CHAPTER-I

INTRODUCTION

‘‘THE WAY TO KEEP YOUR HEALTH IS TO EAT WHAT YOU

DON’T WANT,
DRINK WHAT YOU DON’T LIKE AND DO WHAT YOU
WOULD RATHER NOT”
-MARK TWAIN
The world wide rapidly growing burden of chronic

disease is closely linked to unhealthy environment and lifestyle that

includes diets rich in sugar, widespread use of tobacco and excessive

consumption of alcohol. Most oral disease is closely related to these

factors and is also dependent on clean water adequate sanitation,

proper oral hygiene and appropriate exposure to fluorides.

(WHO - 2005).

India is the sixth biggest country by its area but it is the

second most populous country. The developing economy, lack of

qualified dental manpower in rural areas and poor awareness

towards oral health has contributed for steady raise in the prevalence

of dental disorders in children in the last few decades.

There is a strong relationship between oral health and

overall health of the individual. The mouth is a mirror that can

reflect the health of the

rest of our body. Numerous recent studies investigating the mouth

body connection have suggested an association between oral health

and general health.

The World Health Organization defined oral health as

‘‘the retention throughout life of a functional, aesthetic and natural

dentition of not less than 20 teeth and not requiring prosthesis”.

There has been a tremendous increase in incidence and severity of

oral health problems since the last few decades. So it is very much

important to prevent the outbreak of dental disease among population

of India. An individual may be considered as healthy if she or he

has no dental caries or periodontal disease. However large majority of

the population would be considered unhealthy as oral diseases are

common and often untreated.

Oral hygiene means keeping the mouth clean, and

especially the teeth clean and free of dental plaque, the substance

which leads to most of the dental diseases. Dental decay and gum

disease is mainly caused by plaque. If we are not removing the dental

plaque for longer period of time, the risk of dental disease doubles.

Dental plaque should remove every day, this is the best way for

preventing and treating the dental disease and it is possible by

through brushing and flossing.

 Diet also influences the dental disorders. Foods that are

rich in sugar and carbohydrates enhance the plaque and tartar

formation in teeth. Sweet cookies, some of the soft drinks and cakes

contain more amount of sugar content in that, so by avoiding this

kind of foods dental disease can be prevented to some extent.

Decreasing carbohydrate content helps to control plaque formation

and lessen the probability of periodontal disease and dental decay.

According to US Surgeon General’s report, professional

care and individual action is needed for acquiring and maintaining

oral health, and it should be associated with daily oral care practices

such as brushing and flossing. This can prevent both caries and

gingivitis.

But studies have revealed that there has been a

tremendous increase in incidence and severity of oral health

problems since the last few decades. According to national health

program, dentist population ratio in rural area is only 1:300,000

where as 80% of the children suffer from dental caries,

35 % of children suffer from maligned teeth and jaws affecting

proper functioning.
 According to Surgeon General David Satcher, some

population groups are affected by silent epidemics of oral and dental

disorders. Because of these diseases children may not be able to

perform well in schools, home and their work place. Sometimes it

adversely affects the quality of life too. It is found that because of

dental diseases each year 51 million school hours are losing. Per

year among 100 students, student’s ages 5 to 17 years lost an average

of 3.1 days.

Children are mainly affected by dental plaque, dental

caries, tooth ache, gum disorders and periodontal diseases. Dental

decay can result in early tooth loss and it can lead to impairment in

the development of speech, attention deficit and lack of ability to

concentrate in schools and even reduced ability of interpersonal

relationship. These problems can be prevented by educating the

children at earlier stage in relation to maintenance of good oral

hygiene.

Cavities are another way of saying tooth decay. Tooth

decay is heavily influenced by lifestyle what we eat, how well we

take care of our teeth, the presence of fluoride in our tooth paste

and water. Cavities are most likely to develop in pits on the

chewing surface of the back teeth, in between teeth and near the
gum line.

Gum disease is an inflammation of the gums that can

progress to affect the bone that surrounds and supports teeth. It is

caused by the bacteria in plaque, a sticky, colorless film that

constantly forms on teeth. The stages of gum disease include

gingivitis, peridontitis, and advanced peridontitis.

Mouth irritations and oral lesions are swelling, spots on

sores on your mouth, lips or tongue. The common mouth sores

include canker sores, cold sores, leukoplakia and candidiasis.

Plaque is a sticky, colorless film of bacteria and sugar

that constantly forms on your teeth. It is the main cause of the

cavities and gum disease, and can harden in to tartar if not removed

daily. It can be prevented by daily brushing, flossing, limit the sugar

content in the diet and by regular dental checkups.

Usually children with dental disorders will have chronic

dental pain and are not able to focus on the daily activities, unable to

chew the food thus lack of physical growth and they may face

problems in school work and academic performance. Thus eventually

reduce their self esteem and interpersonal relationships in groups.

Even learning, speaking and eating can be affected by chronic

infection due to tooth decay. Child’s school attendance and mental

and social well-being while at school will be affected by dental pain

and dental diseases.

Shenoy R P and Sequeira P S conducted a study to find

out what is the effectiveness of a school dental education programme

for improving oral hygiene practices and status and oral health

knowledge of 12-13 year old school children in Mangalore. The

study result shows that plaque and gingival score reduction were not

influenced by the socio economic status and are highly significant

in intervention schools. They have concluded that DHE program

conducted at six week intervals was not effective than three

weeks interval in improving oral health knowledge, gingival health,

oral hygiene practice, status of school children.

A study conducted by Christensen LB about the oral

health and oral health behavior among 11- 13 years old in

Bhopal, India recommended that implementation of community

oriented oral health promotion programme is needed in order to

increase the level of knowledge and to change the attitudes and

practices in relation to oral health among children. Essential care

should be provided to control oral disease symptoms.

In the year1995, principle National Oral Health Policy

was accepted by Ministry of Health and Family Welfare, Govt. of

India, to achieve some of the goals like Oral Health for all by the year

2010, the existing prevalence of oral and dental diseases should bring

down to less than 40% from 90%., DMFT in school children

between6-12 years of age should bring down to less than 2 which

is approximately 4 at present., To reduce high prevalence of

periodontal diseases to lower prevalence., At the age of 18 years,

85% should retain all their teeth.( Indian journal of community

medicine.)

Early child hood education of children about oral

hygiene and disease is very important as they are the citizen of

tomorrow. Investments in quality child care an early child hood

education make the children our future citizens. School age is a

period of overall development. During this time the child learn to

become productive members of the society. The children should be

educated about proper technique of brushing, cleaning of the tongue

and oral habits.

Children are the right tool or measure to transmit the

message of oral hygiene to their homes and their community. At the

global level approximately 80% of children attend primary schools

and 60% complete at least four years of education with wide

variation between countries and gender. Children spend considerable

period of their life time in the school right from their childhood to

adolescence. The proper guidance in this time helps in the

development of correct beliefs and attitudes regarding oral health.

Schools can provide a supportive environment for promoting oral

health and they can also be extremely helpful in spreading the right

message to the local community. (WHO-India Biennium project).

Oral health education programs should be conducted in

the schools and the topics should include oral hygiene, measures to

keep oral health, techniques of brushing, oral disorders and its

preventive measures. According to oral health policy, the legislative

measures are adopted to ensure a statutory warning on the wrappers

and advertisement of candy, sweets, chocolates and other sugar

eatables. Usage of too much sugar may lead to more oral health

problems especially tooth decay. These types of warning measures

are also used for bevereges packets and cigarette and other same type

products.

Oral health is very essential to overall health of the

body hence it is an essential component of the school health

program. The child’s normal growth and development, speech

ability, physical condition and self esteem will be adversely

affected by poor oral hygiene. Lack of oral hygiene will leads to

variety of oral diseases and it will cause pain, chronic infections, and

problems with speech, appearance, tooth loss, school dropout and

lack of physical growth due to inability to chew foods. This all will

eventually affect child’s physical, mental and emotional growth and

reduce the child’s interpersonal relationship and academic

performance.

Schools are the second home for the children where they

will learn all the good habits. Various school health programmes

plays an integral part in the promotion of the oral health and in the

development of good oral health habits. Oral health programs helps

to, convey the message of oral health to families and community,

routine oral check up for all the students, prevention of various

dental problems among children, maintenance of good oral hygiene

among children and making them more aware about oral health as an

essential part of the overall health.

It is very important to target oral health education to

the children since the life style and hygiene practices once established

at an early age can go a long way in spending rest of the life in a

healthy way. In spite of fact that oral problems are increasing day by

day not much importance is given to its prevention. According to

WHO’s continuous action for improvement in oral health, national

programmes, which include measures at individual, professional

and community levels are effective in preventing most oral

disease. Worldwide emphasis on oral health promotion and primary

prevention of oral disease is insufficient in developing countries, and

those with economic and health system in transition face considerable

challenge to provide universally accessible or affordable intervention

and care.

Indian culture and values gives more importance to

hygiene and it is a part of daily life. Evidence based oral health

information has to be passed to every home/family and schools can

promote the oral health of all the age groups of family and

community and thus we can build up a new India with smiling faces.

NEED FOR THE STUDY:

“WHEN CHILDREN’S ORAL HEALTH SUFFERS, SO DOES
THEIR ABILITY TO LEARN.” (DAVID SATCHER.)
The high prevalence and incidence of Oral diseases

qualifies it as major public health problem. In all regions of the

world, the greatest burden of the oral disease is on disadvantaged and

socially marginalized population. But poverty the world over is not

the sole factor limiting access to oral health care. In the developing

world a shortage of economic resources often comes with the lack of

reliable information on the available work force and the

epidemiology of oral disease for health authorities to plan cost

effective interventions to improve oral health. (World Health

Organization)

Promoting oral health is a cost effective strategy to

reduce the burden of oral disease and maintain oral health and quality

of life. It is also an essential part of health promotion in general or

oral health is a determinant of general health and quality of life.

According to WHO’s despite great achievement in oral

health of population globally, problems still remain in many

communities all over the world- particularly among underprivileged

groups in developed and developing countries.

Dental caries is still a major health problem in most

industrialized countries, affecting 60-90% of school children and the

vast majority of adults. In many countries, a large number of

children and parents have limited knowledge of the cause and

prevention of the most common oral disease. It is evident that cultural

beliefs and social taboos play an important role in the perception of

the cause of dental decay and gum disease. In countries like India, a

small proportion of children do not clean their teeth at all, some may
not have access to a tooth brush and many are using the traditional

cleaning aids like salt and oil, coal ash locally made powder etc.

( GOI- WHO Biennium project ).

A study conducted by Jose A and Joseph MR in 2003

about the prevalence of dental health problems among school

children in rural Kerala. The findings shown that dental caries is the

most common problem and 50% of children in the 12 to 15 years of

age suffer from some form of dental disease.

