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Vol 13, No 1 (2025) 
ISSN 2167-8677 (online) 

DOI 10.5195/d3000.2025.952  

 

	

	

http://dentistry3000.pitt.edu	

Knowledge, Attitudes and Practices of Dental and Medical Students 
about Hepatitis B 
Noor Na&k Raheem, Abeer Salah Salman, Athraa Ali Mahmood, Wassan Nori, Hashim Mueen Hussein 
 
College of Den*stry, Mustansiriyan University, Iraq 

Abstract 

Objec&ve: This study aimed to evaluate and compare hepaJJs B's knowledge, aPtudes, and 
pracJces among dental and medical students in Iraqi universiJes. Material and Methods: A 
cross-secJonal observaJonal study was conducted from 1 July to 1 September 2024 among 
second, third, fourth, and fiXh-stage medical and dental students. For survey distribuJon, 
the quesJonnaire  consisJng of four domains submiZed to an internet pla[orm (Google 
Forms). Undergraduate students were invited to parJcipate in the research via a survey link 
published on specific groups of students in the social networking pla[orms Viber and 
WhatsApp. Results: 426 students responded to the quesJonnaire. There were staJsJcally 
significant differences in frequency were seen (p < 0.001) regarding source of your knowledge 
about HBV, route of infecJon transiJon, receiving vaccinaJon, doses of vaccine, and periodic 
checking of Jter values of the vaccine. Frequency of answers for quesJons regarding immun-
izaJon programs and strategies against HB infecJon were not staJsJcally different. AddiJon-
ally, dental students had more frequent posiJve responses for use of gloves, changing gloves, 
use of face mask, changing face masks, use of disposable gown, and use of disposable instru-
ments for the paJents posiJve or suspected HB virus (95.4%, 94.6%, 93.8%, 73.0%, 74.3%, 
and 96.3%, respecJvely) whereas medical students less frequently used those (67.6%, 62.7%, 

59.5%, 24.9%, 47.6%, and 85.9%, respec-
Jvely). Conclusion: The study revealed 
that although both medical and dental 
students were knowledgeable about HBV 
transmission, vaccinaJon uptake, parJc-
ularly among medical students, was inad-
equate.  

Open Access 
Cita%on: Raheem NN, et al. (2025) Knowledge, A<tudes 
and Prac%ces of Dental and Medical Students about 
Hepa%%s B. Den%stry 3000. 1:a001 
doi:10.5195/d3000.2025.952 
Received: May 29, 2025  
Accepted: July 6, 2025 
Published: August 13, 2025 
Copyright: ©2025 Raheem NN, et al. This is an open ac-
cess ar%cle licensed under a Crea%ve Commons AUribu-
%on Work 4.0 United States License. 
Email: noorna%kraheem@uomustansiriyah.edu.iq

Introduc)on	
Hepatitis	 is	 a	 potentially	 life-threatening	
liver	 disease	 and	 a	 global	 healthcare	 con-
cern.	Hepatitis	B	virus	(HBV)  is	 the	 leading	
cause	of	this	disease	[1].	Acute	viral	hepatitis	
is	 a	 disease	 that	 starts	 with	 bodily	 aches,	
darker	urine,	nausea/vomiting,	loss	of	appe-
tite,	low-grade	fever,	and	general	malaise	be-
fore	 developing	 into	 jaundice	 [2].	 At	 the	
same	time,	chronic	infection	can	lead	to liver	
cirrhosis	 and	 hepatocellular	 carcinoma	 [3].	
An	 estimated	 296	 million	 persons	 globally	
were	believed	to	have	a	chronic	HBV	infec-
tion,	and	1.5	million	new	infections	occurred	
each	 year	 [4].	 In	 general,	HBV	 is	 infectious	
and	can	be	transferred	by	transfusion	ther-
apy,	the	improper	use	of	treatment-based	in-
jections,	tattooing,	transmission	from	mater-
nal-to-infant,	 and	 sexual	 activity	 [5].	 The	

practice	of	modern	medicine	has	contributed	
signiOicantly	to	the	rise	and	spread	of	blood-
borne	diseases	such	as	Human	ImmunodeOi-
ciency	Virus	(HIV)	and	Hepatitis	B	(HBV)	due	
to	 Olaws	 in	 instrument	 sterilization	 tech-
niques	and	poor	handling	of	hospital	waste.	
Ten	 to	 20%	 of	 healthcare	waste	 is	 consid-
ered	 risky	 [6].	 Occupational	 accidents	 that	
expose	healthcare	providers	 to	 bloodborne	
viruses	 are	 a	 signiOicant	 public	 health	 risk.	
Dental	 healthcare	 professionals	 are	 espe-
cially	vulnerable	to	hepatitis	because	of	their	
frequent	contact	with	sharps	[7,	8]. 
Because	 the	dental	 clinic	 is	 a	high-risk	 set-
ting	 for	 cross-infection,	 controlling	 the	 dis-
semination	 of	 hepatitis	 B	 is	 critical.	 Dental	
students	 should	 know	 the	 dangers	 of	 con-
ducting	dental	processes	and	take	adequate	
precautions	 when	 practicing	 [9].	 Direct	

contact	 with	 blood,	 saliva,	 or	 other	 bodily	
Oluids,	needle	injury,	or	mucosal	contact	from	
splashes,	Oluid	droplets,	and	aerosols,	in	ad-
dition	to	indirect	contact	with	infected	tools,	
equipment,	or	instruments,	could	all	result	in	
infection	transmission	during	dental	proce-
dures	[7].	
Hygienic	 hand	 care,	 correct	 glove	 use,	 and	
safe	disposal	of	sharp	tools	are	all	part	of	the	
Centers	for	Disease	Control	and	Prevention's	
(CDC)	recommended	measures	for	reducing	
the	 spread	 of	 bloodborne	 diseases	 such	 as	
HBV	 [10].	 Because	 some	 exposures	 cannot	
be	 avoided,	 the	 primary	 sources	 of	 protec-
tion	are	immunization	and	good	post-expo-
sure	 treatment.	 As	 a	 result,	 understanding	
HBV	 infection,	 transmission,	 and	 schemes	
for	 disease	 prevention	 is	 critical	 for	 future	
dentists'	safety	[11]. 



