|Year : 2014 | Volume
| Issue : 1 | Page : 25-29
Oral health attitudes and behavior among a group of female Saudi dental students
Mohammad Abdul Baseer1, Ghousia Rahman2
1 Departments of Community and Preventive Dentistry, Annamuthajiya Campus, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia
2 Departments of Periodontics and Dental Hygiene, Annamuthajiya Campus, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia
|Date of Web Publication||2-Jan-2014|
Mohammad Abdul Baseer
Department of Community and Preventive Dentistry, Riyadh Colleges of Dentistry and Pharmacy, King Fahad Road Campus, P. O. Box: 84891, Riyadh 11681
Source of Support: None, Conflict of Interest: None
Aim: Aim of the present study was to evaluate the oral health attitudes and behavior of female undergraduate dental students in Kingdom of Saudi Arabia, according to age and level of dental education.
Materials and Methods: A self-administered questionnaire based on the Hiroshima University - Dental Behavior Inventory (HU-DBI) was distributed among 351 dental students at Riyadh colleges of dentistry and pharmacy.
Results: A response rate of 88% was obtained. The mean HU-DBI score did not show any significant relationship (P < 0.05) with age and academic level dental education by one way-analysis of variance (ANOVA). The students were considerably concerned about the appearance of their teeth and gums and halitosis. The total mean score was not markedly higher in the clinical levels (level 7 to level 12) than in the non-clinical levels (level 1 to level 6), indicating that the students were almost equally aware. The present study showed that dental students in Saudi Arabia had poor oral health awareness.
Conclusion: The oral health behavior of Saudi dental students needs to be improved in order to serve as a positive model for their patients and the community.
Keywords: Attitude, behavior, dental education, dental students, female, Saudi Arabia
|How to cite this article:|
Baseer MA, Rahman G. Oral health attitudes and behavior among a group of female Saudi dental students. Saudi J Oral Sci 2014;1:25-9
| Introduction|| |
Dolan defined oral health as a comfortable and functional dentition that allows individuals to continue their social role.  Oral health is a highly individualized concept, the perception of which is very much affected by an individual's culture and socio-economic status. The attitude of people towards their own teeth, and the attitude of dentists who provide dental care, play an important role in determining the oral health condition of the population.  Students studying dentistry are generally expected to have good oral health. There is evidence to suggest that the oral health knowledge and behavior of dental students varied in the clinical and pre-clinical years of dental education.  Moreover, the oral health attitudes and behavior of dental students vary in different countries and cultures. ,
Dental students act as a role model for oral health by choosing dentistry at the undergraduate level. Certain studies have dealt with the attitude and behavior of dental students in motivating patients for oral health care.  Moreover, little is known about the influence of clinical training and course content on the development of the oral health behavior of dental students.
The ministry of higher education governs dental education in the Kingdom of Saudi Arabia. Based on the guidelines prescribed by the ministry of higher education, the dental curriculum is developed and followed both in the private and government dental universities. The Riyadh Colleges of Dentistry and Pharmacy was the first private university in which dental education was offered for six years with twelve levels followed by one year of internship program. Each level consisting of six months and each year is divided into two semesters of six months. Preclinical subjects and preparatory health science subjects were taught during the first seven levels of dental education. Students start their clinical posting during the level seven. Usually, preventive dentistry topics will be taught during the seventh academic level.
There is no universally accepted or recommended index or inventory to measure dental health attitude and behavior. Of the many questionnaires available, the Hiroshima University- Dental Behavioral Inventory (HU-DBI) questionnaire developed by  Kawamura et al. has been demonstrated to be useful for assessing patient's perceptions and oral health behavior. The HU-DBI also retains excellent psychometric properties after translation into English, and no apparent deficiency found in the translated version. 
