10.59987/ads/2017.3.110-115
Aim. To evaluate knowledge and attitude of caregivers/ healthcare workers regarding oral health of special need patients, at a comprehensive rehabilitation centre.
Material and methods. A validated self-administered structured questionnaire was used in an interview style among 120 caregivers at a comprehensive rehabilitation centre. The first part of questionnaire collected demographic information (age, gender, experience, literacy). The other part of the questionnaire was related to the knowledge and attitude of caregivers regarding importance of oral health including oral hygiene practices, cause of tooth decay, significance of fluoride, common oral problems and need for oral health education. Comparison between oral health knowledge and oral health attitude of caregivers was done using one-sample t Test. The level of significance was set as p=0.005*.
Results. Adequate oral health knowledge was found to be among 59.2% and favourable attitude of caregivers towards oral health care was found among 48.3%. The results indicate that though majority among caregivers had adequate knowledge but their attitude towards oral health was inadequate.
Conclusion. Caregivers showed a deficiency in the proper oral health attitude. To improve oral health attitudes of caregivers, dental education plus training programs should be given high priority.
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Annali di stomatologia
special needs
Oral health knowledge and attitude among caregivers of special needs patients at a Comprehensive Rehabilitation Centre: an analytical study
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Original Article
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2022-08-10
2017-09-01
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110-115
Ann Stomatol (Roma)
R. Nagarajappa 
2017
10.59987/ads/2017.3.110-115
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special needs
en
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Oral health knowledge and attitude among caregivers of special needs patients at a Comprehensive Rehabilitation Centre: an analytical study
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                                                                                                     Original article


    Oral health knowledge and attitude among
    caregivers of special needs patients at a
    Comprehensive Rehabilitation Centre:




                                                                                                  li
    an analytical study




                                                                                                na
    Altaf H. Shah1 BDS, MSc, PG Cert                           (age, gender, experience, literacy). The other part
    (Sp Care Dent), PhD                                        of the questionnaire was related to the knowledge
    Mustafa Naseem2 BDS, MDPH                                  and attitude of caregivers regarding importance




                                                                                              io
    Mohammad Shoyab Khan3 BDS, MDS                             of oral health including oral hygiene practices,
    Faris Yahya I Asiri4 BDS                                   cause of tooth decay, significance of fluoride,
    Ibrahim AlQarni5 BDS                                       common oral problems and need for oral health




                                                                         az
    Shabnam Gulzar6 BDS, MDS                                   education. Comparison between oral health
    Ramesh Nagarajappa7 BDS, MDS                               knowledge and oral health attitude of caregivers
                                                               was done using one-sample t Test. The level of

      Faculty, College of Dentistry, Dar Al Uloom
                                                               significance was set as p=0.005*.
    1




                                                                       rn
    University, Riyadh, Saudi Arabia; Fellow Pacific
                                                               Results. Adequate oral health knowledge was

    Academy of Higher Education and Research
                                                               found to be among 59.2% and favourable attitude

    University, Rajasthan, India
                                                               of caregivers towards oral health care was found

    2 Assistant Professor, Department of Preventive
                                                               among 48.3%. The results indicate that though




                                                         te
                                                               majority among caregivers had adequate knowl-
    Dental Sciences, Dar Al Uloom University, Riyadh,          edge but their attitude towards oral health was in-
    Saudi Arabia                                               adequate.
    3 Lecturer, Division of Periodontics, Department of
                                                       In      Conclusion. Caregivers showed a deficiency in the
    Preventive Dental Sciences, Prince Sattam bin              proper oral health attitude. To improve oral health
    Abdulaziz University AlKharj, Saudi Arabia                 attitudes of caregivers, dental education plus train-
    4 Demonstrator, Department of Preventive Dental            ing programs should be given high priority.
    Sciences, College of Dentistry, King Faisal University,
    Al-Ahsa, Saudi Arabia
                             ni
                                                               Key words: caregivers, knowledge, oral health,
    5 Dentist, Ministry of Health, Alula, AlMadina             special needs.
    Almunawara, Saudi Arabia
    6 Lecturer, Division of Paediatric Dentistry, Department
                           io


    of Preventive dental Sciences, Dar Al Uloom University
    7 Professor and Head, Department of Public Health          Introduction
    Dentistry, Institute of Dental Sciences, Siksha ‘O’
                                                               Oral health in special need patients is one of the
                         iz



