Year : 2010 | Volume
: 21 | Issue : 1 | Page : 84--88
Oral health behavior and its determinants in a group of Iranian students
Hossain Neamatollahi, Masoumeh Ebrahimi
Department of Pediatric Dentistry, Dental School of Mashhad, University of Medical Sciences, Iran
Department of Pediatric Dentistry, Dental School of Mashhad, University of Medical Sciences
Background: Daily toothbrushing and flossing are 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.
Aim: The objective of this study is evaluation of oral health behaviors in a group of students from an Iranian university .
Materials and Methods: This descriptive analytical cross-sectional study was carried out on 1736 Iranian students (1230 non-medical sciences students and 506 medical sciences students). Subjects were randomly selected. The students were asked to fill out a self-completion questionnaire about daily oral health behavior.
Statistical Analysis Used: The chi-square test was used for evaluation of oral health behaviors and relationship between students«SQ» oral hygiene behavior and educational levels.
Results : There was no difference between the frequencies of tooth brushing in the students of two universities. Medical sciences students used dental floss more than non-medical sciences students, which was a significant difference ( P = 0.000). There was no significant difference in toothbrushing frequency among the students with different levels of education. But the students of doctorate and masters degrees used dental floss significantly more than those of bachelor or associate degrees ( P = 0.000).
Conclusions: This study showed that the level of self oral care among Iranian students is at a lower level than in industrialized countries.
|How to cite this article:|
Neamatollahi H, Ebrahimi M. Oral health behavior and its determinants in a group of Iranian students.Indian J Dent Res 2010;21:84-88
|How to cite this URL:|
Neamatollahi H, Ebrahimi M. Oral health behavior and its determinants in a group of Iranian students. Indian J Dent Res [serial online] 2010 [cited 2021 Mar 1 ];21:84-88
Available from: https://www.ijdr.in/text.asp?2010/21/1/84/62820
Plaque has been considered as an important factor in the development of dental caries and periodontal diseases and the reduction in its accumulation promotes oral health status. Tooth brushing and flossing are suggested to be a requisite for reducing the amount of bacterial plaque.  Oral health is an essential component of health throughout life. Poor oral health can have a significant effect on quality of life.  As twice daily brushing with fluoride toothpaste plays an essential role in the prevention and control of dental caries and periodontal diseases, profession suggested it for many years. Such behavior appears to be an essential part of many people's daily hygiene routine.  According to a study by Khami 57% of Iranian dental students brush at least twice a day and 52% used dental floss at least once a day. With Regard to attitude and knowledge, 58% of the students were in the group with high knowledge of preventive dentistry and 59% of them had more positive attitudes towards preventive care than others. It was concluded that the oral health behaviors of Iranian dental students is improved in recent years.  According to a study by Yazdani, oral cleanliness and toothbrushing among 15-year-old young adults in Iran were at poor levels. Intensive attempts need to enhance rates of twice-daily tooth brushing and to improve its quality.  There is an increased risk for imperfective dental health among subjects with unstable self- esteem symptoms or symptoms of anger.  Also emotional intelligence might be a psychosocial risk marker that influences oral health status.  Dumitrescu suggested that self-consciousness might be a psychosocial risk marker that influences self-reported oral health status.  There was no worldwide accepted relation of oral disorders with socioeconomic status. As socioeconomic status is a extensive categorization, it has various components that might be differ in different geographic areas. Some factors such as behavior and habits affect the prevalence of dental diseases. A higher prevalence of oral disorders was considered in lower socioeconomic groups. That may be due to lower educational level, initial idea about oral health and significance of oral disorders, inaccessibility of preventive and curative facility.  Doifode reported higher prevalence of dental caries in upper socioeconomic families, which may partly be attributed to higher prevalence of candy consumption in this group.  Freddo showed that lower socioeconomic status was associated with a lower frequency of daily flossing, fewer annual dental visits and a greater prevalence of dental treatment visits. A healthy lifestyle was associated with better oral hygiene habits and more frequent dental visits.  It is demonstrated that oral and general health behavior should be considered jointly in health promotion lifestyle programs and firstly, the lower socioeconomic level groups should be considered.  Kawamura showed that reported oral health behaviors seemed to be very different between Japanese and Finnish dental students, which reflected different culture and oral health education systems of the students.  The objective of this study was evaluation of oral health behaviors and relationship between students' oral hygiene behavior and educational levels in a group of Iranian university students.
