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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 18  |  Issue : 2  |  Page : 67-71

Assessment of knowledge and awareness among nursing students of a private medical university towards periodontal health and oral-systemic disease link: A cross-sectional study


Department of Periodontology, Teerthanker Mahaveer Dental College and Research Centre, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India

Date of Submission04-Jun-2020
Date of Decision18-Jul-2020
Date of Acceptance12-Jul-2021
Date of Web Publication15-Sep-2021

Correspondence Address:
BDS, MDS Deepa Dhruvakumar
Department of Periodontology, Teerthanker Mahaveer Dental College and Research Centre, Teerthanker Mahaveer University, Moradabad-244 001, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tdj.tdj_12_20

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  Abstract 


Background
Health is a global human demand for all strata of population. Oral health plays an essential role to conserve the overall general health. Many systemic conditions have been linked in association with periodontitis, such as preterm low birth weight infants, cardiovascular disease and related events such as angina, myocardial infarction, stroke, respiratory diseases, and diabetes mellitus. Education of oral health is considered to abide an essential prerequisite for oral health-related behavior. This survey was carried out to determine the level of knowledge and awareness about periodontal health and its oral-systemic disease link amongst the nursing students of private medical university.
Aim
To perceive an understanding among students of nursing college at private university on periodontal health and their knowledge about oral health and link of systemic disease with the help of a questionnaire survey.
Patients and methods
Three hundred and fifty nursing students were provided with a self-constructed 15 items questionnaire. χ2 test was utilized for individual questions and Kruskal–Wallis test was applied to compare overall periodontal health awareness and awareness about oral-systemic link among students of nursing college.
Results and conclusion
A total of 350 questionnaires were distributed, out of which all 350 were completed by the students and evaluated for the study with an overall response of questions rate of 97%. The study indicated that 40% of the nursing students were having knowledge about the health of gums and oral hygiene maintenance. Thirty-seven percent were aware about the oral hygiene practices and 23% were familiar about the perio-systemic disease link. But 77% were unaware about the correlation between the periodontal health and systemic diseases.

Keywords: awareness, nursing personnel, oral health, perio-systemic link, private medical college, questionnaire, survey


How to cite this article:
Verma K, Dhruvakumar D. Assessment of knowledge and awareness among nursing students of a private medical university towards periodontal health and oral-systemic disease link: A cross-sectional study. Tanta Dent J 2021;18:67-71

How to cite this URL:
Verma K, Dhruvakumar D. Assessment of knowledge and awareness among nursing students of a private medical university towards periodontal health and oral-systemic disease link: A cross-sectional study. Tanta Dent J [serial online] 2021 [cited 2021 Oct 19];18:67-71. Available from: http://www.tmj.eg.net/text.asp?2021/18/2/67/326033




  Introduction Top


Health is a globally accepted human demand for mass strata of society. Oral health mask an important role to maintain the overall general health. In accordance with the definition by the WHO, periodontal health is defined as a state free from inflammatory periodontal disease that allows an individual to function normally and not suffer any consequences (mental or physical) because of past disease. Although there is clear confirmation for a bacterial etiology and there are particular bacteria (periodontal pathogens) associated with destructive periodontal disease, the presence of these pathogens does not invariably cause disease. Their absence, on the other hand, appears to be consistent with periodontal health. Perhaps the most significant advance in our understanding of the pathogenesis of periodontitis is that the host response varies among individuals and that an altered, deficient, or exaggerated host immune response to bacterial pathogens may lead to more severe forms of the disease. In other words, the individual host immune response to periodontal pathogens is very important and likely explains many of the differences in disease severity observed from one individual to the next. It is important to recognize that the systemic diseases, disorders, or conditions themselves do not cause periodontitis; rather, they may predispose, accelerate, or otherwise increase the disease's progression. Many systemic conditions have been studied in association with periodontitis, such as preterm low birth weight infants, cardiovascular disease and related events such as angina, myocardial infarction, stroke, respiratory diseases, and diabetes mellitus [1].

Knowledge of oral health is considered the essential prerequisite for oral health-related behavior. Nurses, are the principal health care providers for patients admitted to hospitals and provision of oral care is one of their duties [2]. The role of nurses in maintaining the oral health and wellbeing of hospitalized patients is undeniable [3]. Having this in mind, it is essential that nurses should be aware of evidence-based information and use of standard protocols to deliver appropriate oral care in their setting. The first step is to change the attitude of the nurses from viewing oral care solely as a comfort measure; to oral care as an obligation to help to improve nursing practice, create positive social change by improving the quality of care provided to patients, and improve patient outcomes by providing comfort and decreasing the risk of aspiration [4]. This could be achieved by enhancing their practice via improving the nursing curriculum, providing on the job training and workshops, and equipping the health care setup. In Moradabad, oral care is not considered as an essential care for patients in the hospital. And generally, to date, there is no documented evidence that shows the awareness and of nursing students towards periodontal health and or related studies towards patient oral care and its associated factors in Moradabad. This is therefore the first cross-sectional study to investigate the attitude and practice regarding assessment of knowledge and awareness among nursing students of a private medical university towards periodontal health and oral-systemic disease link.

