Int.j.pathol.

2017;15(4):177-181

Original Article

Variation in Attitude towards Oral Healthcare Among

Undergraduate Students of a Private Medical & Dental
College of Karachi
Uzma Zareef*, Imran Bakar**, Samia Khanam***, Arif Ali****, Shamsul ArfinQasmi***** and
Muhammad Adnan Kanpurwala******
*Dept. of Oral Pathology Liaquat College of Medicine and Dentistry, ** Dept. of Pathology, Hamdard College of
Medicine and Dentistry, *** Dept. of Pathology, Altamash Institute of Dental Medicine **** Dept. Of Statistics,
Dow University of Health Sciences, **** Dept. of Pathology, Karachi Institute of Medical Sciences (KIMS), ******
Dept. of Physiology, Karachi Institute of Medical Sciences

Background: Oral health is a significant attribute of general health. Dental and medical students are expected to
have good oral health care behaviors, as they are meant to evoke the same in their patients. Thus, it is necessary to
assess their oral health care attitudes. The present study aims to compare the attitudes towards oral health care
among dental and medical students.
Methodology: A cross sectional was conducted by utilizing HU-DBI questionnaire. Out of the total 200 students
selected, 132 were medical and 68 were dental students of a private medical and dental collegeof Karachi selected
conveniently in the study after taking oral consent individually. The students suffering from depression or stress
apparently were excluded. The statistical analysis of collected data was conducted with the help of SPSS v.17. The
descriptive analysis was performed followed by inferential statistics.
Results: The mean value for students was 19.77 ± 1.22 years with 114 (57%) females and 86 (43%) males. A
significant difference was found between dental and medical students for oral health behaviors such as worrying
about teeth color, worrying about gums color, cleaning teeth without toothpaste, worrying about bad breath, use
of dye to see teeth cleanliness, use of toothbrush with hard bristles, use of hard strokes, and taking long time to
brush teeth.
Conclusion: It can be concluded on the basis of results that dental students, have better dental health practices
as compared to medical students. It is recommended that the oral health care practices should be further
emphasized in the curriculum of both the dental and medical students from the beginning as good oral hygiene
has good impact on the self confidence and overall healthcare.
Keywords: Oral healthcare, attitudes, students

Introduction Moreover, this reflects the commitment of dental

Oral health is reflected through the absence of disease students towards improving their patients’ oral
in oral cavity and its associated structures. In the past health.3 Thus, development of oral health attitude in
few years, oral health has been regarded equally dental students during undergraduate training is
significant as general health. It is important in terms of necessary. Moreover, it is also important to examine
maintaining oral functions, and depicting overall well- their understanding towards its implementation
being of an individual.1 significance.4 On the other hand, medical students are
The dental students are responsible for promoting also expected to depict better oral health practices than
public oral health education and awareness. Their own general health, as they are educated in this regard
attitude towards oral health depicts their perception through their course work.5
regarding disease prevention and importance of its Generally, it has been noticed that dental students
applicability.2 exhibit positive tendency towards oral health;
however, to become role models for family and
Correspondence:
friends, they need to improve their oral health
Dr. Muhammad Adnan Kanpurwala
Associate Professor, Dept. of Physiology, Karachi Institute of
behavior with time. Thus, it is important to evaluate
Medical Sciences Email: drmuhammadadnan@hotmail.com the understanding and annual progress of dental
students towards oral hygiene during their dental

