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

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.

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%.

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.

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

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

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

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.

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.

1.    Darby M, Walsh MM. Procedures Manual to Accompany Dental Hygiene: Theory and Practice. St. Louis, Mo; Saunders/Elsevier. 2010.
2.    Offenbacher. Periodontal Disease: Pathogenesis, and Periodontal Lesion. 1996;821-878.
3.    Claydon NC. Current Concepts in Tooth Brushing and Interdental cleaning. Periodontology. 2000;48:10-22.
4.    Lee DW, Moon IS. The plaque-Removing Efficacy of a Single-Tufted Brush on the Lingual and Buccal Surfaces of the Molars. Journal of Periodontal and Implant Science. 2011;41:131–134.
5.    Kilian M, Chapple IL, Hannig M, et al. The Oral Microbiome - an Update for Oral Healthcare Professionals. British Dental Journal. 2016;221:657–66.
6.    Soben Peter. Essentials of Public Health Dentistry. Dental Manpower In India. 6th edition. 2019;19:476.
7.    Diksha Nautiyal. Diploma in Dental Hygienist. 
8.    SS. Hiremath. Textbook of Preventive and Community Dentistry. Dental Needs and Resources. 2011;19:243
9.    Ohrn K. The Role of Dental Hygienists in Oral Health prevention. Oral Health and Preventive Dentistry. 2004;2:277-281.
10.    C Luciak-Donsberger, S Aldenhovenv. Dental hygiene in Australia: a Global perspective. International Journal of Dental Hygiene. 2004;2;1655-1671.
11.    Attin T, Hornecker E. Tooth Brushing and oral health: How Frequently and When Should Tooth Brushing be Performed? Oral Health Preventive Dentistry. 2005;3:135-140.
12.    Price R, Sedarous M, Hiltz G. The PH of Tooth-Whitening Products. Journal Can Dental Association. 2000;66:421-26.
13.    Tatikonda A. Effects of Herbal and Non-Herbal Toothpastes on Plaque and Gingivitis: A Clinical Comparative Study. Journal Int Soc Preventive Community Dentistry. 2014;4:126-129.
14.    Westfelt E. Rationale of Mechanical Plaque Control. Journal of Clinical Periodontology.1996;23:263-267.

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.