Oral diseases are among the most common and widespread problems throughout the world. Poor oral health may have a significant impact on children's quality of life, which leads to general deterioration of health.¹ Dental caries and periodontal diseases are the two foremost oral pathologies that remain widely prevalent and affect all populations throughout the lifespan.²

According to the National Oral Health Survey, in India dental caries is prevalent among 63.1% of 15-year-old and as much as 80.2% among adults in the age group of 35-44 years. Periodontal diseases are prevalent in 67.7% of 15-year-olds and as much as 89.6% of 35-44 year olds. Oral diseases restrict activities in school, at work and at home causing millions of school and work hours to be lost each year the world over. Moreover, the psychosocial impact of these diseases often significantly diminishes quality of life.³

Lack of awareness about dental diseases has resulted in gross neglect of oral health. Creating awareness at a very early age has an impact on their health-related behaviors later in life.

Dental health education has emerged as one of the fundamental approaches in the primary prevention. ⁴ Educational and motivational programs in oral health have been implemented so that most of the population can have access to information related to problems in the oral cavity and guidelines for hygiene, as well as motivation to pay special attention to oral health.¹

Schools act as building blocks in shaping up the children’s behavior. Enhancing the levels of child’s knowledge by oral health education plays a pivotal role in improving oral health which in turn affects the overall health.⁴

Therefore, oral health education should be given more attention as it acts as a powerful means of raising awareness of community health. On the other hand, reinforcement is of utmost importance in retaining the established positive oral health behavior in the children.⁵

Aim and Objectives:

Aim:

To assess the impact of oral health education on knowledge, attitude, practices among 12 -15 years old school children of Greater Noida.

Objectives:

• To assess the pretest oral health knowledge, attitude, practices among 12 -15 years old school children of Greater Noida.
• To assess post test oral health knowledge, attitude, practices among 12 -15 years old school children of Greater Noida.
• To compare pretest and posttest oral health knowledge, attitude, practices among 12 -15 years old school children of Greater Noida.

A study was carried out to assess the impact of oral health education on knowledge, attitude, practices among 12 -15 years old school children of Greater Noida over a period of 1 months from July to August 2018. Ethical approval was obtained from the Institutional board of ethics. Before conducting the study, the purpose of the study was clearly explained to the higher authorities of selected schools, and permission was obtained from them. 

Sample Size Determination:

p₁ = proportion (incidence) of study group (50)

p₀ = proportion (incidence) of population (65)
N = sample size for study group
α = probability of type I error (usually 0.05)
β = probability of type II error (usually 0.2)
z = critical Z value for a given α or β

Based on the above calculation the calculated sample size for each group comes out to be 82 which has been increased to 100 to compensate for the dropouts

The address of the institutions was obtained from the Greater Noida Industrial Development Authority. For the study purpose, Greater Noida was arbitrarily divided into four zones namely north, south, east, west and central zones. Four schools were randomly selected through stratified random sampling method such that one schools from each zone were included in the study. From each school 50 children were taken. The age group of children taken for the study in all the institution ranged from 12 to 15 years.

Inclusion Criteria: School children who were willing to participate in the study and Children who were present on the day of visit to school for the conduction of the study Exclusion Criteria: School children who either incompletely or inappropriately filled the study questionnaire were excluded from the study.

Training and calibration: A pilot study was conducted on 20 school children (10 school children in each group i.e study and control group) to assess the sample size feasibility of the study which was not included in the final study. The school authorities were informed prior about the schedule date of conduction of the survey.

Data collection:

At baseline:

Children were assessed for oral health knowledge, attitude and practices using a validated self-administered structured questionnaire. ³ The study sample was further divided randomly through lottery method into study group and control group with 100 children in each. Oral health education was delivered using audiovisual aids both in English and Hindi language for 30 mins. (Figure No 1). It encompasses topics such as: Types of dentition, Importance of brushing twice daily to keep teeth healthy, Etiology of dental caries and how to prevent it, Good dietary practices, Regular visits to Dentist, and Impact of Oral Health on General Health.

At 15^th   day from baseline:

Reinforcement was done using the same audiovisual aid for the study group.(Figure No 2) 

At 30^th day from baseline:

Children's oral health-related knowledge was checked by the same investigator using the same closed-ended questionnaire. (Figure No 3).  As it was unethical to depart any group of the benefits, the control group was also given a similar type of health education after the completion of the study.