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course.2 The understanding of medical students This cross-sectional study took place from Nov 2017 to
towards the importance of oral health care practices is Jan 2018.The participants were the undergraduate
important as it is considered to be a part of general medical and dental students of a private medical and
health.5 dental college of Karachi. The students, who were
Owing to the importance of assessing oral health willing to participate were included in the study after
attitude among dental students, many researchers taking oral informed consent individually, whereas,
have compared oral health behavior of dental students the students suffering from depression or stress
with normal population, medical students and junior apprantelywere excluded.The sampling technique
dental students. A comparison on the basis of oral used wasnon probability convenient sampling. A total
health care was conducted between dental and of 200 (132 medical and 68 dental) students
medical students. This research work has shown better particpated in the study who filled the questionnaire
oral health awareness among the dental students as completely. A questionnaire designed on the basis of
compared to medical ones.6 However, while Hiroshima University Dental Behavioural Inventory
examining the status of oral health among Chinese (HU-DBI) was distributed among the participants. The
and Japanese dental students, Ohshima et al found questionnaire consisted of questions related with
that Chinese and Japanese dental students do not have habits regarding maintaining oral hygiene of the
remarkable oral health care tendencies.7 Kateeb et al participants. The responses of the students were noted
pointed out increased consciousness among female on Likert scale with 1 to 7 with 1 means Strongly
dental students towards their dental health care.8 Disagree and 7 means Strongly Agree. For each item,
However, generally all the students had room for collective score was estimated by adding up
improvement in implementation of health care responses. The statistical analysis of collected data was
knowledge. Same results were advocated by research conducted with the help of SPSS v.17. The descriptive
works conducted by Halawany et al and Ali et al. 9,10 analysis was performed followed by inferential test
Yiltiz and Dogan found that students belonging to such as independent t-test and ANOVA where
clinical years had better oral health tendencies in needed.
comparison with the students from non-clinical
years.11 On the other hand, while comparing between Results
dental and dental technology students, Pacauskiene et The distribution of gender, age, and level of education
al indicated good awareness regarding oral health for the participants is shown in Table 1. The
among dental students.12 While comparing oral health participants had a mean age of 19.77 ± 1.22 years, with
status of dental students to the general population, it the range of 18 to 25 years. A total of 200 (132 medical
was pointed out that dental students had better and 68 dental) students took part in the study. The
periodontital status and self reported oral health students belonging to pre-clinical years were 112,
practices. Kirchoff and Filippi compared oral health whereas, those studying in clinical years were 78. The
concerns among dental students, fashion models and gender distribution for the study comprised of 114
students from other fields. It was found that dental (57%) females and 86 (43%) males.
students and fashion models were more aware about
oral health as compared to general population.13 On Table-1. Distribution of the students age and gender
the other hand, medical students have been compared and year of education
Age(year)Mean±SD 19.77±1.22
to engineering students in terms of oral health care
Gender
practices by Doshi et al. This study has shown better
Female 114 57.0 %
attitudes among medical students towards oral health
Male 86 43.0 %
as compared to the engineering ones.14 Students
This study is aimed to assess oral health habits and Medical 132 66.0 %
attitudes in dental students as compared to medical Dental 68 34.0 %
students in a private medical and dental college of Year of education
Karachi, Pakistan. First 25 12.5 %
Second 97 48.5 %
Third 78 39.0 %

Methodology The oral health attitudes among students:

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The Table 2 shows comparative HU-DBI item scores and dental students on the behaviors such as worrying
between medical and dental students. Majority of the about teeth color, worrying about gums color, cleaning
students check their teeth in a mirror after brushing teeth without tooth paste, worrying about bad breath,
(medical: 5.01 ± 2.30; dental: 5.42 ± 1.36) followed by use of dye to see teeth cleanliness, use of toothbrush
use of standardized tooth brush (medical: 5.05 ± 2.18; with hard bristles, use of hard strokes, and taking long
dental: 5.30 ± 1.45) and brushing each teeth carefully time to brush teeth.
(medical: 5.03 ± 2.11; dental: 5.23 ± 1.67). A significant
difference (p < 0.01) was observed between medical
Table 2. Comparison of the HU-DBI items scores between medical and dental students

Hiroshima university Dental Behavioural inventory Independent sample

Medical (n = 132) Dental (n =68)
Questionnaire t-test
Mean SD Mean SD Statistic P-value
4.6288 2.18393 4.8235 1.42411 -.758 0.449
“I am satisfied with the appearance of my teeth”
3.1212 2.35100 4.1618 2.12034 -3.166 0.002*
“My gums tend to bleed when I brush my teeth”
3.8333 2.36116 4.9265 1.76463 -3.684 <0.001*
“I worry about the color of my teeth”
2.9621 2.24256 3.9853 2.09115 -3.197 0.002*
“I have noticed white sticky deposits on my teeth”
5.0530 2.18011 5.3088 1.45845 -.986 0.325
“I use a standard-sized toothbrush”
“I think that I cannot help having false teeth when I 3.6136 2.47012 4.3235 2.09791 -2.131 0.035
am old”
3.2652 2.49843 4.8382 1.92866 -4.926 <0.001*
“I am worried by the color of my gums”
“I think my teeth are getting worse despite my daily 3.1742 2.19818 4.1618 2.07048 -3.128 0.002*
brushing”
5.0303 2.11118 5.2353 1.67615 -.748 0.455
“I brush each of my tooth carefully”
“I have never been taught professionally how to 4.1288 2.36516 4.3382 1.98209 -.662 0.509
brush. “
“I think I can clean my teeth well without using 2.9470 2.38095 4.2647 2.08490 -4.031 <0.001*
tooth paste”
5.0152 2.30494 5.4265 1.36389 -1.582 0.115
“I often check my teeth in a mirror after brushing”
3.9621 2.42571 5.2206 1.61009 -4.376 <0.001*
“I worry about having bad breath”
“It is impossible to prevent gum disease with tooth 3.9621 2.34897 5.0147 1.79961 -3.520 0.001*
brush’ing alone”
4.7879 2.18960 5.1618 1.41009 -1.460 0.146
“I never go to a dentist until I have a toothache”
2.6667 2.01395 4.4118 2.15265 -5.550 <0.001*
“I have used a dye to see how clean my teeth are”
3.1742 2.09141 4.8529 1.96434 -5.599 <0.001*
“I use a toothbrush which has hard bristles”
“I do not feel I have brushed well unless I brush 3.5530 2.35840 4.7794 1.74361 -4.162 <0.001*
with strong strokes”
“I feel that sometimes I take too much time to brush 3.7424 2.36263 4.7206 1.50468 -3.558 <0.001*
my teeth”
“I have had my dentist tell me that I brush very 3.7121 2.22933 4.6471 1.73433 -3.267 0.001*
well”
“I do not worry much about visiting the dentist if 4.0985 2.22361 4.9412 1.63800 -3.039 0.003*
needed”

