Eğitimin Hemşirelik Öğrencilerinin Ağız ve Diş Sağlığı Farkındalıklarına Etkisi Üzerine Karşılaştırmalı Bir Çalışma

Amaç: Bu çalışmanın amacı, “Toplum Ağız ve Diş Sağlığı” dersinin iki farklı fakültedeki hemşirelik öğrencilerinin ağız ve diş sağlığı farkındalıklarına etkisini değerlendirmektir.

Gereç ve Yöntem: Kırıkkale Üniversitesi’nde “Toplum Ağız ve Diş Sağlığı” dersi alan 164 hemşirelik öğrencisi ile Bolu Abant İzzet Baysal Üniversitesi'nden aynı dersi almayan 230 hemşirelik öğrencisi ankete tabi tutuldu. Anket, ağız ve diş sağlığı farkındalığı ile ilgili çoktan seçmeli sorulardan oluşmaktadır. İstatistiksel analiz Pearson veya Fisher’s exact chi square test ile yapıldı.

Bulgular: Öğrencilerin gargara ve diş ipi kullanma oranları arasında istatistiksel olarak anlamlı bir fark yok iken (p>0.05), diş fırçalama alışkanlıkları arasında vardı (p<0.05). Grupların periodontal hastalıkları etkileyen faktörler ve semptomları konusundaki farkındalıkları (p>0.05) istatistiksel olarak anlamlı farklılık göstermedi. “Annesinde diş çürüğü olan çocuklarda çürük görülme olasılığı daha yüksektir” kavramı dersi alan öğrenciler tarafından daha iyi bilinmektedir (p<0.001). Diş çürümesinin nedeni açısından iki grup arasında istatistiksel olarak anlamlı fark vardı (erken yaşta diş çürüğü bakterileri ile enfekte olma, p=0.001).

Sonuç: “Toplum Ağız ve Diş Sağlığı” dersi alan hemşirelik öğrencilerinde ağız ve diş sağlığı farkındalığı artmıştır. Hemşireler, halk sağlığı eğitimi ve ağız sağlığı değerlendirmeleri için potansiyel aday olduklarından, bu dersin hemşirelik eğitimi müfredatına dahil edilmesi halkın farkındalığını artırıp ağız sağlığını iyileştirmeye katkı sağlayacaktır.

Objective: The aim of this study was to evaluate the effect of “Community Oral and Dental Health” course on the oral and dental health awareness of nursing students from two different faculties.

Materials and Methods: 164 nursing students who took “Community Oral and Dental Health” course at Kırıkkale University and 230 nursing students from Bolu Abant İzzet Baysal University who did not take the same course were subjected to the questionnaire. The questionnaire consisted of multiple choice questions based on oral and dental health awareness. The statistical analysis was performed with Pearson or Fisher’s exact chi square tests.

Results: Although, there was no statistically significant difference (p>0.05) between the mouthwash and dental floss use, there was a statistically significant difference between tooth brushing habits of the students (p<0.05). Also, the groups' awareness of the symptoms and affective factors of periodontal diseases did not indicate statistically significant differences (p>0.05). The concept “Children who have dental caries in their mothers are more likely to have it” was better known by the students taking the course (p<0.001). There was a statistically significant difference between two groups in terms of the cause of dental caries (being infected with caries bacteria at an early age, p=0.001).

Conclusions: The oral and dental health awareness increased among nursing students taking the “Community Oral and Dental Health” course. Since, the nurses are potential candidates for public health education and even oral health assessments, inclusion of this course in the nursing curriculum will increase public awareness and improve oral health.

Giriş

Oral health is considered as an integral part of general health. World Health Organization (WHO) defines oral health as a condition in which craniofacial defects such as chronic orofacial pain, mouth sore and cancer, periodontal diseases, dental caries, tooth loss or other affecting diseases are eliminated [1]. American Surgical Association has declared oral and dental diseases as a silent epidemic due to the prevalence of oral health diseases and the relation between oral health and systemic diseases such as diabetes and heart diseases [2]. WHO has demonstrated that interdisciplinary collaboration practices in healthcare services strengthen patient management practices [3]. For this reason, the instructions and regulations issued by the Ministry of Health in Turkey have demanded primary care healthcare services to prepare preventive and therapeutic programs related to oral and dental health, to educate the society and to conduct periodic screening for oral and dental diseases [4].

