|Year : 2017 | Volume
| Issue : 1 | Page : 9-14
Knowledge, attitude, and practices related to orthodontic treatment among college students in rural and urban areas of Mysore, India: A cross-sectional questionnaire study
Suma Shekar1, BR Chandrashekar2, A Bhagyalakshmi1, BS Avinash3, MS Girish4
1 Department of Orthodontics, JSS Dental College and Hospital, Jagadguru Sri Shivarathreeshwara University, JSS Medical Institutions Campus, Mysore, Karnataka, India
2 Department of Public Health Dentistry, JSS Dental College and Hospital, Jagadguru Sri Shivarathreeshwara University, JSS Medical Institutions Campus, Mysore, Karnataka, India
3 Department of Periodontology, JSS Dental College and Hospital, Jagadguru Sri Shivarathreeshwara University, JSS Medical Institutions Campus, Mysore, Karnataka, India
4 Department of Pedodontics and Preventive Dentistry, JSS Dental College and Hospital, Jagadguru Sri Shivarathreeshwara University, JSS Medical Institutions Campus, Mysore, Karnataka, India
|Date of Web Publication||17-Jul-2017|
Department of Orthodontics, JSS Dental College and Hospital, Jagadguru Sri Shivarathreeshwara University, JSS Medical Institutions Campus, SS Nagar, Mysore, Karnataka
Source of Support: None, Conflict of Interest: None
Objectives: The objective of this study was to assess knowledge, attitude, and practices (KAPs) related to orthodontic treatment among college students in rural and urban areas of Mysore, India. Materials and Methods: This was a cross-sectional questionnaire study conducted among college students in rural and urban areas of Mysore, India, over 2 months from August to September 2015. The sample size was estimated using nMaster software. One government and one private college each in rural and urban areas of Mysore were selected based on administrative convenience. All eligible participants from these colleges were recruited. A sixteen-item questionnaire was developed and validated. This predesigned and validated, self-administered, structured questionnaire was used for data collection. The statistical analysis was done using SPSS. Results: Four hundred and forty-one college students participated in the present study. 89.3% of the participants were aware about malalignment of teeth. The awareness was significantly higher among females and those in urban areas. 39.2% of the study participants expressed willingness to undergo orthodontic treatment even if treatment duration extends up to 1–2 years with no significant difference in relation to gender and area of residence. 14.1% of the study participants have undergone treatment for malalignment of teeth with no significant difference between males and females. However, a significantly higher percentage of participants from urban areas have undergone treatment. Conclusion: The KAP related to orthodontic treatment was significantly higher among females and those in urban areas. This highlights the need to augment orthodontic awareness programs in rural areas.
Keywords: Awareness, college students, malalignment, orthodontic treatment, rural and urban
|How to cite this article:|
Shekar S, Chandrashekar B R, Bhagyalakshmi A, Avinash B S, Girish M S. Knowledge, attitude, and practices related to orthodontic treatment among college students in rural and urban areas of Mysore, India: A cross-sectional questionnaire study. Indian J Oral Health Res 2017;3:9-14
|How to cite this URL:|
Shekar S, Chandrashekar B R, Bhagyalakshmi A, Avinash B S, Girish M S. Knowledge, attitude, and practices related to orthodontic treatment among college students in rural and urban areas of Mysore, India: A cross-sectional questionnaire study. Indian J Oral Health Res [serial online] 2017 [cited 2017 Nov 20];3:9-14. Available from: http://www.ijohr.org/text.asp?2017/3/1/9/210920
| Introduction|| |
Unacceptable dental appearance has been found to exert a negative impact on self-image, career advancement, and peer-group acceptance. This in turn will have an adverse influence on an individual's level of social interactions. Such esthetic concerns and adverse influence on psychosocial well-being are the primary factors for decision to start orthodontic treatment. Changes in morphogenesis and physiology of dentofacial structure over time and an increased concern for dental appearance and orthodontic treatment with age have become apparent rather than inadequate decisions and a provision of care during childhood and adolescence. Orthodontists traditionally have considered oral health and function as the principal goals of treatment. However, recently, there has been growing acceptance of esthetics and its psychosocial impact as an important treatment benefit.
