2215 3411 Odovtos 26 01 100

Odovtos-International Journal of Dental Sciences (Odovtos-Int. J. Dent. Sc.), 26-1 (January-April): 100-115.
ISSN: 2215-3411
https://doi.org/10.15517/IJDS.2022.52197ODOVTOS-International Journal of Dental Sciences
ODOVTOS
https://revistas.ucr.ac.cr/index.php/Odontos
CLINICAL RESEARCH:
Knowledge, Attitudes and Practices Related to Oral Health in First-Year University Students of
the Paraíso Campus of the University of Costa Rica
Conocimientos, actitudes y prácticas relacionadas con la salud bucal en estudiantes universitarios de primer
año del Recinto de Paraíso de la Universidad de Costa Rica
Juan Bautista Barahona-Cubillo DDS, MSc¹ https://orcid.org/0000-0003-1193-9024

Cinthya Rojas-Brenes DDS¹ https://orcid.org/0000-0002-3927-3618
Cristina Barboza-Solís DDS, MSc, PhD¹ https://orcid.org/0000-0002-7208-7374
1. Facultad de Odontología, Universidad de Costa Rica, San José, Costa Rica.
Correspondence to: Dr. Cristina Barboza-Solís - [email protected]
Received: 21-VI-2022 Accepted: 28-VII-2022
ABSTRACT: People’s knowledge, attitudes, and practices related to health are built throughout life,
particularly during childhood and adolescence, and they reflect the practices of their family and social
circle. The aim of this study was to identify the levels of knowledge, attitudes, and practices related to
oral health of first-year university students at the Paraíso Campus of the University of Costa Rica. This
was done through a questionnaire of closed questions that would allow oral health educational strategies
to be established in the future for this population group. For this purpose, a cross-sectional descriptive
study was conducted, where 70 first-year students of the Paraíso Campus participated in the first
semester of the year 2019. For data collection, a survey of 22 closed questions on knowledge, attitudes,
and practices about oral health was applied, and a score on oral health knowledge was subsequently
performed, based on the answers to the questions. According to the results, the level of knowledge
shown about oral health is low, since the average knowledge score (7.02 points) was less than half of
the maximum score (17 points). The greatest deficiency in knowledge was evidenced in topics, such as,
dental biofilm, gingivitis, use of fluorides, and the role of saliva. In addition, several practices that affect
the condition of the oral cavity were identified, such as harmful habits, inadequate nutrition, and poor
oral hygiene habits. In this study, a general lack of knowledge was identified regarding basic concepts
of oral health in young university students, who are not clear about the role of some protective or risk
factors related to the main oral diseases.
KEYWORDS: Oral health; Knowledge; Attitudes; Practices; University students; Costa Rica.
Odovtos -Int J Dent Sc endoses to CC-BY-NC-SA 4.0. ODOVTOS-Int. J. Dent. Sc. | No. 26-1: 100-115, 2024 I ISSN: 2215-3411. 100
Barahona-Cubillo et al: Knowledge, Attitudes and Practices Related to Oral Health in First-Year University Students
RESUMEN: Los conocimientos, actitudes y prácticas relacionados a la salud en las personas se construyen
a través de la vida, particularmente durante la infancia y la adolescencia y reflejan las prácticas de su
círculo familiar y social. El objetivo de este estudio fue identificar los niveles de conocimiento, las
actitudes y las prácticas relacionadas a la salud bucodental en estudiantes universitarios de primer
ingreso en el Recinto de Paraíso de la Universidad de Costa Rica, mediante un cuestionario de preguntas
cerradas que permitirá a futuro establecer estrategias educativas en salud bucal para este grupo de
población. Se trató de un estudio descriptivo transversal de tipo observacional en 70 estudiantes de
primer ingreso del Recinto de Paraíso en el I semestre del año 2019. Para la recolección de datos se
aplicó una encuesta de 22 preguntas cerradas sobre los conocimientos, las actitudes y las prácticas
sobre la salud oral. A partir de las preguntas sobre conocimiento en salud bucal se creó un puntaje
de conocimiento. Se pudo evidenciar que el nivel de conocimiento sobre la salud bucal es bajo, ya
que el promedio del puntaje de conocimiento (7,02 puntos) es menos de la mitad del puntaje máximo
(17 puntos). La mayor deficiencia en el conocimiento se evidenció en temas como el biofilm dental,
gingivitis, uso de fluoruros y el rol de la saliva. Además, se identificaron varias prácticas que afectan
la condición de la cavidad bucal, como los hábitos nocivos, una alimentación inadecuada y hábitos de
higiene oral deficiente. En este estudio se identificó en general una falta de conocimiento respecto a
conceptos básicos de salud bucal en personas jóvenes universitarias, quienes no tienen claro la función
de algunos factores protectores o de riesgo relacionados con las principales enfermedades bucales.
PALABRAS CLAVE: Salud oral; Conocimientos; Actitudes; Prácticas; Estudiantes universitarios; Costa
Rica.
INTRODUCTION ability to speak, smile, smell, taste, touch, chew,

