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INOSR Experimental Sciences 15(3):105-114, 2025. ISSN: 2705-1692
©INOSR PUBLICATIONS INOSRES1530000
International Network Organization for Scientific Research
https://doi.org/10.59298/INOSRES/2025/153105114
Factors Influencing Dental Hygiene Practices among
Patients Aged 18 Years and Above Attending Out-Patient
Department at Mitooma Health Center IV
Abura Geoffrey, Musimenta Allen and Rukundo Annitar
Faculty of Nursing Sciences Kampala International University Uganda
ABSTRACT
Dental hygiene is a state of being free from mouth and facial pain, oral and throat cancer, oral infection and
sores, periodontal (gum) disease, tooth decay, and tooth loss. Dental hygiene is perceived as an essential
component and these includes; brushing “two minutes, two times a day, every day”, rinsing using mouth wash
and chewing sugar free gums. A cross-sectional descriptive design employing quantitative method of data
collection was conducted among 50 adult’s patient attending out-patient department at Mitooma H/C IV chosen
by a convenient sampling technique and examined using a pretested questionnaire. Data were analysed by using
SPSS version 22.0 as frequency and percentage and presented inform of a frequency table, charts and figures.
Out of 50 participants, 32.2% aged 25 to 29 years, 60.0% were males, 74.0% were married, 50.0% were peasant
farmers, 50.0% attained secondary education, 62.0% never went for dental checkup, 54.0% drink alcohol, 60.0%
known smokers, 58.0% had no dental complaints in the past years, 100.0% participants always brush their teeth,
92.0%) brushed it less than twice daily, 76.0%) took less than two minutes when brushing, 68.4% had dentals
checkup within 12 months, 85.7% ever received dental treatment, 66.7% had dental extraction. On conclusion,
it was found out that all the participants 50(100.0%) said they brush their teeth but majority 62.0% never went
for dental checkup, more than a half 92.0% brushed it less than twice daily, however majority 68.4% had dentals
checkup within 12 months with adequate dental treatment which was mainly 66.7% dental extraction. But many
factors such as alcohol intake, cigarette smoking and low socio-economic status which hindered their regular
dental checkup and other lifestyles behavior like diet still put them at risk.
Keywords: Influential factors, Dental Hygiene Practices, Patients, Aged 18 Years and Above, Out-Patient
Department.
INTRODUCTION
Dental hygiene is a state of being free from mouth and facial pain, oral and throat cancer, oral infection and
sores, periodontal(gum) disease, tooth decay, and tooth loss [1], oral or dental diseases lead to serious health
and economic burdens, resulting in a significant reduction in quality of life. [2]. Oral diseases such as caries,
dental fluorosis, tooth loss, periodontal disease, dental injuries, oral cancer, dental anomalies, and craniofacial
disorders have got a negative impact on Oral Health-Related Quality of Life (OHRQoL) [3]. Dental hygiene
(OHRQoL) is perceived as an essential component of overall quality of life, [3] and is a significant predictor of
general health and these includes; brushing “two minutes, two times a day, every day” flossing, rinsing using
mouth wash and chewing sugar free gums, tobacco cessation as well as stopping sweetened eats and drinks [4].
About 3.5 Billion people worldwide have no access to Oral and Dental services [5, 6]. As a result, 11.2% of
world population are suffering from dental hygiene related diseases [7]. However, according to WHO Global
Oral Health Status Report [6] estimated that oral diseases affect close to 3.5 billion people worldwide, with 3
out of 4 people affected living in middle-income countries. [6]. According to a survey of adults expressing a
need for oral health services, access ranges from 35% in low-income countries to 60% in lower-middle-income
countries, 75% in upper middle-income countries, and 82% in high-income countries [2]. Oral health is a key
indicator of overall health, well-being, and quality of life [8]. In East African countries, it was found out that
periodontal oral diseases are on rising due to the higher consumption of sugar, lack of knowledge of oral health,
and inadequate dental hygiene [9]. Tanzania reported a prevalence rate of dental problem of 61% [10] and
South Africa reported a prevalence rate of poor dental hygiene related problems at 50% [11]. As result, the
prevalence of periodontal diseases are affecting at least 63.9% in these areas [11] In Uganda, a study conducted
in the Mbarara district reported that 68% participants had dental plaques showing poor oral hygiene
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practices.[12]. This indicates that Oral and Dental hygiene in Uganda and other regions within Uganda are
poorly practiced. At Mitooma H/C IV, there is no up to date published data on oral hygiene practices, however
oral hygiene indicators including oral smell and other dental and periodontal disorders, at least 1 in every 4
patients assessed with have one or more hygiene related dental disorders pointing a gap in dental hygiene
practices [13]. However, a care practice cannot be described merely in terms of care procedures and its
frequency [8]. Few studies have focused on factors influencing oral care practices in adult patient. Although
some factors have been documented which includes: age, oral hygiene practices, socioeconomic status, education,
dysphagia, and dependence as being associated with the dental hygiene [14]. Although these factors were known
to influence patients’ overall health, the association between these variables and the oral health status of older
stroke patients remains unclear [2]. The main purpose of this research study was to assess factors influencing
the practices of dental hygiene among patients aged 18 years and above attending out-patient department at
Mitooma H/C IV. This would provide the appropriate recommendation to curb down the prevalence and the
influential factors associated with dental caries in adults.
