The hierarchical cluster analysis of oral health attitudes and behaviour using the Hiroshima University--Dental Behavioural Inventory (HU-DBI) among final year dental students in 17 countries

OBJECTIVE: To explore and describe international oral health attitudes/ behaviours among final year dental students. METHODS: Validated translated versions of the Hiroshima University-Dental Behavioural Inventory (HU-DBI) questionnaire were administered to 1,096 final-year dental students in 17 countries. Hierarchical cluster analysis was conducted within the data to detect patterns and groupings. RESULTS: The overall response rate was 72%. The cluster analysis identified two main groups among the countries. Group 1 consisted of twelve countries: one Oceanic (Australia), one Middle-Eastern (Israel), seven European (Northern Ireland, England, Finland, Greece, Germany, Italy, and France) and three Asian (Korea, Thailand and Malaysia) countries. Group 2 consisted of five countries: one South American (Brazil), one European (Belgium) and three Asian (China, Indonesia and Japan) countries. The percentages of 'agree' responses in three HU-DBI questionnaire items were significantly higher in Group 2 than in Group 1. They include: "I worry about the colour of my teeth."; "I have noticed some white sticky deposits on my teeth."; and "I am bothered by the colour of my gums." CONCLUSION: Grouping the countries into international clusters yielded useful information for dentistry and dental education.     

An assessment of oral self-care level among Japanese dental hygiene students and general nursing students using the Hiroshima University – Dental Behavioural Inventory (HU-DBI): Surveys in 1990/1999

PURPOSE: The purpose of this study was to determine the differences in oral self-care levels between Japanese dental hygiene students and general nursing students in 1999, and compare them with a similar study in 1990. METHODS: The examination was mainly based upon responses to a questionnaire titled "Hiroshima University--Dental Behavioural Inventory (HU-DBI)". Higher scores of the HU-DBI indicate better oral health attitudes/behaviour. RESULTS: The mean HU-DBI score of the 2nd-year dental hygiene students was significantly greater than that of the 2nd-year nursing students (9.56 and 6.65, respectively; p<0.001), and much higher than those of the 1st-year students at each course (dental hygiene course; 6.30, nursing course; 5.88). Except for the 2nd-year dental hygiene class, there were no significant differences in the HU-DBI score between the 1990 and 1999 subgroups of each class. About 1/3 of the 2nd-year nursing students reported a belief that they may eventually require false teeth, while 6% of the 2nd-year dental hygiene students held this belief. More than 60% of this study sample stated that they put off going to the dentist until they had toothache. The 2nd-year dental hygiene students were more likely to have this attitude than their 1990 peers. Flossing was not popular among the nursing students in either 1990 or 1999. CONCLUSION: Although the difference in the HU-DBI score across time was not major, the variation in HU-DBI and the favourable attitudes/behaviour toward oral health appeared to reflect the differences in schooling between student hygienists and student nurses.     

Dental health attitudes and behaviour among dental students in Jordan

OBJECTIVE: Examine and compare differences in oral health attitudes and behaviour among Jordanian dental students. BASIC RESEARCH DESIGN AND PARTICIPANTS: Cross-sectional study of 314 dental students was conducted to compare differences in oral health behaviour and attitudes among these students in different levels of academic education. SETTING: Jordan University of Science and Technology. METHODS: Subjects were surveyed using a modified version of the Hiroshima University Dental Behavior Inventory (HU-DBI) questionnaire (20 Items). Multivariate binary and polytomous logistic regression analyses were performed in order to study change of patterns of statements during preclinical and clinical, and year of study, respectively. RESULTS: The percentage of students claiming to brush their teeth twice daily or more often was four times higher amongst clinical students than amongst pre-clinical students.. The odds of visiting a dentist only in case of toothache was reduced by a factor of more than three among clinical year students (OR 0.30, 95% CI 0.15-0.61). Clinical year students rarely complained of bleeding gums after toothbrushing (OR 0.10, 95% CI 0.03-0.27). On the other hand, a number of items regarding use of dental floss and tooth paste, bad breath, colour and appearance of teeth, and cigarette smoking was similar between preclinical and clinical students. Evaluation of trends during dental studies employing polytomous multivariate logistic regression analysis revealed an abrupt change at the end of preclinical studies for items characterizing professional attitude. CONCLUSIONS: With advancement in dental school, dental student's oral health awareness and attitudes improved in some aspects. Preventive dentistry courses should be taught early in the dental curriculum of the pre-clinical years.     

