Development and validation of an Arabic questionnaire to assess dentist knowledge on managing deep caries cavities

Development and validation of an Arabic questionnaire to assess dentist knowledge on managing deep caries cavities | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Development and validation of an Arabic questionnaire to assess dentist knowledge on managing deep caries cavities Rashad Alghourani, Hassan Achour, Hussam Milly This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3949388/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: The interconnection between oral health and systemic well-being is widely recognized, with dental caries being a prevalent global oral disease. This study focuses on the development and validation of a unique Arabic-language questionnaire to evaluate dentists' knowledge and skills in managing deep caries. Aim To create and validate the first Arabic questionnaire specifically for assessing dentists' competence in diagnosing and managing deep caries cavities. Methods The study adopted a multi-stage approach, including translation and adaptation of existing questionnaires, addition of new items by experts, and a thorough validation process. A balanced sample of 20 dentists from Damascus University Faculty of Dentistry participated. The questionnaire encompassed items divided into categories of diagnosis, treatment, and tools. Statistical analysis for internal and external validity, reliability, and other factors was conducted using SPSS. Results The questionnaire demonstrated high internal consistency (Cronbach's Alpha = 0.804, 0.879 for standardized items) and good test-retest reliability. Some items showed strong positive correlations, while a few indicated weaker correlations, revealing areas for potential refinement. The study highlighted significant correlations in most parameters, affirming the questionnaire's reliability. Conclusion This research successfully developed and validated the first Arabic-language questionnaire for assessing dentists' knowledge in managing deep caries cavities. The methodology ensured the tool's reliability and validity, with practical implications for dental education and practice in Arabic-speaking regions. Dental Caries Deep Caries Cavities Dentist Knowledge Assessment Arabic-Language Questionnaire Oral Health Systemic Health Introduction The intricate relationship between oral health and overall systemic well-being is a focal point in modern medical research. Oral health, particularly the management of dental caries, is a critical component of this relationship (Bhatnagar, 2021 ). Dental caries and deep caries cavities, stand as one of the most common oral diseases worldwide, affecting a significant portion of the global population (Wen et al., 2022 ). This prevalence underscores the need for dental professionals to have a profound understanding of the challenges involved in diagnosing and treating these conditions effectively (Wen et al., 2022 ). The complexities of managing deep caries are crucial in both general and specialized dental practices due to their potential systemic implications and the technical skill required for treatment (Kotha et al., 2022 ). The oral cavity, serving as a habitat for a diverse array of microorganisms, plays a vital role in maintaining both oral and systemic health. An imbalance in this microbiota, termed microbial dysbiosis, can lead to a variety of systemic diseases. This intricate connection between oral microbiota and systemic health is evident in the research, which links oral diseases with various systemic conditions, including cardiovascular, respiratory, gastrointestinal, and diabetic complications The management of oral diseases like deep caries is, therefore, essential not only for oral health but also for the overall health of individuals (Kilian et al., 2016 ). Various attempts have been made to understand and enhance dentists' knowledge in managing deep caries cavities. A notable study surveyed 216 pediatric dentists, revealing diverse approaches to caries treatment based on their experience and educational background. It was found that younger dentists, with less than 10 years of experience, were more inclined towards partial caries removal and specific techniques like the Hall technique, compared to senior dentists. The study highlighted that treatment choices, such as the extent of caries removal and the use of specific liners, varied significantly among dentists based on their years of clinical experience and educational background. Senior dentists, with over 10 years of experience, often adhered to more traditional methods like complete caries removal. This variation in clinical decision-making underscores the need for updated and consistent training across the dental profession, particularly in the management of deep carious lesions in primary teeth (Kotha et al., 2022 ). Despite the known importance of proper management of deep caries, there is a notable gap in the assessment of dentists' knowledge and skills in managing these conditions, particularly in Arabic-speaking regions. This gap highlights the need for a specialized tool to evaluate and improve dentists' competencies in this area in Arabic language. The development of a comprehensive questionnaire tailored to these regions could serve as a significant step in enhancing the quality of dental care and, consequently, the systemic health outcomes of patients. Such a tool would not only elevate the standard of dental practice but also contribute to the broader goal of integrated healthcare, where oral health is recognized as a vital component of general health. This research aims to develop and validate a questionnaire specifically designed for Arabic-speaking dentists, focusing on their knowledge and skills in managing deep caries. This initiative is crucial in improving dental care quality and aligns with the global public health objective of integrating oral health into general healthcare, thereby addressing a critical aspect of overall well-being. Aim of the research: The aim of this study is to develop and validate the first Arabic-language questionnaire specifically designed to assess dentists' knowledge and competence in diagnosing and managing deep caries cavities. Methods and materials Study Design This study aims to develop the first Arabic questionnaire to assess dentists' knowledge in diagnosing and managing deep caries cavities. The development process involved the translation of existing questionnaires, the addition of new items by a group of experts, expert review of the translation, and statistical tests to measure internal and external validity, reliability, and other factors. A practical guideline to develop and validate questionnaires was followed (Kishore et al., 2021 ). Questionnaire Development The questionnaire was adapted from previous studies, notably those by (Niemeyer et al., 2023 ), and (Kotha et al., 2022 ). The questions were reviewed, and additional items were contributed by a panel of three expert dentists (HA, HA, MT), all with significant experience in academic research. This process also involved a professional translator to ensure accuracy in translation. Table N.1 explains the research stages of questionnaire development and validity. Questionnaire Translation and Cultural Adaptation