Self-perception Regarding Oral Health Status in Relation with Socioeconomic Determinants: A Study from Hail, Saudi Arabia
Freah Alshammary1, Abdullah Abdulaziz Al Yousaf2, Faisal Abdulrahman Alrashid3, Ammar A Siddiqui4, Junaid Amin5, Eman Afroze6
1 Assistant Professor, Department of Preventive Dental Sciences, College of Dentistry, University of Hail, Hail, Saudi Arabia.
2 Dental Intern, College of Dentistry, University of Hail, Hail, Saudi Arabia.
3 Dental Intern, College of Dentistry, University of Hail, Hail, Saudi Arabia.
4 Assistant Professor of Dental Public Health Head of Department, Preventive Dental Sciences, Chairman of the Research Support Unit, College of Dentistry, University of Hail, Hail, Saudi Arabia; Member of The Royal College of Surgeons of England Fellow Royal Society for Public Health, United Kingdom.
5 Lecturer, Department of Physiotherapy, College of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia.
6 General Practitioner, Private Dental Practice, Islamabad, Pakistan.
NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Dr. Ammar A Siddiqui, Assistant Professor of Dental Public Health Head of Department, Preventive Dental Sciences, Chairman of the Research Support Unit, College of Dentistry, University of Hail, Hail, Saudi Arabia.
E-mail: ammarqta2002@hotmail.com
Introduction
Achieving satisfactory oral health is a subjective state; despite improvement and advances in health, disparities in oral health still occurs. Identification of determinant of health is an initial step to know insights of certain locality.
Aim
To determine the perception of oral health status amongst respondent of Hail region based on gender, age, level of education and income.
Materials and Methods
It was a cross-divtional study conducted from June 2019 to August 2019. The sample (n=412) was selected through non-probability convenient sampling technique. Components of oral health survey questionnaire designed by World Health Organisation, was used as study tool to measure the perception of respondent’s. Data were displayed as number and percentage. Chi square test was used to measured the association of different oral health determinants. p-value <0.05 was considered significant.
Results
Females {84 (62%)} perceived a good oral health status than males {52 (38%)} with p=0.013. The perception of 18-28 years old participants was 33%, and 49 years old and more was 12%, i.e., with increasing age, perception toward oral health status was decreasing. University level of education participants (46%) perceived an excellent oral health. Majority of participants 163 (39%) with high income group perceived a good oral health. The education level and amount of income were also found to be statistically associated in determining respondent’s perception towards their oral health status.
Conclusion
Perception of oral health found to be associated with the age, gender, level of education and income. Female gender, higher level of education and good income contributes to good oral health perception while increasing age inversely affects the oral health perception.
Introduction
It has been expected from healthy individuals that their oral health-related knowledge is up to the mark and they are maintaining good oral hygiene [1]. Many studies on perception of oral health were based on two components, either they were on oral health need assessment or on self-perceptions [2]. Conversely, an educated individual with good socio-economic status will visit the dentist every six months for a routine check-up, and follow-up, etc., [3]. The authors have classified the perception of oral health status among three different groups that are gender, education and income that were studied over years and have given their theories based on the result and findings [4].
The gender-based studies have shown that females had more positive approach towards their oral health with regular visits to dentists and have sufficient knowledge about proper tooth brushing techniques [5]. Women usually perceive oral health as self-grooming habit, improving their health-related quality of life [6]. Gender conscientiousness, in oral health, depends upon individual outlooks to oral health. Furthermore, understanding the intellectual behaviours and thinking of males and females would accelerate dental tactics in modifying oral health behaviour of both genders, thus contributing to lifelong health maintenance [7,8].
