Comment on “Knowledge and awareness of pulp vitality tests among dental interns and postgraduates: A multicenter cross-sectional study”

Dear Editor, The original article “Knowledge and awareness of pulp vitality tests among dental interns and postgraduates: A multicenter cross-sectional study” published in Endodontology, is a valuable contribution.1 The study’s objective was to assess the knowledge and awareness about pulp vitality tests among interns and postgraduate students.1 I agree with the rationale of the study that dentists must be in a position to identify the state of the dental pulp, as this will facilitate the early detection of damaged dental pulp, and timely initiation of a conservative approach, which becomes crucial in reducing the incidence of complications and financial expenses. I read the article thoroughly and have some critical observations and suggestions to improve the overall quality of the research article. To start with, the sample size for any study should be representative of the total population, but in the present study, the sample size has not been scientifically estimated.2 There is no plausible and scientific explanation given by the authors (viz. sharing links across different social media platforms and hoping that students or residents fill makes it biased) as to why 340 was the sample size in their study.1 Ideally, the sample size should be estimated based on a statistical formula, using the prevalence estimates from a previously published research article, and this improves the internal validity of the study.2 Like sample size, the sampling method is an equally important component of the methodology section, and it plays a vital role in enhancing the validity of study results.3 In the present study, it has not been mentioned how the authors identified six dental colleges in India, and thus it is questionable and not clear.1 In my opinion, this can be done by the multistage random sampling (For instance, a line listing of state-wise dental colleges → random selection of say 6 states → from each of these 6 states, one dental college can be selected using a lottery method). I appreciate the authors for following a standardized process to validate the data collection instrument and pilot test the validated instrument.1,4 In this regard, I would have liked it if the authors had mentioned the language of the questionnaire, and whether the findings of students who participated in the pilot stage were included or excluded from the final analysis.4,5 I am happy to note that the authors gave reminders to students to fill out the questionnaire and also measures they took to avoid repetition.1 However, the authors have not mentioned anything about the approval from the Institutional Ethics Committee, and that the approval/permission was obtained from all six dental colleges, plus obtaining written informed consent from the participants.1,6 Regarding statistical analysis, descriptive tests (frequency and percentages) that were employed by the authors have not been mentioned.1 Concerning the results, I feel that postgraduate students are expected to have better knowledge than interns about pulp vitality tests even before the start of the study, and so I am not convinced by the comparison between them.1 The better approach would have been a comparison between interns from six dental colleges and postgraduate students from six dental colleges using the Analysis of Variance test (parametric test) or the Kruskal–Wallis test (nonparametric test).7 The Discussion section is written to “discuss” study results and cite reasons for similar or contrasting findings after comparing with other studies. I feel that the authors have not optimally utilized the discussion section.1,8 However, I am happy to note that the authors have identified some of their study limitations.1 To summarize, the current study adds useful information about the awareness of pulp vitality tests among the study participants; nevertheless, the findings of the study would be more valid if the authors had been systematic in mentioning the details on sample size, sampling methods, and statistical analysis. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.