|Year : 2017 | Volume
| Issue : 1 | Page : 54-58
Oral health knowledge and practice among 9-12-year-old schoolchildren in the region of Madinah, Saudi Arabia, and its impact on the prevalence of dental caries
Khalid H Al-Samadani1, Mohammad Sami Ahmad2, Hala Abdelrahman Bakeer2, May Osman Gamar Elanbya2
1 Department of Restorative Dental Sciences, College of Dentistry, Taibah University, Madinah, India
2 Department of Preventive Dental Sciences, College of Dentistry, Taibah University, Madinah, India
|Date of Web Publication||18-Jan-2017|
Mohammad Sami Ahmad
Department of Preventive Dental Sciences, College of Dentistry, Taibah University, P. O. Box: 2898, Madinah 43353
Source of Support: None, Conflict of Interest: None
Background: Dental caries is one of the most common dental disorders affecting from all over the globe. Dental caries affects 60%-90% of schoolchildren in most developed countries, and in several developing countries, the prevalence rates are increasing. Objective: To know oral health knowledge and practice among 9-12-year-old schoolchildren and its relation with dental caries. Methods: This is a questionnaire-based cross-sectional studies conducted from September 20, 2015, to January 27, 2016, selecting four male and four female primary schools. Two calibrated examiners examined the students under the normal light with mirror and probe. Results: A total of 276 (92%) were included in this cross-sectional study. There were 118 (43%) were males and 158 (57%) were females with mean age of 10.61 years and having mean Decayed, Missing, and Filled Tooth/decayed, missing, and filled tooth (DMFT/dmft) 1.47/1.78 in male and 1.69/5.34 in female. Three-quarters of the sample (75%) reported to cleaning their teeth at least once per day, and >95% reported using a toothbrush and toothpaste. The mean DMFT/dmft and D/d scores of female were significantly higher (P < 0.05) than that of the males. The mean dmft and all the components decreased with age, and there was a significant association (P < 0.01) between oral health knowledge and the caries status. Children with a higher DMFT/dmft score tended to have poor oral health knowledge compared to those with low DMFT/dmft scores. Conclusion: Poor oral health knowledge contributes major role in the prevalence of dental caries in both male and female. In female higher DMFT/dmft was observed in spite of having good oral health knowledge.
Keywords: Decayed, Missing, and Filled Tooth, decayed, missing, and filled tooth, oral health knowledge, toothbrush, toothpaste
|How to cite this article:|
Al-Samadani KH, Ahmad MS, Bakeer HA, Elanbya MG. Oral health knowledge and practice among 9-12-year-old schoolchildren in the region of Madinah, Saudi Arabia, and its impact on the prevalence of dental caries. Eur J Gen Dent 2017;6:54-8
|How to cite this URL:|
Al-Samadani KH, Ahmad MS, Bakeer HA, Elanbya MG. Oral health knowledge and practice among 9-12-year-old schoolchildren in the region of Madinah, Saudi Arabia, and its impact on the prevalence of dental caries. Eur J Gen Dent [serial online] 2017 [cited 2019 Oct 16];6:54-8. Available from: http://www.ejgd.org/text.asp?2017/6/1/54/198615
| Introduction|| |
Dental caries is one of the most common dental disorders affecting the children from all over the globe. , It is the main cause of tooth loss among children, teenagers, and young adults. Dental caries affects 60%-90% of schoolchildren in most developed countries, and in several developing countries the prevalence rates are increasing.  There are many risk factors associated with the development of dental caries which include diet, saliva flow rate, oral health knowledge, and oral health practice.  In developed countries, the decline in dental caries prevalence has been attributed to population-based preventive programs with the use of ﬂuoride, improved participation in oral health programs and changes in oral hygiene and sugar intake habits. However, in many developing countries, there is an increase in dental caries, which has resulted from unhealthy dietary habits, limited use of ﬂuoride, and poor access to oral health services.  In addition, most oral health services in developing countries provide symptomatic treatment with little priority given to curative and preventive services.  Preventive care includes oral health education, the application of fissure sealants in permanent teeth and fluoride as preventive tools. Schools provide the ideal setting to reach millions of children and ensure strong foundations for a healthy life at an early stage of life.  Oral health and general health status depend on a dynamic interplay of many factors, including the individual's personal characteristics, behaviors, and perception.
The prevalence of dental caries varies across the different part of Saudi Arabia. Studies on primary schoolchildren reported the prevalence to be between 68% and 94% with later studies showing a decreased prevalence compared to older studies due to regular visit to school by the dental staff from the health services. ,,, The high prevalence indicates the serious nature of dental caries among young children. Although dental services are provided both by government and private sectors, utilization patterns are still poor. Twelve-year olds represent a standard age category used by the World Health Organization (WHO) to assess and compare dental caries levels in the permanent dentition of children worldwide. 
Social set up, oral health practice and oral health knowledge is important to know for the implementation of prevention of dental caries. This study was a part of outreach program of the final year BDS students from College of Dentistry, Taibah University.
