Jinita Prafulchandra Udani
Fifth year, group 15THE KNOWLEDGE AND ATTITUDE OF TEETH
BLEACHING AND PERCEPTION OF TOOTH AESTHETICS
AMONGST INTERNATIONAL STUDENTS AT
LITHUANIAN UNIVERSITY OF HEALTH SCIENCES
Master’s thesis
Supervisor Dr, Sandra Žemgulytė
LITHUANIAN UNIVERSITY OF HEALTH SCIENCES MEDICAL ACADEMY
FACULTY OF ODONTOLOGY
CLINIC FOR PREVENTIVE AND PAEDIATRIC DENTISTRY
THE KNOWLEDGE AND ATTITUDE OF TEETH BLEACHING AND PERCEPTION OF TOOTH AESTHETICS AMONGST INTERNATIONAL STUDENTS AT LITHUANIAN
UNIVERSITY OF HEALTH SCIENCES Master’s Thesis
The thesis was done
by student ... Supervisor...
(signature) (signature)
... …...
(name surname, year, group) (degree, name surname)
... 20…. ... 20….
(day/month) (day/month)
EVALUATION TABLE OF CLINICAL–EXPERIMENTAL MASTER’S THESIS Evaluation: ... Reviewer: ... (scientific degree, name and surname)
Reviewing date: ...
No. MT parts MT evaluation aspects
Compliance with MT 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
Is the research methodology explained comprehensively? Is it suitable to
11 (2 points) 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 text? 0 0.2 0.4
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?
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 recommendationsPractical
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? points-2 -1 point
34 Does the thesis structure satisfy the requirements of Master’s thesis? -1 point points-2
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? points-2 -1 points
37 Is text consistent, integral, and are the volumes of its structural parts balanced? -0.2 point points-0.5
38 Amount of plagiarism in the thesis. >20%
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 points-0.5
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 points-0.5
*In total (maximum 10 points):
*Remark: the amount of collected points may exceed 10 points.
Reviewer’s comments: ___________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _________________________________________ Reviewer’s name and surname
TABLE OF CONTENTS
SUMMARY ……….8
INTRODUCTION ………...……...9
REVIEW OF LITERATURE ………...………....11
MATERIAL AND METHODS ....……….13
RESULTS………...………..15
DISCUSSION………...………....24
CONCLUSIONS ………....…...27
REFERENCES ………...………28
8
THE KNOWLEDGE AND ATTITUDE OF TEETH BLEACHING AND
PERCEPTION OF TOOTH AESTHETICS AMONGST INTERNATIONAL
STUDENTS AT LITHUANIAN UNIVERSITY OF HEALTH SCIENCES
SUMMARY
Aim: To evaluate the overall perception and knowledge of teeth bleaching and aesthetics among the International Students in Lithuanian University of Health Sciences
Materials and methods: The study enrolled 313 international students (180 medical, 94 dental and 39 veterinarian) at LSMU. The self-administered questionnaire consisted of 28 questions about demographic characteristics, oral hygiene behaviour, knowledge and attitude towards teeth bleaching and tooth aesthetics. The questionnaires were distributed to students before lectures. The participation was anonymous and voluntary. The data was analysed using SPSS. The level of significance was set at P<0.05
Results: 67.7% of international students were non-smokers. The mass of international students (76.4%) brushed their teeth twice a day or more as recommended and significantly more international medical students brushed their teeth twice a day or more (p=0.043). The preferred method for teeth whitening was to go to a dentist over using bleaching kits in all three faculties (60.4%) (p=0.682). Significantly more international dental students (76.6%) knew about differences between teeth bleaching and teeth whitening (p<0.001). Significantly more international medical (53.3%) and dental (45.7%) students were satisfied about their teeth (p=0.039).
9
INTRODUCTION
Dental aesthetics is an elemental part of general facial aesthetics. [1]. Not only does an attractive smile boost self-confidence and personality, but also aids in giving the impression of health [1]. Although there is a general fall in caries and increased tooth retention, patients are progressively demanding aesthetic dentistry, as more people endeavour for a ‘perfect smile’ [1]. With the increase of media influence, an abounding number of people desire whiter teeth, without realizing that many patients are presented with palpable intrinsic or extrinsic staining [2]
The coronal portion of the tooth is made up of enamel, dentine and pulp. [3]. Any alterations to these structures is likely to cause a change in the exterior appearance of the tooth caused by its light transmitting and reflecting properties [3]. Extrinsic staining is a build-up of surface strains which hides the natural tooth colour, whereas intrinsic staining is discolouration of the tooth itself [4]. Extrinsic stains can become internalised through enamel defects or cracks or as a result of dentine becoming exposed but most extrinsic stains appear to be deposited on or in the dental pellicle [5]. They can be caused by a number of factors such as dental plaque, calculus, tobacco and dietary influences [2]. Changes in the thickness of the dental hard tissues would result in intrinsic discolouration [6]. Causal factors can act locally or systematically, affecting only a single tooth or all teeth and cause discolouration as a result [6]. Several diseases disturb the developing dentition especially during enamel and dentine formation can lead to discolouration [6].
