Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
Year : 2018  |  Volume : 16  |  Issue : 1  |  Page : 58-61

Knowledge, attitude, and practice about infant oral hygiene care among Indian professional working mothers: A questionnaire study

Department of Public Health Dentistry, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India

Date of Submission24-Jan-2018
Date of Acceptance07-Feb-2018
Date of Web Publication23-Mar-2018

Correspondence Address:
Dr. Sahana Hegde Shetiya
Department of Public Health Dentistry, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiaphd.jiaphd_3_18

Rights and Permissions

Background: The knowledge of the parents toward the oral hygiene care might get affected by the family structure. Objective: Trend of capsular families in Urban India has led to change in infant oral health practices. Hence, the study was carried out to evaluate the knowledge, attitude, and practice about infant oral care among professional working mothers in Pune city, India. Methods: A 28-item semi-closed, closed-ended questionnaire was administered to 111 professional working mothers in Pune city, India. The data for demographic details, knowledge, attitude, and practice regarding infant oral care were collected with the help of this predesigned self-administered questionnaire from working professional mothers attending outpatient department of Pediatric Hospitals in Pune city. Results: An average, there was limited knowledge among mothers regarding oral health. However, only 13.5% mothers were aware about commercially available tooth wipes, 18% knew when the infant's first dental visit should be scheduled. About 22.5% had practice of bottlefeeding before nap time and 16.2% mothers added sugars/additives in milk while bottlefeeding. Conclusion: All the mothers had overall limited knowledge, positive attitude, and practices were inadequate about infant oral care.

Keywords: Attitude, infant, knowledge, mothers, oral health

How to cite this article:
Shinde PP, Shetiya SH, Agarwal D, Mathur A. Knowledge, attitude, and practice about infant oral hygiene care among Indian professional working mothers: A questionnaire study. J Indian Assoc Public Health Dent 2018;16:58-61

How to cite this URL:
Shinde PP, Shetiya SH, Agarwal D, Mathur A. Knowledge, attitude, and practice about infant oral hygiene care among Indian professional working mothers: A questionnaire study. J Indian Assoc Public Health Dent [serial online] 2018 [cited 2024 Mar 4];16:58-61. Available from: https://journals.lww.com/aphd/pages/default.aspx/text.asp?2018/16/1/58/228301

  Introduction Top

Dental caries is the most common chronic infectious disease during childhood which is caused by interaction between cariogenic bacteria mainly Streptococcus mutans (SM) and tooth surface.[1] Oral microbes start to colonize an infant's mouth soon after birth.[2],[3],[4] Most studies suggest that the bacteria can be acquired at any time from under 6 months to over 3 years of age.[5] The acquisition of SM is suggested to occur during a distinct age period: A “window of infectivity” between 19 and 31 months, in which the proportion of children with SM increases from 25% to 75%.[3]

The onset of early childhood caries occurs in children below 71 months of age, and it is commonly referred as “nursing caries,” “baby bottle caries,” and “baby bottle tooth decay” as inappropriate nursing and baby bottle use in infants are often implicated as main etiological factors of this condition. The direct consequences of early childhood caries are pain and infection which can affect child's ability to eat and result in reduced body weight and failure to thrive.[6] In addition, caries in the primary dentition has been indicated as a risk factor for the future dental caries in the permanent dentition.[7]

Parents/guardians are responsible for almost all the health issues related to their children. Their role in modeling their children toward practicing preventive oral health throughout life is crucial.[8] However, limited data is available about infant oral hygiene practices followed by mothers in India. Traditionally, in India, the elders in the joint families used to always guide the mothers for taking oral health care of their infants using wet cotton or cloth piece. However, recently due to trend of capsule families in India, there is a change in infant oral hygiene practices, especially among professional working mothers.

Therefore, the main purpose of this knowledge, attitude, and practices study is to explore the knowledge, attitude, and practice about infant oral hygiene care among professional working mothers so that best oral health outcomes for children can be achieved. This information will help the dental community understand some of the reasons why children do not receive the oral health care they need. Through this study, the knowledge and importance about infant oral health care can be provided to the working professional mothers, and they can provide proper oral care measures through themselves or through care providers to their children.

