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. 2016 Mar;50(1):49–57. doi: 10.15644/asc50/1/7

Education on occupational health and health related habits among dental students in Croatia

Krešimir Matoš 1, Zrinka Jurec 1, Ivan Galić 2, Marin Vodanović 3
PMCID: PMC5017280  PMID: 27688426

Abstract

Introduction

Occupational diseases are diseases caused by occupational exposures at the workplace, while diseases related to work are diseases caused by many factors, wherein the harmful work conditions are one of the possible causes. Dental medicine is a profession with a high risk of developing occupational diseases. The aim of this paper was to present the results of a survey about occupational health risks and health related habits among dental students at the School of Dental Medicine University of Zagreb and to show how this survey led to an improvement in education by introducing a new course into the dental curriculum.

Participants and methods

Students of all years at the School of Dental Medicine University of Zagreb (total of 663) were offered to participate in a survey about occupational health risks and health related habits.

Results

A questionnaire was completed by 351 students. 28.0% of male students and 22.5% of female students were smokers. During the first two years of study, up to 84.6% of students consumed alcoholic beverages at least once a week. Prior to enrollment in the university, 85.3% male and 77.6% female students were engaged in sports. The significant drop in the number of students who participated in sports was noticed in the first study year in both sexes. Student awareness of the health risks related to dental profession increases with the year of study. Most students believe that occupational diseases can be prevented.

Conclusion

The results have shown that students enter the School of Dental Medicine with a relatively low level of awareness of the health hazards of dental profession. Although the level of awareness increases with years of study, harmful habits such as smoking, alcohol consumption, and the lack of physical activity also remain present in the later years of study.

Key words: Education, Dental, Graduate; Students, Dental; Occupational Diseases; Croatia

Introduction

Although dentistry is considered to be a profession with a high risk for development of occupational diseases and diseases related to work, education on occupational health is not a standard part of the curriculum of dental schools in many countries (1). Beach and DeBiase made an analysis of 216 accredited dental hygiene programs in the United States to determine the existence and extent of ergonomic education in dental hygiene curricula and found that there was insufficient ergonomic education without enough information about body mechanics and preventive exercises specific for dental professionals (2).

Health risks of the dental profession are well known, but availability of data about prevalence of some occupational diseases and diseases related to work is limited and usually available only for countries with large populations and many dental practitioners. The data for small countries are often insufficient.

Croatia is the newest member of the European Union, has a population of 4.28 million and about 4.000 active dental practitioners. There are three institutions (University of Zagreb School of Dental Medicine, University of Rijeka School of Medicine and University of Split School of Medicine) educating doctors of dental medicine with a six year curriculum. There about 100 – 150 new doctors of dental medicine each year. Preliminary studies showed that the prevalence of occupational diseases and diseases related to work among Croatian dentists is high due to increased professional, business and administrative requirements in last decade (3).

Previous studies conducted among dental students around the world have shown that their knowledge of professional related health risk factors was insufficient. Thus, many authors have concluded that the education of students on occupational health risks is the first and crucial step in the prevention of occupational diseases in the future (4-8). Students of dental medicine at the University of Zagreb have never had a course which would provide adequate information about health hazards related to their profession. On the other hand, students in the first two years of this program have a mandatory course in Physical Education and they are therefore required to engage in physical activity under professional supervision. Unfortunately, there are not enough elaborated models that would connect Physical Education with health risks of the dental profession, especially those of musculoskeletal origin, which are the most frequent. Besides, the Physical Education course is not compulsory for senior students who take part in preclinical and clinical work which brings occupational health risks.

The aim of this paper was to present the results of a survey about occupational health risks and health related habits among dental students at the School of Dental Medicine University of Zagreb and to show how this survey led to an improvement in education by introducing a new course in the dental curriculum entitled “Occupational diseases in dental medicine”.

Croatian dental students have never before been surveyed on their knowledge and attitude regarding occupational health hazards and diseases. Croatia is the youngest member of the European Union and probably one of the few EU member countries without relevant data about occupational diseases and diseases related to work for the dental profession. This paper is an attempt to provide a basis for further improvements in this field.

Participants and methods

In the academic years 2014/2015, students of all years at the School of Dental Medicine University of Zagreb (total of 663) were offered to participate in a survey about occupational health risks and health related habits. For this purpose, a questionnaire with questions about health related habits and occupational diseases was made. Participation in the survey was voluntary and anonymous. The research was approved by the Ethics Committee of the School of Dental Medicine, University of Zagreb.

