|Year : 2016 | Volume
| Issue : 2 | Page : 130-136
Evaluation of dent-o-myths among adult population living in a rural region of Andhra Pradesh, India: A cross-sectional study
Ghanta Bhanu Kiran, Srinivas Pachava, Suresh Sanikommu, Bommireddy Vikram Simha, Ravuri Srinivas, Vinnakota Narayana Rao
Department of Public Health Dentistry, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
|Date of Web Publication||5-Jul-2016|
Ghanta Bhanu Kiran
Department of Public Health Dentistry, SIBAR Institute of Dental Sciences, Takkellapadu, Guntur - 522 509, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Context: Even though dentistry is one of the very highly developed fields among the medical sciences, false traditional beliefs and nonscientific knowledge may seed myths that create hindrance in the recognition of scientific and modern dental treatments, thereby acting as a barrier against the utilization of oral health-care facilities.
Aims: The present study was an attempt to evaluate various dental myths prevailing in a rural population.
Settings and Design: The study sample comprised of 305 subjects aged 18 years and above, acquired from six randomly chosen villages of Guntur district in Andhra Pradesh, India.
Materials and Methods: A cross-sectional questionnaire survey was carried out to assess the various dental myths.
Statistical Analysis Used: The data were analyzed using chi-square and multinomial logistic regression tests in SPSS version 20.
Results: The mean age of the study population was 38.03 15.15 years, 57.4% of whom were males and 42.6% females. Of the subjects, 58.7% felt that deciduous teeth did not need any treatment procedures as they would be exfoliated anyway; 40% of those who had never visited a dentist before felt that extraction of the upper teeth affected eye vision. Of individuals aged 18-39 years, 47.6% believed that cleaning with salt made teeth white and shiny. Only a few (3.9%) believed absolutely no dental myths, whereas most (96.1%) believed one myth or another.
Conclusions: The results of this study revealed that dental myths are still prevalent and that they need to be addressed to achieve optimal dental health.
Keywords: Dental myths, false traditional beliefs, nonscientific knowledge, oral misconceptions, taboos
|How to cite this article:|
Kiran GB, Pachava S, Sanikommu S, Simha BV, Srinivas R, Rao VN. Evaluation of dent-o-myths among adult population living in a rural region of Andhra Pradesh, India: A cross-sectional study. J NTR Univ Health Sci 2016;5:130-6
|How to cite this URL:|
Kiran GB, Pachava S, Sanikommu S, Simha BV, Srinivas R, Rao VN. Evaluation of dent-o-myths among adult population living in a rural region of Andhra Pradesh, India: A cross-sectional study. J NTR Univ Health Sci [serial online] 2016 [cited 2020 Mar 31];5:130-6. Available from: http://www.jdrntruhs.org/text.asp?2016/5/2/130/185451
| Introduction|| |
Oral diseases make significant contributions to the global burden of disease, which is particularly high in the underprivileged groups of both developed and developing countries.  For any country to advance, health care should always be among the top-priorities. India is now among the top three countries in the production of scientific manpower. For a population of over 1.2 billion, there are currently over 1,80,000 dentists and the number is expected to grow to 3,00,000 by 2018.  The dentist-to-population ratio in India as mentioned in a report by the Central Bureau of Health Intelligence was 1:10,271 in 2011.  While the World Health Organization (WHO) recommends a dentist-to-population ratio of 1:7500, there are some states in India with a dentist-to-population ratio as high as 1:5000. Even with all these improvements in numbers, the prevalence of oral diseases in India is still high.  The prevalence is particularly high in rural areas due to underutilization of dental services available in rural areas and the accretion of dentists in urban areas.
