ORAL HEALTH PROMOTION AND INTERVENTION ACTIVITIES

CARRIED OUT IN RURAL AREAS OF DAVANGERE DISTRICT.

A GOI – WHO COLLABORATIVE PROGRAMME

2006 - 2007

BAPUJI DENTAL COLLEGE AND HOSPITAL

DAVANGERE-577004
PROJECT TITLE: ORAL HEALTH PROMOTION AND INTERVENTION
ACTIVITIES CARRIED OUT IN RURAL AREAS OF DAVANGERE DISTRICT.

Principal Investigator :
Dr. RAJU H G
Department of Community Dentistry
Bapuji Dental College and Hospital
Davangere.

Co-Investigators :
Dr. NAGESH L
Department of Community Dentistry
Bapuji Dental College and Hospital
Davangere.

Dr. DEEPA D
Department of Periodontology and Implantology
Bapuji Dental College and Hospital
Davangere.

Contributors:
Dr. Cherian Varghese
Cluster Focal Point
(Non Communicable Diseases and Mental Health)
WHO – India Control Office
NEW DELHI.

Dr. K. Sadashiva Shetty,

Principal,
Bapuji Dental College and Hospital,
Davangere.

Dr. Kumar Rajan

National Consultant
WHO – India and Directorate General of Health Services
Government of India.

Post Graduate Students of Department Of Community Dentistry.

• Dr. Umesh. K, • Dr. Mohammed Imranullah,
• Dr. Siddana Goud. R, • Dr. Parappa Sajjan
• Dr. Shilpa Gunjal, • Dr. Muthu Karuppaiah,

Clinical Assistants of Department Of Community Dentistry

• Dr Deepa Reddy • Dr Sneha Bhat
• Dr Shweta R S • Dr Rukmini

i
 PREFACE

Oral health is an integral component of general health. Research in the past few

years has revealed the causal link between oral diseases and systemic diseases. Oral

health has also been found to profoundly influence the quality of life.

Dental caries and periodontal disease are the highly prevalent diseases in many

populations. They are highly irreversible once they occur and also have complex

etiology. Although primary preventive techniques exist, they do not confer total

protection. Dental caries continues to be a major problem in many countries, especially in

developing countries like India, where it is consistently reflecting increasing trend in last

couple of decades.

The point prevalence surveys conducted by the post graduate students in and

around Davangere have shown persistence of “untreated carious lesions” among children

in rural areas. It reflects either non-availability of oral health care services or poor oral

health seeking behavior of rural people.

Awareness related to oral health among them is also found to be poor. The

prevailing poor status of oral health prompted us to plan and execute an integrated

programme in the form of assessing oral health awareness, providing oral health

education and treating untreated carious lesions by ART technique for school children in

villages of Mayakonda Hobli. In addition, the oral health awareness was also provided to

selected school teachers and school children.

At this juncture we sincerely acknowledge the logistic support, expertise,

financial assistance and moral support extended by WHO in this endeavour.

ii
 CONTENTS

INDEX Page No.

1. Executive summary 01

2. Introduction 02

3. Aims & Objectives 04

4. Materials and Methods 05

5. Results 12

a. Descriptive data

b. Statistical analysis

c. Results

6. Discussion 21

7. Recommendations 23

8. References 24

9. Acknowledgements 25

10. Annexure 26

a. Photos.

b. Questionnaire on Oral Health for Adults/Children.

c. IEC Material.

iii
 EXECUTIVE SUMMARY

The present study was conducted in a rural area of Davangere district. It aimed at

assessing knowledge, attitude and practices of school children and school teachers

towards oral health in the selected area followed by re-evaluation after imparting oral

health education. The school children were assessed for dental caries experience and

treatment needs applying Dentition status Treatment need index followed by provision of

ART at the site for indicated carious lesions.

A total of 3937 school children aged 9-15yrs were screened and 1002 children

having caries were provided ART. The mean “DMF-T” was 1.3 and the mean ‘D’ was

0.95. A majority of the decayed teeth were unfilled typically representing lack of

treatment. The knowledge, attitudes and practices of school teachers showed appreciable

improvement after providing oral health education.

1
 INTRODUCTION

India is the sixth biggest country by its area but it is the second most populous

country. The developing economy, lack of qualified dental manpower in rural areas and

poor awareness towards oral health has contributed for steady raise in the prevalence of

caries in the last few decades. The annual health budget is 2% of Gross National Product

and there is no specific budget allocated or earmarked for oral health exclusively. There

is an urgent need for oral health policy which can provide the necessary guidelines for

improvement of oral health.

