EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON

BRUSHING TECHNIQUE ON THE DENTAL STATUS OF CHILDREN IN

SELECTED SCHOOL OF UTTAR PRADESH.

A
SYNOPSIS
SUBMITTED TO THE
ATAL BIHARI VAJPAYEE MEDICAL UNIVERSITY LUCKNOW, U.P
MASTER OF SCIENCE
IN NURSING.

BY
SHALINI NIGAM
MSC NURSING
CHILD HEALTH NURSING
UNDER THE GUIDANCE OF
DINESH KUMAR KHINCHI
MSC NURSING,
PROFESSOR
HOD, CHILD HEALTH NURSING
KRISHNA INSTITUTE OF NURSING & PARAMEDICAL SCIENCE AND
RESEARCH
UTTAR PRADESH 226001
YEAR-2022.

1
1. NAME OF THE
SHALINI NIGAM
CANDIDATE
KRISHNA INSTITUTE OF
NURSING & PARAMEDICAL
SCIENCE AND RESEARCH,
2. NAME OF THE
LUCKNOW
INSTITUTION UTTAR PRADESH 226001

COURSE OF STUDY AND M.SC NURSING II YEAR

3.
SUBJECT CHILD HEALTH NURSING

Effectiveness Of Structured Teaching

Programme On Brushing Technique
4. TITLE OF THE STUDY
On The Dental Status Of Children In
Selected School Of Uttar Pradesh.
Dinesh Kumar Khinchi
Msc Nursing, Professor
Hod, Child Health Nursing
5. GUIDE
Krishna Institute Of Nursing &
Paramedical Science And Research
LUCKNOW
UTTAR PRADESH 226001
SIGNATURE

6. CO GUIDE

SIGNATURE
Mrs. Girja Sharma
Principal &Professor
7. PRINCIPAL Krishna Institute Of Nursing &
Paramedical Science And Research
LUCKNOW
UTTAR PRADESH 226001

2
 SIGNATURE

INDEX

PAGE
S.NO. CONTENT NUMBERS

1 4-9
Introduction

2
Need for Study 9 -12

3 15 - 32
Review of Literature (minimum 20)

4 Problem statement, Objectives, Hypothesis, 13 - 14

Assumption, Operational Definition

5
Research Methodology (Research approach, Research 33 - 39
design, Settings, Variables, Population, Sample, Sample
size, Sampling technique, Sampling criteria, Tool,
Duration of the study, Ethical clearance, Scope of the
study, Statistical technique)

3
6 40 - 56
References( 20-30 references, NLM style)

4
 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.

5
 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 arelosing. 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

6
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

7
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

8
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

9
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

10
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

11
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.

12
 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 video teaching
programme regarding oral hygiene among the school children.

13
PROBLEM STATEMENT:

EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON

BRUSHING TECHNIQUE ON THE DENTAL STATUS OF CHILDREN IN

SELECTED SCHOOL OF UTTAR PRADESH.

OBJECTIVES:

 To describe the socio demographic variables of school children.

 To assess the pre test knowledge scores regarding oral care and its techniques.
 To determine the effectiveness of structured teaching programme on oral care and
its techniques among school children.
 To find the association between post test knowledge scores regarding oral care
and its techniques among school children with their selected socio demographic
variables.

OPERATIONAL DEFINITIONS:-

In this study:

Effectiveness: refers to the extent to which the school children had gained knowledge
regarding oral care and its techniques as assessed by the structured interview schedule.

Structured Teaching Programme: a health education regarding knowledge on oral care

among school children, developed by investigator.

 Knowledge: It refers to correct response given by school children regarding to the

questionnaire on oral care and its techniques by school children.

oral care and its techniques: it refers to measures followed by school children to
maintain their good oral health.

School children: refers to a school children studying 4 th to 8th standard years from
selected schools, Lucknow.

14
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

video 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 5th to 8th standard in a selected

school at uttar Pradesh.

 The study was limited to 60 school children.

15
 The study was limited to children who are present at the time 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

16
 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.

17
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)

18
 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

19
 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)

20
 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)

21
 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

22
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

23
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

24
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

25
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

26
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

27
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

28
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

29
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

30
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–

31
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.

32
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.

33
 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

video 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

34
 ✓ 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 will be considered most appropriate to achieve the

objective of the present study.

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, will be used to assess the knowledge of school

children regarding oral hygiene and video teaching programme regarding

oral hygiene was administered to the selected sample.

STUDY SETTING

35
 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

36
  Children studying in selected school in 4th – 8th standardstandard.

 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 will be 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

37
 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 will be examin the relevancy and accuracy of the tool. Based on the

expert’s opinion the tool will be modified.

RELIABILITY OF THE INSTRUMENT:

The tool will be administered to 10 th percentile of the

sample to observe the validity and reliability.

DEVELOPMENT OF THE STRUCTURED TEACHING PROGRAMME

The structured teaching programme w i l l b e developed

to educate the school children regarding oral hygiene.

Keeping in mind, the objective and the opinions of the

expert the structured teaching will be 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 will be prepared to enhance the

knowledge of the school children on oral hygiene and was given to expert

for their comment.

38
PILOT STUDY
Pilot study is miniature trial version of study before the actual data are

collected. (Rose Marie1993). The function of the pilot study was to obtain

information for improving the project for assessing its feasibility.

PROCEDURE FOR DATA COLLECTION

The investigator w i l l g e t permission from school

headmaster to conduct the study.

PLAN FOR DATA ANALYSIS

The data obtained will be analyzed in terms of objectives of

the study using descriptive and inferential statistics.

* Data will be 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

39
 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.

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