“A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE ON DENTAL HEALTH AMONG SCHOOL GOING CHILDREN AT SELECTED PEDIATRIC OUT PATIENT DEPARTMENT, BANGALORE”.

M. Sc. NURSING DESSERTATION PROTOCOL SUBMITTED TO

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,

KARNATAKA

BY

Ms. RANJANA DEVI S

M. Sc. NURSING 1ST YEAR

YEAR 2009-2011

UNDER THE GUIDANCE OF

HOD DEPARTMENT OF CHILD HEALTH NURSING

K. T. G. COLLEGE OF NURSING,

HEGGANAHALLI CROSS,

PEENYA II STAGE,

BANGALORE – 560091

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DESSERTATION

1 / NAME OF THE CANDIDATE
AND ADDRESS / Ms. RANJANA DEVI S
K. T. G. College of Nursing,
Hegganahalli Cross,
Peenya II Stage,
Bangalore – 560091
2 / NAME OF THE INSTITUITION / K. T. G. College of Nursing,
Hegganahalli Cross,
Peenya II Stage,
Bangalore – 560091
3 / COURSE OF STUDY AND
SUBJECT / M. Sc. Nursing I Year
Child Health Nursing
4 / DATE OF ADMISSION TO THE
COURSE / 15- 05 - 2009
5 / TOTLE OF THE TOPIC / “A study to assess the knowledge and practice on dental health among school age children at selected pediatric outpatient department, Bangalore”.
6 / BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“Wealth and children are the adornment of life”.
- Koran
Childhood age is an important period of life, since most of the behaviors, healthy practices and positive attitudes develop during the period. Learning takes place through various institutions such as family, school, and the community. Children are curious and responsive and they can learn, adopt and practice things easily. In developing healthy behavior and practices school plays an important role. School is not only the place for teaching curricula but it is a place for cultivating healthy behaviors and practicing of an individual. It is important to catch them in young, to leave a long lasting impression in their minds. The age groups of 8-12years are the most ideal, impressionable minds because they are in a accepting adulthood. 1
Despite declines in the prevalence of dental caries, it remains an important public health problem. The goal in dental caries management should be individual risk assessment and targeting of high-risk patients and population need caries prevention and treatment. 2
High quality oral health care is an increasingly important aspiration in most parts of the world. The rapid growth in knowledge of oral disease, the change in disease prevention and the continued improvements in world communication make this a challenging time, with increasing life style emphasis, the importance and need for oral health education. 3
All over the world reported a prevalence of dental caries varying from 30 percent to 80percent. In many developing countries including India, dental caries in on the increasing. During 1940s the prevalence of dental caries in India was 55.5%,during 1950s it is was reported to be 68%.During 1980 it has been estimated to be over 80%(singe et, al) 4
In Tamilnadu it is estimated that in the year 2000, the prevalence rate of dental caries was 90% (Ministry of public health). The general health of the child is poor due to poor oral hygiene measures. Dental caries if untreated results in total destruction of teeth involved. The 8-12years period falls under the mixed dentition. 5
Factors involved in caries teeth are ignored and poverty. Basically Dental caries is painless at the initial stages. The terminal stage of the disease only has the pain; at this stage only most children become aware of the disease, after much damage has been done. Not knowing the importance’s to save the tooth is ignorance and poverty only enhances further and limits any action to be taken till a point the disease has reached the terminal phase.
The easiest way to prevent caries is by, imparting health education, Monitoring the progress, Immediate attention of disease, recognition &proper management
It is an established fact that during development stage the learning will be effective in later period. Hence during childhood period teaching good habits and healthy practices help the children to develop positive attitude towards dental health.
Developing good oral health practices helps to reduce many of the oral health problems later in life. It is very important to impart knowledge regarding dental health and motivate them towards healthy dental health practices among primary school children. 6
6.1 / NEED FOR THE STUDY
Whaley and Wong describes that during the school age years, when permanent teeth erupt, good dental health and regular attention of dental caries are vital parts of health supervision. During this period correct brushing techniques should be taught and reinforced. 7
As per W.H.O expert committee on oral health, considered as one aspect of the overall health and welfare of the society, the predominant demand is for education and assistance in maintaining oral health and primary disease. 8
Joshua R conducted a study to examine the ways in which levels of preventive dental care and unmet dental needs varied among subgroups of low-income children. Data were drawn from the 2002 National Survey of America’s Families. Study shows that more than half of low-income children without health insurance had no preventive dental care visits. The result showed that the levels of unmet dental needs among low-income children who had private health insurance coverage but no dental benefits were similar to those among uninsured children. Children of parents whose mental health was rated as poor were twice as likely to have unmet dental needs as other children. 9
Ratna kumari conducted a study to find out the prevalence of dental caries among primary school children in Kerala. The study found that the prevalence of dental caries was 68.5% among 6-12 years of age. 10
As a researcher based on the Literature review and the researcher’s experience, it was felt that assessing the knowledge and practice of primary school children regarding oral hygiene is important to reduce the oral health problem and to improve the oral health of the children, as a result of teaching program. 11
6.2
6.2.1
6.2.2
6.2.1
6.2.2 / REVIEW OF LITERATURE
Review of literature plays an important role in the research, and it helps to identify the similar studies for the investigator. It enables the researcher to focus on related studies around the world at different set-up. It provides the base for the research study and guides the investigator. 4
This chapter consists of two sections.
Section A: Review of literature.
