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 Vol 4 | Issue 2 | Apr - Jun 2017 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. REFERENCES 61 (64.2) 34 (35.8) 90 (94.7) 5 (5.3) 1. 2. 3. teachers. Pre-school teachers in the present study had inadequate knowledge regarding oral health. Sidra et al. [4] in their study conducted in Karachi reported of similar results where teachers had inadequate oral health knowledge. 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