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Attitude, knowledge and habits of high school pupils in Israel regarding oral health
PTkNT EdCATiON ANd COWSEbJ~ ELSEVIER
Patient Education and Counseling 27 (1996) 171-175
Attitude,
knowledge and habits of high school pupils in Israel regarding oral health U. Brooka***l, M. HeimbT’, Y. Alkalai” “Department of Pediatrics, Wolfson Medical Center, PO. Box 5, Holon 58100, Israel bDepartment of Rehabilitation, Sheba Medical Center, Tel Hashomer, Israel ‘Department of Sociology, Tel Aviv University, Tel Aviv, Israel
Received 22 April 1994; revision received 20 April 1995; accepted 19 June 1995
Abstract The purpose of this project was to study the habits, knowledge and attitudes of 132 high school students in regards to their teeth and oral health. An inflated amount of consumptionof snack food and sweet beverages between mealswas reported. Seventy-two point seven percent claimed to brush their teeth at least twice daily. Forty-nine point three percent claimedto visit their dentist annually. The resultsalsodemonstrateda poor general knowledge and misconceptionsconcerningteeth, food and oral health throughout the years of high schoolstudies. Knowledge levels correlated with with age. More than half of the pupils attributed esthetical importance to the teeth appearance.The students’knowledgeconcerningprevention stemmedmainly from their dentist, parents, and the media and only 2.6% learned anything from formal school teaching. In the light of the students’ poor knowledge,it would appearthat resourcesshouldbe invested in schoolsat the elementary and high schoollevel for oral hygiene and cariesprevention education in the hope of improving bad habits and perpetuating improved oral health and hygiene. Keywords:
Oral health knowledge and attitude; Oral health education; High school pupils
1. Introduction In their daily practice, pediatricians encounter patients with poor dental hygiene which progresses into dental caries, peridontal problems which, in turn, permanently affect the teeth, * Corresponding author. ’ Affiliated with the Sackler School of Medicine, Tel Aviv University.
gums, and jaws [l]. The awareness of good oral health varies from country to country [2-91. In Israel, adolescents reaching the age of 12 years have 5.1 teeth affected. Over the last 3 years, educational programs have been introduced in the hope of improving oral health [lo]. Oral health education of pupils works best when it takes into account their state of knowledge. There is no agreement between educators and clinicians concerning the effect that this imputed
0738-3991/96/$15.00 @ 19% Elsevier Science Ireland Ltd. All rights reserved SSDI 0738-3991(95)00821-G
172
U. Brook et al. / Patient Education and Counseling 27 (1996) 171-175
knowledge has had upon the state of oral hygiene, eating habits such as frequent consumption of cariogenic foods between meal and dental diseases. The reality shows that though most children and adolescents know what causes caries, they still suffer a great amount of them, Russel et al. stated, for example, that pupil habits are neither connected to the level of their understanding, nor to the instruction that they received at school [ll]. Hamilton et al., Kawamura et al, and Ajzen et al. [12-M] noted, on the other hand, a correlation between oral knowledge and attitudes and the state of dental health. Woolgroove et al. commented that children between the ages of 14-16, due to social pressures and/or discomfort, urgently seek dental assistance [15]. Hartshorne et al. stated that improved student knowledge resulted in better handling of dental problems [16]. The aim should be to educate children from early childh~d to prevent dental disease. Schools provide the ideal environment for dental health screening and the institution of preventative care practices. By the application of such methods, the incidence of dental caries has been reported to have decreased [17-201. Hamilton et al. [12] proposed that high risk groups should receive special medical education in prevention, administered by specially trained teachers. The purpose of this study was to investigate knowledge, attitudes and oral behavior related to dental health of high school pupils.
2. Materials
and methods
One hundred thirty-do high school pupils were included in the study, their data are summarized in Table 1. They represent four classes, which were chosen at random from 30 classes consisting of children, aged between 14-18 years, who attend a high school with a total attendance of 1200 pupils. A questionnaire, constructed by a pediatrician, a dentist and a teacher, comprising 115 questions was devised. This ~str~ent was reviewed by ten pediatricians, dentists, and a statistician to assess the pertinence and validity of each question. Only 74 questions were judged valid and accepted by the group, and these were
Table 1 Epidemiological
data of the pupils
Characteristic
n
%
Age (years) 14-15 15-16 16-17 17-18 Total (14-18)
36 38 26 32 132”
27.27 28.79 19.7 24.24
44 88
33.6 c&A
Gender Bays Girls
Parental profession (~ather~mot~er) Hausekeeper 0120 Technical 37/s Commercial 3818 Secretarial 15142 Teaching 8137 Academic 34120
Of15.7 3.9128.3 29.2t5.9
11.3t32.4 5.7t28.5
255115.7
*Mean age: 15.36 t 127. Mean school marks: 80.7 3 8.4 (in comparison with mean pupils’ marks in parallel ciassesf: 78.3 2 9.1.
