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ORIGINAL ARTICLE

An Epidemiological Study to Assess the Knowledge of Dentists, General Medical Practitioners, and Non-Medical Graduates on Oral Hygiene Aids and the Availability of suchproductsinPune City
Rahul Kale,Sonal Tambwekar, Sangeeta Muglikar, Salika Sheikh, S. Sumanth, Amey Bhide, Mohammed Khajehnoori
Department of Periodontology and Implantology, M. A. Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India

ABSTRACT
Background: Oral hygiene is a highly individualized concept, the perception of which is very much affected by an individuals knowledge. Oral hygiene is the single most significant factor when it comes to the prevention of periodontal diseases. This greatly depends on the proper selection and use of home care oral hygiene aids. The concept, importance, and practice of different home care aids in oral hygiene maintenance is expected to be easily understood by all literate members of a population, irrespective of their profession being medical or nonmedical. If nondental health care providers were to play a role in oral health promotion, it is necessary that they demonstrate good knowledge in basic dentistry and practice good oral care behavior. Aims and Objectives: The aim of this study is to assess the knowledge of dentists, general medical practitioners, and nonmedical graduates on home care oral hygiene aids and the sources of their knowledge. The study also aims to assess the availability of the different oral hygiene products in the pharmacy stores. Materials and Methods: For the first part, the study population consisted of three groups in Pune city, which are as follows: GroupI: 200 registered dentists GroupII: 200 registered medical graduates GroupIII: 200 nonmedical graduates For the second part, the study population consisted of randomly selected 200 registered pharmacy stores in Pune city. The questionnaire was chosen as an appropriate methodology as it can be used to obtain standardized information. Results and Conclusions: The dentists had the maximum knowledge of oral hygiene and oral hygiene aids. They not only practiced the oral hygiene methods but also encouraged others to do so. Oral hygiene aids are much in demand among the population, but aids that are deleterious to the oral health are also available over the counter. KEY WORDS: Dentists, medical graduates, nonmedical graduates, oral hygiene aids, pharmacists

INTRODUCTION
Now-a-days, periodontal disease is a major worldwide cause accounting for tooth loss in humans. Lack of public concern and general unawareness of the consequences of periodontal diseases have contributed to its wide prevalence.[1] Therefore, it is better to focus on prevention of periodontal diseases rather than treating them after they occur. Although people have become more and more concerned with their oral and dental health of late, which is encouraging, a significant percentage of people still visit a dentist only when they have problems with their teeth.[2]
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Thus, an effort to educate the public on the importance of dental care is necessary and it is essential to convince the public that problems with the teeth are mostly due to improper care of teeth and that the professional support is only an addition to what people can do themselves to improve their oral health by cleaning their mouth correctly and effectively. This, in turn, greatly depends on the selection and proper use of home care oral hygiene aids. In India, home to the second largest population in the world, it is a common practice for many people to resort to the pharmacists for advice regarding health problems because of a variety of reasons which include financial constraints, lack of time, and difficulty in getting an appointment with the physician or dentist. However, there are only a few
Address for Correspondence:
Dr.Rahul Kale, Department of Periodontology and Implantology, M. A. Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India. Email:dr.rahul_dkale@rediffmail.com

DOI: ***

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studies evaluating the role of community pharmacists in the provision of oral health care advice. Also, even though there are various oral hygiene aids available over the counters in pharmacies, little information exists regarding their source of knowledge, the sort of oral health care products they promote, and their relationship and communication with the local dentist.[3] Little is also known about the knowledge and availability of oral hygiene aids among the dentists, general medical practitioners, and the non-medical graduates. Thus, this study was conducted to assess the knowledge of oral hygiene aids among dentists, general medical practitioners, and non-medical graduates and also to find the availability of such products in pharmacy stores in Pune city.

