Article ID: WMC001618 2046-1690 Factors Affecting The Knowledge On Prevention Of Oral Diseases Among School Teachers Of Dharwad City, A Survey From India Corresponding Author: Dr. Shodan M Raj, Assistant Professor, Public Health Dentistry, SDM College of Dental Sciences and Hospital, 580009 - India Submitting Author: Dr. Shodan M Raj, Assistant Professor, Public Health Dentistry, SDM College of Dental Sciences and Hospital, 580009 - India Article ID: WMC001618 Article Type: Original Articles Submitted on:25-feb-2011, 06:51:42 AM GMT Article URL: http://www.webmedcentral.com/article_view/1618 Subject Categories:DENTISTRY Keywords:School-Teachers, Knowledge, Oral Disease, Prevention Published on: 25-Feb-2011, 10:24:52 PM GMT How to cite the article:raj S M, VV P K, B J S. Factors Affecting The Knowledge On Prevention Of Oral Diseases Among School Teachers Of Dharwad City, A Survey From India. WebmedCentral DENTISTRY 2011;2(2):WMC001618 Additional Files: Article WebmedCentral > Original Articles Page 1 of 14
Factors Affecting The Knowledge On Prevention Of Oral Diseases Among School Teachers Of Dharwad City, A Survey From India Author(s): Raj S M, VV P K, B J S Abstract Aim: To assess factors affecting the knowledge on prevention of oral diseases among school teachers of Dharwad city and to assess the relationship of knowledge about prevention of common oral diseases with the sociodemographic variables. Materials and methods: A cross sectional questionnaire based study was carried out among the school teachers of Dharwad city. The questionnaire was close ended with 26 items. The total sample size was 215 arrived at by stratified systematic sampling. Results: The questionnaire was distributed to 215 study subjects and there was a response rate of 95.34% (n=205). Knowledge about the prevention of common oral diseases varied from 43.90 % to 91.22%, i.e Dental caries à91.22% Gum disease à 68.78 Irregular teeth à 53.17%, Oral cancer à43.90%. Knowledge was highest in the unaided schools followed by the aided schools and then the government schools. Conclusions: Females had a significantly higher knowledge about the prevention of malocclusion than males. Knowledge about the prevention of dental decay and oral cancer was significantly higher in 30-60 year old age group than in the 21-30 age groups. The results showed that school dental health services must compulsorily hold demonstrations or lectures on prevention of oral diseases, in order to involve the teachers in oral health promotion of the child. Introduction India, a developing country faces many challenges in rendering oral health needs. The majority of Indian population resides in rural areas, of which more than 40% constitute children. These children cannot avail dental facilities due to inaccessibility, financial constraints and stagnation of public dental healthcare services. This entails the health professional to adopt a more practical approach to achieve prevention of oral diseases1. The burden of oral disease in children is significant. Most established oral diseases are irreversible, will last for a lifetime and have an impact on quality of life and general health. School teachers are considered to be an important target group for various health educational activities with the underlying objective of inculcating healthy lifestyle practices into children for a lifetime. Schools, with their special characters amongst other behaviour-affecting institutes, provide a big opportunity for promoting schoolchildren's health. School environment, curriculum, and extracurricular activity could all be utilized for promoting student's oral health and general health as well. The school years are a time where many elements of attitude, behaviour and life skills are still forming. School teachers, with their educational experience and contact with students, can actively contribute to student's health promotion, provided that they receive enough training and support to do so2. Knowledge of oral diseases and more importantly about the fact that most of these diseases are preventable to a large extent is a major vehicle for improving the oral health of the children. School teachers have traditionally been considered as potentially important primary agents of socialization, with a capability of influencing the future, knowledge, attitude and behavior of school children.3 Documented evidence shows that teachers and parents can augment dental health behaviour1. The major challenges of the future will be to translate knowledge and experiences of disease prevention into action programmes. Previous studies have indicated that teachers' knowledge about oral health and current methods of prevention were inadequate and was inaccurate in some instances4. The purpose of the present study is to assess factors affecting the knowledge on prevention of oral diseases among school teachers of Dharwad city and to assess the relationship of knowledge about prevention of common oral diseases with the socio-demographic variables. Materials & Methods The present study was of Cross-sectional design, using structured self-administered questionnaires, WebmedCentral > Original Articles Page 2 of 14
