Original Article

Knowledge of periodontal disease among group

of health care professionals in Yenepoya University,
Mangalore
Rajesh.H, Vinita Boloor,
Anupama Rao,
Sruthy Prathap

Department of periodontics, Yenepoya dental college, Yenepoya University,Deralakatte, Mangalore,

Karnataka, India.

ABSTRACT

Address for correspondence:

Dr. Rajesh H,
Department of Periodontics,
Yenepoya Dental College,
Yenepoya University,
Deralakatte, Mangalore - 575 018,
Karnataka, India.
E-mail: drsharaj@gmail.com

Introduction: Health care professionals interact with patients on a daily basis. Assessing and
improving the existing knowledge of periodontal awareness among health care professionals
is needed. They could be a good resource to educate patients on oral health
Aims:
To assess the existing knowledge about periodontal disease among various health care
professionals.
To identify deficit in the knowledge among these health care professionals.
Materials and Methods: This was a written questionnaire based pilot study. A total of 224
subjects (123 male & 101female subjects) were selected for the study from the Yenepoya
University, Mangalore, Karnataka, India. Random sampling method was employed for case
selection. The main topics included in the written questionnaire were knowledge of the
definition of periodontitis, knowledge of risks associated with periodontitis, knowledge of risk
factors for periodontitis and knowledge of preventive measures and treatment of periodontitis.
Results: Bonferroni Multiple Comparisons test showed that there was a statistically significant
difference between mean scores and mean percentage scores when compared between
dentist and other professional groups. There was no statistically significant difference
between the mean scores and mean percentage scores between Medical, Physiotherapy
and Nursing professionals.
Conclusion: Severe knowledge deficit was seen in risks associated with periodontitis and
risk factors for periodontitis. There is a need to improve knowledge about periodontal disease
in the health professionals in the Yenepoya University.

Key words: Health care professionals, knowledge, periodontitis, risk factors

Introduction
Periodontal diseases are the most widespread diseases. A high
prevalence of periodontitis is noted among adult regardless
of sex, race, education, residence or socioeconomic status.[1]
Periodontology is evolving at a rapid pace in past few decades.
Periodontitis is thought to influence systemic health including
Cardiovascular disease, Diabetes mellitus, preterm low birth
weight and respiratory disease.[2] Health care professionals
Access this article online
Quick Response Code:

Website:
www.jeed.in

DOI:
10.4103/0974-7761.136045

60

including dentists need to pay attention to periodontal disease

to improve general health of the patients. Holistic approach
to treat patients requires a team approach between medical
and dental professionals.[3]
Health care professionals working in Yenepoya University
interact with several patients each day.Health education
plays an important role in prevention of periodontal
disease. Well informed health care professionals can be
an important source to educate their patients and act as
role models in the society. Assessing and improving the
existing knowledge about periodontal disease and its
systemic ramifications among health care professionals
will be beneficial to the society.[4] The literature assessing
the knowledge about periodontitis among healthcare
professionals in Mangalore city is sparse. Hence, this study
was conducted to assess the existing knowledge about
periodontal disease among various health care professionals

Journal of Education and Ethics in Dentistry

July-December 2013 Vol. 3 Issue 2

Rajesh, et al.: Knowledge of periodontal disease among health care professionals

and to identify deficit in the knowledge among these health

care professionals.

to be significant. Chi-square test was used to find significance

difference between health professional in various age groups
for men and women.