Culture is often defined as coherent, shared patterns of actions or beliefs specific to named groups of people that provide basic life roadmaps or social contexts, defining behavioral norms and interpersonal relationships as well as unwritten rules for proper living.  Culture has its own influence on health and sickness. The influence of culture is seen in every discipline of health and medical practices, and dentistry is no exception. Society and culture, which are linked to behavioral patterns, largely influence the health outcomes of a population. Information on the status of oral health of the different populations in the USA, North Africa, and Asia suggests that people from specific ethnic minorities often have poor oral health status. , Being part of an ethnic minority group does not inevitably lead a person to have poor oral health. Underlying cultural beliefs and practices influence the conditions of the teeth and mouth, through diet, care-seeking behavior, or use of home remedies. It does suggest that there are certain cultural beliefs and practices common to people that influence their dental service utilization and oral health status. , In India, a country of diverse ethnic groups, geographical character, cultures, and religions, there is a need to explore the influence of social factors on oral health.
Sociocultural factors, false traditional beliefs, lack of proper education, and nonscientific knowledge may seed dental myths. , Furthermore, it is no myth that dental work can be frightening sometimes. With so much unnecessary stress and anxiety built up around dentists and dental health, it is not surprising that several myths were made up over the years to help explain or even alleviate dental issues. Often, people choose to believe these myths rather than finding out the truth and, after a while, the myths can become so ingrained in their respective cultures that it is hard to tell fact from fiction.
Dental health-related disbeliefs and misconceptions, when handed down from one generation to next, can be called dental myths. To have such beliefs indicates an acceptance that something exists or is true, especially one without proof. A misconception is defined as a belief or an idea that is not based on correct information. Myths are defined as stories shared by a group of people that are part of their cultural identity. They have a strong influence on the life of individuals and their way of living, including seeking treatment during illness. , Myths and misconceptions are present in all cultures, all professions, and on all subject matters. While some dental myths are provincial, others are heard everywhere. A close look at tales about "deciduous teeth" that exfoliate gives an idea of how myths vary from one region to another.
- The tooth fairy is a character in modern Western culture said to give children a small gift in exchange for a deciduous tooth when it comes out of a child's mouth. Years ago in Europe, children threw lost teeth in mouse holes, hoping that they would grow sharp teeth. In northern Europe, there was a tradition of a "tooth fee," which was paid when a child lost his/her first tooth. ,
- Children in Asian countries such as India, China, Japan, Korea, and Vietnam toss their lower teeth on the roof and bury their upper teeth in the ground, trusting that the new teeth will grow toward the old teeth and be straight. ,
- In Middle Eastern countries including Iraq, Jordan, Palestine, Egypt, and Sudan, there is a tradition of throwing a baby tooth up into the sky toward the sun or to Allah. ,
Although modern dentistry has come a long way and evidence-based dentistry is on the rise, most people still have some preconceived, false notions about dental care. These preconceived false notions or dental myths can at times be detrimental and result in various degrees of disability. Dental myths thus need to be tackled to facilitate the appropriate utilization of dental services and restrict disability to the bud stage. A study conducted in a North Indian rural population reported 81% prevalence of one or more dental myths,  and a 95.2% prevalence was reported in another study in Karnataka.  Comparable studies were also conducted in Uttar Pradesh and Tamil Nadu. ,, Exploration of the available literature related to myths about dentistry revealed hardly any data from Andhra Pradesh, though myths related to oral diseases and oral health-related practices are very common in the rural population of India, The current study was done to evaluate various dental myths that prevail in a rural population residing in a coastal area of a southern Indian state, Andhra Pradesh.
| Materials and methods|| |
A cross-sectional study was conducted on adults aged 18 years and above using a schedule, in six villages randomly selected from among the 13 villages in Pedakakani Mandal, Guntur. Guntur is a district in the Indian state of Andhra Pradesh, on the eastern coast of the Bay of Bengal. It covers an area of 11,391 km 2 and is divided into 57 administrative areas.  As per the 2011 census, the total population of Pedakakani Mandal was approximately 64,693, the male population being approximately 32,779.  The current study was approved by the Institutional Ethics Board of the Sibar Institute of Dental Sciences, Guntur. The inclusion criterion included subjects who were above 18 years of age and who were continuous residents of that particular village for at least 10 years. The study procedure was explained to villagers, and those unwilling to participate in the study were excluded. Informed consent in verbal form was accepted as adequate by the Ethical Review Board.
