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 Table of Contents  
Year : 2019  |  Volume : 11  |  Issue : 1  |  Page : 15-20

Oral health knowledge, attitude, and practices among Yemeni school students

1 Dental Public Health Unit, School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
2 Oral Biology Unit, School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
3 Oral Medicine and Oral Pathology Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia

Date of Web Publication27-Feb-2019

Correspondence Address:
Dr. Masitah Hayati Harun
School of Dental Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jioh.jioh_176_18

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Aim: Oral health is fundamental to general health and well-being. However, the sources of oral health information among Yemenis are limited. This study aimed to evaluate the oral health knowledge, attitude, and practices among secondary school students in Dawan Valley, Yemen. Materials and Methods: A descriptive cross-sectional survey was conducted among 392 secondary school students. Students were interviewed using structured questionnaires in Arabic. The structured questionnaires included inquiries on oral health knowledge, attitude, and practices. Chi-square test was used to assess significant differences in oral health knowledge, attitude, and practices with respect to gender. Results: The study population comprised 392 participants of 15–22 years' age group. Approximately 87% of students reported brushing their teeth daily. Girls showed better oral hygiene practices compared with boys in terms of daily brushing habit, brushing intervals, and toothbrush replacement (P = 0.001, 0.001, and 0.002, respectively). Statistically significant difference (in favor of females) was observed related to knowledge on the impact of dental diseases on the general health, toothbrushing preventing dental decay, sugar consumption possibly leading to dental decay, bleeding during brushing possibly indicating gum diseases, and effects of smoking and khat chewing on oral health (P = 0.009, 0.020, 0.001, 0.001, 0.002, and 0.023, respectively). Conclusion: The majority of students possess an adequate level of knowledge and practices on oral health, with female students showing predominance. However, regular visits to the dentist remain low among the study participants.

Keywords: Attitude, knowledge, oral health, practice, secondary school students

How to cite this article:
Al-Tayar BA, Ahmad A, Sinor MZ, Harun MH. Oral health knowledge, attitude, and practices among Yemeni school students. J Int Oral Health 2019;11:15-20

How to cite this URL:
Al-Tayar BA, Ahmad A, Sinor MZ, Harun MH. Oral health knowledge, attitude, and practices among Yemeni school students. J Int Oral Health [serial online] 2019 [cited 2023 Dec 4];11:15-20. Available from:

  Introduction Top

One significant aspect of ensuring the quality of life is good oral health. Good oral hygiene practices allow people to eat, talk, and socialize normally and confidently.[1] Oral infections, such as dental caries and periodontal problems, are burdens to the state of global oral health. In societies with low economic status, treatment of dental diseases, including traditional restorative treatments, probably surpasses the available resources allotted to the health-care programs of the entire country.[2],[3] Oral health knowledge is considered as an essential prerequisite for health-related behavior,[4] and studies have demonstrated an association between increased knowledge and improved oral health.[5],[6]

The prevalence of oral diseases, such as dental caries and gingivitis, is extremely high among school students in Yemen.[7],[8] Moreover, a society such as the Yemeni society has developed numerous traditional deleterious habits, such as khat chewing and smokeless tobacco. Such habits are showed to be a risk factor for cancer of the head and neck, precancerous lesions of oral mucosa, and periodontal diseases.[9],[10],[11],[12],[13],[14]

Knowledge on the oral health effects of these habits can motivate school students to quit and consequently help in the prevention of numerous oral diseases at an early age. The level of oral health knowledge, attitude, and practices among secondary school students is extremely low and worth investigating. Therefore, this study was conducted to evaluate the level of oral health knowledge, attitude, and practices among secondary school students in Dawan Valley, Yemen.

  Materials and Methods Top

A descriptive cross-sectional survey was conducted from March 2016 to June 2016 among 392 secondary school students aged between 15 and 21 years from two selected schools in Dawan Valley. The sample size was estimated with the PS software as described by Dupont and Plummer[15] comparing two proportions with the following parameters: P0= 0.13 (proportion of secondary school students who do not use toothbrush reported by the previous study),[16] P1 =0.246 (expected proportion of secondary school students who use toothbrush based on expert opinion), alpha (α) = level of significance at 0.05, (1-β) = power of study at 0.8, and M = 1 (ratio of secondary school students who use toothbrush to those who do not use toothbrush). The sample size for this study was 177 per group, but another 11% was added for the nonrespondents (177+ [177 × 0.11] = 196 × 2) = 392. In this case, the required minimum sample size was 392. Convenience sampling technique was used, and all students who were willing to participate from the selected secondary schools of 1–3 levels were included.

