|Year : 2016 | Volume
| Issue : 2 | Page : 185-189
Dental health behaviors among homemakers and the association with socioeconomic status: A study from Delhi, India
Rahul Sharma1, Dinesh Raja2, Vikas Kumar3
1 Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
2 Department of Community Medicine, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
3 Department of Community Medicine, UCMS and GTB Hospital, New Delhi, India
|Date of Web Publication||29-Sep-2016|
Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
Background: Women who are homemakers represent a vulnerable group regarding dental health, given the traditionally low importance placed on their health and preventive behavior, especially in the developing countries.
Objective: To study the dental health-related behaviors among the homemakers in a region of Delhi, India, and its association with socioeconomic status (SES).
Materials and Methods: A community-based cross-sectional study done in four selected residential colonies in a region of Delhi. Seven hundred and fifty-four homemakers residing in the colonies participated in the study.
Results: Of the women, only 45.5% brushed their teeth twice daily while just 5.2% flossed their teeth at least once a day as recommended. The large majority (92.2%) never visited a dentist for preventive checkup. The most common reason cited for never having visited was "will go to a dentist only if some dental problem" (87.4%). Only 1.2% women were undertaking all the three major preventive health behaviors (brushing, flossing, and dental checkup). A significant direct association was observed between SES and the adoption of positive dental behaviors.
Conclusion: The current study found specific lacunae in the behaviors related to dental health among the homemakers and an association with low SES. Dentistry practitioners and primary care managers need to be cognizant of the importance of promoting positive dental health behaviors in this sizeable constituency of homemakers, especially those who are socioeconomically deprived.
Keywords: Behavior, dental health, homemakers, socioeconomic status, women
|How to cite this article:|
Sharma R, Raja D, Kumar V. Dental health behaviors among homemakers and the association with socioeconomic status: A study from Delhi, India. Indian J Health Sci Biomed Res 2016;9:185-9
|How to cite this URL:|
Sharma R, Raja D, Kumar V. Dental health behaviors among homemakers and the association with socioeconomic status: A study from Delhi, India. Indian J Health Sci Biomed Res [serial online] 2016 [cited 2022 May 17];9:185-9. Available from: https://www.ijournalhs.org/text.asp?2016/9/2/185/191267
| Introduction|| |
Dental care can sometimes be the forgotten part of a healthy lifestyle, often its importance being underestimated. Dental health is an integral part of general health. In most developing countries, the prevalence rates of dental diseases especially caries are now tending to increase. This is largely due to the increasing consumption of sugars and inadequate exposure to fluorides.  On the other hand, evidence shows suboptimal utilization of dental services has been repeatedly reported for population from developing countries. , Positive dental health behaviors need to become the key message for the community.
Many surveys in different parts of the world have found brushing to be the best way to maintain oral health. , Other equally important preventive measures apart from brushing include flossing and regular dental visits.  However, the need for these is not appreciated in many parts of the world. ,,, To prevent oral health problems, the American Dental Association and Indian Dental Association recommend that adults should thoroughly brush their teeth at least twice a day, floss at least once a day, and get oral health checkups done regularly. , Studies have shown that Indian community has low level of oral health awareness and practice as compared to west.  Women especially represent a vulnerable group regarding dental health, given the traditionally low importance placed on their health and preventive behavior. Fotedar et al. had reported women as being significantly less likely to have made a dental visit, compared to the males in their study. 
It has been observed that there exists a socioeconomic gradient in oral health.  It becomes pertinent to study the association of socioeconomic status (SES) with the determinants of oral health including preventive behavior. Community-based studies of dental health in India are few and far in between, , with most being hospital-based. Despite best efforts, we could not come across community-based studies in the specific vulnerable group of women in the study area Delhi. Thus, there was a felt need for studying the oral health-related behavior among the target group. This research was part of a broad study of health behaviors among the specific group of women who are homemakers. The research objective addressed in this paper is the study of the dental health-related behaviors among the homemakers in a region of Delhi and as a secondary objective, its association with SES.
| Materials and Methods|| |
The study comprised of a cross-sectional interview of women who were homemakers in the age group of 18 years and above, residing in either of a high-income group (HIG), a middle-income group (MIG), a low-income group (LIG), and an urban slum resettlement colony in North East Delhi, for more than 6 months. These four areas were chosen to get a representation of the women from different socioeconomic strata, with the hypothesis that each of these localities represents broadly different socioeconomic profiles. The Kuppuswamy's SES scale revised for 2013, using real-time update tool, was used for the SES classification. ,
A homemaker was defined as a woman in charge of the homemaking, who is not employed outside the home. A group of undergraduate medical students was given training in data collection, and each student was asked to interview homemakers from each of the four different types of colonies. A systematic random sampling design was used with each student being allotted specific house numbers to visit each day of interviews. The sampling across the four colonies was proportionate to the population size, largest sample being from the urban slum resettlement colony and least from the HIG residential area. All respondents were informed that their responses would remain anonymous, and informed consent was obtained.
