|Year : 2009 | Volume
| Issue : 1 | Page : 39-43
The state of infant oral healthcare knowledge and awareness: Disparity among parents and healthcare professionals
PK Shivaprakash, I Elango, DK Baweja, HH Noorani
Department of Pediatric and Preventive Dentistry, PMNM Dental College and Hospital, Bagalkot, India
P K Shivaprakash
Department of Pediatric and Preventive dentistry, PMNM Dental College and Hospital, Bagalkot, Karnataka
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Provision of infant oral health (IOH) care is a challenging issue in the rural areas of our country due to lack of pedodontists and other dental workforces. To overcome these barriers it is essential to call the medical and other healthcare professionals to provide IOH care in joint collaboration with dental professionals. However, it is unclear to what extent these medical professionals are really aware of preventive strategies and to what extent they impart them. Thus, the present study was designed to begin from the grass-root levels, that is, assessing the baseline knowledge and awareness regarding IOH care among students (dental/medical) and parents (urban/rural). Variation of opinions with inconsistencies were obtained from both medical and/dental students and as well as from both the parental groups. This study calls for further research to evaluate the role of various factors involved in IOH care and to effectively educate all healthcare providers in this area.
Keywords: Awareness, health knowledge, medical students, parents
|How to cite this article:|
Shivaprakash P K, Elango I, Baweja D K, Noorani H H. The state of infant oral healthcare knowledge and awareness: Disparity among parents and healthcare professionals. J Indian Soc Pedod Prev Dent 2009;27:39-43
|How to cite this URL:|
Shivaprakash P K, Elango I, Baweja D K, Noorani H H. The state of infant oral healthcare knowledge and awareness: Disparity among parents and healthcare professionals. J Indian Soc Pedod Prev Dent [serial online] 2009 [cited 2020 Feb 29];27:39-43. Available from: http://www.jisppd.com/text.asp?2009/27/1/39/50816
| Introduction|| |
Infant oral health (IOH) is the foundation upon which preventive education and dental care must be built to enhance the opportunity for life time free of preventable oral diseases.  Parents are decision-makers in matters of children health and healthcare, thus they play an important role in achieving the best oral health outcomes for their young children. Considering parent's important role in the well being of young children, it is essential to explore their knowledge, attitude, and beliefs as it affects the dental care children receive at home and their access to professional dental services. Also, their assumptions and beliefs may be an important consideration in attempts made to improve IOH. 
Parents are unlikely to solicit dental care of their own accord to their children without education, motivation, and help from physicians who see children at least 11 times for well child visits through age three.  Preventive dental care should start early in infancy, during the first year of child's life to ensure successful outcomes. Physicians are the first health professionals to come in contact with the expectant parents and parents of infants.  Hence, integrating oral health disease prevention and promotion strategies into these healthcare professionals practice would improve access to dental care, especially for the poor and the minority children who suffer disproportionately from dental caries and who have limited access to dental care. 
This strategy of utilizing primary care medical providers to promote oral health is particularly necessary in rural regions where there are few dentists and even few pediatric dentists which compound the problem of obtaining access to dental care.  Studies have shown that physician's body of knowledge in the area of IOH is less than adequate ,,, and it is unclear to what degree these healthcare professionals are knowledgeable about preventive dental care for IOH and at the same time to what level they impart preventive dental counseling as a part of well child visits.
Thereby, examining the baseline knowledge and opinions of medical students during their formative healthcare professional education and comparing the same with the dental students is worthwhile. The aims and objectives of the study were: To assess 1) the knowledge and attitude of parents and medical and dental students on preventive dental care for IOH, 2) the status of IOH in the educational curriculum, and 3) the role of vision in IOH.
| Materials and Methods|| |
A cross-sectional survey was undertaken among 200 parents and dental and medical students. Of the 200 parents surveyed, included 100 rural parents from the nearby villages of Bagalkot city and 100 urban parents from Bangalore city. The 200 dental students surveyed were the third years, final years, and interns of PMNM Dental College, Bagalkot. The medical students included in this study were third years, final years, and interns of SN medical college, Bagalkot.
A multiple choice questionnaire was developed, and the questionnaire administered to the students had 17 observations and that issued to the parents consisted of 13 items which focused on various preventive strategies of preventive dental health. The questionnaire was not pretested and the data were collected by various methods through series of contacts due to varying accessibilities of each group. The responses were assessed based on the recommendations of American Academy of Pediatric Dentistry (AAPD). 
We hypothesized that, 1) medical students were not well informed about preventive dental care on IOH and 2) both rural and urban parents were equally unaware of preventive dental care on IOH.
| Results and Discussion|| |
The results were assessed using descriptive statistics and paired t test to compare the association between the groups. As expected, the overall knowledge of medical students was significantly less than the dental students at 5% level of significance ( P < 0.05), hence the null hypothesis 1 was rejected. [Table 1] and Graph 1-[Additional file 1] shows the response rate of students (dental and medical) to various aspects of IOH. The mean awareness of the medical students was 53.47 and that of dental students were 74.26.