The purpose of the present study was to use the HU-DBI to explore the dental health attitudes and behavior of female dental students in Riyadh Colleges of Dentistry and Pharmacy as correlated to demographic variables.
| Materials and Methods|| |
The English translation of HU-DBI was used in the present study, and data was collected during first semester of academic year 2010-2011 during the month of January to March 2011. The survey was conducted among dental students from Riyadh colleges of dentistry and pharmacy, An-Namuthajiya campus. Ethical clearance was obtained from the Ethical Committee for Research of the Riyadh Colleges of Dentistry and Pharmacy.
The survey was based on a collection of responses to a 20-item questionnaire. Students from all academic levels (from level-1 to level-12) were approached in their respective classroom at the end of lecture. Of a total of 400 questionnaires distributed, 351 students completed the questionnaire and returned it back giving a response rate of 88%. Participation in the study was voluntary. Students were allowed to ask questions regarding the meaning of words in the Arabic language, and the answers to such questions were announced to all other students. The survey was completed anonymously.
The Hiroshima University-Dental Behavioral Inventory (HU-DBI) questionnaire, consists of 20 items in a dichotomous response format (agree/disagree). A quantitative estimate of oral health attitude and behavior is provided by the total appropriate agree/disagree responses. The maximum possible score is 12. Higher scores indicate better oral health attitude and behavior. The mean HU-DBI scores were compared across the level of study using the one-way analysis of variance (ANOVA). The SPSS ver. 19 statistical program (IBM Inc. Armonk, NY, USA) was used to process and analyze the data. The level of significance for all statistical tests was set at 0.05.
| Results|| |
All the participants in the present study were females. The majority of the participants were from academic level 7 while the least were from the level 12 [Table 1]. Most participants were between 18 and 21 years of age [Table 2].
|Table 2: Mean age of respondent participants in each level of dental education |
Click here to view
A majority (59.5%) of dental students agreed with the statement "I don't worry much about visiting the dentist" (Item 1). Bleeding gums (Item 2) were reported in 36.8% of the participants; 53.3% answered that it was impossible to prevent gum disease with only tooth brushing (Item 14); and 50.1% reported that they postponed going to the dentist until they had a toothache (Item 15) [Table 3]. In addition, 58.1% of the students felt that they sometimes took too much time to brush their teeth (Item 19). A higher response of "agree" for Item 3 ("worry about color of teeth" (86%), Item 12 ("Checking the teeth in the mirror after brushing"; 78.6%) and Item 13 ("worrying about bad breath"; 76.6%) was found [Table 3].
|Table 3: HU-DBI questionnaire comparing the responses of clinical and pre-clinical students |
Click here to view
Level 1-6,, level 9 and level 12 dental students showed higher concerns for Item 3 ("worry about color of teeth") as compared to other items. Level 7 and level 11 students showed high responses to Item 12 ("often check my teeth in a mirror after brushing"). Level 8 dental students gave higher response to Item 13 ("worrying about bad breath"). Majority of the Level 10 students showed higher response to Item 1("I don't worry much about visiting dentist") compared to other students for the selected 12 HU-DBI score [Table 3].
| Discussion|| |
Dental students are future oral health professionals, it is mandatory for them to know about the prevention of oral diseases. The basic requirement for this is to assess the existing oral health knowledge of the patients and then raise their awareness especially with prevention of common oral diseases. While providing oral health education, dental students may play an important role to influence the attitude and behavior of the patients and community at large. Keeping this in mind a cross-sectional study was conducted to assess oral self-care attitudes and behavior among the female dental students.
Preventive activities are influenced by three factors: thoughts (beliefs, values, expectations) social environment (inter-personal interactions) and individual ability. ,, However, to follow directions given by the dentist, patients need to believe that they are exposed to the disease, that the disease is serious, and that they can get benefited from the dentist's efforts.  In order to give effective preventive care therefore it can be safely assumed that dentists would themselves need to satisfy all the above three conditions.
There is a lack of literature on self-reported oral health attitudes and behaviors among dental students from Saudi Arabia. This study is of prime importance in this field as it is the first to explore this area among the undergraduate female dental students from private dental university. The response rate of the students who participated in the study was adequate. A total of 351 female undergraduate students from different levels available during the time of survey were considered only. No effort was made to collect the information from the students who were absent during survey days. Undergraduate students who participated in the study learn preventive dentistry and oral health education during level 7 according to university curriculum.
