RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESKARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidate and address (in block letters)

AJINAS A. M.I YEAR M. Sc. NURSINGINDIRA NURSING COLLEGEFALNIRMANGALORE - 575002

2. Name of the Institution INDIRA NURSING COLLEGEFALNIRMANGALORE - 575002

3. Course of Study and Subject M. Sc. NURSINGCOMMUNITY HEALTH NURSING

4. Date of Admission to the Course 15.07.2011

5. Title of the study

A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO

ASSISTED TEACHING PROGRAMME ON ORAL HYGIENE

AMONG RURAL PRIMARY SCHOOL CHILDREN AT

MANGALORE, DAKSHINA KANNADA DISTRICT.

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6. Brief resume of the intended work

Introduction

Oral health is an integral component of general health. Research in the past few years

has revealed the causal link between oral diseases and systemic diseases. Oral health has

also been found to profoundly influence the quality of life. Dental caries and periodontal

disease are the highly prevalent diseases in many populations. They are highly irreversible

once they occur and also have complex aetiology. Although primary preventive techniques

exist, they do not confer total protection.

Dental caries continues to be a major problem in many countries, especially in developing

countries like India, where it is consistently reflecting increasing trend in last couple of

decades. The point prevalence surveys have shown persistence of “untreated carious lesions”

among children in rural areas. It reflects either non-availability of oral health care services or

poor oral health seeking behavior of rural people. Awareness related to oral health among

them is also found to be poor 1

6.1 Need for the study

India is facing many challenges in rendering oral health care to the rural masses. Out

of these 70-72% residing in rural areas more than 40% are children. This report is based on

research survey with respect to different parameters i.e. Oral hygiene practices, dietary

pattern, tobacco smoking & chewing, media habits and awareness regarding dental treatment

to get the complete overview of the existing oral health related problems and the factors

responsible for poor oral health among rural children.

The main purpose of dental hygiene is to prevent the build-up of plaque, the sticky

film of bacteria that forms on the teeth. Bacterial plaque accumulated on teeth because of

poor oral hygiene is the causative factor of the major dental problems.

Poor oral hygiene allows the accumulation of acid producing bacteria on the surface

of the teeth. The acid demineralizes the tooth enamel causing tooth decay (cavities). Dental

plaque can also invade and infect the gums causing gum disease and periodontitis. In both

conditions, the final effect of poor oral hygiene is the loss of one or more teeth. You should

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not wait until a tooth is lost, just then to understand the importance of oral hygiene and

preventive care.

Many health problems of the mouth, such as oral thrush, trench mouth, bad breath

and others are considered as effect of poor dental hygiene. Most of these dental and mouth

problems may be avoided just by maintaining good oral hygiene

Prevention is always better than treatment. Good oral hygiene habits will keep away

most of the dental problems saving you from tooth aches and costly dental treatments. The

interesting part is that it can be achieved by dedicating only some minutes every day to

dental hygiene care. A large number of various oral hygiene products, beyond the usual

toothpaste and toothbrush, are available in the market to help you in this effort.

Unfortunately, most of us remember the importance of oral hygiene instructions only

when a problem occurs. Research has shown that while patient activation can show an

immediate improvement in oral hygene habits, only a small percentage keeps the same

standards six months later. Maintaining good dental hygiene should be a lifelong everyday

habit.

Awareness regarding the importance of oral hygiene has significantly increased in

the developed countries, but contrary to that, the modern dietary lifestyle habits are posing a

greater risk for oral health. Healthy teeth not only enable you to look and feel good, they

make it possible to eat and speak properly. Good oral health is important to your overall

well-being.

Daily preventive oral care, with proper brushing and flossing, will help stop dental

problems before they develop and are much less painful, expensive, and worrisome than

treating conditions that have been allowed to progress.2

6.2 Review of literature

Review of literature is a key step in research process. The typical purpose of

analyzing a review question is to identify what is known and unknown.

The review of literature of the present study id divided into the following aspects:

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Studies related to oral health status of children.

Studies related to prevalence of dental caries in school children

Studies related to importance of Dental Health education.

