INTRODUCTION:

A child is a precious gift which has lots of potential within, which can be the best resource for the nation if raised and molded in good manner. Healthy children can become healthy citizens constituting a healthy nation. Healthy children are also successful learners. School age children represent about 25% of the total population, so it indicates that health care of the school children can contribute to the overall health status of the country and it is the society’s responsibility to nurture and care for them.¹

School health is an important branch of community health. A healthful school environment is therefore necessary for the best emotional, social and personal health of the pupils. The ultimate aim of game-based learning is to bring a significant change in the knowledge and health behavior of children and family.²

According to WHO, aim of “Health for All by the year 2000” the global status for children, should be that 50% of children between the ages of 5 and 6 years will be caries free and at 12 years of age they should have 3 or fewer decayed, missing or filled teeth. In India caries is the commonest disease in school age, affecting 50-75% of them. Children are suffering more from dental disease which is continually increasing at a high rate due to lack of appropriate care and inadequate knowledge regarding Dental hygiene. Dental health is recognized as one of the vital need of the children. The school environment is more conducive to learning, hence dental health education and motivation shall be more effective.³

WHO Oral health Fact sheet [April 2017], reports that worldwide, 60–90% of school children and nearly 100% of adults have dental cavities. Dental caries is the leading dental problem of children, 90% of all children have some tooth decay by 12 years of age. 95% of all cavities are caused by specific eating sugar habits like candies, ice-cream, canned juice, which usually develop during early childhood as a result of changing lifestyle. Dental diseases affecting the child are not same as affecting the adults.⁴

School age years are crucial for establishing positive self-esteem and self-concept and it is during this time the child learns how to master skills and relate to health. Although the school age years are one of the healthiest phases of life, many studies have shown that children are affected by dental caries due to lack of dental hygiene.¹⁷Today the child health is viewed as a holistic and positive component for the total development and health is essential for high quality of life for children.⁵

A school health program recognizes that the child’s best opportunity to learn is through play. Play helps the child to understand their world, to become socialized, to solve problems in an environment and also develop critical thinking skills. Children 8 to 12 years of this age group enjoy many types of games like playing board games, starts different collection, watching TV, listening music, etc. ‘Snake and Ladder’ is a very simple childhood racing board game played among these children and its seesawing nature makes it popular. The game does not need any specific skill to play. It gives a very relaxed feel throughout the game.⁶

Kola Srikanth Reddy, Rapala H, Kethineni B, Reddy H, Reddy A, et Al, conducted a cross sectional study in 2000 children in different areas of Mahabubnagar district in the age group of 6 to 12 years. The dental caries status was assessed by decayed, missing, and filled teeth (DMFT)/dmft index using the World Health Organization criteria 1997. Collected data from each patient are subjected to statistical analysis to know the prevalence of dental caries. The results of dental caries in both primary dentition and permanent dentition were 64.2% and 26.6%, respectively. The prevalence of dental caries in primary dentition were more in 7 to 8 years old children and less in 11to 12 years old children (P>0.05). The overall mean dmft score of both males and females is 1.49±1.56; the overall mean DMFT score of both males and females is 0.57±1.23. This study showed that the frequency of caries was found to be higher in Northern region of Mahbubnagar. The dental caries was more in 7 to 8 years old children and less in 11 to 12 years old children whereas less in the local villages of Mahbubnagar.²

Kamala devi.C [2016], conducted a study to determine the effectiveness of snake and ladder game on knowledge of personal hygiene among 60 primary school children at Sri Ramakrishna Matriculation School, Coimbatore. Education about personal hygiene was given through snake and ladder game for 5 days. The mean score before and after education regarding personal hygiene was 13.68 and 33.31 and the standard deviation was 5.61 and 6.62 respectively, with a mean difference of 19.63. The calculated ‘t’ value 19.62, was greater than the table value at 0.001 level of significance. Hence, it was concluded that snake and ladder game was effective in enhancing the knowledge regarding personal hygiene among school children.⁸

It is very essential to educate children regarding oral hygiene, especially between the age group of 9 to 12 years. Integrating education and entertainment make the process of learning an enjoyable one as it develops children’s’ visual alertness, increased attention span, assist with memory strategies and reasoning. This knowledge helps the school children to maintain good oral hygiene and practice it further. Hence, the investigator selected Play Way method to impart Knowledge to School Children regarding oral hygiene.