1. Dental health and knowledge.
2. Dental health and practice.
1. Dental health and knowledge.
A study was conducted to determine the knowledge and prevalence of non-nutritive sucking habits, their effect on deciduous and permanent dentition and oral health related quality of life in Tanzanian children. In age group 7-12 years, dental caries were assessed using Decayed Missing and Filled Teeth (DMFT) index (WHO 1997) and oral hygiene was assessed using an oral hygiene index by Greene and Vermillion (1964). The result showed that the need for dental treatment were high in preschool children than the school age children and the knowledge regarding the non-nutritive sucking found to be better among school age children. 12
A study was conducted to examine the association between dental caries prevalence and selected variables in school children. A cross-sectional study was carried out with 1,303 school children (ages 8–12 years old), and they completed questionnaires. The result showed that the prevalence of dental caries varies with different age groups at P<0.05. 13
A study was conducted to survey the knowledge, attitude, and practice on oral health in Zimbabwe. The findings showed that the school children’s knowledge was very poor among 8th grade 54%, 9th grade 70% and very few children used tooth brushes and tooth pastes. 14
A study regarding dental health knowledge of a population in Dharwad town. A total of 1000 subjects in the age group of 12years and above were included in the study. The study result showed that least level of dental health knowledge is found among 12-15 years of age group at the level of p<0.05. 15
3. Dental health and practice.
A study of school age children's on oral health was conducted in rural California. A cross sectional study was adopted with 630 children. Parental beliefs and practices in seeking care were compounded by lack of key community or economic resources, and the organization and delivery of professional dental services. The findings showed that state-mandated policies and procedures worked to militate against children receiving timely care that would considerably reduce oral health disparities among this population. 16
A study to assess the prevalence of dental caries among school in urban slums of Delhi. A total of 452 participants were enrolled in the study. The prevalence of dental caries in the 7-10 years age-group was 82.4% and it was 91.9% in those 6 years. A statistically significant association was found between poor hygiene and dental caries ( P = 0.026). The awareness about good and bad dental practices was found to be low among the study participants. One-fifth of the individuals with dental problems relied on home remedies. 17
A study was conducted to describe the dental caries status of school children in Hong Kong and factors which affect their caries status. 658 school children aged 8 to 12 years from six randomly selected schools in Hong Kong were surveyed in. Results show that statistically significant correlations were found between the children's dental caries status and their oral health practices as well as their socio-economic background. Parents' education level, dental knowledge and attitudes were also associated with the children's dental caries experience. 18
A study to assess the relationship between healthful eating practices and dental caries in children aged 5–10 years in United States. The study shown that the odds of experiencing caries in primary teeth were significantly greater in non poor children who did not eat breakfast daily or ate fewer than five servings of fruit and vegetables per day. (Odds ratio, or OR = 3.77; 95 percent confidence interval, or CI, 1.80 to 7.89 and OR = 3.21; 95 percent CI, 1.74 to 5.95, respectively). 19
A study was conducted on the prevalence of dental caries and treatment needs among children of Cuttak (Orissa). An epidemiological investigation was carried out to know the prevalence of Dental caries amongst 1257 children in the age group of 6 to 15 years respectively attending schools in the city of Cuttack. The result showed that the prevalence of dental caries was recorded as 68.3% and showed a pattern of occurrence i.e. prevalence consistently increased from 6 years to 8 years age group and subsequently decreased at 11 years and 15 years age. Regarding treatment needs 63.6% children required dental treatment for various reasons and it is in accordance with dental caries prevalence of different age group. 20
A study was conducted on the impact of salt fluoridation and dental caries among children in Jamaica. Dental examinations of 1120 children aged 6 to 15 years were conducted according to W.H.O criteria to assess dental caries, fluorosis, the presence of and need for dental and Community Periodontal Treatment Needs. The result showed that the mean scores in children 6, 12 and 15 years of children were dramatically lower than the corresponding scores of 1.7, 6.7 and 9.6 obtained at the baseline examination in 1984 for children of the same age groups. 21
A study was carried out to know the prevalence of dental caries in 509 primary school children in the age group of 6 – 10 years in Rohtak District of Haryana. The difference between males and females was statistically significant and the mean decayed, missing and filled primary teeth decayed missing and filled teeth index (DMFT) per child was found to be 0.73 and mean DMFT per affected child was 2.37. The result showed that only 3% of children cleaned their teeth once a day with tooth brush and tooth paste. 22
A study was conducted to determine the oral health status and the impact on school age children (7-10 years) in the rural and semi urban areas of Tanzania. The result showed that the dental caries was more (90.9%) in school children and the information obtained was useful in planning and monitoring overall effects of oral health services in Tanzania. 23
6.3 / STATEMENT OF THE PROBLEM
“A study to assess the knowledge and practice on dental health among school age children at selected pediatric outpatient department, Bangalore”
6.4 / OBJECTIVES OF THE STUDY
  1. Assess the knowledge of school age children on dental health.
  2. Assess the practice of school age children on dental health.
  3. To compare the knowledge and practice of the school age children on dental health.
  4. Associate the knowledge with selected socio-demographic variable on dental health.
  5. Associate the practice with selected socio-demographic variable on dental health

