Year : 2008 | Volume
: 19 | Issue : 3 | Page : 236--242
Oral health-related KAP among 11- to 12-year-old school children in a government-aided missionary school of Bangalore city
AG Harikiran, SK Pallavi, Sapna Hariprakash, Ashutosh, KS Nagesh
Department of Preventive and Community Dentistry, DAPMRV Dental College, Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, India
A G Harikiran
Department of Preventive and Community Dentistry, DAPMRV Dental College, Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka
Background: To organize community-oriented oral health promotion programs systematic analysis of the oral health situation would be needed, including information on oral health knowledge, attitudes, and practices (KAP).
Aim: The aim of this study was to assess knowledge, attitude, and practice (KAP) toward oral health among 11 to 12-year-old school children in a government-aided missionary school of Bangalore city.
Materials and Methods: The study group comprised of 212 children (Male: 108; Female; 104) who were in the age group of 11-12 years studying in a government-aided missionary school of Bangalore city. Data on oral health KAP were collected by means of a self-administered questionnaire. Statistical significance was determined by Chi-square test.
Results: This survey found that only 38.5% of the children brush their teeth two or more times a day. Pain and discomfort from teeth (35.1%) were common while dental visits were infrequent. Fear of the dentist was the main cause of irregular visit in 46.1% of study participants. High proportion of study participants reported having hidden sugar at least once a day: soft drinks (32.1%), milk with sugar (65.9%), and tea with sugar (56.1%). It was found that 5.4% and 3.9% of study participants smoke and chew tobacco, respectively.
Conclusion: Results of this study suggest that oral health KAP of study participants are poor and needs to be improved. Systematic community-oriented oral health promotion programs are needed to improve oral health KAP of school children.
|How to cite this article:|
Harikiran A G, Pallavi S K, Hariprakash S, Ashutosh, Nagesh K S. Oral health-related KAP among 11- to 12-year-old school children in a government-aided missionary school of Bangalore city.Indian J Dent Res 2008;19:236-242
|How to cite this URL:|
Harikiran A G, Pallavi S K, Hariprakash S, Ashutosh, Nagesh K S. Oral health-related KAP among 11- to 12-year-old school children in a government-aided missionary school of Bangalore city. Indian J Dent Res [serial online] 2008 [cited 2020 Jun 6 ];19:236-242
Available from: http://www.ijdr.in/text.asp?2008/19/3/236/42957
Oral diseases qualify as major public health problems owing to their high prevalence and incidence.  Oral health knowledge is considered to be an essential prerequisite for health-related behavior.  It has been shown that Indian children have low level of oral health awareness and practice as compared to their western counterparts. 
Little is known about oral health attitudes and behavior of children from developing countries as comparison with developed countries. 
Aim of this study was to assess oral health attitude, knowledge, and practice (KAP) of school children in a government-aided missionary school of Bangalore city.
Materials and Methods
This study was conducted to assess the KAP among 11 to 12-year-old school children studying in a government-aided missionary school of Bangalore south. A total of 212 school children (Male: 108; Female; 104) were selected for the study. Age group 11-12 years was selected for the study with the intention that the baseline data collected will be used for future planning of a school oral health programs which will be for duration of 2 years. All the children in the age group of 11-12 years who were present on the day of data collection were included in the study. Consent for participation of school children was obtained from the obtained head of the school.
Data on oral health KAP was collected by means of 18 self-administered close-ended questionnaires. The questionnaire was pretested by conducting pilot study among 10% of sample size to assess the children's ability to understand the questions and answer them without any help.
The questions were in local language Kannada as well as in English. Steps were taken to ensure the reliability of the language translation. The questionnaire included details such as demographic data, perceived dental health status, oral health KAP, behavior (practice) toward dental problems and past dental experience, dietary history, and adverse oral habits. It took about 20 min to fill all the questionnaires. Interpersonal communication was not allowed and the children were informed of the importance of answering the questions honestly. Questionnaires were completed under the supervision of investigator. The demographic data of the study subjects are represented in [Table 1].
