Oral diseases are public health problems worldwide (Petersen et al.,
2005). Their impact on individuals and communities in terms of pain and
suffering, functional impairment and reduced quality of life is considerable
and are the fourth most expensive to treat in most industrialized countries
(Petersen, 2004). One of the most common of the oral diseases is dental
caries. It is an affliction, which invades all age groups and the most
important cause of tooth loss in children and young people (Jacobs, 2005).
Adolescents represent a challenging group in terms of oral health because
they have vulnerable permanent teeth erupting by the time they are establishing
their independence from parental influence (Stokes et al., 2006).
In addition, practices such as frequent consumption of sweets, sugary
foods and drinks, which have being identified by several researchers (Lingzhu
et al., 2003; Oloffson and Bratthall, 2003; Jacobs, 2005) as predisposing
factors to dental caries are prominent among the adolescents.
In Nigeria, dental caries constitutes one of the major oral health problems
with its prevalence being particularly high among young children and adolescents
and the occurrence closely related to oral hygiene and socio economic
class (Akpata, 2004).
Enwonwu (1966) observed and reported the prevalence of destructive periodontal
diseases to range between 15% in Northern Nigeria and 10% in Western Nigerians
aged 15 to 19 years. Adegbembo and El-Nadeef (1995) also reported caries
experience as high as 30 and 43% among Nigerians aged 12 and 15 years,
Most of the studies on dental caries among Nigerian adolescents have
been centered on the prevalence of the disease while little have been
done to investigate adolescents knowledge attitude and practice in relation
to dental health. Such information however is necessary as it serves as
an eye opener to factors among the adolescents that can predispose them
to dental caries. This study thus aimed at describing the knowledge, attitude
and practice of adolescents in Ibadan North (LGA) of Oyo State Nigeria
towards preventing dental caries.
MATERIALS AND METHODS
The study was a descriptive study to identify and describe the extent
of knowledge, attitude and practice of adolescents in Ibadan North (LGA)
towards maintaining dental health and to relate these with the occurrence
of dental caries among them.
The subjects for this study were drawn from 10 secondary schools located
within Ibadan North Local Government Area of Oyo State, Nigeria. The schools
were selected using sampling with replacement method. Each of the schools
selected was divided to clusters namely: junior secondary schools one,
two, three and senior secondary schools one, two and three. Two clusters
each (one junior and one senior) were selected randomly from each school.
Thirty students from each cluster in the junior schools and forty from
each cluster in the senior schools (making a total of seven hundred) were
intended to form the participants for this study. However, six hundred
and thirty-seven students (91%), completed the questionnaire. In addition,
the subjects were both male and female with age ranging from 11 to 19
The instruments for collecting the data required for this study were
dental examination and a self-structured close-ended questionnaire. The
content of the questionnaire was guided by review of literature on ways
of maintaining dental health and presented to lecturers in the Department
of Human Kinetics and Health Education University of Ibadan Nigeria and
final year dental students from the university college hospital Ibadan
for content and construct validity. The reliability of the instrument
was carried out using the cronbach alpha coefficient and this yielded
0.75. However, because the items did not follow the same response format,
reliability was based on items in sections B and D.
The questionnaire was organized into five sections. Section A elicited
information on demographic attributes of respondents (gender, age and
type of school). Section B elicited information on dental health knowledge.
Six questions were used to elicit knowledge and the response followed
a 2 way dichotomous format of yes or no. Section C had 5 questions related
to attitude towards dental health and the response format was in line
with the modified likert scale of summative rating with four point scale
of strongly agree, agree, disagree and strongly disagree. Section D also
had 5 questions to elicit information on practices towards dental health
with a yes or no response format. Section E was used to record the result
of the dental examination carried out on each of the respondents.
The instruments were administered with the assistance of twelve final
year dental students from University College Hospital (UCH) Ibadan, Nigeria.
On the spot administration and collection of questionnaire was adopted.
The research was carried out between January and June 2006.
Data analysis was carried out using the SPSS for windows v 11.0. The
variables for testing knowledge and practice were dichotomized. The wrong
options were assigned 1 while right options were assigned 2. Frequency
counts and percentages of adolescents with right and wrong knowledge and
sound and unsound practice of dental health were then obtained. Chi-square
test was carried out on each of the items to test for significant difference.
In addition, bivariate analysis of the association of each of the items
with other variables such as gender, age groups and type of school was
performed using Pearsons Chi-square test.
The variables for testing attitude were on a four point scale of strongly
agree, agree, disagree and strongly disagree. The best option was assigned
4 followed by the next best option 3 the two wrong options were assigned
2 and 1, respectively. During the cause of analysis, the two right options
on each of the items were added together to constitute positive attitude
while the two wrong options constituted negative attitude. Frequency counts
and percentages of adolescents with positive and negative attitude towards
dental health based on each of the item tested were obtained. Bivariate
analysis of the association of adolescents attitude with gender, age
group and type of school was also carried out.
The result of dental examination carried out on the adolescents yielded
the frequency and percentage occurrence of dental caries base on gender,
age group and type of school. The relationship that exists between dental
health knowledge, attitude and practice and dental caries occurrence among
adolescents, was obtained by summing up the right and wrong responses
on the knowledge attitude and practice respectively and correlating these
with the frequency counts of adolescents with and without dental caries
using Pearson product moment correlation. All differences and associations
were considered significant at p<0.05.
Table 1 shows the demographic distribution of respondents.
Over 50% were females, nearly two-thirds were between 14-16 years and
those attending public schools formed 79% of the respondents.
