|Year : 2018 | Volume
| Issue : 1 | Page : 7-12
Dental attendance and teeth cleaning characteristics among medical and pharmacy students
Clement Chinedu Azodo1, Oseremen G Ogbebor2
1 Department of Periodontics, University of Benin, Benin City, Edo State, Nigeria
2 Department of Oral Diagnosis and Radiology, University of Benin, Benin City, Edo State, Nigeria
|Date of Web Publication||3-Jul-2018|
Dr. Clement Chinedu Azodo
Room 21, 2nd Floor, Department of Periodontics, Prof Ejide Dental Complex, University of Benin Teaching Hospital, P.M.B. 1111 Ugbowo, Benin City, Edo State
Source of Support: None, Conflict of Interest: None
Introduction: Oral hygiene and dental attendance are the major factors responsible for the actualization of a healthy mouth. The objective of this study was to assess dental attendance and teeth cleaning characteristics among medical and pharmacy students.
Materials and Methods: A stratified randomly selected medical and dental students of the University of Benin, Benin City, Nigeria were studied using a validated self-administered questionnaire.
Results: About three-quarters (74.9%) of the participants have never visited the dental clinic (77.9% of medical students vs. 71.9% of pharmacy students). Less than half (43.4%) indulge in twice-daily teeth cleaning frequency. Of which 42.5% were medical students and 44.2% were pharmacy students. The leading principal reason for teeth cleaning was to have fresh breath and 52.1% was reported in medical students and 50.4% in pharmacy students. Receipt of professional teeth cleaning instruction was reported by 9.8% of the participants (9.2% of medical students and 10.3% of pharmacy students). Medium texture toothbrush use was reported among 30.9% (29.2% medical students and 32.6% pharmacy students) of the participants. A total of 60% (62.9% of medical students and 57% of pharmacy students) clean teeth more than 4 min. Horizontal brushing technique was reported among 31.5% of the respondents (32.5% in medical students and 30.6% in pharmacy students). Toothbrush renewal frequency of 1–3 months was 47.7% (47.5% of medical students and 47.9% of pharmacy students). The use of dental floss was low (3.5%) among the participants with 2.9% and 4.1% were medical and pharmacy students, respectively.
Conclusion: Suboptimal dental attendance and teeth cleaning characteristics which were not significantly difference were found among the studied medical and pharmacy students.
Keywords: Dental attendance; medical students; pharmacy students; teeth cleaning
|How to cite this article:|
Azodo CC, Ogbebor OG. Dental attendance and teeth cleaning characteristics among medical and pharmacy students. Indian J Multidiscip Dent 2018;8:7-12
|How to cite this URL:|
Azodo CC, Ogbebor OG. Dental attendance and teeth cleaning characteristics among medical and pharmacy students. Indian J Multidiscip Dent [serial online] 2018 [cited 2019 Jan 22];8:7-12. Available from: http://www.ijmdent.com/text.asp?2018/8/1/7/235729
| Introduction|| |
Healthy mouth enables individuals to smell, taste, chew, swallow, look and feel good, smile, speak, and interact properly. Oral hygiene and dental attendance are the principal factors responsible for the actualization of healthy mouth. Oral hygiene is the act of keeping the mouth and teeth clean to make it esthetically pleasing and prevent diseases, most commonly, dental caries, gingivitis, periodontitis, and halitosis. Meticulous oral hygiene is key to prevent periodontal diseases and maintain good oral health because it helps to prevent plaque buildup, which is a primary etiological factor of periodontal diseases and poor oral health. Poor oral hygiene predisposes people to oral diseases which may cause tooth loss and consequently poor quality of life. However, dental attendance, oral rinsing, flossing, and brushing of the teeth are simple methods which are normally sufficient for achieving good oral health.
Self-performed oral hygiene practices include the use of toothbrush and toothpaste, chewing stick, dental floss, toothpick, interdental brush, unorthodox materials, and chemotherapeutic agents such as mouthwash. Teeth cleaning is the daily preventive care that helps to maintain good oral hygiene. It is conventionally a part of general body hygiene and cited a reason for performing such in children include concerns about personal hygiene, desire for good grooming, and good health. The motives of teeth cleaning usually by tooth brushing is categorized broadly into dental reasons and cosmetic or social reason. Ayo-Yusuf and Booyens  reported the motive for tooth brushing in South Africa to be dominantly for cosmetic reasons. Current oral hygiene measures, appropriately used and in conjunction with regular professional care, are capable of virtually preventing caries and periodontal disease and maintaining oral health.
