Oral Health Related Knowledge, Attitude and Practices among Rural Population of Davangere District

INTRODUCTION

Health is a common theme in most cultures¹. It is the magical word about which every individual has his own opinion and it is true that one will know the importance of maintaining their health in one or the other stage of survival. The reawakening during the past decades has led to the realization that health is a fundamental human right and that it forms an essential part of basic human needs to lead improved quality of life¹. 

Oral health is an integral part of the general health² and well-being of an individual as defined by WHO “is a state of complete physical, mental & social well-being and not merely the absence of the disease and infirmity³”. Nowadays, oral health has become a point of concern as despite the decline in dental caries in developed countries as other oral diseases continue to have high prevalence². 

Oral cavity being the gateway for the human body, any impairment of oral health can manifest not only in oral cavity but also elsewhere in body. Oral health problems are mainly because of lack of knowledge, attitude related to oral health and poor oral hygiene practices among the population and improvement in oral health-related knowledge is considered to be an essential prerequisite for improving oral health in a community². Dental caries and periodontal diseases are largely preventable through a combination of professional and self-care activity and people's attitude and behaviour play an important role in development and prevention of oral diseases.

India is one of the largest countries in the World with a population of approximately 1.21billion⁴ , with 28% residing 5 in urban areas and 72% residing in rural areas. Illiteracy, ignorance, unfavourable oral health attitude and behaviour are commonly observed among them.

The knowledge of rural population about the oral health mainly depends upon their education level. There is need to educate the population about the importance of maintenance of oral health and also there is need to bring awareness about the various oral diseases which are common. Attitude of the population towards oral hygiene can only be improved by enlightening the people about the advantages of oral hygiene practices and also by providing health counselling. People's attitude and behaviour play an important role in development and prevention of oral diseases. Availability of health services and health care manpower is generally less in the rural areas as compared to urban cities. Since community participation forms an important part of any programme it is important that in such population appropriate data from representative population studies are needed, that can be used for comprehensive public health programme and developing training programme for dental personnel.

Furthermore as the village is located in the vicinity of dental hospital which would enable the two way channel for exchange of health information and services, therefore, the present study was conducted with an aim to assess the knowledge, attitude and behaviour related to oral health in Attigere village.

MATERIALS AND METHODS

A descriptive cross - sectional study was conducted to assess the knowledge, attitude and practice related to oral health in Attigere village population. Attigere is a village situated in Davangere district of Karnataka state having a population of approximately 2400. The proposed study was reviewed by the Ethical Committee of Bapuji Dental College and Hospital, Davangere and ethical clearance was obtained prior to start of the study. The purpose of the study was explained to each participant and voluntary, written informed consent was obtained.

Study Population & sample size calculation

The study was carried out in the Attigere village, Davangere. The sampling technique adopted was multistage sampling. The study population covered five standard age groups (5, 12, 15, 35-44, 65-74 age groups) as recommended by the World Health Organization (WHO 1997)⁶. The Attigere village was divided into 4 quadrants geographically (North east, North west, South east and South west). In each quadrant, 4 alternative lanes were chosen randomly. And in each lane, alternative houses were selected and all the members of the family were included in the study. Final sample size comprised of 986 people. Out of which, 6% belongs to 5 year age group, 5% belongs to 12 year age group, 15% belongs to 15 year age group, 49% belongs to 35-44 year age group, 25% belongs to 65-74 year age group.

Questionnaire

A specially prepared format exclusively designed for recording all the required, relevant general information was used for recording the data. A pre-tested close-ended questionnaire was used for the collection of data. The questionnaire included 29 items printed in both English and Kannada (regional language) designed to evaluate the oral health knowledge, attitude, behaviour and practices along with the demographic variables. The questionnaire was pilot tested on 10% of the study subjects was assessed for the uniformity of interpretation. Necessary alterations were made before the using the questionnaire on the entire study population. The questions were asked by the investigator to any one of the elder member of the house hold and was filled by the investigator himself.

