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

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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.
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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.
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Aug 2018

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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.
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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 : March | Volume : 16 | Issue : 3 | Page : ZC14 - ZC17 Full Version

Evaluation of Knowledge, Attitude, and Practices about Paediatric Dental Apps among Paediatric Dentists in India: A Questionnaire-based, Cross-sectional Study

Published: March 1, 2022 | DOI:
Krishna Sandeep Kadam, Niraj Satish Gokhale, Shivayogi Mallappa Hugar, Riddhi Shripad Joshi, Neha Kohli, Pooja Kishore Dialani

1. Postgraduate Student, Department of Paediatric and Preventive Dentistry, Kaher's Kle VK Institute of Dental Sciences, Belagavi, Karnataka, India. 2. Reader, Department of Paediatric and Preventive Dentistry, Kaher's Kle VK Institute of Dental Sciences, Belagavi, Karnataka, India. 3. Professor and Head, Department of Paediatric and Preventive Dentistry, Kaher's Kle VK Institute of Dental Sciences, Belagavi, Karnataka, India. 4. Former Postgraduate Student, Department of Paediatric and Preventive Dentistry, Kaher's Kle VK Institute of Dental Sciences, Belagavi, Karnataka, India. 5. Postgraduate Student, Department of Paediatric and Preventive Dentistry, Kaher's Kle VK Institute of Dental Sciences, Belagavi, Karnataka, India. 6. Postgraduate Student, Department of Paediatric and Preventive Dentistry, Kaher's Kle VK Institute of Dental Sciences, Belagavi, Karnataka, India.

Correspondence Address :
Niraj Satish Gokhale,
Reader, Department of Paediatric and Preventive Dentistry, Kaher’s Kle vk Institute
of Dental Sciences, Belagavi, Karnataka, India.


Introduction: Dental anxiety is of prime concern for the paediatric dentist as it can prevent a child from seeking effective dental care by creating conditions that are challenging to the paediatric dentists and thereby not allowing to render the highest quality care. The dental application (apps) can be a useful tool in alleviating the anxiety in children, but these apps have not yet been evaluated for its use by paediatric dentists.

Aim: To assess knowledge, attitude and practices about paediatric dental apps among paediatric dentists in India.

Materials and Methods: This cross-sectional questionnaire-based study was conducted among 450 paediatric dentists in India. The study was conducted over a span of one month. A 16-item validated questionnaire with Cronbach's alpha coefficient value of 0.82, containing professional demographic data, knowledge, attitude, and practices about dental apps were distributed among the participants. The collected data was subjected to descriptive analysis was done using IBM Statistical Package for the Social Sciences (SPSS) software (version 20.0 Chicago IL, USA).

Results: The study included (N=370) out of which 159 (42.97%) were female respondents and 211 (57.03%) were male respondents. The mean age of the surveyed professionals was 34.14±9.11 years. The results showed that the correlation between knowledge and attitude was found to be highly statistically significant (p=0.0001) however, no statistically significant results were found when a comparison was made between knowledge and practices (p-value=0.7684) and also attitude and practices (p-value=0.0930).

Conclusion: The study concludes that, there is a need for creating awareness about the use of dental apps as an adjunct with conventional behaviour modification techniques among paediatric dentists in our country


Applications, Artificial intelligence, Fear, Google form, Perception

The science of today could be the technology of tomorrow, with the advancement in technology a smartphone has gone from being a simple two-way pager to a Global Positioning System (GPS) Navigation device-embedded web browser, instant messaging device and a game console. It is seen that children from all age groups be it a toddler to a teenager are all stuck up to smartphones playing games or browsing the internet. With such an influential platform the question arises that why paediatric dentists could not use these dental apps for educating the patients about the procedure of the treatment which can help to reduce their fear or apprehension. A child’s first dental visit is pivotal for the reduction of dental anxiety and the success of treatment in the future. If this is not managed, it might continue in their adolescence (1).

