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75
© 2016 Journal of Indian Association of Public Health Dentistry | Published by Wolters Kluwer ‑ Medknow
Knowledge, attitude, and practices of oral hygiene among
college students in Bengaluru city
V. Gopikrishna, Nithin N. Bhaskar, Smitha B. Kulkarni, Jeswin Jacob, K. G. Sourabha
Department of Public Health Dentistry, Dayananda Sagar College of Dental Sciences, Bengaluru, Karnataka, India
Address for correspondence:
Dr. Nithin N. Bhaskar, Department of Public Health Dent istry, Dayananda S agar College of De ntal Sciences , Shavige Malleshwara Hill s,
Kumarsw amy Layout, Beng aluru ‑ 560 078 , Karnataka, Ind ia. E‑mail: drnithinbhaskar@gmail.com
ABSTRACT:
Introducon: Poor oral health can have a profound effect on the quality of life. The experience of pain, endurance of dental
abscesses, problems with eating and chewing, embarrassment about the shape of teeth or about missing, discolored or damaged
teeth can adversely affect people’s daily lives and well-being. Aim: To assess the knowledge, attitude, and practices of oral
hygiene among college students in Bengaluru city. Materials and Methods: A descriptive cross-sectional survey was conducted
using a self-administered 21-item structured questionnaire that assessed oral health and hygiene knowledge, attitudes, and
practices of 499 students from various professions. 202 engineering students, 99 MBA/BBM students, 99 nursing students,
and 99 students from B.Com. The study was conducted during June and July 2013. The results were analyzed by descriptive
statistics and Chi‑square test using SPSS version 14. All tests were set at a 0.05 signicance level. Results: The toothbrush with
toothpaste is the most common oral hygiene aid used for cleaning teeth, which was adopted by 304 (60.9%) students. More
than half 287 (57.5) of the students felt that dental caries affected their esthetics. 358 (71.7) students felt that the health of the
mouth and dentition had an impact on the health of the body. Conclusion: The toothbrush with toothpaste is the most common
oral hygiene aid used for cleaning teeth; it was observed that a greater number of students brushed their teeth in the morning.
Dental pain was the main reason to visit a dentist.
Key words:
Attitude, knowledge, oral hygiene, students
INTRODUCTION
Hygiene is a science concerned with the investigations
of environmental factors that affect human health. It
studies how the human body responds to them.[1] Dental
hygiene is the science and practice of the recognition,
treatment, and prevention of oral diseases. Good oral
hygiene is the foundation for a healthy mouth and
prevents 80% of all dental problems.[2]
Obeying the rules of proper oral hygiene is of primary
importance in the prevention of dental caries and
periodontal diseases. Unfortunately, oral hygiene practice
is very low in our society. A survey in India suggested
that there was an insufcient degree of education about
oral health and that many children in the country did
not even use a toothbrush, instead relied on traditional
methods to keep their teeth clean.
In a country like India, the awareness about the dental
disease and their impact on general health and the
need to safeguard oral health and hygiene should be
given utmost importance because of the increased
ORIGINAL ARTICLE
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DOI:
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How to cite this article: Gopikrishna V, Bhaskar NN, Kulkarni SB, Jacob J,
Sourabha KG. Knowledge, attitude, and practices of oral hygiene among
college students in Bengaluru city. J Indian Assoc Public Health Dent
2016;14:75-9.
[Downloaded free from http://www.jiaphd.org on Wednesday, September 28, 2016, IP: 90.65.23.170]
Gopikrishna, et al.: KAP of oral hygiene
76
Journal of Indian Association of Public Health Dentistry
Vol. 14, Issue 1, | January-March 2016
use of tobacco, improper eating habits and inefcient
maintenance of oral hygiene.
Professional students come across a great number of
people of different age groups from different backgrounds
in their day to day course of study hence with proper
knowledge and oral health behavior they can act as role
models for their family and community at large.
