RGUHS Nat. J. Pub. Heal. Sci Vol No: 16 Issue No: 1 eISSN: pISSN:
1Department of Public Health Dentistry, Sri Venkateshwaraa Dental College, Ariyur, Puducherry.
2Century International Institute of Dental Sciences, Kasaragod, Kerala.
3Century International Institute of Dental Sciences, Kasaragod, Kerala.
4Century International Institute of Dental Sciences, Kasaragod, Kerala
*Corresponding Author:
Department of Public Health Dentistry, Sri Venkateshwaraa Dental College, Ariyur, Puducherry., Email: drkuldeepss@gmail.com
Abstract
Background: Dental students have important role to play in oral health education and its promotion. However, their awareness, practice and behavior towards oral health must be adequate and precise if they wish to serve as role models.
Aim: To determine oral hygiene awareness, practice and behavior among students of a dental institute in North Kerala.
Methods: An online survey was conducted to elicit responses for a 12-item closed ended questionnaire. Responses were obtained regarding their self-care oral health related knowledge and practices. Data were also obtained on age, gender, criteria for selecting toothbrushes and their forgetfulness to brush their teeth. The data were analyzed for descriptive statistics.
Results: One hundred and forty-six students participated in the survey. Fifty nine percent of respondents brushed their teeth twice a day, 54.8 percent brushed for ≥ 2 minutes, 32 percent replaced their toothbrush after fraying of bristles and about 35 percent replaced their toothbrush after a brief illness. Only 8.2 percent used dental floss and 2.7 percent used a tongue cleaner. More than 70 percent knew that their toothpaste was fluoridated; however, none were aware of the fluoride compound present in their toothpaste. Design of the bristles was important criteria in selecting toothbrush and about 33 percent had reportedly forgotten to brush their teeth in the morning at least once in the past one month.
Conclusion: More than 50 percent of respondents were following proper self-care oral health practices except the frequency of changing toothbrush and use of other oral hygiene aids. No one knew the fluoride compound present in their toothpaste and the frequency of routine dental visits as per recommendation (once in 6 months) was being followed by less than 25 percent of the participants.
Keywords
Downloads
-
1FullTextPDF
Article
Introduction
Globally the burden of major oral diseases and conditions is high and the curative model is usually expensive in most low-income and middle-income countries. Prevention of oral disease therefore should be a routine part of dental practice. Dentists should take interest in advocacy to promote good oral health and preferring to prevent rather than treat oral diseases.1
One of the core competencies of dental education is to train students who can motivate patients to adopt good oral hygiene.2 However, their future roles in providing oral health promotion and education is related to their own oral health attitudes and behaviors,3 since they are more likely to be able to do so, if they themselves are motivated.2 Therefore, it is essential that dental students acquire knowledge and the right attitudes related to dental health and prevention of oral diseases among other things during their training period.4
Dentists' attitude towards their oral health has been proposed to affect the quality of care delivered to their patients. To disseminate and advocate the right knowledge of oral health, dentists must take positive approaches to their own oral health so that they can effectively impart what they believe.5
It is evident that knowledge regarding oral health is different by year of study and it is empirical that as students are promoted to senior years, there is a noticeable increase in knowledge.6–8 The present study was conducted to determine awareness, knowledge and practice of everyday self-care oral hygiene habits among future oral health care providers.
Materials and Methods
Study design and population
An online survey was conducted among the students of a private dental institution in North Kerala, India. The study was conducted in August 2019. Permission to conduct the survey was obtained from concerned authorities of the institute. The study participants consisted of all the students who belonged to the institution.
A 12-item questionnaire was prepared for the present study. A link was established to access the questionnaire. The online portal was open for two weeks during which they had to respond to items in the questionnaire and submit. After two weeks, the portal was disabled for any further entries. The validity of the questionnaire was not tested. The first page of the questionnaire had information about the study and participants were permitted to proceed only if they understood the nature of the study and gave consent for the same. No incentive of any sort was given to any of the participants. Confidentiality and anonymity of their responses was assured to all the participants. Responses were obtained regarding their basic self-oral hygiene practices. In addition, items like their visits to dentist, fluoride in dentifrices, if they have ever skipped brushing their teeth, their awareness on consistency of their tooth brush bristles and their criteria for selecting a toothbrush were elicited. Data on their age, gender, year of study and place of residence were also collected.
