A Study on Dental Radiographic Interpretation Skills and Knowledge among Undergraduate Students

Abstract

Introduction: Dental radiographs play a pivotal role in oral health diagnostics and treatment planning. Competency in interpreting these images is vital for dental undergraduate students to provide effective patient care. The aim of this study is to evaluate the existing levels of perceived confidence and actual skills in radiographic interpretation among dental undergraduate students, with the ultimate goal of identifying areas for improvement in dental education. Methods: A cross-sectional study was conducted at a private dental college in Chennai, involving 101 dental undergraduate students. A structured questionnaire comprising 20 questions, divided into confidence and knowledge assessment sections, was administered to the participants. The data collected were analysed using statistical software. Results: The majority of participants were female (71.3%) and in their early twenties (mean age 22.5 years). While 37.6% felt moderately comfortable identifying anatomical structures on radiographs, 45.5% expressed moderate confidence in diagnosing dental pathologies. Conclusion: This study highlights the need for continuous improvement in dental education, specifically in radiographic interpretation. Discrepancies between perceived confidence and actual skills suggest the necessity for enhanced curriculum and standardized evaluation methods.

Introduction

I. INTRODUCTION

Dental radiographs, including intraoral and extraoral X-ray images, are indispensable tools in the field of dentistry, serving as an essential component of diagnostic and treatment planning processes.1Radiographs constitute a critical diagnostic tool in the field of dentistry, playing an essential role in the identification and treatment of a wide range of oral conditions. These images are instrumental in diagnosing dental caries, periodontal conditions, bone texture evaluations, post-periodontal surgery changes in bone length, and a spectrum of benign and malignant craniofacial anomalies. Dental students must become proficient in recognizing various radiographic projections and principles to ensure accurate diagnoses. Proficiency in radiographic interpretation serves as the cornerstone for effective diagnosis and treatment planning, not only enhancing diagnostic capabilities but also fortifying patient safety by reducing the risk of missed diagnoses or erroneous treatment decisions. As students strive to evaluate various pathologies and distinguish normal from pathological conditions, they must not merely rely on classroom lectures and demonstrations but delve deep into the fundamental knowledge of human anatomy, physiology, and pathologies, complemented by a thorough grasp of radiology principles. The accurate interpretation of dental radiographs is a fundamental skill for dental undergraduate students, as it directly impacts their ability to provide comprehensive oral health care and make informed clinical decisions. As part of their education and training, dental students must develop competence in interpreting dental radiographs to diagnose a wide range of oral conditions, from caries and periodontal diseases to impacted teeth and oral pathologies.2 Proficiency in this skill not only enhances their diagnostic abilities but also contributes to patient safety by reducing the chances of missed diagnoses or incorrect treatment plans.3 However, the acquisition of radiographic interpretation skills in dental education is a multifaceted challenge. Furthermore, the self-perceived confidence of dental students in their radiographic interpretation skills may not always align with their actual competence, which could lead to discrepancies in clinical practice.4

The development of radiological interpretation skills follows a specific schedule outlined by the Dental Council of India, with training in various radiographic projections and diagnosis for dental diseases occurring during the third professional year. However, before embarking on clinical training in the final year and during internship, it is essential to possess the knowledge to differentiate normal structures from pathological ones. Previous studies have shown that freshly taught curriculum content tends to be better retained by students, while others have indicated that interpretation skills improve as clinical exposure increases. Thus, this study aims to assess the interpretation skills related to radiographic projections, principles, and pathologies by means of a questionnaire, comparing final year students with interns. This study aims to assess the knowledge and confidence levels of dental undergraduate students in interpreting dental radiographs. By examining the extent of their expertise, the study seeks to identify areas where educational interventions may be needed to bridge the gap between perceived confidence and actual radiographic interpretation skills. This research is essential for enhancing the education and training of dental students, ultimately contributing to improved patient care and the overall quality of dental practice.

