Received 2024-10-01

Revised 2024-11-04

Accepted 2024-12-05

Introduction

Today, oral health holds as much importance as general bodily health [1]. Cultural, economic, and social factors significantly influence oral hygiene, which is a personal matter [2]. The World Health Organization (WHO) asserts that oral hygiene is an essential component of physical and mental well-being, shaped by the values and attitudes of individuals and societies [3].

Studies indicate that tooth decay prevalence among students in certain areas surpasses World Health Organization standards. Student life comes with unique circumstances, including being away from family, living in an unfamiliar city, limited access to adequate health amenities, exposure to diverse cultures, and high living costs. These factors, along with irregular sleep patterns, impact students’ oral health behaviors [4]. Within the medical sciences, dental students stand out due to the future importance of their profession for community health. They play a crucial role in enhancing oral health. Consequently, dental students are expected to set an example with their behavior, potentially foreshadowing their future role in promoting oral health in society [5]

The OHI-S index offers a swift method to assess oral health [6]. It serves as a valuable tool in epidemiology and dental evaluation programs, aiding professionals in effectively measuring oral health within communities [7]. Developed by Greene and Vermillion in 1960, the OHI classified and evaluated oral health. While the OHI was simple, sensitive, and useful, it was also time-consuming, leading to efforts to create a simpler version with equal sensitivity, the OHI-S. This clinical evaluation allowed for a more precise assessment of students’ oral health behaviors [8].

Materials and Methods

This cross-sectional study evaluated the oral and dental hygiene practices of medical students using a valid questionnaire. The study group included 175 nursing, operating room and dental students at Shahed University in 2022. After obtaining the code of ethics (IR.Shahed. Rec.1398.044) and necessary permits, data collection began with a reliable questionnaire, which was shown by Cronbach’s alpha of 0.81.

Participants completed a questionnaire that included demographic information and oral hygiene measures. In this study, oral health behavior questionnaire, approved by Khami et al., was used.

The students completed the questionnaire and then the OHI-S assessment was done

To standardize clinical examination conditions, disposable dental instruments such as probes, mirrors and periodontal probes were used on a regular chair with natural daylight from 9:00 AM to 12:00 PM. Following the principles of OHI-S evaluation, one surface of 6 teeth (buccal surfaces of incisors and special molars) was examined. Scoring was as follows: 0 for no plaque or calculus, 1 for plaque or calculus on 1/3 of the tooth surface, 2 for 2/3, and 3 for the entire surface. These scores were summed and divided by the number of levels

The OHI-S index was calculated by averaging and dividing the account and license plate indices. Scores were classified as good, average, or poor. The oral health questionnaire consisted of 15 questions that were classified on a 5-point scale with a total score from 0 to 75 as poor, average, or good performance.

Data analysis was done using SPSS software version 29 and Chi-square and Mann-Whitney tests for statistical inference.

Results

Among the 175 participants, 78 (50%) were dental students, 61 (30%) were nursing students, and 36 (20%) were operating room students. The gender distribution was 105 females (60%) and 70 males (40%). Out of the 75 good calculus indicators, 28 were dental, 10 were operating room, and 37 were nursing students. Among the 100 moderate calculus indicators, 50 were dental, 24 were nursing, and 26 were operating room students. No students had poor calculus indicators.

Due to the nature of the variables, the Chi-square test was employed, revealing no significant relationship between the calculus indicator and field of study (P>0.026). The majority of participants (98, 56%) had a moderate OHI-S status. 74 participants (42.28%) exhibited good OHI-S, and 3 (1.71%) had poor OHI-S. Table-1 presents the frequency and percentage of OHI-S by the field of study, demonstrating a significant relationship (P<0.026). The field of dentistry with the highest number of good OHI-S compared to the total population was at the top, followed by nursing and operating room expert, respectively. In Table-2 and Table-3 , there are the frequency and percentage of responses to the oral health behavior questionnaire.

Discussion

Oral health education and social factors significantly influence oral care. Regarding the training dental students receive, the first factor is crucial, but the social factor also plays a role among other medical groups.This study aimed to compare medical groups regarding oral health behavior and OHI-S. The dental group achieved the highest average score in the questionnaire compared to other disciplines. Additionally, the dental group exhibited better OHI-S status, indicating a significant relationship between OHI-S and oral health behavior, which highlights the impact of education on improving dental students’ attitudes. This, in turn, enhances their oral hygiene practices.

Statistical analysis revealed that dental students’ average scores on the oral health behavior questionnaire were significantly higher than other groups, demonstrating the effect of dental education on improving their attitudes and, consequently, their oral health behavior.

