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ORIGINAL ARTICLE
Year : 2020  |  Volume : 11  |  Issue : 4  |  Page : 161-165

A comparative study of oral health-related quality of life, depression, and periodontal health status of Turkish preclinical dental students


Department of Periodontology, Faculty of Dentistry, Usak University, Usak, Turkey

Date of Submission10-Aug-2020
Date of Acceptance19-Nov-2020
Date of Web Publication05-Feb-2021

Correspondence Address:
Dr. Fatih Karaaslan
Department of Periodontology, Faculty of Dentistry, Usak University, Usak
Turkey
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DOI: 10.4103/srmjrds.srmjrds_74_20

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  Abstract 

Background: The behavior of dental students, future professionals, toward their own oral health is not only a reflection of their understanding of the importance of disease prevention and improving the oral health of their patients but also affects their daily life and personal satisfaction. Through their undergraduate study, dental students develop and modify their attitudes toward their own oral health, which must improve if they are to serve as positive models for their patients. The aim of the present investigation was to compare the quality of life and associated factors, such as level of depression, with the periodontal and smoking status of preclinical (1st, 2nd, and 3rd year) dental students. Materials and Methods: The study consisted of periodontal assessment and a survey. The survey included demographic data, smoking status, Oral Health Impact Profile-14 (OHIP-14), and the Beck Depression Inventory (BDI). Results: No difference was observed between classes in terms of mean global OHIP-14 scores and BDI scores. The mean plaque index scores of 2nd year students were statistically higher than other students. The mean number of cigarettes smoked per day of 1st year students was significantly lower than other students. Conclusion: Current literature indicates that dental students have higher levels of depression, which correlates with higher smoking rates and lower oral health-related quality of life.

Keywords: Dental students, depression, periodontal health, quality of life, smoking


How to cite this article:
Karaaslan F, Dikilitaş A, Kurt SE. A comparative study of oral health-related quality of life, depression, and periodontal health status of Turkish preclinical dental students. SRM J Res Dent Sci 2020;11:161-5

How to cite this URL:
Karaaslan F, Dikilitaş A, Kurt SE. A comparative study of oral health-related quality of life, depression, and periodontal health status of Turkish preclinical dental students. SRM J Res Dent Sci [serial online] 2020 [cited 2021 Mar 5];11:161-5. Available from: https://www.srmjrds.in/text.asp?2020/11/4/161/308789


  Introduction Top


Oral health is essential for general well-being and an important factor of quality of life.[1] Oral health disorders can affect not only the functional and esthetic state of well-being but also psychological aspects of people by influencing their self-esteem and impacting their interpersonal relationships.[2],[3] The behavior of dental students, future professionals, toward their own oral health is not only a reflection of their understanding of the importance of disease prevention and improving the oral health of their patients but also affects their daily life and personal satisfaction.[4],[5] Through their undergraduate study, dental students develop and modify their attitudes toward their own oral health, which must improve if they are to serve as positive models for their patients.

Dental school is widely acknowledged as being associated with high levels of stress.[6] As a major part of their role in oral health-care provision, students suffer from psychological stress and higher levels of depression.[7] Stress-provoking factors in dental students may arise from examinations, lack of free time, and fear of failing.[8] A recent study showed that stress was the main reason dental students took up smoking, the most important environmental risk factor for periodontal diseases.[9]

Although a number of studies have compared dental students' oral health behavior at different stages of their educational process, few have explored how students' oral health behaviors affect their quality of life as an individual. In this context, the purpose of the present investigation was to compare Oral Health-Related Quality of Life (OHRQoL) and associated factors, such as level of depression, with the periodontal and smoking status of preclinical (1st, 2nd, and 3rd year) dental students.


  Materials and Methods Top


One hundred and sixty-one students were recruited for the study from the Faculty of Dentistry, Usak University. The sample included 72 1st year, 42 2nd year, and 47 3rd year dental students. Written informed consent was reviewed and approved by the University's Ethics Committee and signed by all students (Registration No: 224-02). The study consisted of periodontal examinations and a survey. The survey collected demographic data (age and gender), smoking status, Oral Health Impact Profile-14 (OHIP-14),[10],[11] and Beck Depression Inventory (BDI)[12],[13] scores.

The participants completed the OHIP-14 questionnaire, which consists of seven domains and each domain score range from 0 to 4. Mean OHIP-14 scores range from 0 to 56; a score above 14 is considered an indication of poor OHRQoL.[10],[11]

The BDI consists of 21 questions, and each question score ranges from 0 to 3. The mean BDI score can range from 0 to 63; a score of 0–13 no depression; 14–19, mild depression; 20–28, moderate depression; and a score of 29–63 indicates severe depression.[12],[13]

Plaque index (PI),[14] gingival index (GI),[15] probing depth (PD), and clinical attachment loss (AL) were obtained from six points of each tooth, except third molars by a calibrated periodontist.

Version 17.0 of SPSS (International Business Machines Corporation, New York, USA) software was used for data analysis. OHIP-14 scores, BDI scores, PI, and GI were compared using the Kruskal–Wallis test. Mann–Whitney U-test was used for the comparison of the mean OHIP-14 and BDI scores, according to gender. The relationship between smoking rate and classes was examined using the Chi-square test.


