Abstract
Aims and Background
Phytotherapy is a popular practice in several countries and is especially common in rural populations of India for the management of dental pain and breath malodor. Therefore, the present study aimed to evaluate the knowledge, attitude, and practice of using herbal products for dental problems within a rural community of southern India.
Materials and Methods
The study was designed as a cross-sectional survey, which included villagers hailing from Chengalpattu District. A total of 100 participants were included in the survey after obtaining signed Informed consent. Participants were asked to fill out a questionnaire, which had three sections each to gauge the knowledge, perception, and practices on the usage of phytomedicine. Statistical analysis was done using the Chi-Square test.
Results
Statistically significant differences were not noted based on age or gender for all 15 Questions, except the eighth question, where the respondents were asked if they consulted a doctor before using herbal medicine, which showed a statistically significant difference (p = .049) based on gender. However, no significant difference was noted based on age.
Conclusion
The present study sheds light on the regular usage of herbal products in rural areas and the need to educate rural communities through regular dental camps on the importance of being transparent with dental care providers on their herbal usage and to seek regular dental treatment. It also helps us to understand the seriousness of the issue of self-medication, without adequate knowledge on herbal products, and the need for local dental councils in formulating a systematic approach to provide the necessary information and treatment to rural areas that are seldom part of mainstream dental care.
Introduction
The World Health Organization has defined herbal medicine as raw or processed ingredients derived from plant sources that provide therapeutic or other human health benefits. 1 Phytotherapy, the practice of using these plants or herbs to treat or prevent health conditions, is one of the most traditional methods followed by the general population in India. Mainstream dental care is still not accessible to a significant portion of the population, and rural areas are predominantly afflicted, owing to low income, sanitation, and education levels than urban areas, constituting an important factor for worsening health problems. 2 Despite advances in the field of modern medicine, certain communities still prefer the use of herbal products for treating ailments. Several contributing factors, such as a presumption of being less harmful in nature, easily available, cost-effective, and potential for treating ailments, make herbal treatment the preferred choice in most rural populations. Also, herbal medicines are commonly misconceived as being safe because they come from natural sources. The majority of the dental patients from rural areas seldom divulge information regarding the usage of herbal treatment to their health care providers. This could be attributed to the misconception that dentists may not be knowledgeable about herbal medicines and may exhibit a dismissive attitude toward their usage. Herbal products, although derived from natural sources, need to be of good quality and require proper information on usage or can result in toxicity and allergies. 3 Health care providers, including dentists, should therefore be knowledgeable on Phytotherapy and commonly used herbs for treating dental problems, 4 to provide sound advice to patients who seek dental care. To understand the need for improving knowledge on herbal medicine among dentists, we first need to assess the extent of usage among rural populations. Therefore, the present study aimed to evaluate the knowledge, attitude, and practice of using herbal products for dental problems within a rural community of southern India.
Further, the study intended to understand the seriousness of the issue of self-medication among patients, leading to the avoidance of seeking professional dental treatment. There is very limited data available assessing patients’ perspectives on using herbal products for dental problems, making this study essential in analyzing the depth of the issue, especially in rural areas.
Materials and Methods
Study Design
The survey was designed as a cross-sectional study, which was conducted in the Chengalpattu district, in accordance with STROBE guidelines (Table A1). The study population consisted of outpatients who visited our institution for dental treatment.
Inclusion Criteria
Only patients who resided in rural areas and who were between 18 and 65 years were accepted for the study. The second criterion necessitated patients to be able to understand either English or the native language (Tamil).
Exclusion Criteria
All patients from urban and suburban areas, pregnant patients, lactating mothers, and immunocompromised patients, and those not willing to provide consent were excluded from the study.
Sample Size Determination
A convenience sampling method was used for this study, and the calculated sample size using the G Power sampling method was 100. The formula N = Zɑ 2 (PQ)/L 2 was used for the calculation.
Questionnaire Validity and Reliability
A structured questionnaire was prepared for this study. The questionnaire was made available in both English and Tamil. The face validity, content, and ease of understanding of the questionnaire were assessed by three research experts in the field. The validation of the questionnaire was determined by conducting a pilot study on 15 participants who were not part of the final study but fit the same inclusion and exclusion criteria. The survey was repeated by each of the participants after a two-week interval. Cohen’s kappa coefficient was calculated to assess the reliability of the answers. The kappa value from test-retest was found to be between 0.15 and 1.00, which was relatively low.
