An evaluation of the current oral hygiene practices and attitude toward oral health in the population of Jaipur, India

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1 International Dental & Medical Journal of Advanced Research (2015), 1, 1 6 ORIGINAL ARTICLE An evaluation of the current oral hygiene practices and attitude toward oral health in the population of Jaipur, India Ruchi Sharma 1, Swapnil Singh 2, Hemlata Rajmani 3, Heeralal Degra 4 1 Department of Orthodontics & Dentofacial Orthopedics, NIMS Dental College & Hospital, NIMS University, Jaipur, Rajasthan, India, 2 Department of oral and maxillofacial surgery, Daswani Dental College, Kota, Rajasthan, India, 3 Department of Orthodontics & Dentofacial Orthopedics, New Horizon Dental College and Research Institute, Sakri, Bilaspur, Chhattisgarh, India, 4 Department of Prosthodontics & Crown & Bridge, Rajsthan Dental College & Hospital, Jaipur, Rajasthan, India Keywords Attitude, awareness, Jaipur, oral hygiene practices, oral health, population Correspondence Dr. Ruchi Sharma, F-1, Anand Enclave, Modi Nagar, Panchsheel Colony, Ajmer Road, Jaipur , Rajasthan, India. Phone: , dr.sharmaruchi@rediffmail.com Received 06 March 2015; Accepted 13 April 2015 doi: /ins.idmjar.7 Abstract Background: Individual s concerns and knowledge regarding oral health infl uence the oral health status of a particular person. Aim: The study was aimed at the evaluation and assessment of the basic attitude and beliefs of the general masses of Jaipur, India, regarding the very basics of oral hygiene and the accompanying routine oral health care practices in conjunction with the advancing modern scenario. Materials and Methods: A total of 329 individuals aging from 18 to 30 years were randomly selected and interviewed through a structured questionnaire consisting of 13 multiple choice questions regarding their oral hygiene practices and beliefs; with their answers further analyzed for drawing out the results. Results: The study revealed a lack of knowledge regarding the varied oral hygiene options available among the common masses, though most of them use the basic oral hygiene measures, the fi rst being tooth brushing, being followed by 82.67% of the population. It also revealed their comparative negligence toward oral health as majority of people do not prefer visiting the dentists, unless having some dental emergencies like pain. Conclusion: Thus there is a need of spreading knowledge about basic and advanced oral health practices, in addition to those being currently used in Jaipur such as the use of mouthwashes, fl oss, etc. Furthermore, emphasis needs to be laid on enlightening the people with the importance of regular comprehensive oral health care through the initiative of general oral health awareness programs. Introduction Individual s concerns and knowledge regarding oral health infl uence the oral health status of a particular person. It is expected that the concern of individual toward his or her mouth and the attitude to dentists who provide routine as well as emergency dental care would play an important role in determining their oral health condition. Heightened concern is associated with improved health status and practices while low concern is associated with poor health status and practices. [1] The information gathered relative to a person s values, beliefs, and oral self-care practices can reveal the oral health status of a population which may be a useful guide in designing effective oral health care interventions. [2] Poor oral health statuses suggest the need for oral health education and oral health promotion programs in the society. [3] Various studies have been published regarding the status of oral health and oral hygiene practices at many places in the world. According to the literature, very few studies exist showing the status of oral hygiene practices and awareness in Jaipur till now, which is the capital city of Rajasthan. Hence, this study was initiated in an attempt to evaluate the current oral hygiene practices, awareness regarding dental treatment, individual s concerns, and attitude towards oral health in the adult population of this city. International Dental & Medical Journal of Advanced Research Vol