The objective of the study was to know oral health knowledge and practice among male and female primary schoolchildren and its relation with the prevalence of dental caries.
| Methods|| |
This is a cross-sectional analytical study conducted on 9-12-year-old male and female schoolchildren from Madinah, Saudi Arabia. The study was performed from September 20 to January 27, 2016. Four male and four female primary schools were selected randomly from the city of Madinah. The purpose of the study was described to the headmaster of the each selected school. Consent forms were issued to all children for their parents to complete. Only children with signed parental consent were included in the study.
A questionnaire was designed to obtain the necessary information. It consisted of three parts, oral health practice, oral health knowledge, and utilization of dental services. Totally twenty questions were asked related to oral health practice, oral health knowledge, and utilization of dental services including demographic data. There were seven questions related to oral health knowledge, each positive answer was coded with one point while negative and do not know answers were coded as a zero. The maximum number of points that could be obtained was seven. Students who scored 0-2 points were considered "poor" those with 3-4 points were recorded as "average" and those with 5-7 were recorded as "good" knowledge. The questionnaire was in Arabic and was completed in an interview format with the principal investigator asking the questions to the participants.
The clinical oral examination was conducted in the school's classroom. The examination was conducted under the normal room light with a mirror and according to the WHO criteria.  The prevalence of dental caries was recorded using the decayed, missing, and filled tooth (dmft) index and the Decayed, Missing, and Filled Tooth (DMFT) Index for primary and permanent dentitions, respectively. Four calibrated examiners (two males and two females) carried out the oral examinations and the inter- and intra-examiner reliability was measured by re-examining every 10 th patient. The results of the inter- and intra-examiner agreement analysis was κ = 0.79 with P < 0.001. This measure of agreement is substantial. The ethical permission was obtained from the ethical committee of College of Dentistry, Taibah University.
The data were analyzed using IBM SPSS version 22 software package. The descriptive analysis included mean and standard deviations, and the statistically significant level was set on P < 0.05, and it is measured by t-test and correlation bivariate.
| Results|| |
A total of 300 students were given consent forms and of these of 276 (92%) were included in the study. The remaining 24 students were excluded, as they did not have signed consent forms. There were 118 (43%) were males and 158 (57%) were females with mean age of 10.61 years.
Three-quarters of the sample (75%) reported to cleaning their teeth at least once per day, and more than 95% reported using a toothbrush and toothpaste. More than two-thirds of the sample reported not using any additional means of tooth cleaning such as dental floss or toothpicks. The majority of participants (46%) reported visiting the dentist only when necessary. Among the females, 32% reported that they had never visited a dentist before compared to 16% of males.
The mean DMFT of permanent/dmft of deciduous and D/d scores of female were significantly higher (P < 0.05) than that of the males as shown in [Table 1].
The mean DMFT and D scores increased significantly (P < 0.05) with age from 1.18 in 9-year olds to 1.73 in 12-year olds. The mean dmft and all the components decreased with age as shown in [Table 2].
[Table 3] shows the mean oral health knowledge scores for male and female; females had significantly (P = 0.007) better oral health knowledge scores compared to males. The mean oral health knowledge among the different age group was similar as shown in [Table 4].
There was a significant association (P < 0.01) between oral health knowledge and the caries status. Children with a higher DMFT/dmft score tended to have poor oral health knowledge compared to those with low DMFT/dmft scores [Table 5].
|Table 5: Prevalence of dental caries in relation with oral health knowledge |
Click here to view
| Discussion|| |
This was the first study conducted to compare oral health knowledge and practice among 9-12-year-old schoolchildren in the region of Madinah, Saudi Arabia, and its impact on the prevalence of dental caries. The response rate was 92%, which was very much acceptable. There were not much difference between male and female students in time of cleaning and using tools to clean the teeth, but it was surprising that a great number of female students (32%) never visited the dentist. This might be due to not getting proper access because they are dependent on the parents (male members) who take them to the dentist or they ashamed to describe the disease to parents because of social culture.  Related to interdental cleaning most of the children were unaware. Among them, 68% did not use any tools to clean interdental space. Most of the previous studies also reported about unawareness of interdental cleaning aids. 
The mean DMFT/dmft was relatively higher (1.69/5.34) among females as compare to males (1.47/1.78). Mean DMFT score for 9-12-year-old children were little higher as compared to study of Mahrous et al. among 12-year-old schoolchildren.  The difference might be due to our mean DMFT was combination of 9-12-year-old children whereas there mean DMFT was only for 12-year-old children. The reason for high dmft among females might be due to poor communication with the parent, or lack of oral health awareness in addition to access to dental clinic in government hospital is not easy as waitlisted patients has long list due to shortage of pedodontists, so it results in negligence and delaying the treatment timely. The other reason might be the female child spend most of the time in home so they were consuming sweet food or drink after every small gap. They also felt ashamed to show their mouth. Female children mostly wanted to visit female dentist for the treatment. The prevalence of dental caries was 88% among both male and female students, and it showed increasing trends with the increase of age in both gender, which is slightly less than reported (94.4%) by Wyne et al. but their mean DMFT/dmft was similar to our study that was 1.6 ± 3.1/6.3 ± 3.5.  Another study conducted by Al Dosari et al. reported 91.2% prevalence of dental caries among 12-13-year-old schoolchildren.  Farooqi et al. reported mean DMFTl/dmft 1.94 ± 2.0 and 3.66 ± 3.13 respectively from Eastern Province of Saudi Arabia.  The variation of DMFT might be due to study performed at the different province of Saudi Arabia and dental caries prevalence varies due to different social culture in the different area of the country. In another study, Al Ansari reported higher DMFT score among 12-year-old schoolchildren compared to our study.  This might be due to changing level of education and improved oral health status among the schoolchildren. This also reflects in our questionnaire where >75% cleaning their mouth once in a day and 95% using toothbrush and toothpaste to clean their teeth . Filled (F) and (f) percentage is very low in both genders.
