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ORIGINAL ARTICLE
Year : 2021  |  Volume : 39  |  Issue : 1  |  Page : 22-28
 

Attitude and practices of parents toward their children's oral health care during COVID-19 pandemic


Department of Pedodontics and Preventive Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi, India

Date of Submission31-Oct-2020
Date of Decision09-Nov-2020
Date of Acceptance03-Mar-2021
Date of Web Publication22-Apr-2021

Correspondence Address:
Dr. Aditi Garg
Department of Pedodontics and Preventive Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi - 110 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jisppd.jisppd_478_20

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   Abstract 


Rationale: The impact of COVID-19 has affected billions of people affecting nearly all domains of life, including patient's healthcare needs. Due to constrained dental services during lockdown, pediatric dental needs were severely compromised therefore, parental attitude and practices of maintaining child's oral hygiene impose significant impact on child's oral hygiene. Aim: This study aims to assess the attitude and practices of parents toward their children's oral health care during COVID-19 pandemic. Methodology: The present cross-sectional study was conducted with a sample of 120 parents selected randomly from the outpatient department after obtaining informed consent. A structured questionnaire was used to assess attitude and practice of parents toward their child's oral hygiene during lockdown in COVID-19 pandemic. Results: The overall attitude and practice score of parents in maintaining their child's oral hygiene was low, with mean value of 2.36 ± 1.36 and 2.51 ± 1.50, respectively. 60.8% of parents reported the need of dental treatment for their child during the lockdown period whereas 50.8% parents contacted the dentist during this period; majority (37.5%) of which reported due to toothache. 68.3% of parents would like to visit nearby dental hospital for emergencies during lockdown period. Only 33.3% of parents took extra efforts to maintain their child's oral hygiene while 45% made dietary changes in their child's diet to prevent tooth decay. Conclusion: The overall attitude and practices of the parents were poor toward the oral health of their children during the lockdown period in COVID-19 pandemic. There is urgent need of increasing awareness among parents regarding the importance of maintaining their child's oral health. The inability to see the doctor should at least encourage better home practice measures for future. The concept of tele-dentistry is very new and will be the need of the coming modern times.


Keywords: Attitude, COVID-19, oral hygiene, practice, tele-dentistry


How to cite this article:
Goswami M, Grewal M, Garg A. Attitude and practices of parents toward their children's oral health care during COVID-19 pandemic. J Indian Soc Pedod Prev Dent 2021;39:22-8

How to cite this URL:
Goswami M, Grewal M, Garg A. Attitude and practices of parents toward their children's oral health care during COVID-19 pandemic. J Indian Soc Pedod Prev Dent [serial online] 2021 [cited 2021 Sep 27];39:22-8. Available from: https://www.jisppd.com/text.asp?2021/39/1/22/314363





   Introduction Top


Severe acute respiratory syndrome (SARS-CoV-2), initially reported in Wuhan, China, during the end of 2019, was declared a pandemic on March 11, 2020.[1] SARS-CoV-2 is a single stranded RNA virus of beta genera and Coronoviridae family. The infectivity potential of the virus is remarkable due to its airborne transmission through droplets and aerosols[2],[3] transmitting from their natural reservoir to a susceptible host in different pathways such as human-human transmission, airborne transmission, and other means such as endogenous infection, common vehicle, and vector spread.[4]

To control the spread of disease in masses, no definite treatment has been implemented therefore different countries targeted the control of spread by announcing nationwide lockdown. This phase imposed challenges for patients suffering with comorbid diseases requiring consistent medical support, people with lack of resources and financial crisis on individual level. The impact of lockdown on dental professionals and dental patients in the need of urgent dental care posed a bigger challenge. Since dental profession possesses higher risk of transmission, fear of contracting the disease while the treatment has led to restricted elective dental services thereby affecting general population in the need of dental services. Certain measures such as triage, recording temperature before procedure, avoiding elective dental treatment and teleconsultation and are some initiatives adopted by the dental professionals.[5]

Pediatric dental patients in the need of dental care were also restricted from approaching the Pediatric dentist due to fear of contracting infection and official unavailability of dental services at many places. Most parents missed their routine dental visits. They contacted pediatric dentist only in need of emergency such as trauma, extra oral swelling, and severe pain and relied on medicines to relive pain and postpone the required dental treatment. This leads to the need of most vigilance of their child's oral health and implementation of aids for maintenance of better oral hygiene. Therefore, parent's knowledge and attitude have a great impact on maintenance of young children's oral health.

