Oral health knowledge and sources of information among

male secondary school children in Riyadh

Amjad H. Wyne, BDS, BSc, MDS, FASDC, FADI, Arham N. Chohan, BDS, BSc, MSc, FPFA, FADI ,
Ziyad Al-Abdulsalam, BDS   Abdullah Al-Qedrah, BDS , Sari Al-Qahtani,  BDS
King Saud University, College of Dentistry, Riyadh, KSA 

The aim of the present study was to determine the oral health knowledge and sources of information in male secondary school children in Riyadh, Saudi Arabia.  The information on oral health knowledge and sources of information was collected through a specially designed self-administered questionnaire.  A total of 605 randomly selected male secondary school children from six schools completed the questionnaire. The mean age of the children was 17.0 years (SD 1.4, range 15 to 21 years). A great majority (91.4%) of the children was aware that good dental health is important for good general health. Majority (60.5%) of the children correctly thought that teeth should be cleaned after each meal, however, more than one-fourth (28.4%) of the children reported that no one taught them how to clean their teeth. More than one-third (39.5%) of children thought that one must visit a dentist only in case of pain in the teeth. A great majority (94.5%) of the children knew that sweets (chocolates/candies) could cause tooth decay. However, 40.2% of children were not aware of cariogenic potential of soft drinks. A high percentage (80.4%) of children knew that the best way to maintain optimum gingival health was to clean their teeth daily. Dentists were the most popular (34.2%) source of oral health information followed by media (32.2%) and parents/grandparents (23.8%). Only 1.8% children reported their teachers as source of oral health information. It could be concluded that these school children need further oral health information, and that there is a need to reinforce the role of school teachers in enhancing school children's oral health knowledge.

Oral health knowledge and information form the basis of optimal dental health. Recent studies show that caries prevalence is very high among school children in Riyadh,^1,2 including secondary school children.³ Therefore, an effective preventive program is desirable for these children. However, it is important to establish the current status of oral health knowledge and sources of oral health information among school children before designing an effective prevention program. Such information will assist in establishing an effective preventive dental health strategy. It is expected that preventive oral health education based realities on the ground will enhance these children's oral health knowledge, transforming knowledge into appropriate behaviors, and consequently resulting in better oral health.

The approval for the study was obtained from the Ministry of Education. Six secondary schools were selected from a list of schools provided by the Ministry of Education. Each school was randomly selected from every region of Riyadh City, i.e., Eastern, Western, Northern, Southern and Central regions. In addition, a private school was also randomly selected to ensure representation from all segments of the society. There was a similar representation of each three years/levels of secondary school in the sample.

The information about oral health knowledge and sources of information was collected through a questionnaire adopted from that used by Wyne et al.⁴ The study did not obtain any typical confidential information such as income or educational level of parents. However, the questionnaire was provided to the Ministry of Education at the time for approval; and parents were informed of the study through a letter from the ministry. The questionnaire was designed to be comprehensible for the secondary school children and was pre-tested among a group of children who did not participate in the main study causing some modifications to be made. The questionnaires were anonymous distributed in the classrooms and collected after completion by the children at the same time by one of the researchers. The following areas were covered in the questionnaire:

     -    Demographic information such as age and educational level

     -    Knowledge of dental diseases

     -    Knowledge of selected preventive measures

     -    Sources of oral health information

All the information was entered into a computer utilizing FOXPRO Program, and a data file was generated. Statistical Package for Social Sciences (SPSS) was utilized for descriptive statistics.

A total of 605 male secondary school children from the six schools completed the questionnaire. The mean age of the children was 17.0 (SD 1.4) years ranging from 15 years to 21 years.

The children's response about oral health knowledge questions is presented in Table 1. A great majority (91.4%) of the children was aware that good dental health is important for good general health. Most of the children were aware of the importance of teeth in chewing (79.5%) and appearance (65.1%). Less than half (45.8%) of them were not aware of the importance of teeth in speech. Most of the children correctly thought that teeth should be cleaned after each meal (60.5%) or at least twice daily (28.6%). Parents of the children mainly (48.9%) taught them how to brush their teeth, followed by their dentists (17.9%). However, more than one-fourth (28.4%) of the children reported that no one taught them how to clean their teeth. While six in every ten children (59.2%) correctly thought that one must make a routine dental visit every six month or once a year, a large number (39.5%) of children thought that one must visit the dentist only in case of pain related to teeth.

