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ORIGINAL ARTICLE
Year : 2019  |  Volume : 17  |  Issue : 3  |  Page : 206-212

Oral health awareness and oral hygiene status of 12- and 15-year-old children in Chennai


1 Department of Public Health Dentistry, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
2 Department of Public Health Dentistry, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
3 Department of Public Health Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
4 Dental Public Health, Riyadh Elm University, Riyadh, Saudi Arabia

Date of Submission13-Dec-2018
Date of Acceptance23-Jul-2019
Date of Web Publication12-Sep-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_214_18

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  Abstract 


Background: Oral diseases can be considered as a public health problem due to their high prevalence and significant social impact. Aim: This study aimed to assess dental knowledge, oral hygiene, oral hygiene practices, and eating habits among 12- and 15-year-old children in Chennai and to correlate the level of oral hygiene with oral hygiene practices. Materials and Methods: A descriptive cross-sectional survey was conducted among 1600 children from various schools in Chennai. Simple random sampling methodology was used to select the schools from all the four zones. The methodology included a close-ended questionnaire on oral health awareness and recording of Oral Hygiene Index-Simplified (Greene and Vermillion, 1964). The statistical analysis was performed using SPSS software, version 16. Student's t-test and analysis of variance were used for the comparison of two and more than two groups, respectively, followed by post hoc test. Pearson's correlation coefficient was used to find the correlation between two or more variables. The level of significance was set at P < 0.05. Results: Around 1285 (80.3%) children felt that tooth decay is a disease that destroys the teeth and 1101 (68.8%) knew that gum infection makes gums to bleed. Overall distribution reported that 1018 (63.6%) children had fair oral hygiene. Poor oral hygiene score was seen more in government schoolchildren than private schoolchildren with highly statistically significant results. Conclusions: The overall knowledge on oral health was good among the children. Nearly 90% of the children had fair debris score. Oral hygiene practices were positively correlated with the level of oral hygiene.

Keywords: Children, knowledge, oral hygiene


How to cite this article:
Ganesh A, Chaly PE, Reddy V C, Ingle NA, Bhavyaa R. Oral health awareness and oral hygiene status of 12- and 15-year-old children in Chennai. J Indian Assoc Public Health Dent 2019;17:206-12

How to cite this URL:
Ganesh A, Chaly PE, Reddy V C, Ingle NA, Bhavyaa R. Oral health awareness and oral hygiene status of 12- and 15-year-old children in Chennai. J Indian Assoc Public Health Dent [serial online] 2019 [cited 2019 Oct 23];17:206-12. Available from: http://www.jiaphd.org/text.asp?2019/17/3/206/266760




  Introduction Top


Oral diseases are considered as a public health problem because of their increased prevalence with a significant social impact. Loss of tooth is the most common effect of chronic oral diseases and is associated with physical, emotional, and economic impacts. Physical appearance and diet may also worsen leading to a negative impact on the patterns of day-to-day life and social relationships.[1] Dental plaque has been a significant factor in the causality of various oral diseases. Studies conducted in Portugal[2] reported that 90% of 12-year-old children had poor oral hygiene, whereas 55% of the 15-year-old children had poor oral hygiene in Iran.[3]

Dental caries is increasing in incidence across all ages in many developing countries, including China and India. Tremendous progress in health education among child populations has been made in these countries. Yet, the US Surgeon General's Report shows that 45% of the children aged 5–17 years have teeth affected by caries, and the problem is particularly severe among children in specific populations.[1] At age 12, important factors of high caries experience are location (urban) and consumption of soft drinks and fresh fruits.[4]

Regarding the frequency and reason for the visit to the dentist, it was found that 35% of the Indian children never visited a dentist as compared to 11% of American children in the past 12 months.[5] In a study in China,[6] it was reported that 44.4% of the respondents brushed their teeth at least twice a day, but only 17% used fluoridated toothpaste. Children (12-year-old) who visited the dentist during the last 12 months were 31.3% and during the last 2 years were 35.3%.

In a study by Das et al.,[7] it was observed that 57.20% of children in the age group of 6 years were affected by dental caries, indicating a relatively high prevalence of the disease in children. Considering the existing literature, there is an alarming need to provide oral health education among schoolchildren. Prior to this, the existing oral health knowledge and practices are to be known. Knowledge implies awareness of all factors related to oral diseases, including causative factors and protective measures to be followed. Considering the epidemiological triad for the causation of dental caries, there is a need to assess the host factors such as oral health knowledge, oral hygiene practices, dental visits, and eating habits of the children. Hence, a cross-sectional study was planned in all zones in Chennai to prioritize the area requiring the most public health attention for future government-based awareness and treatment programs to be planned. The aim of this study was to assess the dental knowledge, oral hygiene, oral hygiene practices, and eating habits among 12- and 15-year-old children in Chennai and to correlate oral hygiene with oral hygiene practices in 12- and 15-year-old children in Chennai.