The different studies on oral health status have also found the literacy as another potent factor when it comes to oral health status because it aids to understand the cause, and consequences of poor oral health, and also acquire and implement important aspects of positive oral self-care behaviours [9]. Lack of oral health literacy can create a substantial obstacle to communicate with Public health advisors to prevent oral disease and promote oral health. An improved literacy level in a community develops aptitudes of the individual to grasp and acclimatise to healthy lifestyle practices and decrease menace behaviours [10]. Evidence has shown that people without the knowledge of health are making unfair decisions about their health and are more susceptible to diseases and have inferior health outcomes [11]. A study conducted in 2014 shown that Rapid Estimate Of Adult Literacy In Dentistry-30 (REALD-30) score was below 22 for nearly 29% of the participants. Moreover, a substantial amount of people have a low knowledge of oral health which conceivably hinders with their aptitude to process and understand the importance of having a sound oral health status [12].
Likewise, lack of income is another determinant to affect both practical and societal proportions in a community possibly through a psychological and social pathway [13]. A study conducted in 2017 among Brazilian adolescents explored the worst possible health outcomes among people with poor socio-economic status. The findings indicated that at least one of the negative oral health factor exists in the lower-income group [14].
The present study aimed to investigate the association of gender, age, level of education and income on self-perception of oral health status among the Hail city population. To, the best of authors’ knowledge this is the first study of its kind in Hail, Saudi Arabia.
Materials and Methods
It was a cross-sectional study which was conducted in Hail city, that is located in the north of Saudi Arabia with a population of nearly 600,758. The study ethical approval was taken from the Ethical Committee of the University of Hail, having an approval number H-2016-046. The study was carried out from June 2019 to August 2019. The only inclusion criteria were the Saudi adults of 18 years age and above living in the Hail city. People with disability, pregnant women, patients underwent oral prophylaxis and any systemic disease were excluded.
Study tool for the present study was a questionnaire, adapted from the oral health basic survey methods, developed by World Health Organisation (WHO) [1]. The modified version of the questionnaire was face and content validated by a group of field specialists. Reliability was measured through Cronbach’s alpha test, which yielded the internal consistency value 0.74 that lies in the acceptable category. Written Informed consent was obtained. The representative sample (n=414) of the population was collected through non-probability convenient sampling technique. Most of study participants were the patients and visitors attending the clinics of Hail College of dentistry.
Statistical Analysis
Data was decoded and analysed using Statistical Package of Social Sciences (SPSS) version 21.0. Descriptive data were displayed as number and percentages. Pearson’s chi-square test was used to measure the association between various variables such as genders, level of education, income and age group. p-value <0.05 was statistically significant.
Results
The mean age of the study sample was 37.2±18.1 years. A total number of 450 questionnaires were sent and 414 questionnaires were received (response rate=92%). After the exclusion of two questionnaires with missing data, 412 questionnaires were selected in the study. The demographic data of the respondents are presented in [Table/Fig-1].
Demographic characteristics of respondents (n=412).
| Demographics/characteristics | No. (%) of respondents |
|---|
| Gender |
| Male | 168 (40.8%) |
| Female | 244 (59.2%) |
| Age in Years |
| 18-28 | 136 (33.0%) |
| 29-38 | 93 (22.6%) |
| 39-48 | 132 (32.0%) |
| >49 | 51 (12.4%) |
| Income per month in Saudi Riyals (SR) |
| Less than 1000 | 94 (22.8%) |
| 1000-5000 | 81 (19.7%) |
| 5000-10000 | 74 (18.0%) |
| 10000 and more | 163 (39.5%) |
| Education level |
| No formal schooling | 2 (0.5%) |
| Primary school completed | 8 (1.9%) |
| Secondary school completed | 8 (1.9%) |
| High school completed | 134 (32.5%) |
| College/university and Postgraduate degree completed | 260 (63.2%) |
| Oral health status |
| (Teeth Gums) | |
| Excellent | 30 (7.3%) |
| Very good | 103 (25.0%) |
| Good | 136 (33.0%) |
| Average | 87 (21.1%) |
| Poor | 37 (9.0%) |
| Very poor | 15 (3.6%) |
| Don’t know | 4 (1.0%) |
The most of participants 136 (33%) were having a good oral health status according to their perception and most of them were females 84 (62%). The least count of participants said that they don’t know 4 (1%), all of them were females 4 (100%) The perception regarding oral health status was statistically significant amongst gender, “p=0.013” [Table/Fig-2].
