The Journal of School Nursing2023, Vol. 39(4) 295–304© The Author(s) 2021Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/10598405211012981journals.sagepub.com/home/jsn
Oral health is a very critical component of individuals’ physical and psychological well-being. The present study aimed to investigate the dental health knowledge, attitude, and practice among schoolchildren in Abha. A cross-sectional epidemiological study was conducted. Each student completed a questionnaire regarding oral health. The participants were 800 students: 54.8% were male and 45.2% were female. Knowledge scores showed that -59.1% of the participants have fair knowledge. Statistically significant results were found between the age, school type, and students’ educational level with the knowledge of oral health care (p < .05). More than half of the participants had positive attitudes (57.2%) and less than half demonstrated satisfactory oral health habits (45.3%). Students’ educational level was significantly associated with attitudes and practices (p < .05). It can be concluded that the average knowledge, attitude, and practice level was 53.9%, which is not a positive indicator and needs to be strengthened.
Keywordsoral health, oral hygiene, knowledge, attitude, practice, school children
Oral health is a very significant component of an individuals’ physical and psychological well-being (Suzanne & Brenda, 2008), and it is important for general health at every stage of life. In reality, the mouth acts as a window to the rest of the body and offers signs of general health issues (Anand et al., 2019). In 2016, the Federal Dental International (FDI) Dental World Federation comprehensively redefined oral health and agreed that oral health was multifaceted and included the ability to smell, touch, taste, chew, swallow, smile, speak, and transmit a lot of emotions with confidence and without discomfort, pain, and disease of the craniofacial area through facial expressions (Sharma et al., 2019).
Oral diseases are recognized globally as a public health concern and affect almost 3.9 billion people worldwide (Marcenes et al., 2013). Also, they remain the most common chronic disease of adolescents aged 12–19 years, affecting in some countries from approximately 67.5% to over 80.0% of school children (Centers for Disease Control and Prevention, 2019). Many factors may cause an increase in dental caries rate in developing countries, such as increasing exposure to commercialized sugar products, lack of fluoride, less availability to dental health care services, socio-economic status, and lifestyle (Veiga et al., 2015).
Good oral health knowledge is important for achieving good oral health habits, and a link has been shown to exist between improved knowledge and better oral health (Blaggana et al., 2016). Therefore, the World Health Organization (WHO) promotes oral health promotion through schools to improve understanding, behaviors, and practices related to oral health for the prevention and control of dental disease among schoolchildren. Several studies have established numerous sources of information on oral health, such as parents, schoolteachers, dentists, and mass media, which have a direct impact on schoolchildren’s oral health awareness (Al-Darwish, 2016). School-based health education is successful in encouraging awareness, modifying, and changing attitudes and behaviors related to health (Elfaki et al., 2015). Also, students are the perfect population for early intervention because health habits and lifestyles that have evolved at a younger age are more sustainable (Sharada et al., 2011).
Little is known about the oral health attitudes and behavior of children from developing countries such as Saudi Arabia in comparison with those from developed countries (Nagarajappa et al., 2015). Very few studies have been done in Saudi Arabia to assess oral health knowledge, attitude, and practices among students. It has been reported that students had good knowledge of the basic oral health measures, but their attitude regarding oral health was diverse and practices toward oral health were poor (Jaber et al., 2017). Further, Mulla and Omar (2016) found that oral health knowledge among the students was fair; attitude toward oral health was good while practices were moderate.
In a literature review conducted to estimate the prevalence, severity, and secular trends of dental caries among various Saudi populations, investigators found the highest caries prevalence was 91.0%, with the highest Decayed, Missing, and Filled Teeth value of 7.35 among children and adolescents aged 12–19 (Al-Ansari, 2014). Also, another study in 2017 concluded that the overall prevalence of caries in secondary students aged 16–18 years in Ha’il city, K.S.A., was 78.9% (Aljanakh, 2017). Thus, the oral health of school-aged students should receive more consideration in Saudi Arabia. The main aim of this study was to investigate the dental health knowledge, attitude, and practice (KAP) of intermediate and secondary school students in the Assir region, Abha city, K.S.A.
