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ORIGINAL ARTICLE
Year : 2021  |  Volume : 19  |  Issue : 3  |  Page : 224-229

Assessment of degree of dental awareness in schoolchildren aged 10–15 years in Bilaspur District, Chhattisgarh: A cross-sectional study


1 Department of Public Health Dentistry, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India
2 Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India
3 Department of Public Health Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
4 Department of Public Health Dentistry, Government Dental College, Raipur, Chhattisgarh, India
5 Department of Periodontics, Government Dental College, Raipur, Chhattisgarh, India

Date of Submission29-Aug-2020
Date of Decision23-Mar-2021
Date of Acceptance30-Jul-2021
Date of Web Publication15-Oct-2021

Correspondence Address:
Swatantra Shrivastava
Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_172_20

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  Abstract 


Introduction: Oral health may be defined as a standard of health of the oral and related tissues which enables an individual to eat, speak, and socialize without active disease, discomfort, or embarrassment and which contributes to general wellbeing. Aim: This study aimed to evaluate the level of oral awareness among schoolchildren aged 10–15 years in Bilaspur district, Chhattisgarh. Materials and Methods: In an epidemiological cross-sectional survey, 10–15 years old schoolchildren in Bilaspur were examined to assess the dental awareness. A survey form was prepared with help of a self-administered structured questionnaire written in Hindi. The trained dental surgeon distributed questionnaire among the children. A completely answered questionnaire was collected. The observations were reviewed and analyzed. Results: Among the total number of participants (879), 98.1% of them use toothbrush to clean their teeth, 64.7% did not use dental floss, 91.5% of participants clean their tongue, 59.7% of children use mouthwash, and 85.7% rinse their mouth after every meal. Conclusion: The result of the present study suggests that the oral hygiene habits, oral health awareness, and knowledge level among schoolchildren are poor and need to be improved.

Keywords: Awareness, oral health, oral hygiene practices, school


How to cite this article:
Agrawal R, Shrivastava S, Reche A, Wasnik MT, Sangha KS, Patil SR. Assessment of degree of dental awareness in schoolchildren aged 10–15 years in Bilaspur District, Chhattisgarh: A cross-sectional study. J Indian Assoc Public Health Dent 2021;19:224-9

How to cite this URL:
Agrawal R, Shrivastava S, Reche A, Wasnik MT, Sangha KS, Patil SR. Assessment of degree of dental awareness in schoolchildren aged 10–15 years in Bilaspur District, Chhattisgarh: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2021 [cited 2021 Dec 9];19:224-9. Available from: https://www.jiaphd.org/text.asp?2021/19/3/224/328269




  Introduction Top


”While the eyes may be the window to the soul, our mouth is a window to our body's health.”[1],[2] The state of our oral health can offer lots of clues about our overall health. Oral health may be defined as a standard of health of the oral and related tissues which enables an individual to eat, speak, and socialize without active disease, discomfort, or embarrassment and which contributes to general well-being.[3],[4] Oral conditions affect 3.9 billion people globally, the global burden of which increased 20.8% from 1990 to 2010.[5],[6] Dental caries affects 60%–90% of school-age children and most of the adults. Periodontal disease is prevalent in 50%–90% of adults, becoming severe in 10%–15% of them, while gingival diseases occur in majority of children and adolescents.[7],[8] In India, dental caries affects more than four-fifth of children (6–19 years).[7] The prevalence of periodontal diseases ranges from 55% in adolescents to 80% in adults.[9] Adolescence is a stage in which general health is presented at its best, though it is a period of increased risk to oral health because of the greater independence with regard to consumption of sugary foods and a certain revulsion regarding oral hygiene.[4]

The past 50 years have witnessed a reduction in the severity and prevalence of oral disease among the population of the developed countries, whereas there is an uprise in the dental diseases in the developing countries.[10],[11],[12] Dental care has been systematically organized to improve dental health attitudes among children and the young in the developed nations.[10],[13] This development has improved children's dental health and changed the dental caries patterns affecting them.[10],[12],[14] But in several developing countries, a further improvement in oral health needs to be brought about, which can be achieved by improving public health measures, coupled with changing living conditions, lifestyles, and improved self-care knowledge and practices. Hence, the present study was aimed to assess the oral health awareness, knowledge, and practice of 10–16 years old schoolchildren in central India.


