|Year : 2018 | Volume
| Issue : 2 | Page : 154-159
Oral hygiene practices and knowledge among residents of the trans-varuna region (India): A hospital-based study
Farhan Durrani1, Faizia Rahman1, Manjusha K Sathiananthan2, Shivam Kesarwani2, Arpit Galohda3, Patricia Ome Borang3
1 Unit of Periodontics, Faculty of Dental Sciences, BHU, Varanasi, Uttar Pradesh, India
2 Faculty of Dental Science, BHU, Varanasi, Uttar Pradesh, India
3 BHU, Varanasi, Uttar Pradesh, India
|Date of Submission||06-Feb-2018|
|Date of Acceptance||19-Apr-2018|
|Date of Web Publication||24-May-2018|
Dr. Faizia Rahman
64, Lady Doctors Hostel, IMS, BHU, Varanasi - 221 005, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: Periodontal diseases are considered to be the most prevalent chronic infectious disease of the gums. Aim: The present study was conducted to assess the awareness and practices on oral hygiene and its association with the sociodemographic factors among patients attending the general Outpatient Department (OPD) of the Faculty of Dental Sciences, BHU, Varanasi, India. Material and Methods: A cross-sectional study was conducted among 526 patients attending the general OPD of the Faculty of Dental Sciences, BHU, Varanasi, India, from September 2017 to November 2017. The study tool was a predesigned and pretested semi-structured schedule. Data entry was done in Microsoft Excel sheets and analyzed using SPSS 16 (SPSS Inc. Released 2007, SPSS for Windows Version 16.0., SPSS Inc., Chicago, IL, USA). Descriptive statistics and Chi-square analysis were used. Results: About 87.1% of the participants used a toothbrush with toothpaste as a method of cleaning their teeth; 21.7% brushed their teeth twice daily; and very few were using floss or other interdental cleaning aids. About 52.5% of the people visited the dentist due to pain and only 21.7% visited for checkup in the past 1–5 years. Most of the people admitted to the fact that oral health affects general health. Conclusion: Oral health awareness and practices among the study population were poor and need improvement.
Keywords: Awareness, oral hygiene, sociodemographic factors
|How to cite this article:|
Durrani F, Rahman F, Sathiananthan MK, Kesarwani S, Galohda A, Borang PO. Oral hygiene practices and knowledge among residents of the trans-varuna region (India): A hospital-based study. J Indian Assoc Public Health Dent 2018;16:154-9
| Introduction|| |
There is literally no geographic area on the globe inhabited by humans with perfect oral health. Some of the other signs of disease are present in almost every mouth, the leading of which are dental caries and periodontal diseases which may result in tooth loss, debilitating the individual. Oral health thus becomes an important element to maintain the general health and quality of life. The WHO reports promotion of oral health to be a rewarding method of decreasing the incidence and prevalence of oral diseases. Prevention of oral diseases thus gains importance, and this can be achieved by the joint efforts of the policymakers, dentists, and common man. Education and awareness do not necessarily mean the application and implication in routine life activities. Thus, many would be aware of the correct practices for health maintenance, but their routine cannot be assured until an optimum level of motivation is reached. That optimum level of motivation can be correctly identified not only by questioning the nature of the habits practiced by the common people but also by a thorough examination which in the present case is the oral cavity. A multitude of studies have been done in this regard all over the world, but no such study has yet been conducted for the people of this area. The present study was, thus, conducted with the aim of finding out the oral hygiene knowledge, attitude, and behavior among the patients attending the Outpatient Department (OPD) of the Faculty of Dental Science, BHU Varanasi, and to find the relationship between the sociodemographic profiles and oral hygiene knowledge and practices.