  Knowledge, APtudes and PracJces of Dental and Medical Students about HepaJJs B 

Vol 13, No 1 (2025)    DOI 10.5195/d3000.2025.952 

	http://dentistry3000.pitt.edu	
2	

Inadequate	 knowledge	 among	 healthcare	
workers	 in	 low/middle-income	 nations	
leads	 to	 inefOicient	 attachment	 to	 safety	
standards,	provoking	 the	HBV	burden	 [12].	
Improving	understanding	of	HBV	 is	 critical	
for	 lowering	 rates	 of	 infection	 among	
healthcare	workers	[13].	Knowledge	assess-
ments	are	often	utilized	for	evaluating	popu-
lation	 awareness	 of	 illness	 concepts	 like	
causes	and	symptoms.	Conversely,	attitudes	
are	 determined	 by	 a	 convoluted	 intercon-
nection	 of	 emotions,	 values,	 and	 individual	
beliefs.	 At	 the	 same	 time,	 practice	 is	 de-
scribed	as	the	cumulative	behaviors	taken	to	
prevent	 the	 incidence	 or	 spread	 of	 illness	
[14].		
Students	in	medicine	and	dentistry,	integral	
to	the	health	care	system,	are	the	Oirst	line	of	
connect	between	patients	and	medical	care,	
and	their	contact	with	patients	and	contami-
nated	 instruments	may	 increase	 the	risk	of	
HBV	infection,	particularly	if	safety	cautions	
are	 not	 stalked	 accurately.	 At	 the	 start	 of	
their	clinical	years,	they	are	required	to	en-
gage	 in	 patient	 care	 activities.	 Few	 studies	
have	 been	 conducted	 to	 discover	 medical	
and	 dental	 students'	 knowledge,	 practice,	
and	 attitude	 about	HBV	 in	 Iraq.	 This	 study	
aimed	 to	 assess	 and	 compare	 students'	
awareness	of	HBV	and	attitude	and	practice	
among	different	medical	and	dental	colleges	
in	many	Iraqi	universities.	

Material and Methods 
This	 cross-sectional	 study	 included	 dental	
and	medical undergraduate	students	in	gov-
ernment	and	private	colleges	in	Baghdad	city	
(Mustansiriyah,	 Baghdad,	 Al	 Iraqia,	 Alra-
heed,	 ALhadi,	 Alfarahidi	 colleges	 of	 dentis-
try)	and	Mustansiriyah,	Baghdad	and	Ashur	
medical	colleges.	This	study	was	conducted	
from	 1	 July  2024	 to	 1	 September	 2024	
among	 the	 second,	 third,	 fourth,	 and	 Oifth-
stage	 students.	 The	 total	 number	 of	 dental	
students	(Group	1)	was	241	(40	males,	201	
females),	 and	 the	 total	 number	 of	 medical	
students	(Group	2)	was	185	(63	males,	122	
females)	(Figure	1).	
	
Ethical	Approval	
Approval	 was	 received	 from	 the	 Ethical	
Committee,	College	of	Medicine,	Mustansiri-
yah	 University	 with	 IRB	 number	 63	 on	 27	
June	 2024.	 All	 students	 were	 given	 details	
about	the	study	and	guaranteed	conOidenti-
ality.	
The	online	questionnaire	used	to	collect	data	
for	this	study	included	an	opening	sentence	
regarding	the	study's	aim	and	approval	that	
it	 did	 not	 have	 any	 personal	 information;	
hence,	answering	the	questionnaire	was	con-
sidered	 an	 agreement	 to	 participate	 in	 the	
study.	It	included	4	domains,	consisting	of	23	
items.	 The	 domains	 included	

sociodemographic	information	(3	items)	in-
cluding	 age,	 gender,	 and	 stage;	 the	 second	
domain	 consisted	 of	 8	 items	 to	 determine	
awareness	of	HBV	infection	and	vaccination	
[15];	the	third	one	consisted	of	6	items	about	
attitudes	toward	HBV	infection	and	preven-
tion,	 and	 the	 last	 one	 (6	 items)	 is	 clinical	
practices	 about	 HBV	 infection	 and	 preven-
tion	[16].		
	
Study	sample	
The	 present	 study	 uses	 the	 following	 for-
mula	 that	 is	used	commonly	 in	statistics	 to	
calculate	the	sample	size	for	an	inOinite	pop-
ulation:	
n=	!".$	('($)

*"
	

Here,	n	denotes	the	required	number	size.	Z:	
the	 z-score	 (1.96)	 associated	 with	 the	 de-
sired	conOidence	level	(95%).	
P:	estimated	prevalence	or	proportion	in	the	
target	population	(set	at	0.5).	E:	margin	of	er-
ror	(0.05).	
n	=	('.+,)

!.-..	.('(-..)
(-.-.)!

	

n=	/.01',	.-.".
-.--".

