Accepted Manuscript

Public and Patient Knowledge about Dental Implants

George Deeb, DDS, MD, Bryan Wheeler, DMD, Margaret Jones, BS, Caroline
Carrico, PhD, Daniel Laskin, DDS, MS, Janina Golob Deeb, DMD, MS

PII: S0278-2391(17)30342-7
DOI: 10.1016/j.joms.2017.03.024
Reference: YJOMS 57714

To appear in: Journal of Oral and Maxillofacial Surgery

Received Date: 14 December 2016

Revised Date: 15 March 2017
Accepted Date: 15 March 2017

Please cite this article as: Deeb G, Wheeler B, Jones M, Carrico C, Laskin D, Golob Deeb J, Public
and Patient Knowledge about Dental Implants, Journal of Oral and Maxillofacial Surgery (2017), doi:
10.1016/j.joms.2017.03.024.

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 ACCEPTED MANUSCRIPT

Public and Patient Knowledge about Dental Implants

George Deeb DDS, MD1 Bryan Wheeler DMD2, Margaret Jones BS3, Caroline Carrico, PhD4,
Daniel Laskin, DDS,MS5 , Janina Golob Deeb, DMD, MS6

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1
Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia
Commonwealth University, Richmond VA

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Chief Resident, Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia
Commonwealth University, Richmond VA

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3
Student, School of Dentistry, Virginia Commonwealth University, Richmond VA
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Assistant Professor, Department of Research Administration. Virginia Commonwealth
University. Richmond VA.

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Professor Emeritus, Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia
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Commonwealth University, Richmond VA
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Assistant Professor, Department of Periodontics, School of Dentistry, Virginia Commonwealth
University, Richmond VA
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Public and Patient Knowledge about Dental Implants

ABSTRACT

PURPOSE: The more informed a patient is about a given procedure, the better the ultimate
outcome. This study was designed to compare general public awareness and knowledge

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regarding oral implant treatment with that of patients presenting for such treatment and to
determine the sources from which they may have obtained such information and its
accuracy.

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PATIENTS AND METHODS: In this cross-sectional study, two groups of patients were
asked to complete a questionnaire containing implant knowledge questions and questions

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regarding any sources they may have used to obtain information about dental implants.
Group I consisted of patients presenting for treatment of a dental emergency (general
population group) and Group II consisted of patients presenting for an implant
consultation.

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The Chi-squared test was used to determine if there were differences in knowledge and
information source between the two groups.
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RESULTS: A total of 126 adult patients (76 dental emergency patients and 50 implant consult
patients) participated in the study. The general population group was less informed about
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dental implants, especially as it relates to implant material and longevity, and received
information from less reliable sources than patients presenting for implant screening
(friends and relatives vs primary dentist). Both groups reported cost of the procedure as a
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primary barrier to receiving implants (89 and 90%).

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CONCLUSION: There is still a need for continued education of the general public regarding
dental implants.
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INTRODUCTION

Dental implants are becoming increasingly commonplace in clinical practice as the ‘gold
standard’ for replacing missing teeth. However, the general public is often uninformed or
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misinformed regarding who to consult for such treatment, the costs involved, as well as the
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procedures performed and the proper aftercare. Understanding what patients know about
dental implants and where their knowledge comes from is important for translation into
improved clinical care. The purpose of this study was to determine if patients presenting
for consultation regarding the placement of dental implants are more knowledgeable than
members of the general public, if the information they have regarding dental implants is
correct, and the sources they may have used to obtain their information. It was
hypothesized that whereas patients presenting for implant treatment will be relatively
well-informed about the procedure, those in the general public will be less knowledgeable.

PATIENTS AND METHODS

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A brief institutional review board-approved questionnaire (Figure 1) was administered

between March and September, 2016 to two groups of individuals. Group I consisted of
randomly selected new patients presenting to the emergency clinic at the Virginia
Commonwealth University (VCU) School of Dentistry, a population without plans to receive
dental implants, and Group II consisted of patients presenting for implant screening at the
school’s Dental Implant Clinic. In both situations the survey was completed in a private

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setting before the patient was seen by the doctor. Participation in the survey was voluntary
and refusal to participate did not affect subsequent treatment.
Summary statistics for each group were calculated and the responses were compared

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based on education level, gender, and whether the person was having an implant placed
using the chi-squared test. The outcome variables were the responses to the various
implant knowledge questions and the predictor variables were group (implant or

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emergency) and demographics (age, gender, education). The results were tabulated and
analyzed using SAS EG v6.1 software, with a significance level of 0.05.

