Self-Reported Knowledge and Practice of Interdental Aids among People of Riyadh, Saudi Arabia - A Cross-Sectional Study.

BACKGROUND: Periodontal disease is a common pathological oral ailment which affects the supporting structures of the teeth. Dental plaque is one of the major causes for gingivitis and periodontitis. If left untreated, this will lead to tooth loss. Studies have shown that oral prophylaxis will reduce gingival and periodontal inflammation by removing the plaque in all the surfaces. The objective was to assess knowledge and practice of interdental aids among people of Riyadh, Saudi Arabia.
METHODOLOGY: A descriptive study was conducted among people using questionnaire.
RESULTS: 96% of the subjects brushed their teeth with brush and paste. 59% of the study subjects had knowledge regarding interdental aids, whereas only 15% of them practiced it. 72% of the people mentioned that dentists gave information regarding interdental aids.
CONCLUSIONS: Among the study subjects, even though there were deficits in few areas, overall knowledge about interdental aids was good and it increased with increasing level of education. Copyright:

INTRODUCTION

Dental caries is an infectious microbiological disease of the teeth, which results in localized dissolution and destruction of the calcified tissues.[1] It is found universally, irrespective of age, caste, creed, or geographical location, and is the second most common reason for tooth loss. It is also clear that the causative and risk factor for dental caries is dental plaque.[2] Extensive research has shown that dental plaque is a paramount factor in initiation and progression of gingival and periodontal diseases too. Hence, plaque reduction is the hall mark of preventive dentistry.[2]

Effective removal of plaque by personal oral hygiene control is the most effective methodology toward the prevention of dental caries and periodontal diseases. It is established that the severity of chronic inflammatory periodontal disease depends on removal of bacterial plaque either by mechanical or by chemical means.[3]

Brushing, flossing, use of interdental cleansing aids, and oral prophylaxis are mechanical methods, but they have proved to be very time-consuming and their effectiveness depends on skills and technique of an individual carrying out the procedures.[4] Periodontitis progress faster interdentally, and plaque control in these areas is very difficult.[5] Hence, the objective of the present study is to assess the knowledge and practice of interdental cleansing aids among undergraduate and postgraduate students.

METHODOLOGY

The study was conducted to assess knowledge and utilization of interdental aids in the prevention of plaque and in turn the disease associated with it among people in Riyadh, Saudi Arabia. A total of 12 questions were asked in which seven were related to the knowledge and five regarding inter dental aids and its utilization. 552 people responded to the questionnaire.

Study population

People who live in Riyadh city were included. Ethical approval was obtained from College of Dentistry, Prince Sattam Bin Abdul-Aziz University, Alkharj. Informed consent was obtained before study. Those participants denying giving consent were excluded. The questionnaire was in Arabic and English language. It was sent through social media, i.e., WhatsApp and Snap Chat, and was asked people to send link to their friends and family after answering the questions. Consent form was included in the questionnaire and those who did not agree to sign consent were excluded from the survey.

The sample size was calculated by using the formula:

where Z = 1.96 (confidence level or 5% level of significance), P = positive attitude toward prevention of oral diseases 65%, Q = (1 – P) = 100 − 75 = 35%, d = precision limit or proportion of sampling error is 4% confidence limit.

After substituting the values required, the sample size was found to be 546. Finally, a total of 552 responses were received and considered for statistical analysis.

Questionnaire

An objective, anonymous questionnaire was prepared. Personal information (age, gender, and educational status), questions related to awareness about interdental aids, and five questions related to utilization of interdental aids were included. Educational status was classified as masters, bachelors, up to high school, and uneducated. Responses consisted of agree, disagree, and don't know for questions related to knowledge and yes and no for utilization of interdental aids.

Validation of questionnaire

to validate the questionnaire, questions were prepared in English language and then translated to Arabic language and again back translated to English.

Methods

Questionnaire was sent to individual people through social media, i.e., WhatsApp and Snap Chat, which also had a consent form and explanation about the study.

Statistical analysis

Descriptive statistics and Chi-square test were used where 95% confidence interval, and a P < 0.05 was considered statistically significant.

RESULTS

Table 1 depicts the study population distribution according to the age group and education. The age group was from above 18 years, and majority of the participants were belonged to 18–25 years of age (55.8%). 52.5% of the participants had a bachelors' degree, and 39.3% of the subjects had education up to high school only.

Table 1

Distribution of study population according to gender, educational status, and age group

	Frequency (%)
Age group (years)
18-28	308 (55.8)
29-39	120 (21.7)
40-50	103 (18.7)
Above 50	21 (3.8)
Education
Not educated	13 (2.4)
Up to high school	217 (39.3)
Bachelor	290 (52.5)
Masters	32 (5.8)

Table 2 majority of the participants use tooth paste and tooth powder for maintaining their oral hygiene 1.6% or less than that use tooth powder, salt, or charcoal. 42% of the study subjects correctly answered that interproximal or cleaning in between teeth is difficult. 38.2% answered that lingual surface is difficult to clean. With similar finding 47.1% of the study participants are of the view that tooth brushing does not effectively clean interproximal area was recorded the tooth brushing related question. 92.0% of the study subjects are aware that food stuck in between tooth can cause bad breath. 76.6% of the study subjects are aware that food in the interdental area can cause gingivitis. 63.2% of the study subjects use tooth pick to clean food stuck in between teeth. Dental floss is used by 26.6% of the study subjects and 10.1% of the study subjects use pin to remove the food.

