|Year : 2014 | Volume
| Issue : 3 | Page : 215-218
Dental neglect among college going adolescents in Virajpet, India
Sunil Lingaraj Ajagannanavar1, Peter Simon Sequeira2, Jithesh Jain2, Hemant Battur1
1 Department of Public Health Dentistry, KVG Dental College and Hospital Kurunjibhag, Sullia, Karnataka, India
2 Department of Public Health Dentistry, Coorg Institute of Dental Sciences, Maggula, Virajpet, Karnataka, India
|Date of Web Publication||15-Nov-2014|
Sunil Lingaraj Ajagannanavar
Department of Public Health Dentistry, KVG Dental College and Hospital, Kurunjibhag, Sullia 574 237, D.K, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Dental neglect (DN) has been defined as behavior and attitudes which are likely to have detrimental consequences for the individual's oral health, or more specifically as failure to take precautions to maintain oral health, failure to obtain needed dental care, and physical neglect of the oral cavity. Aim: The aim was to assess the association of DN with dental caries and oral hygiene among adolescents in Virajpet, India. Materials and Methods: A total of six hundred adolescents aged 15-18 years were selected. DN was recorded using self-administered questionnaire. Oral health status was clinically assessed using simplified oral hygiene index (OHI-S) and dental caries through dentition status as per WHO criteria. Results: The mean DN score for this population was 10.18. Sociodemographic variables and Dental Attendance pattern were significantly associated with DN. Mean decayed missing filled value and OHI-S values were also significantly associated with DN. Conclusion: The present study revealed that variations in DN exist in relation to sociodemographic characteristics and pattern of dental attendance. In addition, oral health status was significantly associated with DN among adolescents.
Keywords: Adolescents, dental attendance, dental caries, a dental neglect scale
|How to cite this article:|
Ajagannanavar SL, Sequeira PS, Jain J, Battur H. Dental neglect among college going adolescents in Virajpet, India. J Indian Assoc Public Health Dent 2014;12:215-8
|How to cite this URL:|
Ajagannanavar SL, Sequeira PS, Jain J, Battur H. Dental neglect among college going adolescents in Virajpet, India. J Indian Assoc Public Health Dent [serial online] 2014 [cited 2020 Apr 3];12:215-8. Available from: http://www.jiaphd.org/text.asp?2014/12/3/215/144803
| Introduction|| |
Self-neglect is a phenomenon associated with a variety of health and social conditions. In general, individual cases of self-neglect involve one or more defining characteristics: Inadequate personal hygiene, inadequate environmental hygiene, and nonadherence to prescribed health care regimen.  Self-neglecting behaviors are culturally framed, and for this reason, those activities necessary to maintain a socially accepted standard of health and well-being vary from one setting to the next. Understanding various stages of self-neglect is necessary to develop a sound practice approach and create a theoretical framework.
Dental neglect (DN) has been defined as behavior and attitudes which are likely to have detrimental consequences for the individual's oral health, or more specifically as failure to take precautions to maintain oral health, failure to obtain needed dental care, and physical neglect of the oral cavity.  The notion that DN may explain differences in caries experience among various groups in society has a rich anecdotal tradition among dental practitioners, and with more rigorous scrutiny, the concept of DN may offer a viable linkage between dental health and cultural, social and attitudinal factors which have hitherto received attention.
The American Academy of Pediatric Dentistry recognizes that the adolescent patient has unique needs.  Adolescence has been identified as a time when personal oral health behaviors may be internalized and become habits, as parents become increasingly less directly involved in their children's care.  Current research suggests that the overall caries rate is declining, yet remains highest during adolescence.  Immature permanent tooth enamel, a total increase in susceptible tooth surfaces, and environmental factors such as diet, independence to seek care or avoid it, a low priority for oral hygiene, and additional social factors also may contribute to the upward slope of caries in adolescence.  Hence, the purpose of this study was to investigate the association of DN scores with dental caries and oral hygiene among adolescents in Virajpet, India.
| Materials and methods|| |
Study population included Public and Private College going adolescents in Virajpet taluk. The ethical approval for the study was obtained from the Institutional Ethical Board. The students of the colleges were elaborated about the study and only those students who consented were included as study participants. Virajpet taluk consists of 16 Pre University colleges consisting 3396 students. Sample size was calculated from the pilot study in which prevalence was found to be 65%. Margin of error was determined to be 3.7% and confidence level to be 95%. Considering response distribution of 50% for a total population of 3396 students the size of the sample size required was found to be 583. Final sample size of 600 adolescents was chosen for the study.
