ORAL HEALTH PROMOTION AND INTERVENTION ACTIVITIES CARRIED OUT IN RURAL AREAS OF DAVANGERE DISTRICT.

A GOI WHO COLLABORATIVE PROGRAMME 2006 - 2007

BAPUJI DENTAL COLLEGE AND HOSPITAL DAVANGERE-577004

PROJECT TITLE: ORAL HEALTH PROMOTION AND INTERVENTION ACTIVITIES CARRIED OUT IN RURAL AREAS OF DAVANGERE DISTRICT. Principal Investigator : Dr. RAJU H G Department of Community Dentistry Bapuji Dental College and Hospital Davangere. Co-Investigators : Dr. NAGESH L Department of Community Dentistry Bapuji Dental College and Hospital Davangere. Dr. DEEPA D Department of Periodontology and Implantology Bapuji Dental College and Hospital Davangere. Contributors: Dr. Cherian Varghese Cluster Focal Point (Non Communicable Diseases and Mental Health) WHO India Control Office NEW DELHI. Dr. K. Sadashiva Shetty, Principal, Bapuji Dental College and Hospital, Davangere. Dr. Kumar Rajan National Consultant WHO India and Directorate General of Health Services Government of India. Post Graduate Students of Department Of Community Dentistry. Dr. Umesh. K, Dr. Mohammed Imranullah, Dr. Siddana Goud. R, Dr. Parappa Sajjan Dr. Shilpa Gunjal, Dr. Muthu Karuppaiah, Clinical Assistants of Department Of Community Dentistry Dr Deepa Reddy Dr Sneha Bhat Dr Shweta R S Dr Rukmini i

PREFACE Oral health is an integral component of general health. Research in the past few years has revealed the causal link between oral diseases and systemic diseases. Oral health has also been found to profoundly influence the quality of life. Dental caries and periodontal disease are the highly prevalent diseases in many populations. They are highly irreversible once they occur and also have complex etiology. Although primary preventive techniques exist, they do not confer total protection. Dental caries continues to be a major problem in many countries, especially in developing countries like India, where it is consistently reflecting increasing trend in last couple of decades. The point prevalence surveys conducted by the post graduate students in and around Davangere have shown persistence of untreated carious lesions among children in rural areas. It reflects either non-availability of oral health care services or poor oral health seeking behavior of rural people. Awareness related to oral health among them is also found to be poor. The prevailing poor status of oral health prompted us to plan and execute an integrated programme in the form of assessing oral health awareness, providing oral health education and treating untreated carious lesions by ART technique for school children in villages of Mayakonda Hobli. In addition, the oral health awareness was also provided to selected school teachers and school children. At this juncture we sincerely acknowledge the logistic support, expertise, financial assistance and moral support extended by WHO in this endeavour.

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CONTENTS INDEX 1. Executive summary 2. Introduction 3. Aims & Objectives 4. Materials and Methods 5. Results a. Descriptive data b. Statistical analysis c. Results 6. Discussion 7. Recommendations 8. References 9. Acknowledgements 10. Annexure a. Photos. b. Questionnaire on Oral Health for Adults/Children. c. IEC Material. 21 23 24 25 26 Page No. 01 02 04 05 12

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EXECUTIVE SUMMARY The present study was conducted in a rural area of Davangere district. It aimed at assessing knowledge, attitude and practices of school children and school teachers towards oral health in the selected area followed by re-evaluation after imparting oral health education. The school children were assessed for dental caries experience and treatment needs applying Dentition status Treatment need index followed by provision of ART at the site for indicated carious lesions. A total of 3937 school children aged 9-15yrs were screened and 1002 children having caries were provided ART. The mean DMF-T was 1.3 and the mean D was 0.95. A majority of the decayed teeth were unfilled typically representing lack of treatment. The knowledge, attitudes and practices of school teachers showed appreciable improvement after providing oral health education.

