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ORIGINAL ARTICLE
Year : 2016  |  Volume : 14  |  Issue : 2  |  Page : 121-125

Comparison of oral hygiene status before and after health education among 12–18-year-old patients


Department of Public Health Dentistry, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India

Date of Web Publication10-Jun-2016

Correspondence Address:
S G Ramesh Kumar
G-1, Ram Arun Flats, Plot No: 22, 7th Street, Balaji Nagar, Valasaravakkam, Chennai - 600 087, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.183813

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  Abstract 


Introduction: Adolescence is a crucial period of transition with personal responsibility for preventing dental disease. The outcome of health education program has shown considerable results. The knowledge which children received during health education program paves way for the first steps to their healthier life. Aim: To study the impact of oral health education on oral hygiene status of patients aged 12–18 years, attending outpatient department. Materials and Methods: A hospital-based randomized controlled clinical trial with 100 participants (allocated into 50 study group and 50 control group) aged 12–18 years attending the outpatient department, constituted this study. Participants were assessed for basic oral health knowledge, attitude, and practices using a questionnaire. The oral hygiene status was assessed using oral hygiene index (OHI) and patient hygiene performance (PHP) index. After oral prophylaxis, oral health education was given only to study group. Both groups were reassessed after 4 weeks. The values were compared. Statistical analysis was done using SPSS version 15. Results: Comparison shows more reduction of mean OHI score, and PHP score in the study group than control group with a significant P value. Conclusion: Oral health education demonstrates the satisfactory impact on oral hygiene among adolescents.

Keywords: Adolescents, dental hygiene, oral health education


How to cite this article:
Ramesh Kumar S G, Aswath Narayanan M B, Jayanthi D. Comparison of oral hygiene status before and after health education among 12–18-year-old patients. J Indian Assoc Public Health Dent 2016;14:121-5

How to cite this URL:
Ramesh Kumar S G, Aswath Narayanan M B, Jayanthi D. Comparison of oral hygiene status before and after health education among 12–18-year-old patients. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2019 Aug 25];14:121-5. Available from: http://www.jiaphd.org/text.asp?2016/14/2/121/183813




  Introduction Top


Health is a complex issue which involves both the prevention strategies of disease and the promotion of health.[1] In recent years, there is a constant and steady incline in the ability to maintain adequate health in addition to preventing or delaying morbidity and mortality.[1] Oral health is a critical component of general health.[2] A healthy oral cavity helps the individual to do their basic functions such as chewing and swallowing effectively which in turn maintains the proper nutrition to our body. Oral hygiene and diet play major role together in maintaining the good oral health of an individual. Oral hygiene depends on retentive factors such as debris, plaque, and calculus.

Poor oral hygiene is a major risk factor implicated in etiologies of dental caries [3],[4] and periodontal diseases.[5] Development of dental caries is much more in children who implement themselves with poor oral hygiene practices.[6] There is also a positive correlation between diet and dental caries.[7] Oral hygiene is a good predictor for periodontitis.[8] Person who utilizes proper oral hygiene technique for longer period has negligible signs of gingivitis and attachment loss and also showed lesser development of new carious lesions.[9]

The subject of oral hygiene cannot be disassociated from the general context of adolescence. Adolescence has the potential of independently achieving optimal oral hygiene but self-awareness is lacking in adolescence.[10] Hence, these results in need of greater attention and health education.[11] Adolescence is a crucial period of transition with personal responsibility for preventing dental disease beginning at this age and determining future oral health. Therefore, adolescents could benefit from oral health promotion interventions given at this developmental stage.[12] The motivation and reinforcement received by them during the health education paves the way for healthier life in their future.[13] Hence, this study aims to determine the impact of oral health education on oral hygiene status of adolescence.


  Materials and Methods Top


The present study is a randomized control concurrent parallel trial with an allocation ratio of 1:1 conducted in Government Dental College, Chennai, during September 2009–January 2011. The ethical clearance of this study was obtained from the Institutional Review Board. Details of the study were explained to the participants after providing the information sheet. Participants were included in the study after getting informed consent from parents or guardian.

