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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 9
| Issue : 3 | Page : 146-150 |
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Parental perceptions of dental health in children with neurological disorders: Cross-sectional tertiary care center assessment
Anas S Alyazidi1, Sara Y Muthaffar2, Arwa Y Muthaffar2, Osama Y Muthaffar3, Mahmoud A Gaddoury3
1 Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
2 Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
3 Department of Paediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| Date of Submission | 27-Aug-2022 |
| Date of Decision | 02-Nov-2022 |
| Date of Acceptance | 04-Nov-2022 |
| Date of Web Publication | 31-Dec-2022 |
Correspondence Address:
Dr. Anas S Alyazidi
Faculty of Medicine, King Abdulaziz University, 23446, Jeddah
Saudi Arabia
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/sjoralsci.sjoralsci_36_22
Introduction: Neurological disorders present in different age groups. In children, the spectrum of neurological diseases is multifactorial and varies between motor delay, speech delay, cognitive delay, and global developmental delay. Dental caries constitutes a public health problem that impacts approximately 80% of children nationwide.
Aims: This study aims to evaluate the magnitude of dental problems in children with neurological disorders.
Materials and Methods: An epidemiological investigation using a cross-sectional design was conducted. A total number of 2451 electronic surveys were sent to parents of children attending the pediatric neurology clinic. Children who attended the clinic from January 2017 to January 1, 2021, were included. Six hundred and seventy-five parents (28%) answered the survey.
Statistical Analysis Used: For statistical analysis, IBM SPSS Statistics for Windows (Version 21.0; IBM Corp., Armonk, NY, USA) software was used. Categorical variables were presented using numbers, associated frequencies, and percentages (%). Categorical variables were correlated using the Chi-square test.
Results and Discussion: A total number of 2451 surveys were distributed. The response rate was 28%. A total of 675 patients were labeled eligible. Patients' gender characteristics were as follows: 389 (58%) were male while 286 (42%) were female. Patients were distributed into two age groups, a group aged <7 years old and 7–14 years old.
Conclusions: Neurological disorders proved to be a burden on patients with dental caries and their families. Socioeconomic status was an important aspect in the families' ability to manage dental caries. Patients with complicated seizures and require multiple drugs were more prone to worse states of oral hygiene. Multidisciplinary care that combines dentists and medical physicians is required.
Keywords: Dental caries, epilepsy, neurological diseases, oral hygiene, pediatric
How to cite this article:
Alyazidi AS, Muthaffar SY, Muthaffar AY, Muthaffar OY, Gaddoury MA. Parental perceptions of dental health in children with neurological disorders: Cross-sectional tertiary care center assessment. Saudi J Oral Sci 2022;9:146-50 |
How to cite this URL:
Alyazidi AS, Muthaffar SY, Muthaffar AY, Muthaffar OY, Gaddoury MA. Parental perceptions of dental health in children with neurological disorders: Cross-sectional tertiary care center assessment. Saudi J Oral Sci [serial online] 2022 [cited 2023 Mar 22];9:146-50. Available from: https://www.saudijos.org/text.asp?2022/9/3/146/366523 |
| Introduction | |  |
Neurological disorders present in different age groups. In children, the spectrum of neurological diseases is multifactorial and varies between motor delay, speech delay, cognitive delay, and global developmental delay. Other examples including epilepsy, headache, brain trauma, and neurometabolic diseases may present. Recently, SARS-CoV-2 presented a further burden on hospitalized pediatric patients who experienced neurological manifestations on top of their preexisting neurological conditions.[1] Furthermore, some neurological disorders can be clinically associated with irritability, intellectual problems, and swallowing difficulties.[1] These complications may further make it difficult for their caregivers to provide optimal dental hygiene. It is said that proper dental hygiene care can lead to an increase in the health-related quality of life scale even among preschool children.[2] This presents the importance of dental hygiene as an integral part of the overall health of children. Dental caries are not just mouth cavitation, they are chronic pathologic processes that could evolve over weeks or years.[3] They contribute a burden on patients, families, and governments. In certain governmental estimates, the cost of dental treatment was estimated to be €79 billion.[4] In our country, it constitutes a public health problem that impacts approximately 80% of children nationwide.[5] Moreover, in normal children, dental problems such as dental caries, dental infections, toothbrush-usage difficulties, bruxism, and sialorrhea are common. They are classified a chronic conditions which obtain significant short- and long-term consequences.[6] Nonetheless, in children with neurological disorders, these difficulties are expected to be higher in percentage leading to higher frequencies of specialized dental clinic visits. Several strategies were proposed to enhance dental hygiene that primarily focused on education and prevention.[4],[7] Some approaches focused on applying dentist-led patient education, teacher-led, peer-led, and self-learning strategies and they all yielded similar outcomes.[7] However, we believe that a parent-led strategy would significantly contribute to oral health education, especially with the pediatric population. Subsequently, in this study, we aim to explore the parental perception of families with children experiencing a neurological disorder and dental caries.