Statistical analysis was made using the computer program „MS Excel2003“(Microsoft Office 2003, Microsoft, and Redmond, WA) and „SPSS Statistics 17.0 for Windows“(SPSS Inc., Chicago, IL). Descriptive and nonparametric statistical analysis was made and chi- square test and the Kruskal-Wallis test were applied.

Results

The questionnaire was filled out by 351 students, which was 52.9% of the total number of students at the School of Dental Medicine, University of Zagreb in the academic year 2014/2015. The percentage of students who filled the questionnaire ranged from 38.4% in the first year to 61.2% in the 3rd year, which means that the average for all years of study was 53.6%. Distribution of the surveyed students according to gender and year of study is given in Table 1.

Table 1. Distribution of interviewed students according to their gender and year of study.

Year of study Male Female Total % of number of total enrolled students
N % N % N
1 11 22.9 37 77.1 48 38.4
2 13 21.3 48 78.7 61 49.6
3 12 19.0 51 81.0 63 61.2
4 12 18.8 52 81.3 64 58.2
5 11 19.6 45 80.4 56 58.9
6 16 27.1 43 72.9 59 55.1
Total 75 21.4 276 78.6 351 Average: 53.6
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N – Number of subjects

The analysis of the number of smokers among students showed that 28.0% of males out of the total number of interviewed students were smokers as opposed to 22.5% of female smokers. No statistically significant difference was found among students regarding their smoking habits, gender and the year of study. Figure 1 shows the distribution of smokers considering their gender and year of study. A slight increase in the number of smokers is observed among male smokers in the first two years of study while the number of smokers stagnates after the third year. The number of female smokers slightly decreases during the first three years of study while the number of female smokers is doubled and significantly increased after the fourth academic year.

Figure 1.

Figure 1

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Distribution of smokers among students regarding gender

Distribution of students regarding the year of study and frequency of alcohol consumption is shown in Figure 2. Male students statistically consume alcohol significantly more often than female students (p<0.05), however there are no statistically significant differences with respect to the year of study. Consumption of alcohol on a weekly basis among male students tends to increase during the first two years of study to 84.6% in the second year of study. In the third year, the number of male students who consume alcohol is decreased to 83.3% and a decline continues until the sixth year where 56.3% of male students consume alcohol at least once a week. The frequency of alcohol consumption on a weekly basis among female students is quite uniform and varies from 42.2% - 55.7% and with respect to the year of study, it is not possible to observe trends of increased or decreased alcohol consumption compared to the male students.

Figure 2.

Figure 2

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Distribution of the students regarding alcohol consumption

The results of the analysis of the frequency of students who participate in sports have shown that male students do sports more often than female students (Figure 3). It was noticed that in both genders there was a considerable drop in the number of students who participated in sports in the first academic year. Prior to enrolling in university, 85.3% of male students and 77.6% of female students were engaged in sports. The number of male students who partook in sports activities in the first academic year was 36.4% and the number of female students was 32.4%. In the later years of study, the number of male students who participated in sports activities increased to up to 90.9% in the fifth year, but this trend did not apply to female students who completed their education with half the figure (37.2%) of those who regularly engaged in sports compared with the figure before they applied to university (77.6%). Male students are usually involved in cycling, martial arts, fitness, basketball, football, swimming, handball and tennis. Female students mostly partake in aerobics, athletics, badminton, fitness, basketball, volleyball, dancing, swimming, handball, tennis and jogging.

Figure 3.

Figure 3

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Distribution of students participating in sports before and during study

Students travel around the city mostly using public transportation while scooters are rarely used. Male students are more likely to walk than female students. On average, 45.9% of male students walk around the city whereas only 36.5% of female students do the same. Female students use bicycles as a means of transport more often than male students (8.1% female students, 5.7% male students). In senior academic years, there is an increase of car users particularly among male students. Table 2 shows how students get around the city with regard to the means of transportation.

Table 2. Means of transportation in the city.