The questionnaire was translated into Arabic by an official sworn translator (ET). While cultural aspects were considered, no significant cultural adaptations were needed. Study Participants The study involved 20 participants, both general and specialized dentists, with ages ranging from 25 to 30 years. All participants were working or studying at Damascus University Faculty of Dentistry. The sample was gender-balanced between male and female participants. Data Collection Procedure The pilot questionnaire was printed and distributed by hand to participants in a controlled environment, free from distractions. This ensured the quality and consistency of the responses. Data collection was done in Damascus university in the period of 1st to 20th of January 2024. Test-Retest Reliability The test-retest methodology involved administering the questionnaire twice to the same group of participants within a two-week interval. Data analysis was performed using SPSS, including tests for internal validity (e.g., Cronbach's alpha for internal validity), and test-retest for reliability. Statistical Analysis SPSS v.22 was used to carry out statistical analysis. The following test s were applied Intra-class Correlation Coefficient (ICC) : To measure the reliability of the questionnaire by assessing the consistency of responses between the initial test and the retest. Cronbach's Alpha Test for Internal Consistency : To determine the cohesiveness of the questionnaire items and their ability to measure a single, unified concept. Possible Bias and Management Strategies To mitigate recall bias, a two-week interval was implemented between the first and second administrations of the questionnaire. Additionally, a sufficiently large sample size was used to ensure statistical power and reduce the impact of individual variances. Ethical Considerations Ethical approval for this study was obtained from the Ethical Committee at Damascus University. All participants provided informed consent, and measures were taken to ensure confidentiality and compliance with ethical standards. Participants names were coded with a serial number. Table N.1 explains the research stages of questionnaire development and validity. Stage 1: questions development 1- Questions were adopted from previous studies. 2- More questions were added by a panel of experts. 3- Questions were divided into 3 groups: diagnosis, treatment, and tools. Stage 2: translations 1- Forward translations of the questions adopted from previous studies into Arabic. 2- Back translation into all the questionnaire questions into English. 3- Comparison of the original and the final versions and adjustments of discrepancies. Stage 3: pilot study 1- The final version of the Arabic questionnaire was printed and distributed to a sample of dentists at Damascus university (N = 20). 2- The first round of answers was collected. 3- The questionnaire was distributed again after 2 weeks, and the second round of answers were collected (N = 20) Stage 4: validation and statistical analysis The following tests were applied: 1- Cronbach’s alpha test for internal consistency 2- Intra-class correlation (ICC) coefficient Results Demographic variables of the sample: The study's demographic profile encompassed a balanced gender distribution with 40% (8) of the participants being male and 60% (12) female. In terms of clinical experience, most of the participants, accounting for 85% (17), had less than five years of experience, while 15% (3) had between 5 to 10 years, and none had more than 10 years of experience. Regarding their specialty, a small fraction, 5% (1), were general dentists, 55% (11) specialized in endodontics, and the remaining 40% (8) belonged to other dental specialties. The age of the participants varied, with a mean age of 26.3 years, a minimum of 24 years, and a maximum of 29 years, accompanied by a standard deviation of 1.3 years. Table N.2 Table N.2 demographic variables of the study Count Table N % Mean Min Max SD gender male 8 40.0% female 12 60.0% clinical experience less than 5 years 17 85.0% 5–10 years 3 15.0% more than 10 0 0.0% specialty general dentist 1 5.0% endodontics 11 55.0% other 8 40.0% Age 26.30 24.00 29.00 1.30 Test of internal consistency: The internal consistency of the questionnaire was evaluated using the Cronbach’s Alpha test. The analysis included a total of 20 valid cases with no exclusions. The Cronbach's Alpha coefficient for the questionnaire, encompassing 16 items, was found to be 0.804. Additionally, when considering the standardized items, the Cronbach's Alpha value slightly increased to 0.879. Both values are higher than the commonly accepted threshold of 0.7, indicating good internal consistency for the questionnaire. Table N.3 Table N.3 – results of internal consistency test (Cronbach’s Alpha test) Case Processing Summary Reliability Statistics N % Cronbach's Alpha Cronbach's Alpha Based on Standardized Items N of Items Cases Valid 20 .804 0.804 0.879 16 Excluded 0 .0 Total 20 100.0 Test-Retest for questionnaire validity: Overall, the Test-Retest analysis showed encouraging results, indicating good reliability of the questionnaire. Most of the items exhibited significant correlations, affirming the consistency of measurements over time. Notably, variables such as "Dentine hardness" (Pair 1) and "using of rubber dam" (Pair 4) demonstrated strong positive correlations of 0.947 (p < 0.001) and 0.730 (p = 0.006), respectively, underscoring their high reliability in assessing dental parameters. Table N.4 In the category of variables with moderate correlations, "Dentine color" (Pair 2) exhibited a noteworthy correlation coefficient of 0.748 (p = 0.033), indicating acceptable reliability. Additionally, "How to test vitality" (Pair 7) displayed a substantial positive correlation of 0.676 (p = 0.001), suggesting reliable measurement. Table N.4 However, it is essential to acknowledge that some items showed no significant correlation, suggesting limitations in their reliability. Notably, "Treatment of non-reversible pulpitis not complete apex" (Pair 12) and "Treatment non-reversible with complete apex" (Pair 13) displayed weak correlations with coefficients of 0.208 (p = 0.378) and 0.271 (p = 0.249), respectively, indicating limited reliability in assessing these aspects. Table N.4 Table N.4 – test-Retest for questionnaire reliability N Correlation P-value Significance Diagnosis Pair 1 Dentine hardness 20 .947 .000 Significant Pair 2 Dentine color 20 .748 .033 Significant Pair 3 Do a radiograph before the treatment 20 1.000 .000 Significant Pair 4 rubber dam 20 .730 .006 Significant Pair 5 type of x-ray 20 .579 .007 Significant Pair 6 examining vitality 20 .579 .007 Significant Pair 7 how to test vitality 20 .676 .001 Significant Treatment Pair 8 treatment open apex 20 .740 .000 Significant Pair 9 in case of pulp exposure for teeth with open apex 20 .620 .004 Significant Pair 10 treatment closed apex 20 .616 .004 Significant Pair 11 in case of pulp exposure for teeth with closed apex 20 .774 .000 Significant Pair 12 treatment of non-reversible pulpitis open apex 20 .208 .378 Not significant Pair 13 treatment non-reversible with closed apex 20 .271 .249 Not significant Tools used Pair 14 tools for excavation 20 .926 .007 Significant Pair 15 materials used in case of pulp exposure 