Knowledge and practice of caries prevention in mothers from Bialystok, Poland

Joanna Baginska*, Ewa Rodakowska
Department of Conservative Dentistry, Medical University of Bialystok, Poland
Corresponding Author: Department of Conservative Dentistry, ul. M. Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland, phone 48 85 748 57 60, e-mail: [email protected]
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Abstract

Introduction: Parents are directly responsible for the dental health of their offspring and can play an important role in preventing oral diseases in children.

Objective: The aim of this study was to assess knowledge and practice of mothers of young children from the area of Bialystok, Poland, on the prevention of tooth caries.

Method: 140 mothers of 3-4 year old children took part in an anonymous voluntary survey. The questionnaire used in the survey related to the knowledge of principles of dental caries prevention, the sources from which mothers obtain their knowledge and the methods of implementing oral health behavior.

Results: In the survey, 95.7% of mothers knew about the importance of regular removal of dental plaque by brushing teeth, 85.7% knew of the role of fluoride-containing toothpaste and 82.8% indicated avoiding the consumption of sweets. They were also aware that oral health required regular dental visits (89.2%). Most of them (87%) knew that deciduous teeth should be treated as permanent ones, but only 65.7% were convinced that a direct relationship of the condition of deciduous and permanent dentition exists. The survey revealed a discrepancy between the knowledge of principles of dental caries prevention and their implementation in everyday life among mothers of young children from Bialystok, Poland. There was a large percentage of 3-4 year old children who brushed their teeth 1-3 times a week (15%) or less frequently (3.6%). In the sample, 10% of 3-4 year old children visited a dentist for the last time a year ago, and another 42.8% had never been on such a visit.

Conclusion: Mothers in Bialystok, Poland, had basic knowledge of caries prevention. However, their theoretical knowledge has been not fully reflected in the way they cared for their children's teeth.

Keywords

caries, children, dental health, knowledge, mothers

INTRODUCTION

Caries is a transmissible infectious disease. Family members, especially mothers, are the primary source of infection for children. At an advanced stage, dental caries may cause a significant reduction of children’s quality of life due to pain, difficulties in consumption of hard food and sleep disturbances 1,6,8. The main risk factors for dental caries in children are a sugar-rich diet, incorrect feeding practices and abundant dental plaque.
Parents are directly responsible for the dental health of their offspring and can play an important role in preventing oral diseases in children. They clean teeth of their children, teach them proper hygiene and dietary habits, and organize professional dental care. How the prevention of dental caries, consequently dental health care in general, is provided depends to a large extent on the awareness of parents and caregivers 15. Many authors reported that caregivers of young children had multiple deficits in this area, and a poor attitude of parents toward dental habits is associated with increased caries prevalence 4,18,20.
The aim of this study was to assess knowledge and practice of mothers of young children from the area of Bialystok, Poland, on the prevention of tooth decay.

Material and method

Sampled population included 140 mothers of young children attending the first year of 10 randomly chosen preschools in Bialystok, Poland. The completion of the survey was voluntary, and the qualifying criterion was to have a child aged between 3 and 4 years. A questionnaire used in the study was prepared within the Oral Health Monitoring program conducted every year in Poland. Questions related to the knowledge of principles of dental caries prevention, the sources from which mothers obtain their knowledge and the methods of implementing oral health behavior.

Results

Data on the knowledge of principles of dental caries prevention are presented in Table 1. The majority of mothers who took part in the survey knew the basic preventive measures. Almost all knew that most important in the prevention of dental caries are the regular removal of dental plaque by brushing teeth (95.7% of correct answers), the use of toothpaste containing fluoride (85.7%) and avoiding the consumption of sweets (82.8%). They were also aware that oral health requires regular dental visits (89.2%). However, only slightly more than a half indicated additional ways of maintaining proper oral hygiene, such as the use of dental floss as well as rinses and gels with fluoride.
Table 2 shows opinions of the surveyed mothers on selected statements about oral health. Most of them (87%) knew that deciduous teeth should be treated as permanent ones, but only 65.7% were convinced that a direct relationship of the condition of deciduous and permanent dentition exists. We also noticed that more than one fifth of respondents did not know that they should assist their children in cleaning the teeth until the age of 10 years. Only 5 mothers expressed the opinion that the tendency to dental decay is hereditary.
The sources of knowledge for the surveyed mothers were primarily dentists (82.1%), followed by magazines (65.7%) and different kinds of guidebooks (45%). Only about 30% of them received appropriate piece of advice from general practitioners or pediatricians. Surveyed mothers rarely benefited from the knowledge of people around them, such as mothers or friends, or from online resources (5.7%). The data is presented in Table 3.
Figures 1-4 show the behavior of surveyed mothers concerning the prevention of dental caries. Most of them declared that their children brushed the teeth at least once a day. There was, however, a large percentage of 3-4 year old children who brushed their teeth 1-3 times a week (15%) or less frequently (3.6%) (Fig.1). 60% of mothers regularly accompanied their offspring during teeth brushing, but as many as 20% saw no such need (Fig.2). 85% of parents reported that they limited the amount of sweets consumed by their children (Fig.3). In the sample, 10% of 3-4 year old children visited a dentist for the last time a year ago, and another 42.8% had never been on such a visit (Fig. 4).

