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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 9  |  Issue : 1  |  Page : 16-20

Oral health practices and associated caries experience among secondary school students in Lagos State, Nigeria


Department of Preventive Dentistry, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria

Date of Web Publication2-Mar-2017

Correspondence Address:
Modupeoluwa Omotunde Soroye
Department of Preventive Dentistry, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Port Harcourt, Rivers State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4987.201399

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  Abstract 

Aim: The distribution and severity of oral diseases are significantly influenced by oral hygiene practices. The aim of this study was to assess the oral health practices among secondary school students in Lagos State, Nigeria and investigate the influence of oral hygiene practices on caries experience.
Materials and Methods: Questionnaires were administered and dental examinations conducted on 598 schoolchildren aged 11–20 years. The students were recruited from two Local Government Areas of Lagos State. Statistical significance was determined at P < 0.05 using Chi-square tests.
Results: Majority of the participants (57.6%) had never visited the dentist. “Lack of pain” (31.1%) and “no reason” (42.5%) were recorded as the reason for not visiting the dentist. While toothbrush alone was used as a cleaning item by 73.9% of the students, 70.4% used fluoride-containing toothpaste, and 76.9% brush their teeth twice daily. The prevalence of dental caries was 9.7%. Caries prevalence was significantly associated with the use of fluoride-containing toothpaste (P = 0.015) and frequency of cleaning (P = 0.04). Respondents who used fluoride-containing toothpaste were about 2 times less likely to develop dental caries (odd ratio [OR] = 0.425 95% confidence interval [CI]: 0.45–1.32) and those who brush twice or more daily were 2.4 times less likely to develop caries (OR = 0.44 95% CI: 0.20–0.94).
Conclusion: The oral health practices of the participants were not satisfactory. Although the prevalence of dental caries was low, it was significantly influenced by frequency of toothbrushing and the use of toothpaste containing fluoride.

Keywords: Dental caries, fluoride containing paste, oral hygiene, secondary schoolchildren, tooth brushing


How to cite this article:
Soroye MO, Braimoh BO. Oral health practices and associated caries experience among secondary school students in Lagos State, Nigeria. J Oral Res Rev 2017;9:16-20

How to cite this URL:
Soroye MO, Braimoh BO. Oral health practices and associated caries experience among secondary school students in Lagos State, Nigeria. J Oral Res Rev [serial online] 2017 [cited 2017 Nov 17];9:16-20. Available from: http://www.jorr.org/text.asp?2017/9/1/16/201399


  Introduction Top


Dental caries together with periodontal disease constitutes the two major oral health problems globally [1] and has significant short- and long-term consequences. It is essentially a major cause of tooth loss.[2],[3] It is characterized by the breakdown of dental hard tissues (enamel, dentin, and cementum) by acid formed from food debris or refined sugar metabolized by oral bacteria.[4] Since the primary energy source of these bacteria is refined sugar, a diet high in sugar is thus a risk factor.

The interplay between four different factors determines if a tooth will develop dental caries or not. These factors are a fermentable carbohydrate such as sucrose, caries-causing bacteria, tooth susceptibility, and time of exposure.[4],[5] If the dynamic equilibrium that exists between demineralization and remineralization is tilted toward demineralization, dental caries results.[4],[5],[6] Dental caries causes pain, discomfort, headache, restlessness, and sleeplessness and thus impacts on the quality of life. It also results in bad breath and foul tastes.[7] In highly progressed cases, infection can spread from the tooth to the surrounding soft tissues with resultant complications such as cavernous sinus thrombosis and Ludwig's angina which can be life threatening.[8] Depending on the extent of destruction, various treatment options are available to restore a carious tooth to function.[4] The availability of treatment is often poor in the developing countries, and thus preventive measures are encouraged to prevent deterioration in oral health.

The maintenance of optimum oral health is the key to the prevention of dental caries. This depends on dental visits and the efficacy of oral self-care, which includes the use of toothbrushes, fluoride-containing toothpaste, dental floss, and other interdental cleaning materials. Brushing the teeth twice daily with toothpaste containing fluoride and flossing remove plaque from teeth and help in the prevention and control of dental caries and periodontal diseases.[9],[10]

The distribution and severity of oral diseases vary with gender, age, and social status, and oral hygiene practices significantly influence oral diseases.[11],[12] The aim of this study, therefore, was to record the oral health practices and determine the prevalence of dental caries among secondary school students in Lagos State, Nigeria and evaluate the influence of oral hygiene practices on caries experience among this group.


  Materials and Methods Top


Population and sampling

The study was a cross-sectional survey conducted among secondary school students aged 11–20 years in two Local Government Areas (LGAs) of Lagos State.

A minimum sample size of 368 was estimated to be adequate. The assumptions made were the prevalence of dental caries among secondary school children with dental caries was 40%,[13] precision (d) 5%, confidence interval (CI) of 95%, and standard normal deviate at 1.96. Data were obtained from 598 participants. The study units were selected using multistage sampling technique. The participating LGAs were randomly selected from the ballots of all LGAs in Lagos State by simple replacement balloting. Similarly, two schools were selected from each LGA by replacement random sampling, and random sampling was again used to select the participating classes in each school. The number of students selected from each school was based on the proportional allocation. Finally, the study participants were selected by systematic random sampling with the class register representing the sampling frame. The first student was randomly selected from the sampling frame, and subsequent students were selected through a predetermined sequence until final sample size was attained for each school.

