|Year : 2010 | Volume
| Issue : 2 | Page : 100-103
The knowledge, attitude and practice in prevention of dental caries amongst pediatricians in Bangalore: A cross-sectional study
GA Murthy1, U Mohandas2
1 Senior Lecturer, Department of Pedodontics and Preventive Dentistry, Dayanandsagar College of Dental Sciences, Bangalore, India
2 Principal, Professor & Head, Vokkaligara Sangha Dental College and Hospital, Bangalore, India
|Date of Web Publication||24-Jul-2010|
G A Murthy
Department of Pedodontics and Preventive Dentistry, Dayanandsagar College of Dental Sciences, Shavige Malleshwara Hills, Kumaraswamy layout, Bangalore - 560 074, Karnataka
| Abstract|| |
Dental caries comprise the single most chronic disease affecting children today. Evidence increasingly suggests that for successful prevention of dental caries, preventive interactions must begin within the first year of life. Pediatricians are responsible for the primary care of the child and are well positioned to begin this process if they recognize and encourage good preventive habits and refer appropriately. Insufficient information about their role in prevention of dental caries led us to conduct a survey among pediatricians in Bangalore urban to determine their knowledge, attitude and practice in prevention of dental caries.
Keywords: Bangalore, dental caries, pediatricians
|How to cite this article:|
Murthy G A, Mohandas U. The knowledge, attitude and practice in prevention of dental caries amongst pediatricians in Bangalore: A cross-sectional study. J Indian Soc Pedod Prev Dent 2010;28:100-3
|How to cite this URL:|
Murthy G A, Mohandas U. The knowledge, attitude and practice in prevention of dental caries amongst pediatricians in Bangalore: A cross-sectional study. J Indian Soc Pedod Prev Dent [serial online] 2010 [cited 2014 Mar 9];28:100-3. Available from: http://www.jisppd.com/text.asp?2010/28/2/100/66747
| Introduction|| |
Dental caries is an important public health problem and it is the most prevalent oral disease among children. This disease not only causes damage to the tooth, but is also responsible for several morbid conditions of the oral cavity and other systems of the body.  The prevalence of caries is declining in developed countries, increasing in less developed countries and is an epidemic in countries with emerging economies.  Decline in prevalence in developing countries has been associated with improved oral hygiene practices and several preventive programs unlike developing countries where the focus is mostly on curative care. Pediatricians are often the first and only health professionals whom children visit. Therefore, they are in a unique position to address dental disease in these children.  Evidence increasingly suggests that for successful prevention of caries, preventive interactions must begin within the first year of life. Pediatricians are well positioned to begin this process with an early assessment of oral health and provision of anticipatory guidance, ensuring that patients establish a dental home in addition to their medical home.  The pediatricians and family physicians have the responsibility to take the primary care for the child from birth to adolescence.  Dental caries can be prevented if the pediatrician recognizes and encourages good preventive habits and refers appropriately. 
Very few studies have been conducted on dental screening and referrals by pediatricians or the effectiveness of their dental caries preventive activities. The absence of exact statistics on the pediatrician awareness concerning children's caries prevention in India led us to conduct this study.
The purpose of this study was to determine the knowledge, approach and function of pediatricians in the prevention of dental caries in Bangalore.
| Materials and Methods|| |
A cross-sectional survey was undertaken among the pediatricians in Bangalore. The list of pediatricians in Bangalore was obtained from the Bangalore society of Pediatrics. There were 470 registered in this society. Out of this, 20 were not actively practicing. One in every six was selected through systemic random sampling. After getting the consent of the selected pediatricians, they were made to answer the questionnaire. The questionnaire had questions to assess their personal details, knowledge about dental caries, attitude toward its prevention and practice guidelines and opinions. The queries about their personal details included questions on number of years in practice, number of patients seen per day and the type of practice. The knowledge was assessed based on questions about early childhood caries (ECC), fluoride supplement, spread of caries and dental sealants. Their attitude toward prevention of dental caries was assessed based on queries about their role in promoting oral health, assessment of dental caries during routine well child care, counseling in prevention of dental caries during well child care and curriculum in pediatric post graduation to promote oral health. Practice guidelines and opinions were assessed depending on the response to queries on first dental visit, frequency of dental visits, enquiry about bottle to bed, examination of the child's teeth for cavities, importance of tooth brushing and when to begin tooth brushing.
Scores were given to each question in the knowledge, attitude and practice section. The maximum score was given to the correct answer and minimum was given to the incorrect answer.
Scoring criteria: The scores are assessed as follows.
| Results and Discussion|| |
The survey was performed on 75 pediatricians, of whom the majority had less than 5 years of practice, seeing 25-50 patients a day with a solo private practice [Table 1].
More than 50% of them felt that only bottle fed children get ECC. But there is evidence to show that infants who sleep with the mother and nurse all night long have an increased risk of caries. ,,
An overwhelming 84% knew that a 3-month-old baby does not require Fl supplement which is in accordance with American Academy of Pediatrics' guidelines. 
Less than half the aediatricians knew that cavity causing bacteria can be transmitted from the mother , which is also cited in the pediatric literature. 
Most of the pediatricians agreed that fluoride supplements and dental sealants prevent decay [Table 2].
