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DOI: 10.4103/ejgd.ejgd_85_17
Self-reported differences in oral health attitudes and behaviors of health-care students at a University in Malaysia
Abstract
Background: Oral health is a vital part of general health. An individual’s perception on oral health is reflected by their oral health attitudes and behaviors. Aim: To determine and compare the oral health attitudes and behaviors of dental, medical, and nursing students at Universiti Sains Malaysia (USM). Methods: A modified version of Hiroshima University– Dental Behavioural Inventory (HU-DBI)-based questionnaire consisting of 20 items was distributed to all health-care students (n = 1166) of USM. HU-DBI score was calculated using responses to 12 HU-DBI items in the questionnaire. HU-DBI scores of the three groups were compared using one-way ANOVA complemented by Bonferroni test. Scores among preclinical and clinical levels were compared using independent t-test. Chi-square test was used to evaluate the differences in distribution of all items in the HU-DBI survey. Results: Dental students had the highest mean HU-DBI score (7.79 ± 1.58), followed by their nursing (6.99 ± 1.46) and medical (6.42 ± 1.58) counterparts. The mean HU-DBI score for all clinical students (7.04 ± 1.75) was significantly higher than those in their preclinical years (6.64 ± 1.56). Among the 12 HU-DBI items that were used to calculate the HU-DBI scores, items 2, 6, 8, 9, 10, 15, 16 and 19 show significant difference between the distributions of responses within the 3 groups (P < 0.05). Conclusion: Dental students demonstrated better oral health attitudes. However, all our future health-care provider needs to have better attitudes toward oral health. Hence, comprehensive oral health awareness programs need to be incorporated to all health-care students throughout their study programs.
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Keywords
Dental students - Hiroshima University Dental Behavioural Inventory - medical students - nursing students - oral health behaviorIntroduction
Oral health is a vital part of general health and hence affects the total well-being. The individual’s perception on oral health is reflected by their oral health attitudes and behaviors.[[1]] Dental students, who will be our future dental care providers, are expected to have good attitude and behavior toward their own oral health.[[2]],[[3]] Furthermore, as dentists, they will be role models for their patients, friends, and family members.
The oral health conditions of the population are expected to be better when the dentists themselves are motivated.[[4]],[[5]],[[6]] In addition, the quality of oral health-care services provided is greatly affected by the attitude and behavior of the provider toward his or her own oral health.[[7]] Research on dental students in various parts of the world has shown that level of clinical training also had an impact on the student’s attitude and behavior toward oral health. Furthermore, students from different countries, ethnic origin, and course of study demonstrated differences in their attitudes and behavior as well.[[8]],[[9]],[[10]]
Most studies evaluating the oral health attitudes and behaviors, conducted in different parts of the world mainly focused on dental students.[[2]],[[3]],[[6]],[[8]],[[11]],[[12]],[[13]] Even though some studies also compared the attitudes and behavior of dental students and students studying pharmacy,[[14]] medicine,[[5]] paramedical sciences,[[5]] and other professional courses [[10]] in various parts of the world. To the best of our knowledge, there was insufficient data about the oral health attitudes of dental, medical, and nursing students from this region of Malaysia.
Besides, dental students, students from the allied health streams are also supposed to have better oral health knowledge and behavior.[[15]] It is well known that poor oral and periodontal health can lead to or worsen various medical conditions, such as diabetes mellitus, respiratory disorders, cardiovascular disease, and other systemic disorders.[[16]] Thus, by determining the oral health attitudes and behavior of various health-care students, effective steps can be undertaken to improve or instil positive oral health attitudes and behavior in all our future health-care providers. Thus, the aim of this study was to determine and compare the oral health attitudes and behaviors of dental, medical, and nursing students at Universiti Sains Malaysia (USM) Health Campus, Kelantan, Malaysia.
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Methods
The study was conducted at USM Health Campus. It was a cross-sectional survey involving all students from dental, medical, and nursing schools that were attending the university during the study. Ethical approval for carrying out the study was obtained from the Human Research Ethics Committee USM (Ref.USM/JEPeM/16030106). A modified bilingual (English and Bahasa Melayu) version of Hiroshima University– Dental Behavioral Inventory (HU-DBI) questionnaire [Annexure 1] [SUPPORTING:1] was distributed to 1166 students in dental, medical, and nursing schools. Participation was voluntary, and no personal information was recorded. Demographic data such as gender, age, race, and school were collected. Questionnaires that were unfilled or partly filled were excluded from the study.