    Anusandhan University, Kalinganagar, Bhubaneswar,
                                                               most deserted aspects of care. The degree of unmet
    Odisha, India
                                                               dental needs amongst this populace is highly com-
                                                               promised when compared to the general population
           Ed




                                                               (1). Maintaining good and optimal oral health in these
                                                               physically handicapped and intellectually disabled in-
    Mustafa Naseem
    Corresponding author:
                                                               dividuals is very challenging as they also have a com-
    Department of Preventive Dental Sciences, College          promised general health (1, 2). It is known that good
    of Dentistry, Dar Al Uloom University                      oral health can help in improving general health, self-
    Riyadh, Saudi Arabia                                       esteem, social integration and thereby the quality of
 IC




    E-mail: m.naseem@dau.edu.sa                                life (3, 4). Age, severity of impairment and living con-
                                                               ditions have been reported to influence oral as well
                                                               as general health of disabled children and adults (5).
                                                               Prevention of oral diseases in special needs group
C




    Summary
                                                               has higher importance due to limited availability of re-
                                                               sources and poor access to oral health care (6). It
                                                               has been demonstrated that oral health education is
    Aim. To evaluate knowledge and attitude of care-

                                                               well recognised and shows improvement of attitudes
    givers/healthcare workers regarding oral health of
©




                                                               and knowledge towards dental health care especially
    special need patients, at a comprehensive reha-

                                                               among caregivers of special needs patients (7).
    bilitation centre.

                                                               These improvements are found to be significant when
    Material and methods. A validated self-adminis-

                                                               in parallel with better delivery of oral health care for
    tered structured questionnaire was used in an in-

                                                               such people (8).
    terview style among 120 caregivers at a compre-

                                                               It has been proposed that educating people involved
    hensive rehabilitation centre. The first part of
    questionnaire collected demographic information

    110                                                                         Annali di Stomatologia 2017;VIII(3):110-116
    Oral health knowledge and attitude among caregivers of special needs patients at a Comprehensive Rehabilitation Centre:
    an analytical study

    in care of special need patients is beneficial particu-       signed in English, Arabic, Hindi and Bangla lan-
    larly with regard to oral health (1, 9). Disabled chil-       guages using support from native speakers in order
    dren and adults living in long-term accommodations            to improve the comprehensibility for the caregivers.
    are usually dependent on others for their personal            The interview style questionnaire for this study was
    care. Parents, siblings or caregivers usually render          piloted using surveys previously conducted by Prab-
    this care. Hence, it is important that these caregivers       hu et al. (16) and Koneru A & Sigal MJ (17). The
    have the knowledge and are aware of the preventive            questionnaire was divided into three sections follow-




                                                                                                     li
    practices for maintaining optimal oral health for this        ing information about caregivers’ knowledge and atti-




                                                                                                   na
    group under their care (10, 11). Unfortunately, majori-       tudes.
    ty among the caregivers lack the knowledge of proper          Section I: solicited general demographic and profes-
    oral health care themselves and thus fail to recognize        sional background information. Section II: integrated
    its importance resulting in not applying proper oral          questions about oral health knowledge and personal
    health behaviour (12).                                        oral health practice by the caregivers. Section III:




                                                                                                 io
    The incidence of dental disease is on a rise among            comprised of questions, which aimed to assess atti-
    the disabled people in the gulf region. Several studies       tude about oral health care and practice.
    across the globe have focussed on a need to improve           The study was reviewed by the Ethical Committee at




