|Year : 2022 | Volume
| Issue : 2 | Page : 118-125
Oral health awareness among undergraduate medical students and interns: A cross-sectional study
G Sree Vijayabala1, Aruna Bholenath Patil2, S Mohanavalli1, VA Janaga rathinam1, Himasagar Ellampalli1
1 Department of Dentistry, E.S.I.C Medical College and PGIMSR, Chennai, Tamil Nadu, India
2 Department of Community Medicine, E.S.I.C Medical College and PGIMSR, Chennai, Tamil Nadu, India
|Date of Submission||23-Nov-2021|
|Date of Decision||25-Dec-2021|
|Date of Acceptance||07-Jan-2022|
|Date of Web Publication||22-Aug-2022|
G Sree Vijayabala
Department of Dentistry, E.S.I.C Medical College and PGIMSR, KK Nagar, Chennai - 600 078, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Introduction: Oral health is an integral component of general health. Many oral systemic diseases manifest orally, and general medical practitioners are the primary health-care providers in society, so understanding oral health and its significance is critical for medical students and practitioners. The present study was conducted to assess the oral health awareness among MBBS students and interns. Materials and Methods: After obtaining institutional ethical committee approval, the present cross-sectional study was conducted among 318 subjects who were second, third, and final year MBBS students and interns of ESIC medical college and PGIMSR. A validated, self-structured questionnaire comprising of 20 questions pertaining to oral health awareness were prepared using Google forms and was sent to the study participants tthrough WhatsApp and the findings were analysed using proper statistical methods. Results: In the present study, 19% of the study population had good oral health awareness, 49% and 32% had fair and poor oral health awareness, respectively. The final year students had a good oral health awareness compared to the other years of students and interns. Oral health awareness scores did not differ significantly between male and female study participants. Conclusion: The present study found a fair oral health awareness amongst the study population. Clinical Significance: A proper knowledge of oral health is very essential among the medical students as they would be approached by the general population for most of the primary health-care needs.
Keywords: Awareness, box plot, interns, medical students, oral health
|How to cite this article:|
Vijayabala G S, Patil AB, Mohanavalli S, Janaga rathinam V A, Ellampalli H. Oral health awareness among undergraduate medical students and interns: A cross-sectional study. J Dent Res Rev 2022;9:118-25
|How to cite this URL:|
Vijayabala G S, Patil AB, Mohanavalli S, Janaga rathinam V A, Ellampalli H. Oral health awareness among undergraduate medical students and interns: A cross-sectional study. J Dent Res Rev [serial online] 2022 [cited 2022 Oct 2];9:118-25. Available from: https://www.jdrr.org/text.asp?2022/9/2/118/354197
| Introduction|| |
Oral health is a window to general health. The maintenance of oral health is an integral part of maintaining good general health. In a few instances, oral manifestations of systemic diseases may be the key to the diagnosis of the underlying systemic condition. Hence, a proper knowledge about oral health becomes essential for general medical practitioners to provide a holistic treatment for the patient in need.
A healthy oral cavity and its surrounding structures is an indicator of good oral health. The significance of oral lesions in diagnosing many systemic and infectious diseases may be known to the dentist and the general physician. Medical practitioners have an essential role in oral health promotion. Proper knowledge about oral diseases is critical in medical practice as many systemic diseases have oral manifestations, and most of the population approach medical practitioners for their oral health ailments.
Effective integration of primary oral health care to the existing primary health-care activities shall pave the way to good community oral health. Medical practitioners being the primary health-care providers in the community could significantly impact the patients' oral health by integrating oral health in their practices to address the oral health needs of their patients. The impact of oral disease on people's everyday lives is subtle and pervasive, influencing eating, sleeping, work, and social roles. Undergraduate medical and nursing students, the nation's future health-care providers, must be aware of oral health and dental hygiene. The knowledge of oral health acquired by medical students presently will help them in the future as they become general practitioners, and they would be approached by people for their primary health needs.
