THE ORAL HEALTH STATUS AMONG PRIMARY SCHOOL PUPILS IN

IGABI LOCAL GOVERNMENT KADUNA STATE

CHAPTER ONE

1.0 INTRODUCTION

This chapter deals with the background to the study, statement of the problem,
purpose of the study, objectives of the study, research questions, significance of the
study, scope and limitations of the study and operational definition of terms.

Oral hygiene measures in childhood lead to healthy teeth and oral mucosa,
providing optimal general health conditions. Oral diseases are depicted as a major
public health challenge, especially in school children. A total of 90% of them are
suffering from Oral caries, with increasing incidences in Asian and Latin American
countries as reported by the Global Burden of Disease (GBD) in its 2005 report.
The prevalence of tooth decay in school children ranged between 60 and 90%. The
incidence of caries is rising rapidly in developing countries (Ab-Murat et al.,
2006).

Oral caries because of its ubiquitous nature remains one of the most prevalent
afflictions of mankind. It continues to be a major public health problem
predominantly affecting children in spite of its preventable nature and creditable
scientific advances in its treatment modalities. It is cumulative process which if not
intervened in the incipient stages ultimately leads to tooth loss. It is also the most
common oral disease responsible for the absenteeism from schools and loss of
working hours. Children who suffer from poor oral health are 12 times more likely
to have more restricted activity days including missing school than those who do
not (Elizabeth and Mitchelle, 2005).

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Children are very important part of a country’s demography and their health
influences the future of nation. Schools are microcosms of the larger community
and provide the ideal setting for integrated health promotion (Ekeh, 2003).

School age is regarded as the phase of child hood du-ring which a child
acquires the knowledge of the norms and values of a society and emerges as a
contributing member to the community. Hence it is an influential stage in people’s
life when lifelong sustainable oral health related behaviors, beliefs and attitudes
can be established with longer lasting impact. Moreover, the messages can be
reinforced throughout the school years (Elizabeth and Mitchelle, 2005).

At the age of 12 years permanent teeth (except 3rd molars) would have erupted and
by 15 years age these teeth are exposed to the oral environment for almost 3 years.
WHO has recommends both these ages as the index ages for oral health assessment
(Adekoya et al., 2006).

There is plethora of literature available on prevalence of Oral caries and

periodontal conditions in various population groups in different parts of our
country. However, there is scant information on the oral health status including
Oral caries and periodontal disease prevalence among school children in various
district of Kaduna. The education of school-age children in oral health is crucial
because healthy oral habits occur at a young age. The importance of teaching
children (infants, preschoolers, or schoolchildren) about oral hygiene was
recognised as early as 1878. Schools are an optimal location for providing oral
health education, as these services can be given similarly and widely to all
children, especially those who do not have access to other health resources and
cannot receive professional Oral care (Asika, 2000).

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One of the critical issues in oral health is the treatment of Oral injuries. Children
participate in sports activities at school and in cases of close contact or physical
activity, injuries may occur due to reasons such as falls or accidents. In these
trauma cases, successful management of the process from the moment of the event
to the visit to the dentist significantly increases the chances of successful post-
trauma treatments. The good management of this process depends on the teacher’s
level of knowledge. Correct guidance of the child and their parents can give the
dentist a chance for early intervention. A teacher needs to know what to do in an
emergency regarding primary and permanent teeth. Oral trauma in industrialized
countries ranges from 16 to 40% for six-year-olds and 4 to 33% for 12- to 14-year-
olds; in some Latin American countries, it is about 15% of schoolchildren; in the
Middle East, it is about 5 to 12% among 6 to 12-year-olds. Many studies have
shown that getting support from teachers is successful in improving the oral health
of school children (Al-Ansari et al., 2006).

However, according to some reports, teachers were hesitant to participate in

oral health programs that require supervision. The reason for this is thought to be
due to the teachers’ lack of knowledge on oral health. Since schoolteachers are
models for school students, their oral health knowledge must be good, and their
oral health behaviours and attitudes must follow professional advice. For this
reason, their knowledge and attitudes about oral health are important both for their
oral health and for the children they influence and teach as a model. Oral health is
an integral part of overall health and well-being. Individuals with a healthy mouth
live without pain, discomfort, and embarrassment while talking, eating, and
socializing. One study showed that school-age adolescents suffering from poor oral
health were 12 times more often deprived of activities compared to their peers.
More than 50 million school classes are lost worldwide due to poor oral health.

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This can affect the student’s school performance and subsequent success in his life.
Ideally, primary schoolteachers can give information about good oral health, Oral
and gum care, proper oral hygiene, use of fluoride, proper dietary advice, and the
benefit of routine Oral visits. The goal of oral health education is to improve
knowledge within the target population, leading them to be individuals with better
oral health and to adopt positive oral health behaviours (Asika, 2000).

Recent studies revealed that oral-health promotion programs have a

significant effect in improving Oral health status and reducing the cost of
healthcare systems. Therefore, oral-health promotion programs revealed their
effects on children’s oral health and on parental Oral treatment expenses.
Education in and through the media had an increasing tendency that can be seen in
most health-promoting media literacy classes being taught in schools. In order to
prevent the spread of infectious diseases, health personnel are advised to use
audiovisual media to educate the population about health. Mass media campaigns
tend to be helpful in influencing beliefs of the general public and healthcare
practitioners by increasing the alignment between beliefs and current evidence and
promoting self-management concepts (Al-Ansari et al., 2006).

1.2 BACKGROUND OF THE STUDY

The United Nations (UN) gathering of 189 heads of states held in September 2000
resolved and declared the eight Millennium Development Goals (MDGs) to be met
by 2015 (UN, 2012). The MDG number two aims at providing universal free basic
education to all children with equality. Three of the goals focus on health matters.
Goal number four, five and six address child health, maternal health and combating
HIV/AIDS, malaria and other diseases respectively. Most of the diseases and

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illnesses have oral health (OH) implications or are oral in nature which forms the
link to this study.

