UMST University of Medical T:+249 183 228614

Sciences & Technology F:+249 183 224799

P.O. Box 12810, Khartoum, Sudan administration.office@umst-edu.sd
www.umst-edu.sd

Faculty of Dentistry

Research Thesis

ASSESSMENT OF THE COMPETENCY OF 4TH AND 5TH YEAR DENTAL

STUDENTS TO PERFORM INTRA-ALVEOLAR EXTRACTION IN ACADEMIC
DENTAL TEACHING HOSPITAL, IN KHARTOUM STATE.

By: Bishoy Esam Sobhi Fanous (BDS)

A thesis submitted as partial fulfillments for the requirement of the degree of BDS.

(Batch 18)

Supervisor: Dr. Limya Sanhouri

(BDS,MD)

2017-2018
 DEDICATION

I dedicate this research to my parents for their unconditional love and constant support
and without whom I would have never achieved anything in life.
Table of content

Preliminaries
Dedication
List of tables I - VII
Acknowledgment VIII
Abstract IX
Text of thesis
Introduction 2-4
Literature review 6-7
Materials and methods 9-10
Ethical considerations 12
Results 14-16
Discussion 18-19
Conclusion 21
Reference matter
Bibliography 23-24
Appendices 26
Signed declaration sheet 25
Student’s declaration
Supervisors’ approval
 LIST OF TABLES

Report
EXTRACTION COMPETENCY OF ANTERIOR TEETH
4TH YEAR
Week Mean N Std. Deviation
Week 1 8.8750 8 1.12599
Week 2 7.7778 9 1.78730
Week 3 8.0000 2 .00000
Total 8.2632 19 1.48482

Report
EXTRACTION COMPETENCY OF PREMOLARS
TEETH 4TH YEAR
Week Mean N Std. Deviation
Week 1 9.1667 12 .71774
Week 2 8.7778 9 .66667
Week 3 7.5000 6 1.37840
Total 8.6667 27 1.07417

Report
EXTRACTION COMPETENCY OF MOLAR TEETH 4TH
YEAR
Week Mean N Std. Deviation
Week 1 8.8000 20 1.10501
Week 2 8.3333 27 1.07417
Week 3 7.2500 20 1.86025
Total 8.1493 67 1.47970

I
 Report
EXTRACTION COMPETENCY OF 5TH YEAR
Week Mean N Std. Deviation
Week 1 9.0645 31 .89202
Week 2 9.1818 33 .76871
Week 3 8.3953 43 1.49825
Total 8.8318 107 1.19343

Paired Samples Statistics

Mean N
Pair 1 ECAW1 8.8750 1a
ECAW2 7.7700 1a
Pair 2 ECPreW1 9.1600 1a
ECPreW2 8.7700 1a
Pair 3 ECPW1 8.8000 1a
ECPW2 8.3300 1a
a. The correlation and t cannot be computed because the sum of
caseweights is less than or equal to 1.

EC

Frequency Percent
Valid 3.00 2 1.8
4.00 1 .9
5.00 1 .9
6.00 7 6.2
7.00 13 11.5
8.00 30 26.5
9.00 41 36.3
10.00 18 15.9
Total 113 100.0

II
 EC GROUP
Cumulative
Frequency Percent Valid Percent Percent
Valid VERY COMPETENT 88 77.9 77.9 77.9
MODERATE COMPETENT 21 18.6 18.6 96.5
NOT COMEPTENT 3 2.7 2.7 99.1
11.00 1 .9 .9 100.0
Total 113 100.0 100.0

EC GROUP * Tooth Number Crosstabulation

Count
Tooth Number
Anterior tooth Premolars Molars Total
EC GROUP VERY COMPETENT 16 24 49 89
MODERATE COMPETENT 2 3 16 21
NOT COMEPTENT 1 0 2 3
Total 19 27 67 113