| Materials and Methods | | |
Study design and samples
An exploratory investigation using a cross-sectional chart review design in accordance to the Strengthening the Reporting of Observational Studies in Epidemiology criteria was conducted and in accordance with the ethical principles in the Declaration of Helsinki. A total of 2451 electronic surveys were sent to parents of children attending pediatric neurology clinics using the WhatsApp application (WhatsApp LLC). Children who attended the clinic from January 2017 to January 1, 2021, were identified and included using the records of the Phoenix (Al-Anaiah International Co. Ltd., Jeddah, Saudi Arabia) health information system at King Abdulaziz University Hospital, a tertiary care center in Saudi Arabia. Six hundred seventy-five parents (28%) responded to the survey. Included candidates were selected according to the following criteria: (1) children with neurological diseases and (2) children who attended the dental clinic from January 2017 to January 1, 2021.
Ethical approval
Ethical approval for the study protocol, questions, and consent statement was granted by Biomedical Ethics Research Committee at the Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Reference Number: 178–21). Participation was voluntary and anonymous. Participants were able to withdraw from the survey at any point.
Data analysis
The responses collected were compiled in a Microsoft Excel sheet, and the data were analyzed statistically. The following variables were extracted: gender, age, nationality, previous seizure episodes, medication consumption, history of teeth inflammation, parental routine of child's mouth brushing, difficulty by the child to use a toothbrush, difficulty of hospital transferal, dentist visits, and history of bruxism or grinding. For statistical analysis, IBM SPSS Statistics for Windows (Version 21.0; IBM Corp., Armonk, NY, USA) was used. Categorical variables were presented using numbers, associated frequencies, and percentages (%). Categorical variables were correlated using the Chi-square test.
| Results | | |
In this study, a total number of 2451 surveys were distributed. The response rate was 28%. A total of 675 patients were labeled eligible according to the inclusion and exclusion criteria. Patients' gender characteristics that were presented in [Table 1] as follows: 389 (58%) were male while 286 (42%) were female. Patients were distributed into two age groups, a group aged <7 years old and 7–14 years old. A question was asked to explore participants with epileptic children and current medications used; 274 (41%) participants answered that they are on one medication, while 181 (27%) were on more than one medication, and 220 (32%) left it blank. Among the patients, there were 277 (41%) children with dental caries compared to 398 (59%) who do not have any dental caries. There were 184 (27%) patients who experienced inflammation with cheek swollen compared to 491 (73%) who have not. In regard to oral hygiene practices, 203 (30%) parents said that they “always” brush their children's teeth, 234 (35%) said that they “sometime” brush their children's teeth, while 144 (21%) and 94 (14%) parents “rarely” or “do not” brush their children teeth, respectively. Furthermore, 193 (29%) parents reported difficulties using a toothbrush with their children while 482 (71%) stated that they did not. Among the participants, 433 (64%) experienced difficulties in reaching out or transferal to a dentist specialized in children, compared to 242 (36%) who did not face such difficulties. A minority of the patient's parents (30%) stated that they parodically visit a dentist compared to the majority (70%) who stated otherwise [Figure 1]. Furthermore, there were 216 (32%) parents who stated that their children manifested with bruxism (teeth grinding) compared to 459 (68%) who did not observe such manifestations. Furthermore, there were 238 (35%) parents who believed that their child has excessive salivation compared to 437 (65%) who did not have similar beliefs. In the regression test, we compared the answers of two populations according to the presence of dental caries. In general, dental caries was present in 277 (41%) patients compared to 398 patients (59%) who did not. After constructing a Chi-square test, children with dental caries were correlated to their demographic characteristics. A total of 142 (51%) male children experienced dental caries in comparison to 135 (49%) females. One hundred and thirty-six (49%) children were younger than 7 years old and had dental caries compared to 141 (51%) children aged 7–14 years old and had similar conditions. A total of 96 (35%) children who were on a single seizure medication had dental caries while 181 (65%) children were on two seizure medications and experienced dental caries. Detailed findings are further elaborated in [Table 2]. | Figure 1: Gap difference when assessing participants periodical visits to a dentist and if they face any difficulty in obtaining a transferal to a specialized clinic
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 | Table 2: Chi-square test to compare answers among children with dental caries
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| Discussion | | |