The teeth surface cleaning is commonly done using toothbrush and toothpaste, but chewing stick use has persisted in different parts of the world for cultural and religious reasons. The interdental cleaning which is rarely done except in highly dental motivated is done using an interdental brush, dental floss, and toothpicks. Learning proper teeth cleaning is necessary due to its important in oral disease prevention and actualization of general health since oral health is a certified component of general health. Appropriate instruction of tooth brushing and monitoring progress of brushing skills are among the professional roles of dental health-care workers. This is against the backdrop that improper brushing can damage teeth and surrounding tissues by mechanical abrasion resulting in cervical notches, gingival ulceration, and recession.
Regular dental attendance helps to improve and maintain oral and general health. The preventive reason for dental attendance is for oral disease screening, and mouth care motivation and instruction. However, curative dental attendance takes precedence over preventive dental attendance in Nigeria due to the ingrained cultural belief that the healthy have no need for the doctor. Others include ignorance, low awareness, and negative attitude to oral health. There appear that there is a dearth of information on dental attendance and teeth cleaning characteristics among nondental students in comparison to dental students in the literature. The objective of this study is to assess dental attendance and teeth cleaning characteristics among medical and pharmacy students of the University of Benin, Benin City, Nigeria.
| Materials and Methods|| |
The protocol for this study was reviewed and approval granted by the Research and Ethics Committee of College of Medical Sciences, University of Benin, Benin City, Nigeria. Informed consent was obtained from the participants.
This was conducted as a cross-sectional among students of School of Medicine and Faculty of Pharmacy of the University of Benin, Benin City, Nigeria between February and April 2016. Benin City is the capital of Edo State which is located in the South-South geopolitical zone of Nigeria.
Students of the University of Benin studying medicine and pharmacy who consented to participate were included in the study while nonmedical and pharmacy students, and medical and pharmacy students who declined consent were excluded from the study.
Sampling/sample size calculation
The stratified sampling technique was employed to recruit a maximum of 40 students from 100 to 600 level translating to 480 participants(240 medical students and 240 pharmacy students) which exceeded the minimum sample size of 185 calculated using Cochran's formula for epidemiological studies.n = Z 2P (1 − P)/d 2 where n = sample size, z = z statistics for a level of confidence (set at 1.96 corresponding to 95% confidence level), P = prevalence = 14% (0.14) (11), q = 1 − P and d = degree of accuracy desired (error margin) =5% (0.05).
Data collection tool
The data collection tool was an anonymous self-administered questionnaire. The questionnaire elicited information on demographic characteristics, dental attendance, daily teeth cleaning frequency, principal reasons for teeth cleaning, receipt of professional teeth cleaning instructions, tooth brushing characteristics, additional teeth cleaning aids, and mouth rinsing frequency after eating Respondents received a full explanation on how to fill the questionnaire. The students were requested to fill the questionnaire without discussing with each other.
Data obtained were subjective to descriptive statistics in the form of frequency, percentages, and cross-tabulations using IBM SPSS version 20.0 (IBM Corp Armonk, NY, USA). Test for significance was done using either Chi-square or Fisher's statistics. Statistical significance was considered when the value of P < 0.05.
| Results|| |
A total of 540 questionnaires were distributed, but 482 were properly filled and returned giving an 89.3% retrieval rate. About three-quarters (74.9%) of the participants have never visited the dental clinic [medical students 77.9% vs. 71.9% of pharmacy students]. No statistically significant difference was recorded in the dental attendance among the studied medical and pharmacy students [Table 1]. Less than half (43.4%) indulge in twice-daily teeth cleaning frequency. Of which 42.5% were medical students and 44.2% of pharmacy students. The leading principal reason for teeth cleaning was to have fresh breath, and 52.1% was reported in medical students and 50.4% in pharmacy students. Receipt of professional teeth cleaning instruction was reported by 9.8% of the participants (9.2% of medical students and 10.3% of pharmacy students) [Table 2]. Medium texture toothbrush use was reported among 30.9% (29.2% medical students and 32.6% pharmacy students) of the participants. A total of 60% (62.9% medical students and 57% pharmacy students) of the participants reported cleaning their teeth for more than 4 minutes. Horizontal brushing technique was reported among 31.5% of the respondents (32.5% in medical students and 30.6% in pharmacy students). Toothbrush renewal frequency of 1–3 months was 47.7% (47.5% of medical students and 47.9% of pharmacy students) [Table 3]. Additional teeth cleaning aids are chewing stick which the use was 3.2% (3.8% of medical students, 4.1% of pharmacy students), dental floss was 2.8% (medical students 2.9%, pharmacy students 4.1%) while mouthwash was 3.2% (4.6% of medical students, 3.7% of pharmacy students) [Table 4].
