Lesion sterilization and tissue repair Therapy in primary Teeth: knowledge of dentists in Upper Egypt – a cross-sectional study

Conclusion

The following findings can be drawn within the limitations of the present study:

Thekmajoritykofodentists in Upper Egypt had low knowledge about LSTR Technique. In Upper Egypt; Female dentists, pediatric dentists, professionals practicing in educa-tional hospitals, master's degree holders and dentists with less than one year of professional experience had good know-ledge regarding LSTR Technique.

Recommendation

 LSTR should be widely incorporated into undergraduate curricula and continuing education programs. Additionally, further investigations are recommended regarding attitude and practice of dental practioners towards LSTR in Egypt.

Introduction

Treating primary teeth with pulpal involvement is one of the most valuable services a dentist can offer a kid patient. By removing the pulpal infection, pulp treatment preserves the tooth that would otherwise be lost. A child's function, appropriate dental and skeletal structure, and psychological development can all be impacted by early primary tooth loss. Numerous therapeutic techniques, including pulpotomy, pulpectomy, direct pulp capping, and indirect pulp capping, have been proposed to prevent these issues. Pulpectomy can compromise treatment in some clinical scenarios ⁽¹⁾. 

Anatomical complications like curved roots, the proximity of permanent tooth buds, the apparent connection between the coronal floor and the intraradicular area, and the difficulty of achieving a tight seal because of continuous physiologic root resorption are some of the common causes of pulpectomy procedure failure. A child in a pre-cooperative age group, significant root resorption, and insufficient supporting bone and periodontal tissue might all make pulp therapy inappropriate or compromised⁽²⁾.

A fresh approach that involves less invasive and time-consuming procedures could offer both the patient and the clinician hope in the current era. The concept of lesion sterilization and tissue repair (LSTR) therapy has been developed by the Cariology Research Unit of the Niigata University School of Dentistry which utilizes the use of a mixture of antibacterial drugs for disinfection of dentinal, pulpal, and periapical lesions of teeth.⁽³⁾.

LSTR therapy appears to have a bright future in pediatric dentistry. LSTR therapy can be used instead of extraction in young, recalcitrant children making dental treatment nontraumatic. This calls for more long-term follow-up studies in the future. However, LSTR has the qualifications to be a potential treatment for primary molars that show internal resorption and gross periradicular pathosis⁽⁴⁾.

Pediatric dentists (PDs) stay current with the latest techniques and materials in pediatric endodontics. However, general dentists (GDs) and practitioners from other specialties who routinely perform pulp therapy on primary teeth may benefit from regular updates on endodontic procedures ⁽⁵⁾.

To the best of our knowledge and after evaluating the literature, no research have looked into Egyptian dentists' awareness of LSTR therapy for primary teeth. Therefore, in order to assess dental practitioners' awareness of LSTR therapy, the current study was carried out with them in Upper Egypt.

Participants0and0Methods:

Ethical0Consideration

Foremost, The Research Ethics Committee of Minia University's Faculty of Dentistry provided ethical approval to carry out the current survey (Reference number #780-23).

The survey was designed as an anonymous electronic questionnaire, which included a consent form.

Design0and0setting of the study

This study, which is an observational cross-sectional survey, was carried out on a sample of Upper Egypt's registered dentists. The count data of the study population and their contact information were obtained from the Egyptian dental syndicates in four randomly selected governments in Upper Egypt (Minia- Fayoum -Sohag – Bani suef). To guarantee quality, the consolidated standards for reporting qualitative research (COREQ) served as a reference.

Sample0size

Before the study was conducted, the sample size was determined using the EPI INFO 7.2.5.0 software (CDC, Atlanta, Georgia, USA), with the following parameters: the assumed frequency of LSTR knowledge in the population (50%), a design effect of 1, and a 5% confidence interval. These considerations led to the conclusion that in order to evaluate the link between the study's independent variables and outcome, a minimum sample size of 361 participants was required.

Patient selection

The study included a representative sample of registered dentists from four governments in Upper Egypt (Bani sueif – Fayoum – Minia – Sohag). Those 4 governments were randomly selected to be the population of study from the whole upper Egypt government list using a computer-generated simple randomization using IBM SPSS software. While Under-graduate dental students, non‑Egyptian dental practitioners and Egyptian dentists who are not working in Upper Egypt were excluded.