The respondents were instructed to fill in the questionnaire without discussion with anyone. The questionnaire was divided into two parts as follows: 1. To assess the knowledge of home care oral hygiene aids in the study population of dentists, medical graduates, and non-medical graduates 2. To assess the availability of oral hygiene products in pharmacy stores in Pune city. For the first part, the questionnaire was given to the dentists, medical graduates, and non-medical graduates. The questionnaire was designed as follows: i. The preliminary section was designed to gather their demographic data. Anonymity of the respondents was assured ii. The second section assessed their knowledge of oral hygiene aids iii. The last section of the questionnaire inquired about the self-evaluation of oral hygiene, and the sources, and perceived sufficiency and reliability of information concerning oral hygiene aids. For the second part, the questionnaire was given to the pharmacists. The questionnaire was designed as follows: i. The first section dealt with the availability of oral hygiene aids ii. The second section was on whether the pharmacists gave any advice regarding the oral hygiene products to the community.

MATERIALS AND METHODS

The study was approved by the local ethical committee. This epidemiological survey was conducted from November 2009 to April 2010 in M. A. Rangoonwala College of Dental Sciences and Research Centre, Pune. The collection of data was done by a single examiner. The questionnaire was chosen as an appropriate methodology as it can be used to obtain standardized information.

Study population
For the first part of the study, for assessing the knowledge of oral hygiene aids, the study population of Pune city was divided into three groups which are as follows: GroupI: 200 registered dentists GroupII: 200 registered medical graduates GroupIII: 200 non-medical graduates The dentists and the medical graduates were approached by the single examiner by: i. Visiting their respective clinic setups ii. Going to the institutes where they were affiliated; or iii. Going to the medical and dental conferences held in Pune city. The data for non-medical graduates were collected from the individuals visiting the out-patient department of the college. For the second part, the study population consisted of randomly selected 200 registered pharmacy stores in Pune city. The questionnaire was answered by all the pharmacists in the pharmacy stores and the data were collected by visiting these stores.

Statistical analysis
The categorical data are shown as n(%), while the quantitative data are shown as mean(standard deviation) values as the measures of variability. The entire data were entered and cleaned in MS Excel before doing the statistical analysis with Statistical Package for Social Sciences(SPSS). In order to test the statistical significance of difference of categorical variables across the three study groups, we used the Chi-square test of independence of attributes if the cell frequency was higher than 5. Otherwise, we used Fishers exact test for this purpose. To test the statistical significance of difference of quantitative variables across the three study groups, we used one-way analysis of variance(ANOVA) procedure with Tukeys correction for multiple comparisons. Pvalues less than 0.05 were considered statistically significant. All the hypotheses were formulated using two-tailed alternatives against each null hypothesis. The entire data were analyzed using SPSS(version11.5) for MS Windows.
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Questionnaire
A self-administered structured questionnaire written in English and validated through a pilot survey was used in this study(Appendix A shows the entire questionnaire).
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RESULTS
This epidemiological study was done to assess the knowledge of oral hygiene aids among dentists, medical graduates, and non-medical graduates. The availability of the various oral hygiene aids in the pharmacy stores across Pune city was also assessed. Agroup of 600 respondents across Pune city were surveyed in the study for the knowledge of the same. Atotal of 200 pharmacy stores in Pune city were evaluated for the availability of these products. The demographic data of the three groups show the mean age of the dentists was 31.5years, of the medical graduates was 37.4years, and of the non-medical graduates was 34.8years. The distribution of age was significantly different across the three study groups. In the dentists group, out of the 200 dentists, 113 were males and 87 were females. In the medical graduates group, 112 were males and 88 were females. In the non-medical graduates group, there were 142males as compared to 58females. In our study, majority of the participants were males in all the three groups. Significantly higher proportions of participants were males in the non-medical graduates group compared to dentists and medical graduates groups[Table1]. All the individuals in the three groups used toothbrush(100%) as an oral hygiene aid for cleaning teeth. Toothpaste was used as the oral hygiene aid by 200 dentists, 199 medical graduates, and 196 non-medical graduates. Tooth powder was used as the oral hygiene aid along with toothpaste by only 1 dentist, 3 medical graduates, and 13 non-medical graduates. Approximately equal proportion of participants across the three study groups used toothbrush and toothpaste as an oral hygiene aid. No dentist used tooth powder as the only source of