To begin with, a pilot study was done on 30 individuals to find out the prevalence of dental myths and to test the reliability and validity of the schedule. Internal consistency was estimated via Kuder-Richardson Formula 20 and it was satisfactory. The prevalence obtained was used for sample size calculation, and informed verbal consent was taken from all the 305 individuals randomly selected from the six villages included in the study. All the randomization procedures in this multistage sampling were of the nonreplacement type. Review of the literature that was available on dental myths and the experiences that we had while dealing with patients in this region of India were helpful in preparing the schedule. The questionnaire was prepared in the English language first and later translated to Telugu (the local language). The Telugu version was later translated back into English and checked for language reliability and content validity. The questionnaire was self-designed and authenticated for validity and reliability during the pilot study (kappa coefficient value = 0.82; P value = 0.002). The first part of the schedule included information about demographic data and the second part was a questionnaire on dental myths. About 16 myths were studied in total, and the responses were recorded on a dichotomous scale. Data were collected through a schedule instead of by mailing the pretested questionnaire, to overcome the hurdle of illiteracy, and the study procedure continued for a period of 3 months in 2014.
The level of knowledge on the subject of dental myths was graded as low knowledge (respondents with 11-16 myths), medium knowledge (respondents with 6-10 myths), good knowledge (respondents with 1-5 myths), and excellent knowledge (subjects with no myths). Chi-square test and multinomial logistic regression analysis were used for statistical comparisons and P ≤ 0.05 was considered statistically significant. The data were analyzed using SPSS version 20.0 (Armonk, IBM Corp., NY).
| Results|| |
The study population had a mean age of 38.03 ± 15.15 years, and 57.4% consisted of males and 42.6% of females. This male/female ratio in the present study contradicted that of the 2011 census in this region, which can be attributed to the fact that more females were reluctant to participate in the study when compared to males. Out of the total sample, only 42.6% (n = 130) of subjects had visited the dentist at least once in their lifetime. Not many individuals (n = 17) in this study had higher education, as the study was done in rural areas [Table 1]. Individuals aged 18 years and above were included in the study and the percentage distribution by age was 62% (18-39 years), 32.1% (40-64 years), and 5.9% (>64 years). The inclination of population distribution percentage was similar to that given by the government of India in the 2011 census. Regarding professions, 36% of the study population were farmers/small-shop-owners; 33% were unskilled/semiskilled/skilled workers; 27% were unemployed; and 4% were semi-professionals/professionals. Of the study population, 70% had a family income of 4810-12019 INR per month. The education, income, and occupation were classified based on the Kuppuswamy scale;  however, instead of the family head's education and occupation, in this study the participant's data were collected.  No attempt was made to calculate socioeconomic status, as the study was focused on the sociocultural dimension. Though socioeconomic status were not intended to be measured, Kuppuswamy classification criteria for education, occupation, and income levels in rural areas were used, only to maintain a universal standardization system. Limitations in the practical use of socioeconomic scales  compelled us to take this decision, moreover, to facilitate the comparison of the present results with the results of similar studies scheduled in urban areas in the near future.
That deciduous teeth do not need any treatment procedures as they will be exfoliated anyway, was the most prevalent myth (n = 179) found in the study. Next was that 52.5% (n = 160) of the respondents felt that cleaning with salt makes teeth white and shiny. Of the subjects, 32.8% (n = 100) felt that extraction of the upper teeth affects eye vision. When the responses of males and females to various dental myths were compared using the chi-square test, males significantly outnumbered females for belief in the myth that the use of twigs instead of toothbrushes is effective for the maintenance of good oral hygiene (P = 0.000) and that drinking alcohol will reduce tooth pain (P = 0.000). A higher number of females than males felt that having midline diastema or anterior teeth malocclusion is lucky [P = 0.019, [Table 2]].
