World Journal of Dentistry
Volume 12 | Issue 3 | Year 2021

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

Shakuntala B Siddaiah1, Jaya A Ramachandra2, Divya V Mehta3, Gayathri Gopinath4

1–4Department of Pedodontics and Preventive Dentistry, RajaRajeswari Dental College and Hospital, Kumbalgodu, Bengaluru, Karnataka, India

Corresponding Author: Divya V Mehta, Department of Pedodontics and Preventive Dentistry, RajaRajeswari Dental College and Hospital, Kumbalgodu, Bengaluru, Karnataka, India, Phone: +91 9900295444, e-mail: divyavmht@gmail.com

How to cite this article Siddaiah SB, Ramachandra JA, Mehta DV, et al. Assessment of Oral Health Awareness among Residential and Day School-going Children in South Bengaluru: A Questionnaire-based Survey. World J Dent 2021;12(3):234–240.

Source of support: Nil

Conflict of interest: None


Aim: This study was conducted to assess and evaluate the knowledge, attitude, and practice among 9–13 years old day scholars and residential schoolchildren in South Bengaluru, Karnataka.

Materials and methods: A total of 2,155 schoolchildren aged between 9 years and 13 years from 13 schools in South Bengaluru participated in the study out of which 1,039 were residential schools and 1,116 were day scholars. All children were given 36 close-ended questionnaires pertaining to knowledge attitude, diet, practice, and behavior regarding oral health and were requested to complete them within 15 to 20 minutes on the school premises only.

Results: The results of our study showed about 89.2% of the participants had good knowledge about maintaining healthy and good teeth for their good health. Also, 75.7% of children knew that sugar is the cause of tooth decay, 94% of the study participants had good oral hygiene practice, but the awareness regarding other oral hygiene aids (flossing) was found to be 11%.

Conclusion: Results of our study showed general awareness of oral health was quite good and children had a positive attitude toward oral hygiene practices but exhibited limited knowledge on the preventive dental practices. This suggests the need for implementation of the importance of the early preventive dental visit, through effective oral health promotion through school dental health programs.

Clinical significance: Good oral hygiene keeps teeth free from dental plaque buildup, fights off cavities, and bad breath. A healthy diet that is low in sugary foods, regular dental visits, oral hygiene instructions provided by the dentist is an essential part of the maintenance of good oral hygiene. Based on the study, we recommend establishing oral health programs under school health that addresses oral health promotion and awareness of dental diseases.

Keywords: Attitude awareness knowledge, Mixed dentition, Oral health, Questionnaire survey..


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.


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.


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.

General Awareness on Oral Health and its Impact on Social Interaction

Table 1 presents the general awareness on oral health perceived by both the residential and day schoolchildren and they agreed in common with a score of 89.2% of the healthy tooth is white and strong and its importance in maintaining good health, 49.4% did not know about dental plaque and 75.7% agreed that sugar is the cause of tooth decay and 11.7% were not satisfied with the appearance of their teeth.

Food Habits, Oral Habits, and Oral Hygiene Practices

Table 2 describes the distribution of study participants by frequency of consumption of sugary items and fruits. 62.5% of study participants in both groups reported having hidden sugar every day. About 71.5% of residential schoolchildren and 57.2% of day schoolchildren have fresh fruits daily.

About 26.7% of study participants in both groups have a habit of mouth breathing and/or thumb sucking. 99.8% of children from both schools brushed their teeth regularly. 88.9% of day scholars and 92.4% of residential schoolchildren did not know about fluoride and approximately the same results of about 89% of the children from both the groups were not aware of flossing. About 74.7% and 65.3% of day school and 61.6% and 47.5% of residential schoolchildren cleaned their tongue and rinsed their mouth after having their meals.

Dental Care Visits and Attitude

Table 3 presents the awareness of dental care among the study participants.

About 32% of results were common among both the groups who visited a dentist twice a year and similarly among both the groups 34.4% of never visited a dentist. 28.4% of day scholars and 20.9% of residential schoolchildren were afraid to visit a dental doctor. Common results of 38% were shared in both the groups for information regarding oral health from teachers. The source of information regarding oral health from parents was 24.6% of day scholars and 39.9% of residential schoolchildren. 17.8% of day scholar and 6.6% of residential schoolchildren got information regarding oral health from television.


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.68 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.1012

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.1315 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.

