Exploring Knowledge, Awareness, and Practices Regarding Periodontal Health Assessment and Mechanical Plaque Control Among the Shillong Population of Meghalaya, India: A Descriptive Cross-Sectional Investigation

Background Periodontal diseases are widespread oral health conditions. However, there remains a lack of comprehensive understanding regarding the knowledge, awareness, and practices related to periodontal health assessment and mechanical plaque control among specific populations, such as those residing in Shillong, Meghalaya. Shillong, being the capital city of Meghalaya in northeastern India, represents a diverse demographic and cultural landscape. Aim This study aims to evaluate the knowledge, awareness, and practices related to mechanical plaque control among the population of Shillong City. Methodology A descriptive cross-sectional online survey was conducted among the residents of Shillong City, Meghalaya. Data collection involved the administration of an 18-item, closed-ended, self-structured questionnaire. Before the main data collection, a pilot study was conducted involving 63 individuals. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, NY, USA), employing the chi-square test and ANOVA with a significance level of 0.05. Results Study participants were categorized into five age groups spanning from 21 to 64 years old, with the age group of 41 to 50 years demonstrating the highest mean knowledge score. Age exhibited a statistically significant influence on knowledge scores. Conclusion The study reveals a commendable level of knowledge, awareness, and adherence to practices regarding the primary tool for oral hygiene maintenance, the toothbrush, among the residents of Shillong City.


Introduction
The escalating population growth in India is accompanied by a corresponding increase in the incidence of various diseases, among which periodontal diseases are prevalent, ranging from 50% to 100% across different regions of the Indian subcontinent [1].Periodontal disease stands as one of the foremost dental conditions affecting adults, representing a significant chronic inflammatory ailment affecting a substantial segment of the populace.
Periodontal diseases, encompassing gingivitis and periodontitis, can exert their effects on individual teeth or multiple teeth, potentially leading to tooth loss if left untreated [2].Hence, timely intervention for periodontal issues is imperative to safeguard dental integrity and overall oral health [3].The etiology of periodontitis is multifactorial, with poor oral hygiene and addictive substance habits being prime contributors [4].Of particular concern is the widespread consumption of betel ( Areca) nuts, a prevalent oral chewing habit globally that has been associated with the development of oral cancer.India grapples with an alarming surge in registered oral cancer cases, particularly concentrated in hotspots like the northeastern states of Assam and Meghalaya [1,5].
The onset of addictive habits often begins at an early age, warranting urgent intervention strategies to deter addiction and prioritize oral hygiene, especially in regions like Meghalaya where addictive substance usage is more prevalent [6,7].Prevention of periodontal diseases hinges on effective mechanical and chemical plaque control, necessitating correct periodontal assessment, appropriate tooth brushing and flossing techniques, routine dental checkups, and adherence to suitable dietary practices [8,9].The most effective strategy for preventing periodontal diseases unequivocally lies in the mechanical approach to plaque reduction.While toothbrushing effectively combats gingivitis on buccal and lingual surfaces, its efficacy in interdental spaces is limited [10].Consequently, supplementary materials, such as interdental floss and oral irrigators, have been developed to address this lacuna.
Although the global recommendation for using dental floss as an adjunct to oral hygiene varies, its effectiveness in removing interdental plaque surpasses that of a manual toothbrush alone [11].However, reports indicate that only a minority of individuals utilize dental floss.Despite mechanical plaque removal remaining pivotal in managing periodontal diseases, awareness of its significance remains deficient [12].
Dentists play an integral role in patient education and fostering awareness about preventive measures for periodontal diseases and overall oral health.
To this end, the present study focuses on a cross-section of Shillong, where addictive habits are prevalent, aiming to assess the knowledge, awareness, and practice of mechanical plaque control among the populace.

Inclusion and exclusion criteria
Eligible participants for the study were individuals residing in Shillong who possessed smartphones with internet connectivity.The inclusion criteria stipulated that participants must be over 18 years of age.Exclusion criteria encompassed individuals who declined to provide informed consent, lacked a permanent address within the selected states, or did not possess cell phones.

Data collection
A closed-ended, self-structured questionnaire consisting of 18 items was developed to collect data for the study.The questionnaire was divided into four sections, starting with sociodemographic information, followed by inquiries regarding knowledge, awareness, and practices concerning mechanical plaque control.Before the main data collection, a pilot study involving 63 individuals was conducted, which was not included in the final sample size.The questionnaire was validated by three specialists and a statistician from the Department of Periodontics and Implantology at the Kalinga Institute of Industrial Technology Deemed to be University, with a calculated Cronbach's alpha of 0.85.
The finalized questionnaire was disseminated to the target population using Google Forms (Google LLC, Mountain View, California, United States) via WhatsApp (WhatsApp LLC, Menlo Park, California, United States) and email platforms for known contacts.Informed consent was obtained from all participants.Four incomplete surveys were received and subsequently excluded from the analysis, resulting in a total sample size of 301 individuals.

