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Assessing the Necessity of Dietary Education in Oral Health Programs for Young Adults
J Dent Hyg Sci 2024;24:367-73
Published online December 31, 2024;  https://doi.org/10.17135/jdhs.2024.24.4.367
© 2024 Korean Society of Dental Hygiene Science.

Eun-Ha Jung

Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju 26493, Korea
Correspondence to: Eun-Ha Jung, https://orcid.org/0000-0002-3737-5899
Department of Dental Hygiene, Yonsei University, 1 Yeonsedae-gil, Heungeop-myeon, Wonju 26493, Korea
Tel: +82-31-226-5564, Fax: +82-31-226-5534, E-mail: jeunha725@gmail.com
Received November 30, 2024; Revised December 10, 2024; Accepted December 13, 2024.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: This study aimed to assess the necessity of incorporating dietary education into oral care programs for adults in their 20s and to propose a framework for developing dietary education platforms.
Methods: This study included 200 adults in their 20s. A structured questionnaire was used to collect information on participants’ experiences with oral care and dietary education. The adult nutrition quotient (NQ) Questionnaire proposed by the Korean Nutrition Society was used to assess the nutritional status. The questionnaire included 18 checklist items comprise three factors: nutritional balance, moderation of the amount of food intake, and dietary behavior. After completing the survey, the participants were divided into two groups based on their history of dietary education. The nutritional status of dietary education experience (DE) and no dietary education experience (NDE) was analyzed and compared.
Results: Among the participants, 97 (48.5%) reported having received oral care education, while 30 (30.9%) reported receiving dietary education within the past year. In the DE group, 46.7% consumed a balanced diet, compared to 17.1% in the NDE group (p<0.001). However, 86.7% of the DE group showed low food moderation despite receiving dietary education (p<0.01). Appropriate dietary behaviors were observed in 60.0% of the DE group, whereas 41.7% showed adequate dietary behaviors (p=0.108). In addition, 23.3% of the DE group showed good NQ, compared to 19.4% in the NDE group (p=0.198).
Conclusion: The results of this study confirmed the possibility of a good nutritional status among the individuals who received dietary education. However, considering the low proportion of participants who had undergone dietary education, dental hygienists must recognize the importance of including diet-related content into oral care education.
Keywords : Dietary education, Nutrition quotient, Oral care education, Oral health
Introduction

1. Background

Recently, there has been increasing focus on oral health, shifting from treatment-oriented dental care to prevention-focused management and education1). Preventive measures for oral diseases include professional interventions such as regular dental checkups, dental sealants, fluoride applications, and scaling, as well as self-care practices including the use of oral hygiene products, fluoride rinses, and dietary management. Consistent self-care is particularly critical for maintaining oral health, prompting dental professionals to provide oral hygiene education to patients. Educational programs on oral health typically include plaque management, regular dental checkups, preventive measures against oral diseases, and dietary education2). However, in clinical settings, the emphasis often remains on techniques involving oral hygiene products, such as toothbrushing and mouthwash use, while dietary education receives less attention.

Dietary education is essential for fostering healthy eating habits and effective oral health management3). Previous studies have shown that nutrients in food are vital for the growth, development, and maintenance of oral structures and tissues4,5). Inadequate dietary habits can lead to nutritional imbalances and an increased risk of oral diseases. Although the relationship between nutritional status and oral health has been demonstrated, clear guidance on addressing the underlying causes of such issues and implementing improvement strategies is lacking6).

Dietary patterns change throughout life cycle3). Adolescents, who receive meals from caregivers or school programs, tend to consume relatively regular nutritionally balanced diets. In contrast, young adults in their 20s often face higher risks of nutritional imbalance owing to distorted body image perceptions and behaviors aimed at weight loss, such as extreme dietary control7). This group also frequently consumes snacks and sugary beverages while neglecting oral hygiene, highlighting the urgent need for dietary education and promoting healthy habits to prevent oral diseases4).

