INTRODUCTION:

“Mouth is the mirror of the body” Good oral health is important for our well-being. Daily preventive care includes proper brushing and flossing which will help to stop problems before they develop as painful and expensive”.¹

The oral cavity consists of the lips surrounding the opening of the mouth, the cheeks running along the side walls of the cavity, the tongue and its muscles and the hard and soft palate forming the roof of the cavity and teeth. The teeth are the organs of chewing. Tooth is composed of a crown, neck and root with one or more fangs. The main bulk is of dentine enclosing a central pulp; the crown is covered with a hard white substance called enamel.²

After we eat, a thin sticky film (plaque) of material forms around the teeth, if this is not removed by brushing and flossing regularly, it absorbs calcium from the surrounding saliva and hardens to form tartar, which harbours harmful bacteria and leads to irritation, inflammation and bleeding of the gums (gingivitis). If cleaning, is not done at this stage, the tartar forms below the gums, leading to loss of surrounding bone (periodontitis), if periodontitis is not treated, it leads to loosened teeth and their eventual loss.³

Plaque, which is a soft, sticky colourless film of bacteria that constantly forms on the teeth, combines with sugars present in food particles stuck between the teeth and turns them into acid which attacks the tooth enamel. If cleaning is not done, with repeated acid attacks, the enamel wears away and a cavity is formed then it spreads to the next layer-the dentine. If the cavity is not treated at the dentine stage, the cavity spreads deeper into the pulp and this can be very painful.⁴

“Oral health” means more than healthy teeth. Oral health is integral to general health. The individual cannot be healthy without oral health. Oral health and general health should not be interpreted as separate entities.⁵

Oral hygiene involves keeping the teeth and oral cavity clean and free from odour. Oral hygiene can be performed using a toothbrush and toothpaste, dental floss and mouthwash.⁶

Oral hygiene measures should be implemented to remove plaque, soft bacterial deposits that adhere to the teeth and cause dental caries (decay or cavities) and periodontal (gums) diseases. Poor dietary habits are associated with development of caries in children. The most effective methods of removing plague removal are brushing and flossing.³

NEED FOR THE STUDY:

During the school age years, the permanent teeth erupt; good dental hygiene and regular attention to dental caries are a part of health promotion practices. Children of this age tend to be lax about oral hygiene and are not motivated by improved appearance and odour, as they will be during adolescence. In addition, school children prefer raw sugars, candies etc in between meals. That’s why it is important to educate the school age children regarding oral hygiene practices.⁷

Oral hygiene is needed because many harmful organisms enter the body through the mouth and some infections of the gums are communicable in nature and poor oral conditions causes infection and pain in other parts of the body. A person’s mouth condition can interfere with his appetite and with proper nutrition total health is improved by healthy teeth and gums.⁸

Studies have revealed that dental diseases have been increasing both in prevalence and severity over the last few decades. Therefore, there is an urgent need to prevent the rising trend of dental disease in India. The methods used for primary prevention of dental diseases aims at achieving primary prevention of periodontal disease and oral cancers.

The school age children form a very high proportion of India’s population, both in rural and in urban areas. The number of school children between 5 to 14 years age group constitutes about 15% of the total population. Healthy habits regarding personal hygiene, clean surroundings, nutritious diet, exercise, rest and recreation if formed at an early stage will remain with the person throughout life and will help to develop healthy citizen in the full and positive sense of the term. So the school is the best place for giving health education.⁹

Dental caries resulting from poor nutrition is still a significant problem in the school age population. During this period, the permanent tooth begins to erupt. Adequate amount of fluoride, vitamin A, D, C, calcium and phosphorus are necessary for tooth development. Raw sugars and candies are common conditions to the development of the dental caries.¹⁰

Dental check-ups are recommended every six months. Approximately 35% of the population visits a dentist yearly; the school system should incorporate the dental health education programme into the curriculum.

Permanent teeth erupt during the school age years, good dental hygiene and regular attention to dental caries are vital parts of health supervision during this period, children of this age tends to become lax about oral hygiene unless they are carefully supervised.¹⁰

OBJECTIVES OF THE STUDY:

1. To identify the oral hygiene practices among school-age children age between 6-12 years in the experimental and control group during the pre-test.

2. To assess the oral hygiene practices among school- age children in the experimental group after the implementation of learning package on oral hygiene practices.

3. To determine the oral hygiene practices among the school age children of the experimental and control group after the post-test.

4. To associate the oral hygiene practices with selected socio-demographic variables.

MATERIAL AND METHODS:

Research design:

The research design was chosen for the study is an experimental design (pretest posttest control group design).