AAPD recommends that the child be seen within six months of eruption of the first primary tooth and no later than 12 months of age.  Traditionally, the developmental age for initial dental visit was thought to be 3 years. The rationale for this was children are more manageable at this age and the treatment will be more efficient, but early interventions are needed to educate parents on oral hygiene, prevention of dental injuries, and ECC,  hence age one dental visit is recommended. More than half of medical students correctly responded to the question on first dental visit. This response was slightly higher than the results obtained by Retna KN and Chung MH who reported 40 and 38.8%, respectively. ,
Medical students knowledge on ad libitum, most/least cariogenic sugar, and the right time to clean child's gums and teeth were ≤25% and their awareness regarding chewing gums and ECC were <35%. Increasing knowledge in these areas will facilitate establishment of good feeding and oral hygiene practices that will enable to minimize the risk of caries development. More than half of the medical students were unaware of the correct weaning period. An infant should be weaned from breast/bottle by 12-14 months of age and introduction to semisolid foods can begin at six months. Iron fortified cereals or pureed meats along with breast milk/infant formula are most preferable. 
Only 47% of medical respondents were aware that caries is a transmissible disease and that the child can acquire most of the strains of mutans streptococci from the mother. Although this information is prevalent in the dental literature for more than 10 years , there is inadequacy of knowledge among the medical respondents in this area. This calls for IOH counseling of expectant mothers during pregnancy  in OB-GYN offices. Moreover, only two-thirds of the dental students and 60% of medical students considered prenatal counseling to be beneficial which reveals that prenatal counseling of parents need to be encouraged both in the dental and medical schools. Our findings correlated with the findings from previous studies which showed that medical students weren't well informed on some aspects of preventive dental care. ,
The use of pacifiers, sweetened liquid/fruit juice in bottle at night was considered harmful by most of the medical students. Majority of medicos (79%) performed oral health screening during child's physical examination which correlated well with the study conducted by Gonsalves et al and Sanchez et al , , but was not consistent with Lewis et al ,  results, so this variable requires further evaluation. Verbal delivery of information regarding oral health, fluoride benefits and/hazards were imparted by 74% of the medical students. Seventy two percent of the medical students reported that their educational curriculum incorporates a module on IOH and 67% of the students encouraged the incorporation of the same.
It was surprising to note that both groups of respondents (students) were equally unaware regarding - the right time to introduce the child to drink from cup and association of poor maternal oral health to preterm/low birth weight baby. Maternal transient bacteremia seen as a result of gingivitis/marginal periodontitis produces inflammatory effect to the placental membranes, thereby inducing preterm labor. Thus, periodontal therapy during pregnancy can reduce the risk of prematurity.  Enamel defects are more common in children born prematurely thus making these teeth more susceptible to ECC. 
There was no significant difference ( P > 0.05) between the rural and urban parents awareness on IOH [Table 2] and [Graph 2]-[Additional file 2], thus confirming our null hypotheses. Irrespective of the primary access to dental care both group of parents were unaware of age one dental visit and a high proportion of them did not clean their child's mouth before the primary tooth eruption.
A consistently weak knowledge regarding fluoride role in caries prevention was observed among both the parental groups. Optimal fluoride is essential for all dentate infants and children after assessing the child's total fluoride exposure.  More rural parents were able to correctly point out a clear relation between excess fluoride in drinking water and tooth discoloration. This may be because rural parents surveyed in this study belonged to endemic fluorotic area; hence, there may be more chances for these parents to be aware of dental fluorosis.
Sixty two percent of urban parents and 75% of rural parents agreed that milk teeth needs dental care like the permanent teeth. Educating parents on sharing foods and utensils can help prevent early colonization of oral flora in infants.  Prechewing and sharing of child's food obtained uniform response from both groups (55%). However, this uniformity of response was not seen for variables such as ad libitum, use of pacifiers, sweetened liquid/fruit juice at night. A high percentage of urban parents knew that, in-between meals the child should be restricted to water/plain milk/fresh fruits. This will ensure greater likelihood of providing noncariogenic food in-between meals which will decrease the incidence of dental caries.
The right time to introduce the child to drink from cup was appropriately responded by 55% of urban and 49% of rural parents. The proportion of urban and rural parent's assessment of the right weaning period was 43 and 28%, respectively. Infants should be trained to drink from cup as they approach their first birthday and spill-proof sippy cups with sweetened liquids are to be avoided. 
Only half of the parents reported that they receive oral health counseling during their child's well care visit. Lack of knowledge among the general public probably stems partly from the health professionals' time restrictions to counsel them, and their poor appreciation of the value of early oral health evaluations. ,
The results of this study cannot be extrapolated and studies of same design need to be conducted on large samples and on different sectors of the population so as to evaluate which strategies will be effective and efficient in bringing about a behavior change in both parents and healthcare professionals.