In the year 1997, 22.7 % of Indian population was

estimate to be 5-14 years. This is such a high proportion of the

population. The dental diseases among children are increasing year

by year. A very extensive and comprehensive national health survey

conducted in 2004 throughout India has shown that dental caries in

51.9% in 5 years old children and 63.1% in 15 years old teenager.

The oral health policy is mainly aimed to gain oral

health for all by 2010. The existing prevalence of dental caries is 90%

and oral health policy is mainly aiming to reduce it to 40% and also

to reduce the incidence and prevalence of periodontal disease to a

lesser extent.

Dental problems are increasing day by day. Dental

diseases are contributing to the loss of about 51 million school hours

every year. A survey in 1996 shown that 1,611,000 school days

have missed by 5 to 17 years aged school children. Because of the

oral health problems there is a chance of early tooth loss among

children and it will lead to impairment in the normal growth and

development, lack of attention and concentration in the class,

problems with speech and lack of self esteem.

The high prevalence of dental caries has also caused

increase in the absenteeism of school hours a loss of working hours

and economy for the parents.

It is very important to target the oral health education to

the children since the life style and hygiene practices once established

at an early age can go a long way in spending rest of the life in a

healthy way. Learning takes place through various institutions such

as family, school and they can adopt and practice things easily.

Schools play an important role in developing healthy behavior and

practice. Schools are the site for enhancing healthy behaviors and

practicing good habits among children.

Various teaching and learning methods are helpful for

promotion of oral health education to the children who include

discussion methods, lecturing, demonstrations, role play, group

activities, quiz competitions and computer assisted instructions.

Whenever selecting a teaching and learning method keep in mind the

child’s age, socio economic back ground, cultural values and beliefs.

The children and family should be actively involved in the promotion

of oral health and appropriate follow up and reinforcement should be

performed.

A study conducted by Thomas S, Tandon S among rural

child population to find out what is the effectiveness of a dental

health education programme on the oral health status of the child

population. As a developing country, India has lot of drawbacks in

providing adequate oral health measures and to full fill the needs of

oral health. 40% of the Indian populations constitute children and

most of the populations are situated in the rural areas. The health

facilities are mainly concentrated in the urban areas, because of this

and lack of economic availability and lack of public dental health

facilities the rural populations are not able to access all the dental

health facilities. So among this population dental health education

programme is an important strategy of primary prevention. Result

indicated that the group with teachers has improved the dental health

score than the other group. They concluded that well knowledgeable
teachers can improve the oral health status among children so the

teachers should be the target for enhancing the effectiveness of oral

health education among children.

In school children the knowledge, attitudes and

practices towards oral hygiene and oral health was less than

satisfactory. In developing countries like India a significant number

of school children though were using tooth brush were not aware of

its importance and correct method of using them and correct

techniques of brushing. By providing oral health education children

can gain better knowledge. For changing attitudes and practices of

school children it may take more time but the fact is that health

education has long term impact than immediate effect.

There is a famous quotation that “the world will be

excellent when it is lead by children, because they are very close

to the life than others.” If we make the child to be aware about all

the aspects of the life, they can become the great achiever and creator

of the world. Oral health education programme implemented through

schools have the additional advantage of imparting primary

preventive instructions to all socio-economic status. So the

investigator was interested in studying the effectiveness of a

structured teaching programme regarding oral hygiene among the

school children.

STATEMENT OF THE PROBLEM

“A STUDY TO EVALUATE THE EFFECTIVENESS OF

STRUCTURED TEACHING PROGRAMME ON ORAL

HYGIENE ON THE DENTAL STATUS OF SCHOOL

CHILDREN IN A SELECTED SCHOOL AT UTTAR

PRADESH.”

OBJECTIVES

► To assess the knowledge of the school children regarding

oral hygiene before the administration of structured teaching

programme.

► To administer structured teaching programme regarding oral

hygiene.

► To assess the knowledge of school children regarding oral

hygiene after the administration of structured teaching

programme.

► To compare between pretest and post test knowledge on oral

hygiene among school children.

► To explore the relationship between pretest knowledge score

with selected demographic variables like age, sex, class in

 which studying, education and occupation of parents,

family income, source of water supply, residential area,

previous knowledge on oral hygiene and source of previous

information.

OPERATIONAL DEFINITION OF TERMS

 KNOWLEDGE

Knowledge referred to the understanding of school children

regarding oral hygiene measured by semi structured

questionnaire.

 SCHOOL CHILDREN

School children referred those who are between 9-14 years old,

studying 4th – 8th standard and attending the school.

 ORAL PROBLEM

It refers to the altered state of health of teeth and periodontal

tissues include dental caries, gingivitis, halitosis, dental plaque,

oral lesions and malocclusions.

STRUCTURED TEACHING PROGRAMME

Structured teaching programme consist of teaching regarding the

 oral hygiene. It is a structured show of the oral hygiene consists of

structure of teeth, dentition, and importance of brushing, diet for oral

health, common dental problems and prevention.

ASSUMPTIONS

❖ School children may have inadequate knowledge regarding oral hygiene.

❖ Student’s knowledge may be influenced by socio – demographic
variables like age, sex, class in which studying, education and
occupation of parents, family income, residence area, source of
water supply, previous knowledge on oral hygiene and source of
previous information.
❖ Use of structured teaching programme may to help to improve the
knowledge of school children regarding oral hygiene.

HYPOTHESIS

H1: the mean post test knowledge score of subjects, after the

administration of structured teaching program with regard to

knowledge on oral hygiene will be significantly higher than

their pre test score.

H2 : there will be a significant relationship between pretest knowledge

level of school children regarding oral hygiene and selected demographic

variables like age, sex, class in which studying, education and occupation

of parents, family income, residence area, source of water supply, previous

knowledge on oral hygiene and source of previous information.

LIMITATIONS

✓ The study was limited to children studying in VI – VIII

standard in a selected school at Uttar Pradesh.

✓ The study was limited to 60 school children.

✓ The study was limited to children who are present at the

time of the study.

CONCEPTUAL FRAMEWORK

A conceptual framework is a theoretical approach to the

study of the problem that scientifically emphasizes the section

arrangement and classification of the study subject. A conceptual

frame work is a precursor of the theory. It provides a broad aspect

of nursing practice, research and education.

Polit and Hungler (2006) stated that a conceptual

framework is interrelated concept on abstraction that is assembled

together in some rational scheme by virtue of their relevance to a

common theme. It is s device that helps to stimulate research and

extension of knowledge by providing both direction and impetus.

A framework may serve as a spring board for scientific

advancement. The present study is aimed at developing and

evaluating the effectiveness of structured teaching program on oral

hygiene among school children in a selected school at Uttar Pradesh.

The conceptual framework of the study is based on the

Stuffle Beam Context, Input, Process and Product (CIPP) model of

evaluation. This model consists of four steps of programme

evaluation and obtaining information for taking decisions. It

provides comprehensive, systematic and continuous ongoing

framework for programme evaluation.

Stuffle Beam evaluation model consists of the following steps:

► Context evaluation

► Input evaluation

► Process evaluation

► Product evaluation

Context evaluation

It describes the plan for decisions and collection of

data apart from providing rational for the determination of

objectives.

The present study is carried out to determine the

effectiveness of structured teaching programme in terms of gain in

knowledge on oral hygiene. Based on literature review and

findings of the studies were carried out in various cultural and

economic context, it is assumed that the school children have lack

of knowledge regarding oral hygiene.

Input evaluation

Input evaluation consists of development of tool and

structuring the design and it work as a foundation for the

programme which is planned after context evaluation.

Input helps decide appropriate teaching programme

based on the objectives of the study and specifies the resource and

select suitable study design.

Here, in the present study input refers to the

development of a structured teaching programme based on

objectives. A structured knowledge questionnaire is used to assess the

knowledge regarding oral hygiene. The tool is administered for

validity, for setting the expert opinion and reliability with test and

retest of the prepared tool and reviewing the relevant literature.

Process evaluation

It describes about the decisions implemented based on

the limitation by means of establishing validity and reliability of the

developed tool and relevant literature review. In the present study it

refers to Pilot study and activities related to assess the knowledge of

school children participants before administrating structured teaching

programme with semi structured questionnaire.

Product evaluation

The input and the process enable to achieve the

objective of the investigation which is being identified with the

product evaluation. It refers to the valid and reliable development of

the structured teaching programme which is implemented as planned.

The valid structured teaching programme regarding

knowledge related to oral hygiene will show the gain in knowledge

by the participant in most of the area which is identified with the

statistical computation.

The next step of the model is recycling the design and

the re evaluation of the context were not utilized by the researcher.

 CONCEPTUAL FRAMEWORK

Context evaluation Input evaluation Process evaluation Product evaluation

Evaluate the effectiveness of video teaching p

Lack of knowledge of Development of video Conduct pilot study to
school children regarding teaching programme on oral assess feasibility.
oral hygiene. hygiene.
Assess knowledge
Planning process Development of semi before administration of
structured questionnaire to video teaching
Formulation of objectives.
assess the knowledge level programme.
Assess the knowledge of regarding oral hygiene.
Administration of
children.
teaching strategy.
Develop and evaluate the
Assessing knowledge
effectiveness of video
after administration of
teaching programme.
video teaching
Explore the relationship programme.
between pretest knowledge
score with selected
demographic variables.

EVALUATION MODEL BY
STUFFLE BEAM
CONCLUSION
This chapter deals with introduction, need for the

study, statement of the problem, objectives, operational

definition, assumptions, research hypothesis, limitations and

conceptual framework of the study.

 CHAPTER II

REVIEW OF LITERATURE

Review of literature helps the investigator to analyze

the existing literature to generate research problem to identify

what is known about the topic and to describe methods of enquiry

used in earlier work, including their success and short comings.

Review of literature is an essential component of

the research process. Review of literature is a critical examination

of publication related to the topic of interest.

Review of literature helps a plan and conducts the

study in a systematic and scientific means. (Polit and Hungler

2004)

A research literature is the written summary of the

state of existing knowledge on research problem. The task of

reviewing research literature involves the identification, selection,

critical analysis and written description of existing information on

a topic. (Denise F Polit 2004)

Review of literature helps in selecting appropriate

methodology, developing tool, analyzing data and relating the

finding of the study.

In order to accomplish the goal of the present study, the

investigator reviewed and organized the information in the following

areas .They are

Literature related to oral hygiene

Literature related to oral disease and its prevention

Studies related to oral hygiene

Studies related oral disease and its prevention

LITERATURE RELATED TO ORAL HYGIENE AND ITS

PRACTICE

The benefits of maintaining good oral hygiene and

dental care include aesthetic value in having a clean and healthy

mouth, one’s own teeth contributes to an intact body image and

also the digestive process will be enhanced when the mouth and

teeth are in good condition. General good health is as essential as

cleanliness for maintaining a healthy mouth and teeth. (Carol

Taylor 2001)

The oral cavity functions in mastication, secretion

of mucous to moisten and lubricate the digestive system, and

secretion of digestive enzymes. Oral hygiene and loss of teeth

may affect a client’s social interaction and body image as well as

nutritional intake. Daily oral care is essential to maintain the

integrity of the mucous membrane, teeth, gums and lips. (Lois

white 2006)

The oral hygiene is provided to maintain the

integrity of the client’s teeth, gums, mucous membrane and lips.

