International Journal of Oral Health Sciences

: 2018  |  Volume : 8  |  Issue : 2  |  Page : 92--98

Assessment of knowledge, attitude, and practice toward oral hygiene among governmental secondary school students in Debre Tabor Town, Amhara Region, North Central Ethiopia 2018: Institutional-based cross-sectional survey

Yilkal Tafere Gualie1, Asnakew Tigabu Tayachew2,  
1 Department of Public Health, Collage of Health Sciences, Ethiopia University, Debre Tabor, Ethiopia
2 Department of Nursing, Amhara Regional Health Bureau, Metema Primary Hospital, Metema, Ethiopia

Correspondence Address:
Yilkal Tafere Gualie
Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor


Introduction: Oral health is significantly related to oral hygiene behaviors and their knowledge. Poor oral hygiene can have a profound effect on the quality of life. Oral hygiene practices are those measures taken to ensure that the mouth is clean. Oral hygiene practices are essential for the prevention of dental and other associated systemic diseases. The aim of this study is to determine the level of knowledge, attitude, and oral hygiene practices among secondary school students in Debre Tabor town, Amhara region, North Central Ethiopia 2018. Materials and Methods: An institution-based cross-sectional study was conducted among 422 systematically selected students using stratified random sampling technique from January 20 to 30, 2018. Data were collected using a pretested questionnaire on 422 selected students in three secondary schools found in Debre Tabor town. Variables collected included the frequency of brushing teeth and the use of toothpaste, knowledge of plaque, and students' perception of the importance of oral hygiene practices. The data were entered into Epi-Info version 3.5 and cleaned and analyzed using SPSS version 20. Results: A total of 422 patients participated in the study; among whom 216 (51.2%) were female students. The study revealed that 253 (60%) of the respondents had good knowledge with regard to oral hygiene, more than half 281 (66.6%) of the students had positive attitude toward oral hygiene, but their oral hygiene practices were still low that 260 (61.6%) of the students had poor oral hygiene practice. Conclusions: The study showed that more than half of the respondents had good knowledge and positive attitude toward oral hygiene to maintain proper oral health, but their practices toward oral hygiene were remain poor. The majority of students were aware that teachers and parents had not an important role to play in their oral hygiene. Establishment of oral health education programs in the school curriculum that will help a life-long oral hygiene practice in the school environment and at large in the community with the support of teachers and parents are crucial.

How to cite this article:
Gualie YT, Tayachew AT. Assessment of knowledge, attitude, and practice toward oral hygiene among governmental secondary school students in Debre Tabor Town, Amhara Region, North Central Ethiopia 2018: Institutional-based cross-sectional survey.Int J Oral Health Sci 2018;8:92-98

How to cite this URL:
Gualie YT, Tayachew AT. Assessment of knowledge, attitude, and practice toward oral hygiene among governmental secondary school students in Debre Tabor Town, Amhara Region, North Central Ethiopia 2018: Institutional-based cross-sectional survey. Int J Oral Health Sci [serial online] 2018 [cited 2021 Jan 26 ];8:92-98
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Oral hygiene knowledge is considered to be an essential prerequisite for any community members. Good oral hygiene has been shown to contribute greatly to the prevention of oral related diseases. Globally, poor oral hygiene occurring due to increasing plaque and calculus deposits with increasing age have been reported among children and adolescents.[1],[2] Oral hygiene maintenance may be a totally ignored practice in people of the low socioeconomic class of developing countries.[3] Studies indicate that 90% of the students have experienced dental cavities and could lead to tooth loss at a very young age.[4]

Good oral hygiene is the foundation of a healthy mouth and prevents 80% of all dental problems.[5] Primary prevention through tooth brushing has paramount importance in the prevention of dental health problems.[6] Oral disease burden is higher among the poor population with an increase in developing countries.[7] According to the report by the World Health Organization 2008, about 52.2% of the students visited their dentist when they had dental pain only.[8] A study in Canada showed that nearly 50% of the students used dental services once in every 6 months.[9] A study done in Kenyan school children showed that 93% of the children used a toothbrush with toothpaste, 87% of the children knew that dental caries and periodontitis could be prevented.[10]

Oral hygiene practices are prevalent in different countries. For instance, tooth brushing is practiced, in Korea, 97% of Koreans brush their teeth once a day.[11] While in India, about 69% of the population brushes their teeth.[12] A survey in Pakistan showed that 36% of the population cleaned their teeth daily.[13] In Saudi Arabia, 83% of school children used a toothbrush for oral hygiene while 16% used a chewing stick.[14] However in Tanzania, it was reported that 92% of children did not brush their teeth every day.[15]

In Ethiopia, oral health gets low attention from the government and the existing dental services are limited. Even though dental health problems are high in some parts of the country, much is not known about the knowledge, attitude, and practices toward oral hygiene in the study area. Therefore, this study was aimed to assess the knowledge, attitude, and practices among governmental secondary school students in Debre Tabor town.

