|Year : 2015 | Volume
| Issue : 1 | Page : 38-41
Evaluation of the knowledge, attitude and practices regarding oral health of the schoolteachers in Mangalore city
Nishi Gupta1, N Vanishree2, Ashwini Rao3, V Chaithra4, Deepa Bullappa2, RV Bharathi2
1 Department of Public Health Dentistry, Aditya Dental College, Maharashtra, India
2 Department of Public Health Dentistry, Bangalore Institute of Dental Sciences, Bangalore , Karnataka, India
3 Department of Public Health Dentistry, MCODS Mangalore, Manipal University, Bangalore , Karnataka, India
4 Department of Public Health Dentistry, The Oxford Dental College and Hospital, Bangalore , Karnataka, India
|Date of Web Publication||19-Mar-2015|
Dr. N Vanishree
Department of Public Health Dentistry, Bangalore Institute of Dental Sciences, Bengaluru - 560 068, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: School teachers can play a significant role in school dental health education as they can bring about changes in the attitudes and behavior of the children at a very young age, which is long lasting. Objectives: To assess the knowledge, attitude and practice of the primary and middle school teachers. Materials and Methods: A cross-sectional survey was carried out on 241 primary and middle school teachers from 17 selected schools in Mangalore city and was given the questionnaires in English as well as the local language Kannada. There were 18 questions regarding knowledge about dental diseases such as dental caries, periodontal disease, oral hygiene practices, tobacco chewing habits and smoking habits. Results: About 241 (100%) had heard about tooth decay and 228 (94.6%) had heard of gum disease. An inverse relationship between the frequency of changing the brush and awareness about dental caries was observed people with a chewing habit and smoking habit had a low level of knowledge and awareness about the dental caries and periodontal disease. Conclusions: Since the information was gained more from dentists and televisions, more dental health programs should be encouraged in televisions and dentists should play a vital role in enlightening people about oral health.
Keywords: Knowledge, oral hygiene, school teachers
|How to cite this article:|
Gupta N, Vanishree N, Rao A, Chaithra V, Bullappa D, Bharathi R V. Evaluation of the knowledge, attitude and practices regarding oral health of the schoolteachers in Mangalore city. J Indian Assoc Public Health Dent 2015;13:38-41
| Introduction|| |
Oral health surveys show that dental caries and periodontal disease form the most common dental problems among the Asian population.  Despite the high prevalence of dental caries causing health problems, relatively little has been written about dental practices and its effects on oral health status. 
It has been proposed that people's attitudes and behavior toward health in general and dental health, in particular, are a culmination of life experiences and events. Influences from childhood, through school and into adulthood have been shown to determine individual perceptions. 
Children are eager to learn and grasp things very fast. Since they spend a considerable time of their day in schools, teachers could possibly be a very powerful and effective medium to deliver oral health information. The advantage of using school health personnel are, the potential for improved continuity of instruction and lowered cost of services. A possible disadvantage is that such individuals may not have adequate preparation and knowledge to provide health information. 
Most of the people believe that the health of the school population is of paramount importance and that there should be effective school health programs.  In India nearly five million teachers who are teaching in schools can play an important role in school dental health education as they can provide long-term health education and changes in behavior.  A classroom is considered a more adequate setting to present health education programs because the teacher has a profound influence on the school children and could be used as a health educator. 
School dental health programs should assess and enhance the knowledge of teachers and provide aids that can help teachers deliver more effective health education. Before implementing such programs, the basic knowledge, attitudes and practices of this target group should be assessed. Keeping this in mind the present study was carried with the objectives to assess the knowledge, attitude and practice of the primary and middle school teachers in Mangalore city.
| Materials and Methods|| |
A cross-sectional survey was carried out on 241 primary and middle school teachers in Mangalore city. 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, the questionnaire was validated for face and content validity (Aiken V value = 0.87) following which calibration exercises were carried out on 50 school teachers. To assess the inter-examiner variability, reexaminations were done on every 5 th school teacher, and acceptable consistency was obtained. An expert supervised these exercises.
After the necessary modifications, the main study was planned. A total of 49 schools were present in Mangalore city, taking 95% level of confidence and 5% error sample size was estimated to be 238. To obtain this sample size a total of 18 schools were selected from the list of schools by simple random sampling; one school was excluded, as this school did not agree to participate in the study. The purpose of this study was explained, and written permission was taken from the heads of the institutions and informed consent was obtained from all the teachers participating in this study. Hence, finally 241 teachers in the 17 selected schools were included in the study and were given the pretested questionnaires in English as well as the local language Kannada.
Daily and weekly schedules were prepared. The examiner was not aware of the response given by the subjects for the questionnaire, to avoid bias. There were 18 questions regarding knowledge about dental diseases, if the answer was right, then +1 score was given, if it was a wrong answer then a −1 score was given and 0 for "don't know" answer. Similarly, a positive attitude was given +1 score, negative attitude −1 and 0 for "don't know" answer. The first four questions were regarding general awareness about dental caries and were scored together as "caries awareness." Questions 5-7 were related to etiology of dental caries and scored under "caries etiology." Questions 8-10 dealt with the prevention and were clubbed as "caries prevention." Questions 11-18 were regarding periodontal disease. The source of dental health information gathered by the teachers was also recorded. To record their oral hygiene practices and habits, seven questions were included in the questionnaire, which includes; the frequency of cleaning the teeth, brushing aids, frequency of changing toothbrush, other materials used for cleaning the teeth, use of fluoridated toothpaste, tobacco chewing habits and smoking habits.
