Download Awareness of oral health as a gateway to systemic health among the

Awareness of oral health as a gateway to systemic health among the administrative staff
of university of Dammam - A survey.
Abstract;
Objective; Awareness regarding the periodontal disease is helpful to decrease the
mortality of tooth. There are few groups of people who are privileged to have the dental
treatment free of cost and also with the availability of specialist consultation. In this
particular study group, periodontal disease awareness among the university
administrative staffs was evaluated. Methods; Closed ended questionnaire was used
among the university of Dammam administrative staff during september 2015. Oral
hygiene practice, its importance and its incorporation in daily routine was evaluated.
Results; It was found that knowledge regarding the brush; brushing and other oral
hygiene practice was good. Attempt was made to understand their knowledge regarding
the link between systemic disease and periodontal disease. Conclusion; It was found out
that majority of individuals required to undergo awareness in this regard. Tooth loss and
its replacement in time, and the availability of options to replace also need to be made
aware among the group.
‫ هناك مجموعات قليلة من الناس محظوظون أن يكون عالج‬.‫إن الوعي بشأن أمراض اللثة هو مفيد لتقليل فقدان األسنان‬
‫ تم تقييم‬، ‫ وبدراسةهذه المجموعة علي وجه الخصوص‬.‫ وكذلك إمكانية استشارة االخصائي‬،)‫األسنان خالي من التكلفة(مجانا‬
‫ وتم تقييم ممارسة نظافة الفم وأهميته‬.‫الوعي بأمراض اللثة بين الموظفين اإلداريين بالجامعة بواسطة استخدام االستبيان المغلق‬
‫ (تفريش االسنان) وغيرها من ممارسة نظافة الفم كانت‬،‫ وتبين أن المعرفة فيما يتعلق بالفرشاة‬.‫وإدماجه في الروتين اليومي‬
‫ وقد وجد أن غالبية األفراد مطلوب منهم‬.‫ وجرت محاولة لفهم معارفهم بشأن الصلة بين أمراض عضوية وأمراض اللثة‬.‫جيدة‬
1
،‫ وكذلك ايضا يحتاجون الي التوعية بفقدان األسنان واالستعاضة عنها في الوقت المناسب‬.‫الخضوع للوعي في هذا الصدد‬
.‫وتوافر الخيارات الستبدالها‬
Introduction;
Dental health maintenance is equally important as general health of an individual.
Utilization of dental health services are impacted by several positive and negative factors.
Positive factors include the awareness of dental health, free or no cost for the treatment
and unavailability of specialized dental services at door steps, etc. Presence of fear
towards dental treatment, pain factor, and high cost of the dental treatment and
unavailability of specialized dental services are the negative factors, which keep the
individuals away from the dental treatments. Even after attending the dental clinics may
be for the emergency treatment, often patients do not report for follow up or maintenance,
due to several reasons. Eventful dental treatment is among one of the prime reasons for
being absent for follow up. Often eventful dental treatment results because of not reveling
the systemic conditions and medication history to the dental professionals during the
initial visit. Many times patient assumes that it is not relevant to explain the systemic
history or medication history to the dentist. Patients consider that oral cavity is or may
not have any relation to the systemic health or medication history.
2
Oral hygiene practice and awareness reported among urban Saudi population revealed
that the oral hygiene practice of using tooth brush is co-related to the level of education.
Females used less Miswak compared to males. Despite with the availability, free
treatment utilization of dental services was limited to emergency care only. 1 A similar
study involving the administrative staff of one of Saudi university 2 revealed the poor
knowledge regarding the oral health, which they correlated to poor brushing habits and
poor utilization of dental services. One of the concepts about the oral health awareness is
linking oral or periodontal disease to systemic health of an individual.
Periodontal disease is considered to be a risk factor for the systemic disease like diabetes,
atherosclerosis etc.3,4 There is a possibility of diverting better attention to oral health if
awareness is spread among the population regarding the two way relationship between
oral and systemic health. Thus the present cross sectional study is undertaken among a
group of people who have good access to the free dental treatment with specialized
services, to find out their knowledge regarding the oral hygiene practice and their
awareness about the oral and systemic health. The objective of the study is thus to
evaluate the oral health awareness among this privileged group of people.