included in the final draft completed by the pupils. The questionnaire evaluated their general information, oral dental status, dental knowledge, attitudes on dental health, implications of therapy, sources of knowledge already attained, and desire for additional knowledge Within the four classes that participated in this study six pupils were not included. They were new immigrants and had language problems. It was felt that they would be incapable of completing the questiannaire in the 30 min allocated.
3. Results The dental habits of the pupils are summarized in Table 2. Sixty-six point six percent of the pupils overindulge daily in sweets and 47.6% in sweet beverages between meals. Questions concerning their dental health behavior showed the following: 49.3% of the pupils’ visit dental clinics regularly (at least once a year); 44.7% are examined only when suffering from dental pain; 59.4% of the pupils brush their teeth twice a day - 27.3% once a day and 10.2% three times a day
U. Brook
et al.
I Patient
Education
and Counseling
27 (19%)
173
171-175
Table 2 Questions demonstrating the pupils’ dental knowledge Question
Correct answers (% )
1. What is the number of permanent teeth in the mouth of a 15year-old adolescent? (Answer: 28) 2. List the teeth’s functions Cutting Mastication Speaking 3. List the function of fluoride in the mouth, especially for the teeth Strengthens the teeth’s enamel layer Strengthens the gums Whitens the teeth 4. Every day one liter of saliva is secreted in the mouth (T) 5. Germs in the mouth decompose sugars in the food into acid which attacks the enamel of the teeth (T) 6. Sweet and sticky food between meals causes the development of dental caries (T) 7. Flossing will remove dental plaque on both sides of the teeth (T) 8. A tooth brush will efficiently remove the food that remains in the crevices of the teeth (F) 9. Flouridation of drinking water will decrease the occurrence of dental caries (T) 10. Habitual smokers will suffer from gum disease as well as from buccal tumors (T)
16.7
(girls more frequently than boys: r = 0.22, P = 0.018); 33.6% of the pupils admitted that they ate sweets once a day between meals (chocolate, cakes, etc.) - 37.1% twice a day, 17.2% three times a day and 12.1% four (or more) times during the day; 22.4% of the pupils revealed that they drink a glass of a sweet beverage (such as sugared cola) during the day - 27.9% twice a day, 18.7% three times a day, and 28.9% four (or more) times a day (boys more than girls: r = 0.21, P = 0.02). The manner in which pupils coped with urgent dental problems revealed the following: 57.7% of the pupils would consult with their dentist without delay, when suffering from dental pain as a result of warm and cool contact; others would wait. Of pupils 46.3% would consult their dentist immediately, when suffering severe cheekbone pain as a result of trauma; 37.9% would consult other physicians; and 15.7% would wait in the hope that the problem would rectify itself. Results on the general dental problems and care knowledge of the pupils are presented in Table 2. More than half of the pupils gave incorrect answers. The knowledge levels of the different age groups are summarized in Table 3. Pupils in the age group 16-17 years had the highest knowledge levels. There was no significant correlation
Table 3 Knowledge
37.5 46.4 13.4 52.3 30.3 17.4 48.6 63.9 70.3 15.8 15.8 64.5 16.7
level of pupils
Age (years)
n (out of)
Response (% )*
14-15 15-16 16-17 17-18 Total: 14-18
10 11 22 18 59
27.8 45.9 76.9 56.3 56.5
(36) (24) (24) (32) (18)
* Those who responded correctly to at least one half of the questions (x’ = 30.61; P = 0.032; r = 0.312; P = 0.0006).
between knowledge and gender, origin of the families, or socioeconomic class. The attitude of the pupils towards dental problems are summarized in Table 4 (nine examples from the questionnaire are shown.) More than half of the pupils attribute esthetical importance to the appearance of their teeth. The results from Table 4 further show the following: 88.8% felt repelled by persons with decayed teeth; 46% were put off by dental protrusion and 68% by dental spacing irregularities (malocclusion); 52.6% of the pupils recognized that neglect was the cause of dental caries, while 66% attributed dental problems to a question of luck and 14% believe it was genetically determined; and 14% felt that halitosis was due to insufficient brushing, but not related to dental caries. Sources of information concerning the pupils’
174
U. Brook
et al. I Patient
Education
and Counseling
27 (19%)
171-175
Table 4 Pupils attitudes to dental problems
1. 2. 3. 4. 5. 6. 7. 8. 9.
