|Year : 2010 | Volume
| Issue : 4 | Page : 282-287
Mother's knowledge about pre-school child's oral health
BS Suresh1, TL Ravishankar2, TR Chaitra3, AK Mohapatra4, V Gupta2
1 Department of Pedodontics and Preventive Dentistry, Teerthankar Mahaveer Dental College, Moradabad - 244 001, India
2 Department of Community Dentistry, Kothiwal Dental College & Research Centre, Kanth Road, Moradabad - 244 001, India
3 Department of Pedodontics and Preventive Dentistry, Kothiwal Dental College & Research Centre, Kanth Road, Moradabad - 244 001, India
4 Department of Community Dentistry, K.D. Dental College, Mathura, Uttar Pradesh, India
|Date of Web Publication||25-Jan-2011|
T L Ravishankar
Department of Community Dentistry, Kothiwal Dental College & Research Centre, Kanth Road, Moradabad - 244 001, Uttar Pradesh
| Abstract|| |
Children under the age of 5 years generally spend most of their time with their parents and guardians, especially mothers, even when they attend pre-schools or nurseries. It has been found that young children's oral health maintenance and outcomes are influenced by their parent's knowledge and beliefs. This study was done to assess the mother's knowledge about the oral health of their pre-school children in Moradabad, India. Mothers of children aged 1-4 years, attending the hospital for vaccination or regular checkups in the pediatric division of government hospitals, were invited to participate in the study. A 20-item questionnaire covering socio-demographic characteristics, dietary practices, oral hygiene practices and importance of deciduous teeth, was distributed to their mothers, during their visit to the hospital. Responses of the mothers were recorded on a Likert Scale. The sample comprised 406 mothers, with the mean age of children being 3.8 years. Three hundred (73.8%) mothers had a good knowledge about diet and dietary practices, while only 110 (27.1%) and 103 (25.4%) mothers were found to have a good knowledge about the importance of oral hygiene practices and importance of deciduous teeth, respectively. Mothers with higher educational qualification and information gained through dentist had a better knowledge about child's oral health. Oral hygiene habits and dietary habits are established during pre-school days and the parents, especially mothers, function as role models for their children.
Keywords: Importance of primary teeth, oral health knowledge
|How to cite this article:|
Suresh B S, Ravishankar T L, Chaitra T R, Mohapatra A K, Gupta V. Mother's knowledge about pre-school child's oral health. J Indian Soc Pedod Prev Dent 2010;28:282-7
|How to cite this URL:|
Suresh B S, Ravishankar T L, Chaitra T R, Mohapatra A K, Gupta V. Mother's knowledge about pre-school child's oral health. J Indian Soc Pedod Prev Dent [serial online] 2010 [cited 2013 May 21];28:282-7. Available from: http://www.jisppd.com/text.asp?2010/28/4/282/76159
| Introduction|| |
There is a dearth of information on the oral health of pre-school children in India. Very few data are available on the oral health of pre-school children. Data from NOHS 2000 reported a mean Decayed Missing Filled Teeth (DMFT) of 1.40,  which is quite high compared to that of developed countries in Europe, North America and Australia.  Dental caries is a transmissible infectious disease in which Streptococcus mutans0 is generally considered to be the main etiological agent.  Studies using phenotyping and/or genotyping methods strongly suggest that mother is the major primary source of infection for children. Improper feeding practices by mothers/caregivers increase the risk for the development of early childhood caries in infants and toddlers, by promoting the early establishment of S. mutans in the oral cavity. 
Children under the age of 5 years generally spend most of their time with parents and guardians, especially mothers, even when they attend pre-schools or nurseries. These early years involve "primary socialization" during which the earliest childhood routines and habits are acquired.  These include dietary habits and healthy behaviors established as norms in the home and are dependent on the knowledge and behavior of parents and elder siblings. Studies have reported that poor attitude of parents toward oral health of infants and young children are associated with increased caries prevalence (Hind and Gregory, 1995). 
It has been found that the more positive is the parents' attitudes toward dentistry, the better will be the dental health of their children.  Young children's oral health maintenance and outcomes are influenced by their parent's knowledge and beliefs, which affect oral hygiene and healthy eating habits. Without basic knowledge of caries risk factors, importance of the deciduous teeth and oral maintenance, it is difficult to employ effective disease preventive strategies.  Parent's knowledge and positive attitude toward good dental care are very important in the preventive cycle.
