ORIGINAL RESEARCH

https://doi.org/10.5005/jp-journals-10062-0123
Journal of Oral Health and Community Dentistry
Volume 16 | Issue 1 | Year 2022

Patterns, Practices, and Level of Buccodental Hygiene in Individuals Aged 5 to 17 Years in Bafia, Cameroon

Blaise Nguendo-Yongsi

Institute for Population Studies, University of Yaounde II, Yaounde, Cameroon

Corresponding Author: Blaise Nguendo-Yongsi, Institute for Population Studies, University of Yaounde II, Yaounde, Cameroon, e-mail: nguendoyongsi@gmail.com

How to cite this article: Nguendo-Yongsi B. Patterns, Practices, and Level of Buccodental Hygiene in Individuals Aged 5 to 17 Years in Bafia, Cameroon. J Oral Health Comm Dent 2022;16(1):9–13.

Source of support: Nil

Conflict of interest: None

ABSTRACT

Background: Oral hygiene is a set of practices aiming to remove dental plaque on the surface of the teeth. Although its importance is recognized in public oral health, dental health status of the population is far to be well understood.

Research objectives: This study aims to describe oral hygiene habits and practices and to highlight the status of oral hygiene among a younger population.

Methods: A cross-sectional epidemiological study in 1,629 individuals aged 5–17 years was carried out. Those individuals were selected among the 50 enumerated areas that make up the city. We resort to a quantitative approach (using descriptive methods) and to qualitative technique in order to well understand adolescents’ practices regarding dental hygiene.

Results: The study revealed that 82.1% of the respondents brush their teeth, but in an irregular or once daily (78.3%), with very few who respect the brushing technique in accordance with the World Health Organization (WHO) recommendations (12.9%). The cleaning products used are varied: fluoridated toothpaste (54.7%), tooth powder (12.2%), and use of fingers and pieces of tissue (about 2%). Analysis of the debris index and the tartar index shows that the level of oral hygiene in Bafia is poor (72.2%).

Learning objectives: It is important to establish oral hygiene programs or strengthen existing programs, with emphasis on the effective use of fluorides for the prevention of dental caries, promotion of oral hygiene in schools, integration of oral health into national and community health programs.

Keywords: Adolescents, Bafia, Brushing technique, Cameroon, Children, Cleaning agents, Dental health, Dental hygiene habits.

INTRODUCTION

Oral diseases are one of the most prevalent problems throughout the world. The World Health Organization (WHO) emphasized that despite great improvements in the oral health of the population, global problems still persist.1 As oral health and general health are interrelated, a preventive approach consisting of daily oral hygiene procedures and regular checkups can stabilize progressive lesions and prevent acute complications, thereby contributing to a gratifying oral function and satisfying quality of life.2 Oral diseases among young individuals are of special concern because two-thirds of them experience oral health conditions. A necessary condition for maintaining oral health entails to seriously taking care of the oral cavity (mouth). This can only be achieved through oral hygiene. Defined as a set of living practices to ensure good oral health, oral hygiene is essential for the general condition and quality of life.3 It participates in the ability to speak, smile, touch, chew, and express emotions through facial expressions confidently, without pain and without embarrassment. A recent study revealed that oral hygiene is an important public health concern and that oral diseases have significant negative effects on people’s quality of life. Globally, oral disease is a major global public health problem affecting more than 3.5 billion people, and more than 70% of the world’s population (mainly in low- and middle-income countries) do not have access to adapted and affordable oral care.4 These oral diseases and conditions are the source of a significant disease burden in many countries and their effects are felt throughout life, causing discomfort, pain, disfiguring lesions, and even death. However, so far dentistry has not been able to tackle this problem decisively. As oral health is a fundamental human right, WHO has identified priority areas on which efforts should be focused. Among others, we have maintenance of oral hygiene and prevention of oral diseases. It is on the strength of this recommendation and especially of the fact that oral health is a resource of daily life and not the goal of life that we undertook this study whose objective was on the one hand to study oral hygiene habits and on the other hand to highlight the status of oral hygiene within the population, especially since their oral health status is not well known due to the scarcity of surveys carried out in this area. All this is the interest of effectively preventing oral disease, mapping oral disease, and developing a prevention program at the community level.

