Abstract Background andAim: Oralhealth literacy plays an important role in oral health promotion. This studyaimed to assess the level of oral health literacy of senior medical andpharmacy students. Materials andMethods: This cross-sectional study was conducted on senior medical andpharmacy students (n=300) of Tehran University of Medical Sciences in 2015. The oral health literacy-adult questionnaire (OHL-AQ)was used for data collection. This questionnaire has 17 items in four sections.

The first section relates to the assessment of the perception of oral health.The second section is for the assessment of the ability to calculate valuesrelated toantibiotic and mouthwash prescriptions. The third section assesses the efficacyof communication skills, and the fourth section is about decision-making withregard to oral health problems. Chi-square and linear regression were used fordescriptive analyses.

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Results: The mean scoreof oral health literacy was 12.09±3.85 for medicalstudents and 10.48±4.29 forpharmacy students. University degree of the father (P<0.001) and being amedical student (P=0.

002) were significantly correlated with a higher level oforal health literacy. The comparison of the mean score of oral health literacyand its correlation with oral health behavior showed a significantcorrelation between a high level of oral health literacy and a higher frequencyof tooth brushing, use of toothpaste, regular dental visits, and dental visitsduring the last 1-2 years (P=0.001).

Conclusion: Considering themoderate level of oral health literacy of medical and pharmacy students, it isnecessary to include oral health topics in the curricula of medical andpharmacy schools. Key Words: Oral Hygiene,Health Literacy, Medicine, Pharmacy  IntroductionHealth literacyis one of the factors determining the occurrence of health problems.Individuals with a low level of health literacy often have greater healthproblems 1. Limited health literacy is a global dilemma, and about half of theadults in the United States, one-fifth of the British and Canadian adults, andover half of the Iranian adults have a limited health literacy 2-6. Oral healthliteracy, similar to general health literacy, plays an important role in themaintenance and promotion of oral health 7.

Oral health literacy is describedas the ability of individuals to perceive and analyze oral health informationfor decision-making with regard to oral health promotion 8. A low level oforal health literacy can independently be a predictor of a poororal health status in adults 9. All health-careproviders, aside from dentists, can play a role in oral health promotion. Peoplemore commonly refer to pharmacists and physicians compared to dentists, andthis can be an opportunity to promote their oral health 10,11. Pharmacistsand physicians should participate in preventive and educational programs andshould refer the patients to dental centers 12.

Obviously, they can play arole in public oral health promotion given that they have an adequate level oforal health literacy themselves. The Association of American Medical Colleges(AAMC) has designed and incorporated oral health instruction guidelines inmedical education curricula 13. Since studieson the oral health literacy of medical and pharmacy students are limited, thisstudy aimed to assess the level of oral health literacy and behavior of seniormedical and pharmacy students attending Tehran University of Medical Sciencesin 2015.                                Materials andMethods Thiscross-sectional study was conducted on senior medical (n=200) and pharmacy(n=100) students of Tehran University of Medical Sciences in 2015. The datacollection tool in our study was the oral health literacy-adult questionnaire(OHL-AQ). The validity and reliability of this questionnaire for use among theIranian and English-speaking population have been previously confirmed 14,15.

The self-administered questionnaire was distributed among the students at theirclasses, dormitories, hospital, and pharmacy. This questionnaire has 17 itemsin four sections for the assessment of oral health literacy. The first section(perception) includes six questions to assess the perception and knowledge ofthe students with regard to oral health. The second part is the calculationsection and includes four questions for the assessment of the values inprescriptions related to mouthwashes and antibiotics. The third section is thelistening section and includes two questions for the assessment of the efficacyof communication skills, and the last section is the decision-making sectionand includes five questions related to common dental problems and itemsretrieved from the medical history form. Each correct answer was allocated ascore of one, while each wrong answer or no answer was given a score of zero.Based on this scoring system, the lowest and highest acquired scores were 0 and17, respectively.