METHODOLOGY
Study design and rationale
The study design was a descriptive cross-sectional study employing quantitative methods of data collection on
factors influencing the practices of dental hygiene among patients aged 18 years and above attending out-patient
department at Mitooma H/C IV. This design had been chosen because it was easier to be done while exploring
the variables in the study effectively and in shortest time possible since both the independent and dependent
variables were measured at the same time in point.
Study setting and rationale
The study was carried out from the out-patient at Mitooma H/C IV. A government health facility located in
Mitooma Town Council, Mitooma district. The H/C IV has a capacity of 100 beds receiving both inpatient and
outpatients for care including maternal and child health care services. The hospital is used to enhance
communicable and non-communicable diseases treatment including community dental health clinic that handles
most of dental problems in its population. This study area was chosen because of the hospital health record
which revealed that approximately 40 patient comes complaining of dental problems and with no up-to-date
published studies hence the main reason to carry out this study.
Study population and rationale
The study included all adult patients aged 18 years and above attending Mitooma H/C IV outpatient department
during the data collection period. They were chosen because they were the immediate source of information
regarding what affects their dental hygiene.
Sample size determination
Sample size for adult patients were determined using Sloven’s formula [15], given by expression below
N
n=
1 + N(e)2
Where n= sample size
e= margin error
N= total Population of the target population
N= Approximately 60 adult patients (18 years and above) that attend Mitooma H/C IV fortnights.
e= 5 % level of precision at 95% confidence interval= 0.05
60
n=
1 + 60 ∗ (0.05)2
n=52.17
Therefore, a total of 50 adult patients were enrolled for this research study because of time and financial
constraint.
Sampling procedure and rationale
Convenient sampling method was used for quantitative data collection where the researcher collected the data
from adult patients who were available and willing to participate. This helped the researcher to save time since
adult patients number were not bulky hence selecting some basing on any other criteria was time consuming.
Inclusion criteria
The study included all adult patients attending out-patient department at Mitooma H/C IV during the data
collection period and who consented to participate in the study voluntarily.
Exclusion criteria
The study excluded those who were not willing to consent at time of data collection, those who were not feeling
well and those who were mentally incapacitated to give valid information.
Dependent variable
Dental hygiene practice
Independent variables
Socio-demographic characteristics of the participants
Lifestyle factors of the participants
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Research instruments
Data collection were done using a self-developed questionnaire with closed and open ended questions and it was
a researcher- administered semi-structured questionnaire to assess the factors influencing the practice of dental
hygiene among adult patients. The questionnaire was subdivided into 2 sub sections where section A was used
to determine the socio-demographic factors and Section B was used to identify the lifestyle factors of the
participants.
Pretesting of instrument
Five Questionnaires were pre-tested on five patients at Bushenyi H/C IV to ensure relevancy of questions and
for the purpose of easing understanding and appropriateness of questions before the questionnaire were used for
actual data collection. This helped the researcher to ensure accuracy, validity and reliability of the tools.
Data collection procedures
The researcher got an introductory letter from Research Ethical Committee of Kampala International
University School of Nursing after approval of research proposal. Then presented it to the in-charge of
Mitooma H/C IV to obtain permission for data collection. When permission was granted, the researcher
proceeded with data collection. The researcher introduced self to the participants and explained to them the
purpose of the research in order to obtain their consent both verbally and written format by willing participants.
Thereafter, researcher administered the questionnaires to the consented participants where the data were
collected from. Data collection took two weeks.
Data management
The filled questionnaires were checked for completeness and validity before leaving the data collection area.
