RAJIV GANDHI UNERVISTY OF HEALTH SCIENCES

BENGALURU, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / MR. SHREEKANT . S . HADLI
INDIAN COLLEGE OF NURSING,
TILAKNAGAR, BYPASS ROAD,
CANTONMENT,
BELLARY -583104
2. / NAME OF THE INSTITUTION / INDIAN COLLEGE OF NURSING
3. / COURSE STUDY AND SUBJECT / 1ST YEAR DEGREE OF MASTER OF NURSING
CHILD HEALTH NURSING
4. / DATE OF ADMISSION TO COURSE / 18/06/2011
5. / TITLE OF THE TOPIC / A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE AND PRACTICE OF ORAL HYGIENE AMONG CHILDREN AT SELECTED SLUM AREA AT BELLARY

6s. BRIEF RESUME OF THE INTENDED WORK

6.1INTRODUCTION

“The man with a toothache thinks everyone happy whose teeth are sound”.

-George Bernard Shaw

A smile is the facial expression that most engages others, with the help of the teeth which provides structural support of the face muscles. The mouth also plays a role on the digestive system, but it does much more than get digestion started. The mouth especially of teeth, lips, tongue is essential for speech. The hardest substance in the body,they are also necessary for chewing, cut, tear,and grind food in preparation for swallowing.

Oral hygiene includes all the processes for keeping the mouth clean and healthy. Good oral hygiene is necessary for the prevention of dental caries, periodontal diseases, bad breath and other dental problems.1

The main purpose of dental hygiene is to prevent the build-up of plaque, the sticky film of bacteria that forms on the teeth. Bacterial plaque accumulated on teeth because of poor oral hygiene is the causative factor of the major dental problems.1

Poor oral hygiene allows the accumulation of acid producing bacteria on the surface of the teeth.The acid dematerializes the tooth enamel causing tooth decay. Dental plaque can also invade and infect the gums causing gum disease and periodontitis. In both conditions, the final effect of poor oral hygiene is the loss of one or more teeth.Just then to understand the importance of oral hygiene and preventive care. Many health problems of the mouth, such as oral thrush, trench mouth, bad breath and others are considered as effect of poor dental hygiene. Most of these dental and mouth problems may be avoided just by maintaining good oral hygiene.1

Prevention is always better than treatment. Good oral hygiene habits will keep away most of the dental problems saving you from toothaches and costly dental treatments. The interesting part is that it can be achieved by dedicating only some minutes every day to dental hygiene care. A large number of various oral hygiene products, beyond the usual toothpaste and toothbrush, are available in the market to help in this effort. Unfortunately, most of us remember the importance of oral hygiene instructions only when a problem occurs.1

  • Research has shown that while patient activation can show an immediate improvement in oral hygiene habits, only a small percentage keeps the same standards six months later. Maintaining good dental hygiene should be a lifelong everyday habit. Awareness regarding the importance of oral hygiene has significantly increased in the developed countries, but contrary to that, the modern dietary lifestyle habits are posing a greater risk for oral health. Healthy teeth not only enable to look and feel good, they make it possible to eat and speak properly. Good oral health is important to overall well-being.1
  • According to World Health Organization incidence of oral hygiene is still a major health problem in most of the countries affecting 60.90 percentage of school children. Daily preventive oral care, with proper brushing and flossing, will help stop dental problems before they develop and are much less painful, expensive, and worrisome than treating conditions that have been allowed to progress. It is important to learn how to maintain good dental hygiene from early childhood. Parents should teach their children the proper use of oral hygiene products. Good oral hygiene should be a joined effort involving them. The dentist or dental hygienist will give the proper dental hygiene instructions and teach the correct way of brushing and flossing. The dentist will identify the individual needs and helps to build own oral care plan.Good oral hygiene results in a mouth that looks and smells healthy. This means the teeth are clean and free of debris, Gums are pink and do not hurt or bleed while brushing or flossing, Bad breath is not a constant problem1

An oral infection is a cluster of germs causing problems in one area of the mouth. Here is some warning signs includes, swelling or pus around the teeth or gums or any place in the mouth.Pain in the mouth or sinus area that doesn't go away. White or red patches on gums, tongue, cheeks or the roof of themouth. Pain when chewing. Teeth that hurt when eat something cold, hot or sweet. Dark spots or holes in the teeth.1

Infections can make blood sugar hard to control. By planning ahead and discussing a plan of action with the dentist and doctor, it will be prepared to handle needed adjustments.In case of dry mouth, drinking more fluids,chewing sugar-free gum or sugar-free candy, helps keep the saliva flowing. Keeping teeth and mouth healthy requires own effort. Patient will be the most important person on this team to do the day-to-day mouth care. Its need remember, good dental health can create a healthy mouth and a smile that will last a lifetime.1

