ArticlePDF Available

A study of tooth brushing pattern and its effects on dental tissues in Obafemi Awolowo University students

Authors:

Abstract

Objective: To determine the tooth brushing patterns among Obafemi Awolowo University (OAU) students and the effects on dental tissues. Method: A convenient sampling technique was used to select 100 undergraduate students of the Obafemi Awolowo University. A self administered questionnaire designed to determine respondents' demographics and tooth brushing techniques was employed. Thereafter, dental examination was carried out on all respondents. Data was inputted and subjected to computer analysis using the Statistical package for social science version 17.0 (SPSS). Result: Majority (95%) of the respondents used toothbrush in cleaning their teeth while 7% combined toothbrush and chewing stick. Ninety nine percent of the respondents used toothpaste in cleaning their teeth, 72.7% of the respondents brushed their teeth once a day and 24.2% brushed twice a day. Fifty two percent of the respondents who brushed twice a day were females, while 48% were males. The pattern of tooth brushing was correct in 51.7% of the respondents as reported. Use of highly abrasive agents was also rare. Gingival recession was found in 31% of subjects (p=0.15) that employed hard texture toothbrush. The prevalence of non carious cervical lesion was 3% and these lesions were found in males only. Conclusion: The pattern of tooth brushing was correct in 51.7% of the respondents as reported. However the effect on dental tissues though present is not exaggerated when compared to other studies done in other parts of the world.
Abstract
Objective: To determine the tooth brushing patterns among Obafemi Awolowo University
(OAU) students and the effects on dental tissues.
Method: A convenient sampling technique was used to select 100 undergraduate students
of the Obafemi Awolowo University. A self administered questionnaire designed to
determine respondents' demographics and tooth brushing techniques was employed.
Thereafter, dental examination was carried out on all respondents. Data was inputted and
subjected to computer analysis using the Statistical package for social science version 11.0
(SPSS).
Result: Majority (95%) of the respondents used toothbrush in cleaning their teeth while 7%
combined toothbrush and chewing stick. Ninety nine percent of the respondents used
toothpaste in cleaning their teeth, 72.7% of the respondents brushed their teeth once a day
and 24.2% brushed twice a day. Fifty two percent of the respondents who brushed twice a
day were females, while 48% were males. The pattern of tooth brushing was correct in
51.7% of the respondents as reported. Use of highly abrasive agents was also rare. Gingival
recession was found in 31% of subjects (p=0.15) that employed hard texture toothbrush.
The prevalence of non carious cervical lesion was 3% and these lesions were found in males
only.
Conclusion: The pattern of tooth brushing was correct in 51.7% of the respondents as
reported. However the effect on dental tissues though present is not exaggerated when
compared to other studies done in other parts of the world.
Key words: Tooth brushing pattern, dental tissue, gingival recession, non carious
cervical lesion
Introduction
Tooth brushing is the act of using a brush of varying
design to brush the teeth and massage the gingivae
(1)
for cleanliness and oral health . Bacteria plaque is a
key player in the aetiology of dental caries, and
periodontal disease. Touching the social aspect of life,
proper tooth brushing reduces halitosis, and helps to
remove stains from tooth surfaces.
The toothbrush is an implement with bristles fixed to a
head at the end of a handle, used for cleaning the
(2)
teeth and massaging gingival tissues . Various
designs of the implement have emerged over time
(2)
with a bid to enhance functionality .
The American Dental Association recommends a soft-
bristle toothbrush for routine tooth brushing and that
a toothbrush should be changed at least once in three
month. Various patterns of tooth brushing techniques
have been reported. They include vertical, horizontal,
a combination of both vertical and horizontal or
rotational. Using an improper tooth brushing
technique with a hard-bristle toothbrush can be
detrimental to oral health. This could result in tooth
(3,4)
surface loss and gingival recession .
Tooth abrasion is the pathologic wearing of tooth
(2)
structure by an external mechanical source . It can
occur on any part of the tooth surface and structure.
Although clinically detectable, it may be symptomatic
or asymptomatic depending on the tooth structure
affected. Gingival recession on the other hand is
defined simply as the drawing back of gingivae from
the necks of the teeth, with exposure of root
(5)
surfaces . It may result from aggressive tooth
brushing, adult orthodontic movement of teeth,
sensitivity to detergent such as sodium lauryl
sulphate, bruxism, improper flossing and periodontal
(5)
disease . Its risk factors are; high level of dental
plaque and calculus, male gender, smoking duration,
toothbrushing frequency, traumatic toothbrushing
(6)
and high frenum . This study was designed to
determine the pattern of tooth brushing techniques
employed by selected undergraduates in Obafemi
Awolowo University (OAU) and also to determine the
effects of these brushing techniques and toothbrush
texture on dental tissues.
Materials and method
This study employed a descriptive design to evaluate
the pattern of tooth brushing and its effects on hard
dental tissues among undergraduates in Obafemi
Awolowo University (OAU) students. OAU, Ile-Ife is
located in south western Nigeria, comprises of
thirteen faculties. The study population comprised of
randomly selected undergraduates from all the
faculties.
A convenient sampling technique was used to select
100 students with no consideration for gender.
