|Year : 2017 | Volume
| Issue : 2 | Page : 161-166
Knowledge and practices of oral health care in final year undergraduate nursing students: A cross-sectional study
Suryakant C Deogade1, Vinay Suresan2
1 Department of Prosthodontics and Crown and Bridge, Government Dental College and Hospital, Nagpur, Maharashtra, India
2 Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, Bhubaneswar, Odisha, India
|Date of Web Publication||15-Dec-2017|
Suryakant C Deogade
C/o Vivek Thombare, Flat No.301, Gajanan Apartment III, Wanjarinagar, Near Water Tank, Nagpur - 440. 003, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Nursing personnel plays a crucial role in promoting health and preventing information dissemination in the community. Aim: to assess and evaluate the oral health knowledge and practices of final year nursing students of Jabalpur, Madhya Pradesh (India). Materials and Methods: A cross-sectional survey was conducted in five nursing colleges of Jabalpur. A total of 172 students participated in the survey, which were given a questionnaire that comprised 26 questions. The questionnaire were evaluated under four parts such as information on dental and oral health, oral hygiene practices, attitude toward dentist and dentistry, and interest to improve knowledge, after which the data were analyzed to compare the statistical significance among the variables. Results: 84.3% of the participants knew how many teeth we have in our mouth. Many of them were not aware of proper brushing method. However, they revealed an adequate knowledge toward the identification of disease and its relation to general health. They also showed knowledge regarding the effect of diet on oral health, but 83.1% of them were confused with the identification of tooth decay. Approximately 51.7% of participants were unsure about the number of visits a person should make to a dentist. Conclusion: Nursing undergraduates have adequate knowledge on the basic oral structure and identifying oral diseases. However, they are little puzzled with the brushing method, number of visits a person should make to a dentist. They were not updated with the specialties in dentistry. Many of them showed interest toward camps and clinical postings to enhance their knowledge toward oral health care.
Keywords: Attitude, dentistry, knowledge, nursing, oral health
|How to cite this article:|
Deogade SC, Suresan V. Knowledge and practices of oral health care in final year undergraduate nursing students: A cross-sectional study. Arch Med Health Sci 2017;5:161-6
|How to cite this URL:|
Deogade SC, Suresan V. Knowledge and practices of oral health care in final year undergraduate nursing students: A cross-sectional study. Arch Med Health Sci [serial online] 2017 [cited 2018 Aug 14];5:161-6. Available from: http://www.amhsjournal.org/text.asp?2017/5/2/161/220836
| Introduction|| |
Nursing is an important paramedical course that is considered an essential supplementary branch of medicine. Nurses play an important as well prominent role in providing health services, along with the physicians. In recent scenario, their role in dentistry seems to be negligible as they have less training and knowledge regarding the instruments, materials, equipment, and methods in this branch. However, the nurses can be effectively employed to promote dental and oral health awareness among the general public. The oral health should receive greater importance in the nursing curriculum which would include many clinical hands-on courses on identification and diagnosis of dental and oral diseases., A special nursing study groups should be established to review the research, practice, and current literature on oral health care and in which the inclusion of the dental team would be essential.
In context to India, different challenges exist for expanding adequate oral health care across the country. The biggest need is qualified dental health planners and training in public health dentistry. In recent Indian scenario, dentistry faces multiple problems regarding accessibility of health services to all dwelling communities. Oral health services based on primary health care needs a large number of dental auxiliary personnel. Therefore, the aim of this investigation was to assess and evaluate the oral health knowledge and practices among the final year undergraduate nursing students in Jabalpur, Madhya Pradesh (India).