The questionnaire contained 15 questions, which were divided into three sections. The first section tested the knowledge of participants on herbal products, the second section on the perception of usage and the third section on the practices of using herbal products for dental ailments.
Study Population
Approval was obtained from our Institutional Scientific Review Committee prior to the start of the study. A total of 100 participants were included in the survey, after obtaining signed Informed consent. Demographic details such as name, age, gender, and occupation were recorded, and participants were asked to fill out the questionnaire.
Statistical Analysis
The responses obtained were statistically assessed by the chi-square test using SPSS Inc. (IBM Corporation, NY, USA). The level of significance was kept at 5% and the confidence interval was calculated at 90%.
Results
The total sample size was 100, which included 55 males and 45 females. Based on the age, participants were categorized into two groups, namely Group 1: Participants aged between 20 and 45 years, and Group 2: Participants aged between 46 and 65 years. The results of the study have been summarized in Tables 1, 2, and 3. There was no statistically significant difference based on age or gender for all 15 Questions, except the eighth question, where the respondents were asked if they consulted a doctor before using herbal medicine, which showed a statistically significant difference (p = .049) based on gender. However, no significant difference was noted based on age.
Knowledge of Dental Patients’ on Herbal Products Usage.
Perception of Dental Patients on Herbal Products Usage.
Practices of Dental Patients on Herbal Product Usage.
The first part of the questionnaire contained seven questions that assessed the knowledge of the participants about herbal products. 59% of the respondents agreed that herbal products can be used to treat dental problems, and 47% of them used herbal products on a regular basis. However, only 16% of the population had knowledge of the possible side effects of using herbal products. 59% of participants felt that herbal medicines were better than allopathic treatment methods, while 66% of the participants strongly condemned the combined usage of herbal medicines along with allopathic drugs.
The second part of the questionnaire consisted of four questions aimed at understanding the attitude of rural populations toward the usage of herbal medicines. When participants were asked if they consulted a doctor before using herbal medicines, 74% of them accepted that they self-medicated without consultation, and most of the participants (71%) did not research the herbal products before consumption. The majority of the participants (71%) felt that herbal products were cost-effective, and 53% of them would recommend their usage to family members.
The last part of the questionnaire had four questions that assessed the practices of the rural population. 79% of the participants opted to use Clove oil to relieve dental pain, and 58% had used guava/mint leaves to address bad breath. 54% of the respondents stated that they used herbal products not only to treat dental problems but also other health-related ailments such as Hypertension and Diabetes. Interestingly, though, 64% of the respondents accepted the fact that herbal treatments are not permanent solutions to treat dental problems.
Discussion
Ancient Indian civilizations were known to be well-versed in the use of herbs to treat various medical illnesses. Several plants possess antiseptic, antibacterial, antimicrobial, antifungal, antioxidant, antiviral, and analgesic properties that can have potential applications in dentistry. 5 Plant extracts with anti-inflammatory effects and coagulation properties play an important role in dental treatment, 6 and their utilization in the field of dentistry mainly revolves around relieving gum inflammation, tooth pain, and canker sores. 7 However, it is of utmost importance to understand the interactions of plant extracts with the body and other medications, as they can produce untoward consequences. 8 While most of the participants agreed that herbal medicine can be used to treat dental problems, 47% of the respondents felt that herbal medicine was more beneficial than allopathic drugs. A small portion of the study participants agreed to have taken herbal supplements along with the prescribed allopathic medicine to treat dental ailments. This could be attributed to the fact that most people do not take the prescribed medication consistently and alternate it with readily available, cheaper herbal sources. Also, the elderly in the household prefer herbal medicines, as passed on through the generations, over allopathic drugs.
Previous studies on the usage of herbal medicines by dental patients showed similar inferences to our present study. A study by Ege et al. 9 concluded that 54% of the patients used herbal products in general, 31% of the respondents were neutral toward the usage, while 15% of them accepted that these products were not beneficial. The majority of the respondents in our study seldom consulted an oral health care professional before using herbal medicines, and only a small portion researched the herbal products before using them. These findings were consistent with the conclusions drawn from their study, where 56.8% of the patients did not consult a doctor while using herbal products, and approximately half of the patients did not seek medical advice while using these products.
