IJCRR

IJCRR - 4(15), August, 2012

Pages: 49-57

Date of Publication: 15-Aug-2012

SELF PERCEIVED ORAL HEALTH STATUS, ORAL HEALTH PRACTICES AND UTILISATION OF DENTAL SERVICES AMONG 10-16 YEAR OLD CHILDREN: A CROSS SECTIONAL STUDY

Author: A.M.Deva Priya, Anupama Tadepalli, Dhayanand John Victor

Category: Healthcare

Abstract:Aim: The aim of the study was to assess the oral health practices, behaviours, self perceived oral health status and dental service utilisation among children from a single private school in Chennai. Materials and Methods: 560 students, aged 10-16 yrs participated in a dental camp conducted by SRM Dental College and Hospital, Chennai. Students were asked to complete a structured questionnaire. Statistical significance was determined by chi square test. Results: The results of the study showed that, majority of the boys and girls perceived their oral health as good (36.7%). Only 43% of the children have visited dentist before. All the children used toothbrush and tooth paste for cleaning their teeth. The self perceived oral health status was significantly associated with age and gender (p value < 0.05 respectively). Frequency of brushing showed a significant association with age and self perceived oral health status (p value < 0.001 respectively). Conclusion: As evident from the results of this study irrespective of the gender, all the children had better oral hygiene practices, oral health promotion behaviours and good perception of their oral health. Utilisation of dental service showed no association with self perceived oral health and father's education.

Keywords: Chennai, Oral hygiene practices, School children, Self perceived oral health, Utilisation of dental service

Full Text:

INTRODUCTION
Non communicable diseases like oral and dental diseases are widely prevalent in developing countries like India. India is ranked as the second most populated country in the world 1 with 17.38% of world population. Unfortunately only 4.2% of the Gross Domestic Product (GDP) 2 is spent for health policies, hence there is inadequacy in health care facilities. At present the dentist-to-population ratio in India is 1:13,000 whereas in rural areas it is 1:2,50,0003 . The rural areas hardly have any qualified dentists even though 68.84% of the Indian population live in rural areas 4 . The government provides dental care through primary health centres and through higher referral centres however the capacity of these centres to cater to the needs of the entire population is very limited. Majority of the dental care is provided by private dental hospitals and dental clinics therefore considering the cost of treatment at private establishments, the most effective way of reducing disease burden is by primary level of prevention. Children are more commonly affected by dental diseases and therefore schools serve as the ideal setting for promoting oral health. Children are more receptive and earlier the habits are established, the longer lasting the impact 5 . School dental health education programmes are cost effective ways of improving the dental health of not only the children at an individual level but also the community at large .They play a crucial role by helping children to appreciate the importance of healthy teeth, encouraging good oral hygiene practices and behaviour, educating them to seek regular dental treatment, motivating them to follow good lifestyle etc. Implementation of an effective school oral health programme requires that the target population be evaluated and assessed to set priorities and goals. Utilisation of health care services is an important determinant for health. Age, Gender, Socioeconomic status, Ethnic background, Oral Health related behaviours, and Self Perceived Oral Health Status have all been found to be associated with utilisation of dental services. Self reported assessment of oral health and socioeconomic status have received considerable attention in recent years and have been found to be an important determinant of dental service utilisation6 . Studies 6,7,8 from affluent countries have shown that dental care utilisation is strongly determined by self perception of oral health and parent‘s education Unfortunately data regarding the interactions of these predictors in developing countries like India is lacking. Hence, the aims and objectives of this study were 1. To assess the oral health related behaviours of children in the present study population. 2. To analyse the association between their self perceived oral health status and father‘s education. 3. To assess the influence of self perceived oral health status and father‘s education on utilization of dental services. MATERIALS AND METHODS The study was cross sectional and observational in design. It was carried out as a part of school dental health programme organised by SRM Dental College, Ramapuram, Chennai. Prior permission was obtained from concerned school authorities for conducting the study and the study protocol was approved by the Institutional Ethical review board of SRM University. To fulfil the objectives of this study, the original WHO Oral Health Questionnaire for children by Poul Erik Peterson 2004, was modified and utilised as a screening tool to assess self perceived health status and dental service utilisation .560 students, aged 10- 16 years attending a private school in Chennai participated in the dental camp conducted from September 2010 to January 2011 and completed the questionnaire. The pretested structured questionnaire was completed under the supervision of Investigators who were specifically trained for this purpose and were available at all time for clarifying their doubts. After the completion of questionnaire they were given oral health education, with audiovisual aids and models, later dental examination was carried out and necessary treatment done. As the clinical examination was done by multiple undergraduate students at different period of time, findings could not be recorded for further evaluations due to larger inter examiner errors. All the students responded to all the questions in the questionnaire. The final data was collected from 560 students, 335 boys and 225 girls, aged 10-16 years and Statistical analysis was done using Microsoft SPSS 11.5 package. Chi square test was used to assess the association between the different categorical variables.

