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Edition 28 - General Edition

Knowledge, Behavior, and Attitude Towards Oral Health Among a Population Visiting a Dental College and Hospital in South India: A Cross-Sectional Study

By Prudvi Naidu Marneedi, Sujatha Gopal Sooraparaju, Vijay Kumar Yennavaram, Sushma Reddy, Gadwal Mounika, Tummala Shiva Shwetha

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Citation

Marneedi PN, Sooraparaju SG, Yennavaram VK, Reddy S, Gadwal Mounika G, Shwetha TS.  Knowledge, behavior, and attitude towards oral health among a population visiting a dental college and hospital in South India: a cross-sectional study. Harvard Public Health Review. 2021; 28.

Knowledge, Behavior, and Attitude Towards Oral Health Among a Population Visiting a Dental College and Hospital in South India: A Cross-Sectional Study​

Abstract

Objective

This study was carried out to assess the oral hygiene knowledge, attitude, and behavior amongst patients visiting the Department of Public health dentistry at MNR dental college and hospital, Sangareddy, which in turn helps to develop better oral health awareness programs and aids in assessing the current oral health knowledge status.

Materials and Methods

A cross-sectional study was carried out amongst the patients visiting the Department of Public health dentistry at MNR dental college and hospital, Sangareddy. A total of 216 patients were given a structured questionnaire with 15 questions. Responses from the patients were evaluated in terms of numbers and percentages.

Results

Most of the subjects had poor knowledge pertaining to oral hygiene practices. Nearly 47% do not consider using a tongue cleaner.

Conclusion

Implementation of various oral health programs highlighting the basic oral care regimen is necessary for improving oral health care.

Introduction

Humanitarian Martin Luther King Jr. once told the Medical Com­mittee for Human Rights in 1966: ‘Of all the forms of inequality, injustice in health­care is the most shocking and inhumane.’ [1]. The oral healthcare status in India reminds us of the same. Oral health is as important as general health. In fact, it serves as an index of systemic health. Sadly, most of the populations, particularly in India, are underserved when it comes to knowledge pertaining to oral health and, to some extent, treatment accessibility too. Oral hygiene behavior and seeking oral health care depend on several factors. Patients comply better with oral health care regimens when informed and positively reinforced [2]. Dental diseases are a significant public health menace having a substantial impact on the quality of life, affecting daily performance and general life satisfaction [3].  Those who have assimilated the knowledge and feel a sense of personal control over their oral health are more likely to adopt self-care practices. [4]. The level of knowledge regarding oral health is worth assessing as it helps us derive a conclusion that helps build the necessary oral care education programs and thereby bring the actual change in the practices and attitude towards oral health among the public. Over the years, awareness regarding the importance of health literacy in the dental profession has grown, and efforts have been going on to adapt health literacy.

Materials and Methods

All the 216 subjects were given a structured questionnaire with 15 questions comprising six behavior-based questions, six knowledge-based questions, and three attitude-based questions. Subjects from various occupational backgrounds, including daily wagers, farmers, primary school teachers, private jobholders, government jobholders, businessmen, students, unemployed people, were included in the study. Various age groups were included in the study, of which the number of males was 156 while females were 60. Upon receiving the responses, all the papers were analyzed and recorded. Apart from receiving the responses, patients were given education regarding the basics of oral hygiene maintenance. All the responses were analyzed by using the percentage frequency distribution method.

Results

Our study included 216 subjects, of which 72.22% were males, and 27.77% were females. Among them, 10.64% belong to the age group 10-19years, 49.07% belong to the age group 20-30years, 31.48% belong to the age group 31-50yrs, and 8.8% belong the 51-80yrs age group.

Edition 28 – Knowledge, Behavior, and Attitude Towards Oral Health among a Population Visiting a Dental College and Hospital in South India: A Cross-sectional Study
Figure 1 Age distribution of the study participants
dition 28 – Knowledge, Behavior, and Attitude Towards Oral Health among a Population Visiting a Dental College and Hospital in South India: A Cross-sectional Study
Figure 2 Stacked Bar graph showing the occupational distribution of the study participants

Analysis of knowledge-based questions:

Of the 15 questions, 6 were knowledge-based questions. Responses of the same are presented in the table below.