Assessment of participants’ oral health status related to gender.
| Condition | Gender | Total | p-value |
|---|
| Male | Female |
|---|
| Oral health status | Excellent | 14 (47%) | 16 (53%) | 30 (7%) | 0.013 |
| Very good | 33 (32%) | 70 (68%) | 103 (25%) |
| Good | 52 (38%) | 84 (62%) | 136 (33%) |
| Average | 37 (43%) | 50 (57%) | 87 (21%) |
| Poor | 23 (62%) | 14 (38%) | 37 (9%) |
| Very poor | 9 (60%) | 6 (40%) | 15 (4%) |
| Do not know | 0 (0%) | 4 (100%) | 4 (1%) |
| Total | 168 (40.8%) | 244 (59.2%) | 412 (100%) |
Chi square test was used
Overall 136 (33%) respondents perceived their oral health status as good, this finding was also consistent in all the age groups except 18-28 years old in this age group majority of the participants 50 (37%) perceived their oral health status as very good. The perception regarding oral health status was statistically significant amongst different age groups, “p=0.001” [Table/Fig-3].
Assessment of participants’ oral health status related to age group.
| Oral health status (Teeth gums) | Total | p-value |
|---|
| Excellent | Very good | Good | Average | Poor | Very poor | Do not know |
|---|
| Age group | 18-28 years old | 19 (14%) | 50 (37%) | 38 (28%) | 16 (12%) | 8 (6%) | 2 (1%) | 3 (2%) | 136 (33%) | 0.001 |
| 29-38 years old | 7 (8%) | 13 (14%) | 33 (35%) | 21 (23%) | 13 (14%) | 6 (6%) | 0 (0%) | 93 (23%) |
| 39-48 years old | 2 (2%) | 29 (22%) | 45 (34%) | 37 (28%) | 12 (9%) | 6 (4%) | 1 (1%) | 132 (32%) |
| 49 years old and more | 2 (4%) | 11 (22%) | 20 (39%) | 13 (25%) | 4 (8%) | 1 (2%) | 0 (0%) | 51 (12%) |
| Total | 30 (7%) | 103 (25%) | 136 (33%) | 87 (21%) | 37 (9%) | 15 (4%) | 4 (1%) | 412(100%) | |
Chi square test was used
The result of the present study indicated that those who perceived oral health status as good was mostly 88 (65%) belong to higher education level group. The perception regarding oral health status was statistically significant amongst groups with different level of education, “p=0.008” [Table/Fig-4].
Assessment of participants’ oral health status related to level of education.
| Level of the education | Total | p-value |
|---|
| No formal schooling | Primary school completed | Secondary school completed | High school completed | College/University and postgraduate degree completed |
|---|
| Oral health status | Excellent | 0 (0%) | 0 (0%) | 2 (7%) | 14 (47%) | 14 (46%) | 30 (7%) | 0.008 |
| Very good | 0 (0%) | 0 (0%) | 1 (1%) | 32 (31%) | 70 (68%) | 103 (25%) |
| Good | 0 (0%) | 4 (3%) | 2 (1%) | 42 (31%) | 88 (65%) | 136 (33%) |
| Average | 2 (2%) | 3 (3%) | 1 (1%) | 21 (25%) | 60 (69%) | 87 (21%) |
| Poor | 0 (0%) | 0 (0%) | 2 (5%) | 15 (41%) | 20 (54%) | 37 (9%) |
| Very poor | 0 (0%) | 0 (0%) | 0 (0%) | 7 (47%) | 8 (53%) | 15 (4%) |
| Do not Know | 0 (0%) | 1 (25%) | 0 (0%) | 3 (75%) | 0 (0%) | 4(1%) |
| Total | 2 (0.5%) | 8 (2%) | 8 (2%) | 134 (32.5%) | 260 (63%) | 412 (100%) |
Chi square test was used
Among participants who perceived their oral health status as excellent/very good or good most of them were from high-income status as indicated by their percentages 23%, 36% and 46% respectively. The perception regarding oral health status was statistically significant amongst different income groups, “p=0.002” [Table/Fig-5].
