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ORIGINAL ARTICLE  
Year : 2011  |  Volume : 1  |  Issue : 1  |  Page : 33-36
A study to assess the role of teachers in the promotion of oral health in developing countries


Department of Pediatric and Preventive Dentistry, S.K.S.S. Dental College, Ludhiana, Punjab, India

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Date of Web Publication6-Mar-2012
 

   Abstract 

Introduction: With the recent shift in paradigm, dentistry has moved from restorations, replacements or extractions, toward early diagnosis, risk assessment, and prevention of dental diseases in children. Teachers can play a crucial role during the mentor years of the child by imparting oral health knowledge and inculcating positive health attitudes.
Aim: This study aims to relate the oral health status of teachers with children in different age groups and to demarcate a time when children would be most receptive to instructions.
Materials and Methods: One hundred and nineteen teachers (mean age 32.6 ± 3.4 years) and 1500 children divided into six age groups, from 4-10 years, of 250 each, attending selected schools, were examined and their decayed, missing, and filled teeth (dmft/DMFT) scores was recorded using the World Health Organization (WHO) criteria, by trained examiners.
Results: The results were statistically analyzed using the Pearson's correlation coefficient. A significant positive correlation was seen between the DMFT of teachers and children in the seven-to-nine-year age group.
Conclusion: This points out the fact that awareness among teachers can play a pivotal role in health promotion among pupils. They are ideally positioned to inculcate a positive health attitude and refer children to a dental home in a timely manner.

Keywords: Children, teachers, oral health

How to cite this article:
Simratvir M. A study to assess the role of teachers in the promotion of oral health in developing countries. J Educ Ethics Dent 2011;1:33-6

How to cite this URL:
Simratvir M. A study to assess the role of teachers in the promotion of oral health in developing countries. J Educ Ethics Dent [serial online] 2011 [cited 2019 Nov 22];1:33-6. Available from: http://www.jeed.in/text.asp?2011/1/1/33/93406



   Introduction Top


Dental caries is a chronic, complex, transmissible, dietomicrobial, infectious disease, heightened by extraneous factors such as low income or malnutrition. It has become an alarming problem especially in the developing countries. The prevalence of early childhood caries (ECC) in these countries is reported to be as high as 70%. [1]

Dental problems in early childhood have been shown to be predictive of future dental and health problems. [2] It influences the growth and development of children by interfering with their comfort, nutrition, concentration, and school participation. Frequently it leads to pain and infection, necessitating hospitalization for dental extractions, sometimes under general anesthesia. [3]

With the recent shift in paradigm, dentistry has moved from restorations, replacements or extractions, toward early diagnosis, risk assessment, and prevention of dental diseases in children. However, the racial and socioeconomic disparities in the disease burden have a limited access to dental care for many children, especially in developing countries like ours.

These alarming figures [1] can easily be prevented provided there is awareness among the care takers/parents. Teachers can play a crucial role during the mentor years of the child by imparting oral health knowledge and inculcating positive health attitudes during the growing period of the child. Very few studies in literature have been conducted to delineate the timely role of teachers in imparting oral health education. [4],[5] This study was conducted to relate the oral health status of teachers with children in different age groups and to demarcate a time when children can be most receptive to instructions. This knowledge can be applied to the needs of children throughout their everchanging stages of development.


   Materials and Methods Top


Study setting

The study was conducted in the schools of Panchkula from where permission could be obtained.

Study design

It was a community-based, cross-sectional study.

Ethical considerations

An informed written consent of the parent/caretaker of the child and teachers was taken for intra-oral examination.

Participants

One hundred and nineteen teachers (mean age 32.6±3.4 years) and 1500 children divided into six age groups, from 4 - 10 years, of 250 each, attending the selected schools were examined [Table 1].
Table 1: Demographic distribution


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Sampling technique

This is a community-based, cross-sectional study. All four blocks, of the Panchkula district were selected and a list of all the schools in each block was obtained. All the schools in each block were serially numbered. Small chits of paper were prepared and a number was noted on each chit. Thus, by simple random sampling (lottery method), a total of eight schools were selected for the study. Children in the age group of 4 - 10 years from the selected schools were enrolled for this study. From the list of children present on the day of intraoral examination, every second child was selected and included in the study group.

