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Year : 2021  |  Volume : 8  |  Issue : 4  |  Page : 302-311

A comparative evaluation of oral hygiene practice, knowledge, and attitude among hospital employees in Amritsar, India

Department of Dental Sciences, Fortis Escorts Hospital, Amritsar, Punjab, India

Date of Submission18-Jun-2021
Date of Decision09-Jul-2021
Date of Acceptance10-Jul-2021
Date of Web Publication20-Dec-2021

Correspondence Address:
Kamaljot Kaur
Clinical Assistant Irina Singh, Empanelled Consultant Department of Dental Sciences, Fortis Escorts Hospital, House No.B-16, Staff Colony, Government Polytechnic College for Girls, Majitha Road, Bypass, Amritsar, Punjab
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdrr.jdrr_107_21

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Aim: The aim of this study was to assess the oral hygiene awareness, knowledge, and practice attitude of employees, working in different departments of a hospital in Amritsar, India. Materials and Methods: A cross-sectional study was conducted on 203 volunteer participants between the ages of 23 and 56 years, both males and females, who were divided into four groups: doctors, nurses, support medical staff, and support nonmedical staff. Subjects were administered self-administered questionnaire addressing demographics, knowledge, and attitude and practice behavior of participants. The data were collected, segregated, and analyzed. Results: The knowledge score of physicians was adequate, but their attitude and behavior scores were substantially low. Overall performance of the other three groups - nurses, support medical staff, and support nonmedical staff in terms of knowledge, attitude, and behavior sections was not satisfactory. Survey revealed that only 26.2% of subjects brushed twice daily. About 17% reported use of dental floss and 18.7% used either mouthwash or tongue cleaner as adjuncts. Conclusion: The inadequate knowledge about oral health and hygiene of hospital employees as well as their callous attitudes toward these areas suggest a pressing need for the implementation of continuous dental education. The efficacy of dental health education can be increased only if health programs are tailored to directly impinge on attitudes of targeted population. Interprofessional education programs for healthcare staff can create learning environment where health workers from various fields can interact and learn how to prepare them for seamless teamwork in collaboration for coordinated patient care. Hence, a proactive approach is required to create awareness about oral health and hygiene.

Keywords: Hygiene practices, oral health and hygiene knowledge score, oral health awareness, oral hygiene

How to cite this article:
Kaur K, Singh I. A comparative evaluation of oral hygiene practice, knowledge, and attitude among hospital employees in Amritsar, India. J Dent Res Rev 2021;8:302-11

How to cite this URL:
Kaur K, Singh I. A comparative evaluation of oral hygiene practice, knowledge, and attitude among hospital employees in Amritsar, India. J Dent Res Rev [serial online] 2021 [cited 2022 Dec 3];8:302-11. Available from: https://www.jdrr.org/text.asp?2021/8/4/302/332910

  Introduction Top

U. S. Department of Health and Human Services Oral Health Strategic Framework, 2014–2017 asserts that “Oral health is an essential and integral component of health throughout life.”[1] It is better to prevent the disease than to cure it, and prevention is possible only if we have proper knowledge about oral hygiene and its importance. Oral health can contribute to various systemic diseases and vice versa. For example, a common denominator that exists for periodontitis and Type-2 diabetes mellitus is the systemic presence of common pro-inflammatory cytokines.[2] Dental procedures often cause a transient bacteremia and the bacteria may lodge on abnormal or damaged cardiac tissue, especially valves, which may result in endocarditis.[3],[4] By-products of oral bacterial are thought to be involved in the etiopathogenesis of cardiovascular disease by releasing cytokines and other pro-inflammatory that may initiate a cascade of biochemical reactions and cause endothelial damage and facilitate cholesterol plaque attachment.[5]

Bacteria from a mother's oral cavity can be transferred to her unborn child via the blood and amniotic fluid. This could increase the chances of a premature birth, a low-birth-weight infant, early contractions, or infection in the newborn child.[6]

Oral infection also has been implicated in respiratory ailments. Bacteria in periodontal disease can travel from the mouth to the lungs and lower respiratory system, where it can aggravate respiratory conditions, particularly in patients who already have other systemic diseases.[7],[8],[9] Common potential respiratory pathogens can colonize the oropharynx and be aspirated into the lower airways.[10] Disease-damaged lungs are not as able to defend themselves, increasing the risk that the bacteria will cause infections or make lung problems worse.[10],[11]