Statistical analysis:

The resulting data were entered into statistical software (Statistical Package for the Social Sciences version 20) and were analyzed by applying Chi-square test. The significance level was set at P < 0.05

Graph 1 shows the gender wise distribution in the study subjects. In study group 59% were males and 41% were females and in control group 56% were males and 44% were females.

Graph 1 : Gender distribution of study subjects

Graph 2 represents the mean age of different study subjects in which it was seen that study group had a mean age of 13.1 and control group  had a mean age of 13.01.

Graph 2 : Mean Age Of Study Subjects

Table 1 shows comparison between study and control group for the oral health  knowledge  before and after the intervention in which all the questions showed statistically significant improvement in knowledge except two questions “Oral Health Part of General Health” and “ Regular cleaning of mouth can prevent dental caries”  which showed no improvement. Most of the children were unaware about the number of milk teeth, reason for tooth decay and the best way of cleaning teeth before the intervention but after the intervention more than half of the children responded correctly. Before the intervention, 24% participant responded the correct answer about the number of milk teeth and after the intervention 100% participants were able to respond the correct answer. The knowledge about dental floss was increased from among 60% participants to 100% participants.

Table 1: Comparison between study and control group for the oral health  knowledge  before and after  the intervention

Table 2 represent the comparison between study and control group for the attitude  before and after  the intervention 96% of them started believing that improving and maintaining their health is in their control after the intervention, in contrast to, 53% before the intervention. Before the intervention, 60 % participant responded the correct answer about visit a dentist periodically to maintain health of your mouth and after the intervention 91% participants were able to respond the correct answer.

Table 2: Comparison between study and control group for the attitude  before and after  the intervention

Table 3 shows comparison between study and control group for the oral health practice scores before and after the intervention there was drastic improvement seen in the practices related to oral heath after the intervention. 100%, 98% , 94% ,100% children started using soft tooth bristles , started cleaning their teeth and change their tooth brushes and using oral hygiene aids after the intervention respectively.05

Table 3: comparison between study and control group for the oral health practice scores before and after the intervention

Oral health education and constant periodic reinforcement are the key elements in promoting good oral health as it counteracts the effect of fading over a period of time.⁴

At the end of the study, children seemed to have gained improved knowledge about the number of milk teeth,reason for tooth decay, dental floss, best way of  cleaning teeth which was in accordance to the study done by Sanadhya YK et al ²(2014) ,De Farias IA et.al ⁶(2009), Redmond CA et.al ⁷ (1999) and Buischi YA et al ⁸  (1994)

Drastic increase in attitude towards oral health in the individual’s responsibility of maintaining healthy mouth , visit a dentist periodically and frequency of dental visit at the end of the study which was in accordance with the study done by Sanadhya YK et al ²(2014) ,Tai B et al ⁹(2001) and  Laiho M et al ¹⁰ (1993).  A significant shift in the duration of the brushing , type of bristles ,method of brushing, change of the tooth brush which was in accordance  with the results observed by Buischi YA et al ⁸ (1994) and Friel S et al ¹¹ (2002). In the present study there was an   improvement in the practice of change of toothbrush which was not in accordance with study done by Sanadhya YK et al ²(2014) this may be attributed due to the low socioeconomic status of the parents which affected  the affordability of oral hygiene aids.

No improvement was seen before and after intervention in control group regarding the oral health knowledge, attitude and practices in participants.

It was concluded that repeated oral health education results in improved oral health knowledge, attitude and practice. Since Oral health education program is an easy to organise and inexpensive on the short term basis is effective in improving oral cleanliness of children and ultimately helps in  caries prevention. Henceforth, oral health education program should be part of academic curriculum to achieve positive oral health and cavity free future.

PUBLIC HEALTH SIGNIFICANCE

Dental caries affects the children socially as well as psychologically. Furthermore, treating dental caries in children is expensive not only due to direct cost of treatment but also the indirect costs such as the time taken off by the parents to take the child to a dentist. By providing oral health education we as a public health dentist can improve knowledge which may lead to adoption of favorable oral health behavior that contribute to better oral health.

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