It is evident that the more positive is the parents' attitudes, the better will be the oral health of their children.[6] Therefore, parental education and implementation of preventive measures for maintenance of oral hygiene is considered as the only boon during these times for pediatric patients. The present study was conducted to assess parental attitude and practices toward their child's oral health care during COVID-19 pandemic. It highlights different dental preventive regimens used by parents for their child's oral health maintenance specifically during this period.


   Methodology Top


Study design and sample size

The present cross-sectional study was conducted in accordance with the guidelines of “Strengthening the Reporting of Observational Studies in Epidemiology” (STROBE statement).

A total sample of 120 parents were selected from August 2020 to September 2020 using simple random sampling from the outpatient Department of Pedodontics and Preventive Dentistry, Maulana Azad Institute of Dental Sciences after obtaining informed consent from the participants. The sample size was calculated using the representative sample size using a 95% confidence level and margin of error of 5%. The sample included parents of pediatric patients reported for dental treatment. Parents of children aged up to 14 years and willing to participate in the study were included and those with special health care needs were excluded from the study.

Validation of questionnaire

A self-instructed questionnaire was designed in English and Hindi language. The questionnaire was validated by subject experts and agreement analysis was performed to assess inter-rater variability. The kappa score for agreement was 0.92, depicting “Almost perfect” agreement.[7] The questionnaire was pretested on 20 participants as a pilot study.

Procedure

A structured questionnaire was given to the participants after validation and a brief explanation about the objectives of the survey. The first part of questionnaire included the demographic details of each participating subject along with sociodemographic information assessing socioeconomic status of parents using Modified Kuppuswamy Socioeconomic Scale.[8] The second part of questionnaire comprised of five questions assessing attitude and five questions assessing the practices of parents in maintenance of oral hygiene of their children during COVID-19 lockdown period. Multiple choices were provided for each question and the participants were asked to mark the option which they perceived to be appropriate. Statistical analysis was performed using Chi-square test and Student's t-test. All the statistical analysis was performed using Social Sciences 21.0 version (IBM corporation, Java, Chicago, USA) and P < 0.05 was considered statistically significant.


   Results Top


A total of 120 parents participated in the study were in the age group of 20 years or above with the mean age 38.23 ± 10.10 years as shown in [Table 1].
Table 1: Sociodemographic details of the participating parents

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A total of 60.8% parents reported the need of their child's dental treatment during lockdown but 49.2% of parents were unaware about the emergency dental services provided in their nearby areas. 50.8% parents contacted the dentist during the lockdown period in COVID-19 pandemic, majority of which (37.5%) reported due to toothache as shown in [Table 2]. The mode of contacting the dentist for dental emergency during lockdown period was also assessed and was found that 68.3% of parents would visit nearby dental emergency hospital as shown in [Figure 1].
Table 2: Reasons for contacting dentist during lockdown period in COVID-19 pandemic

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Figure 1: Mode of contact to dentist during the pandemic

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Regarding the impact of COVID-19 pandemic on their child's dental treatment, 41.7% parents agreed that it was hampered during the lockdown period. Out of 41.7%, 23.3% parents reported that their child's oral health worsened even after maintaining oral hygiene, 7.5% parents reported that it was under control after maintaining while 8.3% parents did not know the impact on their child's oral health.

Parental attitude in maintaining their child's oral hygiene was recorded. 47.5% parents realized the need to be more attentive toward their child's oral health while 30.8% parents did not realize the need and 21.7% parents were unaware regarding the need to be more attentive toward their child's oral health as dental services were interrupted during COVID-19 pandemic.