OBJECTIVES:

I. To assess the Prevalence of Dental Caries among School Children.

II. To assess the level of Knowledge on Dental Hygiene among School Children before and after Play Way Method of Teaching [PWMT].

III. To evaluate the Effectiveness of Play Way method of Teaching on Dental Hygiene among School Children in terms of gain in Knowledge with post-test 1 and post-test 2.

IV. To find out the Association between the pre-test and post-test 2 Knowledge Scores on Dental Hygiene among School Children with their Selected Demographic Variables.

HYPOTHESIS:

H₁: There will be a significant increase in terms of knowledge in post test 1 and post test 2 than in pretest of School Children regarding Dental Hygiene after Play Way Method of Teaching at 0.05 level of significance.

H₂: There will be a significant association between pretest knowledge scores on Dental Hygiene among school children with selected demographic variables at 0.05 level of significance.

H₃: There will be a significant association between post test knowledge scores on Dental Hygiene among school children with selected demographic variables at 0.05 level of significance.

ASSUMPTIONS:

The study assumes that:

· Children may have some knowledge regarding dental hygiene.

· Play Way method of Teaching may be effective in increasing the knowledge scores on Dental Hygiene.

· The knowledge may vary according to the selected demographic variables.

· It may improve the knowledge and create awareness on the importance and practice of dental hygiene among school children, thereby helps in reducing dental caries.

DELIMITATIONS:

The study is delimited to:

· The children of 9 to 12 years of age, studying at selected school, Hyderabad.

· Only knowledge gain through Play Way method.

· Sample size of 60.

CONCEPTUAL FRAMEWORK:

Conceptual framework adapted for this study was based upon ‘Ludwig Von Bertalanffy’s General System Theory’ (1968).

MATERIAL AND METHODS:

A quantitative research approach was considered as an appropriate research approach for the present study. The research design selected for the present study was Quasi- experimental one group pre-test, post-test design. Independent variable in the present study was Play Way Method of Teaching regarding Dental Hygiene for School Children. Dependent variable in the present study was the Knowledge of School Children regarding Dental Hygiene. The setting selected for the study was St. Arnold High School, Ramachandrapuram, Hyderabad, Telangana. A sample of 60 children was selected for the study using proportionate stratified random sampling technique by lottery method.

To assess the prevalence of Dental Caries status:

The D - decayed, M - missing, and F - filled T - teeth (DMFT/dmft) index by World Health Organization criteria (1997) is modified and developed in the form of a checklist. The tooth was considered carious (D component) if there was visible evidence of a cavity, including untreated dental caries. The missing (M component) included teeth with indications for extractions or teeth extracted due to caries. The filled (F component) included filled teeth. The DMFT components due to caries in this study are:

1. D - Component: Used to describe Decayed teeth which include:

1.1	Tooth Pain on chewing
1.2	Sensitive to cold /hot
1.3	Sensitive to sweet
1.4	Sensitive to foods /Drinks
1.5	Presence of plaque
1.6	Presence of pit and fissure

2. M - Component: Used to describe Missing teeth due to caries, other cases should be excluded.

2.1	Missing/Broken Tooth due to caries
2.2	Extracted tooth due to caries

3. F - Component: Used to describe Filled teeth due to caries.

3.1	Temporary filling because of previous decay
3.2	Permanent filling because of previous decay

The conventional snake and ladder game was modified by incorporating the concepts of dental hygiene, which included symptoms of dental caries, foods increase risk of dental caries, foods promote dental health, practices that cause dental caries, healthy practices and brushing technique.

