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524 Journal of Indian Society of Periodontology - Vol 16, Issue 4, Oct-Dec 2012
Original Article
Address for
correspondence:
Dr. Nitika Jain,
Department of Periodontics
and Oral Implantology,
Vyas Dental College
and Hospital, Jodhpur,
Rajasthan, India.
E-mail: j_nitika@rediffmail.
com
Submission: 28-02-2011
Accepted: 14-09-2012
Department of
Periodontics and Oral
Implantology, Vyas
Dental College and
Hospital, Jodhpur,
Rajasthan, India
Oral hygiene-awareness and practice
among patients attending OPD at Vyas
Dental College and Hospital, Jodhpur
Nitika Jain, Dipika Mitra, K. P. Ashok, Jyothi Dundappa, Sweta Soni, Sameer Ahmed
Abstract:
Background: According to World Oral Health report 2003, the prevalence of periodontitis is 86% in India. Dental
care can sometimes be a forgotten part of a healthy life style. While its importance is often underestimated,
the need for regular dental care cannot be overstated. Oral health has been neglected for long in India. The
scarce literature on dental health awareness, attitude, oral health‑related habits and behavior among the adult
population in Rajasthan prompted us to assess the preventive oral health awareness and oral hygiene practices
in patients attending outpatient department of Vyas Dental College and Hospital (VDCH), Jodhpur through this
study. Materials and Methods: A total of 500 patients in the age group 15–50 years were selected using random
sampling technique. A self‑administered structured questionnaire including 16 multiple choice questions was
given to them. The results were analyzed using percentage. Results: The result of this study shows an acute
lack of oral hygiene awareness and limited knowledge of oral hygiene practices. In Jodhpur, few people use
tooth brush. Conclusions: Hence, there is an urgent need for comprehensive educational programs to promote
good oral health and impart education about correct oral hygiene practices.
Key words:
Motivation, oral hygiene practices, oral hygiene awareness
INTRODUCTION
India, sixth biggest country by area is the second
most populous country. Factors contributing
to the steady rise in prevalence of periodontal
disease include poor oral health awareness.
Annual health budget is 2% of Gross National
Product but no specic budget is earmarked for
oral health. Oral health knowledge is considered
to be an essential prerequisite for health-related
behavior.[1] Although only a weak association
exists between knowledge and behavior in
cross-sectional studies,[2,3] there are studies that
establish an association between knowledge and
better oral health.[4,5]
We keep reading about studies done to judge the
oral health and oral hygiene practices at so many
places scattered all across the globe. According to
the literature, no study has been done to assess the
oral hygiene awareness in Jodhpur till now, which,
is the second largest city in Rajasthan with an area
of 22,850 square km and population of 3,685,681.
This study was therefore initiated in VDCH with
a prime focus to determine the awareness levels
among the patients visiting VDCH, Jodhpur, from
Jodhpur’s urban and rural localities.
Aims and Objectives
1. To assess the oral health awareness among
people of Jodhpur, Rajasthan
2. To learn about their oral hygiene practices
3. To provide insight into educational programs
that have to be organized by health care
professionals.
MATERIALS AND METHODS
A cross-sectional study was conducted among
the patients attending the outpatient department
of VDCH, Jodhpur. This proposed study was
reviewed by the Institutional ethical committee
and clearance was obtained. Five hundred
patients were selected using a simple random
sampling technique. Informed consent was
obtained from each patient. A self-constructed
16-item close-ended questionnaire was
distributed to all subjects above 18 years of age
in English and was lled by a dental professional
for illiterate persons [Figure 1].
The questionnaire included information related
to the patient’s name, age, gender, occupation,
and residential area It was further categorized to
evaluate the knowledge, practices, and behavior
pattern related to oral health. After distribution
of questionnaire, 10 min were allotted for
completing the questionnaire. The completed
questionnaires were then analyzed statistically
to obtain the results in terms of percentages.
