Keywords
attitude - knowledge - oral health - oral hygiene - periodontitis
Introduction
Periodontal disease is a major public health issue that is highly prevalent and adds
to the global burden of chronic diseases. Periodontitis is considered to have bilateral
associations with various systemic diseases such as diabetes mellitus, cardiovascular
disease, hypertension, and adverse pregnancy outcomes. Factors that contribute to
the steady rise in the prevalence of periodontal disease include poor oral health
awareness and its treatment modalities. The condition can be readily reversed by effective
plaque control measures such as daily tooth brushing and the use of interdental cleaning
aids.[1]
Oral health knowledge is considered to be an essential prerequisite for health-related
behavior. It has been observed that oral hygiene has mostly remained an ignored and
unrealized major social problem. People continue to neglect oral health, but seek
medical care as required. However, it is not realized that often poor periodontal
health can be a cause for the deteriorating systemic health of the individuals.
Preventive oral health knowledge, behavior, and practice are essential ways of maintaining
oral health. The WHO reports that 15 to 30% tooth loss is found in adults and that
early diagnosis with immediate implementation of treatment can accomplish prevention
and management of periodontal diseases.[2]
Due to the misconceptions about routine dental treatments and unawareness of the relationship
between oral hygiene and systemic diseases or disorders, most diseases remain undiagnosed
or untreated because of this missing awareness. So it is important to do a recent
study that will help the dentist to improve the understanding of patients about periodontal
diseases and reduce the myths of the general population about periodontal therapy.
Hence, this survey was undertaken to assess an individual’s oral hygiene awareness,
to understand the level of knowledge and information regarding different periodontal
treatment modalities and the association between oral health and systemic well-being.
Objective
The objectives of this study were as follows:
-
To assess the oral hygiene awareness among patients attending the outpatient department
in A.B. Shetty Memorial Institute of Dental Sciences, Mangalore.
-
To assess their knowledge on different oral hygiene practices.
-
To assess their attitude and awareness regarding different periodontal treatment modalities
available.
-
To assess the level of knowledge and information about the association between oral
health and systemic well-being.
Materials and Methods
Screening Examinations
A total of 370 patients from the North Malabar region reporting to the outpatient
department of A.B. Shetty Memorial Institute of Dental Sciences, Mangalore from July
2018 to December 2018 were included in the study. Informed consent was obtained from
all participants. The purpose of the study and all the terms used in the study were
explained to the respondents and they were ensured that total confidentiality would
be maintained.
The study was conducted by the means of a structured self-administered questionnaire.
A questionnaire contained 22 questions. The questionnaire was divided into two parts.
The first part consisted of questions related to age, sex, and the demographic area
along with the oral hygiene practices of the patients. The second part of the questionnaire
consisted of questions that will help understand and evaluate the attitude and understanding
of the patients toward periodontal therapy and the oral-systemic disease link.
Inclusion Criteria
Exclusion Criteria
Statistical Analysis
The data collected from the questionnaire were statistically analyzed. Descriptive
statistics such as frequency and percentage have been used to assess the periodontal
awareness and treatment modalities among patients involved in the study.
Discussion
Periodontal diseases, comprising gingivitis and periodontitis, are probably the most
common disease of mankind (Guinness World Records 2001). The recent Global Burden
of Disease Study (1990–2010)[3] indicates that:
-
Severe periodontitis is the sixth most prevalent disease worldwide, with an overall
prevalence of 11.2% and affected around 743 million people, and
-
The global burden of periodontal disease increased by 57.3% from 1990 to 2010.
Hence oral health is considered an indicator of overall health and is the key resource
for an individual’s social, economic, and personal development.[4] The patient adheres better to oral hygiene care regimens when informed and positively
reinforced. Hence in this study attempts were made to evaluate knowledge of oral health,
oral hygiene measures, relationship between oral and general health, and various periodontal
treatment modalities available, by the means of a structured questionnaire.
The various studies performed by Levin and Landesman,[5] Korsch et al,[6] and Davis et al[7] have suggested that a questionnaire helps to improve the diagnosis and prognostic
skills of the dentist and can help patients to reveal their problems. Yamamoto et
al[8] conducted a questionnaire for periodontitis screening of 250 Japanese males of age
group 50 to 59 years and suggested that self-reported questions are useful for screening
periodontitis.
The findings of the present study revealed that 52% of subjects used to brush once
a day ([Fig. 3]), which is consistent with Hamasha et al,[9] and in Petersen et al[10] study 0.44% of subjects brush their teeth about twice a day which is less when compared
with Al-Shammari et al,[11] Songpaisan and Davies,[12] and Gill et al study.[13] Evidence shows that general oral hygiene conditions are far less than satisfactory
despite people claiming to practice oral hygiene measures on a daily basis.
