Knowledge and attitude of dental students toward thyroid gland and its disorders: A cross-sectional study :Santosh Mahajan, Harsimran Singh Kapoor, International Journal of Oral Health Sciences

ORIGINAL ARTICLE
Year : 2022 | Volume : 12 | Issue : 2 | Page : 79--85

Knowledge and attitude of dental students toward thyroid gland and its disorders: A cross-sectional study

Santosh Mahajan¹, Harsimran Singh Kapoor²,
¹ Department of Biochemistry, Baba Jaswant Singh Dental College, Hospital and Research Institute, Ludhiana, Punjab, India
² Department of Intern, Baba Jaswant Singh Dental College, Hospital and Research Institute, Ludhiana, Punjab, India

Correspondence Address:
Dr. Santosh Mahajan
Department of Biochemistry, Baba Jaswant Singh Dental College, Hospital and Research Institute, Ludhiana, Punjab
India

Abstract

Aim: With an increasing number of patients with thyroid diseases receiving dental care, dental practitioners should have sufficient knowledge about the gland and the associated pathophysiology to avoid any complications during the treatment. Materials and Methods: A cross-sectional survey of the dental students of different academic years of Baba Jaswant Singh Dental College, Hospital and Research Institute, Ludhiana, was done to determine their knowledge and attitude toward different aspects of thyroid gland using a self-administered questionnaire. Results: A total of 234 students including 46 (20%) males and 188 (80%) females aged 19–32 years (mean ± standard deviation [SD] 23.24 ± 2.92 years) participated in the survey. The mean ± SD knowledge score of students was 60.7 ± 8.4. It increased with dentistry years and was between 51% and 75% reflecting overall good knowledge. However, the knowledge of students of all academic years was significantly more for thyroid gland and its hormones compared to other aspects of the gland. There was no significant difference in the mean knowledge (males 60.2% ± 13.6%, females 60.4% ± 8.8% (P = 0.97) and attitude (males 62.7% ± 18.2%, females 71.4% ± 6.0%) (P = 0.25) of the two sexes. However, a significant association was found between knowledge and attitude of the female students toward thyroid patients. Conclusions: The findings of our study indicate that although the dental students have acceptable knowledge about thyroid gland, its functioning, and its abnormalities, they are devoid of awareness about the biochemical mechanisms behind the disease and the treatment plan which can put their patients at risk.

How to cite this article:
Mahajan S, Kapoor HS. Knowledge and attitude of dental students toward thyroid gland and its disorders: A cross-sectional study.Int J Oral Health Sci 2022;12:79-85

How to cite this URL:
Mahajan S, Kapoor HS. Knowledge and attitude of dental students toward thyroid gland and its disorders: A cross-sectional study. Int J Oral Health Sci [serial online] 2022 [cited 2023 Jun 1 ];12:79-85
Available from: https://www.ijohsjournal.org/text.asp?2022/12/2/79/364230

Full Text

Introduction

Thyroid dysfunctioning[1] is a global health issue and is the second most common endocrine disorder after diabetes mellitus worldwide which may rear its head in any system of the body including the mouth. Recent report shows that about 300 million people in the world are suffering from thyroid disorders. Among them, an estimated 20 million people are living in the Unites States and about 42 million people reside in India.[2] The prevalence rate of thyroid diseases depends on the geographical location, age group, ethnicity, and most importantly the iodine intake of the population.[3] It can affect men, women, teenagers, elderly, and even infants and can be present at birth typically as hypothyroidism and can also develop after menopause in women.[4]

The number of people suffering from hypothyroidism is more than from hyperthyroidism and is increasing predominantly among women.[5],[6] Up to 5% of the females and 0.2% of males population have alterations in thyroid function,[7],[8] and up to 6% may have clinically detectable thyroid nodules on palpitation.[9] An estimated 15% of the general population has abnormalities of thyroid anatomy on physical examination. An unknown percentage of these do not complete a diagnostic evaluation, and the number of people affected may be twice as many as the undetected cases.[5],[7]

The patients with undiagnosed hypothyroidism or hyperthyroidism are often seen in dental chair. A dentist may be the first one to identify signs and symptoms of thyroid disorders and thus can aid in its early diagnosis. If a suspicion of thyroid disease arises for an undiagnosed patient, all elective dental treatments could be put on hold until a complete medical evaluation is performed.[10]

The knowledge acquired by the students during their academic years can make them professional who are conscious of their attitudes and have greater awareness of the risks involved within the workplace. The present study was, therefore, planned to explore the knowledge of undergraduate and postgraduate dental students about thyroid gland, its diseases, and its manifestations and to conclude the influence of continuous education on the knowledge of the student of different dentistry years. The study will also help to know that how well the theoretical knowledge gained by the students during their preclinical years about thyroid gland is used in their clinical years when they come across the patients suffering from thyroid disorders and implicate their knowledge in treating these patients without any complications of infection and stress.

