Assessment of knowledge, attitude, and

practices of oral hygiene among undergraduate

dental students at University of Sharjah

Student Names:
Ala Zaouali U16104338
Ala’ R. Yacoub U16104748
Omar Al Shazli U16103019
Zeina Elayan U16104280

Supervised By: Dr. Abier Abdul Sattar Mohammed

1
 Abstract
Background: Maintaining oral health helps in the early detection of serious systemic
diseases and improves the quality of life. As dental students are trained to promote and
encourage oral health habits, this promotion is not only dependent on their acquired
knowledge but is also mirrored by their attitudes and conduct towards their own oral hygiene.
Objective: This study has been conducted with the aim to investigate the levels of
knowledge, understanding, and attitude toward oral hygiene among preclinical and clinical
undergraduate dental students at the University of Sharjah (UOS), amidst the COVID-19
pandemic.

Methods: A cross-sectional study was conducted on 549 undergraduate dental students from
1st to 5th year at the University of Sharjah. A self-administered questionnaire was used for
data collection. Statistical analysis was performed using Exploratory Factor Analysis, using
SPSS version 24.

Results: 283 out of 549 undergraduate dental students participated in this study, yielding a
response rate of (51.54%). The present study showed significant differences between
different academic years and between genders, in oral health knowledge, attitude, and the
level of agreement on the effect of the curriculum on these aspects. The significant
difference in scores for knowledge and curriculum effect between the educational levels was
greater than those related to oral hygiene practices, illustrating the improvement in
knowledge as students advance in academic years.

Conclusion: Participants agreed that the dental undergraduate curriculum of the University
of Sharjah did influence their knowledge and oral health self-care practices, which were
found to be fairly good.

Introduction: expected outcomes are not met. Regarded by

many as the future role models for quality oral
In modern times, oral health is recognized as health habits, dental students are trained to
equal to general health as a means of improving promote and encourage these practices.
quality of life. There is more to oral health than Comprehension of the importance of this
healthy teeth, and one cannot be healthy without promotion is not only dependent on their acquired
it. Not only does maintaining it help control local knowledge but is also mirrored by their attitudes
conditions, but also being the window of the body, and conduct towards their own oral hygiene. If
it plays an integral role in the early detection of they are driven themselves, they are more likely to
serious systemic diseases. To preserve pristine be able to motivate others.
oral health, the best way is to prevent oral diseases
by practicing proper oral hygiene (OH). Controversies on this topic are present, given the
variable results reported by different studies. On
Despite the general public’s awareness of the one end, Daya et. al (2017) revealed low
typical oral hygiene practices, it seems that there’s awareness among students at the start of their
an alarming lack of knowledge regarding the education, which has improved along with their
rationale behind them. In turn, this shortfall attitude and behavior as they progressed in their
contributes to nonadherence, especially when the

