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Saudi Journal of Oral Sciences

ORIGINAL ARTICLE

Influence of mother’s oral health care knowledge

on oral health status of their preschool child
Raghavendra M. She y, Anushka Deoghare, Sujata Rath, Rasna Sarda, Abhishek Tamrakar
Department of Paedodon cs and Preven ve Den stry, Chha sgarh Dental College and Research Ins tute, Rajnandgaon,
Cha sgarh, India

Abstract
Aim: Children under 5 years of age generally spend most of their me with parents or guardians, especially mothers. Parents play
a central role in giving children the informa on and encouragement needed for healthy lives. Parental oral health knowledge,
belief and a tudes 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 ques onnaire including parent’s literacy levels, socioeconomic status, dietary prac ces and oral hygiene prac ces,
was designed to assess the knowledge of the mothers regarding oral health of their child. Oral examina on of the children was
done by World Health Organiza on criteria for recording children’s oral health status.
Results: About 87% of the mothers agreed that intake of food with excessive sugars can cause cavi es, and 95.8% admi ed
that chocolates cause the most decay. 80.5% agreed to the fact that leaving a milk bo le 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 op mal fluoride content. 71.7% mothers agreed that caries in deciduous teeth are a ma er 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 cavi es can
infect child. This could be observed by less number of decayed teeth and good oral hygiene status of the children. However,
parents knowledge, a tudes and few beliefs regarding dental care need to be improved.

Key words: Oral health care, oral health status, preschool children

Introduc on Parents play a central role in impar ng the informa on

The major role of knowledge and a tudes in explaining
behavioral changes has been confirmed by many
behavioral theories such as the health belief model and
theory of reasoned ac on.[1,2] When the assessment of
the role of parents’ knowledge of and a tudes towards
health behavior and status of their offspring is done, the
aspects of these theories are par cularly emphasized.[3]
and encouragement to their children for healthy lives.
Their a tudes have a significant impact on the children’s
dental and overall health.[4,5] The more posi ve a tude
of the parents toward dental health care and dental
professionals, leads to a be er dental health of their
children. Without basic knowledge of caries risk factor,
importance of deciduous teeth and oral maintenance,
it is difficult to employ effec ve disease preven ve
strategies.[6]

Access this article online Children below 5 years of age spend most of their me
Quick Response Code: with parents or guardians, par cularly mothers. Within
Website: the family, the role of mother has been emphasized in
www.saudijos.org
Address for correspondence:
Dr. Anushka Deoghare, Department of Paedodontics and
DOI: Preventive Dentistry, Chhattisgarh Dental College and Research
10.4103/1658-6816.174291 Institute, Rajnandgaon - 491 441, Chhattisgarh, India.
E-mail: dranushkadeoghare@gmail.com

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Shetty, et al.: Mother’s oral health care knowledge and oral health status of preschool child