Materials and Methods

Overall methods and questionnaire
This was a written questionnaire based pilot study. A
total of 224 subjects were selected for the study from the
Yenepoya University (123 male & 101female subjects),
Mangalore, Karnataka, India. Random sampling method
(coin toss method) was employed for case selection.
Clearance from Institutional ethical committee for the study
was taken. Informed consent was taken from the subjects
participating in the study. The main topics included in the
written questionnaire were knowledge of the definition
of periodontitis, knowledge of risks associated with
periodontitis, knowledge of risk factors for periodontitis
and knowledge of preventive measures and treatment of
periodontitis.[5] The Written questionnaire consisted of
32 questions with multiple choice answers. It was divided
into four quarters with eight questions in each quarter.1st
quarter consisted of questions on knowledge of definition
of periodontitis, 2nd quarter-knowledge of risks associated
with periodontitis, 3rd quarter-knowledge of risk factors
for periodontitis and 4th quarter-knowledge of preventive
measures and treatment of periodontitis. Only one correct
answer was present and score given was +1. Knowledge
of the subjects was reflected by their ability to select
correct answer from the number of distractors. Clarity and
comprehensibility of questions were tested in a student
sample prior to the study.[6] The subjects participating in the
study were divided into Dental, Medical, Physiotherapy and
Nursing professionals based on their qualification.

Results
SPSS 15.0 is used for all statistical analyses. One way ANOVA
was used to find whether the mean scores differed significantly
between the four health professionals. P < .05 is considered

Knowledge of definition of periodontitis by the health

professionals:
In the first quarter assessment of knowledge of the definition
of periodontitis was done. Out of eight questions asked
medical professionals achieved an average score of 5.92 1.510,
dentists other than Periodontists had an average score of
7.81 0.459, nursing professionals scored 6.20 1.370 and
Physiotherapy professionals scored 5.41 2.235. F-value was
32.91 and P-value was 0.001(highly significant) [Table 1].
Knowledge of risks associated with periodontitis by the health
professionals:
In the second quarter assessment of knowledge of the
risks associated with periodontitis was done. Out of eight
questions asked medical professionals achieved an average
score of 5.92 1.510, dentists other than Periodontists
had an average score of 7.81 0.459, nursing professionals
scored 6.20 1.370 and Physiotherapy professionals scored
5.41 2.235. F-value was 15.64 and P-value was 0.001(highly
significant) [Table 2].
Knowledge of risk factors associated with periodontitis by the
health professionals:
In the third quarter assessment of knowledge of the risks
associated with periodontitis was done. Out of eight questions
asked medical professionals achieved an average score of
5.04 1.795, dentists other than Periodontists had an average
score of 7.36 0.804, nursing professionals scored 5.04 1.795
and Physiotherapy professionals scored 4.60 1.525. F-value
was 47.52 and P-value was 0.001(highly significant) [Table 3].
Knowledge of preventive measures and treatment of
periodontitis:

Table 1: Knowledge of definition of periodontitis among the health professionals

Mean scores
1st quarter
Medical
Dental
Nursing
Physiotherapy
Total

N
50
74
50
49
224

Mean
5.92
7.81
6.20
5.41

STD DEV
1.510
0.459
1.370
2.235

Minimum
2
6
2
1

Maximum
8
8
8
8

F
32.912

P
0.001

F
15.64

P
0.001

Table 2: Knowledge of risks associated with periodontitis by the health professionals

Mean scores
2nd quarter
Medical
Dental
Nursing
Physiotherapy

N
5.92
7.81
6.20
5.41

Mean
1.510
0.459
1.370
2.235

STD DEV
2
6
2
1

Minimum
0
2
2
1

Journal of Education and Ethics in Dentistry

July-December 2013 Vol. 3 Issue 2

Maximum
8
8
7
7

61

Rajesh, et al.: Knowledge of periodontal disease among health care professionals

In the fourth quarter assessment of knowledge of the

risks associated with periodontitis was done. Out of nine
questions asked medical professionals achieved an average
score of 5.88 2.309, dentists other than Periodontists
had an average score of 7.62 0.789, nursing professionals
scored 6.56 1.312 and Physiotherapy professionals scored
5.50 2.418. F value was 17.57 and P-value was 0.001(highly
significant) [Table 4].
One way ANOVA was used to find whether the mean
scores differed significantly between the four health
professionals. There was highly significant difference
in the mean scores between the health professionals
showing a knowledge deficit in all other groups except
the dentists [Table 5 and Graph 1]. Bonferroni Multiple
Comparisons test showed that there was a statistically
significant difference between mean scores and mean
percentage scores when compared between dentist and

other professional groups [Table 6 and Graph 2]. There

was no statistically significant difference between the
mean scores and mean percentage scores between Medical,
Physiotherapy and Nursing professionals.