Group Statistics
YRS N Mean Std. Deviation Std. Error Mean
EXTRACTION 4TH 113 8.2920 1.39950 .13165
COMPETENCY 5TH 3 9.3333 .57735 .33333

III
 Independent Sampl
Levene's Test for Equality of Variances

F Sig. t
EXTRACTION COMPETENCY Equal variances assumed 1.348 .248 -1.281
Equal variances not assumed -2.905

EC GROUP * YRS Crosstabulation

Count
YRS
4TH 5TH Total P value
EC GROUP VERY COMPETENT 89 3 92 0.029
MODERATE COMPETENT 21 0 21 0.029
NOT COMEPTENT 3 0 3 0.029
Total 113 3 116

Group Statistics
YRS N Mean Std. Deviation Std. Error Mean
EXTRACTION 4TH 113 8.2920 1.39950 .13165
COMPETENCY 5TH 107 8.8318 1.19343 .11537

Independent Samples T

IV
 Levene's Test for
Equality of
Variances

F Sig. T df
EXTRACTION COMPETENCY Equal variances assumed 3.807 .052 -3.070
Equal variances not
-3.083
assumed

EC GROUP * TOOTH CONDITION Crosstabulation

Count
TOOTH CONDITION
BADLY
DECAYED REMAINING SOUND Total
EC GROUP VERY COMPETENT 103 62 22 187
MODERATE COMPETENT 13 14 2 29
NOT COMEPTENT 4 0 0 4
Total 120 76 24 220

EC GROUP * Week Crosstabulation

Count
Week
Week 1 Week 2 Week 3 Total P value
EC GROUP VERY COMPETENT 66 68 53 187 0.030
MODERATE COMPETENT 5 9 15 29 0.030
NOT COMEPTENT 0 1 3 4 0.030
Total 71 78 71 220 0.030

V
 EC GROUP * TOOTH CONDITION Crosstabulation
Count
TOOTH CONDITION

BADLY
DECAYED REMAINING SOUND Total P value
EC GROUP VERY COMPETENT 50 29 10 89 0.232
MODERATE COMPETENT 8 11 2 21 0.232
NOT COMEPTENT 3 0 0 3 0.232
Total 61 40 12 113

EC GROUP * TOOTH CONDITION Crosstabulation

Count
TOOTH CONDITION
BADLY
DECAYED REMAINING SOUND Total P value
EC GROUP VERY COMPETENT 53 33 12 98 0.747
MODERATE COMPETENT 5 3 0 8 0.747
NOT COMEPTENT 1 0 0 1 0.747
Total 59 36 12 107

EC GROUP * Tooth Number Crosstabulation

Count
Tooth Number
Anterior tooth Premolars Molars Total P value
EC GROUP VERY COMPETENT 18 23 57 98 0.910
MODERATE COMPETENT 2 2 4 8 0.910
NOT COMEPTENT 0 0 1 1 0.910
Total 20 25 62 107

VI
 EC GROUP * Tooth Number Crosstabulation
Count
Tooth Number
Anterior tooth Premolars Molars Total
EC GROUP VERY COMPETENT 16 24 49 89
MODERATE COMPETENT 2 3 16 21
NOT COMEPTENT 1 0 2 3
Total 19 27 67 113

EC GROUP * TOOTH CONDITION Crosstabulation

Count
TOOTH CONDITION
BADLY
DECAYED REMAINING SOUND Total
EC GROUP VERY COMPETENT 50 29 10 89
MODERATE COMPETENT 8 11 2 21
NOT COMEPTENT 3 0 0 3
Total 61 40 12 113

VII
ACKNOWLEDGMENT
I would like to thank Dr. Limya for her great help to make this research accessible and all
the advice she has offered. I also express my gratitude to all others peers who helped out
with data collection and last but not least my fellow colleagues and students who have
participated in this study to allow us all to get an overall image of our true level of
competency and what our greatest difficulties were, to try to professionally tackle them in
the future.

I’ am also grateful for Dr .Maisa for all her time and effort she had put in to help with the
data analysis and display of results.