The presence of untreated (unfilled) carious lesions is quite common in rural

areas among school going children. Poor awareness about oral health, lack of dental man

power, lack of required infrastructure and lack of political will are some possible reasons

which have contributed to this picture.

ART is a novel method and highly practical method for treating dental caries in

rural population1. “Oral health promotion in the form of oral heath education + ART” in

an integrated module as developed in this project offers both primary and secondary

prevention to target population. ART is found to be very economical, patient friendly and

highly acceptable in rural masses.

Fear towards dentistry is one important reason which keeps people away from

seeking treatment for dental caries. The trauma caused by rotary instruments and the

noise generated by them all the more frightens the children. ART being a method which

advocates utilization of only hand instruments for cavity debridement, it is well

2
accepted2. The use of Glass Ionomer cement which brings in the advantage of secondary

caries prevention because of ‘Fluoride ion present in it.”

Hence in the present study Oral health promotion through oral health education

and provision of ART for indicated carious lesions were utilized in an integrated manner

for providing services to a rural population of Davangere district.

3
 OBJECTIVES

1) To assess the Knowledge, Attitude and Practices of rural school children and

school teachers towards oral hygiene, oral health and also to assess the dentition

status in school children of rural population.

2) To provide ART to needful 1000 school children.

3) To test the efficacy of ART technique among the school children in rural

population.

4) Children should be made aware of proper techniques of oral hygiene maintenance

measures through their school teachers, thus making it a self-sustainable

programme.

4
 MATERIALS AND METHODS

Brief profile of the area and population included

Davangere district lies in the central Karnataka. The district was newly formed on

August 15th, 1997. Previously, Davangere was a taluk and it was included under

Chitradurga district. Later the district was formed as a result of restructuring of the

districts of Karnataka state. The sex ratio in the district was 952 women to 1000 men. The

literacy rate in the district was 67.4%. Davangere district has a total of six taluks. The

taluks included under the Davangere district are Davangere, Harihar, Channagiri,

Honnali, Harapanahalli and Jagalur.

Davangere taluk has an area of 936.1 kms with a population density of

644person/sq km. It has a total of 153 villages and 40 gram Panchayats. Davangere taluk

has a total population of 6, 02,523 with majority of people residing in Davangere

city.Mayakonda is a Hobli situated in Davangere taluk at a distance of 35 kms. It mainly

consists of agricultural community.

Paddy, Sugar cane, Groundnut, Sunflower, Cotton, Jowar, Ragi, Banana, Mango

to list few which are priority crops. Davangere is also having growing community for

change in traditional crops to medicine plants, floriculture and hybrid crops. Regulated

market located in heart of Davangere city hosts platform for both farmer and dealer for

business. There are many rice mills, oil extraction mills, cotton mills and agriculture

related industries in and around city.

5
 6
3

5
8
7 4
1 2

6
MATERIALS AND INSTRUMENTS USED:

The essential Instruments for ART are: Mouth mirror, straight probe, explorer and pair

of tweezers, hatchet, spoon excavators (small, medium and large), plastic filling

instrument and WHO CPI probe.

The essential materials are: Gloves, cotton roll and pellets, GIC Fuji ix,

Petroleum jelly, plastic strips and articulation paper.

Sufficient numbers of instruments and required amount of material were

made available to have smooth uninterrupted examination and treatment. In the field, the

used instruments were disinfected using Korsolex.

METHODS
ORGANIZATION AND ADMINSTRATION WORKOUT

1) APPROVAL FROM AUTHORITIES:

Permission to implement the project was obtained from the concerned authorities,

DDPI and Gram Panchayats of Mayakonda Hobli, School Head masters, school teachers

and parents of school children.

2) REQUIRED INFORMATION ABOUT STUDY AREAS:

All required and relevant information regarding the Mayakonda Hobli including

Davangere taluk map was obtained from the census office.

3) SCHEDULE OF THE PROJECT:

The project was systematically scheduled to spread over a period of one year

starting from the month of May 2006. A detailed weekly and monthly schedule was

prepared well in advance by informing and obtaining consent from authorities of

respective rural areas. On an average, 50 subjects were interviewed, examined and

7
treated on any given day during the survey period excluding the week ends. Even though

a detailed schedule plan was prepared well in advance, few adjustments and changes had

to be made while working it out practically.