Poor dietary choices and behaviors can lead to numerous health problems, underscoring the importance of dietary education. Furthermore, oral health habits formed during young adulthood serve as predictors of oral diseases later in life8). Thus, acquiring and practicing comprehensive oral health management during this period lays the foundation for a healthy future. However, the lack of structured dietary education and guidelines has restricted dental professionals from effectively addressing patients’ dietary habits. Therefore, the development and incorporation of dietary education into oral health programs is imperative for both dental professionals and their patients.

2. Objectives

This study aimed to evaluate the necessity of incorporating dietary education into oral health programs for adults in their 20s and to propose a framework for designing effective dietary education programs.

Materials and Methods

1. Participants

The sample size for this study was calculated using G*Power software (version 3.1.9.7; Heinrich-Heine-Universität, Düsseldorf, Germany). Based on previous research9), an effect size of 0.5, significance level of 0.05, and statistical power of 0.8 were applied, resulting in a required sample size of 102 participants. The final target sample size was 122, accounting for a potential dropout rate of 20%. The study recruited adults in their 20s, excluding those with physical or systemic conditions that prevented independent dietary intake, individuals working in dental-related fields, and participants unable to read or complete the survey. Questionnaires were distributed to individuals who, as indicated in the recruitment document, expressed willingness to participate in the study and met the inclusion criteria. The survey was conducted from June 1 to June 30, and 200 participants completed the study. The participants were divided into two groups based on their prior dietary education experience. The nutritional status of dietary education experience (DE) and no dietary education experience (NDE) was analyzed and compared. Ethical approval for the study was obtained from the Institutional Review Board of Catholic Kwandong University (IRB No. CKU-23-01-0202).

2. Data collection

This study employed a survey-based approach using a structured self-administered questionnaire provided to participants who consented to participate. The questionnaire consisted of four sections: 1) general characteristics (sex, age, height, weight, and living arrangements); 2) oral health education experience; 3) dietary education experience; and 4) nutritional status. Nutritional status was assessed using the nutrition quotient (NQ) questionnaire developed by the Korean Nutrition Society with support from the Ministry of Food and Drug Safety10-12). Additional items related to oral health were included in the questionnaire to align with the study objectives.

The NQ included three domains: 1) Balance: Evaluating the variety and diversity of essential food consumption; 2) Moderation: Measuring the intake of unhealthy foods; and 3) Practice: Assessing safe and healthy dietary behaviors12).

Scores for each domain were calculated, and the NQ was categorized into three standardized levels based on the national survey percentiles: High (75∼100th percentile), Middle (25∼75th percentile), and Low (0∼25th percentile). This standardized categorization allowed for a comprehensive evaluation of the participants’ nutritional behaviors and their relationship with oral health education12).

The height and weight of the participants were measured to determine their nutritional intake and calculate their body mass index (BMI, kg/m2). BMI was categorized into four levels: underweight (<18.5), normal weight (18.5≤BMI<23), pre-obesity (23≤BMI<25), and obesity (≥25)13).

3. Statistical analysis

The participants were divided into the DE and NDE groups to analyze their nutritional status according to their dietary education experience. Frequency analysis was conducted to evaluate the participants’ general characteristics and experiences with oral hygiene and dietary education. An independent t-test was performed to compare the nutritional status based on the dietary education provided by dental professionals. Cross-tabulation analysis was used to assess the impact of dietary education experience on the three NQ domains (balance, moderation, and practice) and overall NQ. All statistical analyses were performed using IBM SPSS Statistics (version 21.0; IBM Corp., Armonk, NY, USA), with the significance level set at 0.05.

Results

1. General characteristics of the study participants

The general characteristics of the participants are listed in Table 1. The study included 200 adults in their 20s, with an average age of 21.3±15.1 years. Among the participants, 97 (48.5%) reported having received oral hygiene education and 30 (15.0%) indicated that they had received dietary education from dental professionals within the past year.

