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Authors : Dr Anita Rama Kahar, Dr Jayashree Joshi, Dr Usha Radke.

Abstract :

Aim- The aim of the present study was to evaluate the change in oral hygiene practices after the sensitization amongst the clinical support staff of the VSPM Dental Institute; Nagpur (MS) Material & Method- A cross sectional survey was undertaken. A 13 item self administered validated questionnaire were filled out by 82 clinical support staff. A sensitization lecture was delivered. After a month same questionnaire were filled out by same participants. The answers of pre sensitization & post sensitization were compared. Result- The responses towards frequency of two times brushing, increased to 82.92 %. Regarding the criteria of selection of toothpaste with respect fluoride it is increased to 63.44 %. The response towards the 1-2 minutes of brushing has increased to 73.19%. The use of vertical strokes in brushing technique is accepted by 57.34% participants after the sensitization. The knowledge about interdental cleansing aids, after sensitization has increased to 90.25%. Response towards six months visit to dentist has increased to 65.87 %. Conclusion- Sensitization has proven beneficial and motivating factor in changing the knowledge in the oral hygiene practice of the clinical support staff. Key words- Clinical support staff, oral hygiene practices, sensitization, oral health.

Introduction

Oral cavity is the door to castle called body. Same way clinical support staff are the one who inter-act first with patient before the dental professionals. Clinical support staff provides vital assistance in diagnosing, treating and caring for patients.1 So these staff should have their healthy oral cavity and should have a proper knowledge about it.

The dental treatment cannot be imagined without clinical support staff. So this is our prime responsibility to teach them correct oral hygiene practice. So that they will have their healthy oral cavity. In India, studies on clinical support staff is found to be very less or nil. So, we decided to conduct present study on our clinical support staff.

According to World Health Organization, health is defined as, ‘a state of complete physical, mental & social well being & not merely the absence of disease & infirmity’ (1948).2 For the field of dentistry, the new prospective on health suggested that the ultimate goal of dental care, namely good oral health, should no longer merely be as seen as the absence of caries or periodontal disease, a patients mental & social well- being should be considered as well.3 based on this, it is the primary concern of dental professional and oral health educators to impart a positive oral health knowledge and behaviour in the society and there has been a growing idea of health promotion through education, instruction and motivation all over.4

In any dental Institute or dental clinics, clinical support staff are the one who interacts with the patients first. Their role is essential in maintaining asepsis, maintaining records, fixing appointments, delivering oral hygiene instructions etc. Hence, assessment of their oral hygiene practices too becomes important.5 The clinical support staff should have correct knowledge of oral hygiene and they should have healthy oral cavity. They should know the correct oral hygiene measure which they can share with the patients. It is the prime responsibility of dental professionals or dental educators to give proper knowledge to their clinical support staff. In literature also the studies done on oral hygiene practices among the students, 4,6-9 is seen but there is scarce published literature on assessment of oral hygiene practices of paramedical staff in India.9 These people get neglected, but it is essential, as they are the important members of our institute or dental clinics. I think, without their help the dental profession is handicapped. We need their help in every step of treatment. So, they should be taken care of. In the present study we not only assessed their oral hygiene practice but also sensitized them about the correct oral hygiene practice.

It is said that, if you want to bring change in society, the initiative should be done by home. As the dental institute or dental clinics are our second home and the clinical support staffs are our family members. So, we decided to take initiative in the form of this present study by sensitizing the clinical support staff of the institute.

Aim of the study

The aim of the present study was to evaluate the change in oral hygiene practices after the sensitization amongst the clinical support staff of the VSPM Dental Institute, Nagpur

Objectives
  • To evaluate the oral hygiene practices of the clinical support staff of the VSPM Dental Institute, Nagpur
  • To compare the change in the oral hygiene practice of the clinical support staff of the VSPM Dental Institute, Nagpur
Material and methods

A cross sectional survey was undertaken among the clinical support staff of VSPM’s Dental College & Research Centre Nagpur (MS). The ethical approval was obtained by the Institutional ethical committee. The sample size of study was 82.The Survey Instrument was 13 item self administered validated questionnaire5. The questionnaire was in Marathi language. First part of questionnaire dealt with basic demographic criteria & second part dealt with questions regarding the oral hygiene practice. We have included nurses, office staff, technicians & attendants as a study sample. The purpose of the study was explained to each participant and informed consent was obtained from each participant who was willing to participate in the study. Unwilling participants were excluded from the study.

The questionnaire was distributed among them & got collected immediately after completion. Any doubts regarding the questionnaire was solved. A sensitization lecture was delivered. The delivered lecture was also in Marathi language & mostly it was a pictorial. The lecture was dealt with the oral hygiene measures, ill effects of wrong methods of brushing, importance of fluoridated tooth paste and interdental cleansing aids. The most liked part of lecture by the participants was inclusion of various videos on brushing technique & dental flossing. After one month same questionnaire was distributed among them & got collected after their answering. The pre sensitization & post sensitization answers of the same participant were compared.