Statistical Analysis

Data was analysed by applying descriptive and inferential statistics using SPSS package version 12.0. Chi-square test was used to assess the knowledge, attitude and practices among the five different age groups of Attigere village. Level of significance was set at 5% (P=0.05).

RESULTS

Demographic variables:

The total sample comprised of 986 subjects of whom males 515 (52%) and females 471 (48%) participated in the survey. Majority of the population belongs to age group 35-44 years (485, 49%) followed by 65-74 years age group (245, 25%), 15years (149, 15%), 12 years (58, 5%) and 5 years (59, 6%) [Table 1]. Higher proportion of population (111, 39%) reveals to be educated till high school in 35-44 years while (43, 40%) in 15 years age group. Approximately 50% of the subjects (15, 35-44 and 65-74years) are engaged in farming.

Response to questions on Oral health knowledge:

Regarding use of toothpaste, majority of the subjects in the age groups 5 years (38, 90%), 12 years (36, 90%), 15 years (100, 90%), 35-44 years (233, 82%) and 65-74 years (142, 85%) responded brushing with the fluoridated toothpaste [Table 3]. Most of the study subjects changed their tooth brush every 3 months i.e. 5 years (18, 43%), 12 years ( 23, 58%), 15 years (54, 50%), 35-44 years (126, 44%) and 65-74 years (66, 39%) [Table 3]. Majority of the study subjects knew that tooth decay (344, 55%) is the most common oral problem followed by gum disease (67, 11%). For the question regarding causative factors responsible for oral problems 37% (233) responded that eating sweets, chocolates and ice-creams causes oral problems while 33% (211) responded that not brushing teeth regularly causes the same. For the question how to prevent dental problems, 15 years (50, 47%), 35-44 years (140, 49%) and 65-74 years (76, 46%) regular cleaning was the most opted answer.

Response to questions on Oral health Attitude:

About 45% (72) of the 35-44 years and 50% (49) of the 65-74 years subjects had visited dentist when they had dental problems. Majority of the study subjects smoke cigarettes i.e. 35-44 years (36, 45%) and 65-74 years (40, 78%).

Response to questions on Oral health Practices:

In all the 5 age groups, majority of the subjects used toothbrush (95%) and toothpaste (77%) to clean their teeth [Table 2]. Brushing teeth once daily was observed in 62% (28) in 5 years, 72% (28) in 12 years, 65% (71) in 15 years, 58% (164) in 35-44 years, and 60% (100) in 65-74 years subjects. Brushing teeth twice daily was seen in 38% of 5 years, 28% of 12 years, 35% of 15 years, 41% of 35-44 years and 40% of 65- 74 years study subjects [Table 2]. For the question rinsing the mouth with water after eating, 47% in 15 years, 51% in 35-44 years and 40% in 65-74 years responded that they always rinsed their mouth after eating. For the frequency of sweet intake, 51% in 5 years, 36% in 12 years, 41% in 15 years, 34% in 35-44 years and 35% in 65-74 years responded that they ate once daily.

DISCUSSION

The present study assessed oral health knowledge, attitude and practices of rural population of Attigere village, Davanagere district, Karnataka state. The study population covered five standard age groups (5, 12, 15, 35-44, 65-74 age groups) as recommended by the World Health Organization (WHO 1997)⁶ Basic oral health survey. Majority of the population were vegetarian (77%) and wheat was consumed as staple food (41%). Farming and farming related activities was the main occupation in 80% of the rural population of Attigere village. 

