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2022 : Volume 1, Issue 1

Evaluation of Knowledge, Attitude and Practice about Oral Hygiene Aids among Dental Hygienists in Western Maharashtra, India

Author(s) : Shweta Gaikwad 1 , Mandar Todkar 1 , Renuka Nagarale 1 , Chinmayee Deochake 1 , Gouri Dhede 1 and Mayuri Kadam 1

1 Department of Public Health Dentistry , MA Rangoonwala College of Dental Sciences and Research Centre , India

Int J Dent Oral Care

Article Type : Research Article

Abstract

Introduction: Everyday use of oral hygiene aids and annual or biannual oral prophylaxis by dental professionals (Dentists, Dental hygienists, Dental assistants) are two effective ways of maintaining good oral hygiene. The present study was conducted to assess the knowledge, attitude, and practice about oral hygiene among working dental hygienists in Western Maharashtra, India.

Materials and Methods: A questionnaire study was conducted for three months in 2021 among 52 working dental hygienists from different areas of Western Maharashtra. The structured, self-administered, close-ended questionnaire was designed to collect the data which consist of two parts and comprised 31 questions. Statistical analysis was done using descriptive statistics.

Results: In this study, more than 50% of participants were known the importance of oral hygiene maintenance and different types of oral hygiene aids and correct methods of using those oral hygiene aids. About 96% participants thought that proper brushing technique is necessary to maintain good oral hygiene.

Conclusion: The study participant’s overall knowledge, attitude and practise regarding oral hygiene aids were seen at average level.

Keywords: Dental Auxiliary; Dental Hygienists; Oral Hygiene Aids; Oral Hygiene; Oral Prophylaxis

Introduction

Oral hygiene is the practice of keeping one's mouth clean and free of disease and other problems (e.g. bad breath) by regular and proper brushing of the teeth and cleaning between the teeth which serves to maintain a good dental hygiene[1]. It is important that oral hygiene be carried out on a regular basis to enable prevention of dental disease and bad breath. Oral health care practices have been proved to be an effective preventive measure for maintaining good oral health as part of general health[2]. Cleaning between the teeth is called interdental cleaning and is as important as tooth brushing[3]. This is because a toothbrush cannot reach between the teeth and therefore only removes about 50% of plaque from the surface of the teeth[4]. There are many tools to clean between the teeth, including floss, tongue cleaner, mouthwash and inter dental brushes[5]. Along with this, according to patient’s oral hygiene index, annual or biannual oral prophylaxis by professionals is necessary. In Maharashtra, oral prophylaxis is done by dental professionals such as dentist, dental hygienist, dental assistant. Among these a dental hygienist is an operating auxiliary licensed and registered to practice dental hygiene under the laws of appropriate state, province, territory or nation who works under the supervision of dentist[6]. There is a two-year diploma course to become dental hygienist. The programme focuses on preventive dentistry, oral hygiene, dental radiography, periodontal treatment, basic restorations and extracting of deciduous teeth, etc[7]. In 1990, there were 3000 registered hygienists in India, which implies that the service of one hygienist was available to seven dentists whereas it should ideally be a 1:1 ratio[8]. The competencies of dental hygienists focus on disease prevention and oral health promotion; thus referral to a dentist would only become necessary in the event of a failure in the preventive program where disease cannot be controlled[9]. Dental hygienist does oral prophylaxis (scaling and root planning), gives instruction in oral hygiene and preventive dentistry, and assists the dental surgeon in chair side work. A major role of a dental hygienist is to perform periodontal therapy which includes things such periodontal charting, periodontal debridement, prophylaxis (preventing disease) or periodontal maintenance procedures for patients with periodontal disease[10]. The use of therapeutic methods assists their patients in controlling oral disease, while providing tailored treatment plans that emphasize the importance of behavioral changes. Thus, the aim of this study was to establish working patterns and preferences of dental hygienist for oral hygiene awareness, attitude and practices about the use of oral hygiene aids.

