KNOWLEDGE AND PRACTICE ON DENTAL HYGIENE AMONG STUDENTS OF LALITPUR DISTRICT

AcknowledgementI am glad that I have come up with this report of research and to come up with this success there is profound role of some of the good soul to whom I want to acknowledge.First of all my sincere thanks belongs to my research guide Mr I would like to thanks to Principal of Nava Vidya Mandir School of Lalitpur for providing allowed and support to collect data.I would also like to give thanks to all teachers of Nava Vidya Mandir School of Lalitpur for valuable support.I would especially like to thanks the students (respondents) of mine study for giving me data for mine study.I would also like to take this chance to express my sincere thanks to my colleagues for their support throughout the study periods.I am especially thankful to the library staffs of college and Nepal Health Research Council (NHRC) for their internet services and providing valuable information throughout the study.I tried my best to put all the names that helped me throughout the study even if I had missed I would like to thank all of them who helped me directly and indirectly throughout this study.

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LIST OF ABBREVATION1. FDI = Federation Dentaire Internationale2. DMFT = Decayed / missing / filled teeth3. SPSS = Statistical package for social science4. CPI = Community Periodontal Index

Executive Summary The study showed majorities (63%) of respondents were 9-11 years and only 4% were 12-14 years age group. But male (53%) and female (47%) were not significantly different in number. Among the respondents minimum (15%) were of class 1 and maximum (25%).Out of all respondents majority (69%) were Hindu and only 1% were Muslim. And Buddhist and Christian were 23% and 7% respectively. Most of the respondents parents were Teacher (25%) and only 9% were Health personnel.Most of the respondents (80%) had family members no. within 3-6 and only 2% had within 11-14. This showed that majorities of respondent engage in nuclear family.It was found that 100% of respondents had regular tooth brushing practice, which said that a good health behavior. Same as it was also found that 100% respondents used brush and tooth paste for cleaning their teeth.Out of all respondents 51% were brush teeth twice a day, 40% were once a day and only 3% were sometimes brush teeth. Most of the respondents (65%) were brush teeth immediately after waking up and only 2% were brush teeth after lunch.

TABLE OF CONTENTS

CONTENTSPAGR NUMBER

ACKNOWLEDGEMENT

EXECUTIVE SUMMARY

TABLE OF COMNTENT

TIST OF TABLE

CHAPTER 1 INTRODUCTION

CHAPTER 2 LITERATURE REVIEW

CHAPTER 3 OBJECTIVES

CHAPTER 4 RESEARCH METHODOLOGY

CHAPTER 5 RESULT

CHAPTER 6 DISCUSSION

CHAPTER 7 CONCLUSION AND RECOMMENDATION

REFERENCE

ANNEX

LIST OF TABLETable 1: Distribution of the Respondents by Demographic CharacteristicsTable 2: Distribution of the Respondents by Social CharacteristicsTable 3: Distribution of the Respondents by Accident Cases.Table4: Distribution of the respondent according to types if vehicle involved in the accident.Table 5: Distribution of the respondents by causes of an accidentTable6: Distribution of the Respondents by the perception on the Causes of Accident.Table 7: Distribution of the Respondents According to their Behavior Table 8: Distribution of the Respondents According to the Physical Condition of the RoadTable 9: Distribution of the Respondents According to the Preventive Measures of an AccidentTable 10: Distribution of the Victims Accident cases by MonthsTable 11: Distribution of the Victims by the time of an accidentTable12: Distribution of the Victims by the Severity of AccidentTable 13: Distribution of the Victims by Age Table 14: Distribution of the Victims Vehicle involved in AccidentTable15: Distribution of the Victims by Causes of an Accident

