|Year : 2017 | Volume
| Issue : 4 | Page : 152-156
Oral hygiene practices among patients seen in the general outpatient clinic of a tertiary health center
Ibrahim Aliyu1, Godpower Chinedu Michael2, Lawal O Teslim3, Zainab F Ibrahim4
1 Department of Paediatrics, Aminu Kano Teaching Hospital/Bayero University Kano, Kano, Nigeria
2 Department of Family Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Paediatrics, Federal Medical Centre, Birnin Kebbi, Nigeria
4 Department of Nursing, Aminu Kano Teaching Hospital, Kano, Nigeria
|Date of Web Publication||14-Dec-2017|
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano
Introduction: Over the years, incidence of dental diseases has significantly decreased in most developed countries because they have adopted a healthy lifestyle with established effective oral preventive health programs but in most developing countries, the reverse is the case. Materials and Methods: This was a crosssectional study conducted between February and May 2017. One hundred and ten adults seen in the General Outpatient Clinic of Aminu Kano Teaching Hospital, Kano, were consecutively recruited, and a pretested questionnaire was administered by trained assistants. Results: There were 59 (53.6%) males and 51 (46.4%) females with maletofemale ratio of 1.2:1. Toothbrush with paste (46.4%) was the most common material for oral cleaning; and majority changed their toothbrush after 4–11 months. The frequency of oral cleaning was mostly twice per day (43.6%), and the duration was from 2 to 20 min with mean of 5.6 ± 3.4 min. Only 13.1% use dental floss, and 35 (31.8%) of the respondents use mouthwash. Majority of the respondents across the educational qualification subgroups spent 4 min or more in oral cleaning; however, this observation was not statistically significant (Chisquare [χ2] = 4.773, df = 3, P = 0.202); similarly tooth picking for food debris was common among all the subgroups though this was not statistically significant (Fisher's exact test = 5.844, P = 0.089). Wooden toothpick was commonly used across all educational subgroups; whereas use of dental filaments were observed among those with tertiary qualification (χ2 = 27.215, df = 7, P = 0.000). Conclusion: Oral hygiene practices poor in our patients, the use of dental filaments for teeth picking was unacceptably low.
Keywords: Dental floss, fluoride, oral hygiene practice, toothbrush and paste, toothpicks
|How to cite this article:|
Aliyu I, Michael GC, Teslim LO, Ibrahim ZF. Oral hygiene practices among patients seen in the general outpatient clinic of a tertiary health center. SRM J Res Dent Sci 2017;8:152-6
|How to cite this URL:|
Aliyu I, Michael GC, Teslim LO, Ibrahim ZF. Oral hygiene practices among patients seen in the general outpatient clinic of a tertiary health center. SRM J Res Dent Sci [serial online] 2017 [cited 2018 Jul 15];8:152-6. Available from: http://www.srmjrds.in/text.asp?2017/8/4/152/220803
| Introduction|| |
Over the years, the incidence of dental diseases has significantly decreased in most developed countries because they have adopted a healthy lifestyle with established effective oral preventive health programs and effective use of fluoride, but in most developing countries, the reverse is the case with increasing incidence of dental caries reported.,,, However, a proper understanding of oral hygiene practices among our patients is paramount to an effective preventive measures; this study, therefore, seeks to determine the level of understanding, the practice of oral hygiene among adult clienteles seen in our health facility.
| Materials and Methods|| |
The study location was in Kano which is the capital of Kano State located in North-West Nigeria. The inhabitants are mostly Hausas and Fulanis though being a cosmopolitan city other minority tribes, and foreign nationals are also inhabitants. The Teaching Hospital was established in August 1988, and it takes care of over 10 million people; we also receive referrals from neighboring towns and states, and the General Outpatient Clinic treats about 250 patients on a daily basis.
This was a cross-sectional study conducted between February and May 2017. One hundred and ten adults seen in the General Outpatient Clinic of Aminu Kano Teaching Hospital, Kano, were consecutively recruited, and a pretested questionnaire was administered by trained Medical doctors and research assistants.
The minimum sample size was determined using the following formula:
N = Z 2 pq/d 2
where d = degree of accuracy desired, set at 0.05
p = the proportion in the target population estimated to have a particular characteristic; in this study, P=90% (0.90)based on a previous report by Younus and Qureshi.