In the past three decades, a major reorientation of orthodontic thinking has occurred regarding adult patients, the reasons may be changed lifestyle, patient awareness, and multidisciplinary dental therapy that have allowed better management of the more complicated patient population, thereby greatly improving the quality of care and treatment prognosis. There are many reasons why adult orthodontic therapy should be encouraged, including the improvement of function and occlusion, and improvement of esthetics as well as the psychological aspects. The literature on the prevalence of malocclusion in relation to area of residence is conflicting. Some studies revealed a higher prevalence in urban areas,, while others found no significant differences. The malocclusion prevalence is related to knowledge, attitude, and practices (KAPs)-related orthodontic treatment. Literature assessing the KAP related to orthodontic treatment among adolescents in rural and urban areas of Mysore was nonexistent. In this background, the present study was undertaken to assess KAPs related to orthodontic treatment among college students in rural and urban areas in Mysore, India, as well as to identify key factors related to utilization of orthodontic services among the study participants.
| Materials and Methods|| |
This questionnaire survey was conducted among college students in rural and urban areas of Mysore, India, over 2 months from August to September 2015. The ethical clearance for the study was obtained from the Institutional Ethics Committee, JSS Dental College and Hospital, Mysore.
The sample size was estimated using nMaster 1.0 software (Biostatistics Resource and Training Center, Christian Medical College, Vellore, India) software assuming an expected proportion of 0.5 to be having good KAP on oral health with a relative precision of 10%, 95% confidence level. The sample size was computed to be 430 with an anticipated 10% nonresponse in the form of incomplete data.
A convenient sampling was used for selecting required number of eligible participants from rural and urban areas of Mysore. Among the various colleges in Mysore, one government and one private college each in rural and urban areas of Mysore were selected based on administrative convenience. The selection of participants in these four colleges was done according to the following eligibility criteria.
- College students in the selected colleges willing to participate in the study by offering informed consent were included in the study.
- Incomplete questionnaires were excluded from the study.
After reviewing previous published literature assessing KAP related to orthodontic treatment in different settings, all questions were pooled as a first step. A total of 22 items were initially listed. Then, eight redundant questions were deleted. The questionnaire was further modified with addition of six items thought to be relevant. The modified questionnaire had 20 items. The questionnaire was scrutinized independently by two orthodontists and one public health dentist to assess relevance, accuracy, and appropriateness of each item. Each expert was instructed to grade the items for relevance, accuracy, and appropriateness on a five-point Likert scale. Three questions having low scores for relevance, accuracy, and appropriateness from all three experts were removed from the questionnaire. The questionnaire having 17 items was translated to Kannada by an expert having proficiency in English and Kannada. The translated Kannada questionnaire was again back translated to English by another language expert. The back-translated English questionnaire was compared with original 17-item English questionnaire.
The reliability of questionnaire was assessed using test-retest reliability assessment. Questionnaire was administered to a group of 20 college students. The same questionnaire was distributed to these 20 students after a gap of 1 month. Kappa coefficient for each item was assessed. The kappa coefficient ranged from 0.89 to 0.92 for all items except for one question on knowledge which had a reliability score of 0.51. This item was removed from the questionnaire. Hence, the final questionnaire had 16 items with either yes, no, or don't know options [Annexure 1].
The study protocol was explained to the participants in a meeting organized in each college. The participants were requested to fill the questionnaire that had a total of sixteen questions on KAPs-related orthodontic treatment. The instructions for filling the questionnaire were given and filled questionnaires were collected after 20 min following the administration of the questionnaire. The data from completed questionnaires were entered into a personal computer.
