Awareness, knowledge and behavior of medical students and teachers towards oral hygiene-

A questionnaire study

 

Abstract               Background: The aim of the study is to evaluate and compare the awareness, knowledge and behaviour of medical students and teaching staff towards oral health. Materials and Method: A cross sectional questionnaire survey was conducted among 192 medical trainees and teaching professionals in Nanded. The study sample consisted of 60 interns, 40 Postgraduate trainees and 80 teaching faculty. They were asked to answer a questionnaire that contained 21 questions regarding awareness, knowledge and behaviour towards oral health. Responses were collected and the data analysis was done.Descriptive statistics and Pearson’s Chi square test were performed for the comparison of the correct responses among the groups. Results: Majority of medical students were practicing good oral hygiene methods. 46.6% of the interns, 82.5% of the PG’s and 95% of faculty knew that scaling does not have any adverse effect on teeth (P<0.001). Almost 62% of the sample is not sure about how much amount of toothpaste is needed for brushing. Variable frequency of brushing was observed among the groups (P<0.001). Statistically significant variations were observed on the responses of the study subjects about knowledge of systemic and local conditions affecting Oral health. Conclusion: Overall percentage of correct responses in the study was 77.04% suggesting good knowledge, awareness and behaviour of the sample towards oral hygiene. Attendance of dental clinical postings, regular visits to dentists may further improve the personal dental care and knowledge of the trainees which are the future faculties.

Key Words: Medical students, questionnaire, oral health.

 

 

INTRODUCTION

A questionnaire-based descriptive cross-sectional survey was carried out to assess the knowledge, and awareness of medical students and teachers of Dr. SC GMC Nanded. Total sample consisted of 192 trainees and teachers. A specially designed questionnaire consisting of 21 close ended questions, divided into three sections was used to assess the knowledge, awareness and behaviour about oral health and related systemic conditions among the medical interns, PGs and teachers. The questionnaire were distributed by the investigator. The participants were approached personally and the purpose of the study was explained. It was also mentioned that responses would remain confidential. Special instructions were given not to disclose the personal identity and only things to mention on the response sheet were the subgroup and gender. After answering, the filled questionnaire were collected for analysis. Out of 192 Respondents, 180 returned the questionnaires with their responses. It consisted of 60 interns, 40 Postgraduate trainees and 80 teaching faculty..The study protocol was approved by Institutional Review Board.

 

 

Statistical Analysis

Data obtained was analyzed using the Graph Pad Prism Version 5 software. The descriptive statistics like frequency distribution and percentages of the correct and wrong responses were calculated. Pearson’s chi-square test was used to find out the variability of expected responses among the participant groups for their responses based on dental knowledge, awareness and behavior towards oral health. Statistical significance was set at 0.05 level of probability.

 

RESULTS

(Table 1) represents the study population. Based on their qualification 60 (33.33%) were interns (UG), 40 (22.22%) were Post graduates trainees (PG) and 80 (44.44%) were teaching faculty. Overall percentage of the correct responses was 77.04%. It includes 82.43% of the Teachers, 80.65% of PG’s and 67.45% of the interns. General awareness towards oral hygiene: 96.11% of the sample is aware that frequency of sugar containing food is the major factor responsible for dental decay.28.88% of sample are of view that rotary or circular brushing methods is proper and 18.88% of sample says that combination of both circular and vertical brushing are proper brushing techniques.38.33 of the sample known that pea sized amount is sufficient and adequate for brushing. Almost half of the sample (47.77%) uses full length of the tooth paste for brushing. 100% the staff and PG were aware that of pregnancy increase the risk of oral and gingival problems, but 5% of the interns believed that pregnancy does not have impact on oral health.

 

Table 1: Distribution of the study subjects according to sex and seniority

 

Behavior towards oral hygiene: 77.22 % of the total sample replied that they brush their teeth once daily.25% of the PGS and 38.33 % of the staff replied that they brush their teeth more than once daily. Almost all the study sample uses tooth brush and paste for cleaning their teeth except two of the staff who uses finger and tooth powder for cleaning their teeth. 27.22% of the sample reported that they visit their dentist twice in a year and 37.22% reported that they do so once in a year. 26.11 % of the total sample, 49% of the interns and 13.75 % of the staff reported that they visit dentist when they experience dental pain or discomfort. 9.44% of the total sample had never visited the dentist. This percentage is highest (21.66 %) among the interns and it is 10% and 0% among the PGs and staff respectively. 31 of the total study population (17.22%) had never used any tobacco containing product. 13.33 % of the total sample have it occasionally. 11.66% of the interns and 15 % of the PGS reported to have it occasionally. Only 5% among the staff reported that they have tobacco containing products frequently.18.33 % (33) of the total sample reported that they replace their tooth brush once in 6 months.68.33 % of sample changes their toothbrush once in 3 months. 16.66 % among interns, 15 % among PGS and 10% among staff replace the toothbrush when bristles becomes distorted.

