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Dental Health Habits: A Questionnaire Survey
J.A.D.A., Vol. 38, January 1949 . . .
Wisan-Gruebbel
C om m ent
Dental research has constituted an in tegral part of the research program of the National Institute of Health for a num ber of years. The growth of the unit has been slow but continuous, increase in present activities being limited largely by the unavailability of additional trained dental investigators. Ah inspection of the summary of ac tivities of the Dental Research Section
19
gives some inkling of a few of the diverse fields into which dental research may lead. It suggests the complex problems confronting dental research. Obviously many branches of science must be util ized in elucidating problems as they arise; close integration with associated disciplines cannot be too strongly empha sized. Development of basic research consti tutes the major challenge confronting dentistry today.
DENTAL HEALTH HABITS: A QUESTIONNAIRE SURVEY J. M . W isa n ,* D.D.S., Providence, R. I., and Allen O . G ruebbel.f D.D.S., C h ic a g o
authorities long have recog nized the importance of dental health education in aiding people to protect or improve mouth health. A variety of educational technics and media is used for the purpose of disseminating infor mation and of motivating good health habits. In order to select the most effective technics and media, it is important to know the prevailing attitudes and con cepts of the lay public, as well as the extent to which people follow good den tal health habits. To aid in improving dental health education programs, a study was made to determine ( i ) the public’s source of dental health informa tion, (2) the public’s toothbrushing and other oral hygiene habits and (3) the number of persons who obtain the dental
D
en ta l
♦D irector, Joseph Samuels D en tal Clinic, #Rhode Island H ospital, Providence, R . I . ; formerly D irector, Division o f D ental H ealth Education, American D ental Association. fExecutive secretary,. Council on D ental H ealth, Am erican D ental Association.
treatment recommended by the dentist. From answers to mailed questionnaires (Table 1), the dental practices of 5,480 families were surveyed. These families constitute a panel used by a national advertising agency1 as a representative sampling of the buying public of the United States. The families reside in various sections of the United States and in areas of differing populations, repre sent high, medium and low economic levels and are comprised of all ages and both sexes (Table 2). Approximately half of the families were used in the study of toothbrushes.2 The other half were queried to obtain data concerning dental health habits. Of the questionnaires sent to 2,750 families, 2,205 (80 per cent), representing 7,057 persons, were returned. Housewives sup plied the answers for all members of the 1. J . W alter Thompson Company, Chicago. 2. Gruebbel, A . O ., and Wisan, J . M ., A Study of Toothbrushes in Use in American Homes. J.A.D.A. 3 7 :3 4 6 (S ep t.) 1948.
20
The Journal of the American Dental Association Table I.— Questionnaire mailed to 2,750 families
DENTAL H EALTH H ABITS Name_ City and StateRead instructions over carefully and follow them in filling out this special questionnaire. A. Where does your family get its information about diet and nutrition? (For any source(s) used, rank 1, 2, 3, etc. in order of importance of source) .Pamphlets and leaflets
-Friends
-Books
-Physician
-Advertisements—magazines or newspapers
-Dentist
-Articles or items—magazines or newspapers
_Nurse
-Advertising on radio
_Other_ (Explain)
-Lectures or talks on radio -Lectures—public or schools
B. Where does your family get its information about denial health and dental health habits? (For any source(s) used, rank 1, 2, 3, etc. in order of importance of source.) -Pamphlets and leaflets
-Friends
-Books
-Physician
-Advertisements—magazines or newspapers
-D entist
-Articles or items— magazines or newspapers
-Nurse
-Advertising on radio
-Other!____ (Explain)
-Lectures or talks on radio -Lectures—public or schools C. How do you tell when your toothbrush needs replacing? (Explain)-
Age:---- Age:---- Age:---- Age:---- Age:---Sex:___ D. What is your usual practice in using a toothbrush ? (circle number) 1. Use 1 brush until it needs replacing 2. Use 2 or more brushes alternately, change brushes each time teeth are brushed 3. Do not use a toothbrush
Sex:___
Sex:___
Sex:___
1
1
1
1
1
2
2
2
2
2
3
3
3
3
3
E. How many times a day are teeth usually brushed? (Write in 0 ,1 ,2 ,3 , etc.) __times ' __times F . At what time(s) during day are teeth brushed? (circle numbers) 1. On arising 2. After breakfast 3. Before noon meal 4. After noon meal 5. Before evening meal 6 . After evening meal 7. Before retiring
Sex:___
__times
__times
__times
1 2
1 2
1 2
1 2
3 4 5
3 4 5
3 4 S
3 4 5
2 3 4 5
1
6
6
6
6
6
7
7
7
7
7
Wisan-Gruebbel
J.A.D.A., Vol. 38, January 1949 . . . 21 Table I.— Questionnaire mailed to 2,750 families (cont'd.)
G. What dental hygiene habits, other than toothbrushing, are practiced frequently? (circle num bers) 1. None 2. Mouthwash 3. Toothpicks 4. Dental floss S. Chewing gum 6 . Apple eating 7. Finger tip massage 8 Other 1
H. How many times during the last 2 years was a den tist seen for a checkup? I.
How many times during the last 2 years was a den tist seen for an emergency?