Oral hygiene ideally means brushing the client’s teeth or cleaning

the dentures according the clients usual routine. Infant dental

hygiene should begin when the first tooth erupts. Tooth brushing

begins at about 18 months of the age using water. Tooth paste is

generally introduced later, and dentist recommended using one

that contains fluoride. (Helen Harkrader2009)

Oral hygiene consists of those practices used to

clean the mouth, especially brushing and flossing the teeth.

Proper care of the teeth and gums helps prevent gum deterioration

and tooth loss. Most dentists recommended using a soft bristled

tooth brush and brush twice daily. Flossing removes plaque and

food debris that a tooth brush may miss. (Barbara K Timby

2009)

Until the child is 7 to 10 years old the child may

need assistance with actual brushing of teeth. If the child is

developing a good oral hygiene habits, he or she does not run the

risk of developing dental caries and problems that cause

premature tooth loss. (Vicky R Bowden1998)

Proper oral hygiene includes daily brushing,

flossing and rinsing of teeth and care of the dentures and

other appliances. Regular dental checkups ensure the health of

the teeth and gums. Healthy gums are important because they

provide support for the teeth. (Ruth F Craven 2009)

Oral hygiene helps to maintain the healthy state of

the teeth, gums, and lips. Brushing cleanse the teeth of food

particles, debris, plaque and bacteria. It also massages the gums

and relieves the discomfort resulting from unpleasant odors and

tastes. (Patricia A Potter 2007)

Good orodental hygiene, including cleanliness after

each and every meal and correct brushing ensure removal of the

food particles that may form focal points for tooth decay
contribute to healthy teeth. (Suraj Gupte 2004)

The preschool period is a good time to encourage

good dental habits. Children can begin to brush their own teeth

with parental supervision and helps to reach all tooth surfaces.

Parents should floss their children’s teeth, give fluoride as

ordered if the water supply is not fluoridated and schedule the

first dental visit. So the child can become accustomed to the

routine of periodic dental care. (Jane Ball1994)

Oral hygiene is essential for removing plaque, the

almost invisible film of soft bacterial deposits that constantly

forms on teeth and ultimately leads to tooth decay and disease of

the gums. (Dorothy R Marlow2009)

Through brushing of the teeth is very important in

preventing tooth decay. The mechanical action of brushing

removes food particle that can harbor and incubate bacteria. It

also stimulates circulation in the gums, thus maintaining its

healthy firmness. Fluoride tooth paste is often recommended

because of its anti bacterial protection. (Barbara kosier 2008).

Parents should introduce a dental hygiene routine as

soon as their child’s first teeth appear, using a soft baby

toothbrush. Most children require supervision until they are 7 or 8

years old. The teeth should be brushed last thing at night and,

after every meals. (Margaret F Alexander 2006).

School age children need to brush their teeth two to

three times per day for 3 minutes each time. Parents should

replace the tooth brush every 3 to 4 months. Parents must monitor

the tooth brushing, and arrange regular dental examination every

6 months to ensure good dental health and prevent dental

problems. (Terri Kyle2010)

LITERATURE RELATED TO DENTAL PROBLEMS AND

PREVENTION

Mouth disorders may not appear dangerous, but they

are uncomfortable, often painful, and at times disfiguring or

cosmetically unattractive. They can also interfere with nutritional

intake or lead to other undesirable or more serious condition and

life style changes. (Caroline Bunker Rosdahl1999)

 The decay of the teeth with the formation of cavities

is called caries. The other main oral problems include periodontal

disease, gingivitis, halitosis, stomatitis, glossitis and oral

malignancies. (Carol Taylor2001)

Dental caries occur frequently during the toddler

period. Often as a result of the excessive intake of sweets or

prolonged use of bottle during naps and at bed time. Plaque is an

invisible soft film that adheres to the enamel surface of the teeth.

It consists of bacteria, molecules of saliva, and remnants of the

epithelial cells and leukocytes. (Barbara Kozier2006)

Peridontal disease is the pus formation in the socket

of teeth. This involves infection and destruction of the supporting

teeth structures like gingival, cementum, ligaments and alveolar

bone. (TNAI 2005)

The integrity of the teeth largely depends on the

person’s oral hygiene, practices, diet and general health. The

accumulation of food debris especially sugar and plaque supports

the growth of mouth bacteria. The combination of sugar, plaque

and bacteria may eventually erode the tooth enamel causing

caries. (Barbara K Timby 2009)

Proper care of teeth and gums helps to prevent gum

deterioration and teeth loss. Cavities in the enamel are caused by

deposition of plaque, a substance that forms and hardens on the

teeth and is composed primarily of bacteria and saliva.

Bacterial enzymes from the plaque combine with carbohydrate

from foods and organic acid to ferment and breakdown enamel.

(Ruth F Craven 2009)

There is a direct correlation between the incidence

of caries and availability of sucrose. There appears a vicious

circle of deprivation in which poor diet, that is high in sugar and

fat, combined with inadequate intake of fruit and vegetables,

predisposes to dental decay in children. (Margret F Alexander)

The guidelines for prevention of dental caries

include dental oral hygiene, diet, fluoride and fluoridation and

regular dental checkups.(Suraj Gupte2004)

The wide variety of primary oral infection can be

triggered by various bacteria and viruses. Oral infections may be

occurring secondary to vitamin deficiencies, other systemic

disease or treatment or local trauma or stress. (Frances Donovan

Monahan2009)

The measures used to prevent and control dental

caries include practicing effective mouth care, reducing the intake

of starches and sugar, applying fluoride to the teeth or drinking

fluoridated water, refraining from smoking, controlling diabetes.

(Brunner and Suddharth2009)

STUDIES RELATED TO ORAL HYGIENE

Acharya S and et al (2011) conducted a descriptive

study about influence of socio economic status on the relationship

between oral health and locus of control. The main objectives

were to find out the relationship between oral health and locus of

control among a group of rural adolescent school children and to

assess the influence of socio economic status on the various

parameters like LOC, health and oral health. Respondents were

from a public and private school in Manipal, they were 318

children of 15 years of age. Data were analyzed by T test and

correlation analyses. The result showed there is a significant

relationship between dental caries and higher internal locus of

control. Significant interaction between internal LOC and socio

economic status on caries was analyzed by multiple regression

analysis. They have concluded that socio economic status has an

important role in the relationship between locus of control and

oral health.

Singh A and et al (2011) conducted a comparative

study in South India to find out oral health status of two socially

disadvantaged groups among 12 year old children. Comparison

and assessment of oral health status of 12 year children of two

socially disadvantaged groups from Udipi district of South India

was the main objectives of the study. Samples were 327 children

from Ashrama School and 340 children from other government

schools were selected as the comparison group and they were

randomly selected for the study. In the results, from Ashrama

School, 22.9% children had dental flurosis, where as 14.4% in the

comparison group children had dental flurosis. Ashrama

School children had 1.15+-1.62 and 1.15+-1.62 as the mean

decayed teeth and DMFT value and 0.46+-0.98 and 0.48+-1.04

respectively in comparison group. In the conclusion they have

stated that, the Ashrama School children had high incidence of

dental caries, more untreated dental disorders so it is essential to

concentrate in the health inequalities among the children.

Astron an and et al (2011) conducted a cross-

sectional study about factor structures of health and oral health

related behaviors among adolescents in Arusha, Northern

Tanzania. The objective of the study was to evaluate the factor

structure of health and oral health related behaviors and its

invariance across gender and to identify factor associated with

behavioral pattern. Samples were 2412 students attending 20

secondary schools in Arusha. Analysis of seven single health and

oral health related behaviors (tooth brushing, hand wash after

latrine, hand washing before eating , using soaps, intake of fast

foods and intake of sweets) suggested two factor labeled hygiene

behaviors and snacking. The result shown that behavior within

each group might be approached jointly in health promoting

programs. A positive relationship with school and access to

hygiene facilities might play a role in health promotion.

Provision of healthy snacks and improved perceived behaviors

control regarding sugar avoidance might restrict snacking during

school hours.
 Kolawole KA and et al (2011) conducted a study

about oral hygiene measures and the periodontal status of school

children. 242 samples randomly selected and completed a

questionnaire on oral hygiene measures. The gingival health was

assessed by oral hygiene index, plaque index and index of

gingival inflammation. The result shown that tooth brushing daily

was the most common practice (52.1%). Tooth brush with a

fluoride containing tooth paste was the most common tooth

cleaning aid. There was no significant gender difference in tooth

brushing frequency, however significant gender difference were

observed in plaque index and oral hygiene index scores.

Gingivitis was absent in 28.9% of the children while 50.8% had

mild , 13.6% moderate and 6.6% severe gingivitis. There was a

weak but significant negative correlation between oral hygiene

frequency and gingival index. They have concluded that gingival

health was influenced by gender, socio economic status, oral

hygiene frequency and tooth brush texture.

Deepak P Bhagya and et al (2010) conducted an

experimental study about oral hygiene status and prevalence of

gingival disease in 10-12 years school children in Maharashtra,

India. The objective of the study was to assess the oral hygiene

status and to determine the prevalence of gingival and

periodontal disease in 10-12 years old school children in Sholapur

city. Samples were a total of 1045 children (560 boys and 485

girls) of age 10-12 years old evaluated by questionnaire, clinical

examination by using oral hygiene index simplified. The result

shown that out of 1045, 90% children brushed their teeth once in

a day, remaining 10 %brushed their teeth twice daily. Prevalence

of gingival disease was 81% and males are more affected than

females and 10 year old children were affected most by

gingivitis. Good oral hygiene status was seen in30% of

population.

Tomac and et al (2010) conducted a study about

association among sleep disturbances, fatigue and vitality on oral

health status. The objective of the study was to explore the

moderating effects of sleep disturbances, fatigue and vitality on

self reported oral health status and oral health behaviors. Samples

consisted of 213 dental students from Romania. The information

was gathered by vitality scale, fatigue assessment scale and sleep

questionnaire. The result shown that the duration of sleep in

41.2% of students was<7 hours per night and it also revealed that

11.7%of the students experienced daily disturbed sleep.

Significant difference was found among disturbed sleep, impaired

awakening, vitality and fatigue scale according to several

variables. The author concluded that the disturbed sleep index,

impaired awakening, fatigue and vitality were associated with

oral health status and behaviors.