Discussion
Interdisciplinary approach has become the patient
management strategy in recent decades. This approach
requires close cooperation between doctors and dentists. A
team of well informed healthcare professionals and dentists
can benefit the society. Healthcare professionals can act as
good source of knowledge providers to the general public.
Improving periodontal knowledge can play an important role
in the prevention of periodontal diseases.[7] Rapid growth in
information technology have placed a significant burden on
the public to acquire relevant information. Poor literacy skills

Table 3: Knowledge of risk factors associated with periodontitis by the health professionals
Mean scores
3rd quarter
Medical
Dental
Nursing
Physiotherapy

N
50
74
50
50

Mean
5.04
7.36
5.04
4.60

STD DEV
1.795
0 .804
1.795
1.525

Minimum
0
5
1
1

Maximum
8
8
8
8

F
47.52

P
0.001

Maximum
8
8
8
8

F
17.576

P
0.001

F
32.912

P
.001

15.644

.001

47.529

.001

17.576

.001

Table 4: Knowledge of preventive measures and treatment of periodontitis

Mean scores
4th quarter
Medical
Dental
Nursing
Physiotherapy

N
50
74
50
50

Mean
5.88
7.62
6.56
5.50

STD DEV
2.309
0.789
1.312
2.418

Minimum
0
5
2
0

Table 5: One way ANOVA to find the mean scores difference among health professionals
1st quarter

2nd quarter

3rd quarter

4th quarter

62

Medical
Dental
Nursing
Physiotherapy
Total
Medical
Dental
Nursing
Physiotherapy
Total
Medical
Dental
Nursing
Physiotherapy
Total
Medical
Dental
Nursing
Physiotherapy
Total

N
50
74
50
49
223
50
74
50
50
224
50
74
50
50
224
50
74
50
50
224

Mean
5.92
7.81
6.20
5.41

Std. Deviation
1.510
.459
1.370
2.235

Minimum
2
6
2
1

Maximum
8
8
8
8

5.08
5.30
4.90
3.68

1.496
1.107
1.093
1.708

0
2
2
1

8
8
7
7

5.04
7.36
5.04
4.60

1.795
.804
1.795
1.525

0
5
1
1

8
8
8
8

5.88
7.62
6.56
5.50

2.309
.789
1.312
2.418

0
5
2
0

8
8
8
8

Journal of Education and Ethics in Dentistry

July-December 2013 Vol. 3 Issue 2

Rajesh, et al.: Knowledge of periodontal disease among health care professionals

can affect publics ability to seek further health information

and make informed healthcare decisions. Health professionals
form a key link in the dissemination of relevant knowledge
to the general public. In this scenario we felt the need to
assess the existing knowledge of the health care providers and
improve their knowledge if there is deficit.

diverse study population. The weakness of the study was lack

of a standard questionnaire and possible bias in that it may not
represent the general population. T he main drawback of the
questionnaire study in our settings was that not all individual
were forthcoming to participate in the study. The fear of
being judged may be one of the reasons. We included only
those who agreed to participate.

The methodical strength of the study was the novelty in

the aim of the study within the Yenepoya University and a

According to study by Deinzer et al,[8] percentage knowledge

below 80% in their questionnaire was considered as knowledge
deficit. We used a similar criterion in the present study to assess
the knowledge deficit among various health care professionals
and any value above 80% was considered to be sufficient.

