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ORIGINAL ARTICLE
Year : 2019  |  Volume : 17  |  Issue : 1  |  Page : 80-84

Oral health knowledge and practices among school teachers in rural and urban areas of Chennai, Tamil Nadu: A questionnaire survey


Department of Public Health Dentistry, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

Date of Submission13-Mar-2018
Date of Acceptance22-Feb-2019
Date of Web Publication15-Mar-2019

Correspondence Address:
Dr. Akila Ganesh
7/16, First Main Road, Srinivasa Nagar, Kolathur, Chennai - 600 099, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_68_18

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  Abstract 

Introduction: School teachers play a vital role in the overall development of a child. They can be used to combat diseases of a preventable nature as alternate personnel in primary health care. With proper knowledge and oral health practices, they can contribute to the health education of children and act as role models for the general community at large. Aims: To assess and compare the knowledge and practices regarding oral health among school teachers in rural and urban areas in Chennai, Tamil Nadu, India. Materials and Methods: A questionnaire consisting of 15 close-ended questions on oral heath knowledge and practices was formulated and distributed among 200 school teachers in rural and urban areas in Chennai, Tamil Nadu, India. The data obtained were subjected to statistical analysis using SPSS software version 17, and Chi-square test was used to assess the differences in the proportions for various questions. P < 0.05 was considered statistically significant. Results: The school teachers in both rural and urban areas had limited knowledge on oral health. The extent of knowledge and oral hygiene practices among the urban school teachers was found to be comparatively higher than those of the rural school teachers. Further, 11% of the urban school teachers and 53% of the rural school teachers did not discuss oral hygiene practices with their students (P < 0.001). Conclusions: The school teachers in both rural and urban areas had limited knowledge on oral health. The extent of knowledge and oral hygiene practices among the urban school teachers was found to be comparatively higher than those of the rural school teachers.

Keywords: Knowledge, oral health, oral hygiene practices, school teachers


How to cite this article:
Suresh U, Ganesh A, Rajkumar M, Archana B, Balaji S K, Sangeetha H. Oral health knowledge and practices among school teachers in rural and urban areas of Chennai, Tamil Nadu: A questionnaire survey. J Indian Assoc Public Health Dent 2019;17:80-4

How to cite this URL:
Suresh U, Ganesh A, Rajkumar M, Archana B, Balaji S K, Sangeetha H. Oral health knowledge and practices among school teachers in rural and urban areas of Chennai, Tamil Nadu: A questionnaire survey. J Indian Assoc Public Health Dent [serial online] 2019 [cited 2019 Jul 22];17:80-4. Available from: http://www.jiaphd.org/text.asp?2019/17/1/80/254335


  Introduction Top


A school is not just a place for students to receive education, but an institution which molds the behavior, attitude, and perceptions toward life. Children spend a considerable amount of time in schools at the critical period when their health habits are being formed.[1]

According to the WHO Information Series on School Health 2003, a pivotal role is played by teachers and school staff to promote oral health activities in children on a daily basis. Thus, school teachers can be used to inculcate habits that combat diseases of a preventable nature, hence serving in primary health care as alternate personnel.[1],[2] In developing well-informed students, it is necessary that school teachers have adequate knowledge on oral health. Their attitude and behavior should meet the professional recommendations. Hence, studying teachers helps in assessing and educating the segment of the public that is composed of a significant proportion of youth.

In India, with 68% of the population residing in rural areas and 40% constituting children, it is very important to reach out to the school teachers in these areas so as to achieve nationwide progress.[3],[4] It can be safely said that imparting the basic oral health education at an early age can have far-reaching results, such as promoting healthy habits and reducing the chances of illness among the entire population. Previous studies conducted in India have shown that the knowledge and practices among teachers are not sufficient.[5],[6],[7] One study conducted in the United States also compares the difference in knowledge and practices among school teachers in rural and urban areas.[8] The current study aims to do a similar comparison, to assess the difference in knowledge and oral hygiene practices of school teachers from rural and urban areas in Chennai, Tamil Nadu, India.


  Materials and Methods Top


A cross-sectional study was conducted among school teachers across schools from two zones in Chennai, Tamil Nadu, India. The zones included North and Central zones. The total sample size included 100 school teachers each from rural and urban area schools.

All the schools selected for the study from the rural and urban areas were government aided. Simple random sampling strategy was used to select the schools from the zones. The sample size included teachers from rural and urban schools. All the school teachers who were present on that particular day were included in the survey. The school teachers not willing to participate were excluded from the survey.

Sample size was arrived with open EPI Info software (Open Source Epidemiologic Statistics for Public Health) based on a study done by Kumar et al.[9] The minimum sample size for the study was calculated as 167 with 95% confidence interval.

The study protocol was reviewed and approved by the Institutional Ethics Committee (REF: CSP/14/AUG/36/178), and prior permission was procured from the school authorities for conducting the study.

