Medicine/9.Hygiene and Epidemiology

c.med.s Mikhailova T.V., Dubrovina-Parus T.A.

Crimea State Medical University, Department of Therapeutic Dentistry

Studing of hygiene level education in school by questionnaires.

Regular and proper oral care is an integral part of all preventive and curative measures. Proper oral care - a guarantee that it will not form plaque, which is one of the leading pathogenetic factors in the development of dental caries and periodontal diseases. The literature has accumulated sufficient data on the relationship between the state of the teeth and periodontal tissues, on the one hand, and the quality of the sanitary oral care on the other [1,3,10,11].

Formation of the population of motivation to preserve dental health - the main task of preventive work [4,6]. According to WHO, health education is a basic method of prevention. Vaccinated population skills to maintain dental health - a long and difficult process, which includes such necessary elements as health education, hygiene education and training and monitoring their implementation. [2] It is known that the earlier start to teach children to treat oral, the greater the likelihood that this area will not have the disease process [7,8]. This aspect of work is considered an important element for dental services in different countries, where priority is the prevention of dental diseases. Among the social factors influencing the prevalence and intensity of caries distinguished: poor sanitation and living conditions, the level of hygiene knowledge of children, parents and teachers [4,9].

An important direction in the prevention of dental disease is a health education and training of the child population [7,8]. Hygiene education includes two sections: health education and training in oral hygiene.

Despite the fact that the issues of health education are constantly in sight dentists, knowledge and skills of the population are still at a low level.

According to our data, oral hygiene station of children in Crimea school is unsatisfactory. The hygienic index by Fedorov-Volodkin averaged 2.18 points in Crimea, on the South Coast of Crimea - 2.36 (in Yalta - 2.35) in the foothill region - 2.08 (2.04 in Simferopol) in the typical steppe region - 2.20 (in Evpatoria - 2.21).

Questioning - one of the available and simple methods for the study of knowledge and skills for oral health. [5]

Purpose. The study using questionnaires and comparative evaluation of hygienic knowledge and skills in the oral care of children and adolescents living in different climatic and geographical regions of Crimea.

Materials and methods. Questionnaires was carried out among 573 children and adolescents in age group of 9-17 years old, living in a 3-climatic and geographical regions: the steppe, the foothill region of plain Crimea and SCC (South Coast of Crimea). The proportion of boys and girls in each of the three studied regions of the Crimea was approximately equal in all age groups (271 boys, 47.3% and 302 girls, or 52.7%). Number of pupils who participated in the questionnaires is presented in Table 1.

Table 1. Contingents of Crimea students participated in questioning (people / %)

Pupils populations	Crimea	Climatic and geographical regions of Crimea
		the steppe	the foothill region	SCC
Boys	271 / 47,3%	162 / 43,9%	39 / 47,6%	70 / 57,4%
Girls	302 / 52,7%	207 / 56,1%	43 / 52,4%	52 / 42,6%
Total pupils	573 / 100%	369 / 100%	82 / 100%	122 / 100%

Age and sex composition of the Crimea pupils to explore the level of knowledge on oral health are presented in Table 2.

Table 2. Age and sex composition of the Crimea pupils who participated in questioning (person.% of all respondents)

Age of pupils	Climatic and geographical regions of Crimea
	Crimea		the steppe		the foothill region		SCC
	Abs	%	Abs	%	Abs	%	Abs	%
9 years	10	1,7	7	1,2	3	0,5	-	-
10 years	74	12,9	51	8,9	22	3,8	1	0,2
11 years	62	10,8	52	9,1	4	0,7	6	1,1
12 years, of which: boys girls	140 68 72	24,4 11,9 12,5	59 27 32	10,3 4,7 5,6	33 15 18	5,8 2,6 3,1	48 26 22	8,4 4,5 3,8
13 years	84	14,6	53	9,3	5	0,9	26	4,5
14 years	69	12,0	46	8,0	-	-	23	4,0
15 years	61	10,6	55	9,6	1	0,2	5	0,9
16 years	61	10,6	41	7,2	12	2,1	8	1,4
17 years	10	1,7	5	0,9	2	0,4	3	0,5
TOTAL:	573	100	369	100	82	100	122	100