Table 2

Knowledge regarding interdental aids

Knowledge about interdental aids	Frequency (%)
How do you clean your teeth
Tooth brush and tooth paste	530 (96.0)
Charcoal	7 (1.3)
Salt	6 (1.1)
Powder	9 (1.6)
Which surface of the tooth is difficult to clean
Occlusal	56 (10.1)
Lingual	211 (38.2)
Buccal	53 (9.6)
Interproximal or in between teeth	232 (42.0)
Can brushing effectively clean inter proximal area of tooth
Yes	117 (21.2)
No	260 (47.1)
Don’t know	175 (31.7)
Do you know that the food that remains in between the teeth is one of the reason for bad breath
Yes	508 (92.0)
No	18 (3.3)
Don’t know	26 (4.7)
Does the accumulation of food between the teeth lead to gum disease “gingivitis”
Yes	423 (76.6)
No	18 (3.3)
Don’t know	111 (20.1)
If food gets stuck between your teeth, what is your way to clean this area?
Tooth pick	349 (63.2)
Floss	147 (26.6)
Pin	56 (10.1)

Figure 1 shows information about interdental aids. 58.5% of the study subjects have told that they have information on interdental aids.

Figure 1

Information about interdental aids among study subjects

Table 3 shows utilization of interdental aids among the study subjects. 15.0% of the study subjects regularly use dental floss. 63.0% of the study subjects occasionally use dental floss, and 21.9% of the study subjects never used dental floss. When information is asked about other interdental brushes by showing picture, 46.0% of the subjects have told that they have used those brushes. Surprisingly, 45.8% of the study subjects have told that they have never used mouth washes. 13.9% told that they use twice daily and 26.4% occasionally.

Table 3

Utilization of interdental aids among study subjects

Knowledge about inter dental aids	Frequency (%)
Do you use dental floss
Regularly	83 (15.0)
Occasionally	348 (63.0)
Never used	121 (21.9)
Are you using other types of brushes shown in the figure to clean in between teeth
Yes	254 (46.0)
No	298 (46.0)
Do you use mouthwash
Twice daily	77 (13.9)
Once daily	76 (13.8)
Occasionally	146 (26.4)
Never	253 (45.8)

When question is asked whether the study subjects get information about interdental aids from dentist, 72.3% of the study participants told no [Figure 2].

Figure 2

Dentist providing information about interdental aids

Regarding the source of information about interdental aids, majority of the study subjects (72.1%) have told that it is by social media. 424.5% of the study subjects told that information is passed by dentists. 2% of the subjects received information from physicians [Table 4].

Table 4

Source of information about interdental aids

	Frequency	Percentage
Source of information
Dentist	135	24.5
Physician	11	2.0
Books and magazines	8	1.4
Media/social media	398	72.10

DISCUSSION

People's health is in people's hands, so they should be a good example for positive oral health attitudes and behavior to their families, patients, and friends. In general, they should motivate others about maintaining a good oral health.[6]

96% of the students in the present study brushed their teeth with tooth brush and paste daily which was in accordance with other studies.[67] One-third of Kuwait and two-third of Jordanian students brushed with their teeth with tooth and paste twice a day, respectively.[8] 42% of the people said that brushing lingual surface was more difficult than others, which was in contrast to Finnish (78%) and Japanese (55%) students.[9] People gave less importance to individual tooth maintenance which suggested that the level of student's self-care is influenced by their educational levels.[6]

Only 15% of the people practiced interdental aids on a regular basis. Evidence in the literature[61011] shows that there is lack of use of flossing as a preventive measure by the various population of the world, which was similar to the present study along with the use of rinse.

The current study subjects lacked knowledge of use of interdental aids, proper force and technique, and the use of disclosing solutions to identify deposits on the teeth. These results were in line with the studies conducted by Neeraja et al.[6] Oral health education needs to be provided in these areas to enhance the knowledge and practice of interdental.[61213141516] This improvement in personal oral health among people has linked to their educational level.[1718] 72% of the people said that dentists provided information regarding inter dental aids and 78% of the information is provided by social media.

CONCLUSION

Knowledge and practice of interdental aids among people of Riyadh showed that majority of the people were quite aware and knows about interdental cleansing aids, but very few population relatively practiced it. Practicing interdental cleansing aids will help for maintaining of oral hygiene and plaque control and for preventing periodontitis. Further studies to evaluate the oral hygiene and gingival and periodontal status of subjects using toothbrush alone and combination of toothbrush along with the interdental aids are recommended. This would educate the recommendation of interdental aids regularly.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.