|Year : 2016 | Volume
| Issue : 3 | Page : 152-157
Oral health knowledge, awareness and associated practices of pre-school children's mothers in Greater Noida, India
Priyanka Sehrawat, KK Shivlingesh, Bhuvandeep Gupta, Richa Anand, Abhinav Sharma, Monica Chaudhry
Department of Public Health Dentistry, I.T.S. Dental College, Hospital and Research Centre, Greater Noida, Uttar Pradesh, India
|Date of Web Publication||12-Sep-2016|
Department of Public Health Dentistry, I.T.S. Dental College, Hospital and Research Centre, Greater Noida, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Aim: To assess the oral health knowledge, awareness and associated exercised practices of pre-school children's mothers in Greater Noida, India.
Subjects and Methods: The sampling frame for this study was chosen via convenient sampling. It comprised 598 mothers of children aged between 2 and 5 years, attending the paediatrics division of a government and four private hospitals in Greater Noida. A pre-tested questionnaire was distributed to the participants which comprised questions on the participant's sociodemographic characteristics and 23 statements regarding their knowledge, attitude and practices towards their child's oral health. Data were analysed using SPSS 21.0. P < 0.05 was considered statistically significant.
Results: The study showed that merely 24.9% of the participating mothers had good knowledge and 29.1% and 12.5% exhibited poor attitude and practices, respectively, towards their child's oral health. Knowledge about the role of fluorides, causes and prevention of dental caries, gum disease, malocclusion, appropriate timing of commencing of toothbrushing and importance of frequent dental visit was found to be inadequate among the participants. The knowledge varied significantly with respect to age (P = 0.04), education (P = 0.00) and working status (P = 0.006) of the mothers.
Conclusion: The study participants exhibited poor knowledge and attitude towards their child's oral heath which was leading to the adoption of poor oral health practices by these mothers. Thus, to improve the oral health of children, appropriate practices and measures should be promoted among their parents/guardians.
Keywords: Attitude and practice, knowledge, mother's practices, pre-school children
|How to cite this article:|
Sehrawat P, Shivlingesh K K, Gupta B, Anand R, Sharma A, Chaudhry M. Oral health knowledge, awareness and associated practices of pre-school children's mothers in Greater Noida, India. Niger Postgrad Med J 2016;23:152-7
|How to cite this URL:|
Sehrawat P, Shivlingesh K K, Gupta B, Anand R, Sharma A, Chaudhry M. Oral health knowledge, awareness and associated practices of pre-school children's mothers in Greater Noida, India. Niger Postgrad Med J [serial online] 2016 [cited 2019 May 23];23:152-7. Available from: http://www.npmj.org/text.asp?2016/23/3/152/190344
| Introduction|| |
The decision made by parents affects their child's general and oral health. The oral health care provided by the parents to the pre-school children is of crucial importance here as this determines not only the current oral health status of the child but also lays the backbone of attitudes and practices that a child adopts in this age which he carries over in his or her adulthood. Improvement in children's oral health depends on parents awareness and knowledge. It is essential to start basic good oral health habits from childhood so that the important dental norms are formed and then maintained into future. Family background plays an important role in adapting oral hygiene practices. The family is the first institution that influences child behaviour and development, especially the mothers, who are the primary role model for developing behaviour. Therefore, childhood needs close monitoring so that the child will grow up healthy. Mothers play an important role in helping their children develop healthy oral habits early in life. Mothers are known to play the role of primary caregivers in the early formative years of life of their children and also the period of primary socialisation for the child. The relationship between the oral health of mothers and that of their children has been highlighted by many researchers.,,, Considering this crucial and sensitive role of mothers, this study was designed so as to evaluate the knowledge, attitude and practices of mothers towards the oral health of their children and the association of their knowledge, attitude and practices with other potential determinants such as age, educational level and their working status.
| Subjects and Methods|| |
A cross-sectional study was conducted for 2 months among the mothers of below 5-year-old pre-school children who visited the paediatric division of government and private hospitals in Greater Noida, either for vaccination or regular check-ups. Ethical clearance was obtained from the Ethical Committee of I.T.S. Dental College, Hospital and Research Centre, Greater Noida. A total of 598 females gave informed consent for participating in the study.