CHAPTER 1INTRODUCTIONBackgroundNepal is one among the under developed countries. It has many problems among which problem concerning the health is one. Nepal lies far behind in Health sector compared to the developed countries. One of the problems regarding health is of Dental hygiene.Dental hygiene is the practice of keeping the mouth, teeth and gums clean and healthy to prevent diseases, as by regular brushing and flossing and visit to a dentist. [1] Dental hygiene is the maintenance of the teeth and gums in healthy condition, especially by proper brushing, the removal of plaque etc. [2]It is said that children with poor Dental hygiene are 12 times more likely to have restricted daily activity than those who do not. Poor dental hygiene can lead to oral disease like gingivitis, periodontitis especially in children. All of these conditions are very painful. More than 50 million school hours is lost annually due to dental hygiene which affect children's school performance and success in later life. [3]Children of both rural and urban area suffer from dental problems. Rural area's children are suffering from dental problems due to lack of dental education, nutrition, unavailability of health services, unhealthy behavior etc. Similarly, children of urban area's suffering from dental problem due to frequent use of fast foods, highly chemical zed foods but not floss teeth frequently. Busy life style of parents also affects the dental hygiene of children.Children are suffering from so many dental problems. Among them dental carries, periodontitis, gingivitis, gum bleeding, dental calculus are more prevalent. Due to lack of proper management of dental problems children may loss their teeth. Teeth are one of the organs of beauty. So, loss of teeth may become concern of regression in adult age.In some school setting, there is periodic examination of dental hygiene. But it is not sufficient to all school's children. This examination is doing in only some private schools. Community or government schools are not following that examination.Therefore, it is imperative to have good dental health (especially for children and adolescents) which is possible by maintaining dental hygiene. Dental hygiene is maintained only when children have good knowledge, positive attitude and proper practice of dental hygiene and this study has also focused on knowledge and practice about dental hygiene.

CHAPTER 2LITERATURE REVIEWDental hygiene is one of the most striking issues which have global interest since there are many oral health problems in the countries worldwide. Dental health problem is comparatively high in under develop countries like Nepal.Dental carries and gingivitis have been historically been considered as the most important global dental health burden. At present the distribution and severity of dental disease vary in different part of world and within the same country or region. The significant role of socio-behavioral and environmental factors in dental diseases and health is demonstrated in large number of epidemiological survey [4].Dental carries is still a major dental health problem in most industrialized countries affecting 60%-90% of school children and vast majority of adults. It is also most prevalent dental disease in Asian and Latin American countries while it appears to be less common and less severe in most African countries. [4]No one is virtually free of Periodontal Disease in totality. However, based on CPI Scores severe cases affect a relatively smaller proportion (10% - 15%) but most have Calculus or Calculus and Bleeding, Majority affected are the adolescents (60% - 80%). [3]A study was conducted in China on the oral health which showed that 44.4% of the respondents brushed their teeth at least twice a day but only 17% used fluoridated toothpaste. Subjects who saw a dentist during the previous 12 months or two years were 31.3% and 35.3% for 12 years old and 22.5% and 20.2% for 18 years old respectively. Nearly one third (29%) of 12 years old and 40.5% of 18 years old would visit a dentist in case of signs of caries but only when they are in pain. Nearly half of the participants (47.2%) had never received any oral health care instructions. Significant variations in oral health practices were found according to province and regular dental care habits were more frequent in urban than in rural areas. The risk of dental caries was high in the case of frequent consumption of sweets and dental caries risk was low for participants with use of fluoridated toothpaste.[6]Similarly, a study was conducted in the North Jordan about the oral health. In this study, the subjects completed a questionnaire that aimed to evaluate young school children's behavior, knowledge and perception of their oral health and dental treatment. The participants' oral hygiene habits (such as tooth brushing) were found to be irregular, and parents' role in the oral hygiene habits of their children was limited. The study population showed higher awareness of caries than periodontal conditions. Irregular visits to the dentist were found to be common, and toothache was the major driving factor for dental visits. Children had positive attitudes toward their dentists; nevertheless, they indicated that they feared dental treatment. The children in this study also recognized the importance of oral health to the well-being of the rest of the body. Parents were not proactive in making sure that their children received regular dental care. Parents' knowledge and attitudes about the importance of oral health care and their fears about dental treatment influenced their children's dental care. The results of this study indicate that children's and parents' attitudes toward oral health and dental care need to be improved. [6]Nepal National Oral Health 'Pathfinder' survey shows that Nepalese's oral health status lies far behind compared to industrialized and developed countries and needs to be improved. Dental caries prevalence was 57.5%, 25.6%, 57.5% and 69.6% for 5-6 years, 12-13 years, 15-16 years, 35-49 years and 50+ years respectively. The goals recommended by WHO and FDI world dental federation is followed by all age group except 5-6 years. There is the trend of increasing caries in female age cohort. Nepalese of all age groups in the Western Development Region have the highest prevalence of decay while residents of Terrain have the lowest prevalence. Compared to SEARO countries the dentition states of Nepalese is good. [5]Periodontal status of Nepalese decreases with age but is not the main reason of tooth loss. According to CPI (Community Periodontal Index) score of 2 (gingivitis and calculus) is dominant in young children and adolescents: 5-6 years olds (58.2%) 12-13 years old (62.8%) and 15-16 years old (61%). 43.8% of 35-49 years old adults and 34.5% of 50+ adults have the highest CPI score of 4-5mm pocket.[5]The report of pain and discomfort due to toothache ranges from 18% in 5-6 years to 64% in 50+ years adult. Amongst the adolescents school children the most frequently reported impact of pain and discomfort is inability to eat followed by inability to speak, laugh and sleep. With decrease in the dental caries amongst the adolescents, impacts due to pain and discomfort has decreased in the last 5 years 55% of 50+ year adults reported having trouble eating hard foods. [5]More than 99% of the adolescents and 90% of 35-49 years adults use their own brush for oral hygiene, while a toothbrush is used by a lesser proportion of 50+ years adults approximately 75% of 12-13 years old and 80% of 15-16 years old use a fluoride toothpaste while the use of fluoride toothpaste is considerably lower in younger adults and older adults. The consumption of fluoride toothpaste is significantly higher in urban subjects and lower in the Terrain compared to others physiographic divisions and higher in school children attending private schools then government schools. [5]Tea with sugar is the most common sugar containing food consumed. Subjects surveyed in the western developmental region consumed more sugar tea daily other regions. Daily sugar consumption is also the highest in the western developmental region which may be reason for higher carries in this region. Daily sugar consumption pattern is similar in rural and urban adolescents (urban 12-13 years old and 15-16 years old). [5]Knowledge concerning the prevention on oral health problem is high amongst the subjects surveyed. A high proportion of adolescents (94%-97%), 35-49 years old adult (83%-86%) and 50+ years old adults (71%-74%) believe or know that brushing is healthy habit and eating sweet and consuming tobacco is unhealthy. However knowledge concerning the fluoride is very low with 72%-87% of adolescents and 88%-87% of adult ignored the protective effect of fluoride. In 12-13 years old, knowledge concerning tobacco, water fluoride and sweets is associated with parents' level of education and location type in favor of higher education and urban location. [5]63.5% and 19.3% of the 35-49 years old and 50+ years adults reported that they did not visit a dentist in the last 2 years because they did not have a need or did not have any serious dental problem. Of the 35-49 years old adults who reported visiting a dentist, 89.6% went because they had a problem. A very small percentage stated cost or distance to the clinic as barriers to accessing care. Oral examination, dental extraction and cleaning scaling were the major services provided during dental visits for both adult age groups. [5]An experimental study which was conducting throughout development region of Nepal in 1999-2004. That study had shown that dental caries was decrease by 26.6% and DMFT was decreased by 38% who had used flourished toothpaste. That study was conducting in 12-13 years old children. [7]The caries prevalence and mean DMFT score of 5-6 years old was 67% and 3.3. The caries prevalence and mean DMFT score of 12-13 years old was 41% and 1%. [7]The recorded prevalence of untreated dental caries in school children requires an appropriate oral health response based primarily on prevention and health promotion. [7]