Dental caries is an essential health problem that impacts patients and their families. It is globally gaining interest in the field of biomedical research to improve its treatment techniques.[8] Several local literatures presented high prevalence rates among the entire population with an increase in the pediatric population.[5] Recent global studies confirm that dental caries remains an active challenge which has a high prevalence rate.[9] As explained within this study, this can lead to further complications if the child is experiencing some form of neurological disease. Mental and physical well-being of children could severely deteriorate if not given the needed care. The present study provided novel data on the relationship between dental caries and neurological complications. Some findings presented that male children were slightly more prone to acquiring dental caries in comparison to their female peers. However, in comparison to their peers of the same gender, the female had a higher prevalence rate of dental caries compared to male children who were less likely to develop dental caries [Table 2]. The general prevalence was relatively equal in our study, this was consistence with literature findings across the globe.[10],[11] However, some studies suggested that male gender is a risk factor for dental caries and more seriously mouth lesions[12] Nonetheless, children who were on 2 or more seizure medications were on significantly higher (2-folds) chances of developing dental caries compared to those who were under one seizure medications. Another significant relationship was present on children who have had facial inflammation and cheek swollen where they had double the odds of developing dental caries. Patients with inflammatory disorders are at higher risk of developing clinical complications[13] and therefore require medical attention. Consequently, children with neurological disorders, inflammatory conditions, and dental caries require intensive attention. Personal and familial practices can relieve families of multiple problems, the findings of this study explain that parents who always brush their children's teeth were extremely likely to develop dental caries. All participants who were involved in brushing their children's teeth did not report their children to have dental caries unlike those who do not brush their children's teeth had presented to have the highest proportion of dental caries patients. Patients require medical care in adjustment to their personal practices. Unfortunately, the high majority of patients (99%) who experienced dental caries in their children, report to have difficulties in obtaining a transferal to a specialized pediatric dentist [Figure 1]. This requires stakeholders and policymakers attention to resolve such difficulties if they were indeed present. This requirement is further suggested in local literature to encourage better practices.[14] Finally, even patients with dental caries reported to not periodically visit a dentist.
| Conclusions | | |
Neurological disorders proved to be a burden on patients with dental caries and their families. Several issues which were discussed in this study were complicated and require the cooperation of several governmental and private bodies. Socioeconomic status was an important aspect in the families' ability to manage dental caries. Patients with complicated forms of seizures and who require multiple drugs were more prone to poorer states of oral hygiene. Multidisciplinary care that combines dentists and medical physicians, primarily neurology specialists and most specifically specialists who are specialized in the field of pediatric neurology is required. Finally, this study was a questionnaire-based with nonprobability sampling technique, which may not be sufficiently accurate to represent the study population. As a cross-sectional study, there could be potential participation bias. The response rate was relatively small and this research could have more accurate outcomes if implemented on a wider population.
Future recommendation
A system that integrates the care of dentists, pediatric neurologists, as well as neurologists should be adopted to optimize care for the targeted population. Multidisciplinary research can significantly contribute to the literature and practice, ergo, should be prompted. The socioeconomic status of patients must be vividly understood, especially among complicated cases.
Ethical policy and institutional review board statement
Ethical approval for the study protocol, questions, and consent statement was granted by Biomedical Ethics Research Committee at the Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Reference Number: 178-21). Participation was voluntary and anonymous. Participants were able to withdraw from the survey at any point.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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| 12. | Menghini G, Steiner M, Thomet E, Roos M, Imfeld T. Caries prevalence in 2-year-old children in the city of Zurich. Community Dent Health 2008;25:154-60. |
| 13. | Koutsochristou V, Zellos A, Dimakou K, Panayotou I, Siahanidou S, Roma-Giannikou E, et al. Dental caries and periodontal disease in children and adolescents with inflammatory bowel disease: A case-control study. Inflamm Bowel Dis 2015;21:1839-46. |
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[Figure 1]
[Table 1], [Table 2]
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