|Year : 2015 | Volume
| Issue : 2 | Page : 105-111
Assessment of preventive dental care among dental students and dental professionals in India: A knowledge, attitude, and practice study
Paramjit Kaur Khinda1, Rupali Mahajan1, Amarjit Singh Gill1, Ranjit Singh Uppal1, Jyotinder Kaur1, Akhilesh Shewale2, SP Saravanan3, Nidhi Bhatia4
1 Department of Periodontology and Oral Implantology, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India
2 Department of Periodontology and Oral Implantology, SDKS, Dental College and Hospital, Nagpur, Maharashtra, India
3 Department of Dental Surgery, AFMC, Pune, Maharashtra, India
4 Department of Periodontology and Oral Implantology, Santosh Dental College, Ghaziabad, Uttar Pradesh, India
|Date of Web Publication||2-Mar-2016|
Genesis Institute of Dental Sciences and Research, Ferozepur -152 002, Punjab
Source of Support: None, Conflict of Interest: None
Aim: Knowledge and oral health behavior of dental students and professionals play an important role in oral health education of patients and community at large. It is therefore important that their own oral health behavior conforms to expectations of the population. Hence, the aim of the present study was to evaluate the oral health knowledge, attitude, and practices (KAPs) among dental students and dental professionals.
Materials and Methods: In the present study, KAPs of 560 dental students and professionals (postgraduate [PG] students and dental faculty) was explored. The participants were divided into three groups based on their level of education. Group 1 included undergraduate students and interns, Group 2 included PG students, and Group 3 included teaching faculty. Group 1 was further divided into UG1 (BDS 1 st year), UG2 (BDS 2 nd year), UG3 (BDS 3 rd year), UG4 (BDS 4 th year), and UG5 (Interns). A number of participants in each group were 80.
Statistical Analysis: Kruskal-Wallis test was used for intergroup comparison and Mann-Whitney test was used for intragroup comparison.
Result: Results showed that as the education level increased from junior students to senior students to teaching faculty, the mean score of positive responses increased in all the components (KAP), and the values are statistically significant (P < 0.005) and this increase in the KAP was not up to the expected level.
Conclusion: The finding of the present study indicated the poor oral health behaviors (KAP) among dental students and dental professionals, which should be improved in order to serve as a positive model for their patients, family, and friends.
Keywords: Education, health, hygiene, prevention, role model, society
|How to cite this article:|
Khinda PK, Mahajan R, Gill AS, Uppal RS, Kaur J, Shewale A, Saravanan S P, Bhatia N. Assessment of preventive dental care among dental students and dental professionals in India: A knowledge, attitude, and practice study. Saint Int Dent J 2015;1:105-11
|How to cite this URL:|
Khinda PK, Mahajan R, Gill AS, Uppal RS, Kaur J, Shewale A, Saravanan S P, Bhatia N. Assessment of preventive dental care among dental students and dental professionals in India: A knowledge, attitude, and practice study. Saint Int Dent J [serial online] 2015 [cited 2019 Oct 17];1:105-11. Available from: http://www.sidj.org/text.asp?2015/1/2/105/177942
Hygiene refers to a set of practices associated with the prevention of illness and preservation of health and healthy living through cleanliness. The term hygiene is derived from hygieia, the Greek goddess of health, cleanliness and sanitation, whereas hygienics is the science that deals with the promotion and preservation of health.  Oral health knowledge is considered to be an essential prerequisite for health-related behavior.  Oral diseases qualify as major public health problems owing to their high prevalence and incidence.  The state of oral health can offer lots of clues about general health. Oral health may be defined as a standard of health of the oral and related tissues which enables an individual to eat, speak, and socialize without active disease, discomfort or embarrassment and which contributes to general well-being. 
It is the primary concern of oral health educators to impart a positive oral health knowledge and behavior to the society. This knowledge is usually derived from information and the information when believed translates into an action. Behavior is the outcome when that action is sustained.  Dental health is a highly individualized concept, the perception of which is very much affected by an individual's culture and socioeconomic status. The attitude of people toward their own teeth and the attitude of dentists who provide dental care play an important role in determining the oral health condition of the population. 
Although published research has been concerned with how to motivate the patients to follow a prescribed, effective oral health care program, little attention has been given to the context of how and when dental students undergo motivational behavior changes with respect to their self- care regimen.
