Knowledge, Attitude and Practice of School Teachers toward Oral Health of Children in Chennai
Vunnam Sri Sai Charan Saveetha Dental College And Hospitals
Saveetha Institute Of Medical And Technical Sciences Chennai, India
Email: [email protected] Mebin George Mathew
Senior Lecturer Department of Pedodontics Saveetha Dental College And Hospitals
Saveetha Institute Of Medical And Technical Sciences Chennai, India
Dr. Deepa Gurunathan Professor and Head Department of Pedodontics Saveetha Dental College And Hospitals
Saveetha Institute Of Medical And Technical Sciences Chennai, India
Corresponding author Mebin George Mathew
Senior Lecturer Department of Pedodontics Saveetha Dental College And Hospitals
Saveetha Institute Of Medical And Technical Sciences Chennai, India
E mail: [email protected] ABSTRACT
The aim of this study is to determine the knowledge, attitude and practice of school teachers towards the oral health of children in Chennai. The purpose of this study is to create awareness and determine the understanding of the school teachers regarding oral health of children in Chennai. This study was conducted based on a questionnaire which consists of 10 questions through a web-linked application called Google Form. A convenient sample size of 100
overall result, most of the participants have a positive attitude regarding information on the children’s oral health. As a conclusion, school teacher’s awareness on the oral health of children in Chennai are adequate but the knowledge had to be brushed up among them for a better understanding regarding this topic. Furthermore, they need to be trained on these grounds to help them be more disciplined and more consent with oral health issues.
KEYWORDS: school; teacher; oral; health; children
INTRODUCTION
School is an important platform for learning. It not only contributes to an individual's education but also to their health and health-related behavior.(Petersen 2009) In India, “healthy school concept” and “health-promoting school concept” have evolved to strengthen the opportunities for promoting oral health. The WHO has provided an “information series on school health” to advocate “health-promoting schools.” They have also implemented strategies for oral health promotion in schools.(White et al. 2006)
Oral health and dental camps have become an integral part of school curriculum. Indian school textbooks had basic and adequate information on oral health.(Chhabra and Chhabra 2012) Literature review showed the wide perspective of school health education with different modes of education, different educators, reinforcements, and follow-up periods in different parts of the world.(Bagramian, Garcia-Godoy, and Volpe 2009; Moses et al. 2011) Research evaluating the effectiveness of various modes of oral health education (OHE) and its different combinations in improving the oral health status of children has been on the rise in the last decade.(Mehta and Kaur 2012)
Oral health status evaluation includes both objective and subjective parameter components. Kay and Locker in their systematic review concluded that the quality of evidence pertaining to the effectiveness of dental health education is poor.(Kay and Locker 1996) However, a systematic review by Priya et al. assessed the effectiveness of school dental health education in India and found it to be effective, irrespective of their follow-up periods.(Priya et al. 2019)
There is no comprehensive information available in this regard from a global perspective in recent times.(Wong et al. 2001) Hence, this systematic review was planned to assess the interventional studies on the effectiveness of school dental health education on the oral health- related knowledge, attitude, and practice behavior and oral health status of 6–12-year-old children, with a minimum follow-up period of 6 months.(Gill, Chestnutt, and Channing 2009;
Harikiran et al. 2008)
During the school years, children spend most of their time with their teachers.(Kirkwood 1991) Similarly, the knowledge and skills needed to attain their future goals and nurture hidden potentials are acquired during this period. Shaping ways of life and personality development of
school children during elementary education is the key responsibility of school teachers and parents.(El-Qaderi and Taani 2004)
Students follow what teachers do and say. Teachers are considered as role models to transmit values of life.(Ramroop, Wright, and Naidu 2011) School teachers by virtue of their training can influence a large number of children, thereby playing a major role in the planning and implementation of oral health preventive programs. It is therefore important that their own oral health knowledge is good and their oral health behaviour conforms to expectation of the population.(Kakatkar et al. 2012)
The Ministry of Health and Family Welfare, Government of India, accepted in principle National Oral health Policy in the year 1995 to be included in national health policy. They launched the National Oral Health Care Programme which envisaged the implementation of oral health education, preventive and curative services.(Zhu et al. 2005) Against this background, the study was undertaken with the objective of assessing the knowledge, attitude and practice of school teachers towards oral health of school children.Our institution is passionate about high quality evidence based research and has excelled in various fields ( (Jayaseelan Vijayashree Priyadharsini 2019;
Pc, Marimuthu, and Devadoss 2018; Ramesh et al. 2018; Ramadurai et al. 2019; Sridharan et al. 2019;
Ezhilarasan, Apoorva, and Ashok Vardhan 2019; Mathew et al. 2020; Samuel 2021; R et al. 2020;
Chandrasekar et al. 2020; J. Vijayashree Priyadharsini, Smiline Girija, and Paramasivam 2018)
Therefore, this study is conducted to determine the knowledge, attitude and practice of school teachers towards the oral health of children in Chennai.
