See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/304764240

Knowledge, Attitudes And Practices of Parents Regarding Oral Health and Its
Correlation with Dental Caries Status of Their Children: A Cross Sectional Study

Article · September 2015

CITATIONS READS

0 998

2 authors:

Niraj Gokhale Sivakumar Nuvvula

KLE Academy of Higher education and research Narayana Dental College and Hospital
28 PUBLICATIONS   29 CITATIONS    125 PUBLICATIONS   623 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Perceptions of aesthetics in Southrenindian School children View project

Hereditory gingival fibromatosis in a - year old girl: A case report View project

All content following this page was uploaded by Sivakumar Nuvvula on 04 July 2016.

The user has requested enhancement of the downloaded file.

 Original Research
Knowledge, Attitudes And Practices of Parents Regarding
Oral Health and Its Correlation with Dental Caries Status of
Their Children: A Cross Sectional Study
AUTHORS: GOKHALE NIRAJ S1, SIVAKUMAR NUVVULA2
ABSTRACT:
Introduction: Since the oral health of the child depends on the
oral health and awareness of the parents the evaluation of the
parental knowledge, attitudes and practices are an important tool
which projects the parent's outlook towards the oral health of their
children.
Aim: The aim of this cross-sectional study was to assess the
correlation between knowledge attitudes and practices of the
parents regarding oral health to the dental caries status of their
children.
Methods: 1000 school children were given questionnaires to be
completed by their parents and the answers to several questions
regarding oral health were obtained and then the children were
examined for dental caries. The data collected was statistically
Key Words : Attitudes, Dental caries, Knowledge, Parents
INTRODUCTION
Despite considerable decrease in the prevalence of dental caries
among children in the past few decades, a significant proportion of
children are still affected by this disease.[1] Since dental caries is well
recognized as a dietary carbohydrate modified bacterial infectious
disease, caries prevention in young children has been reliant on
mothers being acquainted with information on dental health and
having right attitudes towards oral health.[2] The primary aetiology of
dental caries consists of
1. presence of Streptococcus mutans
2. fermentable carbohydrates metabolized into organic acids
3. a susceptible tooth surface.
Other factors such as feeding patterns, oral hygiene and various
other habits are also associated with dental caries.[3] Less studied
areas are:
1. parental awareness
2. cultural attitudes
3. social influences
knowledge regarding dental caries, which are now thought to be
contributing factors.[4] The dominant paradigm for health promotion
efforts during the 1970s to 1980s focused mainly to change
awareness or knowledge, and in turn, individual's behaviour.
Contemporary health promotion efforts are starting to move away
from this paradigm, recognizing that education is a necessary, but
not sufficient component of any health behaviour change
intervention. There is a growing realization that oral health
promotion efforts need to adopt a broader perspective and address
multiple determinants. Recently, interest in understanding the social
and psychosocial factors like cognitive elements, such as dental
knowledge, beliefs, attitudes, feelings and broader social forces like
1 Bhavnagar University's Journal of Dentistry 2015;5(3) : 1-5
analysed for knowledge levels, attitudes and practices to the
caries status in their children.
Results: The results showed significant correlation between the
knowledge and attitudes of parents and the dental caries status of
their children.
Analysis: The data collected was analysed using the SPSS
(Statistical Package for the Social Sciences) software 18.0
version, and the Chi-square test with the level of significance set at
0.05.
Conclusion: This study showed evidence that, those children
whose parents had less knowledge and showed indifferent
attitudes towards the oral health had high incidence of dental
caries compared to those children whose parents had knowledge
and the right attitude towards oral health.
living conditions has increased. [5]
This paper explores on how parental knowledge, attitudes and
practices relate to dental caries status of their children.
MATERIALS AND METHODS
Prior to the study institutional ethics committee approval was taken
and written informed consent from the parents of the participants
was obtained. Before the start of the study the questionnaire was
pre tested on 250 parents. In this cross-sectional study pretested
questionnaires to be filled by parents were distributed in school
going children of Nellore district, Andhra Pradesh, India. Questions
regarding the knowledge and attitudes of the parents were included
in this questionnaire. Thousand children who duly returned the
completed questionnaires were enrolled into the study and were
examined for dental caries using the WHO criteria and the dental
caries status was recorded onto a standardized decayed, filled,
teeth(dft) and Decayed, Missing(due to caries), Filled Teeth (DMFT)
recording form.
DATA ANALYSIS AND RESULTS
The data collected was analysed using the SPSS (Statistical
Package for the Social Sciences) software 18.0 version, and the
Chi-square test with the level of significance set at 0.05. The most
important questions regarding oral health and the responses of the
parents to theses were tabled and frequencies, p-value were
calculated.
DISCUSSION
In many developed countries, dental caries prevalence has
decreased significantly in the past few decades. The prime reason
for this decrease has been attributed to improvement in oral
hygiene, changes in lifestyle, use of fluoride, and implementation of
school-based preventive programmes. However, during the same
 www.bujod.in Gokhale et al