rela on to a child’s oral health habits and status. Despite were calculated. Study data were analyzed using SPSS
changing roles and areas of responsibility within the (version 12.0) (SPSS Inc., Chicago, IL, USA.).
family, the role of mother has been emphasized in rela on
to a child’s oral health habits and status and she s ll seems
to play the key role.[7] Developing countries like India, face Results
many challenges for providing oral health care to children
of 1-5 years of age, mainly in the rural areas.[8,9] Parental The final study sample comprised of 386 children and
knowledge and awareness of oral health care and oral their mothers. There were 206 boys and 180 girls with
hygiene habits of these children, dietary and feeding an average age of 4.30 years. The average age for boys
habits, care of deciduous teeth and regular dental visits was 4.34 years and for girls 4.23 years. 231 of the total
are necessary for required behavioral changes towards children were the first child, 127 were the second child
health and early disease preven on.[10] and 28 were the third child. 21 mothers (5.4%) were from
low socioeconomic status, 293 (75.9%) were from the
Studies on mother’s knowledge on child’s oral health middle socioeconomic status and 51 (18.7%) belonged
and its influence on their child’s oral health status are to the high socioeconomic status. 55.2% children were
scanty, which has led to design this study. Hence, this breast fed, whereas only 11.1% were bo le fed. The
study evaluates the influence of maternal aspects on remaining 33.7% were breast fed as well as bo le fed.
child’s oral health by es ma on of oral health-related Table 1 shows the mothers’ knowledge in rela on to the
knowledge on diet, feeding habits, oral hygiene prac ces
and maintenance in a developing country. Table 1: Mother’s knowledge related to feeding
and dietary habits
Knowledge Number of pa ents Percentage
Materials and Methods
Do you think prolonged breast
feeding causes dental caries?
This study was carried out in a representa ve sample of No 202 52.3
3-6-year-old primary school children selected from all Yes 130 33.7
public primary schools of the city, in Rajnandgaon, India. Don’t know 54 14.0
Do you think prolonged bo le
A total of 480 mothers along with their child (3-6 years) feeding causes dental caries?
were randomly chosen for the study. Approval for No 71 18.4
conduc ng the study was obtained from the principal Yes 208 53.9
of the school. Ethical clearance was also taken from Don’t know 107 27.7
Excesses intake of food for
Institutional Ethical Board. Informed consent was infants containing sugar can
obtained from the par cipa ng mothers. cause cavi es?
Agree 336 87.0
A 20-point ques onnaire including parent’s background Disagree 31 8.0
Don’t know 19 5.0
informa on, dietary and feeding prac ces, oral hygiene When is it best to give sugary foods
practices and the importance of dental visits, was and drinks to young children?
designed to assess the knowledge of mothers regarding At meals 171 44.3
the oral health of their child. The ques onnaire was In between meals 104 26.9
When child demands 111 28.8
prepared in English and also translated into the local Which of the following foods
language. Oral examination of children was done in cause most decay in children?
schools with the help of mouth mirror, and probe in good Chocolate 370 95.8
light using decayed score (dt) and assessment of oral Biscuits 9 2.3
When child demands 7 1.9
hygiene status. The mothers of a same child a ending It harms a baby’s tooth to let
parents-teachers mee ng were then asked to fill the him/her sleep all night with a
ques onnaire. A total 386 mothers, who a ended the milk bo le in its mouth
Agree 311 80.5
parents-teachers mee ng, comprised the final sample. Disagree 33 8.5
The answers were recorded by asking the mothers to Don’t know 42 11.0
respond to the ques ons by indica ng the suitable op on, Bacteria from mom’s cavi es
which were expressed as scores of 1, 2 and 3 for the can infect baby’s tooth if mom
uses the same spoon when
op ons in that order. The subjects were explained about feeding the baby
how to fill the ques onnaire. The data were collected Agree 272 70.5
and descrip ve sta s cs were obtained. The percentage Disagree 55 14.2
Don’t know 59 15.3
frequency distribu ons of parental responses to ques ons

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Shetty, et al.: Mother’s oral health care knowledge and oral health status of preschool child

dietary and feeding prac ces. 33.7% mothers thought Table 2: Mother’s knowledge regarding brushing habits
that prolonged breast feeding may lead to caries, Knowledge Number of pa ents Percentage
whereas 53.9% thought that caries are caused due How o en should a child’s teeth
to prolonged bo le feeding. 311 of the total mothers be brushed?
agreed to the fact that leaving milk bo le whole night Twice a day 311 80.5
in the child’s mouth harms their teeth. 336 mothers Once a day 56 14.5
A er every meal 19 5.0
believed that excessive intake of sugar containing foods What type of brush is best for a
such as chocolates (370 mothers), mainly can cause young child?
caries. Small 357 92.5
Large 20 5.2
Doesn’t ma er 9 2.3
Table 2 shows the knowledge of the mothers rela ng How much toothpaste should be
to oral hygiene prac ces. 311 mothers said that the placed on the brush?
child’s teeth should be brushed twice daily, and 92.5% Small pea-size 260 67.3
mothers agreed that a small sized toothbrush was best Full length 86 22.3
Doesn’t ma er 40 10.4
for preschool children. 59.3% mothers thought that How much fluoride should the
standing in front of the child during brushing was the paste contain?
right method. Most of the mothers (67.3%) placed a 1000 ppm 81 20.9
500 ppm 77 19.9
small pea-sized amount of toothpaste on the brush; Don’t know 228 59.2
however, 228 mothers were unaware about the op mal How should you brush your
fluoride levels that a paste should contain. child’s teeth?
Standing behind the child 128 33.2
Standing in front of the child 229 59.3
Table 3 shows the knowledge of mothers related to
Don’t know 29 7.5
dental awareness. 304 mothers agreed to the fact that How your child brushes his
with the erup on of the first baby teeth, parents can teeth?
begin to clean them with a piece of gauze or clean Happily 289 74.9
Sad 52 13.5
washcloth. However, 59.3% would visit a den st only in Resistant 45 11.6
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. Table 3: Mother’s knowledge regarding dental awareness
88.1% of the total par cipa ng mothers’ received child Knowledge Number of pa ents Percentage
care informa on from the elders in the family, and only From where you received
8.5% acquired any such informa on from their den sts. informa on on taking care of
your child?
The average dt score of the children was 2.9. On the Den st 33 8.5
TV 13 3.4
assessment of the oral hygiene status of the children, Elders in family 340 88.1
it was found that 51.8% had a score of 1, 26.1% had a At what me babies should
score of 2 and 22.1% had a score of 3. This also indicates have their first dental visit
that mothers par cipa ng in the present study had At the me when the first 120 31.1
tooth erupts
a fairly be er knowledge of oral health care of their 1-year 37 9.6
children. When you see decay in tooth 229 59.3
Cavi es in baby’s tooth don’t
ma er because those teeth will
fall out anyway
Discussion Agree 76 19.7
Disagree 277 71.7
The oral health knowledge of the parents and/or Don’t know 33 8.6
guardians establishes the oral health and related With the erup on of the first
baby teeth, parents can begin
habits of the children during infancy and maintained
to clean them with a piece of
throughout the preschool years. Parents, especially the gauze or clean washcloth
mothers, play an important role for their children. There Agree 304 78.7
are limited data for the oral health of children during Disagree 33 8.6
Don’t know 49 12.7
the early childhood period in developing countries.[6,11]
A good understanding of parental knowledge, a tudes,
beliefs and awareness regarding oral health, habits and oral health promo on efforts aimed at improving the
hygiene is essen al for the effec ve implementa on of dental health of preschool children.