swallow, and convey a range of emotions through
Biological, physical, emotional, and social facial expressions with confidence and without
aspects contribute to oral health (1). Among other pain, discomfort, and disease of the craniofacial
considerations, this implies having a healthy denti- complex” (3).
tion, being able to eat properly, not having injuries
to the oral tissues or pain, as well as having an According to the World Health Organiza-
appearance that stimulates self-esteem. All these tion (WHO), oral diseases such as dental caries,
factors have a positive influence on the quality of periodontitis, and oral cancer are global health
life (2). According to Glick et al., oral health should problems, especially among low-income countries
be defined from a multidimensional perspective, (4). In addition, according to the Global Burden
indicating that it “is multifaceted and includes the of Diseases 2017 study, oral pathologies repre-
ODOVTOS-Int. J. Dent. Sc. | No. 26-1: 100-115, 2024 I ISSN: 2215-3411. 101
ODOVTOS-International Journal of Dental Sciences
sent the greatest scourge of diseases in the entire better knowledge and practices, such as, carrying
world, affecting 50% of the world’s population. a toothbrush to school, knowing what dental
This study also shows the socioeconomic gap that plaque (dental biofilm) was and its effects, use of
is widening between low-income countries and soft-bristled toothbrushes, and they stated that
high-income countries (5). the most important time to perform oral hygiene
was before going to bed (11).
From the diseases determinants perspec-
tive, it has been shown that the level of knowledge The aim of this study was to identify the
may influence health behaviors, and, therefore, a levels of knowledge, attitudes, and practices related
high level of knowledge may be a protective factor to oral health of first-year university students at
against the main oral diseases. Previous evidence the Paraíso Campus of the University of Costa
shows that health knowledge is part of health Rica (RP-UCR, by its Spanish acronym), through
literacy (6), defined by the WHO as “the cognitive a questionnaire of closed questions that would
and social skills which determine the motivation allow educational strategies on oral health to be
and ability of individuals to gain access to, unders- established for this population group in the future.
tand and use information in ways which promote
and maintain good health”(7). Knowledge allows METHODS
improving people's skills to make decisions related
to health (8). In addition, the levels of knowledge STUDY DESIGN
on specific topics increase the chances of a stren-
gthening in health (9). This is a descriptive cross-sectional study
on first-year university students from all majors at
It is important to consider that people's the RP-UCR.
knowledge, attitudes, and practices related to
health are built throughout life, particularly during PARTICIPANTS
childhood and adolescence, and reflect the practi-
ces of their family and social circle. Most oral Research participants were university students
diseases can be prevented, promoting oral health (men and women), first-year students, over 18 years
and allowing population groups to have the neces- of age, which were enrolled at the Paraíso Campus
sary resources to apply prevention measures. For in the first semester of 2019. The data was obtai-
an education program to be more successful, a ned from a sample of 70 first-year students from
prior diagnosis process is required to estimate the the Atlantic Site’s Paraíso Campus (N=70).
level of knowledge about the health issue that is
intended to be addressed in said population (10). ETHICS AND DATA
In background, a study carried out by the An informed written consent was obtained
University of Costa Rica applied an educational directly from the participants, as they were of legal
strategy on oral health promotion for high school age. The consent form was signed by each participant,
adolescents from the Instituto de Alajuela. A as well as by a witness and the researcher. This
subsequent evaluation to verify the effectiveness observational study was approved by the Scientific
of this strategy showed that a greater number Ethics Committee (CEC) of the University of Costa Rica
of students from the aforementioned institution, in session 112, which was held on 07/27/2018, and
in relation to other schools, showed, in average, the official resolution was VI-5042-2018.
MEASUREMENTS RESULTS
For data collection, a survey of 22 closed Table 1 shows the distribution of students
questions was applied; the instrument used was according to their demographic and acade-
divided into four parts: mic characteristics for the samples (N=70). The
majority of the participants were male, which repre-
• General data (age, sex, race, place of origin). sented 60%; regarding the place of residence, the
• Knowledge on oral health, including questions province of Cartago represents 78.57%, and the
about knowledge regarding dental plaque (dental average age of the students is 19 years old.
biofilm), dental caries, periodontal diseases, use
of fluorides, diet, oral cancer, and oral health Table 1. Distribution of students according to
learning and information). From these variables, demographic and academic characteristics (N=70).
a knowledge score was given. One point was
awarded for each correct answer by the partici- Variables Answer options N %
pant. The final knowledge score ranged from 0 Sex Men 42 60%
(worst knowledge) to 17 (best knowledge). Women 28 40%
• Attitudes towards oral health frequency and College Business Management 15 21.43%
major Ecological Tourism 13 18.57%
reasons of visits to the dentist.
• Practices on the use of toothbrush, dental floss, and Business Computing 25 35.71%
