|Year : 2019 | Volume
| Issue : 2 | Page : 141-145
Awareness, attitude, and prevalence of periodontal diseases in West Godavari District of Andhra Pradesh
Praveen Gadde1, Gautami S Penmetsa2, M A. K. V Raju3, A V. Rama Raju4
1 Department of Public Health Dentistry, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
2 Department of Periodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
3 Department of Orthodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
4 Department of Prosthodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
|Date of Submission||06-Jun-2018|
|Date of Acceptance||28-Mar-2019|
|Date of Web Publication||20-Jun-2019|
Dr. Gautami S Penmetsa
Department of Periodontics, Vishnu Dental College, Bhimavaram - 534 202, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Background: Prevention and control of oral diseases, in general, and periodontal diseases, in particular, are influenced by the knowledge attitude and personal behavior of the individual. Aim: The aim of this study was to determine the prevalence of periodontal disease as well as awareness and attitude of the individuals toward periodontal diseases. Material and Methods: This descriptive, cross-sectional epidemiological survey included a total of 3200 individuals with an age range of 18–65 years. For sample selection, West Godavari district was divided into four revenue divisions. From each division, two mandals were selected, and from each mandal, two villages were selected randomly. The examination process included the recording of the indices, namely, Community Periodontal Index (CPI) and Loss of Attachment Index in an attempt to estimate the prevalence of periodontitis. On the other hand, a 23-item questionnaire was given to all the participants involved in the study to assess the knowledge and attitude of the involved individuals. The data collected were analyzed using IBM SPSS version 21.0. Descriptive statistics were computed. T-test and one-way analysis of variance were employed. P < 0.05 was considered statistically significant for all the comparisons. Results: The results of our study showed a prevalence rate of 55.3% in the West Godavari population. Poor knowledge regarding periodontal status was observed in our study in patients above 45 years of age. There was no significant difference in periodontal knowledge score between males and females (P = 0.788). The graduates elicited greater periodontal knowledge compared to illiterates (P < 0.001). Conclusion: Our results showed higher prevalence of periodontal diseases with poor periodontal knowledge score alongside a generally positive attitude toward periodontal health and disease among the West Godavari population. Health education programs should place more emphasis on causes and manifestations of periodontal diseases
Keywords: Education level, periodontal knowledge, periodontitis
|How to cite this article:|
Gadde P, Penmetsa GS, Raju M A, Raju A V. Awareness, attitude, and prevalence of periodontal diseases in West Godavari District of Andhra Pradesh. J Indian Assoc Public Health Dent 2019;17:141-5
| Introduction|| |
An important aspect of the overall health status of an individual owes to the oral cavity, which is regarded as a mirror and a gateway to oral health. Periodontal disease and tooth decay are the biggest threats to oral health among the various diseases affecting the oral cavity. Inflammation of specialized tissues supporting and surrounding the teeth, leading to a progressive loss of connective tissue attachment and alveolar bone eventually resulting in tooth loss which is a consequence of periodontal disease, dates back to the early human civilization as indicated by periopathological studies. The initiation and progression of periodontal disease is mainly a sequel of poor oral hygiene and noncompliance and hence personal knowledge regarding oral hygiene can reduce the progression of dental caries and periodontal disease. On the other hand, a belief that periodontal disease should be considered as a lifestyle disease as the literature has evidenced its relation with tobacco, diet, and physical activity. Taking this aspect into consideration, knowledge related to oral health behavior and its related factors can influence periodontal conditions which, in turn, attributes to its progression and prevention.
Even though knowledge plays a key role in maintaining the oral hygiene of an individual attitude toward health personnel, in general, dentists and dental services, in particular, are a culmination of life experience and events. The seeking of dental services is mainly influenced by the attitude of the public toward dentists, both dental service providers and planners would benefit if they would have a better understanding of the public attitude toward dentists and dental services.
India being the second most populous country in the world with a population of over 1 billion, the prevalence of periodontal disease is high, which ranges in different population groups, although differing in severity between different age groups. As it is very well understood that the successful periodontal outcome is dependent on the knowledge and attitude of the patients toward dentistry, in general, and dental services, in particular, a dire need toward understanding of the public attitude and their level of knowledge toward maintaining a disease-free oral cavity exists. Having >310 dental colleges approximately producing 25,000 dental graduates/year and 5000 specialists and the dental colleges offering excellent tertiary care in the cost-effective manner, it is unfortunate that even the most basic oral health education, simple interventions such as pain relief and emergency care such as acute infections and trauma are not available to a vast majority of cases, especially in the rural areas. Even though the National Oral Health Survey and Fluoride Mapping (2002–2003) were done in Vishakhapatnam and Guntur districts, unfortunately, West Godavari district was not taken into the sample; hence, no reliable information was available regarding periodontal disease in the West Godavari population. As there is a lack of population-based data on the knowledge and attitude and the prevalence of periodontal diseases in West Godavari district of Andhra Pradesh, it is really important to conduct a study that will help dental professionals in improving the understanding of patients about periodontal diseases, thereby reducing the myths of general population toward periodontal diseases and therapy. Hence, the present study was conducted to assess knowledge, attitude, and prevalence of periodontal diseases in West Godavari district, Andhra Pradesh.
