AN INVESTIGATION INTO THE CAUSES AND PREVENTION OF POOR ORAL HYGIENE AMONG SECONDARY SCHOOL STUDENTS IN OBOT AKARA LOCAL GOVERNMENT AREA, AKWA IBOM STATE: (A CASE STUDY OF ST. COLUMBANUS SECONDARY SCHOOL, IKWEN)

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Similar to other regions of the body, the oral cavity harbours a multitude of microorganisms. The majority of the microorganisms are benign. However, it is important to note that the mouth serves as the point of entry into the digestive tract. The gastrointestinal tract is a lengthy tube that extends from the mouth to the anus, serving as the pathway for food passage (Sanchez et al., 2021). The mouth serves as the gateway to the respiratory tracts, which are responsible for breathing. Occasionally, bacteria present in the oral cavity can result in systemic illness. Typically, the immune system and proper dental hygiene effectively manage and regulate the presence of microorganisms in the body. Effective oral hygiene practices encompass regular brushing and flossing on a daily basis (Richard, 2017). Inadequate dental hygiene can result in the proliferation of bacteria, which can potentially cause infections such as tooth decay and gum disease (Darnel, 2022).

Oral health encompasses the maintenance of your teeth and gums, which necessitates consistent attention in order to prevent the development of cavities, infections, and other related problems (Sanchez et al., 2021). Maintaining good oral hygiene can have positive effects on various aspects of your overall health, including as your cardiovascular system (Son et al., 2021). Failure to comply with proper oral hygiene protocols can result in additional oral health concerns that are significantly more preventable than they are reparable. Inadequate oral hygiene leads to heightened buildup of plaque and debris in the oral cavity, including the mouth, teeth, and gums, which can result in gum disease. Gum disease, also known as periodontal disease, is a bacterial infection that affects the tissues and bones surrounding and supporting the teeth (Banks et al., 2019). Ensuring the long-term health of teeth and gums requires a lifelong dedication. Developing good oral hygiene practices, such as regular brushing, flossing, and reducing sugar consumption, at an early age can help prevent expensive dental treatments and long-term health problems (Peniel et al., 2023).

Dental plaque, or dental biofilm, is a cohesive, yellowish film composed of various microorganisms that adheres to the surfaces of teeth and may be noticeable along the gum margin. The reappearance of tooth surface occurs following its cleaning, therefore the importance of regular brushing (Sanchez et al., 2021). A diet rich in sugar promotes the development of plaque. The plaque converts sugar, which is a type of fermentable carbohydrate, into acid. Subsequently, the acid initiates the degradation of the neighbouring tooth, ultimately resulting in dental caries. Failure to remove plaque from the sub-gingival surface, located beneath the gum, not only heightens the likelihood of tooth decay, but also leads to gum irritation, resulting in redness and swelling (Ariel et al., 2019). Occasional bleeding may occur while cleaning or flossing teeth.  

Periodontal disease is a direct consequence of inadequate oral hygiene and can be avoided. Failure to recognise gum disease in its early stages might result in the development of a tooth abscess or tooth loss (Sanchez et al., 2021). When you brush, the gums will become red, swollen, and may bleed. Gum disease can also result in halitosis (poor breath), gingivitis, dental caries, or teeth that are loose or have undergone noticeable displacement (Patrice, 2022). In order to maintain adequate dental hygiene and prevent gum disease or tooth decay, it is essential to regularly clean and treat the surfaces and areas between the teeth and under the gum line (Urube., 2022). Urube further contends that despite normal oral hygiene practices, these areas still require professional dental treatment. Granting dentists and dental hygienists the authority to do professional teeth cleanings enables them to eliminate tartar from the teeth, detect and avoid other oral health complications, and discover further possible issues. Regular dental appointments are an effective means of preventing oral health issues and should be scheduled biannually (Sanchez et al., 2021). 

Dental caries is the prevailing worldwide ailment. In their study, Sanchez et al. (2021) observed that More than 80% of cavities develop within the narrow grooves on the surface of teeth, where food particles might get stuck after eating. These fissures are difficult to clean with brushing, and saliva and fluoride are unable to reach these areas to counteract acid and restore minerals to the demineralized teeth. In contrast, the easily accessible regions of the tooth, which are easier to clean, tend to have fewer cavities. Dental cavities are the prevailing chronic ailment among individuals aged 6 to 19, as stated by the CDC. Additionally, tooth decay affects a concerning 91% of American people aged 20 to 64, according to NBC (Brayden et al., 2022). Regrettably, a significant number of individuals remain oblivious to the impending consequences until they are on the verge of being irreversible, despite their teeth's persistent attempts to alert them over the course of several months. Tooth decay, also known as dental caries, is the process of the gradual weakening and eventual disintegration of the tooth enamel, which is the tough and protective outer coating of the teeth. It occurs due to the corrosive effects of acids on the tooth structure (Sanchez et al., 2021). Acid erosion refers to the loss of tooth structure caused by the breakdown and digestion of carbohydrates (sugars) by plaque bacteria in the mouth. Failure to address the depletion of minerals from the enamel can lead to the formation of a cavity, which is a small opening in the tooth (Oreola, 2021). In the absence of expert treatment, these cavities have a tendency to progressively expand and ultimately have the potential to cause complete destruction of the tooth and the surrounding tissue. 