Oral health education for midwives and nurses has recently gained importance in programs all over the world. Nursing undergraduate education includes few oral health courses and the content is only about understanding the healthy oral cavity [5]. Another problem in improving dental health and providing daily oral hygiene is that individuals and their families, nurses, doctors and caregivers do not give enough priority to oral health. Educating nurses can be difficult and problematic under these conditions [6]. However, educating midwives and nurses on oral and dental health is essential because of their responsibilities. So, they can be confident and provide convenient service [7].

In the light of this information, the aim of this study was to evaluate the effect of “Community Oral and Dental Health” course on the oral and dental health awareness of nursing students, its relation with general health, its effect on their habits and attitudes.

Gereç ve Yöntem

Research and Publication Ethics: The present study was conducted to evaluate the oral and dental health awareness of nursing students of Kırıkkale University and Bolu Abant İzzet Baysal University. The junior and senior nursing students were included in the study. Ethics committee approval (Date: 13.03.2019, No:2019/47) was received from Bolu Abant İzzet Baysal University Clinical Research Ethics Committee and informed consent form was obtained from the participants.

164 junior students who took “Community Oral and Dental Health” course at Kırıkkale University, Faculty of Health Sciences, Department of Nursing and 230 junior and senior students from Bolu Abant İzzet Baysal University, Faculty of Health Sciences, Department of Nursing who did not take the same course were subjected to the questionnaire. The sample size was determined as 188 with a 95% confidence interval and a 5% margin of error.

The questionnaire consisted of questions based on oral and dental health awareness [4] and was divided into two sections: Single-answer Multiple-choice questions and Multiple-answer Multiple-choice questions.

Statistical Analyses: The statistical analysis was performed with SPSS Statistics (SPSS IBM, Turkey). Pearson or Fisher’s exact chi square tests were used to compare two groups. The statistical significance level was accepted as 0.05 in all tests.

Bulgular

394 volunteer junior and senior nursing students (age 19–30 years) participated in the questionnaire (Table 1). The statistical analysis of answers to single-answer multiple-choice questions is shown in Table 2, and those of the multiple-answer multiple-choice questions are shown in Table 3.

Although both groups gave a positive answer to the question “the effect of mothers’ oral health on their child’s oral health”, the response rate was higher for the students taking the course (82.60% - 92.78%, p<0.05). Both groups knew “the importance of oral health for preschoolers.” The rate of going to a dental checkup in the last year was 33.53% for students who took the course and 43.04% for those who did not. Although, there was no statistically significant difference (p>0.05) between the mouthwash (p=0.512) and dental floss use (p=0.533), there was a statistically significant difference between tooth brushing habits of the students (p<0.05). They knew that poor oral hygiene and sugar consumption caused dental caries. There was a statistically significant difference between two groups in terms of “being infected with dental caries bacteria at an early age” (p=0.001). This rate was 57.39% for the students who did not take the course, and 74.39% for the students taking the course.

In the question of preventing dental caries, a significant difference was found only between the rates of "Chewing sugar-free gum" (p<0.001) and "Regular use of fluorine-containing products" (p<0.001). The view that “Children who have dental caries in their mothers are more likely to have it” was better known by the students taking the course (p<0.001). There was a statistically significant difference in “Dental caries in pregnancy is important for both mother and child” (p<0.001).

There was no statistically significant difference between the groups' awareness of the symptoms and affective factors of periodontal diseases (p>0.05). Although there was a statistical difference (p=0.023, p<0.05), “Dental caries is a preventable disease during pregnancy” was not exactly perceived by both groups.

Tartışma

The present study evaluated the oral and dental health knowledge and attitude of nursing students who are candidates for healthcare professionals. The most important limitation was the participants’ responses, which could be subjected to verification bias and be affected by social acceptability. Nevertheless, the results of present study will be useful in educational programs that aim to change students' approaches and attitudes towards oral and dental health.

