All the 320 respondents completed the questionnaire successfully. Among the participants, 207(64.7%) were females and113 (35.3%) were males. The student’s age ranged from 18 to 22 years where 283 (88.4) were in the 18-20 age group and 37(11.6) were in the 21-22 years age group.
Knowledge of students toward oral hygiene
Most of the student know that sweet (168 (52.5%)) and fizzy drinks (231 (72.2%)) affect oral health. However, only 58(18.1%) students know that regular dentist visit is necessary and 32(10%) know that they should replace tooth brush every 3-4 mounts. Majority of the participants (288(90%)) replied that they replace their tooth brush when it is destroyed. Only 43(13.4%) reported that tooth care is as important as care of any part of the body.
Only 59(18.4%) students knew that fluoride strengthens teeth or prevent dental decay while 229(71.6%) do not agree that fluoride strengthen teeth. Nonetheless, 32(10%) students do never know anything about fluoride. Most of the students (263(82.2%)) agreed that Carious/decayed tooth affects teeth appearance whereas 42(13.1%) did not agree with this idea. The major reason for brushing teeth was to remove dental decay as responded by130 (40.6%) students (Table 1).
Table 1: Knowledge of secondary school students towards oral hygiene in Medhanealem High School, Addis Ababa, Sept 2019 (n=320)
Oral hygiene Knowledge questions
|
Frequency
|
%
|
Eating too much sweets lead to:
Affect the tooth health
Affect the gum health
Cause bad mouth odor
All of the above
Not affect oral health
I don’t know
|
168
3
14
111
12
12
|
52.5%
0.94%
4.4%
34.7%
3.8%
3.8%
|
Do fizzy drinks affect the dental health?
Yes
No
Don’t know
|
231
63
26
|
72.2%
19.7%
8.1%
|
Are regular visits to dentist necessary?
Yes
No
Don’t know
|
58
168
94
|
18.1%
52.5%
29.4%
|
When you must replace your toothbrush?
When it is destroyed
After 3-4 months of use
|
288
32
|
90%
10%
|
Do the dental diseases impact the general body health?
Yes
No
Don’t know
|
69
219
32
|
21.6%
68.4%
10%
|
Care about teeth is important as any part of body?
Yes
No
Don’t know
|
43
170
107
|
13.4%
53.1%
33.4%
|
How often you must visit the dentist?
Every 6 months
Occasionally
During dental pain
Never visited
|
9
9
39
263
|
2.8%
2.8%
12.2%
82.2%
|
Fluoride strengthens the teeth
Yes
No
Don’t know
|
59
229
32
|
18.4%
71.6%
10%
|
Carious/decayed tooth affect teeth appearance
Yes
No
Don’t know
|
263
42
15
|
82.2%
13.1%
4.7%
|
Brushing the teeth prevent dental decay
Yes
No
Don’t know
|
130
73
117
|
40.6%
22.8%
36.6%
|
Overall knowledge level of the students towards oral hygiene was low in this study. Majority (201(63%)) had low knowledge and 119(37%) had higher knowledge as shown in (Figure 1).
Figure 1: Level of knowledge among secondary school students towards oral hygiene in Medhanealem High School, Addis Ababa, Sept 2019 (n=320)
Attitude of students toward oral hygiene
Majority of the students (220 (68.7%)) answered that oral hygiene is not important for good oral health and well-being, while only 100(31.3%) students believe that it’s important. About 130(40.6%) students reported that neither the parents nor the teachers showed concern about oral hygiene. A three fourth (75%) of the students thought that visiting a dentist is important and they would advise other students to perform at home oral hygiene practices. When given a chance, about a two third (70.6%) of the students would go for a checkup. As shown in table 4, about 263(82.2%) students have never visited a dentist in the past. Among those who have a history of dental visit, 9 (2.8%) had regular dental visit, 39(12.2%) visited a dentist only when in pain, and 9(2.8%) visited a dentist occasionally.
The reasons given for absence of regular dental visit were high cost (87(27.2%)), no nearby dental clinic (15(4.7%)), lack of time (100(31.3%)). Meanwhile, about one third (31.9%) of the students do not think it is important to visit a dental clinic (Table2).
Table 2: Attitude of secondary school students towards oral hygiene in Medhanealem High School, Addis Ababa, Sept 2019 (n=320)
Oral hygiene attitude questions
|
Frequency
|
Percent
|
|
|
Do you think is your oral hygiene important to your oral health and general well-being?
Yes
No
|
100
220
|
31.3%
68.7%
|
|
At home/ school are your parents or teachers concerned about your oral hygiene
Yes
No
|
190
130
|
59.4%
40.6%
|
|
Do you think it is important for parents and teachers to be concerned with oral hygiene
Yes
No
|
240
80
|
75%
25%
|
|
Have you visited a dentist before?
Yes
No
|
57
263
|
17.8%
82.2%
|
|
If yes, then for what reason?
Decay
Pain
Filling
Extraction
Any other specify
|
5
39
3
10
-
|
8.8%
68.4%
5.3%
17.5%
-
|
|
Do you think it is important to visit a dentist for check-up
Yes
No
Don’t know
|
92
26
202
|
28.7%
8.1%
63.1%
|
|
How often do you visit the dentist?