2 Oral hygiene practices in Jaipur Sharma, et al. Aims and objectives 1. To evaluate the oral health awareness among people from urban and rural localities of Jaipur, India. 2. To gain the knowledge about their oral hygiene practices and their attitude towards oral health. 3. To provide an insight into oral health promotion programs. Therefore, the aim was to document and assess the oral health awareness, as well as the prevailing oral hygiene practices and in the population of Jaipur. Materials and Methods This was a cross-sectional study conducted among the subjects selected randomly from rural and urban localities of Jaipur. A total of 329 subjects including 204 males and 125 females with age range of years fulfi lling the inclusion criteria were recruited. A written informed consent was obtained from each patient before starting the study. A self-structured questionnaire consisting 13 questions was distributed to all subjects. For illiterate persons, questions were asked verbally, and it was fi lled by dental professional. The questionnaire included basic information related to the patient s name, age, sex, occupation, address, education, and socio-economic status. 10 min were given to each subject for completing the questionnaire. The data for this study were collected by interviewing the patients using this questionnaire. Inclusion criteria Overall good general health Presence of more than 16 teeth. Exclusion criteria Patients with having/history of any systemic disease Pregnancy and lactation Habit of using of tobacco or tobacco products Undergone oral prophylaxis within the past 6 months. Proforma of the questionnaire Name: Age/Sex: Occupation: Address: Education: Socio-economic status: How many times do you clean your teeth in a day? Once/twice/thrice Which oral hygiene aid do you use? Toothbrush/datun/fi nger Which dentrifrice do you use? Toothpaste/brick powder/salt/salt and oil/charcol/ toothpowder How frequently do you change your toothbrush? When useless/every 3 months/every 6 months/once in a year Do you know about interdental cleaning aids? Which interdental cleaning aid do you use? Wooden pick/fl oss/interdental brush Do you use a mouth wash routinely? Do you clean your tongue also along with toothbrushing? Have you ever noticed your gums bleeding? Have you ever noticed bad breath in your mouth? How often do you visit your dentist? Never/only when problem/once in 3 months/once in 6 months/ once a year What is your reason for visiting the dentist? Pain/regular checkup/irregular teeth/friends advice What is your reason behind not visiting the dentist? Fear of pain and discomfort/high cost/lack of time The data obtained in this manner from questionnaires were then tabulated analyzed statistically to obtain the results in terms of percentages and signifi cances. Data entry and analysis was done using the IBM SPSS version 17. Chi-square analyses were performed. Results The results obtained from the data with their comparative analysis and statistical signifi cances are shown in Tables 1-10 and corresponding Charts P < value was considered highly signifi cant, P < 0.05 value as signifi cant and P > 0.05 value as non-signifi cant. Discussion It is often seen that poor oral hygiene has always been remained as an ignored issue of our society. Most of the people fail to know the importance of oral hygiene as well as its relationship with many systemic diseases. Hence, in our study, attempts were made to evaluate the current oral hygiene practices and attitude toward oral health in the population of Jaipur as very few studies have been conducted in this regard till now. As the results of our study revealed, toothbrushing was statistically highly signifi cantly found to be the commonly used method of cleaning, as 