1. Studies related to oral health status

A study was conducted to assess the oral health status of 5 years and 12 years school

going children in Chennai city. The study population consisted of 1200 school children of

both the sexes (600 private and 600 corporation school children) in 30 schools, which had

been selected randomly. The survey is based on WHO, 1999 Oral Health Assessment, which

has been modified by including gingival assessment, enamel opacities/ hypoplasia for 5

years. Evaluation of the oral health status of these children revealed, dental caries is the most

prevalent disease affecting permanent teeth, more than primary teeth and more in

corporation than in private schools, thereby, correlating with the socioeconomic status. It

may be concluded that the greatest need of dental health education is at an early age

including proper instruction of oral hygiene practices and school based preventive programs,

which would help in improving preventive dental behaviour and attitude which is beneficial

for life time.4

A randomized clinical trial and oral health-promotion program conducted by

Department of Community Dentistry, Institute of Dentistry, University of Oulu, Oulu,

Finland The aim of our study was to compare the changes in children's oral health-related

behavior, knowledge, and attitudes obtained using an oral health-promotion approach, a risk-

strategy and promotion approach, and reference area, and to report changes in the behavior

of children between the experimental and the control groups of a randomized clinical trial

(RCT). The study population consisted of all fifth and sixth graders who started the 2001-

2002 school year in Pori, Finland (n = 1,691), where the RCT and program of oral health

promotion were implemented for 3.4 yr. Children with at least one active caries lesion were

randomly assigned to experimental (n = 250) and control (n = 247) groups. Children in

Rauma (n = 807) acted as the reference. Changes in children's self-reported behavior,

knowledge, and attitudes were compared between groups. The subjects in the oral health-

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promotion group and in the risk-strategy and promotion group in Pori tended to show greater

improvement in most of their oral health-related behaviors than those in the reference group,

and children in the RCT experimental group showed greater improvement in most of their

oral health-related behaviors than those in the RCT control group. Children can be helped to

improve their oral health-related behavior by intervention, including oral hygiene and dietary

counseling, or by implementing a multilevel-approach oral health-promotion program.5

2. Studies related to prevalence of dental caries in children

A study was carried out to know the prevalence of dental caries in 509 primary

school children in the age group of 3-7 years in Rohtak, Haryana. The mean prevalence of

caries in all the age group from 3 to 6 year was 33.8% while the prevalence 6 years was

38.2%. It was seen that prevalence was significantly higher (P < 0.05) at the age of 6 years

as compared to 3 years. Deciduous molars were most affected by caries and prevalence of

restored teeth was 1.2%. The difference between males and females was statistically

significant and the mean dmft per child was found to be 0.73 and mean dmft per affected

child was 2.37. Assessment regarding oral hygiene habits depicted that only 3% of children

cleaned their teeth once a day with tooth brush and tooth paste.6

Dental caries and periodontal disease, the most commonly seen disease show striking

geographic variation, socio-economic patterns and severity of distribution all over the world.

Hence, an attempt has been made to determine the relationship of oral health status with

socio-economic status in Davangere town. A total of 2007 children of 13 to 14 years age

belonging to both sexes were examined. Type III examination was carried out during the

survey. DMFcaries Index and Oral Hygiene Index was used to assess caries experience and

oral hygiene status. Prasad's classification was used to know the social classification of the

children. It was concluded that dental caries experience and oral hygiene status of children

are strongly correlated to socio-economic status.7

Dept. of Periodontics and Preventive Dentistry, Govt. Dental College,

Thiruvananthapuram conducted epidemiological study to establish the prevalence and

severity of dental caries among primary school children of Varkala municipal area. The

prevalence of dental caries was 68.5% with a standard error (SE) of 1.64% and 95%,

confidence interval (CI) 65.18, 71.82. The highest caries prevalence was found among 10

5

year age group (75.9%) and lowest in the 8 year age group (63%).The highest dmft score

was found in 9 year age group 2.73 +/- 0.443 and highest DMFT score was found in 12 year

age group 2.06 +/- 0.3824. Statistically significant association was found with dental caries

and oral hygiene status(Odds Ratio (OR) 3.59, 95% CI, 2.53, 5.06 and oral cleanliness OR