Materials and Methods
This descriptive analytical cross-sectional study was carried out on 1736 university students (1230 non-medical sciences students and 506 medical sciences students) during 2006- 2007 academic year in Mashhad Medical Sciences University and Mashhad Ferdowsi (non-medical sciences) University in Iran. The Ethics Committee of the University of Mashhad Medical Sciences has approved this study. The students selected by random number method were approached in classrooms by a dentist. Students were asked to remain after class if they were willing to complete a questionnaire about their daily frequency of toothbrushing, frequency of dental flossing, type of toothbrush, frequency of toothbrush replacement, opinion about efficacy of toothbrushing, use of antibacterial rinse and any other oral hygiene aid and factors for visiting dentist and frequency of oral check up. The response rate was 100%.
The data were analyzed using the SPSS. The chi-square test was used for evaluation of oral hygiene behavior of students and relationship between students educational levels and their oral hygiene behavior. Statistical significance was based on probability values of less than 0.05.
Among 1736 studying samples-506 from medical sciences university and 1230 from non-medical sciences university (Ferdowsi University) in Mashhad-31.6% were male and 68.4% were female. Of these, 51.6% of university students were 18-21-years old, 44.4% were 22-25-years old and 3.7% were 26 years old and older.
About 69.9% of students (70.1% of non-medical sciences students and 69.3% of medical sciences university students) brushed their teeth once or twice per day [Table 1]. There was no significant difference between the frequencies of toothbrushing in the students of the two universities. There was no statistical difference between females and males (98.9% vs. 97.8%) with respect to toothbrushing. About 63.3% of students did not use dental floss, while 36.7% used it; therefore, a significant difference was noted in the use of dental floss among the students (P = 0.000) [Table 2]. There was no significant relationship about dental flossing and sex (33.7% vs. 38.2%). Also medical sciences students used dental floss more than non-medical sciences students, which was a significant difference (P = 0.000). About 33.9% of students replaced their toothbrush every 3 months, 43.8% replaced their toothbrush every 3-6 months, 19.5% replaced at 7-12 months and 2.8% replaced at more than 12 months. A total of 48.1% students used brush with medium hardness, 17.9% used brush with soft bristles and 8.7% used hard brush (25.3% had not reported type of toothbrush). Results showed that 55% of students never used wood stick, 30% occasionally used it, nearly 10% used it after meal and 2.7% used it before sleep. About 21.4% of students used mouthwash and they used Iranian mouth wash more than non-Iranian mouthwash.
[Table 3] shows students' attitude on toothbrush efficiency about oral health. In relation to important factors about visiting a dentist, 32.7% were for dental caries, 30% for dental pain, 20.2% for check up and 5.2% for gingival disease.
About intervals of check up, 14% of students visited a dentist every 6 months, 37.8% visited more than 6 months and 48.2% had never visited a dentist for check up.
There was no significant difference in toothbrushing frequency among students with different levels of education (doctorate, masters, bachelors, associate) [Table 4]. But the students of doctorate and masters degrees used dental floss significantly more than those of bachelor or associate degrees (P = 0.000) [Table 5].
Reduction in 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. , 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. ,,,, Investigations showed that there were significant differences between industrialized countries and developing countries with respect to oral health behavior. In Italy, 92% of university students brushed their teeth at least twice a day,  About 85% of 20-25-year-old Swedes brushed their teeth once or twice a day,  34% of health sciences college students brushed their teeth twice or more a day in Kuwait,  and in Turkey  67.6% of students brushed their teeth twice or more a day. Chindia showed that 96% of Kenyan students brushed their teeth once a day in 1992.  According to a study by Khami, frequency of brushing in Iranian dental students was 93% at least once a day and 57% at least twice a day.  In this study, 69.9% of students brushed their teeth once or twice per day, 28.6% brushed their teeth three or more times per day and 1.5% of them never brushed. It seems that a discrepancy exists between internationally accepted recommendations and reports regarding brushing frequency in Iranian students. 