For further analysis, the scores were assigned into threecategories of 0-9: inadequate, 11-12: borderline; and 12-17: adequate 9,14. The demographicvariables including age, gender, level of education, and the gradepoint average (GPA), and oral hygiene behaviors such as the frequency oftooth brushing, consumption of sugary foods between meals, use of toothpaste, and dental visits as well asself-report questions regarding oral health status were also included.Socioeconomic status was self-reported by each student as very good, good,moderate, poor, or very poor. Data wereanalyzed by using descriptive and analytical statistics. Chi-square test wasapplied to compare the answers to each question, while multiple linearregression was used to compare the level of oral health literacy between thegroups and to determine its correlation with the demographics and oral health behavior andpractice. The confounders were adjusted as covariates. The significance level was set at 0.

05.The study protocol wasapproved by the ethics committee of Tehran University of Medical Sciences.M1  TheM2  students participated in the studyvoluntarily and filled out the questionnaire anonymously.  ResultsOut of 300questionnaires, 265 were returned. 178 questionnaires belonged to medicalstudents (response rate=89%), and 87 questionnaires belonged to pharmacystudents (response rate=87%). The mean age of medical students was 24.99±1.

80 years, and the mean age ofpharmacy students was 25.04±1.89 years.Also, 88 (50.9%) medical and 38 (44.2%) pharmacy students were males. The meanGPA was 15.43±1.

52 (of atotal of 20) for medical students and 15.81±1.48 for pharmacy students. Withregard to the level of education of the parents, the majority of the parentshad a bachelor’s degree in both groups.

Also, most medical students reported amoderate socioeconomic status, while most pharmacy students reported theirsocioeconomic status to be poor. The mean score of oral health literacy was12.09±3.85 (of atotal of 17) for medical and 10.48±4.29 for pharmacy students.

Theresults showed that 31.6% of medical and 51.2% of pharmacy students had aninadequate level of oral health literacy (Figure 1). Regarding theknowledge of medical and pharmacy students about oral and dental conditions,the highest frequency of correct answers belonged to pharmaceuticalinstructions as 164 (95.9%) medical and 80 (95.2%) pharmacy students gavecorrect answers to the question “if you take the first capsule at 2 p.

m., at whattime should you take the next capsule?”. In both groups, the lowest number of correct answers was given tothe question “what teeth erupt in the mouth at six years of age?” since 67(39.2%) medical and 31 (36.5%) pharmacy students gave a correct answer to thisquestion (Table 1).

Most studentsin both groups responded correctly to the questions regarding how to manageoral and dental problems and to the following two questions: what does thissentence mean? “The dentist is not held responsible for unwantedconsequences.” and “What does it mean to have a history ofhypersensitivity or allergy?”. The lowest number of correct answers bymedical students was given to the question “What is the best action whenbleeding following the use of dental floss?” as ninety (52.

3%) medical studentsgave a correct answer to this question. Among pharmacy students, the lowestfrequency of correct answers belonged to the question “What is the best actionwhen feeling swelling and pain in the mouth?” as only 33 (38.8%) pharmacystudents gave a correct answer to this question (Table 2). In terms of theoral hygiene behaviors and practice, 90 (51.7%) medical students and 51 (60%)pharmacy students replied “once daily” to the question regarding the frequencyof tooth brushing per day. Ten (5.7%) medical students and one (1.

2%) pharmacystudent reported that they never brush their teeth or they do it very rarely.In both groups, most students had visited a dentist one or two years ago.Medical students reported a higher frequency of consuming sugary snackscompared to pharmacy students.

About one-third of the students stated that theyhad a good oral health status (Table 3). The currentresults showed that oral health literacy was not significantly correlated withgender (P=0.313). The father’s level of education (P<0.001) and the field ofstudy (pharmacy or medicine, P=0.002) were significantly correlated with oral health literacy.The higher the father's level of education, the higher was the oral healthliteracy of the students. Medical students had a higher level of healthliteracy compared to pharmacy students.