Although Oral Health problems on their own do not seem to be life threatening,
their high prevalence and the general discomfort they cause negatively affects
overall quality of life. In developing countries e.g Nigeria, the under privileged and
rural communities are the most affected. According to the Surgeon General’s
Report (2011) on ‘improving oral health the mouth is a mirror that reflects general
health or disease status of a person. The report says that oral tissue may signal
presence of disease and its progression. Further, the mouth can be a window for
diagnosis, treatment and exposure to risks. Similarly, Pau (2012) adds that the
mouth is a portal of entry for infections that affect local tissues before spreading to
other parts of the body. Precisely, oral health is integral to general health and
should be studied keenly among populations (Al-Ansari et al., 2006).

According to Kickbusch and Buse (2000), socio-economic and socio-

cultural impacts of preventable diseases affect health of 15% of the World’s
population with disability (WHO, 2012). Some of the disabilities arise from birth
defects, chronic diseases or injuries (WHO/FAO, 2004). Studies have shown that if
health care needs of people with disabilities (PWDs) are not serviced, they end up
with poorer health and often miss education (Yeo, 2001).

Besides, UNICEF (2005) and WHO (2012) confirms that PWDs need more
social and health care services (screening, counselling, social support, treatment
and rehabilitation) than their able-bodied counterparts (Mishra, 2008). Hence,
Article 25 of the UN Convention on Rights of the Child (UN CRC, 2009)
advocates for free access to health and education without discrimination against
PWDs (Ab-Murat et al., 2006).

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 In Africa, statistics on disease burden show that 71.1% of people suffer from
communicable diseases, 21% from non-communicable diseases and the remaining
7.9% suffer due to injuries hence the United Nations (UN) push to halve disease
prevalence rates by 2015. Although data about health of able-bodied persons exist,
little seems to be known about disease burden and patterns among PWDs in the
sub-Saharan Africa. According to WHO (2012), this is due to their poor access to
education and health services which if unattended will continue affecting their
general health. Further, Harris, Nicolle, Adair & Pine (2004) specifically points at
the fewer studies on oral health practices and oral health status of the
underprivileged in Africa.

In Nigeria, some of the challenges facing oral health care include, poor distribution
of oral health facilities (Kaimenyi, 2004), lack of equipment and qualified oral
health personnel. Studies by WHO (2003) have shown that vulnerability of PWDs
and challenges in conducting daily oral care activities like teeth brushing expose
them to oral diseases. The most affected category of PWDs faced with these
challenges is the physically challenged pupils (PCPs). They need oral health care
assistance due to their activity limitations and participation restrictions that
Tomlinson, Swartz, Allana, Kit, Igor and Shekhar, (2012) term social constructs. In
some communities the PCPs are kept behind scenes (Solarin-Lawal, 2012) to
conceal their disabilities. Such practices violates the rights of PCPs to access free
primary education (FPE), health education and good oral health at home, school or
in the community.

Studies on the relationship between education and health revealed that; people with
high level of education have lower morbidity to common illnesses than those with
low levels of education. The state of a person’s physical health influences their
educational attainment and income, while the WHO (2008) stated that, a direct

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correlation exists between high income and better health. In 2011, the WHO
reported that disability rate in Nigeria was 19% higher among groups with lower
educational attainment compared to 11% among the highly educated. Hence, the
emerging reality is, because more PWDs achieve low education, their income is
low and their morbidity to diseases is high. Health education (HE) taught as a unit
in primary science subject from class one to eight in Nigeria befits an oral health
care intervention. The HE contents include care of teeth, problems related to teeth,
requirements for maintaining strong teeth, functions of teeth (K.I.E., 2009a) among
others (Freund, Graybill, & Keith, 2005).

1.3 STATEMENT OF THE PROBLEM

Oral disease has been an attributes to many factors among children in developing
country of the world including Nigeria. Oral diseases are one of the most prevalent
conditions in the world and are largely preventable for example; Oral caries affects
60-90% of school children and most adults in industrialized countries. There is
increasing prevalence of oral diseases in developing countries with higher ratios
among people with disabilities. One of the major problems is lack of knowledge of
Oral health care. Lack of oral hygiene practices has been identified as a possible
predisposing factor for occurrence of Oral caries. Children generally engage in
unhealthy habits that can cause Oral problems like failing to brush, nibbling of
sweets and consumption of sugary snacks. All these can cause acid formation
which eats away the tooth enamel. The general health of children who suffer Oral
disease is put further at risk and because of this risk to health; their Oral care is of
vital importance. It is therefore paramount to instill proper oral hygiene habit early
in school children in order to prevent Oral ills and promote healthy teeth growth.

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 Despite marked improvements in healthcare over the past century in Nigeria,
serious challenges remain in oral health; According to Bharathi and Singh (2012)
oral health statuses of children with disabilities are generally poorer as compared
to children without disabilities. In India they recommended enhanced preventive
school based Oral health education. In Nigeria, the equivalent of Oral health
education is Health education which is integrated in the Primary science Syllabus.
The Oral health contents of Health education like regular tooth brushing can
inevitably enhance self-efficacy in oral health practices among the Physically
Challenged Pupils. The remaining challenges in Oral health among Physically
Challenged Pupils arise from the pupils self debilitations which compound their
activity limitations and participation restrictions leading to acquisition of
knowledge without putting into practice. In order to prevent the spread of
infectious diseases and to also access the the impact of oral health status among
primary school pupils in Igabi local government Kaduna state

1.4 AIMS AND OBJECTIVES

AIM

The aims of this study are;

i. To access the impact of oral health Status Among Primary School Pupils In
Igabi Local Government Kaduna State

Objectives of the Study

The specific objectives of the study were to;

i. To establish the contributions of health education to oral health practices

among the pupils in primary Schools in Igabi Local government, Kaduna
State.

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 ii. Determine the oral health practices among pupils in Primary Schools in
Igabi Local government, Kaduna State.
iii. To establish the contributions of health education contents to oral health
practices among pupils in Primary Schools in Kaduna State.
iv. Determine the oral health challenges faced by pupils in Primary Schools in
Igabi Local government, Kaduna State.
v. Determine health education strategies used in the Primary Schools to address
challenges in oral health practice among pupils in Igabi Local government,
Kaduna State.

