Oral Epidemiology

Oral health of Rhodesia Africanfirst year student teachers

JAMES RITGHIE

Godfrey Huggirts School of Medicine, University of Rhodesia, Salisbury, Rhodesia

Ritchie, J,: Oral health of Rhodesian African first year student teachers, Contmuniiy Dent,Oral Epidemiol. 1979: 7: 222--226.

Abstract - A basic oral health survey was carried out on a random sample of first year Afri-can student teachers attending four teachers' eolleges in Rhodesia, The nutnber examined andinterviewed was 309, Methods and criteria used are those described in the second (1977)edition of the World Health Organization manual Oral health surveys - Basie methods.Prevalences of dental caries were 31.0 % for the 142 male students and 59,5 % for the 167female students. The difference is statistically significant ( P < 0.001), Mean DMFTs were0,74 for men and 2,02 for wotnen. The prevalences of "intense gingivitis" were 52,8 %for male students and 34,7 % for female students. This difference also is significant( P < ; 0.005), The major treatinent requirements are for one-surface fillings and prophy-laxis with oral hygiene instruction. Dental service utilization is low. Less than 10 % of thesample had obtained dental care iii the previous 12 months. The main reason for seekingcare was pain. Self-assessments of oral health needs were not valid. The stated desire forfillings is greater than for extractions, A need has been demonstrated for dental healthedueation aimed at the prevention of disease and the encouragement, use and demandfor c[uality care services.

Key words: epidemiology, oral; oral health,

J, Ritchie, Godfrey Huggins School of Medicine, P, O, A 178, Avondale, Salisbury,Rhodesia.

Aecepted for publieation 21 January 1979. ,

Teachers are important people iti oral health pro-grammes (9). They can be influential health edu-cators whose training enables them to appreciateconcepts of total health care. Their use of existingservices and desires for dental care may give indica-tions of how they will influence the dental serviceutilization of others.

The present study was designed to obtain in-formation about the oral health of African studentteaehers and to assess their attitudes and opinionsabout oral health. The survey continues the collec-tion of epidemiological data from various popula-tion groups in Rhodesia and adds to the earlierreports of MULDOON (3) and RITGHIE (4, 5). Theinformation gained should provide a basis forplanning atid evaluating preventive and treatmentaspects of oral health programmes.

The study was iti two parts:a) A clinical survey usitig World Health Organiza-

tioti methods and criteria (11). The combinedoral health and treatment assessment was used.This method iticludes a short questiotinaire ondental service utilization.

b) An assessment of knowledge, attitudes and opiti-iotis about oral health using the questionnairedescribed by RITGHIE (7). Forms were com-pleted by the studetits prior to the survey visits.

Dental health talks were giveti at the collegesduring the examiner's visits. Previous studetit reac-tion to this type of programme has beeti describedby RITGHIE (6).

Only the main clinical findings and answers tothe WHO service utilizatioti questions are reportedhere.

0301-5661/79/040222-05$02,50/0 © 1979 Munksgaard, Copenhagen

Oral health of Rhodesian African student teachers 223

Table 1, Age and sex distribution of the sample

SOUTH AFRICA

fg 1. Geographic location of teachers' colleges (X) , 1,j United College of Education, 2, Mkoba Teaehers' College,j 3,Gwelo Teachers' College. 4, Umtali Teachers' College.

IMATERIAL AND METHODSThe target population is first year students attending thefour main African teachers' colleges in Rhodesia. Thegeographical location of these colleges is shown in Fig. 1.The teacher-training eourscs last for 3 years. First yearstudents were chosen as the most readily available groupand as the group likely to benefit most from a concurrentdental health education programme, A 50 % randomsample was drawn. Examiner error was assessed by dupli-cate examinations of a randomly seleeted 10 % of the

j^sample (31 students),'-' T h e WHO questionnaire was put to each student int-

tnediately prior to clinical examination. Clinical findingswere advised individually. Replies to the inten'iew ques-ttons were coded according to the prescribed lisls ( I I ) .The possible answers were not suggested to the s\ibjects.

