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 Table of Contents  
ORIGINAL RESEARCH
Year : 2018  |  Volume : 10  |  Issue : 4  |  Page : 198-205

Oral-dental health knowledge, attitude and practice among dental and pharmacy students at Riyadh Elm University, KSA


1 Department of Community Dentistry, Riyadh Elm University, Riyadh, KSA
2 Department of Prosthodontic, Riyadh Elm University, Riyadh, KSA

Date of Web Publication28-Aug-2018

Correspondence Address:
Dr. Mohammed Mohsin Aljrais
Department of Community Dentistry, Riyadh Elm University, Riyadh
KSA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jioh.jioh_133_18

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  Abstract 

Aim: The aim of this study was to explore and assess oral health knowledge, attitude, and practice of dental students (DS) and pharmacy students (PS) at Riyadh Elm University. Materials and Methods: A cross-sectional study was conducted among 300 undergraduates including 150 DS and 150 PS from Riyadh Elm University using a self-administered structured questionnaire. Each group was further subdivided into equal portions of 75 males and 75 females. The mean percentage scores, standard deviation, and frequency distribution were calculated, while Student's t-test and Chi-square test were employed to test for the association between different variables. Results: DS showed the highest scores on 6 out of 8 of the knowledge questions compared to PS (P = 0.000), while their scores on the rest of the two questions were about similar with no significant difference between the two groups (P = 0.223 and 0.561). The unpaired t-test showed means of 114.375 ± 26.386 for the DS and 48.25 ± 30.046 for the PS who answered yes and the difference was significantly high (P = 0.000). On the other hand, the unpaired t-test showed a means of 101.75 ± 30.046 for the PS and 35.625 ± 26.386 for the DS who answered no (P = 0.000). The scores of the 4-point Likert Scale corresponding to the five attitude questions were comparable between the dental and pharmacy groups. There were no statistically significant differences in the attitude responses of the two groups as indicated by the Chi-square P values for every question (P = 0.155–0.767). Regarding oral care practice, a total of 113 (75.3%) of the DS and 127 (84.6%) of the PS showed to brush their teeth 2–3 times a day. A total of 107 (71.4%) and 111 (74.0%) of the respective DS and PS used to rinse their teeth from 2 to 3 times a daily. The responses of the DS and PS regarding teeth flossing, the use of dental fluorides, and the frequency of their dental checkup were very close. Chi-square P values were 0.215, 0.779, 0.985, 0.677, and 0.769, respectively, for the five practice questions with no significant difference. Conclusion: Oral health knowledge among DS was significantly higher than PS. The higher knowledge of DS could be attributed to their specialized courses on oral health which is lacking in the pharmacy program. PS had positive attitude and practice despite having poor knowledge regarding oral health. Both groups showed positive oral care attitude and practice with no significant statistic differences.

Keywords: Dental students, oral-dental attitude, oral-dental knowledge, oral-dental practice, pharmacy students


How to cite this article:
Aljrais MM, Ingle N, Assery MK. Oral-dental health knowledge, attitude and practice among dental and pharmacy students at Riyadh Elm University, KSA. J Int Oral Health 2018;10:198-205

How to cite this URL:
Aljrais MM, Ingle N, Assery MK. Oral-dental health knowledge, attitude and practice among dental and pharmacy students at Riyadh Elm University, KSA. J Int Oral Health [serial online] 2018 [cited 2020 Feb 18];10:198-205. Available from: http://www.jioh.org/text.asp?2018/10/4/198/240012


  Introduction Top


Health behavior is defined as “the activities undertaken by people in order to protect, promote, or maintain health and to prevent disease.”[1] Many systemic diseases are related to oral conditions, and thus, general health requires efforts of healthcare professionals (HCPs) including medical and dental doctors in addition to pharmacists.[2],[3],[4],[5]

There is evidence to suggest that the oral health knowledge and behavior of dental students (DS) varied in the clinical and preclinical years of dental education.[6] Moreover, the oral health attitudes and behavior of dental students vary in different countries and cultures.[6],[7]

Pharmacists are assumed as an imperative part in the provision of healthcare and well-being at the community level.[8] Pharmacists are in a unique position to understand the needs of community members through daily interaction with patients and customers. In a few areas, pharmacists are often the patient's first point of contact, and for some, they are the only contacted HCP. Therefore, there is a need to determine the status of their own oral health knowledge and behaviors.[9]

