|Year : 2022 | Volume
| Issue : 3 | Page : 347-351
Knowledge and attitude toward dental stem cells among dental professionals: A questionnaire study
LJ Sai Lakshmi1, Nadeem Jeddy1, T Radhika1, S Amutha1, WR Gnanasagar2
1 Department of Oral Pathology and Microbiology, Thai Moogambigai Dental College and Hospital, Dr. MGR Educational and Research Institute, Chennai, Tamil Nadu, India
2 Department of Periodontics, Thai Moogambigai Dental College and Hospital, Dr. MGR Educational and Research Institute, Chennai, Tamil Nadu, India
|Date of Submission||13-Jun-2022|
|Date of Acceptance||09-Aug-2022|
|Date of Web Publication||27-Dec-2022|
Dr. L J Sai Lakshmi
Department of Oral and Maxillofacial Pathology and Oral Microbiology, Thaimoogambigai Dental College and Hospital, Golden George Nagar, Mogappair, Chennai - 600 107, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Introduction: Dental stem cells (DSCs) derived from tooth structures refer to adult stem cells. DSCs can be used to regenerate both dental tissues and nondental organs. DSC research is progressing at a rapid pace and hence it is imperative for dental professionals to possess adequate knowledge and a favorable attitude toward the same. The aim of this study was to assess the knowledge and attitude of dental professionals toward DSCs. Methodology: A cross-sectional, descriptive, questionnaire-based survey was conducted on a sample of 200 dental professionals from various dental colleges in Chennai. The questionnaire included a total of 15 questions to assess the knowledge and attitude toward DSCs. The Pearson's Chi-square test and percentages of the total were used for statistical analysis. Results: A total of 200 dental professionals completed the questionnaire survey; of which 42 (21%) were male and 158 (78%) were female. Maximum respondents were intern (n = 92, 46%), followed by dental practitioners (DP) (n = 58, 29%) and postgraduates (n = 50, 25%). Around 182 (91%) dental professionals are aware of the term stem cells. Overall, 66% of dental participants were not aware of ethical considerations and guidelines related to DSCs given by the Indian Council of Medical Research. The majority of dental participants (83%) were interested in attending workshop/conference/Continuing Dental Education (CDE) program on applications of stem cells. Conclusion: This study revealed that there was a generalized awareness of the term “DSCs” among the study participants. However, there was a huge lacuna in the knowledge of its types, ethical considerations, and the concept of stem cell banking and DSC banks in India. The results of the current study emphasize the need for improvement in knowledge of DSCs for dental professionals by promoting more CDE programs focusing on this subject.
Keywords: Dental professionals, dental stem cells, self-renewal, stem cell banking, stem cells
|How to cite this article:|
Sai Lakshmi L J, Jeddy N, Radhika T, Amutha S, Gnanasagar W R. Knowledge and attitude toward dental stem cells among dental professionals: A questionnaire study. J Sci Soc 2022;49:347-51
|How to cite this URL:|
Sai Lakshmi L J, Jeddy N, Radhika T, Amutha S, Gnanasagar W R. Knowledge and attitude toward dental stem cells among dental professionals: A questionnaire study. J Sci Soc [serial online] 2022 [cited 2023 Jan 27];49:347-51. Available from: https://www.jscisociety.com/text.asp?2022/49/3/347/365168
| Introduction|| |
Stem cells are undifferentiated cells which have the unique property of self-renewal and multilineage differentiation. Dental stem cells (DSCs), a type of adult stem cell, exhibit multipotent differentiation and have found various applications in the field of dentistry in recent years. In dental research and therapeutics, adult stem cells are the preferred cell source.
DSCs have the capacity to generate arrays of cell and tissue types in vitro, and they include odontoblasts, adipocytes, osteoblasts, cartilage, bone, smooth, and skeletal muscle.,, In the oral cavity, DSCs have been isolated from different soft tissues such as the apical papilla, dental follicle, periodontal ligament, pulp of third molars, and stem cells from human exfoliated deciduous teeth. DSCs are viable and easily accessible sources of stem cells, and current research is exploring their capability to differentiate into dental and nondental tissues.
DSC research targets the regeneration of damaged coronal dentin and pulp, regeneration of resorbed root(s), repair of perforations, periodontal regeneration, repair and replacement of bone in craniofacial defects, and whole-tooth regeneration. The advances in applications of DSCs seem to be unsurpassed in the near future, for which skills and knowledge in this area are of prime significance.
Research in the field of stem cells and DSCs is increasing at a fast pace and it is widening the scope and application of DSCs. Since this is a recent advancement, there is a possibility that this topic may not have been a part of the dental education curriculum. The general population is becoming increasingly aware of DSCs through media such as advertisements and news. Dental professionals are approached by patients for further information regarding the same and also approached by DSC companies to the promotion of DSC collection and storage. It is therefore essential that dental professionals possess adequate knowledge regarding the sources, storage, and applications of DSCs.
Hence, the present study aims to evaluate the knowledge regarding DSCs among dental professionals.
| Methodology|| |
Written informed consent was obtained from the study participants.