  Methods Top

A questionnaire survey was undertaken to evaluate the knowledge, attitude, and practice about infant oral hygiene care among professional working mothers in Pune. Before commencing the study, approval was obtained by the Institutional Review Board and Ethics Committee (DPU/431(51)/2014 dated 2/7/2014). Working professional mothers attending outpatient department of randomly selected private pediatric hospitals in Pune were included. The sample size was calculated from a previous study by Nagarajappa et al., on knowledge, attitude, and practice regarding infant oral health among parents in Udaipur.[9] Based on standard deviation of 3.97 and an acceptable difference of 0.75 at a confidence level of 95%, the sample size worked out to 111. Winpepi software was used to calculate the sample size. Professional working mothers in Pune having minimum educational qualification as graduate with child up to 2 years of age were included in the study. Those working in medical or paramedical sector were excluded.

A questionnaire was designed for the participants to assess their knowledge, attitude, and practice about infant oral care. Face validity was done by four subject matter experts from the Department of Public Health Dentistry where few questions were modified and few were deleted after which the questionnaire consisted of 28 questions. The questionnaire was validated by a panel of 15 subject matter experts who were included from Department of Pedodontics, Public Health Dentistry, Oral Medicine and Radiology, and Pediatrics. For a panel of 15 members, a minimum content validity ratio of 0.49 was required to retain an item in the final test form. Based on this, 28 questions were retained from initial 40 questions, out of which few are being presented in the form of tables. The mean content validity index of the questionnaire was calculated to be 0.95. After the face and content validity, the test–retest reliability was assessed based on percentage of agreement (87.5%). Later, it was translated by expert Marathi translator into Marathi, a local language for their understanding and convenience. The Marathi version was translated back into English by an expert English translator who had not seen the original version. The conceptual equivalence between the original questionnaire and the back-translated version was supported by an expert committee. Furthermore, the pretesting of the questionnaire was done among similar population like mothers having infants up to 2 years and working in information technology companies in Pune. The final questionnaire comprised of 28 questions. The participants were approached from nearby selected pediatric hospitals and were given to fill the questionnaire after meeting the inclusion criteria and obtaining their informed consent. After collecting the filled questionnaires, participants were given instructions about infant oral health care and doubts if any were cleared.

Statistical analysis was done using SPSS software version 21 (SPSS inc., IBM, and Chicago, IL, USA), in which numbers and percentages were calculated.

  Results Top

Maximum number of mothers knew that infants first tooth erupt around the age of 6–12 months, 38% of the mothers are cleaning their infants teeth only after teeth erupt. Only 13.5% mothers were aware about commercial tooth wipes. Frozen fruits and vegetables are being used to soothe painful gums [Table 1].
Table 1: Knowledge about infant oral care among professional working mothers in Pune city

Click here to view

Almost 98.2% mothers had a positive attitude toward care of infant's teeth as good as any other body part. Same number of mothers has accepted that it is important to clean the infant's mouth [Table 2].
Table 2: Attitude about infant oral care among professional working mothers in Pune city

Click here to view

63% of the mothers brush their infant's mouth twice daily. Water seems to be the choice of material for cleaning the infant's mouth before teeth erupt; this choice is being shifted toward toothbrush after tooth erupts [Table 3].
Table 3: Practice about infant oral care among professional working mothers in Pune city

Click here to view

Maximum of mothers 42.3% did not know regarding fluoride content of the toothpaste. All the mothers had fair knowledge. About 58.6% were aware as to when the infant's toothbrush should be changed [Table 3].

  Discussion Top

The American Academy of Pediatric Dentistry (AAPD) recognizes that infant oral health is one of the foundations on which preventive education and dental care must be built to enhance the opportunity for a lifetime free from preventable oral disease.[10]

