Evaluation of Good Oral Practices among Students: A Cross-Sectional Study

Objective: The objective of the study was to determine the good oral practices (GOP) among university students. Materials and Methods: A cross-sectional study was conducted using a convenience sampling method. A self-developed and pre-validated tool was used to collect data from students studying at a university in Malaysia. The Statistical Package for Social Science (SPSS) Version 24.0 was used to analyze the data. Results: A total of 324 respondents had participated in the study. The respondents were from four different faculties; pharmacy 118 (36.4%), medicine 81 (25.0%), business 67 (20.6%), and biotechnology 58 (18.0%). Original Research Article Iqbal et al.; JPRI, 32(27): 98-105, 2020; Article no.JPRI.62061 99 Conclusion: The final year students had more good practices towards good oral practices. The unmarried students also had more good practices towards oral health.


INTRODUCTION
Good oral health is essential for good appearance and overall good health [1]. Various severe conditions, such as respiratory diseases, are directly related to oral health [2]. Tooth cavities and gingiva diseases may contribute to many diseases [3]. If the cavities are not treated properly, it may lead to pain and severe infections in the body [1]. Good oral health may comprise the process of maintaining our teeth free from cavities by regular brushing and avoiding gingiva disease [4]. Poor oral health not only can decrease quality of life and appearance but can also cause sleeping disorders in children [5]. Poor oral health may also produce digestion problems for food because they are important for chewing and swallowing of food [6]. Oral health is essential for all ages of life to keep teeth more robust ever before [7].
Poor oral health can be linked to the gastric problems such as stomach ulcers, intestinal cancer, and cardiac diseases [8]. Keeping the teeth clean can help to decrease the bad breath. Bad breath is usually produced by plaque and is considered as the first indication of gum diseases [9]. The brushing of teeth is considered a requirement for reducing the quantity of bacterial plaque in the mouth [10]. Oral infections and disorders are obviously associated with good behavior [11]. Many oral disorders can be vetoed if appropriate awareness is provided to improve the behavior of the people of a community. Proper knowledge about oral health is the first requirement for adequate oral health practice [12].
Various studies have been conducted to evaluate the knowledge of oral health and oral practices for adults and old people [12][13][14], but still, there is a lack in the literature to evaluate the knowledge and practices of university students. The university students are considered as the most educated people of the community. Therefore, the good knowledge of university students should be reflected in their good oral practices. The current study was carried out to appraise the good oral practices of university students regarding their overall oral health.

METHODOLOGY
A cross-sectional observational study was carried out in a private university for evaluating the oral health practices of university students in Malaysia. A reliable and validated questionnaire was self-administered for the current study data collection. A Convenience sampling technique was adopted for sample size calculation from different faculties of a private university in Malaysia. Different oral health practice-related questions were asked from the participants. All the participants were asked to understand the questions entirely before answering. All the respondents were asked to give the answers based on their daily practices. The answer options were divided into 'yes' and 'no' format to make ease for respondents to answer the questions. All the collected data in the form of information for individuals were strictly confidential and used for clinical research only.
Statistical Package for Social Science (SPSS) was used to performed data analyses and statistical presentations. The normality of the data was checked, and the data was found as categorical data. Therefore, categorical data were analyzed by Chi-square and Fisher exact test to find the p-value. For the quantitative measure of the magnitude of statistical significance, the effect size was calculated by Phi φ, Cramer's V test. A value of P < 0.05 was considered statistically significant for the current study.

RESULTS
A total of 324 respondents had participated in the current study. The respondents were from Pharmacy, Medicine, Business, and Biotechnology faculties of a private university in Malaysia. The demographic characteristics of the respondents were as follow in Table 1.