Table 6: Post Hoc (Bonferronis multiple comparison)

test
Dependent (I) group
Variable
1st quarter Medical

Dental

2nd quarter

Nursing
Medical

Dental

3rd quarter

Nursing
Medical

Dental

4th quarter

Nursing
Medical

Dental
Nursing

(J) group
Dental
Nursing
Physiotherapy
Nursing
Physiotherapy
Physiotherapy
Dental
Nursing
Physiotherapy
Nursing
Physiotherapy
Physiotherapy
Dental
Nursing
Physiotherapy
Nursing
Physiotherapy
Physiotherapy
Dental
Nursing
Physiotherapy
Nursing
Physiotherapy
Physiotherapy

Mean
Difference (I-J)
1.891(*)
.280
.512
1.611(*)
2.403(*)
.792(*)
.217
.180
1.400(*)
.397
1.617(*)
1.220(*)
2.325(*)
.000
.440
2.325(*)
2.765(*)
.440
1.742(*)
.680
.380
1.062(*)
2.122(*)
1.060(*)

P
.0005
1.000
.480
.0005
.0005
.042
1.000
1.000
.0005
.655
.0005
.0005
.0005
1.000
.819
.0005
.0005
.819
.0005
.324
1.000
.007
.0005
.017

In the present study, while assessing the definition of

periodontitis we found that the knowledge level was
poor among nurses and physiotherapists. Medical doctors
showed better knowledge compared to them. Dentists
other than periodontists showed good knowledge. In
the second quarter, we assessed the knowledge of risks
associated with periodontitis by the health professionals.
Doctors and physiotherapists showed knowledge deficit. In
the third quarter we assessed the knowledge of risk factors
associated with periodontitis by the health professionals,
the results were similar to the definition of periodontitis.
In the fourth quarter, we assessed the knowledge of
preventive measures and treatment of periodontitis the
knowledge deficit was found in the doctors, nurses and
physiotherapists.
In the present study we found statistically significant
knowledge deficits among medical, physiotherapy and
nursing professionals throughout all the topics examined.
The most severe deficits were found in the knowledge
of risks associated with periodontitis and risk factors for
periodontitis. The trend seen in this study implies that there
is a need to update the healthcare workers on a regular
basis. This can be probably reduced by planning regular

100
87.83

8
80

70.50

68.37

Medical

Dental

Nursing
Physiotherapy

3
2

Mean Percentage

Mean scores

59.20

60

40

20

1
0

1st quarter 2nd quarter 3rd quarter 4th quarter

Graph 1: Difference in mean scores among health professionals

in different quarters

Medical

Dental

Nursing

Physiotherapy

group

Graph 2: Difference in mean percentage scores among health

care professionals

Journal of Education and Ethics in Dentistry

July-December 2013 Vol. 3 Issue 2

63

Rajesh, et al.: Knowledge of periodontal disease among health care professionals

interactive session between periodontists and other health

care professionals. This in turn will translate into better
understanding of the periodontal disease and improved
compliance with the oral health behavior from the general
public. This study shows that education on the recent
advances in the relationship between periodontal disease and
general health is the need of the hour.[9] This kind of team
work could lead to a holistic approach to the treatment of
diseased individuals.
El-Qaderi et al[10] reported that in Jordan dental services
are hampered by the shortage of resources and facilities.
We have similar problems in our country as that reported
by El-Qaderi et al. Rapid increase in the population has
put a strain on dental services rendered. A national health
policy which focuses on prevention of periodontal disease
is needed to handle the increasing burden of periodontal
disease. Education and improvement of knowledge of
allied health education personnel can reduce the cost
and improve the dissemination of general public. This
in turn will improve the quality of care rendered to the
periodontitis patients.

Conclusion
This study shows that knowledge deficit was seen in all topics
investigated in the given population. Severe knowledge deficit
was seen in risks associated with periodontitis and risk factors
for periodontitis. This study points out the need to transcend
the personal barriers and improve communication and
education among all the health professionals. This approach
will benefit the profession and the whole society .This
study should be continued further with a larger sample size.
Reassessment of the knowledge level should be done after
educating respective groups.

Acknowledgements
We would like to acknowledge Dr. A. Shashikanth Hegde, Senior
Professor & Head, Dr. Rajesh KS, Professor and Dr.Arunkumar MS
for their constant guidance and support during the study.

References
1.

