Knowledge Of Dental Students Research Articles

TOOTH AVULSION MANAGEMENT: STATE OF DENTAL STUDENTS’ KNOWLEDGE

Aim: This study was conducted to determine the knowledge of undergraduate dental students regarding the management of avulsed teeth at the College of Dentistry, King Saud University, Riyadh, Saudi Arabia.Methods: A self-administered English-language questionnaire contained of 17 close ended questions with two parts: The first part consisted of questions about demographic and professional data. The second part of the questionnaire consisted of questions to evaluate the knowledge and attitude of the students on managing avulsed traumatic injuries. The data were entered and analyzed using SPSS. The level of statistical significance was set at p < 0.05. Results: Data were collected from 303 students with response rate of 83.4%. About 80% of the students had a previous knowledge about dental trauma. Most of the students 92.7% were able to define avulsion, correct answers were significantly more with advanced academic level (P = 0.003). Majority of the students (80.5%) can distinguish between primary and permanent teeth. About half of the study group (46.2%) correctly answered the ideal time for re-implantation, more female students were responded correctly with p = 0.000 if compared to male students. Most of the students (83.8%) selected milk as a storage medium, almost 15% selected saliva, 14.5% selected Hank’s balanced salt solution (HBSS) and 8.3% selected saline. Only 19.8% answered the flexible splint used for splinting avulsed teeth with significant difference in different academic level and gender p < 0.05.Conclusion: The present study reflects insufficient knowledge of dental students in management of avulsed teeth. In some points the students’ knowledge needs to be improved through enhancing and providing different kinds of education methods in undergraduate courses.

Evaluation of Dental Students' Awareness of Endodontic Procedural Accidents in Babol University of Medical Sciences in 2013-2014

Background: During root canal treatment procedures, unexpected accidents may be confronted affecting long-term prognosis just as in any other dental treatment. The purpose of this study was to evaluate the knowledge of dental students of accidents and errors during endodontic treatment in Medical University of Babol. Materials and Methods: In this cross-sectional study, 52 senior dental students were examined. Required information was collected with a questionnaire with 20 questions relating causes, prevention, treatment and prognosis of accidents during endodontic treatment. Data was analyzed using descriptive parameters, chi-square test and T-test by the statistical software SPSS Ver.21. Results: The students' knowledge was moderate in all of the fields studied including causes, prevention, treatment and prognosis of accident during endodontic treatment. Their knowledge of the causes of accidents during endodontic treatment was the lowest level and their awareness of the required endodontic treatment was the highest. There were no significant differences (P>0.05) in the average knowledge of students in the four areas of causes, prognosis, prevention and treatment of accidents of endodontic treatment. There was a significant difference in the average knowledge of the causes between male and female dental students (P<0.05); however, no significant difference in the average knowledge of other fields was observed between male and female dental students. The average knowledge of causes in female dental students was higher than male students. Conclusion: The findings of this study suggest that the level of awareness of dental students of events during endodontic treatment in Babol University of Medical Sciences is moderate

Awareness of Mercury Toxicity among Dental Students- A Survey Based Study

AIM: The aim of this research is to analyse the knowledge of dental students regarding the harmful effects of mercury. MATERIALS AND METHODS: A questionnaire was designed with various questions about the harmful effects of mercury and was distributed among 100 students in various dental colleges in Chennai. Out of 100 students who responded to the survey 36 were male and 64 were female (fig.1) and 27 were CRRI’s, 26 were final year students and 47 were students from third year (fig.2). The students were questioned about the correct protocol for storage of mercury and disposal methods of scrap amalgam. They were also asked about the precautions to be taken while doing amalgam restorations and the correct ratio for mercury and alloy powder necessary to form amalgam. The results were tabulated and analysed.

Knowledge, attitude and behaviour regarding hepatitis C virus infection amongst Brazilian dental students

