Evaluation of oral health attitude and behavior among a group of dental students in Puducherry, India: A preliminary cross-sectional study.

CONTEXT: Oral behavior reflects individual perception on oral health. Behavior and attitude of oral health providers, especially dentists, towards oral health affect their capacity to deliver oral health care services. This attitude plays a important role in determining the oral health condition of population. AIM: The purpose of this study is to evaluate the oral health attitude and behavior among a group of dental students in India and to find any gender-based differences in terms of oral health attitude and behavior.
MATERIALS AND METHODS: A total of 282 dental students of Indira Gandhi Institute of Dental Sciences, SBV University, Puducherry, India participated in the study. A simplified English version of Hiroshima University Dental-Behavioral Inventory (HU-DBI) was adopted. STATISTICAL ANALYSIS USED: SSP version 2.80 software was used to analyze the data. Chi-square test was used to find the differences in the distribution of "yes" among students from the different academic year as well as between male and female students. Statistical significance was set at P ≤ 0.05.
RESULTS: Statistical significance was observed for the responses between the students from different academic years brushing frequency, careful brushing of teeth, using brush with hard bristles, careful self-evaluation of brushing and satisfied appearance of teeth and gums. Male students preferred to use a tooth brush with hard bristles and regular mouth washes than female students. With regards to worrying about bad breath, male students had more "yes" responses than females.
CONCLUSIONS: Oral health attitude and behavior increased with the increasing levels of dental education, and no significant differences were observed among male and female dental students.

INTRODUCTION

Steptoe et al. defined health behavior as “the activities undertaken by people in order to protect, promote or maintain health and to prevent disease.[1] The broad categories of factors influencing health behavior at individual as well as community level include: Knowledge, beliefs, values, attitudes, skills, finance, materials, time and the influence of family members, friends, co-workers, opinion leaders, and even health workers themselves.[2]

Oral behavior reflects individual perception on oral health. Numerous studies have found oral behavior to vary from among people of different countries and communities.[3] Current disparities in oral health are also attributed to, socioeconomic status, profession, and even levels of education.[456]

Since male and female have a different psychological approach, oral health attitude also defers among gender. Studies on students from different universities found better oral health behavior and practices among female students as compared to male students.[789]

Behavior and attitude of oral health providers, especially dentists, toward oral health affect their capacity to deliver oral health care services.[6] Dental students, in general, have been motivated to maintain a good health attitude.[10] This attitude plays an important role in determining the oral health condition of the population.[11] Development of positive attitude among dental students had been shown to increase with undergraduate and postgraduate exposure.[12]

In lieu of the above, this study aims at determining the gender and education level based oral health attitude and behavior among group of dental students in Puducherry, Union Territory, India.

MATERIALS AND METHODS

This study was conducted by adopting a simplified and modified English version of Hiroshima University-Dental Behavior Inventory (HU-DBI).[13] The inventory is designed with a simple dichotomous response format (Yes/No) [Table 1].

Table 1

Inventory

This study was conducted in Indira Gandhi Institute of Dental Sciences, SBV University, Puducherry, India. The study sample included all the dental students from the five academic years. A total of 282 dental students, 63 male and 219 female participated in the study. Participation in this study was voluntary. All participants were informed about the purpose of the study and how to fill the inventory. They were asked to answer all the items of the inventory and an investigator was available to answer any enquiry regarding the inventory.

The null hypothesis in this study was that there is no gender and education level based difference in oral health attitudes/behavior among dental students. SSP version 2.80 (IBM SPSS Inc, New York) software was used to analyze the data. The Chi-square test was used to find the differences in the distribution of “yes” among students from the different academic year as well as between male and female students. Statistical significance was set at P ≤ 0.05.

RESULTS

Of 282 students present on the day of the survey, all completed the questionnaire. The response rate of 100% was observed. The age of students ranged between 18 and 22 years. The distribution of this study sample over the five academic years is shown in Table 2. Male to female ratio was 1:3.5.

Table 2

Distribution of students by academic year and gender

Table 3 represents the distribution of the percentage of “yes” responses, according to the year of study. The results showed that the % of yes was very low among the students of the 1st year and as the years of education advanced the positive reply also increased. From the response to #1, it was surprising to know that 38% of dental students never bothered to visit a dentist and brush their teeth only once. 56% of total dental students visited the dentist only when they had toothache (#14). 49% of total students were not bothered about teeth color (#9), and interestingly 62% were not bothered about the color of gums (#10). About 20% of students self-reported bleeding in gums during brushing (#11). Only 64% of total dental students were satisfied with the appearance of teeth and gums (#15). Statistical significance was observed for the responses between the students from different academic years for the following questions: #1–3, #5–6, #11, and #14–15.