Essentially, overall health necessitates the collaboration between the medical and dental professionals. Providing adequate training to the medical and paramedical staff to identify the factors responsible for oral diseases will help in expanding the oral health workforce. Optimum health-related practices are more likely to be taken up if an individual feels a sense of better control over their health with a better understanding of diseases and etiology.[12] Before health professionals are trained as oral health educators, there is a need to determine the status of their own oral health knowledge and behaviors.[13] As a result, the present study was conducted to assess oral hygiene knowledge, attitude, and practices of hospital employees at Fortis Escorts Hospital in Amritsar, India, objective is establishing a baseline for future assessments to help measure the effectiveness of the activities of health education changing health behavior.

  Materials and Methods Top

A list of employees working at Fortis Escorts Hospital, Amritsar, India, where I work in the department of dental sciences as a Clinical Assistant, was obtained from the Human Resource Department, and their departments were noted down. Employees were initially divided into four categories: doctors, nurses, support medical staff, and support nonmedical staff. Then, about 50 employees from each category were selected by simple random sampling to get a representative sample. All employees with good general health between the ages of 23 and 56 years were assessed.

A pretested self-administered questionnaire containing 19 questions was administered to all study participants. The questionnaire format was adapted from the questionnaire used in Baseer[13] study, and the language of the questionnaire was English. Pretesting of the questionnaire was carried out by initially administering the questionnaire to 10 employees. Feedback was obtained from participants on any difficulties faced by them in the interpretation of questions and any ambiguity within the responses was checked. The questionnaire was then modified accordingly and administered to all participants. Demographics, practice behavior, and attitude and knowledge were the three domains of the questionnaire form.

Employees who agreed to participate and were available on the day of the survey were instructed to select only one response from a list of options provided in the response format. The participants were given instructions on how to complete the questionnaire. Furthermore, I was present while the questionnaire was being filled out, and I answered all of the participants' questions. Employees were given 10 min to complete the questionnaire without discussing it with one another.

Survey pro forma

A self-administered questionnaire form was designed in English, comprising 19 questions, was given to all study participants. All subjects understood the nature and purpose of the survey and were told how to fill in the survey questionnaire pro forma.

Questionnaire design

The questionnaire form was divided into three domains, namely demographics, practice behavior, and attitude and knowledge. The response format included multiple-choice questions in which participants were instructed to pick the most relevant response from the given list of options.

In the first section, demographic information was given on topics such as profession, age, and gender.

The assessment of participant's oral health practice-related questions, for example, brushing duration, tools used to clean oral cavity, flossing, tongue cleaning, were there in the second section.

In the third section, questions based on their attitude and knowledge about oral health and hygiene were asked. Questions in this section were associated with their visits to a dental clinic, changing of a toothbrush, type of bristles of the toothbrush, amount of toothpaste, and knowledge of hygiene and systemic health.

The data were then collected, segregated, and analyzed using Simple Percentage Analysis [Sample of Questionnaire pro forma provided in [Questionnaire 1].

  Results Top

This survey included a total of 203 employees. There were 50 doctors, 51 nurses, 50 support medical staff, and 52 nonmedical support staff employees considered. The mean age for doctors was 32.8 years (ranging from 24 to 56 years), 31.5 years for nursing staff (23–47-year range), 23–45 years was the range for support medical staff with an average of 32.3 years. For nonmedical staff, the mean age was 32.9 years with a range of 24–48 years. Details are given in Section (A) and (B) of [Table 1].
Table 1: Oral Hygiene Practice, Knowledge, and Attitude questions

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To clean teeth, all doctors use a toothbrush and toothpaste, with 55.6% brushing once a day and the remaining 44.4% brushing twice a day. In addition to this, 38.7% use mouthwash daily. Only 13.7% of nursing staff use mouthwash in addition to their toothbrush and toothpaste to clean their oral cavity, which is a bit lower than doctors. Although all nursing staff, support medical personnel, and nonmedical employees use toothbrushes and toothpaste to clean their teeth, the percentage of people who use mouthwash and adjuncts such as tongue cleaner, turmeric paste, Manjan, powder, and other similar products was different in each case. Interestingly, 18% support medical employees use mouthwash in addition to toothpaste, which is nearly 6% more than nursing staff. On the other hand, only 5.7% of support nonmedical employees add mouthwash to their oral hygiene routine, which are least of all four categories. One percent of employees, both in support medical and support nonmedical staff, use powder (Manjan), turmeric paste, clove oil paste, salt paste, to clean their teeth, as an adjunct (Section-C).

