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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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Year : 2018  |  Volume : 36  |  Issue : 1  |  Page : 21-25

Knowledge, attitude, and behavior of nurses toward delivery of Primary Oral Health Care in Dakshina Kannada, India

1 Department of Paedodontics and Preventive Dentistry, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India
2 Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India

Date of Web Publication28-Mar-2018

Correspondence Address:
Prof. Arathi Rao
Department Paedodontics and Preventive Dentistry, Manipal College of Dental Sciences, Manipal University, Light House Hill Road, Mangalore - 575 001, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JISPPD.JISPPD_80_17

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Majority of young children in many countries do not visit dental clinics for examinations before the age of three though they frequently visit primary health care providers for routine medical check-ups. Nurses are easily accessible and are in frequent contact with waiting mothers and children for routine check-ups and this provides an opportunity to integrate oral health promotion and care into health care. The purpose of this study was thus to study the knowledge, attitude and behaviour towards oral health care among nurses. Methods: The study was a cross-sectional questionnaire survey. Total of 170 medical nurses working in the Institutional Hospital and who provided care for paediatric patients and pregnant mothers participated in the study. Statistical Analysis: Chi-Square test was used to analyse the data using SPSS version 17.0 with a significance value of P < 0.05. Results: All the nurses were aware that good oral health is important for overall health of the child. About 70% of the respondents had poor knowledge regarding dental caries. Good response was obtained regarding importance of oral hygiene maintenance for both the child and mother for prevention of caries. Majority of the nurses showed positive attitudes toward preventive OHC and the role of medical nurses. Routinely the nurses do not refer pregnant mothers and children for dental check up nor do they counsel them regarding oral hygiene and its importance. Conclusion: Appropriate training and encouragement for promotion of oral health and to provide suitable care for the prevention of dental diseases should be included in the curriculum of nurses training.

Keywords: Attitude, knowledge, nurses, oral health care

How to cite this article:
Ahmed F, Rao A, Shenoy R, Suprabha B S. Knowledge, attitude, and behavior of nurses toward delivery of Primary Oral Health Care in Dakshina Kannada, India. J Indian Soc Pedod Prev Dent 2018;36:21-5

How to cite this URL:
Ahmed F, Rao A, Shenoy R, Suprabha B S. Knowledge, attitude, and behavior of nurses toward delivery of Primary Oral Health Care in Dakshina Kannada, India. J Indian Soc Pedod Prev Dent [serial online] 2018 [cited 2023 Feb 6];36:21-5. Available from: http://www.jisppd.com/text.asp?2018/36/1/21/228753

   Introduction Top

The most common chronic disease affecting children's health worldwide is dental caries, which continues to pose a serious problem.[1],[2] Majority of young children in many countries receive no dental examinations before the age of 3 years though they frequently visit primary health-care providers for routine medical checkups.[3],[4]

Medical nurses are easily accessible and are in frequent contact with mothers and children who visit hospitals for routine checkups and this provides an opportunity to integrate oral health promotion and care into health care.[5],[6] Integrating oral health care (OHC) with the existing staff duties will generate cost-effective preventive and health-promoting activities.[7] It has also been found that involving staff in charge of vaccinations to deliver oral health instructions to parents has successfully resulted in reducing caries in toddlers.[8],[9],[10] Nurses receive limited training in OHC during their training periods and also their knowledge in this field seems inadequate.[1],[11],[12]

The rationale of the present study was to study the knowledge, attitude, and behavior of the medical nurses toward OHC. This information can be used to provide training to the nursing staff who form effective source as they form the first contact with children and parents.

   Methods Top

Study design and study sample

The study was a self-administered cross-sectional questionnaire survey. Approval of the Institutional Ethics Committee was obtained before the study. The target population comprised medical nurses working in the Institutional hospital and who provided care for pediatric patients and pregnant mothers. The survey was voluntary and the responses were kept anonymous.

The sample size was calculated, assuming odds of having knowledge about awareness, and willingness to perform children's OHC to be 1.3 using software G* power 3.1.2 (Heinrich Heine, Universität Düsseldorf) to be 170.

