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HEALTH AND WELLNESS 2/2015
WELLNESS AND SOCIETY
CHAPTER XXVII
Non-public Health Care Centre Denticus 2, Szczecin
Niepubliczny Zakład Opieki Zdrowotnej Denticus 2, Szczecin
JOLANTA ŚWIDERSKA
Oral hygiene in relation to education and place of living
of surveyed patients
Higiena jamy ustnej a wykształcenie i miejsce zamieszkania
badanych pacjentów
Key words: oral hygiene, education, place of living
Słowa kluczowe: higiena jamy ustnej, wykształcenie, miejsce zamieszkania
INTRODUCTION
The occurrence of caries and periodontal diseases largely depends on nutritional
behaviours and daily hygiene. By undertaking regularly simple prophylaxis procedures, we help not only to sustain oral cavity health but also health of entire body.
Caries, which is not properly treated for a long time, could be a reason of many distant
organ infections.
The whole concept of health includes various approaches to health education: biomedical, social, pedagogic and cultural [16,24]. Health education is often defined as
actions concerning behaviours and health habits of children, young people and adults
and provision of knowledge about oral health.
According to Pine different factors influence oral cavity health: social and economic status, the resistance to diseases, education received, attitude towards health,
lifestyle, and also the social and physical surroundings, and the accessibility of health
services [13].
Health behaviours are all intentional activities performed with purpose of sustaining and improving health status [12]. Health behaviour is an ongoing process started
in early years of our life. This process is influenced by different role models, most
often acquired from parents but also from playgroup, school, local or religious community and media [14]. For example knowledge about dental caries is provided to
children during early school years and is being developed through whole life.
HEALTH AND WELLNESS 2/2015
Wellness and society
Information given by teachers to children increases the health awareness, while
dentists expands the knowledge and help with improving of proper dental behaviours.
Explaining importance of oral cavity hygiene during the visits, allows patients to gain
practical knowledge in extent of caries and periodontal diseases prevention [9]. Health
education helps patients to effectively reduce the risk of occurrence of oral cavity
diseases [5].
Provided information must be understandable, well thought-out and also to increase health awareness. Provided information should consider not only health behaviours but also regard one’s life style, improving proper hygiene and nutritional habits
and increasing the need for regular dental check-ups.
Systematic pro-health educational programme also shapes the awareness of the
importance of health and pro-health behaviours in society [11,18,23,25]. Popularising
pro-health attitudes is a task for many people and institutions not only from medical
sector [4,7,10,15].
Oral cavity health requires complex approach to be effective. It’s necessary to put
emphasis on health education, preventive care and management of the health care
[19,20].
THE AIM OF RESEARCH, MATERIAL, METHODS
The aim of research was to determine patients’ health behaviours in the range of
oral hygiene regarding their education and place of living.
The research was conducted in 2012-2013 on 180 randomly chosen adult patients,
aged between 35 and 44 years, both genders living in the area of West Pomerania
region – in a big city of Szczecin (over 100.000 inhabitants), in smaller cities (under
100.000 inhabitants) and in villages. The analysis included dental examination of teeth
status of patients, prevalence of caries and evaluation of oral hygiene and was conducted among patients undertaking private dental treatment or treatment reimbursed
by the National Health Fund.
Clinical examination included non-invasive and secure diagnostic methods such
as using WHO scale probe and dental mirror under the artificial light.
The study was based on an anonymous survey, including single and multiple
choices close-ended and open-ended questions.
Following WHO recommendation, the research determined most important socioeconomic determinants of chosen groups of patients and also evaluated socio-demographic characteristics such as: gender and place of living. Socio-economic status and
education – factors acknowledged as one of the socio-medical indicators of health –
were subject of the research.
STATISTICAL ANALYSIS METHODS
All statistical calculations were performed with use of statistical software STATISTICA ver. 10.0 by StatSoft Inc. (2011) and Excel calculation sheet. Quantitative
variables were determined by arithmetical mean, standard deviation, median, minimum and maximum (range) and 95% CI (confidence interval). Qualitative variables
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Oral hygiene in relation to education and place of living of surveyed patients
were determined by number and percentage. Significance of differences between two
groups (independent variables model) was tested with significance test: t-Student or
Mann-Whitney U test. Difference significance between more than two groups was
tested with F (ANOVA) or Kruskal-Wallis test. Independence chi-square test was
used for qualitative variables. To determine the relationship, strength and direction
between variables Pearson’s and/or Spearman’s correlation coefficients were calculated. The level of significance p=0.05 was chosen for conducted study.