4) INFORMED CONSENT:

Voluntary informed consent was obtained from the parents of selected school

children and the school teachers before administering the questionnaire and providing

treatment.

5) METHOD OF OBTAINING DATA:

The required data, for conducting this study, was collected and recorded using

printed questionnaire proforma. A structured questionnaire proforma was used which

included questions regarding personal data, socio-demographic profile and all the

probable common risk factors associated with dental caries. This questionnaire in English

script was translated into Kannada script (local language) by a recognized translator so

that it could be used conveniently during fieldwork. The questionnaire was pilot tested

for feasibility and validity. A few modifications were done and “final proforma” was

designed.

6) DIAGNOSTIC CRITERIA FOR DENTAL CARIES:

Dental caries was recorded according to the criteria of Dentition status and treatment

need index as described by WHO-Oral health survey manual (1997).3

7) CALIBRATION AND TRAINING:

Before the implementation of the project, the principal investigator carried out

training of the whole team regarding the criteria for diagnosing the dental caries and also

the treatment of dental caries using the ART approach. A group of subjects were selected

8
and examined for dental caries. Subjects were reexamined on successive days using same

diagnostic criteria. The kappa statistics for inter-examiner variability was 0.7 and for

intra-examiner variability was 0.8.

8) PILOT STUDY:

A pilot study was conducted on 50 individuals in Mayakonda of Davangere taluk

in order to check the feasibility and clarity of the questions in the proforma. Few

modifications in the questionnaire in terms of rephrasing, certain additions and deletions

were done before finalizing the questionnaire.

9) SAMPLE SIZE AND SAMPLING PROCEDURE

Bapuji Dental College & Hospital is a well-known institution in India and is

located in the heart of Davangere city. The majority of field activities of Bapuji Dental

College & Hospital on improvement of oral health of population are focused on places, in

and around Davangere. Even though, there are two dental colleges, serving the

population of rural Davangere, the prevalence of untreated carious lesions is still high,

especially in children. This was another major reason for implementation of the project in

rural Davangere. Initially, the list of all the schools in Davangere taluk was obtained

from the DDPI office and those schools covered under Davangere south were included in

the study. The reason for including Davangere south was because, the southern part of

Davangere was found to show a higher prevalence of dental diseases when compared to

northern part and this was attributed to lack of awareness regarding importance of oral

health and lack of affordability for dental treatment.

9
 Mayakonda Hobli was selected for the project implementation, which is situated

35kms away from Davangere city. The village of Mayakonda has a population of 5000,

and is the centre place for a majority of surrounding 16 villages.Children from the

villages belonging to this Hobli, study in the schools situated in the head quarters of

Hobli. It was convenient to have an access to school children at school premises in the

Hobli level, which can be an ideal representation of the complete Hobli. All the schools

present in the Mayakonda Hobli were included in the project. Initially, all the school

children aged, 6-16 years were included and examined. Later, only the age group range

of 9-15 years were included in the project because the treatment need was high in the

permanent dentition.

10) INFECTION CONTROL:

The examiner used disposable mouth masks and gloves during examination. The

sterilization of the instruments was done using both chemical and physical methods.

Korsolex (Gluteraldehyde – 7.0 gms; 1-6 dihydroxy 2.5 dioxyhexane – 8.2 gms and

polymethyl urea derivative – 11.6 gms) was diluted by adding 1 part to 9 parts of potable

water and the instruments were disinfected using this disinfectant and later sterilization

was carried out by placing instruments in the pressure cooker. At the end of the day’s

clinical examination and treatment, the instruments were sterilized in autoclave.

IMPLEMENTATION OF THE PROJECT:

The implementation of the project was done in two parts. The part one was related

to school children and the part two was related to school teachers.

10
PART ONE:

1. Oral examination of each subject was done by seating each subject on a chair in

the daylight using required instruments. The investigator applied Dentition status

and treatment need index to assess caries experience and the data was recorded in

the specially prepared proforma.

2. Provided Atraumatic Restorative Treatment for 1002 school children.

3. The knowledge, attitude and practices of selected school children towards oral

health was recorded by using the structured questionnaire in local language.

4. Provided oral health education on scheduled days using the educational aids like

models, charts, manuals and audio-visual aids to the school children.