oral hygiene aid, as compared to one medical graduate and nine non-medical graduates using it. Significantly higher proportion of participants from non-medical graduates group used tooth powder, compared to dentists and medical graduates. Tongue cleaner was used as an oral hygiene aid by 121 individuals in the dentist group as compared to 93 and 53 in the medical graduates and non-medical graduates groups, respectively. Significantly higher proportion of dentists and medical graduates used tongue cleaner, as compared to non-medical graduates. The other oral hygiene aids used in dentists group are mouth rinse(59.5%), dental floss(56.5%), toothpick(33.5%), and 3.5% others which included Ayurvedic products. In the medical graduates group, 33% used mouth rinse, 19% used dental floss, 18.5% used toothpicks, and 10.5% used other oral hygiene aids like the Ayurvedic products. In the non-medical graduates group, 17.5% used mouth rinse, 8.5% used dental floss, 14% used toothpicks, and 17.5% used other oral hygiene aids which included the Ayurvedic products. The use of mouthwash and dental floss was significantly higher among dentists, followed by medical and non-medical graduates. Significantly higher proportion of dentists used toothpick, compared to medical and non-medical graduates. Significantly higher proportion of non-medical graduates used other oral hygiene aids, compared to dentists and medical graduates. Tobacco products were used as an oral hygiene aid by two individuals in the non-medical graduates group compared to none in the dentists and medical graduates groups[Table1].

Self-evaluation results
Self-evaluation regarding the oral health revealed that nearly 65% of the dentists and 63.5% of the medical graduates felt that their oral health was good, while 66.5% of the non-medical graduates felt that their oral health was fair. Sixteen non-medical graduates, four

Table1: The distribution and comparison of general oral hygiene practices between the three study groups
Parameters GroupI Dentists (n=200) 31.5(7.2) 113(56.5) 87(43.5) 200(100.0) 200(100.0) 1(0.5) 121(60.5) 119(59.5) 113(56.5) 67(33.5) 0 7(3.5) GroupII Medical graduates (n=200) 37.4(10.7) 112(56) 88(44) 200(100.0) 199(99.5) 3(1.5) 93(46.5) 66(33) 38(19) 37(18.5) 0 21(10.5) GroupIII Non-medical graduates (n=200) 34.8(10.0) 142(71) 58(29) 200(100.0) 196(98.0) 13(6.5) 53(26.5) 35(17.5) 17(8.5) 28(14) 2(1.0) 35(17.5) Between-group comparison(Pvalues) I vs. II I vs. III II vs. III 0.000 0.920 0.002 0.005 0.018 0.003

Age(years) Sex Male Female Way of cleaning teeth Toothbrush Toothpaste Tooth powder Tongue cleaner Mouth rinse Floss Toothpick Tobacco product Others

0.989 0.623 0.007 0.000 0.000 0.006 0.036

0.123 0.002 0.000 0.000 0.000 0.000 0.499 0.000

0.372 0.019 0.000 0.000 0.003 0.290 0.499 0.059

Values are mean (standard deviation); P values are obtained by analysis of variance with Tukeys correction for multiple comparisons. The rest of the values are n (%) whose Pvalues are obtained using Chi-square test. P value less than 0.05 is considered to be statistically significant

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medical graduates, and no dentists had very poor oral hygiene. Significantly higher proportion of dentists compared to medical and non-medical graduates felt that their oral hygiene was excellent. Significantly higher proportion of dentists reported that the basis for grading their oral health good was by the use of disclosing agents. Significantly higher proportion of medical graduates reported that the basis of grading their oral health was the comments by dentists and advertisements. Significantly higher proportion of non-medical graduates reported that the basis of grading their oral health was their friends comments. Significantly higher proportion of medical graduates reported that the source of information about oral hygiene and oral hygiene products was their dentist, the least significant being others. Significantly higher proportion of non-medical graduates also reported the source of information to be their dentists, the least significant being friends and others. Significantly higher proportion of dentists reported the source of information to be advertisements, the least significant being parents/ relatives[Table2].

97(48.5%) stores had stocked the other oral hygiene Ayurvedic products[Table3]. The customers were always advised by the pharmacists for selection of oral hygiene products in 44(22%) stores, whereas 94(47%) pharmacists sometimes advised the customers for selection of the oral hygiene products. No advice was given to the customers by 63(31.5%) pharmacists on selection of the oral hygiene aids [Table4].