Although slightly more than half (53.4%) of the children had heard about fluoride, only 31.2% knew that fluoride helps to protect teeth from dental caries (Table 2). Only 9.9% of the children recognized fluoridated water as a source of fluoride while 23.7% of the children were not aware of any method of getting fluoride (Table 2). A great majority (94.5%) of the children knew that sweets (chocolates/candies) could cause tooth decay. However, a large number of children were not aware of the cariogenic potential of soft drinks (40.2%) and sweetened milk (77.5%) as shown in Table 2.

The responses to questions about periodontal health are summarized in Table 3. About six in every ten children (61.3%) thought that blood on the tooth brush could be a sign of gum disease. A little more than half, 51.7% of the children recognized that symptoms of gum disease include swelling, redness of gums, bad smell from mouth and bleeding from gums. Approximately 80% of the children knew that the best way to maintain optimum gingival health was to clean their teeth daily.

Most of the children had a satisfactory understanding of importance of good dental health and information about functions of teeth. However, a considerable number of children were not aware of all the functions of teeth. Appropriate knowledge about the functions of teeth is likely to enhance dental care among these children. More than one-fourth of the children were not taught by anyone how to brush their teeth. A proper brushing technique is important in achieving adequate oral hygiene. Therefore, parents of the children should be encouraged to provide oral hygiene guidance to their children.

Although, it was encouraging to note that more than half of the children thought that routine check-up dental visit must be made every six months or once a year, yet a large number of children thought that a dental visit is only necessary in case of dental pain. This attitude could be explained in terms of fear due to previous negative dental experience or continuous parental negligence and attitude. Similar findings were reported by Oliveria et al.⁵ in their study of young school children in Houston, USA. Farsi et al.⁸ also reported that pain was the main reason for dental visits in Saudi school children in Jeddah City. 

Less than one-third of the children knew that fluoride prevents dental caries. Similarly, very few children recognized fluoridated water as an efficient source of fluoride. These results are the same as several other similar studies carried out in various countries,^5,9,10  and indicate the need to educate school children about the benefits of fluoride to teeth. The children's knowledge about sweets (chocolates/candies) as a cariogenic diet was quite adequate. However, a large percentage of the children did not consider soft drinks and sweetened milk as cariogenic; thus requiring appropriate guidance in this area.

The children's knowledge of gum disease was satisfactory in terms of recognizing its symptoms and identifying the best way of preventing it. The results of the present study were in agreement with several similar previous studies in other populatgions.^5,9,10 However, some studies have reported unsatisfactory knowledge of periodontal health among school children.^8,11

Dentists and media were the main source of oral health information. The role of mass media has been gradually increasing in providing health information to the public including oral health information.¹² The need however still exist to enhance the media utilization for children's dental health awareness. The present study confirms the findings of other studies,^5,9 but differs from the Woolfolk et al.¹⁰ study in which parents were the main source of information for children. A useful way to raise children's dental health awareness would be to furnish accurate information to parents. The children whose parents have sufficient oral health knowledge and a positive attitude are likely to adopt satisfactory healthy oral health habits.^13,14 Children spend a good part of their daily time in schools. However, the results of the present study showed that only a small minority of the children obtained oral health information from their school teachers. There is a need therefore for increased provision of oral health information at schools, and utilization of school teachers also as providers of information on dental prevention.

Address reprint requests to:

Dr. Amjad H. Wyne
P.O. Box 60169,
Riyadh 11545, KSA
email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Table 1. Responses to questions regarding oral health knowledge

* Appropriate responses    ** Select one response only

Table 2. Responses to questions about caries prevention 

*Appropriate Response       ** Select one response only

Table 3. Responses to questions about periodontal health -
* Appropriate response   ** Select one response only.

Figure 1. Main source of oral health information.