Study design and participants
The present cross-sectional descriptive study was questionnaire-based, wherein the questionnaire was distributed to the dental professionals (n = 200) (dental practitioners [DPs], postgraduates [PGs], and interns) of various dental colleges in Chennai. The study protocol was approved by the Institutional Review Board of Dr. M. G. R. Educational and Research Institute.
The questionnaire was categorized into two parts. In the first part, demographic details such as age, gender, qualification, specialty, and experience were asked, whereas the second part included both knowledge and attitude-based questions toward DSCs. A total of 15 questions were framed, based on existing literature and the questionnaire was validated using a pilot study. The prevalidated questionnaire includes only close-ended questions and it was hand-delivered to the participants. The obtained data were entered into Microsoft Excel by the investigator.
The data collected were analyzed using the Statistical Package for the Social Sciences version 19.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics for the collected data were recorded. The associations between different variables were tested using the Chi-square test. A P < 0.05 was considered statistically significant.
| Results|| |
A total of 200 participants completed the questionnaire survey and the response rate was 100% [Table 1]. Of the total participants, 42 (21%) were male and 158 (79%) were female. The age of the participants varied from 21 to 53 years. Maximum respondents were interns (n = 92, 46%), followed by DP (n = 58, 29%) and PGs (n = 50, 25%).
Awareness of stem cells, in general, was 182 (91%). Eighty-five percent of interns, 96% of PG, and 100% of DP were aware of stem cells. It was observed that 68% of the total participants knew about the properties of stem cells. Sixty-seven percent of interns, 60% of PG, and 76% of the DP were aware of the properties of stem cells.
Almost 51.5% of the dental professionals said that DSC belongs to the embryonic stem cell variety, whereas 33% called it both embryonic and an adult stem cell type. Only 15.5% considered DSCs to be of adult stem cell types.
The applications of DSC in the development of nondental tissues/organs were known to 24% of interns, 46% of PGs, and 57% of DP.
Overall, 66% of dental participants were not aware of ethical considerations and guidelines related to DSC given by the Indian Council of Medical Research (ICMR). Of the total participants, 35% of interns, 22% of PG, and 41% were aware of the ethical considerations given by ICMR.
Awareness regarding the sources for DSCs was high among PGs and DP, whereas only 52% of interns knew about the same.
Almost 92% of DP were aware of the different clinical applications of DSCs in relation to oral health care, whereas only less than half the percentage of interns and PGs knew about the same.
When inquired about the type of tooth which can be used for stem cell banking, the majority of the DP (66%) and PGs (70%) opted for the tooth extracted due to nonpathological conditions.
The majority of participants (52%) are unaware of the DSC banks in India and almost 76.5% of participants did not know the procedure of DSC banking after extraction.
Around 61% and 55% of dental participants were willing to preserve dental tissues for future regenerative dental treatment and willing to invest in DSC banking, respectively.
According to dental professionals, the main obstacles for the patient in accepting regenerative dental treatments are cost (41%) and lack of patient awareness (42%).
The majority of dental participants (83%) were interested in attending a workshop/conference/Continuing Dental Education (CDE) program on the applications of stem cells.
Around 56% of participants revealed that regenerative dental treatment would definitely be a better treatment option than tooth implant placement. The majority of DP (79%) and interns (50%) opted for the same.
| Discussion|| |
In the present study, all the DPs were aware of stem cells. A substantial percentage of PG and interns were also aware of the term. This was in accordance with the findings Katge et al.
Awareness regarding stem cell properties and types was significantly low among dental professionals. The properties of stem cells are self-renewal, potency, transdifferentiation, or plasticity. The DSC belongs to the adult stem cell type but almost more than half of dental participants had said it belongs to the embryonic stem cell type.
DSCs can differentiate into adipocytes, osteocytes, and neurons, and hence, these have potent nondental applications too. The main reason for the growing advancement in stem cell research is the vast range of applications and treatments of diseases. Certain patient populations suffering from systemic diseases can especially benefit from this tissue regenerative capacity of stem cells. Some of the diseases which are being cured by DPSCs include type 1 diabetes, neurological diseases, immunodeficiency diseases, and diseases of bone and cartilages. In the present study, the knowledge regarding applications of DSC in the development of nondental tissues/organs was minimal.
Overall, 66% of dental participants were not aware of ethical considerations and guidelines related to DSC given by ICMR. The guidelines have been laid down to ensure that research with human stem cells is conducted in a responsible and ethically sensitive manner and complies with all regulatory requirements pertaining to biomedical research in general and stem cell research in particular. These guidelines are applicable to individual researchers, organizations, sponsors, oversight committees, and others, associated with research on human stem cells and their derivatives, both basic and clinical. Hence, dentists aspiring to conduct research related to DSCs should keep themselves updated with these guidelines.
In the present study, 52% of the participants were not aware of the presence of DSC banks in India. Similar results were found in a survey done by Katge et al. The first commercial tooth bank was established in Japan in 2004. Tooth banks have emerged in all parts of the world including India and marketing strategies are employed to promote tooth banking. It is imperative that dentists should also have awareness regarding the commercial aspects of DSC banking.