PART TWO

This part constituted of:-

1. Assessment of knowledge, attitude and practices of school teachers towards oral

health by using pre-designed questionnaire.

2. Providing oral health education to all selected school teachers using models,

manuals, charts, and audio-visual models at school premises.

3. Evaluation of knowledge, attitude and practices towards oral hygiene maintenance

and oral health was done after educational intervention using specific

questionnaire in selected school children and school teachers.

11
 RESULTS

A project sponsored by WHO was implemented in Mayakonda Hobli, to assess

the knowledge, attitude and practices of all the school children belonging to 9-16 years of

age towards oral hygiene practices and oral health. The school children were also

screened for their caries experience using Dentition status and treatment need index, a

total of 3937 school children aged 9-15 years were screened and 1002 school children

having caries were provided ART.

The mean DMFT was found to be 1.3. The mean “D”, mean “M” and mean “F”

were found to be 0.95, 0.15and 0.20 respectively. The prevalence of dental caries was

found to 25.45% in the school children.

1000 school teachers from Davangere taluk were assessed for their knowledge,

attitude and practices towards oral hygiene and oral health using questionnaire. They

were later provided oral health education and post-interventional evaluation was done

using the same questionnaire to know the effect of oral health education.

The knowledge attitude and practices(KAP) of school children was found to be

less than satisfactory when the data of the questionnaire was subjected to qualitative

assessment whereas among school teachers it was found to be just satisfactory. Post

educational intervention KAP assessment showed improvement in their oral health

awareness.

12
Teacher’s results

The following are the findings of the questionnaire study conducted among

teachers.

K-1. Has oral health got any role on general health?

a. Yes b. No c. Don’t know

The above graph shows the distribution of responses to K-1. Most of the

individuals (98%) said oral health played an important role in general health.

K - 2. How can you prevent dental problems?

a. Avoiding sweets and sticky food

b. Brushing regularly

c. Mouth rinsing after meals

d. Regularly visiting a dentist

e. All of the above

13
 The above graph shows the distribution of responses to K-2. Most of the

individuals (30%) said by avoiding sweets and sticky foods they can prevent dental

problems. 26% of the individuals said brushing regularly can prevent dental problems.

After health education majority of the teachers appraised the role of all other reasons.

K - 3. Do you know that clean mouth can prevent tooth decay?

a. Yes b. No

The above graph shows the distribution of responses to K-3. A maximum number

of individuals said that they knew a clean mouth prevents dental decay.

14
K - 4. Does your tooth paste contain fluoride?

a. Yes b. No c. Don’t know

56

The above graph shows the responses to K-4. 56% of the individuals used

fluoridated tooth paste. 16% of the individuals used non-fluoridated tooth paste and the

remaining didn’t know whether they used fluoridated tooth paste or not.

After health education majority of the teachers came to know that tooth paste

contains fluoride and the anti-cariogenic property of Fluorides.

K - 5. Do you know what Floss is?

a. Yes b. No

15
 This graph shows the distribution of responses to K-5. A total of 55% of the

individuals did not know what floss is. The remaining 45% said that they knew what was

meant by floss. After health education everybody learnt how to use floss.

K - 6. Regular cleaning of mouth can prevent

a. Bleeding from gums

b. Loosening of gums

c. Loss of teeth

d. Bad smell

e. All the above

The above graph shows the distribution of responses to K-6. 32% of the total

respondents said that regular cleaning of mouth can prevent bleeding from gums. After

health education majority of them claim that clean mouth can prevent all of those

conditions.

16
P - 1. How often you clean your teeth?

a. Once daily

b. Twice daily

c. More than twice daily

d. After every meal

The above graph shows the distribution of responses to P-1. More than 50% of the

individuals cleaned their teeth once daily (53%). Very few (5%) cleaned their teeth after

every meal. After health education they came to know that brushing after every meal is

more beneficial.

P - 2. How often you change your brush?

a. Once in 3 months

b. Once in 6 months

c. Yearly once

d. When bristles get frayed up

e. Don’t know exactly

17
 The above graph shows the distribution of responses to P-2. 59% of the total

individuals changed their brush once in 3 months. Only 3% of the individuals changed

their brush yearly once. After health education they appreciated the loss of efficiency due

to fraying of the bristles.