	=	384.16	
Thus,	the	required	sample	size	was	approxi-
mately	385	students.	
All	426	study	participants	were	encouraged	
to	 reply	 willingly,	 using	 digital	 devices	 via	
online	 survey	 link	 published	 on	 speciOic	
groups	 of	 students	 on	 social	 networking	
platforms	(Viber	and	WhatsApp).	For	survey	
distribution,	 the	questionnaire	was	submit-
ted	 to	 an	 internet	 form	Google	 Forms.	 Stu-
dents	were	asked	to	answer	yes	or	no	to	atti-
tude	and	practice	questions.	Concerning	stu-
dent	 awareness	 of	 HBV	 transmission	 and	
vaccination-related	 questions,	 some	 an-
swers	were	yes	or	no,	while	the	others	were	
short	 choices,	 and	 incomplete	 responses	
were	excluded.		
A	 pilot	 study	 was	 carried	 out	 involving	
around	10%	of	the	target	population	to	eval-
uate	the	clarity,	practicality,	and	reliability	of	
the	survey	instrument.	Participants	were	se-
lected	 from	 similar	 student	 demographics	
and	were	not	included	in	the	main	study.	
The	objectives	of	the	pilot	study	included	as-
sessing	 the	 comprehensibility	 of	 the	 ques-
tions,	the	time	taken	to	respond,	and	the	in-
ternal	consistency	of	the	survey,	especially	in	
relation	 to	 knowledge	 and	 attitude	 areas.	
Feedback	 from	 participants	 regarding	 any	
unclear	 or	 ambiguous	 questions	 was	 col-
lected,	 which	 guided	 subsequent	 revisions	
aimed	 at	 enhancing	 the	 content	 validity	 of	
the	instrument.	
	
Statistical	analysis	
After	examining	all	the	responses	sent	by	the	
students,	the	collected	data	was	sent	to	excel	
for	analysis	and	then	exported	to	the	data	ed-
itor	of	SPSS	(Statistical	Package	for	the	Social	
Sciences	 version	 28,	 USA).	 A	 descriptive	

statistical	data	analysis	and	a	chi-square	test	
were	conducted	to	compare	categorical	var-
iables.	 A	 p-value	 of	 ≤	 0.05	 was	 considered	
signiOicant	for	statistical	analysis. 

Results 
A	 total	of	23	questionnaires	were	collected	
from	 426	 dental	 and	medical	 students	 [fe-
males	 (56.6%)	 and	males	 (43.4%)]	 among	
the	2nd,	3rd,	4th,	and	5th	year	students.	The	age	
range	of	the	participants	was	from	18	to	24.	
The	 number	 of	 dental	 students	 (Group	 1)	
was	241	[females=201	(83.4%),	males	=	40	
(16.6%)],	 and	 the	 number	 of	 medical	 stu-
dents	 (Group	 2)	 was	 185	 [females	 =	 122	
(65.9%),	 males	 =	 63	 (34.1%)].	 The	 demo-
graphic	data	are	shown	in	Table	1.	
Table	2	shows	that	the	student's	awareness	
of	 H.B.	 infection	 and	 vaccination	was	 good	
for	most	questions.	However	there	are	statis-
tically	 highly	 signiOicant	 differences	 in	 fre-
quency	were	seen	among	student	groups	(p	
<	 0.001)	 regarding	 the	 following:	 source	 of	
your	 knowledge	 about	HBV,	 route	 of	 infec-
tion	transition,	how	it	is	transmitted,	receive	
vaccination,	 doses	of	 vaccine,	 and	 the	peri-
odic	checking	of	the	titer	values	of	H.B.	vac-
cine	in	the	blood;	while	there	are	statistically	
nonsigniOicant	 difference	 in	 frequency	
among	students	groups	for	the	following:	im-
munization	programs	and	strategies	against	
HB	 infection,	 necessary	 to	 get	 immunized	
against	hepatitis	B	even	 if	 infection	control	
policies	 and	 sterilization	 process	 is	 carried	
out	properly,	and	essential	to	get	immuniza-
tion	against	hepatitis.		
93	%	of	the	medical	students	and	94.2	%	of	
the	 dental	 students	 gave	 a	 positive	 reply	
when	asked,	 "It	 is	necessary	 to	get	 immun-
ized	 against	 HBV	 even	 if	 proper	 infection	
control	 and	 sterilization	 process	 is	 carried	
out."	 However,	 only	 29.7%	 of	medical	 stu-
dents	 receive	 vaccinations.	 On	 the	 other	
hand,	approximately 57.3%	receive	vaccina-
tion	among	dental	students.	Among	respond-
ents,	 74.1%	 of	 the	 medical	 students	 and	
91.3%	of	the	dental	students	think that peri-
odic	checking	of	 the	titer	values	of	 the	vac-
cine	is	necessary	to	prevent	infection.	Addi-
tionally,	97.8%	of	the	medical	students	and	
96.3%	of	 the	dental	students	think	 immun-
ization	is	required.	
The	 percentage	 of	 responses	 on	 attitude	
questionnaires	between	groups	is	shown	in	
Table	3.	The	fear	of	infection	with	HBV	from	
practice	 was	 the	 highest	 (84.9%)	 among	
medical	 students	and	were	 (79.3%)	among	
dental	 students,	 with	 nonsigniOicant	 differ-
ences	among	groups	(p=0.138).	As	for	treat-
ing	the	patients	infected	with	HBV,	the	per-
centages	 were	 as	 follows	 (59.5%  ) among	
medical	students	and	(43.6%) among	dental	
students,	with	highly	signiOicant	differences	
among	student	groups	(p=0.001).	