CHAPTER 3OBJECTIVES3.1 General Objectives To find out knowledge and practice on dental hygiene among students of Lalitpur district.3.2 Specific objectives To find out knowledge on dental hygiene To identify practices regarding dental hygiene. To find out the knowledge on prevention and management of dental problem.

CHAPTER 4RESEARCH METHODOLOGY:4.1 Research Method Quantitative research method was used.4.2 Design of study: Descriptive cross sectional study design was used.4.3 Study area: The study area was Nava Vidya Mandir school of Lalitpur sub metropolitan city -6.,Lalitpur district Nepal4.4 Study population: The study populations of this study were Students of Nava Vidya Mandir School of Lalitpur district.4.5 Study Unit: Students of class 1,2,3,4 and 5.4.6 Sampling methods\ Techniques: Purposive sampling technique was used.4.7 Sample size: About `100 respondents were included as it can represent the whole population of Nava Vidya Mandir School.4.8 Sampling process All students of class 5,4,3,2 presented in data collection day and rests from class 1 to meet 100 respondents were visited and data was collected. 4.9 Criteria for sample selectiona) Inclusion criteria: Students of grade 1, 2, 3, 4 and 5 who are interested and present at the day of data collection. b) Exclusion criteria: Students absent at the day of data collection. Uninterested students.4.10 Data collection techniques: After taking permission from concern authority, familiarizes to the students about purpose of dada collection. Verbal consent was taken from students. Was considering inclusion and exclusion criteria. To collect required information questionnaire was asked by face to face interview.4.11 Data collection tool: Structured questionnaire was used as data collection tool. 4.12 Ethical consideration: From the Nepal Health Research council, Kathmandu ethical clearance was taken and hand over to the concern authority of school. To respect the authority school, first of all permission was taken from the school principal. To protect the right of the subject, consent was taken from respondents without forcing. Privacy and confidentiality was maintained.

