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ORIGINAL ARTICLE
Year : 2020  |  Volume : 18  |  Issue : 4  |  Page : 285-289

Awareness of night brushing and its importance in oral health in parents and among their children


Department of Pediatric and Preventive Dentistry, M.R. Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India

Date of Submission28-Feb-2020
Date of Decision05-Oct-2020
Date of Acceptance16-Oct-2020
Date of Web Publication16-Dec-2020

Correspondence Address:
P Akhil
Department of Pediatric and Preventive Dentistry, M.R. Ambedkar Dental College and Hospital, Bengaluru - 560 005, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_32_20

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  Abstract 


Background: One of the goals of a pediatric dentist is providing awareness among children and their parents about oral hygiene and health. Night brushing is an important step in the prevention of plaque accumulation and caries and is inevitable in maintaining good oral health. Aim: The aim of the study was to assess the awareness of importance of night brushing and its significance on oral health among parents and their children aged 3–13 years in East Bangalore, Karnataka. Materials and Methods: Sample of 300 children was divided into three age range groups, and each group was subdivided into five socioeconomic strata (SES). Separate questionnaires, which were validated by pediatric dentists, were used to record data from the child and the parent. Descriptive analysis of all the explanatory and outcome parameters was done using mean and standard deviation for quantitative variables, frequency, and proportions for categorical variables. SPSS for Windows version 22.0 was used to perform statistical analyses, and the value of P < 0.05 was considered statistically significant. Results: There is an increase in awareness about night brushing in all SES due to increased educational standards and influences of social media and advertisements, but the frequency of practicing the same is questionable. The total child awareness scores in Class I SES demonstrated that 3–6-year age group showed a significant difference as compared with 7–10-year age group (P < 0.001) and 11–13-year age group (P = 0.003). In Class II, 3–6-year age group showed a greater awareness as compared to 7–10-year age group (P = 0.02) and total parent awareness scores in Class III and Class V demonstrated that 3–6-year age group showed significant differences with 7–10-year age group and 11–13-year age group. Conclusion: The awareness of the importance of night brushing is an essential factor affecting oral health. The extent of awareness varies in different SES among the various age groups of children and their parents.

Keywords: Awareness, night brushing, oral health


How to cite this article:
Akhil P, Setty JV, Srinivasan I, Suting C, Kakathkar S, Nayana K M. Awareness of night brushing and its importance in oral health in parents and among their children. J Indian Assoc Public Health Dent 2020;18:285-9

How to cite this URL:
Akhil P, Setty JV, Srinivasan I, Suting C, Kakathkar S, Nayana K M. Awareness of night brushing and its importance in oral health in parents and among their children. J Indian Assoc Public Health Dent [serial online] 2020 [cited 2021 Jan 20];18:285-9. Available from: https://www.jiaphd.org/text.asp?2020/18/4/285/303638




  Introduction Top


Oral health habits are measures which people learn and practice on a daily basis to maintain good oral hygiene and prevent oral disease. The most common among oral diseases, namely, dental caries and periodontal disease, are considered to be behavioral diseases as a regular practice of healthy oral habits is important in controlling them. Although various methods are available for maintaining optimal oral hygiene, toothbrushing is the most effective and widely accepted method for the prevention and control of dental diseases and maintaining optimal oral hygiene. Most researchers advise toothbrushing twice a day and also mention that, when done using fluoride toothpaste, it could also reduce dental caries.[1] Children who are above 5 years and are school going may not always get proper supervision or guidance for toothbrushing as parents do not always consider toothbrushing to be of great importance and so they leave children unattended during the same. Night brushing hence becomes just a phrase when morning brushing is only done for namesake.

Oral hygiene has to be practiced twice every day, involving rubbing of the hard and soft palate, upper and lower gums, inner aspects of cheek, and of tongue and the teeth with or without tooth powder or paste probably but is it practiced at night before going to bed is the key. Poor attitude of parents toward oral health of their children is related with increased caries prevalence among children. India, being a developing country, faces many challenges in delivering oral health needs.[2] From ages between 3 and 5 years, one or more cavitated, missing (due to caries), or filled smooth surfaces in deciduous maxillary anterior teeth or a decayed missing filled score of >4 (age 3), >5 (age 4), or >6 (age 5) surfaces are indicative of severe early childhood caries (ECC). The end result of untreated caries in children adds an increased risk for developing new carious lesions in both the deciduous and permanent dentitions. ECC is a multifactorial disease with an etiology that involves a complex interaction between biological, social, and economic factors.

