AN EXAMINATION OF ORAL HEALTH KNOWLEDGE, ATTITUDINAL DISPOSITION, AND PRACTICE PATTERNS AMONG SECONDARY SCHOOL STUDENTS IN NIGERIA

CHAPTER ONE INTRODUCTION 1.1 Background of the Study Oral health conditions represent a major global public health concern, requiring urgent and sustained attention. A solid understanding of oral health forms the foundation for promoting healthy behaviours (Crosby, 2021). Proper oral hygiene is a critical factor in achieving and maintaining good oral health, which is inherently linked to overall physical well-being and quality of life (Chang, 2017). However, in many developing countries, data on the levels of knowledge, attitudes, and practices (KAP) relating to oral health among school-aged children remains limited. In contrast, evidence from developed nations demonstrates the success of oral health education initiatives in improving public dental health (Cheah, 2019). Educational and preventive strategies—such as increasing awareness and limiting exposure to risk factors—are essential to curbing the prevalence of dental caries and periodontal diseases, two of the most common oral health problems leading individuals to seek dental care. Zhuleikha et al. (2021) explain that dental caries, or tooth decay, can be effectively prevented by educating individuals on how to manage plaque through proper oral hygiene practices, adopting healthier dietary patterns—especially reducing the frequency and quantity of sugary food and drink consumption—and using fluoride. Gingivitis, the most prevalent form of periodontal disease, particularly affects adolescents. A range of risk factors contribute to poor oral health outcomes, including inadequate oral hygiene, tobacco use, hereditary predispositions, stress, systemic health conditions, and underutilization of dental care services (Lugmanul et al., 2017). Effective oral care interventions include daily brushing and flossing, plaque control programs, and professional procedures such as scaling and root planing (Ofo, 2020). Oral health encompasses more than just the condition of the teeth and gums; it involves the complete state of the oral and facial systems, supporting essential functions like speaking, smiling, and chewing. Poor oral hygiene can result in discomfort, pain, and serious complications such as periodontal disease and oral cancer, ultimately impairing overall well-being and life quality (Fuller et al., 2021). Moreover, oral health often reflects an individual's nutritional habits, lifestyle choices, and socioeconomic status (Allen et al., 2019). Poor oral hygiene can lead to a host of complications including dental caries, gum disease, and other oral infections—each of which may cause significant discomfort and impact general health (Smart et al., 2019). Palmer (2022) underscores that effective oral health education and consistent hygiene practices are key measures in preventing these diseases and enhancing overall health. According to the Knowledge-Attitude-Practice (K-A-P) model, positive behavioural change can be achieved when individuals acquire adequate knowledge and motivation, leading to an improved attitude and ultimately transforming their behaviours (Edomwonyi et al., 2019). A comprehensive review of studies evaluating the outcomes of school-based oral health education revealed that such interventions positively influence oral health status and behaviours. Improvements were observed in brushing habits, frequency and duration, and the use of fluoride toothpaste among children aged 6 to 12 (Chukwu, 2022). Edomwonyi et al. (2019) further established that oral health education delivered through schools in Lagos, Nigeria, significantly influenced students' oral hygiene behaviours, whether administered by teachers or dental health professionals. School health programs offer cost-effective, long-term benefits by reaching broad populations and promoting improved health for students, teachers, families, and communities (Ehizele et al., 2021). Adolescence is a pivotal developmental period for establishing lifelong health habits. Health behaviours formed during this stage can significantly impact future well-being (Ofili, 2021). Therefore, equipping secondary school students with proper oral hygiene knowledge is crucial in preventing dental problems and promoting sustainable health practices (Chiwuzie et al., 2020). In Nigeria, oral health faces unique challenges due to socio-economic disparities, limited access to dental services, and varying levels of awareness and education (Emmanuel, 2021). Many Nigerian students lack adequate exposure to essential oral health knowledge, leading to suboptimal outcomes. Cultural beliefs, financial barriers, and inadequate resources all influence oral hygiene behaviours (Kolawole et al., 2021). Prior research has highlighted a widespread lack of oral health awareness among Nigerian adolescents. A significant portion of students hold misconceptions about dental hygiene and do not adhere to recommended brushing or flossing routines (Oziegbe & Bamise, 2019). Additionally, research shows high rates of tooth decay and gum disease among Nigerian youth, underscoring the urgent need for better oral health education and preventive practices. Thus, this study intends to assess the extent of oral health knowledge, attitudes, and practices among secondary school students in Nigeria. 1.2 Statement of the Problem There exists a significant gap in the knowledge, attitudes, and oral health practices among secondary school students in Nigeria. This deficiency presents multiple pressing challenges. Developing proper oral hygiene habits and maintaining a positive attitude toward oral health is essential for overall well-being and for preventing common conditions such as dental caries and gum infections. Maintaining good oral health involves a combination of daily practices, including brushing and flossing, as well as preventive strategies like the use of fluoride, application of dental sealants, healthy eating habits, and regular dental checkups (Sa’adu, 2022). According to Ani et al. (2018), a high consumption of sugary snacks and beverages among Nigerian adolescents contributes to poor oral health outcomes, increasing the likelihood of cavities and gum disease. Akpan (2023) estimates that between 30% and 45% of Nigerian youths aged 12 to 15 are affected by dental caries, making it a serious public health concern. In many cases, secondary school students in Nigeria do not fully understand the fundamentals of oral hygiene, including the correct technique for brushing, the necessity of routine dental evaluations, and the relationship between diet and oral health. This lack of awareness often results in poor oral hygiene behaviours and an increased vulnerability to dental diseases. Akpan (2023) also observes that most school curricula in Nigeria do not incorporate oral health education, leading to limited student awareness about the consequences of poor dental hygiene. Peter (2017) links inadequate oral health to various negative outcomes, such as pain, functional limitations, and diminished quality of life. A review of existing literature on students' knowledge, attitudes, and practices toward oral health in Nigeria reveals discouraging findings (Ene, 2023). Therefore, this study seeks to fill this gap by systematically examining oral health knowledge, attitudes, and behaviours among Nigerian secondary school students. 