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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 9  |  Issue : 5  |  Page : 147-153  

Knowledge and attitude of dental surgeons about ocular complications due to dental infection


1 Department of Oral Pathology, AME's Dental College and Hospital, Raichur, Karnataka, India
2 Department of Pedodontics and Preventive Dentistry, Navodaya Dental College and Hospital, Raichur, Karnataka, India
3 Department of Oral Pathology, Guru Gobind Singh College of Dental Sciences and Research Centre, Bhuranpur, Madhya Pradesh, India

Date of Web Publication27-Nov-2017

Correspondence Address:
Vinod Kumar
Department of Pedodontics and Preventive Dentistry, Navodaya Dental College and Hospital, Raichur - 584 102, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.JPBS_108_17

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   Abstract 


Background: Ocular complications such as ophthalmia, defective vision, orbital cellulitis, and blindness (temporary or permanent) are rare complications due to dental infection. Currently, there is lack of guidelines in preventing and managing ocular problems. Hence, we assessed the dentist's knowledge and attitudes about ocular complications due to dental infection. Materials and Methods: A cross-sectional prospective survey selecting practicing dentists or academicians was carried out through e-mail using a standardized self-administered questionnaire. The data were statistically analyzed using descriptive statistics (percentage). Results: Only 25% participants knew about ocular complications due to dental infection. Journals and internet were the key sources of information among dentists. Majority of participants responded that ocular complications are underreported in the literature. Large proportion (90%) of the participants advocated research on ocular complications due to dental infection. Many participants indicated the prevention of ocular complications. Conclusion: In our observation, dentist's knowledge about ocular complications due to dental infection was poor, and the awareness and practice of taking preventive measures were satisfactory. There is need for providing adequate information about ocular problems in the curriculum of dentistry. Dentists should be trained about prevention and initial management of ocular complications due to dental infection through special educations such as continuing dental educations, workshops, and symposium.

Keywords: Dental, ocular, ophthalmia, orbital cellulitis


How to cite this article:
Hunsigi P, Kumar V, Pradeep M R, Arun Kumar B C. Knowledge and attitude of dental surgeons about ocular complications due to dental infection. J Pharm Bioall Sci 2017;9, Suppl S1:147-53

How to cite this URL:
Hunsigi P, Kumar V, Pradeep M R, Arun Kumar B C. Knowledge and attitude of dental surgeons about ocular complications due to dental infection. J Pharm Bioall Sci [serial online] 2017 [cited 2022 Jul 6];9, Suppl S1:147-53. Available from: https://www.jpbsonline.org/text.asp?2017/9/5/147/219254




   Introduction Top


The relationship between infected teeth and diseases of the eye has been known for some time.

Several centuries ago, a case of ophthalmia and loss of eye due to an abscessed tooth had been reported. In 1795, the connection between dental irritation and diseases of the eye has been described, and in 1817, a case was reported in which contraction of the visual field was carried out away with by the extraction of carious tooth. Many cases of defective vision were effectually relieved by the removal of pathological conditions discovered in the mouth. During the past 20 years, the subject of dental focal infection has received much attention due to the experimental work of various researchers.[1]

The present trend of dental thought and research is strongly toward the prevention of oral disease, and for that part of the juvenile public which cooperates, much of the familiar, corrective labors of the dentist are becoming less necessary. Further discoveries in prevention seem imminent, and the increased interest of the medical profession in the one organ concerned in nutrition, the functional activity of which is largely controllable by the patient, will be potent influence in furthering public health. There is a plenty of evidence in case histories of the direct etiological relation of foci of infection of the mouth to inflammatory disturbances of the eye. In this effort to establish a better contact between the medical and dental divisions of health service, one is confronted with the fact that those in each division are poorly informed concerning the anatomy, pathology, and the functions of the organs in care.[2]

However, there have been no guidelines regarding how to prevent and care for ocular problems due to dental infection in the dental curriculum, and surprisingly, research on ocular complications due to dental infection is almost nonexistent in the dental literature.

