Knowledge, attitude and practice of tooth

wear among adults in Bertam, Penang

Cite as: AIP Conference Proceedings 1791, 020008 (2016); https://doi.org/10.1063/1.4968863
Published Online: 19 December 2016

Nurfarhana Farah Abdullah, Husniyati Roslan and Siti Noor Fazliah Mohd Noor

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AIP Conference Proceedings 1791, 020008 (2016); https://doi.org/10.1063/1.4968863 1791, 020008

© 2016 Author(s).
 Knowledge, Attitude and Practice of Tooth Wear
among Adults in Bertam, Penang

Nurfarhana Farah Abdullah¹, ª), Husniyati Roslan¹, b ),

and Siti Noor Fazliah Mohd Noor¹, c)
¹Craniofacial and Biomaterial Sciences Cluster, Advanced Medical and Dental Institute,
Universiti Sains Malaysia, Bertam, Kepala Batas, Penang, Malaysia
a) Corresponding author: farahvoon@gmail.com,
b) husniyati@usm.my
c) fazliah@usm.my

Abstract. Tooth wear is an oral lesion with multifactorial causes. The prevalence is increasing with an increasing age. Knowledge
of tooth wear is part of oral health and essential requirements are needed to modify health related behaviors. This study was
aimed to determine the knowledge, attitude and practice of tooth wear and to compare with the socio-demographic factors. A
cross-sectional study using a modified version of self-administered questionnaire was distributed among 390 adults (aged more
than 18 years old) from three government institutions in Bertam, Penang. A total of 349 (89.5%) subjects had participated in this
study with 55.3% were males and majority of the subjects were Malays. About 58.2% had low level of knowledge with mean
score at 20.8. Meanwhile, 93.4% subjects had a positive attitude and 84.2% had poor level of practice on oral hygiene. The low
mean score of knowledge among subjects was not necessary an indicator that attitude and practice were affected. However,
identification of etiological factors emphasizes on educational approaches, and empowerment of patients and community towards
awareness are the most important factors for preventive strategies.

INTRODUCTION

Tooth wear is described as an oral problem which can manifest into erosion, attrition, abrasion and abfraction
lesions [1,2]. The differences of tooth wear compared to other oral lesions are the causative factors. Tooth wear is
not caused by trauma and bacteria [2,3]. The etiological factors include consumption of acidic drinks and foods,
bruxism, nail biting, wrong tooth brushing technique, types of dentifrice and using toothbrush with hard bristle
[4,5,6,7]. A few studies reported that the prevalence is increasing due to the increasing population’s age [8,9,10].
This has resulted from a continuous exposure to the causative factors and habits that are tear and wear of tooth
surface in oral micro-environment. This phenomenon might lead to a negative impact on the oral status in Malaysia
and globally in regards to cost expenses for prevention strategies program, treatment and management planning
[3,11,12]. The identification of etiological factors, emphasis on educational approaches and empowerment of
patients and community towards awareness and modification of lifestyles are essential.
Knowledge regarding tooth wear is part of the oral health and an essential requirement to modify health related
behaviours. This statement is a sequential finding in other study that shows that an inadequate knowledge might
affect the quality of life of individuals which can then lead to tooth morbidity and mortality [13,14,15]. In addition,
attitude and practice towards tooth wear are correlated to inflict awareness to prevent tooth wear diseases from
becoming worse and thus reducing its prevalence [9,13,16,]. Therefore, knowledge and awareness of the
community is important to reduce the occurrence of this lesion.
Bertam area is one of the six regions in North Seberang Perai, Penang. The majority of the population in Bertam
is Malay and the ratio for males and females is equal [17]. In the present study, the population understudy has
never experienced tooth wear assessment in cognitive and behavioral factors. Hence, our findings may be
beneficial in providing more information about tooth wear [5,13].
Therefore, this current study was aimed to investigate the level of knowledge, attitude and practice of tooth wear
and its association with socio-demographic factors and age among adult subjects in Bertam area.

Translational Craniofacial Conference 2016 (TCC 2016)

AIP Conf. Proc. 1791, 020008-1–020008-8; doi: 10.1063/1.4968863
Published by AIP Publishing. 978-0-7354-1455-6/$30.00

020008-1
 MATERIALS AND METHODS

Study design and population

The study design was a cross-sectional study using questionnaires survey. Three government institutions in Bertam
area; Advanced Medical and Dental Institute (USM), Training Industrial Centre and Community College were
randomly selected. The modified version of self-administered questionnaires were distributed among adults aged
18 years and above who were residing, studying and working in Bertam during the study period. The exclusion
criteria for sampling subjects were non-Malaysian, adults who were wearing dental fixed appliances and pregnant
adults.
By using single proportion formula [18] with 95% confident interval, expected proportion from previous studies
[9,14,16] and 0.05 precision, the calculated number of sample size needed was 390 subjects from three institutions
(after anticipating 10% of non-responses).