The present study also showed that 31% used their toothbrush until the bristles were
frayed ([Fig. 4]). It has been documented that toothbrush with frayed bristles is ineffective for
proper cleaning and also causes adverse effects like oral ulcers and gingival recession,
and it was recommended that toothbrushes should be replaced every 3 months.
The majority of urban and rural populations were unaware of interdental aids ([Fig. 5]). In total, 82% of the study population reported that they were not aware of the
availability of auxiliary aids and hence, had never used them. Inadequate self-performed
oral hygiene practices result in the accumulation of dental biofilms thereby initiating
and sustaining the periodontal disease process.
Gingival bleeding is an early sign of periodontal disease and a leading risk marker
for existing periodontal inflammation that accounts for the onset and progression
of periodontitis. Self-perceived bleeding gums among the sample were 58% and those
never noticed bleeding from gums were 42% ([Fig. 6]). This study is consistent with the studies of Nagarajan and Pushpanjali,[14] Tervonen and Knuttila,[15] and Kallio et al,[16] which showed that most of the patients did not notice bleeding from gums and were
poorly perceived by the patient. In total, 60% of the study population assume that
bleeding gums do not require dental consultation.
Periodic check-up and maintenance are essential for achieving long-term periodontal
health. However, there was a difference in opinion regarding the signs and symptoms
for which the study population opted for a dental consultation. Surprisingly enough,
50% of the population, visit the dentist only in pain ([Fig. 7]). Dental pain appeared to be the most important cause of dental visits.
Since the early stages of periodontal disease are often symptomless, a significant
number of affected patients do not seek professional care. The relatively “silent”
nature of the early stages of the disease, combined with low awareness of periodontal
health, leads to many patients pursue “symptom-driven” care for the advanced disease
.[3]
When asked about availing any dental treatment in the past, 48% of the subjects had
never visited the dentist before and 52% had undergone periodontal treatment, mainly
oral prophylaxis.
A total of 76% of the study population rejected periodontal therapy due to fear and
the source of the origin of fear was 51% from personal experience such as possible
pain, fear of needles, instruments and/or another armamentarium, unsuccessful treatment
results, 21% from friends, 25% from family members’ experience and 3% subjects from
the media ([Fig. 8]).
Responses concerning knowledge about the treatments available for treatable periodontal
problems like brown gums, recession, replacement of missing teeth with dental implants,
and the use of laser in periodontal therapy were poor, suggesting that there is a
need for awareness of these aspects ([Fig. 9]). A similar finding was observed in Pralhad and Thomas study[17] among interns. Half of those interviewed did not know what dental implants are.
With implantology coming up to be recognized as a subspecialty, it is necessary that
information about implants be disseminated among the public and also among the professionals.
Misconceptions about routine dental treatments are common among the general public.
When asked about scaling, the most common periodontal procedure performed, 33% of
the subjects believed that scaling causes tooth mobility. Similar results were seen
and it was surprising to know that 52.6% of the medical professionals in the Dhulipalla
et al study[18] believed that scaling causes loss of enamel.
Periodontal disease has a two-way relationship as far as systemic health is concerned.
Periodontal disease is considered to be the sixth major complication of diabetes mellitus
and constitutes an important risk factor as well.[3] The result of the study also showed that that only a few subjects were aware of
the oral-systemic disease link while almost two-third of the population were unaware
of this. Similar results were concluded by Moeintaghavi et al,[19] Bhatia et al[20] studies. So as a dentist we should educate patients about this important relationship.
A total of 70% of the sample size was of the opinion that periodontal diseases cannot
be prevented and 29% with an opinion that it can be prevented.
This 21-question questionnaire was easy and quick to understand and fill. Within the
limitations of the present study, the clinical use of the questionnaire disclosed
salient information regarding patient’s oral health behavior, perceptions, and knowledge
about the various treatment modalities as well as oral-systemic disease links.
Conclusion
The present study reveals that the general population had minimal awareness regarding
oral health care, various periodontal treatment modalities available, and systemic
effects of periodontal disease. It also emphasizes our duty as oral health care professionals
to not only provide health care but also to improve people’s awareness and knowledge.
Most of the aforementioned dental problems can be prevented by providing awareness
starting from community level on early signs of periodontitis, the need for professional
diagnosis, effect of its treatment outcome, the importance of completing the treatment
of periodontitis before proceeding with replacement, role of dental implants as a
part of the rehabilitation of masticatory dysfunction, and interdependence of periodontal
health and general health.