The statistical analysis was done using SPSS (Statistical Package for Social Sciences) version 20 (IBM, Chicago, IL, USA). The association between KAP on orthodontic treatment and various sociodemographic factors was assessed using Chi-square test. The statistical significance was fixed at 0.05. The research protocol is diagrammatically depicted in [Figure 1].
| Results|| |
A total of 441 college students participated in the present study. Among them, 219 were from rural areas and 222 were from urban areas. Two hundred and forty-four were females and 197 were males. 197 were below 20 years while the remaining 244 were 20 years and above [Table 1].
Overall, 65.8% of the study participants had heard of the term malalignment of teeth. The awareness on malalignment of teeth was significantly higher among females, those in urban areas with no significant difference between individuals aged less than and more than 20 years [Table 2].
40.4% of the study participants expressed willingness to undergo correction of malalignment even if the treatment extended for a duration of around 1–2 years. The willingness to undergo treatment was significantly higher among females, those aged <20 years and those in urban areas [Table 3].
42.4% of the study participants expressed their willingness to continue with the treatment for malalignment even if there is any possibility of pain, ulcerations, or some discomfort during treatment. This willingness was significantly higher among females, those in urban areas with no difference between those aged <20 years compared to those aged >20 years [Table 4].
|Table 4: Responses to various questions in relation to area of residence|
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16.1% of the study participants had undergone treatment for malalignment teeth. A significantly higher percentage of females and those in urban areas had undergone treatment for malocclusion with no significant difference with regard to those aged <20 and >20 years [Table 2],[Table 3],[Table 4].
| Discussion|| |
The knowledge on malocclusion was significantly higher among females, those in urban areas with no significant difference between individuals aged <20 years compared to those aged >20 years. The increase in knowledge facilitates the development of positive attitude which in turn leads to adoption of healthy practices. The higher levels of knowledge related to malocclusion among females may be attributed to higher concerns among females on oral health., These results were consistent with the findings of Chopra et al. The participants in urban areas will have more access to dental care compared to their rural counterparts. This could be responsible for significantly higher levels of knowledge on malocclusion among participants in urban areas. A study by Chand and Arfan (2014) found oral health-related KAP to be significantly higher among female children and those from urban areas similar to the results of the present study.
The attitude of continuing with the orthodontic treatment even when it caused pain or discomfort was higher among females, those in urban areas with no difference between those aged <20 years compared to those aged >20 years. In support of the present study, various studies identified female orthodontic patients as more cooperative than males.,,, The willingness to undergo treatment even when it extended for a long duration was significantly higher among females, those aged <20 years, and those in urban areas. The concern-related esthetics and social pressure of maintaining pleasing appearance drive females to undergo orthodontic treatment. The eagerness to achieve that pleasing appearance may motivate females to bear with any slight pain and discomfort associated with treatment of malocclusion. These factors may be responsible for favorable attitude among females for undergoing orthodontic treatment in comparison with males. The younger individuals and those in urban areas will strive hard to have gratifying appearance which in turn may be responsible for favorable attitude toward malocclusion treatment.
Higher percentage of females and those in urban areas had undergone treatment for malocclusion with no significant difference with regard to those aged <20 and >20 years. This result is in accordance with study by Rafighi et al. and Wedrychowska-Szulc et al. (2010) who stated that girls, in general, undergo orthodontic treatment more frequently than boys as they are more sensitive to dentofacial attractiveness. The higher levels of knowledge and favorable attitude toward malocclusion treatment among females and those in urban areas might have led to favorable practices. Moreover, the necessity to maintain an attractive appearance in social gatherings is high among females and those in urban areas which might have compelled them to undergo orthodontic treatment more than their counterparts.
The KAP related to malocclusion was higher among females, those in areas. This highlights the need to augment orthodontic awareness programs in rural areas. We could not precisely compare our results with previous published literature as studies comparing KAP in relation to gender, age, and area of residence are scanty. Hence, further studies are recommended to validate the results of present study.
| Conclusion|| |
Majority of the subjects in the study were aware about the term orthodontics. Despite having good knowledge on orthodontic treatment, patient's attitude and practice toward orthodontic treatment was moderate. Adult patients provide us the prospect to render the greatest service doable in orthodontics. Continuing education of the general public will result in an increasing claim for this type of service. Adjunctive and comprehensive orthodontic treatment is practicable for adults owing to the growing emphasis on cosmetic dentistry. Furthermore, correction of malocclusion makes it possible to improve the quality of periodontal and restorative treatment outcomes in addition to providing psychosocial benefits. We recommend further studies with a larger sample size to create awareness in the general public on recent technologies as well as to assess the future requirement of treatment needs.