HU-DBI score was calculated using responses to 12 HU-DBI items in the questionnaire [[Table 1]]. Items 4, 9, 11, 12, 16, and 19 with agree responses were given a point, whereas, items 2, 6, 8, 10, 14, and 15 with disagree responses were given a point. Maximum HU-DBI score that could be achieved was 12 while these 12 items appear to be directly related to the oral health behavior, the remaining 8 statements were not included in the analysis as they reflect general oral health-related attitude [[Table 1]].
Statistical analysis
HU-DBI scores of students from three schools were compared using one way ANOVA complemented by Bonferroni test whereas comparison of HU-DBI scores of students based on their clinical level was carried out using independent t-test. Chi-square test was carried out to evaluate the differences in distribution of all items in the HU-DBI survey by school and clinical level. Statistical significance level was set at P < 0.05.
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Results
Out of 1166 students, 1053 students participated in this study (90.3% response rate). Medical school students consisted of 62.3% of the respondents while students from the dental and nursing schools were 24.0% and 13.7%, respectively. Out of all the respondents, 553 were in their preclinical years (52.5%) whereas 500 students belonged to clinical years (47.5%).
[[Table 2]] and [[Table 3]] summarize the comparison of HU-DBI scores between students based on their schools and clinical levels. Dental students had the highest mean HU-DBI score (7.79 ± 1.58) when compared to their nursing (6.99 ± 1.46) and medical (6.42 ± 1.58) counterparts. Mean scores of students from each school were significantly different from the other as summarized in [[Table 4]]. The mean HU-DBI score for clinical students from all 3 schools (7.04 ± 1.75) was significantly higher than those in their preclinical years (6.64 ± 1.56). Comparison of HU-DBI scores between preclinical students from the three schools using the post hoc Bonferroni test depicts a significant difference in HU-DBI score of preclinical medical students as compared to dental and nursing students (P ≤ 0.05) whereas there are no significant differences in HU-DBI score between nursing and dental preclinical students (P > 0.05). On the other hand, clinical dental students had a significantly higher mean HU-DBI score when compared to their medical and nursing counterparts (P ≤ 0.05). However, the mean HU-DBI scores of medical and nursing clinical students were not significantly different from each other (P > 0.05). These results are tabulated in [[Table 5]] and [[Table 6]].
|
Course (I) |
Course (J) |
Mean difference (I-J) |
SE |
P |
95%, CI |
|
|---|---|---|---|---|---|---|
|
Lower bound |
Upper bound |
|||||
|
Medical |
Dental |
–1.373[*] |
0.116 |
<0.001[*] |
-1.65 |
-1.09 |
|
Nursing |
–0.575[*] |
0.144 |
<0.001[*] |
-0.92 |
-0.23 |
|
|
Dental |
Nursing |
0.797[*] |
0.164 |
<0.001[*] |
0.40 |
1.19 |
* Statistically significant (P < 0.05). SE – Standard error, CI – Confidence interval
|
Clinical level |
HU-DBI score |
|||
|---|---|---|---|---|
|
Mean±SD |
Mean difference (95% CI) |
t statistics (df) |
P |
|
|
Preclinical |
6.64±1.563 |
–0.399 (−0.600–0.199) |
–3.904 (1051) |
<0.001[*] |
|
Clinical |
7.04±1.758 |
|||
* Statistically significant (P < 0.05). SD – Standard deviation, HU-DBI – Hiroshima University-Dental Behavioural Inventory
|
School |
Mean±SD |
F |
P |
|---|---|---|---|
|
Medical |
6.42±1.58 |
70.90 |
<0.001[*] |
|
Dental |
7.79±1.58 |
||
|
Nursing |
6.99±1.46 |
* Statistically significant (P < 0.05). SD – Standard deviation
|
School (I) |
School (J) |
Mean difference (I–J) |
SE |
P |
95% CI |
|
|---|---|---|---|---|---|---|
|
Lower bound |
Upper bound |
|||||
|
Medical |
Dental |
–0.651[*] |
0.175 |
0.001[*] |
–1.07 |
–0.23 |
|
Nursing |
–0.646[*] |
0.191 |
0.002[*] |
–1.10 |
–0.19 |
|
|
Dental |
Nursing |
0.006 |
0.234 |
1.000 |
–0.56 |
0.57 |
* Statistically significant (P < 0.05). SE – Standard error, CI – Confidence interval
|
School (I) |
School (J) |
Mean difference (I–J) |
SE |
P |
95% CI |
|
|---|---|---|---|---|---|---|
|
Lower bound |
Upper bound |
|||||
|
Medical |
Dental |
–1.831[*] |
0.156 |
<0.001[*] |
–2.21 |
–1.46 |
|
Nursing |
–0.495 |
0.213 |
0.062 |
–1.01 |
0.02 |
|
|
Dental |
Nursing |
1.337[*] |
0.229 |
<0.001[*] |
0.79 |
1.89 |
* Statistically significant (P < 0.05). SE – Standard error, CI – Confidence interval