Before the study, approval was obtained from the Office of Education in Dawan Valley under the Ministry of Education in Yemen (Reference number: Dawan Office/Seef/13116). Written consent was also obtained from the school principals and each of the participants after selection and before enrolment into the study.

The students were interviewed using structured questionnaires in Arabic. The structured questionnaires were adopted and modified from previous studies.[17],[18],[19] The designed questionnaire consists of three parts: part 1, comprising six questions to assess the participants' practice of oral hygiene, including daily toothbrush, flossing, mouth rinse with water after eating, miswak use, brushing intervals, and toothbrush replacement; part 2, comprising two questions to assess the participants' attitude toward oral health, including the frequency of dental visits and reasons behind not visiting the dentist; and part 3, comprising seven questions to assess the participants' oral health knowledge, including items on the impact of dental diseases on general health, effects of brushing on dental decay, effect of sugars on dental decay, gingival bleeding during brushing and the effects of smoking, khat chewing, and shammah on oral health.

The Statistical Package for the Social Sciences (SPSS, IBM, and Chicago, IL, USA version 22.0) was used for data entry and analysis. Descriptive analysis was presented as frequency with percentage for categorical variables. The Chi-square test was used to assess the significant differences in oral health knowledge, attitude, and practices between males and females.

  Results Top

A total of 392 participants, comprising 195 (49.7%) male and 197 (50.3%) female students, were enrolled in this study. The mean age of the students was 17.68 years (standard deviation = 1.27). The toothbrushing practice of participants (daily toothbrushing, time spent for brushing, brushing intervals, and timing for toothbrush replacement) is shown in [Table 1]. A majority of the participants (87.0%) clean their teeth using a toothbrush. Significantly more females reported daily brushing (P = 0.001) compared to males. Almost 51% of the participants brush their teeth twice daily. There was a significant association between brushing intervals and gender (P = 0.001), whereby females performed toothbrushing twice a day more often than males.
Table 1: Toothbrushing practice according to gender (n=392)

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A majority of the students replaced their toothbrushes when bristle were frayed (61.7%). There was a significant association between gender and toothbrush replacement (P = 0.002). Almost half (46.2%) of the participants spent 1 min for brushing their teeth. However, the association between gender and the time allocated for brushing was not statistically significant (P = 0.144).

[Table 2] presents other forms of oral hygiene aids practiced by the students according to gender. A significantly higher percentage of male students (55.4%) used miswak to clean their teeth compared to female students (31%) (P = 0.001). Only 15.3% of participants practice dental flossing, while more than half (69%) rinse their mouth after meals. A comparison between male and female students showed no statistically significant difference (P > 0.05).
Table 2: Other forms of oral hygiene practice according to gender (n=392)

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Attitude toward oral health according to gender is summarized in [Table 3]. About 56.1% of the participants reported that toothache was the main cause for dental visit. No significant difference was observed in the frequency of dental visits between genders (P = 0.630). High cost of dental treatments was the main consideration among the participants that prevented them from visiting the dentist. The reasons behind not visiting the dentist were significantly different (P = 0.002) [Table 3].
Table 3: Attitude toward oral health according to gender (n=392)

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[Table 4] illustrates the participants' knowledge of oral health according to gender. Most students were aware that dental diseases impact the general health (88.8%), toothbrushing prevents dental decay (94.9%), consumption of sugars can lead to dental decay (92.3%), and bleeding during brushing may indicate gum disease (66.6%). Female students had significantly better knowledge of dental diseases compared to male students (P < 0.05). Knowledge towards deleterious habits on oral health according to gender is represented in [Table 5]. Similarly, statistically significant difference was found (in favor of females) regarding knowledge on the effect of smoking and khat chewing on oral health (P < 0.05).
Table 4: Knowledge of oral health according to gender (n=392)

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Table 5: Knowledge on the effects of deleterious habits toward oral health according to gender (n=392)

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  Discussion Top

Oral health care should be an important component of routine health care for students. Good oral health practice can be accomplished mainly through self-induced habits, such as maintenance of dental hygiene, quitting deleterious habits, and the aid of available dental services. Oral diseases should be avoided before they occur, and the prevention can be achieved through simple oral hygiene practices, such as daily brushing and flossing.[7],[8]