conducted to assess the knowledge about prevention of common oral diseases among school teachers in Dharwad city and in order to assess the relationship of knowledge about prevention of common oral diseases with the sociodemographic variables. Study area and description of the population: The present study was a questionnaire based study carried out among the school teachers of Dharwad city which is located in northern part of Karnataka state in India. Sampling Procedure: A list of total schools was obtained from the Block Education Officer (BEO) of Dharwad City and 215 school teachers were selected by Stratified systematic sampling. Pilot study: The Questionnaire to assess the oral health knowledge of the study subjects was a close ended questionnaire consisting 26 questions and was administered to 30 school teachers selected randomly from three schools. It was shown to have a Validity of 0 0.8469%& Split half reliability of 0.7173. Questionnaire design: The questionnaire used in the present study was a close ended questionnaire consisting of 26 questions with four questions relevant to information on the Sociodemographic factors and the remaining pertaining to their knowledge of the prevention the diseases common to this particular geographical area i.e. like dental caries, gum diseases, malocclusion and oral cancer. The contents of the questionnaire were in the local language i.e., Kannada. Statistical analysis: The questionnaire was distributed to 215 study subjects and there was a response rate of 95.34% (n=205).the data was subjected to statistical analysis using the statistical package STATA 9. Results The questionnaire was distributed to 215 study subjects and there was a response rate of 95.34% (n=205). Table 1 shows the distribution of the study subjects. The total number of government schools was thirty with two hundred and thirty five school teachers, out of whom 10 schools were randomly selected. These ten schools had a total of 72 school teachers, similarly the total number of aided and unaided schools was 30 and 28 respectively, out of which ten and nine schools were chosen randomly. These schools chosen had seventy six and sixty seven school teachers respectively thus making up the total sample size of two hundred and fifteen school teachers. The school teachers had a mean age of 40.175 with 69% of them being between the ages of 31-40. Their ages varied from as low as 21 years to as high as sixty years. Out of the two hundred and fifteen study subjects one hundred and seventy one were male female and forty four were male. Thus a majority i.e. 79.534% of the study subjects were female One hundred and twenty eight study subjects were graduates having completed their B Ed, BA or other qualifying bachelor s degrees and seventy seven were post graduates, thus 62.439% of the study subjects were graduates and 37.56% were post graduates. Regarding the knowledge of school teachers about the prevention of dental caries, 94.36%, 88.73, and 94.23% of the school teachers of government, aided and unaided schools thought that decreased sweet intake contributed to a reduction in dental caries. Thus, a total of 92.68% school teachers knew that decreased sweet intake led to a reduction in dental caries. Among the 215 school teachers, only 50%, 53.2% and 60.3% of the school teachers of government, aided and unaided schools were aware that fluoride caused decrease in caries. Thus only 54.63% of the school teachers were aware of the caries inhibiting properties of fluoride. Regarding the knowledge of school teachers about the primary preventive measures like pit and fissures only 25.35%, 23.94% and 20.45% of the school teachers of government, aided and unaided schools were familiar with the sealant use to prevent dental caries comprising of a total of 21.4%. About the awareness of regular tooth brushing to be an effective method in the control of dental caries and gum diseases, 87.32% 97.1% and 99% of the school teachers of government, aided and unaided school were aware that regular toothbrushing contributed to preventing tooth decay as well as gum disease. This figure was an overwhelming 94.63% of the study sample. Tobacco chewing was considered to be an important factor in the causation of periodontal diseases by 81.69%, 78.87% and 88.88% of the school teachers of government, aided and unaided school respectively. Rinsing after food was believed to be a significant factor in the prevention of periodontal diseases by 94.36%, 90.14% and 98.41% of the school teachers of government, aided and unaided school respectively thus forming a total of 94.15% of the school teachers who were aware of this fact. Only 15.49%, 14.08% and 19.04% of the school teachers of government, aided and unaided school WebmedCentral > Original Articles Page 3 of 14