This study however is not without limitations and these include:
- Variation in class composition
- Students were surveyed from one institution and hence the results cannot be generalized to the whole body of dental and medical students
- Differential response rate
- Method of collection of the data was different for each group because of varying accessibility of each group
| Conclusions|| |
Based on the results of this study the following conclusions were arrived at:
- Medical students lack adequate knowledge on IOH; hence, there is an increasing need to increase the knowledge of medical students through effective strategies.
- Although the dental student's knowledge was significantly better than the medical students, they need to be emphasized on certain aspects of IOH.
- Parent's knowledge on IOH was inadequate irrespective of the locality.
The role of vision on IOH is, the physicians need to improve and impart IOH counseling; provide anticipatory guidance to parents; and serve as a guide in developing positive dental attitudes. For this, the physicians need to be well informed on preventive dental care for an infant which calls for a joint advocacy between the two professions. This will enable the physicians to give adequate counseling and dental care; provide early interpretation and prevention of oral diseases; and to make appropriate referrals as and when required to address the serious problems of disparities in obtaining access to professional dental services.
| References|| |
|1.||American Academy of Pediatric Dentistry. Clinical guidelines on infant oral health care. Pediatr Dent 2004;26:67-70. |
|2.||Talekar BS, Rozier G, Slade GD, Ennett ST. Parental perceptions of their preschool-aged children's oral health. J Am Dent Assoc 2005;136:364-72. |
|3.||Douglass JM, Douglass AM, Silk HJ. A practical guide to infant oral health. Am Fam Physician 2004;70:2113-20,2121-2. |
|4.||Sanchez OM, Childers NK, Fox L, Bradley E. Physicians' views on pediatric preventive dental care. Pediatr Dent 1997;19:377-83. |
|5.||Lewis CW, Grossman DC, Domoto PK, Deyo RA. The role of pediatrician in the oral health of children: A national survey. Pediatrics 2000;106:E84. |
|6.||Douglass JM, Douglass AM, Silk HJ. Infant oral health for pediatric and family practice residents. Pediatr Dent 2005;27:284-91. |
|7.||Ismail AI, Nainar SM, Sohn W. Children's first dental visit: Attitudes and practices of US pediatricians and family physicians. Pediatr Dent 2003;25:425-30. |
|8.||Gonsalves WC, Skelton J, Heaton L, Smith T, Feretti G, Hardison JD. Family medicine residency directors' knowledge and attitudes about pediatric oral health education for residents. J Dent Educ 2005;69:446-52. |
|9.||Kumari NR, Sheela S, Sarada PN. Knowledge and attitude on infant oral health among graduating students in Kerala. J Indian Soc Pedod Prev Dent 2006;24:173-6. [PUBMED] |
|10.||Chung MH, Kaste LM, Koerber A, Fadavi S, Punwani I. Dental and medical student's knowledge and opinions of infant oral health. J Dent Educ 2006;70:512-7. |
|11.||Hashim Nainar SM, Mohummed S. Diet counseling during infant oral health visit. Pediatr Dent 2004;26:459-62. |
|12.||Li Y, Caufield PW. The fidelity of initial acquisition of mutans streptococci by infants from their mothers. J Dent Res 1995;74:681-5. |
|13.||Slavkin HC. First encounters: Transmission of infectious oral diseases from the mother to child. J Am Dent Assoc 1997;128:773-8. [PUBMED] [FULLTEXT]|
|14.||Lopez NJ, Da Silva I, Ipinza J, Gutierrez J. Periodontal therapy reduces the rate of preterm low birth weight in women with pregnancy associated gingivitis. J Periodontol 2005;76:2144-53. |
|15.||Seow WK. Enamel hypoplasia in the primary dentition: A review. ASDC J Dent Child 1991; 58: 441-52. [PUBMED] |
|16.||Wu II, King NM, Tsai JS, Wong HM. Dental knowledge and attitudes of medical practitioners and care givers of preschool children in Macau, HK. J Pediatr 2006;11:133-9. |
[Table 1], [Table 2]
|This article has been cited by|
||Paediatriciansæ awareness of childrenæs oral health: Knowledge, training, attitudes and practices among Turkish paediatricians
| ||Sezer, R.G. and Paketci, C. and Bozaykut, A. |
| ||Paediatrics and Child Health (Canada). 2013; 18(4): e15-e19 |
||Malaysian undergraduatesæ knowledge and opinions on Early Childhood Oral Health
| ||Mani, S.A. and Burhanudin, N.A. and John, J. |
| ||European Journal of Paediatric Dentistry. 2012; 13(1): 64-68 |
||Oral health knowledge, attitudes and practices of parents/guardians of pre-school children in Moshi, Tanzania
| ||Rwakatema, D.S. and Ngæangæa, P.M. |
| ||East African Medical Journal. 2009; 86(11): 520-525 |