JIOH on LinkedIn JIOH on Facebook
  • Users Online: 302
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL RESEARCH
Year : 2019  |  Volume : 11  |  Issue : 1  |  Page : 15-20

Oral health knowledge, attitude, and practices among Yemeni school students


1 Dental Public Health Unit, School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
2 Oral Biology Unit, School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
3 Oral Medicine and Oral Pathology Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia

Date of Web Publication27-Feb-2019

Correspondence Address:
Dr. Masitah Hayati Harun
School of Dental Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan
Malaysia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jioh.jioh_176_18

Rights and Permissions
  Abstract 

Aim: Oral health is fundamental to general health and well-being. However, the sources of oral health information among Yemenis are limited. This study aimed to evaluate the oral health knowledge, attitude, and practices among secondary school students in Dawan Valley, Yemen. Materials and Methods: A descriptive cross-sectional survey was conducted among 392 secondary school students. Students were interviewed using structured questionnaires in Arabic. The structured questionnaires included inquiries on oral health knowledge, attitude, and practices. Chi-square test was used to assess significant differences in oral health knowledge, attitude, and practices with respect to gender. Results: The study population comprised 392 participants of 15–22 years' age group. Approximately 87% of students reported brushing their teeth daily. Girls showed better oral hygiene practices compared with boys in terms of daily brushing habit, brushing intervals, and toothbrush replacement (P = 0.001, 0.001, and 0.002, respectively). Statistically significant difference (in favor of females) was observed related to knowledge on the impact of dental diseases on the general health, toothbrushing preventing dental decay, sugar consumption possibly leading to dental decay, bleeding during brushing possibly indicating gum diseases, and effects of smoking and khat chewing on oral health (P = 0.009, 0.020, 0.001, 0.001, 0.002, and 0.023, respectively). Conclusion: The majority of students possess an adequate level of knowledge and practices on oral health, with female students showing predominance. However, regular visits to the dentist remain low among the study participants.

Keywords: Attitude, knowledge, oral health, practice, secondary school students


How to cite this article:
Al-Tayar BA, Ahmad A, Sinor MZ, Harun MH. Oral health knowledge, attitude, and practices among Yemeni school students. J Int Oral Health 2019;11:15-20

How to cite this URL:
Al-Tayar BA, Ahmad A, Sinor MZ, Harun MH. Oral health knowledge, attitude, and practices among Yemeni school students. J Int Oral Health [serial online] 2019 [cited 2019 May 22];11:15-20. Available from: http://www.jioh.org/text.asp?2019/11/1/15/253136


  Introduction Top


One significant aspect of ensuring the quality of life is good oral health. Good oral hygiene practices allow people to eat, talk, and socialize normally and confidently.[1] Oral infections, such as dental caries and periodontal problems, are burdens to the state of global oral health. In societies with low economic status, treatment of dental diseases, including traditional restorative treatments, probably surpasses the available resources allotted to the health-care programs of the entire country.[2],[3] Oral health knowledge is considered as an essential prerequisite for health-related behavior,[4] and studies have demonstrated an association between increased knowledge and improved oral health.[5],[6]

The prevalence of oral diseases, such as dental caries and gingivitis, is extremely high among school students in Yemen.[7],[8] Moreover, a society such as the Yemeni society has developed numerous traditional deleterious habits, such as khat chewing and smokeless tobacco. Such habits are showed to be a risk factor for cancer of the head and neck, precancerous lesions of oral mucosa, and periodontal diseases.[9],[10],[11],[12],[13],[14]

Knowledge on the oral health effects of these habits can motivate school students to quit and consequently help in the prevention of numerous oral diseases at an early age. The level of oral health knowledge, attitude, and practices among secondary school students is extremely low and worth investigating. Therefore, this study was conducted to evaluate the level of oral health knowledge, attitude, and practices among secondary school students in Dawan Valley, Yemen.


