|Year : 2018 | Volume
| Issue : 3 | Page : 108-113
Assessment of the level of knowledge of Nigerian undergraduates on periodontal diseases
O Akhionbare, AO Ehizele
Department of Periodontics, University of Benin Teaching Hospital, Benin, Edo State, Nigeria
|Date of Web Publication||27-Sep-2018|
A O Ehizele
Department of Periodontics, New Dental Complex, University of Benin Teaching Hospital, P. M. B. 1111 Ugbowo, Benin City, Edo State
Objective: The objective of this study was to determine the level of knowledge of undergraduate students of a Nigerian University on the etiology, associated risk factors, prevention, and treatment of periodontal diseases. Methodology: A 38-item self-administered questionnaire was used to assess the study participants' personal data, source of oral health information, and level of knowledge on issues relating to etiology, associated risk factors, prevention and treatment of periodontal diseases. The responses were based on a 5-item Likert scale. Chi-square test was used to identify significant relationships and differences between participants' level of awareness and demographic factors such as age, gender, course, and level of study. Results: More of the undergraduates studied (52.8%) were within the 20–25 years of age group, 50.7% were male, 69.4% were studying science-based courses, 76.9% rated their level of information on periodontal diseases as inadequate and 89.5% were rated to have inappropriate knowledge on periodontal disease. Internet was the respondents' most utilized source of information on periodontal diseases. The appropriateness of the respondents' knowledge on periodontal diseases was not dependent on their gender, age group, and nature of course of the study or the year of the study. However, only 18.6% of respondents who claimed to have adequate information on periodontal disease had appropriate knowledge of periodontal diseases, while fewer persons (8.0%) in the group who claimed to have inadequate information had appropriate knowledge (P = 0.005). Conclusion: It can be concluded that a few of the undergraduate students of the Nigerian University studied have inappropriate knowledge on the etiology, associated risk factors, prevention and treatment of periodontal diseases.
Keywords: Knowledge, periodontal diseases, undergraduate
|How to cite this article:|
Akhionbare O, Ehizele A O. Assessment of the level of knowledge of Nigerian undergraduates on periodontal diseases. SRM J Res Dent Sci 2018;9:108-13
|How to cite this URL:|
Akhionbare O, Ehizele A O. Assessment of the level of knowledge of Nigerian undergraduates on periodontal diseases. SRM J Res Dent Sci [serial online] 2018 [cited 2018 Oct 22];9:108-13. Available from: http://www.srmjrds.in/text.asp?2018/9/3/108/242457
| Introduction|| |
Periodontal disease is still highly prevalent and it exists in varying degree among all age groups and in both gender., It has also been reported to be more prevalent among the low-socioeconomic class and low-educational level. Periodontal disease is still one of the leading causes of edentulism despite the fact that its initiation and progression can be largely controlled by behavioral changes. Changes such as uptake of appropriate oral health behavior or practices, proper nutrition, and eradication of improper habits are capable of altering the destructive process of periodontal disease. This is because they have the ability to control the main etiological factor, which is bacterial plaque, and other secondary etiological factors such as hormonal changes, metabolic conditions, poor nutrition smoking, and stress. If periodontal disease is largely preventable, why is it so highly prevalent? Could it be as a result of poor awareness of periodontal disease among the various populations?
Previous studies have shown poor awareness of many issues relating to periodontal disease across diverse populations. A study reported a poor awareness of etiological and predisposing factors of periodontal disease, its consequences as well as its preventable nature among the studied. An Asian study also reported poor awareness in areas relating to the meaning and causes of periodontal disease as well as its risk factors, prevention, and treatments. Inadequate awareness of the association between periodontal diseases and systemic illnesses has also been documented among medical and dental practitioners.,,
To improve the awareness of individuals on any health issue, there is a need to determine the individual's present level of knowledge or opinion about the health issue. This will form a basis for future corrective health education or health practices that will bring about the desirable behavioral changes and ultimately reduction of the morbidity or mortality of the disease. This approach is most applicable to periodontal disease management as improved knowledge of issues concerning periodontal diseases translates to better clinical outcomes. The determination of the level of awareness of individuals about periodontal health and disease is considered a very important step in the establishment of periodontal disease preventive practices. Therefore, the objective of this study is to determine the level of knowledge of the undergraduate students of a Nigerian University on the etiology, associated risk factors, prevention and treatment of periodontal diseases.
