Key words:
Dental implant - dental prosthesis - dental prosthesis retention - fatigue
INTRODUCTION
Survival following cardiopulmonary arrest is usually not high, and to some degree
depends on early interference, quality of cardiopulmonary resuscitation (CPR), and
the time of defibrillation.[1]
[2]
[3]
[4] Basic life support (BLS) is the base of rescuing lives following cardiac arrest,[5] as it keeps viability until full resuscitation for cardiopulmonary system can be
commenced.[6] BLS comprises immediate recognition of cardiac arrest and activation of emergency
response system, the early performance of high-quality CPR, and rapid defibrillation.
All these steps will prevent the central nervous system from undergoing irreversible
damage by hypoxia or anoxia.[7]
CPR is controlled by guidelines developed by certain associations such as American
heart association,[8] and some other associations in Europe,[9] Singapore,[10] Australia, and New Zealand.[11] These guidelines are updated regularly to cope with new advances in this field.
Work in the field of dentistry is fraught with many risks leading to life-threatening
emergencies.
These conditions may be related to the use of local anesthesia,[12] dental materials with high sensitivity potential, and the fear of unknown surgical
operations. Consequently, every dentist must be familiar with various protocols to
efficiently manage such emergencies arising in the dental office.
Proper practice of the techniques and maneuvers is mandatory to effectively resuscitate
a victim, which requires adequate knowledge and training during dental education years.
Many studies have evaluated the level of knowledge about BLS among medical and dental
students. However, to our knowledge, none has evaluated the same among dental students
in Saudi Arabia. Therefore, this study aimed to assess the level of awareness regarding
BLS and the attitude toward CPR-needed victims among Saudi dental students and interns.
MATERIALS AND METHODS
This study consisted of a cross-sectional survey of undergraduate dental students
at the school of Dentistry, Al-Farabi Collages, Riyadh, Saudi Arabia. Clinical dental
students (final-year and interns) enrolled during 2015–2016 academic year were eligible
to participate (n = 250). This study was approved by the Al-Farabi College Institutional Ethical Review
Board.
A structured questionnaire was adapted from pretested questionnaires that have been
used in similar studies by Chandrasekaran et al.[13] and Reddy et al.[14] with some modifications to accommodate the student’s educational level. Before submitting
the questionnaire, a pilot study was performed on a random sample of the students
(n = 20), and the questionnaire was modified according to the feedback obtained.
Students were asked to fill out the anonymous self-administered questionnaire at the
end of the lectures and sometimes during the clinical sessions without discussion
for 15 min. Students who agreed to participate in the study and signed a consent form
before answering the questionnaire.
The self-administered questionnaire comprised of 23 closed-ended questions divided
into two parts. The first part assessed the demographic profile of students such as
age, gender, and educational level. The second part investigated the participants’
knowledge and awareness regarding BLS.
For a better assessment, the knowledge scores were categorized into three divisions
as follows: inadequate (<50%), satisfactory (51%–75%), and adequate (>75%).
Statistical Package for Social Studies version 22.0 (IBM Corporation, Chicago, IL,
USA) was used for data entry and descriptive statistics including frequencies and
proportions. Chi-squared test was used to assess statistical significance. A P < 0.05 was considered statistically significant.
RESULTS
Out of the 250 dental students participated in the survey, 203 (145 final-year students
and 58 interns) returned the questionnaires, giving a response rate of 81.2%.
[Table 1] summarizes the demographic data of the participants. Around 52% were males and the
majority were final-year dental students (71.4%).
Table 1:
Demographic distribution of the study population (%)
|
Variables
|
n (%)
|
|
Gender
|
|
Male
|
97 (47.8)
|
|
Female
|
106 (52.2)
|
|
Age groups (years)
|
|
<25
|
141 (69.5)
|
|
26-35
|
61 (30)
|
|
>35
|
1 (0.5)
|
|
Educational levels
|
|
Final year
|
145 (71.4)
|
|
Internship
|
58 (28.6)
|
Overall, the respondents showed a poor level of knowledge with respect to most of
the questions; the proportion of correct answers varied greatly, ranging from 7.4%
to 93%, with significant differences between males and females [Table 2].]