70
Nig Dent J Vol. 21 No. 2 July - Dec. 2013
Ejemai AE, *Oginni FO, ** Oginni AO
* Department of Oral Maxillofacial Surgery,
** Department of Restorative Dentistry,
Faculty of Dentistry, Obafemi Awolowo University,
Ile Ife, Osun State Nigeria.
Correspondence: Oginni FO
Email: torera5265@yahoo.com
A study of tooth brushing pattern and its effects on dental tissues in
Obafemi Awolowo University students
Having calibrated the examiner EE for reproducibility,
a structured self administered questionnaire was used
to col lect d ata from the r esp onden ts. The
questionnaire comprised of four sections:
Section A: Respondent's demographic data
Section B: The pattern of tooth brushing among OAU
students.
Section C: Perception of the effects of tooth brushing
on dental tissues.
Section D: Findings on examination of the dental
tissues. (Appendix 1)
Sections A to C of the questionnaires were completed
by subjects and retrieved immediately, then dental
examination was carried under optimal illumination
by an Author (EE) and findings recorded in section D.
Gingival recession was scored as present whenever
the free gingival margin was apical to the cemento-
enamel junction and root surface was exposed. Non
Carious Cervical Lesion (NCCL) was said to be present
when there is a change in contour (loss of enamel
surface characteristics), when there is a defect or
there is pulp exposure or there is secondary dentine
exposure in the cervical margin of the tooth. (Using
the 'Smith and Knight Tooth Wear Index', with severity
not considered). The teeth were numbered using the
World Dental Federation (FDI) notation. Data was
inputted into a personal computer and subjected to
computer analysis using the Statistical package for
social science version 17.0 (SPSS). The results were
presented graphically and in tabular forms. Chi square
test was applied appropriately and statistical
significance was inferred at p<0.05.
Result
One hundred subjects aged 16 to 29 years were
studied. A slight female preponderance was
observed (Table 1). Subjects' mean age (SD) was 21.9
(3.1) while their median age and modal ages were 22
and 18 years respectively. Close to half of
respondents (47%) were from the non-biological
sciences faculties while 35% were from biological
sciences and 18% from art based faculties.
Table 1: Socio-demographic characteristics
Of respondents
Age group Male Female Total
(Years) No(%) No(%) No(%)
16-20 7(7.0) 28.(28.0) 35(35.0)
21-25 28(28.0) 22(22.0) 50(50.0)
=25 12(12.0) 3(3.0) 15(15.0)
Total 47(47.0) 53(53.0) 100(100.0)
2
x = 18.4, df = 2, p = <0.001
Respondents were from 100 to 600 levels of studies
but majority were from the 200 and 300 levels and
the least representation was from the 600 level
(Figure 1).
The commonest single agent used was toothbrush
/toothpaste(toothbrush only) (85 %) while the
commonest combination was toothbrush/ toothpaste
and chewing stick (7%). Use of dental floss as a
cleaning aid was very unpopular (6.3%) (Table 2).
Table 2: Distribution and combination of tooth
cleaning material used by respondent
Tooth cleaning No. of (%)
materials respondent
Toothbrush 95 88.8
Chewing stick 7 6.5
Cotton wool 2 1.9
Others 3 2.8
Total 107 100.0
Tooth cleaning
materials as comb-
ined in use
Toothbrush only 85 85
Toothbrush and
chewing stick 7 7
Toothbrush and
others 3 3
Others 5 5
Total 100 100.0
Other aids used
Tooth paste 99 52.1
Tooth pick 46 24.2
Mouth wash 26 13.7
Dental floss 12 6.3
Abrasive powder 4 2.1
Charcoal 3 1.6
Total 190 100.0
NB: Totals exceeding 100 in table 2 above are due to use of
more than one material by some respondents.
Majority of respondents use smooth textured
toothpastes (78/99), while in the remainder, (21/99),
their toothpastes contained abrasives. Also, 73/99
respondents use a single brand of toothpaste (63
conventional and 10 herbal) while 12/26 respondents
employ various brands of conventional toothpastes
and 14/26 use conventional and herbal toothpastes
(Figure 2).
Most respondents (53.3%) used medium textured
toothbrushes and a significant majority (72.7%) brush
once a day while only 24.2% brush twice daily.
Frequency of tooth brushing and toothpaste
combinations did not differ significantly between
male and female respondents (Table 4).
71
Nig Dent J Vol. 21 No. 2 July - Dec. 2013 Ejemai, Oginni, Oginni
Effect of toothbrushing pattern on dental tissues
20
23 23
19
13
2
0
5
10
15
20
25
100 Leve l 200 Leve l 300 Level 400 Leve l 500 Level 600 Leve l
Perce ntages
Figure 1. Distribution of respondents by their levels
Majority of the respondents (62.9%) claimed to use
moderate force in brushing, only 3.1 % admitted to
using heavy force while 33% graded the force exerted
as light. The said force was assessed subjectively and
its measure depends on the respondent's perception
and personal grading. Since two respondents may
judge same force differently, this is a limitation of this
study.
60.2% of respondents spend over 2 minutes in tooth
brushing. About half of them (52.1%) laid claim to
brushing their teeth correctly (up and down strokes).
