Factors Influencing Selection of Oral Hygiene Aids Among an Urban Population of Kathmandu District

Introduction: The exact origin of mechanical device for cleaning teeth is not known. In past, plants with high aromatic properties were chewed by people in twigs form. These twigs freshened breath and spread out fibres at their tips as they were used for cleaning teeth and gum surfaces. China was the first country to invent toothbrush. Widely used oral hygiene aids are toothbrush and toothpaste. Objective: To assess the factors influencing selection of oral hygiene aids among an urban population of Kathmandu district. Methods: A cross-sectional analytical study was conducted during July-October 2019 among the adult population from outreach programs and outpatient department of Kantipur Dental College Teaching Hospital after receiving ethical approval from Institutional Review Committee. Convenience sampling was done. A predesigned questionnaire was used for data collection purpose. Data was entered in Microsoft Excel and analysed using SPSS v.20 software. Chi-square test was done at ≤ 0.05 level of significance. Results: Among 301 participants, 133 (44.2%) were male and 168 (55.8%) were female. The factors that influenced selection of toothpaste were: taste 169 (56.1%), fluoride content 160 (53.2%), previous experience 209 (69.4%), dentist’s advice 180 (59.8%). Factors that influenced selection of toothbrush were: texture of bristle 274 (91%), cost of toothbrush 169 (56%), brand 211 (70%), previous experience, 200 (66.4%), 184 (61%) by size of head of toothbrush, and 184 (61.1%) by dentist’s advice. Conclusion: Previous experience, cost, and dentist’s advice seemed influential factors in the choice of oral hygiene aids among the urban population of Kathmandu district.


INTRODUCTION
The two most common dental problems are dental caries and periodontal disease and bacterial plaque is the main aetiological factor in both the cases. Studies have shown that the removal of bacterial plaque is possible only through good oral hygiene practices. 1,2 Oral hygiene is the practice of keeping one's mouth clean and free from diseases and other problems. 3 Globally 4.2 billion people own a toothbrush with an average cost of US $1 per brush. 4 consent to participate in the study were included. Sample size was calculated by taking p=0.26. 6 It was calculated to be 296. Convenience sampling technique was used for data collection. A structured predesigned questionnaire was used for data collection purpose.6 A single interviewer was used for data collection purpose.
Factors that were considered for the choice of toothpaste were the cost, colour, flavour/taste, packaging, content (herbal/fluoride), media advertisement, family influence, and advice of dentist whereas factors considered for the choice of toothbrush were texture of the bristle, cost, packaging, brand, media advertisement, size of the head of toothbrush, family influence, and advice of dentist. For each factors, two options influenced and not influenced were there. Before starting the study, the questionnaire was pretested among 10% of the sample size (30 patients), who were not included in the final analysis to ensure reliability of the questionnaire. The Cronbach alpha value was found to be > 0.7.
Data was entered and coded in Microsoft Excel Sheet and analysed using IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armonk, N.Y., USA). P value of ≤ 0.05 was considered to be statistically significant. Chi-square test was used to assess the association of variables.

RESULTS
Altogether 301 participants participated in study, among When asked about their oral hygiene habits, it was found that 298 (99%) used toothbrush and toothpaste to clean their teeth. Among them 293 (97.3%) used manual toothbrush, 7 (2.3%) used powered toothbrush and 1 (0.4%) did not use toothbrush.
Factors that mostly influenced selection of toothbrush were:  (Table 1).
Chi-square test was applied to assess the association of gender and selection of oral hygiene aids. It was found that only taste of toothpaste was statistically significant ( Table   2).
Chi square test was applied to assess the association of academic qualification and selection of oral hygiene aids. Fluoride content in toothpaste and dentist's advice seemed statistically significant with toothpaste selection. In toothbrush selection, texture of bristle, brand, size of head of toothbrush, and dentist's advice seemed statistically significant while other factors had no significant association (Table 3).      Chi-square test to clean their teeth which is similar to other studies. [6][7][8][9] The extensive use of toothbrush among the participants may be an indication of their shift towards usage of modern tools.
The results of current study showed that the factors influencing choice of toothpaste were taste, fluoride content, previous experience, and advice by dentist. This is in accordance with other studies. 6,10 Most of the customers use certain brand of toothpaste only for the taste. Peppermint taste was found to be the most preferred one in the present study with a belief that it provides the user with a sense of freshness and prevents bad breath.
Previous experience also influenced choice of both the toothpaste and toothbrush in our study suggesting that if respondents are satisfied with a particular product, they will use regularly.
Participants preferred fluoridated toothpaste to protect their teeth from decay process. However, few did not know about importance of fluoride which shows lack of awareness about the composition of toothpaste and needs to be immediately addressed.
The factors that affected selection of toothbrush were: texture of bristle, cost of toothbrush, brand, and previous experience, size of head of toothbrush, and dentist's advice which is in accordance with other studies 4,6 but in contrast to the study conducted by Sharda and Sharda. 11 The texture of bristle was most influential factor while choosing the toothbrush in the present study. Soft bristle was the most preferred one which is similar to other studies 6,9 Cost was also an influential factor for people as they preferred toothbrush ranging from NRs. 50-100. Brands most commonly used are Colgate, Sensodyne, and Oral B. Advice by a dentist was also an influential factor in present study which could be because the study area is hospital and outreach programs conducted by hospital itself.
Factors like beauty, media advertisement, and herbal contents added had no influence in the selection of oral hygiene aids which is similar to the study conducted by Opeodu and Gbadebo 6 but in contrast to other studies. 7,[11][12][13] There was significant difference in the selection of toothpaste based on taste in male and female. Academic qualification was found to be statistically significant with fluoride content and dentist's advice in choosing toothpaste. Also, texture of bristle, size of head of toothbrush, brand, and dentist's advice were statistically significant with choosing toothbrush. This may be due to the fact that as qualification level changes knowledge level also changes.
Since convenience sampling technique was used, findings cannot be generalised. This study serves as a pilot study for future studies.

CONCLUSION
Consumer behaviour is very difficult to predict. In this study, selection of toothbrush and toothpaste were mainly influenced by previous experience and dentist's advice. So, dental professionals should spend more time in educating and motivating the patients about the oral hygiene practices and the products so that incidence of dental diseases could be reduced.
Manufacturers should also give preference to people's health as well as choice before manufacturing oral hygiene aids so that people will use their products forever.

ACKNOWLEDGEMENT
We would like to thank all the patients who gave their valuable time and participated in this study.