MUSHAYEV HAVA
5TH YEAR , GROUP 15
Oral health awareness among odontology and medicine
international students in Lithuanian University of Health
Sciences (LUHS)
Master’s Thesis Thesis supervisor: Sandra Žemgulytė Kaunas, 2017LITHUANIAN UNIVERSITY OF HEALTH SCIENCES MEDICINE ACADEMY
FACULTY OF ODONTOLOGY
CLINIC FOR PREVENTIVE AND PEDIATRIC DENTISTRY
Oral health awareness among odontology and medicine international students in Lithuanian University of Health Sciences (LUHS)
Master’s Thesis
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EVALUATION TABLE OF CLINICAL–EXPERIMENTAL MASTER’S THESIS
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Compliance with MT
No. MT parts MT evaluation aspects requirements and
evaluation Yes Partially No
1 Summary (0.5 point)
Is summary informative and in compliance with the
thesis content and requirements? 0.3 0.1 0 2 Are keywords in compliance with the thesis essence? 0.2 0.1 0 3 Introduction,
aim and tasks
(1 point)
Are the novelty, relevance and significance of the
work justified in the introduction of the thesis? 0.4 0.2 0 4 Are the problem, hypothesis, aim and tasks formed
clearly and properly? 0.4 0.2 0 5 Are the aim and tasks interrelated? 0.2 0.1 0 6
Review of literature (1.5 points)
Is the author’s familiarization with the works of other
authors sufficient? 0.4 0.2 0
7
Have the most relevant researches of the scientists discussed properly and are the most important results and conclusions presented?
0.6 0.3 0
8 Is the reviewed scientific literature related enough to
the topic analysed in the thesis? 0.2 0.1 0 9 Is the author’s ability to analyse and systemize the
scientific literature sufficient? 0.3 0.1 0
10
Material and methods (2 points)
IS the research methodology explained comprehensively? Is it suitable to achieve the set aim?
0.6 0.3 0
11
Are the samples and groups of respondents formed and described properly? Were the selection criteria suitable?
0.6 0.3 0
12
Are other research materials and tools (questionnaires, drugs, reagents, equipment, etc.) described properly?
0.4 0.2 0
13
Are the statistical programmes used to analyse data, the formulas and criteria used to assess the level of statistical reliability described properly?
0.4 0.2 0
14 Results (2
points)
Do the research results answer to the set aim and tasks
comprehensively? 0.4 0.2 0 15 Does presentation of tables and pictures satisfy the
requirements? 0.4 0.2 0 16 Does information repeat in the tables, picture and
17 Is the statistical significance of data indicated? 0.4 0.2 0
18 Has the statistical analysis of data been carried
out properly? 0.4 0.2 0
19
Discussion (1.5 points)
Were the received results (their importance, drawbacks) and reliability of received results assessed properly?
0.4 0.2 0
20
Was the relation of the received results with the latest data of other researchers assessed
properly?
0.4 0.2 0
21 Does author present the interpretation of results?
0.4 0.2 0
22
Do the data presented in other sections (introduction, review of literature, results) repeat?
0 0.2 0.3
23
Conclusions (0.5 points)
Do the conclusions reflect the topic, aim and
tasks of the Master’s thesis? 0.2 0.1 0
24
Are the conclusions based on the analysed material? Do they correspond to the research results?
0.2 0.1 0
25 Are the conclusions clear and laconic? 0.1 0.1 0
26
References (1 point)
Is the references list formed according to the
requirements? 0.4 0.2 0
27
Are the links of the references to the text correct? Are the literature sources cited correctly and precisely?
0.2 0.1 0
28 Is the scientific level of references suitable for
Master’s thesis? 0.2 0.1 0
29
Do the cited sources not older than 10 years old form at least 70% of sources, and the not older than 5 years – at least 40%?
0.2 0.1 0
Additional sections, which may increase the collected number of points
30 Annexes Do the presented annexes help to understand
the analysed topic? +0.2 +0.1 0
31
Practical
recommendations Are the practical recommendations suggested
and are they related to the received results? +0.4 +0.2 0
General requirements, non-compliance with which reduce the number of points
32
General requirements
Is the thesis volume sufficient
(excluding annexes)? 15-20 pages (-2 points) <15 pages (-5 points) 33 Is the thesis volume increased
artificially?
34 Does the thesis structure satisfy the
requirements of Master’s thesis? -1 point -2 points 35
Is the thesis written in correct
language, scientifically, logically and laconically?
-0.5 point -1 points
36 Are there any grammatical, style or
computer literacy-related mistakes? -2 points -1 points 37
Is text consistent, integral, and are the volumes of its structural parts
balanced?
-0.2 point -0.5 points
38 Amount of plagiarism in the thesis. >20%
(not evaluated)
39
Is the content (names of sections and subsections and enumeration of pages) in compliance with the thesis structure
and aims? -0.2 point
-0.5 points
40
Are the names of the thesis parts in compliance with the text? Are the titles of sections and sub-sections distinguished logically and correctly?
-0.2 point -0.5 points
41 Was the permit of the Bioethical
Committee received (if necessary)? -1 point 42 Are there explanations of the key
terms and abbreviations (if needed)? -0.2 point -0.5 points
43
Is the quality of the thesis typography (quality of printing, visual aids, binding) good?
