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Year : 2017  |  Volume : 15  |  Issue : 4  |  Page : 378-382

Periodontal health awareness and self-perceived halitosis among various professional students of West Godavari District of Andhra Pradesh

1 Department of Periodontics and Implantology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
2 Department of Public Health Dentistry, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India

Date of Web Publication13-Dec-2017

Correspondence Address:
Dr. Swati Singh
Department of Periodontics and Implantology, Vishnu Dental College, Vishnupur, Bhimavaram - 534 202, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiaphd.jiaphd_72_17

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Introduction: Oral health is an essential part of maintaining overall health, and poor oral health can have a profound effect on the quality of life. Among the various sections of the population present in the society, professional students include a large group of population and are believed to have a better awareness pertaining to oral health than the common population. Aim: This study aims to determine the periodontal health awareness levels along with the self-perception of halitosis among the medical, pharmacy, and engineering students in the West Godavari district of Andhra Pradesh. Materials and Methods: A descriptive cross-sectional survey was conducted in 1230 students from medical, engineering, and pharmacy professions. A self-administered 27-item structured questionnaire was used to assess periodontal health and knowledge pertaining to oral hygiene practices along with the assessment of self-perceived halitosis. Tests of the association between self-perceived halitosis and the risk factors were conducted using Chi-square test. Intergroup comparison was conducted by ANOVA and t-test. Results: Self-perceived malodor reported was 50%, 54%, and 60% by medical, pharmacy, and engineering students, respectively. The difference in the levels of overall periodontal health awareness was statistically significant among the different specialities with the highest score gained by medical students (4.1 ± 2.0), followed by the pharmacy (2.9 ± 1.6), and engineering (1.6 ± 1.3) students. Conclusions: Even though professional students do have an acceptable level of knowledge regarding oral health, the level of awareness pertaining to periodontal health in particular is lacking. Hence, there is a need to extend the horizon for oral healthcare to other professional students at an elementary level.

Keywords: Halitosis, oral hygiene practices, periodontal health, students

How to cite this article:
Penmetsa GS, Singh S, Gadde P, Teja RG, Bhaskar UR. Periodontal health awareness and self-perceived halitosis among various professional students of West Godavari District of Andhra Pradesh. J Indian Assoc Public Health Dent 2017;15:378-82

How to cite this URL:
Penmetsa GS, Singh S, Gadde P, Teja RG, Bhaskar UR. Periodontal health awareness and self-perceived halitosis among various professional students of West Godavari District of Andhra Pradesh. J Indian Assoc Public Health Dent [serial online] 2017 [cited 2024 Mar 3];15:378-82. Available from: https://journals.lww.com/aphd/pages/default.aspx/text.asp?2017/15/4/378/220718

  Introduction Top

Health is a valuable asset not only for an individual but also for the social system. Oral health which is essential to and inseparable from ones overall health is now recognized as equally important in relation to general health. Several factors such as nutritional status, tobacco smoking, alcohol, hygiene, and stress are linked to a wide range of oral diseases, among which oral hygiene is the most significant factor in terms of prevention of oral diseases.[1]

Periodontitis which is an immunoinflammatory infection,[2],[3] contributes to a major part of the worldwide oral health encumbrances and is one of the major reasons of tooth loss, representing complete and partial edentulism in 5%–20% of the universal adult population.[4] Any human being regardless of age, gender, ethnic group, and residing area can get affected by the periodontal disease to a variable extent and severity.[4]

Among the various presentable clinical features of the periodontal disease, namely, bleeding gums, gingival recession, and oral malodor are one, which may not only affect the individual but can also act as a social stigma. This malodor which is otherwise scientifically termed as halitosis is a result of the accumulation of dental plaque and poor oral hygiene and can vary with the extent and severity of the periodontal disease influencing an individual's levels of self-confidence.

As a bidirectional relationship has been associated with systemic diseases and oral health of an individual,[5] the knowledge of oral health is considered to be an essential prerequisite for health-related behavior.[6] Inspite of the growing evidence of the effect of oral manifestations on the general health of an individual, it is unfortunate that many medical professionals considered to be an epitome of health providers, is unaware and fail to recognize that potential infection may exist within the oral cavity.[7]

The vision on oral health is that health professionals need to improve and impart oral health counseling and serve as a guide in developing positive dental attitudes. Moreover, the young adults of the society are expected to play a role in bringing a behavioral change in the community. For this, they need to be well-informed as to the need for dental care and treatments available, which calls for a joint advocacy between the different professions, and hence, a need is felt for assessing the oral hygiene knowledge and behavior of professional students with different educational backgrounds.

