Knowledge, Attitude and Practice of Dental Caries and Periodontal Disease Prevention among Primary School Teachers in Belgaum City, India

1Professor and Head, Department of Public Health Denti stry, Kothiwal Dental College And Research Centre, Moradabad, Utt ar Pradesh, India. 2Assistant Professor, Department of Public Health Denti stry, Peoples Dental Academy, Bhopal Madhya Pradesh, India. 3Assistant Professor, Department of Public Health Denti stry, Kothiwal Dental College And Research Centre, Moradabad, Utt ar Pradesh, India. 4Professor and Head, Department of Public Health Denti stry, ITS Center for Dental Sciences And Research, Muradnagar Utt ar Pradesh, India. 5Professor, Department of Oral Surgery, Krishna Dental College, Karad, Maharashtra, India. Conhecimento, Atitudes e Práticas Frente à Cárie Dentária e Prevenção da Doença Periodontal Entre Professores do Ensino Primário em Belgaum City, Índia

Objecti ve: To evaluate the knowledge, atti tude and practi ce of dental caries and periodontal disease preventi on among primary school teachers in Belgaum city and to identi fy teacher's level of knowledge of health Informati on and uti lizati on of the services of the school teachers in promoti on of dental health and preventi on of dental diseases. Methods: A cross-secti onal questi onnaire based survey was conducted among 150 primary school teacher from 175 primary school of Belgaum city, Karnataka, India. The questi onnaire comprised six questi ons on knowledge, six questi ons on practi ce, and three questi ons on atti tude regarding dental caries and periodontal disease preventi on. Each questi on was followed by four choices. Chi square test was applied by using the stati sti cal package for the social sciences (SPSS) soft ware (version 11.0).

Results:
The female subjects had bett er knowledge and practi ces as compared to their male counterparts. Also the younger subjects had bett er knowledge and practi ces as compared to the older subjects. The teachers were more aware and they knew that tooth decay was due to chocolate and carbohydrate sti cky food and also they knew the tooth loss in adults was due to decayed teeth and periodontal diseases. Conclusion: They had good knowledge and preventi ve atti tude towards preventi on of dental diseases but a few but important defi ciencies in the fi eld of knowledge, atti tude and practi ce about preventi on of dental diseases have been identi fi ed for which recommendati ons are suggested. Dental professionals are oft en invited by diff erent school authoriti es to deliver lectures on oral health and to provide preventi ve services. The usual target populati on behind most endeavors comprises the, young school children, and it is with the aim of improving their oral health knowledge, that such programmes are held. However the fact remains that any child's knowledge and practi ces are by and large a refl ecti on of what he sees or is taught in his immediate surroundings.

INTRODUCTION
Denti st and dental hygienists are oft en asked to parti cipate in school oral health programmes at the elementary level. Schools are ideal place for preventi ve programmes because service can be made available to all children, including those who, for a variety of reasons, may not be receiving professional care as a result, school teachers are oft en asked to conduct oral health educati on and to administer preventi ve services 1 .
According to Kenney 2 a school administrator, "school have a tremendous capacity to be supporti ve of programs involving preventi ve health and preventi ve denti stry for children". Elementary school teachers traditi onally have played a role in educati ng children about how to prevent oral diseases and promote oral health. Teachers typically are involved in additi onal acti viti es, such as lending support for, and /or acti vely parti cipati ng in various school-based primary preventi on programs. Hence who else but the school teachers, who spend a considerable amount of ti me with the children are to be infl uenced in order to inculcate sound knowledge and ideal practi ces among the young minds, secondly in any school dental health programme. It is the teachers who are the passive recipients of the lectures delivered by the visiti ng denti st. It is they, who are entrusted with the role of secularly carrying out various preventi ve services and delivering on oral health in the long run.
Health educati on programs in schools may be conducted by external groups such as public health agencies dental societi es, and private dents, offi ces, or be provided internally by school nurses and teachers. The advantages of using school personnel are the potenti al for improved conti nuity of instructi on and lowered cost of the service 3 .
Thus increasing in oral health knowledge of the school teachers provides an opportunity to educate an important segment of the public that has an access to the large populati on of the young people 4 Teachers have the unique potenti al of preparing a future generati on of correctly informed health care consumers and decision makers 5 .
So the preset study was carried out to evaluate the knowledge, atti tude and practi ce of dental caries and periodontal disease preventi on among primary school teachers in Belgaum city and to identi fy teacher's level of knowledge of health Informati on and uti lizati on of the services of the school teachers in promoti on of dental health and preventi on of dental diseases.

