Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
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Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
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Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : October | Volume : 16 | Issue : 10 | Page : ZC11 - ZC16 Full Version

Dentists’ Knowledge, Attitude and Practices Regarding Dental Care for Children with Special Healthcare Needs in Saudi Arabia

Published: October 1, 2022 | DOI:
Ullal Anand Nayak, Ruba Bassem Hijji, Masahear Awad Aljuhani, Lama Abduljaleel Aljuhani, Reem Nair Almarwani, Prathibha Anand Nayak

1. Associate Professor, Department of Preventive Dental Sciences, Ibn Sina National College for Medical Studies, Jeddah, Makkah, Saudi Arabia. 2. Intern, Department of Oral Basic and Clinical Sciences, Ibn Sina National College for Medical Studies, Jeddah, Makkah, Saudi Arabia. 3. Intern, Department of Oral Basic and Clinical Sciences, Ibn Sina National College for Medical Studies, Jeddah, Makkah, Saudi Arabia. 4. Intern, Department of Oral Basic and Clinical Sciences, Ibn Sina National College for Medical Studies, Jeddah, Makkah, Saudi Arabia. 5. Intern, Department of Oral Basic and Clinical Sciences, Ibn Sina National College for Medical Studies, Jeddah, Makkah, Saudi Arabia. 6. Associate Professor, Department of Oral Basic and Clinical Sciences, Ibn Sina National College for Medical Studies, Jeddah, Makkah, Saudi Arabia.

Correspondence Address :
Prathibha Anand Nayak,
Associate Professor, Department of Oral Basic and Clinical Sciences, Ibn Sina National College for Medical Studies, Jeddah, Saudi Arabia, Jeddah, Makkah, Saudi Arabia.


Introduction: Despite advancements in dentistry, children with special needs continue to have poor oral health, with a higher prevalence of untreated dental caries and periodontal disease. Many treating dentists and the parents of these children encounter difficulty managing these children and the quality of their oral health will be determined by this. Hence, identifying and overcoming the barriers of managing children with Special Healthcare Needs (SHCN) can be assessed as important step in addressing their treatment needs.

Aim: The study investigated the perceptions of general and paediatric dentists in Saudi Arabia, regarding the treatment needs and challenges posed while providing dental care to children with special needs.

Materials and Methods: A cross-sectional, questionnairebased study was conducted among 447 general dentists and 76 paediatric dentists in Saudi Arabia during five month period between 15th October 2021 to 15th March 2022. A prevalidated questionnaire consisting of 18 close-ended questions assessing the knowledge, attitude and practices of the dentists related to children with SHCN was emailed to each dentist. The data was analysed using the IBM Statistical Package for Social Sciences (SPSS) version 22.0 (IBM, Chicago, USA). The threshold for significance was established at 5%. The significance of study variables was determined utilising Chi-square test.

Results: Most paediatric dentists and general dentists were of the opinion that mental/behavioural/cognitive disability was the most difficult to manage (p<0.001). Out of the total, 66.2% of the dentists were aware of the dental home concept in managing children with SHCN. The knowledge related factors that were significantly associated, included type of impairment most difficult to manage (p<0.001) and awareness of the dental home concept (p<0.001). Regarding attitude, both general and paediatric dentists agreed that providing oral care is as important as providing medical care and that they were confident in treating these children (p<0.001). The practices related factors that were significantly associated included supporting staff's comfort in treating these children (p=0.004), accessibility of clinic (p<0.001), the availability of equipment to treat (p=0.02), and the techniques most commonly used for managing the behaviour of SHCN children (p<0.001).

Conclusion: The two most significant challenges to a SHCN child receiving dental care were a lack of access to a dentist who can provide oral care and limitations in the child’s cooperation during the procedure. The unmet treatment needs of these children can be considerably reduced by improving parental awareness, facilitating approaches that enhance patient compliance and providing convenient access to dental care.


Barriers for dental treatment, Special child, Unmet treatment needs

The higher prevalence of caries and deprived periodontal health among children with special needs as a result of unmet challenges in maintaining proper oral hygiene has become a growing concern among their parents as well as treating dentists worldwide and in Saudi Arabia (1),(2),(3),(4). Although, there is contradictory data reported in the literature regarding the increased prevalence of caries among these children, sufficient data suggests a higher prevalence and severity of periodontal disease among these children (1),(5),(6).

