Oral hygiene behaviour in a 12 level highschool group of students from Bucharest

Pages: 52-64

Ruxandra Sfeatcu (1)*, Alina-Cristina Radu (2), Mariana Cărămidă (3), Christina Mihai (4), Mihaela Adina Dumitrache (5)

(1) Assoc. Professor, Oral Health and Community Dentistry Department, Faculty of Dental Medicine, University of Medicine and Pharmacy “Carol Davila”, Bucharest;(2) Dentist, graduate of Faculty of Dental Medicine, University of Medicine and Pharmacy “Carol Davila”, Bucharest;(3) Teaching Assistant, Oral Health and Community Dentistry Department, Faculty of Dental Medicine, University of Medicine and Pharmacy “Carol Davila”, Bucharest;(4) Teaching Assistant, Preventive Dentistry Department, Faculty of Dental Medicine, University of Medicine and Pharmacy “Carol Davila”, Bucharest;(5) Professor, Oral Health and Community Dentistry Department, Faculty of Dental Medicine, University of Medicine and Pharmacy “Carol Davila”, Bucharest*Corresponding author: Ruxandra Sfeatcu; ruxandra.sfeatcu@umfcd.ro


Aim: Evaluation on the behaviour of a group of highschool students aged between 17 and 19 years old as to their habits of oral hygiene.

Material and method: A transversal study carried on from November 2020 to February 2021, on a group of 55 students, using a questionnaire distributed on-line.

Results: It was noticed that more than 50% of the subjects perform their tooth brushing at least twice a day and only 5% of the study group several times a week. As to the duration of the personal tooth brushing, 65% insist for at least 2 minutes, and 11% do a brushing of only 30 seconds. Most of them moisten their toothbrush before using it and have an adequate behaviour regarding the frequency of replacing it. In terms of behaviour related to using the auxiliary means of oral hygiene, less than half of the subjects involved in the study, use them everyday.

Conclusions: Teenagers are at risk of developing an unhealthy behaviour towards the oral hygiene, being easily influenced by the surrounding factors. That is why there is a great need of educating them for the oral hygiene and making them aware of the necessity of preventing the diseases of the oral cavity.

Key words: behaviour, oral hygiene, teenagers.


Oral health is an important aspect of the general health status, because it has psycho-social implications and can influence the quality of one’s life [1]. Personal habits of  oral hygiene as well as the dietary habits are intrinsec factors for oral diseases, such as tooth decay, periodontal diseases or oral cancer [2]. Oral diseases, due to their increasing incidence and prevalence all over the world, have a particular importance for the public health, especially with the disadvantaged groups [3]. The oral cavity affects a lot of schoolchildren and most of the adults, in particular because of  an excessive consumption of sugar and lack of protective factors, such as drinking fluoridated water and keeping a correct personal oral hygiene [4, 5].

The main barrier in ensuring a good oral condition is related to lacking the education on achiving a correct hygiene, knowing the risk factors and the importance of prevention. As a consequence, evaluating the behaviour as to teenagers’oral hygiene is a first step taken to  intervening in their habits by educational programs aimed to achieving adequate oral health.

This study aimed to identify highschoolchildren’s behaviour as to oral hygiene and finding out about their need of education according to the results obtained, as well as creating and implementing an oral health education lesson.

Material and method

In order to achieve the objectives, a transversal study was performed on a group of 55 teenagers (mean age 17.78 ys; SD+0,45), over a period of 4 months, beginning in November 2020, until February 2021. An on-line questionnaire was delivered to students from a highschool in Bucharest. The target group was made up of students in the 12th grade. The questionnaire was shared in electronic form by Google Forms Platform, due to the pandemic situation in the year 2020, respectively 2021.

The main goal of the questionnaire was to evaluate the level of knowledge and behaviour concerning the oral hygiene with a group of teenagers in order to find out their need of being informed as to oral health and to make targeted recommendations. Subsequently, an education lesson on oral health and dental care was held.


 Demographic data show that 74% of the 55 students were 18 years old, followed by those of 19 years (24%), and 2% were those of 17 ys. (Table I). According to their gender, it can be pointed out that the answers of the female persons prevailed with 60%.

17 y.o.12
18 y.o.4174
19 y.o.1324
Table I. Distribution of the subjects according to age

The evaluation of the personal dental cleaning behaviour showed that only 49% clean their teeth twice a day, 33% do it once a day, 13% clean their teeth several times a day and 5% several times a week. It can be noted that none mentioned never brushing the teeth (Table II).

Several times a day713
Twice a day2749
Once a day1833
Several times a week35
Table II. Frequency of tooth brushing

As to the average duration of the dental brushing it can be ascertained that 18% of the students brush their teeth for 3 minutes, 38% brush their teeth for 2 minutes, 24% do it only for one minute, 9% for more than 3 minutes and 11% brush their teeth for 30 de seconds (Table III).

More than  minutes59
3 minutes1018
2 minutes2138
1 minute1324
30 seconds611
Table III. Duration of the personal dental brushing

It was noted that most of the students moisture their toothbrush before brushing, in a proportion of 84% (Table IV).

Table IV. Moisturing the toothbrush

It was noted that the students in this study replace their toothbrushes every 3 months in a proportion of 65%, every 6 months (31%) and once a year 4% (Table V).