RESULTS
The study sample consisted of 335 boys (59.8%) and 225 girls (40%) with the age ranging from 10 – 16 years. Figure 1 shows the distribution of study population with age and gender. The self perceived oral health status of the study population is shown in Table 1. In this study, the majority of the boys and girls perceived their oral health as good. Only 3.2% of the total respondents perceived their oral health as poor. The self perceived oral health status was significantly associated with age (p value < 0.05) and gender (p value < 0.05). Frequency of brushing was significantly associated with the self perception of oral health (p value < 0.001). Father‘s education taken as an indicator of socioeconomic status showed no significant association with self perceived oral health (p value >0.05). Among the total study population 43% had visited the dentist. 51% of boys and 30% of girls have visited dentist at least once (Figure 2). Majority of the boys and girls in all the age group had visited the dentist except girls in the 11 year age group i.e. 56% had never visited dentist. Utilisation of dental services was not associated with Self perception of oral health and father‘s education (p value > 0.05). In the previous 12 months, 36% of boys and 37% of the girls had some trouble in teeth or gums, whereas 53% of boys and 57% of girls did not have trouble. 44.5% of boys and 28% of girls have visited the dentist in the last twelve months. Among those who had trouble in their teeth or gums in the last twelve months, only 13 % of the boys and 9% of girls had been to a dentist for management of symptoms. A further 4% of boys had been to the dentist as a part of follow up for orthodontic treatment,6% had visited the dentist with their parents and 10% had visited the dentist through screening camps held in their residential area in the last twelve months. Some boys could not remember the reason or didn‘t know the reason for their visit .In the last twelve months 4% of girls had visited dentist for follow up for ongoing orthodontic treatment, 5% had visited along with parents and 6% had visited the dentist through screening camps held in their residential area. All the children used toothbrush for cleaning their teeth. Only 0.5% (two boys) had used chew sticks - whenever they visited their native village, for cleaning their teeth. 10% of children used additional aids for cleaning, i.e. 4% used wooden toothpick, 3% used plastic toothpick, 3% of boys and 0.4% (1) of girl used salt for brushing along with toothpaste. The frequency of brushing in the study population is shown in Table 2. Among the boys 45.6% brushed twice daily and 46.2% brushed once daily. From among the girls, 45.3% brushed twice daily and 48% brushed only once. 3.2% of the study population never brushed or brushed two or three times per month. Frequency of brushing showed highly significant association with age (p value < 0.001). Table 2, shows the direction in which the children are brushing their teeth. Majority of children brushed in horizontal direction 26.7%, while 24.4% of them brushed in no specific direction. Among the boys, major percentage i.e. 27.4% brushed in no specific direction while 25.6% brushed in horizontal direction.28% of the girls brushed in horizontal and circular direction respectively. 47% of the girls and 40% of boys brushed for less than five minutes while 46.8% of the boys and 36.4% of girls brushed for more than five minutes. Among the boys, 88.6% of them changed brush within three months while 3.2% changed every 6 – 12 months. 94% of girls changed brush every three months while 0.8% changed brush every 6-12 months (Table 2). 3% of the boys and 0.4% (1) girl were using powered tooth brush.16% of the boys and 6.6% the girls used mouthwash (Table 2). None of the children were aware of fluoride in toothpaste except one girl. Tobacco products were not used by any of the children. Majority of girls and boys in all age group i.e. 32% and 37.6% respectively had sweets, candies at least once a day. Almost similar percentage i.e. 29% of girls and boys respectively took fizzy drinks once a week. Majority i.e. 26.2% of boys had chewing gum with sugar everyday. Majority of the girls and boys never took tea with sugar while significant percentage i.e. 37% of girls and 31% of boys had it everyday.