Assessment of oral health awareness among medical students is much essential because the undergraduate students need to know the importance of oral health and conglomeration that exists between oral and general health. Studies of such sort would help them to be better medical practitioners in the future. The literature search revealed that only a few studies had assessed oral health awareness among undergraduate medical students. There is a paucity of studies in Tamil Nadu regarding the same. Hence, an attempt has been made to assess the oral health awareness among medical students and Interns at ESIC Medical College, Hospital and PGIMSR, Chennai.
| Materials and Methods|| |
The present cross-sectional survey was conducted among 318 Undergraduate Students and Interns from March 2021 to April 2021 at ESIC medical College, KK Nagar, Chennai. Institutional ethics committee approval (IEC/2020/2/20) was obtained before the start of the study. Informed consent was also obtained after explaining about the details of the study. This study was conducted online by sending Google forms to the study participants. Undergraduate second, third and final year MBBS students and interns of ESIC medical college and PGIMSR were included in the study. Participants who were not willing to take part in the study were excluded from the study. Confidentiality regarding the participants' responses had been maintained throughout the study.
Undergraduate medical students who were admitted in the second, third, final year and interns of the medical college at Tertiary care hospital during March 2021 to April 2021 were invited to participate in the study.
Total sample size in this study was taken 318 participants. The required sample size 289, was computed using the formula, n = 4pq/d2, with a precision of 5%, confidence level 95%, and a 25% proportion of awareness of oral health among medical students.
Considering 10% nonresponse rate, to achieve the required sample size, data collection was done among the total population of students from the institute, was intended to recruit except 1st year students.
A structured questionnaire comprising of 20 questions was used to measure the oral health awareness of the medical students in this study. The self-administrated questionnaire had been converted into Google Forms to collect the data online. The Google form link had been sent to the study participants who were MBBS students from second, third, final years and Interns of ESIC Medical college at KK Nagar through WhatsApp. The participants were requested not to discuss among their friends while marking the responses, as our objectives were to know the individual responses. All the questions were close-ended, and the options were given on a three-point Likert scale. The options were Yes, No, and don't know on the Likert scale. The questionnaire predominantly assessed the knowledge domain of the study participants. The validity of the questionnaire was assessed by the panel of 3 subject experts in the field and modified again with the necessary changes suggested by the panel. The reliability of the questionnaire was tested on a pilot study (n = 15 participants) using the test and retest method. By test-retest method, the consistency of the results in this questionnaire study was checked twice among the same 15 participants at an interval of 20 days between the first and second assessment. Gentle reminders were given to the study participants until the sample size reached the required number.
Using MS Excel Sheet, the master chart was made for the collected data and imported it to SPSS(Version 21.0) for data analysis. Categorical data were presented by frequency, proportion, and percentage. Descriptive statistics for continuous data, mean, median, and standard deviation (SD) were calculated. The three-point Likert scale was analyzed by calculating proportions and presented by staked bar diagram. To find an association between demographical variables and survey responses, Karl Pearson Chi-square test was applied. The nonparametric Chi-square test (for one sample) was used to test the difference among the proportions of responses recorded on each three-point Likert scale question. To compare awareness scores between genders, an independent t-test was applied. One-way analysis of variance (F test) was applied to compare the awareness score among the study year of participants (4 groups). The level of statistical significance was used at <=0.05. Box plots described the variation in the awareness scores of participants. The SPSS (Version 21.0, IBM SPSS, Armonk, NY: IBM group) and Microsoft Excel (10.0) were used for data analysis and graphical presentation.
| Results|| |
In this present study, 318 participants responded to the questionnaire. The proportions for demographic data, male: female ratio was 66.7%: 33.3%. A high proportion of participants, 87.4%, was obtained from the nuclear family, whereas 12.6% were from the joint family.