General Characteristics of Participants (n=200)

Characteristic n (%)
Sex
Male 59 (29.5)
Female 141 (70.5)
Body mass index (BMI)
Underweight (<18.5) 28 (14.0)
Normal weight (18.5≤BMI<23) 104 (52.0)
Pre-obesity (23≤BMI<25) 26 (13.0)
Obesity (≥25) 33 (16.5)
Residence types
With family 45 (22.5)
Single-family home 52 (26.0)
Dormitory 100 (50.0)
Experience in oral health education
Yes 97 (48.5)
No 102 (50.5)
Experience in dietary education
Yes 30 (15.0)
No 170 (85.0)
Total 200 (100)


2. Impact of dietary education on nutritional quality

When comparing NQ based on dietary education experience, the DE group demonstrated more balanced eating habits than the NDE group. However, the DE group scored lower in the moderation domain, which assesses the avoidance of unhealthy food consumption. Although not statistically significant, the DE group showed higher scores in the practice domain and overall NQ (Table 2).

Comparison of Nutritional Quotient Factors by Dietary Education Experience (n=200)

Nutritional quotient domain DE (n=30) NDE (n=170) p-value
Balance 29.53±15.05 21.02±12.26 0.001
Moderation 51.88±12.82 59.02±54.99 0.009
Practice 54.99±15.61 49.41±17.19 0.108
Nutritional quotient 46.42±10.60 43.77±10.31 0.198

Values are presented as mean±standard deviation.

The p-values are calculated by independent t-test.

DE: dietary education experience, NDE: no dietary education experience.



3. Relationship between dietary education experience and nutrition quotient

In the DE group, 46.7% of participants demonstrated balanced eating habits, compared to only 17.1% in the NED group (p<0.001). Although not statistically significant, 60.0% of participants in the DE group exhibited appropriate dietary behaviors, compared to 41.7% in the NDE group (p=0.170). Additionally, 23.3% of the DE group achieved a good NQ, compared to 19.4% of the NDE group (p=0.782) (Table 3).

Difference in Nutrition Status according to Dietary Education Experience

Nutritional status DE NDE χ2 (p)
Body mass index 29 (100) 162 (100) 2.703 (0.440)
Underweight 4 (13.8) 24 (14.8)
Normal weight 13 (44.8) 91 (56.2)
Pre-obesity 4 (13.8) 22 (13.6)
Obesity 8 (27.6) 25 (15.4)
Balance 30 (100) 170 (100) 16.188 (<0.001)
Low (<30.9) 16 (53.3) 141 (82.9)
Middle (≥30.9 and <55.8) 12 (40.0) 28 (16.5)
High (≥55.8) 2 (6.7) 1 (0.6)
Moderation 30 (100) 170 (100) 3.893 (0.143)
Low (<66.1) 26 (86.7) 118 (69.4)
Middle (≥66.1 and <85.3) 4 (13.3) 49 (28.8)
High (≥85.3) 0 (0.0) 3 (1.8)
Practice 30 (100) 170 (100) 3.543 (0.170)
Low (<51.8) 12 (40.0) 99 (58.2)
Middle (≥51.8 and <74.5) 15 (50.0) 57 (33.5)
High (≥74.5) 3 (10.0) 14 (8.2)
Nutrition quotient 30 (100) 170 (100) 0.491 (0.782)
Low (<52.7) 23 (76.7) 137 (80.6)
Middle (≥52.7 and <68.5) 7 (23.3) 32 (18.8)
High (≥68.5) 0 (0.0) 1 (0.6)

Values are presented as n (%).

DE: dietary education experience, NDE: no dietary education experience.


Discussion

1. Interpretation and comparison to previous studies

Young adults in their 20s are reported to have a higher risk of nutritional imbalance compared to other age groups, primarily because of distorted body image perceptions and weight control behaviors. These behaviors are often accompanied by the frequent consumption of snacks and sugar-sweetened beverages, exacerbating poor dietary habits14). These undesirable dietary choices and behaviors can lead to multiple health issues, emphasizing the need for dietary education in clinical dental practice15). Despite the recognized importance of providing appropriate information on dietary habits, the lack of structured dietary education content and guidelines limits dental professionals’ ability to effectively manage patients’ diets. To address this, the present study compared the NQ between groups with and without dietary education experience, aiming to highlight the need for developing dietary education content in dental clinical settings.