G - 1. Have you made an attempt to give education related to teeth and mouth to your

students?

a. Yes b. No

The above graph shows the distribution of responses to G-1. A maximum number

of individuals (92%) made an attempt to give education related to teeth and mouth to

18
their students. The remaining (8%) did not make an attempt to give education related to

teeth and mouth to their students.

After health education they were appraised about the profound influence they bear

in modifying the children’s attitude towards oral hygiene practices.

If yes, to question no G - 1 then

G – 2 . What kind of oral health education have you given to your school children?

a. Education about the teeth types, functions, structure and eruption.

b. Education about brushing, good dietary habits, injurious oral habits.

c. Education about tooth decay, gum diseases, irregular teeth, their causes, treatment and

prevention.

The above graph shows the distribution of responses to G-2. More than 50% of

the teachers gave education about the teeth types, functions, structure and eruption

(56%).

G - 3. How have your students responded to oral health education?

a. Favorably

b. Unfavorably

19
 97

The above graph shows the distribution of responses to G-3. 93% of the students

responded favorably to oral health education.

G - 4. Do you think oral health education has benefited your school children?

a. Yes b. No

This graph shows the distribution of responses to G-4. 97% of the respondents

said oral health education has benefited their school children.

20
 DISCUSSION
Oral health Promotion:

Primary school teachers have been utilized as health education agents for school

children in many countries. This was in response to the call by the World Health

Organization (WHO) for the use of alternative personnel in the primary health care

approach in the struggle to fight preventable diseases. The present project aimed at

assessing the knowledge, attitude and practices of selected school children and school

teachers towards oral hygiene and oral health in selected rural areas of Davangere.

“Pre-test and post-test within group assessment” of knowledge, attitude and

practices towards oral hygiene and oral health among the school teachers reveal they had

moderate attitude and behavior towards oral health related issues and these results are

similar to study done by Mwangosi IEAT and his associates in Tanzania.4

Teachers wanted more information about oral health and were in favor of

including topics related to oral health in the school curriculum. Though they knew sticky

sweets are responsible for caries the exact mechanism of caries occurrence was unknown

to them.

In school children the knowledge, attitudes and practices towards oral hygiene

and oral health was less than satisfactory. A significant number of school children though

were using tooth brush were not aware of its importance and exact method of using them.

After providing oral health education children were found to have gained better

knowledge. For attitudes and practices to change it may take more time as it is said that

health education has long term impact than immediate effect. Similar results were

obtained in study done by Peterson PE et al.5

21
Intervention programme:

Dental caries is a highly prevalent dental disease amongst school children, which

is frequently neglected by the children and the parents until it reaches terminal stages

with painful consequences. Multiple untreated carious lesions are frequently observed

among rural children because of low priority attached to dental care by the rural masses.

Lack of awareness, unavailability of dental man power and fear towards dental treatment

compound this problem. The present intervention programme consisted of assessing the

dentition status and treatment needs of the children aged 9-15 yrs and providing

atraumatic restorative treatment to the selected sample of school children.

Atraumatic restorative treatment (ART) is a new approach to the management of

dental caries, it is a treatment procedure that involves removal of soft, demineralized

tooth tissue, using hand instruments alone followed by restoration of the tooth with an

adhesive restorative material, such as Glass Ionomer cement in the present programme

Fuji IX Glass Ionomer Cement was used for restoration.

In this project out of 3932 school children 1002 school children were selected to

receive Atraumatic Restorative Treatment. The prevalence of dental caries was found to

be 25.45%. In this project, it was both feasible and practical to use the ART approach in

rural school children. A total of 1416 teeth were restored by this technique among 1002

selected school children. It was encouraging to find that vast majority of these young

children who had no prior dental treatment experience found this treatment approach

acceptable. This was probably because the treatment was provided in the familiar setting

of their schools. Similar findings were reported by Lo ECM AND Holmagren J.6

22
 RECOMMENDATIONS

In the current study it was observed that the rural school going children although

had less than alarming level of caries experience, a majority of carious lesions were un-

restored and active by nature. If allowed to continue would certainly result in

complications. The knowledge, attitude and practices towards oral health although not

dismal but was poor among school children and moderate among school teachers.

Evaluation after the educational intervention showed positive changes in the Knowledge,

Attitude and Practices of school teachers which may facilitate transfer to school children

for a long term.

1. Oral health promotion through well structured oral health education programme

(tailor method) can create positive change in awareness and also sensitize them to the

respective issues. Encourage oral health promotion activities at primary health care

level.

