Oral Health Attitudes and Practices among Dental Students in Lebanons

DAOU Dany, ABI AAD Lamia, DOUGHAN Bassel, SAYAH Fida, EL TENN Georges

 ABSTRACT

Aim: The aim of this study was to investigate oral health knowledge and practices among undergraduate dental students and their evolution through academic years.

Materials and Methods: A total of 218 dental students from all academic levels were enrolled in the study and data were collected using an anonymous Self-administered questionnaire. Data collected included: demographic data, oral health knowledge, and self-reported and oral health practices.

Descriptive statistics and Chi-square analysis were performed; significance level was set at p < 0.05. Mean age was 21 years.

Results: There were significant differences between academic years in some fields such as the criteria of choosing the toothbrush. The Softness criteria for the toothbrush evolved from 26.6% between the second year’s students to 57, 8 % and 62, 2% respectively in the fourth and fifth year. Flossing was considered as essential for teeth cleaning for 37.8% of the students in the second year, 46.9% in the third year and 70.3% in the fourth year and 66.7% in the fifth year. The percentage of students visiting their dentist for regular check-up varied from 17.8% in the second year, to 25% in the third and fourth year reaching 40% in the fifth year.

Furthermore, eating habits and choosing Fluoride showed no significant differences between academic years.

Conclusion: Dental students showed higher knowledge and better practices with evolution of academic years. It is important that dental students take an active role in educating other students about oral health.

 

Introduction

Oral health is defined as the oral condition that is free from any kind of disorder which affects the oral cavity and the mouth (1). Oral health is considered to be part of the overall health (2), many factors can affect it, among them oral hygiene and food habit (3). It is presumed that mass media, dental staff and dental literature are the main sources of oral health information for the public (4). Many studies about oral hygiene behaviors have been conducted among university students. Some have focused on the knowledge, attitude, and practices of non-professional college students towards oral health, others studied medical and dental students (5).

Surveys about Oral health of dental students were conducted in several countries and the evolution of the students’ behavior throughout studying years has been frequently assessed as well. By maintaining oral health, dental health providers become role models for their patients. Dental students must acquire knowledge, beliefs, attitudes and practices which positively affect the oral health of their patients, families and colleagues from other disciplines (6).

According to the behavioral model PRECEDE/PROCEED of Kreuter and Green, changing behavior is guided by several parameters: The predisposing factors, enabling factors and reinforcing factors of any behavior (7). This study analyzes the predisposing factors especially the attitudes and behaviors of students. We assume that the change in knowledge is an accomplished fact since that the transition from one academic year to another requires tests that assess these developments in knowledge in relation with the oral hygiene. Similarly facilitating factors are also considered encouraging because that physical and financial accessibility of students to dental health care is ensured within the faculty.

The objective of this survey is to know to what extend there is an improvement concerning the oral health practices, attitudes and behaviors between the dental students of the Lebanese university faculty of dentistry.

 

Materials and Methods

This research was conducted at the Lebanese University between February and May 2013. It focuses on the treatment of the question of changing attitudes and behaviour of dental students towards their own oral hygiene. This methodology has a quantitative character.

Based on the literature review and the exploration of the field, the questionnaire was developed, tested with 10 students then validated.

The self-administered questionnaire used to collect data is composed of 23 items organized into 4 categories:

  • Demographic variables of the study sample (age, year of study, sex).
  • Oral health knowledge and practices (criteria for choosing a tooth brush and toothpaste, frequency of brushing, flossing …).
  • Dental services utilisation (frequency and causes).
  • Food habits knowledge and practices.

 

The questionnaire was distributed to 302 dental students and 218 were collected and included in the study. The questionnaires were hand-distributed by post-graduate dental public health students as part of a research project course. Students were asked to return the questionnaire after answering individually in order to avoid any bias. The questionnaires were anonymous to maintain confidentiality. Prior to distribution of the questionnaire, the students were informed that their participation was voluntary and that refusing to participate would not affect their grades. Data entry was performed using the software “Access” and data analysis was made using the Statistical Package for Social Sciences (SPSS) software. Significance level was set at p<0.05.

