SELF MEDICATION AMONG DENTAL PATIENTS VISITING A TERTIARY CARE DENTAL HOSPITAL.
Self medication or the use of unprescribed drugs is a common practice around the globe. Lack of services lead general population towards self-medication, which needs to be taken in account for patient's safety and health. The aim of this study was to determine the prevalence, leading factors, confidence level of dental patients and their perception regarding self medication.
A quantitative cross-sectional study was conducted on the patients visiting OPD of IIDH and private clinics in Rawalpindi and Islamabad over the period of two months and three days. Sample size constituted of700 dental patients. Standardized questions included, reason of self medication, type of medication, adverse reactions of medication and perception of patients about self medication and demographic questions.
502 respondents out of 700 self medicated (372 males and 130 females).Among this 65 % self-medicated for toothache, 45% for mouth ulcers. Most commonly used medicine was painkiller (43.3%) followed by medicated tooth paste (35.8%) is higher than antibiotics (10%).53.3 % respondents are of the opinion that they can treat themselves. Prevalence of self medications higher in males and among low socioeconomic status.
Key Words: Dental patients, self medication, antibiotics, twin cities.
Al-Razi, the famous physician states that "the best state of health is a medicine free state". Self-medication is defined as obtaining and consuming one (or more) drug(s) without the advice of a physician either for diagnosis, prescription or surveillance of the treatment.1,2
It is also defined as "the use of drugs to treat self-diagnosed disorders or symptoms, or the intermittent or continued use of a prescribed drug for chronic or recurrent disease or symptoms.3
It is being practiced globally with a frequency of 31% in India, 59% in Nepal and can go as high as 68% in some European countries.1,4 The importance of self-medication prevailed when in 1980s World Health Organization approved some prescription status to be sold over the counter without any prescription in order to reduce the burden on Health Care Professionals. The Global Burden of Disease (GBD) 2010 Study stated that the burden of oral conditions seems to have increased in the past 20 years and 60% to 90% of children are affected. In addition the majority of dental decay remains untreated due to inappropriate, unaffordable or unavailable oral health care services.5
According to Montastruc et al most common reasons of self-medication include illiteracy, ignorance, lack of legislation regarding use of prescribed drugs, socioeconomic status, dental instruments phobia, dentist phobia, no health insurance, lack of availability of quality dental clinics and homeopathic drugs.1 The perceived benefits of self-medication include decreased potential frequency of physician/dentist visits, increased patient autonomy and reduced costs but it can also lead to lack of clinical evaluation of the condition by a trained medical professional, which could result in wrong diagnosis, delayed appropriate effective treatments, adverse drug interactions and drug toxicity as result of under or overdosing or development of drug resistance.6
Self-medication is researched extensively in medical patients but there is a dearth of research in dental patients, especially in Pakistan. This issue has always been a subject of concern among health professionals. The aim of this study was to determine the prevalence, and factors that lead to the self-medication among dental patients presenting at private dental hospitals and clinics in Islamabad and Rawalpindi.
A written approval from the ethics committee of Riphah International University and an informed consent from the patients participating in the study was obtained prior to commencement of the study. The study included a purposive cross-sectional sample of 700 dental patients. The setting of the study was out patient department of a tertiary care dental hospital and dental clinics located in Rawalpindi and Islamabad. The data for this quantitative study was collected with the help of research questionnaire. Respondents (patient) who consented for the study were face-face interviewed by the authors on the basis of pre-structured validated 16 items questionnaire. The questions were both open and closed ended.
For the purpose of study, self-medication was properly defined in the informed written consent. The questionnaire was available both in English and Urdu. Questionnaire was based on questions targeting mainly the factors leading to self-medication e.g. history of past self-medication, reasons of self-medication, type of medicine/medicated toothpaste, adverse reactions, perception of patients about self-medicationand demographic questions like income,education,gender and age. Confidentiality of data was ensured to all the respondents.
