Gender-specific oral health attitudes and behaviour among dental students in Palestine

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E. Kateeb¹

المواقف والسلوك لدى طلاب طب الأسنان في فلسطين نحو صحة الفم الخاصة بجنس معين

إلهام طالب الخطيب
الخلاصـة: تقيِّم هذه الدراسة الفروق بين الجنسين في المعارف والمواقف والممارسات بين طلاب طب الأسنان في فلسطين حول صحة الفم. وقد استوفى 260 طالباً تتراوح أعمارهم بين 18 و 22 عاماً في جامعة القدس الإخراجة الإنكليزية لم دْرسَ السلوك لطب الأسنان في جامعة هيروشيما. واتضح أن لدى الإناث مواقف وسلوكيات أكثر إيجابية حول صحة الفم )فهن يقمن بزيارات منتظمة لأطباء الأسنان، وأكثر ثقافةً حول استخدام فرشاة الأسنان بطريقة مهنية، واعتنائهن أكثر باستخدامها(. وقد كان نصف الطلاب من الجنسين يظنون أنهم لا يستطيعون تفادي وضع أسنان صناعية عند بلوغهم سناً متقدمة. وقد كانت بعض جوانب السلوكيات والمواقف في صحة الأسنان مختلفة بين الذكور والإناث، فيما كان التدريب المهني في جوانب أخرى للسلوكيات والمواقف يعوِّض هذه الاختلافات.

ABSTRACT: This study assessed gender differences in oral health knowledge, attitude and behaviour among undergraduate dental students in Palestine. Students aged 18–22 years at Al Quds University (n = 260) completed the English version of the Hiroshima University–Dental Behavioral Inventory. Females had more positive dental health attitudes and behaviours (making regular visits the dentist, being more educated about professional toothbrushing and taking more care with brushing their teeth). Half the students of both sexes thought they could not avoid having false teeth when they were old. Some aspects of oral health behaviour and attitudes were different between males and females, but in other aspects professional training may have compensated for these differences.

Attitudes et comportements spécifiques à chaque sexe en matière d’hygiène bucco-dentaire parmi les étudiants en médecine dentaire en Palestine

RÉSUMÉ: Cette étude évalue les différences selon les sexes en matière de connaissances de l’hygiène buccodentaire ainsi que les attitudes et les comportements des étudiants de premier cycle de médecine dentaire en Palestine. Âgés de 18 à 22 ans, les étudiants de l’université Al Quds (n = 260) ont rempli la version anglaise du questionnaire de l’Université d’Hiroshima sur l’hygiène dentaire (Hiroshima University–Dental Behavioral Inventory). Les attitudes et les comportements des femmes étaient meilleurs (visites régulières chez le dentiste, plus de connaissances en termes de brossage et plus de soin dans le brossage). La moitié des étudiants des deux sexes pensaient qu’ils ne pourraient pas éviter d’avoir de fausses dents lorsqu’ils seraient âgés. Certains aspects liés aux attitudes et comportements en matière d’hygiène bucco-dentaire étaient différents entre les hommes et les femmes, mais pour d’autres, la formation professionnelle peut avoir atténué ces différences.

¹Department of Preventive and Community Dentistry, Al Quds University, East Jerusalem (Correspondence to E. Kateeb: This email address is being protected from spambots. You need JavaScript enabled to view it.).
Received: 19/11/07; accepted: 09/03/08

EMHJ, 2010, 16(3):329-333

Introduction

There is an increased interest in looking at gender differences in health and disease, including dental health [1]. In Lebanon, a survey of oral health practices in 1998 found poor flossing habits and unfavourable dietary habits among students, and that variables such as sex, father’s education, exercise and dietary habits were significantly correlated with how frequently the students brushed their teeth [2]. According to the Report on the Survey of Dental Diseases in Tokyo, data have consistently shown that the mean number of filled teeth in women is higher than in men and that women tend to become edentulous at a younger age [3]. These gender differences are not easy to explain; some researchers think the differences reflect dentist–patient relationships more than disease occurrence [4].

One study of self-reported dental health attitudes and behaviour among dental students showed that gender was not a major feature, but that favourable attitudes/behaviour toward oral health appeared to reflect students’ clinical training experience [5]. In another study, the gender difference was significant among dental students. In Jordan, female students reported brushing their teeth more frequently than male students and believed in the necessity of using toothpaste during brushing more often than did male students [6]. So too in the Islamic Republic of Iran, where female senior dental students reported significantly higher frequencies of toothbrushing, fluoridated toothpaste use and flossing compared with male students [7].

There is very little information from Palestine about gender differences in any aspect of general health or lifestyle practices that influence health. This study therefore aimed to add to the scarce literature documenting the oral hygiene practices and attitudes among Palestinian dental students at Al Quds University and to compare oral health attitudes between male and female dental students.

Methods

All undergraduate dental students at Al Quds University were invited to participate in the survey at the end of the academic year 2006.