1.5 RESEARCH QUESTIONS

The research was guided by the following questions:

i. What are the impacts of oral health Status among Primary School Pupils in
Igabi Local Government Kaduna State?
ii. What are the contributions of health education to oral health practices among
the pupils in primary Schools in Igabi Local government, Kaduna State?
iii. What are the oral health practices among pupils in Primary Schools in Igabi
Local government, Kaduna State?
iv. Are there any contributions of health education contents to oral health
practices among pupils in Primary Schools in Kaduna State?
v. What are the oral health challenges faced by pupils in Primary Schools in
Igabi Local government, Kaduna State?
vi. Are there any health education strategies used in the Primary Schools to
address challenges in oral health practice among pupils in Igabi Local
government, Kaduna State?

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1.6 SCOPE AND LIMITATION OF THE STUDY

This project focus on assessing the effect of the oral health status among primary
school pupils in Igabi Local Government Kaduna State, Only pupils in primary 3-6
were used for the study. These age groups are considered to have acquired health
education knowledge capable of influencing behaviour in various ways. Both male
and female primary school children were used for this study.

1.7 LIMITATION OF THE STUDY

The limitation of this study was the inability of some pupils in the lower classes to
read and comprehend what was contained in the questionnaire. However, the
researcher and the school teachers (research assistants) helped in overcoming this
challenge by explaining and interpreting the content of the questionnaire in the
language they could understand best.

1.8 SIGNIFICANCE OF THE STUDY

The study which assessed the assessing the effect of the oral health status among
primary school pupils in Igabi Local Government Kaduna State is significant in the
following ways.

i. Generate useful information for stakeholders in education about weaknesses

and strengths of the health education interventions to Oral health practices
among primary school pupils. This may help to improve the Health
education contents in the curriculum in order to address oral health
challenges faced by in life.
ii. It will be Benefit to parents and guardians to refine their responsibilities and
oral health care services based on identified weaknesses or strengths to

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 improve ways of encountering challenges facing children with physical
disabilities in oral health practice.
iii. The result of this study will elicit information that would educate primary
school pupils within Igabi Local government on the importance of oral
health care and will also help them to cultivate healthy oral health practice
thus reducing the cases of Oral diseases among primary school pupils in
Kaduna State.
iv. The result of this study will help primary school teachers to improve on their
effort in the teaching of Oral health education in schools.

1.9 OPERATIONAL DEFINITION OF TERMS

Health Education: This refers to the content, strategies and learning experiences
from the primary school syllabus Volume II which is taught in Nigeria to improve
health behaviour of primary school pupils.

Oral Care: In this study refers to taking care of the inner part of the mouth to keep
the gums and teeth healthy.

Care Givers: This refers to people employed in special schools to provide

assistive healthcare services like physiotherapy, nursing care, housekeeping,
feeding, cleaning, and mobility support services.

Oral Health: Refers to the state of health where one is free from chronic mouth
and facial pains, oral sores and bad breath.

Oral Health Practices: In this study refers to activities that lead to cleanliness of
the mouth like regular teeth brushing, flossing, eating well, and visits to the dentist.

Oral Hygiene: This refers to oral care activities that lead to cleanliness of the
mouth.

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Primary Schools: In this study refer to primary schools where student study from
primary 1-6.

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 CHAPTER TWO

REVIEW OF RELATED LITERATURE

2.0 INTRODUCTION

This chapter presents the review of critical literature about the contributions
of Oral health, Health education to oral health practices among primary school
pupils. The literature sheds light on the following aspects; oral health practices,
health education and oral health practices, challenges in oral health practices and
strategies to address the oral health challenges faced by primary school pupils in
Nigeria.

Thus, this chapter undertakes a review of literature related to the study and it is
therefore discussed under the following subheadings.

2.2. Concept and overview of Oral Health

2.3 Health Education and Oral Health practices

2.4 Challenges in Oral Health Practice

2.5 Strategies to address Oral Health Challenges

2.6 Important knowledge of Oral Health care

2.7 Nutrition and Healthy teeth

2.8 Summary

2.2 CONCEPT AND OVERVIEW OF ORAL HEALTH

The majority of oral health conditions are: Oral caries (tooth decay), periodontal
diseases, oral cancers, oral manifestations of HIV, oro-Oral trauma, cleft lip and

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palate, and noma (severe gangrenous disease starting in the mouth mostly affecting
children). Most oral health conditions are largely preventable and can be treated in
their early stages (Ekeh, 2003).

The Global Burden of Disease Study 2017 estimated that oral diseases affect close
to 3.5 billion people worldwide, with caries of permanent teeth being the most
common condition. Globally, it is estimated that 2.3 billion people suffer from
caries of permanent teeth and more than 530 million children suffer from caries of
primary teeth.

In most low- and middle-income countries, with increasing urbanization and

changes in living conditions, the prevalence of oral diseases continues to increase.
This is primarily due to inadequate exposure to fluoride (in the water supply and
oral hygiene products such as toothpaste) and poor access to oral health care
services in the community. Marketing of food and beverages high in sugar, as well
as tobacco and alcohol, has led to a growing consumption of products that
contribute to oral health conditions and other noncommunicable diseases.

2.2.1 Oral caries (tooth decay)

Oral caries result when plaque forms on the surface of a tooth and converts the free
sugars (all sugars added to foods by the manufacturer, cook, or consumer, plus
sugars naturally present in honey, syrups, and fruit juices) contained in foods and
drinks into acids that destroy the tooth over time. A continued high intake of free
sugars, inadequate exposure to fluoride and a lack of removal of plaque by
toothbrushing can lead to caries, pain and sometimes tooth loss and infection.

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2.2.2 Periodontal (gum) disease

Periodontal disease affects the tissues that both surround and support the tooth. The
disease is characterized by bleeding or swollen gums (gingivitis), pain and
sometimes bad breath. In its more severe form, the gum can come away from the
tooth and supporting bone, causing teeth to become loose and sometimes fall out.
Severe periodontal diseases are estimated to affect nearly 10% of the global
population. The main causes of periodontal disease are poor oral hygiene and
tobacco use (Adekoya et al., 2006).

2.2.3 Oral cancer

Oral cancer includes cancers of the lip, other parts of the mouth and the
oropharynx. The global incidence of cancers of the lip and oral cavity) is estimated
at 4 cases per 100 000 people. However, there is wide variation across the globe:
from no recorded cases to around 20 cases per 100 000 people.3 Oral cancer is
more common in men and in older people, and varies strongly by socio-economic
condition (Al-Ansari et al., 2006).