  Materials and Methods Top


A descriptive cross-sectional survey was conducted from March 2016 to June 2016 among 392 secondary school students aged between 15 and 21 years from two selected schools in Dawan Valley. The sample size was estimated with the PS software as described by Dupont and Plummer[15] comparing two proportions with the following parameters: P0= 0.13 (proportion of secondary school students who do not use toothbrush reported by the previous study),[16] P1 =0.246 (expected proportion of secondary school students who use toothbrush based on expert opinion), alpha (α) = level of significance at 0.05, (1-β) = power of study at 0.8, and M = 1 (ratio of secondary school students who use toothbrush to those who do not use toothbrush). The sample size for this study was 177 per group, but another 11% was added for the nonrespondents (177+ [177 × 0.11] = 196 × 2) = 392. In this case, the required minimum sample size was 392. Convenience sampling technique was used, and all students who were willing to participate from the selected secondary schools of 1–3 levels were included.

Before the study, approval was obtained from the Office of Education in Dawan Valley under the Ministry of Education in Yemen (Reference number: Dawan Office/Seef/13116). Written consent was also obtained from the school principals and each of the participants after selection and before enrolment into the study.

The students were interviewed using structured questionnaires in Arabic. The structured questionnaires were adopted and modified from previous studies.[17],[18],[19] The designed questionnaire consists of three parts: part 1, comprising six questions to assess the participants' practice of oral hygiene, including daily toothbrush, flossing, mouth rinse with water after eating, miswak use, brushing intervals, and toothbrush replacement; part 2, comprising two questions to assess the participants' attitude toward oral health, including the frequency of dental visits and reasons behind not visiting the dentist; and part 3, comprising seven questions to assess the participants' oral health knowledge, including items on the impact of dental diseases on general health, effects of brushing on dental decay, effect of sugars on dental decay, gingival bleeding during brushing and the effects of smoking, khat chewing, and shammah on oral health.

The Statistical Package for the Social Sciences (SPSS, IBM, and Chicago, IL, USA version 22.0) was used for data entry and analysis. Descriptive analysis was presented as frequency with percentage for categorical variables. The Chi-square test was used to assess the significant differences in oral health knowledge, attitude, and practices between males and females.


  Results Top


A total of 392 participants, comprising 195 (49.7%) male and 197 (50.3%) female students, were enrolled in this study. The mean age of the students was 17.68 years (standard deviation = 1.27). The toothbrushing practice of participants (daily toothbrushing, time spent for brushing, brushing intervals, and timing for toothbrush replacement) is shown in [Table 1]. A majority of the participants (87.0%) clean their teeth using a toothbrush. Significantly more females reported daily brushing (P = 0.001) compared to males. Almost 51% of the participants brush their teeth twice daily. There was a significant association between brushing intervals and gender (P = 0.001), whereby females performed toothbrushing twice a day more often than males.
Table 1: Toothbrushing practice according to gender (n=392)

Click here to view


A majority of the students replaced their toothbrushes when bristle were frayed (61.7%). There was a significant association between gender and toothbrush replacement (P = 0.002). Almost half (46.2%) of the participants spent 1 min for brushing their teeth. However, the association between gender and the time allocated for brushing was not statistically significant (P = 0.144).

[Table 2] presents other forms of oral hygiene aids practiced by the students according to gender. A significantly higher percentage of male students (55.4%) used miswak to clean their teeth compared to female students (31%) (P = 0.001). Only 15.3% of participants practice dental flossing, while more than half (69%) rinse their mouth after meals. A comparison between male and female students showed no statistically significant difference (P > 0.05).
Table 2: Other forms of oral hygiene practice according to gender (n=392)

Click here to view


Attitude toward oral health according to gender is summarized in [Table 3]. About 56.1% of the participants reported that toothache was the main cause for dental visit. No significant difference was observed in the frequency of dental visits between genders (P = 0.630). High cost of dental treatments was the main consideration among the participants that prevented them from visiting the dentist. The reasons behind not visiting the dentist were significantly different (P = 0.002) [Table 3].
Table 3: Attitude toward oral health according to gender (n=392)

