|Year : 2016 | Volume
| Issue : 3 | Page : 313-317
Knowledge, practice, and training of pediatricians about early childhood caries in Bhubaneswar
Sonali Mallick, Shilpashree Komarla Balaji, Manjunath Chandraiah, Archana Krishnamurthy, Shabana Achapatira Ganesh, Rekha Shantha Venkatesh
Department of Public Health Dentistry, The Oxford Dental College, Hospital and Research Centre, Bengaluru, Karnataka, India
|Date of Web Publication||6-Sep-2016|
The Oxford Dental College, Hospital and Research Centre, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Early childhood caries (ECC) is one of the rapidly emerging oral health problems requiring anticipatory guidance. Pediatricians are in the unique and ideal position to advice parents about the prevention and treatment of ECC in their children. Aim: To assess the knowledge, practices, and training regarding ECC and infant oral health care among pediatricians in Bhubaneswar city, Odisha, India. Materials and Methods: A cross-sectional study was conducted among 100 pediatricians in Bhubaneswar city using a self-administered questionnaire. Analysis of variance and Student's t-test were used to find the significance of study parameters. Any value ≤0.05 was considered to be statistically significant. Results: Knowledge about ECC and child oral health was found to be significantly higher among male pediatricians (P = 0.03) and those practicing in urban localities (P = 0.007). Confidence of diagnosing (P = 0.006) and practice patterns (P = 0.003) was found to be significantly higher with increasing hours of patient care per week. Conclusions: Most of the pediatricians had better knowledge were confident and performed better practices.
Keywords: Caries, early childhood caries, infant oral health, pediatricians
|How to cite this article:|
Mallick S, Balaji SK, Chandraiah M, Krishnamurthy A, Ganesh SA, Venkatesh RS. Knowledge, practice, and training of pediatricians about early childhood caries in Bhubaneswar. J Indian Assoc Public Health Dent 2016;14:313-7
|How to cite this URL:|
Mallick S, Balaji SK, Chandraiah M, Krishnamurthy A, Ganesh SA, Venkatesh RS. Knowledge, practice, and training of pediatricians about early childhood caries in Bhubaneswar. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2019 Nov 20];14:313-7. Available from: http://www.jiaphd.org/text.asp?2016/14/3/313/189834
| Introduction|| |
The most common oral diseases – dental caries, gingival changes, and malocclusion – still affect most children. Dental caries is a common chronic infectious transmissible disease resulting from tooth-adherent specific bacteria, primarily Mutans streptococci, which is responsible to metabolize sugars to produce acid, which over time demineralizes tooth structure and is responsible for the initiation of dental caries. One of the most distressful clinical conditions for both patient and practitioner is rampant caries (early childhood caries [ECC]) in which there occurs a sudden, rapid, and almost uncontrollable destruction of teeth.
ECC is one of the rapidly emerging oral health problems requiring anticipatory guidance. Formerly called “baby bottle tooth decay,” the term “ECC” has been adopted to raise awareness of the multiple factors involved in the etiology of this disease, rather than continuing to attribute cause solely to feeding practices, which is no longer considered to be the principle etiology. According to the American Academy of Pediatric Dentistry (AAPD), ECC can be defined as “the presence of one or more decayed, missing (resulting from caries), or filled tooth surface in any primary tooth in a child 6 years old or younger.”
Regular annual visits are required to determine if there is a need for prevention or treatment. These diseases can be prevented and/or controlled by fundamental measures related to health education by the household. Hence, it would be appropriate to have oral health education developed by the parents or guardians with the guidance of health professionals.
Nearly, all children have a medical visit by their first birthday, which when compared to the dental visit gives a ratio of 250:1. For this reason, the medical home offers an excellent setting to deliver timely preventive oral health care. Because of the frequent contact of the pediatricians with families for routine preventive visits in the child's first few years of life, they are in an ideal and unique position to advice families about the prevention of oral diseases in their children.
Evidence suggests that traditional didactic continuing medical education and training during residency does not improve physician performance in delivering effective oral health education to their patients. To the best of our knowledge, there is little-published literature that focuses on the extent to which pediatricians participate, specifically their knowledge, attitudes, and practices with regard to oral health preventive programs. Therefore, the aim of the present study was to assess the knowledge, practices, and training regarding ECC and infant oral health care among pediatricians and with secondary objective to assess their confidence level for diagnosing ECC in Bhubaneswar city, Odisha, India.
| Materials and Methods|| |
Ethical clearance was obtained from the Institutional Review Board before commencing the study. Verbal and written informed consent was obtained from the pediatricians by disclosing that the data collected were for research purpose only. Pediatricians who agreed to participate in the survey were assured of confidentiality. A specially prepared and pretested pro forma, exclusively designed for recording all the relevant data pertaining to general information was used. A pilot study was carried out on 10% of the desired population to check the feasibility and relevance of the prepared pro forma, and this population was not included in the main study.