20 .846 .000 Significant Factors to consider Pair 16 Oral hygiene 20 .856 .003 Significant Pair 17 Age of patients 20 1.000 .000 Significant Pair 18 Patient compliance 20 1.000 .000 Significant Pair 19 Follow up 20 1.000 .000 Significant Discussion The importance of training and assessing dentists' knowledge in the field of dental health is crucial, especially in terms of enhancing treatment outcomes (Tan and Lin, 2024 ). This is particularly relevant when addressing prevalent and complex issues like deep caries cavities. The gap in the availability of assessment tools, especially in Arabic, highlights a significant need for dental education and practice (Khallof et al., 2019 ). Our research addresses this gap, aiming to develop an Arabic-language tool for evaluating and improving dentists' understanding and management of deep caries cavities. This initiative is vital in regions where such resources are currently lacking, potentially transforming the approach to dental health care, and improving patient outcomes. The methodology employed in this study aimed to create an Arabic questionnaire for evaluating dentists' knowledge in managing deep caries cavities. This was achieved through a 4 stages process of adapting and translating existing questionnaires, supplemented with expert input, developing the final version of the questionnaire, and statistical analysis using test-retest methods to ensure validity and reliability, including the use of Cronbach's Alpha and ICC (Carlson and Morrison, 2009 ). This methodological framework was designed to ensure the questionnaire's effectiveness in a specific cultural and professional context (Niemeyer et al., 2023 ). The study sample included a dentist from Damascus university, gender was balanced, and the sample was approached two weeks after the initial response which allowed to test the reliability of the questionnaire. The questionnaire's internal consistency, as indicated by the Cronbach's Alpha results, demonstrated good cohesion among the items. Both overall and standardized scores exceeded the accepted threshold, affirming the tool's reliability in assessing dentists' knowledge in this field. Furthermore, the test-retest analysis provided a nuanced view of the questionnaire's reliability. Significant correlations in most of the parameters indicated consistent responses over time. However, weaker correlations in some items, particularly concerning the treatment of non-reversible pulpitis, suggest areas for potential refinement and further investigation. The results of the current study can be contextualized within the broader framework of dental research, particularly when compared to similar studies. For instance, the work of Niemeyer et al. ( 2023 ) involved creating a questionnaire to assess knowledge in diagnosing and managing root caries. Their approach mirrors our methodology in its comprehensive development and validation process (Niemeyer et al., 2023 ). In contrast, Schwendicke et al. ( 2013 ) focused on German dentists' approaches to deep dentin caries removal, revealing a strong preference for complete excavation. This contrasts with the findings of our study, where partial caries removal was more favored, especially among younger dentists, however, the aim of our study is to validate the questionnaire without going in depth regarding the answers of the dentist participated in the study (Schwendicke et al., 2013 ). Additionally, Carvalho et al. ( 2018 ) investigated Danish dental professionals' decision-making in occlusal caries management, showing significant agreement in treatment decisions, paralleling the consistency observed in our study. These comparisons underscore the regional and cultural differences in dental practices and attitudes, enriching the understanding of how dentists' approaches to caries management may vary globally (Carvalho et al., 2018 ). The clinical implications of this study are significant, particularly as it introduces the first questionnaire tailored for Arabic-speaking dentists to assess their knowledge in managing deep caries cavities. This tool represents a crucial step in understanding and improving dental care quality in Arabic-speaking regions. It can influence treatment decisions and patient outcomes by providing insights into current knowledge gaps and training needs (Alrashdi et al., 2021). The implementation of this questionnaire can also guide educational programs and professional development, ensuring that dentists are equipped with the latest knowledge and skills in deep caries management. The development of such a resource in Arabic fills a critical gap in dental education and practice, potentially leading to improved oral health outcomes in these communities (Al Zaher and Dashash, 2021 ). Despite the challenging educational environment in Syria, this study successfully validated the first Arabic questionnaire for assessing dentists' knowledge in managing deep caries cavities. The methodology was carefully designed to mitigate potential biases and ensure reliability and validity. To avoid recall bias, a two-week interval between the first and second questionnaire administrations was implemented. This approach, along with the rigorous statistical analysis including Cronbach's Alpha and ICC, strengthened the reliability and validity of the findings, showcasing a resilient and effective research approach in a complex setting. Conclusion This research successfully developed and validated the first Arabic-language questionnaire for assessing dentists' knowledge in managing deep caries cavities. The methodology ensured the tool's reliability and validity, with practical implications for dental education and practice in Arabic-speaking regions. Declarations Ethics approval and consent to participate: Ethics approval for this study was granted by Damascus University's Ethics Committee. All participants provided informed consent, affirming their understanding of the study's purpose and their voluntary agreement to participate. Consent to publish: NA Availability of data and materials: The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. -The datasets generated and/or analysed during the current study are not publicly available due to publication consent from Damascus university , it's not allowed to publish all the data publicly but are available from the corresponding author on reasonable request Competing interests: The authors declare no possible conflict of interest. Funding: No funding. Acknowledgement: We extend our sincere gratitude to Dr. MHD Bahaa Aldin Alhaffar for his invaluable contribution and assistance throughout the study. Authors contribution: RG: designed the research, collected the data, analyzed the data, wrote the manuscript. HA and HM: supervised the research, helped writing and finalizing the manuscript. References AL ZAHER N, DASHASH M. An educational intervention for improving knowledge of Syrian school children about avulsion using the save your tooth poster. BMC Oral Health. 