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An assessment of oral self-care in the student population of a Turkish university

An assessment of oral self-care in the student population of a Turkish university

ARTICLE IN PRESS Public Health (2006) 120, 953–957 www.elsevierhealth.com/journals/pubh An assessment of oral self-care in the student population of...

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ARTICLE IN PRESS Public Health (2006) 120, 953–957

www.elsevierhealth.com/journals/pubh

An assessment of oral self-care in the student population of a Turkish university ¨ mit Sait Yavuz ˘rul Kırtılog ˘lu, U Tug Department of Periodontology, Faculty of Dentistry, University of Ondokuz Mayis, 55139 Kurupelit-Samsun, Turkey Received 22 March 2005; received in revised form 16 March 2006; accepted 12 May 2006 Available online 7 July 2006

KEYWORDS Oral hygiene; Oral health; Tooth brushing; Flossing; Self-care

Summary Objectives: The aim of this study was to determine the oral health behavior of Turkish non-dental university students. Study design and methods: A sample of 610 non-dental university students attending the University of Ondokuz Mayis in Samsun were randomly selected from the whole student population (n ¼ 12 604) via the random number method. The students were asked to fill out a standardized self-completion questionnaire about daily frequency of toothbrushing, kind of toothbrush, frequency of toothbrush replacement, frequency of dental flossing, use of antibacterial rinse, or any other oral hygiene aid, receiving of oral hygiene instruction and frequency of oral checkup. The data were analysed using the SPSS version 12.0.1 statistical software package. Results: Sixty-eight per cent of the students brushed their teeth two or more times per day. Two or more times a day toothbrushing was more common among females than males (Po0.001). Few subjects (3%) used dental floss daily. Forty per cent of students used only the toothpick as an interdental oral hygiene device. Thirty per cent of the students visited a dentist for preventive treatment at least once a year. There was no significant difference in regularity of visits to the dentist between females and males (P40.05). Conclusion: This study indicated that self-preventive oral behaviour of the Turkish university student is at a lower level than in industrialized countries. & 2006 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved.

Introduction Corresponding author. Tel.: +903 624576000-3001;

fax: +903 624576032. ˘lu). E-mail address: [email protected] (T. Kırtılog

People brush their teeth for a number of reasons: to feel fresh and confident; to have a nice smile; and to avoid bad breath and avoid disease.1 Studies which have investigated the relationship between

0033-3506/$ - see front matter & 2006 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2006.05.006

ARTICLE IN PRESS ˘lu, U.S. Yavuz T. Kırtılog

954 oral health behaviour and psychological factors have shown that adolescents with higher selfesteem were more likely to brush their teeth regularly, and to make more frequent dental visits than those with lower self-esteem.2,3 Preventive behaviour is significantly associated with oral health.4 An individual’s dental health status is a result of life-long oral self-care behaviour and attitudes.5 The maintenance and improvement in health status are dependent on good health behaviour,6 but toothbrushing among adolescents does not seem to be a strongly health-oriented behaviour.7 Education, socio-economic conditions, acculturation, psychological stress and cultural and religious belief can affect the oral health behaviour and status.8–13 For example, use of miswak as an oral hygiene device is common among the Saudi population (39.9%). This habit can be related to cultural and religious belief or to the use of a cheaper device.13 Most studies about oral hygiene habits have been conducted among children, adolescents, adult and university students. However, few studies have been conducted on non-dental university students.4,14–19 Although some studies have been done on oral health behaviour and status of Turkish children and young adults,20,21 no data were available about oral health behaviour of Turkish university students. The aim of this study was to determine the oral health behaviour of Turkish university students, excluding dental students.

cement, frequency of dental flossing, use of antibacterial rinse, and any other oral hygiene aid, receiving of oral hygiene instruction and frequency of oral check-up was anonymously filled out. The response rate was 100%. The data were analysed using the SPSS version 12.0.1 statistical software package. The categorical data were analysed by using w2 table analyses.

Results Sixty-eight per cent of the students brushed their teeth two or more times per day (Table 1). The use of an artificial bristle toothbrush of medium stiffness was 73.8%. As for electrical tooth brushes, 2.3% of students used them. Toothbrush replacement every 3–6 months was 60.2%. Very few of the students (3%) used dental floss daily and the great majority of students (91.1%) had never or sometimes used dental floss (Table 2). Other regular application of oral hygiene aids included toothpick (52.4%), antibacterial rinse (18.8%), chewing-gum (52.9%) and interdental brush (1.6%). The proportion of the use of only toothpick as an interdental oral hygiene device was 40%. Of all the students in the study, 30.3% of the students reported a dental visit for preventive treatment at least once a year. However, 55.1% of students visited a dentist only when they had toothache. More than half of the Table 1

Materials and methods This study, performed in accordance with the Declaration of Helsinki, was conducted at the University of Ondokuz Mayis during the 2003–2004 academic year. Subjects, except for dental students, were randomly selected from the entire student population (n ¼ 12 604) via the random number method from the student lists obtained from the university student affairs. The sample consisted of 610 university students (282 males and 328 females) aged 17–27 years. Sample size was calculated in order to have an estimated error of frequencies less than 5% with a 95% probability. The students, selected by random number method, were approached in classrooms by two dentists, and were asked to remain after lesson if they were willing to complete a survey about their oral health behaviour. The standardized self-completion questionnaire about daily frequency of toothbrushing, kind of toothbrush, frequency of toothbrush repla-