Data on oral health behaviour were collected using the English version of the Hiroshima University-Dental Behavioral Inventory (HU-DBI) questionnaire, which was originally developed by Kawamura [8]. It consists of 20 items primarily associated with toothbrushing behaviour, all with a dichotomous response format (agree/disagree). A quantitative estimate of oral health attitude and behaviour is provided by the total of the appropriate responses. Higher scores indicate better oral health attitude and behaviour [9,10]. In a sample of 517 Japanese university students, the HU-DBI had good test–retest reliability (0.73) over a 4-week period [11]. The English version has also shown good test–retest reliability and translation validity in a sample of 26 bilingual individuals [10]. The questionnaire has been used to compare oral health attitudes and behaviours among dental and dental hygiene students in different countries [11–14].

Students were asked by their faculties to remain in class at the end of the final examination of the academic year and participate in the survey on a voluntary basis. The HU-DBI questionnaire was distributed to all students. The English version of the questionnaire was used in this survey as English is the language of instruction at the dental school at Al Quds University. Questions regarding the meaning of words in Arabic were allowed and answers to such questions were announced to all other students. The survey was completed anonymously and no personal, demographic, academic or performance data for the students were collected. No attempt was made to follow up students who were absent on the day of the survey.

Statistical analysis

A total score was calculated based on the response to each statement. All variables of the questionnaires were analysed by sex. Differences were assessed by the chi-squared test. SPSS, version 10, was used to process and analyse the data. The significance level (P-value) was set at 0.05.

Results

Of 271 registered Palestinian students at Al Quds University Dental School, 260 students completed the questionnaire (175 females and 85 males), a response rate of 94.1%. The age of the students ranged from 18 years in the 1st year to 22 years in the 5th year. The distribution of the study sample over the 5 academic years and the response rate by year and by sex are shown in Table 1.

Table 1 Demographic features of the sample of dental students in Palestine

Table 2 shows the dental students’ attitudes and behaviour regarding dental health and hygiene by sex. Significantly more male students than females were not worried about visiting the dentist (52.9% versus 32.6% respectively) (P < 0.01). More males than females agreed that they put off going to the dentist until they had a toothache (57.6% versus 46.9%) but the difference was not significant.

Table 2 Dental students’ agreement with statements about dental health and hygiene in the Hiroshima University–Dental Behavioral Inventory: distribution by sex

The same proportion of males and females (31.8% and 32.0% respectively) agreed that their gums bled when they brushed their teeth. The majority of the students worried about the colour of their teeth and again there was no significant difference between the sexes (84.7% of males and 86.9% of females).

Half of the dental students believed that they could not avoid having false teeth when they were old (54.1% of males and 54.9% of females). Females tended to care more about having bad teeth despite more of them brushing daily than males; 77.7% of females said they brushed each of their teeth carefully compared with 61.2% of the males (P < 0.01). More males (36.5%) than females (22.3%) agreed that they had not been taught how to brush their teeth professionally (P < 0.05). More of the male students (12.9%) used a child-sized toothbrush compared with female students (8.6%).

Discussion 

Dental students at Al Quds University are a good representative sample of dental students in Palestine. There are only 2 dental schools in the Palestinian Authority and Al Quds University is the only one with some financial support from the state, accepting students from all over Palestine and from different socioeconomic classes, based on their high-school performance. The overall response rate in this study was high (94%).

This study compared female and male dental students’ attitudes and dental behaviour. Since males and females have different physiological and psychological behaviours, it is possible that their oral health behaviour might be different as well. Researchers have found that females engage in better oral hygiene behaviour, possess a greater interest in oral health and perceive their own oral health to be better than do males [15].

The present study showed differences in dental health attitudes between the sexes, with significantly fewer males who agreed that they worried about visiting the dentist and more who put off dental visits until they had a toothache. These results agree in general with the results of Ostberg et al. and Fukai et al., who found female dental students had better oral health attitudes and took better care of their teeth than their male colleagues [15,16]. In a study in Jordan, male students reported that they visited the dentist only when they had a toothache, which was more often than their female peers; however, this was not statistically significant [6].

Differences between the sexes were also seen in health behaviour. Significantly more females said they brushed their teeth carefully than did males. Similarly, a study conducted among new undergraduate students in Lebanon showed that females brushed their teeth 4 times as often as males [2]. In a study in Kuwait in 2001 and 2002 female students reported twice-a-day toothbrushing much more often than did male students, and use of fluoride toothpaste more often than males. Oral health knowledge in that study was also significantly higher among the female students than among the male students [17]. In another oral health attitude and behaviour survey of senior Iranian dental students in 2006, female students reported significantly higher frequencies of toothbrushing, use of fluoridated toothpaste and flossing compared with their male colleagues [7]. This agrees with our results. In a sample of 375 dental students at the Jordan University of Science and Technology, female students reported brushing their teeth more frequently than did male students. Approximately 47% of the male students brushed their teeth less than twice daily compared with 21% of the female students. Also, female students believed in the necessity of using toothpaste during brushing more often than did male students [6].

