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ORIGINAL ARTICLE
Year : 2018  |  Volume : 11  |  Issue : 2  |  Page : 146-151  

Oral hygiene practices of doctors in a tertiary hospital in North-West Nigeria


1 Department of Paediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria
2 Department of Paediatrics, Federal Medical Centre, Birnin Kebbi, Nigeria
3 Department of Paediatrics, University of Jos Teaching Hospital, Jos, Nigeria
4 Department of Nursing, Aminu Kano Teaching Hospital, Kano, Nigeria

Date of Web Publication18-May-2018

Correspondence Address:
Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJDRDYPU.MJDRDYPU_107_17

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  Abstract 


Introduction: Oral hygiene is an important aspect of personal hygiene. Doctors are expected to be in the forefront in promoting the general well-being of the populace. However, oral and dental health are areas that are often neglected by nondental doctors during patient consultation; therefore, for a doctor to give an effective advice, his/her knowledge and practice of good oral hygiene should be optimal according to the laid down guidelines. Materials and Methods: This was a cross-sectional study. Medical doctors in the hospital were consecutively recruited, and a pretested self-administered questionnaire was employed. The questionnaire contained information on their oral hygiene and their care for patient oral hygiene. Results: There were 36 (66.7%) males and 18 (33.3%) females, with a male-to-female ratio of 2:1. Toothpaste and toothbrush were the most common materials used for oral cleansing; majority of the respondents change their toothbrush within 2–3 months. Most respondents brushed their mouth/teeth twice (66.7%) in a day; however, other oral cleansing materials were documented in 66.7% of the respondents; their use were mostly after meals and majority (44.4%) used wooden toothpicks. Use of dental floss was reported in only 41.7% of the respondents; lack of information on the need for dental flossing was the main reason among respondents who did not floss. Conclusion: Toothpaste and toothbrush are the most common oral cleansing materials; the respondents in this study frequently changed their toothbrush and most respondents cleaned their mouth twice in a day and use of dental floss was less reported among the respondents.

Keywords: Doctors, knowledge of dental care, practice


How to cite this article:
Aliyu I, Lawal TO, Akhiwu H, Ibrahim ZF. Oral hygiene practices of doctors in a tertiary hospital in North-West Nigeria. Med J DY Patil Vidyapeeth 2018;11:146-51

How to cite this URL:
Aliyu I, Lawal TO, Akhiwu H, Ibrahim ZF. Oral hygiene practices of doctors in a tertiary hospital in North-West Nigeria. Med J DY Patil Vidyapeeth [serial online] 2018 [cited 2020 Aug 5];11:146-51. Available from: http://www.mjdrdypv.org/text.asp?2018/11/2/146/232632




  Introduction Top


Oral hygiene is an important aspect of personal hygiene. Doctors are expected to be in the forefront in promoting the general well-being of the populace. Oral and dental health care are areas that are often neglected by nondental doctors during patient consultation. Oral care is an integral part of general health care; furthermore, oral-related illnesses have been implicated as a precursor of systemic diseases such as infective endocarditis; therefore for a doctor to give an effective advice, his/her knowledge and practice of good oral hygiene should be optimal according to the laid down guidelines.[1],[2],[3],[4] March 20th of every year is set aside as the World Oral Health Day to further remind all stakeholders of the importance of a good oral hygiene.[5] Dentistry is a separate specialty, and medical doctors in other disciplines often have limited exposure to dental training, and hence there is a possibility of limited knowledge. Therefore, the tendency to overlook proper personal and patient dental care is entertained. Therefore, this study seeks to determine the perceptions and practice of oral hygiene by medical doctors in a tertiary health facility in a semiurban setting.


  Materials and Methods Top


Study location

Birnin Kebbi is the capital of Kebbi State located in North-West Nigeria. The inhabitants are mostly Hausas and Fulanis. The Federal Medical Centre was established in the year 2000 and it takes care of over 3 million people.[6]

Sample size

The minimum sample size was determined using the following formula:

N = Z2 P q/d2[7]

Where d = degree of accuracy desired, set at 0.05

p = the proportion in the target population estimated to have a particular characteristic; in this study, P = 72.2% (0.72) based on a previous report by Baseer et al.[8]

Z = standard normal deviation, set at 1.96 which corresponds to 95% confidence level.

q = 1.0 − p

N = (1.96)2 (0.722) (0.278)/(0.05)2

= 305.

For population <10,000, the sample size was nf = N/1 + N/n

Where n = total population of doctors at the time of this study, i.e., 60.

nf = 305/1 + (305/60)

The minimum sample size was 51; however, 54 respondents were recruited.