mouthwashes, as well as their frequency of use. English Teaching 15 21.43%
Mathematics Teaching 1 1.43%
STATISTICAL ANALYSES Accounting 1 1.43%
Province of San José 8 11.43%
Origin
Descriptive statistics of the variables on Alajuela 2 2.86%
knowledge, attitudes, and practices were perfor- Cartago 55 78.57%
med, and STATA V14 ® was used. Heredia 1 1.43%
Guanacaste 0 0%
Bivariate statistics were made between the Puntarenas 3 4.28%
knowledge score and the variables on attitudes Limón 1 1.43%
and practices. The objective of this analysis was Mean Standard
Deviation
to be able to determine if a better level of knowledge
Age 19 1.96
had an influence on some attitudes towards oral
health. The bivariate analysis used the student test of
Student, between the knowledge score (dependent Table 2 shows the distribution of respon-
variable) and the "attitudes and practices" variables ses on knowledge about oral health. To obtain the
(independent variables), which were also obtained distribution of the percentages, all the answers
from the applied questionnaire. The knowledge were taken into consideration, including those of
score variable had a normal distribution. "Do not know/No answer" (DK/NA).
For the question “What is dental plaque dental caries, 40% mistakenly believed that they
(dental biofilm)?”, the answer was considered help to have white teeth; and, in the same
correct only if the option "accumulation of bacteria way, 24.29% considered that they also help to
that adhere to the teeth" was marked affirmatively, prevent gingivitis.
which resulted in 22.86%. The other combinations
of answers, which included "food residue”, “it is 87.14% of the students had received
a stain on the teeth”, and “DK/NA", resulted in a an explanation on the toothbrushing technique
total of 77.14%. sometime in life, the vast majority by the dentist or
dental assistant (85.71%), as well as information
When asked about “How is dental plaque on oral hygiene.
(dental biofilm) removed?”, 64.29% of the students
surveyed believed that dental biofilm is removed Regarding knowledge on harmful habits that
by brushing, while 52.86% of the sample did not may favor the occurrence of oral cancer, 92.86% of
know that dental biofilm can be removed by dental those surveyed considered cigarette smoking and
flossing, and 62.85% incorrectly believed that the use of other tobacco products as one of those
it can only be removed by the dentist. Likewise, habits; however, 57.15% did not consider that
more than half of the participants (51.43%) frequent alcohol intake may favor the occurrence
are unaware that dental plaque (dental biofilm) of oral cancer.
causes gingivitis.
Table 3 shows the results from the informa-
Regarding the factors that may contribute to tion provided by the surveyed about their attitudes
the development of dental caries, 58.57% of the and practices towards oral health. 94.29% had
participants thought affirmatively that the acids visited the dentist sometime in life. Just over half
produced by bacteria in the mouth influence the (51.43%) mentioned having visited the dentist in
appearance of carious lesions; however, 88.57% the last year.
of the students did not know that the flow and
composition of saliva are related to the develop- When students were asked when was the
ment of caries. 91.43% of the participants was last time they visited the dentist, only 41.43%
clear that sugar consumption as part of a regular reported having visited the dentist less than 6
diet is a factor for the development of dental caries. months ago, 20% between 6 months and a year
ago, and 38.56% more than a year ago. Regar-
When asked if dental caries could be a ding the frequency of visits to the dentist, 54.29%
communicable disease, 1.43% of the participants reported visiting the dentist every 6 months or
considered that it is. On the other hand, 100% of once a year, while 34.29% said they only visited
them believed that this disease can be prevented. the dentist when they have some discomfort or
Furthermore, most students (88.57%) were clear pain, and 11.44% never visit the dentist.
that certain types of food have a greater influence
on the occurrence of caries than others. University students were asked about the
importance of having good oral health through
Even though the majority of those surve- two sub-questions: to the sub-question “Is oral
yed (77.14%) knew that fluorides help to prevent health an important part of general health?”, the
students responded 100% “Yes”; and to the other 25.71% use it once or twice a day, 10% mentioned
sub-question “Is it important for aesthetics?”, that they use it three to six times a week, 11.43%
81.43% answered "Yes”. once a week, and 45.71% answered DK/NA.
100% of students stated that they use a When asked for what purpose they use
toothbrush to perform their oral hygiene, but only toothpaste, 68.57% mentioned that it leaves a
50% said that they use dental floss, and 59% good taste in their mouth, 75.71% because it
mentioned using mouthwash as part of their oral makes brushing easier, 87.14% claimed that
health hygiene routine. toothpaste prevents cavities and 61,43% use
it out of habit. In addition, they were asked
When consulting the frequency of tooth how often they smoked tobacco cigarettes, and
brushing, 68.57% mentioned brushing more 94.19% stated that they did not smoke; 2.86%
than twice a day, 22.86% once or twice a day, mentioned that they used to smoke, but they
and 8.57% three to six times a week. Regar- currently do not smoke; 1.43% smoke six or fewer
ding dental floss frequency, 7.14% stated that cigarettes a week, and 1.43% one to two cigaret-
they use dental floss more than twice a day, only tes a day.
Table 2. Distribution of responses on oral health knowledge (N=70).
Variables Answer options Answers * N %

