A perception among general dental practitioners and postgraduates of Central India toward the use of “magnifying loupes” in clinical practice – A questionnaire-based survey

INTRODUCTION

Dental magnification loupes invented in the 1980s is becoming an integral part of all fields of dentistry. The introduction of magnification aids such as dental operating microscope (DOM) and magnifying loupes are one of the most important technologies, which has improved dental treatment quality and allows a dentist to enhance their visibility and accuracy for diagnosis and treatment of various oral health problems. It is proved to be a boon by improving ergonomics and decreasing musculoskeletal injury during operative procedures. Endodontists were the first among the dental professionals to use magnification in their everyday practice.[¹] It aids in detecting hidden canals, particularly the mesiobuccal-2 canal of the maxillary molars, to ensure correct conservative access; in cases of retraction, it removes materials and posts; if necessary, it can also help in removing broken instruments also. If that’s the case, it can increase visual enhancement in cases of perforation repair and material removal at all stages of endodontic surgery.[²,³]

Magnification devices can also be used in other specialties such as in prosthodontics, for defining the finish lines for crowns, in oral surgery for microsurgical procedures, and in oral medicine and radiology for diagnosing the lesions in the oral cavity and accurate analysis of radiographs, periodontal procedures from routine scaling to periodontal surgical procedures, and placements of the smaller brackets in orthodontics.[⁴] Thus, it has a widened the scope and precision right from examination, diagnosis, and performing various treatment procedures.

The application of magnification devices to improve visual acuity in dentistry was started in 1992, but professionals need to evaluate their usefulness in the current scenario. Forgi et al. surveyed general dentists’ use of magnification loupes and found that only 9% of general dentists in Scotland utilize magnification loupes in their clinical practice regularly.[⁴] Therefore, it is essential to encourage the use of magnifying loupes among all dental professionals to improve the quality of treatment in their regular dental practice.

Recently, Penmetsa et al. conducted a survey to assess the awareness, attitude, and prevalence of usage of magnification devices, especially among dental practitioners in Andhra Pradesh, and it revealed that even though the majority of the practitioners were aware of magnification in dentistry, unfortunately their application into clinical practice was not phenomenal.[⁵] However, there is still a lacuna in the literature on the use of magnifying loupes among general dental practitioners and postgraduates in Central India. Thus, the aim of the study was to determine the awareness, attitude, and prevalence of usage of magnifying loupes among the general dental practitioners and postgraduate students in Central India.

METHODOLOGY

A cross-sectional observational study was designed and approved by the institutional ethical committee. A validated questionnaire pro forma consisting of 12 multiple-choice questions were mailed through Google Docs to 200 postgraduate students and dental practitioners, and their responses were collected. The questionnaire included questions that focused on awareness, attitude, and prevalence of magnifying loupes among the general practitioners and postgraduate students.

RESULTS

Out of 200 participants who received the questions, 165 participated in the study, with a response rate of 82.5%. Of total recruited 165 participants, 80 (48.5%) were general dentist/practitioners, 56 (33.9%) postgraduate students, and 29 (17.6%) specialists [Supplementary Questionnaire 1]. Further, among these, 93 (56.4%) had <3 years of experience, 28 (17.0%) had 3–10 years of experience, and 44 (26.7%) had >10 years of experience.

The first part of the questionnaire (Q3–Q5) focused on awareness toward magnifying loupes. Results revealed that 92.1% of the participants were aware and used different magnifying loupes [Q3, Graph 1]. 40.6% of the participants never attended courses or classes on magnification use [Q4, Graph 1]. However, 97.6% of the recruited participants believe that dental magnification can enhance the work’s accuracy and quality [Q5, Graph 1].

