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ORIGINAL ARTICLE
Year : 2019  |  Volume : 17  |  Issue : 1  |  Page : 76-79

Oral hygiene knowledge and practices among mothers of 3- to 6-Year-old preschool children visiting anganwadis of Bangalore City


1 Department of Public Health Dentistry, Lenora Institute of Dental Sciences, Rajahmundry, Andhra Pradesh, India
2 KVG Institute of Dental Sciences, Jaipur, Rajasthan, India
3 NIMS Dental College, Jaipur, Rajasthan, India

Date of Submission29-May-2018
Date of Acceptance19-Feb-2019
Date of Web Publication15-Mar-2019

Correspondence Address:
Dr. S Naganandini
Lenora Institute of Dental Sciences, Rajahmundry, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_117_18

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  Abstract 

Background: Children under the age of 6 years spend most of their time with their parents and guardians, especially mothers, even when they attend preschool or nurseries. It has been found that young children's oral health maintenance and outcomes are influenced by their parent's knowledge and beliefs. Mothers play a vital role in maintaining their children's oral hygiene. Aim: The aim of this study was done to assess the knowledge and practice of oral hygiene among mothers of 3- to 6-year-old preschool children visiting the anganwadis of Bangalore city. Materials and Methods: Mothers of children aged 3–6 years visiting various anganwadis were invited to participate in the study. The sample comprised of 200 mothers through simple random sampling. A pretested questionnaire covering sociodemographic details, importance of brushing deciduous teeth, and oral hygiene practices was distributed to mothers who were willing to participate. Results: In the present study, majority of mothers visiting the anganwadi had only primary school education (79%). About 79.4% of mothers did not have any knowledge regarding the time of eruption of their child's deciduous teeth, 63.8% of mothers did not know the importance of brushing their child's deciduous teeth, and 84.3% mothers did not know that oral diseases can affect general health. Conclusion: The result of the present study showed that the oral health knowledge among the mothers visiting the anganwadis was poor. Awareness programs targeting expectant mothers visiting anganwadis should be employed by training the anganwadi teachers, and importance of primary teeth should be emphasized in different oral health education programs

Keywords: Mother–child relationship, oral health education, preschool children


How to cite this article:
Rajanna V, Khanagar S, Naganandini S. Oral hygiene knowledge and practices among mothers of 3- to 6-Year-old preschool children visiting anganwadis of Bangalore City. J Indian Assoc Public Health Dent 2019;17:76-9

How to cite this URL:
Rajanna V, Khanagar S, Naganandini S. Oral hygiene knowledge and practices among mothers of 3- to 6-Year-old preschool children visiting anganwadis of Bangalore City. J Indian Assoc Public Health Dent [serial online] 2019 [cited 2019 Mar 24];17:76-9. Available from: http://www.jiaphd.org/text.asp?2019/17/1/76/254321


  Introduction Top


Children under the age of 6 years spend most of their time with their parents and guardians, especially mothers, even when they attend preschool or nurseries. It has been found that young children's oral health maintenance and outcomes are influenced by their parent's knowledge and beliefs. Socialization to oral health behaviors may be considered as a modeling process in which children imitate the behavior of their parents, who are available and who provide valued role models to their offsprings.[1],[2] When these habits are taught in early childhood, it is naturally ingrained in the daily routine of the child, with only positive reinforcements needed later.[3] Adoption of consistent behavioral habits takes place at home, with parents, especially mothers, being the primary model for the behavior. Mothers play a vital role in maintaining their children's oral hygiene. Studies have reported that poor attitude of parents toward the oral health of infants and young children is associated with increased caries prevalence.[4],[5] Educating mothers on infant dental care will provide lifelong good oral hygiene habits and will bring down the prevalence of oral diseases considerably.[6] Hence, this study aimed to assess the knowledge and practices of oral hygiene among mothers of 3- to 6-year-old children visiting various anganwadis of Bangalore city.


  Materials and Methods Top


Sampling frame comprised mothers visiting the anganwadi of the children aged between 3 and 6 years. The sample size estimation was done based on the following formula:

N = Z2 pq2

where Z = 1.96, P = probability (0.5), q = 1-p and delta = margin of error, that is, 0.05

N = (1.962 × 0.5 (1-0.5))/(0.05)2

The appropriate sample size required for the study is 150. Estimating a drop out of 5%–10%, the sample size was increased to 200.

Mothers giving consent for participation were included in the study. Mothers of children with acute or chronic health condition that would not allow their full participation were excluded from the study. The study was planned in various anganwadi centers of Bangalore city. A total of 200 mothers of 3- to 6-year-old children participated in the study. Using the list provided by the child development and project office, a total of eight anganwadi centers were selected from both North and South zones of Bangalore city by simple random sampling. A pretested 33-item questionnaire was used to collect information about the knowledge and practices of mothers. Its respective psychometric properties (validity and reliability) were assessed as follows. Content validity was assessed by a panel of eight experts made up of staff members from the Department of Public Health Dentistry. The purpose was to depict those items with a high degree of agreement among experts. Aiken's V was used to quantify the concordance between experts for each item; values higher than 0.92 were always obtained.

