Department of Dental Technology, Federal College of Dental Technology and Therapy, Enugu, Nigeria
Corresponding author details:
Peter C Okorie, Faculty of Dental Health
Department of Dental Technology
Federal College of Dental Technology and Therapy
Nigeria
Copyright: © 2023 Okorie PC, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4. 0 international License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
As a gateway to the body, mouth is constantly challenged by various invading organisms like bacteria, viruses, fungi and parasites but with good oral hygiene practice, such as daily brushing and interdental cleaning, these bacteria are controllable. However, without proper oral hygiene, bacteria can reach levels that might lead to a myriad of health issues. Therefore, healthy mouth, teeth and gums, or oral health, is an important part of good overall health, well-being and quality of life.This study assessed the oral hygiene knowledge and practices among rural and urban dwellers in the three senatorial zones of Abia State, South Eastern Nigeria.The study employed a descriptive cross-sectional design to achieve the study objectives. Structured pretested questionnaires were used to collect data from 349 randomly selected consenting subjects. Items used to assess oral hygiene practices include demographic characteristics of the subject where age and socioeconomic activities play a vital role and their knowledge of various oral hygiene practices. The study found that knowledge of oral hygiene practice was a bit high (61%), but knowledge on when one cleans teeth in relation to meal was not high (13.5%) as reports indicate cleaning teeth before meal. Up to 84.2% of respondents showed positive use of fluoride containing toothpaste as a substance that aids in cleaning their teeth. The study found high compliance of cleaning in-between the teeth among the study group (92.6%). The association between age of subjects and oral hygiene practices (brushing of teeth and frequency of brushing the teeth) among rural and urban subjects in Abia State were weakly correlated F= 2.068 at p = 0.46. Also, association between age of subjects and oral hygiene practices (number of times in a day one brush teeth) was strongly and positively correlated F = 213.850 at P = 0.000. Despite the fact that oral hygiene knowledge and oral heath educational programs are very important, there is lack of systematic study on assessing oral hygiene knowledge and practices in rural and urban areas of South Eastern Nigeria, proper consideration should be given to hygiene education campaigns and health promotion websites need to be encouraged, which are particularly famous in youth population. There is need for mass media campaigns have to start for oral health promotion in order to reduce dental caries incidence. Also oral hygiene campaign is needed in our community to reduce dental caries prevalence in the schools, colleges, universities and madrasas.
Oral Disease; Oral health; Oral hygiene Practices; Knowledge; Nigeria
Health is a fundamental right of every human being without discrimination related to race, religion, and socioeconomic status as postulated by World Health Organization [1]. Oral health is integral to the overall health of human beings [2,3]. However, in most countries, knowledge, access to and practice of oral hygiene are limited [4-6].
Oral hygiene is the science and practice of recognition, prevention and treatment of oral diseases and conditions as an integral component of total health [7,8]. Oral hygiene is further defined by the World Health Organisation as a state of being free from mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss and other disorders that limit an individual´s capacity in biting, chewing, smiling, speaking and psychosocial wellbeing [3,9]. It is evident from these definitions that oral hygiene is an aspect of health affecting the general health and wellbeing of an individual. The limitation to biting and chewing means the individual to an extent will be unable to eat food rich in nutrients needed for the body´s development due to one oral disease or another [9].
Oral diseases are a big public health problem in both developed and developing countries, with the most common oral diseases being dental caries and periodontal (gum) diseases. These two diseases have historically been considered the most important global oral health burdens. At present, the distribution and severity of oral diseases vary among different parts of the world and within the same country or region [10]. The World Dental Federation (FDI) states that disease represents a major global oral disease burden with significant social, economic and health-system impacts [11]. Symptoms of gum disease are highly prevalent among adults in all regions, while severe periodontitis affects 5% to 20% of most adult population [12].
Poor oral hygiene resulting in dental infections has been established as an important risk factor for chronic diseases [13]. The frequency of sugar consumption is more likely to cause cavities than the amount of sugar consumed. Smoking, tobacco chewing habits have strong relationships with various dental diseases. When a person is not maintaining proper oral hygiene, it can lead to dental caries, periodontal disease and tooth loss [14]. An estimated 3.9 billion people worldwide are affected by oral conditions [9]. Due to this high prevalence rate, the WHO added oral health to the list of prioritized non-communicable diseases (NCDs), especially as it shares common risk factors with other NCDs such as diabetes, cardiovascular diseases and cancer [9]. Diseases such as diabetes and HIV/AIDS affect the oral health of an individual, but poor oral hygiene on its own can aggravate these health conditions [15].
