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Nurhan Özalp, DDS, PhD ABSTRACT

Associate Professor, Department of Pediatric,
Background and Aim: Positive attitudes toward health
Faculty of Dentistry, Ankara University,
Ankara, Turkey promotion need to be developed during the students’ study
rather than afterward. Undergraduate dental education should
Canan Dağ, DDS include comprehensive programs in preventive care, including
Department of Pediatric, Faculty of Dentistry,
oral self-care regimens. The aim of the present study was to
Ankara University,
compare the knowledge about preventive dental approaches
Ankara, Turkey
and to gather data about the contribution of clinical experience
Zeynep Ökte, DDS, PhD of the fourth and final year dental students.
Professor, Department of Pediatric,
Faculty of Dentistry, Ankara University, Subjects and Method: All the fourth year (86 individuals) and
Ankara, Turkey final year (91 individuals) students were invited to participate
in this study, which used a self-administered structured
questionnaire written in Turkish, at Ankara University, School
of Dentistry. The questionnaire was designed to evaluate
preventive dentistry knowledge and the contributions of
clinical experience. Continuous variables were compared using
Student’s t test and the differences in proportions between
groups were compared by using Chi-Square or Fisher’s Exact
test, where appropriate. The analyses were performed with
SPSS 12 statistical package and a p value of less than 0.05 was
considered statistically significant.

Results: There was a statistically significant difference

between the final and fourth year students (p<0.05), as
78.9% of the final year students and 71.5% of the fourth
year students responded correctly. Especially with regard to
preventive approaches with children and fluoride applications,
Canan Dağ, DDS final year students demonstrated more knowledge.
Department of Pediatric,
Faculty of Dentistry, Conclusions: The results of this study showed that the
Ankara University, oral health knowledge of the dental students improved with
O6500 Ankara, Turkey increased education. It is clear that clinical experience must be
Phone: +90 312 2965670
the front page of dentistry education, especially in preventive
Fax: +90 312 2123954
Submitted for Publication: 10.12.2011 Key words: Clinical Experience, Dental Education, Preventive
Accepted for Publication : 02.13.2012 Dentistry

Oral Health Knowledge


Knowledge is defined as “understanding of or information All of the fourth year (86 individuals) and final year (91
about a subject which a person gets by experience or study, individuals) students from Ankara University, Faculty of
and which is either in a person’s mind or known by people Dentistry were invited to participate in this study using
generally”.1 The term knowledge is also used to mean the a self-administered, structured questionnaire that was
theoretical or practical understanding of a subject. Attitude written in Turkish at the beginning of the academic year
is defined as a predisposition to classify objects and events 2008-2009. Permission for the investigation was obtained
and to react to them with some degree of evaluative from the administration of the faculty.
consistency. The modified questionnaire14 (Table 1) comprised 19 items
Attitudes are acquired by social interaction, not learned designed to evaluate preventive dental approaches and the
from the textbooks. Previous studies have shown that the contributions of clinical experience. The response format
main sources of oral health knowledge are mass media, included multiple choice questions in which the students
dental professionals, and dental literature.2 were instructed to choose only one response from the
Positive attitudes toward health promotion need to be provided list of options. A full explanation of how to fill in the
developed during students’ days rather than afterward. Due questions was elucidated to the individuals. The students
to substantial changes in the dental curriculum, additional filled in the questions without conferring with each other,
study is recommended by Federation Dental International to and the questionnaire procedure took 25 minutes. The
give dentists, the knowledge, skills, and attitudes they will students were feed-backed with the right answers after
need in future practice.3 Not withstanding, little curricular the study.
change seems to have taken place.4 Undergraduate dental For the purpose of the analysis, each correct answer in the
education should include comprehensive programs in questionnaire was given a score of “one” and each wrong
preventive care, including oral self-care regimens.5 Stable answer was given a score of “zero”. The data was analyzed
health behaviors that can overcome differences in personal using the SPSS version 12 software. Kolmogorov-Simirnov
characteristics must be produced,6 and clinical practice is test was performed as normality test to choice appropriate
the best way to acquire positive behaviors. Eberhard et al.7 test. Group scores were compared using Student’s t test.
emphasized the importance of early and frequent contact A comparison of each answer was evaluated using the
with real patients to improve clinical expertise in dental Chi-square and Fisher’s exact.
The health beliefs and attitudes of dental students are
important because these individuals are the future dental After the evaluation of the answers of the 86 fourth year
health providers. Their attitudes not only affect their oral students and the 91 final year students, the knowledge levels
self-care but also potentially influence their patients’ ability regarding patient care were determined. The results were
to take care of their teeth8-11 and shape the public’s oral appraised both holistically and individually. The statistical
health education level.12 Dental health providers should analysis of the questionnaires demonstrated significantly
be an example for their patients, family, and friends by increased knowledge among final year students compared
maintaining good oral health themselves.13 with that of fourth year student (p<0.05). Fourth-year
In the future, today’s students of dentistry will provide students’ percentage of right answers for was 71.5%, and
dental services and will be responsible for public oral final year students’ percentage of right answers was 78.9%
health education; thus it is important to investigate their (Table 2, Table 3). It was demonstrated that the final-year
knowledge, attitude, and behavior regarding oral health.13 students were more successful than fourth-year students;
The aim of the present study was to compare the knowledge the difference was statistically significant.
about the preventive dental approaches and to gather data When investigating each individual question, the scores
about the contribution of clinical experience of the fourth of some questions were close, but final-year students
and final year dental students. demonstrated increased knowledge overall, with most giving
correct answers to questions about fluoride applications to
children and pregnant women (questions 1, 2, 3, 10, 11 and