4.13 Pretesting the data collection tools For maintaining internal validity questionnaire was pre- tested in 10% of similar setting in Universal Secondary school Lalitpur. Necessary modification was done on instrument after analysis to check reliability of the question designed.4.14 Validity & Reliability: The questionnaire was prepared under the proper guidance & supervision of guider and advisor. Pretesting was done on10% of the sample size. Personal identity was kept Confidential.4.15 Limitation: Resource like budget was limited. The study was limited only Nava Vidya Mandir School of Lalitpur so it cant generalize. 4.16 Data analysis procedure: After collection of data, all responses regarding questionnaire was checked for its completeness, correctness and internal consistency. After checking the correctness, completeness of data, it was analyzed through Statistical Package for Social Sciences (SPSS). This included the statistical presentation, interpretation, and results of collected data.4.19 Operational Definition Dental hygiene:The practice of keeping the mouth, teeth and gums clean and healthy to prevent diseases by regular brushing and flossing and visits to a dentist.Periodontal disease:It is an infection of the tissues that support the teeth.Dental caries:The formation of cavities in the teeth by the action of bacteria, tooth decay.Knowledge:It is a familiarity with someone or something that can include facts, information, descriptions and / or skills acquired through experience or education.Dental plaque:A film of mucus and bacteria on the tooth surface.Practice: The use of one's knowledge in a particular profession.

CHAPTER 5 RESULTSThe main objective of the research was to find out the knowledge and practice on dental hygiene in students of Lalitpur.All of the hundred respondents were participating among which fifty three were male and forty-seven were female. The questions were asked with students of Nava Vidya Mandir School, Lalitpur. Both open and close ended questions were asked. After completion of the research information was grouped according demographic, social and other characteristics. The information related to knowledge, practice.Section A: Socio-demographic characteristicsTable 1: Age wise distribution of respondentsAgeFrequency(n=100)Percentage (%)

6-8 years9-11 years12-14 years3363433634

The study showed majorities (63%) of respondents were 9-11 years and only 4% were 12-14 years age group. Table 2: Sex wise distribution of respondentsSexFrequency (n=100)Percentage (%)

Male5353

Female4747

Boys (53%) and girls (47%) were not significantly different in number. Among the respondents minimum (15%) were of class 1 and maximum (25%) were of class 2.Table 3: Distribution of respondents by social characteristicsReligionFrequency(n=100)Percentage (%)

HinduBuddhistChristianMuslim692371692371

Parents occupation

SculptureMansonTeacherHealth personnelShopkeeperDriver1016259211910162592119

No. of family members

3-67-1011-148018280182

Out of all respondents majority (69%) were Hindu and only 1% were Muslim. And Buddhist and Christian were 23% and 7% respectively. Most of the respondents parents were Teacher (25%) and only 9% were Health personnel.Most of the respondents (80%) had family members no. within 3-6 and only 2% had within 11-14. This showed that majorities of respondent engage in nuclear family.[Table 3]Section B: Knowledge about dental hygiene

Table 4: Distribution of respondents by source of informationMediasFrequency(n=100)Percentage (%)

Radio2815.3

TV5328.9

Newspaper168.7

Books4122.4

Poster/pamphlets31.6

By parents2212

By teacher2010.9

*Frequency may exceed due to multiple response.Showed that 53% of respondents were gaining knowledge about dental hygiene from TV and only 3% were from poster\ pamphlets. 22% were from parents, 20% were from teachers, 41% were from books and 28% were from radio gaining knowledge about dental hygiene.

Table 5: Distribution of respondents by knowledge on reason of tooth brushing:

Reason of tooth brushingFrequency(n=100)Percentage (%)

For healthy teeth4747.0

To make strong teeth4141.0

For shining teeth1212.0

When it was tried to understand about knowledge on reason of tooth brushing then 47% were said that for healthy teeth, 41% were said that to make strong and 12% were said that for shining teeth.Table 6: Distribution of respondents by knowledge on causes of dental problems:

Causes of dental problemFrequency(n=119)Percentage (%)

More use of sticky food1815.1

Irregular brushing of teeth1613.4

Lack of nutrition86.7

Chewing of hard foods1310.9

Dont know6453.7

*Frequency may be exceeding due multiple choice questionMajorities (64%) of respondents have not knowledge about causes of dental problem and only 8% said that lack of nutrition is causes of dental problem.