Z = standard normal deviation, set at 1.96 which corresponds to 95% confidence level
q = 1.0 − p
N = (1.96)2( 0.82) (0.18)/(0.05)2
This was a cross-sectional study, and convenience sampling method was adopted. Adult patients in the General Outpatient Clinic in the hospital were consecutively recruited.
The questionnaire was developed in English Language; it contained 25 questions consisting of both open- and close-ended questions. An internal consistency with Cronbach's alpha value of 0.80 was obtained; and relevant information such as age, sex, and self-practices of oral hygiene were contained.
All outpatients seen at the General Outpatient Clinic at the time of the study were enrolled.
Patients who declined consent were excluded from the study.
Ethical approval was obtained from the Ethics Committee of Aminu Kano Teaching Hospital, Kano.
Obtained data were entered into Statistical Package for the Social Sciences (SPSS Inc. Illinois Chicago) version 16. Categorical data such as the use of toothbrush/toothpaste and toothpick, checking of fluoride content, and changing of toothbrush were summarized and presented as frequency tables, whereas quantitative data such as age were presented as mean and standard deviation. Test of significance using the Chi-square (χ2) and Fisher's exact tests was used where applicable with P < 0.05 as being statistically significant.
| Results|| |
One hundred and ten questionnaires were correctly filled making a response rate of 80%; there were 59 (53.6%) males and 51 (46.4%) females with male-to-female ratio of 1.2:1. Age ranged from 14 years to 78 years with mean of 35.0 +/- 12.8 years. The educational qualification of the respondents was primary school certification in 10 (9.1%), secondary school certification in 36 (32.7%), tertiary school degree in 42 (38.2%), and Arabic qualification in 22 (20.0%).
Toothbrush with paste (46.4%) was the most common material for oral cleaning; however, 65.1% of the respondents reported routinely checking the fluoride content of the toothpaste on purchase, whereas the majority of them change their toothbrush between 4 and 11 months of usage. The frequency of mouth cleaning (brushing and/or chewing stick) was mostly twice per day (43.6%), and the duration of oral care was from 2 to 20 min with mean of 5.6 ± 3.4 min; however, 69.1% of them spend 4 min or more in oral cleaning. Furthermore, 69 (62.7%) of the respondents clean their tongue, while 41 (37.3%) do not [Table 1].
[Table 2] shows that 99 (90.0%) of the respondents teeth pick, but 11 (10.0%) did not; however, among nonusers, the majority of them (63.6%) were unaware of cleansing the teeth of food debris; however, 58.6% of them routinely do it daily. Wooden toothpick was commonly used in 51.5% of the respondents, whereas only 13.1% used dental floss (filament). Thirty-five (31.8%) of the respondents used mouthwash, whereas 75 (68.2%) did not; the main reason (49.3%) for not using mouthwash was their unawareness of mouthwash. Seventy-eight (70.9%) of the respondents had never had a dental checkup, whereas 32 (29.1%) had seen a dentist. However, the reasons for not seeing a dentist were as follows: 49 (62.8%) had never had any dental problem, 27 (34.6%) had no dentist in their locality, and 2 (2.6%) reported seeing a dentist was expensive. Forty-three (39.1%) of the respondents rinsed their mouth after every meal, whereas 67 (60.9%) did not. Seventeen (15.5%) of the respondents were aware that dental problems could cause heart disease, while 93 (84.5%) were unaware.
Majority of the respondents across the educational qualification subgroups spent four minutes or more in oral cleansing; however, this observation was not statistically significant (χ2 = 4.773, df = 3, P = 0.202); similarly cleansing of the teeth of food debris was common among all the subgroups though this was also not statistically significant (Fisher's exact test = 5.844, P = 0.089) [Table 3]. Furthermore, the practice of checking for fluoride content of toothpaste was also observed by majority of the respondent; however, this was also not statistically significant (Fisher's exact test = 14.647, P = 0.056).
|Table 3: The relationship of the educational qualification of respondents and their oral hygiene practices|
Click here to view
|Table 4: The relationship of the educational qualification of respondents and their choice of toothpicks|
Click here to view
Wooden toothpick was the commonly used for tooth picking of food debris across all the subgroups; use of broomstick was seen mostly among those with Arabic with primary and secondary certification while use of filaments was observed among those with tertiary qualification; and this observation was statistically significant (χ2 = 27.215, df = 7, P = 0.000).
| Discussion|| |
There was almost equal representation of both sexes in this study (53.6% males vs. 46.4% females) which was similar to the report (54% males vs. 46% females) of Jain et al.