To the best of our knowledge, there is no previous study comparing the periodontal health awareness levels and self-perceived halitosis among the medical, pharmacy, and engineering students. This survey was therefore initiated with a prime focus to determine the periodontal health awareness levels and the self-perceived halitosis among the medical, pharmacy, and engineering students in West Godavari district of Andhra Pradesh.

  Materials and Methods Top

A descriptive cross-sectional epidemiological survey was conducted from January 2017 to March 2017, over a period of 3 months, among the undergraduate students of medical, pharmacy, and engineering colleges of West Godavari district of Andhra Pradesh after approval by the institutional review board. All the participants were explained about the survey, and informed consent was taken.

For sample selection, a simple random sampling procedure was employed [Figure 1]. The sample size was calculated based on the findings of a pilot study with self-perceived halitosis ranging from 50% to 60% among different professional groups with 95% confidence interval, considering alpha error only. Based on their willingness to participate, a sample of 1230 students in the age group of 18–25 years were included. Those who were absent or not available on the day of the study or who failed to fill the pro forma completely were excluded.
Figure 1: Flowchart for sampling

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For the collection of data, a specially designed pro forma was used. The validity of a questionnaire was conducted using Cronbach's alpha and obtained a score of 0.78. The pro forma consisted of demographic data (age, sex, and year of study), questions on their self-perceived halitosis, oral hygiene practices, food and adverse habits such as smoking, medical history including gastrointestinal disturbances and sinusitis, and treatment received for halitosis as well as questions pertaining to their awareness on periodontal health including their knowledge on common causes of bleeding gums, bad breath, teeth staining, loosening of teeth, sensitivity, and role of oral health in general health. All participants received complete information on how to fill the questionnaire.

For the questions on awareness of periodontal health, Score 1 was given for every right answer, and Score 0 was given for every wrong answer, and the means were then obtained. Descriptive statistical analysis was carried out. Tests of the association between self-perceived halitosis and the risk factors were carried out using Chi-square test. Intergroup comparison of the mean periodontal health awareness between different professional students was conducted by ANOVA. A P< 0.05 was set to be statistically significant.

  Results Top

Out of all the 1230 students, 458 were medical, 349 were pharmacy, and 423 were engineering students. The mean age of the sample population was 20.55 ± 1.59. A total of 515 males and 715 females participated in the study.

Both the males and females equally complained of oral malodor, i. e., approximately 54%. Self-perceived halitosis was highest among engineering students when compared to pharmacy and medical students [Table 1]. The difference among the three groups was statistically significant (P< 0.05). Overall 54.1% of all the students complained of halitosis.
Table 1: Self-perceived halitosis among various groups

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Only 18.6% of medical, 8% of pharmacy, and 11.1% of engineering students were aware about the common cause of bleeding gums. About 43.9% of medical, 17.2% of pharmacy, and 12.1% of engineering students were aware that poor oral hygiene is the common cause for bad breath. Only 40.4% of medical, 26.4% of pharmacy, and 22% of engineering students reported poor oral hygiene as the common cause of loosening of teeth. About 48.5% of medical, 36.4% of pharmacy, and 13.2% of engineering students considered hypersensitivity as a treatable entity. Approximately 50%, 40%, and 13% of medical, pharmacy, and engineering students, respectively, were aware that bad oral hygiene affects general health. Participants who reported improper tooth brushing as the common cause for receding gums were 50% in medical, 40% in pharmacy, and 14% in engineering colleges, approximately. Awareness on an aggressive form of periodontitis was found only in 3.7% of medical, 8.9% of pharmacy, and 11.1% of engineering students. Oral health can play an important role in maintaining ones general health. This is believed by 82.3% of medical students, 49% of pharmacy, and 19.9% engineering students [Table 2].
Table 2: Self-perceived halitosis and its association with various factors

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The difference in the mean knowledge about the periodontal disease was statistically significant among the different specialities with the highest score gained by medical students (4.1 ± 2.0), followed by the pharmacy (2.9 ± 1.6), and engineering (1.6 ± 1.3) students [Table 3]. The mean knowledge score was also higher among females (3.1 ± 2.0) when compared to males (2.6 ± 1.8), and this difference was also statistically significant.
Table 3: Comparison of periodontal awareness score among different professional students

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  Discussion Top

Halitosis, which is one of the common symptoms of a periodontitis affected patient, is a consequence of poor oral hygiene which has mostly remained as a flouted issue. A significant amount of emphasis is now being given for prevention of oral diseases, and thereby a knowledge of preventive oral health and proper oral hygiene practice forms an important aspect of maintaining good oral health.