Table 7: Distribution of respondents by knowledge about healthy teeth:Meaning of healthy teethFrequency(n=115)Percentage (%)

White and shiny teeth2320.0

Strong and caries free teeth4539.1

Free from any pain3026.0

I dont know1714.9

Total115*100

* Frequency may be exceeding due to multiple choice question.When it was tried to understand about knowledge on meaning of healthy teeth then 39.1% said that strong and caries free teeth, 26% said that free from any pain, 20% said that white and shiny teeth and 14.9% said that dont know.Table 8: Distribution of respondents by knowledge about dental hygiene:Meaning of dental hygieneFrequency(n=113)Percentage (%)

Cleaning of teeth5347.0

Shining of teeth1614.1

Regular check up with dentist87.8

Eating nutritious food108.1

Free from dental pain2623.0

Total113*100

* Frequency may be exceeding due to multiple choice question.Result showed that 47% said that cleaning of teeth whereas 7.8% said that regular checkup with dentist as meaning of healthy teeth.Table 9: Distribution of respondents by knowledge on prevention of dental problems:

Methods of prevention of dental problemsFrequency(n=100)Percentage (%)

Wash teeth after eating food2622.4

Eat nutritious food1311.2

Regular check up with dentist2118.1

Regular brushing5648.3

Total116*`100

*Frequency may exceed due to multiple response.In study of knowledge on prevention of dental problems 48.3% said that regular brushing followed by 11.2% eat nutritious food.

Section C: Practices on Dental hygieneIt was found that 100% of respondents had regular tooth brushing practice, which said that a good health behavior. Same as it was also found that 100% respondents used brush and tooth paste for cleaning their teeth.

Table 10: Distribution of respondents according to tooth brushing practice Tooth brushing frequencyFrequency(n=100)Percentage (%)

Once a day4040

Twice a day5151

Once in two day66

Sometimes33

Total100100

Tooth brushing time

Immediately after waking upBefore going to bedAfter break fastAfter lunch65

267265

2672

Total100100

Out of all respondents 51% were brush teeth twice a day, 40% were once a day and only 3% were sometimes brush teeth. Most of the respondents (65%) were brush teeth immediately after waking up and only 2% were brush teeth after lunch.

Table 11: Distribution of respondents by health seeking behavior on dental problem:Health seeking behavior on dental problemFrequency(n=100)Percentage (%)

Wash teeth with salty hot water2323.0

Visit to nearest clinic2020.0

Visit to dentist5757.0

Total100100

Majorities of respondents (57%) were visit to dentist when they had dental problem. And rests were visit to nearest clinic (20%) and wash teeth with salty hot water (23%). [Table 11]Table 12: Distribution of respondents by absent days in class due to dental problem:Absent daysFrequency(n=100)Percentage (%)

No any day7070.0

One day1212.0

Two days1010.0

Three days55.0

More than three days33.0

Total100100

Among 100 respondents 70% were not absent in class due to dental problem in last year or now. But 12% were one days, 10% were two days, 5% were three days and 3% were more than three days absent due to any dental problem. [Table 12]Table13: Distribution of respondents by parents occupation vs. dentist visiting time:

Dentist visiting time

Every 6 monthsNever visitoccasionallyEvery 12 monthsTotal

Parents occupation Sculpture

0

5

3

2

10

Mason078116

Teacher588425

Health personnel24219

Shopkeeper2118021

Driver396119

Total1244359100

It was determined that 56% of respondents were visit to dentist and 44% were never visit to dentist. Among them 35% were occasionally, 12% were half yearly and 9% were yearly visitor of dentist.

When categorized all respondents according to parents occupation then it was found that majorities (11%) of never visitor were shop keeper families and minorities (5%) of never visitor were sculpture families. Dentist visitor were higher (17%) in teacher families lower (5%) in sculpture families. [Table 13]

Table 14: Distribution of respondents by attendance in dental hygiene program:

Attendance on dental hygiene programFrequency(n=100)Percentage (%)

Yes2525.0

No7575.0

Majorities (75%) respondents were not attendance any dental hygiene program which was followed by 25% were attendance on dental hygiene program. All dental hygiene program attendants by respondents were organized by their local clubs. [Table 14]Table 15: Distribution of respondents by dental problem cases from last year to now:Appearances of dental problemFrequency(n=100)Percentage (%)

Yes5252.0

No4848.0

Total100100

Cases of dental problemFrequency(n=52)Percentage (%)

Pain of teeth2446.1

Gum bleeding1223.1

Dental decay815.4

Breaking down of teeth815.4

Total52100

Study showed that 52% respondents had suffered from dental problems and 48% had not suffered from any dental problem from last year to now. Among the respondents who had suffered from dental problems, 46.1% had pain of teeth, 23.1% had gum bleeding and 15.4% had dental decay and breaking down of teeth.