Discussion

Parents of small children attending kindergartens in Bialystok, Poland, knew the basic principles of dental caries prevention, especially with regard to maintaining proper oral hygiene. Unfortunately, they had difficulty in identifying additional ways of controlling dental plaque, for example, by rinsing the mouth with water or using interdental systems (dental floss, toothpicks). Nowadays, it is believed that the mere brushing removes dental plaque inadequately, and additional ways foster the maintenance of oral health.
importance of oral hygiene practices or the importance of deciduous teeth. Mothers surveyed by Akpabio et al. 2 could not give proper answers to questions concerning the age at which children should start brushing their teeth and when they should visit a dentist for the first time. In the study of Naidu and Davis 11, parents did not know whether the toothpaste their children used contained fluoride and what was the appropriate concentration of fluoride for preschool children. According to Vinay at al. 20, half of the surveyed parents from Bangalore, India, believed that children should have a dental visit only if they have a toothache. Also, many parents from the United Kingdom saw no need for the restoration of asymptomatic carious primary teeth 19.
Our survey revealed a discrepancy between the knowledge of principles of dental caries prevention and their implementation in everyday life among mothers of young children from Bialystok, Poland. These observations are also consistent with data from the literature according to which the parents' knowledge and attitudes do not translate into the effective prevention of dental caries in their offspring 9,12,20. Almost all mothers that took part in this survey were aware that proper brushing is the basic form of preventing tooth decay. However, only 46.4% of them reported that their 3-4 year old children brushed their teeth at least 2 times a day. Skaret et al. 16 noted that habits established at the age of 3 years tended to persist during the next years. Therefore it is extremely important to teach a child proper health habits as early as possible. As many as 78.5% of our surveyed parents knew that they should supervise their children during teeth brushing, but only 60% did so on a regular basis. The others probably did not realize that proper plaque removal was difficult and required a great ability from a child. Children usually clean teeth too short, and focus mostly on the front teeth. Additionally, in case of small children, there is a likelihood of ingesting too much of fluoride toothpaste, which may lead to the development of fluorosis. In order to develop proper habits, a child should just brush teeth him- or herself first, and then a parent should check the results and correct it, if necessary. Surveyed mothers were aware that for the oral health regular dental visits were needed, but up to 42.8% of them confirmed that their offspring have never had such control. First visit to a dentist should take place at the age of about one year, and not only in Poland, but also in other countries it often takes place later between 3 and 6 years of age 10. Surveyed mothers knew that avoiding the consumption of sweets had a positive impact on dental health, and declared that they limited their children’s diet, respectively 82.8% and 85% of answers. However, to determine whether attempts to reduce the amount of sugar are essential, analyses of food consumed by children should be performed. Research conducted in Poland showed that caregivers of children eating both large and small quantities of cariogenic products made a similar declaration 3. Also Vinay et al. 20 noted that despite the good level of general knowledge of the causes of dental caries, many parents gave the children nipples covered with sugar or honey, and sweet drinks before their bedtime.
In our study, dentists were the main authority for the mothers as regards oral health. It is important that a pregnant woman has regular checkups. The dentist should not only take care of her teeth, but also explain how to care for the infant’s oral cavity and how to prevent tooth decay when the baby has first teeth. Furthermore, general practitioners and pediatricians should conduct a similar education 7,8. Poor dental health affects the entire body of the child, may be a cause of sleep disturbances, feeding and speech problems 1,6,8. Rothe at al. 14 demonstrated that a 30 min PowerPoint and Video presentation may improve the oral health knowledge of parents caring for an infant. In case of immigrants, the information should be transmitted in their native language 5.
In the literature, the role of factors affecting the parents' knowledge of dental caries prevention and the implementation of appropriate health behaviors is emphasized. Many authors consider the level of parental education, the socioeconomic status of the family, the place of residence and the immigrant status to be most important 2,8,13,15,17,18. The positive impact of educational programs directed to parents from the communities with a greater risk of developing tooth decay in children has been noted 5,9.

Conclusions

Mothers in our survey had basic knowledge of caries prevention. However, their theoretical knowledge has been not fully reflected in the way they cared for their children's teeth. We have concluded that they need better education on oral health promotion, with emphasis on the implementation of appropriate behavior in the daily routine. Educational activities should be promoted not only by dentists, but also by general practitioners and pediatricians.
Conflict of Interest: None declared.
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