Knowledge, Attitude, and Practice of Oral Hygiene Among Students
Chapter One
Aim
The study aimed to assess students’ knowledge, attitudes, and practices and establish their understanding regarding their oral health.
Study objectives
The objectives were:
- To determine the students’ knowledge regarding oral hygiene.
- To explore the students’ attitudes towards oral hygiene.
- To establish the students’ practices with regards to oral health and hygiene.
- To compare results between students in dental assisting, environmental health and in students that are offered generic base subjects within environmental health; and
- To establish whether a course focuses on students’ oral and general health through a curriculum
CHAPTER TWO
LITERATURE REVIEW
Introduction
This chapter outlines topics such as the concept of health and oral health, the common oral diseases and their aetiology, oral health education and knowledge, oral hygiene practices in students from various studies among students, and oral health quality of life and the use of oral hygiene services among students in various countries including Nigeria.
The World Health Organization’s Global Oral Health Program (WHO OHP) has worked tirelessly over the years to bring oral health to the forefront of politicians and decision-makers around the world’s health agenda (Petersen, 2010). In part, the resolutions were to raise awareness of global problems to improve oral health and the unique needs of low-income countries and vulnerable and marginalised populations. It is evident that good oral hygiene contributes to healthy bodies with the mouth as the gateway to good health and a mirror as to how a body is perceived (WHO, 2010).
Of concern among students was the consumption of alcohol, smoking and sugary intake, which appeared to peak between 18 and 25 years of age. School students in this age group are more at risk for increased alcohol consumption than non-enrolled age-matched controls. It was observed that the overall trend of alcohol use increased (Afshin et al., 2019). Ramphoma (2016) cited that despite the impact that oral health has on general health and the quality of life, it is still one of the most neglected aspects of health in most developing countries, including Nigeria (Ramphoma, 2016).
With increased awareness of health in institutions, establishing general knowledge about students’ oral health was necessary (Reddy & Singh, 2017).
Oral health
Oral health is a primary predictor of fitness, nutrition and quality of life overall. WHO defines oral health as ‘the condition of being free from chronic mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that impair the ability of a person to bite, chew, smile, speak, and psychosocial wellbeing’ (Bissett & Preshaw, 2011).
Poor oral health, particularly in developed and underdeveloped countries, is still a major burden for populations worldwide. The WHO (2010) describes oral health as a primary predictor of the quality of life, wellbeing and overall health. This covers several diseases and disorders, including dental caries, periodontal disease, and teeth loss (Glick et al., 2012). Afshin et al. (2019) estimated in the 2017 Global Burden of Disease Study that 3.5 billion people worldwide suffer from oral diseases, with the most prevalent non-communicable diseases of untreated dental caries, and with an established oral and general health relationship. For example, diabetes mellitus is associated with the development and progression of periodontitis. In addition to the previous statement, there is a causal correlation between high intakes of sugar and non-communicable disorders such as cardiovascular disease and diabetes.
(Afshin et al., 2019; Murray et al., 2020; Heilmann, Machuca-Vargas & Watt, 2020).
Oral health conditions
Dental caries, periodontal diseases, oral cancers, oral manifestations of HIV, oro-dental trauma, cleft lip and palate, and noma (described as a severe gangrenous disease that starts in the mouth) are the most common oral health disorders which also often affect children. Most oral health problems are generally preventable in their early stages and can be treated (Reznik, 2005). Globally, an estimated 2.3 billion people are suffering from permanent teeth caries, and over 530 million children are suffering from primary teeth caries (Afshin et al., 2019; Murray et al., 2020). In Nigeria, there is a high rate of dental caries despite public and private services being available. Whilst access is a problem, the knowledge of preventative measures is also very low (Singh, 2011a; Modikoe et al., 2019). The findings of the last National Survey of Oral Health (1999-2002) revealed that approximately 45-60% of young children living in Nigeria require dental decay treatment (Ramphoma, 2016; NDoH, 2002).
In most low- and middle-income countries, the prevalence of oral diseases increases with increasing urbanisation and living conditions changes. This is partly attributed to insufficient fluoride intake (in the water supply and oral hygiene products such as toothpaste) and inadequate community access to oral hygiene services. The promotion of foods and drinks high in sugar and tobacco and alcohol, has contributed to a rise in the intake of products that lead to oral health conditions and other noncommunicable diseases. (Afshin et al., 2019; Heilmann et al., 2020).
Periodontal disease
The tissues that both cover and protect the tooth are affected by periodontal disease. Bleeding or swollen gums (gingivitis), pain and often poor breath are characteristics of the illness. The gum will come away from the tooth and help the bone in its more extreme form, causing teeth to become loose and occasionally fall out. It is estimated that severe periodontal diseases affect more than ten percent of the global population. Poor oral hygiene and tobacco use are the primary causes of periodontal disease (Benzian, Bergman, Cohen, Hobdell & Mackay, 2014).