The percentage and analysis of yes/no response to HU-DBI items are listed according to schools as shown in [[Table 7]] and according to clinical levels as shown in [[Table 8]]. Among the 12 HU-DBI items that were used to calculate the HU-DBI scores, items number 2,6,8,9,10,15,16, and 19 shows a significant difference between the distributions of responses for the three schools (P ≤ 0.05). As for the distributions of responses between preclinical and clinical group, a significant difference (P ≤ 0.05) was seen for items number 2, 4, 8, 11, 15, and 16.
Pearson Chi-square test was done to compare responses between medical and dental, medical and nursing and dental and nursing. ##Statistically significant difference with medical school (P < 0.05), #Statistically significant difference with dental school (P < 0.05), 'Statistically significant difference with nursing school (P < 0.05). HU-DBI – Hiroshima University-Dental Behavioural Inventory
Pearson Chi-square test was done. *P < 0.05, statistically significant. HU-DBI - Hiroshima University-Dental Behavioural Inventory
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Discussion
HU-DBI scores of individuals are directly related to their oral health behavior and attitude.[[8]] Higher scores can be associated with better oral health-related attitude and behavior. The mean HU-DBI scores of dental, medical, and nursing students from USM were higher as compared to students from respective schools in the previous studies with mean scores ranging from 4.74–7.33.[[6]],[[12]],[[13]],[[14]],[[17]],[[18]] However, within the three schools, dental students were the best in terms of mean HU-DBI score as compared to their medical and nursing counterparts. Similarly, other studies have also shown that dental students demonstrate higher mean HU-DBI scores than students from other schools.[[5]],[[10]],[[14]] This is most likely attributed to the wide range of preventive dentistry and periodontics lectures given to dental students during their studies. Furthermore, clinical students in this study reported a better dental health attitude and behavior as compared to preclinical students. Various studies have proposed that the students’ personal dental health attitude and behavior are related intimately with their academic progression.[[2]],[[19]],[[20]]
In general, most of the students from all three schools in USM are not worried about visiting the dentist. These results are similar to students from India and China.[[6]],[[13]] Despite that, it is notable that majority of dental students in this study reported that they regularly visit the dentist as compared to their medical and nursing counterparts, where only 45%–55% reported regular dental visit. This is consistent with a study conducted on dental students in Croatia.[[12]] Dental students have more exposure to the dental clinics and dentists in general as compared to their medical and nursing counterparts, thus experiencing less treatment anxiety. A study conducted in Israel found that treatment anxiety is one of the main factors of delayed dental visits until symptoms arise and could also be the reason for the delayed visits by medical and nursing students.[[21]]
Surprisingly, fewer dental students are worried about the color of their teeth as compared to their medical and nursing counterparts. This depicts that medical and nursing students demonstrate a behavior which is similar to the general population, wherein the presence of symptoms and/or concern for esthetics drive their dental behavior.[[22]] However, dental students are well versed with the agents used in tooth whitening (bleaching) and understand the risks and benefits associated with various esthetic treatments. Furthermore, clinical students are also less worried about the color of their teeth as is reported in some studies.[[19]],[[23]] In addition, in this study, plaque deposits on their teeth were noticed by significantly more number of clinical students than their preclinical counterparts. As expected, clinical students have a higher awareness toward the microbial dental plaque due to their education and clinical training experiences. This result was in contrast to a study in Turkey,[[18]] where the clinical students fared worse than preclinical students. However, there may have been a misinterpretation that this question was about cleanliness of teeth rather than the awareness of plaque.