2.73, 95% CI 2.96, 3.82). Statistically significant association was found between low

socioeconomic status and prevalence of caries (O.R. 1.89, 95% CI--1.28, 2.8).8

3. Studies related to Dental Health Education

Department of Community Dentistry, Yenepoya Dental College, Yenepoya

University, Deralakatte, Mangalore-575 018, India.conducted studyto determine the

effectiveness of school DHE, conducted at repeated and differing intervals, in improving

oral health knowledge, practices, oral hygiene status, and the gingival health of

schoolchildren belonging to two socioeconomic classes. Study conducted for 36-week

duration and study assessed the effectiveness of school DHE conducted every three weeks

against every six weeks on oral health knowledge, practices, oral hygiene status and gingival

health of 415, 12- to 13-year-old schoolchildren belonging to social classes I and V. Of the

three selected schools of each social class, one each was subjected to the intervention of

either three or six weeks or was a control, respectively. Oral health knowledge and practices

were evaluated using a questionnaire. Oral hygiene and gingival health were assessed using

plaque and gingival indices. The results shows that plaque and gingival score reductions

were highly significant in intervention schools, and were not influenced by the

socioeconomic status. When oral health knowledge was evaluated, highly significant

changes were seen in intervention schools; more significantly in schools receiving more

frequent interventions. The socioeconomic status influenced the oral hygiene aids used and

the frequency of change of toothbrush. Controls showed no significant changes throughout.9

Department of Pediatric and Preventive Dentistry, Araçatuba School of Dentistry,

Araçatuba, SP, Brazil,conducted Oral health education in schools and promoting health

agents.The aim of this study was to verify the influence of preschool children participating

in an oral health education programme on daily health practices of their families, through

parent's perception.A sample of 119 parents of 5- to 6-year-old preschool children were

selected. Data were collected using a structured open-closed questionnaire, self-

administered. The questions focused on parents' knowledge about activities of oral health

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education conducted in school, the importance given by them to these activities, learning

from their offspring and the presence of habit change at home. In total, 63 (52.9%)

parentsagreed to participate. Ninety-eight per cent knew about educative and preventive

activities developed at school and all of them affirmed that these activities were important,

mainly because of knowledge, motivation and improvement inchildren's health. Ninety and

half per cent of parents reported that they learnedsomething about oral health from their

children and, among these, almost half (47.8%) cited toothbrushing as the indicator for better

learning. Besides this, 87.3% of participants revealed the change in oral health habits of their

family.10

Federal University of Rio Grande of North, Brazil conducted a health education

program for Brazilian public schoolchildren about the effects on dental health practice and

oral health awareness. The study was aimed to determine the impact of an oral health

education program on oral hygiene and the awareness level of elementary schoolchildren. A

total sample of 247 schoolchildren between the ages of 7 and 15 years from the public

school system of Parnamirim, Brazil, were selected and randomly allocated to a control

(n=115) and experimental (n=132) group. Sociodemographic data were recorded and a

clinical examination was given to establish the decayed, missing and filled surfaces index

(DMFS) and the dmfs index. The visible plaque index (VPI) and gingival bleeding index

(GBI) were collected before and after the intervention. A closed-question questionnaire was

applied to the schoolchildren before and after intervention to determine their knowledge of

oral health. The experimental group took part in oral health education activities over a 4-

month period. The results shows VPI (P = 0.014; CI 0.24-0.86) and GBI (P = 0.013; CI

(0.28-0.87) of the experimental group were significantly lower after educational activities.

Similarly, the experimental group also obtained a higher number of correct answers on the

questionnaire (P < 0.0001; CI 3.73-26.81). However, there was no association between oral

hygiene indicators, VPI (P = 0.311; CI (0.23-1.60), and GBI (P = 0.927; CI 0.43-2.16), and

the information level of the schoolchildren. It concludes that on textualized educational

activities in the school routine had positive effects on oral hygiene and the level of

information about oral health, although the more informed individuals did not always

practice better oral hygiene.11

In Holland University, Amsterdam, Netherlands, conducrted Dental Hygiene Education

under BuddhiBangara Project on oral health promotion for 3- to 5-year old children on