  Knowledge, APtudes and PracJces of Dental and Medical Students about HepaJJs B 

Vol 13, No 1 (2025)    DOI 10.5195/d3000.2025.952 

	http://dentistry3000.pitt.edu	
3	

In	addition,	the	result	showed	that	45.4%	of	
the	respondents	said	medical	students	treat	
patients	 infected	 with	 HBV	 safely,	 while	
merely	41.9%	of	the	participants'	dental	stu-
dents	 thought	 this.	 85.9%	 of	 medical	 stu-
dents	and	90%	of	dentists	worry	about	being	
infected	with	HBV	by	patients.	Thus,	84.9%	
of	the	medical	students	and	90%	of	the	den-
tal	students,	with	signiOicant	differences	(p	<	
0.001),	consider	asking	the	patient	about	his	
infection	with	HBV	a	primary	priority	when	
taking	his	medical	history	in	the	case	sheets	
before	starting	treatments.		
Under	 the	 domain	 of	 questions	 on	 clinical	
practice	 relating	 to	 the	protective	 and	pre-
ventive	 measures	 to	 avert	 transmission	 of	
H.B.	infection,	the	percentage	of	responses	is	
shown	in	Table	4.	The	result	showed	that	for	
taking	 protective  measures	 during	 diagno-
sis,	 treatment	 procedures,	 and	working	 on	
patients,	dental	students	scored	the	highest	
with	 positive	 responses	 of	 95.4%,	 94.6%,	
93.8%,	73.0%,	74.3%,	and	96.3%,	and	medi-
cal	 students	 had	 the	 minimum	 percentage	
with	 67.6%,	 62.7%,	 59.5%,	 	 24.9%,	 47.6%,	
and	 85.9%	 of	 the	 respondents	 (for	 used	
gloves,	 change	 gloves,	 used	 face	 mask,	
change	 face	 mask,	 disposable	 gown,	 and	
used	disposable	instrument	for	the	patients	
positive	or	suspected	for	HB,	respectively). 

Discussion 
This	study	highlights	the	knowledge	and	at-
titude	 of	 both	 dental	 and	medical	 students	
regarding	the	silent	killer	or	silent	epidemic	
HBV	 by	 public	 health	 professionals,	 stu-
dents’	 knowledge	 about	 chronic	 infection,	
safety	 measures,	 and	 precautions	 that	
should	be	 taken	 in	 their	 clinical	practice	 to	
minimize	the	increased	risk	burden	of	infec-
tions.	
Female	 participation	 for	 both	 dental	 and	
medical	dental	students	reported	a	high	per-
centage	 (83.4%,	65.9%)	respectively,	 as	 fe-
males	are	more	likely	to	respond	to	online-
type	surveys	and	tend	to	adopt	more	health-
seeking	 behavior	 than	males	 [17,18];	most	
respondents	 are	 dental	 students,	 as	 they	
seem	more	interested	than	medical	students.	
Awareness	of	HBV	infection	and	vaccination	
status:	 The	 dental	 students	 	 have	 suitable	
knowledge	 about	 HBV	 from	 different	
sources	and	use	safety	precautions	that	raise	
awareness	 regarding	 the	 route	 of	 infection	
and	transmission	[19,20].	Dentists	could	be	
at	 higher	 risk	 of	 acquiring	 viral	 infections,	
hepatitis	 B	 along	 with	 other	 infections	 as	
hepatitis	 C,	 herpes	 simplex	 virus	 infection,	
tuberculosis,	 inOluenza,	 rubella,	 and	 human	
immunodeOiciency	 virus	 [21].	 As	 dentists	
had	more	contact	with	the	saliva,	blood,	and	
secretions	of	nasopharyngeal	by	mouth-nose	
absorption	 or	 accidental	 needle	 injury	 and	
other	 cutting	 instruments	 used	 for	 various	

dental	procedures	are	the	most	common	ex-
posure	routes	to	HBV;	thus,	dentist	had	a	3-	
to	4-times	more	likely	to	be	at	risk	of	HBV	in-
fection	 than	 in	 the	 Overall	 population;	 in	
spite	of		that	the	present	study	shows	a	low	
prevalence	of	dental	students	receiving	vac-
cination	against	HBV,		similar	to	the	Oindings	
of	[22],	but	it	remains	better	than	the	medi-
cal	 students	who	 have	 a	 2–10	 fold	 greater	
risk	 to	 get	 the	 HBV	 infection	 compared	 to	
others.	
Nearly	 half	 of	 the	 Iraqi	 dental	 students	 re-
ceived	vaccination	more	than	in	other	stud-
ies	which	is	higher	than	previous	studies	that	
reported	only	42%	of	dental	students	were	
HBV	immunized,	compared	to	a	lower	num-
ber	 of	 vaccinated	 medical	 students.;	 disa-
greeing	 with	 Bhattarai	 et	 al.	 2014	 [23],	
Holenarasipur	et	al.	2013	[24]	stated	that	the	
majority	of	dental	students	felt	it	was	neces-
sary	to	get	immunization	against	HBV	during	
practice	as	dental	and	oral	surgeons	had	the	
highest	 rates	 of	 HBV	 infection	 among	 all	
healthcare	 workers	 both	 groups	 showed	
high	 responses	 to	 the	 necessity	 of	 routine	
check	 of	 titers	 value	 of	 post-vaccination	
blood	tests	to	check	for	a	sufOicient	antibody	
response	to	HBV	[25].	
Two	important	methods	for	preventing	hep-
atitis	 virus	 are	 vaccination	 and	 the	 use	 of	
properly	sterilized	instruments,	but	most	of	
the	study	participants	did	not	follow	the	vac-
cination	schedule	properly	due	to	their	neg-
ligence	and	other	reasons	as	knowledge	and	
attitude	mentioned	in	our	study	[26].	
A	dentist	considers	every	patient	as	a	poten-
tial	carrier	of	hepatitis	this	explains	the	high	
percentage	 of	 responses	 of	 both	 groups	
about	fear	of	 infection	with	HBV	from	their	
practice.	
In	 the	 current	 study,	 the	 overall	 Oindings	
demonstrated	 the	 gaps	 in	 preventive	
measures	between	the	studied	groups	in	tak-
ing	 personal	 protective	 measures	 during	
routine	 diagnosis	 and	 treating	 patients,	 as	
the	dental	students	reported	the	highest	re-
sponses.	This	Oinding	is	consistent	with	[27];	
Straub	et	al.	[28]	stated	that	the	challenges	of	
insufOicient	 personal	 protective	 equipment	
(PPE)	 availability	 and	 the	 insufOicient	 time	
for	supervision	make	medical	students	face	
weaknesses	in	the	proper	utilization	of	PPE.	
The	dentistry	clinic	must	ensure	routine	and	
regular	disposal	of	needles,	sterilize	 instru-
ments,	and	follow	all	safety	protocols	(such	
as	wearing	PPE	and	disinfecting	all	surfaces,	
tools	and	equipment	after	each	patient)	(29)	
in	 teaching	dental	 hospitals	 the	 dental	 stu-
dents	and	staff	always	advised	to	secure	pri-
mary	protective	gears	as	disposable	surgical	
mask,	cap,	disposable	gloves	and	scrubs	with	
protective	eye/face	shield.		
	