Poor oral hygiene is common among children with disabilities, either as a result of their limited physical dexterity or as a side effect of the medications they consume (7). The focus, however, has been to establish a comprehensive treatment plan that meets the dental, behavioural and medical needs of the patient during their lifetime. Parents’ difficulty in carrying out routine oral hygiene and dentists’ expertise, skill and attitude in treating these children will determine their quality of oral health. Many dentists express their difficulties in managing these children, citing inadequate professional training, ergonomic limitations, the lack of special consulting room facilities that require special equipment, a lack of scientific knowledge and feelings of insecurity (8).

Untreated dental problems can result in poor oral health due to caregivers’ inability to assess the child’s oral condition, the child’s incapacity to verbalise pain or discomfort and more relevantly, the lack of access to dental treatment. So, identifying and overcoming these barriers can be an important step in addressing treatment needs among these children for treating dentists (2). Furthermore, no study till date evaluated and compared the perceptions of the treating general dentists and paediatric dentists regarding the challenges they posed while managing these children. Bridging the gap between them is essential to ensure that early, comprehensive and effective treatment is rendered to these children. Hence, the present study was planned to investigate the perceptions of general dental practitioners and paediatric dentists in Saudi Arabia, regarding the treatment needs and challenges posed in providing dental care to children with special needs.

Material and Methods

A cross-sectional questionnaire-based study was conducted in Saudi Arabia among general dentists and paediatric dentists during five month period between 15th October 2021 to 15th March 2022. The ethical clearance [No: IRRB-02-17102021] from the Institutional Review Board was obtained. A convenient sampling technique was adopted for the study.

Inclusion and Exclusion criteria: The study included general dentists and paediatric dentists practicing in Saudi Arabia who willingly participated and completed the questionnaire. Questionnaires that were not completely filled out were excluded.

Sample size calculation: Considering the number of general dentists and paediatric dentists in Saudi Arabia to be 20000 and 500 respectively (9), a minimal sample size determined was 377 and 64 respectively at a confidence interval of 95%, assuming the frequency of knowledge regarding SHCN in the study population is 50% for general dentists and 90% for paediatric dentists, respectively.


A prevalidated questionnaire from the published study of Adyanthaya A et al., was used for the study (10). After consultation with the subject experts, minor modifications to the questions were made to match them for the health professionals. Cronbach’s alpha was assessed (0.89) to determine the reliability of the questionnaire. The close-ended multiple choice questionnaire consisted of 18 questions to assess their knowledge (5), attitude (5) and practices (8) about oral health and the treatment of special needs children. The questionnaire was mailed to the dentists and they were informed that their response was considered as their willingness to participate in the study. Demographic information about the type and duration of practice was gathered. To maintain confidentiality, the participants were assured that their responses would not be disclosed.

Statistical Analysis

The data received from the duly filled questionnaires was subjected to statistical analysis using the IBM SPSS version 22.0 (IBM, Chicago, USA). The threshold for significance was established at 5%. Chi-square test was used to compare the data between general dentists and peadiatric dentists.


The present study included 447 general dentists and 76 paediatric dentists, majority of them were having less than 10 years of experience, i.e., 36.5% with less than five years and 30.8% with 6-10 years of experience. The (Table/Fig 1) describes the demographic status of the study population describing their type of practice and years of experience of the enrolled dentists. The (Table/Fig 2),(Table/Fig 3),(Table/Fig 4) illustrate general dentists’ and paediatric dentists’ knowledge, attitudes and practices regarding the management of SHCN, respectively. Most paediatric dentists and general dentists were of the opinion that mental/behavioural/cognitive disability was the most difficult to manage (p<0.001). Out of the total, 66.2% of the dentists were aware of the dental home concept in managing children with SHCN.

The knowledge factors that showed a statistically significant association among general dentists and paediatric dentists regarding the management of children with SHCN were the type of impairment most difficult to manage (p<0.001), awareness of the dental home concept (p<0.001), and important strategies adopted to prevent oral disease (p=0.002).

