Satpathy et al

International Journal of Public Health Dentistry

RESEARCH ARTICLE

Patient awareness, acceptance and perceived cost of dental Implants as a treatment

modality for replacement of missing teeth: A survey in Bhubaneswar and Cuttack
Anurag Satpathy, Amit Porwal, Arin Bhattacharya, Pratap Kumar Sahu

Abstract
Background: There is lack of information regarding the patients awareness of dental implants
especially in eastern India. Objective(s): To assess the patient awareness, acceptance and perceived
cost of dental Implants as a treatment modality for replacement of missing teeth in Bhubaneswar and
Cuttack. Materials and Methods: A cross sectional survey was conducted among the patients visiting
the various dental outpatient departments of hospitals and private dental clinics of Bhubaneswar and
Cuttack using a self-explanatory questionnaire. Results: A total of 723 patients (aged 15 86 years;
mean age 39.2514.02 years) participated in the survey. The results of this survey indicate that only
15.91% of the patients knew about dental implants. The patients local dentist was the main source of
information regarding the dental implant treatment modality followed by print and electronic media.
About 71.23% patients disproved the removable prosthesis as replacement for missing teeth. A
majority of them (60.44%) expressed that treatment was unaffordable. The cost and associated
surgery was a major disadvantage and deterrent to this modality. However they were willing to know
more about the dental implant treatment modality. Conclusion: The results of this survey among
patients attending dental hospitals and private dental clinics showed that the majority of the patients
were largely unaware about using dental implants as a treatment modality for replacing missing teeth
in Bhubaneswar and Cuttack.
Key Words: Dental Implants, Oral health awareness, Replacement of missing teeth, Patient
perceived-cost.
Received on: 7/02/2011 Accepted on: 8/03/2011
Introduction
Eastern part of India and especially
the state of Orissa is considered economically
lacking. The literacy rate is comparatively low,
with an average of 62%. Health care is not
well organized and remote places have
inadequate health care facilities. It is reported
that the dental seeking behavior in the state
was poor; 60% of elderly and 67% of adults
had never received any dental care (1). The
need to replace lost teeth with natural
successors has encouraged rapid research
and advancement in the field of dental
implants. Currently, dental implants are widely
accepted as a prosthetic treatment of
completely or partially edentulous patients (2,
3).
They are associated with improved
denture
retention,
stability,
functional
efficiency, and quality of life (4). As implant
therapy is an elective procedure in most of the
patient cases (5) complete information on
implant treatment and alternative therapies
must be provided to guide the patient in the
choice of the most appropriate option (6).
However, little information is available to the
patients regarding the procedure and its
1

success. This problem is more magnified in

developing nations where there is lack of
education and awareness amongst people
about dental implants as a dental treatment
modality. Therefore the aim of the present
study was to assess the patient awareness,
acceptance and perceived cost of dental
Implants as a treatment modality for
replacement of missing teeth in Bhubaneswar
and Cuttack.
Material and methods
A cross sectional survey was
conducted among the patients visiting the
dental outpatient departments of hospitals and
private dental clinics of Bhubaneswar and
Cuttack. The survey was conducted over a
period of 6 months (August 2010 January
2011). A random sampling method with
convenient sample was taken. All patients
above 14 years of age and with at least one
missing tooth (excluding third molars) were
included in the survey. All hospitals with a
dental outpatient department and all private
dental clinics were included in the study. The
information was collected using a self-

