| Abstract|| |
Objective: To assess the knowledge of primary school teachers in Dharwad, India, regarding the prevention of oral cancer and gum disease.
Materials and Methods : In this cross sectional study a self administered questionnaire was used for data collection. A total of 184 school teachers were selected for the study. A response rate of 96.7% (n = 178) was obtained.
Results : Of the respondents, 36.5% (n = 65) had poor knowledge, while 27.5% had good knowledge regarding the prevention of oral cancer and gum disease. School teachers with postgraduate qualification were better informed with regard to the prevention of oral diseases as compared to those with only a bachelor degree. Factors such as education, sex, and type of institutional funding (public/private) were significantly correlated with the level of knowledge (R2 = 0.1128; P < 0.05).
Conclusion : School teachers need to be motivated to improve their awareness and knowledge about the prevention of oral cancer and gum diseases, particularly the younger teachers and those with only bachelor degrees. Establishment of school-based oral-health promotion programs in India is urgently required.
Keywords: Gum disease, oral cancer, oral-health knowledge, prevention, school teachers
|How to cite this article:|
Mangalore S, Venkata PK, Basavantappa JS, Preetha S. Knowledge about prevention of oral cancer and gum disease among school teachers in Dharwad, India. Indian J Dent Res 2013;24:279-83
Schools are ideal site for the presentation of health-related information. They offer an efficient and effective way to reach over 1 billion children worldwide and, through them, their families and community members.  Poor oral health can have a detrimental effect on children's performance in school and their success in later life. 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.  More than 50 million hours annually are lost from school due to oral diseases.  Through schools, health promotion messages can be delivered and reinforced during the most influential stages of a person's life, enabling him or her to develop beneficial attitudes and skills that can be sustained lifelong. Investments in school are intended to yield benefits to communities, nations, and individuals. Such benefits include improved social and economic development, increased productivity, and enhanced quality of life. Schools are a suitable platform for organizing preventive health services that can be made available to all children, including those who, for a variety of reasons, may not be receiving professional care.
|How to cite this URL:|
Mangalore S, Venkata PK, Basavantappa JS, Preetha S. Knowledge about prevention of oral cancer and gum disease among school teachers in Dharwad, India. Indian J Dent Res [serial online] 2013 [cited 2019 Nov 19];24:279-83. Available from: http://www.ijdr.in/text.asp?2013/24/3/279/117986
India, an emerging economy, still faces many challenges in meeting the oral-health needs of its population. Of the country's population of just over one billion, 32.3% are less than 15 years old.  The majority of India's population resides in rural areas and more than 40% of this population constitute children, most of whom have access to schools. 
Among the common oral diseases, oral cancer and gum diseases can be prevented if proper knowledge is provided at an early stage. Often, the high school years are the time that children pick up adverse habits such as tobacco or arecanut chewing, smoking, etc., These are habits that have a considerable effect on oral health and can lead to oral cancer and gum disease. , The school years cover a period that runs from childhood to adolescence. These are influential stages in people's lives when lifelong oral health-related behaviors, as well as beliefs and attitudes, are being developed.
School-based dental education is internationally recognized and plays an important role in increasing the knowledge regarding oral health among school teachers. ,,,,,, Previous studies have shown that school teachers in developed countries have inaccurate knowledge regarding the methods for prevention of dental caries,  and have disappointingly poor knowledge of oral health and disease. 
Health literacy is important for individuals to gain the knowledge and skills necessary for maintaining good health, including oral health, for themselves and for others who depend on them. The health professional needs to adopt a practical approach for prevention of oral diseases.  One of the important components of the healthcare delivery system in any country is the school health program,  and school teachers should be trained to provide oral-health education. In view of the important role that teachers can play in preventing oral diseases, in this study we aimed to assess the knowledge of primary school teachers in Dharwad, India, regarding the prevention of oral cancer and gum disease.
| Materials and Methods|| |
This study was conducted in Dharwad city in the northern region of Karnataka state in India.
Study population and sampling procedure
Dharwad city has a total of 108 primary schools, with 652 teachers. We carried out a multistage random sampling to select the study population. The primary schools in Dharwad are distributed under four zones (east, west, north, and south). In the first stage of sampling, we randomly selected two of these four zones. There were 53 primary schools in the two selected zones. From these 53 schools we again randomly selected 27 schools. Finally, 184 teachers were randomly selected from these 27 schools.
