KELAB PENYELIDIKAN

TOPIC: RESEARCH ON THE IMPORTANCE OF ORAL HYGIENE NAME: CHEAH MEN HOW ALEXANDER JOSEPH ALPHONSO JONATHAN HENG FUQIANG LAU KAH LIN CHONG HOC LEONG SATHES A/L R.SEKAR SAYSTRI A/P ELANCHELIAN
CLASS: 6AB & 6AS

PROBLEM STATEMENT:
What is the importance of oral hygiene and how it affects our oral health?

Purpose of The Study:
TO INVESTIGATE THE TREND OF ORAL HYGIENE OF PEOPLE AND TO INSTIL THE AWARENESS TO PRACTISING ORAL HYGIENE AND ENSURE THE ORAL HEALTH.

INTRODUCTION
Hygiene (from Greek hygienos) is a science concerned with the investigations of environmental factors that affect human health. It studies how the human body responds to them. Obeying the rules of proper oral hygiene is of primary importance in the prevention of dental caries and periodontal diseases. Health education is also very important in dentistry. It is a basic issue of modern prevention programs and is included in all curricula of medical courses. Dental health education is one of the preventive measures. Its aim is to raise awareness and motivate pro-health behaviors to maintain good oral health. The knowledge of prophylactic rules and their application in practice, necessary knowledge and thorough information adjusted to the patient’s age are of high impact in accomplishing good oral health.

DEFINITIONS
What is oral hygiene? Oral hygiene is the practice of keeping the mouth and teeth clean to prevent dental problems and bad breath. Oral hygiene is very important and if we aren't practicing good oral hygiene we are opening the door to dental problems that isn't easy to close. Periodontal Disease is a bacteria infection that affects the gums and bone that support the teeth. If it is left to itself and not treated, it will lead to tooth loss. Periodontal Disease includes gingivitis and periodontitis.

Literature review
SURYEY 1
Survey: l The purpose of the work is to estimate the knowledge connected with the rules of the oral hygiene and its correlation with everyday habits among the students of Dental studies and Medical Studies at Medical School in Lublin and Polytechnics of Lublin.

Country: Poland Conducted by: Krawczyk D, Pels E, Prucia G (Chair and Department of Pedodontics, F. Skubiszewski Medical University of Lublin, Poland) Kosek K, Hoehne D (Students’ Scientific Society, Medical University of Lublin, Poland) Scale: A survey was conducted among 483 students: 58 2nd-year and 88 5th-year students of dentistry, 97 2nd year and 51 5th-year students of medicine and 108 2nd-year and 81 5th-year students from The Polytechnics of Lublin.

• Findings and discussion
Tab. 1 presents the results concerning the frequency of dental visits. They revealed that 60.9% students of dentistry (63.2% 2nd-year and 59.1% 5th-year students), 48.65% students of medicine (49.5% 2nd-year and 47.1% 5th-year students) and 38.38% students of polytechnics (41.1% 2nd-year and 34.6% 5th-year students) go to the dentist every 6 months. Chi2 test found statistically significant differences among the students of dentistry, medicine and polytechnics concerning the answer of going to the dentist once or less than once a year: 21.15%, 27.7%and 41.62% students respectively go to the dentist once a year (Chi2=15.075, p=0.0005); 4.49% students of dentistry, 13.51% students of medicine and 14.05% students of polytechnics go to the dentist less than once a year (Chi2=16.470, p=0.00026). Tab. 2 presents the causes of such frequency of dental visits. Most often mentioned cause was no need to see the dentist: 57.05% students of dentistry, 60.81%% students of medicine and 50.7% students of polytechnics. Another cause was lack of time mentioned by 22.4% students of dentistry, 25.68% students of medicine and 21.13% students of polytechnics. Fear of dental visit was mentioned by 14.74% students of dentistry, 8.11% students of medicine and 14.09% students of polytechnics. Additionally the students of polytechnics reported lack of financial means among the causes (14.09%). Tab. 3 lists most common factors that motivate to make a dental appointment. Dental check-up was mentioned by 64.7% students of dentistry (66.7% 2nd-year and 63.6% 5thyear students), 62.84% students of medicine (64.6% 2nd-year and 59.6% 5th-year students) and 51.85% students of polytechnics (47.3% 2nd-year and 58.2% 5th-year students). Dental caries was the cause for 23.08% students of dentistry (13.0% 2nd-year and 30.7% 5th-year students), 14.87% students of medicine (11.1% 2nd-year and 21.2% 5th-year students) and 19.05% students of polytechnics (14.5% 2nd-year and 25.3% 5th-year students). Chi2 test revealed statistically significant differences among the students of dentistry, medicine and polytechnics as far as pain being the cause of dental appointment was concerned: 7.05%, 16.22% and 22.22% respectively (Chi2=13.2501, p=0.0013).