This survey was carried out to assess knowledge about periodontal health among the nursing students of College of Nursing as there is no previous study based on the nursing students on their awareness about the perio-systemic disease link, in this geographic region. Hence this study was undertaken.

Methodology

This cross-sectional study was conducted in the month of march 2019 and 350 nursing students were included in the study. They were provided with a questionnaire comprising of 21 questions. This information sheet was distributed in respective classes of nursing and collected at the same time. The questionnaire (Appendix 1) was divided under three domains (1) (Q1–Q8) assessed the awareness about the importance of oral health (2) (Q9–Q17) evaluated the awareness about oral health hygiene practices and (3) (Q18–Q21) inferred their knowledge about the perio-systemic disease link.

Data were presented as frequency tables, pie charts, and tabulations. χ2 test was used to identify the level of awareness about the perio-systemic disease link. This study was conducted amongst the nursing students of a private medical university as the nursing students at different educational strata who all are in close contact with the patients and they have a straight forward outlook into the treatment modalities of the patient.

Statistical analyses

The collected data were compiled in Microsoft Excel (Ms Office Version 2010) and analyzed using Windows PC-based software 'MedCalc Statistical Software' version 13.3.1 at alpha 0.05 (95% confidence limits). The scrutiny was done by descriptive analysis as percentage/proportions. χ2 test was applied to test the responses to the various knowledge questions.


  Observations and results Top


A total of 350 questionnaires were distributed, out of which 340 were completely filled and evaluated for the study with an overall response rate of 97%. There were different educational strata of nursing students for evaluation for the study. There were 32 respondents in BSC Nursing first year student out of which 78% were aware about importance of oral health, 68% were aware about the oral hygiene practices and 28% knew the perio-systemic disease link. The other class of BSC Nursing second year were assessed in which 85% were aware about importance of oral health, 76% were aware about the oral hygiene practices and 41% knew the perio-systemic disease link. The other respondents were BSC Nursing third year in which 75% were aware about importance of oral health, 67% were aware about the oral hygiene practices and 6% knew the perio-systemic disease link. In BSC Nursing fourth year which 88% were aware about importance of oral health, 77% were aware about the oral hygiene practices and 59% knew the perio-systemic disease link [Table 1].
Table 1 Compiled data for the parameters of different nursing classes

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The respondents in MSC first year 88% were aware about importance of oral health, 77% were aware about the oral hygiene practices and 11% about the perio-systemic disease link. The GNM first year 82% students knew about importance of oral health, 83% were aware about the oral hygiene practices and 53% knew the perio-systemic disease link.

And the last group of students of post-BSC Nursing responded 95% to the importance of oral health, 7% were aware about the oral hygiene practices and 4% knew the perio-systemic disease link. The study concluded that in all majority of the students were unaware about the perio-systemic disease link which was the main aim of the study.

According to the data, in total 84% knew about the importance of oral health, 76% knew about the oral hygiene practices and 48% were aware about the perio-systemic link [Table 1], [Figure 1].
Figure 1: Bar graph depicting the responses of the nursing students based on perio-systemic disease link questions.

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The study was hence reviewed according to the questions especially based on the perio-systemic disease link which concluded that only 31% of the total students were aware and 69% were unaware about the perio-systemic link. The square test was done where P value more than 0.05. The value was nonsignificant [Figure 2] and [Figure 3].
Figure 2: The pie-chart represents that, majority of the nursing students 40% were aware about the knowledge about gums and oral hygiene maintenance. And were less aware about the perio-systemic link (23%). The χ2 statistics is 113.5586. The P value less than 0.00001. The result is significant at P value less than 0.05.

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Figure 3: Bar graph depicting the total nursing students interviewed.

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  Discussion Top


This study which was based on a questionnaire survey was aimed at the nursing students of different domains who interact with large number of varied patients in their operatory. The questionnaire was designed in a close-ended manner to receive the realistic responses of the nursing students on the three different domains, which were segregated in the survey. It was noted that average 23% of the students were only aware about the perio-systemic disease link. However, the knowledge about the same remained as an unrecognized and ignored among the nursing students. This survey was therefore initiated with a prime focus to determine the perio-systemic disease link understanding amongst the nursing students in a private medical college Teerthanker Mahaveer University in city of Moradabad.

Previous studies suggested that the nursing students have a sound level of general awareness with reference to periodontal disease. However, a majority determined a lack of confidence and advised that knowledge regarding oral health should be expanded within their curriculum [5].

Nursing personnel taking care of the patients should be aware about oral health care and should be recognized by themselves and others as part of a team, where oral health care is clearly described and included among other daily nursing events [6].