-0.2 point -0.5 points
*In total (maximum 10 points):
*Remark: the amount of collected points may exceed 10 points.
Reviewer’s comments: ___________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _________________________________________ ___________________________ Reviewer’s name and surname Reviewer’s signature
CONTENT
Summary ……….……….………..…….…..7
Introduction ……….………..……8
Review of literature……….…….……….….…9
Methods and Materials ……….….……….………..12
Results……….………….……….……..…..13
Discussion……….……….….……….….…..…..23
Conclusion ……….………..……….……..….25
References ………..………..…26
SUMMARY
The aim- to asses and evaluate the oral health awareness, knowledge and attitude among
international students of Odontology and Medicine faculties in LUHS.
The methods and materials-
A total of 282 international students of Odontology and Medicine faculty in LUHS participated in this study. Original questionnaire was chosen from Sujatha et al.[1] study including 25 statements. Content was related to oral health problems and their relation with general health. Questionnaires were used to assess student’s oral health awareness attitude and knowledge. This research was approved by the Ethics committee of the LUHS. The data was collected, coded, computerized and analyzed by using SPSS 19 version. The level of significance was set at P<0.05.
Results: Majority of both faculties’ students reported the correct answers. While statistically
significant differences were noted between the knowledge of medical, preclinical and clinical odontology students about questions related to avulsion treatment (p=0.022), and
temporomandibular disorders risk factors (p<0.001). Mean score of awareness among odontology students was higher than among medicine students (19.14±3.25 vs. 17.44±3.10) (p=0.003), thus it showed good oral health awareness.
Conclusion: Overall oral health awareness among LUHS international odontology and
medicine students was high. Odontology students had higher oral health awareness than medicine students.
Keywords: Oral health awareness, medical and dental students, oral health attitude, oral
INTRODUCTION
Today’s medicine and odontology students are tomorrow’s doctors. The knowledge they are going to acquire at present will be reflected in the future during their practice. Medical practitioners should play an active role in oral health promotion. Proper knowledge of oral diseases is crucial not only for odontology students, but also for medicine students due to the following reasons: periodontal diseases, which are associated with multiple systemic conditions of medical interest, variety of systemic diseases which have oral manifestations, drugs which are associated with oral adverse drug reactions, and majority of the population approach medical practitioners for their oral health problems [1].
Often dentists fail to notice general health problems because they focus on the diagnosis and treatment of oral diseases. Correspondingly medical doctors fail to diagnose oral diseases; therefore enhancing inter-professional collaboration between medical and dental practitioners is important [2].
Inter-professional collaboration allows achievement of a greater resource efficiency and improvement of the standards, comprehensiveness, and continuity of care by reducing duplication and gaps in services [3].
As future health care provider, dental students should act as a good role model to their family members, friends and especially patients for oral health behavior. Their behavior and attitudes towards their own oral health imitates their understanding of the significance of preventive dental procedures and improving the oral health of their patients [4].
Furthermore, dentists, medical doctors and other medical staff should be involved more closely to promote oral health education for pregnant women and to encourage dental care to improve early childhood caries (ECC) prevention in both public health and private practices as well [5]. There are some differences between curriculums of medicine and odontology faculties;
therefore the level of knowledge might be different.
Odontology students in first and second year study the basic preclinical subjects which comprise the basic biomedical studies.
During the three year clinical stage the odontology students receive many subjects related to oral hygiene and prevention of oral diseases, compared with pre-clinical and medical students that do not have a dedicated subject for this field. Therefore a difference is expected in the attitude and awareness towards oral health importance.
Hypothesis
We expect that odontology students are more aware to the risk factors and etiology of oral diseases when compared to medical students. Furthermore, odontology students of clinical year (3rd, 4th, 5th year) should have more profound knowledge than students of pre-clinical year (1st and 2nd year).
The aim-to asses and evaluate the oral health awareness, knowledge and attitude among
international students of Odontology and Medicine faculties in LUHS.
Objectives:
1. To create the questionnaire and to collect the data. 2. To code the findings of data and to analyze the results.
3. To analyze the publications related to this topic and compare the results with similar performed studies.
REVIEW OF LITERATURE
Dental caries is the disease resulting when there is an ecologic shift in the dental biofilm environment, by frequent intake of fermentable dietary carbohydrates. Eventually, this leads to a change from a low cariogenicity balanced population of microorganisms to a more aciduric and acidogenic population, as a result there will be an increase in organic acids production [6]. Most oral diseases such as dental caries and gingivitis caused mainly due to poor oral hygiene [7]. Proper toothbrushing is thought to be the main and basic self-care action for good oral health maintenance and brushing twice a day has become a social norm [8]. Infrequent and improper toothbrushing is considered to be a risk factor for periodontitis [9]. Mechanical plaque removal with a tooth brush is the primary technique for maintaining good oral hygiene [10]. Removal of dental plaque from interdental spaces is performed with auxiliary measures such as dental floss, interdental brush and etc [11]. Oral hygiene has an important role in preventing dental caries and periodontal diseases [12, 13].
Cigarette smoking is one of the main risk factors of periodontal disease and is associated with more than half of the cases in the population[14]; in addition it increases the risk of dental caries [15].
Cigarette smoking is related with a higher incidence of edentulousness and with increased rates of tooth loss compared with non-smokers [16].
Usage of different types of tobacco, for example cigar, pipe, and smokeless tobacco, as well is associated with tooth loss risk [17].
