|Year : 2021 | Volume
| Issue : 2 | Page : 73-78
Assessment of knowledge, attitude, and practices regarding oral and dental hygiene among dental outpatients in Central India: A cross-sectional study
Rakesh Kumar Mahore1, Vikas Gupta1, Ram Kumar Panika2
1 Department of Community Medicine, Government Medical College, Shahdol, Madhya Pradesh, India
2 Department of Community Medicine, Bundelkhand Medical College, Sagar, Madhya Pradesh, India
|Date of Submission||18-Oct-2020|
|Date of Acceptance||31-May-2021|
|Date of Web Publication||18-Aug-2021|
Department of Community Medicine, Government Medical College, Shahdol, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
Background: Orodental diseases present a major public health problem. About 90% of schoolchildren worldwide and most adults have experienced caries, with the disease. Little is known about oral and dental health attitudes and behaviors and practices among people from developing countries and especially, in this part of our country. Aims: The present study was carried out with an aim to assess the knowledge attitude and practices in oral and dental hygiene in patients attending the dentistry outpatient department. Materials and Methods: This hospital-based cross-sectional study was conducted during 2019 among 426 patients visiting the outpatient department of dentistry. A pretested, predesigned, standardized questionnaire was used to collect data. Ethical approval was obtained from the Institutional Ethical Committee prior to the conduct of the study. Collected data were entered into the MS Excel spreadsheet and analysis was carried out using IBM SPSS Statistics for Windows at a 5% level of significance. Results: Only 18.3% of participants were aware that a minimum of two times per day brushing of teeth is essential and nearly one-third of subjects (32.4%) disagreed with the fact that dental problems can lead to other health problems/systemic illness. More than half of subjects (52.1%) were using self-medication (pain killer/clove/clove oil/) as a primary approach to dental problems and was significantly associated with age and gender education (P < 0.05). Conclusions: In the present study, more than half of the study subjects visited dentist only when they had dental problems. Public awareness programs should be run involving health workers, nurses, medical, and paramedical students.
Keywords: Charcoal, clove oil, outpatients, self-medication
|How to cite this article:|
Mahore RK, Gupta V, Panika RK. Assessment of knowledge, attitude, and practices regarding oral and dental hygiene among dental outpatients in Central India: A cross-sectional study. J Sci Soc 2021;48:73-8
|How to cite this URL:|
Mahore RK, Gupta V, Panika RK. Assessment of knowledge, attitude, and practices regarding oral and dental hygiene among dental outpatients in Central India: A cross-sectional study. J Sci Soc [serial online] 2021 [cited 2021 Dec 6];48:73-8. Available from: https://www.jscisociety.com/text.asp?2021/48/2/73/324069
| Introduction|| |
Oral and dental health is fundamental to general health and well-being. A healthy mouth enables an individual to talk, eat, and socialize without experiencing active disease, discomfort, or embarrassment. Prevalence and severity of oral and dental disease vary from individual to individual and are affected by age, gender, education, and socioeconomic status. Orodental diseases present a major public health problem. About 90% of schoolchildren worldwide and most adults have experienced caries, with the disease being most prevalent in Asian and Latin American countries. These could be attributed to several factors mainly lack of oral health awareness.
Most orodental diseases, such as most chronic pathologies in general, are directly related to lifestyle. Orodental disease can be considered a public health problem due to its high prevalence and significant social impact. Chronic orodental disease typically leads to tooth loss and in some cases, has physical, emotional, and economic impacts; physical appearance and diet are often worsened, and the patterns of daily life and social relation are often negatively affected., These impacts, in turn, lead to reduced welfare and quality of life. Poor oral and dental health has also been linked to heart and lung disease, diabetes, stroke, low birth weight, and premature births. A majority of the Indians are unaware of the fact that good oral and dental health not only ensures freedom from pain and suffering associated with oral health problems but is also essential for the overall health improvement.
A majority of the Indians are unaware of the fact that good orodental health not only ensures freedom from pain and suffering associated with oral health problems but is also essential for the overall health improvement and elevation of self-esteem, quality of life, and performance at work. Majority of the population in South East Asia region do not have specific trends to visit qualified health facilities. This may be due to socioeconomic and educational factors, but lack of knowledge and false perception are also very important.