In some Asian-Pacific countries, the incidence of oral cancer ranks among the
three top cancers. Tobacco, alcohol and areca nut (betel quid) use are among the
leading causes of oral cancer.4 In North America and Europe, human
papillomavirus infections are responsible for a growing percentage of oral cancers
among young people (Ares, 1999).

2.2.4 Oral manifestations of HIV infection

Oral manifestations occur in 30-80% of people with HIV,6 with considerable

variations depending on the affordability of standard antiretroviral therapy (ART).

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Oral manifestations include fungal, bacterial or viral infections of which oral
candidiasis is the most common and often the first symptom. Oral HIV lesions
cause pain, discomfort, dry mouth, and difficulties swallowing.

Early detection of HIV-related oral lesions can be used to diagnose HIV infection
and monitor the disease’s progression. Early detection is also important for timely
treatment (Adekoya et al., 2006).

2.2.5 Oro-Oral trauma

Oro-Oral trauma results from injury to the teeth, mouth and oral cavity. Around
20% of people suffer from trauma to teeth at some point in their life.7 Oro-Oral
trauma can be caused by oral factors such as lack of alignment of teeth and
environmental factors (such as unsafe playgrounds, risk-taking behaviour and
violence). Treatment is costly and lengthy and sometimes can even lead to tooth
loss, resulting in complications for facial and psychological development and
quality of life (Ares, 1999).

2.2.6 Noma

Noma is a severe gangrenous disease of the mouth and the face. It mostly affects
children between the ages of 2 and 6 years suffering from malnutrition, affected by
infectious disease, living in extreme poverty with poor oral hygiene and/or with
weakened immune systems.

Noma is mostly found in sub-Saharan Africa, although cases have also been
reported in Latin America and Asia. Noma starts as a soft tissue lesion (a sore) of
the gums, inside the mouth. The initial gum lesion then develops into an acute
necrotizing gingivitis that progresses rapidly, destroying the soft tissues and further
progressing to involve the hard tissues and skin of the face.

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In 1998, WHO estimated that there were 140 000 new cases of noma annually.
Without treatment, noma is fatal in 90% of cases. Survivors suffer from severe
facial disfigurement, have difficulty speaking and eating, face social stigma, and
require complex surgery and rehabilitation. Where noma is detected at an early
stage, its progression can be rapidly halted, through basic hygiene, antibiotics and
improved nutrition (Ares, 1999).

2.2.7 Cleft lip and palate

Clefts of the lip or palate affect more than 1 in 1000 newborns worldwide. Genetic
predisposition is a major cause. However, poor maternal nutrition, tobacco
consumption, alcohol and obesity during pregnancy also play a role. In low-income
settings, there is a high mortality rate in the neonatal period. If lip and palate clefts
are properly treated by surgery, complete rehabilitation is possible.

2.3 HEALTH EDUCATION AND ORAL HEALTH PRACTICES

The aim of Health Education from class one to eight is to enable pupils
acquire and apply health knowledge in their daily lives to improve health-
enhancing behaviours while health-risking behaviours decrease (Gann, 1986). The
health education course enhances health literacy (HL) among population groups
and therefore requires accessible and reliable source of information (Xiamong,
2012).

In a study by Bruun, Schnack, & Simovska (2000) on action competence,

free access to information was found to help children make democratic, practical
and responsible health decisions. Penny (2010) adds that continuous access to
relevant updated information about physiology, aetiology, prevention and available
health care services contributes to well-being. Similarly, Cinnar (2008) says that

17
informed persons generally develop high self-esteem, self-efficacy with reduced
chances of engaging in detrimental health practices.

In pursuit of the UN millennium development goals, many governments

have put strategies to improve access to education and health. In China, promotion
of HL is done to create health behaviour change among pupils through school
curriculum in order to reduce disease prevalence. In Nigeria the re-introduction of
‘Free Primary Education’ (FPE) in 2003 was aimed at giving children equal access
to formal education. While the FPE makes education accessible to all children in
schools, health education makes information about communicable and non-
communicable diseases accessible to all (Oyaya & Rifkin, 2002). Given the three
key objectives of a science lesson in Nigerian primary schools; to impart
knowledge, develop skills and nature attitudes necessary for wellbeing, teachers
have a duty to inculcate good health practices among children guided by the
curriculum. In view of this, school health literacy is an ideal strategy for promotion
of oral health practices because it engages children in activities which develop
their knowledge and skills into expected practices at their formative stage
(Xiamong, et al. 2012).

2.4 CHALLENGES IN ORAL HEALTH PRACTICE

Pupils with physical disabilities have needs like any other children. However,
Bharathi & Sinsgh (2012) found that disabled children in India have more needs
due to actual disability, medical and social reasons e.g. self-mutilating
behaviours/cariogenic effects of medicines which some use. In some cases, parents
are unable to help them carry out proper oral hygiene (Ajala, 2005).

2.4.1 Attitude and Curriculum Based Challenges

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A study by Tomlinson, et al., (2007) lists people’s attitudes, unfriendly
infrastructure, and weak laws as factors which predispose People with Disabilities
to discrimination and misunderstanding by the public in the UK. In terms of oral
health care, the study by Nyamuryekung’e (2012) in Dar es Salaam, a low alpha
coefficient of 0.482 for oral health attitude was found. This represented “Bad
attitude” on the scale and implied that oral care practices of students was greatly
influenced by their beliefs and attitudes than by knowledge gained through
teaching of OH in the school curriculum. The Human Rights Watch, (2007) agrees
that learners with physical disabilities in Nigeria face similar challenges.

2.4.2 Culture Based Challenges

The contents of health education curriculum pertaining to oral health should be

culturally acceptable, relevant and adaptable for teaching oral health in their
diverse environments. Gann (1986) opines that if health information contradicts
people’s culture and beliefs, it may be ignored however good it is. In Bulgaria,
26% of students taking health education admitted they prefer traditional ‘healers’,
prayers, or herbal remedies when sick. They delay to seek medical help until other
methods have failed. While Health eduation programs are designed to create health
awareness in communities, behaviour change depends on self-esteem and self-
efficacy so that the individual accepts the knowledge, develops a vision and
commits to practice (Carlson & Simovska, 2012).