Oral hygiene is an essential component of general health and well-being, particularly in adolescents. Inadequate oral hygiene can result in several dental problems such as tooth decay, periodontal disease, and halitosis, which can also have negative effects on overall health and self-confidence (Ede, 2023). This study examines the aetiology and mitigation of suboptimal oral hygiene among secondary school students, with a specific focus on St. Columbanus Secondary School in Ikwen, situated in the Obot Akara Local Government Area of Akwa Ibom State. Akwa Ibom State, similar to other areas in Nigeria, confronts substantial public health obstacles, particularly in relation to oral healthcare. Although dental health treatments are accessible, a significant number of students still demonstrate inadequate oral hygiene habits. An in-depth analysis of the precise factors contributing to this problem within the setting of St. Columbanus Secondary School can offer significant perspectives for designing focused treatments. Therefore, the investigation is necessary.

1.2 Statement of the problem

The prevalence of poor oral hygiene among secondary school children in Nigeria is alarming. Students often have oral problems that could be prevented via sufficient education and access to services. In order to devise effective preventive methods, it is crucial to identify the root causes of these hygiene difficulties.

According to Sanchez et al. (2021), it is essential to establish and maintain good oral hygiene practices and cultivate a positive attitude towards oral health. This is important for overall well-being as it helps prevent common oral disorders such as tooth decay and gum infections. Abiola (2022) supports this claim by adding that this habit involves consistent dental hygiene procedures, such as regular tooth brushing and flossing, as well as preventive measures like applying fluoride and sealants. In addition, it encompasses the adoption of nutritious dietary practices and routine dental examinations (Sa'adu 2022). Ani et al. (2018) discovered that Nigerian secondary school children and adolescents face challenges with their oral health as a result of frequent intake of sugary foods and beverages. This practice increases their vulnerability to dental caries and periodontal disease. Akpan (2023) asserts that dental caries poses a substantial concern for oral health, impacting between 30 to 45% of Nigerian teenagers between the ages of 12 and 15.

Moreover, a significant percentage of secondary school students in Nigeria may have insufficient understanding of fundamental oral hygiene practices, including correct brushing methods, the significance of regular dental examinations, and the connection between dietary and lifestyle choices and oral well-being (Promise, 2023). Insufficient comprehension of oral health might result in inadequate oral hygiene practices and raise the likelihood of dental ailments. Akpan (2023) highlighted the deficiency of oral health instruction in the curriculum used in most Nigerian schools. Nigerian pupils have a limited understanding of the harmful effects of poor dental hygiene (Peter, 2017). In his 2017 study, Peter highlighted the myriad adverse consequences linked to insufficient dental health, including physical discomfort, impaired functionality, and a reduced quality of life. This study aims to examine the factors contributing to and methods of preventing inadequate oral hygiene among secondary school students in Obot Akara Local Government Area, Akwa Ibom state. The study will specifically focus on St. Columbanus Secondary School, Ikwen as a case study.

Objectives of the study

The primary objective of this study is to critically investigate the causes and prevention of poor oral hygiene among secondary school students in Obot Akara Local Government Area, Akwa Ibom state: (a case study of St. Columbanus Secondary School, Ikwen). Specific objectives of this study are to:

To assess the knowledge level of students regarding oral hygiene practices in St. Columbanus Secondary School, Ikwen

To investigate the oral hygiene habits and practices of students in St. Columbanus Secondary School, Ikwen.

To identify the factors contributing to poor oral hygiene among students in St. Columbanus Secondary School, Ikwen

To propose recommendations for improving oral hygiene awareness and practices among students in St. Columbanus Secondary School, Ikwen

1.4 Research Questions

The following research questions will be answered in this study:

What is the level of knowledge of students regarding oral hygiene practices in St. Columbanus Secondary School, Ikwen?

What are the oral hygiene habits and practices of students in St. Columbanus Secondary School, Ikwen?

