Evaluation of oral-hygiene awareness and practice among dental students

Darivemula Daya; Ummadisetty Teja; Dhishan Babu Paturu; Bhumanapalli Venkata Ramesh Reddy; Sreenivas Nagarakanti; Vijay Kumar Chava

doi:10.4103/2277-8632.202581

ORIGINAL ARTICLE

Year : 2017 | Volume : 6 | Issue : 1 | Page : 24-28

Evaluation of oral-hygiene awareness and practice among dental students

Darivemula Daya, Ummadisetty Teja, Dhishan Babu Paturu, Bhumanapalli Venkata Ramesh Reddy, Sreenivas Nagarakanti, Vijay Kumar Chava
Department of Periodontics, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India

Date of Web Publication

20-Mar-2017

Correspondence Address:
Vijay Kumar Chava
Prof. and HOD, Department of Periodontics, Narayana Dental College and Hospital, Chinthareddypalem, Nellore - 524 003, Andhra Pradesh
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/2277-8632.202581

Abstract

Aim: The aim of this study is to compare oral-health knowledge, attitudes, and self-care practice behaviors among dental students.
Materials and Methods: A questionnaire was prepared regarding oral-health attitudes and behaviors. The survey was carried out at Narayana Dental College and Hospital, Nellore. Three hundred sixty-seven questionnaires were responded by the dental students (208 clinical and 159 preclinical students). The data were tabulated and analyzed by using Statistical Package for the Social Sciences (SPSS) v.17.0. Chi-square tests were also used.
Results: A more significant knowledge (P < 0.001) of oral-hygiene procedures are noticed in clinical students than in preclinical students. The responses varied mainly regarding the type of brush they are using, the brushing technique, motivating people to consult a dentist (clinical — 95.2%, preclinical—78%), and educate people about oral hygiene procedures (clinical — 98.6%, preclinical — 80.5%). oral hygiene practices in different genders were not included in the present study.
Conclusion: The outcome of the study is that there is an appreciably high level of knowledge about oral self-care procedures in clinical students than in preclinical undergraduate dental students. There is a need to educate the undergraduate dental students on oral care procedures as soon as they join the BDS course.

Keywords: Attitudes, dental education, dental students, oral health behavior

How to cite this article:
Daya D, Teja U, Paturu DB, Reddy BV, Nagarakanti S, Chava VK. Evaluation of oral-hygiene awareness and practice among dental students. J NTR Univ Health Sci 2017;6:24-8

How to cite this URL:
Daya D, Teja U, Paturu DB, Reddy BV, Nagarakanti S, Chava VK. Evaluation of oral-hygiene awareness and practice among dental students. J NTR Univ Health Sci [serial online] 2017 [cited 2017 Aug 21];6:24-8. Available from: http://www.jdrntruhs.org/text.asp?2017/6/1/24/202581

Introduction

The prevention of oral disease is the most acknowledged and efficient method of ensuring oral health.^[1] Oral health is now renowned to be equally important in relation to general health.^[2] Written and visual media and dentists are the most common sources of receiving oral health information.^[3],[4] To redirect the focus of oral-health professionals toward effective preventive interventions and to enable them to motivate their parents to adopt healthy behaviors, special educational programs need to be integrated into undergraduate training and made available to established clinicians are required.^{[5],[6],[7],[8],[9],[10]}

Dental students, the future leaders in oral-health care, have a significant role to play in public oral health education and its promotion.^{[11],[12],[13]} Dental students in general have been found to have a positive oral health attitude but their own oral-health behavior must improve if they are to serve as positive models for their patients, families, and friends.^{[8],[14],[15],[16],[17]}

Dental students' oral-health attitude reflects their understanding of the importance of disease prevention and their commitment to improve their patients' oral health; these attitude should be developed and reinforced during undergraduate training.^[14]

Previous studies on dental students, which mostly majored on the comparison of the first and advanced years of education, showed that final year dental students had significant improvements in oral-hygiene practices, attitudes, and behavior.^{[18],[19],[20],[21],[22]} To the best of our knowledge, there are very few studies comparing preclinical and clinical students reporting inconsistent results.^[7],[16]

The aim of this study was to evaluate the difference between the oral-hygiene procedures and oral-health awareness of the pre-clinical and clinical undergraduate dental students.