Materials and Methods

A questionnaire study was conducted for three months among the working dental hygienists from 14th July 2021 to 28th November 2021 in Western Maharashtra, India. The objectives of the study were to assess the knowledge, find out the attitude and evaluate practices regarding the use of oral hygiene aids by working Dental Hygienists. The study duration was three months. The participants were selected based on the following inclusion criteria: i) Working dental hygienist in Western Maharashtra, ii) Diploma or degree certificate in dental hygienist, iii) Those hygienists who were willing to participate. The input parameters for sample size calculation were as follows: 80% power of the study, alpha error 0.05, effect size 0.8, and degree of freedom as 5. The calculated sample size was 42 using G*Power software version 3.1.9.2 (Heinrich Heine University, Düsseldorf). The final considered sample size was around 52. The convenient sampling techniques were used in the study. A questionnaire was pretested and validated among 20 subjects to check reliability and variability and these subjects were not included in the final analysis. The structured, self-administered, close-ended questionnaire was designed to collect the data which consisted of two parts and comprised of 31 questions. The first part consists of demographic data such as name, age, gender, education, occupation. The second part consists of questions based on knowledge, attitude, and practices of use of oral hygiene aids. The reliability statistics were calculated and Cronbach’s Alpha was 0.613. The questionnaire was designed on Google forms (Google LLC, Mountain View, California, United States) and the link was distributed among the dental hygienists through email, whatsapp number and other social media platforms (Instagram, Telegram, etc.)Participants were given brief introduction about the study. Data collected was entered in a spreadsheet (Microsoft Excel 2018). Statistical analysis was done using descriptive statistics using Statistical Package for the Social Science (SPSS) 23.0 version software (IBM Chicago, Illinois, United States). The p-value was set at 5%.

Results

In Table 1, there were a total of 52 participants aged between 20 to 55 years old. Out of these 52 participants, 37 were females and 15 were males. Majority of the participants had diploma in dental hygiene and a very few had a degree in oral hygienist. In Table 2, more than 50% of participants were known the importance of oral hygiene maintenance and different types of oral hygiene aids and correct methods of using those oral hygiene aids. About 78% of the participants knew the different components of toothpaste, mouthwash and their uses and their advantages, disadvantages. Only 50% participants were aware about both methods of using dental floss while about 40% participants were aware about only one method. In Table 3, about 46% participants thought that cleaning of tongue daily is important while 46% thought that it is not important. Approximately, 96% participants thought that proper brushing technique is necessary to maintain good oral hygiene. About 31% participants thought that chemical toothpastes and mouthwashes are more potent than herbal ones, 21% thought that both are equally potent and 48% were neutral about it. About 80% participants advise daily use of oral hygiene aids to their patients. 86% participants give prophylactic mouth rinse to their patients before starting scaling while 13% rarely give or do not give prophylactic mouth rinse.

 

Tables

 

Sr.No

Questions

Responses

Number

Percent

Total N

(N)

age (%)

(%)

1

What is the main purpose of tooth brushing?

Prevention of tooth decay

50

96.2

 

and gum disease

 

To remove stains on teeth

0

0

 

Achievement of cleaner

2

3.8

52

and brighter teeth

-100%

Don’t know

0

0

 

2

Ideally how many times teeth should be brushed?

Once in a day

1

1.9

 

Twice in a day

51

98.1

52

Thrice and more

0

0

-100%

As per once convince

0

0

 

3

 

Toothpaste and Finger

2

3.8

 

Which according to you is ideal brushing material?

Toothpaste and toothbrush

50

96.2

52

 

Neem stick

0

0

-100%

 

Any other

0

0

 

4

How dental plaque looks clinically?

Discoloration of teeth

5

9.7

 

Soft deposits on teeth

43

82.7

52

White patches on teeth

4

7.7

-100%

Don’t know

0

0

 

5

How long after brushing mouthwash should be used?

Immediately

5

9.6

 

After half hour

27

51.9

 

After 10 min

14

26.7

52

Whenever you wish

4

7.7

-100%

Don’t know

2

3.8

 

Table 1: Demographic Details of Study Participants (N=52).

Sr.No

Questions

Responses

Number

Percent

Total N

(N)

age (%)

(%)

1

 

Prevention of tooth decay

50

96.2

 

What is the main purpose of tooth brushing?

and gum disease

 

To remove stains on teeth

0

0

 

Achievement of cleaner

2

3.8

52

and brighter teeth

-100%

Don’t know

0

0

 

2

Ideally how many times teeth should be brushed?

Once in a day

1

1.9

 

Twice in a day

51

98.1

52

Thrice and more

0

0

-100%

As per once convince

0

0

 

3

Which according to you is ideal brushing material?

Toothpaste and Finger

2

3.8

 

Toothpaste and toothbrush

50

96.2

52

Neem stick

0

0

-100%

Any other

0

0

 

4

How dental plaque looks clinically?

Discoloration of teeth

5

9.7

 

Soft deposits on teeth

43

82.7

52

White patches on teeth

4

7.7

-100%

Don’t know

0

0

 

5

How long after brushing mouthwash should be used?

Immediately

5

9.6

 

After half hour

27

51.9

 

After 10 min

14

26.7

52

Whenever you wish

4

7.7

-100%

Don’t know

2

3.8

 

6

What is the proper technique used for using mouthwash?