3
Methods
A cross-sectional study was conducted among the administrative staff of University of
Dammam. This proposed study was reviewed by the Institutional ethical committee and
clearance was obtained. Two hundred participants among the university of Dammam
administrative staff during April 2015 were selected using a simple random sampling
technique. Informed consent was obtained from each patient. Before filling up the form
each individual was explained regarding the possible benefit of the survey. A selfconstructed 16-item close-ended questionnaire was distributed to all subjects above 18
years of age in English and in Arabic. The questionnaire included information related to
the patient's name, age, gender and occupation. The completed questionnaires were then
analyzed statistically to obtain the results in terms of percentages.
4
Results;
In the present study, questionnaire was distributed to 200 individuals who were selected
randomly. To get the good response from all the individuals’ questionnaire was given to
the individual and collected immediately. One interviewer stood beside and explained
the questions if required.
Among the 200 people interviewed, all of them felt there is need for daily cleaning of
teeth (100%).
Frequency of tooth brushing is an important component of tooth brushing. Specially
brushing before going to bed is essential to keep away the building of the plaque deposits.
None of them felt that that brushing once daily is sufficient. 56% and 44% felt brushing
twice and thrice daily is essential respectively (Fig 1). A normal correct way of brushing
not only helps in removing the plaque efficiently, but also avoids the possible trauma to
the tooth and gingiva. It was found out that 92% of the individuals brushed their teeth
vertically, 6 % of the total group brushed both vertically and horizontally and 1% brushed
horizontally. (Fig 2) All of the participants felt that brushing in the night is important.
5
56
60
50
44
40
1
30
2
20
3
10
0
1
2
3
Fig 1 – frequency of brushing
92
100
80
60
1
40
2
20
6
1
4
0
1
2
3
4
Fig 2 – direction of brushing
Changing the tooth brush not only helps in better removal of plaque from the tooth
surface but also avoids any injury to the gingiva otherwise caused by a frayed tooth
brush. Regular changing the tooth brush is utmost important. 68% of the individual in the
study group felt the need to change the tooth brush once in 6 months. 20% of the
individual changed the tooth brush once in 3 months. 10% revealed that there is no
specific period and only 2 % felt the need to change once in a year. (Fig 3)
6
80
68
60
1
40
2
20
20
10
3
2
4
0
1
2
3
4
Fig 3 – frequency of changing the tooth brush
Bad breath or halitosis was one of the most common complaints amongst the patients
who visit the dental clinic. Quite often patients feel it's difficult to express the same to the
dentist and hence often avoids the dentist. It was found out that all the participants of the
study revealed that, periodontal disease was an important cause of the bad breath.
Coating on the tongue is considered to be a cause of halitosis and daily tongue cleaning
along with the tooth brushing is essential to get rid of the halitosis or bad breath. Among
the 250 participants all of them answered positively for the need of the tongue cleaning.
Knowledge regarding the oral hygiene practice was the first part of this cross sectional
study. Knowledge regarding the periodontal disease, and its importance and co-relation to
systemic health/disease was the second part of the study. It is a common notion that often
patient do not visit the dental clinic, unless there is an emergency. Periodontal disease
considered to be a pain less chronic condition that attracts less attention of the patients.
However presence of bleeding gum may drive the patients to seek the dental treatment. It
7
was found out that 45% felt that change in color of the gums is the first sign of the
gingival disease and 48% felt the bleeding is the first sign and for the remaining 7%
overgrowth was the first sign of gingival disease. (Fig 4)
60
50
45
48
40
1
30
2
20
7
10
3
0
1
2
3
Fig 4 - The percentage of individual s knowledge regarding the first sign of gingival
disease.
All the individuals included in the study were well aware of the presence of systemic
disease and medications taken for the same and reported the details to the dentist.
However questioning the impact of systemic disease on periodontal disease or oral
disease showed that, more than half of the individual did not know the co-relation
between the systemic disease and oral and periodontal disease. (Fig 5) Further it was also
8
noted that the knowledge regarding periodontal disease as a risk factor for systemic
diseases was poor among these individuals. (Fig 6)
64
70
60
50
36
40
30
1
2
20
10
0
1
2
Fig 5- Knowledge about the impact of systemic diseases on the periodontal disease.
100
92
80
60
1
40
2
20
8
0
1
2
Fig 6 – Knowledge about the periodontal disease as a risk factor for the systemic disease.