| Materials and Methods|| |
A questionnaire-based descriptive cross-sectional survey was carried out in June 2015 among final year undergraduate nursing students from five nursing colleges of Jabalpur District (Madhya Pradesh). A convenient sampling method was employed for this investigation. All the necessary ethical approval from the respective committee was obtained, and informed consent from the participating students was obtained. A total of 172 final year undergraduate nursing students who gathered on the day of the survey were provided a self-administered questionnaire with a time limit of 30 min to answer the questions. Final year nursing students were solicited for the study as the final year nursing curriculum deals with developing proficiency in the nursing management of patients. All the final year nursing students available at the time of data collection were enrolled for the study. Those who were not willing to participate in the study were excluded from the survey. All the participants in this survey were girls with a mean age of 22 years. The questionnaire included 26 questions, and the answer was evaluated under four parts. The first part obtained information on dental and oral health, which included questions, such as a number of teeth in the mouth, identification of tooth decay, gingivitis, and effect of tobacco on oral health. The second part obtained information on oral hygiene practice, which included questions, such as ideal brushing tool, the frequency of brushing, brushing methods, tongue cleansing, and flossing habit. The third part obtained information on attitude toward dentist and dentistry. The fourth part obtained information on the interest of students to improve knowledge by attending dental camps and their interest toward clinical posting in dental departments.
Statistical analysis was performed using SPSS version 20 software (Statistical Package for Social Science Inc., Chicago, IL, USA) for Windows. Percentages and proportions were used for descriptive statistics. The Chi-square test was used to evaluate significant differences between proportions. The significance level was set to P value (P < 0.05).
| Results|| |
In this study, 172 final year undergraduate nursing students participated on the day of the survey. All the participants were girls with a mean age of 22 years ± 1.08. The descriptive information of participant's responses to oral health knowledge questions and oral health practices and attitudes toward dentistry are demonstrated in [Table 1], [Table 2], [Table 3], respectively. About 84.3% of respondents stated that there are 32 teeth in the adult mouth. When asked for identification of tooth decay, almost 51.1% of participants answered that tooth decay can be identified by pain which was statistically significant (P < 0.05). Nearly 55.8% of respondents stated yellow or greenish yellow depositions near the gums are plaque and calculus. About 56.9% of participants stated that bleeding from the gums is due to infection and this response was statistically significant. Approximately 37.2% of participants stated that periodontal disease is caused due to plaque and 44.8% of participants stated periodontal disease might lead to tooth mobility. When asked about the existence of any relation between oral health and general health, nearly 67.4% of participants agreed strongly that, there is a correlation between the asked parameters which was statistically significant (P < 0.05). In hospitalized patients, the most common dental related complaint the nursing students come across are bleeding gums (37.8%) and oral malodor (38.9%). About 69.8% of participants accepted that diet influences the health of gums which was statistically significant (P < 0.05). When asked for the effect of tobacco on oral health, around 55.9% of participants accepted that tobacco chewing will lead to oral cancer (P < 0.05) which was statistically significant.
Almost 69.2% of participants stated toothpaste and toothbrush are ideal materials for brushing teeth. Nearly 62.2% of participants answered that a person should brush his teeth twice daily. Approximately 43.1% of participants have indicated nonfluoridated toothpaste, and 56.4% suggested a soft bristle toothbrush as a daily usage. When asked regarding brushing technique, 62.2% have suggested circular motion as a proper brushing method and 51.7% suggested that an individual should change his brush once in every 3 months.
About 48.3% of participants stated that a person should visit a dentist every 6 months which was statistically significant (P < 0.05). Nearly 38.4% stated that they advice analgesic and refer the patient nearby dentist. Almost 12.8% of participants stated that there are seven specialties in dentistry. Approximately 62.8% of participants feel they should know more about oral cavity, and oral disease and 64.5% of them stated that they had taken part in a dental camp conducted in their college premises [Graph 1] and [Graph 2]. Majority (72.1%) of participants feel there is a need for the clinical posting in dental clinical departments [Graph 3]. About 85.3% of them agreed to recommend incorporation of dental training into nursing curriculum [Graph 4].
| Discussion|| |
It is the moral responsibility of all the health care personnel to provide an adequate oral care for those patients in need at primary health care settings. Nurses have a major role in providing daily oral care of inpatients, hence greater awareness among such health auxiliaries can do a lot to serve the community with good oral health care.
A cross-sectional questionnaire-based survey was carried among final year undergraduate nursing students in Jabalpur, Madhya Pradesh (India) to determine the levels of oral health knowledge and practices among them. One hundred and seventy-two students participated in the survey, and they were provided with a questionnaire including 26 questions that were evaluated under four parts. All the participants in the investigation were girls and 79.3% among them were about 22 years of age.