VIII
 ABSTRACT
Justification: the aim of this study was to evaluate the competency of the dental
students who graduate to carry out a tooth extraction. It is important to be able to
successfully inject local anesthesia and ensure that it is profound, acknowledge the use of
correct forceps or elevators, have the correct position and remove all fragment of the tooth
from the dentoalveolar socket.

Methods: an observational cross sectional hospital based study checklist was

distributed to teacher assistants, residents and students at Academic Charity Teaching
Hospital. Data was collected from 4th and 5th year students for each tooth they extracted
and all the steps were carefully assessed and the time taken was recorded for comparison.

Results: the study shows that in general students were very competent upon graduation,
however 5th year students had a higher level of competency than their counterparts. It also
revealed that certain factors were synonymous with high levels of competency such as:
badly decayed teeth, molars, week one of practice etc. It also pointed out that statistically
speaking a remaining anterior tooth was the hardest to extract and students were least
competent when having to treat them in comparison to the highest rates of competencies
with badly decayed molars.

Conclusion: The competency of students were deemed fit for the purpose of this study
and safe for the practice of dental extractions in the community, both of which scored
mainly very competent. This ensures that the majority of students were able to acquire the
knowledge they learned and display it in on a ‘hands-on’ approach in the surgery clinic.

IX
X
CHAPTER
O NE

-1-
I N T R O D U C T I O N:
Competence in any particular procedure is a function of experience and training, both
academic and practical. The ability to reflect on one's ability and competence is a key area
of practice that is necessary when considering the risk management for any given
procedure. [1]

Surgical extractions performed by undergraduate dentists are no exception to this. It is

mandatory to carry out a series of sequential pre-clinical investigations in order to diagnose
correctly and offer the patient the best treatment possible.[10] Any surgical operation
regardless of how simple or straightforward it may seem, must be preceded by a complete
proper consideration of all the relevant factors, both local and systemic of the patient being
treated.[1]

Primarily this is achieved by filling out a standard structured medical review form,
which consists of history & examination, medical review, pre-clinical radiographic
evaluation and clinical inspection to lead to precisely diagnosing and determining wether or
not the patient is eligible for the procedure.[1] This is then followed by offering the patient a
treatment plan and explaining the choices available to the patient and any concerns about
the vulnerability of local structures that may be damaged in the normal course of the
procedure or other risk factors.

It is also crucial for the practitioner to reflect honestly on wether he is capable of

smoothly executing the patients plan to the best of his ability. If he feels that he is
inexperienced or may lack the knowledge and may potentially cause harm to the patient,
the practitioner should have the courage to immediately refer the patient to a senior
colleague to guarantee the patients best interest. Careful evaluation of the clinical status of
the offended tooth should include but is not limited to:[2]

1. Presence of infection
2. Maximum mouth opening (any TMJ disorders)

-2-
 3. Tooth Mobility
4. Condition of the crown
5. Condition of surrounding bone [5]

Once that is done the radiographic evaluation is just as important to visualize all aspects
of the tooth such as size, shape, curvature, number of roots, the risk of fracture during
extraction causing a remaining root fragment, the status, density and condition of the
surrounding alveolar bone [6] .The dentist must investigate from these radiographs the
proximity of any vital structures that are prone to damage and inform the patient pre-
hand.[2]

To carry out a ‘textbook-extraction’ the dentist must have skillful hands otherwise
known as manual dexterity to increase the efficiency of the technique.[8] This means that
the range of motion of his hands and wrist should gradually luxate the tooth from its
sockets by tearing the periodontal fibers attaching the tooth to its socket. An inexperienced
practitioner may be further hampered by a lack of knowledge of the appropriate
instruments to select or how to hold the correct one. Incorrect instrumentation used can be
potentially disastrous.[7]

Due to the fact that the oral cavity is full of microorganisms, any surgical procedure in
this area may give rise to postoperative infections, especially in immunocompromised
patients.[4] Thus postoperative antibiotics may be prescribed to hinder microorganism’s
growth.