Data collected were packed in water proof clear bag and transported to storage areas where they were stored in
a cupboard which was locked with a padlock to protect them from unauthorized persons. Soft copy data were
coded with each variable being given a specific code, coded data were entered into SPSS version 22.0 and kept
under strong password for analysis. A copy of the softcopy was saved into a phone as a backup.
Data Analysis
Data were analyzed using SPSS version 20.0. It involved allocating codes for each question and entering the
data codes in data sheet which were analyzed inform of frequency and percentage. The percentages was further
analyzed by establishing the relationship between the independent and the dependent variables where the
information that were obtained were presented in figures, charts and tables to make it more meaningful.
Ethical consideration
An introductory letter was obtained from the Kampala International University School of Nursing and
Midwifery Research Ethics Committee and was presented to the in-charge Mitooma H/C IV seeking for
permission to carry out the research study. All information obtained from the participants were not used for
any purpose other than for this research. The participants’ names were not included anywhere on the
questionnaire; they instead used serial numbers to keep their identity anonymous. An informed consent were
requested first from the respondents prior to the administration of questionnaire. Research assistants and all the
research team members were trained to know that ethics was part of the research activity and anything that
could compromise the adherence to the ethical standards could equally compromise the validity of the findings
so that they desist from bleaching ethics.
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RESULTS
Socio-demographic characteristics of the participants
Table 1: Showing the Socio-demographic characteristics of the participants
n=50
Variables Category Frequency (N) Percentage (%)
Age in years 18-24 06 12.0
25-29 16 32.0
30-34 10 20.0
35 and above 18 36.0
Sex Male 30 60.0
Female 20 40.0
Education status None formal 02 4.0
Primary 05 10.0
Secondary 25 50.0
Tertiary/vocational 18 36.0
Average monthly income Less than 50,000= 28 56.0
50,000= to 100,000= 15 30.0
Above 100,000= 7 14.0
Residence Rural 46 92.0
Urban 04 8.0
Marital status Single 04 8.0
Married 37 74.0
Cohabiting 08 16.0
Divorced/separated 01 2.0
Participant’s occupation
Peasant farmer 25 50.0
Civil servant 03 6.0
Business 18 36.0
Student 04 8.0
In the table 1 above, most 16(32.2%) of the participants were within the age bracket of 25 to 29 years and the
least 06(12.0%) of the participants were within the age bracket of 18 to 24 years. More than a half 30(60.0%)
of the participants were males and only 20(40.0%) were females. Nearly three-quarter 37(74.0%) were married
and only 01(2.0%) had a divorced hence separated. A half 25(50.0%) of the participants were peasant farmers
whereas only 03(6.0%) were civil servants. A half 25(50.0%) had attained secondary level of education whereas
only 02(4.0%) said they didn’t get any formal form of education. Most participants 46(92.0%) were from rural
areas and the least participants 4(8.0%) were from urban areas. The study also found out that more than a half
28(56.0%) of the participants had an average monthly income of less than 50,000= while only 07(14.0%) of the
participants had an average monthly income of 100,000= and above.
Participant’s life style factors influencing dental hygiene practices
Table 2: Showing participant's life style factors influencing dental hygiene practices
n=50
Variables Category Frequency (N) Percentage (%)
Ever gone for dental check up Yes 19 38.0
No 31 62.0
Alcohol intake Yes 23 46.0
No 27 54.0
Cigarette smoking history Yes 20 40.0
No 30 60.0
Ever had dental complaint in the past Yes 21 42.0
years No 29 58.0
Always rinses the mouth with water after Yes 34 68.0%
eating No 16 32.0%
Frequency of teeth brushing < 2 times daily 46 92.0
≥ 2 times daily 4 8.0
Always brushes for two or more minutes Yes 12 24.0%
No 38 76.0%
Tooth brush replacement frequency Less than 3 months 7 14.0
≥ 3 months 43 86.0
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The study finding in the above table 2 highlighted that most participants 31(62.0%) had never gone for dental
checkup at any time in point and the least 19(38.0%) had ever gone for dental checkup. Out of all the interviewed
participants, more than a half 27(54.0%) drink alcohol and only 23(46.0%) had no history of alcohol. Majority
30(60.0%) were known smokers while only 20(40.0%) reported no smoking history. More participants 29(58.0%)
had no dental complaints in the past years and the less participants 21(42.0%) had ever experienced dental pain
in the past years. Many participants 34(68.0%) said they do rinse their mouth with water after eating as compare
to few participants 16(32.0%) who said they had never rinsed their mouth with water after eating. Out of the
participants who do brush their teeth daily, majority 46(92.0%) brushed it less than twice daily and only 4(8.0%)
said they do brush at least twice daily. Out of which majority 38(76.0%) took less than two minutes when
brushing and the least 12(24.0%) who took at least two to three minutes when brushing and the majority
43(86.0%) said they do replace their tooth brush after three months of usage whereas only 7(14.0%) said they
do replace their tooth brush within three months of usage.