                                                                            az
    and prevent dental diseases in special care children          Salman bin Abdulaziz University and was granted
    (13, 14). Some of the people with disabilities may be         ethical approval. An official permission was attained
    directly dependent on caregivers for their private care       from the director of the comprehensive rehabilitation
    and the role of these carers is pivotal in the life of        centre, AlKharj. Furthermore, a written approval from




                                                                          rn
    such people. Therefore, interventions should be               caregivers was also attained. All ethical procedures
    aimed towards caregivers in a culturally appropriate          were in accordance with the ethical standards and in
    and acceptable manner that directly improves their            harmony with the Helsinki Declaration of 1975 re-
    knowledge as well as the attitude, towards special            viewed in 2008.




                                                         te
    needs patients, in providing optimal level of oral care.      The data was analysed and managed by Statistical
    (12, 15).                                                     Package for Social Sciences 20 (SPSS Inc. Chicago,
    To our knowledge, from indexed literature data avail-         IL, USA). Descriptive analysis of the data including
                                                       In
    able on caregivers knowledge and attitude on Saudi            frequencies, percentages and means of caregiver’s
    population is scarce and limited. Therefore, the ob-          knowledge and attitude were calculated. Comparison
    jective of the study was to assess the knowledge and          between oral knowledge and oral health attitude of
    attitude of caregivers/healthcare workers regarding           caregivers was done using one-sample t Test. Level
    oral health of special need patients, at a comprehen-         of significance was set as significant at p=0.05*.
                               ni

    sive rehabilitation centre in Al-Kharj, Saudi Arabia.
    The evidence acquired through this study may benefit
    to assist the level of information and approach, for
                             io


    oral health care, of caregivers working in special care
                                                                  Results

    centres.                                                      Socio demographic data of the subjects is presented
                                                                  in Table 1. Regarding knowledge of caregivers of
                           iz



                                                                  whether oral health is associated to general health,
                                                                  78.3% (n=94) responded in positive whereas 21.7%
                                                                  (n=26) stated that there was no relation. Furthermore,
    Materials and methods
            Ed




    An analytical cross-sectional study was conducted             81.7% (n=98) of the caregivers acknowledged that
    among 120 caregivers at comprehensive rehabilita-             people with disabilities were more prone to oral
    tion centre in AlKharj, Saudi Arabia. The rehabilitation      health problems. 87% (n=98) of the caregivers ac-
    centre accommodated around 168 special needs pa-              cepted that it is important to clean teeth, however
    tients. The caregivers were responsible for providing         13.3% (n=16) did not consider it essential. Regarding
    various needs to these patients i.e. feeding, giving          knowledge about powered tooth brushes only 8.3%
 IC




    bath, clipping nails, changing clothing and bedding as        (n=10) of caregivers responded that they had knowl-
    well as oral care. An interview style questionnaire           edge about powered toothbrushes while the rest
    was designed for this study.                                  91.7% (n=110) did not have knowledge about it.
      The sample was selected by non-probability conve-           Table 2 shows the descriptive knowledge of care-
C




    nience sampling. The total estimated time of the              givers regarding oral health care.
    study was three months. Sample collection was                 Table 3 describes descriptive analysis of caregiver’s
    based on the inclusion criteria i.e. all the caregivers       attitude. 44.2 (n=53) and 21.7% (n=26) of the care-
    who returned the consent form were included. Fur-             givers accepted that oral health care for the people
©




    thermore, caregivers who did not manage to return             with disabilities is difficult and challenging. Majority
    the consent form or were absent on the day of data            among the caregivers 55% (n=66) felt that they
    collection were excluded from the study. Since the            should visit a dentist only when in pain, while the rest
    caregivers who participated in the study were from            22.5% (n=27) and 13.3% (n=16) replied that the visits
    Sudan, Philippines, Egypt, India, Bangladesh, Sri             should be made once and twice a year respectively.
    Lanka and Nepal etc., the questionnaire was de-               Poor communication 33.3 (n=40), bad smelling mouth

    Annali di Stomatologia 2017;VIII(3):110-116                                                                        111
    A. H. Shah et al.


