Knowledge, attitudes, and practices of oral hygiene among dental and non-dental participants - A comparative study

INTRODUCTION

Dental health is an individualized notion influenced significantly by one’s culture and socioeconomic status. The way individuals perceive their own teeth, as well as the approach dentists take in providing dental care, are crucial factors shaping overall oral health within a population.^[1] Oral diseases present a significant public health challenge due to their widespread prevalence and the impact they have on an individual’s quality of life. The World Health Organization states that “Promotion of oral health is a cost-effective strategy to reduce the burden of oral disease and maintain oral health and quality of life.”^[2]

Periodontal disease is an inflammatory condition impacting both the soft and hard tissues surrounding the teeth. If left untreated, early-stage gingivitis can progress to periodontitis, resulting in increased tooth mobility and eventual tooth loss.^[3] The primary cause of periodontal disease is bacterial plaque, while various other factors such as hormonal influences, inadequate nutrition, diabetes, smoking, and stress can contribute to the onset and progression of gingival and periodontal diseases.^[4] Many oral diseases can be prevented through proper tooth brushing, the use of various interdental aids, regular dental flossing, and timely dental visits.^[3] Unfortunately, due to insufficient awareness and misleading advertisements, proper brushing is often neglected or performed incorrectly.^[5] Dental students, as future dentists, have the potential to influence the oral health of their communities through their knowledge and hygiene practices.^[3] Moreover, the perceptions and behaviors of dental professionals significantly influences how they provide oral healthcare. Therefore, enhancing awareness of oral health is crucial, as dentists play a pivotal role in leading health services and promoting public oral health.^[5]

Oral hygiene habits and the willingness to seek dental care are influenced by various factors. One of the main reasons for not adhering to oral hygiene practices is a lack of knowledge.^[6] Many investigations have been conducted across different regions of the world; numerous studies have demonstrated a correlation between amplified oral health knowledge and improved oral hygiene behaviors.^[7] However, comparative studies examining knowledge and practices between dental and non-dental sectors remain limited. Therefore, this study aims to assess the knowledge, attitudes, and practices related to oral hygiene among dental students, dental professionals, and individuals from non-dental backgrounds.

MATERIALS AND METHODS

A cross-sectional study was conducted between July and August 2024 to evaluate the attitudes, awareness, and knowledge of dental practices and habits among the dental sector and non-dental sector. Participants were recruited through an online survey using a self-reported questionnaire shared through social media platforms such as WhatsApp and Gmail. The convenience sampling method was primarily used, followed by snowball sampling, where initial participants were requested to share the invitations with their peers. The minimum required sample was estimated to be 381 with a 50% acceptance rate, 5% absolute precision, and 95% confidence level. A total of 420 participants were recruited, with 202 from the dental field and 218 from outside the dental sector.

The structured questionnaire, based on several related surveys, consisted of 18 questions in two parts. The first part collected demographic and professional data. The second part contained 11 questions related to knowledge about oral health and its maintenance, including frequency of brushing, use of toothpaste, duration of brushing, toothbrush hardness, brush type, frequency of changing the toothbrush, brushing technique, use of interdental aids, use of mouthwash, and frequency of visits to the dentist. Data analysis was conducted using Stata 17 software (STATA Corporation, College Station, TX, USA). The Chi-square test was performed to compare responses from the dental domain and non-dental domain, with a P < 0.05 considered statistically significant.

RESULTS

The distribution of the study participants according to demographic and social characteristics is listed in Table 1. This study included a total of 420 people; among them, 36.4% were males and 63.6% were females. The largest age group was 18-24 years, with 243 participants (57.9%), and approximately 47.6% were graduates. Out of 420 participants, 202 were from the dental domain, while 218 were from the non-dental domain. Table 2 provides insights regarding awareness of daily oral hygiene practices and dental hygiene tools among the study participants, along with their responses to the questionnaire. The data are organized into various categories of oral hygiene practices, including brushing routines, use of dental aids, and professional dental care visits.

Most participants (51.9%) brush twice daily (morning and night), while about 42.1% brush in the morning before breakfast and 2.6% after breakfast. 42.6% do not brush at night, and 46.4% brush occasionally at night. Almost all respondents (98.6%) use toothpaste, while a small percentage use alternative tools such as neem sticks (0.9%) or tooth cleaning powder (0.4%). Among those using manual toothbrushes, 47.9% prefer soft bristles, 14.8% use extra-soft bristles, 32.9% use medium bristles, and only a small group (1.2%) use hard bristles. The most preferred brushing technique is the horizontal/vertical scrub method (44.3%), followed by the modified bass method (24.3%) and the circular method (22.9%). Most participants (56.4%) replace their toothbrush every 3 months, with fewer replacing it every 6 months (20.5%) or based on wear (18.6%).