All examinations and interviews were conducted by oneexatniner (J.R.) with previous experience in survey work.Students were examined in good daylight sittittg in frontof the seated examiner, WHO criteria (11) were used andobservations were reeorded by the examiner himself onthe WHO Combined Oral Health and Treatinent As-sessment Form, The examiner's pace, including question-naire time, was approximately eight students per hour.The data have been proeessed by conventional methodsand the chi-square test has been used for estimations ofstatistical significance.

RESULTSCLINICAL FINDINGSThe age and sex distributiotis of the satnple (Ta-

Age Males Females Bolhi

18192021222324

>24

440402415856

58146205334

912186442011810

Total 142 167 309

Mean age of males: 20,61 years.Mean age of females: 19,90 years.Mean age of santj^le: 20,23 years.

ble 1) show ati overweight of 19-year-old fetnales.This tends to reduce calculated values of chi-squarebut does tiot itavalidate statistical sigtiificatiees.Separate findings for the 20-24-year-old age groupsare shown below wheti these are appropriate.

Data for male and female students are presentedseparately because of differences in disease patternsbetween the sexes. There are no statistically signif-icatit differetices in caries or periodotital fitiditigsbetween groups of the same sex attending differentcolleges {P>Q.Q5).

Dental cariesThe caries findings (Table 2) show low prevalencesand rates for these age groups. The F conipotietitaccoutits for less than 3 % of the total DMF score.The statistically significant differences also apply ifthe 20-24 age groups are considered separately.Prevalences for these groups are, males 28.1 % andfemales 6 3 % ; x' = 19,8511, P<0 ,001 , DMFTseores are 0,65 for males and 2,26 for fetnales.

The treatment requiretnents (Table 3) showthat 70 % of the total need is for one-surface fill-itigs while 16,5 % is for extractions. In assessingextraction requirements the possibilities of success-fully root treating posterior teeth were excluded.

One male atid six fetnales required treattnetit forthe relief of pain. Nine males and 19 fetnales re-quired treattnent for lesions likely to cause pain,Otie tnale stadent required treattnent for ati an-terior tooth with pulp involvement.

Three cases of detital fluorosis were seeti atidgraded accorditig to the WHO version of Dean's

224 RITCHIE

Table 2, Dental

Condition

Students with ahistory ofcaries

Students withuntreatedcaries

Decayed teeth(D)

Extracted teeth(M)

Filled teeth (F)

DMF teeth per100 students

caries status

Males

n %

44 31,0*

42 29,5

83 -

18

4 -

74 -

Females

n %

100 59.9*

84 50.3

265 -

64 -

9 -

202 -

Both sexes

n %

144 46.6

126 40.8

348 -

82 -

13 -

143 -

= 25.3450; 1 df; P<0.001 (significant).

Index (10). One case was mild and two very mild.These students were from a rural area where thedrinking water contains excess fluoride. The fluor-ide content of urban water supplies is under 0.2mg F71,

Periodontal diseaseThe periodontal status of the studetits is shown inTable 4, The examiner error was 3.2 % for per-sons with soft deposits, 3.2 % for calculus, 6.4 %for intense gingivitis and nil for advaticed perio-

involvement. The WHO grading of a soft

Table 4. Periodonta! status

ConditionMales Females Both sexes

n % n %

Soft deposits 137 96,5 149 89,2 286 92,6

Calculus 116 81,7* 106 63.5* 222 71,8

Intensegingivitis(inflamed or ,bleedinggums) 75 52.8** 58 34.7** 133 43,o

Advancedperiodontalinvolvement 13 9.2*** 7 4.2*** 20 6,5

* X̂ = 12,6251; 1 df; P < 0,001 (significant),** x̂ = 10,4183; Idf; P < 0,005 (significant).

**» j,2 = 3,4549; 1 df; P > 0,05 (N,S,),

deposit may have beeti overscored due to a too rigidinterpretation of criteria (11).