    Table 1. Socio demographic data.
    Variables                                Frequency                            Percentage
    Age
    19-25 years                              32                                   26.7
    26-35                                    60                                   50.1




                                                                                                   li
    36 onwards                               28                                   23.2




                                                                                                 na
    Qualification
    Less than high school                    24                                   20
    High school to higher secondary          96                                   80
    school




                                                                                               io
    Experience




                                                                          az
    Less than 2 years                        60                                   50
    2-5 years                                60                                   50

    Care




                                                                        rn
    Direct Patient care                      120                                  100

    Language
    Arabic                                   55                                   45.8




                                                         te
    Non Arabic                               65                                   54.2



    and bleeding gums 25% (n=30) were considered the            eases and poor oral hygiene status (19, 20). A study
                                                       In
    main problems while taking care of the inhabitants.         with the same group pointed out high caries rate,
    On a question asked to the caregivers that how they         higher complexity of periodontal disease as well as
    learnt to take care of individuals with disabilities;       higher incidence of retained teeth (21). Almost 3/4 of
    more than half of caregivers 53.3% (n=64) answered          the caregivers believed that it is important to clean
    that they had learnt from co-workers and others. 75%        teeth and that regular oral care can prevent oral dis-
                              ni

    (n=90) of caregivers established that oral health edu-      eases. This indicates that caregivers knowledge
    cation and training can help in improving the oral          about oral hygiene practices were profound, which
    health of this group.                                       may echo positively on the special care patients of
                            io


    Table 4 presents difference between the knowledge           the rehabilitation centre. Since caregivers who act
    and attitude mean scores. The means score of oral           first themselves on the advice they give, will provide
    health knowledge among caregivers was 15.36. As             good motivation and counselling to patients as well
                          iz



    far as oral health attitude was concerned the mean          (18, 22).
    difference of scores was 18.14, both were found to be       The awareness level of caregivers on fluoride pre-
    statistically significant at p=0.0001 using a single        venting dental decay was acceptable. Almost three in
           Ed




    sample T test.                                              five acknowledged that fluoride prevents caries. Fluo-
                                                                ride tooth pastes have been considered as bench-
                                                                mark to prevent caries for the past three eras, and is
                                                                also the most common method of fluoride delivery
                                                                (23). It is estimated that on average, it reduces 24%
    Discussion

    Oral health care of special needs people seems to be        of DMF score (24). Previous studies have shown par-
 IC




    a challenging task for caregivers (16). Thus, proper        ents and caregivers, understanding the importance of
    knowledge of oral health care is prudent to administer      fluoride in preserving healthy oral health (18, 25).
    best of their services. More than 3/4 of the responses      Interestingly, the caregivers showed adequate knowl-
    by the caregivers agreed that general health is reliant     edge regarding frequency of tooth brushing. Half of
C




    on good oral health (10, 18). In addition, more than        the health workers recognized that teeth should be
    3/4 of caregivers agreed to the fact that disabled indi-    brushed twice daily and the rest halve believed that it
    viduals are more prone to oral health problems.             is better to brush teeth once a day. Professional rec-
    These findings were in relation to different studies        ommendation and evidence suggests that tooth
©




    that individuals with disabilities or some other sort of    brushing is advised for at least 2-3 minutes, twice
    impairment (e.g. mental illness, behaviour problems,        daily using bass technique (26). In addition, a healthy
    learning difficulties, etc.) have poorer oral health con-   trend by the caregivers was witnessed when asked
    ditions compared to healthy people. Furthermore, in-        about aids of cleaning teeth other than brushing. Al-
    dividual with disabilities show higher prevalence of        most 50% of the caregivers used Miswak as one of
    oral diseases such as dental caries, periodontal dis-       the source to clean their teeth. This tendency can be

    112                                                                          Annali di Stomatologia 2017;VIII(3):110-116
    Oral health knowledge and attitude among caregivers of special needs patients at a Comprehensive Rehabilitation Centre:
    an analytical study

    Table 2. Descriptive knowledge of caregivers.

