Knowledge, Attitude & Practices Regarding Oral Health Among 6th Grade Students Of Two Local Schools in Mardan


Fahad Iqbal1                                          BDS, MPH

Shehzad Fahad2                                   BDS

Jawad Iqbal3                                         M Phil

OBJECTIVE: The objective of this paper was to know about the knowledge, attitudes and practices of 6th grade students regarding oral health in rural areas of Mardan.

METHODOLOGY: A total of 80 students (40 boys, 40 girls) from age group 11 to 13 years were selected for the study. Data was acquired by means of tailored close-ended questionnaires.

RESULT: This study shows that 92.2% of study sample consider tooth brushing necessary but only 56.2% used a tooth brush, while less than one thirs (31.2%) brushed twice a day. Sixty seven percent were not aware that unhygienic dental treatment can cause hepatitis. The overall scores for knowledge, attitude and practice were quiet low.

CONCLUSION: The knowledge, attitude and practices of 6th graders were poor.

KEY WORDS: Caries, Gingivitis, Students, Toothbrush, Oral Health, Hepatitis, Knowledge, Attitude, Practice.

HOW TO CITE: Iqbal F, Fahad S, Iqbal J. Knowledge, Attitude & Practices Regarding Oral Health Among 6Th Grade Students of Two Local Schools In Mardan. J Pak Dent Assoc 2014; 23(3):122-125


ental plaque affects more than 80% of the human population, making it the most infectious disease present in humans[1]. Studies suggest that poor oral health can cause gastric cancer, stomach ulcers cardiovascular disease,[2]-[3] osteomyelitis4, discitis5-6, meningitis7, bacteremia8-9 and endocarditis of both prosthetic10 and native valve11. Poor oral hygiene can lead to periodontal disease and dental caries(12). Dental plaque initiates the oral diseases when microbes grow with the passage of time forming a bio-film by bacteria growing jointly with the human salivary glycol proteins and polysaccharides13. Oral biofilms form a precise pattern with a vastly intricate organization of bacterial growth14-15.

In a study carried out in Nigeria, it was found that 90% of teachers had poor knowledge of causing factors of dental diseases16. In Pakistan, oral health is given less importance. In a study carried out by Vakani F, Basaria

N, et al in Karachi, it was found that the mean of DMFT was 1.27 which shows poor oral hygiene practices17 and this leads to a situation that there is a huge gap left in oral diseases treatment i.e. 90% of lesions never get treated. Oral hygiene is also related to socioeconomic and literacy level of the population18. The attitude, knowledge and practice regarding oral hygiene have a defining role in maintaining one’s oral health. Regional KAP studies portray a rather dismal picture19.

The aim of this study was to evaluate oral health knowledge, attitude and practice of 6th grade students in Mardan city.


A total of 80, 6th grade students of two Government Schools in Mardan city, Khyber Pukhtunkhwa were included. It is cross-sectional study and the sample size was eighty; comprising of forty boys and forty girls. Consent was taken from principals of the respective schools as well as students. Anonymity was ensured

throughout. Questionnaires were distributed in classes and 40 minutes were given to the students for filling it up with the permission of the Principal. The questionnaire was collected on the spot after it was filled by the students.

The questionnaire comprised of 26 close-end questionnaires. The language of questionnaires was Urdu and was translated into English for the purpose of evaluation. The participants’ knowledge of oral health was evaluated through questions regarding the importance of brushing, awareness of tooth paste means of cleaning and protections of teeth, knowledge about the relationship between tooth disease and general health, understanding of the causes of tooth disease, reasons behind bleeding gums, and tooth decay. To judge the practices of the participants regarding oral health question about their previous day brushing schedule was asked and for their attitude in oral health their visit to a dentist was enquired.

The importance of dental visits was evaluated through the frequency of the visits and the reason for it (tooth pain, decay). The participants were asked about their frequency of brushing. To understand their social milieu and financial condition, questions were asked if they were taught oral health measures in schools, curriculum, or by Masjid teachers, whereas their financial situations was evaluated through questions about their family’s ownership of any vehicle and education of their parents.


The data was subsequently analyzed employing the (SPSS) statistical package in social sciences version 16.


Sixty percent of the student’s parents had no education on oral health. Students speaking Pashto were 93. 8%. A question regarding transport facility shows that 26.2% students have no vehicle in their house which shows they are lower middle class and 35% have motor cycle which shows that respondents belong to middle class family. The socio economic status was assessed in terms of having personal transport facility.