Research Question 1: What is the level of oral health KAP among schoolchildren in Abha city?
Research Question 2: Is there any significant effect of certain sociodemographic risk factors as age group, gender, school type, students’ grade level, parents’ education level, parents’ occupation, and monthly income on level of oral health KAP among schoolchildren?
Research Question 3: Is there any correlation between higher knowledge and attitude with positive oral health practice among schoolchildren?
A cross-sectional epidemiological study was conducted among school students with age 12–16 years from January 1st to March 1st, 2020. Eighteen is the age that marks the end of obligatory school education in the Kingdom of Saudi Arabia. This period of education is divided into first to sixth primary, first to third intermediate, and first to third secondary. A simple random sampling methodology for data collection was used to select 12 public and private intermediate-secondary schools from a total of 271 in Abha city of the Assir region.
Ethical approval was received from Ethical Research Committee—from where the study had been conducted. Also, the official permission given by the Directorate of Education of Abha city was sent to the selected schools, along with a letter explaining the purpose of the study and the procedures to be followed. As the study included participants less than 18 years of age, before data collection, written-informed consent was obtained from the students and their custodians. The investigator ensured that the relevant protocols were followed, taking into account informed consent, autonomy, anonymity, and confidentiality issues.
Study participants were required to complete a closed-ended questionnaire adopted and updated by Rad et al. (2016). The researcher created and designed a variant of the closedended Arabic questionnaire to gather information regarding oral health. The tool was subjected to linguistic validation to ensure that the questions were translated reliably. To achieve this, experts in both languages translated the questionnaire into Arabic and another person translated it back to English, and the translation was found to be valid. The final version of the questionnaire was checked for face-to-face validity from the expert panel of researchers. The Arabic questionnaire was designed to assess the demographic data and the oral health knowledge, attitudes, and behavior of young school students. Internal consistency for the total scores showed a Cronbach’s coefficient α of 0.734.
The questionnaire consisted of four sections with 44 items. The first section contained questions about sociodemographic data including information on school type, students’ grade level, age-group, gender, family income, and history of dental caries. The second section contained questions that covered students’ knowledge regarding oral health, dental diseases, bleeding, eating sweet foods and drinking sweet liquids, and using fluoride. A score of 1 was given for each correct response and a 0 for “wrong” and “don’t know” answers. Based on the total scores, participants’ knowledge scores were divided into fair knowledge (score equal or greater than mean) or poor knowledge (score less than mean).
The third section consisted of questions exploring the attitude and perception of the participants regarding the importance of taking care of teeth, decay effects and how to prevent decay, regular visits to the dentist, the importance of primary teeth, and treating dental problems. Positive attitude responses were given a score of 1 for an agree response and negative responses were given a score of –1 for disagree and 0 for no opinion responses. Based on the total scores, participants’ attitude scores were divided into positive attitude (score equal or greater than mean) and negative attitude (score less than mean).
The last section assessed the participant’s oral health practices regarding brushing, tools for cleaning teeth, type of toothpaste, rinsing the mouth after each meal, the reason for brushing, and changing toothbrushes. Correct answers were given a score of 1 whereas incorrect and I don’t know answers were given a score of 0. Based on the total scores, participants’ behavior scores were divided into satisfactory practice (score equal or greater than mean) and unsatisfactory practice (score less than mean).
A pilot study was conducted earlier on a random sample of 25 male and 25 female students studying in a school rather than schools selected in the actual study to check the validity, feasibility, clarity, and comprehensibility of the questionnaire and to assess the students’ ability to understand the questions and answer them without any help. After the conducted pilot study, the panel of experts from Al-Ghad college and King Khalid university advised for subtle necessary modifications to make some questions clearer. From the pilot study conducted, it was observed that the average KAP score about oral health was 50.0%, with a 95% confidence interval, 5% of relative precision, and 10% nonresponse rate, sample size was estimated to be 400. This estimate was doubled making a final sample size of 800. The total sample consisted of 800 schoolchildren from grades seventh intermediate to first secondary, including 438 males and 362 females. The participants were informed of the importance of answering the questions honestly and with confidentiality.