Brushing frequency

More than 2  a day 2  a day 1  a day More than 2  a week 1  or 2  a week 1  or 2  a month Never Total

Table 2

n

%

84 328 158 11 24 5 0 610

13.8 53.7 25.9 1.8 4 0.8 0 100

Flossing frequency

1  a day 1  every 2 days 1  a week Sometimes Never Total

n

%

18 12 24 165 391 610

3 2 3.9 27 64.1 100

ARTICLE IN PRESS Assessment of oral self-care students (57%) made their last visit for preventive or treatment needs in the previous year. Toothbrushing two or more times a day was more common among females than males (83.2% vs. 49.3%, Po0.001). There was no statistical difference between females and males (3% vs. 2.8%) with respect to the use of dental floss (P40.05). There was no significant difference in regular visits to the dentist between female and male (P40.05). Sixty-one per cent of students had received oral hygiene instructions from a dentist. Seventy-one per cent of the students who had previously received oral hygiene instructions and motivation brushed their teeth two or more times per day. Thirty-four per cent of the students who did not use interdental cleaning devices daily and 24.9% of the students who did not brush their teeth daily reported that they did not have enough time.

Discussion Reduction of plaque accumulation is an important factor for prevention of periodontal disease and dental caries. Therefore, twice a day toothbrushing is recommended as a good dental self-care procedure.22,23 Frequency of toothbrushing and the use of dental floss were investigated in various studies. In most of those studies authors reported that although frequency of toothbrushing was at a high rate of twice a day or more, the use of dental floss was at a low rate.10,17–19,24,25 Investigations showed that there were significant differences between industrialized countries and developing countries with respect to oral health behaviour. Ninety-two percent of university students in Italy brushed their teeth at least twice a day,19 85% of 20–25-year-old Swedes brushed their teeth once or twice a day,17 34% of health sciences college students brushed their teeth twice or more a day in Kuwait26 and in this study 67.6% of students brushed their teeth twice or more a day. Regular dental flossing rate was 14.9% in Italy,19 7% in Sweden,17 28% in the UK27 and 3% in our study. Toothbrushes do not need to be replaced every 3 months.28,29 However, in our study 49% of subjects and in the study by Rimondini et al.19 81.6% of subjects replaced their toothbrushes every 3 months. This behaviour could be the result of the recommendations of dental professionals and toothbrush manufacturers. Cross-cultural studies conducted among the dental students showed that oral health behaviour was very different among countries, which reflected the different culture and/or health education systems of the students.30–33 Cultural belief

955 and economical factors affect oral hygiene behaviour. For example, use of miswak rate was high among young Saudi school students (39.9%), especially among governmental school students.13 In our study, 52% of the students used the toothpick daily and 40% of the students used only the toothpick as an interdental cleaning device because of its easy use and low cost. Few subjects used the toothpick daily in other studies.17,24 Studies showed that most of the children (81%) did not have a regular brushing habit and 72% of high school students needed oral hygiene education in Turkey.20,21 In the present study, 61% of students had received oral hygiene instructions. However, 5.2% of those students did not want to practice them regularly. This behaviour is an important problem to solve. Those students may not have been informed sufficiently about the relationship between poor oral health and gingivitis, periodontitis and caries. Dental hygienists specialize in the area of preventive information33 and play a key role in oral health.34 The presence of a dental hygienist in health centres would improve the dental health of the population,35 but there are no dental hygiene schools in Turkey. In Japan, the dental hygienist to dental practitioner ratio was 1:1.3 in 2000.36 The lack of dental hygienists could be one of the reasons for the differences in oral health behaviour between Turkey and countries demonstrating better oral health behaviour. Systematic oral health education programs should be implemented in respect to all educational levels and ages to support the improvement of regular oral self-care practices. Dental behaviour is mostly determined by gender.37 Females exhibited significantly higher rates of good oral health behaviour.11,18 Astrom reported that the rates of flossing and toothbrushing were significantly higher in females.38 The results of the present study showed that females brushing their teeth twice or more per day was significantly greater than males (Po0.001), but there was no statistical differences with respect to using dental floss (P40.05). Results of the present study indicated that attendance of students at a dental clinic for preventive check-up was lower (30.3%) than in an Italian university (59.9%).19 There was no significant difference in the regularity of visits to the dentist between females and males (P40.05). Moreover, a study conducted in Turkey reported that most of the patients visiting the outpatient clinic were highly educated and middle-aged people, but no gender differences were observed.39 Daily tooth brushing and flossing are easy, effective and low cost practices for removing the

ARTICLE IN PRESS 956 microbial dental plaque which is an important factor in the development of caries and periodontal disease. This study revealed that these practices were neglected by a substantial number of respondents. Their self-preventive oral behaviour is therefore at a lower level than in industrialized countries.

Acknowledgements The authors thank Prof. Dr. Yu ¨ksel Bek of Ondokuz Mayis University in Samsun for his help with the statistical analyses and Gregory T. Sullivan for his assistance in completing this translation.

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