Regularly (every 6 month)
Occasionally
Only with dental pain
Never visited a dentist
|
9
9
39
263
|
2.8%
2.8%
12.2%
82.2%
|
|
What Do you think reason behind not visiting the dentist
High cost treatment
No clinic near by
No time
Do not think it is important
No specific reason
|
87
15
100
102
16
|
27.2%
4.7%
31.3%
31.9%
5%
|
|
Given the chance to visit a dentist now for check-up, would you go
Yes
No
|
226
94
|
70.6%
29.4%
|
|
Would you advice other students to go for the checkup
Yes
No
|
238
82
|
74.4%
25.6%
|
|
|
|
|
|
|
|
The overall attitude evaluation showed that about half (52 %) of the participants had a negative attitude and 153(48%) participants had positive attitude of oral hygiene (Figure 2).
Figure 2: Types of attitude of secondary school students towards oral hygiene in Medhanealem High School, Addis Ababa, Sept 2019 (n=320)
Practice of students toward oral hygiene
Most (263(82.2%)) students clean their teeth. More than half (155(58.9%)) of the students brush their teeth with horizontal strokes while 69(26.2%) brush with vertical strokes. Few of the students (2.7%) use circular strokes to brush their teeth. Among students who do not brush their teeth, half (51%) reported that they did not think it was necessary.
The chewed stick (Amharic; Mefakiya) is the most common oral hygiene aid used for cleaning teeth, adopted by 134(51%) while 65(24.7%) of the students brushed their teeth with a tooth brush with tooth paste. However the use of dental floss was still not popular among the secondary school students as presented in this study. About a third (30.8%) of the students brushed their teeth at least twice per day or more compared to 119(45.2%) of the students who brushed at least once a day. Around 159(60.5%) of the students reported that they spent 2 minutes or more brushing their teeth. Only 32(12.2%) of the respondents changed their toothbrushes with in 3-4 months of use. A few number of students (2.7%) reported that the time of tooth brushing was before going to bed. In addition 24(7.5%) students did clean their tongue.
Among the reported sources of student’s information about oral health practice, parents were the most popular (120(45.6%)) followed by friends (93(35.4%)). However, the role of parents in the supervision of their children’s oral hygiene was poor accounted only by 35 (13.3%). About 107 (40.7%) parents advised but did not watch their children as they brushed their teeth, while the rest 121 (46%) indicated that they did not care to supervise their children’s oral hygiene practice. On the other hand, 37(14.1%) students did not agree to stop cleaning if their gum bleeds when cleaning their teeth (Table 3).
Table 3: Practice of secondary school students towards oral hygiene in Medhanealem High School, Addis Ababa, Sept 2019 (n=320)
Oral hygiene practice questions
|
Frequency
|
Percent
|
Do you brush (clean) your teeth? (n=320)
Yes
No
|
263
57
|
82.2
17.8
|
In question 1, if you answer “I don’t brush”, what is reason for not brushing? (n=57)
Doesn’t think it’s necessary
Could not afford
Other
|
7
29
21
|
12.3
51
36.8
|
In question 1, if you answer “I do brush”, how do you brush your teeth? (n=263)
Use horizontal strokes
Use vertical strokes
Both in horizontal and vertical directions
Circular strokes
|
155
69
32
7
|
58.9
26.2
12.2
2.7
|
Do you clean your tongue? (n=320)
Yes
No
|
24
296
|
7.5
92.5
|
How often do you brush your teeth (frequency)? (n=263)
Once per day
Twice a day
Same times
|
119
81
63
|
45.2
30.8
24
|
What tools do you use to clean your teeth?(n=263)
Toothbrush and paste
Chewed stick (Mefakiya)
Both tooth brush and chewed stick
Dental floss
Toothpick
|
65
134
55
-
9
|
24.7
51
21
-
3.4
|
Who advise you to use the tool mentioned in question the above? (n=263)
Parent/guardian
Teacher
A friend
A dentist
Other(specify)_
|
120
3
93
29
18
|
45.6
1.1
35.4
11
6.8
|
Role of family in supervising oral hygiene practice (n=263)
Parents watch and advise
Parents advise but do not watch
Parents never care watch
|
35
107
121
|
13.3
40.7
46
|
When do you brush your teeth? (n=263)
Morning
Noon(after lunch)
Before going bed
Before going to bed and Morning
|
162
65
7
29
|
61.6
24.7
2.7
11
|
How long do you brush your teeth? (n=263)
Less than one minute
One minute
Two-five minute
|
14
90
159
|
5.3
34.2
60.5
|
You should change your toothbrush (n=263)
After 3-4 months
After one year
When the bristles start to bend
When the bristles are getting discolored
|
32
29
105
97
|
12.2
11
39.9
36.9
|
If your gums bleed you should stop cleaning the teeth (n=263)
Disagree
Agree
Do not know
|
37
106
120
|
14.1
40.3
45.6
|
* More than one response
|
This study showed that the overall oral hygiene practice among the high school students was inadequate (193 (60%)) (Figure 3).
Figure 3: Practice level of secondary school students towards oral hygiene in Medhanealem High School, Addis Ababa, Sept 2019 (n=320)