Comparison of HU-DBI scores on the basis of statistically different for students with age 21-24 years
age, gender and education level: (4.43 ± 1.11) and 18-20 years (4.02 ± 1.12). When we
The Table 3 depicts comparative analysis of HU-DBI talk about gender we noticed that the males (4.21 ±
scores on the basis of age, gender, and education level. 1.10) were found to be more conscious than female
The difference of HU-DBI score was found to be (4.08 ±1.15) students. On the basis of education level,
no significant difference was found for first year (4.27

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± 1.05) students as compared to second (4.12 ± 1.11) basis of education level, which is contrary to the study
and third year students (4.11 ± 1.19). Moreover, dental by Yildiz et al.11 It can be said that students from final
students were found to have higher HU-DBI score year might had significant difference in oral health
(statistically significant <0.05) as compared to medical behaviors, if considered in the study.
students It is noted that majority of the dental students do not
visit a dentist until they face a dental issue. As most of
Table 3. Comparison of the overall HU-DBI scores in the dental students have been reported to have good
Age groups, gender, students and year of education oral health behaviors, this explains why most of them
Age (year) Mean SD P-value do not feel the need for regular dental examinations.
18 - 20 years 4.023 1.1225 The most important outcome of the study was the
0.021*a
21- 24 years 4.431 1.1132 highly significant difference found between dental and
Gender medical students in terms of oral health care. This
Female 4.082 1.1564
0.415a shows the importance of education related to oral
Male 4.214 1.1017
hygiene practices. The same has been reported by Al
Students
Kawas et al.16 Contrary to the results of Kateeb et al,
Medical 3.830 1.0654
<0.001*a male students were found to be more conscious about
Dental 4.740 1.0167
Year of education their dental health as compared to female students.
First 4.270 1.0557 The present study implies that medical students
Second 4.126 1.1104 0.825b should also be offered with dental courses which
Third 4.113 1.1926 could improve their oral health attitudes. However,
a; p-value obtained by independent sample t test there were some limitations imposed on the study.
b; p-value obtained by Analysis of variance Use of self-report can be an unreliable way of
*; p-value is significant at <0.05 documenting behavior because they can be biased due
to gained knowledge and social beliefs. Secondly,
Discussion cross-sectional design of a study does not explain
Oral health providers are responsible for giving cause of alternations in behaviors of participants.
appropriate information to patients about oral habits.
They are accountable to transmit awareness among Conclusion:
people about oral disease prevention. Being future It can be concluded on the basis of results that dental
health professionals, dental students are expected to students, have better dental health practices as
implement better health attitudes in their life too. This compared to medical students. Similarly, male
is important as such an attitude can act as a students were found to be more conscious about their
motivational force for the patients. According to dental hygiene. However, further clinical studies are
Wagle et al dental students have better oral health required to remove reliability issues arose due to self
practices as compared to laypersons due to the dental reported data. The oral health care practices should be
knowledge they have.15 Thus, the present study further emphasized in the curriculum of both the
asserted to compare oral behaviors between dental dental and medical students from the beginning as
and medical students, as well as, between various good oral hygiene has good impression on self
education levels. This was accomplished with the help confidence and overall health.
of surveys conducted by Hiroshima University-Dental
Behavioral Inventory (HU-DBI) questionnaire. Acknowledgement:
Although previous research works highly emphasizes We highly appreciate the “Research & Medical writing
better health attitudes among clinical students as Consultants” for their assistance in reviewing this
compared to pre-clinical students, no significant article.
difference was found in oral health behaviors on the
basis of education level. This concept is based on the Conflict of Interest: There is no potential conflict of
fact that students take Preventive Dentistry and interest, be it personal, commercial, political, academic
Periodontics course during the third year. Moreover, or financial.
the change of attitude arises due to contact with the
clinical environment. However, in the present study,
oral behavior has not significantly changed on the

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.H I S T O R Y CONTRIBUTION OF AUTHORS
Date Received: 28-03-2018 Author CONTRIBUTION
Date Sent for Reviewer: 13-04-2018 Uzma Zareef A
Date Received Reviewers’ Comments: 16-04-2018 Imran Bakar A,E
Date Received Revised Manuscript: 07-05-2018 Samia Khanam A,C
Date Accepted: 08-06-2018 Arif Ali A,B,D
Shamsul Arfin Qasmi A,B,D,F
Muhammad Adnan Kanpurwala B,C,D,F

KEY FOR CONTRIBUTION OF AUTHORS:

A. Conception/Study Designing/Planning
B. Experimentation/Study Conduction
C. Analysis/Interpretation/Discussion
D. Manuscript Writing
E. Critical Review
F. Facilitated for Reagents/Material/Analysis

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