The practice of parents for maintaining their child's oral hygiene was evaluated. A significant number of respondents (53.3%) reported that their child brushed only once daily while 1.7% parents were not aware of their child's brushing frequency during COVID-19 pandemic as shown in [Figure 2]. Further, 10% parents reported that their child consumed cariogenic food several times a day and 17.5% reported every day as shown in [Figure 3].
Figure 2: Frequency of cleaning child's teeth during the COVID-19 pandemic

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Figure 3: Frequency of consumption of cariogenic food during the COVID-19 pandemic

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It was found that 33.3% of parents took extra efforts to maintain their child's oral hygiene out of which, 29.2% parents increased their child's brushing frequency, 15% added mouthwash, 3.3% added flossing, and 13.9% decreased the frequency of cariogenic diet as new oral health practices for better protection of their child's oral hygiene during the lockdown period in COVID-19 pandemic as shown in [Figure 4]. 45% parents also made dietary changes in their child's diet to prevent tooth decay. Out of 54 respondents implementing dietary changes, 18.3% parents decreased sugar content in their child's diet, 5.8% increased fiber content, 26.7% increased consumption of fruits and vegetables and 17.5% increased consumption of milk and cheese as shown in [Figure 5].
Figure 4: Extra efforts taken by parents to maintain their child's oral health during lockdown period in COVID-19 pandemic

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Figure 5: Dietary changes made by parents in their child's diet during lockdown period in COVID-19 pandemic

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The overall rating of child's oral hygiene by their parents was done such as 45.8% parents rated as good, 44.2% as average and 10% as poor during COVID-19 pandemic. 57.5% parents also reported that they were satisfied with the current dental services, 18.2% were unsatisfied and 24.2% were not aware regarding the current dental services provided during COVID-19 pandemic.

The mean attitude score of fathers was 2.65 ± 1.44 and among mothers was 2.13 ± 1.26, with difference between statistically significant (P = 0.04). Parents belong to upper socioeconomic status have better attitude (P = 0.001) and practices (P = 0.004) in maintaining their child's oral hygiene during lockdown period as shown in [Table 3].
Table 3: Association of attitude and practice score with parent gender using Chi-square test

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   Discussion Top


The impact of COVID-19 has affected billions of people affecting nearly all domains of their life including finances, education, lifestyle and most importantly the health care needs of the patients.[9] Due to lack of medical and dental services during lockdown period along with the fear of contracting infection, health care needs of patients has been severely affected.[20] However, the attitude of individuals and dealing efficiency of circumstances during this period was seen variable depending on factors such as level of awareness, socioeconomic status, accessibility of services and understanding the intensity of any condition.[10] One such challenge was observed in the present study by the parents of pediatric patients requiring dental treatment during lockdown period in COVID-19 pandemic.[11] Since parental attitude and practice of maintaining oral hygiene impose significant impact on child's oral hygiene, the assessment of these variables is significant.

In the present study, 60.8% parents reported the need of pediatric dental treatment during the lockdown period in the COVID-19 pandemic but only 50.8% contacted dentist for their child's dental treatment. 41.7% parents reported that their child's dental treatment was hampered during lockdown and 23.3% parents reported that their child's oral health got worsened even after maintaining oral hygiene at home. The lack of reporting for consultation was also reported in a study conducted by Karacin et al.,[12] in which people avoided medical treatments due to fear of contracting COVID-19 which may increase the risk of serious health issues in the near future. Similar findings were also reported in a study conducted by Collet et al.,[13] in which 46% of population declared that they were not leaving their houses for medical or dental appointments. This was explained as a fact that majority of patients during lockdown period were implying on the pharmacological management thereby preventing exposure.[3],[14]

The concept of tele-dentistry has emerged as a precautionary tool during COVID-19 pandemic as it enables the practitioners to provide effective consultation along with safeguarding the risk of transmitting infection.[8] In the present study, on asking the mode of contact in the dire need of dental treatment for their child, 68.3% parents reported that they would contact dentist by visiting nearby dental emergency hospital, 23.3% contact via phone call, 4.2% through text message and 4.2% through social networking sites. The reason of visiting to the dentist was because of unacceptance of tele-dentistry currently due to its complexity, incoordination between remote and core center and resistance to new skills.[13] This finding was also reported by Ghai,[15] suggesting that there is lack of face-to-face communication leading to apprehension among patients due to inadequacy of proper communication with the dentists.