Data of the total number of pediatricians in Bhubaneswar city were obtained from Indian Pediatrician Association, Odisha state branch, Ganga Nagar, Bhubaneswar city. Pediatricians currently practicing in Bhubaneswar city (156) were selected for the survey, and 100 pediatricians could be approached as others either did not give consent for the survey or were not available during the visit to their workplace. Hence, 100 pediatricians formed the study sample.
Data regarding knowledge, practice, and training about ECC were obtained using a questionnaire, which comprised 28 questions. The questionnaires were distributed to pediatricians who were willing to participate in the survey and were explained about the questionnaire before they answered the questions. The Same investigator collected the completed questionnaire after it is filled. Questions on knowledge and confidence were assessed in a five-point Likert scale, and scores were given from 1 to 5. Hence, the highest score regarding knowledge was given 30 and the lowest was 5, and for confidence, the highest score was 10 and the lowest score was 2. The practice of the pediatricians was assessed with 6 questions and training was assessed using 4 questions.
Descriptive statistical analysis has been carried out in the present study. Results on continuous measurements are presented as mean ± standard deviation (Minimum-Maximum) and results on categorical measurements are tabulated in number and percentage. Significance is assessed at 5% level of significance. Analysis of variance was used to find the significance of study parameters among three or more groups. Student's t-test (two-tailed, independent) had been used to find the significance of study parameters on continuous scale between the two groups (Inter group analysis) on metric parameters.
The Statistical software, namely, Statistical package for the social sciences version 19.0 (SPSS Pvt. Ltd., Chicago, IL, USA) was used.
| Results|| |
A total of 100 pediatricians completed the questionnaire. The study sample was categorized based on various criteria such as age, sex, years of practice, hours of patient care, clinic location, and type of practice. In the age group of 41–50 years of age, 40% of the study participants were there, whereas 32% were in the age group of 51–60 years of age and most of the pediatricians were male. Only 40% of the pediatricians had a practice of 12–24 years and 84% had their clinic located at urban areas and 71% have hospital-based practice.
The total mean knowledge, confidence, and practice were found to be 22.47 ± 2.11, 8.21 ± 0.48, and 5.20 ± 0.82. The mean knowledge was found to be significantly better among male pediatricians (22.78 ± 1.92) than the female pediatricians (21.81 ± 2.36). While the mean confidence (8.22 ± 0.44) was found to be maximum among the female gender [Table 1].
|Table 1: Comparison of knowledge, confidence, and practices among study participants according to gender|
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Among the age group of 51–60 years, 32 pediatricians have a maximum mean knowledge of 22.84 ± 2.23 and also a maximum mean confidence of 8.34 ± 0.55, whereas 23 pediatricians in the age group of 30–40 years of age and 40 pediatricians in the age group of 41–50 years of age have maximum mean practice of 5.74 ± 0.54 and 5.9 ± 0.38. There was no significant mean difference in knowledge (P = 0.668), confidence (P = 0.112), and practice (P = 0.512) [Table 2].
|Table 2: Comparison of knowledge, confidence, and practices among study participants according to age groups|
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Practice was found to be significantly higher among the pediatricians who spend 49–72 h in patient than those who spend 20–48 h in patient care. Knowledge and practice were not found to be significant with hours of patient care with a P = 0.073 and 0.077 [Table 3].
|Table 3: Comparison of knowledge, confidence, and practices among study participants according to hours of patient care|
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The pediatricians having a group practice had a better knowledge (23.5 ± 3.42) than the pediatricians having hospital-based (22.79 ± 1.55) or solo practice (21 ± 2.55) [Table 4].
|Table 4: Comparison of knowledge, confidence, and practices among study participants according to type of practice|
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Majority (56%) of the total pediatricians reported of receiving training in oral health education during medical school, whereas 36% reported of receiving it during residency. Among them, 66% reported the hours of training to be 1–3 h, whereas 22% reported it to be <1 h and a maximum of them were not sure regarding the quality. Moreover, 98% of them said that the mean number of hours among those who had taken oral health CME course was more than 2 h.
| Discussion|| |
Dental caries is still a major global public health problem despite the improvements in oral health in high-income countries. The rate of carious lesion progression can be controlled through various caries control measures such as restricted ingestion of refined sugars, disorganization of the biofilm, application of fluoride-containing vehicles, and restoration of the cavitated carious lesion. Pediatrician can be very important to child's oral health, basically because of two aspects:First because the child usually visits the pediatrician before going to the pedodontist, and second because of the respect and force that the pediatricians exercise on parents.