| Materials and Methods|| |
The observational, descriptive, epidemiologic, hospital-based study was conducted in the OPD of the Faculty of Dental Sciences, BHU, Varanasi, India. All patients who reported to the OPD of Faculty of Dental Sciences excluding those who reported in emergency or painful conditions were included in the study. Ethical clearance was obtained from the institutional ethical committee (ref nu: ECR 526/Inst/UP/2014Dt 31.1.14). Written consent was obtained from each subject and a close-ended questionnaire consisting of two parts (questionnaire and clinical) was handed over to each volunteer. The first part of the questionnaire consisted of two parts one pertaining to the sociodemographic profile of the individual and the second part consisted of close-ended questions pertaining to oral hygiene practices, the other half of the draft consisted of oral examination including three indices. The questionnaire was face and content validated by a team of experts in the field. The reliability of the questionnaire was assessed (Cronbach's α = 0.77). A pilot study was conducted among 20 participants and minor changes were drafted in the final questionnaire. These 20 participants were not a part of the final study. The questionnaire was originally framed in English language and then translated into Hindi (the local language) by a third individual. The translated text was again converted into English language to check the validity of the questionnaire. The questionnaire was subjected to multiple changes before the final draft was made which made sure that every question could be easily understood and answered by any individual and clarity was maintained. The participants of the study were asked to fill the questionnaire themselves, for those who faced difficulty in reading the local language, assistance was provided by their own companions or fellow participants. A strict protocol of confidentiality was maintained to avoid any sort of bias. The study period extended from September 2017 to November 2017. Indices were recorded by a single trained dental professional (intra-examiner reliability was 0.81 [kappa value]). It took around 20 min to completely analyze each patient according to the questionnaire. Sample size was derived by the formula Z2αpq/L2. A sample size of 512 was obtained. Anticipating dropouts from the study, the sample size was rounded off to 525.
Three indices, namely the Oral Hygiene Index (OHI), gingival index (GI), and Community Periodontal Index (CPI) Index, were recorded for each participant. The Simplified-OHI (OHI-S) was recorded for each participant by assessing six index teeth which consisted of both the calculus index and debris index.
Data entry was done in Microsoft Excel sheets and analyzed using SPSS 16 (SPSS Inc. Released 2007. SPSS Inc., SPSS for Windows, Version 16.0, Chicago, IL, USA). Descriptive statistics were applied for each parameter. Association of every parameter with respect to gender, region, and age group was checked through Chi-square analysis.
| Results|| |
A total of 526 voluntary participants were recruited in the present study which consisted of 292 males and 234 females, majority (60.1%) hailing from urban areas. About 70.3% of the participants were young adults, i.e., under or equal to the age of 40 [Table 1].
|Table 1: Distribution of the study population according to gender, region, and age group|
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Most of the people knew that oral health had an impact on general health and good oral hygiene is mandatory for overall well-being. More number of males (61.6%) responded positively to this question than the females (53%). No significant differences were obtained between males and females or between region and age groups. Nearly 87.1% of the participants were using toothbrush, rest 10.6% had confidence in datun, others about 2.3% resorted to other means such as fingers or other aids. When comparing the usage of toothbrush for maintaining oral hygiene, no gender differences were seen, but considerable differences were present when the rural and urban population as well as in young adults and the elderly. Out of the total population, 78.3% brushed their teeth once a day, whereas only 21.7% brushed twice daily. More number of females brushed their teeth twice daily as compared to males. The urban population has a higher frequency of participants who brush twice daily than that of the rural region, but not much difference existed between the young adults and the elderly. As oral hygiene agent, 88.6% participants were using toothpaste, 6.8% resorted to powder while 4.6% used nothing. In the rural population, this number dipped down to 81.9%, whereas in the urban population the number increased to 93%. In the young adults, the number of people using toothpaste was 91.9%, whereas in the elderly it is 80.8%. Further, 8.2% of males and 5.1% of females were using powder as cleansing aid. It is interesting to note that only 34.9% of males and 42.7% of females were using fluoridated toothpaste. The total of 27.4% of the population reported ignorance about the type of brush bristles used, whereas 32.7% of the population reported to using soft bristles. More of the female population was using the soft bristles than the males. In the rural population, 31.4% did not know about brush bristle type and 24.6% of the urban population expressed the same view. Amazingly, 24.32% of the young adults and 34.6% of the elderly had no knowledge about the brush bristle type. A higher number of the urban population was using soft bristle toothbrush than the rural region. The method of brushing was horizontal in 58.3% of the total population. Significant differences were present in the rural and urban population in the brushing method used, but no such differences were observed age wise or gender wise. It is interesting to note that 34.24% of males and 40.17% of females changed their brush only when the bristles got flared. About 38.3% of males and 33.33% of females admitted to changing their brush every 3 months. Nearly 43.6% of the urban population admitted to changing their brush every 3 months while only 24.7% of the rural population admitted to doing so. Significant differences were observed between the rural and the urban population and the elderly and the young adults [Table 2].
