|Year : 2021 | Volume
| Issue : 1 | Page : 6-10
Effect of a school preventive program on oral health measures among children: A longitudinal study
Saima Yunus Khan1, Arjun Unnikrishnan2, Mahendra Kumar Jindal3, Mohammad Kamran Khan2
1 Associate Professor, Department of Pediatric and Preventive Dentistry, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
2 Junior Resident, Department of Pediatric and Preventive Dentistry, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
3 Professor, Department of Pediatric and Preventive Dentistry, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
|Date of Submission||19-Apr-2021|
|Date of Acceptance||22-Apr-2021|
|Date of Web Publication||18-May-2021|
Dr. Saima Yunus Khan
Department of Pediatric and Preventive Dentistry, Aligarh Muslim University, Aligarh - 202 002, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Objective: Comparing caries status and oral health behavior in rural and urban school children can reveal different etiological factors associated with dental caries, which will help in planning appropriate preventive program. Materials and Methods: The present longitudinal study was conducted among 7–9-year-old children, 200 each from randomly selected one urban and one rural school of Aligarh city. A preformed questionnaire was used to assess the oral health knowledge, attitude, and practice. Caries status was recorded using decayed, missing, and filled teeth (DMFT)/deft index. School health education was given to the same children of both the schools. These steps were repeated at 6 and 12 months. Results: By independent t-test, significant effect of dental health education was seen at 6 months (P = 0.029) and 12 (P = 0.000) months with respect to increase in knowledge score and similar significant promising results were seen for increased attitude and practice score at 6 months (P = 0.0039) and 12 months (P = 0.000) for rural group. Reduction in def score was statistically significant by Mann–Whitney U-test at 6 months (P = 0.04) and at 12 months (P = 0.03) for rural group. Conclusion: Planned health education given through lecture – live demonstration lead to reduction in the deft/DMFT score; change in the d/D component to either m/M or f/F respectively as the treatment need be; and progressive increase in the knowledge, attitude, and practice score.
Keywords: Attitude, knowledge, lecture – live demonstration, school health education
|How to cite this article:|
Khan SY, Unnikrishnan A, Jindal MK, Khan MK. Effect of a school preventive program on oral health measures among children: A longitudinal study. Int J Med Oral Res 2021;6:6-10
|How to cite this URL:|
Khan SY, Unnikrishnan A, Jindal MK, Khan MK. Effect of a school preventive program on oral health measures among children: A longitudinal study. Int J Med Oral Res [serial online] 2021 [cited 2021 Oct 20];6:6-10. Available from: http://www.ijmorweb.com/text.asp?2021/6/1/6/319419
| Introduction|| |
Dental caries is one of the most common chronic diseases of the world. In India, more than 50% of children are affected by dental caries. Epidemiological studies show that caries prevalence among children is more in the urban than in the rural areas, due to the ease of accessibility and availability of sticky, acidic, and refined sugary food items. Comparing the caries status and oral health behavior in rural and urban school children can reveal different etiological factors associated with dental caries, which will be helpful in planning appropriate preventive program, like oral health education for management of caries. Studies reveal the importance of oral health education in preventing dental caries., Hence, the present study was planned to assess the difference in caries status, oral health awareness, and practices along with the evaluation of the effectiveness of school health education given to both the study groups.
| Materials and Methods|| |
A longitudinal study was conducted among 7–9-year-old school children from randomly selected urban and rural schools. Selection of schools was done by using systematic random sampling. Every 5th school was picked up in both the locations from the list of total schools. We went within an area of 5 km from the dental college for the urban school and within 10 km for rural school, hence ended with one school each in both the study groups. Three visits were paid to both schools at a fixed interval of 6 months and the impact of dental health education was evaluated and recorded on a preformed questionnaire. The conducted study was bound by the following inclusion and exclusion criteria.
- Healthy children in the age group of 7–9 years without any known systemic disease.
- Physically and mentally challenged children
- All those not willing to participate in the study
- Children who had received oral health education previously.
It was confirmed from literature survey that the expected mean ± standard deviation of decayed, missing, and filled teeth (DMFT) scores for two groups were 0.56 ± 1.20 and 1.01 ± 1.91, respectively. By using the following formula, sample size was 196 for each group at 5% precision and 95% confidence interval, which was rounded to 200.
