Abstract

Dentists are the role models for the society as far as oral health is concerned. However, student’s attitudes and practices were found to differ across academic levels and gender. The present study aimed to assess oral health attitudes and behavior among undergraduate dental students, and to analyze the variations in oral health attitudes based on level of education and gender using the Hiroshima University-Dental Behavioral Inventory (HU-DBI). A self-administered questionnaire based on the Hiroshima University-Dental Behavioural Inventory (HU-DBI) was distributed to 260 undergraduate dental students at the International University of Rabat. Overall, the mean questionnaire score for the total sample was 6.33±3.16. Most clinical students reported brushing each of their teeth carefully. More clinical (33.88) than preclinical (2.87) students have used a dye to see how clean their teeth are (p<0.001). Moreover, larger proportion of men (27.4) than women (16.2) use a toothbrush with hard bristles (p=0.03). A higher proportion of women (100) do check their teeth in a mirror after brushing (p<0.001). Prompt initiatives should be launched to critically revise the dental program and the education processes, and to redesign these programs in a constructive and productive manner to positively influence students’ behavior and attitudes.

1. Introduction

The carious disease is currently ranked by the experts of the WHO (World Health Organization) as the third most serious disease in the world, immediately after cancer and cardiovascular diseases ¹.

Good oral hygiene is the key factor for prevention of oral diseases. Thus, the role of dentists is crucial by providing dental care and encouraging their patients to change their behaviors and attitudes toward oral hygiene ².

One study suggested that dentists’ attitudes toward their oral health can affect the quality of care delivered to patients (Peker and Alkurt, 2009) ³.

The behavior of dental students and their attitudes toward their own oral health reflects their understanding of the importance of oral prevention, and their commitment to improve the oral health of their patients ^{3, 4, 5}.

However, student’s attitudes and practices were found to differ across academic levels, gender, countries and cultures ⁶.

In 1988, Kawamura developed the « Hiroshima University Dental Behavioral Inventory (HU-DBI) », that consists of 20 dichotomous questions (agree – disagree) which examine patient’s knowledge, attitudes and practices among oral health. It has good test-retest reliability ^{4, 7, 8}.

The HU-DBI has been useful to assess the differences of knowledge, attitudes and practices of dental students among oral hygiene between different countries ^{9, 10}.

Studies that assessed the knowledge, attitudes and practices of dental students among oral hygiene have been carried out in several arab countries : Saudi Arabia, United Arab Emirates, Yemen, Kuwait, Palestine, Iraq, Sudan, Egypt, Tunisia, Syria, Lebanon and Jordan ^{2, 13, 17, 18, 19, 21}, but also in non-arab countries: United states, Korea, Japan, Finland, Greece, Peru, India, Colombia, Turkey, Croatia, Lithuania, England, Germany, Czech republic, Slovakia, Estonia, Brazil, and China ^{3, 12, 11, 14, 15, 16, 20, 22, 23, 24, 25, 26}, but no data was found for Morocco.

The aim of this study was to assess the knowledge, attitudes and practices of oral hygiene among dental students in Morocco. The primary objective was to assess dental students at the International University of Rabat (IUR) using the HU-DBI, and the secondary objective was to analyze the impact of educational level study and gender on the score.

2. Method

The Hiroshima University-Dental Behavioral Inventory (HU-DBI) survey was distributed to dental students in the International University of Rabat. The sample size calculation was performed using Epi Info with a 5% risk of error, 95% for the confidence interval.

The overall sample size for our study was 260 students randomly selected from a population of 868 students distributed as follows: 139 preclinical students and 131 clinical students.

All the participants were informed about the purpose of the study. The questionnaires were completed anonymously to ensure the confidentiality of the information provided.

No information on the identity of the respondents was collected. The 20-item questionnaire was designed to have dichotomous responses (agree/disagree). The codes of 0/1 for the agree/disagree responses, respectively, were defined according to the question’s direction: the higher score (1) indicates better oral health attitudes/behavior. Therefore, the total score (maximum = 12) is derived from summing the scores for the 12 questions ^{2, 4, 6, 8, 9, 10, 11, 12, 14, 15, 16, 19} which gives a quantitative estimate of individuals’ responses. The present items were chosen because of the high reliability of the scale, as shown in previous studies ^{7, 8}. Along with the questionnaire responses, demographic data such as age, sex, and educational year were collected in the same questionnaire.