The above-mentioned studies reported significant differences between men’s and women’s health attitudes and health behaviours. In contrast, other studies of the oral health behaviour of senior dental students [18] and dentists [19] found no gender differences, probably because of the effect of professional training. Contrary to our results, Tseveenjav et al. found no differences between male and female Mongolian dental students in toothbrushing frequency [18].

In Sweden the results from a questionnaire-based study on 20–25-year-old adults showed that about 59% of the samples were satisfied with the appearance of their teeth [20]. In our study, 86% of the sample (who were from a similar age group) worried about the colour of their teeth and there was no difference between males and females. Also 52% of our sample were bothered about the colour of their gums, again without a significant difference between males and females. However, female students in general tended to be less satisfied with the appearance of their teeth than their male colleagues despite daily brushing.

The finding that females had more positive dental health attitudes and behaviours could be explained on the basis that females usually care more about their body and appearance. They would thus be more concerned about visiting the dentist and would tend to be more educated about their dentition even before entering a course related to dentistry.

This study was the first formal assessment of dental attitudes and behaviour among dental students in Palestine. The results were in agreement with studies in other countries showing that some aspects of oral health behaviour and attitude are different between males and females, but that in other aspects, professional training of the dental students may compensate for these differences. Further studies are needed to evaluate whether there is a difference in caries experience and in gingival health between male and female dental students.

References

1. Zakrzewska JM. Women as dental patients: Are there any gender differences? International dental journal, 1996, 46:548–57.
2. Kassak KM, Dagher R, Doughan B. Oral hygiene and lifestyle correlates among new undergraduate university students in Lebanon. Journal of the American College of Health, 2001, 50:15–20.
3. Dental Health Division of Health Policy Bureau, Ministry of Health and Welfare, Japan. Heisei 5 nen shika shikkan jittai chosa hokoku [Report on the Survey of Dental diseases, 1993]. Tokyo, Oral Health Association, 1995:126–8.
4. Kawamura M et al. An analytical study on gender differences in self-reported oral health care and problems of Japanese employees. Journal of occupational health, 1999, 41(2):104–11.
5. Kawamura M, Iwamoto Y, Wright FAC. A comparison of self-reported dental health attitudes and behavior between selected Japanese and Australian students. Journal of dental education, 1997, 61:354–60.
6. Al-Omari QD, Hamasha AA. Gender-specific oral health attitudes and behavior among dental students in Jordan. Journal of contemporary dental practice, 2005, 6(1):107–14.
7. Khami MR et al. Oral health behaviour and its determinants amongst Iranian dental students. European journal of dental education, 2007, 11:42–7.
8. Kawamura M. Dental behavioral science: the relationship between perceptions of oral health and oral status in adults. Journal of Hiroshima University Dental Society, 1988, 20:273–86.
9. Kawamura M et al. Relationship between CPITN and oral health behavior in Japanese adults. Australian dental journal, 1993, 38:381–8.
10. Kawamura M et al. Dental behavioral science part IX: bilinguals’ responses to the dental behavioral inventory (HU–DBI). Journal of Hiroshima University Dental Society, 1992, 22:198–204.
11. Kawabata K et al. The dental health behavior of university students and test–retest reliability of the HU–DBI. Journal of dental health, 1990, 40:474–5.
12. Kawamura M et al. Comparison of United States and Korean dental hygiene students using the Hiroshima University–Dental Behavioral Inventory (HU–DBI). International dental journal, 2002, 52:156–62.
13. Kawamura Met al. A cross-cultural comparison of dental health attitudes and behavior among freshman dental students in Japan, Hong-Kong and West China. International dental journal, 2001, 51:159–63.
14. Kawamura Met al. Cross-cultural differences of self–reported oral health behavior in Japanese and Finnish dental students. International dental journal, 2000, 50:46–50.
15. Ostberg AL, Halling A, Lindblad U. Gender differences in knowledge, attitude, behavior and perceived oral health among adolescents. Acta odontologica scandinavica, 1999, 57:231–6.
16. Fukai K, Takaesu Y, Maki Y. Gender differences in oral health behavior and general health habits in an adult population. Bulletin of Tokyo Dental College, 1999, 40(4):187–93.
17. Al-Ansari JM, Honkala S. Gender differences in oral health knowledge and behavior of the health science college students in Kuwait. Journal of allied health, 2007, 36(1):41–6.
18. Tseveenjav B, Vehkalahti M, Murtomaa H. Preventive practice of Mongolian dental students. European journal of dental education, 2002, 6(2):74–8.
19. Tseveenjav B, Vehkalahti M, Murtomaa H. Oral health and its determinants among Mongolian dentists. Acta odontologica scandinavica, 2004, 62:1–6.
20. Stenberg P, Håkansson J, Åkerman S. Attitudes to dental health and care among 20 to 25-year-old Swedes: results from a questionnaire. Acta odontologica scandinavica, 2000, 58:102–6.