Pharmacists are capable of providing oral health information based on request by the patient, and a few did it proactively. Most of the pharmacists believed that providing oral health advice is within the realm of their profession.[10] In addition, individuals with lack of access to dental services and those from lower socioeconomic conditions are more likely to seek oral health-related advice from pharmacists (Cohen et al., 2013).[13]

Frazier (1983)[7] stated that DS act as a role model for oral health by choosing dentistry at the undergraduate level. Certain studies have dealt with the attitude and behavior of DS in motivating patients for oral health care; however, little is known about the influence of clinical training and course content on the development of the oral health behavior of DS. Based on the guidelines prescribed by the Ministry of Higher Education, the dental curriculum is developed and followed both in the private and government dental universities.

For conveyance of primary health care, the role played by pharmacists in the provision of overall and oral health cares has been acknowledged as an important and relevant issue by the government of the United Kingdom.[11] Recently, the pharmacist's function evolved from dispenser of drugs to the approved member of the healthcare team.[12]

A study of pharmacists found that the pharmacist has to face at least one inquiry each week on some mouth-related issue; almost 50% of these inquiries were identified with oral sores or ulcers.[13] Pharmacists provided some oral health advice, and in the coming years, the demand for such advice is going to increase for which pharmacists have expressed their readiness to expand their knowledge related to oral health.[14],[15]

Data from Saudi Arabia suggested that almost 34% of the pharmacists reported 10 daily requests for oral health advice mainly related to toothache, mouth ulcers, and mouth malodor. These complaints were mainly managed by medications and only very small percentages of the dental patients were referred to the dentist.[16] Most of the recommendations of oral health products made by pharmacists in Riyadh, Riyadh Province, Saudi Arabia, were mainly based on personal experience and patient inputs, rather than scientific information highlighting deficiencies in oral health knowledge.[17]


  Materials and Methods Top


A modified cross-sectional self-administered questionnaire was conducted among the undergraduate DS and pharmacy students (PS) at Riyadh Elm University, Riyadh, Saudi Arabia. The questionnaire was designed after a detailed review of relevant literature.[17] It was written in English, which has been the teaching language in dentistry and pharmacy courses. Demographic data such as age, gender, state, nationality, and study specialty were collected. The questionnaire consisted of three sections with 16 questions. Six questions evaluated the knowledge, five questions evaluated the attitude, and another five questions evaluated the practice toward oral health.

The study was approved by Riyadh Elm University Ethics Committee and the students were informed about the purpose of the study together with providing them with written consents before the study. Ethical approval number is REU/08032018. Software was used to determine the minimum required sample size for the present study (Sample Size Calculator, Retrieved June 28, 2006, from http://www.surveysystem.com/sscalc.htm). 1/√N = 1/ 17.4 = 0.057 (which is the margin error. fraction) = 5.7 (which is the margin of error, Percentage) With about 94.3% confidence level Which is found suitable sample in our study from Software was used to determine the minimum required sample size for the present study (Sample Size Calculator,” Oral-Dental Health Knowledge, Attitude, and Practice among Dental and Pharmacy Students at Riyadh Elm University, KSA.

A pilot study was conducted on a total of 40 DS and PS (20 students each) to validate the questionnaire. Cronbach's alpha test was used to assess the reliability. The questionnaire was found to have a reliability coefficient of 0.76.

Data analyses including descriptive and inferential analysis were carried out using SPSS version 23 (IBM Corp, Armonk, NY). The variables for testing knowledge questions were dichotomized. The right option was assigned 1, whereas the wrong option was given 2. Frequency and percentage of DS and PS with right and wrong responses were also then obtained. Correlation bivariate test was performed to find the relationship between the DS and PS knowledge, attitude, and practice toward oral health. P = 0.05 was used as a level for statistical significance.


