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A Study on the Survey of Oral Health Behavior and the Actual Condition of Oral Health by Smoking in Some Local Residents
Int J Clin Prev Dent 2020;16(4):185-191
Published online December 31, 2020;  https://doi.org/10.15236/ijcpd.2020.16.4.185
© 2020 International Journal of Clinical Preventive Dentistry.

Min Seo Kim

Department of Oral Health, Dankook University, Cheonan, Korea
Correspondence to: Min Seo Kim
E-mail: kms790204@naver.com
https://orcid.org/0000-0003-4206-3731
Received November 27, 2020; Revised December 14, 2020; Accepted December 21, 2020.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objective: This study is considered to be an important data for establishing oral health education data plan using information on oral health and oral health behavior by analyzing oral health behavior and oral health status of some local residents. In addition, in order to further improve oral health by finding out the oral health behavior of smokers, it motivates smoking cessation and provides basic data necessary for oral health education for oral health improvement.
Methods: From March to June 2019, 76 patients who participated in the dental hygiene management process practice at a university located in city A were selected as those who understood the purpose of this study and agreed in writing. 76 subjects were used for the final analysis except for.
Results: The average number of times brushing was 3.13 times in female, higher than 2.48 times in male, and in smoking or not, smokers were 2.52 times, and non-smokers were 3.05 times. When looking at the use of oral hygiene products, sex and age groups showed the highest level of not using oral hygiene products. In terms of scaling experience, there were 19 males (25%), more than 11 females (11.8%). As for the presence or absence of smoking, 12 (15.8%) non-smokers had scaling experience, lower than 31 (40.8%) non-smokers. According to the halitosis test, non-smokers were 79.02±13.68, which was 84.39±15.80 in smokers. In the oral hygiene management ability test, nonsmokers were 2.56±0.61, which was lower than smokers’ 2.61±0.69.
Conclusion: As a result of this study, it is suggested that the research will be repeatedly conducted in various fields and levels in the future. It is also proposed to verify the effectiveness as a follow-up study.
Keywords : dental hygiene management process, oral health status
Introduction

Recently, as research in the field of dentistry has been actively conducted, and the mechanisms and progression of oral disease have been identified, oral health activities that prioritize prevention rather than treatment have been actively conducted, and their awareness has also changed to improve and maintain oral health through prevention [1]. Oral health is a basic element of today’s daily life, and it is emphasized that oral health should be managed rationally, and in the seven national health guidelines suggested by the Ministry of Health and Welfare in Korea, teeth are brushed after meals. It is clear that health is an essential element of health [2]. Oral health activities are carried out in order to maintain a healthy oral condition before an oral disease occurs, and the types of activities are very diverse [3]. For oral health, oral health practices that can be maximized at the lowest cost include brushing teeth, use of oral hygiene products, regular oral checkups, and periodic scaling [4]. In order to keep oral health in a healthy state, it was argued that this is a process that individuals must take the lead in and perform continuously with a sense of respon-sibility. In addition, it was reported that the dental floss and tartar already formed due to the negligence of oral hygiene management should be removed through the dental scrubbing process, which is one of the primary prevention methods. The study on removal was analyzed [5
-10].

Smoking is not only harmful to general health, but also to oral health, and is known to be associated with oral cancer, periodontitis, and tooth loss. Smoking causes many oral diseases such as life-threatening cancer, bad breath, pigmentation, etc., that interfere with social life and harms the oral condition. Oral problems caused by cigarettes include bad breath, periodontal disease, increased tooth surface bacteria, weakened immune response, unclean oral environment, destruction of tooth rat tissue, black hair, tartar, mucosal infection, delay in wound healing after tooth extraction, etc. [11]. Adult smokers have three times the incidence of severe periodontitis than non-smokers [12], and even when the degree of plaque accumulation is similar, the probing depth is deeper, the adhesion loss is more severe [13], bone loss is greater [14], and the number of teeth is higher. It is reported that the degree of improvement in probing depth and attachment level after periodontal treatment in smokers is reduced to 50%-75% of non-smokers as well as the response to periodontal treatment, and the frequency of implant failure is more than two times higher.