The evaluation of available information and facilities, attitude, and practices is very important for the provision of proper health-care facilities as they form the baseline of the strategic planning and decision-making. A number of features, namely diet, smoking, alcohol, hygiene, stress, and exercise, are linked to a wide range of important diseases forming the fundamental basis of common risk factor approach to prevent a range of conditions including orodental diseases. Among these, hygiene is most significant when it comes to the prevention of orodental diseases. Little is known about oral and dental health attitudes and behaviors and practices among people from developing countries and especially, in this part of our country. Improvement in orodental health-related knowledge is considered to be an essential precondition for improving oral health in a community. The primary concern of the dental professional should be to impact positive oral health, knowledge, and behavior in the society.,
Numerous studies regarding oral health have been conducted in India, but as far as the Sagar division of Madhya Pradesh is concerned, no data are available for the knowledge attitude and practices of the schoolchildren regarding oral health. The above factors acted as driving force prompted us to conduct the present study. The present study was carried out with an objective to assess the knowledge, attitude, and practices in orodental health in patients attending dentistry outpatient department at Bundelkhand Medical College, Sagar (M. P.).
| Materials and Methods|| |
Study setting and design
This hospital-based cross-sectional study was conducted at Bundelkhand Government Medical College, Sagar, Madhya Pradesh, from January to March 2019. It is a tertiary care hospital with daily outpatient of around 1275/day and an average inpatient of 95/day.
Study population and sample size
The study participants included the patients visiting the outpatient department of dentistry. Patients who were seriously ill such as malaria (fever in the evening hours associated with chills), severe anemia (extreme paleness of either palm or tongue or lower inner side of eyelids), high-grade fever (temperature of 39.4°C or more), present history of urinary or vaginal discharge or burning micturition, and psychological distress were excluded from the study. The purpose of the study was explained and informed written consent was obtained from all the eligible study participants, and anonymity and confidentiality of the participants was maintained.
The sample size was calculated (n = 384) considering the proportion of outpatients having adequate knowledge regarding orodental hygiene as 50% (studies not found in Madhya Pradesh) with confidence level of 95% and 5.0% absolute allowable error by applying the following formula: N = (Z1 − a/2)2 × p (1 −p)/d2 where Z = standard normal variate for level of significance (at 5% type I error [P < 0.05], Z = 1.96 for 2-sided test), a = Level of significance (0.05), P = Prevalence (proportion - 50%), d = absolute allowable error (5.0%), and n = sample size. Furthermore, considering a nonresponse rate of 10%, a sample of 426 study participants was included for the study.
A pretested, predesigned, standardized questionnaire containing objective, and multiple-choice questions was first prepared in English. Then, it was translated into Hindi by an expert in that language keeping semantic equivalence. To check the translation, it was back-translated into English by two independent researchers who were unaware of the first English version. The questionnaire was piloted among a small number (n = 10) of subjects and the average time taken to complete the survey was around 30 min. The presentation and validity of the questionnaire were undertaken by 12 randomly selected faculty members for clarity, relevance, and acceptability. All efforts were made to keep the questions simple and unambiguous according to the objectives of the study. Refinements were made as required to facilitate better comprehension and to organize the questions before initiation of the study. The questions regarding the knowledge, attitude, and practices toward orodental hygiene were compiled from the existing literature.,, The questionnaire was divided into three parts. The first part consisted of 6 questions to assess the knowledge. The second part consisted of 7 questions to assess the attitude, the questions were answered on a 3-point Likert scale (the answers were either agree, neutral, and disagree), and the third part consisted of 12 questions to assess the practice.
The baseline sociodemographic details and knowledge, attitude, and practice components of questionnaire for subjects were administered by the investigator himself by face-to-face interview technique and direct observation. The questionnaire required 30–35 min per subjects to be completed. Also, the filled questionnaires were then checked for the completeness. In this way, the calculated sample size of subjects were enrolled in the study during the defined period. Being elective and not requite were the properties for participating in the study. The ethical approval was obtained from Institutional Ethical Committee (IEC) prior to the conduct of the study.
Collected data were entered into the MS Excel spreadsheet, coded appropriately, and later cleaned for any possible errors. Analysis was carried out using IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp. Armonk, NY, USA). During data cleaning, more variables were created so as to facilitate association of variables. Clear values for various outcomes were determined before running frequency tests. Categorical data were presented as percentages (%). Pearson's Chi-square test was used to evaluate differences between groups for categorized variables. All tests were performed at a 5% level of significance; thus, an association was significant if P < 0.05.
| Results|| |
A total of 426 participants were enrolled in the study out of which 53.8% were male and the remaining 46.2% were females [Table 1]. About one-third of subjects (32.2%) belonged to 46–60 years of age and 17.8% of subjects were above 60 years of age. One-fourth of study participants (24.2%) were illiterate and participants from urban areas dominated the study as they consisted their representation was two-third (64.1%) of total study participants. Most common source for information on orodental hygiene was television (65.3%) and the most common reason for visiting dental OPD was tooth pain (60.1%) or dental cavities (74.6%).