Materials and Methods

The present study was a cross-sectional survey done to explore knowledge and attitude of 234 undergraduate and postgraduate students of Baba Jaswant Singh Dental College, Hospital and Research Institute, Ludhiana. The study was approved by the Ethical Committee of the Institute. The study protocol was explained to the students, and written consent was obtained from the interested participants. The study material was a questionnaire consisting of questions adapted from various validated questionnaires in the literature.

The questionnaire was divided into three main sections, i.e., demographic section including age, sex, and the academic year (Section 1), knowledge section (Section 2), and attitude section (Section 3).

The data obtained were tabulated in MS-Excel. The number and the percentage of students taking part in the study and their responses to each question were calculated and scored. Each Correct/Yes response was given one mark and each Incorrect/No response was marked as zero. The total knowledge scores ranged from 0 to 32. The attitude response score ranged from 0 to 6.

The mean score per student and the percentage were calculated. The knowledge score was interpreted into four categories, i.e., poor (<25%), moderate (25%–50%), good (51%–75%), and excellent (>75%). The attitude score was interpreted as positive (>75%), passive (50%–75%), and negative (<50%). Data were analyzed using Chi-square and Student's t-test. Significance of the results was set at P ≤ 0.05.

Results

A total of 234 students including 46 (19.7%) males and 188 (80.3%) females aged 19–32 years, with a mean age (±standard deviation [SD]) of 23.24 (±2.92) years, participated in the survey [Figure 1]. The number of female participants was more than male participants, and there was no male participant in MDS 1st year. No significant difference is observed in the ages of the two sexes (P = 0.93). Out of 234 students, 50 students were each from BDS 2nd year to interns, 12 were from MDS 1st year, and 11 each were from MDS 2nd and 3rd years. Frequency distribution of students of different years and their ages (mean ± SD) are given in [Figure 2] and [Figure 3], respectively.{Figure 1}{Figure 2}{Figure 3}

The overall knowledge score (mean ± SD) of the students about thyroid gland and its different aspects was 60.7 ± 8.4 and attitude score about thyroid patients was 70.7 ± 7.04. The knowledge score increased with dentistry years, and it ranged from 43.4% (in 2nd year) to 69.3% (in MDS 3rd year). The mean knowledge of interns was less compared to the 4th-year undergraduate students. The attitude score ranged from 58.3% (in 2nd year) to 75.75% (in MDS 3rd year) [Figure 4]. There was no significant difference in the mean knowledge (males 60.2% ± 13.6%, females 60.4% ± 8.8%, P = 0.97) and attitude (males 62.7% ± 18.2%, females 71.4% ± 6.0%, P = 0.25) of the two sexes. However, a significant association was found between knowledge and attitude of the female students toward thyroid patients [Table 1].{Figure 4}{Table 1}

The knowledge of students of all academic years was significantly more for thyroid gland and its hormones compared to the other aspects of this gland (P < 0.05 and P < 0.01). No difference is observed in the knowledge of two genders [Table 2].{Table 2}

Significance difference is observed in responses of the students regarding some of the statements on the knowledge about different aspects of thyroid gland [Table 3],[Table 4],[Table 5].{Table 3}{Table 4}{Table 5}

About 98.7% of the students were aware that thyroid gland is located in the neck and >85% of students knew that tyrosine is the precursor of tri-iodothyronin (T3) and tetra-iodothyronin or thyroxin (T4), the main hormones secreted by this gland. More than 65% answered correctly about T3 as the physiologically active form (P = 0.002) of the two hormones. Fifty-seven percent of the students were aware that thyroglobulin is the basic building block for hormones produced by the thyroid and is the marker of thyroid cancer treatment [Table 3].

More than 80% of the students were aware about goiter as an abnormal enlargement of thyroid gland, treatment of hypothyroidism involves replacement of thyroid hormone, and acromegaly is not a disease of this gland. However, <50% were aware that hypothyroidism is more common and enlargement of the thyroid gland is directly related to elevated thyroid stimulating hormone (TSH) in iodine-deficient patients (P = 0.036). In addition, <50% knew about the euthyroid state (P = 0.007) and thyroid disorders are sometimes mistaken as menopause. Least correct answer (only by 21.8% of students) was given for TSH as the screening test for the diagnosis of thyroid diseases [Table 4].

Although 70% of the students were aware of increased basal metabolic rate (BMR) and sweating as the clinical manifestations of hyperthyroidism, but 85.5.5% could not correlate it with hyperglycemia. Correct answer was given by only 23.5% and 35.5% of the students about hypocholesterolemia and hypercholesterolemia as the clinical manifestations of hyperthyroidism and hypothyroidism, respectively [Figure 5] and [Figure 6].{Figure 5}{Figure 6}

As regards the oral manifestations, 73.5% knew that rapid tooth growth and osteoporosis of jaw is seen in patients suffering from hyperthyroidism (P = 0.005), but only 46.6% were aware of the burning mouth syndrome as the symptom of this condition. Less than 60% of the students answered correctly that delayed tooth growth, enamel hypoplasia, and micrognathia are the features of patients suffering from hypothyroidism (P = 0.0003) [Table 5].