Structured questionnaires included our test tasks and contained specific questions about oral health knowledge and skills of dental care. Then questionnaires were processed statistically, the correlation analysis was used. Children and adolescents answered independently on questions designed specifically. Questionnaire suggested to obtain information about the frequency of tooth brushing and the use of funds of the oral care and others. The majority of respondents gave detailed answers to the questionnaire.

Own investigations.

As a result of our survey of schoolchildren, the following results were obtained. Data analysis on major issues and questionnaire responses is presented in table 3.

26,70% of Crimea children believe they have bad teeth (22,22% - in the foothill region of Crimea, 31,71% - in the steppe and 36,89% - in the South Coast). 52,53% sure that they have healthy teeth (56,64% - in the foothill region of Crimea, 42,68% - in the steppe and 46,72% - in the South Coast), and 21,29% are hesitant in answering this question (21,68% - in the foothill region of Crimea, 25,61% - in the steppe and 17,219% - in the South Coast).

More oral hygiene means than a toothbrush do not use for cleaning teeth, 49,21% questionnaired Crimea children (43,90% - in the foothill region Crimea, 63,41% - in the steppe and 55,74% - in the South Coast). Toothpicks are used 43,11% of the Crimean pupils (48,51% - in the foothill region of Crimea, 32,93% - in the steppe and 33,619% - in the South Coast). As an additional means of oral hygiene dental floss use 13,79% of children in Crimea. Most questionnaired using dental floss, live in the foothill region of Crimea (17,62%), the least - in the steppe region (3,66%), and the South Coast – 9,02%. Other items (matches, needles, etc.), non-hygiene use 2,09% of the Crimea children, 1,90% of pupils - in the foothill region region of Crimea, 1,22% - in the steppe and 3,29% - in the South Coast. To the question "How often do you change your toothbrush?" Received the following answers. The answer is "One time in 3 months" gave 38,39% of the pupils of the Crimea: 41,46% - in the foothill region of Crimea, 28,05% - in the steppe and 36,07% - in the South Coast. Twice a year, change the toothbrush 16,40% of all children of the Crimea: 16,80% - in the foothill region of Crimea, 19,51% - in the steppe and 13,11% - in the South Coast; once a year – 16,23% of children of Crimea (14,36% of children living in the foothill region of Crimea, 18.29% - in the steppe and 20,49% - in the South Coast). Change your toothbrush with a new one if it is unusable, 20,42% of the children of Crimea (18,43% - in the foothill region of Crimea, 23,17% - in the steppe and 24,59% - in the South Coast).

Table 3. The level of Crimea pupils knowledge on the basics of oral hygiene.