| Methodology|| |
This observational cross-sectional study was carried out among the undergraduate students residing in the halls of residence within the Nigerian University's main campus. A multi-stage sampling technique was used to select the study participants from all the halls of residence. This is to have a sample representative of the entire undergraduate students. Four halls of residence were randomly selected. Each hall had an average of 240 rooms; therefore, a sampling interval of eight was used to select 30 rooms from each randomly selected hall, giving a total of 120 rooms. All the undergraduate students occupying these selected rooms were eligible to participate in the study, but only the students who give informed consent were included in the study. Based on the minimum sample size calculated using the prevalence formula, 400 questionnaires were administered. However, a total of 373 questionnaires were returned completely filled, giving a response rate of 93.3%.
The 38-item self-administered questionnaire used assessed the study participants' personal data (age, gender, course, and level of study), source of oral health information, and level of knowledge on issues relating to etiology, associated risk factors, prevention and treatment of periodontal diseases. The questionnaire, based on one previously used for a similar study, had both open- and closed-ended questions requiring dichotomous yes or no responses and responses based on a 5-item Likert scale (i.e., strongly disagree, disagree, undecided, agree, and strongly agree). A true statement was expected to elicit an “agree” or “strongly agree” response, while a false statement was expected to elicit a “disagree” or “strongly disagree” response.
The data were collected and analyzed using the Statistical Package for the Social Sciences version 21.0 for Windows (SPSS Inc., Chicago, IL, USA). Data were presented as frequency tables, percentages, and cross-tabulations. Chi-square test was used to identify significant relationships and differences between participants' level of awareness and demographic factors such as age, gender, course, and level of study. Statistical significance was based on P < 0.05.
| Results|| |
Of the 400 respondents selected, a total of 373 respondents returned completely filled questionnaires, giving a response rate of 93.3%. More of the undergraduates studied were males (50.7%) and within the 20–25 years of age group (52.8%). Furthermore, majority 69.4% were studying science-based courses. Although 76.9% self-rated their level of information on periodontal diseases as inadequate, 89.5% were rated to have inappropriate knowledge on periodontal disease based on their responses to the questions that were to elicit knowledge [Table 1].
Internet was the respondents' most utilized source of information on periodontal diseases (23.9%) followed by friends, dentists, textbooks, and television (17.4%, 13.7%, 10.5%, and 1.3%, respectively) [Figure 1].
The appropriateness of the respondents' knowledge on periodontal diseases was not dependent on their gender, age group, and nature of the course of study or the year of study. However, only 18.6% of respondents who claimed to have adequate information on periodontal disease had appropriate knowledge on periodontal diseases, while fewer persons (8.0%) in the group who claimed to have inadequate information had appropriate knowledge (P = 0.005) [Table 2].
|Table 2: Relationship between participants' sociodemographic factors and appropriateness of their knowledge on periodontal diseases|
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The respondents did not unanimously give correct answers to any of the questions asked to assess their knowledge on periodontal diseases. A total of 42.4% disagreed (strongly disagree = 12.9% and disagree = 29.5%) that periodontal diseases affect only the gums. Furthermore, 13.1% agreed (strongly agree = 2.1% and agree = 11.0%) that periodontal disease can lead to preterm low birth weight delivery of babies [Table 3].
On the question that gum swellings sometimes occur during pregnancy, a total of 29.7% agreed (strongly agree = 3.2% and agree = 26.5%). A slight majority (54.1%) of the respondents agreed (strongly agree = 5.6% and agree = 48.5%) that gum swellings can be caused by drug with a greater proportion (74.3%) also agreeing (strongly agree = 22.0% and agree = 52.3%) that improper tooth brushing technique can cause gum recession [Table 4].
|Table 4: Respondent's opinion on possible causes of periodontal disease and its treatment|
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The need to visit a dentist when there is bleeding gum was agreed on by 77.0% of the respondents (strongly agree = 34.9% and agree = 42.1%). Nearly, the same proportion (75.4%) agreed that there is a need for twice a year oral prophylaxis (strongly agree = 29.0% and agree = 46.4%). Although 70.8% agreed (strongly agree = 23.6% and agree = 47.2%) that scaling can remove deposit and stains on the teeth, only 36.8% agreed (strongly agree = 7.8% and agree = 30.8%) that scaling can treat gum overgrowth [Table 4]. Few respondents 18.8% agreed that periodontal treatment is not necessary since teeth will eventually be lost with age (strongly agree = 5.1% and agree = 13.7%) [Table 4].