According to the FDA, the difference between bleaching and whitening is that the term "bleaching" is permitted to be used only when the teeth can be whitened beyond their natural colour and when the products contain bleach [7]. Whitening refers to restoring a tooth's surface colour by removing dirt and debris. Often the terms are used interchangeably [7].
Teeth bleaching dates back as late as the Ancient Romans [8], where urine and goat milk was used in an attempt to achieve whiter teeth [9]. In 1877, ‘oxalic acid’ was introduced to the market for whitening teeth, shortly after, calcium hypochlorite was used in replacement [1]. Seven years later, for the first-time peroxide was used in order to successfully whiten teeth [8]
10 Concerns have been raised regarding the safety of bleaching teeth with high concentrations of hydrogen peroxide [13]. In order to achieve a successful therapy, it is crucial to define indications and contraindications, to correctly set the diagnosis and to select the most suitable tooth¬ whitening technique for a patient [12].
Hypothesis
We expect the results to appraise the students’ knowledge about teeth bleaching and the potential negative affect. We predict that international dental students will have a greater level of knowledge about teeth bleaching in contrast to international medical and veterinarian students. We conjecture there to be a higher interest and attention towards teeth aesthetics for female students in comparison to male students.
The Aim
To evaluate the overall perception, knowledge and attitude toward teeth bleaching and aesthetics among the international dental, medical and veterinarian students in Lithuanian University of Health Sciences
Objectives:
1. To collect and analyse the data about the knowledge and attitude that international students have regarding teeth bleaching and their perception for teeth aesthetics.
2. To compare results among international students of different faculties.
11
REVIEW OF LITERATURE
Tooth bleaching has become the blessings in the development of restorative and aesthetic dentistry [14]. Tooth colour is variable, it is the result of the tooth structure and a merge of organic and inorganic components of the enamel and dentin and spectral distribution of incoming light [15]. It is considered that double bonds in dental structures can create discoloration; Consequently, breaking these bonds often eliminates discoloration. [16].
Thus far, three contemporary techniques of tooth bleaching have been described in literature: in-office bleaching (also known as power bleaching), at-home bleaching (also known as night guard vital bleaching), and over-the-counter (OTC) bleaching agents. [17]. At home techniques are regarded as more cost-effective while in-office treatments allow changes in the colour of the enamel from the first session [18]. Multiple studies which compared the efficacy, side effects, and patient acceptance of in-office, at-home, or over-the-counter whitening concluded that the fastest time to achieve a six-tab difference on a Vita Classical shade guide, occurred with in-office whitening, followed by at-home whitening, with over-the-counter whitening requiring the longest time [19]. In addition, OTC bleaching products are accessible extensively all around the world with a low cost, nonetheless, there is minimal clinical evidence regarding the safety and effectiveness of the OTC products. [20]
Considering the various whitening products available and the thorough consumer interest in whiter teeth, it is the responsibility of the dental profession to educate the public about the advantageous and disadvantageous effects of different tooth whitening procedures. [16]. The risks commonly associated with tooth bleaching include increased tooth sensitivity and mild gingival irritation [21]. The intensity of these side effects is precisely linked to the concentration of the peroxide bleach component, period of the treatment, and the non-bleach composition of the product used [21]. Additionally, other risks associated with tooth bleaching have been reported from in vitro studies which include tooth erosion, tooth mineral degradation, increased susceptibility to demineralization, and pulpal damage [21]. A study conducted between different schools in the University of Zagreb on tooth bleaching presented that amongst the range of bleaching treatments available, the students of the Dental School of Medicine had a higher awareness about oral hygiene and subsequently would go to the dental office if they decided to whiten their teeth. [22].
12 [23]. Despite being characterised as having a high educational background, the students of other disciplines in this study had a lower knowledge on the practice of tooth cleaning and were perceived as being less motivated for self-reliant oral hygiene. [23]. Likewise, Carlsson et al. determined that non-professionals are more likely to prefer whiter teeth than dentists [24]. Coupled with occupational incentive, Shulman et al. indicated that female teenagers were more captious of their teeth colour than male teenagers and younger subjects were more critical than older subjects [25]. Additionally, Rosenstiel et al concluded from their findings that an increased preference for whiter teeth was common amongst women than in men [26].
13
MATERIAL AND METHODS
The study was carried out during the Autumn semester of the academic year of 2017/2018. The questionnaires were collected from October 2017 to January 2018. The study was approved by the Head of LSMU Bioethics Centre (Reference no. BEC-OF-67). The participants were students from the international section of Lithuanian University of Health Sciences of three faculties (Odontology, Medicine and Veterinary). The integrated Medicine studies’ duration is six academic years, while Odontology and Veterinary are five academic years.
A total of 790 international students from all three faculties studied in academic year of 2017/2018. This includes 571 international students in Medicine faculty, 146 in Odontology faculty and 73 in Veterinary faculty. The goal was to give the questionnaires to all international dental and veterinarian students, to select the same number of international medical students randomly, thus 365 international dental, medical and veterinarian students had to be enrolled. 313 international students of Medicine, Odontology and Veterinary faculty participated in this study. Distribution according to faculties was the following: 180 international medical students, 94 international dental students and 39 international veterinarian students from all academic years. The overall response rate was 85.5%. 145 male students and 168 female students answered the questionnaires, the age ranged from 18 years to above the age of 30 years. Later all students according to age (in years) were grouped into three groups (18-24, 25-29, >30 years).