Thus, the aim of this study was to assess the knowledge,
attitude and practices of oral hygiene among college
students in Bengaluru city.
MATERIALS AND METHODS
A descriptive cross‑sectional survey was conducted
during June and July 2013. The sampling frame
consisted of 12,000 students of a college campus in
Bengaluru city. Cluster random sampling technique
was used to obtain the nal sample size. The inclusion
criteria for selection of subjects were from the current
engineering, MBA/BBM, B.Com and nursing students.
A pilot study was conducted on 50 students to assess
the feasibility and to estimate the sample size. Using the
formula for sample size determination as S = 4pq/n2. The
nal sample size was 499.
The study proposal was approved by the Institutional
Review Board. Standard procedures of informed consent
were used inclusive of anonymity and condentiality.
Questionnaires were given to the students during their
class hours and then collected within 15 min. The
questionnaire was a closed‑ended type consisting of
21 questions, of which 11 were knowledge based, 5 were
attitude based, and 5 were practice‑based questions. The
questionnaire contained multiple responses. The answers
to each question were numerically coded, and the data
were entered in the Statistical Package for Social Sciences
(SPSS) software 14.0 version (Chicago, SPSS Inc.). The
results were analyzed by descriptive statistics including
frequencies, percentages, and Chi‑square test. All tests
were set at a 0.05 signicance level.
RESULTS
In this study, 202 were engineering students,
99 MBA/BBM students, 99 nursing students and
99 students from B.Com. Preventive oral hygiene
behaviors were judged by the use and frequency of oral
hygiene aids such as tooth brushing, ossing and use
of mouthwash and toothpicks. The toothbrush with
toothpaste is the most common oral hygiene aid used
for cleaning teeth, which was adopted by 304 (60.9%)
students; of which 59.4% were engineering students,
53.5% MBA/BBM students, 54.5% nursing/pharmacy
students and 77.8% were B.Com students. Other students
used either dental oss (2.6%) or mouthwashes (4.6%)
along with toothbrush and toothpaste. It was observed
that 159 (31.8%) students were using all these methods.
There was a signicant difference in the oral hygiene
methods between the groups (P = 0.003) [Table 1].
Table 2 presents the answers to the question about
the frequency of toothbrushing. Statistical differences
among the students of engineering, MBA/BBM,
nursing/pharmacy and B.Com was found. It was
observed that 44.1%, 31.2%, 42.5%, and 46% students,
respectively brush their teeth in the morning; 49.5%
of students respectively brush their teeth both in the
morning and before bed.
Table 3 presents the answers concerning the frequency
of changing one’s toothbrush. Statistical differences
among the students of engineering, MBA/BBM,
nursing/pharmacy and B.Com in the frequencies of
Table 1: Oral hygiene methods used among study
groups
Answers Engineering
students,
n (%)
MBA/
BBM
students,
n (%)
Nursing/
pharmacy
students,
n (%)
B.Com
students,
n (%)
P
Tooth brush
and tooth pate
120 (59.4) 53 (53.5) 54 (54.5) 77 (77.8) 0.003
Dental oss 9 (4.5) 1 (1) 2 (2.0) 1 (1)
Mouth wash 11 (5.4) 6 (6.1) 2 (2.0) 4 (4.0)
All of the above 62 (30.7) 39 (39.4) 41 (41.5) 17 (17.2)
Total 202 (100) 99 (100) 99 (100) 99 (100)
Table 2: Frequency of brushing among study groups
Answers Engineering
students,
n (%)
MBA/
BBM
students,
n (%)
Nursing/
pharmacy
students,
n (%)
B.Com
students,
n (%)
P
At morning 89 (44.1) 31 (31.2) 42 (42.5) 46 (46.4) 1.15