Practice question 1: I brush my teeth twice a day.
The majority of the response of respondents to question 1 answered 'Yes' as shown in Table 2. The statistically significant and weak positive association was observed in faculty (p=0.005), place of living (p=0.032), gender (p=0.009), and residence (p=<0.001) variable. Statistically significant and weak negative association were observed in marital status (p=<0.001) variable of question 1. There was no statistical significance seen in any other variable.
Practice question 2: I use mouthwash after every meal.
The majority of the response gotten from the respondents in question 2 showed to have answered with 'No'.
The statistically significant and weak positive association were observed in faculty (p=0.018), year of education (p=0.021), and gender (p=0.002). Statistically significant and weak negative association were observed in the marital status (p=<0.001) variable of question 2. There was no statistical significance seen in any other variable.

Practice question 3: I floss my teeth every day.
Majority of the response gotten from the respondents in question 3 showed to have answered with 'No'.
The statistically significant and weak positive association were observed in faculty (p=0.048), year of education (p=0.018), and place of living (p=0.011). Statistically significant (p=029) and weak negative association was observed in marital status variable of question 3. There was no statistical significance seen in other any variable.
Practice question 4: I use toothpaste with fluoride.
The response from the respondents to question 4 majority had showed to have selected the answer 'Yes'.
The statistically significant and weak positive association were observed in year of education (p=0.021) variable. Statistically significant and weak negative association were observed in marital status (p=010) variable of question 4. There was no statistical significance seen in any other variable.

Practice question 5: I change my toothbrush regularly.
Majority of the response gotten from the respondents in question 5 showed to have answered with 'Yes' instead of 'No'.
The statistically significant and weak positive association were observed in faculty (p=0.040), year of education (p=0.033), gender (p=0.005) and age (p=0.041) variable. Statistically significant and weak negative association were observed in marital status (p=0.002) variable of question 5. There was no statistical significance seen in other any variable.

DISCUSSION
The current study was the first-ever study in any Malaysian university on good oral practices assessment of university students. The findings of the present study proved that the medical students of the university had a more negative practice (14.8%) as compared to the other students (6.0%) when the question was asked about the brushing of the teeth twice a day. The statistically significant and weak positive association were observed in faculty variable (p=0.005). A total of 14.8 % of medical students were from the point of view that there is no need to brush the teeth twice in a day. Nevertheless, most of the students were agreed to brush the teeth twice a day. The probable reason behind could be the appearance of the students. All the students wanted to have clean teeth in university life. The findings of current study were in line with the finding a study conducted in China, where most of the students had proper knowledge and positive behavior about good oral health [14].
The results of the present study showed that the final year students had a more positive practice (31.6%) as compared with the pre-final year students (18.3%) when the question was asked about the use of mouthwash after every meal. The possible reason behind could be the knowledge of the respondents. The final year students may have better knowledge as compared to the pre-final year students. Similar results reported for the response when the question was asked about the floss of teeth every day. The final year students had better practice as compared with the prefinal year students. The previous studies reported that knowledge is directly affecting the good practice of the respondents [15]. The finding of current study is similar with the finding of a study conducted in Kuwait, according to which the knowledge is directly effecting on the behaviors and practices of the students [16].    The findings of the current study showed that the unmarried students had a more positive practice (86.3%) as compared with the married students (50.0%) when the question was asked about the use of toothpaste with fluoride. The reason behind could be the number of students in each category. The number of unmarried students was more in the study as compared to married students. The number of students is directly affecting the results of studies. The finding of current study are similar to the finding of a study conducted in Malaysia on root canal treatment in oral health, according to which the unmarried students had better knowledge as compared with the married students [17].
Similarly, the results of the present study presented that the female students had better practice (87.2%) as compared to the male students (78.7%) when the question was asked about the change of toothbrush regularly.

CONCLUSION
The present study described mixed answers regarding the good oral practices among different students in a private university in Malaysia. The final year students had more good practices towards good oral practices. The unmarried students also had a more good practices towards oral health.

CONSENT AND ETHICAL APPROVAL
The ethical approval of the present study was taken from the university research and ethical committee. The pre consent form was signed from all the willing participants of the current study.