Comparison of United States and Korean dental hygiene students using the Hiroshima university-dental behavioural inventory(HU-DBI)

OBJECTIVE: To compare cross-national differences of dental health behaviour among dental hygiene students. DESIGN: Cross-cultural differences. Setting: United States (USA) and Korea. SUBJECTS AND METHODS: One hundred and twenty-six dental hygiene students in USA and 246 in Korea were surveyed using the Hiroshima University-Dental Behavioural Inventory (HU-DBI) (in English and Korean versions respectively). RESULTS: There were considerable differences in oral health behaviour between USA and Korean dental hygiene students. Of great significance were findings that while only a small proportion of the USA students (1%) reported gum bleeding when they brushed their teeth, 37% of the Korean students did so (P<0.001). Furthermore, only 19% of the Korean students had been told by their dentist that they were performing a high level of plaque control, contrasted with 76% of the USA students. Logistic regression model showed that it was possible to distinguish USA students from Korean peers with a probability of more than 90% by using the HU-DBI. CONCLUSIONS: There were considerable differences in dental health attitudes/behaviour among dental hygiene students in the two countries. The variation in the favourable attitudes/behaviour toward oral health appeared to reflect the students' clinical training experience in Korea.     

An exploratory study on cultural variations in oral health attitudes, behaviour and values of freshman (first-year) dental students

OBJECTIVE: To identify similarities and differences in oral health attitudes, behaviour and values among freshman dental students. DESIGN: Cross-cultural survey of dental students. SETTING: 18 cultural areas. PARTICIPANTS AND METHODS: 904 first-year dental students completed the Hiroshima University-Dental Behavioural Inventory (HU-DBI) translated into their own languages. Individual areas were clustered by similarity in responses to the questions. RESULTS: The first group displayed an 'occidental-culture orientation' with the exception of Brazil (Cluster 1 comprised: Australia, United Kingdom, Ireland, Belgium and Brazil, Cluster 2: Germany, Italy, Finland and France). The second group displayed an 'oriental-cultural orientation' with the exception of Greece and Israel (Cluster 3 comprised: China and Indonesia, and Cluster 4: Japan, Korea, Israel, Hong Kong, Malaysia, Thailand and Greece). Australia and United Kingdom were the countries that were most alike. Ireland was the 'neighbour' to these countries. Greece and Malaysia had similar patterns of oral health behaviour although geographic conditions are very different. Although it was considered that in Hong Kong, occidental nations have affected the development of education, it remained in the oriental-culture group. Comparison with the data from the occidentals indicates that a higher percentage of the orientals put off going to the dentist until they have toothache (p < 0.001). Only a small proportion of the occidentals (8%) reported a perception of inevitability in having false teeth, whereas 33% of the orientals held this fatalistic belief (p = 0.001). CONCLUSIONS: Grouping the countries into key cultural orientations and international clusters yielded plausible results, using the HU-DBI.     

Gender-specific oral health attitudes and behavior among dental students in Jordan

The aim of this study was to determine the difference in oral health attitudes and behavior between male and female dental students at Jordan University of Science and Technology (JUST). A self-administered questionnaire based on a modified version of the Hiroshima University Dental Behavior Inventory (HU-DBI) was distributed among 375 dental students. The response rate was 83.7% with 48% males and 52% females responding. Female students reported brushing their teeth more frequently than male students (P<0.001). Approximately 47% of the male students brushed their teeth less than twice daily compared to 21% of the female students. Also, female students believed in the necessity of using toothpaste during brushing more often than male students (P<0.01). On the other hand, smoking was much more frequent among males than among females (31% vs. 4%) (P<0.001). Male students indicated they had been smoking for longer periods of time than female students. This survey shows male students visit the dentist only when they have dental pain. While this was more than their female peers, it was not statistically significant (P= 0.056). In general the present study showed dental students in Jordan had poor oral health. Further research is needed to examine the students clinically for periodontal and caries conditions. Students should be encouraged to be a model for oral health for their families, friends, and patients.     

A cross-cultural comparison of dental health attitudes and behaviour among freshman dental students in Japan, Hong Kong and West China

OBJECTIVE: To clarify the differences in dental health attitudes/behaviour among freshman dental students. DESIGN: Cross-cultural differences. SETTING: Japan, Hong Kong and West China. PARTICIPANTS AND METHODS: The original version of the Hiroshima University-Dental Behavioural Inventory (HU-DBI) was written in Japanese. After testing the validity of both English and Chinese versions, the original version of the HU-DBI was administered to 58 freshman Japanese dental students, the English version to 43 Hong Kong Chinese peers and the Chinese version to 39 West Chinese peers. RESULTS: Significant cultural differences were found for 16 items out of 20. The most striking result was that the Japanese students were more likely to have used a dye to see how clean their teeth were, compared to their Chinese peers (P<0.001). The Chinese students were less likely to have a belief that they could clean their teeth well without using toothpaste (P<0.001), whereas higher percentages of the Chinese students worried about having bad breath (P<0.001). A higher percentage of the Hong Kong students reported that they regularly checked their teeth in a mirror than did their West Chinese or Japanese peers (P<0.05). CONCLUSIONS: There were considerable differences in dental health attitudes/behaviour among freshman dental students in the three cultural groups.     