In present study, questions about oral hygiene in children were answered correctly by both groups at similar rates in contrast to a previous study [8]. The rate of brushing teeth two or more times a day was lower than Mohd-Dom et al. [9] and higher than Oyetola et al.[10]. It can be concluded that tooth brushing habits of the students taking the course were relatively better. These studies of well-educated young adults reflect much better oral hygiene behavior than the national average, as 15% of adults in a national study did not have a toothbrush, and only half of those with a toothbrush used it every day. In addition, it is stated that only 26% of people in our country brush their teeth two or more times a day [11]. In present study, the oral hygiene behaviors of the nursing students were sufficient and the results of the students taking the course were similar to other studies [8,12,13]. On the other hand, the use of dental floss and mouthwash was found to be lower in both groups compared to other studies [14,15]. The effects of tooth brushing and flossing on caries prevention and nutrition on caries were perceived by both groups. As in the previous study, this may be related to basic nutrition courses [5]. Although, it was stated that dental caries is a driving factor in going to the dentist [14-16], approximately 98% of the students in both groups stated that regular visits are necessary for oral and dental health, and this was higher than in other studies [17,18].

In present study, the use of fluorine-containing products in the prevention of dental caries was better known by the students taking the course. This was confirmed by Kim et al., but they stated that a lack of information was also observed [13]. In the literature, the response rate regarding the role of fluoride in dentistry is considered low [14,19].

Sharda and Shetty [17] and Kılınç and Günay [20] concluded that the knowledge level of university students who received health education was higher than those who did not. In another study, it was stated that the lower oral health knowledge of medical students compared to dental students may be due to the absence of an oral health course. Therefore, oral health education should be included in the medical curriculum [21]. This was confirmed by the results of the present study as the radiotherapy question, which is a more detailed question, was better known by the students taking the course.

In oral health services, it is essential to inform and guide mothers during pregnancy as the mother's oral hygiene has a significant impact on the child's future oral hygiene status [22]. For this reason, midwives and nurses should have sufficient knowledge about dental problems that are common during pregnancy and early childhood [5]. This was relatively well known to the students taking the course. Both groups stated that they would highly recommend a dental examination to mothers who gave birth. They also had more information about the gingival health of pregnant women, the importance of dental caries in pregnancy and primary tooth. However, both groups did not have sufficient information about the relation between oral health and general health, unlike the previous study [4]. For this reason, these subjects should be included more in the course content.

Andhare et al. stated that oral health attitudes and behaviors were related to education [21]. Therefore, the level of oral health can be improved with education programs for various professionals. The motivation of the next generation of professionals to maintain excellent oral health practices may be possible with the oral health motivation program that is part of the academic curriculum of universities and colleges [23]. It was also stated that oral health education should be improved and strengthened as nurses and caregivers must be able to meet oral health standards [24]. This was confirmed by a study in New Zealand that analyzed the effects of implementing the oral health curriculum on nurses' knowledge and concluded that most nurses had the right knowledge [25]. Various studies have demonstrated that continuing and regular education programs help to provide comprehensive knowledge both in the short and long-term [26,27]. In this respect, this study seems to be compatible with them.

While most children in many countries are not examined by a dentist before age 3, they are in frequent contact with primary care providers, including nurses, for routine checkups and vaccinations before age 1. These routine check-ups give healthcare professionals an opportunity to assess children's oral and dental health and refer them to the dentist when a disease is diagnosed. Therefore, it is crucial to train these healthcare professionals to enable them to provide appropriate advice and promote oral and dental health in the community [8].

Since the inclusion of oral and dental health education in healthcare curricula has been discussed all over the world [28], there is a need for further studies evaluating oral and dental health education in nursing in order to determine the content of the curriculum and to plan educational programs for the society.

As a result, the oral and dental health awareness increased among nursing students taking the “Community Oral and Dental Health” course. Since, the nurses are potential candidates for public health education and even oral health assessments, inclusion of this course in the nursing curriculum will increase public awareness and improve oral health.

Acknowledgement
We would like to thank all the participating students. The authors declare no competing interest.

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