Collected data was analyzed using SPSS version 16. Frequency tables were generated. Statistical data was analyzed using ANOVA test where p value <0.05 was considered significant. Most participants were of (16 -55) years of age. There were 372 males (74%) and 130 females (26%) who responded to the questionnaires.21 of the respondents were illiterate,22 completed their basic schooling, 158 did high school, 133 graduates and 100 postgraduates participated in the study and 67 patients didn't respond to this question. 104 patients out of 502 belonged to low socioeconomic status (below 10,000 PKR monthly income). Surprisingly 316 (63%) of the 502 respondents were confident that they can treat the infectious diseases themselves successfully and unfortunately only 1.7% thought they needed a doctor. The results are summarized in Figs 1-5 and Tables 1-3.
TABLE 1: TYPE AND FREQUENCY OF SELF MEDICATION (%)
###Type of drug used for self medication###Frequency of self medication in past one year
Type of medicine###Percentage of patients###Self-medication in 1yr###Percentage of patients
###More than that###6.7%
TABLE 2: ADVERSE REACTIONS AND RESPONSE TOWARDS THEM (%)
Patients experiencing adverse reaction###Response after adverse reaction
Response###Percentage of patients###Response###Percentage of patients
Yes###27.5%###Stop the medicine###43.3%
###Changed the medicine###7.5%
###Consulted friends and family###1.7%
This study provides vital insight on self-medication that is a phenomenon being practiced worldwide both in developing and developed countries with a frequency of 59% in Nepal,7 59% in India,8 30%in Ibadan9 and 57% in USA and Germany.10
The study was conducted to know the extent of self-medication as well as perception of dental patients towards self-medication. The study showed the self-medication prevalence of 71.4% which relates to a study conducted in Fatima Memorial Dental Hospital, Lahore where a prevalence rate of 70.6 % was obtained.11
The Global Burden of Disease 2010 Study stated that the burden of oral conditions seems to have increased in the past 20 years.5 Oral conditions combined accounted for 15 million disability-adjusted life-years globally (DALY), implying an average health loss of 224 years per 100,000 persons. 5 60% to 90% of children with dental decay remains untreated due to inappropriate, unaffordable or unavailable oral health care services, which might be a cause of self-medication.5
Shankar et al have suggested mild illness, previous experience of treating a similar illness, and non-availability of health personnel and trend towards allopathic drugs as a probable reason for self-medication.7 Other reasons for self-medication in Pakistan might also include minor illness, long waiting lines in hospitals, ignorance towards dental care, cost issues, lack of health insurance and lack of legal documentation.
In the present study 325 out of 502 (64%) dental patients self medicated for tooth ache and other 35% reportedly self medicated for mouth ulcers, bleeding gums, bad breath and fever etc. (Fig 2) This research results showed that self-medication is reported more in males with percentage of 74% as compared to females(26 %) which is contrary to western reports.12,13
Previous studies have reported a positive association between level of education and self-medication.11,14
Non doctor's treatment was more prevalent among low income and high school educated respondents, this is confirmed by study conducted at Armed Forces Institute of Dentistry, Rawalpindi where 82.8% respondents had at least passed the secondary school examination.8, 15 Our results are in the agreement to the study carried out in Spain where the prevalence rate of self-medication is higher in educated people and the study mentioned that the prevalence rate was higher among those who live alone. Parents/family/friends are the top listed source for drug recommendation suggested by a systematic review.10
Although it is true that self medication can help treat minor illness that do not require medical consultation and hence reduce the pressure on medical services particularly in the underdeveloped/developing countries with limited health care resources, however these alternative medical practices lack clinical evaluation by a trained medical professional. Furthermore, the practice of self medication has many adverse effects and can lead to many problems including the global emergence of Multi-Drug Resistant pathogens, delays of appropriate effective treatment,wrong diagnosis, drug dependence and addiction, masking of malignant and potentially fatal diseases, problems related to over and under dosage and the adverse effects of the drugs.
Results of the present study showed that most common self medication was in the form of pain relievers with the percentage of 64.2% which is in agreement of the research conducted in coastal Karnataka, India and is similar to the findings in the literature.2,8,16 Surprisingly the results of our study showed that prevalence of medicated tooth paste is still higher as compared to the antibiotics which is 10% whereas frequency of medicated toothpaste is 35.8%, the reason being that the former study conducted only covered antibiotics while our study covers all groups of drugs including painkillers, medicated toothpastes/gels etc. The drugs/medicated toothpastes named by the respondents included in our research were Paracetamol, Ansaid, TorexIR, Sensodyne toothpaste and Medicam toothpaste.
