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Year : 2022  |  Volume : 20  |  Issue : 1  |  Page : 81-85

Impact of general hygiene behaviors on oral hygiene among adolescents of Ghaziabad - A cross-sectional study

Department of Public Health Dentistry, ITS Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India

Date of Submission17-Aug-2020
Date of Decision09-Nov-2021
Date of Acceptance27-Dec-2021
Date of Web Publication25-Feb-2022

Correspondence Address:
Iram Ahsan
D-1302 Charms Castle, Rajnagar Extension, Ghaziabad, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiaphd.jiaphd_163_20

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Background: There is the presence of plenty of evidence supporting the unidimensionality of hygiene behaviors inferring oral hygiene and general hygiene is correlated. More than two-third of India's population still lives in rural areas; therefore, this study is also conducted in the rural areas only. Rural areas generally tend to have poor general hygiene behaviors because of sociodemographic and educational factors and that directly affect the oral hygiene behaviors. Aim: The aim of this study is to assess the impact of general hygiene behaviors on oral hygiene among adolescents of Ghaziabad district of Uttar Pradesh. Materials and Methods: Data were collected from 800 adolescents among 510 households from all the four blocks of Ghaziabad district. A pretested questionnaire was used to assess the demographic variables, oral hygiene, and general hygiene behaviors. Oral hygiene was assessed using oral hygiene simplified index, and general hygiene behaviors were recorded using the four indices related to drinking water index (score 0–3), food index (score 0–3), personal hygiene index (score 0–3), and domestic household hygiene index (score 0–6) and one summary hygiene index (SHI; range 0–15). Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) software version 20.0. Results: More than 50% of the study participants had a low level of general hygiene. A significant association was observed between general hygiene (SHI) and oral hygiene of the individuals. Conclusion: The present study demonstrates significant association between general hygiene and oral hygiene behaviors among adolescents.

Keywords: Adolescents, behaviors, general hygiene, households, oral hygiene

How to cite this article:
Ahsan I, Menon I, Gupta R, Arora V, Das D, Ashraf A. Impact of general hygiene behaviors on oral hygiene among adolescents of Ghaziabad - A cross-sectional study. J Indian Assoc Public Health Dent 2022;20:81-5

How to cite this URL:
Ahsan I, Menon I, Gupta R, Arora V, Das D, Ashraf A. Impact of general hygiene behaviors on oral hygiene among adolescents of Ghaziabad - A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2022 [cited 2024 Mar 4];20:81-5. Available from: https://journals.lww.com/aphd/pages/default.aspx/text.asp?2022/20/1/81/338510

  Introduction Top

Oral and general hygiene are two of the most important factors affecting the health of the public. Thus it is important to gain insights into factors influencing hygiene behaviors to improve preventive strategies. It becomes more important in a low income country such as India, where most of the population still lives in rural areas, generally possessing poor hygiene trends. Hygiene behaviors have usually been considered as the part of oral and general health behaviors.[1]

Conventionally, hygiene is defined as the practice of keeping oneself and one's surroundings clean. Good oral hygiene not only affects oral health but also it is the most effective way of reducing and preventing systemic problems. Thus, health-promoting activities that do not include good hygiene may lead to only small improvements in oral and general health. It has also been suggested that general hygiene behaviors and oral hygiene behaviors are strongly related. As an oral health-care provider, it is important to identify the factors influencing general hygiene behaviors and oral hygiene behaviors to improve the health of the public.[2]

Hygiene plays an important role in preventing the spread of infectious diseases. It includes procedures used in a variety of domestic situations such as hand hygiene, respiratory hygiene, food and water hygiene, general home hygiene (hygiene of environmental sites and surfaces), care of domestic animals, and home health care (the care of those who are at greater risk of infection).[2]

Good oral and dental hygiene can help prevent bad breath, tooth decay, and gum disease − and can help you keep your teeth as you get older. Researchers are also discovering new reasons to brush and floss. A healthy mouth may help you ward off medical disorders.

Normally, the body's natural defenses and good oral health care, such as daily brushing and flossing, keep bacteria under control. However, without proper oral hygiene, bacteria can reach levels that might lead to oral infections, such as tooth decay and gum disease.