A comparative study of oral health knowledge,attitude and behaviour of first and final year dental students of Udaipur city,Rajasthan, India

Abstract: Objective: To assess and compare differences in oral health knowledge, attitudes and behaviour among first and final year dental students in Udaipur city, Rajasthan, India. Materials and methods: In a cross‐sectional study, 182 first year students (59 males and 123 females) and 157 final year students (75 males and 82 females) of the two dental colleges in Udaipur city; Rajasthan, were surveyed using a self‐administered structured questionnaire including 37 multiple choice questions pretested through a pilot survey. The data was analysed using the spss version 10.0. The mean percentage scores, standard deviation and frequency distribution were calculated. The Student’s t‐test and anova test were used as test of significance. The linear regression analysis were used to assess the relation of knowledge, attitude and behaviour. Results: The mean % score for oral health knowledge, attitude and behaviour were significantly higher in final year students compared to first year students (P < 0.001). The linear regression analysis showed a statistically significant linear relationship of attitude with the knowledge (P < 0.001) and behaviour with the attitude (P < 0.001) of the students. Conclusion: Besides the positive changes revealed in the oral health knowledge, attitude and behaviour, among the students from first to final year of dental studies, preventive behaviour among the students could still be improved.     

Differences in self-reported oral health behavior between dental students and dental technology/dental hygiene students in Jordan

The aim of this study was to compare differences in oral health behavior between dental students and dental technology/dental hygiene students in Jordan. One hundred and five dental students and seventy-eight dental technology/dental hygiene students were recruited into this study. All subjects were recruited from the students who were receiving training at the clinics and laboratories that belong to the Faculty of Dentistry, Jordan University of Science and Technology. The Hiroshima University-Dental Behavioral Inventory (HU-DBI) was used to assess the oral heath behavior of the subjects. Significant differences were found between students from different disciplines. Dental students were found to worry more about visiting their dentist, to be less aware of bleeding gums when brushing and were less bothered by the color of their gums compared with dental technology and dental hygiene (DT/DH) students (P < 0.05, P < 0.001 and P < 0.05, respectively). Dental students tended to be more professionally educated about brushing and to have a belief that they cannot clean their teeth well without using toothpaste (P < 0.01 and P < 0.001, respectively). Most of them did not feel they have brushed well unless they brush with strong strokes (P < 0.05). A logistic regression model showed that it might be possible to distinguish dental students from DT/DH students by using three items of the HU-DBI and the level of dental education. The difference in the HU-DBI scores was not a major feature. There were significant differences in oral health attitudes/behavior between dental students and DT/DH students. The findings might reflect differences in students' training experience and education between different specialties.     

Cross-cultural differences of self-reported oral health behaviour in Japanese and Finnish dental students

OBJECTIVE: To determine whether any differences existed in dental health behaviour between Japanese and Finnish dental students. SETTING: Hiroshima University School of Dentistry and the University of Helsinki. DESIGN: Comparison of cross-cultural differences of self-reported oral health behaviour. SUBJECTS: Dental students, 337 in Japan and 113 in Finland. METHOD: Subjects were surveyed using the Japanese and Finnish versions of a 20-item questionnaire entitled Hiroshima University--Dental Behavioural Inventory (HU-DBI). RESULTS: Only 2 per cent of Finnish students reported that they put off going to the dentist until they had toothache, compared to 56 per cent of Japanese students. Similarly, significantly more Japanese students thought that their teeth were getting worse despite their daily brushing, compared to their Finnish peers. The mean HU-DBI score of Year 1 Finnish students was higher than that of their Japanese peers, which suggested a higher level of dental health awareness in Finnish students upon entry into dental school. The mean scores of the Japanese students were lower than those of their Finnish peers until Year 3. The mean scores of Year 5 and Year 6 Japanese students were higher than that of Year 1 students, indicating raised self-care levels influenced by the course in preventive dentistry. The gender difference of the HU-DBI score was not a major feature in either country. CONCLUSIONS: Self-reported oral health behaviours seemed to be very different between the two countries, which reflected different culture and/or health education systems of the students.     