II. MATERIALS AND METHODS

This research employed a cross-sectional research design to evaluate the competence and self-assurance of dental undergraduate students in the interpretation of dental radiographs. The study was conducted at a private dental college in Chennai, with the participation of dental students from different academic years. A structured questionnaire was developed to gather information regarding the students' aptitude and confidence in interpreting dental radiographs, alongside recording their demographic details. For evaluating confidence, five questions were utilized, and for assessing knowledge, 15 image-based questions were included in the questionnaire. The questionnaire underwent scrutiny and approval by the department of oral medicine and radiology within the private dental college. Additionally, the research received ethical clearance from the Institutional Review Board (IRB), and all participants provided informed consent, signifying their willingness to partake in the study, emphasizing the voluntary nature of their involvement. Throughout the study, participant anonymity and data confidentiality were strictly maintained, with no personally identifiable information collected. To gather data, the questionnaire was distributed via Google Forms through various social media platforms. A total of 101 dental students actively participated in this study. The collected data were coded and analysed using IBM SPSS Version 26 software. Descriptive statistics were calculated for demographic variables and the responses provided by the participants, including frequency, percentage, mean, and standard deviation. Statistical significance was assessed using Pearson's chi-square test. The statistical significance in the present study was kept at p<0.05.

III. RESULTS

A total of 101 undergraduate dental students took part in this study. The majority, 71.3%, were female, while 28.7% were male. On average, the participants were 22.5 years old, with the youngest being 20 and the oldest 27. In terms of their academic standing, 46.5% were in their house-surgeon (CRRI) year, 34.7% were fourth-year dental students, and the remaining 18.8% were in their third year.

When it came to their comfort level in identifying anatomical structures on dental radiographs, 37.6% were moderately comfortable, and 28.7% were somewhat comfortable. About 45.5% expressed moderate confidence in diagnosing dental pathologies from radiographic images, while 5% had no confidence at all. In their study habits, 57.4% occasionally referred to textbooks or reference materials when interpreting dental radiographs, while 55.4% occasionally practiced this skill outside of scheduled coursework or clinical rotations. Interestingly, 10.9% never practiced outside of their coursework. When faced with difficulties in interpreting dental radiographs, 74.3% typically sought help or clarification from faculty, and 64.4% referred to textbooks or online resources. Regarding their performance on image-based questions, 51.5% correctly identified the lateral fossa [image 1] in a maxillary anterior periapical radiograph, 68.3% identified the nasal septum [image 2], and 65.3% correctly identified gutta-percha [image 3] as the radiopaque structure.

Furthermore, 72.3% correctly identified dilacerations [image 4], 65.3% identified Dens Invaginatus,[ image 5] and 63.5% named a given radiograph as a peri-apical radiograph. [Image 6] When it came to identifying anatomical features, 72.3% correctly identified the mental ridge, [ image 7] while 43.6% correctly identified the mental foramen [ image 8] and 40.6% confused it with a periapical cyst. A majority of 58.6% correctly identified a well-defined oval radiolucent lesion as a lateral periodontal cyst.[ image 9] Only 35.6% correctly identified the cause of radiolucency as one of the three options: root fracture, periodontal pocket, or chronic periodontitis.[ image 10] Additionally, 57.4% correctly identified a given radiograph as panoramic,[ image 11] and 38.6% correctly identified errors in the radiograph as film bending and a rectangular BID cone cut.[ image 12] Most impressively, 76.2% correctly identified the artifact in the radiograph as a cone cut,[ image 13] and 70.3% correctly identified a large multi-locular lesion with a honeycomb or soap bubble appearance as an ameloblastoma.[ image 14] In terms of improving their skills in interpreting dental radiographs, 39% of the participants expressed a desire for more webinars, and 57% were interested in additional clinical training.