DISCUSSION
Oral hygiene has been recognized as the staple and inescapable component of preventing oral diseases, including gingivitis and periodontitis, for which various oral hygiene aids have been devised.[4] Also, use of these oral hygiene aids in the maintenance phase following periodontal therapy enhances its success.[5] However, in a developing country like India, the availability, affordability, and knowledge of such preventive aids are limited. This may be attributed to the fact that majority of the population fall into the lower to middle socioeconomic status strata with lower literacy levels.[6] The present epidemiological study was undertaken with the main aim of assessing the knowledge of oral hygiene aids amongst different strata of literate population, namely, dentists, medical graduates, and non-medical graduates. The availability of the various oral hygiene aids in the pharmacy stores across Pune city was also evaluated. Agroup of 600 respondents across Pune city

Availability of oral hygiene products in the pharmacy stores in Pune city

A total of 200 pharmacy stores were visited to evaluate the availability of oral hygiene aids. All the pharmacy stores visited had stocked toothbrushes and toothpastes(100%). Tooth powder was stocked by 190 pharmacy stores(95%). Mouth rinses were available in 184(92%) stores, tongue cleaners in 171(85.5%) stores, toothpicks in 163(81.5%) stores, and dental floss in 149(74.5%) stores. The tobacco products were available in 152 stores(76%), whereas

Table2: The distribution and comparison of self-evaluation regarding oral health between the three study groups
Parameters GroupI Dentists (n=200) 0 2(1.0) 34(17) 130(65) 34(17) 95(47.5) 23(11.5) 37(18.5) 95(47.5) 48(24) 67(33.5) 29(14.5) 11(5.5) 61(30.5) 60(30) 91(45.5) 45(22.5) GroupII Medical graduates (n=200) 4(2.0) 3(1.5) 59(29.5) 127(63.5) 7(3.5) 121(60.5) 92(46) 55(27.5) 38(19) 29(14.5) 140(70) 45(22.5) 11(5.5) 50(25) 73(36.5) 89(44.5) 8(4) GroupIII Non-medical graduates (n=200) 16(8.0) 14(7.0) 133(66.5) 22(11) 15(7.5) 10(5.0) 15(7.5) 75(37.5) 10(5) 5(2.5) 92(46) 58(29) 78(39) 14(7.0) 23(11.5) 58(29) 13(6.5) Between-group comparison(Pvalues) I vs. II I vs. III II vs. III 0.000 0.000 0.000

Knowledge of oral health Very poor Poor Fair Good Excellent Basis of grading oral health Comments by dentist Advertisement Comments by friends Use of disclosing agents Others(self) Source of information about oral hygiene products Dentist School/education Parents/relatives Friends Mass media Advertisement Others

0.016 0.000 0.033 0.000 0.023 0.000 0.039 0.989 0.265 0.203 0.920 0.000

0.000 0.232 0.000 0.000 0.000 0.014 0.000 0.000 0.000 0.000 0.000 0.000

0.000 0.000 0.043 0.000 0.000 0.000 0.170 0.000 0.000 0.000 0.000 0.004

The values are n (%); P values are obtained using Chi-square test. P value less than 0.05 is considered to be statistically significant

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Table 3: The distribution of availability of oral hygiene aids

Oral hygiene aid Toothbrush Toothpaste Tooth powder Mouth rinse Tongue cleaner Toothpick Dental floss Tobacco based Others Number of shops(n=200) 200 200 190 184 171 163 149 152 97 Percentage 100.0 100.0 95 92 85.5 81.5 74.5 76 48.5

