Abstract

The aim of the present study was to evaluate the oral health attitudes and behaviors of dental students in Sudan based on the current year in dental school and gender.

Materials and Methods: A self-administered questionnaire based on the Hiroshima University-Dental Behavior Inventory (HU-DBI) was distributed in 429 dental students at the University of Sciences and Technology (UST), Khartoum, Sudan.

Results: The response rate was 51.9% (males: 28.7%; females: 71.3%). The mean value of the HU-BDI score was 5.08, which is low compared to that of other countries. Females showed a significantly higher score than males. On the other hand, there was no statistically significant difference between preclinical (1st, 2nd and 3rd year) and clinical (4th and 5th year) dental students.

Conclusions: The present study showed that the awareness of oral hygiene was low amongst dental students in Sudan with no direct relationship to level of education. It is necessary therefore to promote a comprehensive educational program for dental hygiene in Sudan.

Keywordsoral hygiene, attitude, dental students

Author and Article Information

Author info
University of Sciences and Technology, Omdurman, Sudan.

ReceivedSep 29 2014　　AcceptedDec 24 2014　　PublishedJan 9 2014

CitationAl-Shiekh L, Muhammed MED, Muhammed AER, El-Huda MA, Hashim NT (2015) Evaluation of dental students' oral hygiene attitude and behavior using HU-DBI in Sudan. Science Postprint 1(2): e00040. doi:10.14340/spp.2015.01A0001

Copyright©2014 The Authors. Science Postprint is published by General Healthcare Inc. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 2.1 Japan (CC BY-NC-ND 2.1 JP) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

FundingThis work was not supported by any fund to disclose.

Competing interestThe authors have no competing of interest in this work.

Ethics StatementEthical clearance was obtained from the ethical committee for research from UST. The aim of the study was explained to all students and informed consent was obtained from all respondents before participation.

Corresponding authorNada Tawfig Hashim
AddressUniversity of Sciences and Technology, Middle street—Elthawra, Omdurman, Sudan.
E-mailnadatawfig@yahoo.com

Introduction

Good oral health is essential for overall health and as such has a positive impact on physical, mental and social wellbeing. Poor oral health can cause pain, interrupt sleep, affect the ability to consume a healthy diet, has an impact on social interaction and cause difficulty with speech. Also, it can adversely affect other health conditions. For instance, periodontal disease may contribute to cardiovascular disease, low birth weight, aspiration pneumonia, and nutritional deficiencies in children and elders 1.

Oral self-care practice is an effective preventive measure for maintaining good individual oral health which is an integral part of one's general health. For dental health professionals, their health beliefs and attitudes not only affect their oral self-care habits but may also potentially influence their ability to motivate patients to undertake preventive oral health measures 2.

Therefore, acquiring knowledge and attitudes related to dental health and prevention of oral diseases is especially important during the future dentists' training period. Although oral health knowledge does not necessarily relate to better health behavior, people who have assimilated this knowledge and feel a sense of personal control over their oral health are more likely to adopt self-care practices 3. Moreover males and females have different physiological and psychological behaviors, so it is possible that their oral health behavior may be different as well 4.

There are controversies among researchers on the impact of education on attitude, behavior and oral hygiene of dental students. Many studies have addressed this issue and different results were obtained 5, 6.

The Hiroshima University-Dental Behavioral Inventory (HU-DBI), originally formulated by Kawamura (1988) 7 and translated into numerous languages, has been utilized in studies worldwide to assess dental students’ attitudes toward their oral health 5, 6. The HU-DBI is comprised of 20 items with dichotomous response options (agree/disagree) and has demonstrated good reliability 8.

In Sudan the dental faculties accept candidates from various socio-economic backgrounds, who become eligible to study dentistry based on their score in their Sudanese entrance exams. The dental curricula in Sudan encompasses of five years including preclinical (years 1, 2 and 3) and clinical (years 4 and 5) years. Sudanese dental students are introduced to preventive aspects of oral health much later during their educational years and this may affect their oral health behavior with regards to their level of dental education.

University of Sciences and Technology (UST) is a private University and the students are accepted by their scores in their Sudanese entrance exam and also by their socioeconomic status, the fees for the dental faculty is not feasible to people of low socioeconomic status, therefore the student socioeconomic status is similar and most of them belong to high social class.

Literature lacks studies about oral health attitude and behavior among Sudanese dental students and therefore the purpose of this study was to use the HU-DBI to explore the dental attitude and behavior of Sudanese dental students in University of Sciences and Technology (UST) based on dental education level and gender.

Materials and Methods

An Arabic version of modified HU-DBI was used for the present study. The study was conducted among students from UST. Ethical clearance was obtained from the Ethical Committee for Research from University of Sciences and Technology. The aim of the study was explained to all students and informed consent was obtained from all respondents before participation. The study was based on a collection of responses to a 16 item questionnaire during the period of February to April 2014. Students from all five academic years were invited to complete the questionnaire in their classrooms after lectures rather than outside the class. The respondent’s identity was anonymous; gender as well as academic level were obtained and were considered as independent variables.

