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ORIGINAL ARTICLE
Year : 2014  |  Volume : 12  |  Issue : 4  |  Page : 306-311

Knowledge, attitude and practices related to oral health among English and Telugu medium school teachers in two districts of Andhra Pradesh, India: A comparative study


1 Department of Public Health Dentistry, Government Dental College, Vikarabad, Hyderabad, Telangana, India
2 Department of Public Health Dentistry, JSS Dental College and Hospital, JSS University, Mysore, Karnataka, India
3 Department of Public Health Dentistry, Sri Sai College of Dental Surgery, Vikarabad, Hyderabad, Telangana, India

Date of Web Publication24-Dec-2014

Correspondence Address:
Jagadeeshwar Rao Sukhabogi
Department of Public Health Dentistry, Government Dental College, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.147675

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  Abstract 

Background: A teacher with adequate oral health knowledge, positive attitude toward dental health can always play an important role in health education of school children and be a role model for children, lay people and the community at large. Objective: To assess and compare the oral health knowledge among English and Telugu medium primary school teachers in Hyderabad and Ranga Reddy districts of Andhra Pradesh. Materials and Methods: A cross-sectional questionnaire study was conducted among 300 primary school teachers selected from two districts of Andhra Pradesh. A combination of cluster and systematic random sampling technique was employed for the selection of study participants. The data on oral health knowledge, attitude and practices (KAP) were collected by two investigators using a structured questionnaire. The data were entered onto a personal computer, and statistical analysis was done using SPSS version 20. Results: A total of 150 school teachers each from English (62 males and 88 females) and Telugu medium (62 males and 88 females) schools participated in the study. By considering the oral hygiene aid used and frequency of brushing, it was evident that the oral hygiene practices were better among English medium teachers compared to their counterparts in Telugu medium. The teachers in English medium had favorable attitudes toward dental health than teachers in Telugu medium. Conclusion: The study found English medium teachers to be having better oral hygiene practices, more frequent dental visits, and better awareness about first aid in dentistry. However, the lack of preventive attitude, lack of motivation to be role models for children in oral health maintenance, reflect that there is a tremendous need to improve the oral health KAP among schoo teachers.

Keywords: Attitude and practices, knowledge, oral health, oral hygiene practices, rural and urban teachers, school teachers


How to cite this article:
Sukhabogi JR, Chandra Shekar B R, Hameed IA. Knowledge, attitude and practices related to oral health among English and Telugu medium school teachers in two districts of Andhra Pradesh, India: A comparative study . J Indian Assoc Public Health Dent 2014;12:306-11

How to cite this URL:
Sukhabogi JR, Chandra Shekar B R, Hameed IA. Knowledge, attitude and practices related to oral health among English and Telugu medium school teachers in two districts of Andhra Pradesh, India: A comparative study . J Indian Assoc Public Health Dent [serial online] 2014 [cited 2019 Aug 25];12:306-11. Available from: http://www.jiaphd.org/text.asp?2014/12/4/306/147675


  Introduction Top


The teacher is a dynamic force of the school and plays a pivotal role in any educational system. A school without a teacher is just like a body without the soul, a skeleton without flesh and blood, a shadow without substance. [1] The school teachers by virtue of their opportunity to influence large numbers of children and their parents are a significant resource to implement the recommendation for the use of alternative personnel in an effort to reduce the burden of preventable diseases such as oral diseases. [2] The number of teachers worldwide at the primary school level has been reported to be around 23.9 million. [1] The many advantages of utilizing the services of school teachers in health education and health promotion activities are continuity in instructions being given, integration of general and oral health with other activities as well as the low costs associated with such programs. [3],[4]

The lack of adequate oral health knowledge, training on aspects of oral health, [5] lack of resources, [6] lack of time, and failure to incorporate oral health into the curriculum have been implicated as barriers to teaching oral health education in schools. [7]

Since school teachers may play a significant role in passing the preventive information and health promotion, it is important that their own oral health knowledge, attitude, and behavior conform to the professional recommendations. A teacher with adequate oral health knowledge, positive attitude toward dental health can always play an important role in health education of school children and be a role model for children, lay people and the community at large. [8],[9],[10],[11] Similarly, a teacher with poor oral health knowledge, negative attitude, and unfavorable health behaviors may have an adverse impact on children's attitude and behaviors. It becomes important to assess the level of oral health knowledge, attitude and behaviors of school teachers who are in such a vital position while molding the future generation of the society. The teachers may be grouped in a number of ways such as those teaching primary school children, higher secondary school children, college students, etc. and t hose teaching the children of different medium of instructions etc. The two major medium of instructions in Andhra Pradesh is English and Telugu. The published literature on the oral health knowledge, attitude and practices (KAP) among school teachers in India is scanty. Moreover, the literature comparing the oral health KAP between the teachers in a different medium of instructions in the state is nonexistent. This prompted us to undertake the present study with an objective to assess and compare the oral health knowledge among English and Telugu medium primary school teachers in Hyderabad and Ranga Reddy districts of Andhra Pradesh.