Table 16: Distribution of respondents by age vs. occurrence of dental problems:Occurrence of dental problemTotal

YesNo

Age 6246

771017

85510

911920

10131225

1112618

12224

Total5248100

When it was tried to understand about age wise occurrence of dental problem among the respondents who had suffered from dental problem then it was found that 25% were of 10 years age, 21.1% were of 11 years age and only 3.8% were of 6 & 12 years age.Table 17: Distribution of respondents by sex vs. occurrence of dental problems:SexOccurrence of dental problem

YesNoTotal

Male272653

Female252247

Total5248100

Among the respondents who had suffered from dental problems 51.9% were male and 48.1% were female.Table 18: Distribution of respondents by sex vs. type of dental problemDental problem

Pain of teethGum bleedingBreaking down of toothDental decay

Sex Male81153

Female16225

Total241378

Among boys who had suffered from dental problem 40.7% had gum bleeding and 11.11% had dental decay. Like as among the girls who had suffered from dental problems 64% had pain of teeth and only 8% had gum bleeding.

CHAPTER 6 DISCUSSIONThe study is one snap shot type that is cross-sectional type. At the mean time it is support to be descriptive type of study. The basic objectives of the studies were to find out knowledge and practice on dental hygiene in school children and effects of IEC materials in their dental health. This study was conducted in Nava Vidya Mandir School, Lalitpur.Socio-demographic findings of this study give us the basic information about the social, cultural and other demographic result about the respondents. Studies shows more than 60% of respondents were 9-11 yrs age group, 33% were 6-8 yrs and only 4% were 12-14 yrs age group. 53% were male and 47% were female respondents of this study. Maximum 25% respondents were class 2 and minimum 15% respondents were of class 1. Majorities (69%) respondents were Hindu and only 1% was Muslims. Among all respondents maximum 25% were from teacher family and only 9% were from health personnel family. About 80% of respondents have family members 3-6 and only 2% have 11-14 family members.According to WHO, dental caries affects about 60-90% of school children. It is the most prevalent in Asian and Latin American country where people have low socio-economic condition. [4] This study also showed that 52% school children had different dental problems and among them 15.4% had dental caries.100% of respondents have regular tooth brushing and they all were used to brush and toothpaste for cleaning their teeth. Majorities (51%) of respondents were brushing their teeth twice a day and only 3% were brushing sometimes. Majorities (65%) of respondents were brushing immediately after waking up and only 2% were after lunch. From above explanation it can be say that respondent practices were considerably good. 57% of respondents were visit to dentist when they suffer from any dental problems. And 20% were visit nearest clinic for treatment.Kadir R.A in Oral Health Burden of Illness indicates the poor dental health which is the consequences of poor or improper dental hygiene habits due to lack of knowledge or ignorance. [3].This study also showed that in average respondents had good knowledge about dental hygiene but ignorance was prone. So, that half of the respondents were suffering from different dental problems. The significant role of socio-behavioral and environmental factors in dental disease and health was demonstrated in large number of epidemiological survey [4]. This study also found relation of socio-behavioral factors in dental disease and health; it was found that among sculpture families respondents 50% were never visit to dentist and among mason families respondents 40% were never visit to dentist. Majorities (51%) of respondents were brushed twice a day but only 30% used to fluoridated toothpaste. A study was conducted in China on the oral health which also showed that 44.4% of respondents brushed their teeth at least twice a day but only 17% used fluoridated tooth paste. Significant variation in oral health practices were found according to province and regular dental care habits were more frequent in urban than rural areas [6], which was also found that practice and knowledge on dental hygiene comparatively better than rural areas.Mahmoud Al Omiri et al (2005) showed that parents role in oral hygiene habits of their children was limited. [6].This study also showed that only 16% of respondents were gain knowledge and practice about dental hygiene from parents. Irregular visit to the dentist were found to be common and toothache was the major driving factors for dental visit [6], which was exactly similar that only 21% were regular visit the dentist and pain of teeth (46.1%) was major cause of dental visit.The results of a study entitled, Oral Health Attitudes, Knowledge and Behavioral Among School Children in North Jordan; 2005 indicates that childrens and parents attitude towards oral health and dental care need to be improved.[6]. Like that current study also indicates improvement of childrens and parents knowledge and practice regarding dental hygiene because only 52% had good knowledge about dental hygiene.National Oral Health Pathfinder Survey 2004 showed there is the trend of increasing caries in female age cohort. [5]. This study also showed that caries for female was 62.5% and for male was 37.5%. More than 99% of adolescents used their own brush for oral hygiene. [5], which gave similarity to current study that 100% of respondents used their own brush. This study showed 56% respondents had knowledge that regular brushing is prevents dental problems. National Oral Health Pathfinder Survey 2004 also indicates that 71-74% old adults beliefs or know that brushing is health habit. [5].The recorded prevalent of untreated dental caries in school children requires an appropriate oral health response based primarily on prevention and health promotion. [7]This study also recommended that organization of dental hygiene camp is very necessary. The findings in this study might not be similar to studies in other places because of the variation in the socio-demographic characteristics and economic status of the people. More researches need to be done in this regards in order to explore in depth the knowledge and practice on dental hygiene.

