Characteristics and attitudes of general and pediatric dentists who use loupes

Introduction

Dentistry is a physically and visually demanding profession, requiring assessment and work on small structures. As a result, dental professionals often practice in unfavorable postural positions to get closer to the working field, and many of them suffer from musculoskeletal disorders [1, 2]. Dental loupes are special magnifying glasses that are used by many professionals, such as beauticians, surgeons, dentists, and ophthalmologists, as an aid for performing precise, and extremely delicate procedures.

Loupes and other magnification aids are recommended for dentists with both low and moderate visual acuity [3, 4]. As the quality of vision tends to decline with age, to compensate for individual or age-related visual limitations that might over time impair the quality of the dentistry work, the use of optical aids, such as loupes or microscopes, should be started at a relatively early stage [5]. Loupes also decrease eye strain, thus can lead to reduced fatigue [6].

Improving the visibility of small details using loupes contributes to the detection of clinical errors, such as problems with marginal sealing, marginal leakage, and secondary caries [7, 8, 9]. Studies have shown that using loupes improved the quality of tooth preparation [10, 11, 12, 13].

The use of loupes also helps to improve dental practitioners’ posture [14, 15] and prevent musculoskeletal disorders [16].

Data on the use of loupes in pediatric dentistry are scarce. Therefore, we aimed to characterize the use of loupes among pediatric dentists in comparison to general dentists and to evaluate the attitudes of dentists toward them.

MATERIALS AND METHOD

RESULTS

DISCUSSION

Our findings showed that the use of loupes is more prevalent among general dentists (64.3%) compared to pediatric specialists and residents (35.7%). In terms of the benefits of using loupes, more participants who reported using loupes than those who did not, agreed that their use contributes to comfortable and stable posture, better detection of caries, higher quality of work, more confidence at work, increased accuracy, and better radiographic assessment ability. According to James and Gilmour, the significant benefits of using loupes in operative dentistry were improved visibility of small details, compensation for presbyopia, and ensuring proper posture [7].

Studies on the use of loupes among pediatric dentists are lacking. Our findings showed that among the dentists who reported that they do not use loupes, 63.6% were pediatric dentists and residents, and 82.5% were dentists working with children. Possibly less pediatric dentists choose to use loupes because their appearance wearing loupes might have on their pediatric patients. Moreover, compared to general dentists or other specialists, their appearance wearing loupes during treatment might hinder their attempts of effective contact and good rapport, marked by confidence and trust in a relaxed and safe atmosphere. Nevertheless, loupes may be especially useful to pediatric dentists because their magnification allows better visualization of the small dimensions of primary tooth structures. Additionally, as dental treatment of children, especially young ones, should be carried out quickly, improved visualization of the oral structures enables dentists to work faster while maintaining high-quality treatment.

Most participants who reported using loupes also reported working in a private dental clinic (92.7%) compared with 72.2% of participants who reported not using loupes and working in an academic clinic. The use of dental loupes in private clinics may indicate to patients that the dentist uses state-of-the-art technology and works precisely and accurately.

The prevalence of loupes use in dentistry varies widely by country. In a study conducted among 370 dental practitioners in the state of Andhra Pradesh, India, only 23.8% reported using loupes, although over 90% were aware of the use of loupes in modern dentistry [18]. In a study conducted among 400 dentists and dental students in Saudi Arabia, only 12.25% reported using dental loupes in their clinical practice [19], while in another study in Saudi Arabia the prevalence of loupes uses among dental professionals—most of them general dentists—was 32.4% [20]. In a study conducted among dentists working in private clinics in Switzerland, 64% reported owning dental loupes [5], while in a study conducted in the United Kingdom, the prevalence of loupes use among general dentists was 44% [21].

A significantly higher percentage of dentists (84.2%) who started using loupes when they were students, did not continue using them in their clinic, compared to dentists (62.5%) who started using loupes during their studies and continued using them afterward. Despite the benefits of loupes, not everyone who uses them adapts well [22] and wants to continue using them or feels that they benefit their work. Maggio et al.[23]reported that the use of loupes by dental students during their studies was an important tool that significantly improved the performance and level of clinical work. In a qualitative study among 24 dental students, they reported that magnification using loupes led to an improvement in their work postures, hand skills, and quality of dental procedures. However, an adjustment period was needed [4].

A dentist who is aware of the importance and benefits of using loupes will use them more often. Aldosari reported that the use of loupes improves the therapist’s visual acuity and thus contributes to achieving better diagnosis and treatment [24]. In contrast, a dentist who is aware of the shortcomings of the loupes or thinks that they do not improve his work refrains altogether or uses them only in isolated cases. In the current study, more dentists who did not use loupes than those who did claim that using them entails a long adjustment period, weakening of the eyes, and discomfort. Loupes’ high price was also considered a disadvantage by more participants who did not use loupes. Price was a limiting factor to purchasing loupes in other studies as well [18, 19, 20,21], while Basunbul found that the importance of magnification was a consideration, before price [20].

More participants who used loupes, compared to those who did not, stated that their use may be beneficial in endodontics, orthodontics, periodontics, and pediatric dentistry, partially corresponding to Low et al. who indeed found most loupes users were general dentists and endodontists [25]. In endodontic treatments, the use of loupes by dentists helped improve the detection of root canals, diagnosis of fractures, and correct perforations [26]. Aldosari reported that the success rate of endodontic surgery performed with loupes, or a microscope was higher than treatment without a magnification device [24]. Wong et al.[13] found that performing root canal treatment in primary teeth with loupes significantly shortened treatment time compared to performing the same procedure without loupes. The use of loupes for orthodontic debonding allows less damage to the enamel and less composite residue [27].

The limitations of the study include its sampling method; some of the study population was recruited at a professional dentistry conference, private clinics, and online via email. Hence, our findings might not be representative of the general population of dentists. In addition, we have no information on the rate of non-responders.

CONCLUSIONS

Among general dentists, there is a higher prevalence of loupes usage, stemming from their higher awareness, compared to pediatric specialists and residents. Moreover, we found low rates of loupes usage among pediatric dentists and dentists who treat children. Therefore, there is still a need to raise awareness for using loupes among pediatric dentists, and to promote their advantages to reap benefits associated with their usage. Although the use of loupes in general dentistry is becoming more prevalent, further studies on their use in pediatric dentistry are warranted.

ACKNOWLEDGMENTS

The authors express their gratitude to Ms. Dalia Dawn Orkin for her English language contributions and editing services.

CONFLICTS OF INTEREST

The authors declare no conflict of interest.

FUNDING

This research received no external funding.

INSTITUTIONAL REVIEW BOARD STATEMENT

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Ethics Committee of Tel Aviv University.

INFORMED CONSENT STATEMENT

Informed consent was obtained from all subjects involved in the study.

DATA AVAILABILITY STATEMENT

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to confidentiality issues.