INTRODUCTION 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 caries in the last few decades. The annual health budget is 2% of Gross National Product and there is no specific budget allocated or earmarked for oral health exclusively. There is an urgent need for oral health policy which can provide the necessary guidelines for improvement of oral health. The presence of untreated (unfilled) carious lesions is quite common in rural areas among school going children. Poor awareness about oral health, lack of dental man power, lack of required infrastructure and lack of political will are some possible reasons which have contributed to this picture. ART is a novel method and highly practical method for treating dental caries in rural population1. Oral health promotion in the form of oral heath education + ART in an integrated module as developed in this project offers both primary and secondary prevention to target population. ART is found to be very economical, patient friendly and highly acceptable in rural masses. Fear towards dentistry is one important reason which keeps people away from seeking treatment for dental caries. The trauma caused by rotary instruments and the noise generated by them all the more frightens the children. ART being a method which advocates utilization of only hand instruments for cavity debridement, it is well

accepted2. The use of Glass Ionomer cement which brings in the advantage of secondary caries prevention because of Fluoride ion present in it. Hence in the present study Oral health promotion through oral health education and provision of ART for indicated carious lesions were utilized in an integrated manner for providing services to a rural population of Davangere district.

OBJECTIVES

1) To assess the Knowledge, Attitude and Practices of rural school children and school teachers towards oral hygiene, oral health and also to assess the dentition status in school children of rural population. 2) To provide ART to needful 1000 school children. 3) To test the efficacy of ART technique among the school children in rural population. 4) Children should be made aware of proper techniques of oral hygiene maintenance measures through their school teachers, thus making it a self-sustainable programme.

MATERIALS AND METHODS Brief profile of the area and population included Davangere district lies in the central Karnataka. The district was newly formed on August 15th, 1997. Previously, Davangere was a taluk and it was included under Chitradurga district. Later the district was formed as a result of restructuring of the districts of Karnataka state. The sex ratio in the district was 952 women to 1000 men. The literacy rate in the district was 67.4%. Davangere district has a total of six taluks. The taluks included under the Davangere district are Davangere, Harihar, Channagiri, Honnali, Harapanahalli and Jagalur. Davangere taluk has an area of 936.1 kms with a population density of 644person/sq km. It has a total of 153 villages and 40 gram Panchayats. Davangere taluk has a total population of 6, 02,523 with majority of people residing in Davangere city.Mayakonda is a Hobli situated in Davangere taluk at a distance of 35 kms. It mainly consists of agricultural community. Paddy, Sugar cane, Groundnut, Sunflower, Cotton, Jowar, Ragi, Banana, Mango to list few which are priority crops. Davangere is also having growing community for change in traditional crops to medicine plants, floriculture and hybrid crops. Regulated market located in heart of Davangere city hosts platform for both farmer and dealer for business. There are many rice mills, oil extraction mills, cotton mills and agriculture related industries in and around city.

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6 5 4 2

MATERIALS AND INSTRUMENTS USED: The essential Instruments for ART are: Mouth mirror, straight probe, explorer and pair of tweezers, hatchet, spoon excavators (small, medium and large), plastic filling instrument and WHO CPI probe. The essential materials are: Gloves, cotton roll and pellets, GIC Fuji ix, Petroleum jelly, plastic strips and articulation paper. Sufficient numbers of instruments and required amount of material were made available to have smooth uninterrupted examination and treatment. In the field, the used instruments were disinfected using Korsolex. METHODS ORGANIZATION AND ADMINSTRATION WORKOUT 1) APPROVAL FROM AUTHORITIES: Permission to implement the project was obtained from the concerned authorities, DDPI and Gram Panchayats of Mayakonda Hobli, School Head masters, school teachers and parents of school children. 2) REQUIRED INFORMATION ABOUT STUDY AREAS: All required and relevant information regarding the Mayakonda Hobli including Davangere taluk map was obtained from the census office. 3) SCHEDULE OF THE PROJECT: The project was systematically scheduled to spread over a period of one year starting from the month of May 2006. A detailed weekly and monthly schedule was prepared well in advance by informing and obtaining consent from authorities of respective rural areas. On an average, 50 subjects were interviewed, examined and 7