In Nigeria, based on a previously conducted national oral health survey, the prevalence rates of dental caries and periodontal diseases stand at 30% and >80% [16]. The occurrence of oral diseases is higher among poor and disadvantaged population groups in both developing and developed countries of the world, with the most commonly observed conditions being dental caries and periodontal diseases. Others include; cleft lips and palate, oral cancer, noma and oro-dental trauma [17- 20,9]. The most common risk factors of oral diseases are poverty, ignorance/low level of awareness, poor oral hygiene, as well as unhealthy lifestyles and behaviors such as tobacco use and excessive alcohol consumption [20,21]. These risk factors invariable require proper oral hygiene practices.
Oral hygiene practices depend on age, gender, awareness, economic status of an individual and availability of oral hygiene aids. These practices are usually formed and established during adolescence and continue to be practiced throughout life. During adolescence, the individual gains more independence in oral care as parental involvement reduces. Increased autonomy may lead to inadequate oral hygiene practices and a greater risk of dental caries and early periodontal disease [22-25]. It is important that oral hygiene be carried out on a regular basis to enable prevention of dental diseases. Darby & Walsh asserted that the most common types of dental diseases are tooth decay (cavities, dental caries) and gum diseases, including gingivitis, and periodontitis [26]. Regular brushing consists of brushing twice a day: after breakfast and before going to bed. Generally, American Dental Hygienist Association recommend that teeth be cleaned professionally at least twice per year and included that professional cleaning includes tooth scaling, tooth polishing, and, if tartar has accumulated, debridement; this is usually followed by a fluoride treatment [27].
Considering the health impact of poor oral hygiene among rural and urban dwellers in Abia State, which includes but not limited to poor productivity and absenteeism among youths and adults in the school and workplace, this study was designed to assess oral hygiene knowledge and practices among rural and urban subjects in Abia State, South Eastern Nigeria. An understanding of oral hygiene practices will enable policymakers understand the drivers of demand for oral hygiene knowledge and inform the implementation of appropriate oral hygiene strategies to improve practice.
Study area
The study area is Abia State and the state is situated in the South East Zone of Nigeria.Abia state was created in 27th August 1991 and has the geographical coordinates of 5.4309° N 7.5247° E. As at the 2006 census, the population of Abia state was put at 2,833,999 [28]. Its capital city is Umuahia and the major commercial city is Aba. English is widely spoken and serves as the official language in governance and business. Christianity is the predominant religion of Abia people. Abia State has a 2018 projected total population of 3,628,055 (1,777,747 females and 1,850,308 males) [28].
Abia State has a predominantly rain forest vegetation though some parts of the (Abia) north have derived rich savannah woodland. Most (95%) of the inhabitants of Abia State are Igbo [29]; and non-indigenes are mainly seen in Umuahia and Aba which are the major urban areas [30]. The National Primary Health Care Development Agency (NPHCDA) estimates that about 70% of Abia State’s population lives in rural areas [29]. The predominant occupation is farming and trading; as well as welding, weaving and sculpturing which are evident in their culture [30]. The State is blessed with resources such as crude oil and agricultural products including cashew, rice, yam and palm [31].
Study design and sampling
The study employed a cross sectional descriptive design with the study population comprising of rural and urban resident within Abia State, Nigeria. A pretested questionnaire was used to assess oral hygiene knowledge and practices among urban and rural dwellers in Abia State, South Eastern Nigeria. The questionnaire was validated using face and content validation. Thirty five questionnaires were pretested in another in non-randomly selected communities in the local governments of the state with similar characteristics but not included for the actual study. The questionnaire was tested for reliability using Cronbach Alpha test [32] and a reliability coefficient of 0.73 was obtained. Multistage sampling technique was adopted to select the samples included in the study.
In the first stage, Abia state was divided into three senatorial zones and a total of 6 Local Government Areas (LGAs) were randomly selected through balloting which covered at least 35.3% of the LGAs. Abia North senatorial zone has 5 LGAs and Abia central senatorial zone has 6 LGAs while Abia south senatorial zone has 6 LGAs each, hence two LGAs namely Bende LGA and Ohafia LGA were selected from Abia North; Umuahia North LGA and Isialangwa South LGA were randomly selected from Abia Central senatorial zones and Aba North LGA and Osisioma LGA were randomly selected from Abia South senatorial zones.
In the second stage, simple random selection of communities from the sampled LGAs took place. Four communities were each selected from all the sampled LGA. They include Umuhu Ezechi, Igbere, Ozuitem, Okoko Item, Amaeke Abiriba, Elu Ohafia, Ndiupung Ohafia and Amaekpu Ohafia from Abia North Senatorial zone of Abia State. Afara Ukwu, Afugiri Umuahia, Ohuhu Umuahia, Umuhu Umuahia, Amaise Ahaba, Mbutu ukwu, Mbutu Ngwa and Ovuokwu Ngwa from Abia Central Senatorial zone of Abia State. Eziama, Ogbor, Osusu, Uratta, Amasa, Arongwa, Okpulu Umuobo and Amasator from Abia South Senatorial zone of Abia State.