Research tool
The questionnaires used were based on Saerah et al. [13]. The questionnaires were adopted and modified
following a pilot study to check for internal validity and reliability. The adopted version of the questionnaire was
validated and reliability check was performed in terms of the accuracy and consistency of each item with the others
[19]. The final results indicated a moderate agreement (Cronbach’s Alpha 0.7). The modified version of
questionnaire contained seven (7) sections which were divided into Section A:- Socio-demographic status (5 items);
Section B:- General question (2 items); Section C:- Knowledge about tooth wear (16 items); Section D:-Attitude
towards tooth wear (6 items); Section E:- Oral hygiene practice (5 items); Section F:- Other practices related tooth
wear (6 items) and section G:- Table of frequency of acidic foods and drinks intake.

Data management

Ethical approval (USM/JEPem/16010031) was obtained from the Human Ethics Committee of USM before field
study was conducted. Responses data variables for knowledge domain were classified into high, moderate and
low knowledge. Meanwhile, the responses variables from the attitude domain were categorized into positive and
negative attitudes. In addition, feedback data variables in practice domain were classified into good, fair and poor
practices. The data was checked for completeness and underwent a thorough data cleaning to reduce biasness.
The data were coded, keyed and analysed using SPSS version 22.0. Analyses were performed by using simple
descriptive statistics. Inferential statistical analyses were performed using One-way ANOVA test, chi-square test
and Independent T-test to detect the differences of mean between groups with P-value less than 0.05 considered
significant with 95% confidence interval and 5% error due to chance.

RESULTS AND DISCUSSIONS

A total of 349 (89.5%) subjects had participated in this study out of 390 subjects that were recruited. The mean
age of the subjects was 24.3 years old, ranging from 18 to 64 years old (Table 1). This corresponds to the age
group where the tooth wear lesions can be detected clinically [9,16,20]. The gender distribution favors many male
subjects (55.3%) compared to females and this was in accordance with previously reported studies where male
subjects tend to acquired pathological dental erosion due to habit such as bruxism or tobacco chewing [21,22,23].
Malay population (88.8%) was the major ethnic group from the population under study and reflected the population
in Bertam area [17] (Table 1). Most subjects (73.1%) received education from college and industrial training.
The results on the level of knowledge towards tooth wear indicated that 58.2% of the subjects had a low knowledge
score with the mean score of 20.8 + 5.3 (Mean + SD) (Table 2). The low knowledge score may be correlated to
limited knowledge in understanding the etiological factor and habit related to tooth wear. This was in contrast with
the distribution of the positive responses on knowledge items by subjects (Table 3). Hence, the finding is depicted
in results on the source of information where subjects (64.5%) claimed that they have never heard about tooth
wear (Figure 1). This indicates that people may have problem in retaining their knowledge into adulthood [13]. The
finding highlighted the importance of preventive strategies and emphasis must be given towards incorporating
educational approaches with motivation and innovation [2,4,11].

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 TABLE 1. Characteristic Profile of Socio-Demographic of Adult Subjects.

Variables Mean n (%)

Age (years) 24.3
Gender Male 193 (55.3)
Female 156 (44.7)
Ethnic Malay 310 (88.8)
Chinese 6 (1.7)
Indian 32 (9.2)
Other 1 (0.3)

TABLE 2. The Level of Knowledge towards Tooth Wear.

Variables n (%)
High (26 - 32 scores) 12 (3.4)
Moderate (20 – 25 scores) 134 (38.4)
Low (0 – 19 scores) 203 (58.2)
Mean = 20.8 SD = 5.3 Min = 4 Max = 32

TABLE 3. Distribution of the positive responses on the knowledge towards

tooth wear by subjects (n = 349) on each item.

Items of knowledge n (%)

What are the factors that can cause tooth wear occurrence?

Frequent consumption of carbonated beverages. 174 (49.9)

Frequent intake of acidic food. 148 (42.2)

Frequent intake of sour fruit. 98 (28.1)

Which of the following is a habit that can cause tooth wear occurrence?

Biting finger nails. 68 (19.5)

Teeth grinding during sleep (bruxism). 133 (38.1)

Brushing teeth with hard pressure. 126 (36.1)

Information about saliva:

Important as a natural cleanser in the oral cavity. 229 (65.6)

The flow rate is influenced by size of the body. 51 (14.6)

The flow rate is affected by smoking status. 108 (30.9)

Which of the following can reduce the effect on tooth wear occurrence?

Consume dairy products such as milk powder and fresh milk. 209 (59.9)

Using a soft-bristled toothbrush 213 (61.0)

Food rich in calcium and phosphate minerals 206 (59.0)

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 Information about treatment of tooth wear:

The best treatment is to reduce the frequency intake of sour 220 (63.0)
food, beverages and fruits as well as carbonated drinks.

