Abstract
Objective
To compare the attitudes of preclinical and clinical dental students toward their own oral health using the Hiroshima University-Dental Behavioral Inventory (HU-DBI).
Methods
The English-language version of the 20-item HU-DBI was distributed to all preclinical and clinical students at the College of Dentistry, University of Dammam, Kingdom of Saudi Arabia. Dichotomized (agree/disagree) responses to 12 HU-DBI items were used in this study, with a maximum possible score of 12. Responses to the remaining eight statements reflected general oral health attitudes and were excluded from the analysis. Data were analyzed statistically.
Results
The overall response rate was 72.2% (preclinical, 72.5%; clinical, 72%). The mean HU-DBI score was significantly higher among clinical than among preclinical dental students (7 vs. 5.8; P < 0.05). Higher proportions of preclinical than clinical students did not worry about visiting the dentist but postponed dental visits until they experienced toothache. Furthermore, more preclinical than clinical students reported that their gums bled upon brushing, used a child-sized toothbrush, had observed white, sticky deposits on their teeth, and used strong strokes for toothbrushing. More clinical than preclinical students reported that they did not feel that the condition of their teeth was worsening despite brushing, worried about the color of their teeth, brushed each of their teeth carefully, and checked their teeth in the mirror after brushing.
Conclusions
Dental health awareness programs should be implemented and information about positive oral health attitudes should be provided to the students at an initial stage of dental training.
Keywords: Hiroshima University-Dental Behavioral Inventory, HU-DBI, Dental students, Oral health attitudes, Oral health behaviors
Introduction
Good oral hygiene is key to good general health and plays a fundamental role in improving quality of life (Halawany, 2012). Dentists play vital roles in this regard by providing appropriate dental treatment and encouraging patients to change their behaviors and attitudes toward oral hygiene. One study suggested that children with adequate knowledge of oral health maintenance were less likely to develop dental caries than were those with insufficient knowledge (Oliveira et al., 2000). Dentists’ attitudes toward their oral health have been proposed to affect the quality of care delivered to patients (Peker and Alkurt, 2009). To equip the general population with a proper knowledge of oral health, general dental practitioners must take positive approaches to their own oral health so that they can effectively teach what they believe (Maaatouk et al., 2006).
The Hiroshima University-Dental Behavioral Inventory (HU-DBI), originally formulated by Kawamura (1988) and translated into numerous languages, has been utilized in studies worldwide to assess dental students’ attitudes toward their oral health (Cortes et al., 2002; Kateeb, 2010; Santosh et al., 2012). The HU-DBI comprises 20 items with dichotomous response options (agree/disagree) and has demonstrated good reliability (Kawamura et al., 1993). However, no data about the oral health attitudes of dental students from this particular region of the Kingdom of Saudi Arabia (KSA) have been published. Thus, this study was performed to compare oral health attitudes of preclinical and clinical students at the College of Dentistry, University of Dammam, KSA.
Methods
The English-language version of the HU-DBI was distributed to all preclinical (2nd and 3rd year) and clinical (4th–6th year) students at the College of Dentistry, University of Dammam, at the end of lectures. Participation in this study was voluntary.
The study was designed according to the principles of the Helsinki Declaration and approved by the Ethics Committee of the College of Dentistry, University of Dammam. All ethical protocols were strictly followed during the study period and informed consent was obtained from all respondents before participation.
Only male dental students were recruited to participate in the study, as no female student beyond the 2nd year of study was available. The overall response rate was 72.2% (preclinical, 72.5%; clinical, 72%); 112/155 (58/80 preclinical, 54/75 clinical) students returned the questionnaire.
The HU-DBI provides a quantitative estimate of respondents’ attitudes toward oral health based on the sum of agree/disagree responses. Twelve items were included in the present analysis; responses to the remaining eight statements reflected general oral health attitudes and were excluded. One point was given for “agree” and disagree” responses to six items each. The maximum possible score was 12, with higher scores representing better oral health attitudes.
