We should keep our teeth, tongue, and gum clean to prevent oral diseases and bad odors. Gum diseases and cavities are problems caused by poor oral hygiene. When teeth and gum are not properly cleaned after eating, plaque forms. This is a sticky layer where bacteria multiply and produce toxic substances that cause tooth decay. The bacteria can also cause gum irritation because of the acid they produce. The gum becomes very soft and separates from the teeth resulting in cavities. In an attempt to protect our teeth, sugary foods should be avoided and thorough teeth cleaning encouraged. Foods like vegetables, fruits, and milk are important for strong teeth.
School children aged between 12 and 16 years are at risk of developing oral problems. They love eating snacks and forget to clean their teeth properly. The National Committee of Oral Health will conduct a survey on the oral health status of school children in the North East region. The objective of the study is to determine the oral health status of the students and the pattern of their oral health habits. They also aim at assessing the effect of social and cultural factors on their dental health, for example, the occurrence of dental caries. Pupils from rural and urban areas were sampled according to the WHO procedures. Records from the clinicians and simple questionnaires will be used to collect the relevant data. This study will help the National Committee of Oral Health in the proper arrangement and evaluation of oral health promotion programs in schools. According to the response given by the children through the self-administered questionnaires, measures will be taken to clinically examine those with dental problems and give them treatment according to the methods recommended by the World Health Organization.
Literature shows that the DMFT of the students is 0.77 and most of the caries index is comprised of DT. Approximately 65 percent of students have a maximum score of two of CPI. About 40 percent of these children remember to clean their teeth two times a day and less than 50 percent had visited a dentist in the previous year. The number of children suffering from dental caries in the urban areas is different from that in the rural areas. This is caused by the availability of sugary food, location, and the availability of dental services in these regions. This review showed the urgency of oral health promotion programs for students in this region.
Several factors contribute to the development of dental problems example diet which is the main factor. Some foods are vital for healthy teeth and gum because they provide the necessary minerals for proper teeth and cells formation. Vegetables like carrots contain vitamin A and raw onions have sulfur in small quantities that strengthens the enamel and kill micro-organisms in the mouth respectively. Milk products especially cheese provide calcium that regulates the mouth acidity to prevent the survival of bacteria. Phosphorous from beef and chicken is also important for strong teeth. Clean water removes food particles from the teeth and hydrates the mouth. It also has essential minerals that help to keep the teeth strong and healthy.
Biological factors also cause poor oral health with some conditions being hereditary example low weight at birth. Some diseases such as diabetes and stroke cause poor oral health. Another factor is the behavior of a person, if one is smoking and or taking alcohol she or he increases the risk of suffering from dental problems. Several epidemiological surveys show that cultural, social, and environmental factors play a major role in the oral health of people. Some food consumed by people of a given society or environment may be detrimental to their oral health. Some cultures do not allow people to go for treatment or check-ups making them vulnerable. Some areas do not have dental services and the living standard of the people is low that they cannot afford a proper diet. Society should train the children and adolescents behaviors and health-related attitudes that they should adopt and practice throughout their lifetime. Therefore, these are important stages that determine the healthy lifestyle of a person in adulthood.
North East region has a high population of school children both in the rural and urban areas but no study has ever been conducted to determine their oral health status and behaviors related to their health. Therefore, this study aims at collecting relevant data on the oral health status of the students and their oral health behaviors. This will be done using a sample of school children between the ages of 12 to 16 years. Through this study, the status and behaviors of these teenagers will be determined. This will help the health planners in the local areas, different regions, and countries to improve the oral health systems and also develop programs to educate people on the importance of dental hygiene. To achieve these goals, a pilot study will be carried out before the larger study.
The pilot study is important because it helps the researcher improve the quality of the main project as it shows deficiencies in the proposed procedures and equipments.
Why conduct a pilot study?
- To determine the efficiency of the research equipment
- To be able to develop a good research plan
- To design an appropriate research procedure
- To determine the feasibility and workability of the research
- To be able to estimate the variability in results of the data
- To train the researchers on the research processes
- To determine the possible hardships to be encountered during the main research project
- To convince the sponsors of the feasibility of the project
Two methods will be used to carry out the pilot study: quantitative method and qualitative method. The oral health status of the children will be collected qualitatively and analyzed. The results will then be used in the quantitative stage of the research.
The research is scheduled to start in September and end in November 2011. Boys and girls between the age of 12 and 16 in secondary schools will be allowed to participate. It is important to carry out the study on children who are twelve years old because many of them complete their primary education at this age; this makes it possible to obtain an accurate sample from the school. At this age, the permanent teeth have fully developed. It is at this age group that children learn and obtain habits that they practice throughout their lifetime. Examples of these behaviors are smoking, taking alcohol, eating habits, and exercising. If a bad habit is acquired at this age group, the young individual finds it hard to abandon it and causes serious illness or early death in adulthood. Therefore, it is important to study the health status of this population both in private and public secondary schools found in the rural and urban areas of the North East region. The Local Education Authority will provide us with a list of all schools in this region.
The participants were chosen depending on their age and health conditions. Those students below the age of twelve and above sixteen were excluded. Children with serious diseases or abnormalities will not participate, example autistic children, those with Down syndrome, and dyslexia will not be examined and their schools will not be visited for data collection. Before the research on the students is carried out approval must be obtained from relevant authorities. Permission to visit the schools will be given by the local education authority and the National Ethical Committee will approve the study on human beings. To be more accurate on the estimated number of students and ensure that the expected population is represented correctly, a multi-stage stratified sampling method will be used. The school and the class will be the primary and secondary sampling units respectively. The Local Education Authority will provide a list of all secondary schools in the North East region. The first step will involve the random selection of one school in the urban area and another in the rural area in every district. Then from these selected schools, a random number table will be used to choose the classes to be sampled. Every cluster will consist of 25-50 children from the selected classes.
