Assessment of knowledge, attitude, and practice of oral hygiene and maintenance among dental students, postgraduates, and academicians

INTRODUCTION

A healthy oral cavity is the main gateway to a healthy body. As a valuable and priceless treasure of the human system, it is undisputable right of every individual to maintain good health. For decades, oral health has been a requisite suggested to be a direct key indicator of overall health. In 2016, Federal Dental International (FDI) comprehensively defined oral health as an integral component of human health with diverse functions, such as the ability to touch, smell, chew, taste, smile, swallow, and speak as well as numerous emotions through facial expressions without pain, ailment, and discomfort in the cranio-facial region with self-assurance [1].
A proximal relationship exists with many health diseases, including cardiovascular disease, stroke, diabetes, metabolic syndrome, adverse pregnancy outcomes, digestive diseases, obesity, and poor oral health [2-7]; therefore, oral health cannot be detached from the overall health. Studies have indicated that individuals with poor oral health have a higher risk of occurrence of dental caries and periodontal diseases [8-10]. In addition, much clinical researches have also demonstrated an association between oral cancers and poor dental oral hygiene [11-14].
The emergence of focal infection theory and the concept of periodontal medicine have established the relationship between the oral and overall health. It has been suggested that 6th complication of diabetes mellitus is periodontal disease, with two-way relationship [15], while diabetics with periodontal diseases demonstrated an improvement in glycemic levels with good oral hygiene habits and periodontal treatment [16]. The maintenance of oral hygiene and health demands practicing a meticulous daily oral hygiene routine. Therefore, a rigorous oral hygiene regimen is the basis for maintaining good oral health.
Dental academicians (teaching staff) and dental students are the prime body of professionals responsible for providing oral health. The importance, maintenance, and education about appropriate oral hygiene maintenance and habits have been observed multiple times throughout their undergraduate and postgra­duate training. They are considered to play role models to the public, providing dental-related advice, guidance, and treatment. Hence, they have the responsibility and are ethically bound to provide the therapy and promote oral hygiene among the population. But the question is, are these ambassadors of oral hygiene themselves following the right paths? Do they practice what they teach others?

OBJECTIVES

It is essential to determine the attitude, knowledge, and practices of dental academicians and dental scholars in maintaining their oral hygiene and practices. Therefore, the current study was conducted to investigate the knowledge, attitude, and practices (KAP), with the objective to assess oral hygiene awareness and maintenance among dental academicians and dental students at various dental institutions of Bangalore City.

MATERIAL AND METHODS

This cross-sectional descriptive questionnaire study was performed between July 2017 and August 2018, following the Declaration of Helsinki (revised version 2013), with prior clearance from the Institutional Ethics Committee (IEC). A multi-stage cluster sampling technique was employed; Bangalore City was split into four zones (North, South, East, and West) and one dental institution in every zone was randomly selected using a lottery method. All dental students (interns), postgraduates, and academicians in each of the selected dental institutions, who were available on the day of study were invited to participate. In group 1, interns were included as representatives of undergraduate students for uniformity, and to prevent inherent deviation in knowledge levels among students in various years of undergraduate training. Group 2 included post-graduate scholars, and group 3 comprised academicians (teaching faculty) irrespective of specialization. All participants consented to participation before the start of the study, and the investigator cleared any doubt and answered questions related to the research.
Study’s instrument was a pre-validated, structured, self-designed questionnaire divided into 4 parts. The first part included participants’ socio-demographic details, such as age and sex, while the next three parts covered three main domains of oral health-related practices, attitude, and knowledge. Questions about participants’ oral habits, dental-periodontal status, and systemic health status were also included. Out of a total of 25 questions, 23 were close-ended questions with dichotomous responses, and 2 were open-ended (Supplemental material). A total score was calculated based on the response to each question. Participants’ anonymity and confidentiality were maintained throughout the survey.

Statistical analysis

Analysis was carried out using SPSS package, version 17.0 (IBM Corp., released 2015, IBM SPSS Statistics for Windows, version 23.0. Armonk, NY: IBM Corp., USA). Descriptive statistics were calculated; one-way ANOVA with Tukey’s post-hoc test was applied to estimate the difference in knowledge, attitude, and practice among the study groups, and Kruskal-Wallis test with Bonferroni’s correction was employed to assess the difference in oral habits and conditions among the groups. Statistical significance was set at 5%.

RESULTS

The total of 523 participants (males, 215; females, 308; interns, 172; postgraduates; 215, academicians, 100) responded and completed the questionnaire. The mean age of interns (group 1) was 23.67 ± 1.717 years, for postgraduates (group 2) it was 26.59 ± 2.951, and for academicians (group 3) 33.92 ± 5.906 years (Table 1).
On inter-group comparison of knowledge, attitude, and practice among the three groups (Table 2), interns exhibited the highest knowledge score with statistically significant difference (p < 0.007). Postgraduates and the teaching faculty exhibited better scores in terms of their practice of oral health, which was statistically significant (p < 0.010); however, in attitude, there was no significant difference (p = 0.96) among the groups.
For the type of brush used, a greater number of teaching faculty showed a high knowledge score (mean, 0.83) in comparison with interns (mean, 0.8) and postgraduates (mean, 0.77). Academicians scored the highest mean knowledge score (mean, 67.0) regarding brushing time of about two minutes than the mean knowledge score of interns (mean, 51.7) and postgraduates (mean, 65.3).
When the groups were compared based on the ha­bits, dento-periodontal status, and systemic health status (Table 3), a high statistically significant difference was observed among the groups. On inter-group comparison, interns showed a statistically significant difference (p = 0.014) when compared with the other two groups.

