JOURNAL OF DENTAL SCIENCES

Volume 2 Issue 2

ORAL HYGIENE STATUS IN CENTRAL GUJARAT, 2010 - AN EPIDEMIOLOGICAL STUDY

Dr. Heena Pandya M.D.S. Dr. Rushik Dhaduk B.D.S. Abstract: Objective: This study was aimed to evaluate oral hygiene habit, attitude and status in Central Gujarat. Method and material: Oral Hygiene Index Simplified was recorded in adult subjects (n -1340 between the age group of 18 to 60 years), who attended free dental check up camps held by Faculty of Dental Science, Dharmsinh Desai University, Nadiad. It was a cross sectional study. Subjects included in the study completed interview and oral examination in natural day light at camp site. All were given privilege card for free treatment at the Faculty of Dental Science and given proper advice for further dental treatment and oral hygiene care. Result: Total 1340 subjects were questioned about oral health practices and clinically examined. Oral Hygiene Index Simplified was good in 29.47%, fair in 32.08%, poor in 38.43%. Conclusion: Till today, large numbers of people are not aware of correct oral hygiene and home care methods. If importance of tooth brush, dentifrice, frequency of brushing and proper brushing technique is advocated to the community at large, oral hygiene can be uplifted easily and burden of prevalent periodontal diseases can be remarkably reduced. The change to the healthy attitude and practice can be instilled by furnishing proper information, and motivation. Key words: Oral hygiene, Oral hygiene index, Oral health. Introduction The 20th century was noteworthy for many epidemiological advances that occurred in the study of oral diseases and conditions. The biologic perspective to these epidemiologic studies contributed a wealth of valuable information about the burden of oral diseases, how it has changed over time and its distribution among the population according to important demographic and social characteristics. Tai BJ et al1 in China and Garbin at al2 in Brazil 2009 had demonstrated that oral health promotion in school children is an effective way to reduce new caries incidence, improve oral hygiene and establish positive oral health practices. This study was conducted to evaluate current status and to develop correct oral health habits in population so that teeth, mouth, jaws can be maintained in a good health and function well 3 and to review the prevalence of oral hygiene status of population which can be used in public health practice particularly for monitoring the impacts of oral diseases on quality of life at the national level and in public health surveillance of oral disease burdens at the local and state levels. Gujarat is among the most prosperous provinces in the country but deplorably there is a shocking lack of awareness and understanding of oral health. This lack of awareness combined with prevalence of myths and superstitions has lead to alarmingly high rates of dental caries, periodontitis, malaligned teeth and many other dental diseases which ultimately affect the general health.4 Hart JT in Lancet5, 1971 Reader Tutor Department of Public Health, Faculty of Dental Science, Dharmsinh Desai university, Nadiad - 387 001. Gujarat, India stated that inverse care law is prevalent in dentistry The availability of good medical care tends to vary inversely with the need for it in the population served. The comprehensive oral health assessment gives in sight to the oral health issues and distinct dental needs. With our sincere desire to collect data of oral health status, this study was targeted at rural people who are deprived of even private dental practitioners. Aims and Objective : The objectives of this study include; To evaluate the awareness and knowledge about dental health among rural people and their oral hygiene practices. To evaluate oral hygiene status and to make the people aware of proper home care. To develop healthy attitude and practice by giving adequate information and motivation. Material and method : The study was a cross-sectional study. Random sampling method was selected for qualitative data collection of 1340 subjects. Kheda and Anand districts are situated in central Gujarat. Faculty of Dental Science is situated at college road in the city of Nadiad. It is easily approachable by people of Nadiad, Anand (20km from Nadiad) and many villages situated within the periphery of 30 kms. Patients (age ranging 18 to 60 years) who attended serial camps organized by the Faculty of Dental Science, Dharmsinh Desai University were
Address for Correspondence : Dr. Heena Pandya M.D.S. Department of Public Health, Faculty of Dental Science, Dharmsinh Desai university, Nadiad - 387 001. Gujarat, India M 9879559689 E-mail : pandyaheena@yahoo.com