RESULTS
In the present study, questionnaire was
distributed to 500 patients who were selected
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DOI:
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Jain, et al.: Oral hygiene ‑ awareness and practice in Jodhpur
Journal of Indian Society of Periodontology - Vol 16, Issue 4, Oct-Dec 2012 525
Figure 1: Questionare
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Jain, et al.: Oral hygiene ‑ awareness and practice in Jodhpur
526 Journal of Indian Society of Periodontology - Vol 16, Issue 4, Oct-Dec 2012
Figure 2: Different types of cleaning methods other than tooth brushing
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Figure 5: Different types of brushing technique
randomly. Of the 500 participants, 54% were male and 46%
were female. Fifty-six percent of these participants were literate
and the remaining 44% were illiterate.
• Almost 58% of participants used tooth brush as a method
to clean their teeth
• In response to other methods of cleaning their teeth, 17%
were using salt with nger, 18% indicated use of neem
stick and 23% charcoal, 34% use tooth powder with nger,
whereas 8% of the subjects even resort to using brick
powder with nger [Figure 2]
• Forty-four percent people brush their teeth occasionally,
33% of them were brushing once a day, 23% were brushing
twice a day, and none of them brushed more than 2 times
a day [Figure 3]
• Approximately 50% of the participants were unaware about
the type of tooth brush used by them and only 10% of the
sample use soft tooth brush [Figure 4]
• Around 75% of the subjects brush their teeth in horizontal
direction, which is the most dangerous method of brushing
[Figure 5]
• None of the patients use dental oss
• Only 10% uses mouth wash [Figure 6]
• Although 40% noticed bleeding from gums, only 10%
among them want to get their teeth cleaned [Figure 6]
• Surprisingly enough, 50% of the population, visit dentist
only in pain [Figure 7]
• Only 20% of the sample cleans their tongue [Figure 8]
• Twenty-nine percent of study sample rinse their mouth
after eating a meal [Figure 8].
DISCUSSION
It has been observed that oral hygiene has mostly remained
as an ignored and unrealized major social problem. Majority
of the people are unaware about the relationship between oral
hygiene and systemic diseases or disorders. Most diseases
show their rst appearance through oral signs and symptoms
and they remain undiagnosed or untreated because of this
missing awareness.
According to the consumer usage and attitudes study done in
2010, among the most shocking of revelations is that nearly half
of the Indian population does not use a tooth brush and only
51% brushed their teeth using a tooth brush and toothpaste.[6]
Over the past 20 years a signicant amount of emphasis has
been made on prevention of diseases rather than the treatment
aspect. Healthy teeth can last us a lifetime with the proper
Figure 4: Types of tooth brush being used
20%
20%
10%
50%
Hard
Medium
Soft
No idea
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Jain, et al.: Oral hygiene ‑ awareness and practice in Jodhpur
Journal of Indian Society of Periodontology - Vol 16, Issue 4, Oct-Dec 2012 527
preventive dental care. Preventive oral health knowledge,
behavior, and its practice are the important ways of keeping
our teeth healthy. Hence, in this study attempts were made
to evaluate preventive oral health knowledge, practice, and
behavior of the population of Jodhpur.
Although brushing was the commonly used method of
cleaning, the percentage of subjects brushing their teeth twice
daily is 23% [Figure 3], which is very less as compared with
58% of the Police recruits in a study by Dilip,[7] 67% of the
Chinese urban adolescents in a study by Jiang et al,[8] 62% of
the Kuwaiti adults in a study by Al-Shammari et al,[9] and 50%
of the middle aged and 75% of the elderly Chinese adults in
urban areas in a study by Zhu et al.[10]
It is noteworthy that 75% of the respondents brushed their teeth
using traditional horizontal method, which will jeopardize the
tooth structure [Figure 5]. This nding is in agreement with
that of the study done by Zhu et al.[10] where 60% of the sample
did the same.
Only 10% of the subjects use soft brush, which is less than
that observed among Zhu et al.’s subjects[10] where 27% of the
sample uses the same.
