LJM 1993-2820 1819-6357 Libyan Journal of Medicine, Vol. 5, No. 0, August 2010, pp. 1–5 sici xxx PUBMED Abbreviation ClementC.Azodo

*Clement C. AzodoDepartment of PeriodonticsUniversity of Benin Teaching HospitalBeninNigeria

AdebolaO.Ehizele AgnesUmoh PatrickI.Ojehanon OsagieAkhionbare RobinsonOkechukwu LawrenceIgbinosa Department of Periodontics University of Benin Teaching Hospital

BeninNigeria

Department of Periodontics University of Benin

BeninNigeria

Federal School of Dental Therapy and Dental Technology

EnuguNigeria

Libyan Journal of Medicine SHORT COMMUNICATION A descriptive study on toothbrushing and tongue cleaning habits among dental auxiliary students Objective: To determine the tooth brushing, tongue cleaning and snacking behaviour of dental technology and therapist students. Methods: A descriptive cross-sectional study of students of Federal School of Dental Therapy and Technology Enugu, Nigeria. Self-administered questionnaire was used to obtain information on demography, frequency, duration and technique of tooth brushing and tongue cleaning as well as information on consumption of snacks. Results: A total of 242 students responded. Dental technology students made up 52.5% of the respondents and dental therapist in training made up 47.5%. Majority (63.2%) of the respondents considered the strength of tooth brush when purchasing a tooth brush and 78.9% use tooth brushes with medium strength. Seven-tenth (71.9%) of the respondents brush their teeth twice daily and 52.1% brush for 3–5 minutes. About one-third (30.2%) brush their teeth in front of a mirror. Chewing stick was used by 51.7% of respondents in addition to the use of tooth brush. Tongue cleaning was done by 94.2% with only 9.5% using a tongue cleaner. Only 20.2% reported regular snacks consumption. Nine-tenth (90.4%) of respondents were previously involved in educating others, apart from their colleagues, on tooth brushing. Conclusion: This survey revealed that most of the dental therapy and technology students had satisfactory tooth-brushing behaviour. The zeal to educate others about proper tooth brushing revealed in this study suggests that the students may be helpful in oral health promotion. toothbrushing tongue cleaning snacking behaviour dental auxiliary students Nigeria Oral diseases exert a negative impact on an individual's quality of life and also represent a huge burden for healthcare systems worldwide 1. In many low-income countries, the burden of oral diseases is on the increase thus certifying it, a substantial health problem 2 with enormous consequences 345678. Achieving optimal oral health through preventive efforts is a hallmark of the dental profession 9 and such efforts are geared towards encouraging patients to practice appropriate oral self-care behaviours 9. Achieving optimal oral and dental health requires a commitment to self-care, embracing preventive behaviours as well as the receipt of appropriate professional care. The improvement of personal oral health has been shown to be linked to dental education experience 10.Dental health providers need to set a good example for their patients by maintaining good oral health since they influence their patients’ oral health-related behaviour 11. Dental auxiliary personnel's role in oral health promotion after graduation has been reported 12. Oral health practice of this group should be good and conform to professional recommendations.Studies have also shown that dental students with positive oral health attitude are good models for oral health behaviour and serve as instructors to their friends, family members, patients and their society on how to maintain good oral health 13141516.Dental therapists and dental technicians in training will contribute to the realisation of the oral health vision of Nigeria 17. This is because they are equipped with information necessary for oral health promotion. It is therefore important that their own oral health knowledge is good and that their oral health behaviour conforms to professional recommendations. With proper knowledge and oral health behaviour, they can play an important role in health education of individuals and groups 18192021, and act as role models for lay people and the community at large.The objective of this study was to determine the tooth brushing, tongue cleaning and snacking behaviour of dental technicians and dental therapist in training. It was also to identify gaps in their oral health behaviour and suggest ways of filling them. A descriptive cross-sectional study of students of Federal School of Dental Therapy and Technology, Enugu, Nigeria was conducted using self-administered questionnaire. All the students in Year 1–4 were included in the study. Data was obtained on demography, frequency and duration of tooth brushing, texture of tooth brush, factors influencing choice of tooth brush, how often tooth brush is changed and why, the use of additional tooth cleaning agent, the practice of tongue cleaning and tongue cleaning agent used, frequency of snacking and types of snacks consumed.Recruitment was voluntary. Prior to administration of questionnaire, the aim and nature of the study was explained to the participant and informed consent obtained. Students completed the questionnaire anonymously during normal class sessions. Approval for this study was obtained from the Ethics and Research Committee of the University of Benin Teaching Hospital.Statistical Package for Social Science (SPSS version 15.0) was used for data analysis. Frequency distribution and percentages were analysed and presented in tabular and graphic forms. Significance of differences was tested by &khgr;² test and P<0.05 was considered significant. A total of 242 students responded with dental technology students constituting 52.5% and dental therapist students constituting 47.5%. Male:female ratio was 1:1.6. Majority (95.5%) of the respondents were single, in 20–25 year age group (75.2%) and 45% were in the first-year class.About one-fifth (21.1%) of the respondents brushed their teeth once daily, 71.9% brushed their teeth twice daily and 5.8% brushed more than twice daily (Table 1). More than half (52.1%) spent 3–5 minutes brushing and 30.2% usually checked their teeth in the mirror after brushing (Table 1). Texture of tooth brush used by respondents were soft (17.4%), medium (78.9%) and hard (2.5%) (Table 1). About half (51.7%) also combined chewing stick and only 0.8% use dental floss. The main factors that influenced the choice of tooth brush was strength (63.2%), brand 12.8% and size (10.3%), cost (1.2%), combination of factors (4.2%), no special consideration (5.8%) and no response (2.5%) (Table 1). Parameter Frequency (no.) Percentage (%) Frequency of tooth brush  Once 51 21.1  Twice 174 71.9  More than twice 14 5.8  No response 2 0.8 Duration of tooth brushing  1–3 min 57 23.6  3–5 min 126 52.1   > 5 min 56 23.1  No response 3 1.2 Use of mirror  Yes 73 30.2  No 164 67.8  No response 5 2.1 Texture of tooth brush  Soft 42 17.4  Medium 191 78.9  Hard 6 2.5  No knowledge 1 0.4  No response 2 0.8 Total 242 100.0 Four-tenth of the respondents replaced their tooth brush every 3 months. Fraying of tooth brushes was the most common reason for tooth brush replacement (Table 2). Parameter Frequency (no.) Percentage (%) Frequency of changing tooth brush  Every month 42 17.4  Every 3 months 98 40.5  Every 6 months 53 21.9   > 1 year 9 3.7  Defective tooth brush 21 8.7  Missing tooth brush 8 3.3  No specific time 6 2.5  No response 5 2.1 Reasons for changing tooth brush  Frayed bristles 110 45.5  Softening of bristle 70 28.9  Colour faded 12 5.0  Missing tooth brush 2 0.8  Dentist's advice 1 0.4  No special reason 34 14.0  No response 13 5.4 Total 242 100.0 Tongue cleaning was carried out by 94.2%. The following were used for tongue cleaning: tooth brush (81.8%), tongue cleaner (9.5%), chewing stick (2.1%) and knife (0.8%).Majority (66.1%) consumed snacks occasionally and only 20.2% reported regular snack consumption. Meat pie (46.7%) was the most common snack consumed followed by biscuits (18.2%), cakes (11.2%), others include egg roll, chin-chin, ice cream and fruits (Fig. 1). Majority (92.6%) expressed confidence in teaching people how to brush properly and 90.5% had done that in the past, of which 35.1% had discussed with everybody they knew, i.e. parents, siblings, other relatives, friends and neighbours (Table 3).