 

Results

Demographic Characteristics of the study Sample

The sample included dental students from second to fifth academic year. From 302 questionnaires distributed, only 218 responded and were included in the study. The Mean age of the students was 21 years. The percentage of female was 65%.

The distribution of students according to their academic levels is shown in table1.

Table 1:  The distribution of respondents according to their academic levels

Academic year Second year Third year Fourth year Fifth year Total
Frequency 45 64 64 45 218
Percentage 20,6 29,4 29,4 20,6 100,0

 

Oral health Knowledge and practices

Toothpaste criteria

In total, 44, 6% of the students mentioned Fluoride as a criteria for choosing the toothpaste. This percentage increased from 30.5% in the second year to reach respectively 57.7% and 44.6% in the fourth and fifth year. Furthermore, the taste and brand were not considered as a priority among the 4th and fifth year students compared to their colleagues from the second academic year.

 Table 2: Criteria of choosing toothpaste by Academic year

  Fluoride Taste Brand Bleach Sensitivity
Second year 30,4 23,9 23,9 10.8 0
Third year 42,5 6,2 8,7 5 10
Fourth year 57,7 7 8,4 1,4 4,2
Fifth year 44,6 14,2 3,5 10,7 7,1
All years merged 44,6% 11,4% 10,2% 5,9% 6,3%

Expressed by percentage of students

Toothbrush criteria

Regarding the criteria of choosing a toothbrush, 50, 5% of students preferred a soft toothbrush. No significant difference was found between genders. In higher academic years, students focused more on the softness of the toothbrush than the brand (p<0.01), (Table 3 and 4).

 

Table 3: Criteria of choosing toothbrush by Academic year

  Softness / Hardness Size Brand Price
Second year 46,7 20,7 23,3 6,4
Third year 59.3 13,5 18,7 8,3
Fourth year 53,2 22,9 16,5 7,3
Fifth year 53,9 19,7 17,1 6,5
All years merged 53,6 19,2 18,7 7,2

Expressed by percentage of students

Table 4: Hardness of toothbrush by Academic year

                            Academic year Total
2 3 4 5
Kind of the toothbrush Hard 6,7 3,1 1,6 0 2,7
 Medium 44,4 37,6 40,6 37,8 39,9
Soft 26,6 51,5 57,8 62,2 50,5
Don’t Know 22,2 7,8 0 0 6,9

Expressed by percentage of students

In addition, 91, 7% of students prefer using a manual toothbrush. The majority of students 72, 9 % have their toothbrush from less than 3 months with p<0,5 (Table 5).

Table 5: Frequency of changing toothbrush

  Frequency Percent Cumulative Percent
Valid   1 ,5 ,5
Less than 3 months 158 72,5 72,9
Less than 6 months 46 21,1 94,0
Less than one year 8 3,7 97,7
More than one year 3 1,4 99,1
No answer 2 ,9 100,0
Total 218 100,0  

Brushing frequency

Sixty five percent of the students brush their teeth twice per day with no significant difference between academic years. (Table 8). In addition to that, results show that 58, 7 % of the students do clean their tongue.

Table 8: Brushing frequency

  Frequency Percent Valid Percent Cumulative Percent
Valid Less than once per day 6 2,8 2,8 2,8
Once per day 39 17,9 17,9 20,6
Twice per day 143 65,6 65,6 86,2
More than twice per day 28 12,8 12,8 99,1
No answer 2 ,9 ,9 100,0
Total 218 100,0 100,0  

Dental floss, mouthwash and toothpick

The results concerning the use of dental floss showed that 37.8% of the students in the second year agreed that the floss is essential for teeth cleaning. This percentage increased with the academic level to reach 66.7% in the fifth year.

The mouthwash and toothpick variables showed no significant differences between academic years. Overall, 35.8 % of the students totally agreed that the mouthwash is essential for the oral hygiene compared to 3.2% that disagreed, and half of the sample use mouthwash in their oral hygiene practices (50.5%). As for the toothpick, 51.8% totally disagreed that the toothpick is essential and only 2.8% totally agreed while 25.7 % use it.

Dental services utilization

 Only 26.6% of the students visit their dentist for a regular check-up with a significant difference between years (p=0.002) (Table 9). The percentage of students doing regular checkups increases from 18% in the second year to 40% in the fifth year. Furthermore, the percentage of treatments increased too with academic years. In addition, the percentage of dental students visiting dentists because of pain decreased with academic years.