Oral health is an important part of general health and poor oral health for young children can have significant negative consequences for general and social, intellectual, physical, and emotional development.[11] Mothers are undoubtedly the primary source of early education in children with regard to a good oral health. Since there is an increasing trend of nuclear families in cities, working parents of children in nuclear families have mainly two options, to leave the child at home with a family member/hired help or to leave the child at a nursery or daycare center, which caters to children, maybe as young as 4 months. Parents opt to leave children at such centers for the majority of the day, during the working hours of the parent. Thus, change in the parenting trends with mothers joining the workforce has led to decrease in time spent with the child which prevents them from providing adequate attention to basic health needs.[12] Majority of mothers in the present study had good knowledge about infant's first tooth eruption which was in accordance with the study by Kakatkar et al.[13] and Mani et al.[14] The first dental visit of a child is considered to be one of the important caries preventive measures; hence, AAPD recommends that by the age of 6–12 months, oral examination with adjunctive diagnostic tools must be completed.[15] The present study found that only 18% mothers had knowledge about the scheduling of infant's first dental visit. In the present study, about 36.9% mothers reported that infant's mouth must be cleaned right from birth which was comparable to around 30% of parents, in the study by Alshehri and Nasim.[16] Since infants have tendency to swallow toothpastes, there has been concern that use of commonly available over the counter toothpastes containing up to 1000 ppm fluoride, can cause enamel fluorosis of the permanent incisors in future. Using 1000-ppm-F toothpaste (compared with 400–550 ppm F toothpaste) and eating/licking toothpaste were associated with higher risk of fluorosis without additional benefit in caries protection.[17] In response to the growing concern over enamel fluorosis, some manufacturers now market low fluoride pediatric toothpastes containing <600 ppm fluoride or no fluoride. Thus, it is important that parents must be aware about infant toothpastes available in the market. In the present study, about 44.1% mothers were aware about the infant toothpastes. About 55% mothers had good knowledge while others had limited knowledge about the factors responsible for tooth decay such as excess sugar in the diet, lack of oral hygiene, vitamin deficiency, and sticky foodstuffs.[18] It is observed that infants usually become irritable and their feeding is affected during teething. Applying medications such as teething powder/gels, refrigerated teething rings, pacifiers, spoons, fruits, and vegetables are certain measures to relieve pain during teething.[19] In the present study, about 66.7% mothers were aware about the distress that occurs during the teething but about 47.7% did not have the knowledge to relieve the same. Overall, all the mothers had a good attitude toward the oral hygiene care of their infants. Nearly 98.2% mothers agreed that taking care of infant's teeth is equally important as any other part of the body, hence they must be kept clean. Most of them agreed that it is possible to prevent tooth decay and were willing to receive more information about infant's oral health care. About 88.3% mothers have agreed that periodic visit to the dentists for their infant's oral examination was necessary. In a study by Alshehri and Nasim, only 65.77% mothers agreed that visit to dentist is necessary regardless of the health of their child.[16] Milk has been served with sugar as sweetening milk makes it easier for a child to drink it. Most babies prefer sweet milk because even the breastmilk contains milk sugars and so the infants are used to the sweet flavor. However, holding such fluids in the oral cavity for a prolonged time or constant sipping of sugary milk can increase the risk of caries.[20] Among those mothers, who were bottlefeeding their infants, about 16.2% added sugars or additives to the bottle milk. About 47.7% mothers used toothbrush after the eruption of primary teeth and rest used other oral cleaning aids such as wet cotton, cloth piece, rubber finger brush, and tongue cleaner. All the mothers were given oral health education about infant oral hygiene care by the investigator during data collection or through e-mails later.

