Abstract
Background
The school is an important avenue for promoting oral health most especially in developing countries with low resources. However, the success of any school based preventive oral health programme is dependent on the teachers about whom there is little information on their present state of oral health awareness and practices in Ibadan, South-western Nigeria.
Aim & Objectives
To investigate the oral health awareness and practices of primary school teachers in Ibadan, Nigeria.
Materials & Methods:
A cross sectional study of randomly selected public primary school teachers in Ibadan was performed. Data were collected using structured self-administered questionnaire, which assessed their socio-demographic characteristics, oral health awareness, oral hygiene measures and utilization of dental services. Data were analysed using SPSS version 21. Chi square statistics was used to test for association between variables and p value set at < 0.05
Results
A representative sample of 309 teachers participated in the study with a mean age of 48.7 (± 5.94) years. The majority, 284 (91.9%), were females. A few, 39 (12.6%), of the teachers knew what dental caries and its causes were, while 1 (0.3%) knew the cause of oral cancer. Only 149 (48.2%) knew that oral diseases could be prevented. If the teachers had problems with their teeth; 154 (49.8%) would go to the hospital, 115 (37.2%) would self-medicate, 20 (6.5%) would visit the drug shop (chemist), 1 (0.3%) would visit the traditional healer and 19 (6.2%) were not sure of what to do. About a third of participants, 99 (32.0%) have had previous consultations with the dentist, with many 72 (72.0%) doing so because of pain. Many of the teachers 183 (59.2%) cleaned their teeth twice or more daily before eating. Male teachers (84.0%) and those with less teaching experience (60.6%) were found spending longer time in cleaning their teeth (p = 0.035 and p = 0.002).
Conclusion
Poor oral health awareness and practices still exists among the teachers. There is a need for urgent intervention to promote oral health amongst them.
Keywords: Awareness, Oral health knowledge, Practices, Teachers, Nigeria
Introduction
A school is an institution designed to teach pupils or students under the supervision of teachers. It plays key roles in the development of a child as the child spends considerable time in school. Therefore, the school is an important environment for the development of healthy behaviour1. Different school oral health programmes have been developed based on this and were effective in improving the oral health awareness, behaviour and oral health status of children2,3,4. The importance of schools in health promotion with teachers playing important roles since they exert considerable influence on pupils5, cannot be over emphasized. School teachers teach the pupils, thereby imparting knowledge that will be used in both the present time as children and adolescents and distant future as adults and are thus expected to be knowledgeable about general health as well as their oral health. Although a previous study reported that teachers have fair knowledge about their oral health6, others7,8 have documented that poor oral health knowledge and practices exist among them. The latter study7,8 was conducted in South-western Nigeria over a decade ago and since then there has been improvement in primary health care delivery, including oral health, in the region. It is therefore necessary to review the present situation in schools, especially as it relates to the oral health awareness and practices of the teachers. This is particularly important as no formal school based oral health programme exists in Oyo State and in many parts of the country. Information on this will be used in reinforcing the existing oral health programmes or in effective planning of oral health promoting programmes for the teachers, their pupils and the community as the case may be, since the success of any school based programme has been found to be largely dependent on teachers5. This study therefore investigated the oral health awareness and practices of primary school teachers in Ibadan, Oyo state, Nigeria.
Materials & Methods
The study, descriptive cross-sectional in design, was conducted among a representative sample of primary school teachers, over a period of six months, in Ibadan, Nigeria. The study participants were teachers from 16 randomly selected public primary schools in Ibadan metropolis. A minimum sample size of 297 participants was obtained using Kish’s sampling calculation method for cross sectional studies9, with a power of 90 and a degree of error of 5%. The prevalence of oral care practices was obtained from a previous study7. Before commencement of the study, ethical approval was obtained from the University of Ibadan and University College Hospital Institutional Ethics Review Board. Approval was also obtained from each school’s head teacher. Consent was obtained from each of the participating teacher and no personal identifiers were used on the questionnaires. Only teachers who gave their consents and were available at the time of the study were recruited.