Result of data analysis on adolescents knowledge (Table
2) revealed that significantly large number of the adolescents displayed
right knowledge on the variables tested. Bivariate analysis of the association
between adolescents knowledge and their gender, age group and type of
school being attended (Table 5), revealed that knowledge
of adolescents was not significantly influenced by gender, age group and
type of school. However, analysis of the mean difference in knowledge
(Table 5) revealed that male respondents, those within
the age range of 11-13 years and those attending private schools, had
higher mean dental health knowledge than their counterparts.
Attitude towards dental health among adolescents was significantly positive
(Table 3). Majority of the adolescents irrespective
of gender, age group and the type of school, saw the care of the mouth
and teeth as important as the care of other parts of the body, had a right
attitude towards brushing before eating in the morning and towards going
for dental checkup whether one is having tooth pain or not, displayed
right attitude towards brushing twice daily and showed right attitude
to rinsing the mouth with water after each meal. Bivariate analysis (Table
5) revealed that age group of adolescents and type of school being
attended had significant influence on their attitude towards dental health.
In addition, female respondents, those within the age range of 17-19 years
and those attending private schools had more positive dental health attitude
than their counterparts.
|| Respondents demographic and Dental Caries (DC) occurrence
distribution by age, gender and type of school
||Frequency counts, percentages and Chi-square value of Adolescents
knowledge of dental health by gender, age group and type of school
|χ2 cal = 2879.65, χ2
tab =11.07, df = 5, p<0.05
||Frequency counts, percentages and Chi-square value of Adolescents
attitude towards dental health by gender, age group and type of school
|χ2 cal = 175.52, χ2 tab =
9.49 , df = 4, p<0.05
||Frequency counts, percentages and Chi-square value of Adolescents
practice towards dental health by gender, age group and type of school
|χ2 cal = 530.50, χ2
tab =9.49, df = 4, p<0.05
||Mean difference and Pearson Chi-square test of Adolescents
knowledge, attitude and practice of dental health base on gender, age group
and type of school
|*Significant at p<0.05.
The practice of dental health among adolescents was significantly sound
(Table 4). Many of them irrespective of gender, age
group and type of school being attended, brushed twice daily, use good
toothbrush and tooth paste, use the up down and sideways technique for
brushing and claimed to always rinse the mouth with water after each meal.
Findings of this study however showed that only few of the adolescents
go for dental check up at least once a year. Bivariate analysis (Table
5) further revealed that the type of school the adolescents attend
significantly influenced their dental health practice. Moreover, further
analysis (Table 5) revealed that female respondents,
those within the age range 11-13 years and those attending private schools
had better dental health practice than their counterparts.
The result of the dental examination (Table 1) showed
that only 39(6.1%) of the adolescents had dental caries. More females
(69.2%) than male (30.8%) had dental caries. About 25.6, 61.6 and 12.8%
of adolescents with dental caries were between the ages 11-13 years, 14-16
years and 17-19 years respectively. In addition, majority of the adolescents
(76.5%) with dental caries were from public schools. Dental caries occurrence
was negatively non-significantly correlated with adolescents dental health
knowledge, attitude and practice (Table 6).
A significantly high knowledge, positive attitude and sound practices
of dental health were found to exist among these adolescents. This is
most likely the reason for the low percentage occurrence of dental caries
(6.1%) observed among them. Negative relationship existed between the
knowledge, attitude and practice of dental health and dental caries occurrence
among the respondents. This indicates that as these variables increased
among the respondents, occurrence of dental caries reduced and vice versa.
This research confirms the fact that healthful knowledge, when allowed
to influence our attitude and practice is capable of reducing disease
occurrence. Knowledge influences people health. Through basic education
and public knowledge individuals become aware of the meaning of self-protection
and personal hygiene (Badran, 1995). It can thus be recommended that schools
incorporate health instructions that relate to maintaining dental health,
into their health instructional programs and make it as practical as possible.
The finding of this study that female respondents displayed more positive
dental health attitude and practice than their male counterparts, is similar
to that of Ostberg et al. (1999), Fukai et al. (1999) and
Al-Omari and Hamasha (2005). Respondents attending private schools displayed
better dental health knowledge, attitude and practice and had lower percentage
occurrence of dental caries (23.1%) than their counterparts in the public
schools (76.9%). Hoffmann et al. (2004) also found out in their
study that caries index was highest among public school children. Students
in private schools are often those of high self-esteem and whose parents
can afford means of keeping their dental health in good shape. It should
however be noted that dental problems constitute one of the reasons for
students absenteeism from schools hence schools whether private or public
should make all efforts to assist their students to keep off dental problems.
Schools can make arrangement for periodic visit by the dentists in their
provinces so as to give room for early detection of carious activity among
the students. In addition, schools can organize in-service training programs
for their health teachers to enable them acquire necessary practical skills
relevant to dental health.
The low percentage occurrence of dental caries (Table 1)
observed in this study can be attributed to the significantly high dental
health knowledge, attitude and practice displayed by these adolescents.
This is similar to the findings of Petersen et al. (2001) that
positive oral health attitude was highly correlated with low risk of dental
problems among school children in Southern Thailand. The finding of this
research also supports the fact that caries is age related. One of the
peaks reported by Lewis and Ismail (1995) for the initiation of dental
caries is 14 years and present findings (Table 1) revealed
that majority of the caries discovered were observed among adolescents
between 14 and 16 years of age.
The findings of this research revealed a low percentage occurrence of
dental caries, which was negatively correlated with dental health knowledge,
attitude and practice among adolescents. This implies that occurrence
of dental caries among these adolescents reduced with an increase in knowledge,
positive attitude and sound practices towards attaining dental health
and vice versa. It can thus be concluded that having a good knowledge,
positive attitude and a sound practice of healthful habits is capable
of reducing disease occurrence.