Table 1. The questionnaire form.

‘Systemic fluoride usage is beneficial during pregnancy’
( ) True ( )False
Which of the fluoride usage techniques is more effective for all population?
( ) Fluoridated water
2 ( ) Fluoridated milk
( ) Fluoridated salt
( ) Water fluoridation in schools
The use of fluoride toothpaste begins at the age of…
( )2 ( )3 ( )6 ( )10
‘Bone calcium level decreases during pregnancy’
( ) True ( )False
‘The exact age for fissure sealant application is…’
( )3 ( )6 ( )12 ( ) all
Which of these cause poor oral health?
6 ( ) Feeding bottle ( ) Open mouth respiration
( ) Pacifier ( ) All
When should the parents allow their children brushing teeth by themselves?
( )4 ( )5 ( )6 ( )9
The treatment of opaque enamel lesion is ?
( ) Restoration after cavity preparation
( ) Fluoride application to lesions
( ) Following without any application
‘The chlorhexidine mouthrinses should be used…’
( ) Before tooth brushing
( ) After tooth brushing
( ) 30 minutes after tooth brushing
‘The fluoride tablets should be taken by
( ) Swallowing
( ) At night before bedtime
( ) Chewing after meals
‘Fluoride varnish does not have any medical disadvantages.’
( ) True ( ) False
‘Fluoride varnish is effective for root caries.’
( ) True ( ) False
‘Dental decay and cavities are infectious.’
( ) True ( ) False
‘Poor oral health during pregnancy causes low birthweight and/or premature birth.’
( ) True ( ) False
Appropriate age for children’ s first dental visit should be…
15 ( ) Before first birthday ( ) Before school life
( ) Between 2 and 3 ages ( ) When a dental problem improved
‘Sleeping with a bottle containing formula could cause cavities on primary teeth’
( ) True ( ) False
‘Opaque lesion of enamel causes caries’
( ) True ( ) False
‘Preventive dental applications to enamel lesions are cheaper than treatment’
( ) True ( ) False
Curriculum of dentistry education must touch on preventive dentistry
( ) True ( ) False

Oral Health Knowledge

Table 2. Results of both classes (p<0.05)

Student t test

n Mean Median Minimum Maximum sd t p

Fourth-year students 86 71.5 73.7 52.6 89.5 9.3

-5.6 0.0001
Success Point
Final-year students 91 78.9 78.9 47.4 94.7 8.4

Table 3. Analysis of the results graphically.