The questionnaire used in this study was adapted from Jain et al. A study was conducted on fifty mothers in a hospital to check the reliability of the questionnaire which was excluded from the main study. A kappa statistic value of 0.7 was obtained subsequent to which appropriate and necessary changes were made in the questionnaire which was used throughout the study for the evaluation of the knowledge and attitude of mothers regarding oral health of their pre-school children (1–5 years). The questionnaire was designed in English and then translated by a Hindi translator into Hindi, which was again translated back to English. The back-translated version was compared with the English version to verify that the questions were properly translated. The questionnaire consisted of 23 statements which were divided into two parts. The first part consists of sociodemographic details and second part consists of 23 questions related to knowledge, attitude and practices towards children's oral health. Out of which nine questions were related to knowledge, six were related to attitude and eight were related to practice.
The statements which scored knowledge of the participants were regarding the realisation of information of a number of teeth in a child's mouth, presence of fluoride and its role in the toothpaste, common dental diseases and their causation, treatment and prevention and awareness of pressure habits in children. The statements for attitude assessed the inclination of the mothers towards regular dental check-ups, cleaning of teeth and the relative importance of oral health. For the evaluation of practices related to oral health care, the participants were analysed against their actual routine of regular dental check-ups, feeding or cariogenic diet and the oral hygiene regimens performed in relation to the timings, frequency and the aids used. The participants were scored on the basis of the number correct responses given by them. The scores obtained were categorised as knowledge - good: ≥6, fair: 3–5 and poor: <3; attitude - good: ≥5, fair: 3–4 and poor: <3; practices - good: ≥6, fair: 3–5 and poor: <3.
The investigator herself administered the questionnaires to the study participants which in this study were the mothers of children aged below 5 years attending the paediatric division of hospitals in Greater Noida from July 2015 to August 2015 and were asked to fill the questionnaire and return them back on the same day.
The data were analysed using SPSS Inc., version 21, Chicago, IL, USA. Descriptive statistics were carried out to calculate responses for each question. Further analysis was performed using one-way ANOVA determine the association of knowledge, attitude and practice scores and other factors such as age, education and working status. Pearson's correlation test was used to test the relation between knowledge, attitude and practice scores.
| Results|| |
In this study, a total of 598 mothers filled the questionnaire. The mean age of the mothers who participated in this study was found to be 28.1 ± 3.9 years.
Overall knowledge, attitude and practice
Based on this scoring criterion used, it was found that 45.10% mothers exhibited poor knowledge, 29.1% showed poor attitude and 12.5% showed poor practices. Whereas around 30% exhibited fair knowledge, 22.8% fair attitude and only 29.6% showed fair practices. In this study, very few participants were in the good category. Merely 24.9%, 37.40% and 57.9% mothers were in the good category for knowledge, attitude and practices, respectively.
To assess the knowledge of the mothers, they were asked if they believed that the milk teeth did not require any care as they would eventually shed away. About 26.3% participants agreed with the statement, and 51% disagreed with the same [Table 1]. Tooth decay (44.1%) and bleeding gums (24.4%) were rated as the most common diseases by the mothers in their children [Table 2]. Most of the mothers reported that their children brushed his/her teeth once a day and only 31.4% of the children brushed their teeth two times in a day. About 43.1% were aware the presence of fluoride in their toothpaste and 50.8% were unaware of its presence [Table 3]. Majority of the mothers did not seek any professional help until and unless they faced some problem. As a result of which, majority of the children were not seeing a dentist for regular check-ups, merely 4.3% visited the dentist regularly in every 6 months [Table 4].
|Table 1: Distribution of study participants according to their responses to knowledge, attitude and practice questions|
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|Table 2: Variation of mean knowledge, attitude and practice scores with age|
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|Table 3: Variation of mean knowledge, attitude and practice scores with education level|
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|Table 4: Variation of mean knowledge, attitude and practice scores among participants according to their working/not working status|
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Association with age, educational qualification and working and not working status
Mothers aged 25 years and above showed significantly higher mean knowledge scores when compared with the mothers who aged 24 years or below (P = 0.040). However, the difference in mean attitude and practice scores was not found to be statistically significant between both the age groups (P > 0.05). It showed that knowledge towards oral health increased with age, but there was no significant effect on the attitude and practice [Table 2].
