Original Article
Doi: 10.32677/IJCH.2017.v04.i02.034
Oral health knowledge and oral hygiene practices of pre-school teachers in a
selected region of Kathmandu city
Parajeeta Dikshit1, Senchhema Limbu1, Sujaya Gupta2
From Departments of 1Pediatric Dentistry, 2Periodontology and Implantology, Kantipur Dental College Teaching Hospital and Research Centre,
Basundhara, Kathmandu, Nepal
Correspondence to: Dr. Parajeeta Dikshit, Department of Pediatric Dentistry, Kantipur Dental College Teaching Hospital and Research
Centre, Basundhara, Kathmandu, Nepal. Phone: 00977-9849695261. E-mail: parajeeta9@yahoo.com
Received – 28 February 2017
Initial Review – 28 March 2017
Published Online – 20 April 2017
ABSTRACT
Background: Dental caries and periodontal diseases are the most common oral health problems seen globally. Schools provides an
ideal environment for all forms of education, including oral health and teachers can be instrumental in imparting it. The teachers,
therefore, need to be well versed in the knowledge regarding oral health as well as practice good oral hygiene measures to teach the
children. Objectives: The objective of this study is to assess pre-school teachers’ oral health knowledge and oral hygiene practices
in a selected region of Kathmandu city. Methodology: An observational, descriptive cross-sectional study was conducted on preschool teachers in a selected region of Kathmandu city. The teachers of pre-school level completed a self-administered structured
questionnaire on knowledge of oral health and oral hygiene practices Result: The pre-school teachers had more knowledge about
dental caries than about periodontal diseases. Overall, scores of school teacher’s (n=95) oral health knowledge were inadequate
(54.7%) but the oral hygiene practices (69.5%) were found to be good. Conclusion: The pre-school teachers had inadequate oral
health knowledge but good oral hygiene practices. This shows a need for training and motivation of pre-school teachers’ regarding
the oral health education and promotion through school-based programs.
Key words: Dental caries, Oral health, Oral hygiene, Periodontal diseases, Pre-school teachers
T
he WHO, Global Data Bank (WHO 1995), shows that
children up to 12 years, in more than 15% of the countries
in the world have an average of 4.5 decayed, missing, or
filled teeth per child [1]. The WHO Information Series on School
Health states that more than 50 million hours annually are lost
from school due to oral diseases [2]. Similarly, Gift et al. [3]
noted in their study that 117,000 h of school were lost per 100,000
school age children due to oral health problems. Dental caries
and periodontal disease are among the most prevalent conditions
in human populations, other conditions such as trauma of teeth
and jaws, dental erosion, developmental enamel defects, and oral
cancer are also important [1].
Children spend more than half of their time in schools and
teachers play a pivotal role in the overall development of the
child academically, socially, and psychologically. The teachers
are the role models who motivate children toward healthy
lifestyle, including oral health care. The teachers are more skilled
in educational psychology than dentists [4-6]. The majority of
studies on dental caries prevention have indicated the teachers to
be the best educators for regular oral health education to school
children [7]. The significant amount of time spend in school
develops their lifetime beliefs and habits [5]. Hence, starting oral
health education at this age can have a lifetime influence on the
Vol 4 | Issue 2 | Apr - Jun 2017
oral health of children. To provide this education, it is essential
that the teachers have an adequate knowledge regarding oral
health themselves.
Many developing countries have introduced school-based
oral health education program to keep a tab on the increasing
burden of oral diseases because schools provide a conducive
environment for the oral health education activities. The WHO
instigated a Global School Health Proposal in 1995 giving
an emphasis on the importance school health education [4].
Studies have indicated satisfactory knowledge of teachers
regarding oral health in developed countries, but teachers in the
developing countries reported to have inappropriate knowledge
about oral health despite of having adequate educational
qualification [4].