All the teachers from the schools were enrolled as study participants.

Data collection

In accordance with the WHO criteria, intraoral examinations of the children and teachers were carried out using a mouth mirror and a No. #23 explorer. [6] For children less than 5.11 years deft was recorded and for children beyond six years only DMFT was recorded.

Data was recorded by two trained calibrated dentists. Inter- and intra-examiner variability was assessed used the kappa coefficient (k>0.85). An adequate number of sterilized probes, mirrors, and tweezers were carried for each examination. The examination was conducted in natural daylight; 0.2% w/v chlorhexidine gluconate solution was used as an antiseptic.

Duration of study

The study was carried out over a period of six months, including the period for data collection, statistical analysis, and writing the report.

Main output variables


deft/DMFT index score of children, DMFT of teachers.

Data analysis

Data were analyzed further using SPSS-8.0 (Statistical Program for Social Sciences).


   Results Top


A total of 119 teachers (mean age 32.6±2.4 years) were examined. The mean DMFT in was 2.03±1.93.

Two hundred and fifty children each of age 4 - 4.11 years (KG) and 5-5.11 years (first standard) had a mean deft of 0.68±1.34 and 1.70±2.35, respectively.

Children aged 6 - 6.11 years (second standard), 7 - 7.11 years (third standard), 8 - 8.11 years (fourth standard), and 9 - 9.11 years (fifth standard) had a mean DMFT of 1.55 ± 2.26, 2.35 ± 2.40, 1.83 ± 1.64, and 1.09 ± 1.69, respectively.

Also the DMFT of the teachers correlated positively with the children of the third and fourth class (0.04 and 0.09, respectively). In all other age groups the correlation coefficient was negative (-0.03, -0.04, -0.11, -0.003 respectively) [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5] and [Figure 6].
Figure 1: Graph showing correlation between DMFT of teachers and dmft of children aged 4-4.11 years

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Figure 2: Graph showing correlation between DMFT of teachers and dmft of children aged 5-5.11 years

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Figure 3: Graph showing correlation between DMFT of teachers and DMFT of children aged 6-6.11 years

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Figure 4: Graph showing correlation between DMFT of teachers and DMFT of children aged 7-7.11 years

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Figure 5: Graph showing correlation between DMFT of teachers and DMFT of children aged 8-8.11 years

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Figure 6: Graph showing correlation between DMFT of teachers and DMFT of children aged 9-9.11 years

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   Discussion Top


The fact that the DMFT of the teachers did not correlate with the children of age less than 5.11 years might be attributed to the fact that during the early year's children are more under the influence and supervision of parents/caretakers. Studies have shown a positive correlation between the DMFT and the Streptococcus mutans counts of parents. [7],[8]

However, six years is the age when permanent teeth begin to erupt in the oral cavity. A significant positive correlation was seen between the DMFT of teachers and children in this age group clearly pointing out to the fact that teachers can play a pivotal role in the health of permanent dentition, especially at a time when the children are more susceptible to peer influence than family practices. This might be attributed to the fact that besides being role models, teachers who are more self-conscious of their oral health status have a tendency toward instilling positive health attitudes in children and their caretakers. They are in a better position to assess the daily oral health regime of children, thus facilitating health supervision specific to a child in a specific setting. Besides they can be instrumental in referring the child during early stages of disease progression.

The role of teachers in promoting oral health

Anticipatory guidance, [9] guides the parents by alerting them to impending change, teaching them their role in maximizing their children's developmental potential and identifying their children's special needs. The concept's evolution within well-child-care visits has been hastened by the growing evidence that early identification of problems and appropriate intervention is cost-effective, because of the increasing base of information about health available to parents. [10] Teachers can be targeted for such programs as children spend a major part of their day in the school setting.

Although preventive practices have dramatically reduced oral disease in some populations during the last several decades, the need for oral health care is still great. Oral health professionals - especially pediatric dentists - who are willing to see infants and children are relatively few in number and are unevenly distributed. Prevention and early intervention is unavailable for many infants and young children, particularly those from vulnerable populations. Teachers who come in contact with young children are in an excellent position to prevent the onset of oral health problems from occurring by identifying problems at an early stage and by helping families to locate oral health services. School teachers can promote the oral health of infants and children by learning about oral development, oral disease, oral hygiene, fluorides, nutrition, and injury and violence prevention, and by sharing this information with parents and working in partnership with oral health professionals.