respectively were aware that the use of dental floss plays a considerable role in the prevention of periodontal disease which is only 16.1% of the total study sample. Regarding the knowledge of school teachers about the prevention of malocclusion 78.87%, 8.32% and 87.3% of the school teachers of government, aided and unaided school respectively were aware that once a primary tooth fell off prematurely the space needs to be maintained to enable the eruption of its successor. This opinion was shared only by 84.39% of the study subjects. Thumb sucking was considered to be an important factor in the development of malocclusion by 81.69%, 87.32% and 66.19% of the school teachers of government, aided and unaided school respectively which formed a total of 81.46% of the study sample. Similarly tongue thrusting was considered to be a cause for malocclusion by 78.87%, 63.38% and 60.31% of the school teachers of government, aided and unaided school respectively which formed a total of 67.8% of the study sample. 56.33%, 46.47%, and 49.2% of the school teachers of government, aided and unaided school respectively felt that milk teeth require care to ensure that its successors will be healthy this was a total of 50.73% of the total sample. Tobacco smoking was thought to be a cause for oral cancer by 87.32%, 77.46%, and 93.65% of the school teachers of government, aided and unaided school respectively comprising of a total of 85.85% of the sample. Chewing of tobacco was linked to the causation of oral cancer by 87.32%, 71.83%, and 96.82% of the school teachers of government, aided and unaided school respectively comprising of a total of 84.88% of the sample. Consumption of alcohol was thought to promote oral cancer by 53.52%, 47.88%, and 68.25% of the school teachers of government, aided and unaided school respectively comprising of a total of 56.1% of the total number of study subjects. Spicy food was associated with the development of oral cancer by 22.53%, 36.61%, and 41.26% of the school teachers of government, aided and unaided school respectively comprising of a total of 33.17% of the total number of study subjects who had knowledge about spicy food playing an important role in the development of oral cancer. ANOVA test shows that there was a significant difference between the school teachers of government, aided and unaided schools regarding their knowledge about prevention of dental decay, gum disease and oral cancer but there was no significant difference in their knowledge regarding the prevention of malocclusion. It also showed that there was a significant difference between the different age groups regarding their knowledge about prevention of dental caries and oral cancer. ANOVA also showed a significant difference in gender regarding their knowledge about prevention of malocclusion. The results were then subjected to Scheffes multiple comparison tests which revealed that aided schools had significantly more knowledge than unaided and government schools regarding the knowledge about prevention of dental decay,gum diseases and oral cancer. Unaided schools had significantly more knowledge about prevention of oral cancer followed by aided and then by government schools. Unaided schools had higher total knowledge score followed by aided and then by government schools as disclosed by Scheffes multiple comparison tests. The 31-60 yr age group had significantly higher knowledge about prevention of dental decay and oral cancer than the 21-30 age groups. Females had significantly more knowledge about the prevention of malocclusion than males. There was no significant difference between the knowledge of the graduate and postgraduate teachers. Discussion The present study was of Cross-sectional design, using structured self-administered questionnaires, conducted to assess the knowledge about prevention of common oral diseases among school teachers in Dharwad city and in order to assess the relationship of knowledge about prevention of common oral diseases with the sociodemographic variables. In India the data available on knowledge about prevention of common oral diseases among school teachers is scarce and in the present study an attempt was made to assess the factors affecting the same. Schools, with their special characters amongst other behavior-affecting institutes, provide a big opportunity for promoting schoolchildren's health. School environment, curriculum, and extracurricular activity could all be utilized for promoting student's oral health and general health as well. School teachers, with their educational experience and contact with students, can actively contribute to student's health promotion, provided that they receive enough training and support to do so2. School teachers have the unique potential of preparing the future generation of correctly informed health care consumers and decision makers3. The current study is an attempt to tap the knowledge of the school teachers about the prevention of the oral WebmedCentral > Original Articles Page 4 of 14