Study	limitations	and	confounders		

Other	limitation	of	this	study	was	that	online	
surveys	were	only	done	by	students	with	in-
ternet	access,	but	not	all	of	them	might	have	
looked	intently,	realized,	and	provided	hon-
est	 and	 accurate	 responses;	 speciOically,	
there	was	no	direct	supervision	of	students	
or	 face-to-face	 questionnaires.	 Increasing	
the	number	of	dental	 and	medical	 colleges,	
besides	 increasing	 the	number	 of	 students,	
increases	 the	 necessity	 to	 conduct	 future	
similar	studies	for	all	students.	
This	study	offers	important	insights	into	the	
differences	in	knowledge,	practices,	and	atti-
tudes	 regarding	 HBV	 among	 medical	 and	
dental	students	in	Iraqi	universities.	A	nota-
ble	strength	of	the	research	is	its	identiOica-
tion	 of	 signiOicant	 disparities	 in	 infection	
control	 practices,	 with	 dental	 students	
showing	greater	compliance	with	protective	
measures. 

Conclusions 
The	present	study	concludes	a	good	level	of	
awareness	and	knowledge	of	the	HBV:	route	
of	infection	and	transmission	of	both	dental	
and	 medical	 students,	 but	 unsatisfactory	
Oindings	 about	 receiving	 vaccination	 and	
completing	 the	vaccine	 schedule,	 especially	
in	 medical	 students.	 Dental	 and	 medical	
schools	should	reOlect	more	on	HBV	teaching	
and	advise	students	to	complete	the	vaccine	
schedule	in	preclinical	years	so	that	they	can	
protect	 themselves	 and	 their	 patients	 and	
play	 a	 critical	 role	 in	 increasing	 awareness	
among	healthcare	staff. 

Conflict of Interest 
None.	

Funds 
None.	

Acknowledgements 
The	authors	thank	Mustansiriyah	University	
(www.uomustansiriyah.edu.iq),	 Baghdad,	
Iraq,	for	its	support	in	the	present	work.	

Author’s Contribu)ons 
A:	Conception	and	design:	NNR,	ASS,	AAM	
B:	 Analysis	 and	 interpretation	 of	 the	 data:	
NNR,	ASS,	AAM	
C:	Drafting	of	the	article:	NNR,	ASS	
D:	 Critical	 revision	 of	 the	 article	 for	 im-
portant	intellectual	content:	AAM,	HMH	
E:	 Final	 approval	 of	 the	 article:	 NNR,	 ASS,	
AAM,	WN,	HMH	
F:	Provision	of	 study	materials	 or	 samples:	
NNR,	ASS,	WN	
G:	Statistical	expertise:	NNR,	WN	
H:	Obtaining	of	funding:	NNR,	ASS	
I:	 Administrative,	 technical,	 or	 logistic	 sup-
port:	AAM,	WN,	HMH	



