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Year : 2011  |  Volume : 29  |  Issue : 3  |  Page : 216-221

The most effective and essential way of improving the oral health status education

Department of Pedodontics and Preventive Dentistry, Swami Devi Dayal Dental Hospital and Dental College, Haryana, India

Date of Web Publication10-Oct-2011

Correspondence Address:
S Chachra
Department of Pedodontics and Preventive Dentistry, House No.75, Sector 10, Panchkula - 134 109, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-4388.85825

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Background: Oral health is an essential component of health throughout life. Two major oral diseases, dental caries and periodontal diseases, are both ancient and widespread. The oral health situation analysis demands that the preventive program be implemented in both the developing and developed countries. Therefore, this study was conducted to evaluate the effectiveness of delivering the primary preventive strategies through non dental and dental personnel. Aims and Objectives: To develops the preventive package for improving the oral health status of children utilizing the different communication approaches. To find out the most feasible and effective communication approach for delivering the preventive package. To evaluate the changes produced in terms of various soft and hard core parameters after 6 months of implementation of the oral-health preventive package in the school children of different study groups as compared to control. Materials and Methods: This study was conducted on total of 972 children in the age group of 5-16 years who were randomly selected from four schools of Chandigarh and Panchkula to evaluate and compare the prevalence of dental caries and knowledge, attitude, and practice about oral health. Results and Conclusions: The results of various parameters indicate that direct communication through the dentist proved to be the most effective communication approach as compared to the other two indirect communication approaches.

Keywords: Attitude, dental education technique, dental caries, knowledge, practice, prevention

How to cite this article:
Chachra S, Dhawan P, Kaur T, Sharma A K. The most effective and essential way of improving the oral health status education. J Indian Soc Pedod Prev Dent 2011;29:216-21

How to cite this URL:
Chachra S, Dhawan P, Kaur T, Sharma A K. The most effective and essential way of improving the oral health status education. J Indian Soc Pedod Prev Dent [serial online] 2011 [cited 2023 Jan 27];29:216-21. Available from: http://www.jisppd.com/text.asp?2011/29/3/216/85825

   Introduction Top

Two major oral diseases, dental caries and periodontal diseases, are ancient and widespread. [1],[2],[3] Approaches to deal with these two oral diseases have neither been preventive nor curative, but rather symptomatic and reparative. The developed countries have already switched over to the organized preventive programs over the last 2 to 3 decades and have started showing remarkable results as far as the prevention of dental caries in the younger generation is concerned. [4],[5],[6],[7]

In a country like India, with limited resources and manpower, the most feasible and cost-effective method of preventing rising trend of oral diseases should be community based and directed toward school children. Dentists are the most effective to deliver the packages; however, in developing countries like India, the dentist, population ratio (1: 47000), does not favor this proposal. The latest trend is to explore the possibilities of the services of para health and other categories of workers in disseminating the preventive orientation information to the community. With these facts in mind, this study was undertaken to compare the various direct and indirect methods of communication for the delivery of the oral health education program.

   Materials and Methods Top

This study was carried out on a total of 972 children in the age range of 5-16 years randomly selected from four schools of urban areas of Chandigarh and Panchkula, India. The four schools selected were randomly assigned one to each of the following groups.

  • One control group, where no education or delivery of preventive package was carried out.
  • Direct delivery of oral health preventive package using direct communication through the dentist.
  • Indirect communication by way of training the school teachers through the dentist who were made responsible for the delivery of the oral health education program to the school children.
  • Indirect communication by training the members of social organization, who further trained school teachers in implementing oral health education program in schools.

Oral health education kit

Teaching material

A standardized oral health education material in the form of albums in local language, that is, Hindi with colored photographs for children in the age range of 10-16 years and short stories for children aged between 5-9 years were used as help for the delivery of oral health education to the school children.

Materials required for demonstration of tooth brushing

2% mercurochrome, super soft tooth brush, spandex (cheek retractor), and a looking mirror.

Materials required for fluoride mouth rinses

NaF powder, plastic spoon of 2 gm capacity, graduated plastic jug, plastic cups, and plastic stirrer.

Pre- and post evaluation of questionnaire

A pre- and post evaluation questionnaire with relevant questions was used to evaluate the level of oral health knowledge of trainers, that is, school teachers and members of voluntary organization before and after the training, which were the key persons in second and third level delivery of oral health preventive package to the children in experimental groups no. C and D. The cut-off point of training was kept at the 95% level for these categories of personnel.

Materials required for recording of oral health status using soft and hard core parameters.

The various soft core and hard-core parameters included were as follows.

  1. Recording of knowledge, attitude, and practice (KAP) about oral health using KAP Performa.
  2. Dental caries (Modified Moller's Index - 1966).

The prevalence of dental caries and KAP was recorded at base line and 6 months after the implementation of the program.

