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PARVEEN N, AHMED B AND BARI A.. ORO DENTAL HEALTH sectors. This report states that in the age group of 12-15 years, on an average, every individual ...
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ORO DENTAL HEALTH: AWARENESS AND PRACTICES Nagina Parveen1, Bilal Ahmed2, Amjad Bari3, Aamir Mahmood Butt4

1Associate Professor, Nishtar Institute of Dentistry, Multan. 2 Assistant Professor, UMDC, The University of Faisalabad, Faisalabad. 3 Assistant Professor, Nishtar Institute of Dentistry, Multan. 4Assistant Professor, LUMS Jamshoro, Hyderabad. ABSTRACT Objective:

To assess the knowledge, attitude, practices and perceptions regarding oro-dental health in the patients attending the outpatient department of Nishtar Institute of Dentistry, Multan, Pakistan. Methodology:

This was a cross sectional descriptive hospital based survey, conducted in Nishtar Institute of Dentistry, Multan, Pakistan from January 2010 to March 2010. A total of 221 subjects were interviewed on a questionnaire proforma using Non Probability convenient sampling technique. SPSS version 17.0 was used to analyze the collected data. Results:

Of the study participants, 41.7%, received information regarding oral health mainly from media and 46.2% from Community members. 64.3% of the study participants (Male 55.6% & Female 44.4%) knew the reason that eating sugars causes tooth decay and 47.1% were afraid of dental check up because of pain perception. Results showed that 46.2% (Male 51.9%: Female: 48.1%) brushed their teeth once a day and 6.9% did not brushed at all. It was found that 42.5% (Male: 46.8%; Female: 53.2%) of study participants visited the dentist during the last 6 months and about 56.1% of the subjects came because of dental pain. Conclusion:

Results of this study suggest that oral health KAP among study participants was poor and needs to be improved. Findings of this study also show that utilization of available dental service is mainly for emergency pain relief & very occasionally for routine oral health maintenance. Based upon these findings, systematic community-oriented oral health promotion programs are needed to target the lifestyles in different general population groups. Keywords: Oral health education, oral dental health, dental treatment INTRODUCTION Oral Diseases are a major public health concern owing to their higher prevalance and their effects on the individual’s quality of life.1 Dr. Bilal Ahmed, House No. 47 Block No. 30, Sargodha, Pakistan. [email protected] The possible etiological factors leading to these oral diseases are genetic predispositions, developmental problems, poor oral hygiene and traumatic incidents. The management of JUMDC Vol. 2, Issue 2, Jul-Dec 2011

these conditions is definitely dependant on the proper diagnosis and evaluation of their causative factors and treatment of their symptomatic defects.2 A large ratio of these diseases can be prevented on individual and public levels by providing oral health related education thus improving oral health attitudes and practices among the general population. Oral health knowledge is considered to be an essential pre requisite for health related behavior.3 According to the National Oral Health Survey of Pakistan, majority of the people do not have access to the basic curative dental health facilities in the public & the private 5

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sectors. This report states that in the age group of 12-15 years, on an average, every individual has lost about two to three teeth due to dental caries.4 Majority of population in South East Asian 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 perceptions are also very important.5 The evaluation of available information and facilities, perceptions, behavior and practices is very important for provision of proper health care facilities as they form the base line of the strategic planning and decision making.6 This study was a part of a larger hospital based survey that was conducted simultaneously in different teaching dental hospitals and dental health facilities of the country both from public as well as from the private sector. A questionnaire was designed for this survey which included questions regarding socio demographic profiles, presenting complaints, allied health problems and habits, intra oral health status, knowledge, attitudes, perceptions and behavior regarding the oral health. The purpose of this study in particular was to assess the oral health related knowledge, attitude and practices among the patients visiting the outpatient department of Nishtar Institute of Dentistry, Multan, Pakistan. Aims and objectives

To assess the knowledge, attitude, practices and perceptions regarding oro-dental health in the patients visiting Nishtar Institute of Dentistry, Multan. MATERIALS AND METHODS This was a cross sectional descriptive hospital based survey, conducted from January 2010 to March 2010. A total of 221 subjects were interviewed on a questionnaire using Non Probability convenient sampling technique. Inclusion criteria

1. Patients visiting Nishtar Institute of Dentistry, Multan for their oral and dental problems. 2. Patients who gave verbal consent to take part in the study.