  Knowledge, APtudes and PracJces of Dental and Medical Students about HepaJJs B 

Vol 13, No 1 (2025)    DOI 10.5195/d3000.2025.952 

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4	

J:	Collection	and	assembly	of	data:	NNR,	ASS 

References 
1.	 Systematic	 review	 and	 meta-analysis	 of	 HIV,	
HBV	 and	 HCV	 infection	 prevalence	 in	 Sudan.	
Badawi	MM,	Atif	MS,	Mustafa	YY.	Virol	J.	2018;	15,	
148.	
2.	Hepatitis	B	awareness	among	the	dental	profes-
sionals,	students	and	dental	hygienists	in	a	dental	
school	 –	An	epidemiological	 study.	Tripati	 S,	Ka-
mala	BK,	Kiran	K.	Int	J	Contemp	Dent.	2011;2:45-
50.	
3.	 Chronic	Hepatitis	 B	 Infection:	 A	Review.	 Tang	
LSY,	 Covert	 E,	 Wilson	 E,	 Kottilil	 S.	 Jama.	
2018;319(17):1802-13.	
4.	World	Health	Organization.	Hepatitis	B	Geneva:	
WHO;	 2022	 [[online]	 Available	 at:	
https://www.who.int/news-room/fact-
sheets/detail/hepatitis-b.	Accessed	23	May	2023.	
5.	Effect	of	gender	and	age	on	the	knowledge,	atti-
tude	and	practice	regarding	hepatitis	B	and	C	and	
vaccination	 status	 of	 hepatitis	 B	 among	medical	
students	of	Karachi.	Pakistan.	Khan	N,	Ahmed	SM,	
Khalid	MM,	Siddiqui	SH,	Merchant	AA.	J.	Pak.	Med.	
Assoc.	2010;	60(6):	450-455.	
6.	Indian	perspective	Journal	of	Hospital	Infection.	
Taneja	 N,	 Biswal	 M.	 Safe	 disposal	 of	 infectious	
waste.	2009	;62(4):	525–26.	
7.	Competency	assessment	for	infection	control	in	
the	 undergraduate	 dental	 curriculum.	 	 Milward	
MR,	 Cooper	 PR.	 Eur.	 J.	 Dent.	 Educ.2007;	 11(3):	
148-154.	
8.	Infection	control	practices	among	undergradu-
ate	students	from	a	private	dental	school	in	India.	
Kumar	S,	Sharma	J,	Duraiswamy	P,	Kulkarni	S.	Rev.	
Odonto	Ciênc.	2009;	24(2):	124-128.	
9.	Knowledge,	attitudes,	and	practice	regarding	in-
fection	control	measures	among	dental	students	in	
Central	 India.	 Singh	 A,	 Purohit	 BM,	 Bhamba	 A,	
Saxena	 S,	 Singh	 A,	 Gupta	 A.	 J.	 Dent.	 Educ.	 2011;	
75(3):	421-427.	
10.	 Hepatitis	 B	 and	 C	 infection	 among	 dentists–
Risk,	 prevention,	 and	 management.	 Sheikh	 AN,	
Siddiquee	 B,	 Chahande	 J.	 Journal	 of	 Advances	 in	
Dental	Practice	and	Research.	2022;1(1):31-6.	
11.	 Hepatitis	 B:	 Knowledge,	 Preventive	 Attitude	
and	Vaccine	Status	of	Dental	Students	and	Interns	
at	Umm	Al-Qura	University,	Makkah,	Saudi	Arabia.	
Aiiii	 IK,	Al-Zahrani	AK,	Al-Sulimani	RS,	Alqahtani	
M.	Journal	of	Umm	Al-Qura	University	for	Medical	
Sciences.2020;	6.	10.54940/ms45403892.	
12.	Awareness	and	Prevalence	of	Needle	Stick	In-
jury	 among	 Nursing	 Students	 at	 King	 Abdulaziz	
University.	 Almuslami	 OK,	 Fadul	 SS,	 Munshi	 SS,	

Sangoof	 FM,	Mersal	NA.	Evidence-Based	Nursing	
Research.	2022;5(1):14-23.	
13.	Sero-prevalence	of	hepatitis	B	virus	 infection	
and	associated	factors	among	health	care	workers	
and	medical	waste	handlers	 in	primary	hospitals	
of	 North-west	 Ethiopia.	 Yizengaw	 E,	 Getahun	 T,	
Geta	M,	Mulu	W,	Ashagrie	M,	Hailu	D,	Tedila	S.	BMC	
Res	 Notes.	 2018	 Jul	 3;11(1):437.	 doi:	
10.1186/s13104-018-3538-8.	
14.	 Seroprevalence	 of	 Hepatitis	 B	 Among	
Healthcare	Workers	in	Asia	and	Africa	and	Its	As-
sociation	With	Their	Knowledge	and	Awareness:	A	
Systematic	 Review	 and	 Meta-Analysis.	 Maamor	
NH,	Muhamad	NA,	Mohd	Dali	 NS,	 Abdul	Mutalip	
MH,	 Leman	 FN,	 Aris	 T,	 Lai	 NM,	 Abu	Hassan	MR.	
Front	Public	Health.	2022	Apr	28;10:859350.	doi:	
10.3389/fpubh.2022.859350.	
15.	Knowledge	and	attitude	of	dental	students	to-
ward	 hepatitis	 B	 virus	 and	 its	 vaccination	 -	 A	
cross-sectional	study.	Benarji	KA,	Anitha	A,	Suresh	
B,	 Aparna	 V,	 Praveena	 A,	 Penumatsa	 LA.	 J	 Oral	
Maxillofac	Pathol.	2021	Sep-Dec;25(3):553.		
	16.	 Knowledge,	 Attitudes,	 and	 Practices	 Toward	
the	 Prevention	 of	 Hepatitis	 B	 Virus	 Infection	
Among	Medical	Students	in	Medina	City,	Kingdom	
of	 Saudi	 Arabia.	 Albadrani	 MS,	 Abdulaal	 AM,	
Aljabri	AM,	Aljohani	SS,	Aljohani	SF,	Sindi	MA,	Jan	
HK,	Alsaedi	H,	Alamri	WM,	Alharbi	AM,	Alraddadi	
AA.	Cureus.	2023	Nov	15;15(11):e48845.		
17.	"Does	gender	iniluence	online	survey	partici-
pation?	A	record-linkage	analysis	of	university	fac-
ulty	 online	 survey	 response	 behavior"	 Smith	
G.	ERIC	 Document	 Reproduction	 Service	 No.	 ED	
501717	(2008).	
18.	An	Event	History	Analysis	of	the	Gender	Effects	
of	 Survey	 Participation	 in	 a	 Probability-based	
Multi-wave	Panel	Study	with	a	Sequential	Mixed-
mode	Design.	Becker	R.	Gender	and	Survey	Partic-
ipation:	methods,	 data,	 analyses,2022	 16(1),	 30.	
doi:https://doi.org/10.12758/mda.2021.08	
19.	 A.	 Knowledge,	 Awareness	 And	 Practice	 To-
wards	 Hepatitis	 B	 Infection	 Among	 Dental	 Stu-
dents	In	The	International	University	For	Science	
And	Technology,	Syria	Kadou	M,	Dannan.	J	Comm	
Med	 And	 Pub	 Health	 Rep.2024;	 5(01):	
Https://Doi.Org/10.38207/JCMPHR/2024/JAN.	
20.	Knowledge	about	Hepatitis	B	Virus	and	Rele-
vant	Safety	Precautions	among	Dental	Students	in	
Kurdistan	 Region,	 Iraq.	 Kareem	 FA,	 Mohammad	
RF,	 Zardawi	 FM,	Gul	 SS.	 J	 Environ	Public	Health.	
2022	 Sep	 18;2022:8516944.	 doi:	
10.1155/2022/8516944.	 PMID:	 36172400;	
PMCID:	PMC9510674.	
21.	Hepatitis	B	in	health	care	workers:	Indian	sce-
nario.	Singhal	V,	Bora	D,	Singh	S.	J	Lab	Physicians	
2009;	1:41–8.	