Dental erosion is a progress where tooth substance is lost by acids that do not involve bacteria due to extrinsic or intrinsic factors [18]. Intrinsic factors can be repeated vomiting,
gastroesophageal reflux disease(GERD), anorexia and bulimia. Extrinsic causes such as acidic drinks, acidic fruits and medications [19].
The soft drinks erosive ability depends on their total titrable acids and their pH [20]. A change in the tooth surface texture will occur when there will be an excessive contact between the tooth surface and acidic drinks [21].
There is a positive interrelationship between dental erosions and the excessive consumption of acidic drinks [22]. Most energy drinks containing a large amount of glucose having caffeine as their main principle element [23]. A study performed in Sweden demonstrated a strong
association between energy drinks and dental erosion [24]. Cervical dentin hypersensitivity can be caused by intake of energy drinks due to their low pH and high sugar concentration [25,26]. Development of primary dentition begins in mother's uterus and terminates after birth.
During this period there are some factors that have an effect on the ameloblasts cell function (enamel formation) and may lead to enamel defects. Enamel does not obtain remodeling and resorption properties, therefore it is sensitive to structural changes, which result in permanent marks on the teeth [27].
Systemic and topical fluoride, sugar substitutes and tooth brushing with fluoridated toothpaste are protective factors for dental caries. For individuals from communities in non-fluoridated areas, fluoride supplements have shown a significant caries reduction in primary and permanent teeth [28]. Fluoride has proved its function in preventive dentistry and we can obtain it in the form of toothpastes, mouth rinses, gels and varnishes [29].
Oral carcinoma is the main cause of death due to cancer worldwide [30] and is often preceded by various potentially malignant disorders (PMDs) with variable morbidity and mortality rates. Precancerous lesions are defined as a morphologically altered tissue, in which cancer is more likely to occur than in its apparently normal counterpart, whereas a precancerous condition is an overall condition associated with a significantly higher risk of cancer [31].
Leukoplakia/erythroplakia, submucous fibrosis, palatal lesions in reverse smoker, lichen planus and discoid lupus erythematosus are considered as PMDs [32]. Many of the factors related to the development of oral cancer are also involved in the development of PMDs, such as chronic
exposure to UV radiation, alcoholism, smoking, nutritional deficiency, genetic inheritance [33] and HPV infection [34]. It is still unclear whether or not all clinically detectable lesions
characterized as precursors lesions will eventually develop into carcinoma [35].
Painful temporomandibular disorder (TMD) is a complex and multidimensional process, caused by a variety of psychosocial and environmental factors [36].
Sleep and awake bruxism and parafunctional habits are associated with painful TMD [37]. Higher muscle activity (intensity, duration) leads to overloading and muscle pain [38]. Sleep bruxism, awake bruxism and parafunctional habits, are strongly associated with painful TMD[37].
Loss of permanent teeth is a main indicator used in order to monitor overall oral health[39]. Interdependence between frequent intake of sugar-sweetened beverage (SSB) and adverse health outcomes such as caries, obesity, type 2 diabetes, cardiovascular disease, and kidney disease has been reported [40-42]. There is a positive correlation between SSB consumption and dental caries among adults [43] and young children [44]. Sunkyung Kim et al. observed increased likelihood of tooth loss among young adults who frequently SSBs in the United States[45].
Arnad et al. reported an association between sugars intake frequency (rather than amount of sugars intake) and caries among 150 Icelandic teenagers [46].
Behaviors associated to the transmission of oral bacteria, especially S. mutans, together with diet and oral hygiene, play an important role in the etiology of ECC in toddlers [47–49]. ECC preventive dental care should be started at pregnancy [5].
Decreasing mother’s own oral bacteria considered as minimizing its transmission to the child and thus reducing the risk for caries [50].
The mutans streptococci (MS) agents are most strongly related with dental caries, and the most substantial reservoir from which the child receive these microorganisms is the mother [51, 52]. Dental appearance is an important factor in the facial and physical appearance of an individual, it makes up a substantial part in social interaction, career aspiration and accomplishments of individuals [53-55]. Individuals with less dental and oral disease are more social, have higher intellectual accomplishments and better psychological orientation [56].
Contentmentwith dental appearance is affected by gingival contour , tooth color, size, shape, strength and alignment [57-59].
METHODS AND MATERIALS
This survey was carried out at the LUHS Medical Academy, Odontology and Medicine faculties during autumn semester of academic year of 2016-2017. Subjects were international students of both faculties. A total of 658 international students of both faculties study in 2016/2017, whereas 153 students study in Odontology faculty and 505 in Medicine faculty, respectively. 282 international students of Odontology and Medicine faculty participated in this study. The goal was to give the questionnaires for all Odontology students and to select the same number of Medicine students randomly.
Original questionnaire was chosen from Sujatha et al. [1] carried out study. Questionnaire related to oral health problems and their relation with general health was used to assess student’s oral health awareness attitude and knowledge. It consisted of 25 questions with options on Likert scale.
Students were requested to participate in the survey on a voluntary basis and to fill in the questionnaire. The students received a full explanation of how to fill- in the questionnaire in a standardized manner and they were asked not to discuss with each other. Completed
questionnaires were collected at the end or beginning of the lecture.
This research was approved by the Ethics committee of the LUHS. Participation was voluntary, and all participants remained anonymous.