All the individuals knew that it is necessary to replace the missing teeth once it has been
extracted. However all the individuals did not know that, failing to replace the missing
teeth would have an impact on the remaining teeth and other oral structures.( fig 7). New
treatment modalities are invented and being available to the patient community. However
9
they need to be aware of such treatment available. One of such popular treatment option
is implant retained prosthesis. In our study it was found that almost more than 60 %
individuals were aware of such a treatment. (Fig 8)
100
83
80
60
1
40
17
20
2
0
1
2
Fig 7 – knowledge regarding the impact of not replacing the missing teeth on teeth and
other oral structures.
80
64
60
36
40
1
2
20
0
1
2
Fig 8 – knowledge about the presence of implant retained prosthesis treatment modality.
A visit to a dentist on a regular basis not only helps in maintaining the oral and
periodontal health but also helps in finding out the occurrence of new lesions (carious or
10
periodontal or cancerous lesion). More than half of the individuals interviewed in the
survey answered that once in 6 months a visit to a dentist is necessary.
Discussion
The sample in the present study involved the privileged group in terms of accessibility to
dental treatment (location and cost wise); the administrative staff from the university. All
of them were educated, atleast having diploma. Facility of the dental treatment was easily
available with close location and free of cost. Often administrative staffs come across
dental faculties with different specialties too. Thus, it was expected that such group
would have better oral health awareness and related aspects about the dentistry. Many
basic questions were included in the study in an attempt to evoke the required minimum
knowledge from the participants regarding the oral health awareness.
It was found that all the interviewed participants had a good awareness regarding tooth
brushing. Daily tooth brushing is necessary for the freshness of mouth and to get rid of
11
the gingival and periodontal disease. It is a known fact that first signs of gingivitis are
visible after two days of not brushing the teeth. 5 All of the participants in the study
expectedly answered positively for need for teeth cleaning. All of them felt that daily
tooth cleaning is necessary. It is very common that in this region, people use miswak
prior to the prayers. There are many previous studies that have reported that 75% males
and 66% females used miswak regularly. 6 Al-otaibi M et al also concluded that in their
study that 75% individuals used both miswak and tooth brush. 7 Present study results
were similar to study conducted by Guile et al 8 where they have found 89% males and
98% females cleaned their teeth with tooth brush. Frequency of cleaning the teeth at least
twice daily is essential to prevent the buildup of the pathogenic micro flora in the dental
biofilm. Succession of the micro- organisms from gram positive to gram negative and to
the pathogenic flora can occur as the time elapses. 5 Many of the participants felt the
need for cleaning of teeth more than once in a day. Participants in this group were better
aware of the oral hygiene practice in terms of frequency than the similar group observed
in the other part of Saudi Arabia 2 and in India. 9 There was a difference in the question
asked in the studies compared and also in educational and socioeconomic status among
the group compared. Tooth abrasion, gingival recession and associated hypersensitivity
of teeth are common problems with wrong brushing technique.10 Correct way of
brushing will help in better removal of plaque, especially from the interdental areas. It
was found out that, many of the individuals were brushing in the vertical direction and
only few were brushing in both vertical and horizontal direction. Preventive programs
and dental education imparted previously to the group may be the reason for the
knowledge about the correct way of brushing among the university officials, interviewed
12
in this study compared to similar study done in the other countries. Regular changing the
tooth brush not only helps in better removal of plaque; it also avoids gingival injuries due
to frayed tooth brush. 11 Many studies reported that changing the tooth brush once in 3
months is essential.12,13 In the present study, in privileged group more than half of the
individuals felt the need to change the tooth brush only once in 6 months. The combined
use of miswak along with the tooth brush and may be more use of miswak make the
individuals tooth brush maintained in a better condition and delay changing the brush
frequently as recommended.
Awareness about the signs of gingival disease and periodontal disease are very important,
so that patients may seek dental treatment at the earliest and maintain their periodontal
health in good status. Chronicity and no pain with the periodontal disease makes the
individuals to neglect their periodontal condition until some of the warning signs
individual notices, like bleeding gums, mobile tooth, pus discharge and spacing between
the teeth. Other most common complaint with which patient visits a dental clinic is bad
breath or halitosis. Many of the participants in this study revealed that reddish gums and
bleeding gums while brushing as a first sign of gingival disease. Few of them reported as
gingival overgrowth as the first sign. 80% of humanities faculties and 90% of scientific
faculties knew that gingival bleeding is the first sign of gingival disease.14 Educational
status and scientific knowledge probably are the two reasons for the better response
shown by these staff compared to the participants in our study (48%).