The data were analyzed according to the appropriate statistical technique determined by the level of measurement. After doing data analysis by using the IBM SPSS Statistics 22, descriptive statistics in the form of means, standard deviations, frequencies, and percentages were computed to describe students’ demographic characteristics. Different differential statistical tests were used to compare students’ knowledge, attitudes, and practices with their demographics. In all statistical tests, a value of p < .05 was considered significant.
A total of 800 students, 54.8% (n = 438) were males, while 45.2% (n = 362) were females. More than half of the students belonged to the age group >14 years. Nearly one third, 34.2% (n = 274), of the participants enrolled in first secondary grade followed by 27.9% (n = 223) in third intermediate grade. More than one third, 36.3% (n = 290), had suffered from dental caries. Table 1 shows the sociodemographic data of the study sample.
Raw oral health knowledge scores ranged from 0 to 9 out of 10 with M ± SD of 6.5 ± 1.45. General well-being needs to keep natural teeth (K1), keeping your mouth clean and healthy is good for health (K2), and teeth are an integral part of your body (K5) were areas that the participants were most knowledgeable. Overall, more than half of the participants, 59.1% (n = 473), had fair knowledge, and 40.9% (n = 327) had poor knowledge as shown in Table 2.
Raw oral health attitude scores ranged from –10 to 10 out of 10 with M ± SD of 4.26 ± 3.16. A higher score indicates a more positive attitude toward oral health. The findings revealed that less than half of the participants (42.8%) have negative attitudes toward oral health. A large proportion of the participants showed positive attitudes toward oral health “it is important to take care of my teeth (94.3%),” “decay makes my teeth look bad (89.3%),” “I can prevent my teeth from decaying,” and “you care about your teeth as much as any part of your body (85.6%)” as revealed in Table 3.
Raw oral health practices scores ranged from 0 to 12 out of 12 with M ± SD of 6.87 ± 2.65. Higher score indicates satisfactory practice toward oral health. Analysis of participants’ practices regarding oral health revealed that nearly half of the participants (45.3%) showed satisfactory practices. The vast majority of participants had a high commitment to using a toothbrush with paste as a cleaning aid, used either a soft or medium toothbrush, and complied with morning and night as an appropriate time of brushing. On the other hand, findings revealed unsatisfactory practices in approximately three quarters of participants that reported eating sweets daily (74.4%). Furthermore, more than one half of the participants did not know the right reason for brushing teeth (53.6%), and half of the participants spent less than 1 min brushing (50.5%) as shown in Table 4.
Among the demographic variables, students’ grade level was found statistically significant factor affecting all the three dimensions KAP of oral health (p < .001). Interestingly, the third intermediate grade scored higher than the other grades in all three dimensions of KAP. There was a significant gender difference in two aspects of oral health that is, attitude and practice (p < .05). It should be noted that female students’ scores were higher than the male students in all aspects of KAP. School type and students’ age groups were significantly associated with knowledge (p<0.05). Findings revealed that students within the age group of more than 14 years and from a public school had a higher score in knowledge than other groups. Parental education and monthly income were found statistically significant factors affecting the practice aspect of oral health (p < 0.05). The students of highly educated parents and high monthly income showed a higher level of KAP than less-educated parents and those with a low monthly income as shown in Table 5.
By using the Spearman test to examine the correlation between oral health KAP, results showed a weak positive relationship between knowledge and practice (r = .282, p < .001), attitude and practice (r = 0.310, p < .001), knowledge and attitude (r = .285, p < .001).
In the Southern region of the Kingdom of Saudi Arabia, data on oral health knowledge, attitudes, and practices of school-age children were scarce; however, the present study was carried out to provide a comprehensive overview and information about the level of oral health knowledge, attitudes, and practices among 12- to 16-year-old schoolchildren in Abha city. Oral health is considered as one of the most important health issues worldwide. Today, oral care, including tooth brushing, is considered as an easy and affordable procedure for people of different age groups. Furthermore, oral health practices and attitudes are used as measures of a community’s knowledge of oral health (ALBashtawy, 2012).