Regarding tooth brushing techniques, significantly higher number of dental and nursing students reported that they brush each of their teeth carefully as compared to the medical students. Likewise, almost all (93.7%) dental students agreed that the correct brushing technique has been professionally taught to them, which is significantly higher than students from the other two schools. Other studies have also observed similar results.[[12]],[[17]] Moreover, when compared to dental students, significantly higher numbers of medical and nursing students use a hard bristled toothbrush. This is in accordance to the study done in China and Kingdom of Saudi Arabia.[[14]],[[24]] Again, this result can be attributed to dental health education, particularly the periodontology and dental public health subjects which emphasize on toothbrush selection and tooth brushing techniques for good oral hygiene.
Strength and limitations
The strength of this study includes the large sample size of health-care students and the rigor of survey and questions which addresses in breadth various aspects of oral health attitudes and behavior.
There are several limitations in this study. First, because this is a cross-sectional study, any changes in HU-DBI scores cannot be attributed entirely toward the curricular level. Furthermore, dental students are well versed with the correct dental health behaviors and attitudes. Therefore, a bias may occur as these dental students may not practice these behaviors in real life yet answer the questions correctly.
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Implications for practice
The oral health of a patient is closely linked to their general health. Evidence suggests that diabetes mellitus and periodontal disease have an adverse bidirectional interrelationship.[[16]] Furthermore, dental plaque can also serve as a reservoir of infection in hospital inpatients.[[25]] These are among a few examples that highlight the importance of oral health status relating to general health. This study shows that medical and nursing students did not demonstrate good attitude and behavior toward their oral health. Therefore, there needs to be an improvement in the oral health awareness for the medical and nursing schools. It is crucial that these students improve their own awareness and thus can provide comprehensive health-care services to their patients in the future. Furthermore, when our future health-care providers are aware of the oral health-related problems and its effects on the general health, they will refer patients to dentists in an appropriate and timely manner.
Further studies can be implemented on the same students to properly determine the impact of increased educational experience by correlating their dental health attitudes and behaviors with their actual oral health status. In addition, further studies emphasizing on gender and cultural differences of students in Malaysia regarding dental health attitudes and behaviors can also be carried out.
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Conclusion
Dental students demonstrated better oral health attitudes as compared to their medical and nursing counterparts, which indicate the positive impact of dental health education on these students. It is well known that oral health is closely related to general health, thus, when our future health-care providers are aware of the effects of oral health-related problems on general health, they will refer patients to dentists in an appropriate and timely manner. Hence, comprehensive oral health awareness programs need to be incorporated to all health-care students starting from their preclinical years to improve the oral health attitudes of all our future health-care providers.