When the variation of knowledge, attitude and practice was observed across the different levels of education which were categorised according to the Kuppuswamy's socioeconomic scale, statistically significant difference was found. Mothers with higher educational qualification (graduates and postgraduates) scored significantly higher mean knowledge (4.65 ± 2.6), attitude (4.71 ± 1.8) and practice (4.28 ± 1.8) scores compared with lower educational qualification (P = 0.000) [Table 3]. Thus, as the educational qualification increased, the mean knowledge, attitude and practice scores also increased significantly.
It was observed that the working mothers had significantly higher mean knowledge (3.99 ± 2.7) and attitude (3.71 ± 1.93) scores as compared to the mothers who were not working, and this difference was found to be statistically significant (P = 0.006). However, it was observed that the practice scores of non-working mothers (3.90 ± 1.86) were higher compared to that of the working mothers (P = 0.000) [Table 4]. This suggested that the working mothers had better knowledge and attitude for good oral health, but their practice was poorer than the mothers who were not working which may be attributed to the lack of time availability.
A strong positive correlation was found between knowledge and attitude, knowledge and practice as well as attitude and practice scores by running Pearson's correlation test [Table 5].
| Discussion|| |
Habits established in early childhood are retained in the adulthood and also, in this age group, the oral health care received comes from the oral care regimens practiced by the parents. Hence, the child's parents/guardians play an important role in the development of healthy habits in children and sustaining the same during the child's transition into adulthood. In this study, we found that mothers could identify tooth decay as the most common dental disease among children which was in agreement with the results found by Kamolmatyakul, Shivaprakash et al., Suresh et al., Wyne et al., Chan et al.,,,, It was found that 43.2% of the mothers knew that their toothpaste had fluoride, which was in contrast to the study conducted by Jain et al. Knowledge about the caries preventive methods, causes and prevention of gum disease was found to be low (30.4%, 25.3% and 34.2%, respectively) which was in line with the study done by Jain et al. and Suresh et al. Hence, the knowledge about the oral health among the mothers seemed to be poor, and it indicated a need for effective oral health education programme to be implemented.
It was shown that 64.7% [Table 1] of the mothers had an opinion that it is necessary to take the child for regular dental visits, which was similar to the studies done by Moulana et al., Chan et al., Nagarajappa et al., Talekar et al. and Pasareanu et al. It is suggested that the earlier a child visits the dentist, the greater would be his likelihood of being caries-free. The factors responsible for irregular visits and follow-up could vary depending on financial status, fear and lack of awareness and motivation. Despite the fact that majority of the mothers were aware of the fact that regular dental check-ups are necessary, only 4.3% of the mothers took their child for dental visit in every 6 months which was in accordance with the study of Jain et al. A randomised controlled trial done in the UK showed that mothers visit to trained dental educator (dentist) of those pre-school children at risk of caries increased the parental knowledge and improved the attitude toward the dental health of their offsprings. Thus, frequent dental visits (at least once every 6 months) are very crucial to reinforce good oral health habits and knowledge among parents which are passed on to the children.
In this study, it was seen that 34.1% of mothers commenced cleaning of their child's teeth after first milk teeth eruption and 18.6% started cleaning their child's teeth after eruption of all primary teeth. Contrary to our results, 95% of the parents in the rural Australia believed that they should commence toothbrushing when the first tooth erupts, as reported in a study done by Gussy et al. It was found that mothers with higher education had better knowledge, attitude and practice. This was in accordance witf Jain et al., Szatko et al. and Williams et al. The results of the study showed that respondents had partial knowledge regarding the importance of deciduous teeth. Many of them believed that milk teeth do not need good care as they are going to fall off. This was similar with the study done by Suresh et al.
