burke FJ, Wilson NH, Christensen GJ, Cheung SW, Brunton PA. Contemporary dental practice in the UK: Demographic data and practising arrangements. Br Dent J 2005;198:39-43.
Topkara C, Ozyurek T, Demiryürek EO, Bursalı T, Özler M. Attitudes, materials, and methods preferred in root canal treatment in Turkey: A survey. Turk Endod J 2017;2:31-7.
Low JF, Dom TN, Baharin SA. Magnification in endodontics: A review of its application and acceptance among dental practitioners. Eur J Dent 2018;12:610-6.
] [Full text]
Bowers DJ, Glickman GN, Solomon ES, He J. Magnification's effect on endodontic fine motor skills. J Endod 2010;36:1135-8.
Sunell S, Rucker L. Surgical magnification in dental hygiene practice. Int J Dent Hyg 2004;2:26-35.
Monea M, Hantoiu T, Stoica A, Sita D, Sitaru A. The impact of operating microscope on the outcome of endodontic treatment performed by postgraduate students. Eur Sci J 2015;11:305-11.
World Health Organization. Programme on Mental Health: WHOQOL User Manual. Geneva, Switzerland: World Health Organization; 1998.
Alhazzazi TY, Alzebiani NA, Alotaibi SK, Bogari DF, Bakalka GT, Hazzazi LW, et al.
Awareness and attitude toward using dental magnification among dental students and residents at King Abdulaziz University, Faculty of Dentistry. BMC Oral Health 2016;17:21.
Malterud MI. Magnification: You can't effectively practice minimally invasive biomimetic dentistry without it. Gen Dent 2013;61:14-7.
Leknius C, Geissberger M. The effect of magnification on the performance of fixed prosthodontic procedures. J Calif Dent Assoc 1995;23:66-70.
Del Fabbro M, Taschieri S, Lodi G, Banfi G, Weinstein RL. Magnification devices for endodontic therapy. Cochrane Database Syst Rev 2009;3:CD005969.
Christensen GJ. Magnification in dentistry: Useful tool or another gimmick? J Am Dent Assoc 2003;134:1647-50.
Mallikarjun S, Devi P, Naik A, Tiwari S. Magnification in dental practice: How useful is it? J Health Res Rev 2015;2:39. [Full text]
Friedman MJ. Magnification in a restorative dental practice: From loupes to microscopes. Compend Contin Educ Dent 2004;25:48, 50, 53-5.
Maillet JP, Millar AM, Burke JM, Maillet MA, Maillet WA, Neish NR. Effect of magnification loupes on dental hygiene student posture. J Dent Educ 2008;72:33-44.
Tsesis I, Rosen E, Schwartz-Arad D, Fuss Z. Retrospective evaluation of surgical endodontic treatment: Traditional versus modern technique. J Endod 2006;32:412-6.
Forgie AH, Pine CM, Longbottom C, Pitts NB. The use of magnification in general dental practice in Scotland – A survey report. J Dent 1999;27:497-502.
Narula K, Kundabala M, Shetty N, Shenoy R. Evaluation of tooth preparations for Class II cavities using magnification loupes among dental interns and final year BDS students in preclinical laboratory. J Conserv Dent 2015;18:284-7.
] [Full text]
Savani GM, Sabbah W, Sedgley CM, Whitten B. Current trends in endodontic treatment by general dental practitioners: Report of a United States national survey. J Endod 2014;40:618-24.
Neukermans M, Vanobbergen J, De Bruyne M, Meire M, De Moor RJ. Endodontic performance by Flemish dentists: Have they evolved? Int Endod J 2015;48:1112-21.
Alrejaie M, Ibrahim NM, Malur MH, Alfouzan K. The use of dental operating microscopes by endodontists in the Middle East: A report based on a questionnaire. Saudi Endod J 2015;5:134-7. [Full text]
Khalighinejad N, Aminoshariae A, Kulild JC, Williams KA, Wang J, Mickel A. The effect of the dental operating microscope on the outcome of nonsurgical root canal treatment: A retrospective case-control study. J Endod 2017;43:728-32.
Nath KS, Shetty K. Comparative evaluation of second mesiobuccal canal detection in maxillary first molars using magnification and illumination. Saudi Endod J 2017;7:166-9. [Full text]
[Table 1], [Table 2], [Table 3]