Observations, Interpretation & Analysis

The present study was carried out to evaluate the knowledge of oral hygiene practices and to compare the effect of sensitization lecture on oral hygiene practices amongst the clinical support staff of VSPM Dental college & Research Centre, Nagpur. Out of the 82 participants, 53 were female and 29 were male. Table 1 & 2 describes the participants according to age groups and education respectively. Table 3 shows the responses towards the questionnaire. The response rate was 100%. The sensitization lecture has proven very beneficial regarding the responses towards frequency of two times brushing. Initially the response was 57.31% which has increased to 82.92 %. Regarding the criteria of selection of toothpaste with respect fluoride it is increased to 63.44 % which was initially only 13.41%. The response towards the 1-2 minutes of brushing has increased to 73.19%, which was 23.19% before sensitization. The use of vertical strokes in brushing technique is accepted by 57.34% participants which were only 7.31% before the sensitization. There were very few about 36.59% participants, who have knowledge about interdental cleansing aids. After sensitization this has increased to 90.25%. Response towards six months visit to dentist has increased to 65.87 %, which was 20.75% before the sensitization. The graphical representation of pre sensitization and post sensitization responses are figured out from Graph 1to graph 13

Table1- Participants according to age group

Below 34 yrs 22
35 yrs- 44yrs 32
45 yrs  & above 28

Table 2- Participants according to education

Below 12th 36
Above 12th  46

Table 3- Responses of participants to the questions


Que no
Questions Pre-sesitization response in percentage (%) Post-sesitization response in percentage (%)
1. Use of  toothbrush
  • Yes
  • No
  • Sometimes
91.46
3.65
4.89
100
0
0
2. No of times to brush daily
  • Twice daily
  • Once daily
  • Thrice daily
57.31
40.26
2.43
82.92
17.08
0
3. Type of toothbrush
  • Medium
  • Hard
  • Soft
  • Ultrasoft
  • No answer
67.07
1.21
24.39
1.24
6.09
87.82
0
10.97
0
1.21
4. Dentifrice  used along with tooth brush
  • Tooth paste
  • Tooth powder
  • Charcoal
  • Other
  • Two answer
82.92
13.41
0
2.46
1.21
97.57
2.43
0
0
0
5. Selection of tooth paste
  • Fluoride containing
  • Pleasantness
  • Cost
  • Attractiveness
  • Two answer
  • No answer
13.41
73.19
3.65
4.89
2.43
2.43
63.44
31.70
0
2.43
0
2.43
6.  Time given to brush  teeth
  • For 1-2 min
  • For less than one min
  • For 2-5 min
  • For 5-10 min
23.19
1.21
42.68
32.92
73.19
8.53
15.85
2.43
7. Brushing technique
  • Vertical strokes
  • Horizontal strokes
  • Circular
  • Both horizontal & vertical strokes
7.31
26.84
18.29
47.56
57.34
6.09
2.43
34.14
8. Time to change  tooth brush
  • Once in three mths
  • Once in six mths
  • Every year
  • When bristles are frayed
  • No answer
51.21
24.39
2.43
19.54
2.43
87.83
3.65
0
7.31
1.21
9. Cleaning of tongue
  • Tongue cleaner
  • Tooth brush
  • Finger
  • Do not clean
35.36
21.95
39.04
3.65
48.7932.
92
18.29
0
10. Knowledge about interdental cleansing aids
  • Yes
  • No
36.59
63.41
90.25
9.75
11. Knowledge of different interdental cleansing aids
  • Dental floss
  • Tooth pick
  • Proxa/Interdental brush
  • Use of mouthwash
  • Rinsing
13.41
27.29
3.65
17.09
38.56
73.48
7.31
10.65
3.69
4.87
12. No. of times to use these aids
  • Once daily
  • Twice daily
  • Occasionally
  • Do not use
  • No answer
28.04
18.29
23.17
21.95
8.55
53.65
15.85
17.09
7.32
6.09
13. Visit to dentist
  • Every six months
  • Once in a year
  • Only when required
  • Never visited the dentist
20.73
0
69.52
9.75
65.87
6.09
28.04
0

Graphical representation of responses of participants to the questions

Graph 1- Responses of participants for Use of toothbrush in% Graph 2- Responses of participants for No of times to brush daily in %
Graph 3- Responses of participants for Type of toothbrush in % Graph 4- Responses of participants for Dentifrice used along with tooth brush in %
Graph 5- Responses of participants for Selection of tooth paste in % Graph 6- Responses of participants for Time given to brush teeth in %
Graph 7- Responses of participants for Brushing technique in % Graph 8- Responses of participants for Time to change tooth brush in %/td>
Graph 9- Responses of participants for Cleaning of tongue in % Graph 10- Responses of participants for Knowledge about interdental cleansing aids in %
Graph 11- Responses of participants for Knowledge of different interdental cleansing aids in % Graph12- Responses of participants for No. of times to use these aids in %
Graph 13- Responses of participants for Visit to dentist in %