Those who had not visited a dentist at least once till date believed more dental myths than did those who had visited the dentist at least once, which establishes that people with more dental myths are less likely to utilize dental services. The health education and awareness provided by a dentist to the patient also might have influenced the distribution pattern. Myths such as that drinking alcohol reduces tooth pain (P = 0.016); that the use of twigs instead of toothbrushes will be effective for maintenance of good oral hygiene (P = 0.003); that extraction of upper teeth affects eye vision (P = 0.002); burying exfoliated teeth or placing them in cow dung (P = 0.047); and that using tobacco or tobacco products as a remedy for tooth pain is effective (P = 0.048) were found significantly more in those who had not visited a dentist at least once till date [Table 3].
Significant differences in positive responses were found between various levels of educational status for the dental myths that cleaning with salt makes teeth white and shiny (P = 0.045), that removal of milk teeth will lead to noneruption of permanent teeth (P = 0.012), and that tooth infections are because of God's curse (P = 0.028). Of subjects aged 40-64 years, 63.3% felt that cleaning with salt makes teeth white and shiny, which is statistically significant (P = 0.033) when compared to other age groups. Of all the individuals who participated in study, 2% (n = 6) had low knowledge about dental myths, 20.3% (n = 62) had medium knowledge, 73.8% (n = 225) had good knowledge, and 3.9% (n = 12) had excellent knowledge. Bivariate analysis of the distribution of different grades of knowledge in the study subjects according to age groups, gender, and previous dental visit revealed no significance [Table 4].
|Table 4: Distribution of level of knowledge in the study subjects according to age groups, gender, and previous dental visit|
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Males when compared to females were less likely to have medium, good, or excellent knowledge than poor knowledge. Similar results were produced when illiterate subjects and educated subjects were compared. Respondents who had not visited the dentist previously when compared to those that had visited at least once were less likely to have good or excellent knowledge than low knowledge. However, the differences that were found are not statistically significant [Table 5].
|Table 5: Association of gender, education, and previous dental visit with levels of knowledge about myths|
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| Discussion|| |
Health belief theory states that dental health beliefs are associated with dental health behaviors. Unfavorable oral health beliefs are related to increased odds of having poor self-rated oral health, increased risk of gingivitis, high plaque score, and tooth loss due to caries. Individuals with favorable dental beliefs tend to have better oral health than those who do not, particularly in terms of gingivitis, self-rated oral health, and tooth loss due to dental caries.  Oral hygiene practices may vary from one region to another depending on local traditional beliefs. Myths such as that using coal for cleaning teeth makes them strong, that cleaning with salt makes teeth white and shiny, and that the use of twigs instead of toothbrushes will be effective for the maintenance of good oral hygiene, will have a negative effect on oral health as these are not recommended oral hygiene practices. Though the extracts of many twigs/stems of plants have yielded potent antimicrobial and antiplaque substances, the disadvantages include gingival trauma and occlusal wear. Usage of coarse materials such as coal and salt in cleaning procedures could abrade the enamel and damage periodontal ligament. 
Although deciduous teeth are not permanent, problems in permanent teeth can develop in the long term if deciduous teeth are not properly cared for. Caregivers of young children frequently feel that the first teeth are not as important as the permanent teeth. , It is crucial that children learn the basics of proper oral hygiene at an early age. Doing so will help them form permanent habits that are essential for oral health. Furthermore, early loss of milk teeth will interfere with chewing and affect the child's nutrition, which leads to drifting of the adjacent teeth and closure of some of the space that is required for the succeeding permanent teeth to erupt into. Such a loss of space will cause the permanent teeth to erupt in irregular positions and result in crowding. Therefore, milk teeth need to be cared for as much as permanent teeth. It is advisable to start the habit of cleaning the infant's teeth soon after they appear in the mouth. In fact, it is advised to clean a baby's gum pads every day by gentle massage even before the teeth erupt.  Only 37.5% of the subjects considered the retention of baby teeth to be important in a study by Saad Ahmed Khan et al. 