A self-administered questionnaire consisting of 14 questions was used in the survey. The questionnaire was typed both in Kannada (regional) and English language to ensure comprehensibility by all adolescents. The first part of the questionnaire consisted questions on socio-demographic factors that recorded sex, age and family income. The second part of the questionnaire regarded dental attendance patterns asking whether the adolescent visited the dentist during the time of study and those who have had dental checkups anytime during the 3 years preceding the study. The third part of the questionnaire consisted of questions measuring the DN of the study participants on a 6-item dental neglect scale (DNS).  The adolescent answered each item on a 5-point scale, with answers ranging from "Definitely no" to "Definitely yes." Possible scores ranged from 6 to 30, with higher scores indicative of greater DN. The internal reliability (Cronbachs' alpha) of the questionnaire was tested in a pilot study done before the final study, and it was found to be acceptable (0.62). The oral hygiene of study participants was assessed using the simplified oral hygiene index (OHI-S). Dental caries experience (decayed missing filled teeth [DMFT]) of the study participants was recorded as per WHO criteria. 
The collected data were classified and tabulated in Microsoft Office Excel SPSS for windows version 17 software (IBM Corp). SPSS for windows version 11.5 software (Chicago, USA) was employed for statistical analysis. Frequency distributions of responses to the questions were produced. Mean scores were created for DNS. In addition to descriptive statistics, t-tests were used to compare mean DNS scores with those who currently visited the dentist and who had dental checkups in past 3 years. Cross tabulation was used to differentiate DNS groups (higher and lower) according to age and sex. One-way ANOVA was used to examine the relationship between mean DNS scores and different family income groups. Pearson's Correlation was used to analyze the relationships between mean DNS score and mean DMFT, mean OHI-S values. P <0.05 was selected in describing levels of significance.
| Results|| |
Six hundred adolescents satisfactorily completed the DN questionnaire. Of these, more than half of the study participants (58.5%) were females. Their mean age was 16.33 (standard deviation = 0.63 range = 15-18). More than three-fourth (76%) of the participant's family income (per year) was 1-2 lakhs. More than half (56.8%) of the adolescents had been for a dental checkup in the past 3 years and many of them (67.5%) did not visit the Dentist during the time of study [Table 1].
|Table 1: Distribution of study subjects according to age, sex, family income and dental attendance |
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The data in [Table 2] reveals the responses of the adolescents to DN items. Regarding the item-1, more than half of the respondents (78.2%) responded that they brushed as well as they should. With respect to item-2, many of the respondents (35.7%) responded that they control snacking between meals as well as they should. For the item-3, more than half of the respondents (50.7%) responded that they receive the dental care they should. In response to item-4, more than half of the subjects (59%) answered that they need dental care, but they put it off. With reference to item-5, more than half of the respondents (62.7%) responded that they keep up their dental care. In relation to item-6, more than half of the respondents (59.2%) consider their dental health to be important.
A median split of the DN score was considered to divide the population into two groups, that is, high (DNS score ≥ 11) and Low (DNS score ≤ 10) DN groups. Higher DN group had more mean DMFT values and OHI-S when compared with scores of lower DN group and these differences between two DN groups are found to be statistically highly significant [Table 3]. It was also found that high positive correlation exists between DN and dental caries and OHI.
|Table 3: Relationship between dental neglect and dental caries and oral hygiene |
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| Discussion|| |
The DNS can be considered to be a ''behavioral audit'' which encompass both attitudinal and behavioral aspects. Therefore, the inclusion of both aspects in the same scale is both purposeful and indicated, given the nature of the construct.  DNS appears to operate in similar ways in adolescents as it has been previously found to act in samples of parents rating their children, young adults, and adults in general. 