12). Especially in questions relating to systemic fluoride DISCUSSION

usage during pregnancy (p<0.05) and fluoride varnishes Sharda and Shetty13 reported that the mean percentage
(p<0.05), results were statistically significant between behavior scores of final-year students were significantly
final-year and fourth-years students. higher compared than those of the first year students. It
In the questions about bone calcium levels during pregnancy, is vital to understand the importance of preventive dental
exact age for fissure sealants applications, causes of poor procedures and preventive patient care15,16 so that the
oral health, chlorhexidine mouthrinses, causes of early students of dentistry will be well educated as future oral
childhood caries, and cost-effective results of preventive health providers. Effective teaching is critical for student
approaches, data were not statistically significant between learning, especially in professional fields such as dentistry
the 2 groups of students. and dental hygiene.
According to the Chi-square test, there were significant “Preventive care” was defined as visiting the dentist for a
differences in questions concerning teeth brushing (p<0.05), routine check-up. It was demonstrated that the final year
treatment of opaque enamel lesions (p<0.05), carious teeth students showed better preventive care behaviors than the
(p<0.05), effects of a mother’s poor oral health on birth- other classes.13 Clinical experience is the best way to learn
weight or birth (p<0.05), and appropriate age for the first clinical sciences.
dental visit (p<0.05) (Table 4). It is reported that dental students want to improve
The results of the questions about dentistry education their clinical sense, and to accomplish this, they need
curriculum were analyzed using Fisher’s exact test, and exposure to more patients. The dental school curriculum
statistically significant differences were found between must include much clinical experience.17 As in this study,
the two groups of students. although theoretical education about preventive dentistry


Table 4. Analysis of the answers (p<0.05)

4-year students 5-year students Total Chi-square Analysis

n % n % n % Chi-square p

True 63 73.3 90 98.9 153 86.4

Q1 False 23 26.7 1 1.1 24 13.6 22.6 0.0001

Total 86 100.0 91 100.0 177 100.0

True 3 3.5 24 26.4 27 15.3

Q7 False 83 96.5 67 73.6 150 84.7 16.18 0.0001

Total 86 100.0 91 100.0 177 100.0

True 83 96.5 79 86.8 162 91.5

Q8 False 3 3.5 12 13.2 15 8.5 4.18 0.041

Total 86 100.0 91 100.0 177 100.0

True 42 48.8 65 71.4 107 60.5

Q11 False 44 51.2 26 28.6 70 39.5 9.4 0.002

Total 86 100.0 91 100.0 177 100.0

True 43 50.0 62 68.1 105 59.3

Q13 False 43 50.0 29 31.9 72 40.7 6.02 0.014

Total 86 100.0 91 100.0 177 100.0

True 52 60.5 68 74.7 120 67.8

Q14 False 34 39.5 23 25.3 57 32.2 4.12 0.042

Total 86 100.0 91 100.0 177 100.0

True 37 43.0 58 63.7 95 53.7

Q15 False 49 57.0 33 36.3 82 46.3 7.16 0.006

Total 86 100.0 91 100.0 177 100.0

True 80 93.0 91 100.0 171 96.6

Q19 False 6 7.0 0 0.0 6 3.4 Fisher’s Exact 0.012

Total 86 100.0 91 100.0 177 100.0

is given during the fourth year, final-year students showed exposure.18 It must be stressed that theoretical education is
increased knowledge because of more clinical experience. insufficient without clinical experience.
Dental curricula, as generally agreed, should be scientifically Instructors have more interaction with students and have
based, clinically relevant, and medically informed, and continuing communication with them.19 Thus, instructors
it should promote social responsibility. The necessary could have a potentially important effect on dental
theoretical, clinical, and interpersonal competences must be students’ learning in the clinic as well as in the classroom.20
acquired, and “clinical experience” must be acquired through They can present teaching strategies consistent with

Oral Health Knowledge

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