Oral health awareness score was calculated after recording of the following questions: answer “Agree” was recorded as”1”for 1-11th ; 14-18th and 21-25th items and answer “Disagree “was
recorded as “1” for 12th ,13th , 19th and 20th, respectively. Consequently, if this score was <12-
Poor oral awareness, 12-16- Fair oral health awareness, and >17 Good oral health awareness. The data was collected, coded, computerized and analyzed by using statistical program for social sciences (SPSS) 19 version. A statistical model was developed for analysis of
questionnaire's items as the dependent variable and level of education, gender as an independent variable. The level of significance was set at P<0.05.
RESULTS
Overall 282 students, 125 international students of Odontology faculty and 157 international students of Medicine faculty participated in survey. Figure 1 shows subject’s distribution according to the academic year in Odontology and Medicine faculties.
Figure No. 1 Distributions by students’ academic year.
Table 1 shows the gender distribution of subject's answered questioners. There is no significant
difference between male and female gender , both in odontology 22.3% male, vs 22.1% female, as well as in medicine 26.2% male, vs 29.4% female (P=0.335).
Table No. 1 Distribution by gender.
Faculty Odontology students (N=125) Medicine students (N=157) N % N % Gender Male 63 22.3% 74 26.2% Female 62 22.1% 83 29.4%
Response rate was 92.1%.
The main results of study are presented in Table 2, which shows the total questionnaires’ responses given by both faculties’ students. Table 3 compares between the questionnaire
responses given by medicine and odontology students and shows the statistical differences between them.
Majority of students (98.2%) agreed with the statement that "oral health is an integral part of general health”, 1.4% disagreed and only 0.4% neither agreed nor disagreed. There were no statistically difference among both faculties (p=0.491).
96.1% of both medicine and odontology faculties students agreed with the item "Certain systemic diseases can manifest in the oral cavity which includes a total of 96% of odontology students and 96.2% of medicine students, meanwhile a total of 2.8% of all students neither agreed nor disagreed. Higher prevalence of medicine students (3.2%) neither agreed nor disagreed than odontology students (2.4%). There was no statistically significant difference (p=0.685)
A total 79.4% of students agreed with the item “Proper maintenance of primary dentition is as important as the permanent dentition”, whereas 15.6 % neither agreed nor disagreed.
Considering the faculty, higher prevalence of odontology students agreed than medicine, furthermore a higher number of medicine students did not have an opinion about this question. Moreover, there was no statistically significant difference (p=0.073)
Similar prevalence of medicine (80.3%) and odontology (80.8%) students agreed that saliva can be used in the diagnosis of oral as well as certain systemic diseases. At the same time a higher prevalence of medicine faculty students (16.5%) neither agreed nor disagreed when compared to odontology students (14.4%), furthermore there was no statistically significant difference (p=0.713)
Results of the survey showed that odontology and medicine students had different opinion about dental plaque importance for caries and periodontal diseases development. More dentistry students (39%) than medicine students (36.9%) agreed that dental plaque is an important risk factor for caries and periodontal diseases development, meanwhile a higher number of medicine students neither agreed nor disagreed with this statement (p<0.001).
Majority of the odontology students (92%) agreed that dental caries is a complex disease but can be prevented by adopting healthy oral health behaviors, meanwhile only 86% of medicine students agreed with this statement. This shows that a higher prevalence of odontology faculty students agreed. Meanwhile a higher prevalence of medicine faculty students disagreed (4.5%) and neither agreed nor disagreed (9.6%) compared to the prevalence of odontology students disagreeing (2.4%) and neither agreeing nor disagreekng (5.6%). There was no statistically significant difference (P=0.285)
86.2% of all students agreed that proper brushing of teeth and flossing are able to prevent both dental caries and gingival diseases, whereas a higher prevalence of medicine students have agreed comparing to odontology, furthermore a total of 8.9% of all students neither agreed nor disagreed with this statement, while a higher prevalence of odontology students (10.4%) was recorded when compared to medicine students (7.6%). However there was no statistically significant difference (p=0.720)
After analyzing the results of survey we found that the majority of odontology students (91.2% of all odontology students) agreed that fluoride has a protective role against dental caries in contrast to medicine students where only 75.2% agreed. Moreover, the prevalence of medicine students (17.8%) that didn’t have an opinion about this item was almost 4 times higher than the prevalence of odontology students (4.8%). In addition 7% of all medicine students disagreed while only 4% of odontology students disagreed. The results showed significantly different opinions between both groups (p<0.001)
A significant difference was recorded related to whether dental care should be started even before birth of a child-prenatal care. Slightly more than half of medicine faculty students (51%) have disagreed while only 38.4% of odontology students disagreed (p<0.001).
The prevalence of odontology students (39.2%) that agreed with this statement was almost triple the prevalence of medicine student agreement (14.6%). Furthermore only 22.4% of odontology students didn’t have an opinion, medicine students that neither agreed nor disagreed prevalence was 34.4%.
"Micro-organisms that cause dental caries are transmitted mainly from the mother to the child", 45.5% of total students (both medicine group and odontology group) disagreed, and higher prevalence was of medicine students (49%) than odontology students (45.6%)
In addition 33.7% of all students neither agree nor disagree. Furthermore, higher prevalence of odontology students (27.2%) agreed with this statement when compared to medicine (15.9%) (p=0.065).