The sigtiificatitly higher prevaletices of intensegitigivitis and calculus among male studetits alsoapply when data for the 20-24-year-old group areexpressed separately. The prevalences of intense gin-givitis iti this group are 52,2 % for tnales and 32.9% for females (x' = 6,1354; P < 0.025). Cal-culus prevalences are 82.6 % amotig tnales and57 % among females (x' = 13.7646; P < 0.001).

The periodotital treatment requiremetits shownin Table 5 refleet the lower periodontal status oftnale students. There were tio extractions requiredas a result of periodontal disease.

Table 3, Treatment requirements, permanent teeth

Type oftreatmentrequired

Requiretnetits perTotal requirements 100 students

Male Female Both Male Female Both

1-surface fillings

2-surface fillings

3-surface fillings

I> 3-surfacefillings

Extractions dueto caries

Extractions forother reasons

55 191

33

2

246

41

2

19 39 58

39 114 78

6 20 13

1 1 < 1

I I < 1

13 23 19

0 1 < 1

Table 5, Periodontal treatment recjuircments

Type oi treat-ment required

Males Females

No treatment

Oral hygieneinstruction(OHI)

Prophylaxisand OHI

1 0.7 11 6.6

Both sexes

12 3,9

27 19.0* 45 26.9* 72 23.3

10! 71.1 104 62,3 205 66.3

Periodontaltherapy, noextraction(s) 13 9.2** 7 4.2** 20 6.5

* X̂ = 6,1290; Idf; P < 0 , 0 5 (significant),** x̂ = 3,4549; Idf; P > 0.05 (N.S.),

Oral health of Rhodesian African student teachers 225

Table 6. Use of dental care facilities

Questioti 1.months?

Answers

YesNo

Did you obtain

Male

//

7135

%

4.995.1

dental care

Female

Jl /Q

22 13.2145 86.8

in the last 12

Both sexes

n

29280

%

9.490,6

SERVICE UTILIZATIONThe first sectioti of the questionnaire attempts torneasure actual use of oral care faeilities, reasotisfor non-use atid types of detital persotmel visited,A second set of questiotis tries to assess the individ-ual's utiderstatiditig of his detital needs atid hisdesire for detital care.

Table 6 shows the very low demand for dentaleare during the preceding 12 months, with painas the maiti reasoti for seeking treatmetit (Table7). Of the 29 students seeking dental care, 10 at-tended detitists. The retnaitider were treated byauxiliaries (tnedical assistatits with traitiitig in basicdental extraction techniques). The overwhelmingreason for tiot seekitig treatmetit is a belief thatnotbing is wrotig (Table 8).

The students' self-assessments of their oral healthwere not valid. Forty percent thought that nothitigwas wrong with their teeth or gutns; 33 % thought

Table 7, Reasons for obtaining dental care

Question l (a) ,males)

To get teethcleaned

Something washurting

To get some-thing fixed

Went forcheck-up

Was sentappointment

Other reason

For what reasons?

Males

n

0

6

0

0

0

1

%

0.0

85.7

0.0

0.0

0.0

14,3

("• =

Females

tt

0

19

1

1

0

1

%

0.0

86.4

4.5

4.5

0.0

4.5

7 males.

Both

tt

0

25

1

1

0

2

22 fe-

sexes

%

0.0

86.2

3.4

3.4

0.0

6.9

Table 8. Reasons for not obtaining dental care in last12 months

Question l(c). Why not? i.e. why was no care obtained(n = 135 males and 145 females)

Male Female Both:

Nothing wrong

Afraid ofdentists

Costs too tnuch

Did not wish tospend themoney

Too busy

No serviceavailable

Other reason

Don't know

n

113

0

6

1

7

5

0

3

%

83.7

0.0

4.4

0,7

5.2

3.7

0,0

2.2

tt

116

2

10

0

5

2

2

8

%

80.0

1.4

6.9

0.0

3.4

1.4

1.4

5.5

tt

229

2

16

1

12

7

2

11

%

81.8

0.7

5.7

0.4

4.3

2.5

0.7

3.9

that something was wrong with their teeth; 10 %diagtiosed gutn trouble otily; 5 % blatiied teethand gutns; 10.4 % did tiot ktiow. A comparisonwith the clinical fitiditigs shows that some 50 %of tnale studetits atid 24 % of the females withdetital caries are unaware of the cotiditioti. Con-versely, 40.5 % of male students and 24,4 % offemales who thitik that there is something wrongwith their teeth do not have caries. Of the studetitswith advatieed periodontal disease, seven out of 13males atid otily otie of seveti females were awareof their condition. As regards intetise gingivitis,22 (29 %) males and 26 (45 %) females with thecotiditioti thought that there was somethitig wrongwith their gums.