  Materials and methods Top


The study was a cross-sectional questionnaire study conducted among 300 primary school teachers selected from a total of 60 schools (30 schools in each district) in two districts of Andhra Pradesh. The permission to carry out the study was obtained from the head masters of the schools selected, and an informed consent was also obtained before the questionnaire was filled by the participant.

A combination of cluster and systematic random sampling technique was employed for the selection of study participants. In the first stage, the list of all the government (Telugu medium) and private primary schools (English medium) in Hyderabad and Ranga Reddy districts of Andhra Pradesh was obtained. Totally, 30 schools (fifteen each from English and Telugu medium) from each of these districts were selected on a random basis using a lottery method. Then, the list of teachers from these 60 selected schools was prepared. The list of teachers in government schools was obtained from the office of the concerned district education officer, and the list of private school teachers was prepared by telephonic conversation with the head master of the concerned school. The schools where the permission was not given by the concerned head master were replaced by other randomly selected schools in the same district. The two lists consisted of 240 government teachers and 290 private teachers. This was used as a sampling frame. Then, a systematic random sampling technique was employed to select 150 teachers from each of these lists. All the teachers in each of these lists were given a unique ID. Then, the first 10 numbers were entered on 10 paper slips of identical size. One number was selected by lottery method, and every third number from this point onward was selected till a sample of 150 was attained from each of these lists.

The data on oral health KAP were collected by two investigators using a structured questionnaire. This questionnaire was pilot tested on a convenient sample of 15 participants to check the feasibility of self-administration and consistency of response. Each of these fifteen participants was given an identification number and was requested to fill the questionnaire in 30 min. None of the participant had difficulty in filling the questionnaire. The participants were given the same questionnaire 5 days after the first examination. The data in the first examination were compared with that of the second to obtain a reliability score. The kappa coefficient value for each of these questions ranged from 0.78 to 1. The time limit of 30 min was finalized as all the teachers in the pilot study comfortably filled questionnaires within 30 min without encountering any difficulty in interpretation.

A schedule for investigation in each school was prepared and sent to all the schools requesting selected school teachers to be present on the scheduled day of investigation. The questionnaires were personally distributed by the investigators to ensure that the selected teachers only took part in the study. The questionnaire consisted of 19 questions related to oral hygiene practices, dental visits, reasons for visiting the dentist, the knowledge on causes of oral diseases, their prevention and the need for self-care etc. These questionnaires were prepared in both languages. The close-ended questionnaire had 10 questions with dichotomous responses and others with multiple options. The questionnaire was self-administered, and the teachers were requested to complete the questionnaire in 30 min.

The filled questionnaires were collected, and data were entered onto a personal computer and statistical analysis was done using SPSS version 20. The qualitative information was expressed in frequencies and percentages. The difference in the distribution of study participants according to the responses for each question between different categories was tested using the Chi-square test, and statistical significance was fixed at 0.05.


  Results Top


A total of 150 school teachers each from English (62 males and 88 females) and Telugu medium (62 males and 88 females) schools participated in the study [Table 1]. The response rate was 100%. All the English medium teachers used brush and paste for cleaning their teeth, while 44%, 36.7%, 16% and 3.3% of the Telugu medium teachers used brush and paste, brush and powder, finger with tooth powder and other methods for cleaning their teeth respectively. The difference in the oral hygiene aid used between English and Telugu medium teachers was statistically significant [P = 0.001, [Table 2]. There was no significant difference in oral hygiene aid used between the genders [P = 0.186, [Table 2].
Table 1: Gender distribution of study population in a different medium


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Table 2: Distribution of the study participants according to the material used for cleaning the teeth


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About 71.3% of the English medium teachers brushed once and 28.7% brushed twice daily. The percentage of Telugu medium teachers brushing once and twice daily was 90% and 10% respectively. More number of English Medium teachers cleaned their teeth twice daily, and the difference was significant [P = 0.001, [Table 3]. There were no gender differences in the frequency of brushing in both categories. By considering the oral hygiene aid used and frequency of brushing, it can be presumed that the oral hygiene practices were better among English medium teachers compared to their counterparts in Telugu medium.
Table 3: Distribution of study participants according to frequency of cleaning the teeth


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Majority (83%) of the English medium teachers visited dentist in the last 6 months while this was noted among 56.7% of Telugu medium teachers. The difference was statistically significant [P = 0.001, [Table 4]. There was no gender differences in the visit to the dentist among both English [P = 0.127, [Table 4] and Telugu medium teachers [P = 0.385, [Table 4].
Table 4: Distribution of study participants according to visit to a dentist