METHODOLOGY
A cross-secti onal questi onnaire based survey was conducted among 150 primary school teacher from 175 primary school of Belgaum city, Karnatka, India. It is situated in the north west region of Karnataka. It has an area of 72.59 sq. km. Kannada, Marathi and Urdu medium school were 135, and the English medium school were 40. 10 of the total schools were selected for survey. Four of the English medium, and fourteen of the other medium school were selected using systemati c sampling method. Total 175 questi onnaire proforma were distributed to the 175 selected primary school teachers. 25 teachers did not complete the proforma so they excluded from the study. So fi nal survey was conducted among 150 primary school teachers to assess knowledge, atti tude and practi ce of dental caries and periodontal disease preventi on.
The questi onnaire was framed and its validity was accredited by experts in the fi eld of density. The questi onnaire comprised six questi ons on knowledge, six questi ons on practi ce, and three questi ons on atti tude regarding dental caries and periodontal disease preventi on. Each questi on was followed by four choices and the subjects were instructed to ti ck the most correct response. Data was also collected pertaining to the subject's age, sex, educati onal qualifi cati on, durati on of teaching experience and att endance at a school -dental health programme. The questi onnaire was pretested on a group of school teachers who were not included in the main survey.
The investi gati on was completed in 15 days. All the teachers present at the ti me of the visit to the school were surveyed by using the self administered questi onnaire and a second visit was made in cases where some of the teachers were absent on fi rst day. Anonymity was guaranteed to the subjects in -order to seek their personal responses. The subjects were requested to att empt all the questi ons. All the questi onnaires were completed in the presence of the examiners. The total ti me allott ed for questi onnaire completi on was ten minutes per respondent. Aft er that Data were computerized and analyzed using the stati sti cal package for the social sciences (SPSS) version 11.0. Before starti ng the study ethical clearance was obtained from Ethical committ ee of K. L. E. S's Insti tute of Dental Sciences, Karnataka.

RESULTS
The questi onnaires were completed by 150 primary school teachers. 63 of the subjects were females and 37 were males. Their mean age was 40.75 years, with the youngest subject being 21 years old and eldest being 55 years old. Mean years of their teaching experience were 20.22 years with the least being 1 year and the highest being 39 years. 71 of the subjects had done only the schooling and the others 39 had completed a college degree. 23 of the subjects had att ended a school dental health programmes in the last six months. Table 1 reveals knowledge of the male and female primary school teachers. The teachers were more aware and they knew that tooth decay was due to chocolate and carbohydrate sti cky food and also they knew the tooth loss in adults was due to decayed teeth and periodontal diseases. 43 female teacher knew that tooth decay was due to chocolate in comparison to 20 male teacher. 26.6 female teachers knew that most common reason for tooth loss in adults is dental caries in comparison to male teachers. 41.3 female teacher knew that fl uorides are used to protect the teeth from decay in comparison to 13.3 male teachers.

