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19 ISDH 2016 der Arzt und Patient gemeinsam die Entscheidung treffen. In der vorlie- genden Studie scheint dieses Modell in Kraft getreten zu sein. Die Zahnmedizin verlangt, wie die meisten gesundheitsbezogenen Fachgebiete, die Mitarbeit des Pati- enten, damit die vom Arzt eingeleite- ten Massnahmen am effektivsten sein können. Das gesteigerte Be- wusstsein der Studienteilnehmer zeigt, dass eine einstündige Präsen- tation ausreichend war, um den Pati- enten genügend Informationen zur Verfügung zu stellen und ihren Ent- scheidungsfindungsprozess zu be- einflussen. Tatsächlich stellte sich ein Teil der Teilnehmer im Nachfeld der Studie freiwillig zur Verfügung, um im Gefängnis als Teil einer Im- plantationsweiterbildung für Zahn- ärzte mit Dentalimplantaten behan- delt zu werden. Dennoch sagte mehr als die Hälfte der Patienten aus, dass die Kosten einer Behandlungsmethode bei der Entscheidungsfindung eine signifikante Rolle spielen. Dieses Er- gebnis entspricht den Erkenntnissen aus anderen Studien. Van der Wijk et al. konnten beobachten, dass die hohen Kosten von Dentalimplanta- ten einer der stärksten Faktoren für die Entscheidungsfreudigkeit für eine Behandlung ist.16 Dies macht die Notwendigkeit für Zahnärzte und die Implantatindustrie deutlich, Kosten zu senken und dadurch neue Behandlungsoptionen zu schaffen. Zusammenfassend kann die per- sönliche Interaktion mit Ärzten und Gesundheitsdienstleistern – obwohl vergleichsweise ressourcenintensiv – als eine effektive Möglichkeit gese- hen werden, Patienten mit einge- schränkten Optionen zur Verbes- serung Ihrer Gesundheit zu motivie- ren. There is a raising awareness of oral and dental health. As a consequence, the options for tooth replacement, among them implant-based prosthe- ses, are of importance to the popula- tion.1 Today, the internet is a major form of education3 , which offers op- portunities to learn about prosthetic options. However, this medium is less likely to be used by people from lower social sectors,4 who are also less likely to avail themselves of these dental services.5 Often, introductory explanations by dental healthcare professionals can allow/encourage pa- tients to seek further knowledge. This approach will be most successful if the initial presentation or contact with the dental healthcare professional succeeds in significantly increasing the understanding and awareness of the patient.4 This study examines the usefulness of a presentation by a pro- sthodontist/implantologist and a gener- al dentist team to a prison population to increase their aware- ness and moti- vation in seek- ing further dental care for missing teeth. Methods A cohort of 500 male prisoners of the Sharjah Central Prison (United Arab Emirates) was randomly selected to participate in the study. The cohort was not segregated by age, educational background, or reason for incarceration. All subjects agreed to par- ticipate in the study. The po- pulation was administered a questionnaire designed to identify: a. The patient’s interest in tooth re- placement for missing teeth b. The patient’s preferred treatment modalities c. The patient’s perceived obstacles to the preferred treatment This questionnaire (Fig. 1) which was available in five languages was administered both before and after one hour of standardised presenta- tions by a dentist in the language that the prison cohort understood. The subjects of the presentation included general principles of oral health, the value of tooth replacement, the op- tions for tooth replacements and the advantages of each restorative option. The questionnaires were scored and a cross tabulation test performed for the group using SPSS.6 Result The interest of the cohort in the replacement of missing teeth was sig- nificantly increased after attending the educational lecture (Table 1, p < 0.001). The preferred method of replacement was influenced signifi- cantly by the presentation (Table 2). Before the lecture, 30% of the patients chose a bridge, 17.2% a removable partial denture, and 52.8% an im- plant. After the lecture, only 21.2% of patients chose the bridge option while the rest, 78.8%, chose an implant as their preferred replacement option (p < 0.001). Before the lecture, 57.6% of the patients had received infor- mation about implant therapy. This increased significantly to 95.2% after the lecture (Table 3, p < 0.001). How- ever, both before and after the lecture, the cost was the main reason for pa- tients not selecting implants (Table 4). Before the lecture, 34% of the patients chose insufficient information about implant procedure as an obstacle to treatment. After the lecture, this num- ber decreased to 10.8%. Discussion The opportunity to frequently ob- tain further information and become aware of new op- tions and oppor- tunities for health improvement has a significant impact both on attitudes and dental healthcare deci- sions. This study, utilising a prison po- pulation, demonstrated the effective- ness of a presentation by a dental