Dental health professionals, including dental students, are at high risk of exposure to infection with the hepatitis C virus (HCV) through occupational percutaneous injuries and eye exposure. Further, fear of HCV infection is associated with discriminatory attitudes. The current study aimed to evaluate the knowledge about HCV infection amongst dental students and their attitudes towards patients infected with HCV. A cross-sectional survey was conducted amongst 340 Brazilian dental students from two public universities using an instrument containing information regarding demographic characteristics, knowledge of HCV and attitudes towards patients with HCV infection. Descriptive statistics, Fisher's exact test, Student's t-tests, Mann-Whitney U-test and multiple logistic regression (MLR) were carried out (P < 0.05 was considered significant). Response rate was 90% (n = 306), and more than half (54%, n = 165) of participants had high knowledge level (above the mean); 97.7% (n = 299) demonstrated positive attitudes. MLR showed that high knowledge of dental students regarding HCV was substantially influenced by advancement in year of study (last year; P < 0.001) and type of university (federal; P = 0.049). Positive attitude towards HCV-infected patients was mainly influenced by age (P = 0.004) and male gender (P = 0.022). These results demonstrated a satisfactory knowledge about HCV infection amongst dental students, but some gaps were observed, suggesting the importance of continuous education about HCV in this population to prevent HCV infection as well as discrimination and prejudice towards patients with hepatitis C.

Attitude toward Public Health Dentistry as a career among dental students in Odisha: A Cross-sectional study.

Knowledge of dental students' expectations of their profession as well as their attitudes to study a particular specialty of dentistry is of great importance. These attitudes and expectations make studying dentistry meaningful to dental students and society and understanding these factors facilitate workforce planning in the dental sector The aim of the study was to assess the attitude of dental students towards considering Public Health Dentistry as their future career. A questionnaire-based, cross-sectional survey was conducted, which included the 3rd year, 4th fourth year and dental interns studying in the State of Odisha. It consisted of 27 questions that were graded on 5-point Likert scale. The responses for the attitude questions toward selecting Public Health Dentistry for postgraduation were categorized into three factors, which are a negative attitude (includes score 0-21), neutral attitude (score 22-44), and positive attitude (score 45-64). Differences between groups were examined using Chi-square test for proportions. The level of statistical significance was set at P < 0.05. Among 886 respondents, 302 (34.08%) were males and 584 (65.91%) were females. One-third (33.52%) of them had a positive attitude toward selecting public health dentistry as their future career, and nearly two-third of them (58.23%) had neutral attitude, with very few students having a negative attitude (8.23%) toward the specialty for pursuing postgraduation. Respondents had a considerable amount of interest in pursuing postgraduation in this specialty. Efforts should be intensified, both by the dental council and by the dental colleges, to develop this specialty, keeping in mind the increasing attitude of dental undergraduates toward it.

Assessment of interns and postgraduate dental student's knowledge regarding equipment ergonomics.

The substantial knowledge concerning ergonomics and its practical application is vital for forestalling musculoskeletal disorders. The role of equipment ergonomics (EE) in preventing these work-related ailments is significantly noteworthy. The aim of the study was to assess the prevailing perception of postgraduates (PGs) and interns regarding EE and preparing the Indian dental workforce for the challenges of India's growing economy and population. Authors conducted a cross-sectional survey between December 2013 and February 2014 amidst the interns and PG dental students of Davangere city, Karnataka, India. The data were collected using 21-item custom designed proforma, comprising of questions evaluating student's basic knowledge about EE. Statistical analysis was done using Chi-square test in each group (PGs and interns) and Mann-Whitney test was implemented for comparison between both groups. Of 358 subjects surveyed, 48% PGs and 52% interns affirmed that they came across EE only through this survey. In addition, 91.18% of PGs and 90.59% interns believed that the accentuation on EE is less in the current dental curriculum. Comprehensive understanding and practical application of EE among the participants was found to be lacking. The importance of microbreaks and chair side exercises should be emphasized and training should be initiated at an early stage before improper postural habits develop.

Dental students' knowledge and attitude towards cone-beam computed tomography: An Indian scenario.

Cone-beam computed tomography (CBCT) is an upcoming imaging modality in field of dentistry with promising outcomes. To assess the dental student's knowledge and attitude regarding CBCT in K. M. Shah Dental College and Hospital as they are future practitioners. An anonymous questionnaire consisting of 11 questions was distributed among 320 dental students which included final BDS students, interns, and postgraduate students. Descriptive statistics was used to analyze the responses of the participants, and Chi-square test was applied to statistically evaluate the differences in the responses according to the education level. Totally, 96.9% response rate was achieved. All the students had heard of CBCT used for dental practice. The majority of them gained knowledge about CBCT through faculty lessons. Lower radiation dose was given as the most important advantage of CBCT over medical computed tomography. Many of the students thought that CBCT should be taught during clinical phase of their education, and there is necessary for CBCT unit at dental faculties. More than half of the students believed that the use of CBCT would become more widespread in the near future, and they aspire to use CBCT technology in their future careers. Seeing the positive attitude, it was concluded that the students' should be provided with thorough practical knowledge and efforts should be made to improve their concepts regarding CBCT.