Dental anxiety is of prime concern for the paediatric dentist as it can prevent a child from seeking effective dental care by creating the most challenging and uncooperative environment. Some children express fear and anxiety while others exhibit reluctant behaviour such as crying, rage, cessation of talking, and playing or attempting to run away from dental chairs which in turn also leads the fluctuations in blood pressure and heart rate (2).

Treatment of anxious children is stressful as it could consume more time and resources which then lead to an unpleasant experience for both dentists as-well-as the child. Thus, anxiety could ultimately reduce the efficacy and quality of overall treatment in children (3).

The ultimate success of paediatric dental treatment depends on behaviour management involving interaction between the dentist and the patient which then builds trust and helps to alleviate anxiety and overall fear of treatment. Thus, it enhances the child’s effective coping skills for acceptance of dental treatment (4).

Tell-Show-Do modelling, positive and negative reinforcement, are the most frequently used techniques by the dentist to alleviate a child’s fear and anxiety, of which, Tell-Show-Do developed by Addlestone in 1959, is a cornerstone of behaviour modification techniques. It is based on the principle of learning and helps the children to familiarise to dental procedure thus reducing the anticipatory anxiety (5).

In India, the frequency of mobile phone use is 68.6%, the rate of use by children is 56.6%. The rate also shows that 40% of them were below 10 years of age (6). Fear of dental treatment is a common problem in children and adolescents worldwide; hence, new strategies are being constantly developed to manage the anxiety-provoking situation. Smartphone apps have been used for behaviour guidance by developing virtual reality immersion. This being a promising distraction technique helps them to adapt to the dental environment and also been proved for allowing them to develop excellent rapport between the dentist and paediatric patients (7).

Dental apps like “my lovely dentist”, “doctor kids: dentist”, “Baby bus dentist”, are useful in reducing the anxiety and can be installed on the Android/ IOS/Windows platform. These apps are user-friendly and animated thus, the children would love playing the game and watching step by step procedure an animated dentist performs (8).

After the literature search was carried out, there were no studies found regarding knowledge, attitude and practices of the concept of dental apps among paediatric dentists in India. This study aims to assess and understand the gap between knowledge, attitude, and practices regarding the concept of anxiety-reducing dental apps.

Material and Methods

A cross-sectional questionnaire-based study that was conducted in the Department of Paediatric and Preventive Dentistry in the month of August 2020. Ethical approval was obtained from the Research and Ethics Committee KLE VK Institute of Dental Sciences, Belagavi with approval number 1387.

Inclusion criteria:

• Practicing paediatric dentists
• Faculty members (academicians)
• Postgraduate students.

Exclusion criteria:

• Participants who gave an incomplete questionnaire.
• Those who did not consent for the study and those who did not respond in the time frame of one month.

Sample size calculation: Sample size was calculated using standard sample size calculating formula (9):

n=Z2 pq/d2 where,

• n=Total sample size
• p=11.67% (percentage of perception)
• q=88.33% (other than perception)
• d=5% (acceptable error)
• z=2.576 at 99% confidence (standard normal variable)

Hence, n=450


A 16-item questionnaire was formed on the basis of questions that are needed to be asked to obtain the knowledge, attitude and practice components. The questionnaire was validated with Cronbach’s alpha coefficient value of 0.82. The questionnaire consisted of four components;

• The first component asked the participants to provide the demographic data.
• Second component contained eight knowledge questions about dental apps.
• The third component that contained five questions dealt with the attitude.
• The fourth component that contained three questions dealt with the practices for the use of dental apps.

The responses to the questions were measured on a two-point Likert scale “yes” and “no”. The mean knowledge, attitude, practice scores were calculated by adding all the number of correct entries and dividing by the number of respondents.

