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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 14  |  Issue : 1  |  Page : 11-17

Knowledge, attitude, and practice of school teachers regarding dental caries for school children in Navi Mumbai, India


1 Department of Pediatric and Preventive Dentistry, TPCT's Terna Dental College, Navi Mumbai, Maharashtra, India
2 Department of Public Health Dentistry, TPCT's Terna Dental College, Navi Mumbai, Maharashtra, India

Date of Submission14-Dec-2020
Date of Acceptance27-May-2021
Date of Web Publication31-Dec-2021

Correspondence Address:
Farhin Katge
Plot No. 12, Sector – 22, Opp. Railway Station, Nerul West, Navi Mumbai - 400 706, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJDS.IJDS_214_20

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  Abstract 


Background: Schools form a platform for molding habits in children, and teachers have a potential role in school-based dental education programs. Aim: The objective of this study was to evaluate level of knowledge, attitude, and practice of school teachers regarding dental caries in children in schools of Navi Mumbai. Materials and Methods: A cross-sectional survey was conducted among school teachers in Navi Mumbai. A total of 554 teachers completed the questionnaire, which included questions on demographic data, knowledge about etiology of dental caries, its prevention, their attitude, practice, and role of teachers in the management of dental caries. The data were analyzed using Chi-square test. Results: A total of 554 school teachers filled the questionnaire. The number of female teachers (84.8%) was very high as compared to male teachers. Approximately 60% of study population considered bacteria and amount of sweets consumed as the cause of dental caries. More than 52% considered eating less sugar as one of the ways to prevent caries. Furthermore, 57.4% of teachers were willing to implement future training programs on caries prevention. Conclusion: Knowledge regarding dental caries among school teachers in Navi Mumbai was adequate. Teachers were willing to participate in oral health promotion training programs.

Keywords: Attitude, dental caries, knowledge, practice, school teachers


How to cite this article:
Patil D, Khakhar P, Katge F, Bhanushali N, Bhanushali P, Deshpande S. Knowledge, attitude, and practice of school teachers regarding dental caries for school children in Navi Mumbai, India. Indian J Dent Sci 2022;14:11-7

How to cite this URL:
Patil D, Khakhar P, Katge F, Bhanushali N, Bhanushali P, Deshpande S. Knowledge, attitude, and practice of school teachers regarding dental caries for school children in Navi Mumbai, India. Indian J Dent Sci [serial online] 2022 [cited 2022 May 22];14:11-7. Available from: http://www.ijds.in/text.asp?2022/14/1/11/334522




  Introduction Top


Nearly 60%–70% of the schoolchildren are suffering from oral diseases, according to the World Health Organization.[1] Despite several preventive measures, dental caries remains the most common oral health disease worldwide. Numerous social and behavioral factors are involved in the etiology of the carious process along with the role of environment, diet, and microorganisms.[2] Dental caries and periodontal diseases are however largely preventable.[3] A child's health is the result of a complex interaction of several biological elements with social, cultural, and community variables.[4] Furthermore, oral health is an essential component of general health and well-being. A multidisciplinary approach is required for successful oral health education and prevention of dental diseases.

Healthy habits are formed early in childhood by their repeated long-term reinforcement. Schools, where children spend a majority of their time, form an important platform for forming habits in children and developing their personality. School teachers play an effective role in transmitting knowledge and shaping the behavior and attitude of students. They have the opportunity of preparing a future generation of well-informed health-care consumers. Teachers are known to have a potential role in school-based dental education program.[5],[6] In order to implement oral health values and plan preventive programs, it is essential for teachers to have a sound knowledge in this regard. Studies pertaining to knowledge of oral health among teachers have been conducted, but few have specifically assessed their awareness regarding management and prevention of dental caries.

Thus, the objective of the study was to identify the level of knowledge, attitude, and practice of school teachers regarding dental caries in children in schools of Navi Mumbai, to correlate it with their demographic, professional characteristics, and evaluate the need of oral health education programs for teachers.