Table 2:
Comparison of correct response knowledge scores based on gender groups (%)
|
Question number
|
Questions
|
Gender, n (%)
|
Total
|
P
|
|
Male
|
Female
|
|
*Means statistically significant. CPR: Cardiopulmonary resuscitation, AED: Automated
external defibrillator, BLS: Basic life support, EMS: Emergency Medical Services
|
|
1
|
Abbreviation of “BLS”?
|
85 (87.6)
|
102 (98.1)
|
187 (93)
|
0.004*
|
|
2
|
Find someone unresponsive in the middle of the road, what will be your first response?
|
6 (6.2)
|
38 (35.8)
|
44 (21.7)
|
0.000*
|
|
3
|
If you confirm somebody is not responding to you even after shaking and shouting at
him, what will be your immediate action?
|
1 (1)
|
14 (13.2)
|
15 (7.4)
|
0.000*
|
|
4
|
Location of chest compression?
|
66 (68)
|
46 (44.7)
|
112 (56)
|
0.003*
|
|
5
|
Location for chest compression in infants?
|
70 (72.2)
|
62 (59)
|
132 (65.3)
|
0.005*
|
|
6
|
If you do not want to give mouth-to-mouth CPR, the following can be done “except”?
|
93 (95.9)
|
70 (68)
|
163 (81.5)
|
0.000*
|
|
7
|
Rescue breathing in infants?
|
74 (76.3)
|
37 (35.2)
|
111 (55)
|
0.000*
|
|
8
|
Depth of compression in adults during CPR?
|
5 (5.2)
|
17 (16)
|
22 (10.8)
|
0.000*
|
|
9
|
Depth of compression in children during CPR?
|
11 (11.6)
|
51 (49)
|
62 (31.2)
|
0.000*
|
|
10
|
Depth of compression in neonates during CPR?
|
61 (63.5)
|
43 (43.4)
|
104 (53.3)
|
0.001*
|
|
11
|
Rate of chest compression in adult and children during CPR?
|
84 (87.5)
|
43 (41.3)
|
127 (63.5)
|
0.000*
|
|
12
|
Ratio of CPR, single rescuer in adults is?
|
8 (8.2)
|
55 (53.4)
|
63 (31.5)
|
0.000*
|
|
13
|
In a newborn, the chest compression and ventilation ratio is?
|
4 (4.3)
|
11 (11)
|
15 (7.7)
|
0.000*
|
|
14
|
Abbreviation AED stands for?
|
66 (68)
|
47 (44.8)
|
113 (55.9)
|
0.006*
|
|
15
|
Abbreviation EMS stands for?
|
53 (54.6)
|
63 (60.6)
|
116 (57.7)
|
0.000*
|
|
16
|
If you and your friend are having food in a canteen and suddenly your friend starts
expressing symptoms of choking, what will be your first response?
|
0
|
22 (21)
|
22 (10.9)
|
0.000*
|
|
17
|
You are witnessing an infant who suddenly started choking while he was playing with
the toy, you have confirmed that he is unable to cry (or) cough, what will be your
first response?
|
10 (10.3)
|
54 (51.4)
|
64 (31.7)
|
0.000*
|
|
18
|
You are witnessing an adult unresponsive victim who has been submerged in fresh water
and just removed from it. He has spontaneous breathing, but he is unresponsive. What
is the first step?
|
3 (3.1)
|
30 (28.6)
|
33 (16.4)
|
0.000*
|
|
19
|
You noticed that your colleague has suddenly developed slurring of speech and weakness
of right upper limb. Which one of the following can be done?
|
69 (71.1)
|
20 (2.9)
|
89 (44.1)
|
0.000*
|
|
20
|
A 50-year-old gentleman with retrosternal chest discomfort, profuse sweating, and
vomiting. What is next?
|
90 (92.8)
|
64 (61.0)
|
154 (76.2)
|
0.000*
|
[Table 3] illustrates the mean knowledge scores by gender, age, and the academic level. Overall,
more than half of the respondents showed inadequate knowledge (scoring <50%). Comparing
the mean knowledge scores, males showed higher mean scores (45.41 ± 10) than females
(42.31 ± 16.3), and the difference was statistically significant (P < 0.01). With reference to age groups and educational levels, the mean knowledge
scores were comparable, with no significant difference between the groups [Table 3].