According to Solarin-Lawal (2012), factors or interests of the pupils should

be considered because they contribute towards the success of a health intervention
like oral care. Nyamuryekung’e (2012) again noted the negative influences of
culture in terms of dietary behaviour; use of tobacco and alcohol among other
behaviours on OH knowledge gained through the school curriculum.

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2.4.3 Economic and Infrastructural Challenges

A majority of Physically Challenged Pupils with mobility disorders cannot afford

the high cost of assistive devices. Others face neglect by peers, family and the
community. The Ministry of Education Task Force Report (2012) on Re-
Alignment of Education Sector to the Constitution of Nigeria 2010 acknowledges
that lack of funds aggravate the challenges facing PCPs in Nigeria due to poor
infrastructure, ill-equipped facilities, low staff to population ratio and the slow
pace of implementation of the adapted syllabus for physically challenged learners.
The Human Rights Watch, (2007) notes that health challenges facing learners with
physical disabilities in Nigeria includes; poor access to health facilities and
inadequate social support services among others. This was confirmed by Boika
(2009) who found that due to poverty, most Physically Challenged Pupils are poor
and live in rural areas where health care services are inadequate and poorly
networked (Ajala, 2005).

Finally this study admits that economic and infrastructural challenges affect school
oral health education and practices among PCPs in Kaduna County given that OH
practices require financial support in terms of buying materials and there is less
recognition of its contributions to the general well-being of individuals in Nigeria
(Kaimenyi, 2004).

2.4.4 Weak Laws and School Rules

Disability is said to be one of the barriers to access to information, education, and

healthcare Middleton (1992). Middleton laments that, disabled children are treated
differently and often suffer physical, geographical and social isolation even within
their own families. Disability can be frustrating when it causes exclusion from
facilities and services (Bradley, 2006). However, the existence of special boarding

20
schools for learners with disability has attempted to solve this challenge even
though Westcott (1991) says that, the likelihood of abuse of PCPs increases when
they are in such exclusive special care institutions. According to Carlson &
Simovska (2012) psychological and administrative factors within the special
institutions influences the processes and outcomes of health education among the
PCPs. In view of this, Xiamong, et al. (2012) identified knowledge as input,
motivation as a process factor and personal skills as indicators of outcomes in
order to achieve the desired OH practices through health literacy programmes. The
next section looks at provisions in the PSPS to help the pupils improve their oral
health practices and general well-being (Ajala, 2005).

2.5 STRATEGIES TO ADDRESS ORAL HEALTH CHALLENGES

Factors that determine oral health and well-being were classified by Owens et al.,
(2010) based on the individual’s culture, genetics, environment, socioeconomic
status, personal behaviours, access and organization of oral health care systems.
These factors according to Tinanoff (1998) interact throughout life and determine
oral health status of individuals, groups, and communities.

In a study of oral health status of 12-year old children with disabilities in India,
Bharathi & Singh (2012) found that literacy level had influence on occupation and
income of parents hence the amount of pocket money given to children. The study
found that, the more pocket money the higher the consumption of sweetened foods
between meals at school which negatively affects oral health of the children.

In Pitt County, North Carolina, a strong association was found between oral
health status of Kindergarten children and the knowledge, attitudes, beliefs and
practices of their parents (Pirate, 2006). However, the two studies did not identify
strategies put to manage undesired parental or any other influences on the

21
children’s oral health. Looking at “Risk factors for Oral caries in young children”
Rebecca, Alison, Pauline, & Cynthia (2004) recommended that that, legislations to
control childhood carries are required to regulate diet and promote good oral
hygiene habits among children. In California, Susan & Stuart et al, (2007) listed
individual, family and community level factors as major influencers in children’s
oral health practices but also recommended that strategies to control their
influences need to be established.

In Nigeria, most of the previous oral health researches seem to have been
conducted by dentists with bias on pathologies and clinical interventions. Little
information exists from social sciences to show strategies put to promote healthy
oral care practices through education. In 2004, a study by Kaimenyi recommended
that Nigeria government should improve national oral health structures and
processes in order for outcomes of OH interventions to be more responsive to the
needs of citizens and priorities of the government. In view of this and the fact that
studies from America, China and India have not clearly determined strategies put
by institutions to address oral health needs of PCPs, this study will seek to
establish strategies put in place by the PSPS in Kaduna County to address the oral
health needs of PCPs. The findings will form new oral health data about PCPs in
special institutions in this area of study.

2.6 IMPORTANT KNOWLEDGE OF ORAL HEALTH CARE

The schools provide an ideal setting for providing Oral health education at an early
stage. Prasi, Ajayi& Mash (2013). It has as its aim, the dissemination of Oral
health facts in such a way that the behaviour of the learner is changed. Knowledge
of Oral health care can help the school children to alter unhealthy habits.
According to Betsey (1980), Oral health education depends largely upon the

22
acquisition of accurate and useful knowledge concerning good Oral health on the
part of the individual. This becomes successful when the knowledge is put into
daily practice resulting in behavioural change. The awareness of Oral health care is
poor among school children as most of them do not know some of the Oral
problems that they experience. It is only when they are exposed to Oral
information that they can understand and know their Oral health status. There are
multiple reasons for school children to be susceptible to Oral disease which include
social, economic and demographic factors like awareness, limited access to
professional Oral care and lack of all the more basic resources. Oral health
knowledge is considered to be an essential pre-requisite for health –related
practice, and studies have shown that there is an association between increased
knowledge regarding Oral hygiene and better Oral health. Oral hygiene is
considered to be the most important factor in preventing Oral disease. Those who
have assimilated the knowledge and feel a sense of personal control over their oral
health are more likely to adopt self care practices. Developing such knowledge
plays a key role in improving the Oral health of school children. The American
Oral Association (2006) states the following objectives as a basis for school Oral
health programme:

 To help every school child appreciate the importance of healthy mouth:

It is possible for every school child to have a healthy mouth if the

knowledge of Oral health care is put into daily practice by actually brushing, at
least twice daily and observing every other Oral hygiene tips. The teeth are meant
to last for a life time but somehow along the line, a lot of people lost their teeth due
to Oral problems that have invaded the oral environment. Plaque has been known
to be the major causes of periodontal diseases, but other factors can also affect the
health of the gums. Periodontal (gums) disease, including gingivitis and

23
periodontal, are serious infections that if left untreated can lead to tooth loss.
Periodontal disease can affect one tooth or many teeth. The main cause of
periodontal disease is bacterial plaque, a sticky colourless film that constantly
forms on the teeth (AAP 2007). An important part of good oral health is to know
how to brush and floss correctly.Thorough brushing each day removes plaque.