Medical emergencies like uncontrolled bleeding, syncope and others are few problems
en-countered during the dental procedures. One of the ways to avoid them is to assess and
review the medical histories during each follow up.15 If the patient fails to reveal the
13
medical histories/ medication history to a dentist or unaware of the importance of telling
the same, there is more probability of occurrence of medical emergencies during the
procedure or following that. Thus patient awareness regarding informing the dentist is of
utmost importance. It was found out that all the participants of study group knew the
importance of revealing the systemic history to the dentist. However, more than half of
the individuals were not aware of the relation between systemic disease and periodontal
or oral disease. Thus it is necessary educate to all the individuals regarding the existing
relation between systemic disease and its impact on oral and periodontal disease. It is
well known that periodontal disease is considered as sixth complication of diabetes.
Prevalence of diabetes is found to be in the range of 36% in Saudi Arabia. It is a factor to
worry because the prevalence seems to be doubling every two decades, 16,17 and in
Saudi Arabia this could soon reach 50% in those over 50 years of age.16 Thus it is
necessary to educate the patient to maintain the oral and periodontal health and thus their
systemic health. Periodontal medicine is the emerging concept in periodontics. There is
resurgence of focal infection theory, co-relating periodontal disease with many systemic
diseases, like atherosclerosis, diabetes, obesity, low birth weight outcome etc. 18 It was
one of the objective of the study to have the response linking periodontal disease with
systemic disease. Most of the participants were not aware that periodontal disease had
any impact on systemic disease. If they were made aware of this concept, it will be one of
the motivating factor to attend the dental clinic and maintain the periodontal and oral
health. The low response and awareness obtained in the present study regarding the
periodontal disease as a risk factor for systemic diseases is not surprising. Since
awareness among the medical students and inters were much lower (16%), as it is a
14
common belief that oral cavity is a remote cavity to the internal organs, so no relationship
exists between them.
Replacing the missing teeth in the arch is essential to maintain the integrity of the arch
and the tooth. If there are any missing teeth, it may have impact on the oral health,
periodontal health and TMJ.19,20 Moreover if patient comes early after extraction
retained space can be utilized properly and many treatment options can be made available
to the patients. Delay in obtaining the treatment may result in drifting or pathologic
migration with subsequent effect on the remaining teeth in the arch, resulting in
“collapsed bite”. 21 Thus understanding the consequences of extraction and not replacing
the tooth in time is important from the patient point of view. All of our participant's
awareness regarding the replacement of missing teeth was good. However all of them
were not aware of the impact that, not replacing missing teeth had on the remaining teeth
and the arch. Treatment options for replacing missing teeth were Removable and Fixed
partial denture prosthesis and implant supported prosthesis. It is assumed that most of the
participants were aware of removable or fixed replacement of missing teeth. Since
implant retained teeth were relatively new to the treatment modality, question pertaining
to this was felt necessary. It was found out that 64% of the individuals positively
answered and was aware about the implant treatment. This result was comparable to the
previous studies done on general population.
Frequency of visit to a dentist depends upon several factors. 22 Multiple carious teeth,
multiple restorations, medically compromised patients etc. are the other factors which
15
influence the follow up visit. However in a well maintained dental patient it is assumed
that once in 6 months visit to a dentist is optimal. All of the participants of our study
group expressed the need to visit their dentist once in 6 months. This actor showed that
most of the participants were well motivated and informed regarding dental treatment.
Conclusion
Awareness amongst the University officials selected in this study was satisfactory.
However educating them regarding the relation between systemic disease and
oral/periodontal disease should be undertaken. Dental education in few other aspects with
the help of pamphlets or group discussion may further improve the oral health awareness.
This may help in improving the oral health, which in turn will help to maintain good
systemic health.
16
References
1. Al- otaibi. M and Angmar Mansson. Birgit: oral hygiene habits and oral health
awareness among urban Saudi population.oral health and prev dent: 2004:2:398396.