treated on any given day during the survey period excluding the week ends. Even though a detailed schedule plan was prepared well in advance, few adjustments and changes had to be made while working it out practically. 4) INFORMED CONSENT: Voluntary informed consent was obtained from the parents of selected school children and the school teachers before administering the questionnaire and providing treatment. 5) METHOD OF OBTAINING DATA: The required data, for conducting this study, was collected and recorded using printed questionnaire proforma. A structured questionnaire proforma was used which included questions regarding personal data, socio-demographic profile and all the probable common risk factors associated with dental caries. This questionnaire in English script was translated into Kannada script (local language) by a recognized translator so that it could be used conveniently during fieldwork. The questionnaire was pilot tested for feasibility and validity. A few modifications were done and final proforma was designed. 6) DIAGNOSTIC CRITERIA FOR DENTAL CARIES: Dental caries was recorded according to the criteria of Dentition status and treatment need index as described by WHO-Oral health survey manual (1997).3 7) CALIBRATION AND TRAINING: Before the implementation of the project, the principal investigator carried out training of the whole team regarding the criteria for diagnosing the dental caries and also the treatment of dental caries using the ART approach. A group of subjects were selected

and examined for dental caries. Subjects were reexamined on successive days using same diagnostic criteria. The kappa statistics for inter-examiner variability was 0.7 and for intra-examiner variability was 0.8. 8) PILOT STUDY: A pilot study was conducted on 50 individuals in Mayakonda of Davangere taluk in order to check the feasibility and clarity of the questions in the proforma. Few modifications in the questionnaire in terms of rephrasing, certain additions and deletions were done before finalizing the questionnaire. 9) SAMPLE SIZE AND SAMPLING PROCEDURE Bapuji Dental College & Hospital is a well-known institution in India and is located in the heart of Davangere city. The majority of field activities of Bapuji Dental College & Hospital on improvement of oral health of population are focused on places, in and around Davangere. Even though, there are two dental colleges, serving the population of rural Davangere, the prevalence of untreated carious lesions is still high, especially in children. This was another major reason for implementation of the project in rural Davangere. Initially, the list of all the schools in Davangere taluk was obtained from the DDPI office and those schools covered under Davangere south were included in the study. The reason for including Davangere south was because, the southern part of Davangere was found to show a higher prevalence of dental diseases when compared to northern part and this was attributed to lack of awareness regarding importance of oral health and lack of affordability for dental treatment.

Mayakonda Hobli was selected for the project implementation, which is situated 35kms away from Davangere city. The village of Mayakonda has a population of 5000, and is the centre place for a majority of surrounding 16 villages.Children from the villages belonging to this Hobli, study in the schools situated in the head quarters of Hobli. It was convenient to have an access to school children at school premises in the Hobli level, which can be an ideal representation of the complete Hobli. All the schools present in the Mayakonda Hobli were included in the project. Initially, all the school children aged, 6-16 years were included and examined. Later, only the age group range of 9-15 years were included in the project because the treatment need was high in the permanent dentition. 10) INFECTION CONTROL: The examiner used disposable mouth masks and gloves during examination. The sterilization of the instruments was done using both chemical and physical methods. Korsolex (Gluteraldehyde 7.0 gms; 1-6 dihydroxy 2.5 dioxyhexane 8.2 gms and polymethyl urea derivative 11.6 gms) was diluted by adding 1 part to 9 parts of potable water and the instruments were disinfected using this disinfectant and later sterilization was carried out by placing instruments in the pressure cooker. At the end of the days clinical examination and treatment, the instruments were sterilized in autoclave. IMPLEMENTATION OF THE PROJECT: The implementation of the project was done in two parts. The part one was related to school children and the part two was related to school teachers.

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PART ONE: 1. Oral examination of each subject was done by seating each subject on a chair in the daylight using required instruments. The investigator applied Dentition status and treatment need index to assess caries experience and the data was recorded in the specially prepared proforma. 2. Provided Atraumatic Restorative Treatment for 1002 school children. 3. The knowledge, attitude and practices of selected school children towards oral health was recorded by using the structured questionnaire in local language. 4. Provided oral health education on scheduled days using the educational aids like models, charts, manuals and audio-visual aids to the school children. PART TWO This part constituted of:1. Assessment of knowledge, attitude and practices of school teachers towards oral health by using pre-designed questionnaire. 2. Providing oral health education to all selected school teachers using models, manuals, charts, and audio-visual models at school premises. 3. Evaluation of knowledge, attitude and practices towards oral hygiene maintenance and oral health was done after educational intervention using specific questionnaire in selected school children and school teachers.