Oral health education program

After collection of baseline data of dental caries and KAP about oral health of selected children of three experimental and a control school, the preventive program was launched in the experimental schools. The package was delivered once in 15 days for a period of 6 months. The preventive package to the children was delivered using three different communication modes (as mentioned earlier) and consisted of:

  1. Oral health education lectures;
  2. Practical demonstration of dental plaque and proper method of brushing;
  3. Use of 0.2% NaF mouth rinses once in every 15 days; and
  4. Knowledge about the relationship of sugar with dental caries and intelligent use of sugars.

Statistical method used

The recorded data of dental caries, in terms of prevalence and severity and KAP at baseline and after 6 months was compared and analyzed statistically.

   Results Top

The Graphs 1-5 show the baseline and values taken after 6 months in all the four groups. Graph 1 shows the knowledge of participating children about oral hygiene that is, brushing: at baseline, 84 -90% of the children in all four study groups had the knowledge of brush as the best oral hygiene measure. This knowledge increased from 86-98 % in group B, 90% to 99% in group C and from 87% to 90.7 % in group D after 6 months. The increment in knowledge about brush to be the best oral hygiene measure was statistically significant at the 0.1% level in groups B and C (P < 0.001) and at the 1% level in the case of group D (P < 0.01).

Graph 2 shows the knowledge about role of fluorides, that is, it makes the teeth stronger. At baseline 30.26% children in the control group and 38.72%, 29.41%, and 23.62% of the children in experimental groups B, C, and D were using a fluoridated dentifrice. The practice findings of use of fluoride dentifrice correspond with the knowledge regarding role of fluoride in prevention of dental caries, as at baseline only 13% children in group B, 9% in group C, and 12% in group D had the correct knowledge.

Six months after the implementation of the preventive program in schools, the percentage of children using fluoridated toothpaste increased form a baseline value of 38.72% and 29.41% in group B and C to 87.65% and 95.47 % respectively which is found to be statistically significant at the 0.1% level (P <0.001). The percentage of children using fluoride toothpaste in these groups correlate with the percentage having correct knowledge regarding the role of fluoride, which after 6 months was 88% and 98% in group B and C, respectively.

Graph 3 shows the frequency of sugar intake, that is, three times a day. At baseline only 2% to 17% of the children had the correct knowledge of three sugar exposures that could be safely taken per day for prevention of dental caries. Six months after implementation of the program the percentage of children having correct knowledge increased from 2.12%, 16.74%, and 17.59 % at baseline to 52.76%, 51.13%, and 28.70 % in experimental groups B, C, and D, respectively.

Graphs 4 and 5 show the prevalence of dental caries in the deciduous and permanent teeth, respectively. The result of this study revealed a highly significant DMFT and DMFS percentage reduction in group B and D compared to control whereas in group C the reduction was statistically significant at 5% level (P < 0.05) for DMFT only. The reason for this decrease in dental caries may be due to the double fluoride therapy being practiced in all the three experimental schools, that is, regular fortnightly fluoride mouth rinses with the 0.2 % NaF solution throughout the school year and use of fluoridated dentifrices by almost all the children. (88 % in group B, 95% in group C.) The maximum percent reduction observed in group B corresponded with the maximum increase in knowledge, attitude, and practice regarding frequency of brushing, safe no. of sugar exposures and role of fluoride observed in this group.

   Discussion Top

In India, the point prevalence studies conducted in various parts, over the last 4 decades depict a consistently increasing prevalence of dental caries. [8],[9],[10] In 1940s the prevalence figures at the age of 15 years used to be 40% with an average DMFT of 1.5 whereas in 1985, the figures have increased to 85-90 % in the same age group children, with an average DMFT of 4-5. To prevent the increasing trend of dental caries in India, the most effective method appears to be community based, as has been proven beyond doubt from the developed countries of world. [11],[12] This study had been conducted to evaluate the best feasible implementation approach for educating the school children in primary preventive strategies of oral health for prevention of the most common dental disease, that is, dental caries that has its inception in children.

Age group

The children taken up for study were in the age group of 5-16 years. This age range in an individual's life represents all the three types of dentitions, that is, 5-6 years period of age; the children usually have a deciduous dentition. The age group 6-12 years represents the mixed dentition period and 12 years onwards is the age by which usually children have permanent dentition. Thus, it was possible to evaluate the effect of the oral health preventive program using different communication techniques on all three different types of dentitions.

Recording criteria

Dental caries

For this study, Moller's Index (1966) was found to be the best-suited index for caries recording. This is an internationally accepted index that is quite sensitive for recording of dental caries. This index can be used for quantitative and qualitative caries assessment. Examination of the children for dental caries was carried out under adequate day light facing away from the sun, seated on an ordinary chair with a head-rest adapted to it. For uniform recording of incipient carious lesion on pits and fissures, a standardized stainless steel explorer 18 μ thick at the tip was used; a fresh explorer was used for each child.

KAP evaluation

In order to assess the knowledge, attitude, and practice of the participating children initially at the base line and then at 6 months after the implementation of the program, a specially prepared computerized KAP performa was used, which contained a total of 28 questions, 13 on knowledge (K), 4 on attitude (A), and 11 on practice (P) about the oral health.

