|Year : 2020 | Volume
| Issue : 3 | Page : 236-240
Factors associated with the dental health status of health promotion students in the Faculty of Public Health, Universitas Indonesia: A cross-sectional study
Anggia R Renjana, Hadi Pratomo, Ririn Arminsih
Health Promotion and Behaviour Science Departement, Public Health Faculty, Universitas Indonesia, Kota Depok, Jawa Barat, Indonesia
|Date of Submission||21-Dec-2018|
|Date of Decision||23-Dec-2019|
|Date of Acceptance||04-Jan-2020|
|Date of Web Publication||02-Jun-2020|
Prof. Hadi Pratomo
Health Promotion and Behaviour Science Departement, Public Health Faculty, Universitas Indonesia, Kota Depok, Jawa Barat
Source of Support: None, Conflict of Interest: None
Aim: The aim of this study was to identify factors associated with the dental health status of public health promotion graduate students. Materials and Methods: This was a cross-sectional study of 67 graduate public health promotion students. A self-administered questionnaire on dental health knowledge, attitudes, and practices was administered, in addition to a dental caries examination. The data were collected during 5 days (from June 5 to 9, 2017). Statistical Test Used: Statistical analysis was performed using both chi square and multiple logistic regression tests with 95% confidence interval (CI). Results: The Decayed, Missing, and Filled Tooth (DMF-T) index of the students was higher (4.7) than that of the national DMF-T index in 2013. Most of the students (86.6%) had a low level of knowledge of dental health. About half had negative attitudes toward dental health care, as well as a high number of caries. About three of every four students had inadequate dental health care practices. Although the students knew about a free dental clinic at the university, only one-eighth of the study group used this clinic. The respondents who had an inhibiting social environment were 41.8%, whereas 23.9% of them had a supporting social environment. There was a significant correlation between an inhibiting social environment and dental health status (P = 0.036; odds ratio [OR] = 0.347; 95% CI = 0.1–0.9). A multivariate test showed that the students with a supporting social environment had an OR of 2.949. Thus, students without a supporting social environment had a 2.95 higher probability of having a high number of dental caries. Conclusions: Factors associated with the dental health status of public health promotion graduate were identified.
Keywords: Dental health status, Health promotion, Public health student
|How to cite this article:|
Renjana AR, Pratomo H, Arminsih R. Factors associated with the dental health status of health promotion students in the Faculty of Public Health, Universitas Indonesia: A cross-sectional study. J Int Oral Health 2020;12:236-40
|How to cite this URL:|
Renjana AR, Pratomo H, Arminsih R. Factors associated with the dental health status of health promotion students in the Faculty of Public Health, Universitas Indonesia: A cross-sectional study. J Int Oral Health [serial online] 2020 [cited 2020 Aug 4];12:236-40. Available from: http://www.jioh.org/text.asp?2020/12/3/236/285577
| Introduction|| |
Good dental and oral health is important for good general health and an improved quality of life. Without appropriate dental hygiene, good systemic health may be difficult to achieve., As reported in previous research, caries is a preventable and controllable disease, with adverse consequences if left untreated.
According to a basic health research (Riskesdas) report published by Ministry of Health, Republic Indonesia, in 2013, the prevalence of dental caries in Indonesia among those aged older than 12 years was 25.9%, and the national Decayed, Missing, and Filled Tooth (DMF-T) index was 4.6. As reported previously, dental disease affects the productivity of an individual, reducing the productive period by approximately 3.86 days and a range of daily activity stops between 2.5 and 5.28 days. Therefore, although not causing death, dental disease can decrease labor productivity.
