Oral health awareness, attitude and oral hygiene practice among nursing students of apollo school of nursing mizoram.

INTRODUCTION 

Oral health is a fundamental part of general health and well being which has to be maintained throughout one’s life time. The existence or nonexistence of dental caries and periodontal disease as well as the degree of oral hygiene found in the population decides the oral health status of an individual. This is because dental caries and periodontal infections have truly been considered the most significant worldwide oral health problems. Improvement of oral health status can be achieved by reduction in accumulation of plaque which has been considered as an important factor in the development of dental caries and periodontal diseases. Prevention and control of dental caries and periodontal diseases and different mucosal lesions can be attained by tooth brushing twice daily with toothpaste containing fluoride and flossing.¹

It has been established that good oral hygiene and standard visits to the dental specialist enhances oral health.^2,3 Also, Adachi et al, 2002 ⁴reported significant reduction of infection rates with once-weekly professional oral care.

Good oral hygiene is the foundation of a healthy mouth and prevents 80% of all dental problems⁵ . Control of plaque is the basic treatment modality for the prevention of periodontal disease and dental caries, since plaque is the essential etiological factor in the presentation and advancement of both of these infection oriented disease.Plaque removal with a toothbrush is the most frequently used method of oral hygiene ⁶ . Oral disease is higher among the poor population with an upsurge in developing nations⁷ . As per World Health Organization 2008 report, when tooth related problem arises just about 52.2% of students visited their dental specialist⁸ . Nearly half of the students utilized dental service once in 6 months in an investigation conducted in canada⁹ . A study done in Kenyan younger students reveals that 87% knew dental caries and periodontitis could be prevented and demonstrated that 93% of the kids utilized a toothbrush with toothpaste¹⁰. Prevalence of Oral hygiene practice is different among nations. For example, 97% of Koreans brush their teeth once per day¹¹. The frequency of tooth brushing varies between 1 to 5 times per day among participants in a study conducted in Tanzania ,but most of the study participants did brush twice per day or more. Those who brushed once per day ranged from 24% to 38.8%¹². A survey in Pakistan demonstrated that 36% of the population cleaned their teeth once a day¹³.

The WHO 2010 reported connection between oral well being and general well being, with common risk factors including poor diet, tobacco use and alcohol consumption. People who suffer from general health problems (diabetes, HIV) are at greater risk of oral diseases (periodontal diseases) that, in turn, further complicate their well being. Thus, oral health is an integral part of general health.

Nurses play an important role in maintainance of health and spread of health related information, as a result it is essential that their very own oral health knowledge should be upto date and their oral health behaviour substantiate to expectation of the community.^14,15

One of the many road block to standard oral healthcare includes a lack of awareness of oral health by non-dental health care professionals (e.g., nurses, pharmacists, physicians, physician assistants). Nurses, being the primary health care provider to the patients, play an important role in health sector. At present, their role in dentistry is negligible. However, nurses can be effectively utilized to improve oral health awareness among the public. Oral health should be given more importance in the nursing educational plan, which ought to incorporate progressively clinical hands-on preparing in oral assessment and finding of oral disease ^16,17. Gallagher and Rowe, 200118 stated that community nurses play a significant role in the oral healthcare of the general public, especially among those less inclined to go to dental service, and there is a need to improve their insight with respect to oral health aspects. Since Nurses play an important role in health promotion and preventive information dissemination, therefore it is imperative that oral health knowledge should be good to minimize poor oral health outcomes.

Materials and Methods

The present study was conducted upon total 150 nursing student of Apollo School of Nursing Mizoram. Official permission was obtained from principal of the school before the study. A self administered structured questionnaire (Table 1) was distributed among the 150 nursing student.The questionnaire was divided into three parts and consisting of 22 multiple choice questions. The first part consist of knowledge and awareness about oral health. The second part consist of attitude towards oral health. The third part comprise of knowledge regarding oral hygiene practice. The nature and purpose of the study was explained to the participants before the survey and consent was taken. The completed questionnaires were tabulated and evaluated for knowledge and awareness,attitude and oral hygiene practice (KAP) level .

STATISTICAL ANALYSIS: All the response of the participants were analyzed and their knowledge and awareness,attitude and oral hygiene practice level (KAP level) were evaluated by dividing the number of ideal response by total no of participants multiplied by 100.

KAP level (%)=number of ideal response ÷ number of participants × 100. Statistical Analysis was done by calculating the mean of the KAP level (%) using the formula

͞x = ( Σ xi ) / n where ͞x represents mean ( Σ xi ) represents summation of all the values of the KAP level(%) n represents number of values of KAP level (%).