MATERIALS AND METHODS

Study Area

This study focuses on the city of Bafia, which is located in Cameroon slightly above the Equator between 4°40’00”–4°47’00” latitude North and 11°07’30”–11°17’30” longitude East. It is a secondary city located about 120 km from Yaoundé the national capital of Cameroon, at 1,100 and 1,300 m above sea level, and over the southern Cameroonian plateau in the Mbam-and-Inoubou department, over an area of approximately 1,300 km2. She experiences a typical Equatorial climate: regular and abundant rainfall (1,500 mm/year), an annual average temperature of 25°C, and four seasons (two dry seasons and two rainy seasons). With an estimated population of 69,270 inhabitants, Bafia has an average density of 800 inhabitants/km2. This population is unevenly distributed, because there are high-density areas such as the Riidiébi communities in Ngam and Biabiri.5 Bafia is essentially an administrative city. Economic activities are dominated by agriculture, hunting, fishing, and other informal activities such as catering and small retail trade.

Study Design, Target Population, and Sampling

An epidemiological survey under an observational and descriptive cross-sectional design was conducted. The survey targeted only individuals aged 5–17 years, because this age-group represents the population at risk of several infectious health conditions in the country. The sampling size was determined using the following formula:

(n: size of the sample; e: sought precision; f: average household size; k: nonresponse rate; r: proportion of households with health conditions; z: value of the normal distribution for the desired confidence level 1 − α; and p: expected coverage or prevalence rate). From this, a size of 1,683 individuals was determined. The study being a cross-community one (i.e., covering the whole city of Bafia); individuals were selected in each of the 50 enumeration areas that make up the city. After determining the draw step, we generated a random number thanks to the Excel tool ALEA.ENTRE.BORNES; the random number did constitute the first household in the sample; we added the draw step q to this random number and got the number of the second household; we repeated the procedure until we obtained the determined sampling size.

Data Collection and Management

In the selected households, we conducted both sociodemographic and clinical surveys. The first was conducted using a structured and standardized questionnaire containing items on gender, school attendance, parents’ socioprofessional activity, dietary habits, buccodental practices, etc. As for the clinical dimension, examination was done by three odontostomatologists according to the WHO Basic Oral Health Assessment.6 All selected subjects were examined by examiners seated on a chair and examined under natural light using standardized instruments (dental mirror, precell, WHO spherical tip probe, periodontal probe, and gloves). Data obtained were compiled systematically, transformed from a precoded proforma to a computer and a master table was prepared. The total data were distributed meaningfully and presented as individual tables along with graphs. Descriptive statistical analysis has been carried out in the present study. The statistical software, namely Statistical Package for the Social Sciences (SPSS) 18.0, was used for the analysis of the data, and Microsoft Excel was used to generate results.

Ethical Clearance

The study was approved by the Institutional Research Ethics Board for Human Health of the School of Health Science (Catholic University of Central Africa). The informed consent of each individual was taken prior to recording oral health.

RESULTS

Demographic Details

A total of 1,683 individuals were selected to participate to this study. However, 1,629 completed the questionnaires and properly undertook the clinical examination, yielding a response rate of 96.8%. Of the 1,629 individuals, 835 (51.2%) were males and 794 (49.8%) were females, that is, a sex ratio of 1.0. Majority of the study population belonged to the age-group of 15–17 years (47.1%) and 10–15 years (44.8%). The school attendance varied among the respondents with majority of them (51.8%) attending a secondary school. Table 1 also indicates that a high proportion consume foods rich in adhesive sugars (72.7%) and sweet drinks (56.8%).

