Testing five social-cognitive models to explain predictors of personal oral health behaviours and intention to improve them.

PURPOSE: To test the ability of several social-cognitive models to explain current behaviour and to predict intentions to engage in three different health behaviours (toothbrushing, flossing and mouthrinsing). MATERIALS AND METHODS: Constructs from the health belief model (HBM), theory of reasoned action (TRA), theory of planned behaviour (TPB) and the motivational process of the health action process approach (HAPA) were measured simultaneously in an undergraduate student sample of 172 first-year medical students. RESULTS: Regarding toothbrushing, the TRA, TPB, HBM (without the inclusion of self-efficacy SE), HBM+SE and HAPA predictor models explained 7.4%, 22.7%, 10%, 10.2% and 10.1%, respectively, of the variance in behaviour and 7.5%, 25.6%, 12.1%, 17.5% and 17.2%, respectively, in intention. Regarding dental flossing, the TRA, TPB, HBM, HBM+SE and HAPA predictor models explained 39%, 50.6, 24.1%, 25.4% and 27.7%, respectively, of the variance in behaviour and 39.4%, 52.7%, 33.7%, 35.9% and 43.2%, respectively, in intention. Regarding mouthrinsing, the TRA, TPB, HBM, HBM+SE and HAPA predictor models explained 43.9%, 45.1%, 20%, 29% and 36%, respectively, of the variance in behaviour and 58%, 59.3%, 49.2%, 59.8% and 66.2%, respectively, in intention. The individual significant predictors for current behaviour were attitudes, barriers and outcome expectancy. CONCLUSION: Our findings revealed that the theory of planned behaviours and the health action process approach were the best predictor of intentions to engage in both behaviours.

Associations among sleep disturbance, vitality, fatigue and oral health.

PURPOSE: The objective of the present study was to explore the moderating effects of sleep disturbance, fatigue and vitality on self-reported oral-health status and oral-health related behaviours. MEASUREMENTS AND RESULTS: The present study sample consisted of 213 first-year dental students at the University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania. The questionnaire included information about sociodemographic factors, behavioural variables and self-reported oral-health status. Subjective Vitality Scale, Fatigue Assessment Scale and Karolinska Sleep Questionnaire were used to assess quality of sleep, vitality and fatigue. The duration of sleep in 41.2% of students was < 7 h per night. It was revealed that 11.7% of the students experienced daily disturbed sleep, 20.4% had daily premature awakening and 50.5% presented frequent difficulties awakening. Significant differences were found among disturbed sleep, impaired awakening, vitality and fatigue scales according to several variables: perceived dental health, satisfaction by appearance of own teeth, self-reported gingival condition, mouth rinse frequency and reason for the dental visit, while multiple linear regression analyses revealed that vitality and impaired awakening were independent determinants of self-rated oral and gingival health status. Disturbed sleep index, impaired awakening, fatigue and vitality were positively associated with oral-health related behaviours. CONCLUSIONS: The authors concluded that the disturbed sleep index, impaired awakening, fatigue and vitality were associated with oral-health status and behaviour.

Self-liking, self-competence, body investment and perfectionism: associations with oral health status and oral-health-related behaviours.

PURPOSE: The aim of this study was to investigate whether self-liking, self-competence, body investment and perfectionism were associated with self-reported oral health status and oral-health-related behaviours. MATERIALS AND METHODS: The study sample consisted of 217 first-year dental students. The questionnaire included information about sociodemographic factors, behavioural variables, self-reported oral health status, self-liking, self-competence, body investment and perfectionism. RESULTS: Significant differences were found on self-liking, self-competence and body investment subscales according to several variables: perceived dental health, current non-treated caries, current extracted teeth, satisfaction by the appearance of own teeth, the last time toothache occurred, self-reported gingival condition and self-reported gum bleeding. When oral health behaviours were analysed, an association between self-liking, self-competence and body investment subscales and flossing, mouthrinse and dental visit pattern was revealed. Toothbrushing frequency once a day or less was observed in persons with low-levels of self-liking, body care, body protection and perfectionism. Multiple linear regression analyses revealed that age, gender, smoking habits, anxiety, stress, depression in everyday life, self-liking, self-competence, body image, care and protection were positively associated with oral health behaviours. CONCLUSIONS: The results suggested that self-liking, self-competence and body investment subscales might be the psychosocial risk markers that influence self-reported oral health status and behaviour.