Bharathi M and et al (2010) conducted a cross-

sectional study about oral health status and treatment needs of

children attending special schools in South India. The objective

of the study was to assess and compare the oral health status and

treatment needs of children with special health care needs

between the ages of 5 and15 with a matched group of healthy

children in Udupi district. The respondents were 265 children

with SHCN compared to 310 healthy children to assess the

difference in Peridontal disease, dentition status, treatment needs

and dento facial anomalies using the WHO criteria. The result

shown a significantly higher prevalence of caries (89.1%)

malocclusion and poorer Periodontal status among children with

SHCN compared to the healthy control group. They have

concluded that oral health status of these children require

maintaining good oral hygiene practices, which can be achieved

with appropriate target based oral health approaches.

Mahesh Kumar and et al (2005) conducted an

epidemiological study about oral health status of 5 year and 12

year school children in Chennai. The study was indented to assess

the oral health status of 5 year and 12 year school children in

Chennai. The study population consisted of 1200 school children

of both the sexes (600 private and 600 corporation school

children) in 30 schools. The result shown that dental caries is the

most prevalent disease affecting permanent teeth and more in

corporation than in private schools, there by correlating with

socio economic status. They are concluding that the greatest need

of dental health education is at an early age including proper

instruction of oral hygiene practices and school based preventive

programs will improve the preventive dental behaviors and

attitudes.

Christen and et al (2003) conducted cross sectional

study about oral health and oral health behavior among 11-13

years old in Bhopal, India. The objective of the study was to

assess the prevalence of dental caries, to describe the Periodontal

conditions and to assess the level of attitude, knowledge and

practice in relation to oral health and oral health behaviors.

Random sampling procedure were used to obtain representative

samples of children in rural (n=181) and urban areas (n=277).The

result shown that the caries was 2.5 times higher among children

in slum areas compared to children living in rural areas. 31%

used a plastic tooth brush and the general level of knowledge on

oral health was low. Intake of sugary foods and soft drinks were

more frequent in the slum areas compared to rural areas. They

have concluded that implementation of community oriented oral

health promotion programmes is needed in order to increase the

level of knowledge and to change attitudes and practice in

relation to oral health among children.

 STUDIES RELATED TO ORAL DISEASE AND ITS
PREVENTION

Joyson Moses and et al (2011) conducted a study

about prevalence of dental caries, socio-economic status and

treatment needs among 5 to 15 years old school children of

Chidambaram. The objective of the study was to assess the

prevalence of dental caries in school children in Chidambaram.

The population consisted of 2362 children, 1258 were boys and

1104 were girls. The result shown that of all the three groups,

group II (9-11 years old) should high percentage of caries. Total

dental caries were observed in 1484(63.83%) of study population.

In all 80.4% of the student belongs to low socio-economic group

have showed dental caries. They have concluded that there still

exist a large segment of the population who continue to remain

ignorant about the detriment effects of poor oral health and the

multiple benefits enjoyed from good oral health.

Vadiakash and et al (2011) conducted a survey

about socio- behavioral factors influencing oral health of 12 and

15 years old Greek adolescents. The objective of the study were

to estimate the frequency in use of oral health services, oral

health assessment , oral hygiene practice of 12 and 15 years old

Greek children and adolescent to investigate possible influence of

these factors and other socio-demographic parameters on oral

health. Samples of 1224 12 year old and 1257 15 year old

children and adolescents of Greek nationality were selected.

Peridontal index and interview technique was used to collect

the data. The result shown that caries experience was higher in

children who visited the dentist only when in pain. Tooth

brushing at least twice a day and flossing were significantly

associated with Peridontal and oral hygiene status. Parental

educational status and reason for visiting dentist were strong

determinants for caries experience. By concluding, this study has

identified several socio- demographic and behavioral

determinants for dental caries, oral hygiene and Peridontal health

of Greek children.

Shenoy R P and Sequeria P S (2010) conducted a

study among 12- 13 years old school children to find out the

effectiveness of dental education programme for improving oral

hygiene practices, status and oral health knowledge. The

objective of the study to find out the effectiveness of school

DHE, conducted at repeated and differing intervals between two

socio-economic classes in improving oral health knowledge,

gingival health, oral hygiene practice and status of school

children. The study was conducted for 36 week duration and

assessed the effectiveness of school DHE conducted every 3

weeks against every six weeks on gingival health, oral health,

knowledge, oral hygiene practice and status of 415, 12 to 13 year

old school children belonging to social classes I and V. From the

result it was identified that plaque and gingival score reduction

were not influenced by socio-economic status and highly

significant in intervention schools. The socio-economic status

influenced the oral hygiene aids used and the frequency of change

of tooth brush. They have concluded that DHE program

conducted at six week intervals was not effective than three

weeks interval in improving oral health knowledge, gingival

health, oral hygiene practice, status of school children.

Parimala M and et al (2010) conducted a cross

sectional study about dental fear in children and its relation to

dental caries and gingival condition, in Bangalore city India. The

aim of the study was to determine the level of dental fear, and its
association with dental caries and gingivitis among 12-15 years

old government high school children in Bangalore city. Eight

government high schools were selected by simple random

method. Dental anxiety question was used to assess the dental

fear and underwent oral examination for dental caries and

gingivitis. The result shown high prevalence of dental fear among

the study population was 23.4%. High significant correlation was

found between presence of bleeding on gentle probing and high

dental fear. They have concluded that high dental fear plays an

important role in the oral health status of 12 to 15 years old

children.

Rao S K and et al (2009) conducted a randomized

controlled trial in Bangalore, India about the efficacy of casein

phosphopeptide containing toothpaste in the prevention of dental

caries. The study was aimed to assess the efficacy of CPP

containing toothpaste in the prevention of dental caries among

school children. Samples include 150 school children randomly

divided in to three groups, each using one of the three types of

toothpaste (a) containing 2% CPP (b) containing 1.190mg/kg

fluoride as 0.76% sodium monoflurophosphate (c)placebo

toothpaste without CPP. For 24 months students brushed with the

given toothpaste. In the results it is observed that there is a

massive reduction in caries development among students using

SMFP toothpaste or CPP toothpaste. They have concluded that it

is very effective to incorporate CPP in to calcium carbonate based

toothpaste and the toothpaste containing CPP is very much

effective in preventing caries. Tooth pastes which containing 2%

CPP seemed containing 1.190mg/kg SMFP in the prevention of

caries.

Meera R and et al (2008) conducted a retrospective

study about first dental visit of a child. The study was aimed to

assess the Indian children’s common chief complaints and

commonly at which age group they report in their first dental

visit. The respondents were 716 children who reported to the

Meenakshi Ammal Dental College Chennai and they are divided

in 0-3 years, 3-6 years and 6-12years. Result showed that

maximum number of children’s first dental visit was between 6-

12 years (59.08%). Pain was the most common chief complaint

(42.04%), dental caries was the second common complaint

(28.49) and they have concluded that most commonly only after 6
years children report for the first dental visit and for complaints

like dental caries and pain.

Abdul Arif khan and et al (2008) conducted a

study about prevalence of dental caries among the population of

Gwalior (India) in relation of different associated factors. The

objective of the study was to analyze the role of different factor in

the occurrence of dental caries including dietary habits. Samples

were 5-72 years of age. The dental examination was performed to

collect the data. The result shown that incidence of dental caries

was higher in female, high number of dental caries patients were

observed among vegetarian population.21–30 age group was

found to be most infected with dental caries. The study concluded

that it was helpful to analyze the respective role of different

dietary factors including protein rich diet, age, gender etc on the

prevalence of dental caries which can be helpful to counter act

the potential increase of dental caries.

Sudha P and et al (2005) conducted a cross

sectional study about the prevalence of dental caries among 5-13

years old children of Mangalore city. Samples were 524 children

and consisted of children in the 5-7, 8-10 and 11-13 years of age
group respectively. Dental caries was examined visually. Plaque

index and gingival index were used to record the peridontal

status. Result shown that dental caries was highest in 5-7 years of

age group compared to 8-10 years of age group and 11-13 years

of age group. They have concluded that the increasing prevalence

of dental caries needs dental health programmes, which target the

segment of population.

Jose A and Joseph MR (2003) conducted a cross

sectional study in rural Kerala to find out the dental health

problem’s prevalence among school children over there. The

purpose of the study was to know the dental health problem’s

prevalence and patterns in rural school children of Kerala and to

assess the most important area for dental health education

programme. After the examination the findings recorded. The

findings revealed that more than 50% of the children in the 12 -15

years of age group in rural Kerala suffers from some form of

dental disease. Most common problem identified was dental

caries and both the sexes are equally affected.

CONCLUSION

The investigator reviewed the literature related to pediatric

as well as the oral hygiene, and its various aspects like knowledge

of mothers regarding oral hygiene, oral hygiene practices of

school children and various measures for prevention of dental

diseases. The review enriched the knowledge and concept of oral

hygiene. It was indeed very informative and educative.

 CHAPTER –III

METHODOLOGY

Methodology in simple words means a system of

ways of doing teaching or studying something. (Cambridge

advanced learners dictionary).

Methodology is the steps procedures and strategies

for gathering and analyzing data in a research investigation.

(Denis F Polit2004)

The method section is often subdivided in to several

significant parts which help the readers to locate vital

information.

This chapter deals with the methodological

approach of the study. The purpose of the present study is to

assess the effectiveness of structured teaching program regarding

oral hygiene among school children in a selected school at Adoor,

Kerala.

Methodology for the present study involves

✓ Description of research approach

✓ Research design
 ✓ Study setting

✓ Target population

✓ sample and sampling technique

✓ selection criteria

✓ selection and development of tool

✓ content validity and reliability

✓ Pilot study

✓ Data collection procedure and plan for the data analysis

RESEARCH APPROACH

A research approach instructs the researcher from

where the data is to be collected how to analyze the data. It also

suggest possible conclusion and helps the researcher in ensuring

specialist question in the most accurate and efficient way. (Rose

Grippe and Gorney).

Quasi experimental research design with one group

pretest and post test method was considered most appropriate to

achieve the objective of the present study.

 SCHEMATIC REPRESENTATION OF THE RESEARCH
DESIGN

DESIGN
Quasi experimental one group pretest post test research design

STUDY SETTING
Thrichenna Mangalam Government higher secondary school Adoor

POPULATION
VI, VII, VIII class students of Thrichenna Mangalam Govt higher secondary school Adoor

SAMPLING TECHNIQUE
Simple random sampling by lottery method

PRETEST SAMPLE POST TEST

Assess the Sample of 60 children in VI, Assess the knowledge of
knowledge of school VII and VIII Standard school children on oral
children on oral hygiene
hygiene
VARIABLES

DEPENDENT ATTRIBUTE
INDIPENDENT
Knowledge of school Age, sex, class, education and
Video teaching program
children on oral hygiene occupation of parents,
monthly income, source of
water supply, place of
residence, previous
ANALYSIS
knowledge, source of previous
knowledge

Frequency and Mean, SD, mean score Paired t test and chi
percentage of socio percentage of knowledge of square to compare the
demographic school children pretest and post test score
variables

FINDINGS AND CONCLUSIONS

RESEARCH DESIGN

Research design is the overall plan for addressing a

research question including specification for enhancing the

study’s integrity. (Denise E Polit and Cheryl Tatano Beck 2008).