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Satpathy et al

explanatory questionnaire based on previous

studies (7-8). Eighteen questions were chosen
to assess patient awareness, acceptance and
perceived cost of dental Implants as a
treatment modality for replacement of missing
teeth. Authors reviewed three successive
revisions of the survey questionnaire and after
piloting in an initial fifty six patients for its
efficiency, sixteen questions were finalized.
The questionnaire recorded the demographic
information and the responses to questions.
The nature and purpose of the survey was
explained to the subjects and written consent
was obtained. This protocol was approved by
the Institutional Ethical Committee of Siksha
O Anusandhan University, Bhubaneswar,
India. The questionnaires were handed to the
patients during their regular dental visits to
various dental hospitals and private dental
clinics in cities of Bhubaneswar and Cuttack.
The content of the questionnaire was read out
and explained in local language to those
needing assistance. Descriptive statistics were
generated to summarize the responses.
Results
The present survey gives information
about patients awareness, acceptance and
their perceived-cost of dental Implants as a
treatment modality for replacement of missing
teeth in dental patients in the Bhubaneswar
and Cuttack, Orissa, India. This study
population (aged 15 86 years; mean age
39.2514.02 years) was selected for ease of
access and to increase the response rate as
they were dental patients who approached
various dental hospitals and private dental
clinics for their dental needs. In all 723
patients participated in the survey (M =
375(51.86%); F = 348(48.14%)). Table 1
summarizes the demographic data of the
participating patients.
Replacing missing teeth
For the question on whether missing
teeth should be replaced overall 63.49% were
of the opinion that it was imperative to go for
replacement of missing teeth in all cases while
only 30.57% thought it was required only if it is
aesthetically unpleasant (Table 2). A majority
of surveyed population seemed to understand
the need for replacement of missing teeth.
Alternatives for replacing teeth
Questioned about alternatives for
replacing missing teeth, merely 15.91%
patients were aware about implant-supported
reconstructions. Most of the patients were
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International Journal of Public Health Dentistry

equally aware of Fixed (46.89%) and

removable partial (48.55%) and complete
dentures (44.81%) as alternatives (Table 2)
Level of information about dental implants.
Demographic Data (n=723)
Gender
Male
Female
Age Groups
15-30
31-50
> 51
Occupation
Student(St)
Unemployed (Unemp)
Housewife (Hw)
Unskilled (Un)
Professional (Pro)
Business (Bus)

375(51.86)
348(48.13)
225(31.12)
370(51.17)
128(17.7)
23(3.18)
20(2.76)
36(4.97)
422(58.36)
152(21.02)
70(9.68)

Education
Uneducated (Uned)
22(3.04)
Primary (Prim)
91(12.58)
Secondary (Sec)
430(59.47)
Graduate (Grad)
166(22.95)
Postgraduate (PG)
14(1.93)
Table1: Demographic data of the participating patients n
(%)

Majority (55.33%) of patients felt they

were not at all informed about dental implants
while 29.6% patients said they were poorly
informed. Only 6.67 % patient population felt
that they were adequately informed about
dental implants (Table 2).
Contentment with removable denture
as replacement for missing teeth 71.24 % of
the total patients expressed discontent with a
removable option as a replacement for
missing teeth (Table 2).
Disadvantage of dental implant-supported
dentures / bridges
High cost (58.79%) and need of
surgery (43.99%) were seen as the main
disadvantages of the dental implant treatment
by most patients (Table 2).
Biggest advantage of dental implant-supported
dentures / bridges
Fixed nature of dental implant
treatment was seen as major advantage by
37.63% patients while 34.58% patients felt
avoidance of grinding of natural teeth was the
biggest advantage. Only 11.48% of patients
thought that the functional improvement was a
big advantage (Table 2).

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Satpathy et al

International Journal of Public Health Dentistry

Table 2: Patient response to questions regarding awareness and knowledge of dental implants as a
treatment modality for replacement of missing teeth
like natural teeth, 23.24% did feel that they
Source of information about dental implants
require more care than the natural teeth
and alternatives for replacing missing teeth
(Table 3).
For majority of patients (44.96%) it
Opinion about dental implant option
was their dentist from whom they got to know
about dental implants while sizeable patients
Most Patients were willing to opt for
(31.54%) came to know about it from print and
dental implants treatment (71.65%) while
electronic media. 28.08% patients were
others (28.36%) wanted to go for the
passed on this information from their friends
alternative options of replacing missing teeth.
and acquaintances (Table 3).
When asked about who should opt for this
treatment modality 58.23% of the patients felt
Interested in knowing more about dental
that it was an expensive treatment and only
implants
rich and affluent should opt for it (Table 3).
An overwhelming 89.35% expressed
Treatment charges involved in this procedure
their desire to be informed and educated
and major contributors to its cost
about dental implant treatment (Table 3).
Life span of dental implant treatment
Most patients (59.62%) thought dental
implants would last upto 5 years while 12.73%
expected it to last for a lifetime (Table 3).
Need for special care and hygiene
While 39.29% felt dental implants
needed less care in comparison to natural
teeth and 37.49% felt they are cleaned just
3