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Exclusion criteria

1. Patients suffering from debilitating diseases or severe maxillofacial trauma and were unable to respond to the questionnaire. 2. Patients who refused to take part in the study. Data collection procedure

A special questionnaire was designed and permission was sought from the ethical review committee of the Institute. Patients visiting to the dental OPD were selected and an informed verbal consent was taken from these patients to take part in the study. Data analysis

SPSS version 17.0 was used to analyze the collected data. RESULTS A total of 221 study participants were selected in which 41.7%, received information regarding oral health mainly from media and 46.2% from friends and community members, whereas dental profession’s contribution was only 12.2% (Table 1). It was found that 64.3% of the study participant’s (Male 55.6% and Female 44.4%) knew the reason that eating sweets causes tooth decay (Table 2). Out of the study subjects, 47.1% were afraid of going for the routine or even mandatory dental check up because of perception of expected pain (Table 3). Table 1. Sources of information about oral health. Source of information Radio and Television Friends Newspapers Community Dentist/Dental Health Care Workers Total

Frequency 68 59 24 43

27 221

Percent % 30.8 26.7 10.9 19.5 12.2 100.0

Table 2. Gender * sweet intake cross Gender

Male Female Total

Yes 79 63 142

Sweet intake No None 38 3 34 4 72 7

Total 120 101 221

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Table 3. Dental fear/perception of pain. Frequency 104 117 221

Yes No Total

Percent % 47.1 52.9 100.0

Oral health practices were studied and it was found that 46.2% (Male 51.9%, Female 48.1%) (Table 4) brushed their teeth once a day while 6.9% did not brushed at all. Figure 1 shows the frequency of tooth brushing related to the educational status of the study subjects, where the participants having inter and graduate level education showed best responses. Whereas 25.8% (Figure 2) use plastic tooth picks, 14.5% used mouth washes and only 15.6% use dental floss. Table 4. Gender * frequency of brushing cross. Gender

Male Female Total

Frequency of brushing Once Twice Weekly No 53 43 14 10 49 43 5 4 102 86 19 14

Total 120 101 221

It was found that 42.5% (Table 5) (Male 46.8%, Female 53.2%) (Table 6) of study participants had visited the dentist during the last 6 months. During the last visit, 19% (Figure 3) of study participants came for routine checkup, 56.1% came because of pain/discomfort, 19% for prophylactic cleaning and 5.9% for extractions of teeth. Table 5. Past six months dental visits. Frequency 94 127 221

Yes No Total

Percent % 42.5 57.5 100.0

A very high proportion of study participants reported to have hidden sugars every day. As much as 85% (Table 7) participants used tea up to two times a day whereas 15% didn’t use it. Among the study subjects, 57.9% were used to soft drinks regularly whereas 42.1% didn’t use soft drinks (Table 8).

frequency of brushing once twice weekly no

25

20

Count

15

10

5

0 no schooling

primary

middle

matric

inter

graduate

post graduate

Educational status

Figure 1. Educational status *frequency of brushing

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ORO DENTAL HEALTH

100

80

Count

60

40

20

0 dental floss

tooth pick

mouth wash

charcoal

none

Additional means of oral hygiene

Figure 2. Additional means of oral hygiene. 120

100

Count

80

60

40

20

0 routine check up

pain

scaling

extraction

Reason for last visit

DISCUSSION

Figure 3. Reason of last dental visit.

This was a cross sectional descriptive, hospital based survey to identify and correlate different factors affecting the oral hygiene status thus affecting different dental disease conditions in population visiting a teaching dental hospital. Patients comply better with oral health care regimens when informed and

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positively reinforced. The motives prompting people to seek preventive dental care include the beliefs that one is susceptible to dental diseases, that dental problems are serious and that the dental treatment is beneficial. This Health education attempts to change behaviors by altering knowledge, attitudes and perceptions.7 JUMDC Vol. 2, Issue 2, Jul-Dec 2011

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Table 6. Gender * past 6 months dental visits Gender Male Female

Past 6 months visits Yes 44 50

dental No 76 51

Table 7. Frequency of tea intake. Once Twice None Total

Frequency 128 60 33 221

Total 120 101

Percent % 57.9 27.1 14.9 100.0

Table 8. Frequency of soft drinks intake. Once Twice More than twice None Total

Frequency 48 43 37 93 221

Percent % 21.7 19.5 16.7 42.1 100.0

The participants in this study reported to receive information regarding oral health mainly from media. However, this information was mainly certain brand specific and was focusing on only one or two aspects. The role of dental profession is questionable. The public oral health awareness should be improved through the school health programs as well as different community based projects in collaboration with media. Only 42.5% of the study population reported that they have visited dentist during last 6 months and this finding was consistent with the findings of Harikiran.5 Dental pain (56.8%) appeared to be the most important cause for dental visits during past 6 months. This again was consistent with Harikiran (59.7%).5 Dental visits were infrequent (57.5%) which was similar to a study by Varenne et al.8 Fear of pain during dental treatment (43.4%) and chances of cross infection (38.0%) were the main causes of irregular visits in our study participants which was very high compared to a study by El-Qaderi and Taani et al.9 High proportion of study participants reported to have hidden sugars every day in the form of soft drinks (57.9%) and tea (21.7%) which was high compared to a study by Petersen et JUMDC Vol. 2, Issue 2, Jul-Dec 2011