| Material and Methods|| |
The study is a cross-sectional, population-based survey conducted from October 2013 to September 2014 among individuals between 18 and 65 years living in West Godavari district of Andhra Pradesh, individuals willing to participate and who agreed to give informed consent were included in the study. To select a representative sample, we applied stratified, multistage, random area sampling. For sample selection, West Godavari district was divided into four zones. From each zone, two mandals were selected, and from each mandal, two villages were randomly selected. A sample size of 3200 was included based on the findings from a pilot study, which showed the prevalence of periodontal diseases at 56% considering 80% power, 95% confidence level, and 1.75% confidence interval.
For data collection, a specially designed pretested pro forma was used. The pro forma consisted of demographic details such as name, age, sex, income, education, occupation, personal habits, and systemic diseases if any. The pro forma also included a structured, 14-item questionnaire designed from the previous studies to assess the knowledge and attitude level of participants regarding periodontal health and disease. In the knowledge section, few items focused on gingival health, some items addressed causes and outcomes of periodontal disease, and few items were related to the impact of systemic disease on the progression of periodontal conditions and prevention. In the attitudes section, there were nine statements about periodontal health and disease. In the pilot study, the external reliability reported was 0.85 for all questions by test–retest method. To assess internal consistency, Cronbach's alpha was calculated and found to be 0.77. The clinical examination included recording of CPI and loss of attachment scores (Oral Health Surveys: Basic Methods, 4th Edition. WHO, Geneva) in an attempt to estimate the prevalence of periodontal diseases. All participants were provided with full explanation of the study objectives, and the questionnaire was in their native language. For assessing knowledge score, each question was given one correct statement, and the other statements were wrong and the participant responded to the statement by selecting one of the three responses, namely, Yes, No, or Do not know. The responses to the questions about periodontal knowledge were scored as true (Score 1) and false (Score 0), and a sum score derived from 14 questions (range 0–14) was calculated for each participant. Five response categories were assigned to the statements associated with the periodontal attitude, namely, strongly agree, agree, no opinion, disagree, and strongly disagree. The categories strongly agree and agree were combined to yield the measure of agreement, whereas the categories no opinion, disagree, and strongly disagree were combined to yield the measure of disagreement. Measure of agreement for Questions 1 and 2 and disagreement response to remaining all questions indicates positive attitude. Once completed each questionnaire was double checked to ensure that all the items were answered, and participants were requested to complete any missing data.
Six trained interviewers carried out data collection. To ensure uniformity in data collection and avoid interviewer variability, detailed information regarding the process of interviewing and ethical considerations were delivered by the main researcher in which interviewers received relevant guidelines on the ethical issues, questionnaires, and interview. Ethical clearance was obtained from the Institutional Review Board, Vishnu Dental College (VDC/RP/2013/04). The data collected were analyzed using IBM SPSS Statistics for Windows, Version 21.0. (IBM Corp., Armonk, NY, USA). Frequency tables, percentages, and cross-tables were generated. For comparison of knowledge with sociodemographic variables, a t-test and one-way analysis of variance were employed. The significance level was set at <0.05.
| Results|| |
Distribution and demographic variables of study population
The study population comprised 54.36% of males and 45.64% of females with the mean age of 46.1 years. Employed participants were 1764 constituting 55.10% when compared with overall participants in the study; on the other hand, illiterate participants comprised 49.30%. Majority of the study population had income >5000 [Table 1].
Comparison of periodontal knowledge score among different study variables
On comparison of periodontal knowledge score with age, 18–24 years group depicted the highest periodontal knowledge score (9.52 ± 3.28). The lowest score of 8.0 ± 3.07 was observed in the age groups of >45 years showing statistically significant difference between the younger and older age group. On the other hand, with respect to gender, the mean and standard deviation (SD) of 8.58 ± 3.11 and 8.63 ± 3.16 were observed in males and females, respectively. Taking occupation levels into consideration, the highest mean and SD levels of 8.65 ± 3.13 were elicited in the employed group with the mean score of 7.66 ± 3.14 and 9.57 ± 3.45 in unemployed and students, respectively. The least periodontal knowledge score (8.56 ± 3.13) was observed in homemakers. There was no statistically significant difference when males and females were compared (P = 0.788) and also when different occupations were compared (P = 0.187). Taking into consideration the education levels, the highest score (9.98 ± 3.04) was observed among graduates and the lowest score (7.47 ± 3.02) for illiterates (P < 0.001).