The questionnaire consisted of 28 questions about background information (gender, age, faculty and year of academic study) of the participants, oral hygiene behaviour and knowledge and attitude towards teeth bleaching and tooth aesthetics. Three questions were asked about their habits and six questions were geared towards their oral hygiene habits. Of the remaining 14 questions, five were asked for their opinion on dental bleaching and whitening, three questions were asked in order to identify their knowledge of teeth bleaching and six questions were orientated towards their dental history and teeth satisfaction. The final three questions contained options for the answers in the form of the Likert scale (very unsatisfied, unsatisfied, neutral, satisfied and very satisfied), later they were regrouped to unsatisfied, neutral and satisfied.
15
RESULTS
The questionnaires were answered by a total of 313 international students, which included – 46.3% male students and 53.7% females students with 180 (57.5%) international students from the Faculty of Medicine, 94 (30%) from the Faculty of Odontology and 39 (12.5%) from the Faculty of Veterinary. There is no significant difference between male and female gender.
Age distribution of the study participants ranged from 18 to 35 years and above. Of the total participants, 66.8% were in the age range of 18 to 24 years, and this was the largest age group in each faculty (38.1%, 23.3% and 5.5% respectively). The smallest age group in each faculty was students above the age of 35 years (only 1.6% in total).
The Medical faculty consist of six academic years, while Odontology and Veterinary are five academic years. The highest response rate from Medical international students was fifth year students (n=64), first year (n=27) from Odontology and first years (n=9) from Veterinary also. (Table 1)
Table 1. Demographic description of participants Variable Faculty Total N (%) P-Value Medicine N (%) Odontology N (%) Veterinary N (%) Gender Male 80 (25.6) 43 (13.7) 22 (7.1) 145 (46.3) 0.394 Female 100 (31.9) 51 (16.3) 17 (5.4) 168 (53.7) Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100) Age (Years) 18-24 119 (38.1) 73 (23.3) 17 (5.5) 209 (66.8) >0.001 25-29 53 (16.9) 18 (5.8) 14 (4.5) 85 (27.2) >30 8 (2.6) 3 (1.0) 8 (2.6) 19 (6.2) Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100) Academic Year 1st 34 (10.9) 27 (8.6) 9 (2.9) 70 (22.4) >0.001 2nd 19 (6.1) 21 (6.7) 8 (2.6) 48 (15.3) 3rd 22 (7.0) 19 (6.1) 8 (2.6) 49 (15.7) 4th 27 (8.6) 10 (3.2) 8 (2.6) 45 (14.4) 5th 64 (20.4) 17 (5.4) 6 (1.9) 87 (27.7) 6th 14 (4.5) 0 (0) 0 (0) 14 (4.5) Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100)
16 totalled to 10.2%, while those who smoked both cigarettes and hookah/shisha were 6.4%. There was no a statistically significant difference among all three faculties (p=0.09), but statistically significantly more male international students smoked than female (p=0.001).
Among the participants, 84% consumed tea or coffee (47.2% from Medicine, 25.8% from Odontology and 10.8% from Veterinary faculties) and only 16% in total did not consume and findings did not differ statistically significantly among all faculties (p=0.592). Of the international students who consumed tea/coffee, 40.5% did so twice a day or more, while 22% did irregularly. Although there was no significant difference among all three faculties was found (p=0.094)
(Table 2)
Table 2. Participants smoking and tea/coffee consumption habits. Variable Faculty Total N (%) P-value Medicine N (%) Odontology N (%) Veterinary N (%) Smoking habit None 124 (39.6) 59 (18.8) 29 (9.3) 212 (67.7) 0.090 Cigarettes 29 (9.3) 15 (4.8) 5 (1.6) 49 (15.7) Hookah/Shisha 19 (6.1) 8 (2.6) 5 (1.6) 32 (10.2) Both 8 (2.5) 12 (3.8) 0 (0) 20 (6.4) Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100) Tea/Coffee consumption Yes 148 (47.2) 81 (25.8) 34 (10.9) 263 (84.0) 0.592 No 32 (10.3) 13 (4.2) 5 (1.6) 50 (16.0) Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100)
Frequency of tea/coffee consumption
Never 30 (9.6) 13 (4.2) 3 (1.0) 46 (14.7)
0.094
Once a day 20 (6.4) 15 (4.7) 5 (1.2) 40 (12.8)
Twice a day or more 99 (31.6) 36 (11.5) 23 (7.4) 158 (40.5)
Irregularly 31 (9.9) 30 (9.6) 8 (2.6) 69 (22.0)
Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100)
Information on oral hygiene habits showed that from all three faculties, majority of students have done a professional oral hygiene at least once a year (47.9%) – 25.9% from the Medicine faculty, 14.7% from Odontology and 7.3% from Veterinary. More international medical students have never had a professional oral hygiene done (8.6%) than those who have one done every two years (8.1%), although the results did not statistically signify a difference among all three faculties (p=0.135).