Comparing questionnaire responses with OHI-S showed that students with better OHI-S scores tend to have more regular dental check-ups, brushing, and flossing habits. Dental students consume fewer sugary snacks and drinks, and most use fluoride toothpaste when brushing [2, 10].

Considering that children often visit doctors before dentists and that accessing dentists is challenging in some areas, other medical groups should also receive oral health training to provide necessary care to their patients. However, their training protocols currently lack such courses. Therefore, the performance of these students is solely influenced by their family’s culture and socioeconomic level, which is insufficient. It is suggested that medical groups should include oral health education in their curriculum. Nursing students had a better differential index status compared to the dental and operating room groups, and the plaque index was better in the dental group, followed by the nursing and operating room groups, but there was no significant difference between nursing and operating room students.

The average score for male students was lower than that of females, emphasizing the importance of women’s health habits and their increased attention to personal care.

In this study, dental students’ average questionnaire score was lower than that of Indian students, possibly due to differences in the educational system and culture between the two countries, which influence people’s attitudes. However, the average score of the dental students in this study was higher than that of students in Kuwait [12] and Sudan [13], likely due to variations in the educational systems and cultures of these countries. Another reason for this difference is that in Kuwait, students receive training in preventive dentistry and periodontology courses for seven years.

A similar study in Safar, Iran, found a significant relationship between male gender and poor oral hygiene behavior, and between female gender and studying dentistry with a positive attitude. The probability of regular flossing was higher among women than men. With a better attitude, similar to our study, there was a significant relationship between a positive attitude and regular oral hygiene check-ups [14]. Additionally, in Al-Sheikh’s research, the association with female gender was also significant. Consequently, annual evaluations of dental students are crucial for monitoring students and the educational system [15].

Conclusion

This study highlights that education plays a more significant role in improving oral health behavior compared to social and economic factors. Dental students demonstrated superior oral hygiene practices relative to other groups. Additionally, female students exhibited better oral hygiene behavior than their male counterparts. These findings emphasize the impact of education in health-related fields, as dental students’ specialized training resulted in enhanced attitudes and behaviors towards oral health. This underscores the importance of education within health-related disciplines.

Furthermore, the study reveals that gender can also influence oral health behavior. Women tend to pay closer attention to their health habits, leading to improved oral hygiene practices. These findings can be considered when designing educational and health programs to more effectively influence individuals’ health

Acknowledgment

This article is taken from the student’s dissertation. Thanks to Shahed University for cooperation in conducting this research.

Conflict of Interest

The authors declare no conflict of Intrest with respect to the research, authorship and / or publication of this article.

GMJ Copyright© 2024, Galen Medical Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/) Email:gmj@salviapub.com

 Correspondence to: Dr. Mojgan Faezi, Department of Community Oral Health, School of Dentistry Shahed University, Tehran , Iran. Telephone Number: +98 9018578681 Email Address: drm.faezi@gmail.com

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Table 1. Pattern of Oral Hygiene Status of Students

Poor		Moderate		Good		OHI-S
Frequency	Number	Frequency	Number	Frequency	Number	Field of Study
33/33	1	31/08	23	55/10	54	dentistry
33/33	1	33/78	25	10/20	10	Operating room
33/33	1	35/14	26	34/70	34	nursing
100	3	100	74	100	98	total

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Table 2. Students Attitude Toward Oral Health Care

Questions	Answer
	Completely agree agree		Agree		Disagree		Completely agree disagree		I don’t know
	frequency	percentage	frequency	percentage	frequency	percentage	frequency	percentage	frequency	percentage
Adding fluoride to drinking water is an effective way to prevent decay	58	33/14	80	45/71	12	6/85	10	5/72	15	8/58
The number of times the sugar is consumed in causing caries is more than the total amount consumed	47	26/85	78	44/58	23	13/14	19	10/85	8	4/58
Figure sealant therapy is an important factor in preventing peat and fissure of newly erupted teeth	15	8/58	21	12	33	18/85	36	20/57	70	40
The probability of losing a tooth that has undergone restorative treatment is greater than the number of teeth extracted	100	57/14	65	37/14	2	1/14	5	2/86	3	1/72
The use of small amounts of water to wash the teeth after brushing with fluoride causes more impact	20	11/42	20	11/42	97	55/44	25	14/28	13	7/44
Examination of freshly grown tooth grooves with catheters causes enamel damage and more talent for decay	76	43/42	50	28/57	22	12/57	15	8/58	12	6/86
White or brown enamel decay can be seen on the surface of moist tooth enamel has come full-width	57	32/58	41	23/42	27	15/42	35	20	15	8/58
Using fluoride toothpaste is more important than brushing	15	8/58	20	11/42	73	41/71	50	28/58	17	9/71
Oral diseases can lead to systemic diseases	71	40/57	50	28/57	33	18/86	14	8	7	4