The findings from this study showed that toothpaste is commonly used for toothbrushing among the study population and is in agreement with those in the similar Arab population.[17],[18],[19],[20] The present study also showed that majority of the students brush their teeth in the morning and before bed, and fraying of toothbrush bristles was reported as the most common explanation for tooth brush replacement. These results were in accordance with those of Gopikrishna et al.[21] However, the females appeared to be statistically more conscious of oral hygiene in terms of daily toothbrushing, brushing intervals, and toothbrush replacement. This finding is consistent with those of other studies conducted in school children and dental students.[22],[23],[24]

Numerous populations in Arab countries still use miswak,[25],[26],[27] which is a tooth-cleaning twig made from the Salvadora persica tree (also known as arak in Arabic). Miswak is a traditional alternative to the modern toothbrush and offers stronger mechanical and chemical cleaning of oral tissues compared with a standard toothbrush.[28] In the present study, miswak was used by 169 (43.1%) of the study participants, with significantly more males using miswak compared to females. This finding was similar to that of Al-Shammari et al. and Bahannan et al. (2018).[29],[30] The present study reported that only 15.3% of the study participants used dental floss, indicating that the importance of dental floss use is still underestimated among study participants. However, the present value was higher than the reported value in a study conducted in Saudi Arabia by Al-Sadhan (5.1%)[31] and the study by Al Subait et al.,[16] which reported that the study participants did not frequently use dental floss.

Our results were in agreement with those described in previous studies, which documented that toothache was the main driving factor for participants to visit the dentist.[32],[33],[34],[35] However, no statistically significant difference in the frequency of dental visits was observed between girls and boys. Meanwhile, when the participants were asked regarding forgoing dental visits, almost 71% of participants cited the high cost of the treatment as the reason. This finding was identical to the results published by Ahmad et al.[36] A report by the World Bank confirmed that Yemen is the most populous country in the Arabian Peninsula and that half of the total population live below the poverty line.[37] These data may explain why high cost of dental treatment hinders dental visits.

In general, this study showed that the majority of students possess adequate level of knowledge on oral health. These findings were in agreement with the results obtained by Carneiro et al.[38] but superior to those of a study by Farsi et al.[39] Girls are more knowledgeable on the impact of dental diseases on general health, toothbrushing preventing dental decay, and consumption of sugars possibly leading to dental caries and bleeding during brushing possibly indicating gum diseases, as supported by the study of Al Subait et al.,[16] who reported that girls are more aware of gum bleeding and the influence of oral health on general health. In addition, girls are more conscious of the effects of smoking and khat chewing on oral health. In addition to the harms of tobacco and khat chewing, tobacco use and khat chewing among women in a conservative community are considered shameful and result in social stigma, and our study area is one such community. This finding may explain why females are more conscious of these habits compared to males.

The current study has strengths and limitations. In terms of strengths, females were almost equal to male participants in this study. This makes the comparison between males and females more reliable with respect to oral health knowledge, attitude, and practices categories. In addition, this is one of few studies that have explored the differences in oral health knowledge, attitude, and practices with respect to gender among secondary school students in Yemen. With regard to the limitations, this study was carried out in only two schools using nonprobability sampling method with a small sample size. However, the findings of this study would provide local baseline data on the oral health knowledge, attitude, and practices among Yemeni school students. Moreover, better understanding of the importance of oral hygiene practices may help to reduce the burden of oral diseases. The results could be utilized in planning programs on school students' awareness of smoking, shammah, and khat-related oral problems. Future research should also consider the following: an increased sample size that includes students from different areas of Yemen and prevalence and factors associated with smoking, shammah, and khat chewing among Yemeni school students as well as common oral diseases such as dental caries and periodontal diseases.

  Conclusion Top

Secondary school students reported a high level of oral health knowledge and practices, with female students showing predominance. However, their attitude towards regular dental visits was relatively poor. Increased awareness of oral health-related knowledge, practices, and attitude of school students can facilitate the prevention of oral diseases.


The authors acknowledge the staff of the Office of Education in Dawan Valley, Yemen, who helped to make this study a reality. We would like to thank all staff and participant students from the selected schools, Eng. Abdulrahman Ahmed Omer Al-Madfa and Miss. Fosyah Omar Al-Tayar for all their support and assistance in the progress toward the completion of this study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]

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