Table4: The distribution of pharmacists giving advice regarding oral hygiene products
Advice Yes, always Yes, sometimes Never Number of shops(n=200) 44 94 63 Percentage 22 47 31.5

world.[15] Toothbrush and toothpaste help in the mechanical removal of cariogenic and periodontopathic plaque, thereby achieving primary prevention of oral diseases.[16,17] The use of tooth powder instead of toothpaste was found to be more in the non-medical graduates group. In a study by Khan etal.,[18] it was found that there was no difference in the plaque removing efficacy of toothpaste and tooth powder. The preference for tooth powder in the non-medical graduates group could be explained by the significant influence of the cost factor. Ackerman and Tellis[19] found that Asian customers are more price-sensitive than those in the US and South Africa. The reason for the negative effect of product price on customer preference is the consumers unwillingness to pay a higher price for products that are available in alternative form at a cheaper price. The use of tongue cleaner was found to be more prevalent among the group of dentists and least among the non-medical graduates. This finding is in contrast to the study by Doshi etal.[7] on 120 medical and 120 engineering students, where it was found that 61% of the engineering students used tongue cleaner as compared to 51% of the medical students. Thus, the finding of our study suggests that dentists have more knowledge about the role of tongue cleaning as a preventive measure for oral diseases. Tongue has been shown to be colonized by a variety of organisms which include Treponema denticola, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythensis, Fusobacterium nucleatum, Porphyromonas endodontalis, and Eubacterium species.[20] Removal of tongue coating reduces the bacterial load in the oral cavity and has also been shown as an important component in the full-mouth disinfection protocol[21] and management of oral malodor.[22-24] Recently, in a systematic review by Van der Sleen etal.(2010)[25] on the effectiveness of mechanical tongue cleaning on breath odor and tongue coating, it was concluded that the use of tongue cleaner has the potential to successfully reduce the breath odor and tongue coating, thereby preventing the occurrence of periodontal disease. In our study, the use of chemical plaque control agents(mouth rinse) and interdental aids(dental floss and toothpick) was found to be the most in the dentists group and the least in the non-medical graduates group. Toothbrushing is an effective means of removing plaque on many tooth surfaces, but it is incapable of removing the plaque completely on its own.[26] Hence, chemical plaque control agents like chlorhexidine have been used as an adjunct for controlling plaque and maintaining the gingival health. DeVore(2002)[27] reports that the use of mouth rinse is favored by the public because of its ease of use and breath freshening effect. The interdental aids like dental flosses and interdental brushes have shown to reduce the interproximal gingival bleeding by removing the interdental plaque. It
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were surveyed in the study for the knowledge of the same. Atotal of 200 pharmacy stores in Pune city were evaluated for the availability of these products. The present questionnaire-based study was carried out in Pune city of Maharashtra state in India where the participants had an equal opportunity to access dental care. Since various questionnaire-based studies have been conducted regarding oral hygiene and oral hygiene products,[7-11] it appears to be an appropriate methodology to obtain standardized information regarding oral hygiene and oral hygiene products. To our knowledge, not a single study has been done regarding the same or on similar backgrounds in Pune city. The collection of data was done by a single examiner which helped to minimize the bias. In our study, the mean age of participants in all the three groups was in the range of 30-40years. There were more males as compared to females in all the three study groups, which was statistically significant. This is suggestive of higher literacy rates among the males as compared to females in the Indian population.[12,13] In the present study, majority of the participants in all the groups used toothbrush and toothpaste for the maintenance of oral hygiene. These findings are similar to the studies done by Al Omiri etal.,[8] Doshi etal.,[7] and Tuti etal.,[11] wherein it was reported that majority of the respondents used toothbrush and toothpaste for the maintenance of oral hygiene. This suggests that toothbrush and toothpaste are considered as the essential mechanical aids for the maintenance of oral hygiene. These aids are used to remove plaque in order to prevent oral diseases including gingivitis and dental caries, while also maintaining dental esthetics and preventing bad breath.[14] Brushing the teeth with dentifrice is universal and has been documented as the most widely used oral hygiene habit in the industrialized