The research design selected for this study was one group pretest

and post test design.

One group pretest and post test design is a subtype

of quasi experimental research design, was used to assess the

knowledge of school children regarding oral hygiene and

structured teaching programme regarding oral hygiene was

administered to the selected sample.

STUDY SETTING

The study setting is the location in which study is

conducted. (Nancy Burns and Susan K Groove 2007).

The study will be conducted in selected schools,

uttar pradesh. The selection of study set up will be based on

feasibility of conducting study and availability of sample

subjects. The study was conducted for 60 selected samples of

school children from 4th – 8th standard.

 POPULATION

Population is termed as the larger group about

whom the researcher is interested in gaining knowledge. (Carole L

Mac née 2004)

Population is defined as the entire aggregation of

cases that meet a designated set of criteria. (Polit and Hungler

1999).

The population for present study included all school

children of selected schools uttar pradesh.

SAMPLE AND SAMPLING TECHNIQUE

Sample is the subset of population that is selected for

a study. (Nancy Burns and Susan K Groove 2007).

For the present study the researcher used simple

random sampling with lottery method and sample comprises of

60 school children of 4th – 8th standard pf selected schools Uttar

Pradesh.
CRITERIA FOR SAMPLE SELECTION

INCLUSION CRITERIA

 Children studying in selected school in 4th – 8th standard.

 Students who are present at the time of the data collection.

SELECTION AND DEVELOPMENT OF THE TOOL

According to Carol .L. Mache, the study methods

used to collect data are intended to allow the researcher to

construct a description and meaning of the variable under study.

Semi structured questionnaire was used to assess the

knowledge of the school children. Questionnaire is considered as

the most appropriate instrument to elicit the response from the

literate subjects.

DESCRIPTION OF THE TOOL

The tool was organized in to 4 sections.

Section A: demographic data consist of 9 items – age, sex, class

in which studying, education and occupation of parents, monthly

income, place of residence, source of water supply and previous

knowledge on oral hygiene.

Section B: the knowledge aspect consists of 10 question regarding
dentition.

Section C: The knowledge aspect consists of 12 questions related to oral

hygiene.

Section D: The knowledge aspect consists of 12 questions

regarding oral problems and its prevention.

CONTENT VALIDITY

Validity reflects how accurately the measures yield

information about the true and real variable being studied.

(Carol.L.Macnee, 2004).

The experts from the field of nursing, dental

medicine, and teachers examined the relevancy and accuracy of

the tool. Based on the expert’s opinion the tool was modified.

RELIABILITY OF THE INSTRUMENT:

The tool was administered to 6 students of 6 th to 8th

standard in Government higher secondary school, Uttar Pradesh.

The reliability was established by using Spearman Brown Split

Half technique and co-efficient co-relation of knowledge was

found to r=0.99, which indicates reliability.

DEVELOPMENT OF THE STRUCTURED TEACHING
PROGRAMME

The structured teaching programme was

developed to educate the school children regarding oral

hygiene.

Keeping in mind, the objective and the opinions

of the expert the structured teaching was developed. The main

factors considered while preparing structured teaching included

the method of teaching adopted, simplicity of language, areas

covered in knowledge assessment and relevance of teaching aid.

The structured teaching was prepared to enhance

the knowledge of the school children on oral hygiene and was

given to expert for their comment.

PILOT STUDY

Pilot study is miniature trial version of study

before the actual data are collected. (Rose Marie1993). The pilot

study was conducted in the month of September 2011 at selected

school at Uttar Pradesh. The function of the pilot study was to

obtain information for improving the project for assessing its

feasibility.

After obtaining permission from the headmaster,

pilot study was conducted. Six students were selected and semi

structured questionnaire was used to assess the knowledge of the

school children regarding oral hygiene. structured teaching

programme was conducted and the effectiveness of the structured

teaching was evaluated after seven days with the same tool.

PROCEDURE FOR DATA COLLECTION

The investigator got permission from school

headmaster to conduct the study. Data was collected on the

month of the October. The purpose of the study was explained to

the samples with self introduction. The questionnaire was

distributed to the children and they took 30-35 minutes to fill the

answers and structured teaching program was conducted after the

pretest. The subjects were very active and participated with

interest and co operated well. Post test was done seven days after

the structured teaching programme. Nearly 30-35 minutes taken

to fill the same questionnaire.

PLAN FOR DATA ANALYSIS

The data obtained were analyzed in terms of

objectives of the study using descriptive and inferential statistics.

* Data were organized in master sheet.

* The frequencies and percentages for the analysis of socio

demographic variables like age, sex, class in which

studying, education and occupation of parents etc.

* Mean, mean score percentage and standard deviation of

pretest and post test score.

* Paired t test to find out the effectiveness of structured

teaching program in terms of gain in knowledge of school

children regarding oral hygiene.

* Inferential statistics especially chi-square test to find out

the association between knowledge of school children with

selected demographic variables

CONCLUSION

This chapter includes description of research

approach, research design, study setting, target population,

sample and sampling technique, selection criteria, selection and

development of the tool, content validity and reliability, pilot

study, data collection procedure and plan for data analysis.

 CHAPTER IV

DATA ANALYSIS, INTERPRETATION AND DISCUSSION

This chapter will present the quantitative result of

the study attempted to examine the effectiveness of structured

teaching programme regarding oral hygiene among school

children in a selected school at Uttar Pradesh. The purpose of

analysis is to reduce the data in to interpretable and meaningful

form, so that the result can be compared and significance can be

identified.

Data analysis is the systematic organization and

synthesis of research data, and the testing of research hypothesis

using those data. (Polit and Beck 2003)

The data analysis contains five major sections. The

first is frequencies and percentage analysis which will be used to

describe the socio demographic variables of sampled school

children. The second and third sections of the data analysis

include descriptive analysis which will describe knowledge of

school children regarding oral hygiene before and after the

structured teaching programme. The fourth section includes the

comparison of knowledge level of school children regarding oral

hygiene before and after the structured teaching programme.

Final section of the data analysis involves chi- square analysis

were run to examine the association of pretest knowledge with

selected demographic variables.

OBJECTIVES:

 To assess the knowledge of the school children regarding

oral hygiene before the administration of structured

teaching programme.

 To administer structured teaching programme regarding oral

hygiene.

 To assess the knowledge of school children regarding oral

hygiene after the administration of structured teaching

programme.

 To compare between pretest and post test knowledge on

oral hygiene among school children.

 To explore the relationship between pretest knowledge

score and selected demographic variables like age, sex,

class in which studying, education and occupation of

parents, family income, source of water supply, residential

 area, previous knowledge regarding oral hygiene and

source of previous information.

PRESENTATION OF DATA

The analysis of the data was organized and

presented under the following broad headings.

Section1 : Description of the socio demographic variables.

Section2 : Assessment of the knowledge of school children

regarding oral hygiene after the structured teaching

programme.

Section 3 : Assessment of the knowledge of the school

children regarding oral hygiene after the

structured teaching programme.

Section 4 : Comparison of knowledge level of school

children regarding oral hygiene before and

after structured teaching programme.

Examining the effectiveness of structured

 teaching programme.

Section 5 : association between pretest knowledge and

selected demographic variables of school

children.
 SECTION - I
DESCRIPTION OF SOCIO DEMOGRAPHIC VARIABLES OF SCHOOL CHILDREN

Table 4.1.1: Distribution of Respondents by age

Respondents
S No Category No %
1 11-12 years 35 58.33

2 13-14 years 25 41.66

3 Above 14 years 0 0

Total 60 100

60

50

40

30

20

10

0
11‐12 years 13‐14 years above 14 years

11‐12 years 13‐14 years above 14 years

Fig: 4.1.1 Distribution of Respondents by age

The table 4.1.1 and figure 4.1.1 shows the distribution of the sample according to

their age. Among 60 school children 35 (58.3%) were in the age of 11-12 years, 25

(41.66%) were within the age 13-14 years and none of them were above 14 years.
 Table 4.1.2 Distribution of Respondents by sex

S No Category Respondents
No %
1 Male 30 50

2 female 30 50

Total 60 100

60
50 50
50

40

30

20

10

0
MALE FEMALE

MALE FEMALE

Fig 4.1.2Distribution of Respondents by sex

Table 4.1.2 and figure 4.1.2 shows that among 60 subjects studied 30 (50%) of

school children were male and 30 (50%) of school children were females.
 Table 4.1.3 Distribution of Respondents by class in which studying.
Respondents
S No Category No %
1 VI std 20 33.33

2 VII Std 20 33.33

3 VII Std 20 33.33

Total 60 100

33.33 33.33 33.33

35
30
25
20
15
10
5
0

VI Std
VII Std
VIII Std

VI Std VII Std VIII Std

Fig4.1.3 Distribution of Respondents by class in which studying

The above table 4.1.3 and fig 4.1.3 presents frequency of school children over

class in which they are studying. Out of these 60 school children studied all are

equally distributed, 20 (33.33%) in each class VI, VII, VIII.

 Table 4.1.4 Distribution of Respondents by education of father

S No Category Respondents
No %
1 Illiterate 7 11.66
2 Primary education 12 20
3 High school 14 23.33
4 Higher secondary 13 21.66
5 Graduate 14 23.33

Total 60 100

23.33 23.33
21.66
20

11.66

illiterate a
prim ry high school higher graduate
education seconary
illiterate primary education high sch ool higher seconary graduate

Fig 4.1.4 Distribution of respondents by education of father

Table 4.1.4 and figure 4.1.4 shows the educational qualification of father of school

children under study. Among those, 7(11.66%) were illiterate. 12(20%) had

primary education, 14(23.33%) studied up to high school and 13 (21.66%) were

studied up to higher secondary and 14 (23.33%) were graduates.

 Table 4.1.5 distribution of respondents by their education of mother

S No Category Respondents
No %
1 Illiterate 6 10
2 Primary education 9 15
3 High school 15 25
4 Higher secondary 14 23.33
5 Graduate 16 26.66

Total 60 100

10%
27%

15%

23%
25%
illiterate primary education high school
higher secondary graduate

Fig 4.1.5 Distribution of Respondents by their education of the mother

Education of the mother of school children observed under this study is shown in
the above table 4.1.5 and figure 4.1.5. Among those 16(26.66%) were graduate, 15
(25%) were studied up to high school, 14 (23.33%) has completed higher
secondary, 9 (15%) were studied up to primary education level and 6(10%) were
illiterate.
 Table 4.1.6 Distribution of Respondents by occupation of father

S No Category Respondents
No %
1 Unemployed 0 0
2 Private employee 29 48.33
3 Government employee 2 3.33
4 Laborers 11 18.33
5 farmers 18 30

Total 60 100

50
45
0
45
30
5
3
0
25
20
5
1
0
1

unempl oyedprivate government laborers farmers

employee employee
g employeelaborersfarm rs
unemployedprivate employeeovernment e

Fig 4.1.6 Distribution of Respondents by occupation of father

Table 4.1.6 and figure 4.1.6 shows the distribution of school children based on the

occupation of father. Among 60 subjects studied 29 (48.33%) were private

employees, 18 (30%) were farmers, 11(18.33%) were laborers, 2(3.33%) were

government employees and none of them were unemployed.