RESULTS

In this study, 150 undergraduate nursing students participated on the day of the survey. All the participants were girls with a mean age of 20 years ± 1.08. Table 2 shows the frequency of the ideal responses and other responses to the oral hygiene knowledge and awareness, attitude and oral hygiene practice questionnaire (KAP) and KAP level. The oral hygiene knowledge and awareness level was found to be 59.75%, the attitude level was 48.7% and oral hygiene practice level was 62.82%(Fig 1). The average knowledge, attitude and oral hygiene practice level(KAP level) of the student examined was found to be 60.54 %.

Among the paticipants, when asked for habits which will be harmful for oral cavity, 60% answered that smoking,betel nut chewing, pan chewing and tobacco chewing together is harmful to the oral cavity. Nearly 36.7% of respondents stated carbonated drinks is harmful to the oral cavity. About 89.3% of participants stated that general body health has a relationship to oral and dental disease. Approximately half of participants expressed that dental plaque leads to inflammation of gums and 54 % of participants expressed plaque implies soft debris on the teeth. Also 67% of participants reacted that gum bleeding means inflamed gums and nearly 60 % use toothbrush toothpaste and dental floss to protect against gum bleeding.

About 91.4% of respondents expressed that they care about their teeth as much as any part of their body. About 6 % of participants stated that they visited a dentist regularly .

Almost 100 % of participants stated they use toothpaste and toothbrush for brushing teeth. Around 60 % of participants addressed that they brush their teeth twice daily. About 52% of participants search for the kind of tooth brush while purchasing toothbrush and 38% utilize a soft fibre/bristle toothbrush as an every day usage.When asked regarding how often they change toothbrush, 66 % responded they change their brush once in every months and 46.7% change their toothbrush due to fraying of bristles . Approximately 46 % of the respondent use mouthwash as other aids with brushing and furthermore 90 % of them clean their tongue out of which 38 % utilized tongue cleaner for cleaning tongue. Among the participants 90 % brush their teeth on different occasions other than morning,noon and 34% brush their teeth for 2 minutes .Nearly 56% stated that they brush their teeth before the mirror .

DISCUSSION

Nurses play a important role in achieving a conduct change in the patient as well in the society.In this present study it was found that majority of the participant were practising good oral hygiene practice. This constructive finding might be ascribed to the fact that individual cleanliness is a key part of nursing care.About 60% of participants were brushing twice daily which is more than the study done by Dilip CL¹⁹ among the police recruits in Karnataka where 58% brush twice daily It was found that 38 % of participants used soft toothbrush which is more than study conducted by Doshi D,Baldava P,Anup N,Sequiera PS²⁰ among the medical students Manipal Academy of Higher Education where 35.8% used soft brushes suggestive of better awareness of the participants than medical students regarding the usage of soft bristles to avoid damage to the tooth structure.About 66% change their toothbrush every month whereas 13.3 % of medical student change toothbrush every month in a study conducted by Doshi D,Baldava P,Anup N,Sequiera PS. ²⁰

Majority of the participants knew that gum bleeding means inflamed gum which is in agreement with the studies of Kaira LS, Srivastava V, Giri P, Chopra D15 This study showed that 6% of participant visited dental specialist regularly which is lower than studies conducted by Cheah W L et al 21 where 24.4% reported visiting a dental specialist regularly.

However, this study have some limitations due to less sample size . The students' selfreported behaviors may have resulted in overreporting of their actual oral hygiene practices. Another limitation is that it was done in a specific school, so it cannot represent the overall population of that group.

CONCLUSION

The present study showed good oral hygiene practices and fair knowledge of oral health among nursing students of Apollo School of Nursing Mizoram. Since Nurses, being the primary health care provider to the patients, play a vital and a significant role in health sector, the knowledge acquired must be transferred into daily practice. This can be achieved by a change in their attitude towards oral health. Inclusion of oral health-oriented education programs in their curriculum would improve their knowledge and behaviour and they would be a good model to the community as well as play an important role in prevention of oral disease.

LEGENDS

1. (Table 1): Questionnaire consisting of three sections to assess the knowledge, attitude and practice level (KAP)

2. (Table 2) : Response of questionnaire consisting of three sections assess the knowledge attitude and practice level (KAP level)

3. (Fig 1): Bar graph showing the oral hygiene knowledge and awareness level, the attitude level and oral hygiene practice level.