Oliver RC, Brown LJ, Loe, H. Variations in the prevalence and extent of
periodontitis. J Am Dent Assoc 1991;122:43-8.
2. Thomas BS, Bhat M, Nair S. Periodontal disease and awareness among
patients. Indian J Dent Res 2005;16:103-8.
3. Harris NO, Godoy FG. Primary preventive dentistry in hospital setting.
In: Godoy FG, editor. Primary preventive dentistry. 6th ed. New Jersey:
Julie Levin Alexander Publisher; 2004. p. 605-36.
4. Baseer AM, Alenazy MS, AlAsqah M, AlGabbani M, Mehkari A.Oral
health knowledge, attitude and practices among health professionals
in King Fahad Medical City, Riyadh. Dent Res J (Isfahan) 2012;9:386-92.
5. Micheelis W, Hoffmann T, Holtfreter B, Kocher T, Schroeder E. Zur
epidemiologischein Einschatzung der parodontitislast in Deutschland
Versuch einer Bilanzierung [Epidemiological estimation of the burden
of periodontal disease in Germany-attempt of a conclusion]. Deutsche
Zahnarztliche Zeitschrift. J Clin Periodontol 2008;63:464-72.
6. Holtfreter B, Schwahn CH, Biffar R, Kocher TH. Effect of periodontal diseases
in the study of health in Pomerania. J Clin Periodontol 2009;36:114-23.
7. Taani DQ. Periodontal awareness and knowledge, and pattern of
dental attendance among adults in Jordan. Int Dent J 2002;52;94-8.
8. Deinzer R, Micheelis W, Granrath N, Hoffman T. More to learn about:
Periodontitis-related knowledge and its relationship with periodontal
health behavior. J Clin Periodontol 2009;36:756-64.
9. Vignarajah S. Oral health knowledge and behaviors and barriers to
dental attendance of school children and adolescents in the Caribbean
island of Antigua. Int Dent J 2002;52:94-8.
10. El-Qaderi SS, Taani DQ. Assessment of periodontal knowledge &
status of an adult population in Jordan. Int J Dent Hyg 2004;2:132-6.

How to cite this article: Rajesh H, Boloor V, Rao A, Prathap S. Knowledge

of periodontal disease among group of health care professionals in
Yenepoya University, Mangalore. J Educ Ethics Dent 2013;3:60-5.
Source of Support: Nil, Conflict of Interest: None declared

Questionnaire
1. Gum disease means
a. Decay of the tooth with pain
b. Disease of supporting structures of the tooth
c. Gums growing into decayed tooth
d. Disease of mucosa after removal of tooth.
2. Periodontitis means
a. Inflammation of gums
b. Inflammation of gums involving alveolar bone
c. Overgrowth of gums into a decayed tooth
d. Decayed teeth
3. Gum disease (periodontitis) may show all the signs except
a. Pocket formation
b. Loss of alveolar bone
c. Loss of tooth function
d. Tooth decay
4. Gum disease is caused by
a. Using of tooth picks
b. Bacteria & virus
c. Liver infection
d. Kidney infection
64

5. Dental plaque is
a. Soft deposit consisting of colonies of microorganism
b. Hard deposit
c. Food debris around the gums
d. Decay close to the gum
6. Dental calculus is
a. Soft deposit around the tooth
b. Hard deposit
c. Food debris around the gums
d. Decay close to the gum
7. Gum disease is not associated with
a. Bleeding gums
b. Mobile tooth
c. Receding gums
d. Bleeding nose
8. Bad breath is caused by
a. Controlled diabetes mellitus
b. Controlled hypertension
c. Chewing of fibrous foods
d. Gum disease

