|Year : 2016 | Volume
| Issue : 1 | Page : 12-16
Influence of mother's oral health care knowledge on oral health status of their preschool child
Raghavendra M Shetty, Anushka Deoghare, Sujata Rath, Rasna Sarda, Abhishek Tamrakar
Department of Paedodontics and Preventive Dentistry, Chhattisgarh Dental College and Research Institute, Rajnandgaon, Chattisgarh, India
|Date of Web Publication||18-Jan-2016|
Department of Paedodontics and Preventive Dentistry, Chhattisgarh Dental College and Research Institute, Rajnandgaon - 491 441, Chhattisgarh
Source of Support: None, Conflict of Interest: None
Aim: Children under 5 years of age generally spend most of their time with parents or guardians, especially mothers. Parents play a central role in giving children the information and encouragement needed for healthy lives. Parental oral health knowledge, belief and attitudes influence the oral health maintenance, dietary habits and healthy behavior of their children. The aim of this study was to assess the mothers oral health care knowledge and to assess the oral health status of their child.
Materials and Methods: A total of 386 mothers along with their child of 1-6 years were randomly selected for the study. A 22-point questionnaire including parent's literacy levels, socioeconomic status, dietary practices and oral hygiene practices, was designed to assess the knowledge of the mothers regarding oral health of their child. Oral examination of the children was done by World Health Organization criteria for recording children's oral health status.
Results: About 87% of the mothers agreed that intake of food with excessive sugars can cause cavities, and 95.8% admitted that chocolates cause the most decay. 80.5% agreed to the fact that leaving a milk bottle all night increases the risk for tooth decay, however, 59.3% mothers were of the opinion that dental visit is must only in the presence of decay. 59.3% mothers were unaware about the optimal fluoride content. 71.7% mothers agreed that caries in deciduous teeth are a matter of concern. The average decayed score of the children was 2.9 and 77.9% of the children had a fair to good oral hygiene status.
Conclusion: Instead of the fact that most of the health care knowledge that the mothers had was primarily from the family elders, they were aware of caries risk factors, tooth brushes and amount of toothpaste and bacteria from mother's cavities can infect child. This could be observed by less number of decayed teeth and good oral hygiene status of the children. However, parents knowledge, attitudes and few beliefs regarding dental care need to be improved.
Keywords: Oral health care, oral health status, preschool children
|How to cite this article:|
Shetty RM, Deoghare A, Rath S, Sarda R, Tamrakar A. Influence of mother's oral health care knowledge on oral health status of their preschool child. Saudi J Oral Sci 2016;3:12-6
|How to cite this URL:|
Shetty RM, Deoghare A, Rath S, Sarda R, Tamrakar A. Influence of mother's oral health care knowledge on oral health status of their preschool child. Saudi J Oral Sci [serial online] 2016 [cited 2019 Mar 18];3:12-6. Available from: http://www.saudijos.org/text.asp?2016/3/1/12/174291
| Introduction|| |
The major role of knowledge and attitudes in explaining behavioral changes has been confirmed by many behavioral theories such as the health belief model and theory of reasoned action. , When the assessment of the role of parents' knowledge of and attitudes towards health behavior and status of their offspring is done, the aspects of these theories are particularly emphasized.  Parents play a central role in imparting the information and encouragement to their children for healthy lives. Their attitudes have a significant impact on the children's dental and overall health. , The more positive attitude of the parents toward dental health care and dental professionals, leads to a better dental health of their children. Without basic knowledge of caries risk factor, importance of deciduous teeth and oral maintenance, it is difficult to employ effective disease preventive strategies. 
Children below 5 years of age spend most of their time with parents or guardians, particularly mothers. Within the family, the role of mother has been emphasized in relation to a child's oral health habits and status. Despite changing roles and areas of responsibility within the family, the role of mother has been emphasized in relation to a child's oral health habits and status and she still seems to play the key role.  Developing countries like India, face many challenges for providing oral health care to children of 1-5 years of age, mainly in the rural areas. , Parental knowledge and awareness of oral health care and oral hygiene habits of these children, dietary and feeding habits, care of deciduous teeth and regular dental visits are necessary for required behavioral changes towards health and early disease prevention. 