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included in the study. They were questioned about their oral health practices through a structured questionnaire. This includes general information (Personal data like name, age, address, and occupation), medical history, dental history, etc. Patients were also questioned about their dental hygiene practices and data of frequency of changing tooth brush, frequency of brushing per day etc were collected. Examination points also included extra oral examination (swelling, jaw and temporomandibular joint examination), intra oral examination (soft tissues and deposits). Evaluation of clinical condition was carried out by Oral Hygiene Index Simplified. This index is used to evaluate an individuals level of oral cleanliness and to a more limited extent in clinical trials.6 This index is easy to use because the criteria are objective, the examination may be performed quickly and a high level of reproducibility is possible with a minimum of training sessions. Oral Hygiene Index Simplified was recorded for each patient. Its values range from 0 to 6, which can be interpreted as: Good 0 to 1.2 Fair 1.3 to 3 Poor 3.1 to 6 No. of Subjects out of 1340 Percentage

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it was observed that1153 (86.04%) were brushing once a day and only 187 (13.96%) were brushing twice a day. 1179 (87.98%) were aware about the type of brush they were using. 161 (12.02%) were not aware of the type of tooth brush they have been using. Chart 2 shows the analysis of dental visits.1105 (82.31%) had never visited a dental surgeon, 186 (13.88%) visited a dental surgeon when they have a specific complaint, 49 (3.65 %) would regularly visit a dental surgeon at every six months. Chart 3 shows the analysis of dentifrices used. 1107 (85.15%) were using a regular tooth paste. 115 (8.58%) were using a regular tooth powder. 22 (1.64%) were using tobacco containing dentifrice. It was also found that 96 (7.16%) were using an ayurvedic tooth paste. Male No. of Subjects out of 1340 Percentage Table 1 : Sex distribution of subjects Good 395 29.47 Fair 430 32.08 Poor 515 38.43 902 67.32 Female 438 32.68

Patients were made comfortable in the chair and were examined by an examining doctor standing besides the patient. Whenever possible, natural light was used to examine the patients oral cavity. Inspection was done using the Type 3 examination7 which includes use of a mirror and an explorer and it is carried out under good illumination. Tooth was probed to detect sub gingival calculus and debris score. Regular infection control protocol for both examiner and subjects were strictly observed. The main aim of public education was kept in the minds of examiners during surveying. Adequate counseling was done and importance of preserving normal tooth structure was explained to all the individuals. All subjects were given free treatment cards. Results : Defining oral health related quality of life is difficult because the concept is illusive and abstract, multidimensional without clear demarcations of its different components, subjective and personal and evolving within and across population groups as culture and societal expectations change. In this study total 1340 adult subjects were examined. Table 1 shows that out of them 902 (67.32%) were male and 438 (32.68%) were female. The gender wise comparison shows that the number of males was more than females who attended free dental check up camps. Table 2 shows that out of total subjects examined by Oral Hygiene Index Simplified, 395 (29.47%) were interpreted as a good, 430 (32.08%) were interpreted as fair and 515 (38.43%) were interpreted as poor. This analysis shows that more than 1/3 of people have poor oral hygiene and they need to be addressed for their oral conditions. Table 3 shows that 1288 (96.12%) were not aware about specific brushing techniques, rest 52(3.88%) were using specific brushing technique. Out of the later group 49 (3.65 %) were using vertical brushing technique and 3 (0.15%) were using Bass sulcular brushing technique which was advocated by dental surgeons. About the brushing frequency,

Table 2 : Results of Oral Hygiene Index - Simplified Aware Not Aware Bass Sulcular Vertical Method Method No. of Subjects out of 1340 Percentage 1288 96.12 03 0.15 49 3.65

Table 3 : Brushing technique, frequency of brushing and type of brush : Brushing Technique : Once a Day No. of Subjects out of 1340 Percentage 1153 86.04 Twice a Day 187 13.96