Pour,take into mouth,swish for 30 sec, spit, Rinse

 

 

 

7

13.5

 

Pour, Dilute, take into mouth,swish for 30 sec,spit

 

 

20

32.7

52

Pour, take into mouth,swish for 30 sec, spit

8

38.5

-100%

 

Pour, Dilute, take into mouth, swish for 30 sec, spit, Rinse

17

15.5

 

 

Do you know the difference between therapeutic and cosmetic components of

Yes

38

73.1

52

7a

 

 

 

-100%

 

No

14

26.9

 

7b

If yes, which is the component used for tooth whitening?

Fluorides

8

16.3

 

More amount of abrasives

18

36.7

52

Surfactants

16

32.7

-100%

Don’t know

7

14.3

 

 

What is the adverse effect of tooth whitening toothpaste?

Gum diseases

6

11.5

 

 

Tooth sensitivity

41

78.8

52

8

No adverse effects

3

5.8

-100%

 

Don’t know

2

4.85

 

9

What is the effect of fluorides on teeth?

Prevention of gum

3

5.8

52

-100%

Prevention of tooth decay

46

88.5

 

Cleaning of teeth decay

3

5.8

 

Don’t know

0

0

 

Choose the antiplaque component in toothpaste from following?

Sodium lauryl sulphate

26

50

 

 

Sodium fluoride

22

42.3

52

10

Menthol

2

3.8

-100%

 

Glycerine

2

3.8

 

11

When do you give the interproximal instructions?

To every patient

29

55.8

 

 

When you assume that

3

5.6

 

patient will comply

52

Halitosis

2

3.8

-100%

To patients undergoing

18

38.6

 

orthodontic treatment

 

 

Do you know the correct technique of using dental

Yes

50

96.2

52

12

No

2

3.8

-100%

13

If yes, which of the following are you aware of?

Spool method

9

17.3

 

Loop method

12

23.1

52

Both

26

50

-100%

Don't know

5

9.6

 

14

Which of the following types of dental floss are you aware of?

Waxed/unwaxed

7

13.5

 

Monofilament/multifilame

5

9.6

 

nt

 

Bonded/non-bonded

1

5.8

52

All of the above

37

91.1

-100%

Don't know

2

5.8

 

Table 2: Knowledge Related Questions’ Responses of Study Participants (N=52)

Sr.No Questions Responses Number Percentage Total
(N) (%)
  According to you can health of teeth and mouth affect health of body? Strongly Agree 25 48.1  
  Agree 21 40.4
  52
1 Neutral 5 9.6 -100%
  Disagree 2 1.9  
   
  Strongly Disagree 0 0
  Proper brushing of teeth Strongly Agree 3 5.8  
  Agree 3 5.8
  52
2 Neutral 4 7.7 -100%
  Disagree 20 38.5  
   
  Strongly Disagree 22 42.3
3 Do you think toothbrush with hard bristles causes abrasion? Strongly Agree 21 40.4  
Agree 29 55.8  
Neutral 1 1.9 52
Disagree 1 1.9 -100%
Strongly Disagree 0 0  
4   Strongly Agree 24 46.2  
Cleaning of tongue daily is important? Agree 24 46.2 52
Neutral 4 7.7 -100%
Disagree 0 0  
  Strongly Disagree 0 0  
5 Using mouthwash daily causes staining of teeth? Strongly Agree 11 21.2 52-100%
Agree 18 34.6
Neutral 19 36.5
Disagree 3 5.8
Strongly Disagree 1 1.9
6 Do you think use of 1cm thick layer of toothpaste is necessary? Strongly Agree 6 18.8  
Agree 13 40.6  
Neutral 5 15.6 52
Disagree 6 18.8 -100%
Strongly Disagree 2 6.3  
7 Do you think appropriate technique is essential? Strongly Agree 36 69.2  
Agree 14 26.9  
Neutral 1 1.9 52
Disagree 1 1.9 -100%
Strongly Disagree 0 0  
  Do you believe packaging, advertisement or cost has nothing to do with quality of toothpaste? Strongly Agree 11 21.2  
  Agree 25 48.1  
8 Neutral 8 15.4 52
  Disagree 7 13.5 -100%
   
  Strongly Disagree 1 1.8  
  Do you think chemical toothpastes or mouthwashes are better than herbal ones? Strongly Agree 3 5.8  
  Agree 13 25
  52
9 Neutral 25 48.1 -100%
  Disagree 11 21.2  
   