Data Collection
Data were collected using a structured self-administered questionnaire that was pretested prior to commencement of the study. The pre-test was conducted on 20 teachers in a school that was not part of those selected for the study. This was to validate the questionnaire and to assess its comprehensibility by the teachers. Information obtained with the questionnaire included; socio-demographic characteristics, oral health awareness and practices of the teachers.
The socio-demographic details included the age, gender, marital status and years of teaching experience of the participants. Awareness of oral health was tested by questions that addressed causes of tooth decay, causes of oral cancer and their knowledge of if and how oral diseases could be prevented. Information obtained on the oral health care practices of the teachers were tooth cleaning aids used by the teachers, frequency of tooth brushing, interdental cleaning aids used, what they would do if they had oral health problems and if they had ever consulted a dentist before as well as reasons for the consultations.
Data Management
Data collected were analysed using SPSS version 21. Chi-square statistics was used to determine the associations between the various variables and the level of significance set at p < 0.05. To reduce the number of empty cells for cross tabulation and analysis, variables such as marital status, age and years of teaching experience were dichotomized. Marital status was re-coded as married and others (with others comprising singles and widowed). Age and teaching experience were dichotomized according to the median.
Results
A total of 330 teachers were approached for the study and 309 consented to participate i.e. a response rate of 93.6%.
Socio-demographic characteristics of the study participants
The median age of the study participants was 50 years (range: 28 to 59 years). There were 284 (91.9%) females, 294 (95.1%) participants were married and 236 (76.4%) had National Certificate of Education - the basic teachers’ tertiary qualification in the country. Table 1 shows the socio-demographic characteristics of the teachers. The teaching experience of the teachers ranged from 3 to 35 years (median of 24 years).
Table 1 . Demographic characteristics of the study participants.
| Variable | Number | Percentage |
| Age | ||
| < 50 years | 150 | 48.5 |
| ≥ 50 years | 159 | 51.5 |
| Total | 309 | 100.0 |
| Gender | ||
| Male | 25 | 8.1 |
| Female | 284 | 91.9 |
| Total | 309 | 100.0 |
| Highest level of education | ||
| NCE | 236 | 76.4 |
| University | 73 | 23.6 |
| Total | 309 | 100.0 |
| Years of teaching experience | ||
| ≤ 24 | 155 | 50.2 |
| > 24 | 154 | 49.8 |
| Total | 309 | 100.0 |
| NCE – National Certificate of Education | ||
Awareness of oral health and oral diseases
The answers to the question on causes of tooth decay revealed that 39 (12.6%) knew the causes of dental caries and were able to pick the correct answers, 20 (6.5%) got two answers correct, 87 (28.2%) ticked one correct answer and 163 (52.8%) were unable to select a correct answer or answer the question. A total of 109 (35.3%) teachers had heard about oral cancer and only one teacher was able to state a (correct or any) possible cause of oral cancer. Concerning the prevention of oral diseases; 149 (48.2%) believed oral diseases could be prevented, 53 (17.2%) believed they could not be prevented while 107 (34.6%) did not know.
The teachers were asked what they would do if they had problems with their teeth; 154 (49.8%) said that they would go to a hospital, 115 (37.2%) would self-medicate, 20 (6.5%) would visit a drug shop (chemist), 1 (0.3%) would consult a traditional healer and 19 (6.2%) would use warm saline mouthwash, ask friend and relatives for advice or do nothing. A total of 118 teachers have had problems with their teeth in the past of which 71 (60.2%) consulted a dentist.
Oral health practices
Sixty percent of the respondents cleaned their teeth twice or more often every day. The majority (79.3%) cleaned their teeth for two minutes or longer each time. The choice of tooth cleaning aids were toothbrushes only (68.6%), chewing sticks only (3.6%) and both (27.8%). Overall, 298 (96.4%) teachers used toothbrush solely as their tooth cleaning aid or in combination with chewing sticks. Out of these 298 teachers, the choice of toothbrush bristle texture was such that 123 (41.3%) used soft, 100 (33.6%) medium, 70 (23.5%) hard and 5 (1.7%) did not know the texture of their toothbrushes. As regards toothbrush changing frequency; toothbrushes were changed every three months by 138 (46.3%), whenever bristles were fraying by 85 (28.3%) or at no particular time by 75 (25.2%).
