Abstract

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Objective: The objective of this study was to assess knowledge, attitudes and practice (KAP) about oral health among the secondary level students of rural Nepal.

Study Design: A total of 1000 secondary level school children (622 male, 378 female) of age group 13 to 18 years were selected for the study. Data on oral health knowledge, attitudes and practice was collected by means of 30 self-administered close ended questionnaires.

Results: The result of this study show that only 35.1% of the study sample brushes their teeth at least twice daily while 64.9% reported regular brushing once daily. 66.3% of the study population was aware that gingival bleeding reflects gingivitis and only 48% knew the significance of dental plaque. Only 20% reported that they were regular dental attendees, while only 19 % of the respondent visited dentist only when they got dental pain. Majority of the study sample reported that dentist did provide proper care (99%) and explained dental procedures (76%) and preventive instructions (80%).

Conclusion: Results of this study suggested that oral health related KAP among the secondary school level students of rural Nepal is poor. The findings of this study suggested that group of secondary level students would be the appropriate target group to receive the first organized intervention leading towards improving the periodontal health status and reducing prevalence of dental caries through increasing their knowledge, attitude and behavior, then followed by other groups.

Key words: Oral Health, Knowledge, Attitude, Practice

Introduction

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Oral disease qualifies as major public health problems owing to their higher prevalence and significant social impact¹. ?Oral health is considered as fundamental to general health and well-being. A healthy mouth enables an individual to speak, eat and socialize without experiencing any active disease, discomfort or embarrassment². Oral health knowledge is considered to be an essential prerequisite for health related behavior³. It has been shown that Nepali children have low level of oral health awareness and practice as compared to their western counterparts⁴.

Health promotions in developing country like Nepal, where the geo-socio-political and economic factors offer meager and inadequate health care resources to its rapidly growing population, make this an uphill task. Moreover, the low literacy rates (? 39.6 % ?)⁵ ?further weakens the effort.

Numbers of features namely; diet, smoking, alcohol, hygiene, stress & exercise are linked to a wide range of important diseases forming the fundamental basis of common risk factor approach (WHO 2000) to prevent a range of conditions including oral diseases⁶. Among these, hygiene is the single most significant factor when it comes to the prevention of oral diseases. Little is known about oral health attitudes and behaviors of children from developing countries as comparison with developed countries⁷, although such knowledge is an indication of the efficacy of applied dental health education programs. The aim of this study was to assess oral health knowledge, attitude and practice (KAP) of secondary school level students of rural Nepal.

Methods and Methodology

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The subjects comprising the population of this study were recruited from secondary level students of Shree Chandeshwori Higher secondary School, Nala, and Nava Prativa High School, Kushadevi, Kavre, Nepal. A total of 1000 school children (622 male, 378 female) of age group 13 to 18 years were selected for the study. Consent for the participation of school children was obtained from the head of the school.

Data on oral health knowledge, attitude and practice was collected by means of 30 self- administered close ended questionnaires adopted from study done by Yee et al⁴? and ?Al- Omiri et al⁷. The questions were in Nepali as well as English language. The questionnaire included thirty items designed to evaluate knowledge, attitudes and behavior of young school children regarding their oral health and dental treatment. Assessment of participants? oral health knowledge included items on the effects of brushing and using fluoridated toothpaste, the meaning of bleeding gums and how to protect against it, the meaning of dental plaque and its? effects, the number deciduous teeth, the effects of sweets and soft drinks on the dentition.

Assessment of oral health behavior included brushing activity (such as frequency, duration and brushing aids), the parents? role in participants? oral hygiene and?? dental education, and dental visits (such as regularity, reason behind the visit, effect of pain and economy on dental attendance, information on first visit and sought treatment). Participants? attitudes towards oral health was assessed by questions on fear from dental treatment, feelings regarding the treatment, thoughts about involvement in the dental treatment, opinion about and attitudes towards the dentists and dental care, and attitudes towards regular dental visits.

Statistical Analysis

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Descriptive statistics were obtained and mean, standard deviation and frequency distribution were calculated. Data were analyzed using the statistical package for social science 10.0 (SPSS 10.0).

Results:

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40% of the study sample brushes their teeth at least twice daily while 60% reported irregular tooth brushing. All the respondents i.e. 100% used tooth brush and paste while brushing; few respondents also used tooth pick (6%), salt (4%), coal (3%) and datiwan (3%). Most subjects brushed their teeth before going to the bed and / or in the morning. 32% of the respondents took at least 2-3 minutes to brush while 4% took less than one minute (Table 1). 63% of the study population was aware that gingival bleeding reflects gingivitis (infection of gum), while rest either did not know or gave wrong answers such as gingival bleeding reflects healthy gingiva or recession (table 2). Only 21 % of the sample knew that brushing with toothpaste prevents gingivitis, while rest either did not knew or reported wrong answers. Only 48 % the respondents knew the significance of dental plaque. 39% thinks that dental plaque causes dental caries and only 9% thinks it cause inflammation of gum and 26 % thought that it might causes tooth staining. 26% of the respondents failed to report a link between plaque and any of these conditions. 93% of the subjects were aware that carious teeth and dental caries affects dental aesthetics (table 3). Awareness of the importance of tooth brushing for caries prevention was high (87%) among the study population.55 % of the study population were aware of the prevention of caries using fluoridated toothpaste. Only 11 % of the subjects knew the correct number of deciduous teeth, while 45% knew the correct number of permanent teeth.84% of the subjects knew that health of tooth means strong and caries free teeth. Most subjects were aware that sweets (100 %) and soft drinks (73%) have a negative impact on dental health (Table 3). 96% of the respondents were aware of the impact of oral health to systemic health and 61% knew that tobacco and tobacco products can cause oral cancer. Only 20 % of the study subjects reported that they were regular dental attendees, while 19% of the respondent visited dentists only when they got dental pain. 27% of the respondent never visited dentists. 44 % of the participants had visited dentist during last year. Most of them (approx. 60%) reported that dental pain was the driving factor for their last visit. The most common cause of not visiting the dentist on a regular basis or disliking to visit dentist was fear (31%). Lack of dental pain (15%), high cost (18%) and no nearby clinic (16%) were also the causes of not visiting the dentists on regular basis (Table 4). 71 % of the study population admits the necessity of regular visit to dentist. Majority of the study sample reported that dentists did provide proper care (99%) and explained dental procedures (76%) & preventive instructions (80%).

