In a recent study from the Kingdom of Saudi Arabia (KSA),10 it has been reported that out of 120 school teachers, 73% knew regarding the role of sugar plus bacteria in the development of dental caries, bleeding gums were related to improper tooth cleaning by 68%; and 76% considered tooth brushing can prevent dental caries. Moreover, 56% responded positively to the statement that school teachers should teach the children regarding the causes of dental disease. In another study by Khan et al11 from Riyadh City, KSA, it was found that 34% of teachers had good oral hygiene, while 50.2% fair and 15.8% were poor. Regarding their knowledge, 65% of schoolteachers had a knowledge regarding tooth decay while 45% of schoolteachers were aware of gum diseases. Another study from Riyadh,12 concluded that there is a deficiency in dental and general health knowledge among female teachers.

The aim of this study was to investigate the knowledge and practices of oral hygiene methods and attendance pattern to dentists among primary and secondary school teachers and to investigate the effect of economic status on their oral hygiene practice and level of satisfaction.

The data were entered into a computer using FoxPro Program. Statistical Package for Social Sciences was utilized for data analysis. The data were generated for frequency distributions and Chi-square test for comparisons. The p-value was set at 0.05 for significance level. The missing data were excluded from the analysis.

Regarding the knowledge pertaining to periodontal diseases, 75% male and 72% female responded that no regular tooth brushing is the cause of gingival disease. Regarding etiology of periodontal disease, 32% male and 39% of female teachers did not know with regards to microbial relationship of the gums disease (P=0.005) (Table 2). Regarding oral hygiene methods 34% male and 48% female teachers used brushing (P=0.000) while on aggregate data, <5000 Saudi Riyals (SR) group monthly income teacher had the habit of brushing by 42% while >5000 SR almost 39% used brushing. There was no significant difference due to income (P= 0.665) (Table 3).

Tooth brushing, 3 times a day was more common among female teachers (33.5%) than male teachers (18.6%) P=0.000. In relation to income, tooth brushing 3 times a day was 20.5% among <5000 SR income group and 31% in >5000 SR group (P=0.001). Towards preference of using toothbrush or miswak 45% of males and 48% female teachers preferred to use a toothbrush due to better cleaning effect, and regarding the use of the miswak 62% of males and 62% of females used it due to Sunnah, while 8% of males and 18% of females used it due to freshness (P=0.002) (Table 4). The majority of the teachers, males 40% used horizontal brushing method while 45% of female teachers used circular brushing (P=<0.002). There was no significant difference in using miswak methods in both groups P=0.189. Fifty-nine percent of female teachers used miswak once a day while 47% male teachers used miswak more than 3 times a day (P= 0.000). There was no significant difference among different income groups on frequency of daily use of miswak (P=0.382) (Table 5). There was a significant difference among male and female teachers as far as level of satisfaction from oral health was concerned. Male teachers were more satisfied as compared to female teachers (P=0.001). The monthly income was significantly different among male and female schoolteachers. The majority of the male teachers had a lesser monthly income compared to females; such as 15% of males and 41% of female teachers had a monthly income in the range 5000-7000 SR (P=0.000). Only 32% of females and 28% of male teachers were regular visitors to the dentist (Table 6). The majority of the males 56% and females 63% visited the dentist only on feeling pain (P=0.206).

A recent consensus statement on oral hygiene concluded that bacterial plaque plays an important role in the etiology of dental caries, gingivitis and periodontitis that effective removal of dental plaque can result in the prevention or reduction of these disease.13 It has been established that mechanical cleaning procedures are reliable means of controlling plaque, provided cleaning is sufficiently thorough and performed at regular intervals.14,15 The present study was conducted to look into the knowledge of schoolteachers regarding oral health and their oral hygiene methods. Then the results were compared for male and female schoolteachers from primary and secondary schoolteachers from Riyadh, KSA. Though questionnaire approach is acceptable but it does inherent limitations of the investigation in the absence of the clinical examination of the subjects. The clinical examination would help to assess the gap between knowledge and practices of oral hygiene methods.