In our study, the complaint of self-perceived halitosis was almost 60% in engineering students which was the highest among the three groups and was least in medical students, i. e., approximately 40% which showed that medical students were more aware and conscious about their oral hygiene when compared to engineering students.

Although, brushing was the commonly used method of cleaning, the percentage of participants brushing their teeth twice daily regularly was 33.5% which was less than a study done by Jiang et al. (67%)[8] and Al-Shammari et al. (62%).[9]

Inspite of being health professionals, only 28% of the medical students used other oral hygiene aids. In contrast, Hamilton and Coulby found that a high percentage (44%) of the sample in northeastern Ontario used dental floss.[10] The reason for this may be the educational program that is consistently carried out in Canada, where oral health instructions are included annually in class teaching, and specially trained dental assistants present lessons on oral health principles and prevention of dental disease in schools which lacks in our society.[10]

It is noteworthy that 13% of all the professional students brushed their teeth using horizontal method that might result in compromised tooth structure and gingival health which is significantly less than the results obtained in the study done by Zhu et al. (60%)[11] and Dayakar et al. (26%).[7]

In contrast to this, significantly lower percentage of students (17.2% of pharmacy and 12.1% of engineering) were aware that poor oral hygiene is a common cause of bad breath while most of the medical (50%) and pharmacy (40%), and few of the engineering students (13%) were aware that bad oral hygiene affects general health. These results were lower than the results reported by Ali et al. (81%).[12]

In our study, 34.6% of all the students regularly visit their dentist for cleaning their teeth every 3 months which was in line with the studies done by Behbehani and Shah (49%),[13] Petersen et al. (37%),[14] and Al-Hussaini et al. (44%).[15] On the other hand, Johani showed that only 12.8% of the population in Jeddah visit their dentist on a regular basis.[16]

The awareness of these professional students on aggressive forms of periodontitis was very low and the results were similar to the study done by Dayakar et al. (80%).[7]

Among the three groups, greater awareness was seen among the medical students when compared to students of engineering and pharmacy. Recently, a study done by Kale et al.[17] demonstrated poor oral health knowledge among engineering students. However, another recent study showed that almost 71% of professional students agreed with the fact that poor oral health adversely affects ones general health.[18]

The results of our survey revealed that the professional students, who are going to become the foundation of our modern society, possess poor level of awareness and knowledge about the periodontal health and diseases. The above finding in these students is not very encouraging.

The results obtained in our study are an eye opener for the dental faculty of the fact that standards pertaining to knowledge of periodontal health and oral hygiene practices are very poor in the West Godavari district. The task of spreading this awareness needs to be extended to general masses, including school children, working, and nonworking population, along with the professional students.

Medical practitioners should possess the basic dental knowledge to uncover signs and symptoms of dental diseases from patients, and as a result help in providing appropriate treatment or advice to these patients thereby acting as public health educators. On the other hand, the pharmacists, who perform a vital role in health promotion, health maintenance, and health improvement of the community, are in a unique position to understand the needs of community members through regular interaction with patients. They can educate the patients not only about the appropriate use of medications, but also the potential oral side effects associated with many drugs such as xerostomia, dysgeusia, and stomatitis. This association would promote them to collaborate with dentists in improving oral health as a part of whole person care, provided they are appropriately educated or trained in oral health. Like so, pharmacists can actively participate in oral disease identification, management, and concerned referral of the individual thereby promoting prevention of the disease.

Another large group of population includes the nonhealth-care professionals such as the engineering students who, with a higher educational background, can easily understand and follow the concept of prevention and well-being, leading them to be the role models for their family and community at large. Thus, it can be emphasized that health education and promotion enhances the quality of life of an individual irrespective of their social status or field of expertise. Emerging health-care professionals as well as nonhealth-care professionals form a significant part of the society and belong to the echelon who are believed to have a better knowledge and awareness than the common population, but assessment of the actual existing status demands a proper channelled study.