Table 1: Sociodemographic characteristics of the respondents
Variables Count Percentage
Gender
Male 835 51.2
Female 794 49.8
Age (years)
[05–10] 131 08.1
[10–15] 730 44.8
[15–17] 768 47.1
School attendance
No 75 04.6
Nursery school 210 12.9
Primary school 501 30.7
Secondary school 843 51.8
Parent’s economic activity
Unemployed/retired 64 03.9
Civil servants 126 07.7
Informal activities 927 56.9
Farmer/hunter 512 31.5
Dietary habits*
Foods rich in adhesive sugars 1,185 72.7
Sugar-free sweets 282 17.3
Sugar milk and dairy products 351 21.5
Fruits 532 32.6
Foods with semihydrolyzed starch 428 26.3
Sweet drinks 926 56.8
Sugar-free foods 381 23.4
*Respondents could provide more than one answer

Oral Health-related Behavior

Table 2 indicates that it was noticed that 82.1% brush their teeth, using toothbrush (74.0%) or stick rubs tooth (22.5%). Though 22.1% do not use any tooth cleaning products, 54.7 and 12.2%, respectively, use toothpaste and tooth powder for cleaning. Only 15.7% of the respondents brush their teeth twice daily, and most of them on waking (96.3%). Furthermore, 46.2% of the participants brushed their teeth with a soft-bristled brush, whereas 16.3% use hard-bristled brush. Only 31.2% of the participants clean their teeth for about 2 minutes, and nearly 50% of them use their toothbrushes for more than 3 months or to the full length of the bristles. Regarding the direction of brushing stroke, only 12.9% brush their teeth in a combination of vertical, horizontal, and circular motion. And only 11.8 and 12.5% again of those adolescents have the habit of cleaning their tongue and of rinsing their mouth after meals, respectively.

Table 2: Oral health-related behaviors and practices
Count Percentage
Teeth brushing/cleaning (n = 1,629)
No 292 17.9
Yes 1,337 82.1
Frequency of teeth brushing (n = 1,337)
Once daily 1,047 78.3
Twice daily 210 15.7
More than twice daily 80 06.0
Teeth brushing timing (n = 1,337)
On waking 1,288 96.3
After meals 41 03.1
At bedtime 08 00.6
Duration of brushing (n = 1,337)
Less than 2 minutes 870 65.1
2 minutes 417 31.2
More than 2 minutes 50 03.7
Tooth cleaning instrument
Piece of cloth or sponge 16 01.2
Finger 29 02.2
Stick rubs tooth or chewing sticks 302 22.6
Toothbrush 990 74.0
Type of toothbrush used
Hard bristle 218 16.3
Medium bristle 501 37.5
Soft bristle 618 46.2
Frequency of replacement of the toothbrush
1–2 months 198 14.8
2–3 months 472 35.3
>3 months or until the bristles are worn out 667 49.9
Direction of the brushing stroke
Vertical 589 44.1
Horizontal 491 36.7
Circular 84 06.3
Combination of above 173 12.9
Teeth cleaning aids used with a toothbrush
Toothpaste 731 54.7
Tooth powder 163 12.2
Charcoal or ash 71 05.3
Chewings 49 03.7
Salt or baked soda 27 02.0
None 296 22.1
Habit of cleaning the tongue
Yes 158 11.8
No 1,179 88.2
Habit of rinsing the mouth after meals
Yes 167 12.5
No 1,170 87.5

Level of Oral Hygiene

The level of oral hygiene was measured using the Simplified Oral Hygiene Index (OHIS). OHIS is an index made up of the Simplified Debris Index (DIS) and the Simplified Calculus Index (CIS), each of these indices being at turn based on 12 numerical determinations representing the amount of debris or tartar found on the buccal cavity and on lingual surfaces of each of the three oral cavity segments. Table 3 shows that three-quarters of those examined have a DIS fair and low and a simplified tartar index equally low and fair.