Schematic Representation of the research design:

An experimental study with two groups is mentioned below:

Group	Pre-test	Intervention	Post-test
Experimental	O₁	X	O₂
Control	O₁	--	O₂

Key:

X= Learning package on oral hygiene practices

Oı=Pre-test was conducted by using a structured interview schedule on oral hygiene practices prior to the administration of learning package.

O₂ = Post-test was conducted by using a structured interview schedule on oral hygiene practices after the implementation of the learning package to the experimental group.

Setting of the study:

The study was conducted in the selected School (English Medium), Hassan (Karnataka).

Sample size:

The sample size includes 60 school-age children, 30 in the experimental and 30 children were in the control group.

Sampling technique:

In this study simple random technique, lottery method was utilized for the selection of the subjects.

Criteria for the sample selection:

Inclusion criteria:

1 The male and female school –age children aged between 6-12 years.

2 The school–age children who are willing to participate in the study.

3 The school-age children who know reading, speaking and writing English and Kannada.

Exclusion criteria:

1. The male and female school-age children suffering from chronic illness.

2. The male and female school age children who are not willing to participate in the study.

Description of the instrument:

The instrument was organized into two parts: -

Part I: - Information regarding socio-demographic variables.

Part II: - Information regarding oral hygiene practices among school-age children aged between 6-12 years.

Validation of the instrument:

The content validity of the instrument was given by the experts in the field of child health Nursing, pediatrician and dentist. The instrument was further modified as per the recommendations of the experts and guidance was sought for the preparation of the learning package on oral hygiene practices.

RESULTS AND ANALYSIS:

On the basis of objectives the data is presented in four sections:

Section I: Distribution of subjects according to socio-demographic variables.

Section II: Assessment of pre-test level of knowledge of school-age Children in experimental and control group on oral hygiene practices.

Section III: Assessment of post-test level of knowledge of school-age children in experimental and control group on oral hygiene practices.

Section IV: Comparison of pre-test and post-test level of knowledge of school-age children in experimental and control group on oral hygiene practices.

Experimental group.

Section I: Distribution of subjects according to socio-demographic variables

Table 1: Distribution of Socio-demographic Variables (n=60)

Socio-demographic variables		Group
		Experimental (30)		Control (30)
		n	%	n	%
Age	11 yrs	18	60.0%	15	50.0%
	12 yrs	12	40.0%	15	50.0%
Sex	Male	23	76.7%	18	60.0%
	Female	7	23.3%	12	40.0%
Residence	Rural	14	46.7%	9	30.0%
	Urban	16	53.3%	21	70.0%
Type of family	Joint family	13	43.3%	8	26.7%
	Nuclear family	17	56.7%	22	73.3%
Religion	Hindu	24	80.0%	25	83.3%
	Christian	2	6.7%	1	3.3%
	Muslim	4	13.3%	4	13.3%
Family income	Rs.2000-3000	1	3.3%	3	10.0%
	Rs.3000-4000	3	10.0%	1	3.3%
	Rs.4000-5000	8	26.7%	7	23.3%
	>Rs. 5000	18	60.0%	19	63.3%
Dental examination in a year	Once	12	40.0%	14	46.7%
	Twice	1	3.3%	2	6.7%
	Not at all	17	56.7%	14	46.7%
Dental problems in the past 3 years.	Yes	12	40.0%	18	60.0%
	No	18	60.0%	12	40.0%

Table 2: Pre-test knowledge score on different aspects of Oral hygiene

Oral hygiene	Experimental (30)		Control (30)		Two sample binomial proportion test
Oral hygiene	N	%	N	%	Two sample binomial proportion test
Oral hygiene practices	14	47%	12	40%	Z=0.29 P=0.78
Habits on oral hygiene	6	20%	7	23%	Z=0.00 P=1.00
Oral health problems	6	20%	8	27%	Z=0.33 P=0.74
Average no. of persons	9	30%	9	30%	Z=0.00 P=1.00

Table 3: Post-test knowledge score on Different aspects of Oral hygiene

Oral hygiene practices	Experimental (30)		Control (30)		Two sample binomial proportion test
Oral hygiene practices	N	%	N	%	Two sample binomial proportion test
Oral hygiene practices	26	87%	14	47%	Z=0.29 P=0.78
Techniques and Habits on oral hygiene	22	73%	7	23%	Z=3.62 P=0.001
Oral health problems	23	77%	8	27%	Z=3.62 P=0.001
Overall	24	80%	10	33%	Z=3.41 P=0.001

The results of the study showed that pre-test score of oral hygiene practices of the school-age children in the experimental group was 9 (30%) and in the school-age children of the control group the score of oral hygiene practices was also 9 (30%). Post-test score of the school –age children in the experimental group on oral hygiene practices was 24 (80%) and post-test score of the school-age children in the control group on oral hygiene practices was 10 (33%). Hence the difference between pre-test score and post-test score of the school-age children in the experimental group on oral hygiene practices was 15 (50%). Whereas difference in pre-test score and post-test score of the school-age children in the control group on oral hygiene practices was 1 (3%).