Oral health and general well-being in children

Poor oral health can profoundly affect an infant's or child's health and his general well-being. Early tooth loss caused due to advanced tooth decay can result in failure to thrive in young children. Oral health problems can lead to impaired speech development, inability to concentrate on important early learning experiences, and frequent absences from school or child development programs. [11]

Unfortunately, in developing countries oral health competency and participation of teachers is less than adequate. For teachers to address child oral health issues, they must have adequate knowledge about the initiation of the disease process, the risk factors, signs, symptoms, prevention, and various intervention strategies. The knowledge base required by the teachers to perform successful oral health risk assessment can and should be built and reinforced throughout their education course. This might prove to be instrumental in spreading health awareness among the masses, far and wide, especially in developing countries like ours, where although it has not still been possible to provide dental services to all, the bill for educating every child has been successfully implemented.


   Conclusions Top


A significant positive correlation was seen between the DMFT of teachers and children in the seven-to-nine year age group, clearly pointing to the fact that teachers can play a pivotal role in health of permanent dentition, especially at a time when the children are more susceptible to peer influence and role models than family practices.

Recommendations

When there is no access to a dentist, the teachers should consider administering risk-based preventive oral health guidance until a dental home can be made available. Furthermore, they are ideally positioned to refer children to a dental home in a timely manner. Establishing collaborative relationships between teachers/caretakers and pediatric dentists/dentists at the community level is essential for increasing the access to dental care for all children, to help in improving their oral and overall health.

 
   References Top

1.Shobha T. Dental caries in early childhood, Textbook of Pedodontics, 1 st ed, Paras Publication; 2001. p. 183.  Back to cited text no. 1
    
2.Peres MA, Barros AJ, Peres KG, Araújo CL, Menezes AM. Life course dental caries determinants and predictors in children aged 12 years: A population-based birth cohort. Community Dent Oral Epidemiol 2009;37:123-33.  Back to cited text no. 2
    
3.Association between ECC and clinical, microbiological, oral hygiene and dietary variables in rural Turkish children, Seval Olmez. Turk J Pediatr 2003;45:231-6.  Back to cited text no. 3
    
4.Petersen PE, Esheng Z. Dental caries and oral health behavior situation of children, mothers and school teachers in Wuhan, Peoples Republic of China. Int Dent J 1998;48:210-6.  Back to cited text no. 4
    
5.Lang WP, Woolfolk MW, Faja BW. Oral health knowledge and attitudes of elementary school teachers in Michigan. J Public Health Dent 1989;49:44-50.  Back to cited text no. 5
    
6.WHO - Oral Health Survey: Basic Methods 4 th ed, Geneva: WHO; 1997.  Back to cited text no. 6
    
7.Berkowitz RJ, Jones P. Mouth to mouth transmission of bacterium Streptococcus mutans between mother and child. Archives of Oral Biology 1985;30:377-79.  Back to cited text no. 7
    
8.Berkowitz RJ, Jordan HV. Similarity of bacteriocins of Streptococcus mutans from the mother and infant. Arch Oral Biol 1975;20:725-30.  Back to cited text no. 8
    
9.Nowak AJ, Casamassimo PS. Using anticipatory guidance to provide early dental intervention. J Am Dent Assoc 1995;126:1156-63.  Back to cited text no. 9
    
10.Plutzer K, Spencer AJ. Efficacy of oral health promotion intervention in the prevention of ECC. Community Dent Oral Epidemiol 2008;36:335-46.  Back to cited text no. 10
    
11.Schechter N. The impact of acute and chronic dental pain on child development. J South Eastern Soc Pediatr Dent 2000;6:16-7.  Back to cited text no. 11
    

Top
Correspondence Address:
Mauli Simratvir
Assistant Professor, Department of Pediatric and Preventive Dentistry, S.K.S.S. Dental College, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-7761.93406

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

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    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
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