|Year : 2015 | Volume
| Issue : 4 | Page : 454-458
Exploration of different school of thoughts among undergraduate dental students regarding dental caries and periodontal diseases
Anmol Mathur, Manu Batra, Diljot Kaur Makkar, CL Dileep, Puneet Kaur, Nikita Goyal
Department of Public Health Dentistry, Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan, India
|Date of Web Publication||7-Dec-2015|
Department of Public Health Dentistry, Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan
Source of Support: None, Conflict of Interest: None
Introduction: The concepts about dental caries and periodontal diseases are learned at dental schools may directly influence the conduct of the future dentists regarding the control and treatment of these diseases. Aim: To assess the variation in the understanding of the concepts of dental caries and periodontal diseases among first to final year undergraduate dental students. Materials and Methods: A cross-sectional, questionnaire-based study was conducted among 400 students pursuing their graduation in a private dental college situated in Sri Ganganagar city, Rajasthan, India. Descriptive analysis was done, and Chi-square test with a significance level of 5% was done to compare the frequency based data. Results: For concepts related to dental caries, the 1st year students' response showed shift toward biological concept, which was also present for the 2nd year but the 3rd year onwards the majority of students cited the comprehensive multi-factorial concept (P = 0.0002). Final year students were more knowledgeable than the 1st, 2nd, and 3rd year students regarding gingival bleeding, swelling, redness, and bad breath being the most important signs of periodontal disease (P = 0.004). Conclusion: Significant variation in the school of thoughts and limited knowledge regarding the concepts of common dental diseases among dental undergraduate students is seen. There might be a need to reform the initial concept building methods utilized in dental institutions to improve the basic knowledge of undergraduate students of the common dental diseases.
Keywords: Biofilm, dental caries, dental students, periodontal disease
|How to cite this article:|
Mathur A, Batra M, Makkar DK, Dileep C L, Kaur P, Goyal N. Exploration of different school of thoughts among undergraduate dental students regarding dental caries and periodontal diseases. J Indian Assoc Public Health Dent 2015;13:454-8
|How to cite this URL:|
Mathur A, Batra M, Makkar DK, Dileep C L, Kaur P, Goyal N. Exploration of different school of thoughts among undergraduate dental students regarding dental caries and periodontal diseases. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2020 Feb 19];13:454-8. Available from: http://www.jiaphd.org/text.asp?2015/13/4/454/171177
| Introduction|| |
The scientific concepts acquired while learning develop into the reflective consciousness and, subsequently, become spontaneous concepts. Understanding of concepts is not only just restricted about knowing how to define a certain phenomenon, but also includes understanding its history and determinants. Through the analysis of concepts, we are able to delineate the attributes or characteristics of the studied phenomenon because the concept itself is an abstraction that reflects the dynamism of the context.
Dental caries and periodontal diseases are the most common oral health problems faced by the world., Both of them have a multi-factorial nature encompassing several determinants and modulating factors.,
The knowledge base concerning dental caries has expanded over time, marked by a clear separation between the restorative and preventive dental fields.,, As a result of this dichotomy, several conceptualizations about caries have arisen. An important milestone in cariology was met in the 1960s, with the proposal of the triad of Keyes. This concept attempted to encompass all of the caries-related knowledge that was available at that time. Three factors (host, microbiota, and substrate) were identified as being essential for caries occurrence. They were schematically illustrated as a Venn diagram of overlapping circles whose common area represented disease occurrence. A modification of the triad of Keyes concept was proposed by Newbrun, who added a time factor to the analysis because caries is a chronic disease and its signs or symptoms on dental surface take time to be detected clinically.
Dental caries is currently conceptualized as a multi-factorial disease involving the known biological factors and social modifying factors such as education, social class, behavior, and attitude. Rationally, it should be considered as a biofilm (dental plaque) sugar-dependent disease. However, biofilm accumulation alone is not sufficient for manifestation of the disease; daily exposure to dietary sugars (mainly sucrose) is the negative determinant factor responsible for the process of the disease, and the changes made on the dental structure. However, despite the advanced state of knowledge in the field of cariology, conceptual understandings of the disease remain centered on the previously held beliefs.