The participants were instructed regarding the filling of the questionnaire. Written informed consent was taken. A pilot study was conducted among 70 subjects. In the pilot study, the suggestions made by the respondents were considered, after suitable modifications and validation of the questionnaire the final questionnaire was finalised. Time given to fill the questionnaire was seven days. The e-questionnaire was sent through google forms to respective email ids of paediatric dentists in India. Ten incomplete questionnaires were removed from the sample size. Thus the final sample size available for statistical analysis was n=370.

Statistical Analysis

The data were entered into an MS Excel sheet (Microsoft Corp.) and statistically analysed, the data were then entered using IBM SPSS software (version 20.0 Chicago IL, USA) and percentages were calculated. Based on test the reliability, Cronbach’s alpha coefficient of 0.82 was calculated which indicated acceptability and internal consistency. Descriptive statistics were generated for all questions and each answer frequency distribution and percentages were examined. Correlations among knowledge, attitude, and practice scores were calculated using Karl Pearson’s correlation coefficient.


The study included (N=370) out of which 159 (42.97%) were female respondents and 211 (57.03%) were male respondents. The mean age of the surveyed professionals was 34.14±9.11 years. The number of respondents that participated was 129 practicing paediatric dentists, 139 postgraduate students, 102 faculty members that constituted about 34.86%, 37.57%, 27.57%, respectively.

The e-questionnaire distributed among the professionals focused on questions related to knowledge, attitude, practices regarding the use of dental apps. The mean scores with the standard deviation of knowledge, attitude, practice were 6.07±0.54, 4.95±0.23 and 2.06±1.10, respectively.

The analysis showed that 98.11% of participants agreed that dental apps could be used as an adjunct with behaviour modification technique to reduce preappointment anxiety of child and 100% agreed that dental apps could be a useful tool in the future to treat paediatric patients (Table/Fig 1).

Concerning the various age groups evaluated using one-way ANOVA, it was found out that experienced professionals aged above 61 years had better knowledge as compared to other age groups with an F-value of 0.4049 and p-value of 0.7495 when the comparison was carried out for attitude it was found out that the professionals aged from 41-50 years had a better attitude as compared to other age groups with F-value of 4.7314 which was highly statistically significant with the p-value of 0.0030 (p-value <0.05). However, when the comparison was done based on practices related to dental apps it was found out that professionals aged between 31-40 years were better as compared to other age groups with F-value of 0.1846 and p-value of 0.90681 (Table/Fig 2).

When a comparison of knowledge attitude and practices was made between the three groups of paediatric dental professionals using one-way ANOVA test the practicing paediatric dentists had better knowledge, attitude, practice scores as compared to faculty and postgraduate students. Especially when the attitude was compared, the practicing paediatric dentists had a better attitude with a statistically significant p-value of 0.0203 (p-value <0.05) and F-value 3.9407 (Table/Fig 3).

When seen in accordance to gender comparison using t-test, males had better knowledge, attitude scores than females with p-value of knowledge scores 0.8862, t-value of 0.1432, highly statistically significant attitude scores with p-value of 0.0001 (p-value <0.05) and t-value of 4.0659 and with p-value of practice scores 0.5862 and t-value of -0.5448. However, the practice scores of females were more than males (Table/Fig 4). The correlation between knowledge, attitude and practices was done using Karl Pearson’s correlation coefficient it was observed that the correlation between knowledge and attitude was highly statistically significant with r-value of 0.2198 and p-value of 0.0001. However, no statistically significant results were found when a comparison was made between knowledge and practices and also attitude and practices (Table/Fig 5).


The clear understanding of why and how we need to do something is knowledge. The desire to transform the knowledge into skills and ultimately into habits is attitude and skill is application of the knowledge acquired in any practical situation (10). In the present study, 50% of respondents stated that they translate their knowledge in clinical practice too, by regularly using dental apps as a preappointment behaviour management technique.

Dental anxiety has been considered an important source of trouble in the management of anxious children during dental treatment (11). It is considered as a major hurdle to provide efficient dental care and diagnosis of the pathological condition, which could significantly affect the child psychologically. A child’s first dental visit is crucial as he or she might be apprehensive and exhibits poor behaviour at their appointment (12).