The majority, 166 (53.7%), of the teachers used both horizontal and vertical strokes to clean their teeth. In order to remove food stuck in between their teeth; 273 (88.3 %) teachers used toothpick, 5 (1.6%) dental floss, 3 (1.0%) broomstick, 3 (1.0%) used pointed objects like pins and 25 (8.1%) did not respond. The additional medicaments the teachers use to clean their teeth apart from dentifrices included; herbal powder (7), Aloe Vera (5), mouth rinses (4), ash (2) and tooth cleaning powder (2).
Consultation with a dentist
A total of 99 (32.0%) teachers had consulted a dentist before, of which 53 (17.2%) did so within the preceding five years, 15 (4.9%) within 6 to 10 years, 9 (2.9%) within 11 to 15 years, 11 (3.6%) within 16 to 20years and 11 (3.6%) did so more than 20 years before the interview.
Reasons for consulting with the dentist
The most common reason for consulting the dentist stated by the respondents was toothache (72), followed by routine check-up (14), tooth decay (4), tooth replacement (3), tooth cleaning (3), trauma (2) and oral ulcer (1).
Reasons for consulting with the dentist within a year of the study
Only 18 (5.8%) teachers had visited a dentist in the twelve months preceding the study and they went for routine dental check-up (8), relief of acute pain (8) or other reasons (2).
Reasons for not visiting the dentist
The major reason for 172 (81.9%) teachers not having consulted a dentist before was that “I perceived no need for it because there was no problem with my teeth and mouth”. The other teachers gave reasons such as financial constraints 15 (7.1%), “I have no time to spare” 8 (3.8%), “I do not believe in orthodox dental care” 2 (1.0%), “I am fearful of pain” 1 (0.5%), “I fear that I may lose more teeth” 8 (3.8%) and fear of contracting infections 4 (1.9%).
Association between sociodemographic characteristics and oral health knowledge, attitude and practices
No significant association was found between sociodemographic characteristics of the teachers, oral health knowledge and their attitude towards oral health.
A higher proportion of male teachers (84.0%) spent three minutes or longer in cleaning their teeth compared to the females (52.1%), p = 0.002. No significant association was found between gender and other oral health practices. Teachers with less teaching experience were more likely to spend three minutes or longer in cleaning their teeth compared to teachers with more than 24 years of teaching experience (60.6% vs. 48.7%), p = 0.035 Table 2. No significant association was found between age, marital status and oral health practices (p > 0.05).
Table 2 . Sociodemographic characteristics and oral health practices .
| Frequency of tooth cleaning | |||||
| Sociodemographic characteristics | < 2ce No (%) | ≥ 2ce No (%) | Total No (%) | χ2 | p value |
| Age (years) | |||||
| < 50 | 60 (40.0) | 90 (60.0) | 150 (100.0) | 0.073 | 0.787 |
| ≥ 50 | 66 (41.5) | 93 (58.5) | 159 (100.0) | ||
| Total | 126 (40.8.) | 183 (59.2) | 309 (100.0) | ||
| Gender | |||||
| Male | 11 (44.0) | 14 (56.0) | 25 (100.0) | 0.117 | 0.732 |
| Female | 115 (40.5) | 169 (59.5) | 284 (100.0) | ||
| Total | 126 (40.8) | 183 (59.2) | 309 (100.0) | ||
| Marital status | |||||
| Married | 120 (40.8) | 174 (59.2) | 294 (100.0) | 0.004 | 0.950 |
| Others | 6 (40.0) | 9 (60.0) | 15 (100.0) | ||
| Total | 126 (40.8) | 183 (59.2) | 309 (100.0) | ||
| Teaching experience (years) | |||||
| ≤ 24 | 62 (40.0) | 93 (60.0) | 155 (100.0) | 0.078 | 0.780 |
| > 24 | 64 (41.6) | 90 (58.4) | 154 (100.0) | ||
| Total | 126 (40.8) | 183 (59.2) | 309 (100.0) | ||
| Time spent in tooth cleaning | |||||
| Sociodemographic characteristics | < 3minutesNo (%) | ≥ 3minutes No (%) | Total No (%) | χ2 | p value |
| Age (years) | |||||
| < 50 | 63 (42.0) | 87 (58.0) | 150 (100.0) | 1.287 | 0.257 |