Expectedly, majority of the respondents were right
handed (94.9%), and an almost equal proportion
engaged their right hands in tooth brushing. 23.2% of
respondents reported injury to their gum during tooth
brushing. This was occasional in majority of the
subjects (63.2%) and a frequent occurrence in only
one respondent (2.6%). 80.9% of patients did not
perceive that they had defects on their teeth, but
19.1% did. Most subjects (58.8%) did not know why
they had the defects, others attributed their perceived
defects to toothbrush pressure (29.4%).
A total of 3,099 teeth were examined in 100 subjects.
62% of respondents had all their teeth present and the
rest had varying numbers of missing teeth. Non
carious cervical lesion and gingival recession were
found in 3 and 16 subjects respectively. A total of 11
teeth had non carious cervical lesion (prevalence
=0.35%) while 62 teeth were affected by gingival
recession (prevalence =2.0%). All NCCL were located
in the mandibular left quadrant in right handed
individuals.
Three am bi dextrou s i nd ividu al s iden ti fied
themselves as right handed in tooth brushing while
only one of them reported left handedness in tooth
brushing. Out of the 47 males and 53 females that
were examined, 11(23.4%) and 5(9.4%) had gingival
rec ession and/o r NCCL respectively. Si xteen
respondents used hard texture toothbrush, out of
which 5(31%) had gingival recession and/or NCCL and
8(15%) of the 53 respondents that used medium
texture toothbrush had gingival recession and/or
NCCL (Table 5).
Table 3: Frequency of toothbrushing and toothpaste
combination
Variables Gender
Males No(%) Females No (%)
Frequency of
Toothbrushing
Once a day 36(50%) 36(50%)
Twice a day 12(48%) 13(52%)
More than once a day 1 (50%) 1 (50%)
2
X =0.03, df = 2, p = 0.99
Table 4: Time spent in tooth brushing, brushing
technique and handedness
Time spent in brushing
(minutes) No(%)
Less than 2 minutes 39(39.8)
Between 2-3 minutes 38(38.8)
More than 3 minutes 21(21.4)
Total 98(100.0)
Toothbrush movement
Up and down strokes 74(51.7)
Side to side 53(37.1)
Circular 16(11.2)
Total 143(100.0)
Respondents’ handedness
Right handed 92(92.0)
Left handed 3(3.0)
Ambidextrous 5(5.0)
Total 100(100.0)
Hand used in brushing
Right hand 95(95.0)
Left hand 4(4.0)
Both hands 1(1.0)
Total 100(100)
NB: Two respondents did not indicate the time spent
in brushing hence total is 98. Combination of
movements engaged in tooth brushing accounted for
a total of 143 toothbrush movements recorded.
72
Nig Dent J Vol. 21 No. 2 July - Dec. 2013 Ejemai, Oginni, Oginni
Effect of toothbrushing pattern on dental tissues
0
5
10
15
20
25
30
35
Conventional Combination
Conventionals
Conventional &
Herbal
Herbal
Males Females
Figure 2. Distribution of toothpaste combination
used by respondents’ gender
Figure 3. Distribution of gingival recession and non
carious cervical lesion by tooth type
2
χ = 0.24 , df = 3, p= 0.97
No f teh affeceo ettd
0
2
4
6
8
10
12
14 13 11 21 22 23 31 32 33 44 43 42 41
Gingival recession Cervical Abrasion
Table 5: Effects of tooth brushing practices on dental tissues
Variables Gingival recession NCCL GR and or NCCL
Yes NO Yes NO Yes No
Brushing techniques NO(%) NO(%) NO(%) NO(%) NO(%) NO(%)
Side to side only 1(7.0) 13(93.0) 1(7.1) 13(93.0) 1(7.0) 13(93.0)
Up and down only 8(22.2) 28(77.8) 1(2.8) 35(97.2) 8(22.2) 28(77.8)
Circular/ round only 1 (17.0) 6 (83.0) 1 (14.0) 6 (86.0) 1(17.0) 6(83.0)
Combination of more-
than one technique 6 (16.0) 32 (84.0) 0 (0.0) 38 (100.0) 6(16.0) 32(84.0)
2
2
χ= 1.7 df= 3 p= 0.6 χ= 4.8 df= 3 p=0.2
Toothbrush texture
Soft 2 (8.3) 22(91.7) 0 (0.0) 24(100.0) 2(8.3) 22(91.7)
Medium 8 (15.0) 45 (85.0) 1 (1.9) 52(97.1) 8(15.0) 45(85.0)
Hard 5 (31.0) 11 (69.0) 2(12.5) 14(87.5) 5(31.0) 11(69.0)
Not sure 1 (17.0) 5 (83.0) 0 (0.0) 6 (100.0) 1(17.0) 5(83.0)
22
χ= 3.8 df= 3 p= 0.2 χ=6.06 df= 3 p= 0.1 p=0.28
force on brushing
Light 5 (15.6) 27(84.4) 1 (3.0) 31 (97.0) 5(15.6) 27(84.4)
Moderate 10 (16.0) 51 (84.0) 2 (3.0) 59 (97.0) 10(16.0) 51(84.0)
Heavy 0 (0.0) 3 (100.0) 0 (0.0) 3 (100.0) 0 (0.0) 3 (100.0)
I don't know 0 (0.0) 1 (100.0) 0 (0.0) 1 (100.0) 0 (0.0) 1 (100.0)
p=0.81 p=0.99 p=0.86