In this study, 97 participants (48.5%) reported receiving oral hygiene education, whereas only 30.9% had received dietary education from dental professionals within the past year. Furthermore, schools were identified as primary sources of dietary education among those who has received such guidance (data not shown). These findings indicate that dietary education has been insufficiently addressed within oral health education. Oral diseases are closely related to dietary habits and should be considered for prevention16,17). This highlights the importance of efforts by dental professionals to address this issue. In this study, the NQ questionnaire developed by the Korean Nutrition Society was used to evaluate the participants’ dietary behavior and nutritional status10,11). When comparing balance domain based on dietary education experience, the group with dietary education had a higher average score (29.53±15.05) than the group without such experience (21.02±12.26). This indicates that participants with dietary education were more likely to consume a balanced diet, including protective foods such as fruits, vegetables, legumes, tofu, and milk, which are beneficial for oral health18). Although not statistically significant, the dietary education group showed higher scores in the practice domain, which included behaviors such as checking nutrition labels and handwashing, as well as in the overall NQ. However, in the moderation domain, which evaluates the restriction of unhealthy foods such as sugary snacks and beverages (cariogenic foods)19), the DE group scored approximately 7.2 points lower than the NDE group. This suggests that limiting sugary foods should be emphasized in adults in their 20s. Despite higher scores in the balance and practice domains, the NQ for participants with dietary education were below the threshold for “good” nutritional status: 52.7 for overall NQ, 30.9 for balance, 66.1 for moderation, and 51.8 for practice20). This indicates that improvements are required in all domains. These findings may be attributed to the characteristics of the study population, which consisted primarily of individuals in their early 20s—a group prone to nutritional imbalances. Additionally, approximately 50% of the participants lived independently in dormitories or managed their meals without parental support, which probably influenced their dietary habits7).

Using the standardized percentile-based NQ classification provided by the Korean Ministry of Food and Drug Safety, participants were divided into high, middle, and low categories for comparison12). Among those with dietary education, 46.7% exhibited balanced eating habits in the upper middle compared to only 17.1% without dietary education (p<0.001). A previous study evaluating the effects of dietary education on nutritional knowledge found no statistically significant differences between groups before education. However, post-education, the educated group showed an 8.13-point increase in knowledge, scoring 14.15, compared with a 0.67-point increase in the non-educated group, which scored 6.88. This demonstrates the positive effect of dietary education on fostering balanced eating habits in adults21).

These results suggest that providing well-structured dietary education that integrates nutritional and oral health perspectives is essential. Such programs can contribute significantly in improving nutrition and promoting oral and overall health in adults.

2. Suggestion

The results showed that only 30 out of 200 participants had received dietary education from dental professionals, indicating its low prevalence. Given the importance of nutritional management in oral healthcare, dental professionals should prioritize the development and implementation of dietary education.

Based on the findings of this study, the following recommendations are proposed for developing dietary education content related to oral health: encourage the consumption of foods rich in fruits, vegetables, and proteins, which fall under the “balance” domain. These foods are classified as protective or clean foods that promote oral health and should be included in educational content. Limit the intake of sugary foods and beverages, which are categorized under the “moderation” domain. These cariogenic foods are strongly associated with the development of dental caries, and their restrictions should be emphasized in dietary education.

Dietary education can support nutrition and oral health more effectively by focusing on these recommendations.

3. Limitations

This study evaluated the relationship between dietary education experience and nutritional status, providing valuable insights into the need for dietary education in oral health management. However, this study has several limitations. First, the study population was limited to adults in their 20s. Future studies should include a broader age range to better understand the effects of dietary education across diverse demographic groups. Second, the relatively small number of participants with experience in dietary education made it difficult to draw definitive conclusions about its effects. Future research should aim to develop standardized dietary education platforms and evaluate their effectiveness through large-scale studies.

4. Conclusion

This study confirmed that participants with dietary education were more likely to achieve a better nutritional status. However, the low proportion of individuals receiving such education highlights the urgent need to develop and implement tailored dietary education platforms within dental-care settings.

Acknowledgements

None.

Notes

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Ethical approval

This study was approved by the institutional review board of Catholic Kwandong University (IRB No. CKU-23-01-0202).

Funding

None.

Data availability

Raw data is provided at the request of the corresponding author for reasonable reason.

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