Frequency of snacking.

Who Frequency Percentage (%) Parents 14 5.8 Siblings 29 12.0 Relatives 10 4.1 Neighbour 4 1.7 Friends 45 18.6 Multiple group 115 47.5 No response 25 10.3 Total 242 100.0 The frequency and duration of tooth brushing correlates with oral hygiene and oral health. Brushing twice daily for acceptable duration and the use of a mirror to visualise one's efforts appear to be part of an optimal oral self-care 22. Twice-daily brushing confers optimal effect on oral hygiene and gingival condition of both males and females 23. Twice-daily brushing is recommended by most dentists in order to improve plaque control, since most patients are not able to achieve sufficient plaque removal by performing oral hygiene measures at home 24.In this study, majority of the students (71.9%) brushed twice daily and 52.1% brushed for 3–5 minutes. This is comparable with 68% twice or more daily brushing recorded among Turkish non-dental university students 25, lower than 81% among Mongolian dentists 26 but higher than what was recorded in many other similar studies 1227282930. In this study, female students reported brushing their teeth more frequently than their male counterpart. This is consistent with findings of other studies 222531. Females have been said to have better oral health knowledge 32, to exhibit greater interest in oral health and to consider sound teeth more important than males 3334.The texture of a tooth brush contributes to tooth wear lesion and its sequelae. Medium texture is the recommended strength. In this study, medium texture tooth brushes were the most frequently used and the most important factor considered when purchasing a tooth brush by the students was the texture. This shows that most of the students are conforming to the standard.It has been documented that tooth brush with frayed bristles is ineffective for proper cleaning and also causes adverse effects like gingival recession and oral ulcer, and it was recommended that tooth brushes should be replaced every 3 months or when the bristles are frayed 193536. In this study, 40.5% replaced their tooth brush every 3 months and the usual reason for tooth brush replacement was frayed bristles in 45.5% of respondents.Chewing stick is known to contain antimicrobial agents which are beneficial for prevention and treatment of periodontal disease 37 but when not properly used it can cause tooth wear lesions. Some tooth brush users believe that the use of chewing stick in addition to tooth brushing is the most effective way of reducing mouth debris 38. A study even concluded that the chewing stick is more effective than tooth brushing for reducing plaque and gingivitis, when preceded by professional instruction on its correct application 39. It has also been said that the use of chewing stick appears to be more effective than tooth brushing for removal of plaque from the embrasures, thus enhancing interproximal health 39. The additional tooth cleaning method used by 51.7% of respondents in this study is chewing stick. The use of dental floss was minimal and this is similar to the findings of Kirtiloglu et al. 25.Tongue cleaning is a component of oral hygiene measure, as tongue coating is known to be the predominantly implicated cause of halitosis 4041. Several volatile sulphur compound producing bacteria have the ability to colonise the dorsum of the tongue in periodontally healthy subjects 42 and they are reduced by tongue cleaning 4344. In this study, tongue cleaning was carried out by majority using the tooth brush and only 9.5% used the tongue cleaner.Increased snacking frequency and inadequate tooth-brushing have been identified as predisposing factors for tooth decay 28. Regular snack consumption was practiced by 20.2%. This percentage is fewer than what was reported previously in other studies 1145.The dental auxiliaries have been said to play an important role in educating their friends, family members, patients and their society on how to maintain good oral health 18192021. Respondents in this study will be able to carry out this role as 92.6% expressed confidence in teaching people how to brush their teeth and 90.5% are presently actively discussing issues on tooth brushing with parents, siblings, other relatives, friends and neighbours. 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