2021;21:24. ALRASHDI M, LIMAKI, M. E., ALRASHIDI A. 2021. Oral Health Knowledge Gaps and Their Impact on the Role of Pediatricians: A Multicentric Study. Int J Environ Res Public Health, 18. BHATNAGAR DM. Oral Health: A Gateway to Overall Health. Contemp Clin Dent. 2021;12:211–2. CARLSON MD, MORRISON RS. Study design, precision, and validity in observational studies. J Palliat Med. 2009;12:77–82. CARVALHO JC, QVIST V, AIMEE, N. R., MESTRINHO, H. D., BAKHSHANDEH A. Diagnosis, Risk Assessment, and Treatment Decisions for Occlusal Caries: A Survey from the Danish Public Dental Health Service. Caries Res. 2018;52:58–70. KHALLOF RO, FARID DOUMANIM, MOSTAFA FAS, D., ALHAFIAN RAA. Dental education in the Arabic language vs English language: A survey among Arab dentists. J Family Med Prim Care. 2019;8:3908–14. KILIAN M, CHAPPLE IL, HANNIG M, MARSH PD, MEURIC V, WADE PEDERSENAMTONETTIMS, W. G., ZAURA E. The oral microbiome - an update for oral healthcare professionals. Br Dent J. 2016;221:657–66. KISHORE K, JASWAL V, KULKARNI V, DE D. Practical Guidelines to Develop and Evaluate a Questionnaire. Indian Dermatol Online J. 2021;12:266–75. KOTHA SB, BINHUWAISHEL HA, ALMUHAYDIB RN, ALZEGHAIBI, L. Y., ALHAJRI MA. Clinical decision-making in managing deep carious lesions in primary teeth based on clinical experience among pediatric dentists-A cross-sectional study. J Popul Ther Clin Pharmacol. 2022;28:e17–28. NIEMEYER SH, MANIEWICZ S, CAMPUS G, TENNERT C, YILMAZ B, ESTEVES-OLIVEIRA ZEKERIDOUAROCCUZZOA, M., CARVALHO, T. S., WIERICHS RJ. Design, development and validation of a questionnaire to assess dentists' knowledge and experience in diagnosing, recording, and managing root caries. Clin Oral Investig. 2023;27:2705–11. SCHWENDICKE F, MEYER-LUECKEL H, DORFER C, PARIS S. Attitudes and behaviour regarding deep dentin caries removal: a survey among German dentists. Caries Res. 2013;47:566–73. TAN WW, LIN GSS. 2024. Integrating personal and professional development course to undergraduate dental education. J Dent Educ. WEN PYF, CHEN MX, ZHONG YJ, DONG, Q. Q., WONG HM. Global Burden and Inequality of Dental Caries, 1990 to 2019. J Dent Res. 2022;101:392–9. Additional Declarations No competing interests reported. Supplementary Files appendex1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3949388","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":278462095,"identity":"bffa24ab-4661-4ae3-8c6b-9b639b1f32b0","order_by":0,"name":"Rashad Alghourani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYHACNhBKADMTeGyAJGPjARK0yKSBtDSQoIXB5jCYwqvFvP34swc/ymrz+KUPP3vwIOe83dr2w0BbamyicWmROZNjbthz7nixZF+auUHCmdvJ284kArUcS8ttwKFFgiGHTYK37VjihjMMZhKJPbeTzQ4AtTA2HMathf/5M8m/YC3s3yQS/51LNjv/kIAWiQQzad62GqAWHjOJBJ4DdmY3CNki8cZMWubcgcSZPTxlQC3JCWY3gLYk4PMLf/ozyTdldYn9POzbJH/w2NmbnU9/+OBDjQ1OLVBwGM5KBKtMwK8cBOrgLHvCikfBKBgFo2CkAQAe8GN/uqPFlAAAAABJRU5ErkJggg==","orcid":"","institution":"Damascus University","correspondingAuthor":true,"prefix":"","firstName":"Rashad","middleName":"","lastName":"Alghourani","suffix":""},{"id":278462096,"identity":"d9911a1a-60b1-4f82-87e5-c7edd0e84fe4","order_by":1,"name":"Hassan Achour","email":"","orcid":"","institution":"Damascus University","correspondingAuthor":false,"prefix":"","firstName":"Hassan","middleName":"","lastName":"Achour","suffix":""},{"id":278462097,"identity":"4f2d9019-ff0f-4e68-956f-5e1dd54783bb","order_by":2,"name":"Hussam Milly","email":"","orcid":"","institution":"Damascus University","correspondingAuthor":false,"prefix":"","firstName":"Hussam","middleName":"","lastName":"Milly","suffix":""}],"badges":[],"createdAt":"2024-02-11 21:19:49","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3949388/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3949388/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59037222,"identity":"fb5be2c0-5bcb-4f77-b93b-31ce56e8c5e6","added_by":"auto","created_at":"2024-06-25 15:30:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":709853,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3949388/v1/92bd4025-db4c-48cd-8abd-68a2a2b4aa8b.pdf"},{"id":52579781,"identity":"e08f6156-bd0e-4c6a-8709-3ca34cb02f98","added_by":"auto","created_at":"2024-03-13 07:41:16","extension":"docx","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":23737,"visible":true,"origin":"","legend":"","description":"","filename":"appendex1.docx","url":"https://assets-eu.researchsquare.com/files/rs-3949388/v1/fbef5d5cc294d0d222b06b2a.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development and validation of an Arabic questionnaire to assess dentist knowledge on managing deep caries cavities","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe intricate relationship between oral health and overall systemic well-being is a focal point in modern medical research. Oral health, particularly the management of dental caries, is a critical component of this relationship (Bhatnagar, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Dental caries and deep caries cavities, stand as one of the most common oral diseases worldwide, affecting a significant portion of the global population (Wen et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). This prevalence underscores the need for dental professionals to have a profound understanding of the challenges involved in diagnosing and treating these conditions effectively (Wen et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The complexities of managing deep caries are crucial in both general and specialized dental practices due to their potential systemic implications and the technical skill required for treatment (Kotha et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e The oral cavity, serving as a habitat for a diverse array of microorganisms, plays a vital role in maintaining both oral and systemic health. An imbalance in this microbiota, termed microbial dysbiosis, can lead to a variety of systemic diseases. This intricate connection between oral microbiota and systemic health is evident in the research, which links oral diseases with various systemic conditions, including cardiovascular, respiratory, gastrointestinal, and diabetic complications The management of oral diseases like deep caries is, therefore, essential not only for oral health but also for the overall health of individuals (Kilian et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eVarious attempts have been made to understand and enhance dentists' knowledge in managing deep caries cavities. A notable study surveyed 216 pediatric dentists, revealing diverse approaches to caries treatment based on their experience and educational background. It was found that younger dentists, with less than 10 years of experience, were more inclined towards partial caries removal and specific techniques like the Hall technique, compared to senior dentists. The study highlighted that treatment choices, such as the extent of caries removal and the use of specific liners, varied significantly among dentists based on their years of clinical experience and educational background. Senior dentists, with over 10 years of experience, often adhered to more traditional methods like complete caries removal. This variation in clinical decision-making underscores the need for updated and consistent training across the dental profession, particularly in the management of deep carious lesions in primary teeth (Kotha et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the known importance of proper management of deep caries, there is a notable gap in the assessment of dentists' knowledge and skills in managing these conditions, particularly in Arabic-speaking regions. This gap highlights the need for a specialized tool to evaluate and improve dentists' competencies in this area in Arabic language. The development of a comprehensive questionnaire tailored to these regions could serve as a significant step in enhancing the quality of dental care and, consequently, the systemic health outcomes of patients. Such a tool would not only elevate the standard of dental practice but also contribute to the broader goal of integrated healthcare, where oral health is recognized as a vital component of general health.