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Research Article
Dental Health Knowledge, Attitude and Practice on the Occurrence of Dental Caries Among Adolescents in a Local Government Area (LGA) of Oyo State, Nigeria

B.O. Ogundele and S.E. Ogunsile
 
ABSTRACT
This study was carried out in order to identify the extent of dental caries occurrence and to relate it with the dental health knowledge, attitude and practice among adolescents in Ibadan North (LGA) of Oyo State Nigeria. Descriptive survey research design was adopted for the study. Self structured questionnaire and dental examination were instruments used for obtaining the necessary information. A total number of six hundred and thirty seven adolescents, who were drawn from ten schools within Ibadan North (LGA) of Oyo State Nigeria, participated in the study. Participants displayed significantly high knowledge, positive attitude and sound practices towards dental health. Percentage dental caries occurrence was 6.1% and this was found to be prevalent among females (69.2%), among those within the age bracket 14-16 years (61.5%) and those attending public Schools (76.9%). Dental caries occurrence among these adolescents was also observed to be negatively correlated with their dental health knowledge (r = -0.026), attitude (r = -0.031) and practice (r = -0.060). Health instructional programs that encourage healthful dental habits among adolescents should be intensified in schools.
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B.O. Ogundele and S.E. Ogunsile, 2008. Dental Health Knowledge, Attitude and Practice on the Occurrence of Dental Caries Among Adolescents in a Local Government Area (LGA) of Oyo State, Nigeria. Asian Journal of Epidemiology, 1: 64-71.

DOI: 10.3923/aje.2008.64.71

URL: http://scialert.net/abstract/?doi=aje.2008.64.71

INTRODUCTION

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, respectively.

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

Study Design
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.

Subjects
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 years.

Instrument
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
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 Pearson’s 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.

RESULTS

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.

Table 1: Respondents’ demographic and Dental Caries (DC) occurrence distribution by age, gender and type of school

Table 2: 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

Table 3: 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

Table 4: 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

Table 5: 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.

Table 6: Correlation coefficient of Adolescents’ knowledge, attitude and practice towards dental health on the occurrence of dental caries

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).

DISCUSSION

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.

CONCLUSION

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.

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