Among doctors, 55.6% brushed their teeth once a day, which is significantly lower than the expected. The brushing frequency and duration of all four categories is given in detail in Section (D) of [Table 1].

About 51% of doctors, 47% of nurses, 36% support medical staff, and 46% of nonmedical staff brush their teeth for more than 2 min. Forty-seven percent of doctors spent 1–2 min and 2% spent 1 min on brushing. Surprisingly, 25.4% of nurses spend only 1 min brushing their teeth. Details of the duration of brushing of all four categories are given in Section (E) of [Table 1].

Fifty-three percent of doctors brush their teeth with pea-sized toothpaste. While brushing, 17.6% of nurses, 12% of support medical staff, and 11.6% of support nonmedical staff use pea-size toothpaste. Section (F) shows the details of the amount of toothpaste used by the four categories while brushing.

Surprisingly, only 2% of support medical staff use a toothbrush with extra soft bristles, while 4% use a toothbrush with hard bristles. The majority of employees brush their teeth with a soft-bristled toothbrush. Section (G) shows detailed information about the different types of toothbrush bristles in each of the four categories.

Only 15.3% of support nonmedical employees change their toothbrush within 3 months of an interval, whereas the majority of them, i.e., 61.5% do not have any idea for how long they have been using their current toothbrush. Section (H) shows the frequency with which employees in each of the four categories change their toothbrushes.

Only 79.6% of doctors rinse their oral cavity after every meal. Astoundingly, merely 22% of support medical staff employees do that, which is way less than expected. The response of staff, when asked about the cleaning of the tongue after brushing, was better than that of the previous response (Section I). The following bar graph provides detailed information for all four categories regarding rinsing after every meal and tongue cleaning. Details are given in Section (I) of [Table 1].

Results of the study revealed striking neglect of flossing habits among employees no one from the nursing staff or in the nonmedical support fields uses a water flosser. Water flossers are used by 14.3% of doctors and 20% of support medical staff on a daily basis. Section (J) shows more information about flossing habits and tools.

Only 55.1% of doctors get their oral check-up done once a year. 29.4% of nurses, 22% support medical staff, and 28.8% support nonmedical staff get their oral check-up done once a year. Section (K) shows detailed information on the frequency of visits for each of the four categories.

16.8% of doctors mentioned their sensitivity problem and out of these 16.8%, only 63% consulted a dentist regarding this. The remaining 37% of people with sensitivity did not seek treatment from a dentist. Section (L) shows the details as expected, all doctors are aware that oral health and systemic conditions are linked. They are also aware that habits such as betel chewing, tobacco consumption, and excessive sugar intake can have a negative impact on teeth and other oral structures. The awareness scores of nurses, support medical staff, and support nonmedical staff are satisfactory. Section (M) and (N) provide more information.

  Discussion Top

In comparison with dental surgeons, medical clinicians usually are more likely to encounter underserved and vulnerable patients. As the providers of primary health care for the majority of patients, medical professionals are also expected to play a part in oral health promotion.[14] Adequate communication among healthcare providers and their patients is the foundation for improved oral and general health. Dental caries, periodontitis, premature tooth loss, and oral cancer are major public health issues in developing countries. Deterioration of oral health can adversely affect the medical situation of the patient. Oral health problems such as dental caries, periodontal inflammation, and oral abscess can develop when hospitalized patients receive insufficient oral care. Therefore, it is necessary to educate healthcare staff who deliver bedside care (i.e., primarily nursing staff) regarding any pathological changes in the oral cavity that can be caused by a patient's medical condition or medication side effects, so as to prevent any deterioration that may lead to other health problems.[15],[16],[17]

Almost all of the health professionals who participated in the study said they brush their teeth with a toothbrush. However, there were significant differences between the groups when it came to brushing teeth, with the majority of them mentioning brushing once a day. This finding was similar to a study conducted in Ludhiana, India[18] in which once a day brushing of teeth was reported in approximately 50% of the health professionals.[18] In all the groups, participants used toothbrush and toothpaste for cleaning their teeth (100%). This was in accordance to study done by Doshi et al.[19] who reported a percentage of 100% in terms of using toothbrush and toothpaste for brushing teeth by healthcare professionals.[20]

