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 Table of Contents  
Year : 2019  |  Volume : 11  |  Issue : 5  |  Page : 268-273

Oral hygiene status and practices among health-care workers: A cross-sectional study

1 Rafaya Al Gamsh Hospital, Ministry of Health, Al-Kharj, Riyadh, Kingdom of Saudi Arabia
2 Prince Salman Ibn Muhammad Al Saud Hospital, Ministry of Health, Al-Kharj, Riyadh, Kingdom of Saudi Arabia
3 Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Kingdom of Saudi Arabia
4 Department of Dental Services, King Khalid Hospital and Prince Sultan Centre for Health Care, Al-Kharj, Riyadh, Kingdom of Saudi Arabia

Date of Web Publication24-Sep-2019

Correspondence Address:
Dr. Moaz M Almoteb
Rafaya Al Gamsh Hospital, Ministry of Health, Riyadh.
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jioh.jioh_315_18

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Aims and Objectives: Health-care professionals have an important role in health education for their patients, families, and friends also at the community levels. However, understanding their own behavior toward their oral health is more important for the oral health educators who are also health-care professionals. Assessment and practice of oral hygiene status among health-care professionals working in King Khalid Hospital, Al-Kharj, Riyadh, Kingdom of Saudi Arabia was the aim of the study. Materials and Methods: A study was carried out with the aid of specially designed questionnaire consisting of details regarding demographic variables and oral hygiene practice among the health-care workers (HCWs). Convenience samples were selected and preformed questionnaire was given and oral examination was conducted on 267 male HCWs and 164 female HCWs. Data were analyzed using the Statistical Package of the Social Sciences (SPSS) software, version 20, to perform chi-square test and analysis of variance. Results: Among 431 HCWs, 267 males and 164 females participated. A total of 302 people told they brush once daily and it was significant among age group. Mean calculus (0.82) was more among the participants aged >50 years. Mean oral hygiene index-simplified (2.23) was more among those aged >50 years. Mean debris (1.40) was more among >50 years and was statistically significant. Conclusion: HCWs showed that their oral hygiene status was fair. Awareness programs must be conducted frequently to boost up the oral self-hygiene practices among them for many good reasons.

Keywords: Calculus Index, Debris Index, Health-Care Workers, Oral Health

How to cite this article:
Almoteb MM, Alalyani SS, Gowdar IM, Penumatsa NV, Siddiqui MA, Sharanesha RB. Oral hygiene status and practices among health-care workers: A cross-sectional study. J Int Oral Health 2019;11:268-73

How to cite this URL:
Almoteb MM, Alalyani SS, Gowdar IM, Penumatsa NV, Siddiqui MA, Sharanesha RB. Oral hygiene status and practices among health-care workers: A cross-sectional study. J Int Oral Health [serial online] 2019 [cited 2023 Dec 9];11:268-73. Available from:

  Introduction Top

Oral health is considered as the quality of health that enables an individual to socialize easily without any active disease, discomfort, or embarrassment, which impact general well-being. One of the major public health problems is oral disease, which has higher prevalence and significant social impact. To improve an oral health in a community, it is essential to have oral health–related knowledge.[1] Oral hygiene is the practice of keeping the mouth healthy and clean by brushing and flossing to prevent tooth decay and gum disease. Good oral hygiene has been shown to contribute greatly to the prevention of oral diseases.[2] Oral diseases may lead to impairment of functions due to pain, disruption of daily performance, leading to loss of working hours, income, education, and other social activities. Thus, they affect the quality of life and overall productivity of an individual and therefore present an economic burden to the society.[3]

Personal health behavior is important in individuals for the maintenance of general health or total health of the body and this depends to some or more extent on the behavior of their oral health. Educating the patients, families, and friends majorly relies on the health-care professionals. However, knowing their own behavior toward oral health is important for the health-care professionals who play a role as oral health educators. Hence, using multi-professional approach by considering comprehensive health-promoting strategies and practices needs consideration.[4]

By providing adequate training to the medical and paramedical staffs to identify the factors responsible for oral diseases, we can expand oral health work force. Most of times undeserved and vulnerable population’s more are encountered by health-care professionals.