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collaborative programme combining support, education and research in Nepal.The overall

purpose of the BuddhiBangara Project (BBP) is to investigate if oral health promotion

(OHP) will be a realistic way to improve the oral hygiene and dental awareness of Nepalese

schoolchildren aged 5-12 years. This study is the first aspect of the overall project. Dental

hygiene students from Kantipur School of Dentistry, Kathmandu and the Dental Hygiene

Programme at the INHOLLAND University in Amsterdam were actively involved in this

assessment phase as well as the implementation phase which included oral health education

activities. This descriptive study is the first phase of a larger longitudinal study directed

towards improving the oral health of children in Nepal. The first phase involves the

assessment of children in several schools, one of which acts as a control group. It is directed

toward the baseline data collected prior to the implementation of the OHP initiatives.

Qualitative data on knowledgeabout oral health was collected through observations and a

questionnaire. TheWorld Health Organization community index of treatment needs was used

to assess the clinical status of the participants. The data show that knowledge about

preventing oral diseases is high, but awareness about the benefits of fluoride is low. It also

suggests that the oral health of the examined children is affecting their quality of life in

several different ways. The social status of participants appears to influence their dietary

intake as well as their choice of professionals to visit when experiencing pain. It appears that

children in Nepal have oral health problems and oral health does appear to influence their

quality of life.12

6.3 Statement of the problem

A study to assess the effectiveness of video assisted teaching program on oral

hygiene among rural primary school children at Mangalore, Dakshina Kannada district.

6.4 Objectives of the study

1. Assess the knowledge of Oral Hygiene among primary school children.

2. Determine the effectiveness of Video Assisted Teaching program among Primary

School children.

3. Associate the selected demographic variables with level of knowledge through pre-

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test and post- test.

6.5 Operational definitions

1. Effectiveness: This refers to significant difference between pre and post-test

knowledge score regarding oral hygiene after administering a video assisted teaching

program.

2. Video assisted teaching: It is a systematically planned audio visual teaching on oral

hygiene. It includes various brushing methods, preventive measures for oral diseases,

various dental health promotional activities.

3. Primary School Children: Children who belong to class 1 – 5 between the age

group 6 – 10 years.

6.6 Hypotheses

H1: The mean post-test knowledge score of the primary school children will be

significantly higher than the mean pre-test knowledge score.

H2: There will be significant association between knowledge scores and selected

demographic variables

6.7 Assumptions

The primary school children may have inadequate knowledge regarding oral hygiene.

Video assisted teaching program may enhance their knowledge regarding oral

hygiene.

6.8 Delimitations

The study is delimited to primary school children.

The study is delimited to selected primary school children in Mangalore.

The study is delimited to knowledge aspect only.

7. Material and methods

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7.1 Source of data

Primary school children studying in class 1 to 5, in the age group 6 to 10 years.

7.1.1 Research design

The one pre-test and post-test design.

Variables

Independent variable: Video assisted teaching program.

Dependent variable: Knowledge of primary school children.

7.1.2 Setting

Study will be conducted in 60 students selected from the total of 220 students in

Dakshina Kannada Zilla Higher Primary school, Moodushedde situated 25 KM away from

the college.

7.1.3 Population

In the present study, the population will be rural primary school children who are

willing to participate in the study.

7.2 Method of data collection

7.2.1 Sampling technique

Non-randomized purposive sampling technique

7.2.2 Sample size

The proposed sample size for the present study is 60.

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7.2.3 Inclusion criteria for sampling

Primary school children.

Children those who are present on the day of teaching program.

Children who can understand Kannada.

Children those who are willing to participate.

7.2.4 Exclusion criteria for samplings

Children those who are absent on the day of teaching program.

Children those who are not willing to participate.

7.2.5 Instruments intended to be used

Section A: Socio demographic questionnaire prepared by the investigator.

Section B: Structured knowledge questionnaire will be developed to assess the knowledge

regarding oral hygiene among primary school children.

7.2.6 Data collection method

1. A prior formal permission is obtained from the higher authority of the school.

2. Consent of all the participants will be obtained prior to the study.

3. Structured questionnaire will be administered to assess the knowledge on oral

hygiene.