J. Which of the following most nearly describes what you actually did in carrying out recommenda tions dentist made for fillings, extractions, bridges, etc. during the last 2 years'*. 1. No work necessary— teeth O.K. 2. All work recommended completed 3. Part of work done; postponed some 4. None of recommended work done
family. In evaluating the information obtained, one must bear in mind the possibility of error through obtaining a report from only one member of a fam ily. In this article are presented the most significant data obtained from our study. Readers interested in obtaining more comprehensive data are referred to the report entitled “Dental Health Habits of 2,205 Families,” single copies of which may be obtained from the American Den tal Association, 222 East Superior Street, Chicago. Sources of Information
Dental authorities agree that optimum dental health may be attained most effec tively by eating proper foods, by follow ing accepted dental hygiene practices and by obtaining regular and complete den tal care. However, the average person
Age:---- Age:----
Age:----
Sex:___
Sex-----
Age:----
Age:----
Sex:----
Sex:----- Sex-----
1 2
1 2
1 2
1 2
1 2
3 4 s
3 4 5
3 4
3 4 5
3 4 5
6
6
6
6
7
7
7
8
8
8
__times
5 6
7
7 8
■
.
8
__times
__times
__times
__times
__times __times
__times
__times __times
1 2
1 2
1 2
1 2
1 2
3 4
3 4
3 4
3 4
3 4
must be given specific information con cerning foods conducive to dental health. Likewise, he must be instructed with regard to effective dental hygiene prac tices and dental treatment. What are the most effective media for providing the public with such information? From data presented in Table 3, ob tained from answers to questions A and B in the questionnaire, it would appear that most of the respondents (82.9 per cent) obtained information about nutri tion from physicians. An even greater proportion of the respondents (92.7 per cent) obtained dental information from dentists. Pamphlets, books, advertise ments, radio and public school lectures were resorted to by many of the respond ents. Thus, all available media for dis seminating authentic dental health infor mation may be recommended to support
22
The Journal of the American Dental Association
Table 2.— Comparison of families reporting (2,205) with total families on panel (5,480)
Economic class
Upper Middle Lower Total Population* Metropolitan Smaller cities Small towns and rural
Per cent o f 2,205 families
Per cent of 5,480 families
14.0 35.1 50.9
15.1 32.9 52.0
100.0
100.0
37.2 28.6 34.2
36.9 28.7 34.4
100.0
100.0
27.7 25.8 34.4 12.1
27.5 26.0 33.4 13.1
100.0
100.0
Table 3.— Sources from which 2,164 families ob tained information about nutrition and dental health
Sources of information
No.
States Northeastern Southern North Central Western
%
Pamphlets and leaflets.......... 1,091 50.4
No.
% 889 41.1
970 44.8
740 34.2
Newspaper advertisements . 1,042 48.2
945 43.7
Books.........................................
A rticles.................................... 1,613 74.5 1,342 62.0 985 45.5
900 41.6
Radio lectures......................... 1,065 49.2
863 39.9
Public and school lectures..
954 44.1
939 43.4
Friends......................... ............
833 38.5
579 26.8
Physician.................................. 1,795 82.9
964 44.5
Radio advertising................. Total
Diet and Dental nutrition; health; respond respond ents ents
969 44.8 2,008 92.7 Total
^Metropolitan cities, 250,000 and m ore; smaller cities, 25,000 to 250, 000; small towns and rural areas, up to 25, 000.
Others........................................
681 31.5
653 30.2
344 15.9
191 8.8
advises brushing the teeth immediately after eating. Evidently the American public is not aware of the importance of Dental H abits brushing the teeth immediately after eat ing or finds it inconvenient to do so. Table 4, based on answers to questions Table 5, based on answers to question D, E and F, indicates that 95.6 per cent of the respondents used a toothbrush. Of G, indicates that the use of mouthwash these, 42.8 per cent brushed their teeth outranks dental hygiene habits except twice a day, and only 18.8 per cent toothbrushing, with 37.1 per cent of the brushed their teeth at least three times persons studied reporting the use of a a day. Eighty per cent of the individuals mouthwash. It would be interesting to studied used only one brush. Slightly obtain information concerning the rea better routine care in toothbrushing was sons for using mouthwashes. Do persons reported by the high economic groups expect a mouthwash to prevent odors than by the lower groups. Likewise, which they assume come from the better care was noted among the females mouth? Do they still expect therapeutic than among the males. Before retiring or cosmetic benefits from commercial was the time preferred for brushing mouthwashes in spite of proof to the teeth by 59.9 per cent of the persons contrary by dental authorities? studied; 49.4 per cent brushed their teeth The use of chewing gum was reported on arising; 34 per cent after breakfast; by 27.9 per cent of the respondents, and 18.3 per cent after the noon meal, and the use of toothpicks was reported by 25.3 20.5 per cent after the evening meal. per cent. Dental floss was used by 18.2 The American Dental Association per cent. Other adjuncts reported by a through its Council on Dental Health few of the respondents (2.8 per cent) the efforts of dentists, physicians, nurses and dental hygienists.