\u003c/p\u003e \u003cp\u003eThis research aims to develop and validate a questionnaire specifically designed for Arabic-speaking dentists, focusing on their knowledge and skills in managing deep caries. This initiative is crucial in improving dental care quality and aligns with the global public health objective of integrating oral health into general healthcare, thereby addressing a critical aspect of overall well-being.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eAim of the research:\u003c/h2\u003e \u003cp\u003eThe aim of this study is to develop and validate the first Arabic-language questionnaire specifically designed to assess dentists' knowledge and competence in diagnosing and managing deep caries cavities.\u003c/p\u003e \u003c/div\u003e"},{"header":"Methods and materials","content":"\u003cp\u003e \u003cstrong\u003eStudy Design\u003c/strong\u003e \u003cp\u003eThis study aims to develop the first Arabic questionnaire to assess dentists' knowledge in diagnosing and managing deep caries cavities. The development process involved the translation of existing questionnaires, the addition of new items by a group of experts, expert review of the translation, and statistical tests to measure internal and external validity, reliability, and other factors. A practical guideline to develop and validate questionnaires was followed (Kishore et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eQuestionnaire Development\u003c/strong\u003e \u003cp\u003eThe questionnaire was adapted from previous studies, notably those by (Niemeyer et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), and (Kotha et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The questions were reviewed, and additional items were contributed by a panel of three expert dentists (HA, HA, MT), all with significant experience in academic research. This process also involved a professional translator to ensure accuracy in translation. Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003eN.1\u003c/span\u003e explains the research stages of questionnaire development and validity.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eQuestionnaire Translation and Cultural Adaptation\u003c/strong\u003e \u003cp\u003eThe questionnaire was translated into Arabic by an official sworn translator (ET). While cultural aspects were considered, no significant cultural adaptations were needed.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy Participants\u003c/strong\u003e \u003cp\u003eThe study involved 20 participants, both general and specialized dentists, with ages ranging from 25 to 30 years. All participants were working or studying at Damascus University Faculty of Dentistry. The sample was gender-balanced between male and female participants.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData Collection Procedure\u003c/strong\u003e \u003cp\u003eThe pilot questionnaire was printed and distributed by hand to participants in a controlled environment, free from distractions. This ensured the quality and consistency of the responses. Data collection was done in Damascus university in the period of 1st to 20th of January 2024.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTest-Retest Reliability\u003c/strong\u003e \u003cp\u003eThe test-retest methodology involved administering the questionnaire twice to the same group of participants within a two-week interval. Data analysis was performed using SPSS, including tests for internal validity (e.g., Cronbach's alpha for internal validity), and test-retest for reliability.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStatistical Analysis\u003c/strong\u003e \u003cp\u003eSPSS v.22 was used to carry out statistical analysis. The following test s were applied\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eIntra-class Correlation Coefficient (ICC)\u003c/b\u003e: To measure the reliability of the questionnaire by assessing the consistency of responses between the initial test and the retest.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eCronbach's Alpha Test for Internal Consistency\u003c/b\u003e: To determine the cohesiveness of the questionnaire items and their ability to measure a single, unified concept.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePossible Bias and Management Strategies\u003c/strong\u003e \u003cp\u003eTo mitigate recall bias, a two-week interval was implemented between the first and second administrations of the questionnaire. Additionally, a sufficiently large sample size was used to ensure statistical power and reduce the impact of individual variances.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical Considerations\u003c/strong\u003e \u003cp\u003e Ethical approval for this study was obtained from the Ethical Committee at Damascus University. All participants provided informed consent, and measures were taken to ensure confidentiality and compliance with ethical standards. Participants names were coded with a serial number.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable N.1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eexplains the research stages of questionnaire development and validity.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage 1: questions development\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1- Questions were adopted from previous studies.\u003c/p\u003e \u003cp\u003e2- More questions were added by a panel of experts.\u003c/p\u003e \u003cp\u003e3- Questions were divided into 3 groups: diagnosis, treatment, and tools.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStage 2: translations\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1- Forward translations of the questions adopted from previous studies into Arabic.\u003c/p\u003e \u003cp\u003e2- Back translation into all the questionnaire questions into English.\u003c/p\u003e \u003cp\u003e3- Comparison of the original and the final versions and adjustments of discrepancies.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStage 3: pilot study\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1- The final version of the Arabic questionnaire was printed and distributed to a sample of dentists at Damascus university (N\u0026thinsp;=\u0026thinsp;20).\u003c/p\u003e \u003cp\u003e2- The first round of answers was collected.