DISCUSSION

Oral health prevents various oral diseases, and thus remains a mainstay for maintaining overall health. The utilization of oral hygiene measures and practices on daily basis as a self-care regimen, augments the conservation of oral health in successful way. Keeping that in mind, dental healthcare experts play a pivotal role in the field of education of oral health by instilling awareness among patients and community [17, 18].
The strength of the current study is that, for the first time, a formal estimation of oral health knowledge, attitude, and practices among interns, postgraduates, and dental academicians in Bangalore City was conducted, with adequate inclusion sample size.
The study results demonstrated that the percentage score of interns’ oral health knowledge was statistically higher (mean, 2.06), owing to their exposure to preventive dentistry taught in the third and final years of dental studies; however, the percentage score for the practice of oral health was higher for postgraduates (mean, 3.15) and academicians (mean, 3.66) (Figure 1). The reason might be attributed to their basic understanding of periodontology and clinical practices, which account for the difference, reflecting the disparity in the educational and experience level, which is in line with previous studies’ results by Al-Batayneh et al. [19] and Saran et al. [20].
In the current study, all the groups utilized toothbrush and toothpaste as they are better educated about the effectiveness of tooth brushing, in mechanical removal of dental plaque, and adjuvant significance of toothpaste in the prevention and maintenance of gum diseases (Figure 1). Comparable results are shown in a KAP study by Baser et al. [21], evaluating professionals’ health in Riyadh.
Brushing twice daily has been recommended for efficient cleaning of teeth [22]. However, in the present study, no significant difference was found between the groups in the frequency of brushing between the interns, postgraduates, and teaching staff.
There was a strong statistically significant difference between interns (mean score, 23.8), postgraduates (mean score, 31.1), and dental staff (mean score, 53) in the brushing technique, mainly regarding the bass technique, which can be explained by the added knowledge and experience of academicians (Figure 2).
The toothbrush bristles vary from hard to soft, with various designs being manufactured with plastic shapes and cluster patterns. The entirety of these bristles has an indispensable role in cleansing action and bacterial colonization. Many toothbrush design elements have been examined. Bunetel et al. [23] reported that the survival of bacteria that get trapped in-between the toothbrush bristles, depended on the toothbrush design and bacteria. More quantity of microbes was retained and trapped in frayed bristles and closely arranged bristles in toothbrushes [24]. In a study by Mehta and Bachmann [25], retention of oral debris and moisture in the bristles increases bacterial survival. This knowledge and oral health practice faired successfully among the postgraduates and academicians in the present study.
There was a significant difference between the postgraduates and academicians in the knowledge of inter-dental aids (Figure 2). The tongue cleaning behavior in all the three groups had only slight percentage differences, but this result differs from that of Sharada et al. [26]. The possible explanation may be that factors other than knowledge, such as beliefs, attitudes, and oral health behaviors vary between dentists and dental professionals on an individual level regarding own hygiene maintenance, in accordance with the fledged information.
The World Health Organization suggests a periodic dental check-up at an interval of 6 months for adequate maintenance of oral hygiene. Here, all the three groups showed a positive attitude (Figure 3) to oral hygiene maintenance, and were compliant in attending the dental office even though they had no dental problems. This study demonstrate the importance and attention paid by the participants to their oral hygiene maintenance and concerns for dental esthetics. This improved awareness in the personal oral health behaviors among dentists and dental professionals can be linked to their dental education and experience. No significant difference was found between the groups in the knowledge of type of brush, bristles, frequency of brushing, and use of dentifrices.
The limitation of the present study is that it was a questionnaire survey, and longitudinal and cross-sectional comparisons would be more useful to evaluate the effect of education. Apart from the questionnaire, clinical examination would probably affirm the results. The study participants were all dental professionals and hence, reducing the errors in interpretation of concepts related to probability of bias that exist in self-administered questionnaire studies among specific populations. Especially when utilizing a self-assessment tool, a tendency for a socially desirable response cannot be completely ruled out. In addition, screening of intra-oral clini­cal status of the study participants was not performed.

CONCLUSIONS

All the participants in this study were aware of the fact that the knowledge and attitude related to oral health is a gateway to physical health. The findings of the current study highlight that the attitude towards oral health and practices improved and increased with a direct correlation to the level of education in the study groups (interns, postgraduates, and teaching staff). However, to determine the correlation between self- reported and intra-oral clinical status, further clinical studies are required. There is a need for a vivid patient education survey that should include and investigate subjects’ perception of their oral health and awareness.

Disclosures

1. Institutional review board statement: This study was approved by the Institutional Ethics Committee (approval number: KIDS/IEC/JUN2017/22).
2. Assistance with the article: None.
3. Financial support and sponsorship: None.
4. Conflicts of interest: The authors declare no potential conflicts of interest concerning the research, authorship, and/or publication of this article.

References