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 Table of Contents  
Year : 2019  |  Volume : 11  |  Issue : 3  |  Page : 153-157

Differential pattern of awareness about oral health and its hygiene practices among rural and urban schoolchildren of two index age groups in Al Qassim Region, Saudi Arabia

Department of Oral Basic and Clinical Sciences, Division of Oral Medicine, Diagnosis and Radiology, College of Dentistry, Qassim Private Colleges, Kingdom of Saudi Arabia

Date of Web Publication25-Jun-2019

Correspondence Address:
Dr. Kumar Chandan Srivastava
Department of Oral Basic and Clinical Sciences, Division of Oral Medicine, Diagnosis and Radiology, College of Dentistry, Qassim Private Colleges
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jioh.jioh_80_19

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Aims: A good compliance with oral hygiene practices depends on the level of awareness and source of information. The present study attempts to evaluate and compare the level of awareness of oral health and its hygiene practice among rural and urban schoolchildren in Al Qassim Region, Saudi Arabia. Materials and Methods: The study included 228 boys in the age group of 6–7 and 12–13 years from three schools each in the rural and urban area in Al Qassim, Saudi Arabia. Data on oral health knowledge and practices were collected by means of a self-administered questionnaire. Statistical Analysis: Data were represented in percentages. Comparison of response between rural-urban and age groups of schoolchildren was done using Chi-square test, with a confidence interval at 95% (P < 0.05). Results: Children residing in urban areas found to prefer professionals (P < 0.001) as their source for acquiring knowledge about oral health and hygiene practices. They also outscored in translating knowledge in terms of vertical technique (P < 0.001) and frequency (P < 0.05) of brushing. Professionals were found to be the source for majority of children of elder group (P < 0.001), whereas younger were dependent on parents for the same. Elder group also showed to have better practice in terms of frequency (P < 0.001) and choice of medium for brushing (P < 0.01). Conclusion: Wider availability of healthcare services in the urban areas has improved the awareness for oral health. By large, younger group of children has considered parents as their role model and approach them to seek advice on health issues.

Keywords: Awareness, Oral health, Oral hygiene practices

How to cite this article:
Srivastava KC. Differential pattern of awareness about oral health and its hygiene practices among rural and urban schoolchildren of two index age groups in Al Qassim Region, Saudi Arabia. J Int Oral Health 2019;11:153-7

How to cite this URL:
Srivastava KC. Differential pattern of awareness about oral health and its hygiene practices among rural and urban schoolchildren of two index age groups in Al Qassim Region, Saudi Arabia. J Int Oral Health [serial online] 2019 [cited 2022 Sep 27];11:153-7. Available from:

  Introduction Top

An oral and general health is intricately related and complements each other.[1] Although maintenance of oral health is equally important in all ages, pediatric age group is of utmost importance. Its significance is multifactorial. First, damage to primary dentition does not restrict itself to the tooth in question; rather, it has the potential to make great impact on the permanent tooth bud. Second, poor oral health generally shows adverse effects on child's growth and development of the jaws in specific. Finally, dental diseases and their resultant defects such as malocclusion might influence the child's psychological make-up and can eventually affect quality of life.[2] Thus, it is widely understood that primary dentition lays the foundation for healthy permanent teeth. Hence, oral diseases in schoolchildren are recognized as a major global concern.[3] In a situation where a child maintains poor oral hygiene, dental caries and gingival diseases have found to be prevalent.[4],[5]

Patient's compliance, effects on the tooth bud, and economic burden make preventive approaches popular over the curative treatment options. Appropriate and adequate practice of oral hygiene aids remains a mainstay in the preventive approach.[6]

The school-going children come from different socioeconomic background, and it is considered as an important determinant for their oral hygiene practices. Awareness, source of knowledge, and constant reinforcement about the correct oral hygiene practices can act as major modifying factors to the above-mentioned determinants. Moreover, regular dental visits have shown greater impact on improving child's oral health via parental knowledge,[7] especially in younger age group. It also facilitates translation and adaption of knowledge about oral hygiene practices into routine practice.[8]

There are very few studies in the literature[9],[10],[11],[12],[13] that have dealt with the impact of socioeconomic background and age group of children on knowledge and practice of maintaining oral hygiene status in the Saudi Arabian population.

The aim of the study is to compare the awareness of oral hygiene practice among rural and urban schoolchildren in Al Qassim Region of Saudi Arabia.