Dental students and professionals come across a large number of patients of different age groups from different backgrounds in their day to day practice or course of study. Hence, with proper knowledge and oral health behavior, they can play an important role in oral health education and act as role models for patients and community at large. Many oral diseases can be prevented if proper education and awareness are provided. By virtue of their professional role, they play a vital role in health promotion and preventive information dissemination among their family and society. It is therefore important that their own oral health behavior conforms to expectations of the population. Hence, it is essential to ascertain the oral hygiene awareness and its practices among dental students and professionals.
Aim of this knowledge, attitude, and practice (KAP) study was to assess KAP of dental students (undergraduate students and interns) and professionals (teaching faculty, postgraduate [PG] students) from different dental colleges of Punjab, India about various aspects of oral hygiene and to evaluate whether progressive dental education and their understanding of preventive dentistry will improve their commitment toward enhancement of their oral health attitude and practices. An attempt was also made to assess the influence of dental students and professionals on general population by being their role model.
| Materials and Methods|| |
Study subjects and data collection
This cross-sectional study was conducted from June to September 2015 in Dental Colleges of Punjab State, India. Permission was obtained from the concerned authorities. Study design and protocol was approved by the Institution's Research and Ethical Committee. Selected subjects were informed about the study protocol, and informed consent was obtained. About 560 subjects were enrolled in the study. The sample size was calculated based on a total of 2000 dental students and dental professionals in 8 dental colleges out of 15 dental colleges listed under the Baba Farid University of Health Sciences in Punjab, which served as a sampling frame. To obtain a representative sample of dental students, PG students and dental professionals (faculty) working in six dental colleges listed under the Baba Farid University were selected by a simple random sampling approach. With the prevalence of knowledge (89%) from the pilot study, using the confidence level of 95% and design effect one, sample size was estimated to be of 560 participants.
The subjects were divided into three groups. Group 1 included undergraduate students, Group 2 included PG students, and Group 3 included teaching faculty. Group 1 was further divided into UG1 (BDS 1 st year), UG2 (BDS 2 nd year), UG3 (BDS 3 rd year), UG4 (BDS 4 th year), and UG5 (Interns). A number of participants in each group were 80.
The dental students, PG students, and dental faculties on the day of data collection were individually asked to voluntarily complete a pretested anonymous questionnaire.
Pretesting of the questionnaire
Before data collection, a pilot study was conducted among fifty dental students, fifty PG students, and fifty dental faculties. The pilot study subjects were not included in the main study. To estimate the reliability of the questionnaire used in this study [Table 1], a questionnaire was given twice to the respondents, first on the day of the pilot study and then again after 1-week to ensure reliable answers. The coefficient of reliability was calculated using Cronbach's alpha (0.85) that indicated good reliability. A pilot study was also done to assess the appropriateness of the questionnaire, and it was found that the questions were unambiguous and easy to respond.
|Table 1: Self-administered questionnaire (knowledge, attitude, practice for the study) |
Click here to view
There is no universally accepted or recommended index/inventory to measure oral health behavior. A self-administered, structured questionnaire written in English and validated through a pilot survey included four questions to test the knowledge about oral hygiene, five questions to determine the attitude toward oral hygiene, and seven questions to assess practice responses. The participants were asked to respond to one choice among 3 or 4 choices for a question [Table 1].
Dental students and professionals were visited by a single investigator, and all available and willing participants were given the questionnaire. Participants were asked to respond to each item according to the response format provided with the questionnaire. The investigator was always available during the completion of the questionnaires, and the participants were encouraged to approach the investigator for any clarification. Majority of the filled questionnaires were collected back immediately on the day of data collection. PG and dental faculty who said they were busy on the day of data collection and for a few days, a one week time was given and questionnaires were then collected accordingly.
The data were analyzed using Statistical Package for the Social Science (SPSS) version 13 software (Chicago, IL, USA). Normality tests showed that data were not normally distributed so nonparametric tests were applied. Kruskal-Wallis test was used for intergroup comparison. Mann-Whitney test was used for intragroup comparison.
| Results|| |
The present study was to assess the KAP among dental students and professionals. There were 700 participants in the study and were equally divided into seven groups and all the participants responded. The results suggested that as the education level increased from junior students to senior students to teaching faculty, the mean score of positive responses increased in all the components (KAP) [Table 2].
|Table 2: Average mean knowledge score, attitude score, and practice score |
Click here to view
On comparison of the mean knowledge score among dental students and professionals, UG1 has least score (1.78), followed by UG2 (1.79), UG3 (2.33), UG4 (3.50), UG5 (3.88), and maximum mean knowledge score was recorded for PG students (4.00) and teaching staff (4.00) as shown in [Table 2] and this increase in the mean score of knowledge among these groups is statistically significant (P < 0.001). Similarly, comparison of the mean attitude score showed least scores for UG1 (0.68), followed by UG2 (0.74), UG3 (0.82), UG4 (1.20), UG5 (1.40), PG student (2.03), and maximum for teaching staff (2.40) as shown in [Table 3] and this increase in the score was statistically significant (P < 0.001). A significant increase in practice score (P < 0.001) was observed among different groups as shown in [Table 2].