Self-control and self-confidence: their relationship to self-rated oral health status and behaviours.

PURPOSE: The aim of this study was to examine the relationship between self-control and self-confidence, and students' self-rated oral health and oral-health-related behaviours. MATERIALS AND METHODS: The present study sample consisted of 178 first-year medical students. The questionnaire that was used in this study included information about sociodemographic factors, behavioural factors, self-reported oral health status, self-control and self-confidence. RESULTS: The results showed that mean levels of self-confidence in individuals with current extracted teeth and with poor/very poor perceived gingival condition were statistically significant and lower than those with no current extracted teeth and with self-rated excellent gingival health (P < 0.05). Also participants with self-reported gingival bleeding showed lower values of self-control compared with those with healthy non-bleeding gingiva (P < 0.05). When oral health behaviour was evaluated, it was shown that students with higher scores of self-control were more likely to use everyday mouthrinses (P < 0.05). The multiple linear regression analyses showed, for self-rated oral and gingival health status as dependent variable, a strong association with students' self-confidence level (P < 0.05). CONCLUSIONS: The results support the view that self-confidence is related with oral health status, and individuals with impaired oral and gingival health have a low self-confidence level.

Self-reported oral health status, oral health-related behaviours, resilience and hope in Romania.

PURPOSE: The aim of the present study was to investigate whether resilience, hope, perceived oral health status and oral health-related behaviours were associated. MATERIALS AND METHODS: The study sample consisted of 198 first-year medical students in Romania. The questionnaire included information about sociodemographic factors, behavioural variables, perceived oral health status, resilience and hope. RESULTS: Women had more resilience and 'personal competence' than men (P < 0.05). Resilience and hope were correlated with perceived dental health (P < 0.01). Perceived dental health was related to current non-treated caries, satisfaction with the appearance of one's own teeth, toothache last time and resilience (P < 0.001). Age, gender, current extracted teeth, perceived gingival bleeding and hope were not independent distinguishing variables after adjustment for internal heterogeneity. When oral health behaviours (toothbrushing, flossing, mouthrinse frequency and pattern of dental visit) were evaluated, it was demonstrated that flossing frequency was correlated with resilience and hope (P < 0.01). CONCLUSIONS: The results suggested that resilience and hope might be a psychosocial risk marker that influences perceived oral health status and behaviours.

Exploring the relationships between sense of hopelessness, worry, self-rated oral health status, and behavior in a Romanian adult population.

AIM: The purpose of this study was to examine the impact of psychological states, self-rated oral health, and oral health behavior on hopelessness. METHODS AND MATERIALS: A cross-sectional study design was used. Data were collected between September and November 2006. The sample consisted of 233 Romanian adults (mean age 47.3 years; 65.6% women; 65.8% married). The questionnaire included information about demographic, psychological, self-reported oral health, and oral health related behavior items. RESULTS: 'Hopeless' participants were more likely to self-evaluate their dental health as poor/very poor (P<0.001), to be less satisfied by the appearance of their teeth (P<0.05), to report more non-treated caries (P<0.01), to brush their teeth less than twice per day (P<0.01), and never use mouthrinse (P<0.05). Logistic regression analysis showed 'hopeless' participants were apt to have a lower educational level, brush less frequently, have higher financial problems as the reason for not visiting the dentist, and report higher anxiety (odds ratio = 5.4, 4.2, 2.6, and 12.6, respectively). Forty-seven (73.4%) of 64 'hopeless' participants and 90 (80.4%) of 112 'non-hopeless' participants were correctly predicted by the above four variables. CONCLUSION: The results of this study found impaired oral health and financial problems may pose an increased risk for hopelessness. CLINICAL SIGNIFICANCE: Poor oral health can be regarded as a risk marker for the level of hopelessness.