2
schooling [1]. Similar results were presented by An online self-administered questionnaire in
Hasan et. al. [2]. Opposingly, Baseer et. al. found English has been sent to a sample (N=548) which
that better self-reported attitudes unexpectedly had was chosen using simple convenient random
moderate plaque and gingival bleeding scores [3]. sampling method. The chosen sample consists of
dental students from all the academic levels, that
This study has been conducted with the aim to is year 1 to 5. The study focused on these students
investigate the levels of knowledge, because of their exposure to the theoretical
understanding, and attitude toward oral hygiene education, preclinical laboratory-based training,
among preclinical and clinical undergraduate and clinical training.
dental students at UOS, amidst the COVID-19
pandemic. Participants would complete a self- Data collection
administered questionnaire designed by the The developed online form of the questionnaire,
research team, which would measure three which is written in English and reviewed by the
aspects: knowledge, oral hygiene practices, and research conducting members, is based on a
the influence of the educational curriculum. This previously developed questionnaire, with new
may provide for a better understanding of the questions regarding the impact of COVID-19 on
impact of the UOS dental college's curriculum on dental visits added. It involved an explanatory
these practices, as well as the implementation of description of the purpose of the research, the
required changes to improve any deficiencies participants’ role and their freedom to participate
discovered. in this project, the way that the results will be
handled, and the contact details of the research
conductors, as well as the head of the ethical
Method: committee at UOS.
In this project, which was approved by the
The participants who consented to be a part of this
research ethics committee of UOS, a cross- research responded to 23 questions designed to
sectional design was used with analyses based on assess students’ oral health knowledge, self-care
self-reported data collection from undergraduate practices, and the curriculum impact. The first part
dental students at the University of Sharjah. of the online questionnaire covered the socio-
demographic characteristics of the participants
Authors obtained the ethical approval from the such as gender and educational level. The second
Research Ethical Committee in the University of and third parts of the questionnaire included
Sharjah, Reference number: REC-21-10-14-S. questions on knowledge and oral hygiene
The questionnaire was conducted between practices, respectively. Then, they continue to
November 2021 -February 2022. answer the last part of the questionnaire, which
was a Likert scale format: 1(agree), 2(disagree),
and 3(not sure), eliciting the respondents’
perceptions on whether the theoretical education,
Sample selection practical sessions in the skills laboratory, or
exposure in the clinical environment were
The questionnaire was sent as a google form contributing factors to self-oral hygiene attitude.
through the WhatsApp numbers and emails of
undergraduate dental students. Statistical Methodology:

All participants who took part in the questionnaire Statistical analysis was performed using
were undergraduate dental students from the Exploratory Factor Analysis with SPSS version
University of Sharjah, College of Dental Medicine 24. Univariate descriptive statistics, such as
from all five academic levels, BDS1, BDS2, frequency and mean distribution, were conducted
BDS3, BDS4, and BDS5. Foundation year for all variables. Pearson correlation analysis was
students, interns, and postgraduate students were done to assess the possible correlation between the
excluded. independent variables (sex and year of study) and
the dependent variables (toothbrushing frequency,

3
use of dental floss, and mouth rinses). Significant Where the eldest batch is the only one that had a
difference was considered at P<0.05. higher response rate (50.6%) of correct answers
compared to the younger batches who
Results: predominantly answered wrongly. Similarly, in
Totally, 283 out of 549 undergraduate dental question number 6 “Gingivitis eventually leads to
students participated in this study, yielding a periodontitis”, (35.0%) answered “no” which is
response rate of (51.54%). 73.5% of the the correct answer, as only fifth year students
participants were females, and 26.5% were males. mostly answered correctly (51.9%), with P=0.000.
The majority of the respondents were from the 5th Even though the younger batches showed higher
year with female predominance, with response rates of incorrect answers, as we go from the
rate of (78.5%.). Additionally, 1st-year students younger batch to the older ones, the number of
participated the least, with response rate (13.8) %. students who answered correctly is increasing.
Table 1. Starting from BDS1, BDS2, BDS3, and BDS4,
Table1: Distribution of dental students according
(2,9,21, and 26) students respectively answered
to academic years and gender correctly. Furthermore, questions number 5,7,9,
Year of Male Female Total and 10 showed a P-value of less than 0.05, with
study most of the students picking the correct answer.
1st year 5 34 39
nd The small P value could be interpreted by the
2 year 14 26 40
3rd year 12 42 54 number of correct answers that is not only seen
4th year 27 44 71 majorly in older batches, but also are increasing as
5th year 17 62 79 they go up from the youngest batch to the next
Total 75 (26.5%) 208 (73.5%) 283 one.

