|Year : 2015 | Volume
| Issue : 3 | Page : 274-279
Assessment of the relationship among the oral health status, oral hygiene practices, and habits of school teachers in Mangalore city
Nishi Gupta1, N Vanishree2, Ashwini Rao3, Peter Sequeira4, Deepa Bullappa2, N Naveen2
1 Department of Public Health Dentistry, Aditya Dental College, Maharashtra, India
2 Department of Public Health Dentistry, Bangalore Institute of Dental Sciences, Bengaluru, India
3 Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, India
4 Department of Public Health Dentistry, Coorg Institute of Dental Sciences, Virajpet, Karnataka, India
|Date of Web Publication||14-Sep-2015|
Department of Public Health Dentistry, Bangalore Institute of Dental Sciences, Bengaluru
Source of Support: None, Conflict of Interest: None
Background: In India, teachers play an important role in providing long-term health education and changes in behavior. Aim: To assess the relationship among the oral health status, oral hygiene practices, and habits of primary and middle school teachers in Mangalore city. Methodology: A cross-sectional survey was carried out for 1½ months on 241 primary and middle school teachers in Mangalore city. Oral hygiene practices and habits were assessed using a questionnaire. The oral health status of the teachers was examined using simplified oral hygiene index, gingival index, and caries experience was scored using the decayed, missing, and filled teeth index. Descriptive statistics and Chi-square were done. P < 0.05 was taken as statistically significant. Results: A total of 241 school teachers were included in the study. The majority of the males and females were in the age group of 30-39 years and 40-49 years, respectively. The increase in the gingival score in subjects was not statistically significant with the use of indigenous methods along with the brush. With respect to caries experience and oral hygiene practices, as the frequency of brushing increase, there was a decrease in the number of decayed and missing teeth and increase in the number of filled teeth (P < 0.05). Conclusion: The findings of this study highlight the importance of proper oral hygiene habits and its relationship of oral health status and recommend the continuous implementation of school-based programs to promote the oral health.
Keywords: Oral health status, oral hygiene practices, school teachers
|How to cite this article:|
Gupta N, Vanishree N, Rao A, Sequeira P, Bullappa D, Naveen N. Assessment of the relationship among the oral health status, oral hygiene practices, and habits of school teachers in Mangalore city. J Indian Assoc Public Health Dent 2015;13:274-9
|How to cite this URL:|
Gupta N, Vanishree N, Rao A, Sequeira P, Bullappa D, Naveen N. Assessment of the relationship among the oral health status, oral hygiene practices, and habits of school teachers in Mangalore city. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2019 Nov 19];13:274-9. Available from: http://www.jiaphd.org/text.asp?2015/13/3/274/165271
| Introduction|| |
Every child should have a caring adult in their lives. And that's not always a biological parent or family member. It may be a friend or neighbor. Often times it is a teacher
Good health is essential for learning and cognitive ability. Ensuring good health when children are of school age can boost attendance and educational achievement.
"The things taught in Schools are not an education but the means of an education"
-Ralph Waldo Emerson
Education can impact on health in two-way; first through Life-Skills Based Education which teaches children to learn about health, and second through the educational process as a whole which provides skills such as critical thinking and making choices enabling for options for healthy lifestyles.  In the health education field, as in all other fields, teachers' activities do not simply consist of implementing government circulars or programs. The factors that determine this type of education are much more complex. Activities depend on factors that can be institutional (requirements of programs, the school's goals, and circulars) but also personal (teachers' own representations of their task in health education, personal narratives) or connected to the intended audience (students and their needs and expectations). 
At the global level, prevalence rates and patterns of oral diseases have changed considerably over the past two decades. In most industrialized countries, the prevalence proportion rates of dental caries and mean dental caries experience in children have declined. Such changes are often ascribed to changing living conditions and lifestyles, effective use of oral health services, implementation of school-based programs.  The majority of the studies have focused on parent/primary caretaker's attitudes and beliefs which put the child at risk for early childhood caries. ,,,,,, Fewer studies have been done to determine schoolteacher's oral health knowledge and his/her behavior toward children. ,,, Keeping this in mind, the present study was carried out with an aim to assess the relationship among the oral health status, oral hygiene practices, and habits of primary and middle school teachers in Mangalore city.
| Methodology|| |
A cross-sectional survey was carried out on 241 primary and middle school teachers in Mangalore city. School teachers constitute one of the biggest organized forces and in Mangalore city there are about 900 primary and middle school teachers. Oral hygiene practices and habits were assessed using a questionnaire. The oral health status of the teachers was examined using simplified oral hygiene index (OHI-S), gingival index, and caries experience was scored using the decayed, missing, and filled teeth (DMFT) index.