The collected data were analyzed using SPSS version 10. The statistical significance was determined by the Chi-square test, and the level of significance was set at P Perceived oral health status
[Table 2] presents the perceived oral health status of the study participants. Approximately 33% and 7% of study participants considered their oral health excellent and poor, respectively, 9.4% were not satisfied with the appearance of their teeth, and 21.9% of study participants avoided smiling and laughing because of their teeth. It was also found that 83.8%, 47%, and 40.7% of study participants thought that the dentist would advice them to brush better, for cleaning of teeth, and filling of teeth if they visit dentist now.
Oral health knowledge and attitude
[Table 3] presents the distribution of 11 to 12-year-olds by their answers to statement on knowledge and attitudes toward oral health. Study participants, 58.4%, received information regarding oral health mainly from television. Only 20.9% considered keeping natural teeth was important. Thirty-seven percent of study participants agreed that tooth decay makes them look bad. It was found that 75.1% thought that brushing teeth prevents tooth decay and gum disease and 48.9% (46%: Male; 52.6% Female) knew the reason that eating sweets causes tooth decay. Only 36.3% knew that fluoride prevents tooth decay.
Study participants, 46.1%, were afraid of going to dentist because of pain and 67.8% agreed that regular visit to dentist keeps away dental problem.
Oral health practices
Oral health practices of the study participants are highlighted in [Table 4]. It was found that 58.9% (Male 60.6%: Female: 57%) brushed their teeth once a day, while 38.5% (male 34.4%: Female:43%) two or more times a day and 2.6% irregularly. It was also found that 50.9% use fluoridated tooth paste for tooth brushing, 23.7% use plastic tooth picks, 10.4% use chew sticks, and only 4.6% use dental floss for cleaning teeth and gums.
Behavior (practice) toward dental problems and past dental experience
[Table 5] shows that 59.7% (Male: 63.8%; Female: 55.2%) had toothache during past 12 months and 21% missed classes because of tooth ache. It was found that 35.1% (Male: 33.7%; Female: 36.6%) of study participants have visited the dentist during last 12 months. The main reason for the last visit was because their parents (50.9%; with mother; 51.2%) had made an appointment with the dentist. During the last visit, 66.7% of study participants have undergone screening, 21.6% of study participants have undergone restoration, 23.9% scaling, and 30.9% extraction of teeth.
[Table 6] describes the distribution of children by frequency of consumption of fruits and sugary items. Seventy-nine percentage consumes sweets regularly, i.e. several times a day to once in a week while 21% never consume sweets. High proportion of study participants reported having hidden sugar every day: soft drinks (32.1%), milk with sugar (65.9%), and tea with sugar (56.1%).
Adverse oral habits
[Table 7] highlights the adverse oral habits of the study participants. It was found that 5.4% and 3.9% smoke cigarettes and chew tobacco regularly ranging from everyday to once in a week.
This study assessed oral health attitudes, knowledge, and practice of school children in a government-aided missionary school in Bangalore city. In this study, a government-aided missionary school was selected. Such schools in addition to catering to children of lower socioeconomic strata offer certain administrative advantages and a favorable framework for development, implementation of comprehensive oral-health programs. A number of schools situated in the country are of similar nature. In the present study, all the study participants in the age group of 11-12 years who were present on the day of the study were selected. The data were collected by means of structured questionnaires. The questions were written at a language level that should have allowed comprehension by even the youngest subjects (age 10 years). Furthermore, the investigator was always available during the completion of the questionnaire, and the subjects were encouraged to approach him whenever they needed clarification of any point.
In the present study, 10.9% and 26.1% of fathers and mothers of the study participants were illiterate. This is comparable to the data from National oral health survey and fluoride mapping, India  where it was 17.4% and 28.1% for males and females in the age group of 35-44 years.