A successful extraction is one that is done under minimal pain, causes no damage to the
condyle’s, done with correct positions,[9] ensures the complete tooth was extracted, the
correct tooth was extracted, leaves intact bone plate, doesn’t disturb continuity of the
maxillary sinus and surrounding soft tissues, doesn’t paralyze the 7th cranial nerve,
postoperative bleeding is controlled, a normal clot forms within 6-8 hours and present with
no complications. This yields the advantage that patients may further continue his
treatment if he desires, by receiving dental implants to replace the missing tooth.

Practitioners must not fail to identify that a complication has occurred and therefore
delay both diagnosing and treating the complication. Practitioners need to be alert to odd

-3-
patterns of healing and other unusual outcomes of surgery. [3] Dental students are the
highest sector of the profession that are likely to cause a complication or fail to extract the
tooth, usually due to the very limited experience they have. Common complications
include: hematoma, bleeding, retained tooth and dry socket. Failure to identify
complications may subject the dentist to medico-legal cases, large fines as compensation or
even elimination of his practicing license. [1]

-4-
CHAPTER
TWO

-5-
LITERATURE REVIEW
According to a recent study carried out in Liverpool Dental School there was no correlation
between the real life competency of a dentist and the amount of simple extractions the
students have carried out during his undergraduate years.

A similar study across various universities in Europe by distribution of questionnaire’s to

the deans of numerous universities and data collected showed a positive correlation was
found between students who were exposed to preclinical stimulatory training models prior
to working on patients and their effectiveness of carrying out a tooth extraction
independently. However this study suffers in that students who were educated on models
are exposed to an ideal anatomy and may experience difficulties in treating patients with
slight anatomical variations, which may be displayed as failure to achieve profound
anesthesia in patients. Also the pupils are only subjected to a narrow range of cases and are
not exposed to the ‘full image’ of bone complexity, root curvature etc. Furthermore, the
fact that more 23 dental schools across Europe were included ensure biased and reliable
results, but the curricula varied massively. For example some universities included
standard forceps others included elevators, apexon’s etc .Similarly the removal of retained
roots, impacted teeth or 3rd molars surgically by means of a flap was considered above
graduate levels certain places. On the other hand one of the strengths of that paper was that
data was collected by means of questionnaires but was not included unless the participant
has received an education of tooth extraction before clinical practice, to ensure they had the
knowledge required to safely commence any procedures. Another limitation of a web based
survey is that a significant amount of time may have elapsed between the time students
-6-
filled in the survey and their actual clinical work. Also, the fact that the survey was
conducted in English may have caused some people to misinterpret the questions and give
false answers.

Durham et al. conducted a research to assess and observe the competency in oral surgical
skills during a 3 year undergraduate program. 75 students were evaluated from the
beginning of the clinical course till their graduation and also their logbook were monitored.
The study concluded that the level of competency of undergraduate doing oral surgical
procedures could be measured, even though it is a time intensive process. Results showed a
97% of students completed the assessment however only a mere 23% were capable of
surgically extracting a tooth or root without assistance of their supervisor, with a mean of
only four tooth surgically removed upon graduation. Likewise this study was evident of a
poor correlation between the amount of surgical procedures performed and the competency
of graduates.[11]

K. Ali et al published a research on November 2013 carried out a study on management of

impacted wisdom tooth and wether or not the theoretical knowledge was sufficient for
students to successfully remove 3rd molars with all their variations. Data was collected
using a cross sectional online questionnaire. 16 dental schools in the UK were involved and
13 of them responded positively. Results showed that 6 schools required a preclinical
competency exam before treating patients. Although most schools were consistent in their
overall indications of extraction, treatment modalities and all the variations, however very
few were competent in applying this knowledge in a clinical scenario. This study also
stressed on the fact that different schools have unique perspectives of teaching when it
comes to the 3rd molar, and some consider its education is best left for post-graduation.[13]