hand often used in
brushing
Right 14(15.2) 81(84.8) 3 (3.3) 89(96.7) 14(15.2) 81(84.8)
Left 2 (50.0) 2 (50.0) 0 (0.0) 4 (100.0) 2(50.0) 2(50.0)
Interchanging both 0 (0.0) 1 (100.0) 0 (0.0) 1 (100.0) 0 (0.0) 1 (100.0)
P=0.17 P=0.92 p=0.16
Gender
Male 11(23.4) 36(77.6) 3 (6.4) 44(93.6) 11(23.4) 36(77.6)
Female 5 (9.4) 48(90.6) 0 (0.0) 53 (100.0) 5(9.4) 48(90.6)
2
χ=3.6 p=0.057 P=0.062 p=0.14
Toothpaste texture
Smooth 13(16.7) 65(83.3) 2 (2.6) 76(97.4) 13(16.7) 65(83.3)
Smooth with small granules 2 (1.0) 18 (99.0) 1 (5.0) 19 (95.0) 2(1.0) 18(99.0)
Smooth with big granules 0 (0.0) 1 (100.0) 0 (0.0) 1 (100.0) 0 (0.0) 1 (100.0)
p=0.69 p=0.84 p=0.7
Frequency brushing
Once a day 13(18.1) 59(81.9) 1(1.4) 71(98.6) 13(18.1) 59(81.9)
Twice a day 2(8.3) 22(91.7%) 1(4.2%) 23(95.8) 2(8.3) 22(91.7)
More than twice a day 1(50.0) 1(50.0) 1(50.0) 1(50.0) 1(50.0) 1(50.0)
Others 0 (0.0) 1 (100.0 0 (0.0) 1 (100.0 0 (0.0) 1 (100.0
P=0.37 p=0.001 p=0.40
Duration of toothbrushing
Less than 2 minutes 4(10.3) 35(89.7) 0(0.0) 39(100.0) 4(10.3) 35(89.7)
Between 2-3 minutes 8(21.1) 30(78.9) 2(5.3) 36(94.7) 8(21.1) 30(78.9)
More than 3 minutes 4(19.0) 17(81.0) 1(4.8) 20(85.2) 4(19.0) 17(81.0)
P=0.41 P=0.36 p=0.50
Perceived tooth surface loss
Yes 2(11.8) 15(88.2) 0 (0.0) 17(100.0) 2(11.8) 15(88.2)
No 13(18.1) 59(81.9) 3(4.2) 69(95.8) 13(18.1) 59(81.9)
P=0.42 p=0.53 p=0.42
73
Nig Dent J Vol. 21 No. 2 July - Dec. 2013 Ejemai, Oginni, Oginni
Effect of toothbrushing pattern on dntal tissues
Discussion
Historically, diverse methods and aids have been
employed in maintaining oral health. The relationship
between tooth surface integrity and methods of teeth
cleaning have been reported in scientific literature.
While the aids employed in tooth cleaning can be said
to vary between socioeconomic classes, the
attendant effect(s) of such aids in Nigerian
undergraduates have not been reported to the best of
our knowledge.
One hundred subjects were selected by convenient
sampling and a slight female preponderance which
did not attain statistical significance was observed.
The peak age of subjects at 16-29 years is a clear
reflection of the pattern of the age of undergraduates
in Obafemi Awolowo University (one of the few
Universities that admit student less than 18 years in
Nigeria).
Also, the greatest percentage of the respondents are
in 200 and 300 levels, accounting for about 23% each,
with only 2% in 600 levels. Again this is a true
reflection of the pattern of students' population and
length of courses offered on the campus. While most
courses span four years, very few last five or six years.
Minority of our respondents were art students and a
majority from the non biological based sciences. This
distribution cannot be related directly to the
proportion of student population on the campus but
can be attributed to chance as a convenient sampling
technique was used.
As expected in an academic community, 95% of the
respondents used toothbrush in cleaning their teeth.
85% used toothbrush alone, while 12% combined
toothbrush with other tooth cleaning materials, with
toothbrush and chewing stick being the commonest
combination, accounting for 7%. This is in agreement
with the findings of Umesi-Koleoso, et al who
reported 96.3% toothbrush use and 4% combination
(7)
with chewing stick in Lagos State Nigeria. These
finding continue to corroborate the fact that chewing
sticks; the traditional cleaning aid among most
(8,9)
Nigerians has not gone into extinction . Its use
among Nigerian u ndergraduates lends mu ch
credence to its existence in the present and younger
generation.
The use of toothpaste from this study is popular
among undergraduates as reported in 97% of
respondents. A few decades ago, there were very few
brands of toothpastes available on the Nigerian
market. Events around the importation of goods into
the country have since given rise to a multiplied
variety of brands. Classified broadly as conventional
and herbal toothpastes, majority of undergraduates
use single brands of conventional toothpaste but over
a quarter of them use combinations. Only 10% use
herbal toothpastes, which are available but not very
popular in the market.