J.A.D.A., Vol. 38, January 1949 . . . 23
Wisan-Gruebbel Table 4.— Habits in use of toothbrush practiced by 7,057 persons
Practice in using toothbrush Use 1 brush until it needs replacing Using 2 or more brushes alter nately Do not use toothbrush No reply
Number Percent o f re of 7,057 spond ents 5,643
80.0
1,101
15.6 2.4
172 141
2.0
Number of times'a day teeth are brushed None One Two Three or more No reply
163 2,307 3,023 1,322 242
2.3 32.7 42.8 18.8 3.4
3,489 2,397
49.4 34.0 1.7 18.3 2.3 20.5 59.9 4.5
When teeth are brushed On arising After breakfast Before noon meal After noon meal Before evening meal After evening meal Before retiring No reply
122
1,288 162 1,449 4,225 320
were Stimudents, Bon-Ami, calcium tab lets, cotton, olives, washcloth and vita mins. Dental Treatment
Checkups.—The premise that the aver age person should visit the dentist twice a year for dental examination was ac cepted by the investigators. This survey revealed that only 20.4 per cent of the persons studied had gone to a dentist twice a year for a checkup during the preceding two years (Table 6, first sec tion), in spite of the fact that during this period the American people enjoyed the highest standard of living in history.3 Of the males, 17.8 per cent reported semi annual dental checkups; females showed a higher percentage (22.8 per cent).4 3 . M onthly letter, National City Bank, New York.
Chicago Journal of Commerce (Ju ly 3 ) 1948.
4 . Wisan, J . M ., and Gruebbel, A. O ., Dental H ealth Habits o f 2,205 Families. Chicago: American Dental Association, 1948 .
Since 1 and 2 year olds rarely require visits to the dentist, they were not in cluded in the compilation. Table 7 shows that 16.1 per cent of the 3 to 9 age group had gone to the dentist twice a year dur ing the past two years; of the 10 to 19 age group, 29.6 per cent had gone to the dentist twice a year for a checkup ; of the 20 to 29 age group, 22.3 per cent; of the 30 to 49 age group, 21.6 per cent, and of the 50 and over group, 15.7 per cent. The most marked neglect seemed to be in the 3 to 9 age group. This neglect among the youngest children is even more striking when one compares the various age groups with respect to the failure to go to the dentist even once within the past two years. Of the 3 to 9 age group, 29.9 per cent had not gone to a dentist for a checkup within the past two years. The percentages of those in the other groups who had not gone to a dentist within the past two years were as follows : of the 10 to 19 age group, 8 per cent; of the 20 to 29 age group, 11.5 per cent; of the 30 to 49 age group, 16.8 per cent. In this category the 50 and over group with 31.8 per cent showed the poorest record. However, it must be remembered that since so many of the persons aged 50 and more no longer have their natural teeth, the high percentage who fail to go to a dentist is not as significant as the Table 5.— Dental hygiene habits other than tooth brushing practiced by 7,057 persons
Dental hygiene habits None Mouthwash Toothpicks Dental floss Chewing gum Apples Finger tip massage Other* No reply
Number of respondents
Per cent of 7,057
1,603 2,616 1,784 1,285 1,971 1,034
22.7 37.1 25.3 18.2 27.9 14.7
462 198 535
'
6.5 2.8
7.6
*Stim udents, Bon-Ami, calcium tablets, cotton, olives, washcloth, vitamins A, B and C for tender red mouth tissue, an a so forth.
24
The Journal of the American Dental Association Table 6.— Dental treatment during last two years by economic groups
Upper economic group
Checkups
None.................................................... Tw o...................................................... Three................................................... Four or more .................................. No reply............................................. Total
Middle economic group
Number Per cent Number Percent of re o f re of re - of re spond spond spond- spond ents ents ents ents
Lower economic group
Total
Number Percent Number Per cent of re- of re of re of re spond- spond spond spond ■ents ents ents ents
115 193 223 109 340 39
11.3 18.9 21.9 10.7 33.4 3.8
460 516 632 217 563 103
18.4 20.7 25.4 8.7 22.7 4.1
895 839 800 288 536 189
25.2 23.7 22.6 8.1 15.1 5.3
1,470 1,548 1,655 614 1,439 331
' 20.8 21.9 23.5 8.7 20.4 4.7
1,019
100.0
2,491
100.0
3,547
100.0
7,057
100.0
601 207 67 7 17 120
59.0 20.3 6.6 0.7 1.7 11.8
1,552 454 142 36 30 277
62.4 18 2 5.7 1.4 1.2 11.1
2,111 682 198 60 36 460
59.5 19.2 5.6 1.7 1.1 12.9
4,264 1,343 407 103 83 857
60.5 19.0 5.8 1.5 1.1 12.1
1,019
100.0
2,491
100.0
3.547
100.0
7,057
100.0
Emergency None.................................................... Tw o...................................................... Three................................................... Four or more..................................... No reply............................................. Total
Treatment: fillings, extractions, bridges and so forth No treatment necessary................. All recommended treatment com pleted............................................... Part of recommended treatment obtained......................................... None of recommended treatment obtained......................................... No reply........................; ................... Total
143
14.0
377
13.6
527
14.8
1,007
14.2
645
63.3
1,386
55.6
1,560
44.0
3,591
50.9
81
7.9
234
9.4
424
12.0
739
10.5
8 142
0.8 14.0
21 513
0.8 20.6
60 976
1.7 27.5
89 1,631
1.3 23.1
1,019
100.0
2,491
100.0
3,547
100.0
7,057
100.0
high percentage in the 3 to 9 age group. In the 3 to 9 age group, neglect of visits to the dentist is deplorable because dental authorities are confident that many dental diseases in adults can be prevented by providing dental treatment for the younger children.5 Differences were shown among the three economic groups studied. Of the upper economic group, 33.4 per cent had gone to a dentist twice a year for a checkup; of the lower economic level, 15.1 per cent (Table 6, first section). 5. T he Control o f Dental Caries. Chicago: American Dental Association, 1948, p. 2 .
