The aim of this study was to evaluate the knowledge and habits of students from Centro Educational José de Paiva Netto, in the city of Rio de Janeiro, considering the use of toothpaste. A questionnaire, with semi-open and closed questions about knowledge and attitudes towards the use of toothpaste and self perception of oral health impact profile (OHIP), was applied to 156 elementary school students, aged 6 to 12 years, and it allowed to evaluate that 65.4% of them reported use toothpaste, 42.3% choose the toothpaste by brand, 23.7% by the price and 72.4% do not look the chemical composition of toothpaste. 122 students have never received a recommendation of the dentifrice by their dentist, 55.1% of students have learned to brush their teeth with their mother and 10.3% with their father, what shows that more than half of the sample did not get guidelines from dentist or dental hygienist. In addition, seven students reported feeling always embarrassed about their oral health condition. It was concluded that students have a low level of knowledge and need more information and guidance about the use of toothpastes and oral health.

Keywords: tooth paste, knowledge, oral health

Tooth decay has successively reduced its incidence in recent decades.^1,2 Despite the scientific knowledge describe the use of fluoridated toothpaste as one of the responsible for the reduction of the DMFT^1-6 (number of decayed, missing and filled teeth), most of the population in developing countries have not yet incorporated this knowledge, turning them into habits, as well as the time and amount of dentifrice brushing.^7-10

According to the World Health Organization (WHO), oral health care should be based on the pillars of oral hygiene orientation, educating and motivating individuals to self-care in order to promote and maintain oral health¹¹ and since health is “[...] complete physical, mental and social well-being”, dentistry has been trying to replace the biomedical model, that values the environmental disease model, where social and physical environments are critical to the health, valuing health.¹² This appreciation imposes the need for new forms of measurement, such as the measurement of perceptions, feelings and behaviors, giving increasing importance to the subjective experiences of each individual and their health and interpretations disease.¹³

The oral health impact profile (OHIP) indicator measures the individual’s perception of the bio psychosocial impact of oral disorders associated with quality of life, it was developed by Slade,¹⁴ according to the conceptual model of Locker¹⁵ and its simplified form with 14 items was validated and has been widely used.^14,16

The aim of this study was to evaluate the knowledge and habits of students of Educational Center José de Paiva Netto, in the city of Rio de Janeiro, considering the use of toothpastes and their self-perception of oral health.

Oral health is regarded as an integral part of overall health, allowing individuals to feed themselves and communicate, being decisive in social confidence, self-esteem and quality of life.^11,17 Watt⁸ described the challenge of creating opportunities and conditions for individuals and communities to enjoy good oral health.¹⁸ In this context, oral health education is designed to control the risk factors of disease dental caries and gum, among other oral diseases and it is necessary to work the oral health issues grounded in knowledge of each community and awareness is an essential instrument for the importance of oral health in life quality.^19,20 The health-promoting schools can contribute and take the knowledge to many children. Bring to school environments subsidy to improve overall health, from the promotion of oral self-care, stimulating, interactive and contemporary way, extends citizenship, as it promotes social inclusion and makes individuals participating agents in building a better quality of life for the adoption and promotion of favorable habits to the state of oral health and general.²¹

90% of adult Swedish indicated that brushing teeth once or twice per day.²² In Finland 47% of men and 79% of women reported brushing at least twice a day, while the daily use of fluoride toothpaste was reported by 86% and 96%, respectively⁶ and in Sweden 95% of participants answered brushing teeth twice a day, fluoride toothpaste is used by almost all, about 75% of respondents rinse with water after brushing and only 9% rinse their mouth after brushing with water containing toothpaste.²³

Despite the self-rated health is a subjective evaluation, the group of the World Health Organization (WHO) Quality of Life (QoL) reported that health perceptions, positive or negative, should be measured both in adults and in children, since that it is important to the impact of oral health perception.²⁴ The evaluation of the self-perception that the individual has regarding your health is not an easy task; however, the association of quality life indicators and oral health are needed for the relevance on planning health promotion actions.²⁵

Among developed indicators, the Brazilian version of the Oral Health Impact Profile (OHIP)-14, translated and validated for the Portuguese of Brazil, has shown excellent psychometric, properties similar to the original instrument.^26,27

All questions of OHIP-14 questionnaire are related to oral health.^26,27 The topic functional limitation includes questions about difficulty speaking and worsening in the taste of food; in the dimension pain, questions are about the sensation of pain and bother to eat; in psychological discomfort dimension, the questions refer to the worry and stress by oral health. The loss in power and the need to have to stop feeding are questions of the dimension physical disability, while in psychological disability questions refer to the difficulty to relax and sense of shame due to the oral condition. The social disability dimension includes irritation with people and difficulties in performing activities of daily routine because of oral health; and the questions about the disability dimension assess if there is a perception that life has become worse and if the person felt totally unable to develop their routine activities.²⁶

Evaluating 3,678 edentulous adults between 18-91 years of age, of both genders, through multiple regression, authors concluded that the style of creation of parents in their children, is strongly associated with oral health in later life, however, it has not significant relation to the presence of psychosocial factors.²⁸ The results of the SB Project-Brazil (2003),²⁹ showed that oral health predisposing factors were associated with self-rated oral health among adults (35-44 years) and elderly (65-74 years) living in southeastern Brazil, as in other countries.²⁹

The LBV is an institution that acts in dozens of Brazilian cities, providing quality services that covers the elderly and children, extends to their families. More than 70 socio-educational units between schools, homes for the elderly and community centers for social assistance, which rescue in each attended their self-esteem and turn better their realities.