 To help every school child appreciate the relationship of Oral health to

the general health and appearance:

A compressive Oral health programme is based on the concept of teaching the

“whole child,” emphasizing Oral health as an integral part of total body health.
There is a direct relationship between Oral health and the general body health.
According to ADA (2007), the health of your gums can affect your overall health.
Recent studies have shown a possible link between periodontitis and other disease,
such as diabetes and heart disease. According to Saunders and Robert (1997),
cardiovascular disease in children complicates oral care by making them
susceptible to infective endocarditic and for children taking war far in, there is the
risk of prolonged bleeding. Although the cases of cardiac disease is rare in children
as only one baby out of hundred is born with a cardiac defect. The condition of
your Oral health can also affect appearance as it can cause physical disfigurement.

 To encourage the observance of Oral health practices, including

personal care, professional care, proper diet and Oral habit:

Positive Oral hygiene and health should be part of your day to day routine. Oral
health starts with good oral hygiene. Proper brushing helps to remove the germs
that live on your teeth from outside, inside and chewing surfaces of your teeth.
Gargliadi (2007). Personal and professional care of the teeth is necessary for Oral
24
health. Nutritional factors can also affect tooth integrity, enamel solubility and
salivary flow and composition. Even moderate nutritional factors can cause defect
in tooth development. In humans, deficiencies of protein calories, vitamins, A, C,
D and Iodine and excesses of fluoride have all been shown to affect human
dentition development, Depaola,Faine& Palmer, (1999)

 To correlate Oral health activities with the school health programme:

Many health problems facing students today are both interrelated and preventable
through co- ordinate school health programme, schools can help young people
acquire the knowledge and skill necessary to make healthy choices. A coordinated
programme is holistic not focusing solely on physical health but also addressing
other areas of health. When Oral health activities are correlated with school health
programme, It will help school children to overcome a lot of Oral health
challenges. Integrated in the school health programme, nutrition services should
promote a healthy diet among school children. The ultimate purpose is to promote
health by emphasizing a balance and adequate eating habit. Nutrition, services
should provide students, access to a variety of nutritious and appealing meals that
accommodate the health and nutrition need of school children. (Maryland, school
health service 2006)

 To stimulate dentist to perform adequate health services for children:

There are a number of health services that are provided by the dentist in order to
ensure good oral health care. Some of the commonly used Oral services include;
cleaning, flossing, teeth, coating, placing Oral crowns, teeth whitening for
discoloured teeth, root canal treatment and anti-cavity fillings, artificial tooth

25
implantation and so on. In all of these cases, care is taken to ensure that oral
hygiene is not compromised for aesthetic purposes. Check-dent (2011).

If there must be a reduction in cases of Oral health problems among school

children, they must first have adequate knowledge about Oral health care and
disease associated with poor oral hygiene. This will help them improve on their
attitude towards Oral health care.

2.7 NUTRITION AND HEALTHY TEETH

Nutrition plays an important role in oral health and healthy teeth. Healthy teeth are
possible for most people, if the knowledge of oral disease is used to alter unhealthy
habits. A balance diet is important in preventing cavities; however cavities are also
the result of what we eat and how often we eat them. At every time we eat or chew,
there are food particles or debris that becomes trapped on or between the teeth
surface. when refined carbohydrates food such as bread, corn flakes, pasta,
crackers and potato chips are allowed to remain in the mouth without brushing the
bacteria that is already present in the mouth break down these structures into
sugars. These sugars are in turn converted to acids and these acids have ability to
eat away at tooth enamel. Some food, by the reason of their texture causes them to
remain in the mouth for a long time. Such foods are: caramel, sweet, butter, bread
etc. thus hastening the decay process. It is therefore advisable to consume a variety
of nutrient-dense foods and beverages within and among the basic food groups.
Focus on fruits and vegetables, whole-grain products and fat free or low-fat milk or
equivalent milk products. Reading the nutrition facts label on packaged foods
before buying or consuming can help in making smart food choices. If we must

26
take sugary snacks it must be at meal time so that increased saliva production will
help to neutralize the acid attack.

Research has shown that certain foods have the ability to reduce the amount of acid
that the teeth are exposed to. They are said to be dentally sound because they can
fight plaque and neutralize the acid producing bacteria. Examples of such dentally
sound food are:hard cheese, raw fruits, vegetables, Cashew, and peanut.

In our daily diet, it is important to alternate these dentally preferred snacks. This
helps to provide a variety of choices and also ensures a balanced intake of
nutritious meals. Acid producing foods include:- Honey, candy, cookies, cough
drops, Doughnuts, Mints, pies, Soft drinks, Table sugar, Syrup, Cakes, Popsicles,
Jellies.(Gagliardi 2007).

2.8 SUMMARY

The chapter which reviewed literature related to the study, considered various
aspects of oral health and diseases associated with poor oral hygiene. It is
understood that plaque plays an important role in the initiation and progression of
various oral problems like Oral Caries, Materiaalba, and Oral etc. The importance
of maintaining high standard of oral hygiene is therefore highlight health
education. Children are the most susceptible to Oral Caries because sugar and
sweet nibbling addiction is a characteristic of children more than adults. Moreso
they have not been able to attached importance to oral hygiene because of their age
or their physical and mental limitation and hence they need a specialized oral
physiotherapy instruction.

The intervention is among primary schools pupils in order to create awareness and
increase knowledge on how Nutrition plays an important role in oral health and
healthy teeth. The knowledge of nutrition and oral health can help in selecting
27
dentally sound food and making smart choices in every food group. Oral health
education should be a life-long practice and incorporated into the school
environment with the support of teachers and Parents.