RESULTS
The study involved 180 patients, 90 women and 90 men, who underwent dental
examination determining their teeth and oral hygiene status. Study was conducted in
a big city, smaller cities and villages. Each examined person completed a questionnaire on utilization of dental services, oral hygiene and access to dental services.
Tab. I. Gender of surveyed patients
Gender N
%
Women 90 50.0
Men
90 50.0
Sum 180 100.0
The study involved 90 women and 90 men.
Tab. II. Place of living and gender of surveyed patients
Place of living
Big city
Smaller cities
Villages
Sum
Women
N
%
30 33.3
30 33.3
30 33.3
90 100.0
N
30
30
30
90
Men
%
33.3
33.3
33.3
100.0
The study involved 30 women and 30 men from a big city, 30 women and 30 men
from smaller cities and also 30 women and 30 men from villages.
Tab. III. Education and gender of surveyed patients
Education
Primary
Vocational
Secondary
Higher
Sum
Women
N
%
4
4.4
21 23.3
37 41.1
28 31.1
90 100.0
Men
N
2
19
30
39
90
%
2.2
21.1
33.3
43.3
100.0
In the study 90 women and 90 men have indicated their education. Among women
most had secondary education (41.1%), whereas among men most had higher education (43.3%).
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Tab. IV. Education and place of living of surveyed patients
Big city Smaller cities
N
%
N
%
Primary
1
1.7
0
0.0
Vocational 14 23.3
7
11.7
Secondary 21 35.0 24
40.0
Higher
24 40.0 29
48.3
Sum
60 100.0 60 100.0
Education
Villages
N
%
5
8.3
19 31.7
22 36.7
14 23.3
60 100.0
Most patients from a big city and smaller cities indicated higher education (respectively 40.0% and 48.3%), whereas most patients from villages indicated secondary
education (36.7%).
Tab. V. Frequency of brushing teeth
How often do you brush
your teeth?
After every meal
Twice a day
Once a day
Less often than once a day
Sporadically
Sum
N
%
30
116
30
1
2
179
16.8
64.8
16.8
0.6
1.1
100
Majority of surveyed patients brush their teeth twice a day (64.8%).
Tab. VI. Frequency of brushing teeth in relation to gender of surveyed patients
How often do you brush
your teeth?
After every meal
Twice a day
Once a day
Less often than once a day
Sporadically
Sum
Women
N
%
18 20.2
59 66.3
12 13.5
0
0.0
0
0.0
89 100.0
N
12
57
18
1
2
90
Men
%
13.3
63.3
20.0
1.1
2.2
100.0
Majority of women (66.3%) and men (63.3%) brush their teeth twice a day.
Women (20.2%) more often than men (13.3%) brush their teeth after every meal.
Tab. VII. Frequency of brushing teeth in relation to place of living of surveyed
patients
How often do you brush
your teeth?
After every meal
Twice a day
340
Big city
N
%
11 18.3
39 65.0
Smaller cities Villages
N
%
N
%
12
20.0
7 11.9
39
65.0 38 64.4
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Oral hygiene in relation to education and place of living of surveyed patients
Big city
Smaller cities Villages
How often do you brush
your teeth?
N
%
N
%
N
%
Once a day
9
15.0
9
15.0 12 20.3
Less often than once a day 1
1.7
0
0.0
0
0.0
Sporadically
0
0.0
0
0.0
2
3.4
Sum
60 100.0 60
100.0 59 100.0
Regardless of the place of living surveyed patients most often brush their teeth
twice a day (65% of patients from a big city and smaller cities and 64.4% of patients
from villages). More than 80% of patients from a big city and smaller cities brush
their teeth at least twice a day. Approximately 24% of patients from villages brush
their teeth once a day or less often.