Sets of Data and table
Table 1. How often do you visit dental office? (in %)

Answer

Students of dentistry

Students of medicine

Students of polytechnics

2nd-year 5th-year Every 3 months 7.4 3.8 63.2 34.6

Total 18.2 6.49 59.1 38.38

2nd-year 5th-year Total 13.46 11.3

2nd-year 5th-year Total 7.8 10.14 7.5

Every 6 months

60.9

49.5

47.1

48.65

41.1

Once a year

25.0 52.6

18.2 41.62
4.4 9.0

21.15

26.8

29.4

27.7

33.6

Less than once a year

17.8

4.5 14.05

4.49

12.4

15.7

13.51

Table 2. Answer

What influences the frequency of dental visits? (in %) Students of dentistry Students of medicine Students of polytechnics

2nd-year 5th-year Fear 7.5 15.1

Total 17.9 14.09 3.0 16.1 17.9 21.13 57.7 50.70

2nd-year 5th-year Total 14.74 9.5

2nd-year 5th-year Total 1.9 8.11 13.3

Lack of financial means 12.5 Lack of time 28.4 17.2 61.2 51.6

6.4 14.09 22.44

5.77

6.3

1.9

4.73

25.3

32.1

25.68

24.2

No need

57.05

58.9

64.2

60.81

50.0

Table 3. Answer polytechnics

What are the causes of making a dental appointment? (in %) Students of dentistry Students of medicine Students of

2nd-year 5th-year

Total

2nd-year 5th-year Total

2nd-year 5th-year Total

Dental appointment 66.7 47.3 Dental caries 13.0 14.5 11.6 31.8 8.7 6.4

63.6 58.2 30.7 25.3 3.4 8.9 2.3 7.6

64.74 51.85 23.08 19.05 7.05 22.22 5.13 6.88

64.6

59.6

62.84

11.1

21.2

14.87

Pain

16.2

15.4

16.22

other causes

8.1

3.8

6.76

SURVEY 2

Survey: 1. To ascertain the dental caries prevalence among school children in the age group of 6-12 years. 2. To gain knowledge about their brushing habits' in between meal snacking, their knowledge about dental decay and their attitude towards dental professionals.

Country: India

Conducted by: N Joshi, R Rajesh, M Sunitha (Department of Pedodontics, Sree Mookambika Institute of Dental Sciences, Kulasekharam, K.K. District, Tamil Nadu, India)
R Rajesh (Department of Pedodontics, Sree Mookambika Institute of Dental Sciences, V.P.M Hospital complex, Kulashekaram, K.K. District, Tamil Nadu - 629 161 India)

Scale:150 children

Materials and Matter

This study was conducted at the Government Primary School, Kulashekharam, Tamil Nadu. A written consent was obtained from the school authorities and parents before the commencement of this study. Hundred and fifty children in the age group of 6-12 years were selected from the school by simple random sampling. Care was taken to include those children under same socioeconomic strata and those exhibiting similar dietary patterns. The children were examined in their respective schools in an ordinary chair in broad daylight facing away from sunlight. Examination was carried out using mouth mirror and explorer. The instruments used were sterilized after every single use. The children were asked to fill a questionnaire that included the vital statistics, their knowledge about dental decay, their brushing habits, in-between meal snacking procedure and attitude toward dentists. After the questionnaire was answered the children were examined for DMFT and deft. The water from the local well, and from the surrounding areas was collected and the fluoride level was tested at the Regional Research Laboratory, Trivandrum. The data gathered was analysed using chi square test in the statistical package SPSS and the results were tabulated.

FINDINGS
A total of 150 children in the age group of 6-12 years with an equal distribution of 75 boys and 75 girls were included in the study. Out of the total population, 77% of the children were affected by dental caries. Distribution according to the gender showed that 80% of the boys and 73% of girls were affected with dental caries. There was no statistically significant difference between the dental caries experience of boys and girls. Sixty-seven percent of children (57% boys and 76% girls) reported sweet snacking in between meals. Here there was a significant difference between boys and girls. Significantly higher number of boys (76%) reported a good knowledge about dental caries, whereas only 47% of the girls knew about it.
Seventy-six percent of girls amongst the total number of children and 41% of boys were scared of the dentists. However, only 59% of the total population was reportedly scared of the dentist. This also showed a highly significant relationship. The mean DMFT was 1.25 for boys and 0.96 for girls, whereas deft showed ranges of 1.36 for girls and 2.09 for boys (bar diagram). The brushing habits and its association with the gender showed that when 83% of boys brushed with brush and paste, only 68% of the girls did the same. Paddy husk powder was used by 25% of girls, whereas only 9% of boys used it. The water from the local areas was collected and tested to determine its fluoride content at the Regional Research Laboratory, Trivandrum, Kerala. The fluoride content was found to be 0.17 part per million.