Caries are always the results of negligence Yellow teeth are always the result of poor buccal hygiene Bad mouth odour (halitosis) proves the absence of teeth brushing Teeth problems come always as a matter of luck Regular check-up by the dentist will prevent caries Colored decayed teeth evokes in me a feeling of repulsion Gaps between the teeth decrease the beauty of a girl Protruding teeth will always decrease the self image of a boy/girl Orthodontal treatment will help alleviate feelings of frustration
Table 5 Sources of information of dental health Source
n
%
Dentist Parents Newspapers Television Books (general health) Radio School (biology lessons)
32 26 24 22 12 5 4
25.6 20.8 19.2 17.6 9.6 4 3.2
knowledge are summarized in Table 5. The principal source for over a quarter of the pupils was their dentist. Only 3% of the pupils had learned anything useful about teeth at school. Sixty-four point two percent of the pupils pointed out that nobody had spoken with them during their high school years about dental health (neither dentists, nurses, nor teachers). Sixty-three point three percent of the pupils (n = 84) (53.1% boys and 68.8% girls) were interested in having talks about dental health at school. On the other hand, 36.7% (n = 48) of the pupils declared that they are not interested in receiving any talks in school on the subject of dental health.
4. Discussion
The study demonstrated that the hypothesis of lack of knowledge was correct (Tables 2, 3) and that knowledge increased with age. According to the self-evaluated reported behavior, there was
Responded affirmatively (% )
Responded negatively (% )
52.6 51.3 46.9 6.6 71.7 88.8 68.1 45.9 51.1
26.7 26.6 36.6 93.4 10.6 11.2 19 26.6 15.2
poor knowledge of prevention of caries. In our study, 70.3% of the pupils knew that consumption of sugared food and beverages between meals is harmful to their teeth and causes caries; even though they could not free themselves from these bad habits. Hamilton et al. [12] feels that increasing knowledge is associated with better oral health. Woolgroove et al. and King et al. agree with that perception [l&21]. Hungoson et al. [6], who investigated these problems over 10 years, found that there is a correlation between oral habits, knowledge and academic achievements. Our study showed that most oral hygiene knowledge is imparted to the students by dentists with least coming from school educational programs (Table 5) . This situation should be corrected. Our study did not show any correlation between the level of oral knowledge and socioeconomic class, nor with country of family origin. Keogh et al. [22] presented the opposite finding in which high socioeconomic level is linked to higher knowledge and appropriate oral behavior. Half of the pupils believe that dental problems are the results of negligence, poor oral hygiene and a lack of regular brushing. More than half of the pupils attribute high esthetical importance to the appearance of their teeth. Half of the pupils expressed a disciplined attitude; they prevent dental problems by regular visits to dental clinics. Forty-five percent receive treatment only after dental pain had appeared (48% of the boys and 39% of the girls). The lack of sufficient knowledge is of great concern, and there is a need for formal health education in this
U. Brook
et al.
I Patient
Education
area. The Ministry of Education, in conjunction with the Ministry of Health, should sponsor dental health programs with the schools. This instruction should provide pupils with adequate theoretical knowledge as well as practical advice. This early investment will improve the quality of oral health in the maturing population in the long run .
Acknowledgements The authors express their thanks to Judy Brandt for her skillful editing and word processing expertise and contributions.
