DENTAL CARIES KNOWLEDGE AND DENTAL HYGIENE PRACTICES OF 12-13
YEARS OLD URBAN AND RURAL MYANMAR SCHOOL CHILDREN
Aung Zaw Zaw Phyo1,*, Natkamol Chansatitporn2,#, Kulaya Narksawat2,#
1
Master of Public Health - International Program - 2012, Faculty of Public Health, Mahidol
University, Bangkok, Thailand.
2
Faculty of Public Health, Mahidol University, Bangkok, Thailand.
*e-mail: azzpster@gmail.com, dr.aungzawzawphyo@gmail.com
#e-mail: nutkamol.cha@mahidol.ac.th, kunlaya.nar@mahidol.ac.th
Abstract. Dental caries continues to be a major public health problem despite credible scientific
advances and the facts that caries is preventable. Poor oral health condition can have negative
impact on children’s academic and social performance. This cross-sectional study aimed to
access the dental caries knowledge and dental hygiene practices of 12-13 years old urban and
rural Myanmar school children. A total of 220, 12- to 13-year-old schoolchildren (110 urban
children and 110 rural children) were examined by one calibrated dentist using the DMFT; WHO
criteria and self-administered structured questionnaires. The prevalence rates of dental caries on
urban and rural students were 60 % and 46.36 % respectively. Just over 10 % of urban and rural
school children recognized good level of knowledge in dental caries. 96.4% and 82.7% of the
each urban and rural respondent brushed their teeth two or more times per day but only 31.8%
and 17.3% of urban and rural students received fissure sealant treatment. While 72.7% of urban
school children had been received oral health education every three months, the percentage of
rural students was only 10.9%. Students who had been visited to dental clinic for dental checkup
during last year were 40% for urban school and 19.1% for rural school. Most of the urban and
rural students were at fair level of knowledge on dental caries (75.5% and 72.7% respectively)
and dental hygiene practices (70.9% and 61.8% respectively). There is a difference in the
prevalence of dental caries between rural and urban Myanmar school children. The findings of
this study highlight an essential need to emphasize on preventative and community dentistry
strategies to meet the primary needs of school children and increase awareness of dental caries.
Keywords: dental caries knowledge, dental hygiene practices, urban and rural Myanmar school
children.
Introduction
Dental caries is defined as localized, post-eruptive, pathological process of external
origin involving softening of hard tooth tissue and proceeding to the formation of a cavity.(1)
Many industrialized countries and western countries have experienced a decline in dental caries
prevalence among children.(2,3) This trend of caries reduction may be ascribed to several factors
of which the most important are improved dental hygiene practices, a more sensible approach to
sugar consumption, effectively utilization of fluorides and the presence of school based dental
caries prevention and oral health promotion program.(2,4)
Dental hygiene practices are the practices of keeping the mouth, teeth, and gums clean
and healthy to prevent dental problems most commonly, dental cavities, gingivitis, and bad
breath by removing plaque and bacteria. (5) Maintaining oral hygiene has ramification for the
entire body. (5) Knowledge of effective preventive measures is one of the essential prerequisites
for the practice of these measures. Information on effective preventive measures on dental caries
has been available in the dental literature for many years. (6)
A minority of children (less than 20 percent) (7), usually from more deprived background,
still experience dental caries, despite a significant decline in caries rate for majority of children.
(8,9)
Despite great achievement in dental health of population globally and credible scientific
advances that caries is preventable, problems still remain in many communities including
Myanmar – particularly dental caries which have historically been considered as the major public
health problem and the most important global oral health burdens.(10) Like other developing
countries, the prevalence of dental caries among school children in urban area is higher than that
in rural area of Myanmar.(11) The 12-13 years aged group has been chosen in this study because
all permanent teeth except third molars will have erupted and that age group is also recognized as
the global monitoring age for caries for international comparisons and monitoring of disease
trends.(12) Poor oral health condition can have negative impact on children’s academic and social
performance.(13) Therefore, the specific aim of this study was to access the level of dental caries
knowledge and dental hygiene practices of 12-13 years old urban and rural Myanmar school
children.
Methodology
Participants
School children who were studying in a high school of Yangon City and a rural school in
remote area of Yangon Region of Myanmar were study participants of this study. Inclusion
criteria were 12-13 years old school children with general good health who were willing to
participate in this study and had permission from their parents to participate in this study under
inform consent, children with severe medical diseases and those who did not attend to school on
the day of survey were excluded. Three classes from Grade 8 and Grade 7 were randomly
selected from each school. The total numbers of 220 of each urban and rural school were
selected.
Data collection
Before data collection, ethical approval was obtained by the Ethical Review Committee
for Human Research, Faculty of Public Health, Mahidol University, Thailand. Approval from
concerned headmasters and written informed consent forms signed by parents were obtained
prior to data collection. The self-administrated questionnaire was trialed with a sample group of
30 for reliability. The resulted Cronbach’s alpha coefficients were 0.723 and 0.725 respectively.