22.	 	Hepatitis	B	vaccination	and	immunization	of	
dental	students,Lira	ALS,	Martins	KRJ.	Rev	Odontol	
Bras	 Central	 2021;	 30(89):	 180-194.	 DOI	
10.36065/robrac.v30i89.1445.	
23.	Hepatitis	B	vaccination	status	and	Needle-stick	
and	Sharps-related	Injuries	among	medical	school	
students	 in	 Nepal:	 a	 cross-sectional	 study.	Bhat-
tarai	SKCS,	Pradhan	PM,	Lama	S,	Rijal	S.		BMC	Res	
Notes.	 2014;	7,	 774.	
https://doi.org/10.1186/1756-0500-7-774	
24.	 Awareness	 regarding	 hepatitis	 B	 immuniza-
tion	 among	 preclinical	 Indian	 dental	 students.	
Vasanthakumar	AH,	D’Cruz	AM.	J	Oral	Health	Oral	
Epidemiol	2013;	2(2):	97-101.	
25.	Dentists	 and	Hepatitis	B	Vaccination	 –	An	 In	
Vivo	National	Study.	Yared	G,	Al	Khatib	A,	AL	Man-
hal	W,	Yared	N,	Younes	R.	International	Arab	Jour-
nal	of	Dentistry.	2023;	Vol.	14:	Iss.	2,	Article	17.	
26.	Knowledge,	Attitude	and	Awareness	of	Hepati-
tis	B	Vaccine	Among	Medical	and	Dental	Students,	
KarthiknV,	 Rani	 L,	 Brundha	 MP.	 Biosc.	 Biotech.	
Res.	Comm.	2020;	Special	Issue	Vol	13	No	(7)	Pp-
120-124.	
27.	Dental	 professionals’	 use	 of	 personal	 protec-
tive	 equipment	 during	 COVID-19:	 a	 cross-sec-
tional	study	in	China.	Wan	Q,	Han	L,	Yang	X,	Yu	S,	
Zheng	X.	Front.	Public	Health.	2023;	11:1183580.	
doi:	10.3389/fpubh.2023.1183580.	
28.	 Personal	 protective	 equipment	 and	 medical	
students	 in	 times	 of	 COVID-19:	 experiences	 and	
perspectives	from	the	iinal	clerkship	year.	Straub	
J,	 Franz	 A,	 Holzhausen	 Y,	 Schumann	 M,	 Peters	
H.		 BMC	 Med	 Educ.2023;	23,	 806.	
doi.org/10.1186/s12909-023-04784-2.	
29.	Transmission	of	blood-borne	pathogens	in	US	
dental	 health	 care	 settings:	 2016	 update.	 Cleve-
land	JL,	Gray	SK,	Harte	JA,	Robison	VA,	Moorman	
AC,	Gooch	BF.	J	Am	Dent	Assoc.	2016;147(9):729-
738.	doi:10.1016/j.adaj.2016.03.020.	
	
	
	
	
	
	
	
	
	
	
	
	
	



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Figure	1.	Flowchart	of	study	participants'	recruitment.	
	
Table 1. DistribuJon of groups in the study and demographic data. 

Student Groups No. (%)  Age (%) Gender Stage 

Dental students (G1) 241(56.6 %) 18= 11(4.6%), 

19= 45(19.0%), 

20=74(31.2%), 

21=48(20.3%), 

22= 33(13.9%), 

23= 14(5.9%), 

24= 12(5.1%) 

Females = 201  (83.4%) 

Males = 40 (16.6%) 

2= 71(29.5%), 

3=75(31.1%), 

4=65(27.0%), 

5=30(12.4%) 

Medical students (G2) 185 (43.4 %) 18= (31.5%), 

19= 16(8.0%), 

20=49(24.4%), 

21=82(40.8%), 

22= 33(16.4%), 

23= 12(6.0%), 

24= 6(3.0%) 

Females = 122 (65.9%) 

Males = 63 (34.1%) 

2=21(11.4%), 

3=30(16.2%), 

4=111(60.0%), 

5=23(12.4%) 

No: number, %: percentage 

 

 

 

 



  Knowledge, APtudes and PracJces of Dental and Medical Students about HepaJJs B 

Vol 13, No 1 (2025)    DOI 10.5195/d3000.2025.952 

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Table 2. Comparison of percentages of awareness of HBV infecJon and vaccinaJon quesJonnaire between groups. 