    Variable                                                    Frequency (n= 120)            Percentage
    Is oral health related to general health
    Yes                                                         94                            78.3
    No                                                          26                            21.7




                                                                                                         li
    Do you think disabled people are more prone to Oral
    health problems




                                                                                                       na
    Yes                                                         98                            81.7
    No                                                          22                            18.3
    Do you think cleaning teeth is important
    Yes                                                         104                           86.7




                                                                                                     io
    No                                                          16                            13.3
    Daily care of teeth can prevent Oral Disease
    Yes                                                         120                           100




                                                                               az
    No                                                          0                             0
    Fluoridated toothpastes prevents dental decay
    Yes                                                         66                            55
    No                                                          54                            45
    How many times it is ideal to brush teeth




                                                                             rn
    Not necessary                                               0                             0
    Whenever possible                                           0                             0
    Once daily                                                  58                            48.3
    Twice daily                                                 60                            50




                                                         te
    More than twice daily                                       2                             1.7
    What are the aids apart from brushing that is used
    Rinse with water                                            25                            20.8
    Finger
                                                       In       26                            21.8
    Mouthwash                                                   20                            16.6
    Tooth pick                                                  0                             0
    Miswak                                                      49                            40.8
    Which things can cause decayed teeth
                               ni
    Sweetened confectionary                                     38                            31.7
    Fruits like date                                            46                            38.3
    Tea/ coffee                                                 10                            8.3
                             io

    Carbonated drink                                            26                            21.7
    Have you seen or heard about powered tooth brush
    Never                                                       0                             0
                           iz



    Only heard about it                                         10                            8.3
    Have seen it but not used                                   110                           91.7
    Used it                                                     0                             0
            Ed




    considered healthy as there are many oral as well as             givers towards oral health was considered unsatisfac-
    general health benefits quoted by the use of miswak              tory and inadequate (Tab. 5). When inquired about
    (2). These may include anti plaque, anti-fungal, and             how many times it is necessary to go for dental
    anti-microbial effects (2, 27). Miswak is also consid-           check-up in a year, more than half of the responders
    ered as the cost effective, inexpensive, cheap                   thought only in case of dental problem. This tendency
 IC




    method of maintaining good oral health (2, 28).                  has been shown in previous studies as well where
    Intriguingly, the awareness level of care providers on           utilization and access to care is symptom oriented
    diet and caries was agreeable. This is important and             (29, 30). Regular dental check-up is of prime impor-
    may provide good wire of knowledge of healthy and                tance in the prevention of dental disease. These vis-
C




    balanced diet to the parents plus the disabled individ-          its provide an opportunity for dentists to take clinical
    uals themselves. Balanced dietary habits are very im-            preventive measures such as dental prophylaxis, top-
    portant for disabled individuals as if ignored or not            ical fluoride application, etc. and reinforce healthy
    taken care off may result in compromised oral hy-                home dental care. In a study by Watt (31), he ex-
©




    giene status and thus increase in the incidence of               plains how majority of the diseases is preventable.
    caries in the dependents. The caregivers should                  The challenging task is to carve opportunity, which is
    strictly adhere to the current and up to date knowl-             conducive, both at individual and community level.
    edge regarding suitable and healthy diet for disabled            Though there is a marked advancement in operative
    individuals (18, 25).                                            dental care, symptoms or treatment oriented ap-
    In contrast, enthrallingly in the study attitude of care-        proaches never can eradicate oral diseases (32).

    Annali di Stomatologia 2017;VIII(3):110-116                                                                          113
    A. H. Shah et al.


    Table 3. Descriptive analysis of caregiver’s attitude.