The three main steps in fighting gum disease are brushing, flossing, and consulting dentist regularly. Brush at least twice a day and floss at least once a day. To show the correct way to brush and floss, it includes a toothbrush can only clean one or two teeth at a time. Allow about three minutes of brushing to clean all your teeth well. Using a brush with soft bristles and rounded ends. Soft bristles are less likely to hurt gums. Angle the brush against the gum line, where teeth and gums meet. Move the brush back and forth with short strokes. Using a gentle, scrubbing motion. Brush the outside surfaces of the teeth. Do the same for the backs of the teeth and chewing surfaces. Brush the rough surface of the tongue to remove germs and freshen the breath.2

6.2. Need for the study

World Health Organization (WHO)Bulletin says that the burden of oral diseases worldwide and describes the influence of major sociobehavioural risk factors in oral health. Despite great improvements in the oral health of populations in several countries, global problems still persist. The burden of oral disease is particularly high for the disadvantaged and poor population groups in both developing and developed countries. Oral diseases such as dental caries, periodontal disease, tooth loss, oral mucosal lesions and oropharyngeal cancers, orodental trauma are major public health problems worldwide and poor oral health has a profound effect on general health and quality of life. The diversity in oral disease patterns and development trends across countries and regions reflects distinct risk profiles and the establishment of preventive oral health care programmes. Worldwide strengthening of public health programmes through the implementation of effective measures for the prevention of oral disease and promotion of oral health is urgently needed. The challenges of improving oral health are particularly great in developing countries.3

In the 21st century the approach of the world health organization global oral health programmes. The rapidly changing disease patterns throughout the world are closely linked to changing lifestyles. Oral diseases qualify as major public health problems owing to their high prevalence and incidence in all regions of the world, and as for all diseases, The world health organization global strategy for prevention and control of noncommunicable diseases. The world health organizationoral health programme has also strengthened its work for improved oral health globally through links with other technical programmes within the department for on communicable disease prevention and health promotion. The current oral health situation and development trends at global level are described and world health organization strategies and approaches for better oral health in the 21st century are outlined.4

The child dental health survey ofWestern Australia indicated that children as young as five years of age could have high levels of caries. Dental caries was the fifth most common cause of hospitalization among preschool children aged one to five years.The U.S. National health and nutrition examination Survey found that 41percentage of children aged 2–11 years had dentalcaries of their primary teeth and 21percentage of children had untreated dentalcaries42percentage of children, aged 6–19 years had dentalcaries of their permanent teeth and 14percentage of children had untreated dentalcaries. World oral health reported that 18percentage of children aged two to four years had dental caries.5

An author says that Oral health knowledge, attitudes and behavior of children and adolescents. To analyze the oral health behavior profile of the two age groups in relation to province and urbanization, and to assess the relative effect of socio-behavioral risk factors on dental caries experience. The total number of 4,400 of each age group was selected. It revealed that nearly one third 29 percentage of 12 year-olds and 40.5percentage of 18-year-olds would visit a dentist in case of signs of caries but only when in pain. Nearly half of the participants 47.2 percentage had never received any oral health care instruction and they suggest that systematic community-oriented oral health promotion programmes are needed to target lifestyles and the needs of children, particularly for those living in rural areas. A prevention-oriented oral health care policy would seem more advantageous than the present curative approach.6

A study was conducted on caries prevalence and treatment needs of rural school children in Chidambaram Taluk, Tamil Nadu, and South India. Objective was to obtain information on caries prevalence and treatment needs of children aged five to ten years to plan appropriate dental care services in rural areas. Results found that the five hundred and eight five to ten year-old school children 247 boys and 261 girls were surveyed. Caries prevalence was 71.7 and 26.5 percentages in primary and permanent dentition, respectively. The mean of decayed missing filled tooth scores were 3.00 and 0.42 respectively. The mean decayed missing and filled teeth decreased with age whereas the mean increased with age. Although the mean decayed missing and filled teath scores were not statistically significant different for the two sexes, the mean decayed missing and filled teeth score was found to be higher among girls than among boys. The entire decayed missing and filled teethvalue represented the 'decay' component only. There was a strong need for single surface restorations 60.6 percentage. In the World health organization index age five to six years, the caries prevalence was 70.2 percentages, 29.8percentage caries-free with a mean decayed missing and filled teeth value of 3.54 ± 3.71. It concluded that the Dental caries is a significant public health problem in this population. An extensive system to provide primary oral health care has to be developed in the rural areas of India. In India standardized incidence rate per 100,000 children ranges from 13 percentage in India .The prevalence of oral hygiene health problems is approximately 60-65percentage. In Karnataka prevalence is 40-45percentage in children age five to fourteen years7

The prevalence of caries is increasing rapidly in developing nations, which is of concern because dental caries is mostly a childhood disease and 80percentagesof the world’s children live in the developing countries. The most likely reasons for this increase in developing countries are a combination of poor nutrition and poor oral hygienic practices.8

On extensive review of literature and community field experience the investigator motivated that there is need to assess the existing knowledge and practice of slum children and betterment of knowledge and practice, with a view to identify the areas of knowledge and practice deficit and to strengthen those area by establishing appropriate measures

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6.3 REVIEW OF LITERATURE.

