The 4th Chinese National Oral Health Survey showed that the problems of caries and periodontal diseases were still serious in China. Education for the adults might be an efficient way for OHE. For the concern, we tried to focus on undergraduates, hoping to improve themselves and indirectly helps the elderly and children.
Previous study showed that oral health care awareness and behaviors of dental students were better than non-dental students . For dental students in Sichuan University, simple education for oral health was set up in their first year. Some clinical research or practice was open to them, e.g., the university students' innovation and entrepreneurship training program. Also, some of them had opportunities to get in touch with seniors and may obtain information. These OHE-related pre-clinical education and practices could enhance their knowledge about oral health care. For non-dental students in this University, they had similar educational background with dental students. So, they might be able to receive the same simple education for oral health. And these knowledges were almost enough for the daily care. Therefore, we used the dental group as a reference to find the differences of oral health care between two groups. Also, we explored the role of OHE on both dental and non-dental students by comparing their oral health knowledge and attitude before and after course.
The study investigated the oral health care habits of dental and non-dental students. The tooth brushing frequency was well known among all the students. However, half of non-dental students didn’t meet the recommended brushing time of two minutes. Additionally, non-dental students had difficulty in selecting tooth brushing method. The (modified) Bass method, the Roll method, the Fones method and horizontal method are the most widely used brushing methods . Several studies have shown that the (modified) Bass technique was effective in controlling dental plaque and alleviating gingival inflammation [24, 25]. Horizontal method, which could result in wedge-shaped defect , was not recommended. But it was a common method in China. In this survey, only 18.5% of non-dental students used the Bass method, 20.8% of them used horizontal method and 20.8% knew little about methods. From the result, we found that although non-dental students had good knowledge and tooth-brushing frequency, the actual brushing methods may not be appropriate enough. After the education by the course, much more non-dental students were willing to use the Bass method.
It was worth noticing that interproximal cleaning was overlooked by both dental and non-dental students. It was surprising that quite few dental students floss for daily cleaning. The findings revealed the sign of the ignorance about interproximal cleaning in China. Floss is so efficient that it can remove up to 80% of plaque . However, floss is comparably difficult to use and this may limit its application . Therefore, the dexterity and learning ability should be taken into account. Undergraduates are quite eligible learner for this concern. Interestingly, the tendency of using toothpick increased among non-dental students after the course. Toothpick is quite popular in China and can be found in restaurants and take-away-cutlery easily. OHE on toothpicks should be strengthened to minimize periodontal damage caused by improper use.
Later, the choice of toothbrushes was surveyed. Function and price were the most important considerations. Many studies have confirmed that electric toothbrush was more effective than manual toothbrush [29, 30]. Before the course, more than half of the students in both groups thought electric toothbrush was better than manual toothbrush. But the actual use rate was much lower than that, especially in non-dental group. Price might also be a possible reason. The nation-wide usage is much lower. A report showed that the penetration rate of electric toothbrush in China was only 5%, while in some developed countries was more than 15%, even up to 40%  After introduction about electric toothbrush through the course, more students realized its advantages and were intended to use, even with a relatively high price.
When choosing toothpaste, function and price were also the first two considerations. Interestingly, more non-dental students than dental students were willing to use Chinese herbal toothpaste before and after course. As a part of traditional Chinese medicine, Chinese herbal toothpaste may have some effects in alleviating gingival inflammation . Several studies showed that Chinese herb even had effect on preventing caries . The Chinese herbal toothpaste was preferred by traditional Chinese. Its correct usage should be focused on in the future OHE course, e.g., do not substitute scaling for Chinese herbal toothpaste.
One thing cannot be ignored is that some students cared about the popularity when choosing toothpaste and toothbrush. This brings us a new way of OHE—new media. Recently, a large number of popular media platforms have emerged, such as Tiktok (video platform), WeChat (social media platform) and Taobao (shopping platform), etc. New media has a wide range of young users . OHE might attract more attention if it is edited and delivered on these platforms. The modified OHE may be much more popular, convenient, low cost and easier to learn than before.
In all, the OHE course improved the oral health knowledge and habits among both dental and non-dental students. Dental students had much better performance than non-dental students before course. The result was in accordance with previous study . Dental students surpassed non-dental students in terms of tooth-brush frequency, method, time and floss use. For both dental and non-dental students, a single course could improve their oral health care knowledge and habits a lot. It was demonstrated that OHE plays a positive role for university students. The future OHE should pay more attention to the floss, toothbrushing methods, toothpick, Chinese herb toothpaste and modification to adapt new media.
Due to the time constraints, we conducted the after-course survey in a short period of time. So, we could only know the change of students' knowledge and attitude towards oral health care, the actual habit is unknown. The final effect of OHE for undergraduates and their parents or offspring(s) needs further verification.