This is the first survey on ocular complications due to dental infection. The subject of this study was the assessment of the knowledge and attitudes of dentists toward ocular complications of the dental infection.


   Materials and Methods Top


A cross-sectional prospective survey by means of an e-mail targeting the dentists was carried out using a self-administered questionnaire. The questionnaire covered demography, knowledge of occurrence of ocular problems due to dental infections, immediate reaction, prevention, and ophthalmologist consultation. Six hundred survey questionnaires were e-mailed to registered dental practitioners or academicians. In total, 430 dentists responded with replies to all questionnaires. The study group comprised of all the dental surgeons practicing in the private sector, government sector, and academics. Personal data were not collected to maintain the anonymity of the study subjects. The data were statistically analyzed using descriptive statistics (percentage).


   Results Top


The level of knowledge about ocular complications due to dental infection among study participants was unsatisfactory, but they had a relatively positive attitude toward its prevention which enables them the provision of the better prevention to the patients when it was required. Out of 600 e-mailed questionnaires, a total of 430 dentists answered to all questionnaires, and the response rate was 71.6%. Among the study population, 140 were with graduate-level qualification and 290 were with postgraduate-level qualification.

Knowledge of ocular complications among dentists with graduate qualification

Only 24.2% of surveyed participants knew about the occurrences of ocular complications due to dental infection, while 30% responded that ocular complications do not happen due to dental infection and 45.7% were unaware of such complications. Among the participants who knew about the ocular complications due to dental infection, 35.7% said internet as important source of information, while 28.6% indicated that they had personal experience of it in their clinical practice, 21.4% expressed that journal was their leading source of information, and many others said that a combination of internet, personal experience, and journals was their prime source of information. About 32.8% of dentists confronted with ocular complications due to dental infection in their practice, where in the commonly observed symptoms were orbital cellulitis (56.8%), defective vision (19.6%), ophthalmia (15.6%), and contraction of visual field (8.6%). Those symptoms remained for few hours to few days and only 15.3% of dentists consulted ophthalmologist for better management of these complications. Surprisingly, only 12.8% study subjects responded that untreated tooth infection leads to ocular complications. 19.2% of the dentists indicated that ocular complications due to dental infection leads to cavernous sinus thrombosis, 23.5% said no, and 57.1% were unaware. 42.1% participants said that visual loss is serious ocular complication, while 29.2%, 9.2%, 7.8%, and 6.4% of the respondents associated serious ocular complications with orbital cellulitis, defective vision, ophthalmia, and contraction of visual field, respectively. Edited: While 2.8% of respondents responded that all the ocular complications can lead to seriousness and 2.1% respondents did not associate any of these ocular complications with seriousness.63.5% of participants said ocular complications due to dental infection are underreported in the literature. While 18.5% responded that it is over reported and few, i.e., 17.8%, indicated that it is adequately reported. Interestingly, 30% responded that maxillary premolars teeth infections are more prone for ocular complications, 23.5% responded maxillary molars, 21.4% said maxillary anterior teeth, 9.2% indicated mandibular anterior teeth, 5.7% opted mandibular molars, 3.5% said mandibular premolars. Remaining 3.5% said that all teeth are prone and very few (2.8%) opted none of the above option [Table 1].
Table 1: Knowledge questions

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Attitude of dentists with graduate qualification

