Quality of Life of Academic Dentists ’ Families ; a Cross-Sectional Survey

Methods: This study was based on an online questionnaire. The questionnaire was composed of two parts; the first part was directed to academic and non-academic dentists asking them about relevant demographic/professional data, and the second part was directed to their family members asking them about social, cultural, financial and health-related issues. Data were analyzed to obtain descriptive statistics and determine significance of association of different variables.


Background
Dentistry as a profession is stressful, [1,2] and may lead to adverse impact on the dentists' quality of life.[3][4][5][6] Dentists are at risk of developing physical health complaints as a result of their work environment including infections, chemical and radiation injury, hearing and neuropathic problems.[7] Within the social context, a recent study showed that the majority of the study sample of dentists were dissatisfied with their personal time due to long working hours.[8] Gender and age may play a role in determining the type and frequency of complaints.For instance, female dentists seem to be more at risk to develop physical complaints and psychological distress than their male colleagues.[9] Also, with increasing age, the prevalence of mental complaints such as anxiety, sleeplessness, feeling of loneliness.[10] and musculoskeletal physical complaints [11] tend to increase.
Academic dentistry as a career can be intellectually stimulating and consistently exciting through teaching and research away from boredom and monotony.On the other hand, certain challenges can adversely affect the academic career like difficulty in obtaining research grants, limited pay and competitiveness with colleagues.[12] Literature reported on the job satisfaction of dentists, [13,14] and many studies reported on the occupational health hazards that dentists are exposed to.[15,16] Quality of social life of dentists, on the other hand, was not given much attention.Further, up to our best knowledge no studies were done so far on the quality of life of dentists' families.This is in contrary to the medical profession which has gained much attention in this regards as shown by studies investigating critical issues like work-home conflict among physicians whether there is one parent, [17] or both parents working as physicians in the same family.[18] It is important to investigate quality of life of the families of academic dentists.Life style/ family compatibility has been listed among the positive influen-ces on the quality of the academic work environment and career satisfaction among dental school faculty.[19] While personal issues leave their impact on the professional success of academics, job satisfaction and professional success will inevitably influence family life.
The aim of this study is to assess some aspects of the quality of life of families of academic dentists and compare them to those of non-academic dentists and to investigate the factors that may influence the quality of life.

Participants and Methods
Ethical approval was obtained from Research Ethics Committee of College of Dentistry, Taibah University, in the Central Western region of Saudi Arabia, and was granted after providing copies of research proposal, consent form and questionnaire.

The questionnaire
This was a questionnaire based study.The questionnaire was composed of 2 parts; first part was directed to dentists consisting of questions on demographic/professional data of gender, age, nationality, marital status, year and country of graduation, final specialty degree and its field if applicable, experience in years, work sector (public or private), affiliation (private practice, public hospital, private hospital, academia, other), average work hours/ week, city of work and city of residence.Also if they travel between workplace and residence.
The second part was composed of questions directed to family members.These questions were about: relation to dentist, gender, age, educational level, type of residence (apartment, house/villa), whether they own or rent the house, or if housing allowance was provided by the employer.Other questions included: occupation of the family member, data on schooling for the children, shopping, dining, fast food consumption, tobacco

Participants
The link to the questionnaire was distributed to a number of dentists' groups on the WhatsApp™ smart-phone application.There were a total of 300 dentists who were either: intern dentists, general dentists or specialist dentists.Each group received 2 subsequent reminders over two consecutive weeks to participate in the study.
The Epi Info software (Center for Disease Control and Prevention) was used for sample size determination.Population size was set to be: the total number of dentists in the city of Al Madina, Saudi Arabia.Total number of dentists was about 400 dentists, with 50% expected frequency, 5% confidence limit, and 1 cluster.At 80% power of study sample size was calculated to be 116 participants, and at 90% power of the study sample size was calculated to be 161 subjects.