al.10 Approximately 64.3% were aware that this sweet intake affects oral hygiene and this finding was similar as to a study by Al-Omiri et al.11 This survey also found that only 38.9% of the study subjects were used to brush their teeth two or more times a day which was very consistent with the findings of Harikiran5 where it was 38.8%. The use of other recommended oral hygiene methods such as dental floss (15.4%) was found to be less which was similar to a study conducted in North Jordon by Al-Omiri et al.11 where the use of dental floss (2%) was very less. In contrast, Hamilton and Coulby12 found that a high percentage (42%) of the sample they studied used dental floss. These striking differences indicate the value of oral health programs being carried out in different regions. However, the individual’s oral stereognostic and oral motor abilities should also be considered while comparing these different groups.13, 14. These findings present almost similar results as the earlier studies in different population groups of the same region.15 Most of the aforementioned dental problems can be prevented by simply providing awareness on the community level. This can be better, cost effective alternative to more expensive dental procedures. There should be a continuous ongoing oral health awareness program that must be a part of curriculum at the school, college and university levels. Dental professionals, Dental Marketing Agencies and media should join hands with the government Health Care Authorities to help the general population in preventing dental problems by improving their knowledge, attitudes, behaviors and habits towards oral hygiene. CONCLUSION Results of this study suggest that oral health KAP among study participants was poor and needs to be improved. Findings of this study also show that utilization of available dental service is mainly for emergency pain relief and very occasionally for routine oral health maintenance. These results suggest that simple preventive oral health measures among study participants like brushing twice a day is not a normal practice in our population. Based upon these findings, systematic 9

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community-oriented oral health promotion programs are needed to target the lifestyles in different general population groups. REFERENCES 1. Butt AM, Ahmed B, Parveen N and Yazdanie N. Oral Health Related Quality of life in complete dentures. Pak Oral Dent J 2009; 29(2):397-402. 2. Tash RH, O’Shea MM and Cohen K. Testing a Preventive-Symptomatic Theory of dental health behavior. Am J Public Health 1969; 59:514-521. 3. Kegeles SS. Some motives for seeking preventive dental care. J Am Dent Assoc 1963; 67:110-118. 4. Khan AA et al. National Oral Health Pathfinder Survey. 2002. 5. Harikiran AG, Pallavi SK, Hariprakash S, Ashutosh and Nagesh KS. Oral Healthrelated KAP among 11 to 12-year-old school children in a government-aided missionary school of Bangalore city. Indian J Dent Res 2008; 19:236-42. 6. The World Oral Health Report 2003: Continuous improvement of oral health in the 21st century–The approach of the WHO Global Oral Health Programme. 7. Mirza KM, Khan AA, Ali MM and Chaudhry S. Oral Health Knowledge, Attitude and Practices and Sources of Information for Diabetic Patients in Lahore, Pakistan. Diabetes Care 2007; 30(12):3046-7. 8. Varenne B, Petersen PE and Ouattara S. Oral health behaviour of children and adults in urban and rural areas of Burkina Faso, Africa. Int Dent J 2006; 56:61-70.

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9. El-Qaderi SS and Taani DQ. Oral health knowledge and dental health practices among schoolchildren in Jerash districtJordan. Int J Dent Hyg 2004; 2:78-85. 10. Petersen PE, Hoerup N, Poomviset N, Prommajan J and Watanapa A. Oral health status and oral health behaviour of urban and rural schoolchildren in Southern Thailand. Int Dent J 2001; 51:95-102. 11. Al-Omiri MK, Al-Wahadni AM and Saeed KN. Oral health attitudes, knowledge, and behavior among school children in North Jordan. J Dent Educ 2006; 70:179-87. 12. Hamilton ME and Coulby WM. Oral health knowledge and habits of senior elementary school students. J Public Health Dent 1991; 51:212. 13. Ahmed B, Hussain M and Yazdanie N. Oral Stereognostic Ability: A Test of Oral Perception. J Coll Physician Surg Pak 2006; 16(12):794-8. 14. Ahmed B, Mirza KM, Mehmood A, Hussain M and Yazdanie N. Oral Stereognostic Ability in Hypodontia Patients. Pak J Med Research 2010; 49(1):14-17. 15. Ahmed B, Imran MF, Amin M and Saeed F. Sources of information and oral hygiene practice among patients visiting dental dection of University Medical and Dental College, Faisalabad. JUMDC; 1(2):8-10. Submitted for publication: May, 2011 Accepted for publication: Sept., 2011

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