We extend our sincere thanks to all college authorities for permitting us to undertake this project and volunteers for extending their valuable support in completing the questionnaire.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hamamci N, Basaran G, Uysal E. Dental Aesthetic Index scores and perception of personal dental appearance among Turkish university students. Eur J Orthod 2009;31:168-73.
Urtane I, Pugaca J, Liepa A, Rogovska I. The severity of malocclusion and need for orthodontic treatment in correspondence with the age. Stomatologija 2006;8:35-8.
Klages U, Claus N, Wehrbein H, Zentner A. Development of a questionnaire for assessment of the psychosocial impact of dental aesthetics in young adults. Eur J Orthod 2006;28:103-11.
Rastogi S, Jatti RS, Keluskar KM. Assessment of awareness and social perceptions of orthodontic treatment needs in adult age group: A questionnaire study. J Oral Health Community Dent 2014;8:95-100.
Shekar BR, Suma S, Kumar S, Sukhabogi JR, Manjunath BC. Malocclusion status among 15 years old adolescents in relation to fluoride concentration and area of residence. Indian J Dent Res 2013;24:1-7.
Chandra Shekar BR, Suma S, Kumar S, Sukhabogi JR, Manjunath BC. Prevalence of malocclusion among 15 year old school children using dental aesthetic index in Nalgonda district, Andhra Pradesh, India: A cross sectional study. J Indian Assoc Public Health Dent 2014;12:173-8.
Gupta R, Chandrashekar BR, Goel P, Saxena V, Ganavadiya R, Verma N. Prevalence of malocclusion in relation to area of residence among 13-15 years old Government and Private school children in Bhopal district, Madhya Pradesh, India. Int J Adv Res 2015;3:918-25.
El-Qaderi SS, Taani DQ. Oral health knowledge and dental health practices among schoolchildren in Jerash district/Jordan. Int J Dent Hyg 2004;2:78-85.
Kassak KM, Dagher R, Doughan B. Oral hygiene and lifestyle correlates among new undergraduate university students in Lebanon. J Am Coll Health 2001;50:15-20.
Chopra K, Kathariya MD, Kathariya R, Mohammed IB, Patil SK, Kasat V. Knowledge, attitude and practices regarding oral health among orthodontic and non-orthodontic patients in a dental institute. Int J Dent Case Rep 2015;5:18-24.
Chand S, Arfan HM. Oral health-related knowledge, attitude, and practice among school children from Rural and Urban areas of district Sheikhupura, Pakistan. Pak Oral Dent J 2014;34:109-12.
Kreit LH, Burstone C, Delman L. Patient cooperation in orthodontic treatment. J Am Coll Dent 1968;35:327-32.
Gravely JF. A study of need and demand for orthodontic treatment in two contrasting National Health Service regions. Br J Orthod 1990;17:287-92.
Gray M, Anderson R. A study of young people's perceptions of their orthodontic need and their experience of orthodontic services. Prim Dent Care 1998;5:87-93.
Starnbach HK, Kaplan A. Profile of an excellent orthodontic patient. Angle Orthod 1975;45:141-5.
Rafighi A, Foroughi Moghaddam S, Alizadeh M, Sharifzadeh H. Awareness of orthodontic treatments among school teachers of two cities in Iran. J Dent Res Dent Clin Dent Prospects 2012;6:25-8.
Wedrychowska-Szulc B, Syrynska M. Patient and parent motivation for orthodontic treatment – A questionnaire study. Eur J Orthod 2010;32:447-52.
[Table 1], [Table 2], [Table 3], [Table 4]