DATA

Literature review
SURYEY 3
Survey:
The main aims of our study was thus to determine the oral hygiene levels and periodontal status among terapanthi svetambar Jain monks attending a Chaturmass in Udaipur, India, and to correlate them with various demographic variables of the Jain monks, including age, oral hygiene habits, caloric intake and education level.

Country : India Conducted by: Manish JainII; Anmol MathurII; Santhosh KumarI; Prabu DuraiswamyII; Suhas KulkarniII IBDS - Department of Preventive & Community Dentistry, Darshan Dental College and Hospital, Udaipur, Rajasthan, India

IIMDS - Department of Preventive & Community Dentistry, Darshan Dental College and Hospital, Udaipur, Rajasthan, India

ABSTRACT
The main objective of the study was to determine the oral hygiene levels and periodontal status among Jain monks attending a Chaturmass in Udaipur, India. To date, no study has been conducted on Jain monks. The study comprises of 180 subjects and the overall response rate was 76% among them. Oral hygiene status was assessed by the Simplified Oral Hygiene Index (OHI-S) of Greene, Vermillion14 (1964), and periodontal status was assessed by the Community Periodontal Index. Additional information was collected regarding food habits, education level and oral hygiene habits. Analysis of variance (ANOVA), Chi Square Test and Step-wise multiple linear regression analysis were carried out using SPSS Software (11.0). The results showed that the oral hygiene status of Jain monks was poor and only 5.6% of the subjects had good oral hygiene. Overall periodontal disease prevalence was 100% with bleeding and shallow pocket contributing a major part (72.8%) among all the age groups (p < 0.001). Multiple linear regression analysis revealed that oral hygiene habits, caloric intake and education level explained a variance of 11.7% for the Oral hygiene index collectively. The findings confirmed that Jain monks have poor oral hygiene and an increased prevalence of periodontal disease compared to that of the similarly aged general population because, as a part of their religion, many Jain individuals avoid brushing their teeth especially during fasting, keeping in mind not to harm the microorganisms present in the mouth.

Materials and Matter
A cross-sectional survey was conducted among Terapanthi Svetambar Jain monks attending Chaturmass in the month of August, 2007, in Udaipur, Rajasthan, India. The study population comprised of 180 Jain monks, with ages from 25-64 years. The overall response rate was 76%. Non-response was due either to systemic illness of the respondent on the day of data collection or to the respondent's refusal to cooperate. All the subjects who were present on the days of survey were included in the study. Subjects who were uncooperative and systemically ill comprised of the exclusion criterion. Clinical examination was performed by a single trained examiner in a mobile dental unit under artificial light source using standard explorers, mouth mirrors and CPI periodontal probes, and the study was conducted during the first week of October 2007. The oral hygiene variables of each subject were assessed using the Simplified Oral Hygiene Index (OHI-S) of Greene, Vermillion14 (1964). The Community Periodontal Index (CPI)15 was used to record the periodontal conditions. In addition to clinical data, Education level, Food habits and oral hygiene habits were also integrated through interviews with the person in charge. Statistical analysis was done with the help of a statistical package for social sciences (SPSS). Analysis of variance (ANOVA) was used to compare between the groups for oral hygiene indicators, namely debris index, calculus index and simplified oral hygiene index. Step-wise multiple regression analysis was used for multiple comparisons where the dependent variables comprised of debris index, calculus index and oral hygiene index. Independent variables consisted of various demographic variables like oral hygiene habits, calorie intake and education level. According to oral hygiene habits, the subjects were categorized into three groups: 1) those who usually clean their teeth with their fingers after every meal, 2) those who clean their teeth once a day, and 3) those who never clean their teeth or use only oral rinsing. According to caloric intake, the subjects were categorized into two groups: those whose caloric intake in a whole day was above 1,000 kcal and below 1,000 kcal. According to their caloric intake, all the subjects were considered to be malnourished. According to Jainic Education level, the subjects were categorized into under-graduates and post-graduates. All the subjects were well educated. Ethical clearance was obtained from the ethical committee of the Darshan Dental College and Hospital before the study was initiated. Informed consent was obtained from the subjects.

Data and results
Table 1 shows the oral hygiene status of Jain monks by age groups. Only 5.6% of the sample had good oral hygiene. The remaining 70% and 24.4% had, respectively, fair and poor oral hygiene. The proportion of the sample with poor and fair oral hygiene increased with age.