Before visiting the selected schools for a survey, two letters will be sent to the principals of each school; an ethical approval and an introductory letter to explain more about the intended study. To avoid interrupting the schedule of these schools we will call the principals to know the appropriate date and time when the students are free. Before the day of fieldwork, Information sheets and consent forms will be presented to the selected students and their parents or guardians. A child will not be allowed to participate in the study if the parent or guardian refuses to sign the consent form. It will also be clearly stated in these forms that a participant is free to pull out at any phase of the study. On the day of fieldwork, the researchers will be introduced to the participants and the teachers. The research team will explain to the participants all the procedures of the research and the roles they will play.
On the day of fieldwork, self-administered questionnaires will be used to collect data then the oral examination will be conducted. During the feasibility study, about 20 students will be given the questionnaires to fill in an attempt to validate it. They will report to the researchers any difficulties experienced when filling the questionnaires and corrections will be done. The questionnaires will have about 23 questions. Some of these questions are: How old are you? Are you a male or a female? How many times do you brush your teeth in a day? Do you use toothpaste to clean your teeth? Did you visit a dentist last year? The students will answer the questions in about 10 minutes without writing their names on the questionnaires.
Two qualified examiners will inspect the teeth of the participants. Dental problems such as caries, gingivitis, cavities, and dental fluorosis will be assessed in accordance with the World Health Organization procedures. A record of the two most affected teeth will be made. If one of the teeth is less damaged, it will score and in case of uncertainty, a lower mark will be recorded.
The assessing criteria
DMFT index will be used to assess the extent of dental caries and CPI will be used to measure the severity of gingivitis. The WHO criteria will also be used to record these conditions. For the Community Periodontal Index, scores will be recorded as zero if the tooth is healthy, one if there is gingival bleeding, and two in case of calculus. Periodontal pockets will not be examined because some of the students are less than 15 years old and the moral teeth are erupting.
A qualified epidemiologist will train and calibrate the examiners before the fieldwork. This will be repeated during the data collection period to ensure accurate information is collected. They will be trained at least for two days on the WHO criteria then calibrated for not more than three days. Calibration will not be done immediately after the training to give them time to understand and learn how to apply the procedures and the indices. Only three examiners will carry out the survey thus it is very important to check the intra and inter reproducibility of every examiner. Kappa method will be used to measure the level of their agreement after these preparations.
A suitable place to set up the apparatus will be chosen. During the examination process, high control standards will be observed and WHO guidelines followed to avoid cross-infection. No examiner will check a student without disposable hand gloves and must change them before examining the next participant. They may also choose to have an eyewear, mask, or lab coat. This examination will take about 10 minutes per child. A CPI periodontal probe and a mouth mirror will be used in presence of sunlight to examine the students. More advanced examination methods such as radiography will not be used in case of uncertainty but instead, it will be assumed that the tooth is not affected. After examination, those participants who need treatment will be issued with referral letters. Every student will be given a toothbrush before going back to class.
The researchers will move in pairs to the selected schools for security reasons. They are also expected to observe cross-infection control measures when collecting data throughout the research period. Ethical values supported by the WHO such as acceptable practices and relevant verbal examination will be observed. The questionnaire will be cautiously formulated so as not to interfere with cultural and social beliefs. The questionnaire will not address sensitive issues and the language will be simple and polite. Its validation during the pilot study will ensure that it is acceptable. If the participant decides to withdraw from the study he or she shall not be persuaded to continue. Researchers will not demand an explanation from the students instead they will allow him or her to leave.
The data will be stored in the computer system for analysis. Before analysis, the data will be modified, cleaned, and replaced to ensure that all the parts are complete, accurate, and relevant. The final data will then be evaluated using computer packages such as statistical packages for social sciences and the STATA program. The rates of occurrence of dental caries and bleeding caused by gingivitis will be computed. The means of DMFT indices and bleeding teeth will also be calculated. The means will be statistically analyzed using several tests. The t-test will be used to evaluate the means of two clusters, ANOVA will be used to evaluate the means of many clusters, and the Chi-square test will be used to compare the results obtained during the study with the theoretical results. This will help us to realize the degree of discrepancy between these two proportions. The data will be represented using several methods example linear and bar graphs. In linear regression, dependent and independent variables will be used. Dental caries indices will be used as dependent variables both in linear and logistic regression analyses. When evaluating the regression coefficient, the t-test will be used and will be analyzed using the Wald chi-square test.
All the information will be stored in hard and soft copies safely. The hard copies will be filed and stored in cabinets and the soft copies will not be accessed before authentication. This will ensure that the information is not accessed by unauthorized persons. To enhance the privacy of the information, the Data Protection Coordinator will register the filing and database systems. A detailed report of the research findings will be given to relevant authorities such as the school, Local area, and health. This report will be simple, clear, and direct so that even nonexperts in these authorities will understand it. It will propose the workable measures that can be taken to improve the status of the students. This research will then be published in a journal.
Therefore, this study is beneficial to society. It will reveal the health status of young people and show the need for schemes and programs to improve oral health in several regions. Stronger preventive measures will be taken and the implementation of health programs will be emphasized. Young people will realize the importance of visiting a dentist and maintaining oral hygiene. Those with severe oral problems will be referred to qualified clinicians for treatment. Factors causing these dental problems will be evaluated and control measures are taken. Parents will see the need of providing a balanced diet to their children. They will also guide them on acceptable health behaviors and this will promote oral health among the young individuals.
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