In the present study, majority of nursing students accepted that there is a relation between oral health and systemic health, which is in accordance with Andersson et al. who reported in their study that nurses were acquainted of the impact of oral health in old age [7].

In contrast, Heinrichs and Famili reported that maximum nurses and physicians in their university/health science center, geographic location, and in general were not knowledgeable about oral health and its relationship to systemic disease [8].

The health care professionals require classes regarding the periodontal disease for a better health education to the population and prevention of the periodontal disease. As reported by Sudhakar et al.[9] in a study that overall knowledge towards periodontal disease among health care workers including nurses is deficit.

Gallagher and Rowe quoted that an important role in the oral health care of the society is played by the community nurses, particularly among those less likely to access dental services, and there is a need to improve their knowledge regarding oral health aspects [10].

A cross-sectional study was conducted to assess attitude and awareness towards periodontal health among the health care professionals and nonhealth care professionals. A questionnaire study consisting of 13 questions, within 798 patients within the age range of 17–25 years. Health care professionals, had a good lifestyle as compared to nonhealth care professionals. So the basic knowledge about dentistry should be incorporated in the syllabus [11].

Further a study was conducted to assess to assess the knowledge, attitude, and awareness of oral hygiene using a pretested questionnaire among nursing students in Chennai. Questions based on the dental knowledge and attitude toward oral hygiene were asked to the students. About 98% of the nursing students do care about their oral hygiene. Moreover, about 90% of the students are aware of the advantages of good oral hygiene. About 66% do realize that refusing to go to a dentist does have an influence on their oral hygiene. Yet, only 33% go to a dentist for a regular checkup. This study concluded that even though the participants are aware of the certain consequences of bad oral hygiene, sufficient steps are not being taken by the nursing students to improve their oral hygiene [12].


  Conclusion Top


The majority of the nursing students were aware about the importance of oral health and had adequate knowledge about the same, but a high percentage of them were unaware about the association between the periodontal disease and systemic disease. Therefore, it is important to increase the awareness specially among health care professionals regarding the perio-systemic link and hence improvement of overall general health.

Future recommendations

It is recommended that continuing oral health care programs should be conducted for allied professionals in an attempt to update their knowledge about the periodontal health and systemic disease. It is important to identify that proactive approach at national level must be adopted in government and private sectors.

Acknowledgements

The authors thank Professor Dr N.V. Muninarayanappa, Principal of Nursing College for helping with the survey validation and data analyses.

Financial support and sponsorship

Nil.

Conflicts of interest



 
  References Top

1.
Lang NP, Bartold PM. Periodont health. J Clin Periodontol 2018; 45:S9–S16.  Back to cited text no. 1
    
2.
Al Rababah DM, Nassani MZ, Baker OG, Alhelih EM, Almomani SA, Rastam S. Attitudes and practices of nurses toward oral care of hospitalized patients – a cross-sectional survey in Riyadh, Saudi Arabia. J Educ Health Promot 2018; 7:149.  Back to cited text no. 2
    
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Perrie H, Scribante J. A survey of oral care practices in South African intensive care units. South Afr J Crit Care 2011; 27 (2):42–46.  Back to cited text no. 3
    
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Dayakar MM, Kumar J, Pai GP, Shivananda H, Rekha R. A survey about awareness of periodontal health among the students of professional colleges in dakshina kannada district. J Indian Soc Periodontol 2016; 20:67–71.  Back to cited text no. 5
    
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Malkin B. The importance of patients' oral health and nurses' role in assessing and maintaining it. Nurs Times 2015; 105:17.  Back to cited text no. 6
    
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Porter J, Ntouva A, Read A, Murdoch M, Ola D, Tsakos G. The impact of oral health on the quality of life of nursing home residents. Health Qual Life Outcomes 2015; 13:102.  Back to cited text no. 7
    
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Paquette DW, Bell KP, Phillips C, Offenbacher S, Wilder RS. Dentists' knowledge and opinions of oral-systemic disease relationships: relevance to patient care and education. J Dent Educ 2015;79:626–635.  Back to cited text no. 8
    
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Sudhakar U, Vishnupriya R, Varsha V. Knowledge of periodontal disease among various health care professionals. Int J Appl Dent Sci 2019; 5:284–292.  Back to cited text no. 9
    
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Razak PA, Richard KJ, Thankachan RP, Hafiz KA, Kumar KN, Sameer KM. Geriatric oral health: a review article. J Int Oral Health 2014; 6:110–116.  Back to cited text no. 10
    
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Rathod S, Khan F, Sarda T. Attitude and awareness towards periodontal health among health care and non-health care professionals. SRM J Res Dent Sci 2016; 7:23–26.  Back to cited text no. 11
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Sivarajan M, Sengottaiyan V, Ganapathy D. Knowledge and awareness of oral hygiene among nursing students. Drug Invention Today 2019; 11:117–120.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
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