Knowledge: Oral hygiene practices and attitudes:

Participants provided answers to their The participants provided the answers to the
understanding of basic oral health-related questions based on their oral hygiene practices
knowledge. and attitudes.
Six out of ten questions were answered correctly
Four out of the 8 questions showed that there is no
by the majority of students from all five batches,
association between the educational level and how
giving a percentage of 64.3% of accurately many times the participant brushes his/her teeth
answered questions. (P=0.121), tongue cleaning (P=0.59), when the
The remaining four questions that were answered participant changes his/her toothbrush (P=0.291),
incorrectly showed different degrees of and whether they choose the toothpaste according
associations between the year of studying and the to the active ingredient (P=0.37)).
number of students that picked the right answer.
For the other four questions, most of the
As shown in Table 2, the second question “dental
participants from BDS2 to BDS5 showed that they
biofilm can accumulate within”, (50.6%) picked
know the technique for toothbrushing that they
the wrong answer with a P-value of 0.000. use as all of them chose (Modified Bass), while
(71.8%) and (62.5%) of 1st and 2nd year, most of the participants from BDS1 didn’t know
respectively, picked the wrong answer. Whereas the name of the brushing technique (P=0.000).
the majority of the older three batches picked the Moreover, we asked the participants about their
correct answer with percentages of (51.9%) for the OH practices other than toothbrushing (dental
3rd year, (57.7%) for the 4th year, and (65.8%) for floss, mouthwash, and toothpick), Most of the
the 5th year. Moving on to the fourth question participants answered that they use either floss or
“Does patient’s age influence the amount and /or mouthwash and that they don’t use the toothpick.
composition of the dental biofilm?”, (62.9%) COVID-19 affected a lot of aspects of our lives,
picked the wrong answer with a P-value of 0.006. so we asked the participants if the pandemic

4
affected their oral hygiene practices as well as when we asked them how many times they brush
their dental clinic visits. Most of the participants their teeth (P=0.000), what other method they use
from BDS1-BDS5 answered that it didn’t affect other than toothbrushing, and whether the
their oral hygiene practices and they went pandemic affected their visits to the dental office
normally to the dental clinic for their check-ups (P=0.031) [Table 4].
with P=0.011 and P=0.031, respectively [Table
3].
After comparing the gender and the oral hygiene
practices and attitudes, most of the respondents
were female with a percentage (73.5%), while the
male participants were (26.5%). 5 out of the 8
questions about oral hygiene practices and
attitudes showed that there is no association
between gender and oral hygiene practices and
attitudes. It only showed that there is a difference