Every 3 months3665
Every 6 months1731
Every year24
Table V. Frequency of replacing the toothbrush

Out of the subjects in the study, 49% make use of mouthwash, 18% use toothpicks, 13% dental floss, while the others answer that they use mouthwash and interdental brush in a percentage of  6%, dental floss and mouthwash 5%, and other combinations (Table VI).

Dental floss712
Mouthwash, interdental toothbrush35.5
Dental floss, mouthwash35.5
Toothpicks, mouthwash, dental floss47
Dental floss, mouthwash, interdental toothbrush12
Table VI. Auxiliary means of oral hygiene used by the respondents

Among the students involved in the present study, 47% use supplementary means of oral hygiene daily, 14% several times a week, sometimes 13%, rarely 22% and 4% do not use any (Table VII).

Several times a week814
Table VII. Frequency of using auxiliary means of oral hygiene

As to the behaviour of dental office attendence, the ratio of going in for a dental consult once a year is of 13%, twice a year 11%, 65% visit the dentist only when they face a dental issue, which points to an unhealthy behaviour (Table VIII).

Only when I have a dental issue/problem3665
Once a year611
Twice a year713
Table VIII. Frequency of dental visits

When they were inquired about the way they acquired oral hygiene knowledge, 53% of the subjects answered that they had learned it in the family, 13% from the dentist, 3% from  mass-media, 16% from their family and the dentist, 3% within the oral helath education classes and their parents, and the rest gave various answers (Table IX).

Lesson of oral dental care education at school36
Family and dentist916
Other answers59
Table IX. Sources of acquiring information related to the oral health

Following the results obtained in the questionnaires it was noted the need of a lesson on oral health education aiming at improving the oral hygiene habits, making the teenagers become aware of the importance of the oral hygiene as well as improving the timing of their periodic dental control.

In order to achieve the goals of the lesson, a PowerPoint presentation was used, together with samples of toothbrushes, dental floss, fluoride toothpaste, and a dental study model with a toothbrush to illustrate the brushing technique. By help of the study model the correct brushing technique was shown and the way the dental floss should be used, too, as well as other auxiliary methods of dental  hygiene. To understand the level of the assimilated information, an experiment was staged at the end of the oral healthcare education lesson, in which two volunteers took part. They brushed their teeth according to the correct technique previously acquired, and after that dental plaque disclosing agent was applied to reveal any missed spots. Consequently, they proved to have acquired the correct technique of toothbrushing and there were no spots left uncleaned.

The teenagers showed curiosity and asked a lot of questions during the dental care education lesson. The students in the study proved to have some knowledge about the means of oral hygiene. On the other hand, their behaviour is unsatisfactory. Few of them would appropriate the necessary oral health preventive measures.


According to this study, 62% of the subjects perform a toothbrushing at least twice a day. World research studies, including Romania, ascertained the behaviour of children aged 11, 13 and 15 years old. Thus, it was found that less than half of these children perform the toothbrushing twice a day [6]. Another study performed on teenagers in Bangladesh proved that out of the 944 individuals included in the study, only 37.4% clean their teeth at least twice a day [7]. Considering these values we can realize that the differencies of education in point of the oral hygiene may be connected to the economic status of the country the persons belong to and that there is a real need of promoting oral health education with the disadvanteged groups.

Also, in this study, 65% of the subjects have an adequate behaviour about replacing their toothbrushes every 3 months. More satisfying results showed in a survey done in Iași, Romania (2016) where the majority of students (90%) replace their toothbrushes every 3 months [8].

In the present study, less than half of the students use auxiliary means of oral hygiene daily. Of these supplementary means, the most frequently used are the mouthwash, dental floss or both of them. Yet, it should be said that 18% of the students use toothpicks. In the previously mentioned study, made on the students in Iași, similar results were registered, mouthwash being used by the students in a proportion of 64%, and the interdental toothbrushes in a proportion of 3.3% [8].

More than half of the subjects in this study said that their main source of oral health information is the family and only 13% of the students said that they had received information from their dentist. But, the teenagers from Iași in 2016 said that they had acquired the correct toothbrushing technique in a proportion of 50% from the dentist and 39% from parents [8].

In this study, 65% of the subjects visit the dentist only in emergencies, and 11% say that they have never been in a dental office. As opposed to this study, the students involved in a study from the Czech Republic have been at least once to the dentist in a proportion of 88.7% [9]. Also, another study performed on teenagers between 15 and 16 years old, from Bucharest, concluded that one third of them have a low educational level concerning oral health care, and the fact that 54% of them only visit the dentist only in emergencies [10].


According to the results from this study, it has been found that the teenagers in the survey group present some knowledge about the oral hygiene, but their behaviour is unsatisfactory.

Taking into account their age, we can state that they belong to a population group of transition to self knowing and their need of experimenting is increased. They are being exposed to the background factors and are easily influenced by mates, friends, and mass-media. Personal beliefs related to healthy habits and their perception regarding oral health can be improved.

As to a periodical dental appointment, most of them see the dentist only when they have got an oral health problem, and a number of students have never been at a dental office, indicating to an unhealthy behaviour related to dentisty attendance.

It shall be ascertained that there is a real need for getting informed through educational programmes of oral health and dental care in order to influence and improve the degree of interest in the personal oral hygiene and the motivation to adopting a healthy behaviour with the young generation.


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