Therefore, a total of 24 communities were randomly selected. In these communities, 116 subjects were interviewed in Abia North and Abia South Senatorial zone respectively, making it 232 subjects in these zones. In the same zones, 58 subjects were interviewed in each of the local government randomly selected and 14 subjects in each community. In Abia South Senatorial zone, a total number of 117 subjects were interviewed and approximately 15 subjects were interviewed in the various communities randomly selected with the helped of the designed harmonized questionnaire, which make the total interviewed subjects selected through systematic random sampling to be 349.
Sampling started from the community centre of each community and households were selected at intervals of two households. This process went round the community until the required sample size for each selected community was reached. Additionally, at occasion nonhousehold eligibility, the next household was selected. The next stage was the selection of eligible study participants from the households. The eligible participants were those who were resident in the area for the past 1 year, between 6 years and above year of age. Prior to data collection, the members of the selected communities were gathered at each community centre for a sensitization exercise concerning the survey to be performed at their households and the need for their support. The appointment to that effect was scheduled in agreement with the community leaders who also helped to mobilize the members of their respective Communities.
Data collection Data
collection processes lasted for 5 months. Data was collected by administering structured pretested questionnaires to the study participants by members of the study group. For the selected participants, the study was once more introduced and informed consent was sought for their participation in the study. For those who gave their consent, the questionnaire was then elicited in the local (Igbo) language.
Data analysis
The method of data analysis was descriptive. Data collected were presented in tables of frequency distribution and were all expressed as the percentage of the distribution. ANOVA was used to test for association between the age of the subjects and oral hygiene practices among rural and urban dwellers in Abia State at 5% significant level. Data analysis was performed on IBM-SPSS Statistics version 23.
Socio‑demographic characteristics
A total of 349 subjects from the 6 Local Government Areas in Abia State participated in this study. In tables below, “n” represents the number while “%” represents percentage value. Table 1a depicted the socio-demographic characteristics of the study area. In Bende LGA, 42(22.6%) were male while 16(9.8%) were female. In Ohafia LGA, 36(19.4%) were male while 22(13.5%) were female. In Umuahia North LGA, 23(12.4%) were male while 35(21.5%) were female. In Isialangwa South LGA, 30(16.1%) were male while 28(17.2%) were female. In Aba North LGA, 23(12.3%) were while 35(21.5%) were for female. In Osisioma LGA, 32(17.2%) were male while 27(16.6%) were female. In general, 186(53.3%) were male while 166(46.6%) were female.
Concerning the age of the respondents; in Bende LGA, 1- 10 years had 04 (15.4%), 11- 20 years had 4(12.9%), for 21-30 years had 07(16.7%); 31-40 years had 10(14.5%); 41-50 years had 10(14.7%) and 51-60 years had 11(18.3%); 61- 70 years had 08(26.7%); 71 years and above had 04(17.4). In Ohafia LGA, 1-10 years had 06 (23.1%); 11- 20 years had 04 (12.9%), for 21-30 years had 8(19.0%); 31-40 years had 10(14.5%); 41-50 years had 12(17.6%) and 51- 60 years had 07(11.7%); 61 - 70 years had 05(16.7%) and 71 and above had 06(26.1%). In Umuahia North LGA, 1- 10 years had 04 (15.4%), 11-20 years had 03 (9.7%), for 21-30 years had 8(17.8%); 31-40 years had 12(17.4%); 41-50 years had 16(23.5%); 51 - 60 years had 10 (16.7%); 61-70 years had 3 (10.0%) and 71 and above had 4 (17.4%). In Isialangwa LGA, 1-10 years had 03 (11.5%), 11- 20 years had 7 (22.6%), for 21-30 years had 5(11.9%); 31-40 years had 15(21.7%); 41-50 years had 08(11.8%) and 51 -60years had 12(20.0%) 61-70 years had 4(13.3%) and 71 and above had 04(17.4%). In Aba North LGA, 1-10 years had 04 (15.4%), 11- 20 years had 06 (19.4%), for 21-30 years had 6(14.3%); 31-40 years had 10(14.5%); 41-50 years had 12(14.7%) and 51 - 60 years had 14 (23.3%); 61-70 years had 04 (13.3%) and71 years and above had 02 (8.7%). In Osisioma LGA, 1- 10 years had 05 (19.2%), 11- 20 years had 07 (22.6%), for 21-30 years had 10(23.8%); 31-40 years had 12(17.4%); 41-50 years had 10(18.7%); 51-60 years had 6 (10.6%); 61- 70 years had 6 (20.0%) and 71 years and above had 03(13.0%). In all the LGAs, 1- 10 years had 26 (7.4%), 10- 20 years had 31 (8.9%), for 21-30 years had 42(12.0%); 31-40 years had 69 (19.8%); 41-50 years had 68(19.5%); 51-60 years had 60 (17.2%); 61-70 years had 30 (8.6%) and 71 years and above had 23(6.6%).