4. Video assisted teaching program will be given to the children on the same day itself.

5. Post-test will be conducted with same structured knowledge questionnaires among

the school children after 7 days.

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7.2.7 Plan for data analysis

The investigator will

1. Organize the data in master sheet/computer.

2. Frequencies and percentage of the analysis of demographic data.

3. Chi square testing method will be used to determine the significance and association

between the demographic variables.

7.3 Does the study require any investigations or interventions to be conducted on

patients, or other animals? If so please describe briefly.

No, the study does not require administration of video assisted teaching program

among school children of Mangalore.

7.4 Has the ethical clearance obtained from the institution?

Yes, permission has being obtained from the Principal of Indira Nursing College

Permission is obtained from the authority of the school. Before conducting the study,

permission will be obtained from the participants.

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8. References

1. Raju HG, Nagesh L, Deepa D. Oral health promotion and prevention activities

carried out in rural areas of Davanagere District, Bapuji dental college And Hospital

Davengere. GOI-WHO Collaborative Programme, 2006-2007.

2. WHO. Oral Health Facts Sheets, 2011. [online]. Available from:

URL:http//www.who.int/mediacentre/factsheets/fs318/en/index.html.

3. Friel S, Hope A, Kelleher C, Comer S, Sadlier D. National Nutrition Surveillance

Centre, Department of Health Promotion, National University of Ireland, Galway and

Dental Health Foundation, Dublin, Ireland.

4. Kumar MP, Joseph T , Varma RB , Jayanthi M. Ragas Dental College and Hospital,

East Coast Road, Uthandi, Chennai.

5. Tolvanen M, Lahti S, Poutanen R, Seppä L, Pohjola V, Hausen H. Department of

Community Dentistry, Institute of Dentistry, University of Oulu, Oulu, Finland.

[online]. Available from: URL:URL:http//mimmi.tolvanen@oulu.fi

6. Tewari S, Tewari S. Department of Preventive and Community Dentistry, Govt.

Dental College, Rohtak. Indian Soc Pedod Prev Dent 2001 Jun;19.

7. Sogi GM, Bhaskar DJ. Dept. of Community Dentistry, Albadar Dental College &

Hospital, Gulbarga, Karnataka. PMID: 12587751 [PubMed - indexed for MEDLINE]

8. Retnakumari N. Dept. of Periodontics and Preventive Dentistry, Govt. Dental

College, Thiruvananthapuram. J Indian Soc Pedod Prev Dent 1999 Dec;17(4):135-

42.

9. Shenoy RP, Sequeira PS. Department of Community Dentistry, Yenepoya Dental

College, Deralakatte, Mangalore, India Indian J Dent Res 2010 Apr-Jun;21.

10. Garbin C, Garbin A, Dos Santos K, Lima D. Department of Pediatric and Preventive

Dentistry, Araçatuba School of Dentistry, UNESP-São Paulo State University,

Araçatuba, SP, Brazil, cgarbin@foa.unesp.br, Int J Dent Hyg 2009 Aug;7(3):212-6.

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11. De Farias IA, de Araújo Souza GC, Ferreira MA. Federal University of Rio Grande

of North, Brazil. J Public Health Dent 2009 Fall;69(4):225-30, PMID: 19453867

12. Knevel RJ, Neupane S, Shressta B, de Mey L. Dental Hygiene Education, IN

HOLLAND University, Amsterdam, The Netherlands ron.knevel@inholland.acta.nl,

Int J Dent Hyg 2008 Nov;6(4):337-46.

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9. Signature of the candidate

10. Remarks of the guide

11. Name and designation of (in block letters)

11.2 Guide PROF. (MRS.) INDIRANIHOD, COMMUNIT HEALTH NURSINGINDIRA NURSING COLLEGEFALNIR, MANGALORE – 575 002.

11.2 Signature

11.3 Co-guide (if any)

11.4 Signature

12 12.1 Head of the department PROF. (MRS.) INDIRANIHOD, COMMUNIT HEALTH NURSINGINDIRA NURSING COLLEGEFALNIR, MANGALORE – 575 002.

12.2 Signature

13. 13.1 Remarks of the Chairman and Principal

13.2 Signature