|Table 3: Comparison of knowledge, attitude, and practice of dental professionals |
Click here to view
Comparison of UG1 with other groups
Observation from the study showed that there were statistically significant differences in knowledge scores when responses of UG1 group were compared with UG3, UG4, UG5, PGs (P < 0.001), and teaching faculty (P < 0.001) but comparison of UG1 with UG2 yielded a nonsignificant difference (P = 0.618) [Table 3].
On comparing UG1 with PGs and teaching faculty, a statistically difference in attitude was observed (P < 0.001) but with other groups it was statistically nonsignificant (P > 0.001) [Table 3].
Comparison of the practice of UG1 with UG2 and UG3 showed nonsignificant difference (P > 0.001), but on comparison with other groups, the results were found to be statistically significant (P < 0.001) [Table 3].
Comparison of UG2 with other groups
The result of the study showed that there was a statistically significant difference in the knowledge of UG2 on comparison with UG3, UG4, UG5, PGs, and teaching faculty (P < 0.001) [Table 3].
On comparing UG2 with PGs and teaching faculty, a statistically significant difference in attitude was observed, but a comparison of UG2 (P = 0.823) with UG3 (P = 0.119) and UG4 (P = 0.337) yielded a statistically nonsignificant result [Table 3].
Comparison of practice of UG2 with PGs and faculty showed statistically significant difference (P < 0.001), but on a comparison of UG2 with UG3, UG4, and UG5 it was observed that the differences were nonsignificant (P > 0.001) [Table 3].
Comparison of UG3 with other groups
It was observed that there was a statistically significant difference in the knowledge of UG3 in comparison with UG4, UG5, PGs, and teaching faculty [Table 3].
On comparing UG3 with PGs and teaching faculty, a statistically significant difference in attitude was observed but a comparison of UG3 with UG4 (P = 0.112) and UG5 (P = 0.377) yielded statistically nonsignificant result [Table 3].
Comparison of practice of UG3 with PGs and faculty showed statistically significant differences (P < 0.001), but when UG3 was compared with UG4 and UG5, it showed nonsignificant difference (P > 0.001) [Table 3].
Comparison of UG4 with other groups
Results revealed a statistically significant difference in the knowledge of UG4 on comparing with interns, PGs, and teaching faculty [Table 3].
On comparing UG4 with PGs and teaching faculty, a statistically significant difference in attitude was obtained, but when UG4 group was compared with UG5 the results were found to be statistically nonsignificant (P = 0.460) [Table 3].
Comparison of practice of UG4 with PGs and teaching faculty showed statistically significant differences (P < 0.001), but UG5 showed nonsignificant difference (P > 0.001) on comparison with UG4 [Table 3].
Comparison of UG5 with other groups
Results revealed statistically significant difference in the knowledge of UG5 on comparison with PGs and teaching faculty (P < 0.001) [Table 3].
On comparing UG5 with PGs and teaching faculty, a statistically significant difference in attitude was obtained (P < 0.0.001) [Table 3].
Comparison of the practice of UG5 with PGs showed the nonsignificant difference (P = 0.198), the results were nonsignificant when compared with teaching faculty as well [Table 3].
Comparison of postgraduates with teaching faculty
Results revealed that there is statistically nonsignificant difference in responses of PGs when compared to teaching faculty, regarding knowledge (P = 0.793), attitude (P = 0.124), and practice (P = 0.136) [Table 3].
| Discussion|| |
Preventive activities are influenced by three factors: Thoughts (beliefs, values, and expectations), social environment (interpersonal interactions), and individual ability.  Moreover, to follow directions given by the dentist, patients have to believe that they are exposed to the disease, the disease is real, and they can be helped by the dentist's efforts.  Hence, a need was felt for assessing the oral health-related KAPs of dental students and dental faculty keeping in mind the expected role to be played by them. Moreover, preventive oral health education is in a transition stage in India.  Despite the current emphasis on prevention in dental education, and although there have been some studies of the preventive knowledge of dental students, dentists, and dental hygienists, very few studies have focused on the orientation of preventive aspects among both dental students and teaching staff. To our knowledge, no study exists which has together analyzed the oral hygiene awareness, attitude, and practice among dental students which also included PG students and teaching faculty. Previous studies had compared oral health, attitudes among dental students ,,, and teaching faculty,  but no study has compared KAP of dental students, PGs, and the teachings faculty.
