ORAL HEALTH KNOWLEDGE, ATTITUDES, AND PRACTICES AMONG SECONDARY SCHOOL STUDENTS IN NIGERIA

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Oral diseases are substantial public health concerns that necessitate attention, and understanding oral health is seen as a fundamental basis for promoting good conduct (Crosby, 2021). Oral hygiene is a crucial determinant of optimal oral health, which is intricately connected to an individual's general health and well-being (Chang, 2017). Limited information exists regarding the knowledge, attitudes, and practices concerning oral health among children in underdeveloped countries. However, the effectiveness of oral health education campaigns in developed regions is evident (Cheah, 2019). Preventive approaches, such as educating individuals about the reasons and reducing their exposure to risk factors, can help people avoid dental caries and periodontal diseases, which are the most frequent oral health issues that lead individuals to seek dental care.

According to Zhuleikha et al. (2021), the occurrence of tooth decay, known as caries, can be avoided by acquiring knowledge on how to control plaque through proper oral hygiene practices, being mindful of one's diet in terms of the frequency and types of sugary foods and drinks consumed, and utilising fluoride. Gingivitis is the most common type of periodontal disease and is particularly widespread among young individuals. Poor oral hygiene, smoking, genetic factors, psychological stress, pre-existing conditions, and inadequate utilisation of dental services are all risk factors for the development of oral health problems (Lugmanul et al., 2017). Consistent oral hygiene habits such as daily brushing and flossing, plaque control programmes, and scale and root planing are regarded as preventive and definitive treatments (Ofo, 2020).

Oral health encompasses the holistic state of the teeth, gums, and the entire oral-facial system, facilitating functions such as smiling, speaking, and chewing. Poor dental hygiene can lead to pain, discomfort, and serious conditions such as periodontal disease and oral cancer, which can have a negative impact on overall health and quality of life (Fuller et al., 2021). Oral health is a crucial component of one's overall health and state of well-being. Dental health can provide insights into an individual's dietary habits, lifestyle preferences, and socioeconomic conditions (Allen et al., 2019). Oral health include the preservation of the teeth, gums, and overall oral cavity. Inadequate oral hygiene can result in dental caries, periodontal disease, and various oral infections, which can give rise to pain, discomfort, and even affect overall health (Smart et al., 2019). Palmer (2022) emphasises the importance of providing thorough oral health education and maintaining adequate hygiene practices as crucial measures to prevent these disorders and enhance overall health. According to the knowledge, attitude, and behaviour (K-A-P) model, an individual's behaviour can change from bad to good if they acquire sufficient knowledge and motivation, leading to a positive attitude and subsequent improvement in their actions (Edomwonyi et al., 2019).

Reliable findings from a comprehensive analysis of articles assessing the efficacy of dental health education in schools revealed that oral health education (OHE) had a beneficial influence on oral health status, oral health-related knowledge, and oral health practices, including brushing frequency and duration, as well as the use of fluoride toothpaste, among children aged 6 to 12 years (Chukwu, 2022). In a study conducted in Lagos, Nigeria, Edomwonyi et al (2019) found that the implementation of oral health education (OHE) had a substantial influence on the behaviours of school pupils. This impact was observed regardless of whether the intervention was carried out by teachers or dental professionals. In addition, school health programmes have advantages such as being cost-effective, having a long-lasting impact that extends into later years, reaching a larger population, and enhancing the health and well-being of students, staff, families, and community members (Ehizele et al., 2021).

Adolescence is a crucial stage for developing long-lasting health habits. Throughout this period, individuals develop routines that can have a substantial influence on their future well-being (Ofili, 2021). It is crucial to provide secondary school pupils with education on proper oral hygiene in order to prevent dental problems and promote healthy behaviours (Chiwuzie et al., 2020). Nigeria encounters distinctive obstacles in the realm of oral health as a result of socioeconomic inequalities, restricted availability of dental services, and differing degrees of education and consciousness (Emmanuel, 2021). 

A significant number of Nigerian pupils may not receive sufficient information regarding oral cleanliness, resulting in less than optimal oral health outcomes. Cultural views, economic restraints, and limited resources are influential factors in determining oral health behaviours (Kolawole et al., 2021). Prior research conducted in Nigeria has emphasised a widespread deficiency in oral health awareness among teenagers. A significant number of students possess incorrect beliefs regarding oral hygiene practices and fail to follow the suggested brushing and flossing procedures (Oziegbe & Bamise, 2019). Research has also indicated a significant occurrence of dental decay and gum disease among Nigerian teenagers, highlighting the necessity for enhanced oral health education and habits. This study aims to examine the level of oral health knowledge, attitudes, and practices among secondary school students in Nigeria.

1.2 Statement of the problem

Secondary school pupils in Nigeria have a notable lack of understanding when it comes to oral health information, attitudes, and practices. This discrepancy presents numerous crucial concerns that require attention.