Academic year Male
Walking Bike Public transport Scooter Car
N % N % N % N % N %
1 5 45.5 0 0.0 6 54.5 0 0.0 0 0.0
2 5 41.7 0 0.0 6 50.0 1 8.3 1 8.3
3 5 45.5 0 0.0 5 45.5 1 9.1 1 9.1
4 8 80.0 0 0.0 2 20.0 0 0.0 2 20.0
5 2 20.0 2 20.0 6 60.0 0 0.0 1 10.0
6 6 42.9 2 14.3 6 42.9 0 0.0 2 14.3
Academic year Female
Walking Bike Public transport Scooter Car
N % N % N % N % N %
1 9 24.3 0 0.0 28 75.7 0 0.0 0 0.0
2 20 41.7 0 0.0 28 58.3 0 0.0 0 0.0
3 11 21.6 1 2.0 39 76.5 0 0.0 0 0.0
4 25 48.1 4 7.7 22 42.3 0 0.0 1 1.9
5 16 38.1 1 2.4 25 59.5 0 0.0 3 7.1
6 19 45.2 1 2.4 22 52.4 0 0.0 1 2.4
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N- Number of subjects

When asked if they considered that dental medicine could harm their health, it was noticed that the higher the academic year, the higher the level of awareness of health issues that come with practicing dental medicine. There was a statistically significant difference considering the level of awareness among different academic years (p<0.05) regardless of the gender. In the first academic year, 29.7% of female students were aware of health issues while none of the male students were aware of them (0.0%). On the other hand, in the sixth academic year, the number of male students who were aware of harmful effects that practicing dental medicine could have, was 87.6% while 79.1% of female students were aware of the same problem (Figure 4). Generally, among all students, 60.2% of them considered that practicing dental medicine could cause musculoskeletal disorders, 31.8% thought various infections could occur, 28.7% believed that issues with sight were possible as well as skin diseases (24.1%) and hearing impairments (21.0%) as a result of practicing dental medicine. Students consider improper posture during work, microorganisms (28.7%), stress (22.4%), injury (20.5%), and ionizing radiation (20.7%) to be the main causes of occupational diseases.

Figure 4.

Figure 4

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Percentage of students who consider dental medicine as a profession harmful for their health

The results of the questionnaire considering the attitude of students towards the prevention of occupational diseases are shown in Figure 5. Most of the students considered that occupational diseases could be prevented and their percentage increased with the year of study. On the other hand, first year students do not share this opinion. The difference between individual years is statistically significant (p<0.05). Students stated that the main measures of prevention from occupational diseases for doctors of dental medicine was the use of protective masks (35.8%) and gloves (31.0%), changing the body position while working with patients (19.0%), vaccination (17.3%) and use of radiation protective gear (17.3%).

Figure 5.

Figure 5

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Attitude of students towards prevention of occupational diseases

Discussion

Occupational diseases are diseases caused by occupational exposures, while diseases related to work are diseases caused by many factors, where the harmful work conditions are one of the possible causes. Dental medicine is a profession with a high risk of developing occupational diseases or work-related diseases (1, 9). Adverse effects that may occur while providing dental services may be: biological, biomechanical, chemical, physical and psychological (10). Harmful biological factors are prions, viruses, bacteria and fungi that can cause various infections affecting the skin, eyes, respiratory system and other body systems or tissues (11). Harmful biomechanical elements are improper posture during work, repetitive movements, prolonged mechanical straining, vibrations, etc. Damaging biomechanical factors can lead to musculoskeletal disorders, disorders of the peripheral neurological system, neurological and other health problems (12). Factors that may adversely affect the health via their chemical properties are medicines, dental material and disinfectants (13, 14). They can cause hypersensitivity, allergies, skin diseases, injuries and burns (15). Physical factors that can damage one’s health in dental medicine are noise, ionizing and non-ionizing radiation, artificial lighting, polymerization light and alike (16). Physical factors can cause hearing and sight impairments as well as other disorders caused by excessive radiation. The main psychological factors are stress and chronic fatigue. These factors can cause not only mental disorders such as depression and burnout syndrome but can also have somatic manifestations such as cardiovascular and digestive disorders (17).

A relatively high number (52.9%) of students who were willing to fill out the anonymous and voluntary questionnaire pointed to their readiness to be informed on this subject. This is especially seen in senior years of study where the percentage of students who filled out the questionnaire was 61.2%, indicating that students with some experience in preclinical and clinical dental practice are more aware of the problem of occupational diseases and work related health hazards.