5
6
7
8
The effect of curriculum: step in forming a favorable oral-health habit is to
supply patients with relevant information and
The participants were further asked to assess their
enhance their awareness of strategies to prevent
level of agreement with the influence of different oral disorders. Dental students with a high level of
curriculum components on their knowledge and oral self-care awareness are better equipped to
attitude toward oral hygiene practices (Table 4 assess their patients' oral health and motivate them
and Table 4.1). Starting with the first assessed and transmit oral awareness to the broader public
component, “the theory taught in the classroom”, [1]
.
the majority (90.8%) of the students in all the
To evaluate the level of oral self-care awareness
batches agreed that it has an influence, with P=
among undergraduate dental students at UOS, a
0.300. Fourth-year students showed the highest
self-reported questionnaire assessing the
agreement rate (94.4%), whereas third-year
knowledge and oral hygiene habits was to be filled
students showed the lowest agreement rate out. Answers for the knowledge section were
(85.2%). Additionally, none of the second-year deemed accurate if they were in accordance with
students disagreed, and around 1 to 3 students the following: biofilm is an accumulation of
from the remaining batches did. bacteria and can collect within 2-3 hours, the
Furthermore, when comparing the preclinical and accumulation is affected by neither age nor eating
clinical students, (78.1%) of all dental students fibrous foods, and brushing and interdental
agreed that “Preclinical lessons in the laboratory” cleaning are the best methods to remove the
affected their knowledge and attitude, biofilm. Furthermore, bleeding on probing (BOP)
P = 0.072. Third-year students showed the highest is the first clinical sign of gingivitis. External
agreement rate (90.7%), whereas fifth-year stains do not lead to gingivitis, and periodontitis
students showed the lowest agreement rate does not necessarily occur, despite the presence of
(67.1%), and the highest rates of disagreement gingivitis. Also, halitosis is usually the result of
intraoral pathologies. According to the present
(26.6%) and unsureness (6.3%) compared with the
study’s results, most of the study sample
younger batches. Upon these findings, (Table 4.1)
(approximately 64.3%) responded correctly,
shows more precisely the effect of these
which entails proper knowledge of the basics of
curriculum components on clinical students, as the oral hygiene among the participants.
P-value was less than 0.05. Reaching the final
component “Practicing in clinical environment”, As for oral hygiene habits, practices were
as seen in Table 4, (89.4%) of all dental students considered optimal if toothbrushing was done
agreed on the influence of this component, P = twice daily, in addition to flossing and use of
mouthwash, both of which are crucial in dental
0.072. The highest percentages of agreement were
hygiene. All brushing techniques were considered
from the older batches: BDS 3 (92.6%), BDS4
proper as it depends on the individual’s oral
(95.8%), and BDS5 (92.4%), compared with the
needs. Furthermore, choosing toothpaste
higher levels of unsureness and disagreement that according to the active ingredient (a fluoride
were expressed by the younger batches, BDS2 toothpaste) and changing the toothbrush every 3
(20.0%) and BDS1 (10.3%). months were deemed more appropriate. The
results of this study demonstrated that
Discussion: approximately 56.7% of the study sample adopted
the optimum oral hygiene practices.
When it comes to enhancing the quality of life, the
role of oral health is just as important as that of The study sample of the present study included all
general health. The most effective way to maintain the undergraduate dental batches from BDS 1 to
superb oral health is to adopt the correct oral BDS 5, which can be further categorized into
hygiene practices to help prevent oral diseases. preclinical students including BDS 1 and BDS 2,
Dentists are considered experts in the field of oral and clinical students including BDS 3, BDS 4, and
health education and promotion as part of their BDS 5. Any contrast in oral health knowledge and
role in providing oral health treatment. The first habits during the years of university academic
9
study will reflect variation in dental students' populations utilizing self-administered
educational training experience. questionnaires [1].
Since all study participants were dentistry
students, this eliminates the risk of bias caused by
misconceptions and errors in concept
interpretation that might occur in studies with lay