Al Dajani carried out a similar research in Saudi Arabia, at Aljouf University College of
Dentistry. He assessed confidence level using a four point Likert scale by means of a
questionnaire on 32 students, where 1 = very little confidence and 4 = high confidence. His
study found that students were most confident in giving local anesthesia, understanding
indications of extractions and performing simple extractions at 96.9%, 93.8%, 90.6%
respectively, whereas the extraction of 3rd molars lagged back at 56.3%. This study also
noted a positive correlation between clinical experience and student’s confidence. However

-7-
for more reliable results I would recommend that it should include a higher number of
participants if it were to be repeated in the future.[12]

CHAPTER
THREE

-8-
 METHODS AND MATERIALS
The Study design used will be Cross sectional study as participant’s of different year
groups will be assessed at the same point in time. Namely groups 1-5 in both 4th and 5th
year at the University of Medical Sciences & Technology in Khartoum, Sudan.

The inclusion criteria for this research will be any tooth permanent or deciduous indicated
for intra-alveolar extraction (or ‘forceps extraction’) regardless of its condition or position
in the jaw. Whereas, the exclusion criteria will be any tooth indicated for a transalveolar
extraction (otherwise known as ‘open view extraction’), this includes but is not limited to
impacted teeth, bone removal, flap elevation etc. As well as the dental clinic apparatus
including dental chairs, condition of forceps, efficiency of dental syringe.

The sample size will cover the total number of all patients who are referred to the Surgery
department for extraction from the period of September 2017 to December 2017 until
entries reach a sample size of 250 with reference to a confidence interval of +/- 5.3-5.4%
and a confidence interval of 95% in a population size of 1000 patients.

Data collection:

The data will be collected be taken by an observational checklist of all non-surgical

extractions at Academic Dental Hospital carried out by 4th and 5th year student by means of
a structured checklist including all the factors under investigation. The data was collected

-9-
as 3 separate weeks with roughly a month between each week for both year groups, to
allow gathering information throughout the whole span of the academic year for better
results. Then all six spreadsheets were taken to a statistician for analysis and reporting the
results of the study. The data was taken by teacher assistants, interns and a consultant at the
Surgery department for a fair evaluation of competencies.

The first part of the checklist includes the year group of the participant, tooth number and
tooth condition and all other personal details are completely anonymous. The second part
evaluates all steps of an extraction. If the person has adequately carried out the step being
investigated he would get a ‘Yes’ ( = 1) otherwise anything else would get a ‘No’ (= 0)
without any further evaluation such as grading for the undertaken step. All data collected
was entered into a Word Excel spreadsheet where Yes was denoted as 1 and No as 0.

Data Analysis: The samples will be sent to a statistician to determine the conclusive result
which where each entry will receive a score for the extraction competency on a scale of 1 –
10 and the results will be presented by tables and chart using SPSS software version 23.0.
In addition the factors most likely to hinder a successful extraction will be noted and
presented on basis of highest occurrence.

- 10 -
CHAPTER
FOUR

- 11 -
ETHICAL CONSIDERATIONS:
This proposal will be approved by the IRB or REC and the Department of Surgery at ADH.
Students will be asked to join the study freely and their refusal will not be questioned and
shall be fully respected. Informed consent will be obtained from all participants after
explaining the overall perspective of the research. All participants will be granted the right
to freely withdraw without giving an explanation. Privacy and confidentiality will be
ensured by asking the participants to answer the questionnaire anonymously. This study
will be beneficial to both pupils who will gain a real view as to what helps them develop
and evolve as safe practicing dentists and what factors hinder the extraction process or at
least prolong the time taken, for the academic tutors to have an idea on what sections
require more work on and the amount of student’s who can safely apply the theory studied
on a clinical scenario, and last but not least for the patient who by attending the hospital is
entitled to a full right of receiving proper treatment under ‘safe hands.’ No major risks were
included in this study however a few amount of students felt rushed to finish the extraction
as quickly as possible when they felt that they were under assessment, so this may have
tampered with the overall results.