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Shetty, et al.: Mother’s oral health care knowledge and oral health status of preschool child
Majority of the mothers had good knowledge about
the dietary and feeding prac ces. 87% of the mothers
believed that excessive intake of sugar containing food
causes dental cavi es. 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
prac ces.[6,12,13] 95.8% of the mothers found chocolates
to be the most cariogenic agent. 53.9% mothers believed
that prolonged bo le 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 bo le 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
bo les at bed me, similar to the findings of Gussy
et al., in rural mothers in Australia.[6,14]
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 contradic on to the findings of Suresh
et al., Chhabra and Chhabra and Sakai et al.[6,11,15] Dental
caries is an infec ous 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 infec on 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.[16] The bacteria
may be transmi ed by contact, either direct (through
saliva, by kissing) or indirect (shared utensils, toys or
toothbrush).[6]
Majority of the mothers responded positively for
ques ons rela ng 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.[11] 78.7% of the parents
believed that with the erup on 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.[14]
S J Oral Sci Vol 3 No 1
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.[6] 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 posi ve a tude 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 informa on 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 Ma la et al., also suggested that the elders
of the family had a much higher influence on the
parents for child care.[11,17,18] Only 8.5% of the mothers
received informa on from the den sts. 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 erup on of the first primary teeth.
This can be a ributed 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 cavi es 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[11,19] It has been
reported that the lower a en on paid towards the
importance of primary teeth can prove to be an obstacle
to develop effec ve preven ve programs.[20] The parents
believe that primary teeth are present in mouth only
for a short dura on, and are ul mately replaced by
permanent teeth.[11] The children whose parents ignored
the importance of primary teeth or paid less a en on
toward decay in these teeth were more suscep ble 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
formula on of preven ve programs that targets the
rural popula on and increase awareness, knowledge
and help in the removal of nega ve a tudes among
the rural popula on. The habits developed during the
15 January 2016
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Shetty, et al.: Mother’s oral health care knowledge and oral health status of preschool child
preschool period provide a founda on for be er oral
health care, dietary habits and encourages regular dental
checkup and use of dental services in the later years.
Parents, par cularly 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 s cky 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 preven ng decay, about
the background levels of fluoride in their drinking water
and the appropriate use of fluoridated toothpastes, since
fluoride has a protec ve ac on against the development
of caries. There should be an emphasis on the preven ve
strategies, about the importance of fluoride and op mal
fluoride exposure required for the children in the programs
conducted for educa ng the parents. Regular dental visits
should be encouraged by the pediatrician to develop
posi ve a tudes among parents and subsequently the
children, towards oral health care.
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Cite this ar cle as: She y 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.
Source of Support: Nil, Conflicts of Interest: None declared.
16 January 2016