|Year : 2015 | Volume
| Issue : 1 | Page : 33-37
Parental and family influences on dental treatment need among school children from north Bengaluru: A cross-sectional study
R Murali1, Deepak Viswanath2, Hemalatha Rajendran2, Priya Nagar2
1 Department of Public Health Dentistry, Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
2 Department of Pedodontics and Preventive Dentistry, Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
|Date of Web Publication||19-Mar-2015|
Dr. R Murali
Department of Public Health Dentistry, Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru - 562 157, Karnataka
Source of Support: Self Funded study approved by the ethical committee
board of Krishnadevaraya college of dental sciences and hospital., Conflict of Interest: None
Introduction: Very few studies have documented the relative significant factors that assess the parents and their family status that can have some impact towards dental treatment needs. Aim: To assess the burden of dental caries among children aged 8-14 years in relation to parental influence and family characteristics from North Bengaluru. Materials and Methods: A cross-sectional epidemiological survey was carried out on 1216 school children aged 8 years to 14 years. Children were examined in schools and data comprised information about dental caries status. Structured questionnaires were given to parents to collect information regarding their socioenvironmental and family characteristics. Student's t-test on metric parameters and Chi-square/Fisher for study parameters between two or more groups were used. Results: In families where the average monthly income <6000/-, decayed, missing, and filled teeth was proportionately lower in comparison to decayed, missing, and filled surfaces which were higher. Conclusions: The socioeconomic status, which is primarily influenced by parental factors and family structure, have a definite role in dental needs of children from underprivileged background. Dental health program should aim to reduce the gross inequalities in the oral health status of these children and their families.
Keywords: Decayed, dental caries, filled indices, missing, oral health, parental influence, underprivileged
|How to cite this article:|
Murali R, Viswanath D, Rajendran H, Nagar P. Parental and family influences on dental treatment need among school children from north Bengaluru: A cross-sectional study. J Indian Assoc Public Health Dent 2015;13:33-7
| Introduction|| |
General health and within it, the dental health reflects an individual's health habits and general health behavior in various ways. Changes in life and their lifestyle can affect oral health. Dental diseases are often connected with lifestyle's multiple risk factors which further affect the overall health. , Oral health is intrinsically linked to the individual's general health and quality of life (QOL), the impact is reflected in their days lost at school and work, difficulty with eating, reduced self-esteems poor QOL, among other consequences. ,
Dental caries is one of the most prevalent chronic diseases in children worldwide; most dental caries in young children is untreated.  Dental caries is generally not life-threatening, but the burden of untreated caries is very high then the context of general and emotional health and treatment cost is considered. ,, Untreated severe caries can lead to pulpitis and sepsis, sometimes causing serious complications such as cellulitis and brain abscesses.  Caries experience is often associated with poor child growth and low weight gain. , Increased treatment time and cost, , higher risk of hospitalization,  days missed from school and work and compromised school performance. 
Dental Hospitals play a significant role in promoting access to dental services for school children. ,,, Brazil has successfully developed a project entitled "Progress Always Smiling" in partnership with various public and private institutions in order to provide proper dental care for underprivileged children between 6 and 10 years of age every year. This dental care model comprises preventive and curative interventions with the aim of promoting oral health of children and their families. 
Although the influence of social determinants on oral health has been recognized in the literature  very little information is known about the differences in parental influence and family characterization between school children with and without curative dental treatment needs belonging to lower strata income groups. Thus, the objective of this study was to investigate the parental influence and family characterization of school children with and without curative dental treatment needs, from poor families participating in a dental health program. Our study centered on the following hypotheses.
Type of dwelling
Any person living in his own shelter will have optimum standards of living including overall general and dental health. 
Kind of living
Not just parents but elders in the family which includes grandparents, uncles etc., also have a positive impact in the overall health of the child. 
| Materials and Methods|| |
A cross-sectional study was conducted in government and private schools from Bengaluru North. The Study was approved by the ethical committee of the Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru, Prior permission was obtained from the school authorities for conducting the study. Along with the questionnaire, an informed consent form was handed out to the school authorities so as to obtain parents' permission.