  Results Top


A total of 300 students (n = 150 from each program) filled up the assigned questionnaire and returned it to the investigator. The demographic characteristics of the concerned participants are presented in [Table 1]. Each of the 150 participants from the dentistry and pharmacy groups was composed from two male and female subgroups of 75 students each. 94% of the dental group and 76% of the pharmacy group were between 20 and 25 years of age, while those aged >25 years represent 6.0% of the DS and 24% of the PS. The distribution of the participants according to nationality was mostly Saudi with average rates of 81.3% and 74% of the dental and pharmacy groups, respectively.
Table 1: Demographic characteristics of the participants (total n=300)

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[Table 2] represents the eight questions that assess the oral health knowledge among Dental students (DS) and Pharmacy students (PS). No PS (0%) agreed for question 1 “Do you have any dentistry-oriented subjects in oral health knowledge in your study syllabus?” while 100% of the DS positively agreed for the question with high significant value (Chi-square P = 0.000). Up to 72.6% of the DS answered yes for question 2 “Do you know the etiology of dental caries and gum bleeding?” while about 27.4% of them said no; in the meantime, the majority of PS (78.6%) answered no and only 21.4% said yes. The yes/no answer for question 3 “Do you know the different techniques for teeth brushing?” seems to be slightly higher for the yes answer with a rate of about 69.4% for the PS compared with 62.6% for the DS, while the answer with no was at the rates of 37.4% and 30.6% for the DS and PS, respectively, with Chi-square P = 0.223, indicating no significant difference between the two group.
Table 2: Knowledge toward oral health among dentistry and pharmacy students (n=150 each)

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Regarding question 4 “Do you know that there are different types of dental floss to be used?”, the respondents said yes at the respective rates of 42.6% and 46.0% for the DS and PS, while the respective rates for the no answers were 57.4% and 54.0% with no significant difference between the two groups (P = 0.203). The majority of DS (74.7%) answered yes for question 5 “Do you have any idea about halitosis?, while the rate of the yes responses in the pharmacy group was (36.89%) and the difference was highly significant (P = 0.000).

DS anonymously answered yes for questions 6 “Do you know teeth grinding can expose the teeth dentin?, question 7 “Do you know about oral thrush?, and question 8 “Do you know what is stomatitis? with respective rates of 86.7%, 54.0%, and 686.0% compared with the yes answer for the PS with the respective rates of 46.6%, 36.6%, and 25.3%, and the differences were highly significant in all cases (P = 0.000).

[Table 3] represents unpaired t-test in terms of mean, variance, standard deviation (SD), and P values for the knowledge data of the DS and PS. The mean difference between the dental and pharmacy groups for the yes answer was about 2.5 folds higher than that of the PS with highly significant difference in the P value (P = 0.000). Again, it is also seen from [Table 3] that the mean difference of the PS for the no answers was about 2.8 folds higher than that for the DS with highly significant difference in the corresponding P value (P = 0.000).
Table 3: Unpaired t-test analysis of the yes and no responses for the oral health knowledge of the dentistry and pharmacy students (n=150 students each)

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The 4-point Likert scale for the attitude questions are presented in [Table 4] with their corresponding Chi-square P values of significance. It is seen from [Table 4] that the responses of the DS and PS to each of the five attitude questions were more or less similar. The scores for the strongly agreed, agreed, disagreed, and strongly disagreed for the DS were comparable with the pharmacy scores in each of the five questions. The scores of the DS for the strongly agree points were between 53.3% and 76.7%, whereas the scores for the PS ranged between 48.7% and 85.4%. On the other hand, the scores of the DS for the agree points were between 20.7% and 38.7% and of the PS were between 13.3% and 40.7%. There were no statistically significant differences in the attitude responses of the two groups as indicated by the Chi-square P values in every question (P = 0.155–0.767).
Table 4: Attitude toward oral health among dentistry and pharmacy students (n=150 each)

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[Table 5] is a presentation of the data regarding the DS and PS practice about oral health. It is clear from [Table 5] that a total of 113 (75.3%) of the DS and 127 (84.6%) of the PS showed to brush their teeth 2–3 times a day while 37 (24.7%) of the dental respondents and 23 (15.3%) of the pharmacy respondents used to brush their teeth from 0 to 1 time.
Table 5: Oral health practice among dentistry and pharmacy students (n=150 each)

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A total of 107 (71.4%) and 111 (74.0%) of the respective DS and PS used to rinse their teeth from 2 to 3 times daily while those who rinse their teeth from 0 to 1 times per day were, respectively, 43 (28.6%) and 39 (26.0%). The responses of the DS and PS regarding teeth flossing were very close, and the distribution of their flossing practice was every day, 4–6 times per week, 2–3 times per week, or less than twice per week. Similarly, both groups responded similarly to question 4 “How often do you use fluoride toothpaste to brush your teeth in a week?” and question 5 “How often do you go for dental checkup every year? The responses of the DS and PS showed statistically insignificant difference for all the five questions regarding oral care practice with respective Chi-square P = 0.215, 0.779, 0.985, 0.677, and 0.769.