References [l] Griffen AL, Goopferd SJ. Preventive oral health care for the infant, child and adolescents. Pediatr Clin N Am 1991; 38(5): 1209-1226. [2] Elkman, A. Dental health knowledge and behavior in 14 year old children of Finnish immigrant families in the north of Sweden. Swed Dent J 1989; 13(3): 95-102. [3] Kay EJ, Shaikh I, Bhopal RS. Dental knowledge, beliefs, attitudes, and behavior of the Asian community in Glasgow. Health Bull (Edinb) 1990; 48(2): 73-80. [4] Woolfolk MN, Lang WP, Wirth Faja B. Oral health knowledge and sources of information among elementary school children. J Public Health Dent 1989; 49(l): [5] gn Hsu JC, Hankelman SL. Patients’ knowledge of caries prevention, a study. NY State Dent J 1989; .55(2): 28-30. [6] Hugoson A, Koch G, Bergenda T, Hallonsten D, Laurel1 L et al. Oral health of individuals aged 3-80 years in Jonkoping, Sweden in 1973 and 1983. A review of findings on dental care habits and knowledge of oral health. Swed Dent J 1986; lO(3): 103-117. [7] Durward CS, Wright FA. Dental knowledge, attitudes, and behavior of Indochinese and Australian born adolescents. Community Dent Oral Epidemiol 1989; 17(7): 14-18. [8] Nuttall NM, Davies JA. Dental attendance behavior of
and Counseling
27 (1996)
171-175
175
children in Scotland between 1983 and 1988. Br Dent J 1992; 172: 378-382. [91 Bagramiga RA, Narendran S, Khavari AM. Oral health status, knowledge, and practice in an Amish population. J Pub1 Health Dent 1988: 48(3): 147-151. El01Man Y, Kaplan R. Primary prevention of oral diseases in Israel. Harefuah 1990; 11% 547-549. 1111Russel BA, Horowitz AM, Frazier PJ. School based prevention regiments and oral health knowledge and practice of Sixth Grade. J Pub1 Health Dent 1989; 49(4): 192-200. WI Hamilton ME, Coulby WM. Oral health knowledge and habits of senior elementary school students. J Pub1 Health Dent 1991; 51(6): 212-18. 1131 Kawamura M, Auyama H, Sasahara H, Tsuchida K, Nagao M et al. Behavioral dental science. Part VIII. The dentist rating and adolescent’s perception of oral health. Nippon Shisulyo Gakkai Kaishi 1988; 30(4): 1097-107. 1141 Ajzem J, Fishbein M. Understanding attitudes and predicting social behavior. Englewood Cliffs, NY: Prentice Hall 1980, 5-12. WI Woolgroove J, Cumberbatch G. Gelbier S. Understanding dental attendance behavior. Community Dent Health 1987; 4: 215-221. WI Hartshorne JE, Carstens IL, Beilinsohn D, Potgieter G. The effectiveness of a school based oral health education program - a pilot study. Tydskr-Tandheelkd Ver S Afr 1989; 44(l): 5-10. [171 Rayner JA. A dental health education program including home visits, for nursery school children. Br Dent J 1991; 172: 57-62. WI Wright FAC. Oral health promotion in the School. A historical analysis and care study. Health Educ Q 1991; 18( 1): 87-96. P91 Flanders RA. Effectiveness of dental health education programs in schools. J Am Dent Assoc 1987; 114: 239242. lW1 Horowitz AM. Effective oral health education and promotion programs to prevent dental caries. Int Dent J 1985; 33: 172-181. WI King AJ, Robertson AS, Warren WK. Summa~ report: Canada Health Attitudes and Behaviors Survey: 9-, 12-, and 15-year-olds. Kingston, Ontario: Queen’s University, 1985. P21 Keogh T, Linden GJ. Knowledge, attitudes and behavior in relation to dental health of adults in Belfast, Nothern Ireland. Community Dent Oral Epidemiol 1991; 19: 246-248.