Table 1: Responses of study subjects based on general awareness towards oral health

Questions on general awareness about oral health		Distribution of study sample
		Total 180(100%)	Interns 60(100%)	PG 40(100%)	Faculty 80(100%)	P value# X2 test
1.Which factor is responsible for dental caries?	a. Brushing once daily	5(2.77%)	2(3.33%)	3(7.5%)	0	0.053 NS
	b. Smoking	0(0%)	0	0(0)	0
	c.Frequency of sugar containing foods#	173 (96.11)	56(93.33%)	37(92.5%)	80(100%)
	d. Tobacco chewing	2(1.11%)	2(3.33%)	0(0)	0
2.What is the proper brushing method?	a) Horizontal	32(17.77%)	13(21.66)	8(20)	11(13.75)	0.96 NS
	b) vibratory with vertical sweeping#	62(34.44%)	18(30)	14(35)	30(37.5)
	c) Rotary or circular	52(28.9%)	22(36.66)	8(20)	22(27.5)
	d) Combination of above	34(18.9%)	7(11.66)	10(25)	17(21.3)
3.How much amount of toothpaste should be used for tooth brushing?	a. Full length of brush head	86(47.77%)	33(55)	18(45)	35(43.75)	0.42 NS
	b. Half-length of tooth brush head	25(13.89%)	8(13.33)	5(12.5)	12(15)
	c. Pea sized tooth paste#	69(38.33%)	19(31.66)	17(42.5)	33(41.25)
	d. Quantity dosn’t matter	0(0%)	0(0)	0(0)	0(0)
4.Does pregnancy increases the risk of dental problems?	a. Yes #	177(98.33%)	57(95)	40(100)	80(100)	0.047 S
	b. No	3(1.66%)	3(5)	0(0)	0(0)
5.At what age would you advice regular dental check-up for pediatric group?	a. When first tooth erupts#	92(51.11%)	29(48.33)	26(65)	37(46.25)	0.13 NS
	b. At age of 6 yrs	84(46.66%)	27(45)	14(35)	43(53.75)
	c. No need if no discomfort or pain	4(2.222%)	4(6.66)	0(0)	0(0)
6.What adverse effect does scaling has on teeth?	a. Thinning of teeth	12(6.66%)	12(20)	0(0)	0(0)	0.0001 HS
	b. Increase in interdental space	0(0)	0(0)	0(0)	0(0)
	c. Increase in mobility of teeth	0(0)	0(0)	0(0)	0(0)
	d. All of above	31(17.22%)	20(33.33)	7(17.5)	4(5)
	e. None of above#	137(76.11%)	28(46.66)	33(82.5)	76(95)
7.Does dental attendance improve quality of life?	a. Yes #	180(100%)	60(100)	40(100)	80(100)	NA
	b. No	0(0)	0(0)	0(0)	0(0)

#: Correct responses, S: Significant (p <0.05), HS: Highly significant (P<0.001), NS: Non significant (p >0.05), NA: Not Applicable

Table 2: Responses of study subjects based on behavior towards oral hygiene

#: Correct responses, S: Significant (p <0.05), HS: Highly significant (P<0.001), NS: Non significant (p >0.05), NA: Not Applicable

 

Table 3: Responses of study subjects based on knowledge of systemic and local conditions affecting dental and oral health

#: Correct responses, S: Significant (p <0.05),HS: Highly significant (P<0.001), NS: Non significant (p >0.05), NA: Not Applicable

 

 

Table 4: Responses of study subjects based on Personal interest in Dentistry: (For Interns Only)

 