Periodontal disease, including gingivitis and periodontitis, is considered to be one of the most common diseases among population and if left untreated, can lead to tooth loss. The main cause of periodontal disease is bacterial plaque although many other factors such as hormonal changes, diabetes, poor nutrition, smoking, and stress may affect the initiation and progression of gingival and periodontal diseases. The foundation of knowledge of periodontal diseases is not the product of a linear chronology of events, but rather bringing together of theories, discoveries, and advances that have occurred in parallel.
It is evident that conceptualizations about the disease held by professionals may affect their daily practices and, on the other hand, existing practices may affect concepts about the disease. The dental school is where the initial foundation is laid regarding the dental diseases which later on have an impact in clinical practice. Keeping in mind, the multi-factorial nature and numerous concept theories related to dental caries and periodontal diseases, the current study aimed to assess the variation in the understanding of the concepts of dental caries and periodontal diseases among first to final year undergraduate dental students.
| Materials and Methods|| |
A cross-sectional, questionnaire-based study was conducted among dental undergraduate students Pursuing their graduation in Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan, India, during January 2015. Each year comprised 100 dental students. The approval of the research protocol was taken by the Ethical Committee of the Institution.
A close-ended, self-administered questionnaire comprising 8 questions concerning etiological concepts, signs, and preventive measures regarding dental caries and periodontal disease along with demographic data were used in the research. Pre-testing of the questionnaire was carried out among 20 students (five from each academic year) to check its reliability and validity of the questionnaire. The internal consistency of the questionnaire showed good reliability for undergraduates during the pilot study (Cronbach's alpha: 0.86). Intraclass correlation coefficient (ICC) with 95% confidence interval was used for assessing this validity. ICC measures the strength of agreement between repeated measurements. The value of the ICC was 0.70. This pre-tested questionnaire was distributed among the students by the researcher in their respective lecture halls. For dental caries and periodontal diseases related questions, the respondent was allowed to select multiple options wherever possible. The participant responded to the statement by selecting one of three responses (yes, no, or I do not know). It took most of the participants 7–10 min to complete the questionnaire.
The frequencies of the variables were expressed as absolute numbers and percentages. The differences in the responses of the students in relation to their year of school were assessed by the Chi-square test, with a significance level of 5% using SPSS version 20.0 (SPSS, Inc., Chicago, IL, USA).
| Results|| |
Students completed the questionnaire with a response rate of 87%. Male and female students comprised 34.2% and 65.8%, respectively [Table 1].
|Table 1: Frequency distribution of the sample according to year of study|
Click here to view
For concepts related to dental caries, the 1st year students' response showed shift toward biological concept, which was also present for the 2nd year but 3rd year onwards the majority of students cited the comprehensive multi-factorial concept. There was statistically significant difference reported when concepts of dental caries were tested with academic years (P = 0.0002) [Table 2].
|Table 2: Concepts of dental caries by undergraduate students from the first to the last year of the course|
Click here to view
Although increased levels of knowledge regarding the cause of periodontal disease were reported by students in a chronological order, there was no statistically significant difference reported (P = 0.92). Final year students were more knowledgeable than the 1st, 2nd, and 3rd year students regarding gingival bleeding, swelling, redness, and bad breath being the most important signs of periodontal disease (P = 0.004). Final year students showed statistically significant better knowledge of the preventive measures for periodontal disease in comparison to other year students (P = 0.008) [Table 3].
|Table 3: Distribution of responses to periodontal health knowledge questions by year of study|
Click here to view
There was marked difference between the knowledge of relationship of oral diseases with the systemic diseases among the different year students (P < 0.05). It was reported that only 56.1% of the 1st year students were aware that smoking has an effect on gum diseases [Table 4].