The HU-DBI comprises of 16 items with dichotomous response options (agree/disagree) regarding the respondent’s own oral health attitudes and behavior 7.

The maximum HU-DBI score is 11; a higher score indicates better oral health attitude and behavior. The score of each item related to oral health attitude and behavior, was analyzed and a mean score was calculated for academic level and gender.

SPSS version 22.00 was used to process and analyze the data. An independent T-test was used to detect differences in mean HU-DBI scores of students by level of academic years and gender. P values of ≤0.05 were considered statistically significant.

Results

HU-DBI was distributed to 429 dental students and completed by 223 students (51.9%). 64 (28.7%) were male and 159 (71.3%) were female (Table 1).

Table 1 Distribution of females and males by academic level

Table 2 presents the numbers and percentages of preclinical and clinical students’ agree/disagree responses to all HU-DBI items, and Table 3 presents the numbers and percentages of students’ agree/disagree by gender.

Table 2 HU-DBI^* responses given by clinical and preclinical dental

^* Hiroshima University-Dental Behavioral Inventory

Table 3 HU-DBI^* responses given by gender

^* Hiroshima University-Dental Behavioral Inventory

Female preclinical students (N = 106) were more than females in the clinical level students (N = 53), while there were an equivalent number of male students in both preclinical (N = 35) clinical (N = 29) levels.

From a total of 429 dental students, 223 students (51.9%) completed the questionnaire; 64 males students (28.7%) and 159 female students (71.3%) participated in the research.

The number of females and males in the preclinical level of dental education is shown in Table 1. The majority of participants from the preclinical level of education were females (75.2% vs 64.4%), while most of the participants from the clinical level of education were males (35.4% vs 24.2%).

The data was categorized into preclinical and clinical students (Table 4). The means of preclinical and clinical students were 5.03 and 5.17, respectively, and there was no statistically significant difference between them.

Table 4 T-test of the mean value of HU-BDI^* score and preclinical and clinical level of dental education

^* Hiroshima University-Dental Behavioral Inventory

The data was also categorized into male and female groups (Table 4). The HU-DBI score of female (5.25) was significantly higher than that of males (4.67) (Table 5).

Table 5 T-test of the mean value of HU-DBI^* and gender

^* Hiroshima University-Dental Behavioral Inventory

Discusion

The dental learning experience has a great impact on the formation of a student’s attitude towards oral health. Thus, it can directly or indirectly affect their behavior and influence their ability to motivate their patients 9. Recent studies suggest that improved personal oral health among dental students is linked to their progression through their academic years 10.

The awareness of oral hygiene has not been investigated among dental students in Sudan. The present study demonstrated that the dental students in UST had a low awareness of oral hygiene and it also revealed that no significant differences between preclinical and clinical students’ mean HU-DBI scores, which does not coincide with other studies where the clinical level students were reported to have higher HU-DBI scores than those in preclinical levels 10-12.

The overall HU-DBI was 5 which is not consistent with the scores reported in other studies performed in various countries (Table 6) 13-16. This may be attributed to the weak exposure of students to preventive dentistry, and this is reinforced by the fact that the dental students who participated in the present study were taught preventive dentistry during year 4 according to the University’s curricula, and as such may have caused a poor impact on their attitude and behavior.

Table 6 HU-DBI^* scores of dental students in various countries

^* Hiroshima University-Dental Behavioral Inventory

There are statistically significant differences in HU-DBI scores among males and females. Female students had reported higher mean HU-DBI scores than males (5.25 vs 4.67). This could be attributed to females being more likely to have positive self-care attitudes for internal psychosocial reasons in order to improve their appearance and self-esteem. Also, they showed better habits than males in terms of tooth brushing frequency; 112 (70.4%) females mentioned that they brush their teeth more than once daily compared to 34 (53.1 %) males. They also seemed to floss more frequently than males (18.2% vs 12.5%). This finding is consistent with a recent study done in Israel 17, in which female dental students showed a significantly improved attitude than their male colleagues. However, in a previous survey among Japanese employees, no significant difference was shown in the HU-DBI scores between males and females 18.

Conclusions

This study reports on the attitudes toward dental hygiene of dental students in Sudan by using the HU-DBI questionnaire. The survey revealed that their awareness did not increase even in relation to higher education levels. Furthermore, there was a significant difference between the genders; females showed a higher awareness score than males.

This is the first report about the dental hygiene attitudes of dental students in Sudan and could be useful for improving education programs in the country.

Author contributions

All authors equally contributed the work.

Acknowledgments

Our sincere gratitude and appreciation go to staff and the dean of University of Sciences and Technology for their continuous help and support throughout stages of this study. We are also truly indebted and thankful to both Dr. Rania and Professor Waleed for their guidance and encouragement. Our thanks extended to Dr. Sally Abdelkarim for helping us in editing this work. Furthermore, we are obliged to all dental students at UST whom without their participation this study would not have materialized.

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