The data thus obtained was entered into the computer using Microsoft Excel (Windows MS Office XP professional version). The data were analyzed using (SPSS 14, IBM). Means and standard deviations were calculated wherever needed. For discrete variables, Chi-square test was used. When >2 means were present, analysis of variance was used. P < 0.05 was taken as statistically significant.
| Results|| |
This is an observational study, carried on 241 school teachers in Mangalore city. Their age ranged from 20 years to 59 years, with 53 (22%) belonging to the 20-29 years age group, 67 (27.8%) to the 30-39 years age group, 74 (30.7%) to the 40-49 years and 47 (19.5%) belonging to the 50 years and above age group. Of the total 17 (7.1%) were males and 224 (92.9%) females.
[Table 1] shows the percentage of subjects giving answers on questions related to caries and periodontal disease. Though the overall knowledge was high among the teachers, the important findings were that 241 (100%) had heard about tooth decay and 228 (94.6%) had heard of gum disease. About 171 (71%) of the teachers reported that it was natural to lose teeth with increasing age, while 204 (84.6%) said that brushing helps to prevent gum disease.
|Table 1: Percentage of answers by the subjects to questions on caries and periodontal disease |
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[Table 2] shows the various sources of dental information stated by the teachers. Out of the 241 schoolteachers, 172 (71.4%) teachers stated dentist as the source of dental information, other sources stated were the television, magazines, newspapers, friends/neighbours, radio, physician and health clinic.
|Table 2: Various sources of dental health information stated by the subjects |
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[Table 3] reveals that there is an inverse relationship between the frequency of changing the brush and awareness about dental caries. Teachers with a chewing habit and smoking habit had a low level of knowledge and awareness about the dental caries and periodontal disease.
|Table 3: Mean value of knowledge and attitude score about dental caries and periodontal disease in relation to oral hygiene practices and habits |
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| Discussion|| |
Kennedy et al. in 1977, described the school's role in affecting dental health for children as a potential yet unrealized. Schools have a tremendous capacity to be supportive of programs involving preventive health and dentistry for children.  Well informed teachers have the potential to contribute positively to the process of developing and maintaining effective school dental health programs.  Schoolteachers have been traditionally considered as potentially important primary agents of socialization with the capacity of influencing the future knowledge, attitudes and behavior of school children. 
Understanding the association of knowledge about preventing oral disease with preventive dental behaviors could facilitate the development of appropriate and effective health education programs in the society. An investigation to assess the dental knowledge and attitude of the teachers is a comparatively recent trend, and very few reports are available in the literature and because of this reason direct comparisons are difficult to make. 
In the present study, knowledge about caries awareness was assessed and was found to be high, which was similar to the corresponding study by Kwan and Williams  and was in contrast to the study conducted by Kawamura and Iwamoto  But the knowledge about dental caries and periodontal disease did not show significant increase with the increase in the educational quantification, which was in contrast to the studies conducted by Boehmer et al.  and Schwarz and Lo. 
Most of the teachers felt that educating people about dental caries could help prevent dental problems. All the teachers said that children should be educated in schools about oral health. While perceptions to responsibilities and attitudes was nearly similar to the other studies. ,,,,
Oral health practices, lifestyles influences including diet, 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. Values and norms with respect to oral health are reflected in the knowledge, attitude and self-care practices. Since oral health behavior is conditioned by culture, the variations by education are often predominant. In the present study, 22.8% (55) of the teachers brushed once a day, 68.5% (165) brushed twice daily and 8.7% (21) brushed more than twice a day but was not significantly associated with the education as 65.3% kannada medium teachers brushed twice daily and 70.1% of the English medium teachers also brushed twice daily similar findings were found in studies conducted by Peng et al. 
Similarly, the brushing aids, frequency of changing toothbrush also did not have any significant association with the educational qualification, which was similar to the findings in the literature.  In the present study, the knowledge about periodontal disease was not significantly associated with the oral hygiene practices and habits whereas in the study done by Bader et al.  a weak association was found between signs of periodontal disease with better oral health in most practices but Astrøm et al.  showed oral health behaviors to be significantly associated with oral health knowledge. It is necessary to provide classroom education about general and dental health to the children by school teachers who should be trained to conduct school dental programs and about the aspects of good oral care. There are very few studies in the literature that have made comparisons of the knowledge, attitude and oral hygiene practices with the oral health further longitudinal and qualitative studies are recommended in the future for further research.
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. Since the information was gained more from dentists and televisions, more dental health programs should be encouraged in televisions and dentists should play a vital role in enlightening people about oral health.
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[Table 1], [Table 2], [Table 3]