The aim of this study was to assess the mother's knowledge about the oral health of their pre-school children in Moradabad, India.
| Materials and Methods|| |
The sampling frame for this study comprised mothers of the children aged between 1 and 4 years, attending the pediatric division of government district hospitals in Moradabad. Mothers of children attending the hospital for vaccination or regular checkups in pediatric division were invited to participate in the study. Approval to conduct the study was obtained from the Chief Medical Officer of the District Hospital, Moradabad. Informed consent was also taken from the participating mothers. Ethical clearance was also taken from the dental college ethical board.
A questionnaire was designed to assess the knowledge and the attitude of mothers regarding oral health of their pre-school children (1-4 years). The 20-item questionnaire in local language covered socio-demographic characteristics, dietary practices, oral hygiene practices and importance of deciduous teeth, and also, the source of information. Some questions were modified after a pilot study was carried out with a convenience sample of mothers to improve understanding and clarity. The questionnaires were distributed to the mothers of children during their visit to pediatric division of hospital from July 2009 to Oct 2009.
A total of 406 mothers participated in the study. The mothers were asked to respond to the knowledge questions by indicating "strongly agree," "somewhat agree" "somewhat disagree" or "strongly disagree" on a modified Likert scale. The correct answer with strong convection was awarded a score of 3, while completely wrong answer with strong convection was awarded 0 as the score. The results were expressed as scores of responses for each category of questions. Chi-square test was utilized to find out the significant difference between the responses. One-way analysis of variance (ANOVA) was used for comparing the knowledge of mothers between different subgroups. For all the tests, a P value of 0.05 or less was used for statistical significance.
| Results|| |
The sample comprised 406 mothers, with the children's mean age being 3.8 years. Mother's knowledge about oral health of their pre-school children was accessed using a questionnaire which was grouped under three categories: (a) Diet and dietary practices (b) Oral hygiene practices and (c) Importance of deciduous teeth. The responses to the questionnaire were given scores, wherein a completely correct answer was awarded a score of 3 while a completely wrong answer was awarded/given 0 as the score.
[Table 1] shows the mothers' knowledge of three categories of questions. Three hundred (73.8%) mothers had a good knowledge about the diet and dietary practices, while only 110 (27.1%) and 103 (25.4%) mothers were found to have a complete knowledge about the importance of oral hygiene practices and importance of deciduous teeth, respectively. No significant difference was seen between the knowledge of oral hygiene and that of importance of deciduous teeth.
[Table 2] shows that the diet and dietary practice scores show no significant difference among three educational groups (P ≤ 0.057), whereas knowledge regarding importance of deciduous teeth and oral hygiene practices among mothers of different educational qualifications varies significantly (P≤0.001) and (P ≤ 0.004), respectively. Graduates were seen to have a better knowledge on importance of deciduous teeth as well as about the importance of oral hygiene practices, with the mean scores of 2.98 ± 0.79 and 2.96 ± 0.81, respectively.
|Table 2 :Distribution and comparison of knowledge scores between different educational subgroups |
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[Table 3] shows that knowledge scores of diet and dietary practices do not vary significantly between urban and rural mothers (P = 0.388), whereas knowledge scores regarding oral hygiene practices or importance of deciduous teeth varies significantly between urban and rural mothers with P = 0.013 and P = 0.007, respectively. Urban mothers had a better knowledge about the dietary practices, oral hygiene practices, and importance of deciduous teeth than the rural mothers.
|Table 3 :Distribution and comparison of knowledge scores between urban and rural population |
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[Table 4] shows that only the oral hygiene scores varies significantly (P = 0.001) between the different sources of information. Information acquired from dentist is better with a mean score of 2.90 ± 0.88, when compared to 2.61 ± 1.13, 2.10 ± 1.26, and 2.77 ± 0.95 for television, elders, and others, respectively, as the sources of information.
|Table 4 :Distribution and comparison of knowledge scores according to the source of information |
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| Discussion|| |
Oral health of the children is associated with oral health knowledge of their mothers/guardians, as oral health related habits (such as those related to oral hygiene and diet) are established during infancy and maintained throughout early childhood.  Parents, especially mothers, function as role models for their children. This study provides important new data to the evidence base related to knowledge of mothers toward oral hygiene of infants. To our knowledge, there are very few Indian studies involving mother and children of this age group. The questionnaires particularly focus on the knowledge of mothers about relevant risk and protective factors that are likely to have influence on oral health of infants, and also, the influence of socio-demographic factors on mothers' knowledge.
