Assessment of oral hygiene practices among medical students

INTRODUCTION

Oral health is an important aspect of general health and wellbeing.¹ Oral cavity is a well-known nidus of infection, so oral hygiene if adopted properly can help get rid of majority of oral diseases.² Dental carries and periodontal problems are due to poor oral hygiene practices.^3-5

Since historical times, the focus of oral healthcare has been on the prevention of the diseases caused by dental carries. Many studies have proved that better knowledge and attitude towards oral healthcare linked to good oral care habits and healthier oral cavity.^6-9 Also, it is important to remember that control on such diseases by self-care depends on awareness, motivation, knowledge of oral hygiene practices and manual dexterity and not only on the oral hygiene aids. For prevention of oral diseases, community must be made aware, educated, motivated and proper oral hygiene instructions must be given.

As per available researches the high prevalence of oral diseases is a major public health problem.¹⁰ Many studies have shown that lack of knowledge among rural community and negligent behaviour among urban community are main factors responsible for burden of dental diseases in both communities.^11,12 Oral hygiene is further compromised by unhealthy habits like tobacco use and lack of dental specialist care.¹³ Improved oral health is still a dream come true in developing countries like India.¹⁴ So World Health Organization (WHO) has set the goals for the year 2020 as Recommended Oral Self Care (ROSC) which includes tooth brushing more than once a day, lesser consumption of sugar containing snacks once daily or rarely and regular use of fluoride containing toothpaste.²

Undergraduate medical and nursing students should be aware of oral health and dental hygiene as they are the future healthcare provider on whom the health of nation will depend. Hence with an aim to evaluate oral hygiene awareness and dental health problems among medical and nursing undergraduate students, this study was planned.

METHODS

The present cross-sectional study was conducted at Raipur Institute of Medical Sciences, Raipur (C.G.), India" during study period July 2019 to September 2019. Purposive sampling method was used to select M.B.B.S. and B.Sc. nursing students as study subjects. Ethical consideration was met through institutional ethical committee. Only those students present in the college on the days of the data collection and those willing to participate were included in the study. The students who were not present on the day and those unwilling to participate were excluded from the study. The nature and purpose of the study was explained to the students before the survey. Confidentiality regarding the responses was maintained. After taking their informed consent 313 students were included in the study. Data (background information, awareness and practice regarding oral hygiene) was collected using a predesigned pretested questionnaire.

Data was recorded in MS Excel and checked for its completeness and correctness, then it was analysed by using suitable statistical software and p value <0.05 was considered as statistically significant.

RESULTS

52.7% of the study subjects were female and 47.3% were male. 85.94% were M.B.B.S. students and rest were B.Sc. nursing students (Table 1).

87.9% students were confident of their healthy teeth and expressed as good and very good condition. All the students were brushing teeth daily and few students even brushed twice a day (30.7%). 99% students used toothbrush and 98.7% used paste for brushing the teeth. 51.4% students use toothbrush having medium type of bristles and 62.9% of them change toothbrush within three months. 75.7% of the students practice combined style of tooth brushing. More number of students (87.2%) clean their tongue daily. 98.7% use toothpaste for brushing. 51.4% students were using fluoride toothpaste where as 29.7% were unaware about presence or absence of fluoride in their paste. It was good to observe from the study that almost all students restrained from tobacco use (97.7%) and alcohol consumption (91.4%). 33.2% students experience bad breathing problem because of eating garlic and onion. It was observed from our study that 68.4% of students had pain/discomfort in past 12 months and 11.2% consulted dentist. About 43.1% students visited dentist in last 2 years and most common reason was treatment for other dental problem (15.7%) (Table 2).

Frequency of changing toothbrush, method of tooth brushing, use of inter-dental aid, use of tobacco, use of alcohol and causes of bad breath were significantly associated with gender variable (Table 3).