Before bed 10 (5) 4 (4) 2 (2.0) 2 (2)
At morning
and before bed
95 (47) 63 (63.8) 54 (54.5) 49 (49.5)
Other times 8 (3.9) 1 (1) 1 (1) 2 (2)
Total 202 (100) 99 (100) 99 (100) 99 (100)
Table 3: Frequency of changing toothbrush among
study groups
Answers Engineering
students,
n (%)
MBA/
BBM
students,
n (%)
Nursing/
pharmacy
students,
n (%)
B.Com
students,
n (%)
P
Every month 89 (44.1) 55 (55.6) 38 (38.4) 49 (49.5) 0.10
Every 3 months 74 (36.6) 24 (24.2) 38 (38.4) 38 (38.4)
<6 months 21 (10.4) 12 (12.1) 10 (10.1) 8 (8.1)
Every 6 months 18 (8.9) 8 (8.1) 13 (13.1) 4 (4)
Total 202 (100) 99 (100) 99 (100) 99 (100)
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Gopikrishna, et al.: KAP of oral hygiene
77
Journal of Indian Association of Public Health Dentistry
Vol. 14, Issue 1, | January-March 2016
changing one’s toothbrush every month, every 3 months,
<6 months and every 6 months: 44.1%, 55.6%, 38.4%,
and 49.5% students respectively said that a toothbrush
should be changed every month; 36.6%, 24.2%, 38.4%,
and 38.4% students respectively said it should be
changed every 3 months.
It was observed that 73.3% engineering, 69.7% MBA/BBM,
74.8% nursing/pharmacy and 67.7% B.Com students felt
that the health of the mouth and dentition had an impact
on the health of the body (P = 0.03) [Table 4].
About 27.8% engineering, 21.2% MBA/BBM, 29.3%
nursing/pharmacy and 32.3% B.Com students felt
that gingivitis can be prevented by tooth brushing and
ossing. Many of them felt that gingivitis can be prevented
by taking in soft foods or Vitamin C. 228 (45.6%) students
answered that they did not know how to prevent
gingivitis. There was a signicant difference in their
knowledge (P = 0.03) [Table 5].
The visits to the dentist did not show any interesting
trends. A large number of students, 140 (28.05%) had
never been to a dentist, and 191 (38.7%) only went to a
dentist when in pain. Only 77 (15.43%) students observed
the recommended six‑twelve monthly dental visits. Again,
distribution of this indicator of oral hygiene attitude
within the two schools was equal as 39.1% of engineering,
42.4% MBA/BBM, 34.3% nursing/pharmacy and 36.4%
B.Com students visited the dentists only when driven by
pain. Similarly, 27.7% of engineering, 16.2% MBA/BBM,
37% nursing/pharmacy and 31% B.Com students had
never been to the dentist. This similarity in oral health
attitude was not signicant (P = 0.07) [Table 6].
Statistically significant differences were observed
among the students of engineering, MBA/BBM,
nursing/pharmacy and B.Com when they were
asked if they could decide on the treatment that they
require (P = 0.001) [Table 7] and when asked if it
was necessary for patients to decide their treatment
needs (P = 0.01) [Table 8].
This study showed that 87.1% engineering, 81.8%
MBA/BBM, 84.8% nursing/pharmacy and 75.6% B.Com
students felt that brushing the teeth will prevent dental
decay. The others answered that there would not be any
inuence (P = 0.16) [Table 9].
DISCUSSION
Knowledge and awareness studies on oral hygiene among
students have been primarily conducted among dental
college students with health sciences backgrounds.
Keeping in mind the expected role to be played by the
student community on the whole in effecting a behavioral
change in the society, a need is felt for assessing the oral
hygiene knowledge, attitude and behavior of professional
students with different educational backgrounds.
Table 4: Response of study groups to the question
“does health of the mouth and dentition impact the
health of the body”?