Click here to view


[Table 4] illustrates the participants' knowledge of oral health according to gender. Most students were aware that dental diseases impact the general health (88.8%), toothbrushing prevents dental decay (94.9%), consumption of sugars can lead to dental decay (92.3%), and bleeding during brushing may indicate gum disease (66.6%). Female students had significantly better knowledge of dental diseases compared to male students (P < 0.05). Knowledge towards deleterious habits on oral health according to gender is represented in [Table 5]. Similarly, statistically significant difference was found (in favor of females) regarding knowledge on the effect of smoking and khat chewing on oral health (P < 0.05).
Table 4: Knowledge of oral health according to gender (n=392)

Click here to view
Table 5: Knowledge on the effects of deleterious habits toward oral health according to gender (n=392)

Click here to view



  Discussion Top


Oral health care should be an important component of routine health care for students. Good oral health practice can be accomplished mainly through self-induced habits, such as maintenance of dental hygiene, quitting deleterious habits, and the aid of available dental services. Oral diseases should be avoided before they occur, and the prevention can be achieved through simple oral hygiene practices, such as daily brushing and flossing.[7],[8]

The findings from this study showed that toothpaste is commonly used for toothbrushing among the study population and is in agreement with those in the similar Arab population.[17],[18],[19],[20] The present study also showed that majority of the students brush their teeth in the morning and before bed, and fraying of toothbrush bristles was reported as the most common explanation for tooth brush replacement. These results were in accordance with those of Gopikrishna et al.[21] However, the females appeared to be statistically more conscious of oral hygiene in terms of daily toothbrushing, brushing intervals, and toothbrush replacement. This finding is consistent with those of other studies conducted in school children and dental students.[22],[23],[24]

Numerous populations in Arab countries still use miswak,[25],[26],[27] which is a tooth-cleaning twig made from the Salvadora persica tree (also known as arak in Arabic). Miswak is a traditional alternative to the modern toothbrush and offers stronger mechanical and chemical cleaning of oral tissues compared with a standard toothbrush.[28] In the present study, miswak was used by 169 (43.1%) of the study participants, with significantly more males using miswak compared to females. This finding was similar to that of Al-Shammari et al. and Bahannan et al. (2018).[29],[30] The present study reported that only 15.3% of the study participants used dental floss, indicating that the importance of dental floss use is still underestimated among study participants. However, the present value was higher than the reported value in a study conducted in Saudi Arabia by Al-Sadhan (5.1%)[31] and the study by Al Subait et al.,[16] which reported that the study participants did not frequently use dental floss.

Our results were in agreement with those described in previous studies, which documented that toothache was the main driving factor for participants to visit the dentist.[32],[33],[34],[35] However, no statistically significant difference in the frequency of dental visits was observed between girls and boys. Meanwhile, when the participants were asked regarding forgoing dental visits, almost 71% of participants cited the high cost of the treatment as the reason. This finding was identical to the results published by Ahmad et al.[36] A report by the World Bank confirmed that Yemen is the most populous country in the Arabian Peninsula and that half of the total population live below the poverty line.[37] These data may explain why high cost of dental treatment hinders dental visits.

In general, this study showed that the majority of students possess adequate level of knowledge on oral health. These findings were in agreement with the results obtained by Carneiro et al.[38] but superior to those of a study by Farsi et al.[39] Girls are more knowledgeable on the impact of dental diseases on general health, toothbrushing preventing dental decay, and consumption of sugars possibly leading to dental caries and bleeding during brushing possibly indicating gum diseases, as supported by the study of Al Subait et al.,[16] who reported that girls are more aware of gum bleeding and the influence of oral health on general health. In addition, girls are more conscious of the effects of smoking and khat chewing on oral health. In addition to the harms of tobacco and khat chewing, tobacco use and khat chewing among women in a conservative community are considered shameful and result in social stigma, and our study area is one such community. This finding may explain why females are more conscious of these habits compared to males.