Table 3: Debris and calculus indices
Count (n = 1,629) Percentage (%)
Debris indice1
Low 96 07.2
Fair 218 16.3
High 1,023 76.5
Tartar or calculus indice2
Low 148 11.1
Fair 372 27.8
High 817 61.1
1The debris index was measured tooth by tooth with a score of 0–3, using the plaque developer. The result was noted as follows: 0: no deposit or stain present on the tooth; 1: soft deposits covering less than one-third of the tooth surface or presence of stains; 2: soft deposits covering more than one-third of the tooth surface but less than two-thirds of the teeth; and 3: soft deposits covering more than two-thirds of the tooth surface. Low, soft debris is absent or covers less than one-third of the surface of the exposed tooth; Fair, soft debris covers more than one-third of the surface of the exposed tooth; High, soft debris covers more than two-thirds of the surface of the exposed tooth
2To measure the tartar index, the periodontal probe was inserted into the sulcus of the tooth and moved horizontally from one contact area to another. Tartar was also quantified tooth by tooth with a score of 0–3. The result was noted as follows: 0: no tartar; 1: supragingival calculus covering less than one-third of the tooth surface; 2: supragingival calculus covering more than one-third of the tooth surface or distinct patches of subgingival calculus around the cervical portion of the tooth or both; and 3: supragingival calculus covering more than two-thirds of the tooth surface. Low, No tartar or supragingival tartar covering no more than one-third of the exposed surface of the tooth; Fair, Supragingival tartar covering more than one-third but not more than two-thirds of the exposed surface of the tooth, or the presence of spots of subgingival tartar around the cervical part of the tooth or both; High, Tartar covering more than two-thirds of the exposed surface of the tooth or a continuous band of subgingival tartar around the cervical portion of the tooth, or both

The OHIS was obtained by adding the debris index and the tartar index. Table 4 shows the general level of oral hygiene among those adolescents. Thus, we see that the level of hygiene in the entire population is poor (72.2%).

Table 4: Level of buccodental hygiene among individuals aged 5–17 in Bafia
Count (n = 1,629) Percentage (%)
Niveau
Poor 2,050 72.2
Fair 469 16.5
Good 321 11.3
The OHIS = individual mean scores of debris indices + mean scores of tartar indices. Poor, average score between 1.9 and 3.6; Fair, average score between 0.7 and 1.8; Good: average score between 0.3 and 0.6

