Introduction

Dentistry is an ever-changing science, and a practitioner must keep up to date in all aspects [1]. In 2017 during the World Workshop on the Classification of Periodontal and Peri‐implant Diseases and conditions, which was co‐sponsored by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) and introduced a new periodontal classification having an enormous impact on the implant and periodontal specialties [2].

One of the significant updates was removing aggressive and chronic periodontitis terms and introducing a single category for periodontitis [2]. The new sorting of periodontal illnesses and cases also contains systemic diseases and conditions that affect periodontal supporting tissues [3]. Commonly known diseases and conditions that affect the course of periodontitis, such as diabetes mellitus, an essential modifying factors of periodontitis and should be included in periodontitis clinical diagnosis as a descriptor [4]. 

In 2014 a new guideline for diagnosing diabetes mellitus was introduced by the American diabetes association, and it specified the parameters of diabetes mellitus diagnosis [5]. Meanwhile, low glycemia is present in about 74.9% of diabetes mellitus patients in Saudi Arabia [6]. However, there is insufficient information regarding the maximum acceptable blood glucose level for emergency tooth extraction in diabetic patients. Therefore, dentists must better understand glycemic control factors to improve diabetic patients' management at the dental clinic [7]. When faced with uncontrolled diabetic patients, a level of uncertainty arises among dentists, especially when they need an emergency tooth extraction. Their insufficient knowledge regarding the case and the safest blood glucose level for emergency tooth extraction needs to be well understood [8, 9].

In 2017 a new update on hypertension was released regarding its parameters and diagnosis [10]. "Silent killer" is a known name for hypertension as it affects 80 million adults older than 20 years in the USA alone [11] and just <1 billion people globally [11-13]. It is estimated that the number of hypertension-diagnosed patients will reach 1.56 billion by 2025 [13], and >7 million deaths annually are attributed to hypertension. As for cardiovascular mortality, hypertension is a forerunner risk factor [14]. The disease can be described as systolic blood pressure (SBP) of 140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg in any person under the prescription of antihypertensive medication to manage hypertension [11, 12, 15].

Furthermore, hypertension can be described as elevated blood pressure readings on a minimum of two occasions without or with provocation. Hypertension is divided into two main categories: essential/primary hypertension and secondary hypertension [16]. Lack of apparent etiologic factors for blood pressure elevation is defined as essential or primary hypertension, which is observed in most hypertension cases, making up ∼90%–95% of all cases. The presence of an identifiable cause is defined as secondary hypertension, affecting 5%–10% of USA adults diagnosed with hypertension [12, 16, 17]. Hence this study aimed to evaluate the awareness of dental practitioners regarding new classifications in periodontics, diabetes mellitus, and hypertension.

Materials and Methods

Study design

This was a descriptive cross-sectional study conducted amongst dental professionals working in Saudi Arabia.

Ethical approval and informed consent

The study proposal was submitted to Riyadh Elm University's research center, and ethical approval was obtained by the institutional review board (FUGRP/2020/197/289/170). Study participants indicated their agreement to participate by clicking the electronic link.

Study sample and sample size calculation

The study sample comprised final-year undergraduate students, interns, general dentists, specialists, and consultants in Saudi Arabia. A sample of 180 dental professionals was calculated based on the 5% acceptable margin of error, the confidence level of 82%, assuming 20000 dental professionals, and a response rate of 50% for the questionnaire items.

Reliability and validity of the questionnaire

A pilot study was carried out by sending the questionnaire to 20 study participants to determine its reliability of the questionnaire. Chronbach's coefficient alpha was calculated (0.88). At the same time, the face validity of the questionnaire was established by sending the questionnaire to the periodontic experts.

Questionnaire contents and administration

This cross-sectional survey questionnaire consisted of 17 items related to demographic information and questions related to updates in periodontics, diabetes mellitus, and hypertension. The dental professionals administered the questionnaire through emails and social media platforms. 

Statistical analysis

All the collected data were analyzed using the statistical package for social sciences version 25. Descriptive statistics of frequency distribution and percentages were calculated for the categorical variables. The relationship between demographic data and knowledge items on updated protocols in periodontics, diabetes mellitus, and hypertension was assessed using a chi-square test. A p-value of <0.05 was considered significant for all the statistical tests.

Results and Discussion

One hundred and eighty practitioners answered the questionnaire, 131 were males, and 49 were female, with the mean age of the participants being 27.6 ± 5.7 years old, and 60.6% of the practitioners were from the central region of Saudi Arabia. Most of the participants were undergraduate dental students and general dentists. The majority of the study participants had <4 years of experience. Almost 97.3% of the dental professionals agreed to stay updated with the current information on protocols in periodontics, diabetes mellitus, and hypertension (Table 1).

Table 1. Demographic characteristics of the study participants (N=180)

Table 2 shows the questionnaire items and the correct responses provided by the study participants. One of the changes in the 2107 classification of periodontal and peri-implant diseases was 4 Stages and 3 Grades of Periodontitis, known to 33.9% of the respondents. Similarly, the change from plaque-induced gingivitis to dental biofilm-induced gingivitis was correctly answered by  74.4% of dental professionals. Tertiary Occlusal Trauma is not a type of traumatic occlusal force was reported by 37.8% of respondents. Almost 38.9% attended lectures or conferences or read an article regarding the new classification of diabetes Mellitus. However, only 14.4% of respondents knew that 240 mg‎/dl was the critical blood sugar level point for any dental treatment. In comparison, 36.1% were aware that the cut-off fasting blood glucose level for emergency extraction is 180 mg‎/dl. Contrarily, only 15% agreed that 234 mg‎/dl is the cut-off point of blood sugar level after 2 hours from the last meal (Table 2).

Table 2. Questionnaire items and the correct responses

Almost 30.6% of the study participants attended lectures or conferences or read an article regarding the new classification of hypertension. However, 40% considered systolic and diastolic blood pressures of 130-139 / 80-89 mmHg stage I hypertension. Nearly 30.6% agreed to seek a physician's consultation before proceeding if the patient's systolic and diastolic blood pressure is 180 mmHg or higher / 109 mmHg or higher. The majority (71.7%)  of the study participants knew that almost all classes of antihypertensive medications cause xerostomia (Table 2).

Table 3. Comparison of responses across demographic variables (gender and level of education)