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has been observed that toothbrushing is less effective in interproximal plaque removal in the proximal surfaces of posterior teeth. This limitation has contributed to the inefficiency of toothbrushing in controlling interproximal gingival bleeding as shown in the studies by Warren etal.(1996),[28] Pucher etal.(1995),[29] and Spolsky etal.[30] It is very unfortunate that there is a wealth of evidence showing that the routine use of dental floss has consistently been dramatically low, ranging from 10% to as high as 30%, due to lack of patient ability and lack of motivation.[30-33] Several oral tobacco preparations such as mishri, gudhaku, bajjar, and creamy snuff are intended primarily for cleaning the teeth. Mishri, which is commonly used is applied to the teeth and gingiva, often for the purpose of cleaning the teeth.[34] In the present study, the use of tobacco preparations for cleaning the teeth was found only among the non-medical graduates. Not a single dentist or medical graduate used the tobacco products for cleaning the teeth. The present finding shows the lack of awareness or ignorance about the hazardous effects of tobacco use among the non-medical graduates. Tobacco use is established as a risk factor for periodontal disease and other oral premalignant and malignant diseases.[35] On the other hand, many people believe that tobacco has medicinal value for curing or palliating common discomforts such as toothache, headache, and stomachache. This influences the non-users to initiate usage of tobacco products.[36,37] In a survey conducted among 100,000 individuals in Maharashtra for mishri application in cleaning the teeth, it was found that 22% were mishri users; the prevalence was 39% among women and 0.8% among men.[38] Other oral hygiene aids like the Ayurvedic products were used by the individuals in small numbers across all the three groups, the most being in the non-medical graduates group. On self-evaluation, majority of the dentists and medical graduates considered their oral hygiene to be good, whereas the non-medical graduates considered it to be fair. For majority of the dentists, the basis for grading their oral health as good was self-knowledge of oral hygiene as well as by the use of disclosing agents. Plaque disclosing agents are used to view the areas of plaque coverage. Disclosing plaque helps the clinician to motivate and educate the people on plaque removal. These agents are useful visual feedback tools, showing the patients the areas they have missed while brushing during home care.[39] Significantly higher proportion of medical graduates relied on dentists for assessing the oral health and also as a source of information regarding oral hygiene and the oral hygiene products. This is suggestive of regular visits of medical graduates to the dentists. It was encouraging that the medical graduates were willing to seek advice from the dentists regarding their improvement of oral health
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and choosing the various oral hygiene products. These findings are consistent with the findings by Krawczky etal.(2006),[40] where nearly 40% of the medical students reported that their source of information of oral hygiene products was the dentists. Significantly higher proportion of non-medical graduates reported that the basis of their oral health being fair was the comments by their friends. The source of information of oral hygiene and oral hygiene products was the dentists. These findings are similar to the findings by Krawczky etal.(2006),[40] where majority of the polytechnic students reported their source of information of oral hygiene products to be the dentists. The knowledge of the non-medical graduates needs to be improved regarding the maintenance of their oral health and they should be encouraged to visit the dentists frequently so as to improve their oral health. Approximately equal proportion of dentists and medical graduates reported that the source of information about oral hygiene and oral hygiene products was advertisements, thus suggesting that advertisements influence the selection of oral hygiene products equally among them. This finding is similar to that of Krawczky etal.(2006),[40] where advertisement was reported to be the source of information of oral hygiene aids equally among the dental and medical students. Toothbrushes, toothpastes, and tooth powders were available in all the pharmacy stores, thus suggesting that the general public is aware of their importance for maintaining oral hygiene. West etal.(2008)[41] reported that toothbrushes and accompanying toothpastes/powders occupy the major slice of the pie when it comes to public money spent on oral hygiene products. It was surprising to note that the other adjunctive oral hygiene aids like mouth rinses, tongue cleaner, dental floss, and toothpicks were also available in majority of the stores. This suggests that the general public have access to incorporate these aids in their routine oral hygiene program. Tobacco products were available in 76% of the pharmacy stores, which was unfortunate, suggesting significant demand for the tobacco products as oral hygiene aids among the general public. The other oral hygiene aids available in 48.5% of the pharmacy stores were the Ayurvedic products. Nearly 70% of the pharmacists gave advice to the customers when solicited, for the selection of oral hygiene products. This finding coincides with the study by Priya etal.(2008),[3] where 70% of the pharmacists expressed interest in giving advice to the consumers regarding oral health and the selection of oral hygiene products. Though the pharmacists are not familiar to give a proper guidance regarding maintenance of oral hygiene to the consumers, they were still found to be giving advice to the customers. Ideally, these customers should be referred to the dentists for seeking the oral hygiene aids. However, on the other
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hand, not every person can visit a dentist owing to the financial constraints, lack of time, fear of dentist, lack of appointments, etc., So, in such situations, pharmacists play an important role in oral health promotion, thereby sharing the responsibility as a member outside the dental profession in preventing dental and periodontal disease.