A pilot study was carried out on 14 primary and middle school teachers in Mangalore city and they were not included for the main study. Before conducting the pilot study, calibration exercises were carried out on 50 middle school teachers in a dental institution. To assess the inter-examiner variability, reexaminations were done on every 5 th middle school teacher and acceptable consistency was obtained. These exercises were supervised by an expert. From the pilot study, the prevalence of dental caries and periodontal diseases was found both to be approximately 70%.
The officially published list of schools in Mangalore was obtained from the Block Educational Office. There were 49 schools in Mangalore and totally 900 school teachers, so taking 95% level of confidence, with permissible error of 5%, the sample size was calculated by the formula:
Sample size = (Z 2 × [p] × [q])/Δ2
Where Z = Z value for the confidence level chosen = 1.96 (for 95% confidence level - from standard normal distribution):
Therefore, SS = ([1.96] 2 × (0.70) × (0.30)]/(0.05) 2
- p = 50% = 0.50
- q = 1 − p = 50% = 0.50
- Δ = Margin of error, which is acceptable = 0.05 (or 5%).
SS = 322.
For finite population: New SS = (SS)/1 + (SS − 1/population).
Substituting the values in the formula, the final sample size required was 238. To obtain this sample size, 18 schools were selected from the official list of schools by simple random sampling. One of the schools did not agree to participate in the study and was excluded out. Hence, finally, 241 teachers in the 17 selected schools in Mangalore were examined in the present study.
Before conducting the pilot study, calibration exercises were carried out on 50 middle school teachers in a dental institution. To assess the inter-examiner variability, reexaminations were done on every 5 th middle school teacher and acceptable consistency was obtained. These exercises were supervised by an expert.
Before starting with the study, the purpose of the study was explained to the head of the institutions/management and written permission was taken to examine the school teachers. Daily and weekly schedules were prepared. On the 1 st day, teachers were explained the purpose of the study and informed consent was taken was obtained. According to the teachers' convenience, another day was set up for the oral examination. In a day, not more than 15 examinations were carried out. Two attempts were made to contact those teachers who were absent on the day of examination.
The oral health status of the teachers was examined using OHI-S,  gingival index by Loe and Silness  and caries experience was scored using the DMFS index. Caries was recorded using WHO criteria.  The examinations were carried out by a single examiner. Recording of data was done throughout the study by a previously trained person. The study was carried out for a period of 1 months.
The examinations were carried out during school hours, beginning from the maxillary right quadrant and proceeding in a clockwise direction to the mandibular right quadrant. The subjects were seated in a chair with proper backrest and the examiner stood in front of the chair allowing maximum visibility. Clinical examinations were carried with natural light so as to receive maximum illumination while avoiding discomfort from direct light. As far as possible, examinations were carried out away from classrooms to avoid crowding and noise.
The oral health status of the teachers was examined using OHI-S,  gingival index by Loe and Silness,  and caries experience was scored using the DMFT index. Caries was recorded using WHO criteria.  The examinations were carried out by a single examiner. Recording of data was done by a previously trained person. The study was carried out for a period of 1 months.
The data thus obtained were entered into the computer using Microsoft Excel (Windows MS Office XP professional version). The data were analyzed using IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. Means and standard deviations were calculated, wherever needed. For discrete variables, Chi-square test was used and P < 0.05 was taken as statistically significant. After checking for normalcy, ANOVA was applied for multiple group comparison and for continuous variables.
| Results|| |
Of total 241 (100%), 17 (7.1%) were males and 224 (92.9%) were females. The majority of the males and females were in the age group of 30-39 years and 40-49 years, respectively. Based on teaching experience, 85 (35.3%) had teaching experience in the range of 10 years followed by 73 (30%) had experience of 21-30 years; 57 (23.7%) had 11-20 years experience and 26 (10.8%) had experience of 31 years and above [Table 1] and [Table 2].
|Table 1: Distribution of subjects according to gender in relation to age |
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|Table 2: Distribution according to oral hygiene practices and smoking habits used in relation to years in teaching |
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With regard to oral hygiene practices and teaching experience, subjects with least number of years in teaching (0-10 years) showed the highest frequency of brushing but the difference was not statistically significant, whereas, all the subjects were using a brush, out of which 230 (95.4%) teachers used only toothbrush; 7 (2.9%) used finger along with a brush; and 4 (1.7%) used neem stick along with brush (P > 0.05). It was noticed that as the teaching experience increased (parallel with increasing age) the frequency of changing the brush decreased (P > 0.05) and subjects with 0-10 years of experience used mainly toothpaste [Table 2].