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Table 3. Students behavioural characteristics Toward Oral Health Care

Questions	Answer
	Irregular or never		Once a week		Two or three times a week		Once a day		More than once a day
	frequency	percentage	frequency	percentage	frequency	percentage	frequency	percentage	frequency	percentage
You usually brush your teeth every once in a while	91	52	58	33/14	12	6/86	12	6/86	2	1/14
	Always or almost always		Most of the time		Rarely		Never
Do you use fluoride toothpaste when brushing	53	30/28	47	26/88	48	27/42	27		15/42
	Irregular or never		Once a week		Two or three times a week		Once a day		More than once a day
How often do you floss once	74	42/28	41	23/42	35	20	15	8/58	10	5/72
	About three times a day or more		About twice a day		About once a day		Not every day		Not every day
How often do you eat sugary snacks or sugary drinks between meals	19	10/86	51	29/14	58	33/14	17	9/72	30	17/14
	Go to the dentist		I ask my classmates to do this		I do it myself		I do not see the need to do this
What do you usually do to check your mouth and teeth	49	28	59	33/72	35	20	32		18/28
	6 months ago		Between 6 months and 12 months		During 1 to 2 years		2 to 3 years ago5		I have not been examined yet
When was the last check-up of your mouth and teeth	45	25/71	51	29/14	29	16/57	19	10/86	31	17.72

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References

1. Dilip CL. Health status, treatment requirements, knowledge, and attitude towards oral health of police recruits in Karnataka. J Ind Assoc Pub Health Dent. 2005; 5:20-1.
2. Vangipuram S, Rekha R, Radha G, Pallavi S K. Assessment of oral health attitudes and behavior among undergraduate dental students using Hiroshima University Dental Behavioral Inventory HU-DBI. J Ind Assoc Public Health Dent. 2015; 13: 52-7.
3. Gift HC. Social factors in oral health promotion. Oral health promotion. New York: Oxford University Press Inc. 1993; 65-102
4. Pakshir HR. Dental education and dentistry system in Iran. Med Princ Pract 2013: 12(Suppl. 1): 56–60.
5. Mohebi S, Ramazani A, Motalebi M, Mohammad Pour L. Investigated the oral health status of third-grade students in Gonabad in 1383. Journal of Gonabad University of Medical Sciences and Health Services. 2011;12: 107-12
6. Khami MR, Virtanen JI, Jafarian M, Murtomaa H. Prevention-oriented practice of Iranian senior dental students. Eur J Dent Educ. 2007; 11:48-53.
7. Brown A, Al-Khayal Z. Validity and reliability of the Arabic translation of the child oral health-related quality of life questionnaire (CPQ11-14) in Saudi Arabia. Int J Paediatr Dent. 2016; 16:405-411.
8. Khoramian S, Forghani R, Rahim Zadeh M, Zeynali B. Investigation of DMFT & OHI-S Indices in Students of Alborz University of Medical Sciences in 2018. Alborz University of Medical Sciences Journal. 2020;9: 1-10
9. Greene J C, Vermillion J R. The simplified Oral Hygiene Index. J Am Dent Assoc. 1964; 68:7-13.
10. Acosta – Gio AE, Meta – Portuguez VH, Herrero – Farias A, Sanchez Perez L. Biologic monitoring of dental office sterilization in Mexico. Am j infect Control. 2012; 30(3): 153-57.
11. Ghadimi S, Razaghi S, Khami MR, Zare H. Oral health attitudes and behavior among medical and dental students in Tehran, Iran. Iraqi Journal of Public Health. 2017; 1(2):30- 34.
12. Arnljot HA, Barmes DE, Cohen LK, Hunter PBV, Ship II. Oral health care systems. An international collaborative study. London: Quintessence. 1985; 136-137.
13. Ali Dena A. Assessment of oral health attitudes and behavior among students of Kuwait University Health Sciences Center. Journal of International Society of Preventive & Community Dentistry. 2016; 6(5):436-46.
14. AlShiekh L, Lubna Tawfig, Nada Muhammed, Magd Muhammed, Abd ElHuda, et al. Evaluation of dental students' oral hygiene attitude and behavior using HU-DBI in Sudan. Sci Postprint. 2015; 1(2):e00040.
15. Safari H, Moradi R, Elahi A, Jafary Nodoushan Z, Asayesh H. knowledge, Attitude, and Preventive Oral and Dental Self-Care Behaviors among Dentistry and Medical Students of Qom University of Medical Sciences, (Iran). Qom Univ Med Sci J. 2018;12(3):96-104.