Surprisingly, no appreciable difference between metropolitan and rural areas was found (Table 8, first section). «
Emergency Treatment. —During the past two years 27.4 per cent of the respondents found it necessary to go to a dentist for emergency treatment (Table 6, second section). The number of individuals from the various economic groups showed only slight differences in the amount of emer gency treatment required. Evidently peo ple in the low economic group make fi nancial sacrifices, and residents of rural areas disregard traveling difficulties in order to obtain emergency dental treat-
163 41 1,017
T o ta l.......................................................................................
1.0 33.5
34 10
341 1,017
None of recommended treatment obtained.....................
No reply.....................................................................................
20 to 29 years
30 to 49 years
50 years and more Total
T o ta l................................................................. -,................... 100.0
1,087
100.0
9.2
1.4
9.7
65.5
14.2
100.0
762
90
15
112
442
103
21.6
S59
2,592
423
11.8 100.0
32
100.0
16.4
1.2
13.3
57.0
1,479 345
12.1
313
100.0
10.1
261
2,592
24.9
2.6
24.0
622 646
68
16.8
436
2.0
14.7
58.0
13.5
100.0
3.1
24 762
22.3
169
29.6 2.S
12.6
96
10.9
26.4
24.1
11.5
201
184
88
26.3
22.7
8.0
1,645
19.5
281
6,900
1,442
100.0
37.8
1.2
17 54S
9.8
41.0
10.2
142
591
147
1,442
6,9C0
1,499
100.0
21.7
1.3
10.7 89
52.0 739
14.3 3,588
985
100.0
297
136
100.0
4.3
1,439 9.4
227
20.9
614 78
5.4
8.9
23.8
22.2
19.9
15.7
1,533
18.2
263
1,372
31.8
457
J.A.D.A., Voi. 38, January
100
15
106
712
35.8
364
All recommended treatment completed............................
P art of recommended treatment obtained.......................... 3.3
154
26.4
1,087
28
321
118
286
247
87
268
No treatment necessary.........................................................
100.0
4.0
16.1
6.0
61
Four or more.............................................................................
22.7
No reply.....................................................................................
21.3
231
29.9
217
304
Tw o.............................................................................................
Fillings, extractions, bridges and so forth
10 to 19 _ years
Number Percent Number Percent Number Percent Number Percent Number Percent Number Per cent o f re o f re of re o f re o f re o f re o f re-, of re of re of re of re o f re spond spond spond spond spond spond spond- spond spond spond spond spond ents ents ents ents ents ents ents ents ents ents ents ents
O n e .............................................................................................
Checkups
3 to 9 years
Table 7.— Dental treatment during last two years
Wisan-Gruebbel 1949 . . . 25
26
The Journal of the American Dental Association Table 8.— Dental treatment during last two years by population groups
Metropolitan cities* Checkups
Smaller cities*
Small towns and rural areas*
Total
Number Percent Number Percent Number Percent Number Percent o f re o f re of re of re o f re of re o f re o f re spond spond spond spond spond spond spond spond ents ents ents ents ents ents ents ents
Tw o....................................... ........... Three................................................... Four or more..................................... No reply.............................................
626 242 618 96
19.4 21.5 23.6 9.0 23.0 3.5
T o ta l................................................
2,679
100.0
1,982
100.0
2,396
100.0
7,057
100.0
397
14.8
266
13.4
344
14.3
1,007
14.2
1,418
53.0
1,057
53.3
1,116
46.6
3,591
50.9
263
10.0
186
9.4
290
12.1
739
10.5
25 576
0.9 21.3
26 447
1.3 22.6
38 608
1.6 25.4
89 1,631
1.3 23.1
2,679
100.0
1,982
100.0
2,396
100.0
7,057
100.0
None....................................................
521
576
398 427 441 183 429 104
20.1 21.4 22.2 9.2 21.8 5.3
551 545 588 189 392 13Ì
23.0 22.7 24.5 7.9 16.4 5.5
1,470 1,548 1,655 614 1,439 331
20.8 21.9 23.5 8.7 20.4 4.7
Fillings, extractions, bridges and so forth No treatment necessary................. All recommended treatment com pleted .............................................. Part of recommended treatment obtained.......................................... None of recommended treatment obtained......................................... No reply............................................. T o tal................................................
•Metropolitan cities, 250,000 and m ore; smaller cities, 25,000 to 250, 000; small towns and rural areas, up to 25 , 000.
ment. There were also only slight differ ences among the various geographic areas. Completed Treatment. —During the past two years 63.3 per cent of persons with high incomes and 55.6 per cent of those with moderate incomes had all recom mended dental treatment completed (Table 6, third section). However, only 44 per cent of persons in the low eco nomic group had all recommended treat ment. Note the significant differences among the economic levels in obtaining complete dental treatment, although rela tively small differences were noted for emergency treatment. The data showed that 50,9 per cent obtained all treatment recommended by the dentist within the past two years.
Small towns and rural areas showed that 46.6 per cent of persons obtained all necessary treatment, with metropoli tan and smaller cities showing percent ages of 53 and 53.3, respectively (Table 8, lower half). Among all age groups, the younger children showed the most glaring neglect; 35.8 per cent of the 3 to 9 age group, 65.5 per cent of the 10 to 19 age group, 58 per cent of the 20 to 29 age group, 57 per cent of the 30 to 49 age group and 41 per cent of the 50 and over age group had all recommended treatment completed within the past two years (Table 7, lower half). Obviously, meas ures should be taken by parents, dentists and health educators to motivate more attention to dental problems of younger children.