DISCUSSION

Buccodental hygiene is a set of practices that help get rid of food debris, prevent periodontal disease, and be healthy. These practices date back to prehistoric times, precisely to the Paleolithic when initial observations of gingivitis, tartar deposits, and loosening of teeth were made on samples of human teeth.7 It is therefore understandable why worldwide habits tend toward prophylaxis and promotion of good oral health. In Bafia, teeth cleaning is perceived as part of personal hygiene, as people here believe that oral hygiene helps to keep the mouth clean, healthy, and in good health and therefore ensure well-being. Such a knowledge that poor dental health can increase general health conditions was once the concern of Etruscans and Egyptians during the Pharaonic era8 and has just turned to be currently a daily concern of many communities around the world.9–11 Most of those young people brush their teeth irregularly or just once a day when they wake up. This habit, mentioned in some previous studies,12,13 clearly indicates that brushing remains a pattern related to personal hygiene and therefore without connection with meals. Yet, it is recognized by Jessor et al.14 and to Albino15 that to properly fight against plaque buildup, brushing should be done after meals and that in the case of a single brushing, the best is to do so in the evening, so the bacterial plaque is eliminated before sleep because during the night, salivary secretion decreases. The study showed that most adolescents brush their teeth for less than 2 minutes; a finding close to that of Mosha et al.16 However, we should mention that such a time duration is insufficient because dental plaque responsible for dental caries builds up very slowly, and therefore, brushing should be 2 or 3 minutes.17 The fact that the majority of youth use toothbrushes is encouraging from a dental health promotion perspective. It shows that despite a precarious economic situation, use of toothbrush is still popular since its invention by the Chinese in the year 1500. The relatively low cost of toothbrushes and their availability in almost all small shops probably explain this widespread use. This result is nonetheless contrasted by those of Niazi et al.18 and Norton et Addy,19 who indicated that teeth rubbing sticks are common instruments used in east and west rural African communities. Chewstick has appeared to be the second most used instrument by the youths in Bafia. This finding is close to that of Lababidi20 and Daluz.21 As first used by the Babylonians between 7000 and 3500 BC, chew sticks are still used in Bafia because they derive from plant species (such as Maytenus Senegalis, Présopis, Africana Potentilla Rubra) which contain chemical elements such as fluorine, sulfur, bicarbonate, tannin, alkaloids, essential oils, well known for their antibacterial and antifungal properties, and in salivary stimulation.22,23 They are very beneficial for the strengthening of the gum, and in addition, they contain a substance that facilitates digestion and protects the teeth against limescale. In their studies, Garcia24 and Chen et al.25 have emphasized the cleaning technique as a determining factor for good oral hygiene. However in Bafia, only few youths use the right technique, as previously reported by Otuyemi et al. and Sarita et al.26 According to the WHO guidelines, the recommended direction of the brushing stroke is as follows: place the toothbrush at a 45° angle at the edge of the gum, brush the teeth in a circular manner on-site to effectively clean between the teeth and the edge of your gum and then gently lift from the gums to the crown of the tooth. Among the cleaning products associated with brushing in Bafia, fluoridated toothpaste is the most frequently used (54.7%). This result is similar to studies on oral hygiene habits and practices conducted by Petersen27 and Majoli.28 As popularized in the 17th century by the French nobility for whom oral hygiene had a purely aesthetic aim, toothpaste has turned as the main cleaning product due to the fluoride it contains and which stops the development of bacteria, protects tooth enamel, and eliminates tooth staining. This can also be attributed to increasing sources of information available through mass media and health education posters available in the schools. Tooth powder used by some youths is a mixture of crushed pumice stone, oyster shells, eggshells, crushed ginger, and honey or mint. With powerful astringent properties, these substances are believed to prevent tartar development, strengthen enamel, and improve smiles. As reported by Ahouah,29 tooth powder is a “two products in one formula” because of its dual role: hygienic and aesthetic. Another finding is that the youth use chews or masticatory to clean their teeth. The preferred masticatory here is Kola nut and Garcinia kola Heck called bitter-kola because of its bitter taste. Both contain alkaloids and tannoids which would have a coagulating action on the bacterial plaque and would stimulate the formation of reactive dentin, thus stopping the development of caries. In addition, they are thought to have sialagogic, tonic, stimulating, and aphrodisiac effects.30 It is unfortunate to know that 88.2% of the youths do not have the habit of cleaning the tongue, slightly higher than that reported by Sofola et al.31 In a study among university students in Benin, Djossou et al.32 indicated that nearly 70% had the habit of rinsing the mouth after every meal, whereas 12.5% had reported the habit in the present study indicating their poor practice of cleansing out the tucked food particles. Regardless of the number of daily brushing, brushing techniques, and cleaning products used, the study underlines that oral hygiene among youth in Bafia is poor. A general finding is shared by several studies conducted in sub-Saharan Africa including Adegbembo et al.33 and Assimi et al.34

CONCLUSION

Results of this study indicated that buccodental hygiene is nowadays made up of a set of practices to ensure the good health of the oral sphere, especially as a poor condition of the oral sphere can increase general health risks (cardiovascular diseases, respiratory infections, diabetes, and obesity). It is recognized that oral health problems are currently public health concern as they affect all segments of the population, although to varying degrees. With regard to the youth, the results of this study clearly point to the need for interventions in oral hygiene practices and dietary habits. This intervention must be dealt with from two perspectives, household and community, because eventually many of these young individuals are involved in activities in the community. At this community level, the promotion of positive oral health practices can take place through the media (school newspapers, posters, brochures, flyers, and audiovisuals), lectures and seminars, social and health fairs, and curricula. Moreover, dental and oral health issues, because they represent a threat to the overall health of the individual, providing access to appropriate dental care for the underserved segments of the population are an imperative. Preventive measures to improve dental care and provision of dental health education are very much necessary to ensure optimum oral health among the youth.