Ques&onnaire Choices No. (%) of groups X2 P-value 

G1 G2 

1. The source of your knowledge 

about HBV infecJon and vaccina-

Jon 

- Syllabus 86 (35.7%) 113(61.1%) 29.326 

 

<0.001 *** 

- Media 103 (42.7%) 40(21.6%) 

- Others 52 (21.6%) 32(17.3%) 

2. The most common route of infec-

Jon is a transiJon from 
DenJst /doctor to paJent 20 (8.3%) 23(12.4%) 16.730 <0.001 *** 

PaJent to paJent 30(12.4%) 48(25.9%) 

PaJent to denJst/doctor 191(79.3%) 114(61.6%) 

3. How it (HBV) transmiZed Saliva 55 (22.8%) 16 (8.6%) 30.986 <0.001 *** 

Blood 135 (56.0%) 143(77.3%) 

Sneezing and cough  27 (11.2%) 5 (2.7%) 

From mother to infant 10 (4.1%) 6 (3.2%) 

Sexual route. 14 (5.8%) 15(8.1%) 

4. Do you receive vaccinaJon Yes 138 (57.3%) 55(29.7%) 32.015 <0.001 *** 

No  103(42.7%) 130(70.3%) 

5. No. of doses of vaccine you receive 

if you have it 

 

 

 

One 55 (32.0%) 30(16.2%) 30.499 <0.001 *** 

Two  71 (41.3%) 130(70.3%) 

Three 43 (25.0%) 23(12.4%) 

Four 3 (1.7%) 2(1.1%) 

6. if you did not menJon the possible 

reason 
lack of opportunity 118 (49.2%) 118(63.8%) 16.577 0.002*** 

lack of awareness 28 (11.7%) 16(8.6%) 

fear of side effects 37(15.4%) 19(10.3%) 

The vaccine is non-available. 12(5.0%) 16(8.6%) 

Non-suscepJbility of infecJon 45(18.8%) 16(8.6%) 

7. With proper infecJon control and 

sterilizaJon strategies. Do you think 

is it necessary to get immunized 

against HBV? 

Yes 226(94.2%) 172(93.0%) 0.250 0.617NS 

No  14(5.8%) 13(7.0%) 

Yes 220 (91.3%) 137(74.1%) 22.896 <0.001 *** 



  Knowledge, APtudes and PracJces of Dental and Medical Students about HepaJJs B 

Vol 13, No 1 (2025)    DOI 10.5195/d3000.2025.952 

	http://dentistry3000.pitt.edu	
7	

8. Do you think it is necessary to check 

the Jter values of the HB vaccine in 

the blood periodically? 

No 21 (8.7%) 48(25.9%) 

***: p < 0.001 using the chi-squared test, NS: nonsignificant, X2: Chi-square 

Table 3. Comparison of percentages of aPtude quesJonnaire between groups. 

Ques&onnaire Choices No. (%) of group X2 P-value 

G1 G2 

9. Do you fear about infecJon with HBV from 

your pracJce 
Yes 191(79.3%) 157(84.9%) 2.204 0.138 NS 

No 50(20.7%) 28(15.1%) 

10. Can you treat paJents infected with HBV Yes 105(43.6%) 110(59.5%) 10.573 <0.001 *** 

No 136(56.4%) 75(40.5%) 

11. Is it safe to treat paJents infected with HBV 

safely? 
Yes  101(41.9%) 84(45.4%) 0.521 0.470 NS 

No 140 (58.1%) 101(54.6%) 

12. Do you have the right to know your paJent's 

HBV infecJon status? 
Yes  207(85.9%) 165(89.2%) 1.028 0.311 NS 

No 34(14.1% ) 20(10.8% ) 

13. Do you worry about being infected with HBV 

by paJents? 
Yes  217(90.0%) 159(85.9%) 1.695 0.193 NS 

No 24(10.0% ) 26(14.1% ) 

14. Do you consider asking the paJent about his 

infecJon with HBV as a primary priority when 

taking his medical history in the case sheets 

before starJng treatments?  

Yes  230(95.4%) 157(84.9%) 14.062 <0.001 *** 

No 11(4.6%) 28(15.1%) 

***: p < 0.001 using the chi-squared test, NS: nonsignificant, X2: Chi-square 

 

 

 

 

 

 

 

 

 

 

 



  Knowledge, APtudes and PracJces of Dental and Medical Students about HepaJJs B 

Vol 13, No 1 (2025)    DOI 10.5195/d3000.2025.952 

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8	

Table 4. Comparison of percentages of items on your clinical pracJce quesJonnaire between groups. 

Ques&onnaire Choices No. (%) of group X2 P-value 

G1 G2 

15. Do you wear latex gloves during diagno-

sis and treatment?? 
Yes 230(95.4%) 125(67.6%) 58.523 <0.001 *** 

No  11(4.6%) 60(32.4%) 

16. Do you change gloves between paJents 

during diagnosis and treatment? 
Yes 228(94.6%) 116(62.7%) 68.532 <0.001 *** 

No  13(5.4%) 69(37.3%) 

17. Do you wear a face mask during diagno-

sis and treatment?? 
Yes   226(93.8%) 110(59.5%) 73.964 <0.001 *** 

No 15(6.2%) 75(40.5%) 

18. Do you change face masks between pa-

Jents? 
Yes  176(73.0%) 46(24.9%) 97.289 <0.001 *** 

No 65(27.0%) 139(75.1%) 

19. Using disposable gown during diagnosis 

and treatment??   
Yes  179(74.3%) 88(47.6%) 31.909 <0.001 *** 

No 62(25.7%) 97(52.4%) 

20. Using disposable instruments for the pa-

Jents suspected or posiJve for HBV?? 
Yes   232(96.3%) 159(85.9%) 14.780 <0.001 *** 

No 9(3.7%) 26(14.1%) 

***: p < 0.001 using the chi-squared test, NS: nonsignificant, X2: Chi-square