Regarding attitude, most general and paediatric dentists agreed that providing oral care is as important as providing medical care to a child with SHCN (p<0.001) and that they were confident in treating these children (p<0.001). There was a significant difference (p=0.002) in the perception between general dentists and paediatric dentists regarding the level that special care dentistry needs to be taught during the undergraduate course, which can affect the quality of care for children with SHCN. Most general dentists believed that training should be theoretical or clinical observation-based, whereas paediatric dentists believed that various levels of treatment and assistance in special care dentistry, in addition to clinical observation, were required.

The factors related to practices that showed a statistically significant association among general dentists and paediatric dentists regarding the management of children with SHCN included supporting staff’s comfort in treating these children (p=0.004), accessibility of clinic (p<0.001), the availability of equipment to treat (p=0.02), and the techniques most commonly used for managing the behaviour of SHCN children (p<0.001).


According to the findings of the present study, among all types of special children, dentists were least comfortable treating those with mental disabilities because it is more difficult to manage their behaviour. They may exhibit resistive behaviour as a result of dental fear or a lack of knowledge about dental care which can jeopardise the delivery of safe dental care (11). Most patients with physical and developmental disabilities can be managed in the dental office with the help of their parents or caregivers. In patients with mental disability for whom typical behaviour management strategies are ineffective, protective stabilisation can be beneficial (11). Children with SHCN may display anxiety during dental treatment, which can affect the frequency of dental appointments and, as a result, can affect the oral health. Assessing anxiety or dental fear can be difficult, thus a parent or caregiver narrative can be beneficial in some circumstances (12). The patients’ cognitive, motor and sensory elements can be overcome in these patients under general anaesthesia, allowing the dentists to complete the diagnosis and perform dental treatments with less difficulty and higher quality (13). Furthermore, evidence from the studies by Mallineni SK and Yiu CKY suggests that parental satisfaction with GA-assisted dental care has been steadily growing in recent years, and that it is currently preferred over conventional behavioural management strategies performed in the dental clinic (14). However, American Academy of Paediatric Dentistry (AAPD) recommends that sedation or general anaesthesia are the behavioural guidance tools that may be used as the last resort when protective stabilisation is not possible (15).

The age at which these children report for their first dental visit would also determine the level of difficulty in managing these children (16). In the present study, only 26.2% of dentists stated that children with SHCN visited to the dentist for the first time below the age of one year and 25.4% parents reported for first dental visit of their child between three to six years which is similar to the findings of Nayak UA et al., in Saudi Arabia (17).

Children with SHCN are considered high risk and should undergo a dental check-up by the age of one year, as per the recommendations of American Academy of Paediatrics (16),(18). Depending on risk factors, these children need to see a paediatric dentist for professional preventive care every three months. Any child who presents with caries, gingivitis, or eruption abnormalities should see a paediatric dentist right away (17). The dentists in the present study firmly believed that early establishment of dental home would help these children get early interventions in these children. These findings are in accordance with the recommendations of AAPD which suggests that SHCN children utilising dental home facilities are also more likely to receive tailored preventive and regular oral care, lowering the risk of preventable dental and oral diseases (19).

Lack of awareness and knowledge among parents had been cited by the dentists of the present study as the most important reason that hinders a child with SHCN from seeking preventive dental care. When a child with SHCN has a family member who has a chronic emotional, behavioural, or developmental disorder, the rate of unmet need is greater (20). Untreated dental problems may lead to a child’s general oral health being impaired owing to a parent’s failure to evaluate the child’s oral health, the child’s inability to articulate pain or discomfort, or a lack of access to dental treatment (21). A strong positive association was identified in a study by Bernabé E et al., in 2011, between the carers’ level of education and the frequency of visits to the dentist, which is consistent with present study. This observation may be linked to their financial situation. Highly educated caregivers are more likely to live in better socioeconomic and social environment, which contributes to higher utilisation dental services (22).

The dentists of the present study were of the opinion that the access to a dentist providing care and the limitations in the child’s cooperation are the two most barriers that can hinder the SHCN child from receiving dental care. According to Skinner AC et al., rural children with SHCN had more unmet dental care needs than urban children. This is attributed to difficulties in obtaining care and their parents’ failure to recognise a need (23). Furthermore, due to the child’s pre-existing medical condition, dental treatment may become more challenging. The financial strain on parents is exacerbated by multiple trips and pricey dental care (24).