One thousand two hundred and eighteen school going children of both genders from 10 different schools (both government and private) of Bengaluru north in the age group of 8-14 years were chosen for the present study. A random sampling method was followed in each designated school by the concerned teacher.
- Children in the age group - 8-14 years
- Children and parents who were willing to participate in the study.
- Children with compromised health.
A specially designed questionnaire was used in the present study that had a set of 15 questions. The questions ranged from general questions on demographic information's; number of sibling; any previous dental visit or oral health program; type, time and kind of tooth paste and brushes used; monthly household income; Parents qualification and job status etc. 
The questionnaire critically evaluated the following:
- Monthly household income - here a reference value of Rs. 6000 international normalized ratio (INR) was taken as per the Karnataka Minimal Wage, 2013 Government Manual where 6000 INR is the baseline salary. 
- Parents Qualification and Employment:
- Both parents were separately asked to record their status regarding educational qualification and employment. The parents were asked whether they were graduates or had they stopped their education midway
- Type of dwelling 
- Kind of living (nuclear/single family).
All the subjects were clinically examined by one trained dentist under field conditions that included gloves, disposable mirrors and probes for every child. The study was performed under natural light, and the examination of caries was carried out in a systematic fashion using Federation Dentaire Internationale tooth numbering system. Caries experience was assessed using the decayed, missing, and filled teeth (DMFT)/dmft index according to the World Health Organization  caries diagnostic criteria.
A tooth was diagnosed "sound" if there was no evidence of treated caries (filling) or untreated caries (decay), white chalky spots (incipient enamel lesion), staining, calculus or rough spots, a deep pit or fissure (stained or unstained) that was caught on the probe but had no detectable softened dentin floor, undermined enamel or softened walls, fluorosis or any questionable lesion which could not reliably be diagnosed as caries.
Confidentiality was maintained throughout the study and the collected data were subjected to statistical analysis.
| Results|| |
The sample composed of a similar number of male (54.3%) and female (45.7%) subjects (P = 0.920). As regards to the socioeconomic variables, 66.9% of families had an income ≤6000 Rs. and 70.9% family's had mostly 1-2 children with income > 6000/- (P < 0.001) and 60.2% parents felt their children had good hygiene (P = 0.094). Children who brushed twice daily had lesser dental caries score compared to their counter parts (P ≤ 0.001) and there was not a significant difference in using children's or adults toothpaste (P = 0.416). Fathers (65.6%) and mothers (55.2%) are qualified above graduation, (P ≤ 0.001, P = 0.056), 88.3% fathers were employed and only 55.6% mothers were employed and their children had lesser dental caries score (P ≤ 0.001, P ≤ 0.001). People residing in their own property had less dental caries score (P = 0.142). Government facilities was provided to only 17.4% of the sample and did not have any direct relation with dental caries score (P = 0.002). With respect to the family environment, 97.5% of children lived with both parents and had lesser dental caries score (P = 0.001) [Table 1].
Children(14.8%) who have attended dental program before (P-0.530) and who have visited dentist before had a low dental caries score between 0-2. (P = < 0.001). ([Table 2]). Mostly 58.1% children used medium bristles. (P < 0.001) Up to 72.5% parents above 6000/- salary felt their children have better hygiene. ( P =<0 .001). ([Table 3])
Decayed, missing, and filled teeth score in children with parents having salary >Rs. 6000/- (100.068$), where 69.7% had score of 0 (P = 0.609), compared to the decayed, missing, and filled surfaces, where 71.1% had a score of 0 (P = 0.49). Finally comparing the DMF and DMF score (comparison of two means), children of parents having salary < Rs. 6000/- had higher DMFT and > Rs. 6000/- salary had higher DMF score [Table 4].
| Discussion|| |
The results in the present study revealed that there are social inequalities in the oral health of school children, where researchers have emphasized the family environment and its conditions as mediators of health and disease in schoolchildren. ,,, In the present study it was observed that, Children living in homes with a monthly family income of > Rs. 6000/-, had less dental caries than their counterparts. , Thus, even in underprivileged families, a deprivation gradient for dental caries was found. Mostly due to less access to broader and better health information fewer resources to buy and replace oral hygiene aids, and fewer favorable conditions to make healthier choices, including dietary choices and access to dental care.  In addition, psychological and social problems because of living in poverty, influencing the way parents care for their children.