Questionnaire details

Questionnaires were given to all the nurses who have agreed to be a part of the study after signing the informed consent. All the questions were in English. The questionnaire was developed based on two studies.[13],[14] Questions were validated for face value, reliability, and linguistic errors by subject experts.

Questions related to knowledge included information acquired by the respondents through experience or education. Questions related to attitude involved mind's predisposition to certain ideas and information, whereas questions involving behavior relate to the actual expression or action taken with regard to the ideas or information.

Questions in knowledge domain consisted of questions pertaining to general information regarding teeth and oral health (question number 1-4), questions regarding dental caries (question number 5-10) and its prevention (question number 10-15), and scoring included true/don't know/false. The questionnaire also enquired specific questions such as time of tooth eruption; the time to begin brushing and cleaning teeth and using fluoride; the transmission of bacteria and the first signs of tooth decay and its etiology, the effects of fluoride.

Questions in attitude part consisted of 10 items and used a 5-point Likert scale. Questions in behavior section consisted of 10 questions with choice of always, sometimes, and never.

Sociodemographic information was also collected that included age, gender, and educational degree and work experience (in years).

The purpose of the questionnaire was explained to the respondents. They were told to answer all the questions without discussing with others. The questionnaires were collected the next day.

Data analyses

Chi-square test was used to analyze the data using SPSS version 17.0 with a significance value of P < 0.05.

   Results Top

A total of 200 nurses were given the questionnaires and 170 of them returned the fully completed questionnaire forms. The participants varied in age from 21 to 55 years (mean: 30.56 years, SD: 6.93), and all of them were female with a mean work experience of 6.59 ± 5.71 years. Among the nurses, 41.8% had bachelor and master's degrees, 54.7% had general nursing midwifery degree, and 3.5% were auxiliary nursing midwifery.


Data collected regarding knowledge among the nurses yielded a mixed answer [Table 1]. All the nurses were aware that good oral health is important for overall health of the child. However, only 23% knew that early loss of milk teeth may result in malocclusion of permanent teeth. 38% of them were not aware that a child should be seen by a dentist by 1 year.
Table 1: Knowledge of oral health among the respondents

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89% of the nurses were not aware that dental caries can be transmitted from mother to the child and 74% were unaware about transmission of caries through utensils. There was a mixed opinion regarding development of caries in children below 2 years. Majority of them agreed to the point that sugar and poor oral hygiene form the important etiology for caries development.

69% of the respondents felt that fluoridated toothpaste is not recommended for children as small as 2 years old. Good response was obtained regarding importance of oral hygiene maintenance for both the child and mother for prevention of caries.

22.9% of the respondents mentioned that they obtained the above knowledge during the training provided in nursing college. 69.4% nurses responded that they received the information by reading on their own and 2.4% through exchange of information from colleagues and friends.


Majority of the nurses showed positive attitudes toward their role in preventive OHC and 83% were willing for training in OHC. However, there were few answers which need to be observed. About 69% feel that OHC provided by them would be inefficient. 81% of them believe that milk tooth does not need care as it will be shed [Table 2].
Table 2: Nurses' attitude toward delivery of oral health care

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69% of the nurses are not consistent in recommending dental visits for pregnant mothers. 73% do not enquire about pregnant mother's oral health and 57% of them rarely counsel them regarding importance of milk tooth and tooth brushing [Table 3].
Table 3: Respondents behavior toward oral health care

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Majority of them used toothbrush and paste for brushing themselves, but only 24% of them are regular users of floss. Only 9.4% of the nurses visited dentist every 6 months for checkup.

[Table 4] shows that knowledge and attitude and knowledge and behavior had a positive correlation with r = 0.38 and 0.27 (P< 0.01), respectively.
Table 4: Correlation between knowledge, attitude, and behavior

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   Discussion Top

Medical and paramedical faculty dealing with children may provide immense support in providing OHC. Children visit hospitals and primary health centers very early in life for vaccinations and checkup. Therefore, health-care providers are in an advantageous situation to provide basic oral examination, counseling, and referral.