Anxiety could affect the effective delivery of oral care since it could express itself in descriptive and interruptive behaviours. The emotional quality of the first dental visit has more effect on anxiety than subsequent visits, where behaviour management plays an important role in building trust and alleviate the fear of treatment in future dental visits. The dental team should provide effective and efficient treatment by developing an overall positive attitude in the child by efficient behaviour guidance. Most comprehensive approaches aim to develop a good connection between child, dentist, parents by understanding the emotional, cognitive, and social development. Thus, a comprehensive approach is beneficial than the individualisation of techniques in building trust by elevating anxiety and fear of subsequent dental visits (13).

In the world, India is the third-largest user of smartphones. The World Health Organisation (WHO) has proposed a new term “mobile health” which is a component of e-health define as “medical and public health practice strengthened by mobile devices such as mobile phones, patient monitoring devices, and personal digital assistant”. Thus, Healthcare professionals have been discovering innovative ways to provide services and teaching patients using smartphone apps designed for use in medical and dental fields (14).

Dental apps like “My lovely dentist”, “Doctor kids: dentist”, “Baby bus dentist” could be used to cope up with anxiety by educating the patients about dental treatment and hence reducing fear. Due to the limited availability of information regarding the use of smartphones in the reduction of dental anxiety, this study was conducted to create awareness among paediatric dentist about the use of anxiety-reducing dental apps as a preappointment behaviour management technique in children (15).

Anxiety developed during dental treatment affects systolic and diastolic blood pressure and heart rate while maintaining a steady oxygen saturation level. Thus, the heart rate could be utilised to access dental anxiety and is considered safe physiological measurements to use during dental treatment (16),(17).

A comparative study conducted with film modelling and Tell-Show-Do as a behaviour management technique to estimate anxiety levels in children found that, Tell-Show-Do being non playful and non interactive did not reduce heart rate in children than film modelling does. Thus, using anxiety-reducing dental apps as a preappointment behaviour management technique could significantly reduce anxiety, as a child would love playing and watching the dental procedure the animated dentist performs (18). Similar study was conducted to study the effectiveness of dental apps to reduce anxiety in children while performing dental procedure where they found smartphone as a modest and effective tool to reduce anxiety in children (19). According to the results of the present study, almost all believed that new apps have to be developed in the future.

In the current study, its was found that males had better knowledge, attitude scores of dental apps while females had better practice scores than males when comparison was done using t-test. It was found that the female practitioners are likely to use these dental apps more frequently in their practice hence the practice score is likely to be more (20).

As currently available apps are developed by software engineers who have little or no knowledge of paediatric dentistry, hence newer apps could be developed from a paediatric dentist’s point of view. The dental apps could be used as an adjunct to conventional behaviour management techniques and hence would help to alleviate anxiety and fear of treatment in the future. Dental apps can prove to emphasise overall patient health and aid in rendering quality treatment. Further educational seminars and/or workshops, if necessary, could be conducted for the paediatric dentists regarding awareness of dental apps if required.


A small sample size was the main limitation of this study. Also, most apps are available in English language only so there could be language barrier hence there is need to create apps in regional languages.


Based on the current study, it may be concluded that there is a lack of awareness among paediatric dentists that anxiety-reducing dental apps could be used as an adjunct with conventional behaviour management techniques among paediatric dentists in India. Further educational seminars and/or workshops, if necessary, could be conducted for the paediatric dentists regarding awareness of dental apps newer apps could be developed in different regional languages too for apps to be more effective.


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DOI and Others

DOI: 10.7860/JCDR/2022/52961.16083

Date of Submission: Oct 21, 2021
Date of Peer Review: Nov 23, 2021
Date of Acceptance: Dec 17, 2021
Date of Publishing: Mar 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? No
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Oct 25, 2021
• Manual Googling: Dec 16, 2021
• iThenticate Software: Jan 18, 2022 (15%)

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