Eman F.doc J Bagh College Dentistry Vol. 25(4), December 2013 Oral health status 100Pedodontics, Orthodontics and Preventive Dentistry Oral health status, dental knowledge and behaviors among children and adolescents (8-15) years old in the cities of Baghdad and Thamar Eman K. Chaloob, B.D.S., M.Sc. (1) ABSTRACT Background: Investigating dental health knowledge among children is important. Knowing what behaviors are right in relation to dental health does not guarantee that children will practice those behaviors. However, lack of knowledge and misconceptions about dental health may lead to behaviors that are harmful to teeth and gum. Baseline data on knowledge levels are required to determine which particular areas of dental health education are in need of improvement for high-risk children living in different geographical areas. This research was conducted to study the oral health status, dental knowledge and behavior in relation to two different cities, among children in Baghdad and Thamar (republic of Yemen) governorate. Materials and Methods: The sample collected was composed of two geographically different groups, first group from Baghdad city: composed of 144 children and adolescents and the second group collected from the city of Thamar (republic of Yemen) composed of 108 of an age range 8-15 years old children. Dental plaque and Gingival health condition was assessed by using plaque index of Silness and Loe (1964),and gingival index of Loe and Silness (1963), Ramfjord index teeth were examined to represent the whole dentition. Oral examination was performed by a single examiner using mouth mirror and dental explorer for each child. Ten questions were fabricated to evaluate the dental health knowledge and behavior of the two groups. Results: This study was recorded that the age group 12-15 years old the significant difference was found in relation to gingival health condition, the dental Knowledge and behaviors was the highly significant difference was found between Baghdad and Thamar group. As well as highly scores of dental knowledge and behavior was significantly related to the dental plaque for both Baghdad and Thamar group. Conclusion: The difference in the geographical location could affect on oral hygiene, dental health knowledge and behavior of the children and adolescent. Keywords: Oral health status, geographical location, dental knowledge. (J Bagh Coll Dentistry 2013; 25(4):100-103). INTRODUCTION Oral health is a significant problem, which is the most common disease of childhood, it is one of the most prevalent infectious diseases, it begins soon after teeth erupt, and affected by age, culture, genetic and biological factors, social and physical environment, health behaviors, dental and medical care all these factors can help to change or improve oral health (1, 2, 3). Oral health is an integral part of overall health status as well as the oral diseases are the most prevalent of all health problems, As efforts continue to improve the health of all citizens, oral health could not be overlooked (4).The level of dental knowledge, ethnicity, deprivation, and education, and the lifestyle and diet choices, all together could affect the oral health (5, 6).So that to provide guidance for a public health intervention we should deal with understanding cultural issues surrounding children's oral health (7). Race/ethnicity is a marker for oral health status underlying cultural beliefs and practices influence the condition of the teeth and mouth, through diet, care-seeking behaviors, or use of home remedies, It is important to note that among and within all racial/ethnic groups there are substantial differ- (1)Lecturer. Department of Pedodontics and Preventive Dentistry, College of Dentistry, University of Baghdad. ences in beliefs and behaviors, which can lead to varying health status. Such differences are often associated with demographic characteristics (8, 9). Populations have different health experiences and patterns of service use due to socio-cultural differences. Research on poor health outcomes generally examines deterrents such as high cost, lack of insurance and availability of services, often aspects of cultural ideas and health practices are suggested as additional deterrents (10). Health is a basic human right and oral health is a significant component of general health, as well as the oral health problems are mostly not life threatening, but they are important because of effect on the quality of life. These will make the attention to oral health care (11). Knowledge, beliefs and attitudes that students acquire during school can influence their behavior towards not just their own health, but also towards health in their immediate environment (12) Dental health problems could be related to many other factors like social, cultural and environment, from this point of view this study was conducted in order to identify if there is a difference in the oral health status and dental knowledge and behaviors according to two different Arabic cities. J Bagh College Dentistry Vol. 25(4), December 2013 Oral health status 101Pedodontics, Orthodontics and Preventive Dentistry MATERIALS AND METHODS The sample of this study was composed of two groups, the first group was conducted in Baghdad governorate in republic of Iraq, and second group was collected in the city of Thamar governorate in republic