MDS, Professor Department of Periodontology Rama Dental College, Kanpur (INDIA)

Transcription

1 Journal of Oral Health & Community Dentistry original article Assessment of Oral Hygiene Practices and Awareness of Periodontal- Systemic Health Interrelationship Amongst the Local Population of Kanpur Region A Cross Sectional Study Gupta V 1, Singh AK 2, Gupta B 3 ABSTRACT Objective: This study was carried out to know the oral hygiene practices and the awareness of periodontalsystemic health inter-relationship amongst the general population of Kanpur region. Materials and Methods: A cross sectional epidemiological survey was conducted among the patients reporting to the department of Periodontology, Rama Dental College and Hospital Kanpur U.P. A total of 1000 new patients were selected and a self-constructed questionnaire was presented to them. Oral hygiene status was checked through OHI index and patient s awareness for periodontal-systemic health inter-relationship was assessed by a self made awareness index. Results: The results of our study showed limited oral hygiene practices and lack of knowledge for the effect of poor oral hygiene on systemic health amongst the surveyed population. Although 96.5 % of patients reported using brush and toothpaste and most of them (68.5 %) brushed their teeth once daily, only 35.8 % patients replaced their toothbrush within 3 months, a very minimal percentage of subjects (3.2%) were using other methods of oral hygiene and frequency of cleaning tongue daily was found in only 48.5% patients. Out of 1000 patients included, majority paid dental visits on having any problem (84.0%) rather than regular visitors. It was found that majority of the assessed population s (94.7 %) awareness about periodontal-systemic health interrelationship was poor. Conclusion: There is an urgent need for comprehensive educational programs to promote good oral hygiene awareness and its impact on systemic health amongst the general population of Kanpur region. Keywords: Awareness, Oral hygiene, Periodontitis, Systemic health Contact Author Dr. Vivek Gupta drvivek10feb@gmail.com J Oral Health Comm Dent 2016;10(1)1-8 1 MDS, Professor Department of Periodontology Rama Dental College, Kanpur (INDIA) 2 Post Graduate Student Department of Periodontology Rama Dental College, Kanpur (INDIA) 3 MDS,Senior Lecturer Department of Oral and Maxillofacial Pathology Rama Dental College, Kanpur (INDIA) JOHCD January 2016;10(1) 1

2 INTRODUCTION Oral health is an inseparable part of the general health and there are number of factors which influence the oral health of an individual such as diet, oral hygiene practices, socioeconomic status, geographic location, literacy etc (1). Oral health knowledge is considered to be an essential prerequisite for health related behavior (2). The attitude of people towards their own teeth and the attitude of dentists who provide dental care, play an important role in determining the oral health condition of the population (3). Oral cavity is the mirror of systemic health. Researchers have proved interrelationship between periodontal and systemic health such as diabetes, cardiovascular disorders, maternal health during pregnancy, chronic respiratory diseases, rheumatoid arthritis, etc (4). Given the high prevalence of periodontal disease in India and its deleterious association with systemic disease, patients visiting dental hospital are required to be educated and guided for this relationship. In India where the dentist to population ratio is 1:30000 in urban areas and 1: in rural areas, people themselves should be aware and educated enough to take care of their oral health needs (5). It has been noticed that proper oral hygiene practices in Indian population has mostly remained as an ignored and unrealized major social problem. Majority of the people are unaware about the relationship between oral hygiene and systemic diseases or disorders. Most diseases show their first appearance through oral signs and symptoms and they remain undiagnosed or untreated because of this missing awareness (6). According to the World Health Organization (WHO) (7) Promotion of oral health is a cost-effective strategy to reduce the burden of oral disease and maintain oral health and quality of life. To determine the particular need of oral health education it is necessary to know what the general population thinks about the oral health and systemic health inter-relationship and which dental health practices that they follow. Till this date there is paucity of literature to assess the oral hygiene practices and the awareness regarding inter-relationship between periodontal and systemic diseases in Northern part of India. Kanpur is the industrial capital of U.P. and is the largest city in Uttar Pradesh with an area of 3,029 square km and population of 3,767,031 (8). The lack of this data prompted us to conduct this epidemiological study surveying the oral hygiene practices of the general population of Kanpur region along with the assessment of awareness for the periodontal-systemic health inter-relationship. MATERIALS AND METHODS The instrument used was a self-constructed questionnaire formulated both in English and in Hindi version containing questions regarding oral hygiene practices and periodontal systemic health inter-relationship along with demographic details. The questionnaire was distributed to all subjects who gave their consent for participating in the study between the age group of 18 to 70 years. Ten minutes of time was allocated for completing the questionnaire and for illiterate subjects, the investigator himself filled up the Table 1: Demographic Details questionnaire upon verbal instructions and conversation. SAMPLE DESIGN The sample consisted of one thousand subjects (n = 1000) who attended the Department of Periodontology, Rama Dental College, Kanpur between November 2014 till August 2015 and who agreed to participate by signing the consent for study. Healthy sound teeth were only considered to be functional to record the dental status of the patient. Mobile teeth (grade II and grade III), grossly carious teeth, root stumps and impacted teeth were excluded from the counting. OHI-S (9) index were recorded with the help of mouth mirror and explorer. Age, gender and educational status of the subjects were recorded and then divided into groups on the following basis Age Group A 1 Group A 2 Group A 3 : years : years : years Gender Group M : Males Group F : Females Educational status S.No. Group Description Number of cases Percentage (%) I. Age Group A. Group A1 Age yrs II. III. B. Group A2 Age yrs C. Group A3 Age yrs Gender A. Group F Females B. Group M Males Educational Status A. Group E0 Illiterate B. Group E1 Upto Class 8th C. Group E2 Class 9th Graduation D. Group E3 Postgraduates JOHCD January 2016;10(1)

