ORIGINAL ARTICLE

https://doi.org/10.5005/jp-journals-10063-0137
CODS Journal of Dentistry
Volume 14 | Issue 2 | Year 2022

Knowledge, Attitude, and Perception (KAP) of Dental Undergraduates and Interns on Radiographic Protection in Davangere City: A Questionnaire-based Cross-sectional Study

Poorvika B Gowda¹, BK Lilly², Sushanth VH³, Allama Prabhu CR⁴, Vivek H Prakash⁵, Srinidhi P Basavraj⁶

^1,3-6Department of Public Health Dentistry, College of Dental Sciences, Davangere, Karnataka, India

²Department of Public Health Dentistry, Davangere, Karnataka, India

Corresponding Author: BK Lilly, Department of Public Health Dentistry, College of Dental Sciences, Davangere, Karnataka, India, Phone: +91 9591099124, e-mail: lillybk8@gmail.com

Received on: 31 May 2023; Accepted on: 20 June 2023; Published on: 29 September 2023

ABSTRACT

Introduction: Radiation risks can be hazardous. It becomes precarious when there is professional negligence. It’s very important to provide proper and adequate knowledge regarding radiation hazards and protection protocols to dental undergraduates and interns during their course of training.

Aims and objectives: The current study’s objective is to evaluate dentistry students’ knowledge, attitudes, and perceptions (KAP) of radiation protection in Davangere city.

Materials and methods: In Davangere, Karnataka, India a cross-sectional questionnaire-based study was conducted with a sample of 140 dental students (third and final years) and interns. The study included dental radiology in the curriculum. Each student provided information using a structured questionnaire (15 in total), which only allowed for Yes or No responses. The data was then analyzed using the Pearson’s Chi-squared test to determine the statistical significance.

Results: Among 140 students enrolled in the study, 45 were undergraduates (45 from third–51 from final year) and 44 were interns. A total of 104 students responded out of which 45 were third years, 51 were final years, and eight were interns.

Conclusion: The most correct answers were provided by interns, followed by third- and final-year students. Interns, final-year students, and third-year students all scored higher on measures of radiation safety protocol KAP.

Key message: It is recommended that dental professionals adhere to radiation safety guidelines strictly, and it is crucial that dental institutions offer enough radiation protection training.

How to cite this article: Gowda PB, Lilly BK, VH S, et al. Knowledge, Attitude, and Perception (KAP) of Dental Undergraduates and Interns on Radiographic Protection in Davangere City: A Questionnaire-based Cross-sectional Study. CODS J Dent 2022;14(2):52-56.

Source of support: Nil

Conflict of interest: None

Keywords: Dental Students, Interns, Radiation protection.

INTRODUCTION

Living tissues are harmed by X-ray radiation.¹ Deterministic and stochastic effects are two different types of X-ray effects.² While stochastic effects are not dose-dependent.³ The strength of the reaction is proportionate to the dose in deterministic effects. Because of this, operators must be well-versed on radiation risks.⁴ When a patient undergoes an X-ray examination, photons pass through their bodies which may cause chromosome alteration.⁵ Hence exposure should be kept as low as reasonably practicable.⁶ As a result of their limited understanding, dental students and interns are more vulnerable to risk.⁷

OBJECTIVES

To assess the knowledge, attitudes, and perceptions (KAP) of dental students regarding the radiation protection protocols in Davangere city.

MATERIALS AND METHODS

Study Design

The current study was a cross-sectional survey conducted from December 2022 to January 2023.

Study Participants and Study Location

A total of 140 clinical undergraduate dental students (third and final-year dental students) and interns from two colleges (College of Dental Sciences and Bapuji Dental College & Hospital) in Davangere city, Karnataka, India made up the study sample.

Pretesting of Questions

The self-made, pilot-tested questionnaire was composed of 15 closed-ended questions and was specifically created for the study.

Sample Size Determination and Method of Sampling

The formula used to determine sample size is as follows:

Sampling Method and Administrative Procedure

Before distributing the questionnaire, permission from the Institutional Ethics Committee was acquired, and the participants were informed of the study’s importance. This study employs a practical approach. Each dental undergraduate student and intern from the two dental institutions stated above received a link to a questionnaire, which they were given enough time to complete, and the findings were then gathered from them. Two portions of a structured questionnaire were given to the participants. General information including name, age, gender, year of study, and college were included in the first section. The second component was a questionnaire that asked 15 questions about dental undergraduates and interns’ KAP about radiographic protection.

Statistical Analysis

In an Excel sheet created with Microsoft, the data was gathered and tabulated. Using International Business Machines Corporation’s Statistical Package for the Social Sciences (SPSS) (frequency analysis, Pearson’s Chi-squared statistical tests, and SPSS, software version 22.0) was run on the data. (p 0.05 will be viewed as a significant value).