Parents participating in this program having lesser than 1-2 children have lesser dental caries score then those who lived with more than 3-4 children. Mostly due to household overcrowding, which had an inverse relationship with healthy habits of nutrition and hygiene, oral health-related QOL, and were predictors of traumatic dental injuries in children and adolescents. , Thus, poorer schoolchildren living in homes with fewer individuals had lesser dental caries prevalence.
Owning a House, an environmental living condition, improve the psychological well-being of homeowners and support better parenting practices, which may lead to better child outcomes even in disadvantaged families. 
Family structures are changing globally and in Bengaluru, it has an impact on the oral health status, oral health-related QOL, and self-perceived oral health of children and adolescents. Underprivileged children living with both biological parents were a protective factor, as they presented dental caries than those in nonnuclear families. There is evidence that nuclear families were more likely to have a supportive economic and psychological environment for performing better health behaviors than the environment provided by single or separated parents. The latter are generally more stressed to earn enough income to sustain their children, resulting in negligent attitudes towards monitoring oral health and using dental services for both themselves and their children. ,
Telleen et al.  pointed out that to encourage access to dental care for schoolchildren, it is necessary for mothers to incorporate the value of preventive and curative dental care into their children's upbringing, especially in vulnerable populations and mothers who believed that dentist's visits were for the purpose of keeping the child's teeth healthy and believed in the importance of dental visit were more likely to return to the dental office.
However, parental influence such as scheduling caregivers, transportation difficulties, fear of the dentist, provider availability, past satisfaction with dental care received, oral health beliefs, among other factors, could be a barrier that restrains/prevents the capacity of motivation from being transformed into action, impeding the access of low-income caregivers to oral health services for their children, and leading to them having a higher level of accumulated treatment needs. ,,
Furthermore, dental screening at schools helps with the detection of normative dental treatment needs that are often not detected by the guardians. Such programs encourage access to dental care and awareness of both parents and children of the need for this, especially among low-income groups. Therefore, they are an essential requirement for tackling the oral health inequalities of children.
Evidence has shown that the availability of a regular source of dental care was a strong predictor of dental visits in the past 12 months,  among persons in a vulnerable population. Thus, improving access to oral health services could allow standardization of the risk profile of children from different sociodemographic backgrounds and act on children requiring urgent dental treatment, and on the number of decayed teeth. 
According to Acs's study,  it would be better for dental professionals to know the impact of socioenvironmental conditions and family structure on the oral health of individuals, in order to plan inter-sectorial actions, which positively impact the health of populations in a sustainable manner, especially those who are most vulnerable. 
These study results are generalizable to healthy children with severe dental caries and without severe functional limitations enhance the community-based sampling. Limitations of this study is the amount of knowledge of parents of different socioeconomic status could have hampered the results of the questionnaire, and the wide age group of the sample and different dentition, may not give an unbiased result. The calculation of the sample size may not be appropriate as the estimation of the required number was calculated using expert opinion and an uncontrolled study in an industrialized country. Further it is a cross-sectional study, in which the causal relationship cannot be adequately assessed. Therefore, longitudinal follow-up is required for further insights into the reduction of inequalities in oral health of underprivileged schoolchildren.
| Conclusions|| |
The following conclusions were drawn from the present study:
- Parents who have attended dental program and seen a dentist before had less dental caries score
- Majority of the employed parents (fathers 88.3% and mothers 55.6%) had lesser dental caries score
- Children's residing with both parents in their own property had less dental caries score
- Children of parents having salary < 6000/- INR had higher DMFT and more then 6000/- INR salary had higher DMF score.
Our present study reflected relevant areas and it is here where the inequalities in oral health status and the means to access the same should be simplified for the common man thus positively impacting the QOL and more so the oral health in particular.
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[Table 1], [Table 2], [Table 3], [Table 4]