In this study of the 100 pediatricians, 68% were males and similar findings were reported in the study done by Ismail et al. (58.8%), whereas in contrast to Balaban et al., Bozorgmehr et al., and Soares et al. studies, majority of the study participants were female pediatricians. Majority of the participants in the present study were in the age group of 41–50 years and reported 20–48 h of patient care per week which was in contrast to Balaban et al., Bozorgmehr et al., and Prakash et al. Majority of them had medical practice background of 12–24 years which is almost similar to the findings of the study done by Yahya and Solmaz  and Soares et al.
Comparatively, male pediatricians had a significant better knowledge than the female pediatricians, and it was found to be statistically significant. Knowledge of the pediatricians was found to be significantly increasing with the increase in years of practice, and those who work for hospital or group-based practice showed a better level of knowledge about oral health. The reason for better knowledge might be due to the maximum exposure to cases and in hospital-based practice since a dental wing is always attached, which leads to easy referral and approach. Pediatricians knowledge regarding ECC was very low, and most of them consider ECC as dental caries and majority of them reported that they encounter 11–20 cases per month, whereas in a study conducted by Prakash et al., majority of the pediatricians saw one child with dental caries every 2 months or less.
Lack of familiarity with oral health issues may make it difficult for pediatricians to promote oral health and for preventive oral health counseling and care. Pediatricians can contribute significantly to the oral health of children through the early identification of carious lesions. Training can allow pediatricians to achieve an adequate degree of precision in identifying caries. Although respondents reported having knowledge on the diagnosis of caries, as also reported by Prakash et al. However, 27% of pediatricians were aware of the etiology of ECC and such knowledge is important to the success of reversing the carious process.
The use of fluoride dentifrices is associated with the disorganization of the dental biofilm buildup, which is necessary for the development of dental caries. In the present study, 68% of the pediatricians said that fluoride toothpaste should not be given to children younger than 3 years  and 90% of the pediatricians in the present study reported that they were aware of the initial white spots, whereas study done by Prakash et al. and Sodani et al. reported 23.5% and 40% of being aware of the initial signs of the tooth decay, respectively.
Inspection the oral cavity of the child should be done while examining the oropharynx and nasopharynx; it is necessary for the diagnosis of the pathologies affecting children, particularly oral diseases. Similar to the findings reported by Bozorgmehr et al., Soares et al., and Balaban et al., we found that almost all of the pediatricians in the present study routinely examined the oral cavity of their patients. Pediatricians routinely examine oral cavity for identifying any systemic illness rather than finding any dental problem; this might be the reason why almost all of them reported about examining the oral cavity regularly.
According to the AAPD, a child's first visit to the dentist should occur within the first 12 months. Only 47% of the study participants in the present study said that the first dental visit should be recommended before 1 year of age. In contrast, Prakash et al. reported that only 2.7% of the pediatricians agreed to the AAPD guidelines. While Sodani et al. and Bozorgmehr et al. have reported that 50% and 61.7% of pediatricians agreed to the AAPD guidelines, respectively. Majority (96%) of the study participants in the study done by Dela Coleta et al. reported recommending the child to the dentist before 1 year of age. Early visits to the dentist allow preventive measures, early diagnosis, and orientations regarding proper diet and oral hygiene as well as the prevention of dental trauma and nonnutritive sucking habits. For such, however, it is important to have an effective, efficient reference, and counter-reference system among health professionals in the fields of dentistry and medicine to ensure the care of pediatric patients. It is also important for dentists to be prepared and willing to treat young children, as this issue has been a constant concern on the part of pediatricians. Studies done by Sodani et al. and Dela Coleta et al. reported that 40% and 47% of their study participants reported making a formal referral to a dentist when they see a child with dental caries, whereas in the present study, 85% of the pediatricians did the same. The difference in the percentage might be due to the lack of time in the practice of pediatricians, so they tend to refer the patients rather than counseling them regarding prevention and treatment aspects.