Inclusion criteria

  • Cooperative subjects with 12–18 years of age.


Exclusion criteria

  • Subjects with any systemic diseases
  • Subjects with pain and oral lesions or ulcers
  • Subjects with any prosthesis and orthodontic appliances.


Sample size has been scientifically determined as 50 per group based on results of pilot study. With an adjustment for dropouts, final sample constituted 107 participants aged 12–18 years. Participants are randomly allocated into intervention group constituting 53 participants and control group constituting 54 patients. Initially, case record form was prepared, which contained the sociodemographic data and details of history and examination. The details of participants of intervention group and control group were recorded using the case record form.

A questionnaire was specifically designed with a total of 23 questions (9 questions to assess knowledge, 4 questions to assess attitude, and 10 questions to assess practices) to assess the knowledge, attitude, and practices of the participants. Questionnaire was pretested using 30 individuals to check internal validity and analyzed using Cronbach's alpha. Value obtained was 0.88, which was evident about internal consistency. Questionnaire was prepared in English and translated into local language Tamil with the help of an expert in Tamil literature.

Questionnaire contains details about oral hygiene practices, dietary habits, various dental diseases, their etiologies, progression treatment, and prevention. At first, participants of the study group were assessed for the oral health knowledge, attitude, and practices with a questionnaire which was duly filled by them.

Computer method of health education program was designed using MS Power point both in English and Tamil language consisting of basic knowledge about the teeth, various plaque control measures, dental diseases, their etiologies, progression, treatment, and prevention.

Oral hygiene status of the participants in both the group was assessed using oral hygiene index (OHI)[14] and also using patient hygiene performance (PHP) index.[15] The debris score, plaque score, and calculus score are tabulated.

Complete oral prophylaxis to each participant was provided after assessment of oral hygiene status. Then, the participants of the intervention group alone were given health education on one to one basis using specifically designed health education program and instructed to follow the same. After 4 weeks, patients were recalled for their review. In this review visit, oral hygiene status of the patient was reassessed using the same indices.

The debris score, plaque score, and calculus score were tabulated. The mean difference of the scores before and after health education among intervention group and control group was tabulated. Then, mean change of various parameters among OHI and PHP index were analyzed using Wilcoxon signed rank test in the software, statistical package for social sciences (SPSS) version 15 (SPSS Inc., released 2006 Chicago, IL, USA) with P < 0.05 considered statistically significant.


  Results Top


A total of 107 participants for intervention and control group participated in this study. Out of 53 patients in the intervention group and 54 patients in the control Group, 3 patients and 4 patients, respectively, did not come for review after 4 weeks. Final sample constitutes 100 patients [Figure 1]. Attrition rate is 6.6% (intervention group 5.7% and control group 7.4%). Results of demographic profile showed that 68% of participants were belonged to upper-lower class of socioeconomic status and 66% of participants have only primary school education level.
Figure 1: Flowchart showing allocation of participants and progress of trial

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Around 80% and 70% of the participants knew about dental caries and gum diseases, respectively [Figure 2]. Around 65% of the participants acquired their knowledge of brushing themselves. About 60% and 65% of participants were aware that stick foods cause dental caries and improper brushing causes gum diseases, respectively [Figure 3].
Figure 2: Various dental diseases

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Figure 3: Awareness of etiologies of dental diseases

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Around 70% of participants were not visited to the dentist. Around 75% of participants were not undergone scaling by a dentist. Around 80% and 70% of the participants were using toothbrush and toothpaste, respectively. Around 75% of the participants were brushing only once in a day.