Efficacy of Video-Assisted Instruction on Knowledge and Performance of Dental Students in Access Cavity Preparation.

Introduction:The conventional method of teaching endodontics has some drawbacks. Due to the small size of the oral cavity, students cannot closely observe the clinical procedure. Use of new teaching modalities such as the intraoral camera may obviate this problem. This study assessed the effect of video-assisted clinical instruction in dentistry (VACID) on dental student’s knowledge and performance in access cavity preparation during endodontic treatment. Methods and Materials:In this interventional study, twenty six undergraduate students were equally divided into two groups and received instructions on access cavity preparation via conventional demonstration (CD) or VACID using intraoral camera plus conventional demonstration. Students’ knowledge was assessed before and after the demonstration. The scores obtained by students were compared between the two groups. Data were analyzed using the Mann Whitney U test. Results:No significant difference was found between the two groups in knowledge and performance scores of students about pulp chamber removal, under-extension, over-extension, gouging, perforation or finding the main and extra canals. However, use of intraoral camera significantly reduced the number of student visits to instructors for problem solving (P=0.001). Conclusion:VACID is an effective educational method and as efficient as conventional demonstration in endodontics; as a result it can be used in combination with conventional teaching.

Knowledge and attitude of dental trauma among dental students in Saudi Arabia.

Objective:The aim of this study was to assess the level of knowledge and attitude of Saudi dental students in the management of dental trauma in children.Materials and Methods:A self-administered questionnaire comprising 17 close-ended questions was used in this survey. The questions were divided into three parts including: Personal and professional profile; knowledge assessment; attitude toward dental trauma. Data of 307 respondents were analyzed using SPSS (Statistical Package for Social Studies) version 22.0 (IBM Corporation, Chicago, IL, USA).Results:The response rate was 76.8%. Around 40.3% of students reported attending additional courses about dental trauma with a significant difference between males (57.2%) and females (19.4%). The vast majority of students (95.7%) stressed the importance of dental trauma education. While 77% could correctly identify the media of transportation of an avulsed tooth, only 26.9% of the students knew the proper method of transportation. Regarding the knowledge of immediate replantation, only 67.5% of students responded correctly.Conclusion:The present study demonstrates an insufficient knowledge concerning dental trauma management among dental students in Saudi Arabia. This highlights the need to improve the knowledge of dental students regarding dental trauma and its management using a variety of educational methods such as problem-based learning and powering the curriculum concerning those topics of dental trauma.

Student Perceptions of Effectiveness of Case-Based Learning in Orthodontic Education

Background :Teacher-centered education dominates dental education in China. This report introduced the redesign of an orthodontic course previously delivered in a traditional lecture format into a case-based and student-centered learning format that focuses on improving students’ ability in clinical problem-solving and decision making skills.Methods :Thirty five dental students at the fourth year of a five-year B.D.S. program met in a ten-period series of seminars. Case details with relevant diagnostic records were provided to each student ahead of time. A diagnostic worksheet was used to guide students through the analytical process to develop the diagnosis and treatment plan. Students took turns leading the discussion at each seminar. Instructors served as facilitators and evaluators. Following the last session, a questionnaire was distributed to each student to evaluate the case-based learning program.Results :Responses from students revealed that the case-based orthodontic course was well received. Students commented favorably upon improvement in the aspects of problem lists, diagnosis and treatment planning.Conclusion :It was our initial attempt of using case-based learning format often used in postdoctoral dental education as a curriculum innovation in undergraduate orthodontic education. Our pilot investigation indicated that CBL is worthy of wide use and could be applied in multilevel dental education to develop the dental student's knowledge and skill in comprehensive patient evaluation and diagnosis in preparation for treatment planning.

Opinions of Romanian Dental Students Toward Tobacco Use Interventions in the Dental Setting.