Data Collection

A questionnaire-based cross-sectional survey of registered dentists from 4 governments in Upper Egypt (Minia – Bani sueif – Sohag – Fayoum) was conducted in 2023. A self-administered questionnaire including 12 questions was used as a survey instrument.The questions were designed and validated by five experienced dentists till reaching its current final form.

The completed questionnaire was transformed into an electronic form through the use of Google Forms, a free online survey tool (Google Forms, 2023). Through the social media site WhatsApp, a link to the survey was shared in English. Every seven days, a reminder to take part was sent out.

Questionnaire design

The questionnaire consisted of a cover page and two main sections including a total of 12 questions. The cover page provided the following data; the aim of the study, assurance statement for respondents that the current study is voluntary, and participants are free to leave at any time without giving a reason. And finally a consent form.

The first section comprised 10 questions regarding participants’ demographic and working characteristics. Two questions were included in the second portion to gauge participants' familiarity with LSTR.

Participants who had never heard about LSTR were bypassed from the questions of the second section and were suggested to visit Chairside recommendations for the use of LSTR which provided by the American Academy of Pediatric Dentists (AAPD).

Data analysis

Knowledge assessment was calculated based on the number of correct answers regarding LSTR techniuqe.

Statistical Analysis

Categorical data were presented as frequency and percentage values. Numerical data were presented as mean with 95% confidence intervals, standard deviation (SD), median, minimum (min.), maximum (max.), and values of the interquartile range (IQR). To assess associations, the Kruskal-Wallis test was used and Dunn's post hoc test with p-values adjustment using Bonferroni's correction. The significance level was set at p<0.05 within all tests. Statistical analysis was performed with R statistical analysis software version 4.4.2 for Windows.

Results

General characteristics of participants

The questionnaire was completed by 419 dentists, with 260 (62.05%) identifying as male and 159 (37.95%) as female. The age distribution showed that the majority of participants were between 24 and 35 years, accounting for 365 (87.11%) of the sample, followed by 48 (11.46%) aged 36-45, and 6 (1.43%) aged over 45. The participants were spread across 4 different governorates in Upper Egypt, with 97 (23.15%) from Fayoum, 148 (35.32%) from Minia, 88 (21.00%) from Sohag, and 86 (20.53%) from Beni Suef. (Table 1).

Regarding their specialty, a large proportion of respondents were general practitioners (GPs), totaling 342 (81.62%), with 14 (3.34%) specializing as pedodontists and 63 (15.04%) holding other specialties. Regarding their educational background, 299 (71.36%) graduated from governmental universities, while 120 (28.64%) attended private universities. For the highest degree obtained, 345 (82.34%) held a Bachelor of Science (BSc), 33 (7.88%) held a Master of Science (MSc), 18 (4.30%) a Doctor of Philosophy (PhD), and 23 (5.49%) held other types of qualifications as showen in (Table 1).

The place of practice for participants varied, with 181 (43.20%) working in educational hospitals, 168 (40.10%) in general hospitals, and 70 (16.71%) in private clinics. Experience levels were as follows: 54 (12.89%) had less than 1 year of experience, 243 (58.00%) had 1-5 years, 74 (17.66%) had 6-10 years, and 48 (11.46%) had over 10 years of experience. Finally, the number of pediatric patients seen per day by participants was distributed as follows: 96 (22.91%) saw fewer than 3 patients, 189 (45.11%) saw 3-6 patients, 62 (14.80%) saw 6-9 patients, 27 (6.44%) saw 9-12 patients, and 45 (10.74%) saw more than 12 pediatric patients weekly as showen in (Table 1).

Discussion

Primary teeth with infected pulp and root canals may be treated with non-instrumental endo-dontic therapy, lesion sterilization, and tissue repair. To close the knowledge gaps and contribute to the body of existing literature, more research from varied ethnic populations in African countries is needed⁽⁶⁾. As far as we are aware, no study has looked into Egyptian dentists' awareness of it. Therefore, the current cross-sectional study was conducted to assess

knowledge level of dentists in Upper Egypt, regarding0Lesion sterilization0and0tissue0

repair0therapy0in0primary0teeth.

One of the most practical and efficient ways to gather data is by using survey questionnaires, which are beneficial to both participants and researchers. Participants0in0the study typically prefer a tool that is easy to follow and comprehensive⁽⁸⁾ .