The data were stored by Google form and was transferred to an excel sheet. The data was analyzed using Statistical Package for Social Sciences [SPSS ver 16.0, SPSS Inc., IL, Chicago, USA] for descriptive statistics.
Results
A total of 146 students consented and participated in the survey. The mean age of study participants was 22±1.8 years. Females were more in number than males and senior students (Compulsory rotating resident interns & Final year students) constituted more than 50 percent of the respondents. More than 85 percent were staying in hostel (Table 1).
All the participants were using a manual tooth brush and almost 59 percent brushed their teeth twice a day. More than 85 percent of respondents brushed their teeth before consuming tea/coffee and breakfast. About 43 percent brushed their teeth for two minutes and 37 percent replaced their tooth brush after six months, followed by 32.9 percent who changed/replaced their toothbrush once the bristles get frayed. Only 28.7 percent used other oral hygiene aids (mouth washes, dental floss etc.) and 35.6 percent reportedly replaced their toothbrush after a brief illness (Table 2).
About 71.2 percent of the respondents knew that their toothpaste had fluoride but, did not know the compound (form of fluoride), whereas 28.8 percent did not know whether their toothpaste had fluoride. About 32.8 percent had reportedly forgotten to brush their teeth at least once in the past one month. More than 90 percent of the respondents knew the consistency of their toothbrush bristles and were aware of the reasons for tooth brushing. About 13.6 percent of the respondents reported bleeding from gums after brushing their teeth (Table 3).
About 38 percent of respondents had never been to dentist for a routine dental checkup (Table 3) and design of bristles of tooth brush was reportedly an important criterion for purchasing toothbrush. However, 21.9 percent had no such criteria and purchased the same toothbrush that they had been using before (Figure 1).
Discussion
The study was conducted among students of a private dental institute who would perhaps be the ambassadors of good oral health and a role model for society. Cleaning the teeth with tooth brush twice a day is an established norm, since it is regarded as a vehicle for application of anti-caries agent like fluorides.9 In the present study, 58.9% of respondents reportedly brushed their teeth twice a day. Other studies conducted in similar settings in India had varied results with studies reporting 74%, 43.5% and 46.5%, respectively.7,10,11 These slight variations could be attributed to differences in sample size, since our study had the least sample when compared to the above-mentioned studies. In addition, in the present study, majority of the study respondents brushed their teeth before breakfast and/or tea/coffee which was also observed among a group of dental students in a different study setting.10,12
The present study observed that 43.5% of participants spent two minutes to brush their teeth which was higher than a study conducted among a group of dental students in Northern India.13 Oral health care professionals generally recommend spending at least two minutes to brush the teeth, at least twice a day. This is supported by the findings of a study which reported that brushing time of two minutes removed 26% more plaque compared to brushing for less than one minute. In addition, brushing for about three minutes was associated with 55%
increase in plaque removal.14
When asked about the method of brushing, majority of respondents reported using both vertical and horizontal strokes to clean their teeth which was similar to a study conducted among dental students of a South-East Asian country.12 Replacing the toothbrush is a common norm followed for effective plaque removal. A number of studies reported the participants replacing their toothbrush once in three months.10,12 Contrastingly in the present study, 37% of respondents replaced their toothbrushes once in six months. Apart from ‘time’, visible damage (fraying of bristles) was also a criterion followed by 32% of study participants to replace the toothbrush. This was less when compared to 70% of study participants who followed a similar criterion in Northern India.13 The use of other oral hygiene aids such as dental floss, mouth rinses, etc. is recommended for effective plaque control and for reducing morning bad breath.15 Therefore the incorporation of other oral hygiene aids in daily oral hygiene practices is highly recommended. However, in the present study, only 28.7% (46/146) participants reportedly used other oral hygiene aids daily. The most commonly used aid was mouth rinses (26/46) followed by dental floss (12/46). The usage of dental floss in the present study was very less when compared to the results reported by a study conducted in a different geographical setting.12,16 In addition, another study conducted among university students with a broader age range reported only 5.8% of respondents using dental floss.17
The present study observed that about 35% of study participants replaced their toothbrush after brief illness. Toothbrushes get contaminated with various pathogenic microorganisms that remain viable for a day to a week after brushing.18 Contamination happens after initial use, from oral cavity, environment, aerosols and storage containers.19 Frequent change in toothbrushes may be recommended among patients with systemic diseases since minor trauma during tooth brushing can act as a portal of entry, thereby posing a risk for infection and associated diseases. However, there is unsatisfactory data regarding the negative consequences of the microorganisms on the tooth brushes to the oral and systemic health.20 This belief among dental students and by extension probably in the general population needs to be probed for possible scientific validity.