To improve skills of health-care professionals in oral health care, we need to create awareness and educate regarding oral diseases. Health-care professionals can help in finding general risk factors influencing dental health, in identification of health status and problems, preventive aspects, and also in education about the importance of changing toothbrush at regular intervals. Dentists play a major role in maintaining overall dental health.[5]

A study conducted by Baseer et al.[6] in Riyadh, to assess oral hygiene status and practice among health-care professionals working in King Khalid Hospital, Al-Kharj revealed that the health-care professionals’ knowledge was less compared with the expectation among these groups. Their attitude toward oral diseases was positive indicating they can play a major role in educating the hospital patients and the community about oral health care.

  Materials and Methods Top

After getting the ethical approval from Institutional Review Board of College of Dentistry (PSAU/CDS/430400428/2016), Prince Sattam Bin Abdulaziz University and permission from King Khalid Hospital Al-Kharj, this study was conducted. To record oral health, a prior informed consent was obtained from each subject. This study was a cross-sectional study. Health-care workers (HCWs) included doctors, technicians, pharmacists, and nurses. It was conducted among 20- to >50-year-old HCWs. A close-ended questionnaire was designed. Questions were explained whenever necessary and the participants were given assurance regarding the confidentiality of their responses.

In this study, a total of 431 HCWs (267 males and 164 females) were selected using simple random method. The sample size was calculated using the following formula:


where, e is the desired level of precision, which we have selected to be 5%.

Two examiners were trained and calibrated in the College of Dentistry, Prince Sattam Bin Abdulaziz University and standardization of instruments was done. Assessment was by Oral Hygiene Index Simplified (OHI-S) version in a dental chair using No. 5/Shepherd’s hook explorer, mouth mirror, and tweezers.[7] To complete the oral examination of each subject it took approximately 5–6min. The instruments that were used were autoclaved every day. Information regarding the age (years), gender, education, occupation, oral hygiene practices, number of visit to dentist, and their understanding of daily activities impact on oral health was collected.

Oral hygiene assessment was performed using the OHI-S by examining the calculus stains and debris on particular tooth surfaces of six index teeth.

By seating the HCWs on a dental chair, oral examination was carried out. On the basis of the following scale, the results of oral debris were given as following:

  1. 0: When there is no debris or stain.

  2. 1: When debris covers more than one-third of the tooth surface or with or without extrinsic stain or both.

  3. 2: When debris is more than one-third but less than two-third of the exposed tooth surface.

  4. 3: When debris covers more than that of the exposed tooth surface.

Scoring for oral calculus is as following:

  1. 0: When there is no calculus.

  2. 1: When supragingival calculus covering more than one-third of the tooth surface

  3. 2: When supragingival calculus covers more than one-third but less than two-third of the tooth surface or individual flecks of subgingival calculus.

  4. 3: When supragingival calculus covers more than two-third of the tooth surface, or a continuous heavy band of subgingival calculus is found.

The Debris Index (DI) and Calculus Index (CI) scores were calculated separately. Values of individual tooth were summed for both the indices. The OHI-S was measured by adding DI and CI together.

Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software (IBM SPSS Statistics for Windows, version 20.0., IBM, Armonk, New York). To test the variation in frequency of categorical data in two groups, levels of statistical significance were set at P < 0.05, and the chi-square test was used. To find the mean difference of different scores or indexes in different age groups of HCWs, analysis of variance (ANOVA) test was performed.

  Results Top

Among 431 HCWs, 267 males and 164 females participated. [Table 1] shows that the majority of male participants smoked cigarette; among 267 males, 187 smoked cigarettes. A total of 33 female participants smoked cigarettes and it was found to be statistically significant (P < 0.001).
Table 1: Association of smoking cigarette with gender

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Among 431 HCWs, 189 males and 105 females used interdental aid to clean teeth, whereas 78 males and 59 females did not use interdental aid to clean teeth, and it was not statistically significant [Table 2].
Table 2: Association of use of interdental aid to clean their teeth with gender

