Oral health behaviors in pupils – a comparative study

Pages: 45-57

Ruxandra Sfeatcu(1)

(1)Șef Lucrări Dr., Disciplina de Sănătate Orală și Stomatologie Comunitară, Facultatea de Medicină Dentară, Universitatea de Medicină și Farmacie ,,Carol Davila”, București, România


School is the ideal environment for education because medical information reaches a large number of children who are in an important stage of behavioral development.

Aim: to assess the behaviors towards oral health among two groups of students aged between 9 and 13, from Bucharest and Tehran.

Material and Method: The study included 110 students (mean age 11.24, SD±1.26), 55 from a general school in Bucharest and 55 from a school in Tehran in 2015 and used an anonymous closed-ended questionnaire.

Results: The behavior is correct in terms of brushing frequency. Students in Tehran use dental floss more than those in Bucharest (18.2% vs 7.3%), consume citrus more frequently and do not drink carbonated soft drinks. Regarding eating behavior, students prefer cooked food (62.7%), vegetables and fruits (70.9%), but 60% consume sweets. 50% of the students have been to the dental office in the last 6 months.

Conclusion: Pupils need oral health education lessons in schools, especially in terms of eating foods with cariogenic potential and regular visits to the dentist.

Key words: schoolchildren, behaviour, oral health.


Schools are an ideal environment for health education programs because medical information reaches a large number of children who are in an important stage of personality and behavioral development [1, 2, 3]. In children there is dependence on the family and the school environment, so the sanogenic behaviors monitored by parents and teachers, become habits in adult life [4, 5]. Along with the family, there are social factors that largerly influence children’s behavior [6, 7, 8].

If the material and social conditions are very good, the state of health is satisfactory. The set of knowledge, attitudes and skills of the population, oriented towards obtaining and maintaining health status is a relevant aspect for the social and cultural determinism of a community’s health [6, 7]. When we refer to dental sanogenic behaviors, we refer mainly to the following: tooth brushing, practices towards sugar consumption; addressability behavior at the dental office [4, 5].

Dentists need to understand behavior to effectively promote oral health, they need to communicate appropriately for the benefit of shaping the health behavior of patients and individuals in the community [5, 6].

Aim of the study

The study’ objective is to assess the behaviors towards oral health among two groups of students aged between 9 and 13 years, from Bucharest and Tehran.

Material and method

The study group included 110 students (mean age 11.24, DS±1.26), 55 from a school in Bucharest and 55 from a school in Tehran, in 2015. The students were given an anonymous questionnaire related to behaviors towards oral health, recommended by World Health Organization. The questionnaire was translated by a student at the Faculty of Dentistry and was applied to complete the diploma thesis. Descriptive statistics of the obtained results were performed.

The ethical aspect of the research consisted in obtaining the agreement for the study from the school management and the pupils, to whom the purpose of the study was explained. Data confidentiality was ensured. We started from the hypothesis that there are differences in oral health behavior between the two groups, due to the social and cultural context.


Of the 110 participants, 57.3% are female students. Most subjects are 12 years old (24.5%), 11 years old (23.6%), 10 years old (22.7%), 11 and 13 years old (20%) and the youngest (9.1%) are 9 years old. The results are presented in tables, for the whole group and separately, for each of the two groups studied, from Bucharest and Tehran.

Results regarding the oral hygiene behavior

About half of the schoolchildren (43%) brush their teeth after every meal (more students from Bucharest), 22% twice a day, so it can be considered a relatively correct tooth brushing behavior related to frecquency. However, there are also students who tooth brush less often than they should. However, there are also students who wash less often than they should, more those from Bucharest (Table I).

Table I. Behavior related to the frequency of personal tooth brushing

Most of the subjects use the toothbrush (93.6%) and the toothpaste (75.5%). Only 12.7% use dental floss (more students in Tehran, 18.2% compared to 7.3%) and 20% mouthwash, as auxiliary means for personal brushing. Almost a third (24.5%) say that they use chewing gum instead of tooth brushing (Table II).