 Materials and Methods

Setting and study area

This cross-sectional epidemiologic study was conducted among secondary schools students in Debre Tabor Town, Ethiopia from January 20 to 30, 2018. Debre Tabor town is located in the south Gondar zone; it is located about 100 km far from Bahir Dar the capital of Amhara region and 667 km Addis Ababa, the capital city of Ethiopia. Debre Tabor town has an estimated population of 81,145. The study was conducted in three governmental secondary Schools, which provides free education to children in Grades 9–10 in Debre Tabor town. There are 4111 students in the town, among this 2213 students are females and the remains are males.


Source population

All secondary school students in Grades 9–10.

Study population

All secondary school students in Grade 9–10 who attend their education in the three secondary schools during the study.

Inclusion and exclusion criteria

Inclusion - All regular secondary school students who attend their education in the three secondary schools during the study period.

Exclusion - Students who were critically ill and unable to communicate were excluded from the study.

Sampling technique and procedure

A sample size of 422 was determined using a single population proportion formula.


With the following assumptions: proportion (P) The proportion of oral hygiene knowledge, attitude and practice of dental caries to be 50%, a confidence level of 95%, and marginal error (d), 5% and 10% nonresponse rate.

Operational definitions

Good knowledge

Respondents were considered to be knowledgeable if he/(s) correctly answered greater than or equal to the mean of the total knowledge assessing questions.

Poor knowledge

Respondents were considered to be knowledgeable if he/(s) correctly answered less than to the mean of the total knowledge assessing questions.

Favorable attitude

Those respondents who were positively worded and scored points greater than or equal to the mean in the attitude questionnaire.

Unfavorable attitude

Those respondents who were negatively worded and scored points less than to the mean of the total attitude assessing questions.

Good practice

Respondents were considered to have good practice of oral hygiene if he/(s) correctly answered/practice greater than or equal to the mean of the total practice assessing questions.

Poor practice

Respondents were considered to have poor practice of oral hygiene if he/(s) correctly answered/practice less than to the mean of total practice assessing questions.

Data collection

The data were collected using pre-tested questionnaire structured questionnaire at working hours. The questionnaire was translated into the local language, Amharic by experts in both languages and was translated back to English by another person to ensure consistency and accuracy. The data collection process was closely supervised by one dentist professional and the principal investigator. The data collector and supervisors were recruited based on previous experience in data collection and fluency in the local language. In addition, training was given for 1 day on how to interview, handling ethical issues, and maintaining confidentiality and privacy.

The pretest was conducted to familiarize enumerators with the administration of the interview process and for ensuring consistency. Debriefing sessions were held with the Pretest field staff, and the questionnaires were modified based on lessons drawn from the Pretest. Completed questionnaire crosschecked daily for inconsistencies and completeness.

Data analysis

Data were checked for completeness and then coded, entered into EPI-Info 3.5.3 statistical software ( Then, the data were exported to SPSS windows version 20 (IBM) for data checking, cleaning. Data were sorted and then represented in frequencies. Calculating frequencies and sorting. Descriptive results were presented using mean, proportions, and tables.

Ethical consideration

Ethical approval for this study was obtained from Debre Tabor University research evaluation and Ethical Review Committee. Approval from the town Education Office and Debre Tabor town secondary schools was granted before the commencement of this study. Verbal informed consent was obtained from each participant after providing complete information about the purpose of the study. At the end of the data collection session, all the study participants were advised on how they can maintain their oral hygiene.


Sociodemographic characteristic of the respondents

The study involved 422 secondary school students found in Debre Tabor town. Among this 216 (51.2%) were female students, whereas 206 (48.8%) were male.

Regarding religion of the respondents, 358 (84.8%) were orthodox Christian, 44 (10.4%) Muslim and the rest 20 (4.7%) were protestant. The mean age of the respondent was 17.76 with ± 2.5 standard deviation. With regard to the level of education, 231 (54.7%) of students were in Grade 9, and the rest 191 (45.3%) were Grade 10 students. The average family monthly income of the respondents was 3550 Ethiopian birr [Table 1].{Table 1}

Knowledge on oral hygiene

In this study, most of the students 345 (81.8%) responded that bleeding of gums indicated gum disease, 18 (4.3%) said did not know whereas 24 (5.7%) responded that it indicated healthy gum, 35 (8.3%) said that others like lack of Vitamin C. With regard to prevention of bleeding of gums, majority of the students 146 (34.6%) said cleaning teeth using mouthwash can prevent it, 85 (20.1%) thought that using a toothpaste could solve the problem, 56 (13.3. %), using tooth brush, 20 (4.7%) by avoiding cleaning of teeth, 22 (5.2%) believed that eating soft food could help prevent bleeding of gums, 8620.4%) did not know how to do so, and 1.7% others. The present study asses the awareness of students to what dental plaque means; most of the students 150 (35.5%) said staining of teeth, whereas 120 (28.4%) thought that it is soft debris containing bacteria, 58 (13.7%) said that plaque is hard debris, 86 (20.4) said that both are what dental plaque mean.