  Strongly Disagree 0 0
10 Will you refer the patient to dentist if patient has periodontal disease? Strongly Agree 29 55.8 52-100%
Agree 21 40.4
Neutral 2 3.8
Disagree 0 0
Strongly Disagree 0 0
  Which of the following interdental aids will you highly recommend to your patients? Water rinses 8 15.4  
11 Interdental brush 12 23.1 52
  Dental floss 31 59.6 -100%
   
  Toothpick 1 1.9
  Do you demonstrate appropriate brushing technique according to patient clinical scenario? Always 30 57.7  
12 Often 18 34.6 52
  Rarely 3 5.8 -100%
   
  Never 1 1.9
    Always 26 50  
13 Do you give prophylactic mouth rinse to patient before starting scaling? Often 19 36 52
  Rarely 6 11.5 -100%
     
  Never 1 2
14 Do you advice floss holders for orthodontic patients? Always 15 28.8  
Often 15 28.8 52
Rarely 12 23.1 -100%
Never 10 19.2  
  Do you advice use of dental floss and tongue cleaner after brushing to your patients? Always 30 57.7  
15 Often 16 30.8 52
  Rarely 5 9.6 -100%
   
  Never 1 1.9
16 Do you advice use of mouthwash to your patients? Always 12 23.1    52               -100%
Often 30 57.7
Rarely 9 17.3
Never 1 1.9
17 Do you advice use of disclosing agent after brushing to evaluate cleaning of teeth to your patients? Always 12 23.1  
Often 10 19.2  
Rarely 16 30.8 52
Never 14 26.9 -100%

Table 3: Attitude and Practice Related Questions’ Responses of Study Participants (N=52).

Discussion

Oral hygiene aids are an effective way of biofilm control. Dental plaque is primarily composed of microorganisms enclosed within an extracellular matrix. Dental plaque cannot be removed by rinsing or with use of sprays. Oral prophylaxis is a professional method of cleaning teeth. In Maharashtra, oral prophylaxis is done by dentists, dental hygienists and dental assistants. In 1990, there were 3000 registered hygienists in India. In the study, the overall knowledge, attitude and practice of study participants regarding oral hygiene aids were found to be of average level. More than half of the participants were aware of the importance of oral hygiene maintenance and different types of oral hygiene aids, different components of toothpaste, mouthwash and their uses, advantages and disadvantages and advised daily use of oral hygiene aids to their patients. According to Attin T et al., there is a consensus in the literature that (meticulous) tooth brushing once per day is sufficient to maintain oral health and prevent periodontal diseases[11]. Whereas, 98.1% of hygienists included in the survey felt that brushing teeth twice daily is necessary. This may be due to the fact that brushing just once a day is not sufficient for effective plaque control. Tooth brushing is also regarded as an important vehicle for application of anti-caries agents (fluorides). In the study, 36.7% of subjects were aware of the whitening component in toothpaste and 78.8% thought that tooth hypersensitivity is also an adverse effect of whitening toothpastes. Tooth hypersensitivity may be caused by acidic pH of whitening toothpastes. When the pH falls below 5.2, enamel demineralization and root resorption have been reported[12]. Most of the hygienists in the study agree with the correlation of oral health to general health. Tatikonda A et al. concluded that herbal dentifrice was as effective as chemical dentifrice in the control of plaque and gingivitis[13]. However in our study, 48.1% of hygienists are neutral with regards to chemical toothpastes being better herbal toothpastes. About 25% think that chemical toothpastes are better than herbal once while 21.2% subjects disagree. According to Westfelt E et al., the patient should be advised to use appropriate aids and technique to achieve optimum plaque control[14]. Hygienists involved in the study also feel the same and more than half of them are aware of both the techniques of using dental floss. The responses gathered were received through social media platforms via Google form links sent to individual participants. There is a possibility of bias as dental hygienists working in rural areas were not approached for participation in the study. The limitation of the study was the small sample size. The study could have been done using large sample size and different variables in different regions in India.

Conclusion

The overall knowledge, attitude and practice of study participants regarding oral hygiene aids were found average level. Therefore, more comprehensive awareness programmes are needed in the population.


To update knowledge and practice of oral hygiene maintenance among dental hygienists; dental camps and orientation programmes should be arranged in Maharashtra.

References

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CORRESPONDENCE & COPYRIGHT

Corresponding Author: Shweta Gaikwad, Rangoonwala College of Dental Sciences Research Centre, Pune, Maharashtra; Email: shwetagaikwad7543@gmail.com 
Copyright: © 2021 All copyrights are reserved by Shweta Gaikwad, published by Coalesce Research Group. This This work is licensed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

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