6.5 / OPERATION DEFINITIONS
  1. Assess: Identifying the knowledge and practice on dental health among school age children
  2. Knowledge: Awareness and understanding level of dental health among school age children.
  3. Practice: Routine activities on dental health among school age children.
  4. Dental health: The wellbeing state of teeth.
  5. School age: The children who are attending pediatric OPD between the age group of 8-12yrs.of age

6.6 / HYPOTHESIS
H1: There will be significant co relation between knowledge and practices of school age children on dental health.
H2: There will be significant association between the level of knowledge with their selected demographic variables (Age, sex, location, type of family, economic status).
H3: There will be significant association between the practices of children with their selected demographic variables (Age, sex, location, type of family, economic status).
6.7 / ASSUMPTIONS
  1. Dental caries cause serious physical disorders in school age children.
2. Knowledge on dental health enhances practice on combating dental related health disorders.
6.8 / DELIMITATIONS
  1. The study period will be limited to four weeks
  1. The study was limited only to the school age who is attending pediatric OPD.
  1. The sample size was limited to 60.

6.9 / PROJECTED OUTCOME
The study will increase the levels of knowledge and practices in dental hygiene among school children. The study increases the scope of teaching programme on dental hygiene among school age children. The study will increase interest of mothers on dental care of their children.
7 / MATERIALS AND METHODS
7.1 / SOURCE OF DATA / Data will be collected from school age who is attending pediatric OPD, Bangalore.
7.2 / METHOD OF DATA COLLECTION
7.2.1 / SAMPLING CRITERIA
INCLUSION CRITERIA /
  1. Male and female children between the age group of 8-12 years of age.
  2. Children who are willing to participate.
  3. Children who knows to read and understand kannada and English

EXCLUSION CRITERIA /
  1. Children who are not willing to participate.
  2. Children who cannot read and understand English and Kannada

