Comparison of Knowledge and Attitude Towards Orthodontic Treatment Among High School Students

Introduction: Adolescence is the time when a person attains awareness including the self-awareness about his/her health. Hence if proper knowledge is instilled during this time, it will be effective and good oral health behavior can last lifetime. The aim of this study was to assess knowledge and attitude towards orthodontic treatment among the students of public and private schools and compare between them. Materials & Method: A descriptive cross-sectional questionnaire-based study was performed among 700 students (350 from private and 350 from government schools around Kathmandu valley) of grade 8-10. Questionnaire consisted of 14 questions about knowledge and 10 questions about attitude relating to orthodontic treatment. Each response as “yes” was given score ‘1’ and responses “no” and “don’t know” were given score ‘0’. Total score was calculated, followed by mean and compared between that of private and government schools and between genders. Result: No significant difference was found in the knowledge between the students of private and government schools. The difference in attitude score was found to be statistically significant (p=0.00). 54.29% of participants had never heard of an orthodontists, 48.57% never thought that crooked teeth have ill effects, and around 50% of participants were not aware that orthodontic treatment would improve the facial appearance. 47% of participants would not undergo treatment if it took 1-2 years, 53% would not agree for extractions and 42% were not willing to wear retainers. Conclusion: The knowledge and attitude level on orthodontics can be improved by incorporating the basic aspects of oral health in the syllabus of school education.


INTRODUCTION
Oral health is an integral part of general health of the human being. One of the most common dental problems effecting the oral health is malocclusion. 1 Furthermore, malocclusion can result in social embarrassment, rejection and inevitable psychological disorders. 2 In a developing country like Nepal greater fractions of younger populations are unaware of the causes, occurrence, prevention and consequences of malocclusion. Awareness is the state or ability to perceive, feel or to be conscious. Awareness forms the basis for practicing oral health which is an inseparable part of general health. 3 Orthodontists have been giving more importance to impact of malocclusion on oral health and function in deciding the need of treatment. Lately, dental appearance and its effect on psychosocial wellbeing has been primary factors on determining the orthodontic treatment need as esthetics plays a vital role during pre-adolescent and adolescent phases. 4 Being self-aware of malocclusion will ensure early treatment seeking behavior. If school children can be taught healthy lifestyle, this can be expected to last lifetime. 3 If this leads to early treatment of malocclusion, it would lead to many benefits including prevention of consequences. From a patient's perspective, understanding the ill-effects of malocclusion can play vital role in planning of public health interventions. 5 In a literature review, there are some studies assessing knowledge, attitude and practices (KAP) related to orthodontic treatment, 6,7 but there are not sufficient researches to assess the awareness of orthodontic treatment in school children. Hence, the objective of this study was to assess knowledge and attitude towards orthodontic treatment among the students of public and private schools and to compare between them. A written consent was taken from every participant of the study. This is a questionnaire-based study, which was developed with the reference from different studies. 2,4,8 The questionnaire was first validated by doing pre- Mann-Whitney U test was performed as the data were not normally distributed to test the difference between the mean scores of knowledge and attitude between the students of private and government schools.

MATERIALS AND METHOD
Significance level was set at p ≤ 0.05.

RESULT
The study population comprised of 700 students (350 from private and 350 from government schools) of grade 8-10 at 5 private and government schools around Kathmandu valley. 324 of the students were male and 376 were female. Table 1 and 2 show the response of the participants to the questions relating to orthodontic treatment knowledge and attitude. For each response as 'yes', '1' score was given and for 'no' and 'don't know', '0' score was given. The individual scores were summed up to obtain the total score.  10a, 10b and 10c questions were only considered if the response to question 10 was 'yes'.  The mean knowledge and attitude score were calculated and compared between the students of private and government schools (table 3) and between the gender (table 4).
Mean score of knowledge among students of private and government schools were 8.59±2.44 and 8.71±2.84, respectively. No significant difference was found between the knowledge among the students of private and government schools. Mean score of attitude among the students of private and government schools were 4.47±1.96 and 5.20±2.54 respectively. The difference in attitude score was found to be statistically significant (p=.00).
Mean score of knowledge among males and females The difference was not statistically significant. (21) wore retainers as specified by the doctor and around 57% (48) went for post treatment follow up.

DISCUSSION
Mean score of knowledge and attitude of students of private and government schools was found to be just above 50 percent of total knowledge score that could be obtained. This signifies need for improvement in orthodontic treatment knowledge among high school students. The improved level of orthodontic treatment knowledge will help in attainment of good oral health of teenagers which will be beneficial for improving quality of life.
There was no any significant difference between the mean score of knowledge among students of private and government schools. Mean score of attitude was found to be statistically higher in students of government school compared to those of private school. Students of government school though having similar level of knowledge were found to be exposed more towards orthodontic treatment and its aspect.

CONCLUSION
The level of orthodontic treatment knowledge and attitude of high school students assessed in this study was found to be just above 50% of the total score.
The knowledge and attitude level can be improved by incorporating basic aspects of oral health in the syllabus of school education. If we can instill good oral health behavior during adolescence, it's most likely to last lifelong.