CHAPTER 7CONCLUSION AND RECOMMENDATION7.1 CONCLUSIONThe study found that 100% of respondents had regular brushing habit. This may be because of availability of materials, affordability and proper education. It was also found that 100% of respondents were using brush and tooth paste for cleaning their teeth. Maximum respondents were brushing teeth twice a day at immediately after waking and before going to bed.It was found that more than 50% of respondents had been suffer from any dental problems in last year to now. Among these dental problems, pain of teeth was more prone and gum bleeding, dental decay, breaking down of tooth were respectively less prone. During dental problems time more than 50% were visiting to dentist for treatment. Rests were visit to nearest clinic and used hot salty water.The study showed that 70% of respondents were no absent in class and 12% were absent at least one day due to dental problems in last year. It was found that at least 50% respondents had knowledge about reasoned behind toothbrush. But 65% respondents had not knowledge about causes of dental problems, healthy tooth and dental hygiene was found to be very low. It may be because of lack of dental education in curriculum. More than 50% of respondents had perception that regular brushing is best habit for prevention of dental problems.It was found that maximum respondents were gain knowledge about dental hygiene by TV. And then by books, radio, parents, teacher, etc respectively. TV was best media for dental health education.Regular check up of teeth and dental hygiene were not organized in respondents school. Some respondents were got chance to attained dental camp organized by their local club.It was found that occurrence of dental problems was same in both sexes. Number of class absent respondents due to dental problems was highest in class 2. Occurrence of dental problems in female was pain of teeth and in male was gum bleeding.

7.2 RECOMMENDATION Dental health is one of the mostly ignored and least addressed issue, hence people should be made aware to addressed dental health issues.

Most of the respondents were suffering from dental problems. So dental camp should be organized for entire age group by concerned authorities. Study showed that school authority wasnt that concerned to the students dental hygiene. So, school authority should organize different dental hygiene programs. For most respondents TV was best media for dental education. So broad casting of dental program focusing this age group should be necessary. Parents and teacher role was showed very low so that it should be increased. There should be organizing campaigns regarding food consumptions habit and their association with dental problems.

REFERENCES1. Mifflin H. The American Heritage Dictionary of the English language 4th edition. Houghton Mifflin company, 2000.

2. Harper C. Collins English Dictionary 2003

3. Kadir R.A; Oral Health Burden of Illness: Global perspective; 100 year celebration health convention, Ministry of Health; University Kebangsaan Malaysia. Available at www.moh.gov.bn

4. Peterson P.E; The world oral health report 2003: continuous improvement of Oral Health in 21st century- the approach WHO Global Oral Health Programme; Community Dentistry and Oral Epidemiology; 2003; 31; 5-8. Available at www.blackwell_synergy.com

5. Yee R, Mishra R; Nepal National Oral Health 'Pathfinder' Survey 2004. Kathmandu, Nepal; Oral Health Focal point; Ministry of Health; HMG Nepal, 2004; final report III IV, VIII X

6. Mahmoud A.O et.al; Oral Health attitudes knowledge and behaviour among school children in North Jordan; 2005. Available at www.jdentaled.org

7. UMN Oral Health care management. 2011 Jun 24. Available at www.ncbi.nlm.nih.gov/pubmed/16972393

ANNEX

Annex I

Annexes III

Oral QuestionnaireDate: Q.N.QuestionsAnswersGo to

Group A

1Name

2Age

3Sex

4Address

5Class

6Religion

7Parents occupation

8No. of family members

Group B

9Do you clean your teeth?a) Yes b) NoIf no, go to Q.N.15

10What do you use for cleaning your teeth?a) Brush + toothpasteb) Mouthwashc) Fingerd) Charcoale) Tooth picksf) Saltg) Dental flossh) Others (specify) ..