Answers Engineering
students,
n (%)
MBA/
BBM
students,
n (%)
Nursing/
pharmacy
students,
n (%)
B.Com
students,
n (%)
P
Yes 148 (73.3) 69 (69.7) 74 (74.8) 67 (67.7) 0.03
No 37 (18.3) 11 (11.1) 12 (12.1) 12 (12.1)
Don’t know 17 (8.4) 19 (19.2) 13 (13.1) 20 (20.2)
Total 202 (100) 99 (100) 99 (100) 99 (100)
Table 5: Response of study groups to the question
“methods to prevent gum diseases”
Answers Engineering
students,
n (%)
MBA/
BBM
students,
n (%)
Nursing/
pharmacy
students,
n (%)
B.Com
students,
n (%)
P
Brushing
and ossing
56 (27.8) 21 (21.2) 29 (29.3) 32 (32.3) 0.03
Soft food 9 (4.4) 8 (8.1) 9 (9.1) 7 (7.1)
Vitamin C 35 (17.3) 23 (23.2) 29 (29.3) 13 (13.1)
Don’t know 102 (50.5) 47 (47.5) 32 (32.3) 47 (47.5)
Total 202 (100) 99 (100) 99 (100) 99 (100)
Table 6: Frequency of visiting a dentist among study
groups
Answers Engineering
students,
n (%)
MBA/
BBM
students,
n (%)
Nursing/
pharmacy
students,
n (%)
B.Com
students,
n (%)
P
Regularly every
6‑12 months
32 (15.8) 20 (20.2) 15 (15.2) 10 (10.1) 0.07
Occasionally 35 (17.4) 21 (21.2) 13 (13.1) 22 (22.2)
When I have
dental pain
79 (39.1) 42 (42.4) 34 (34.3) 36 (36.4)
I never visited
a dentist
56 (27.7) 16 (16.2) 37 (37.4) 31 (31.3)
Total 202 (100) 99 (100) 99 (100) 99 (100)
Table 7: Response of study groups to the question “do
you think you can decide the treatment you need”?
Answers Engineering
students,
n (%)
MBA/
BBM
students,
n (%)
Nursing/
pharmacy
students,
n (%)
B.Com
students,
n (%)
P
Yes 83 (41.1) 45 (45.5) 40 (40.4) 67 (67.7) 0.001
No 119 (58.9) 54 (54.5) 59 (59.6) 32 (32.3)
Total 202 (100) 99 (100) 99 (100) 99 (100)
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Gopikrishna, et al.: KAP of oral hygiene
78
Journal of Indian Association of Public Health Dentistry
Vol. 14, Issue 1, | January-March 2016
In the study[3] which compared the oral hygiene practices
in dental and pharmacy students, it was found that
toothbrush with toothpaste was the most common oral
hygiene tool used for cleaning teeth by 423 (92%) students
while only 7 (1.6%) used traditional methods of miswak,
dandasa, rock salt, etc., only. Toothbrush and toothpaste
were the most commonly used oral hygiene aids, as that
reported elsewhere[4‑7] However, the use of dental oss
was still not very popular among the secondary school
students as evident in this study (11.5%). This was in
contrast with the nding in San Francisco where 75%
of the 12–14 years old students there used dental oss
at least once per day and in Iraq where over half of the
students used dental oss once or more a week.[4,8]
This study revealed all of the respondents were using
a toothbrush and toothpaste to clean their teeth. This
result reects on the homogeneity of the study group
with the current lifestyle (hostel, campus, and access to
dental care) inuences overpowering the varying cultural
backgrounds from which the students come. The use of
other recommended oral hygiene methods such as dental
oss and mouthwash was found to be rare; this also
could be attributed to the lack of oral health education
and/or the cost of such aids.
In a study,[9] 95.7% of the students brushed their
teeth at least twice a day, which was more than twice
the figure (44.4%) reported by WHO.[10] There were
95.7% of the students who brushed their teeth at least
twice or more per day, which was higher than Finnish
adolescents[11] girls were found to brush their teeth more
frequently, and spent longer time during toothbrushing
as compared to boys, supported by other studies[6,7,11‑14] A
study,[3] stated that 282 (61.3%) students brushed their
teeth twice or more times a day, 163 (35.4%) brushed at
least once a day while only 11 (2.4%) claimed to not brush
their teeth on a daily basis. In our study, most of the
students had satisfactory knowledge on tooth brushing
practices. It was encouraging to note that all participants
reported to brush their teeth at least once a day although
they did not know how to brush systematically.