\u003c/p\u003e \u003cp\u003e3- The questionnaire was distributed again after 2 weeks, and the second round of answers were collected (N\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStage 4: validation and statistical analysis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe following tests were applied:\u003c/p\u003e \u003cp\u003e1- Cronbach\u0026rsquo;s alpha test for internal consistency\u003c/p\u003e \u003cp\u003e2- Intra-class correlation (ICC) coefficient\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eDemographic variables of the sample:\u003c/h2\u003e \u003cp\u003eThe study's demographic profile encompassed a balanced gender distribution with 40% (8) of the participants being male and 60% (12) female. In terms of clinical experience, most of the participants, accounting for 85% (17), had less than five years of experience, while 15% (3) had between 5 to 10 years, and none had more than 10 years of experience. Regarding their specialty, a small fraction, 5% (1), were general dentists, 55% (11) specialized in endodontics, and the remaining 40% (8) belonged to other dental specialties. The age of the participants varied, with a mean age of 26.3 years, a minimum of 24 years, and a maximum of 29 years, accompanied by a standard deviation of 1.3 years. Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003eN.2\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable N.2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003edemographic variables of the study\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCount\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTable N %\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMax\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003egender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eclinical experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eless than 5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emore than 10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003especialty\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003egeneral dentist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eendodontics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eTest of internal consistency:\u003c/h2\u003e \u003cp\u003eThe internal consistency of the questionnaire was evaluated using the Cronbach\u0026rsquo;s Alpha test. The analysis included a total of 20 valid cases with no exclusions. The Cronbach's Alpha coefficient for the questionnaire, encompassing 16 items, was found to be 0.804. Additionally, when considering the standardized items, the Cronbach's Alpha value slightly increased to 0.879. Both values are higher than the commonly accepted threshold of 0.7, indicating good internal consistency for the questionnaire. Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003eN.3\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable N.3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; results of internal consistency test (Cronbach\u0026rsquo;s Alpha test)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eCase Processing Summary\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eReliability Statistics\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCronbach's Alpha\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCronbach's Alpha Based on Standardized Items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN of Items\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eCases\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eValid\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.879\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eExcluded\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eTest-Retest for questionnaire validity:\u003c/h2\u003e \u003cp\u003eOverall, the Test-Retest analysis showed encouraging results, indicating good reliability of the questionnaire. Most of the items exhibited significant correlations, affirming the consistency of measurements over time. Notably, variables such as \"Dentine hardness\" (Pair 1) and \"using of rubber dam\" (Pair 4) demonstrated strong positive correlations of 0.947 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and 0.730 (p\u0026thinsp;=\u0026thinsp;0.006), respectively, underscoring their high reliability in assessing dental parameters. Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003eN.4\u003c/span\u003e\u003c/p\u003e \u003cp\u003eIn the category of variables with moderate correlations, \"Dentine color\" (Pair 2) exhibited a noteworthy correlation coefficient of 0.748 (p\u0026thinsp;=\u0026thinsp;0.033), indicating acceptable reliability. Additionally, \"How to test vitality\" (Pair 7) displayed a substantial positive correlation of 0.676 (p\u0026thinsp;=\u0026thinsp;0.001), suggesting reliable measurement. Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003eN.4\u003c/span\u003e\u003c/p\u003e \u003cp\u003eHowever, it is essential to acknowledge that some items showed no significant correlation, suggesting limitations in their reliability. Notably, \"Treatment of non-reversible pulpitis not complete apex\" (Pair 12) and \"Treatment non-reversible with complete apex\" (Pair 13) displayed weak correlations with coefficients of 0.208 (p\u0026thinsp;=\u0026thinsp;0.378) and 0.271 (p\u0026thinsp;=\u0026thinsp;0.249), respectively, indicating limited reliability in assessing these aspects. Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003eN.4\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable N.4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; test-Retest for questionnaire reliability\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCorrelation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSignificance\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u003cb\u003eDiagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePair 1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDentine hardness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.947\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePair 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDentine color\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.748\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePair 3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDo a radiograph before the treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePair 4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003erubber dam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.730\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePair 5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003etype of x-ray\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.579\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePair 6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eexamining vitality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.579\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePair 7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ehow to test vitality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.676\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eTreatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePair 8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003etreatment open apex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.740\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePair 9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ein case of pulp exposure for teeth with open apex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.620\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePair 10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003etreatment closed apex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePair 11\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ein case of pulp exposure for teeth with closed