Patient Education and Counseling 27 (1996) 171-175
Attitude,
knowledge and habits of high school pupils in Israel regarding oral health U. Brooka***l, M. HeimbT’, Y. Alkalai” “Department of Pediatrics, Wolfson Medical Center, PO. Box 5, Holon 58100, Israel bDepartment of Rehabilitation, Sheba Medical Center, Tel Hashomer, Israel ‘Department of Sociology, Tel Aviv University, Tel Aviv, Israel
Received 22 April 1994; revision received 20 April 1995; accepted 19 June 1995
Abstract The purpose of this project was to study the habits, knowledge and attitudes of 132 high school students in regards to their teeth and oral health. An inflated amount of consumptionof snack food and sweet beverages between mealswas reported. Seventy-two point seven percent claimed to brush their teeth at least twice daily. Forty-nine point three percent claimedto visit their dentist annually. The resultsalsodemonstrateda poor general knowledge and misconceptionsconcerningteeth, food and oral health throughout the years of high schoolstudies. Knowledge levels correlated with with age. More than half of the pupils attributed esthetical importance to the teeth appearance.The students’knowledgeconcerningprevention stemmedmainly from their dentist, parents, and the media and only 2.6% learned anything from formal school teaching. In the light of the students’ poor knowledge,it would appearthat resourcesshouldbe invested in schoolsat the elementary and high schoollevel for oral hygiene and cariesprevention education in the hope of improving bad habits and perpetuating improved oral health and hygiene. Keywords:
Oral health knowledge and attitude; Oral health education; High school pupils
1. Introduction In their daily practice, pediatricians encounter patients with poor dental hygiene which progresses into dental caries, peridontal problems which, in turn, permanently affect the teeth, * Corresponding author. ’ Affiliated with the Sackler School of Medicine, Tel Aviv University.
gums, and jaws [l]. The awareness of good oral health varies from country to country [2-91. In Israel, adolescents reaching the age of 12 years have 5.1 teeth affected. Over the last 3 years, educational programs have been introduced in the hope of improving oral health [lo]. Oral health education of pupils works best when it takes into account their state of knowledge. There is no agreement between educators and clinicians concerning the effect that this imputed
0738-3991/96/$15.00 @ 19% Elsevier Science Ireland Ltd. All rights reserved SSDI 0738-3991(95)00821-G
172
U. Brook et al. / Patient Education and Counseling 27 (1996) 171-175
knowledge has had upon the state of oral hygiene, eating habits such as frequent consumption of cariogenic foods between meal and dental diseases. The reality shows that though most children and adolescents know what causes caries, they still suffer a great amount of them, Russel et al. stated, for example, that pupil habits are neither connected to the level of their understanding, nor to the instruction that they received at school [ll]. Hamilton et al., Kawamura et al, and Ajzen et al. [12-M] noted, on the other hand, a correlation between oral knowledge and attitudes and the state of dental health. Woolgroove et al. commented that children between the ages of 14-16, due to social pressures and/or discomfort, urgently seek dental assistance [15]. Hartshorne et al. stated that improved student knowledge resulted in better handling of dental problems [16]. The aim should be to educate children from early childh~d to prevent dental disease. Schools provide the ideal environment for dental health screening and the institution of preventative care practices. By the application of such methods, the incidence of dental caries has been reported to have decreased [17-201. Hamilton et al. [12] proposed that high risk groups should receive special medical education in prevention, administered by specially trained teachers. The purpose of this study was to investigate knowledge, attitudes and oral behavior related to dental health of high school pupils.
2. Materials
and methods
One hundred thirty-do high school pupils were included in the study, their data are summarized in Table 1. They represent four classes, which were chosen at random from 30 classes consisting of children, aged between 14-18 years, who attend a high school with a total attendance of 1200 pupils. A questionnaire, constructed by a pediatrician, a dentist and a teacher, comprising 115 questions was devised. This ~str~ent was reviewed by ten pediatricians, dentists, and a statistician to assess the pertinence and validity of each question. Only 74 questions were judged valid and accepted by the group, and these were
Table 1 Epidemiological
data of the pupils
Characteristic
n
%
Age (years) 14-15 15-16 16-17 17-18 Total (14-18)
36 38 26 32 132”
27.27 28.79 19.7 24.24
44 88
33.6 c&A
Gender Bays Girls
Parental profession (~ather~mot~er) Hausekeeper 0120 Technical 37/s Commercial 3818 Secretarial 15142 Teaching 8137 Academic 34120
Of15.7 3.9128.3 29.2t5.9
11.3t32.4 5.7t28.5
255115.7
*Mean age: 15.36 t 127. Mean school marks: 80.7 3 8.4 (in comparison with mean pupils’ marks in parallel ciassesf: 78.3 2 9.1.
included in the final draft completed by the pupils. The questionnaire evaluated their general information, oral dental status, dental knowledge, attitudes on dental health, implications of therapy, sources of knowledge already attained, and desire for additional knowledge Within the four classes that participated in this study six pupils were not included. They were new immigrants and had language problems. It was felt that they would be incapable of completing the questiannaire in the 30 min allocated.