The individual responses to each question in the questionnaire were assessed to depict the in-depth understanding of the awareness about oral health among the study participants [Table 1]. An overall analysis of the data using interquartile range as cut-offs showed that 19% of the study participants had good oral health awareness, fair oral health awareness among 49% and poor oral health awareness among 32% of the study participants [Graph 1] and [Table 2].
|Table 1: Proportions of three categories of each question were compared by nonparametric Chi-square test|
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|Table 2: Percentage of oral health awareness among the study participants|
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The gender-wise comparison of oral health awareness was also assessed [Graph 2]. Among males, 37.7% had good oral health awareness, 26.5% had fair oral health awareness, and 41.2% had poor oral health awareness. Among female participants, 62.3% had good oral health awareness, 73.5% had fair oral health awareness, and 58.8% had poor oral health awareness. This comparison showed a statistically significant difference in the above proportions at P = 0.036. However, the Box-Whisker plot was drawn to compare the variation of oral health awareness score among male and female study participants, which showed almost no difference in mean score (10.5, 11.12; P = 0.078) [Graph 3].
Year-wise comparison of oral health awareness among the study participants revealed a good, significant oral health awareness among the final year MBBS students [Graph 4]. Interestingly, final year students showed better understanding than interns except for one student (an outlier with a higher score).
It also revealed that, while comparing the awareness scores among the study year participants (4 groups), a higher and statistically significant difference in mean scores was found in 3rd year (Mean = 12.05, SD = 2.57), final year (Mean = 12.13, SD = 2.52), and interns (Mean = 12.02, SD = 2.61); all three groups with almost the same mean score as compared to 2nd year with lower mean score (Mean = 9.62, SD = 2.84) (F test = 21.937, P = 0.0001) [Graph 5].
| Discussion|| |
The present study evaluated the oral health awareness among interns and MBBS students, and the overall results depicted a fair oral health awareness among the study subjects. In the present study, a significant proportion of the study population was aware that chewing and smoking tobacco would predispose to oral premalignancy and malignancies, and oral submucous fibrosis was a potentially malignant disorder.
The study participants gave an equivocal response to whether deep dental caries could result in urticaria, and a statistically insignificant result was obtained for this question. This exemplified the need for medical students and professionals to have a thorough understanding of the oral foci of infection. A significant number of study participants were unaware of the color change in an internally resorbing tooth. Furthermore, a significant number of study participants were under the impression that potentially malignant disorders inadvertently precede all oral cancers. It is thus emphasized that medical students must be familiar with dental trauma and oral premalignancy. A statistically significant proportion of the population was also not aware of the number of branches in dentistry [Table 1].
Few studies have been done in the past to evaluate oral health awareness among medical students and practitioners. The present study results were also compared to the studies done in the past to see if it was in accordance with our study or contrary to the present study.
A significant percentage, 49%, of the study population in our present study had fair oral health awareness. A study done by Sujatha et al. to assess oral health awareness among undergraduate medical students in Davangere city showed that 25% had good oral health awareness, 38% with fair, and 37% with poor oral health awareness.
The present study results showed that only 19% of study participants had good oral health awareness. However, a cross-sectional survey conducted among international medical and dental students by Petrauskiene et al. depicted an overall good, fair, and poor oral health awareness reported by 71.3%, 24.1%, and 4.6%, respectively.
In the present study, a statistically significant population (88%) was aware that oral health is an integral part of general health. This was in accordance with the study conducted by Usman et al. in which most of the medical (80%), dental (96%), and paramedical (85%) students consider that good oral health maintenance is equally essential like that of maintaining good general health (P < 0.001).
A study done by Patil et al. among medical practitioners showed that the majority of the medical practitioners were not aware that, Caries is infectious and transmissible from mother to child, OSMF to be precancerous and had inadequate knowledge about oral health relation with other parts of the body. But, it is inferred from the present study that a statistically significant population is aware that caries has an infective etiology, OSMF being a precancerous condition, and that systemic diseases could manifest orally.
The overall oral health awareness was good among final year students, followed by interns, 3rd year and 2nd year MBBS students. The 2nd year students and the 3rd year students might have a lesser overall knowledge than the final year students and interns as the exposure to Dentistry as a subject and the overall knowledge about oral health might be less comparatively in their initial study period. To avoid response-variation bias, the 1st-year students were excluded from the study because they would have had less clinical exposure and knowledge about oral health than the other years. The limitation of this study was that, because it was a questionnaire study, subject bias (or participant bias) could be present.
| Conclusion|| |
This study makes recommendations to inculcate knowledge about various spectrum of oral health, dental trauma, and oral premalignancy to the MBBS students during their undergraduate study. Further exposure to various academic society meetings and Continuing Dental Education programs for the medical students would also help to enhance their oral health awareness to become better practitioners in the future.