A questionnaire consisting of 15 close-ended questions on oral health knowledge and practices was formulated by the authors of the study. There were three questions to assess the knowledge about human dentition and dental caries, ten questions about the oral hygiene practices, and two questions to assess if the teachers included oral hygiene as a part of their teaching curriculum. The questionnaire was validated by two dentists and one medical professional who are experts in the field of public health. Consensus method was used to validate the questionnaire. Consensus methodology was used to arrive at an agreement between the three validators. A pilot study was conducted among a few school teachers who were picked on a random basis. Based on the pilot study survey, the questionnaire was modified with consultation from the experts in the field. The questionnaire was then re-validated by the same professionals. The questionnaire was also translated in the vernacular language, Tamil, which was validated by an expert in the field of Tamil literature. Back translation was done to further check the accuracy of the questionnaire.

The questionnaire was distributed in person to the school teachers. The purpose of the study was explained, and the teachers were guided to fill the questionnaire. In order to eliminate social desirability bias, the school teachers were asked to fill the form themselves with no pressure from an interviewer. In addition, it was optional for them to reveal their identities in the questionnaire.

The data obtained were subjected to statistical analysis using the Statistical Package for the Social Sciences version 17.0 (SPSS Inc., Chicago, IL, USA). Chi-square test was used for analysis. P < 0.05 was considered statistically significant.


  Results Top


Out of the 200 school teachers who were surveyed, 65% were females.

Oral health knowledge

Majority (67%) of the urban school teachers and 36% of the rural school teachers had correct knowledge on the number of teeth present in the oral cavity. About 77% of the urban school teachers and 58% of the rural school teachers had correct knowledge about dental caries. These results were found to be statistically significant (P < 0.001). The relation between sugar consumption and dental caries was known to 73% and 68% of the urban and rural school teachers, respectively [Figure 1].
Figure 1: Oral health knowledge

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Majority of the urban and rural school teachers (96% and 78%, respectively) knew that it is necessary to rinse the mouth after every meal [Table 1].
Table 1: Comparison of oral health knowledge among urban and rural school teachers

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Oral health practices

Nearly 16% and 69% of the urban and rural school teachers brush only once daily, whereas 81% and 30% brush twice daily. About 1% of the rural school teachers brush their teeth depending on the situation. This result was found to be statistically significant (P < 0.001) [Table 2].
Table 2: Comparison of oral health practices among urban and rural school teachers

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Almost all the school teachers used toothpaste to brush. 4% and 20% of the urban and rural school teachers replace their toothbrush only once a year; 23% and 21% replace once in 6 months; 71% and 34% replace every 3 months; and 2% and 25% replace only when the toothbrush is damaged, respectively. However, only 42% and 26% of the urban and rural school teachers, respectively, follow brushing with tongue cleaning [Figure 2].
Figure 2: Oral health practices

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Around 44% of the urban school teachers and 17% of the rural school teachers were aware that a dentist should ideally be visited every 6 months, whereas 49% of the rural and 73% of the urban school teachers visit the dentist only when there is pain or a swelling [Table 2].

Almost 11% of the urban school teachers and 53% of the rural school teachers did not discuss oral hygiene practices with their students [Figure 3].
Figure 3: Discussing oral health practices with students

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Overall, the results showed a significant difference in the knowledge and oral hygiene practices among the school teachers in rural and urban areas (P < 0.05).


  Discussion Top


The importance of forming healthy habits at an early age cannot be overemphasized. Schools play a key role in this through education that can contribute to raising children with healthy habits, thus preventing many illnesses.

A good percentage of the school teachers surveyed had correct knowledge on the number of teeth present in the human dentition, the etiology of dental caries, and the correlation between sugar consumption and dental caries, which was in accordance with previous studies conducted by Chandrashekher et al. and Ramroop et al.[5],[6] Despite having adequate knowledge, in this study, 53% of the rural school teachers did not discuss any oral hygiene measures and practices with their students. This result is highly variable from those obtained by Lang et al. in Michigan, USA.[8] This variation in result in India as compared to the USA could be attributed to the lack of oral health education as part of school curriculum and not giving the teachers enough time or appropriate material to discuss with the students.[4]

The correlation between the oral health and general health of individuals was known to 93% of the urban school teachers and 59% of the rural school teachers, which is in accordance with a previous study conducted by Vanka et al.[10] The fact that the teachers were well aware is considered a positive sign. However, it should be ensured that the knowledge is imparted to the students.

It was observed that 81% of the urban school teachers and 30% of the rural school teachers were brushing twice daily and 97% of the urban school teachers and 96% of the rural school teachers were using a toothpaste. Some of the urban and rural school teachers were also aware of fluoridated toothpaste and used it. This is in accordance with previous studies conducted in India and China.[11],[12]

Results of the study showed that a majority of rural school teachers visit a dentist only when there is pain or swelling. Even in the presence of dental pain, 22% and 34% of the urban and rural school teachers, respectively, manage the problem with home remedies such as placing a clove or taking pain medications. This is in accordance with a previous study conducted in Andhra Pradesh by Manjunath and Kumar.[13] In a developing country like India, the reason for visiting dentist only when there is a persistent problem could be attributed to the poor public health systems including a lack of a finance support system such as dental insurance.

