|Ahead of print publication
Oral health knowledge and practices among healthcare students of Al-Jouf province, Saudi Arabia
Josna Vinutha Yadiki, Faris Alturqi K. Alruwaili
Department of Preventive Dentistry, College of Dentistry, Jouf University, Kingdom of Saudi Arabia
|Date of Submission||16-Dec-2020|
|Date of Decision||27-Oct-2021|
|Date of Acceptance||23-Feb-2022|
|Date of Web Publication||04-Oct-2022|
Josna Vinutha Yadiki,
Lecturer in Pediatric Dentistry, Department of Preventive Dentistry, College of Dentistry, Jouf University
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Aim of the Study: Oral disease has an inverse relationship with good oral health practices. The present study was aimed at assessing the level of oral health knowledge and practices among healthcare students of Al-Jouf province, Saudi Arabia.
Methodology: All male and female students from the first to the fifth year of studying in different colleges (medical, dental, and college of allied health sciences) in Jouf University were included as the study sample. The study included 20 structured questions. Among the 20 questions, 12 related to oral health practices and 8 related to oral health knowledge.
Results: Chi-squared test was used to determine the association among variables, and Pearson correlation analysis was used to determine the correlation between the scores of oral health knowledge and oral health practices. One-way analysis of variance (ANOVA) was done to see if there was any statistically significant association (P > 0.05) of knowledge and practice scores with level, gender, and college of study. The overall mean oral health knowledge score was 4.9 ± 2.3. The range for oral health practice score was from 0 to 12, and the overall mean score was 6.8 ± 2.9.
Conclusion: Our observations concluded that the overall knowledge level of the students toward oral health was low, and visiting a dentist for regular dental checkup were not given importance by the students. Health practices of students and their knowledge towards oral health determines what and how they educate their patients in the future to create better oral health in society.
Keywords: Healthcare students, oral health, Saudi Arabia
| > Introduction|| |
Oral health is an important component of overall health and psychological wellbeing. It helps a person to chew, bite, smile, and speak without discomfort. Oral health affects people physically and psychologically and influences their feelings of social wellbeing.
According to FDI World Dental Federation General Assembly, “Oral health is multifaceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow, and convey a range of emotions through facial expressions with confidence and without pain, discomfort, and disease of the craniofacial complex.”
Oral diseases are recognized globally as a public health concern and affect almost 3.9 billion people worldwide. Oral health knowledge is considered to be crucial for developing healthy behaviors, and it has been shown that there is an association between increased knowledge and better oral health. There has been an increased emphasis on the educational approach in the prevention and control of oral health problems throughout the world. Poor oral hygiene practices lead to the development of different types of oral diseases. Healthy oral health practices, such as brushing, flossing, and periodic dental visits should be maintained by everyone throughout their life.
Conducting health promotional programs may have a greater impact on parents and school children, but may not have an impact on university students. As healthcare students are future health professionals, having oral health knowledge and practices is crucial. The level of oral health knowledge and practices of graduates is unknown and worthy of investigation. Before they are trained, there is a need to determine the status of their own oral health knowledge and practices.
Several studies have been done on school students, nurses, health professionals, parents, and dentists to assess their oral health knowledge and practices, but very few studies have been done on healthcare students in Saudi Arabia. Hence, the present study is planned to assess the oral health knowledge and practices among healthcare students of Al-Jouf province, Saudi Arabia.
Aim and Objective: The aim and objective of the study is to assess the level of oral health knowledge and practices among healthcare students of Al-Jouf province, Saudi Arabia.
| > Materials and Methods|| |
A cross-sectional study was conducted among healthcare students of Jouf University. The participants were invited by sending a mail and informing them verbally. All male and female students from the first to the fifth year of study in different colleges (medical, dental, and college of allied health sciences) in Jouf University were included in the study sample.
Survey sampling method was used. As there were no study groups, no randomization was done for sample selection. Interns were excluded to eliminate selection bias considering they have enough oral health knowledge. The students who were not willing to participate in the study were excluded. No clinical examination was conducted. The study was conducted in the months of November and December 2019. Ethical clearance was obtained from Research and Ethics committee of Jouf University.
Data was collected through a self-administered questionnaire which was previously used in a study done by Jegede et al. in 2016. The questionnaire's validity and reliability had been reported by Folayan et al. As the participants were university students, the questionnaire was used in English language. The questionnaire has 20 structured questions. Among those 20 questions, 12 were related to oral health practices and 8 were related to oral health knowledge. Tooth brushing practices, flossing, diet, and utilization of dental services were included in the questionnaire. Each question had a range of 3–5 options from which the participants chose the best that described their practices or knowledge. Scoring (0 for incorrect answer and 1 for correct answer) was given to assess the knowledge and practices of participants. Minimum score was 0 and maximum score 8 for oral health knowledge whereas minimum score was 0 and maximum score 12 for oral health practices.