Table 3:
Association of variables with mean knowledge score levels (%)
|
Variables
|
Knowledge scores, n (%)
|
Mean knowledge scores (%)
|
P
|
|
Inadequate (<50)
|
Satisfactory (51-75)
|
Adequate (<75)
|
|
*Means statistically significant
|
|
Gender
|
|
Males
|
52 (53.6)
|
45 (46.4)
|
0
|
45.41±10.0
|
0.003*
|
|
Females
|
74 (69.8)
|
28 (26.4)
|
4 (3.8)
|
42.31±16.3
|
|
Age groups (years)
|
|
<25
|
85 (60.3)
|
53 (37.6)
|
3 (2.1)
|
43.94±13.9
|
0.889
|
|
26-35
|
40 (65.6)
|
20 (32.8)
|
1 (1.6)
|
43.44±13.6
|
|
>35
|
1 (100)
|
0
|
0
|
45.0
|
|
Educational levels
|
|
Final-year
|
85 (58.6)
|
57 (39.3)
|
3 (2.1)
|
43.97±13.5
|
0.275
|
|
Internship
|
41 (70.7)
|
16 (27.6)
|
1 (1.7)
|
43.36±14.5
|
DISCUSSION
Medical emergencies that threaten the life may occur at any time in the dental clinic.
It may occur as a result of local anesthesia administration, the fear of unknown surgical
procedures, or due to other reasons.[12] Therefore, the knowledge about the chain of survival can improve the chances of
survival and recovery in conditions such as heart attack, stroke, or any other emergencies.
This chain includes immediate recognition of cardiac arrest and activation of the
emergency response system, early CPR, rapid defibrillation, and effective advanced
life support with postcardiac arrest care.[15] This study was planned to examine BLS knowledge among interns and final-year dental
students at Alfarabi Collages of dentistry and nursing.
Overall, the dental students in the present survey showed an inadequate level of knowledge
of BLS. This result is in agreement with other previous studies such as Chandrasekaran
et al.,[13] Reddy et al.,[14] and Owojuyigbe et al.,[16] who concluded that dental students’ knowledge of BLS was very poor before the BLS
training. However, our results are different from a study conducted by Narayan al,[17] in which dental interns showed an adequate level of knowledge.
In one study conducted among dental students in India, only 26.9% and 73.1% of males
and females, respectively, knew the abbreviation of “BLS,” whereas, in our study,
the figures were much higher (87.6% and 98.1%, among males and females, respectively).[14] The correct response of participants to the item “chocking in adults” in the present
study was 10.9%. This figure is comparable to the 16.8% and 19.8% reported by Reddy
et al.[14] and Roshana et al.,[18] respectively.
This study showed a slight difference in the mean knowledge score between males (45.41%)
and females (42.31%), with statistically significant difference (0.003). This finding
contradicts the findings by some studies[14]
[19] which reported that females revealed a higher mean score as compared to males; this
may be attributed to the difference in sample size with regard to gender between the
two studies, as well as to the cultural barriers imposed on female gender in Saudi
Arabia. This fact was proven in other subjects in a similar students’ sample.[20]
In the current study, it was noted that both final-year students and interns had inadequate
knowledge with nearly similar findings (43.97% vs. 43.36%). Nevertheless, the final-year
dental students (39.3%) showed better satisfactory (between 51% and 75%) scores in
comparison to the interns (27.6%). This finding is compatible with another study by
Reddy et al.,[14] which showed better knowledge scores among undergraduate students. This finding
can be explained by the fact that the topics of CPR and medically compromised emergencies
are included in the 5th year (before final-year) curriculum, so final-year students
still memorize the information far better than their interns counterparts, emphasizing
the need for continuous refreshing courses about these critical topics. Further, these
results could be attributed to inadequate didactic and practical training regarding
BLS in dental schools. This fact was emphasized by recent studies that reported that
CPR training and short courses had a positive impact in self-assurance toward BLS.[16]
[21]
CONCLUSION
The findings of the present study demonstrates poor knowledge among dental students
regarding BLS and showed the urgent need for continuous refreshing courses for this
critical topic.
Financial support and sponsorship
Nil.