17 teeth twice a day or more as recommended and significantly, international medical students did the most (43.1%) (p=0.043).
A majority of students used manual toothbrush (73.5%) and this was not statistically significantly different among all three faculties (p=0.072). A toothpaste with fluoride was the most common option for students (37.7%) and the second favoured toothpaste type was whitening (23.6%). Results showed that 25.5% of international medical students did not pay attention to what on toothpaste they used and significantly more dental students used toothpaste with fluoride (44.7%) (p=0.018).
18 Table 3. Participants oral hygiene habits.
Variable
Faculty
Total N (%) P-Value
Medicine
N (%) Odontology N (%) Veterinary N (%) Frequency of professional oral hygiene
Never 27 (8.6) 7 (2.2) 7 (2.2) 41 (13.1) 0.135 Once a year 81 (25.8) 46 (14.6) 23 (7.3) 150 (47.9) Twice a year 47 (15.0) 31 (10.0) 5 (1.6) 83 (26.5) Every 2 years 25 (8.1) 10 (3.2) 4 (1.4) 39 (12.5) Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100)
Frequency of tooth brushing
Never/Irregularly 8 (2.6) 4 (1.3) 0 (0) 12 (3.8) 0.043 Once a day 37 (11.8) 14 (4.4) 11 (3.6) 62 (19.8) Twice a day or more 135 (43.1) 76 (24.3) 28 (8.9) 239 (76.4) Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100) Type of toothbrush Manual 123 (39.3) 77 (24.6) 30 (9.7) 230 (73.5) 0.072 Electric 50 (16.0) 12 (3.8) 7 (2.2) 69 (22.0) Sonic/Ultrasonic 7 (2.2) 5 (1.6) 2 (0.6) 14 (4.5) Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100) Type of toothpaste With fluoride 58 (18.5) 42 (13.3) 18 (5.8) 118 (37.7) 0.018 Fluoride free 10 (3.2) 1 (0.3) 5 (1.6) 16 (5.1)
For sensitive teeth 14 (4.5) 14 (4.5) 2 (0.6) 30 (9.6)
Whitening 46 (14.8) 20 (6.4) 8 (2.6) 74 (23.6)
None 6 (1.9) 4 (1.3) 1 (0.3) 11 (3.5)
Doesn’t pay attention 46 (14.6) 13 (4.2) 5 (1.6) 64 (20.4)
Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100) Use of mouthwash Use 86 (27.4) 60 (19.0) 22 (7.1) 168 (53.7) 0.038 Doesn’t use 94 (30.1) 34 (11.0) 17 (5.4) 145 (46.3) Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100)
Frequency of mouth washing
Doesn’t use 94 (30.0) 37 (11.8) 17 (5.4) 148 (42.3)
0.282
Once a day 40 (12.8) 21 (6.7) 8 (2.6) 69 (22.0)
Twice a day or more 22 (7.0) 15 (4.8) 4 (1.3) 41 (13.0)
Irregularly 24 (7.7) 21 (6.7) 10 (3.2) 55 (17.6)
Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100)
19 The preferred method of whitening was to go to a dentist over using bleaching kits in all three faculties (60.4%) without statically significant difference (p=0.682).
20 Table 4. Teeth whitening/bleaching preferences
Variable
Faculty
Total N (%) P-Value
Medicine
N (%) Odontology N (%) Veterinary N (%) Would you like to whiten your teeth?
Yes 94 (30.0) 45 (14.4) 20 (6.4) 159 (58.8)
0.551
No 49 (15.7) 21 (6.7) 10 (3.2) 80 (5.8)
Maybe 37 (11.8) 28 (8.9) 9 (2.9) 74 (35.5)
Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100)
Method preferred for whitening teeth
None 47 (15.0) 21 (6.7) 10 (3.2) 78 (24.9)
0.682
Purchase teeth bleaching kit 30 (9.6) 11 (3.5) 5 (1.6) 46 (14.7)
Go to dentist 103 (32.9) 62 (19.8) 24 (7.7) 189 (60.4)
Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100)
Have you ever bleached your teeth?
Yes 30 (9.6) 18 (5.7) 10 (3.2) 58 (18.5)
0.276
No 146 (46.6) 71 (22.7) 29 (9.3) 246 (78.6)
I don’t know 4 (1.3) 5 (1.6) 0 (0) 9 (2.9)
Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100)
Method used for teeth bleaching
None 148 (47.3) 78 (24.9) 29 (9.3) 255 (81.5) 0.076 Home Kit 7 (2.2) 6 (1.9) 2 (0.6) 15 (4.8) Hydrogen Peroxide 1 (0.3) 2 (0.6) 0 (0) 3 (1.0) Bleaching Gel 6 (1.9) 4 (1.3) 3 (1.0) 13 (4.2) Toothpastes 9 (2.9) 0 (0) 5 (1.6) 14 (4.5) In-Office 9 (2.9) 4 (1.3) 0 (0) 13 (4.2) Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100)
Where did you first hear about teeth whitening?