Smoking is an oral practice, and quitting smoking will reduce the risk of various oral diseases caused by smoking and increase the effectiveness of dental treatment [15
-17]. Ac-cordingly, there is a need to reveal the oral health status of smokers to raise awareness of oral health and to reveal the importance of oral health.

This study is considered to be an important data in establishing oral health education data plan by analyzing oral health behavior and oral health condition according to smoking for some local residents, utilizing information on oral health status and oral health behavior. In addition, it is intended to provide basic data necessary for oral health education to improve oral health and motivate smoking to further improve oral health by grasping the oral health behavior of smokers.

Materials and Methods

1. Research target

This study was selected as a person who understood the purpose of this study and agreed in writing to participate in 76 patients who participated in the dental hygiene management course practice at the universty located in A city from March to June 2019. 76 people were used for the final analysis, excluding inappropriate surveys.

2. Research method

The examination process of this study was to investigate the experience of brushing, use of oral hygiene products, and scaling among oral care activities, and the oral health status was examined and analyzed by measuring bad breath and oral environment management ability index (PHP index). To measure bad breath, B&B Checker (mBA-21, Plustech, Korea), a volatile sulfide gas analyzer, is used to measure bad breath, close your mouth for 3 minutes, do not breathe, collect gas in the mouth, and insert the measurement sense into the mouth, measured for 15 seconds while holding the breath. The measurement results were expressed as OG values. The oral environment management ability index (PHP index) is an index that measures the amount of colored tooth surface bacterial membranes to indicate the ability to manage an individual’s oral cavity. The teeth to be examined are the upper left and right first molar buccal surfaces, the upper right central incisor pure surface, and the lower left central incisor. The tooth surface of the labial surface, the left and right first molar teeth of the mandible is covered. The tooth surface to be examined is divided into mesial, distal, gingival, central, and cut (5 parts) and evaluated as 1 point for attaching the tooth surface bacteria film to each area and 0 point for non-attachment. At this time, the highest point is 5 points and the lowest point is 0 point.

3. Data analysis method

In this study, the statistical package used for statistical analysis was analyzed with the IBM SPSS Statistics for Windows ver. 18.0 (IBM Co., Armonk, NY, USA).

1) The general characteristics of the subjects were analyzed using frequency and percentage, mean and standard deviation.

2) Determine the t-test and chi-square for the use of brushing in the experimental group.

3) Determine the t-test and chi-square for the use of oral hygiene products in the experimental group.

4) Identify the t-test and chi-square for the presence or absence of the experimental group’s scaling experience.

5) The t-test for the sex of the experimental group, the change of bad breath according to the presence or absence of smoking, and the oral hygiene management ability index (PHP index) is identified.

Results

1. General characteristics of the subject

The general characteristics of the subject of this study were 80.2% (61 people) in their 20s, 6.5% (5 people) in their 30s, 7.8% (6 people) in their 40s, 5.2% (4 people) in their 50s and over, female 51.3% (39 people), and male 48.6% (37 people). In terms of occupation, students accounted for more than half with 69.7% (53 people), others (15.7%), office workers (7.8%), self-employed (6.5%) was in the order of smoking, 43.4% (33 people) of smokers and 64.4% (49 people) of drinking alcohol in the presence or absence of smoking (Table 1).

Table 1 . General characteristics of the subject (n=76)

VariableExperimental group
Age (yr)20-2961 (80.2)
30-395 (6.5)
40-496 (7.8)
≥504 (5.2)
SexFemale39 (51.3)
Male37 (48.6)
JobStudent53 (69.7)
Employee6 (7.8)
Self-employment5 (6.5)
Other12 (15.7)
SmokingNo43 (56.5)
Yes33 (43.4)
AlcoholNo27 (35.6)
Yes49 (64.4)
Total 76 (100.0)

Values are presented as number (%), or mean±standard deviation.



2. Comparison of the use of brushing in the experimental group

When looking at the use of brushing in the experimental group, the average number of brushings by gender was 3.13 times for females, higher than 2.48 times for males, and in the age group, 30s were the highest with 3.33 times. Non-smokers were found to be 3.05 times, while alcoholic people were 2.76 times and non-alcoholics were 2.96 times. As for the brushing learning experience, males learned 17 out of 37 people, 33 out of 39 females learned, and 43 out of 61 people in their 20s learned about the experience of brushing, and 13 out of 33 smokers learned with or without smoking. 38 out of 43 non-smokers learned, 30 out of 47 alcoholics learned with or without alcohol, and 22 out of 27 learned non-alcoholic. In the type of bristles, average was the highest among the types of bristles in gender and all age groups (Table 2).