DISCUSSION

In India there is scarcity of the dental graduates in the rural population. The world health organization recommended dentist to population ratio of 1:7500. But despite of increase in the number of dental graduates passing every year from 20000 in 1990 to 30570 in year 2010⁸ this ratio recommended by WHO was never achieved. In 2004 there was one dentist for every 10000 persons in urban areas, while in the rural areas there was one dentist for every 250,000 population⁹.This imbalance is 25 times though the 69% of the Indian population resides in rural areas. Similarly 54% of the dental colleges are concentrated in only five large states as Maharashtra, Telangana, Karnataka, Tamilnadu and Uttarpradesh¹⁰. Due to significant geographic imbalance in the distribution of dental colleges, a great variation in the dentist to population ratio in the rural and the urban areas is seen. Reports suggest that there are about more than one million unqualified dental health-care providers, or 'quacks', in India¹¹. To avoid quacks and to promote dental and oral health, general medical practitioners serving 70% of the rural India plays a vital role. So their knowledge and practices of oral hygiene plays a role model act for the society. As William Osler said mouth is the mirror of general health¹² poor oral conditions may adversely affect general health and certain medical conditions may have a negative impact on oral health. This cross sectional study was conducted to assess the dental knowledge, awareness and behavior of Medical graduates and post graduates at different levels of their seniority.

General awareness about oral health: Results of the study showed that the medical professionals are well aware about dentistry. In the present study with regards to dental awareness 173 (96.11) of the doctors said that frequency of sugar containing foods is responsible for dental caries. In a study conducted by S Srinidhi et al¹³271 (90.3%) medical practitioners believed that sugar contained foods consumed per day is responsible for tooth decay.Similarly in a study conducted by Eve line KL Wong and Elischwartz¹⁴ 98 (81%) house officers believed that poor oral hygiene causedperiodontal disease. A great confusion was noted among the participants with regards to the proper brushing method and the amount of toothpaste used for brushing the teeth. 32 (17.77%) of the sample believe in horizontal method whereas 52 (28.9%) believe in rotary or circular method.62 (34.44%) recommend vibratory with vertical rolling method and 34 (18.9%) believe in combination of the methods. Muttineni, et al¹⁵ in a study on nursing students reported quite similar values to the present study with Horizontal17.7 %, Circular66.7%, Vertical10.2% and both circular and vertical 5.4 %.In Similar study conducted by Permi SR et al¹⁶ on paramedical professionals reported 4% of the respondents practised horizontal brushing technique 19% used circular method, 7.3% used vertical and majority of them practised combination of all. Thus there is a variable views about the brushing strokes among the different health care professionals. Only 38.33% of the sample uses pea sized amount of the toothpaste for brushing and 47.77% of sample uses amount equal to full length of brush head. This variability may be attributed to the wrong message from the video advertisements on television. Except 3 interns almost all the sample is aware that pregnancy increases the risk of dental problems. Almost half (51.11%) of the total sample and 48.33% of interns responded that first visit to dentist should be when first tooth erupts. 4 interns (5%) believe that there is No need to visit unless there is discomfort or pain. AAPD (2013) recommends that, the child should see the dentist within 6 months of eruption of the first primary tooth and no later than 12 months of age.¹⁷ Traditionally, the developmental age for initial dental visit was thought to be 3 years, the rationale for this being, children are better manageable at this age and treatment will be more effective and efficient. However, early interventions are needed to educate parents on oral hygiene, prevention of dental injuries and ECC¹⁷. 137 (76.11%) of the total participants are aware that there are no harms of scaling, but 43 (23.88%) report that there are harms from the scaling procedure. Only 4 faculty (5%) members marked that scaling has ill effects on teeth. This Belief may be attributed to wrong message from society or previous experiences. All the participants agree that dental attendance improve quality of life.