Tab. VIII. Frequency of brushing teeth in relation to education of surveyed
patients
Primary
How often do you brush
your teeth?
N
%
After every meal
2
33.3
Twice a day
2
33.3
Once a day
2
33.3
Less often than once a day 0
0.0
Sporadically
0
0.0
Sum
6 100.0
Vocational
N
%
2
5.1
22 56.4
13 33.3
0
0.0
2
5.1
39 100.0
Secondary
N
%
9 13.4
46 68.7
11 16.4
1 1.5
0 0.0
67 100.0
Higher
N
%
17 25.4
46 68.7
4
6.0
0
0.0
0
0.0
67 100.0
Regardless of education surveyed patients most often brush their teeth twice a day.
Tab. IX. Frequency of brushing teeth in relation to place of living and gender of
surveyed patients
Big city
Women
Men
N % N %
After every meal
4 13.3 7 23.3
Twice a day
25 83.3 14 46.7
Once a day
1 3.3 8 26.7
Less often than once a day 0 0.0 1 3.3
Sporadically
0 0.0 0 0.0
Sum
30 100.0 30 100.0
How often do you brush
your teeth?
Smaller cities
Women
Men
N % N %
9 30.0 3 10.0
15 50.0 24 80.0
6 20.0 3 10.0
0 0.0 0 0.0
0 0.0 0 0.0
30 100.0 30 100.0
Villages
Women
Men
N % N %
5 17.2 2 6.7
19 65.5 19 63.3
5 17.2 7 23.3
0 0.0 0 0.0
0 0.0 2 6.7
29 100.0 30 100.0
Regardless of gender and place of living surveyed patients most often brush their
teeth twice a day. Women from a big city more often than women from smaller cities
and villages brush their teeth twice a day or after each meal (respectively approximately 97%, 80% and 83%). Women from smaller cities and villages more often brush
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their teeth after every meal than men from smaller cities and villages (from smaller
cities: women 30%, men 10% and from villages: women 17.2%, men 6.7%).
Tab. X. Frequency of brushing teeth in relation to education of surveyed patients
from a big city
How often do you brush
your teeth?
After every meal
Twice a day
Once a day
Less often than once a day
Sporadically
Sum
Education of patients from a big city
Primary
Vocational Secondary
Higher
N
%
N
%
N
%
N
%
1
100.0 1
7.1
4
19.0
5 20.8
0
0.0
10
71.4 12 63.2 17 70.8
0
0.0
3
21.4
4
19.0
2
8.3
0
0.0
0
0.0
1
4.8
0
0.0
0
0.0
0
0.0
0
0.0
0
0.0
1
100.0 14 100.0 21 100.0 24 100.0
Among patients from a big city, those who indicated vocational education least
often of all patients brush their teeth after every meal (7.1%). Patients with vocational,
secondary and higher education brush their teeth most often twice a day (respectively
71.4%, 63.2%, 70.8%).
Tab. XI. Frequency of brushing teeth in relation to education of surveyed
patients from smaller cities
How often do you brush
your teeth?
After every meal
Twice a day
Once a day
Less often than once a day
Sporadically
Sum
Education of patients from smaller cities
Primary
Vocational Secondary
Higher
N
%
N
%
N
%
N
%
0
0
0.0
4
16.7
8 27.6
0
3
42.9
16 66.7 20 69.0
0
4
57.1
4
16.7
1
3.4
0
0
0.0
0
0.0
0
0.0
0
0
0.0
0
0.0
0
0.0
0
7
100.0 24 100.0 29 100.0
Patients from smaller cities with vocational education most often brush their teeth
once a day (57.1%). Patients with secondary and higher education most often brush
their teeth twice a day (respectively 66.7% for secondary education and 69.0% for
higher education)
Tab. XII. Frequency of brushing teeth in relation to education of surveyed
patients from villages
How often do you brush
your teeth?
After every meal
Twice a day
342
Education of patients from villages
Primary
Vocational Secondary
Higher
N
%
N
%
N
%
N
%
1
20.0
1
5.6
1
4.5
4
28.6
2
40.0
9
50.0 18 81.8
9
64.3
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Oral hygiene in relation to education and place of living of surveyed patients
How often do you brush
your teeth?