The marital status; in Bende LGA, single had 15(10.9%), married had 37(18.6%); divorced had 6(1%). In Ohafia LGA, single had 25(18.1%), married had 30(15.1%); divorced had no response, widowed had 3(50%). In Umuahia North LGA, single had 25(18.1%), married had 33(16.6%); divorced and widowed had no response. In Isialangwa LGA, single had 23(16.7%), married had 35(17.6%); divorced and widowed had no response. In Aba north LGA, single had 28(20.3%), married had 30(15.1%); divorced had no response, widowed had no response. In Osisioma LGA, single had 22(15.9%), married had 34(17.1%); divorced had no response, widowed had 3(50%). In all the LGAs; single had 138(39.5%), married had 199(57.0%); divorced had 6(1.72%), widowed had 6(2.01%).
Educational background; in Bende LGA, no formal Education had 3(16.7%), non-formal Education had 6(17.6%); primary school education had 15(24.2%); secondary school education had 28(19.7%); tertiary school education had 6(6.4%). In Ohafia LGA, no formal Education had 4(22.2%), non-formal Education had 8(23.5%); primary school education had 12(19.4%); secondary school education had 24(16.9%); tertiary school education had 10(10.6%). In Umuahia North LGA, no formal Education had any response, non-formal Education had 9 (26.5%); primary school education had 2 (3.2%); secondary school education had 17(12%); tertiary school education had 30(31.9%). In Isialangwa LGA, no formal Education had 2(11.1%), non-formal Education had 5(14.7%); primary school education had 5(8.1%); secondary school education had 31(21.8%); tertiary school education had 15(16%). In Aba north LGA, no formal Education had 2(11.1%), non-formal Education had 6(17.6%); primary school education had 10(16.1%); secondary school education had 23(16.2%); tertiary school education had 17(19.1%). In Osisioma LGA, no formal Education had 7(38.9%), non-formal Education had no response; primary school education had 18(29%); secondary school education had 19(13.4%); tertiary school education had 15(16%). In all the LGAs; no formal Education had 18(5.16%), non-formal Education had 34(9.74%), primary school education had 62(17.8%); secondary school education had 142(40.7%); tertiary school education had 93(18.3%).
The religion; in Bende LGA, Christianity had 56(16.1%), no response to Islam and African Traditional had 2(1%). In Ohafia LGA, Christianity had 58(16.7%), no response to Islam and African Traditional. In Umuahia North LGA, Christianity had 58(16.7%), no response to Islam and African Traditional. In Isialangwa LGA, Christianity had 58(16.7%), no response to Islam and African Traditional. In Aba north LGA, Christianity had 58(16.7%), no response to Islam and African Traditional. In Osisioma LGA, Christianity had 348(99.7%), no response to Islam and African Traditional. In all the LGAs; Christianity had 347 (99.4%), no response to Islam and African Traditional had 2(0.6%).
Occupation of respondents; in Bende LGA, farming had 23(51.1%); business had 14(10.5%); civil servant/ public servant had 6(7.4%); student had 15(16.7%). In Ohafia LGA, farming had 15(33.3%); business had 28(21.1%); civil servant/ public servant had 8(9.9%); student had 10(15.2%). In Umuahia North LGA, farming had no response; business had 19(14.3%); civil servant/ public servant had 23(28.7%); student had 16(17.8%). In Isialangwa LGA, farming had 7(15.6%); business had 10(7.5%); civil servant/ public servant had 20(24.7%); student had 21(23.3%). In Aba north LGA, farming had no response; business had 38(28.6%); civil servant/ public servant had 11(13.6%); student had 9 (10.0%). In Osisioma LGA, farming had no response; business had 24(18%); civil servant/ public servant had 13(16%); student had 22 (24.4%). In all the farming had 45(12.9%); business had 133(38.1%); civil servant/ public servant had 81(23.2%); student had 66(25.9%).