Studies on mother's knowledge on child's oral health and its influence on their child's oral health status are scanty, which has led to design this study. Hence, this study evaluates the influence of maternal aspects on child's oral health by estimation of oral health-related knowledge on diet, feeding habits, oral hygiene practices and maintenance in a developing country.
| Materials and Methods|| |
This study was carried out in a representative sample of 3-6-year-old primary school children selected from all public primary schools of the city, in Rajnandgaon, India. A total of 480 mothers along with their child (3-6 years) were randomly chosen for the study. Approval for conducting the study was obtained from the principal of the school. Ethical clearance was also taken from Institutional Ethical Board. Informed consent was obtained from the participating mothers.
A 20-point questionnaire including parent's background information, dietary and feeding practices, oral hygiene practices and the importance of dental visits, was designed to assess the knowledge of mothers regarding the oral health of their child. The questionnaire was prepared in English and also translated into the local language. Oral examination of children was done in schools with the help of mouth mirror, and probe in good light using decayed score (dt) and assessment of oral hygiene status. The mothers of a same child attending parents-teachers meeting were then asked to fill the questionnaire. A total 386 mothers, who attended the parents-teachers meeting, comprised the final sample. The answers were recorded by asking the mothers to respond to the questions by indicating the suitable option, which were expressed as scores of 1, 2 and 3 for the options in that order. The subjects were explained about how to fill the questionnaire. The data were collected and descriptive statistics were obtained. The percentage frequency distributions of parental responses to questions were calculated. Study data were analyzed using SPSS (version 12.0) (SPSS Inc., Chicago, IL, USA.).
| Results|| |
The final study sample comprised of 386 children and their mothers. There were 206 boys and 180 girls with an average age of 4.30 years. The average age for boys was 4.34 years and for girls 4.23 years. 231 of the total children were the first child, 127 were the second child and 28 were the third child. 21 mothers (5.4%) were from low socioeconomic status, 293 (75.9%) were from the middle socioeconomic status and 51 (18.7%) belonged to the high socioeconomic status. 55.2% children were breast fed, whereas only 11.1% were bottle fed. The remaining 33.7% were breast fed as well as bottle fed. [Table 1] shows the mothers' knowledge in relation to the dietary and feeding practices. 33.7% mothers thought that prolonged breast feeding may lead to caries, whereas 53.9% thought that caries are caused due to prolonged bottle feeding. 311 of the total mothers agreed to the fact that leaving milk bottle whole night in the child's mouth harms their teeth. 336 mothers believed that excessive intake of sugar containing foods such as chocolates (370 mothers), mainly can cause caries.
[Table 2] shows the knowledge of the mothers relating to oral hygiene practices. 311 mothers said that the child's teeth should be brushed twice daily, and 92.5% mothers agreed that a small sized toothbrush was best for preschool children. 59.3% mothers thought that standing in front of the child during brushing was the right method. Most of the mothers (67.3%) placed a small pea-sized amount of toothpaste on the brush; however, 228 mothers were unaware about the optimal fluoride levels that a paste should contain.
[Table 3] shows the knowledge of mothers related to dental awareness. 304 mothers agreed to the fact that with the eruption of the first baby teeth, parents can begin to clean them with a piece of gauze or clean washcloth. However, 59.3% would visit a dentist only in cases of tooth decay. 277 mothers disagreed to the fact that caries in deciduous teeth can be ignored since these teeth will be replaced with the permanent successors. 88.1% of the total participating mothers' received child care information from the elders in the family, and only 8.5% acquired any such information from their dentists.
The average dt score of the children was 2.9. On the assessment of the oral hygiene status of the children, it was found that 51.8% had a score of 1, 26.1% had a score of 2 and 22.1% had a score of 3. This also indicates that mothers participating in the present study had a fairly better knowledge of oral health care of their children.
| Discussion|| |
The oral health knowledge of the parents and/or guardians establishes the oral health and related habits of the children during infancy and maintained throughout the preschool years. Parents, especially the mothers, play an important role for their children. There are limited data for the oral health of children during the early childhood period in developing countries. , A good understanding of parental knowledge, attitudes, beliefs and awareness regarding oral health, habits and hygiene is essential for the effective implementation of oral health promotion efforts aimed at improving the dental health of preschool children.