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RESULTS A project sponsored by WHO was implemented in Mayakonda Hobli, to assess the knowledge, attitude and practices of all the school children belonging to 9-16 years of age towards oral hygiene practices and oral health. The school children were also screened for their caries experience using Dentition status and treatment need index, a total of 3937 school children aged 9-15 years were screened and 1002 school children having caries were provided ART. The mean DMFT was found to be 1.3. The mean D, mean M and mean F were found to be 0.95, 0.15and 0.20 respectively. The prevalence of dental caries was found to 25.45% in the school children. 1000 school teachers from Davangere taluk were assessed for their knowledge, attitude and practices towards oral hygiene and oral health using questionnaire. They were later provided oral health education and post-interventional evaluation was done using the same questionnaire to know the effect of oral health education. The knowledge attitude and practices(KAP) of school children was found to be less than satisfactory when the data of the questionnaire was subjected to qualitative assessment whereas among school teachers it was found to be just satisfactory. Post educational intervention KAP assessment showed improvement in their oral health awareness.

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Teachers results The following are the findings of the questionnaire study conducted among teachers. K-1. Has oral health got any role on general health? a. Yes b. No c. Dont know

The above graph shows the distribution of responses to K-1. Most of the individuals (98%) said oral health played an important role in general health.

K - 2. How can you prevent dental problems? a. Avoiding sweets and sticky food b. Brushing regularly c. Mouth rinsing after meals d. Regularly visiting a dentist e. All of the above

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The above graph shows the distribution of responses to K-2. Most of the individuals (30%) said by avoiding sweets and sticky foods they can prevent dental problems. 26% of the individuals said brushing regularly can prevent dental problems. After health education majority of the teachers appraised the role of all other reasons. K - 3. Do you know that clean mouth can prevent tooth decay? a. Yes b. No

The above graph shows the distribution of responses to K-3. A maximum number of individuals said that they knew a clean mouth prevents dental decay.

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K - 4. Does your tooth paste contain fluoride? a. Yes b. No c. Dont know

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The above graph shows the responses to K-4. 56% of the individuals used fluoridated tooth paste. 16% of the individuals used non-fluoridated tooth paste and the remaining didnt know whether they used fluoridated tooth paste or not. After health education majority of the teachers came to know that tooth paste contains fluoride and the anti-cariogenic property of Fluorides. K - 5. Do you know what Floss is? a. Yes b. No

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This graph shows the distribution of responses to K-5. A total of 55% of the individuals did not know what floss is. The remaining 45% said that they knew what was meant by floss. After health education everybody learnt how to use floss. K - 6. Regular cleaning of mouth can prevent a. Bleeding from gums b. Loosening of gums c. Loss of teeth d. Bad smell e. All the above

The above graph shows the distribution of responses to K-6. 32% of the total respondents said that regular cleaning of mouth can prevent bleeding from gums. After health education majority of them claim that clean mouth can prevent all of those conditions.

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P - 1. How often you clean your teeth? a. Once daily b. Twice daily c. More than twice daily d. After every meal

The above graph shows the distribution of responses to P-1. More than 50% of the individuals cleaned their teeth once daily (53%). Very few (5%) cleaned their teeth after every meal. After health education they came to know that brushing after every meal is more beneficial. P - 2. How often you change your brush? a. Once in 3 months b. Once in 6 months c. Yearly once d. When bristles get frayed up e. Dont know exactly

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The above graph shows the distribution of responses to P-2. 59% of the total individuals changed their brush once in 3 months. Only 3% of the individuals changed their brush yearly once. After health education they appreciated the loss of efficiency due to fraying of the bristles. G - 1. Have you made an attempt to give education related to teeth and mouth to your students? a. Yes b. No