№	Criteria level of hygiene knowledge (questions and answers)		Crimea				the steppe				the foothill region			SCC
			abs		%		abs		%		abs		%	abs		%
1	Do you have a sick teeth?
	Yes		153		26,70		82		22,22		26		31,71	45		36,89
	No		301		52,53		209		56,64		35		42,68	57		46,72
	Don’t know		122		21,29		80		21,68		21		25,61	21		17,21
2	Do you use a dentifrice additional means?
	No		282		49,21		162		43,90		52		63,41	68		55,74
	Toothpicks		247		43,11		179		48,51		27		32,93	41		33,61
	dental floss		79		13,79		65		17,62		3		3,66	11		9,02
	Other items		12		2,09		7		1,90		1		1,22	4		3,28
3	How often do you change your toothbrush to a new one?
	Once a year		93		16,23		53		14,36		15		18,29	25		20,49
	Twice a year		94		16,40		62		16,80		16		19,51	16		13,11
	Once every 3 months		200		38,39		153		41,46		23		28,05	44		36,07
	More than once in 3 months		40		6,98		29		7,86		4		4,88	7		5,74
	When unusable		117		20,42		68		18,43		19		23,17	30		24,59
4	Do you rinse your mouth after you eat?
	Yes		285		49,74		177		47,97		54		65,85	54		44,26
	No		121		21,12		72		19,51		16		19,51	33		27,05
	Sometimes		176		30,72		124		33,60		14		17,07	38		31,15
5	Do you rinse you mouth after brushing your teeth?
	No		12		2,09		9		2,44		2		2,44	1		0,82
	Rinse with water		540		94,24		348		94,31		78		95,12	114		93,44
	Rinse mouthwash		23		4,01		16		4,34		1		1,22	6		4,92
6		What do you use to clean teeth?
		Toothpaste	571	99,65		368		99,73		82		100,00			121		99,18
		tooth powder	13	2,27		9		2,44		1		1,22			3		2,46
7		How often do you brush your teeth?
		1 time in the morning	74	12,91		42		11,38		16		19,51			16		13,11
		1 times in the evening	15	2,62		9		2,44		1		1,22			5		4,10
		2 times in the morning and evening	432	75,39		286		77,51		62		75,61			84		68,85
		More than 2 times a day	45	7,85		30		8,13		3		3,66			12		9,84
		I clean every day	11	1,92		5		1,36		1		1,22			5		4,10
8		How much time do you spend brushing your teeth?
		1 min	45	7,85		24		6,50		8		9,76			13		10,66
		2 min	124	21,64		79		21,41		12		14,63			33		27,05
		3 мин	213	37,17		147		39,84		31		37,80			35		28,69
		4 min	101	17,63		61		16,53		17		20,73			23		18,85
		5 min and more	103	17,98		68		18,43		18		21,95			17		13,93
9		How often do you visit a dentist?
		When a toothache	239	41,71		136		36,86		43		52,44			60		49,18
		When I feel that there is a cavity in the tooth	155	27,05		105		28,46		27		32,93			23		18,85
		1 time a year	56	9,77		37		10,03		7		8,54			12		9,84
		2 times a year	89	15,53		67		18,16		6		7,32			16		13,11
		More than 2 times a year	11	1,92		9		2,44		-		-			2		1,64
		Less than 1 time a year	26	4,54		17		4,61		2		2,44			7		5,74
		does not appeal	25	4,36		18		4,88		2		2,44			5		4,10
10		Whether you trained of oral care?
		Yes	302	52,71		176		47,70		48		58,54			78		63,93
		No	261	44,54		91		51,76		29		35,37			41		33,61
		I do not remember	6	1,05		1		0,27		4		4,88			1		0,82
11		Who taught you about of oral care?
		Parents	515	89,88		340		92,14		73		89,02			102		83,61
		Health workers	126	21,99		82		22,22		17		20,73			27		22,13
		School teachers	18	3,14		8		2,17		4		4,88			6		4,92
		Nobody taught	13	2,27		7		1,90		2		2,44			4		3,28
12		Are you forced by parents to brush your teeth?
		Yes	117	20,42		61		16,53		14		17,07			42		34,43
		No	46	80,28		314		85,09		66		80,49			80		65,57
		Sometimes	3	0,52		2		0,54		1		1,22			-		-