| Discussion|| |
Previous studies in Nigeria have shown that dental patients generally have poor knowledge of issues concerning periodontal diseases. This situation is compounded by the fact that the knowledge of health-care givers on this issue is also not optimal.,, To address this deficiency, a population-based approach to health promotion, which targets specific population with the ultimate goal of reaching the entire population, will be the most effective. The undergraduate population is a strategic population that can be targeted for oral health education. They are capable of promoting the overall health status of the entire community in the sense that as they change any practice or habit potentially harmful to oral health, they can also transmit their new knowledge to their peers, family members, and other members of the community. The first step in any population-based health intervention is assessment. The assessment will reveal areas of strength and weaknesses which can be used to establish prevention practices. This study was carried out to provide such an assessment in our environment.
The respondents' knowledge was rated on the Likert scale of responses. This was to capture all the true variance in their responses and allow them to respond in a degree of agreement instead of forcing them to take a “yes” or “no” stand. This allowed neutral or undecided opinion of the participants. This study revealed inappropriate knowledge in both sexes, irrespective of the age, course of the study, and level of the study. The concept of multiple etiology of periodontal diseases has been widely advocated. This takes into consideration the role of microbial plaque as well as other factors such as local irritation from calculus and improper restorations, systemic conditions, diet and nutritional deficiencies, and habits and hormonal changes as well as genetics. This study revealed that not all the undergraduates agreed with the concept of multiple etiology because a few respondents in this study did not agree that plaque, hormones, diabetes, drugs, genes, and tobacco have any role in the etiology of periodontal diseases. A few of the respondents were also not in agreement with some possible risk factors and consequences of periodontal disease as well as some preventive measures.
This pattern of inappropriate knowledge in this study was seen in students studying both science-based and nonscience-based courses. This result is similar to what was reported among professional students in medical, Ayurveda, and engineering fields in India. Insufficient knowledge about periodontal diseases has also been reported among nursing students in Denmark. Another study also reported poor knowledge among university student in Saudi Arabia but concluded that students from science-oriented faculties had better knowledge of various aspect of periodontal disease than students from humanity disciplines. The Tanzania study that reported that majority (96.8%) had adequate knowledge on causes and prevention of periodontal diseases was carried out among secondary school students and employed very basic questions to elicit their knowledge. This may have accounted for the better knowledge reported.
This study also revealed that more respondents who claimed to have inadequate information on periodontal diseases had more inappropriate knowledge than those who claimed to have adequate knowledge. This reflects the accuracy of their self-assessment and suggests that improvement of the quality of their information may translate to better knowledge. The respondents in this study access information on periodontal health mainly through the internet. This may have accounted for the inaccurate information reported. Dental practitioners have expressed reservation concerning internet-derived oral health information. This is because its quality and reliability cannot be ascertained and because it may not be easy for internet users to determine appropriate sites with accurate information. Apart from the internet, the respondents also claim to have relied on information from friends. It is, therefore, not surprising that information is inaccurate in some case. The most reliable source of information on periodontal disease is the dentist, but many of the undergraduates did not benefit from this source. Regular oral health campaigns and free dental checkups may go a long way in exposing them to accurate information on periodontal diseases.
The major merit of this study is that it serves as a relatively easy and inexpensive way of eliciting information on periodontal diseases among the undergraduate students. Since the entire study participants had a similar educational level, it is unlikely that the disparity in their responses can be attributable to the difference in their level of comprehension. Another merit of this study is that the questionnaire was designed in such a way that the response was given to any question truly reflects the knowledge of the study participants. However, being a self-reported study, there may have been some overestimation or underestimation.
| Conclusion|| |
It can be concluded that a few of the undergraduate students of the Nigerian University studied have inappropriate knowledge on the etiology, associated risk factors, prevention and treatment of periodontal diseases. Interventions, in the form of health education addressing the emerging concerns, are, therefore, highly recommended. Future studies will also be needed to determine the effect of such interventions on the knowledge of the undergraduate students on periodontal disease.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Jin LJ, Armitage GC, Klinge B, Lang NP, Tonetti M, Williams RC, et al.
Global oral health inequalities: Task group – Periodontal disease. Adv Dent Res 2011;23:221-6.
Watt RG, Petersen PE. Periodontal health through public health – The case for oral health promotion. Periodontol 2000 2012;60:147-55.