Th is is p robab ly becau se the co nventi onal
toothpastes are more readily available in the market in
this environment while a number of respondents may
not have developed enough confidence in the newly
erupting brands of herbal toothpastes. Others
possibly believe that herbal toothpastes should be
applicable to a particular oral condition.
Out of those that used combination of toothpaste
brands, 14% combined both herbal and conventional
toothpastes, and 12% combined various conventional
toothpastes, with the remaining 1% making up for
those that did not respond to the question.
Herbal toothpastes are said to be made from natural
ingredients. There is absolutely no difference in
consistency of these toothpastes when compared
with the conventional toothpastes. They are however
different in their flavour.
It was also observed that more females (58%) combine
conventional toothpastes. This is probably because
females are more meticulous about their health and
may not want to dabble into new products (herbal
toothpastes) easily.
The presence of granules and abrasive components
was elicited among 21% of respondents. Some of the
respondents, (20.2%) classified their toothpaste as
having small granules, and only 1% said they use
toothpaste with granules classified as big. We believe
that with the availability of diverse toothpaste types,
more studies need to be conducted on toothpaste
combination use and its effect in a wider population
(possibly national).
The frequency of toothbrushing was predominantly
once a day (72.7%) and a minority brushed twice a day.
A slight female preponderance was observed among
the few who brush twice a day. Our finding is at
variance with the pattern in Scottish population
reported by Oliverira et al where 71% of respondents
(10)
brushed twice a day . A significant proportion of
respondents (61.5%) who brushed twice a day were
females but only 52% were females in our study. The
differences in proportion could be interpreted as an
expression of a better oral hygiene practise among
Scottish respondents than Nigerians. This appears to
be more in female Scottish respondents than the
female Nigerian undergraduates studied.
Unlike a 90% of the respondents used the horizontal
(6)
“scrub” method reported by Poyato-Ferrera, et al,
(11)
2003 , we found a 51.7% use of up and down stroke
and a 37.1% horizontal scrub technique. The difference
observed may be attributed to the educational status
and possible consequent better oral health awareness
in an academic environment, compared with an urban
Spanish population. aged 18-30 years.
About 53.5% of the respondents used medium texture
toothb rush, while 16.2% used hard textured
toothbrush.
Most of the cases of gingival recession were
associated with the use of medium texture (15%) and
hard texture (31%) toothbrushes (p=0.15).
1.9% of respondents with non carious cervical lesion
used of medium texture toothbrush and 12.5% used
hard texture toothbrush. Despite the fact that
respondents' measure of force used was absolutely
subjective, and constitute a limitation, our finding is in
agreement with the study conducted by Brandini et
(4)
al, which concluded that the use of medium and hard
toothbrushes and greater force applied during tooth
brushing might contribute to the development and/or
(4)
aggravation of non carious cervical lesions .
Non carious cervical lesion in this study was found in a
74
Nig Dent J Vol. 21 No. 2 July - Dec. 2013 Ejemai, Oginni, Oginni
Effect of toothbrushing pattern on dental tissues
total 11teeth out of all the teeth examined and has a
prevalence of 3%, with all the cases seen in the male
respondents. In a related study conducted by Smith
WA et al, on patients with mean age 40.6 years in
(12)
Trinidad, they recorded a prevalence of 62.2% .
(4)
Also, Brandini et al, recorded a prevalence of 53%,
among students (males aged 23.6±1.8yeras and
females aged 22.3±2.4years) with males accounting
(4)
for 80% . The age difference between our group and
Smith's may be enough reason for the disparity
observed. It is not unlikely that additional factors like
dietary and oral habits may have compounded the
picture. The age group studied in this study compares
(4)
quite favourably with Bradini's but our findings
contrast sharply. We opine that our group is probably
better enlightened in tooth brushing technique and
use of safe cleansing aids. The use of toothpicks in
about a quarter of our respondents shows a
substantial knowledge gap with regards to the use of
toothpicks.
22.2% of respondents that used vertical brushing
technique (despite the use of smooth toothpaste) had
gingival recession. Hence the force exerted and
bristle strength may be implicated. Also, of the 3
respondents with non carious cervical lesion, 2 used
smooth toothpaste while 1 used smooth toothpaste
with small granules (p=0.602) while only 1 patient
each applied horizontal scrub technique, vertical and
circular motion in tooth brushing. This is at variance
(13)
with a study conducted by Bergstrom J. et al, in 1979
. They concluded that tooth brushing factors related to
the individual (brushing frequency and brushing
technique) exert a greater influence than material-
oriented tooth brushing factor such as dentifrice
(13)
abrasivity and bristle stiffness . We opine that our
sample size and age group studied may be
responsible for differences seen.
Less frequent tooth brushing means force over less
time and more time before damage manifests. It is
interesting to note that tooth surface loss was present
in the left quadrant only and in respondents that are
right handed. This is in line with the findings of Oginni
et al, which concluded that NCCL was commoner in
the left quadrant of right handed brushers, although
(14)
their result did not attain statistical significance .