Perceived oral health status [Table 2]
In the present study, 33.3% of participants answered that health of their teeth was poor which was very less when compared to a previous study by Benoit Varenne et al.  where it was 63%. It was found that 21.9% of study participants avoided smiling and laughing because of their unattractive teeth which was similar to study by Petersen et al.  (20%) and is in contrast with the findings of study by Varenne et al.  (8%).
Oral health knowledge and attitude [Table 3]
The study participants received information regarding oral health mainly from television. This finding agrees with the findings of the study by Jamjoum.  In contrast to this, in a previous study by Varenne et al.,  many children living in urban areas received oral health information from their parents; the reason for this difference may be because parents of the children had high level of education when compared to the present study.
Approximately 37% were aware that carious dental caries affect dental aesthetics which was very less compared to study by Al-Omiri et al.  (77%). Awareness of the importance of tooth brushing for caries prevention was high (75.1%) among the study population. This finding is similar to study by Varenne et al.,  where majority of children in urban areas reported that tooth cleaning and regular dental visits may prevent oral disease. The children, 51.1%, were not aware whether consumption of sugary products may cause tooth decay which was similar to study by Varenne et al. (57%).  In all, the caries preventive effect of fluoride was not realized by a substantial proportion of the children. Only one-third (36.3%) correctly identified the action of fluoride as preventing tooth decay which was similar to study by Wyne et al. 
Children had positive attitudes toward their dentists; nevertheless, they indicated that they feared dental treatment. Although 67.8% of the study population was aware of the importance of regular dental visits, only 35.1% of the study population reported that they have visited dentist during last 12 months and this finding is consistent with the findings of other studies. 
A surprising finding in this regard was that most participants were aware of the importance of regular dental attendance. Fear of the dentist was the main cause of irregular visit in 46.1% of study participants which was very high compared to study by El-Qaderi and Taani et al.  In the present study, the participants were mainly from lower socioeconomic strata. It can also be considered that because of the high cost of dental treatment may have limited the accessibility of dental care.
Oral health practices [Table 4]
This survey found that only 38.5% brushed their teeth two or more times a day, but in a study by Zhu et al.  it was 44.4% of study participants. The subjects also reported irregular times of tooth brushing (2.6%) similar to study by Al-Omiri et al.  Lack of both parental and child oral health education might also explain these findings.
The use of other recommended oral hygiene methods such as dental floss (4.6%) was found to be rare; this also could be attributed to the lack of oral health education and/or the cost of such aids. This finding is similar to study conducted in North Jordon by Al-Omiri et al.,  where the use of dental floss [2%] was very less. In contrast, Hamilton and Coulby  found that a high percentage [42%] of the sample they studied in north eastern Ontario used dental floss, reason for this may be because significant resource allocation to health education programs are carried out.
In the present study, it was found that female performance was better than male performance in oral health practices which was similar to study by El-Qaderi and Taani.  Females performed the oral hygiene practices better than their male counterpart which is in agreement with other previous studies.  This difference can attributed to a higher concern regarding personal hygiene and health care among females.
Behavior (practice) toward dental problems and past dental experience [Table 5]
Though high percentage of study participants had pain from teeth (59.7%) during past 12 months, dental visits were infrequent (35.1%) which was similar to study by Varenne et al.  In contrast to this, in the studies by Petersen et al.  [66%] and Wierzbicka et al.  (61%), a high percentage of the study participants claimed annual dental visit. Fear of dental treatment was found to be high among the study population in the present study.
Dietary history [Table 6]
High proportion of study participants reported having hidden sugar every day: soft drinks (32.1%), milk with sugar (65.9%), and tea with sugar (56.1%) which was very high compared to study by Petersen et al.  Overall, there was no significant difference between male and female participants concerning the frequency of sweet consumption which was similar to study by El-Qaderi and Taani. 