Data were collected by means of a self-administered questionnaire that included 15 items. Each item had four possible responses: One correct and three incorrect. The response for each item was scored as either correct (=1) or incorrect (=0). The questionnaire consisted of two parts; part I was related to prevention of oral cancer and included questions on tobacco chewing, smoking habit, consumption of spicy food, alcohol consumption, ill-fitting denture, and brushing twice a day. Items on prevention of gum disease were included in part II; these included questions on chewing tobacco, smoking habit, loose teeth, bad breath, bleeding gums, dental flossing, brushing twice a day, and dentist visits.
The validity and reliability of the questionnaire was assessed in a pilot study. The index of homogeneity (i.e., Cronbach's alpha) was performed for the questions related to knowledge regarding prevention of oral diseases; the alpha value was found to be 0.8079. The item test correlation,(item means questions related to asses the knowledge) the percentage of correct answers, and the relationship between true score and error for each of the questions on knowledge ranged from 0.1264-0.5384. The split-half reliability of the questionnaire was estimated as 0.9510. We also assessed the influence of age, sex, educational qualifications (Bachelor of Education [BEd] and postgraduate Master of Education [MEd]), years of teaching experience, and type of institutional funding on knowledge regarding prevention of gum disease and oral cancer. (The schools were categorized into three groups according to the type of institutional funding: Schools managed by public funds only, schools receiving public funds but governed by private management, and schools managed by private funding only).
Data were analyzed using Stata ® 9.2 software. Internal consistency of the questionnaire was calculated by Cronbach's alpha. For convenience of statistical analysis, in order to develop a continuous variable this could be utilized for regression analysis. (For convenience of statistical analysis, in order to develop a continuous variable which could be utilized in regression analysis, a total score was estimated by adding the knowledge responses to the all 15 items.) The knowledge score ranged from 0 to 15. The total knowledge score was calculated by adding the scores for all 15 items. The same procedure was applied for both parts of knowledge towards prevention of oral diseases (oral cancer and gum disease). Later, the total knowledge score for each teacher was classified as 'good,' 'fair,' or 'poor' on the basis of quartiles of the scores (i.e., ≤Q 1 = poor knowledge, between Q 1 and Q 3 = fair knowledge, and ≥ Q 3 = good knowledge). The Chi-square test for association was used to determine the associations between categorical variables. The independent t-test was performed to determine the significance difference between two sample means, and the one-way ANOVA was used to find out the difference between more than two sample means; Newman-Keuls multiple post hoc tests procedure used for pair-wise comparison. A step-wise multiple linear regression procedure was performed to examine the impact of independent factors on knowledge regarding prevention of oral diseases and its dimensions. Consequently, the relative contribution of each independent factor was calculated by taking beta coefficient and the Pearson correlation coefficient on total knowledge and its dimensions.(its karl pearson - name of a test) Statistical significance was set at P < 0.05.
| Results|| |
From the selected schools, 184 school teachers were identified for inclusion in the study. Out of these, 178 teachers (approximately equally distributed among the three types of institutional funding schools)(Types of institutional funding were, schools managed by public funds only, schools funded by public funds but managed by private management, and schools managed by private funding only.) participated, giving a response rate of 96.7%. Of the 178 teachers, 82.02% were females and 17.98% were males. The mean age was 42.2 ± 9.8 years. The mean teaching experience was 7.17 ± 3.25 years. About 48% of teachers had bachelor degrees (BEd), while 52% possessed postgraduate degrees.
Of the subjects, nearly 37% had poor knowledge and 27.5% had good knowledge about prevention of oral diseases. The association between level of knowledge and age, sex, type of institutional funding, and years of teaching experience were not statistically significant (P > 0.05). Teachers with postgraduate degrees had significantly higher knowledge about prevention of oral diseases compared to those with only bachelor degrees (P = 0.0000) [Table 1].
|Table 1: Association of different characteristics with knowledge regarding prevention of oral diseases|
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The mean scores for knowledge regarding prevention of oral cancer differed significantly with age. Older teachers had higher mean scores as compared to the younger teachers (20-29 years old). Male and female teachers did not vary significantly with respect to overall knowledge, but females had higher scores than males with respect to knowledge regarding prevention of gum diseases.