Oral diseases are the biggest public health problem.[3] According to the World Health Organization (WHO), Promotion of oral health is a cost-effective strategy to reduce the burden of oral disease and maintain good oral hygiene.[4] Periodontal diseases are among the most prevalent dental disease affecting people worldwide as well as in the Indian community. The possible etiological factors leading to the periodontal diseases are poor oral and general hygiene. Along with this a number of diseases are generated because of poor general hygiene such as Athletics' foot, Swimmer's ear, chronic diarrhea, and pinworms.[5]

To prevent these health issues, practicing good oral hygiene is very important. People at an early age should get into good practices. Regular dental visits, brushing regularly, flossing, and watching what you eat are all the important steps in preventing dental diseases and keeping one in good health.

Despite improvements in global health scenario during the last decade, infectious diseases are still a major global public health problem.[6] United Nations Children's Fund and multi-national reviews have suggested that hygiene plays a key role in reducing the pan nation burden of communicable diseases and it can be noted in most low- and middle-income countries, as they have a limited system to educate, motivate, and intervene about infection control. A notable finding is the substantially high infant mortality rates in the low-income countries due to infections of gastrointestinal and respiratory origin backed up by inadequate general hygiene.[7]

Infectious disease is one of the major burdens worldwide. Person-to-person transmission in the home can occur by direct hand-to-mouth transfer, or food prepared in the home by an infected person, or by transmission due to aerosolized particles resulting from sneezing, vomiting, and diarrhea.[8]

Hand and surface hygiene plays an important role reducing the spread of not only hospital-acquired infection but also influenza.[9] Personal and household hygiene can also play as a defensive strategy against future epidemics.[10] Hygiene is therefore important as a first line of defense to mitigate the spread of pathogens in people's everyday environments.[11] Handwashing with soap is one of the most important means of preventing infectious disease transmission; systematic reviews show it can reduce rates of diarrheal disease by 30%[12] to 47%[10] and rates of respiratory infection by 23%[13] both of which are among the top five causes of death globally (WHO 2008).

Several studies conducted by Magiorakos et al.[14] and Ray et al.[15] have shown that children growing in the household where the mothers do not maintain hand sanitization were more likely to suffer from a specific infectious disease and proposed that specific hand hygiene measures could substantially bring about a decline in mortality rates.

The household surfaces remain clean can be important. Preventing food-related infections, in this context is the regular cleaning of household surfaces in kitchens and bathrooms. In a developing country context, food can become infected with human pathogens and even children's toys can be a significant contamination risk. Domestic infectious disease burden worldwide, then, is handwashing with soap and surface cleaning.[16]

Worldwide, poor oral and general hygiene behaviors among the adolescents are associated with a high risk of oral health problem and systemic problems such as gastrointestinal and respiratory infections. There is a scarcity of data regarding oral and general hygiene behaviors among the adolesecents of Ghaziabad district. Keeping this in mind, the present study was conducted to assess the impact of general hygiene behaviors in households on oral hygiene among adolescents of Ghaziabad district, Uttar Pradesh.

  Materials and Methods Top

A descriptive cross-sectional study was conducted to assess the impact of general hygiene behaviors in household on oral hygiene of adolescents in Ghaziabad district, Uttar Pradesh.

Ghaziabad district is a largely suburban district of Western Uttar Pradesh in National Capital Region of India. Ghaziabad district has four blocks, namely Razapur block, Muradnagar block, Bhojpur block, and Loni Block. An official Census 2011 detail of Ghaziabad released by Directorate of Census Operations in Uttar Pradesh states that Ghaziabad has a population of 4,681,645, of which male and female were 2,488,834 and 2,192,811, respectively.

The present study was conducted in four blocks of Ghaziabad where the adolescents had access to preventive and diagnostic services in the households of Ghaziabad district.

Source of data

A total sample of 800 adolescents aged 13–17 years from 510 households from 10 villages from each of the 4 blocks were included in the study. Households in each village were selected using the systematic random sampling.

Sample size determination and sampling procedure

The sample size for the present study was calculated based on the data obtained from the pilot study conducted in four blocks of Ghaziabad to check for the feasibility of the study, and these subjects were not included in the main study. It was revealed by pilot study the correlation coefficient r = 0.1 between oral hygiene index-simplified (OHI-S) and general hygiene index.