28
 CHAPTER THREE

RESEARCH METHODOLOGY

3.0 INTRODUCTION

The purpose of this study was to assess the impact of the Oral Health status among
primary school pupils in Igabi Local Government Kaduna State. To achieve this,
the research design, population of the study, sample and sampling techniques,
instrumentation for data collection, procedure for data collection and methods of
data analysis are described in this chapter

3.1 RESEARCH DESIGN

The expost-facto research design was used for the study. It was considered suitable
because the information required was within the subjects and was elicited by the
research instrument.

3.2 POPULATION OF THE STUDY

The population for this study consisted of pupils from public primary schools in
Makarfi Rigasa Igabi Local Government Areas of Kaduna. This included pupils
from classes 3 – 6. There are 18 public schools in Rigasa Igabi LGAs. The total
school for the LGAs was 407 pupils (Kaduna State Universal Basic Education
Board), Local Government Education Authority. The study uses Makarfi Road
Rigasa public school known as (Day Hayin). 407 students and teachers comprises
of the total populations of the study.

3.3 SAMPLE AND SAMPLING TECHNIQUES

Stratified random sampling technique was used in this study. With this technique,
all the 30 public primary schools in Makarfi - Rigasa were stratified into Igabi

29
Local Government Areas. From the study population of four hundred and seven
pupils (450), a sample size of one hundred and twenty eight (128) was drawn for
the study.

The common hat-draw method was used to select schools from each of the strata.
The names of the schools were written in pieces of paper, squeezed and thrown
into the hat and shaken to ensure proper shuffling before they were drawn.

According to Asika, (2000) and Ugodulunwa (2004), in the method of

proportionate sampling, there is need to obtain a true representation of the parent
population consisting of many strata, once the size of the sample is decided, then
schools and subjects can be selected. To determine the number of schools and
respondents for each stratum, Mukherjee (1975), Nworgu (1991), Bello and Ajayi
(2000), opined ten percent (10%) of the sample to compute specific number of
schools and respondents for proportional representation. The statistical formular
for proportional representation of schools and respondents is;

Where;

nh = number of schools or subjects to be drawn per stratum.

n= total number of subject in a stratum in the case of number of schools per

stratum / or total sample size for the study to determine subject.

N= total population size for study.

Nh= The ten percent (10%) of total sample size in the case of number of schools
per stratum /or total subject or respondent per stratum.

In selection of respondents from their classes the common hat draw method was
used where (Yes) and (No) responses were written in pieces of paper for pupils to

30
pick, boys and girls alike depending on the number of respondents that were
needed. The above description agrees with Ekeh (2003), Razaq&Ajayi (2000),
method of purposive sampling.

3.4 INSTRUMENTATION FOR DATA COLLECTION

The instrument that was used for data collection is a questionnaire that was
developed by the researcher. The questionnaire was based on the 5-points Likert
scale items for the respondents to select from. The scales and options are as
follows:

Strong agree (SA) 5 points

Agree (A) 4 points

Undecided (UD) 3 points

Disagree (DA) 2 points Strongly disagree (SD) 1 point

The questionnaire was divided into 4 sections; A, B, C and. D

Section A contained demographic information of the pupils like Age, Sex and
Class.

Section B contained items eliciting information on the oral health status among
primary school pupils in Igabi Local Government Kaduna State

Section C contained items eliciting information on attitude of Oral health care

among primary school pupils in Igabi Local Government Kaduna State

Section D contained items eliciting information on practice of Oral health care

among primary school pupils in Igabi Local Government Kaduna State.

31
3.5 VALIDATION OF THE INSTRUMENT

Copies of the questionnaire were distributed to experts in the department of Human

Kinetic and health education in Ahmadu Bello University Zaria, to assess the
content and face validity. Necessary corrections and modification were made and
on the basis of these corrections, suggestions and modifications, the items were
then restructured and a final draft of the questionnaire was then prepared for
collection of data for the study.

3.6 METHODS OF DATA COLLECTION

A total number of 100 questionnaires were made available for the respondents. The
administration was done with the help of research assistants (school teachers). The
pupils responded to the items contained in the questionnaires inside their class
rooms and returned them immediately. The 100 questionnaires were retrieved after
administration but one got missing in the process of analysis left with 99.

3.7 METHODS OF DATA ANALYSIS

Data collected was analyzed using the Statistical Package of Social Sciences
(SPSS). Statistical procedure that was used for the analysis of variables included
descriptive statistics of frequency and percentages for demographic characteristics
of the respondent. Mean and standard deviation were used to answer the research
questions the oral health status among primary school pupils in on Igabi Local
Government Kaduna State. The major hypothesis was tested with Pearson Product
Moment Correlation Coefficient and the sub-hypotheses were tested with paired
sample t-test respectively.

32
 CHAPTER FIVE

SUMMARY, CONCLUSION, AND RECOMMENDATION

5.1 SUMMARY

According to a poet laureate, Ogdeh Nash, „some pains are physical, some are
mental, and the one that is both is dental‟. Our oral health is of utmost importance
to the overall body health that is why the practice of oral hygiene is not optional; it
is a thing we must practice religiously to avoid Oral problems. Parents must not
shy away from the responsibility of teaching their children at an early stage in life
on good oral hygiene and brushing techniques till they have the dexterity to do it
themselves.

To achieve the purpose of the study which sought to assess the oral health status
among primary school pupils in Igabi Local Government Kaduna State, a total
number of thirty eight (30) schools were drawn from the local government areas.
The sample size for the study was 128. A self-constructed questionnaire was used
to collect the data from the respondents. At the end of the collection 128
questionnaire were returned.

5.2 CONCLUSION

On the basis of the findings of this study, the following conclusions were drawn.

1. Primary school pupils in Rigasa, Igabi Local Government Areas of Kaduna

state lacked some basic knowledge of Oral health care.
2. The attitude of primary school pupils toward oral health care was poor as
evident in the study.
3. Primary school pupils use different method of oral hygiene aids such as salt
and ash, chewing sticks, finger and water.

33
 4. Most teachers and parents did not carry out inspection of school children‟s
teeth regularly.