In our study, only a small portion of participants found herbal products to be quite beneficial and referred the use of herbs to their friends and family members, similar to a study by Tulunay et al. 10 Interestingly, only 16% of the participants were aware that herbal products can produce side effects. Many earlier studies have concluded that using herbal products without the advice of a doctor or pharmacist is not safe and may produce deleterious effects. This might relate to the fact that some plants inherently possess toxic components, and many herbal products also interact with allopathic drugs. 11 Warfarin, a commonly prescribed anticoagulant, has interactions with many known herbal products. 58 different plants have been identified that can alter blood hemostasis and anti-coagulation by interacting with warfarin. Plants that show the greatest potential to interact with warfarin include herbs used for food or therapeutic purposes, such as garlic, ginger, grapefruit, ginkgo, St. John’s wort, and ginseng.12, 13
A small number of the respondents considered phytotherapy as a permanent treatment solution for dental problems, and a large portion of them agreed that herbal medicines were a treatment of choice in rural areas, as they were cost-effective, and the belief passed on over generations that natural substances are a safer option. Most popular herbal remedies used by the participants included guava/mint leaves to treat bad breath and Clove to alleviate pain. Essential oils such as Clove, Mint, and Thyme, which are frequently preferred for oral and dental health, can irritate the mucosa when applied directly. 14 Clove oil is known to cause serious problems like pharyngitis, vomiting, cytotoxicity, kidney failures, damage to the liver, seizures, difficult breathing, and others if used in higher doses. The use of medicinal plants can at times be an advantage in dental practice, for example, eugenol is a part of our therapeutic arsenal,15, 16 and some herbal products have undergone a thorough investigation with regard to their potential for preventing oral diseases, such as dental caries. 17
In the present study, 54% of the population accepted the usage of herbs for other health-related problems, similar to a study by Biçen et al., where 61% of the patients believed that herbal medicine was a cure for Hypertension. 18 Our study results corroborated with findings from earlier studies, where it was observed that patients preferred herbal products as therapeutic or preventive for a wide spectrum of diseases, from minor to major diseases such as cancer.19, 20 Most of these patients combined herbal products with their current treatments and seldom disclosed this important information to their doctors. 21 This can impact the treatment process of the patients negatively, or even lead to dangerous repercussions in terms of drug interactions and side effects. 22 The results of our study reflect that the majority of patients use herbal products to treat dental ailments, especially in rural parts of India, while most patients did not seek a doctor’s advice on this issue.
Limitations of the Study
Due to the small sample size, extrapolating the results to a larger community may be a limiting factor in this study. Future studies need to be conducted addressing the issue with larger sample sizes. Also, no multiplicity adjustment was done as this was an exploratory KAP survey.
Conclusion
The present study sheds light on the regular usage of herbal products in rural areas to treat various ailments, including dental problems, without proper knowledge of possible side effects or drug interactions. It also highlights the need to educate rural communities through regular dental camps on the importance of being transparent with dental care providers on their herbal usage and to seek regular dental treatment without opting for self-medication.
Communities living in rural areas, especially in the southern part of India, rely on herbal treatments due to ease of procurement and cost-effectiveness. These communities need to be educated by dental professionals on the severity of certain dental problems that require early intervention and proper addressing of etiology, and not just temporary symptomatic relief. This study helps us to understand the seriousness of the issue of self-medication without adequate knowledge on herbal products, and the necessity of formulating a systematic approach by local dental councils to provide the necessary information and treatment to rural areas that are seldom part of mainstream dental care.
Footnotes
Authors’ Contribution
Nanditha S: Concept, data analysis, supervision, manuscript preparation and validation.
Nilofer Farjana H: Manuscript review, validation and data analysis.
Muhammed Ali, Parvathi C, Murugan K, Nila V and Prathiksha N: Data collection, data analysis and manuscript review.
Data Availability
Data will be available upon request.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Ethical Approval Institutional Statement
Ethical approval was obtained from the Institutional Review Committee, Asan Memorial Dental College prior to commencing the study.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Informed Consent
Informed patient consent was obtained from all willing participants prior to the study.