Health development, including oral and dental health, is indispensable for quality of life of the human being, and health development is an investment in human resources There is a strong need to change the perspective of curative health services and the paradigm of illness approach to a promotive healthy paradigm, which was the vision of Healthy Indonesia 2010. As part of this vision, individuals were encouraged to routinely visit their dentist rather than waiting for oral and dental health problems to occur. Routine dental checkups can provide a range of benefits, including the early detection of dental caries and the prevention of a range of dental and oral health problems. Community empowerment in oral health can support the implementation of health development. The action is about health promotion and health prevention. Therefore, health promoters have a role in community empowerment.,
Health promoters have a responsibility to educate the community in maintaining their health, including dental health. As future health promoters, public health graduates should be role models in terms of their health behaviors, including dental health. Graduate students majoring in health promotion at the Department of Health Education and Behavioural Sciences, Faculty of Public Health (FPH), Universitas Indonesia (UI), should have the competence to recognize public health problems that require health promotion interventions. The health promoter as an educator should be equipped with appropriate knowledge, attitudes, actions, and skills. Dental health knowledge should be an important part of the public health curriculum in university.
Individuals with poor knowledge of both dental and oral health may have a high risk of dental and oral diseases. Such lack of knowledge may give rise to difficulties in communicating with the dentist. It may also affect decision-making regarding access to dental care and preventive dental care. In previous research in Nigeria, good knowledge of preventive dental care was associated with a one-fold increase in teeth brushing more than once a day and a five-fold increase in the use of recommended oral self-care.
As shown in a previous study, low utilization of dental care facilities may result in poor dental and oral health status., However, many individuals do not visit their dentist on a regular basis. The reasons for noncompliance with routine dental visits vary, from feeling no need for visits to concerns about dental service fees, and to scheduling problems in terms of fitting in dental appointments. According to a previous study, only 12% of respondents aged ≥15 years underwent routine dental examinations, and nearly 50% of respondents only visited when they had a dental complaint. Previous research also showed that dental health maintenance, especially regular visits to the dentist, was uncommon., Instead, most people considered that routine checkups were unnecessary in the absence of specific dental and oral problems.
Many people ignore dental care and avoid visits to the dentist because of fear and anxiety. The latter may be caused by several factors, including illiteracy, a lack of awareness of dental health, infrequent or even no visits to the dentist, socioeconomic status, or trauma from past experience with a dentist. Excessive anxiety can have an adverse effect on a person’s dental health status. Several social environment factors, such as family, also influence a person’s dental health status. Family dental care habits affect the dental caries status of children and the child’s dental care behavior in later life.
A radical shift in government policy in Indonesia is needed to ensure the long-term success of dental health promotion programs. The aim of this study was to determine the factors associated with the dental health status and dental caries status of graduate students majoring in health promotion in the FPH, UI.
| Materials and Methods|| |
This was an analytic quantitative research study, with a cross-sectional design of factors related to the dental health status of health promotion students in the FPH, UI. The dependent variable was the dental caries status of graduate students majoring in health promotion. The independent variables were the student’s dental health care knowledge, attitudes, practices; the use of a satellite dental clinic at UI; and the supporting as well as the inhibiting social environment factors.
Prior to participating in this study, informed consent was secured from each participating respondent. The study was approved by the research ethics committee of the FPH, UI, on May 24, 2017 (Ref no: 278/UN2.F10/PPM.00.02./2017).
The respondents were graduate students majoring health promotion in the FPH, UI. Inclusion criteria of the respondents included students who had passed health promotion and health behavior subject courses. Meanwhile, the exclusion criteria included students who are dentist. In total, 67 students participated in this study. Informed consents were taken from all participants before enrolling them in the study.
All the data were systematically collected at the same time. Data were collected through a self-administered questionnaire, which was developed specifically for the study. The questionnaire was modified and translated from the Oral Health Survey, the Hiroshima University Dental Behavioral Inventory and the Oral Hygiene Practices, and Self-Reported Oral Health Behaviour questionnaire, which contains 21 questions on oral health knowledge, 12 questions on oral health attitudes, 14 questions on oral health behavior, 5 questions on dental health facilities, and 4 questions on the respondents’ dental health history. To keep the standardization of the questionnaire, the Indonesian version was translated back into English by an English native speaker.