REFERENCES

1. Peterson PE, Bourgeois D, Ogawa H, et al. The global burden of oral diseases and risk to oral health. Bull World Health Organ 2000;83(9):661–669. PMID: 16211157.

2. World Health Organization (WHO). Global Oral Health Data Bank [Acessed March 2, 2021]. Available from: http://www.who.int/oral_health/databases/en/.

3. Peres MA, Macpherson LMD, Weyant RJ, et al. Oral diseases: a global public health challenge. Lancet 2019;394(10194):249. DOI: 10.1016/S0140-6736(19)31146-8.

4. World Health Organization (WHO). Global Oral Health: keys facts [Acessed March 31, 2021]. Available from: http://www.who.int/oral_health/databases/en/.

5. Bureau Central des Recensments et des Études de Population, 2011. CAMEROUN-Recensement Général de la Population et de l’Habitat. Ministère de l’Économie, de la Planification et de l’Aménagement du Territoire, Yaoundé, 2005. p. 243.

6. World Health Organization. Oral Health Surveys. Basic methods. WHO Publications, 4th ed. Geneva; 1997.

7. Cabanes D. Dents et dentistes à travers l’histoire. vol. 2. Musée dentaire de Lyon. 1928. p. 279.

8. Winter A. L’Hygiène dans l’Égypte pharaonique. Paris; 1972. p. 179.

9. Petersen PE, Kaka M. Oral health status of children and adults in Republic of Niger, Africa. Int Dent J 1999;49(3):159–164. DOI: 10.1002/j.1875-595x.1999.tb00901.x.

10. Sekhon TS, Grewal S, Gambhir RS. Periodontal health status and treatment needs of the rural population of India: a cross-sectional study. J Nat Sci Biol Med 2015;6(1):111–115. DOI: 10.4103/0976-9668.149102.

11. Azogui-Levy S, Boy-Lefevre ML. La santé bucco-dentaire en France. n°51. Département de Santé Publique, UFR d’Odontologie. 2005 [Accessed April 03, 2021]. Available from: http://www.hcsp.ensp.fr/hcspi/explore.cgi/ad510408.pdf.

12. Kassem M, Kassak P, Dagher R, et al. Oral hygiene and lifestyle correlates among new undergraduate university students in Lebanon. J Am Coll Health 2015;50(1):13–17. DOI: 10.1080/07448480109595706.

13. Otuyemi OD, Abidoye RO, Dada D. Oral health knowledge, attitude and behaviour of 12-year-old Suburban and rural school children in Nigeria. Afr Dent J 1994;8:205–210. PMID: 9590883.

14. Jessor R, Turbin MS, Costa FM. Protective factors in adolescent health behavior. J Pers Soc Psychol 1998;75(3):788–800. DOI: 10.1037//0022-3514.75.3.788.

15. Albino J, Lawrence S. Promoting oral health in adolescents. In: Millstein SG. Petersen A, Nightingale E, editors. Promoting the health of adolescents: new directions for the twenty-first century. New York: Oxford University Press; 1993. p. 242–259.

16. Mosha HJ, Ngilisho LAF, Nkwera H, et al. Oral health status and treatment needs in different age groups in two regions of Tanzania. Community Dent Oral Epidemiol 1994;22:307–310. DOI: 10.1111/j.1600-0528.1994.tb02057.x.

17. World Health Organization (WHO). Global Oral Health Data Bank [Accessed April 01, 2021]. Available from: http://www.who.int/oral_health/databases/en/.

18. Niazi F, Naseem M, Khurshid Z, et al. Role of Salvadora persica chewing stick (miswak): a natural toothbrush for holistic oral health. Eur J Dent 2016;10(2):301–308. DOI: 10.4103/1305-7456.178297.