Once a day
Less often than once a day
Sporadically
Sum
Education of patients from villages
Primary
Vocational Secondary
Higher
N
%
N
%
N
%
N
%
2
40.0
6
33.3
3
13.6
1
7.1
0
0.0
0
0.0
0
0.0
0
0.0
0
0.0
2
11.1
0
0.0
0
0.0
5
100.0 18 100.0 22 100.0 14 100.0
Patients from villages with primary and higher education most often of all patients
brush their teeth after every meal (respectively 20% and 28.6%). Patients with vocational, secondary and higher education brush their teeth most often twice a day (respectively 50.0%, 81.8%, 64.3%).
Tab. XIII. Use of dental hygiene products in relation to place of living and gender
of surveyed patients
Big city
What oral hygiene
Women
Men
products do you use?
N % N %
Traditional toothbrush 25 83.3 24 80.0
Electric toothbrush 3 10.0 8 26.7
Interdental toothbrush 0 0.0 1 3.3
Dental floss
15 50.0 15 50.0
Toothpicks
4 13.3 5 16.7
Fluoride toothpaste 10 33.3 17 56.7
Specific type
17 56.7 8 26.7
toothpaste
Mouthwash
17 56.7 20 66.7
Number of people
30
30
in a group
Smaller cities
Villages
Women
Men
Women
Men
N % N
%
N %
N
%
27 90.0 26 86.7 26 86.7 28 93.3
3 10.0 7 23.3 3 10.0 2
6.7
5 16.7 0 0.0 0 0.0 0
0.0
15 50.0 9 30.0 11 36.7 7 23.3
9 30.0 11 36.7 5 16.7 9 30.0
19 63.3 24 80.0 15 50.0 16 53.3
15 50.0
6
20.0
14 46.7 20 66.7 11 36.7 12
40.0
30
7
23.3 11 36.7
30
30
30
*surveyed patients were able to select many answers, values do not sum up to 100%
Women from a big city (83.3%) and smaller cities (90.0%) more often than men
(respectively 80.0% and 86.7%) use traditional toothbrush. Men regardless of their
place of living more often than women use electric toothbrush, mouthwash and fluoride toothpaste.
Tab. XIV. Use of dental hygiene products in relation to education of surveyed
patients
What oral hygiene products
do you use?
Traditional toothbrush
Electric toothbrush
Interdental toothbrush
Dental floss
N
5
0
0
2
Primary
%
83.3
0.0
0.0
33.3
Vocational
N
%
37 93.8
2
5.0
0
0.0
6
15.0
Secondary
N
%
62 92.5
5
7.5
3
4.5
30 44.8
Higher
N
%
52 77.6
19 28.4
3 4.5
33 49.3
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Primary
Vocational Secondary
Higher
What oral hygiene products
do you use?
N
%
N
%
N
%
N
%
Toothpicks
1
16.7
7
17.5 17 25.4 18 26.9
Fluoride toothpaste
4
66.7
24 60.0 38 56.7 35 52.2
Specific type toothpaste
2
33.3
8
20.0 20 29.9 34 50.7
Mouthwash
3
50.0
8
20.0 39 58.2 44 65.7
Number of people in a group 6
40
67
67
*surveyed patients were able to select many answers, values do not sum up to 100%
Patients with primary and vocational education most often use traditional toothbrush (respectively 83.3% and 93.8%) and fluoride toothpaste (respectively 66.7%
and 60.0%). Patients with secondary and higher education most often use traditional
toothbrush (respectively 95.2% and 77.6%), mouthwash (respectively 58.2% and
65.7%) and fluoride toothpaste (respectively 56.7% and 52.2%).
DISCUSSION
International studies on dental care showed that in countries with highly developed
health awareness there is a decreasing need for dental restorative services [5]. In Poland prosthetics and restorative treatment are still very popular. Occurrence of oral
diseases is mostly determined by life style and nutritional habits. Therefore it is necessary to improve health education, disease prevention and management of health care
[21].
Decrease in caries occurrence in society is achieved thanks to disease prevention,
including professional mechanical teeth cleaning, application of fluorine agent and
fissure sealing, but also by dental education [22].