The findings of the current study suggest that the levels of knowledge and attitude were fair, while the level of practice was unsatisfactory. Although it was found that the mean knowledge score was considered good for all the questions (6.55 ± 1.45) and fair knowledge, in general, was 59.1%, which means that the knowledge among children of school age was good. This may illustrate why improved health behavior does not inherently apply to oral health awareness. Furthermore, Pearson’s correlation between oral health knowledge, oral health practice, and oral health attitude was examined. A weak positive linear relationship was found between knowledge and practice, knowledge and attitude, respectively (r = .282, r = .285). These findings are in disagreement with other studies carried out worldwide (Khamaiseh & ALBashtawy, 2013; Lian et al., 2010). This difference may be related to the difference in sample size with the region and time of the study. Most of the children had a satisfactory understanding of keeping natural teeth is important for general well-being, and teeth are an important part of the body, which is similar to other studies (Al-Omiri et al., 2006; Mirza et al., 2011). The awareness among the children in the present study about the effect of fluoride on teeth (60.2%), the effect of sweet eating (81.2%), and bleeding as a sign of poor oral health (68.7%) was fair.
Concerning schoolchildren’s attitude, the overall oral health attitude level (57.2%) of school children was positively satisfied, except for their attitudes about tooth loss in old age (34.8%); unimportance of primary teeth (36.4%); and importance of dental disease (48.3%). In agreement with previous studies that were conducted in Jordan and Saudi Arabia, the majority of the children (76.3%) recognized that regular visits to the dentist were necessary (ALBashtawy, 2012). This attitude could be explained in terms of fear of getting dental caries and periodontal diseases. This may be due to the high knowledge of the value of regular dental check-up visits to improve oral hygiene and avoid tooth decay, but this could be attributed to variations in population sample demographics relative to the outcomes of previous research.
Regarding oral health practices, the most common hygiene aid used (78.3%) was the use of a toothbrush with toothpaste; this is in line with findings obtained among children in Saudi Arabia and Jordan (Al-Ansari, 2014; Al-Omiri et al., 2006). More than one third of school students brushed their teeth at least twice a day. This result is comparable to several studies (Al-Omiri et al., 2006; ALBashtawy, 2012), compared to 66.5% in central Saudi Arabia (Al Subait et al., 2016) and 58.3% in India (Priya et al., 2013). Almost half of the study participants (49.5%) spent 2 min or more brushing, and more than one third of the students in the school brushed their teeth before going to bed at night and after waking up in the morning. These findings are in agreement with the literature that revealed the most important time of day to brush is right before going to bed, and in the morning after breakfast is another good time for brushing. Teenagers frequently strive to achieve independence and develop their own identity with little parents’ attention over oral health practices may explain these findings (ALBashtawy, 2012; Lian et al., 2010).
Evidence has shown that tooth brushing with paste alone is not adequate to clean proximal teeth surfaces, and hence, it has been advised to use dental floss, mouthwash, and Miswak to further assist in the prevention of dental caries as well as periodontal disease (Al-Ansari, 2014; Al-Tayar et al., 2019). Tooth surface loss or erosion may also be caused by frequent use of toothpicks and Miswaks (Karia & Kelleher, 2014; Warreth et al., 2020). Approximately 12.0% of schoolchildren in this study used dental floss, Miswak, and mouthwashes as a cleaning system between the teeth and rinsing the oral cavity, which indicates that the value of teeth cleaning was less well known, and schoolchildren were unaware that dental floss, Miswak, and mouthwash could help to remove the plaque and food particles between teeth; this also could be attributed to the cost of such aids. The findings are consistent with the findings of the Al-Sadhan study conducted in Riyadh, which showed that only 5.1% of students used dental floss (Al-Sadhan, 2006). These findings contrast with a study conducted among 1,115 male students in Al Hasa Saudi Arabia in 2008 who recorded that 45.0% of students used Miswak as a brushing tool (Amin & Al–Abad, 2008). This result indicates that awareness development is required to improve dental-related practice among that age-group and is consistent with other studies (Al Subait et al., 2016).