A review of literature reveals that different authors have used different KAP [13],[14],[15] questionnaire to suit the aims and objectives of their studies; however, none was found to be suitable for the present investigation.

To assess the knowledge, the children were interviewed about the best method of oral hygiene; common dental diseases especially tooth decay and its recognition, etiology, and relationship with sugars etc. The knowledge about and role of fluoride in dental diseases was also assessed. The various questions included about practice were to evaluate the oral hygiene measures being used, for example, brush, daatun, powder, salt and oil etc. frequency being followed and the agent used along with the brush. The various questions that were included to assess the attitude of the children were on the best oral hygiene measures to be practiced for prevention of dental caries and the role of fluoride in relation to dental caries.

Oral health education program

Community-based program has been described as the most effective and the less expensive method of the oral disease prevention. [16],[17],[18]

Oral health education lectures

In this study the two different types of oral health education lectures were used, one for 5-9 years age group children and another for 10-16 years.

A number of authors [13],[14] have shown that oral health education lectures in their preventive program proved to be an effective tool for bringing about the changes in KAP and thus have direct bearing on the prevention of dental diseases. [14],[15]

Practical demonstration of dental plaque and proper method of tooth brushing

Mercurochrome 2% was used to demonstrate the dental plaque in the mouth of a volunteer from amongst the children of class.

On the basis of the well-proven beneficial role of brushing [19],[20],[21],[22] to control and prevent the periodontal disease, the education program in this study emphasized the children to brush their teeth after major meals using fluoridated tooth paste, so that both the periodontal and dental caries could be taken care off.

Use of fluorides

In this study, use of fluorides constituted a very important component of the preventive package. All the children of three experimental schools were made to rinse fortnightly with 0.2 % NaF solution that was prepared freshly each time. After the fluoride rinsing session, the children were instructed not to eat or drink anything for at least 2 hours so as to enhance the local effect of fluoride on the teeth.

A number of authors [5],[18] have investigated the cariostatic effect of fluoride in the form of mouth rinses and dentifrices. [23] The percentage reduction of caries depicted has been to the tune of 30-50% with fortnightly use of the 0.2% NaF solution and about 50-60% with fluoridated tooth paste.

Knowledge about relationship of sugars with dental caries and intelligent use of sugars

On the basis of studies such as the Vipeholm study, [24] Hopewood House study, [25] Turku sugar study etc. [26] It became apparent that a direct relationship exists between sucrose and dental caries. It is the frequency of sugar consumption that matters in producing dental caries rather than the quantity. It can be concluded from the various epidemiological studies that a total of three exposures/day is a safe limit as far as dental caries is concerned. [27],[28],[29],[30] Based on these findings in this study, the children were educated for restriction of sugar exposures to three times a day, twice at meal, and once in between meals.

Need for three different types of communication modes in this study

India is a developing country with expanding population where a greater proportion of population is younger (in year 1980, approximately 320 million and in 2007 approximately 390 million). Since caries is predominantly a disease of childhood, there is an urgent need to prevent our population from this risk. Since the dentist population ratio of our country is not favorable, that is, 1: 47000 (1: 16000 in urban areas and 1: 320000 in rural areas), so dentists are not available in rural areas even for emergency dental services. The other avenues to deliver the preventive package to the children appear to be through school teachers. Literature reveals that teachers are the effective and useful personnel other than the dentists in providing preventive strategies to the school children.

The other feasible way of training school teachers in delivering and implementing the primary preventive oral health program appears to be through volunteers of various social organizations. In this study, the services of personnel of social organizations, that is, inner wheel and rotary club of panchkula (Haryana) were utilized. Investigator educated and trained the personnel of social organizations for further training school teachers in delivering the preventive package to the school group D.

   Summary Top

A significant improvement in knowledge, practice, and attitude was observed regarding tooth brushing in experimental groups B, C, and D 6 months after implementation of the preventive program. In group D, however, the attitude of children regarding brushing teeth and gums did not change significantly, probably because of communication gap or inadequate motivation.

The maximum caries reduction was seen in group B; however, even in group C and group D significant caries reduction was observed.

The results of the above parameters indicate that direct communication through dentist proved to be the most effective communication approach compared to indirect communication by school teachers and through members of social organization. Although the latter two approaches were almost equally effective in implementing the oral health preventive package to the school children. Therefore, there is still a long way to go to reach our goals, that is, a healthy smile for every child.

   References Top

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2.Leigh RW. Notes on the stomatology and pathology of ancient Egypt. J Am Dent Assoc 1935; 22:199-222.  Back to cited text no. 2
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4.Bagramian RA, Graves RC, Srivastava S. A combined approach to preventive dental caries in school-children: Caries prediction after 3 years. Community Dent Oral Epidemiol 1978; 6:165-71.  Back to cited text no. 4
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