Sample size n = (Zα/2 + Zβ) 2 × (σ12 + σ22)/d2
The study was approved by the Institutional Ethical and Research Advisory Committee of Faculty of Medicine (D. No. 1030/FM/13/07/2018). A written informed consent was obtained from parents and permission was sought from school authorities of both schools before the start of study. All procedures performed in the study were conducted in accordance with the ethics standards given in 1964 Declaration of Helsinki, as revised in 2013. Data were recorded on a self-prepared questionnaire. A pilot study was conducted among twenty children, each from rural and urban school. Those children who participated in the pilot study were not included in the main study. After conducting the pilot study, the questionnaire was modified accordingly.
Questions were explained in local language and responses were recorded on a close-ended questionnaire by a single investigator. The intra-examiner agreement was found to be 0.80 by kappa statistics. The questionnaire comprised different sections. The first section included questions to assess oral health knowledge, attitude, and practice of the children. The last section included clinical examination using DMFT/deft index done in accordance with the WHO guidelines for epidemiological studies using plane mouth mirror and Community Periodontal Index probe under natural light. After evaluation based on the questionnaire and clinical examination, group approach mode (lecture and demonstration) of dental health education was given to the same children of both schools. Children who were absent on that day were evaluated next day and health education was also given to them to ensure participation of all children in the calculated study sample. The above steps were repeated at 6 months and 12 months on same children to assess the effectiveness of preventive program.
Data were analyzed using IBM Statistical Package for Social Sciences Windows software, version 20 (IBM, Corp, Armonk NY, USA). Descriptive statistics, Independent t-test, and Mann–Whitney U-test were used with a P < 0.05 as statistically significant.
| Results|| |
[Table 1] shows the mean knowledge, attitude, and practice score with standard deviation and standard error of mean of both the schools. A progressive increase was seen in the mean scores of knowledge, attitude, and practice from baseline to 6 and 12 months for both schools.
|Table 1: Distribution of mean and standard deviation of knowledge, attitude, and practice scores at three time intervals (0, 6, and 12 months) of urban and rural groups|
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[Table 2] presents the comparison of knowledge, attitude, and practice score between rural and urban schools by Independent t-test at 0, 6, and 12 months. Effect of dental health education was clearly seen with a significant value of P = 0.029 at 6 months and P = 0.000 at 12 months for knowledge score, and similar promising results were seen for attitude and practice score with a significant value of P = 0.039 at 6 months and P = 0.000 at 12 months for rural group. [Table 3] and [Table 4] show the mean with standard deviation and standard error of mean for deft and DMFT score for both the groups. A relative decline was seen in mean deft and DMFT score from baseline to 6 and 12 months for both schools.
|Table 2: Comparison of mean of knowledge, attitude, and practice scores at three time intervals (0, 6, and 12 months) between urban and rural groups by independent t-test|
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|Table 3: Distribution of mean and standard deviation of d, e, f and decayed-extracted-filled scores of rural and urban school children at baseline, 6 months, and 12 months|
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|Table 4: Distribution of mean and standard deviation of D, M, F decayed-missed-filled scores of rural and urban school children at baseline, 6 months, and 12 months|
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| Discussion|| |
In the present study, oral health knowledge score was 6.395 ± 1.526 among rural school children and was 6.470 ± 1.575 among urban school children at the baseline. Knowledge score drastically increased to 14.2650 ± 3.7823 in rural school and 14.9750 ± 2.6073 in urban school at 6 months of follow-up and further increased to 15.2550 ± 0.9974 in urban school and 16.9500 ± 0.3130 in rural school at 12 months of follow-up. Our study was successful in deducing a significant increase in knowledge score for rural group from baseline to 6 months with P = 0.029 and P = 0.000 at 12 months of follow-up of health education imparted to them. Similarly, increase in oral health knowledge after implementing health education has been reported by Elfaki et al., Gauba et al., Peter et al., Naidu and Nandlal, Haque et al., Sadana et al., Geetha Priya et al., and Angelopoulou et al. in their studies.
In the present research, oral health attitude and practice score was 28.900 ± 3.795 among rural school children and was 28.975 ± 4.816 among urban school children at baseline. There was a significant increase in attitude and practice score for rural group from baseline to 6 months with P = 0.039 and P = 0.000 at 12 months of follow-up of health education imparted to them. This shows the effectiveness of demonstration mode of health education given in the present study, which has high motivational value and upholds the principle of “seeing is believing.” Similar improvements in oral health attitude and practice score after conducting health education program were reported by Gauba et al., Naidu and Nandlal, Haque et al., and Angelopoulou et al. in their studies. Significant increase of knowledge, attitude, and practice was seen in rural group as compared to urban group. This can be attributed to the cultural factor as one of the barriers of communication of health education. Rural school children had the attitude of being more receptive in gaining the new information given to them. These cultural barriers pose a serious problem in the achievement of health behavior modification.
