Background
Methods
Sample size calculation
Clinical oral assessments
KAP survey on oral hygiene
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What should one use for cleaning his/her teeth?
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When should one brush his/her teeth?
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In addition to brushing, should one floss his/her teeth?
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Do you think that brushing your teeth improves your dental health?
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Do you think dental problems can affect general health?
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How often should one visit a dentist?
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How would you describe the state of your teeth and gums?
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What do you use for cleaning your teeth?
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How do you brush your teeth?
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How often do you clean your teeth?
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Do you use toothpaste containing fluoride?
Statistical analysis
Results
Socio-demographic characteristics of the study participants
Characteristics | Number (Percentage) | |
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Country of origin | Syria | 239 (61.9) |
Iraq | 147 (38.1) | |
Gender | Male | 309 (80.1) |
Female | 77 (19.9) | |
Age group in years | 18–24 | 162 (42.0) |
25–29 | 66 (17.1) | |
30–34 | 55 (14.2) | |
35–44 | 69 (17.9) | |
more than 44 | 34 (8.8) | |
Educational level (years in school) | No education | 21 (5.4) |
Primary school (1–6) | 71 (18.4) | |
Preparatory school (7–9) | 109 (28.2) | |
Secondary school (10–12) | 97 (25.1) | |
University (more than 12) | 88 (22.8) |
Oral health indices and KAP survey
Oral health index | Number | |
Caries prevalence, mean (SD) | DMFT | 6.38 (5.058) |
DT | 4.00 (3.352) | |
MT | 1.46 (3.388) | |
FT | 0.92 (1.694) | |
Presence of bacterial plaque, n (%) | No plaque observed | 2 (0.55) |
Plaque observed on one sextant | 20 (5.49) | |
Plaque observed on two sextants | 7 (1.92) | |
Plaque observed on three sextants | 41 (11.26) | |
Plaque observed on four sextants | 1 (0.27) | |
Plaque observed on five sextants | 6 (1.65) | |
Plaque observed on six sextants | 287 (78.85) | |
Presence of calculus, n (%) | No calculus observed | 35 (9.59) |
Calculus observed on one sextant | 107 (29.32) | |
Calculus observed on two sextants | 4 (1.10) | |
Calculus observed on three sextants | 107 (29.32) | |
Calculus observed on four sextants | 1 (0.27) | |
Calculus observed on five sextants | 2 (0.55) | |
Calculus observed on six sextants | 109 (29.86) | |
Dental trauma, n (%) | No sign of injury | 369 (95.60) |
Treated injury | 4 (1.04) | |
Enamel fracture only | 7 (1.81) | |
Enamel and dentine fracture | 5 (1.30) | |
Pulp involvement | 0 (0.0) | |
Missing tooth due to trauma | 1 (0.26) | |
Enamel fluorosis, n (%) | Normal | 363 (94.04) |
Questionable | 4 (1.04) | |
Very mild | 3 (0.78) | |
Mild | 9 (2.33) | |
Moderate | 5 (1.30) | |
Severe | 2 (0.52) | |
Intervention urgency, n (%) | No treatment needed | 18 (4.66) |
Preventive or routine treatment | 124 (32.12) | |
Prompt treatment (including scaling) | 202 (52.33) | |
Immediate treatment due to pain or infection | 42 (10.88) | |
Referred for comprehensive evaluation | 0 (0.0) | |
KAP Questionnaire | ||
Question | Answer | Number |
What should one use for cleaning his/her teeth? n (%) | Toothbrush a | 379 (98.19) |
Miswak b | 7 (1.81) | |
Others (finger, charcoal or wooden toothpicks) b | 0.0 (0.0) | |
When should one brush his/her teeth? n (%) | Once or less a day b | 74 (19.17) |
Twice or more a day a | 312 (80.83) | |
In addition to brushing, should one floss his/her teeth? n (%) | Yes a | 76 (19.69) |
No b | 267 (69.17) | |
I don’t know | 43 (11.14) | |
Do you think that brushing your teeth improves your dental health? n (%) | Yes a | 352 (91.19) |
No b | 26 (6.74) | |
I don’t know | 8 (2.07) | |
Do you think dental problems can affect general health? n (%) | Yes a | 249 (64.51) |
No b | 115 (29.79) | |
I don’t know | 22 (5.70) | |
How often should one visit a dentist? n (%) | Regularly a | 175 (45.34) |
Whenever there is a problem b | 207 (53.63) | |
I don’t know | 4 (1.04) | |
How would you describe the state of your teeth and gums? n (%) | Participant’s answer showed a proper perception of his/her own oral health a | 239 (61.92) |
Participant’s answer showed a considerable over or underestimation of his/her own oral health b | 141 (36.5) | |
Participant answered: I don’t know | 6 (1.55) | |
What do you use for cleaning your teeth? n (%) | Toothbrusha | 382 (99.22) |
Miswak b | 3 (0.78) | |
Others (finger, charcoal or wooden toothpicks) b | 0.0 (0.0) | |
How do you brush your teeth? n (%) | Up and down circular motion, involving gums a | 176 (45.60) |