|Table 4: Distribution of responses to oral and general health knowledge by year of study|
Click here to view
| Discussion|| |
Oral health means more than good teeth. Oral health is an integral component of general health and is essential for well-being. Although oral tissues and fluids normally provide significant barriers and protection against microbial infections, at times these infections can not only cause local disease but also, under certain circumstances, disseminate to cause infections in other parts of the body. The control of existing oral infections is clearly of intrinsic importance and a necessary precaution to prevent systemic complications. This wider meaning of oral health does not diminish the relevance of the two globally leading oral afflictions-dental caries and periodontal diseases.
Poor oral health conditions, such as these, have a profound impact on health and the general quality of life. The clinician's treatment plan for a disease very much relies on his concepts regarding etiology of the disease. Generally, the concepts are instilled during the learning phase of graduation tenure. The literature lacks the research about the understanding of concepts regarding dental caries and periodontal diseases among dental students. This study is of prime importance in this field as it is the first one to explore it among Indian dental students.
The conceptualization of dental caries requires biofilm and sugar, which represent a necessary factor and a negative determinant of the disease, respectively. The specific location of disease development (tooth/tooth surface) is understandable, given the imbalance of demineralization-remineralization processes that occurs in the complex tooth-oral environment. However, this strictly biological understanding of dental caries is insufficient because it does not consider other factors related to the disease, such as fluoride, saliva, and social factors. The present study showed overall 41.3% of the students agreed on biological concept of dental caries whereas study done by Ferreira-Nóbilo et al. report 53.6% for the same. The erroneous concept of the disease transmissibility of caries was persistent among the students (12.8%) which is near about the same as reported by Nóbilo et al. (15.8%). In the present research, the most interesting fact came out is that from the 2nd year onwards the majority of students cited the comprehensive multi-factorial concept (50–51.8%) while no such trend was noticed by the study done by Nóbilo et al. This may be due to the fact that the 3rd year marks the inception of clinical training in India which can act as a positive thrust toward understanding of the concepts related to various dental diseases.
In the present study, health conceptualizations also found a predominance of the comprehensive multi-factorial model. Whereas the studies conducted by Nunes and Freire  and Júnior et al. found a predominance of the biological framework in relation to dental caries when tested in Brazil.
Senior students had better knowledge of periodontal disease signs, preventive measures, and relations to general health. The impact of above-mentioned result can be assumed as better periodontal health-related attitudes in senior students, which was also supported by some previous studies., This may be due to the reason that within the same specialty the dental health knowledge and attitudes became more positive with the increase in level of education.
The present research reported that plaque has impact on person's oral health which is in accordance with the study conducted by Al-Batayneh et al. Ahuja et al. in his study found that most of faculty members believe bleeding as the most indicating sign of periodontal disease and toothbrush, dental floss as an effective measure to prevent periodontal disease. It is a general perception that knowledge passes from generation to generation. Therefore, if the faculty members have clear concepts regarding oral disease, then only the students will get acquired accurate knowledge.
However, the questions referred in this study may just provide insight of student's profile with respect to the concepts behind common dental diseases. Since the questions were more of theoretical domain, more detailed assessment will be required to look into the different nuances of this focus area. This research concept can also be applied in other educational scenarios to evaluate the ground reality.
Greater coordinated efforts should be made to bridge the gap of diverse thoughts, by orienting the students with current concepts of dental diseases in early years of their dental education so as to have a firm foundation. Compendium for staffs should be held at regular intervals regarding changing paradigms of oral diseases so as to bring unity of thought. Undergraduate students need to be made aware of the availability of the vast amount of biomedical literature to facilitate critical and scientific thinking in the formative years regarding current concepts.
| Conclusion|| |
The concepts presented by the respondents reflected the organization of the dental educational curriculum. The curriculum is indicative of the values of the profession. The outcome of the current study shows the trend of diversity of thoughts and limited knowledge regarding the concepts of common dental diseases among dental undergraduate students. To change the current state, there might be a need to reform the initial concept building methods utilized in dental institutions to improve the basic knowledge of Undergraduate students about the common dental diseases and which will reflect in decision making in tackling dental diseases.