After the meal, always rinse the mouth with 49,74% of the pupils of Crimea (47,97% - in the footfill region, 65,85% - in the steppe and 44,26% - in the South Coast). Occasionally rinse your mouth after eating – 30,72% of children of Crimea (33,60% - in the foothill region, 17,07% - in the steppe and 31,15% - in the South Coast). Do not rinse your mouth after eating – 21,12% questionnaires children (19,51% - in the foothill region of Crimea, 19,51% - in the steppe and 27,05% - in the South Coast). Mouthwash (oral rinse) are just 4,01% of all children of the Crimea: 4,34% - in the foothill region, 1,22% - in the steppe and 4,92% - in the South Coast. Dentifrice use toothpaste 99,65% of the pupils of the Crimea, and tooth powder - 2,27%. Brush your teeth twice a day (morning and evening), 75,39% of all children of Crimea (77,51% - in the foothill region, 75,61% - in the steppe and 68,85% - in the South Coast). Once in the morning to brush their teeth, 12,91% of the pupils (11,38% - in the foothill region of Crimea, 19,51% - in the steppe and 13,11% - in the South Coast). Brush your teeth every day – 1,92% questionnaires (1,36% - in the foothill region of Crimea, 1,22% - in the steppe and 4,10% - in the South Coast). Within three minutes, brushing their teeth 37,17% pupils of Crimea (39,84% of the children in the foothill region, 37,80% - in the steppe and 28,69% - in the South Coast). Less than three minutes teeth are brushed 29,49% of all children of Crimea (27,91% - in the foothill region, 24,39% - in the steppe and 37,71% - in the South Coast). Duration of brushing your teeth more than three minutes in the responses observed 35,61% of the pupils of the Crimea: 34,93% - in the foothill region, 42,68% - in the steppe and 32,78% - in the South Coast. Refer to the dentist 2 times a year for inspection 15,53% of all children of Crimea (18,16% - in the foothill region, 7,32% - in the steppe and 13,11% - in the South Coast). Go to the dentist for medical help turn when they feel that the tooth is carious cavity, but it still does not hurt, 27,05% pupils of Crimea (28,46% - in the foothill region, 32,93% - 18.85 in the steppe and % - in the South Coast). With a toothache treated to the dentist, 41,71% of Crimean children, of whom 36,86% - in the foothill region, 52,44% - in the steppe and 49,18% - in the South Coast. 45,44% of the pupils of the Crimea to the question, "Who taught you to oral care?" Responded that they had not been taught (51,76% - in the foothill region, 35,37% - in the steppe and 33,61% - in South Coast). On average in the Crimea on the issue Profile 89,88% of the students reported that their parents were taught (92,14% - in the foothill region, 89,02% - in the steppe and 83,61% - in the South Coast). Based on the responses to the questionnaires, health workers trained children in oral health in 21,99% of cases (22,22% - in the foothill region of Crimea, 20,73% - in the steppe and 22,13% - in the South Coast). The answer is "School teachers" is marked in the questionnaire children only 3,14% of cases. 20,42% of children Crimea note that they are reluctant to brush their teeth, they are forced to do so parents (16,53% - in the foothill region, 17,07% - in the steppe and 34,43% - in the South Coast).

Analysis of the results. Analyzing the results, it can be noted that the use of questionnaires in identifying hygiene habits and skills of the child population, despite his outward subjectivity, is an informative and brings some benefit, because it allows you to identify trends and motivation of respondents to the proper oral care and maintenance of dental health. The questionnaire helps to get information about the skills, the possession of which helps to reduce the intensity and frequency of the most common dental disease population: dental caries and periodontal diseases. Despite the subjectivity of evaluation of hygienic knowledge pupils Crimea, a sufficient number of responses you can get an overall picture of the real phenomen and trace its development trends - an idea of the hygiene habits of the population and their dynamics, make the necessary corrections to the work of the dental service.

Conclusions. As a result of analysis of the questionnaires Crimea pupils can be concluded that the overall level of hygiene knowledge and skills in the prevention of dental diseases is insufficient. The value of oral health of children is underestimated as throughout the Crimean region, as well as in individual physical and geographical areas.

Evaluation of hygienic knowledge pupils Crimea with integrated indicator shows the average level of their knowledge on hygiene - 0,689 points (from schoolchildren living in the steppe area - 0,651 points, the foothill region - 0,712, the South Coast – 0,646). The highest figure appeared in schoolchildren foothill region, which indicates a higher level of hygiene knowledge of prevention of dental diseases among these pupils.

These hygienic oral health among schoolchildren Crimea are directly dependent on the knowledge of hygiene, wich we determined through questionnaires.

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