The subject's perception of tooth surface loss was
correct only in 2 respondents. This was a very low
level of correctness. The need for routine dental check
up in detect ing, m anagi ng and preven ting
progression of these lesions is very important among
undergraduates.
Conclusion and Recommendations
Most of the students studied have toothbrushing
patterns which conform with the recommended
standard by the American Dental Association (ADA),
while some engaged in tooth brushing practices
which greatly deviates from this recommended
standard. This pattern could be as a result of poor oral
health awareness imbibed from various family
backgrounds.
Despite these varying patterns of tooth brushings, the
effects on dental tissues is not marked compared with
other studies conducted in other parts of the world,
with gingival recession having a prevalence of 16%
(affecting 2% of all the teeth examined) and non
carious cervical lesion as low as 3% (accounting for
0.35% of all the teeth examined).
A low prevalence at this age group might however give
way to a larger figure with time if bad brushing
techniques are sustained. Hence, these findings
notwithstanding, we advocate that effort should be
made to educate the students on proper brushing
te chniques pos si bl y a t the ori en ta ti on of
undergraduates.
Aspects requiring improvement are frequency of tooth
brushing, discouraging the use of harmful cleansing
aids like abrasives, and enlightenment on the use of
dental floss instead of toothpicks. Availability of
convenient and affordable dental f loss must
accompany such enlightenment talks if knowledge
acquired will be put to proper use.
References
nd
1. Mosby's Dental Dictionary, 2 edition. Elsevier,
Inc 200
th
2. Mosby's Medical Dictionary, 8 Edition. Elsevier,
Inc 2009.
3. Checchi L, Daprile G, Gatto MRA, Pelliccioni GA.
Gingival recession and toothbrushing in an
Italian School of Dentistry: a pilot study. J Clin
Periodontol 1999; 26:276-280.
4. Brandini DA, de Sousa, Trevisan CI, Pinelli LA, do
Couto Santos SC, Pedrini D, Panzarini SR.
No ncario us ce rv ic al lesio ns an d thei r
association with toothbrushing practices: invivo
eval uation. Oper De nt 2 011; 36:581-589.
5. Miller-Keane Encyclopedia and Dictionary of
Medicine, Nursing and Allied Health, by
Saunders. Seventh Edition. Elsevier, Inc 2003.
6. Toker H, Ozdemir H. Gingival recession:
epidemiology and risk indicators in a university
dental hospital in Turkey. Int J Dent Hyg 2009;
7:115-120.
7. Umesi-Koleoso DC, Ayanbadejo PO. Oral hygiene
p r a c t i c e s a m o n g a d o l e s c e n t s i n
Surulere, Lagos State, Nigeria. Nig Q J Hosp
Med 2007; 17:112-115.
8. Bukar A, Danfillo IS, Adeleke OA, Ogunbodede
EO. Traditional oral health practices among
Ka nur i women of Bo rno State, Nigeria .
Odontostomatol Trop 2004; 27:25-31.
9. Lawal FB, Taiwo JO, Oke GA. Oral health
practices of adult inhabitants of a traditional
community in Ibadan, Nigeria. Niger J Med
2013; 22:212-217.
10. Ces ar de Oliveira, Watt R , H am er M.
Toothbru shing, i nflammation, and risk of
cardiovascular disease: result from Scottish
Health Survey. Bri Med J 2010; 27: 340:c2451.
75
Nig Dent J Vol. 21 No. 2 July - Dec. 2013 Ejemai, Oginni, Oginni
Effect of toothbrushing pattern on dental tissues
Doi: 10.1136/bmj.c2451.
11. Poyato-Ferrera M, Segura-Egea JJ, Bullon-
Fernandez P. Comparison of modified Bass
technique with normal toothbrushing practices
for efficacy in supragingival plaque removal. Int J
Dent Hyg 2003;1:110-114.
12. Smith WA, Marcha n S, Rafeek RN . The
prevalence and severity of non-carious cervical
lesions in a group of patients attending a
university hospital in Trinidad. J Oral Rehabil
2008; 35:128-134.
13. Bergstom J, Levstedt S. An epidemiologic
approach to tooth brushing and dental abrasion.
Community Dent Oral Epidemiol 1979; 7: 57-64.
14. Oginni AO, Olusile AO, Udoye CI. Non-Carious
Cer vical lesion in a Nigerian population:
abrasion or abfraction. Int Dent J 2003; 53:275-
279.
APPENDIX 1
PATTERN OF TOOTH BRUSHING AND ITS EFFECTS
ON DENTAL TISSUES AMONG OBAFEMI
AWOLOWO UNIVERSITY STUDENTS.
SECTION A:
Age............Years........ Sex: Male ( ) Female ( )
Department/Faculty………. / …………
Level ………………
SECTION B:
1) What do you use in cleaning your teeth? (Tick all
applicable option or options).
Toothbrush ( ) Chewing stick ( ) Cotton wool ( )
Foam ( ) Finger ( ) Others ( )
2) What other aids do you or did you ever use in
cleaning your teeth? (Tick all applicable options).