1.3 Objectives of the study The primary objective of this study is to examine Oral Health Knowledge, Attitudinal Disposition, and Practice Patterns among Secondary School Students in Nigeria. Specific objectives of this study are to: i.To assess students' knowledge of proper oral hygiene techniques, the importance of oral health, and common oral health problems. ii.To determine students' attitudes toward oral health iii.To identify students' actual oral hygiene practices iv.To assess barriers to proper oral hygiene Among Secondary School Students in Nigeria v.To offer recommendations for improving oral health education and practices among secondary school students in Nigeria 1.4 Research Questions The following research questions will be answered in this study: i.What is the level of students' knowledge of proper oral hygiene techniques, the importance of oral health, and common oral health problems? ii.What are students' attitudes toward oral health? iii.What are students' actual oral hygiene practices? iv.What are the barriers to proper oral hygiene Among Secondary School Students in Nigeria? v.What area the recommendations for improving oral health education and practices among secondary school students in Nigeria? 1.5 Research Hypotheses The following research null hypotheses will be formulated to guide the study: Ho: The level of students' knowledge of proper oral hygiene techniques, the importance of oral health, and common oral health problems is low Ha: The level of students' knowledge of proper oral hygiene techniques, the importance of oral health, and common oral health problems is high 1.6 Significance of the study This study is important because it will offer vital insights on the present condition of oral health knowledge, attitudes, and practices (KAP) among secondary school students in Nigeria. The discoveries can assist educators, healthcare practitioners, and policymakers in formulating focused initiatives to enhance oral health outcomes. This study seeks to enhance oral hygiene and general health among Nigerian teenagers by addressing the gaps in their knowledge, attitudes, and practices. Furthermore, enhancing the understanding of oral health among students in secondary schools plays a significant role in advancing public health initiatives in Nigeria. By providing students with knowledge on correct oral hygiene habits, the significance of regular dental examinations, and the influence of diet and lifestyle on oral health, they can be empowered to make educated decisions and become proponents for oral health in their communities.  Moreover, the study's findings can provide valuable insights to curriculum architects and legislators regarding the imperative of incorporating comprehensive oral health education within the secondary school curriculum. This integration guarantees that oral health subjects are comprehensively addressed, equipping students with the requisite knowledge and abilities to uphold optimal dental hygiene throughout their lifetimes.  Furthermore, enhancing the understanding, beliefs, and behaviours related to oral health in secondary school children can result in enduring health advantages. Optimal dental hygiene is associated with holistic wellness, encompassing enhanced nourishment, articulate communication, and improved social engagement. Early intervention in oral health problems can help alleviate the financial strain linked to the treatment of complex dental conditions. Finally, this study contributes to the current understanding of oral health practices among teenagers, particularly in the context of Nigeria. This research can serve as a foundation for future inquiries into different aspects of oral health education and behaviour among various age groups and populations. 1.7 Scope of the study Broadly, this study focus is to examine Oral Health Knowledge, Attitudinal Disposition, and Practice Patterns among Secondary School Students in Nigeria. Specifically, this study seeks to assess students' knowledge of proper oral hygiene techniques, the importance of oral health, and common oral health problems, determine students' attitudes toward oral health and identify students' actual oral hygiene practices in Nigeria.  Further, this study will focus on assessing barriers to proper oral hygiene Among Secondary School Students in Nigeria and it also seeks to offer recommendations for improving oral health education and practices among secondary school students in Nigeria. 1.8 Limitations of the study As with any human endeavor, the researchers faced many minor constraints during the investigation. The main limitation was the lack of extensive literature on the subject, due to the limited availability of data regarding oral health knowledge, attitudes, and practices among secondary school students in Nigeria. Hence, a significant allocation of time and exertion was necessary to ascertain the appropriate materials, books, or information and amass data.  Furthermore, this study is constrained by its small sample size and narrow geographical scope, focusing solely on Nigeria. Therefore, the conclusions of this study cannot be extended to other situations, thus requiring further investigation.  Moreover, the researcher's restrictions were mostly due to financial constraints, as they are a student without any source of income to sustain themselves. The exorbitant transportation costs at the research location, exacerbated by the prevailing inflation in Nigeria, posed a significant challenge in meeting the expenses associated with transportation. Furthermore, the researcher faced a time constraint due to the need to do this research while still fulfilling the obligations of attending lectures and participating in other educational activities. 1.9 Definition of terms Oral disease: Oral diseases encompass a range of diseases and conditions that include dental caries, periodontal (gum) disease, tooth loss, oral cancer, oro-dental trauma, noma and birth defects such as cleft lip and palate. Oral health: Oral health is the state of the mouth, teeth and orofacial structures that enables individuals to perform essential functions such as eating, breathing and speaking, and encompasses psychosocial dimensions such as self-confidence, well-being and the ability to socialize and work without pain, discomfort and embarrassment. Oral practice: This is an activity undertaken by people in order to protect, promote, or maintain oral health and prevent dental diseases. The practices include tooth brushing and sugar consumption practice among others.