Table 2 shows that the mean debris and oral hygiene scores were increasing with age. However, the F value for the mean debris, calculus and OHI denotes that there was significant variation for the mean debris and calculus levels between the various age groups with the F value at 62.72 (p < 0.001) and 6.13 (p = 0.003) respectively.

Table 3 presents the CPI scores among Jain monks according to age groups. There were no subjects with healthy periodontal status. Bleeding and shallow pocket were more prevalent among all the age groups. Overall periodontal disease prevalence was 100%, with bleeding and shallow pocket contributing a major part (72.8%). There were very few subjects (8.9%) with calculus who belonged to the age group of 45-64 years, and 18.3% of the subjects presented deep periodontal pockets among the whole sample.

Table 4 shows that more than half of the sextants were with periodontal disease. The mean number of bleeding sextants was greater than the other three periodontal disease indicators. Among these subjects, 5.00 sextants were diseased with shallow pockets involving 2.78 sextants. The mean number of sextants without periodontal disease was 1.00.

Table 5 presents a step-wise multiple linear regression analysis in which the dependent variables were community periodontal index and oral hygiene index. The demographic independent variables were age, oral hygiene habits, caloric intake value and level of education. All the independent variables were significantly associated with the CPI and Oral hygiene index. The CPI showed a great association with caloric intake value. The amount of variation for the CPI with caloric intake value and age was 91.6% and 2.0% respectively. The OHI-S showed a great association with oral hygiene habits. The amount of variation for the OHI-S was 7.6%, 6.0% and 3.9%, respectively with oral hygiene habits, caloric intake value and education level.

Discussion
The accumulation and comparison of data from different studies is difficult because of the scarcity of literature on the oral hygiene status of Jain monks. In the present study, most of the subjects had not been to a dentist in their lifetime for a check-up or treatment. The non-attendance of Jain monks could be due to the principles of Jainism and as a part of their religion. Many Jain individuals avoid dental treatment especially during fasting, keeping in mind not to harm the microorganisms present in their mouths. The OHI-S index devised by Green and Vermillion (1964) was used to assess the degree of oral hygiene. It was found that the OHI-S index scoring gradually increased with age. In our study, 5.6%, 70% and 24.4% had, respectively, good, fair and poor oral hygiene status. This difference might be due to the peculiar oral hygiene habits of Jain monks. The CPITN has been used extensively for epidemiological surveys and screening in clinical practice for periodontal disease. There has, however, been criticism of the index because of the potential error in overestimating periodontal treatment needs in young individuals and failure to detect some localized severe periodontitis in adults.16 The CPITN indicators, however, did give correct estimates of the prevalence of bleeding in a population tested for the index validity. The present study showed that the periodontal status of the study population was poor with a prevalence rate of 50.0% and 47.5% respectively for the bleeding and shallow pocket components in the 3544 years age group. In a previous study conducted by Guile17 (1992) on the population of Saudi Arabia, the prevalence rates for these components were respectively 2.3% and 26.6% in the same age group. The higher rates observed in the present study might be due to the poor oral hygiene habits of Jain monks. The proportion of subjects with bleeding, calculus or pockets for the age group of 35-44 years was 100%, which is greater than that of the general population of Rajasthan state, where the proportion of periodontal disease in the same age group was 83.6% according to Bali et al.18 (2004).

The mean number of healthy sextants in the study population was 1.5 for the age group of 35-44 years, which is less than that of the general population of comparable ages in Rajasthan state, where it was found to be only 1.6.18 In the present study, most of the subjects had not been to the dentist for a check-up or treatment. Bleeding and shallow pocket were widespread in all the age groups. Similar results were observed by Wang et al.19 (2002), and destructive periodontitis was less frequent in the 35-44 years age group when compared to the rates observed in other studies.20-23