About 60.45% of the patients felt that

the dental implants treatment option was not
affordable while 57.27% felt that the cost of
the dental implant itself was the reason for
high treatment cost. However, 16.33% felt it
was the surgical procedure which was mostly
contributing to the cost. About 13.28% also felt
that the dental practitioners were responsible

International Journal of Public Health Dentistry 2011:2(1):1-7. Publishing Division, Celesta Software Private Limited

Satpathy et al

for the overall high cost for this treatment

International Journal of Public Health Dentistry

(Table 3).

Table 3: Patient response to questions regarding source of information, acceptance and perceived
cost of dental implants as a treatment modality for replacement of missing teeth.
Discussion
Dental implant treatment has been at
the forefront of clinical dental practice for over
a decade and a half now. With increasing
success rate of implant treatment more
patients are opting for dental implants as
premier choice for replacement of missing
teeth. Rising awareness of an advanced
treatment modality in the society paves way
for its acceptability. However, advanced dental
facilities are not in equal offering in all areas.
In a time when metros and first tier cities boast
of latest advancement and technology same is
not true for the second tier cities and rural
areas. Surveys conducted to collect to assess
awareness level in patient population always
come handy in deciding future approach.
Although many surveys have been conducted

on dental awareness there exists limited data

on the patient awareness about dental
implants in India. Bhubaneswar and Cuttack
are two prominent cities of eastern India and
with increasing dental activity over past few
years. A survey of this kind provides data on
patients
awareness
level,
knowledge,
acceptance, and mindset towards a particular
treatment modality. This data could be very
well utilized to formulate patient education and
motivation strategies, treatment policies,
marketing strategies and guidelines for dental
implants in this region.
Conducting surveys for collection of
information regarding dental implant is not
uncommon and several researches have
contributed in this field. Survey reports of

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Satpathy et al

several countries present different awareness

levels. Our survey reports 15.91% awareness
about dental implants which is quite low and in
contrast to one of the earliest surveys
conducted on this topic by Zimmer et.al (9)
which investigated the public awareness and
acceptance of dental implants in 120
American citizens and reported awareness as
high as 77%. A recent study conducted in
1000 Austrian individuals by Pommer et al
(10) also reports awareness of dental implants
of 79% while a Norwegian survey (11)
reported in 2001 reported dental awareness
level of 70%. Our results were however lower
than the reported awareness level of 23.24%
in a survey conducted in Indian population by
choudhary et al. (12). Such low awareness
level may well be attributed to the lower
socioeconomic and education levels of this
region. Also, majority of the participating
patients were unskilled workers and educated
only till secondary school level or less.
Majority (71.24%) of the patients were
not content with a removable prosthesis as the
treatment in replacing missing teeth, which
confirms the fact that most patients prefer
fixed prosthesis in replacing their missing
teeth regardless of the clinical situation they
have. This result was in accordance with those
concluded by Tepper et al.(7), Zimmer et al.
(9) and Pommer et al.(10). Also, a breakdown
by age groups showed that a higher
percentage of younger and middle aged
patients rejected removable dentures. Patients
of older age group were more willing to accept
functionally poor dentures. This may be
because of the fact that they tend to develop
compensatory adaptive processes and to
some extent unconsciously accept age-related
losses of masticatory function (13).
Our survey shows that most patients
learnt about dental implants from their dentists
followed by print and electronic media which is
in contrast to that reported by earlier
researchers. Studies by Berge (14), Best (15)
and Zimmer et al. (9) reported media to be the
main source of information. Our result
however is consistent with a recent Indian
survey (16) which reports 55.2% of people
getting information from their dentist. The
survey results reveal that patients in India get
to know about the treatment modality only
when they visit a dental office as compared to
other countries where media plays a
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International Journal of Public Health Dentistry