Participants last date of dental health check up
n=19
KEY
6(31.6%)
Less than 12 months
12 months ago
13(68.4%)
Figure 1: Showing the participants last date of dental health check up
NB: Only those who had ever gone for dental checkup at any time in point
From the figure 1 above, more than a half 13(68.4%) of the participants had their dentals checkup within 12
months and only 6(31.6%) had their dental checkup in the last 12 months.
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Had ever received any dental treatment pertaining their dental complaints
n=21
3(14.30%)
18(85.70%)
Yes No
Figure 2: Showing whether participants had ever received any dental treatment pertaining their dental
complaints
NB: Only those participants who ever had any dental complaints in the past years.
In the figure 2 above, more than three-quarter 18(85.7%) said they had ever received dental treatment pertaining
their dental complaints whereas only 3(14.3%) said they had never received any dental treatment pertaining
their dental complaints.
Difference means of dental treatment received by the participants
n=18
12(66.7%)
5(27.80%)
1(5.50%)
Extraction Prevention/restoration No treatment
Difference methods of dental treatment
Figure 3: Showing difference means of dental treatment received by the participants
NB: Only participants who had ever received any dental treatment about their dental complaints.
From the figure 3 above, it was found out that most participants 12(66.7%) had dental extraction and the least
1(5.5%) didn’t receive any dental treatment.
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Difference ways by which participants do care for their teeth
n=50
50(100.0%)
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
15(30.0%)
40.0% 10(20.0%)
30.0%
3(6.0%)
20.0%
10.0%
0.0%
Brushing Regular dental Rinsing with Doesn't eat
checkup water every sweetened
morning things like sweet
Difference ways of dental care
Figure 4: Showing the difference ways by which participants do care for their teeth
From the figure 4 above, the study found out that all the participants 50(100.0%) said they do always brush their
teeth, 15(30.0%) said they always rinse their mouth with water in the morning, 10(20.0%) talked about going
for regular dental checkup and the least 3(said they don’t eat sweetened things like sweet.
DISCUSSION
According to this study, it was found out that most 16(32.2%) of the participants were within the age bracket
of 25 to 29 years. This could be due to their risky life styles which prone them vulnerable in seeking health care
services. This study doesn’t conform to a research study done among a sample of adult Nigerians revealed that
67.7% of the participants who utilized dental checkup were those aged 40 years and above, this was believed to
be due to their irregular dental checkup in their early ages and the least utilization was reported among those
in early 20s. [16]. It also contradict another studies by Alade and Bamigboye[17] where they found out that
age of 43.9 ± 14.6 years highly utilized dental services hence had good dental hygiene practices. But conform a
study finding conducted by Griffin [18]on factors influencing the impact of oral health among adults and older
adults where they observed that dental decay prevalence among older adults was at 27.9%. This study also
found that more than a half 30(60.0%) of the participants were males. This could be due to their nature of work
which do predispose them to various ill-health and also due to some activities like smoking and alcohol
consumption.. This is in line with a study conducted by Chikte et al., [11] in South Africa which revealed that
males had poor dental hygiene and presented worse periodontal conditions than females However, it contradict
another studies by Nazir [19] where they found out that majority that is 61% of female were associated with
poor dental hygiene and periodontal disorders. This research study also highlighted that a half 25(50.0%) had
attained secondary level of education. This could be due to the free secondary education services but they had
inadequate training regarding dental hygiene since it’s not part of their curriculum. This is not in line with a
study carried out by OHAAC, [20] which revealed that more than two thirds 47 (77%) of the total respondents
agreed that low levels of education hinder the utilization of oral and dental hygiene and health services. It also
contradict another study conducted by Andrade, et al, [21] in Illinois, U.SA where utilization of oral and dental
services was low and 12.7% was linked to low educational attainment and it also disagrees another research
study by Tefera & Bekele [22] which revealed that low education below secondary school, was significantly
associated with poor dental hygiene and it was also not in line with a study carried out by WHO [23]on factors
Influence the Oral Hygiene Practices and Oral Health Status of Tea Garden Workers which revealed that most
of the workers (62.1%) were illiterate. This study also found out that most participants 46(92.0%) were from
rural areas. This could be attributed to their low socioeconomic status which hindered their early access to dental
checkup. This correspond to a study conducted by Deolia, et al, [24] on oral health service utilization among
rural population of western Rajasthan, India, findings which revealed that 52.1% had no access to the oral care
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supplies and more so, Deolia et al conform a research which revealed that rural residency were significantly
associated with poor dental hygiene.