Study design

This was a cross-sectional study and convenience sampling method was adopted. Medical doctors in the hospital were consecutively recruited.

Survey tool

A pretested self-administered questionnaire was employed. The questionnaire was developed in English, which had 23 questions and contained both open- and close-ended questions. An internal consistency was determined having a Cronbach's alpha value of 0.8 and information such as age, sex, cadre, self-practice of oral hygiene, and patient oral hygiene care were obtained.

Inclusion criteria

Doctors working at Federal Medical Centre, Birnin Kebbi, at the time of the study were enrolled.

Exclusion criteria

Doctors who declined consent and medical officers who had clinical rotation in the dental unit were excluded from the study.

Ethical approval

Ethical approval was obtained from the Ethics Committee of Federal Medical Centre, Birnin Kebbi.

Data analysis

The obtained data were entered into the Statistical Package for the Social Sciences (SPSS) version 16 (SPSS Inc., Chicago, IL, USA). Categorical data such as use of toothbrush/toothpaste and toothpick were summarized and presented as frequency tables, while quantitative date such as age were presented as mean and standard deviation. Test of significance using the Chi-square (χ2) test was deplored with P < 0.05 being set as statistically significant.


  Results Top


There were 36 (66.7%) males and 18 (33.3%) females, with a male-–to-female ratio of 2:1.

Medical officers (57.4%) were the predominant group among the respondents, and the department of medicine was most represented among the respondents in the clinical department; however, the nonmajor clinical departments (29.6%) such as ophthalmology, ear, nose, and throat, and psychiatry as a group were the most predominant [Table 1].
Table 1: Staff cadre and their departments

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Toothpaste and toothbrush were the most common materials used for oral care; however, most respondents routinely checked the fluoride content of the toothpaste, but majority of the respondents changed their toothbrush within 2–3 months. Furthermore, among those who changed their toothbrush within 3 months, 83.4% were females while 41.7% were males [Table 2].
Table 2: Oral hygiene and dental practices among respondents

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Most respondents brushed their mouth/teeth twice (66.7%) in a day and again, 98.1% of the respondents did always brush their tongue; however, the use of other cleansing options was documented in 66.7% of the respondents; their use was mostly after meals and majority (44.4%) used wooden toothpicks. Use of dental floss was reported in only 41.7% of the respondents, and lack of information on the need for dental flossing was the main reason among respondents who did not floss. Nineteen (35.2%) respondents did not use mouthwash, while 35 (64.8%) used mouthwash; however, lack of awareness on the use of mouthwash and their belief of lack of effectiveness were the two major reasons among those who did not use mouthwash (36.8% each).

Twenty-four (44.4%) respondents washed their mouth after every meal, while 30 (55.6%) did not.

Furthermore, 41 (75.9%) of them were aware that dental problem is a risk factor for cardiovascular disease while 13 (24.1%) were not aware [Table 3].
Table 3: Toothbrushing and oral cleansing practices among respondents

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Oral examination of patients during consultation was routinely practiced by a majority of respondents. Similarly, patient education on good oral hygiene was routinely practiced; furthermore, dental referrals of patients were routinely practiced among respondents. Two respondents (40%) believed that it was not necessary because they could handle it, while three (60%) reported absence of dental services as the main reason for nonreferral. Thirty-five respondents (64.8%) use mouthwash, while 19 (35.2%) do not use mouthwash [Table 4].
Table 4: Patient oral care, education, and referral practices

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Half of the house officers used dental floss and majority of the medical officers used dental floss. While the only consultant represented used dental floss, this observation was not statistically significant (Fisher's exact test = 3.373, P = 0.513). Twenty-eight (51.9%) respondents brushed their teeth for <4 min, while 26 (48.1%) reported brushing for 4 or more minutes; apart from the senior medical officers, majority of the subgroups brushed their teeth for >4 min. However, this observation was not statistically significant (Fisher's exact test = 7.534, P = 0.073) [Table 5].
Table 5: Comparing staff status and oral hygiene practices of respondents

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An equal proportion of respondents who used other oral cleansing materials brushed for more than and less 4 minutes; however among those who did not, majority brushed for <4 min, but this observation was not statistically significant (χ2 = 0.148, df = 1, P = 0.777) [Table 6].
Table 6: Comparing brushing time with the use of other oral cleaning options