Concept of dental plaque (dental biofilm) Affirmative answer only for: "Accumulation of CA 16 22.86%
bacteria that adhere to the teeth"
Other combinations of answers, including: "Food IA 54 77.14%
residue", "It is a stain on the teeth" and DK/NA
Method to remove dental plaque (dental Tooth brushing
biofilm)?
No IA 10 14.29%
Yes CA 45 64.29%
DK/NA IA 15 21.43%
Dental floss
No IA 16 22.86%
Yes CA 33 47.14%
DK/NA IA 21 30%
Only a dentist can do it
No CA 26 37.14%
Yes IA 26 37.14%
DK/NA IA 18 25.71%

Factors that may contribute to the develop- Acids produced by bacteria in the mouth
ment of dental caries
No IA 10 14.29%
Yes CA 41 58.57%
DK/NA IA 19 27.14%
The flow and composition of saliva
No IA 36 51.43%
Yes CA 8 11.43%
DK/NA IA 26 37.14%
Sugar consumption as part of the regular diet
No IA 1 1.43%
Yes CA 64 91.43%
DK/NA IA 5 7.14%
Transmission of microorganisms that cause No IA 56 80%
dental caries
Yes CA 1 1.43%
DK/NA IA 13 18.57%
Dental caries is preventable No IA 0 0%
Yes CA 70 100%
DK/NA IA 0 0%
Dental plaque (dental biofilm) causes No IA 3 4.29%
gingivitis
Yes CA 34 48.57%
DK/NA IA 33 47.14%
Influence of diet on the occurrence of caries No, it's not related. IA 1 1.43%
Yes, certain types of food have a greater influence CA 62 88.57%
on the occurrence of dental caries.
Yes, all foods influence the occurrence of dental IA 6 8.57%
caries in the same way.
DK/NA IA 1 1.43%
Role of fluorides To have white teeth
No CA 17 24.29%
Yes IA 28 40%
DK/NA IA 25 35.71%
To prevent gingivitis
No CA 21 30%
Yes IA 17 24.29%
DK/NA IA 32 45.71%
To prevent dental caries
No IA 3 4.29%
Yes CA 54 77.14%
DK/NA IA 13 18.57%
Explanation received about dental care No IA 9 12.86%
sometime in life
Yes CA 61 87.14%