RESULTS

A total of 140 students participated in the study with a response rate of 74.2% (n = 104) out of which third-year students were 45 (43.26%), final-year students were 51 (49.03%), and interns were eight (7.69%) (Table 1). The average age group was between 20–24 years. Out of 104 students, fourth-year students and interns are more aware of radiation hazards followed by third-year students (Fig. 1). Question no. 2: Do you think X-rays reflect from the walls of the room? Where 76.5% of correct responses were noted with fourth-year students followed by 57.8% of third-year students and 50% of interns. 100% of interns and 95.6% of third-year students responded positively that X-rays play an important role in dentistry followed by 88.2% of fourth-year students (Fig. 2). Out of 104 students, 100% of interns responded positively to wearing protective aprons during exposure followed by 96.1% of fourth-year students and 88.9% of third-year students (Fig. 3). Interns, followed by fourth-year students and third-year students, had the highest awareness of the appropriate distance an operator should stand during dental radiography exposure at 100% (Fig. 4). Out of 104 students, 100% of interns responded that X-rays are safe for children. For questions like “Do you follow radiation protection protocols?” and “Do you think computerized tomography (CT) scans are safe?”—more negative responses are noted with fourth-year students followed by third-year students and interns. 87.5% of interns and 82.4% of fourth-year students are aware of personal monitoring badges followed by 40% of third-year students. Third-year students are less likely to adhere to radiation safety procedures during their upcoming private clinical when compared to interns and fourth-year students. When the students questioned whether high-speed films reduce exposure, 100% of interns responded positively followed by 84.3% of the fourth-year and 66.7% of third-year students. Out of 104 students, 75% of interns are aware of the radiation hazard symbol followed by 72.5% of fourth-year and 60% of third-year students. For the question—“Do you ask the patient to hold the films?” Only 57.8% of third-year students responded negatively followed by 68.6% of fourth-year students and 75% of interns (Fig. 5). Out of 104 students, 100% of interns agreed that dental radiographs are strictly contraindicated for pregnant women compared to third-year and fourth-year students (Fig. 6). 100% of interns say that X-rays are harmful followed by 96.1% of fourth-year and 88.6% of third-year students (Fig. 7).

**Table 1:** Frequency distribution of responses of the Chi-square distribution
Questions	Response	III year (n)	IV year (n)	Interns (n)	Total (N)	Total (%)	p-value
1. Are you aware of radiation hazards?	Yes No	91.1% 8.9%	100% 0.0%	100% 0.0%	100 4	96.2% 3.8%	0.065
2. Do you think X-rays reflect from walls of the room?	Yes No	57.8% 40.0%	76.5% 23.5%	50.0% 50.0%	69 34	66.3% 32.7%	O.223
3. Do you think X-rays play an important role in dentistry?	Yes No	95.6% 4.4%	88.2% 11.8%	100.0% 0.0%	96 8	92.3% 7.7%	0.283
4. Do you prefer to wear any protective aprons during exposure?	Yes No	88.9% 11.1%	96.1% 3.9%	100.0% 0.0%	97 7	93.3% 6.7%	0.273
5. Are you aware of the ideal distance an operator should stand while dental radiographic exposure?	Yes No	86.7% 13.3%	96.1% 3.9%	100.0% 0.0%	96 8	92.3% 7.7%	0.157
6. Do you think X-rays are safe for children?	Yes No	93.3% 6.7%	90.2% 9.8%	100.0% 0.0%	96 8	92.3% 7.7%	0.590
7. Do you follow radiation protection protocols?	Yes No	26.7% 73.3%	19.6% 80.4%	37.5% 62.5%	25 79	24% 76%	0.469
8. Do you think CT scans are safe?	Yes No	48.9% 51.1%	41.2% 58.8%	50.0% 50.0%	47 57	45.2% 54.8%	0.721
9. Are you aware of personal monitoring badges?	Yes No	40.0% 60.0%	82.4% 17.6%	87.5% 12.5%	67 37	64.4% 35.6%	0.000
10. Do you follow radiation protection protocols at the time of your future private clinical practice?	Yes No	93.3% 6.7%	98.0% 2.0%	100.0% 0.0%	100 4	96.2% 3.8%	0.411
11. Do you think high-speed films reduce exposure?	Yes No	66.7% 33.3%	84.3% 15.7%	100.0% 0.0%	81 23	77.9% 22.1%	0.034
12. Are you aware of the radiation hazard symbol?	Yes No	60.0% 40.0%	72.5% 27.5%	75.0% 25.0%	70 34	67.3% 32.7%	0.378
13. Do you ask the patient to hold the films?	Yes No	42.2% 57.8%	31.4% 68.6%	25.0% 75.0%	37 67	35.6% 64.4%	0.438
14. Do you think radiographs are strictly contraindicated for pregnant women?	Yes No	80.0% 20.0%	80.4% 19.6%	100% 0.0%	85 19	81.7% 18.3%	0.379
15. Do you think X-rays are harmful?	Yes No	88.6% 11.4%	96.1% 3.9%	100.0% 0.0%	96 7	93.2% 6.8%	0.260

Fig. 1: Are you aware of radiation hazards?