source for enhancing the knowledge of oral hygiene and oral hygiene products, as a part of globalization of the oral hygiene products, among the population. Most of the basic oral hygiene aids were easily available in the pharmacy stores. At the same time, undesirable products like tobacco containing oral hygiene products were also available. These findings reveal the following: 1. Oral hygiene aids are much in demand among the population, but aids that are deleterious to the oral health are also available over the counter 2. The pharmacists, though not qualified to prescribe oral hygiene products, advised the customers on the products when solicited. However, on the other hand, these pharmacists, by advising the customers promote oral hygiene in their own way. Although pharmacists contributions to oral health care are not yet recognized, there is every reason to be optimistic toward making patient care in community pharmacy setting a success. For this, the educational system for pharmacists has to be adapted. Therefore, if the pharmacists are educated toward the importance of the oral health, they can play an important role as a member outside the dental profession in promoting the oral health at the community level. However, this study was carried out in Pune city where the study population was literate and had an access to various dental clinics, hospitals, and pharmacy stores. Amore detailed study comprising larger sample size, including different strata of population, with diverse geographic distribution and different access to the dental care will help in better understanding of the knowledge of oral hygiene aids as well as availability of these products across pharmacy stores.

CONCLUSIONS
Oral hygiene forms the basis for prevention of oral disease, for which a variety of oral hygiene aids have been devised. These oral hygiene aids form an essential component of the maintenance protocol of the dental therapy and, thereby, help to restore the oral and dental health. Therefore, the knowledge of these oral hygiene aids will help to prevent the occurrence of oral and dental diseases at the primary level. The present study assessed the knowledge of the oral hygiene aids among the dentists, medical and non-medical graduates. The knowledge was found to be better among the dentists, followed by the medical graduates, and was the least among the non-medical graduates. Thus, we can arrive at the following conclusions: 1. Dentists, having the maximum knowledge regarding oral hygiene and oral hygiene products, among all the three groups, can enhance the knowledge of the other groups. The dentists can enhance the knowledge of medical graduates by conducting short-term workshops. For the non-medical graduates, the knowledge can be enhanced by organizing various educational and motivational dental camps 2. It was observed that the medical graduates had an average knowledge regarding certain aspects of oral hygiene and oral hygiene products. Therefore, the medical graduates can upgrade the peripheral knowledge about overall dentistry, for which dental professionals can play an important role by interdisciplinary interaction and exchange of knowledge 3. The non-medical graduates had comparatively less knowledge regarding the oral hygiene and oral hygiene aids. So, there is a scope for increasing awareness among the non-medical graduates 4. In our study, it was observed that school education played a very little role as a source of information regarding oral hygiene and oral hygiene products. So, it is clear that school education is an underutilized source. Therefore, to improve the knowledge of oral hygiene and oral hygiene products, it would be beneficial if oral health education is included in the curriculum at school education level, thereby preventing the occurrence of oral and dental diseases. Advertisement and mass media can be another major
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APPENDIX A QUESTIONARE FOR ASSESSING THE KNOWLEDGE OF ORAL HYGIENE AIDS

Instructions
Anonymity will be maintained. Please: Do not write your name Pick the correct answers to the best of your knowledge and circle the correct answers Answer all questions Avoid discussions. Consent: The questions that I have answered are to the best of my knowledge and I have answered them without any pressure from anyone.
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Signature and Initials

1. Your profile: Age: Sex: Qualification: 2. How do you clean your teeth? Toothbrush Yes/No Toothpaste Yes/No Tooth powder Yes/No Tongue cleaner Yes/No Mouth rinse Yes/No Floss Yes/No Toothpick Yes/No Tobacco products Yes/No Others(specify)

1. What are the oral hygiene aids available in your stores?

Oral hygiene aid Toothbrush Toothpaste Tooth powder Mouth rinse Tongue cleaner Toothpick Dental floss Tobacco based Available Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No