Higher prevalence of odontology students (81.6%) agreed with the statement "Frequent consumption of sugar containing food is more detrimental than the quantity of the sugar consumed" when compared with medicine students group where 66.9% agreed. Meanwhile, there was a low prevalence of odontology students (4%) who disagreed with this statement; however the prevalence of medicine students (9.5%) who disagreed was more than double when compared with odontology.
The statement "Tobacco is the only risk factor for oral cancer" was disagreed by the majority of odontology and medicine students, the prevalence of both of the groups was almost the same. The odontology group disagreement prevalence was 80% meanwhile the medicine students group prevalence was 80.9%.
In addition, the total prevalence of agreement was 10.6%. 4.2% prevalence of odontology students and 6.4% of medicine students from the total sample of participants, which shows a higher prevalence of agreement within the medical students group. There was no statistical significant difference (p=0.660)
No statistically significant difference was found between opinions of the two groups about the item "All precancerous lesions of the oral cavity invariably lead to oral cancer even if the predisposing factors are removed".
A higher prevalence of odontology students (28%) have agreed with this statement compared to medicine students (22.3%) and a higher prevalence of medicine students (45.2%) disagreed compared to odontology students (36%)
A total of 34.1% of all students didn’t have any opinion, 36% of odontology students and 32.5% of medicine students. (p=0.272)
"Para-functional habits like thumb sucking, lip biting, lip sucking and nail biting are very common among children. These habits need to be cured as they affect oro-facial structures." The highest prevalence within the odontology students group was associated with the students who agreed (81.6%) with this item, a lower prevalence of students didn’t have any opinion (11.2%) and the lowest was of students who did not agree (7.2%). Meanwhile in the medicine students group 72.6% agreed. When comparing to odontology group the disagreement
prevalence of medicine students (13.4%) was almost double than odontology groups, however no statistically significant difference was found (p=0.160).
83.7% of all respondents agreed that a proper alignment of teeth is important for functional as well as aesthetic purposes, moreover, a higher prevalence of these answers were among odontology students (p=0.054)
A high prevalence of agreement with the statement “Mouth-guards are useful in preventing sport-related injuries/trauma”was noticed among all students (85.5%) and no significant difference among both faculties was recorded (p=0.815).
Answers about replantation of avulsed teeth were controversial and only
58.2% of students agree that avulsed teeth can be replanted, whereas 30.5% neither agreed nor disagreed. In addition, a higher prevalence among medical students did not have a knowledge about this question (p=0.023).
Higher prevalence of odontology students (84.8%) agreed that bruxism, trauma from occlusion, reduced vertical dimension of jaws can cause temporomandibular joint problems and pain in orofacial region, when compared to medicine students group where 63% agreed. Meanwhile, there was a low prevalence of odontology students (2.4%) who disagreed with this statement; however the prevalence of medicine students (6.4%) who disagreed was more than double when compared with odontology. In addition, a high prevalence of medicine students had no opinion about this item. There was a statistically significant difference between the two groups
(p<0.001).
No statistical significant difference was found between opinions of the two groups about the item "Loss of teeth during old age is a natural phenomenon. Neither dentist nor the patient can prevent tooth loss".
A higher prevalence of medicine students (47.1%) have agreed with this statement compared to odontology students (40.8%) and a higher prevalence of odontology students (36%) disagreed compared to medicine students (34.4%). 20.6% of all students didn’t have any opinion. (p=0.487)
A total of 59.2% of all students disagreed that artificial teeth can perfectly replace the function of natural teeth. Hence, too much care for natural teeth is unwarranted.
Meanwhile, a higher prevalence of medicine student (17.8%) neither agreed nor disagreed when compared to odontology students (13.6%). However there was no significant difference between both faculties (p=0.542).
The statement "Soft drinks can cause erosion of dental enamel which is the hardest tissue in the human body" was agreed by a higher prevalence of odontology students (84.8%) than medicine students (75.1%). At the same time a higher prevalence of medicine faculty students disagreed (8.3%) and 16.6% of them didn’t have any opinion; meanwhile, only 8% of odontology students didn’t have an opinion.
In this item there was no statistical significant difference (p=0.086).
Majority of the students agreed (80.1% ) with the statement"Cleft palate and cleft lip are developmental defects. Proper surgical and prosthetic treatment is available that will enable patients with clef lip/palate to lead a normal life". Only 15.6% students from both faculties neither agree nor disagree, whereas the prevalence of medicine students (19.1%) was higher than odontology students (11.2%). Disagreement prevalence was 4.3%. No significant difference was noted between the groups (p=0.186).
A high prevalence of agreement with the statement “Health education has an important role to play in creating awareness about oral health among public" was registered among
all students(93.6%) and no significant difference among both faculties was recorded (p=0.637).
70.2% agreement prevalence was noticed among all students with the statement “Oral diseases have an implication on certain systemic diseases/conditions like cardiovascular diseases, pregnancy, low birth weight babies etc” and no significant difference among both faculties was recorded (p=0.526).
"Oral health has an influence on the overall quality of life", majority of the students from both faculties agreed. Only 1.3% of medicine students disagreed, whereas the prevalence of
disagreement among odontology faculty students was more than triple (4%). There was not even one student from odontology faculty that didn’t have any opinion about this item, in contrast to medicine students were the prevalence was 5.7%. There was a statistically significant difference between the two groups (p=0.009).