I, the author would be more than happy if anyone would like to repeat this study in the
future with or without the use of parameters from my research, for we all share one goal
namely to graduate students who are capable of safely offering the require medical care to

- 12 -
patients. If he or she would require any help or has any questions feel free to contact me
and I will willing help in what I can.

CHAPTER
FIVE

- 13 -
 RESULTS
The results of this study show that there is a significant difference in the competency
between students in 4th year and 5th year, with a mean of extraction competency 8.29 and
8.83. In addition, a certain trend was noticed that students actually performed better during
the first weeks of assessment rather than the second and third week, this was true for both
year groups and for all the teeth. Statistically speaking among 4th year students extraction
competency for the anterior teeth each week was 8.875, 7.7 and 8.0 for week 1, 2 and 3
simultaneously. Likewise the extraction competency of premolar teeth was 9.16, 8.77 and
7.50 and that of molars was 8.8, 8.33 and 7.25 accordingly.

Overall, one hundred and thirteen samples were used from 4th year compared to one
hundred and seven used from fifth year equaling a total of two hundred and twenty tooth
samples. The results of 4th year demonstrated that 88 teeth (77.9%) were extracted by very
competent pupils who scored > = to 8 out of 10 , a further 21 extractions(18.6%) were
carried out by moderately competent students who scored from 5 to 7 out of a possible 10
and lastly 3 students(2.7%) were incompetent scoring less than 5.

When comparing the relation between both year groups and the tooth condition an
immediate pattern was noticeable that amongst pupils who were very competent the vast
majority of them were extracting badly decayed teeth specifically 103, in contrast to only

- 14 -
62 remaining roots in the same skill level, which is nearly half of the latter; whereas, they
merely extracted only 22 sound teeth. Those who were inferior in competency level at
moderate competency did not have a distinguishable pattern were the number of extracted
teeth which were badly decayed and those remaining were 13 and 14 respectively. Lastly
those were not competent were only capable of extracting badly decayed tooth and failed to
remove both remaining and sound teeth.

Similarly when comparing the relation between both year groups and the week number a
significant relation was found with a P value of 0.030 that is dramatically larger than the
significance level of 0.05% which means that both variables under investigation are
strongly related to one another. Within the very competent students range as the weeks
progressed the extraction started off at 66 than inclined slightly to 68 and then declined
again to 53 at the last week. However, those who were moderately competent and not
competent at all demonstrated a gradual improvement of competency as the weeks
progressed, which is a good indicator that pupils were learning and self-improving their
capabilities as they practiced more. In summary when evaluating the link between 4th year
dental students at ACTH and the tooth condition, no significant link was found as the Chi
square analysis reported a P value of only 0.232. in the same manner the outcome was the
true for 5th year dental students as well with a P value of 0.747 with the tooth condition and
0.910 with the tooth number.

The findings also showed that competency for extracting molars exceeded premolars, and
premolars exceeded anterior teeth throughout all competency levels, however because the
amount of molars, premolars and anterior teeth extracted was not the same, so to assure
that this did not impact the results and to ensure homogeneity of variables Levene’s test
was conducted (and results displayed below) that showed no significant differences
between the number of each tooth group extracted and the level of competency
demonstrated. The results exhibited by very competent fourth year students was 49, 24 and
16 for molars, premolars and anteriors respectively. Meanwhile, those who were slightly
less competent confirm the same outcome with only different values at 16, 3 and 2. A
noticeable exception to the above stated fact was that those who were not competent found
extracting anterior teeth easier than premolars, which could be explained by the fact that

- 15 -
premolars are commonly referred to as ‘king of fracture’ and have the highest rate of
complications associated with them.