Table 9: Reason for the dentist visiting / year

                                Academic year Total
         2         3         4         5
Reason of the Dentist Visiting            
 Regular check-up        17,7       25       25       40      26,6
 Pain        28,9       14         6,25        0      11,9
 Dental treatment        28,9       42,2       45,3       48,9      41,7
 Ortho treatment        15,5         7,8       20,3         4,4      12,4
Cosmetic reason          6,7         1,6         0         2,2        2,3
 Cleaning          0         6,2         1,6         2,2        2,7
Extraction          0         0         1,6         0        0,4
Implant          0         1,6         0         0        0,4
No answer          2,2         1,6         0         2,2        1,3
           

Expressed by percentage of students

 

Food Habits practices

 In this study, the consumption of cariogenic food (Soft drink, Chocolate, Biscuits, Potato ships…) and or protective food (Peanuts, Cheese and milk products…) showed no significant differences between academic years.

DISCUSSION

This study investigated the impact of learned dental  education on attitudes and practices of dental students regarding oral health. As expected, dental students from the last academic years were the highest among all to do regular checkups, to use auxiliary oral hygiene aids, to base their choice of toothpaste upon fluoride content and their choice of toothbrush upon softness of bristles and to use dental floss.

Education, socio-economic conditions, psychological stress, cultural and religious beliefs can affect oral health knowledge, behavior and practices (8) – (9). Cross-cultural studies conducted among dental students showed that oral health behavior was different among different cultures (10).

 

Although the percentage of students doing regular checkups increases from 18% in the second year to 40% in the fifth year, only 26,6 % of the students visit their dentists for a check-up, this shows that the students in this study don’t give enough importance to preventive dentistry. 

About 60% of the students visited a dentist recently, this proportion is lower than the one from a Jordanian study (86%) (11), but similar to dental students in Japan (56%) (12) or Hong kong (67%), and China (64%) (13).

A cross sectional study in 2014 showed that in spite of access to free dental care provided by the dental school, periodic dental check-ups were only common among nearly one-third of the students (5). In another study, 47% of a sample of dental, dental technology and dental hygiene students delayed dental care until they had a toothache (14). Batayneh in 2014 indicates that students’ dental care seeking behavior at a university dental clinic for preventive check-ups was lower in Jordan [29.1%] (5) than in an Italian university [59.9%] (15).

The percentage of students choosing fluoride as a major component to select a toothpaste was 44.6%. In a Jordanian study, dental students were the highest to base their choice of toothpaste upon fluoride content (5), but pharmacy students were the highest to use Chlorhexidine® mouth-rinse [92.6%] reflecting the educational background of these students (8).

 

Regarding tooth brushing, the results of our study were similar to other studies reported in Jordan (11), 65% of the students brush their teeth twice daily much more than the one reported from Kuwait where only third of the students brush twice daily.

The proportion of students using daily dental floss was 57%. This is higher than the proportion found among dental students in Bangalore India (16%) (17) and Jordanian students  (33.9%) (5). Most studies report a high rate of twice daily or more tooth-brushing, yet the frequency of dental floss use remains low. For example, 67.6% of Turkish university students brushed their teeth twice or more a day, however, regular dental flossing was only reported in 3% of Turkish university students (5).

In general, female dental students had higher intention to bleach their teeth; this condition may be explained by the fact that females usually care more about their look and appearance. Other studies confirm that due to higher concerns about body and facial image, females seek more regular dental care and possess better oral health awareness (18).

The high sugar consumption among dental students from different academic years might need further studies to analyze and explain. Assuming that the knowledge increases with the academic levels, the oral health attitude and practicing among the dental students in the Lebanese university seems to be sufficient although the study shows some practices deficits, additionally the responses of the fourth and fifth years were very similar (19).

CONCLUSION

The current study revealed that the oral health attitudes and behavior of dental students improved with increasing levels of education even though there were deficits in some practicing aspects. Dental students of fourth and fifth academic years show higher knowledge and better oral health practices and may serve as good role models for their colleagues and community.

 

 

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