Table 1b presented the years of residing in the area. In Bende LGA, less than 5years had 4(7.3%), 5-10 years had 10(18.2%); 11-15 years had 11 (23.4%); 16-20 years had 5 (8.5%); 21-25 years had 7 (15.2%) and 26 and above had 21 (24.1%). In Ohafia LGA, less than 5 years had 6(10.9%); 5-10 years had 8 (14.5%); 11-15 years had 12 (25.5%); 16-20 years had 04 (6.8%); 21-25 years had 6 (13.0%1) and 26 and above had 22 (25.3%). In Umuahia North LGA, less than 5years had 8(14.5%), 5-10 years had 10(18.2%); 11-15 years had 05 (10.6%); 16-20 years had 10 (16.9%); 21-25 years had 10 (15.2%) and 26 and above had 15 (17.2%). In Isialangwa South LGA, less than 5 years had 5 (9.1%); 5-10 years had 5 (9.1%); 11-15 years had 10 (23.3%); 16-20 years had 17 (28.8%); 21-25 years had 11(23.9%) and 26 and above had 10 (11.5%). In Aba North LGA, less than 5years had 20 (36.4%), 5-10 years had 8(14.5%); 11-15 years had 5 (10.6%); 16-20 years had 12 (20.3%); 21-25 years had 8 (17.4%) and 26 and above had 5 (5.7%). In Osisiomangwa LGA, less than 5 years had 12(21.8%); 5-10 years had 14 (25.4%); 11-15 years had 4 (8.5%); 16-20 years had 11 (18.6%); 21-25 years had 4 (8.7%) and 26 and above had 14 (16.1%). In general, less than 5 years had 55 (15.8%); 5-10 years had 55 (15.8%); 11-15 years had 47 (13.5%); 16-20 years had 59 (16.9%); 21-25 years had 46 (13.2%) and 26 years and above had 87 (24.9%).
Income per month of respondents; in Bende LGA,Less than N30,000 had 10 (11.0%); N30,000 – N40,000 had 20 (16.5%); N41,000 – N50,000 had 20(29.0%); N51,000 – N60,000 had 12(4.5%) and greater than N60,000 had 6 (25.0%).. In Ohafia LGA,Less than N30,000 had 20 (22.0%); N30,000 – N40,000 had 18 (14.9%); N41,000 – N50,000 had 6(8.7%); N51,000 – N60,000 had 10(22.7%) and greater than N60,000 had 2(16.7%). In Umuahia North LGA,Less than N30,000 had 18 (20.0%); N30,000 – N40,000 had 40 (16.5%); N41,000 – N50,000 had 2(18.8%); N51,000 – N60,000 had 15 (4.5%) and greater than N60,000 had 51 (20.8%). In Isialangwa LGA,Less than N30,000 had 10 (11.0%); N30,000 – N40,000 had 38 (31.4%); N41,000 – N50,000 had 4(5.8%); N51,000 – N60,000 had 03(6.8%) and greater than N60,000 had 3 (2.5%). In Aba North LGA,Less than N30,000 had 18 (20.0%); N30,000 – N40,000 had 11 (09.1%); N41,000 – N50,000 had 20(29.0%); N51,000 – N60,000 had 07(15.9%) and greater than N60,000 had 2 (8.3%). In Osisioma Ngwa LGA, Less than N30,000 had 15 (16.5%); N30,000 – N40,000 had 14 (11.0%); N41,000 – N50,000 had 6 (8.7%); N51,000 – N60,000 had 20 (43.5%) and greater than N60,000 had 4 (16.7%). In general, Less than N30,000 had 91 (26.1%); N30,000 – N40,000 had 121 (34.7%); N41,000 – N50,000 had 69(19.8%); N51,000 – N60,000 had 44(12.6%) and greater than N60,000 had 24 (6.9%).
Table 2a depicted nature of oral hygiene practices in the study area. Knowledge of oral hygiene practices in selected LGAs; in Bende LGA, 35(16.4%) said yes while 23(16.9%) said no. In Ohafia LGA, 30(14.1%) said yes and 28(19.9%) said no. In Umuahia LGA, 42(19.7%) said yes while 16(11.7%) said no. In Isialangwa LGA, 32(15%) said yes while 26(19.1%) said no. In Aba North LGA, 40(18.8%) said yes while 18(14%) said no. In Osisioma LGA, 34(16%) said yes while 25(18.4%) said no. In general, 213(61%) said yes while 136(39%) said no.
The participants were asked the type of cleaning aid they used in cleaning their teeth; In Bende LGA, Cleaning with Chewing stick only 10 (33.3%); Commercial toothbrush 22 (9.3%), Both chewing sticks and Commercial toothbrush 26(31.7%). In Ohafia LGA, Cleaning with Chewing stick only 06 (20.0%); Commercial toothbrush 40 (16.9%), both chewing sticks and Commercial tooth brush 12(14.6%). In Umuahia North LGA, Cleaning with Chewing stick only 3 (10.0%); Commercial toothbrush 41 (17.3%), both chewing sticks and Commercial toothbrush 14(14.6%). In Isialangwa LGA, Cleaning with Chewing stick only 06 (20%); Commercial toothbrush 40 (16.9%); Both chewing sticks and Commercial toothbrush 12(14.6%); In Aba North LGA, Cleaning with Chewing stick only 5 (16.6%); Commercial toothbrush 41 (17.3%), Both chewing sticks and Commercial toothbrush 12 (14.6%). In Osisioma LGA, Cleaning with Chewing stick has no response; Commercial toothbrush 53 (22.4%); both chewing sticks and Commercial toothbrush 6 (7.3%). Generally, Cleaning with Chewing stick only 30 (8.6%); Commercial toothbrush 237 (67.9%), both chewing sticks and Commercial toothbrush 82 (23.5%).