diseases common to this geographical area. In the present study the school teachers showed a good amount of knowledge regarding dental caries, this is in accordance with the findings of a similar study by Goel P, et al5. In the present study school teachers showed high knowledge regarding the fact that increased sweet intake caused increase in dental caries. This could be because of the popular belief in this area that to the sole cause of tooth decay is sugar. They also were aware that regular toothbrushing prevented tooth decay. However, they exhibited a lack of knowledge regarding the caries inhibitive properties of fluoride. Pit and fissure sealants seemed to be unheard of in this population with only 21.4% showing some awareness about its caries preventive benefits. The effectiveness of fissure sealants, one of the most preventive measures seems to be universally unknown to the public6. The utilization of dental services is quite poor in this area and preventive services like sealants are almost unheard of. In the present study the knowledge regarding the importance of rinsing habits as a preventive measure against gum diseases is very high with 94% of subjects being aware of its benefits. This could be because mouth rinsing is culturally ingrained into the lives of people and its benefits known almost to all. On the contrary the knowledge regarding flossing habits, which is one of the important aids in the prevention of periodontal disease and in the maintenance of good oral hygiene7, is alarmingly low. These results are similar to the results of a study conducted by Marcia Boyer8 who in addition to finding that school teachers had poor knowledge about the importance of flossing also discerned that that many teachers do not even consider dental health activities to be responsibilities of the public school teacher Female teachers demonstrated more positive levels of dental knowledge regarding malocclusion. Most of the school teachers were aware that thumb or digit sucking was the main cause of malocclusion. The knowledge regarding importance of primary teeth on the contrary was very low this is in agreement with a study conducted by Mohammed Al Bokhamseen who conducted a study on the knowledge regarding importance of primary teeth. He found that there is a paucity of knowledge in this area and he also related this to low socioeconomic status. This could be probably because of lack of health educational measures and awareness regarding the importance of primary teeth9. It is seen in the results of the present study that the school teachers had a significant knowledge about the harmful effects of tobacco both when chewed as well as smoked. In a study conducted by Arzu Yorgancioglu10, he found that teachers had a good awareness bout the hazards of tobacco especially smoking. This could be because of the effects of mass media especially television, and magazines that repeatedly caution the general public about the risk of tobacco related diseases and also the statutory warning seen on the covers of all commercially available tobacco products as a result of stringent government regulations. The knowledge regarding the possible role of spicy food as a risk factor in causing oral cancer was low this is in accordance with a study conducted by Sinha R11, et al who in their article said that very little is known, about the role of the Indian diet in causation of cancer or its role, if any, in prevention of cancer, and that from a public health perspective, there is an increasing need to develop cancer prevention programs responsive to the unique diets and cultural practices of the people of India. In our study females had more knowledge about the prevention of malocclusion than males. In a study conducted by Emmanuel12 et al they found that females have more orthodontic concerns than males. This fact is in agreement with our findings where females significantly had more knowledge about the causes of malocclusion than males. Though it is quite well known that as educational qualifications increase knowledge about preventive measures against common oral diseases would also simultaneously increase this was not so in our study in which there was no significant differences in the knowledge levels of graduate and post graduate teachers. This could be because of the general lack of awareness of the public regarding oral diseases. The results in this study thus give us a clear indication that a significant knowledge gap exists between the public and the established scientific literature. This constitutes a significant obstacle when seeking the co operation and support of school teachers in school based programmes3. It is indeed high time that adequate health educational measures as well as other preventive measures are taken to inform this particular population about the prevention of common oral diseases. School children are largely responsible for the epidemiological transition of the population thus school teachers must indeed be regarded as an invaluable resource while imparting health education. Conclusion 1. Females had a significantly higher knowledge about the prevention of malocclusion than males. Knowledge about the prevention of dental decay and oral cancer WebmedCentral > Original Articles Page 5 of 14