In a study,[1] 71.8% students of dentistry (71.9% 2nd‑year
and 75.95% 5th‑year students), 61.49% students of
medicine (68.8% 2nd‑year and 47.1% 5th‑year students)
and 54.4% of students of polytechnics (49.5% 2nd‑year
and 61.3% 5th‑year students) change their toothbrush
every 3 months. Statistically significant differences
were found concerning the answer of changing one’s
toothbrush every month among the students of dentistry,
medicine, and polytechnics: 10.26%, 11.49% and
18.68% students, respectively (P = 0.041). In a study,[15]
a comparison of the two groups for the frequency of
renewal of toothbrush showed a statistically signicant
result with 32.5% respondents among the engineering
group changing their brush every month as compared to
13.3% among the medical group. Fraying was the most
common reason cited for the renewal of toothbrush in
both the groups. These results were in accordance with
the results of our study.
In a study,[16] most of the medical (80%), dental (96%)
and paramedical (85%) students considers oral
health as important as maintaining a good general
health (P < 0.001). This result was in accordance with
the results of our study as students felt that the health
of the mouth and dentition had an impact on the health
of the body. The study also showed that only a small
proportion of medical (20%), paramedical (12%), and
dental (34%) thought that visiting dentist was the right
way to prevent dental problems while a greater majority
held the belief that tooth brushing with paste was the
right option (P < 0.001).
A study,[17] showed that pain is the main driving factor for
patients to visit the dentist. Most of the study subjects in
this study reported irregular dental attendance, and this
nding is consistent with the ndings of other studies.
In this study, there was no difference in the frequency of
dental visits, and the most common reason for a dental
visit was cited to be pain. This may be due to the lack of
oral health knowledge among these students that caused
the frequency of visit low. Low dental visits may probably
due to low awareness of the importance of oral health
thus affects the student’s health seeking behavior.
CONCLUSION
The toothbrush with toothpaste is the most common
oral hygiene aid used for cleaning teeth; it was observed
that a greater number of students brushed their teeth
in the morning. Dental pain was the main reason to
visit a dentist. The majority of the students felt that
Table 8: Response of study groups to the question
“is it necessary for patients to decide their dental
treatment needs”?
Answers Engineering
students,
n (%)
MBA/
BBM
students,
n (%)
Nursing/
pharmacy
students,
n (%)
B.Com
students,
n (%)
P
Yes 128 (63.4) 79 (79.8) 70 (70.7) 76 (76.8) 0.01
No 74 (36.6) 20 (20.2) 29 (29.3) 23 (23.2)
Total 202 (100) 99 (100) 99 (100) 99 (100)
Table 9: Response of study groups to the question
“does brushing teeth prevent dental decay”?
Answers Engineering
students,
n (%)
MBA/
BBM
students,
n (%)
Nursing/
pharmacy
students,
n (%)
B.Com
students,
n (%)
P
Yes 176 (87.1) 81 (81.8) 84 (84.8) 75 (75.6) 0.16
No 26 (12.9) 18 (18.2) 15 (15.2) 24 (24.2)
Total 202 (100) 99 (100) 99 (100) 99 (100)
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Gopikrishna, et al.: KAP of oral hygiene
79
Journal of Indian Association of Public Health Dentistry
Vol. 14, Issue 1, | January-March 2016
patients should be given autonomy to decide their dental
treatment. Effective oral health education and promotion
programs are needed to improve oral health knowledge,
attitude, and practices of the students.
Financial support and sponsorship
Nil.
Conicts of interest
There are no conicts of interest.
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