Fig. 2: Do you think X-rays play an important role in dentistry?

Fig. 3: Do you prefer to wear any protective aprons during exposure?

Fig. 4: Are you aware of the ideal distance an operator should stand during dental radiographic exposure?

Fig. 5: Do you ask the patient to hold the films?

Fig. 6: Do you think radiographs are strictly contraindicated for pregnant women?

Fig. 7: Do you think X-rays are harmful?

DISCUSSION

The incidence of cancer, birth abnormalities, cataracts, and life expectancy lowering have all increased over time as a result of various research aimed at measuring radiation exposure. Although not definitive and possibly not applicable to diagnostic dental radiography, the aforementioned claim is nonetheless valid because it cannot be proven that risk does not exist. The as low as reasonably achievable principle, which acknowledges the possibility that some stochastic consequence may occur regardless of how small the dosage is, was developed in response to this issue and advocates limiting radiation exposure to the lowest level that is reasonably achievable.¹ As was previously said, stochastic effects are those in which the likelihood of the change (harmful effects of radiation) occurring does not depend on dose as is the case with deterministic effects. As a result of even a small amount of radiation exposure, a person either experiences symptoms or has no effects at all. Due to this, the radiation protocol’s primary focus should be on preventing the occurrence of deterministic consequences and lowering the risk of stochastic effects by limiting exposure to patients and staff.⁷^,⁸ When the operating staff is equipped with in-depth information and applies it in a clinical setting, the aforementioned goal can be accomplished. Due to the fact that they have a radiology syllabus in their curriculum, interns (junior resident doctors) and undergraduate students from the third and final years of bachelor of dental surgery programs were chosen as the study’s participants. In order to get accurate replies on the knowledge, attitude, and perception of dentistry undergraduates and interns on radio graphic protection, the following questionnaire was designed as a closed-ended survey. Analysis of the study’s findings revealed that every participant was aware of the dangers associated with X-rays used in diagnostic dental radiology and the need for specified levels of safety measures to be taken while using them. A slight difference was found in each group’s knowledge and comprehension of the fundamental physics of radiation. The goal of the current study was to evaluate the radiation protection KAP among dental undergraduates and interns at two Davangere city institutions (College of Dental Sciences and Bapuji Dental College & Hospital). Only 80% of the participants responded positively when the study was conducted at the St. Joseph Dental College and Hospital in Eluru, Andhra Pradesh, India, where 100% of the participants vowed to follow radiation protection protocols during their future private clinical practice.¹ Compared to St. Joseph Dental College and Hospital students, who had a frequency of 100%, 64% of the students objected to asking the patients to hold the films.¹ When compared to the students at Sri Sai College of Dental Surgery in Vikarabad, Telangana, India, interns, and final-year students were the most knowledgeable of radiation threats and had 100% frequency, and that college had a frequency of 55.81%.² When asked about the reflection of X-rays from the walls of the room, final-year students have more physics knowledge with 76.5% frequency when compared with the students of Egyptian dental college which had a frequency of 69.7%.³ When students were questioned whether the radiographs are safe for children, 9.8% of students said it is harmful whereas students of Saveetha Dental College and Hospitals responded negatively with 100% frequency.⁴ In contrast to the students at the Rama Dental College Hospital and Research Centre in Kanpur, Uttar Pradesh, India, where only 59.8% of students believe dental radiographs are strictly contraindicated for pregnant women, 81.7% of students hold this belief.⁵ In the present study, it is showing a statistically significant relationship between awareness of radiation protection protocols and the participant’s level of education, with interns having the highest awareness followed by final- and third-year students.

CONCLUSION

It is evident from the study that interns had better KAP regarding radiation protection protocols compared to third-year students. The goal of radiation protection is to minimize the exposure of both patients and dental staff to radiation while still enabling patients to benefit from diagnostic radiography. However, the study has also identified disparities in awareness levels, particularly among third and fourth-year students. This suggests a need for increased education and training on radiation protection protocols for these students to improve their knowledge and attitudes towards radiation safety.

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