The present study revealed that nurses were aware of the importance of oral health for the overall health of the child. However, their knowledge in terms of details was lacking. Most of the studies found that nurses are not well informed regarding oral examination and counseling but are aware that oral health is very important for child's overall development.[13],[14]

In many countries with developing health-care systems, most young children are not included in regular dental recall systems by dentists until they reach the age of 3–6 years; they do, however, see nurses regularly for health screenings and vaccinations before their first birthday.[15],[16]

In many health-care systems, nurses may be the only trustworthy source to provide preventive oral health information from birth and based on their early relationships with young children and their parents can provide counseling on feeding practices, oral homecare (brushing/flossing), and the use of fluorides early on in the child's life. They could also help diagnose early caries followed by referral to dental clinics for further examination and preventive procedures or possible treatment. Studies have shown that these auxiliary workers have a considerable impact on preventive activities and are a potential target for educational interventions.[17],[19] In the present study, majority of the nurses held positive attitudes toward OHC but felt that the service provided by them may not be efficient and were willing to learn and the same trend is seen in other parts of the word.[11],[13],[14]

Nurses are interested in obtaining more training in OHC, and thus, the same needs to be added in their curriculum.[2],[11],[20]

The statistical analysis showed that there was a high relationship between knowledge and attitude about OHC while the relationship between knowledge and behavior was weak. Most of the nurses were educated with a higher degree which may be the reason for their positive attitude. Knowledge and behavior had a weak correlation because nurses may think that “oral examination is not in their scope of practice” or perhaps because of their already existing hectic daily workload.[21]

The WHO Global Oral Health program emphasizes that oral health is integral and essential to general health, and that any attempt to improve oral health should be integrated into other health-promoting strategies and actions.[22] Dental and pediatric associations have also underscored the importance of integrating oral health into general health for sharing the responsibility of OHC with primary care medical practitioners.[6],[23]