METHOD AND MATERIALS
A convenience sample size of 100 consecutive school teachers who are working in Chennai, currently. A cross-sectional observational online based study was conducted. Questionnaire was constructed on the Google Form website with demographic details and multi option questions.
The questionnaire consists of 10 questions as shown in Table 1. A link containing these questionnaires was shared with all the participants and required them to answer the questions.
All the responses were analysed and recorded.
QUESTIONS
Q1. Are you aware of the oral health of children in your school?
Q2. Do you know what is the main cause of dental caries in children?
Q3. What is the prevention of tooth caries?
Q4. What is the cause of gum diseases in children?
Q5. Do you know what is the prevention for gum bleeding?
Q6. What will be the frequency of brushing for children?
Q7. What is the correct brushing timing?
Q8. What is the frequency of brush changing?
Q9. What is the frequency of dental visits for a child?
Q10. Do you inspect the lunch boxes of your students?
Table 1 shows the questions asked in the questionnaire to school teachers
RESULTS
Figure 1 shows the gender distribution of school teachers who participated in this study
Figure 2 shows the education category of the participants
AGE RANGE
20-29 years old 12%
30-39 years old 43%
40-49 years old 39%
50 years old and above 6%
Table 2 shows the age range of the school teachers who participated in this study
Figure 3 shows the percentage of school teachers that aware of oral health of children
Figure 4 shows the percentage of response from participants regarding causative of dental caries
Figure 5 shows the response regarding prevention of tooth caries in children
Figure 6 shows the percentage of answers regarding causes of gum disease in children
Frequency of brushing for children
Once daily 30%
Twice daily 57%
Thrice daily 10%
More than 3 times daily 3%
Brushing timing
Less than 1 minute 37%
1 minute 45%
2 minutes 10%
More than 2 minutes 8%
Frequency of brush changing
Monthly 73%
3 months once 19%
6 months once 8%
Children’s lunch box inspection
Yes 89%
No 11%
Table 3 shows the response for remaining question asked to the participants
About 66% of the participants were female whereas 34% were males, as shown in figure 1.
Figure 2 shows the demographic details of the education category of the participants, where 79%
of them were undergraduates. Remainig 21% of them were postgraduates. Table 2 showed their age ranges. 12% of them were between 20-29 years old, 43% were 30-39 years old(majority), 39% of them were 40-49 years old, and remianig 6% were above 50 years old school teachers.
About 76% of the participants claimed that they are aware of the oral health of children.
Remaining 24% of them were not aware of this topic, as shown in figure 3. Figure 4 explained about the causes of tooth caries in children which showed that about 45% of them chose bacteria and sugar. 27% of them choose only bacteria and 20% of them choose only salt. Remaining 8%
of them chose none of the above options.
Figure 5 showed the response of participants regarding the question asked about prevention of tooth caries in children. 40% claimed the best prevention is by applying fluoride on children’s oral cavities. Remaining 34%,15% and 9% choose the option to avoid sugar, regular brushing and none of above, respectively. Figure 6 showed the response regarding causes of gum disease in children. 54% of them choose the option plaques and calculus, 40% of them choose improper brushing technique, 4% of them choose to consume gum disease and 2% of them choose none of the above options.
Table 3 showed the remaining question and response of participants. 57% of the participants claimed that a child should brush twice daily, whereas some assumed as once daily(30%), thrice daily(10%) and more than 3 times daily(3%). When asked about the brushing timing, 45% of them claimed 1 minute for children, and others chose less than 1 minute(37%), 2 minutes(10%), more than 2 minutes(8%). Only 89% kept track of a child’s lunch box, remaining 11% kept no tract on the lunch boxes of the children.
DISCUSSION
This study was similar to a study by Prathap et al.,(Pratap and Mahalakshmi 2013) where 82 % of the study population was females. The mean age of the teachers in our study is 47 years, while in other studies, the mean age is around 30years. We can stipulate then that the teachers in our study have more experience of around 10-15 years as compared to the few other studies conducted in our country. Around 45% of the subjects had knowledge of the cause of dental caries namely bacteria and sugar.