  Results Top


The age and sex distribution of the students are shown in [Table 1]. There were no significant differences between classes in terms of mean global OHIP-14 scores (P > 0.05) (Kruskal–Wallis test). There were significant differences between classes in terms of mean functional limitation score (P < 0.05) (Kruskal–Wallis test) [Table 2].
Table 1: The age and sex distribution of the students

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Table 2: The mean oral health impact profile-14 global and domain scores of each class

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The mean BDI, GI, and PI scores of students are shown in [Table 3]. The mean BDI score of 1st-year students was significantly lower than 2nd and 3rd year students (P < 0.05) (Kruskal–Wallis test). There were no students with AL and PD more than 3 mm. The mean PI score of 2nd year students was statistically higher than other students (P < 0.05) (Kruskal–Wallis test).
Table 3: The mean Beck depression inventory, gingival index, and plaque index scores of first-, second-, and third-year students

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Smoking status of students is shown in [Table 4] and [Table 5]. There was a significant relationship between classes and smoking (P < 0.05) (Chi-square test). The smoking rate of 2nd year students was the highest. The mean number of cigarettes smoked per day of 1st year students was significantly lower than that of 2nd and 3rd year students (P < 0.05) (Chi-square test). There were no significant differences in the mean years of smoking duration (P > 0.05) (Chi-square test).
Table 4: Smoking status of students

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Table 5: The mean number of cigarettes smoked per day and the mean years of smoking duration of smoker students

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  Discussion Top


Dental students should be encouraged to improve their own OHRQoL by applying the information they have learned about preventing oral diseases before embarking upon their professional responsibility to promote oral awareness in the general population and set an example for their patients.[16] Although there are some data related to oral health behavior of students, little is known about the influence of dental education on the OHRQoL of dental students.[17],[18],[19] In this study, OHRQoL of dental students and associated factors were examined. The 1st, 2nd, and 3rd year dental students who were preclinical dental students were included in the study to investigate the effect of knowledge they acquired in preventive dentistry on their OHRQoL as an individual and to consider whether the quality of life and stress levels of the clinical students will vary, depending on the clinical environment. Another reason for the inclusion of preclinical students in this study is to determine the oral health-related behavioral states of students who do not have contact with the patient and do not have responsibility to set an example in terms of oral health attitude and behavior toward their patients.

Although dental students have been found to have good oral health attitudes and have lower scores of PI and GI, their mean global OHIP-14 score was higher than people who have worse oral health and attitudes.[5],[20] In some studies, people with destructive periodontitis have lower OHIP-14 scores than these dental students.[20],[21],[22] It may be explained that poor oral health does not inevitably mean poor quality of life, because people with poor oral health may perceive their quality of life as better than healthy individuals do.[12],[23] Students' expectations, standards, concerns about oral health, and health perceptions are different from patients.[24] In accordance with this result, it was reported that dental students are greatly concerned with the appearance of their teeth and gums.[25],[26] Although the mean global OHIP-14 score of 2nd year students was higher than other students, it was no significant. The reason for this may be that students have similar respect for their oral health as for their school performance, social interactions, and emotional well-being and are affected by oral health in the same way.[27] In addition, dental students have similar attitudes regarding their teeth.[28] The mean global OHIP-14 score of female students was higher, whereas the difference was not statistically significant but may nevertheless indicate that female students are more concerned about their teeth than their male counterparts.

The domain score of functional limitation of 2nd year students was significantly higher than other students, whereas other domain scores did not differ meaningfully. Most 2nd year students reported that their sense of taste had worsened due to problems with their mouths. We hypothesized that this is associated with tobacco use, because smoking decreases the sensitivity of taste receptors and in turn leads to changes in salivary flow rates,[29],[30] and the proportion of smoking students was highest in 2nd year students.

The mean BDI score of 1st year students was significantly lower than other students. These findings contrast with findings reported by Acharya[31] and Radeef et al.[8] but are in agreement with Uraz et al.[32] The increase in stress in the 2nd and 3rd years may be due to constant heavy workload, lack of time for relaxation, fear of failing, and daily hassles. Stress due to academic factors and performance pressure was less in the 1st year, increasing in the 2nd and 3rd years. The more didactic and lecture-based education and the increase of hands-on preclinical practice can cause stress in the 2nd and 3rd years. The mean BDI scores of female students were higher although the difference was not statistically significant. These results are in keeping with previous literature.[33],[34]

When the periodontal conditions of the students were examined, it was observed that none had periodontal pocket or AL. Although there was no difference in GI, the PI of 2nd year students was statistically higher than other students. We think this is related to the higher smoking rates and high BDI scores of 2nd year students. Higher PI scores of 2nd year students, despite lower GI scores, may be explained by the gingival vasoconstriction induced by smoking.[35] The PI score of 1st year students was higher than 3rd year students. This finding may be because 1st year students are not yet adequately motivated about maintaining good oral health attitudes.

Dental students who smoke may well become tobacco-smoking dentists, thereby seriously undermining their tobacco control activities in their dental practice and their status as a role model for patients. As mentioned above, we observed that the rate of smoking was higher among 2nd year students. We believe that this situation is related to the higher beck values of 2nd year students. Supporting our results, it has been reported that the main reason for dental students to begin smoking is stress.[9] Another study revealed a strong association between smoking and psychological well-being.[36],[37] In addition, the number of cigarettes smoked per day of 1st year students was lower than that of 2nd and 3rd year students, proportional to their beck scores. There was no significant difference between classes in terms of mean years of smoking. Most smoking students began after entering dental school. This may be associated with dental education, universally recognized as being highly demanding, and their concern for their ability to succeed.


  Conclusion Top


Current literature indicates that dental students have higher levels of stress, which exacerbates their smoking status and lower OHRQoL. At a crucial stage in their preparation to take on a role in oral health-care provision, dental students – our future dentists – have poor OHRQoL, despite their educated awareness of self-care. Broader and more detailed research is needed to determine why their quality of life is low.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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