Clinical dental students did not show a significantly higher dental awareness score when compared to pre-clinical dental students; however, they did score slightly higher. This minor difference may be because of their previous experiences with preventive dentistry learnt during clinical levels, which increases the student's attitude and behavior towards personal oral health.
A study by Ostberg et al.  found that females engage in better oral hygiene behavioral measures, possess a greater interest in oral health and perceive their own oral health to be good to a higher degree than males. Kassak et al.  found that the female university students have better habits in terms of tooth brushing than male students, while some studies found that females visited their dentists and brushed their teeth more often than males. , In the case of dental students a recent study in Turkey showed that female dental students had significantly better oral health attitude and behavior than their male colleagues.  However, a study by Tseveenjav et al.  did not show any significant difference in oral health attitude and behavior of male and female Mongolian dental student. Since the present study included only female undergraduate students; gender difference was not a factor for comparison.
The dental students in this study were particular about the appearance of their teeth, gums, halitosis and looking in the mirror after brushing. Similar findings were reported among Chinese dental students by Komabayashi et al.  In the present study, 86% of the students were worried about the appearance of their teeth. Similar studies among dental students in Jordan  (66.9%); and India  (68.1%) reported lower levels of concern with appearance.
The present study showed a higher score for "My gums tend to bleed when I brush my teeth" (Item 2) as compared to the studies conducted by Dagli et al.  and Neeraja et al.,  (31.6%) among Indian dental students, respectively, and that of Peker and Alkurt, 2009, among Turkish dental students. Similarly the item "I have noticed some white sticky deposits on my teeth" (Item 4) was scored 24.2% by dental students in the present study which is lower than the scores reported by Dagli et al.  and Neeraja et al.  among Indian dental students, but higher than that reported by  among Turkish dental students. This indicates that dental students in different countries have variable oral hygiene practices, but these practices are better than the general population due to better oral health attitude and behavior. 
Nearly half of the respondents had never been professionally instructed on how to brush their teeth (Item 10), and half of the participants said that they would postpone going to the dentist until they had a toothache (Item 15). This indicates lacunae in the existing knowledge of preventive dentistry among the dental students. Therefore, an accurate practical knowledge of preventive activities should be provided and significance of regular visits to the dentist needs to be emphasized. So that the well-informed oral health professional about preventive activities will make big change in the individual's knowledge, attitude and practices affecting society at large.
There may be a bias associated with few items of uncertainty leading to increased positive responses. Almost 70% of the participants said that they brushed their teeth carefully. This does not imply that all people who agreed with this statement did it so. There may be some possibility of measurement error connected with self-reported behavior. The main purpose of the HU-DBI is to measure dental behavior as a whole to compare the data from different populations. The Analysis of Variance (ANOVA) was applied for 12 HU-DBI questions only; the remaining questions were used to evaluate overall oral health attitude and behavior.
In the present study, age was not a significant factor affecting attitude and behavior of female dental students while assessing it with HU-DBI. This result is in agreement with the other previous studies involving Greek, Japanese, Finnish and Chinese dental students ,, and in contrast with the study reported among Indian dental students by Dagli et al.,  where in a statistically significant results were observed with age and HU-DBI.
The effect of socio-economic status and grade point average (GPA) can also be a factor affecting the HU-DBI score, which was not evaluated in the present study. Study subjects were comprised of female students who belonged to all socio-economical strata studying in private dental university. HU-DBI was tested on a relatively small group of female students, which could be a limitation. A further study involving a larger group of male and female dental students from private and government universities might reveal stronger relations than those reported here. A problem arises when cross-sectional studies of different groups are compared. These studies are not uniform in their original design, and include different age groups for males and/or females. It is difficult to assess knowledge with brief instruments, such as the one adopted herein, and draw firm distinctions from attitudes and beliefs.