Thirty percent change their toothbrush once in 3 months, and
surprisingly 60% change their brush only when it is useless
[Figures 4 and 9].
There is generally a failure in the use of dental oss as a
preventive tool. None of the subjects has used dental oss,
which is similar to a study conducted by Hanaa M. Jamjoom in
Saudi Arabia in 2001.[11] In contrast, Hamilton and Couby found
that a high percentage (44%) of the sample they studied in
Northeastern Ontario used dental oss.[5] Reason for this may be
the signicant resource allocation to health education programs
that are carried out in Canada. This emphasizes the urgent need
for educating and motivating the public to use this efcient
method for oral health care.
Only 20% of the studied population showed that they clean
their tongue either with tooth brush or tongue cleaner.
Also, only 29% of the sample population rinses their mouth
after eating food. This missing and very basic method of
maintaining oral hygiene is a clear indication of lack of
awareness.
Ten percent of subjects used a mouth wash [Figure 10].
Interestingly enough, they used it to treat malodor.
Furthermore, 80% reported halitosis [Figure 10]. This study is
in contrast with that of an epidemiologic survey of the general
Figure 7: Frequency of dental visit
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Figure 8: Percentage of people cleaning their tongue and using mouth wash
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Figure 6: Percentage of people noticed bleeding from gums and smell from mouth
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Figure 9: Percentage of people changing toothbrush
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Jain, et al.: Oral hygiene ‑ awareness and practice in Jodhpur
528 Journal of Indian Society of Periodontology - Vol 16, Issue 4, Oct-Dec 2012
population of Japan where 24% of the individuals examined
complained about bad breath.[12]
Forty percent of the total subjects reported bleeding gums.
This study is in agreement with studies of Gilbert et al.[13] and
Buhlin et al.[14] who showed that self-reported bleeding gums
was high in percentage. This study is in contrast with the
studies of Nagarajan and Pushpanjali in India,[15] Tervonen
and Knuttila,[16] and Kallio et al.[17] who showed that most of
the patients did not notice bleeding from gums.
Our study showed that 54% of the subjects visited a dentist
when they were in pain, which is similar to the study done
by Nabil Al-Beiruti, in 1997, where 69.5% of the participants
reported visiting a dentist only when they have pain.[18]
Unsurprisingly, standards of oral health are very poor in India,
with a large proportion of the population being affected due
to poor socio – economic conditions. In addition to this, two
thirds of people have never seen a dentist.
Missing awareness about the crucial role of regular dental
checkups in preventing and detecting dental diseases is another
gap in public education. As dentists, it is our responsibility to
educate and motivate people to visit a dentist.
CONCLUSION
The indifferent results of this study in Jodhpur are a critical
indicator of the task on hand, the task to spread awareness
among the masses about Oral Hygiene. The information on
developments in vital combination of Oral Hygiene, Oral
Diagnosis, and overall health needs to be spread by us, the
dentists. Establishing and demonstrating this connection will
be critical to achieve this goal and this process will have to
be taken at all levels including a denite beginning with our
patients.
We, as dentists, will have to keep reinforcing the importance of
correcting all aspects related with brushing and ossing along
with the importance of regular checkups.
The task of spreading this awareness extends beyond our
clinic to general masses and it will have to be achieved in a
similar way by various outreach programs and relevant public
health awareness measures through various mediums, such
as Print/Press Media, Audio/Radio/Television, Internet, and
Organizing Social Activities.
All of these and more innovative methods of reaching the
public will not only ensure a healthy individual but a healthy
society as well.
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How to cite this article: Jain N, Mitra D, Ashok KP, Dundappa J,
Soni S, Ahmed S. Oral hygiene-awareness and practice among
patients attending OPD at Vyas Dental College and Hospital,
Jodhpur. J Indian Soc Periodontol 2012;16:524-8.
Source of Support: Nil, Conict of Interest: None declared.
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Figure 10: Frequency of changing toothbrush
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