apex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.774\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePair 12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003etreatment of non-reversible pulpitis open apex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.378\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNot significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePair 13\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003etreatment non-reversible with closed apex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.271\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNot significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eTools used\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePair 14\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003etools for excavation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.926\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePair 15\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ematerials used in case of pulp exposure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eFactors to consider\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePair 16\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOral hygiene\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePair 17\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge of patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePair 18\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatient compliance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePair 19\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFollow up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe importance of training and assessing dentists' knowledge in the field of dental health is crucial, especially in terms of enhancing treatment outcomes (Tan and Lin, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This is particularly relevant when addressing prevalent and complex issues like deep caries cavities. The gap in the availability of assessment tools, especially in Arabic, highlights a significant need for dental education and practice (Khallof et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Our research addresses this gap, aiming to develop an Arabic-language tool for evaluating and improving dentists' understanding and management of deep caries cavities. This initiative is vital in regions where such resources are currently lacking, potentially transforming the approach to dental health care, and improving patient outcomes.\u003c/p\u003e \u003cp\u003eThe methodology employed in this study aimed to create an Arabic questionnaire for evaluating dentists' knowledge in managing deep caries cavities. This was achieved through a 4 stages process of adapting and translating existing questionnaires, supplemented with expert input, developing the final version of the questionnaire, and statistical analysis using test-retest methods to ensure validity and reliability, including the use of Cronbach's Alpha and ICC (Carlson and Morrison, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). This methodological framework was designed to ensure the questionnaire's effectiveness in a specific cultural and professional context (Niemeyer et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe study sample included a dentist from Damascus university, gender was balanced, and the sample was approached two weeks after the initial response which allowed to test the reliability of the questionnaire. The questionnaire's internal consistency, as indicated by the Cronbach's Alpha results, demonstrated good cohesion among the items. Both overall and standardized scores exceeded the accepted threshold, affirming the tool's reliability in assessing dentists' knowledge in this field. Furthermore, the test-retest analysis provided a nuanced view of the questionnaire's reliability. Significant correlations in most of the parameters indicated consistent responses over time. However, weaker correlations in some items, particularly concerning the treatment of non-reversible pulpitis, suggest areas for potential refinement and further investigation.\u003c/p\u003e \u003cp\u003eThe results of the current study can be contextualized within the broader framework of dental research, particularly when compared to similar studies. For instance, the work of Niemeyer et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) involved creating a questionnaire to assess knowledge in diagnosing and managing root caries. Their approach mirrors our methodology in its comprehensive development and validation process (Niemeyer et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In contrast, Schwendicke et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) focused on German dentists' approaches to deep dentin caries removal, revealing a strong preference for complete excavation. This contrasts with the findings of our study, where partial caries removal was more favored, especially among younger dentists, however, the aim of our study is to validate the questionnaire without going in depth regarding the answers of the dentist participated in the study (Schwendicke et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Additionally, Carvalho et al. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) investigated Danish dental professionals' decision-making in occlusal caries management, showing significant agreement in treatment decisions, paralleling the consistency observed in our study. These comparisons underscore the regional and cultural differences in dental practices and attitudes, enriching the understanding of how dentists' approaches to caries management may vary globally (Carvalho et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe clinical implications of this study are significant, particularly as it introduces the first questionnaire tailored for Arabic-speaking dentists to assess their knowledge in managing deep caries cavities. This tool represents a crucial step in understanding and improving dental care quality in Arabic-speaking regions. It can influence treatment decisions and patient outcomes by providing insights into current knowledge gaps and training needs (Alrashdi et al., 2021). The implementation of this questionnaire can also guide educational programs and professional development, ensuring that dentists are equipped with the latest knowledge and skills in deep caries management. The development of such a resource in Arabic fills a critical gap in dental education and practice, potentially leading to improved oral health outcomes in these communities (Al Zaher and Dashash, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the challenging educational environment in Syria, this study successfully validated the first Arabic questionnaire for assessing dentists' knowledge in managing deep caries cavities. The methodology was carefully designed to mitigate potential biases and ensure reliability and validity. To avoid recall bias, a two-week interval between the first and second questionnaire administrations was implemented. This approach, along with the rigorous statistical analysis including Cronbach's Alpha and ICC, strengthened the reliability and validity of the findings, showcasing a resilient and effective research approach in a complex setting.