of Yemen, the First group composed of 144, second group composed of 108 with an age range 8-15 years old children and adolescents for both group. These two groups were selected from different schools in different area in the Baghdad city as well as the sample of Yemen was selected from different schools in different area of Thamar city. Oral examination was performed by a single examiner using mouth mirror and dental explorer for each subject. Dental plaque was assessed by using plaque index (PlI) (13). Gingival health condition was assessed by gingival index (GI) (14). The teeth were examined to represent the whole dentition by using Ramfjord index teeth (15). The examination of the children in the sitting and light position was done according to the criteria of WHO (16). Finally ten questions fabricated for the evaluation of dental knowledge and behaviors of the children, questions that related to dental knowledge and behavior was: 1. Do you use tooth brush with tooth paste? 2. Should we brush teeth at least twice per day? 3. What is the Number of deciduous teeth? 4. What is the Number of permanent teeth? 5. Should we drink milk to reduce dental caries? 6. Sweet will or will not cause dental caries? 7. Do you visit the dentist regularly? 8. Is caries progression leads to losing teeth? 9. Is early loosing teeth lead to disharmony of teeth arrangement? 10. Do you think that good oral hygiene can lead to healthy teeth and gum? The answer of these questions either yes or I don’t know .The correct answer was yes and take score 1 for each question, for questions 3 and 4 the answer was giving correct number of deciduous or permanent teeth. So that the total maximum score was 10, it means that the entire question was correctly answered. Zero score was recorded when the answer was I don’t know. Statistical analysis was done using SPSS computer software (Statistical Package for Social Sciences) using t-test, Z-proportion. RESULTS The sample of this study was composed of two groups divided according to the geographical area B represents Baghdad city and TH represent Thamar governorate in the city of Yemen, the sample are subdivided according to age and gender. According to age the sample distributed in to two age groups 8-11 and 12-15, distribution illustrates in table (1). Table (2) demonstrates the mean and standard deviation of PlI and GI in relation to area location and age group. The significant at age group 12-15 years old according to GI was significant to the area location (p<0.05), as we can see the significant was found at all age group according to the GI. Table (3) illustrates the number of children that the answers was positive according to question type in relation to area of Baghdad and Thamar, the significant was found in question seven and nine (p<0.05),and the highly significant was found (p <0.01) in question 1,2,3,4,5,6,8 and 10. Table (4) shows that the children take ten scores was highly significant in relation to geographical area, while the children take zero was significant in relation to geographical area. DISCUSSION In this study the significant in the age group 12-15 was found could be related to that this age group was the pubertal so that the several hormonal changes could occur. Several epidemiological studies revealed that the periodontal disease is wide spread in children and may vary from community to another (16). other studies have been reached different result by other investigator (15-18).It is important to say that this study found that the calculus was absent in these two group of children present in Baghdad and Thamar area this result agree with other studies (17,19), and disagree with Al-Azawi (20). The data of the present study revealed that the dental knowledge and behavior of the children was highly significant related to the geographical area, this could be due to the different believes and habit in their country. Several past study compare that the dental knowledge and behavior could differ according to geographical or socially level of the area (17- 23). In the present study the result shows that the zero score of dental knowledge shows the significant relation according to area location, as well as in the degree of highly scores of dental knowledge the significant was high according to area location. This result could be related to the knowledge about dentistry cannot collected easily, so the children for example doesn't know the number of deciduous teeth and this may be related to other factors like the different social level in the same geographical area. While according to mean plaque, the significant was not found, but in case of score ten the significant was found, this may be due to that J Bagh College Dentistry Vol. 25(4), December 2013 Oral health status 102Pedodontics, Orthodontics and Preventive Dentistry the children with the zero score doesn't have any interest or knowledge about cleaning their teeth in contrast to the children of score ten were they could have a dental knowledge to take care to their teeth and oral hygiene. Several previous studies found that dental knowledge effected on the oral hygiene (19, 20), and some other study found that the dental knowledge and behavior does not affected the oral hygiene (24, 25). REFERENCES 1. DavidsonT. Fluoridation of drinking water to prevent dental caries. J Am 2000; 23(10):12. 