Then, on how often do the participants engaged in cleaning of their teeth; In Bende LGA, 58 (16.6%) reported daily; In Ohafia, 58 (16.6%) reported daily; In Umuahia North, 58 (16.6%) reported daily; in Isialangwa South, 58 (16.6%) reported daily; In Aba North LGA, 58 (16.6%) reported daily and thus in Osisioma LGA, 59 (16.9%) reported daily. It is noted in responses on weekly and monthly has no responses. General 349(100%) has responded daily.
On the right time to brush teeth in relation to meals; majority 291(83.4%) reported before the meals, 47(13.5%) said after meals and only 2(0.57%) said in between the meals. In Bende LGA, 51 (17.6) does that once daily; 7 (11.7%) does that twice daily; In Ohafia LGA, 54 (18.7%) does that daily and 4 (6.7%) does that twice. In Umuahia North LGA, 33 (11.4%) does that daily while 25 (14.7%) does that twice daily. In Isialangwa South LGA, 54 (18.7%) does that daily while 4 (6.7%) does that twice daily. In Aba North LGA, 49 (17.0%) does that once daily while 9 (15.0) does that twice daily. In Osisioma LGA, 48 (16.6%) does that once daily while 11 (18.3%) does that twice daily. Generally, 289 (82.8%) noted that they clean their teeth once daily while 60 (17.1%) clean their teeth twice daily.
In respect to other substances used in cleaning the teeth, 3 (0.9%) responded to none, 294 (84.2%) responded using toothpaste, 41 (11.7%) uses plain water while 7 (7.0%) and 4 (1.1%) responded using toothpowder and charcoal respectively.
Table 2b shows the extension of knowledge of oral hygiene practices; use of toothbrush and toothpaste in teeth cleaning as a common aid / material include; 291 (83.4%) reported yes while, 58 (16.6%) reported No. In the aspect of the role of toothpaste in tooth cleaning, 192(55.0%) said it kills germs, 20(8.6%) said it tastes good, 66(18.91%) said removes the dirt from my teeth 71(17.5%) said all of the above. On whether they clean in-between their teeth, 323 (92.6%) said yes while 26 (7.4%) responded no.
On how often do one change his / her tooth brush, 4(1.15%) said once per year, 141(40.4%) said after every three months and when it gets lost or spoiled and 54(15.5%) said after every three months. The participants were asked if they clean in-between the teeth, 323(92.5%) said yes and 26(7.4%) said no. On the aid used in cleaning in-between the teeth, 259 (74.2%) responded tooth picks; 29 (8.31%) responded match stick; 22 (6.30%) responded dental floss, No response on the use of interdental brush; 20 (5.73%) uses broom stick and 19 (5.44%) uses mouth rinsing method. In general reasons for cleaning the teeth, 158 (45.3%) responded to avoid bad breath; 92 (26.4%) responded to avoid tooth decay; 50 (14.3%) responded to have a whiter teeth; 1 (0.3%) responded that he sees his friend doing so; 48 (13.8%) responded all of the above.
Association between age of subjects and oral hygiene practices
The association between age of subjects and oral hygiene practices (brushing teeth and frequency of brushing teeth) among rural and urban subjects in Abia State were weakly correlated F= 2.068 at p = 0.46. Also, association between age of subjects and oral hygiene practices (number of times in a day one brushes) was strongly and positively correlated F = 213.850 at P = 0.000 (table 3).
This study provides a snapshot of Oral Hygiene knowledge and Practices among Rural and Urban dwellers in Abia State, South Eastern Nigeria. As it is strongly fostered by Nigeria Oral Health Policy 2012 [33,34], the findings yielded by this state wide study provide a strong basis from which to commence oral health promotion interventions. It will be noted that the delivery of health care services to Nigerians will not be complete without the inclusion of oral health policy. This can only be possible through the development and promotion of accessible, effective integration of oral health into National Health Programme [33]. These policies are in line with the Nepal National Oral Health Policy 2014 on the execution of oral health related surveys [35]. Hence in this study, attempts were made to describe the demographic profile of subjects in rural and urban centers of Abia state, South Eastern Nigeria; Knowledge of oral hygiene practices among rural and urban subjects in Abia State, South Eastern Nigeria and thus finding the association between the age of the subjects and the oral hygiene practices in rural and urban centres in Abia State, South Eastern Nigeria.