RESULTS
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A total of 126 questionnaires were completed. There were 50 participants in Group I
(control group presenting for a dental emergency) and 76 participants in Group II
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(presenting for an implant consult). Respondent demographics are presented in Table

1. There was a representative sample of both males and females in both groups (54%
female, 46% male in Group I; 41% female, 59% male in Group II). The ages ranged from 18-
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65+ years, with Group II having more respondents in the oldest age groups (p-
value=0.0004). A variety of educational backgrounds was seen in both groups, but Group II
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had more respondents with some college or a college degree whereas Group I had more
with a high school education (p-value=0.0085). As expected, group I also had a significantly
lower percent with previous implant experience (8 vs 20%, p-value=0.0459).
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Table 2 contains the overall responses to each of the questions about implant knowledge
and sources of information. There were significant differences in responses between Group
I and Group II for four of the seven questions. A majority of respondents in both groups had
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heard of dental implants (76% of general population vs 94% of implant patients), although,
as expected, there were significantly more in the implant group (p-value=0.0104). There
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were also significant differences between the two groups in terms of sources of
information (p-value=0.0143). Those in the Group II were more likely to report their
dentist as their primary source of information regarding implants (54 vs 22%) whereas
respondents in the Group I were more likely to select family/relatives for information (39
vs 22%). While 70% of those in the Group II identified titanium as the material for
implants, 60% of Group I identified porcelain (p-value<0.0001). The two groups also
differed in their response regarding the longevity of implants (p-value=0.0273).
Respondents in Group I (controls) tended to select shorter lifespans than Group II (implant
group); specifically, 49% of Group II selected 20+ years compared to only 31% of Group I.

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The two groups did not differ on questions regarding hygiene, factors that influence getting
an implant, and who is the most qualified to place implants. Both groups predominantly
responded that implants would require the same dental hygiene as a natural tooth (94 vs
88%). Both also reported the most important factor for not getting an implant would be the
cost of the procedure (89 and 90%). Oral-maxillofacial surgeons were most often selected
as best qualified to place implants by both groups (88 vs 72%).

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Gender and education level were also associated with differences in responses. Females
were more likely to report using the internet as a source of information about implants (30
vs 15%, P-value=0.0354). Additionally, those with a college education or higher were more

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likely to report using dentists (47 vs 23%) and the internet (33 vs 15%) and significantly
less likely to report using television (9 vs 27%) as a sources of information. Those with
high school education or less were more likely to report fear and not wanting a foreign

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object in their body as factors influencing their decision not to get an implant (17 vs 4%).

DISCUSSION
The successful implant experience involves patients not only having an understanding of the

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procedure involved, but also being aware of the importance of their role in such things as
postoperative care and maintenance of proper oral hygiene. The treating doctor plays an
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important part in seeing that such information is provided to the patient (1, 2). However, the
more informed the patient is prior to being treated, the more likely these issues will receive
proper attention. Thus, it is essential that the treating doctor not only has some idea of the prior
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knowledge that patients who come seeking implants have, but also the accuracy of that
information. It is also important that the doctor has some idea of the factors that may cause
patients to reject the idea of implant placement. This study has attempted to address some of
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these issues by comparing patients presenting for a screening appointment for dental implants
with a group of patients not seeking implants.
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It was evident from this study that a large percentage of people are now aware of implants as a
means of replacing missing teeth, however, the fact that 25% of Group I respondents were
unaware of this indicates that there is still a need for greater education of the general public.
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There is also a significant difference in where informed people got their information about
implants. The largest number of respondents in Group II generally received their information
from a dentist whereas the primary source for Group I was friends or relatives. The latter group
also relied more on television than did Group II. This has also been reported in other studies (2-
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4). These sources of information could be the reason why fewer Group I respondents correctly
answered two of the three knowledge questions on the questionnaire, and this means that treating
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doctors will have to spend more time on correctly educating such persons should they become
implant patients.

Although the choices on the questionnaire were limited, it is evident that cost is a major factor in
why patients may decide not to have implants (3, 5). The fact that the participants in this study
were a dental school population, individuals who often seek such care for economic reasons, may
have contributed to this finding. However, cost is still an issue that needs to be addressed.

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In addition to the cross-sectional nature of this study, another limitation of this study was the use
of dental school emergency patients as representatives of the general population. This could
potentially have positively influenced some of the answers to questions about implant awareness
and knowledge and concerns about implant cost because they were also in the process of seeking
dental care. However, the fact that they were less informed about implants and correctly
answered fewer knowledge questions than Group II would indicate that this was not a significant
factor. It is clear that there is still a need to continue educating the general public about dental

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implants and that dental providers need to reinforce this information.

CONCLUSION

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Although this study showed that patients presenting for dental implants generally are better
informed than the general public, the fact that even in this group some were less knowledgeable

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than others indicates that there is still a need for public education.

REFERENCES:
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1. Zimmer CM , Zimmer WM, Williams J, Liesener J. Public awareness and acceptance of
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dental implants. Int. J. Oral Maxillofac. Implants. 7:228-32, 1992.