The current study shows that the majority of the students 119 (28.2%) said that dental plaque could lead to tooth decay. Those who said that it could lead to staining of teeth were 86 (20.4%), with 45 (10.7%), and 86 (20.4%) assumed that it could lead to gum disease and I did not know respectively, 86 (20.4%) said that all could lead dental plaque. With regard to the purpose of cleaning teeth, the majority of the students 152 (36.0%) thought that to prevent bad breath, dental disease and bleeding of gums, 129 (30.6) said that to prevent bad breath, 71 (16.8) said that to prevent dental disease, whereas 25 (5.9%) said that to prevent bleeding of gums, 40 (9.5%) of participants said that others like cosmetic purpose, 5 (1.2) they did not know what is the purpose of tooth cleaning [Table 2].{Table 2}

Attitude of students toward oral hygiene

The majority (87.7%) of students answered that oral hygiene is important for good oral health and general well-being. About 291 (69%) of the students said that neither the parents nor the teachers showed concern about oral hygiene, the rest 131 (31%) participants said that their teachers and parents were concerned. Majority of the students 365 (86.5%) believed that it was important for the parents and teachers to be concerned, whereas 57 (13.5%) were on the contrary. More than half of 221 (52.4) students thought that visiting a dentist is important, and they would advise other students to perform at home oral hygiene practices. When given a chance, 54.7% of the students would go for a checkup, and they would also advise other students to do the same [Table 3].{Table 3}


In this study, the higher percentage of students, 263 (62.3%) reported that they cleaned their tooth using different tools and dentifrices. Among the students who clean their tooth 234 (88.97%) brushed once daily, 10 (3.8%) brushed twice, 4 (1.52%) brushed three times per day, and other 15 (5.71%) student brushed their teeth occasionally. From those students who clean their teeth, 134 (50.96%) used chewing stick only to clean their teeth, 65 (24.7%) used a toothbrush and 55 (20.92) used both chewing stick and toothbrush and 9 (3.42) students use different material toothbrush their teeth. About 230 (87.43%) of the students brushed their teeth before meal, most students 14 (5.3%) brushed their teeth both before and after meals, and the rest 19 (7.22%) students brushed their teeth after meal.

The present study shows that 248 (58.8) of the participants had never visited a dentist. And 172 (40.7%) visited a dentist due to that they experienced any dental pain, 2 (0.5%) visited a dentist every year. With regard to reasons for visiting a dentist, among those who had visited a dentist, majority 127 (73%) went for to toothache, 37 (21.26%), went for tooth extraction be, 8 (4.6) went for to have tooth cleaned, and 2 (1.15%) went for regular checkup. The reasons for not visiting a dentist, among those students who never visit the dentist 213 (85.89%) were due to that they never experienced any dental pain and 359 (14.11%) students said that it is expensive.

The present study showed that the overall oral hygiene practice 162 (38.4) of students had good oral hygiene practices to prevent oral health problems [Table 4].{Table 4}


Adequate knowledge on the causes, prevention, and signs of dental disease depicts that students can retain their oral hygiene. This study evaluates the oral hygiene knowledge, attitudes, and practices of secondary school students found in Debre Tabor town. In the present study, 422 students were participated making 100% response rate. Among participants 48.8% were males, and 51.2% were female. The result of this study found that 253 (60%) students had good oral hygiene knowledge. These data reflect that there is a chasm that 40% of students had poor knowledge toward oral hygiene. This might be due to the lack of an organized and systematic oral health education program in the schools and community at large. Lack of knowledge toward oral hygiene could reflect that the information on dental health is most likely limited to a certain level of understanding.

This result is lower than the previous study done in India (90.9%), but higher than studies in Mysore city, India (9%), in Al Hassa, Saudi Arabia (38.7%) had a high level of knowledge toward oral hygiene.[16],[17],[18] This might be due to the lack of an organized and systematic oral health education program in the schools and community at large. The Possible reasons that can be attributed to this difference of response might be the demographic variations of the study population and study setting. Another possibility of discrepancy might be the sampling technique and accessibility of the services.