However, the mother’s level ofeducation, GPA, and socioeconomic status showed no significant association withthe level of oral health literacy (P>0.05). The comparison of the mean scoreof oral health literacy and oral health behaviors showed that a significantassociation existed between a high level of oral health literacy and a higherfrequency of tooth brushing per day, use of toothpaste, regular dental visits,and the date of the last dental visit (P=0.001).

No significant associationexisted between the consumption of sugary snacks and the self-reportedoral health status of students and the mean level of oral health literacy(P>0.05).  Discussion This study wasconducted on senior medical and pharmacy students ashealth-care providers. These individuals can promote community oral health asnon-dental professionals 10.

The AAMC has included oral health guidelines inmedical curricula to achieve this goal 13. The level of oral health literacyand behavior of these groups can, to some extent, determine their role in oralhealth promotion. Physicians and pharmacists can play a role in public oralhealth promotion only when their level of oral health literacy and oral healthbehaviors improve 16. Our studyshowed that the level of oral health literacy and behavior of senior medicaland pharmacy students was inadequate and similar to that of the generalpopulation of Tehran city 9. One-third of medical and half of pharmacystudents had an inadequate oral health literacy. This difference can beexplained by the fact that most courses provided for medical students in theircurriculum are clinical, while pharmacy students mainly receive paraclinicaland basic science courses. Pharmacy students require more extensive oral healtheducational programs in their curriculum. This finding is in line with that ofother studies on the oral health knowledge of medical students 17,18.

Thelack of educational programs on oral health is the reason behind the low levelof knowledge about oral health among students. These results highlight the needfor oral health instructions and inclusion of such courses in the curricula ofmedical and pharmacy schools.Our studyshowed that oral health literacy had no significant association with gender.Naghibi et al 9 evaluated the health literacy of adults in Tehran in 2013 andshowed that the mean level of health literacy of females was higher than thatof males. In 2009, Sabbahi et al 4 evaluated adults in Canada and showed thatgender was not correlated with health literacy. Our study was conducted onmedical and pharmacy students, which may explain the difference with theresults of the studies conducted on the general population since, in thegeneral population, males and females may have different levels of education.

However, there is no need to provide separateoral health instruction programs for males and females in universities. In terms of theperception of the topic and decision-making with regard to dentalproblems, approximately one-third of the students gave correct answers to thequestions in our study. These results confirm the low mean level of oral healthliteracy and highlight the inadequate dental knowledge of the students. Thisindicates the need for inclusion of oral health topics in the educationalcurricula. These programs can promote the oral health of students and thepublic since these students are the future health-care providers of thecommunity.

The mean scoreof oral health literacy and its association with oral health behaviors showedsignificant correlations between a high level of oral health knowledge and ahigher frequency of tooth brushing per day, use of toothpaste, regular dentalvisits, and the date of the last dental visit. These results show that a highlevel of oral health literacy results in proper oral health behaviors whichlead to individual and public oral health promotion. Parker and Jamieson 19showed that individuals who do not regularly brush their teeth have a lowerlevel of oral health literacy.

Based on theresults of the present study, subjects with a higher level of oral healthliteracy reported a better oral health status. This finding was in agreementwith those reported by Naghibi et al 9 and Parker and Jamieson 19 on theoral health status of adults. However, the present assessment was subjective(self-reported by the students), and future clinical studies are required to confirm thisfinding and to validate the accuracy of self-reports by students. We used theOHL-AQ in our study, which is one of the most comprehensive and up-to-datequestionnaires for the assessment of oral health literacy in adults 14,15.

This questionnaire simultaneously evaluates perception, knowledge, calculationskills, communication skills, and decision-making. Clinical examinationscombined with the use of this questionnaire can yield more accurate results infuture studies. Conclusion The results ofthe present study showed that senior medical and pharmacy students, as futurehealth-care providers, demonstrated a moderate level of oral health literacy. The oralhealth literacy of these students can be promoted by inclusion of oral healthcourses in their educational curricula.   M1 M2Please insert the ethical code.