11How often do you brush your teeth?a) Once a dayb) Twice a dayc) once in two dayd) Sometimes e) never brushf) Others (specify)

12When do you brush your teeth?a) before going to bedb) After lunchc) Morning (after breakfast)d) Morning (immediately after waking up)e) Others (specify)

13For how long do you brush your teeth?a) Less than one minuteb) 1 minutec) 2 minuted) 3 minutee) 4 minutesf) Others (specify)...

14Why do you brush your teeth?a) For shining teetha) to make strong teethb) For healthy teethc) To follow order of parentsd) to taste sweetness of toothpastee) Others (specify)

15Did you suffer from any dental problem in last year or now?a) Yesb) NoIf no go to Q.N.17

16What is that dental problem?a) Pain of teethb) Gum bleedingc) Formation of dental plaqued) breaking down of toothe) dental decayf) Others (specify)

17What are the causes of dental problems? (Multiple choice question)

a) More use of sticky foodb) Irregular brushing of teethc) Lack of nutritiond) chewing of hard foodse) I dont knowf) Others (specify)

18If you are suffering from dental problems, what do you at that time?

a) visit to Dhami, Jhakrib) Wash teeth with salty hot waterc) Visit to nearest clinicd) Visit to dentiste) Others (specify).

19How many day you absent in class due to dental problems within last year?a) 1 dayb) 2 dayc) 3 dayd) more than 3 daye) No any dayf) Others (specify)

20What does gum bleeding mean? (Multiple choice question)

a) Inflamed gumb) Healthy gumc) Ruptured gumd) Unhealthy gume) I dont knowf) Others (specify)..

21How do you protect gum bleeding?a) Using toothbrush, paste and dental flossb) Using salt foodc) Using salt foodd) Using vitamin Ce) Using medicinef) Others (specify)

22What does dental plaque mean? (multiple choice question )a) Staining of the teethb) Hard debris on the teethc) Soft debris on the teethd) I do not knowe) Others (specify) ...

23What does dental plaque lead to? Multiple choice question)a) Inflammation of the gumb) Staining of teethc) Dental carriesd) I do not knowe) Others (specify)..

24What is a healthy tooth? (multiple choice question)

a) White and shiny teethb) Strong and carries free teethc) Free from any paind) I dont knowe) Others (specify) .

25How often do you visit dentist?a) Regularly every 6 monthsb) I never visit a dentistc) Occasionallyd) Regularly every 12 Monthse) Others (specify)

26What do you mean by dental hygiene? (multiple choice question)

a) Cleaning of teethb) Shining of teethc) regular check up with dentistd) eating of nutritious foode) free from dental painf) Others (specify)..

27What should be done to prevent dental problem? Multiple choice question)a) wash teeth after eating foodb) Eat nutritious foodc) Regular check up to dentistd) Regular brushinge) Others (specify)..

28Why it is necessary to become teeth healthy? (multiple choice question)

a) to prevent dental diseaseb) To make easy to eatc) To avoid mouths bad smelld) For beautiese) Others (specify) ..

29Brushing teeth prevents dental decay?

a) Yesb) Noc) Don't know

30Using fluoride strengthens the teeth?

a) Yesb) Noc) Don't know

31Regular visits to the dentist are necessary?

a) Yesb) Noc) Don't know

Group C

32By which media you gain knowledge about dental hygiene? (multiple choice question)

a) Radiob) TVc) Newspaperd) Bookse) Poster / pamphletf) by parentsg) by teachersh) Others (specify)

33From which media you gain knowledge about dental hygiene more properly?a) Radiob) TVc) Newspaperd) Bookse) Poster / pamphletf) by parentsg) by teachersh) Others (specify)

34Did you attain any program about dental hygiene?a) nob) Yes

If no , go to Q.N.36

35Who organized that program?

a) School b) clubc) Mothers group

Group D

36Did your school organize any dental hygiene program?

a) no b) Yes

If no , go to Q.N.38

37What was that program?a) Dental hygiene awareness programb) Distribution of brush, toothpaste, etcc) Dental checkup programd) Others (specify).

38In your school, regular checkup of teeth of children should be done?

a) nob) Yes

39How often that program should be done?

a) Daily b) Monthly c) Three monthlyd) weeklye) once in two day

Work Plan

Activities Time Frame1m2m3m4m5m6mPlanning PhaseReview of the LiteratureConsultation with ExpertExploration of the study siteDevelop instrument for the data collectionData collectionData analysisReport writingPreparation for draft Report SubmissionPreparation for final reportSubmission of final report