Socio-Demographic Characteristics of Subjects
Regarding socio-demographic information of the subjects, among the total respondents, 53.3% of the respondents were male. This is in contrast with a similar study carried out in Nepal in 2013 on Oral Hygiene Practices and their Socio-demographic correlates among Nepalese adults were (67.8%) were female [36] but similar to a study conducted in Kwara state, Nigeria on common oral conditions and correlate: an oral health survey were majority of the respondents were female [37]. The difference in this current study and that of previous may be as a result of the occupation of the respondents, most Abians in the rural areas are predominantly farmers and traders. Some of the females might have gone to the farm at the time of the survey leaving the men who mostly are traders at home and shops. Among all 349, (19.5%) of the subjects are between 41- 50 years in age. This study was in contrast with many other studies done on oral hygiene practices were majority of the respondents are between ages 10-19 years [38- 40]. The disparity in the age range could be because of the current study dealt with the subjects in Abia State while the previous studies concentrated on school students and pupils.
In Marital Status, (57.0%) of the respondents in the current study were married. This is in line with the previous study carried out in Nepal [36], were majority of the respondents were also married but in contrast with a similar study carried out in United Arab Emirates. On the level of Education, (40.7%) were of Secondary Education, which is High School Education in some other countries. This is in agreement with the studies carried out by Al-Qurashi et al. [41] in Saudi Arabia were (47.5%) are of High Grade Education but are in contrast with a similar research carried out in United Arab Emirates by Abu-Gharbieh et al. [42] were (50.0%) are of University Education. It will be agreed that Igbos as a tribe are predominately business men and women. Most of them leave school immediately after secondary school to involve in one business or the other. Findings from this study showed that the majority of the respondents were Christians. The results were in accordance with the research carried out in Russia by Avdeenko, Novikova, Turkina & Makeeva [43] on Oral Behaviour and Dental Status of Orthodox Christian Priests and Monks, were all the respondents were predominately Christians and in Ede, Osun State, Nigeria by Salawu & Omitoye [44] on an assessment of Dental Care practices among students of Adeleke University, Ede, Osun State, Nigeria were (70.4%) of the respondents are Christian. The reason for the majority of respondents being Christians is that during the colonial administration in Igboland, a lot of the citizens’ embraced Christian religion against the traditional religion they were practicing, thus resulting to having more Christians in the state.
In this study, (38.1%) of the subjects reported that Business is their occupation. This is in line with the similar study done in Nepal by Poudel & Chalise [45] on Oral Hygiene Practices, its associated factors and evaluation of oral health promotion package among 6-8 grade students of Bajra Baraha Municipality, Lalitpur, were (50.0%) of the pupils reported that their parents are businessmen and women. But in contrast with a similar work done in Nigeria by Salawu & Omitoye [44] were all the respondents were civil servant. It will noted that Abia State is one of the hubs of business activities in Nigeria, with Umuahia main market, Ariaria International Market etc, Abia citizens tends to be more involved in businesses than other states in Nigeria. Only (22.0%) out of the 349 subjects reviewed in this study have resided in their locality for more than 26 years. This does not imply that the remaining (78%) subjects have resided between 1- 25 years in Abia State. The family income per month as reported in this study is (34.7%) for persons earning less between N30,000.00 and N40,000.00 per month, which is approximately 63 United State Dollars (USD). This is in contrast with a similar research carried out in Japan by Kato et al.[46] on parental occupations, educational level, and income and prevalence of Dental caries in 3-year-old Japanese children, where (18.8%) reported to have an average yearly income of less than 4,000,000 Yen, which is approximately 333,333 per month and 3, 623 USD. This disparity is not connected with the state of affairs in Abia State, where workers are being owed salary and business has gone down due to bad roads, poor patronage and economic meltdown. It may interest one to know that the (25.5%) response by the subjects may not really represent the actual income figure of the respondents as many people find it difficult to disclose their monthly earnings.
Knowledge of Oral Hygiene Practices
According to the finding of this study, (61%) of the respondents has vast knowledge on oral hygiene practices. This is in consonant with a similar work done by Poudel & Chalise [45] on Oral Hygiene Practices, its associated factors and evaluation of oral health promotion package among 6-8 grade students of Bajra Baraha Municipality, Lalitpur were more than (80%) has knowledge of oral hygiene practices. Regarding tooth cleaning practices, among the total respondents, 100% of the respondents clean their teeth on daily basis. Among all 349 respondents who clean their teeth once on daily basis, (82.8%) of the subjects clean their teeth once a day. There is a very weak (0.034) association between having any form of oral problem before and number of times of brushing teeth with 0.034 at P-value of 0.530.This finding was slightly higher than the study which was done in Oral Hygiene Status, Knowledge, Perceptions and Practices among School Settings in Nepal and rural South India [47,48] and in a marked differences with the findings of similar studies done in Denmark (68.0 %) and Kuwait (62.0 %) [49,50] were the respondents reported of brushing their teeth twice a day. This is in dissonance with earlier findings that there is no association between age and oral hygiene practices. Age is considered a critical factor in the oral hygiene practice [51].