Journal of Education and Ethics in Dentistry

July-December 2013 Vol. 3 Issue 2

Rajesh, et al.: Knowledge of periodontal disease among health care professionals

9. Ageing causes
a. Definite increase in prevalence of gum disease
b. Definite decrease in prevalence of gum disease
c. Not related to gum disease
d. Teeth is lost in aged patients, so no question of gum disease arises.
1O. Gum disease is seen
a. More in males
b. More in females
c. Equal distribution
d. Is related to preventive practices by the patient & not gender
11. Lower socioeconomic status causes more prevalence of gum disease
because
a. Dentists are not interested in treating them
b. Dental institutions are not interested in treating them
c. Poor oral hygiene & lack of affordability
d. Both a & b
12. Osteoporosis
a. Causes gum disease
b. Is a risk factor for gum disease
c. Has no relation with gum disease
d. Causes pores in the gum.
13. Gum disease could be due to
a. Smoking
b. Genetic problem
c. Both a & b
d. Only b
14. Gum disease can be associated with
a. Malnutrition
b. Obesity
c. Short stature
d. Malnutrition & obesity
15. Gum disease is not associated with
a. Heart disease
b. Diabetes mellitus
c. Pulmonary disorders
d. Hemarrhoids
16. Rheumatoid arthritis is not associated with
a. Gum disease
b. Painful joints
c. Autoimmune disorder
d. Dental caries
17. Gum disease causes
a. Early loss of tooth
b. No tooth loss
c. Firm tooth
d. Both b & c
18. Female sex hormone is not related to
a. Pubertal gingivitis
b. Pregnancy tumor
c. Post menopausal gingivitis
d. Dental caries
19. Gum disease
a. Does not affect the blood sugar control in uncontrolled diabetic
patients
b. Does not affect pregnant women
c. Does not affect heart disease
d. Is totally independent of systemic disease
2O. Cutaneous disorder manifestations
a. Can be seen in the gums
b. Can be seen only in the skin
c. No relationship with gum disease
d. Can be seen on tooth surface.

21. Oral manifestation of AIDS patients includes all except

a. Kaposis sarcoma
b. Linear erythema in gingival margin
c. Cysts around erupting tooth
d. Black hairy tongue
22. Pregnant women with gum disease can have
a. Deformed child
b. Autistic child
c. Low birth weight child
d. Obese child
23. Necrotizing gum disease is not commonly seen nowadays because of
advent of
a. Electronic tooth brush
b. Tooth picks
c. Antimicrobial agents
d. Fluoride containing tooth paste
24. Faulty dental treatment can
a. Decrease gum disease
b. Increase gum disease
c. Has no relationship with gum disease
d. Exfoliation of tooth
25. Prevention of gum disease can he achieved by
a. Maintaining good oral hygiene
b. Infrequent dental visits
c. Avoid brushing & rinse mouth with chemical mouth rinses
d. It cannot be prevented
26. How many times should we brush daily
a. Once in a day
b. Twice in a day
c. Once in 2 days
d. Use only chemical mouth rinse & avoid brushing daily.
27. Prevention of gum disease is
a. Responsibility of government of India
b. Responsibility of dentists only
c. Sharing of responsibility between dentist & patient
d. Tooth paste manufacturing companies
28. Frequent teeth cleaning (scaling)
a. Improves health of the gums
b. Causes loosening of teeth
c. Causes receding gums
d. Dental caries
29. Gum disease can recur after dental treatment if
a. Oral hygiene is not maintained
b. Frequent scaling is done
c. It never recurs
d. Non smokers
30. Local drug delivery
a. Is an useful treatment for gums
b. Can cause destruction of gum by local irritation
c. Can cause dental caries
d. Can decrease salivation
31. Surgical treatment for gum disease
a. Should not be done
b. Should be done only if necessary
c. Is harmful to the patient
d. Should be done in systemically compromised patients.
32. If the diagnosis & treatment of gum disease is included as a part of
general health assessment of the patient
a. It will improve overall health of the patient
b. It will improve only oral health
c. It is a time consuming procedure. So avoid.
d. If does not require interdisciplinary approach.

Journal of Education and Ethics in Dentistry

July-December 2013 Vol. 3 Issue 2

65

Copyright of Journal of Education & Ethics in Dentistry is the property of Medknow

Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites
or posted to a listserv without the copyright holder's express written permission. However,
users may print, download, or email articles for individual use.