|Table 2: Distribution of sample in relation to gender, region, and age group according to oral hygiene habits|
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About 80.1% of the male population and 83.7% of the female population were not using any interdental cleaning aid. 11.4% of the rural and 8.8% of the urban population was using mouthwashes as an adjunct to maintaining oral hygiene. Only 1.1% of the total population was using dental floss to maintain the oral hygiene. Comparison of gender, region, or age groups does not vary significantly. Tongue cleaning was reported by 472 participants, more males were cleaning their tongue than females. An almost equivalent number of males and females were using tongue cleaner as the most preferred device (69.5%) followed by brushing (8.3%), fingers (1.1%), and plain rinsing (1.1%), respectively. The urban population had better tongue cleaning habits than the rural population, and the results were statistically significant however no such significant differences were seen between the age groups [Table 3].
|Table 3: Distribution of the study population according to gender, region, and age group in relation to auxiliary oral hygiene habits and awareness*|
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Nearly 34.9% of males and 37.6% of females had never visited a dentist in their life, whereas 32.1% of males and 29.9% of females had visited the dentist in the past 1 year. Of the total population, 21.7% people have visited a dentist in the past 1–5 years, of which 52.5% visited only because of pain [Table 3].
The OHI-S was reported to be good for majority of the population in all the three groups. A higher number of males (6.1%) recorded poor oral hygiene than the females (2.5%). Highly significant differences were observed area wise and age wise (P < 0.005). The gingival index was good in 86.9% of males and 92.2% of females, fair in 10.2% males, and 5.9% of females. The differences however did not reach statistically significant levels. GI score was fair in 5.9% young adults and 14.1% in elderly showing statistically significant difference. CPI index code 4 was seen in majority of males and urban population. About 44.8% of the young adults and 29.4% of the elderly had a code zero. A code of 4 was recorded in 4.3% of people under the age of 40 whereas it was 11.5% in above 40 thus showing significant differences in the age groups, but gender and region did not have any significant differences [Table 4].
|Table 4: Distribution of sample according to oral hygiene index, gingival index, community periodontal index*|
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| Discussion|| |
It is a very difficult task to define the quality of life of an individual or the society depending on oral health since the basic concept itself is very vague, elusive, subjective, multidimensional, and without definitive boundaries. Oral health has thus remained an ignored entity and an unrealized, unrecognized issue in the Indian society. It poses a threat globally in terms of the general well-being and providing a good quality of life to an individual. It remains well established that the oral cavity becomes the gateway for many systemic diseases as also the first signs and symptoms of many systemic diseases find their first manifestations in the oral cavity.
In the present study, 87.1% of the total population used toothbrush to maintain oral hygiene. Majority of the population used toothbrush irrespective of gender, age or region. However, differences do crop up when comparing the rural society with the urban population as also in the elderly when compared to the young adults. Dilip  reported in his study that 97% of an educated society were using toothbrush. Pankaj et al. reported a frequency of 98% and Sharda and Sharda  reported a frequency of 94.4%. Our results are in terms of the study carried out by Kapoor et al. who also reported 90% use of toothbrush and toothpaste for oral hygiene maintenance in North India. In the present study, better results have been found than those obtained by Paul et al. 2014 who reported a mere 69.25% people to be using toothbrush for the same. On comparing the rural with the urban society more of the urban population tended to use toothbrush for maintaining oral hygiene than the nonurban society. This finding is in accordance with the findings of Sen et al. and Varenne et al. who reported that healthier tooth cleaning habits are better reported in the urban society than the rural population. This is obvious because the villagers do not have proper education and thus are unaware of correct oral hygiene measures and tend to use those techniques which are easily accessible and more comfortable for them.