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Hiroshima University-Dental Behavioral Inventory Inventori Tingkah Laku Pergigian Universiti Hiroshima
|
Statement/ Penyata |
Agree Setuju |
Disagree Tidak Setuju |
|
|
1 |
I don't worry about visiting the dentist Saya tidak bimbang untuk berjumpa doktor gigi |
Agree Setuju |
Disagree Tidak Setuju |
|
2 |
My gums bleed when I brush my teeth Gusi saya berdarah apabila saya memberus gigi |
Agree Setuju |
Disagree Tidak Setuju |
|
3 |
I worry about the color of my teeth Saya risau tentang warna gigi saya |
Agree Setuju |
Disagree Tidak Setuju |
|
4 |
I have noticed some white sticky deposits on my teeth Saya telah menjumpai beberapa deposit putih melekat pada gigi saya |
Agree Setuju |
Disagree Tidak Setuju |
|
5 |
I use a child-sized toothbrush Saya mengguna berus gigi saiz kanak-kanak |
Agree Setuju |
Disagree Tidak Setuju |
|
6 |
I think I cannot help having false teeth when I am old Saya berasa tidak dapat mengelakkan diri daripada memakai gigi palsu apabila saya berumur |
Agree Setuju |
Disagree Tidak Setuju |
|
7 |
I am bothered by the color of my gums Saya berasa terganggu dengan warna gusi saya |
Agree Setuju |
Disagree Tidak Setuju |
|
8 |
I think my teeth are getting worse despite my daily brushing Saya berasa gigi saya menjadi semakin teruk walaupun memberus gigi setiap hari. |
Agree Setuju |
Disagree Tidak Setuju |
|
9 |
I brush each of my teeth carefully Saya memberus setiap gigi dengan teliti |
Agree Setuju |
Disagree Tidak Setuju |
|
10 |
I have never been taught professionally how to brush Saya tidak pernah diajar cara memberus gigi secara profesional |
Agree Setuju |
Disagree Tidak Setuju |
|
11 |
I think I can clean my teeth well without using toothpaste Saya berasa bahawa saya boleh membersihkan gigi dengan baik tanpa menggunakan ubat gigi |
Agree Setuju |
Disagree Tidak Setuju |
|
12 |
I often check my teeth in a mirror after brushing Saya selalu memeriksa gigi dengan cermin selepas memberus gigi |
Agree Setuju |
Disagree Tidak Setuju |
|
13 |
I worry about having bad breath Saya berasa bimbang tentang nafas berbau |
Agree Setuju |
Disagree Tidak Setuju |
|
14 |
It is impossible to prevent gum disease with toothbrushing alone Ia adalah mustahil untuk mencegah penyakit gusi dengan memberus gigi sahaja |
Agree Setuju |
Disagree Tidak Setuju |
|
15 |
I put off going to a dentist until I have a toothache Saya melengahkan perjumpaan dengan doktor gigi sehingga saya mengalami sakit gigi |
Agree Setuju |
Disagree Tidak Setuju |
|
16 |
I have used a dye to see how clean my teeth are Saya pernah mengguna pewarna untuk lihat kebersihan gigi saya |
Agree Setuju |
Disagree Tidak Setuju |
|
17 |
I use a toothbrush with hard bristles Saya menggunakan berus gigi berbulu keras |
Agree Setuju |
Disagree Tidak Setuju |
|
18 |
I don't feel I have brushed unless I brush with strong strokes Saya tidak berasa bahawa saya telah memberus gigi sehingga saya memberus dengan gerakan memberus yang kuat |
Agree Setuju |
Disagree Tidak Setuju |
|
19 |
I feel I sometimes take too much time to brush my teeth Saya berasa bahawa kadang kala saya mengambil masa yang terlalu panj ang untuk memberus gigi |
Agree Setuju |
Disagree Tidak Setuju |
|
20 |
I have had my dentist tell me that I brush very well Doktor gigi pernah memberitahu saya bahawa saya memberus gigi dengan baik |
Agree Setuju |
Disagree Tidak Setuju |
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Conflict of Interest
There are no conflicts of interest.
Financial support and sponsorship
Nil.
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References
- 1 Hobdell M, Sinkford J, Alexander C, Alexander D, Corbet E, Douglas C, et al. 5.2 ethics, equity and global responsibilities in oral health and disease. Eur J Dent Educ 2002;6 Suppl 3:167-78.
- 2 Cortes FJ, Nevot C, Ramon JM, Cuenca E. The evolution of dental health in dental students at the University of Barcelona. J Dent Educ 2002;66:1203-8.
- 3 Brusokaite J, Januleviciute I, Kukleris A, Zekonis G. Evaluation of dental health of dental students at Kaunas University of Medicine. Stomatologija 2003;5:133-6.
- 4 Al-Omari QD, Hamasha AA. Gender-specific oral health attitudes and behavior among dental students in Jordan. J Contemp Dent Pract 2005;6:107-14.
- 5 Usman S, Bhat SS, Sargod SS. Oral health knowledge and behavior of clinical medical, dental and paramedical students in Mangalore. J Oral Health Comm Dent 2007;1:46-8.