3 Table 2 : Association of Oral Hygiene with Gender Total Fair (n=639) Good (n=144) Poor (n=217) Statistical Significance No. % No. % No. % c² P Group F (df=2) <0.001 Group M % were having postgraduate degree (Table 1). Figure 1 : Oral Hygiene Status Group E 0 : Illiterate Group E 1 : Educated up to or below standard VIII Group E 2 : Educated above standard VIII up to graduation Group E 3 : Post graduates Periodontal systemic health interrelationship awareness index was made and scoring done on the following basis Awareness Index 0-2 POOR 3-4 FAIR 5 GOOD The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 statistical Analysis Software. The values were represented in Number (%) and Mean ± SD. RESULTS The present study was carried out on 1000 new patients who reported to the Department of Periodontology in Rama Dental College Hospital and Research Centre Kanpur, U.P. The study population included 572 (57.2%) male and 428 (42.8%) female patients. The number of subjects in yrs age group was maximum being 601 (60.1%). Only 2.0 % of the study population was illiterate and about 18.5 Figure 2 : Tooth Cleaning Methods Majority (n= %) had fair oral hygiene status, oral hygiene status was poor in 21.7% while good in only 14.4% patients. Proportion of good oral hygiene was higher in females (21.96%) as compared to males (8.74%) and oral hygiene was poor in higher proportion of males (25.87%) as compared to females (16.12). Difference in oral hygiene status of patients in the two genders was found to be statistically significant (p<0.001) (Table 2 & Figure 1). The use of toothpaste and toothbrush (n = 965, 96.5%) was reported to be the most common cleaning aid for oral prophylaxis among the study population. There were no statistically significant gender differences with regards Table 3 : Association of Frequency of Tooth Cleaning with Gender Group Total Once (n=685) Twice (n=315) Statistical Significance No. % No. % c² P Group F (df=1) <0.001 Group M JOHCD January 2016;10(1) 3

4 Table 4 : Association of Duration of Tooth Cleaning with Educational Status Total <1 min (n=105) 1-3 min (n=465) 3-5 min (n=257) >5 min (n=173) No. % No. % No. % No. % Group E Group E Group E Group E c² = (df=9); p=0.005 (26.92%) and this difference was found to be statistically significant (Table 3). There were no significant differences between males and females with respect to duration of cleaning teeth with most of the patients cleaning their teeth for 1-3 minutes (n = 465, 46.5%) whereas (n = 257, 25.7%) patients cleaned their teeth for 3-5 minutes. Difference in time taken for tooth cleaning in patients with different educational status was found to be statistically significant (p=0.005) (Table 4 & Figure 3). Figure 3 : Duration of Tooth Cleaning to the use of cleaning aids among the study participants but more number of males (n = 555, 97.03%) reported use of toothbrush in comparison to females (n = 410, 95.79%). Whereas the use of Finger and toothpowder/toothpaste and Datoon was more among illiterate and older age group when compared to young and educated population (Figure 2). Only (n = 358, 35.8 %) patients Most of the patients (n=685, 68.5%) reported cleaning their teeth once daily only. Proportion of females with twice frequency of tooth cleaning was higher (37.62%) as compared to males Figure 4 : Frequency of Change of Toothbrush Table 5 : Association of Frequency of Change of Brush with Educational Status Total 1 month (n=133) 3 months (n=358) 6 months (n=374) >6 months (n=103) No. % No. % No. % No. % Group E Group E Group E c² = (df=9); p< JOHCD January 2016;10(1)

