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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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Year : 2006  |  Volume : 24  |  Issue : 4  |  Page : 173-176

Knowledge and attitude on infant oral health among graduating medical students in Kerala

Deparment of Pedodontics, Govt. Dental College, Trivandrum, India

Correspondence Address:
N Retna Kumari
Deparment of Pedodontics, Government Dental College, Trivandrum
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-4388.28072

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Providing dental and oral health care to all children in Kerala remains a thorny challenge. Lack of community water fluoridation, dental workforce shortages and geographical barriers all aggravate oral health and access problems. Children from low-income and minority families and children with special needs are at particular risk. Family centered disease prevention strategies are needed to reduce oral health disparities in children. Oral health promotion can take place in a primary care practitioner's office, but medical providers often lack relevant training. Present study was conducted to evaluate knowledge and attitude of graduating medical students towards infant oral health qualitative methods were used to evaluate the program.

Keywords: Attitude, knowledge, medical students, oral health

How to cite this article:
Kumari N R, Sheela S, Sarada P N. Knowledge and attitude on infant oral health among graduating medical students in Kerala. J Indian Soc Pedod Prev Dent 2006;24:173-6

How to cite this URL:
Kumari N R, Sheela S, Sarada P N. Knowledge and attitude on infant oral health among graduating medical students in Kerala. J Indian Soc Pedod Prev Dent [serial online] 2006 [cited 2023 Feb 6];24:173-6. Available from: http://www.jisppd.com/text.asp?2006/24/4/173/28072

   Introduction Top

Although the American Academy of Pediatric Dentistry calls for every child to have a dental visit by the time the first primary tooth erupts and to have access to preventive dental care throughout childhood, the reality is very different, especially for children in low-income families.[1] Despite the decline in caries rates achieved in recent decades with the use of fluorides, disease rates remain high in these populations. Pediatricians and family physicians have the opportunity to affect the oral health of children because of their early and frequent contact during well-child and chronic condition visits.[2] Children <5 years of age see a physician more often than they do a dentist. The strategy of utilizing primary care medical providers to promote oral health is particularly necessary in rural regions where there are few dentists and even fewer pediatric dental specialists. A recent survey of medical students concluded that the medical school and residency curriculums are inadequate in this area. Before primary care practitioners and pediatricians can be expected to increase their involvement in oral health prevention, such practices must be incorporated into medical education. Family medicine's focus on maternal and infant care promotes targeting the origin of pediatric oral health problems, including transmission of cariogenic bacteria from mother to infant as well as parental attitudes, knowledge, cultural practices and behaviors associated with oral disease. The family medicine setting provides opportunities to intervene with pregnant women whose oral disease may place them at increased risk for premature labor and low birthweight babies.[3],[4]

Dental professionals often assume that medical professionals have adequate knowledge about infant oral health and will refer children before it becomes irreversible. Even though they are the first health professionals in contact with expectant parents, parents of infants and infants, they are not well informed about dental health and do not appropriately refer children with dental disease. They treat the presenting complaint and sometimes a few gives a wrong notion to parents that primary teeth are only temporary, do not require treatment and will eventually exfoliate Moral and pragmatic reasons to prioritize children for special interventions in oral health are that the children are at the beginning of the life span when there is maximal opportunity for disease prevention and health promotion. Children are dependent upon their families and cannot advocate for themselves and adult oral health is directly proportional to infant oral health.

The present study was conducted to evaluate the knowledge and attitudes of graduating medical students towards infant oral health; and to propose ways to strengthen the incorporation of infant oral health and prevention of oral diseases in children into clinical medical education. Qualitative methods were used to evaluate the program.


  1. To evaluate the knowledge and attitudes of graduating medical students towards infant oral health and
  2. To propose ways to strengthen the incorporation of infant oral health and prevention of oral diseases in children into clinical medical education.