Instability of self-esteem and affective lability as determinants of self-reported oral health status and oral health-related behaviors.

AIM: The aim of the study was to examine the impact of the instability of self-esteem and affective lability on students' self-rated oral health and oral health-related behaviors. METHODS AND MATERIAL: The present study sample consisted of 178 first year medical students. A questionnaire was used to collect information about socio-demographic factors, behavioral factors, self-reported oral health status, the instability of self-esteem, and affective lability. RESULTS: Significant differences were found on the instability of self-esteem and affective lability on the following variables: gender, smoking, anxiety, depression, stress in everyday life, number of extracted teeth, and satisfaction with appearance of one's own teeth (Ps<0.05). The level of instability of self-esteem had a consistent association with the self-reported oral health status and satisfaction with appearance of teeth. The affective lability total score was a determinant of the number of extracted teeth, last toothache, self-rated gingival status, while anger was correlated with the number of current non-treated caries, extracted teeth, toothbrushing, and flossing frequency. CONCLUSIONS: The results indicate there is an increased risk for impaired dental health among subjects with instable self-esteem symptoms or symptoms of anger.

Tobacco and alcohol use among Romanian dental and medical students: a cross-sectional questionnaire survey.

PURPOSE: The aim of this study was to assess smoking and alcohol use in Romanian dental and medical students. MATERIALS AND METHODS: A total of 185 questionnaires were distributed to male and female dental and medical students (first and sixth year). RESULTS: Across all groups, 60.86% of the responders have never been smokers, while the prevalence of smoking among the different groups was 28.84% for Year 1 dental students, 53.18% for Year 6 dental students, 39.58% for Year 1 medical students and 36.36% for Year 6 medical students. Unadjusted linear regressions showed significant linear relationships between average number of cigarettes smoked a day and average age when students started smoking (p < 0.05). Of Year 6 dental students, 41.30% have drunk at least once a week, compared with 24% of dental freshmen. The use of alcohol among males was significantly higher than in females (p < 0.0001). Unadjusted linear regressions showed significant linear relationships between frequency of smoking and alcohol consumption (p < 0.05). CONCLUSIONS: Both medical and dental students in Romania may benefit from preventive interventions in universities addressing the health risk behaviours of alcohol use and smoking.

Attitudes of Romanian dental students towards tobacco and alcohol.

AIM: The aim of this study was to assess smoking and alcohol use in male and female Romanian dental students and to compare this with different levels of education. METHODS AND MATERIALS: A total of 315 questionnaires were distributed to male and female dental students (first to sixth year students). RESULTS: Among the 315 respondents, 37.33% were smokers and 71.04% o f students used alcohol on a regular basis. Overall, there was a 30-day smoking prevalence of 32.47%. Among those who smoked daily, 24% were sixth year students and only 10% were first year. The average number of cigarettes smoked was thirteen cigarettes per day with males smoking more than females (p<0.0001). The average number of years as a smoker was five years, with fifth and sixth year students smoking longer than others (p<0.001). The average age when students started to smoke was 17.15 years. Statistically significant differences were observed between genders related to alcohol drinking (p<0.0001). Significant linear relationships were shown between smoking and alcohol consumption (r;2=0.47, p<0.0001). CONCLUSION: There was a clear difference in smoking and alcohol consumption between groups of Romanian dental students.

Predicting undergraduates' intentions to improve oral health behaviors: the importance of self-identity--a pilot study.