The current study has strengths and limitations. In terms of strengths, females were almost equal to male participants in this study. This makes the comparison between males and females more reliable with respect to oral health knowledge, attitude, and practices categories. In addition, this is one of few studies that have explored the differences in oral health knowledge, attitude, and practices with respect to gender among secondary school students in Yemen. With regard to the limitations, this study was carried out in only two schools using nonprobability sampling method with a small sample size. However, the findings of this study would provide local baseline data on the oral health knowledge, attitude, and practices among Yemeni school students. Moreover, better understanding of the importance of oral hygiene practices may help to reduce the burden of oral diseases. The results could be utilized in planning programs on school students' awareness of smoking, shammah, and khat-related oral problems. Future research should also consider the following: an increased sample size that includes students from different areas of Yemen and prevalence and factors associated with smoking, shammah, and khat chewing among Yemeni school students as well as common oral diseases such as dental caries and periodontal diseases.


  Conclusion Top


Secondary school students reported a high level of oral health knowledge and practices, with female students showing predominance. However, their attitude towards regular dental visits was relatively poor. Increased awareness of oral health-related knowledge, practices, and attitude of school students can facilitate the prevention of oral diseases.

Acknowledgments

The authors acknowledge the staff of the Office of Education in Dawan Valley, Yemen, who helped to make this study a reality. We would like to thank all staff and participant students from the selected schools, Eng. Abdulrahman Ahmed Omer Al-Madfa and Miss. Fosyah Omar Al-Tayar for all their support and assistance in the progress toward the completion of this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Locker D. Measuring oral health: A conceptual framework. Community Dent Health 1988;5:3-18.  Back to cited text no. 1
    
2.
Kathmandu RY. The burden of restorative dental treatment for children in third world countries. Int Dent J 2002;52:1-9.  Back to cited text no. 2
    
3.
Watt RG. Strategies and approaches in oral disease prevention and health promotion. Bull World Health Organ 2005;83:711-8.  Back to cited text no. 3
    
4.
Usman S, Bhat SS, Sargod SS. Oral health knowledge and behavior of clinical medical, dental and paramedical students in Mangalore. J Oral Health Community Dent 2007;1:46-8.  Back to cited text no. 4
    
5.
Smyth E, Caamano F, Fernández-Riveiro P. Oral health knowledge, attitudes and practice in 12-year-old schoolchildren. Med Oral Patol Oral Cir Bucal 2007;12:E614-20.  Back to cited text no. 5
    
6.
Mitrakul K, Laovoravit V, Vanichanuwat V, Charatchaiwanna A, Charatchaiwanna A, Bunpradit W, et al. Factors associated with parent capability on child's oral health care. Southeast Asian J Trop Med Public Health 2012;43:249-55.  Back to cited text no. 6
    
7.
Al-Haddad KA, Ibrahim YT, Al-Haddad AM, Al-Hebshi NN. Assessment of gingival health status among 5- and 12-year-old children in Yemen: A cross-sectional study. ISRN Dent 2013;2013:352621.  Back to cited text no. 7
    
8.
Al-Akwa AA, Al-Maweri SA. Dental caries prevalence and its association with fluoride level in drinking water in Sana'a, Yemen. Eur J Dent 2018;12:15-20.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Sawair FA, Al-Mutwakel A, Al-Eryani K, Al-Surhy A, Maruyama S, Cheng J, et al. High relative frequency of oral squamous cell carcinoma in Yemen: Qat and tobacco chewing as its aetiological background. Int J Environ Health Res 2007;17:185-95.  Back to cited text no. 9
    
