2010年06月12日

その2

J Periodontol
Mar-10
Knowledge and orientations of internal medicine trainees toward periodontal disease

Aimee Quijano,* Amit J. Shah,* Aron I. Schwarcz,* Evanthia Lalla, and Robert J. Ostfeld
=============
Background:

There is growing evidence that periodontal disease may be a source of systemic inflammation that impacts overall health.

As such, periodontal disease is associated with an increased risk of systemic illnesses such as cardiovascular disease and adverse outcomes in diabetes mellitus and pregnancy.

With the aim of assessing oral health knowledge and orientations of physicians in training, we surveyed incoming internal medicine trainees about their general knowledge, attitudes, and behaviors/practices about periodontal health and disease.

Methods:

A 16-question survey was distributed during orientation to incoming internal medicine trainees at a single urban teaching hospital in New York City in 2007 and 2008.

Questions aimed to assess the knowledge levels of the subjects about periodontal disease and their attitudes toward discussing/evaluating the periodontal status of their patients.

The study was approved by the Montefiore Institutional Review Board.

Results:

Of 125 incoming medical trainees queried, 115 responded (92% response rate).

Of the 115 responders, 96% were medical interns.

The median age of the trainees was 27 years (interquartile range: 26 to 29 years), and 61% were female.

Overall, 34% of the trainees answered all five true/false general knowledge questions correctly,

82% reported that they never asked patients if they were diagnosed with periodontal disease,

90% reported not receiving any training about periodontal disease during medical school,

69% reported that they were not comfortable at all performing a simple periodontal examination,

17% agreed that patients expect physicians to discuss/screen for periodontal disease,

46% felt that discussing/evaluating the periodontal status of their patients was peripheral to their role as physicians,

76% reported never screening patients for periodontal disease,

and 23% stated that they never referred patients to dentists.

Conclusions:

In this study, incoming internal medicine trainees had inadequate knowledge regarding periodontal disease.

They were also generally uncomfortable with performing a simple periodontal examination.

Oral health training in medical school and the medical postgraduate setting is recommended.

J Periodontol 2010; 81:359-363.

KEY WORDS
Dental health education;knowledge;orientation;periodontal diseases;physicians;preventive medicine.

=======
* Department of Internal Medicine, Montefiore Medical
Center, Albert Einstein University, Bronx, NY.
*1 Division of Periodontics, College of Dental Medicine,
Columbia University, New York, NY.
*2 Department of Cardiology, Montefiore Medical Center,
Albert Einstein University.

========
Periodontal disease is a bacterially induced chronic inflammatory process that affects tooth-supporting connective tissue and alveolar bone in the oral cavity, potentially leading to tooth loss.
1
In the United States (U.S.), periodontal disease occurs in ;
8% of adults, with a disproportionately higher prevalence in blacks (13%) and Hispanics (8%) than whites (7%).
2
There is growing evidence that periodontal disease may be a source of systemic inflammation that impacts overall health.
1
As such, periodontal disease is associated with an increased risk of systemic illnesses such as cardiovascular disease, stroke, peripheral vascular disease, and adverse diabetes mellitus and pregnancy outcomes.
3月8日
These associations pose a compelling reason for physicians to increase their role in inquiring about oral health care and screening for oral problems and led to a call for greater collaboration between dentists and physicians.
9
As such, a recent consensus statement 10 recommended that patientswith therosclerotic cardiovascular disease should receive a periodontal evaluation, and patients with moderate to severe periodontitis should be informed about their potential increased risk of atherosclerosis.

Nevertheless, few studies 11,12 examined a physician's role in identifying, discussing, or preventing oral disease and only focused on children.

With the aim of assessing oral health knowledge and orientations of physicians in training, we surveyed internal medicine trainees about their general knowledge, attitudes, and behaviors/practices about periodontal health and disease.
=========
material and methods

A short questionnaire was distributed to incoming internal medicine trainees at Montefiore Medical Center, Albert Einstein University, during their orientation in June 2007 and June 2008.

It was developed to assess the knowledge, attitudes, and behaviors about periodontal disease of incoming internal medicine trainees.