Majority of the mothers had good knowledge about the dietary and feeding practices. 87% of the mothers believed that excessive intake of sugar containing food causes dental cavities. The findings of the present study were in line with the findings of Suresh et al., Lin et al., and Kumar et al., who also reported that parents of preschool children had good knowledge about dietary practices. ,, 95.8% of the mothers found chocolates to be the most cariogenic agent. 53.9% mothers believed that prolonged bottle feeding leads to decay, but only 33.7% believed that tooth decay may be caused by prolonged breast feeding. A vast majority of the mothers (80.5%) believed that leaving the bottle all night in the infant's mouth increases the risk for tooth decay. The mothers, who disagreed or were unaware of this, had low literacy levels. Suresh et al., reported that despite having good knowledge, many mothers used nursing bottles at bed time, similar to the findings of Gussy et al., in rural mothers in Australia. ,
70.5% mothers had adequate knowledge regarding sharing of utensils when feeding the baby, can transmit bacteria from mothers to their children and this could also be observed in the oral health status of the children where 59.4% children had a dt score of 2 or less. This is in contradiction to the findings of Suresh et al., Chhabra and Chhabra and Sakai et al. ,, Dental caries is an infectious disease caused by Streptococcus mutans. It has been strongly suggested by studies using phenotyping and/or genotyping methods that mother is the main primary source of infection for children. Early establishment of S. mutans is promoted by improper feeding habits, which increases the risk for early childhood caries in infants and toddlers.  The bacteria may be transmitted by contact, either direct (through saliva, by kissing) or indirect (shared utensils, toys or toothbrush). 
Majority of the mothers responded positively for questions relating to the oral hygiene, which suggested that they had adequate knowledge about tooth brushing and oral hygiene, except for their knowledge about fluoride. 59.2% of the mothers did not know about the fluoride content of the toothpaste. 80.5% mothers were of the opinion that the children's teeth should be brushed twice a day. Majority of them knew that small sized tooth brush should be used for brushing and only a pea sized amount of tooth paste should be used. The results of this study were much higher than the findings of Chhabra and Chhabra who found that only 41.3% of the children brushed twice a day.  78.7% of the parents believed that with the eruption of the first baby teeth, parents can begin to clean them with a piece of gauze or clean washcloth, similar to the findings of Gussy et al.  However, in the study conducted by Suresh et al., most of the parents felt that brushing should be started when all the primary teeth have erupted.  This reflected the lack of parental knowledge. 74.9% of the mothers claimed that their children happily brushed their teeth. This showed that the mothers had adequate knowledge and a positive attitude toward oral hygiene maintenance which reflected in the children as more than 75% had a fair to good oral hygiene status.
Surprisingly, in the present study despite the fact 88.1% of the mothers received information about child care from the elders in the family, they had a good knowledge about tooth brushing habits and other dietary habits. The studies conducted by Chabbra and Chhabra, Wong et al., and Mattila et al., also suggested that the elders of the family had a much higher influence on the parents for child care. ,, Only 8.5% of the mothers received information from the dentists. This suggests that there was a lack of regular dental visits and it was not considered to be important by many mothers. Furthermore, 59.3% of the mothers believed that dental checkup is required only if a caries is detected in the child's teeth. However one-third of the mothers were aware of the fact that the first dental visit should be preceded with the eruption of the first primary teeth. This can be attributed to the fact that the literacy level of the mothers in this study was quite high. The mothers were also aware to the importance of primary teeth, due to the fact that two-thirds of the mothers believed that cavities in primary teeth should be treated, since they can lead to further caries in the permanent teeth. This was contradictory to the findings of Chhabra and Chhabra and Harrison and Wong , It has been reported that the lower attention paid towards the importance of primary teeth can prove to be an obstacle to develop effective preventive programs.  The parents believe that primary teeth are present in mouth only for a short duration, and are ultimately replaced by permanent teeth.  The children whose parents ignored the importance of primary teeth or paid less attention toward decay in these teeth were more susceptible to early childhood caries.