In the present study, the majority of nursing students were aware that an ideal tool for tooth brushing is a toothbrush and paste and an individual should brush his teeth twice daily with a soft bristle brush to maintain a proper oral hygiene. This finding was in agreement with the studies conducted by Asif et al. and Muttineni et al. However, the results are contrary to other studies conducted by Al-Beiruti  where most of the nursing students were not aware about the type of toothbrush used and contents present in the toothpaste. Almost, 51.7% of students suggested that every individual should change their toothbrush once in 3 months which was in accordance with the studies conducted by Asif et al. and Muttineni et al. Approximately 51.1% of students in the present study stated that initially tooth decay can be identified by pain which was in agreement with the previous studies., Only 16.9% of students were sure that tooth decay can be identified as black spot and cavity, whereas, more than two-thirds of them (83.1%) were confused with the identification of tooth decay. However, their knowledge regarding periodontal disease and its effect on tooth and surrounding structure was adequate. This finding was in accordance with Walid et al., Asif et al. and Muttineni et al., however these are in contrary to the previous study conducted by Rak and Warren  Walid et al. reported that nurses have adequate knowledge in identifying the dental caries, periodontal disease, oral manifestations of HIV infection, and oral cancer. However, Rak and Warren  observed a paucity of specific dental knowledge in their study, for example, there was some confusion over the etiology and prevention of dental caries and also as to the difference between gingivitis and periodontitis.
In this study, the majority of nursing students agreed that there is a relation between oral health and general health. This finding is similar to the findings reported by Asif et al., Muttineni et al. and Andersson et al. Andersson et al. concluded that the district nurses in their study were aware of the impact of oral health in elderly, their attitude was that this was a matter for dentistry. However, Heinrichs and Famili  reported that most nurses in their university were not aware of oral health and its affect on systemic disease. Rak and Warren  reported that few nurses in their study seemed to be aware of the effects systemic disease and drugs on the oral tissues. Coleman  discussed the opportunities for nursing dental collaboration and stated that poor oral health in elderly people is been associated with their general health. He emphasized that nurses and dental professionals can improve awareness and promotes high standards of oral health care in elderly people.
In the present study, nearly 48.3% of nursing students answered that an individual should visit the dentist once in every 6 months. These findings were in agreement with the previously documented studies conducted by Asif et al., Muttineni et al., Al-Beiruti  and Preston et al. The majority of the students in this study agreed that they should know more about oral cavity and its diseases and displayed their keen interest in participation of health promotion camps. This finding was in agreement with previous studies., In his study, Adams  has observed that the nurses indicated a high level of interest and enthusiasm and in updating themselves in oral health care. In contrary, Wårdh et al. reported a low priority toward oral care with nurses working in old age homes that could be due to increase in workload and time schedule. In this study, the nursing students feel the need of clinical posting in dental departments.
The external validity regards generalizability of the results. As opposed to quantitative studies, the external validity of a qualitative study is determined by the readers. We argue that the transferability of the results can be questioned by the fact that all the participants originated from the same region with convenient access to dental care service. Therefore, the results of the present study may not be representative for groups from other regions without similar resources.
Several authors , have strongly suggested that nursing institutes should include oral health assessment in their curriculum. An oral health promotion module for the primary health care nursing course could sensitize nurses the importance of oral health and enhance their awareness and knowledge on oral health and skills. The future of oral health care will require that dental schools work in collaboration with other healthcare team members to promote oral health and teach medical health care personnel about the relationship between oral health and general health. The nurses are in ideal position to provide health promotion education and screening across the multitude of setting in which they work. Community nurses play an important role in the oral health care of society, particularly among those less likely to access dental services and there is a need to improve their knowledge regarding oral health aspects.
