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Investment in training and knowledge of
periodontal diseases in dental careers
Formación odontológica para enfermedades
periodontales
Rosario Leonela Auqui Coronel*
Damián Alfredo Tello Terán*
Isabel Cristina Auqui Coronel*
Edwin Patricio Villavicencio Urvina*
Abstract
Periodontal disease involves a state of chronic progressive
destruction of the supporting tissues of teeth caused by predisposing
factors most often poor hygiene. The knowledge acquired by
students during their undergraduate studies on the management of
periodontal disease is of vital importance for their performance in
their dental practice. Objective: To evaluate the level of knowledge
about periodontal disease in students of the Dentistry course at the
Catholic University of Cuenca, Azogues Campus during the
academic period March - August 2024. Methodology: The data were
collected through the application of a survey previously validated by
Díaz (2023), which was aimed at the students of this university
campus. The sample size consisted of 235 students from fifth to tenth
grade. Results: Periodontal knowledge was rated as good in 48.5%
* Estudiante de la Carrera de Odontología
Universidad Católica de Cuenca
rosario.auqui.68@est.ucacue.edu.ec
https://orcid.org/0009-0005-0490-8344
* Especialista en Periodoncia e Implantología
Docente de la Carrera de Odontología
Universidad Católica de Cuenca
damian.tello@ucacue.edu.ec
https://orcid.org/0000-0002-1279-3779
* Odontóloga General
Universidad Católica de Cuenca
icauquic76@est.ucacue.edu.ec
https://orcid.org/0009-0008-3943-307X
* Estudiante de la Carrera de Odontología
Universidad Católica de Cuenca
edwin.villavicencio@est.ucacue.edu.ec
https://orcid.org/0009-0008-5260-3619
Article
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and fair in 36.17% of the participants. The socio-demographic
variables studied did not represent any relative significance, among
these were: sex, origin and academic cycle and the level of
periodontal knowledge. Although the majority of respondents were
female, this did not have a significant impact on the level of
knowledge. Both men and women showed similar levels according
to the knowledge assessed, irrespective of their origin or academic
cycle. Conclusions: The research carried out evidences that the level
of knowledge in the different students evaluated is good emphasising
the need to promote continuing education in diagnosis, prevention of
the same.
Keywords: Periodontal disease, perception, knowledge, prevention,
oral health.
Resumen
La enfermedad periodontal involucra un estado de destrucción
progresiva crónica de los tejidos de soporte de las piezas dentales
ocasionado por factores predispones con mayor frecuencia la mala
higiene. El conocimiento adquirido en los estudiantes durante su
pregrado para el manejo de la misma es de vital importancia para su
desempeño en su práctica odontológica. Objetivo: Evaluar el nivel
de conocimiento sobre enfermedad periodontal en los estudiantes de
la carrera de Odontología de la Universidad Católica de Cuenca,
Campus Azogues durante el periodo académico marzo – agosto
2024. Metodología: Los datos se recolectaron a través de la
aplicación de encuesta previamente validada por Díaz (2023), misma
que estuvo orientada a los estudiantes de este campus universitario.
El tamaño muestral se conformó de 235 estudiantes de quinto a
décimo ciclo. Resultados: El conocimiento periodontal fue
catalogado como bueno en un 48.5% y regular en un 36.17% de los
participantes. Las variables sociodemográficas estudiadas no
representaron significación relativa alguna, entre estas estuvieron:
sexo, procedencia y ciclo académico y el nivel de conocimiento
periodontal. Aunque la mayoría de los encuestados fueron mujeres,
esto no tuvo un impacto significativo en el nivel de conocimiento.
Tanto hombres como mujeres mostraron niveles similares de
acuerdo al conocimiento evaluado, independientemente de su origen
o del ciclo académico. Conclusiones: La investigación realizada
evidencia que el nivel de conocimiento en los diferentes alumnos
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evaluados es bueno recalcando la necesidad de fomentar la
educación continua en diagnóstico, prevención de las mismas.
Palabras Clave: Enfermedad periodontal, percepción,
conocimiento, prevención, salud oral.
Introduction
The concept of periodontal diseases emphasises a series of
inflammatory processes that occur within the oral cavity, specifically
the periodontium is related to structures such as: gingiva, bone and
periodontal ligament, which if left untreated for a certain period of
time can cause the loss of teeth; as a predisposing factor is the
accumulation of bacterial plaque that in the long term conditions the
appearance of inflammatory periodontal diseases (Rufasto Goche et
al., 2023).
