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ORIGINAL RESEARCH Table of Contents   
Year : 2008  |  Volume : 19  |  Issue : 2  |  Page : 104-108
Knowledge and attitudes of pharmacists regarding oral health care and oral hygiene products in Chennai city


Department of Preventive and Community Dentistry, Ragas Dental College and Hospital, 2/102, East Coast Road, Uthandi, Chennai - 600 119, India

Click here for correspondence address and email

Date of Submission25-Jul-2007
Date of Decision16-Oct-2007
Date of Acceptance22-Oct-2007
 

   Abstract 

Objectives : This study was done to find out the knowledge and attitudes of pharmacists regarding oral health care and oral hygiene products in Chennai city.
Materials and Methods : A cross-sectional survey among a sample of the pharmacists in Chennai city was done and data regarding their knowledge and attitudes towards oral health care and oral hygiene products were obtained using a closed-ended questionnaire.
Results: Among the 60 pharmacies approached, 50 pharmacists participated in the study and completed the questionnaire. Though 48% of the participants gave a positive answer when asked whether they had met the dentist practicing close to their pharmacies, the frequency with which they met the dentist ranged from once a week (24%) to once a month (28%). Most of the pharmacists stocked oral health-related products, which comprised 15-25% of their total stock. Of these products toothpaste was the most common (62%), followed by mouth rinses (12%). Toothache or painful teeth was the most common dental problem (78%) for which patients approached the pharmacists for advice. With regard to the advice given, 38.5% of the pharmacists asked the patient to consult a nearby dentist after dispensing medications, while 22.4% of the pharmacists dispensed antibiotics and painkillers without any referral. Seventy percent of the pharmacists expressed interest in giving oral health care advice to patients. However, many of them (38%) felt that lack of proper knowledge is a barrier to providing oral health care advice.
Conclusion : It is clear from the present study that pharmacists are presently an underutilized resource, and there is a definitive need to improve their training and access to information on available dental services.

Keywords: Community pharmacies, oral health advice, oral hygiene advice, pharmacists

How to cite this article:
Priya S, Madan Kumar P D, Ramachandran S. Knowledge and attitudes of pharmacists regarding oral health care and oral hygiene products in Chennai city. Indian J Dent Res 2008;19:104-8

How to cite this URL:
Priya S, Madan Kumar P D, Ramachandran S. Knowledge and attitudes of pharmacists regarding oral health care and oral hygiene products in Chennai city. Indian J Dent Res [serial online] 2008 [cited 2014 Apr 23];19:104-8. Available from: http://www.ijdr.in/text.asp?2008/19/2/104/40462
The role of community pharmacists in the provision of general and oral health care is an important and relevant one in view of the national government's plans to improve the delivery of primary health care. There have been several initiatives by the department of health in the last few years to increase the contributions made by community pharmacists in improving the range and quality of primary care services. [1]

Of late, the pharmacists' role has expanded from dispenser of medications to recognized member of the health care team. [2] Community pharmacists have long served as the medication expert of the health care team and, due to their knowledge and accessibility, are frequently approached by the public to answer health-related questions. [3] A survey of community pharmacists in Edinburgh, Scotland, in the fall of 2002, revealed that the pharmacist was asked at least one question every week about some oral health-related problem; [4] nearly half of these questions were related to mouth ulcers or persistent soreness. Data from another European survey of pharmacists showed that some oral problems clearly warrant prompt referral to either a dentist or a physician (for example, trauma to the anterior teeth); however, the majority of patients with oral problems can be managed appropriately within the pharmacy setting. [5]

There are a variety of ways by which the pharmacist can take a frontline approach to oral disease prevention, identification, assessment, management, and referral. These include promoting topical fluorides, especially fluoride toothpastes; promoting the use of rounded-ended soft-bristle toothbrushes; encouraging effective oral hygiene practices; promoting healthy eating; encouraging use of dental services and preventive therapies; and giving parents and other family caregivers information, motivation, confidence, and the skills to prevent oral disease. [1]

Chesstnutt et al . [6] discussed the potential contribution of pharmacy staff to dental and oral health in the recent times. They noted important deficiencies in the oral health care knowledge of pharmacists. Anderson [7] published a paper highlighting the need for pharmacists to be incorporated into multidisciplinary oral healthcare teams. An investigation published in 2001 assessed the contribution of pharmacists to oral health care in a group of drug users as compared to that in a group of non-drug users. This research demonstrated that pharmacists already play a important role within 'special risk groups' as far as oral hygiene is concerned, and this could be extended to include a much larger client base. [1]

In India, home to the second largest population in the world, it is common practice for many people to resort to pharmacists for advice regarding health problems because of variety of reasons: for example, financial constraints, lack of time, difficulty in getting an appointment with the physician or dentist, etc. However, there are few studies evaluating the role of community pharmacists in the provision of oral health care advice. Little information exists regarding their source of knowledge, the sort of oral health care products they promote, their relationship and communication with the local dentist, etc.