FINDINGS:

Out of 657 school children examined for the prevalence of Dental Caries, the mean DMFT value was 2.16 (±2.21). The decayed component contributed 98.3% of the score as it had 2.02 (±1.2), the Missing components contributed 1.3 (±.3), and Filled components contributed 0.01 (±.1) to the mean DMFT value. It shows that out of every 10 population, 2 are having dental caries. The overall pre-test mean score of knowledge was (9.65± 3.66) whereas in post-test after the administration of Snake and Ladder Game, the total mean of post-test 1 knowledge score was increased to (20.43±4.04) and the mean of post-test 2 knowledge score was increased to (21.91±3.11). Thus the study revealed that the mean percentage between pre-test and post-test 1 was 41.46% and between post-test 1 and post-test 2 was 5.7%. The overall mean improvement percentage between pre-test and post-test 2 was 47.19%. The calculated paired ‘t’ value t = 14.734, t = 19.370 and t = 4.119 between pre-test, post-test 1 and post-test 2 was found to be statistically highly significant at p, 0.001 level respectively.

The calculated repeated measures ANOVA of F = 252.216 was found to be statistically highly significant at p<0.001. The intervention of Play Way method of Teaching on Dental Hygiene imparted to School Children was found to be Effective to improve the level of Knowledge among School Children on Dental Hygiene.

DISCUSSION:

a. To assess the Prevalence of Dental Carries among School Children

The study evaluated the prevalence of dental caries of 657 school children belong to the age group of 9 to 12 years studying 4th,5th, 6th, and 7th respectively. Out of 657 school children the mean DMFT value was 2.16 (±2.21). The decayed component contributed 98.3% of the score as it had 2.02 (±1.2), the Missing components contributed 1.3 (±.3), and Filled components contributed 0.01 (±.1) share to the mean DMFT value. It shows that out of every 10 population 2 were having dental caries.

Prevalence assessment of dental caries among school children. n = 657

DMFT CHECKLIST	TOTAL	TOTAL NUMBER OF SUBJECTS	MEAN DMFT
D – Components	1326	657	2.02
M – Components	86	657	0.13
F – Components	8	657	0.01
T – Total	1420	657	2.16

b. To assess the pretest and post-test 1 and 2 level of knowledge on dental hygiene among school children.

The study revealed that, In the pre-test Out of 60 School children, 35(58.33%) had inadequate knowledge and 25(41.67%) had moderately adequate knowledge and none of the School children had adequate knowledge on Dental Hygiene. This reveals that majority of School Children need to be educated and informed about Dental hygiene. In post test 1, 48(80%) had adequate knowledge and 12(20%) had moderately adequate knowledge. In post test 2, 54(90%) had adequate knowledge and 6(10%) had moderately adequate knowledge on Dental Hygiene and none of them having inadequate knowledge on Dental Hygiene. This reveals that majority of School Children had improved their knowledge scores after play way method of teaching through snake and ladder game on Dental Hygiene.

c. To find out the effectiveness of play way method of Teaching on dental hygiene in terms of gain in knowledge among school children.

The pre-test mean score of knowledge was 9.65±3.66, the post-test 1 mean score of knowledge was 20.43± 4.04 and the post-test 2 mean score of knowledge was 21.91±3.11. The calculated Repeated Measures ANOVA of F = 252.216 was found to be statistically highly significant at p<0.001. The intervention of play way method of teaching on dental hygiene imparted to school children was found to be effective to improve the level of knowledge and retaining capacity among School Children on Dental Carries. Thus, it can be inferred that the enhancement of School Children’s knowledge on Dental Hygiene was due to their exposure to play way method of teaching on dental hygiene and not by chance. Hence H1 was accepted, indicating the mean post-test 1 and 2 knowledge scores of school children regarding dental hygiene is significantly higher than the mean pre-test knowledge scores.