A questionnaire based cross-sectional survey was carried out among the 514 dentists working as academicians or clinicians or both in and around Ghaziabad. All the registered dentists, registered at Chief Medical Office (CMO), District Hospital, Ghaziabad and the faculties working in four dental colleges around the Ghaziabad city were contacted to be part of the study.

Ethical approval was obtained from the Institutional Review Board, D.J. College of Dental Sciences and Research, Modinagar, Ghaziabad district, Uttar Pradesh, India and informed consent was taken from all the study participants prior to the study. Participation in the study was voluntary and confidentiality of data was maintained.

The questionnaire used in the study consisted of two parts. The first part included the patients’ demographic data and the second one included the KAP related questions regarding SDA concept. There were 04 knowledge, 02 attitude and 03 practice related questions.

Questionnaire Validation: The questionnaire was pretested on 75 dentists who were not included in the main study and comprised 15% of the study sample for reliability and validity. Reliability of the questionnaire was assessed using test-retest and internal consistency of the questionnaire was ascertained by Chronbachs-Alpha (α). Construct validity of the questionnaire was assessed using Spearman’s correlation coefficient between individual parameter/construct and overall score of the construct.

Data Collection: The questionnaire was self administered after explaining the study design to all the dentists who consented to participate in the study. All dentists working in colleges were approached in their respective colleges. Dentists were requested to complete the questionnaire within two weeks and were reminded once before the deadline.

The collected data were analyzed using Statistical Package For Social Sciences (SPSS) 18.0 (SPSS Inc., Chicago, IL, USA) and descriptive and analytical tests, including mean, standard deviation, and Chi square test.

The questionnaire based study was carried out among the 514 dentists regarding the KAP towards SDA concept. Reliability measured through test-retest showed measured kappa (k) of 0.86 and weighted kappa (k) of 0.9. Internal consistency measured through Chronbachs-Alpha (α) was found to be 0.78. Construct validity was assured using spearman’s correlation coefficient (p<0.001).

A total of 493 dentists completed the questionnaire, generating the response rate of 95.5%. The study sample comprised of 239 (48.5%) males and 254 (51.5%) females. Demographic characteristics such as years of teaching/practicing experience, level of qualification, and career perspective of dentists are summarized in [Table/Fig-1].

[Table/Fig-2] present the views of all the dentists who responded to the questionnaire and among 493 dentists only 113 (22.9%) had knowledge about this concept and among these 113 dentists, majority i.e., 47 (41.6%) were aware about this concept since a decade.

[Table/Fig-3] explains the association of level of qualification with KAP regarding SDA concept. Postgraduates were more aware regarding the requirement of minimum number of teeth to meet functional demands and the difference was found to be statistically significant (p< 0.05).

[Table/Fig-4] shows the association of teaching /practicing experience with KAP regarding SDA concept. It was seen that dentists who had experience of 1-5 years were more aware. According to them, there is no change in masticatory efficacy with shortened dental arch and patients with shortened dental arch do not require further treatment. The difference was found to be statistically significant (p< 0.05).

[Table/Fig-5] explains the association of academician, clinician or both with KAP regarding SDA concept and majority of clinicians showed positive attitude regarding the SDA concept. Majority of the clinicians said that SDA doesn’t lead to TMD and patients with SDA do not require further treatment. The difference was found to be statistically significant (p< 0.05).

Due to various oral diseases like periodontitis and dental caries, molars are often lost earlier than any other tooth leading to shortening of dental arch and thus the treatment and resources should be directed to anterior and premolar teeth making them functionally durable as the masticatory system is adaptable in nature [6,7].

In this study it was seen that majority i.e., 65.7% were MDS and among them 43.4% were both academician and clinician but only 22.9% of all the dentists studied were aware of SDA concept and results are in agreements with study done by Allen PF et al., in 1996 in UK, where SDA is widely accepted but not widely practiced [9]. This could be due to the reason that SDA concept is not well known or may be due to lackness of current evidence based treatment approaches [8,9].

