Dental Neglect Score and its Association with Oral Hygiene and Dental Caries among Adults visiting A Tertiary Hospital in Kathmandu

Introduction: Dental neglect is a harmful behavior which brings many unwanted consequences in oral health. It has been found to be related to poor oral hygiene and increase in oral diseases. Dental neglect scale is a valid measure to record dental neglect among adults. Objective: To assess dental negligence using Dental Neglect Scale (DNS) questionnaire and assess its association with oral hygiene status and dental caries. Methods: Study consisted of convenient sample of 287 adults visiting Kantipur Dental Hospital who were given six-item Dental Neglect Scale questionnaire followed by oral examination using Oral Hygiene Index-Simplified (OHI-S) and Decayed Missing Filled Teeth (DMFT) index. Results: The mean DNS score was found to be 18.40. Statistically significant difference was seen between age of the participants and mean DNS score (P value 0.033) as well as with gender and mean DNS score (P value 0.001). Association between dental neglect score and DMFT categorised and OHI-S shows statistically significant difference the groups with p value 0.022 and 0.001 respectively. Conclusion: Dental neglect was found to be high among adults in Kathmandu and caries and oral hygiene status were significantly associated with dental neglect. Variation in dental neglect exists in relation to various sociodemographic variables like age and gender.


INTRODUCTION
Dental neglect has been defined as behavior and attitudes which are likely to have detrimental consequences for the individual's oral health, or more specifically as failure to take precautions to maintain oral health, failure to obtain needed dental care and physical neglect of oral cavity. 1 Dental neglect is playing an important role in the negative outcomes regarding oral health and the functioning among individuals altogether. 2 Thomson and Locker in 2000 3 had designed the Dental Neglect Scale (DNS) to be used in adults by modifying the Adelaide scale used to measure dental neglect among children based on parental response. 4 It helps to assess the extent to which a person cares for his/her teeth, seeks professional dental treatment and prioritises oral health.
Assessment of dental neglect in a population helps in recognizing the disparities in dental neglect and oral health behavior. Hence this study was conducted to assess dental negligence using DNS questionnaire and assess their association with oral hygiene status and dental caries in Kathmandu to know whether dental neglect still prevails despite dental awareness and abundant resources for dental care.

RESULTS
Out of total 300 participants approached, 287 people participated in the study that is the non-response rate was 4.33% and there was no difference between participants who wished and refused to study. Mean age of the participants was 32.23 years (standard deviation = 12.43 and range = 18-75). The mean DNS score was found to be 18.40 (standard deviation = 3.77 and range = 9-27). Table 1 shows distribution of study participants based on their socio-demographic variables and their relationship with mean DNS score.
Statistically significant difference was seen between age of the participants and mean DNS score (P value=0.033) as well as with gender and mean DNS score (P value=0.001). Table 2 shows the responses of the participants to the six items of the dental neglect scale. Majority of the participants agree to keeping up with their home dental care (43.9%), receiving dental care as they should (43.9%), needing dental care but putting it off (32.8%), brushing as well as they should (52.6%) and considering dental health to be important (63.4%). However, majority of the participants 45.3% disagree that they control snacking between meals as well as they should. Table 3 shows the association of dental neglect score and categories based on DMFT scores that is ≤3 and >3.
Independent t-test was used and statistically significant difference was found in the dental neglect score between the groups(P value=0.022). Table 4 shows the association of dental neglect score and OHI-S. ANOVA test was used which showed statistically significant difference between the dental neglect score and OHI-S (P value=0.001).

DISCUSSION
Dental neglect scale measures the behavioral aspects of the individuals as the first four items of the scale look for information on self-care and professional dental care behavior. 4 The last item measured the global rating of the importance placed upon dental health. 8 The mean dental neglect score for this population was found to be 18.40. However, they were higher than those reported by Ajagannanavar et al. 9 in India that is 10.18, Cooligde et al. 2 in Seattle-Tacoma area that is 13.2, McGrath et al. 8

in Hong
Kong that is 14.81 and Jamieson and Thomson 10 in Dunedin, New Zealand that is 12.4. In developing countries like Nepal, oral health needs are treated as secondary compared to general health needs due to various reasons like lack of awareness, high cost of the treatment, lack of insurance and inaccessibility which could be the reason for the higher dental neglect. They neglect in seeking preventive dental care leading to the increase in many dental diseases and people often visit the hospital when these unattended diseases cause pain and suffering.
Significant DNS score differences were found related to gender where mean score was slightly better than males i.e.
49%. Similar findings were found in a other studies 9 but were in contrast to other studies 2,8 where no gender difference was found with respect to mean DNS score.
Statistically significant difference was found between DNS score and age similar to other studies. 8,9 Further studies comparing various age group may be needed for better understanding of the association between age group and dental neglect. Mean neglect score was found to be more among the active working group of people which could be because they prioritise other things in life before dental care and with advancing age due to financial security and time, dental is given attention by them.

CONCLUSION
The mean dental neglect score was found to be high among the study participants with variation among the age groups and gender. Dental caries status and oral hygiene status varied based on the dental neglect. Patients need to be counseled and motivated about their oral health.

Clinical implications
Patients need to be counselled and motivated about their oral health. As prevention poses less financial burden than treatment when the disease has progressed, oral health promotional programs need to be promoted to increase the knowledge, understanding and practices to improve oral health.