The self-administered questionnaire was distributed in classrooms to assess knowledge on dental
caries and dental hygiene practices. After answering the questionnaires, dental caries
examination by one calibrated researcher and trained recorder was performed in the classroom
under natural light. Method of dental caries examination was based on World Health
Organization, Oral Health Surveys basic methods concerning DMFT index (12). Prevalence of
dental caries from those who had at least one DMFT, and prevalence of caries-free status from
those who had DMFT equal to zero were calculated(12). Calibration of the examiner was
conducted according to WHO calibration of examiners for oral health epidemiological surveys(14)
before the data collection.
Statistical Analysis
The data were analyzed using Statistical Package for Social Science (SPSS) version 18.0.
Descriptive statistics were done in number and percentage for scores regarding knowledge on
dental caries and dental hygiene practices. The associations between dental hygiene practices,
knowledge and dental caries status were examined by using chi-square test.
Results
The total number of 110 students aged 12 – 13 years from each urban and rural school
was included in this study. The prevalence rate of dental caries among urban school children was
higher than that from rural school (60% and 46.36% respectively) (Table 1). Most of the student
from both urban and rural school had fair level of knowledge in dental caries (83% and 80%
respectively). Around 10% of both urban and rural school children recognized good level of
dental caries knowledge. Turning to dental hygiene practices, 31.8% of rural student had poor
level in dental hygiene practices but only 7.3% of urban school children were at poor level of
practices (Table 2).
In addition, 96.4% and 82.7% of the each urban and rural respondent brushed their teeth
two or more times per day but only 31.8% and 17.3% of urban and rural students received fissure
sealant treatment. Tooth brushing with fluoride toothpaste was reported for 98.2% and 95.5% of
the urban and rural children; only 41.8% and 45.5% of urban and rural school children aged 1213 years had experiences in using dental floss to clean their teeth after tooth brushing. While
72.7% of urban school children had been received oral health education every three months, the
percentage of rural students was only 10.9%. Students who had been visited to dental clinic for
dental checkup during last year were 40% for urban school and 19.1% for rural school (Table 3).
Among school children from both urban and rural schools, there were no significant associations
of dental caries by knowledge in dental caries and dental hygiene practices (p-value > 0.0.5)
(Table 4).
Discussion and Conclusion
The prevalence rate of dental caries (60%) among urban school children was higher than
that (46.36%) of rural school children. This survey result is comparable of dental caries status
among 12 years old children in urban and rural area of Burkina Faso, Africa.(15) In contrast, this
result was different from the study conducted in Nepal, which showed that the caries prevalence
was high in the rural compared with urban area(16). The differences of the result of these two
studies can be caused by the following factors.
a. The oral health survey of Yee and Donald was conducted in Nepal; however, this study
was carried out in urban and rural area of Yangon Region, Myanmar.
b. The oral health survey of Yee and Donald was conducted in 2002 and this study was
carried 11 years later.
c. The last one needed to be considered is that the difference in life style and socioeconomic situation and country nature between Myanmar and Nepal.
Around 10% of both urban and rural school children recognized good level of dental
caries knowledge. This result revealed that the weak knowledge on dental caries was reflected to
inadequate dental health education program in the school education curriculum of Myanmar.
Moreover, above 80% of urban and rural students brushed their teeth two or more times per day
and practiced rinsing the mouth after meal when brushing is inconvenience brush. This result
was different from the national representative oral health study conducted in China in which only
44.4% of the respondents brushed their teeth at least twice a day.(17) In this study, tooth brushing
with fluoride toothpaste was reported for 98.2% and 95.5% of the urban and rural children. This
result was reverse from one study conducted in China in which only 17% used fluoridated
toothpaste. (17)
Students who had been visited to dental clinic for dental checkup during last year were
40% for urban school and 19.1% for rural school. This habits regarding dental checkup was
consistent with the study of oral health behavior of schoolchildren and parents in Jordan. (18)
Only 10.9% of rural student has been received oral health education every three months. This
study result was not very similar with the survey assessment of China in which nearly half of the
participants (47.2%) had never received any oral health care instructions(17). According to the
result of these two studies, oral health education program for school children should be
incorporated into social and personal health educational program of school curriculum.
In both urban and rural study area, only 31.8% and 17.3% of urban and rural students
received fissure sealant treatment. Furthermore, only 41.8% and 45.5% of urban and rural school
children aged 12-13 years had experiences in using dental floss to clean their teeth after tooth
brushing. Therefore, school based dental public health program should be considered and
encourage more dentists to do dental caries assessment and give fissure sealant treatment. There
were no significant associations between dental caries by knowledge in dental caries and dental
hygiene practices among both urban and rural school children.