[Table 6] content should be cited or belong to [Table 6] (DS means Dental students and PS means pharmacy students. The mean scores of the knowledge for the DS and PS were, respectively, 114.375 ± 26.386 and 48 ± 30.0856 with highly significant difference between the two groups (P = 0.000). On the contrary, the respective mean scores of the attitude was 70.2 ± 31.569 and 70.9 ± 35.880 with no significant difference between the two groups. Similarly, there was no statistically significant difference between the DS and PS (P = 0.989) with respective practice means of 37.4 ± 37.5 and 22.57 ± 26.448.
Table 6: Mean scores±standard deviation of knowledge, attitude, and practice among student's specialties

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  Discussion Top


Medical care is a collaborative practice that needs advice and consultancy from HCPs. The role of pharmacists as an effective medical team has been augmented and strongly recommended as a front-line HCP to provide information and advice for individuals frequently visiting them in their community pharmacies. As future healthcare educators, DS and PS must have positive oral health knowledge, attitudes, and practice to be able to convey them to the society after being graduated.

The demographic data are indicative that the students are mostly within the college age; however, an accountable higher number of the PS appeared to exceed the average college age (>25 years). This can be explained as many PS joined their program through a bridging system after sometimes of their work as assistant pharmacists.

Data analysis on the knowledge section of the questionnaire revealed that DS were more knowledgeable about oral health compared to PS. The positive response of the DS to the eight questions of knowledge revealed a significant positive variation in favor of the DS.

DS knowledge about oral health is mainly obtained from the information taught to them in their syllabus throughout the study program. Consequent lack of oral health knowledge in PS could be attributed to the absence of comparable or related oral health courses in the pharmacy curriculum (Q.1). Opposite to DS, the majority of PS did not know about the questions related to the etiology of dental caries (Q.2), halitosis (Q.5), teeth grinding (Q.6), oral thrush (Q.7), and stomatitis (Q.8). Similar to DS, PS knew about the different techniques for teeth brushing (Q.3) and the different types of dental floss (Q.4) as has been parts from the pharmacy courses.

The mean for the DS is about 2.5 folds higher than that of the PS and t- test P = 0.000 for the yes responses to knowledge, indicating highly positive significant difference in sfavor of the DS. On the other hand, the mean for the PS is about 2.8 folds higher than that for the DS and the t- test P = 0.000 for the no responses, indicating highly negative significant difference in favor of the PS.

The failure of PS to positively respond to the majority of the knowledge questions could be attributed to the absence of related oral health care courses in their syllabus. This finding was consistent with that from previous studies.[17],[18],[19] Besides the unavailability of specialized oral health care topics in the pharmacy program, the overall lacking of oral health knowledge may also be a consequence of the scares professional interaction between PS and DS as both groups study in isolation from each other.[20],[21]

The participant's attitude toward oral-dental health showed some discrepancy in the 4-point Likert scale among the dental and pharmacy groups; however, the variation was not statistically different for all the five attitude questions with statistically insignificant Chi-square P values ranging from 0.155 to 0.767. The majority of the DS and PS showed positive attitude and strongly agreed or agreed for the necessity to brush their teeth in the morning and night to keep them healthy (P = 0.155). This was in agreement to the reported 100% among medical and engineering students in a study by Doshi et al., 2007[22] and similar results in other studies.[23],[24],[25]

Olusile et al., 2014[26] and other study[27] reported that 81% of their studied sample had used toothbrushes and paste for cleaning. The increasing use of toothbrush among the participants may be an indication of their complete shift toward the use of toothbrush solely or in combination with the traditional Swak stick to maintain their oral and dental cleanliness.

DS and PS unanimously either strongly agreed or agreed that rinsing mouth with water after meal is necessary to remove accumulated food debris (P = 0.7.67); however, fewer participants from the DS (4.0%) and of the PS (2.6%) disagreed on that statement; perhaps, they preferred to brush their teeth rather than to rinse them with water for better oral health care. When the participants were asked about if sweets, sugary food, and drinks can cause tooth decay, the dental (66.0%) and pharmacy (70.0%) participants strongly agreed or agreed for the statement (P = 0.528). This reflects that it is a common and obvious fact that sugary materials are well-known factors that cause tooth decay.