While 78.3% of participants are aware of interdental cleaning aids, only 47.3% use them. Among those using floss, 22.5% use it daily, while 21.7% use it weekly, 0.8% use it monthly, and (2.4%) use it occasionally or when something is stuck. More than half (58.8%) use mouthwash, with the most common types being essential oil-based (37.6%) and chemical-based (35.9%). Most participants (52%) visit the dentist only when they have a problem, while 22.4% visit every 6 months, and about 5.5% prefer home remedies.

Table 3 highlights the demographic and educational differences between people working in or associated with the dental field versus those in non-dental professions. The age distribution is quite similar across both domains, with the 18-24-year age group representing the largest proportions in both the dental domain (58.9%) and the non-dental domain (56.9%). The p-value for gender is 0.006, indicating a significant difference in gender distribution between the two domains, with a higher proportion of females in the dental domain (70.3%). The p-value for education level is 0.000, which is highly significant, showing that the dental domain has a higher proportion of graduates (61.8%), while the non-dental domain has a higher proportion with diploma or higher secondary education (33.0%). Table 4 compares various dental awareness practices between individuals in the dental domain and those in the non-dental domain, with the P-value indicating the statistical significance of the differences.

The P-value is 0.001, indicating statistically significant results. In the dental domain, 58.0% brush twice daily, while in the non-dental domain, brushing once in the morning before breakfast (50%) is more common. A highly significant difference (P = 0.000) is observed, with the modified bass method more commonly used in the dental domain (40.6%) compared to the non-dental domain (9.2%). The horizontal/ vertical scrub method is preferred in the non-dental domain (56.9%). A significant difference (P = 0.000) is seen, as 89.1% in the dental domain are aware of interdental cleaning aids, compared to 68.4% in the non-dental domain.

The study shows significant results with a P-value of 0.000, and chemical-based mouthwash is more commonly used in the dental domain (50.0%) compared to the non-dental domain (22.3%). A majority in both domains dilute mouthwash with water (60.5% in the dental domain and 55.7% in the non-dental domain), with no significant difference (P = 0.443). A significant difference is found (P = 0.000), with individuals in the dental domain more likely to use mouthwash after 30 minutes of brushing (42.0%) compared to the non-dental domain (17.7%). In context to professional dental visits, the P-value is 0.007, indicating a significant difference: 30.2% of individuals in the dental domain visit a dentist every 6 months, compared to only 15.15 in the non-dental domain. Moreover, 57.8% in the non-dental domain visit only when there is a problem, while 45.5% in the dental domain do so. These results suggest that individuals in the dental domain exhibit better dental awareness and practices, particularly in terms of oral hygiene techniques, use of interdental cleaning aids, and more frequent dental check-ups.

DISCUSSION

Periodontal health is a key component of oral health. In this study, 11 questions were designed to assess participants’ attitudes, knowledge, and oral health behaviors. In our study, 58% of dental professionals reported brushing their teeth twice a day, a finding consistent with the results of Gattani et al.,^[5] and Malla et al.^[3] Conversely, 51.1% of non-dental participants in our study reported brushing once a day, while 46.3% brushed twice a day. Jain et al.,^[8] found that 33% of their participants brushed once a day, and 23% brushed twice daily. In contrast, Sabounchi et al.,^[9] found that a majority of participants (73.1%) brushed only once a day. In the present study, brushing emerged as the most common method of teeth cleaning. Among dental professionals, 98.5% used a toothbrush and toothpaste, a finding consistent with the studies by Andhare et al.,^[10] and Rahman and Al Kawas,^[11] where 96% and 98.3% of dental students, respectively, preferred this method. Non-dental participants in our study also exhibited similar behavior, with 98.6% using a toothbrush and toothpaste. A comparable trend was observed in the study by Kapoor et al.,^[6] where 90.3% of patients employed this method. Regarding toothbrush type, the majority of non-dental respondents (92.7%) in our study used a manual toothbrush, a finding that aligns with Tadin et al.,^[7] which reported that 90.1% of their participants also used manual brushes.