In order to better understand these lacunae, the present study aimed to find out the knowledge and attitudes of pharmacists regarding oral health care and oral hygiene products in Chennai city.


   Materials and Methods Top


The present study was a cross-sectional survey among a sample of the pharmacists in Chennai city. Data regarding the total number of pharmacies in the Chennai city limits were obtained from the department of health. A list of all the registered pharmacies was prepared. The pharmacies could be broadly divided into three types: those owned by individual pharmacists; those that were part of a chain of pharmacies spread all over the city, the state, or the country; and those pharmacies that were attached to hospitals. From the list, 60 pharmacies were selected randomly using a random number table.

Data regarding knowledge and attitudes toward oral health care and oral hygiene products were obtained using a closed-ended questionnaire. The questionnaire comprised 18 closed-ended questions that had been earlier pre-tested on a group of pharmacists. One pharmacist from each selected pharmacy participated in this study. Each pharmacist took around 15 min to complete the questionnaire. The questionnaire was divided into four sections: section I dealt with details regarding the vicinity of the dentist to the pharmacy, their appointment details, and the frequency with which the pharmacist met the dentist. Section II focused on the range of dental products stocked in the pharmacy. Section III dealt with the advice given by the pharmacist to customers regarding oral hygiene products and oral health, while section IV dealt with the pharmacist's source of information regarding oral health and oral hygiene, the barriers faced by them, and also methods to improve their knowledge and attitudes regarding oral health.

Data was collected by a single investigator, who personally met the pharmacists and explained to them the purpose of the study. The completed questionnaire was collected by the same investigator.

Statistical analysis of the collected data was done using the Statistical Package for Social Sciences 10.


   Results Top


Among the 60 pharmacies approached, 50 pharmacists participated in the study and completed the questionnaire. Among them, 42 pharmacies were owned by individuals, one belonged to a chain of pharmacies, and the rest were attached to hospitals. The mean number of years of practice of the pharmacies was around 7.1 years. [Table - 1] gives the details of the pharmacies that participated in this study along with the years of practice.

Thirty (60%) pharmacists who participated in the present study said that there were less than four dentists practicing within 5 km of their pharmacies and 24% felt that there were five to nine dentists practicing near (within a 5 km distance) their pharmacy. When asked whether they had met the dentists practicing close to their pharmacies, only 24 (48%) pharmacists gave a positive answer. Among them, 86% had met the dentist less than six times in the past one year on a regular basis. Eight percent of the pharmacists said they did not meet the dentist at any fixed time interval. Nearly 30 pharmacists (60%) who participated in this study gave a negative answer when asked whether they had tried to interact with the dentist regarding oral health. Similarly, 26 (52%) of the participating pharmacists were not even aware of the appointment arrangements of the local dentist.

Less than 15% of the total stock was related to oral health in 36% of the pharmacies. Most of the pharmacist had oral health-related products in the range of 15-25% of the total stock. Toothpaste was the most common (62%) among the oral health care products stocked, followed by mouth rinses (12%). Toothbrushes contributed to around 2% of the total stock.

Forty-two pharmacists (84%) said that around ten patients with dental problems visit their pharmacies every day. Among them, nearly 62% ask the pharmacist for oral health-related advice. Toothache is the most common dental problem (78%) for which patients approach the pharmacist for advice; this is followed by gum problems like bleeding gums and/or bad breath and mouth ulcers. Patients seldom seek advice regarding toothbrushes, toothpastes, whitening of teeth, etc. Though 19 (38.8%) of the participating pharmacists ask the patient to consult a nearby dentist after dispensing medications, 11 (22.4%) dispensed antibiotics and painkillers without any referral to a nearby physician or dentist. Twelve (24.5%) pharmacists said that they just ask the patient to consult a nearby dentist, without dispensing drugs.

Sixty-six percent of the pharmacists feel that financial constraints are the reason for patients approaching a pharmacist (instead of a dentist) for oral health care advice. A few (16%) feel that patients approach them for advice because of the difficulty in getting appointments with the nearby doctor/dentist. Twenty-eight percent of the pharmacists give advice based on their comprehensive knowledge of the products available. An equal number give advice based on the suggestions/instructions from the local dentists/doctors. When asked whether fluoride in toothpaste is beneficial, nearly 25 (50%) pharmacists were unaware of the benefits. Only 36% were aware of the benefits, while 14% felt that there was no benefit in the presence of fluorides in toothpastes. Eighty-six percent of the pharmacists were aware of the different types of toothbrushes present in the market.