  Materials and Methods Top


This cross-sectional epidemiological study was conducted among the 12- and 15-year-old children in Chennai. Two ages, namely 12 and 15 years, were selected specifically because these are the index ages as recommended by the World Health Organization.[8] Ethical clearance was obtained from the Institutional Review Board of the university (Ref. No. IRB-XIX/2018/334).

Training and calibration exercises

The examination was carried out by a single examiner who underwent training exercises under the guidance of an expert. Calibration exercises were carried out on a group of twenty students who were examined twice on successive days to assess the consistency of intra-examiner reproducibility. The agreement for most assessments was found to be 90%.

Pilot study

The sample size was calculated based on a pilot study done on 200 schoolchildren. The prevalence of dental caries and the oral hygiene levels were calculated from the collected data. Using these data, the minimum sample size required for the survey was calculated using the following formula:



Using the above formula, prevalence values differed for dental caries and oral hygiene levels. Good oral hygiene was reported by 16% of the 12-year-old private schoolchildren; this result from the pilot study yielded the maximum sample size as 767, which was rounded to 800 for each age group to make the results more accurate and valid.

Sampling methodology

The list of schools in Chennai was obtained from the office of the chief educational officer. Eight government and eight private schools were selected equally from all the four zones by random sampling methodology. From the selected schools, 50 children aged 12 years and 50 children aged 15 years were identified by stratified random sampling. A total of 400 students were selected from each of the four zones, i.e., north, south, east, and central.

Designing the questionnaire

Because there was no standard questionnaire to assess oral health knowledge and practices that was readily available, a new questionnaire was designed based on the inputs obtained from various scientific articles. The tool was initially developed by the authors, and its face validity and content validity were assessed. Face validation was done by an independent subject expert not involved in the study following which the content validity was assessed by three experts in the field, and the suggestions regarding content, relevance and number of questions, choice of answers for each question, language, and simplicity of the questionnaire were discussed in a panel meeting to arrive at a consensus before incorporating the changes in the final questionnaire. The internal consistency of the questionnaire was measured using Cronbach's alpha and was estimated at 0.88.

Questionnaire

A close-ended questionnaire which assessed the demographic variables, dental knowledge, oral hygiene practices, and dental problems of the children was distributed to the children who were willing to participate and were guided to fill the questionnaire.

Oral Hygiene Index-Simplified

The Oral Hygiene Index-Simplified[9] by Greene and Vermillion, 1964, was recorded to assess the level of oral hygiene of the children.

Statistical analysis

The statistical analysis was performed using IBM SPSS version 21.0, USA. Student's t-test and analysis of variance were used for the comparison of two and more than two groups, respectively, followed by post hoc test. Proportions were compared between different groups by using Pearson's Chi-square test. The level of significance was set at P < 0.05.


  Results Top


A total of 1600 schoolchildren were involved in the study. The study population was equally distributed between the 12- and 15-year-old children, i.e., 800 in each of the age groups. A similar distribution was done between the government and private schools.

Assessment of dental knowledge among the children

80% and 68% had the right knowledge regarding tooth decay and gum infection. This result was found to be very highly statistically significant ( P < 0.001) [Figure 1].
Figure 1: Assessment of dental knowledge. Option 1* – Good oral hygiene and eating fewer sweets, Option 2** – Eating fewer sweets and using fluoride, Option 3*** – Using fluoride and going to dentist regularly, Option 4**** – Good oral hygiene, eating fewer sweets, using fluoride, and going to dentist regularly

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Assessment of oral hygiene practices of the children

It was surprising in this case that 12-year-old children had better oral hygiene practices than the 15-year-old children. The habits of mouthrinsing and tongue cleaning had a statistically significant difference between the two groups of schoolchildren ( P < 0.001) [Figure 2].
Figure 2: Assessment of oral hygiene practices

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Assessment of factors related to dental visits

The frequency of visiting dentist and missing school due to dental problems decreased with age, with statistically significant results ( P < 0.001) [Table 1]. Toothache was the common reason to visit the dentist among the government schoolchildren [Figure 3], whereas correction of misaligned teeth was the reason among the private schoolchildren, with statistically significant results ( P < 0.05) [Table 2]. In this study, boys (129 [17%]) outnumbered girls (72 [8.6%]) in all the other reasons for visiting the dentist as well as for missing school due to dental problems, yielding highly statistically significant results ( P < 0.001) [Table 3].
Table 1: Association of dental visits with age of the children