A total of 92.0% of the DS and 93.3% of the PS have either strongly agreed or agreed that fluoride toothpaste strengthens the teeth (P = 0.509). This indicates that the majority of the DS and PS knew about the benefits of fluoride in the prevention of dental caries as has been taught in their courses. Our finding is opposite to those reported in other publications, showing that the overall knowledge of fluoride was inadequate among the graduating medical student.[24] A greater percentage of medical and paramedical students (96%) seem to ignore the importance of fluoride toothpaste in tooth decay protection.[2]

Routine checkup visits to dental clinics were attributed to the need for preventive care measures. In the present study, 92.0% of the DS and about 88.0% of the PS strongly agreed or agreed to visit dentist for routine checkup (P = 0.261). This finding was higher than those studies previously reported by Dagli et al., 2008;[28] Azodo and Ogradi, 2016;[29] Sharda and Shetty, 2010;[30] Timmerman et al. 1997;[28] Hoogstraten and Broers, 1997.[29] The positive attitude of the DS and PS in the present study toward dental visits may be a result of the students' high concern about their oral health as being medically oriented.

The positive attitude displayed by the students is consistent with the study by Buxcey et al., 2012,[19] where almost all the pharmacists felt that it was one of their responsibilities to give oral advice to the general public. This result was also consistent with another study by Baseer et al., 2012,[4] where HCPs including pharmacists, doctors, nurses, technicians, and also medical students showed positive attitude toward dental care.

Turning next to the student's oral health practice, there was no statistically significant difference regarding the five statements of oral health practice and both groups showed positive response. Students showed that they brush their teeth between 1 and 3 times a day with the majority brush their teeth twice per day (51.3% for the DS and about 60.6% for PS) with insignificantly different, P = 0.215. The participants showed to rinse their teeth between 1 and 3 times with the majority said they rinse their teeth 3 times a day (41.4% for the DS and 46.0% for the PS) with insignificant difference, P = 0.779.

The frequency of dental flossing among the students considerably varied; however, the majority reported that they floss 4–6 times per week (35.3% for DS and 53.3% for PS). The relatively higher percentage of the PS who do flossing at 2–4 times per week may be because they have more knowledge about its benefits and how it works as being part of their pharmacy courses. Furthermore, the fluoride toothpaste was shown to be frequently used every day by the DS (60.0%) and PS (64.6%) with no significantly different variations between the DS and PS (P = 0.0.677). The benefits of fluoride toothpaste are taught in many topics regarding dentistry and pharmacy courses. The majority of the DS (40.0%) and PS (40.0%) said that they do dental checkup twice per year indicating very good oral care practice with no significant difference (P = 0.769) in the practice of the two groups. Young students especially those who are medically oriented give more concerns to their general outlooks and more specific to their oral health care more than elder individuals.

The mean ± SD scores of the knowledge of the dental group was higher than that for the pharmacy group as shown in [Table 5] with highly significant difference in favor of the dental group), indicating that DS were highly knowledgeable in oral health care as knowledge is part of their study which was lacking for the pharmacy group. Despite the low knowledge of the pharmacy group, yet, the means for their attitude and practice were comparable with the dental group. These results indicate that there is no appreciable connection between oral health care from the one side with the attitude and practice from the other side, indicating the effect of culture and personal habits of each individual.

The present study was based on DS and PS from private university and the results do not represent the entire DS and PS in the governmental and private sectors in Saudi Arabia. Furthermore, self-reported information and the lack of standard questionnaire for assessing the oral health knowledge, attitude, and behavior among the respondents are the limitations of the study.


  Conclusion Top


The findings in this study showed that DS have better oral health knowledge than PS. This could be attributed to related oral health topic in their syllabus, while these specialized topics are almost lacking in the pharmacy program. Despite having poor knowledge, PS had positive attitude and practice toward oral health with no significantly different scores when compared to the DS.

Recommendations

Recommendations that may help improve the overall knowledge, attitude, and practice among dental and pharmacy students toward oral health may include:

  1. Oro-dental health seminars and workshops can be incorporated into the curriculum of the DS in general and PS in specific to improve their oral health knowledge, attitude, and practice
  2. It is recommended to accommodate pharmacy graduates during their internships hospital practice in rounds in dental clinics to understand the basics of oral health care management.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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