In conclusion, the prevalence rate of dental caries on urban and rural students were 60 %
and 46.36 % respectively. Around 10 % of urban and rural school children recognized good level
of knowledge in dental caries. Only 10.9% of rural student has been received oral health
education every three months and 19.1% of rural school children had been visited to dental clinic
for checkup. There were no significant association of dental caries status by dental caries
knowledge and dental hygiene practices. There is a difference in the prevalence of dental caries
between rural and urban Myanmar school children. The findings of this study highlight an
essential need to emphasize on preventative and community dentistry strategies to meet the
primary needs of school children and increase awareness of dental caries. Recommended
strategies include the establishment of dental health information incorporated into general health
promotion interventions and social health education program of school curriculum, the
introduction with fissure sealant program, water fluoridation, dental caries screening and referral
system for school children, and the establishment of school based dental health program and
encourage more dentists to participate in school oral health activities.
Table 1. Prevalence rate of Dental Caries by the geographical area of school
Variable
Total
Caries Free
At least one DMFT
Prevalence rate (%)
Number
Number
Percent
Number
Percent
Urban
110
44
40
66
60
60
Rural
110
59
53.6
51
46.4
46.36
Table 2. Number and Percent of level of Knowledge on dental caries and Dental Hygiene Practices by the
geographical area of school (n (Urban) = 110, n (Rural) = 110)
Variables
Urban
Number (Percent)
Rural
Number (Percent)
14 (12.7)
83 (75.5)
13 (11.8)
19 (17.3)
80 (72.7)
11 (10.0)
8 (7.3)
78 (70.9)
24 (21.8)
35 (31.8)
68 (61.8)
7 (6.4)
Level of Knowledge on dental caries
Poor (score 0 – 5)
Fair (score 6 – 8)
Good (score 9 – 10)
Level of Dental Hygiene Practices
Poor (scores 0 – 8)
Fair (scores 9 – 12)
Good (scores 13 – 15)
Table 3. Number and Percent of correct answers in dental hygiene practices by the geographical area of school
(n (Urban) = 110, n (Rural) = 110)
Contents
Urban
Number (%)
106 (96.4)
Rural
Number (%)
91 (82.7)
1.
Brushing teeth two or more times per day.
2.
Brushing teeth in the morning and before
going to bed.
Using dental floss to clean your teeth after
tooth brushing.
Having snack between meals more than 3
times per day.
Brushing teeth after eating sweet and
sticky food.
Received fissure sealant treatment to
prevent dental caries
Using tooth paste with fluoride
105 (95.5)
90 (81.8)
46 (41.8)
50 (45.5)
66 (60.0)
67 (60.9)
55 (50.0)
55 (50.0)
35 (31.8)
19 (17.3)
108 (98.2)
105 (95.5)
Using toothpick if food gets stuck between
the teeth.
Rinsing the mouth after meal when
brushing is inconvenience.
Changing toothbrush when the bristles of
toothbrush were worn out.
Spending at least 2 minutes for brushing
every day.
Brushing your teeth vertically from gums
toward tooth surfaces, and horizontally on
grinding surfaces.
Have been received oral health education
every 3 months.
Have been visited to dental clinic for dental
checkup during last year.
Going to see dentist for treatment when
you got toothache.
85 (77.3)
87 (79.1)
99 (90.0)
91 (82.7)
103 (93.6)
104 (94.5)
88 (80.0)
87 (79.1)
101 (91.8)
90 (81.8)
80 (72.7)
12 (10.9)
44 (40.0)
21 (19.1)
91 (82.7)
63 (57.3)
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Table 4. Association of dental caries by knowledge on dental caries and dental hygiene practices according to the
geographical area of school (n (Urban) = 110, n (Rural) = 110)
Geographical
area of the
school
Urban
Rural
Variable
Knowledge on Dental Caries
Poor
Fair
Good
Dental Hygiene Practices
Poor & Fair
Good
Knowledge on Dental Caries
Poor
Fair
Good
Dental Hygiene Practices
Poor
Fair & Good
Caries Free
2
p-value
Number (%)
At Least One
DMFT
Number (%)
2 (4.5)
35 (79.5)
7 (15.9)
12 (18.2)
48 (72.7)
6 (9.1)
5.06
0.08
32 (72.7)
12 (27.3)
54 (81.8)
12 (18.2)
1.28
0.26
14(23.7)
41 (69.5)
4 (6.8)
5 (9.8)
39 (76.5)
7 (13.7)
4.57
0.10
15 (25.4)
44 (74.6)
20 (39.2)
31 (60.8)
2.40
0.12
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Acknowledgements
We would like to express our sincere gratitude to the school children for their participation and
also convey our indebt thanks to Dean, all participants and staff of Faculty of Public Health,
Mahidol University, Bangkok, Thailand for their valuable help.