Oral Health Attitude Related Questions and Their Responses:

This survey has shown that 96.2% consider it necessary to brush their teeth, 56.2% respondents said that they used brush and 38.8% used Miswak for tooth cleaning.  For protecting their teeth, 57.5% used tooth paste for teeth protection. Sixty five percent said that tooth disease and general health has a relation.

Oral Health Knowledge Related Questions and Their Responses:

To a question regarding knowledge about hepatitis, 90% answered “No” whereas, 67.5% did not know as to whether it can be caused by unqualified dental intervention.

About their source of information about oral health practices 58% got it from their parents while three percent learned it from dentists. Eighty two and half percent use words or rephrase the sentence said that their teacher told them about tooth cleaning and protection. Eighty five percent said that their books contained information about tooth cleaning and protection. Fifty one percent respondents said that their Masjid teacher told them about tooth cleaning and protection. Eighty one percent respondents knew that sugar is cause of tooth decay. Oral Health Practice Related Questions and Their Responses:

Seventy five percent never visited a dentist, whereas 18% did not consider it important, 12% answered that they were not going to dentist because they self-medicate. In the study population, 58% of the respondents brushed their teeth once daily.


This study evaluated oral health attitudes, knowledge and practice of 6th grade students in two schools of rural Mardan, Khyber Pukhtunkhwa. All of the respondents belonged to rural Mardan. Sixty percent of parents of the respondents had no education at all. This study shows that 92.2 percent of the respondents considered brushing necessary which shows a high level of awareness. Besides that, 56.2% used Brush for tooth cleaning which is considerably lower than the statistics of research done by Manoj Humagain in rural Nepal where all the respondents used tooth brush and paste while brushing(20). It was reported that individuals who do not brush their teeth have higher number of microbes in their oral cavity21. It has also been found that 38.8% did brushing twice which is almost equal to the statistics of the study

carried out by Arun Kumar Prasad22, whereas 21.2% did brushing more than twice a day, which is similar to the study done in Burkina Faso, Africa by V, Poul E.P.23. Miswak has a high content of fluoride24 though in some microbes which can cause caries and plaque are resistant to its effects25. Majority of the respondents were unaware of the effects of oral health on overall health. Similar results were seen in the study done by Arigbede AO, Ogunrinde TJ.26. About 75 percent of the participants did not visit/consulted a dentist whereas only 15 percent of the participants visited a dentist only when they had toothaches, 46 percent had ‘no time’ to visit a dentist . If we compare this result with that of Arun Kumar Prasad’s we  find that attitude towards visiting dentist was still lower (36.7%)21 but comparatively much better than this paper’s findings where 75% did not visited a dentist.

This study was conducted keeping in view resources and time constraints other than small sample size. Limited resources included financial constraints as no financial support was provided for conducting this study which eventually leads to a restricted number of sample size. Further, the sample was selected through a non-random method constraining the external validity/generalizability of the study. Other such and related studies are required with a better sample size.


The knowledge, attitude and practices of our study population were poor.


It is recommended that:

  1. Such studies shall be arranged on national level to accumulate a general database which will later help in policy making related to oral health of general population.
  2. School-based health centers shall be established which will be responsible for providing oral and dental health services. Such bodies will enhance awareness of oral health on a very grass-root level which will apparently improve knowledge, attitude and practices.