|Table 2: Daily teeth cleaning frequency, principal reason for teeth cleaning and receipt of professionally teeth cleaning instructions among the respondents|
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|Table 4: Additional teeth cleaning aid and mouth rinsing frequency after eating among the respondents|
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| Discussion|| |
Nearly every person will be in need of dental treatment in his or her lifetime, whether purely for health or esthetic reasons. About three-quarters (74.9%) of the participants have never visited the dental clinic (medical students 77.9% vs. 71.9% of pharmacy students). This was comparable to the 73.6% reported by Olusile et al. among adult Nigerians and 71.6% reported by Bashiru and Anthony  among undergraduates of the University of Port Harcourt but lower than 61.9% reported by Azodo and Unamatokpa among medical house officers in Nigeria  and 92.2% reported by Bamise et al. among undergraduate students of Obafemi Awolowo University. This may be explained by the fact that living on low income or lower middle income is associated with less than less regular dental attendance among undergraduates.
Problem-oriented attendance accounted for about half of the dental attendance in this study reflecting the preference of curative to preventive dental attendance among Nigerians. High problem-oriented dental attendance has also been reported among physicians in Nigeria. The culturally ingrained belief that the healthy has no need for the doctor is explained this dental attendance pattern. The fact that large proportion of health-care workers (doctors, nurses, and medical students) do not consider routine dental attendance necessary may explain this overall low dental attendance. No statistical significant difference was recorded in the dental attendance among the studied undergraduate regarding age, gender, and course of study.
The primary goal of a preventive-oriented dental practice is to encourage patients to practice appropriate oral self-care behavior. Healthy habits and good oral hygiene, including twice-daily tooth brushing, has been cited as a critical factor in and good oral health maintenance and periodontal disease prevention. Twice-daily tooth brushing is an important factor because it plays a role in plaque reduction. It is easy, effective, and low-cost practices for removing the microbial dental plaque, which is an important factor in the development of caries and periodontal disease. Several countries Dental Associations recommend twice-daily tooth brushing with fluoride-containing toothpaste due to its effectiveness in plaque removal and control. In this study, <½ (43.4%) indulge in twice-daily (42.5% were medical students and 44.2% were pharmacy students) teeth cleaning frequency and 18.5% (17.9% in medical students 19% in pharmacy students) vertical brushing technique. The low receipt of professional teeth cleaning instruction was reported by 9.8% of the participants (9.2% of medical students and 10.3% of pharmacy students) may be the explanation.
The leading principal reason for teeth cleaning was to have fresh breath, and 52.1% was reported in medical students and 50.4% in pharmacy students. Similarly, social or cosmetic reason has been cited as the principal motive for tooth brushing in South Africa. The status of this students which reasonable ranks them high in the society and with jobs that have high interaction potential may have triggered them into a wish for fresh breath. Fresh breath is considered to be of importance in social interaction.
The medium strength toothbrush is considered adequate for thorough teeth cleaning with minimal adverse effects on the soft-tissues and hard-tissues of the mouth. A total of 30.9% (29.2% medical students and 32.6% of pharmacy students) of the participants use medium texture toothbrush which is lower than 52.5% reported by among undergraduates of University of Port Harcourt than 73.0% reported among undergraduates in the same university 4 years ago. The high consideration giving to the strength of toothbrush while purchasing in the previous study may be the explanation.
Horizontal scrubbing of teeth leads to abrasion and gingival recession. Yet about one-third (31.5%) of the respondents constituting 32.5% of medical students and 30.6% of pharmacy students use horizontal brushing technique. This may be linked to the fact that this is the tooth brushing advertised on the television and also because the majority had not been taught how to brush by professional. It is hereby recommended that dental professionals should help disseminate information on the most effective tooth brushing techniques with minimal adverse effects.
The duration of tooth brushing is considered as one of the critical factors that affect its efficacy in dental plaque removal. Too short a brushing time has been cited as the main cause of insufficient oral hygiene in the general population. In this study, a total of 60% (62.9% of medical and 57%) 57% of pharmacy students cleaning their teeth more than 4 min per episode which is reasonably adequate for topical fluoride exposure and thorough plague removal with implemented dexterity. When compared 58.5% of other undergraduates in the same university  reported brushing for 3 min on the average while 34.4% of the general population  in Nigeria brush fir more than 2 min reflecting better tooth brushing time among undergraduates in Nigeria.
Patients should, therefore, be encouraged to replace their toothbrush regularly before bristle wear becomes excessive because a worn toothbrush is less efficient with respect to plaque removal than a new brush. In this study, toothbrush renewal frequency of 1–3 months was 47.7% (47.5% of medical students and 47.9% of pharmacy students) which is lower than 65.5% reported among residents of Karachi  but higher than 28.8% reported by Bashiru and Anthony  among undergraduates.