The above graph shows the distribution of responses to G-1. A maximum number of individuals (92%) made an attempt to give education related to teeth and mouth to

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their students. The remaining (8%) did not make an attempt to give education related to teeth and mouth to their students. After health education they were appraised about the profound influence they bear in modifying the childrens attitude towards oral hygiene practices. If yes, to question no G - 1 then G 2 . What kind of oral health education have you given to your school children? a. Education about the teeth types, functions, structure and eruption. b. Education about brushing, good dietary habits, injurious oral habits. c. Education about tooth decay, gum diseases, irregular teeth, their causes, treatment and prevention.

The above graph shows the distribution of responses to G-2. More than 50% of the teachers gave education about the teeth types, functions, structure and eruption (56%). G - 3. How have your students responded to oral health education? a. Favorably b. Unfavorably

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97 The above graph shows the distribution of responses to G-3. 93% of the students responded favorably to oral health education. G - 4. Do you think oral health education has benefited your school children? a. Yes b. No

This graph shows the distribution of responses to G-4. 97% of the respondents said oral health education has benefited their school children.

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DISCUSSION Oral health Promotion: Primary school teachers have been utilized as health education agents for school children in many countries. This was in response to the call by the World Health Organization (WHO) for the use of alternative personnel in the primary health care approach in the struggle to fight preventable diseases. The present project aimed at assessing the knowledge, attitude and practices of selected school children and school teachers towards oral hygiene and oral health in selected rural areas of Davangere. Pre-test and post-test within group assessment of knowledge, attitude and practices towards oral hygiene and oral health among the school teachers reveal they had moderate attitude and behavior towards oral health related issues and these results are similar to study done by Mwangosi IEAT and his associates in Tanzania.4 Teachers wanted more information about oral health and were in favor of including topics related to oral health in the school curriculum. Though they knew sticky sweets are responsible for caries the exact mechanism of caries occurrence was unknown to them. In school children the knowledge, attitudes and practices towards oral hygiene and oral health was less than satisfactory. A significant number of school children though were using tooth brush were not aware of its importance and exact method of using them. After providing oral health education children were found to have gained better knowledge. For attitudes and practices to change it may take more time as it is said that health education has long term impact than immediate effect. Similar results were obtained in study done by Peterson PE et al.5

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Intervention programme: Dental caries is a highly prevalent dental disease amongst school children, which is frequently neglected by the children and the parents until it reaches terminal stages with painful consequences. Multiple untreated carious lesions are frequently observed among rural children because of low priority attached to dental care by the rural masses. Lack of awareness, unavailability of dental man power and fear towards dental treatment compound this problem. The present intervention programme consisted of assessing the dentition status and treatment needs of the children aged 9-15 yrs and providing atraumatic restorative treatment to the selected sample of school children. Atraumatic restorative treatment (ART) is a new approach to the management of dental caries, it is a treatment procedure that involves removal of soft, demineralized tooth tissue, using hand instruments alone followed by restoration of the tooth with an adhesive restorative material, such as Glass Ionomer cement in the present programme Fuji IX Glass Ionomer Cement was used for restoration. In this project out of 3932 school children 1002 school children were selected to receive Atraumatic Restorative Treatment. The prevalence of dental caries was found to be 25.45%. In this project, it was both feasible and practical to use the ART approach in rural school children. A total of 1416 teeth were restored by this technique among 1002 selected school children. It was encouraging to find that vast majority of these young children who had no prior dental treatment experience found this treatment approach acceptable. This was probably because the treatment was provided in the familiar setting of their schools. Similar findings were reported by Lo ECM AND Holmagren J.6