Discussion:

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This study assessed oral health attitudes, knowledge and practice of secondary level school children of rural Nepal. This is a small scale single descriptive cross sectional study with 100 respondents selected through cluster sampling using self- administered structured questionnaire. In this study it was found that most of the respondents were Brahmin (42%) and Newar (40%). 93% of the respondents were Hindu and most of the respondents were from age group 15 years (38%), 16 years (28%) and 14 years (20%). 60% of the respondents were female and 52% from grade 9. Majority of respondents were from Nala (99%) and rest from Banepa. Most of their parent's occupation was agriculture i.e. 87%. This survey found that cent percent of respondent brush their teeth, which is higher than the study done in North Jordan by Al Omiri et. al.7 and Nepal National Oral Health ?Pathfinder? 20044 for adolescents. It also found that only 40% brushed their teeth twice daily (i.e. in the morning and before bed) which is lower than the both study done by Al Omiri et. Al7 and Zhu L et al8 . Awareness on the gingival bleeding as indicator of periodontal disease especially gingivitis (66%) was found, finding that agreed with the study done by. Al Omiri et. al.7 . Despite this, majority (91%) failed to link gingivitis to dental plaque and 79% did not recognize the role of tooth brushing in treating gingivitis. High awareness of dental caries including its impact on the dentition (i.e. 93% knew dental caries affect tooth appearance), cause (100% knew that sweet food can lead to dental caries) and prevention (i.e. 87% knew brushing prevent caries) in comparison with periodontal health could be attributed to the fact dental caries is more prevalent among the adolescents than periodontal disease. This will eventually improve children knowledge regarding dental caries as they attend dental clinics seeking treatment for it. Thus, they may receive more professional advice in this regard. The similar finding was found in the study done in North Jordan7 and Nepal National Oral Health ?Pathfinder? 20044 . Most of the study subject reported irregular dental attendance (49%) and this finding is consistence with the finding of similar studies done in North Jordan7 and China8 . A surprising finding in this regard was that most participants were aware of importance of regular dental attendance (71%). Some finding in this study might offer an explanation for the irregular dental attendance among the participants. A high proportionate of the subjects did not attend or disliked attending dentists due to fear of dental treatment (i.e. 10% is afraid of drilling and 21% is afraid of needle), high cost (18%) of dental treatment, no nearby dental clinic (16%) and no dental pain (15%). Fear of dental treatment was found to be high among the study population; this coincides with study done by Al Omiri et. al.7 , Smyth et al 9 and Harikiran et al10 . This might be attributed to lack of oral health education program for children and parents who in addition to above mention regions rendered dental treatment undesired. The participant demonstrated positive attitude towards their dentists (80%) and high awareness of the link between oral health and systemic well-being (96%) which is similar to study done by Al Omiri et. Al7 , Farsi et al11 and El-Qaderi et al12 . This is important to mention that emphasis on the link between oral health and well-being of the rest of the body might help promote oral health care and oral self-care practice among school children and the public. However, educational oral health programs in Nepal have been mainly conveyed to the public on a narrow scale by certain formal medical/dental institutes and dental schools in Nepal. Unfortunately, these efforts are limited and insufficient nationwide; hence, there is a need for comprehensive educational programs to improve the oral health practice, knowledge, and attitudes of the secondary school children.

Conclusion:

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The findings of this study suggested that group of secondary level students would be the appropriate target group to receive the first organized intervention leading towards improving the periodontal health status and reducing prevalence of dental caries through increasing their knowledge, attitude and behavior, then followed by other groups. Within oral health education it is clearly important to increase public knowledge of the risk factors for dental disease. However, the efficacy of such education will be limited if health programs do not directly impinge on attitudes, and take into account factors related to the environment, education, social status and economic level of targeted population.

References:

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11. Farsi JMA, Farghaly MM, Farshi N. Oral health knowledge, attitudes and behavior among Saudi school students in Jeddah city. Journal of Dentistry 2004; 32: 47-53. 12. El-Qaderi SS, Taani DQ. Oral Health knowledge and dental health practices among school children in Jersh district- Jordan. Int J Dent Hyg 2004; 2: 78-85.

Source(s) of Funding

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No funding was given by institute for this study.

Competing Interests

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None

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