CHAPTER THRE
RESEARCH METHODOLOGY
Introduction
This chapter provides a discussion of the methodology used. The researcher discusses the research design, settings, population and sample size, data collection methods, analysis, and data management. Limitations of the research, pilot study, validity and reliability, and ethical considerations are also discussed.
This was a descriptive study where qualitative and quantitative methods of research were applied. As described by the Centre for Evidence-Based Medicine, Study Designs (2016), descriptive studies merely seek to explain the data on one or more aspects of a group of people. They do not attempt to answer questions or generate interactions between variables. Babbie (2013) and Botma, Greeff, Mulaudzi and Wright (2010) referred to quantitative analysis as studying a phenomenon that transforms data to a numerical format (Babbie, 2013; Botma et al., 2010). A non-experimental quantitative study was one of the methods used to collect data in this study, whereby a set of questions was used and answered by the participants. Quantitative data in response to each question was entered into an Excel spreadsheet. The results were tabulated, and the statistical analysis of the data was carried out.
Braun and Clarke (2006) referred to a qualitative study as primarily exploratory research (Braun & Clarke, 2006). It is used to obtain an understanding of motives, beliefs, and motivations that are central. Qualitative data were collected in this study by using open-ended questions in the questionnaire. A qualitative analysis was carried out, and the results from the groups were added to an excel spreadsheet and analysed.
Research design
The study survey used a questionnaire to test the attitudes, opinions and status of the population. Surveys obtain information from large samples of populations, and the results can be applied to broader population contexts (Babbie, 2013). Furthermore, questionnaires allow data to be obtained more easily than interviews, so it is possible to access larger samples, choosing that method by the researcher. The present thesis included a comparatively high degree of analysis. The questionnaire layout further helped to present information in a structured way; hence, the questionnaire was used for data collection. Quantitative data were collected and analysed for the study from the close-ended questions (Babbie, 2013; Braun & Clarke, 2006).
Qualitative research offers insights into the issues or helps to generate ideas for future quantitative analysis or theories. Qualitative research is often used to identify patterns in thinking and perceptions and to dig deeper into a problem (Braun & Clarke, 2006). The method used to analyse qualitative data was content analysis by following the steps defined by Braun and Clarke (2006), using a thematic process. Therefore, qualitative data in this study analysed the participant’s oral health knowledge and practices of oral hygiene in open-ended questions, and it was thematically analysed. A coding guide was then created to help the coding process. The inductive reasoning of the emerging themes was made possible by this coding method (Theron, 2015). The guidelines for implementing each code to ensure rigour and thoroughness were also included (Braun & Clarke, 2006).
Study population
The School had 260 students, and all students were selected for the study, i.e. the total sample (n=260). The Dental Assisting program had 75 students, and the Environmental Health had 185 students. The study included both males and females of all race groups in the department.
CHAPTER FOUR
RESULTS
Demographics
For this study, an online survey of a questionnaire was used. The total sample that the study was distributed to was (n=260). A total of (n=220) participants completed the questionnaire. The research instrument consisted of 50 items, with a level of measurement at a nominal or an ordinal level. The questionnaire was divided into five sections which measured various themes: Biographical data, Habits, Knowledge, Attitudes and Practices.
CHAPTER FIVE
DISCUSSION, RECOMMENDATIONS AND CONCLUSION
Introduction
This chapter will discuss assessing the knowledge, attitudes and practices concerning oral hygiene in CUT students. It will also provide an analysis of how the objectives were addressed. The limitations of the research are outlined thereafter, and the recommendations and the conclusion follow.
Poor oral health has a significant effect on the patient’s general health and quality of life. The preservation of good general and oral health is a priority and a key factor in adults for overall wellbeing and enhanced quality of life. Therefore; it is important to determine how people rate their oral health status, their perceived dental needs, and the actual use of available dental services (Azodo et al., 2010). Structures are in place to promote oral health behaviour, but it is important to remember how the knowledge, attitude and practices (KAP) are applied, as investigated in this study.
Discussion
This is the first research study to evaluate oral health awareness and practice of oral health behaviours among CUT students. In this research, we concentrated on the relationships between the source of dental knowledge, attitudes, and oral health behaviours. In this study population, we found that variations in the source of dental information were correlated with oral health behaviour; that is, both positive and negative associations were observed between the sources and oral health behaviour.
The 2020 mid-year population estimates from Statistics Nigeria (Stats SA) were estimated at 59.62 million. Around 51,1% (about 30.5 million) of the population is female. The ages of the participants in this study ranged from 18 to 24 years, with the majority being females, in line with Nigeria’s gender demographics. Overall, the ratio of males to females is approximately 1:2.3; 28.4% (n=62): 70.2% (n=153).