3. Results The dental habits of the pupils are summarized in Table 2. Sixty-six point six percent of the pupils overindulge daily in sweets and 47.6% in sweet beverages between meals. Questions concerning their dental health behavior showed the following: 49.3% of the pupils’ visit dental clinics regularly (at least once a year); 44.7% are examined only when suffering from dental pain; 59.4% of the pupils brush their teeth twice a day - 27.3% once a day and 10.2% three times a day
U. Brook
et al.
I Patient
Education
and Counseling
27 (19%)
173
171-175
Table 2 Questions demonstrating the pupils’ dental knowledge Question
Correct answers (% )
1. What is the number of permanent teeth in the mouth of a 15year-old adolescent? (Answer: 28) 2. List the teeth’s functions Cutting Mastication Speaking 3. List the function of fluoride in the mouth, especially for the teeth Strengthens the teeth’s enamel layer Strengthens the gums Whitens the teeth 4. Every day one liter of saliva is secreted in the mouth (T) 5. Germs in the mouth decompose sugars in the food into acid which attacks the enamel of the teeth (T) 6. Sweet and sticky food between meals causes the development of dental caries (T) 7. Flossing will remove dental plaque on both sides of the teeth (T) 8. A tooth brush will efficiently remove the food that remains in the crevices of the teeth (F) 9. Flouridation of drinking water will decrease the occurrence of dental caries (T) 10. Habitual smokers will suffer from gum disease as well as from buccal tumors (T)
16.7
(girls more frequently than boys: r = 0.22, P = 0.018); 33.6% of the pupils admitted that they ate sweets once a day between meals (chocolate, cakes, etc.) - 37.1% twice a day, 17.2% three times a day and 12.1% four (or more) times during the day; 22.4% of the pupils revealed that they drink a glass of a sweet beverage (such as sugared cola) during the day - 27.9% twice a day, 18.7% three times a day, and 28.9% four (or more) times a day (boys more than girls: r = 0.21, P = 0.02). The manner in which pupils coped with urgent dental problems revealed the following: 57.7% of the pupils would consult with their dentist without delay, when suffering from dental pain as a result of warm and cool contact; others would wait. Of pupils 46.3% would consult their dentist immediately, when suffering severe cheekbone pain as a result of trauma; 37.9% would consult other physicians; and 15.7% would wait in the hope that the problem would rectify itself. Results on the general dental problems and care knowledge of the pupils are presented in Table 2. More than half of the pupils gave incorrect answers. The knowledge levels of the different age groups are summarized in Table 3. Pupils in the age group 16-17 years had the highest knowledge levels. There was no significant correlation
Table 3 Knowledge
37.5 46.4 13.4 52.3 30.3 17.4 48.6 63.9 70.3 15.8 15.8 64.5 16.7
level of pupils
Age (years)
n (out of)
Response (% )*
14-15 15-16 16-17 17-18 Total: 14-18
10 11 22 18 59
27.8 45.9 76.9 56.3 56.5
(36) (24) (24) (32) (18)
* Those who responded correctly to at least one half of the questions (x’ = 30.61; P = 0.032; r = 0.312; P = 0.0006).
between knowledge and gender, origin of the families, or socioeconomic class. The attitude of the pupils towards dental problems are summarized in Table 4 (nine examples from the questionnaire are shown.) More than half of the pupils attribute esthetical importance to the appearance of their teeth. The results from Table 4 further show the following: 88.8% felt repelled by persons with decayed teeth; 46% were put off by dental protrusion and 68% by dental spacing irregularities (malocclusion); 52.6% of the pupils recognized that neglect was the cause of dental caries, while 66% attributed dental problems to a question of luck and 14% believe it was genetically determined; and 14% felt that halitosis was due to insufficient brushing, but not related to dental caries. Sources of information concerning the pupils’
174
U. Brook
et al. I Patient
Education
and Counseling
27 (19%)
171-175
Table 4 Pupils attitudes to dental problems
1. 2. 3. 4. 5. 6. 7. 8. 9.