2. Do you give the customers any advice regarding oral hygiene products? Yes No Sometimes

SELF-EVALUATION OF HIS/HER OWN ORAL HEALTH AND KNOWLEDGE

1. 2. Grade your knowledge of oral hygiene. Very poor Poor Fair Good Excellent On what basis do you grade your oral hygiene? Comments by dentist Watching advertisement Comments by friends Use of disclosing agents Any other(specify)

REFERENCES
1. PeterS, MaheshCP. Plaque control. In: PeterS, editor. Essentials Of Preventive And Community Dentistry. 2nd edn. NewDelhi: Arya(Medi) Publishing House; 2003. p.447-67. 2. ChungRT. Survey on Shatin residents opinion on medical and health services. The Shatin district board of social sciences research centre. Hong Kong: University of Hong Kong; 1992. 3. PriyaS, Madan KumarPD, RamchandranS. Knowledge and attitudes of pharmacists regarding oral health care and oral hygiene products in Chennai city. Indian J Dent Res 2008;19:104-8. 4. LoeH. Oral hygiene in the prevention of caries and periodontal disease. Int Dent J 2000;50:129-39. 5. Wilson TG Jr. Atypical supportive periodontal treatment visit for patients with periodontal disease. Periodontol 20001996;12:24-8. 6. Census of India. Census data 2001; India at a glance. Rural urban distribution. Office of the Registrar Central and Census Commisioner, India. Available from: http://www.censusindia2001.com[Last retrieved on 2008Nov 26]. 7. DoshiD, BaldavaP, AnupN, SequieraPS. AComparative Evaluation of Self-Reported Oral hygiene practices among medical and engineering university students with access to Health-promotive Dental Care. JContemp Dent Pract 2007;1:68-75. 8. Al-OmiriMK, Al-WahadniAM, SaeedKN. Saeed oral health attitudes, knowledge, and behavior among School Children in North Jordan. JDen Edu 2006;70:179-87. 9. MagdaT. Attitude to and knowledge of oral Hygiene of secondary school students, social and health aspects of health education; School and Health School and Health journal, 2008;21:199-210. 10. ShardaAJ, ShettyS. Acomparative study of oral health knowledge, attitude and behaviour of non-medical, para-medical and medical students in Udaipur city, Rajasthan, India. Int J Dent Hyg 2008;6:347-53. 11. TutiNM, ShahidaMS, ZamirahZA. Dental knowledge and self-reported oral care practices among medical, pharmacy and nursing students Simposium Sains Kesihatan Kebangsaan ke 7 Hotel Legend, Kuala Lumpur, Malaysia; 2008. p.38-42. 12. India 2009: AReference Annual. 53rded. India 2009. p.225. 13. MenonSK, Shiva KumarAK. Women in India: How Free? How Equal?. UnitedNations. Archived from the original on 2006-09-11. Available from: http://www.web.archive.org/web/20060911183722/ http://www.un.org.in/wii.htm).[Last retrieved on 2006Dec 24]. 14. TerezhalmyGT, BartizekRD, BiesbrockAR. Relative plaque removal of three toothbrushes in a nine-period crossover study. JPeriodontol 2005;76:2230-5. 15. Sjgren K, LundbergA, BirkhedD, DudgeonDJ, JohnsonMR. Interproximal plaque mass and fluoride retention after brushing and flossing - a comparative study of powered toothbrushing, manual toothbrushing and flossing. Oral Health Prev Dent 2004;2:119-24. 16. JohnsonBD, McInnesC. Clinical evaluation of the efficacy and safety of a new sonic toothbrush. JPeriodontol 1994;65:692-7. 17. WadeWG, AddyM. Antibacterial activity of some triclosan containing

3. From where do you usually receive information about oral hygiene and oral hygiene products? Dentists School education Parents/relatives Friends Mass media Advertisements Others(specify)

QUESTIONNAIRE FOR AVAILABILITY OF ORAL HYGIENE AIDS

Instructions
Please: Do not write your store name and answer all questions Pick the correct answers to the best of your knowledge and circle the correct answers.
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[Downloadedfreefromhttp://www.urjd.orgonMonday,March10,2014,IP:59.91.128.229]||ClickheretodownloadfreeAndroidapplicationforthisjournal Kale, etal.: Knowledge of oral hygiene aids

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