Participants reported to be living at home were 45% (n=97) which might influence their oral hygiene methods. Literature supports the statement in a study on oral hygiene knowledge, attitudes, and practices in adult patients in Mangaung, Ilishan Remo conducted by Modikoe et al., 2019. Modikoe et al. (2019) suggested that living at home could influence the oral hygiene methods in a good or bad way to fight dental caries. However, the correlation between students staying at home and toothbrushing in our study revealed no degree of association or significance – between the number of household individuals and toothbrushing habits of the participants (Modikoe et al., 2019).
In our research, it was noted that significantly more males smoked compared to the other two groupings. Out of (n=220) participants, 25.6% (n=58) smoked and in the same category of smokers, 22% (n=48) of them smoked more than (n=3) cigarettes per day. Interesting enough, over 51% (n=114) in our study, agreed that smoking could affect their gums. This is in line with the Formicola (2017) and Park et al., (2011), in their study, they found that tobacco use may influence students’ oral hygiene methods. An analysis of smoking and bleeding gums was done, and no significant difference was found in our study.
Almost all the participants, 99.1% (n=218) have had an alcoholic drink, and of the 99%, over 60% (n=132) drink over (n=7) alcoholic drinks per week. These findings might influence the participants’ oral hygiene as seen in a study conducted by Afshin et al. (2019), it was observed that the overall trend of alcohol use increased in students. Furthermore; the study suggested that alcohol intake influenced students in all educational institutions regarding their lifestyle.
This study’s habits were also structured around the participant’s sugar intake as reported in a study conducted by Modikoe et al., (2019), whose findings indicated a low intake of vegetables and more sugary products in adults. In our study, over 80%; (n=187) of the participants agreed that they love sugar and only 14%; (n=32) do not like sugar. Over 22%; (n=50) stated that they take sugar more than three times a day. This finding is also to be noted as 72.2% (n=159) participants believed that dental caries is caused by a combination of sugar, bacteria and poor oral hygiene but the results of their drinking and smoking habits prove otherwise as discussed in the statement above. Their intake of sugar is to be noted, as it is significantly high. There was a strong and significant positive correlation between high sugar levels, bad breath and missing teeth using the Pearson Chi-Squared Test (p=0.01).
Recommendations
The following recommendations were made:
- Promoting oral health and awareness campaigns to inform the students about the importance of oral health and oral hygiene.
- In order to provide appropriate and relevant data, educational campaigns should be introduced on campus.
- The initial phase of incorporating oral health into general health requires quality training and education for oral health staff, stakeholders and decision-makers to convey significant oral health messages to the population.
- Pamphlets or websites can have online education programmes to encourage students to learn about Oral health.
- Data collected will provide the basis to modify the current teaching module to improve the outcomes. A module about oral and general health care for Environmental Health students is suggested to be added to the first years’ curriculum.
- Noting that there is little research done on oral health in CUT, more research on KPA in students needs to be conducted.
- The faculty could use this research as a starting point to better understand the great need for oral hygiene and oral hygiene for school students.
Conclusion
Oral health is now an important component of general health, and oral health awareness is growing worldwide. The Global Oral Health Program of the World Health Organization has done a lot in the past five years to raise this awareness. This study has generally shown that students have good oral hygiene behaviour. However, this study’s results can be used to form a baseline to other departments in the plight to fight dental caries and promote good oral hygiene to students.
Within the study’s limitations, the findings show that advocacy for oral health promotion is significant for the students. As much as oral health promotion is available in school-health programmes, evidence demonstrating the sustainability and success is questionable. Students in the universities are mostly regarded as role models to the youth, and that is why it is essential to take preventative measures for oral hygiene as early as possible and throughout life in general.
Problems with oral health can affect the quality of life in many ways. What can be noted is that good oral hygiene plays a huge role in nutrition, which equates to a healthy body, a healthy mind, which is what this study aimed at achieving. It was found that the use of other suggested oral hygiene strategies such as dental floss and mouthwash oral health education was important. The study findings indicate that general and oral health would benefit students in Environmental Health programme, as recommended for inclusion in the curriculum syllabus attached (Appendix 6) as there is one already in place for dental assisting students.
More emphasis on oral health promotion and preventive measures (such as the use of fluoridated toothpaste and application of topical fluoride) is suggested instead of curative measures. Oral health promotion should be an awareness and should be community-based and must be included in the curriculum for all students with more emphasis on preventative than curative measures. This can be achieved through community campaigns and school health programs already in place in Nigeria. Subsequently, it is proposed that oral health education and prevention programmes be established, and they should aim to gain the support of the entire society (leaders, educators, healthcare practitioners, decision-makers) to ensure the effectiveness of the oral health education and promotion programme
The study, therefore, concludes that oral hygiene knowledge, attitudes and practices are enhanced by education.
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