Magazine/Book 6 (1.9) 11 (3.5) 2 (0.6) 19 (6.1) 0.112 TV 47 (15.0) 31 (9.9) 10 (3.2) 88 (28.1) At a dental office 30 (9.6) 10 (3.2) 8 (2.6) 48 (15.3) Internet 43 (13.7) 14 (4.5) 8 (2.6) 65 (20.8) Friends/Family 54 (17.3) 28 (8.9) 11 (3.5) 93 (29.7) Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100)
Approximately 58.8% of the subjects understand that there is a difference between the procedures of teeth bleaching and teeth whitening. Significantly, more international dental students (76.6%) knew about differences between teeth bleaching and teeth whitening (p<0.001).
21 caused (p=0.005). A high prevalence of international students (44.1%) didn’t know if the side effects are irreversible and 25.9% of international students agreed that side effects could be irreversible and it did not differ statistically among all three faculties (p=0.376)
(Table 5).
Table 5. Participants’ knowledge of teeth bleaching Variable Faculty Total N (%) P-Value Medicine N (%) Odontology N (%) Veterinary N (%)
Is there a difference between teeth bleaching and teeth whitening?
Yes 86 (27.5) 72 (23.0) 26 (8.3) 184 (58.8)
>0.001
No 16 (5.1) 2 (0.6) 0 (0) 18 (5.8)
I don’t know 78 (24.9) 20 (6.4) 13 (4.2) 111 (35.5)
Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100)
Do you think that teeth bleaching causes side effects?
Yes 99 (31.6) 73 (23.3) 27 (8.7) 199 (63.6)
0.005
No 21 (6.7) 5 (1.6) 2 (0.6) 28 (8.9)
I don’t know 60 (19.2) 16 (5.1) 10 (3.2) 86 (27.5)
Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100)
Do you think these side effects are irreversible?
There are no side effects 17 (5.4) 7 (2.2) 2 (0.6) 26 (8.3)
0.376
Yes 40 (12.8) 28 (9.0) 13 (4.2) 81 (25.9)
No 35 (11.2) 23 (7.3) 10 (3.2) 68 (21.7)
I don’t know 88 (28.1) 36 (11.5) 14 (4.5) 138 (44.1)
Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100)
22 Table 6. A self-reported teeth restorations history
Variable
Faculty
Total N (%) P-Value
Medicine
N (%) Odontology N (%) Veterinary N (%) Do you have any aesthetic restorations?
Yes 36 (11.5) 17 (5.4) 9 (2.9) 62 (19.8)
0.933
No 142 (45.4) 76 (24.3) 30 (9.6) 248 (79.2)
I don’t know 2 (0.6) 1 (0.3) 0 (0) 3 (1.0)
Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100)
A self-reported reason for aesthetic restoration
Don’t have any restorations 141 (45.0) 77 (24.5) 30 (9.6) 248 (79.2)
0.915
Unaesthetic fillings 16 (5.1) 10 (3.2) 4 (1.3) 30 (9.6)
Unaesthetic shape 13 (4.2) 4 (1.3) 3 (1.0) 20 (6.4)
Unaesthetic colour of crown 10 (3.2) 3 (1.0) 2 (0.6) 15 (4.8)
Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100)
Did the aesthetic restoration have a positive effect on your confidence?
Don’t have any restorations 141 (45.0) 78 (24.9) 30 (9.6) 249 (79.6)
0.857
Yes 25 (8.0) 11 (3.5) 7 (2.3) 43 (13.7)
No 5 (1.6) 2 (0.6) 0 (0) 7 (2.2)
I don’t know 9 (2.9) 3 (1.0) 2 (0.6) 14 (4.5)
Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100)
The present study revealed that 38.2% of international students were satisfied with the overall appearance of their teeth. Moreover, significantly more international medical (53.3%) and dental (45.7%) students were satisfied about their teeth (p=0.039).
Furthermore, 43.1% of international students had satisfaction towards their tooth colour, while significantly more international veterinarian students did not have an opinion about this statement (48.7%) (p=0.005).
23 Table 7. A self-satisfaction of participants toward teeth aesthetics.
Variable
Faculty
Total N (%) P-Value
Medicine
N (%) Odontology N (%) Veterinary N (%)
How satisfied are you with your own teeth?
Unsatisfied 21 (6.7) 17 (5.4) 4 (1.3) 42 (13.4) 0.039
Neutral 63 (20.1) 34 (10.9) 23 (7.4) 120 (38.3)
Satisfied 96 (30.7) 43 (13.7) 12 (3.8) 151 (48.2)
Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100)
How pleased are you with the colour of your teeth?
Unsatisfied 35 (11.2) 16 (5.1) 7 (2.2) 58 (18.5) 0.005
Neutral 65 (20.7) 36 (11.5) 19 (6.1) 120 (38.3)
Satisfied 80 (25.6) 42 (13.4) 13 (4.2) 135 (43.1)
Total 180 (57.5) 94 (30.0) 39 (12.5) 313 (100)
How pleased are you with your smile in photographers?