2. Mohammad Sami Ahmad, Ahmed Bhayat, Khalid H. Al‑Samadani1, Ziad
Abuong: Oral health knowledge and practice among administrative staff at
Taibah university, Madina, KSA: European Journal of General Dentistry | Vol 2 |
Issue 3 | September-December 2013:308-311
17
3. Genco RJ, Borgnakke WS: Risk factors for periodontal disease: Periodontol
2000. 2013 Jun;62(1):59-94
4. Lockhart PB, Bolger AF, Papapanou PN, Osinbowale O, Trevisan M, Levison
ME, Taubert KA, Newburger JW, Gornik HL, Gewitz MH, Wilson WR, Smith
SC Jr, Baddour LM: Periodontal disease and atherosclerotic vascular disease:
does the evidence support an independent association?: a scientific statement
from the American Heart Association: Circulation. 2012 May 22; 125(20):252044.
5. Theilade E: The Experimental Gingivitis Studies: The Microbiological
Perspective: J DENT RES July 1996 75: 1434-1438
6. Almas k, Albaker A, Flebam N: knowledge and denta health and disease among
dental patients. multi-center study in saudi: Indian Jour of dental research :2000:
145-55
7. Otaibi Al Meshari , Zimmerman M and Manson Angmar B: Prevailing oral
hygiene practices among urban suadi Arabian in relation to age gender and socioeconomic back ground: Acta Odontol Scand:2003:61: 212-216
8. Guile EE, Al shimmery AR, El backly MN : Oral health survey of Saudi
Arabia:oral health knowledge attitudes and practice among adults : J Dent
Res:1996:75: 1276
9. Jayakumary M, Binoo Divakaran, Jayadevan S1, Salini K, Santhosh S: Oral
health behaviour among adolescents in Kerala, India: Italian journal of public
health:vol6: no 3 : 2009:218-224
18
10. Wiegand A, Burkhard JP, Eggmann F, Attin T: brushing force of manual and
sonic toothbrushes affects dental hard tissue abrasion. Clin Oral Investig. 2013
Apr;17(3):815-22
11. . Smukler H, Landsberg J: The toothbrush and gingival traumatic injury: J
Periodontol. 1984 Dec;55(12):713-9
12. ADA: Time to change that brush. Chain Drug Review 2009. Available from:
http://www.findarticles.com/p/articles/mi_hb3007/is_3_31/ai_n31352565/
[last
accessed on 2010 Apr 20].
13. GN Karibasappa, L Nagesh, BK Sujatha: Assessment of microbial contamination
of toothbrush head: An in vitro study: Ind Jour dental res :Volume : 22 :Issue : 1 :
: 2011 : Page : 2-5
14. Bader K. Al-Zarea: Oral Health Knowledge of Periodontal Disease among
University Students: International Journal of Dentistry: vol13: 2013:1-7
15. JoAnn R. Gurenlian, and Frieda Atherton Pickett, : Medical history review —
Part 1:registed dental hygienist :vol 7 : 2010: 7-12
16. Bener A et al (2009). Prevalence Of Diagnosed And Undiagnosed Diabetes
Mellitus And Its Risk
Factors In A Population-Based Study Of Qatar. Diabetes Res Clin Pract, 84: 99–
106.
17. Wild S, Roglic G, Green A. (2004). Global Prevalence Of Diabetes: Estimates
For 2000 And Projections For 2030. Diabetes Care, 27:1047–53.
19
18. Pizzo G, Guiglia R, Lo Russo L, Campisi G: tistry and internal medicine: from
the focal infection theory to the periodontal medicine concept.: Eur J Intern Med.
2010 Dec;21(6):496-502
19. Firas A Al-Quran, Raed F Al-Ghalayini, and Bashar N Al-Zu'b: Single-tooth
replacement: factors affecting different prosthetic treatment modalities: BMC
oral health :11:2011:34
20. . Wang M.Q Xue F
He JJ et al : Missing Posterior Teeth and Risk of
Temporomandibular Disorders: October 2009 vol. 88 no. 10 942-945
21. Shifman A, Laufer BZ, Chweidan H.: Posterior bite collapse--revisited.: J Oral
Rehabil. 1998 May;25(5):376-85
22. Jean Williams : University of Michigan study evaluates frequency of dental
visits: ADA News: http://www.ada.org/news/8702.aspx.
20