|Table 1: Baseline sociodemographic characteristics of study participants (n=426)|
Click here to view
In the present study, 91.4% of subjects were aware of common cause for dental problems and the most common causes answered were irregular brushing (90.8%) and tobacco consumption (85.7%). The awareness regarding the importance of teeth as chewing and appearance was observed among 97.2% and 88.5% of subjects, respectively. Only 18.3% of participants were aware that a minimum of two times per day brushing of teeth is essential and only 11.8% of participants were aware that there should be biannual visits to dental clinic on regular basis [Table 2]. More than four-fifth of participants (81.2%) believed that dental procedures are painful and scary and nearly one-third of subjects (32.4%) disagreed with the fact that dental problems can lead to other health problems/systemic illness [Table 3].
|Table 2: Knowledge and awareness of oral hygiene and dental health among the study participants (n=426)|
Click here to view
|Table 3: Attitudes toward oral hygiene and dental health among the study participants (n=426)|
Click here to view
In the present study, only one-tenth of subjects (10.5%) were having habit of cleaning teeth on twice or more a day basis and 82.5% were spending <2 min on tooth cleaning. Nearly one-third of subjects (31.8%) were having habit of cleaning teeth with charcoal or ash or salt. More than half of subjects (54.2%) were visiting dentist only when they were having dental problems. More than half of subjects (52.1%) were using self-medication (pain killer/clove/clove oil/) as a primary approach to dental problems instead of visiting dentist [Table 4]. [Table 5] shows that there was a significant association of practices among subjects with age, gender, education, and place of residence (P < 0.05).
|Table 4: Oral hygiene and dental care practices among the study participants (n=426)|
Click here to view
|Table 5: Association between dental health practices and baselines characteristics of study participants (n=426)|
Click here to view
| Discussion|| |
In the present study, about three-fourth (65.3%) of study subjects acquired information on oral health from television, and it was consistent with the findings of studies by Singh et al. where television (40.1%) was the most common source of orodental hygiene. However, community-based educational programs by health professionals in collaboration with print and media would also be effective in spreading the awareness and importance of proper dental care. At the individual and family levels, every opportunity should be utilized by family physicians and primary care physicians for imparting health education for the prevention of common dental diseases.
In the present study, it was observed that overall knowledge regarding orodental health among study participants was satisfactory as more than four-fifth of study participants were aware that irregular cleaning of teeth results in dental caries or cavities. The studies by Vinodha and Simon and Oberoi et al. have shown that 43.0% and 60.4% of study subjects, respectively, were having satisfactory awareness which was lower when compared to the present study.,
In the present study, more than 30.0% of the study population agreed that poor oral hygiene is the reason for bad breath which is similar to the study by Dayakar et al. Other studies done in similar settings by Saha and Mandal and Manna et al. have shown that 57.4% and 63.6% of the study population had knowledge on brushing in one time, that was in the morning., A study by Sohi et al. has shown that the knowledge pertaining to oral health among the participants was good as about 65% of the subjects were aware of the harmful effects of excess sweet, cold drink, alcohol consumption, and smoking/pan chewing/gutkha and other tobacco products on oral hygiene.
The present study found that brushing with toothbrush and toothpaste/powder was the most commonly used method of teeth cleaning (75.1%). In similar, the studies done by Singh et al. and Subha et al. have shown that 70.2% and 82.0% of study subjects, respectively, were using toothbrush and toothpaste to maintain dental hygiene., Surprisingly in the present study, only around one-tenth of the study participants were having practice of brushing their teeth twice a day which was supported by Vinodha and Simon and Kuppuswamy et al. where only 18% and 17% of subject, respectively, brushed teeth twice daily., The study by Singh et al. and Dasgupta et al. revealed that 40.7% and 35.7% of the subjects, respectively, used to brush their teeth twice daily.,
Regarding a visit to the dentist, the findings of the present study shown that only 15.7% of the study subjects were visiting dentist every half-yearly which was very low in comparison to the study done by Singh et al. where 44.6% of subjects were visiting dentist on a regular basis. Studies by Saha and Mandal have shown that only 3.46% of the study population visited the dentist regularly. Sohi et al. have shown that 25% of respondents visited dentist when they experienced bleeding from gums and similarly in the present study more than half of the study subjects visited dentist only when they had dental problems. This mindset of not reaching dentist for regular checkup and oral prophylaxis may be due to a generalized view that oral hygiene is a separate entity from overall health in the general population.