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About 28.7% of the English medium teachers visited dentist for routine dental check-up, while this was seen only in 21.3% of Telugu medium teachers. The difference was statistically significant [P = 0.001, [Table 5]. There were no gender differences in the reasons for dental visits in both English [P = 0.347, [Table 5] and Telugu medium teachers [P = 0.899, [Table 5]. There was no significant difference in the reasons for taking care of teeth and gums between English and Telugu medium teachers as well as between males and females in both the categories [Table 6]. Only 11.3% of the English medium teachers and 10% of the Telugu medium teachers cited "being role models for children" makes them to improve their personal oral hygiene.

There was no significant difference in the distribution of study participants between the teachers in two medium of instructions as well as gender variations in both categories in relation to the following oral health knowledge related questions: "Can decayed teeth heal themselves?" [Table 7], and "Is it better to visit the dentist once in 6 months?" [Table 8]. The awareness about first-aid in dentistry was significantly better among English medium teachers compared to Telugu medium teachers. Male Telugu medium teachers had significantly higher level of awareness on first aid in dentistry than female teachers. But, this difference was not seen among English medium teachers [Table 9].
Table 5: Distribution of study participants according to reason for going to a dentist


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Table 6: Distribution of the study participants according to the reason for taking care of teeth and gums


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Table 7: Distribution of the study participants based on response to the statement "Can decayed teeth can heal by themselves?"


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Table 8: Distribution of the study participants based on response to the statement "Is it better to visit a dentist once in 6 months?"


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Table 9: Distribution of the study participants according to the response on the statement related to "Awareness about first-aid in dentistry"


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  Discussion Top


School teachers have traditionally been considered as potentially important primary agents of socialization, with the capability of influencing the future knowledge, attitude and behavior of school children. [3] Documented evidence shows that teachers and parents can augment dental health behavior. [12] There is a proposal to train school teachers on how to prevent dental diseases and also provide proper resource material for their training purposes. [13] It is always better to have baseline information on the KAP among this special group before embarking on the mission of training them.

The study assessed and compared the KAP related to oral health between, male and female as well English and Telugu medium teachers. English and Telugu are the two medium of instructions commonly seen in the state. This was the reason for selecting fifteen schools from each medium of instruction in both these districts.

The response rate in the present study was 100% as the filling of the questionnaire was done in the presence of an investigator and these teachers were informed about the day and time of their assessment through a schedule that was circulated well in advance. This was in agreement with a study conducted among school teachers in Kurnool district of Andhra Pradesh. [1]

Considering the aids used in regular oral hygiene practices and the frequency of oral cleaning in a day, we found that the oral hygiene practices were significantly better among English medium teachers compared to their counterparts in Telugu medium schools. There was no significant gender difference in the oral hygiene practices in both the categories. Majority of the English medium schools are located in urban areas while government schools are in both urban as well as rural areas. [14] The published literature has found the oral hygiene practices to be better among urban residents in comparison to rural folk. [15],[16] The difference in the oral hygiene practices between urban and rural population may be attributed to the cultural differences in the oral hygiene aid used and the oral hygiene awareness and attitude to maintain teeth in good condition. [15],[16] In the absence of literature comparing the oral hygiene practices between rural and urban school teachers or between English and Telugu medium teachers, we can also speculate that the social pressure of maintaining teeth in good condition might have influenced the teachers in urban areas for better oral hygiene practices, which may not be case in rural areas. The level of social interactions among teachers in rural areas may be less than that in urban areas. [16] A study by Manjunath and Kumar [1] on oral health KAP among school teachers in Kurnool district Andhra Pradesh found 92.4% of the teachers to be using brush and paste for cleaning the teeth. Around 31.8% of the teachers in this study reported to be brushing once, 63% twice and 5.2% more than twice daily. The oral hygiene practices among English medium teachers in our study were comparable to the results of this study. But, the oral hygiene practices among Telugu medium teachers in our study were significantly inferior to the results of this study.

By considering the dental visits and the reasons for dental visits, it can be concluded that the teachers in English medium had favorable attitudes toward dental health than teachers in Telugu medium. The accessibility to a dentist in urban areas, the awareness about dental treatments and the social pressure of maintaining teeth in good conditions might have prompted the English medium teachers to have more dental visits than Telugu medium teachers who may be posted in a rural school. Overall, the teachers making dental visits on a routine basis in the present study was significantly less. This highlights the need to improve dental health attitude among school teachers as a whole. It is important to make the teachers realize that the dentist is not a person to be visited in times of pain and suffering. They should be made aware that the dentist can guide them to prevent dental diseases and promote dental health with simple cost effective self-care procedures.