DISCUSSION
The perception of oral health may influence oral health decisions, health care utilisation patterns and may be associated with clinical, psychosocial and socioeconomic factors. Studies reporting the relationship between dental service utilisation and perception of oral health among school children, in India are lacking, hence in this study we have assessed the oral health awareness of the children and analysed the association between oral health practices, self perceived oral health status, father‘s education and dental service utilisation. Self perceived oral health of majority of the respondents in this study was good and is in accordance to the study by Arun kumar Prasad et al 9 . Eight percentage of children in this study felt their oral health was excellent and 15.2% did not know the status of their oral health, this is similar to study by Navneet Grewal et al 10 among Indian children in Amritsar where 6% of children felt that their oral health was excellent and 16% did not know the status of their oral health. Among 12 year old children in Kerala, 77% perceived their oral health as good 11, which is similar to the current study, where 74% of the 12 year old children felt that their oral health is good. Ostberg and colleagues 12 investigated the association between dental attitudes, behavior and self-perceived oral health in Swedish adolescents, and concluded that girls, more often than boys perceived their oral health as good and that there is a strong association between attitudes towards dental care and self-perceived oral health. Similarly, Corinna Pellizer et al 13 reported in their study that among adolescents in Croatia, girls had a better perception of their oral health. In accordance to the above studies, our analysis showed that girls had better perception of their oral health than boys. Respondents who brushed twice or once daily had better perception of their oral health than those who brushed at lesser frequency. The current study results showed that better self perception of oral health status, increased significantly with age. This could be attributed to the increased frequency of brushing with increasing age, which was shown to be highly significant (p < 0.001). Longitudinal studies that may be conducted to evaluate this hypothesis may be more conclusive. David et al 11 observed no social gradient in correlation with self perceived oral health among Indian school children. Similarly in this study father‘s education, which could be taken as an indicator of socioeconomic status, showed no significant association with self perceived oral health status. In Indian society, father‘s education does not necessarily determine the socioeconomic status as there are multiple factors that decide the economic status of the family. However studies 14, 15 have reported that adolescents, who had parents with high level of education were less likely to be dissatisfied with their oral health compared to those who had parents with low level of education. Pattusi et al 16 among 14-15 year old Brazilian adolescents failed to relate utilisation of dental service with perception of oral health, the results of this study similarly showed no association. It has been shown that children who rated their oral health as poor, with lower parental income and education were strongly associated with lesser utilisation of dental services. Several factors influence the utilisation pattern among children like household income, parents knowledge and awareness of oral health, perceived need for treatment, dental anxiety and fear, hence the results from this study should be interpreted with caution, as only limited variables were assessed and it was a cross sectional study hence causal relationship cannot be determined. Majority of children have never been to a dentist in this study. Among the respondents, more number of boys visited dentist than comparative age group girl. In spite of having trouble in teeth or gums i.e. 37%,only 28% of girls visited the dentist, this could be attributed to good perception of oral health among the girls and ignorance regarding dental visit and disease. Visit to dentist among 12 years old is high (57%) when compared with 12 years old children in Sudan (48%) 17. It is reported that, in developed countries like United States higher percentage of children visit the dentist more frequently i.e. 72% 18 this is attributed to better dental health awareness, good dental care facilities, efficient public dental services, dental insurance etc. whereas, in developing countries like India, visit to dentist is mainly symptomatic. In the current study in spite of having dental problems, only a few children visited the dentist, this shows the poor knowledge regarding preventive and interventional dental care. It was also observed that some children have visited dentist along with their parents and