As this was a students' project, the study was reviewed and approved by departmental experts. The methodology was similar to previous studies undertaken in the same area. , A pretested semi-open-ended questionnaire was prepared based on a review of literature. Questions were framed to elicit sociodemographic profile and attitude and behaviors among the homemakers about various health-related topics including dental health. The questionnaire was pilot tested by the investigators among homemakers not included in the final study and suitably modified before use in the final data collection. The data collection was supervised by the investigators. The data thus collected were converted into a computer-based spreadsheet and analyzed. The statistical analysis comprised of calculating proportions and applying Chi-square test for studying associations with various sociodemographic characteristics. ANOVA test was applied to study the difference in SES by locality. In this paper, the findings relating to dental health behaviors among the women are being discussed.
| Results|| |
The study results are based on information collected from a total of 754 women belonging to different families in the studied residential areas. The age of the women ranged from 21 to 80 years with mean 41.6 ± 12.3 years. Largest sample (303; 40.2%) was from the urban slum resettlement colony, 253 (33.6%) women from the LIG colony, 171 (22.7%) from the MIG colony, and 27 (3.6%) from the HIG residential area. ANOVA test of significance followed by suitable post hoc test was applied to study the difference in mean SES score as measured by the revised Kuppuswamy scale, between the four residential colonies. All four residential areas were found to have significantly different average SES, hence proving the a priori hypothesis that the selected residential colonies represent women belonging to different socioeconomic strata. Among the women, 171 (22.7%) were illiterate while 140 (19.7%) had done college graduation or higher studies. The majority (636; 84.4%) were residing in their owned house while the remaining 118 (15.6%) were tenants.
The women were asked that how often they visit a dentist only for preventive checkup, in a year. It was specified that the visits for an obvious problem or symptom were not to be counted. The large majority (695; 92.2%) never visited a dentist for a preventive checkup, 25 (3.3%) made one visit annually, 17 (2.3%) women reported such visits as twice and another 17 (2.3%) thrice or more. The women who had not made a preventive visit to the dentist for the past 1 year were asked the reasons for the same [Table 1]. The number of such women was different from the previous question which had asked about visits in general. There were 701 women who had not visited a dentist in the previous year. The most common reason, by a wide margin, was "will go to a dentist only if some dental problem" (87.4%). "Lack of money" was mentioned as a factor by 11.3% while "no one has told me about preventive checks" was given as a reason by 4.4%. The total does not add up to 100% as multiple responses were allowed.
|Table 1: Reasons for not visiting a dentist for a preventive check as reported by the women (n=701 who had not made a preventive dental visit in the last 1 year)|
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The respondents were asked about their usual frequency of brushing and flossing of teeth in a day [Table 2]. Only 343 (45.5%) of the women brushed their teeth at least twice daily as recommended while just 39 (5.2%) flossed their teeth at least once a day as recommended. Only nine (1.2%) were doing all the three major preventive measures (brushing, flossing, and dental checkup). Association of the three major preventive measures studied (brushing, flossing, and dental checkup) with various sociodemographic variables was then studied using the Chi-square test [Table 3]. Significant associations were observed with the education level and type of locality, but not with age and type of residence. A significant direct relationship was observed between the SES and all the three preventive dental behaviors [Figure 1].
|Figure 1: The association of socioeconomic status with the dental health behaviors among the respondents (n = 754). The y-axis represents the proportion among the socioeconomic status class who reported the particular behavior. The Kuppuswamy scale revised for 2013 was used for socioeconomic classification|
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|Table 2: Frequency of brushing and flossing of teeth in a day, as reported by the women (n=753, one missing response)|
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|Table 3: Association of sociodemographic characteristics of the respondents with the practice of positive dental health behaviors by them (n=754)|
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| Discussion|| |
A total of 754 women representing varied socioeconomic spectrum in the study area in Delhi were interviewed as part of the present study. The large majority (92.2%) never visited a dentist for preventive checkup, while just 4.6% made the recommended twice annual visits. Bayat et al. noted that in most developing countries dental services are provided mainly to relieve pain or harmful symptoms, rather than for preventive purpose.  Kumar et al. in their study in Udaipur, Rajasthan, too found that majority of the adults did not visit a dentist regularly. 
The most common reasons for not making a preventive dentist visit were "will go to a dentist only if some dental problem," "lack of money," and "aware but do not want to do anything." Devaraj et al. too had found the chief reason cited by people for not visiting dentist to be "dental problem not severe enough to go to a dentist," followed by "did not care."  Other studies have reported similar findings. , Previous studies too have noted that high costs are a barrier factor contributing toward avoidance of dental visits. ,,, A recent WHO paper notes that over the past years, savings in dental expenditures have been noted in developed countries which have invested in preventive oral care.  Prevention is most definitely a cost-effective pressing need for the developing countries too. Dental insurance has been recommended as one of the key factors that can affect the use of dental services. 
In this study, almost all women did brush their teeth daily. However, only 45.5% of the women brushed their teeth at least twice daily as recommended, while just 5.2% flossed their teeth at least once a day as recommended. Similar to our result, Patro et al. too reported that almost all adults did brush their teeth daily.  Previous studies have reported that the females have significantly higher frequency of brushing twice than males, , and the reasons have been reported to be esthetics and social norms. 
The proportion of women following all three preventive dental health behaviors (brushing, flossing, and dental checkups) was very low at 1.2% in our study. SES was found to have a robust direct relationship with the adoption of positive dental behaviors in the present study. Similar finding has been reported earlier too.  It has been pointed out earlier that social and cultural factors act as access barriers to oral health care.  However, as demonstrated by the current study, the role of SES is beginning even earlier through its association with preventive behavior.
| Conclusion|| |
The current study raises concerns that the situation vis-à-vis preventive dental health is grim in the urban population and that too in the capital city. Lack of dental facilities can be expected to be even grimmer in rural parts of India. We found specific lacunae in the behaviors related to dental health among the homemakers, a group that has been noted to face more barriers to accessing dental health care especially in the sociocultural milieu true of large parts of India. Due to these facts, the role of dentistry practitioners and those who are involved in primary health care becomes very important. They need to be cognizant of the importance of promoting positive dental health behaviors in this sizeable constituency of homemakers, especially those who are socioeconomically deprived. The doctors can be a window of opportunity to encourage positive health behaviors including dental behaviors, at the time of their interaction with the constituency of women who are homemakers.
Dr. S.K. Bhasin for the kind guidance in various stages of the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]