Table No. 2 Total questionnaire responses given by medicine and odontology students.
Statement Agree N(%) Disagree N(%) Neither agree nor disagree N(%)
1.Oral health is an integral part of general health 277 (98.2) 4 (1.4) 1 (0.4)
2.Certain systemic diseases can manifest in the oral cavity 271 (96.1) 3 (1.1) 8(2.8)
3.Proper maintenance of deciduous dentition is as important as the permanent dentition
224 (79.4) 14 (5) 44 (15.6)
4. Saliva can be used in the diagnosis of oral as well as certain systemic diseases
227 (80.5) 11 (3.9) 44 (15.6)
5.Dental caries and periodontal disease are plaque-mediated diseases 214 (75.9) 10 (3.5) 58 (20.6)
6. Dental caries is a complex disease but can be prevented by adopting healthy oral health behaviors
250 (88.7) 10 (3.5) 22 (7.8)
7.Proper brushing of teeth and flossing will enable to prevent both dental caries and gingival diseases
243 (86.2) 14 (4.9) 25 (8.9)
8. Fluorides have a protective role against dental caries 232 (82.3) 16 (5.7) 34 (12)
9. Dental care should be started even before birth of a child-prenatal care 72 (25.5) 128(45.4) 82 (29.1)
10. Micro-organisms that cause dental caries are transmitted mainly from the mother to the child
59 (20.9) 128(45.4) 95 (33.7)
11. Frequent consumption of sugar containing food is more detrimental than the quantity of the sugar consumed
207 (73.4) 20 (7.1) 55 (19.5)
12.Tobacco is the only risk factor for oral cancer 30 (10.6) 227
(80.5)
13.All precancerous lesions of the oral cavity invariably lead to oral cancer even if the predisposing factors are removed
70 (24.8) 116(41.1) 96 (34.1)
14. Para-functional habits like thumb sucking, lip biting, lip sucking and nail biting are very common among children. These habits need to be cured as they affect oro-facial structures
216 (76.6) 30 (10.6) 36 912.8)
15.Alignments of teeth is done both for functional as well as aesthetic purpose
236 (83.7) 16 (5.7) 30 (10.6)
16.Mouth-guards are useful in preventing sport-related injuries/trauma 241 (85.5) 20 (7.1) 21 (7.4) 17.A tooth avulsed due to trauma can be re-implanted into the tooth
socket
164 (58.2) 32 (11.3) 86 (30.5)
18.Bruxism, trauma from occlusion, reduced vertical dimension of jaws can cause Temporomandibular joint problems and pain in oro-facial region
205 (72.7) 13 (4.6) 64 (22.7)
19. Loss of teeth during old age is a natural phenomenon. Neither dentist nor the patient can prevent tooth loss
125 (44.3) 99 (35.1) 58 (20.6)
20. Artificial teeth can perfectly replace the function of natural teeth. Hence, too much care for natural teeth is unwarranted
70 (24.8) 167(59.2) 45 (16)
21.Soft drinks can cause erosion of dental enamel which is the hardest tissue in the human body
224 (79.4) 22 (7.8) 36 (12.8)
22. Cleft palate and cleft lip are developmental defects. Proper surgical and prosthetic treatment is available that will enable patients with clef lip/palate to lead a normal life
226 (80.1) 12 (4.3) 44 (15.6)
23.Health education has an important role to play in creating awareness about oral health among public
264 (93.6) 9 (3.2) 9 (3.2)
24.Oral diseases have an implication on certain systemic
diseases/conditions like cardiovascular diseases, pregnancy, low birth weight babies etc
198 (70.2) 34 (12.1) 50 (17.7)
25.Oral health has an influence on the overall quality of life 266 (94.3) 7 (2.5) 9 (3.2)
Table No. 3 Questionnaire responses given by medicine and odontology students.