  Materials and Methods Top


The present study was approved by the Institutional Review Board Ethics Committee (IRB-EC) (Registration no. IRB-EC/139/2017).

Study design and participants

A cross-sectional survey was conducted among school teachers in the city of Navi Mumbai. The present study was conducted from June 2017 to February 2018. All the available primary and secondary school teachers (n = 554) of government, semi-aided, and private schools were considered for the study.

Data collection

The survey involved the completion of a self-administered, structured, anonymous questionnaire by the teachers. A prior permission was obtained from the Navi Mumbai Municipal Corporation (NMMC) to conduct the study in all government, semi-aided, and private schools of NMMC region. Permission regarding the circulation of questionnaires to teachers in various schools was obtained from the principals/school headmasters of the respective schools.

Questionnaire design and validation

The initial version of questionnaire was pilot tested for its validity and operational feasibility. The suggestions of the responders regarding pattern and wording aided in refining the questionnaire further.[Additional file 1]

The development of questionnaire was based on the aims of the study. Overall, it included five questions on teachers' demographic data of which three were “open ended.” There were 13 questions on the knowledge, attitude, and practice regarding dental caries in children, all of which were of “closed type.” These included knowledge of etiology of dental caries, its prevention, and role of teachers in its management. Questions on their attitude and practice included necessity to inspect students' tiffin boxes by teachers, instructing parents about food packed in tiffin boxes, discussing the child's oral health status with parents during meetings, and the need to implement training programs on prevention of dental caries. A three-point Likert scale of “yes,” “no,” and “don't know” was employed for data collection. The questionnaire was developed in English and translated into Hindi and Marathi languages to ensure better comprehension by the respondents.

The survey was voluntary in nature and strict confidentiality was assured. Informed consent of the participants was obtained before participation in the study. The respondents were asked to tick the most appropriate option from the alternative choices provided. The questionnaires thus filled were collected within a period of 1 week.

The questionnaire was checked for internal consistency through SPSS version 17.0 (IBM SPSS, Chicago, IL,USA) using Cronbach's alpha. It was found to be 0.782. Inclusion criteria included primary school teachers, secondary school teachers, assistant primary school teachers, secondary school teachers, and headmasters or principals of schools. Exclusion criteria included personnel who did not give consent to participate. Based on the results of the pilot study, the sample size was determined to be 554 with consideration of 3% precision and 95% confidence level. Knowledge, attitude, and practice among school teachers regarding dental caries in children formed the outcome variable. The demographic characteristics of age, gender, qualification, and teaching experience are the explanatory variables. The data collected were coded and statistically analyzed using the Statistical Package for the Social Sciences 17.0 (SPSS version 17.0, IBM SPSS software). The level of significance was set up at P = 0.05 and Chi-square test was applied.


  Results Top


Demographic characteristics of the participants

A total of 554 school teachers completed the questionnaire survey. [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d shows the demographic distribution of the participating teachers. Approximately 45.3% of the teachers were <35 years of age, whereas 54.7% teachers were more than 35 years old. The number of female teachers (84.8%) was very high as compared to male teachers (15.2%). Maximum respondents were graduates (54.7%) followed by those with a diploma (22.9%), postgraduate degree (22%), and other qualification (0.4%). Furthermore, 32.3% of the participants had a teaching experience of more than 10 years.
Figure 1: Frequency distribution graph-Demographic data of school teachers

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Knowledge about etiology of dental caries

Around 57% of the study population considered the presence of bacteria as the cause of dental caries. According to 60% of the population, the amount of sweets consumed had a role in causation of dental caries. However, 35% of the participants were not aware about the role of frequency of sweet intake in causing caries. In the present study, 56% considered irregular brushing habit as the causative factor, while nearly 61% attributed it to lack of calcium in the body [Figure 2].
Figure 2: Frequency distribution of knowledge, attitude and practice of school teachers regarding dental caries in school children

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Knowledge about prevention of dental caries

Nearly 95% of the participants agreed that prevention of tooth decay was necessary. Regarding methods of prevention, more than 50% considered eating less sugar as one of the ways to prevent caries. About 63% of the participants agreed that visiting the dentist and regular toothbrushing can prevent dental caries. Only 57% of the participants were aware about the role of fluoride tooth paste in caries prevention. The positive impact of fibrous food in caries prevention was known to 55.2% of the participants [Figure 2].