Statistical analysis
The collected data were imported into Microsoft Excel (Microsoft Corporation, Redmond, Washington, United States) and subjected to analysis using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, NY, USA).Descriptive statistics, such as frequencies and percentages, were utilized to characterize categorical variables.Statistical tests, including the chi-square test and ANOVA, were employed to assess relationships and differences within the data.A significance level of 0.05 was predetermined for all analyses.

Results
In this study, participants were categorized into five age groups spanning from 21 to 64 years old, with 52.8% identified as male and 47.2% as female (Table 1).Furthermore, a comparative assessment of domain scores across gender groups revealed significant differences in all knowledge items except K3 (Table 4).Similarly, items A2, A3, and A5 displayed statistical significance in awareness, while all items except P3 exhibited significance in practice.

Discussion
In 2016, the inaugural endeavor to evaluate India's state-wise Global Disease Burden omitted oral health, an essential component of overall well-being.Instead, this study relied on prevalence data concerning oral diseases spanning from 2001 to 2004 [13].
Periodontitis, a concerning condition, stems from various etiological factors, including inadequate oral hygiene and addictive habits.
Moreover, the widespread consumption of betel nuts, a prevalent oral habit globally, has been implicated in oral cancer development, with India bearing the highest burden of registered cases worldwide.Predominantly, betel nut consumption is concentrated in India's North Eastern Region, coastal areas, and select parts of the northern plains [1,14].
The concept of "periodontal medicine," coined by Offenbacher, encompasses a burgeoning sub-specialty of periodontology that underscores the interplay between periodontal health and systemic well-being [15].This paradigm shift acknowledges bidirectional influences, wherein periodontal health can impact systemic health and vice versa, a relationship that has long been observed alongside traditional dentistry [16].
Fundamental oral health knowledge is pivotal for fostering self-preventive behaviors and adopting effective preventive measures.This includes consistent dental hygiene practices, dietary modifications, and adherence to professional guidance and care [17].Notably, the reduction of plaque formation plays a pivotal role in mitigating the prevalence of dental caries, gingivitis, and periodontal diseases [18,19].
Gender emerges as a consistent determinant of tooth brushing frequency, with females typically exhibiting greater concern for personal hygiene compared to males.This gender disparity underscores the importance of tailored oral health interventions.
A study conducted by Aryal et al. to evaluate the knowledge, attitude, and practices concerning periodontal health among patients visiting a dental college demonstrated good oral hygiene practices among the patients with favorable knowledge and attitude concerning periodontal health and its measures to control the disease [20].A study was conducted by Suragimath et al. to assess the knowledge, attitude, and practices concerning periodontal diseases among school teachers.The results showed that the majority of the teachers had good knowledge about the causes and prevention of gingival diseases, but awareness and practices were poor [21].A cross-sectional study conducted by Cinthya et al. to evaluate the oral health knowledge, attitudes, and behavior of the patients showed a lack of awareness and negligence toward oral health among the general public [22].A study conducted by Kannan et al. among children to assess their awareness of mechanical and chemical plaque control showed that 72% of the population brushes their teeth two times per day [23].
Mechanical plaque control, encompassing knowledge, attitudes, and practices, is indispensable for both personal oral hygiene and patient education [24].Dentists and healthcare professionals play a crucial role in imparting education and motivating patients to adhere to optimal oral hygiene practices, including interdental cleaning procedures [25].This collaborative approach aligns with the evolving paradigm of periodontal medicine, wherein oral health becomes increasingly intertwined with overall health outcomes.Effective communication between dental and medical practitioners is essential, necessitating a deeper understanding of systemic disorders among dental professionals and the integration of new educational objectives within the profession.

Conclusions
In Shillong, there exists a commendable level of knowledge, awareness, and adherence to practices concerning the primary tool for oral hygiene maintenance, namely the toothbrush.However, the utilization of interdental aids to enhance oral hygiene practices among the populace is notably low.Further investigation is warranted to assess the oral health and periodontal status of individuals employing solely toothbrushes versus those incorporating interdental devices into their oral care regimen.Such research endeavors would elucidate the efficacy and routine recommendation of interdental assistance.
In the Indian context, enhancing periodontal knowledge by promoting the utilization of interdental devices alongside toothbrushing represents a pivotal public health imperative.Emphasizing the intrinsic link between dental health and overall bodily well-being is paramount.

TABLE 2 : Responses of study participants (n = 301)
Analysis of knowledge, awareness, and practice domain scores revealed variations across age groups.Notably, individuals aged 41 to 50 years demonstrated the highest mean knowledge score of 3.40 ± 1.384, with age exerting a statistically significant influence on knowledge scores.Additionally, significant differences were observed among participant groups concerning awareness and practices in items A1-A5 and P1-P5 (Table3).

TABLE 3 : Knowledge, awareness, and practice of study participants according to gender
* indicates a significant difference at p ≤ 0.05