The purpose of the study was explained to the students and their individual queries were answered. The students completed the questionnaire anonymously and no personal information except their age was collected.
Statistical analysis
Data were collected and entered into spreadsheets. Analyses were performed using SPSS software (version 19.0; SPSS Inc., Chicago, IL, USA). The chi-square test was used to analyze discrete data and the Z-test was used to compare HU-DBI scores of preclinical and clinical dental students. P-values <0.05 were considered statistically significant.
Results
The mean HU-DBI score was significantly higher among clinical than among preclinical dental students (7 vs. 5.8; P < 0.05; Table 1). Table 2 presents the numbers and percentages of students’ agree/disagree responses to all HU-DBI items.
Table 1.
Mean ages and Hiroshima University-Dental Behavioral Inventory (HU-DBI) scores of clinical and preclinical dental students.
| Students | n | Mean age (years) | Mean HU-DBI score | Standard deviation | Z | P |
|---|---|---|---|---|---|---|
| Clinical | 54 | 19.9 | 7 | 2.45 | 2.33 | 0.019 |
| Preclinical | 58 | 22.3 | 5.8 | 3 |
Table 2.
Hiroshima University-Dental Behavioral Inventory responses given by clinical and preclinical dental students.
| Statement | Clinical students |
Preclinical students |
||
|---|---|---|---|---|
| Agree | Disagree | Agree | Disagree | |
| I don’t worry about visiting the dentist | 31(57.4%) | 23(42.6%) | 41(70.7%) | 17 (29.3%) |
| My gums bleed when I brush my teeth (D)⁎ | 5(9.3%) | 49(90.7%) | 23(39.7%) | 35(60.3%) |
| I worry about the color of my teeth⁎ | 48(88.9%) | 6(11.1%) | 42(72.4%) | 16(27.6%) |
| I have noticed some white sticky deposits on my teeth (A)⁎ | 17(31.4%) | 37(68.6%) | 24(41.4%) | 34(58.6%) |
| I use a child-sized toothbrush⁎ | 1(1.9%) | 53(98.1%) | 8(13.8%) | 50(86.2%) |
| I think I cannot help having false teeth when I am old (D) | 20(37.0%) | 34(63.0%) | 20(34.5%) | 38(65.5%) |
| I am bothered by the color of my gums | 11(20.3%) | 43(79.7%) | 20(34.5%) | 38(65.5%) |
| I think my teeth are getting worse despite my daily brushing (D)⁎ | 7(13.0%) | 47(87.0%) | 24(41.4%) | 34(58.6%) |
| I brush each of my teeth carefully (A)⁎ | 51(94.5%) | 3(5.5%) | 38(65.5%) | 20(34.5%) |
| I have never been taught professionally how to brush (D)⁎ | 14(26.0%) | 40(74.0%) | 26(44.9%) | 32(55.1%) |
| I think I can clean my teeth well without using toothpaste (A) | 6(11.1%) | 48(88.9%) | 9(15.5%) | 49(84.5%) |
| I often check my teeth in a mirror after brushing (A)⁎ | 51(94.5%) | 3(5.5%) | 25(43.1%) | 33(56.9%) |
| I worry about having bad breath | 46(85.0%) | 8(15.0%) | 41(69.0%) | 17(31.0%) |
| It is impossible to prevent gum disease with toothbrushing alone (D) | 31(57.4%) | 23(42.6%) | 32(55.1%) | 26(44.9%) |
| I put off going to a dentist until I have a toothache (D)⁎ | 19(35.1%) | 35(64.9%) | 31(53.4%) | 27(46.6%) |
| I have used a dye to see how clean my teeth are (A) | 11(20.4%) | 43(79.6%) | 19(32.8%) | 39(67.2%) |
| I use a toothbrush with hard bristles | 7(13.0%) | 47(87.0%) | 10(22.4%) | 48(77.6%) |
| I don’t feel I have brushed unless I brush with strong strokes⁎ | 8(16.7%) | 45(83.3%) | 22(38.0%) | 36(62.0%) |
| I feel I sometimes take too much time to brush my teeth (A) | 26(48.1%) | 28(51.9%) | 25(43.1%) | 33(56.9%) |
| I have had my dentist tell me that I brush very well | 24(44.4%) | 30(55.6%) | 36(62.0%) | 22(38.0%) |
Data are presented as n (%). D, correct response is “disagree”; A, correct response is “agree.”