The parental need to visit pediatric dentist was evaluated and it was reported that 73.81% pediatric patients visited dental clinic due to toothache, 9.84% due to gum swelling, 4.9% due to extra oral swelling, and 8.2% due to traumatic dental injury. Similar results were reported by Sun et al.,[16] in which 83.78% parents reported that they would take dental consultation only if their child had a toothache while the study conducted by Collet et al.[12] reported only 31.1% parents reported to pediatric dentist due to pain, 17% due to trauma and 4.4% due to caries.

Since the availability of health care system possessed major challenge during lockdown, the availability of emergency dental services and parental satisfaction was also assessed. 50.8% parents reported the availability of emergency dental service in their area, 37.5% reported no availability of emergency services and 11.7% were not aware of emergency services available in their area during the lockdown period in COVID-19 pandemic. 57.5% parents reported that they were satisfied with the current dental services. 24.2% parents were not aware and 18.3% reported that they were not satisfied with the current dental services because during nationwide lockdown, various national and international organizations permitted the guidelines to restrict elective treatment in government and private dental practice which lead to increased disease burden in the community.

The parental need to be more attentive toward their child's oral hygiene was assessed as 44.2% realized the need to be more attentive however only 22.5% implemented the necessary preventive measures. In spite the dental services were interrupted during COVID-19 pandemic, 21.7% were not aware while 30.8% did not realize the need to be more attentive towards their child's oral hygiene. This finding can be explained as a fact as lack of resources and communication during lockdown period imposed psychological stress to both parents as well as pediatric patients,[17] Similar finding was reported in a study conducted by Brown et al.[18] among 148 parents of child below 18 years of age, stating that 21%–47% parents reported the negative impact on their child's health and mental status during COVID-19 pandemic.

Parental practice for maintaining their child's oral hygiene was recorded in the present study and it was found that the mean practice score of parents was low. It was found that 53.3% parents assisted their children for brushing once daily, 1.7% few times a week while 1.7% parents were not aware of their child's brushing frequency during COVID-19 pandemic. Due to constraint in achieving adequate dental services, some parents reported that they increased the brushing frequency so as to maintain their child's oral hygiene. The effects of increasing brushing frequency was reported in a study conducted by Barenie et al.[19] in which children that claimed to brush their teeth more frequently had lower mean OHI-S and GI scores indicating less oral debris and gingivitis. Dietary habits were assessed as 10% parents reported that their child consumed cariogenic food several times a day, 17.5% reported every day, 22.5% reported several times a week during the COVID-19 pandemic. The effect of dietary habits on oral health was explained by Kotha et al.[20] as children consuming cariogenic food such as soft diet, confectioners, and sweets had maximum DMFT score.

It was noted that only 33.3% parents took extra efforts to maintain their child's oral hygiene, 55.8% did not while 10.8% were not aware of the efforts taken to maintain child's oral hygiene. To improve the oral health prognosis, parents added oral hygiene measures to their child's oral hygiene regimen such as 29.2% increased brushing frequency, 15% added mouthwash, 3.3% added flossing, and 13.9% decreased the frequency of cariogenic diet as new oral health practices for better protection of their child's oral hygiene during the lockdown period in COVID-19 pandemic. 45.8% parents rated their child's oral health as good, 44.2% rated as average, and 10% rated as poor during COVID-19 pandemic.

Several dietary changes were adopted by the parents as 45% reported that they made dietary changes in their child's diet during lockdown period to prevent tooth decay. 18.3% reported that they decrease sugar content in their child's diet, 5.8% reported that they increased fiber content, 26.7% increased consumption of fruits and vegetables, and 17.5% increased consumption of milk and cheese. This was similar to a study conducted by Collet et al.,[13] in which 33.1% parents made changes in their child's dietary habits and chose healthier foods whereas others increased the consumption of processed foods. 77% respondents increased the intake of high-carbs food.