Adverse oral habits [Table 7]
It was found that 5.4% and 3.9% of study participants smoke and chew tobacco, this when compared to National family health survey-2, India,  it was 1.8% and 4.1% respectively.
Based upon the present study findings, oral health KAP of the surveyed children is poor. This poor oral health-related KAP have to be addressed and focused upon as an important component of any comprehensive school oral health program.
The present study indicates that participants are mainly from lower socioeconomic status and parent's education is mainly limited to high school education. Results of this study suggest that oral health KAP among study participants are poor and needs to be improved. Findings of this study also show that utilization of dental service is mainly for pain relief with the mother being the prime person involved in the utilization of dental services. The results suggest that simple preventive oral health measures among study participants like brushing twice a day is not a norm. Based upon these findings, systematic community-oriented oral health promotion programs are needed to target lifestyles and the needs of school children. Also, information regarding oral health should be included on wider basis in the school curriculum in an attempt to prevent and control dental diseases. In this background, an oral health promotion program has to involve partnership of school authorities, parents, and dental-care providers such as dental colleges or public health department and funding agencies. Comprehensive oral health educational programs for both children and their parents are required to achieve this goal.
|1||The World Oral Health Report 2003: Continuous improvement of oral health in the 21st century - the approach of the WHO Global Oral Health Programme.|
|2||Al-Ansari J, Honkala E, Honkala S. Oral health knowledge and behavior among male health sciences college students in Kuwait. BMC Oral Health 2003;3:2.|
|3||Grewal N, Kaur M. Status of oral health awareness in Indian children as compared to Western children: A thought provoking situation (a pilot study). J Indian Soc Pedod Prev Dent 2007;25:15-9.|
|4||Al-Omiri MK, Al-Wahadni AM, Saeed KN. Oral health attitudes, knowledge, and behavior among school children in North Jordan: J Dent Educ 2006;70:179-87.|
|5||Dental council of India: National Oral Heath Survey and fluoride Mapping, India: 2002-2003.|
|6||Varenne B, Petersen PE, Ouattara S. Oral health behaviour of children and adults in urban and rural areas of Burkina Faso, Africa. Int Dent J 2006;56:61-70.|
|7||Petersen PE, Hoerup N, Poomviset N, Prommajan J, Watanapa A. Oral health status and oral health behaviour of urban and rural schoolchildren in Southern Thailand. Int Dent J 2001;51:95-102.|
|8||Jamjoum H. Preventive oral health knowledge, practice and behaviour in Jeddah, Saudi Arabia: Odonto-Stomatologie Tropicale: p. 13-8.|
|9||Wyne AH, Chohan AN, Al-Dosari K, Al-Dokheil M. Oral health knowledge and sources of information among male Saudi school children. Odontostomatol Trop 2004;27:22-6.|
|10||El-Qaderi SS, Taani DQ. Oral health knowledge and dental health practices among schoolchildren in Jerash district-Jordan. Int J Dent Hyg 2004;2:78-85.|
|11||Zhu L, Petersen PE, Wang HY, Bian JY, Zhang BX. Oral health knowledge, attitudes and behaviour of adults in China. Int Dent J 2005;55:231-41.|
|12||Hamilton ME, Coulby WM. Oral health knowledge and habits of senior elementary school students. J Public Health Dent 1991;51:212-9.|
|13||Beiruti N, Boles D, Poulsen S. Oral health knowledge and behaviour of a group of 15-year old school children from Damscus, Syria. Int J Paediatr Dent 1995;5:187-8.|
|14||Wierzbicka M, Petersen PE, Szatko F, Dybizbanska E, Kalo I. Changing oral health status and oral health behaviour of schoolchildren in Poland. Community Dent Health 2002;19:243-50.|
|15||Kapil U, Goindi G, Singh V, Kaur S, Singh P. Consumption of tobacco, alcohol and betel leaf amongst school children in Delhi. Indian J Pediatr 2005;72:993|