Wisan-Gruebbel
C om m ent
Dental research has constituted an in tegral part of the research program of the National Institute of Health for a num ber of years. The growth of the unit has been slow but continuous, increase in present activities being limited largely by the unavailability of additional trained dental investigators. Ah inspection of the summary of ac tivities of the Dental Research Section
19
gives some inkling of a few of the diverse fields into which dental research may lead. It suggests the complex problems confronting dental research. Obviously many branches of science must be util ized in elucidating problems as they arise; close integration with associated disciplines cannot be too strongly empha sized. Development of basic research consti tutes the major challenge confronting dentistry today.
DENTAL HEALTH HABITS: A QUESTIONNAIRE SURVEY J. M . W isa n ,* D.D.S., Providence, R. I., and Allen O . G ruebbel.f D.D.S., C h ic a g o
authorities long have recog nized the importance of dental health education in aiding people to protect or improve mouth health. A variety of educational technics and media is used for the purpose of disseminating infor mation and of motivating good health habits. In order to select the most effective technics and media, it is important to know the prevailing attitudes and con cepts of the lay public, as well as the extent to which people follow good den tal health habits. To aid in improving dental health education programs, a study was made to determine ( i ) the public’s source of dental health informa tion, (2) the public’s toothbrushing and other oral hygiene habits and (3) the number of persons who obtain the dental
D
en ta l
♦D irector, Joseph Samuels D en tal Clinic, #Rhode Island H ospital, Providence, R . I . ; formerly D irector, Division o f D ental H ealth Education, American D ental Association. fExecutive secretary,. Council on D ental H ealth, Am erican D ental Association.
treatment recommended by the dentist. From answers to mailed questionnaires (Table 1), the dental practices of 5,480 families were surveyed. These families constitute a panel used by a national advertising agency1 as a representative sampling of the buying public of the United States. The families reside in various sections of the United States and in areas of differing populations, repre sent high, medium and low economic levels and are comprised of all ages and both sexes (Table 2). Approximately half of the families were used in the study of toothbrushes.2 The other half were queried to obtain data concerning dental health habits. Of the questionnaires sent to 2,750 families, 2,205 (80 per cent), representing 7,057 persons, were returned. Housewives sup plied the answers for all members of the 1. J . W alter Thompson Company, Chicago. 2. Gruebbel, A . O ., and Wisan, J . M ., A Study of Toothbrushes in Use in American Homes. J.A.D.A. 3 7 :3 4 6 (S ep t.) 1948.
20
The Journal of the American Dental Association Table I.— Questionnaire mailed to 2,750 families
DENTAL H EALTH H ABITS Name_ City and StateRead instructions over carefully and follow them in filling out this special questionnaire. A. Where does your family get its information about diet and nutrition? (For any source(s) used, rank 1, 2, 3, etc. in order of importance of source) .Pamphlets and leaflets
-Friends
-Books
-Physician
-Advertisements—magazines or newspapers
-Dentist
-Articles or items—magazines or newspapers
_Nurse
-Advertising on radio
_Other_ (Explain)
-Lectures or talks on radio -Lectures—public or schools
B. Where does your family get its information about denial health and dental health habits? (For any source(s) used, rank 1, 2, 3, etc. in order of importance of source.) -Pamphlets and leaflets
-Friends
-Books
-Physician
-Advertisements—magazines or newspapers
-D entist
-Articles or items— magazines or newspapers
-Nurse
-Advertising on radio
-Other!____ (Explain)
-Lectures or talks on radio -Lectures—public or schools C. How do you tell when your toothbrush needs replacing? (Explain)-
Age:---- Age:---- Age:---- Age:---- Age:---Sex:___ D. What is your usual practice in using a toothbrush ? (circle number) 1. Use 1 brush until it needs replacing 2. Use 2 or more brushes alternately, change brushes each time teeth are brushed 3. Do not use a toothbrush
Sex:___
Sex:___
Sex:___
1
1
1
1
1
2
2
2
2
2
3
3
3
3
3
E. How many times a day are teeth usually brushed? (Write in 0 ,1 ,2 ,3 , etc.) __times ' __times F . At what time(s) during day are teeth brushed? (circle numbers) 1. On arising 2. After breakfast 3. Before noon meal 4. After noon meal 5. Before evening meal 6 . After evening meal 7. Before retiring
Sex:___
__times
__times
__times
1 2
1 2
1 2
1 2
3 4 5
3 4 5
3 4 S
3 4 5
2 3 4 5
1
6
6
6
6
6
7
7
7
7
7
Wisan-Gruebbel
J.A.D.A., Vol. 38, January 1949 . . . 21 Table I.— Questionnaire mailed to 2,750 families (cont'd.)
G. What dental hygiene habits, other than toothbrushing, are practiced frequently? (circle num bers) 1. None 2. Mouthwash 3. Toothpicks 4. Dental floss S. Chewing gum 6 . Apple eating 7. Finger tip massage 8 Other 1
H. How many times during the last 2 years was a den tist seen for a checkup? I.
How many times during the last 2 years was a den tist seen for an emergency?