Caries status was assessed using deft/DMFT index at baseline, 6 months, and 12 months intervals for both schools. The mean deft score was 2.66 ± 1.89 in rural school and 3.31 ± 2.58 in urban school at baseline. Higher caries experience among urban school children as compared to rural school children in the present study may be due to the cariogenic diet pattern that they followed, such as refined, sugary, sticky, and acidogenic food items such as pastries, chocolates, candies, cream biscuits, chips, and soft drinks, while Peterson et al. reported a comparatively equal deft score of 8.1 in rural school and 8.2 in urban school children in Thailand. The reason cited for higher deft score in both rural and urban schools was lack of oral health knowledge and poor dietary pattern, hence necessitating the need of health education.
After oral health education, def score reduced to 2.38 ± 1.61 from 2.66 ± 1.89 in rural school and 3.16 ± 2.43 from 3.31 ± 2.58 in urban school at 6 months. At 12 months, def score further reduced to 2.20 ± 1.24 in rural school and 3.05 ± 2.28 in urban school. Similar, reduction in mean deft score after health education has also been reported by Naidu and Nandlal, Sharma et al., and Gupta et al., primarily due to increase in oral health awareness and knowledge.
Whereas no reduction in caries experience after health education has also been reported by Petersen et al., Vanobbergen et al., and Ajithkrishnan et al. The reason cited was shorter duration of study period, hence difficulty to demonstrate the effect of health education on reduction on caries incidence.
In the present research, the mean scores of decayed, extracted, and filled primary teeth were 2.70, 1, and 0, respectively, in rural school, at baseline. The mean d score reduced to 2.07 from 2.70 and e and f scores increased to 1.14 and 2, respectively, from 1 and 0, at 12 months of follow-up. Similarly, in urban school, the mean scores of decayed, extracted, and filled primary teeth were 3.04, 1.20, and 2.22, respectively, at baseline. Whereas, the mean d score reduced to 2.31 from 3.04, and e and f scores increased to 1.40 and 3.29, respectively, from 1.20 and 2.22, at 12 months of follow-up. That means, many children in both schools sought dental treatment as a result of imparted oral health education and decayed teeth were either restored or extracted as treatment needed. This is a substantial effect of school health education. It is believed that if necessary behavioral changes are to take place, and people should be educated through a planned format like done in the present research in the form of school health education. Because behavioral patterns and attitudes are formed early in life, health education should be provided at a younger age as it is much easier to modify a child's behavior and attitudes than that of an adult, again like done in the present research on 7–9-year-old school children.
By health education, knowledge and skills are acquired actively, which makes people think for themselves. Health education trains people to think before acting and it helps in developing favorable attitudes and behavior. Decrease in mean d score and increase in mean e and f scores after health education were also reported by Petersen et al. and Vanobbergen et al.
In rural school children, the DMF score was 1.44 ± 0.73 at baseline, 1.51 ± 0.78 at 6 months, and 1.49 ± 0.77 at 12 months. Whereas in urban school children, the DMF score was 1.36 ± 0.73 at baseline, 1.32 ± 0.57 at 6 months, and 1.32 ± 0.57 at 12 months. The reason for lesser DMF score as compared to def score may be attributed to 7–9 years' age group of our study. At this age, only permanent incisors and 1st molars will be erupted (rest all are primary teeth) in the oral cavity, hence the duration of exposure of permanent teeth to the oral environment will be shorter than that of primary teeth.
In the present research, the mean scores of Decayed, Missing, and Filled permanent teeth were 1.44, 0, and 0, respectively, in rural schools, at baseline. Whereas the mean D score reduced to 1.41 from 1.44, and F score increased to 2.33 from 0 at 12 months of follow-up. Similarly, in urban schools, the mean score of Decayed, Missing, and Filled permanent teeth were 1.32, 1, and 0, respectively, at baseline. Whereas, the mean D score reduced to 1.24 from 1.32, and F score increased to 1.17 from 0 at 12 months of follow-up. Peterson also reported similar increase in F score after health education.
| Conclusion|| |
Planned school health education given in the present conducted research was able to reduce deft/DMFT score; change the d/D component to either e/M or f/F respectively as treatment need be; and progressively increase knowledge, attitude, and practice scores. It is believed that if necessary behavioral changes are to take place, people should be educated through a planned format like done in the present research in the form of school health education given by lecture and demonstration, which has a high motivational value and upholds the principle of “seeing is believing.” Because behavioral patterns and attitudes are formed early in life, health education should be provided at a younger age as it is much easier to modify a child's behavior and attitude than that of an adult.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]