The oral health knowledge levels were influenced by sociodemographic factors, notably age (p = .006), school type (p = .049), and students’ grade level (p < .001). Oral health behavior levels were differently significant in gender (p = .048), students’ grade level (p < .001), father and mother occupation, respectively (p = .001; p = .003), while oral health practice levels were affected by gender (p < .001, students’ grade level (p < .001), and mother and father education, respectively (p = .034; p < .001). Findings showed that mother and father’s educational level and their jobs had an effective role in increasing KAP among schoolchildren. This finding was similar to other studies (Bener et al., 2013; Petersen et al., 2008). Findings support that educated parents have children with better oral health.
One of the interesting findings in this study is that, compared to male students (6.50 ± 1.47, 4.06 ± 3.34, 6.12 ± 2.59), female students had the best average information, attitude, and practice score (6.61 ± 1.43, 4.50 ± 2.92, 7.77 ± 2.44). One of the reasons for this outcome may be that during puberty, females are usually more concerned with their appearance and therefore more attentive to oral health aspects than males (ALBashtawy, 2012; Mulla & Omar, 2016). This is contradictory to the results stated by Rabiei et al. (2012) where there were no gender gaps. Fotedar et al. (2018) on the other hand found that males had higher awareness scores than females.
The limitations of the present study include self-reported data derived from school-age children with varying levels of familiarity with completion of questionnaires and varying levels of language ability, which may have influenced the selection of responses. Another limitation is the low number of comparable studies in the literature that deal with this issue in all regions of the Kingdom of Saudi Arabia.
The current survey provides essential data regarding the knowledge, practices, and attitudes of schoolchildren in the Southern region aged 12–16 years. The results of this study show that the average KAP level was 53.9%, which is not a positive indicator and needs to be strengthened. It can be used as a basis for comparison with other studies conducted in other regions of Saudi Arabia or other studies in developing or developed countries. To address the disparity between KAP, evidence-based interventions should be introduced at school.
The scientific rationale for the study is as follows: A few studies have been conducted among schoolchildren in Abha to deal with their oral KAP. Hence, there is a clear need for students to develop their skills as the population demands oral health services. The current study shows that most students in the school have a fair knowledge and a satisfactory attitude toward oral hygiene, but their oral hygiene practices have been poor. Oral hygiene education programs should be implemented in the school curriculum to enhance students’ knowledge, attitudes, and practices toward oral health. Furthermore, health workers need to cooperate to convey a message to students about oral hygiene.
The author would like to thank the administration and research ethical committee of Al-Ghad International Colleges-Abha branch for their valuable role in achieving this study and great thanks to the Assir education officer, headmasters, teachers, and all students for their participation in this study.
Alshloul M. contributed to conception and design, acquisition, analysis, and interpretation; drafted the manuscript; critically revised the manuscript; gave final approval; and agrees to be accountable for all aspects of work ensuring integrity and accuracy.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Mohammad N. Alshloul https://orcid.org/0000-0001-9448-9369
Al-Ansari, A. A. (2014). Prevalence, severity, and secular trends of dental caries among various Saudi populations: A literature review. Saudi Journal of Medicine and Medical Sciences, 2(3), 142–150. https://doi.org/10.4103/1658-631X.142496
ALBashtawy, M. (2012). Oral health patterns among schoolchildren in Mafraq Governorate, Jordan. The Journal of School Nursing, 28(2), 124–129. https://doi.org/10.1177/1059840511427405
Al-Darwish, M. S. (2016). Oral health knowledge, behaviour and practices among school children in Qatar. Dental Research Journal (Isfahan.), 13(4), 342–353.
Aljanakh, M. (2017). Prevalence and severity of dental caries among public school students aged 16-l8 in Hail, Kingdom of Saudi Arabia. International Journal of Health Sciences, 11(3), 50–53.