Medical practitioners are approached many a time for oral health ailments. Overall knowledge about oral health and awareness about oral health is essential to provide preventive and prompt care to patients in need. Such an approach would result in early diagnosis of oral health conditions, which would pave the way for oral health care, thereby curtailing the morbidity associated with the conditions.
Before starting the study, the Institutional ethics committee approval (IEC/2020/2/20) was obtained.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
The questionnaire had been used for data collection in this study
(Answer options in Likert scale as Yes, No, and Don't know for each question)
1. Are you aware of the proper technique to brush the teeth?
2. It is not mandatory to brush the teeth twice a day.
3. Dental caries has no bacterial etiology
4. Topical fluoride application over teeth can help to prevent dental caries in children.
5. Smoking and chewing of tobacco predispose to oral premalignant and malignant lesions of the oral cavity.
6. Most of the oral ulcers scar while healing
7. Oral submucous fibrosis is a potentially malignant condition
8. All oral cancers are inadvertently preceded by a potentially malignant condition
9. A tooth can become discolored due to trauma
10. Internally resorbing deciduous tooth changes to orange color
11. We can reimplant an avulsed tooth after 24 h
12. Mouth breathing can cause malocclusion
13. Occlusal discrepancies of teeth can cause myofascial pain dysfunction syndrome.
14. Consumption of soft drinks can cause erosion of teeth
15. Artificial Removable Dentures must be cleansed everyday
16. Are you aware that deep dental caries can cause chronic urticaria?
17. Are you aware that tooth is a tool for age estimation?
18. Systemic diseases can manifest in the oral cavity
19. Are you aware of the nine different branches in Dentistry?
20. Are you aware of the branch of dentistry that in particular deals with the oral management of medically compromised patients?
| References|| |
Kumar H, Behura SS, Ramachandra S, Nishat R, Dash KC, Mohiddin G. Oral health knowledge, attitude, and practices among dental and medical students in eastern India – A comparative study. J Int Soc Prev Community Dent 2017;7:58-63.
Marshall JA, Lucia SP. Oral manifestations of systemic diseases. J Am Dent Assoc Dent Cosmos 1938;25:943-6.
Sujatha BK, Yavagal PC, Gomez MS. Assessment of oral health awareness among undergraduate medical students in Davangere city: A cross-sectional survey. J Indian Assoc Public Health Dent 2014;12:43. [Full text]
Fotedar S, Fotedar V, Bhardwaj V, Thakur AS, Vashisth S, Thakur P. Oral health knowledge and practices among primary healthcare workers in Shimla District, Himachal Pradesh, India. Indian J Dent Res 2018;29:858-61.
] [Full text]
Sharma BS, Sharma J, Upadhyay M, Agrawal A, Dayma A, Yadav SP. Knowledge and awareness about dentistry among medical students, residents, and medical practitioners in Bhairahawa city, Nepal. J Family Med Prim Care 2021;10:922-8. [Full text]
Almoteb MM, Alalyani SS, Gowdar IM, Penumatsa NV, Siddiqui MA, Sharanesha RB. Oral hygiene status and practices among healthcare workers: A cross-sectional study. J Int Oral Health 2019;11:268. [Full text]
Gupta V. Assessment of oral hygiene practices among medical students. Int J Community Med Public Health 2020;7:1170-7.
Petrauskiene S, Mushayev H, Zemgulyte G, Narbutaite J. Oral health awareness among international dental and medical students at Lithuanian University of Health Sciences: A cross-sectional study. J Oral Maxillofac Res 2019;10:e3.
Usman S, Bhat SS, Sargod SS. Oral health knowledge and behavior of clinical medical, dental and paramedical students in Mangalore. J Oral Health Community Dent 2007;1:46-8.
Patil A, Chavan S, Baghele O, Patel K, Patil K. Awareness of oral health among medical practitioners in Sangamner City – A cross-sectional survey. Int J Clin Dent Sci 2010;1:26-9.
[Table 1], [Table 2]