Data collected from the participants’ questionnaire were analyzed using SPSS software 20. Qualitative variables were described in terms of numbers and percentages. The chi-square test was used to compare HU-DBI scores of different level of education. P-values < 0,05 were considered statistically significant.

3. Results

More than one half ofthe sample (59.2%) were women, and 40.8% were men (Table 1).

The mean HU-DBI score was 6.33 ± 3.16. There was no statistically significant difference between pre-clinical and clinical students (6.10 ± 2.83 Vs 6.92 ± 3.13), or between men and women (6.33 ± 3.24 vs 6.34 ± 3.05) (Table 2).

More pre-clinical (12.9) than clinical (4.13) students were bothered by the color of their gum (p<0.05). Furthermore, a higher proportion of clinical (63.6) than preclinical (16.54) students reported brushing each of their teeth carefully (p<0.001). Moreover, all clinical students (100) versus 89.2% of pre-clinical students do check their teeth in a mirror after brushing (p<0.001).

Most clinical students (38.12) than preclinical (32.23) students disagreed with the statement that is impossible to prevent gum disease with toothbrushing alone (p<0.001).

More clinical (33.88) than preclinical (2.87) students have used a dye to see how clean their teeth are (p<0.001). However, more pre-clinical (28.77) than clinical (11.57) students use a toothbrush with hard bristles (p<0.001).

More clinical (11.57%) than preclinical (1.43%) students feel they take too much time to brush their teeth (p<0.001) (Table 3).

A higher proportion of men (33) than women (20.8) noticed white sticky deposits on their teeth (p=0.02). However, more women (20.8) than men (11.3) think their teeth are getting worse despite their daily brushing (p=0.04). More women (100) than men (85.8) do check their teeth in a mirror after brushing (p<0.001). Moreover, larger proportion of men (27.4) than women (16.2) use a toothbrush with hard bristles (p=0.03). (Table 4)

4. Discussion

The overall mean HU-DBI score of our study was 6,33 +/- 3,12. A literature review of attitudes, knowledge and practices of dental students in arab countries conducted, showed that 15 studies were published in 11 countries : Egypt, Jordan, Kuwait, Palestine, Saudi Arabia, Sudan, United Arab Emirates, Yemen, Lebanon, Syria and Tunisia. The first study was carried out in Jordan. The average HU-DBI score from 2000 to 2010 was 5,82, and from 2011 to 2020 it was 6,27 (Table 5).

Howat et al. (1979) reported that students’ oral hygiene improves from the preclinical to clinical years of study ³⁶. Moheet and Farook’s study found that clinical students had better oral health attitudes than preclinical students ². However, in this study, there was no statistically significant difference between the average HU-DBI score of preclinical and clinical students.

El Mostehy and al. (1969) noted a lack of improvement in oral hygiene ‘s students despite training ³⁷. In India, Dagli and al. (2008) didn’t notice a statistically difference between levels of education ⁹. Also in Yemen, Halboub and al. (2016) reported no statistically significant difference between preclinical and clinical students ⁶.

Moreover, studies have shown that gender had an influence on the total HU-DBI mean scores ⁶. Indeed, females, for internal psychological reasons, usually care more about their body and appearance and they would thus tend to visit health professionals for treatment or advice ⁶. In the current study, female did check their teeth in a mirror after brushing more often than male did. However, we haven’t noticed any statistically significant difference between the average HU-DBI score of women and men. This finding is in accordance with several previous studies (Kawamura and al. 2000, Dagli and al. 2008, Khami and al. 2007, Badovinac and al 2013, Riad and al. 2022) ^{9, 10, 12, 20, 38}.

Moreover, larger proportion of men than women use a toothbrush with hard bristles. This finding is in accordance with Yildiz and al. 2011, Riad and al. 2022 ^{20, 39}.

5. Conclusion

Overall, Moroccan dental students have shown good oral health attitude and behavior.

However, gender and dental education has shown limited impact on the oral health and behavior improvement. Prompt initiatives should be launched to critically revise the dental program and the education processes, and to redesign these programs in a constructive and productive manner to positively influence students’ behavior and attitudes.

References