Table 2 . t-test for the use of brushing in the experimental group (n=76)

RankDegree centralityBetweenness centralityCloseness centrality



KeywordCentralityKeywordCentralityKeywordCentrality
1Dentistry0.808Dentistry0.083Dentistry0.839
2Medical0.727Medical0.058Medical0.786
3Hospital0.697Region0.046Hospital0.767
4Region0.636Hospital0.045Region0.733
5Health0.545Corona0.035Health0.688
6Corona0.545Patient0.029Corona0.688
7Patient0.535Health0.028Patient0.683
8Examination0.525Support0.027Examination0.678
9Support0.515Potential0.022Support0.673
10Treatment0.515Treatment0.021Treatment0.673
11Potential0.485Implant0.021Potential0.660
12Implant0.475Examination0.019Implant0.656
13Business0.404Business0.012Business0.627
14Institution0.384Market0.011Institution0.619
15Doctor0.374Institution0.011Doctor0.615
16Management0.364Community0.011Management0.611
17Education0.364Oral0.010Education0.611
18Oral0.364Government0.010Oral0.611
19Community0.354Doctor0.010Community0.607
20Progress0.354Education0.009Progress0.607


3. Comparison of the use of oral hygiene products in the experimental group

When looking at the use of oral hygiene products in the experimental group, the sex and age group did not use oral hygiene products the highest. Among them, the oral hygiene products used were the highest in males with 5 teething solutions, and the females. Floss and mixed use were the highest at 6 patients. In the age group, flossing was the highest among those in their 20s with 5. Among the 43 non-smokers, 20 people did not use it with or without smoking, and among the oral hygiene products, floss was the highest at 6 people. Of the 33 smokers, 24 out of 33 did not use oral hygiene products, and among them, tongue washing was high in 5. In terms of whether or not to drink, 12 out of 29 people who were not drinking were found to not use it, among them, 5 of the oral hygiene products used were tongue washer, and 30 out of 47 drinkers did not use it. Among oral hygiene products, tongue washer was high in 5 patients (Table 3).

Table 3 . t-test for the use of oral hygiene products in the experimental group (n=76)

VariableOral care productst or χ2(p)

Dental flossInterdental toothbrushMouthwash solutionTongue washerWater injection machineNot usedMixed use
SexMale1 (1.3)5 (6.6)4 (5.3)26 (34.2)1 (1.3)15.148 (0.019)*
Female6 (7.9)3 (3.9)1 (1.3)6 (7.9)1 (1.3)16 (21.1)6 (7.9)
Age20’s5 (6.6)2 (2.6)5 (6.6)8 (10.5)1 (1.3)34 (44.7)6 (7.9)22.027 (0.231)
30’s3 (3.9)1 (1.3)1 (1.3)1 (1.3)
40’s1 (1.3)2 (2.6)3 (3.9)
50’s3 (3.9)1 (1.3)
SmokingNo6 (7.9)3 (3.9)2 (2.6)5 (6.6)1 (1.3)20 (26.3)6 (7.9)9.075 (0.169)
Yes1 (1.3)3 (3.9)4 (5.3)24 (31.6)1(1.3)
DrinkingNo3 (3.9)2 (2.6)3 (3.9)5 (6.6)1 (1.3)12 (15.8)3 (3.9)4.086 (0.665)
Yes4 (5.3)2 (2.6)2 (2.6)5 (6.6)30 (39.4)4 (5.3)

Values are presented as number (%), or mean±standard deviation. *p<0.05.



4. Comparison of the experimental group’s experience in scaling

As for the presence or absence of scaling experience of the experimental group, 29 males and females (38.1%) and 27 (35.5%) males and females in the oral discomfort area, showed discomfort, followed by 32 non-smokers (42.1%) and 24 smokers (31.5%), showed oral discomfort. In the dental visit experience, 21 males (27.6%) and females (31.5%) were found, followed by 36 (47.3%) people in their 20s and 25 non-smokers (32.9%) in smoking. 20 smokers (26.3%) were in the order, while non-drinking was 15 (19.7%) and 30 (39.4%) drinkers had dental visit experience.