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RECOMMENDATIONS In the current study it was observed that the rural school going children although had less than alarming level of caries experience, a majority of carious lesions were unrestored and active by nature. If allowed to continue would certainly result in complications. The knowledge, attitude and practices towards oral health although not dismal but was poor among school children and moderate among school teachers. Evaluation after the educational intervention showed positive changes in the Knowledge, Attitude and Practices of school teachers which may facilitate transfer to school children for a long term. 1. Oral health promotion through well structured oral health education programme (tailor method) can create positive change in awareness and also sensitize them to the respective issues. Encourage oral health promotion activities at primary health care level. 2. At primary health centre a special manpower as oral health educator can be created by giving training or the existing health educators can be trained by conducting crash courses, so that they can take care of oral health education to rural masses. 3. ART was found to be well accepted treatment by rural school children. Specific manpower (A special dental auxiliary), named as RURAL SCHOOL DENTAL NURSE can be trained to deliver ART to rural school children. 4. The same rural school dental nurse can be delegated the duty to provide ART for rural masses other than the school children during school vacations. 5. Ministry of Health should encourage and endorse National oral health policy which can provide clear directions for oral health care delivery at national level.

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REFERENCES 1. Frencken JE, Songpaisan Y, Phantumvanit P, Pilot T, An atraumatic restorative treatment (ART); Rationale, Technique and Development. J Public health dent 1996; 56 (3): 135-40. 2. Frencken JE, Holmgren CJ. Manual for ART. 3. WHO, ORAL HEALTH SURVEY - BASIC METHODS, 4TH EDITON (1997),GENEVA. 4. Mwangosi I E A T, Nyandindi U. oral health related knowledge, behaviors, attitude and self assessed status of primary school teachers in Tanzania. Int Dent J. 2002: 52(3) : 130-136 5. Petersen PE, Danila I, Samoila A. Oral health behavior, knowledge, and attitudes of children, mothers, and schoolteachers in Romania in 1993. Acta Odontol Scand. 1995 Dec;53(6):363-8. 6. Lo E C M and Holmgren J . Provision of atraumatic restorative treatment (ART) restorations to Chinese pre-school children- a 30-month evaluation. Intl J Paed dent. 2001;11: 3-10 7. Multi centric Oral Health Survey of WHO Govt. of India, Unpublished data, 2004-05.

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AKNOWLEDGEMENTS It is my immense pleasure to thank the World Health Organization and the Government of India for selecting our institution for the project. It is my deep sense of gratitude; I thank Dr. Cherian Verghese and Dr. Kumar Rajan, for their inestimable aid, unflinching support, keen surveillance, valuable guidance and help rendered in completing this project. I am grateful to Dr. K. Sadashiva Shetty, Principal, Bapuji Dental College and Hospital, Davangere, for his ever encouraging support of academic pursuits. I would like to thank Dr Nagesh L, Professor and Head, Department of Community Dentistry with reference, for he has guided and inspired me throughout the project. I would like to thank Dr.Deepa D., Reader, Department of Periodontics and all the post-graduate students of Department of Community Dentistry, for their help in successively completing this project. I thank the deputy director of public instructions and the block educational officer, Davangere. For their cooperation and I also thank the school teachers and the school children for their active participation. My sincere thanks to Mrs. Rajshree Patil, Bio-statistician, S S Institue of Medical Sciences, Davangere for her help in carrying out the statistical analysis.

Dr. Raju. H.G

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ANNEXURE Photographs of school children being screened

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Photograph Showing Providing Health Education to the School Children

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Photographs of schoolchildren undergoing ART

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Photograph showing Investigator discussing with National Consultant (WHO)

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Questionnaire for Children WHO PROJECT KNOWLEDGE, ATTITUDES AND PRACTICES OF SCHOOL CHILDREN IN RURAL AREAS OF DAVANAGERE DISTRICT TOWARDS ORAL HYGIENE Note: Please tick the appropriate answer ( ) A. KNOWLEDGE: K1. Has oral health got any role on general health? a. Yes b. No c. Dont know . K2. What does irregular tooth brushing cause? a. Decay b. Gum Disease c. Bad Breath d. Stains on Teeth e. Nothing f. Dont Know K3. Why do we get dental problems? a. Eating sweets and ice creams b. Not brushing properly c. Not rinsing the mouth d. Not regularly visiting a dentist e. Any others specify.. K4. How can you prevent dental problems? a. Avoiding sweets and sticky food b. Brushing regularly c. Mouth rinsing after meals d. Regularly visiting a dentist e. All of the above. K5. Do you know that clean mouth can prevent tooth decay? a. Yes b.No K6. Do you know that a dentist can clean and polish your teeth? a. Yes b.No K7. Does your tooth paste contain fluoride? a. Yes b.No c. Dont know

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K8. Do you know what is a floss? a. Yes b.No K9. a. b. c. d. e. Regular cleaning of mouth can prevent Bleeding from gums Loosening of gums Loss of teeth Bad smell Any other specify.