The association of attitude and practice score with gender was evaluated and it was found that the mean attitude score in males was significantly higher than females with difference being statistically significant (P = 0.04) and the mean practice score was similar, with difference being statistically insignificant (P = 0.74). It was also found that the mean attitude score (P = 0.001) and mean practice score (P = 0.004) of parents of upper socioeconomic status was significantly higher, with difference being statistically significant. This depicted that parents belonging to upper socioeconomic strata were more aware and implemented appropriate oral hygiene measures for maintenance of their child's oral hygiene. This could be explained due to the fact that parents belonging to lower and lower middle socioeconomic strata tend to be less educated and were suffering from financial crisis more than those with upper strata thereby utilizing less health-care aids for their child's oral hygiene.

The importance of present study is enumerated in [Table 4] highlighted significant lack of measures taken by parents for maintaining their child's oral hygiene. This could be also be attributed due to lack of awareness, fear of exposure, unavailability of dental services, cancellation of appointments during lockdown period and inconvenience in practicing tele-dentistry. However, there were certain limitations in the present study as the study sample belongs to a general population of centrally located hospital in the city, thus, diversity of population based on COVID-19 containment zones, nation, and socioeconomic strata may bring variation in results.
Table 4: Importance of the study

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   Conclusion Top


  1. The overall attitude and practices of the parents were poor toward the oral health of their child during the lockdown period in COVID-19 pandemic. Only 33.3% parent's implemented additional oral hygiene aids to maintain their child's oral hygiene
  2. Majority of the parents reported need of dental treatment for their child during lockdown period in COVID-19 pandemic
  3. A high percentage of parents had no clue about tele-dentistry as the mode of contact with dental surgeons during dental emergency in the lockdown period and maximum preferred to visit hospital even during the pandemic
  4. Toothache was found to be the prime reason of dental visit along with traumatic dental injuries, gum swelling and extra oral swelling
  5. A significant number of parents were unaware regarding their child's dental need, availability of emergency services and importance of maintaining oral health during lockdown period in COVID-19 pandemic.


Importance of the study

  1. The study highlights the need of increasing AWARENESS among parents regarding the importance of maintaining their child's oral health by implementation of various oral hygiene practices
  2. There is need of increasing awareness regarding various causative agents of dental caries, importance of diet counseling including controlled intake of sugar and substantial intake of fibers and fruits in the diet
  3. Oral health education among parents specially belonging to lower socioeconomic strata of society was found to be low hence needs reinforcement
  4. Increasing the available emergency dental services in hospitals, clinics, dispensaries at various government and private levels needs attention as many parents could not find such services active during the needy hour
  5. There is urgent need of enhancing the concept and practice of TELE-DENTISTRY as in case of health crisis like COVID-19 pandemic it is useful for future prevention and precaution.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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2.
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McHugh ML. Interrater reliability: The kappa statistic. Biochem Med (Zagreb) 2012;22:276-82.  Back to cited text no. 7
    
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Saleem SM. Modified kuppuswamy socioeconomic scale updated for the year 2018. Ind J Res. 2018;7(3).  Back to cited text no. 8
    
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Pereira LJ, Pereira CV, Murata RM, Pardi V, Pereira-Dourado SM. Biological and social aspects of Coronavirus Disease 2019 (COVID-19) related to oral health. Braz Oral Res 2020;34:e041.  Back to cited text no. 14
    
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Ghai S. Teledentistry during COVID-19 pandemic. Diabetes Metab Syndr 2020;14:933-5.  Back to cited text no. 15
    
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Ornell F, Schuch JB, Sordi AO, Kessler FH. “Pandemic fear” and COVID-19: Mental health burden and strategies. Braz J Psychiatry 2020;42:232-5.  Back to cited text no. 17
    
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Barenie JT, Leske GS, Ripa LW. The effect of tooth brushing frequency on oral hygiene and gingival health in school children: Reassessment after two and one-half years. J Public Health Dent 1976;36:9-16.  Back to cited text no. 19
    
20.
Kotha SB, AlFaraj NS, Ramdan TH, Alsalam MA, Al Ameer MJ, Almuzin ZM. Associations between diet, dietary and oral hygiene habits with caries occurrence and severity in children with autism at Dammam City, Saudi Arabia. Open Access Maced J Med Sci 2018;6:1104-10.  Back to cited text no. 20
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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