When compared to the other three categories of professionals, the support medical staff scored the lowest in terms of flossing. Only 32.6% of doctors and 15.6% of nurses said they do flossing. This was in respect to the research carried out by Baseer[13] where <50% of the health professionals used mouth wash and dental floss.[13]

When it came to visiting a dental clinic, none of the four groups scored well. Furthermore, despite having easy access to dental care, healthcare professionals are still vulnerable to dental diseases due to bad dietary habits, an unhealthy lifestyle, indifferent attitude, busy schedule, and inadequate knowledge. Majority of the people were “problem-oriented dental clinic visitors” rather than “prevention oriented visitors.” The population at large in developing nations considers dental treatment as their least priority. Strong belief in dental myths, negligent attitude, illiteracy, and the prevalence of quackery, particularly in rural areas, inadequate oral health awareness in schools and emphasis on home remedies, insufficient budget for dental treatment or no dental insurance, dental fear and belief that visiting a dentist is only necessary for pain relief.[20] could all be reasons why people avoid dental treatment.

The collection of data on this subject would aid in the planning of preventive oral health care programs, which could include health care professionals educating the public about oral health through seminars, oral health education programs, and educational institution campaigns, as well as encouraging or educating their patients during regular or problem-oriented health checkups. The current analysis was limited by its small sample size. Larger trials with a larger sample size will aid in obtaining a more accurate picture of the attitude of healthcare professionals toward oral health awareness and care.

  Conclusion Top

The present investigation endeavored to provide a basic and broad representation of the oral health and hygiene knowledge, attitude, and practice among employees working in the hospital. Optimally, total health care requires the combined efforts of the medical and dental professions.[13] Cardiologists, Gynecologists, Pediatricians, Gastroenterologists, and Pulmonologists, for example, who have a greater impact on their patients than dentists, may advise and encourage them to maintain good oral health. Interprofessional education programs for healthcare staff can help to close the gap. Interprofessional education programs for healthcare staff can create a learning environment where health workers from various fields, for example, physicians, nurses, registered auxiliary nurse-midwife or a registered nurse and registered midwife can interact and learn how to prepare them for seamless teamwork in collaboration for coordinated patient care. In primary care, these healthcare workers meet children and their families regularly in child-health clinics, with excellent opportunities to promote oral health. Raising public awareness about dental check-ups may assist in early diagnosis. The affected population needs to receive information on oral diseases, risk factors, and measures that can be adopted to prevent them. The change from an unhealthy attitude to a healthy attitude will occur when adequate information and motivation are provided; and adequate practice measures are adopted by the subject.[15],[17],[18],[21]

The findings highlighted the need for a standardized training curriculum for healthcare workers is on the value of oral health care, which should be viewed as a right rather than a privilege for patients. This will enhance their oral health and provide information about the value of oral health and how to maintain it. Clear policies and guidelines about the oral health awareness of patients structured by a professional dental team should be instituted.[22],[23]

Future score

Overall, the results of this study infer that oral health awareness and practices among the study population are not satisfactory and need improvement. The findings add to the body of knowledge regarding self-regulatory components in health behavior change by expanding on previous studies and elucidating the mechanisms that help to transform oral hygiene intentions into behavior.

Ethical clearance

Before starting the survey, the Ethical clearance was obtained from the Institutional Review Board, Fortis Escorts Hospital, Amritsar.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