There are certain limitations of the present study. Since the study was conducted among the children and mothers of the schools located in the city, the literacy level was considerably high. Thus, further studies with children and parents of rural areas and a larger sample are encouraged. This will aid in the formulation of preventive programs that targets the rural population and increase awareness, knowledge and help in the removal of negative attitudes among the rural population. The habits developed during the preschool period provide a foundation for better oral health care, dietary habits and encourages regular dental checkup and use of dental services in the later years. Parents, particularly the mothers should be encouraged to improve their child's oral habits since they are role models for their children.
| Conclusion|| |
The results of this study suggested that the response of the mothers regarding the role of frequent intake of sweets and sticky food products in causing decay was quite encouraging. However, it was unfortunate to find that there was a lack of knowledge by the parents regarding the role of fluoride in preventing decay, about the background levels of fluoride in their drinking water and the appropriate use of fluoridated toothpastes, since fluoride has a protective action against the development of caries. There should be an emphasis on the preventive strategies, about the importance of fluoride and optimal fluoride exposure required for the children in the programs conducted for educating the parents. Regular dental visits should be encouraged by the pediatrician to develop positive attitudes among parents and subsequently the children, towards oral health care.
| References|| |
Ajzen I, Fishbein M. Understanding Attitudes and Predicting Social Behaviour. Englewood Cliffs, NJ: Prentice Hall; 1980.
Noar SM. A health educator's guide to theories of health behavior. Int Q Community Health Educ 2005-2006;24:75-92.
Christensen P. The health-promoting family: A conceptual framework for future research. Soc Sci Med 2004;59:377-87.
Okada M, Kawamura M, Miura K. Influence of oral health attitude of mothers on the gingival health of their school age children. ASDC J Dent Child 2001;68:379-83, 303.
Szatko F, Wierzbicka M, Dybizbanska E, Struzycka I, Iwanicka-Frankowska E. Oral health of Polish three-year-olds and mothers' oral health-related knowledge. Community Dent Health 2004;21:175-80.
Suresh BS, Ravishankar TL, Chaitra TR, Mohapatra AK, Gupta V. Mother's knowledge about pre-school child's oral health. J Indian Soc Pedod Prev Dent 2010;28:282-7.
Saied-Moallemi Z, Virtanen JI, Ghofranipour F, Murtomaa H. Influence of mothers' oral health knowledge and attitudes on their children's dental health. Eur Arch Paediatr Dent 2008;9:79-83.
Grewal N, Kaur M. Status of oral health awareness in Indian children as compared to Western children: A thought provoking situation (a pilot study). J Indian Soc Pedod Prev Dent 2007;25:15-9.
Pine CM, Adair PM, Nicoll AD, Burnside G, Petersen PE, Beighton D, et al.
International comparisons of health inequalities in childhood dental caries. Community Dent Health 2004;21:121-30.
Green W, Kreuter M. Health Promotion Planning: An Educational and Ecological Approach. 3 rd
ed. Mountain View, CA: Mayfield Pub. Co.; 1999.
Chhabra N, Chhabra A. Parental knowledge, attitudes and cultural beliefs regarding oral health and dental care of preschool children in an Indian population: A quantitative study. Eur Arch Paediatr Dent 2012;13:76-82.
Lin HC, Wong MC, Wang ZJ, Lo EC. Oral health knowledge, attitudes, and practices of Chinese adults. J Dent Res 2001;80:1466-70.
Kumar RP, John J, Saravanan S, Arumugham IM. Oral health knowledge, attitude and practices of patients and their attendants visiting College of Dental Surgery, Saveetha University, Chennai. J Indian Assoc Public Health Dent 2009;13;43-53.
Gussy MG, Waters EB, Riggs EM, Lo SK, Kilpatrick NM. Parental knowledge, beliefs and behaviours for oral health of toddlers residing in rural Victoria. Aust Dent J 2008;53:52-60.
Sakai VT, Oliveira TM, Silva TC, Moretti AB, Geller-Palti D, Biella VA, et al.
Knowledge and attitude of parents or caretakers regarding transmissibility of caries disease. J Appl Oral Sci 2008;16:150-4.
Berkowitz RJ. Mutans streptococci: Acquisition and transmission. Pediatr Dent 2006;28:106-9.
Wong D, Perez-Spiess S, Julliard K. Attitudes of Chinese parents toward the oral health of their children with caries: A qualitative study. Pediatr Dent 2005;27:505-12.
Mattila ML, Rautava P, Sillanpää M, Paunio P. Caries in five-year-old children and associations with family-related factors. J Dent Res 2000;79:875-81.
Harrison RL, Wong T. An oral health promotion program for an urban minority population of preschool children. Community Dent Oral Epidemiol 2003;31:392-9.
Riedy CA, Weinstein P, Milgrom P, Bruss M. An ethnographic study for understanding children's oral health in a multicultural community. Int Dent J 2001;51:305-12.
[Table 1], [Table 2], [Table 3]