Knowledge, Attitudes and Practice Behaviors About Caries Risk Assessment and Management

Brief Background: The World Health Organization (WHO), the International Association for Dental Research (IADR) and the World Dental Federation (FDI) in 1981 established the first global oral health goals and promoted the development of oral health objectives targeting reduction in key oral health indicators by 2020. Among the oral health indicators identified in this initiative was the reduction of caries. While there is evidence to suggest that from a global perspective the prevalence of caries is decreasing, there are geographical locations, like Saudi Arabia, where the prevalence of caries is exceeding worldwide statistics. Hence, dental professional, research, and educational associations have promoted caries risk assessmentand management as a key approach to mitigate the prevalence of caries. One of the most recognized comprehensive caries risk assessment and management approach is known as the Caries Managementby Risk Assessment (CAMBRA Objectives: To investigate the CAMBRA knowledge, attitudes and practice behaviors of dentists in Saudi Arabia. Methods: The proposed investigation is a cross-sectional study that employed a survey using REDCap to solicit responses from dentists in Saudi Arabia about their knowledge, attitudes and practice behaviors of the CAMBRA. Results: 130 individuals responded to the survey. The majority of the dentists were male (n=72, 56.3%), while 43.7% were female. Most of the participants selected an age range between 25 to 34 years old (n=121, 94.5%), the remaining selected ages older than 34 years old. Furthermore, 68% of the dentists (n=87) reported that they worked in a governmental hospital or clinic. In regards to level of education, 68.8%(n=88) stated their highest level of education was a dental degree, while 31.3% (n=40) stated their highest level of education was a postgraduate degree in dentistry. Most of the dentists 60.9% (n=78) had less than five years of experience. The majority of the dentists 71.6% reported (n=73) that they were using CAMBRA. The participants were asked to select their level of agreement with nine caries risk assessment statements about the importance or relevance of caries risk assessment in dental practice. For example, approximately 96% (n=113,) of the respondents agreed with the following statement “Performing caries riskassessment is an integral part of dental practice”. Nine items measured knowledge about carious lesions, caries pathology and potential risk for individuals who have caries. Correct responses for these items ranged from 64% to 100%. Three cases were employed to measure skills about the application of CAMBRA. Most respondents selected correctly the risk level for the low risk patient; however, for the moderate and high risk patient scenarios over 50% of the respondents selected the wrong answer. Additionally, a 4-point Likert-type scale was used to select the frequency of specific caries management recommendations. For example, 68% of the participants selected always for “Fluoridated over the counter toothpaste” and “Individualized oral hygiene instructions”. Also, 4% selected always for “Calcium phosphate products”. Results from the Multivariable Logistic Regression analysis indicated that workplace and specialty were significant predictors of total knowledge. Dentists who worked in a governmental hospital or clinic were 2.46 times more likely to obtain higher total knowledge scores than dentists who worked in other sectors while general dentists were 2.3 times more likely to obtain higher total knowledge scores. Our study did not point to any of the demographical variables as significant determinants of CAMBRA attitudes, however, practicebehaviors were significant determinants of attitudes and vice versa (AOR= 0.30, CI 95% 0.11, 0.79). Additionally, gender and specialty were significant predictors of practice behaviors. For instance, males were less likely than females to obtain high practice behavior scores and general dentists were three times more likely to score higher than dentists with a specialty. Conclusion: The outcomes from this study are consistent with other studies in the literature pointing to the need for educational interventions for dentists aimed at improving knowledge about CAMBRA and to influence their practice behaviors. These educational interventions should cover information and strategies to change attitudes that prevent dentists from practicing CAMBRA