Table 1: General awareness on oral health and its impact on social interaction
QuestionsResponsesDay scholars (n = 1,116)
Residential (n = 1,039)
Total (n = 2,155)
χ2 valuep value
How many teeth do you have?Between 20 and 2422219.933332.155525.846.783<0.001*
Between 25 and 2832729.329828.762529.0
Between 29 and 3256750.840839.397545.2
A healthy tooth is?White and strong97887.690086.61,87887.11.9080.39
Little yellow also ok908.1817.81717.9
Do not know484.3585.61064.9
Dental problems can affect general healthYes68661.550848.91,19455.4126.388<0.001*
Not sure14513.034533.249022.7
Good teeth are important for maintaining good healthYes, it is important97787.594691.01,92389.27.0770.03*
No, it is not related756.7535.11285.9
Not completely645.7403.81044.8
Do you know about the dental plague?Do not know59052.947545.71,06549.412.5640.002*
Know little44139.548847.092943.1
Understand fully857.6767.31617.5
“Sugar is a cause of tooth decay”Yes82473.880777.71,63175.710.1010.006*
Do not know16715.010810.427512.8
How many oral or dental diseases are you aware of?Do not know any47742.729428.377135.852.845<0.001*
1–2 Diseases50645.355653.51,06249.3
More than 2 diseases13311.918918.232214.9
Are you satisfied with the appearance of your teeth?Yes, it is good70463.157555.31,27959.439.109<0.001*
It is ok25923.236435.062328.9
It is bad and not ok15313.71009.625311.7
Do you avoid smiling and laughing because of your teeth?No65658.857955.71,23557.355.712<0.001*
Do other children make fun of your teeth?No70563.268666.01,39164.510.2720.006*

* Statistically significant

Table 2: Food habits, oral habits, and oral hygiene practices
QuestionsResponsesDay scholars (n = 1,116)
Residential (n = 1,039)
Total (n = 2,155)
χ2 valuep value
Chocolates/candies/sweets do you eat every day0–2 nos69462.265362.81,34762.53.4370.18
3–6 nos30827.625924.956726.3
More than 6 nos11410.212712.224111.2
Frequency of milk/milk shake/tea/coffee with sugar every dayNever23821.310510.134315.951.028<0.001*
Once or twice73165.578875.81,51970.5
%3E; 2 times14713.214614.129313.6
Frequency of aerated soft drinks or packaged juicesNever22520.220719.943220.00.1760.92
Once daily35131.532030.867131.1
At least once a week54048.451249.31,05248.8
How often do you eat fresh fruits?Never16715.0474.52149.979.488<0.001*
Once daily63857.274371.51,38164.1
At least once a week31127.924924.056026.0
Do you have a habit of mouth breathing or thumb sucking?Yes14513.012512.027012.514.6590.001*
Do your gums bleed while brushing your teeth?No67060.057155.01,24157.67.5180.02*
Do you have a problem with bad breath?No72965.371168.41,44066.83.2410.20
Do you brush your teeth?Yes1,11199.61,039100.02,15099.84.6660.03*
Frequency of cleaning your teeth every dayOnce35431.745143.480537.433.437%3C;0.001*
%3E;2 times353.1181.7532.5
When should you brush your teeth?Morning only36032.345043.381037.631.101<0.001*
Morning and night75267.458956.71,34162.2
Not sure40.400.040.2
Which is the cleaning aid used by you?Tooth brush1,06295.296292.62,02493.915.841%3C;0.001*
How much time you spend for cleaning your teeth<1 minute22620.332931.755525.844.520<0.001*
1 to 2 minutes54048.438136.792142.7
%3E;2 minutes35031.432931.767931.5
What do you use to brush your teeth?Toothpaste1,07696.496392.72,03994.614.9120.001*
Tooth powder373.3726.91095.1
Do you know about fluoride?Yes12411.1797.62039.47.7590.005*
Which type of toothpaste do you use?Fluoridated807.2767.31567.260.023%3C;0.001*
Do not know87178.084881.61,71979.8
Not using paste252.2666.4914.2
How much paste do you apply on the brush?<half brush24822.230929.755725.817.533<0.001*
Half brush62355.854552.51,16854.2
Full brush24522.018517.843020.0
Frequency of change of your toothbrushWhen it is damaged53648.060458.11,14052.925.731<0.001*
3–6 months51746.337035.688741.2
%3E;6 months635.6656.31285.9
How do you brush your teeth?Horizontal motion57451.464261.81,21656.424.235<0.001*
Circular motion49944.735934.685839.8
Do not know433.9383.7813.8
Do you know about flossing?Yes12110.811711.323811.00.0960.76
Should you floss your teeth?Yes15513.920719.936216.814.3120.001*
Not sure66259.358356.11,24557.8
Do you clean your tongue after meals or during brushing?Regularly83474.764061.61,47468.445.038%3C;0.001*
Not every time23721.235133.858827.3
Do you rinse your mouth after eating food?Regularly72965.349147.51,22056.895.368<0.001*
Not every time23120.723022.346121.5

* Statistically significant

Table 3: Dental care visits and attitude
QuestionsResponsesDay scholars (n = 1,116)
Residential (n = 1,039)
Total (n = 2,155)
χ2 valuep value
How many times do you visit to a dentist clinic?Once a year38334.334132.872433.63.4380.18
Twice a year36933.132030.868932.0
Never visited36432.637836.474234.4
When was the last time you visited the dentist’s clinic?In last 30 days23130.510515.933623.755.837<0.001*
2–6 months28537.623836.052336.9
%3E;6 months24131.831848.155939.4
Are you afraid to visit a dental doctor?Yes31728.421720.953424.832.021<0.001*
Sometimes afraid20918.714814.235716.6
Source of information regarding oral health and dental careFriends565.0494.71054.9104.874<0.001*
TV program19917.8696.626812.4

* Statistically significant

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%.