82.67% of total subjects used toothbrush [Table 2 and Chart 2] as a cleaning aid and no signifi cant diff erences were detected between male and female subjects. However, the percentage of subjects brushing their teeth twice daily was only 36.78% [Table 1 and Chart 1], which is remarkably less as compared with the studies done by Dilip [4] in Karnataka, Jiang et al. [5] in China, Al-Shammari et al. [6] in Kuwait. Moreover, majority of subjects (61.09%) brushed only once in a day which was found to be statistically highly signifi cant. In addition, 22.06% subjects changed their toothbrush once in 3 months, and the most surprising fact 2 International Dental & Medical Journal of Advanced Research Vol

3 Sharma, et al. Oral hygiene practices in Jaipur Table 1: Frequency of cleaning teeth Frequency (%) (%) (%) Once 118 (57.56) 83 (66.93) 201 (61.09) Twice 83 (40.48) 38 (30.64) 121 (36.78) Thrice 4 (1.95) 3 (2.42) 7 (2.13) Chi-square for total group comparison= with 2 degrees of freedom; P=0.000**. Chi-square for male and female comparison=3.226 with 2 degrees of freedom; P=0.199 Table 2: Oral hygiene aid Oral hygiene (%) (%) (%) aid used Toothbrush 173 (84.39) 99 (79.84) 272 (82.67) Datun 18 (8.78) 14 (11.29) 32 (9.73) Finger 13 (6.34) 12 (9.68) 25 (7.60) Chi-square for total group comparison= with 2 degrees of freedom; P=0.000**. Chi-square for male and female comparison=1.807 with 2 degrees of freedom; P=0.405 Table 3: Dentifrice used Material used (%) (%) (%) as dentifrice Toothpaste 154 (75.12) 94 (75.81) 248 (75.38) Brick powder 6 (2.93) 4 (3.22) 10 (3.04) Salt 5 (2.44) 2 (1.61) 7 (2.13) Salt and oil 2 (0.97) 2 (1.61) 4 (1.21) Charcoal 4 (1.95) 5 (4.03) 9 (2.73) Toothpowder 25 (12.19) 7 (5.64) 32 (9.73) ne 9 (4.39) 10 (8.06) 19 (5.77) Chi-square for total group comparison= with 6 degrees of freedom; P=0.000**. Chi-square for male and female comparison=6.971 with 6 degrees of freedom; P=0.324 Table 4: Frequency of changing toothbrush (of percentage of toothbrush users only) Toothbrush (%) (%) (%) changed When useless 80 (46.24) 31 (31.31) 111 (40.81) Every 3 months 30 (17.34) 30 (30.30) 60 (22.06) Every 6 months 66 (38.15) 35 (35.35) 101 (37.13) Once in a year 3 (1.73) 8 (8.08) 11 (4.04) Chi-square for total group comparison= with 3 degrees of freedom; P=0.000**. Chi-square for male and female comparison= with 3 degrees of freedom; P=0.003* Table 5: Knowledge about interdental cleaning aids Knowledge of (%) (%) (%) interdental aids 48 (23.41) 22 (17.74) 70 (21.28) 157 (76.58) 102 (82.26) 259 (78.72) Chi-square for total as well as male and female group comparison >0.05 (non-significant) Table 6: Interdental cleaning aid used, use of mouthwash and tongue cleaning Additional hygiene (%) (%) (%) measures taken Interdental cleaning aid used Wooden pick 166 (80.97) 98 (79.03) 264 (80.24) Floss 11 (5.36) 13 (10.48) 24 (7.29) Interdental brush 0 (0) 1 (0.81) 1 (0.31) ne 28 (13.66) 11 (8.87) 39 (11.85) Use of mouthwash 45 (21.95) 34 (27.42) 79 (24.12) 160 (78.05) 90 (72.58) 250 (75.99) Tongue cleaning 141 (68.78) 80 (64.52) 221 (67.17) 64 (31.22) 44 (35.48) 108 (32.87) Chi-square for total group comparison (in Interdental cleaning aids used)= with 3 degrees of freedom; P=0.000** (highly significant) Table 7: Bleeding gums and bad breath Problems (%) (%) (%) noticed as Bleeding gums 61 (29.76) 49 (39.52) 110 (33.43) 144 (70.24) 75 (60.48) 219 (66.56) Bad breath 99 (48.29) 73 (58.87) 172 (52.28) 106 (51.71) 51 (41.13) 157 (47.72) Chi-square for total and male and female group comparison for bleeding gums and bad breath >0.05 (non-significant) Table 8: Frequency of visiting dentist Visit or visited dentist (%) (%) (%) Never 38 (18.54) 47 (37.90) 85 (25.83) Only when problem 151 (73.66) 61 (49.19) 212 (64.44) Once in 3 months 8 (3.92) 9 (7.26) 17 (5.17) Once in 6 months 7 (3.41) 6 (4.84) 13 (3.95) Once a year 1 (0.49) 1 (0.81) 2 (0.61) Chi-square for total group comparison= with 4 degrees of freedom; P=0.000**. Chi-square for male and female comparison= with 4 degrees of freedom; P=0.000** Table 9: Reason for visiting dentist Reasons for visiting (%) (%) (%) Pain 128 (62.44) 64 (51.61) 192 (58.36) Regular check-up 22 (10.73) 19 (15.32) 41 (12.46) Irregular teeth 32 (15.61) 25 (20.16) 57 (17.32) Friend s advice 23 (11.22) 16 (12.90%) 39 (11.85) Chi-square for total group comparison= with 3 degrees of freedom; P=0.013*. Chi-square for male and female comparison=3.967 with 3 degrees of freedom; P=0.356 International Dental & Medical Journal of Advanced Research Vol