Most commercially available dentifrices are fluoridated and about 71% of respondents were aware that their toothpaste was fluoridated. However, they were not aware of the fluoride compound in their dentifrice. Despite the participants being well aware of the importance of tooth brushing, it was surprising that about 32% had forgotten to brush their teeth in the morning at least once in the past one month. Similar pattern was observed among a smaller proportion of dental interns.21 We were unable to identify any factor associated with having forgotten to brush one’s teeth. However, possible reasons might point towards a weak belief in the importance of regular tooth brushing.
Similar to other studies, when asked about the consistency of their respective toothbrushes, a majority of them were using toothbrushes with medium consistency bristles.11,13 In addition, about 2.7% of respondents were not aware of the consistency of their toothbrush bristles. Our results showed that about 13.6% observed bleeding gums during tooth brushing which was less when compared to the reports of various studies conducted among dental students in North India, South India, Finland and Japan.10,11, 22
In the present study, more than 65 percent of the respondents reportedly went for a routine dental examination in the last one year. This collectively included the respondents who visited once in month (11.3%), six months (24.7%) and annually (23.8%). This was higher when compared to the results reported in literature.7,12 On the contrary, a study conducted in North India reported about 56% of undergraduate dental students visiting a dentist on an annual basis.23 It is highly likely that this self-oral care practice may be attributed to repeated screening by their seniors from clinical years in an attempt to complete their quota in various departments as established by the universities. However, the results observed indicate an overall lack of awareness regarding routine dental visits for better oral care.
Toothbrushes are available in various sizes/ shapes and selecting a manual toothbrush is determined by an individuals’ financial situation, education and attitude towards oral health.24 Choice of toothbrush in this study was influenced by design of bristles which is similar to a study conducted among students of a non-medical institute.25 The second factor in choosing a manual toothbrush was previous experience. Students preferred to use the same toothbrush that they had been using. We did not attempt to determine the reasons for the same. This was followed by the texture of bristles which is similar to the responses provided by a group of patients reporting to a dental institute in Nigeria.26 We made an attempt to compare the findings with other groups since we could not find any study that outlines the factors for choosing a toothbrush among dental students.
The present study indicates that although appropriate self-care oral hygiene practice and behavior was observed in more than 50% of the participants, their awareness and behavior towards their self-care oral hygiene was inadequate and warrants improvement. Since majority of the students were from senior years, it is most essential to focus on acquiring appropriate knowledge, practice and more importantly sustain them forever. The cross-sectional nature of the study and certain degree of measurement error in reporting self-care oral hygiene practices were a few limitations associated with the present study.
Acknowledgement
We thank the students for their participation in this study.
Source of Support
Nil
Conflict of Interest
None
Supporting Files
References
- Oral Health: Prevention is key. Lancet 2009;373 (9657):1.
- Rahman B, Al Kawas S. The relationship between dental health behavior, oral hygiene and gingival status of dental students in the United Arab Emirates. Eur J Dent 2013;7:22-7.
- Khami MR, Virtanen JI, Jafarian M, Murtomaa H. Prevention-oriented practice of Iranian senior dental students. Eur J Dent Educ 2007;11:48-53.
- Bertolami CN. Rationalizing the dental curriculum in light of current disease prevalence and patient demand for treatment: Form vs. content. J Dent Educ 2001;65:725-35.
- Alam Moheet I, Farooq I. Self-reported differences between oral health attitudes of pre-clinical and clinical students at a dental teaching institute in Saudi Arabia. Saudi Dent J 2013;25:149-52.