Frequency of Brushing : Type of Brush : Not Aware No. of Subjects out of 1340 Percentage Table 4 : Type of Dentifrices used Tooth Paste No. of Subjects out of 1340 Percentage 1107 85.15 Tooth Tobacco Ayurvedic Powder containing Tooth Paste Paste 115 8.58 22 1.64 96 7.16 52 1179 87.98 Aware 161 12.02

JOURNAL OF DENTAL SCIENCES

Chart 1 : Results of OHI-S Index

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Chart 2 : Analysis of Dental Visits

90 80 70 60 50 40 30 20 10 0 82.31 3.65 13.88

Never Visited Regularly Visited Visited when have complains

Chart 3 : Analysis of Dentifrices

100 80 60 40 20 0 85.15 Tooth Paste 8.58 Tooth Powder 1.64 7.16 Tobacco Ayurvedic containing Tooth Paste Paste

Dentifrices

Conclusion : This study on oral hygiene assessment provided data of oral health status which can be used to estimate the level of oral hygiene. Significant number of subjects was not aware of proper brushing techniques. Only 3.65% were aware of injurious effects of horizontal brushing on teeth. 86.04% were brushing once a day which is a routine habit of cleaning the mouth in the morning resulting in high calculus and debris score. At the same time, large number of the subjects was not aware of the type of tooth brushes available. Less than one third of Indian population use a tooth brush and tooth paste to clean their teeth. More than 50% of those who use a tooth brush, are not aware of proper brushing techniques. Other hygiene aids like dental floss, interdental cleaning aids and mouth washes are not widely available and are rarely used. 8

This study helps in improving the preventive dental behavior and attitudes which is beneficial for a life time. This can be achieved by educating people about dental health through dental health programs. For the benefit of the community, dental health programs should be conducted repeatedly in order to improve the oral hygiene status. People should be made aware of brushing methods, usage of pit and fissure sealants and importance of preventive measures. Tooth brushing and other mechanical cleaning procedures are considered the most reliable methods of effective plaque removal, which is essential for prevention of periodontal diseases. There are number of people who are using tobacco containing dentifrices. It shows the need for oral health education on the use of dentifrices and its importance in oral hygiene among the population especially the lower social classes. Motivation and regular reinforcement are essential to promote ample oral hygiene. Dentists should actively promote the prevention of oral diseases through patient education that encourages self care prevention of dental caries, supplemented by needs related to professional preventive services. It is of utmost importance to highlight the necessity of improving oral health care at large. Summary: This epidemiological study covering 1340 subjects was done in central Gujarat to evaluate the oral hygiene status of a population with help of Oral hygiene index - simplified. The study shows that number of females who attended the dental check up camp was quite less in comparison of males. More than one third of people had poor oral hygiene and very few people (3.65%) were using proper brushing technique which signals the high need of oral hygiene education and awareness. The study also indicates significant lack of knowledge of proper brushing technique, type of tooth brush and use of proper dentifrices. References: 1) Tai Bj, Jiang H, Du MQ, Peng B. Assessing the effectiveness of school-based oral health promotion programme in Yichang Ci China. Community Dent Oral Epidemiol. 2009 Oct; 37:391-8. Ep 2009 Jul 14. 2) Garbin C, Garbin A, Dos Santos K, Lima D. Oral health education schools; promoting health agents. Int J Dent Hyg. 2009 Aug:7:212-6 3) Petersen PE, Torres AM. Preventive oral health care and health promotion provided for children and adolescent by Municipal Dental Health Service in Denmark. Int J Paediatr Dent.1999Journel 9:81-91. 4) School Dental Health Program: A Potential untapped yet? By M Ganesh et al. The Journal Of Ahmedabad Dental College and Hospital; 1(1),Mar-Aug.2010 pg2228 5) Hart JT. The inverse care law. Lancet1971; 1:405-12 6) Soben Peter, Preventive and Community Dentistry 3rd ed. Pg135, Arya publications New Delhi 1999. 7) Soben Peter, Preventive and Community Dentistry 3rd ed. Pg594 Arya publications New Delhi 1999. 8) Soben Peter, Preventive and Community Dentistry 3rd ed. Pg135 Arya publications New Delhi 1999. 53