  1. Petersen P. Continuous improvement of oral health in the 21st century: The approach of the WHO Global Oral health Programme. Chin J Stomatol. 2004;15-39.
  2. Wu T, Trevisan M, Genco R, Dorn J, Falkner K, Sempos C. Periodontal disease and risk of cerebrovascular disease: the first national health and nutritional examination survey and its follow-up study. Arch Int Med. 2000; 160:2749–2755.
  3. Watabe K, Nishi M, Miyake H, Hirata K. Lifestyleand gastric cancer: a case-control study. Oncol Rep. 1998; 5:1191-1194.
  1. Singh N, Yu V. Osteomyelitis due to Veillonella parvula: case report and review. Clin Infect Dis 1992 ;14:361-363
  2. Wren M. Anaerobic cocci of clinical importance. British Journal of Biomedical Sciences. 1996;53:294301.
  3. Isner-Horobeti M, Lecocq J, Dupeyron A, De Martino S, Froehlig P, Vautravers P. Veillonella discitis: a case report. Joint Bone and Spine. 2006;73:113-115
  4. Bhatti M, Frank M. Veillonella parvula Meningitis: Case Report and Review of Veillonella Infections. Clinical Infectious Diseases. 2000;839-840.
  5. Fisher R, Denison M. Veillonella parvula bacteraemia without an underlying source. Journal of Clinical Microbiology. 1996; 34:3235-3236.
  6. Strach M, Siedlar M, Kowalczyk ZM, Grodzicki T. Sepsis caused by Veillonella parvula infection in a 17 year old patient with X-linked agammaglubulinemia. J Clin Microbiology. 2006;2655-2656.
  7. Boo T, Cryan B, O’Donnell A, Fahy G. Prosthetic valve endocarditis caused by Veillonella purvula. J Infect. 2005;50:81-83.
  8. Oh S, Havlen P, Hussain N. A case of polymicrobial endocarditis caused by anaerobic organism in an injection drug user. Journal of General Internal Medicine. 2005; 20(10).
  9. Marsh P. Microbiology of Dental Plaque and Their Role in Oral Health and Caries. Dental clinNorth Am. 2010; 54:441-454
  10. Marsh P. Dental Plaque as a Biofilm and a Microbial Community-Implications for Health and Disease. BMC Oral Health. 2006:15;6 Suppl 1:S14.
  11. Kolenbrander P. Oral Microbial Communities: Biofilm, Interactions, and Genetic Systems. Annu Rev Microbiology. 2000; 54:413-437.
  12. Zijnge V, Leeuwen B, Degener J, Abbas F, Thurnheer T, Gmur R. Oral Biofilm Architecture on Natural Teeth. PLoS One. 2010;5:e9321.
  13. Ehizele A, Chiwuzie J, Ofili A. Oral Health Knowledge, Attitude, Practices among Nigerian Primary School Teachers. Int J Dent Hyg. 2001;4:569–591.
  14. Vakani F, Basaria N, Katpar S. Oral Hygiene KAP Assessment and DMFT Scoring among Children Aged 11-12 Years in an Urban School of Karachi. J Coll Physicians Surg Pak. 2011;21:223-226
  15. Ernesto S, Francisco C, Paula FR. Oral Health Knowledge, Attitudes, and Practices in 12-year old Children. Med Oral Patol Oral Cir Bucal. 2007;12:614620.
  16. Aslam M. Oral Health in Pakistan A SituationAnalysis. Dental Aid. 2005.
  17. Humagain DM. Evaluation of Knowledge, Attitudeand Practice (KAP) About Oral Health Among Secondary Level Students of Rural Nepal – A Questionnaire Study. Rural Nepal 2011;36-45.
  18. Al-Ahmad A, Roth D, Wolkewitz M, WeidmannAl-Ahmad M, Follo M, Ratka-Kruger P, et al. Change in diet and oral hygiene over an 8 week period: effects on oral health and oral biofilm. Clini Oral Invest. 2009; 14.
  19. Arun Kumar Prasad P, Shankar S, Sowmya J, Priya Oral Health Knowledge, Attitude, Practice of School Students. JIADS. 2010; 1(1).
  20. Benoît Varenne PEPO. Oral health behaviour of children and adults in urban and rural areas of Burkina Faso, Africa. International Dental Journal. 2006; 56.
  21. Wu C, Darout I, Skaug N. Chewing Sticks: Timeless natural toothbrushes for oral cleansing. J Periodontal Res. 2001; 36.
  22. Bowden G, Odlum O, Nolette N, Hamilton R.Microbial populations growing in the presence of flouride at low ph isolated from dental plaque of children living in an area with flouridated water. Infection and Immunity. 1982:255-262
  23. Arigbede A, Ogunrinde T, Okoje V. HIV/AIDS andClinical Dentistry: Assessment of Knowledge and Attitude of Patients Attending a University Dental Centre. Niger J Med. 2011:90–95

  1. Private practice/Research study coordinator Save the Children, Khyber Pakhtoonkhwa, Pakistan.
  2. Private practice, District Swat, Khyber Pakhtoonkhwa Pakistan.
  3. Lecturer AWKUM, Mardan, Pakistan.

Corresponding author: “Dr Fahad Iqbal” < >