Left to right, horizontal direction b | 204 (52.85) | |
I don’t know | 6 (1.55) | |
How often do you clean your teeth? n (%) | Once or less a day b | 158 (40.93) |
Twice or more a day a | 228 (59.07) | |
Do you use toothpaste containing fluoride? n (%) | Yes a | 11 (2.85) |
No b | 8 (2.07) | |
I don’t know | 367 (95.08) |
Association between main oral health indices and socio-demographic characteristics
Variables | DMFT | DT | MT | FT |
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Regression Coefficient (Standard error), P-value | ||||
Increase in age per year (continuous variable) | 0.031 (0.003), < 0.001 | 0.008 (0.004), 0.047 | 0.089 (0.010), < 0.001 | 0.043 (0.013), < 0.001 |
Country of origin (ref. Syrians) | −0.013 (0.078), 0.873 | − 0.165 (0.091), 0.069 | 0.657 (0.203), 0.112 | 0.001 (0.222), 0.997 |
Gender (ref. Male) | 0.003 (0.091), 0.975 | 0 .070 (0.106), 0.507 | −0.398 (0.250), 0.001 | 0.382 (0.246), 0.121 |
Increase in education per year (continuous variable) | −0.019 (0.009), 0.037 | −0.021 (0.010), 0.047 | − 0.069 (0.023), 0.003 | 0.050 (0.025), 0.045 |
Overall model Pseudo R-squared value, P-value | 0.035, < 0.001 | 0.006, 0.022 | 0.093, < 0.001 | 0.012, 0.001 |
Variables | Model 1 (OLR) | Model 2 (Multilevel mixed-effects GLM) | ||
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Calculus | Plaque | Calculus | Plaque | |
Odds ratios (95% Confidence Interval), P-value | Regression Coefficient (Standard error), P-value | |||
Increase in age per year b | 1.060 (1.035–1.085), < 0.001 | 1.046 (1.011–1.082), 0.009 | 0.028 (0.006), < 0.001 | 0.018 (0.007), 0.008 |
Country of origin (ref. Syrians) b | 0.610 (0.410–0.917), 0.018 | 0.856 (0.496–1.477), 0.576 | − 0.350 (0.126), 0.006 | −0.053 (0.123), 0.667 |
Gender (ref. Male) b | 0.298 (0.182–0.487), < 0.001 | 0.471 (0.260–0.852), 0.013 | −0.658 (0.151), < 0.001 | − 0.332 (0.144), 0.021 |
Increase in education per year b | 0.946 (0.904–0.991), 0.019 | 0.930 (0.872–0.992), 0.028 | −0.031 (0.013), 0.018 | − 0.032 (0.013), 0.019 |
Pseudo R-squared value, P-value | 0.048, < 0.001 | 0.029, 0.002 | ||
Wald Chi-squared, P-value | 42.02, < 0.001 | 15.70, 0.003 | ||
Hosmer-Lemeshow test: Estimate, P-value c | 37.729, 0.944d | 40.382, 0.899d | ||
Lipsitz test: Estimate, P-value c | 2.022, 0.991d | 9.787, 0.368d |
Association between KAP scores and socio-demographic characteristics
Variables | Knowledge | Attitude | Practice |
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Regression Coefficient (Standard error), P-value | |||
Increase in age per year (continuous variable) | − 0.002 (0.006), 0.729 | 0.029 (0.010), 0.005 | −0.010 (0.008), 0.187 |
Country of origin (ref. Syrians) | −0.157 (0.124), 0.206 | −0.595 (0.213), 0.005 | − 0.132 (0.160), 0.408 |
Gender (ref. Male) | 0.312 (0.146), 0.034 | 0.093 (0.250), 0.710 | 0.633 (0.189), 0.001 |
Increase in education per year (continuous variable) | 0.055 (0 .0140), < 0.001 | 0.0920 (0.024), < 0.001 | 0.086 (0.018), < 0.001 |
Overall model R-squared value, P-value | 0.064, < 0.001 | 0.089, < 0.001 | 0.096, < 0.001 |
Discussion
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The use of convenience sampling instead of randomized cluster sampling making the study sample less representative. In addition, the sampling procedure may have led to a selection bias, as study participants recruited in private practices may tend to have a higher occurrence of dental disease in comparison to those recruited in refugee shelters.
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The sensitivity of field oral examinations (for obtaining DMFT scores in particular) without the use of extra diagnostic methods like bitewing radiographs. This may have led to underestimating the prevalence of caries and to increased false negative values especially for caries on the proximal surfaces. In addition, it was only feasible to examine the intra-rater reliability for participants recruited in private practices (a convenience sample). This may have put the resulting intra-class correlation coefficient at risk of bias.
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The social desirability bias with regard to KAP survey, as participants may tend to satisfy the examiner with their answers rather than to express what they believe or practice in their daily life reality.
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The study has examined the association of oral health status with certain socio-demographic characteristics. However, there are other important characteristics that were not analyzed in our study. Some of these could be associated with the population of origin like sugar intake and smoking, others are related to the post arrival adversities like waiting times associated with asylum application and linguistic barriers. These and similar potential associations could be investigated in future studies.