The percentage of individuals with shallow and deep pockets was greater in the age groups of 3544 and 45-64 years. Similar results were observed in studies done by Dini, Guimarães24 (1994) in a worker population. The results of the present study have shown 1.5 mean healthy sextants in the age group of 35-44 years while Mengel et al.25 (1996) have observed the same 1.5 healthy sextants in the same age group in the Yemen upland, and Mumghamba et al.26 (1996) have found 2.5 in their study. The mean sextants with deep pockets were 0.5, in accordance with the study done by Buorgeois et al.27 (1997) who observed an average of 0.1 sextants in 35-44 yr olds. The mean number of excluded sextants (0.67) in the surveyed population is in contrast with those found in the general population of South East Asia (0.0 - 0.7), America (0.2 - 0.15), Europe (0.0 - 1.5), Africa (0.0 - 0.7), the Middle East (0.0 - 0.1) and the Western Pacific regions (0.0 - 0.9) and French Polynesia (1.7).28 The relationship between nutrition and oral health is multifaceted. Nutrition has both local and systemic impacts on the oral cavity.29 While diet and eating patterns have a local effect on the teeth, saliva and soft tissues, the systemic impact of nutrition also has considerable implications. Periodontal diseases, including gingivitis and periodontitis, are serious infections that, if left untreated, can lead to tooth loss. Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression. It has been concluded that early childhood protein-energy malnutrition (ECPEM) is related to the subsequent development of periodontal disease in adolescents and young adults. The present study also concluded that the CPI and OHI-S have a great association with the caloric intake value by Jain monks because, according to their caloric intake, all the Jain monks were considered to be malnourished. The amount of variation for the CPI and OHI-S with caloric intake value was respectively 91.6% and 6.0%. In our study, various demographic independent variables like age, oral hygiene habits, caloric intake value and level of education were significantly associated with the CPI and Oral hygiene index. The CPI showed a great association with caloric intake value. The amount of variation for the CPI with caloric intake value and age was respectively 91.6% and 2.0%. The OHI-S showed a great association with oral hygiene habits. The amount of variation for the OHI-S was 7.6%, 6.0% and 3.9%, respectively with oral hygiene habits, caloric intake value and education level. Taking into account the disease status and the available resources for periodontal care in this surveyed population, the priority should be based on a population strategy and primary prevention programs to improve the periodontal health by promoting self care and oral hygiene.

Overall Discussion
Effects of poor oral hygiene
The main purpose of dental hygiene is to prevent the build-up of plaque, the sticky film of bacteria that forms on the teeth. Bacterial plaque accumulated on teeth because of poor oral hygene is the causative factor of the major dental problems. Poor oral hygiene allows the accumulation of acid producing bacteria on the surface of the teeth. The acid demineralizes the tooth enamel causing tooth decay (cavities). Dental plaque can also invade and infect the gums causing gum disease and periodontitis. In both conditions, the final effect of poor oral hygiene is the loss of one or more teeth. You should not wait until a tooth is lost, just then to understand the importance of oral hygiene and preventive care. Many health problems of the mouth, such as oral thrush, trench mouth, bad breath and others are considered as effect of poor dental hygiene. Most of these dental and mouth problems may be avoided just by maintaining good oral hygiene. Importance of good oral hygiene

Prevention is always better than treatment. Good oral hygiene habits will keep away most of the dental problems saving you from toothaches and costly dental treatments. The interesting part is that it can be achieved by dedicating only some minutes every day to dental hygiene care. A large number of various oral hygiene products, beyond the usual toothpaste and toothbrush, are available in the market to help you in this effort. Unfortunately, most of us remember the importance of oral hygiene instructions only when a problem occurs. Research has shown that while patient activation can show an immediate improvement in oral hygene habits, only a small percentage keeps the same standards six months later. Maintaining good dental hygeine should be a lifelong everyday habit. Awareness regarding the importance of oral hygiene has significantly increased in the developed countries, but contrary to that, the modern dietary lifestyle habits are posing a greater risk for oral health. Healthy teeth not only enable you to look and feel good, they make it possible to eat and speak properly. Good oral health is important to your overall well-being. Daily preventive oral care, with proper brushing and flossing, will help stop dental problems before they develop and are much less painful, expensive, and worrisome than treating conditions that have been allowed to progress.

How to maintain good oral hygiene It is important to learn how to maintain good dental hygiene from early childhood. Parents should teach their children the proper use of oral hygiene products. Good oral hygiene should be a joined effort involving you and your dentist. Not all of us have the same needs. Ask your dentist how to maintain good oral hygiene. Your dentist or dental hygienist will give you the proper dental hygeine instructions and teach you the correct way of brushing and flossing. The dentist will identify your individual needs and help you build your own oral care plan. Signs of good oral hygiene Good oral hygiene results in a mouth that looks and smells healthy. This means: 1)Your teeth are clean and free of debris 2)Gums are pink and do not hurt or bleed when you brush or floss 3)Bad breath is not a constant problem The most important oral hygiene instructions

In between regular visits to the dentist, there are simple steps that each of us can take to greatly decrease the risk of developing tooth decay, gum disease and other dental problems. These instructions include: 1)Brush your teeth at least twice a day or after every meal, with a fluoride toothpaste. 2)Floss your teeth at least once a day

3)Watch your diet. Avoid sugar and limit snacks between meals

References
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