There was no significant difference in the reasons for taking care of teeth and gums between English and Telugu medium teachers as well as between males and females in both the categories. This highlights the fact that teachers neglect oral health, and they do not presume oral health to be important. More surprisingly only 11.3% of the English medium teachers and 10% of the Telugu medium teachers cited "being role models for children" drives them into oral care. This needs to be taken care of immediately. There is an immediate need to awaken the preventive approach among teachers and they should be made aware that prevention-oriented approach is more beneficial as well as less expensive than curative based approach. Pai et al. [17] in their study compared the dental awareness among Kannada and English medium primary school teachers in Mangalore city. They found setting an example for students was not considered an important reason to maintain good oral hygiene by any of the group of teachers. These results were consistent with the results of our study and others. [18]

There was no significant difference in the distribution of teachers between the two medium of instructions as well as genders in both categories in relation to the questions "Can decayed teeth heal themselves?" "Is it better to visit the dentist once in 6 months?" Although some of the questions with dichotomous responses appear to be leading to response in one direction, it was evident that almost 25% of the teachers opined that the decayed teeth heal themselves and approximately 40% of the teachers believe that visiting dentist frequently (once in 6 months) is not necessary. However, the possibility of these questions leading to a biased response cannot be ruled out. In view of this, the results of responses to these dichotomous questions need to be cautiously interpreted and require validation with more appropriate questions in future studies. The awareness about first-aid in dentistry was significantly better among English medium teachers compared to Telugu medium teachers. Male Telugu medium teachers had significantly higher level of awareness on first aid in dentistry than female teachers. But, this difference was not seen among English medium teachers. The more frequent dental visits among English medium teachers might have resulted in better awareness about first aid in dentistry. More male Telugu medium teachers had visits to the dentist than their female counterparts. This may explain the difference in level of awareness about first aid in dentistry between the gender groups among Telugu medium teachers. However, this needs to be further evaluated as no such studies have been conducted in the past to correlate our results.


  Summary and conclusion Top


The study found English medium teachers to be having better oral hygiene practices, more frequent dental visits, and better awareness about first aid in dentistry. But, the overall awareness on the causative factors for oral diseases, their prevention was poor among the study population in the present study. The lack of preventive attitude, lack of motivation to be role models for children in oral health maintenance, reflect that there is a tremendous need to improve the oral health KAP among school teachers.

The improvements in their knowledge on oral diseases, their prevention using simple self-care procedures can be imparted through regular training of school teachers. The priority should always be given for Telugu medium teachers in any such training programs as their KAP seems to be inferior compared to English medium teachers. The trained and motivated teachers in turn may play a vital role in imparting the oral health knowledge among school children. By being role models, the teachers can mold attitudes and practices among the children that facilitate the promotion of oral health and prevention of oral diseases. This will go a long way in the promotion of health and oral health of society at large.

 
  References Top

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Manjunath G, Kumar NN. Oral health knowledge, attitude and practices among school teachers in Kurnool - Andhra Pradesh. J Oral Health Community Dent 2013;7:17-23.  Back to cited text no. 1
    
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Uitenbroek DG, Schaub RM, Tromp JA, Kant JH. Dental hygienists' influence on the patients' knowledge, motivation, self-care, and perception of change. Community Dent Oral Epidemiol 1989;17:87-90.  Back to cited text no. 8
    
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Brown LF. A comparison of patients attending general dental practices employing or not employing dental hygienists. Aust Dent J 1996;41:47-52.  Back to cited text no. 9
    
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McConaughy FL, Lukken KM, Toevs SE. Health promotion behaviors of private practice dental hygienists. J Dent Hyg 1991;65:222-30.  Back to cited text no. 10
    
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Introduction to Education Department. Government of Andhra Pradesh Abstract. Education (SE - TRG) Department; G.O.MS.No. 76 dated 10.06.2008. [Available from: www.aponline.gov.in/.../Departments/School%20Education/Govt.../GO.Ms. 76.2008.pdf . Last cited on 2013 Oct 07].  Back to cited text no. 14
    
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Kamath DG, Varma BR, Kamath SG, Kudpi RS. Comparison of periodontal status of urban and rural population in Dakshina Kannada district, Karnataka state. J Oral Health Community Dent 2010;4:34-7.  Back to cited text no. 15
    
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Rao S, Homagain S, Singh BP. Periodontal status and treatment needs of an adult rural community. J Pierre Fauchard Acad 1993;7:72-8.  Back to cited text no. 16
    
17.
Pai V, Sequeria PS, Rao A, Kundabala M. Dental awareness among Kannada and English medium primary school teachers in Mangalore city. J Indian Assoc Public Health Dent 2006;7:7-12.  Back to cited text no. 17
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]



 

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