Educational intervention about oral piercing knowledge among dental students and adolescents at schools

Abstract

Introduction: Oral piercing can lead to complications and dentists are in a unique position to detect such complications. The purpose of this study was: (i) to assess the immediate and the long-term effects, on dental students, of a training programme about oral piercing knowledge; and (ii) to assess the immediate effect, on adolescents, of a single educational intervention session about oral piercing. Methods: A training programme for dental students (n = 66) was carried out in three phases. The last phase consisted of preparing and giving talks about oral piercing at schools, which was delivered by a random selection of dental students involved in the training programme. Dental students answered a questionnaire about oral piercing knowledge, before, immediately after (only the dental students included in the last phase) and 12 months after the training programme. Adolescents (n = 347) answered a survey about oral piercing knowledge before and after the talks. Results: There were statistically significant differences in all comparison groups, except for the results in the ‘before intervention’ and in the ‘12 months after intervention’ groups among dental students who had not prepared and given the talks to adolescents. Knowledge about oral piercing significantly improved among adolescents when comparing results before (mean questionnaire score = 3.0) and after (mean questionnaire score = 6.2) the talks. Conclusions: Oral piercing educational intervention had a favourable impact on adolescents and dental students, particularly among those who were more involved in the learning process.

Introduction

Body piercing is an historic practice used for cultural or identity purposes¹. Specifically, oral and perioral piercings are those in which part of the piercing is located in the oral cavity. They are becoming a popular fashion among young people, mainly for aesthetic reasons². The location of oral and lip piercings can pose some risks, ranging from local infections to systematic complications [such as endocarditis, hepatitis and human immunodeficiency virus (HIV)]3., 4.. The presence of piercings in the mouth is related to dental and periodontal problems; the longer the piercings are worn, the greater the probability of these complications⁵. In addition to acting as a reservoir for periodontopathogenic bacteria, some labiodental consequences of wearing oral piercings are enamel fissures, enamel cracks, gingival recession, colonisation by Candida albicans or malposition of the teeth⁶. The most prevalent location for oral piercing is the tongue7., 8..

Despite these potential problems, there is a lack of awareness among people who have oral piercing and even among the piercers9., 10., 11.. Dental professionals are in a unique position to detect dental complications early and to provide information about prevention and maintenance of oral piercings. In fact, the need for education programmes targeted at young adults is widely recommended in the literature2., 9., 10., 12.. However, for this to be carried out efficiently, adequate training of dental students is necessary.

Educational interventions have been demonstrated to result in an improvement in oral health knowledge, immediately after intervention and over time, and not only among dentists but also among young people13., 14., 15., 16.. However, according to our knowledge, educational programmes about oral piercing have not been documented. Hence, the aims of this study were: (i) to assess the immediate and long-term effects of a training programme about oral piercing knowledge on dental students; and (ii) to assess the immediate effect of a single educational intervention session about oral piercing that was delivered by dental students to adolescents.

Methods

This study was part of an innovative teaching project during the academic year, 2013–2014. It was carried out over 2 years and was conducted in full accordance with the World Medical Association Declaration of Helsinki. Dental students involved in the study gave their verbal consent to participate. Parents/guardians of all adolescent participants (i.e. those under 18 years of age) gave written consent for their child to take part in this project. This written consent was sent from participating secondary schools. All procedures were approved by the Ethics Committee of the Stomatology Department of the University of Granada.

An overview of the educational programme is given in Figure 1. Before the training programme, fourth-year dental students completed a 10-question anonymous test about oral piercing (Time 0). The questions were on the process of collocation (two questions), causes of collocation (one question), location (one question), complications (three questions), prevention (two questions) and follow up (one question).

Figure 1.

Overview of the 1-year educational programme.

The training programme was carried out in three phases. The first phase was a seminar lasting approximately 90 minutes, which was delivered to groups of 30–35 students. It was developed by the same person who developed the teaching project. The content of the session was the same as the content of the questions in the anonymous test that was given before the progamme started (i.e. collocation, causes of collocation, location, complications, prevention of complications and maintenance of oral piercing). This phase was complemented with additional material (articles, news, bibliography, etc.) published online and then made available as an interactive DVD in the library (second phase). The third phase consisted of preparing talks about oral piercing adapted for adolescents and delivering these in the participating schools. This last phase was carried out with a subgroup of the total number of dental students because there were a limited number (n = 5) of participating secondary schools. The dental students were selected at random to create groups of four or five. Then, from these groups, 10 students were selected, again at random, to give talks in the secondary schools.

