A target sample of the study comprised 180 postgraduate students and 170 faculty members of dentistry from three private dental schools in India; Institute of Dental Sciences (Bhubaneswar), Meghna Institute of Dental Sciences (Nizamabad) and Rajasthan Dental College and Hospital (Jaipur). All the postgraduate students were pursuing the Master of Dental Surgery (MDS) course in one of the nine specialities of Dentistry as approved by the Dental Council of India and the entire dental faculty included in the study had completed their MDS in at least one of the specialties of Dentistry.

The survey form used in the study consisted of three sections. The first section described the purpose of the survey and instructions for participants. The personal information section enquired their professional status (postgraduate student/faculty) and gender (female/male). The name and the specialty of the participant were omitted to maintain anonymity and reduce acquiescent response.

This was followed by the Integrative Medicine questionnaire (IM-30), a 30-item self-reported measure devised by Hsiao et al., [18]. (available at http://onlinelibrary.wiley.com/doi/10.1111j.1475-6773.2005.00425.x/suppinfo). It evaluates the health care provider’s orientation towards IM in five subscales; awareness and openness to working with practitioners from other paradigms (ten items), readiness to refer patients to other paradigms (seven items), learning from alternate paradigms (five items), patient-centred care (three items), and safety of integrative medicine (five items). Each item in the instrument is scored on a 4 or 5 point Likert scale. This questionnaire needed less than five minutes of administration time, demonstrated good reliability (alpha of 0.9 for the whole scale and 0.7 or above for all the subscales) and has been tested for construct validity [18]. As the Indian norms are not available for this instrument, the interpretations in this study were based on the hypothetical median scores for each domain and the whole instrument considered representing a neutral orientation. The hypothetical median was calculated as {Lowest possible score + highest possible score/2}. The lowest possible, highest possible and the hypothetical median scores for each domain and the whole instrument are given in [Table/Fig-1].

After obtaining permission from the administrative heads of these dental schools, the printed forms were distributed to the participants in November 2014. A verbal reminder was passed on after a week and all the completed forms returned within next two weeks were included for the study. As the participation was voluntary and anonymous, the study was exempted from ethical clearance in these dental schools.

The data entry was performed and verified independently by two operators. Summary statistics were calculated for the whole scale and each subscale of IM-30. As the data failed to satisfy the normality criteria (Shapiro-Wilk Test), inter-group comparisons based on gender and professional status were made with Independent samples Mann-Whitney U test. The alpha level for all the tests was set at 0.05 and IBM^® SPSS^® Statistics Version 20 was used for the data management.

Two hundred and eighty six usable forms were returned yielding a response rate of 81.7%. 51.7% were postgraduate students (n=148) and the rest (n= 138) were dental faculty members. Females constituted 50.7% (n=145) of the total sample.

The overall and groupwise data for the whole scale and all the subscales is presented in [Table/Fig-1]. As the total score and subscale scores for awareness and openness, readiness to refer and safety are very near the hypothetical median, the orientation of the dental professionals in these regards could best be described as neutral. While the use of learning resources on CAM was lower (13 vs subscale median of 15), the current sample exhibited a more positive orientation towards patient centred care (11 vs. subscale median of 9).

Groupwise comparison based on professional status [Table/Fig-1] revealed that the dental faculty scored higher than the postgraduate students in the total score (median of 82 vs 79.5, p< 0.01) and in the subscales related to learning (14 vs 12, p< 0.01) and safety (13 of 12 vs 79.5, p< 0.01) of CAM. Statistically significant differences were also noted in the gender-based comparisons. Females were more oriented towards patient-centred care than males (median of 12 vs 11, p< 0.001). The overall orientation towards IM was also higher in the female professionals (82 vs 78, p< 0.01).

There is a growing demand on the health care system to shift from a bio-medical orientation to an Integrative care. The unfavourable attitude of the allopathic health care professionals and students towards CAM is seen as a significant barrier to this transition. As the status quo among dental professionals in India is unknown, the current study evaluated and compared the orientation of the postgraduate students and faculty of dentistry towards Integrative Medicine.

The results indicated that the orientation of the dental professionals towards IM was largely neutral. Lack of any similar studies has precluded the possibility of comparison. Studies comparing the attitudes of medical students and professionals with those from other health care sciences like nursing, pharmacy, physiotherapy etc. have shown a relatively more positive attitude in the latter [8,19].

The postgraduate students showed a lesser orientation towards IM than the faculty. A lesser score in the learning subscale is a significant contributor towards this effect. The curriculum followed in most dental schools across India has virtually nothing related to CAM throughout the period of study. Hence, it is logical that the students would have a lesser need, time and motivation to use the learning resources on CAM. On the contrary, Lie and Boker found no difference in the total number of CAM information resources used by the medical students, interns and the faculty with internet being the most frequently used [9]. Another domain in which the postgraduate students showed a less favourable orientation was regarding the safety of CAM treatments. This scepticism could have probably resulted from the lack of adequate knowledge and exposure to CAM therapies. In a survey involving all Dutch medical schools, nearly three-quarters of the respondents described that their knowledge on CAM was limited and more research was needed to establish their effectiveness and safety [20]. A positive correlation has also been reported between educational exposure to CAM and its perceived usefulness in health science students [19]. Hence integrating CAM into the curriculum right from initial stages of professional training appears to be the need of the hour.

Females in the study exhibited a higher orientation towards IM than males primarily because of a more positive orientation towards patient centred care. An earlier study on postgraduate orthodontic students in India has, reported that the females were more considerate of the role of psychosocial factors in health and the importance of good doctor-patient relationship [21]. However, the overall attitudes towards patient-centred care were not different from males.

The study is not without limitations. The lack of Indian norms for the instrument forced the use of hypothetical median score as a reference value representing neutral orientation. Availability of the psychometric properties of the instrument in the regional population could have facilitated more meaningful interpretation of the data. Further, the faculty included in the study varied in their experience from a neophyte to senior level professors. The influence of experience, if any, on the orientation towards IM has not been investigated in this study. Another possible area of exploration would be the evaluation of the differences in the orientation of dental professionals from different specialties.

The following are the salient conclusions from this study that evaluated and compared the orientation of the dental professionals towards integrative medicine:

The need to improve the orientation of the Indian dental professionals towards IM by appropriate professional exposure to CAM modalities cannot be over-emphasized.