7.2.2 / RESEARCH DESIGN / A descriptive research design will be instituted for the study
RESEARCH APPROACH / Survey approach
7.2.4 / SETTING OF THE STUDY / The study will be conducted in selected pediatric OPD at Bangalore.
7.2.4 / SAMPLPING TECHNIQUE / The sampling technique for this study is non probability convenient sampling technique
7.2.6 / SAMPLING SIZE / The proposed sample for this study is 60 School age Children.
7.2.7 / TOOLS FOR THE RESEARCH / The tool consists of three parts:
Part I. Consist of demographic variables about the study samples which includes age of the child, sex of the child, locality, religion, types of family, educational status of the mothers and family income.
Part II. Consists of 20 questions on knowledge.
Scoring procedure Yes: 1, No: 0
Part III. Consists of 10 questions regarding practice.
Scoring procedure: Checklist method, score
Fair: 75- 100% / (2)
Good : 50 – 75% / (1)
Poor : <50% / (0)
7.2.8 / DATA COLLECTION PROCEDURE / Permission will be obtained prior to the study from Director of selected hospital at Bangalore. The samples are selected by convenient sampling technique. Before data collection procedure permission will be obtained from the study participants.
The semi structured questionnaire will be given to the school age children. The time allotted for each samples will be 30 minutes, the questionnaire will be collected and scored accordingly.
The proposed study duration is 30 days.
7.2.9 / METHOD OF DATA ANALYSIS / The collected data will be tabulated and analyzed by using descriptive statistics (frequency, percentage) and inferential statistics (Chi square), ‘t’ test
7.3 / DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMAL? IF SOPLEASE DESCRIBE BRIEFLY
No the study does not requires any investigation or intervention on patients.
7.4 / HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION?
Yes, ethical clearance will be obtained from research committee of KTG college of nursing.
Consent will be taken from the director of selected pediatric hospitals Bangalore.
8 / LIST OF REFERENCES
BOOKS
  1. Ghai.O.P, “Essentials of pediatrics”, 15th Edition, J.V. Publications, New Delhi. 2001 P: 136-142
  2. Marlow, “Text book of pediatric nursing”, 6th edition, Philadelphia, W. B. Sanders Company, 2001, P: 428 – 444.
  3. Park, “Text book to preventive and social medicine”, 18th edition, Banarsiar Bhanot Publication, Jobalpur, 2002, P: 382 - 389
  4. Polit and Hungler, “Nursing Research, principles and methods”, 16th Edition Philadelphia, J.B Lippincott Company, 1999, P: 114 – 118.
  5. Suraj Gupta, “The short text book of pediatrics”, 8th Edition, Jaypee brother’s, New Delhi, 1998, P: 256 - 260
  6. Whaley and wongs, “Nursing care of infants and children”, 4th edition, Philadelphia, W .B. Sanders company, 1999, P: 632 - 639
  7. WHO health organization, “Global Data base on child Growth”, 2005.
JOURNALS
  1. Craig, “Fluoride and the prevention of dental decay”, British Dental Journal. 2008, 188 (12), 654-659.
  2. Hescot.P.S AND Caron.H, “Oral health begins at primary school” Journal of dental health, 1994, 209(76), 10-11.
  3. Jackson D.B, “Effect evaluation of an oral health education programme in primary school in Tanzania”, Journal of Australian dental health, 2003, 496(34), 654-667.
  4. Iverson.M.N, “Indigenous Australia dental health a brief review of carries experiences”, Australian dental health, 2000, 45(6), 17-20.
  5. Mistry.k.k, “Oral health goals for Indian strategies to achieve them by 2000:A.D”, Journal of Indian Dental association, 2005, 10 (10), 668-676.
  6. Melani C.D,Chairman, “Disorders among college students in the city of Madras” .Journal of Indian dental association, 2003, 107(4), 239-241.S
  7. Neeraja Rao.G, “Oral health status of certified school children of Mysore state”, Journal of Indian Dental association, 2005, (43), 234-240.
  8. Sabarwal B, “Dental caries vaccine” .Dental education society India, 1998, 97(60), 534-538.
  9. Saradha.K, “Evaluating the efficiency of selected program for prophylaxis of caries and periodontal diseases in school children with special reference to guidelines for oral cavity hygiene”, 28(87)365-368.
  10. Sharma.J.K, “Effective oral hygiene requires effective education”. Journal of Dental association, 2004, 435(3), 85-94.
  11. Srivastav.R.P, “Oral cleaning habits of school going children in Jnansi”, Journal of Indian Dental Association, 23(5), 64-68.
  12. Singh D.K, “Prevalence of Dental caries in school going children of Patna”, Journal of Indian Dental association, 2001, 40 (2), 112-118.
  13. Tewari.A.Chawla.H.S, “Dental caries in school going children of Patna”, Journal of Indian Dental association, 2000, 34(7), 324-328.
  14. Victor Luickham, “Dental cavities and how to prevent them”, Harland of health38 (3), 128-139.
  15. Walsh.J.K, “Preventive dentistry for the general practitioner”. Australian dental Journal, 2004, 23(2), 64-68.
  16. Watcheter.H.E.Phillips, “Nursing care for children”, Journal of Canadian nurses, 2004, 114 (9).