The majority of the participating pharmacists, i.e., 35 (70%) in number, expressed interest in giving oral health care advice to patients. However, many of them (38%) feel that lack of proper knowledge is a barrier to providing oral health care advice. Seventy-four percent feel that oral health care and details regarding oral hygiene products should be made a part of their curriculum. Information disseminated through leaflets/pamphlets/posters was the preferred choice of many pharmacists for improving their knowledge regarding oral health. However, 30% also feel that their knowledge could be improved by oral health care courses, meetings, and training programs.


   Discussion Top


Teamwork is now acknowledged as a key concept in the delivery of oral health care. While this is most often discussed in the context of members of the 'dental team,' the role played by pharmacists should not be underestimated. The pharmacists' role has expanded significantly in recent decades from dispenser of medication to recognized member of the health care team. Rather than consult a dentist or physician, many individuals with oral problems seek help from their pharmacists. [2] Hence, this study was done to find out the knowledge and attitudes of pharmacists regarding oral health and oral hygiene products.

Overall, the response rate of the pharmacists who participated in this study was good and most of them had a positive outlook regarding their potential contribution to the provision of advice relating to oral health and were confident in their ability to do so. This was similar to the findings of the study done by Maunder and Landes. [1] However, more than half of the respondents in the present study had not met the dentists practicing close to their pharmacies, nor were they aware of the arrangements for taking an appointment with the dentist. Pharmacists should always be a part of the primary health care team and develop a relationship with their local dental practitioners; at present, their operating fields are very different. [8],[9] Studies [1] have shown that pharmacists should be a part of interdisciplinary team meetings and together they should create a joint pathway of care to meet the needs of the local population.

Stocks of oral health care products in the pharmacies were also assessed in the present study. The proportion of oral health products in the stock was low when compared to general healthcare products. Toothpastes were the most common oral health care product stocked. Surprisingly, in the present study, toothbrushes made up only around 2% of the total stock. This is in sharp contrast to other studies, [1] where toothbrushes comprised nearly 58% of the stock of oral health care products. The reason for this difference might be because of the fact that, in India, most of the oral health care products are sold not just in pharmacies but is also available in all small shops and supermarkets.

Earlier studies [1] have shown that though the number of people seeking general health advice per week was over 100, the number asking for advice on oral health matters was usually around 11. In the present study, 84% pharmacists said that less than 10 patients a day seek advice regarding oral health.

Toothache or painful teeth tops the list of the common dental problems for which patients seek advice from the pharmacist. This is similar to the findings of the study done by Maunder and Landes. [1] Most of the pharmacists, similar to the latter study, referred the patients to the nearby dentist after dispensing medications for short-term pain relief. However, it is interesting to note that nearly 22.4% of the pharmacists dispense antibiotics and painkillers and do not refer the patient to a dentist or physician. This is a matter of concern since short-term pain relief might mean that the patient will postpone consulting a dentist or physician and, thereby, an opportunity to diagnose a disease in its early stage may be lost.

Our research showed that most of the respondents felt that financial constraints were the main reason for patients approaching the pharmacist for advice. Studies [10] have shown that the reason given by patients for approaching a pharmacist for advice instead of a doctor was that there was 'no need to bother the doctor' just then and they had not 'needed an appointment' to see the pharmacist. There is no reason why this may not apply to dentists too.

The present study showed that personal experience and knowledge about the product was the basis for recommendation of specific oral health care products by pharmacists. However, only 36% felt that fluoride in toothpaste was beneficial; a majority of them were unaware of the benefits of fluoride in toothpastes. This shows that there is a serious lack of knowledge regarding oral health care products, which has to be addressed. Similar to an earlier study, [1] 70% of the pharmacists expressed interest in advising their patients regarding oral health care. This demonstrates that pharmacists are an underutilized, but potentially valuable, oral healthcare resource. Major flaws in the oral healthcare knowledge of pharmacists has been demonstrated by previous studies but if some effort is invested in their training, they can be expected to take up more responsibilities as oral healthcare providers. Our research is consistent with other studies which show that pharmacists generally wish to play a more active role in health promotion. [11] Of the pharmacists in this study, the majority expressed the wish to participate in oral health promotion activities. There is a need to support the pharmacists in this respect, especially during national campaigns. Their expectations by way of such support are the provision material such as relevant information leaflets, pamphlets, posters, etc.; this is not financially demanding. Ghalamkari et al . [10] reported the benefits that accrue from having proactive pharmacists who have been provided with relevant training and support. This study reiterates that proactive pharmacists, and the pharmacy environment, can be conducive to the dissemination of health-related advice.

