Assessment of Oral Health Awareness among Residential and Day School-going Children in South Bengaluru: A Questionnaire-based Survey

INTRODUCTION

Oral health has always been a key indicator of overall health, well-being, and quality of life. It encompasses a range of diseases and conditions that include dental caries and periodontal disease.¹ Despite much advancement in preventive and interventional approaches a range of oral diseases remain prevalent in children. To combat these oral health diseases, basic oral health practices are to be installed from early childhood as this is an important period of life that needs to be monitored closely.²

Good knowledge and a positive attitude toward oral health care play a vital role in preventive dentistry.³ Parents with good oral hygiene skills and positive attitude have shown to reflect their child’s oral health, brushing practices, and dietary sugar intake.²

For improving oral health in a community, improvement in oral health-related knowledge is considered to be an essential prerequisite. Very few studies have been done to assess the level of oral health-related knowledge, attitude, and practices of children in developing countries, especially those residing in rural areas as compared to that of children in developed countries.⁴

Here, knowledge pertains to the information about general dental health and provision of care. Attitude is the behavioral approach of the child toward oral habits. Awareness is the consciousness of the child about their own oral health status, implicating their dental health knowledge.

School provides a comprehensive environment for a child’s overall development such as intellectual development, skill acquirement, and achievement of goals in life. Residential or boarding schools are institutions where students live and learn outside their family homes whereas nonresidential/day schoolchildren go home after their fixed working time. A boarding school or residential school has both positive and certain limitations. Many kinds of literature have reported that the prevalence of dental caries among residential schoolchildren was high as compared to nonresidential schoolchildren suggesting timely emphasis and interventions.⁵ Therefore, our study mainly aims to assess and evaluate the knowledge, attitude, and practice regarding oral health among the residential and day school-going children in South Bengaluru, Karnataka.

MATERIALS AND METHODS

A total of 2,155 children aged between 9 years and 13 years, out of which 1,039 children were from 5 residential schools and 1,116 from 8 nonresidential schools, from south Bengaluru, Karnataka participated in the study. The study was approved by the ethical committee of RajaRajeswari Dental College and Hospital and consent for participation of schoolchildren was obtained from the heads of the schools. All the children who were present on the day of the data collection were included in the study. All the participants were requested to complete a close-ended questionnaire, which consisted of 36 questions 9 questions pertaining to knowledge, 8 questions assessing attitude, 4 questions regarding diet, and 15 questions related to practice and behavior regarding oral health.

The bilingual (local language and English) questionnaire was made and steps were taken to ensure the reliability of the language-translation. All the participants were asked to complete the questionnaires under our supervision. Interpersonal communication was not allowed and the children were informed of the importance of answering the question honestly. The duly filled questionnaire was collected from the participant on the same day after 15–20 minutes. Any query in the structured questionnaire was clarified by the investigator; the data collected were entered in the SPSS for Windows, Version 22.0, and were further analyzed.

RESULTS

Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) for Windows, Version 22.0. Released 2013. Armonk, NY, USA, IBM Corp. The descriptive analysis includes the expression of responses for the study questionnaire in terms of frequency and proportions. The Chi-square test was used to compare the responses for the study questionnaire between two study groups. The level of significance (p value) was set at p %3C; 0.05.

DISCUSSION

The children in the age group of 9–13 years were selected since they could read and answer the questions on their own. Studies have shown a high prevalence of dental caries in this age group, which has made it a high priority for the dental profession.^6–8 Goel et al. found identical results and stated that children aged 9 years were affected by caries more frequently in both primary and permanent dentition as compared with other age groups.⁹

To get appropriate data coverage, children brought up under different environments were included, like the residential children whose eating habits are consuming regular meals on a regular schedule and the day scholar children who have a habit of in-between-meal consumption.

In our study, it was found that general awareness on oral health among both the study participants was quite good, where most of the children had a satisfactory understanding of healthy teeth (87.1%) and the importance of good teeth for maintaining good health (89.2%), but only 29% were aware of the number of teeth present. Studies done by Al-Darwish, Wahengbam, and Wyne et al. have shown children understand the importance of good and healthy teeth.^10–12

Only 49.4% of children among both groups knew about dental plaque and its effect on the teeth. Al-Darwish’s study was supportive of our results. This suggests that awareness regarding the harmful effects of dental plaque should be implemented in the curriculum.

