The ultimate aim of periodontal treatment is to control disease progression or achieve a rate of progression which is compatible with a functional dentition for the lifetime of the individual [2, 4]. Our study created an opportunity for such through oral health education as intervention and platform for interaction between populace and the dental professionals in the communities. It also served as an opportunity to introduce basic dental scaling to the people who though needed the service were yet to attend dental clinic.
From our study we observed that more females than males enlisted in the study. However, this higher attendance of women than men does not necessarily translate to increased awareness because the effect of gender on awareness was found not to be significant in this study. This could mean that females were probably more readily available at the time of our visit or that given the fact that women are the primary care givers in the home, and tend to visit health facilities more than males, either for themselves or their children; they had better opportunity to partake than the males. A previous study on gender influence on oral health proposed that females are more informed about oral health than men and take more interest in their oral health than men [29]. In as much as we do not disagree with this notion, most public or community dental practices are usually incorporated in a regular medical facility and as such women who visit for other purposes such as maternal and child health issues, are readily available for dental awareness creation programs. Therefore, they were in a better position to get more information about preventive oral health services.
We observed that only a minority of the participants with scaling treatment need (9.6%) demanded for scaling services at the outreaches, however post-intervention, we recorded an uptake of scaling by 90.4% of participants which most likely was spurred up by some factors (see Table 4). We attributed this mainly to the motivation and educational talks received during the program having positive effect on participants. This corroborates the statement by Nash and Brown (2012) that “Oral disease and the resulting need for information, therapy, and rehabilitation are the starting point for the demand for dental services” [30]. Our oral health intervention interlaced with the supply of the scaling services to the participants might have addressed the barriers posed by availability, and access to treatment similar to reports from other studies [31, 32]. Access can no longer be looked at from the patients’ ability to obtain or utilize care alone but is now essentially a concept of supply - demand where both availability of dental care which can represent the supply side and individual factors related to patients need, cultural and community considerations relating to the demand side are both taken into consideration [33]. On the overall, with a recorded percentage difference of 80.8% in demand and uptake of scaling for those with scaling treatment need and 63.7% all participants (Table 4), we can infer that the intervention in this study positively influenced uptake of scaling. This is similar to the report of a study in school aged children that OHE is effective in increasing knowledge, attitude and practice of individuals [34].
Looking at gender influence on demand and uptake of scaling, males demanded for scaling of teeth more than women but more women took up the scaling treatment at the long run. This may be due to cultural and behavioural attributes of men where they are initially more decisive than women. However, the actual uptake of healthcare is subject to a myriad of factors such as their workplace demands, self- perceived oral health need, and their perception of the seriousness of the condition [32, 35, 36]. This is corroborated by a report that females had better oral healthcare habits than the males, were more concerned about how their teeth looked than males, thus would be more inclined to get their teeth scaled and polished and retain their teeth in good health [37].
Furthermore, we observed that individuals with CPI scores 3 and 4, that is, more severe periodontal conditions, were not interested in S & P; we attributed this to lack of perceived need for it. In our environment, credible reports show perceived need of dental condition is a function of how aware the individuals are about oral health or health in general. [32, 35]. Awareness creation can motivate behavioural change in respondents and improve their dental health seeking pattern as reported in other studies. [14] It is our view that the oral health education created a platform to motivate those with severe periodontal condition who initially did not demand for scaling to take up.
Furthermore, a number of factors affected oral health awareness in the present study (Table 5). The location of the participants, that is rural or urban, affected awareness significantly. This observation also flows with our other finding stated above that more urban participants than rural demanded for scaling (p = 0.00). Rural dwellers have been known to face challenges of awareness and use of oral health facilities [14, 22]. By implication, low oral health awareness has a direct effect on the illness seeking behaviour of the individuals and population and need to be built up in order to motivate the use of dental services; our study was able to achieve this to a reasonable extent. Other factors such as age, gender and number of times brushed, illustrated a trend in influencing the outcome variable, but the results were not statistically significant.
The present study has limitations that must be taken into account to correctly interpret the findings. First, the use of prior dental visit alone as proxy for awareness may lead to partial assessment of oral health awareness as other facets exist but within the scope of our study, we were able to synergize the two. Secondly, using community outreach programs to recruit study participants could be a limitation for our study. However, this method has been known to aid recruitment of hard to reach populations or minority groups into studies. In the light of this, our approach was able to capture women, children as well as men who most often do not seek healthcare [38]. This approach has proved effective in other studies as a means of recruiting study participants. [21, 22]. Another limitation to our study could be the use of CPI to measure periodontal status of participants. CPI is saddled with the challenge of either underestimating or overestimating periodontal treatment needs as fake pockets resulting from gingival overgrowth without attachment loss could be mistaken for true periodontitis.
In terms of strengths, we were able to reach out to a good number of people especially the grassroots, hoist promotional activities like oral health education, and provide professional dental scaling of teeth to the individuals within the ambit of our study. These gains could be sustained by instituting appropriate health policies which will inform better planning and encourage the viability of oral health care activities in the communities possibly by incorporating them into existing primary health care centres.