   Materials and Methods Top

A cross-sectional survey was undertaken among 200 final year medical students of Medical Colleges at Trivandrum and Kozhikode districts of the Kerala State. These two colleges were chosen being affiliated to two different universities. A self-administered questionnaire with 23 items was administered to those students volunteered for the study of dental. The survey questions were divided into six domains assessing, the Knowledge regarding Infant dental anatomy, Early childhood caries (ECC), Maternal Oral Health and ECC, Preventive strategies on ECC, Use of fluorides and Behaviors associated with ECC. We hypothesized that the students' infant oral health knowledge, preventive strategies and opinions about the importance of oral health would be associated with their propensity to refer children who are younger than 3 years and are suspected of having risk factors for future dental disease or a few teeth in the beginning stages of decay.

   Results and Discussion Top

The data were analyzed using descriptive statistics and Chi square test was carried out to assess association across groups. Though the overall knowledge on infant dental anatomy was adequate, most of the respondents were unaware that the deciduous dentition does not have premolars and only 32% knew the association between natal teeth and  Riga-Fede disease More Details [Table - 1].

In spite of the respondents being aware on the aetiology of ECC, they did not associate prolonged demand breast-feeding with ECC. Only 6% were aware that demand feeding should be stopped when the first tooth erupts. Most of the respondents opined that the causative organism of dental caries is lactobacillus and only 10% opined on Streptococus mutans [Table - 2].

About 48% of the students were aware of the association of poor maternal gum health and preterm, low birth weight baby, but only 9% knew that Streptococus mutans can be transmitted from the mother or primary caretaker to the child. Only 3% were aware of the benefits of antenatal counseling of parents on infant oral health [Table - 3].

Nearly 40% of the respondents were aware that the first dental visit should be carried out before the first birthday of the infant, but the overall awareness on preventive measures were very poor [Table - 4].

The respondents awareness of the benefits of fluorides were good, but their overall knowledge on fluorides were inadequate. Only 19% knew the optimal fluoride level of drinking water. 90% were unsure whether the corporation water supply was fluoridated. Most of them recommended fluoride toothpastes in toddlers [Table - 5].

Gender-wise association on behaviours attributed to nursing caries was not significant.

Most of the respondents knew that frequent exposure to sweetened liquids, use of sweetened pacifiers and any liquid other than plain water in the bottle at night could cause ECC. However, only 15% associated prolonged breast-feeding to ECC [Table - 6].

A prime example of where dental-medical collaborations can target oral health disparities through prevention is in pediatric oral health. Children are dependent upon their families for access to healthcare and home health practices, which may vary with cultural or social milieu. For instance, high-risk diet/feeding practices in some cultures, such as pre-chewing children's food or high consumption of acid snacks, can be deleterious to teeth. Because children cannot advocate for themselves, special arrangements may be needed to ensure children receive needed care. Such arrangements include case management services for families who have difficulty getting to dental appointments and the promotion of children's health wherever they are-in school, daycare or, in this case, the primary care practitioner's office.[5],[6]

Mutans streptococci are believed to colonize the mouth only when teeth are present and most studies reported that initial colonization occurred only after eruption of the primary teeth and poor maternal oral hygiene and dietary habits increase the likelihood of transmission of the infection from mother to child. Child-rearing habits which facilitate saliva transfer from adults to the child, such as sharing of food and utensils and habits which involve close contact, such as breast feeding and sleeping beside the mother, were also significantly associated with colonization of S. mutans .[7],[8],[9],[10]

One hypothesis to explain the association between periodontal disease (PD) and preterm/low birth weight (PT/LBW) is that PT/LBW may be indirectly mediated through translocation of bacteria or bacterial products in the systemic circulation. Transient bacteremias occur in subjects with marginal periodontitis or with gingivitis and it is possible that bacteria and their products may reach the placental membranes hematogenously and provide the inflammatory effect to induce preterm labor.[4]

Breast-feeding should be promoted during the first year of life, although ad libitum nocturnal breast-feeding should be discouraged after the first primary tooth erupts. Bottle-fed infants should not be put to sleep with the bottle. Weaning from the breast or the bottle should be encouraged by

12-14 months of age. Iron-fortified infant cereals, along with breast milk or infant formula, should be consumed by infants who are at least 6 months of age. Establishment of good dietary habits during infancy and childhood can minimize risk of caries development throughout life.