J. Which of the following most nearly describes what you actually did in carrying out recommenda tions dentist made for fillings, extractions, bridges, etc. during the last 2 years'*. 1. No work necessary— teeth O.K. 2. All work recommended completed 3. Part of work done; postponed some 4. None of recommended work done
family. In evaluating the information obtained, one must bear in mind the possibility of error through obtaining a report from only one member of a fam ily. In this article are presented the most significant data obtained from our study. Readers interested in obtaining more comprehensive data are referred to the report entitled “Dental Health Habits of 2,205 Families,” single copies of which may be obtained from the American Den tal Association, 222 East Superior Street, Chicago. Sources of Information
Dental authorities agree that optimum dental health may be attained most effec tively by eating proper foods, by follow ing accepted dental hygiene practices and by obtaining regular and complete den tal care. However, the average person
Age:---- Age:----
Age:----
Sex:___
Sex-----
Age:----
Age:----
Sex:----
Sex:----- Sex-----
1 2
1 2
1 2
1 2
1 2
3 4 s
3 4 5
3 4
3 4 5
3 4 5
6
6
6
6
7
7
7
8
8
8
__times
5 6
7
7 8
■
.
8
__times
__times
__times
__times
__times __times
__times
__times __times
1 2
1 2
1 2
1 2
1 2
3 4
3 4
3 4
3 4
3 4
must be given specific information con cerning foods conducive to dental health. Likewise, he must be instructed with regard to effective dental hygiene prac tices and dental treatment. What are the most effective media for providing the public with such information? From data presented in Table 3, ob tained from answers to questions A and B in the questionnaire, it would appear that most of the respondents (82.9 per cent) obtained information about nutri tion from physicians. An even greater proportion of the respondents (92.7 per cent) obtained dental information from dentists. Pamphlets, books, advertise ments, radio and public school lectures were resorted to by many of the respond ents. Thus, all available media for dis seminating authentic dental health infor mation may be recommended to support
22
The Journal of the American Dental Association
Table 2.— Comparison of families reporting (2,205) with total families on panel (5,480)
Economic class
Upper Middle Lower Total Population* Metropolitan Smaller cities Small towns and rural
Per cent o f 2,205 families
Per cent of 5,480 families
14.0 35.1 50.9
15.1 32.9 52.0
100.0
100.0
37.2 28.6 34.2
36.9 28.7 34.4
100.0
100.0
27.7 25.8 34.4 12.1
27.5 26.0 33.4 13.1
100.0
100.0
Table 3.— Sources from which 2,164 families ob tained information about nutrition and dental health
Sources of information
No.
States Northeastern Southern North Central Western
%
Pamphlets and leaflets.......... 1,091 50.4
No.
% 889 41.1
970 44.8
740 34.2
Newspaper advertisements . 1,042 48.2
945 43.7
Books.........................................
A rticles.................................... 1,613 74.5 1,342 62.0 985 45.5
900 41.6
Radio lectures......................... 1,065 49.2
863 39.9
Public and school lectures..
954 44.1
939 43.4
Friends......................... ............
833 38.5
579 26.8
Physician.................................. 1,795 82.9
964 44.5
Radio advertising................. Total
Diet and Dental nutrition; health; respond respond ents ents
969 44.8 2,008 92.7 Total
^Metropolitan cities, 250,000 and m ore; smaller cities, 25,000 to 250, 000; small towns and rural areas, up to 25, 000.
Others........................................
681 31.5
653 30.2
344 15.9
191 8.8
advises brushing the teeth immediately after eating. Evidently the American public is not aware of the importance of Dental H abits brushing the teeth immediately after eat ing or finds it inconvenient to do so. Table 4, based on answers to questions Table 5, based on answers to question D, E and F, indicates that 95.6 per cent of the respondents used a toothbrush. Of G, indicates that the use of mouthwash these, 42.8 per cent brushed their teeth outranks dental hygiene habits except twice a day, and only 18.8 per cent toothbrushing, with 37.1 per cent of the brushed their teeth at least three times persons studied reporting the use of a a day. Eighty per cent of the individuals mouthwash. It would be interesting to studied used only one brush. Slightly obtain information concerning the rea better routine care in toothbrushing was sons for using mouthwashes. Do persons reported by the high economic groups expect a mouthwash to prevent odors than by the lower groups. Likewise, which they assume come from the better care was noted among the females mouth? Do they still expect therapeutic than among the males. Before retiring or cosmetic benefits from commercial was the time preferred for brushing mouthwashes in spite of proof to the teeth by 59.9 per cent of the persons contrary by dental authorities? studied; 49.4 per cent brushed their teeth The use of chewing gum was reported on arising; 34 per cent after breakfast; by 27.9 per cent of the respondents, and 18.3 per cent after the noon meal, and the use of toothpicks was reported by 25.3 20.5 per cent after the evening meal. per cent. Dental floss was used by 18.2 The American Dental Association per cent. Other adjuncts reported by a through its Council on Dental Health few of the respondents (2.8 per cent) the efforts of dentists, physicians, nurses and dental hygienists.