Odontology students N (%) Medicine students N (%) P- value
Statement Agree Disagree Neither
agree nor disagree
Agree Disagree Neither
agree nor disagree 1.Oral health is an integral part of general health
124 (44) 1 (0.3) 0 (0) 153(54.3
)
3(1.1) 1 (0.3) 0.491
2.Certain systemic diseases can manifest in the oral cavity
120(42.5) 2 (0.7) 3 (1.1) 151(53.5
)
3.Proper maintenance of deciduous dentition is as important as the permanent dentition
104 (36.9) 8 (2.8) 13 (4.6) 120 (42.6) 6 (2.1) 31 (11) 0.073
4. Saliva can be used in the diagnosis of oral as well as certain systemic diseases
101 (35.8) 6 (2.1) 18 (6.4) 126
(44.7)
5 (1.8) 26 (9.2) 0.713
5.Dental caries and periodontal disease are plaque-mediated diseases
110 (39) 4 (1.4) 11 (3.9) 104
(36.9)
6 (2.1) 47 (16.7) 0.000
6.Dental caries is a complex disease but can be prevented by adopting healthy oral health behaviors
115 (40.8) 3 (1.1) 7 (2.5) 135 (47.8) 7 (2.5) 15 (5.3) 0.285
7. Proper brushing of teeth and flossing will enable to prevent both dental caries and gingival diseases
106(37.6) 6 (2.1) 13 (4.6) 137(48.6
)
8 (2.8) 12 (4.3) 0.720
8.Fluorides have a protective role against dental caries
114(40.4) 5 (1.8) 6 (2.1) 118
(41.8)
11 (3.9) 28 (10) 0.00
0 9.Dental care should be started even before birth of a child-prenatal care
49 (17.4) 48 (17) 28 (9.9) 23(8.2) 80
(28.4)
54 (19.1) 0.000
10.Micro-organisms that cause dental caries are transmitted mainly from the mother to the child
34 (12) 51 (18.1) 40 (14.2) 25 (8.9) 77
(27.3)
55 (19.5) 0.065
11. Frequent consumption of sugar containing food is more detrimental than the quantity of the sugar consumed
102 (36.2) 5 (1.8) 18 (6.4) 105
(37.2)
15 (5.3) 37 (13.1) 0.018
12.Tobacco is the only risk factor for oral cancer
12 (4.2) 100 (35.5) 13 (4.6) 18 (6.4) 127 (45) 12 (4.3) 0.660
13.All precancerous lesions of the oral cavity invariably lead to oral cancer even if the predisposing factors are removed
35 (12.4) 45 (15.9) 45 (15.9) 35 (12.4) 71
(25.3)
51 (18.1) 0.272
14.Para-functional habits like thumb sucking, lip biting, lip sucking and nail biting are very common among children. These habits need to be cured as they affect oro-facial structures
102 (36.2) 9 (3.2) 14 (5) 114
(40.4)
21 (7.4) 22 (7.8) 0.160
15.Alignments of teeth is done both for functional as well as aesthetic purpose
112 (39.7) 5 (1.8) 8 (2.8) 124 (44) 11 (3.9) 22 (7.8) 0.054
105 (37.2) 10 (3.5) 10(3.5) 136 (48.2)
10 (3.5) 11 (3.9) 0.815
17.A tooth avulsed due to trauma can be re-implanted into the tooth socket
84 (29.8) 11 (3.9) 30 (10.6) 80 (28.4) 21 (7.4) 56 (19.9) 0.023
18.Bruxism, trauma from occlusion, reduced vertical dimension of jaws can cause Temporomandibular joint problems and pain in oro-facial region
106(37.6) 3 (1.1) 16 (5.7) 99 (35.1) 10 (3.5) 48 (17) 0.00
0 19. Loss of teeth during old age is a natural phenomenon. Neither dentist nor the patient can prevent tooth loss
51 (18.1) 45 (16) 29 (10.3) 74 (26.2) 54
(19.1)
29 (10.3) 0.487
20. Artificial teeth can perfectly replace the function of natural teeth. Hence, too much care for natural teeth is unwarranted
30 (10.6) 78 (27.2) 17 (6) 40 (14.2) 89
(31.6)
28(9.9) 0.54
2 21.Soft drinks can cause erosion of dental enamel which is the hardest tissue in the human body
106 (37.6) 9 (3.2) 10 (3.5) 118
(41.8)
13 (4.6) 26 (9.2) 0.086
22. Cleft palate and cleft lip are developmental defects. Proper surgical and prosthetic treatment is available that will enable patients with clef lip/palate to lead a normal life
105 (37.2) 6 (2.1) 14 (5) 121
(42.9)
6 (2.1) 30 (10.7) 0.186
23.Health education has an important role to play in creating awareness about oral health among public
117 (41.5) 5 (1.8) 3 (1.1) 147
(52.1)
4 (1.4) 6 (2.1) 0.637
24.Oral diseases have an implication on certain systemic diseases/conditions like cardiovascular diseases, pregnancy, low birth weight babies etc
89 (31.6) 17 (6) 19 (6.7) 109
(38.7)
17 (6) 31 (11) 0.526
25.Oral health has an influence on the overall quality of life
120 (42.5) 5 (1.8) 0 (0) 146 (51.8) 2 (0.7) 9 (3.2) 0.009
*Pearson chi-square test was used. P- Level of significance.
Finally, mean score of awareness among odontology students was higher than among medicine students (19.14±3.25 vs. 17.44±3.10) (p=0.003), but overall awareness of LUHS students was good. The awareness score ranged from 8 to 23 in medicine students group, whereas it ranged from 11 to 24 in odontology students group.
Figure 2 shows the comparison between oral health awareness among odontology, medicine students and all participants. 79.2% of all odontology students had good oral health awareness and only3.2% of them had poor awareness. Meanwhile, a higher prevalence of medicine
students had poor (5.7%) and fair (29.3%) oral health awareness when compared to odontology students.
Figure No. 2 Oral health awareness among odontology, medicine students and both faculties
DISCUSSION
Sujatha et al. [1] carried the study analyzing Odontology students’ oral health awareness and results showed that only 25% had a good awareness, 38%- fair awareness and 37%- poor oral health awareness. While in our study the same questionnaire was used and results showed that overall 71.3% had good oral health awareness, 24.1% reported the fair awareness and only 4.6%- poor awareness, respectively. Mean score of awareness among odontology students was higher than among medicine students (19.14±3.25 vs. 17.44±3.10) (p=0.003), but overall awareness of LUHS students was good.
A study performed in University of Peradeniya by Jayasinghe et al in 2016 [60] investigated the awareness about oral potentially malignant disorders (OPMD) and oral cancer among medical and dental students. They found that 54% of respondents had poor knowledge. Dental students that had a significantly higher knowledge showed greater awareness. While in our study there was no significant difference between medical and dental students (p=0.272).