MS has been implicated as the principal bacterial component responsible for dental caries in humans. The major source from which infants acquire MS is their mothers. The majority of pregnant women get no instructions during pregnancy regarding oral health, even though this is a phase of increased acceptance of instructions that should be used as an opportunity to introduce preventive programs. Prenatal education becomes the key to the dental care of the infant because mothers should serve as models for their children and interventions with children are much more likely to be successful in an environment where the mother is already a successful patient.

A survey of physicians' attitudes about pediatric dental health concluded that, although they are the first health professionals in contact with expectant parents, parents of infants and infants, they are not well informed about dental health. Sanchez et al. assessed the knowledge, attitudes and beliefs of pediatricians and family practice physicians toward pediatric preventive dental care. Both groups recognized that they received inadequate information about pediatric preventive dental care during training and almost unanimously advocated increasing their knowledge through medical and specialty training or continuing education. Clearly, family practitioners and other primary healthcare providers must receive additional education before they can assume a larger role in the early detection of oral disease primary care medical and dental services.[1],[11],[12]

   Conclusions Top

Tooth decay remains a substantial problem in young children and is made worse by existing barriers that prevent them from obtaining dental care. Because most children are exposed to medical care but not dental care at an early age, primary care medical providers have the opportunity to play an important role in helping children and their families gain access to dental care. This study has identified several factors that need consideration in the further exploration and development of primary care physicians' role in providing for the oral health of their young patients. Knowledge and attitudes on infant oral health among medical students were inadequate.

Medical students will require adequate training in infant oral health in medical school, residency and in continuing education courses. At this juncture we recommend that a module on oral health and dental care should be included in the medical curriculum. All newly graduated doctors, medical practitioners and pediatricians should be updated on the current information and guidelines on preventive dental care.

   References Top

1.Jose B, King NM. Early childhood caries lesions in preschool children in Kerala, India. Pediatr Dent 2003;25:594-600.  Back to cited text no. 1  [PUBMED]  
2.Sanchez OM, Childers NK, Fox L, Bradley E. Physicians' views on pediatric preventive dental care. Pediatr Dent 1997;19: 377-83.  Back to cited text no. 2  [PUBMED]  
3.Douglass JM, Douglass AB, Silk HJ. Infant oral health education for pediatric and family practice residents. Pediatr Dent 2005;27:284-91.  Back to cited text no. 3    
4.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.  Back to cited text no. 4    
5.dela Cruz GG, Rozier RG, Slade G. Dental screening and referral of young children by pediatric primary care providers. Pediatrics 2004;114:e642-52.  Back to cited text no. 5    
6.Mouradian WE, Berg JH, Somerman MJ. Addressing disparities through dental-medical collaborations, part 1. The role of cultural competency in health disparities: Training of primary care medical practitioners in children's oral health. J Dent Educ 2003;67: 860-8.  Back to cited text no. 6    
7.Masuda N, Tsutsumi N, Sobue S, Hamada S. Longitudinal survey of the distributionn of various serotypes of Streptococcus mutans in infants. J Clin Microbiol 1979;10:497-502.  Back to cited text no. 7    
8.Caufield PW, Cutter GR, Dasanayake AP. Initial acquisition of mutans streptococci by infants: Evidence for a discrete window of infectivity. J Dent Res 1993;72:37-45.  Back to cited text no. 8    
9.Karn TA, O'Sullivan DM, Tinanoff N. Colonization of mutans streptococci in 8- to 15-month-old children. J Public Health Dent 1998;58:248-9.  Back to cited text no. 9    
10.Wan AK, Seow WK, Purdie DM, Bird PS, Walsh LJ, Tudehope DI. A longitudinal study of Streptococcus mutans colonization in infants after tooth eruption. J Dent Res 2003;82:504-8.  Back to cited text no. 10    
11.Zanata RL, Navarro MF, Pereira JC , Franco EB, Lauris JR, Barbosa SH. Effect of caries preventive measures directed to expectant mothers on caries experience in their children. Braz Dent J 2003;14:75-81.  Back to cited text no. 11    
12.Graham E, Negron R, Domoto P, Milgrom P. Children's oral health in the medical curriculum: A collaborative intervention at a university-affiliated hospital. J Dent Educ 2003;67:338-47.  Back to cited text no. 12    


[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6]

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