| ≥ 50 | 77 (48.4) | 82 (51.6) | 159 (100.0) | ||
| Total | 140 (45.3) | 169 (54.7) | 309 (100.0) | ||
| Gender | |||||
| Male | 4 (16.0) | 21 (84.0) | 25 (100.0) | 9.428 | 0.002* |
| Female | 136 (47.9) | 148 (52.1) | 284 (100.0) | ||
| Total | 140 (45.3) | 169 (54.7) | 309 (100.0) | ||
| Marital status | |||||
| Married | 132 (44.9) | 162 (55.1) | 294 (100.0) | 0.410 | 0.522 |
| Others | 8 (53.3) | 7 (46.7) | 15 (100.0) | ||
| Total | 140 (45.3) | 169 (54.7) | 309 (100.0) | ||
| Teaching experience (years) | |||||
| ≤ 24 | 61 (39.4) | 94 (60.6) | 155 (100.0) | 4.447 | 0.035* |
| > 24 | 79 (51.3) | 75 (48.7) | 154 (100.0) | ||
| Total | 140 (45.3) | 169 (54.7) | 309 (100.0) | ||
| *Statistically significant | |||||
Discussion
The present study showed that the majority of the study participants were females and were married. This is a reflection of the demography of teachers in Ibadan where the study took place. The higher proportion of the primary school teachers being females shows the recent trend in gender distribution in the employment of public primary school teachers in Southern Nigeria. That females dominate the teaching profession had been similarly reported by others10,11,12. The mean age of teachers in this study was 48.7 years, which is similar to findings by other authors10,13 but contrary to that of Vanka et al12. This reveals that the study participants are experienced in the teaching profession.
The present study investigated the oral health awareness and practices of primary school teachers in Ibadan. Analysis of the data showed that very few of the teachers knew either what tooth decay was or its causes, which differs from findings by other authors where a higher proportion of teachers had good knowledge of what tooth decay is and were able to correctly mention its aetiological cause7,13. Furthermore, the findings from this study whereby less than 50% of the respondents were able to mention a cause of dental caries differs from what was reported in a previous study by Sofola et al.,8 in the South West region of Nigeria, where it was observed that 71% of the respondents mentioned at least a cause of dental caries. This is worrisome as it would be expected that there should be an improvement in the level of oral health knowledge of the teachers after a decade of a previous report of the need to promote oral health among teachers; rather, the proportion of teachers having the correct knowledge about the causes of dental caries has dropped. Dental caries is one of the most common chronic diseases affecting children worldwide and as such calls for a well structured intervention strategy to improve knowledge about the aetiology as well as its prevention.
Also noted among the teachers in the present study was the very poor awareness about the causes of oral cancer. The proportion of teachers in this study who were aware of oral cancer is lower than the proportion of the public that were aware of oral cancer reported in Yemen14. This may be partly due to the relatively low incidence of oral cancer as well as general poor awareness about oral diseases in this environment. Moreover, less than half of the teachers believed that oral diseases could be prevented, a pointer to poor knowledge about prevention of oral diseases, among the study group. This thus further corroborate the existing literature in this part of the world that have shown that teachers have poor knowledge about oral health7,8, but contrasts findings from other studies in India, where many of the teachers that were studied mentioned different modes of preventing oral diseases10,13. The presence of institutionalized school oral health programmes in parts of India, unlike in the country where the present study was conducted, could be partly responsible for this difference.
