Journal of Dental Research and Review

: 2014  |  Volume : 1  |  Issue : 3  |  Page : 114--117

Oral hygiene practices, attitude, and access barriers to oral health among patients visiting a rural dental college in North India

Manavjot Gill1, Khayati Pal2, Ramandeep Singh Gambhir3,  
1 Department of General Dentistry, Dental Centre, Command Hospital, Panchkula, Haryana, India
2 Department of General Dentistry, Dental Centre, Zirakpur, Punjab, India
3 Department of Public Health Dentistry, Gian Sagar Dental College and Hospital, Rajpura, Punjab, India

Correspondence Address:
Ramandeep Singh Gambhir
Department of Public Health Dentistry, Gian Sagar Dental College and Hospital, Rajpura, Punjab


Background: Oral health is an inseparable part of general health and there are large number of factors that influence the oral health of an individual such as attitude, awareness, literacy etc., The present study was carried out to assess the oral hygiene practices, attitude, and assess barriers among patients visiting the out-patient department (OPD) of Gian Sagar Dental College and Hospital, Rajpura. Materials and Methods: A cross-sectional study was conducted on 400 subjects who visited the OPD of Gian Sagar Dental College and Hospital. A self-constructed questionnaire was given to each of the participant. Statistical analysis was performed using the SPSS package version 15 (SPSS, Chicago, IL, USA). Number, percentages, and Chi-square test were used to do the necessary calculations. P < 0.05 was used to denote the statistical significance. Result: Majority of the subjects (62.8%) belonged to rural areas. 59.5% subjects had never visited dentist before. Lack of time was cited as a major barrier by majority of the subjects to avail dental treatment. A major proportion of the study subjects (64%) used to brush their teeth at least once a day. Smoking and chewing tobacco were reported by 17.6% of the male subjects and 4.2% of the female subjects. Conclusion: There is an urgent need for comprehensive educational programs to promote good oral health and impart oral health education so that barriers to oral health can be reduced.

How to cite this article:
Gill M, Pal K, Gambhir RS. Oral hygiene practices, attitude, and access barriers to oral health among patients visiting a rural dental college in North India.J Dent Res Rev 2014;1:114-117

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Gill M, Pal K, Gambhir RS. Oral hygiene practices, attitude, and access barriers to oral health among patients visiting a rural dental college in North India. J Dent Res Rev [serial online] 2014 [cited 2022 May 21 ];1:114-117
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India is the sixth biggest country geographically and is the second most populous country of the world. Factors contributing to the steady rise in prevalence of oral disease include poor oral health awareness. Oral health is an inseparable part of the general health and there are number of factors which influence the oral health of an individual such as diet, oral hygiene practices, socioeconomic status, geographic location, literacy etc. [1] Oral health knowledge is considered to be an essential prerequisite for health-related behavior. [2] The attitude of people toward their own teeth and the attitude of dentists who provide dental care, play an important role in determining the oral health condition of the population. [3]

Dental caries and periodontal diseases have historically been considered the most important global oral health burdens. At present, the distribution and severity of oral diseases vary in different parts of world and within the same country or region. [4] India is a vast country with diverse cultural practices, dietary habits, and geographical variations. About 60-70% of the population resides in rural areas. Rural mass is generally not able to reap the benefits compared to the urban residents. [1] Hence, it is imperative that health services should be made available to all rural/semi urban areas as well. Such people have been known not to seek dental care for a variety of reasons such as social reasons, physical reasons, psychological reasons etc., Although many studies have been carried out from time to time to assess the knowledge and behavior of people about oral health, there is still a dearth of education regarding the same especially for rural people, who make up for >70% of the population in India. [5] Furthermore, even the people living in cities, in spite of having easy reach to dental care, fall prey to dental diseases due to their negligence in dietary habits and unhealthy lifestyle. [6] Therefore, the present study was carried out:

To assess attitude and practices of patients regarding oral healthTo know about various access barriers faced by these people to avail treatment in the dental collegeTo suggest possible remedial measures if required.

 Materials and Methods

Study population and ethical clearance

A cross-sectional study was conducted on the patients visiting the out-patient department (OPD) of Gian Sagar Dental College and Hospital, Rajpura. Ethical clearance was obtained from the Ethical Committee of Gian Sagar Dental College and Hospital for conducting the study. A pilot survey was conducted on 50 subjects to judge the aptness of the questionnaire, and it was found that an average of 10 min was needed to answer all the questions.

Study sample

The study sample consisted of 400 subjects selected using a convenience sampling technique. Individuals older than 20 years of age were included in the study. The purpose of this study was informed and explained to the participants and those who voluntarily agreed to participate in the study and gave a written consent were asked to fill the questionnaire according to the response format provided in the questionnaire.

Data collection

The questionnaires were handed to the patients while they were seated in the waiting area of the OPD. At all times, one of the investigators was present with the respondent, while the questionnaires were being filled to ensure that the concerned respondent did not discuss the questions or the answers with any other patients sitting in the waiting area and also to make sure that the concerned respondent fully understood the questions as well as the probable answers completely.