Means by which the explanation about dental Dentist or Dental Assistant
care was received
No 8 11.43%
Yes 60 85.71%
DK/NA 2 2.86%
A teacher at school
No 50 71.43%
Yes 15 21.43%
DK/NA 5 7.14%
On the Internet
No 42 60%
Yes 23 32.86%
DK/NA 5 7.14%
On TV
No 38 54.29%
Yes 27 38.57%
DK/NA 5 7.14%
On magazines or brochures
No 50 71.43%
Yes 15 21.43%
DK/NA 5 7.14%
Harmful habits that favor the occurrence of Cigarette smoking and use of other tobacco
oral cancer products
No IA 1 1.43%
Yes CA 65 92.86%
DK/NA IA 4 5.71%
Frequent alcohol intake
No IA 10 14.29%
Yes CA 30 42.86%
DK/NA IA 30 42.86%
*CA: correct answers. IA: incorrect answers.
Table 3. Distribution of responses on attitudes and practices towards oral health (N= 70).

Has visited the dentist sometime in life No NR 4 5.71%
Yes R 66 94.29%
Has visited the dentist in the last year No NR 34 48.57%
Yes R 36 51.43%
Last visit to the dentist Less than 6 months ago R 29 41.43%
Between 6 months and a year ago R 14 20%
Between 1 and 2 years ago NR 15 21.43%
Between 2 and 3 years ago NR 2 2.85%
More than 3 years ago NR 6 8.57%
DK/NA NR 4 5.71%
Frequency of visits to the dentist Every 6 months R 27 38.58%
Once a year R 11 15.71%
Only when there is discomfort or pain NR 24 34.29%
Never NR 6 8.58%
DK/NA NR 2 2.86%
Why they care about oral health It is an important part of general health
No NR 0 0%
Yes R 70 100%
DK/NA NR 0 0%
For aesthetics
No NR 7 10%
Yes R 57 81.43%
DK/NA NR 6 8.57%
Tools used to perform oral hygiene Toothbrush
No NR 0 0%
Yes R 70 100%
DK/NA NR 0 0%
Dental floss
No NR 32 45.71%
Yes R 35 50%
DK / NA NR 3 4.29%
Mouthwash
No NR 26 37.14%
Yes R 41 58.57%
DK/NA NR 3 4.29%
Tooth brushing frequency More than twice a day R 48 68.57%
1 to 2 times a day R 16 22.86%
3 to 6 times a week NR 6 8.57%
Once a week NR 0 0%
DK/NA NR 0 0%

