Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ
NESA Publicação oficial
ISSN: 2177-5281 (Online)
|Original Article|| Imprimir
Páginas 57 a 62
Autores: Daniela Salvador Marques de Lima1; Kamila Azoubel Barreto2; Rosário Maria Maciel Pessoa da Silva3; Sara Grinfeld4; Viviane Colares5
1. Doctoral student in Pediatric Dentistry. Master's Degree in Adolescent Medicine, Pediatric Dentistry Department, Pernambuco School of Dentistry, Pernambuco University (FOP/UPE). Camaragibe, Pernambuco State, Brazil
Daniela Salvador Marques de Lima
How to cite this article
Keywords: Feeding and eating disorders, oral health, Dentistry.
Adolescence is a time when youngsters are frequently dissatisfied with their own bodies, and some aspects of adolescent behavior may affect their growth and health. Adopting extreme eating habits in order to keep pace with beauty standards may result in eating disorders that include anorexia and bulimia nervosa1,2.
In addition to systemic alterations that undermine the nutritional status of their victims, eating disorders may also result in alterations to the oral cavity. Their occurrence and severity depend on the type and duration of each eating disorder3,4,5.
Inadequate compensatory practices designed to control weight, such as induced vomiting, result in a chronically acid mouth that may adversely affect teeth and oral tissues through erosion, caries, hypersensitivity, hyposalivation and swollen parotid glands3,6,7,8,9.
Dentists may well be the first healthcare practitioners to note the appearance of eating disorders, due to the possibility of diagnosing oral expressions of these disorders during routine appointments10.
In addition to the importance of being familiar with the signs and symptoms, in order to ensure fast diagnoses, dentists also played an important role in the dental treatment and supervision of these patients. Early diagnosis and the adoption of appropriate strategies for controlling the development and progress of oral symptoms foster well-being and enhance self-esteem, while minimizing damage to structures, ensuring the ongoing oral health of these patients11.
As a result, the objective of this study was to assess knowledge, interest and sources of information on eating disorders among students enrolled in undergraduate Dentistry courses, assessing the importance of dentists in identifying these pathologies.
This is a descriptive cross-sectional census-based study conducted in 2012 in four dental schools in Pernambuco State, approved by the Research Ethics Committee at Pernambuco University (Protocol CEP/UPE: 258/11 - CAAE Registration Nº 0262.0.097.000-11). Its objectives were explained to the participants, in addition to possible risks and benefits, confirmed through signed Deeds of Informed Consent, with participation in this study being voluntary and anonymous, with signatures required for participation.
A pre-validated questionnaire was drawn up for this study in order to assess knowledge, interest and sources of information on eating disorders among Dentistry students.
This study was conducted at four universities in Pernambuco State offering undergraduate courses in Dentistry, with students in the final year of the course in 2012. The respondents were 218 male and female students enrolled in classes for the first and last semesters of this course.
The questionnaire consisted of seven questions, five of which explored knowledge of eating disorders among these students, with the others assessing interest and sources of information. The five questions exploring their knowledge addressed the concept of eating disorders, the oral lesions most frequently associated with them, age brackets and gender with the highest prevalence of these disorders, in addition to whether dentists are practitioners able to identify such patients. In the knowledge analysis, the replies were scored as: 2 (correct), 1 (partially correct) or 0 (incorrect or no reply) for the open questions and: 1 (correct) or 0 (incorrect) for the objective items. Consequently, student scores could range from 0 to 7. These values were categorized in order to obtain the final scores (0 - no knowledge; 1, 2 and 3 - some knowledge; 4, 5 and 6 - partial knowledge and 7 - full knowledge).
In order to analyze the sources of information, each item was categorized and described as: Lay Knowledge (television, magazines or non-scientific journals); Friends; Scientific Knowledge (scientific journals, University classes, presentations at congresses or textbooks); Internet; Others.
The questionnaires were answered collectively in a classroom, with standardized self-completion. This research technique followed a pre-set guideline in order to maintain the same rigor with all the participants. The questionnaire was completed by the students at the same time, in the presence of the researcher.
The analysis appropriate data analysis was conducted through the Statistical Package for the Social Sciences (SPSS), version 20.0.
The descriptive analysis of the variables was conducted through appropriate statistical procedures, using the frequency distribution as a descriptive procedure, as the variables are measured on a nominal or ordinal scale. Multivariate analyses were processed through binary and multinomial logistic regression. In all the analyses, a 5% significance level was taken as the criteria for rejecting the null hypothesis.
RESULTS AND DISCUSSION
Most (~66%) of the respondents were women, with more than half of them between 20 and 25 years old. Some 10% of the students demonstrated no knowledge about eating disorders and 36.7% of them stated that they had no or little interest in this topic (Table 1).
In a specific analysis of the questions on knowledge, it was noted that 77% of the students answered the questions correctly on the age bracket with the highest prevalence of eating disorders, as well as the most frequent gender (76%). However, for specific dental knowledge, the results were less satisfactory, with most (51%) of the students unable to define nor mention the oral lesions most frequently associated with eating disorders (Table 2). Understanding of the characteristics, signs, symptoms and oral consequences of eating disorders provide input for drawing up individual treatment plans3. For Jugale et al.,12 early detection of eating disorders may prevent or lessen severe associated conditions.
Although 95.4% of the students believed that dentists are able to identify patients with eating disorders, it was noted that the knowledge acquired by these students is superficial and not specific to associated oral alterations, hampering recognition and diagnoses of these disorders in dental practice. In their study, Jugale et al.12 noted that early identification indications may help with the treatment of oral expressions of eating disorders.
With regard to sources of information, it was noted that most knowledge acquired about eating disorders is at the lay level, mentioned by most of the students. The percentage for scientific knowledge as the source of information was significant, despite the low percentage of correct answers in the specific questions on this topic (Table 3).
When analyzing factors associated with the group rated as having full knowledge of this topic, it was noted that female students were 9.5% more likely to be in this group than their male counterparts, with the odds of being in this group reaching 67. In terms of the semester in which they were enrolled, students in the final semester were 26.6% (CI: 3.3% - 120%) more likely to demonstrate full knowledge of the topic than first-semester students, demonstrating that during this undergraduate course, dental students obtain information that allows them to recognize eating disorders in general. For Amoras et al.,3 the treatment of patients with eating disorders must involve a dentist within the multidisciplinary team, in order to ensure that the treatment is more complete, as limiting treatment to oral signs and symptoms is not enough to ensure a cure.
The main strategy for preventing the development of new lesions in the oral tissues is familiarity with the causal agent. Lima et al.13 felt that the multi-professional approach is necessary for adequate intervention, in order to ensure future health. For healthcare teams, dentists may be the first practitioners to reach this diagnosis, due to oral alterations caused by eating disorders, contributing significantly to the treatment of eating disorders.
Students between 18 to 20 years old were 20.4% (CI: 3% - 137%) more likely to be in the group with full knowledge than students more than 25 years old. There was no difference among the students between 20 and 25 years old and those over 25 years old (Table 4 and Figure 1).
Figure 1. Characteristics associated with Dentistry students in Recife, Pernambuco State rated as having full knowledge.
Both male and female dental students presented partial knowledge of eating disorders, to a greater extent among females between 18 and 20 years old. The main sources of information mentioned by the students were lay, acquired through television, magazines, newspapers and non-scientific journals.
Although the students presented general knowledge of this topic, specific knowledge allowing identification and recognition of the oral lesions most frequently related to eating disorders was not significant, indicating the need to include information on eating disorders in undergraduate courses in Dentistry.
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