Table II. Auxiliary means used for personal brushing

More than half of the students (60%) behave correctly, drink plain water, and a quarter (25.5%) no longer consume food or drink after the evening tooth brushing (Table III). However, 6.4% still eat sweets, 22.7% drink tea or milk and 15.5% drink mineral water. Different results in the two groups: more those in Bucharest consume mineral water, tea, milk or sweets (23.6% compared to 7.3%; 32.7% compared to 12.7%; 10.9% compared to 1.8%).

Table III. Behavior of schoolchildren after the evening brushing

 Results on eating behavior of the subjects included in the study

Most pupils consume citrus 2-3 times a week (40%), 12% less often, a third daily (32%) and 13% several times a day. Students in Tehran consume citrus more often and do not drink fizzy drinks. 40% consume carbonated beverages once a week, more frequently a lower percentage (16%), and daily a percentage of 9%. 26% say they do not consume carbonated drinks. A quarter consume sweetened drinks daily, 27% less often (2-3 times a week), and 16% do not consume. A low percentage declares a frequent consumption (several times a day) of sweets (7%). A quarter consume daily, about a third 2-3 times a week (33%, respectively 32.5 %) or less often (once a week). The results are similar in the two groups. There is a frequent consumption of pastries (62% daily), 18% more often, 14% several times a week, only 4% less often and only 2% do not consume (Table IV).

Table IV. Frequency of fruit and beverage consumption among schoolchildren

Almost half of the responding pupils eat sandwiches at school (51.8%). About one third consume chips, natural juices, sweets and fruits. carbonated drinks, only in 15.5% of cases, but students in Bucharest consume more (25.5%) compared to those in Tehran, only 5.5%. Students in Tehran prefer natural juices and fruits, those in Bucharest consume chips. In general, the behavior at home is correct, students prefer cooked food (62.7%), vegetables and fruits (70.9%). But, 60% consume sweets; natural juices (40%). Moreover, those in Tehran consume natural juices and plain water. Students in Bucharest consume more sweets (72.7%) compared to 47.3% (in Tehran) (Table V).

Table V. Types of snacks and drinks consumed at school and at home

Results regarding the addressability behavior to the dentist

Regarding the dental visits, 50% of the pupils have been to the dentist’s office in the last 6 months. 6.4% have never been to the dentist (Table VI). More students from Bucharest reported their last visit to the office in the last 6 months (61.8%), compared to one third from Tehran.

Table VI. Date of last visit to the dental office


Results are different for the two groups, especially in terms of eating behavior. Thus, students in Tehran have a more frequent consumption of fruits (citrus) and a lower consumption of carbonated drinks, they prefer natural juices, aspects that reveal the specifics of the area, the social and cultural model [7, 8]. More pupils in Tehran consume sweetened beverages. Those in Tehran consume more frequently, 33% daily, compared to 16% in Bucharest. Students eat sandwiches at school, especially those in Tehran (60%, versus 43.6%). Consumption of chips at school is increased in Bucharest (49.1% compared to only 9.1% in Tehran). Almost half of the students in Tehran consume natural juices at school, compared to one third in Bucharest; similar for fruits. Almost half in the group from Tehran eat sweets at school compared to 14.5% in Bucharest. Moreover, those in Tehran consume natural juices and plain or mineral water. At home, those in Bucharest consume more sweets (72.7% compared to 47.3% in Tehran). Eating after brushing evening stands out more to schoolchildren in Bucharest.


The data presented support the need for health education lessons among pupils included in the study, especially in terms of eating foods with cariogenic potential and regular visits to the dentist. The relationship between schools and community is essential, and to be effective, education programs must actively involve schoolchildren, parents and teachers and also to provide the appropriate medical and dental information, as well as motivation for improving behavior towards oral health.

ACKNOWLEDGMENTS to former dental student Shabani Elmira for collecting data among students in Tehran, as well as to schoolchildren involved in the study.


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