The present study showed that literacy status had an association with the orodental hygiene practices as 75.7% of illiterates were dependent on self-medication for dental problems compared to literate ones (P < 0.05) and it was in concordance with the study by Saha and Mandal where people with low socioeconomic status and low educational status have more dental morbidities. Studies by Bhardwaj et al. have shown a statistically significant difference between teeth abrasions and age-wise and gender-wise comparison and a similar association was observed in the present study.
| Conclusions|| |
In the present study, more than half of the study subjects visited dentist only when they had dental problems and only 15.7% of study subjects were visiting dentist every half-yearly. Awareness has to be created regarding the regular dental visit and oral prophylaxis which can improve the lifetime of natural teeth and also help to reduce overall inflammatory reactions as periodontitis is related to many systemic diseases. Public awareness programs should be run involving health workers, nurses, and medical and paramedical students. Documentaries, posters, and pamphlets can be used to generate awareness among the people.
This was a cross-sectional study done in hospital OPD setting so for more generalizability community-based study would have been better.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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.
Jamjoom HM. Preventive oral health knowledge and practice in Jeddah, Saudi Arabia. JKAU Med Sci 2001;9:17-25.
Padma KB, Kumar A, Aruna CN. Preventive oral health knowledge, practice, and behavior of patient attending dental institution in Bangalore, India. J Int Oral Health 2010;2:1-12.
Sharda A, Sharda J. Factors influencing choice of oral hygiene products used among the population of Udaipur, India. Int J Dent Clin 2010;2:7-12.
Jain N, Mitra D, Ashok KP, Dundappa J, Soni S, Ahmed S. Oral hygiene-awareness and practice among patients attending OPD at Vyas Dental College and Hospital, Jodhpur. J Indian Soc Periodontol 2012;16:524-8.
] [Full text]
Petersen PE, Peng B, Tai B, Bian Z, Fan M. Effect of a school-based oral health education programme in Wuhan City, Peoples Republic of China. Int Dent J 2004;54:33-41.
Sheiham A, Watt RG. The common risk factor approach: A rational basis for promoting oral health. Community Dent Oral Epidemiol 2000;28:399-406.
Nagarajappa R, Sahare P, Shukla N, Tuteja JS, Bhalla A. Knowledge, attitude and practices regarding oral health among out patients at Rama Dental College, Kanpur. Rama Univ J Dent Sci 2015;2:8-14.
Devishree RA, Mahesh R. Assessment of oral hygiene knowledge, attitude and practice among 13-17 years old children. J Med Sci Curr Res 2016;49:11892-99.
Priya M, Devdas K, Amarlal D, Venkatachalapathy A. Oral health attitudes, knowledge and practice among school children in Chennai, India. J Educ Ethics Dent 2013;3:26-33. [Full text]
Singh D, Tiwari VK, Raj S. Knowledge awareness and practice regarding oral hygiene and its consequences among dental patient attending OPD in tertiary care hospital in Delhi. IOSR J Dent Med Sci 2018;17:7-16.
Vinodha C, Simon AK. Awareness of oral hygiene among patients attending dental out patient department in a tertiary hospital in Coimbatore: A cross sectional study. PARIPEX Indian J Res 2019;8:36-9.
Oberoi SS, Mohanty V, Mahajan A, Oberoi A. Evaluating awareness regarding oral hygiene practices and exploring gender differences among patients attending for oral prophylaxis. J Indian Soc Periodontol 2014;18:369-74.
] [Full text]
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.
] [Full text]
Saha TK, Mandal BC. Knowledge, perceptions and oral health status among general OPD attendees in a tertiary care hospital of Darjeeling district, West Bengal. IOSR J Dent Med Sci 2019;18:60-4.
Manna N, Biswas S, Pandit D, Mondal K, Baur B, Mundle M. Oral hygiene practice and health status among adolescent girls: A rural school based study. IOSR J Dent Med Sci 2014;13:29-33.
Sohi RK, Sandhu KS, Kushwah PS, Sharma S, Dhaliwal AK. Knowledge, attitude, and practices regarding oral health among patients visiting dental OPD at Sri Sukhmani Dental College and Hospital, Dera Bassi, Punjab. Int J Health Res Educ 2018;1:1-5.
Jyothi S, Subha M. Oral health awareness among the general population in Chennai. Res J Pharm Tech 2017;10:3873-6.
Kuppuswamy VL, Murthy S, Sharma S, Surapaneni KM, Grover A, Joshi A. Oral hygiene status, knowledge, perceptions and practices among school settings in rural South India. Oral Health Dent Manag 2014;13:146-54.
Dasgupta U, Mallik S, Naskar S, Choudhury K, Paria B, Bhattacharya SK. Dental problems and its epidemiological factors: A study on adolescent and adult patients attending dental OPD of a tertiary care hospital in Kolkata, India. J Dent Med Sci 2013;5:1-7.
Bhardwaj VK. Tooth brushing behaviours and dental abrasion among the population in Shimla, Himachal Pradesh in India: A cross-sectional study. J Cranio Maxillary Dis 2014;3:89-94.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]