5.3 RECOMMENDATIONS

Based on the findings of thestudy, the following recommendations were made;

1. Awareness on the importance of oral health needs to be enhanced among e

school children in Zaria and Sabon- Gari Local Government Areas of
Kaduna state.
2. School children should be encouraged to develop a positive attitude towards
their oral health through regular health appraisal.
3. Parents should always endeavour to inspect their children‟s teeth to detect
the onset of any oral problem whether tooth decay or discoloration and
should also ensure that they do not engage in bad oral practices.
4. Parents should teach their children/wards proper brushing techniques and
also they should encourage them to make healthy food choices.
5. Generally, the oral health knowledge, attitude and practice of the primary
school pupils in Rigasa, Igabi Local Government Areas of Kaduna State is
below the satisfactory level and needs to be improved upon.

5.4 RECOMMENDATION FOR FURTHER STUDY

There will be need to carry out a study on the effectiveness of the use of ash and
salt as oral hygiene aids in rural areas.

34
REFERENCES

Ab-Murat, N., Watt R.G.,(2006).Chief dentist, Perceived Strengths and Weakness

of Oral health promotion activities in Malaysia: Annal Oral University,
Malaysia 13: 1- 5.

ADA (1974), Council on Oral Materials and Devices:Withdrawal of Acceptance

of Water PikOral Irrigation device. JAM Oral Association. 89,1178

Adekoya, C.A., Nasir, W. W., Oginn A.O. &Taiwo. M. (2006). Oral caries in
12-year old Suburban Nigerian School Children.African Health Science.6
(3): 145-150

ADHA (2006). Standards for Clinical Oral Hygiene practice. www.adha.org.

Ajala, J. A. (2005).Health education in wellness and sickness– This day,

University of Ibadan, Ibadan Pp 17 – 23.

Al-Ansari J.M., Al-jiran, L.Y.&Gillespie G.M.(2006).Dietary habits of primary to

secondary school population and implication for oral health.Journal Allied
Health, 35 (2); 75-80

Al-sadhan,S.A., (2003).Oral health practices and dietary habits of intermediate

school in Riyadh, Saudi Arabia. Saudi DentalJournal, 15 (2); 81 -87.

Amelia,Timmerman, M. F., Abbas, F., Loss, B.G., Vandr

Weijden,G.A.Van&Winkelhoff, A.J., (2007). Java project on period ontal
diseases: Therelationship between Vitamin C+ and the severity of
periodontitis JournalofclinicalPeriodontal34 (4): 299-304.

35
Academy of Periodontology (2011) htt://www.perio.org/consumer/29./html. All
rights reserved 737 Michigan.

American Oral Association (1980) – Learning about Oral health: A Prevention

Oriented Program (Vol. 1 – 4) Chicago Author.

American Oral Hygienist, Association: (1998). Policy on prevention of Oral caries

and Food programme 13-98/15-94/30-75 16-64.

American Society of Dentistry for Children (1975) Tooth Talk, a teacher’s

guide,flip chart k-3 Chicago 14 Author.

Asika N. (2000).Research Methodology in Behavioral Science, Lagos Longman

Nig. Plc.

Awotude, P.O.&Ugodunlunwa, C.A.(2004). Research Methods in EducationJos

Fab Anieh (Nig) Ltd.

Ares, U. (1999). British Nutrition Foundation Task Force Report Oral health Diet
and other factors Elsevier, Oxford.

Barker J.C. and Horton SB (2008).An Ethnographic Study of Latino Preschool

Children’s Oral Health in Rural California: Intersections among family,
community, provider and regulatory sectors. BMC oral Health, 8:8

Bello, R.&Ajayi O.O. S., (2000).Research Methods and Statistical Analysis.Haytee

press and publishing company limited 154, Ibrahim Taiwo Road, Ilorin.

Betsey, A. A. (1980).Oral Health Communications;InDimensions of oral

hygiene 2nded. Pp 307-315.Great Britain Henry Krympton Publishers
London.

36
Borges, K.A. (2008). Society for Maternal-Oral Medicine Publications
Committee. Maternal Oral Health in pregnancy obstet. Gynecol, 111 (4):
976 – 86.

Boyd, L.D. Dwyer, J. T., Papas, A. (1997). Nutritional Implication of Xerostomia

and Caries caused by serotonin re-uptake inhibitor: A case study Nutr. Rev
199755:362-68.

Brown, W. (1995).Facts on Water Fluoridation Sacraments CA California

Department of Health Services.

Burt, B. A. &Pai S. (2001).“Sugar Consumption and Caries Risk – Conference on

oral caries.

Carole, A. P. (2007).Diet and Nutrition in Oral Health 2nd (ed.) Julie Levin
Alexander Publishing Company.

Cheah W.L. Tay, S.P. Chai S.C Bong C.S, Luqmanul H.B. Zhuleikha (2009).Oral
health Knowledge, Attitude and Practice among secondary school students
in Kuching Sarawak. Archives of Orofacial Sciences (2010), 5 (1); 9-16

Children’s Oral disease prevention program, SB Health and safety code 360 –
375 (1975) Article 4.5 children’s oral disease prevention program.

Christenson, L. A., Zambon, J. J. &Genco, J. J. (1991).Oral Bacterial plaques.

Nature and Role in Periodontal disease;.Journal of Clinical Periodontal 18,
441 – 446.

Daramola, S. O. (1992).Research and Statistical Method in Education for students

and researchers in Tertiary Institution.Ado-EkitiPetoa Education publishers
Encyclopedia (1988).

37
Dellinger, T. M. Livingstone, H. M. (1998) Aspirin burn of the oral cavity. Ann
Pharma. (Other 1998) 32(10):1107.

Dembo, Myron, H. (1994).Applying Educational Psychology, 5th (ed.) Longman

publishing group.

Depaola, D., Faine M. Palmer, C. (1999). Nutrition in relation to oral medicine.

In Shills M. Olsen, J. A. Shike M. Ross AC (eds.).Modern Nutrition in
Health and Disease 9th ed. Baltimore.Williams& Wilkins.

Dolby, A. WalkerM.& Mathew, N. (1981).Introduction to Oral Immunology.

Edward Arnold (publishers) Ltd 41 Bedford Square, London.

Ekeh, F. I. (2003). Research Methodology and Statistics in education 1st (ed.)

Mandol Press Ltd.

Elizabeth A.K Mitchelle H. (2005) The Older Oral Patient:In Diet and Nutrition
in Oral Health by Carole A. Palmer,2nd edition

38