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A majority of doctors used interdental aid to clean their tooth compared to others. Among 178 doctors, 143 used interdental aids, whereas among 253 others, only 151 used interdental aids, and a statistically significant difference was found [Table 3].
Table 3: Association of use of interdental aid to clean their teeth with occupation

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[Table 4] shows the comparison of age groups with OHI-S using ANOVA. A statistically significant difference was found between age groups and CI only.
Table 4: Comparison of age groups with Oral Health Index Simplified using analysis of variance

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[Graph 1] shows the daily frequency of cleaning teeth among 431 HCWs. A total of 100 males and 27 females were not cleaning their teeth; 81 males and 72 females were cleaning their teeth once daily; 81 males and 57 females were cleaning their teeth twice daily, and 5 males and 8 females were cleaning their teeth three times daily.
Graph 1: Frequency of cleaning teeth in a day

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[Graph 2] shows the visit to dentist during emergency. Among 431 people, 33 undergraduate people used to visit the dentist during emergency and among 358 postgraduate HCWs, eight told they will not visit dentists even during emergency and 32 PhD people told they will visit dentist during emergency.
Graph 2: Visit to dentist during emergency

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[Graph 3] shows age-wise satisfactions with oral health. Among 431 people, 104 people of 20–30 years age group told they were satisfied with their oral health. Among 31–40 years age group, 85 people were not satisfied with oral health, whereas 26 and 7 people were satisfied by their oral health, belonging to age group 41–50 and >50, respectively.
Graph 3: Age-wise satisfaction with oral health

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  Discussion Top

Health is a universal human need. It has been established that optimal health cannot be attained independent of oral health. The impact of oral disease on people’s everyday lives is subtle and pervasive, influencing eating, sleeping, work, and social roles. Practicing the new medicine has turned out to be a combined effort of health-care professional. To provide comprehensive care to the society and large group of people, health team constituting medical and paramedical professionals are working together.

As a part of their profession, there is interaction with variety of people on daily basis. To provide comprehensive care to the individuals and in community, the doctors, nurses, pharmacists, and technicians work together. In our society, the prevalence of oral disease is high. Scarcity of resources, illiteracy, and negligence may be the reason for this. The large number of people consider dental treatment as their least priority.[7]

In this study, majority of the subjects used to brush their teeth once daily and the result was similar to a study by Reddy et al.[8] and was contrast to a study conducted in Brazil and four Asian countries by Frazão and Marques,[9] where HCWs and dental students used to brush their teeth more than once daily and used floss similar to this and the Brazilian studies, but dental students of four Asian countries admitted of not using floss and mouthwash. Comparing results of another study conducted by Adeniyi et al.[10] with the results of this study, it was found that the oral self-care habits were better but the oral hygiene was more satisfactory in this research and was similar to the study conducted by Khalaf et al.[11]

In this study, it was very common to use the interdental aid among males when compared to that among females. Nondoctors using floss were on more than that among the type of health professionals. This was in respect to the research carried out by Baseer et al.[6] The attitude of medical and paramedical professionals toward oral disease varied. Among the two groups, nondoctors provided the suggestion to visit the dentist regularly. Thus, not much significant difference was observed among them for the response of visiting a dentist.

However, all participants accepted the fact that regular checkup by dentists is essential, this is similar to past studies conducted by Baseer et al.[6] and Timmerman et al.[12] This may result in beneficial conditions with the proximity of dental care, free dental treatment, or discounted fare for the members of health team.

Majority of the people told they visited the dentists during emergency. This was similar to the previous studies, such as those by Baseer et al.[6] and Doshi et al.,[13] wherein toothache was the most common factor that was reported. The result was in contrast with the results by Baseer et al.[6] where 65.3% of the people had routine dental checkup. The mean of majority of HCWs was 1.734 fair oral hygiene, which was similar to the study conducted by Kuppuswamy et al.[14]

In our study, the debris among those aged >50 years was significantly high, which is in contrary to the study conducted by Kuppuswamy et al.,[14] where debris was lesser among higher grade students. Mean calculus was 0.82 (fair) among those in >50 year age group, which was similar to a study conducted by Nalini and Prakash[15] in dental hospital population and it was in contrast with the result of study by Aggnur et al.[16] This shows that HCWs do not have adequate knowledge regarding the maintenance of oral hygiene.[15] Mass oral health education program should be established to increase public awareness about oral health and further to implement community-based oral health education at province-level hospitals.