2. Susan A. Fisher-wens, Influences on Children's Oral Health: Pediatrics 2007; 120(3): 510-20. 3. Broder H, Reisine S, Johnson R. Role of African- American fathers in child-rearing and oral health practices in an inner city environment-a brief communication. J Public Health Dent 2006; 66(2):138-43. 4. Green BL, Person S, Crowther M, Frison S, Shipp M, Lee P, Martin M. Demographic and geographic variations of oral health among African Americans based on NHANES III. Community Dent Health 2003; 20(2):117-22. 5. Mattson L, Goldberg P. Gingival inflammatory reaction in children at different ages. J Clin Periodontol 1995; 12: 98-101. 6. Niki F, Andrew J. Oral hygiene and systemic diseases, health professionals. J Dental Res 2012; 12: 5. 7. Riedy CA, Weinstein P, Milgrom P, Bruss M. An ethnographic study for understanding children's oral health in a multicultural community. Department of Dental Public Health Sciences, University of Washington, Seattle 98195-7475, USA. Int Dent J 200; 51(4): 305-12. 8. Flores G, Vega LR: Barriers to health care access for Latino children: a review. Fam Med 1998; 30(3):196- 205. 9. Aguiree-Molina MMC, Zambraa RE. Health issues in the latino community, 2001. 10. Kiyak HA. Age and culture: influences on oral health behaviour. Int Dent J 1993; 43(1): 9-16. 11. Mautsch W, Sheiham A. Promoting oral health in deprived communities. 1995. pp.68-73. 12. Bojana D, Svjetlana J, Dragan I, Ivana G. Oral health assessment among dental students. Stomatološki Glasnik Srbije 2012; 59(3): 141- 7.(IVSL) 13. Silness J. Loe H. Periodontal disease in pregnancy II correlation between oral hygiene and Pd condition. Acta Odontol Scand 1964; 22: 121-5. 14. Loe H, Silness J. Periodontal disease in pregnancy I prevalence and severity. Acta Odontol Scand 1963; 21: 533-51 15. Ramfjord SP. Indices for prevalence and incidence of periodontal disease. J Periodontal 1959: 30: 51-9 16. World Health Organization. Oral health surveys, basic methods.3rd. Geneva: WHO; 1997 17. Al-Sayyab M. Oral health status among 15 years old school children in the central region of Iraq. A master thesis, College of Dentistry University of Baghdad, 1989. 18. Al-Alousi W, Al-Sayyab M. Plaque, gingival condition and brushing behavior in 15 year old Iraqi school children in central region of Iraq. Iraqi Dent J 1996; 8(1):127-37. 19. Al-Eissa DTY. Oral health status of preschool children aged 3-5 years old and its relation to their socioeconomic status and parental dental knowledge, behavior and attitude in two different social areas in Baghdad city. A master thesis, College of Dentistry, University of Baghdad, 2004. 20. Al-Azawi L. Oral health status and treatment needs among Iraqi 5 years old kindergarten children and 15 years old students (national survey). PhD. Thesis. College of Dentistry, University of Baghdad, 2000. 21. Al-Sayyab M. Periodontal treatment needs among Iraqi children living in two Iraqi villages (Sheha and AL-Buetha). College of Dentistry, 1998; 2: 219-224. 22. Kamsarco TY, AL-Naimi RJ, AL-Muktar BS. The effect of social class on periodontal condition and treatment needs of 13-15 year old students in Mosul city –Ninevah: Iraq. Al-Rafidain Dent J 2001; 1: 78- 85. 23. Yogita B, Jane W, Judith B. Oral health-related cultural beliefs for four racial/ethnic groups: Assessment of the literature. BMC Oral Health, 2008; 8(1): 26. (IVSL) 24. Rayant GA. Relationship between dental knowledge and tooth cleaning behavior. Community Dent Oral Epidemiol 1979; 7:191-4. 25. Chu CH, Fung DSH, LO ECM. Dental caries status of preschool children in Hong Kong. Br Dent J 2000; 187(11): 1-10. Table 1: The distribution of the two sample according to age and gender Age area Male Female Both No. % No. % No. % 8-11 B 40 44.4 50 55.6 90 62.5 TH 37 54.4 31 45.6 68 62.9 12-15 B 25 46.3 29 53.7 54 37.5 TH 18 45.0 22 55.0 40 37.0 Total B 65 45.1 79 54.9 144 100 TH 55 50.9 53 49.1 108 100 J Bagh College Dentistry Vol. 25(4), December 2013 Oral health status 103Pedodontics, Orthodontics and Preventive Dentistry Table 2: The mean and standard deviation of the PlI and GI in relation to area location according to age Age area plI t-test GI t-test Mean ±SD Mean ± SD 8-11 B 1.286 0.160 0.596 NS P=0.34 0.755 0.559 0.011 NS P=0.99 TH 1.405 0.590 0.823 0.548 12-15 B 1.453 0.414 0.501 NS P=0.617 3.470 1.203 2.244 S P=0.031 TH 1.453 0.516 0.895 0.498 Total B 1.322 0.401 0.016 NS P=0.998 1.562 0.333 2.233 S P=0.039 TH 1.321 0.522 0.732 0.922 S=Significant, NS=Not Significant. Table 3: The distribution of total sample according to the dental knowledge and behavior (positive answers) in relation to geographical area S=Significant, HS=Highly Significant. Table 4: The distribution of children and adolescents according to zero and ten scores of dental knowledge and behaviors among two geographical areas Knowledge / Behavior A No. % Z-propr. 0 B 20 9.4 4.68 S P<0.05 TH 8 5.5 10 B 16 7.5 6.82 HS P<0.01 TH 9 6.3 S=Significant, HS=Highly Significant. Question number area No. of positive Z-prop No. % Q1 B 102 70.8 14.6 HS P<0.01 TH 43 39.8 Q2 B 97 67.4 1.66 HS P<0.01 TH 80 74.1 Q3 B 54 37.5 9.66 HS P<0.01 TH 19 17.6 Q4 B 66 45.8 47.3 HS P<0.01 TH 10 9.3 Q5 B 107 74.3 44.7 HS P<0.01 TH 32 29.6 Q6 B 114 79.2 45.8 HS P<0.01 TH 27 25.0 Q7 B 58 40.3 1.114 S P<0.05 TH 48 44.4 Q8 B 108 75.0 66.8 HS P<0.01 TH 67 62.0 Q9 B 32 22.2 2.66 S P<0.05 TH 51 47.2 Q10 B 97 67.4 12.3 HS P<0.01 TH 49 45.4