DISCUSSION

Dental health is an important issue as bright and healthy teeth are the mirror of healthy body. Various studies have been conducted to assess the knowledge, attitude, and practices on oral hygiene in students with a background of health sciences. Oral health is usually ignored not only by common people but also by medical professionals so basically this study was conducted keeping in mind this fact that today’s students are tomorrow’s doctor.^2,15

A higher percentage (67%) of students cleaned teeth two times a day in studies done by Kakkad et al and Peltzer and Pengpid in comparison to our study (30.7%). Few studies also reported similar observation to ours. This may be attributed to the lack of oral health knowledge or negligence due to busy study schedule.^16-20

In our study, 51.4% students were using medium toothbrush while two other studies conducted in different parts of the world it was observed that 58% of medical students in Manipal and 66% of medical officers in Nigeria were using medium toothbrush.^21,22

In this study, 62.9% of students change their toothbrush in every 3 months similar finding was observed by Amith et al.²³ The attitude of regularly changing toothbrush was much lower (10%) in law students of Chennai.²⁴ This infers that these students are unaware of the fact that prolonged usage of toothbrushes not only decreases effectiveness in cleaning of plaque but also causes trauma to gingival tissue. They should be educated about the importance of changing of toothbrush at regular intervals.

Dental flosses are useful aids designed specifically to clean the inter-dental areas.²⁵ Approximately 13.1% of students in our study flossed whereas in a study in Riyad city less than 50% health professionals used mouth wash and dental floss as cleaning aid.²⁶ Nevertheless, many studies showed that use of dental floss was not very popular.^20,24,27 Almost 40% of students in Bhubaneswar city were in view that lack of proper brushing and flossing is the reason for tooth decay and bad breath.

About half of the students in this study used fluoridated toothpaste, which was nearly similar to the study done by Doshi et al where 48.5% of engineering students and 58.7% of medical students used fluoridated toothpastes.²¹ Also in one of the comparative studies it was 58.7% and 55.1% in a study in Chennai.^21,22 58% graduates from North India used the fluoridated toothpaste whereas it was 64% in a study on undergraduate female medical students in Pune.²⁸

Smoking is a life style disease and many young people are addicted to smoking. In our study fortunately 97.1% students did not use tobacco. Similar results were observed by Lavanya et al where 93.6% of the dental students and staff, were found to be non-smokers.¹ According to a study conducted by Gopinath et al 18.1% of dental professionals had used tobacco at some point or the other.²

In contrast study conducted by Arthie et al showed 24% of dental patients were smokers. Many studies have revealed that smoking has a negative effect on periodontal health.^29,30

Dentists play a major role in maintaining overall dental health. Nearly 16.6% of the population had at least visited their dentist once in <6 months which was nearly consistent with the result of studies by Doshi et al and Al-Hussaini et al.^21,31 Almost 37.4% of individuals had never been to a dentist, which was in consonance with the study done by Gopikrishna et al among engineering students of Bengaluru.²⁷ A still lower percentage of students (29.4%) had visited a dentist within 1 year, though 73.9% were in opinion that one should visit a dentist once in 6 months.²⁰

Oral health is always a last priority unless it troubles the patient in the form of pain, caries or gum problems etc. People visit dentist only when there is a severe problem. In our study toothache was the most common reason for visit to dentist (26.9% including treatment). A study conducted in Norway among adults by Sarah et al showed that only 28% visited a dentist when in pain or lost a filling and 51% visited a dentist regularly.³²Another study in Southern Poland among adults by Wojciech et al observed only 8% visited a dentist for regular check-up and 53% visited a dentist only in case of a tooth ache. ³³

This study was limited by the survey design being self-reported behaviors which may have led to over reporting of oral hygiene practices. The psychological and socioeconomic factors were not taken into consideration. Moreover, small sample size of 313 students may limit the generalize ability of data.

CONCLUSION

Awareness with respect to oral health (using fluoridated toothpaste) among students was adequate. However, awareness of usage of toothbrushes and non-practicing tobacco and alcohol habit show the oral health knowledge in these students. The correct knowledge about maintaining good oral health needs to be given to the individuals in an effective manner at earliest so that it becomes a part of their life style. Medical and nursing students are definitely the future role models for the society; however, every student should get the correct information about maintaining their oral health. Further studies are required on a sufficient larger scale so that the ways to increase the promotive and preventive oral health practices can be identified (e.g., behavior change communication) to prevent the occurrence of oral health problems.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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