In the scaling experience, there were 19 males (25%), similar to those with and without scaling, 18 (23.6%), and in females, 11 (11.8%) had no scaling experience. It was lower than 30 (39.4%). In terms of age, 39 people (51.3%) in their 20s showed a high degree of no scaling experience. In the presence or absence of smoking, 12 people (15.8%) of non-smokers had scaling experience, which was lower than that of 31 people (40.8%) who had no scaling experience. 17 people (22.4%) who had no experience in scaling were similar. In the presence of alcohol, non-drinking was lower than 9 (11.8%) people with scaling experience and 20 people (26.3%) without scaling experience. It was lower than 28 people (36.8%) who had no experience (Table 4).

Table 4 . t-test for the presence or absence of the experimental group’s scaling experience (n=76)

VariableDiscomfort in the oral cavityt or χ2(p)Dental visit experiencet or χ2(p)Scaling experiencet or χ2(p)



HaveNoneHaveNoneHaveNone
SexMale29 (38.1)8 (10.5)1.510 (0.279)21 (27.6)16 (21.0)0.117 (0.811)19 (25.0)18 (23.6)6.266 (0.015)*
Famale27 (35.5)12 (15.7)24 (31.5)15 (19.7)9 (11.8)30 (39.4)
Age20’s49 (64.5)12 (15.7)10.4 (0.015)*36 (47.3)25 (32.9)5.485 (0.140)22 (28.9)39 (51.3)1.493 (0.684)
30’s4 (5.2)1 (1.3)3 (3.9)2 (2.8)3 (3.9)2 (2.8)
40’s2 (2.8)4 (5.2)5 (6.6)1 (1.3)4 (5.2)2 (2.8)
50’s1 (1.3)3 (3.9)3 (3.9)1 (1.3)3 (3.9)1 (1.3)
SmokingNo32 (42.1)11 (14.5)0.019 (0.890)25 (32.9)18 (23.6)0.111 (0.809)12 (15.8)31 (40.8)3.115 (0.087)
Yes24 (31.5)9 (11.8)20 (26.3)13 (17.1)16 (21.0)17 (22.4)
DrinkingNo22 (28.9)7 (9.2)0.178 (0.782)15 (19.7)14 (18.4)1.112 (0.292)9 (11.8)20 (26.3)0.787 (0.452)
Yes34 (44.7)13 (17.1)30 (39.4)17 (22.4)19 (25.0)28 (36.8)

Values are presented as number (%), or mean±standard deviation. *p<0.05.



5. Comparison of test group’s sex, bad breath measurement according to smoking, oral hygiene management ability test

In the test for measuring bad breath and oral hygiene management ability according to sex and smoking in the experimental group, the female was 81.69±14.40, male was 81.00±15.38, non-smokers was 79.02±13.68, which was 84.39±15.80 for smokers. In the oral hygiene management ability test, the female was 2.58±0.62, similar to the male 2.59±0.67, and the non-smoker was 2.61±0.61, which was lower than the smoker’s 2.61±0.69 (Table 5).

Table 5 . Measurement of bad breath, oral hygiene management ability according to sex, smoking or not of the experimental group (n=76)

Oral healthSext or χ2(p)Smokingt or χ2(p)


FemaleMaleNoYes
Bad breath measurement test81.69±14.4081.00±15.380.203 (0.202)79.02±13.6884.39±15.801.585 (1.555)
Oral hygiene management ability test (PHP index)2.58±0.622.59±0.670.048 (0.048)2.56±0.612.61±0.690.278 (0.273)

Values are presented as mean±standard deviation.


Discussion

Since oral health has characteristics that can be prevented by each individual having a healthy and correct lifestyle, it is important to understand each individual’s characteristics and have a healthy and correct lifestyle for the promotion of oral health [18].

Therefore, this study is to understand the oral health status of individuals and to analyze the oral health management behavior of individuals to remind them of the importance of prevention and early management of oral diseases. This was conducted for local residents who are interested in promoting oral health.