time period, prevalence of dental caries has been increasing in How often do you
many developing countries.[6] The National Oral Health Survey and visit dental clinic
Fluoride Mapping found a high prevalence of caries in primary Once in 6 months 102 10.20
dentition of 5 year old children in India with 51.9% of the children in Once in 1 year 67 6.70
this age group affected with caries.[7] This high prevalence of caries Once in 2 years 56 5.60
has been associated with low level of oral health awareness among Whenever need arises 775 77.50
mothers as well as with consumption of a cariogenic diet and poor If you do not visit the
oral hygiene.[8] dentist reasons are
Most people consider that primary teeth are not of great importance Afraid of dentist 294 29.40
to themselves or their children and serious oral care need not start Afraid of dental tools 177 17.70
until the permanent teeth have erupted. Unfortunately this belief is No time 158 15.80
not true and could eventually lead to physical and emotional Treatment cost is more 173 17.30
distress later on.[9] In a study by Bodhale et al it was found out that Afraid sitting in waiting room 198 19.80
parents with low socioeconomic status had lesser awareness about How important do you
importance of primary teeth and timely treatment of the same.[10] In think are milk teeth
the present study also 33.7% of the parents considered that the Very important 226 22.60
primary teeth are not important, 22.6% considered primary teeth to Moderately important 226 22.60
be very important and 21.1% responded that they did not know Not at all important 337 33.70
anything about it. Children of parents, who considered the primary None 211 21.10
teeth to be unimportant, had high incidence of dental caries which Do you supervise your children while
was statistically significant (Table 2) (p=0.0378). they brush their teeth
Finlayson et al [5] reported that mothers, who brushed their teeth Yes. Watch them while brushing 163 16.30
regularly, were more knowledgeable, felt more efficacious about Do not watch but advice 158 15.80
their children's oral hygiene needs and were more likely to take good Never care 529 52.90
care of their children's oral hygiene. According to Singh et al the Only my spouse watches 150 15.00
barriers oral health care in India is lack of knowledge about disease Do you prefer to snack while
watching TV or listening to radio
prevention and awareness of clinical needs. [11] In the present study
62.1% reported that they brushed only once, while only 36.4% Yes 919 91.90
responded that they brush twice and 1.4% agreed to be brushing No 81 8.10
more than twice. It was found that the children of parents who Total 1000 100.00
brushed only once had more caries than those children whose
parents brushed more than once but the values were not statistically Table 2: Comparison of different items with DMFT and dft scores
significant. (Tables 1&2) The attitude of the parents might have Factors DMFT Dft
predisposed the child to higher caries as the child will try to inculcate Mean SE Mean SE
the habit of brushing only once following their parent's habit. The How Many times do you brush your teeth in a day.
results are in accordance to study conducted by Kaur. [12] Regarding Less than once 0.00 0.00 0.00 0.00
the timing of brushing it was found that 62% of the respondents Once 0.42 0.03 0.71 0.06
brushed their teeth only in the morning, 15.6% brushed after meals Twice 0.47 0.05 0.87 0.08
or after in between meal snacking. It was observed that caries More than twice 0.00 0.00 0.91 0.37
experience in children of parents who had the habit of brushing after F-value 1.1878 1.1108
each meal or snacking had significantly less dental caries. (Table p-value 0.3134 0.3438
1&2) When do you usually brush your teeth.
Morning 0.43 0.04 0.78 0.06
Table 1: Distribution of samples by different items
Noon 0.50 0.29 0.60 0.60
Items No of samples % of samples Before going to sleep 0.40 0.05 0.64 0.08
How many times do you Other times 0.45 0.08 0.93 0.15
brush your teeth in a day F-value 0.1059 1.2944
Less than once 1 0.10 p-value 0.9566 0.2752
For how long do you brush your teeth
Once 621 62.10
Twice 364 36.40 Less than a minute 0.47 0.09 0.47 0.10
More than twice 14 1.40 One minute 0.48 0.07 0.88 0.10
When do you usually Two minutes 0.41 0.04 0.75 0.06
brush your teeth More than two minutes 0.40 0.08 0.77 0.12
Morning 620 62.00 F-value 0.3581 1.4502
Noon 5 0.50 p-value 0.7832 0.2269
Before going to sleep 219 21.90 How of the do you visit dental clinic
Other times 156 15.60 Once in 6 months 0.44 0.09 0.68 0.12
For how long do you Once in 1 year 0.23 0.11 0.68 0.15
brush your teeth Once in 2 years 0.26 0.08 0.43 0.17
Less than a minute 73 7.30 Whenever need arises 0.46 0.03 0.81 0.05
One minute 232 23.20 F-value 1.8318 1.2724
Two minutes 545 54.50 p-value 0.1399 0.2827
More than two minutes 150 15.00 If you do not visit the dentist reasons are