Around the same number also agreed that regular brushing could in fact reduce the incidence of gum disease. Although, this is in agreement with studies conducted by Nyandindi et al.,(Nyandindi et al. 1994) and Alhussain et al.,(AlHussain et al. 2017) it is not in agreement with a study by Lang et al.,(Lang, Woolfolk, and Faja 1989) in China. Around 59% of the school teachers felt that vitamin C supplementation is effective in reducing gum bleeding. While it is proven that deficiency of vitamin C results in scurvy leading to a bleeding tendency in the mouth, it is not the main cause of gum disease.
Around 9% of them did not have any idea regarding the causes of bleeding gums nor about its prevention. Poor knowledge of the gum disease among the school teachers is prevalent and thus has to be corrected by health education. Around 57% of the study population assumed that children need to brush their teeth twice daily. This is in agreement with a study done by Zhu et al(Zhu et al. 2005). However, the percentage of teachers brushing twice daily is higher in our study as compared to others. In agreement with studies by Vanka et al.(Vanka et al. 2012) 78%
of teachers advise their children to clean their tongue and 87% to rinse their mouths after every meal.
Change of their toothbrush every 3 months is higher in our study as compared to a study by Ling Zhu. Change of the toothbrush is dictated by not only the number of months used by the individual, but also dictated by the fraying of the bristles. Fraying of the bristles reduces the efficiency of the tooth brush.
The awareness regarding dental problems being very poor relates to the percentage of the population visiting the dentist. It is the general belief of most teachers that children’s teeth should regularly be checked by the dentist for not only treatment but also in the preventive aspect. Many deep pits and fissures can be filled prior to the development of dental caries. Also many malocclusions can be corrected by using appliances at the growth spurts. This attitude of the teachers will be helpful and instrumental in arranging regular visits by the dentist to the school as a part of camps organized by dental colleges and welfare societies.
Young children need to be constantly monitored in all aspects to shape and mould their character. The school teacher not only instills moral values to the children but can also give ideas
to the parents so as to improve their children’s health. Health is a state of complete physical mental and social well-being and not merely the absence of disease or infirmity. Advice on monitoring their children’s brushing and eating habits could be given during the regular parent teachers’ association meetings. At these meetings, it is also stressed that the parents send healthy meals and snacks to the children at school.(Park 2005)
Many schools have an option of midday meals where they see to it that the nutritious food is provided. Inculcating good eating habits is essential as obesity, diabetes; hypertension is affecting individuals at a very young age. Commonly eating junk foods would not only be a risk factor for obesity but also for dental diseases. Thus it is the responsibility of both the teachers and the parents to monitor the children’s diet. Teachers must inspect lunch boxes and make sure that parents send healthy food.(Sumit et al. 2013)
Around 40% teachers know that fluoride protects against tooth decay. Knowledge about fluoride could be shared with the parents where kids have a higher incidence of dental caries. It is the role of the dentist to do preventive deeds apart from the dental treatments he/she provides. Primary health care is the best way to provide health services to the community. The Ministry of Health and Family Welfare, Government of India accepted the principle “The National Oral Health Policy” in the year 1995. It plans to extend minimum oral health to the entire Indian population.
The policy gave special emphasis to preschool children primary and secondary school children, expected and nursing mothers and for the increasing geriatric population. It has also emphasized oral health education and training of trainers. Oral health education chapters should be included in the school curriculum.(Lal, Paul, and Vashisht 2004)
Teachers training programme is a welcome proposal under the National Oral Health care Program and a guide book has been prepared in English and local languages. Regularly one hour can be devoted in each school for socially useful and productive work and that hour can be used for learning correct brushing techniques and other good habits. In that hour lectures can be taken by teachers themselves or a dentist may be called to promote oral health education.
CONCLUSION
Hygiene is embedded in Indian culture and it is the way of life. School children are ambassadors of health messages to their homes and can also act as change agents. In our study, the knowledge of the school teachers regarding oral health was fair. Their knowledge regarding gum disease and its treatment options were poor. However, their knowledge regarding preventing dental caries was good. Their attitude towards maintenance of oral hygiene was also not commendable. Oral Health education must be imparted to preschool and primary school teachers as a part of the National Oral Health care Program on a regular basis and further studies must be done to assess their awareness levels and make the necessary changes in further education modules.
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