DISCUSSION
Oral health educati on would play a most important role in order to control oral disease. So the preset study was carried out to evaluate the knowledge, atti tude and practi ce of dental caries and periodontal disease preventi on among primary school teachers in Belgaum city and to identi fy teacher's level of knowledge of health Informati on and uti lizati on of the services of the school teachers in promoti on of dental health and preventi on of dental diseases.
Preventi on of periodontal diseases as compared to dental caries was bett er understood by the subjects. This could be a result of their general awareness on routi ne oral hygiene procedures as compared to lack of specifi c knowledge on dental caries eti ology. Though most of the subjects reported ideal oral hygiene practi ces regarding the method and frequency of tooth brushing, a small number underrated the importance of cleaning in-between the teeth and that of replacing the tooth brush every 3 months. Also, very few of them understood the importance of visiti ng a denti st bi-annually. These fi ndings emphasize the need for promoti ng the principles of preventi ve denti stry among this group of school teachers and are in agreement with previous studies 6,7 on elementary school teachers in Romania and Michigan respecti vely.
Knowledge: The teachers were more aware and they knew that tooth decay was due to chocolate and carbohydrate sti cky food and also they knew the tooth loss in adults was due to decayed teeth and periodontal diseases. Regarding belief about tooth decay most of the response came as no when they were asked about whether tooth decay is infecti ous or spreads from person to person. The teachers also knew that fl uorides when best used protect the teeth from decay. The teachers were also aware of bleeding gums and also they knew the reason for bleeding gums, and also they knew that if mouth is cleaned every day it could be well protected from gum diseases.
Practi ce: Most of the teachers reported that the ideal oral hygiene practi ces regarding the method and frequency of tooth brushing. Regarding use of a new tooth brush most of them changed the brush every 3 months. Tooth brush was most commonly used by the teachers for cleaning in between the teeth. Majority of the teachers visited the denti st only when needed, but when they were having tooth ache problem majority of them visited to the denti st.
Atti tude: Most of the teachers thought that mass media was the best source to teach children about preventi on of oral diseases. Most of the teachers suggested a chapter on preventi on of oral diseases in school curriculum only. When asked regarding responsibility of the teacher they recommended instructi ng the students on preventi on of oral diseases.
The female subjects had bett er knowledge and practi ces as compared to their male counterparts. Also the younger subjects had bett er knowledge and practi ces as compared to the older subjects. This refl ects that the younger generati on of school -teachers in this study have acquired a higher sense of responsibility towards preventi on of oral diseases ; and is in agreement with the fi ndings of a study conducted on a group of future elementary school teachers at Minnesota 2 .
A previous study conducted among elementary school children showed that most of subject 74.9 were agreed that fl uoride protect the teeth from decay and 84.9 were agreed that clean your mouth everyday is the best way to keep from getti ng gum diseases. While it is similar to our study in which 61.3 subject thought that clean your mouth every day is the best way to protect against gum diseases and 55.7 subjects thought that fl uoride protect the teeth from decay 8 .
Studies in Romania, China, Saudi Arabia have reported that positi ve atti tudes among school teachers towards school based dental health educati on and willingness to be involved in oral health promoti on 6,9,10 their is similar to result of our study in which 60 of teachers were agreed that introducing students on preventi on of oral diseases and responsibility of teachers.
Similar to our study a higher level of knowledge was revealed among Kuwaiti school teachers, and teachers reported a positi ve atti tude towards preventi on of dental diseases 11 . While among Tanzanian school teachers low level of oral health knowledge were found, accompanied by a poor atti tude towards becoming involved in dental health educati on 12 .
Responses to the atti tude questi ons include that the subjects were less inclined to accept supervisory rates other than the traditi onal instructi onal acti viti es on oral disease preventi on. This fi ndings is in accordance with other study 13 . The atti tudes of the subjects regarding teaching of oral disease preventi on appears to be based on a very limited understanding of child psychology. Though most subjects thought that mass media was the best of all sources to teach the children, it has been shown to be of minimal usefulness since it does not moti vate behavioural changes. Similarly, the health professionals and the family/ parents are also at a loss in disseminati ng oral health informati on due to their limited fi eld area of practi ce and the potenti al for improper source of informati on, respecti vely. School teachers, in fact, can act as ideal oral health educators for the children in mass since they possess several inherent qualiti es which are described as follows: 1. Their very experti se lies in delivering informati on to the children.
2. They have access to a variety of educati onal audiovisual aids, which can supplement the eff ect of teaching.
3. As childhood is a stage of habit formati on, teaching correct oral hygiene habits at this stage are more likely to be adopted. 4. Initi ally, the children might be more comfortable in confi nding in their teachers rather than in the health professional, regarding any diffi culty at performing an oral hygiene procedure.
5. The teachers too, is turn, are bett er than health professionals at perceiving the logic and limitati ons of their students.
6. Besides being acti vely involved with these in school acti viti es, the school teachers as a group form a very infl uenti al community and can hold the key to deciding certain community dental health programme.
7. Schools are the ideal sites for preventi ve programmes as not only can services be made available to a whole bulk of children, but more importantly to all the children.
8. The advantage of using school personnels is the potenti al for improving conti nuity of instructi on and lowered cost of the service. 9. School teachers can also instruct parents regarding the oral health of their child during one of the many parent teacher meeti ngs. 10. The school teachers themselves are also parents and hence can apply their knowledge for the bett erment of their child's oral health also.
In view of the scarce health resources and the current patt ern of the oral diseases in India, Nati onal oral health policy that emphasis preventi on would seems more advantageous than curati ve care. Oral health educati on would play a most important role in order to control oral disease and school based approach should be combined with family and community oriented oral health programmes.
All this is only possible if these school teachers are well versed with the correct and latest concepts on preventi on of oral diseases. Hence, within the limitati on of this study, the following recommendati ons are made to make the subject of oral disease preventi on not just acceptable, but also of interest to the school teachers: 1. Panel discussions or oral group discussions should be taken to cover those aspects which were generally answered inaccurately.
2. The school teachers can be involved personally in oral health care endeavors by including their children in a school dental programme free of cost. This would be both a source of interest and incenti ve for them 3. The dental personnel appointed for carrying out school dental health programmes should hold workshops for the teachers before starti ng on the project. This way the teachers would bett er understand the importance of this acti vity and its performance.
4. Literature should be made available in both regional languages and in English for general circulati on among schools from ti me to ti me.
5. School dental health services must compulsorily hold demonstrati ons or lectures on preventi on of oral diseases during school feasts and .parent teacher meeti ngs in order to involve the teachers and parents in oral health promoti on of the child. 6. A system of monitoring oral health of all the children and school teachers in the registered schools must be slated mandatory. Besides providing useful insight on the success of health programmes, it would also promote changes of employment for dental hygienists in these school.
The present student was conducted to assess the knowledge , atti tude and practi ce of dental caries and periodontal disease preventi on among primary school teachers in Belgaum city. they had good knowledge and preventi ve atti tude towards preventi on of dental diseases but a few but important defi ciencies in the fi eld of knowledge, atti tude and practi ce about preventi on of dental diseases have been identi fi ed for which recommendati ons are suggested.