Materials and Methods

Before conducting a full-scale survey, a 17-item questionnaire was administered to a population of 50 subjects for pretesting. The main cross-sectional study was conducted at Narayana Dental College and Hospital, Nellore, AP, with the preclinical (1^st and 2^nd year) and clinical (3^rd and 4^th year students and interns) undergraduate dental students with 90% power. The study was approved by institutional ethical committee, XxxxxxxxXxxxxxxxxxxxx and Xxxxxxxx, Xxxxxxx, X.X. A self-constructed 17-item close-ended questionnaire [Table 1] was distributed among all the students. The questionnaire included questions related to the age, gender, year of study. It was further categorized to evaluate the knowledge, practices, and behavior pattern related to oral health. Before the distribution of questionnaire, an informed consent was taken from all the participants. Each subject was given 5-10 mins time for completing the questionnaire. The questionnaires were collected immediately after the completion.

TABLE 1: QUESTIONNAIRE FORM

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Inclusion criteria

Preclinical students — 1^st and 2^nd year students

Clinical students—3^rd and 4^th year students and interns.

Exclusion criteria

Students who are not willing to participate in the study.

The data were tabulated and analyzed using Statistical Package for the Social Sciences (SPSS) v.17.0 (SPSS-Inc., Chicago, IL). Chi-square test was also used to compare the oral-health attitudes and behavior of the preclinical and clinical undergraduate dental students. A P-value of less than 0.05 was considered statistically significant, and a P-value of less than 0.001 was considered strongly significant.

Results

A total of 367 students from both preclinical and clinical years participated in the study. All the questionnaires were returned after the completion and were analyzed. The sample description of both preclinical and clinical undergraduate dental students is given in [Table 2]. The percentages of responses given by both the preclinical and clinical students are presented in [Table 3].

TABLE 2: SAMPLE DESCRIPTION

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TABLE 3: PERCENTAGE AND ANALYSIS OF RESPONSES IN PRECLINICAL AND CLINICAL STUDENTS

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No significant differences were observed between the preclinical and clinical students regarding the following data: Frequency of brushing (Q₂), frequency of changing brush (Q₅), cleaning the tongue with a tooth brush/tongue cleaner (Q₉), using a mouthwash (Q₁₁), having bleeding gums (Q₁₂), wants their teeth cleaned (Q₁₅) [Table 3], and type of brush they use (Q₃) [Table 4].

TABLE 4: PERCENTAGE AND ANALYSIS OF RESPONSES IN PRECLINICAL AND CLINICAL STUDENTS

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Strongly significant differences (P< 0.001) were found between the preclinical and clinical students with regards to the brushing technique they use (Q₄) [Table 4], knowledge regarding interdental aids (Q₆), use of dental floss (Q₇), tongue cleaning (Q₈), visiting a dentist (Q₁₄), recommending parents/relatives to dentist (Q₁₆), and educating the people about oral hygiene procedures (Q₁₇) [Table 3].

Discussion

As a major part of their role in the oral-health-care provision, dentists are considered experts in the field of oral-health education and promotion. The first step in establishing a positive oral-health habit is to provide significant knowledge to the patients and to raise their awareness regarding the ways to prevent oral diseases. High awareness regarding oral self-care among dental students enables them to assess their patients' oral health condition and to motivate their patients and may help them to spread oral awareness in the general population.^{[12],[13],[17]}

The results of the present study indicated that the percentage score for oral-health knowledge, attitude, and behavior of clinical students were significantly higher than that of the preclinical students, which agrees with the results of some previous studies by Kawamuraet al.,^[23] Tseveenjavet al.,^[5] and Ronget al.^[21] Preventive dentistry and periodontology are taught in the 3rd year of dental studies, so the difference in the knowledge, attitude, and behavior percentages of preclinical and clinical dental students appears to reflect the variation in the student's educational level.

In the present study, all the preclinical and clinical students used tooth brush and tooth paste as they are better informed about the effectiveness of the mechanical removal of dental plaque and the secondary role of the tooth paste in the prevention of gum diseases, which is in accordance with the study by Polychronopoulouet al.^[24] No significant difference was found in the frequency of tooth brushing behavior between the pre-clinical and clinical students, unlike the finding of a study by Barrieshi-Nusairet al.,^[7] which showed that the percentage of students claiming to brush their teeth twice daily or more often was four times higher among the clinical students than that among the preclinical students. This suggests that the level of student's self-care may have been influenced by their course contents.