through screening camps conducted by private dental practitioners in their residential area hence, parent‘s need to be educated and motivated to take their children for regular dental visits and dentist should actively take part in creating oral health awareness among the general public. The children in this study population brushed more frequently i.e. twice daily which indicates their health promoting behaviour and motivation. Contrary to the findings by Deepak et al 19, 45.5% of 12 year old children in this study brushed twice daily. Boys in this study brushed more frequently and for more time than girls, this is contrary to as reported by Rise et al 20, Al Sadan et al 21 . Similar to the study by Lian et al 22, Lin et al 23 , toothbrush and toothpaste was the most commonly used oral hygiene aid in this study. Assessment of oral hygiene practice among rural children in Tamil Nadu 24, showed that only 62.96% and 55.5% of children respectively used brush and tooth paste for cleaning their teeth. In this study, maximum use of toothpaste and brush is as expected because the children are living in urban area, studying in a private school, with extensive exposure to mass media and better standards of living. Awareness regarding use of dental floss is very poor among the children in this study as only 2 boys (0.4%) were flossed regularly. Gagandeep kaur et al 25 reported that 25.8% of Indian children were aware of dental floss in his study which is significantly high when compared with this study. Children need to be educated about the benefits and techniques of flossing. Most of the children were aware of powered toothbrush and mouthwash from animated cartoon series and advertisements in television. The parents of the children who were using powered toothbrush were either professionals or working in other countries. The impact of mass media is so enormous that not only does the information reaches even the farthest village instantaneously but also in huge numbers, hence government agencies and Non Govermental Organisations should effectively make use of this media for creating oral health awareness. Frequency of intake of sweets was similar among all age group and no difference between genders is seen which is similar to finding by Al sadan et al 21, since age difference among the groups is small, respondents had similar liking. Intake of fizzy drinks among children in this study is very less i.e. once a week, this is in contrary to findings among secondary school children in Sarwak, Malaysia 17 where 26.3% had it once per day. In Western, European and other countries, fizzy drinks forms a part of their every day diet ,so percentage of intake of those drinks among the children is very high while in Indian food system intake of drinks like milk, tea or coffee is more among the children. Limitations of the study are, students tend to report socially desirable answers and underestimate their negative behaviours when structured questionnaire is administered, only convenient sampling was done, single indicator i.e. education of father was taken for assessment of socio economic status and oral health status could have been compared objectively by clinical examination.

CONCLUSION
Within the limitations of the study, it can be concluded that irrespective of gender all the children had better oral hygiene practices and good perception of oral health. Majority of the children never visited the dentist, this could be attributed to high level of oral hygiene practices, good perception of oral health and lesser incidence of trouble in teeth or gums, hence preventive care seeking behaviour among the study population is lesser and could also be attributed to other factors like socioeconomic status, parent‘s education and motivation etc. Girls had a better perception of their oral health than boys, and children who brushed frequently had a better perception of their oral health. Dental care utilisation showed no association with father‘s education and self perception of oral health. Identifying factors influencing the utilisation of dental services among the children would encourage prevention oriented dental visits as they are more cost effective. In view of the scarce dental resources available in India and high economic burden of the disease, more systematic and efficient oral health education programme should be regularly implemented and reinforced in schools to target children and their parents. Source of funding: Nil Conflict of interest: Nil

ACKNOWLEDGEMENT
Authors like to thank Ms.Aarthi ,Bsc,Msc Biostatistics for helping with the statistics.Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript.The authors are grateful to authors/editors/publishers of all those articles,journals and books from where the literature for the article has been reviewed and discussed.

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