Table 4.1.7 Distribution of Respondents by occupation of mother

S No Category Respondents
No %
1 Unemployed 25 41.66
2 Private employee 9 15
3 Government employee 4 6.66
4 Laborers 10 16.66
5 Farmers 12 20

Total 60 100

41.66

20
16.66
15

6.66

unemployedprivate government laborer farmers

e ployee m employee

Fig 4.1.7 Distribution of Respondents by occupation of mother

As seen in the above table 4.1.7 and figure 4.1.7, 25(41.66%) of mothers of school

children were unemployed, 12(20%) were farmers, 10 (16.66%) were laborers,

9(15%) were doing private job and 4(6.66%) were government employees.
 Table 4.1.8 Distribution of Respondents by monthly income of family

S No Category Respondents
No %
1 < Rs.2000/- 10 16.66
2 Rs2000-Rs3000 20 33.33
3 Rs 3000-Rs 4000 11 18.33
4 Rs 4000 and above 19 31.66

Total 60 100

33.33
31.66
16.66
18.33

<Rs. 2000/‐
Rs 2000‐Rs
3000/‐ Rs3000‐ Rs
4000/‐ >Rs 4000

Fig 4.1.8 Distribution of Respondents by monthly income of family

Table 4.1.8 and figure 4.1.8 shows the distribution of school children by monthly

income of family. Among those 20 (33.33%) were in the category of Rs 2000-

Rs 3000, 19 (31.66%) were in the category of Rs 4000 and above, 11(18.33%)

were Rs 3000-Rs 4000 and 10 (16.66%) were below Rs 2000.

 Table 4.1.9 Distribution of Respondents by place of residence

S No Category Respondents
No %
1 Urban 9 15

2 Rural 51 85

Total 60 100

85%
100

80

60 15%
40

20

0
urban rural

urban rural

Fig 4.1.9 Distribution of Respondents by place of residence

Table 4.1.9 and figure 4.1.9 shows the distribution of respondents by place of

residence. Of these children under study, 51(85%) were from rural area and

remaining 9(15%) from urban area.

 Table 4.1.10 Distribution of Respondents by source of water supply

S No Category Respondents
No %
1 Well water 53 88.33

2 Bore well water 0 0

3 Public water supply 7 11.66

Total 60 100

100
90 88.33%

80
70
60
50
40
30
20
11.66%
10
0
well water bore well water public water
supply
well water public water supply

Fig.4.1.10 distribution of respondents by source of water supply

Table 4.1.10 and figure 4.1.10 shows the distribution of 60 schools going children

by source of water supply. Of these 53(88.33%) were using well water, 7(11.66%)

were using public water supply and none of them were using bore well water.
Table 4.1.11 Distribution of Respondents by previous knowledge on oral
hygiene

S No Category Respondents
No %
1 Yes 56 93.33

2 No 4 6.66

Total 60 100

100 93.33

80

60

40

20 6.66
0

yes
no
yes no

Fig 4.1.11 Distribution of Respondents by previous knowledge on oral

hygiene

As seen in the above table and figure 4.1.11, 56 (93.33%) of school children had

previous knowledge on oral hygiene and 4(6.66%) had no previous information

about oral hygiene.

Table 4.1.12 Distribution of Respondents by source of knowledge on oral
hygiene.

S No Category Respondents
No %
1 Newspaper 4 6.66
2 Television 12 20
3 Parents 22 36.66
4 Teachers 19 31.66
5 Health workers 3 5

Total 60 100

5% 6%

20%

32%

37%

Newspaper Television Parents Teachers Health workers

Fig 4.1.12, Distribution of Respondents by source of knowledge on oral

hygiene.

Table 4.1.12 and figure 4.1.12 shows the distribution of school children by their
source of knowledge on oral hygiene. Among 60 subjects studied 22(36.66%),
were received the information from parents, 19(31.66%), were received from
teachers, 12(20%) from television, 4 (6.66%) from news papers and 3(5%) got the
information from health workers.
 SECTION- II
ASSESSMENT OF KNOWLEDGE LEVEL OF SCHOOL
CHILDREN REGARDING ORAL HYGIENE BEFORE
STRUCTURED TEACHING PROGRAMME.

Table 4.2.1: Pretest knowledge level on oral hygiene among school

children.

N=60

Respondents
Knowledge level Number %
Inadequate (<50%) 27 45
Moderate (50-75%) 33 55
Adequate (>75%) 0 0
Total 60 100

The pretest knowledge level reveals inadequate, moderate, and

adequate level. Table 4.2.1 depicts that 33(55%) of respondents
belongs to moderate level and 27 (45%) belongs to inadequate
level and none of them had adequate level of knowledge.

Table 4.2.2 pretest knowledge score on oral hygiene among school

children.

N=60

Aspect Max Range Respondents knowledge

score score
Mean Mean SD (%)
(%)

Pre test 58 19-41 29 50 4.36

Table 4.2.2 depicts that the overall pretest knowledge score of
school children regarding oral hygiene. It was found to be 50%
with SD 4.36%.
Table 4.2.3 Aspect wise pretest mean knowledge score on oral

hygiene among school children before structured teaching

programme.

N=60

S Aspects Max Range Respondents knowledge

No score score Mean Mean (%) SD (%)

1 Dentition 12 3-9 4.933 41.10 1.493

2
Oral hygiene 19 8-15 11.25 59.21 1.946

3 Oral problems 27
and prevention 6-19 12.88 47.70 2.98

Combined 58 19-41 29 50 4.36

The above table 4.2.3 presents the pretest mean knowledge score

on oral hygiene among school children before structured teaching

programme.

The mean, mean score percentage and standard deviation

percentage based on maximum possible scores of each area

before the structured teaching programme were explicated and

displayed.
The pretest mean knowledge score regarding dentition before

structured teaching programme was 4.933 with standard

deviation 1.493 %. The respondents had 11.25 mean

knowledge score with standard deviation 1.946% regarding

oral hygiene. The subjects had 12.88% of mean knowledge score

with standard deviation 2.98% regarding oral problems and

prevention. The pretest knowledge means score percent 41.10%

regarding dentition, 59.21% regarding oral hygiene and 47.70%

regarding oral problems and prevention.

 SEECTION - III

ASSESSMENT OF KNOWLEDGE LEVEL OF SCHOOL

CHILDREN REGARDING ORAL HYGIENE AFTER
STRUCTURED TEACHING PROGRAMME.

Table 4.3.1: Post test knowledge level on oral hygiene among school
children.

N=60

Respondents
Knowledge level Number %
Inadequate (<50%) - -
Moderate (50-75%) 37 61.66
Adequate (>75%) 23 38.33
Total 60 100

The post test knowledge level reveals inadequate, moderate and

adequate level. Table 4.3.1 depicts that 37 (61.66%) of
respondents belongs to moderate level and 23 (38.33%) of
respondents belongs to adequate level of knowledge.

Table 4.3.2: Post test knowledge score on oral hygiene among school
children.

N=60

Aspect Max Range Respondents knowledge

score score
Mean Mean SD (%)
(%)

Post test 58 31-52 43.11 74.32 4.69

Table 4.3.2 depicts that the overall post test knowledge score on
oral hygiene among school children was 74.32% with SD 4.69%.
Table 4.3.3 aspect wise posttest mean knowledge score on oral

hygiene among school children after structured teaching

programme.

N=60

Max Range Respondents knowledge

S. Aspects score score Mean Mean SD (%)
No %

1 Knowledge on 12 4-12 8.65 72.08 1.93

dentition

2
Oral hygiene 19 11-19 15.75 82.89 1.62

3 Oral problems
and prevention 27 10-25 18.65 69.07 1.01

Combined 58 31-52 43.11 74.32 4.69

The above table 4.3.3 presents the aspect wise post test mean

knowledge score on oral hygiene among school children after

structured teaching programme.

The mean, mean score percentage and standard deviation

percentage based on maximum possible scores of each area after

the structured teaching programme were explicated and

displayed.

The post test mean knowledge score regarding dentition after

structured teaching programme was 8.65 with standard deviation

1.93 %. The respondents had 15.75 of mean knowledge score

with standard deviation 1.62% regarding oral hygiene. The

subjects had 18.65% of mean knowledge score with standard

deviation 1.01% regarding oral problems and prevention. The

post test knowledge means score percent 72.08% regarding

dentition, 82.89% regarding oral hygiene and 69.07% regarding

oral problems and prevention.

 SECTION IV

COMPARISON OF KNOWLEDGE LEVEL OF SCHOOL CHILDREN

REGARDING ORAL HYGIENE BEFORE AND AFTER STRUCTURED
TEACHING PROGRAMME.

Table 4.4.1 pre and post test knowledge on oral hygiene among school
children before and after structured teaching programme.

N=60

Respondents knowledge
Pretest Post test
Aspect
No % No %

Inadequate 27 45 - -
moderate 33 55 37 61.66
Adequate - - 23 38.33
Combined 60 100 60 100

7
61.22
0
55
6
45
0
38.33
5
0
4
0
3 0 0
0
2
0
1
0
0
Inadequate moderate Adequate

Pretest Post test

Fig4.4.1 pre and post test knowledge on oral hygiene among
school children before and after structured teaching
programme.
 Table 4.4.2 pre and post test knowledge score on oral hygiene
among school children before and after structured teaching
programme.

N=60

Max Range Respondents knowledge Paired

Aspect score score t
Mean Mean SD(%)
Test
%
Pre test
58 19-41 29 50 4.36

Post test 58 31-52 43.11 74.32 4.69 20.22*

enhancement 58 12-11 14.11 24.32 0.33

Significant at 5% level, t (0.05, 59 df) = 2.001

74.32%
80%

60% 50%

40% 24.32%
20%

0%
Pretest post test enhancement

Pretestpost testenhancement
Fig 4.4.2 pre and post test knowledge score on oral hygiene

among school children before and after structured teaching

programme.

The table 4.4.2 and figure 4.4.2 shows that the overall knowledge

score on oral hygiene among school children in pretest and post

test which reveals the post test mean knowledge score found

higher 74.32 with SD of 4.69% when compared with pretest

mean knowledge score value which was 50 with SD of 4.36%.

The statistical paired t test implies that the difference in the

pretest and post test knowledge score found statistically

significant at 5% level p<0.05. The paired‘t’ test worked out be

20.22 reveals that there exist a statistical significance. The

enhancement score indicating the impact of effectiveness of

structured teaching programme.