  Conclusions Top

Self-perceived halitosis was highest among engineering students followed by the pharmacy and medical students. The level of periodontal health awareness was higher among medical students when compared to pharmacy and engineering students. Since poor oral hygiene is a major cause of halitosis and periodontal disease, as dentists, we should reinforce the importance of correcting all aspects related with brushing and flossing along with the importance of regular dental checkups.


Dr. C D Dwarakanath (professor and head of the department) for his constant support and encouragement throughout the study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Sheiham A, Watt RG. The common risk factor approach: A rational basis for promoting oral health. Community Dent Oral Epidemiol 2000;28:399-406.  Back to cited text no. 1
Javed F, Näsström K, Benchimol D, Altamash M, Klinge B, Engström PE, et al. Comparison of periodontal and socioeconomic status between subjects with type 2 diabetes mellitus and non-diabetic controls. J Periodontol 2007;78:2112-9.  Back to cited text no. 2
Javed F, Al-Askar M, Samaranayake LP, Al-Hezaimi K. Periodontal disease in habitual cigarette smokers and nonsmokers with and without prediabetes. Am J Med Sci 2013;345:94-8.  Back to cited text no. 3
Jin LJ, Armitage GC, Klinge B, Lang NP, Tonetti M, Williams RC, et al. Global oral health inequalities: Task group – Periodontal disease. Adv Dent Res 2011;23:221-6.  Back to cited text no. 4
Haumschild MS, Haumschild RJ. The importance of oral health in long-term care. J Am Med Dir Assoc 2009;10:667-71.  Back to cited text no. 5
Ashley FP. Role of dental health education in preventive dentistry. In: Murray JJ, editor. Prevention of Dental Disease. 3rd ed. Oxford: Oxford University Press; 1996. p. 406-14.  Back to cited text no. 6
Dayakar MM, Kumar J, Pai GP, Shivananda H, Rekha R. A survey about awareness of periodontal health among the students of professional colleges in Dakshina Kannada district. J Indian Soc Periodontol 2016;20:67-71.  Back to cited text no. 7
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Jiang H, Petersen PE, Peng B, Tai B, Bian Z. Self-assessed dental health, oral health practices, and general health behaviors in Chinese urban adolescents. Acta Odontol Scand 2005;63:343-52.  Back to cited text no. 8
Al-Shammari KF, Al-Ansari JM, Al-Khabbaz AK, Dashti A, Honkala EJ. Self-reported oral hygiene habits and oral health problems of Kuwaiti adults. Med Princ Pract 2007;16:15-21.  Back to cited text no. 9
Hamilton ME, Coulby WM. Oral health knowledge and habits of senior elementary school students. J Public Health Dent 1991;51:212-9.  Back to cited text no. 10
Zhu L, Petersen PE, Wang HY, Bian JY, Zhang BX. Oral health knowledge, attitudes and behaviour of adults in China. Int Dent J 2005;55:231-41.  Back to cited text no. 11
Ali NS, Khan M, Butt M, Riaz S. Implications of practices and perception on oral hygiene in patients attending a tertiary care hospital. J Pak Dent Assoc 2012;1:20-3.  Back to cited text no. 12
Behbehani JM, Shah NM. Oral health in Kuwait before the gulf war. Med Princ Pract 2002;11 Suppl 1:36-43.  Back to cited text no. 13
Petersen PE, Hadi R, Al-Zaabi FS, Hussein JM, Behbehani JM, Skougaard MR, et al. Dental knowledge, attitudes and behavior among Kuwaiti mothers and school teachers. J Pedod 1990;14:158-64.  Back to cited text no. 14
Al-Hussaini R, Al-Kandari M, Hamadi T, Al-Mutawa A, Honkala S, Memon A, et al. Dental health knowledge, attitudes and behaviour among students at the Kuwait University Health Sciences Centre. Med Princ Pract 2003;12:260-5.  Back to cited text no. 15
Johani HA. Oral hygiene practice among Saudi patients in Jeddah. Cairo Dent J 2008;24:395-401.  Back to cited text no. 16
Kale T, Bhartiya GK, Raghavan M. Periodontal disease awareness among engineering students in Nashik. J Clin Periodontol Implant Dent 2016;1:12-6.  Back to cited text no. 17
Gopikrishna V, Bhaskar NN, Kulkarni SB, Jacob J, Sourabha KG. Knowledge, attitude and practices of oral hygiene among college students in Bengaluru city. J Indian Assoc Public Health Dent 2016;14:75-9.  Back to cited text no. 18
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  [Figure 1]

  [Table 1], [Table 2], [Table 3]


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