A dentist’s lack of knowledge and practical experience can also make it difficult to provide dental treatment to these special children (17). The level at which special care dentistry is taught during undergraduate course can impact the level of knowledge and skills a dentist can acquire. The present study throws more light to the fact that the paediatric dentists display better knowledge and skills in managing these children in the dental office when compared to the general dentists because they receive more comprehensive practical training and where is the general dentists’ training is limited to theory and or clinical observation. Only a small percentage of general dentists receive professional training in treating these children. Hence, positive outcomes require effective care coordination and communication between dentists, parents/guardians and other providers. Our current dental healthcare system has fallen short of meeting the needs of people with SHCN (25).

Non financial barriers include language, emotional, structural and cultural inhibitions among children with SHCN. Oral health views, caregiver accountability norms and the caregiver’s previous dental experience are all psychosocial hurdles. Transportation, school absence policies and difficulties finding medicaid accepting providers are examples of structural hurdles (26). The present study suggested that the paediatric dentist have an edge over general dentist and their technique is well equipped to treat these children. They were also involved in training their supporting staff to better manage a special child patient in dental clinic.

The technique most commonly followed for managing behaviour of these children had been significantly different between the paediatric dentists and the general dentists of the present study (p<0.001). The general dentists used more conservative approaches using behaviour management techniques such a voice control, Tell-showdo, distraction, contingency management, whereas the paediatric dentists preferred to use gender anaesthesia to manage the behaviour of these children. The paediatric dentists also followed more comprehensive approach in treating these children when compared to the general dentists.

Children with pre-existing medical illnesses reportedly consume more drugs and were older than those with intellectual disabilities. Dental restorations (63%) and extractions (47%) were the most common dental treatments (27). However, there was no link between the type of disability and the requirement for dental therapy. Children with intellectual disabilities were three times more likely than the other group to require general anaesthesia and seven times more likely to require physical restraint for dental care (28). It is imperative to improve the compliance of paediatric dental patients with preventive dental visits after treatment under GA, regardless of health status. Caregivers must be better educated in order to implement change, and care barriers must be investigated regularly (28). Frequently updating knowledge through continuing dental educations, conferences, etc. would aid the practicing dentist in delivering evidence based dental care to these needy children.

The following are some of the benefits of a family centered approach to building a strong parent provider relationship. To begin with, parents must be recognised as the primary supervisors of their children’s healthcare. Second, consider flexibility when arranging appointments, since they may have many healthcare visits for various therapies, as well as avoid no-show or canceled appointments. Third, if necessary, facilitate any necessary referrals. Fourth, provide information about community-based options and advocate for the utilisation of appropriate services, such as hospitals and, most importantly, involve families in child care decisions (29). The (Table/Fig 5) summarises the studies regarding barriers of treatment among children with SHCN (10),(30),(31),(32),(33).


One limitation of the present study could be addressed by assessing the role of specific barriers to treatment among the parents and children too. These studies would provide a panoramic view regarding improving the unmet treatment needs of these children. Hence, it is recommended to conduct region-based studies to overcome the barriers for treatment among the parents of children with SCHN, as well as among their treating dentists.


The present study inferred that access to a dentist providing care and the limitations in the child’s cooperation are the two most barriers that can hinder the SHCN child from receiving dental care. The paediatric dentists were more confident and had superior knowledge and skills, allowing them to provide comprehensive treatment to children, whereas general dentists provided conservative dental treatment due to their limited knowledge and training. The take-away message from the present study is to identify and eliminate challenges as soon as possible in order to deliver the best possible healthcare to these individuals. These children’s unmet treatment needs can be considerably lowered by improving parental awareness and education, supporting patient compliance-enhancing strategies and providing convenient access to dental care through early dental home utilisation, all of which will help them live a better life.


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DOI and Others

DOI: 10.7860/JCDR/2022/57379.16933

Date of Submission: Apr 27, 2022
Date of Peer Review: May 21, 2022
Date of Acceptance: Jun 18, 2022
Date of Publishing: Oct 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: May 02, 2022
• Manual Googling: Jun 16, 2022
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