[Table 1] showed that OHI debris score in intervention and control group at the initial visit was 1.95 and 2.03, respectively, and after 4 weeks, it was 0.65 and 1.0, respectively, with mean reduction of 1.30 in the intervention group and 1.03 in the control group with P < 0.05 as significant. Analysis showed that OHI calculus score in intervention and control group at the initial visit was 1.30 and 1.56, respectively, and after 4 weeks, it was 0.07 and 0.20, respectively, with a mean reduction of 1.23 in intervention group and 1.36 in control group with P < 0.05 as significant.
Table 1: Mean ± standard deviation and test of significance of mean values among the study groups

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Analysis showed [Table 1] that PHP plaque score in intervention and control group at initial visit was 2.54 and 2.33, respectively, and after 4 weeks, it was 0.35 and 1.15, respectively, with mean reduction of 2.19 in intervention group and 1.18 in control group with P < 0.05 as significant. Analysis showed that PHP debris score in intervention and control group at initial visit was 2.44 and 2.27, respectively, and after 4 weeks, it was 0.45 and 1.10, respectively, with mean reduction of 1.98 in intervention group and 1.17 in control group with P < 0.05 as significant.

Comparison between intervention group and control group [Table 2] showed more reduction (mean change) of OHI debris score, PHP plaque score, and PHP debris score after intervention in intervention group. The same parameters were also showed reduction in control group without intervention but when compared with intervention group, the reduction was lesser with P < 0.05.
Table 2: Comparison of mean change between groups

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  Discussion Top


Oral hygiene plays major role in oral health. Retentive factors such as debris, plaque, and calculus play an important role in the development of dental caries and periodontal disease. Removal of retentive factors such as debris, plaque, and calculus by various oral hygiene measures such as mechanical and chemical improves oral health.[16] Various studies have shown a significant effect in improving oral health knowledge from dental health education.[13],[17],[18] Study conducted by Petersen et al. in 2004[19] among school children has shown the positive impact of oral health education on maintaining good oral hygiene which is similar to that of present study. Similarly, study by Yazdani et al. in 2009[20] showed 50% reduction of plaque scores in school children after health education program, but in present study, it has only 34.04% reduction of plaque scores. The reason might be the duration in these studies (12 weeks intervention in the study by Yazdani et al.) in contrast with 4 weeks intervention in the present study.

Health education has been used to improve awareness and also motivation to maintain good oral health. Outcome of health education program on oral health has shown considerable results.[17],[19] Study conducted by Lian et al. in 2010[21] showed that 69.4% and 59.4% of children were aware that sticky foods cause dental caries and improper brushing lead to periodontal disease, respectively, which is similar to that of the present study. Study by Lian et al. showed that only 9% of children have not visited to dentist in contrast with 70% in the present study which may be due to lower economic status and illiteracy of the study population in the present study. Study by Lian et al. showed that 50% of children have the habit of toothbrushing twice a day in contrast to only 25% in the present study which may be due to illiteracy of the study population in the present study as the toothbrushing frequency is one of the parameters to analyze the education level of adolescence.[22]

Systematic health literacy programs for children and adolescents will need to be developed and administered through collaboration between education and health professionals.[23] A study conducted by Rajesh et al. in 2008,[24] has shown that impact of computer method of oral health education is much more than other methods of health education and hence the same method of health education has been implemented in the present study.

It revealed that in intervention group, all parameters of indices except OHI calculus score showed more reductions after intervention in compared with control group which also showed significant differences but lesser reduction than intervention group. In the intervention group, 15.97%, 34.04%, and 29.61% more reduction of parameters such as OHI debris score, PHP plaque score, and PHP debris score, respectively, than the control group were obtained. It is a well-known fact that retentive factors such as debris and plaque are very well controlled by individual's hygiene performance method which is evident from the results of the present study. In the present study, oral prophylaxis may have a role in reduction of scores among various parameters in OHI and PHP index. To overcome this, mean change of the score was compared between group. The present study emphasizes by stating that health education has positive impact on oral hygiene status and also in lowering plaque scores of participants.

Since follow-up was done only for 4 weeks, the long-term efficiency of health education intervention was not assessed. Second, health education was not reinforced at periodic intervals during the follow-up period. Hence, we recommend further studies to evaluate the long-term effect of health education intervention with periodic reinforcement during the follow-up period.


  Conclusion Top


Health education increases the individuals knowledge and awareness and also reinforces the desired behavioral patterns. The oral health education plays a major role in improving oral hygiene that helps in prevention of oral diseases such as dental caries and periodontal disease. Thus, oral health education demonstrates the satisfactory impact on oral hygiene among adolescents.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]



 

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