Graph 1. Frequency distribution toward magnifying loupes

The second part of the questionnaire (Q6 and Q7) focused on attitude toward magnifying loupes. The participants were asked what factors were considered while purchasing magnifying loupes. The results indicate that 61.7% of the participants considered the power of magnification as the main reason before purchasing any magnifying loupes, followed by its cost (43.5%) and depth of field (42.4%) [Q6, Graph 2a]. In addition, participants were asked about the reason for not using magnifying loupes. The results suggested that about 55.9% of the participants responded for their inadequate training to be the main reason for not using loupes followed by its cost (44.5%) and discomfort (43.3%) [Q7, Graph 2b].

Graph 2. (a and b) Attitude toward magnifying loupes

The last part of the questionnaire (Q8–Q12) focused on magnifying loupes’ prevalence and usage [Graph 3]. It demonstrated that about 47.27% of the participants were using magnifying loupes in their clinical practices. Approximately 35.75% of the participants preferred the “through-the-lens” (TTL) type of magnifying loupes. 36.96% of the participants prefer the ×2.5–×3 magnification loupes. About 27.27% of the participants reported using magnification loupes with light sources. In comparison, 35.72% of the participants were using loupes since their postgraduates’ courses.

Graph 3. Prevalence toward magnifying loupes

DISCUSSION

In the modern era of dentistry, magnification devices have gained momentum, which helps clinicians enhance their skills with the highest accuracy in their work quality. However, this depends on the up-gradation of the practitioner’s knowledge and skills. Literature reveals that there is an increased awareness among dental practitioners regarding magnifying loupes. The current study results suggested that more than 90% of the participants were aware of the usage of magnifying devices in dentistry. Similar results were reported by Penmetsa et al., which showed that 91.9% of participants were mindful of the use of magnifying devices, including loupes.[⁵,⁶] There were more than half of the participants who neither attended any courses or nor any workshop on the use of magnification. These results were concurrence with the study reported by Alhazzazi et al.[²,⁷,⁸]

In the present study, all participants were quite aware of the type of magnification gadgets available and their benefits such as improved visualization and ergonomics, which will eventually benefit from more referral practice.[⁶,⁹]

The only hindrance to their usage was the cost of these gadgets. Hence, considering this factor, magnifying loupes can be a suitable option contrary to DOM to start with contemporary practice. Similar results were reported by Basunbul, which stated that 63.1% of participants considered magnification as the key factor followed by its cost.[⁷,¹⁰] However, contrasting results were reported by Penmetsa et al. and Farook et al., who stated that cost was the key factor before purchasing loupes.[⁵,⁸,¹¹,¹²] In the present study, results showed that inadequate training was the main reason for not using magnifying loupes. However, contrasting results were reported Basunbul stated that heavyweight was the main reason for not using magnifying loupes.[⁷,¹³] In the current study, it was observed that even though most participants were aware of magnifying loupes, only 47.27% of the participants were using them in their clinical practice. Similar results were reported by

Basunbul et al. in 2018 that only 32.4% of the participants were using them.[⁷]

Those participants using magnifying loupes preferred the loupes with a light source, with a magnification of × 2.5–×3.5 loupes, for a routine general dental practice. Most of the participants preferred the TTL type of loupes in their clinical practice. Similar results were reported by Basunbul et al. (2018)[⁷] and Penmetsa et al. (2017).[⁵]

Participants who were actually using loupes, they preferred loupes in the particular case in their clinical practice. Similar results were observed by Basunbul et al. (2018).[⁷] Jain et al. (2017)[⁹] emphasized the effectiveness of the removing broken instrument from the middle third of the root canal using magnifying loupes.[¹⁴] Therefore, the use of magnifying loupes during endodontic therapy can be of immense importance for dental practitioners.

CONCLUSION

Magnification gadgets are gaining as one of the most important assets in the armamentarium of dental setups. In the present study, most of the general dental practitioners and postgraduate students were aware of magnifying loupes, but its practical usage in clinical practice lacked owing to its cost. Therefore, it is essential to encourage the use of magnifying loupes among all dental professionals to enhance the quality of treatment services with modern practices.

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