Computer literacy and attitudes of dental students and staff at the University of the West Indies Dental School

Introduction:  The University of the West Indies (UWI) Dental School is planning to implement computer-based information systems to manage student and patient data. In order to measure the acceptance of the proposed implementation and to determine the degree of training that would be required, a survey was undertaken of the computer literacy and attitude of all staff and students.
Methodology:  Data were collected via 230 questionnaires from all staff and students.
Results:  A 78% response rate was obtained. The computer literacy of the majority of respondents was ranked as 'more than adequate' compared to other European Dental Schools. Respondents < 50 years had significantly higher computer literacy scores than older age groups (P < 0.05). Similarly, respondents who owned an email address, a computer, or were members of online social networking sites had significantly higher computer literacy scores than those who did not (P < 0.05). Sex, nationality and whether the respondent was student/staff were not significant factors. Most respondents felt that computer literacy should be a part of every modern undergraduate curriculum; that computer assisted learning applications and web-based learning activity could effectively supplement the traditional undergraduate curriculum and that a suitable information system would improve the efficiency in the school's management of students, teaching and clinics.
Conclusion:  The implementation of a computer-based information system is likely to have widespread acceptance among students and staff at the UWI Dental School. The computer literacy of the students and staff are on par with those of schools in the US and Europe.     

Present state of dental health knowledge, attitudes/behaviour and perceived oral health of Japanese employees

The aim of this survey was to assess the present state of dental health knowledge, attitudes/behaviour and perceived oral health of Japanese employees. A 60-item questionnaire was used in a dental health project in the work place. The subjects comprised 77,845 employees, 76 per cent of whom reported delaying a dental visit until they had toothache, with about 60 per cent delaying even when they discovered a decayed tooth. The majority did not regard decayed teeth as a disease and only a minority reported regular dental visits. About three quarters reported bleeding gums on brushing, although more than half had never been taught professionally how to clean their teeth and less than 5 per cent flossed daily. More than half believed that false teeth were inevitable in old age, and that their teeth were getting worse despite daily brushing. About 70 per cent of the employees thought that it was impossible to prevent gum disease with toothbrushing alone, and nearly half believed a toothpaste with fluoride was effective in preventing periodontal disease. Reorientation of oral health care in Japan, therefore, is urgently needed and dental services have to be provided for the implementation of systematic oral health promotion for employees in the workplace.     

Self-reported differences between oral health attitudes of pre-clinical and clinical students at a dental teaching institute in Saudi Arabia

ObjectiveTo compare the attitudes of preclinical and clinical dental students toward their own oral health using the Hiroshima University-Dental Behavioral Inventory (HU-DBI).MethodsThe English-language version of the 20-item HU-DBI was distributed to all preclinical and clinical students at the College of Dentistry, University of Dammam, Kingdom of Saudi Arabia. Dichotomized (agree/disagree) responses to 12 HU-DBI items were used in this study, with a maximum possible score of 12. Responses to the remaining eight statements reflected general oral health attitudes and were excluded from the analysis. Data were analyzed statistically.ResultsThe overall response rate was 72.2% (preclinical, 72.5%; clinical, 72%). The mean HU-DBI score was significantly higher among clinical than among preclinical dental students (7 vs. 5.8; P < 0.05). Higher proportions of preclinical than clinical students did not worry about visiting the dentist but postponed dental visits until they experienced toothache. Furthermore, more preclinical than clinical students reported that their gums bled upon brushing, used a child-sized toothbrush, had observed white, sticky deposits on their teeth, and used strong strokes for toothbrushing. More clinical than preclinical students reported that they did not feel that the condition of their teeth was worsening despite brushing, worried about the color of their teeth, brushed each of their teeth carefully, and checked their teeth in the mirror after brushing.ConclusionsDental health awareness programs should be implemented and information about positive oral health attitudes should be provided to the students at an initial stage of dental training.     

Attitudes of dental and medical students in their first and final years of undergraduate study to oral health behaviour

OBJECTIVE: To compare differences in attitude to oral health behaviour amongst medical and dental students when they were in years 1 and 5 of University study respectively. METHODS: Medical and dental students of Peking University in Beijing, China were invited to take part in this study. The original version of the Hiroshima University-Dental Behavioural Inventory (HU-DBI) was written in Japanese. After testing the validity of both English and Chinese versions, the revised Chinese version of the HU-DBI was administered to new medical and dental students. In their final year of University study, the same questionnaire was again administered. RESULTS: Significant differences were found for 13 of 21 items, reflecting an improvement in oral health attitudes and behaviour in final year dental students when compared with the time they were entrants. This difference was not found to be significant in the sample of medical students. CONCLUSIONS: There were significant differences in oral health attitudes and behaviours in dental students between entrance to University and the final year of their study. The same was not found to be true for medical students.     