  Materials And Methods Top

A cross-sectional study was conducted with a total, random sample of 228 boys. Based on the nature of dentition, two categories of age group: 6–7 years (Group I) and 12–13 years (Group II) were considered for the current study. Group I represented the early mixed dentition, whereas Group II included subjects with late mixed dentition. Equal number (114) of subjects was present in each study group. Three schools each were randomly selected in the rural and urban area in Al Qassim Region of the Kingdom of Saudi Arabia. Mentally challenged and physically handicapped children were excluded from the present study.

Before commencing the study, ethical clearance was obtained from the institutional human ethical body (EAC 210/2016). Permissions were procured from the school authorities for conducting camps wherein data were supposed to be collected through questionnaire. Through the school authorities, parents/guardians were informed before the objectives of the study and informed consent was collected.

A self-administered questionnaire was designed for the purpose of data collection. Its content validity and reliability were tested and modified before data collection. The questionnaire consisted of six sections including source of knowledge about the oral hygiene methods, frequency of visit to the dentist, purpose of visit, adopted method of brushing, frequency of brushing, and technique of brushing. Before using the tool for data collection, it was pretested with 30 schoolchildren. They were requested to complete the questionnaire on two different occasions. Based on the kappa coefficient (0.91), it was found suitable for application among the study population as there was high agreement with the answers to the items being recorded on both occasions.

Statistical analysis

Regarding sample size, post hoc analysis was performed using software – G Power (Heinrich-Heine-Universität Düsseldorf, Germany) at confidence interval (α) 0.05, effect size of 0.3, and 1 degree of freedom. The sample size achieved a statistical power of 0.99.

The data from the completed forms were entered into Microsoft Excel software program. Being qualitative data, it was expressed in percentages. The Chi-square test was used as test of significance for comparing percentages between the study groups for all variables. Association was considered statistically significant when P < 0.05. Data analysis was performed with version 21 of the Statistical Package for the Social Sciences (SPSS IBM, Chicago, IL, USA).

  Results Top

In the present study, both study groups (urban vs. rural) had equal number (114) of subjects. The age groups considered for the study included 6–7 years and 12–13 years which coincides with the level of education: elementary 1st year and elementary 6th year, respectively.

Inferential analysis–comparative analysis between urban versus rural population was analyzed. Significantly (P < 0.001) increased number (46.5%) of children from urban locations were found to be dependent on oral health-care professionals for their knowledge about the oral health and diseases when compared to subjects from rural locations (27.2%). They also significantly (P < 0.01) outscored (41.2%) from the subjects belonging to rural areas (21.9%) in making visits to dentist primarily for the preventive nature of treatments. Vertical technique of brushing was found to be significantly (P < 0.001) popular among the urban-inhabited children (38.6%) when compared with subjects from rural inhabitants (7%). Urban-placed children (14.9%) were also found brushing three times/day (P < 0.05) in contrast with subjects (6.1%) from rural locations [Table 1].
Table 1: Comparative analysis of oral hygiene related variables between the different rural and urban group of school children

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Inferential analysis–comparative analysis between elder (12–13 years) versus younger (6–7 years) age groups of populations was also calculated. The majority (46.4%) of elder group of children has opted professionals (P < 0.001) for acquiring information regarding oral health and hygiene, whereas the younger group (70.1%) received it from parents. Children of 12–13 years of age group have shown significantly (P < 0.001) majority (79.8%) of visit to dentist for seeking curative nature of treatment when compared with 6–7 years of age group (57%) subjects. Statistically significant (P < 0.001) difference was observed in respect to the technique of brushing. More number (15.8%) of subjects from 12 to 13 years of age group was recorded who brushes three times/day when compared with subjects from 6 to 7 years of age group (5.3%). Toothpaste was found to be preferred (21.1%) medium of brushing by elder age group children than their younger counterpart (8.8%) [Table 2].
Table 2: Comparative analysis of oral hygiene related variables between the different age groups of school children

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  Discussion Top

For the overall development, it is important for a child to maintain a healthy oral cavity. In the absence of doing so, the child can have various dental diseases such as dental caries and periodontal disease with lasting effects.[4],[5] Oral health status is often determined by the amount of plaque/calculus deposited on the surfaces of teeth, and poor oral hygiene has been recognized as a predisposing factor for periodontal diseases. Preventive approach such as usage of proper oral hygiene aids maintains an edge over the available curative treatment options for dental diseases.[14]

Despite the awareness of the oral hygiene measures, child's oral health has always been a neglected area. Previous studies have found an association between poor oral hygiene status, gingivitis, and sociodemographic status but have largely concentrated on children residing in urban areas.[15],[16] Similarly, data on oral hygiene knowledge as well as practice in the Middle East, in generalized, and Saudi Arabia, in particular, were scanty.