This study finding also revealed that more than a half 28(56.0%) of the participants had an average monthly
income of less than 50,000=. This could be because majority of them are from rural areas and their main source
of income is through farming hence could not afford costs of good dental hygiene. This study finding also
highlighted that most participants 31(62.0%) had never gone for dental checkup at any time in point. This could
be associated with their low-income level and their unawareness about the importance of dental checkup.
Furthermore, reasons for poor dental hygiene included high cost of treatments for dental hygiene (47.5%,) and
fear of pain (8.5%) during dental hygiene as well as limited number of dental health care providers. High cost
associated with inadequate health insurance coverage also hindered their regular checkup as also mentioned
Okoroafor et al., [25], in African countries. This also correspond to a research study done among a sample of
adult Nigerians which revealed that 60.8% of the respondents had never utilized dental health services [16].
This study also found out that more than a half 27(54.0%) drink alcohol and 30(60.0%) were known smokers.
This was because they believed it could help in relieving stress and other personal problem. This study also
found out that, all the participants 50(100.0%) said they do always brush their teeth, 15(30.0%) said they always
rinse their mouth with water in the morning, few participants 16(32.0%) who said they had never rinsed their
mouth with water after eating. 10(20.0%) talked about going for regular dental checkup and the least 3(said they
don’t eat sweetened things like sweet. This contradict a research study by Tefera & Bekele [22] which revealed
that the majority (72.1%) of the study participants had no regular habit and fixed time of tooth brushing which
resulted into poor dental hygiene. This study also found out that majority 46(92.0%) brushed it less than twice
daily and only 4(8.0%) said they do brush at least twice daily. This could be attributed to inadequate knowledge
regarding the number of times a person should brush each day. This conform to a study by Okoroafor et al.,[25]
in Eastern Nigeria which revealed greatest majority believed brushing one’s teeth could prevent tooth decay.
According to this study, it was found out that most participants 12(66.7%) had dental extraction and the least
1(5.5%) didn’t receive any dental treatment. This could be because dental extraction is a simple procedure and
it’s less costly. This correspond to a research study done among a sample of adult Nigerians revealed that having
had an extraction done and having a dental complaint in the previous year were significantly associated with
higher odds of non-utilization.[16]. In this study also, it was found out that more than a half 13(68.4%) of the
participants had their dentals checkup within 12 months. This could be due to their dental pain and could be
those ones who resided near the health facilities. This is not in line with a research study done among a sample
of adult Nigerians revealed that 28.5% had their last dental visit >12 months preceding the study, while 10.8%
had a last dental visit ≤12 months preceding the study .[16].
CONCLUSION
On conclusion, it was found out that all the participants 50(100.0%) said they brush their teeth but majority
62.0% never went for dental checkup, more than a half 92.0% brushed it less than twice daily, however majority
68.4% had dentals checkup within 12 months with adequate dental treatment which was mainly 66.7% dental
extraction. But many factors such as alcohol intake, cigarette smoking and low socio-economic status which
hindered their regular dental checkup and other lifestyles behavior like diet still put them at risk.
Recommendation for further study
Based on this study, the followings are some of the recommendations
The dental department and the hospital administrators should engage in community outreaches to
encourage the public to seek early treatment and regular dental checkup at least once a year.
The participants especially young adults and youth should be educated about their diet especially sugary
diet and to limit the alcohol and smoking intake.
Dental treatment if possible should be a free services and it should be covered by the government of the
republic of Uganda.
Study limitations and delimitations
Financial constraint such as high-cost stationery and other related costs like time. This was solved by the
researcher by doing all the work like typing, questionnaire distribution and collection and shortening the data
collection periods. The researcher also faced a challenge of poor cooperation from some respondents and
biasness since the nature of the questions were targeting the participants hence this was overcome by re-
assuring the respondents that the study were for academic purpose only and it would be kept confidential. The
study population turn up at the area of study was at times lower than the required sample size; however, the
researcher took an extra day(s) until the study sample were fully realized
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