The aim of the present study was to assess smoking habits as well as attitudes toward smoking cessation counseling among Romanian dental students in order to build an evidence base for further undergraduate curriculum development. A 38-item self-administered questionnaire was delivered to first to sixth dental students enrolled at the University "Lucian Blaga" Sibiu. The questionnaire covered sociodemographics, smoking habits, knowledge concerning health effects, attitudes, and confidence toward smoking cessation counseling. Smoking was reported by 37 % of participants and was more prevalent among clinical (48.98 %) than preclinical (29.58 %) and basic science students (35.93 %). Students' knowledge that tobacco affects general and oral/dental health and knowledge of dental students regarding the smoking and alcohol behavior taken during medical history varied according to academic year and smoking status, but not according to gender. Only 51.1 % of all students agreed or strongly agreed that they were adequately trained to provide tobacco cessation education. 58.6 %, respectively 52.9 %, strongly agreed that is part of their role as a dentist to assist their patients to stop smoking and to prevent patients from starting to use tobacco products, while only 35.8 % believed that smoking cessation counseling provided by a dentist can be effective in helping patients stop smoking. The main determinants of student's attitudes toward smoking cessation counseling were academic year, clinical experience in the dental settings, and knowledge of smoking adverse effects. Dental school should offer adequate training in tobacco dependence and available continuing education in tobacco intervention in aim to encourage oral health care practitioners to have up-to-date information in aim to play their role effectively in the overall smoking cessation and prevention activities.

Progress testing in undergraduate dental education: the Peninsula experience and future opportunities.

Progress testing is well established as a longitudinal form of assessment in undergraduate medical programmes to measure growth in knowledge. Peninsula Dental School is the first school to use progress testing and remains the only one to do so. To share the experience of developing progress testing in an undergraduate dental programme as a major summative assessment tool at a newly established dental school in the United Kingdom. Data were collected for progress tests conducted from 2007 to 14. The tests were formative in the first 2years of the programme and summative in subsequent years. Each test was based on 100 single best answer multiple-choice items with an appropriate vignette. The students chose their answer from 5 options. A score 1 mark is awarded for each correct answer, minus 0.25 for an incorrect answer and 0 for 'don't know' (DK). The standard setting for each sitting was carried out using Angoff and Hofstee methods. There were two tests per year with each cohort undertaking eight tests in their 4years of study providing a total 14 test occasions. The reliability of each test for each student cohort tests was measured using Cronbach's alpha. The average reliability over 42 test/cohort combinations was 0.753 (±SD 0.08). Data analyses show growth in knowledge of dental students across successive years with the largest increase in knowledge observed between tests 1 and 5 and concomitant reduction in DK responses. This is the first study to report the establishment and use of progress testing as the principle form of written summative testing in an undergraduate dental curriculum. Progress testing is a valid and reliable tool to assess growth in knowledge longitudinally over the duration of a dental programme. Although a labour-intensive process, progress testing merits more widespread use in dental programmes.

Computational structure analysis of PPO enzyme from UPASI selected clone of Camellia sinensis (L.) O. Kuntze

Objective: This study was conducted among the dental students to evaluate the knowledge and attitude towards pharmacovigilance and adverse drug reactions reporting among the dental students in a private university, Malaysia. Methods: The survey was carried out among the pre-final and final year dental students using a pre-validated questionnaire that included the demographics details and survey items related to knowledge and perception aspects towards adverse drug reactions and pharmacovigilance. The questionnaire was distributed to the participants (n=100). A total of 61 questionnaires were duly filled out, giving a response rate of 76.25%. The survey data was analyzed using SPSS version 20. Results: The overall mean score on knowledge among the dental students was found to be 15.84. The study also observed that mean score on attitude in pre-final year and final year dental students were 11.03 and 20.44 respectively. The overall mean score for attitude on ADRs reporting and pharmacovigilance was found to be 22.65. Conclusion: The results show that knowledge of dental students who participated in the study towards pharmacovigilance and adverse drug reaction reporting was low. However, 15.6% of pre-final year students and 27.6% of final year students expressed positive attitude towards pharmacovigilance and ADRs reporting. As part of future health care professionals, they are expected to have sound knowledge and positive attitude towards pharmacovigilance activities. Key words: Adverse Drug Reactions, Attitude, Dental Students, Knowledge, Pharmacovigilance.