32.8% dentists responded that their immediate reaction on facing with ocular complication is shifting the patient to hospital care, 23.5% indicated calling the medical emergencies, 22.1% preferred reassurance to the patient and stop the intended dental procedure, and only 21.4% opted for summoning the ophthalmologist. None indicated to ignore and proceed with intended dental procedure. About the prevention of ocular complications, 27.1% expressed that it can be prevented by knowing the facial planes and route of spread of tooth infection and treating dental infection immediately, 25% preferred to report immediately to ophthalmologist if patient complains of visual problems, 22.1% opted for institution of intravenous (IV) antibiotics in case of severe tooth infection, 21.4% respondent's answered that it can be prevented by all above methods, and only few (4.2%) of the respondents preferred for none of the above option. Majority of respondents (40%) preferred that they will consult ophthalmologist if signs and symptoms of ocular problem last for >24 h, 21.4% indicated immediate consultation, 28.5% after completing intended dental procedure, and 10% were not inclined to consult ophthalmologist. Regarding seriousness of ocular complications, 20% answered yes, 10% indicated no, and majority of the participants (70%) responded don't know. A large proportion of respondents (94.2%) expressed that more research and review should be carried out on ocular complications due to dental infection and only 5.8% said that it is not needed. 93.5% of participants are in opinion that more information should be published in journals, textbooks, and other sources about ocular complications due to dental infection, and very small percentage (6.4%) of respondents expressed that there is no need of more information. Great majority of respondents (96.4%) favored prevention of ocular complications, and very few (3.5%) indicated no need of prevention [Table 2].
Table 2: Attitude questions

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Knowledge of ocular complications among dentists with post graduate qualification

Only 26.8% postgraduate dentists examined were aware about occurrence of ocular complications due to dental infection, while 16.2% replied that ocular complications do not occur due to dental infection and 45.7% were unaware of such complications. Among the participants aware of the ocular complications due to dental infection, 29.7% responded journal as a prime source of information, while 25.5% experienced personally in their clinical practice, 21.2% mentioned internet, and many others pointed out a combination of internet, personal experience, and journals, being their important source of information. Majority of dentists (82.5%) did not face ocular complications due to dental infection, only 17.5% confronted ocular complications where in the usual symptoms found were orbital cellulitis (62.7%), defective vision (15.6%), ophthalmia (11.7%), and contraction of visual field (9.8%). Those symptoms' lasted for few hours to few days, and only few (25.5%) of dentists summoned ophthalmologist to address these complications. Many (61.3%) respondents are ignorant that untreated tooth infection leads to ocular complications, 23.7% of the dentists mentioned that untreated tooth infection will not cause ocular complications, and only 14.8% were aware that tooth infection causes ocular complications. 34.8% answered ocular problems due to dental infection leads to cavernous sinus thrombosis, 16.2% mentioned no, and 48.9% were ignorant. 35.8% participants pointed out that visual loss is serious ocular complication, while 34.1%, 12.4%, 11.7% and 3.4%, of the study subjects related serious ocular complications with orbital cellulitis, contraction of visual field, defective vision and ophthalmia respectively. Only 2.8% subjects answered that all the ocular complications can cause seriousness, and remaining few (0.6%) participants did not relate any of these ocular complications with seriousness. Greater number (67.5%) of participants replied that ocular complications due to dental infection are underreported in the literature. While 18.2% answered that it is over reported, only 14.1% pointed out that it is adequately reported. 34.1% mentioned maxillary molars teeth infection are more prone for ocular complications, 27.5% responded maxillary anteriors, 19.3% answered maxillary premolars, 10% specified mandibular anteriors, 3.4% said mandibular molars, 2.7% picked mandibular premolars, 1.7% expressed that all teeth are prone, and very few (0.6%) selected none of the above option [Table 1].

Attitude of dentists with post graduate qualification

Large proportion of respondents (49.6%) mentioned that their immediate response on confronting with ocular complication is shifting the patient to hospital care, 18.2% chose to call medical emergencies, 16.2% favored for reassurance to the patient and stop the intended dental procedure, and 11.3% answered they will invite ophthalmologist and few (4.4%) said they will ignore and proceed with intended dental procedure. About the prevention of ocular complications, 24.8% expressed that it can be prevented by knowing the facial planes and route of spread of tooth infection and treating dental infection immediately, 20.6% preferred to send the patient immediately to ophthalmologist, if patient complains of visual problems, 26.2% preferred for administration of IV antibiotics in case of severe tooth infection, 22.7% participants replied that it can be prevented by all above methods, and only 2% of participants chose none of the above option.