Statistical analysis
After data collection, analysis was carried out using IBM-SPSS version 21.
Kolmogorov-Smirnoff test was used to determine normal distribution of the sample.Cross tabulation with Chi square was used to determine significance of association between variables.

Results
Out of 300 dentists in WhatsApp™ groups who were invited to participate, a total of 133 dentists responded by completing the online questionnaire.The number of this convenient sample was further reduced to 125 after eliminating 8 responses as they did not answer a large number of questions.The response rate thus, after eliminating empty responses, was around 41.7%.This produced a power of study between 80% and 90%.
Specialty degrees for non-academics were significantly different to the academics', with more doctorate degrees among academics.Table 1 shows other relevant sociodemographic characteristics of dentists who participated in the survey, and Table 2 shows the sociodemographic characteristics of their family members.(Table 1, 2   Results show that there are significantly less Saudi academics in the sample, and that academic dentists have graduated significantly earlier than non-academics (Mean=1998 and 2002 respectively).Moreover, their professional degrees vary significantly Family members participating in the survey were: 77 (61.6%) females and 43 (34.4%)males while 5 (4%) subjects did not state their gender.
Age of subjects ranged from 16 to 65, and 12 did not disclose their ages.  of social and cultural behavior of dentists' families which are comparable in both groups however, families of non-academics read significantly more books/month.When percentages don't add up to 100%, this is because of missing data (unanswered questions) Table 4 shows the financial and economic characteristics of the study sample.Non-academics' families more significantly live in villas than academics' families, have more bank loans and have family drivers.
Table 5 shows important health indicators in the study sample.The following criteria are significantly associated with non-academics' families; waterpipe smoking, practicing sports and having depression.