 Table 4.4.3 Aspect wise pre and post test knowledge score on
mean hygiene. oral

S Max Respondents knowledge t

No Aspects score Pre test Post test Enhancement value
Mean SD Mean SD Mean SD
% % %
1 Dentition 12 41.10 1.493 72.08 1.93 30.98 0.43 13.98

2 Oral 19 59.21 1.946 82.89 1.62 23.68 3.91 13.24

hygiene

3 Oral 27 47.70 2.98 69.07 1.01 21.37 1.97 12.70

disease
and
prevention
Combined 58 50 4.36 74.32 4.69 24.32 0.33 20.22

Significant at 5% level, t (0.05, 59 df) =2.001

90 82.8 9
8072.08
69.07
70
59.21
60
47.7
41.1 Pre test
50
40 Post test
30.98
30 23.68 21.37 Enhancement
2
0
1
0
1 2 3
0

Fig 4.4.3 Aspect wise pre and post test mean knowledge score on
oral hygiene.
Table 4.4.3 depicts the aspect wise mean knowledge score of pre

test and post test. In the aspect of dentition pre test mean score

41.10% and the post test mean score 72.08% with an

enhancement in the knowledge by 30.96%. Regarding oral

hygiene pre test mean score was 59.21% and the post test mean

score was 82.89% with an enhancement in the knowledge by

23.688%. Regarding oral disease and prevention pre test mean

score was 47.70% and the post test mean score was 69.07% with

an enhancement in the knowledge by 21.37%.

The statistical paired t test incites that the enhancement in the

mean knowledge score found to be significant (p<0.05) revealing

the effectiveness of structured teaching programme for all

aspects.
 Table 4.4.4. Outcome of paired t test analysis.

Differences

S. No Variable In Mean t- Value df P-Value

1 Knowledge 24.32 20.22 59 0.05

In view of inferring the statistical significance of

increase in the knowledge of school children regarding oral

hygiene, the paired t test worked out to compare the pre and post

test knowledge, was observed to be 20.22 which was statically

significant (t value = 20.22, df= 59) at 0.05 level, i.e. significant.

It implies the effectiveness of structured teaching programme in

gaining the knowledge on oral hygiene among school children.

There by the research hypothesis H1 is accepted.

 SECTION V

In this section, the researcher is interested to bring

out the association between knowledge of school children and

age, sex, class in which studying, education and occupation of

parents, monthly income, place of residence, source of water

supply, previous knowledge on oral hygiene and source of

information.

In order to determine the association chi –square analysis

was used.

Research hypothesis

H1: the mean post test knowledge score of subjects, after the

administration of Structured teaching program with

regard to knowledge on oral hygiene will be

Significantly higher than their pre test score.

The ‘t’ value between pretest and post test was computed for

knowledge on oral hygiene and which indicate that there was a

significant improvement in scores from pre test to post test at 5%

level (ie P=0.05).

H2 : there will be a significant relationship between pretest

knowledge level of school children regarding oral

hygiene and selected demographic variables

like age, sex, class in which studying, education and

occupation of parents, family income, residence area,

source of water supply, previous knowledge on oral

hygiene and source of previous information.

 ASSOCIATION BETWEEN PRETEST KNOWLEDGE AND DEMOGRAPHIC
VARIABLES OF SCHOOL CHILDREN.
Table 4.5.1 Association between pretestknowledge and demographic
variables of school children.

No of students Calculated
Demographic variables value
In adequate Moderate
<29 29-45
No % No % 2
Age < 13 years 21 77.77 14 42.42
>13 years 6 22.2 19 57.57 7.62*
Sex Male 13 48.14 17 51.5
Female 14 51.85 16 48.48 0.04
Class <VII Std 11 40.74 9 27.27
>VII Std 16 59.25 24 72.72 2.21
Education Illiterate 5 18.5 2 6.06
of father Literate 22 81.48 31 93.93 2.21
Education Illiterate 0 0 6 18.18
of mother Literate 27 100 27 81.8 5.44*
Occupation Employees 13 48.14 18 54.5
of father Laborers 14 51.85 15 45.45 0.22
Occupation Employed 17 62.96 18 54.54
of mother Unemployed 10 37.03 15 45.45 0.41
Monthly <3000/- 16 59.25 15 45.45
income >3000/- 11 40.74 18 54.54 1.12
Place of Urban 4 14.8 5 15.15
residence Rural 23 85.18 28 84.84 0.0011
Source of Well water 24 88.88 29 87.87
water 0.014
supply Public water supply 3 11.11 4 12.12
Previous Yes 23 85.18 33 100
knowledge No 4 14.81 0 0 5.22*
Source of Newspaper/television 3 11.11 13 39.39
information Parents/teachers 24 88.88 20 60.60 6.06*
Significant at 5% level, x (0.05, 1 df) = 3.84
2
Table 4.5.1 presents substantive summary of chi-square analysis

which used to bring out the relationship between the pretest

knowledge with selected demographic variables.

School children who were in the age of < 13 years

21(77.77%) had inadequate knowledge, 14(42.42%) had

moderate knowledge. Subjects who were in the age of > 13 years

6(22.22%) had inadequate knowledge, 19 (57.57%) had moderate

knowledge. The chi- square value of association between age and

pretest knowledge level was 7.62, significant chi square (0.05,

1df) =3.84. It is inferred that there is a significant association

between age and pretest knowledge.

The subjects who were male 13, (48.14%) had

inadequate knowledge and 17(51.5%) had adequate knowledge.

Female 14(51.85%) and 16(48.48%) had adequate knowledge.

The chi-square value for association between sex and pretest

knowledge level was 0.04, which is insignificant chi square (0.05,

df =3.84). It is inferred that there is no significant relationship

between sex and pretest knowledge.

The subjects who were <VII Standard, 11 (40.74%)

had inadequate knowledge and 9 (27.27%) had adequate

knowledge. >VII Standard, 16(59.25%) had inadequate

knowledge and 24(72.72%) had adequate knowledge. The chi

square value for association between class and pretest

knowledge level was 2.21, which is insignificant, chi square

(0.05, 1df=3.84). It is inferred that there is no significant

relationship between class and pretest knowledge.

The subjects who had inadequate knowledge

5(18.5%), 2(6.06%) had moderate knowledge, their fathers were

illiterate. The subjects who had inadequate knowledge

22(81.48%), 31(93.93%) had moderate knowledge, their fathers

were literate. The chi square value for association between

education of father and pretest knowledge level was 2.21, which

was 2.21, which is insignificant chi square (0.05, 1df=3.84). It is

inferred that there is no significant relationship between

education of father and pretest knowledge.

The subjects whose mothers were illiterate

6(18.18%) had moderate knowledge and none of them had

inadequate knowledge. The subjects whose mother were literate

27(100%) had adequate knowledge and 27(81.8%) had moderate

knowledge. Chi square value 5.44 significant.

The school children whose father was an employee

13(48.14%) had inadequate knowledge, 18(54.5%) had adequate

knowledge level. The subjects whose father were laborers

14(51.85%) had inadequate knowledge 15(45.45%) had adequate

knowledge. The chi square value for association between

occupation of father and pretest knowledge level was 0.22

which is insignificant chi square (0.05, 1df=3.84). It is inferred

that there is no significant relationship between occupation of

father and pretest knowledge

The subjects whose mother were employed

17(62.96%) had inadequate knowledge, 18 (54.5%) had adequate

knowledge. The subjects whose mothers were unemployed 10

(37.03%) had inadequate knowledge. 15 had moderate

knowledge. The chi square value for association between

occupations of mother and pretest knowledge level was 0.41

which is insignificant.

The subjects who had monthly income <Rs 3000/-

16 (59.25%) had inadequate knowledge, 15 (45.45 %) had

moderate knowledge. The subjects who had monthly income

>3000/- 11 (40.74%) had inadequate knowledge, 18(54.54%) had

moderate knowledge. The chi square value for association

between monthly income and pretest knowledge level was 1.12

which is insignificant chi square (0.05, df=3.84). It is inferred that

there is no significant relationship between monthly income and

pretest knowledge.

The school children who were residing in urban, 4

(14.8%) had inadequate knowledge, 5(15.15%) had moderate

knowledge. The subjects who were residing at rural area,

23(85.18%) had inadequate knowledge and 28(84.84%) had

moderate knowledge. The chi square value for association

between place of residence and pretest knowledge was

0.0011, which is insignificant chi square (0.05, df=3.84). It is

inferred that there is no significant relationship between place of

residence and pretest knowledge.

The subjects who were using well water, 24

(88.88%) had inadequate knowledge and 29 (87.87%) had

moderate knowledge. The subjects who were using public water

supply, 3(11.11%) had inadequate knowledge, 4(12.12%) had

moderate knowledge. The chi square value for association

between source of water supply and pretest knowledge is 0.014

which is insignificant chi square (0.05,df=3.84). It is inferred that

there is no significant relationship between source of water

supply and pretest knowledge.

The subjects who had previous knowledge,

23(85.18%) had inadequate knowledge and 33(100%) had

moderate knowledge. The subjects who had no previous

knowledge, 4(14.81%) had inadequate knowledge and none of

them had moderate knowledge. The chi square value for

relationship between previous knowledge and pretest knowledge

was 5.22, which is significant chi square (0.05, df =3.84). It is

inferred that there is a significant relationship between pretest

knowledge and previous knowledge on oral hygiene.

The subjects who had the source of information from

the news papers and television 3(11.11%) had inadequate

knowledge and 13(39.39%) had moderate knowledge. The

subjects who had the source of information from the parents

and teachers 24(88.88%) had inadequate knowledge and

20(60.60%) had moderate knowledge. The chi square value for

relationship between source of information and pretest

knowledge was 6.06, which is significant chi square (0.05,

1df=3.84). It is inferred that there is a significant relationship

between pretest knowledge and source of information on oral

hygiene.

DISCUSSION

The basic aim of the present study was to evaluate

the effectiveness of structured teaching programme regarding

oral hygiene among school children and to find out the

relationship between pretest knowledge score with selected

demographic variables.

The discussion is delineated and formulated in

accordance with the outlined objectives of the research, under the

following headings.

 Socio demographic variables.

 Analysis of effectiveness of structured teaching programme.

 Association between socio demographic variables with pretest

knowledge.
Socio demographic variables

► 58.33% of the subjects were below 13 years, of age and

41.66% of the subjects were above 13 years.

► In this study 50 % were male and 50 % of the subjects were

females.

► Among the subjects 33.33% were selected from VI, VII and VIII
standards.

► Most of the subject’s fathers (88.4%) were literate

and 11.66% were illiterate.

► Most of the subject’s mothers (90%) were educated

and 10% were uneducated.

► In this study 51.66% of the subjects were working in

government and private sector and 48.33% were laborers.