Borrell LN, Beck JD, Heiss G. Socioeconomic disadvantage and periodontal disease: The dental atherosclerosis risk in communities study. Am J Public Health 2006;96:332-9.
Jin LJ, Lamster IB, Greenspan JS, Pitts NB, Scully C, Warnakulasuriya S, et al.
Global burden of oral diseases: Emerging concepts, management and interplay with systemic health. Oral Dis 2016;22:609-19.
Alam S, Khan AA, Zakir S, Tajjudin. Awareness about periodontal disease among patients – A study. Pak Oral Dent J 2015;35:96-9.
Azodo CC, Umoh AO. Periodontal disease awareness and knowledge among Nigerian primary school teachers. Ann Med Health Sci Res 2015;5:340-7.
] [Full text]
Habib ZM, Moshy J. Periodontal disease; Knowledge awareness and attitude of medical doctors towards periodontal disease in Dares Salaam, Tanzania. Prof Med J 2013;20:290-5.
Sede MA, Ehizele AO. Oral diseases and diabetes: Nigerian medical and dental caregivers' perspective. Ann Afr Med 2015;14:193-9.
] [Full text]
Umeizudike KA, Iwuala SO, Ozoh OB, Ayanbadejo PO, Fasanmade OA. Association between periodontal diseases and systemic illnesses: A survey among internal medicine residents in Nigeria. Saudi Dent J 2016;28:24-30.
Longtin Y, Sax H, Leape LL, Sheridan SE, Donaldson L, Pittet D, et al.
Patient participation: Current knowledge and applicability to patient safety. Mayo Clin Proc 2010;85:53-62.
Geisinger ML, Robinson M, Kaur M, Gerlach RW, Griffin R, Geurs NC, et al
. Individualized oral health education improves oral hygiene compliance and clinical outcomes in pregnant women with gingivitis. Oral Hyg Health 2013;1:111-20.
Gholami M, Pakdaman A, Jafari A, Virtanen JI. Knowledge of and attitudes towards periodontal health among adults in Tehran. East Mediterr Health J 2014;20:196-202.
Daniel WW, editor. Biostatistics: A Foundation for Analysis in the Health Sciences. 7th
ed. New York: John Wiley & Sons; 1999.
Pralhad S, Thomas B. Periodontal awareness in different healthcare professionals: A questionnaire survey. J Educ Ethics Dent 2011;1:64-7. [Full text]
Umeizudike KA, Iwuala SO, Ozoh OB, Ekekezie OO, Umeizudike TI. Periodontal systemic interaction: Perception, attitudes and practices among medical doctors in Nigeria. J West Afr Coll Surg 2015;5:58-75.
Kumar S, Preetha G. Health promotion: An effective tool for global health. Indian J Community Med 2012;37:5-12.
] [Full text]
Office of the Surgeon General (US). Population-based Approaches to Promote Bone Health. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville (MD): Office of the Surgeon General (US); 2004. p. 12. Available from: https://www.ncbi.nlm.nih.gov/books/NBK45512/
. [Last accessed on 2017 Oct 12].
Teles R, Teles F, Frias-Lopez J, Paster B, Haffajee A. Lessons learned and unlearned in periodontal microbiology. Periodontol 2000 2013;62:95-162.
Page RC, Sturdivant EC. Noninflammatory destructive periodontal disease (NDPD). Periodontol 2000 2002;30:24-39.
Dayakar MM, Kumar J, Pai GP, Shivananda H, Rekha R. A survey about awareness of periodontal health among the students of professional colleges in Dakshina Kannada district. J Indian Soc Periodontol 2016;20:67-71.
] [Full text]
Grønkjær LL, Nielsen N, Nielsen M, Smedegaard C. Oral health behaviour, knowledge, and attitude among nursing students. J Nurs Educ Pract 2017;7:1-6.
Al-Zarea BK. Oral health knowledge of periodontal disease among university students. Int J Dent 2013;2013:647397.
Carneiro L, Kabulwa M, Makyao M, Mrosso G, Choum R. Oral health knowledge and practices of secondary school students, Tanga, Tanzania. Int J Dent 2011;2011:806258.
Chestnutt IG, Reynolds K. Perceptions of how the internet has impacted on dentistry. Br Dent J 2006;200:161-5.
[Table 1], [Table 2], [Table 3], [Table 4]