PURPOSE: The purpose of this study was to explore the predictive ability of factors associated with the Theory of Planned Behavior (TPB) on oral health behaviors. METHODS: The participants of this descriptive, cross-sectional study were 179 first year medical students at the Carol Davila University of Medicine and Pharmacy that completed a questionnaire assessing TPB variables, self-identity and their current oral hygiene behaviors. RESULTS: Significant differences in self-identity regarding the toothbrushing behavior and reason for the dental visit were observed (p < 0.0001). When participants were classified in 2 groups according to their levels of self-identity, significant differences were found according to their age, toothbrushing frequency, attitudes, perceived behavioral control and intention for improving oral hygiene (p < 0.0001). Self-identity had a statistically significant positive correlation with affective attitudes, cognitive attitudes, subjective norms, perceived behavioral control and intention for improving oral hygiene. Hierarchical multiple regressions for toothbrushing frequency revealed that the TPB factors and self-identity explained 31% and 35% from the intention to improving behaviors, the coefficients for self-identity being significant. The structural equation model revealed the effect of self-identity on intention on improving oral health behaviors and the effect of past-behavior on self-identity. CONCLUSION: The findings revealed the value of the extended TPB model as a predictor of intention to improve oral health behaviors. Dental educators should focus on issues of students' self-identity as a person concerned by their oral health.

The interplay of attention and self-monitoring with self-reporting oral health.

OBJECTIVES: We examined the effects of self-monitoring and focus of attention as predictors of self-reported oral health behaviors. MATERIAL AND METHODS: In this study of212 first year dental students, attention was measured with The Focus of Attention Questionnaire (FAQ) and self-monitoring with Revised Self-Monitoring Scale (SMS-R). The questionnaire included also information about socio-demographic factors, self-reported oral health status and behaviors. RESULTS: Self-Focused Attention (FAQself) was statistically significantly higher in participants who reported more than only one gingival sign (such as gingival bleeding) compared with those who reported healthy gums. Significant differences were observed between the high and low self-monitors regarding the insatisfaction by appearance of own teeth, gingival health, dental visits and mouthrinse frequency. Relation between tootbrushing frequency and self-reported gingival status was moderated by Other-Focused Attention (FAQexternal). FAQexternal also emerged as a moderator for dental visit frequency and self-rated gingival status / dental decays. FAQself and FAQ were moderators for self-reported dental decays, dentist visit frequency and reasons for dental visiting. The relation between flossing frequency and self-rated gingival bleeding, between mouthrinse frequency and self-reported dental decays, between dental visit frequency or reason for dental visits and self-reported dental decays, between reason for dental visits and self-reported dental extractions was moderated by self-monitoring. CONCLUSIONS: The effect of focus of attention and self-monitoring should be considered when tailoring intervention efforts to oral health promotion as well as in studies involving self-reporting as a tool in screening the oral health of populations.

Modeling the theory of planned behavior for intention to improve oral health behaviors: the impact of attitudes, knowledge, and current behavior.

The aim of this study was to test the efficiency of an extended model of the theory of planned behavior (TPB) in predicting intention to improve oral health behaviors. The participants in this cross-sectional study were 153 first-year medical students (mean age 20.16, 50 males and 103 females) who completed a questionnaire assessing intentions, attitudes, subjective norms, perceived behavioral control, oral health knowledge, and current oral hygiene behaviors. Attitudes toward oral health behaviors and perceived behavioral control contributed to the model for predicting intention, whereas subjective norms did not. Attitudes toward oral health behaviors were slightly more important than perceived behavioral control in predicting intention. Oral health knowledge significantly affected affective and cognitive attitudes, while current behavior was not a significant predictor of intention to improve oral health behavior. The model had a slightly better fit among females than among males, but was similar for home and professional dental health care. Our findings revealed that attitude, perceived behavioral control, and oral health knowledge are predictors of intention to improve oral health behaviors. These findings may help both dentists and dental hygienists in educating patients in oral health and changing patients' oral hygiene habits.

Body weight, shame, guilt and oral health: a path analysis model in undergraduate students.