In the experimental group the difference among school-age children between pre-test and post-test score is statistically significant and this difference is due to the learning package on oral hygiene practices. There is a significant association between post-test knowledge score in the experimental group and in the socio-demographic variables like sex, residential area, Number of dental examinations in a year, any dental problems present in the past 3 years in the school-age children.

DISCUSSION:

The first objective of the study was:

“To identify the oral hygiene practices among school age children aged between 6-12 years in the experimental and control group during the pre-test”.

The findings of the pre-test level of knowledge scores shows that in the experimental group as well as in the control group n=9 (30%) school age children were having the knowledge in all the aspects of oral hygiene practices. This knowledge score indicates that both experimental and control group school-age children were having inadequate knowledge in all the aspects of oral hygiene practices.

This present study in well supported by a study conducted a survey on prevalence of dental caries among school-age children of moodbidri. 2902 children aged between 5 and 12 years were selected randomly from 13 primary schools in various areas. The caries prevalence was found to be 76.9%. There was no difference found between male and female children.

The second objective of the study was: -

“To assess the oral hygiene practices among school-age children in the experimental group after the implementation of learning package on oral hygiene practices”.

The findings of the post-test knowledge score of the school-age children of the experimental group was n = 24 (80%). These findings show that after the implementation of the learning package on oral hygiene practices, the level of knowledge of the school-age children has increased adequately but in the control group the school-age children gained score was n = 10 (33%). Thus in the control group, negligible changes were seen in the knowledge score during the post-test.

The third objective of the study was: -

“To determine the oral hygiene practices among the school-age children of the experimental and control group after the post-test”.

The findings of the study revealed a significant increase in the post-test knowledge score after the implementation of learning package on oral hygiene practices. The pre-test knowledge score of school-age children in the experimental group was n = 9 (30%) and the post-test knowledge score was n = 24 (80%). Difference between the pre-test and post-test knowledge score was 50%.

In the control group pre-test knowledge score was n = 9 (30%) and post-test score was n = 10 (33%). So the difference is not significant.

Therefore it is confirmed that the learning package is effective for improving the knowledge of school-age children regarding the oral hygiene practices.

The forth objective of the study was:-

“To associate the oral hygiene practices with selected socio-demographic variables”.

The findings of the study revealed that a significant increase in post-test gained score in the school age children of the experimental group with selected socio-demographic variables.

According to the sex of the school age children, the male school age children answered 10 more questions correctly where as female school age children answered 12 more questions correctly in the experimental group. So female children answered more questions correctly than male children after implementation of the learning package. This association between answered question correctly and sex was statistically significant.

According to the number of dental examinations in a year, dental examination having children gained more score on oral hygiene practices than children with no dental examination in the experimental group. The association between gained score and dental examination in a year was statistically significant.

REFERENCES:

1. Mrs R. Alphonsa, Dental care for Health and Sick. Journal –Nurses of India, 2005 August; 6(8):10-11.

2. Patricia. A. Potter, Ane. G. Perry, Fundamentals of Nursing, Third Edition, Mosby – St Louis, Missiori, 1993 1046 – 1047.

3. Dr P.C. Jacob, Teething problems; News paper Deccan Herald, Health – December 16, 2006.

4. Pepsodental,-Plaque, gum diseases, bad breath web Health center.com- oral care 2005.

5. Suraj Gupte. The short text book of pediatric 10^th edition. New Delhi: Jaypee Publication; 2004:778.

6. Dr Supria.N.Nahar. Dental Health For a Life Time. Herald of health magazine,2006 Dec: 4-7.

7. P. A. Potter, Ane. G. Perry, Fundamentals of Nursing, 4^thEdition, Philadelphia Mosby publication: 2001.

8. Dr H.K. Bakhru, Nature cure for dental caries Punne. Nisargopchar Varta: May 2003:5:5.

9. B.T. Basavanthappa, Text book of community health nursinf.2^nd edition, New Delhi, Jaypee publication 2005,536.

10. D.R. Marlo, B.A. Redding, Text Book of Paediatric Nursing .6^th edition Philadelphia, W.B. Saunders Company ;2001.

Received on 18.01.2016 Modified on 23.02.2016

Int. J. Adv. Nur. Management.2016; 4(2):130-134.

DOI: 10.5958/2454-2652.2016.00029.9