► More than half of the subject’s mothers (58.34%) were

employed and 41.

66% were unemployed.

► 51.66% of the subjects had monthly income less than Rs

3000/- month and 48.33% of the subjects had monthly

income more than Rs 3000/-.

► Majority of the subjects (85%) were residing in rural area and

where as 15

% of the subjects were residence of urban area.

► Most of the subjects 88.33% were using well water where

 as 11.66% were using public water supply.

► Majority of the subjects 93.33% had previous knowledge

on oral hygiene and 6.66% not had previous knowledge on

oral hygiene.

► It was observed that 2.66% of the subjects received the

information from news papers and television and 73.33%

of the subjects received the information from parents,

teachers and health workers.

Analysis of effectiveness of structured teaching programme.

► In pretest 27(45%) had inadequate knowledge but 0 % in

post test. 33(55%) were moderate in pretest, 37(61.66%) in

post test. Adequate level 0% in pretest but in post test it

increased to 23(38.33%).

► School children had inadequate knowledge regarding oral

hygiene.

► Structured teaching programme increased the knowledge

of school children regarding oral hygiene.

► The mean knowledge score percentage of pretest was 50%.

► The mean knowledge score percentage of post test was 74.3%

► The post tests mean score percentage of knowledge was

higher than the pretest mean score.

 ► The paired t test was significant (p<0.05) i.e., the

intervention was effective in increasing knowledge.

Relationship between socio demographic variables

and their pretest knowledge.

The knowledge and socio –demographic variables

such as age of the child, education of mother, previous

knowledge regarding oral hygiene and source of information

were found to be significantly associated and sex, class in which

studying, education of father, occupation of parents, monthly

income, place of residence, and source of water supply were not

significantly associated with their pretest knowledge.

SUMMARY

This chapter deals with the analysis and

interpretation of the data collected from the 60 school children in

a selected school at Kerala.

 CHAPTER V

SUMMARY, FINDINGS, CONCLUSION,

IMPLICATIONS AND RECOMMENDATIONS

This chapter deals with summary of the study, its

findings and conclusions. The implications of structured teaching

program for improving knowledge also added. Explanations with

regard to objectives and findings are presented briefly followed

by recommendations.

SUMMARY

The main aim of the study was to evaluate the

effectiveness of structured teaching programme regarding oral

hygiene among school children.

THE OBJECTIVE OF THE PRESENT STUDY ARE

► To assess the knowledge of the school children

regarding oral hygiene before the administration of

structured teaching programme.

► To administer structured teaching programme regarding oral

hygiene.

► To assess the knowledge of school children regarding oral

 hygiene after the administration of structured teaching

programme.

► To compare between pretest and post test knowledge on

oral hygiene among school children.

► To explore the relationship between pre test knowledge

score with selected demographic variables like age, sex,

class in which studying, education and occupation of

parents, family income, source of water supply, residential

area, previous knowledge about oral hygiene and source of

previous information.

HYPOTHESIS

H1: the mean post test knowledge score of subjects, after the

administration of Structured teaching program with

regard to knowledge on oral hygiene will be

significantly higher than their pre test score.

H2 : : there will be a significant relationship between pretest

knowledge level of school children regarding oral hygiene

and selected demographic variables like age, sex, class in

 which studying, education and occupation of parents,

family income, residence area, source of water supply,

previous knowledge on oral hygiene and source of previous

information

Based on literature review and the guidance from

various subjects experts the investigator developed conceptual

framework, methodology and data analysis plan in the most

effective and efficient way.

The conceptual frame work adopted for this study

was based on context, input, process and product the Stuffle

Beam Model. It provides comprehensive, systematic and

continuous ongoing frame work for program evaluation.

The research approach adopted for the study was

quasi experimental with one group pre test post design.

The instrument developed and used for the study

was semi structured questionnaire. It comprised of three sections.

Section A consists of 9 items related to socio demographic

variables, section B consist of 10 questions related to knowledge

on dentition. Section C consist of 12 questions related to

knowledge on oral hygiene. Section D consists of 12 questions

regarding knowledge on oral problems and its prevention.

The content validity of the tool was established on

the basis of expert’s judgment. The semi structured questionnaire

was administered to 6 school children who were studying in

Government higher secondary school, Thengamam, Kerala. The

reliability of the tool was r= 0.99, established by split half

method. The instrument was found to be reliable and feasible.

The structured teaching programme consists of

structure of teeth, dentition, and importance of brushing, diet

for oral health, common dental problems and prevention. The

sessions of structured teaching programme was prepared to

enhance the knowledge level of school children regarding oral

hygiene. The structured teaching programme was validated by the

experts with the assistance of language experts. The structured

teaching programme was translated in to regional language.

A pilot study was conducted in the month of the

September at Government higher secondary school, Thengamam.

 The purpose of the study were,

To find out the feasibility of conducting final study.

To determine the method of statistical analysis.

To test the tool.

The final study was conducted during the month of

the October. Simple random sampling technique by using lottery

method was used to select the sample. The sample consists of 60

school children studying in Thrichenna Mangalam Government

higher secondary school, Adoor. Confidentiality was assured to

the subjects. Pretest was conducted to assess the knowledge of

school children regarding oral hygiene and structured teaching

programme conducted immediately after the pretest. The

post test was conducted to assess the effectiveness of

structured teaching programme 7 days following the

administration of structured teaching program.

The data gathered were analyzed and interpreted in

terms of objectives. Descriptive and differential statistics were used for

the data analysis.

Major findings of the study:

The major findings of the study are summarized as follows

Findings related to socio –demographic variables.

 58.33% of the subjects were below 13 years, of age and

41.66% of the subjects were above 13 years.

 In this study 50 % were male and 50 % of the subjects were

females.

 Among the subjects 33.33% were selected from VI, VII and VIII
standards.

 Most of the subject’s fathers (88.4%) were literate and

11.66% were illiterate.

 Most of the subject’s mothers (90%) were educated and

10% were uneducated.

 In this study 51.66% of the subjects were working in

government and private sector and 48.33% were laborers.

 More than half of the subject’s mothers (58.34%) were

employed and 41.

66% were unemployed.

 51.66% of the subjects had monthly income less than Rs

3000/- month and 48.33% of the subjects had monthly

income more than Rs 3000/-.

  Majority of the subjects (85%) were residing in rural area and
where as 15

% of the subjects were residence of urban area.

 Most of the subjects 88.33% were using well water where

as 11.66% were using public water supply.

 Majority of the subjects 93.33% had previous knowledge

on oral hygiene and 6.66% not had previous knowledge on

oral hygiene.

 It was observed that 2.66% of the subjects received the

information from news papers and television and 73.33%

of the subjects received the information from parents,

teachers and health workers.

Findings related to effectiveness of structured teaching programme.

 In pretest 27(45%) had inadequate knowledge but 0 %

in post test. 33(55%) were moderate in pretest,

37(61.66%) in post test. Adequate level 0% in pretest but

in post test it increased to 23(38.33%).

 School children had inadequate knowledge regarding oral

hygiene.
  Structured teaching programme increased the knowledge of school children

regarding oral hygiene.

 The mean knowledge score percentage of pretest was 50%.

 The mean knowledge score percentage of post test was 74.3%

 The post tests mean score percentage of knowledge was higher than the

pretest mean score.

 The paired t test was significant (p<0.05) i.e., the intervention was very

much effective in increasing knowledge.

Relationship between socio demographic variables and their pretest

knowledge.

The knowledge and socio –demographic variables such as age of the

child, education of mother and previous knowledge regarding oral hygiene and

source of information were found to be significantly associated and sex, class in

which studying, education of father, occupation of parents, monthly income, place

of residence, and source of water supply were not significantly associated with

their pretest knowledge.

CONCLUSION

The above, were the conclusion drawn from the findings of the study.

The subjects had inadequate knowledge regarding oral hygiene. The

structured teaching program about structure of teeth, dentition and importance of

oral hygiene, methods of brushing, diets for oral health, oral problems and its

prevention was found to be effective in improving the knowledge of school

children regarding oral hygiene.

IMPLICATIONS

NURSING PRACTICE:

Now – a- days, the nursing practice is mainly focusing on the

preventive aspects than the curative aspects. The community health nurse can

educate the teachers regarding oral hygiene and prevention of dental problems.

The teachers need to be informed about oral hygiene, ways of keeping oral

hygiene and identification and prevention of oral disease. So they can impart this

knowledge to the students and function effectively. School health program can be

conducted regarding oral hygiene and ways of keeping oral hygiene to the school

children and they can be thought on prevention of common oral problems. So they

can teach their friends, family members and community. Health personnel can

perform the periodic dental health checkups and maintain the data regarding the

observations so that it will be used by the researcher for conducting the research

studies on oral hygiene and oral problems.

EDUCATION

Education includes training about correct methods of brushing and

flossing, selection of correct dental aids, good oral habits as part of the curriculum

in the primary education level. There should be regular campaign regarding oral
hygiene with the help of the medical team, and school authority. School personnel

can prepare a self instructional module and structured films on good oral habits

and consequences of oral problems and which should be used in the school

periodically. World dental health month can be celebrated by the school to create

awareness and quiz programs can be conducted and reward to be given to motivate

the school children.

NURSING ADMINISTRATION

The health care administrators should initiate oral health education

programs in the community by utilizing the dental health authorities and should

initiate preventive measures and awareness programs by encouraging the health

personnel to involve in such activities. Extend the role in strengthening and

designing the primary healthcare services as per the felt needs of the community.

The public health nurse has a major role in creating awareness about

the oral hygiene and she should be in collaboration with medical authorities for

arranging the campaigns about oral hygiene and collection of information about

incidence of oral problems.

NURSING RESEARCH

There is a lot of scope for research in this area to identify the various

health problems in the school children and to find out the effectiveness of various
teaching methods for educating the school children about oral hygiene and good

oral habits. There is a need for extensive research in this area to identify the

awareness of family members and teachers about the oral problems and oral

habits. The findings of the study can be utilized to motivate further research in this

area, to identify the oral health problems and different interventions to reduce the

incidence of oral problems. Nurse researcher should be motivated to conduct more

studies on oral hygiene among various age groups.

RECOMMENDATIONS:

 The study can be replicated on larger samples; thereby findings can be

generalized to larger population.

 A similar study can be conducted with control group.

 A comparative study can be conducted in two different schools with similar

set up.

 A study can be carried to assess the knowledge and attitudes of teachers and

parents regarding oral hygiene.

 A similar study can be conducted using other teaching strategies.

 A descriptive study can be conducted among school children regarding oral

hygiene.

 A study can be undertaken to evaluate the effectiveness of periodic health

checkups in the prevention of oral problems.

 A comparative study can be conducted among primary school children high

 school children.

 A retrospective study can be conducted regarding cause of oral problems

among school children.

SUMMARY

This chapter deals with summary, major findings of the study,

conclusion, implications and recommendations.

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