In relation to smoking habits and teaching experience, none of the 31-40 years experience age group had tobacco-chewing habit, whereas only one subject with 0-10 years of teaching experience and another with 21-30 years of teaching experience had the habit of smoking (P > 0.05) [Table 2].
With respect to caries experience and oral hygiene practices, as the frequency of brushing increase, there was a decrease in the number of decayed and missing teeth and increase in the number of filled teeth (P < 0.05). Brushing aids did not show a significant difference in caries experience. There was an increase in the number of decayed and missing teeth with decreased frequency of changing the brush, but the findings were not statistically significant (P > 0.05). More number of decayed teeth and less number of filled teeth were found in subjects who used toothpowder or salt (P > 0.05). In relation to smoking habits and caries experience, the relation was not found to be statistically significant [Table 3].
|Table 3: Distribution of the mean value scores of caries experience based on oral hygiene practices |
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Considering the oral hygiene and gingival scores in relation to years in teaching, it was found that there was an increase in the OHI-S score and gingival score with more number of years in teaching, with all the findings being statistically significant with maximum effect seen on the gingival score (P < 0.0).
As the frequency of brushing increased from once a day to more than twice a day, there was a decrease in the value of oral hygiene and gingival scores with the maximum statistical significant difference on the gingival score (P = 0.00). There was an increase in the gingival score in subjects using indigenous methods along with brush, but it was not statistically significant. Frequency of changing the brush did not have significant association on the debris score though there was a slight increase in the debris score with decreased frequency of changing the brush. There was no significant difference found with respect to tobacco usage and smoking habits [Table 4].
|Table 4: Distribution of the oral hygiene and gingival mean scores based on oral hygiene practices |
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| Discussion|| |
School teachers have been traditionally considered as potentially important primary aspects of socialization with the capacity of influencing the future knowledge, attitude, and behavior of school children. Investigations to assess the health status of the teachers is a comparatively recent trend and very few reports are available in literature, and because of this reason direct comparisons are difficult to make. 
The study population comprised of 241 teachers in 17 schools in Mangalore city. Most of the teachers were females and this was similar to study by Lang et al. 
Oral health practices, lifestyle influences include effective oral hygiene and smoking are pivotal to the occurrence of oral diseases. Examining trends in these conditions can illuminate our approach to oral health and disease.  Occupation, which is a reflection of education, is also closely linked to lifestyles. The goals of public health include knowledge and understanding of health problems and their causes, technical capability to deal with the problems, a sense of values that problems matter and political will. Therefore, although some habits seem to be immutable, we need to remember that change can filter through resulting in social norms. Since oral health behavior is conditioned by culture, the variations by education are often predominant. ,
In the present study, 55 (22.8%) brushed once daily which is in line with Prasad's study  and contrast to study done by Bagramian et al.  where only 1.3% of the sample brushed twice, which was much lower than the present study. They also reported 2.6% of the subjects never having brushed their teeth, while in the present study none of the teachers reported of it. In a study by Ambjψrnsen,  70.4% of the subjects cleaned their teeth twice a day and 24.9% cleaned their teeth lesser than twice per day. The findings of the present study are similar to the study by Astrψm et al.  Frequency of brushing was not significantly associated with years in teaching which is similar to study by Peng et al.  but was in contrast to Lang et al.  study. Only 24.5% as compared to 53.76% in a study by Prasad et al.  changed their brush when the bristles frayed out. The higher frequency of changing the brush could be due to over reporting by the teachers in the present study. In the present study, the increase in the years in teaching (increasing age) was not associated with the frequency of changing the brush, but this finding is refuted by a study done by Peng et al. 
Since the study sample comprised of mainly females, the chewing habit was reported only by nine teachers. As the subjects are very few, the findings are difficult to compare. Only two teachers (both males) reported of the smoking habit. Here also the number of subjects is very few, so findings cannot be compared. In a study by Prasad et al.,  70% of the sample had no habit.
In the present study, debris, calculus, oral hygiene, and gingival score decreased as the frequency of brushing increased which is similar to study done by Lang et al.  and Boehmer et al.  Frequency of brushing was associated with DMFT score in the present study which can be compared to the findings by Ashley et al.  but was refuted by the study done by Boehmer et al. 
Limitations of this study are small sample size and since it's a cross-sectional study, results would have been better if the design would be a longitudinal study. From the above study, we would like to recommend that classroom education about general as well as dental health should be given by teachers to the school children; teachers should be educated about the importance of maintaining their personal oral health and should also be guided so that they can motivate children; teacher training programs should be designed to train school teachers on all aspects of good oral care; dental health weeks should be organized annually to create awareness on good standard of oral hygiene; sponsorships of scientific seminar/symposia; and CDE program for the exposure of teachers to recent advances in dental science should be conducted.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]