Discussion

Oral hygiene is the practice of keeping the mouth clean and healthy by brushing and flossing to prevent tooth decay and gum disease. Maintaining oral hygiene should be a lifelong habit. Negative consequences arise from improper or infrequent brushing and flossing. The five major oral health problems are plaque, tarter, gingivitis, periodontitis and tooth decay.10Dental health education is one of the preventive measures. Its aim is to raise awareness and motivate pro-health behaviors to maintain good oral health. The knowledge of prophylactic rules and their application in practice, necessary knowledge and thorough information adjusted to the patient’s age are of high impact in accomplishing good oral health.11-15One of the communication strategy for the quality of care initiative involves, sensitization.16 Sensitization is a non-associative learning process in which repeated administration of a stimulus results in the progressive amplification of a response. 17

It is important to sensitise the community leaders and health workers about the quality of care strategy as they are key to the overall implementation of the program. With the support of these main audiences, the program has a higher likelihood of success. Sensitisation will involve a Elements of the sensitisation campaign include not only developing the quality "symbol" for the program, but also producing materials that describe the program and identify channels for disseminating these materials. Before developing the sensitisation program, it was necessary to outline the parameters for the quality symbol.16

The symbol should represent/evoke:
  1. Good quality
  2. Caring, friendly service providers
  3. Appropriate, competent treatment
  4. Partnership between service providers, clients and community.
The symbol should be:
  • Unique
  • Recognisable by low literates
  • Easily reproduced (can be printed in black & white and is still legible; minimal colours)
  • Not language dependent
  • Appealing to all cultures
  • Easily described in words
  • Simple
By considering all these points, we selected our clinical support staff as the main audience. We translated the questionnaire in Marathi language, got its validation done. The sensitization lecture had also been delivered in Marathi language. The lecture was pictorial with various videos. The main aim of our study was to motivate them. Because for a motivated, well-instructed person with time and skill, mechanical plaque-control measures are sufficient to attain complete dental health.18 A number of factors have been suggested as playing a role in motivation of people in performing oral hygiene procedures. Most important amongst these factors are self recognition of the disease and the knowledge of various preventive measures.19Good oral hygiene and a positive attitude towards maintaining it, reflects individual’s health, confidence, life style and personality also.

Paramedical staff such as receptionists, nurses, technicians and attendants forms an important group in a dental institution. They play a role of linking between patients and doctors in the hospital. It is therefore important that auxiliary staff caring for people in hospitals themselves have a core of knowledge of their oral care needs. They are also expected to maintain their oral hygiene. There is scarce published literature on assessment of oral hygiene practices of paramedical staff in India.5

At the same time sensitizing them about the good oral hygiene not only will improve their oral health but also they can share their knowledge about the oral hygiene practice with their family members, collogues, friends and relatives. They can guide our patients properly, as many patients are found to be talking with the clinical support staff about their treatments. The most of the studies which have been undertaken have assessed the oral hygiene the practices. But in our study we have not only evaluated the oral hygiene practice but also sensitized them for a correct oral hygiene practice.

Limitations

As the questionnaire was self reported, answers given by the participants may be biased.

Recommendations

The sensitization cycle will have to be kept as a continuous practice for the benefit of clinical support staff. The importance of oral health will have to be explained them again and again until we achieve 100% result of the study. There are still some participants who are not in favour of visit to dentist every six months even though they are working in the dental institutes. For such participants the ill effects of poor oral hygiene will have to be explained properly which will help to sensitize them to accept the fact and motivate them.

Conclusion

Sensitization has proven beneficial and motivating factor in changing the knowledge in the oral hygiene practice of the clinical support staff. A desirable change is seen in the oral hygiene practice of the participants.

References
  1. Clinical support staff. www.nhscareers.nhs.uk
  2. Park K. Park’s textbook of preventive & social medicine: Concept of health & disease (19th ed). Jabalpur: M/s Banarasidas Bhanot Publishers 2005: 12-13
  3. Inglehart MR Bagramian RA. Oral health- related quality of life: An introduction. Chicago: Quintessence Publishing Co, Inc 2002, p.1
  4. Laxman Singh Kaira et al; Oral health related knowledge, attitude and practice among nursing students of Rohikhand and Medical College and Hospital: A questionnaire study. Journal of Orofacial Research, January-March 2012;2(1): 20-23.
  5. Amith Holenarasipur Vasanthakumar et al; Oral hygiene practices among paramedical staff of a private dental institution in India. Journal of RSBO. 2013 Jul-Sep;10(3):205-10
More references are availabe on request.

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