Demographic backgrounds

Mothers' name, age, religion, number of children, present address, phone number, and socioeconomic status (SES) of family served as background information, the SES of the family was assessed as per the Modified Kuppuswamy SES Scale.[7] Knowledge and practices of oral hygiene among mothers were recorded. Before the start of the study, informed consent was obtained from mothers participating in the study.

Questionnaire

A pilot study was performed on 10% of the sample size taken for the main study. To check the internal consistency of the questionnaire, the questionnaire was distributed to the study participants and collected back by the examiner. The results thus obtained were subjected to statistical analysis. Cronbach's alpha value of 0.81 showed good internal consistency of the questionnaire. Participants from the pilot study were not included in the main study.

Descriptive statistical analysis has been carried out in the present study. Results on continuous measurements are presented in mean standard deviation (min-max), and results on categorical measurements are presented in number (%). Significance is assessed at 5% level of significance. The Statistical software, namely, SPSS 15.0 Inc. Chicago, IL 60606-6412 was used for the analysis of the data and Microsoft Word and Excel have been used to generate graphs, tables, etc.


  Results Top


In our study, majority (90 [45.2%]) were in the age group of 21–25 years; also most of them were Muslims, that is, 120 (60.30%). In our study, 49 (24.6%) of them reported having one child, 123 (61.8%) reported having two children, and 28 (13.7%) reported having three or more children. About 20 (10.5%) participants reported that they did not go to school and most of them, that is, 158 (79.3%), reported having only primary school education. In this study, most of the mothers, that is, 162 (81.4%), belonged to the upper-lower class [Table 1].
Table 1: Distribution of subjects according to demographic details

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With respect to the statement “Dental Diseases can affect general health,” only 17.1% answered “Yes.” When asked “Brushing your child's tooth is important for oral health, only 12.6% answered “Yes” and majority answered do not know. To the statement “Soft Bristle toothbrush is good for your child,” only 12 (6%) answered “Yes” while majority said do not know. To the statement “you should use toothpaste containing fluoride,” most of the mothers 119 (59.3%) answered “did not know.” Majority of the mothers 171 (85.9%) had no knowledge regarding the presence of yellow coating on the teeth. With respect to the time of cleaning of their child's teeth, most of the mothers 148 (74.4%) said “when all the milk teeth erupt.”

Knowledge of mothers regarding “harmful effects of swallowing toothpaste” was found to be very poor (90 [45.2%]). When mothers were asked about their source of oral health information, majority of the mothers (169 [84.9%]) answered “TV” [Table 2].
Table 2: Distribution of mothers according to their knowledge of oral hygiene

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Knowledge of oral hygiene practices among mothers was found to be very poor. When the mothers were asked “when your child's teeth should be cleaned,” only 21 (10.6%) answered when the first milk tooth erupts. When asked about the frequency of brushing their teeth, 170 (85.4%) in the study group reported brushing their teeth once daily. When asked about the “device used to clean their teeth,” majority (129 [54.8%]) reported using a toothbrush. When mothers were asked about the material used to clean their child's teeth, 139 (69.8%) said they used “toothpaste,” while 53 (26.60%) used tooth powder. Regarding “method used to brush their child's teeth,” most of them (187 [94%]) followed “horizontal” method of brushing. When mothers were asked about the frequency of changing their child's toothbrush, majority (159 [79.8%]) reported changing the brush only when it Frey's. When asked about the “method of cleaning their child's tongue,” majority (165 [82.9%]) used their “hand.” When mothers were questioned “do you make your child gargle his/her mouth after food,” only 20 (9.4%) said “Yes” and 180 (90.6%) answered “No.” When mothers were asked about the amount of toothpaste to be dispensed to brush their child's teeth, only 21 (10%) said they dispensed “small pea size amount” of toothpaste. When mothers were asked “who brushes your child's teeth,” 127 (63.8%) answered they brushed their child's teeth [Table 3].
Table 3: Distribution of mothers according to oral hygiene practices