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.


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.


1. World Health Organization. Available at http:www.who.int/topics/oral_health/en/ accessed on 01-09-2020.

2. Sami A, Fatima K, Moin H, et al. Relationship of parental knowledge and attitude with oral health status of children in Karachi east. J Adv Med 2016;24(9):1–9. DOI: 10.9734/BJMMR/2016/24767.

3. Krishnan L, Prabha G, Madankumar PD. Knowledge, attitude, and practice about oral health among mothers of children with special needs – a cross-sectional study. J Dent Res Rev 2019;6(2):39–43. DOI: 10.4103/jdrr.jdrr_21_19.

4. Mehta A, Kaur G. Oral health-related knowledge, attitude, and practices among 12-year-old schoolchildren studying in rural areas of Panchkula. India Indian J Dent Res 2012;23(2):293. DOI: 10.4103/0970-9290.100446.

5. Somaraj V, Karthika C, Roshni R, et al. Dental caries prevalance among 12-15 years old residential and non-residential school children: a comparative study. EC Dent Sci 2018;17:1695–1698.

6. Naidu J, Nandlal B. Evaluation of the effectiveness of a primary preventive dental health education programme implemented through school teachers for primary school children in Mysore city. J Int Soc Prevnt Communit Dent 2017;7(2):82. DOI: 10.4103/jispcd.JISPCD_326_16.

7. Blaggana A, Grover V, Anjali AK, et al. Oral health knowledge, attitudes and practice behaviour among secondary school children in Chandigarh. J Clin Diagn 2016;10(10):ZC01. DOI: 10.7860/JCDR/2016/23640.8633.

8. Narang S, Khinda VI, Brar GS, et al. Oral health status and treatment needs among 6, 9 and 12 years old rural and urban school children in India: an epidemiological survey. J Adv Oral Res 2016;7(2):27–31. DOI: 10.1177/2229411220160205.

9. Goel P, Sequeira P, Peter S. Prevalence of dental disease amongst 5-6 and 12-13 year old school children of Putter municipality, Karnataka state - India. J Indian Soc Pedod Prev Den 2000;18(1):11–17.

10. Al-Darwish MS. Oral health knowledge, behaviour and practices among school children in Qatar. J Dent Res 2016;13(4):342. DOI: 10.4103/1735-3327.187885.

11. Wahengbam P. Assessment of oral health knowledge, attitude and self-care practice among adolescents - a state wise cross-sectional study in Manipur, North Eastern India. J Clin Diagn Res 2016;10(6):ZC65–ZC70. DOI: 10.7860/JCDR/2016/20693.8002.

12. Wyne AH, Chohan AN, Al-Dosari KH, et al. Oral health knowledge and sources of information among male Saudi school children. Dentist 2004;69:53–61.

13. Varenne B, Petersen PE, Ouattara S. Oral health behaviour of children and adults in urban and rural areas of Burkina Faso, Africa. Int Dent J 2006;56(2):61–70. DOI: 10.1111/j.1875-595X.2006.tb00075.x.

14. Harikiran AG, Pallavi SK, Hariprakash S, et al. Oral health-related KAP among 11-to 12-year-old school children in a government-aided missionary school of Bangalore city. Indian J Dent Res 2008;19(3):236. DOI: 10.4103/0970-9290.42957.

15. Petersen PE, Hoerup N, Poomviset N, et al. Oral health status and oral health behaviour of urban and rural schoolchildren in Southern Thailand. Int Dent J 2001;51(2):95–102. DOI: 10.1002/j.1875-595X.2001.tb00829.x.

16. Priya M, Devdas K, Amarlal D, et al. Oral health attitudes, knowledge and practice among school children in Chennai. India J Educ Ethics Dent 2013;3(1):26. DOI: 10.4103/0974-7761.126940.

17. El Qaderi SS, Taani DQ. Oral health knowledge and dental health practices among schoolchildren in Jerash district/Jordan. Int J Dent Hyg 2004;2(2):78–85. DOI: 10.1111/j.1601-5029.2004.00070.x.

18. Jamjoum H. Preventive oral health knowledge, practice and behaviour in Jeddah, Saudi Arabia. Trop Dent J 1997. 13–18.

19. Shailee F, Girish MS, Kapil RS, et al. Oral health status and treatment needs among 12-and 15-year-old government and private school children in Shimla city, Himachal Pradesh, India. J Int Soc Prevent Communit Dent 2013;3(1):44. DOI: 10.4103/2231-0762.115715.

20. Kamath A, Bijle MN, Walimbe H, et al. Oral hygiene awareness among school children of rural Mangalore. J Dent Res 2014;1(1):7. DOI: 10.4103/2348-3172.126156.

21. Pereira WD. Knowledge, attitude and practice on oral hygiene measures among students in rural areas: Kanchipuram. J Pharma Innov 2017;6(9, Part F):382.

© The Author(s). 2021 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.