In the study done by Vohra F et al., in Saudi Arabia in 2015, 53.9% of the specialists applied SDA concept in only less than 10% of their patients. Also, the SDA concept was never applied in their practice by 54.8% residents and 46.6% of general dental practitioners [11].

In the present study 38.1% of dentists with knowledge regarding SDA concept, said initially their patients had objections but agreed after explanation regarding shortening of his/her dental arch for the treatment purpose. The findings are similar to the study conducted by Kumar PC et al., in 2010 where it was found that 57% of the patients either had no objection or initially objected to SDA but later agreed following detailed explanation [12].

The presence of approximately 10 pairs of occluding anterior and premolar teeth and having less dysfunction or ill health with limited possibilities for extensive restorative care [6]. Even in this study also, majority i.e., 52.2% dentists who knew about SDA concept believed that patient with SDA do not need further treatment and 50.4% patients with SDA who came across the dentists in our study had not received treatment.

Many studies have shown that there is association of reduced eating ability and TMJ discomfort in patients with SDA but researches have proved it wrong as satisfactory chewing ability is perceived as long as the dental arch comprise an intact anterior region and occluding pairs of posterior teeth [7]. Moreover, in this study also, only 41.6% dentists with knowledge of SDA concept believed that there is change in masticatory efficiency with SDA and only 39.8% of the dentists have said that there was no Temporomandibular Joint Disorders (TMD) associated issues in the patients with SDA and the difference was found to be statistically significant (p<0.05) between clinicians, academicians and both. The results are more or less in agreement with study done by Vohra F et al., in Saudi Arabia in 2015 where 76.4% dentists believed shortened dental arch provided satisfactory or acceptable function, 76.1% and 76.8% dentists believed SDA provided aesthetics and comfort respectively and also a significant difference between the opinions of Specialists (SP), General Dental Practitioners (GDP), and Residents (RES), regarding the effect of SDA on aesthetics (p=0.039), tooth wear (p<0.001), TMD (p<0.001), and tooth migration p=0.002) was seen [11]. But Nassani MZ et al., in Syria in 2015 through their study said that there were no significant differences in dentists’ attitudes towards SDAs of varying arch length [13].

In this study, significant association was found between the level of qualification and knowledge regarding minimum number of teeth required to meet functional demands. Significant difference (p<0.05) in knowledge was also seen among the clinicians, academicians and both, and years of experience. Clinicians with 1-5 years of experience had positive attitude towards SDA concept but are not incorporating this concept in their clinical practice. This may be due to fear of losing income [8].

Our study showed majority (77.1%) of the dentists were unaware of the SDA concept. Also of the few dentists aware of the SDA concept majority were not practicing it in their field due to limited knowledge regarding it; implying lack the knowledge regarding recent developments and evidence in the field of dentistry as SDA is relatively a new concept. Therefore, SDA concepts need to be promoted as this is relevant for many developing countries as it offers a functional approach at lesser cost [3].

It is recommended that the postgraduate training in dentistry should be based on best available current evidence to align the practice of SDA in trainees and for further future practices.

Along with training regarding SDA, it should be employed on the treatment plan for every patient who has a shortened dental arch. Though it may not be used each time but thought should be given to each and every individual as each patient has a unique situation and they need to be treated uniquely.

Till date most of the studies regarding this concept have been carried out in other countries and majority of them were on prosthodontists, very limited studies have been done in our country and none of them on general practitioners. Therefore, there was not much literature available for comparison of this study which proved a major limitation. Also, further studies involving larger sample size should be carried out to elucidate the knowledge and importance of SDA in comparison to other treatment modalities.

Dentists having knowledge regarding SDA concept are scarce. Dentists are not applying SDA in their day to day practice due to lack of awareness and knowledge. SDA provides the oral comfort, hygiene and the functional dentition at reduced cost without compromising the patient’s health. Therefore, it should be on treatment list of each dentist because it’s a simple as well as qualitative approach. So, each dentist has to plan the treatment by keeping SDA concept in his mind.