In the current study, among dental domain, 69.4% preferred a soft-bristled toothbrush, a preference analogous to the findings of Vangipuram et al.,^[12] and Peker and Alkurt,^[13] where 85.1% and 80.7% of dental students, respectively, did not favor using hard brushes. Among 220 non-dental participants in our study, 57.4% preferred a soft brush, 38.1% favored a medium brush, and 1.8% used a hard brush. These results are in line with those of Manju et al.,^[2] who found that 51% of 100 participants preferred a soft brush, 38% chose a medium brush, and 2% used a hard brush. In contrast, a study by Jain et al.,^[8] found that only 10% of participants used a soft brush, indicating a significant difference in preferences.

Brushing techniques such as Bass, Fones, Charter’s, Stillman’s, and the vertical and horizontal scrub methods are commonly taught. Interestingly, in our study, the majority of dental participants (40.6%) used the Bass method, while 30.7% employed the horizontal/vertical technique. Correspondingly, Malla et al.,^[3] reported that about 50% of dental students preferred the horizontal/vertical method. These results differ from those of Gattani et al.,^[5] where the majority of dental students (72%) used both vertical and horizontal techniques. Whereas the majority (56.9%) of non-dental participants in the present study preferred the horizontal/vertical brushing technique, while 21.1% favored the circular technique. These findings are similar to those of Tadin et al.,^[7] where 19.7% of participants preferred the circular technique, while only 4.1% used the horizontal/vertical method.

In terms of toothbrush replacement, the majority of dental participants (58.0%) in our study replaced their toothbrush every 3 months, while 22.3% replaced it every 6 months. This contrasts with the findings of Gattani et al.,^[5] where 52% of dental students replaced their toothbrushes every 6 months. Among non-dental domain, more than half (55.1%) replaced their toothbrush every 3 months, which is consistent with the results of Tadin et al.^[7] Our study found that 89.1% of dental participants were aware of interdental cleaning aids, unlike the study by Malla et al.,^[3] where 50% of dental students were unaware of these aids. In a study by Merchant et al.,^[14] 56.3% of dental participants and 36.4% of non-dental health professionals flossed at least once daily. In comparison, our study showed that only 23.0% of dental participants and 22.1% of non-dental participants flossed once daily.

Regarding mouthwash use, more than half of the respondents in our study, both from the dental domain (60%) and non-dental domain (57.8%), reported using mouthwash, with 45.7% of dental participants and 47.8% of non-dental participants using it at least once a day. These findings align with those of Neeraja et al.,^[15] where 54.8% of dental students used mouthwash daily. However, the findings from AI-Omari and Hamasha^[16] study differ, with only 33.1% of dental participants using mouthwash daily. In addition, a study by Tadin et al.,^[7] found that only 20.9% of non-dental participants used mouthwash daily. Finally, in our study, 45.5% of dental participants reported visiting dental clinic only when they had a problem, while 30.2% visited every 6 months. These results are comparable to the study directed by Malla et al.,^[3] where 28.3% of the study population had a dental checkup at least once every 6 months. Concerning, non-dental participants of the present study, 57.8% visited the dentist only when necessary, and only 15.1% visited every 6 months. These findings are consistent with the study by Kapoor et al.,^[6] where only 10% of participants visited the dentist regularly, while 75% visited only when there was a problem. Similarly, Jain et al.,^[8] found that 54% of subjects visited the dentist only when they experienced pain.

Regarding the strengths of the study, 420 participants were recrutied, which is a large sample size. This provides a substantial dataset, increasing the reliability and generalizability of the findings. By including both dental participants and non-dental individuals, the study provides a comparative analysis, allowing for insights into differences in oral health knowledge, practices, and attitudes across different sectors. Regarding limitations, the cross-sectional design limits the ability to infer causal relationships. While associations can be observed, the study cannot determine whether certain behaviors directly lead to better oral health outcomes.

CONCLUSION

This study reveals notable differences in how dental participants and the general public approach oral hygiene. Dental participants demonstrated better oral hygiene habits, including more frequent brushing, use of interdental aids, and regular dental visits. Conversely, many in the general population sought dental care only when problems arose. The findings emphasize the need for better oral health education, especially for the general public, to encourage healthier habits and regular dental checkups. Dental professionals, as influential figures in public health, have an essential role in leading efforts to raise awareness about the importance of maintaining good oral hygiene habits, which can help reduce the risk of oral diseases like periodontal disease. Further educational interventions and targeted campaigns may help bridge the knowledge gap and encourage preventive care across diverse populations.