This study was carried out among 560 dental students and professionals of various educational levels (UG1, UG2, UG3, UG4, UG5, PGs, and teaching staff) to assess the KAPs about oral hygiene.
In our study, it was observed that teaching faculty and PGs showed a higher average mean score of the KAP among all groups. Teaching faculty and PGs responded all knowledge-based questions [Figure 1] but the attitude score and practice score was lower than that would be expected from these groups as shown in [Figure 2] and [Figure 3], respectively. The results are consistent with the study done by Neeraja et al.  who assessed the oral health and behavior among a group of dental students in Bengaluru, India and concluded that the overall knowledge of oral health was good, even though there were deficits in knowledge in a few areas. Another study done by Baseer et al.  showed that the oral health knowledge among the health professionals was lower than what would be expected from these groups. Similar results were also reported by Madan et al.  and Togoo et al.  Nilchian et al.  evaluated the attitude and awareness of future dental graduates toward preventive dentistry regarding gender and educational characteristics and concluded that dental students of the Isfahan state University and Azad University of Khorasgan had acceptable levels of awareness about the role of sugar and fluoridated water in caries process but were not aware enough about the role of fluoridated toothpaste in preventing dental caries. On the assessment of knowledge, attitude, self-reported practices, and prescription patterns regarding dental floss, Madan et al.  reported that there was a lack of adequate knowledge regarding dental floss among dentists in India.
The present study showed that the oral health attitudes and behavior of dental students improved with increasing levels of education and it also revealed that an increase in education level resulted in an increase in the KAP of dental students and professionals. These findings are in agreement with previous studies. , In the present study, it was found that the level of knowledge varied among dental students and professionals. The average mean knowledge score of all the groups showed that UG1 (mean score = 1.78) had less knowledge and PGs and teaching faculty (mean score = 4) had more knowledge. Dental students belonging to the 1 st year can be compared with the strata of society which has limited awareness about dentistry in general and oral hygiene in particular. With progressive dental education through the undergraduate curriculum, dental students and professionals develop understanding about oral hygiene and oral hygiene practices. Without proper knowledge and oral health behavior among individuals and groups, they cannot act as role models for patients, friends, families, and the community at large. The students belonging to the 3 rd and 4 th year can be compared to the strata of educated and highly motivated subjects of society. This suggested that preventive dentistry, motivational lectures or courses if started early in the curriculum would be beneficial.
The mean value of the attitude score of UG1 (0.68), UG2 (0.74), UG3 (0.82), UG4 (1.20), UG5 (1.40), PGs (2.03), and teaching faculty (2.40) increased as education level is increased [Table 2]. The present study found that positive attitudes developed as the level of education increased; this could be the result of receiving dental health care education as their course progressed. The attitude score found in the present study were also found to be below the expected value [Figure 2]. Therefore, the present study indicated that the teaching faculty, PGs, and other groups are not acting as role model for their patients, family members, and neighbors. They found preventive dentistry difficult to practice and personally disreputable. Similar findings have been reported in studies by Ghasemi et al.  and Khami et al. These attitudes among dental students and teaching staff may originate from their lack of importance given to prevention during their training and education. To meet the demand for producing highly competent dental students and teaching staff, more evidence-based programs on prevention should be integrated into dental education during graduation as well as postgraduation and emphasis should be placed on continuing dental education courses for teaching faculty. The present study was in contrast to the study conducted by Ghasemi et al.  in which positive attitude was reported among dentists about oral health care.
The present study has 8 practice-based questions which showed that the score value of practice increased as the education level increased, but this increase is not up to the expected value [Figure 3], thus indicating that neither dental students nor professionals are acting as role models for their patients. The results also suggested that students in the dental profession should be introduced early to oral health care education. This is a key factor in developing their dental health attitudes and behaviors in order to allow them to have a positive impact on the dental health attitudes and behaviors of their patients. The results of the study showed that oral health behaviors and attitudes of dental students and professionals improve with increasing level of dental education but is not up to the expected level. The study provides valuable baseline information that will allow comparison of dental students and dental faculty about oral health awareness with other population.
As nonresponses, misconceptions, and errors are common with surveys using a self-administered questionnaire; these should be minimum in this study since the respondents were highly educated health professionals. Faculty of public health dentistry department was also excluded from our study, as this might influence our results indicating a high level of knowledge since it mainly deals with prevention related research. To the best of our knowledge, there is no study which has included PG students and teaching faculty along with dental students of various years for the assessment of their KAP.