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  Discussion Top


Oral hygiene is an integral and very important part of personal hygiene, and its impact affects our overall well-being and self-esteem. An observation from this study showed that toothbrush and toothpaste were the most common materials used for oral cleansing. This may be considered a favorable oral hygiene practice which was comparable to that reported by Baseer et al.[8] and Bhoopathi et al.[9] However, the observation that 88.9% of respondents used toothbrush and toothpaste was lower than the 100% documented by Kaur et al.[10] Furthermore, 6% of the respondents in our study used a combination of toothpaste/toothbrush and “chewing” (tooth) stick; use of chewing stick among health professionals was also reported by Younus and Qureshi [11] and Baseer et al.[8] In their study in Saudi Arabia, they stated that 1.2% of their respondents used “miswak/siwak;” however, they attributed this to their religious beliefs. Being a Muslim country, Prophet Mohammed had advised his followers to clean their teeth with the “siwak” as a modality of expressing cleanliness, worship, and praise to God.[12] This may also explain our observation in this study because the northern region of Nigeria is a predominantly Muslim setting.

Majority of the respondents (51.9%) in our study reported to have routinely checked for the fluoride content on the toothpaste pack; this practice reflects an impressive dental behavior and consciousness. However, our observation differed from that of Baseer et al.[8] who reported only 1.2% of their respondents being conscious of the need to check for fluoride application during dental visits. Their observation was similar to that of Usman et al.[13] and Kumari et al.[14]

Many professional bodies, including the American Dental Association, recommend change of toothbrush every 3–4 months or even earlier if the brush head appears fray;[15] however, this is a practice that is not routinely observed despite the cheapness of a toothbrush, probably this is as a result of lack of this information. Our study observed that 55.6% of the respondents changed their toothbrushes within 1–3 months. This result was lower than the 65% reported by Younus and Qureshiamong Karachi residents.[11] Furthermore, more females routinely changed their toothbrush than males in our study; this observation was similar to that reported by Younus and Qureshi [11] and Oberoi et al.[16] Females are more likely to be self-conscious of their look; therefore clean and white teeth add to their beauty.

Oral cleansing twice per day improves oral hygiene and significantly reduces the risk of dental plaque formation.[11] Our study showed that 85.2% of the respondents brush more than once in a day; this finding was higher than the 20% reported by Baseer et al.[8] and 50% reported by Kaur et al.[10] but lower than the 100% reported by Pradhan et al.[17] This disparity may be related to differences in training and practice among the respondents.

Majority of the respondents in our study use other oral cleansing materials and mouthwash. This observation was higher than that reported by Baseer et al.[8] and Kaur et al.;[10] however, it was lower than that reported by Madan et al.[18] Lack of awareness of the need, cost, and availability were the common reasons reported for not using them; therefore, this further highlights the need for improving our dental practices. The use of wooden toothpick which was almost of equal proportion with dental filament was observed in our study; dental filaments have a higher tendency of plaque removal, especially on the difficult-to-reach areas such as the lingual axial surfaces.[19] Furthermore, wooden toothpicks can easily traumatize the gum resulting in gum bleeds; therefore, its use should be discouraged.

Most of the respondents would visit or at least refer their patients to a dentist when the need arises. This is a favorable dental behavior which was also documented by Baseer et al.;[8] however, this observation differed from that reported by Oyetola et al.[20] who reported that 61% of their respondents did not have the need for dental visit. Their general perception was that they need a dentist only when there was a significant complaint. However, preventive dentistry is a field that should not be overlooked; dental problems have been associated with systemic disorders such as cardiac diseases, and 75.9% of respondents in our study were aware of this information which was higher than that reported by Oyetola et al.[20]

The routine use of dental floss, regular toothbrushing, and adequate time spent on toothbrushing for at least 4 min are generally recommended;[21],[22] however, most of the respondents brush for <4 min, which was mostly observed among doctors at the medical officers' cadre; and why this was so is poorly understood. Our findings were lower than that reported by Kaur et al.,[10] in which more than 50% of the respondents brushed for >4 min. Again, we noted that the use of dental floss had no relationship with the duration of brushing. Therefore, we advocate proper education of nondental doctors on the basic practices; this may be included in our medical curriculum considering the importance of oral health. Nondental doctors constitute the greater population of medical doctors, and patients usually consult them on all their health-related problems; therefore, a poor oral health practice by the respondents will extend to how they manage the oral care of patients.


  Conclusion Top


The use of toothbrush and toothpaste was universal in this study, but there is still a need for improvement on oral hygiene practices of the respondents such as the use of mouthwash and dental floss; furthermore, the frequency of dental flossing and duration of toothbrushing were reportedly low in this study. Therefore, a poor personal oral hygiene practice may influence poor patient oral health care.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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