This research has shown that there were 28.0% of male smokers and 22.5% of female smokers. These results match the ones from the study of Šimat at al. who found that the frequency of smokers among the students of the School of Dental Medicine University of Zagreb was 23.8% (18). Warren et al. conducted a research about smoking among students of dental medicine in 44 world countries in 2011. They have established that in more than half of the countries involved in this study research has shown that at least 20% of students were smokers (19). These results match the ones from other researches such as those in Tanzania where there were 12.8% of smokers or those from Poland where there were 18.3% of smokers among dental medicine students (20, 21). The increase in the number of smokers in the first two years of study and the later decrease of that same number, which was established with this research, could be explained by coping with stress in the most difficult years of study. On the other hand, among the female students, at the beginning of their study there was a slight stagnation in the number of smokers until the fourth year of study when their number significantly increased and doubled. It may be concluded that during the years at the university, male students became more aware of harmful effects smoking has on their health as opposed to female students.

It was shown that almost half of the male and female students alike consumed alcohol at least once a week; regardless of their academic year and that this percentage was as high as 80% in some academic years. This fact should be investigated individually (a means to cope with stress) but also on a social level (socially acceptable situation for alcohol consumption). In Amemoria research from 2011, the highest recorded percentage of alcohol consumption among students was 23.8% on a monthly basis (21). For many students, going to university also means moving away from their parents’ homes which for some of them brings the temptations of smoking and drinking alcohol more often than they usually would. This trend was especially expressed among the male students.

It is a positive fact that before commencing their studies, 85.3% percent of male students and 77.6% of female students of the School of Dental Medicine University of Zagreb participated in sports at least once a week. On the other hand, the most unfavorable fact is that in the first years of study, only 36.4% of male students and 32.4% of female students partake in sports at least once a week. Naturally, this decrease can simply be explained by new surroundings and new life circumstances which a young person has to manage while simultaneously meeting the requirements of schooling which are very extensive and demanding at the beginning. Physical education course and regular partaking in sports are basic preconditions for the prevention of health issues in students of dental medicine, especially regarding musculoskeletal problems (7, 22). Increased use of public transportation points to the lack of healthy habits of walking and cycling.

A low level of awareness of students, especially ones at the beginning of university, about occupational diseases and work related diseases points to the fact that some level of education should be implemented in high schools to inform the students about the risks that are involved with certain professions. On the other hand, dental medicine students should have the possibility to enroll in a course that would give them theoretical and practical knowledge on occupational diseases among doctors of dental medicine, their etiology, pathogenesis, treatment and prevention (23, 24). Although the students have recognized potential harmful health effects in the dental office and cited basic measures of prevention, it does not mean that they have the necessary knowledge to deal with stressful situations and risks which are part of an everyday routine in a dental office.

Motivated by the results of this survey which indicated a low degree of awareness of students about occupational and work related diseases, high frequency of some bad health-related habits such as smoking and alcohol consumption, insufficient number of students who are regularly involved in sports and a lack of ergonomic education, establishing a new course in the dental curriculum was taken into consideration. After careful analysis of health related issues reported by Croatian dentists, the results of the student survey and program of other dental courses at the School of Dental Medicine University of Zagreb, it was decided to start a new course entitled “Occupational diseases in dental medicine”. The course was planned as a multidisciplinary course based on lectures and practical lessons for students of the 6th semester. At the School of Dental Medicine University of Zagreb, the 6th semester is the last semester before students start clinical work with patients lasting the next 6 semesters. This semester was considered to be ideal for teaching students about health hazards, occupational and work related diseases because students have some preclinical experience and insights into everyday work in a dental office allowing them to understand the importance of a correct working position, ergonomics, physical activity, mental health and stress managing techniques etc. Teachers of the course are doctors of dental medicine and physicians of different specialties such as otorhinolaryngologists, dermatologists, ophthalmologists, immunologists, cardiologists, orthopedic specialists etc. During 15 lectures students have an opportunity to learn about almost all health risks related to dental profession and how to prevent the health related problems. During the practical lessons students are introduced to dental ergonomics and shown how to avoid musculoskeletal disorders by applying special exercises for dentists.

Conclusion

The results have shown that students enroll into the School of Dental Medicine University of Zagreb with a relatively low level of awareness of the health hazards of the dental profession. Students are capable of identifying harmful and health endangering factors that can occur while practicing dental medicine as well as possible ways of prevention and protection. Although the level of awareness increases with years of study, harmful habits such as smoking, alcohol consumption and the lack of physical activity still remain present in the later years of study. Preventive measures should be applied during the years of study in order to avoid occupational diseases and maintain the health of new generations of doctors of dental medicine. Students should be aware of these problems and learn how to prevent health issues when they finish university and start practicing dental medicine on their own.

Footnotes

None declared

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