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Figure 3: Assessment of factors related to dental visits

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Table 2: Assessment of dental problems

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Table 3: Association of dental visits with gender

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Assessment of oral hygiene of the children

Majority of the children (1017 [64%]) had a fair level of oral hygiene. Fair oral hygiene was equally distributed among both the age groups. Most of the government schoolchildren (272 [34%]) presented with poor oral hygiene, when compared with the private schoolchildren (63 [7.6%]), yielding very highly statistically significant results ( P < 0.001) [Table 4].
Table 4: Distribution of the study population according to Oral Hygiene Index-Simplified scores

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Association of Oral Hygiene Index-Simplified with the age and type of school

Majority of the children with fair oral hygiene (12 years – 277 [69.3%] and 15 years – 267 [67.3%]) were private schoolchildren. Government schoolchildren outnumbered private schoolchildren with regard to poor oral hygiene score in both the age groups, 12 years – 138 (34.5%) and 15 years – 134 (33.5%), yielding statistically significant results ( P < 0.05) [Table 5].
Table 5: Association between oral hygiene and age/type of school

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  Discussion Top


In the current study, 59.4% of the children brushed twice daily, which was similar to a study done by de Almeida et al.[2] in 2003 on Portuguese children (55.6%). However, in a study done by Yazdani et al.[3] in 2008 among 15-year-old Iranian children, only 26% brushed twice and 32% brushed less than once or never. In another study done by Varenne et al.[4] in 2006 on African children, it was claimed that 36% never brushed their teeth. This shows the vast difference in the oral hygiene knowledge and practice among the different developing nations. Keeping into account that all these studies were done on children aged below 15 years, and most of the 15 year olds still attend school, authorities should take advantage of this group's accessibility for such activities and thereby try to improve the oral practices of the children. In a study done by Leung and Zhu,[6] developed countries like China have shown that 12% of the children brushed once in 2–3 days. The main reason for the poor oral practices could be the principal oral health workers being middle-level dentists, who are equivalent to the dental therapists of various countries. Hence, there is lack of personnel to impart oral health education to the children.

However, in certain developed countries like Sweden, a study conducted by Flinck et al.[10] in 1999 showed that 78% of the children brushed their teeth twice a day and 13.6% brushed once a day. The reason for this is that in Sweden, dental care is provided free of cost for all children and adolescents up to the age of 19 years and most children had their dental care in public dental health clinics. Thus, regular visit to the dentist would have led to better oral hygiene practices. Hence, it could be concluded that the resources allocated by the government for oral health play a major role in the knowledge and practices among the students.

In our study, there was no difference in toothbrushing behavior according to gender, which was similar to a study done by Zhu et al.[6] in China. However, a contrary result was obtained in a study done by Yazdani et al.[3] on Iranian children, where girls seem to have better oral hygiene practices when compared to boys. The use of fluoridated toothpaste was 56.3% in our study and 50%–60% in a study done in Chandigarh by Chawla et al.,[11] thus proving that at least half of the Indians tend to use fluoridated toothpaste. In a study done by Zhu et al.[6] in China, only 17% used fluoridated toothpaste and in a study done by Varenne et al. in Africa[4] in 2006, only 9% of the children used fluoridated toothpaste. However, in a study done by García-Closas et al. in Spain,[12] 88% of the children reported the use of fluoridated toothpaste. Toothbrush was used by >95% of the children aged 12–15 years in a study conducted by Okeigbemen in Nigeria,[13] the percentage of which was similar to the current study. Over 90% of the 12-year-old children in a study by Lo et al. in Tibet[14] claimed to brush their teeth at least once in a day and close to one-third said that they brushed twice daily, similar to the findings of the current study. In spite of Tibet being a rural area, the reason for the abovementioned oral practices may be that the study was conducted in the capital city of Tibet. Thus, we can observe a vast difference between the oral hygiene practices of children in developed and developing countries. These differences may be due to various reasons such as lack of oral health awareness, lack of dentists, lack of interest on the part of the people, lack of facilities, lack of public dental health centers, and lack of school-based preventive programs in developing countries when compared with developed countries.