2 Bhavnagar University's Journal of Dentistry 2015;5(3) : 1-5

 www.bujod.in Gokhale et al

Afraid of Dentist 0.45 0.06 0.88 0.08 Numerous studies refer to mothers as the “key figure” in the child's
Afraid of Dental tools 0.44 0.07 0.72 0.10 general and oral health as they are usually the gatekeepers between
No time 0.43 0.07 0.83 0.14 the family and the outside world. Thus it is generally agreed among
Treatment cost is more 0.40 0.07 0.75 0.11 health educators that young children and their mothers are an
Afraid sitting in waiting room 0.41 0.06 0.60 0.09 important target group for dental health education. From a
F-value 0.1088 1.2046 developmental perspective, the maternal influence remains
p-value 0.9794 0.3074 important throughout childhood, even if the societal influence
How important do you think are milk teeth increases as the child grows. Failure to adequately educate and
Very important 0.54 0.07 0.81 0.12 support mothers at an early stage can lead to subsequent dental
Moderately important 0.31 0.05 0.75 0.10
problems in children. It is also believed that good oral habits
Not at all important 0.39 0.05 0.75 0.07
introduced to the child during the primary stage of socialization are
F-value 2.8263 0.1144
p-value 0.0378* 0.9516 likely to stay with it into later life.[20], [21] Behaviour which is learnt during
Do you supervise your children while they brush child's early years becomes deeply ingrained and is resistant to
Yes. Watch them while brushing 0.55 0.08 0.66 0.11 change. Dental health education given to mothers and aimed at
Do not watch but advice 0.43 0.07 0.66 0.11 children is more concerned with forming habits, rather than trying to
Never care 0.38 0.04 0.84 0.07 change the established routines. Intervention that requires
Only my spouse watches 0.48 0.08 0.76 0.11 behavioural change at a later stage is more difficult to implement
F-value 1.7019 0.9946 and chances of it benefitting the dental health are less. If positive
p-value 0.1652 0.3947 dental health routines are taught in early childhood, later dental
Do you prefer to snack while watching T.v. or listening to radio health educational intervention can be of a reinforcing nature. [22]
Yes 0.42 0.03 0.74 0.05 According to Kadaluru et al majority of the visits to dental clinic were
No 0.48 0.10 1.15 0.26 for treatment of acute symptoms rather than preventive approach.
Total 0.43 0.03 0.77 0.05
Also the other reasons stated are fear from white coat, lack of need
t-value -0.5906 -2.3197
p-value for routine check up and misconceptions and taboos associated
0.5550 0.0206
with dentistry. [23]
Children below 6 years lack motor dexterity and as they cannot
In the present study also it was found that 77.5% of the parents
brush their teeth on their own, it is advised that the parent should
visited the dentist only when the need arised, 69.5 % of parents took
brush their child's teeth but in the present study it was found that
their children to dental clinic, more than six months back and for
52.9% of parents do not supervise their child while brushing while
most of them the reason was a toothache. Only 10.2% parents
16.3% of the parents supervised and guided their child while he/she
visited dentist biannually and 14.4% took their children for regular
is brushing and in such children there were significantly less number
dental check-ups. It was shown that children whose parents have
of carious teeth. The results obtained are similar to results obtained