Edition 28 – Knowledge, Behavior, and Attitude Towards Oral Health among a Population Visiting a Dental College and Hospital in South India: A Cross-sectional Study
Table 1 Responses for the knowledge-based questions.

Analysis of attitude-based questions:

Of the 15 questions in the questionnaire, three were attitude-based. Responses for the same are presented in the table below.

Edition 28 – Knowledge, Behavior, and Attitude Towards Oral Health among a Population Visiting a Dental College and Hospital in South India: A Cross-sectional Study
Table 2 Responses for the attitude-based questions.

Analysis of behavior-based questions:

Of the 15 questions, 6 were behavior-based questions. Responses of the same are as follows.

Edition 28 – Knowledge, Behavior, and Attitude Towards Oral Health among a Population Visiting a Dental College and Hospital in South India: A Cross-sectional Study
Table 3 Responses for the behavior-based questions.

Discussion

Oral health knowledge is usually obtained from information that subsequently translates into action. Behavior is an outcome measure when an action is sustained. Attitudes toward oral health determine the condition of the oral cavity. Oral diseases are clearly related to behavior, and the prevalence of dental caries and periodontal disease has decreased with improvements in oral hygiene and a decrease in the consumption of sugary substances [5]. This study presents an overview of oral health knowledge, attitude, and behavior of the population visiting department of public health dentistry at the MNR dental college and hospital, Sangareddy. The promotion of good oral hygiene is advocated and supported by the World Health bodies.[6] [7] [8] [9].

 

In our study, 78.2% have reported brushing their teeth once a day which is relatively higher compared to a study by Christensen LB et al. [10] where only 32% brushed their teeth once a day, and similar reports were noticed in other studies [13][14]. Only 25% were aware that it is a brushing technique that is important for better cleaning of teeth. Large populations must be taught correct brushing techniques depending on age and oral health conditions. We have noticed in our study that many participants, nearly 75% using toothpaste, were unaware of the fluoride content of the paste. This is unsatisfactory and indicates a lack of awareness about toothpaste content, which should be addressed urgently [11]. In the present study, 11.5% of the participants chose their toothpaste based on the cost, 41.7% based on the advertisements, 21.3% opted for Ayurveda-based toothpaste, and only 25.1% looked for fluoride content in toothpaste. These findings can be compared to another Nigerian study among hospital patients, where cost, taste, and fluoride content were the major factors influencing the choice of toothpaste [12].

 

When mentioned if tongue scraper is essential along with a toothbrush, 47% opted No. This gives a clear picture that the knowledge pertaining to the importance of tongue cleaning is highly lacking among the study population. Tongue coating, a grayish-white deposit on the tongue, is the main cause of intra-oral halitosis, a socially unacceptable condition. Dental flossing is less practiced by the study participants as only 6.4% have reported using dental floss, and when it comes to taking sugary snacks/drinks alarmingly, 64% have reported taking it at various times in a day. This is also a point of concern as its sugary snacks/drinks that nourish the oral bacteria and lead to dental caries. One of the most depressing response which is visiting a dentist only when there is pain. This kind of mindset must be changed among the populations because unless this kind of attitude diminishes among the public, desired oral health conditions cannot be achieved.

 

Serious efforts pertaining to improving the attitudes of individuals towards dental health maintenance have to be made from each and every corner of the globe. In a developing country like India, improving oral health conditions in rural populations brings a huge difference in the lives of people, thereby overall growth. 71.3% have reported delaying their dental treatment stating the most common reason to be the time factor. Taking time out of busy schedules may not be easy, but the importance of oral health must be understood as health is wealth. 54.3% of study subjects were unaware of the relationship between oral health and systemic health. A healthy oral cavity is important for overall systemic health. The ultimate way to avoid diseases of the oral cavity and other systemic conditions begins with educating patients about this relationship [15].

Conclusion

Even after the advent of various oral health programs being implemented by government and private organizations, rural populations’ oral health conditions are still at stake, which may relate to the knowledge, attitude, and behavior of people towards oral health as observed in our study. Teaching basic techniques of brushing teeth and oral hygiene practices to the rural populations brings a huge difference in terms of oral health. Focus on the importance of tongue cleaning should also be highlighted.