B. ATTITUDE A1. Do you think maintaining healthy mouth is individual responsibility? a. Yes b.No A2. Do you think that improving and maintaining health of the mouth is not in your Control? a. Yes b.No A3. Have you visited a dentist before? a. Yes b.No A4. If yes, then for what reason? a. Decay b. Pain c. Filling d. Extraction Any other reason specify A5. Do you think it is required to visit a dentist periodically to maintain the health of Your teeth and mouth? a. Yes b.No C. PRACTICE P1. How do you clean your teeth? a. Tooth Brush and Tooth Paste b. Tooth Brush and Tooth Powder c. Finger and Tooth Powder d. Neem Sticks e. Any other Specify P2. How often you clean your teeth? a. Once daily b. Twice daily

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c. More than twice daily d. After every meal P3. How do you brush your teeth? a. Use horizontal strokes b. Use vertical strokes c. Both in horizontal and vertical directions d. Circular strokes P4. How often you change your brush? a. Once in 3 months b. Once in 6 months c. Yearly once d. When bristles get frayed up e. Dont know exactly P5. What amount of paste you apply on your brush? a. Full length of bristles b. Half length of bristles c. Pea sized amount P6. Do you press the paste in between the bristles? a. Yes b.No P7. Do you rinse your mouth after meals? a. Yes b.No c. Sometimes P8. Do you clean your tongue? a. Yes b.No P9. How do you clean your tongue? a. Tongue cleaner b. Fingers c. Tooth brush d. Any others specify .. P10. Do you use any other oral hygiene aids? a. Mouth Wash b. Dental Floss c. Tooth Picks d. Any Other Specify

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DENTITION STATUS AND TREATMENT NEEDS

18 17 16 55 15 54 14 53 13 52 12 51 11 61 21 62 22 63 23 64 24 65 25 26 27 28

C R T
85 48 47 46 45 84 44 83 43 82 42 81 41 71 31 72 32 73 33 74 34 75 35 36 37 38

C R T

Primary teeth crown A B C D E F G T -

Permanent teeth crown / root 0 1 2 3 4 5 6 7 8 T 9 0 1 2 3 7 8 9

Status
Sound Decayed Filled & decayed Filled, no decay Missing as a result of caries Missing any other reason Fissure sealant Bridge abutment special crownor veneer / implant Unerupted tooth (Crown) / unexposed root Trauma (fracture) Not recorded

Treatment
0 = None P = Preventive, caries arresting care F = Fissure sealant 1 = One surface filling 2 = Two of more surface fillings 3 = Crown for any reason 4 = Veneer or laminate 5 = Pulp care and restoration 6 = Extraction 7 = Need for other can (specify) .. 8 = Need for other can (specify .. 9 = Not recorded

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QUESTIONNAIRE FOR SCHOOL TEACHERS KNOWLEDGE, ATTITUDES AND PRACTICES OF SCHOOL TEACHERS WORKING IN RURAL AREAS OF DAVANAGERE DISTRICT TOWARDS ORAL HYGIENE Note: Please tick the appropriate answer ( ) A. KNOWLEDGE: K1. Has oral health got any role on general health? b. Yes b. No c. Dont know . K2. What does irregular tooth brushing cause? a. Decay b. Gum Disease c. Bad Breath d. Stains on Teeth e. Nothing f. Dont Know K3. Why do we get dental problems? c. Eating sweets and ice creams d. Not brushing properly e. Not rinsing the mouth f. Not regularly visiting a dentist g. Any others specify.. K4. How can you prevent dental problems? h. Avoiding sweets and sticky food i. Brushing regularly j. Mouth rinsing after meals k. Regularly visiting a dentist l. Any other specify .. K5. Do you know that clean mouth can prevent tooth decay? a. Yes b.No K6. Do you know that a dentist can clean and polish your teeth? a. Yes b.No K7. Does your tooth paste contain fluoride? a. Yes b.No c. Dont know K8. Do you know what is floss? a. Yes b.No