IV. DISCUSSION

The primary aim of this study is to comprehensively assess and understand the variations in comfort, confidence, study habits, and proficiency levels among dental undergraduate students in radiographic interpretation. With these insights, the study aims to inform the development and implementation of targeted educational interventions, encompassing enhanced curriculum design, additional clinical training, and the creation of online resources like webinars. By addressing these disparities, the overarching goal is to improve the radiographic interpretation skills of dental students, ensuring they are well-equipped to provide high-quality oral health care in their future professional practice. A notable proportion of students reported being moderately comfortable identifying anatomical structures and moderately confident in diagnosing dental pathologies from radiographs. However, a small percentage expressed a lack of confidence, emphasizing the need for targeted educational interventions. Study habits were also diverse, with a significant number of students occasionally referring to textbooks or reference materials when interpreting dental radiographs. Interestingly, a portion of students did not practice outside of scheduled coursework. This highlights the importance of encouraging regular practice and self-directed learning in radiographic interpretation. When faced with difficulties in interpreting dental radiographs, a substantial majority of students sought help from faculty or referred to textbooks and online resources. This proactive approach to addressing challenges is commendable and indicative of a desire to improve their skills.5The study assessed the students' ability to identify various radiographic features, and the results showed varying levels of success. While some students correctly identified certain structures, there were instances where confusion or incorrect identifications occurred. In SomayyehAzimi's research, it was found that the participants demonstrated a commendable level of knowledge, with 70% displaying acceptable understanding of the characteristics of radiographic images pertaining to bony lesions in the jaw.6 In our own study, a similarly high percentage of 70.3% accurately identified the presence of ameloblastoma from a radiograph, indicating a substantial level of proficiency in recognizing specific pathological conditions in dental radiographs among our participants. In our study, 43.6% of participants accurately identified the mental foramen. In contrast, a study conducted by AsaadJavaidMirza et al found that a lower percentage, specifically 27%, correctly recognized the mental foramen.7Conversely, a comparable study conducted with dental undergraduate students in Saudi Arabia, specifically at Qassim University, indicated that the students who participated in that study exhibited stronger performance in identifying radiographic landmarks associated with the anatomy of the head and neck when compared to our study.4 These findings underscore the need for targeted training in specific areas of radiographic interpretation. Notably, a significant proportion of students expressed interest in enhancing their radiographic interpretation skills. A substantial percentage indicated a desire for webinars, suggesting an appetite for online learning resources. The majority of students in our study expressed a strong interest in additional clinical training, which emphasizes the potential benefits of hands-on experience and mentorship in enhancing their radiographic interpretation skills. This aligns with the findings of Lanning et al., who demonstrated that the implementation of targeted training programs could significantly increase awareness of radiographic interpretation by up to 72%.8 Furthermore, their research also highlighted that effective follow-up instructions and well-designed training initiatives had the capacity to substantially improve knowledge levels in radiographic interpretation, achieving an improvement of up to 85%.9 This convergence of our study's findings with Lanning et al.'s research suggests that focused training and mentorship opportunities could be a promising approach to address the existing disparities in radiographic interpretation skills among dental students. The findings indicate variations in confidence, study habits, and performance on image-based questions. To address these disparities, it is imperative for dental education programs to consider targeted interventions, such as improved curriculum design, additional clinical training, and the development of online resources like webinars. By addressing these areas, dental colleges can better prepare their students for the challenges of radiographic interpretation and ultimately ensure that they are well-equipped to provide quality oral health care in their future professional endeavors.10

Conclusion

In summary, this research underscores the significance of ongoing enhancements in dental education, with a specific focus on the domain of radiographic interpretation. It highlights the need for rectifying these discrepancies to provide dental institutions with the means to better prepare their students, ensuring the delivery of top-tier patient care and enriching their impact on the field of dentistry. This study lays the groundwork for future progress in dental education, paving the way for the creation of more potent training initiatives aimed at strengthening the radiographic interpretation abilities of dental undergraduate students.

References

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Copyright

Copyright © 2023 Dr. K. V. Vijila, Dr. Priya Ramani, Keerthika T, Dr. Masheeha Fara Tabasum. M. S, Keerthilakshme K H , Vaishnavi S. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.