Unsatisfied 41 (13.1) 21 (6.7) 10 (3.3) 72 (23.0) 0.379
Neutral 40 (12.8) 33 (10.5) 12 (3.8) 85 (27.2)
Satisfied 99 (31.6) 40 (12.8) 17 (5.4) 156 (49.8)
24
DISCUSSION
Since the innovation of the tooth whitening technique, society has vastly changed its attitudes and perceptions towards dentistry. The face has become the most evident feature and thus is said to be a fundamental physical characteristic in the development of self-image and self-esteem. [30]. The present study was conducted among international students at Lithuanian University of Health Sciences.
In this present study, a two third of international students were non-smokers and cigarette smokers were a total of 15.7%. Notably, a higher number of international students from Odontology faculty smoked both cigarettes and hookah/shisha in contrast to medical students (2.5%). A previous study was carried out about smoking habits at LSMU and revealed that the international dental students had a profound knowledge of the harmfulness/addictiveness of smoking and held more constructive attitudes towards smoking cessation among their patients compared to Lithuanian dental students [31].
Information on oral hygiene habits showed that from all three faculties, majority of students have done a professional oral hygiene at least once a year (47.9%). The results of the present study displayed that attendance of students at a dental clinic for preventive reasons was lower than that in an Italian university, which conclude at 59.9% [32]. Šimat et al. published that students from the School of Dental Medicine have exceptional oral hygiene routines than students from other faculties [33]. Regarding, the frequency of brushing, 76.4% of subjects brush their teeth twice a day, and comparing the three faculties, the mass of international students brushed their teeth the recommended twice a day or more. Similarly, a study conducted in four Asian countries concluded that the majority of dental students reported brushing their teeth twice a day, nonetheless, regarding oral hygiene aids, the majority of the dental students admitted not using dental floss (61.5%) and mouthwash (64%) [34] However, in this present study a total of 46.3% of international students do not use mouthwash, a noticeably lower percentage than that of the study conducted by Halanway et al [34]. The most widespread conjunction of toothbrush and toothpaste type in each faculty in this study was a merge of manual toothbrush and fluoride containing toothpaste. This is in contrast with the study done over a period of ten years among final year students, which displayed that likewise, all students brushed with fluoride toothpaste but over 85% of students used mouthwash. [35].
25 that the deficiency of betterment in the practices of oral hygiene in students over the course of their academic years, despite having received dentistry related information.
In reference to tooth bleaching, 58.8% of the subjects would like to have their teeth whitened in the future and their preferred method of whitening was to go to a dentist over using bleaching kits in all three faculties (60.4%). Dinka D et al showed that 80% of students from different faculties would go to their dentist's office rather than use some of ‘over the counter’ bleaching products [22]. However, Hatherell S et al study with students in Cork showed that they would use home whitening kits over in office treatments [11].
The present study findings suggested that more than half of students knew that there is a difference between teeth bleaching and teeth whitening. Dinka D et al reported that when students of different schools in Zagreb were asked if there are any differences between tooth bleaching and tooth polishing, it turned out that there was a statistical significant difference in accordance with their type of education. 78% of the subjects speculated that there was a difference between the two dental procedures; however, the percentage was higher among dental and medical students [22]. This was not the case in this present study, as all three faculties had similar answers and there was no statistical difference.
In relation to international students’ aesthetic restoration history, 19.8% of international students have had an aesthetic restoration, deriving from those who have an aesthetic restoration, the prevalent reason was to fix an unaesthetic filling, followed by unaesthetic shape and unaesthetic colour of crown. When subjects were asked if their aesthetic restoration had a positive effect on their confidence only 13.7% claimed that it had a positive influence on their confidence. In Dudea D et al study the total number of subjects, 22.40% considered dental colour as being the most evident defect, compared to 33.14% who indicated that non-aesthetic restorations were their most evident defect [39].
26 dissatisfied with their dental shade, but when the same group were reviewed by dentist, only 8.5% of was found by dentists as actually having a dissatisfactory dental shade. In the current study, 49.8% of the total number of international students were appeased with their smile in photographers, which was a positive response [25].
27
CONCLUSION
International students at LSMU had an overall positive attitude towards teeth bleaching and there was no extensive difference amongst the three faculties. However, it can be concluded that knowledge towards teeth bleaching is greater amongst international dental and veterinarian students in comparison to international medical students. Limited gender differences existed with regards to the attitude towards tooth aesthetics and side effects of teeth bleaching. Additionally, most international students are satisfied with their overall dental appearance.
ACKNOWLEDGEMENT
I would like to express my deepest appreciation to Dr. Sandra Žemgulytė, LSMU Odontology Faculty, Clinic for Preventive and Paediatric Dentistry, for her patience, guidance and encouragement throughout my master thesis research. Her efforts and excellent teaching enabled me to develop an understanding and interest of the subject. In addition, I would like to thank all the international medical, dental and veterinarian students who participated in the survey for their contribution to this study.
PRACTICAL RECOMMENDATIONS
Oral health education is essential and can be beneficial in improving ones’ perception of their dental appearance and aid in prevention of side effects caused by dental products. Therefore, I believe that knowledge and awareness for oral health and oral hygiene should be further stressed for medicine and veterinary faculty. This can be accomplished with the integration of additional dental topics and electives to their curriculum followed by testing of these topics in the preclinical years.