J.A.D.A., Vol. 38, January 1949 . . . 23
Wisan-Gruebbel Table 4.— Habits in use of toothbrush practiced by 7,057 persons
Practice in using toothbrush Use 1 brush until it needs replacing Using 2 or more brushes alter nately Do not use toothbrush No reply
Number Percent o f re of 7,057 spond ents 5,643
80.0
1,101
15.6 2.4
172 141
2.0
Number of times'a day teeth are brushed None One Two Three or more No reply
163 2,307 3,023 1,322 242
2.3 32.7 42.8 18.8 3.4
3,489 2,397
49.4 34.0 1.7 18.3 2.3 20.5 59.9 4.5
When teeth are brushed On arising After breakfast Before noon meal After noon meal Before evening meal After evening meal Before retiring No reply
122
1,288 162 1,449 4,225 320
were Stimudents, Bon-Ami, calcium tab lets, cotton, olives, washcloth and vita mins. Dental Treatment
Checkups.—The premise that the aver age person should visit the dentist twice a year for dental examination was ac cepted by the investigators. This survey revealed that only 20.4 per cent of the persons studied had gone to a dentist twice a year for a checkup during the preceding two years (Table 6, first sec tion), in spite of the fact that during this period the American people enjoyed the highest standard of living in history.3 Of the males, 17.8 per cent reported semi annual dental checkups; females showed a higher percentage (22.8 per cent).4 3 . M onthly letter, National City Bank, New York.
Chicago Journal of Commerce (Ju ly 3 ) 1948.
4 . Wisan, J . M ., and Gruebbel, A. O ., Dental H ealth Habits o f 2,205 Families. Chicago: American Dental Association, 1948 .
Since 1 and 2 year olds rarely require visits to the dentist, they were not in cluded in the compilation. Table 7 shows that 16.1 per cent of the 3 to 9 age group had gone to the dentist twice a year dur ing the past two years; of the 10 to 19 age group, 29.6 per cent had gone to the dentist twice a year for a checkup ; of the 20 to 29 age group, 22.3 per cent; of the 30 to 49 age group, 21.6 per cent, and of the 50 and over group, 15.7 per cent. The most marked neglect seemed to be in the 3 to 9 age group. This neglect among the youngest children is even more striking when one compares the various age groups with respect to the failure to go to the dentist even once within the past two years. Of the 3 to 9 age group, 29.9 per cent had not gone to a dentist for a checkup within the past two years. The percentages of those in the other groups who had not gone to a dentist within the past two years were as follows : of the 10 to 19 age group, 8 per cent; of the 20 to 29 age group, 11.5 per cent; of the 30 to 49 age group, 16.8 per cent. In this category the 50 and over group with 31.8 per cent showed the poorest record. However, it must be remembered that since so many of the persons aged 50 and more no longer have their natural teeth, the high percentage who fail to go to a dentist is not as significant as the Table 5.— Dental hygiene habits other than tooth brushing practiced by 7,057 persons
Dental hygiene habits None Mouthwash Toothpicks Dental floss Chewing gum Apples Finger tip massage Other* No reply
Number of respondents
Per cent of 7,057
1,603 2,616 1,784 1,285 1,971 1,034
22.7 37.1 25.3 18.2 27.9 14.7
462 198 535
'
6.5 2.8
7.6
*Stim udents, Bon-Ami, calcium tablets, cotton, olives, washcloth, vitamins A, B and C for tender red mouth tissue, an a so forth.
24
The Journal of the American Dental Association Table 6.— Dental treatment during last two years by economic groups
Upper economic group
Checkups
None.................................................... Tw o...................................................... Three................................................... Four or more .................................. No reply............................................. Total
Middle economic group
Number Per cent Number Percent of re o f re of re - of re spond spond spond- spond ents ents ents ents
Lower economic group
Total
Number Percent Number Per cent of re- of re of re of re spond- spond spond spond ■ents ents ents ents
115 193 223 109 340 39
11.3 18.9 21.9 10.7 33.4 3.8
460 516 632 217 563 103
18.4 20.7 25.4 8.7 22.7 4.1
895 839 800 288 536 189
25.2 23.7 22.6 8.1 15.1 5.3
1,470 1,548 1,655 614 1,439 331
' 20.8 21.9 23.5 8.7 20.4 4.7
1,019
100.0
2,491
100.0
3,547
100.0
7,057
100.0
601 207 67 7 17 120
59.0 20.3 6.6 0.7 1.7 11.8
1,552 454 142 36 30 277
62.4 18 2 5.7 1.4 1.2 11.1
2,111 682 198 60 36 460
59.5 19.2 5.6 1.7 1.1 12.9
4,264 1,343 407 103 83 857
60.5 19.0 5.8 1.5 1.1 12.1
1,019
100.0
2,491
100.0
3.547
100.0
7,057
100.0
Emergency None.................................................... Tw o...................................................... Three................................................... Four or more..................................... No reply............................................. Total
Treatment: fillings, extractions, bridges and so forth No treatment necessary................. All recommended treatment com pleted............................................... Part of recommended treatment obtained......................................... None of recommended treatment obtained......................................... No reply........................; ................... Total
143
14.0
377
13.6
527
14.8
1,007
14.2
645
63.3
1,386
55.6
1,560
44.0
3,591
50.9
81
7.9
234
9.4
424
12.0
739
10.5
8 142
0.8 14.0
21 513
0.8 20.6
60 976
1.7 27.5
89 1,631
1.3 23.1
1,019
100.0
2,491
100.0
3,547
100.0
7,057
100.0
high percentage in the 3 to 9 age group. In the 3 to 9 age group, neglect of visits to the dentist is deplorable because dental authorities are confident that many dental diseases in adults can be prevented by providing dental treatment for the younger children.5 Differences were shown among the three economic groups studied. Of the upper economic group, 33.4 per cent had gone to a dentist twice a year for a checkup; of the lower economic level, 15.1 per cent (Table 6, first section). 5. T he Control o f Dental Caries. Chicago: American Dental Association, 1948, p. 2 .