A self-made closed ended questionnaire written in English language was given to each one of them. In order for them to fully understand the questionnaire, the subjects selected were above 12 years. The questionnaire form was divided into 2 parts. The first part of the questionnaire collected the demographic details of the individuals participating in the study such as age, sex, gender, and occupation [Table 1]. The subsequent part was designed with questions to assess attitude, practices, and various access barriers related to oral health.

Statistical analyses

The data were first transferred to Microsoft Excel (Microsoft Corporation, Redmond, WA, USA). Results were statistically analyzed using SPSS package version 15.0 (SPSS, Chicago, IL, USA) in terms of percentages. For other descriptive statistics, Chi-square test was used to test significance of association between two factors. P < 0.05 was selected to denote statistical significance.


This present study was done on 400 subjects. Among them, 65% were males and 35% were females. All the subjects were above 20 years of age. The age distribution was variable [Table 1]. The number of subjects in 21-30 age group was maximum being 139 (34.7%). Approximately, 251 (62.8%) study subjects belonged to rural areas and farming was the primary source of earning of 98 (24.5%) subjects.{Table 1}

When asked about availing any dental treatment in the past, 238 (60%) subjects had never visited dentist before [Figure 1] and among those who visited cited decayed tooth (92, 54.7%) and tooth pain (76, 45.2%) as the main reasons for their visit. When place of residence was taken into consideration, more percentage of urban people (55%) had visited the dentist before as compared to rural people (32%) and this difference was statistically significant (P = 0.02) [Table 2].{Table 2}{Figure 1}

When asked about the access barriers, lack of time because of other priorities was cited as the main reason for not seeking dental care by majority of the subjects (190, 61.5%) whereas less severity of the dental problem was cited as the second common reason which prevented them to avail dental care [Figure 2].{Figure 2}

[Figure 3] depicts the frequency of brushing teeth among the study subjects. It can be noted that majority of the study subjects (256, 64%) used to brush their teeth at least once a day and 26% (104) of the study subjects were brushing twice daily. Various deleterious habits were also reported by the study subjects [Figure 4]. Smoking and chewing tobacco were reported by 17.6% (44) of the male subjects and 4.2% (6) of the female subjects. 21.5% (56) of the male subjects used to consume alcohol as compared to 5.7% (8) of the female subjects. Moreover, there was a statistically significant association of brushing frequency with the presence of deleterious habits among the study population (P < 0.05) whereas there was no significant difference in case of age with brushing frequency (P > 0.05).{Figure 3}{Figure 4}


Oral health is an essential and integral component of health throughout life. [3] We as dental health professionals understand that the oral health is a standard of health of the oral and related tissues which enables an individual to eat, speak, and socialize without active disease, discomfort, or embarrassment and which contributes to general well-being. [7] People should be made aware of all these facts in order to lead a healthy and longer life.

Similar studies in different nations have also been carried out in the past to assess the knowledge, attitude, and behavior among different groups, professionals, students, and populations. The 1998 survey of Adult Dental Health in the UK was carried out under the auspices of the Office of National Statistics together with the Universities of Birmingham, Dundee, Newcastle-upon-Tyne, and Wales. [8] A key behavioral indicator in these decennial surveys is whether people say they go to a dentist for a regular dental check-up, an occasional dental check-up, or only when they have trouble with their teeth.

Unfortunately, oral health standards in India still pose a major problem due lack of awareness. Various barriers were reported by the subjects in the present study which prevented then to avail dental care. Similar findings were reported by subjects in another study conducted in Bulgaria. [9] However, results of a study conducted on adult population in Kuwait revealed some different access barriers. [10] Lack of time was one of the important barriers that prevent the patients from visiting the dentist in the present study. This finding is similar to some other study findings conducted on patients visiting another rural dental college. [1] Having no serious dental problem was the second most common barrier reported by the subjects for not seeing a dentist in the present study. This is comparable to the findings of some other study conducted in Southern China. [11] Ageing and financial constraints were reported as important barriers by some authors in some other study. [12]

About 60% of the subjects in the present study never visited a dentist and about 40% of the remaining only visited in case of a problem. Similar results were obtained in another study conducted in a dental college in India in which about 58% of subjects had never visited a dentist. [13] However, some contrasting results were obtained in some other study conducted in Karnataka in which only one-third of the subjects had never visited a dentist before. [14] When place of residence is taken into consideration, significantly more percentage of urban subjects had visited the dentist previously as compared to the rural subjects which is similar to findings of some other study. [13],[15] This may be due to the fact that most of the dental college hospitals and private dental clinics are within the city limits and very less or virtually no dental health care services are available in rural areas. This may contribute toward one of the access barriers for not availing dental services.