CONFLICT OF INTEREST
28
REFERENCES
1. Freedman GA. "Chapter 14: Bleaching". Contemporary Esthetic Dentistry: Elsevier Health Sciences; 2011.
2. Sharif N, Macdonald E, Hughes J, Newcombe R.G.; Addy M. Bleaching: The chemical stain removal properties of ' whitening' toothpaste products: studies in vitro. Br Dent J 2000;188(11):620.
3. Pindborg J J. Pathology of the dental hard tissues. Copenhagen: Munksgaard, 1970. p221
4. Chi A, Damm DD, Neville BW, Allen CA, Bouquot J. Oral and Maxillofacial Pathology: Elsevier Health Sciences; 2008. p. pp. 70–74.
5. Rajendran A, Sivapathasundharam B. Shafer's Textbook of Oral Pathology. 7th ed.: Elsevier Health Sciences; 2014. p. 386-387.
6. Sparks VL. A History of Tooth-Whitening 2010.
7. U.S. Food and Drug Administration. Available at: https://www.fda.gov/.
8. Alani A, Kelleher M, Hemmings K, Saunders M, Hunter M, Barclay S, et al. Balancing the risks and benefits associated with cosmetic dentistry - a joint statement by UK specialist dental societies. 2015.
9. Alqahtani, Mohammed Q. Tooth- bleaching procedures and their controversial effects: A literature review. Tooth- bleaching procedures and their effects. The Saudi Dental Journal 2014. 10. Clifton MC. Tooth Whitening: What We Now Know. BA, MS, PhD, Professor 2014.
11. Hatherell S, Lynch CD, Burke FM, Ericson D, Gilmour ASM. Attitudes of final-year dental students to bleaching of vital and non-vital teeth in Cardiff, Cork, and Malmo. Journal of Oral Rehabilitation 2010.
12. Watts A, Addy M. Tooth Discolouration and Staining: A Review of the Literature. Br Dent J 2001;190(6):309.
13. Walsh JL. Concerns have been raised regarding the safety of bleaching teeth with high concentrations of hydrogen peroxide. Australian Dental Journal 2000
14. Dahl JE, Pallesen U. Tooth bleaching--a critical review of the biological aspects. Crit Rev Oral Biol Med. 2003:292-304.
29 16. Aschheim., Kenneth W. Esthetic Dentistry: A Clinical Approach to Techniques and Materials.
Saint Louis: Saint Louis: Elsevier; 2014.
17. Burrows S. A review of the efficacy of tooth bleaching. 2009.
18. Ameri H. Effects of different bleaching time interval on fracture toughness of enamel. J Conser Dent. 2011(14):73–5.
19. Auschill TM, Hellwig E, Schmidale S, Sculean A, Arweiler N. Efficacy, side-effects and patients' acceptance of different bleaching techniques (OTC, in-office, at-home). 2005.
20. Demarco FF, Meireles SS, Masotti AS. Over-the-counter whitening agents: a concise review Braz Oral Res (2009);23: 64-70.
21. Goldberg M, Grootveld M, Lynch E. Undesirable and adverse effects of tooth-whitening products: a review. Clinical oral investigations. 2010 Feb 1;14(1):1-0.
22. Dinka D, Sever KE, Galić N, Spajić J, Prskalo K. Attitudes of Students of Different Schools of University of Zagreb on Tooth Bleaching Acta Stomatol Croat. 2016;50(4):301–309.
23. Kirchhoff J, Filippi A. Comparison of oral health behaviour among dental students, students of other, disciplines, and fashion models in Switzerland. Swiss Dental Journal (2015).
24. Carlsson GE, Johansson A, Ordell S, Ekbäck G, Unell L. Attitudes toward Dental Appearance in 50-and 60-Year-Old Subjects Living in Sweden. Journal of Esthetic and Restorative Dentistry 2008;20(1):46-55.
25. Shulman J, Maupome G, Clark D, Levy S. Perceptions of desirable color among parents, dentists and children. Journal of American Dental Association 2004; 135:595-604.
26. Rosenstiel SF, Rashid RG. Public preferences for anterior tooth variations: a web-based study. Journal of Esthet and Restorative Dentistry 2002:97-106
27. Nomay N. Public attitude and awareness towards their teeth color and dental bleaching in Saudi Arabia: A cross-sectional survey 2015.
28. Ashworth P, Davis LG, Spriggs L. Personal change resulting from porcelain veneer treatment to improve the appearance of teeth. 1996.
29. Kaur P, Singh S, Mathur A, Makkar KD, Aggarwal PV, Batra M, et al. Impact of Dental Disorders and its Influence on Self Esteem Levels among Adolescents. J Clin Diagn Res. 2017;11(4). 30. Allyn & Bacon. Social thought and social behaviour. 2nd ed ed.: Baron RA. Essentials of
psychology; 1999.
30 32. Rimondini L, Zolfanelli B, Bernardi F, Bez C. Self-preventive oral behavior in an Italian
university student population. J Clin Periodontol 2001;28(3):207-211.