The questioti "Do you watit any detital adviceor treatment?" elicited affirtnative replies frotn97.4 % of the students. Their desires for particulartypes of dental eare show some differences betweenthe sexes. A significantly higher percentage of tnaleswatit exatiiitiatioti, cleatiitig or prevetitive adviee(64.8:42.5; P < 0.001) but a higher proportion ofwomen want fillings (20.4:6.3; P < 0.001).

There is a low demand for extractiotis atid scal-ing/periodotital care, 4.5 % for each eategory.Eighteen students (5,8 %) wanted tnore than onetype of treatment, 6,5 % wanted an unlistedtreatment, and 9.1 % were "don't knows".

226 RITCHIE

DISCUSSIONDENTAL CARIES AND PERIODONTAL DISEASEThe dental caries experietice of these students islow in cotnparisoti with that of sitniiar white groupsbut the amount of untreated caries is high enoughto cause concerti. The higher earies rate of wonietistudents has a predictable effect on their treatmentrequirements.

The statistically significant differences in cariesexperience between the sexes are similar to thosereported in African secotidary schools (5) andprobably reflect social differences. Many moreAfricati boys thati girls receive a secotidary educa-tioti. Girls tetid to come from tnore affluent fatnilieswith more cariogenic diets. Since the teachers' col-leges recruit from secotidary schools the same soeialand ecotiomic pattenis cotititiue to operate.

The statistically significant differetices betweetithe sexes in the prevalence of periodontal diseaseare expected findings and are consistent with theviews of other workers such as DUNNING (2),SiiEitiAM (8) , BAUME (1) and Mut.DOON (3), i,e,females tetid to have less periodonta] disease thatimales. Females in our students' age group arecotiscious of appearance atid have higher statidardsof oral hygiene than male students.

Taken together the data of caries prevalence,severity atid treatmetit requirements (Tables 2and 3) show need either for improved treatmentservices or for greater use of existitig services. Theperiodontal statistics (Tables 4 and 5) show treat-ment needs whieh could be greatly reduced bymore attetition to oral hygiene. The greatest tieedin this respect is for effective health education.

SERVICE UTILIZATIONNeither costs nor availability of services seem to bedeterrents to seeking dental care. Only 17 out of280 studetits gave costs as a reason for inactionatid only seveti said that no service was available(Table 8) . However, low treatment experiencemay result iti igtioratice of the type atid costs ofavailable treattnent.

The high demands for detital advice atid treat-metit may have beeti itifluenced by the students'personal experience of the exatnitier as a lectureroti preventive detital health. The reasotis for themale students' greater preference for preventive

care are tiot known. The female studetits clearlyfavour fillings but tieither sex shows the demandfor extraetiotis which might be inferred from pat-terns of previous treatmetit (Table 2) and theirreasons for obtaining it (Table 7).

The results of the questiotitiaire tetid to cotifirnithe clinical fitidings. The use of existitig treattnetitservices has been low atid does tiot match the tieedsof this educated group. Despite a theoretical de-tnand for more sophisticated treatment than re-moval of sources of paiti there is little evidetice tbatconservative detital care has beeti sought. Thereis an obvious need for effective dental health educa-tion programmes whose major purpose is preven-tive. There is also a need to encourage the use ofatid dematid for quality rather thati emergenc)'care services.

Ackttowledgemctits - I am grateful to the University ofRhodesia for the research grant which supported thisproject. I also wish to thank the Ministry of Educationand the staffs and students of the teaehers' colleges fortheir willing co-operation.

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