Participation was voluntary and anonymous, and the questionnaire, including five true/false knowledge items, and eight Likert-scale questions, was completed in ; 15 minutes.

Respondents were instructed to circle the single best answer.

The participants were also queried regarding gender, age, and training level.

Trainees who were beginning their first year were asked to respond to questions related to clinical practices based on their clinical experiences during medical school outpatient rotations or to reflect what they would do in future clinical practices.

Analyses were performed using commercially available statistical software.
§

Medians and interquartile ranges are reported.

Residents were given a total quiz score ranging from 0 to 5, earning a point for each true/false question answered correctly.

Chi-square analyses were conducted to compare male and female subgroups.

The Spearman correlation coefficient was used to correlate the self-assessed knowledge and quiz scores of trainees.

The study was approved by the Montefiore Medical Center Institutional Review Board and informed consent waived because of the minimal risk nature of this study.


===========
RESULTS

The survey was given to a total of 125 incoming medical trainees; 115responded, foraresponserateof92%.

The 115 responders had graduated from 57 different medical schools (70% in the U.S. and 30% internationally).

Their median age was 27 years (interquartile range: 26 to 29 years): 70 (61%) were female, and 45 (39%) were male.

Of the responders,96%were incoming medical interns (first-year trainees).

The rest were incoming medical residents (second- and third-year trainees).

Table 1 shows the true/false knowledge items with the correct answer and the percentage of subjects who answered each question correctly.

The percentage of trainees that answered any one question correctly ranged from 56% to 98%.

Although most trainees demonstrated knowledge regarding the signs of periodontal disease and its association with diabetes and cardiovascular disease, nearly half did not know about the association of periodontal disease with increased levels of systemic inflammatory markers.

Figure 1 summarizes the overall results of the responders’ scores on the five-question quiz.

The median quiz score was 4 (interquartile range: 3 to 5), and a perfect quiz score was achieved by 34% of the residents.

Three subjects did not complete all five quiz questions and were excluded from the analysis.

No subject answered fewer than two questions correctly.

Figures 2 through 4 summarize the responses to questions exploring attitudes, orientations, and behaviors.

Questions regarding clinical practices (Fig. 2) were interpreted to reflect practices in medical school and/or future behaviors for those entering their first year of internal medicine training: 82% of the responders never asked their patients whether they were diagnosed with periodontal disease, 76% never screened their patients for periodontal disease, and 23% never referred patients to a dentist for evaluation and care.

As shown in Figure 3, 69% of the responders did not feel comfortable doing a simple periodontal examination, 81% reported limited understanding of the association between periodontal health and general health, and 90% did not receive any training in periodontal disease during medical school.

Finally, as shown in Figure 4, 83% of responders disagreed/ strongly disagreed that patients expected them to discuss/ screen for periodontal disease, and 46% agreed/ strongly agreed that discussing or evaluating periodontal status of their patients was peripheral to their role as physicians.

For the subgroup analysis by gender, no significant difference was found between genders for the total quiz score or for each question in Figures 2 through 4.

There was a trend toward a positive correlation between self-rated knowledge and the total quiz score, with a Spearman correlation coefficient of 0.19 (P = 0.055).


===========
DISCUSSION
We found that knowledge of internal medicine trainees about periodontal disease is limited.

The trainees rarely asked about periodontal diseasewhen taking a patient ’s medical history, and they were not comfortable performing a simple periodontal examination; most trainees received no training in periodontal health in medical school (Fig. 3), and many somewhat or strongly agreed that discussing/ evaluating the periodontal status of their patients is peripheral to their role as a physician (Fig. 4).

To the best of our knowledge, this is the first study to assess the knowledge levels, attitudes, and behaviors of physician trainees about issues related to periodontal health.

Our findings raise concerns.

Given the high prevalence of periodontal disease, its deleterious impact on oral health and its association with systemic disease, patients seeing internal medicine physicians may not be receiving the education and guidance needed.
1,2
An increased awareness of certain aspects of periodontal disease and its link to systemic conditions are important, and patients should be counseled about this at each health care contact they have, whether it is with a dentist, a physician, or any other health care provider.