Review of literature is defined as broad, comprehensive in depth systematic and critical review of scholarly publication, unpublished scholarly print materials, audiovisual materials and personal communications. Review of literature is a key step in research process. Review of literature refers to an extensive, exhaustive and systemic examination of publication relevant to research project. One of the most satisfying aspects of the literature review is the contribution it makes to the new knowledge, insight, and general scholarship of the researchers.9

A longitudinal study of dental caries risk among very young low socio economic status childrenin the United States.The study was to assess baseline risk factors for 18-month caries prevalence as part of a longitudinal study of high-risk children. About 212 children, six to twentyfourmonths of age were recruited from a rural community in Iowa. Results found that about 128 children 60 percentage remained in the study after 18months. Among these children, prevalence of d1, d2–3/f level caries increased from ninepercentages to 77 percentages, while d2–3/f level caries increased from twopercentages to 20percentages. Logistic regression models for baseline predictors of d2–3f caries at the 18-month follow-up found the presence of MS in children OR=4.4; 95percentage CI: 1.4, 13.9 and sugar-sweetened beverages OR=3.0; 95percentage CI: 1.1, 8.6 to be the only significant risk factors. Results suggest that early colonization by MS and consumption of sugar-sweetened beverages are significant predictors of early childhood caries in high-risk populations.10

The cross-sectional descriptive study was conducted on Oral hygiene practices, dental knowledge, dietary habits and their relation to caries among male primary school children in, oral hygiene practices and dental health knowledge among Saudi male primary school children in relation to socio-demographics and to find the possible predictors for dental caries among them. Study included 1115 Saudi male selected by multistage random sample from 18 public primary schools.Results found thatthe clinically decayed tooth was diagnosed in 68.9percentageof the included children, more in urban and younger students. Caries affected the subjects consumed cariogenic foods at greater frequency compared with caries-free children. Only 24.5percentage of the students brushing their teeth twice or more per day, and 29percentage of them never received instructions regarding oral hygiene practices. It concludes the poor oral hygiene practices, lack of parental guidance and appropriate dental health knowledge with frequent exposure to cariogenic foods in addition to socio-demographics are the main risk factors for dental decay among the surveyed students.11

A cross-sectional study was conducted on mothers as facilitators of oral hygiene in early childhood. To investigate oral hygiene and frequency of oral cleaning in children up to three years, in relation to mother-related factors. Study includes 504 children. Results shown that the twice daily oral cleaning was reported for five percentage of all children and once daily cleaning for 19percentage of the 12- to 15-month-old children, 18percentage of the 16- to 23-month-old children, and 48percentage of the 24- to 36-month-old children. Of the mothers, 59percentage stated that they lacked the skill to clean their children's teeth. Dental plaque was observed in 65–76percentage of the children. Clean teeth were more likely OR=1·7, 95percentage CI 1.3–2.3 in children of mothers who themselves have a higher tooth brushing frequency. It concludes that to improve oral hygiene in early childhood, more emphasis should be placed on mothers’ own tooth brushing and their skills in their children's oral cleaning.12

A study was assessed on the oral hygiene and parent-related factors during early childhood in relation to approximal caries at 15 years of age. To investigate whether oral hygiene habits and parent-related factors, recorded in early childhood, have a predictive value in relation to approximal caries experience at the age of 15 years n = 568. The result shown that statistically significant and predicted a caries experience of DFa > 0 at 15 years. The following four variables predicted DFa ≥4: female gender, plaque on maxillary incisors at one year, mother’s self-estimation of her oral health care being less good and father being less satisfied with his social situation. Ic concluded that the factors explaining good dental health at 15 years of age pertained to both children and parents. Thus, it seems that good oral hygiene habits, established in early childhood, provide a foundation for a low experience of approximal caries in adolescents.13

A study was stated on the role of oral hygiene in inflammatory bowel disease. To evaluate oral hygiene and dental care practices of 137 subjects. Resultsof the 83 cases, 31percentagehad ulcerative colitis and 69percentage had crohn’s disease. For the frequency of brushing at disease onset was significantly higher than in controls. Also, the frequency of use of dental floss and breath freshener at disease onset was significantly higher in patients, respectively. Also, patients with more frequently visited their dentist at disease onset and continued to visit their dentist more often. These findings suggest that oral hygiene practices may cause alterations in the flora of the oral mucosa, which causes imbalance in the gut micro biome, and thereby contributes to the pathogenesis of. Conversely, the increased frequency of dental problems in patients might be due, at least in part, to alterations in oral flora or to their disease.14