UNLABELLED: The purpose of the present study was to answer the question of whether experiences of shame, guilt and body investment can explain such the association between BMI, oral health behaviours and status in an undergraduate student population-based sample. METHODS: The study was performed on a sample of 150 first year medical students (19.62 +/- 2.62 years old). Data were collected through a self-administered questionnaire, Weight- and Body-Related Shame and Guilt Scale and Body Investment Scale. RESULTS: 61.3% of students were of normal weight, 21.3% were underweight and 11.3% were overweight. Statistically significant differences were observed between males and females regarding the body mass index (P < 0.0001) and WEB-shame (P < 0.0001). Among females, statically significant higher values of WEB-Shame, WEB-Guilt and lower levels of Body investment were noted among normal weight compared with under-weight students (P < 0.05). The normal-weight female and underweight participants reported statistically significant different frequency of gingival involvement (P < 0.05). Among males, WEB-S was correlated with satisfaction by appearance of own teeth, current extracted teeth and self-reported gum bleeding, while WEB-G, self-reported current extracted teeth, toothbrushing and mouthrinse frequency were also correlated. Among females, WEB-S was correlated with flossing and dental visit frequency. The structural equation model demonstrated a good fit among female students but not among males. CONCLUSIONS: These findings highlight the importance of targeting and understanding the realm of body-related self-conscious emotions and the associated links to regulations and health investment behavior.

Involvement of psychosocial factors in the association of obesity with periodontitis.

The present case-control study of 79 subjects (19-69 yr) was designed to assess the relationship of several psychological determinants to periodontal disease and obesity. Periodontal clinical examinations were performed, and the subjects were asked to complete a set of questionnaires measuring Type A personality, anxiety, depression, dental anxiety, hopelessness, emotional intelligence, stress, self-esteem, optimism and satisfaction with life. In a bivariate analysis, overweight individuals presented higher levels of smoking exposure, anxiety and depression and lower levels of optimism and satisfaction with life. They were mainly females, with a higher number of sites and teeth with probing depth (PD) >6 mm and clinical attachment level (CAL) >5 mm. Patients with a mean PD exceeding 3 mm and a bleeding on probing index of >25% presented higher values of dental anxiety and lower levels of self-esteem. Multiple linear regression analyses revealed that dental anxiety was positively associated with the number of teeth with a PD of >6 mm and with reasons for visiting a dentist, while satisfaction with life was associated with flossing frequency. We conclude that there is an association between several psychological determinants, periodontitis, and body mass index.

Metabolic syndrome and periodontal diseases.

The metabolic syndrome (also known as syndrome X, insulin resistance syndrome, dysmetabolic syndrome, deadly quartet and plurimetabolic syndrome) is a cluster of factors associated with increased risk of developing coronary heart disease and/or type 2 diabetes. Several recent studies reviewed in the present paper have indicated an association between the metabolic syndrome and periodontitis, and suggest that people exhibiting several components of metabolic syndrome should be encouraged to undergo a periodontal examination. Further investigations are required to clarify the mechanisms of the relationship between metabolic syndrome and periodontal disease in men, and to determine whether oral health care in individuals exhibiting metabolic syndrome has the potential to reduce the incidence of various systemic diseases.

Is it an association between body appreciation, self-criticism, oral health status and oral health-related behaviors?