About 64% of the children used toothbrush for cleaning their teeth. This was comparable to the studies done by Chan et al., Moulana et al., Pasareanu et al.,, Majority of the respondents did not know the importance of time of intake of sugars. Only 36.8% of the mothers restricted the intake of sugary foods to meal times only [Table 1]. Similar results were seen in the studies conducted by Moulana et al. and Chan et al., In contrast, this percentage was as high as 78% in the study conducted by Blinkhorn et al. A significant association was observed in this study between scores of knowledge, attitude and practice and the educational level of the participants which was in accordance with the studies conducted by Jain et al., Suresh et al. and Williams et al., wherein it was shown that parents with lower education level had poor dental knowledge and attitude also. Probably, the parents with higher education level had better knowledge regarding the oral health care of their children which resulted in favourable attitudes and adoption of better practices to render oral health care to their child.
| Conclusion|| |
This study concluded that mothers had poor knowledge and attitude towards oral health, which reflected in their poor oral health practices towards their children. Moreover, it was observed that there was no variation of knowledge, attitude and practice with the age of the mother, but it varied significantly with the level of education. Thus, the level of education should be improved among the mothers, so as to improve the oral health of their children. Variation of attitude and practice among the working and non-working mothers suggests a lack of time and attention given to the child. An interdependency between knowledge, attitude and practice inferred by the strong correlation observed is a secondary outcome which can be used in the future studies. Mothers need to be helped to realise that they are role models for their children and to be encouraged in improving the child's dental health habit. A matter of high priority is, therefore, given to the development and pursuance of wide-scale, long-term community health education programme and health promotional activities, especially for mothers. Educational activities should be promoted not only by dentists but also by general practitioners and paediatricians.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Blinkhorn AS. Dental preventive advice for pregnant and nursing mothers – Sociological implications. Int Dent J 1981;31:14-22.
Mouradian WE, Wehr E, Crall JJ. Disparities in children's oral health and access to dental care. JAMA 2000;284:2625-31.
Oredugba FA. Use of oral health care services and oral findings in children with special needs in Lagos, Nigeria. Spec Care Dentist 2006;26:59-65.
World Health Organization. Diet, Nutrition and the Prevention of Chronic Diseases. WHO Technical Report Series 916. Geneva: WHO; 2003.
Finlayson TL, Siefert K, Ismail AI, Delva J, Sohn W. Reliability and validity of brief measures of oral health-related knowledge, fatalism, and self-efficacy in mothers of African American children. Pediatr Dent 2005;27:422-8.
Nagarajappa R, Kakatkar G, Sharda AJ, Asawa K, Ramesh G, Sandesh N. Infant oral health: Knowledge, attitude and practices of parents in Udaipur, India. Dent Res J (Isfahan) 2013;10:659-65.
Shivaprakash PK, Elango I, Baweja DK, Noorani HH. The state of infant oral healthcare knowledge and awareness: Disparity among parents and healthcare professionals. J Indian Soc Pedod Prev Dent 2009;27:39-43.
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.
Wyne AH, Chohan AN, Alrowily FH, Shehri BM. Oral health knowledge, attitude and practices by parents of the children attending KSUCD clinics. Pak Oral Dent J 2004;24:145-8.
Chan SC, Tsai JS, King NM. Feeding and oral hygiene habits of preschool children in Hong Kong and their caregivers' dental knowledge and attitudes. Int J Paediatr Dent 2002;12:322-31.
Jain R, Oswal KC, Chitguppi R. Knowledge, attitude and practices of mothers toward their children's oral health: A questionnaire survey among subpopulation in Mumbai (India). J Dent Res Sci Dev 2014;1:40-5.
Moulana SA, Yashoda R, Puranik MP, Hiremath SS, Gaikwad R. Knowledge, attitude and practices towards primary dentition among the mothers of 3-5 year old pre-school children in Bangalore city. J Indian Assoc Public Health Dent 2012;19:83-92.
Talekar BS, Rozier RG, Slade GD, Ennett ST. Parental perceptions of their preschool-aged children's oral health. J Am Dent Assoc 2005;136:364-72.
Pasareanu M, Rotaru D, Balan A. The mother's role in effecting and supervising the early childhood oro-dental hygiene. Int J Prev Med 2008;16:116-24.
Blinkhorn AS, Gratrix D, Holloway PJ, Wainwright-Stringer YM, Ward SJ, Worthington HV. A cluster randomised, controlled trial of the value of dental health educators in general dental practice. Br Dent J 2003;195:395-400.
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.
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.
Williams NJ, Whittle JG, Gatrell AC. The relationship between socio-demographic characteristics and dental health knowledge and attitudes of parents with young children. Br Dent J 2002;193:651-4.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]