- 6 Dagli RJ, Tadakamadla S, Dhanni C, Duraiswamy P, Kulkarni S. Self reported dental health attitude and behavior of dental students in India. J Oral Sci 2008;50:267-72.
- 7 Dumitrescu AL, Wagle M, Dogaru BC, Manolescu B. Modeling the theory of planned behavior for intention to improve oral health behaviors: The impact of attitudes, knowledge, and current behavior. J Oral Sci 2011;53:369-77.
- 8 Kawamura M, Honkala E, Widström E, Komabayashi T. Cross-cultural differences of self-reported oral health behaviour in Japanese and Finnish dental students. Int Dent J 2000;50:46-50.
- 9 Komabayashi T, Kawamura M, Kim KJ, Wright FA, Declerck D, Goiâs Mdo C, et al. 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. Int Dent J 2006;56:310-6.
- 10 Kumar Tadakamadla S, Kriplani D, Shah V, Tadakamadla J, Tibdewal H, Duraiswamy P, et al. Oral health attitudes and behaviour as predisposing factor for dental caries experience among health professional and other professional college students of India. Oral Health Prev Dent 2010;8:195-202.
- 11 Peker I, Alkurt MT. Oral health attitudes and behavior among a group of Turkish dental students. Eur J Dent 2009;3:24-31.
- 12 Badovinac A, Božić D, Vučinac I, Vešligaj J, Vražić D, Plancak D, et al. Oral health attitudes and behavior of dental students at the University of Zagreb, Croatia. J Dent Educ 2013;77:1171-8.
- 13 Komabayashi T, Kwan SY, Hu DY, Kajiwara K, Sasahara H, Kawamura M, et al. Acomparative study of oral health attitudes and behaviour using the Hiroshima University – Dental Behavioural Inventory (HU-DBI) between dental students in Britain and China. J Oral Sci 2005;47:1-7.
- 14 Kumar S, Busaly IA, Tadakmadla J, Tobaigy F. Attitudes of dental and pharmacy students to oral health behaviour at Jazan University, Kingdom of Saudi Arabia. Arch Orofac Sci 2012;7:9-13.
- 15 McConaughy FL, Lukken KM, Toevs SE. Health promotion behaviors of private practice dental hygienists. J Dent Hyg 1991;65:222-30.
- 16 Teng YT, Taylor GW, Scannapieco F, Kinane DF, Curtis M, Beck JD, et al. Periodontal health and systemic disorders. J Can Dent Assoc 2002;68:188-92.
- 17 Polychronopoulou A, Kawamura M. Oral self-care behaviours: Comparing Greek and Japanese dental students. Eur J Dent Educ 2005;9:164-70.
- 18 Yildiz S, Dogan B. Self reported dental health attitudes and behaviour of dental students in Turkey. Eur J Dent 2011;5:253-9.
- 19 Dumitrescu AL, Kawamura M, Sasahara H. An assessment of oral self-care among romanian dental students using the Hiroshima University – Dental Behavioural Inventory. Oral Health Prev Dent 2007;5:95-100.
- 20 Polychronopoulou A, Kawamura M, Athanasouli T. Oral self-care behavior among dental school students in Greece. J Oral Sci 2002;44:73-8.
- 21 Samorodnitzky GR, Levin L. Self-assessed dental status, oral behavior, DMF, and dental anxiety. J Dent Educ 2005;69:1385-9.
- 22 Mumcu G, Sur H, Yildirim C, Soylemez D, Atli H, Hayran O, et al. Utilisation of dental services in Turkey: A cross-sectional survey. Int Dent J 2004;54:90-6.
- 23 Peker K, Uysal O, Bermek G. Dental training and changes in oral health attitudes and behaviors in istanbul dental students. J Dent Educ 2010;74:1017-23.
- 24 Rong WS, Wang WJ, Yip HK. Attitudes of dental and medical students in their first and final years of undergraduate study to oral health behaviour. Eur J Dent Educ 2006;10:178-84.
- 25 Scannapieco FA. Role of oral bacteria in respiratory infection. J Periodontol 1999;70:793-802.
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Publication History
Article published online:
01 November 2021
© 2018. European Journal of General Dentistry. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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