Table 3

Percentages and analysis of “yes” responses according to years of study

Table 4 shows the distribution and comparison of “yes” responses between male and female students. Highly significant results were observed with regards to questions: #5, #12, and #13.

Table 4

Percentages and analysis of “yes” responses according to gender

Male students preferred to use toothbrush with hard bristles and regular mouth washes than female students. With regards to worrying about bad breath, male students had more yes responses than females.

DISCUSSION

One of the noted factors influencing the oral health condition of the population is the attitude of dentists, who play the primary role in providing dental care.[11] A dental student's self-awareness of oral health, highly impacts reflects his/her attitude for patient education in creating oral awareness in general population.[5] Assessment of oral health attitude and behavior has previously been assessed in different populations and cultures.[1214151617] Due to lack of studies about oral health attitudes and behavior among dental students in India, this study is of prime importance in this field.

In this study, gender-based the oral health attitudes and behavior among dental students of different academic years was compared. This is the first study to do a cross-sectional analysis of dental attitudes and behavior among dental students in Puducherry state, India. Dental students from Indira Gandhi Institute of Dental Sciences, SBV University, Puducherry participated in the study. This study adopted a simplified English version of HU-DBI.

A total of 282 dental students present on the day of the survey were included in the study. The questionnaires were handed out, and an investigator remained to clarify any doubts regarding the questions. The response rate was observed as 100%.

Several studies[14181920] reported improvement in dental health attitudes with increasing level of education. In studies conducted among dental students in Jordan[19] and Australia,[20] dental education experience definitely improved the health attitudes and behavior with more positive attitudes found during the 4th and 5th year of dental education.

In this study, statistically significant difference was found for improvement in dental visits, the number of time they brush and a how carefully they brush (P < 0.05). Again there was the notable difference for using toothbrush with hard bristles and checking the teeth in the mirror after brushing. Interestingly, the reports of bleeding gums increased with the senior years (P = 0.001). Conversely, this might indicate an increase in awareness with education levels. The satisfaction of appearance of the teeth also increased with the year of study (P = 0.001).

In general, female engage in better oral hygiene behavior measures and studies have reported the females possess a greater interest in oral health and perceive their own oral health care to a higher degree than males.[7] Studies conducted in Lebanon, Thailand, and Malaysia, have also found that female university students have better habits in term of tooth brushing than male students.[8921] However, in this study, no highly significant differences were noted among male and female students.

More male students used hard bristled toothbrushes than female students (33% vs. 17%). Percentage of male students using mouthwash was greater as compared to female students (35% vs. 21%). However, surprisingly, it was male students who were more worried about bad breath (38% vs. 23%). Again this might explain the increased use of regular mouth rinses among this group.

This study did not show any statistical difference between male and female students with respect to oral health attitude or behavior. This is also consistent with studies on Japanese and Mongolian dental students.[2022] Same results were observed in group of dental students from Rajasthan, India. However in a study done among dental students in Israel female students exhibited better attitude and behavior than male students.[23] The authors attribute this to different physiological and psychological behaviors among the gender. This might reflect on their oral health as well.

In another study, oral health knowledge and behavior of clinical medical, dental, and paramedical students in Karnataka were compared and concluded that oral health knowledge and attitude was high among the dental students as it is significant part of their professional education.[24]

Comparing the results of this study with student studies among dental students of other countries, Indian dental student need more self-awareness about oral hygiene practices. Another study has also pointed out that, dental students in India had poorer oral hygiene awareness compared to several other countries.[5]

Few differences found among the results from different countries, and Indian students might be due to differences in concepts regarding health and disease between the countries in the east and the west. In Asia, most health beliefs and practices are learned and practiced in the home, and professional help is only sought when home remedies fail.[25] This strong reliance on self-care may undermine the effectiveness of organized oral health care and delaying dental visits or considering them unnecessary.

CONCLUSIONS

The results showed that the dental attitude and behavior among dental students significantly improved with the level of education. We also found no gender-based difference among the students with regards to oral health attitude and behavior. However, further clinical studies are needed to access the real oral hygiene status of the dental students.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.