2. At primary health centre a special manpower as “oral health educator” can be created

by giving training or the existing health educators can be trained by conducting crash

courses, so that they can take care of oral health education to rural masses.

3. ART – was found to be well accepted treatment by rural school children. Specific

manpower (A special dental auxiliary), named as ‘RURAL SCHOOL DENTAL

NURSE’ can be trained to deliver ART to rural school children.

4. The same rural school dental nurse can be delegated the duty to provide ART for

rural masses other than the school children during school vacations.

5. Ministry of Health should encourage and endorse “National oral health policy” which

can provide clear directions for oral health care delivery at national level.

23
 REFERENCES

1. Frencken JE, Songpaisan Y, Phantumvanit P, Pilot T, An atraumatic

restorative treatment (ART); Rationale, Technique and Development. J Public

health dent 1996; 56 (3): 135-40.

2. Frencken JE, Holmgren CJ. Manual for ART.

3. WHO, ORAL HEALTH SURVEY - BASIC METHODS, 4TH EDITON

(1997),GENEVA.

4. Mwangosi I E A T, Nyandindi U. oral health related knowledge, behaviors,

attitude and self assessed status of primary school teachers in Tanzania. Int Dent

J. 2002: 52(3) : 130-136

5. Petersen PE, Danila I, Samoila A. Oral health behavior, knowledge, and

attitudes of children, mothers, and schoolteachers in Romania in 1993. Acta

Odontol Scand. 1995 Dec;53(6):363-8.

6. Lo E C M and Holmgren J . Provision of atraumatic restorative treatment (ART)

restorations to Chinese pre-school children- a 30-month evaluation. Intl J Paed

dent. 2001;11: 3-10

7. Multi centric Oral Health Survey of WHO – Govt. of India, Unpublished

data, 2004-05.

24
 AKNOWLEDGEMENTS

It is my immense pleasure to thank the World Health Organization and the

Government of India for selecting our institution for the project.

It is my deep sense of gratitude; I thank Dr. Cherian Verghese and Dr. Kumar

Rajan, for their inestimable aid, unflinching support, keen surveillance, valuable guidance

and help rendered in completing this project.

I am grateful to Dr. K. Sadashiva Shetty, Principal, Bapuji Dental College and

Hospital, Davangere, for his ever encouraging support of academic pursuits.

I would like to thank Dr Nagesh L, Professor and Head, Department of

Community Dentistry with reference, for he has guided and inspired me throughout the

project.

I would like to thank Dr.Deepa D., Reader, Department of Periodontics and all the

post-graduate students of Department of Community Dentistry, for their help in

successively completing this project.

I thank the deputy director of public instructions and the block educational

officer, Davangere. For their cooperation and I also thank the school teachers and the

school children for their active participation.

My sincere thanks to Mrs. Rajshree Patil, Bio-statistician, S S Institue of Medical

Sciences, Davangere for her help in carrying out the statistical analysis.

Dr. Raju. H.G

25
 ANNEXURE
Photographs of school children being screened

26
Photograph Showing Providing Health Education to the School Children

27
Photographs of schoolchildren undergoing ART

28
Photograph showing Investigator discussing with National Consultant (WHO)

29
 Questionnaire for Children
WHO PROJECT

KNOWLEDGE, ATTITUDES AND PRACTICES OF SCHOOL CHILDREN IN

RURAL AREAS OF DAVANAGERE DISTRICT TOWARDS ORAL HYGIENE

Note: Please tick the appropriate answer ( √ )

A. KNOWLEDGE:

K1. Has oral health got any role on general health?

a. Yes b. No c. Don’t know .

K2. What does irregular tooth brushing cause?

a. Decay
b. Gum Disease
c. Bad Breath
d. Stains on Teeth
e. Nothing
f. Don’t Know

K3. Why do we get dental problems?

a. Eating sweets and ice creams
b. Not brushing properly
c. Not rinsing the mouth
d. Not regularly visiting a dentist
e. Any others specify…..

K4. How can you prevent dental problems?

a. Avoiding sweets and sticky food
b. Brushing regularly
c. Mouth rinsing after meals
d. Regularly visiting a dentist
e. All of the above.