In Nepal, school health activities are minimal and the only
activity seen is health camps organized by certain schools as
well as medical and dental institutions. The services of school
teachers in Nepal have not been utilized adequately in the
education of children regarding oral health. There is a need to
develop School oral health programs in Nepal. The present study,
therefore, aimed to assess the pre-school teacher’s oral health
knowledge and oral hygiene practices in a selected region of
Kathmandu city.
Indian J Child Health 260
Dikshit et al.
METHODOLOGY
Traumatic injuries to anterior teeth
Table 1: Demographic profile of the study population
Variable
An observational, descriptive, cross-sectional study was
conducted on pre-school teachers in schools in selected regions
of Kathmandu city from September 2016 to December 2016. The
study was conducted after getting approval from the Institutional
Research Committee. Permission to conduct the study was
obtained from the concerned school authorities. The sample
consisted of 100 teachers teaching pre-school level children, who
were selected from 15 randomly selected schools both private
and government. All teachers teaching in pre-school level were
included and teachers who exercise other functions and are not
directly working with students, including those who refused to
participate were excluded from the present study. Questionnaires
which were inadequately filled were also excluded from the study.
The components of the pro forma include demographic
information, questionnaire about oral health knowledge, attitude,
and practices. The questionnaire used was self-administered
structured questionnaire consisting of 22 close-ended questions,
adopted from Sidra et al. [4]. Knowledge scale was used in
measuring knowledge based on 15 items containing statements
about oral health knowledge related to dental plaque, dental
caries, and periodontal diseases. For every correct answer, score
1 was given and 0 for an incorrect answer. A score below 6 was
inadequate knowledge while that above 6 was considered as
adequate knowledge. Practice scale was based on 9 questions on
oral hygiene practices of teachers and delivery of oral hygiene
related knowledge among students and parents, and a score of
0-9 was poor practice and above 9 was good practice. The data
obtained was analyzed using SPSS version 20.
Frequency (n=95) (%)
Gender
Male
Female
Age range
19-30
31-40
41-50
Educational qualification
Intermediate
Bachelors
Masters
Others
Marital status
Married
Single
Experience in years
0-5
6-10
11-15
16-20
21-25
8 (8.4)
87 (91.6)
60 (63.2)
28 (29.5)
7 (7.4)
9 (9.5)
66 (69.5)
19 (20)
1 (1.1)
65 (68.4)
30 (31.6)
57 (60)
33 (34.7)
2 (2.1)
2 (2.1)
1 (1.1)
RESULTS
A total of 100 questionnaires were distributed to pre-school
teachers in a selected region of Kathmandu city, and only
95 could be adapted in the study. The sociodemographic details
are presented in Table 1. Out of 95 teachers, 87 were female, and
8 were male, and 68.4 were married. Nearly 63.5% teachers were
in the age group between 19 and 30 years. 69.5% teachers had
a bachelor’s degree, and 60% had 5 years or less experience in
teaching. The source of information about oral health for 34.7%
teachers was the dentist followed by television (27.4%) as shown
in Fig. 1.
When asked about dental plaque, 28.4% teachers knew that
it was soft debris on the teeth and 24.2% and 16.8% stated that
it caused inflammation of gums and dental caries, respectively,
(Table 2). Nearly, 42.1% did not know what plaque was and
further 37.9% did not know what it can lead to. On the questions
regarding dental caries, 78.9% responded positively about having
knowledge about dental caries. Regarding the cause of dental
caries, a higher frequency knew the causes to be plaque (54.7%),
poor oral hygiene (86.3%), sweetened food (77.9%), inadequate
brushing (66.3%), and excessive intake of soft drinks (46.3%).
Out of the 95 teachers, 54.7% did not have knowledge about
periodontal diseases. The majority responded that they did not
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Figure 1: Source of information on oral health
know the causes such as dental plaque and malaligned teeth could
cause periodontal disease (Table 2). 60% teachers knew that
improper tooth brushing was the cause for periodontal disease.
Nearly 54.7% teachers had inadequate knowledge regarding oral
health (Table 3).