Bhagavathula et al [61] have evaluated the potential risk factors of oral carcinoma development in 2015. A majority of the dental students identified a number of different risk factors for oral cancer such as poor oral hygiene as a major risk factor, diet with low vitamin C, tobacco smoking chronic infections, alcohol and chewing beetle leaves. In our survey we found that 80.5% of all students have disagreed that tobacco is the only risk factor for oral cancer. There was statistically significant difference between medical and odontology faculties students (p=0.660).
It was complicated to find quite similar studies carried out in other countries which focused on dental and medicinal students' awareness about the relationship between esthetics and correct alignment of teeth. Tufekci et al (2008) [62] determined whether there are differences in self-awareness and perception of an individual's own profile among Laypeople, orthodontic patients and dental students. Third-year dental students were most accurate in identifying their own profiles than laypeople and orthodontic patients. In our survey we noticed that 83.7% of all students agree that proper teeth alignments is important both for functional as well as aesthetic purposes.
Alsafi et al (2015) [63] have checked the knowledge about temporomandibular
disorders/orofacial pain etiology, diagnosis and classification, treatment and prognosis in two dental schools in Sweden and Italy. Results showed no significant difference between the knowledge and understanding between the two dental schools. Responses in our study
concerning bruxism, trauma from occlusion, reduced vertical dimension of jaws can cause temporomandibular joint problems and pain in orofacial region showed significant differences between both faculties, as well as between preclinical and clinical odontology years. A higher prevalence of clinical (97.4%) years students agreed comparing to preclinical (65.3%) which indicates a higher level of knowledge (p<0.001).
Although results showed that odontology and medicine students had different opinion about dental plaque importance for caries and periodontal diseases development, the comparison between preclinical and clinical years of odontology students did not show a significant difference (p=0.062).
The results showed significantly different opinions about the role of fluoride in caries prevention between medicine and odontology students, but no significantly difference was noticed between clinical and preclinical years of odontology students (p=0.855).
A significant difference was recorded between both medicine and odontology faculties regarding to whether dental care should be started even before birth of a child-prenatal care, however when comparing the preclinical to clinical years of odontology students there was no significant difference (p=0.218).
Higher prevalence of odontology students agreed that frequent consumption of food containing sugar is more detrimental than the quantity of the sugar consumed when compared with
medicine students group. Meanwhile, there was no significant difference in the opinion of preclinical and clinical odontology students (p=0.167).
Answers about replantation of avulsed teeth were controversial. A significant difference was noted when analyzing responses of preclinical and clinical odontology students. Only 53% of preclinical odontology students agreed while 76.3% of clinical odontology students agreed (p=0.022).
CONCLUSIONS
Overall, oral health awareness among LUHS international odontology and medicine students was high. Odontology students were found to have a better oral health awareness than medicine students.
Medicine students had a lower level of knowledge about the importance of dental plaque in oral diseases development, protective role of fluoride, frequency of sugar consumption, prenatal oral care, avulsion's treatment, risk factors of temporomandibular disorders and oral health influence on life quality.
ACKNOWLEDGEMENT
Thanks and appreciation to Dr. Sandra Žemgulytė, LSMU Odontology Faculty, Clinic for Preventive and Pediatric Dentistry, for her invaluable assistance and collaboration. In addition the author also acknowledges all the medical and odontology students who participated in the survey for their contribution to this study.
ENSURING OF CONFIDENTIALITY
Confidentiality of responses will be maintained by using an anonymous questionnaire. The name, surname and address will not be included in the questionnaire. The generalized results of study will be published.
EVALUATION OF POSSIBLE RISK AND DAMAGE FOR PATIENT
The questionnaire will be used as a method of subject's examination. The participants will not experience any possible risk and damage, only the time consumed when filling of questionnaire can be a disadvantage.PRACTICAL RECOMMENDATIONS
Proper knowledge of oral diseases is crucial in medical practice. Therefore I believe that awareness and knowledge about importance of oral health among both medicine and
odontology faculty students should be raised. This can be achieved by additional dental topics to their curriculum.
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EVALUATION FORM OF THE MASTER’S THESIS FOR THE MEMBER OF DEFENCE COMMITTEE
Graduate student
___________________________________________________________________, of the year ______, and the group _____ of the integrated study programme of Odontology Master’s Thesis title:
………...……….………...…………
………...….………...……...
No. MT evaluation aspects Evaluation
Yes Partially No 1 Has the student’s presentation lasted for more than 10 minutes?
2 Has the student presented the main problem of the Master’s thesis, its aim and tasks?
3 Has the student provided information on research methodology and main research instruments?
4 Has the student presented the received results comprehensively? 5 Have the visual aids been informative and easy to understand? 6 Has the logical sequence of report been observed?
7 Have the conclusions been presented? Are they resulting from the results?
8 Have the practical recommendations been presented?
9 Have the questions of the reviewer and commission’s members been answered correctly and thoroughly?
10 Is the Master’s thesis in compliance with the essence of the selected study programme?
Remarks of the member of evaluation committee of Master’s Thesis
_____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Evaluation of the Master’s Thesis
_____________________________________________________________________________
Member of the MT evaluation committee:
________________ ___________________________ _____________________