The knowledge related to oral health that is conveyed by pediatricians to parents and guardians is usually derived from practical experience. There are a few professionals who were educated on oral health during the undergraduate courses in medicine, medical homes, or formal education programs. Analysis of Indian studies on the amount of oral health education received in the form of continuing medical education programs were not available, yet most respondents received 1–3 h of training in oral health education during medical and specialty training, similar to the present findings; Prakash et al. reported that 37.2% of the pediatricians in their study reported receiving 1–3 h.
The most disconcerting results of the present study were with regard to the quality of oral health content taught during the medical course and residency. A total of 53% of the respondents were not sure about the training they received. Training in oral health would be easier if basic knowledge and positive attitudes were obtained during the medical education. Medical schools have the important responsibility of imparting skills to medical students through a curriculum that encompasses the striving for interdisciplinary and a commitment to the overall health of patients. For this reason, in 2008, the Association of American Medical Colleges issued a recommendation for an increase in oral health education. Moreover, specific oral health protocols should be developed for routine use by pediatricians. Such materials should be easy to read, self-explanatory, broad scoped, and culturally appropriate.
In the present study, nonrespondents may have different practices and experiences with respect to children's oral health. Pediatricians must be ensured that all of their patients can receive timely preventive and restorative dental care. Adding a module on oral health and dental care to the undergraduate medical school and physical examination skills courses are recommended.
| Conclusions|| |
Among the pediatricians, knowledge level about oral health and clinical application of this knowledge is less and hence pediatrician's knowledge about oral health can and must be improved, provided that there is more integration with dentistry area, especially when doctors are still in graduation or postgraduation. Despite having knowledge regarding oral health, the pediatricians are not readily referring the children to dentist and the reason might be due to the lack of awareness in them regarding referrals and severity of this condition affecting the child.
| References|| |
Soares IM, Borges AM, Moura A, Deus M, Batista S, Marcoeli S. Conduct of pediatricians in relation to the oral health of children. Rev Odontol UNESP 2013;42:266-72.
American Academy of Pediatric dentistry Guideline on infant oral health care–Reference manual. 2012;35:137-41.
Nikiforuk G. Understanding Dental Caries: Basic and Clinical Aspects. 1st
ed. John Wiley and Sons; 1985. p. 9-10.
Schroth RJ, Smith PJ, Whalen JC, Lekic C, Moffatt ME. Prevalence of caries among preschool-aged children in a Northern Manitoba community. J Can Dent Assoc 2005;71:27.
Sodani V, Sujan SG, Shah HG, Dave B. Anticipatory guidance regarding early childhood caries (ECC) among health professionals in Vadodara city, Gujarat. J Adv Oral Res 2011;2:77-9.
Bozorgmehr E, Mohammadi TM, Hajizamani A, Vahidi A, Khajoee F. Knowledge, attitude and practices of pediatricians about children's oral health. J Oral Health Oral Epidemiol 2012;1:93-8.
Long CM, Quinonez RB, Beil HA, Close K, Myers LP, Vann WF Jr., et al.
Pediatricians' assessments of caries risk and need for a dental evaluation in preschool aged children. BMC Pediatr 2012;12:49.
Di Giuseppe G, Nobile CG, Marinelli A, Angelillo IF. Knowledge, attitude and practices of pediatricians regarding the prevention of oral diseases in Italy. BMC Public Health 2006;6:176.
Douglass JM, Douglass AB, Silk HJ. Infant oral health education for pediatric and family practice residents. Pediatr Dent 2005;27:284-91.
Dela Coleta KE, Pereira Neto JS, Araujo Magnani MB, Nouer DF. The role pediatrician in promoting oral health. Braz J Oral Sci 2005;4:904-10.
Ismail AI, Nainar SM, Sohn W. Children's first dental visit: Attitudes and practices of US pediatricans and family physicians. Pediatr Dent 2003;25:425-30.
Balaban R, Aguiar CM, da Silva Araújo AC, Dias Filho EB. Knowledge of paediatricians regarding child oral health. Int J Paediatr Dent 2012;22:286-91.
Prakash P, Lawrence HP, Harvey BJ, McIsaac WJ, Limeback H, Leake JL. Early childhood caries and infant oral health: Paediatricians' and family physicians' knowledge, practices and training. Paediatr Child Health 2006;11:151-7.
Yahya BN, Solmaz S. The knowledge, approach and function of pediatricians in prevention of caries in Tehran. J Indian Soc Pedod Prev Dent 2004;22:148-53.
Lewis CW, Grossman DC, Domoto PK, Deyo RA. The role of the pediatrician in the oral health of children: A national survey. Pediatrics 2000;106:E84.
[Table 1], [Table 2], [Table 3], [Table 4]