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K9. Regular cleaning of mouth can prevent a. Bleeding from gums b. Loosening of gums c. Loss of teeth d. Bad smell e. Any other specify. B. ATTITUDE A1. Do you think maintaining healthy mouth is individual responsibility? a. Yes b.No A2. Do you think that improving and maintaining health of the mouth is not in your Control? a. Yes b.No A3. Have you visited a dentist before? a. Yes b.No A4. If yes, then for what reason? a. Decay b. Pain c. Filling d. Extraction Any other reason specify A5. Do you think it is required to visit a dentist periodically to maintain the health of Your teeth and mouth? a. Yes b.No C. PRACTICE P1. How do you clean your teeth? a. Tooth Brush and Tooth Paste b. Tooth Brush and Tooth Powder c. Finger and Tooth Powder d. Neem Sticks e. Any other Specify

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P2. How often you clean your teeth? a. Once daily b. Twice daily c. More than twice daily d. After every meal P3. How do you brush your teeth? a. Use horizontal strokes b. Use vertical strokes c. Both in horizontal and vertical directions d. Circular strokes P4. How often you change your brush? a. Once in 3 months b. Once in 6 months c. Yearly once d. When bristles get frayed up e. Dont know exactly P5. What amount of paste you apply on your brush? a. Full length of bristles b. Half length of bristles c. Pea sized amount P6. Do you press the paste in between the bristles? a. Yes b.No P7. Do you rinse your mouth after meals? a. Yes b.No c. Sometimes P8. Do you clean your tongue? a. Yes b.No P9. How do you clean your tongue? a. Tongue cleaner b. Fingers c. Tooth brush d. Any others specify .. P10. Do you use any other oral hygiene aids? a. Mouth Wash b. Dental Floss c. Tooth Picks d. Any Other Specify

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D. GENERAL G1. Are there topics related to teeth and mouth in the present school curriculum? a. Yes b.No G2. Have you been trained to give education on topics related to teeth and mouth to School children? a. Yes b.No G3. Have you made an attempt to give education related to teeth and mouth to your Students? a. Yes b.No

If yes, to question no G3 then G4. What kind of oral health education have you given to your school children? a. Education about the teeth types, functions, structure and eruption. b. Education about brushing, good dietary habits, injurious oral habits. c. Education about tooth decay, gum diseases, irregular teeth, their causes, treatment and prevention. G5. What methods are you employing to give oral health education to school children? a. Oral Health Talks b. Models, Charts and Posters c. Any others G6. How have your students responded to oral health education? a. Favorably b. Unfavorably G7. Do you think oral health education has benefited your school children? a. Yes b. No

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LIST OF SCHOOLS Sl no 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 School Government high school, Avaragolla. Government higher primary school, Avaragolla. Government higher primary school Angodu Government high school, Huvinamadu Government higher primary school, Huvinamadu Sri maganur basappa high school, Taralabalunagara, belavanuru Government high school, Ramagondanahalli P.N.H.G.K. High school, Attigere Sri maralu siddeshwara high school, Mayakonda Government higher primary school, Gopnal Government junior college, Gopnal Government Urdu primary school, Gopnal Government higher primary school, Taralabalunagara Government higher primary school, Hadadi Sri matruti high school, Davangere Sri maruti junior college, Hadadi Government higher primary school, Bada Government higher primary school, Anaberu Government pre university college, Mayakonda Government higher primary school, Mayakonda Government pre university college, Mayakonda Girls residential high school, Mayakonda Government higher primary boys school, Mayakonda S T G school, Bada Sri Anaberu kenchappa high school, Bada Government higher primary girls school, Mayakonda S A K higher primary school, Bada S G V boys school, Anaberu Government higher primary school, Mayakonda

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IEC Materials: ( Teachers manual)

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