52% of 5th-year students knew that bleeding on

probing was the first clinical sign of gingivitis, in
Knowledge:
contrast to the younger batches, with percentage
When analysis of the responses to the knowledge scores approximately ranging between 2.1% to
section was performed, an increasing trend was 37%, with a P-value = 0.000. Statistically
noted in the percentage scores of correct responses significant increases were also noticed in response
as the educational level increased. When asked percentages to other theoretical questions, in favor
about the signs and causes of periodontal diseases, of the clinical batches. Most clinical students
significant differences were observed, as denied that pockets are detectable on radiographs
illustrated in Table 2. For instance, approximately (approximately 92.9%) and that external stains
10
may lead to periodontitis (89.76%), compared to et al. who found no statistical significance [5,6,7].
78.45% and 64.3% of preclinical students, Similar results were revealed in several studies
respectively. This mirrors the variability in the such as Ahamed et al. regarding dental floss use
[7]
educational experience between the different . Contrarily, Khami et al. found a greater
batches. prevalence in males [8]. No gender differences
were found in the type of brushing technique
Practices:
adopted in the present study.
When analysing the responses reported about the
Tongue cleaning also plays a crucial role in the
oral hygiene practices among the different
maintenance of proper oral hygiene, as it reduces
batches, we observed that the majority of
the number of microorganisms colonizing the
undergraduate (clinical and preclinical) students
tongue surface [2]. When asked if they cleaned
(approximately 70.3%) brushed their teeth twice
their tongue, most dental undergraduates in our
daily using toothpaste chosen according to the
study (approximately 77.7%) claimed to do so,
active ingredient, such as fluoride. Furthermore,
with no statistically significant association
most students reported flossing, and only about
between the habit and educational levels or
11.7% mentioned not using any additional
gender. However, our study’s results contrasted
methods. The associations were found as
with those reported by other studies such as Hasan
statistically insignificant, as observed in Table 3.
et. al., which revealed that 74% of students did not
Interestingly, mouthwash use was more prevalent
regularly clean their tongues, and Daya et. al [2,1].
among preclinical students, with a significant
Consideration should be given to the over-
association of p = 0.012. Our results resembled
reporting that can result from the undergraduate’s
those detailed by Daya et. al, implying that dental
self-reported practices.
students are more knowledgeable about the
mechanical debridement of plaque [1]. Opposing As for the frequency of changing the toothbrush
results were presented by Barrieshi-Nusair et al., and choosing fluoride toothpaste, no associations
in which clinical students brushed more frequently were reported when compared with either the
than preclinical students, implying that different educational level or gender.
educational courses influenced their self-care level
[4] The COVID-19 pandemic has influenced many
.
changes in our lives in terms of social distancing
When asked about the brushing technique, 89.7% regulations and hygiene practices. No differences
of first-year undergraduates claimed not knowing were identified between different educational
the technique, showing a statistically significant levels attending clinic visits, with most students
difference (p<0.001) given that the majority of reporting visiting for check-ups. This is different
second to fifth-year students reported using the from the notion of reduced clinic visits amidst the
modified Bass technique. pandemic, as noted by Stennett et al (2022) and
Nardi et al (2021) [9,10]. The reason this might be
According to the results of the individual
not seen in this research might be that UOS dental
questions, brushing two times a day was more
students, preclinical or clinical, have access to
significantly prevalent among female participants
dental care in the university dental hospital. In
(74.5%) than male participants (58.7%)
addition, due to COVID-19, the dental hospital
(P<0.001). It was also found that females are more
provides dental treatments for longer hours of the
likely to use dental floss or mouthwash compared
day to avoid oversaturation of the clinics as a
to males, meanwhile, males have a higher
protective regulation. This might have caused
tendency to not use any additional methods to
flexibility in timings when it comes to dental
basic teeth brushing at all (25.3%), than females
appointments for those who seek treatment. As for
(6.7%). These results imply that females are more
gender, a greater percentage of males reported not
likely to take better care of their dental hygiene
visiting a dental clinic since the pandemic
with better oral health attitudes than males. This
compared to their female colleagues. One reason
was in accordance with studies such as Kawamura
may be fear to contract the virus, especially in the
et al. and Fukai et al. and in contrast with Ahamed
earlier period of the pandemic. Moreover,
11
Ahamed et al. explained their results, which were personal neglect, and greater attention provided by
similar to ours, being due to males having habitual females to their appearance and hygiene [7].
percentage scores for knowledge as the
educational level progressed, indicative of the
As for the impact on oral hygiene habits, most
positive impact the UOS educational curriculum
dental undergraduates revealed no changes done
possesses. On the contrary, practices were optimal
in their practices, with only a small percentage of
among the majority of the study sample, with no
the sample having increased practices. A possible
significant differences between the BDS batches.
justification would be that most of the participants
Social influences may be a causative factor. Also,
already have proper habits implemented, even
females seemed to have better oral hygiene habits.
before the COVID-19 pandemic.
It is recommended to assess the relationship
Educational curriculum: between the self-reports and the intraoral clinical
status in future studies.
The present study found no significant difference
in the impact of the first two components on Financial support and scholarship:
preclinical and clinical undergraduates. However, Nil
when evaluating the effect of laboratory practical
sessions on the clinical batches, years 3-5, a Conflict of interest:
statistically significant association (p=0.011) was There are no conflicts of interest in this study.
detected. As demonstrated in Tables 5 and 5.1, it
seems that senior dental undergraduates, unlike
their third-year colleagues, reported the lowest References:
percentage of agreement given that almost their 1. Daya, D., Teja, U., & Paturu, D. (2017).
entire training is spent in the clinical environment. Evaluation of oral-hygiene awareness and
Also, the fact that they have gone through a practice among dental students. Journal Of Dr.
greater period of clinical training may overshadow NTR University Of Health Sciences, 6(1), 24-
28. doi: 10.4103/2277-8632.202581
the impact of laboratory sessions as certain
2. Hasan, A., & Abdulqadir, M. (2017).
aspects are different in real-life cases. No gender Assessment of knowledge, attitude and
differences were detected for any of the three practices of personal and oral hygiene among
components. undergraduate university students in Sulaimani
city. Kurdistan Journal Of Applied Research,
Limitations: 2(2), 71-77.
https://doi.org/10.24017/science.2017.2.9
It is worth mentioning that the present study has a 3. Baseer, M., & Rahman, G. (2014). Oral health
few limitations. First, the study is bounded to a attitudes and behavior among a group of
questionnaire. Cross-sectional and longitudinal female Saudi dental students. Saudi Journal Of
comparisons would be more effective in Oral Sciences, 1(1), 25.
https://doi.org/10.4103/1658-6816.124182
researching the influence of education. Also, a
4. Barrieshi-Nusair, K., Alomari, Q., & Said, K.
clinical check of the oral status in addition to the (2006). Dental health attitudes and behaviour
questionnaire would most likely confirm the among dental students in Jordan. Community
findings. Finally, when using self-assessment dental health, 23(3), 147–151.
tools, it is difficult to entirely exclude the 5. Kawamura, M., Wright, F., Sasahara, H.,
tendency towards socially desirable responses. Yamasaki, Y., Suh, S., & Iwamoto, Y. (1999).
An Analytical Study on Gender Differences in
Self‐Reported Oral Health Care and Problems
of Japanese Employees. Journal Of
Conclusion: Occupational Health, 41(2), 104-111.
https://doi.org/10.1539/joh.41.104
Students who exhibit a high level of oral self-care 6. FUKAI, K., TAKAESU, Y., & MAKI, Y.
awareness can assess their patients' oral health, (1999). Gender Differences in Oral Health
motivate them, and spread awareness. The present Behavior and General Health Habits in an
Adult Population. The Bulletin Of Tokyo
study demonstrated an increasing trend in