It is interesting to note though that brushing the teeth using toothbrush and toothpaste has been the most common method of maintaining oral hygiene, but the frequency of toothbrushing still lags behind. In the present study, the number of people brushing their teeth twice daily was 21.7% only. These results are similar to the study done by Jain et al. in Jodhpur where only 23% were brushing twice daily. These results are very bleak when compared to studies having international population samples. 62% Kuwaitis, 67% Chinese, and 90% of the US population  have been reported to brushing their teeth twice daily. In this study, highly significant differences have been noticed in the rural and urban population and between the young and the elderly with more number of the young urban adults brushing their teeth twice a day. This may be explained by the fact that oral hygiene awareness was imparted to them in their childhood probably due to school education and various other media such as television, radio, and advertisements.
A total of 36.9% participants were changing their brush when the bristles got frayed, whereas an almost equivalent percentage was changing their brush every 3 months. This is a very promising scenario as compared to the study by Jain et al. where 60% respondents were changing their brush only when the brush became useless. The results of our study are in tune with that done by Sen et al. where 39% of the population changed their brush only when the bristles turned hopeless. This may be explained by the socioeconomic standards of the population who visit our dental hospital. This is further justified by our results which portray a highly statistically significant difference between the rural and the urban population. This difference is also strikingly noticeable in the age groups where the young adults more frequently changed their toothbrush than the elderly who again can be explained by a lack of resources and education.
In the present study, 81.7% of people reported of not using any adjuvant aids, 9.9% affirmed to using regular mouthwash, 5.5% used toothpicks, and only 2.1% were using dental floss. This finding is similar to the results of the study of Jamjoom in Saudi Arabia  where none of the respondents were using adjuvant cleaning aids. Studies on the Indian population have also reported none of the respondents to be using dental floss. In a study by Sen et al., 72% of the participants were not using any adjuvant cleaning aid. This comes in stark contrast when compared to results from Canada where a whopping 44% used dental floss in routine practice. This emphasizes the urgent need for educating and motivating our people on effective use of dental floss as an adjuvant and efficient method for maintaining oral hygiene. About 69.6% of the participants used tongue cleaner whereas 8.45% used brush as an aid to clean their tongue. The rest of the respondents could not affirm to these standards. This is much higher when compared to the findings by Jain et al. where only 20% of the participants were cleaning their tongue. The tongue cleaning habits are very much comparable to the findings of Kapoor et al. and Sen et al. where 67% and 52% respondents were cleaning their tongue. In the study by Oberoi et al., more males were cleaning their tongue than females, and similar results have been obtained in our study.
Oral hygiene still remains a very untouched concept of maintaining a good systemic health. Majority of people express their ignorance on the relationship between oral health and general health. The present study reports 39.2% of people to be unaware of the relationship between systemic health and oral health, and this value is not significant in terms of gender, region, or age group. These results are better than the results reported by Sen et al. (66%) and Kapoor et al. (56.8%) and in line with the study done by Nagarajappa et al. (28.5%).
Visit to a dentist is still deemed necessary only when in pain. The findings of our study corroborate to this observation. Only 31.2% people had visited dentist in the last 1 year of which majority of them had visited only when in pain. Multiple reasons may be allocated for the same including lack of awareness, motivation, or economic.
| Conclusion|| |
This epidemiological study has provided us with baseline data into the oral hygiene habits, motivation, and awareness of the study population of the trans-Varuna region which we find to be better than many other study populations but still lagging behind in many aspects. The poor epidemiological results make it obligatory for us to enforce better oral health education programs which will provide with better results rather than the traditional curative measures. Further research with the people of the same area and larger samples at different time intervals are also required to provide us with more information on the effectiveness of the oral health programs and care given to the study population which will be effective in bringing down the morbidity rates of the oral diseases in this region.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest
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[Table 1], [Table 2], [Table 3], [Table 4]