The col of interdental gingiva is the first point of gingival inflammation because there is a limitation in cleaning the interdental surfaces of teeth using toothbrush and toothpaste., The prevention of the inflammation is done by the use of interdental cleaning aids as addition to tooth brushing. The interdental cleaning aids recommended varies with the type of embrasure. The use of dental floss was low (3.5%) among the participants with 2.9% and 4.1% being medical and pharmacy students, respectively. Other additional tooth cleaning aid includes chewing sticks and mouthwash. The use of chewing stick for teeth cleaning is more popular in rural and urban areas of Nigeria. The prevalence of chewing stick and mouthwash use in this study was far lower than the values (chewing stick – 16.8% and mouthwash – 20.5%) reported in a previous study among undergraduates in the same university. The training in medicine and pharmacy low tendencies may have geared the respondents into the lesser use of unorthodox materials and supplementary teeth cleaning agents.
| Conclusion|| |
Suboptimal dental attendance and teeth cleaning characteristics which were not significantly difference were found among the studied medical and pharmacy students.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Glick M, Williams DM, Kleinman DV, Vujicic M, Watt RG, Weyant RJ, et al.
A new definition for oral health developed by the FDI World Dental Federation opens the door to a universal definition of oral health. Br Dent J 2016;221:792-3.
Ayo-Yusuf OA, Booyens S. Principal motives for toothbrushing in a population of South African adolescents: Implications for oral health promotion. SADJ 2011;66:174-8.
Sofola OO. Implications of low oral health awareness in Nigeria. Niger Med J 2010;51:131-3. [Full text]
Cochran WG. Sampling Techniques. 3rd
ed. New York: John Wiley and Sons; 1977. p. 190-205.
Poplinger A. Adherence to oral hygiene and dental self-care. Refuat Hapeh Vehashinayim (1993) 2010;27:38-49, 62-3.
Olusile AO, Adeniyi AA, Orebanjo O. Self-rated oral health status, oral health service utilization, and oral hygiene practices among adult Nigerians. BMC Oral Health 2014;14:140.
Bashiru BO, Anthony IN. Oral self-care practices among university students in port Harcourt, rivers state. Niger Med J 2014;55:486-9.
] [Full text]
Azodo CC, Unamatokpa B. Gender difference in oral health perception and practices among medical house officers. Russ Open Med J 2012;1:208.
Bamise C, Bada T, Bamise F, Ogunbodede E. Dental care utilization and satisfaction of residential university students. Libyan J Med 2008;3:140-3.
Peltzer K, Pengpid S. Oral health behaviour and social and health factors in university students from 26 low, middle and high income countries. Int J Environ Res Public Health 2014;11:12247-60.
Iwuala SO, Umeizudike KA, Ozoh OB, Fasanmade OA. Oral self-care practices, dental attendance and self-perceived oral health status among internal medicine residents in Nigeria. Eur J Gen Dent 2015;4:79-86. [Full text]
Oyetola EO, Oyewole T, Adedigba M, Aregbesola ST, Umezudike K, Adewale A, et al.
Knowledge and awareness of medical doctors, medical students and nurses about dentistry in Nigeria. Pan Afr Med J 2016;23:172.
Azodo CC, Ojehanon PI. Cigarette smoking, Tooth brushing characteristics and perceived efficacy in gingivodental health among undergraduates in a Nigerian university. Ann Biomed Sci 2012;11:20-9.
Van der Weijden FA, Timmerman MF, Snoek IM, Reijerse E, Van der Velden U. Toothbrushing duration and plaque removing efficacy of electric toothbrushes. Am J Dent 1996;9:S31-6.
Saxer UP, Barbakow J, Yankell SL. New studies on estimated and actual toothbrushing times and dentifrice use. J Clin Dent 1998;9:49-51.
Conforti NJ, Cordero RE, Liebman J, Bowman JP, Putt MS, Kuebler DS, et al.
An investigation into the effect of three months' clinical wear on toothbrush efficacy: Results from two independent studies. J Clin Dent 2003;14:29-33.
Younus A, Qureshi A. Tooth brush changing frequency and associated sociodemographic and oral hygiene factors among residents of Karachi. J Dent Oral Hyg 2016;8:4-11.
Berchier CE, Slot DE, Haps S, Van der Weijden GA. The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: A systematic review. Int J Dent Hyg 2008;6:265-79.
Slot DE, Dörfer CE, Van der Weijden GA. The efficacy of interdental brushes on plaque and parameters of periodontal inflammation: A systematic review. Int J Dent Hyg 2008;6:253-64.
[Table 1], [Table 2], [Table 3], [Table 4]