The mean DN score for this population was 10.18 (out of possible range: 6-30) indicating modest or mediocre self-oral health care. However, DN scores were lower than reported in New Zealand population studies , and with other studies done in United States,  South Australia  and in Hong Kong. 
Dental avoidance is apparent in some individuals by adolescence, as youth of this age is able to influence their dental attendance.  DNS scores were significantly related to age, with older adolescents having greater levels of DN. The finding that older adolescents have higher DN is consistent with that reported by Skaret et al.  who found that the dental avoidance increased as adolescent's age. This finding is troublesome, from a public health standpoint, as it seems to imply that increased autonomy in adolescence may be associated with poorer oral health behaviors.
Significant DNS score differences were found related to gender with DNS scores higher for males when compared with females. The reasons for this could be because females demonstrate greater compliance to authority than males, and are more concerned about behaving in ways that are socially approved. 10 Other reason is that young males are more indifferent to dental care than young females. Similar finding was reported by other study that was done in Dunedin  but was in contrast to those reported by studies done in United States4 and Hong Kong  that found that there was no gender difference with respect to mean DNS scores.
DNS Scores were positively associated in adolescents who responded that they did not have dental check-up in past 3 years and who did not currently visited the dentist during the time of study, which were similar to the results of other studies. , Although it is very easy to place all patients who failed to attend for dental treatment in one category as nonattenders, such a broad generalization contributes little to an understanding of why this should be so. Financial implication, loss of time (loss of work hours, for example), discomfort experienced and over treatment may be associated with dental attendance that has to be investigated by further studies.
Reported avoidance or delay in seeking dental care because of cost represents a barrier prior to seeking care and these financial barriers may reduce the likelihood of dental attendance and it can adversely influence the timeliness and comprehensiveness of care that is sought and provided. There was a negative association between DN and family income which was statistically significant. Greater neglect scores were observed among those with lesser family income which was similar to other studies. ,
Mean decayed, missing filled (DMF) value and OHI-S value for this population were 1.83 and 0.39 respectively. Mean DMF value and OHI-S value were 1.64 and 0.58 for higher DN group and 1.09 and 0.24 for lower neglect group respectively. Individuals, who had Higher DNS scores, had more mean DMF values and mean OHI-S values.
| Conclusion|| |
Variations in DN exist in relation to sociodemographic characteristics and pattern of dental attendance. In addition, oral health status was significantly associated with DN. Oral health education programs for adolescence are required to increase knowledge, understanding and practices that foster improved oral health. Universities and colleges charged with the responsibilities of preparing school personnel must include oral health as a component of the curriculum.
| References|| |
Gibbons SW. Theory synthesis for self-neglect: A health and social phenomenon. Nurs Res 2009;58:194-200.
Skaret E, Astrøm AN, Haugejorden O, Klock KS, Trovik TA. Assessment of the reliability and validity of the Dental Neglect Scale in Norwegian adults. Community Dent Health 2007;24:247-52.
The American Academy of Pediatric Dentistry website. Available from: http://www.aapd.org/media/policies_guidelines/g_adoleshealth.pdf. [Last accessed on 2011 Jan 17].
Coolidge T, Heima M, Johnson EK, Weinstein P. The dental neglect scale in adolescents. BMC Oral Health 2009;9:2.
McGrath C, Sham AS, Ho DK, Wong JH. The impact of dental neglect on oral health: A population based study in Hong Kong. Int Dent J 2007;57:3-8.
World Health Organization. Oral Health Survey-Basic Methods. 4 th
ed. Geneva, Switzerland: WHO; 1997.
Thomson WM, Locker D. Dental neglect and dental health among 26-year-olds in the Dunedin Multidisciplinary Health and Development Study. Community Dent Oral Epidemiol 2000;28:414-8.
Jamieson LM, Thomson M. Dental neglect and dental health among 26-year-olds in the Dunedin Multidisciplinary Study. N Z Dent J 2002;98:4-8.
Thomson WM, Spencer AJ, Gaughwin A. Testing a child dental neglect scale in South Australia. Community Dent Oral Epidemiol 1996;24:351-6.
[Table 1], [Table 2], [Table 3]