Teachers' attitude and practice regarding dental caries in children

In the present study, 73.5% of respondents felt that teachers must inspect students' tiffin boxes to ensure they carry healthy food to school. Furthermore, 69.5% of teachers thought they should instruct parents about what to pack in tiffin boxes. Nearly 68% of teachers believed that parents should take the child to the dentist when there is pain in the tooth while only half (51.6%) agreed that they must visit the dentist every 6 months. Furthermore, 3.4% and 6.5% of teachers agreed that the school canteen provides chocolates and aerated drinks, respectively. Nearly 96.6% of teachers advised children to rinse their mouth after eating and 59.9% of them discussed child's oral health with parents during meetings [Figure 2].

Teachers' interest and willingness to be involved in oral health promotion

Nearly 16.2% of respondents agreed that teachers play a role in the management of dental caries. However, only 14.3% of them had attended training programs on caries management earlier. In the present study, 57.4% of them were willing to implement training programs on caries prevention in future [Figure 2].


  Discussion Top


This study illustrates a detailed view of the knowledge, attitude, and practice of school teachers regarding dental caries in children in the city of Navi Mumbai. Petersen and Esheng demonstrated that school teachers in Wuhan, China, had a better level of dental knowledge compared to the mothers and were eager to participate in oral health education of children.[6] Ramroop et al. showed that, although teachers in Trinidad, West Indies, had good knowledge regarding cause of dental caries and gum diseases, dearth of resources and training were major barriers in the implementation of oral health education by teachers.[7] Studies from a majority of other developing countries such as Romania, Israel, and Kuwait have shown that though teachers lacked knowledge of oral health, they were keen in providing oral health education to their students.[8],[9],[10] It was also shown that teachers were less motivated to take part in activities that needed direct supervision and involved use of school time. Nyandini et al. have shown that though some teachers were quite knowledgeable with regard to oral health, they were not persuaded enough to incorporate oral health programs.[11]

The association between knowledge and attitude of school teachers regarding dental caries and gender, age, qualification, or teaching experience was not found to be statistically significant [Table 1], [Table 2], [Table 3], [Table 4].
Table 1: Association of gender of teachers with knowledge, attitude, and practice of school teachers regarding dental caries in school children

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Table 2: Association of qualification of teachers with knowledge, attitude and practice of school teachers regarding dental caries in school children

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Table 3: Association of age of teachers with knowledge, attitude, and practice of school teachers regarding dental caries in school children

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Table 4: Association of teaching experience of teachers with knowledge, attitude, and practice of school teachers regarding dental caries in school children

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Knowledge of school teachers regarding dental caries

Studies have also been conducted in India to assess knowledge of school teachers regarding the same. Singh et al. in a study in Lucknow showed that, though urban and rural school teachers had a fair knowledge about oral diseases, their knowledge related to preventive dentistry was less.[12] Shodan et al. concluded that there was a greater need to motivate younger school teachers with only basic educational qualifications to increase their awareness about oral health, particularly dental caries and malocclusion.[13] In the present study, around 85% of the participants were females. This is similar to a study conducted by Kompalli and Mahalakshmi where 82% of the participants were females, thus denoting the larger impact they can have in oral health promotion.[14] More than half of the participants (54.7%) in the present study were above 35 years of age.