Flossing Frequency More than twice a day R 5 7.14%
1 to 2 times a day R 18 25.71%
3 to 6 times a week NR 7 10%
Once a week NR 8 11.43%
DK/NA NR 32 45.71%
Reason for using toothpaste Makes brushing easier
No R 10 14.29%
Yes NR 53 75.71%
DK/NA NR 7 10%
No NR 3 4.29%
Yes R 61 87.14%
DK/NA NR 6 8.57%
To have good breath
No NR 15 21.43%
Yes R 48 68.57%
DK/NA NR 7 10%
Out of habit
No R 20 28.57%
Yes NR 43 61.43%
DK/NA NR 7 10%
Frequency of tobacco cigarette smoking I don't smoke tobacco R 66 94.29%
I used to smoke, but I currently don't smoke NR 2 2.86%
6 or fewer cigarettes a week NR 1 1.43%
1 to 2 cigarettes a day NR 1 1.43%
3 to 5 cigarettes a day NR 0 0%
6 to 10 cigarettes a day NR 0 0%
11 or more cigarettes a day NR 0 0%
*R: Recommended. NR: Not recommended.
Table 4 presents the descriptive statistics by the participants was 11, which only three
of the knowledge score (0-17 pts). An oral health people achieved.
knowledge score was established based on the
answers to the knowledge questionnaire, except Table 5 describes the bivariate statistics
for the question about the means by which they between the knowledge score and the attitudes
received the explanation about dental care. and practices variables. There were no statisti-
cally significant differences between the average
The knowledge score had a mean of knowledge score and the different variables of
7.02 (S.D.1.99). The maximum score obtained attitudes and practices analyzed.
Table 4. Description of the knowledge score (0-17 pts).
Knowledge score Frequency Percentage

0 0 0%
1 0 0%
2 1 1.43%
3 3 4.29%
4 5 7.14%
5 6 8.57%
6 8 11.43%
7 16 22.86%
8 18 25.71%
9 6 8.57%
10 4 5.71%
11 3 4.29%
12 0 0%
13 0 0%
14 0 0%
15 0 0%
16 0 0%
17 0 0%
Table 5. Bivariate statistics between knowledge score and attitudes and practices variables.
Variable Answer Options N (%) Knowledge SD p

Score Average
Has visited the dentist sometime No 4 6.25 0.96 NS
in life
Yes 66 7.08 2.04
Has visited the dentist in the last No 34 6.68 1.90 NS
year
Yes 36 7.36 2.05
Last visit to the dentist Less than 1 year 43 7.35 2.06 NS
More than 1 year or DK/NA 27 6.52 1.83
Frequency of visits to the dentist At least once a year 38 7.34 2.16 NS
More than 1,2,3 years or DK/NA 32 6.66 1.75
Why they care about oral health For aesthetics
No 13 6.31 2.21 NS
Yes 57 7.19 1.93
Tooth brushing frequency 1,2, or more times a day 64 6.94 1.91 NS
From 1 to 6 times a week or DK/NA 6 8 2.83
Flossing Frequency 1, 2, or more times a day 23 7.26 1.98 NS
From 1 to 6 times a week or DK/NA 47 6.91 2.02
Tools used to perform oral hygiene Dental floss
No 32 7.03 1.92 NS
Yes 35 7.23 2.01
Mouthwash
No 26 7.04 1.82 NS
Yes 41 7.22 2.03
Reason for using toothpaste Makes brushing easier
No 10 6.5 1.78 NS
Yes 53 7.30 2.03
No 3 6.66 1.53 NS
Yes 61 7.20 1.99
Out of habit
No 20 7.15 1.90 NS
Yes 43 7.07 2.13
Tobacco cigarette smoking No 66 6.95 1.99 NS
Yes 4 8.25 2.06
DISCUSSION the study herein, on the other hand, participants