In case if they encounter with ocular complications due to dental infection 45.8% mentioned that they will consult ophthalmologist if signs and symptoms of ocular problem last for >24 h, 26.5% expressed immediate consultation, 20.3% preferred to consult ophthalmologist after completion of intended dental procedure, and 7.2% were not inclined to consult ophthalmologist.

About seriousness of ocular complications, 21% replied that they are serious about ocular complications, 9.3% said that they are not serious, and most of the participants (69.6%) are unaware of seriousness of ocular problems. Overwhelming number of respondents (91.8%) believe that more research and review should be carried out on ocular complications due to dental infection and only few (8.2%) expressed that it is not needed. Great majority (96.2%) of respondents are in opinion that more information should be published in journals, textbooks, and other sources about ocular complications due to dental infection and only 3.8% pointed out no need of more information. Relatively large proportion of respondents (97.2%) revealed prevention of ocular complications, and very few (2.7%) expressed no need of prevention [Table 2].


   Discussion Top


There is need to have in-depth knowledge of the ocular complications due to dental infection and also assessment of dentists knowledge and attitude help in broadening preventive strategies toward ocular complications due to dental infection. Extension of odontogenic infection into the orbit can occur through a variety of pathways. Root apices are anatomically proximal to adjacent muscle, connective tissue, and sinuses. The most common route of spread is through the maxillary sinus into the inferior orbit via the inferior orbital fissure or defect in the orbital floor,[3],[4],[5] Less common paths include extension via the pterygopalatine regions,[6],[7] infection ascending from the canine fossa to the orbit,[4] or retrograde spread through the ophthalmic vein.[8]

This study assessed the level of knowledge and attitudes of dentists toward ocular complications due to dental infection. The observations of our study indicated the low level of knowledge among dentists which is a reflection of inadequate understanding about ocular complications due to dental infection. In our study, approximately 75% respondents did not know that ocular complications occur due to dental infection. Dentists who deal routinely with dental infection should know all complications. It is important for dentists to be fully equipped with latest information, treatment modalities, and knowledge of resources available on a daily basis.

In this report, 57% graduates and 51% postgraduates answered they gathered information from internet and journals. Nowadays, several types of mass media have been discovered that can be effectively used as informatory source. In our findings, however, internet and journals were important sources of information. However, many studies and proper information through textbooks, about prevention of ocular complications and management can reassure dentists and enable them to efficiently prevent and manage ocular problems.

Only few (20%) of participants (graduates and postgraduates) appreciated the seriousness of ocular complications due to dental infection, about 10% dentists said that ocular complications are not serious in nature, but large majority (70%) of dentists (graduates and postgraduates) were unaware of the value of seriousness of ocular complications. Although ocular complications are transient and rare to happen, there are few reported cases of permanent visual loss. In our study, many dentists (around 60%) indicated that among all ocular complications, they found odontogenic orbital cellulitis (OCC) is frequently seen ocular complication due to dental infection. OOC is a rare complication due to dental infection but serious infection with high risk of visual loss. This infection can necessitate intensive monitoring, serial imaging, multidisciplinary care, and surgical intervention.[9],[10]

The value of seriousness about ocular complications by dentist appears to be quite low due to the belief that ocular complications are very rare and last for short period. The prevalence rate of serious ocular complications due to dental infection is very low and dentist attention has not been extensively triggered regarding ocular complications due to dental infection. Steinbugler[1] in 1930, Gillett[2] in 1930, Stübinger et al.[3] in 2005, Caruso et al.[4] in 2006, and Mehra et al.[5] in 1999 have reported serious ocular complications due to dental infection. Hence, dentist should perceive the seriousness about ocular complications due to dental infection and try to prevent the complications by addressing the dental infection at initial stage.