- Al-Omari QD, Hamasha AA. Gender- specific oral health attitudes and behavior among dental students in Jordan. J Contemp Dent Pract 2005;6:107-114.
- Neerajaa R, Kayalvizhia G, Sangeethaa P. Oral health attitudes and behavior among a group of dental students in Bangalore, India. Eur J Dent 2005;5:163–167.
- Al-wesabi AA, Abdelgawad F, Sasahara H, El Motayam K. Oral health knowledge, attitude and behavior of dental students in a private university. BDJ Open 2019;5(1):1-5.
- Attin T, Hornecker E. Tooth brushing and oral health: how frequently and when should tooth brushing be performed? Oral Health Prev Dent 2005;3(3):135-40.
- Gupta S, Saxena S, Sikka N, Bhatia G. Oral health attitude, knowledge, and behavior of dental students of Jaipur, Rajasthan: A comparative study. J Indian Assoc Public Health Dent 2015;13:459-64.
- Daya D, Teja U, Paturu DB, Reddy BV, Nagarakanti S. Evaluation of oral-hygiene awareness and practice among dental students. J NTR Univ Health Sci 2017;6:24-8.
- Ahmad I, Qadri MM, Niazi M, Saleem T, Khalid, U. A survey of oral hygiene practices amongst dental students. Pak Orthod J 2017;9(1):50-55.
- Kaul V, Gupta N, Rathore PK, Kaul N. A comparative evaluation of oral hygiene practices and habits among medical & dental students in Ghaziabad district. Med Res Chron 2018;5(6):544- 555.
- Creeth JE, Gallagher A, Sowinski J, Bowman J, Barrett K. The effect of brushing time and dentifrice on dental plaque removal in vivo. J Dent Hyg 2009;83(3):111-6.
- Godha S, Dasar PL, Sandesh N, Mishra P, Kumar S. Impact of different oral hygiene aids for the reduction of morning bad breath among dental students: a crossover clinical trial. Clujul Med 2016;89(4):525–533.
- Bennadi D, Halappa M, Kshetrimayum N. Self-reported knowledge and practice of inter dental aids among group of dental students, Tumkur, India. J Interdiscip Dent 2013;3:159-62.
- Bashiru BO, Anthony IN. Oral self-care practices among university students in Port Harcourt, Rivers State. Niger Med J 2014;55(6):486–489.
- Efstratiou M, Papaioannou W, Nakou M, Ktenas E, Vrotsos IA. Contamination of a toothbrush with antibacterial properties by oral microorganisms. J Dent 2007;35(4):331-7.
- Frazelle MR, Munro CL. Toothbrush contamination: a review of the literature. Nurs Res Pract 2012;2012:420630.
- Pesevska S, Ivanovski K, Mindova S, Kaftandzieva A, Ristoska S. Bacterial contamination of the toothbrushes. J Int Dent Med Res 2016;9:6.
- Kumar G, Sethi AK, Tripathi RM, Pratik, Barman D. Assessment of knowledge, attitude, and practice of dental and medical interns toward toothbrush maintenance and replacement in Bhubaneswar City, Odisha, India. J Pharm Bioallied Sci 2018;10(2):77– 82.
- 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.
- Singh MS, Tuli AK. A comparative evaluation of oral hygiene practices, oral health status, and behavior between graduate and post-graduate dentists of North India: An epidemiological survey. J Int Soc Prev Community Dent 2013;3(1):19–24.
- Sowinski J, Petrone DM, Wachs GN, Chaknis P, Kemp J. Efficacy of three toothbrushes on established gingivitis and plaque. Am J Dent 2008;21:339-45.
- Kote S, Dadu M, Soumya AR, Aruna DS, Arora D. Knowledge, attitude and behaviour for choosing oral hygiene aids among students of management institutes, Ghaziabad, India. West Indian Med J 2013;62(8):758-63.
- Opeodu OI, Gbadebo SO. Factors influencing choice of oral hygiene products by dental patients in a Nigerian teaching hospital. Ann Ib Postgrad Med 2017;15(1):51–56.