Grupo 4 Rev1
Grupo 4 Rev1
Grupo 4 Rev1
http://dx.doi.org/10.1590/0103-6440201302359
Naiara de Paula Ferreira-Nóbilo1, Maria da Luz Rosário de Sousa1, Jaime Correspondence: Maria da Luz Rosário
de Sousa, Avenida Limeira 901, Caixa
Aparecido Cury2 Postal 52, 13414-903 Piracicaba,
SP, Brasil. Tel.: +55-19-2106-5364.
e-mail: luzsousa@fop.unicamp.br
Dental caries, still one of the most common diseases affecting people around the world,
has a multifactorial nature encompassing necessary (biofilm accumulation), determinant
(exposure to sugars and fluoride) and modulating factors (biological and social). The
concepts about caries learned at dental schools may directly influence the conduct of the
future dentists regarding the control and treatment of this disease. The aim of this study
was to determine the concept that students at the Piracicaba Dental School, University
of Campinas, Brazil, have about dental caries. In this cross-sectional descriptive study,
274 students answered the discursive question “Conceptualize dental caries”. Students’
answers were analyzed by a content analysis technique that allowed the creation of
response categories and classification of the concepts in categories. Frequencies were
expressed as absolute numbers and percentages. Differences between the responses
according to the students’ class years were tested by the chi-square test. Differences with
p<0.05 were considered statistically significant. The response categories were: biological
concept (53.6%), restrictive multifactorial concept (12.1%), comprehensive multifactorial
concept (8.1%), transmissibility concept (15.8%), and other (10.4%). Differences in
response category frequencies were seen between the class years (p<0.001). There was no
consensus on the disease definition, although students predominantly had a biological Key Words: dental caries, dental
concept of dental caries. students, concept formation.
caries reduction worldwide. However, despite the advanced multiple categories. Among the concepts mentioned by
state of knowledge in the field of Cariology, conceptual the students, most cited the biological concept, followed
understandings of the disease remain centered on the by the transmissibility concept and the strict multifactorial
previously held dogmas (e.g., triad of Keyes). Furthermore, concept (Table 2).
there is no consensus among professionals on a definition
for the disease. Discussion
Conceptualizations about the disease held by Given the wide scope of this subject, it is important to
professionals may affect their daily practices and conversely, consider the methodological approach used in this study.
existing practices may affect concepts about the disease The use of a discursive question prompts the respondent
(11). To address these concerns, this study aimed to to reflect upon, organize and synthesize the information
determine the conceptualization that undergraduate dental that he or she holds, without the subjectivity of his or her
students of the Piracicaba School of Dentistry, University own judgment. However, although the question asked
of Campinas (FOP/UNICAMP) have about caries disease. in this study may provide clues about the profile of the
professional practice formed by graduates of this institution
Material and Methods with respect to the prevention and treatment of caries,
A descriptive, quantitative and qualitative cross- the question does not allow a detailed understanding of
sectional study was conducted among students of all the knowledge of dental caries. To address this question,
years of graduation (first, second, third and fourth year; other methods would be needed to assess the different
320 enrolled students) at FOP/UNICAMP after approval nuances of this topic.
of the research protocol by the local Ethics Committee The diversity of concepts presented by the students
(Registration number 006/2010). Data collection was reflects the historical perspective of the evolution of
performed through the use of a single discursive question, theories used to explain the disease process (11). However,
“Conceptualize dental caries”, which was presented to the concepts were largely compartmentalized and there
N.P. Ferreira-Nóbilo et al.
Results
A total of 274 students answered
Table 2. Concepts of dental caries by undergraduate students from the first to the last year
the question (response rate: 85.6%), of the course
including 72 first-, 76 second-, 74
Concepts* 1st Year 2nd Year 3rd Year 4th Year Total
third- and 52 fourth-year students.
From the analysis of the reply contents, Biological concept 45 (54.2) 55 (52.9) 46 (52.9) 40 (54.8) 186 (53.6)
the concepts produced by the students Transmissibility concept 4 (4.8) 13 (12.5) 23 (26.4) 15 (20.5) 55 (15.8)
were grouped into five categories:
Strict multifactorial concept 8 (9.7) 25 (24.0) 4 (4.6) 5 (6.9) 42 (12.1)
biological concept; transmissibility
Multifactorial concept 6 (7.2) 6 (5.8) 4 (4.6) 12 (16.4) 28 (8.1)
concept; strict multifactorial concept;
comprehensive multifactorial concept; Other 20 (24.1) 5 (4.8) 10 (11.5) 1 (1.4) 36 (10.4)
and other (Table 1). The response from Data are shown as number (percentage). χ²=65.062, p<0.001. *More than one answer was
a single respondent could fall into possible for each response.
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Braz Dent J 25(1) 2014
was a predominance of biological concepts in the students’ observed the predominance of physiological and functional
answers. concepts over social factors. The same findings were noted
The development of the microbiology field led by Louis in a study of health concepts performed with teachers and
Pasteur in the 19th century, which was motivated by the primary school students from 10 public and private schools
segmentation and fragmentation of knowledge since the in Rio de Janeiro (2). Similar data emerged in a survey of
creation of the scientific method, ushered into the so-called students from four universities in the state of Rio de Janeiro,
Bacteriological Era. This scientific era was characterized Brazil, in various courses, who demonstrated a fragmented
by an unrealistic expectation that all diseases could be and reductionist vision of health and disease (16).
eradicated by the centralization of efforts on biological The biomedical concept of disease remains dominant in
aspects (14). The conceptualization of dental caries requires health practices and education, despite efforts to move this
biofilm and sugar, which represent a necessary factor concept towards a more comprehensive and interdisciplinary
and a negative determinant of the disease, respectively. understanding (17-19). The persistent value placed on the
The specific location of disease development (tooth/ biomedical model reflects the overvaluation of biological
tooth surface) is understandable, given the imbalance of conditions and compartmentalization of the disease.
demineralization-remineralization (DE-RE) processes that The concept of health promotion has been replaced by a
occurs in the complex tooth-oral environment. However, professional practice based on a model in which technique
this strictly biological understanding of dental caries is and individual attention prevail (11).
insufficient because it does not consider other factors Although a low percentage of students overall
related to the disease, such as fluoride, saliva and social responded with a multifactorial concept of disease, this
factors. FOP/UNICAMP is one of the largest research percentage was highest in the final year, which may indicate
centers for Cariology in Brazil, and the work performed a tendency towards a discrete change in the perception
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Braz Dent J 25(1) 2014
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16. Andrade Júnior H, Souza MA, Brochier JI. Social representation of
The study was supported by a scholarship to the first author granted by
environmental education and health education in college. Psicol Reflex
The São Paulo State Research Foundation - FAPESP (Grants 2009/12370-1
Crit 2004;17:43-50.
and 2011/24042-9).
17. Brazil. Law 9394/96, issued December 20, 1996. Law of Guidelines and
Bases of the National Education. Diário Oficial da União 1996; 20 dez.
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Accepted November 22, 2013
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