Boczkowski and Szatko state that there is a statistically significant relation between intensity of pro-health behaviours concerning the health of oral cavity and living environment and education – in the city area proper pro-health behaviours’ pattern
can be found more often [3].
Regardless of the place of living and education surveyed patients most often brush
their teeth twice a day (65% of patients from a big city and smaller cities and 64.4%
of patients from villages). More than 80% of patients from a big city and smaller cities
brush their teeth at least twice a day. The higher the education the lower the percentage
of patients who brush their teeth once a day of less often.
According to Szczurek and Grocholewicz only deep, thorough knowledge allows
to recognise the influence of everyday hygiene on oral cavity health [17]. Axelesson
also carried out research on dental hygiene training. For two years, every two weeks
he carried out training on the correct brushing of teeth. The results were surprising –
90 % of instructed patients showed noticeable reduction of dental caries [1].
A lifestyle beneficial to the health is significantly influenced by everyday hygiene,
health behaviours that also regard oral cavity [9].
Klichowska-Palonka et al. obtained the results which showed that most respondents – 46.5% - brush teeth twice a day, 41.4% - once a day and 12.1% - after every
meal [8]. In the study conducted by Bałczewska 18.2% of surveyed patients brushed
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Oral hygiene in relation to education and place of living of surveyed patients
their teeth 3 times a day, 60.9% - twice a day, 10.9% - once a day and only 2.2% of
respondents do not brush their teeth at all [2].
Carried out research showed that majority of surveyed patients brush their teeth
twice a day (64.8%). Women more often than men brush their teeth after every meal.
Ilewicz et al showed that 100% of surveyed patients use toothbrush, 26% - toothpicks, 22% - dental floss, 21% - mouthwash and 6% - interdental toothbrush [6].
Carried out research showed that majority of patients use traditional toothbrush
and toothpaste. Other popular products are fluoride toothpaste, dental floss, toothpicks
and mouthwash.
CONCLUSIONS
Following conclusions were drawn from the study:
1. Regardless of gender, education and place of living surveyed patients most
often brush their teeth twice a day.
2.
The higher the education the lower the percentage of patients who brush their
teeth once a day of less often.
3.
Patients from a big city more often than patients from smaller cities and villages use varied dental hygiene products.
4.
The higher the education of surveyed patients, the better care they take by
using various dental products.
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ABSTRACT
The aim of research was to determine patients’ health behaviours in the range of
oral hygiene regarding their education and place of living. Study included 180 patients, 90 women and 90 men, aged 35-44 from a big city, smaller cities and villages
of West Pomerania region. Dental examination was performed, which allowed to evaluate oral health state. Questionnaire including utilization of dental services, oral hygiene and access to dental services was completed by patients. Regardless of gender,
education and place of living surveyed patients most often brush their teeth twice a
day. Patients from a big city more often than patients from smaller cities and villages
utilize various dental products. Patients with higher education take better care of their
oral hygiene by using wide range of dental products for maintenance of proper oral
cavity.
STRESZCZENIE
Celem pracy było zbadanie zachowań pacjentów w zakresie utrzymania higieny
jamy ustnej z uwzględnieniem ich wykształcenia oraz miejsca zamieszkania. Grupę
badawczą stanowiło 180 pacjentów, 90 kobiet i 90 mężczyzn w wieku 35-44 lata z
dużego miasta, małych miejscowości i wsi województwa zachodniopomorskiego.
Przeprowadzono lekarskie badanie stomatologiczne, które pozwoliło określić stan
zdrowia jamy ustnej pacjentów oraz badanie ankietowe dotyczące między innymi korzystania przez pacjentów ze świadczeń stomatologicznych, higieny jamy ustnej, dostępu do opieki stomatologicznej. Niezależnie od płci, wykształcenia i miejsca zamieszkania, pacjenci najczęściej myją zęby dwa razy dziennie. Badani pacjenci z dużego miasta częściej niż pacjenci z małych miejscowości i wsi używają różnorodnych
produktów higienicznych. Pacjenci z wyższym wykształceniem lepiej dbają o higienę
jamy ustnej, poprzez korzystanie z różnych środków i przyborów służących do utrzymywania prawidłowej higieny jamy ustnej.
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