    Variable                                                        Frequency (n= 120)            Percentage
    How do you rate your personal Oral health
    Excellent                                                       17                            14.2




                                                                                                      li
    Very good                                                       28                            23.3
    Good                                                            40                            33.3




                                                                                                    na
    Fair                                                            24                            20.0
    Poor                                                            11                            9.2
    How would you rate the oral health care for the disabled
    Easy                                                            15                            12.5
    Difficult                                                       22                            18.3




                                                                                                  io
    Very difficult                                                  26                            21.7
    Challenging                                                     53                            44.2
    I don’t know                                                    4                             3.3




                                                                            az
    How many times should we visit a dentist in a year
    When you have a problem                                         66                            55.0
    Frequently                                                      8                             6.7
    Once every year                                                 27                            22.5
    Twice every year                                                16                            13.3




                                                                          rn
    I don’t know                                                    3                             2.5
    When you should change your tooth brush
    Whenever you like                                               13                            10.8
    When bristles are out of shape                                  49                            40.8




                                                               te
    Every three months                                              19                            15.8
    Every six months                                                17                            14.2
    I don’t know                                                    22                            18.3
    How did you learn to take care of oral health of the
                                                             In
    inhabitants
    Previous training programs                                      0                             0
    By myself                                                       15                            12.5
    From other co workers                                           64                            53.3
                              ni
    I did not learn                                                 41                            34.2
    What is the most common problem faced while taking care
    of the inhabitants
                            io


    Non co-operation                                                25                            20.8
    Bites or aggressive behaviour                                   20                            16.7
    Cannot understand or communicate                                40                            33.3
                          iz



    Bad smelling mouth and bleeding gums                            30                            25
    I don’t know                                                    5                             4.2
    Do you think oral health training can be helpful for you to
           Ed




    deliver better oral care to the inhabitants
    Yes                                                             90                            75.0
    No                                                              20                            16.7
    Don’t know                                                      10                            8.3
    Which of the following do you think you need to be able to
    give better oral health care to the present group
    Audio video training                                            68                            56.7
 IC




    Hands on training                                               42                            35.0
    No training required                                            10                            8.3
C




    A lack of knowledge was felt when asked about when            half of the caregivers learnt oral care training by other
    it is recommended to change toothbrush. More than             co-workers while 41% learnt oral training by them-
    40% stated that when bristles are out of shape,               selves, though 75% of caregivers considered training
    whereas one in five had no idea about it. These re-           in oral care useful. It was also observed that 80% of
©




    sults raise questions on the attitude of caregivers.          caregivers was educated until school level and 20%
    Toothbrushes are considered as one of the vital tools         being less than that. This clearly shows that the cur-
    in achieving acceptable plaque control and improving          rent system of training and education is sub-standard
    periodontal health (26, 33).                                  and disappointing. Caregivers should be educated to
    The present study revealed that no health care work-          a minimal level of standards and should have a ho-
    ers or caregivers took training in oral care. More than       mogenous guidance. These findings were concurrent

    114                                                                             Annali di Stomatologia 2017;VIII(3):110-116
    Oral health knowledge and attitude among caregivers of special needs patients at a Comprehensive Rehabilitation Centre:
    an analytical study

    Table . Difference between caregiver’s knowledge and attitude

    Variables                        ± SD
                                Mean +                  Mean Difference          P-Value                95% CI of the
                                                                                                        difference
    Caregivers Attitude         18.14 (6.7)             18.14                    0.0001*                Lower                  Upper
                                                                                                        16.91                  19.36




                                                                                                                    li
    Caregivers                  15.36 (1.94)            15.36                    0.0001*                15.01                  15.71




                                                                                                                  na
    Knowledge
    One Sample T test; *statistical significant.




                                                                                                                io
                                                                                       az
                                                                                     rn
    with the study reported by Sumi et al. (34). In addi-
    tion, caregivers apparently assumed that better train-
                                                                   te          atol (Roma). 2016;7(3):52-59. Epub 2017/02/06. doi:
                                                                               10.11138/ads/2016.7.3.052. PubMed PMID: 28149451;
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