In our study, many respondents favored the prevention of ocular complications which is a good indicator to improve and broaden the preventive services to people at large. Surprisingly in our observations dentists showed adequate preventive control and care for ocular complication affected patients despite the low level of knowledge.

Most of the studies have investigated attitudes in combination with the level of knowledge and have concluded that to change negative attitudes continuous education is must. In our study, though the level of knowledge was low among the dentists, they were willing to learn about ocular complications and prevent it, but dental curriculum lacks the preventive strategies for prevention and initial management of ocular complications due to dental infection. Need of the hour is optimally formulated guidelines to dentists to prevent ocular complications due to dental infection and also to increase awareness on identifying and managing initial ocular complications.

Therefore, in dental curriculum, proper guidelines should be framed to prevent and manage ocular complications due to dental infection. Furthermore, general education for the dentist should be well supported with special education through continuing dental education, workshops, and symposiums to provide initial care of ocular complications due to dental infection in dental clinics and definite treatment in consultation with ophthalmologist.

The lacunae of inadequate literature related to ocular complications due to dental infection has to be addressed by providing sufficient information through journals, textbooks, continuing dental educations and also encouraging research. There is need to train the dental practitioners on the importance of ocular complications and methods of proper care and management. Initial ocular complications management should be a part of academic curriculum in dentistry.


   Conclusion Top


Data from our study revealed low level of knowledge about ocular complications due to dental infection among dental surgeons in India. Their attitude is adequate but needs further improvement. Inclusion of proper guidelines to prevent and initial care of ocular complications due to dental infection is therefore deemed a necessity in the curriculum of dentistry. Further, more information should be available to dentists through research, continuing dental education, workshops, and symposium.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Steinbugler WC. Dental infection in diseases of the eye. Arch Ophthalmol 1930;4:220-7.  Back to cited text no. 1
    
2.
Gillett HW. Infections of the mouth and their relation to diseases of the eye from the point of view of a general practitioner of dentistry. Arch Ophthalmol 1930;4:228-39.  Back to cited text no. 2
    
3.
Stübinger S, Leiggener C, Sader R, Kunz C. Intraorbital abscess: A rare complication after maxillary molar extraction. J Am Dent Assoc 2005;136:921-5.  Back to cited text no. 3
    
4.
Caruso PA, Watkins LM, Suwansaard P, Yamamoto M, Durand ML, Romo LV, et al. Odontogenic orbital inflammation: Clinical and CT findings – Initial observations. Radiology 2006;239:187-94.  Back to cited text no. 4
    
5.
Mehra P, Caiazzo A, Bestgen S. Odontogenic sinusitis causing orbital cellulitis. J Am Dent Assoc 1999;130:1086-92.  Back to cited text no. 5
    
6.
Muñoz-Guerra MF, González-García R, Capote AL, Escorial V, Gías LN. Subperiosteal abscess of the orbit: An unusual complication of the third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:e9-13.  Back to cited text no. 6
    
7.
Thakar M, Thakar A. Odontogenic orbital cellulitis. Report of a case and considerations on route of spread. Acta Ophthalmol Scand 1995;73:470-1.  Back to cited text no. 7
    
8.
Poon TL, Lee WY, Ho WS, Pang KY, Wong CK. Odontogenic subperiosteal abscess of orbit: A case report. J Clin Neurosci 2001;8:469-71.  Back to cited text no. 8
    
9.
Blake FA, Siegert J, Wedl J, Gbara A, Schmelzle R. The acute orbit: Etiology, diagnosis, and therapy. J Oral Maxillofac Surg 2006;64:87-93.  Back to cited text no. 9
    
10.
DeCroos FC, Liao JC, Ramey NA, Li I. Management of odontogenic orbital cellulitis. J Med Life 2011;4:314-7.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2]


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