The social actions of the LBV comply with legal and National Social Assistance Policy, according to the National Grading of Social Assistance Services, in basic social services (coexistence and strengthening of ties).³⁰

The largest unit of the LBV in the State of Rio de Janeiro is called Educational Center José de Paiva Netto, it is in the city of Rio de Janeiro, founded in 1996, and it is located at Avenida Dom Helder Camara, 3214-Del Castilho. It belongs to the Program Area 3.2 in the city of Rio de Janeiro, attended by Family Health Clinic Barbara Starfield (CSF), with a total population of 576,268 people; it has 86 Family Health Strategy Teams and only 30 Oral Health Teams, leading to 51.49% population coverage, so.³¹

After approval by the Ethics Committee and signing of the Informed Consent Form (ICF) (Annexure I) by those responsible, the questionnaire Jensen, 2012 and OHIP (Annexure II), both previously validated in Brazil, containing semi open and closed questions about knowledge, oral hygiene habits and toothpaste, was applied in 156 school children, 6-12 years old, of the elementary school education from Educational Center José de Paiva Netto, of the LBV.

Data were collected by the same appraiser, post-graduate student of Public Health and Family, linked to the Department of Social and Preventive Dentistry, Federal University of Rio de Janeiro, who interviewed students and held educational lectures about oral hygiene care and elucidation of questions, in order to make them aware of the importance of oral health care, after their responses to applied questions.

Data were tabulated using SPSS, version 17.0 and the test used was non-parametric chi-square.

The total sample consisted of 156 students, aged between 6-12 years, with: 38 to six years (24.4% of the sample), 105 students aged 7 to 11 years (67.3%) and 13 to 12 years (8.3%).

The frequency distributions according to gender were similar, with 52.6% male and 47.4% female, showing no statistically different results for the genders about the knowledge of fluoride toothpastes and/or OHIP.

Regarding brushing habits, in the question about owning a toothbrush, the entire sample described has a toothbrush, however, of the 156 patients, 102 (65.4%) reported using toothpaste. Of the 156 students, 66 (42.6%) did not report which brand of toothpaste they use, 26 patients prefer the Colgate brand, 17 (10.9%) prefer Tandy and 16 (10.4%), Oral B. One hundred and eighteen students (75.6%) reported that they perform their own brushing, 88 (56.4%) put the toothpaste on the brush by themselves and in 44 (28.2%) cases, this process is carried out by the mother, and 79 (50.6%) placing half size of bristles with dentifrice. Regarding the consumption of fluoridated toothpaste and water supply, 148 (94.9%) did not ingest toothpaste and the predominant water consumption is by 117 (74.4%) students who use the public water supply.

Regarding the quality of life assessed by OHIP, in all questions predominated NEVER answer; although seven people (4.5%) reported always feel ashamed for their oral health condition, as shown in Table 1 below. There was no significant difference between any of the answers on self-perception of oral health and gender, or between age groups of the sample.

The criterion of choice of toothpaste, predominated 66 students (42.3%) who choose it by brand, 37 (23.7%) by price and the majority, 113 (72.4%), don’t look at the chemical composition of toothpaste. There were no significant differences in the choice of toothpaste between the sexes (P=0.528) or between age groups (Xa=53.09 and P=0.628, not significant) (Graph 1).

Graph 1 Simple frequency distributions and percentages as: How do you choose your toothpaste?

Although 110 students (70.5%) declare that verify the validity of toothpaste, 45.4% did not know the reasons why they check the validity and preferred to leave without information, only 1.4% described the reason is to check the presence of fluoride and 4.2% said that it is important to verify the effectiveness of toothpaste. The other answers were dispersed, like not having habit, forget and not be interested, for example.

About the use of toothpaste as a treatment: 131 (84.0%) did not use toothpaste as treatment and among the rest that did, 88.5% do not have information about the toothpaste used or treatment.

Among the 156 students, 118 (75.6%) reported that the whole family uses the same toothpaste. Most 126 (80.8%), never asked for guidance on which toothpaste to use. Of the 30 patients who asked for guidance on which one to use, 24 (15.4%) asked the dentist, however, the 156 students, 122 (78.2%), never received the recommendation of the dentifrice by dentist. On the question asking if the patient think that the dentist should recommend the toothpaste and why, 139 (89%) did not give information and six people (3.8% of the sample) reported that it should be done because of the sensitivity dentin.

About dentist’s recommendation on some kind of special bristle, there was no recommendation by brand in 131 students (84.0%), however when asked which toothbrush were using at the time, the main results showed that: 55 (35 4%) did not answer; 32 (20.8%) use oral B, 31 students (20.1%) use Colgate and 2 people (1.3%), use brush received by Shaheed Udham Singh College of Engineering & Technology (SUS) us and the same quantity / percentage for the more cheap toothbrush. Of the total of 156 participants, 114 (73.1%) reported that the dentist does not also recommended no special technique of brushing. There was no significant difference between age groups (Xa= 35.59, where P=0.747, so, not significant).

When asked about the toothpaste they were currently using and why, most 63 (40.4%) were using Colgate, and 88 students of the sample (56.4%) did not give information about why and 16 students (10.3% of the sample), claimed to be the best. The results are shown in Table 2.1 and Table 2.2.

When asked about who taught them how to brush their teeth, of the 156 patients, 86 (55.1%) were taught by mother and 16 (10.3%) by the father, and three cases (1.9%) reported having learned from the oral health technical (TSB) and six (3.8%), with the dentist, as best seen in Graph 2.

The level of knowledge of the students is still not enough, and the consequent incorporation of habits of the age groups assessed too. Knowing the self-perception of oral health will allow the development of educational activities that address the bio-psychological dimension of the individual and their social context.

None.

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