Knowledge assessment on cleft lip and palate among recently graduated dentists: a cross-sectional study

In order to evaluate the knowledge of CLP among recently-graduated dentists we developed a novel questionnaire adhering to standard methodology for questionnaire development [24‐26]. Four distinct phases were undertaken, including questionnaire construction, validity and reliability, factor construction and assessment, and questionnaire distribution for target respondents. A good level of internal consistency (Cronbach’s alpha = 0.70) suggests that the 15-item questionnaire is adequate to test the knowledge assessment of dental interns [24]. The overall findings demonstrated gaps in basic understanding and exposure to CLP. There is limited appreciation among dental interns of the risk factors for CLP as well as post-surgical complications. Half of the participants were not aware of the oronasal fistula, which is the most common complication of cleft palate repair due to the failure of wound healing.

The number of correct answers was not associated with the participant’s age or affiliation. Although a non-significant difference was found between low and high GPAs, the number of participants with a C or D grade was half that of those with grades A and B. This suggests that the low overall correctness rate is a function of the structure and delivery of CLP teaching provided by dental schools rather than reflecting students’ ability.

Gender difference in learning capacity has been reported in the literature, including differences in learning methods, habits, and environments [27]. In the current study, female participants had significantly higher knowledge than male in particular questions including prevalence of CLP and associated oronasal complication, which is more linked to theoretical knowledge. Students’ performance could be influenced by the type of teaching methods. Females may perform better in theoretical elements than male [27, 28].

Hypodontia and microdontia are commonly observed in CLP with ectopic eruption, supernumerary teeth and macrodontia less prevalent [29]. In the current study, a high percentage of interns were aware of the association between dental anomalies and CLP. This may relate to the logical perception of the proximity of dentition to the cleft defect.

The need of multidisciplinary team for CLP management was identified by almost all the participants. However, the role of each specialty was not addressed. Therefore, various aspects of CLP management and additional teaching material such as efficient referral and quality of life assessment for both parents and child should be explored in more detail [30]. Case-based learning is considered more effective than other teaching methods in addressing inter-disciplinary care in an enjoyable and interactive way [31]. This approach may therefore be considered in order to produce improved knowledge related to the CLP management.

Patients with CLP suffer from a variety of health complications such as speech and hearing problems, feeding difficulties, and dental complications due to anatomical abnormalities [32‐35]. Dental interns awareness of CLP complications was high, with a minor percentage unaware of the importance of effective surgery and audiology assessment and their role in improving speech and hearing. In comparison, a significant proportion of medical students (25%) were aware of the association between speech problems and CLP [36]. More recently, Palee et al. [37] suggested implementation of new education methods such as digital educational games in order to improve CLP knowledge for medical students. However, a systematic review found unclear evidence regarding educational games as a teaching strategy for medical students [38]. Alternatively, a study involving 25 graduates of communication sciences and disorders program, who had not undergone previous CLP training courses, demonstrated the usefulness of video training tutorials for the assessment and treatment of patients with CLP [18].

In regards to post-surgical complications, less than half of our participants were not aware of oro-nasal fistulae in CLP. This is probably correlated to several factors including lack of subject interest, limited teaching material and absence of student assessment for CLP.

A low percentage of dental interns attended CLP clinical sessions in their undergraduate program with 78% not being exposed to CLP cases. This is consistent with the findings of Vallino et al. [36] study, where only (13.9%) of participants had previous exposure to CLP. Chairside teaching sessions would help dental students and/or interns to develop and retain their obtained knowledge and to reshape their education [39, 40]. In addition, the role of the tutors in the clinic and their impact on the learning and teaching process should be highlighted [41]. Therefore, evidence-based chairside teaching is recommended to promote critical thinking development for dental students [42].

Although the literature demonstrates a clear association between maternal smoking and CLP [43], only a quarter of the participants in the current study were aware of this relationship. Gender differences in the prevalence of CLP have been reported in the literature with males being more frequently affected [7]. In the present study, two-thirds of the participants were aware of the differences in CLP incidence by gender. There is also convincing evidence demonstrating that folic acid deficiency in pregnant women may predispose to CLP with a daily intake of 0.4 milligrams of folic acid during pregnancy reducing the risk of having babies with CLP by one-third [44]. In the current study, the importance of folic acid intake for pregnant women in reducing the risk of CLP was recognized by less than 50% of our sample. A study by Alnujaim et al. [45], involving 310 pregnant women, found approximately 50% of the women were aware of the risk of folic acid deficiency and its relation to CLP. However, the internet was found to be the major source of knowledge (34.8%) with health professionals (8.7%) and public health campaigns (8.1%) less influential [46].

The strengths of the current study include the original analysis and the use of a reliable and validated bespoke questionnaire to address the study question. The complete validated questionnaire is provided in supplementary file 2.

In terms of limitations, the generalizability of the findings was limited by the characteristics of the study participants. The limited sample size of 105 participants could impact the generalizability of the findings. In addition, the study was conducted in a specific geographical area (Jeddah, Saudi Arabia), and we acknowledge the potential impact of this localized context on the wider applicability of the findings. Other counties with differing healthcare systems and educational structures may yield different results. Future research involving a more extensive and diverse population of recently graduated dentists may therefore be beneficial in augmenting the insights gained in the present study.

The nature of the study design and the restricted sample comprising dental interns make the study prone to selection bias. The results should therefore be interpreted with caution. Nevertheless, the potential for non-response bias was limited in the present study given the acceptable response rate [23]. In addition, social bias was limited by considering both genders, while questions that might lead to socially desirable responses were avoided.

The pivotal role of oral health care among the multidisciplinary pathways of CLP management was identified. Addressing fundamental knowledge gaps could positively influence patient care and lead to improved outcomes in the context of cleft lip and palate treatment. In particular, enhanced and more focused chairside teaching for dental interns could attenuate the knowledge gap concerning some aspects of CLP. In addition, the role of dentists in the parental education of children with CLP could be considered in more depth.