10.
Al-Tayar BA, Tin-Oo MM, Sinor MZ, Alakhali MS. Association between shammah use and oral leukoplakia-like lesions among adult males in Dawan Valley, Yemen. Asian Pac J Cancer Prev 2015;16:8365-70.  Back to cited text no. 10
    
11.
Al-Tayar B, Tin-Oo MM, Sinor MZ, Alakhali MS. Prevalence and association of smokeless tobacco use with the development of periodontal pocket among adult males in Dawan Valley, Yemen: A cross-sectional study. Tob Induc Dis 2015;13:35.  Back to cited text no. 11
    
12.
Wyss AB, Hashibe M, Lee YA, Chuang SC, Muscat J, Chen C, et al. Smokeless tobacco use and the risk of head and neck cancer: Pooled analysis of US studies in the INHANCE consortium. Am J Epidemiol 2016;184:703-16.  Back to cited text no. 12
    
13.
Kalakonda B, Al-Maweri SA, Al-Shamiri HM, Ijaz A, Gamal S, Dhaifullah E, et al. Is khat (Catha edulis) chewing a risk factor for periodontal diseases? A systematic review. J Clin Exp Dent 2017;9:e1264-e1270.  Back to cited text no. 13
    
14.
Al-Maweri SA, AlAkhali M. Oral hygiene and periodontal health status among khat chewers. A case-control study. J Clin Exp Dent 2017;9:e629-e634.  Back to cited text no. 14
    
15.
Dupont WD, Plummer WD. Power and sample size calculations for studies involving linear regression. Control Clin Trials 1998;19:589-601.   Back to cited text no. 15
    
16.
Al Subait AA, Alousaimi M, Geeverghese A, Ali A, El Metwally A. Oral health knowledge, attitude and behavior among students of age 10-18 years old attending Jenadriyah festival Riyadh; a cross-sectional study. Saudi J Dent Res2016;7:45-50.  Back to cited text no. 16
    
17.
Togoo RA, Yaseen SM, Al Zamzami M. Oral hygiene knowledge and practices among school children in a rural area of Southern Saudi Arabia. Int J Contemp Dent 2012;3:57-62.  Back to cited text no. 17
    
18.
Khan AH, Ahad B, Amanat U, Khan KH, Hassan D. Dental health selef care among school going children of Peshawar. J Med Sci 2017;25:398-402.  Back to cited text no. 18
    
19.
Sayed ME, Bosly RA, Hakami HA, Mugri MH, Bhandi SH. Patterns of restorative failure among khat and Shammah users in Jazan city, Kingdom of Saudi Arabia: A cross-sectional survey. J Contemp Dent Pract 2017;18:234-40.  Back to cited text no. 19
    
20.
Quadri MF, Shubayr MA, Hattan AH, Wafi SA, Jafer AH. Oral hygiene practices among Saudi Arabian children and its relation to their dental caries status. Int J Dent 2018;2018:3234970.  Back to cited text no. 20
    
21.
Gopikrishna V, Bhaskar NN, Kulkarni SB, Jacob J, Sourabha K. Knowledge, attitude, and practices of oral hygiene among college students in Bengaluru city. J Indian Assoc Public Health Dent 2016;14:75-9.  Back to cited text no. 21
  [Full text]  
22.
Azodo CC, Ehizele AO, Umoh A, Ojehanon PI, Akhionbare O, Okechukwu R, et al. Tooth brushing, tongue cleaning and snacking behaviour of dental technology and therapist students. Libyan J Med 2010;5:1-5.  Back to cited text no. 22
    
23.
Kamath A, Bijle MN, Walimbe H, Patil V. Oral Hygiene awareness among school children of rural Mangalore. J Dent Res Rev 2014;1:7-9.  Back to cited text no. 23
  [Full text]  
24.
Mamai-Homata E, Koletsi-Kounari H, Margaritis V. Gender differences in oral health status and behavior of Greek dental students: A meta-analysis of 1981, 2000, and 2010 data. J Int Soc Prevent Communit Dent 2016;6:60-8.  Back to cited text no. 24
[PUBMED]  [Full text]  
25.
Al Sadhan RE, Almas K. Miswak (chewing stick): A cultural and scientific heritage. Saudi Dent J 1999;11:80-7.  Back to cited text no. 25
    