The emphasis on dental esthetics is increasing in daily life and concerns about outward appearance also affect children. In the present study, only 11.7% of children were unhappy and dissatisfied with the appearance of their teeth, which is in accordance with the results obtained by Varenne et al., Harikiran et al., and Petersen et al.^13–15 Thus, improving the dental esthetics definitely improve the self-confidence socialization and academic performance.

In the present study, about 75.7% of participants agreed that sugar is the cause of tooth decay. Though children had a good knowledge of the cariogenic properties of sugar the consumption of chocolates/sweets (62.5%) and aerated soft drinks (31.1%) between both the study groups was more when compared to other studies done by Priya et al. and El Qaderi and Taani.^16,17 However, studies conducted by Blaggana et al., Al-Darwish, and Varenne et al. showed the majority of children were not aware on the fact that sugar is the cause of tooth decay.^7,10,13 Appropriate guidance regarding the ill-effects of sugary foods must be given. Consumption of natural fruits should be promoted as 71.5% of children of the residential school have fresh fruits daily as compared to 57.2% of day schoolchildren, which means residential schoolchildren have a more balanced diet.

Awareness regarding adverse effects of oral habits was found to be less and only 26.7% of both group children accepted having thumb sucking/mouth breathing habit which is in accordance with the study conducted by Blaggana et al.⁷

In our study, majority of children from both the study groups brushed regularly (99.8%) with 62.2% of children brushing twice daily, similar results were obtained from studies conducted by Jamjoum and Shailee et al.^18,19 However, variation in results was noted by studies conducted by Petersen et al. and Kamath et al. where 77% and 52% of participants brushed twice daily.^15,20

88.9% of day scholar and 92.4% of residential children were ignorant of the benefits of fluoride and its presence in toothpaste, thus they should be educated about fluoride and its benefits on teeth. The results of the study conducted by Wyne et al. showed a positive response among the children (55.4%) for the knowledge on the benefits of fluoride. Fluoride when provided consistently, topically helps to maintain resistance to dental caries that counteracts the effects of acids produced from bacterial metabolism of dietary carbohydrates.

The use of dental floss to prevent dental diseases was apparently less understood by both the study groups (89%) which are in accordance with studies conducted by Jamjoum and Kamath et al.^18,20 The evidence from the studies suggests the improvement of knowledge toward the use of dental floss is much needed. Our participants had a good habit of tongue cleaning and rinsing the mouth after meals about 74.7% and 65.3% of day school and 61.6% and 47.5% of residential school. The results of the study conducted by Pereira are in accordance with our study.²¹ It will be an ideal habit for all the remaining pupils to inculcate this habit in their routine.

In our study, approximately about 65.6% of participants among the study groups visited the dentist out of which 39.4% visited in the last 6 months. Fear of the dentist and low awareness of routine dental check-ups could be the reason for 34.4% of participants among both the study groups never visiting a dentist. Similar results were obtained by Harikiran et al., Priya et al., and this attitude could be due to previous negative dental experience or negligence of parents.^14,16

In our study, the source of information regarding oral health was 38% from teachers for both the study participants, from parents 24.6% of day scholar and 39.9% of residential schoolchildren, which is in accordance with the study conducted by Varenne et al.¹³ However, studies conducted by Jamjoum and Kamath et al. showed a majority of children gained information regarding oral health from parents.^18,20 Since children spend adequate time with teachers, the school curriculum is the optimal way to raise children’s dental health awareness and knowledge about oral health and practices. Since day scholars spend time at home and have more exposure to television, 17.8% of day schoolchildren receive their information regarding oral health from television which is more than residential children 6.6%.

LIMITATIONS

The limitation of this study is it is a 1-day program and long-term follow-up of the program needs to be conducted to evaluate the long-term impact on oral health practices, or altering dental health behavior that would positively influence the outcome of the program. More emphasis on the effect of culture and socioeconomic status on oral health status and practices should also be stressed in future studies.

CONCLUSION

This survey furnishes the background data to get insight into the status of awareness of schoolchildren aged 9–13 years regarding oral health, as school age is the right time when the behavior can still be molded. The knowledge attitude and practices regarding oral health status, practices and food habits were found to be satisfactory. Oral hygiene is an essential part of school health services that have to be highlighted.

Based on our study, we recommend establishing age-appropriate oral health awareness on dental education under school dental health programs that address oral health promotion and diseases.

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