Assessment of Knowledge, Attitude, and Practice about Oral Health in Patients with Cardiovascular Diseases - An Original Study.

BACKGROUND: Lack of exercise and change in diet habits and urbanization had led to the rapid increase in the case of cardiovascular diseases (CVDs). Study was conducted to assess knowledge, attitude, and practice (KAP) about oral health in patients with CVDs.
MATERIALS AND METHODS: This study was conducted among 172 CVDs patients. Oral health indices (OHIs) such as OHI, decay-missing-filled, and periodontal disease index were recorded. KAP components were categorized into poor, moderate, and good.
RESULTS: Out of 172 patients, males were 102 and females were 70, age group 30-60 years had 46 and >60 years had 126 patients. Thirty-four were illiterate, 72 had up to primary and 46 had up to secondary and 20 had degree, 104 were married and 68 were unmarried. Resident was urban in 110 and rural in 62 and financial status was very good in 26, good in 50, and moderate in 96. Females had higher KAP score than males; however, the difference was nonsignificant (P > 0.05). As the age advanced, KAP score increased (P < 0.05), patients living in urban area had significantly higher KAP score than living in rural area, and the difference was statistically significant (P < 0.05). Patients with very good financial status had significantly higher KAP score than living in rural area (P < 0.05). As the education level increased, KAP score increased, the difference was statistically significant (P < 0.05).
CONCLUSION: Authors found that patients with CVDs had moderate knowledge and attitude, but the practice was poor. There is need to educate the people about the importance of oral hygiene and their subsequent effect on general body. Copyright:

INTRODUCTION

In the last few years, due to urbanization, lack of exercise, and change in diet habits, there is the rapid increase in case of cardiovascular diseases (CVDs).[1] The number is highly prevalent in developing countries as compared to developed countries. Numerous interlinked factors have been proposed as risk factors for CVDs. Genetic, socio-economic and environmental variables have been put forward.[2] Oral health is the mirror of general body health. With the enhanced and vigorous consumption of tobacco products in youth, oral cancer has spread all over the world.[3] Periodontal diseases are risk factors for CVDs. Few studies mentioned that suggests that periodontal diseases increase 15%–20% risk of CVDs. The pathogenesis of CVDs has been well established.[4] Dental infections and dental procedures in compromised patients with weak immunity can lead to the spread of infection. Oral health is dependent upon the knowledge, awareness, and attitude of an individual. Studies demonstrated the correlation of CVDs and periodontal diseases and found that patients are 25% high risk of getting CVDs.[5] Considering this, the present study was conducted to assess knowledge, attitude, and practice (KAP) about oral health in patients with CVDs.

MATERIALS AND METHODS

This study was conducted among 180 patients with confirmed cases of CVDs of both genders. Eight patients lost follow-up making a total count of 172. All recruited patients were informed regarding the study and their consent was obtained. The study was commenced after the ethical committee of the institute approved this study. Demographic profile of patients, such as name, age, and gender was recorded. Factors such as financial status, education, and living place were recorded. A well-experienced dental surgeon examined the oral cavity in all patients. Oral health indices (OHIs) such as OHI, decay-missing-filled (DMFs), and periodontal disease index (PDI) were recorded. In PDI, assessment of plaque, calculus, mobility, pocket depth, and gingival status were considered. In DMFs index assessment of decayed, missing, and filled teeth were taken into consideration. KAP components were categorized into poor, moderate, and good based on scores under 40, 40–69, and 70 or more, respectively. Mean, standard deviations, and level of significance was set accordingly.

RESULTS

Table 1 shows that out of 172 patients, males were 102 and females were 70, age group 30–60 years had 46 and >60 years had 126 patients. Thirty-fourwere illiterate, 72 had up to primary and 46 had up to secondary and 20 had degree, 104 were married and 68 were unmarried. Resident was urban in 110 and rural in 62 and financial status was very good in 26, good in 50 and moderate in 96. The difference was significant (P < 0.05). Table 2 shows the mean score of KAP by sociodemographic characteristics. Females had higher KAP score than males; however, the difference was nonsignificant (P > 0.05). As the age advanced, KAP score increased (P < 0.05), patients living in urban area had significantly higher KAP score than living in rural area, and the difference was statistically significant (P < 0.05). Patients with very good financial status had significantly higher KAP score than living in rural area (P < 0.05). As the education level increased, KAP score increased, the difference was significant (P < 0.05). Table 3 shows significant correlation between knowledge and attitude, OHI and knowledge and knowledge and practice. Similarly, there was correlation between OHI and attitude, OHI and practice and attitude and practice (P < 0.05). Table 4 shows that hypertension (HTN) was reported in 35%, diabetes mellitus (DM) in 26%, hyperlipidaemia (HLP) in 35%, other comorbidities in 34%, family history of CVD was seen in 47%. Table 5 shows the mean KAP score in patients with hypertension, HLP and DM. There was a significant difference in mean DM (P - 0.02) and knowledge and HLP and practice (P - 0.01).

