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Table of Contents
ORIGINAL ARTICLE
Year : 2013  |  Volume : 3  |  Issue : 2  |  Page : 79-85

To assess knowledge and awareness of North Indian population towards periodontal therapy and oral-systemic disease link: A cross-sectional survey


1 Department of Periodontology and Oral Implantology, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab, India
2 Department of Oral medicine and Radiology, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab, India

Date of Web Publication11-Feb-2014

Correspondence Address:
Archana Bhatia
Department of Periodontology and Oral Implantology, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5194.126865

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   Abstract 

Aim of the Study: The aim of the present study was to explore and gain an understanding of patients' views on their periodontal conditions, their attitudes to oral health and expectations of treatment, as well as their knowledge toward oral-systemic disease link with the help of a questionnaire survey. Materials and Methods: The study subjects were patients with chronic periodontitis, who had been referred to Department of Periodontics. A total of 245 patients comprising of 125 males and 120 females were included in this study who attended department of Periodontics in Dasmesh Dental College and Hospital, Faridkot Punjab State during the study period from 10 th December 2010 to 10 th May 2011. Study was divided into two parts: First part consist of questions related to age, sex, demographic area along with oral hygiene measures and the second part consist of attitude toward periodontal therapy and oral-systemic disease link. Results: The results illustrated that females participate in this randomized study were more fearful about the periodontal therapy and only (13.8%) subjects were aware about the oral-systemic disease link while almost two-third population (68.9%) was unaware about this. Hence as a dentist, we should educate patients about this important relationship. Conclusion: The significant associations that were found between some of the self-care behaviors and oral hygiene levels document the important role of patient-centered oral health assessment in periodontal care. Utilization of dental services in this country should, therefore, be improved not only by improving the availability and accessibility by manpower arrangements, but also to a great extent by increasing people awareness and knowledge of their own dental disorders and by attempting to change their attitudes and behavior in relation to oral health care.
Clinical Relevance to Interdisciplinary Dentistry

  • The present article highlights the importance of an interdisciplinary approach for the purpose of providing knowledge and awareness to patients regarding periodontal therapy and oral systemic links.

Keywords: Cross sectional survey, oral health, oral-systemic disease link, periodontitis


How to cite this article:
Bhatia A, Bains SK, Singh MP. To assess knowledge and awareness of North Indian population towards periodontal therapy and oral-systemic disease link: A cross-sectional survey. J Interdiscip Dentistry 2013;3:79-85

How to cite this URL:
Bhatia A, Bains SK, Singh MP. To assess knowledge and awareness of North Indian population towards periodontal therapy and oral-systemic disease link: A cross-sectional survey. J Interdiscip Dentistry [serial online] 2013 [cited 2019 Oct 15];3:79-85. Available from: http://www.jidonline.com/text.asp?2013/3/2/79/126865


   Introduction Top


Health is a fundamental right and a universal human need that is same for people from all cultures and walk of life. General health cannot be attained or maintained without oral health. The mouth is regarded as a mirror and the gateway to health. Integration is required between the dental practitioner and the patient, if good dental health is to be attained. [1] Periodontal disease is one of the most prevalent diseases affecting human dentition and one of the principle causes of tooth loss. Gingivitis, a milder form of periodontal disease, is commonly found among individuals of all age groups. Periodontitis is an infectious disease characterized by inflammatory changes in the tissues surrounding to teeth leading to periodontal attachment loss and alveolar bone destruction. As dental caries has declined, periodontitis has become the most common reason for tooth loss in adults. [2]

It is generally agreed that microorganisms residing in the periodontal pockets are responsible for periodontitis. Approximately 500 taxa inhabit periodontal pockets, which provide a moist, warm, nutritious and anaerobic environment for microbial colonization and multiplication. The abundance and diversity of periodontal pocket microorganisms depend upon several factors, including effectiveness of oral hygiene procedures, pocket depth, flow of gingival crevicular fluid, type of interacting microbes and viruses, transmission rate of microbes from other individuals and the antimicrobial efficacy of the host immune response. [3]

There is a lack of population based data on attitude toward periodontal therapy in the Punjab State (India), so it is important to do a recent study that will help dentist to improve the understanding of patients about periodontal diseases and reduces the myths of the general population about periodontal therapy. The aim of the study was to explore and gain an understanding of patients' views on their periodontal conditions, their attitudes to oral health and expectations of treatment, as well as their knowledge towards oral-systemic disease link with the help of a questionnaire survey.