Significant difference between clinical and preclinical students (chi-square test, P < 0.05).
More preclinical (70.7%) than clinical (57.4%) students did not worry about visiting the dentist, but more preclinical (53.4%) than clinical (35.1%) students delayed dental visits until they experienced toothache. Furthermore, a higher proportion of preclinical (41.4%) than clinical (31.4%) students noticed white, sticky deposits on their teeth. However, larger percentages of clinical than preclinical students were concerned about having bad breath (85.0% vs. 69%) and brushed their teeth carefully (94.5% vs. 65.5%). Few clinical students reported that they used a child-sized toothbrush (1.9%) and that their gums tended to bleed after brushing (9.3%).
Most clinical (74.0%) and preclinical (55.1%) students disagreed with the statement that they had never been taught professionally about brushing. Most clinical (87.0%) and preclinical (77.6%) students reported that they did not use a hard-bristle toothbrush, and more clinical (94.5%) than preclinical (43.1%) students checked their teeth in the mirror after brushing.
Discussion
Howat et al. (1979) reported that students’ oral hygiene improves from the preclinical to clinical years of study. In this study, mean HU-DBI scores demonstrated that clinical students had better oral health attitudes than preclinical students. This difference is probably due to clinical students’ greater levels of dental education and clinical experience.
The overall mean HU-DBI score was 6.4, which is consistent with scores reported in other studies performed in various countries (Table 3).
Table 3.
Hiroshima University-Dental Behavioral Inventory (HU-DBI) scores of dental students in various countries.
| Publication | Country | Mean HU-DBI score |
|---|---|---|
| Rushabh et al. (2008) | India | 6.0 |
| Al Wahadani et al. (2004) | Jordan | 6.2 |
| Sinem and Basak (2011) | Turkey | 6.7 |
| Polychronopoulou and Kawamura (2005) | Greece | 6.8 |
Our finding that fewer preclinical than clinical students were concerned about visiting the dentist differs from that of Sinem and Basak (2011), who reported that similar proportions of clinical and preclinical students had this concern.
Gaare et al. (1990) reported that proper toothbrushing could improve gingival health. In this study, more preclinical than clinical students reported gingival bleeding after brushing. This result may be related to other outcomes of this study, such as the significant differences in careful toothbrushing and concern about tooth color favoring clinical students.
Our finding that more preclinical than clinical students deferred dental visits until they experienced toothache was consistent with that of Barrieshi et al. (2006). This result may also explain the greater proportion of clinical than preclinical students who had received instruction in proper toothbrushing from their dentists.
As in other studies (Dumitrescu et al., 2007; Polychronopoulou et al., 2002), we found that more preclinical than clinical students reported using strong strokes to brush their teeth, but that their teeth were getting worse despite daily brushing. This result is related to the other evidence of improper toothbrushing technique and inadequate oral health knowledge among preclinical students in comparison with clinical students.
The results of this study characterize the oral health attitudes and behaviors of dental students from Dammam, KSA. Similar studies of dental students from other regions of KSA could provide a clearer picture of these attitudes and behaviors at a national level.
Conclusions
The results of this study highlight considerable differences in the oral health attitudes of clinical and preclinical dental students. Clinical students demonstrated better attitudes and had higher HU-DBI scores, which may be attributed to their increased levels of education and clinical experience. Thus, dental health awareness programs and education in positive oral health attitudes should be implemented in the early stage of dental training.
Conflict of interest
The authors declare no conflict of interest.
Acknowledgement
The authors would like to thank all the undergraduate students of College of Dentistry, University of Dammam for their participation in this study.
Footnotes
Peer review under responsibility of King Saud University.
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