Al-Omiri, M. K., Al-Wahadni, A. M., & Saeed, K. N. (2006). Oral health attitudes, knowledge, and behavior among school children in North Jordan. Journal of Dental Education, 70(2), 179–187. https://doi.org/10.1002/j.0022-0337.2006.70.2.tb04074.x
Al-Sadhan, S. (2006). Dental caries prevalence among 12-14 yearold schoolchildren in Riyadh: A 14 year follow-up study of the oral health survey of Saudi Arabia phase I. Saudi Dental Journal, 18(1), 2–7.
Al Subait, A. A., Alousaimi, M., Geeverghese, A., Ali, A., & El Metwally, A. (2016). Oral health knowledge, attitude and behavior among students of age 10-18 years old attending Jenadriyah festival Riyadh; A cross-sectional study. The Saudi Journal for Dental Research, 7(1), 45–50. https://doi.org/10.1016/j.sjdr.2015.05.001
Al-Tayar, B. A., Ahmad, A., Sinor, M. Z., & Harun, M. H. (2019). Oral health knowledge, attitude, and practices among Yemeni school students. Journal of International Oral Health, 11(1), 15–20. https://doi.org/10.4103/jioh.jioh_176_18.
Amin, T. T., & Al-Abad, B. M. (2008). Oral hygiene practices, dental knowledge, dietary habits and their relation to caries among male primary school children in Al Hassa, Saudi Arabia. International Journal of Dental Hygiene, 6(4), 361–370. https://doi.org/10.1111/j.1601-5037.2008.00310.x
Anand, A., Ranvijay, T. A., & Sharma, S. (2019). Knowledge, attitude and practices among gynecologists regarding oral health of pregnant woman’s of Patna, Bihar. International Journal of Contemporary Medical Research, 4(5), 1093–1095.
Bener, A., Al Darwish, M. S., Tewfik, I., & Hoffmann, G. F. (2013). The impact of dietary and lifestyle factors on the risk of dental caries among young children in Qatar. The Journal of the Egyptian Public Health Association, 88(2), 67–73. https://doi.org/10.1097/01.EPX.0000430962.70261.8e
Blaggana, A., Grover, V., Anjali, A. K., Blaggana, V., Tanwar, R., Kaur, H., et al. (2016). Oral health knowledge, attitudes and practice behaviour among secondary school children in Chandigarh. Journal of Clinical and Diagnostic Research: JCDR, 10, ZC01–ZC06. https://doi.org/10.7860/JCDR/2016/23640.8633
Centers for Disease Control and Prevention (2019). Oral health surveillance report, 2019. CDC [On-line]. http://www.cdc.gov/OralHealth/publications/factsheets/dental_caries.htm
Elfaki, N. K., Algarrai, A. S. E., Brair, S. L., & Alsheikh, M. A. (2015). Health education promotes knowledge and practices of oral health among schoolchildren. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), 14(4), 2279–2861. https://doi.org/10.9790/0853-14485461
Fotedar, S., Fotedar, V., Bhardwaj, V., Thakur, A. S., Vashisth, S., & Thakur, P. (2018). Oral health knowledge and practices among primary healthcare workers in Shimla District, Himachal Pradesh, India. Indian Journal of Dental Research, 29(6), 858–861.
Jaber, M. F., Khan, A., Elmosaad, Y., Mustafa, M. M., Suliman, N., & Jamaan, A. (2017). Oral health knowledge, attitude and practices among male Qassim university students. International Journal Community Medicine Public Health, 4(8), 2729–2735. https://doi.org/10.18203/2394-6040.ijcmph20173316
Karia, R., & Kelleher, M. G. (2014). Bizarre tooth surface loss and the Miswak stick. Dental Update, 41(4), 355–364. https://doi.org/10.12968/denu.2014.41.4.355
Khamaiseh, A., & ALBashtawy, M. (2013). Oral health knowledge, attitudes, and practices among secondary school students. British Journal of School Nursing, 8(4), 194–199. https://doi.org/10.12968/bjsn.2013.8.4.194
Lian, C. W., Phing, T. S., Chat, C. S., Shin, B. C., Baharuddin, L. H., & Jalil, Z. B. (2010). Oral health knowledge, attitude and practice among secondary school students in Kuching, Sarawak. Archives of Orofacial Sciences, 5(1), 9–16.