Tooth pick ( ) Toothpaste ( ) Dental floss ( )
Mouthwash ( ) Dental probe ( ) Charcoal ( )
Abrasive powder ( ) Grinded broken plates
Others; specify…………………….
3) Wh at to ot hp as te do yo u us e? Giv e
name(s)………………………………………………………
4) Describe the texture of the toothpaste. Smooth
( ) smooth with small granules ( ) smooth with
big granules ( ) Others; specify…………………………..
5) What texture of tooth brush do you use? ( ) Soft
( ) Medium ( ) Hard ( ) Not sure / don't know
6) How often do you brush your teeth? ( ) Once a
day ( ) Twice a day ( )More than twice a day ( )
Alternate days Others (specify) ………………………
7) How long do you spend brushing your teeth at a
time? Less than 2 minutes ( ) Between 2 to 3
minutes ( ) More than 3 minutes ( )
Others (specify)……..........................
8) How do you move your tooth brush when
brushing? ( Pick more than one if appropriate) Up
and down ( ) Side to side ( ) Circularly/round ( )
Others; specify…………………………
9) Are you right handed ( ), left handed ( ) or
Ambidextrous (use both hands with equal ease
( )
10) Which hand do you use in brushing your t eeth ?
Right hand ( ) Left hand ( ) interchange both
hands ( )
11) Do you brush your teeth with force? ( ) Yes
( ) No
12) How would you grade the force you apply or
exert during tooth brushing.
Light ( ) Moderate ( ) Heavy ( ) I don't
know ( ).
SECTION C
13) Do you injure your gum when brushing? ( ) Yes
( ) No ( ) I don't think so
14) If yes, how often do you injure your gum? ( )
Always ( ) Occasionally ( ) Rarely
15) Have you noticed any groove or defect on the
front surface of your teeth near your gum?
( ) Yes ( ) No
16) If yes what is / are the cause(s)? …………………………..
SECTION D (Examination)
Teeth present
Teeth with gingival recession
Teeth with non carious cervical lesion
Other Remarks ………………………………………………………….
76
Nig Dent J Vol. 21 No. 2 July - Dec. 2013 Ejemai, Oginni, Oginni
Effect of toothbrushing pattern on dental tissues
... When used correctly, chewing sticks, a traditional cleaning aid in Nigeria [21] and other parts of the world [17] even among health care professionals [17] demonstrate beneficial effects on oral health. [22,23] Surprisingly, the frequency of chewing stick use among the residents in this study was higher than the 7% reported among 100 undergraduate students in the Nigerian study by Akhimie et al. [24] In their study, chewing stick was used in combination with toothbrush. The reason for the higher prevalence of chewing stick use among our study participants can be ascribed to their relatively older age since older persons may be more likely than younger persons to adhere to traditional practices. ...
... It would be interesting to assess their reasons for the choice of brushing techniques in future studies. On the other hand, the lower frequency of use of the horizontal (scrub) method by the doctors in our study (5.6%) compared to the higher frequency (37.1%) among the university undergraduates in Nigeria [24] may be attributed to the doctors' greater oral health knowledge and awareness of the association between the horizontal brushing method and gum recession and cervical abrasion. ...
... Our study found a higher frequency of persons who brushed twice daily compared to 24.2% of the university undergraduates in Nigeria. [24] On the contrary, it was lower than the 55.9% in an Indian study of dental professionals. [14] This poor oral hygiene practice will compromise effective plaque control and should be addressed among the resident doctors through proper oral health education. ...
Article
Full-text available
Background: Oral health is important for well‑being and chronic disease prevention. Physician’s confidence and willingness to counsel patients on lifestyle practices is related to their personal behavior. Limited data exists regarding oral self‑care practices among physicians in developing countries, as the majority seeks oral health advice and care from doctors rather than dentists. Aim: To determine the oral self‑care practices, dental attendance, and self‑perceived oral health status of internal medicine residents in Nigeria. Methods: A cross‑sectional study was conducted among internal medicine resident doctors attending an update course using a self‑administered structured questionnaire, which included oral care practices. Data were analyzed with SPSS version 21.0, P < 0.05 was significant. Results: The response rate was 82.0%. Data from 109 residents from the 6 geopolitical zones in Nigeria were analyzed. The mean age of the residents was 33.1 (4.0) years. 39.8% brushed twice a day, 20.2% used dental floss regularly, 10.1% used the roll technique for brushing and 30.3% of the doctors had never been to a dentist. However, 61.1% felt dental visits should be undertaken every 6 months and 57.8% strongly agreed/agreed that the state of their oral health was excellent. There was no difference in the oral hygiene practices by gender, designation or geopolitical zone of the residency program apart from dental flossing (female > male, P = 0.002). A higher proportion of junior compared to senior residents strongly agreed/agreed and strongly disagreed/disagreed that their oral health status was excellent (P = 0.026). Conclusion: The oral self‑care practices of these doctors involved in managing patients with medical conditions linked to oral health is inadequate. There is a need for better education on oral self‑care among physicians. Key words Dental attendance, internal medicine, Nigeria, oral health, oral self‑care
... This is similar to a study by Azodo et al among dental technologist and dental therapists in training which reported that 78.9% of the respondents used medium textured brush [28]. A study on the effect of toothbrushing patterns on dental tissues that was carried out amongst Obafemi Awolowo University students revealed that gingival recession was found in 31% of subjects that employed hard textured toothbrush [29]. ...