Nurses have the ability to incorporate oral health risk assessments, screenings, application of fluoride varnish and oral health education into the infant, child, adolescents, and elderly health assessments. Unfortunately, nurses need to acquire additional knowledge in this area to become competent and skilled enough in performing the oral health assessment. In India, the Nursing Council of India has no specific recommendations for teaching oral health care in the nursing undergraduate curriculum. Hence, it is highly recommended that oral health be stressed greater emphasis in the nursing curriculum that should incorporate more clinical hand-on training in oral examination and diagnosis of oral diseases. Such clinical exposure may provide the nursing students with the information and skills required to become oral health care partners on their graduation.
| Conclusion|| |
Nursing care plays an important role in providing oral health needs of patients with widely diverse health and sick care needs in multiple contexts worldwide. Undergraduate nursing students have adequate knowledge in identification of oral structure and oral diseases, but in other context to dentistry, they are little confused. Most of the nursing students showed enthusiasm and interest in participation of dental camps and clinical postings in dental departments to improve their knowledge and serve the society. This study governs the strong need for interdisciplinary training and collaboration between the health care professions in promoting oral health care of community people. Incorporation of clinical training and teaching of the essential components of oral health care into the nursing curriculum is the need of time. Recognizing the importance of sensitizing nursing students to the need for oral health care management skills in a nursing curriculum is highly needed in Indian nursing schools.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Walid EI, Nasir F, Naidoo S. Oral health knowledge, attitudes and behaviour among nursing staff in Lesotho. SADJ 2004;59:288,290,292.
Tetuan T. The role of the nurse in oral health. Kans Nurse 2004;79:1-2.
Rak OS, Warren K. An assessment of the level of dental and mouthcare knowledge amongst nurses working with elderly patients. Community Dent Health 1990;7:295-301.
Tandon S. Challenges to the oral health workforce in India. J Dent Educ 2004;68 7 Suppl:28-33.
Asif N, Asif SM, Babu DB, Whagrey S. Assessing the oral health awareness among the final year undergraduate nursing students in Abha, Saudi Arabia. World J Dent 2014;5:213-7.
Muttineni N, Bolla SC, Naheeda S, Shaik RB, Reddy SS, Gantha NS. Oral health awareness among the final year undergraduate nursing students in Khammam district, Telangana. J Health Res Rev 2014;1:70-3. [Full text]
Al-Beiruti N. Oral health behavior among a sample of school teachers, physicians and nurses in the Syrian Arab republic. East Mediterr Health J 1997;3:258-62.
Andersson K, Nordenram G, Wårdh I, Berglund B. The district nurse's perceptions of elderly patients' oral health: A qualitative interview study. Acta Odontol Scand 2007;65:177-82.
Heinrichs EP, Famili P. Dental school faculty teaching the periodontal-systemic connection to medical students: A pilot mini-elective. J Dent Educ 2011;75:1370-3.
Coleman P. Opportunities for nursing-dental collaboration: Addressing oral health needs among the elderly. Nurs Outlook 2005;53:33-9.
Preston AJ, Punekar S, Gosney MA. Oral care of elderly patients: Nurses' knowledge and views. Postgrad Med J 2000;76:89-91.
Adams R. Qualified nurses lack adequate knowledge related to oral health, resulting in inadequate oral care of patients on medical wards. J Adv Nurs 1996;24:552-60.
Wårdh I, Hallberg LR, Berggren U, Andersson L, Sörensen S. Oral health education for nursing personnel; Experiences among specially trained oral care aides: One-year follow-up interviews with oral care aides at a nursing facility. Scand J Caring Sci 2003;17:250-6.
Spielman AI, Fulmer T, Eisenberg ES, Alfano MC. Dentistry, nursing, and medicine: A comparison of core competencies. J Dent Educ 2005;69:1257-71.
Ogunbodede EO, Rudolph MJ, Tsotsi NM, Lewis HA, Iloya JI. An oral health promotion module for the primary health care nursing course in Acornhoek, South Africa. Public Health Nurs 1999;16:351-8.
Formicola A, Valachovic RW, Chmar JE, Mouradian W, Bertolami CN, Tedesco L, et al.
Curriculum and clinical training in oral health for physicians and dentists: Report of panel 2 of the Macy study. J Dent Educ 2008;72 2 Suppl:73-85.
Clemmens DA, Kerr AR. Improving oral health in women: Nurses' call to action. MCN Am J Matern Child Nurs 2008;33:10-4.
Gallagher J, Rowe J. Community nurses' contribution to oral health. Br J Community Nurs 2001;6:526, 528-34.
[Table 1], [Table 2], [Table 3]