the habit of visiting a dentist only when the need arises showed
by Chand et al where 72% parents agreed to not supervise their
higher incidence of dental caries. (Table 1&2) A total of 29.4% of
children while brushing and 78% said they did not help the child in
parents avoided dental treatment as they were afraid of the dentist,
brushing. [13] (Table 1&2). In a study by Gussy et al they found out that
19.8% were afraid of waiting in the waiting room and 17.7% were
44% of parents were confident of cleaning their Childs teeth 12%
afraid of the dental operatory and 17.3% were afraid of the cost of
were not and 41% were somewhat confident. This degree of
treatment. (Table 1) This pattern of behaviour may indicate barriers
confidence is directly related to cleaning and supervision of childs
to dental services and utilization which needs to be explored in
brushing trends. [14]
future studies. [16], [11]
The habit of snacking of the children was questioned and it was
Reported behaviour is particularly inaccurate for it is
found that 91.9% of children liked to snack and such children had
understandable that mothers when asked, will be tempted to write
higher number of dental caries which was statistically significant.
what they know should occur, rather than what actually happens.[23]
(p=0.0206*) Parents agreed to give some form of bakery and
With respect to oral health knowledge, attitudes towards dental
confectionery foods to their children to eat in between meals. This
care, oral hygiene habits, frequency of dental visits some over
could be because they are readily available, easy to store and well
reporting may be assumed where as under reporting has to be
accepted by children. Potato chips and chocolates topped the list in
considered with regard to consumption of sweets, sugary foods
preferences. The results obtained in present study were similar to
and drinks.[24] This acknowledges the inherent bias in the
Jain et al and Chan et al who reported snacking habits of children
questionnaire or interview method of data collection.
with preferred foods being candies or sugary snack type foods
(57%). [15], [16] Dental health education has been considered to be an important
and integral part of the dental health services. Meta-analysis of
As dental caries is already evident in many children in preschool
studies on effectiveness of dental health education indicated that
years and as patterns of dietary habit and oral hygiene practice are
knowledge and attitudes could be improved through dental health
likely to become established at this time, mothers of these young
education, however, studies showing reduction in dental caries
children appear to represent a particularly important group.[6] The
status are few. [22] [23] Studies which have shown a reduction in caries
primary purpose of assessing parents' knowledge is because
after dental health education have implemented preventive
parents and in particular mothers as principal care givers exert the
programmes to women during pregnancy and early childhood up to
strongest influence on a young child's life.[17],[18] According to
4 years of age. This is because of positive attitude to dental care and
Poutanen et al oral health and knowledge of parents is associated
improved oral health of mother and child. [25], [26]
with children's oral health behaviour. Parents' behaviour but not
The best time to begin counselling parents and establishing a
attitudes were associated with child's oral health behaviour. [19]