   Conclusion Top

Our study revealed lack of knowledge in OHC among nurses, who simultaneously exhibited a generally positive attitude and notable willingness to obtain more training in this field. These findings point to an essential need for appropriate training and encouragement in OHC, especially among nurses working in hospitals and primary healthcare centers, to promote oral health and to provide suitable conditions for the prevention of dental diseases.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Lewis CW, Grossman DC, Domoto PK, Deyo RA. The role of the pediatrician in the oral health of children: A national survey. Pediatrics 2000;106:E84.  Back to cited text no. 1
Hallas D, Shelley D. Role of pediatric nurse practitioners in oral health care. Acad Pediatr 2009;9:462-6.  Back to cited text no. 2
Samadzadeh H, Hessari H, Naghavi M. Oral Health Situation of Iranian Children, Tehran, Ministry of Health and Medical Education, Oral Health Bureau. Seow WK: Biological Mechanisms of Early Childhood; 1999.  Back to cited text no. 3
Wendt LK, Carlsson E, Hallonsten AL, Birkhed D. Early dental caries risk assessment and prevention in pre-school children: Evaluation of a new strategy for dental care in a field study. Acta Odontol Scand 2001;59:261-6.  Back to cited text no. 4
Raybould TP, Wrightson AS, Massey CS, Smith TA, Skelton J. Advanced general dentistry program directors' attitudes on physician involvement in pediatric oral health care. Spec Care Dentist 2009;29:232-6.  Back to cited text no. 5
Hale KJ; American Academy of Pediatrics Section on Pediatric Dentistry. Oral health risk assessment timing and establishment of the dental home. Pediatrics 2003;111(5 Pt 1):1113-6.  Back to cited text no. 6
Jesmin S, Thind A, Sarma S. Does team-based primary health care improve patients' perception of outcomes? Evidence from the 2007-08 Canadian Survey of Experiences with Primary Health. Health Policy 2012;105:71-83.  Back to cited text no. 7
Mohebbi SZ, Virtanen JI, Vahid-Golpayegani M, Vehkalahti MM. A cluster randomised trial of effectiveness of educational intervention in primary health care on early childhood caries. Caries Res 2009;43:110-8.  Back to cited text no. 8
Ekstrand KR, Kuzmina IN, Kuzmina E, Christiansen ME. Two and a half-year outcome of caries-preventive programs offered to groups of children in the Solntsevsky district of Moscow. Caries Res 2000;34:8-19.  Back to cited text no. 9
Feldens CA, Vítolo MR, Drachler Mde L. A randomized trial of the effectiveness of home visits in preventing early childhood caries. Community Dent Oral Epidemiol 2007;35:215-23.  Back to cited text no. 10
Wooten KT, Lee J, Jared H, Boggess K, Wilder RS. Nurse practitioner's and certified nurse midwives' knowledge, opinions and practice behaviors regarding periodontal disease and adverse pregnancy outcomes. J Dent Hyg 2011;85:122-31.  Back to cited text no. 11
Mohebbi SZ: Early Childhood Caries and a Community Trial of its Prevention in Tehran, Iran. PhD thesis, University of Helsinki, Oral Public Health Department. 2008 Available from: http:/ethesis.helsinki.fi/julkaisut/laa/hamma/vk/mohebbi/. [Last accessed on 2017 Mar 1].  Back to cited text no. 12
Rabiei S, Mohebbi SZ, Yazdani R, Virtanen JI. Primary care nurses' awareness of and willingness to perform children's oral health care. BMC Oral Health 2014;14:26.  Back to cited text no. 13
Mani SA, Aziz AA, John J, Ismail NM. Knowledge, attitude and practice of oral health promoting factors among caretakers of children attending day-care centers in Kubang Kerian, Malaysia: A preliminary study. J Indian Soc Pedod Prev Dent 2010;28:78-83.  Back to cited text no. 14
[PUBMED]  [Full text]  
Nammalwar RB, Rangeeth P. Knowledge and attitude of pediatricians and Family Physicians in Chennai on Pediatric Dentistry: A survey. Dent Res J (Isfahan) 2012;9:561-6.  Back to cited text no. 15
dela Cruz GG, Rozier RG, Slade G. Dental screening and referral of young children by pediatric primary care providers. Pediatrics 2004;114:e642-52.  Back to cited text no. 16
Kuronen R, Jallinoja P, Patja K. Use of and attitudes toward current care guidelines among primary and secondary care nurses in Finland. Clin Nurs Res 2011;20:310-25.  Back to cited text no. 17
Amemori M, Virtanen J, Korhonen T, Kinnunen TH, Murtomaa H. Impact of educational intervention on implementation of tobacco counselling among oral health professionals: A cluster-randomized community trial. Community Dent Oral Epidemiol 2013;41:120-9.  Back to cited text no. 18
Ford CR, Foley KT, Ritchie CS, Sheppard K, Sawyer P, Swanson M, et al. Creation of an interprofessional clinical experience for healthcare professions trainees in a nursing home setting. Med Teach 2013;35:544-8.  Back to cited text no. 19
Rabiei S, Mohebbi SZ, Patja K, Virtanen JI. Physicians' knowledge of and adherence to improving oral health. BMC Public Health 2012;12:855.  Back to cited text no. 20
Fulmer T, Cabrera P. The primary care visit: What else could be happening? Nurs Res Pract 2012;2012:720506.  Back to cited text no. 21
Petersen PE. Global policy for improvement of oral health in the 21st century – Implications to oral health research of world health assembly 2007, world health organization. Community Dent Oral Epidemiol 2009;37:1-8.  Back to cited text no. 22
Haden NK, Catalanotto FA, Alexander CJ, Bailit H, Battrell A, Broussard J Jr., et al. Improving the oral health status of all Americans: Roles and responsibilities of academic dental institutions: The report of the ADEA President's Commission. J Dent Educ 2003;67:563-83.  Back to cited text no. 23


  [Table 1], [Table 2], [Table 3], [Table 4]


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