This questionnaire based, cross-sectional survey was conducted during June 2011 and July 2011. Questionnaire was distributed to students during class hours for each year, with prior permission from Dean of the Institution. A total of 320 undergraduate dental students who were registered under Dr. NTR University of Health Sciences, India, were approached for their participation in the survey. After explaining the aims and objectives of the study, verbal consents were obtained from the participants prior to the start of the survey. Students were assured that their information would be held confidential. Ethical clearance was obtained from the ethical committee of Mamata Dental College, Khammam, India.

Inclusion Criteria: All students present on the day of the survey were included.

Exclusion Criteria: Students who were absent on the days of survey and who were not willing to participate were excluded.

A self-administered, pretested, structured questionnaire was employed to record the data. The questionnaire consisted of two sections; the first section included information on demographic characteristics, and second section explored the attitudes of dental students regarding considering Public Health Dentistry as their future career and it consisted of 27 questions that were graded on five point Likert scale, with grades; STRONGLY AGREE (4), AGREE (3), UNDECIDED (2), DISAGREE (1) and STRONGLY DISAGREE (0). The scores were given in the parenthesis. Minimum and maximum scores ranged between 0 and 108.

Sample size calculation

Pilot study was conducted on 40 participants, in which 26% of them showed a positive attitude.

A sample size of 293 is required to test the hypothesis with 95% confidence interval and 80% power to reject the null hypothesis.

Test-retest reliability was performed to test the reliability of the questionnaire, it was found to be good with Cronbach’s alpha (α) 0.75.

Descriptive analysis was undertaken to present the findings from this study. Differences between groups were examined by using Chi-Square test for proportions, t-test and ANOVA, with post hoc tests for means. Statistical analysis was done by using SPSS, version 12 and the significance level was set at p value of < 0.05.

A total of 293 of the 320 registered undergraduate students participated in the study, with an overall response rate of 91.5%.

Among 293 students, 80 (27%) were males and 213 (73%) were females. The age distribution was in between 17-23 years.13.6% of the study population belonged to the age group of 17-18 years, while 43.4% of them were between the ages of 19-20 years. While 34.1% of the study population was in between 21-22 years, only 8.9% were above the age of 23 years. Participation varied according to the years of study (29%, 20.4%, 16.7%, 19.1% and 14.6% for first year, second year, third year, fourth year and interns respectively). This has been illustrated in [Table/Fig-1].

The responses for the attitude questions were categorized into three factors, which are low attitude (includes score 0-35), average attitude (score 36-75) and high attitude (score 76-108). Among the total sample which was studied, it was observed that only one third (35.4%) of them had high attitude towards selecting public health dentistry as their future career and nearly two thirds of them (58.02%) had an average attitude, with very few students having low attitude (6.48%) [Table/Fig-2].

[Table/Fig-2]:

Clearly shows the distribution of the entire study population according to the levels of attitude. Most of subjects exhibited an average towards choosing public health dentistry as a career

While only 6.25% of the male students had high level of attitude, nearly half of the female students expressed high level of interest (46.48%) in choosing Public Health Dentistry as their future career. This was a significant finding and a high level of variation in attitude between males and females was found [Table/Fig-3].

When mean of the total attitude score was compared between males and females, it was found to be significant, with females having higher mean levels [Table/Fig-4].

When attitude was compared between years of study, high attitude was found to be more among interns and fourth year students, whereas more number of first, second and third year students had average attitude. Low attitude was found to be more in first year students as compared to the students from remaining years of study. The association between the years of study for low, average and high attitudes was found to be significant, with interns and fourth year students having high attitude levels [Table/Fig-5].

When mean attitude was compared between different years of study, it showed high significant difference, with means of interns and fourth year students having high attitudes. On doing multiple comparisons, it was found that significant difference existed between first year and fourth year students and between first year students and interns [Table/Fig-6].

Among the various disciplines in dentistry, Public Health Dentistry forms the basis for dental health care services and it holds the key for developing awareness on the social aspects of the profession and the responsibility towards community, amidst all those who are engaged in the profession [11]. Operation of a meaningful and balanced oral health care delivery system requires specialists from all aspects of dentistry [9]. In India, of all the various disciplines of dentistry, Public Health Dentistry is the one which was given least importance by dental colleges, as is evident from the paucity of post graduate seats which are available in the country; the reason being the attraction towards clinical dental specialties by dental undergraduates.

The dilemma of choosing a branch becomes even more profound, especially when one is choosing a career in a specialty which is still in its budding stage and is growing for e.g. Public Health Dentistry. Little interest is developed towards the subject during graduation, reasons being,

Keeping this in view, the present study was conducted to know the attitudes of dental students towards choosing Public Health Dentistry as their future career, which can help in establishing post- graduation courses in various Public Health Dentistry departments among existing universities. Due to scarcity in the number of studies which are concerned with this aspect, no comparisons could be made with other studies.

The present study found an average attitude towards joining public health dentistry among 58% of the sample, which showed that they had a considerable amount of interest in pursuing post-graduation in this specialty.

Attitude towards the specialty was significantly less among male students as compared to females, which could be due to their assumptions and misinterpretations about Public Health Dentistry as a non clinical specialty, that doesn’t include clinical training and so “loss of hands” on dental practice. Other reasons for this low attitude towards public dental health among male students may be lower income, lower professionalism, poorer working conditions in communities and greater dependency on the job as compared to other specialties of dentistry [12]. However, this result was not in accordance with that of study conducted by Gurmukh Singh and SS Hiremath, in which higher inclination to join public health dentistry was seen among males [13].

Attitude towards dental public health was found to be more among students from higher academic years as compared to those from first and second years. This may be due to their increased awareness on the importance of doing post-graduation, demand for it in the society and better income which was associated with it, as compared to under graduation. This reflected their attitude towards post-graduation in general rather than specifically towards public health dentistry, but most of them felt that public health dentistry was a challenging job, as they had to face community and solve dental health problems. Among the first and second year students, this awareness was less, as they were still in the early years of the course and were not exposed to working in a clinical environment, where they would usually come to know the difference between under-graduation and post-graduation.

In the past one decade, Dental Council of India has made some efforts in establishing post-graduation in Public Health Dentistry, but these efforts should be intensified further, both by council and by the dental colleges, to develop this specialty, keeping in mind the increasing attitudes of dental undergraduates towards it. This can also help in increasing the number of dental personnel who are specialized in implementation of oral health policy, which does not exist in India.

A major limitation of the present study was the low number of respondents. Because of this limitation, the present results should be viewed as preliminary. Further studies with larger sample sizes, which involve the entire country are needed, to know the attitude of dental students towards choosing public health dentistry as their future career.

The findings of the present study suggest that there has been a change in the dynamics in the post-graduation studies, from it being a male dominated profession to a nearly equal number of females joining the course. There is a need to broaden the scope of the specialty and to make it more practical. Proper orientation on the subject from the under graduation level is the need of the hour. Prior counselling of the students who are not aware of the future prospects of the subject should be done.

The students who seem to view academics/teaching as their future prospects with regards to this specialty require more attention. It is necessary to broaden the limits of the subject spectrum from just being a lucrative teaching option in terms of financial interests, to a specialty which is much useful to the people of the country. Innovative and strategic areas of alliance with other fields of dentistry and medicine should be sought during and after post-graduation for the students. Interactions between the students should be encouraged, for them to carry out at least small pilot projects in the field and to give shape to committed and confident public health dentists for the future.