was significantly higher in 30-60 year old age group than in the 21-30 age groups. 2. Knowledge about the prevention of common oral diseases varied from 43.90 % to 91.22%,i.e., Dental caries à 91.22% Gum disease à 68.78 Irregular teeth à 53.17% Oral cancer à 43.90%. 3. Knowledge about dental floss, and pit & fissure sealants need further improvements 4.Findings suggest that teachers' knowledge about prevention of common oral diseases could be improved. 5. School children as educated by teachers are not only important as far as preventing disease among themselves in the present, but also in their future role as adults and opinion leaders of the next generation3. References 10. Arzu Yorgancioglu, et al Attitudes of the High School Teachers and Students Towards Smoking:Two Sides of the Story Turkish Respiratory Journal, August 2002,Vol.3,No.2 11. Sinha R, Anderson DE, McDonald SS, Greenwald P. Cancer Risk and Diet in India. J Postgrad Med 2003;49:222-8 12. Emmanuel O. Ajayia and Yetunde O. Ajayib Attitudes to Malocclusion in a Nigerian School Population Journal of Medicine and Biomedical Research, Vol. 5, No. 1, June 2006, pp. 16-23 1. Thomas S, Tandon S, Nair Effect of dental health education on the oral health status of a rural child population by involving target groups S.J Indian Soc Pedod Prev Dent. 2000 Sep;18(3):115-25 2. Dr. SALEH S. AL-ANSARI Preventive oral health programmes at school health (MOE) Prospective of a new collaboration Saudi Dental Journal 2007;19(SI)-Abstr.018 3. Harold D et al. Dental knowledge and attitudes among Arab school teachers in Northern Israel Int Dent Journal 1999, 49; 269-74 4. Nazeer Khan et al. Dental caries, hygiene, fluorosis and oral health knowledge of primary school teachers of Riyadh, Saudi Arabia Saudi Dental Journal,. 3(3) September - December 2001 5. Goel P, Shetty V. Knowledge, attitude and practice of dental caries and periodontal disease prevention among primary school teachers in Udupi municipality J Indian Soc Pedod Prev Dent. 1997 Dec;15(4):124-9 6. Mafeni. J O, messewr LB. Parental knowledge and attitude towards pit and fissure sealants. Australian dent J 1998, 20: 317-22 7. Michael Newmann, Henry H Takei, Fermin A Carranza, A textbook of clinical periodontology9th edition, Elsevier Publications. 8. E. Marcia Boyer Classroom Teachers' Perceived Role in Dental Health Education Journal of Public Health Dentistry 36 (4), 237 243. 9. Mohammed Al Bokhamseen, Shaker Al Saad, Thakib A Al Shalan. The Relative Effect of Different Socio-Economic Corresponding Author Factors on Saudi Parent`s Knowledge about the Importance of Primary Teeth. Pak J Orthodont Ped and Comm Dentistry Dec 2002;1(2):118-20. WebmedCentral > Original Articles Page 6 of 14
Illustrations Illustration 1 Table 1: Distribution of study subjects Govt Aided Unaided Govt sample Aided sample Unaided sample No of schools No of study subjects 30 30 28 88 10 10 9 29 235 229 215 679 72 76 67 215 WebmedCentral > Original Articles Page 7 of 14
Illustration 2 Table 2: Educational qualification of the study subjects Sl no Degree No of study subjects 1 TCH, BA, Bed 128 2 MA, Med 77 3 205 WebmedCentral > Original Articles Page 8 of 14
Illustration 3 Table 3: Comparison among the different variables by ANOVA test Variable SV F-value p-value Signi. Between schools 3.9131 0.0215 S Within schools Decay Between schools 10.3129 0.0001 S Within schools Gum disease Between schools 1.5025 0.2250 NS Within schools Malocclusion Between schools 7.7638 0.0006 S Within schools Cancer WebmedCentral > Original Articles Between schools 3.4203 0.0346 S Page 9 of 14 Within schools
Illustration 4 Table 4 and 5: Comparison among different types of schools by Scheffes Multiple comparison tests Decay Gum diseases Types of schools Aided Govt Unaided Aided Govt Unaided Mean 4.3803 3.8028 4.3016 3.8028 3.3239 3.8889 Aided 1.0000 1.0000 Government 0.0365 1.0000 0.0017 1.0000 Un aided 0.9429 0.0969 1.0000 0.8191 0.0003 1.0000 Cancer Overall Knowledge Types of schools Aided Govt Unaided Aided Govt Unaided Mean 2.7042 2.8873 3.5873 14.1410 13.6200 15.0320 WebmedCentral > Original Articles Page 10 of 14 Aided 1.0000 1.0000 Government 0.7237 1.0000 0.6143 1.0000
Illustration 5 Table 6: Comparison among different age groups by ANOVA Variable SV F-value p-value Significance Between age groups 5.0008 0.0023 S Within age groups Decay Between age groups 1.5699 0.1979 NS Within age groups Gum disease Between age groups 0.8492 0.4685 NS Within age groups Malocclusion Between age groups 3.1658 0.0255 S Within age groups Cancer WebmedCentral > Original ArticlesBetween age groups 1.7391 0.1602 NS Page 11 of 14 Within age groups
Illustration 6 Table 7: Comparison among different age groups by Scheffes Multiple comparison tests Decay Cancer Age 21-30 31-40 41-50 51-60 21-30 31-40 41-50 51-60 Mean 3.4872 4.2319 4.2295 4.6111 2.4359 3.1304 3.1803 3.2778 21-30 1.0000 1.0000 31-40 0.0471 1.0000 0.1002 1.0000 41-50 0.0563 1.0000 1.0000 0.0471 0.9977 1.0000 51-60 0.0038 0.5752 0.5880 1.0000 0.0456 0.9654 0.9902 1.0000 WebmedCentral > Original Articles Page 12 of 14
Illustration 7 Table 8: Comparison among male Variable Sex Mean SD t-value p-value Sign Decay Male 4.0286 1.4650-0.6151 0.5392 NS Female 4.1824 1.3220 Gum disease Male 3.6000 0.8471-0.5004 0.6173 NS Female 3.6765 0.8184 Malocclusion Male 2.6571 1.4337-3.4560 0.0007 S Female 3.5235 1.3332 Cancer Male 3.2286 1.3303 0.8793 0.3803 NS Female 3.0000 1.4142 Knowledge Male 13.5143 3.7992-1.4757 0.1416 NS Female 14.3824 3.0267 WebmedCentral > Original Articles Page 13 of 14
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