33. Šimat S, Mostarčić K, Matijević J, Simeon P, Rošin Grget K, Jukić K S. A Comparison of Oral Status of the Fourth¬Year Students of Various Colleges at the University of Zagreb. Acta Stomatol Croat. 2011;45(3):177–83. Acta Stomatol Croat. 2011;45(3):177–83.
34. Halawany HS, Abraham NB, Jacob V, Al-Maflehi N. The perceived concepts of oral health attitudes and behaviors of dental students from four Asian countries. The Saudi Journal for Dental Research 2015;6(2):79-85
35. Messer L, Calache H. Oral health attitudes and behaviours of final-year dental students. European Journal of Dental Education 2012;16(3):144-155.
36. El-Mostehy M,R., Zaki H,A., Stallard R. The dental student’s attitude toward the profession as reflected in his oral cavity. Egypt Dent J 1969;15(2):104–9.
37. Meister J,F. Comparison of the oral hygiene and periodontal health status of a class of dental students as freshmen and as seniors. J Prev Dent 1980;6:245–52.
38. Ainamo J, Ainamo A. Development of oral health during dental studies in India and Finland. Int Dent J 1978;28(4):427–33
39. Dudea D, Lasserre J, Alb C, Culic B, Ciutrila ISP, Colosi H. Patients’ perspective on dental aesthetics in a South-eastern European community. J Dent 2012;40:p72-p81.
40. Khan M, Fida M. Assessment of psychosocial impact of dental aesthetics. Journal of the College of Physicians and Surgeons Pakistan 2008;18(9):559.
41. Wisniewski P, Szatko F, Wierzbicka M, Dybizbanska E, Rusyan E, Ganowicz M. Patients’ attitudes to tooth bleaching - a questionnaire study 2004.
42. Tin-Oo M, Saddki N, Hassan N. Factors influencing patient satisfaction with dental appearance and treatments they desire to improve aesthetics. BMC Oral Health 2011;11(6).
31
ANNEXES
Annex No. 1
Questionnaire for International Students
Knowledge and attitude of teeth bleaching and perception of tooth aesthetics amongst international students at Lithuanian University of Health Sciences.
I am JINITA PRAFULCHANDRA UDANI, the dental student conducting masters of scientific research, which is aimed evaluate the overall perception and knowledge of teeth bleaching and aesthetics among the international students in LSMU.
Research data will be used only for scientific purposes. The confidentiality is guaranteed.
Thank you for your participation.
If you have any questions please contact Jinita Udani, Tel. No: +370 (653) 40 628,
32 Please answer all 25 questions to the best of
your ability. *Required 1. Gender * Male Female 2. Age * 18 – 24 25 – 29 30 – 34 >35
3. Which faculty do you study in? *
Medicine Odontology Veterinary
4. What is your year of academic study? * 1 2 3 4 5 6
5. How often do you get a professional oral hygiene (tooth cleaning)? *
Once a year Twice a year Every 2 years Never
6. Do you do any of the following? * Smoke Cigarettes
Smoke Hooka/Shisha I don't smoke
7. Do you drink tea/coffee? * Yes
No
8. If yes, how often do you drink? Once a day
Twice a day > twice a day Irregularly
9. How often do you clean your teeth?* Once a day Twice a day > twice a day Irregular Never
10. What type of toothbrush do you use? *
Manual Electric
Sonic/ultrasonic
11. What kind of toothpaste do you use? *
Fluoride
For Sensitive Teeth Fluoride-free Whitening None
I don’t pay attention to the type
12. Do you use mouthwash? * Yes
No
13. If yes, how often do you use mouthwash?
Once a day Twice a day > twice a day Irregularly
14. Would you like to whiten your teeth? *
33 15. If yes, you will:
Purchase teeth bleaching kits (over the counter)
Go to the dentist
16. Have you ever bleached your teeth?*
Yes No
I don’t know
17. If yes, what techniques have you used? Home kits Hydrogen peroxide Bleaching gel Toothpastes In office treatment
18. Where did you first hear about teeth whitening? * Magazines/Books TV At a dental office On the Internet Talking to friends/family
19. According to your opinion, is there a difference between teeth bleaching and teeth polishing? *
Yes No
I don’t know
20. Do you think that teeth bleaching causes side effects? *
Yes No
I don’t know
21. If yes, do you think these side effects are irreversible?
Yes No
I don’t know
22. Do you have any aesthetic
restorations (e.g. crowns, veneers)?* Yes
No
I don’t know
23. If yes, what was your reason for getting the aesthetic restoration?
Unaesthetic filling
Unaesthetic shape of crown Unaesthetic colour of crown (too dark)
24. If yes do you think getting an aesthetic restoration had a positive effect on your confidence?
Yes No
34 25. Rate the following questions from 1 to 5:
1 - Very Unsatisfied 2 - Unsatisfied 3 - Neutral 4 - Satisfied 5 - Very Satisfied 1 2 3 4 5
How satisfied are you with your own teeth? How pleased are you with
the colour of your teeth? How pleased are you with
35 Annex No. 2
36 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:
________________ ___________________________ _____________________
