Explain how Chi-square test was used in this research

INTRODUCTION

Dental caries and periodontal diseases exert tremendous social, economic, and financial burden on a global scale. Despite a plethora of preventive measures available, dental plaque, the precursor of dental caries and periodontal disease, remains an enigma. The mechanical removal of dental plaque, if effectively carried out, can be the most effective method of maintaining good oral hygiene, reducing tooth decay, and promoting better gingival health.[1] Various methods are employed to maintain oral hygiene, of which the most common is toothbrushing.[2] It is an effective way of removing plaque, preventing gingivitis, and also managing dental caries.[3] However, the value of uncontrolled toothbrushing in prevention of dental caries has always been questioned.[4] Effective plaque removal depends not only on the type of toothbrush but also on the proper brushing technique.[5] It is obvious that manual dexterity and motivation of an individual are of paramount importance in maintaining oral hygiene.[6] The plethora of literature is enormous on the effectiveness of the toothbrushing for achieving good oral hygiene; however, no study has been carried out exclusively to evaluate the efficacy of supervised toothbrushing by parents and the impact of oral health education on improving the oral hygiene status of school children. More so, no study exclusively has been conducted in the Indian environment. The obscurity in achieving a satisfactory standard of oral hygiene among the rural and few urban areas is of paramount significance when the child is not assisted or supervised by an adult.[7]

Thus, to explore this aim, the present study was designed with the objectives to evaluate and compare the effectiveness of supervised toothbrushing and its impact on oral health in school children of urban and rural communities.

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MATERIALS AND METHODS

Study population and methodology

This comparative study was carried out by the Department of Pediatric and Preventive Dentistry, Nair Hospital Dental College, Mumbai. The research protocol outlining the purpose and precise methodology of this study of 3 months duration was reviewed and approved prior to its implementation by the institutional ethics committee as well as by the administrative authorities of Municipal Corporation of Greater Mumbai and Thane Administration. Two schools, Gilderlane Municipal School of Mumbai Central (urban) and D. J. Galvankar High School, Arnala (rural), were selected for the study. The fluoride level of drinking water samples of the study area is 0.03 mg/l.

The children who were in good general health as well as the permanent residents of the area were included. Children with physical limitation or motor incoordination, medically compromised children, and children with any evidence of significant oral soft tissue pathology other than gingivitis were not included. A total of 200 school children in the age group 12-15 years were selected by stratified random sampling technique from two schools and were further divided into two groups: Group A (urban school; Mumbai - 100 children) and Group B (rural school; Arnala - 100 children). Both the groups were again subdivided into control group and study group having 50 children (25 girls and 25 boys).

The children of the study groups were taught toothbrushing as per bass methodology, using models, charts, and also by live demonstrations under the supervision of parents, and were instructed to brush their teeth twice daily for 2 min using a peanut size of study dentifrice (containing 1000 ppm of fluoride, standardized for all). They were asked to refrain from all other oral hygiene measures during the course of the study. Oral care instructions were specified, which included the topics on importance of oral health, etiology and pathogenesis of oral diseases, methods of oral hygiene maintenance, etc., No intervention was provided to the children in the control groups and routine oral hygiene maintenance procedures were continued. The dentifrices and toothbrushes were provided to all the children who participated in the study, at regular intervals. The children were further instructed to maintain a 3-day diet diary, provided in local language as well as in English. The diet of the children was analyzed for sugar exposure as per the recommendation of Nizel.[8] At each subsequent visit, the feedback regarding the dentifrice usage was recorded.

The recording procedures of decayed, missing, filled teeth and surfaces (DMFT/DMFS), plaque scoring, and gingival index were standardized by sessions of calibration between the investigator and the supervisor. Single examiner recorded all the parameters. Intra-examiner reliability of the recorded data was assessed by re-examining 10% of the children after 2 weeks of the initial examination. The detailed oral health examination was carried out in their respective schools where they were seated on an ordinary chair ensuring adequate daylight, supplemented with a torch (3.0 V DC) to facilitate the examination. The dental caries, plaque score, and gingival status were assessed as per the World Health Organization (WHO) criteria (1997), Turesky-Gilmore-Glickman modification of the Quigley Hein Plaque Index, and Loe-Silness Gingival Index, respectively. Clinical examination after 1 month of baseline examination and further at 3 months interval was carried out to evaluate the plaque scores, gingival status, and dental caries. Data collected were then subjected to statistical analysis using Cronbach's alpha, Chi-square test, pairedt-test, and unpairedt-test.