Regarding oral health knowledge, more than 50% had average knowledge but more number of females had good oral health knowledge. The similar report was presented by Amin and Al-Abad 2008; Farsi et al. 2004; Togoo et al. 2012. ,, The percentage of females having good oral health knowledge as more than twice as compare to male and knowledge had significant relation with gender P = 0.007. However, there was little difference in mean oral health knowledge among males and females. Mean oral health knowledge among males and females were 3.14 ± 1.13 and 3.47 ± 1.53, respectively. A similar study reported by Al Subait et al. among 10-18 years old attending Jenadriyah festival Riyadh.  Mean oral health knowledge in all age group was more or less same and it was not significant (P = 0.836) with the age. It might be due to the getting information regularly about oral health by the teachers and the dentist visiting school time to time. Females mean DMFT/dmft was higher [Table 1] as compare to male instead of having better oral health knowledge and it had significant relation (P = 0.01) with the knowledge of the subjects. It was surprising that female in spite of good level of awareness suffering more in number. Actual compliance of instruction back home might be variable from male group. Mean DMFT reduced as the knowledge of oral health among the student increased. ,,,
| Conclusion|| |
It was observed that poor oral health knowledge contribute major role in the prevalence of dental caries but in female higher DMFT/dmft was observed among girl in spite of having good oral health knowledge. Maybe due to hiding the problem and not brushing regularly.
The authors would like to thank the final year BDS students for contribution in arrangement of the program.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Amin TT, Al-Abad BM. Oral hygiene practices, dental knowledge, dietary habits and their relation to caries among male primary school children in Al Hassa, Saudi Arabia. Int J Dent Hyg 2008;6:361-70.
Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ 2005;83:661-9.
Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21 st
century - The approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003;31 Suppl 1:3-23.
Wyne AH, Al-Ghorabi BM, Al-Asiri YA, Khan NB. Caries prevalence in Saudi primary schoolchildren of Riyadh and their teachers' oral health knowledge, attitude and practices. Saudi Med J 2002;23:77-81.
Al Dosari AM, Wyne AH, Akpata ES, Khan NB. Caries prevalence and its relation to water fluoride levels among schoolchildren in central province of Saudi Arabia. Int Dent J 2004;54:424-8.
Farooqi FA, Khabeer A, Moheet IA, Khan SQ, Farooq I, ArRejaie AS. Prevalence of dental caries in primary and permanent teeth and its relation with tooth brushing habits among schoolchildren in Eastern Saudi Arabia. Saudi Med J 2015;36:737-42.
Al Ansari AA. Prevalence, severity and secular trends of dental caries among various Saudi populations: A literature review. Saudi J Med Med Sci 2014;2:142.
Mahrous MS, Bhayat A, Hifnawi T, Bakeer H, Ahmad MS. Can the prevalence of dental caries be used as an indicator of the quality of dental services? A cross- sectional study among children in Madinah, Saudi Arabia. J Taibah Univ Med Sci 2015;11:41-5. [Doi: 10.1016/j.jtumed. 2015.08.007].
Farsi JM, Farghaly MM, Farsi N. Oral health knowledge, attitude and behaviour among Saudi school students in Jeddah city. J Dent 2004;32:47-53.
Togoo RA, Yaseen SM, Zakirulla M, Nasim VS, Al Zamzami M. Oral hygiene knowledge and practices among school children in a rural area of Southern Saudi Arabia. Int J Contemp Dent 2012;3:57-62.
Al Subait AA, Aousaimi M, Geeverghese A, Ali A, El Metwally A. Oral health knowledge, attitude and behavior among students of age 10-18 years old attending Jenadriyah festival Riyadh; a cross-sectional study. Saudi J Dent Res 2016;7:45-50.
Al Agili DE. A systematic review of population-based dental caries studies among children in Saudi Arabia. Saudi Dent J 2013;25:3-11.
Prasai Dixit L, Shakya A, Shrestha M, Shrestha A. Dental caries prevalence, oral health knowledge and practice among indigenous Chepang school children of Nepal. BMC Oral Health 2013;13:20.
Khan SQ, Khan NB, Arrejaie AS. Dental caries. A meta analysis on a Saudi population. Saudi Med J 2013;34:744-9.
Al Shamrani AS, Bassuoni MW, Mohamed MA, Mohamed RN, Hussein YM. Caries prevalence and treatment need among primary school children in Taif, Saudi Arabia. Indian J Appl Res 2015;5:326-8.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]