In the present study, the schoolchildren from urban locations have shown their preference to seek knowledge about dental diseases and control measures from the professionals (P < 0.001) over the media or parental advice. Consequently, it was observed in this group of population to receive more prevention-oriented treatment (P < 0.01) over the curative modalities, when compared with their rural counterparts [Table 1]. Our results are in consistent with Togoo et al.[17] and Narang et al.[18] This might be an outcome of numerous oral health awareness programs conducted in urban schools.[18],[19] As per the previous studies,[19],[20],[21] dental service utilization has been reported significantly higher by the urban schoolchildren compared to their rural counterparts. Remote locations, nonaffordability of dental treatment, and less awareness of oral health can be the possible reasons for clustering of dental clinics in urban locations.[11]

The observations from the present study also feature the effect of professional advice. The urban-based schoolchildren were able to translate the advice by adopting vertical technique of brushing (P < 0.001) with a frequency of three times per day (P < 0.05). This result clearly states the importance of source and mode of delivering the information [Table 1]. Due to the availability of high number of dental services in urban areas, the reinforcement of advice on multiple interactions in terms of health awareness programs has probably made this possible. Our results are consistent with previous researchers.[18],[19]

Our study also made an attempt to compare the oral hygiene-related variable with another important determinant, which is age. Children with age group of 12–13 years fall under adolescent category with mixed dentition, considered comparatively responsible than age group of 6–7 years. In the present study, they have shown to be better aware about their oral health. This age group has significantly (P < 0.001) larger number, who seeks professional advice regarding their oral health needs, in contrast to younger age group who depends mostly of parental advice [Table 2]. This is consistent with the studies done in other geographical locations.[15] Studies have been conducted in the past with an aim to assess the awareness levels of paternal, maternal, as well as of school teachers. They results made them to draw conclusion that awareness programs that will educate parents/guardians[22] and teachers should be an essential part of school awareness programs.[16]

The significance of 6–7 years is that it represents the earliest mixed dentition state, where the first permanent tooth, which is usually the mandibular first molar, has erupted in the cavity. The current study has shown this age group to undergo large number (P < 0.001) of preventive dental treatment in comparison to curative treatments [Table 2]. Considering the diet pattern and limited psychomotor skill to practice proper brushing, primary dentition falls into high-risk category for dental caries. Primary level of prevention with application of pit-and-fissure sealants is a popular and effective therapy instituted at this age group.

As per the results of the current study, children of 12–13 years of age group have shown better oral hygiene practices in terms of usage of toothpaste (P < 0.01) and frequency of brushing (P < 0.001) as compared to 6–7 years of age group children [Table 2]. This may be because of the assimilation to knowledge and translation of the knowledge into practice is more in the adolescent group.[16]

Results from the present study draw our attention toward few crucial areas which need immediate attention and intervention. The existing pattern of health services depicts uneven distribution. Where there is duplication of health services in urban location, at the same time, there is scarcity in rural areas. This imbalance leads to wide gap between the health statuses of population residing in these locations. Practitioners should be encouraged to expand their scope of services to include remote locations. Another key area which needs to be addressed is the emphasis of awareness among the guardians. With limited ability of understand and comprehend, the younger age group largely depends on their care providers (parents/teachers). Thus, for the maintenance and restoration of oral health of children, the school awareness programs should be designed in a way to address the guardians.

The current study has few limitations as well. The study included only male subjects and few schools from each study group. Future studies can be planned with larger sample size with gender representation to identify more determinants of oral health.

  Conclusion Top

Maintaining good oral hygiene is the key to remain healthy. It can be concluded from the present study that geographical location can play an important role in doing so. In a larger context, it can be assumed that the prevalence of diseases will eventually differ. The prime reason for this can be attributed to disparity in availability of health-care services. This concentration of dental services in the urban location needs to be addressed at a national level. Innovative methods to increase awareness about oral hygiene, especially in the rural areas, should be considered.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2]

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