  Materials and Methods Top


Samples

In the present cross-sectional survey, 10–15 years old schoolchildren studying in government schools, Sakri, Kota, Ganihari, in Bilaspur district were examined to assess the dental awareness. All the students of 5th to 10th class in school who were present on the day of data collection were included as the study group. The total strength of the class was 1120 out of which 879 students who consented to participate were involved in the study. Before starting the survey, ethical approval was obtained (#19/0065) from the Ethical ccommittee of Institute, Bilaspur, and official permission was obtained from concerned authorities (Principal/Director). Parents' approval and the subject's informed consent were obtained before recruiting the children into this study.

The sample size was calculated as follows:

Sample size = p (1 − p)/e 2

p = prevalence of disease in the population

e = required size of standard error = 0.02

Survey

A survey form was prepared with help of a self-administered structured questionnaire which was adapted from a previous similar study and was translated into Hindi. Prior to the start of the study, the questionnaire was tested on 50 study subjects. Cronbach'salpha and split-half reliability values for knowledge were 0.762 and 0.646, and for practice were 0.86 and 0.88, respectively. The questions were subsequently revised before commencing the main study, for a better understanding of the students. The revisions were related to clarity of 3 questions of knowledge and 4 questions each from behavior. The results of the pilot study were not included in the main study, only the reliability and validity were assessed. The pilot study subjects did not take part in the main study.

The final questionnaire included 20 multiple-choice questions. The survey form included the following:

  1. Oral health knowledge: The assessment of participant's oral health knowledge included 8 questions on method of cleaning teeth, need to rinse mouth, use of dental floss, etc.
  2. Oral health practices: 12 questions on practices followed by regular dental visits, treatment of tooth decay, etc.


All the children available on the days of survey were asked to respond to each item according to the response format provided in the questionnaire. The response format included multiple-choice questions in which the students were instructed to choose only one response from the provided list of options. The students received a full explanation of how to fill in the questionnaire. Furthermore, the investigator was always available during the completion of the questionnaire and the participants were encouraged to approach the investigator for clarification of any queries.

The students who were asked to fill in the questionnaire without discussion with each other took an average of 20 min to complete the procedure. It was later checked by the investigator that none of the questions were left un-attempted.

The data were entered into the MS Excel (MS Office version 2007 developed by Microsoft, Redmond, WA) and Intercooled STATA version 9.2 (StataCorp, TX, USA) was employed to perform statistical analysis. For the purpose of analysis, each correct answer was given a score “one” and wrong and don't know answers were given a score “zero” in the questions included in knowledge and practice sections of the questionnaire.


  Results Top


This survey was conducted to assess oral health knowledge and practice among 10–15 years old school students in Bilaspur, India. A total number of 879 children were participated in the survey of which 500 (56.88%) were boys and 379 (43.12%) were girls. The distribution of the study participants by gender is illustrated in [Table 1]. The mean percentage knowledge scores were 4.11 ± 1.46 and for practice, scores were 4.50 ± 1.365 for all the children.
Table 1: Distribution of the study participants according to age, sex, and standard

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Brushing: Among the total number of participants (879), 98.1% of them use toothbrushes to clean their teeth. It is also found that 70.0% were brushing twice a day, 46% use circular method.

Majority of the participants (69.2%) did not know that an electronic toothbrush is more effective in cleaning teeth while.

Other oral hygiene aids: When oral hygiene practices were assessed, it was found that 64.7% did not use dental floss. It was also found that 91.5% of participants clean their tongue and 59.7% of children use mouthwash.

Oral hygiene practices: A majority of the participants (85.7%) rinse their mouth after every meal and according to 48.5% answered that mouthwash should be used once a day, 49.8% thought that mouthwash prevents tooth decay as well as prevents foul odor [Table 2].
Table 2: Distribution of knowledge among the participants according to standard/age

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Visiting the dentist

Regular dental checkup has a significant impact on oral health, 54.2% of them visited whenever needed; out of the total participants, 34.6% children got their teeth cleaned by a dentist 1 year ago. Frequency of professional cleaning was assessed and it was found that 43.6% answered that it is appropriate to get their teeth cleaned by a dentist whenever required.

Comparison between oral health and other health conditions: The participants of this study show high awareness (66.1%) of the link between oral health and systemic well-being,

Prevention and treatment of dental caries: It is said that prevention is better than cure, thus knowledge regarding the prevention of dental caries is extremely important. When questioned regarding the best method of preventing tooth decay, 28.7% of them answered use of fluoridated water and dental fluoride products.

Restoration of caries in deciduous teeth is essential for the prevention of caries in their successors, 54.8% of the participants answered correctly.