The highest periodontal knowledge score (9.42 ± 3.12) was observed in individuals with income of 5000 or more, and the lowest score (7.85 ± 3.08) was found in individuals with income < 1500. The difference was found to be statistically significant (P < 0.001).
There was a statistically significant difference in periodontal knowledge score was found between participants with or without adverse effects (P < 0.001). The highest score (8.74 ± 3.13) was observed in patients with no adverse habits. When systemic diseases were taken into consideration, the score was higher in patients without systemic diseases (8.77 ± 3.11), which was statistically significant (P < 0.001) [Table 2].
|Table 2: Comparison of periodontal knowledge score among the different study variables|
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When attitude response toward periodontal diseases was taken into consideration, it was largely positive toward the impact of gum disease, also participant's attitude was positive toward preventive practices. On the other hand, a negative attitude toward using unconventional oral hygiene practices was observed [Table 3].
|Table 3: Response of the study participants to questions on attitude toward periodontal diseases|
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| Discussion|| |
The present study was the first of its kind, which was carried out exclusively and extensively on the periodontal status in the population of West Godavari district of Andhra Pradesh. As in the literature, no studies have been carried out on the oral health status in the West Godavari district of Andhra Pradesh, our study aimed to identify the association between oral health knowledge and attitude which could have an impact on the performance level of oral care among the population and also to assess the prevalence of periodontal disease in West Godavari district. The alarming rise in the rate of prevalence in periodontal disease in India has drawn interest from various parts of the country. A multicentric oral health survey was envisaged under the Government of India and the WHO collaboration in the year 2004 in order to have a baseline data of the burden of oral diseases in various age groups in seven different geographical locations in India, namely, Arunachal Pradesh, Delhi, Maharashtra, Puducherry, Rajasthan, Orissa, and Uttar Pradesh, thereby surveying a total of 22,400 people in rural and urban areas of selected districts. High prevalence of periodontal disease was reported from the states of Orissa and Rajasthan, wherein the other states had evidenced a low prevalence of the disease. In this study, the prevalence rate of periodontitis was 55.3%.
Our study also aimed at assessing the periodontal knowledge score with respect to sociodemographic variables. Patients with an age group of 18–24 years had high awareness on the periodontal diseases when compared to patients with age >45 years. Age was found to be significantly associated with periodontal knowledge in the present study, which is in accordance with the studies of Diofode, Alsinaide, and Albander.,, In this study, females have shown greater knowledge scores when compared to males even though the difference was statistically not significant, which is in accordance with the studies of Albandar JM et al. On comparison of scores regarding periodontal knowledge among different occupational groups, students had greater knowledge score, whereas the unemployed section had low knowledge. Based on the education level of the study population, graduates had greater awareness and knowledge regarding periodontal disease compared to illiterates. The higher prevalence of periodontitis in our study is concomitant with low level of education, income, occupation, and vice versa, which is in accordance with the studies of Torrungruang et al. conducted in Thailand and Borrell et al. conducted in the USA. It has also been observed in our study that the individuals with low level of socioeconomic status and low level of parental education may lack awareness about the importance of oral health education, and this may be attributed to their inability and accessibility in affording the appropriate oral hygiene needs and health-care facilities, which could be explained by the results of a study done by Ameer et al.,
When personal habits and periodontal knowledge were taken into consideration, the present study revealed that the knowledge among smokers and alcoholics was less when compared to individuals with no habits, and this finding was inconsistent with the study conducted by Shimazu et al. One of the most important aspects included in the present study was the systemic diseases, especially diabetes as the literature search strongly proposes a dual relationship between diabetes and periodontitis., In this study, an increased prevalence of periodontitis in individuals with diabetes mellitus who had less knowledge score was evidenced, and these results are in agreement with those of Cianciola et al. As our study also aimed at the attitude response of the population toward periodontal diseases apart from the prevalence and knowledge, the study participants have shown a largely positive attitude toward the impact of gum disease and preventive practices including regular checkups. On the other hand, the attitude that oral prophylaxis would be harmful for the gums was observed in our study, which was in accordance with the findings of a study conducted in Hongkong and Tehran.,
Strengths and limitations of our study
The knowledge, attitude, and practice model served as our theoretical framework for the development of the survey tool. This model explains changes in attitude through knowledge improvement and despite the weaknesses attributed to it; the model is still useful as the theoretical framework for various dental health education interventions. Since we had no access to a standard questionnaire to assess periodontal knowledge and attitudes, a researcher-created instrument allowed the collection of information after tests of its validity and reliability. Our sampling covered all the revenue divisions to increase the representativeness of the sample. This data can be utilized for further planning of oral health programs in West Godavari. To reduce information bias, all interviewers were calibrated, and the interview process was supervised.
| Conclusion|| |
Our results showed the higher prevalence of periodontal diseases with poor periodontal knowledge score alongside a generally positive attitude toward periodontal health and disease among the West Godavari population. Health education programs should place more emphasis on causes and manifestations of periodontal diseases.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]