19. Norton M, Addy M. Chewing sticks versus toothbrushes in west Africa. A pilot study. Clin Prev Dent 1989;11(3):11–13. PMID: 2605858.

20. Lababidi S. Salvadora Persica L. Iintérêt en hygiène bucco-dentaire. Thèse de Doctorat en chirurgie dentaire, Université Paris Descartes; 2019. p. 79.

21. Daluz K. Le «Sothiou» ou bâtonnet frotte-dents comme outil d’hygiène bucco-dentaire dans les pays en développement: exemple du Sénégal. Thèse de Doctorat en chirurgie dentaire, Université de Toulouse; 2018. p. 90.

22. Portères, R. Un curieux élément culturel arabico-islamique et néo-africain: les baguettes végétales mâchées servant de frotte-dents. J d’agriculture traditionnelle et de botanique appliquée 1974;21(1):1–36. https://www.persee.fr/doc/jatba_0021-7662_1974_num_21_4_3157.

23. Haque M, Alsareii S. A review of the therapeutic effects of using miswak (Salvadora Persica) on oral health. Saudi Med J 2015;36(5):530–543. DOI: 10.15537/smj.2015.5.10785.

24. Garcia C. Étude et prévention bucco-dentaire chez une population autochtone colombienne : « les u’was. Université Toulouse III-Paul Sabatier, Thèse de Doctorat en Chirurgie dentaire; 1997, p. 101.

25. Chen X, Zhan JY, Lu HX, et al. Factors associated with black tooth stain in chinese preschool children. Clin Oral Investig 2014;18(9):2059–2066. DOI: 10.1007/s00784-013-1184-z.

26. Sarita PT, Tuominen R. Tooth cleaning methods and their effectiveness among adults in rural Tanzania. Proc Finn Dent Soc 1992;88(3–4):139–145. PMID: 1298964.

27. Petersen PE. Dental caries and dental health behaviour situation among 6 and 12 years old urban School children in Madagascar. Afr Dent J 1991;5:1–7. PMID: 1819289.

28. Majoli S. Santé et hygiène bucco-dentaires au Cameroun: étude préliminaire pour la mise en place d’un programme de prévention chez des écoliers. Université de Genève, Faculté de Médecine, Thèse Doctorat en Médecine dentaire; 2003. p. 43.

29. Ahouah Akesse J. Hygiène bucco-dentaire et mesures d’asepsie au cours de la rehabilitation prothetique: enquête réalisée au service de prothèse du cctos d’Abidjan Cocody. Université d’Abidjan, Thèse de Doctorat Chirurgie dentaire; 2005. p. 204.

30. Lourdel C. Évolution des moyens et techniques d’hygiène bucco-dentaire: des origines à nos jours. Thèse de Doctorat en chirurgie dentaire, Université de Toulouse III; 1993. p. 169.

31. Sofola OO, Shaba OP, Jeboda SO. Oral hygiene and periodontal treatment needs of urban school children compared with that of rural school children in Lagos State, Nigeria. Odonto-Stomatologie Trop 2003;26(101):p. 5. PMID: 12868141.

32. Djossou D, Houngbegnon P, Kponon S, et al. Hygiène orale et carie dentaire: enquête auprès de 191 étudiants sur le campus d’abomey-calavi (BÉNIN). Rev Col Odonto-Stomatol Afr Chir Maxillo-fac 2016;23(2):47–50. http://www.revues-ufhb-ci.org/fichiers/FICHIR_ARTICLE_495.pdf.

33. Adegbembo AO, EL-Nadeef MA. National survey of periodontal status and treatment need among Nigerians. Int Dent J 1995;45:197–203. PMID: 7558358.

34. Assimi S, Tajmouti R, Keltoum EO. Hygiène bucco-dentaire d’enfants scolarisés marocains et de leurs mères. Santé Publique 2016;28(2):245–250. https://bdsp-ehesp.inist.fr/vibad/controllers/getNoticePDF.php?path=Sfsp/SantePublique/2016/2/245.pdf.

________________________
© The Author(s). 2022 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.