What are factors contributing to poor oral hygiene among students in St. Columbanus Secondary School, Ikwen?

What are the recommendations for improving oral hygiene awareness and practices among students in St. Columbanus Secondary School, Ikwen?

1.5 Research Hypotheses

The following research hypotheses are formulated to guide the study:

Ho: The level of knowledge of students regarding oral hygiene practices in St. Columbanus Secondary School, Ikwen is low

Ha: The level of knowledge of students regarding oral hygiene practices in St. Columbanus Secondary School, Ikwen is high

1.6 Significance of the study

This study is important since it focuses on a crucial health problem that has an impact on the well-being of students. The study seeks to enhance the overall health and academic performance of pupils by comprehending the causes and formulating prevention strategies to improve their oral health. The study will provide a fundamental reference point for educators, healthcare practitioners, the local community, the general public, policymakers, students, and scholars.

Maintaining good oral hygiene is essential for one's general health and well-being. An examination of the factors contributing to inadequate oral hygiene among secondary school students will yield valuable insights into the prevailing challenges faced by this particular demographic. 

Additionally, the study's results can offer vital proof to curriculum designers and lawmakers on the necessity of including thorough oral health education in the secondary school curriculum. This integration ensures that all aspects of oral health are thoroughly covered, providing students with the necessary information and skills to maintain excellent dental hygiene for their whole lives. This study contributes to the current understanding of oral health among young individuals in Nigeria. This study fills in the gaps in research and offers important insights that can help policymakers make well-informed decisions about promoting oral health and preventing diseases in the future.

Moreover, the results obtained from the study can provide valuable insights for making policy decisions about oral health education and promotion in secondary schools in Akwa Ibom State, as well as in other comparable places throughout Nigeria. This can facilitate the creation of focused initiatives designed to enhance oral health outcomes at the policy level.

Furthermore, this study adds to the current knowledge base of oral hygiene practices among secondary school students in Nigeria. The data it provides is empirical and can be utilised for additional study and comparative analysis, both domestically and globally, on oral health concerns among teenagers.

1.7 Scope of the study

Broadly, this study focus is to critically investigate the causes and prevention of poor oral hygiene among secondary school students in Nigeria. Specifically, this study seeks to assess the knowledge of students regarding oral hygiene practices in Nigeria, identify the factors contributing to poor oral hygiene among students in Nigeria and investigate the oral hygiene habits and practices of students in Nigeria. 

Further, this study will focus on evaluating the existing oral health education programs in Nigeria and it also seeks to propose recommendations for improving oral hygiene awareness and practices among students in Nigeria.

The study is carried out in St. Columbanus Secondary School, Ikwen, in Obot Akara Local Government Area, Akwa Ibom. The respondents of this study includes the staff and students of St. Columbanus Secondary School, Ikwen.

1.8 Limitations of the study

As with any human endeavor, the researchers faced many minor constraints during the investigation. The main limitation was the lack of extensive literature on the subject, due to the limited availability of data regarding an investigation into the causes and prevention of poor oral hygiene among secondary school students in Obot Akara Local Government Area, Akwa Ibom state: (a case study of St. Columbanus Secondary School, Ikwen). Hence, a significant allocation of time and exertion was necessary to ascertain the appropriate materials, books, or information and amass data. 

Furthermore, this study is constrained by its small sample size and narrow geographical scope, focusing solely on St. Columbanus Secondary School, Ikwen. Therefore, the conclusions of this study cannot be extended to other situations, thus requiring further investigation. 

Moreover, the researcher's restrictions were mostly due to financial constraints, as they are a student without any source of income to sustain themselves. The exorbitant transportation costs at the research location, exacerbated by the prevailing inflation in Nigeria, posed a significant challenge in meeting the expenses associated with transportation.

Furthermore, the researcher faced a time constraint due to the need to do this research while still fulfilling the obligations of attending lectures and participating in other educational activities.

1.9 Definition of terms

Oral disease: Oral diseases encompass a range of diseases and conditions that include dental caries, periodontal (gum) disease, tooth loss, oral cancer, oro-dental trauma, noma and birth defects such as cleft lip and palate.

Oral health: Oral health is the state of the mouth, teeth and orofacial structures that enables individuals to perform essential functions such as eating, breathing and speaking, and encompasses psychosocial dimensions such as self-confidence, well-being and the ability to socialize and work without pain, discomfort and embarrassment.

Oral practice: This is an activity undertaken by people in order to protect, promote, or maintain oral health and prevent dental diseases. The practices include tooth brushing and sugar consumption practice among others.