26.
Al-Hammadi AA, Al-Rabai NA, Togoo RA, Zakirulla M, Alshahrani I, Alshahrani A, et al. Knowledge, attitude, and behavior related to use of miswak (Chewing stick): A Cross-sectional study from aseer region, Saudi Arabia. Contemp Clin Dent 2018;9:S64-8.  Back to cited text no. 26
    
27.
Aumeeruddy MZ, Zengin G, Mahomoodally MF. A review of the traditional and modern uses of Salvadora persica L. (Miswak): Toothbrush tree of prophet Muhammad. J Ethnopharmacol 2018;213:409-44.  Back to cited text no. 27
    
28.
Malik AS, Shaukat MS, Qureshi AA, Abdur R. Comparative effectiveness of chewing stick and toothbrush: A randomized clinical trial. N Am J Med Sci 2014;6:333-7.  Back to cited text no. 28
    
29.
Al-Shammari KF, Al-Ansari JM, Al-Khabbaz AK, Dashti A, Honkala EJ. Self-reported oral hygiene habits and oral health problems of Kuwaiti adults. Med Princ Pract 2007;16:15-21.  Back to cited text no. 29
    
30.
Bahannan SA, Eltelety SM, Hassan MH, Ibrahim SS, Amer HA, El Meligy OA, et al. Oral and dental health status among adolescents with limited access to dental care services in Jeddah. Dent J (Basel) 2018;6. pii: E15.  Back to cited text no. 30
    
31.
Al-Sadhan SA. Oral health practices and dietary habits of intermediate school children in Riyadh, Saudi Arabia. Saudi Dent J 2003;15:81-7.  Back to cited text no. 31
    
32.
Al-Omiri MK, Al-Wahadni AM, Saeed KN. Oral health attitudes, knowledge, and behavior among school children in North Jordan. J Dent Educ 2006;70:179-87.  Back to cited text no. 32
    
33.
Hamid S, Kouchaji C. Oral health and dental treatment knowledge, attitudes and behavior among Syrian school children. Jordan Med J 2015;171:1-10.  Back to cited text no. 33
    
34.
AlHumaid J, El Tantawi M, AlAgl A, Kayal S, Al Suwaiyan Z, Al-Ansari A. Dental visit patterns and oral health outcomes in Saudi children. Saudi J Med Med Sci 2018;6:89-94.  Back to cited text no. 34
  [Full text]  
35.
Nazir MA. Patterns of dental visits and their predictors among male adolescents. Dent Med Probl 2018;55:185-90.  Back to cited text no. 35
    
36.
Ahmad MS, Bhayat A, Al-Samadani KH, Abuong Z. Oral health knowledge and practice among administrative staff at Taibah university, Madina, KSA. Eur J Gen Dent2013;2:308-11.  Back to cited text no. 36
  [Full text]  
37.
World Bank. World Development Indicators; 2010. Available from: http://www.data.worldbank.org/sites/default/files/wdi-final.pdf. [Last accessed on 2016 Oct 18].  Back to cited text no. 37
    
38.
Carneiro L, Kabulwa M, Makyao M, Mrosso G, Choum R. Oral health knowledge and practices of secondary school students, Tanga, Tanzania. Int J Dent 2011;2011:806258.  Back to cited text no. 38
    
39.
Farsi JM, Farghaly MM, Farsi N. Oral health knowledge, attitude and behaviour among Saudi school students in Jeddah city. J Dent 2004;32:47-53.  Back to cited text no. 39
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed543    
    Printed51    
    Emailed0    
    PDF Downloaded45    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]