Regarding knowledge of etiology of dental caries, bacteria and amount of sweets consumed as causative factors was known to approximately 60% of the participants. This was similar to a study conducted by Sekhar et al. in Pondicherry, in which about 50% of the subjects had knowledge about the cause of dental caries.[15] This was however in contrast to results of studies conducted in Riyadh and Michigan that showed a higher percentage of teachers, around 80%–90% with adequate knowledge about cause of dental caries.[16],[17] This difference may be attributed to the socioeconomic and cultural factors along with differences in the infrastructure and organization of the education systems in different countries. In the present study, no significant association was seen between the qualification of teachers and their knowledge about the etiology of caries. In the present study, 65.2% of participants recognized the role of frequency of sugar intake in causing caries, which was higher than a study by Ramroop et al. in West Indies that showed a lower percentage (52%).[7] Furthermore, 95.3% of respondents agreed that prevention of caries was necessary; however, no statistically significant difference with respect to the age and teaching experience of participants was seen [Table 3] and [Table 4]. When enquired about methods of caries prevention, more than 50% of the teachers believed eating less sugar, regular tooth brushing, use of fluoride tooth paste, and fibrous foods prevented caries.

Attitude and practice of school teachers regarding dental caries

Regarding the attitude and practices of school teachers, about 74% of them agreed that teachers must check students' tiffin boxes. Furthermore, 69.5% of teachers believed that they should instruct parents what to pack for the same. However, no significant association was observed between attitude of school teachers with their age, gender, qualification, and teaching experience. Although teachers do have knowledge about importance of healthy eating practices, the increased years of teaching experience reaffirms their belief and directs them to actively instruct teachers regarding same. In the present study, 59.9% of the teachers agreed that they discuss child's oral health with parents during meetings. Although only 14.3% of teachers had attended training programs on dental caries management, 57.4% were keen on implementing them in their practice. This is consistent with a study by Aljanakh et al. in Hail Saudi Arabia, but in contrast to a study done among Tanzanian teachers in which merely 11% of teachers were keen on obtaining training for oral health promotion.[18],[19]

Limitation

Study with a larger sample size and geographic distribution needs to be considered to get a better idea of the knowledge, attitude, and practice of school teachers regarding dental caries in school children. This study only determined the knowledge, attitude, and practice of school teachers which are more subjective in nature. More studies should be carried considering both subjective and objective outcome measures. Objective outcome measures majorly involve knowledge, attitude, and practice of school teachers after attending dental training program.


  Conclusion Top


Based on the results of this study, knowledge regarding dental caries among school teachers in Navi Mumbai is adequate. The causative role of bacteria, sweets, and irregular brushing was well recognized. Furthermore, teachers agreed on the importance of regular visit to the dentist for preventing caries, knowledge regarding fluoride in caries prevention was less prevalent. Teachers had a positive attitude toward oral health promotion and were willing to participate in caries management programs. Often, school teachers are found to be quite knowledgeable, but not sufficient enough to influence their practices and behavior. This may be due to lack of resources and reinforcement by dental professionals. Hence, oral health training programs for teachers must be implemented and backed on a regular basis. Based on results from this study, these should be particularly targeted at the younger age group of teachers, below 25 years who have acquired only basic educational qualification such as a diploma. These training programs will help to consolidate our efforts toward caries prevention in children.

Why this paper is important to pediatric dentists?

  • School teachers play an effective role in transmitting knowledge and shaping the behavior and attitude of students
  • Teachers have the opportunity of preparing a future generation of well-informed health-care consumers
  • This paper helps to signify the role of teachers in the prevention or management of dental caries in children.