Overall, the difference in knowledge and oral hygiene practices among the urban and rural school teachers surveyed in this study was much higher compared to the study conducted by Lang et al. in Michigan, USA.[8]

Training sessions for the school teachers have been arranged by many dental health programs. This was done to keep motivation levels high by ensuring regular follow-up and reinforcement, and also facilitating the exchange of experience and knowledge, which were proven effective.[8],[14],[15]

Limitations

The samples collected were only from select schools in each zone, and all the school teachers from the schools selected were not included in the study. However, since all zones were involved in the selection of the study participants, the external validation of the study is not compromised.


  Conclusions Top


From the results of the study, it is evident that school teachers in both urban and rural areas, with more emphasis on the rural area, need to be provided with adequate training on effective oral hygiene practices. More such measures need to be taken by the government to ensure that adequate knowledge and training is received by school teachers and thereby imparted to the students.

Acknowledgment

I would like to thank Dr. D. Kandaswamy, Advisor and Former Dean, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Health, and the faculty of the Department of Public Health Dentistry, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Health, Porur, Chennai.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Sai Sankara AJ, Sreedevi E, Suresh Babu M, Naveen V, Rajavardhan K. School teacher's knowledge regarding dental health. Indian J Dent Sci 2013;5:155-8.  Back to cited text no. 1
    
2.
WHO Information Series on School Health. Available from: http://www.who.int/oral_health/media/en/orh_school_doc11.pdf?ua=1. [Last accessed on 2016 Feb 18].  Back to cited text no. 2
    
3.
Census of India 2011. Rural Urban Distribution of Population. Available from: http://www.censusindia.gov.in/2011-proV-results/paper2/data_files/india/Rural_Urban_2011.pdf. [Last accessed on 2016 Feb 18].  Back to cited text no. 3
    
4.
Gambhir RS, Sohi RK, Nanda T, Sawhney GS, Setia S. Impact of school based oral health education programmes in India: A systematic review. J Clin Diagn Res 2013;7:3107-10.  Back to cited text no. 4
    
5.
Chandrashekher BS, Vanishree N, Jayakumari HL, Mohan AN, Gupta N. Knowledge, attitude and practices towards oral health among school teachers of Kanakapura Taluk, Bengaluru rural district. J Indian Assoc Public Health Dent 2011;18:654-9.  Back to cited text no. 5
    
6.
Ramroop V, Wright D, Naidu R. Dental health knowledge and attitudes of primary school teachers toward developing dental health education. West Indian Med J 2011;60:576-80.  Back to cited text no. 6
    
7.
Amith HV, D'Cruz AM, Shirahatti RV. Oral health knowledge and practices among rural government school teachers of Mangalore, Karnataka. J Indian Assoc Public Health Dent 2013;11:63-7.  Back to cited text no. 7
  [Full text]  
8.
Lang P, Woolfolk MW, Faja BW. Oral health knowledge and attitudes of elementary schoolteachers in Michigan. J Public Health Dent 1989;49:44-50.  Back to cited text no. 8
    
9.
Kumar S, Kulkarni S, Jain S, Meena Y, Tadakamadla J, Tibdewal H, et al. Oral health knowledge, attitudes and behaviour of elementary school teachers in India. Rev Gaucha Odontol 2012;60:19-25.  Back to cited text no. 9
    
10.
Vanka A, Yadav NS, Saxena V, Sahana S, Shanti G, Shivakumar GC. Oral health acquaintance, approach and practices among schoolteachers in Bhopal, central India. J Orofac Res 2012;2:15-9.  Back to cited text no. 10
    
11.
Petersen PE, Esheng Z. Dental caries and oral health behaviour situation of children, mothers and schoolteachers in Wuhan, People's Republic of China. Int Dent J 1998;48:210-6.  Back to cited text no. 11
    
12.
Haloi R, Ingle NA, Kaur N. Caries status of children and oral health behaviour, knowledge and attitude of their mothers and schoolteachers in Mathura city. J Contemp Dent 2012;2:78-83.  Back to cited text no. 12
    
13.
Manjunath G, Kumar NN. Oral health knowledge, attitude and practices among school teachers in Kurnool – Andhra Pradesh. J Oral Health Commun Dent 2013;7:17-23.  Back to cited text no. 13
    
14.
Tewari A, Gauba K, Goyal A. Evaluation of KAP of oral hygiene measures following oral health education through existing health and educational infrastructure. J Indian Soc Pedod Prev Dent 1992;10:7-17.  Back to cited text no. 14
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15.
Almas K, Al-Malik TM, Al-Shehri MA, Skaug N. The knowledge and practices of oral hygiene methods and attendance pattern among school teachers in Riyadh, Saudi Arabia. Saudi Med J 2003;24:1087-91.  Back to cited text no. 15
    


    Figures

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

  [Table 1], [Table 2]



 

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