We are thankful to Dr. Yogesh Kumar, Principal Director of the institution for his kind support and guidance.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Batista CG. Concept formation in blind children: Theoretical questions and educational implications. Psychol Theory Res 2005;21:7-15.
Boruchovitch E, Sousa IC, Schall VT. The concept of disease and of the preservation of health in a sample population of teachers and pupils of a school course for 7-14 year olds. Rev Saude Publica 1991;25:418-25.
Rodgers BL. Concepts, analysis and the development of nursing knowledge: The evolutionary cycle. J Adv Nurs 1989;14:330-5.
Williams RC. Understanding and managing periodontal diseases: A notable past, a promising future. J Periodontol 2008;79 8 Suppl: 1552-9.
Ferreira-Nóbilo Nde P, Sousa Mda L, Cury JA. Conceptualization of dental caries by undergraduate dental students from the first to the last year. Braz Dent J 2014;25:59-2.
Scannapieco FA. Position paper of the American academy of periodontology: Periodontal disease as a potential risk factor for systemic diseases. J Periodontol 1998;69:841-50.
Löe H. Changing paradigms in restorative dentistry. J Am Coll Dent 1995;62:31-6.
Clark TD, Mjör IA. Current teaching of cariology in North American dental schools. Oper Dent 2001;26:412-8.
Cury JA, Tenuta LM, Serra MC. Paradigms in teaching cariology. In: Fernandes CP, editor. A World Class Dentistry: FDI 2010 Brazil. São Paulo: Santos; 2010.
Keyes PH. Recent advances in dental research: Bacteriology. Int Dent J 1962;12:443-64.
Usha C, Stahyanarayanan R. Dental caries – A complete changeover (Part I). J Conserv Dent 2009;12:46-54.
Newbrum E. Cariology. 2nd
ed. Baltimore: Williams and Wilkins; 1983. p. 389.
Fejerskov O. Changing paradigms in concepts on dental caries: Consequences for oral health care. Caries Res 2004;38:182-91.
Akshata KR, Ranganath V, Nichani AS. Thesis, antithesis, and synthesis in periodontal and systemic interlink. J Indian Soc Periodontol 2012;16:168-73.
Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21st
century – The approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003;31 Suppl 1:3-23.
Patro BK, Ravi Kumar B, Goswami A, Mathur VP, Nongkynrih B. Prevalence of dental caries among adults and elderly in an urban resettlement colony of New Delhi. Indian J Dent Res 2008;19:95-8.
Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 1997;25:284-90.
Nunes FC, Freire MC. Concepts of health among dental students. Arq Odontol 2008;44:5-12.
Júnior HA, Souza MA, Brochier JI. Social representation of environmental education and health education in college. Psicol Reflex Crit 2004;17:43-50.
Kawamura M, Iwamoto Y, Wright FA. A comparison of self-reported dental health attitudes and behavior between selected Japanese and Australian students. J Dent Educ 1997;61:354-60.
Kawamura M, Spadafora A, Kim KJ, Komabayashi T. Comparison of United States and Korean dental hygiene students using the Hiroshima university-dental behavioural inventory (HU-DBI). Int Dent J 2002;52:156-62.
Al-Batayneh OB, Owais AI, Khader YS. Oral health knowledge and practices among diverse university students with access to free dental care: A cross-sectional study. Open J Stomatol 2014;4:135-42.
Ahuja N, Pramila M, Krishnamurthy A, Umashankar GK, Ranganath R, Sharma N. Knowledge and attitude towards preventive dental care among dental faculties in Bangalore city. J Indian Assoc Public Health Dent 2014;12:93-9.
[Table 1], [Table 2], [Table 3], [Table 4]