3 Bhavnagar University's Journal of Dentistry 2015;5(3) : 1-5

 www.bujod.in
child's dental preventive programme is actually before the birth of
the child. For an expectant couple, particularly if the child is their
first, this is a time in their lives when they are the most receptive to
preventive health recommendations. These parents to be have a
strong instinct to provide the best that they can for their child.
Counselling them on their own hygiene habits and the effect they
can have on their children as role models will aid in improving both
the parents' and child's oral health.[27]
The present study assessed the knowledge attitudes and practices
of parents regarding oral health. These attributes were found to
have a strong correlation with dental caries. These people clearly
need more than just simple information, cajoling or simple
encouragement to change their everyday behaviour. They may
require regular intermittent counselling along with demonstration
and practical assistance before they feel that they can put their
knowledge into everyday practice. [28] [29]
Zaki, Bandt and Euller et al concluded that a single session of
motivational activities does not alter oral hygiene performance. [30]
Williford et al incorporated repetition and reinforcement of oral
hygiene instructions and found that there was significant
improvement in oral hygiene. [31] Blinkhorn et al reported that after
two years of educational programme, there was a higher adherence
of parents with respect to the position of the child while tooth
brushing and the use of a small amount of tooth paste. The authors
advised a reinforcement of the educational concept every four
months. [28]
“Knowledge is lost without putting it into action.”Practice refers to a
way that something is done. It is a learning method, the act of
rehearsing behaviour over and over or engaging in an activity again
and again for the purpose of improving it or mastering it. [32]
CONCLUSION
Parents had some knowledge regarding the oral health they were
not able to use this knowledge or put it in application because of
various factors like time constraint, some beliefs or myths related to
the oral care. It is recommended that the parents should receive oral
health related information which is easy to understand and the ways
to apply the gained information should also be taught. The
paediatric dentist must include these factors into their counselling
session and help the parents to modify their lifestyle. The paediatric
dentist must make the parents understand the value of good oral
hygiene measures and help the child to remain caries free. Efforts
by the Government and the Non Governmental Organizations
towards the improvement of the oral health of children are needed,
which may be in the form of insurance, re-imbursement or
incentives.
REFRENCES
1. Marthaler TM. Changes in dental caries 1953-2003. Caries
Res 2004; 38:173-81.
2. Van Houte J. Role of micro-organisms in caries etiology. J
Dent Res 1994; 73:672-81.
3. Ripa LW. Nursing caries: A comprehensive review. Pediatr
Dent 1988; 10:268-82.
4. Wong D, Perez-Spiess S, Julliard K. Attitudes of Chinese
parents towards the oral health of their children with caries: A
qualitative study. Pediatr dent 2005; 27: 505- 12.
5. Finlayson TL, Siefert K, Ismail Ai, Sohn W. Maternal self
efficacy and 1-5 year old children's brushing habits. Comm
4 Bhavnagar University's Journal of Dentistry 2015;5(3) : 1-5
Gokhale et al
Dent Oral Epidemiol 2007; 35: 272-81.
6. Holt RD, Winter G B, Fox B, Askew R. Effects of dental health
education for mothers with young children in London.
Comm Dent Oral Epidemiol 1985; 13: 148-51.
7. National Oral Health Survey and fluoride mapping 2002-
2003. Dental Council of India, New Delhi 2004.
8. Masiga MA, Holt RD. The prevalence of dental caries and
gingivitis and their relationship to social class amongst
nursery school children in Nairobi, Kenya. Int J Pediatr Dent
1993; 3: 135-40.
9. Szatko F, Maria W, Dybizbanska E, Struzycka I, Iwanicka-
Frankowska E. Oral health of polish three year olds and
mothers' oral health related knowledge. Comm Dent Health
2004; 21: 175-80.
10. Bodhale P, Karkare S, Khedkar S. Knowledge and attitude of
parents toward oral health maintenance and treatment
modalities for their children. J Dent Res Rev 2014;1: 24-7.
11. Singh S, Shah V, Dagrus K , Bs Manjunatha , Kariya P , Shah
S. Oral Health Inequality And Barriers To Oral Health Care In