Discussion
This study investigated important aspects of the quality of life of academic dentists' families compared to non-academic dentists.Both groups had comparable demographics when addressing important variables like age, marital status, and years of experience in their careers.However, both groups were not matched in nationality; most of the academics group expectedly, were non-Saudi nationals and most of the non-academics were Saudis.Saudi higher education in general still relies on large numbers of non-Saudis particularly in health-related specialties.In recent years, however, the continuous efforts of government to sponsor abroad postgraduate studies through the grant of the Custodian of the two great mosques (Menhat Khadem Al Haramain in Arabic), have provided more Saudis in the academic work force.So it is expected that there will be more Saudi academics working in Saudi universities during the next decade.Also, almost half of the non-academic dentists' sample had higher degrees like Board, masters and PhD.As for the academic degrees that both groups of dentists have, there was a statistically significant difference since the group of academics expectedly had more postgraduate degrees.Another statistically significant difference was noticed between both groups in the year of obtaining the bachelor's degree; nonacademics have graduated more recently than academics mainly after the year 2000.Regarding the families of both groups, they were matched in age, education level of the spouses and of other family members.This contributes to the validity of results provided by this study.
Important social aspects were investigated in this study.Perhaps the most important of these is children; they are the center of concern in any family.Indeed, balancing family and career responsibilities was a prevalent problem and was the strongest predictor of discontent among a sample of faculty at an American school of medicine.[20] In both academic and non-academic groups children receitutoring mostly in private schools.Furthermore, children achievement in school was mostly excellent or very good.A satisfactory family atmosphere was evident as the general trend was assisting children in their study, and having meals as a family by dining outdoors, and lunching at home where the main trend was home-cooked meals and having fast foods less frequently.
From the children's perspective, the children of both groups mostly feel that their parents' dental career deprive them from care, but at the same time, almost half of the children in both groups feel that their parents are caring, and most of them believe that there is dialogue in the family.Socially and culturally both academic and non-academic families were similar in being bilingual and undertaking annual travels with all the family travelling together.Both groups showed a high use of internet daily of around 5 hours, while a minority of academics' and one third of non-academics' families read one book per month and the difference is significant favoring the non-academics' families.
A long screen time, including internet usage has been linked to a number of adverse outcomes.Excess body weight in adolescents has been related to sedentary behaviors like screen time.[21] Screen time exceeding 3 hours has been associated with poor health, [22] low academic performance, [23] and obesity.[24] Interestingly, approximately 40% of the study sample in both groups report obesity in the family Some important health indicators were investigated including tobacco smoking, oral hygiene habits, and sporting.A minority smoke cigarettes in both groups.As for waterpipe smoking, a tobacco use method that has gained increased popularity in recent years, none of the academics' and approximately 20% of non-academics' families smoked waterpipe showing a statistically significant difference between both groups.Evidence suggests that water pipe smoking is gaining popularity among populations that may "resist" cigarette smoking as the former is mistakenly perceived a healthier option for tobacco use.The increased popularity has been reported among physicians, [25] and medical students.[26] The academics in a university in a neighboring country have also been reported to smoke the waterpipe at a prevalence of 13.5%.[27] There are no studies published so far on the prevalence of waterpipe smoking among dentists in general.Recently, we conducted a study in Al Madina/ Saudi Arabia to investigate waterpipe tobacco smoking among dentists and found that almost 25% of them smoke the waterpipe on a regular basis (unpublished data).When considering the fact that none of the academic dentists families smoke waterpipe, one must be cautious when interpreting the results, since studies have shown that the practice of water pipe smoking is not dependent on cultural background or educational level of smokers.[28] Academics are supposed to be role models for their students as well as their families, and their health risk behaviors are also supposed to be minimal.Whether this has an influence on the practice of waterpipe smoking or not, further research may be needed.Results showed that non-academic dentists' family practice sport weekly more significantly than academic families, however, almost half of the sample in both groups reported obesity in the family, and almost one third of both groups reported the presence of chronic diseases in the family.Most of both groups have private medical care, and almost half of both groups have free medical insurance, the latter is a favorable health indicator.
High oral hygiene standards were reported by almost 60% of the sample in both groups.This was not expected as the families of dentists in general, whether academics or not, should acquire and practice good oral hygiene habits.Another interesting finding was the statistically significant difference in reporting depression between both groups with a higher depression rank among families of non-academics.This finding needs more in-depth research to explore its causes.
We did not include questions on the monthly income of the family because it is better to investigate the indicators of financial security.Financially less than half of each groups have financial projects, but a higher percentage plan to do financial projects in the future.Both groups own at least one car but more non-academics live in villas and the difference is significant.Another statistically significant difference was noticed in having a family driver, a trend which was more prevalent in non-academic families.Both of these findings do not necessarily reflect financial prosperity since significantly more non-academic families have bank loans than academic families.Although non-academics' families may have up to 3 maids, there was no statistically difference in having maids between both groups.
Academia is known to be associated with a limited pay, however, an advantage of academia is that it provides a predictable, steady source of income and benefits that increase over time.
In general quality of life of academic dentists and their families may vary according to geographic location and this study is no exception since our sample live in a country that is known to be one of the richest countries in the Middle East.
Academic dentistry in North America and Europe may face a different situation.It has been stated that dental education in the United States faces shortage of faculty that is reaching crisis proportions.[29] The ageing academics is one of the problems that face academic dentistry.[30] This is paralleled by increase in the number of professors starting from the year 2000 and a decrease in lecturers.[31]

Conclusions
It can be concluded that families of academic and non-academic dentists showed comparable quality of life, however, they are affected by similar trends affecting families nowadays like long hours of internet usage, obesity, and waterpipe smoking, and the latter was exclusively affecting non-academic dentists' families.More research is needed to explore some interesting findings among academic and non-academic dentists' families.

Table 1 .
) Relevant sociodemographic and professional data of the dentists who participated in the survey.

Table 3 .
Social and cultural aspects of the study sample.

Table 2 .
Sociodemographic characteristics of the dentists' families.

Table 3
shows aspects

Table 4 .
Financial and economic aspects of the study group.When numbers don't add, this is because of missing data (unanswered questions).

Table 5 .
Health indicators of the study sample.