Sample size was calculated using the following formula:

N = [(Zα+Zβ)/C] 2 + 3

Substituting the Z α/2 value for 5% level of significance and Zβ value for 80% power of the study:

Zα = 1.960

Zβ = 0.842

C = 0.5* ln ([1 + r]/[1-r]) =0.1

Substituting the above values,

N = ([1.96 + 0.84]/0.1)2 + 3 = 783 rounded off to 800

The total sample of 800adolesecents was proportionately selected in each block based on the total population of each block.

Inclusion criteria

  1. All participants aged 13–17 years were included in this study
  2. Multiple participants were eligible within households.

Exclusion criteria

  1. Participants not willing to participate in the survey
  2. Patients on antibiotics or with insufficient information were excluded.

Data collection

The study protocol was approved by the Institutional Ethical Committee and Review board, Ghaziabad. Official permission to conduct the study was obtained from higher authorities of respected places where the study was conducted and written Informed consent was obtained from all the study participants. The data were collected over a period of 6 months from September 2019 to February 2020.


A pretested questionnaire was interviewer-administered to the adolescents to know the demographic variables and oral hygiene practices. An assessment of per capita income classified according to the Modified BG Prasad Scale[17] for the socioeconomic status was used.

General hygiene was assessed using four indices, i.e., drinking water index (DWI), food index (FI), or hands during defecation personal hygiene index (PHI); and presence of animals or insects that can transmit fecal contamination to previously clean surfaces domestic household hygiene index (DHI). Each item was scored as 0 or 1, with 1 representing positive behaviors and was recorded according to the criteria given by Amy L Webb in 2006.[18] The indices were calculated as the simple sum of the items. Summary hygiene index (SHI) was calculated as the sum of the four individual indices.

Clinical examination

Adolescents were examined for oral hygiene. Oral hygiene was assessed using Oral Hygiene Index-Simplified and was recorded according to the criteria given by Greene and Vermillion in 1964.[19]

Training and calibration

Two-day training sessions for standardization and calibration of the data collection methods were organized in the Department of Public Health Dentistry. The examiner was trained and calibrated by carrying out the examinations on the preselected participants twice at the interval of 30 min. The diagnostic variability in two assessments was found to be small, and an agreement was found to be in the range of 88%.

Statistical analysis

The statistical package IBM SPSS Statistics for Windows, Version 20 (IBM Corp., Armonk, N.Y., USA). Descriptive statistics such as mean, standard deviation, and percentage were used. Association was evaluated using the Chi-square test. Any P < 0.05 was considered statistically significant. Spearman's correlation coefficient was calculated for the correlation between oral hygiene with general hygiene behaviors.

  Results Top

The present study was conducted on adolescents aged 13–17 years, with a mean age of 13.6 (1.43) years.

Demographic characteristics

[Table 1] shows the sociodemographic characteristics of the adolescents. The study was conducted in all the four blocks of Ghaziabad district, and the sample was proportionately collected based on the population of each block. The majority 55.8% of the adolescents were male.
Table 1: Demographic characteristics of the adolescents

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Majority of the adolescents, 45.5% belonged to upper lower class followed by 34.4% belonging to lower class. A total of 91.3% used toothbrush with toothpaste to clean their teeth, while nearly only 4.2%, used finger and toothpaste to clean their teeth.

[Table 2] shows mean according to oral and general hygiene behaviors among adolescents. The mean oral hygiene index in the present study was 4.23 ± 1.17, mean DWI was 1.11 ± 0.77, mean FI was 1.11 ± 0.49, mean PHI was 1.49 (1.0), mean DHI was 1.53 ± 0.71 and simple hygiene index was 5.26 (1.23).
Table 2: Mean according to oral and general hygiene behaviors

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A highly significant positive correlation was found between oral hygiene index and subdomains of simple hygiene index. Furthermore, a statistically significant negative correlation between socioeconomic status and simple hygiene index subdomains; DWI (−0.082), DHI (−0.269) and oral hygiene index (OHI-S) (−0.124) except PHI (0.150) where highly positive correlation was observed. A significant negative correlation was found between the number of dependents and subdomains of simple hygiene index except DHI (0.042) [Table 3].
Table 3: Correlation between the oral hygiene index, simple hygiene index, socioeconomic status and number of family dependents

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  Discussion Top

The present cross-sectional study demonstrated the impact of general hygiene behaviors on oral hygiene among adolescents in rural area. Adolescence is a period of adopting new attitudes and behaviors, along with increased autonomy, which allows adolescents to take part in several situations that can affect general and oral hygiene.