Data was collected in an Excel sheet and analyzed using SPSS software. College of the study, student's year of study, and gender were assessed as predictors, and the outcome was oral health knowledge and practice scores. Chi-squared test was used to determine association among variables and Pearson correlation analysis was used to determine the correlation between the scores of oral health knowledge and oral health practice. One-way analysis of variance (ANOVA) was done to see if there was any statistically significant association of knowledge and practice scores with level, gender, and college of study. A P value of less than 0.05 was considered significant. As the number of participants was unequal in each variable and to eliminate confounding, homogenous subsets were made to determine the harmonic mean sample size for level, gender, and college. Multiple comparisons using post-hoc Tukey HSD were run to determine the significant difference between the outcome variables.
| > Results|| |
A total of 1,219 students from all colleges filled the questionnaire. 74 (6.1%) were from the first year, 217 (17.8%) were from the second year, 190 (15.6%) from the third year, 159 (13%) from the fourth year, and 579 (47.5%) from the fifth year [Table 1] and [Figure 1]. The students comprised of 989 males (81.1%) and 230 females (18.9%).
|Figure 1: Distribution of participants according to the college of study|
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The range for oral health knowledge score was from 1 to 8. The overall mean oral health knowledge score was 4.9 ± 2.3. The range for oral health practice score was from 0 to 12 and the overall mean score was 6.8 ± 2.9 [Table 2] and [Figure 2].
On comparing it with different colleges, there was highly significant difference (P < 0.001) in both knowledge and practice scores. The mean knowledge and practice scores were highest for the college of dentistry with 6.7 ± 2.6 and 10.8 ± 1.8, respectively, and lowest for the college of pharmacy with 4.5 ± 2.1 and 5.4 ± 2.3, respectively.
The mean knowledge scores and practice scores were not significant (P > 0.05) among different level of students from first year to fifth year. The mean knowledge and practice scores were higher for females with scores 5.2 ± 2.2 and 8.1 ± 2.7, respectively, when compared with males who had scores 4.8 ± 2.4 and 6.5 ± 2.9, respectively [Table 3] and [Figure 3], [Figure 4].
|Table 3: Oral health practice score and knowledge score according to level, gender and college|
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|Figure 3: Mean Oral health practice scores according to level, gender and college of study|
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|Figure 4: Mean oral health knowledge scores according to Level, Gender and College of study|
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The questionnaire responses for oral health practices revealed that only 41.9% of the students brushed their teeth twice a day. Only 35.1% of the students brushed their teeth either after every meal or morning after meal and night before bed. 66.4% of the students changed their tooth brush every 2–3 months. Overall, 56.8% of the students used floss. 79.4% of the students responded that they quite often ate a sugar containing snack or drink (other than tea and coffee) between meals. Only 47.7% of the students responded that they went for a dental checkup once every six months or once in a year. [Table 4].
Regarding oral health knowledge, the findings revealed that regarding the question about frequency of brushing, changing tooth brush, and the type of the tooth brush to be used, 80.5%, 63.3%, and 50.7% of the students, respectively, responded correctly. Regarding flossing techniques, 61.3% of the students had knowledge that flossing should be done after every meal and night before sleep. 54.6% of the students had knowledge about rinsing mouth or brushing after eating refined carbohydrates. 66.3% responded that the regular dental checkup to prevent dental caries every six months or one year was necessary [Table 5].
The study showed that even though 66.3% of students knew the importance of regular dental checkup, only 47.7% of students visited the dentist every six months or once in a year.
| > Discussion|| |
Oral health is the window to our overall health and wellbeing. Exposure to good oral health knowledge and practices is very important, especially for future healthcare professionals. There are different colleges of health sciences like medicine, dentistry, applied health sciences, and pharmacy. Though students study health sciences, education and training might influence their oral health. Hence understanding the oral health knowledge and practices of students in different colleges was worthy of investigation before they finish their training. Several studies, have been done to know the oral health among males and females, and females had good oral health knowledge compared to males. According to the previous studies, final-year medical students had a significantly higher score of oral health knowledge, attitude, and behavior than their first year counterparts.
In the present study, effort was made to understand the level of oral health knowledge and practices of male and female students from the first year to the fifth year of study, in different colleges of health sciences.
Oral health knowledge is associated with better oral health practices. The attainment of good oral health needs acquisition of knowledge about oral disease prevention, having acceptable oral health behavior such as oral and dental hygiene, restriction of sugar products, use of fluoride products, and utilization of dental services. Preventive oral health practices include regular, twice daily conscious cleaning of the teeth, dental flossing, decreased intake of sugar between meals, and regular attendance at the dental clinic, at least once every year.