Ethical approval was obtained from the Research and Ethical Committee of the Lagos University Teaching Hospital, Idi-araba, Lagos. Approval was also sought from Lagos State Ministry of Education and Local Education Authorities. Written informed consent was obtained from the parents and guardians of the participating children after explaining the nature of the study. Students between the ages of 11 years and 20 years were enrolled into the study except those who refused to participate or whose parents or guardians refused to sign the consent forms. Participants with mixed dentition were also excluded from the study.

Data collection

Data were collected using pretested self-administered questionnaire and clinical examination. The questionnaire was pretested using approximately 40 (10%) of the calculated sample size recruited from a secondary school not selected for the study. Necessary modifications were made to the questionnaire before data collection to ensure the validity and reliability of the instrument.

The questionnaire was designed to obtain information on sociodemographic characteristics and practices. The sociodemographic characteristics considered were age, sex, and ethnic group. The questionnaire assessed the oral practices of the students; questions asked included the frequency of mouth cleaning, items used for cleaning, and type of toothpaste used. Information on dental visits, treatments done, and reason for nonattendant was also obtained. Dental caries was recorded based on the World Health Organization (WHO) diagnostic criteria.[14] The participants were interviewed and examined by four trained examiners who are dentist, who were trained by a Community Dentist experienced in the use of Decayed-missing filled teeth index according to the WHO guidelines. The training ended with double examination of the same set of twenty students by each of the examiners. The intra- and inter-examiner reliability using Kappa statistics were 0.80 and 0.75, respectively.

Method of data analysis

Data entry and analysis were done using Epi Info 2002 version 3.5.1 (wwwn.cdc.gov/epiInfo/html/prevVersion.htm, wwwn.cdc.gov/epiinfo ) (Centers for Disease Control). Descriptive summary statistics were obtained for demographic variables, and difference in proportion was tested using Chi-square tests at 95% CI. P < 0.05 was considered statistically significant. Multivariable analysis using binary logistic regression was further used to analyze the influencing of oral hygiene practices on dental caries experience.


  Results Top


A total of 598 secondary school students were interviewed and examined in this study. This consisted of 302 (50.5%) females and 296 (49.5%) males. The difference in gender was not statistically significant. Most of the participants (81%) were aged 11–15 years with 351 (58.7%) of them in the junior secondary school. The Yoruba made up the most dominant ethnic group. The demographic characteristics of the respondents are presented in [Table 1].
Table 1: Demographic characteristics of the study population

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[Table 2] shows the pattern and reason for dental visits among the participants. The majority of the participants (57.6%) had never visited the dentist. “Lack of pain” (31.1%) and “no reason” (42.5%) were recorded as the reason for not visiting the dentist. About two-third (64.4%) who visited the dentist had done that for more than 2 years. Only 9.1% had visited the dentist within a 1-year period. The reasons for dental visits reported by the students were dental checkup - 42.3%, pain - 21.7%, and tooth restoration - 19%.
Table 2: Pattern and reason for dental visits among the participants

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Toothbrush alone was used as cleaning item among 73.9% of the students and 70.4% used fluoride-containing toothpaste. About three-quarter of the participants (76.9%) brush their teeth twice daily [Table 3].
Table 3: Oral cleaning aids and frequency of cleaning

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Overall, 58 (9.7%) school children examined had dental caries. Regarding the severity of dental caries, approximately half (53.4%) of the students with dental caries had one carious lesion and 20.7% had three or more carious lesions [Table 4].
Table 4: Caries prevalence and distribution of the decayed-missing-filled teeth scores among the students

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Caries prevalence was not significantly associated with cleaning items used; however, it was significantly associated with the use of fluoride-containing toothpaste and frequency of cleaning. Respondents who used fluoride-containing toothpaste were about 2 times less likely to develop dental caries compared to students who used toothpaste without fluoride (P = 0.015, odd ratio [OR] = 0.425 95% CI: 0.45–1.32). In addition, respondents who brush twice or more daily were 2.4 times less likely to develop caries compared to those that cleaned their teeth once daily (P = 0.04, OR = 0.44 95% CI: 0.20–0.94) [Table 5].
Table 5: Oral hygiene practices and caries experience

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  Discussion Top


This study assessed the influence of oral hygiene practices on caries experience among secondary school students in Lagos State, Nigeria. A cross-sectional method was used in the present study because of its low cost, speed of data acquisition, and ease of implementation. However, it is weak in establishing causal relationships, and hence a longitudinal study is recommended. In spite of this limitation, the results obtained from this investigation would contribute to existing information on dental caries experience among secondary school students in Nigeria and would be of immense benefit in designing caries prevention and oral health promotion programs for this population.