The general characteristics of the study subjects were 80.2% (61 people) in their 20s, 6.5% (5 people) in their 30s, 7.8% (6 people) in their 40s, and 5.2% (4 people) in their 50s and over. Sex was female 51.3% (39 people), male 48.6% (37 people). In terms of occupation, students accounted for more than half with 69.7% (53 people), others (15.7%), office workers (7.8%), and self-employed (6.5%), in the order of smoking, 43.4% (33 people) of smokers and 64.4% (49 people) of people who drink alcohol (Table 1).

When looking at the use of brushing in the experimental group, the average number of brushing by gender was 3.13 times for women, which was higher than 2.48 times for men. In the presence and absence of smoking, smokers were 2.52 times and non-smokers were 3.05 times. In non-alcoholic, 2.76 times were found for alcoholic and 2.96 times for non-alcoholic. In the study of An and Lee [19], 2 times were the most common with 46.6%, and in the study result of Won [20], twice a day was 90.3%, and the results of Kang and Lee [9] were similar to 81.8%. As for the brushing learning experience, it was found that men learned 17 out of 37 men and 33 out of 39 women. In the study of An and Lee [19], the relationship between the existence of oral health education and brushing method was correlated with the oral health education experience. There is a high response to brushing up, down, left and right without the need for continuous education. In the presence or absence of smoking, 13 out of 33 smokers learned, 38 out of 43 non-smokers, 30 out of 47 alcoholics learned with or without alcohol, and 27 out of 47 non-alcoholics. It turns out that 22 people on hit learned. As for the type of bristles, average was the highest among the types of bristles in gender and all age groups (Table 2).

When looking at the use of oral hygiene products in the experimental group, the sex and age group did not use oral hygiene products the highest. Among them, the oral hygiene products used were the highest in males with 5 teething solutions, and the females. Floss and mixed use were the highest at 6 patients. In the age group, flossing was the highest among those in their 20s with 5. Among 43 non-smokers, 20 people did not use smoking, and among them, dental floss was the highest among 43 people. Of the 33 smokers, 24 people did not use oral hygiene products, and among them, tongue washing was high in 5 people. In terms of the presence or absence of alcohol, 12 out of 29 people who were not drunk did not use it, among them, 5 of the oral hygiene products used were tongue washer, and 30 out of 47 drinkers were found to not use it. Among oral hygiene products, tongue washer was high in 5 patients (Table 3). In the study results of Kim and Lee [21], the ratio of not using oral health behavior was very high in the use of dental checkup, floss and interdental toothbrush, and brushing solution. It is thought that for oral health, education on the use of oral hygiene products is necessary in addition to brushing.

As for the scaling experience of the experimental group, in the scaling experience, 19 males (25%) were similar with those with and 18 without scaling (23.6%), and in the females, those with scaling (11.8%), was lower than that of 30 people (39.4%) who had no scaling experience. In the presence or absence of smoking, 12 people (15.8%) of non-smokers had scaling experience, which was lower than that of 31 people (40.8%) who had no scaling experience. 17 people (22.4%) who had no experience in scaling were similar. In the presence of alcohol, non-drinking was lower than 9 (11.8%) people with scaling experience and 20 people (26.3%) without scaling experience. It was lower than 28 people (36.8%) who had no experience (Table 4). The research results of An and Lee [19] showed that 59 (47.6%) of the total subjects had experience of scaling treatment, indicating that the scaling experience was high. The results of the studies so far show that the number of people with scale work experience is low, similar to this study [7
-10,22-23].

In this study, in the oral discomfort area, 29 (38.1%) and 27 (35,5%) males and females all had discomfort. 31.5%, and in the scaling experience, 19 males (25%) were males, and those with and without scaling 18 (23.6%) were similar, and in females, those with scaling (11.8%). It was lower than 30 people (39.4%) who had no experience. It was found that females than males had lower experience of scaling than dental visits.

In the halitosis measurement test according to sex and smoking status of the experimental group, the female was 81.69±14.40, which was similar to male 81.00±15.38, and the non-smoker was 79.02±13.68 and the smoker 84.39. It was lower than ±15.80. The halitosis test shows that smokers have a lot of bad breath.