In the current study, 40.7% of the children had never visited a dentist. However, in a study done by Varenne et al.[4] in 2006 in Africa, 93% of the children and in a study by Leung and Chu in China,[15] 90% of the children had never visited a dentist. In Africa, there is a scarcity of dentists (1:200,000) and dental nurses (1:100,000). In a study done on Indian and Western children in Punjab by Grewal and Kaur[5] in 2007, it was reported that the proportion of Indian children who visited a dentist was three times more when compared to the Western children living in Punjab. This is because of the increased awareness of oral hygiene measures and practices among the Western children. There is only a minor variation between Punjabi children and Chennai children visiting a dentist, with the latter being 40.7%.

The current study reported that majority (63.9%) of the Indian children had fair oral hygiene and 20.9% had poor oral hygiene. The presence of calculus was seen in 84.88% of the children. In a study by de Almeida et al. in Portuguese,[2] 75% of the 12-year-old schoolchildren had fair oral hygiene. In a study by Bruce et al. in Ghana,[16] majority of the children had poor oral hygiene and 73%–98% of the children had calculus. This may be due to the cultural habit of mouth cleansing using local plants. Similarly, in a study by Leung and Chu in China,[15] 85% of the children had calculus.

The current study reveals the mean oral hygiene as “fair” in both age groups. The mean oral hygiene among 12- and 15-year-old children was “fair” in a study by Milciuviene et al. in Lithuania.[17] The current study reported poor oral hygiene in 20.9% of children, which was similar to a study conducted in Chennai by Mahesh Kumar et al.[18]


  Conclusions Top


The overall knowledge on oral health was good among the children. On assessing the oral hygiene of the children, the results revealed that: Nearly 90% of the children had fair debris score, Nearly 50% of the children had fair calculus score, more than 60% of the children had fair oral hygiene, the frequency of visits to dentists decreased with age, oral hygiene practices were positively correlated with the level of oral hygiene.

Recommendations

Oral health education should be incorporated in primary and secondary school syllabus, which will serve an effective platform for oral health education programs. Community-oriented oral health-care program strategies should be developed by the concerned health authorities. This would aim at further improvement of oral self-care practices and encourage the youth for regular dental visits and thereby better control of dental diseases.

Emphasis should be put on school-based prevention programs which focus on caries prevention and improvement of oral hygiene. In addition, priority should be given to community-oriented oral health-care programs in order to prevent oral disease and promote oral health. National health authorities should take the initiative toward this motive.

Financial support and sponsorship

This was a self-funded study.

Conflicts of interest

There are no conflicts of interest.



 
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de Almeida CM, Petersen PE, André SJ, Toscano A. Changing oral health status of 6- and 12-year-old schoolchildren in Portugal. Community Dent Health 2003;20:211-6.  Back to cited text no. 2
    
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Yazdani R, Vehkalahti MM, Nouri M, Murtomaa H. Smoking, tooth brushing and oral cleanliness among 15-year-olds in Tehran, Iran. Oral Health Prev Dent 2008;6:45-51.  Back to cited text no. 3
    
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Varenne B, Petersen PE, Ouattara S. Oral health behaviour of children and adults in urban and rural areas of Burkina Faso, Africa. Int Dent J 2006;56:61-70.  Back to cited text no. 4
    
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Grewal N, Kaur M. Status of oral health awareness in Indian children as compared to Western children: A thought provoking situation (a pilot study). J Indian Soc Pedod Prev Dent 2007;25:15-9.  Back to cited text no. 5
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Flinck A, Källestål C, Holm AK, Allebeck P, Wall S. Distribution of caries in 12-year-old children in Sweden. Social and oral health-related behavioural patterns. Community Dent Health 1999;16:160-5.  Back to cited text no. 10
    
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García-Closas R, García-Closas M, Serra-Majem L. A cross-sectional study of dental caries, intake of confectionery and foods rich in starch and sugars, and salivary counts of Streptococcus mutans in children in Spain. Am J Clin Nutr 1997;66:1257-63.  Back to cited text no. 12
    
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Okeigbemen SA. The prevalence of dental caries among 12 to 15-year-old school children in Nigeria: Report of a local survey and campaign. Oral Health Prev Dent 2004;2:27-31.  Back to cited text no. 13
    
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Lo EC, Jin LJ, Zee KY, Leung WK, Corbet EF. Oral health status and treatment need of 11-13-year-old urban children in Tibet, China. Community Dent Health 2000;17:161-4.  Back to cited text no. 14
    
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Bruce I, Addo ME, Ndanu T. Oral health status of Peri-urban schoolchildren in Accra, Ghana. Int Dent J 2002;52:278-82.  Back to cited text no. 16
    
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    Figures

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

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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