5 Figure 5 : Uses of Other Methods changed their toothbrush once in 3 months. While (n = 374, 37.4 %) patients changed their toothbrush once in 6 months. Proportional differences in duration of change of tooth brush of patients of different gender was not found to be statistically significant (p=0.917). Difference in duration of change of brush in patients with different educational status was found to be statistically significant (p<0.001) (Table 5 & Figure 4). It is noteworthy that among all, only around (n = 32, 3.2 %) of the patients used any interdental aids like floss, toothpick, interdental brush, and mouth wash. Out of these 32 patients, most common other method was Mouth wash used by 27 (84.38%) patients, followed by tooth pick by 4 (12.5%) and dental floss by 1 (3.13%) patient (Figure 5). Figure 6 : Frequency of Tongue Cleaning Figure 7 : Frequency of Dental Visits Daily tongue cleaning was reported by (n = 485, 48.5%) patients with % females using tongue cleaner more frequently than % males which was found to be statistically significant (p<0.001). About (n =46, 4.6 %) of total study population were never tongue cleaners (Figure 6). Majority (n = 840, 84.0%) of the patients in the present study visited a dentist for only if a problem is there. Yearly visit and visits at 6 months was higher in patients with higher educated population as compare to illiterate and Table 6 : Association of Frequency of Dental Visits Educational Status Total 3 m (n=15) 6 m (n=65) Every year (n=68) If problem (n=840) Never (n=11) Group E0 No % Group E1 No % Group E2 No % Group E3 No % c²=37.935(df=15); p=0.001 JOHCD January 2016;10(1) 5

6 Figure 8 : Awareness for Periodontal-Systemic Health Interrelationship similar to the study conducted by Hind Al-Johan (11) where 95.4 % patients used brush and paste for cleaning their teeth and Ali et al (12) in which 88.0 % patients preferred using brush and paste. It was found that proportion of patients using brush and paste as their tooth cleaning method was lower in illiterate population group i.e. E0 (65.0 %) as compared to E1 (94.12 %), E2 (97.39 %) and E3 (97.3 %). Finger brushing and use of datoon was observed in only illiterate section (E0) of the surveyed population. less educated population which was found to be statistically significant (p=0.001) (Table 6 & Figure 7). Our results showed that for the question asking the link between oral hygiene and associated heart disease was answered yes by only 2.0% of the respondents. Similarly the effect of periodontal disease on pregnant females, for the effect of poor oral hygiene on blood sugar levels and for the effect of medication on gingival health, awareness was found to be merely 2.0 %, 1.3 % and 3.4 % respectively. The highest percentage was found for the question of association of effect of diabetes on gums and teeth and this was 14.5 % of the surveyed population (Figure 8). DISCUSSION Oral health is an integral part of general health and a valuable asset for any individual. Oral health has usually remained a neglected entity; people have underestimated consequences of bad oral health, which have led to bigger problems which later on becomes difficult to treat. Majority of the people are unaware about the relationship between oral hygiene and systemic diseases or disorders. Most diseases show their first appearance through oral signs and symptoms and they remain undiagnosed or untreated because of this missing awareness (6). Many studies have been carried out from time to time to assess the knowledge and behavior of people about oral health, but there is still a dearth of literature for oral hygiene practices and awareness for periodontal-systemic health relationship region wise. Therefore the present study was conducted to assess the oral hygiene practices and awareness for periodontal-systemic link on patients reporting to the Department of Periodontology in Rama Dental College Hospital and Research Centre Kanpur, U.P. A total of 1000 patients (N=1000), both male (57.20 %) and female (42.80 %) fulfilling the inclusion criteria and giving their consent for inclusion in the study were included in this epidemiological study. The results of our study showed that the oral hygiene of the surveyed population was in the range of fair category in 63.9 % of the population with mean OHI score of ± 0.876, while it was good in only (14.4 %) of the patients. Our results are in agreement with the study conducted by Vandana KL et al (10) who found 73.9 % of patients to be having fair oral hygiene. The level of oral hygiene was found to be in direct correlation with the level of educational strata. People with highest educational degree i.e. group E3 were able to maintain their oral hygiene to the level of good as compared to other educational strata subjects. This directly implies the significance of education. Regarding the oral hygiene practices, the majority of the patients in our study used brush and paste (96.5 %) for cleaning their teeth, which was In our study we found 68.5 % people brushed only once a day, which is in agreement with the study conducted by Agiapal Singh et al (13) where 69.0 % people brushed only once a day. However for maintaining good oral hygiene the American Dental Association recommends brushing the teeth twice a day (14). Brushing twice daily was reported by 31.5 % of the subjects in the present study which was similar to the study conducted by Al-Johani (38.5 %) (12). Overall the results of our study showed that the mean OHI index of patient with twice daily brushing habit was significantly lower i.e. better oral hygiene (2.107 ± 0.841) as compare to OHI index of patients with once daily brushing ( ). Our result implies that females and higher educated people were more concerned about their oral health and were more aware about the benefits of twice daily brushing. Professional recommendations for good oral hygiene maintenance include tooth brushing for 2-3 min (15) % of the our surveyed population brushed their teeth for 1-3 min time duration which is similar to the study conducted by Ganss et al (15). It was observed in our study population that the patients who brushed their teeth in this recommended time period had better mean OHI score (2.13 ± 0.828) as compare to patients who brushed their teeth for lesser time i.e ± and this difference was found to be statistically significant (p<0.001). 6 JOHCD January 2016;10(1)