Regarding the practice of oral hygiene, 74.7% had the habit of
brushing their teeth twice a day and 90.5% used toothpaste. 83.2%
rinsed their mouth after meal and a high frequency of teachers
reported of occasional sweet food intake (71.6%). Teachers
frequently discussed oral hygiene practices with students (89.5%)
and 94.7% encouraged the students to brush their teeth regularly
(Table 4). However, they discussed it only occasionally (47. 7%),
and 64.2% teachers discussed oral hygiene practices with the
parents as well. Nearly 69.5% teachers had good oral hygiene
practices (Table 3).
DISCUSSION
Over the years, oral health has evolved from being a narrow focus
on teeth and gums to identifying the mouth as a mirror of general
Indian J Child Health 261
Dikshit et al.
Traumatic injuries to anterior teeth
Table 2: Knowledge of teachers regarding oral health
Table 2: (Continued)
Variable
Variable
Plaque is
Soft debris on teeth
Staining of teeth
Hard debris on teeth
I don’t know
Plaque leads to
Inflammation of gums
Staining of teeth
Dental caries
I do not know
Knowledge of dental caries
Yes
No
Cause of tooth decay
Plaque
Yes
No
Don’t know
Poor oral hygiene
Yes
No
Don’t know
Sweetened food
Yes
No
Don’t know
Inadequate brushing
Yes
Know
Do not know
Excessive intake of soft drinks
Yes
No
Don’t know
Knowledge of periodontal diseases
Yes
No
Periodontal disease cause
Dental calculus (tartar)
Yes
No
Don’t know
Malaligned teeth
Yes
No
Do not know
Improper tooth brushing
Yes
No
Do not know
Frequency n (%)
27 (28.4)
15 (15.8)
13 (13.7)
40 (42.1)
23 (24.2)
20 (21.1)
16 (16.8)
36 (37.9)
75 (78.9)
20 (21.1)
52 (54.7)
7 (7.4)
36 (37.9)
34 (35.8)
20 (21.1)
41 (43.2)
35 (36.8)
14 (14.7)
46 (48.4)
Table 3: Oral health knowledge and oral hygiene practices scores
of school teachers
Variable
Total
score
Mean±SD
Frequency
n (%)
Frequency
n (%)
Knowledge
15
6.82±2.99
Practice
17
9.46±2.25
Adequate
knowledge
43 (45.3)
Good
practice
66 (69.5)
Inadequate
knowledge
52 (54.7)
Poor
practice
29 (30.5)
SD: Standard deviation
82 (86.3)
6 (6.3)
7 (7.4)
74 (77.9)
6 (6.3)
15 (15.8)
63 (66.3)
10 (10.5)
22 (23.2)
44 (46.3)
22 (23.2)
29 (30.5)
43 (45.3)
52 (54.7)
42 (44.2)
4 (4.2)
49 (51.6)
16 (16.8)
17 (17.9)
62 (65.3)
57 (60)
6 (6.3)
32 (33.7)
(Contd...)
Vol 4 | Issue 2 | Apr - Jun 2017
Frequency n (%)
Growing age
Yes
No
Do not know
Hard food stuff
Yes
No
Do not know
health and critical to overall well-being. Although effective
means are known for prevention and treatment of dental diseases
yet the oral health of children has not seen an improvement [8].
Primary school teachers have been utilized in many countries
as health education agents in response to a call by WHO for the
use of alternative health promoting personnel [9]. It is generally
acknowledged that kindergarten teachers have a role to play in
caring for pre-school children’s teeth, but their lack of knowledge
and awareness have been widely reported [10,11]. However, they
are more skilled in the teaching process and understanding the
child psychology as compared to dental professionals [6,12,13].
In the present study, teachers were in the age range from 19 to
50 years, and 63.2% were between 19 and 30 years. There was a
female predominance of 91.6% which was similar to many other
studies [4,14,15]. In a study conducted by Dawani et al. [5], all
respondents of pre-school level were female. It may be attributed
to the fact that at pre- school level female tutors are preferred as
shown in previous reports [14].