Among all the respondents majority of responses (83.4%) clean their teeth before meal. This is in line with the report of the research carried out in USA by Jack Toumba on Tooth Brushing before or after breakfast, were majority responded that tooth brushing should be done after breakfast [52]. Appreciable number of the responses (68.2%) uses commercial tooth brush in brushing their teeth. This is in agreement with a similar work done in Indian, where majority of the respondents (70.2%) uses commercial toothbrush in cleaning their teeth [53]. However, these findings corroborate the fact that chewing sticks; the traditional cleaning aid among most used by Nigerians have not gone into extinction [54,55].
In this study, majority of the respondents (83.4%) uses toothpaste on the toothbrush while cleaning their teeth. (55.0%) of the subjects reported that the role of toothpaste in tooth brushing is that it helps in killing germs. This is in a way in line with what has been reported elsewhere [56]. Therefore, the use of certain toothpastes, especially fluoridated toothpaste, should be recommended for not only dental caries prevention but also managing halitosis.
On the issue of changing of toothbrush, (43.0%) of the respondent reported of changing the toothbrush when they feel it is spoilt. This is in contrast with various researches done on issue of the longer use of a tooth brush more than three months, which is associated with higher occurrence of halitosis and this could be explained by the fact that cleaning effectiveness of the bristle brushes diminishes with time of use and that changing the toothbrush after every use leads to decrease of microbes responsible for plaque formation [57]. The toothbrush has a significant role in reintroducing microorganisms into the oral cavity [58]. Since it is not feasible to change the toothbrush every day, it is recommended as a sound practice to change the toothbrush at least after every three months [59]. Majority of the subjects agree to always clean in-between their teeth and (74.2%) of these respondents does that with the use of toothpick. There is generally a failure in the use of interdental aid as a preventive tool. In a study conducted in Saudi Arabia in 2001, where no subject used dental floss but sticks for interdental cleaning, which is similar to results of this research [60]. However, this is in contrast with the research done on Interdental brushes, from theory to practice: literature review and clinical indications by Asquino& Villarnobo [61] where dental floss has been used for many years together with brushing to remove dental biofilm between teeth.
On general reason for cleaning the teeth, (45.3%) are of the opinion that cleaning the teeth helps in avoiding bad breath. This is in line with the reports showing that the dentifrice containing triclosan and copolymer in a sodium fluoride/silica base reduces the number of VSC-producing bacteria that causes bad breath [62] and that the concentration of triclosan in plaque biofilm inhibits the growth of bacteria and therefore retards the return of halitosis [63].
Findings from this study revealed that certain number of subjects in rural and urban areas of Abia State were unaware and had low knowledge of various oral hygiene practices. The majority of the subjects self-reported to cleaning their teeth once daily with fluoridated toothpaste using mostly toothbrush rather than chewing stick, which is against the regular oral hygiene practice of cleaning the teeth at least twice daily, and appreciable numbers of the subjects do their tooth cleaning before meal, which is contrary to the regular oral hygiene advice of cleaning the teeth last in the morning and last at night before bed. Although the knowledge of various oral hygiene practices are relatively good from the subjects responses, but the actual practice by study population responded poorly that they only changed their tooth brushes only when it gets spoilt, which is against the proper oral hygiene practices. Therefore, it is important to note that most established oral diseases and conditions are irremediable, will last a lifetime and influence the quality of life and general health. This heightens the need to increase the awareness and consequently, practice of oral hygiene for both preventative, curative and restorative purposes (with focus on the preventive aspect) to prevent conditions and complications related to oral hygiene in the nearest future.
We thank the study participants who were involved in this study. We also acknowledge the contributions of the community leaders, community health workers, the local government areas department of health and five final class students of the departments of Dental Technology and Dental Nursing of the Federal College of Dental Technology and Therapy, Enugu in this study.
The authors declare that they have no competing interests.
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Not applicable.
The study was approved by the ethical committee of the College of Medicine and Health Sciences, Abia State University, Uturu and the Abia State University Teaching Hospital, Aba, Nigeria. Permission was obtained from the community leaders. Informed oral consent was obtained from all the study participants before they were allowed to take part in the study
No funding was received.
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