There was a lot of resemblance of responses by both male and female schoolteachers. Female schoolteachers had more brushing frequency as compared to male teachers. Miswak was used more by male teachers than female teachers. Sixty-two percent of both male and female teachers used miswak due to Sunnah. This reflects the social and religious norm of the society. The comparative studies of miswak and toothbrush have shown that, low periodontal treatment need was found among Saudi adults who used miswak.16,17 Recently Darout et al18 assessed and compared the periodontal status of adult Sudanese habitual miswak and toothbrush users. It was found that the periodontal status of the miswak users was better in the Sudanese population than that of toothbrush users and the efficacy of miswak used for oral hygiene was comparable to or slightly better than that of the toothbrush.

All of the above mentioned studies are in favor of promoting traditional oral hygiene tool of miswak. This can be integrated for oral health promotion activities as it is socially, culturally and religiously motivated. At all 3 levels, the miswak is practiced in KSA as an effective oral hygiene tool. Al-Tamimi and Peterson showed10 that 26% of Medina City schoolteachers did not know anything with regards to tooth decay, and one third did not know anything regarding gums disease, which is in accordance with our study and the etiological factors, microbial relationship of caries and periodontal disease were similarly expressed by Riyadh schoolteachers. Khan et al11 came with the same conclusion that one third of the teachers showed poor knowledge regarding caries and gum diseases. In our study we found that almost 3 quarters of the female and male teachers used miswak, which are in accordance with Khan et al11 A study by Wyne et al19 from Riyadh, KSA on a very small sample of 39 schoolteachers has shown that there is discrepancy among knowledge and practices of oral hygiene habits among primary schoolteachers. It is recommended that in future, studies on schoolteachers should be considered for socioeconomic status, oral health knowledge and their practices. In our study, we tried to find out any influence of monthly income on oral hygiene practices and it was found that higher income group had better oral hygiene practices.

Over all the female teachers practiced oral hygiene methods more frequently, majority of those concerned regarding their oral health and they were less satisfied with their oral health. But, there was no significant difference among both male and female schoolteachers as far as attendance to the dentist was concerned. Both male and female teachers visited the dentist in the dental pain (toothache) rather than having a regular pattern of visit to dentist. Further, research should also focus the barriers to visit dentist regularly among schoolteachers. Our results are in accordance with a study by Bokhari,8 Almas20 regarding dental attendance pattern of schoolteachers, as there was no difference among male and female schoolteachers.

A study by Lang et al21 has shown that schoolteachers have incomplete knowledge regarding oral diseases. In our study almost quarter of the teachers did not have knowledge regarding microbial relationship of caries and periodontal disease. These responses emphasize that there is a need of delivering the basic knowledge and information of health sciences especially the knowledge of oral health, hygiene practices and life style of the diseases. That would help to improve the oral health among school children in KSA as better awareness teachers can dissipate the oral hygiene information to the children. Both male and female schoolteachers had a very high level of knowledge regarding tooth brushing, role of sugar in dental caries and the importance of regular visit to dentist. Approximately 23% of males and 30% of female schoolteachers did not know the bacterial relationship to the dental caries. Thirty-two percent male and 39% female teachers did not know details regarding microbial relationship to periodontal disease. Three times daily tooth brushing was more common among female higher income group of schoolteachers. Use of miswak was more common and frequent among male schoolteachers and 62% of both female and male schoolteachers used miswak due to Sunnah. Male teachers were more satisfied with their oral health compared to female teachers. The majority of the males 56% and female 63% teachers visited dentists only on having pain (toothache).

In conclusion, there is a need to enhance the knowledge of oral health and disease among schoolteachers, so they could dissipate the knowledge to their pupils. There is a need to persuade schoolteachers to visit the dentist regularly and not only on having toothache, so early detection and treatment of dental and oral diseases may be provided. Further, research can be carried out to look into the effects of socioeconomic status, level of knowledge and oral health status of schoolteachers.