One half of the teachers in this study mentioned that they will seek dental consultation if they have dental problems and 60% of those with previous dental problems had visited the dentist. This portrays a problematic dental seeking behaviour. Although, this finding suggests that many of the teachers knew that dental care could be obtained at the hospital, which is quite assuring, some of the teachers engage in self-medication, visiting the drug store or seeking for advice from friends and relatives when they had problems with their teeth or mouth. Those may be contributory to the usually late presentation seen among patients presenting to the dentist in this environment. The teachers engaging in self-medication amongst other practices as observed in the present study will need to be corrected in order to encourage a favourable attitude towards dental care.
The self oral care of the teachers was such that 96.4% of the teachers used toothbrush as a tooth cleaning aid as similarly reported by some authors11,13. Furthermore, and in agreement with a previous study13 the majority of the teachers used soft and medium textured toothbrushes, which are the recommended types. However, the proportion of the teachers using toothbrushes with hard textured bristles in this study is high13. Hard toothbrushes could be injurious to the gums and teeth traumatizing the gums and increasing the risk of developing gingival recession if the wrong technique of tooth brush is also employed15,16. The recommended frequency of tooth cleaning being a minimum of twice daily, was similarly the norm for many of the teachers in this study, which is consistent with findings by Sekhar et al.,13 and Manjunath and Kumar11. Although the proportion of teachers doing so in the present study (55.9%) is lower than that reported in the east - 82.5% and south of India - 68.5%11,13. This contrasts with the findings by Sofola et al.,8 where over 75% of the respondents cleaned their teeth once daily. This could be seen as an improvement over the latter study over the years and should thus be encouraged. However, the time when tooth cleaning is done would have to be a point of emphasis during health education programmes since tooth cleaning is best done as soon as possible after meals to achieve a plaque free mouth. Many of the teachers cleaned their teeth for two minutes or longer consistent with findings by other authors11,13. Teachers in this study, majorly, used toothpicks, wood sticks and sharp objects to remove food stuck in between their teeth, with very few using dental floss. This was similarly reported by Ehizele et al.,7 in the South-South region of Nigeria where 84.4% of teachers in that study used potentially harmful objects such as wood sticks, pin amongst others to remove food or other particles stuck in between their teeth with only 8.4% using dental floss. The use of these potentially harmful objects, which may also damage the oral tissues, is a point to actively discourage at any available opportunity.
A few of the teachers had consulted the dentist before, similar to what was reported in the South Western part of the country8, although about 5% of the teachers in this study consulted the dentist within one year of the study compared to 40% in the previous study8. Furthermore, many consulted the dentist because of one complaint or the other, with toothache being the most prevalent reason for seeing the dentist. The present finding is consistent with other reports11,13,17,18 where teachers consult the dentist mainly because of toothache and other complaints. The fact that dental consultation is problem driven has been documented in the Nigerian population19,20. The main reason for not consulting the dentist was that there was no perceived need for dental care since they did not have dental problems. This still points to poor level of awareness among the teachers, which still exists at present. The present study found that male teachers were more likely to spend more time in cleaning their teeth although females have been noted to be more health cautious, oral health inclusive17, this is not the case here and an explanation for the inadequate time spent on tooth cleaning may be due to the work load on females. Having to cope with the house chores may leave them with little time to spend on tooth brushing. Since teachers are important role models to the pupils, they are expected to have better knowledge, awareness and practice of oral health than most people in the society, which will translate to good oral health practices among pupils and the school community at large. This is however, not the case in this environment and probably may be a contributory factor to the absence of a formal school oral health programme in the state.
Conclusions
The present study showed that poor awareness and practices of oral health care exists among primary school teachers in Ibadan. Utilization of dental services among them is poor and problem driven. There is a need for urgent intervention to promote oral health amongst them. This should include education of the teachers as well as including oral health promotion programmes into the curriculum of school teachers during training. Those who have graduated and are presently teaching in various schools should be trained and evaluated on oral health knowledge, attitude and practices on regular basis.
Footnotes
Competing Interests: The authors have declared that no competing interests exist.
Grant support: None
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