  Conclusion Top

Overall, all the mothers had limited knowledge about infant oral care. Almost all mothers had positive attitude toward their infant's oral care. Even though the mothers had a positive attitude toward oral care of the infants, due to lack of adequate knowledge, they were not able to provide appropriate oral hygiene care for their infants. A good attempt has been made through the present study to deliver knowledge to the mothers so that in the future they are able to take appropriate care of their infant's oral health.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Colak H, Dülgergil CT, Dalli M, Hamidi MM. Early childhood caries update: A review of causes, diagnoses, and treatments. J Nat Sci Biol Med 2013;4:29-38.  Back to cited text no. 1
Pearce C, Bowden GH, Evans M, Fitzsimmons SP, Johnson J, Sheridan MJ, et al. Identification of pioneer viridans streptococci in the oral cavity of human neonates. J Med Microbiol 1995;42:67-72.  Back to cited text no. 2
Caufield PW, Cutter GR, Dasanayake AP. Initial acquisition of mutans streptococci by infants: Evidence for a discrete window of infectivity. J Dent Res 1993;72:37-45.  Back to cited text no. 3
Rotimi VO, Duerden BI. The development of the bacterial flora in normal neonates. J Med Microbiol 1981;14:51-62.  Back to cited text no. 4
Law V, Seow WK, Townsend G. Factors influencing oral colonization of mutans streptococci in young children. Aust Dent J 2007;52:93-100.  Back to cited text no. 5
6. Acs G, Lodolini G, Kaminsky S, Cisneros GJ. Effect of nursing caries on body weight in a pediatric population. Pediatr Dent 1992;14:302-5.  Back to cited text no. 6
7. al-Shalan TA, Erickson PR, Hardie NA. Primary incisor decay before age 4 as a risk factor for future dental caries. Pediatr Dent 1997;19:37-41.  Back to cited text no. 7
Ramazani N, Zareban I, Ahmadi R, ZadSirjan S, Daryaeian M. Effect of anticipatory guidance presentation methods on the knowledge and attitude of pregnant women relative to maternal, infant and Toddler's oral health care. J Dent (Tehran) 2014;11:22-30.  Back to cited text no. 8
Nagarajappa R, Kakatkar G, Sharda AJ, Asawa K, Ramesh G, Sandesh N, et al. Infant oral health: Knowledge, attitude and practices of parents in Udaipur, India. Dent Res J (Isfahan) 2013;10:659-65.  Back to cited text no. 9
American Academy of Pediatric Dentistry Reference Manual: Guideline on Infant Oral Health Care. Pediatr Dent 2014;Special Issue:141-5.  Back to cited text no. 10
Brown A, Lowe E, Zimmerman B, Crall J, Foley M, Nehring M, et al. Preventing early childhood caries: Lessons from the field. Pediatr Dent 2006;28:553-60.  Back to cited text no. 11
Hegde A, Jose N, Gururaj G. Oral health knowledge and attitude among working and non working mothers and their children. J Indian Dent Assoc 2009;3:365-7.  Back to cited text no. 12
Kakatkar G, Nagarajappa R, Bhat N, Prasad V, Sharda A, Asawa K, et al. Parental beliefs about children's teething in Udaipur, India: A preliminary study. Braz Oral Res 2012;26:151-7.  Back to cited text no. 13
Mani SA, Aziz AA, John J, Ismail NM. Knowledge, attitude and practice of oral health promoting factors among caretakers of children attending day-care centres in Kubang, Kerian, Malaysia: A preliminary study. J Indian Soc Pedod Prev Dent 2010;28:78-83.  Back to cited text no. 14
[PUBMED]  [Full text]  
American Academy of Pediatric Dentistry. Reference manual: Guideline on periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children and adolescents. Pediatr Dent 2013;36:118-25.  Back to cited text no. 15
Alshehri A, Nasim V. Infant oral health care knowledge and awareness among parents in Abha city of Aseer Region, Saudi Arabia. Saudi J Dent Res 2015;6:98-101.  Back to cited text no. 16
Do LG, Spencer AJ. Risk-benefit balance in the use of fluoride among young children. J Dent Res 2007;86:723-8.  Back to cited text no. 17
Prado A, Oliveira F, Abrão LM, Novaes MS, Prado TT. Perception of parents of children with and without disabilities about teething disturbances and practices adopted. Braz J Oral Sci 2013;12:76-9.  Back to cited text no. 18
American Academy of Pediatrics. A Pediatric Guide to Children's Oral Health. Elk Grove Village, IL: American Academy of Pediatrics; 2009.  Back to cited text no. 19
Touger-Decker R, van Loveren C. Sugars and dental caries. Am J Clin Nutr 2003;78:881S-92S.  Back to cited text no. 20


  [Table 1], [Table 2], [Table 3]

This article has been cited by
1 Knowledge, Attitude and Practices of Mothers Regarding Oral Hygiene and Dental Caries Among Children: A Systematic Review
Zunaira Iqbal, Arooj ul Hassan, Seema Shafeeq, Tahira Ashraf, Wamik Ehsan
Pakistan BioMedical Journal. 2022;
[Pubmed] | [DOI]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Article Tables

 Article Access Statistics
    PDF Downloaded624    
    Comments [Add]    
    Cited by others 1    

Recommend this journal