Assessment of participants’ oral health status related to income per month.
| Income per month in Saudi Riyal (SR) | Total | p-value |
|---|
| Less than 1000 | 1000-5000 | 5000-10000 | 10000 and more |
|---|
| Oral health status | Excellent | 11 (37%) | 7 (23%) | 5 (17%) | 7 (23%) | 30 (7%) | 0.002 |
| Very good | 33 (32%) | 21 (20%) | 12 (12%) | 37 (36%) | 103 (25%) |
| Good | 24 (18%) | 23 (17%) | 26 (19%) | 63 (46%) | 136 (33%) |
| Average | 14 (16%) | 10 (11%) | 20 (23%) | 43 (50%) | 87 (21%) |
| Poor | 9 (24%) | 11 (30%) | 8 (22%) | 9 (24%) | 37 (9%) |
| Very poor | 2 (13%) | 6 (40%) | 3 (20%) | 4 (27%) | 15 (4%) |
| Do not know | 1 (25%) | 3 (75%) | 0 (0%) | 0 (0%) | 4 (1%) |
| Total | 94 (23%) | 81 (20%) | 74 (18%) | 163 (39%) | 412 (100%) |
Chi square test was used
Discussion
In the present study, majority of the subjects confirmed the strong influence of gender, level of education, and income on oral health status. The findings of the present study indicated good oral conditions among female participants. The previous gender based studies have also reported that women had more positive dental attitude and behaviour for their oral problems as compared to men making regular dental check-ups, more educated about proper brushing techniques [5,15-18].
In the present study, in young age groups, perception about oral health is good but it was decreasing in old age group participants. These findings are in line with a study done amongst Danish population [19]. It was also in agreement with another study conducted in Skaraborg, Sweden among 17,280 students, between the ages of 13-18 years who were self-assessed about their oral health status, based on contentment with look of their teeth, bleeding gums, and using a “perceived Oral Health Index (OHI)”. The study revealed that having sound teeth and good oral health status was a prevailing approach among the students in which 94% of the boys and 97% of girls significantly perceived their good oral health status [7]. In this study, significant influence of education level on oral health was observed. The low literacy among population contributes to bad health outcomes. The previous studies also reported that the educated individual and good socio-economic status had relatively better health and oral health [20].
In the current study, it was also observed that the income of the people influences how they perceive their health status. The people with good monthly income perceived better about health than the low income participants. In general, having a good financial resources provides accessibility and availability to best healthcare facilities, regular dental visits and preventive approach to their oral as well as general health [21]. In both developing and developed countries, oral problems are the most expensive treatment. The findings of the present study are in agreement with the prior studies done on oral health and quality of life. These studies found the good oral health behaviour and better quality of life among children of high income families [22,23]. In worldwide, population based studies have reported the burden of oral diseases among poor population due to social, behavioural and environmental factors [24]. Most of the previous studies conducted in Hail region measured the respondents’ perception, attitude, and practice towards oral health but did not contrast it with potential determinants of health [25-27]. The present study will help in better assessment of oral health needs giving value to socio-economic determinants of the local community.
Limitation
Due to lack of logistic support, the current study included the sample only from Hail city using non-probability sampling technique. Due to this reason, data may not represent whole Hail province.
Conclusion
Based on the results of present study it is concluded that perception of oral health status is associated with socio-economic determinants of health in particular level of income, level of education, age, as well as amongst gender. Perceived oral health status was poor in old age whilst female have perceived their oral health status much better than male. Likewise, the people with high level of education, and income perceived positive attitude towards their oral health status.
Chi square test was usedChi square test was usedChi square test was usedChi square test was used
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