4 Oral hygiene practices in Jaipur Sharma, et al. Table 10: Reason for not visiting dentist Reasons for not visiting (%) (%) (%) Fear of pain and discomfort 46 (22.44) 54 (43.55) 100 (30.39) High cost 74 (36.10) 29 (23.39) 103 (31.31) Lack of time 34 (16.58) 21 (16.93) 55 (16.72) Lack of awareness 51 (24.88) 20 (16.13) 71 (21.58) Chi-square for total group comparison=4.245 with 3 degrees of freedom; P= Chi-square for male and female comparison= with 3 degrees of freedom; P=0.000** When useless Every 3 months Every 6 months Once in a year Chart 4: Frequency of changing toothbrush Once Twice Thrice Chart 1: Frequency of cleaning teeth Chart 5: Knowledge about interdental cleaning aids Wooden Pick Toothbrush Datun Floss Interdental brush Finger ne a 0% 50% 100% Chart 2: Oral hygiene aid Toothpaste Brick powder Salt Salt & oil Charcoal Toothpowder ne b Chart 3: Dentifrice used was that, 40.81% subjects changed their brush only when it was useless [Table 4 and Chart 4] which was found to be statistically highly signifi cant. Furthermore, statistically highly signifi cant diff erences were found between male and female subjects with respect to the frequencies of changing their toothbrushes. c Chart 6: (a) Interdental cleaning aids used; (b) Use of mouthwash (c) Tongue cleaning 4 International Dental & Medical Journal of Advanced Research Vol

5 Sharma, et al. Oral hygiene practices in Jaipur Pain Regular check-up Irregular teeth 0% 50% 100% a Friend's advice Chart 9: Reason for visiting dentist Fear of pain & discomfort 0% 50% 100% b Chart 7: (a) Bleeding gums; (b) bad breath High cost Lack of time Lack of awareness Chart 8: Frequency of visiting dentist Never Only when problem Once in 3 months Once in 6 months Once a year In our study, it was found that toothpaste was the most commonly used dentrifrice (statistically highly signifi cant) [Table 3 and Chart 3] used by almost three fourth of the study population. Our study also revealed that only 21.28% subjects had knowledge about interdental cleaning aids [Table 5 and Chart 5] meaning what they are, why they are used and what are their types. Only 7.29% of the subjects in this study used dental fl oss [Table 6 and Chart 6], which is similar to the study done by Jamjoom [7] in Saudi Arabia. Thus, there is earnest need for educating people to use this interdental aid for effective oral health care. It is noteworthy that 67.17% of our study population showed that they clean their tongue also but only 24.12% subjects used mouth wash routinely [Table 6 and Chart 6] % of study population noticed no bleeding in their gums but 52.28% subjects complained of halitosis or bad breath [Table 7 and Chart 7]. This fi nding is in disagreement with study of Kaira et al. [8] who showed that most of the subjects noticed (86.4%) bleeding from gums. However, this difference might have been arisen due to the Chart 10: Reason for not visiting dentist reason that their study was conducted among nursing students. Besides these fi ndings observed in adults, a review also highlights that maintaining good oral hygiene in children with autism is a diffi cult task both for the parents of the child, and the dental staff because of the lack of interest by these children, hypersensitivity to various stimulus and lack of necessary manual dexterity. [9] Furthermore, our study showed that 58.36% of the subjects visited a dentist only when they felt pain [Table 9 and Chart 9] and this was found to be statistically signifi cant, which