professional. In a similar study, Alani et al. showed that discussion as well as the opportunity to review options and reflect upon the discussion result- ed in a number of subjects reconside- ring their original treatment deci- sions.9 The utilisation of advanced tech- nologies in health care in countries with large uneducated populations, is challenging. In studies by Chowd- haty,10 Al-Omiri11 and Shigli,12 lack of knowledge and the perception that im- plants were extremely costly was common and prevented third-world populations from considering dental implants as a treatment option. Howe- ver, even in more affluent countries, e.g. Swedish, Japanese, and American people, reported that dental implants were too costly.13 Here, a relationship of trust between patient and dentist can improve the receptivity of pati- ents to implant treatment.14 These results are similar to those of Alani et al.9 As it relates to patient awareness of implant treatment op- tions, almost half of the patients in this study were unaware of the nature of implant procedures and their prog- nosis prior to the presentation. Pra- gati reported that, although about one million dental implants are inserted each year worldwide, the information available to the patients regarding the procedure and its success is often fragmentary.15 Chowdhary et al. repor- ted that only 23.24% of the Indian ur- ban population had heard of dental implants as a treatment option for replacing missing teeth.10 A further issue that requires con- sideration is the quality and accessi- bility of the information available to the consumer.5 In addition, the educa- tion and background of the consumer may limit the opportunity to utilize these tools.4 Literacy may also be limi- ted and thus the ability to read bro- chures and fact sheets may be lacking. While labour-intensive, personal inter- actions between healthcare personnel and the patient may be fit to assist many of these individuals. However, this also requires some examination.4 Charles described three different types of medical decision- making. In the doctor-centred model, the healthcare provider has establis- hed credibility with the patient and makes the significant decisions. In the second type, patient-centred, the pa- tient acquires sufficient information to become confident in his or her deci- sion-making abilities. The third type, a combination of the first two, is one in which the healthcare provider and the patient jointly make the medical decision. This model appears to have been effective in this study. Dental care, as most health-re- lated issues, requires patient commit- ment to complement the dental care provided by the clinician to be most effective. The increased awareness demonstrated by the subjects in this study suggests that the hour-long lec- ture was effective in providing the subjects with useful quality informa- tion that could influence the subjects’ decision-making process. Indeed, a number of the subjects in the study subsequently volunteered to be trea- ted in the prison with dental implants as part of an implant training program for dentists. However, more than half of the pa- tients reported cost to be significant. This result is comparable to several other studies. Van der Wijk et al. ob- served that the high cost of the im- plants is one of the major limiting fac- tors in the willingness of patients to undergo treatment.16 This clearly indi- cates the necessity for dentists and the implant industry to reduce costs and thus create opportunities for treatment. In conclusion, while this appro- ach is more resource-intensive, it would seem that personal interactions with healthcare professionals may be an effective way to motivate individu- als whose opportunities to indepen- dently seek improved health are limit- ed. continuing education "This is the first report in dentistry showing that prisoners, whom we think we cannot educate, have the potential to do so." Author Dr Souheil Hussaini Before After Significance level Interested in replacing missing teeth Yes 87,2 % 97,6 % 0.000 sig No 12,8 % 2,4 % Tab. 1: Pecentage of interest in replacing missing teeth before and after informative lectures. Before After Significance level Preferable treatment option Bridge 30 % 21,2 % 0.000 sig Removable P.D. 17,2 % .0 % Implant 52,8 % 78,8 % Tab. 2: Percentage of each treatment option selected. Before After Significance level Most probable obstacle cost 52,4 % 54 % 0.077 N.S. fear 9,6 % 9,6 % unclear 34 % 10,8 % cost and fear 4 % 25,6 % Tab. 4: Percentage of obstacle effecting implant selection. Before After Significance level Awareness of implant therapy Yes 57,6 % 95,2 % 0.000 sig No 42,4 % 4,8 % Tab. 3: Percentage of public awareness about implants. Kontakt | contact Hussaini, Souheil BDS, MS. Director of Research, Oral Implantology Research Institute, #39 Knowledge Village POBox 502221, Dubai, UAE Mobile: +971 50 4568100 Tel.: +971 4 2956595 (land line) info@ID-SC.com © ib re a k s to c k /S h u tt e rs to c k .c o m Mobile: +971504568100 Tel.: +97142956595 (land line)