In the present study, 55.8% were male and 44.2% were female with a mean age of 13.6 ± 1.43 years. Socioeconomic status is one of the risk factors for poor oral hygiene and general hygiene. Persons of lower socioeconomic status suffer disproportionately more from nearly all diseases than people of higher socioeconomic status. In the present study, 45.5% of the households were of upper lower socioeconomic status followed by lower class and very low fraction of the households studied were from high socioeconomic status. This might be due to the study setting which was mainly assessed among the rural population of Ghaziabad district where majority of population is illiterate and unemployed.

In our study, the overall OHI-S scores of adolescents (4.23) were higher which indicates that they have poor oral hygiene. This could be due to socioeconomic factors and the availability and affordability of toothbrushes and fluoridated toothpaste. This finding is supported by the observations of the study on adolescents by Yee et al.[20] where school children enrolled in urban schools had better oral cleanliness (good) than their counterparts in both rural towns (fair) and villages. This is contrast to the study done by Bashirian et al. 2018 in school children; in this study, OHI-S scores depicted that more than half of the primary school students had good oral hygiene status (65.2%). This might be due to in this study majority of the population belonged to urban and suburban area.[21]

The analysis of subdomains of the mean SHI demonstrates that the mean of FI was lower (1.11) as compared to DWI, PHI (1.49), DHI (1.53), and overall SHI score of adolescents (5.26). This depicts that the adolescents who have lower SHI score have poor general hygiene, reason might be this study is done on rural population and there is a need to improve the knowledge and general hygiene practices to prevent the occurrence of systematic and oral diseases that will prove to be yet another financial burden, especially on those belonging to the low income group.

Spearman's correlation coefficient test was performed to see the correlation between the oral hygiene simplified index (OHI-S) and SHI subdomains. There was a highly significant positive correlation between OHI-S and SHI subdomains; DWI (.626**), FI (.460**), PHI (.346**), DHI (.370**) and simple hygiene index (.948**) was observed among adolescents. Thus indicating adolescents living households with poor general hygiene also had poor oral hygiene. This could be due to the lack of attitude and negligence toward oral hygiene that has a negative impact on the general hygiene. This finding is in agreement with previous studies done by Dorri et al.[1] 2010 and Ghanbariha et al.[22] 2014 in adolescents where oral and general hygiene behaviors are not only positively associated but also share common social indicators, including sociodemographic factors, peer social networks, and sense of coherence.

Socioeconomic status was a negative correlation between OHI-S (−0.124**), simple hygiene index (−0.071*), and other subdomains in the present study indicating adolescents belonging to lower socioeconomic status had poor oral hygiene. This is comparable to the study done by Paula et al.[23] in Brazil which found that school children who belonged to families whose income was lower than one minimum wage were 1.89 times more likely to have dental problems, as the home environment is an important social determinant of children's oral health.

In our study, also a highly significant negative correlation number of dependents between OHI-S (−0.110**) and simple hygiene index (−0.151**).

Government of India is working rigorously to improve the standard of cleanliness, and hence, the General Hygiene of Masses. Swachh Bharat Abhiyan was launched on Oct 2' 2019 with same goal. The program includes elimination of open defecation, conversion of unsanitary toilets to pour flush toilets, eradication of manual scavenging, municipal solid waste management, and bringing about a behavioral change in people regarding healthy sanitation practices. The Nirmal Bharat Abhiyan has been restructured into the Swachh Bharat Mission (Gramin). The mission aims to make India an open defecation free (ODF) country in 5 years. It seeks to improve the levels of cleanliness in rural areas through solid and liquid waste management activities and making Gram Panchayat ODF, clean and sanitized. Even after taking several initiatives by government of India. We still came across poor general hygiene which leads to diseases such as diarrhea, gastroenteritis, and skin infections. General hygiene is significant public health menaces which have a substantial impact on oral hygiene which in turn affects the daily performance and life.

  Conclusion Top

This study demonstrated that positive association between general hygiene behaviors and oral hygiene behaviors among adolescents. Composite indices may provide for a more accurate and consistent representation of a household's true hygienic state. This association has important implications for planning health and hygiene-promoting programs. Strategies to promote oral hygiene are not usually carried out jointly with other health personnel. As all hygiene behaviors are based upon similar motivations and are inter-related, it is rational for personnel promoting hygiene to collaborate to increase the efficiency and effectiveness of their health-promotion efforts.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3]


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