The validity and reliability of the instrument was tested using Cronbach’s alpha method. Cronbach’s alpha was 0.762, there by demonstrating the validity and reliability of the instrument. All the participants also underwent a dental caries examination using the DMF-T index. The examination was performed by a registered dentist. The examination took place at the satellite dental clinic at the UI campus from June 5 to 9, 2017.
Data were analyzed using SPSS, version 24 (IBM, Armonk, NY), by a univariate analysis, as well as a bivariate analysis. A chi-square test was performed, with the level of significance accepted as P = 0.05. Furthermore, a logistic multivariate analysis was performed to test which of the independent variables, that is, the student’s dental health care knowledge, attitudes, and practices; the use of a satellite dental clinic at UI; and the (inhibiting and supporting) social environment factor, are most associated with their dental health status.
| Results|| |
Of the 67 respondents, almost three of every four (72%) students had active caries, and about half of the students (50.7%) had a high dental caries status. The majority of the students (86.6%) had poor knowledge of dental health care, and half of the students (52.2%) had poor attitudes toward dental health care. Seven of 10 students (71.6%) practiced poor dental health care, and knew about the satellite dental clinic at the university. Nine of 10 students (91%) had never used the clinic. Half of them (58%) did not have experiences that could prevent the respondents attending a dental examination. Only one-fourth (24.9%) of the respondents had a supporting social environment (i.e., an environment conducive to regular dental examinations).
Results of the chi-square test showed only inhibiting social environmental factors were related to the dental health status of the students (P = 0.036; odds ratio [OR] = 0.347; 95% confidence interval = 0.1–0.9) [Table 1]. As all the independent variables were related to dental health status, they were all included in the multivariate test [Table 2]. The results from the multiple logistic regression test showed that the supportive social environment variable was the most common factor related to the dental health status of the students, with an OR of 2.949. Thus, students with inhibiting social environment had a high caries status (2.95 times greater than students with supporting social environment).
|Table 1: The association between the independent variables and the dental caries status of health promotion the students, Faculty of Public Health, Universitas Indonesia, 2017 (N = 67)|
Click here to view
| Discussion|| |
The subjects in this study were all public health graduate students majoring in health promotion. Almost three of four (72%) students had active caries and tooth decay (DMF-T index = 4.7), which is higher than the national index of 4.6. On the basis of the theory, in order to become a role model in educating the community, the health status of all health promoters should be good. With a good dental health status, a health promoter can understand and fulfill his competence., Almost 9 of 10 students (86.6%) had poor knowledge of dental health maintenance.
This is in contrary with results of previous research that indicated that good knowledge of dental health would positively affect dental hygiene practice. Prior studies also suggested that improved knowledge of oral hygiene would result in a positive attitude among individuals to dental health, and has a positive impact on reducing the caries prevalence.,[25-28] Furthermore, research indicated that public health students could serve as a source of information for the community.
In this study, on the basis of the OR value of 1.3, students with a negative attitude had a high caries status as compared with that of students with a positive attitude. This finding is in contrast to that found in a previous study, which reported that a positive attitude toward dental health was associated with a good dental health status.
The maintenance of dental health among the study population was poor. Dental health maintenance actions can be divided into those that are performed by the individual and those that are performed by the dentist. The maintenance of dental health at the level of the individual is an effective preventive measure to maintain good oral health, which is an important part of a person’s general health., Although most of the students (71.6%) knew about the satellite dental clinic at UI and were aware of the free facility, only 12.5% of the study population utilized the clinic. The apathetic attitude of the students in this study was mirrored in those of previous studies, which showed that only 12% of respondents aged ≥15 years underwent routine dental checkups and that nearly 50% of respondents only visited a dentist when they had dental-related problems.,
In total, 35.7% of the students with a high dental caries status attributed their poor dental health maintenance behavior to dental traumas in the past. This finding is consistent with that of previous studies, which suggested that excessive anxiety can cause someone to avoid dental care, with such avoidance having adverse consequences in terms of their health. Only 19.4% of the students had routine dental checkups, and only 9% stated that UI had a dental examination policy for new students. On the basis of the OR score of 2.95, students with inhibiting social environment had higher caries status compared with the students with supporting social environment. The supporting social environment in this study consisted family history of routine, regular visits to the dentist with the family, and the university’s policy, which requires students to undergo dental checkups. In accordance with the Ottawa Charter, which states that government policy has a key role to play in improving the health of a population, the emphasis on oral health in government policy in Indonesia remains low.,
Strengths and limitations of the study
There are no previous studies concerning the dental health knowledge, attitudes, practices, and maintenance in relation to the dental health status of students of public health, especially those who intend to become health promoters. Similar existing studies were conducted among both medical and dental students and students outside of the health field. Furthermore, in this study, a direct examination of dental caries was performed.