The results of the present study indicated that 93.6% of the students brushed their teeth twice or more a day. This is comparable to results obtained in several developed countries where twice daily toothbrushing is an established practice.[15] However, this is in contrast from other studies in Nigeria that have reported once daily brushing as a norm.[10],[16] In a study to assess oral self-care practices among university undergraduate students, 90% of the participants brush their teeth once a day, and in another study among medical undergraduates, 86% of them did so once daily.[10],[16] The variation may be attributed to difference in study population, for instance, the population in this study was secondary school children who are dependent on their parents or guardian for the provision of teeth cleaning material, unlike in the reported studies above, where the participants have to provide themselves with oral cleaning items from their stipends. Differences in lifestyle and behavior may also account for this variation.

Fluoride enhances the resistance of the teeth to acid attack and brushing the teeth with fluoride-containing toothpaste is recommended. About 70% of the participants in the present study used fluoride-containing toothpaste.

Approximately, 40% of the respondents had visited the dentists in the past and about two-third (64.4%) had done so for >2 years. Among those that have not visited the dentist, about half of them could not state any reason for not visiting the dental clinic. The poor utilization of dental services among the study population may be due to lack of perception of the need for dental care, poor access to oral health services, or generally poor attitude toward oral health. Therefore, it may be necessary to institute an oral health program focused on oral health education, providing dental care, and raising oral health awareness for schoolchildren in Lagos State, Nigeria.

The prevalence of dental caries in the present study was low, this confirms the results of earlier studies that indicated a low prevalence of dental caries among Nigerian schoolchildren.[17],[18] In agreement with Gibson and Williams, frequency of cleaning was found to significantly influence the occurrence of dental caries in the study population.[19] Oral diseases are clearly related to behavior, and the prevalence of dental caries and periodontal disease has decreased with improvements in oral hygiene. Cleaning the teeth twice daily improves oral hygiene. A recent Nigerian study reported that poor oral hygiene was a risk factor for developing dental caries.[20] Therefore, one way of preventing dental caries among Nigerian secondary schoolchildren may be the institution of good oral hygiene practices in this group. This may be achieved by teaching the population effective toothbrushing methods in schools through oral health education programs. Oral health promotion strategies aimed at increasing access to affordable toothbrushes and fluoride-containing dentifrices would also help in preventing caries.


  Conclusion Top


The oral health practices of the participants were not satisfactory. Although the prevalence of dental caries was low, it was significantly influenced by frequency of toothbrushing and the use of toothpaste containing fluoride. This suggests the need to educate and promote oral health among schoolchildren in Nigeria.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Marcus BJ, Kaplan J, Collins KA. A case of Ludwig angina: A case report and review of the literature. Am J Forensic Med Pathol 2008;29:255-9.  Back to cited text no. 8
    
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Rimondini L, Zolfanelli B, Bernardi F, Bez C. Self-preventive oral behavior in an Italian university student population. J Clin Periodontol 2001;28:207-11.  Back to cited text no. 9
    
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Jürgensen N, Petersen PE. Oral health and the impact of socio-behavioural factors in a cross sectional survey of 12-year old school children in Laos. BMC Oral Health 2009;9:29.  Back to cited text no. 11
    
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World Health Organization. The World Oral Health Report, 2003. Geneva: World Health Organization; 2003. Available from: www.who.int/oral health/publications/report03/en/. [Last assessed on 2016 Jun 10].  Back to cited text no. 12
    
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Akpata ES. Oral health in Nigeria. Int Dent J 2004;54 6 Suppl 1:361-6.  Back to cited text no. 13
    
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World Health Organization. Oral Health Surveys. Basic Methods. 5th ed. Geneva, Switzerland: World Health Organization; 2013. p. 43-8.  Back to cited text no. 14
    
15.
Peng B, Petersen PE, Fan MW, Tai BJ. Oral health status and oral health behaviour of 12-year-old urban schoolchildren in the People's Republic of China. Community Dent Health 1997;14:238-44.  Back to cited text no. 15
    
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Braimoh OB, Udeabor SE. Self-assessed oral health behaviour and knowledge of undergraduate medical students. Afr J Med Sci 2012;5:55-9.  Back to cited text no. 16
    
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Sofola OO, Jeboda SO, Shaba OP. Dental caries status of primary school children aged 4-16 years in Southwest Nigeria. Odontostomatol Trop 2004;27:19-22.  Back to cited text no. 17
    
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Sowole A, Sote E, Folayan M. Dental caries pattern and predisposing oral hygiene related factors in Nigerian preschool children. Eur Arch Paediatr Dent 2007;8:206-10.  Back to cited text no. 18
    
19.
Gibson S, Williams S. Dental caries in pre-school children: Associations with social class, toothbrushing habit and consumption of sugars and sugar-containing foods. Further analysis of data from the National Diet and Nutrition Survey of children aged 1.5-4.5 years. Caries Res 1999;33:101-13.  Back to cited text no. 19
    
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Folayan M, Sowole A, Kola-Jebutu A. Risk factors for caries in children from South-Western Nigeria. J Clin Pediatr Dent 2008;32:171-5.  Back to cited text no. 20
    



 
 
    Tables

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



 

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