The relationship between dental caries status and oral health attitudes and behavior in young Israeli adults

The aim of this study was to investigate the epidemiologic relationship between oral health attitudes and behavior as measured by the Hiroshima University-Dental Behavioral Inventory (HU-DBI) and dental caries status using the DMF in a sample of young Israeli adults. The HU-DBI (in Hebrew) was used to survey 123 young Israeli army recruits (eighteen and nineteen years old). All participants submitted to a clinical and radiographic dental examination. Dental caries status was evaluated using the World Health Organization (WHO) caries diagnostic criteria for decayed, missing, and filled teeth and surfaces (DMFT and DMFS, respectively). Data were statistically analyzed. DMFT and DMFS scores, which measure dental disease, ranged from 0 to 24 (average 6.77) and from 0 to 48 (average 10.95), respectively. There were sixteen (13 percent) caries free (DMF=0) participants. When relating the different DMF values to the HU-DBI responses, a statistically significant relation was found between seven items and DMF scores or their components and indices. The HU-DBI score ranged from 2 to 9 (mean 5.8, SD=1.5). Low DS and DT values significantly correlated with a high total HU-DBI score (p<0.05); that is, subjects with low levels of dental disease had more positive oral health attitudes and behavior. In young Israeli adults, dental disease, as measured by DMF scores or their components, were related to HU-DBI, which demonstrate the relationship of dental caries status with oral health behavior. Special emphasis should be given to improving patients' oral health attitudes and behaviors by providing patient education during treatment.     

The evolution of dental health in dental students at the University of Barcelona

The aim of this research was to study the evolution of dental health of dental students during their academic training and to assess the extent to which the knowledge acquired was reflected in their own dental care. A sample of 107 students at the schools of dentistry and medicine (the latter as a comparison group) of the University of Barcelona, Spain, underwent an oral examination and completed a questionnaire during their training in the third and fifth academic years. The oral examinations were limited to the status of teeth. Bitewing radiographs were used for both posterior sectors, and these were interpreted using the criteria proposed by Pitts (1984). The data were analyzed using the SPSS package. At the end of the study, medical students had more teeth present than dental students (29.80 vs. 28.94 [p = 0.022]) and a lower DMFT index of 4.33 vs. 5.91 (p=0.038), with an FT component of 2.44 and 5.23 (p = 0.011), respectively. All dental students underwent more treatment of all types than medical students, and dental health habits and knowledge were superior in dental students. The third year was the key year for decision making with regard to the student's dental health. We conclude that dental students are highly motivated about maintaining their dental health and their dental education experiences appear to have had a clear influence on this behavior.     

Dental health behaviour in relation to caries status among medical and dental undergraduate students of Udaipur district,India

To cite this article:
Int J Dent Hygiene
DOI: 10.1111/j.1601‐5037.2008.00346.x
Kumar S, Motwani K, Dak N, Balasubramanyam G, Duraiswamy P, Kulkarni S. Dental health behaviour in relation to caries status among medical and dental undergraduate students of Udaipur district, India. Abstract: Objective: To compare the caries status and oral hygiene behaviour of dental and medical students and to assess the influence of oral hygiene behaviour on the caries status. Methods: A questionnaire survey was conducted to assess the knowledge, attitudes and behaviour along with clinical examination to asses the caries status. A total of 403 dental and medical students enrolled with Rajasthan University of Health Sciences of Udaipur district, India were recruited in the study. Results: 56.4% of dental students brushed their teeth twice daily compared to 38.5% of medical students. There was no significant difference between the mean decayed components of males and females of dental stream, whereas among medical subjects, males had a higher decayed score than females (P = 0.012). The mean behaviour score obtained by dental students (19.38) was greater than that of medical students (18.34). Moreover, medical students presented a higher decayed, missing and filled teeth (DMFT) score (1.96) than dental students (1.16). Subjects who had a habit of brushing after every meal showed lower DMFT score (1.4) than those who brushed only once a day (1.64). Step‐wise linear regression analysis revealed that course of education and final behaviour score were the best predictors for the DMFT status. Conclusion: This study revealed significant differences between the oral hygiene behaviour and caries status of dental and medical students; furthermore, caries status was significantly influenced by the oral hygiene behaviour.