Caries are always the results of negligence Yellow teeth are always the result of poor buccal hygiene Bad mouth odour (halitosis) proves the absence of teeth brushing Teeth problems come always as a matter of luck Regular check-up by the dentist will prevent caries Colored decayed teeth evokes in me a feeling of repulsion Gaps between the teeth decrease the beauty of a girl Protruding teeth will always decrease the self image of a boy/girl Orthodontal treatment will help alleviate feelings of frustration
Table 5 Sources of information of dental health Source
n
%
Dentist Parents Newspapers Television Books (general health) Radio School (biology lessons)
32 26 24 22 12 5 4
25.6 20.8 19.2 17.6 9.6 4 3.2
knowledge are summarized in Table 5. The principal source for over a quarter of the pupils was their dentist. Only 3% of the pupils had learned anything useful about teeth at school. Sixty-four point two percent of the pupils pointed out that nobody had spoken with them during their high school years about dental health (neither dentists, nurses, nor teachers). Sixty-three point three percent of the pupils (n = 84) (53.1% boys and 68.8% girls) were interested in having talks about dental health at school. On the other hand, 36.7% (n = 48) of the pupils declared that they are not interested in receiving any talks in school on the subject of dental health.
4. Discussion
The study demonstrated that the hypothesis of lack of knowledge was correct (Tables 2, 3) and that knowledge increased with age. According to the self-evaluated reported behavior, there was
Responded affirmatively (% )
Responded negatively (% )
52.6 51.3 46.9 6.6 71.7 88.8 68.1 45.9 51.1
26.7 26.6 36.6 93.4 10.6 11.2 19 26.6 15.2
poor knowledge of prevention of caries. In our study, 70.3% of the pupils knew that consumption of sugared food and beverages between meals is harmful to their teeth and causes caries; even though they could not free themselves from these bad habits. Hamilton et al. [12] feels that increasing knowledge is associated with better oral health. Woolgroove et al. and King et al. agree with that perception [l&21]. Hungoson et al. [6], who investigated these problems over 10 years, found that there is a correlation between oral habits, knowledge and academic achievements. Our study showed that most oral hygiene knowledge is imparted to the students by dentists with least coming from school educational programs (Table 5) . This situation should be corrected. Our study did not show any correlation between the level of oral knowledge and socioeconomic class, nor with country of family origin. Keogh et al. [22] presented the opposite finding in which high socioeconomic level is linked to higher knowledge and appropriate oral behavior. Half of the pupils believe that dental problems are the results of negligence, poor oral hygiene and a lack of regular brushing. More than half of the pupils attribute high esthetical importance to the appearance of their teeth. Half of the pupils expressed a disciplined attitude; they prevent dental problems by regular visits to dental clinics. Forty-five percent receive treatment only after dental pain had appeared (48% of the boys and 39% of the girls). The lack of sufficient knowledge is of great concern, and there is a need for formal health education in this
U. Brook
et al.
I Patient
Education
area. The Ministry of Education, in conjunction with the Ministry of Health, should sponsor dental health programs with the schools. This instruction should provide pupils with adequate theoretical knowledge as well as practical advice. This early investment will improve the quality of oral health in the maturing population in the long run .
Acknowledgements The authors express their thanks to Judy Brandt for her skillful editing and word processing expertise and contributions.
References [l] Griffen AL, Goopferd SJ. Preventive oral health care for the infant, child and adolescents. Pediatr Clin N Am 1991; 38(5): 1209-1226. [2] Elkman, A. Dental health knowledge and behavior in 14 year old children of Finnish immigrant families in the north of Sweden. Swed Dent J 1989; 13(3): 95-102. [3] Kay EJ, Shaikh I, Bhopal RS. Dental knowledge, beliefs, attitudes, and behavior of the Asian community in Glasgow. Health Bull (Edinb) 1990; 48(2): 73-80. [4] Woolfolk MN, Lang WP, Wirth Faja B. Oral health knowledge and sources of information among elementary school children. J Public Health Dent 1989; 49(l): [5] gn Hsu JC, Hankelman SL. Patients’ knowledge of caries prevention, a study. NY State Dent J 1989; .55(2): 28-30. [6] Hugoson A, Koch G, Bergenda T, Hallonsten D, Laurel1 L et al. Oral health of individuals aged 3-80 years in Jonkoping, Sweden in 1973 and 1983. A review of findings on dental care habits and knowledge of oral health. Swed Dent J 1986; lO(3): 103-117. [7] Durward CS, Wright FA. Dental knowledge, attitudes, and behavior of Indochinese and Australian born adolescents. Community Dent Oral Epidemiol 1989; 17(7): 14-18. [8] Nuttall NM, Davies JA. Dental attendance behavior of
and Counseling
27 (1996)
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175
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