At least 80% of the respondents in this study used toothpaste and brush for oral cleaning; this report is comparable to the 82% reported by Amith et al. but higher than the 58% reported by Jain et al. and also higher than the 51% reported among Indian population. However, this was lower than the 96% reported by Walsh  among individuals in San Francisco, 88% observed by Ali et al. among respondents in Saudi Arabia, and 90% observed by Younus and Qureshi  among residents in Karachi. The use of teeth stick (chewing stick) as the only oral cleaning material was observed in 20% of our respondents; this is comparable to the 18% reported by Jain et al. but higher than the 2% reported by Baseer et al., 2.64% reported by Ali et al., and 0.3% reported by Younus and Qureshi  their religious beliefs may account for this findings. Muslims clean their teeth with the “siwak” which is a modality of expressing cleanliness, and Northern Nigeria is a predominantly Muslim society.
However, 35% of the respondents routinely changed their toothbrush within 3 months; this is higher than the 28.8% reported by Bashiru and Anthony  however, this was lower than the 65% reported by Younus and Qureshi  and 55% reported by Amith et al. The American Dental Association recommend change of toothbrush every 3–4 months; therefore, this practice was not upheld by majority of respondents despite cheapness of toothbrush; of lack of proper information may account for this observation.
About 58.1% of the respondents brush their teeth at least twice in a day; this observation is comparable to the 58% reported among police recruits by Dilip  and higher than the 23% reported by Jain et al. but lower than the 62% reported by Al-Shammari et al. and the 100% reported by Pradhan et al.
Only 13.1% of the respondents use dental floss; this is similar to that reported by Kaira et al. but higher than the 2% reported by Gopikrishna et al.; the 0% reported by Jain et al. and Jamjoom  However, our observation was lower than the 44% reported by Hamilton and Couby. Only 29.1% of our respondents had ever visited a dentist; this figure is low when compared to those of Chandra Shekar et al. Paul et al., and Bhat et al. but higher than those of Jain et al. and Pandya and Dhaduk. Lack of dental services and cost of care are possible hindrances. Furthermore, this study observed that 26.3% of the respondents used broomstick for teeth picking; which has not been reported before now. This is worrisome because the broomstick which is derived from the raffia palm is traditionally used for sweeping the floor, hence the risk of it being contaminated with microbes, therefore introducing it to the gum increases the chances of gum infection. Health education on the hazard of such practice will alleviate this harmful practice.
Majority of the respondents in our study irrespective of their educational background, spent >4 min to clean and brush their teeth/mouth, they also did tooth picking although the use of dental filaments was very low its use was observed mostly among those with tertiary educational qualification; this observation is at variance to those of Chandra Shekar et al. and Paul et al. who reported the influence of literacy on the outcome of hygiene practice. Educational qualification only influenced the use of dental filaments in our study.
| Conclusion|| |
Oral hygiene practices of adults seen in our health facility is poor though majority of the respondents spend at least 4 min for oral cleaning, less than half of them do oral cleaning twice in a day, and the use of dental filaments for teeth picking was unacceptably low; therefore, health practitioner should use every opportunity of patient contact for oral health education.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Christensen LB, Petersen PE, Krustrup U, Kjøller M. Self-reported oral hygiene practices among adults in Denmark. Community Dent Health 2003;20:229-35.
Enwonwu CO, Phillips RS, Ibrahim CD, Danfillo IS. Nutrition and oral health in Africa. Int Dent J 2004;54:344-51.
Hugoson A, Koch G, Helkimo AN, Lundin SA. Caries prevalence and distribution in individuals aged 3-20 years in Jönköping, Sweden, over a 30-year period (1973-2003). Int J Paediatr Dent 2008;18:18-26.
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.
Federal Republic of Nigeria. National Population Census. National Bureau of Statistics; 2006. Available from: http://www.nigerianstat.gov.ng
. [Last accessed on 2009 Jul 15].