In the schools, adolescents were asked to complete a 10-question anonymous test before and after the talks. The questions in the test were about reasons for collocation (one question), the place of collocation (one question), complications and action against them (three questions) and recommendations (five questions) for oral piercing. At this point, the dental students who had prepared and given the talks repeated the questionnaire that had been used at the beginning of the project in order to identify possible changes in the results (Time 1). In addition, teachers from the different secondary schools were asked about their satisfaction with the project.

After 12 months, the questionnaire about oral piercing was given to all dental students who had participated in the project, differentiating between students who had participated in the three phases of the project and students who had only participated in two (Time 2).

Statistical analysis of the data was performed using the statistical software SPSS v.17.0 (IBM, Chicago, IL, USA). The results of the oral piercing questionnaires were adjusted to reduce the likelihood of obtaining false-positive and false-negative results. The statistical procedures used are expressed in detail at the bottom of each Table. The level of significance was set at P ≤ 0.05.

Results

Descriptions of age and sex, the results of the questionnaires and bivariate analysis between different time points and groups of dental students are given in Table 1. There were 66 dental students in their fourth year of study. Of these, 38 completed all three phases of the project. There were statistically significant differences between all groups compared, except in those before the training intervention and after 12 months, for dental students who had not prepared and given the talks to the adolescents (T0–T2 control). The training programme on oral piercing resulted in improvement of knowledge among dental students immediately and this improvement was still evident after 12 months (T0–T1 and T0–T2 interventions). Although there were significantly lower results after 12 months compared with the results immediately after intervention (T1–T2 intervention), they were significantly better than the results of dental students who had not prepared and given the talks (T2 intervention-T2 control).

Table 1.

Comparison of oral piercing knowledge between groups of dental students

Variable	T0 N = 66	T1 n1 = 38	T2 inter n1 = 38	T2 control n0 = 28
Age (years)*	21.6 ± 1.7	21.6 ± 1.6	22.9 ± 1.8	23.0 ± 1.4
Sex†
Male	25 (37.9)	10 (26.3)	10 (26.3)	11 (45.8)
Female	41 (62.1)	28 (73.7)	28 (73.7)	13 (54.2)
Mark*	6.3 ± 1.9	8.7 ± 1.4	7.7 ± 1.4	6.5 ± 1.8
Mean difference, P-value‡
T0-T1	−2.4, <0.001
T1-T2 inter	1.0, 0.001
T0-T2 inter	−1.4, <0.001
T0-T2 control	−0.2, 0.601
T2 inter-T2 control	1.2, 0.005

^*Values are given as mean ± standard deviation.

^†Values are given as n (%).

^‡Student's t-test for independent samples. N; n₀; n₁; T0, time 0 (before the educational programme); T1, time 1 (just after having prepared and given the talks for adolescents); T2 control, Time 2 control (12 months after; dental students who had not prepared nor delivered the talks for adolescents); T2 inter, time 2 intervention (12 months after having prepared and delivered the talks for adolescents).

N, total sample; n₀, students who completed the two first phases; n₁, students who completed the three phases.

In total, 347 adolescents participated in the project. The educational intervention results for the adolescents are presented in Table 2. The scores for the questionnaires on oral piercing significantly improved after the single session given by dental students (the mean score was 3.0 before the educational session and 6.2 after the educational session).

Table 2.

Scores of oral piercing knowledge among adolescents before and after educational intervention

Variable	Before intervention	After intervention	P-value
	(n = 347)	(n = 344)
School
Virgen de las Nieves	115 (33.1)	112 (32.6)	1*
Cristo de la Yedra	84 (24.2)	84 (24.4)
Ave María Vistilla	53 (15.3)	53 (15.4)
Ave María Casamadre	53 (15.3)	53 (15.4)
Los Cahorros	42 (12.1)	42 (12.2)
Age (years)	14.8 ± 1.3	14.8 ± 1.5	0.753†
Sex
Male	198 (57.1)	186 (54.1)	0.460‡
Female	149 (42.9)	158 (45.9)
Questionnaire score	3.0 ± 2.1	6.2 ± 2.3	<0.001†

Values are given as n (%) or mean ± standard deviation.

^*Chi-square test.

^†Student's t-test for independent samples.

^‡Chi-square test, Yates correction for continuity.

Table 3 shows the description of the satisfaction questions given to teachers. Most considered the project to be very interesting and 100% stated that they would participate in a similar project again. Although they proposed to improve the preparation and material used, they valued that the talks were given by dental students (68.4%).

Table 3.