Surprisingly, no appreciable difference between metropolitan and rural areas was found (Table 8, first section). «
Emergency Treatment. —During the past two years 27.4 per cent of the respondents found it necessary to go to a dentist for emergency treatment (Table 6, second section). The number of individuals from the various economic groups showed only slight differences in the amount of emer gency treatment required. Evidently peo ple in the low economic group make fi nancial sacrifices, and residents of rural areas disregard traveling difficulties in order to obtain emergency dental treat-
163 41 1,017
T o ta l.......................................................................................
1.0 33.5
34 10
341 1,017
None of recommended treatment obtained.....................
No reply.....................................................................................
20 to 29 years
30 to 49 years
50 years and more Total
T o ta l................................................................. -,................... 100.0
1,087
100.0
9.2
1.4
9.7
65.5
14.2
100.0
762
90
15
112
442
103
21.6
S59
2,592
423
11.8 100.0
32
100.0
16.4
1.2
13.3
57.0
1,479 345
12.1
313
100.0
10.1
261
2,592
24.9
2.6
24.0
622 646
68
16.8
436
2.0
14.7
58.0
13.5
100.0
3.1
24 762
22.3
169
29.6 2.S
12.6
96
10.9
26.4
24.1
11.5
201
184
88
26.3
22.7
8.0
1,645
19.5
281
6,900
1,442
100.0
37.8
1.2
17 54S
9.8
41.0
10.2
142
591
147
1,442
6,9C0
1,499
100.0
21.7
1.3
10.7 89
52.0 739
14.3 3,588
985
100.0
297
136
100.0
4.3
1,439 9.4
227
20.9
614 78
5.4
8.9
23.8
22.2
19.9
15.7
1,533
18.2
263
1,372
31.8
457
J.A.D.A., Voi. 38, January
100
15
106
712
35.8
364
All recommended treatment completed............................
P art of recommended treatment obtained.......................... 3.3
154
26.4
1,087
28
321
118
286
247
87
268
No treatment necessary.........................................................
100.0
4.0
16.1
6.0
61
Four or more.............................................................................
22.7
No reply.....................................................................................
21.3
231
29.9
217
304
Tw o.............................................................................................
Fillings, extractions, bridges and so forth
10 to 19 _ years
Number Percent Number Percent Number Percent Number Percent Number Percent Number Per cent o f re o f re of re o f re o f re o f re o f re-, of re of re of re of re o f re spond spond spond spond spond spond spond- spond spond spond spond spond ents ents ents ents ents ents ents ents ents ents ents ents
O n e .............................................................................................
Checkups
3 to 9 years
Table 7.— Dental treatment during last two years
Wisan-Gruebbel 1949 . . . 25
26
The Journal of the American Dental Association Table 8.— Dental treatment during last two years by population groups
Metropolitan cities* Checkups
Smaller cities*
Small towns and rural areas*
Total
Number Percent Number Percent Number Percent Number Percent o f re o f re of re of re o f re of re o f re o f re spond spond spond spond spond spond spond spond ents ents ents ents ents ents ents ents
Tw o....................................... ........... Three................................................... Four or more..................................... No reply.............................................
626 242 618 96
19.4 21.5 23.6 9.0 23.0 3.5
T o ta l................................................
2,679
100.0
1,982
100.0
2,396
100.0
7,057
100.0
397
14.8
266
13.4
344
14.3
1,007
14.2
1,418
53.0
1,057
53.3
1,116
46.6
3,591
50.9
263
10.0
186
9.4
290
12.1
739
10.5
25 576
0.9 21.3
26 447
1.3 22.6
38 608
1.6 25.4
89 1,631
1.3 23.1
2,679
100.0
1,982
100.0
2,396
100.0
7,057
100.0
None....................................................
521
576
398 427 441 183 429 104
20.1 21.4 22.2 9.2 21.8 5.3
551 545 588 189 392 13Ì
23.0 22.7 24.5 7.9 16.4 5.5
1,470 1,548 1,655 614 1,439 331
20.8 21.9 23.5 8.7 20.4 4.7
Fillings, extractions, bridges and so forth No treatment necessary................. All recommended treatment com pleted .............................................. Part of recommended treatment obtained.......................................... None of recommended treatment obtained......................................... No reply............................................. T o tal................................................
•Metropolitan cities, 250,000 and m ore; smaller cities, 25,000 to 250, 000; small towns and rural areas, up to 25 , 000.
ment. There were also only slight differ ences among the various geographic areas. Completed Treatment. —During the past two years 63.3 per cent of persons with high incomes and 55.6 per cent of those with moderate incomes had all recom mended dental treatment completed (Table 6, third section). However, only 44 per cent of persons in the low eco nomic group had all recommended treat ment. Note the significant differences among the economic levels in obtaining complete dental treatment, although rela tively small differences were noted for emergency treatment. The data showed that 50,9 per cent obtained all treatment recommended by the dentist within the past two years.
Small towns and rural areas showed that 46.6 per cent of persons obtained all necessary treatment, with metropoli tan and smaller cities showing percent ages of 53 and 53.3, respectively (Table 8, lower half). Among all age groups, the younger children showed the most glaring neglect; 35.8 per cent of the 3 to 9 age group, 65.5 per cent of the 10 to 19 age group, 58 per cent of the 20 to 29 age group, 57 per cent of the 30 to 49 age group and 41 per cent of the 50 and over age group had all recommended treatment completed within the past two years (Table 7, lower half). Obviously, meas ures should be taken by parents, dentists and health educators to motivate more attention to dental problems of younger children.