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis research successfully developed and validated the first Arabic-language questionnaire for assessing dentists' knowledge in managing deep caries cavities. The methodology ensured the tool's reliability and validity, with practical implications for dental education and practice in Arabic-speaking regions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval for this study was granted by Damascus University\u0026apos;s Ethics Committee. All participants provided informed consent, affirming their understanding of the study\u0026apos;s purpose and their voluntary agreement to participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e-The datasets generated and/or analysed during the current study are not publicly available due to publication consent from Damascus university , it\u0026apos;s not allowed to publish all the data publicly but are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no possible conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our sincere gratitude to Dr. MHD Bahaa Aldin Alhaffar for his invaluable contribution and assistance throughout the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contribution:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRG: designed the research, collected the data, analyzed the data, wrote the manuscript.\u003c/p\u003e\n\u003cp\u003eHA and HM: supervised the research, helped writing and finalizing the manuscript.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAL ZAHER N, DASHASH M. An educational intervention for improving knowledge of Syrian school children about avulsion using the save your tooth poster. BMC Oral Health. 2021;21:24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eALRASHDI M, LIMAKI, M. E., ALRASHIDI A. 2021. Oral Health Knowledge Gaps and Their Impact on the Role of Pediatricians: A Multicentric Study. Int J Environ Res Public Health, 18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBHATNAGAR DM. Oral Health: A Gateway to Overall Health. Contemp Clin Dent. 2021;12:211\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCARLSON MD, MORRISON RS. Study design, precision, and validity in observational studies. J Palliat Med. 2009;12:77\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCARVALHO JC, QVIST V, AIMEE, N. R., MESTRINHO, H. D., BAKHSHANDEH A. Diagnosis, Risk Assessment, and Treatment Decisions for Occlusal Caries: A Survey from the Danish Public Dental Health Service. Caries Res. 2018;52:58\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKHALLOF RO, FARID DOUMANIM, MOSTAFA FAS, D., ALHAFIAN RAA. Dental education in the Arabic language vs English language: A survey among Arab dentists. J Family Med Prim Care. 2019;8:3908\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKILIAN M, CHAPPLE IL, HANNIG M, MARSH PD, MEURIC V, WADE PEDERSENAMTONETTIMS, W. G., ZAURA E. The oral microbiome - an update for oral healthcare professionals. Br Dent J. 2016;221:657\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKISHORE K, JASWAL V, KULKARNI V, DE D. Practical Guidelines to Develop and Evaluate a Questionnaire. Indian Dermatol Online J. 2021;12:266\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKOTHA SB, BINHUWAISHEL HA, ALMUHAYDIB RN, ALZEGHAIBI, L. Y., ALHAJRI MA. Clinical decision-making in managing deep carious lesions in primary teeth based on clinical experience among pediatric dentists-A cross-sectional study. J Popul Ther Clin Pharmacol. 2022;28:e17\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNIEMEYER SH, MANIEWICZ S, CAMPUS G, TENNERT C, YILMAZ B, ESTEVES-OLIVEIRA ZEKERIDOUAROCCUZZOA, M., CARVALHO, T. S., WIERICHS RJ. Design, development and validation of a questionnaire to assess dentists' knowledge and experience in diagnosing, recording, and managing root caries. Clin Oral Investig. 2023;27:2705\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSCHWENDICKE F, MEYER-LUECKEL H, DORFER C, PARIS S. Attitudes and behaviour regarding deep dentin caries removal: a survey among German dentists. Caries Res. 2013;47:566\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTAN WW, LIN GSS. 2024. Integrating personal and professional development course to undergraduate dental education. J Dent Educ.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWEN PYF, CHEN MX, ZHONG YJ, DONG, Q. Q., WONG HM. Global Burden and Inequality of Dental Caries, 1990 to 2019. J Dent Res. 2022;101:392\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Dental Caries, Deep Caries Cavities, Dentist Knowledge Assessment, Arabic-Language Questionnaire, Oral Health, Systemic Health","lastPublishedDoi":"10.21203/rs.3.rs-3949388/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3949388/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eThe interconnection between oral health and systemic well-being is widely recognized, with dental caries being a prevalent global oral disease. This study focuses on the development and validation of a unique Arabic-language questionnaire to evaluate dentists' knowledge and skills in managing deep caries.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eTo create and validate the first Arabic questionnaire specifically for assessing dentists' competence in diagnosing and managing deep caries cavities.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study adopted a multi-stage approach, including translation and adaptation of existing questionnaires, addition of new items by experts, and a thorough validation process. A balanced sample of 20 dentists from Damascus University Faculty of Dentistry participated. The questionnaire encompassed items divided into categories of diagnosis, treatment, and tools. Statistical analysis for internal and external validity, reliability, and other factors was conducted using SPSS.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe questionnaire demonstrated high internal consistency (Cronbach's Alpha\u0026thinsp;=\u0026thinsp;0.804, 0.879 for standardized items) and good test-retest reliability. Some items showed strong positive correlations, while a few indicated weaker correlations, revealing areas for potential refinement. The study highlighted significant correlations in most parameters, affirming the questionnaire's reliability.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis research successfully developed and validated the first Arabic-language questionnaire for assessing dentists' knowledge in managing deep caries cavities. The methodology ensured the tool's reliability and validity, with practical implications for dental education and practice in Arabic-speaking regions.\u003c/p\u003e","manuscriptTitle":"Development and validation of an Arabic questionnaire to assess dentist knowledge on managing deep caries cavities","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-13 07:40:35","doi":"10.21203/rs.3.rs-3949388/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"95cbeada-11fe-4254-b7cf-5c8cd3476c29","owner":[],"postedDate":"March 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-25T15:22:19+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-13 07:40:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3949388","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3949388","identity":"rs-3949388","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}