recognized the dentist or dental assistant for
The application of the questionnaire comple- instructing them about dental care (85.71%).
ted by first-year university students presented a
clearer picture of their level of knowledge, attitu- Most of the students who were part of the
des, and practices about oral health, through research study by Ferreira et al. were unaware of
the creation of a score based on questions on aspects such as the constitution and removal of
knowledge. In this aspect, the level of knowledge dental biofilm, and 77% of the participants belie-
about oral health demonstrated was low, since ved that the dentist is the one who should remove
the average (7.02 points) is less than half of the dental biofilm, when in fact anyone can remove
maximum score (17 points). The greatest deficiency it on their own with proper personal oral hygiene
in knowledge could be determined in topics such (13). On the other hand, RP-UCR students consi-
as dental biofilm, gingivitis, use of fluorides, and dered that dental biofilm can be removed by tooth-
the role of saliva as a protective factor of the oral brushing (64.29%).
cavity. In addition, several actions that affect the
condition of the oral cavity were identified among In relation to sweet food consumption, 41%
this population group, such as harmful habits, of the students in the study by Ferreira et al.
inadequate nutrition, and poor oral hygiene habits. believed sweet foods should be totally restricted
(13). For their part, the participants of the RP-UCR
Health education is one of the main ways considered sugar intake to be a factor that can
to integrate health-related knowledge, in order to contribute to the development of dental caries
promote self-care both individually and collectively, (91.43%).
and should start early in the undergraduate years
and take advantage of multiple forms of teaching In another investigation carried out in
and knowledge systems to create effective reinfor- 2015 at the Universidad del Pacífico in Paraguay,
cements of transdisciplinary thinking and holistic about half (51.9%) of the participating population
approaches (12). correctly answered one to four of the 10 questions
about dental caries prevention. Given this scena-
As a pillar of health promotion, health educa- rio, the authors recommend promoting oral health
tion allows an empowered population to modify and increasing knowledge on the subject to
their habits to maintain or improve their condi- prevent the progression of the disease (10). In our
tions. Therefore, identifying the level of knowledge research, the level of knowledge recorded is also
of a population regarding a health issue may allow low, since the knowledge score had an average of
a subsequent application of successful educatio- 7.02 (SD 1.99) out of a total of 17 possible points.
nal interventions (10).
A cross-sectional study conducted among
A study conducted by Ferreira et al. (13), pre-university students in the city of Mysore, India,
in which 101 students enrolled in the last year of between 2009 and 2010, concluded that the
the Pedagogy course at the Federal University of students had good knowledge about the basic oral
Paraíba in Brazil participated, showed that 83% health measures necessary to maintain adequate
of them had received information on preventive oral health, but their attitudes and practices
dentistry previously, being the dentist the answer towards oral health were not adequate. For
to the question on the means by which they had example, 88% of the participants knew that proper
received this information in 64% of the cases. In brushing prevents tooth decay and gum problems,
but the majority of students (90%) agreed that (16). These data are very similar to those reported
they visited the dentist only when they had pain, in this study.
and cleaned their teeth just once a day. 89% of
students knew that sweets and sticky foods cause On the other hand, in a qualitative research
tooth decay, and the majority of students (88%) study carried out in Sweden on the perceptions
knew that dental health is reflected in general of oral health of adolescents between 15 and 18
health (14), which is similar to the data collected years of age, the respondents showed that tooth-
from RP-UCR students, where 100% of the parti- brushing is the main tool they use for oral health
cipants believed that having good oral health is an care. Most of them knew that other factors, such
important part of general health. as flossing and eating habits, could be factors
that influence the improvement of oral health, but
Most of the Mysore City study participants found them difficult to use (17).
(90%) considered drinking alcohol and smoking to
be harmful to dental health, as well as that they Another study on attitudes about oral health
may cause cancer (14). A similar percentage of in Swedes aged 20-25 years found that a high
participants (92.86%) at RP-UCR considered that proportion of respondents considered that they are
cigarette smoking and the use of other tobacco in great need of dental care. A high percentage of