Gingivitis and periodontitis, depending on different degrees of
evolution and extent, can be classified in different ways with severe
consequences for the carrier from the inflammatory state to tooth
loss. Therapeutic control of these diseases by eliminating the factors
that help the progression of the patient's disease through preventive
habits or health-promoting actions (Alzammam and Almalki, 2019;
Santa Cruz-Gonzalez et al., 2019).
According to data published by the World Health Organisation
(WHO), when referring to the term dental balance, it emphasises
much more than having teeth without any pathological affectation.
Periodontal diseases have become a global health impact problem
that is present in most populations, statistically speaking
approximately 40 % of humans have inflammatory diseases of the
periodontium (Canales and Cooper, 2019; Mofidi et al., 2022).
Within this context, nine out of ten patients seen during dental
consultations have periodontal conditions. For example, in Ecuador,
approximately 45 % of our population has plaque-induced gingivitis,
while 52.5 % has periodontitis, thus corroborating the relative
significance of these types of diseases in today's society (Falcón and
Falcón, 2021).
The main oral health problems affecting oral health in recent decades
have been periodontal diseases, which is why it is necessary for
future dental professionals, in their role, to contribute to their
prevention, control and treatment, revealing a concern for the
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knowledge imparted in the classroom and the different academic
cycles of dental careers, specifically in the subjects related to
periodontics. Therefore, in order to avoid unsuccessful
consequences on the patient's oral health or possible acts of
negligence during professional practice, this study seeks to identify
the degree of educational knowledge on this topic and thus to elicit
future timely educational solutions that will have an impact on the
training of students from the initial stages of their teaching and
learning process.
For the above reasons, the objective of this research is to evaluate
the level of knowledge about periodontal disease in students of
dentistry at the Universidad Católica de Cuenca campus Azogues
during the academic period March - August 2024.
The present research project on the level of knowledge about
periodontal disease in students of the Dentistry course at the Catholic
University of Cuenca Campus Azogues in the academic period 2024,
transcends in different areas, such as the social, by contributing to
the academic training of practitioners will allow to have a higher
quality care, the same that will benefit the oral health of the
population in general. Scientifically, when talking about periodontal
disease, it is essential to know the methods of diagnosis, treatment
and pharmacological interventions, so that they become the focus of
other future research that will help in the development of educational
training, ensuring the cognitive capacity of students to be able to
decipher much more complicated clinical cases.
The term periodontal disease refers to the progressive act of
inflammation of the tissues of the periodontium, which usually
begins with oedema of the marginal gum around the tooth known as
gingivitis. However, if the necessary therapeutic approach is not
provided, it can evolve into periodontitis, which is responsible for
the degradation of the tissues that support the tooth, causing tooth
loss as a serious consequence. In this context, when we talk about
this disease we refer to the constant inflammatory infection in which
bacteria enter the periodontal tissues, severely damaging them (de
León Ramírez et al., 2022; Malla et al., 2017).
This condition is manifested by oedematisation of the gums, which
is observed through increased gum size, bleeding during brushing
and erythema. The main cause is the increased production of blood
vessels in the affected area. It is crucial to note that not all patients
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develop this condition, but when it occurs and is not treated in a
timely and adequate manner, it can progress to periodontitis. This
progression can cause aggressive and severe damage to the
individual, compromising the tooth-supporting tissues and
potentially leading to tooth loss. To avoid these complications and
preserve good oral health, prevention and early treatment are
essential (Naruishi et al., 2022). The accumulation of bacterial
plaque exposed for several days on the tooth surface is considered to
be the cause of the development of gingivitis. If not adequately
removed, it becomes mineralised tissue that is difficult to remove by
mechanical brushing and is called dental calculus. It is an essential
factor in the development of periodontal disease that can cause
anything from halitosis to pain in the orofacial area. Thus, the
presence of bacteria located in the periodontium together with poor
hygiene in the long term causes tooth loss that may not even be
rehabilitated, hence the importance of knowledge of students to
create an effective treatment plan (Sood et al., 2010). It is important
to recognise that studies on the aetiology of gingivitis agree that the
main cause is the presence of dental plaque accumulation, but there
may be other variables that help in its progression but not in its
evolution (Parsegian et al., 2021).