OBJECTIVES: Our aim was to investigate whether body appreciation and self-criticism are associated with self-reported oral health status and oral-health-related behaviors were associated. METHODS: The present study sample consisted of 178 first year medical students. The questionnaire included information about socio-demographic factors, behavioral variables, self-reported oral health status, self-criticism and body appreciation. RESULTS: Significant differences were found on body appreciation and self-criticism scales according to several variables: gender, anxiety, stress, depression, smoking status, perceived dental health status, current extracted teeth, satisfaction by appearance of own teeth, self-reported gingival condition. When oral health behaviours were analysed we observed that toothbrushing frequency once a day or less was reported mainly in persons with low-levels of body appreciation (P < 0.01) and comparative self-criticism (P < 0.05). Moreover, individuals who visit their dentist mainly when treatment is needed or when in pain were compared with persons who visit their dentist mainly for check-up or for tooth cleaning and scaling; they showed lower levels of body appreciation (P = 0.005), as well as higher levels of comparative self-criticism (P < 0.05), internalized self-criticism (P < 0.05) and total self-criticism (P = 0.009). Multiple linear regression analyses revealed that anxiety in everyday life, body appreciation and comparative self-criticism scales were significantly positively associated with oral health status (r2 = 0.144; F = 3.436, P = 0.001), while body appreciation was related also to gingival health-related status (r2 = 0.087; F = 1.943, P = 0.057). When oral health behaviors were evaluated, it was shown that gender and body appreciation scale were positively associated with toothbrushing frequency (P < 0.0001). CONCLUSIONS: The results suggest that there is an increased risk for impaired dental health status and behaviour among subjects with low levels of body appreciation and high levels of self-criticism.

Investigating the relationship between self-reported oral health status, oral health-related behaviors, type A behavior pattern, perceived stress and emotional intelligence.

AIM: Our aim was to determine students' self-rated oral health and oral-health-related behaviors in relation to type A behavior pattern (TABP), self-perceived stress (PSS) and emotional intelligence (EI). MATERIAL AND METHODS: The present study sample consisted of 344 first to sixth year dental students. The questionnaire included information about socio-demographic factors, behavioral variables, self-reported oral health status, TABP, PSS and EI. RESULTS: Significant differences were found on EI and PSS Scale according to several variables: gender, year of study, anxiety in the every day life, perceived dental health, self-reported gingival condition, self-reported gum bleeding and reason for the dental visit (P<0.05). Oral health behaviors such as flossing and mouthrinse frequency and last dental visit were not influenced by TABP, EI or PSS-10 scales. However, the results showed that mean levels of TABP in individuals with a toothbrushing frequency more than twice a day were higher than, but not statistically different from, those of individuals brushing less than once a day. The scales are inter-correlated, as was replicated there: TABP with EI, EI with PSS, anxiety with PSS (P<0.01). CONCLUSIONS: The result suggested that emotional intelligence might be a psychosocial risk marker that influences self-reported oral health status and behaviour.

Social desirability, social intelligence and self-rated oral health status and behaviours.

OBJECTIVES: Our aim was to examine the impact of social intelligence and social desirability on students' self-rated oral health and oral health-related behaviors. METHOD AND MATERIALS: The present study sample consisted of 217 first year dental students. The questionnaire included information about socio-demographic factors, behavioral factors, self-reported oral health status, social intelligence (Tromsø Social Intelligence Scale-TSIS) and social desirability (Marlowe-Crowne Social Desirability Scale short form C). RESULTS: Social desirability was correlated with age, perceived dental health, current nontreated caries, toothache last time, self-reported gum bleeding and reason for the dental visit. Other measures were not influenced by social desirability: current extracted teeth, satisfaction with appearance of own teeth, self-reported gingival condition, daily toothbrushing, flossing, mouthrinse and dental visit frequency. It was revealed that participants with stronger social intelligence tended to evaluate as excellent their self rated oral health status, to be less dissatisfied by the appearance of their teeth, not to have untreated dental decays, extracted teeth (others than third molars) or gingival bleeding, to brush their teeth more than twice a day, to use everyday dental floss and to visit their dentist mainly for check-up or for tooth cleaning and scaling. Multiple regression analyses models demonstrated significant contributions of social awareness, social skills and social information processing were observed to oral health behaviours: toothbrushing, flossing and dental visit frequency. CONCLUSION: The results support the view that social desirability should be considered as a factor which may impact measurements and decisions, while social intelligence has a significant association with oral health behaviours.