substantial role in educating general public

about dental implants.
It is interesting to note that a
Norwegian study (14) found that electronic
media broadcast provided more negative
information by focusing on complications and
treatment failures it also reported that
magazines were found to be presenting facts
after a research on the subject more carefully.
In a recent study, 56% of the dentists
expressed concern that patients are likely to
misinterpret information on oral health gained
from the Internet (17).
Around 37% of patients found fixed
nature of dental implants more advantageous.
This finding is in accordance with the results
revealed by clinical studies on implanted
patients that patients already fitted with
implants perceived no difference in chewing
compared with natural teeth (18-20).
Around 89% of the dental patients
questioned in this survey were interested in
having more information about dental
implants. Breakup analysis shows that this
was consistent across all gender, age groups,
occupational and educational status. This
outlines the yearning in dental patients for
dental education about dental implants.
Asked about the most major
disadvantages of dental implant treatment
modality, 58% of those interviewed mentioned
high costs and 43% the need for stressful
surgery. While middle and older age group
patients found high cost to be a major
deterrent to dental implants, younger patients
wanted to avoid surgery. This is consistent
with the American (9) and Japanese studies
(21) where the cost factor and resentments
regarding surgery were reported to be the
major disadvantages of dental implants. This
information indicates that dental surgeons
need to allay the fear in patients regarding the
dental implants treatment by explaining
surgical
procedure
carefully
and
comprehensively.
A pertinent observation was made
when patients were asked about their
expectation of life span of a dental implant,
around 60% of the patients expected the life
span to be within 5 years and 12.72%
expected it to last for a life time. With highly
unrealistic patient expectations the need for

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Satpathy et al

patient education arises (7). Around 28% of

Japanese subjects believed their implants
would last forever (21). Such misconceptions
point to misinformation or incomplete
information of the public in terms of a major
information gap (10).
Conclusion
In conclusion this survey among
patients attending dental hospitals and private
dental clinics showed that the majority of the
patients were largely unaware about using
dental implants as an option for replacing
missing teeth. It also shows that most patients
found dental implants treatment to be
expensive and unaffordable but they were
interested to know more about dental
implants. The survey underlines the need for
providing correct information through various
means to the patients to improve awareness
about this treatment modality.
Affiliations of authors: 1. Dr. Anurag Satpathy,
MDS, Reader, Department of Periodontics, Institute
of Dental Sciences, Siksha 'O' Anusandhan
University, Sector 8, Kalinganagar, Ghatikia,
Bhubaneswar, Orissa, 2.Dr. Amit Porwal, MDS,
Reader, Department Prosthetic Dentistry, Pacific
Dental College & Hospital, Udaipur, Rajasthan,
3.Mr. Arin Bhattacharya, B. Pharm, Postgraduate
student, School of Pharmaceutical Sciences, 4. Dr.
Pratap Kumar Sahu, Ph.D, Assistant Professor,
School of Pharmaceutical Sciences, Siksha 'O'
Anusandhan University, Sector 8, Kalinganagar,
Ghatikia, Bhubaneswar, Orissa, India.
Conflict of Interest:
The author(s) declared no conflict of interests.

International Journal of Public Health Dentistry

4.
5.

6.

7.

8.

9.

10.

11.

12.

Source of Funding: Nil

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Corresponding Author:
Dr. Anurag Satpathy, MDS
Reader, Department of Periodontics,
Institute of Dental Sciences,
Siksha 'O' Anusandhan University, Sector 8,
Kalinganagar, Ghatikia,
Bhubaneswar 751003 Orissa, India
Ph: +91 9338333999
Email: a.satpathy@yahoo.com

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