In terms of aetiology, the origin of gingival disease is described as
multifactorial, with bacteria being the main aggressor, and the
interrelationship with the host and the environment may act together
to develop periodontal disease (Wu et al., 2021). The main reasons
for the existence of periodontium diagnosed with periodontal disease
is the presence of bacterial biofilm due to poor oral hygiene, lack of
use of hygienic elements according to the patient's need that allow
the entry of these microorganisms into the gingival sulcus (Al-Zarea,
2013). Thus, the entry of bacterial strains initiates inflammation that
is triggered as a defensive response to the presence of foreign bodies
in the tissues of the periodontium. Its process occurs through
bacterial aggregation, by a process of extravasation and the presence
of different chemical factors, through this reaction a defensive
process is initiated that consists of various cells of the immune
system that act to prevent overgrowth of the affected gingival area,
in this way by the type of mechanism of affection is likely to be
reversible, with proper control of plaque, mechanical self-learning
of toothbrushing and periodic controls through prophylaxis by an
oral health professional (Sedghi et al., 2021).
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It is an affection of the periodontal tissues (bone, gum, cementum,
periodontal ligament) but unlike gingivitis, it usually affects the
support of the dental organ causing bone loss with the formation of
periodontal pockets, increased clinical attachment loss, gingival
recession, endoperiodontal lesions, furcation lesions, abscesses and
vertical bone defects (Sedghi et al., 2021). The process of destruction
that occurs in periodontitis is the spread of inflammation towards the
supporting tissues in which there is extreme aggression to the bone
and ligament that support the tooth. It manifests with symptoms such
as oedema, erythema and gingival haemorrhage, the main
predisposing factors being stress, smoking, overweight, diabetes
and, of course, poor oral hygiene (Wilder et al., 2009).
In terms of aetiology, there is an interrelationship between several
factors, these can be, according to :
- Local factors: they have repercussions on the oral microbiota, on
the periodontium in such a way that they originate an inflammatory
infectious process such as: the accumulation of bacterial plaque and
tartar, dental malocclusions, defective dental restorations, ill-fitting
prostheses, occlusal trauma and parafunctional habits such as
bruxism.
- Systemic factors: diabetes mellitus, hormonal disorders,
immunodeficiencies, cardiovascular diseases, as well as tobacco
consumption and chronic stress have an unfavourable influence on
the periodontium with its destruction and also on its regenerative
capacity.
Cleaning: Therapeutic care of a periodontal disease starts with the
analysis and planning of a professionally trained prophylaxis, it is
important that the patient is aware of his disease, its causes, possible
consequences and the necessary therapeutic actions to reverse the
disease. In this context, during the oral hygiene phase, we teach the
patient the proper maintenance of oral hygiene, according to the
clinical characteristics of their disease, we indicate different oral
health care additions, and they should be aware of the repercussions
that bacterial plaque has on the periodontium (Benza-Bedoya and
Pareja-Vásquez, 2017).
Scaling and root planing: When mineralised deposits are present, the
health of the periodontium must be restored by deflating the gingival
tissues using appropriate instruments such as curettes. RAR (scaling
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and root planing) defines it as the process by which the root surface
is scraped and smoothed, to leave the dental organs free of calculus,
sometimes only scraping is needed to obtain a healthy periodontium,
since, with the removal of subgingival calculus, and controlling the
predisposing factors, we can maintain the results of the therapy in
the long term, avoiding the recurrence of periodontal disease (Benza-
Bedoya and Pareja-Vásquez, 2017; Sanz-Sánchez and Bascones-
Martínez, 2017).
After completion of periodontal treatment, the periodontal
maintenance phase is scheduled, which involves re-evaluation of the
treated areas and, if necessary, reinstrumentation to prevent the
formation of new periodontal pockets. Check-ups are performed 3
months after the patient is discharged, and then depending on the
patient's compliance, every 6 months, but if in the course of the
check-ups inflammation sites appear, a new periodontal treatment
approach is performed (Mendoza, 2022; Rischmoller, 2020).
Materials and methods
The study is qualitative, descriptive and cross-sectional.
The study population will be composed of 241 students enrolled in
the fifth to tenth cycles of the Dentistry course at the Universidad
Católica de Cuenca Campus Azogues in Ecuador, during the March-
August 2024 academic year.
For the study, the sample consisted of 235 students from the total
population who agreed to participate voluntarily and met the stated
inclusion and exclusion criteria.