In the present study, majority of the study population (95%) used toothbrush to clean their teeth. There was limited use of other oral hygiene aids like finger, neem stick, etc. 41% of 35- 44 years and 40% of 65-74 years study subjects brushed their teeth twice daily which is in close relation with a study done by Zhu L et al⁷ where 32% of the 35–44-year-olds and 23% of the 65–74-year-olds brushed twice daily. The oral health practices of the subjects were good as compared studies of Lin et al⁸ and Petersen et al⁹ . For example 94% in 35-44 age group and 92% in 65-74 age group use toothbrush to clean the teeth. Majority of the subjects used Fluoridated tooth paste (82% in 35-44 age group and 84% in 65-74 age groups) in contrast to 4% in 35-44 years and 1% in 65-74 years (Lin et al)⁸ and 5% in (Zhu L et al)⁷ . The reasons for using toothbrush and fluoridated tooth paste by majority of the study population may be because of the availability and the mass medias like television, print media etc.

Changing brush regularly is unsatisfactory and poor (42% in 35-44 age group and 16% in 65-74 age groups changed brush in 6 months), probably because of lack of knowledge regarding the same. Oral hygiene practices such as rinsing the mouth after meal was observed (51% in 35-44 age group and 44% in 65-74 age groups). This can be attributed to the tradition and customs of the community. Use of tooth pick as oral hygiene was also observed (32% in 35-44 age group and 26% in 65-74 age groups).

Majority of the study population were aware about the common dental problems. Tooth decay, gingival and periodontal diseases were the main answers given by the subjects in all age groups. Similar results have been found by Wu et al¹⁰ and Lin et al⁸ . Most of the subjects knew that consuming sugar, sweets and not brushing regularly could cause tooth decay. Tooth brushing and avoiding sweet items were two most common answers given by the subjects in all age groups when asked about ways to prevent tooth decay. Similar results were obtained from the studies conducted by Lin et al⁸, Wong MC et al¹¹, National Oral Health Survey and Fluoride Mapping, Karnataka¹² .

Approximately 50% of the total population consulted dentist when they had any dental problem. The possible reasons for remaining people not visiting the dentist were painful procedure, too expensive treatment, distance from their village to the dental hospital and it is not life threatening.

Adverse habits like smoking (bidis, cigarettes), chewing gutkha, and chewing pan with tobacco were also observed in the elderly population. Majority of them smoked bidis in both age groups. This shows their lack of awareness regarding harmful effects of tobacco consumption.. Around 93% in 35- 44 age group and 92% in 65-74 age group had no access to the 13 dental care which to similar to Lin HC et al . Lack of dentists in rural areas and affordability of rural adults may be the major reasons for underutilization of dental care in rural adults. Lack of dental insurance in India may also be the reason for poor dental services in India.

Limitations of the study: Because of lack of personnel and funds, this study was done in one of the rural areas of Davangere district i.e Attigere viallage. Results obtained from the present study can be reflected only to the Attigere village and it cannot be generalized to other population.

CONCLUSIONS

Health of the individual reflects the health of the community. The importance of oral health has now been looked beyond the understanding of a common person. The present epidemiological study has furnished the base line data about people's knowledge; attitude and practices regarding oral health, also the lack of utilizations of dental health services have further aggravated its effect. Thus the need for care should be aimed both at individual level and also at the community level. These findings make it imperative to introduce organized community oral health preventive programmes rather than focusing exclusively on individual treatment and also there is a need to educate the rural population regarding the importance of oral health in order to bring down the disease burden in the community.

Recommendations: Findings from this survey suggest a need for primary preventive measures, which can be best attained by motivating them through health education.

 1. To improve their oral hygiene practices, it is essential to make them aware about the importance of using toothbrush and toothpaste in maintaining oral hygiene and guide them to make use of it.

2. Since most of the people have not utilized the oral health care because of lack of awareness, a mobile dental unit must be established which will visit all the villages according to a fixed schedule to render the required oral health care.

3. Dental health education activities should be introduced to increase the awareness of the importance of oral health for school children.

4. Educating them about the harmful effects of habits like smoking, Pan-Masala chewing and the chances of getting oral cancer and advise them to control habits.