Marcenes, W., Kassebaum, N. J., Bernabé, E., Flaxman, A., Naghavi, M., Lopez, A., & Murray, C. J. (2013). Global burden of oral conditions in 1990-2010: A systematic analysis. Journal of Dental Research, 92(7), 592–597. https://doi.org/10.1177/0022034513490168
Mirza, B. A. Q., Syed, A., Izhar, F., & Khan, A. A. (2011). Oral health attitudes, knowledge, and behavior amongst high and low socioeconomic school going children in Lahore, Pakistan. Pakistan Oral & Dental Journal, 31(2), 396–401.
Mulla, R. O., & Omar, O. M. (2016). Assessment of oral health knowledge, attitude and practices among medical students of Taibah University in Madinah, KSA. Journal of Advances in Medicine and Medical Research, 18(12), 1–10. https://doi.org/10.9734/BJMMR/2016/29778.
Nagarajappa, R., Sahare, P., Shukla, N., Tuteja, J. S., & Bhalla, A. (2015). Knowledge, attitude and practices regarding oral health among out patients at Rama Dental College, Kanpur. Rama University Journal of Dental Sciences, 2(1), 8–14.
Petersen, P. E., Jiang, H., Peng, B., Tai, B. J., & Bian, Z. (2008). Oral and general health behaviours among Chinese urban adolescents. Community Dentistry and Oral Epidemiology, 36(1), 76–84. https://doi.org/10.1111/j.1600-0528.2007.00375.x
Priya, M., Devdas, K., Amarlal, D., & Venkatachalapathy, A. (2013). Oral health attitudes, knowledge and practice among school children in Chennai, India. Journal of Education and Ethics in Dentistry, 3(1), 26–33.
Rabiei, S., Mohebbi, S. Z., Patja, K., & Virtanen, J. I. (2012). Physicians’ knowledge of and adherence to improving oral health. BMC Public Health, 12(1), 1–9. https://doi.org/10.1186/1471-2458-12-855
Rad, M., Shahravan, A., & Haghdoost, A. A. (2016). A systematic review of questionnaires used on oral health knowledge, attitude, and practice in 12-year-olds. Journal of Oral Health and Oral Epidemiology, 5(1), 1–12.
Sharada, A., Shetty, S., Ramesh, N., Sharda, J., Bhat, N., & Asawa, K. (2011). Oral health awareness and attitude among 12-13 year old school children in Udaipur, India. Journal of Dental Clinics, 3(4), 16–19.
Sharma, V., Yadav, A., Thakur, A., Dubey, S., Mohanty, L., & Paul, R. (2019). Knowledge about oral health, hygiene and practices among under-graduate and post-graduate dental students in the state of Jharkhand in Eastern India. International Journal of Research in Health and Allied Sciences, 5(5), 1–6.
Suzanne, C., & Brenda, G. (2008). Textbook of Brunner and Suddarths medical-surgical nursing (A. R. Fathollahy, trans, 1st ed.). Arjmand Publication.
Veiga, N., Pereira, C., & Amaral, O. (2015). Prevalence and determinants of dental caries in Portuguese children. Procedia-Social and Behavioral Sciences, 171, 995–1002. https://doi.org/10.1016/j.sbspro.2015.01.219
Warreth, A., Abuhijleh, E., Almaghribi, M. A., Mahwal, G., & Ashawish, A. (2020). Tooth surface loss: A review of literature. The Saudi Dental Journal, 32(2), 53–60. https://doi.org/10.1016/j.sdentj.2019.09.004
Mohammad N. Alshloul, RN, MPH, DNSc, is Vice-dean and academic deputy, assistant professor of community health nursing in the nursing department at Al-Ghad International College for Applied Medical Sciences, Abha, Saudi Arabia.
1 Al-Ghad International College for Applied Medical Sciences-Abha, Saudi Arabia
Corresponding Author:Mohammad N. Alshloul, Al-Ghad International College for Applied Medical Sciences, PO Box 3932, PC 61481, Abha 61481, Saudi Arabia.Email: abhav@gc.edu.sa