Attitude of the respondents toward thyroid patients is found to be positive to passive as >75% of the students answered “Yes” to the attitude statement except that they ever talked to the physician of the patient suffering from thyroid disease and advised the patients for regular dental checkup (P = 0.02) [Table 6].{Table 6}

Discussion

The present study is perhaps the first and only study done to evaluate the knowledge about different aspects of the thyroid gland in undergraduate and postgraduate dental students. Since the patients with both hyper- and hypo-thyroidism can be seen in dental chair, it is important for the dental students and the dentists to be well versed with the symptoms and manifestations of its disorders to avoid complications during the treatment of their patients.

The overall knowledge score of the students about thyroid gland was between 51% and 75% indicating good knowledge. The knowledge increased with dentistry years indicating the expansion of their knowledge with their academic profile. Less knowledge about pathophysiology, oral manifestation, and clinical manifestation than the knowledge about thyroid gland and its hormones highlights the need of more focused study toward these aspects during their academic years.

Hypothyroidism has been documented to be more common than hyperthyroidism in the literature.[5],[6] However, the perception of our students toward the prevalence of hypothyroidism is less than hyperthyroidism. In addition, <50% of the students were aware of the euthyroid state occurring as a result of pregnancy where total thyroid hormones are increased due to increase in thyroglobulin[11] and thyroid dysfunction is mistaken as the symptoms of menopause.[12] This lack of awareness may pose difficulty in identifying and treating the patient.

Synthesis of thyroid hormones require active uptake of iodine by thyroid gland and its incorporation in the thyroglobulin. The synthesis is autoregulated by negative feedback control of TSH, the hormone secreted by anterior pituitary, and thyrotropin-releasing hormone, the hormone from hypothalamus. “Deficiency of iodine in diet leads to compensatory enlargement of the thyroid gland due to increased TSH level”[13] is answered correctly by 50% of the students. TSH as the screening test of thyroid disorder[14] is documented by 21.8% of the students. Awareness of our students was, however, more than the study in the literature.[15]

Although >50% of the students were aware of the oral manifestation of the hypo- and hyper-thyroidism, the burning mouth syndrome as the characteristic feature of hyperthyroidism[10] is recognized by <50% of the students and the number is less than reported in the literature.[15] This highlights the need of understanding the correlation of oral and clinical manifestations of the disease.

Thyroid hormones help the liver to process blood and have direct effects on cholesterol levels. In hypothyroidism, liver processes cholesterol slowly leading to increase in cholesterol and vice versa.[16] Thyroid hormones are hyperglycemic hormone and increase blood sugar level by enhanced rate of gluconeogenesis and glycogenolysis. “Hyperthyroidism due to raised BMR affects the secretion, action, and clearance of insulin faster than normal causing hyperglycemia”[17],[18] is answered by only 14.5% of the students. These observations indicate that the students of our study are deficient in their knowledge about the various biochemical integrations during normal and pathological state of the body.

The communication of dental professional and endocrinologist is fundamental and convenient follow-up of such patients that helps in the control of potential intricacies during dental treatment.[10],[19],[20] Stress reduction is necessary for thyroid patients, and a keen eye for the presence of signs and symptoms of thyroid disorders is among the responsibilities of the oral healthcare providers.[21] Attitude of about half of the respondents of not communicating with the physician taking care of the patient and not advising them for regular dental checkup may put their patients at high risk of developing complications during and after treatment and must have been improved.

Conclusions

The findings of our study indicate that though the dental students have acceptable knowledge about thyroid gland, its functioning, and its abnormalities, they are devoid of the awareness about the biochemical mechanism behind the disease and the treatment plan which can put their patients at risk. Dentist could be the first practitioner to refer the patients to a medical counterpart if they are well versed with the diseased pattern of an organ. Thus, more collective efforts should be put toward improving the knowledge and attitude of future dental clinician that can help them to provide the best possible oral and general health to their patients.

Acknowledgment

We are highly thankful to the Institute for providing all the facilities needed during the course of study. The authors would like to thank the students of the institute for their willingness to participate in the study and their cooperation during the collection of data. Nonteaching staff of the department of biochemistry is highly acknowledged for their help in collecting the data. We express our appreciation to the computer operator of the institute for his time to time help.

Financial support and sponsorship

Baba Jaswant Singh Dental College, Hospital and Research Institute, Ludhiana, supported the study.

Conflicts of interest

There are no conflicts of interest.

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