Article
Full-text available
Aims: To evaluate the academic stress and oral hygiene practices among students in health-related profession such as medicine and surgery, nursing, dentistry and pharmacy Study design: This study was a cross sectional survey done among students in health-related professions Place and duration of study: Faculties of Medicine and Surgery, Dentistry, Pharmacy and Nursing in College of Health Sciences, University of Port Harcourt between August and September, 2021. Methodology: Four hundred and twenty-two participants in health-related professions (dentistry, pharmacy, medicine and surgery and nursing) in the penultimate and final year who gave their consents were recruited for the study (266 females, 156 males; age range= 17-37 years). Self-administered questionnaires were used to collect data on demographics, perception of course Original Research Article Omotunde and Dorcas; AJDS, 5(1): 1-11, 2022; Article no.AJDS.78617 2 stress and oral hygiene practices. Data was analyzed using IBM SPSS (statistical package for the social sciences) version 25. Results: Sample size was 422 and response rate was 100%. P value was set at <0.05. About two-third of participants reported a high academic stress and said they spend between 9 and 15 hours daily on academic work (p=0.02). Majority of the respondents cleaned their teeth with toothbrush and fluoridated toothpaste. 56.4% of the participants brush twice daily, 49.3% change their toothbrush every 3 months and 18.7% change their toothbrush when it lost its efficiency. 84.8% of the respondents were aware of interdental Conclusion: The oral hygiene practice among the undergraduates was fair despite their high academic demands. There is however, still the need to motivate them for improved oral hygiene practice.
... Brushing twice daily, (before going to bed and after breakfast) has been reported to enhance oral hygiene [28]. In this study, three-fifth (60.3%) brushed twice daily; more males, greater number of consultants and more participants in federal hospital. ...
Article
Full-text available
Maintenance of good oral hygiene practice is the key to having a good oral health and invariably, an improved quality of life. Consecutive consenting medical practitioners attending the 2019 National Medical Association Annual General Meeting were recruited for this study. Data was analyzed using the Statistical Package for Social Sciences version 20.0 (IBM SPSS Statistics Armonk New York). One hundred and fifty-six participants were recruited. Ninety-four (60.3%) were male and 62(39.7%) females. Age ranged between 23 and 72 years with a mean age of 41.6±11.18 years. Almost all participants cleaned their teeth with toothbrush and fluoridated toothpaste. More males, more consultants and more participants in the federal hospital brushed their teeth twice daily and used medium bristled toothbrushes. Equal number of males and females used dental floss and interdental brushes. More consultants than all other cadre of participants and more participants in the federal hospital used dental floss (p=0.02). More participants in the federal hospital visited the dentist in the past (p=0.05); however, more males and more consultants did not have time to visit. Twice the participants with six to ten years of practice compared to those with more than fifteen years of practice did not access dental service because they felt they had no dental problem (p=0.248). The longer the year of medical practice, the better the oral hygiene practice. One out of every 5 participants regularly visit the dentists; a consultant will likely visit more regularly than other designated participants.
... A study of tooth brushing trends in 20 countries in Europe and North America from 1994 to 2010 revealed that a largely positive trend was brushing twice daily was observed across all the countries studied with the younger age groups showing more potential of oral hygiene improvement from oral health education (Honkala et al., 2015). Local studies on brushing techniques have been majorly descriptive, Oginni et al (2013) in a study amongst Obafemi Awolowo University Undergraduates, reported 73% of the respondents brush only once daily. The study further reported 52%, 37% and 11% of respondents used vertical (up and down), horizontal (side by side) and circular brushing techniques respectively. ...
Article
Full-text available
The Modified Bass Technique (MBT) of tooth brushing is the most effective in plaque removal compared to some other reported techniques like Fones, Scrub, Charters and Stillman. We hypothesize that there will be a greater plaque reduction using the MBT as compared to the other reported techniques. The aim of this study therefore is to determine the effectiveness of the MBT compared to other tooth brushing techniques in plaque control. A 28 day clinical trial amongst 50 preclinical dental students was done. Participants were randomized into two groups, MBT group and other preferred tooth-brushing methods group. Data was collected using a self-administered semi-structured questionnaire on sociodemographic, oral health habits and knowledge on brushing techniques. The oral examinations were done by two calibrated examiners. Simplified Oral Hygiene Index (OHI-S), percentage plaque score and gingival bleeding score were recorded. The examiners and data analyst were blinded and data analysis was done using Paired T test with statistical significance of p< 0.05. Significant reduction was found in facial and interproximal plaque scores for both groups but more in the MBT group. There was significant reduction in gingival bleeding on probing in the MBT group after seven days while this was not significant in the other group (p>0.05). However, after 28 days, there was significant reduction in bleeding on probing in both groups. Within the limitations of this study, we found the Modified Bass Technique of tooth brushing to be more effective in plaque control compared to other brushing techniques..
ResearchGate has not been able to resolve any references for this publication.