   Materials and Methods Top


Study area and study population

The present study was done on patients reported to the department of Periodontics in Dasmesh Dental College and Hospital, Faridkot (Punjab State). This hospital is located away from the city. People of different socioeconomic and educational status visit the hospital for their dental care needs.

Inclusion criteria

245 patients (Males = 125, Females = 120) were included in this study who attended department of Periodontics in Dasmesh Dental College and Hospital, Faridkot, Punjab State during the study period from 10 th December 2010 to 22 nd January 2011.

Performa

A structured questionnaire was formulated in the English version. The questionnaire contained 14 questions about attitude of patients toward periodontal treatment and knowledge about oral-systemic diseases link along with their demographic details.

Oral health education

After completion of the questionnaire, oral health education was given to the patients regarding the methods of tooth brushing and oral hygiene practices.


   Results Top


A total of 245 patients (125 males and 120 females) agreed to participate and responded to the questionnaire. Approximate time required for a participant to fill out the questionnaire ranged from 15 min to 20 min. Out of 245,125 (51.02%) were males and 120 (48.98%) were females [Table 1].
Table 1: Distribution of sample size according sex and age of the population


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In this study most of the patients about 82 (33.4%) were between 46 and 60 years, 80 (32.6%) were between 31 and 45 years followed by 53 (21.6%) and 30 (12.2%), 21 (9.76%) were of age above 60 years respectively [Table 1]. Patients with different occupation participated in the study [Table 2].
Table 2: Distribution of sample size according occupation of the population


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Result of this survey concluded that females are more illiterate than males in this area. In this study, from total female participants 58.3% were illiterate whereas about 81.6% males were educated and doing the job at present [[Table 3] and [Figure 1].
Figure 1: Education status of sample size

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Table 3: Distribution of sample size according education and oral hygiene measures performed by population


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Out of 245 subjects 167 were doing brushing mostly once a day while 78 subjects did not performing brushing due to some reasons [Table 3]. This study showed that the major reasons for compliance with brushing were the prevention of dental caries (58.6%) and esthetic reasons (15.5%) [Table 3]. Most of the subjects mentioned that the main reason for no brushing was carelessness (53.8%) and the least important reason was expenses (1.2%) [Table 3].

About 71.6% females participate in this randomized study were fearful about the periodontal therapy and most of the females visit dentist once or twice in her life [Table 4], [Figure 2]. Out of 120 females, 79.1% patients delayed or turn down her treatment because of fear whereas from 125 males, 32% patients delayed or turn down her treatment because of fear in his life. Data of this survey showed that females are more fearful about periodontal therapy [Table 4], [Figure 3].
Figure 2: Graph showing fearful attitude of people toward receiving periodontal treatment

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Figure 3: Delay or turn down periodontal treatment because of fear

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Table 4: Fearful attitude of patients about receiving periodontal therapy


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About 72% males and 42.5% females undergo periodontal therapy in his/her life. Males are having more positive attitude towards dental treatment in this area [Table 4], [Figure 4]. Females are more illiterate in this area so about 76.6% female participants believe in myth that scaling causes tooth mobility. Most of the females avoid periodontal treatment due to this myth [Table 5], [Figure 5].
Figure 4: Graph showing numbers of patients underwent any periodontal procedure in his/her life

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Figure 5: General population's myth about scaling

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Table 5: Myth of population about scaling and type of pain they felt during treatment


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Out of the total population, only 11.2% males and 45% of females experienced and pain or discomfort after periodontal therapy [Table 6], [Figure 6]. Results of this study showed that females (65%) are more stressed about periodontal treatment than men (42.4%) [Table 6], [Figure 7]. Most common source of origin of pain in both males (34.4%) and females (30.0%) is personal bad experience followed by family source (32.8%) in males and by friends (24.1%) in females [Table 7].
Figure 6: Graph showing persons discomfort or pain felt during periodontal therapy

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Figure 7: Number of patients feels more stressed about performing the treatment

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{Table 5}
Table 6: Frequency of pain or discomfort felt by population


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The result of the study showed that only (13.8%) subjects were aware about the oral-systemic disease link while almost two third population (68.9%) was unaware about this. So as a dentist, we should educate patients about this important relationship [Table 7].
Table 7: Origin of pain and awareness of population about oral-systemic link


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   Discussion Top


In an age of assessment and accountability, the field of periodontics as well as dental hygiene could benefit by adopting models that emphasize the multidimensional nature of oral problems and by considering patient behaviors and perceptions on oral health.