There is a strongly statistical significance difference between preclinical and clinical students regarding the brushing technique (P< 0.001) [Table 4], mainly regarding the bass technique (circular/roll — 22.6%, horizontal/scrub — 28.3%). The rate of the usage of dental floss among the preclinical students was 52.8% and among the clinical students was 71.1% (P< 0.001) [Table 3]. Gender difference in the usage of dental floss is not considered in the study. These rates are higher than the results obtained by Neerajaet al.^[25] (1^st year — 22%, 5th year — 14%). In a similar study by Yildiz et al., the rate of the usage of dental floss among preclinical students was 19% and among the clinical students was 31%.^[26] In another study by Rong et al., 4% of the 1st year students and 22% of the 5th year students used dental floss at least once in a week.^[21] This can be explained by the fact that the basic course in clinical periodontology starts in the 3^rd year.

There was a strongly statistical significance between the preclinical and clinical students regarding the knowledge on interdental aids (P< 0.001) [Table 3]. The tongue cleaning behavior is better in preclinical students than in clinical students (P < 0.001). This observation differs from Sharada et al.^[22] this could be explained, that the effect of factors other than knowledge, like, beliefs, values, attitudes, influence of family members and friends on the oral health behaviors more in preclinical students than in clinical students.

There was no statistically significant difference in the use of mouthwash between the clinical and preclinical students, and also no significant difference regarding bad breath among the preclinical and clinical students, which was same as the findings of Barrieshi-Nusair et al.^[7] The preclinical dental students were more concerned about bad breath than the clinical students in our study, which is in accordance with the results of Dumitrescu et al.^[27]

Our results also shows that 26.4% of preclinical students and 24% of clinical students [Table 3] had bleeding gums which was in higher proportion than found among, Japanese (45%) dental students and lower proportion found among Finnish (25%) dental students.^[23] These rates are higher in clinical students when compared to the preclinical student as per the research by Neerajaet al.^[25] (preclinical — 16% and clinical — 32%). This showed that the students in this study paid good attention to their oral-hygiene maintenance, and were also very much concerned about their dental esthetics.

The results of the present study also found a statistically significant difference (P 0.01) suggesting pre clinical students visit a dentist much frequently than clinical students when toothache occurs. The results also revealed that there was significant difference among the preclinical and clinical students in recommending their parents/relatives to dentist (P< 0.001), and in educating people about oral-hygiene procedures (P < 0.001). This improvement in personal oral-health behaviors among dental students has been shown to be linked with their dental education experience. Differences in the age in self -oral care was not reported in the present study. This is in accordance with previous studies by Komabayashi et al.,^[18] and Tseveenjav et al.,^[28] Gender difference has not been reported in the present study While significant gender differences existed in the use of recommended oral-health self-care in studies by Khami et al.,^[29] and Al-Omari.^[30]

All study participants were dental students thereby reducing the probability of bias related to misconceptions and errors in interpretation of concepts that exist in studies using self-administered questionnaires with lay populations. However, there might be certain amount of measurement error in handling self-care reported in the present study instead of observed behaviors.

Limitations

Screening of intraoral clinical status of the study participants was not done.
The tendency toward socially desirable response cannot be completely excluded especially when using a self-assessment tool.

This study is limited with a questionnaire. To research the effect of education, cross-sectional and longitudinal comparisons would be more useful. Clinical examination besides questionnaire would probably affirm the results.