Table 1

Socio-demographic profile of patients

Parameters	n	P
Gender
Males	102	0.01
Females	70
Age group (Years)
30-60	46	0.02
>60	126
Education
Illiterate	34	0.05
Primary	72
Secondary	46
Degree	20
Marital status
Married	104	0.02
Unmarried	68
Resident
Urban	110	0.04
Rural	62
Financial status
Very good	26	0.02
Good	50
Moderate	96

Table 2

Comparison of knowledge, attitude and practice (KAP) by socio-demographic characteristics

Parameters	Knowledge score	P	Attitude score	P	Practice score	P
Gender
Males	58.2	0.14	50.6	0.54	43.3	0.82
Females	59.3		55.6		44.2
Age group (Years)
30-60	53.2	0.02	52.6	0.31	43.6	0.64
>60	65.4		53.1		46.8
Education
Illiterate	46.5	0.05	42.5	0.09	36.7	0.02
Primary	53.6		51.7		45.2
Secondary	56.9		53.4		51.6
Degree	65.3		54.2		54.6
Marital status
Married	68.4	0.02	62.4	0.41	65.4	0.72
Unmarried	52.8		54.7		61.8
Resident
Rural	42.3	0.01	38.2	0.001	38.5	0.14
Urban	57.3		54.7		45.2
Financial status
Very good	65.2	0.03	63.2	0.41	54.6	0.02
Good	58.3		61.2		45.3
Moderate	48.6		57.2		44.1

Table 3

Pearson correlation of knowledge, attitude and practice (KAP)

Parameters	Knowledge		Practice		Attitude		Age
	r	P	r	P	r	P	r	P
DMFs	0.01	0.92	-0.092	0.32	0.142	0.129	0.412	0.001
PDI	-0.161	0.13	-0.127	0.01	0.03	0.654	0.132	0.05
OHI	-0.341	0.01	-0.219	0.002	-0.026	0.016	-0.003	0.912
Age	0.034	0.612	-0.023	0.722	0.015	0.76
Knowledge			0.342	0.04	0.423	0.04
Practice					0.125	0.01

Table 4

Health status based on self-reporting

Variable	Yes (%)	No (%)	Do not know (%)	Not specified (%)
HTN	32	35	17	16
HLP	35	52	7	6
DM	26	63	6	5
Co- morbidity	34	36	15	15
Medication	46	42	-	12
Family CVD history	47	49	3	1
	Good	Moderate	No Problem	Not specified
General health status	9.4	72.4	4.5	13.7

Table 5

Knowledge, attitude and practice (KAP) in patients with hypertension, diabetes mellitus and hyperlipidaemia

Patients	%	Knowledge		Attitude		Practice
		Mean	P	Mean	P	Mean	P
HTN
Yes	34	58.2	0.98	48.3	0.14	46.5	0.19
No	66	58.0		56.3		42.8
HLP
Yes	36	58.9	0.91	51.4	0.90	38.5	0.01
No	64	59.4		53.6		46.1
DM
Yes	25	51.3	0.02	48.3	0.16	48.2	0.84
No	75	62.5		54.2		47.8

DISCUSSION

Oral health is the mirror of general body health. It is essential to assess then knowledge about self-oral health, particularly in all age groups. It is found that poor oral health is related with sufferings and pain; hence, the maintenance of good oral health is essential to prevent occurrence of comorbidities such as hypertension, HLP, and DM which are related with poor dietary habits, sedentary lifestyle, and environmental factors.[6] In this study, we recruited a total of 172 patients of CVDs, in which males were 102 and females were 70, age group 30–60 years had 46 and >60 years had 126 patients. Thirty-four were illiterate, 72 had up to primary and 46 had up to secondary and 20 had degree, 104 were married and 68 were unmarried. Resident was urban in 110 and rural in 62 and financial status was very good in 26, good in 50, and moderate in 96. Rasouli-Ghahroudi et al.[7] in their study assessed 150 CVD patients and their KAP score based on the questionnaire. We found that females had higher KAP scores than males; however, the difference was nonsignificant (P > 0.05). With the advancement of age, there was significant increase in the mean KAP score (P < 0.05). We observed that patients living in urban area had significantly higher KAP score than living in rural area, and the difference was statistically significant (P < 0.05). Patients with very good financial status had significantly higher KAP score than living in rural area (P < 0.05). We observed that as the education level increased, KAP score increased, the difference was significant (P < 0.05). Batra et al.[8] in their study evaluated the knowledge, attitudes, beliefs, practices, and behaviors of included subjects. It was found that in the absence of symptoms, preventive oral hygiene practices were limited. Barriers to access varied with the country of origin; from lack of trust in dentists and treatment cost in studies. We observed that significant correlation between knowledge and attitude, OHI and knowledge and knowledge and practice. Similarly, there was the correlation between OHI and attitude, OHI and practice and attitude and practice (P < 0.05). Zhu et al.[9] in their studies demonstrated that 35% of population living in rural region and 65% in urban areas had economic support for dental visits and treatments. In the present study, we found that HTN was reported in 35%, DM in 26%, HLP in 35%, other comorbidities in 34%, family history of CVD was seen in 47%. It is mentioned in various studies that most of individuals lack trust in dentists. It is also demonstrated in their studies that it is the belief that Indian dentists intentionally delay and increase the total duration of treatment and prolong the overall time. It is further suggested that dental faculty, including dental hygienists, attendants can help in accessing dental care by promoting education related to oral health, particularly with their vernacular language.[1011] We observed that mean KAP score in patients with hypertension, HLP, and DM. There was a significant difference in mean DM (P < 0.05) and knowledge and HLP and practice (P < 0.05). Other factors which limits visit dentists may be const of treatment, overall treatment duration, language problem, higher age group, low education level, and socioeconomic status.[12] In our study, we found that moderate oral hygiene status of CVDs patients.

CONCLUSION

Authors found that patients with CVDs had moderate knowledge and attitude, but the practice was poor. There is a need to educate the people about the importance of oral hygiene and their subsequent effect on the general body.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.