Furthermore,; 31 million people in the U.S. live in‘‘dental shortage areas,’’ where there is less than one full-time equivalent dentist per 5,000 people, highlighting the need for physicians to be competent in advising about the importance of periodontal health.
13
At a minimum, our findings suggest that medical schools should provide more comprehensive training in oral/periodontal health.

And, given that the cohort surveyed in this study came from 57 different national and international medical schools, it appears that suboptimal oral health training in medical schools may be widespread.

Future efforts to improve physicians’ability to contribute to oral health should include at least a rudimentary curriculum in medical school that would be supplemented by postgraduate training.

Although medical schools in different countries may vary in their curricula, many medical schools in the U.S. allot 2 years for preclinical basic sciences, which would allow for some education on oral disease and the systemic effects of periodontal infections.

Furthermore, many medical schools offer an introduction to clinical medicine during the first and/ or second year, during which an examination of the oral cavity could be incorporated into teaching the physical exam.

This could be coupled with instructions on prevention counseling, especially during outpatient encounters.

These sessions could be reinforced during the clinical rotations in the third and fourth years.

This way, oral/periodontal health may both be taught theoretically and reinforced into practice during early training.

Our study has certain limitations.

Although it was anonymous, the self-reported attitudes and practices may be biased by what responders believed was ideal or socially desired.

It was performed at a single medical center, and findings may not be generalizable.

Finally, most of the cohort was entering internal medicine training.

Although their answers reflected current opinions and may provide an estimate for future practices, their attitudes and orientations may change at the completion of their training.
==========
CONCLUSIONS

In this study, internal medicine trainees were not equipped to screen for or discuss issues related to periodontal health.

Oral health education in medical school and the postgraduate setting is recommended.
===========
ACKNOWLEDGMENT

The authors report no conflicts of interest related to this study.
============

Table 1.
true/ false knowledge items with correct answers and ercentages of subjects who answered correctly (N = 112)

Item
Correct answer
Answering correctly
(%)

1
Bleeding gums, gum recession, unsteady teeth, and tooth loss are signs and symptoms of periodontal disease.
TRUE 98

2
Periodontal disease affects as many as 75% of the U.S. population.
True 69

3
Periodontal disease has been associated with suppressed levels of serum inflammatory markers.
False 56

4
Poor oral health may increase the risk of cardiovascular disease.
True 89

5
Periodontal disease is less prevalent/severe in patients with diabetes.
False 97
====
Figure 1.
Percentage of subjects achieving two, three, four, or five orrect answers on the five true/false knowledge items of the questionnaire (N = 112).
Number of questions answered correctly
Subjects (%)
====
Figure 2.
Questions exploring clinical practice behaviors/orientations.
Percentage of trainees responding never, sometimes, or always/often to these items are shown (N = 115).
2-1) Do you ask your patients if they have ever been diagnosed with periodontal disease ?
2-2) Do you screen your patients for periodontal disease?
2-3) Do you refer patients to a dentist for evaluation / care ?
Never / sometimes / always
====
Figure 3.
Questions exploring perceived knowledge and training.
Responses of trainees with percentages are shown (N = 115).
3-1) How comfortable are you in performing a simple periodontal exam ?
Not at all / Somewhat / Very
3-2) How would you rate your knowledge about periodontal disease and its association with...
Limited / Moderate / Good / Excellent
3-3) Did you receive training in periodontal disease in medical school?
Yes / No
=====
Figure 4.
Questions exploring attitudes toward periodontal disease and perceptions that may influence clinical practices.
Responses of trainees with percentages are shown (N = 115).

4-1) Agree or disagree ? “Patients expect me to discuss / screen for periodontal disease”

Strongly Disagree / Disagree / Agree / Strongly agree
Agree or disagree ? “ Discussing / evaluating periodontal
status is periodontal to my role...
Strongly Disagree / Disagree / Agree / Strongly agree
=======
==========
posted by 繭玉 at 05:51| 新潟 ☀| Comment(0) | TrackBack(0) | 日記 | このブログの読者になる | 更新情報をチェックする
この記事へのコメント
コメントを書く
お名前:

メールアドレス:

ホームページアドレス:

コメント:


この記事へのトラックバック
×

この広告は1年以上新しい記事の投稿がないブログに表示されております。