Although 28.5% teachers knew what plaque was the majority
did not have an idea about what plaque would lead to. The
majority of the teachers (78.9%) had knowledge about the causes
of dental caries. In regard to periodontal disease, 54.7% did not
have an idea about periodontal disease. Although many knew that
improper tooth brushing would lead to it, but most of the teachers
did not know that other causes such as dental calculus, malaligned
teeth, and hard food stuff can also lead to periodontal disease.
This was similar to findings by Sidra et al. where the teachers
knew the cause for dental caries but had less knowledge about
periodontal disease. The lack of awareness in teachers related to
gum disease has been mentioned in many studies [4,5,15-17].
There was no significant relationship of the knowledge or
practices with gender, years of experience, and education level of
Indian J Child Health 262
Dikshit et al.
Traumatic injuries to anterior teeth
Table 4: Oral hygiene practices in children
Variables
Frequency of brushing teeth
Once daily
Twice daily
More than twice daily
Tooth cleaning aid
Toothpaste
Datyun
Ayurvedic paste such as meswak
Tooth powder
Mouth rinse after meal
Always
Never
Sometimes
Frequency of sweet food intake
In every meal
Once a day
Sometimes
Oral hygiene practice discussion
with school children
Yes
No
Frequency of discussing oral hygiene
practices
Occasionally
Weekly
Monthly
Never
Reason of not discussing oral
hygiene practices
I discuss it
School admin does not allow
School children are not interested
No reason
Oral hygiene practice discussion
with parents
Yes
No
Encouraging tooth brushing regularly
Yes
No
Frequency n (%)
21 (22.1)
71 (74.7)
3 (3.2)
86 (90.5)
3 (3.2)
3 (3.2)
3 (3.2)
79 (83.2)
1 (1.1)
15 (15.8)
12 (12.6)
15 (15.8)
68 (71.6)
85 (89.5)
10 (10.5)
45 (47.7)
32 (33.7)
10 (10.5)
8 (8.4)
66 (69.5)
1 (1.1)
1 (1.1)
27 (28.4)
sugar intake. 89.5% teachers discussed oral hygiene practices
with children though majority discussed it only occasionally
and 64.2% even discussed it with parents. Similar findings were
affirmed by other studies [5,20]. However, Sidra et al. [4] reported
in contrast with higher frequency of teachers not discussing
oral hygiene with students or parents. Almost all the teachers
(94.7%) encouraged students to brush their teeth regularly. The
oral hygiene practices of teachers in the present study were good
(69.5%). This was similar to many studies [5,20] but again in
contrast to findings by Sidra et al. [4]. Fernando et al. [21] in Sri
Lanka conducted an intervention study to assess their influence on
oral health promotion in the school environment and concluded
that oral health promotion activities can be effectively instilled in
a pre-school environment by the education of teachers. This study
could be conducted only in a selected region of Kathmandu city.
It is suggested that similar studies involving a larger group can be
conducted in the future.
CONCLUSION
Pre-school teachers had good oral hygiene practices, and they
encouraged the students to adopt such practices. However, they
had inadequate knowledge regarding oral health which may be
enhanced by more educational programs related to oral health in
schools. There is a need for adoption school oral health programs
in Nepal to keep a tab on the developing burden of oral diseases
in children.
ACKNOWLEDGMENTS
We express our gratitude to all the staff of the Department of
Pediatric Dentistry and Management of Kantipur Dental College
for supporting us in the study. We also would like to thank all
the teachers who showed their enthusiasm in participating in the
present study.
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How to cite this article: Dikshit P, Limbu S, Gupta S. Oral health knowledge
and oral hygiene practices of pre-school teachers in a selected region of
Kathmandu city. Indian J Child Health. 2017; 4(2):260-264..
Indian J Child Health 264