K5. Do you know that clean mouth can prevent tooth decay?
a. Yes b.No

K6. Do you know that a dentist can clean and polish your teeth?
a. Yes b.No

K7. Does your tooth paste contain fluoride?

a. Yes b.No c. Don’t know

30
 K8. Do you know what is a floss?
a. Yes b.No

K9. Regular cleaning of mouth can prevent

a. Bleeding from gums
b. Loosening of gums
c. Loss of teeth
d. Bad smell
e. Any other specify…….

B. ATTITUDE

A1. Do you think maintaining healthy mouth is individual responsibility?

a. Yes b.No

A2. Do you think that improving and maintaining health of the mouth is not in your
Control?
a. Yes b.No

A3. Have you visited a dentist before?

a. Yes b.No

A4. If yes, then for what reason?

a. Decay
b. Pain
c. Filling
d. Extraction
Any other reason specify

A5. Do you think it is required to visit a dentist periodically to maintain the health of
Your teeth and mouth?
a. Yes b.No

C. PRACTICE

P1. How do you clean your teeth?

a. Tooth Brush and Tooth Paste
b. Tooth Brush and Tooth Powder
c. Finger and Tooth Powder
d. Neem Sticks
e. Any other Specify

P2. How often you clean your teeth?

a. Once daily
b. Twice daily

31
 c. More than twice daily
d. After every meal

P3. How do you brush your teeth?

a. Use horizontal strokes
b. Use vertical strokes
c. Both in horizontal and vertical directions
d. Circular strokes

P4. How often you change your brush?

a. Once in 3 months
b. Once in 6 months
c. Yearly once
d. When bristles get frayed up
e. Don’t know exactly

P5. What amount of paste you apply on your brush?

a. Full length of bristles
b. Half length of bristles
c. Pea sized amount

P6. Do you press the paste in between the bristles?

a. Yes b.No

P7. Do you rinse your mouth after meals?

a. Yes b.No c. Sometimes

P8. Do you clean your tongue?

a. Yes b.No

P9. How do you clean your tongue?

a. Tongue cleaner
b. Fingers
c. Tooth brush
d. Any others specify …..

P10. Do you use any other oral hygiene aids?

a. Mouth Wash
b. Dental Floss
c. Tooth Picks
d. Any Other Specify

32
 DENTITION STATUS AND TREATMENT NEEDS
55 54 53 52 51 61 62 63 64 65
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
C
R
T
85 84 83 82 81 71 72 73 74 75
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
C
R
T

Primary teeth Permanent teeth

crown crown / root
A 0
B 1
C 2
D 3
E 4
- 5
F 6
G 7
- 8
T T
Status Treatment
0 Sound 0 = None
1 Decayed P = Preventive, caries
arresting care
2 Filled & decayed F = Fissure sealant
3 Filled, no decay 1 = One surface filling
- Missing as a result of caries 2 = Two of more surface
fillings
- Missing any other reason 3 = Crown for any reason
- Fissure sealant 4 = Veneer or laminate
7 Bridge abutment special crownor veneer 5 = Pulp care and restoration
/ implant
8 Unerupted tooth (Crown) / unexposed 6 = Extraction
root
- Trauma (fracture) 7 = Need for other can (specify) …..

- 9 9 Not recorded 8 = Need for other can (specify …..

9 = Not recorded

33
 QUESTIONNAIRE FOR SCHOOL TEACHERS
KNOWLEDGE, ATTITUDES AND PRACTICES OF SCHOOL TEACHERS
WORKING IN RURAL AREAS OF DAVANAGERE DISTRICT TOWARDS ORAL
HYGIENE

Note: Please tick the appropriate answer ( √ )

A. KNOWLEDGE:

K1. Has oral health got any role on general health?

b. Yes b. No c. Don’t know .

K2. What does irregular tooth brushing cause?

a. Decay
b. Gum Disease
c. Bad Breath
d. Stains on Teeth
e. Nothing
f. Don’t Know

K3. Why do we get dental problems?

c. Eating sweets and ice creams
d. Not brushing properly
e. Not rinsing the mouth
f. Not regularly visiting a dentist
g. Any others specify…..

K4. How can you prevent dental problems?

h. Avoiding sweets and sticky food
i. Brushing regularly
j. Mouth rinsing after meals
k. Regularly visiting a dentist
l. Any other specify …..