The findings of the present study revealed only 6% of subjects used to brush their teeth occasionally. This is contrary to some other study findings in which 44% of subjects used to brush their occasionally. [7] About 64% people brushed only once a day in the present study, which is more than the results of the study conducted elsewhere. [16] On the other hand, according to some other study reports, about 74% subjects brush their teeth about twice a day showing a vast difference in dental professionals and common people. [17] 16.1% of the male subjects and 8.5% of the female subjects used to chew tobacco (smokeless form) in the present study. On the contrary, very high prevalence of smokeless tobacco use was reported in both male and female subjects in another study conducted on dental patients in Maharashtra. [18] Findings of some other study conducted in an urban dental school revealed that 38.2% of the patients were consuming tobacco in some or the other form. [19]


Oral health has the potential to be forgotten beside other health needs. However, its contribution to overall health reinforces the importance of oral health. In rural population, barriers to accessing dental health care may exacerbate oral health problems by delaying preventative and curative dental health services, leading to greater health concerns and societal costs. Multiple causes exist and simultaneously interact to influence uneven or limited access to dental health care services. Despite of accessible dental health center, the rural population is still unable to seek dental treatment depicting their negligence, lack of knowledge, and unawareness toward their oral health. Acknowledging social causes and distributing accountability allow the diverse participation of constituencies, strengthening efforts to address health inequalities in rural areas. Access to care strategies can occur on the local, state, and national level. By working with communities, rather than simply for communities, interventions can lead to sustainable oral health improvement.


1Randhawa AK, Veeresha KL, Gambhir RS, Sohi RK, Bansal V, Dodamani A. Assessment of oral health status, treatment needs, coverage and access barriers of patients reporting to a rural dental college in Northern India. J Indian Assoc Public Health Dent 2011;18:899-904.
2Ashley FP. Role of dental health education in preventive dentistry. In: Murray JJ, editor. Prevention of Dental Disease. 3 rd ed. Oxford: Oxford University Press; 1996. p. 406-14.
3Gholami M, Pakdaman A, Montazeri A, Jafari A, Virtanen JI. Assessment of periodontal knowledge following a mass media oral health promotion campaign: A population-based study. BMC Oral Health 2014;14:31.
4Patil AV, Somasundaram KV, Goyal RC. Current health scenario in rural India. Aust J Rural Health 2002;10:129-35.
5Gundala R, Chava VK. Effect of lifestyle, education and socioeconomic status on periodontal health. Contemp Clin Dent 2010;1:23-6.
6Singh A, Gambhir RS, Singh S, Kapoor V, Singh J. Oral health: How much do you know? - A study on knowledge, attitude and practices of patients visiting a North Indian dental school. Eur J Dent 2014;8:63-7.
7Jain N, Mitra D, Ashok KP, Dundappa J, Soni S, Ahmed S. Oral hygiene-awareness and practice among patients attending OPD at Vyas Dental College and Hospital, Jodhpur. J Indian Soc Periodontol 2012;16:524-8.
8Nuttall NM, Bradnock G, White D, Morris J, Nunn J. Dental attendance in 1998 and implications for the future. Br Dent J 2001;190:177-82.
9Rechel B, Blackburn CM, Spencer NJ, Rechel B. Access to health care for Roma children in Central and Eastern Europe: Findings from a qualitative study in Bulgaria. Int J Equity Health 2009;8:24.
10Al-Shammari KF, Al-Ansari JM, Al-Khabbaz AK, Honkala S. Barriers to seeking preventive dental care by Kuwaiti adults. Med Princ Pract 2007;16:413-9.
11Lo EC, Lin HC, Wang ZJ, Wong MC, Schwarz E. Utilization of dental services in Southern China. J Dent Res 2001;80:1471-4.
12Thomas S. Barriers to Seeking dental care among elderly in a rural South Indian population. J Indian Acad Geriatr 2011;7:60-5.
13Devaraj CG, Eswar P. Association between socio-demographic factors and dental service utilization among people visiting a dental college hospital in India - A descriptive cross-sectional study. Indian J Stomatol 2011;2:212-5.
14Poudyal S, Rao A, Shenoy R, Priya H. Utilization of dental services in a field practice area in Mangalore, Karnataka. Indian J Community Med 2010;35:424-5.
15Ugur ZA, Gaengler P. Utilisation of dental services among a Turkish population in Witten, Germany. Int Dent J 2002;52:144-50.
16Zhu L, Petersen PE, Wang HY, Bian JY, Zhang BX. Oral health knowledge, attitudes and behaviour of adults in China. Int Dent J 2005;55:231-41.
17Neeraja R, Kayalvizhi G, Sangeetha P. Oral health attitudes and behavior among a group of dental students in Bangalore, India. Eur J Dent 2011;5:163-7.
18Kasat V, Joshi M, Somasundaram KV, Viragi P, Dhore P, Sahuji S. Tobacco use, its influences, triggers, and associated oral lesions among the patients attending a Dental Institution in rural Maharashtra, India. J Int Soc Prev Community Dent 2012;2:25-30.
19Epstein JB, Villines D, Drahos G, Kaufman E, Gorsky M. Oral lesions in patients participating in an oral examination screening week at an urban dental school. J Am Dent Assoc 2008;139:1338-44.