| Conclusion|| |
The findings of the present study revealed the relatively poor oral health behavior of female dental students studying at Riyadh Colleges of Dentistry and Pharmacy. There is a need to emphasize on prevention-oriented dental educational activities for improving the dental health behavior of students; so that they can be a positive role model for their patients and communities in which they serve.
| Acknowledgments|| |
We would like to thank female undergraduate dental students of Riyadh Colleges of Dentistry and Pharmacy who participated in the present study and we also would like to thank Fatima Al Khamees and Hawra Al Zayr, dental hygiene interns for their help during the study.
| References|| |
|1.||Dolan T. Identification of appropriate outcomes for an aging population. Special care dentistry 1993;13:35-9. |
|2.||Davis P. Social context of dentistry. London: Elsevier; 1980. |
|3.||Polychronopoulou A, Kawamura M, Athanasouli T. Oral self-care behavior among dental school students in Greece. J Oral Sci 2002;44:73-8. |
|4.||Kawamura M, Honkala E, Widström E, Kobayashi T. Cross-cultural differences of self- reported oral health behavior in Japanese and Finnish dental students. Int Dent J 2000;50:46-50. |
|5.||Kawamura M, Yip HK, Hu DY, Kobayashi T. A cross-cultural comparison of oral attitudes and behavior among freshman dental students in Japan, Hong Kong and West China. Int Dent J 2001;51:159-63. |
|6.||Frazier PJ. Public health education and promotion for caries prevention: the role of dental school. J Public Health Dent 1983;43:28-41. |
|7.||Kawamura M, Iwamoto Y. Present state of dental health knowledge, attitudes/behavior and perceived oral health of Japanese employees. Int Dent J 1999;49:173-81. |
|8.||Tedesco LA, Keffer MA, Davis EL. Social cognitive theory and relapse prevention: reframing patient compliance. J Dent Educ 1991;55:575-81. |
|9.||Tedesco LA, Keffer MA, Fleck-Kandath C. Self-efficacy, reasoned action, and oral health behavior reports: a social cognitive approach to compliance. J Behav Med 1991;14:341-55. |
|10.||Wardle J, Steptoe A. The European Health and behavior Survey: rationale, methods and initial results from the United Kingdom. Soc Sci Med 1991;33:925-36. |
|11.||Barker T. Role of health beliefs in patient compliance with preventive dental advice. Community Dent Oral Epidemiol 1994;22:327-30. |
|12.||Ostberg AL, Halling A, Lindblad U. Gender differences in knowledge, attitude, behavior and perceived oral health among adolescents. Acta Odontol Scand 1999;57:231-6. |
|13.||Kassak KM, Dagher R, Doughan B. Oral hygine and lifestyle correlates among new undergraduate university students in Lebanon. J Am Coll Health 2001;50:15-20. |
|14.||Fukai K, Takaesu Y, Maki Y. Gender differences in oral health behavior and general health habits in an adult population. Bull Tokyo Dent Coll 1999;40:187-93. |
|15.||Sakki TK, Knuuttila ML, Anttila SS. Lifestyle, gender and occupational status as determinants of dental health behavior. J Clin Periodontol 1998;25:566-70. |
|16.||Peker I, Alkurt MT. Oral health attitude and behaviour among a group of Turkish dental students. Eur J Dent 2009;3:24-31. |
|17.||Tseveenjav B, Vehkalahti M, Murtomaa H. Preventive practice of Mongolian dental students. Eur J Dent Educ 2000;6:74-8. |
|18.||Komabayashi T, Kwan SYL, 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.||Al-Omari QD, Hamasha AA. Gender-specific oral health attitudes and behavior among dental students in Jordane. J Contemp Dent Pract 2005;1:107-14. |
|20.||Dagli RJ, Tadakmandla S, Dhanni C, Duraiswamy P, Kulkarni S. Self reported dental health attitude and behavior of dental students in india. Journal of oral scieces 2008;50:267-72. |
|21.||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. |
[Table 1], [Table 2], [Table 3]