The sample size of the study was limited. The small number of students in this study affects the P value and the significance of the relationship between the independent variables and the dependent variable. In addition, this study was conducted in a very specific population (i.e., undergraduate and graduate students majoring in health promotion at the FPH, UI).
Interpretation and implications
We suggest that UI should create a policy that requires students to undertake routine dental checkups at least every 6 months to 1 year. These students are required to undertake a complete dental examination as one of the requirements of their course. We also suggest that basic dental knowledge should be added to the curriculum of health promotion subjects.
Future research directions
In future studies, research involving a larger sample, which includes all the students of the FPH, UI, and its faculty members, would be worthwhile. Such research could be extended to other faculty of public health. In this study, only an examination of dental caries was performed. We strongly recommend that future research should include the Oral Hygiene Index Simplified examination. Furthermore, to explore the reasons behind the lack of knowledge of dental care and the students’ poor attitudes toward dental care, a qualitative study is recommended.
| Conclusion|| |
The dental health status and dental care knowledge, attitudes, and practice among graduate students majoring in health promotion in the FPH, UI, were poor. Only negative social environmental factors showed a statistically significant relationship with the dental health status of the students. Therefore, negative factors associated with the dental health status of public health promotion graduate were identified.
An appreciation is extended to Dr. Astrid Sulistomo, MPH, Sp.OK (chairperson of the satellite clinic at Universitas Indonesia), for giving permission and support for the implementation for this research.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Purohit BM, Singh A, Acharya S, Bhat M, Priya H. Assessment and validation of the oral impact on daily performance (OIDP) instrument among adults in Karnataka, south India. Community Dent Health 2012;29:203-8.
Rahmati-Najarkolaei F, Rahnama P, Gholami Fesharaki M, Behnood V. Predictors of oral health behaviors in female students: An application of the health belief model. Iran Red Crescent Med J 2016;18:e24747.
Mehta A. Comprehensive review of caries assessment systems developed over the last decade. RSBO Rev Sul-Brasileira Odontol 2012;99:16-21.
Ministry of Health Republic of Indonesia. Jakarta, Indonesia: Basic Health Research. 2013.
Ministry of Health Republic of Indonesia. Status of oral and dental health of visitor of public health center/Puskesmas, Special Province of Jakarta 2007. Jakarta, Indonesia: Health Research Bulletin.
Indirawati T, Lannywati G. Status of dental and oral health of the patients attending public health center in Jakarta 2007. Jakarta, Indonesia: Health Research Bulletin. 2010; p. 38.
Ministry of Health Republic of Indonesia. Guideline Book Training for Cadre of Oral and Dental Health in the Community. Jakarta, Indonesia: Directorate General of Community Health. 2012.
Thomson WM, Williams SM, Broadbent JM, Poulton R, Locker D. Long-term dental visiting patterns and adult oral health. J Dent Res 2010;89:307-11.
Amarasena N, Kapellas K, Skilton MR, Maple-Brown LJ, Brown A, Bartold M, et al
Factors associated with routine dental attendance among aboriginal Australians. J Health Care Poor Underserved 2016;27:67-80.
Ueda M, Bernucci, Picinin M, Pavanelli, Cezar G. Scientific research about the National Policy for Health Promotion. Cien Saude Colet 2016;21:27-37.