Last but not least the average extraction competency of 4th year students treating anterior
teeth (incisors and canines) displayed a mean of 8.88, 7.77 and 8.0 for weeks one to three.
While the same year group operating on premolars had a mean of 9.17.8.77 and 7.5. Finally
the removal of molars scored 8.80, 8.33 and 7.25, since there was no major variations
between the mean competency between the type of tooth under investigation a unified
calculation was carried out for 5th year dental students where the average extraction
competency was established regardless of which tooth was being treated and results were
as follows: week one = 9.06, week two = 9.18 and week three = 8.40. therefore we can
deduce that the average level of a 5th year undergraduate student is superior to that of 4th
year as the figures suggest.

- 16 -
CHAPTER
SIX
- 17 -
 DISCUSSION
The results obtained from this study show a significant association between years of
practice and the level of extraction competency, specifically a P value of 0.029 was
calculated that is dramatically higher than the significance level of 0.05, assuring that the
two variables are not independent and share a significant link.

This study shows that the more students were exposed to clinical cases and requirement’s
the higher their level of competency seemed to score. This is because as you practice you
generate more confidence and you gradually master the skill of injecting a profound
anesthesia, assuring the correct motion of extraction, understand the significance of
studying and evaluating the preoperative radiograph. Also the pupil will be exposed to a
broader range of clinical difficulties from calcified roots, dense alveolar bone,
endodontically treated tooth. Not only that but you are more likely to experience a
complication and learn how to manage it safely which equally falls under the criteria of a
safe extraction.

- 18 -
Another finding was that although the average competency for all the teeth types was
essentially similar but the overall level of competency seemed to have dropped as the
weeks passed from week one to week three. This could suggest that perhaps at first it is
more important for tutors to stress on accurately applying the theoretical knowledge on a
practical platform than it is to increase the number of cases that students should work, for
the results shown, suggest that perhaps students’ performance declined because their where
in a rush to complete their requirements towards the end of the semester or maybe they felt
nervous when they learnt that their performance was being assessed. Although even 5th
year students’ also shared the same trait and began declining to an average of 8.40 at week
three. This may suggest that unfortunately students’ are compromising the level of
treatment their offering patients towards the end of the course for various reasons.

In addition both year groups seemed to have higher experience when dealing with posterior
teeth in general (both premolars and molars) than anterior teeth, and that may be indicative
of the remarkably outstanding difference in competency shown and as a result they were
more successful in treating molars than premolars and anteriors. A similar conclusion was
also applicable to badly decayed teeth which averaged higher in terms of competency with
reference to remaining roots. This could be attributed to the fact that students’ performed
better when using regular forceps than they did with elevators.

One of the limitations of this study is that studies like this are never 100% reliable because
each case in a completely different scenario with many factors affecting the overall result
and not all of which can be taken into consideration by this study. Also the grading of
different seniors could have meant that one may be strict on the assessment whereas the
other is perhaps more lenient and this would definitely alter the score of each case. An area
of improvement in the future would be to expose the students to a predetermined set
number of cases according to the tooth type, condition and so on for more unbiased results.

- 19 -
- 20 -
 CHAPTER
SEVEN

CONCLUSION
In conclusion, I ‘am pleased to find that students who graduate from UMST compete with
worldwide institutes in the level of their extraction competency. The data suggests that a true
level of competency is directly proportional to the years of clinical experience, accordingly
I do recommend that in the future students should be exposed to certain restricted
procedure’s such as simple extraction under direct supervision in third year to add on to the

- 21 -
amount of cases undertaken before graduation that would boost the level of extraction
competency. An alternative option would be to have a simulation clinic that challenges
students’ with real life scenario’s and ensure that nothing catastrophic would be done to the
patient’s.

Although this did not affect the results but any and all complications were noted down and
each were found to be correlated with extreme time taken results, either the extraction was
too quick or was prolonged and that may indicate the importance of being capable of
managing any complications that may arise.

- 22 -
 CHAPTER
EIGHT

BIBLIOGRAPGHY
1. 1.Henderson, S. (2017). Risk management in clinical practice. Part 11. Oral surgery.

