Oral Hygiene maintenance- A Survey ABSTRACT The purpose of the study was to evaluate and analyze the oral hygiene condition and practices among the patients visiting Dental outpatient department of Altamash Institute of Dental Medicine

Oral Hygiene maintenance- A Survey ABSTRACT The purpose of the study was to evaluate and analyze the oral hygiene condition and practices among the patients visiting Dental outpatient department of Altamash Institute of Dental Medicine, Karachi came for their dental check-up from mid-January,2018 to mid-February, 2018. A descriptive cross-sectional survey was conducted on 100 patients.The questionnaire included information related to the patient’s name, age, gender, occupation, and residential area.

It was further categorized to evaluate the knowledge, practices, and behavior pattern related to oral health. Among all participants 60% (60) were female and 40% (40) were male. Study showed that tooth brush and toothpaste (94%) were the main products used for the maintenance of oral hygiene. Only 6% of the people used other oral hygiene aids.

KeywordsOral Hygiene, Oral health, Oral Hygiene Products INTRODUCTION Oral hygiene is the action to keep the oral cavity and teeth clean. The knowledge of oral hygiene is considered to be an essential necessity for wellness-related behavior.1 The oral health is now recognized as equally important in association to general health.2Obeying the directive of proper oral hygiene is of primary importance in the prevention of dental caries and periodontal diseases.3

Various aspects like nutritional standing, tobacco smoking, alcohol, hygiene, stress etc. are linked to a wide range of oral diseases forming thefirst harmonic basis of the common peril factor approach (WHO 2000) to prevent the oral diseases.4,5 The best way of maintaininggood oral hygiene is by “Plaque Control” since plaque is the major factor responsible for dental and gingival diseases. Tooth brush and tooth paste are the most widely used oral hygiene aids.7Although using a toothbrush significantly improves the level of adequacy of oral hygiene, there are many other contributing factors such as dental flossing and mouth rinsing etc.8

METHODOLOGY A descriptive cross-sectional hospital-based survey was carried out during mid-Jan to mid-Feb 2018 on the patients visiting Altamash Dental Hospital’s outpatient department (OPD). The study protocol was cleared through the Institutional Ethics Committee of the institute. Informed consent was taken from all the participants who were also informed that their participation in the study will be anonymous, voluntary, and non-compulsory.There was no intervention involvedas it was a descriptive study.As a result, there was less than minimal risk to all the participants.

All new patients attending dental OPD in the age group of 18-50 years and giving consent to participate in the study were included. Whereas, all the young and old patients were excluded. This cross-sectional study was conducted to assess oral hygiene knowledge and awareness in a sample of patients (n = 100) seeking dental care. A convenient sampling technique was adopted in the present study.

Only new patients who were visiting the dental hospital during the study period and agreed to participate were included till the estimated sample size was reached. A total of 100 patients participated in the current study and the response rate was 100%. A self-made 16 item closed ended questionnaire written in English language was given to each one of them. The patients were selectedfrom both rural and urban population which included both educated and illiterate groups between 18 to 50 years of age.

All the patients were assisted by one dental hygienist so that even illiterate patients could get it filled with ease. The questionnaire was in two parts: Part 1: Demographic details of the study participants. Part 2: Information about practice of oral hygiene methods and awareness. The questionnaires were handed over while the patients were seated in the waiting area of the Department of Periodontology. At all times, one of the investigators was present with the respondent while the questionnaires were being filled to ensure that the concerned respondent did not discuss the questions or the answers with any other patients sitting in the waiting area.

After distribution of questionnaire, 10 minutes were allocated to complete the questionnaire. Results were subjected for statistical analysis. Variables recorded in the study were Oral hygiene maintenance material, duration of use, frequency of use, changing of brush, method of brushing, secondary method of cleaning, use of floss, halitosis,tongue cleaning, material used to clean tongue, use of mouthwash, selection criteria of toothpaste, frequency of dental visits, personal opinion on visiting dentists, knowledge about relation to systemic health.

The data was first transferred to Microsoft Excel and the results were analyzed by using SPSS statistical software in terms of percentages. RESULTS The present study was carried out on 100 patients. Among them, 40% were males and 60%were females. Patients were further divided on the basis of age groups; group 1 (G1) being 18-25 years and group 2 (G2) having 26-50 years old. Highest proportion was from group 2 females. Distribution of patients according to age and gender is depicted in the pie chart.

The detailed educational, work and social status distribution is depicted in the table. Showing the maximum number of undergraduate/graduates in group 1 females, highest unemployment rates in group 1 females and the most underprivileged being the group 2 females. On evaluation, it was revealed that the oral hygiene aids show notable difference among different patient groups. Majority of patients including both males and females preferred toothbrush and toothpaste while only 6% females preferred other cleaning aids like finger and miswak.