THE BENEFICIAL EFFECTS OF APPLIED PHYSIOLOGY STUDY GUIDES ON DENTISTRY STUDENTS’ LEARNING

Introduction: Previous studies have shown that study guides are effective tools that recognize students’ educational needs and help teachers to attain satisfactory results. Unfortunately, this effective learning tool has not been used in the coursework and teaching of basic sciences in Tabriz University of Medical Sciences. Therefore, this study was proposed to evaluate the effects of a study guide in an applied physiology course on the overall learning quality of dental students.Methods: In this semi-quasi experimental study, 45 dental and 63 medical students in an Applied Physiology course were included. A study guide was given to the dental students at the beginning of the course. At the end of the course, a final examination was held for both groups separately using the OSCE method. The medical and dental students’ final scores were compared using a T-test with SPSS v.16 software. A 34-question Likert-scaled questionnaire was prepared by researchers to evaluate the experimental group’s opinion about the effects of the study guide on their learning.Results: The final exam score of the dental students was 18.01±1.57, and it was 17.94±1.42 for the medical students. The final score of both groups was not different significantly (p=0.804). Based upon the questionnaire, the dental students believed that study guide significantly improved their knowledge and skills in applied physiology (Mean= 61.12±13.7). Conclusion: Use of a study guide improves both the attitude and knowledge of dental students in the applied physiology course.

Smoking and attitudes towards it and its cessation among dental students in Latvia

Background. The prevalence of smoking is higher in Latvia than in most EU countries. This study aimed to determine the level of knowledge of dental students in Latvia about the effects of smoking on oral health and their attitudes toward smoking and its cessation. Methods. A cross-sectional survey among all the dental students in Latvia was conducted in 2011. Students at the Riga Stradins University were asked to participate in this anonymous, voluntary survey. The questionnaire included items concerned with the students’ own smoking habits, their knowledge of smoking as an addiction and its health effects and their attitudes towards its prevention and cessation in a dental setting. The response rate was 87% (173/200). The Chi-square test and logistic regression were used for the statistical analyses. Results. About one quarter of the students (24%) were daily or occasional smokers and almost half of the male students (46%) had smoked at least 100-times in their lifetime. The students revealed a lack of knowledge about the addictive nature of smoking, in that about half of the students did not consider smoking physically or socially addictive. About one fifth (21.4%) didn’t consider environmental tobacco smoke (ETS) harmful to one’s health. Although the students’ awareness of smoking improved during their studies, the most significant factor related to their knowledge was their own smoking history (OR = 2.7; p = 0.021). Conclusions. Smoking was frequent among undergraduate dental students and they lacked knowledge of its addictiveness. More emphasis ought to be placed on education with regard to smoking and on cessation services.

Caries severity in relation to oral health knowledge and behavior of third and fifth year dental students / University of Baghdad (A comparative study)

The knowledge of dental students is important because these individuals are the future dental health providers. The purpose of the present study was to explore the severity of dental caries in relation to oral health knowledge and behavior between two different grades of undergraduate dental students in the College of Dentistry / University of Baghdad. Materials and methods: One hundred dental students were included in this study (50 third years and 50 fifth year students). A questionnaire was distributed among them to evaluate their oral health knowledge and behavior. Dental students were examined for recording of dental caries severity. Results: Data analysis revealed that third year dental students had higher mean of decayed surfaces (DS) and missing surfaces (MS), compared to the other group, the difference was statistically highly significant (P<0.01) for DS and significant for MS (P<0.05), while fifth year dental students were found to have higher mean value of filled surfaces (FS) and the difference was highly Significant (P<0.01). However, higher DMFS value was recorded for final year students without any significant difference. Oral health knowledge was better for fifth grade and the difference was highly significant (p<0.01) except for the question about complete removal of dental plaque by brushing only, the difference was significant (p<0.05) .Oral health behavior of third grade students was at lower level, the difference was highly significant (P<0.01) except for the questions about frequency of brushing and sweet eating, it was significant (p<0.05) and it was not significant difference regarding use of siwak. Conclusion: The findings of this study highlights that increase the theoretical education of dental students in addition to clinical experience will improve their oral health knowledge and behavior, which in turn affect positively the oral hygiene towards health promotion and prevention of oral diseases.

Oral cancer knowledge of senior dental students in Zahedan, South-East of Iran.

Oral carcinoma is one of the common types of cancer and one of the 10 leading causes of death around the world. This study was conducted to evaluate senior dental student knowledge about oral cancerous lesions in Zahedan Dental School. In this cross-sectional research, all the students in the last academic year at the School of Dentistry were studied during year of 2013. The study questionnaire covered demographic data as well as 12 questions concerning the knowledge of oral cancer. Data were collected and analyzed with SPSS18 using independent t-test, one way ANOVA. Significance level was considered as p≤0.05. Of the 104 senior dental students, with an average age of 27.34± 7.79 years, who participated in this study, 32 (30.8%) were female and 72 (69.2%) were male. The mean score of the students regarding the knowledge of oral cancer was 7.24±2.61. 20 students (19.2%) had a weak knowledge, 45 students (43.3%) had a moderate knowledge, and 39 students (37.5%) had a good knowledge. The student knowledge of oral cancer is not satisfactory and they need to receive additional information and education.