Regular dental flossing rate was 14.9% in Italy,  7% in Sweden,  28% in United Kingdom  and 3% in Turkey.  Kawamura showed that using dental floss is not common in Japanese students.  According to a study by Khami, 52% of Iranian dental students used dental floss at least once a day.  Just 36.7% of students in the present study used dental floss; however, in a study by Khami  only dental students were evaluated. It is established that toothbrush is not enough for removal of dental plaque and it is emphasized using dental floss daily.  Also Medical Sciences University students used dental floss more than did Ferdowsi University students; it could be more their health information and knowledge because of their majority.
Toothbrushes do not need to be replaced every 3 months. , However, in the study by Kirtiloglu  49% of subjects and in that by Rimondini  81.6% of subjects replaced their toothbrushes every 3 months. About 33.9% of students in this study replaced their toothbrush every 3 months. This behavior could be the result of the recommendations of dentists and toothbrush manufacturers.
This study showed that 48.1% of students brushed with medium hard toothbrush, 17.9% with soft brush and 8.7% with hard stiffness brush (25.3% had not reported type of their toothbrush). Rimondini found that 33.2% of Italian students used hard toothbrush and 58.4% used medium hard toothbrush, which is more than our results. 
Dental behavior is mostly determined by gender. Females exhibited significantly higher rates of good oral health behavior.  Astrom  and Khami  reported that the rates of flossing and tooth brushing were significantly higher in females. Kirtiloglu showed that females brushed their teeth twice or more per day, that was more common than males (83.2% vs. 49.3%), but there was no statistical difference with respect to using dental floss.  There was no statistical difference about toothbrushing frequency and dental flossing between males and females in this study.
The present study showed that 26.5% of students believed that tooth brushing alone was not sufficient and used dental floss, 33.6% of Italian students had this characteristics,  that showed better behavior and attitude comparison to the present study. Also 40.6% of students believed that tooth brush is not enough for oral and dental health but hardly used dental floss that there is controversy between their knowledge and behavior.
In the present study, 21.4% of students used mouthwash and they used Iranian mouth wash more than non-Iranian mouthwash (because of its price); however, just 12.8% of Italian students used mouthwash  that it is less than our results. In a study by Kirtiloglu,  52% of the students used the toothpick daily and 40% of the students used only the toothpick as an interdentally cleaning device because of its easy use and low cost. Few subjects used the toothpick daily in other studies. , Also in this study, 45% of students used wood sticks, which is more than Italian and American students (1%). 
The current study showed that the most important factors about visiting the dentist was dental caries (32.7%) and dental pain (30.8%). Kawamura  and Kim  showed that 60% of Japanese students and more than half of Korean students visited dentist because of dental pain,  which is more than what was observed this study. Also Kawamura showed that 60% of Korean students and just 1% of American students visited dentist because of dental pain. It shows that American students visit the dentists because of dental pain less than other countries. Also Kawamura showed that just 2% of Finnish students and 56% of Japanese students visited dentist because of dental pain. 
Results of the present study indicated that attendance of students at a dental clinic for 6-month check up was lower (14%) than that of an Italian university  (59.9%) and a Turkish university  (30.3%). Astron found that 48% of urban students and 24% of rural students in Tanzania had check up in 1999 that increased (56% and 44%, respectively) in 2001:  t0 he rate of dental check up in these students is higher than that in our students.
Education, socioeconomic conditions, acculturation, psychological stress and cultural and religious belief can affect the oral health behavior and status. , 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 use of a cheaper device. 
This study showed that self-preventive oral behavior in Iranian students is therefore at a lower level than in industrialized countries. Preventive practice among Iranian students could be improved. Knowledge of self-preventive oral behavior should be increased by emphasizing the caries preventive procedures.
This study was supported by a grant from Mashhad University of Medical Sciences Research Council. Their financial aid is acknowledged.
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