Our observations concluded that the overall knowledge level of the students toward oral health was low, which is similar to the study done by Abate et al.
Results from the present study showed that there was highly significant difference in both knowledge and practice scores among different colleges. Exposure to oral health–related curriculum and teaching could be the reason for the higher oral health knowledge and practice scores in students of college of dentistry. The results of a previous study conducted among the university students of different colleges in Saudi Arabia and India had a similar finding. According to Baseer MA et al., oral health practices were influenced by education and type of training received during health professional courses, which is similar in this study.
On evaluating the knowledge and practice scores among different levels of students from first year to fifth year, the mean knowledge scores and practice scores were not significant. This finding is different from those reported in the previous studies done in India and Nigeria where older students had better oral health, attitude, knowledge, and practice as compared to younger students.
According to Ahmed FA et al. and Al-Wesabi et al., the oral health knowledge, attitude and behaviour improved with increasing academic levels. This indicates that all healthcare students who participated in this study had almost similar oral health knowledge and practices.
On analyzing the gender differences, the mean knowledge and practice scores were higher for females when compared with males, which is in agreement with the results of similar studies by Al Omari et al., Al-Jawfi AK et al., Farsi NJ et al. and Kumar H et al. This could be explained by the fact that females had positive self-oral health care to improve their esthetics. The results of the present study were in contrast with other studies by Khami et al. and Baseer MA et al. in which gender differences were not found in the knowledge of senior Iranian dental students.
The level of oral health knowledge regarding brushing of teeth twice a day or after meals was more among all the study participants (80.5%) when compared to all other questions; but the practices were poor, such as brushing once a day in the morning either before meal or after meal which indicates that most of the healthcare students were aware of brushing habits but were did not follow them. This might be due to the reason that students did not have enough time to brush their teeth twice a day or after meal. The results coincided with a study done by Baseer MA et al. in which 77.9% of the health professionals brushed their teeth once in the morning. Another study by Gualie YT et al. concluded that the knowledge on oral hygiene was good, but the practices were poor. Our observations vary from those of Kumar H et al. and Al Omari et al. that a higher number of students brushed their teeth twice daily.
Brushing and flossing are equally important for complete cleanliness of teeth. Flossing should be started as soon as possible when there is contact between the teeth. The least number of correct responses (41.1%) were given for the question “When should dental flossing begin,” which could be because of lack of knowledge regarding dental floss. But 56.8% of the students were using dental floss. The results contradict the findings of the study conducted by Al Subait A et al. where more than half of the students had knowledge regarding brushing and flossing.
Among oral health practices, the least number of correct responses were given for the question “How often do you eat a sugar containing snack or drink (other than tea and coffee) between your meals in a day” (20.6%) and “Which of the following do you often take between meals” (27%). This indicates that students were having sugar containing snacks or drinks between their meals once or twice a day or quite often, which leads to dental caries. The results were similar to a study done by Folayan et al. In the present study, 81% of the students had decayed, missing (due to caries), and filled teeth. This could be due to the fact that the students were having readily accessible sugary snacks and drinks during their college hours as well as not practicing proper brushing habits.
To maintain optimal oral health, the American Dental Association (ADA) recommends regular dental visits at intervals determined by a dentist. Despite having knowledge about the necessity of regular checkup for prevention of dental caries, most of the students (52.3%) were not giving importance to dental checkup and to visit the dentist if they did not have a dental problem. The results of our study coincided with the findings of Al Tayar et al., that an adequate level of knowledge and practices of oral health was apparent but regular visits to the dentist was low.
Poor oral hygiene can have a detrimental effect on the overall health and quality of life of an individual. The importance of the present study is that the health practices of students and their knowledge of oral health determines what and how they educate their patients. Answering multiple choice questions about oral health might have a greater impact on the student's behavior to change their oral hygiene habits. The students might be influenced by the questions to avoid sugary snacks and drinks in between meals to protect their teeth from dental caries, which is an advantage of performing this study.
The limitations of the present study are self-reported data obtained from the participants who might have given incorrect answers and that the dental examination was not performed. The dental examination along with the questionnaire could have given accurate information to compare their knowledge with their oral health status.
Further long-term studies by conducting dental examination along with pre– and post–oral health education questionnaire to evaluate the student's oral health knowledge, practices, and oral health status among healthcare students of different colleges would be beneficial.
| > Conclusion|| |
Despite having good knowledge of oral health, brushing practices were not followed by the students in the present study. Visiting a dentist and regular dental checkup were not given importance by the students, which is particularly necessary for all healthcare students. Hence, oral health awareness among healthcare students during their training period helps to improve the oral health of society.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]