Satisfaction questionnaire for teachers about the oral piercing project (n = 19)

Question	n (%)
1. Is this the first time you have participated in a project of such characteristics?
Yes	15 (78.9)
No	4 (21.1)
2. Do you consider that the oral piercing content is of educational interest to students?
Very interesting	16 (84.2)
Interesting	3 (15.8)
Little interest	0
3. Would you participate in a similar project again?
Yes	19 (100)
No
4. How would you say that the organisation of the project was?
Very good	11 (57.9)
Good	7 (36.8)
Fair	1 (5.3)
Poor	0
5. What is the best part of the project in your opinion?
The theoretical content	6 (31.6)
Preparation by dental students	13 (68.4)
Teaching material used	0
6. What could be improved?
The theoretical content	1 (5.3)
Preparation by dental students	6 (31.6)
Teaching material used	8 (42.1)
Not know/no answer	4 (21.1)

Discussion

Having an oral piercing may lead to complications and such piercings require maintenance. These facts should be known by young people (the population group that most frequently has oral piercing) and also by dentists who are in an ideal position to prevent problems and deliver education. The aims of this study were to evaluate the effectiveness of an educational intervention among dental students and among adolescents at schools. Data from the present study revealed that, first, the training programme had a positive effect on oral piercing knowledge of dental students, particularly when they were more involved in the process. Moreover, this positive effect was maintained over time. Second, educational intervention at schools also increased knowledge about oral piercing among adolescents.

This study presents some potential limitations. As the questionnaires were anonymous, to respect the privacy of participants, it was not possible to analyse the data individually (using dependent-samples analysis). Although this results in loss of statistical power, the anonymous process increases the validity of the responses. Second, we cannot ensure that dental students did not receive additional training about oral piercing during the follow-up year, which could have influenced our results. Nevertheless, according to the dental degree programme in Granada, there was no further course material, specifically related to oral piercing, for the students involved in this training project, making it unlikely that they had further training on the subject at any other time.

Previous studies16., 17., 18. have demonstrated that education regarding preventive dentistry, which combine different methodologies of learning, can improve the knowledge of dental students. Similarly, our results showed a significant improvement in the scores for the oral piercing questionnaire among dental students immediately after completing the training programme (three phases), which integrated support material, an online platform and an interactive DVD. After 12 months, this improvement was still significant in dental students who had completed the training programme but it was not significant for students in those groups who had not prepared or given the talks in schools (third phase). Active participation of students in preparing and giving talks, and having direct contact with adolescents, was the difference between both groups (T2 inter–T2 control). These results are in line with other studies which have demonstrated that active learning obtains leads to results and produces higher long-term retention knowledge in students19., 20., 21.. Traditional approaches produce short-term retention of course content because they do not include elaboration. Moreover, students value active learning22., 23., which promotes greater motivation. Another advantage is that encouraging students to have active learning develops not only knowledge but also general skills and competences, reaching an important objective proposed in the Bologna educative process24., 25. and significant learning skills.

Another highlight of this study was that although there was a significant improvement in dental students who had completed the training programme, their knowledge about oral piercing lessened over time. This could be a result of the fact that the educational intervention was of limited length. It was carried out in the fourth year of study and not included in the course content of the final (fifth) year. This should be taken into account because these students are very close to joining the workforce and being responsible for providing health education to patients. Lack of sufficient knowledge about oral piercing could be a barrier to dentists because of lack of knowledge²⁶.

Oral piercing education at schools led to a significant improvement in the knowledge of adolescents. Added to the positive effects of the oral health educational intervention27., 28., schools offer a good environment to improve oral health knowledge, which could be a first step to changing poor behaviour. It can also be beneficial that dental students deliver the talks as this could be perceived as a relaxed environment by adolescents which stimulates learning and a positive response. The teachers’ positive reaction to the project also identified it as valuable. However, there are studies which demonstrate that dental students have little intention of carrying out oral health education in schools29., 30.. It could be that students focus their attention on restorative care, not emphasising prevention. As health professionals, they could use education as a powerful way to change knowledge and attitudes in the population. Educational professionals have an important role in developing these competencies through training of students.

In conclusion, educational intervention on the subject of oral piercing had a favourable impact on dental students and on adolescents. Dental students who were more involved in the learning process retained more knowledge over time.

Acknowledgements

We would like to thank the schools, adolescents and teachers for their participation in this study. This study was part of a teaching innovation project financed by Vicerrectorado de Ordenación Académica y Profesorado of the University of Granada.

Conflict of interest

The authors have no conflict of interests.