In the oral hygiene management ability test, females were 2.58±0.62, similar to males 2.59±0.67, and non-smokers were 2.56±0.61, lower than smokers 2.61±0.69. As it was higher than that of non-smokers, and the risk of oral health management was shown, Kim and Lee [21]’s study showed that smoking was 1.862 times higher in the relationship between smoking and periodontal disease.

This study recognizes the importance of prevention and early management of oral diseases by identifying individuals’ oral health status and analyzing individual’s oral health management behaviors, and in particular, understanding the habits of oral health behaviors of smokers and motivation to quit smoking. Smokers had more bad breath and oral hygiene management ability than non-smokers, but the frequency of using oral hygiene products was that 24 out of 33 smokers did not use oral hygiene products. Non-smokers and oral non-smokers were high in 20 out of 43, so they felt desperately needing oral health education on the use of oral hygiene products and the need for scaling.

This study is limited to visitors to the dental hygiene management course practice of the university located in A city, and the sample is limited, and it is difficult to generalize the study. Therefore, through a more extensive and continuous study, the oral health behavior and oral health of residents of various communities. It is considered that the delivery method of oral health education should also be considered by investigating changes in health consciousness.

Conclusion

This study is a basic data for establishing oral health education data plans by analyzing oral health behaviors and oral health conditions according to smoking for local residents and utilizing information on oral health conditions and oral health behaviors. It is intended to help motivate smoking cessation and help oral care by grasping health conditions and oral care behaviors.

1. Looking at the general characteristics of the study subject, 80.2% (61 people) in their 20s, 6.5% (5 people) in their 30s, 7.8% (6 people) in their 40s, 5.2% (4 people) in their 50s and over, female 51.3% (39), and male 48.6% (37). In terms of occupation, students accounted for more than half with 53 (69.7%), others (15.7%), office workers (7.8%), self-employed (6.5%) appeared in the order of smoking, 43.4% (33 people) of smokers, and 64.4% (49 people) of drinking alcohol in the presence or absence of smoking (Table 1).

2. Looking at the use of brushing in the experimental group, the average number of brushings by sex was 3.13 times for females, higher than 2.48 times for males, and 2.52 times for smokers and 3.05 times for non-smokers (Table 2).

3. Examining the use of oral hygiene products in the experimental group, the sex of the oral hygiene products was the highest. Among them, the oral hygiene products used were the highest in the mouthwash solution of 5 people, and the females. Floss and mixed use were the highest at 6 patients. In the age group, flossing was the highest among those in their 20s with 5. Among the 43 non-smokers, 20 people did not use it with or without smoking, and among the oral hygiene products, floss was the highest at 6 people. Of the 33 smokers, 24 did not use oral hygiene products (Table 3).

4. Looking at whether or not the experimental group had scaling experience, 19 males (25%) and 18 (23.6%) were similar in terms of scaling experience, and in females, those with scaling experience (11.8%) had no scaling experience. It was lower than 30 people (39.4%). In the presence or absence of smoking, 12 people (15.8%) of non-smokers had scaling experience, which was lower than that of 31 people (40.8%) who had no scaling experience. 17 people (22.4%) who had no experience in scaling were similar (Table 4).

5. In the test for measuring bad breath and oral hygiene ability management ability test according to sex and smoking in the experimental group, females were 81.69±14.40, males were 81.00±15.38. Non-smokers were 79.02±13.68, and smokers were 84.39±15.80 lower. In the oral hygiene management ability test, the female was 2.58±0.62, similar to the male was 2.59±0.67, and the non-smoker was 2.61±0.61, which was lower than the smoker was 2.61±0.69.

Therefore, this study is considered to be an important data in establishing oral health education data plan by analyzing oral health behaviors and oral health conditions due to smoking for some local residents, utilizing information on oral health conditions and oral health behaviors. In addition, it is intended to provide basic data necessary for oral health education to improve oral health and motivate smoking to further improve oral health by grasping the oral health behavior of smokers.

As a result of the above results, it is a study targeting a part of a region, and in the future, it is suggested to repeat studies targeting various fields and classes. In addition, a follow-up study to verify the effectiveness by applying is suggested.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

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