India. E J of Dent Therapy and Res, 2015, 4, 242-5.
12. Kaur B. Evaluation of oral health awareness in parents of
preschool children. Indian J Dent Res 2009;20: 463-5.
13. Chand S, Chand S, Dhanker K, Chaudhary A. Impact of
mothers' oral hygiene knowledge and practice on oral
hygiene status of their 12-year-old children: A cross-
sectional study. J Indian Assoc Public Health Dent 2014;12:
323-9.
14. MG Gussy, EB Waters, EM Riggs, SK Lo, NM Kilpatrick.
Parental knowledge, beliefs and behaviors for oral health of
toddlers residing in rural Victoria. Australian Dental Journal
2008; 53: 52–60.
15. 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 Develop 2014;1:40-5.
16. Chan S C L, Tsai J S J, King N.M. Feeding and oral hygiene
habits of preschool children in Hong Kong and their
caregivers' dental knowledge and attitudes. Int J Pediatr
Dent 2002; 12: 322-31.
17. Buischi YAP, Axelsson P, Oliveira LB, Mayer MPA, Gjermo P.
Effect of two preventive programs on oral health knowledge
and habits among Brazilian schoolchildren. Comm Dent
Oral Epidemiol 1994; 22: 41-6.
18. Gomez SS, Weber AA. Effectiveness of a caries preventive
program in pregnant women and new mothers on their
offspring. Int J Pediatr Dent 2001; 11: 117-22
19. Raija Poutanen, Satu Lahti1, Mimmi Tolvanen, Hannu
Hausen. Parental influence on children's oral health-related
behavior. Acta Odontologica Scandinavica, 2006; 64: 286-
92.
20. Plutzer K, Spencer AJ. Efficacy of an oral health promotion
intervention in the prevention of early childhood caries.
Comm Dent Oral Epidemiol 2008; 36: 335-46.
21. Whittle J.G, Whitehead H.F, Bishop C.M. A randomized
control trial of oral health education provided by a health
visitor to parents of pre-school children. Comm Dent Health
2008; 25: 28-32.
 www.bujod.in
22. Grytten J, Rossow I, Holst D, Steele L. Longitudinal study of
dental health behaviors and other caries predictors in early
childhood. Comm Dent Oral Epidemiol 1988; 16: 356-59. 28.
23. Kadaluru UG, Kempraj VM, Muddaiah P. Utilization of oral
health care services among adults attending community
outreach programs. Indian J Dent Res 2012;23:841-2.
24. Petersen PE, Esheng Z. Dental caries and oral health 29.
behavior situation of children, mothers and school teachers
in Wuhan, People's Republic of China. Int Dent J 1998; 48:
210-16. 30.
25. Kay EJ, Locker D. Is dental health education effective? A
systematic review of the current evidence. Comm Dent Oral
Epidemiol 1996; 24: 231-35. 31.
26. N. Chabra, A. Chabra. Parental knowledge, attitudes and
cultural beliefs regarding oral health and dental care of
preschool children in Indian population: a quantitative study. 32.
Eur arch of Ped Dent 2012; 13(2): 76-82.
27. Dean J and Hughes C. Mechanical and chemotherapeutic
home oral hygiene. In: Dentistry for the child and adolescent.
PARTICULARS OF CONTRIBUTORS :
1. Lecturer, Department of Pedodontics and Preventive Dentistry, Kle's VK Institute of Dental Sciences Belagavi, Karnataka.
2. Prof. & Head, Department of Pedodontics and Preventive Dentistry2, Narayana Dental College and Hospital, Nellore, Andhra Pradesh
ADDRESS FOR CORRESSPONDENCE:
Gokhale Niraj S, MDS, Lecturer
Department of Pedodontics and Preventive Dentistry1
KLE's VK Institute of Dental Sciences, Nehru Nagar
Belgaum, Karnataka, India. E : neerajpedo@gmail.com
neeraj_gokhale05@rediffmail.com (M) 9535551937
5 Bhavnagar University's Journal of Dentistry 2015;5(3) : 1-5
View publication stats
Gokhale et al
McDonald Avery and Dean (eds), Reed Elsevier India Private
Limited, 8th edition 2005: 251-52.
Blinkhorn A.S, Wainwright-Stringer Y.M, Holloway P.J. Dental
Health Knowledge and attitudes of regularly attending
mothers of high risk, pre-school children. Int Dent J 2001;
51:435-38.
Akpabio, A Klausner, CP Inglehart, MR. Mothers'/Guardians'
Knowledge about Promoting Children's Oral Health. J.Dent
Hygiene, 2008; 82:1-11.
Zaki H A, Bandt C L.Model presentation and reinforcement-
an effective method for teaching oral hygiene skills. J
Periodontol 1970; 41(7):394-97.
John. W. Williford, Joseph Muhler, George Stookey. Study
demonstrating improved oral health through education. J
Am Dent Assoc 1967; 75: 896-902.
Oxford Advanced Learner's Dictionary, Oxford University
Press, 7th edition, pg 85,
Source of Support : NIL
Conflict of Interest : NOT DECLARED
Date of Submission : 10-01-2015
Review Completed : 10-04-2015