Implementing appropriate oral hygiene routines and cultivating a favourable attitude towards oral health are essential for general wellness as they aid in the prevention of common mouth ailments such as dental caries and periodontal infections. This habit includes regular oral hygiene routines such as frequent tooth brushing and flossing, as well as preventive measures like the use of fluoride and sealants. In addition, it encompasses the practice of adhering to nutritious dietary patterns and scheduling routine visits to the dentist (Sa’adu 2022). Ani et al., (2018) reported that Nigerian secondary school students and adolescents face challenges with their oral health as a result of frequent use of sugary foods and beverages. This habit increases their vulnerability to dental caries and periodontal disease. Akpan (2023) asserts that dental caries pose a substantial concern for oral health, impacting between 30 to 45% of Nigerian youth aged 12 to 15 years.

In Nigeria, a significant number of secondary school pupils may have insufficient understanding of fundamental oral hygiene practices, including correct brushing methods, the significance of regular dental examinations, and the connection between diet/lifestyle choices and mouth health. Insufficient knowledge about oral health might result in inadequate oral hygiene practices and heighten the likelihood of dental ailments. Akpan (2023) explained in further detail that the curriculum used in most Nigerian schools does not include oral health education. As a result, Nigerian pupils have a limited understanding of the harmful effects of poor oral health (Peter, 2017). Peter (2017) highlighted various adverse consequences of insufficient oral health, including physical discomfort, functional limits, and a reduced quality of life. A review of the current research on the knowledge, attitudes, and behaviours about oral health among students in Nigeria indicates disappointing results (Ene, 2023). Therefore, this research seeks to fill the current gap in the literature.

Objectives of the study

The primary objective of this study is to critically assess the oral health knowledge, attitudes, and practices among secondary school students in Nigeria. Specific objectives of this study are to:

To assess students' knowledge of proper oral hygiene techniques, the importance of oral health, and common oral health problems.

To determine students' attitudes toward oral health

To identify students' actual oral hygiene practices

To assess barriers to proper oral hygiene Among Secondary School Students in Nigeria

To offer recommendations for improving oral health education and practices among secondary school students in Nigeria

1.4 Research Questions

The following research questions will be answered in this study:

What is the level of students' knowledge of proper oral hygiene techniques, the importance of oral health, and common oral health problems?

What are students' attitudes toward oral health?

What are students' actual oral hygiene practices?

What are the barriers to proper oral hygiene Among Secondary School Students in Nigeria?

What area the recommendations for improving oral health education and practices among secondary school students in Nigeria?

1.5 Research Hypotheses

The following research null hypotheses will be formulated to guide the study:

Ho: The level of students' knowledge of proper oral hygiene techniques, the importance of oral health, and common oral health problems is low

Ha: The level of students' knowledge of proper oral hygiene techniques, the importance of oral health, and common oral health problems is high

1.6 Significance of the study

This study is important because it will offer vital insights on the present condition of oral health knowledge, attitudes, and practices (KAP) among secondary school students in Nigeria. The discoveries can assist educators, healthcare practitioners, and policymakers in formulating focused initiatives to enhance oral health outcomes. This study seeks to enhance oral hygiene and general health among Nigerian teenagers by addressing the gaps in their knowledge, attitudes, and practices.

Furthermore, enhancing the understanding of oral health among students in secondary schools plays a significant role in advancing public health initiatives in Nigeria. By providing students with knowledge on correct oral hygiene habits, the significance of regular dental examinations, and the influence of diet and lifestyle on oral health, they can be empowered to make educated decisions and become proponents for oral health in their communities. 

Moreover, the study's findings can provide valuable insights to curriculum architects and legislators regarding the imperative of incorporating comprehensive oral health education within the secondary school curriculum. This integration guarantees that oral health subjects are comprehensively addressed, equipping students with the requisite knowledge and abilities to uphold optimal dental hygiene throughout their lifetimes. 

Furthermore, enhancing the understanding, beliefs, and behaviours related to oral health in secondary school children can result in enduring health advantages. Optimal dental hygiene is associated with holistic wellness, encompassing enhanced nourishment, articulate communication, and improved social engagement. Early intervention in oral health problems can help alleviate the financial strain linked to the treatment of complex dental conditions.

Finally, this study contributes to the current understanding of oral health practices among teenagers, particularly in the context of Nigeria. This research can serve as a foundation for future inquiries into different aspects of oral health education and behaviour among various age groups and populations.

1.7 Scope of the study

Broadly, this study focus is to critically assess the oral health knowledge, attitudes, and practices among secondary school students in Nigeria. Specifically, this study seeks to assess students' knowledge of proper oral hygiene techniques, the importance of oral health, and common oral health problems, determine students' attitudes toward oral health and identify students' actual oral hygiene practices in Nigeria. 

Further, this study will focus on assessing barriers to proper oral hygiene Among Secondary School Students in Nigeria and it also seeks to offer recommendations for improving oral health education and practices among secondary school students in Nigeria.

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 oral health knowledge, attitudes, and practices among secondary school students in Nigeria. 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 Nigeria. 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.

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