Attitude and knowledge of dental students of National Capital Region regarding HIV and AIDS.

Background:India is estimated to have third highest number of Human Immunodeficiency Virus (HIV) infection in world with about 2.4 million people currently living with HIV/Acquired Immunodeficiency Syndrome (AIDS). There is a possibility of HIV transmission in the oral health care setting and thus adequate knowledge and proper attitude among dental students is vital to prevent the chances of transmission and for proper care of the patient.Aims and Objectives:The present study aimed to investigate the knowledge of dental students about HIV infection and their attitude toward treating HIV/AIDS patients and behaviour practiced.Materials and Methods:A cross-sectional survey was conducted among 600 dental students of different colleges present in National Capital Region (NCR). The students were from third and fourth year and they completed a predesigned questionnaire assessing the knowledge, attitude and willingness to treat HIV/AIDS patients. One-way analysis of variance (ANOVA) was applied to compare mean level of knowledge and attitude toward HIV/AIDS.Result:The results showed that only 28% students have excellent knowledge regarding HIV/AIDS. Certain misconceptions were prevalent regarding mode of transmission. It also shows that around 43% of the dental students have an overall negative attitude.Conclusion:The findings suggest that the students had adequate knowledge about HIV/AIDS and their attitude toward this group of people was significantly negative. There is need and scope to provide correct and detailed information on HIV/AIDS for dental students.

A global assessment of knowledge of dental students about nicotine replacement therapy: findings from 43 countries

Knowledge of nicotine replacement therapy (NRT) is a competency that is expected from receiving training in the treatment for tobacco dependence. This study therefore assessed the knowledge of dental students in 43 countries about NRT. The 2005-2011 dental Global Health Professions Student Survey data were analysed for 13,040 third-year dental students from 43 countries. Knowledge about NRT was self-reported and country-specific prevalence estimates were calculated. To assess for correlates of knowledge about NRT amongst dental students, a multivariate logistic regression model was fitted (P<0.05), with pooled data from all 43 countries. The model assessed for geographical location, gross national income, tobacco cessation training in school, sex, current tobacco use and survey year. Amongst all dental students, the proportion that knew about NRT ranged from 37.0% (Mongolia) to 97.6% (Slovakia). The odds of knowing about NRT were lower amongst dental students in the Eastern Mediterranean region (aOR=0.52; 95% CI: 0.34-0.79) compared to those in the European region. Dental students in upper-middle-income (aOR=2.46; 95% CI: 1.57-3.85) and high-income countries (aOR=4.55; 95% CI: 2.28-9.09) both had higher odds of knowing about NRT compared to dental students in low-income countries. Also, current use of any tobacco product and receipt of tobacco cessation training in school were both associated with higher likelihood of knowing about NRT. No significant gender differences in knowledge of NRT were observed. A large proportion of dental students in several countries knew about NRT. However, disparities in knowledge existed across regions. Enhanced efforts are needed to formally train dental students on tobacco cessation techniques.

Improving Multiple–Choice Questions to Better Assess Dental Student Knowledge: Distractor Utilization in Oral and Maxillofacial Pathology Course Examinations

How many incorrect response options (known as distractors) to use in multiple-choice questions has been the source of considerable debate in the assessment literature, especially relative to influence on the likelihood of students' guessing the correct answer. This study compared distractor use by second-year dental students in three successive oral and maxillofacial pathology classes that had three different examination question formats and scoring resulting in different levels of academic performance. One class was given all multiple-choice questions; the two other were given half multiple-choice questions, with and without formula scoring, and half un-cued short-answer questions. Use by at least 1 percent of the students was found to better identify functioning distractors than higher cutoffs. The average number of functioning distractors differed among the three classes and did not always correspond to differences in class scores. Increased numbers of functioning distractors were associated with higher question discrimination and greater question difficulty. Fewer functioning distractors fostered more effective student guessing and overestimation of academic achievement. Appropriate identification of functioning distractors is essential for improving examination quality and better estimating actual student knowledge through retrospective use of formula scoring, where the amount subtracted for incorrect answers is based on the harmonic mean number of functioning distractors.