products may favor the occurrence of oral cancer; participants indicated that they were satisfied with
however, only 42.86% believed that alcohol may their dental function, but few people were satisfied
also predispose individuals to the occurrence of with the appearance of their teeth. Most respon-
oral cancer. dents had adopted good oral hygiene habits, but
flossing was infrequent (18).
Another research on knowledge of oral
health problems among low-income people in One of the limitations of this study is the
Baltimore, United States showed that 91% of size of the sample, which could have resulted in
respondents knew that sugar causes dental caries, the absence of statistically significant differen-
while 82% understood that the best way to prevent ces when associating the knowledge score and
dental caries was brushing and flossing every day. the variables of attitudes and practices, so further
However, only 15% knew how often to floss, and research with a larger sample is recommended.
only 21% knew that dental biofilm was made up
of germs (15). Similarly, in the study herein, only Among the strengths of this study, it is worth
22.86% of participants knew of the presence of mentioning that this is the first study of its kind to
bacteria in the composition of dental biofilm. be carried out in Costa Rica. Additionally, impor-
tant data and information was obtained to validate
In a study on the beliefs regarding caries the questionnaire used, as well as to be able to
and oral hygiene that school adolescents have in replicate it with a sample that is more consistent
the Department of Valle del Cauca, Colombia, the and, ideally, representative of the population.
results regarding the etiology of caries showed that
65% believed that dental caries is due to poor oral CONCLUSION
hygiene, 18% due to bacteria, 7% due to sugar
consumption, and 10% do not know. Furthermore, In this study, a general lack of knowledge
99.8% responded that they brush their teeth, regarding basic concepts of oral health was identi-
brushing frequency averaged three times per day, fied among young university students. First of all,
55% use dental floss, and 51% use mouthwash. students were not clear about the role of some
protective or risk factors related to the main oral AUTHOR CONTRIBUTION STATEMENT
diseases. Moreover, students lack knowledge about
the role of microorganisms in oral health and how Conceptualization and design: J.B.B.C., C.R.B.
imbalance or dysbiosis may cause the appea- Literature review: J.B.B.C., C.R.B.
rance of diseases, such as, caries and periodontal Methodology and validation: J.B.B.C., C.R.B. and
disease, among others. Therefore, it is important C.B.S.
for educational activities to include clarification on Investigation and data collection: J.B.B.C., C.R.B.
the role of fluorides to prevent the appearance of Data analysis and interpretation: C.B.S.
dental caries, as well as an explanation on which Writing-original draft preparation: J.B.B.C., C.R.B.
daily use products contain fluorides and how Writing-final draft: J.B.B.C., C.R.B. and C.B.S.
fluorides may be administered by the dentist.
ACKNOWLEDGMENTS
The findings of this study will allow a tailored
and specific strategy to be created to satisfy the We thank the authorities of the Paraíso
needs of the student population at RP-UCR, aimed Campus of the University of Costa Rica for the
at recommending positive practices to improve opportunity to carry out this study. In addition, we
this population’s oral health conditions and to thank all the participants for their valuable contri-
prevent the appearance of the most frequent oral bution to scientific research in health. Likewise, we
diseases. In addition, this strategy will enable this acknowledge all the collaborators, dental students
population to counteract the negative effects of and dental assistants who contributed during the
these diseases, in case they are already present, study on a voluntary basis.
and to adopt appropriate therapeutic measures.
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Odovtos-International Journal of Dental Sciences (Odovtos-Int. J. Dent. Sc.), 26-1 (January-April): 100-115.

Juan Bautista Barahona-Cubillo DDS, MSc¹ https://orcid.org/0000-0003-1193-9024

1. Facultad de Odontología, Universidad de Costa Rica, San José, Costa Rica.

Correspondence to: Dr. Cristina Barboza-Solís - [email protected]

Received: 21-VI-2022 Accepted: 28-VII-2022

INTRODUCTION ability to speak, smile, smell, taste, touch, chew,

Table 2. Distribution of responses on oral health knowledge (N=70).

Variables Answer options Answers * N %

Variables Answer options Answers * N %

Variables Answer options Answers * N %

Variables Answer options Answers * N %

Variables Answer options Answers * N %

Table 4. Description of the knowledge score (0-17 pts).

Knowledge score Frequency Percentage

Variable Answer Options N (%) Knowledge SD p

DISCUSSION the study herein, on the other hand, participants

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