In addition, it is emphasised that no descriptive data containing
private information about the student or the interviewers in charge
of the implementation process will be requested or provided in order
to avoid affinity bias. The data will be single-blinded so that the
evaluators do not have access to the information of the students being
evaluated.
- All students regularly enrolled and taking the pre-professional
clinical area from fifth to tenth cycle of the Dentistry Career of the
Universidad Católica de Cuenca Campus Azogues in March 2024 -
August 2024.
- Students who freely accept their participation in this research study
through informed consent.
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- All students who register their answers through the virtual
application form of the Google forms survey.
- Students who do not attend the survey application day.
After holding face-to-face meetings with the students and explaining
to them the composition of the questionnaire, the duration (15
minutes), the ethical parameters and requesting their signature on the
informed consent form. After the verbal explanation of the survey,
the students were asked to access the link to the Google Forms form.
Results were obtained on the knowledge of periodontal diseases.
The instrument that was applied corresponds to the study by Díaz et
al. (2017), which contains 16 questions sectioned into two parts, of
which the first 10 questions are related to knowledge and the 6 are
linked to the qualitative measurement of the students' perception.
The distribution of questions was as follows: question 1 was about
the conceptualisation of the disease, the next 4 questions were about
the classification, 5 questions were about the treatment plan, the last
6 questions were about the perception of the practitioners in the
dental clinics when dealing with these diseases.
The score given for the assessment of the questionnaire is 10 points,
divided into categories which are: bad, fair, good. In relation to the
attitude section, there is a score from 0 to 3 points considered as not
good, up to a score of 6 as good. It is important to stress that this
instrument is evaluated with a pilot test with a regular sample of
students that maintains an Aiken coefficient to evaluate attitudes
effectively. Also, for the evaluation of the validity of this
questionnaire in the knowledge section, the Richardson test was used
which has a reliability percentage of 82.9%, while for the evaluation
of perceptions through the Cronbach test with a reliability
percentage of 84.9%. In addition, the questionnaire was pre-
approved by experts as suitable for the assessment of dental students.
For the determination of knowledge, each correctly answered
question will be assessed with a score:
- To assess knowledge, a score of 10 points was established and
categorised as follows.
- 0 to 3 poor
- from 4 to 7 fair
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- from 8 to 9 good
- from 10 very good
As for the section on attitudes, its valuation is of one point,
corresponding to questions 11 to 16 of the questionnaire, according
to the results, the following will be obtained:
- 0 to 3 will be considered unfavourable or negative.
- 4 to 6 will be considered favourable or positive.
The data collected were recorded using a Microsoft Excel
spreadsheet. The data were analysed using descriptive statistics and
SPSS version 25 statistical software was used to elaborate the
frequency tables of the numerical and categorical variables. The Chi-
Square test was used to establish the association between the
variables and was assessed with a significance of p<0.05.
The questionnaire is based on anonymity and confidentiality, at no
time will the identity of the respondent be revealed. It is important
to mention that the students included in the study agreed to
participate in the study by signing the informed consent form. In
addition, the research has the approval of the bioethics committee.
Results
In this research, the level of periodontal knowledge of 235 students
who agreed to participate in the study was established, of whom 142
(60%) were female and 93 (40%) were male. In relation to the level
of periodontal knowledge according to its classification, it can be
observed that there is a predominantly good level of knowledge
among the students, which is not optimal, followed by a regular level
of knowledge, very good and with a smaller group as bad, with a
percentage of only 2.55%. 55%, with respect to the sex variable, a
p=0.544 was obtained, which determines that there is no significant
relationship between the variables, the predominance was reflected
in the female sex, with a knowledge between good and regular, in
the same way in the male sex with representative percentages,
however it must be considered that the sample size has a prevalent
dominance since the female sex represents the majority of the
surveyed population.
As for the level of periodontal knowledge according to the variable
of origin, p=0.648 was obtained, which determines that there is no
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significant relationship between the variables. There was a higher
prevalence of students from urban areas with good knowledge,
followed by average. Meanwhile, students from rural areas also had
good and regular knowledge, but with a smaller population size.
The level of knowledge of students by academic cycle respectively
studied, a good predominance was obtained in the academic cycles
from fifth to tenth cycle, followed by a regular one, taking into
account that the percentage in the classification of very good is
relatively low in the respondents. The value p<0.001 indicates that
there is a significant association between the variables of academic
cycle and level of knowledge.