According to dental professionals in the present study, the main obstacles for the patient in accepting regenerative dental treatments were cost (41%) and lack of patient awareness (42%). Similar results were also reported in a survey done by Chitroda et al. and Goyal Chitroda et al. in their study revealed that around 49.6% of dental professionals believed that the main obstacles to seek treatment with the aid of DSCs are high cost, lack of awareness, ethical issues, and insufficient knowledge about stem cells among DPs. The survey by Goyal also showed that 63.50% agreed that the high cost, lack of awareness, and lack of sufficient knowledge were hindering people to obtain treatment using DSCs. The factors that prevent patients from obtaining treatment using DSCs could be minimized by reasonably charging the fees and by spreading awareness at the public level by conducting seminars/lectures at the public level.
In this study, dental professionals (83%) expressed interest in participating in workshop/conference/CDE program on the applications of stem cells. Chitroda et al. in their study (89.42%) also showed that a significant number of study participants were interested to attend CDE programs or conferences in near future. Goyal A also reported that 73% of the participants were enthusiastic to attend such conference/workshop/CDE programs because they had never attended the same. It could be due to increasing research and applications in this field, and also may be due to insufficient knowledge about DSCs.
Around 61% and 55% of dental participants showed a positive attitude toward the preservation of dental tissues for future regenerative dental treatment and also for DSC banking, respectively. Around 56% of participants revealed that regenerative dental treatment would be a better treatment option than tooth implant placement.
The present study revealed a significant lack of knowledge regarding the type of stem cells, ethical considerations and guidelines given by ICMR, DSCs banks in India, and also procedures of DSC banking after extraction. Dental professionals also showed a positive attitude toward the preservation of dental tissues for future regenerative dental treatment and are also willing to invest in DSC banking. The majority of dental professionals are interested to attend any workshop/conference/CDE program on the application of stem cells.
| Conclusion|| |
Data from this study confirmed the fact that there is awareness regarding stem cells in general. However, there is a significant lacuna in the awareness regarding types, ethical considerations, and DSC banks in India. Considering the widening horizon of DSC applications with the recent focus on the fascinating topic of “regenerative medicine,” it is the need of the hour to enhance the knowledge of dental professionals in this subject by incorporating it into the dental curriculum and conducting CDE programs and conferences on this topic.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
M. Khazaei, Bozorgi A, Khazaei S, Khademi A. Stem cells in dentistry, sources, and applications. Dent Hypotheses 2016;7:42.
Gronthos S, Mankani M, Brahim J, Robey PG, Shi S. Postnatal human dental pulp stem cells (DPSCs) in vitro
and in vivo
. Proc Natl Acad Sci U S A 2000;97:13625-30.
d'Aquino R, Graziano A, Sampaolesi M, Laino G, Pirozzi G, De Rosa A, et al.
Human postnatal dental pulp cells co-differentiate into osteoblasts and endotheliocytes: A pivotal synergy leading to adult bone tissue formation. Cell Death Differ 2007;14:1162-71.
Jo YY, Lee HJ, Kook SY, Choung HW, Park JY, Chung JH, et al.
Isolation and characterization of postnatal stem cells from human dental tissues. Tissue Eng 2007;13:767-73.
Huang GT, Gronthos S, Shi S. Mesenchymal stem cells derived from dental tissues vs. those from other sources: Their biology and role in regenerative medicine. J Dent Res 2009;88:792-806.
Saraswathi Gopal K, Lankupalli AM. Stem cell therapy: A newhope for dentist. J Clin Diagn Res 2012;6:142-4.
Katge F, Shetty AJ, Rusawat B, Vamsi KC. Knowledge and attitude of Indian dentists regarding dental stem cells: A cross-sectional descriptive survey. Indian J Dent Res 2017;28:367-74.
] [Full text]
Zakrzewski W, Dobrzyński M, Szymonowicz M, Rybak Z. Stem cells: Past, present, and future stem cell research and therapy. Stem Cell Research and Therapy 2019;10:68.
Potdar PD, Jethmalani YD. Human dental pulp stem cells: Applications in future regenerative medicine. World J Stem Cells 2015;7:839-51.
Verma K, Bains R, Bains VK, Rawtiya M, Loomba K, Srivastava SC. Therapeutic potential of dental pulp stem cells in regenerative medicine: An overview. Dent Res J (Isfahan) 2014;11:302-8.
Mittal S. Stem cell research: The India perspective. Perspect Clin Res 2013;4:105-7.
] [Full text]
Chitroda PK, Katti G, Attar NM, Shahbaz S, Sreenivasarao G, Patil A. Stem cells in dentistry: A study regarding awareness of stem cells among dental professionals. Indian J Dent Res 2017;28:711-6.
] [Full text]
Goyal A. Knowledge, awareness and attitude regarding stem cells among dental practitioners in Udaipur city, Rajasthan. Int J Adv Res 2015;3:677-84.