Teachers with postgraduate qualifications had better knowledge about prevention of oral diseases compared to those with only a bachelor degree. Knowledge scores did not differ according to type of school (i.e., institutional funding) [Table 2].
|Table 2: Comparison of knowledge and its component scores between the subpopulations|
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Nearly 93% of the respondents knew that oral cancer could be prevented by stopping tobacco chewing; 91.57% knew that smoking increased the risk of oral cancer and 70.22% indicated that consumption of spicy foods also increased risk of the disease. Also, 63% knew that brushing teeth at least twice a day would help reduce risk of oral cancer. Most (84.83%) of the school teachers felt that gum disease could be prevented by avoiding tobacco chewing and 84.27% thought that gum disease could be prevented by flossing teeth and visiting the dentist regularly. Also, 83.15% and 68.54%, respectively knew that bleeding on gums and loose teeth could lead to gum disease.
[Table 3] clearly shows that the contribution or influence of three of the background variables within the regression equation is statistically significant (P < 0.05). These variables are education (those with an additional educational degree have better knowledge), type of institutional funding (those have working in both public and private funding institutions have higher knowledge), and sex (male teachers were less likely to have good knowledge). These finding explain 11.28% of the variance of the knowledge scores. In which, the contribution of education on knowledge is maximum (6.8396%) followed by types of institutional funding (2.8429%) and gender contributed least (1.6066%).Study subjects with post graduate degree had better knowledge followed by institutional funding (public or private) and gender.
|Table 3: Summary of stepwise regression analysis of overall knowledge and knowledge regarding the individual components (oral cancer and gum disease)|
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Though, the three variables of age, type of institutional funding, and educational qualification contributed significantly (P < 0.05) to explain 15.45% of the variance of the knowledge scores towards prevention of oral cancer. Older teachers with postgraduate degrees had a greater knowledge about prevention of oral cancer. Moreover, the contribution of only education on knowledge towards prevention of gum disease was found to be statistically significant (P < 0.05) and explains about 4.87% of the variance of preventive knowledge of gum disease.
| Discussion|| |
Of the diet- and lifestyle-related diseases, oral disease is one of the most costly to treat.  Moreover, the cost of neglect is also high in terms of its financial, social, and personal impacts.  Many oral health problems are preventable and their early onset is reversible. However, in several countries, a considerable proportion of children, parents, and teachers have limited knowledge of the causes of oral disease and the methods of prevention. ,
The school is where most school-age children spend much of their time: Up to 6 or 7 hours a day, 9 months a year. According to Frazier: 'Society has a responsibility to educate its youngsters concerning the scientific knowledge about measures for preventing oral diseases.  School children, as educated by the teachers, are not important as far as prevention of disease among themselves in the present, but also their future role as adults and opinion leaders of next generation. Hence, in the present study, an effort was made to assess the knowledge regarding oral cancer and gum disease among Indian primary school teachers by means of self-administered questionnaire.
In the present study, 92.70% and 84.88% of school teachers knew that oral cancer and gum disease could be prevented by avoiding tobacco chewing. To utilize the potential of teachers, the dental profession should encourage the inclusion of topics on oral health, methods of prevention of oral diseases, and oral health promotion in the curriculum of schools.
Older teachers with post graduate degree had greater knowledge about the prevention of oral cancer as they may have gained knowledge over the years of teaching. Also, school teachers with additional educational degrees had better knowledge about the prevention of oral cancer and gum disease. A similar study  done earlier has shown that school teachers, with their educational experience and close contact with students, can actively contribute to students' health promotion, provided that they receive enough training and support to do so.
Through school teachers there is the potential for reaching all children, but if they themselves are misinformed about oral health and preventive measures they cannot assist in developing well-informed students. In India, it has been recommended in the National Oral Health Policy  that school teachers be trained in giving oral-health education. Also primary preventive measures should be implemented in the urban and rural areas through school health schemes. In addition, topics on oral health can be included in school textbooks of 3 rd , 5 th and 8 th grade levels. Regular oral-health promotional activities in form of health education, regular dental check-ups, demonstration of brushing and rinsing techniques, and preventive and interceptive treatment can be undertaken at the school level.
The results of the present study show that a large proportion of school teachers has poor knowledge about oral cancer and gum disease. Awareness can be improved by providing teachers, the accurate knowledge about oral health and preventive measures. Special emphasis should be given to training younger teachers and those with only bachelor degrees. The establishment of school-based oral-health promotion programs in India is urgently required.
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Department of Public Health Dentistry, Shri Dharmastala Manjunatheshwar College of Dental Sciences and Hospital, Dharwad, Karnataka
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3]