This study is a cross-sectional study that includes only less samples and was limited to one hospital. Because of the cross-sectional research design, establishment of causality was not performed. Hence, there is a need for longitudinal study to know various factors and habits of maintaining oral hygiene among HCWs in other different areas. This study represented only King Khalid Hospital, Al-Kharj Region, the results cannot be generalized to cover all HCWs in Saudi Arabia. At the same time, we assessed only oral hygiene status, that is, debris and calculus. Instead, we should have checked oral hygiene status and treatment needs using the World Health Organization (WHO) pro forma. Because of lack of time and resources, we could not use WHO pro forma.

This study concluded that the oral hygiene status of the HCWs was fair. There is a need to increase oral health knowledge, attitude, and practices among health-care professional. We suggest dental professionals should join hands and develop strategies so that desired goals are achieved. Oral health topics should be integrated with medical and paramedical professional course during their training. Consideration of including comprehensive care preventive services during their training will help in improving knowledge of health-care professional toward oral health. Continued Medical Education programs should include oral health topics. Further studies should be conducted with a larger sample size from all the areas of Saudi Arabia.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Mehta A, Kaur G Oral health-related knowledge, attitude, and practices among 12-year-old schoolchildren studying in rural areas of Panchkula, India. Indian J Dent Res 2012;23:293.  Back to cited text no. 1
Gualie YT, Tayachew AT Assessment of knowledge, attitude, and practice toward oral hygiene among governmental secondary school students in Debre Tabor Town, Amhara Region, North Central Ethiopia 2018: Institutional-based cross-sectional survey. Int J Oral Health Sci 2018;8:92-8.  Back to cited text no. 2
Swamy A, Sogi GM, Sudan J, Vedi A, Sharma H. Assessment of oral health status among teaching and non-teaching employees of Maharishi Markandeshwar (Deemed to be University) Mullana Ambala—A cross-sectional study. J Indian Assoc Public Health Dent 2018;16:203-7.  Back to cited text no. 3
  [Full text]  
Fotedar S, Fotedar V, Bhardwaj V, Thakur AS, Vashisth S, Thakur P Oral health knowledge and practices among primary healthcare workers in Shimla District, Himachal Pradesh, India. Indian J Dent Res 2018;29:858-61.  Back to cited text no. 4
Desai K, Patel S Assessment of oral hygiene awareness among college students in Surat City. Nat J Community Med 2018;9:236-9.  Back to cited text no. 5
Baseer MA, Alenazy MS, Alasqah M, Algabbani M, Mehkari A Oral health knowledge, attitude and practices among health professionals in King Fahad Medical City, Riyadh. Dent Res J (Isfahan) 2012;9:386-92.  Back to cited text no. 6
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Reddy L, Saimadhavi N, Sudhakara Reddy R, Ramesh T, Padma R, Saikiran Ch Oral hygiene practices and habits among dental students and staff in a dental college, India. Cumhuriyet Dent J 2014;17:7-13  Back to cited text no. 8
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Adeniyi AA, Oyapero A, Ajieroh V, Sofola O, Asiyanbi O Effect of health education intervention conducted by primary health care workers on oral health knowledge and practices of nursing mothers in Lagos State. J Public Health Afr 2018;9:833.  Back to cited text no. 10
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Timmerman EM, Hoogstraten J, Meijer K, Nauta M, Eijkman MA On the assessment of dental health care attitudes in 1986 and 1995, using the dental attitude questionnaire. Community Dent Health 1997;14:161-5.  Back to cited text no. 12
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Nalini MS, Prakash S Periodontal health status and treatment needs in dental hospital population Davangere, Karnataka, India. J Indian Asso Public Health Dent 2010;16:44-52.  Back to cited text no. 15
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  [Graph 1], [Graph 2], [Graph 3]

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

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