Regarding another dental myth, 20% of subjects as reported by Saravanan et al.,  32.8% in the present study, and 36.4% in a study done by Vignesh et al.  felt that extraction of upper teeth affects eye vision. One possible reason for the development of this myth is that when an abscess develops from any of the maxillary anterior teeth, the patient may sometimes develop a large swelling under the eye leading to the closing of that eye. Such a situation may lead to fear that the eye is getting affected because of the tooth. The other reason could be that people start losing their teeth in middle age, which can coincide with the period when people start to develop short sight and are in need of glasses. This may have prompted some to incorrectly come to the conclusion that the extraction of upper teeth affects eye vision.
While scaling actually helps teeth to be more strongly held by the surrounding gums and bone, and promotes oral health, 24.6% of respondents in the current study stated that professional scaling creates sensitivity, mobility, and gaps between teeth; this is in concordance with a myth among Hispanics/Latinos, as found by Vazquez et al.  In addition, 63.2% responded similarly in a study done by Vignesh et al.,  and Tewari et al.  noted 82% prevalence of a similar myth. The fact that the calculus would have been filling the gaps, masking mobility and sensitivity, and that only after removal of the calculus would the underlying dentin be exposed, resulting in sensitivity of teeth, should be emphasized along with the oral prophylaxis procedure.
Professional dental cleanings can be performed at any point during pregnancy. Emergency dental care can also be performed at any time with physician clearance. However, 21.3% of subjects in the current study were of the opinion that dental treatments should not be done during pregnancy, while 56.8% were of that opinion in an earlier study by Vignesh et al.  Awareness should be created regarding the oral foci of infection, which when untreated can lead to a baby with preterm low birth weight.
Dental myths were more marked in less educated groups in the current study, analogous to what was reported by Singh et al. and  Khan et al.  Males had more myths, contradicting the outcome of a prior study done by Singh et al.  where females had more myths. In the current study 52.5% and in a study done by Vignesh et al.  56.8% felt that cleaning with salt makes teeth white and shiny. In contrast, only 15% felt so in the study done by Saravanan et al.  Apart from the discussion on whether salt causes whitening of teeth or not, this practice can definitely cause abrasion of teeth, and dentinal sensitivity shoots up.
In contrast to the present study, bivariate analysis of distribution of the level of knowledge about dental myths in the study population with gender was found to be significant in a study by Kanduluru et al.  Only a small percent (3.9%) of the individuals are absolutely without dental myths, whereas most of them (96.1%) have one myth or the other. This demonstrates a need for a health promotion program in this area emphasizing scientific dental practices.
- The study design being cross-sectional and observational could only unearth information about the prevalence of dental myths. Further studies in longitudinal design are required to know the association of risk factors involved, to completely eradicate myths.
- Use of the Kuppuswamy classification criterion for education, income, and occupation
- Taking account of myths that are predominantly observed in this region restricted our study to one mandal. However, some myths that can be generalized to all areas can be studied over a large area.
| Conclusion|| |
The present study shows that there is a need to educate people more about the facts of dentistry. The dentist should be aware of the various myths about teeth prevailing in a particular area in order to educate and provide correct information to patients. The dentist should also maintain good rapport with the patient so that the patient openly tells him/her about his/her beliefs and gets a clearer idea. It is our responsibility to debunk harmful dental myths and promote the truth. Villages, which constitute a large part of India, should be given due attention for dental health education and awareness programs in an effort to reduce the disparities between rural and urban communities. In addition, measures to achieve equal utilization of dental services in rural/urban localities should also be taken by the government authorities.
We wish to thank all the participants in the study for their cooperation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]