12
 Dental College, 40(4), 187-193.
https://doi.org/10.2209/tdcpublication.40.187
7. Ahamed, S., Moyin, S., Punathil, S., Patil, N.
A., Kale, V. T., & Pawar, G. (2015).
Evaluation of the Oral Health Knowledge,
Attitude and Behavior of the Preclinical and
Clinical Dental Students. Journal of
international oral health : JIOH, 7(6), 65–70.
8. Khami, M., Virtanen, J., Jafarian, M., &
Murtomaa, H. (2007). Prevention-oriented
practice of Iranian senior dental students.
European Journal Of Dental Education, 11(1),
48-53. https://doi.org/10.1111/j.1600-
0579.2007.00436.x
9. Stennett, M., & Tsakos, G. (2022). The impact
of the COVID-19 pandemic on oral health
inequalities and access to oral healthcare in
England. British Dental Journal, 232(2), 109-
114. https://doi.org/10.1038/s41415-021-3718-
0
10. Nardi, G., Grassi, R., Grassi, F., Di Giorgio,
R., Guerra, F., & Ottolenghi, L. et al. (2021).
How Did the COVID-19 Pandemic Effect
Dental Patients? An Italian Observational
Survey Study. Healthcare, 9(12), 1748.
https://doi.org/10.3390/healthcare9121748
11. S Singh, S Pottapinjara. (2017). Dental
undergraduate students’ knowledge, attitudes
and practices in oral health self-care: A survey
from a South African university..African
Journal of Health Professions Education.Vol 9

13