Behavior of medical practitioners towards oral hygiene: In the present study 23.33% of the sample brush their teeth once daily,75% PG and 90% faculty does it more than once daily. In a study conducted by Permi et al¹⁶ among para medical students, found that 32%of the respondents brush their teeth once daily and 64.7% brush twice a day, 3.3%brushmore than twice.67.3% of the nursing student adviced to brush teeth twice daily in a study conducted by Muttineni et al¹⁵. 98.89 % of the sample uses toothbrush and toothpaste to clean their teeth. Only 2.5% of the faculty use finger and toothpowder to clean their teeth. This may be attributed to their periodontal status and brush would cause bleeding while brushing. In the study ofPermi et al¹⁶ on physiotherapy, Nursing and medical lab technicians 82.7% used toothpaste and brush for cleaning teeth. 76.2 of the nursing student recommended toothbrush and paste as ideal material for brushing teeth in the study conducted by Muttineni et al¹⁵. None of the respondents used charcoal orneem. 37.22 % of the sample visit the dentist once in a year. 26.11 % of the sample would like to visit dentist when experience dental pain. 37.5% of the PGS and 32.5% of the faculty visits dentists twice in a year. In the study conducted by S Srinidhi et al¹³ on dental awareness and attitudes among medical practitioners in Chennai, 76.3% of the medical practitioners have answered that they would suggest their patients to visit the dentistonce in six months. In a study conductedby Jagadish Chandra et al¹⁸ on medical practitioners of Davangere cityit was seen that regular visit of once in sixmonths was suggested by 86.3%of sample which is slightly high when compared with the attitudes of medical practitioners in Chennai. This major difference among our study and the study conducted by S Srinidhi et al and Jagadish Chandra et al may be attributed to the question frame as both these study seek advice/ suggestion to patients and in our study actual visits of the participants to the dentist in the past were asked. In the study of Muttineni et al¹⁵ 49% of the nursing students answered that a person should visit dentist once in six months. This was also reflected in the findings of Oyetola EO et al¹⁹ which showed only 78(38%) participants had ever visited the dentist for dental checkup/treatment. Also Doshi et al²⁰ studied medical students and reported that 79.4% of the participants had visited a dentist for check-up at one point or the other in their life. 67.22% of the sample answered that they do not have any tobacco habit, only 2.22% of the sample use tobacco containing products frequently that too were among the faculty. In a study conducted by Kamble VS et al²¹ on 1^st year medical students only 1.2% of the students reported the use of tobacco. 68.33 % of the sample answered that they change their tooth brush once in 3 months and 13.33 % answered that they change their brush when its bristles gets distorted. In a study conducted by Muttineni et al¹⁵ on nursing students 53.7 % of the sample answered that brush should be changed once in 3 months and 8.2 % of the sample answered that it should be changed when it gets spoiled. Saha et al ²²in their study on nurses reported that majority of nurses changed their toothbrush after 3 months.

Knowledge of systemic and local conditions affecting oral health: In the present study 161(89.44%) of the sample answered that Ludwig’ sangina is a kind of dental space infection but only 41(68.33%) of the interns could answer this correctly compared to 100% of the PG’S and faculty. In the study conducted by Srinidhi et al¹³ among medical practitioners in Chennai 87-91% PGS knew about ludwig’s angina. Compared to present study Oyetola EO et al¹⁹ in their study on medical doctors, medical students and nurses about dentistry in Nigeria., Only 21% respondents knew that Ludwig angina to be a fascial space infection, majority of who were medical doctors. Others either believed it to be a cardiac disease 39.8% or did not know what it was 35.4%. In the present study with regard to Untreated dental and perioral infections 152 (84.44%) of the doctors had answered correctly that it may cause cavernous thrombosis, a life threatening situation due to untreated dental infection. These findings were similar to the study conducted by Jagadish Chandra et al¹⁸ and Srinidhi et al¹³ where85 %and 85.7% of subjects respectively, were aware that some dental diseases are life threatening. In the preset study the sample is well aware about the endemic cause of the discoloration of teeth as many cases usually report to the hospital for this reason and is also common in the surrounding areas of the hospital. With regards to the oral manifestation of the systemic diseases PGS and faculty are well aware compared to the interns. This could be because of the fact of detailed study of the systemic diseases during the Post graduate entrance preparation after the internship completion and also because of the clinical experience of the faculty and PGS. 42 (23.33%) of the sample agree that All precancerous lesions of the oral cavity invariably leads to oral cancer even if the predisposing factors are removed. Majority among them were interns (36.67%) This facts shows that awareness of the oral diseases and oral manifestations of the systemic diseases is less among the interns. This could be because of the facts that most students neglect their dental posting during their MBBS curriculum and if they do not undergo through preparatory phase of post-graduation their oral health and hygiene knowledge remains limited. They could not give a better advice to their patients in the future if they come across to these kind of cases. Almost 85-90% of the interns showed their interest to learn more about the dentistry and expressed the need of dental postings in their syllabus.

 

CONCLUSION

Awareness of the undergraduate medical students was low as compared to the senior faculty which can be improved by incorporating basic information aboutoral health in their academic curriculum, conducting various inter‑disciplinary workshops, CDE programs and conferences. There is need of increasing the clinical exposure of the students to oral findings as most of the systemic diseases manifests in the oral cavity. Special study modules emphasizing the importance of the oral health and knowledge of oral and dental diseases should be conducted by involving the dental faculty.

 

ACKNOWLEDGEMENT

We are very thankful to the Dean, Teaching faculty, Post graduate students and Interns for their contribution towards completion of this study.

 

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