- 23 -
2. Anon, (2017):
https://www.dentalacademyofce.com/courses/1471/pdf/oralsurgery_generaldentist.pdf
[Accessed 23 Jun. 2017].
3. Brand, H., van der Cammen, C., Roorda, S. and Baart, J. (2017). Tooth extraction education
at dental schools across Europe.
4. Emedicine.medscape.com. (2017). Tooth Extraction: Overview, Periprocedural Care,
Technique. [online] Available at: http://emedicine.medscape.com/article/82774-overview
[Accessed 23 Jun. 2017].
5. Sciencedirect.com. (2017). Sonosurgery for atraumatic tooth extraction: A clinical report -
ScienceDirect. [online] Available at:
http://www.sciencedirect.com/science/article/pii/S0022391312001692 [Accessed 23 Jun.
2017].
6. Malik, N. (2005). Textbook of oral maxillofacial surgery. New Delhi: Jaypee Brothers.
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teeth: a pilot study - ScienceDirect. [online] Available at:
http://www.sciencedirect.com/science/article/pii/S0266435608001587 [Accessed 23 Jun.
2017].
8. Google Books. (2017). American Journal of Dental Science. [online] Available at:
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n-
Y52w6rNcJnhRuo9JzW_0Veuc&hl=en&sa=X&ved=0ahUKEwiQocG0lNXUAhVkDMAK
HReSCAk4ChDoAQglMAE#v=onepage&q=successful%20extraction%20of%20molars%2
0article&f=false [Accessed 23 Jun. 2017].
9. Parjournal.net. (2017). The most compatible position of operator for mandibular right
posterior teeth extraction. [online] Available at: http://parjournal.net/article/view/1600/1048
[Accessed 23 Jun. 2017].
10. Edward Ellis III (2017). Contemporary Oral and Maxillofacial Surgery. 6th ed. Missouri:
Elsevier Mosby, pp.4-5.
11. Durham, J., Moore, U., Corbett, I. and Thomson, P. (2018). Assessing competency
in Dentoalveolar surgery: a 3-year study of cumulative experience in the
undergraduate curriculum.

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12. Anon, (2018). Dental students’ perceptions of undergraduate clinical training in oral
and maxillofacial surgery in an integrated curriculum in Saudi Arabia.
13. Ali, K., McCarthy, A., Robbins, J., Heffernan, E. and Coombes, L. (2018).
Management of impacted wisdom teeth: teaching of undergraduate students in UK
dental schools.

SIGNED DECLARATION SHEET:

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I, the undersigned, declare that the thesis is my original work and has not been presented
for a degree in any university.

Name:

Signature:

Date of submission:

This thesis has been submitted for examination with our approval as university supervisors:

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 APPENDICES
Year group:

Tooth no:
Tooth condition:
(RR= remaining root, BD = badly decayed, N= normal/sound)
Criteria YES / NO Comments or
complications

Infection control (mask,

gloves, wrapping, sterile
instruments)

Preoperative History and

Examination

Preoperative clinical
assessment of tooth

Preoperative radiographic
evaluation

Proper patient position

Proper clinician position

Accurate LA technique

Profound Anesthesia

Correct forceps used

Correct motion of extraction

Tooth removed completely

Time taken for

extraction(mins)

Post-operative instructions

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 INFORMED CONSENT
Dear future dentists,

You are kindly requested to participate in this study, which will guide us to identify the
level of extraction competency of 4th and 5th year dental students in the University of
Medical Sciences and Technology. You may participate or refuse to do so without
clarifying any reasons.

This study will be assessing your overall performance with certain criteria’s in the surgery
clinic without interfering with the actual treatment process and will in no way or form
influence your academic results. All data collected will be cancelled from third parties and
shall be used for the sole purpose of this study

I the undersigned agree to participate in the study, given that all data and results are only to
be used to serve the best interest of this research and nothing else.

Signature of student :

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