Although misconceptions about oral hygiene still exist in the present study, 81.8% of students responded that bleeding of gums indicates gum disease. The proportion of students who thought that bleeding of gums could be prevented by cleaning teeth using mouthwash was 34.6%, which is inconsistent with a study done in Jeddah City that 87% of students knew that gum diseases could be prevented through regular tooth brushing.[19]

In this study, about 20.4% of the students did not know of any measure that could prevent gums from bleeding. Nearly a quarter (22.3%) and 20.4% of students did not know what does dental plaque mean and what does dental plaque lead to, respectively. This results put in the picture, it is important that the school curriculum and health clubs should integrate oral hygiene-related issues to other health problems to teach students in their schools, In addition, the population should be educated on all aspects of oral health issues in the different community organizations.

In the present study, most students (89.4%) knew the purpose of cleaning teeth. In this study, the knowledge of the purpose of cleaning teeth among students was encouraging and may have implications for prevention of oral health problems. Thus, from a theoretical point of view, oral health habits are a function of perceived vulnerability to an oral disorder and the belief that a particular preventive measure will be sufficient to overcome this vulnerability. People who have assimilated oral hygiene knowledge and feel a sense of personal control over their oral hygiene are more likely to adopt self-care practices.

In the present study, 281 (66.6%) students had positive attitude attitudes toward oral hygiene. This finding is relatively higher than a study done in Mysore city, India that 52% of students had an unfavorable attitude toward oral hygiene.[17] However, it is lower than a study reported in the Indian children (79.8%) had a favorable attitude toward oral hygiene.[18] In many cases, modification of attitude is needed that allows a change in the behavior of preventing oral health problems. Their attitude not only affects their own oral hygiene behavior but also influence the oral hygiene behavior of family and community. In this study, 57.6% of the students felt that it is important to visit a dentist for the regular check-up.

The study findings of the study showed that 162 (38.4%) students had good practices of oral hygiene. This result is supported by other studies in different countries that Only 16.1 of the respondents had good oral hygiene practice.[16] The result of this study is lower than a study in Manipur, India 70.4% had adequate oral hygiene practice.[20] Even though 57.6% of the respondents stated that regular dental visit was necessary, the data showed that only 2 (0.8%) of them practiced it. This shows that the awareness of oral hygiene only does not necessarily influence good oral hygiene practice. The inhibition of visiting the dentist may perhaps arise from lack of accessibility to dental services. Arrangements should be made in the form of periodic visits of the dentist to school and frequent dental camps in the communities so that the people become familiar with the service. Even though the knowledge is high, it seemed to be insufficient to influence the habit. Hence, reinforcement programs regarding changing the knowledge in practice need to be evaluated.

In this study, 62.3% of students reported they clean their teeth. Among those students who clean their teeth, high percentage (89%) of students reported that they brush their teeth only once daily, 3.8% of students brushed twice daily, and 1.5% of students brushed three times daily which is similar to other studies, Kakkad et al.,[21] found that 67% of students brushed their teeth twice daily. Peltzer and Pengpid[22] reported it to be 67.20%, Rimondini et al.[23] described a much higher percentage (92.1%) in Italian University students.

The finding of this study showed that among those students who clean their teeth 57% of the participants reported using toothpaste whereas the rest use “mefakia” (chewing stick prepared from a variety of plant stems, and twigs) users did not use any adjuvant. Tooth brushing with toothpaste is perhaps the most common form of tooth cleaning practice by individuals in the industrialized countries, whereas the chewing stick is often used as the sole cleansing agent by individuals in developing countries. Proper guidance and instructions about tools and substances used are supreme central for oral hygiene.

Although most of the students 57.6% stated that regular dental visit was necessary, the data showed that only 1.15 of the students had regular dental visit. Low-dental visits may probably due to low awareness of the importance of oral hygiene thus affects the student's health-seeking behavior. This result is lower than a study done in Kuching, Sarawak Malaysia.[20] 24.4% students had the regular dental visit. This shows that the awareness of oral hygiene does not really influence good hygiene practice. Delay in seeking dental care could be attributed to other factors such as parental beliefs and practices, lack of economic resources, and accessibility of dental services.

However, this study does have some inherent limitations. First, the students' self-reported behaviors may have resulted in over-reporting of their actual oral hygiene practices. Second, the study design makes it difficult to determine the direction of causality.

 Conclusions and Recommendations

The present study shows that most of the secondary school students have a good knowledge and positive attitude toward oral hygiene, but their practices toward oral hygiene were poor. Majority of students never visited a dentist and the reason was never experiencing pain. There is a definite need for the students to improve their knowledge as the demand for oral health services in the community.

Oral hygiene education programs should be conducted with reinforcement so that students can close the gap between knowledge and practice by using appropriate tools. There is a need to encourage students to take responsibility for their own oral hygiene. The schools may serve as the best platform for the promotion of oral health care among teenagers. The oral hygiene education programs should be intensified to promote oral hygiene a lifelong practice. To positively influence and improve the oral hygiene practices among students oral hygiene education programs could be included in the school curriculum and oral health promotion activities need to be carried out. Undoubtedly, the support from the parents and teachers participation is essential.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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