Assessment of Oral Health Knowledge, Attitude and Practice among SchoolTeachers: A Cross-Sectional Survey

Introduction

The importance of imparting knowledge on oral hygiene to children has been recognized as early as 1878.¹ Since the beginning of modern day dentistry, emphasis has been placed on the importance of oral hygiene. In fact, the single most continuous, cornerstone of preventive and public health dentistry has always been cleaning of teeth. Despite this consensus, there have been changes in the importance attached to oral hygiene over time. Concurrently, different perceptions on the subject have been noted in different parts of the world.² There has been an increase in recognition both in the scientific and social community on the enormous influence a school teacher has not only in encouraging good health habits, but also in promoting overall development.³ As school is the first level of learning, the World Health Organization in 1995 launched a global school health initiative in which delivery of health education was imparted to the students.⁴ Children spend considerable amount of time in school, especially during the age when their habits are being formed. School teachers play a very important role in shaping the personality of the students and imparting knowledge to them.⁵ Hence, the current study was carried out to assess the oral health knowledge, attitude and practice among school teachers.

Methods

The current study was carried out in Bangalore city, in both government as well as private schools. A total of 100 school teachers were selected and a written informed consent was obtained before the start of survey.

A self-administered questionnaire consisting of 15 multiple choice questions based on likert scale (3 point) was handed out to the teachers. The questionnaire consisted of three parts - oral health knowledge, attitude and practice. An average time of five minutes was given to each participant. The data was analysed using a Chi-Square test. The Institutional Ethical Committee approval was obtained before the commencement of study.

Statistical Analysis

Statistical Package for Social Sciences [SPSS] for Windows Version 22.0 (Released 2013; Armonk, NY: IBM Corp.,) was used to perform statistical analysis. Descriptive analysis of all the explanatory and outcome parameters was done using mean and standard deviation for quantitative variables, frequency and proportions for categorical variables. Chi square test was used to compare the responses towards awareness of school teachers towards effect of consumption of sweets and soft drinks on oral health. The level of significance (p value) was set at p <0.05.

Results

This cross-sectional study was carried out among school teachers in both government and private sectors. All the 100 questionnaires handed out were completed and returned recording a response rate of 100%. Among all the teachers, 16% were males and 84% were females (Table 1). The teachers were categorised into four age groups: 21-30, 31-40, 41-50, 51-60 years. Almost half of the teachers enrolled in the present study were between 31-40 years of age (44%). Median age of 37 years has been considered to group the participants based on the age group (Table 1, Figure 1).

A majority of the teachers (78%) believed that consumption of sweets affects oral health and 75% of the teachers believed that oral health impacts overall health of the body (Table 2, Figure 2).

Coming to attitude of the teachers towards oral health, 93% of the teachers agreed that as a teacher they could influence oral hygiene of the children. 92% of them believed that maintaining a healthy mouth is an individual’s responsibility; however, 64% of the teachers visited the dentist only when in pain (Table 3, Figure 3).

When asked on practice based questions, 84% of the teachers used toothbrush and toothpaste as a cleaning aid, while only 44% of the teachers brushed their teeth twice daily (Table 4, Figure 4).

A statistically significant difference was seen in the attitude of the teachers < 37 years and >37 years when asked a question if as a teacher, they can influence oral hygiene (0.03*). A statistically significant difference was also seen in the practice of the teachers < 37 and >37 years when asked on how often they brush their teeth (0.04*) (Table 5, 6, 7).

Discussion

The teachers play an important role in the formation, modification and behaviour of the children. A teacher with adequate oral health knowledge, positive attitude towards dental health can always play an important role in children’s health education, and thus, be a role model for children and the community at large. Similarly, a teacher with poor oral health knowledge may have an adverse impact on children’s oral health practices, and thus on their oral health status. Almost half of the teachers in this study (44%) were between 31-40 years of age. Their age represents their teaching experience. In the current study, 78% of the teachers agreed that sweets affect oral health. These results are in accordance with findings reported by Israa et al. ⁶

In the present study, 63% of the teachers agreed that soft drinks affect oral health. This finding of the present study is comparable to 61.3% recorded by Lang et al⁷ but less when compared to 75% as reported by Al-Tamimi and Petersen,⁸ and 86.6% as reported by Manjunath and Kumar.⁹

When asked on how often they visit the dentist, about 64% of the participants answered that they visit the dentist only when they are in pain and only 21% of them responded that they make regular visits to their dentist.

In developing countries, traditionally pain is the main motivating factor for visiting the dentist or doctor as seen among our study participants. From this, it can be understood that oral health knowledge is poor among school teachers which is also observed in their attitude.

Nearly 58% agreed that regular visits to dentist are necessary, while 13% of the teachers were unaware of the importance of regular dental visits.

Regarding practice, 44% responded that they brushed twice a day which is similar to the findings of other studies done by Zhu et al. and Manjunath & Kumar, while about 52% of the teachers brushed only once daily.

Nearly 84% of the teachers used toothbrush and toothpaste in order to clean their teeth and 62% of school teachers brushed their teeth in the morning, and only 32% of them brushed both in the morning and in the night.

About 44% of teachers used toothbrush with soft bristles, whereas only 9% used hard bristled toothbrushes.

Few studies with little variations compared to our study were carried out by different authors. Ain¹¹ carried out a cross-sectional questionnaire based study on 530 school teachers of various government and private schools of Srinagar, Kashmir, India, to assess the knowledge, attitude, and practice of school teachers towards oral health. Around 36% of the teachers believed that dental problems can be prevented by brushing and rinsing mouth regularly, by visiting dentists every six months, and by avoiding sweet and sticky foods. Nearly 47% of the private school teachers and 20.2% of government school teachers agreed that they try to provide oral health education to their students in schools. Although not all the teachers have attempted to give oral health education to the children, almost all of them have agreed that it benefits children. This study highlights the need to tailor oral health counselling for teachers.

Because of insufficient knowledge, there were teachers who were not presenting lectures to the children on oral health. For the most part, teachers were consistent in what they considered should be their responsibility regarding dental health- passive activities which involved being a good model or referring students to the school nurse. All of the teachers, irrespective of their experience, had acceptable scores for attitude towards oral health. This showed that although few participant teachers did not have good knowledge, they still had positive attitude regarding their oral health. These results are similar to those reported by Wyne et al, ¹⁰ Ahmad,¹¹ and Sukhabogi et al. ¹²

Conclusion

The present study concludes that school teachers had overall good knowledge, attitude, and behaviour towards oral health care. However, there is a tremendous need to improve oral health knowledge and attitude among school teachers. Dental education programs should be continued and teachers training programs should be organized in order to impart scientific knowledge to teachers to improve their oral health. It would be beneficial to include school teachers effectively in oral health care delivery system, especially in school oral health care programs.

Conflict of Interest

None.