7 More number of illiterate people was seen to spend less time on cleaning their teeth, which once again signifies the value of education on maintaining proper oral hygiene. Regarding the practice of frequency of change the brush, 3 month duration of time have been advocated as ideal (16). This time frame was practiced by only 35.8 % of our population similar to the study conducted by Jain et al (6) whereas 37.4 % of population in our study discarded their brush at 6 months. The rest either discarded their tooth brush either in 1 month or after the use of more than 6 month. Education and awareness at dentist level is hereby required to lay stress on the change of brush at 3 months interval. The use of interdental cleaning aids (i.e. dental floss, interdental brush and tooth pick) and mouth wash were seen only by 3.2 % of our surveyed population. None of the subjects has used dental floss, which is similar to a study conducted by Hana M. Jamjoom (17) in Saudi Arabia and Jain et al (6). This emphasizes the urgent need for educating and motivating the public to use this efficient method for oral health care. Tongue cleaning is the integral part of maintaining good oral hygiene. This practice of oral hygiene was seen in 48.5 % of the population reporting daily tongue cleaning. Almost as the same extent 46.9 % of the population occasionally cleaned their tongue. Education again was found to play an important role as majority of the daily tongue cleanser belonged to group E3. For those who never cleaned their tongue the maximum percentage was in illiterate group i.e. E0. Females outnumbered males among the daily tongue cleanser, again signifying that females are more aware for their oral hygiene as compared to males % of the population surveyed, agreed to visit their dentist only when there is a dental problem. Our finding were slightly higher when compared to the findings of study conducted by Nabil Al-Beiruti (18) in which they found 69.5 % of the participants reported visiting a dentist only when they have pain. The rest 16.0 % of the our surveyed population wanted to visit their dentist regularly either 3 month (1.5 %), 6 month (6.5 %) and every year (6.9 %), which is in agreement with the findings of study conducted by Hind Al Johani (12.8%) (11). The number of intact, immobile and functional teeth was also counted in our study for the surveyed population and it was found that overall subjects with higher number of intact teeth had better mean OHI score (2.14) as compared to subjects with lesser number of functioning teeth (3.62) and this difference was statistically significant. Regarding the awareness for periodontal-systemic health relationship we formulated an awareness index based on the knowledge of the patient for specific questions like linkage of periodontal disease with other body system such as heart, diabetes, pregnancy etc. Overall, it was found that majority of the assessed population s (94.7 %) awareness index was poor, which according to our indexing criteria implies that out of six questions the patients were aware for only two associations maximally. The first question was a general one asking about the relationship between oral health and general health for which 99.1% of the Figure 9 : Mode of Knowledge subjects agreed to know this association. The picture completely changed when specific periodontal-systemic health inter-relation association was asked. Our results showed that for the question asking the link between oral hygiene and associated heart disease was answered yes by only 2.0% of the respondents. Similarly the effect of periodontal disease on pregnant females, for the effect of poor oral hygiene on blood sugar levels and for the effect of medication on gingival health, awareness was found to be merely 2.0 %, 1.3 % and 3.4 % respectively. The highest percentage was found for the question of association of effect of diabetes on gums and teeth and this was 14.5 % of the surveyed population. For comparing our results on awareness of periodontal systemic health relationship, very few studies are available that has surveyed the general population. Only two studies were found who have surveyed the general population by Kapoor D et al (19) and Bhatia A et al (20) surveying the local population of Punjab region and similar to our findings they also concluded that majority of the people were unaware about the relationship between oral hygiene and systemic health. Rest of the literature is available with studies done on specific group of professionals like medical interns, doctors, gynecologists (21-24) where such awareness was assessed through a questionnaire based survey and it will not be prudent to compare our results where we have surveyed the general population. JOHCD January 2016;10(1) 7

8 Media can play a very important role in spreading this awareness as we also noted from our study that the resource which maximally (10.9 %) provided our aware population the knowledge about periodontal-systemic health interrelationship was media, be it electronic or print media (Figure 9). This resources further needs to be raised on a higher level to improvise the standards of awareness amongst the general people. CONCLUSION To summarize this questionnaire based study of ours facilitated data on the general population of Kanpur region for their oral hygiene practices and awareness for periodontal-systemic health relationship. There seems to be much room for improvement of oral hygiene and self care standards amongst the local population of Kanpur region. More over there is lack in appropriate oral health awareness particularly for periodontal-systemic health relationship even among the literate section of this part of the country. 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