Above half of the pediatricians felt that 1 year would be ideal for the first dental visit. This is in accordance with the AAPD (American Academy of Pediatric Dentistry) guidelines and AAP (American Academy of Pediatrics) which say that the first dental visit should be within 6 months of eruption of the first teeth per year. , Half of the pediatricians were not aware of the biannual dental visit that is recommended by AAPD. 
There is enough evidence to show that bottle to bed can cause ECC. More than 90% pediatricians enquired about this and also counselled on the importance of tooth brushing. Almost all of them examined the teeth for cavities.
More than 60% of the pediatricians felt that tooth brushing should begin after few teeth have erupted though AAPD guidelines say that brushing should begin with the eruption of first tooth.
Though most of them reported to have seen one or more ECC case/week, the practice of pediatricians toward caries prevention was good in only half of them [Table 3].
Majority of (>90%) them felt that assessment of dental caries and counseling about prevention of it should be a part of well child care. Almost all of them agreed to have a role in promoting oral health and half of them felt that the present curriculum in pediatric post graduation is not enough to promote oral health care [Table 4].
Our study indicates that most of the pediatricians in Bangalore had moderate knowledge (82.6%), followed by good knowledge (10.6%) and poor knowledge (8.6%) about dental caries [Figure 1]. Practice guidelines and opinions of pediatricians in the survey were good (50.6%) in about half, followed by moderate (41.3%) and poor (8%) [Figure 2].The attitude for prevention of dental caries was positive in almost everybody (99%) [Figure 3].
This survey indicates that pediatricians overwhelmingly believe that they have an important role in the promotion of oral health. They also report encountering dental caries in their patients on a regular basis. Lack of familiarity with oral health issues may make it difficult for them to promote prevention of dental caries. Given the frequency with which pediatricians encounter dental caries, additional oral health related training in pediatric residency can be considered. With their attitude towards prevention of dental caries, even setting up of dental home along with medical home by 1 year of age for all children can be done in our public health centres. 
The survey had a few limitations which included
- Overestimation of the attitude and practices to provide more desirable response and
- Inability to use open ended questions to probe participants' responses for greater detail.
| Conclusions|| |
Our study concluded that pediatricians in Bangalore had good attitude and practices, but had moderate knowledge and lacked proper awareness about dental caries. They also compromised on providing good preventive dental care to the community.
The following measures may be taken to improve the pediatrician's knowledge about prevention of dental caries and to expand their role in the same.
- More communication between medical and dental societies.
- Including preventive dentistry topics in the medical curriculum so that pediatricians assume a greater role in oral health related activities.
- Continued dental education programs for pediatricians. 
- Preventive dentistry articles to be published in medical journals.
- Information about dental caries can be given in the form of brochures, posters, etc.
- Advocate dentists to be a part of well child care.
- Establish dental home along with medical home.
- Referral of cases to pedodontist regularly.
- Encourage group practice with pedodontists.
| References|| |
|1.||Chakraborthy M, Saha JB, Bhattacharya RN, Roy A, Ram R. Epidemiological correlates of dental caries in an urban slum of West Bengal. Indian J Public Health 1997;41:56-60. |
|2.||Lundeen TF, Roberson TM. Cariology: The lesion, etiology, prevention and control. In: Studervant CM, Roberson TM, Heymann HO, Studeervant JR, editors. The art and science of operative dentistry. 3 rd ed. Harcourt Asia PTE Ltd., Singapore: Mosby Co.; 1995. p. 62-3. |
|3.||US preventive services task force recommendation. Am J Prev Med 2004;26:326-9. |
|4.||Johnsen DC. The role of the paediatrician in identifying and treating dental caries. Pediatr Clin North Am 1991;38:1049-52. |
|5.||Yahya BN, Solmaz S. The knowledge, approach and function of paediatricians in prevention of caries in Tehran. J Indian Soc Pedod Prev Dent 2004;22:148-53. [PUBMED] |
|6.||Schafer TE, Adair SM. Prevention of dental disease. The role of the paediatrician. Pediatr Clin North Am 2000;47:1021-42,v-vi. [PUBMED] |
|7.||Brice DM, Blum JR, Steinberg BJ. The aetiology, treatment, and prevention of nursing caries. Compend Contin Educ Dent 1996;17:92,94,96-98. |
|8.||Matee M, van't Hof M, Maselle S, Mikx F, van Palenstein Helderman W. Nursing caries, linear hypoplasia, and nursing and weaning habits in Tanzanian infants. Community Dent Oral Epidemiol 1994;22:289-93. [PUBMED] |
|9.||Wyne AH, Adenubi JO, Shalan T, Khan N. Feeding and socioeconomic characteristics of nursing caries children in a Saudi population. Pediatr Dent 1995;17:451-4. [PUBMED] |
|10.||Davey AL, Rogers AH. Multiple types of the bacterium Streptococcus mutans in the human mouth and their intra-family transmission. Arch Oral Biol 1984;29:453-60. [PUBMED] |
|11.||Berkowitz RJ, Jones P. Mouth-to-mouth transmission of the bacterium Streptococcus mutans between mother and child. Arch Oral Biol 1985;30:377-9. [PUBMED] |
|12.||American academy of Paediatrics policy statement. Pediatrics 2003;111:1113-5. |
|13.||American academy of Paediatric Dentistry policy statement. Pediatr Dent 2009;31:1-302. |
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4]
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