Ethical clearance

Ethical clearance obtained by the Institutional Review Board Ethics Committee (IRB-EC) (Registration no. IRB-EC/139/2017).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Available from: http://www.who.int/oral_health/policy/en/. [Last accessed on 2020 Oct 20].  Back to cited text no. 1
    
2.
Bagramian RA, Garcia-Godoy F, Volpe AR. The global increase in dental caries. A pending public health crisis. Am J Dent 2009;22:3-8.  Back to cited text no. 2
    
3.
Schoen MH, Freed JR. Prevention of dental disease: Caries and periodontal disease. Annu Rev Public Health 1981;2:71-92.  Back to cited text no. 3
    
4.
Mouradian WE, Huebner CE, Ramos-Gomez F, Slavkin HC. Beyond access: The role of family and community in children's health. J Dent Educ 2007;71:619-31.  Back to cited text no. 4
    
5.
Loupe MJ, Frazier PJ. Knowledge and attitudes of schoolteachers towards oral health programs and preventive dentistry. J Am Dent Assoc 1983;107:229-34.  Back to cited text no. 5
    
6.
Petersen PE, Esheng Z. Dental caries and oral health behaviour situation of children, mothers and schoolteachers in Wuhan, People's Republic of China. Int Dent J 1998;48:210-6.  Back to cited text no. 6
    
7.
Ramroop V, Wright D, Naidu R. Dental health knowledge and attitudes of primary school teachers toward developing dental health education. West Indian Med J 2011;60:576-80.  Back to cited text no. 7
    
8.
Petersen PE, Danila I, Samoila A. Oral health behavior, knowledge, and attitudes of children, mothers, and schoolteachers in Romania in 1993. Acta Odontol Scand 1995;53:363-8.  Back to cited text no. 8
    
9.
Sgan-Cohen HD, Saadi S, Weissman A. Dental knowledge and attitudes among Arab schoolteachers in northern Israel. Int Dent J 1999;49:269-74.  Back to cited text no. 9
    
10.
Petersen PE, Hadi R, Al-Zaabi FS, Hussein JM, Behbehani JM, Skougaard MR, et al. Dental knowledge, attitudes and behavior among Kuwaiti mothers and school teachers. J Pedod 1990;14:158-64.  Back to cited text no. 10
    
11.
Nyandini U, Palokas TP, Robinson V. Participation, willingness and abilities of schoolteachers in oral health education in Tanzania. Community Dent Health 1994;11:101-4.  Back to cited text no. 11
    
12.
Singh P, Singh I, Gupta ND, Tewari RK, Agrawal N, Yadav P. Oral health knowledge, attitude, practices and oral health status among school teachers in and around Lucknow, UP. J Dent Med Sci 2015;14:111-6.  Back to cited text no. 12
    
13.
Shodan M, Prasad KV, Javali SB. School teachers' knowledge of oral disease prevention: A survey from Dharwad, India. J Investig Clin Dent 2012;3:62-7.  Back to cited text no. 13
    
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Kompalli PV, Mahalakshmi M. Knowledge, attitude and practices of schoolchildren and teachers of khammam towards oral hygiene. Web Med Cent Dent 2013;4:1-6.  Back to cited text no. 14
    
15.
Sekhar V, Sivsankar P, Eswaran MA, Subitha L, Bharath N, Rajeswary K, et al. Knowledge, attitude and practice of school teachers towards oral health in pondicherry. J Clin Diagn Res 2014;8:ZC12-5.  Back to cited text no. 15
    
16.
Almas K, Al-Malik TM, Al-Shehri MA, Skaug N. The knowledge and practices of oral hygiene methods and attendance pattern among school teachers in Riyadh, Saudi Arabia. Saudi Med J 2003;24:1087-91.  Back to cited text no. 16
    
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Lang P, Woolfolk MW, Faja BW. Oral health knowledge and attitudes of elementary schoolteachers in Michigan. J Public Health Dent 1989;49:44-50.  Back to cited text no. 17
    
18.
Aljanakh M, Siddiqui AA, Mirza AJ. Teachers' knowledge about oral health and their interest in oral health education in Hail, Saudi Arabia. Int J Health Sci (Qassim) 2016;10:87-93.  Back to cited text no. 18
    
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Elena B, Petr L. Oral health and children attitudes among mothers and school teachers in Belarus. Stomatol Balt Dent Maxillofac J 2004;6:40-3.  Back to cited text no. 19
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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