The level of knowledge of periodontal diseases is evident in 235
students, where the majority achieved a score of 8 representing 26%,
followed by 22.6% who received a score of 9 and 18.7% a score of
7, and 12.8% with a perfect percentage of 10, these cumulative
scores suggest a tendency towards high knowledge. The lowest
scores were between 2 and 3 points with 9% and 1.7% respectively.
The categorisation of the level of knowledge into four levels: very
good, good, fair and poor. Very good was obtained by 30 students or
12.8% of the total, good by 114 students or 48.5%, fair by 85
students or 36.2% and bad by 6 students with 2.6% of the total
sample universe. Respondents demonstrate Good or Very Good
knowledge of periodontal disease, representing 61.3% of the total
sample.
A significant 94.47% of the participants (222 people) consider their
periodontal status to be favourable, suggesting that the majority of
students believe they have good periodontal health. On the other
hand, only 5.53% (13 people) have an unfavourable perception,
indicating that these people believe they have periodontal problems.
Discussion
This research project involved a population of 235 students, with a
predominance of the female sex representing 60% of the total over
the male sex, an important fact to consider in the interpretation of the
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results, because we observed the presence of a greater number of
women during their academic training at the Catholic University of
Cuenca in the Azogues Campus of Dentistry. It is relevant to
highlight that, although there is a greater predominance of females
than males, both sexes present comparable levels of knowledge
within each category, which suggests that the level of periodontal
knowledge is not significantly influenced by gender, but rather by
other factors such as academic training and origin.
Similar to the data presented in the research of Diaz Reissner et al.
(2017), which also evaluated the knowledge and perception of
students who are in a university field of Dentistry, through their
findings determined that there is a good level with a percentage of
82% associated with the definition of periodontal disease, but was
not associated with the sex variable significantly with a p>0.05.
Furthermore, it was found that 75% of the students consider
periodontal disease to be an oral condition that requires immediate
attention, 59% consider oral hygiene to be an important triggering
factor and only 45% are frequently trained to educate their patients
on prevention.
This study significantly evidenced that the knowledge acquired
about periodontal diseases and their perception in the different
students is relatively good, similar to the study by Canales and
Cooper (2019) conducted in Honduras, which reflects that the
knowledge about this disease was 75% in a good categorisation, with
the parameters of the survey being more accurate to the definition,
classification and treatment of the same.
According to the study conducted by Santa Cruz-González et al.
(2019) in Peru obtained a level of knowledge between the parameters
of fair to good in the same categories with a high perception of
periodontal diseases, taking into account that this increased
according to the academic cycle belonging, the significant
differences are prioritised between the cycles with the recently
acquired chair of Periodontics in relation to the last cycles.
On the other hand, when evaluating periodontal knowledge
according to the variable of origin, no relative significance was
observed, because the students surveyed from both rural and urban
areas demonstrated the same ability, taking into account that the
majority of students from urban areas had a good knowledge of 57%
compared to 43% from rural areas. It is important to emphasise the
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fact that in both distributions knowledge was found to be at a good
level, followed by fair, as academic training is homogeneous
regardless of the background of each student, although the
differences could be related to the accessibility of educational
resources that could influence understanding. However, in Quispe's
(2018) research in Paraguay, a higher proportion of knowledge was
found in students who come from rural areas compared to urban
areas due to the time dedicated and differential study methods.
With regard to the distribution by academic cycle, it is observed that
students in the fifth cycle have a knowledge rated as good with a
representative percentage of 27.2%, followed by the sixth cycle with
23.7%, suggesting that the academic cycles with recently acquired
knowledge have more information than students in the last cycles
who are no longer taught the subject, reflecting the importance of
continuous educational training and academic reinforcement for
dental practice. Similarly, the study by Mendoza (2022) showed that
the level of knowledge increased gradually according to the
academic cycle studied by each student.
The students' perception of periodontal health with questions asked
by means of the survey significantly demonstrated their positive
perception without significant differentiation of the academic year
studied, which can be associated with the academic training from the
beginning of the course because it is based on oral hygiene habits
and the prevention of oral diseases, which are confirmed in the
results of this research. In the study by Díaz Reissner et al. (2017),
the perception was 80% favourable and 20% unfavourable, which is
attributed to the diversity of factors that can modify these aspects,
such as the level of interest in a subject on the part of the student,
continuous preparation to provide care to society and prevent
periodontal diseases.
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