Early treatment can help extending the life span of teeth. 252 (72.2)

Tooth wear occurrence when untreated can cause:

Teeth feel a throbbing pain (sensitive) even though no cavity is 213 (61.0)
detected.

Size of the teeth become shorter when tooth wear occurs on the 161 (46.1)
chewing surfaces.

Figure 1. Status of Adult Subjects Response on Source of Information.

TABLE 4. The Level of Attitude towards Tooth Wear.

Variables n (%)
Positive (89 - 150 scores) 326 (93.4)
Negative (6 - 88 scores) 23 (6.6)
Mean = 25.1 SD = 7.4 Min = 6 Max = 121

TABLE 5. The Level of Practice on Oral Hygiene towards Tooth Wear.

Variables n (%)
Good (8 – 10 scores) 0
Fair (6 – 7 scores) 55 (15.8)
Poor (0 – 5 scores) 294 (84.2)
Mean = 4.1 SD = 1.4 Min = 1 Max = 7

About 93.4% of subjects had a positive attitude and 6.6% had a negative attitude towards tooth wear with a
mean score of 25.1 + 7.4 (Mean + SD) (Table 4). Majority of the subjects have a positive insight on using soft
bristle toothbrush, eliminate bruxism habits and intention to change their dietary patterns. In addition, the attitude
and awareness were important elements for modification in behavioural factors [9,11,12 ]

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In terms of practice of oral hygiene towards tooth wear, about 84.2% of the subjects have a poor oral hygiene
practicing habits (Table 5). Hence, the mean score was 4.1 + 1.4. Most of the time, the oral hygiene method has
been taught at an early age such as during nursery and preschool education with motivation and incentive [11].
This psychological approach has given a positive impact on behavioural factors on an individual that can lead to
modification of the negative attitude [11,12].

TABLE 6: Comparison between mean age and the levels of knowledge, attitude, and practice
among subjects (n=349).
Variable Age

Mean(SD) t statistic (df) P value* OR**(95% CI)

Level of knowledge
High 25.42 (8.15)
Moderate 25.25 (9.58) 1.407 0.246 1.33
(-0.29 –2.96)
Low 23.67 (8.13)

Level of attitude
Positive 24.38 (8.64) 0.116 0.734 0.64
(-3.07, 4.35)
Negative 23.74 (10.05)

Level of practice
Fair 25.33 (8.91) 0.839 0.360 1.17
(-1.35 –3.69)
Poor 24.15 (8.69)
*** P < 0.05

TABLE 7: Association between levels of knowledge and gender.

Variable Level of Knowledge X² (df) P value*

High Moderate Low

n (%) n (%) n (%)

Gender
Male 4 (2.1) 67 (34.7) 122 (63.2) 5.756 (1) 0.056*
Female 8 (5.1) 67 (2.9) 81 (51.9)
*** P < 0.05

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 TABLE 8: Association between levels of knowledge and gender.

Variable Level of Attitude X² (df) P value*

Positive Negative
n (%) n (%)
Gender
Male 178 (92.2) 15 (7.8) 0.980 (1) 0.322
Female 148 (94.9) 8 (5.1)

*** P < 0.05

TABLE 9: Association between levels of practice and gender.

Variable Level of Practice X² (df) P value*

Fair Poor
n (%) n (%)

Gender
Male 24 (12.4) 169 (87.6) 3.594 (1) 0.058*
Female 31 (19.9) 125 (80.1)

***P < 0.05

There were no significant differences indicated between the level of knowledge, attitude and practice with
the age of the subjects (Table 6). Age of subjects was not categorized in a specific group for determination
of age, behavioural and cognitive components. Each category of age was influenced by different previous
experiences, skills, capability to absorb the knowledge and apply in practise, and adopt as a habit [2,9,20].
However, our study found that there were significant differences on the association between knowledge and
practice, with gender of the subjects (Table 7 and 9). Previous studies reported that male subjects tend to
have a low index score on oral hygiene and developed more pathological dental erosion compared to female
subjects [21,22].

CONCLUSION

The present study revealed the subjects had low mean score knowledge that suggested the population
encounter problem in retaining the information which is similar with report by Saerah et al. However, the
population had positive attitude towards awareness on oral healthcare, changing bruxism and dietary habits.
Future study is needed to investigate the correlation between knowledge, attitude and practice domains
concurrent with a clinical examination that may provide stronger evidence.

ACKNOWLEDGMENT

The authors would like to express their gratitude to Advanced Medical and Dental Institute, Universiti Sains
Malaysia, for the financial grant support (USM/IPPT/700-02) and Dr. Nama Bibi Saerah Abd. Karim, for her
approval to adopt the questionnaire. Great appreciation to all staff and students of AMDI USM, Training
Industrial Centre (ILP) Bertam and Community College Bertam who participated in the study.

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