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  Discussion Top


Over the past decade, the decreasing caries incidence in children has been demonstrated in several studies, most of them have dealt with children in industrialized countries, where there is decline in caries, with a few exceptions being undisputable. The dental health of the preschool children has not nearly been documented as compared to dental health of the school children. This is probably because primary teeth in many countries still are not considered to be as important or as valuable as permanent teeth.[1] It has been shown that mothers' own dental health behavior and SES are associated with the children's behaviors and to the prevalence of dental caries.[2] No statistical difference was seen between the age distributions of the mothers. Most of the mothers in the study group were between 20 and 25 years of age, which was in accordance with the study conducted by Sufia.[3] Majority of the mothers were Muslims, that is, 60.3% mothers in the study group. This was in accordance with the study conducted by Sufia.[3] About 24.6% of the mothers in the study group reported having one child and 61.8% reported having more than one child which is in strong contrast to the study conducted by Kowash, where majority of the mothers reported having only one child.[4] In the present study, most of the mothers reported having only primary school education, which was in accordance with the study conducted by Sufia, Kowash, and Kiwanuka et al., and was in strong contrast to the study conducted by Mani et al., where majority of the mothers had secondary school education.[3],[4],[5],[6] In our study, 91.1% mothers in the study had knowledge regarding importance of brushing teeth every day. This was in accordance with the study conducted by Mani et al.[6] In the present study, knowledge of mothers regarding the importance of cleaning their child's teeth after food was found to be very poor when compared to the study conducted by Mani et al.[6] The usage of toothpaste to clean their child's teeth was found to be 94.6%. This was in accordance with the study conducted by Kiwanuka et al. and Mani et al.[5],[6] In our study, the knowledge of mothers regarding the importance of primary dentition and knowledge of eruption of primary teeth was found to be very low. This was in accordance with the study conducted by Suresh et al.[7] Most of the mothers belonged to the upper-lower class, which was similar to the study conducted by Suresh et al. and Sasahara et al. where the mothers belonged to low SES.[7],[8] In our study, 17% mothers had knowledge regarding oral health and its influence on general health. The overall knowledge of all the mothers regarding health in our study was found to be low. This was in accordance with the study conducted by Szatko et al.[9] In our study, we found that 88.6% mothers were using brush to clean their child's teeth. This was in accordance with the study conducted by Iqbal.[10] In our study, we found that 82.7% mothers in the study reported using toothpaste to clean their teeth, which was in accordance with the study conducted by Chan et al. and Rothe et al.[11],[12]

Recommendations

The study population is representative of the mothers of 3- to 6-year-old children visiting the anganwadi centers in Bangalore city. Although the study is representative of the culturally and socioeconomically heterogeneous population, further research needs to be conducted with greater sample size not only in anganwadis but also in different schools in rural areas of Bangalore and other parts of Karnataka.

Limitations

The cross-sectional study included only those mothers visiting the anganwadi centers. Hence, it cannot be generalized to the whole population. Questionnaires were printed in Kannada and English only. Some of the study participants could not read both the languages, and the questions had to be translated to their mother tongue, which could have led to some bias in the answers. Lack of interest among some mothers resulted in incomplete filling of the questionnaires which made it difficult during statistical analysis.


  Conclusion Top


Parents have a tremendous amount of influence in their children's lives. To increase their influence, parents need to increase the time children spend with them. Adoption of consistent behavioral habits takes place at home, with parents, especially mothers, being the primary model for the behavior. Educating mothers on infant dental care will provide lifelong good oral hygiene habits and will bring down the prevalence of oral diseases considerably. The result of the present study showed that the oral health knowledge among the mothers visiting the anganwadis was poor. Awareness programs targeting expectant mothers visiting anganwadis should be employed by training the anganwadi teachers, and importance of primary teeth should be emphasized in different oral health education programs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Mohebbi SZ, Virtanen JI, Murtomaa H, Vahid-Golpayegani M, Vehkalahti MM. Mothers as facilitators of oral hygiene in early childhood. Int J Paediatr Dent 2008;18:48-55.  Back to cited text no. 1
    
2.
Okada M, Kawamura M, Kaihara Y, Matsuzaki Y, Kuwahara S, Ishidori H, et al. Influence of parents' oral health behaviour on oral health status of their school children: An exploratory study employing a causal modelling technique. Int J Paediatr Dent 2002;12:101-8.  Back to cited text no. 2
    
3.
Sufia S. Maternal factors and child's dental health. J Oral Health Commun Dent 2009;3:45-8.  Back to cited text no. 3
    
4.
Kowash MB. Oral health-educating mothers with young children. Br Dent J 2000;188:201-5.  Back to cited text no. 4
    
5.
Kiwanuka SN, Astrøm AN, Trovik TA. Dental caries experience and its relationship to social and behavioural factors among 3-5-year-old children in Uganda. Int J Paediatr Dent 2004;14:336-46.  Back to cited text no. 5
    
6.
Mani SA, Aziz AA, John J, Ismail NM. Knowledge, attitude and practice of oral health promoting factors among caretakers of children attending day-care centers in Kubang Kerian, Malaysia: A preliminary study. J Indian Soc Pedod Prev Dent 2010;28:78-83.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
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.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Sasahara H, Kawamura M, Kawabata K, Iwamoto Y. Relationship between mothers' gingival condition and caries experience of their 3-year-old children. Int J Paediatr Dent 1998;8:261-7.  Back to cited text no. 8
    
9.
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.  Back to cited text no. 9
    
10.
Iqbal M. Prevalence of dental practice and dietary habits among students under six years of age, in urban Karachi. J Pak Dent Assoc 2011;20:93-7.  Back to cited text no. 10
    
11.
Chan CL, 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.  Back to cited text no. 11
    
12.
Rothe V, Kebriaei A, Pitner S, Balluff M, Salama F. Effectiveness of a presentation on infant oral health care for parents. Int J Paediatr Dent 2010;20:37-42.  Back to cited text no. 12
    



 
 
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