Šiljak S, Janković J, Marinković J, Erić M, Janevic T, Janković S. Dental service utilisation among adults in a European developing country: Findings from a national health survey. Int Dent J 2019;69:200-6.
Health education and behavioral sciences. Universitas Indonesia [cited April 16 2017]. Available from: http://www. f k m . u i . a c . i d / t e n t a n g -kami/departemen/pendidikan-kesehatan-dan-ilmu-perilaku/.
Cottrell RR, Girvan JT, McKenzie JF. Principles and Foundations of Health Promotion and Education. San Francisco, CA; 5th Edition; 2012: 384.
Mathai T, Vinod K, Sujatha G, Tom M, Anoop K, Kranti E. Dental anxiety among dental, medical, and nursing students in India and Its correlation with their field of study. J Int Oral Health 2016;8:860-4.
Guo Y, Logan H, Dodd VJ, Muller KE, Marks JG, Riley JL. Health literacy: A pathway to better oral health. Am J Public Health 2014;104:85-92.
Folayan MO, Khami MR, Folaranmi N, Popoola BO, Sofola OO, Ligali TO, et al
Determinants of preventive oral health behaviour among senior dental students in Nigeria. BMC Oral Health 2013;13:28.
Arino M, Ataru I, Fujiki S, Sugiyama S, Hayashi M. Multicenter study on caries risk assessment in adults using survival Classification and Regression Trees. Sci Rep 6, 29190 2016;1-8.
El Bcheraoui C, Tuffaha M, Daoud F, Kravitz H, AlMazroa MA, Al Saeedi M, et al
Use of dental clinics and oral hygiene practices in the Kingdom of Saudi Arabia, 2013. Int Dent J 2016;66:99-104.
Rahbari M, Gold J. Knowledge and behaviors regarding early childhood caries among low-income women in Florida: A pilot study. J Dent Hyg 2015;89:132-8.
Irani S. Oral health and related factors. J Int Oral Health 2016;8:1140-4. [Full text]
Watt RG, Listl S, Peres M, Heilmann A, editors. Social inequalities in oral health: From evidence to action. London, UK: International Centre for Oral Health Inequalities Research and Policy; 2015.
Aggarwal VR, Javidi H, Joughin A, Crawford FI, Sharif MO. Patients’ knowledge of risk factors for dental disease. A pilot service evaluation in a general dental practice. Prim Dent Care 2010;17:173-7.
Kawamura M, Iwamoto Y, Wright FA. A comparison of self-reported dental health attitudes and behavior between selected Japanese and Australian students. J Dent Educ 1997;61:354-60.
Gopinath V. Oral hygiene practices and habits among dental professionals in Chennai. Indian J Dent Res 2010;21:195-200.
] [Full text]
Rodakowska E, Kierklo A, Jamiołkowski J. Self-reported oral health behaviour among Scandinavian and Polish medical students studying in Poland. Cent Eur J Public Health 2016;24:68-75.
Al-Darwish MS. Oral health knowledge, behaviour and practices among school children in Qatar. Dent Res J (Isfahan) 2016;13:342-53.
Smith L, Blinkhorn F, Moir R, Blinkhorn A. Results of a two year dental health education program to reduce dental caries in young aboriginal children in new South Wales, Australia. Community Dent Health 2018;35:211-6.
Dikhsit P, Limbu S, Gupta S, Pradhan R. Evaluation of knowledge, attitude and practices of parents toward their children oral health compared with their dental caries status. Birat J Heal Sci 2018;3:447-52.
Kumar MPS. Knowledge, attitude and practices towards oral health among law students in Chennai. J Pharm Sci Res 2016;8:650-3.
Hobdell M, Petersen PE, Clarkson J, Johnson N. Global goals for oral health 2020. Int Dent J 2003;53:285-8.
Jegede AT, Oyedele TA, Sodipo BO, Folayan MO. Oral health knowledge and practices of dentists practicing in a teaching hospital in Nigeria. Indian J Dent Res 2016;27:137-44.
] [Full text]
[Table 1], [Table 2]