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2. Pommer B , Zechner W, Watzak G, Ulm C, Watzek G, Tepper G. Progress and trends

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in patients' mindset on dental implants. I: level of information, sources of

information and need for patient information. Clin Oral Implants Res. 22:223-9, 2011
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3. Al-Johany S , Al Zoman HA, Al Juhaini M, Al Refeai M. Dental patients' awareness and

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knowledge in using dental implants as an option in replacing missing teeth: A

survey in Riyadh, Saudi Arabia. Saudi Dent. J. 22:183-8, 2010.
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4. Ozçak r Tomruk C , Ozkurt-Kayahan Z , Sençift K Patients knowledge and awareness

1 2 1.
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of dental implants in a Turkish subpopulation. J. Adv. Prosthodont. 6:133-7, 2014.

5. Suprakesh B, Ahammed ARY, Thareja A, Kandadwamy R, Kumar N, Bhondwe S.

Knowledge and Attitude of Patients toward Dental Implants as an Option for
Replacement of Missing Teeth. J Contemp Dent Pract. 14:115-118, 2013.

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Table 1: Demographics for Survey Respondents

n, %
Gender Implant Non-Implant P-value*
Female 22, 54% 29, 41% 0.1896
Male 19, 46% 42, 59%

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No response 9 5

Age
18-24 0, 0% 8, 11% 0.0004

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25-29 1, 2% 12, 16%
30-34 0, 0% 8, 11%
34-39 2, 4% 0, 0%

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40-44 3, 6% 9, 12%
45-49 4, 8% 7, 9%
50-54 6, 12% 4, 5%

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55-59 7, 14% 10, 13%
60-64 13, 27% 6, 8%
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65+ 13, 27% 12, 16%
No response 1

Previous Implant 10, 20% 6, 8% 0.0459

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Education Level
Grade school 4, 8% 2, 3% 0.0085
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High school 15, 30% 41, 54%

Some college 14, 28% 13, 17%
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College degree 14, 28% 9, 12%

Advanced or professional degree 3, 6% 11, 14%
*P-value from chi-squared test
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Table 2: Summary of Responses to Survey Questions

Non-
Implant
Question Implant Group Group P-value
Have you ever heard of Implants?
Yes 46, 94% 58, 76% 0.0104
No 3, 6% 18, 24%

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Where did you get most of your information about dental
implants?*

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Friends/Relatives 11, 22% 29, 38% 0.0143
My Dentist 27, 54% 17, 22%
Internet 15, 30% 15, 20%

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Television 7, 14% 16, 21%
Newspaper or Magazine 3, 6% 2, 3%

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What material are dental implants made from?
Porcelain 6, 14% 41, 60% <0.0001
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Stainless Steel 4, 9% 8, 12%
Titanium 30, 70% 11, 16%
Ceramic 3, 7% 3, 4%
Unknown 0, 0% 5, 7%
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How long do you think dental implants last?

Less than 5 Years 0, 0% 7, 10% 0.0273
5-10 Years 11, 22% 19, 28%
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10-20 Years 14, 29% 16, 24%

20+ Years 24, 49% 21, 31%
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Unknown 0, 0% 4, 6%
Do dental implants require the same hygiene?
Yes 44, 94% 59, 88% 0.3226
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No 3, 6% 8, 12%

Most important factor when deciding to have a dental implant placed?

Cost of the procedure 42, 89% 61, 90% 0.2373
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Fear of operation 5, 11% 4, 6%

Do not like a foreign object placed in my body 0, 0% 3, 4%
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Who do you think is the most qualified to place implants?*

Oral surgeons 44, 88% 55, 72% 0.0587
Prosthodontists 9, 18% 12, 16%
Periodontists 15, 30% 5, 7%
Cosmetic dentists 5, 10% 9, 12%
General dentists 3, 6% 8, 11%
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IMPLANT KNOWLEDGE SURVEY

Male: _____ Female: _____ Age: _____

Highest level of education:

Grade school _____ Some college _____ Advanced or professional degree _____

High school _____ College degree _____

Have you ever had a dental implant placed? Yes _____ No _____

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If you answered NO, please answer the following question

Have you ever heard of dental implants? Yes _____ No _____

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If you answered Yes, please answer the following questions:

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1. Where did you get most of your information about dental implants (select all answers that
apply)
Friends or relatives _____

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My dentist _____
The internet _____
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Television _____
Newspaper or magazine _____

2. What material are dental implants made from?

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Porcelain _____
Stainless steel _____
Titanium _____
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Ceramic _____
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3. How long do you think dental implants last?

Less than 5 years _____
5-10 years _____
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10-20 years _____

More than 20 years _____

4. Do implants require the same brushing and flossing as natural teeth? Yes _____ No _____
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5. Which of the following would be the most important factor in your deciding not to have a dental
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implant placed if you had a missing tooth?

The cost of the procedure _____
Fear of the operation _____
I would not like a foreign object placed in my body _____

6. Which of the following practitioners do you think are most qualified to place dental implants?
Oral surgeons _____
Prosthodontists (dentists who specialize in making dentures) _____
Periodontists (dentists who specialize in treating gum diseases) _____
Cosmetic dentists _____
General practice dentists _____