U.S. Department of Health and Human Services Oral Health Coordinating Committee. U.S. department of health and human services oral health strategic framework, 2014-2017. Public Health Rep 2016;131:242-57.  Back to cited text no. 1
Gurav A. Periodontitis and insulin resistance: Casual or causal relationship? Diabetes Metab J 2012;36:404.  Back to cited text no. 2
Kilian M. Systemic disease: Manifestations of oral bacteria. In: McGhee JR, Michalek SM, Cassell GH, editors. Dental Microbiology. Philadelphia: Harpers and Row; 1982. p. 832-8.  Back to cited text no. 3
Herzberg M, Meyer M. Effects of oral flora on platelets: Possible consequences in cardiovascular disease. J Periodontol 1996;67:1138-42.  Back to cited text no. 4
Haraszthy V, Zambon J, Trevisan M, Zeid M, Genco R. Identification of periodontal pathogens in atheromatous plaques. J Periodontol 2000;71:1554-60.  Back to cited text no. 5
Jeffcoat MK, Hauth JC, Geurs NC, Reddy MS, Cliver SP, Hodgkins PM, et al. Periodontal disease and preterm birth: Results of a pilot intervention study. J Periodontol 2003;74:1214-8.  Back to cited text no. 6
Donowitz GR, Mandell GL. Acute pneumonia. In: Mandell GL, Douglas RG, Bennett JE, editors. Principles and Practice of Infectious Diseases. New York: Churchill Livingstone; 1990. p. 540-55.  Back to cited text no. 7
Levison ME. Pneumonia, including necrotizing pulmonary infections (lung abscess) In: Isselbacher KJ, Braunwald E, Wilson JD, editors. Harrison's Principles of Internal Medicine. New York: McGraw-Hill; 1994. p. 1184-91.  Back to cited text no. 8
Bonten M, Gaillard C, van Tiel F, Smeets H, van der Geest S, Stobberingh E. The stomach is not a source for colonization of the upper respiratory tract and pneumonia in ICU patients. Chest 1994;105:878-84.  Back to cited text no. 9
Scannapieco FA, Mylotte JM. Relationships between periodontal disease and bacterial pneumonia. J Periodontol 1996;67 Suppl 10S: 1114-22.  Back to cited text no. 10
Coffee L, Sockrider M. Dental health and lung disease. Am J Respir Crit Care Med 2019;199:P9-10.  Back to cited text no. 11
Freeman R, Maizels J, Wyllie M, Sheiham A. The relationship between health related knowledge, attitudes and dental health behaviours in 14-16-year-old adolescents. Community Dent Health 1993;10:397-404.  Back to cited text no. 12
Baseer MA, Alenazy MS, Alasqah M, Algabbani M, Mehkari A. Oral health knowledge, attitude and practices among health professionals in King Fahad Medical City, Riyadh. Dent Res J (Isfahan) 2012;9:386-92.  Back to cited text no. 13
Sujatha BK, Yavagal P, Gomez M. Assessment of oral health awareness among undergraduate Medical Students in Davangere city: A cross-sectional survey. Indian J Public Health Res Dev 2014;12:43-6.  Back to cited text no. 14
Khanbodaghi A, Natto ZS, Forero M, Loo CY. Effectiveness of interprofessional oral health program for pediatric nurse practitioner students at Northeastern University, United States. BMC Oral Health 2019;19:170.  Back to cited text no. 15
Ragotero IG, Balabagno AO, Rodriguez HM. Impact of oral health education program (OHEP) on competencies among nurses caring for totally dependent patients in two government tertiary hospitals in the Philippines. Philipp J Health Res Dev 2016;19:4.  Back to cited text no. 16
Ashour A. Knowledge, attitudes and practices regarding oral health and oral care among nursing staff at a mental health hospital in Taif, Saudi Arabia: A questionnaire-based study. J Adv Oral Res 2020;11:34-44.  Back to cited text no. 17
Kaur S, Kaur B, Ahluwalia SS. Oral health knowledge, attitude and practices amongst health professionals in Ludhiana, India. Dentistry 2015;5:315.  Back to cited text no. 18
Doshi D, Baldava P, Anup N, Sequeira PS. A comparative evaluation of self-reported oral hygiene practices among medical and engineering university students with access to health-promotive dental care. J Contemp Dent Pract 2007;8:68-75.  Back to cited text no. 19
Sujatha BK, Yavagal P, Gomez M. Assessment of oral health awareness among undergraduate Medical Students in Davangere city: A cross-sectional survey. Indian J Public Health Res Dev 2014;12:43-6.  Back to cited text no. 20
Emmanuel A, Chang'endo E. Oral health related behaviour, knowledge, attitudes and beliefs among secondary school students in Iringa municipality. Dar Es Salaam Med Stud J 2010;17:24-30  Back to cited text no. 21
Khami MR, Virtanen JI, Jafarian M, Murtomaa H. Prevention-oriented practice of Iranian senior dental students. Eur J Dent Educ 2007;11:48-53.  Back to cited text no. 22
Rabiei S, Mohebbi SZ, Patja K, Virtanen JI. Physicians' knowledge of and adherence to improving oral health. BMC Public Health 2012;12:855.  Back to cited text no. 23


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