A web-based online format, created and supported by the Google form platform, was utilized due to its low cost, ease of distribution among participants, quick and easy analysis⁽⁹⁾.

In the current study, 87.11% of the participants were aged between 24 and 35 years. This result aligns with a previously published national survey on general dental practitioners in the Kingdom of Saudi Arabia⁽¹⁰⁾. One possible explanation for this is that younger generations tend to be more familiar with online surveys⁽¹¹⁾.

Concerning the question “Have you ever come across the term LSTR (Lesion Sterilization and Tissue Repair)?” 64.92% of respondents answered “No”. This might be attributed to the inadequate incorporation of LSTR to the undergraduate curricula and diminished professional development of respondents as most of them were general practioners.

Additionally, many dentists may be more aware about the concept of local use of antibiotics in teeth but not familiar with the term LSTR0or (Lesion Sterilization and Tissue Repair) aa therapeutic technique name.

Participants who had never heard about LSTR were suggested an external link of American Academy of Pediatric Dentists (AAPD)0chairside guidelines for the use of LSTR to increase their awareness about LSTR.

The current study's findings demonstrated that females had significantly higher knowledge than males This may be related to that Females are more interested and passionate about the pediatric dental field. These findings go in accordance with other studies conducted by Tiwari et al., (2020) and Aied et al., (2023); who reported higher knowledge scores  among female partici-pants than males^(12)(13). On contrast, Patil et al., (2016) reported that the knowledge of male practitioners were more than females in Bhopal city⁽¹⁴⁾. Differences in gender ratios between research could be the cause of the disparity.

Concerning Years of professional experience, practitioners with less than one0year of experience had0significantly0higher know-ledge than practitioners with more years0of0experience.This may indicate that young pediatricians are more prone to embrace novel work methods, as suggested byqEl-Bayoumi (2021) among Egyptian pediatric-ciansoin0Tanta0city⁽¹⁵⁾. However,0thispfinding  contrasts with the results of Aburahima0et0al., (2020) When compared to participants with less years of expertise, those with more years of experience showed noticeably superior knowledge⁽¹⁶⁾. The discrepancy might be due to difference between populations.

The results of the current study indicated that the workplace was a statistically significant positive predictor of knowledge scores, with dentists working in educational hospitals showing the highest knowledge scores. This finding aligns with a survey conducted by (Abbas et al., 2022 ⁽¹⁷⁾. It also supports the findings of a survey conducted in Upper Egypt by (Samer et al., 2023), who reported that respondents practicing in teaching hospitals were more likely to have a better knowledge of Silver Diamine Fluoride (SDF) ⁽¹⁸⁾.

This outcome may be attributed to the fact that dentists working in academic settings have more direct access to evidence-based practices, providing them with up-to-date knowledge and safety protocols for using new materials and techniques.

Also, the results revealed that practitioners treating more pediatric patients per week had significantly higher knowledge than those treating fewer patients. This finding is consistent with Tadin and Dzaja (2023)⁽¹⁹⁾.

Concerning Specialty influence, the current study's findings demonstrated that pedodo-ntists had significantly higher knowledge than general practitioners and specialists in other fields of dentistry. due to the high exposure and adaptability of pedodontists to advancement in pediatric dentistry through their continued education so they have easier access to recent scientific findings in their field, enabling them to learn about and employ novel items or methods. On the other hand, there is inadequate incorporation of LSTR to the undergraduate curricula.

In terms of credentials, MDS practitioners were more knowledgeable than BDS practitioners or practitioners with other credentials. This is in line with research by Keerthika et al., (2024) and Patil etnal., (2015)⁽²⁰⁾. This could be because MDS practitioners have more clinical and academic expertise. In the current study, the association between age and scores of knowledge was not statistically significant. These results are consistent with previous studies conducted by Premnath and lJohn (2015), Patilo eto al., (2016) and Mohamed et al., (2024)^{(21) (22)}.

Assessment of the association between LSTR knowledge and general characteri-stics of participants revealed a significant positive association with dental specialty (especially pediatric dentistry), years of professional experience and practicing in teaching hospitals. A finding that might be attributed to the professional upgrading.

A limitation of the current study was the limited target population; only dentists registered in Upper Egypt. However, the survey covered adequate number of specialists and general practitioners with different ages, sex, and clinical experiences, so the study's results will serve as a baseline for future research on LSTR awareness in Egypt.