Among the respondents who participated in this study maximum of them were unaware of the type of medicine and group of medicine they were taking. Unfortunately 90% of the respondents did not respond to the question 'When did you stop taking medicine?' Only 9.2% of the 502 patients responded that they stopped taking the medicine when they felt better. According to our study 85% of the 502 respondents usually obtain medicine from the medical stores located nearby, which definitely does not provide professional healthcare.
A systematic review showed that adverse drug reactions due to self medication have been largely unexplored. One-third of 594 US adolescents experienced side effects probably because of sharing of prescription or lack of proper instructions, one in five reported sharing prescription medication.17 Another study on adverse drug reactions (ADR) among 245 adolescents in Germany observed 31.1% female and 19.6% males experiencing therapeutic failure and other over the counter drug-related problems because of wrong drug selection, under dosing, or overdosing.10 Our study explored this adverse drug reaction factor and showed the rate of 27.5%. Unfortunately out of this 27.5% only 36.7% consulted the doctor whereas 43.3% stopped taking the medicine themselves as a response to those adverse reactions. (Table 2)
A positive attitude towards self-care and overconfidence in medication knowledge often acts as a driving force for self medication. Our study also supports this fact because the response rate on the question 'Do you think you can treat yourself successfully?' was 63.3% which was quite distressing.
Sadly 53.3% of the 502 respondents thought that the self-medication was an acceptable practice, 38.3% regarded it as a good practice whereas only 8.3% of them condemned this malpractice. This shows that this malpractice needs urgent and strict action.
* The issue of usage of self medication has not been considered enough.
* It was distressing to find that every other patient attending the dental department for treatment had practiced self medication.
* The respondents self medicated analgesics more than the antibiotics the major reason being tooth ache and perception that they were confident enough and their irresponsible attitude towards the disease.
* There must also be an enforcement of legislation which limits the sale of prescription drugs without a written prescription by licensed practitioner. Moreover professional organizations should also perform public awareness for patient's safety.
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2 Castel J, Laporte J, Reggi V, J A, Buschiazzo P, Coelho H, et al. Multicenter study on self-medication and self-prescription in six Latin American countries. Drug Utilization Research Group, Latin America. Clin Pharmacol Ther. 1997;61(4):488-93.
3 Organization WH. Guidelines for the regulatory assessment of Medicinal Products for use in self-medication. 2000.
4 Abid I, Yousaf A, Akhtar T, Yousaf N, Manzoor A. Self medication practice among dental patients of afid: A cross sectional study. PODJ. 2012;32(3).
5 Marcenes W, Kassebaum NJ, Bernabe E, Flaxman A, Naghavi M, Lopez A, et al. Global burden of oral conditions in 1990-2010: a systematic analysis. J Dent Res. 2013;92(7):592-97.
6 Ao A, Akinmoladun V, Elekwachi G. Self-medication profile of dental patients in Ondo State, Nigeria. Nigerian Journal of Medicine. 2010;19(1).
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12 Figueiras A, Caamano F, Gestal-Otero JJ. Sociodemographic factors related to self-medication in Spain. Eur J Epidemiol. 2000;16(1):19-26.
13 Habeeb G, Gearhart J. Common patient symptoms: patterns of self-treatment and prevention. Journal of the Mississippi State Medical Association. 1993;34(6):179-81.
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15 Rawlani SM, Rawlani S, Bhowte R, Degwekar S, Rawlani S, Chandak R. Prevalence of self-medication among dental patients in rural area of Maharashtra, India: A cross-sectional study. Indian Journal of Oral Sciences. 2015;6(2):51.
16 Arrais PS, Coelho HL, Batista Mdo C, Carvalho ML, Righi RE, Arnau JM. [Profile of self-medication in Brazil]. Rev Saude Publica. 1997;31(1):71-77.
17 Goldsworthy RC, Mayhorn CB. Prescription medication sharing among adolescents: prevalence, risks, and outcomes. Journal of Adolescent Health. 2009;45(6):634-37.
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|Publication:||Pakistan Oral and Dental Journal|
|Date:||Dec 31, 2016|
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