Araoye MO. Research Methodology with Statistics for Health and Social Sciences. Ilorin, Nigeria: Nathadex; 2004. p. 123-9.
Younus A, Qureshi A. Tooth brush changing frequency and associated sociodemographic and oral hygiene factors among residents of Karachi. J Dent Oral Hyg 2016;8:4-11.
Jain N, Mitra D, Ashok KP, Dundappa J, Soni S, Ahmed S, et al.
Oral hygiene-awareness and practice among patients attending OPD at Vyas dental college and hospital, Jodhpur. J Indian Soc Periodontol 2012;16:524-8.
] [Full text]
Amith HV, Audrey MD, Shahima S, Shanima S, Shazmi HD, Sheikh MM, et al
. Oral hygiene practices among paramedical staff of a private dental institution in India. RSBO 2013;10:205-10.
Walsh MM. Effects of school-based dental health education on knowledge, attitudes and behavior of adolescents in San Francisco. Community Dent Oral Epidemiol 1985;13:143-7.
Ali NS, Khan M, Butt M, Riaz S. Implications of practices and perception on oral hygiene in patients attending a tertiary care hospital. J Pak Dent Assoc 2012;1:20-30.
Baseer MA, Alenazy MS, Alasqah M, Algabbani M, Mehkari A. Oral health knowledge, attitude and practices among health professionals in King Fahad Medical City, Riyadh. Dent Res J (Isfahan) 2012;9:386-92.
Mandel ID. Chemotherapeutic agents for controlling plaque and gingivitis. J Clin Periodontol 1988;15:488-98.
Bashiru BO, Anthony IN. Oral self-care practices among university students in Port Harcourt, Rivers State. Niger Med J 2014;55:486-9.
] [Full text]
Dilip CL. Health status, treatment requirements, knowledge and attitude towards oral health of police recruits in Karnataka. J Indian Assoc Public Health Dent 2005;5:20-34. [Full text]
Al-Shammari KF, Al-Ansari JM, Al-Khabbaz AK, Dashti A, Honkala EJ. Self-reported oral hygiene habits and oral health problems of Kuwaiti adults. Med Princ Pract 2007;16:15-21.
Pradhan D, Kumar J, Shavi GR, Pruthi N, Gupta G, Singh D. Evaluating the oral hygiene knowledge, attitude and practices among dental and medical students in Kanpur City. Natl J Integr Res Med 2016;7:73-6.
Kaira LS, Srivastava V, Giri P, Chopra D. Oral health-related knowledge and practice among nursing students Rohilkland Medical College and Hospital. A questionnaire study. J Orofac Res 2012;2:20-3.
Gopikrishna V, Bhaskar NN, Kulkarni SB, Jacob J, Sourabha KG. Knowledge, attitude, and practices of oral hygiene among college students in Bengaluru city. J Indian Assoc Public Health Dent 2016;14:75-9. [Full text]
Jamjoom HM. Preventive oral health knowledge and practice in Jeddah, Saudi Arabia. J KAU Med Sci 2001;9:17-25.
Hamilton ME, Coulby WM. Oral health knowledge and habits of senior elementary school students. J Public Health Dent 1991;51:212-9.
Chandra Shekar BR, Reddy C, Manjunath BC, Suma S. Dental health awareness, attitude, oral health-related habits, and behaviors in relation to socio-economic factors among the municipal employees of Mysore city. Ann Trop Med Public Health 2011;4:99-106.
Paul B, Basu M, Dutta S, Chattopadhyay S, Sinha D, Misra R, et al.
Awareness and practices of oral hygiene and its relation to sociodemographic factors among patients attending the general outpatient department in a tertiary care hospital of Kolkata, India. J Family Med Prim Care 2014;3:107-11.
] [Full text]
Bhat PK, Kumar A, Aruna CN. Preventive oral health knowledge, practice and behaviour of patients attending dental institution in Bangalore, India. J Int Oral Health 2010;2:17-6.
Pandya H, Dhaduk R. Oral hygiene status in central Gujarat, 2010 – An epidemiological study. J Dent Sci 2012;2:51-3.
[Table 1], [Table 2], [Table 3], [Table 4]