Although it may be desirable to use a full instrument based on single or multiple health behavior models for a comprehensive assessment, clinicians often experience time constraints posed by active patient care. Therefore, we sought to develop a simple questionnaire that could be completed quickly, yet it would provide information relevant to the planning of periodontal treatment. Our 12-item questionnaire imposed very little burden on the patients; they had little difficulty in completing it. Within the limitations of the present study, the clinical use of the questionnaire disclosed salient information regarding periodontitis patients' oral health behavior, perceptions and knowledge about the oral-systemic disease link.

The present study was undertaken to determine the periodontal awareness among patients visiting the department of Periodontics in Dasmesh Dental College and Hospital, Faridkot (Punjab). A total of 245 dental patients were subjected to a self-administered questionnaire to assess their periodontal status. In this study, from total female participants 58.3% were illiterate whereas about 81.6% males were educated and doing the job at present. About 71.6% females participate in this randomized study were fearful about the periodontal therapy and most of the females visit dentist once or twice in her life. Out of 120 females, 79.1% patients delayed or turn down her treatment because of fear whereas from 125 males, 32% patients delayed or turn down her treatment because of fear in his life. Whereas the result of AAP (1999) [4] survey showed males were more fearful about periodontal therapy than females.

Yamamoto et al., [5] conducted a questionnaire for periodontitis screening of 250 people of age group 50-59 years males Japanese employees and suggest that the self-reported questions are useful for screening of periodontitis in this age group people.

According to Vandana and Reddy, [6] in the study of 1029 subjects of Davangere district, incidence of gingivitis and periodontitis was more in females than males.

Saito et al., [7] conducted the pre-tested 19-item questionnaire comprised 3 domains; (1) oral hygiene, (2) dietary habits and (3) perception of oral condition on 65 patients. Result of the study showed that the clinical utilization of the questionnaire facilitates the inclusion of multiple aspects of patient information, before initiation of periodontal treatment. The significant associations that were found between some of the self-care behaviors and oral hygiene levels document the important role of patient-centered oral health assessment in periodontal care.

In another study obtained by Abrahamsson et al., [8] open-ended interviews were conducted after periodontal examination, but before treatment. The results illustrated that subjects diagnosed with chronic periodontitis felt ashamed and were willing to invest all they had in terms of time, effort and financial resources to become healthy and to maintain their self-esteem. However, they perceived a low degree of control over treatment decisions and treatment outcome.

Nagarajan and Pushpanjali, [9] the study population included 216 patients aged between 20 and 44 years who attended the outpatient department of the M.S. Ramaiah Dental College, Bangalore. The study population was subjected to a self-administered questionnaire (questions regarding bleeding gums, deposits on teeth, receding gums, swelling of gums, loose teeth), which was followed by periodontal examination. Result of the study showed that the awareness of the periodontal problems has been reported to increase with increasing severity of the disease due to the destructive changes that set in.

In the present study, most common source of origin of pain in both males (34.4%) and females (30.0%) is personal bad experience followed by family source (32.8%) in males and by friends (24.1%) in females. Another study conducted by AAP (1999), [4] showed that personal bad experience and family sources both factors equally affect the attitude of patient toward therapy.

End of the study concluded that only (13.8%) subjects were aware about the oral-systemic disease link while almost two third population (68.9%) was unaware about this. So as a dentist, we should educate patients about this important relationship. Similar results were concluded by Moeintaghavi et al., [10] they found that most of the subjects were unaware about the effect of oral problems to the vital organs.


   Conclusion Top


Epidemiological research indicates that periodontal diseases are widespread throughout the world and evidence exists to show that their extent and severity increases with age. The prevention and management of periodontal diseases are accomplished primarily by maintaining tooth surfaces which are free of dental plaque. The maintenance of periodontal health requires an informed patient. Treatment will fail and in fact will not even start, if individuals are not aware of the differences between periodontal health and disease; the significance of these differences and the part they can play in prevention and control. The result of study also showed that that only few subjects were aware about the oral-systemic disease link while almost two third population was unaware about this. So as a dentist, we should educate patients about this important relationship. This present study is based on the self-addressed questionnaire and without any clinical examination of the rural population of Punjab. The following conclusions can be drawn from the study:

  • Result of this survey concluded that females are more illiterate than males in this area. In this study, from total female participants 58.3% were illiterate whereas about 81.6% males were educated and doing the job at present
  • Major reason for brushing teeth in population was prevention of dental caries (58.6%) and reason for no brushing was carelessness (53.6%)
  • About 71.6% females participate in this study were fearful about the periodontal therapy and most of the females visit dentist once or twice in her life
  • Out of 120 females, 79.1% patients delayed or turn down her treatment because of fear whereas from 125 males, 32% patients delayed or turn down her treatment because of fear in his life
  • Females are more illiterate in this area so about 76.6% female participants believe in myth that scaling causes tooth mobility
  • Results of this study shows that females (65%) are more stressed about periodontal treatment than men (42.4%)
  • Most common source of origin of pain in both males (34.4%) and females (30.0%) is personal bad experience followed by family source (32.8%) in males and by friends (24.1%) in females
  • About 72% males and 42.5% females undergo periodontal therapy in his/her life. Males are having more positive attitude towards dental treatment in this area
  • The result of the study showed that only 13.8% subjects were aware about the oral-systemic disease link while almost two third population was unaware about this. So as a dentist, we should educate patients about this important relationship.


In summary, the questionnaire facilitates the inclusion of multiple aspects of patient information, before initiation of periodontal treatment. There seems to be much room for improvement of oral hygiene and self-care among individuals presenting for an initial periodontal examination. Within the limits of the present study, the significant associations that were found between some of the self-care behaviors and oral hygiene levels document the important role of patient-centered oral health assessment in periodontal care. Utilization of dental services in this country should, therefore, be improved not only by improving the availability and accessibility by manpower arrangements, but also to a great extent by increasing people awareness and knowledge of their own dental disorders and by attempting to change their attitudes and behavior in relation to oral health care.

 
   References Top

1.George AC, Hoshing A, Joshi NV. A study of the reasons for irregular dental attendance in a private dental college in a rural setup. Indian J Dent Res 2007;18:78-81.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Meyle J, Ayham A, Hamid H, Bodekar R.,Chakraborty T. Domann E. Sustained local delivery of chlorhexidine during initial therapy of chronic periodontitis. Periodontol 2000 2005;2:117-29.  Back to cited text no. 2
    
3.Tezel A, Yucel O, Orbak R, Kara C, Kavrut F, Yagiz H, et al. The gingival crevicular fluid ciprofloxacin level in subjects with gingivitis and periodontitis, and its effects on clinical parameters. J Periodontal Res 2005;40:395-400.  Back to cited text no. 3
[PUBMED]    
4.Results of member surveys: patient perceptions and fear. Am Acad Periodontol 1999. Available from: http://www.dentalwebsmith.com/PerioNewsletters/ptPages0009.pdf. [Last accessed on 2014 Jan 17].  Back to cited text no. 4
    
5.Yamamoto T, Koyama R, Tamaki N, Maruyama T, Tomofuji T, Ekuni D, et al. Validity of a questionnaire for periodontitis screening of Japanese employees. J Occup Health 2009;51:137-43.  Back to cited text no. 5
[PUBMED]    
6.Vandana KL, Reddy MS. Assessment of periodontal status in dental fluorosis subjects using community periodontal index of treatment needs. Indian J Dent Res 2007;18:67-71.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.Saito A, Kikuchi M, Ueshima F, Matsumoto S, Hayakawa H, Masuda H, et al. Assessment of oral self-care in patients with periodontitis: A pilot study in a dental school clinic in Japan. BMC Oral Health 2009;9:27.  Back to cited text no. 7
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8.Abrahamsson KH, Wennström JL, Hallberg U. Patients' views on periodontal disease; attitudes to oral health and expectancy of periodontal treatment: A qualitative interview study. Oral Health Prev Dent 2008;6:209-16.  Back to cited text no. 8
    
9.Nagarajan S, Pushpanjali K. Self-assessed and clinically diagnosed periodontal health status among patients visiting the outpatient department of a dental school in Bangalore, India. Indian J Dent Res 2008;19:243-6.  Back to cited text no. 9
[PUBMED]  Medknow Journal  
10.Moeintaghavi A, Mazloomi SS, Ghahraee F. A study on the reasons of noncompliance with tooth brushing in young males in Azadshahr region of Yazd, Iran. Indian J Dent Educ 2009;2:107-11.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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