In interpreting the findings of the present study, it is important to acknowledge possible limitations. There is a possibility of social desirability bias wherein the respondents overreported the KAP questions. Furthermore, some of the students and teaching staff gave back the filled questionnaire after 1 week; this may have led to the possibility of reporting bias.
The following measures should be taken to improve dental student's and professional's KAP about preventive dental care and expand their role model:
- Including preventive dentistry topics in all the 4 years of under graduation and 3 years of postgraduation program irrespective of the specialty so that these students in their present as well as in future play a greater role in oral health related activities
- Developing and testing the outcomes of curriculums, designed to increase the understanding of the importance of signs and symptoms of oral diseases and prevention
- Continuing dental education activities together with increasing emphasis on prevention-related research should be applied to enhance KAP toward prevention.
- After implementation of the above-given program, similar studies can be conducted to evaluate the strength to the programs.
| Conclusion|| |
Results of the study suggested that oral health KAP among dental students and professionals is poor and needs to be improved. This study demonstrated that there were significant differences in oral health KAP among different groups. These findings might reflect the difference in students' experience, attitudes, behavior, and education. Findings of this study also showed that dental students and professionals are not acting as role models for the general public. Future studies with a much larger sample size are warranted and should be carried out.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Motakpalli K, Indulli AS, Sirwar SB, Jayalaxmi JN, Bendigeri ND, Jmadar DC. A study on health hygiene among school children in rural field practice area of AJIM Mangalore in Karnataka: India. Int J Bioassays 2013;2:1407-10.
Usman S, Bhat S, Sargod S. Oral health knowledge and behavior of clinical medical, dental and paramedical students in Mangalore. J Oral Health Community Dent 2007;1:46-8.
Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21 st
century - The approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003;31 Suppl 1:3-23.
Prasad PK, Shankar S, Sowmya J. Oral health Knowledge attitude practice of school students of KSR matriculation school, Thiruchengode. J Indian Acad Dent Spec Res 2010;1:5-11.
Freeman R, Maizels J, Wylir M, Sheiham A. The relationship between health related knowledge, attitudes and dental health behavior in 14-16 year old adolescents. Community Dent Health 1993;10:397-404.
Baseer MA, Alenazy MS, Alasqah M, Algabbani M, Mehkari A. Oral health knowledge, attitude and practices among health professionals in King Fahad Medical City, Riyadh. Dent Res J (Isfahan) 2012;9:386-92.
Dagli RJ, Tadakamadla S, Dhanni C, Duraiswamy P, Kulkarni S. Self reported dental health attitude and behavior of dental students in India. J Oral Sci 2008;50:267-72.
Peker I, Alkurt MT. Oral health attitudes and behavior among a group of Turkish dental students. Eur J Dent 2009;3:24-31.
Bhat PK, Kumar A, Aruna CN. Preventive oral health knowledge, practice and behavior of patients attending dental institution in Bangalore, India. J Int Oral Health 2010;2:17-26.
Khami MR, Murtomaa H, Jafarian M, Virtanen JI. Knowledge and attitude of Iranian dental school educators towards prevention. Oral Health Prev Dent 2007;5:181-6.
Neeraja R, Kayalvizhi G, Sangeetha P. Oral health attitudes and behavior among a group of dental students in Bangalore, India. Eur J Dent 2011;5:163-7.
Madan C, Arora K, Chadha VS, Manjunath BC, Chandrashekar BR, Rama Moorthy VR. A knowledge, attitude, and practices study regarding dental floss among dentists in India. J Indian Soc Periodontol 2014;18:361-8.
Togoo RA, Al-Rafee MA, Kandyala R, Luqam M, Al-Bulowey MA. Dentists' opinion and knowledge about preventive dental care in Saudi Arabia: A nationwide cross-sectional study. J Contemp Dent Pract 2012;13:261-5.
Nilchian F, Kazemi SH, Abbasi M, Ghoreishian F, Kowkabi M. Evaluation of Isfahan's dental students' awareness about preventive dentistry. J Dent (Shiraz) 2014;15:1-5.
Polychronopoulou A, Kawamura M, Athanasouli T. Oral self-care behavior among dental school students in Greece. J Oral Sci 2002;44:73-8.
Ghasemi H, Murtomaa H, Torabzadeh H, Vehkalahti MM. Knowledge of and attitudes towards preventive dental care among Iranian dentists. Eur J Dent 2007;1:222-9.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]