Conclusion

The findings of present study highlights that the students had rather low oral-health awareness in the beginning of their dental education, i.e., preclinical students has low oral-health awareness when compared to clinical students. The oral-health attitude and behavior of dental students improved with the increase in the level of education. Further clinical studies are needed for determining the correlation between the self-report and the intraoral clinical status of dental students.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Dharmashree S, Chandu GN, Shafiulla N. Knowledge, attitude and practices (KAP) towards oral health among professional attending to the mentally disable children in Davangere, Karnataka, India. J Ind Assoc Pub Health Dent 2005;6:5-8.
2.	Dilip CL. Health status, treatment requirements, knowledge and attitude towards oral health of police recruits in Karnataka. J Ind Assoc Pub Health Dent 2005;5:20-1.
3.	Lin HC, Wong MC, Wang ZJ, Lo EC. Oral health knowledge, attitudes, and practices of Chinese adults. J Dent Res 2001;80:1466-70.
4.	Paik DI, Moon HS, Horowitz AM, Gift HC, Jeong KL, Suh SS. Knowledge of and practices related to caries prevention among Koreans. J Public Health Dent 1994;54:205-10.
5.	Tseveenjav B, Vehkalahti M, Murtomaa H. Time and cohort changes in preventive practice among Mongolian dental students. Eur J Dent Educ 2003;7:177-81.
6.	Autio-Gold JT, Tomar SL. Dental students' opinions and knowledge about caries management and prevention. J Dent Educ 2008;72:26-32.
7.	Barrieshi-Nusair K, Alomari Q, Said K. Dental health attitudes and behaviour among dental students in Jordan. Community Dent Health 2006;23:147-51.
8.	Umsan S, Bhat SS, Sargod SS. Oral health knowledge and behaviour of clinical medical, dental and paramedical students in Mangolore. J Oral Health Comm Dent 2007;1:46-8.
9.	Wagner JA, Redford-Badwal D. Dental students' beliefs about culture in patient care: Self-reported knowledge and importance. J Dent Educ 2008;72:571-6.
10.	Porat D, Kawamura M, Eli I. Effect of professional training on dental health attitudes of Israeli dental students. Refuat Hapeh Vehashinayim (1993) 2001;18:51-6, 63.
11.	Khami MR, Virtanen JI, Jafarian M, Murtomaa H. Prevention-oriented practice of Iranian senior dental students. Eur J Dent Educ 2007;11:48-53.
12.	Gallagher EB, Moody PM. Dentists and the oral health behavior of patients: A sociological perspective. J Behav Med 1981;4:283-95.
13.	Frazier PJ. Public health education and promotion for caries prevention: The role of dental schools. J Public Health Dent 1983;43:28-42.
14.	Peker K, Uysal O, Bermek G. Dental training and changes in oral health attitudes and behaviors in Istanbul dental students. J Dent Educ 2011;74:1017-23.
15.	Al-Omari QD, Hamasha AA. Gender-specific oral health attitudes and behaviour among dental students in Jordan. J Contemp Dent Pract 2005;6:107-14.
16.	Dagli RJ, Tadakamadla S, Dhanni C, Duraiswamy P, Kulkarni S. Self reported dental health attitude and behaviour of dental students in India. J Oral Sci 2008;50:267-72.
17.	Freeman R. The psychology of dental patient care. 5. The determinants of dental health attitudes and behaviours. Br Dent J 1999;187:15-8.
18.	Komabayashi T, Kwan SY, Hu DY, Kajiwara K, Sasahara H, Kawamura M. A comparative study of oral health attitudes and behaviour using the Hiroshima University - Dental Behavioural Inventory (HU-DBI) between dental students in Britain and China. J Oral Sci 2005;47:1-7.
19.	Peker I, Alkurt MT. Oral health attitudes and behaviour among a group of Turkish dental students. Eur J Dent 2009;3:24-31.
20.	Doğan B, Filizi K, Küçükdoğan Ü. Gender-specific oral health attitudes and behaviour among dental students. GÜ Diş Hek Fak Derg 2009;26:87-93.
21.	Rong WS, Wang WJ, Yip HK. Attitudes of dental and medical students in their first and final years of undergraduate study to oral health behavior. Eur J Dent Educ 2006;10:178-84.
22.	Sharda AJ, Shetty S. A comparative study of oral health knowledge, attitude and behavior of first and final year dental students of Udaipur city, Rajasthan, India. Int J Dent Hyg 2008;6:347-53.
23.	Kawamura M, Honkala E, Widström E, Komabayashi T. Cross-cultural differences of self- reported oral health behavior in Japanese and Finnish dental students. Int Dent J 2000;50:46-50.
24.	Polychronopoulou A, Kawamura M. Oral self-care behaviours: Comparing Greek and Japanese dental students. Eur J Dent Educ 200;9:164-70.
25.	Neeraja R, Kayalvizhi G, Sangeetha P. Oral health attitudes and behavior among a group of dental students in Bangalore, India. Eur J Dent 2011;5:163-7.
26.	Yildiz S, Dogan B. Self-reported dental health attitudes and behaviour of dental students in Turkey. Eur J Dent 2011;5:253-9.
27.	Dumitrescu AL, Kawamura M, Sasahara H. An assessment of oral self-care among Romanian dental students using the Hiroshima University — Dental Behavioural Inventory. Oral Health Prev Dent 2007;5:95-100.
28.	Tseveenjav B, Vehkalahti M, Murtomaa H. Oral health and its determinants among Mongolian dentists. Acta Odontol Scand 2004;62:1-6.
29.	Khami MR, Virtanen JI, Jafarian M, Murtomaa H. Oral health behaviour and its determinants amongst Iranian dental students. Eur J Dent Educ 2007;11:42-7.
30.	Al-Omiri MK, Barghout NH, Shaweesh AI, Malkawi Z. Level of education and gender-specific self-reported oral health behavior among dental students. Oral Health Prev Dent 2012;10:29-35.