References

  1. Luther King M., Jr Presentation at the Second National Convention of the Medical Committee for Human Rights, Chicago, 25 March 1966.
  2. Indian J Dent. 2014 Apr-Jun; 5(2): 64–68. doi: 10.4103/0975 962X.135262 PMCID: PMC4184328 PMID: 25565727
  3. Gambhir RS, Gupta T. Need for Oral Health Policy in India. Ann Med Health Sci Res. 2016 JanFeb;6(1):50-5. doi: 10.4103/2141-9248.180274. PubMed PMID: 27144077; PubMed Central PMCID: PMC4849117
  4. Freeman, J. Maizels, M. Wyllie, and A. Sheiham, “The relationship between health related knowledge, attitudes and dental health behaviours in 14–16-year-old adolescents,” Community Dental Health, vol. 10, no. 4, pp. 397–404, 1993.
  5. Bashiru BO, Omotola OE. Oral health knowledge, attitude and behavior of medical, pharmacy and nursing students at the University of Port Harcourt, Nigeria. J Oral Res Rev 2016;8:66-71.
  6. Petersen PE. Challenges to improvement of oral health in the 21st century – The approach of the WHO Global Oral Health Programme. Int Dent J 2004;54 6 Suppl 1:329-43.
  7. Petersen, P. E., Bourgeois, D., Ogawa, H., Estupinan-Day, S., & Ndiaye, C. (2005). The global burden of oral diseases and risks to oral health. Bulletin of the World Health Organization, 83(9), 661–669.
  8. Davies, R. M., Davies, G. M., & Ellwood, R. P. (2003). Prevention. Part 4: Toothbrushing: what advice should be given to patients?. British dental journal, 195(3), 135–141. https://doi.org/10.1038/sj.bdj.4810396
  9. World Health Organization. The World Oral Health Report, 2003. Geneva: World Health Organization; 2003.
  10. Christensen LB, Petersen PE, Krustrup U, Kjøller M. Self-reported oral hygiene practices among adults in Denmark. Community Dent Health 2003;20:229-35.
  11. Umanah AU, Braimoh OB. Oral hygiene practices and factors influencing the choice of oral hygiene materials among undergraduate students at the University of Port Harcourt, Rivers State, Nigeria. J Dent Allied Sci 2017;6:3-7
  12. Adegbulugbe IC. Factors governing the choice of dentifrices by patients attending the dental centre, Lagos University Teaching Hospital. Nig Q J Hosp Med 2007;17:18-21.
  13. Villa A, Kreimer AR, Polimeni A, Cicciù D, Strohmenger L, Gherlone E, et al. Self-reported oral hygiene habits among dental patients in Italy. Med Princ Pract 2012;21:452-6.
  14. Al-Otaibi M, Zimmerman M, Angmar-Månsson B. Prevailing oral hygiene practices among urban Saudi Arabians in relation to age, gender and socio-economic background. Acta Odontol Scand 2003;61:212-6.
  15. Alpert, P. T. (2017). Oral Health: The Oral-Systemic Health Connection. Home Health Care Management & Practice, 29(1), 56–59. https://doi.org/10.1177/1084822316651658.

About the Authors

Prudvi Naidu Marneedi

Dr. Prudvi Naidu Marneedi, BDS, MNR Dental College and Hospital, Sangareddy. 

*Correspondence: prudvimarneedi@gmail.com

Sujatha Gopal Sooraparaju

Dr. Sujatha Gopal Sooraparaju, Principal, Head of the Department – Dept. of Conservative Dentistry and Endodontics,

MNR Dental College and Hospital, Sangareddy.

*Correspondence: sujasmiles@yahoo.com

Vijay Kumar Yennavaram

Dr. Vijay Kumar Yennavaram

Head of the Department – Dept. of Public Health Dentistry,

MNR Dental College and Hospital, Sangareddy.

M. Sushma Reddy

Dr. M. Sushma Reddy

Sr. Lecturer – Dept. of Public Health Dentistry,

MNR Dental College and Hospital, Sangareddy.

Gadwal Mounika

Dr. Gadwal Mounika

Post graduate student (Dept. of Periodontics)

MNR Dental College and Hospital, Sangareddy.

Tummala Shiva Shwetha

Dr. Tummala Shiva Shwetha

Postgraduate student (Dept. of Conservative Dentistry and Endodontics)

MNR Dental College and Hospital, Sangareddy.