It was further observed that most of the patients brushed their teeth twice daily (50%), 38% brushed once daily and 12% patients brushed more than twice a day.Moreover, most of the patients (48%) brushed for 2-5 minutes, while 40% for 1 minute and 12% brushed less than a minute. Besides, 68% of patients changed their toothbrush once in every three months, 16% changed it within a month, 10% changed it once in six months, 4% changed it every year and 2% changed it when the bristles were frayed. In addition to this,combined brushing technique was used by 68% participants.

Nonetheless, 18% used horizontal, 12% used vertical and 8% used circular brushing method. It was evaluated that 44% participants used toothpicks as secondary mode of plaque control and 16% used dental floss. However, only 10% used interdental brush and 30% used no aid.Also, 54% participants did not use a dental floss, 32% used it occasionally, 10% used it once daily and 4% flossed twice daily.Evaluation of halitosis showed 68% of clients had no halitosis while the rest 32% did feelbad breath from their oral cavity.

Tongue cleaning is also considered one the remarkable aspects of cleaning oral cavity. 70% of the participants cleaned their tongue whilst the rest 30% did not. Furthermore, 58% of the participants performed tongue cleaning by using a toothbrush, 6% used a tongue cleaner, 6% used finger and 30% were those who did not clean their tongue.It was also noticed that 48% patients never used a mouthwash, 28% used it once a week whereas 24% used it only when prescribed by the dentist. Selectionof toothpaste,according to 32% of the participantswasbased onfluoride content.

On the other hand, 26% selected on the basis of pleasant taste, 14% dentist recommendation, 12% advertisement, 10% packaging and 6% on cost. It is surprising that around 62% of the total population visit the dentist only when in problem whilst only 16% of the patients visit the dentist once in 6 months and 4% patients visited a dentist once in a year. Moreover, 18% patients did not even feel the need to visit a dentist. Nevertheless, 72% participants think it is essential to visit dentist every six months whereas, 28% think it is notmandatory.Regarding theassociation between oral health and systemic health, 6% of the patients did not have any idea while 94% of the participants did have some knowledge.

Lastly, the results of the study pointed out that educational level was one of the most important factors that governed the knowledge, perspective and behaviour of the people. DISCUSSION Around the world, a variety of methods were used by people to maintain their oral hygiene. Contemporary oral hygiene materials include toothpastes, toothbrushes, dental floss, tongue cleaners and mouthwashes. Basic prodigy is to clean all surfaces of teeth so the bacterial growth is decreased and oral diseases are arrested.9

In the present study, efforts were made to assess different measures taken by studied population to maintain their oral hygiene and to test their understanding of correlation between oral and systemic health. Although, all the participants cleaned their teeth on regular basis but still our study has shown little awareness on prevention and preventive dental behavior.10 The relationship between dental service utilization and main demographic variables e.g., age, sex, address, education and occupation are discussed in this study.11

Our study included 60 female participants and 40 male participants. All of these subjects cleaned their teeth regularly, with brushing being the most common mode of cleaning. In addition to this, 94% of the total participants cleaned their teeth using toothbrush and toothpaste. Out of these, 50% cleaned their teeth twice daily, 38% once daily and 12% cleaned more than twice a day.

There is a lack of success seen with the use of interdental aid as a secondary medium of plaque control. In a study conducted in Saudi Arabia in 2001, it was seen that dental floss was not used by a single subject for interdental cleaning, which is somewhat close to our results as well. In the present study, about 70% of the total participants used interdental aids, out of which only 10% subjects used dental floss, 44% used toothpick and 16% of them used interdental brush.12 Moreover, in the present study bad breath was experienced by almost 32% of the patients.

However, in the study findings of Kumar et al. 21% of the subjects experienced bad breath.13 Besides, tongue cleaning was done by 70% of the patients in the present study which is in contrast to the study done by Jain et al. where only 20% of the studied group cleaned their tongue.10 Furthermore, visiting a dentist is still not considered a preventive dental behavior. The present study shows that around 62% of the patients visited the dentist only when required. About 16% of the subjects visited the dentist every 6 months.

Moreover, 4% visited once a year and 18% were those who never visited a dentist. These results are almost identical to the study done by Jain et al. where 54% of the subjects visited the dentists only when in pain. Lastly, we concluded that 94% of the people were aware of the association between oral hygiene and systemic diseases. CONCLUSION Study have pointed out that educational level was one of the most important factors that governed the knowledge, attitude and behavior of the people.

The research provides a review that tooth brushing and the use of fluoride toothpastes appeared to be most universal and flossing, mouth rinsing and other oral hygiene methods are less documented.