Diet and dietary practices
The response to this section of questionnaire was encouraging as 300 (73.9%) mothers had good knowledge about diet and dietary practices which include questions regarding sugar and caries, feeding practices, snacking practices. Similar results were reported by Lin et al,  and Pradeep Kumar et al.  Majority of the mothers had good knowledge regarding the role of diet in oral health; they believed that sweet snacks and sweet drinks contribute to caries. Despite having good knowledge, many mothers reported of using nursing bottle at bed time. Similar results were reported by Gussy et al, in rural Australian mothers, which is contrary to the MCHN recommendation,  although it is apparent that the content of the bottle is more important than the use of the bottle. 
Oral hygiene practices
In the present study, the knowledge regarding the oral hygiene practice which includes brushing, sharing of utensils, especially feeding spoon, and knowledge about fluoride was not satisfactory, as nearly 294 (72.8%) of the mothers had only inadequate or partial knowledge. Majority of the mothers had inadequate knowledge about the fact that sharing of utensils can transmit S. mutans which can cause caries in children, which is similar to that reported in a study by Sakai et al.  The mode of transmission of cariogenic bacteria appears to be contact, either direct or indirect. Direct contact is commonly by kissing, so that oral flora is transmitted in saliva; indirect contact occurs via objects such as a cup, utensils, toothbrush, or even shared toys, which are contaminated with cariogenic bacteria. ,,
The concept of dental caries as an infectious and transmittable disease was convincingly demonstrated by Keyes (1960).  Another aspect of oral hygiene practice was brushing. Most of the parents felt that they should brush their child's teeth when all the primary teeth have erupted. Contrary to our result, 95% of the parents in rural Australia believed that they should start brushing when the first tooth erupts, as reported in a study done by Gussy et al.  In the present study, mother's knowledge regarding fluoride was found to be inadequate.
Importance of deciduous teeth
Respondents have partial knowledge on the importance of deciduous teeth. Many of the mothers said that cavities in baby's teeth do not matter, and are not able to identify common dental problems like dental caries and gingivitis.
There is a significant difference between the three categories of questionnaires. Most of the mothers had good knowledge about diet, but knowledge of oral hygiene and importance of primary teeth was very poor. This suggests a need for pediatricians and the primary health workers, who come in contact with new mothers, to play an active role in oral health promotion and to draw mother's attention to the need for their child to be seen by a dentist.
Dietary knowledge is mostly influenced by the dietary tradition of a specific area, which is also clear from the results that knowledge about the diet and dietary practice does not depend upon with mother's educational qualification or the demographic inhabitation. In addition to this, as the main source of information were the elders in the family, the dietary tradition was inherited. This also speaks of the inefficiency of the dentist and dental organizations in educating the masses. This result is not in accordance with that of William et al, who stated that parents coming from the deprived areas and with lower educational level have low level of oral health knowledge.  Mothers with higher education have a better knowledge regarding the oral hygiene practice and importance of deciduous teeth. This is similar to a Polish study which reports that mothers with lower level of education also have low levels of oral health knowledge.  It has been suggested that the parents with a general, improved level of education may be able to assess appropriate source of information and understand that information more completely. 
One of the basic factors that may give some idea about oral health awareness among parents is the frequency of dental visits,  and the mother with higher educational qualification does visit the dentist more often. Zavras et al, (2002) have reported that 53% of well-educated mothers visited the dentists one or two times per year versus 19.6% mothers with basic education.  A randomized control trial in UK showed that visits to trained dental educator (dentist) by mothers of pre-school children at risk of caries increased the parental knowledge and improved the attitude toward dental health of their offsprings. 
Wyne et al, had reported that 34.2% of the Saudi population get the oral health information from dentist, followed by media,  whereas in the present study very few subjects got the information from dentist. This is due to low utilization of dental services by the pre-school children as the parents do not perceive that dental problem might exist in their child.  Personnel, communal, cultural, and economic factors influence dental health behavior when families seek dental care. 
Conditions established in pre-school years provide a foundation for oral health condition and patterns for use of dental services later and in adulthood. Parents, especially mothers, need to be helped to realize that they are role models for their children and to be encouraged to improve the child's dental health habit.
| Conclusions|| |
Health professionals, who are the first to come into contact with expectant and new mothers, need to disseminate appropriate and accurate information about oral health care for infants, especially the use of nursing bottle at night, the value of tooth brushing and regular dental visits. A matter of high priority is therefore the development and implementation of wide-scale, long-term programs of health education and promotion for expectant new mothers.
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[Table 1], [Table 2], [Table 3], [Table 4]