It is interesting to note that most of the barriers to health promotion in pharmacies that have been mentioned in previous studies [12] have also been cited in the present study; in addition, possible solutions have been suggested, mostly by the pharmacists themselves. Multidisciplinary meetings, especially meetings with local dentists or practitioners can improve the 'team' spirit and thereby improve the delivery of oral health care advice. Production of information leaflets and provision of courses can be useful, and inexpensive, options.


   Conclusion Top


Pharmacists already provide some amount of oral health advice and they are keen to expand their knowledge. Patients regularly ask for their advice on both general and oral health care issues. They are presently an underused resource, and it is only now that they are beginning to get the recognition they deserve. There is a definitive need for training of pharmacists and providing them with access to information on available dental services.

Recommendations

Pharmacists have long served as the medication experts of the health care team and, due to their knowledge and accessibility, are frequently approached by the general public and other professionals to answer health-related questions. In this context, the recommendations by Maunder and Landes [1] need to be considered for improving the oral healthcare provision by pharmacists; these recommendations are:

  1. Setting up of regular multidisciplinary and primary care team meetings.
  2. Funding for more opportunities for continuing professional development, such as oral health courses.
  3. Funding for information leaflets, especially during national oral health campaigns.
  4. A list of key contacts within the area of practice to be provided to pharmacists for advice regarding tobacco cessation, clarifications regarding oral health, etc.
  5. Support for window displays, especially about targetting health issues, including oral health.


The above recommendations would enable the pharmacist to follow the correct procedures agreed upon at the local multidisciplinary meetings. They would however have to be validated to meet national standards.

 
   References Top

1.Maunder PE, Landes DP. An evaluation of the role played by community pharmacies in oral healthcare situated in a primary care trust in the north of England. Br Dent J 2005;199:219-23.  Back to cited text no. 1    
2.Graham L, Stensland S. Pharmacist's expanding role in oral health and dental care. Available from: https:www.secure.pharmacytimes.com/lessons/200406-04.asp, accessed on 20 th July 2007.  Back to cited text no. 2    
3.Iwanowicz SL, Marciniak MW, Zeolla MM. Obtaining and providing health information in the community pharmacy setting. Am J Pharm Educ 2006;70:57.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.McLcod I, et al. Oral health: A role of pharmacist in cancer detection. The Pharmaceutical Journal. (Accessed from Graham L and Stensland S. Pharmacist's expanding role in oral health and dental care. https:www.secure.pharmacytimes.com/lessons/200406-04.asp, accessed on 20 th July 2007.  Back to cited text no. 4    
5.Caruana S. The management of oral disease in community pharmacy. Available from: http://www.cis.um.edu.mt/phcy/symp98/StephanieCaruana.html.  Back to cited text no. 5    
6.Chestnutt IG, Taylor MM, Mallinson EJM. The provision of dental and oral health advice by community pharmacist. Br Dent J 1998;11:532-4.  Back to cited text no. 6    
7.Anderson C. Promoting oral health: Nurses and pharmacist working together. Br J Comm Nurs 2001;19:453-7.  Back to cited text no. 7    
8.US Pharmacist. Available from: http://www.uspharmacist.com/oldformat.asp?url=nelook/files/cons/oralhealth.html.  Back to cited text no. 8    
9.Canker sores (apthous ulcers). McKinley Health Center. University of Illinois. Available from: http://www.mckinlev.vive.edu/health-infor/dis-cond/misu/cankerso.html.  Back to cited text no. 9    
10.Ghalamkari HH, Rees J, Saltrese-Taylor A, Ramsden M. Evaluation of pilot health promotion project in pharmacies: (2) Clients' initial views on pharmacists' advice. Pharm J 1997;258:314-7.  Back to cited text no. 10    
11.Rozeir RG. Available from: http://www.nider.nih.gov/news/consensus.asp.  Back to cited text no. 11    
12.Moore S, Cairns C, Narding G, Craft M. Health promotion in the high street: A study of community pharmacy. Health Econ J 1995;54:275-84.  Back to cited text no. 12    

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Correspondence Address:
P D Madan Kumar
Department of Preventive and Community Dentistry, Ragas Dental College and Hospital, 2/102, East Coast Road, Uthandi, Chennai - 600 119
India
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DOI: 10.4103/0970-9290.40462

PMID: 18445925

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