is similar to the study done by Gautam et al. [10] in Himachal Pradesh where majority of the participants did not visit a dentist especially people belonging to lower socio-economic status. This clearly shows that standards of oral health care are very poor not only in Jaipur, but also in our whole country where majority of the population is affected due to poor socio-economic status. In addition to this, one fourth of our study subjects had never seen a dentist [Table 8 and Chart 8]. Furthermore, statistically highly signifi cant differences were found between males and females regarding their frequencies of visiting dentist. The frequency of visiting the dentist only in problem was higher in male subjects than was in female subjects while the frequency of not visiting the dentist was higher in females than was in males. When the reason behind not visiting the dentist was asked, 31.31% subject reported it to be the high cost of dental treatment and 30.39% subjects found it to be the fear of pain and discomfort associated with dental procedures [Table 10 and Chart 10]. Statistically, highly signifi cant differences were found between males and females. Majority of male subjects considered high International Dental & Medical Journal of Advanced Research Vol

6 Oral hygiene practices in Jaipur Sharma, et al. cost while majority of female subjects considered fear of pain and discomfort as a reason behind not visiting the dentist. Thus, the fi ndings of this study conclude that there is lack of knowledge and awareness about oral hygiene practices and role of regular dental visits in preventing oral diseases in Jaipur population emphasizing the need of oral health promotion programs. Conclusion This study shows that there is a need for spreading knowledge about basic and advanced oral health practices, in addition to those being currently used in Jaipur such as the use of mouthwashes, dental fl oss, etc. Furthermore, the emphasis needs to be laid on enlightening the people with the importance of regular comprehensive oral health care through the initiative of general oral health awareness program s. References 1. Bolden AJ, Logan HL, Jakobsen JR, Evans TA. Perception of oral health needs by Southeast Iowa non-dental health care providers. Spec Care Dentist 1994;14: Vick VC, Harfst S. The Oral Risk Assessment and Early Intervention System a clinician s tool for integrating the bio/ psycho/social risk into oral disease interventions. Compend Contin Educ Dent Suppl 2000;???: Nutbeam D, Aar L, Catford J. Understanding childrens health behaviour: The implications for health promotion for young people. Soc Sci Med 1989;29: Dilip CL. Health status, treatment requirements, knowledge and attitude towards oral health of police recruits in Karnataka. J Indian Assoc Public Health Dent 2005;5: 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: Al-Shammari KF, Al-Ansari JM, Al-Khabbaz AK, Dashti A, Honkala EJ. Self-reported oral hygiene habits and oral health problems of Kuwaiti adults. Med Princ Pract 2007;16: Jamjoom HM. Preventive oral health knowledge and practice in Jeddah, Saudi Arabia. J King Abdulaziz Univ: Med Sci 2001;9: Kaira LS, Srisvastava V, Giri P, Chopra D. Oral health related knowledge, attitude and practice among nursing students of rohilkhand medical college and hospital: A questionnaire study. J Orofac Res 2012;2: Gupta M. Oral health status and dental management considerations in autism. Int J Contemp Dent Med Rev 2014;2014: Gautam DK, Vikas J, Amrinder T, Rambhika T, Bhanu K. Evaluating dental awareness and periodontal health status in different socioeconomic groups in the population of Sundernagar, Himachal Pradesh, India. J Int Soc Prev Community Dent 2012;2:53-7. How to cite this article: Sharma R, Singh S, Rajmani H, Degra H. An evaluation of the current oral hygiene practices and attitude towards oral health in the population of Jaipur, India. Int Dent Med J Adv Res 2015;1: International Dental & Medical Journal of Advanced Research Vol