Majority of the students (45.5%) answered that calcium makes their teeth stronger and 8.4% of the students were aware of the fact that fluoride present in water helps make teeth stronger [Table 2] and [Table 3].
Table 3: Distribution of knowledge among the participants according to standard and age

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  Discussion Top


It has been found that a considerable number of children in developing countries have limited knowledge of the causes and prevention of oral disease.[4],[15],[16],[17],[18],[19],[20],[21] The traditional behavior change model states that imparting knowledge will enhance the attitude and health-related behavior. Children can be provided with knowledge that enables them to make healthy choices, to adopt a healthy lifestyle, and to deal with conflicts. Children are the ideal target group for an early intervention because healthy behaviors and lifestyles developed at a young age are more sustainable.[4],[15]

The intention of this study was to provide systematic information on the oral health awareness (knowledge) and practice of the 10–15 years old schoolchildren in Central India.

According to the present study, 98.1% (862) of subjects used toothbrush for cleaning their teeth, which was similar to the study by Bhat et al. in Bengaluru, India, out of which 70% (615) brushed twice in a day.[22] The results of the present study were higher than the study conducted by WHO (2008) which showed that 44.4% of the participants brushed their teeth twice a day.[23] The use of dental floss was still not very popular among the secondary school students as evident in this study (35.3% [310)) when compared to a survey conducted in San Francisco where 75% of the 12–14 years old students use dental floss at least once per day (Walsh, 1985),[24] and in Iraq where over half of the students used dental floss once or more a week,[25] whereas our findings were higher than the findings of Lian et al., Malaysia (11.5%)[26] and also in the study by Bhat et al., in Bengaluru, India (7%).[22] This could be attributed to a lack of oral health education via social media and/or cost of such aids. The low percentage of participants who use floss in this study emphasizes the urgent need for educating and motivating the public to use this efficient method for oral health care. About 54.1% (475) of the students did not know the ideal method to brush their teeth, which is comparable with the study carried out in south India by Kuppuswamy et al. (69%).[5]

Lack of parental health education as well as attention toward their child's brushing practice may be the reason for the implementation of improper brushing technique. Out of the total number of participants, only 8.4% were aware that fluoride helps to strengthen teeth, this was considerably lesser than observed in the study carried out by Manjunath G and Kumar NN in Andhra Pradesh in which 47.2% of the participants were aware of this fact.[27] Lack of awareness about the beneficial effects of fluoride on teeth may be due to a lack of oral health education and social media. The awareness among the participants of the present study regarding the ideal methods of preventing tooth decay by limiting sugary snacks was 22.3%, using fluoridated toothpaste was 28.7%, and brushing teeth was 18.3%, while the scores of the study carried out in Udaipur by Sharda et al. were 34.6%, 12.6%, and 40.5%, respectively.[4] Misconceptions regarding the ill effects of fluoride and fluoride anti-lobbies may be the reason for the limited use of fluoridated toothpastes. Restoration of dental caries is in deciduous teeth is extremely important to prevent further spread of caries in their permanent successors, 54.8% of the participants in the present study agreed with this, while only 38.2% of the participants were aware of it in the study carried out by Petersen and Esheng in China.[17]

Oral health may be considered as a key to general health; 66.1% of the participants in the present study were aware of the correlation between oral health and general health, the findings were in agreement with the studies carried out by Mahmoud K. Al-Omiri shows that 67.0% and 54.2% of the study participants also agreed for the same.[10] This may be attributed to the increase in awareness about oral health, general health, and their correlation.

It has been proven that professional dental cleaning should be carried out twice a year for the maintenance of good oral hygiene. In the current study, the participants who got their teeth cleaned by the dentist in the last 1–2 years were 25.8%; which was similar to the findings of Ling Zhu et al. in China (22.2%).[28]

Children, parents, and teachers need to be informed, motivated about dental care so that their attitudes change. Based upon this finding, the establishment of school-based oral health education programs in rural schoolchildren, including parents and teachers, is recommended. A longitudinal study is needed to understand the possible determinants of oral hygiene and its oral health-seeking behavior among children in different settings.


  Conclusion Top


Evidence had shown that strong knowledge of oral health demonstrates better oral practice. The change to healthy attitude and practice can be occurred by giving adequate information, motivation, and practice of the measures to the subjects. Result of the study proved that the oral hygiene habits, oral health awareness, and knowledge level among schoolchildren are poor and need to be improved. Knowledge imparted through these programs would go a long way in the maintenance of oral health in these children.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3]



 

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