K5. Do you know that clean mouth can prevent tooth decay?
a. Yes b.No

K6. Do you know that a dentist can clean and polish your teeth?
a. Yes b.No

K7. Does your tooth paste contain fluoride?

a. Yes b.No c. Don’t know

K8. Do you know what is floss?

a. Yes b.No

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 K9. Regular cleaning of mouth can prevent
a. Bleeding from gums
b. Loosening of gums
c. Loss of teeth
d. Bad smell
e. Any other specify…….

B. ATTITUDE

A1. Do you think maintaining healthy mouth is individual responsibility?

a. Yes b.No

A2. Do you think that improving and maintaining health of the mouth is not in your
Control?
a. Yes b.No

A3. Have you visited a dentist before?

a. Yes b.No

A4. If yes, then for what reason?

a. Decay
b. Pain
c. Filling
d. Extraction
Any other reason specify

A5. Do you think it is required to visit a dentist periodically to maintain the health of
Your teeth and mouth?
a. Yes b.No

C. PRACTICE

P1. How do you clean your teeth?

a. Tooth Brush and Tooth Paste
b. Tooth Brush and Tooth Powder
c. Finger and Tooth Powder
d. Neem Sticks
e. Any other Specify

35
P2. How often you clean your teeth?
a. Once daily
b. Twice daily
c. More than twice daily
d. After every meal

P3. How do you brush your teeth?

a. Use horizontal strokes
b. Use vertical strokes
c. Both in horizontal and vertical directions
d. Circular strokes

P4. How often you change your brush?

a. Once in 3 months
b. Once in 6 months
c. Yearly once
d. When bristles get frayed up
e. Don’t know exactly

P5. What amount of paste you apply on your brush?

a. Full length of bristles
b. Half length of bristles
c. Pea sized amount

P6. Do you press the paste in between the bristles?

a. Yes b.No

P7. Do you rinse your mouth after meals?

a. Yes b.No c. Sometimes

P8. Do you clean your tongue?

a. Yes b.No

P9. How do you clean your tongue?

a. Tongue cleaner
b. Fingers
c. Tooth brush
d. Any others specify …..

P10. Do you use any other oral hygiene aids?

a. Mouth Wash
b. Dental Floss
c. Tooth Picks
d. Any Other Specify………

36
D. GENERAL

G1. Are there topics related to teeth and mouth in the present school curriculum?
a. Yes b.No

G2. Have you been trained to give education on topics related to teeth and mouth to
School children?
a. Yes b.No

G3. Have you made an attempt to give education related to teeth and mouth to your
Students?
a. Yes b.No

If yes, to question no G3 then

G4. What kind of oral health education have you given to your school children?
a. Education about the teeth types, functions, structure and eruption.
b. Education about brushing, good dietary habits, injurious oral habits.
c. Education about tooth decay, gum diseases, irregular teeth, their causes, treatment
and prevention.

G5. What methods are you employing to give oral health education to school children?
a. Oral Health Talks
b. Models, Charts and Posters
c. Any others

G6. How have your students responded to oral health education?

a. Favorably
b. Unfavorably

G7. Do you think oral health education has benefited your school children?
a. Yes b. No

37
 LIST OF SCHOOLS

Sl no School
1 Government high school, Avaragolla.
2 Government higher primary school, Avaragolla.
3 Government higher primary school Angodu
4 Government high school, Huvinamadu
5 Government higher primary school, Huvinamadu
6 Sri maganur basappa high school, Taralabalunagara, belavanuru
7 Government high school, Ramagondanahalli
8 P.N.H.G.K. High school, Attigere
9 Sri maralu siddeshwara high school, Mayakonda
10 Government higher primary school, Gopnal
11 Government junior college, Gopnal
12 Government Urdu primary school, Gopnal
13 Government higher primary school, Taralabalunagara
14 Government higher primary school, Hadadi
15 Sri matruti high school, Davangere
16 Sri maruti junior college, Hadadi
17 Government higher primary school, Bada
18 Government higher primary school, Anaberu
19 Government pre university college, Mayakonda
20 Government higher primary school, Mayakonda
21 Government pre university college, Mayakonda
22 Girls residential high school, Mayakonda
23 Government higher primary boys school, Mayakonda
24 S T G school, Bada
25 Sri Anaberu kenchappa high school, Bada
26 Government higher primary girls school, Mayakonda
27 S A K higher primary school, Bada
28 S G V boys school, Anaberu
29 Government higher primary school, Mayakonda

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IEC Materials: ( Teacher’s manual)

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