Elements such as social deprivation, income inequality, and poor social cohesion have been associated with increased caries prevalence. Recent child oral health literature has highlighted the role of caregivers in oral health and disease prevention. There is a strong evidence linking the health literacy of caregivers, defined as the comprehension and effective use of health information in making health choices, to early childhood health-related behaviors.[3] The social and economic factors of the population need to be taken into consideration. Differences in socioeconomic status stand up as one of the main reasons for health disparities. Among the various factors, social factors are the most complex and challenging among all. It is dependent on various aspects of human life and the environment an individual resides in. There is a great difference in the incidence or prevalence of oral health of individuals with different socioeconomic status.[4] A simple assessment of the knowledge and awareness of night brushing may be the starting point, easy, and yet the most important step toward this.


  Materials and Methods Top


This is a questionnaire study based on knowledge attitude and practice. This study was conducted in Bangalore, Karnataka. The samples were selected based on inclusion and exclusion criteria. The study was commenced after obtaining approval from the institutional ethical committee and review board (EC no – EC646). It was a questionnaire-based study. The patient and parent who visited the department for consultation or treatment and fulfilled the inclusion and exclusion criteria and children who wilfully assented and for whom parent or legal guardian gave written informed consent were included in the study. Children from both sexes aged between 3 and 13 years were included in the study. Medically compromised and special children, children who visited the department for emergency treatment, and children who were not willing or for whom parents or legal guardians did not give written informed consent were excluded from the study.

The sample size for the present study was estimated considering the effect size to be measured (f) at 25%, power of the study at 80%, and the margin of the error at 5%, the total sample size needed was 300. Thus, each age group comprised 100 samples. Among them, each socioeconomic strata (SES) class comprised twenty participants (Three age groups ×5 SES Class ×20 participants = 300 samples). Group I: children of age range 3–6 years, Group II: children of age range 7–10 years, and Group III: children of age range 11–13 years. Each of these groups will be divided into subgroups based on their socioeconomic status as per B G Prasad's scale.[5] Children were asked the questions and the operator provided help to those who required to understand the same. A questionnaire with demographic details and closed-ended questions for obtaining information about knowledge, awareness, and practice on oral hygiene was prepared and was validated by 15 practicing pediatric dentists with 2–20 years of clinical experience. Questions were asked to children of lower age group and their responses were noted by the operator as the children were unable to answer the questionnaire themselves. Separate questionnaires validated by pediatric dentists were used for both parents and children. Questions were intended to assess the awareness regarding night brushing including the basic information about their brushing habit. All the data were collected by a single operator to avoid bias. The data thus collected were tabulated and statistically analyzed using Statistical Package for the Social Sciences for Windows version 22.0 Released 2013. Armonk, NY, USA: IBM Corp., with the level of significance set at P < 0.05. Two-way ANOVA test was used to compare the mean knowledge/awareness scores between the study groups and Pearson's correlation test to assess the correlation between child and parent responses in different age groups and SES classes.


  Results Top


Among the study participants, equal number of children and parents were included in each of the SES in all three age groups with almost equal sex distribution among the study groups [Graph 1]. Multiple comparison of the various SES for each groups yielded ten different combinations per group, so a total of 30 P values were obtained. Here, only those with statistical significance are being discussed. Multiple comparison of mean difference in total scores of children among the various SES demonstrated no significant difference in Group II and III and a significant difference in Group I with P = 0.006 between Class I and III, P = 0.04 between Class I and IV, and P = 0.01 between Class I and V. However, no statistical significance was observed between Class I and II (P = 0.24) [Table 1]. Multiple comparison of mean difference in total scores of parents in Group 1 demonstrated a significant difference between Class I and III (P = 0.02), Class I and V (P = 0.001), and Class II and V (P = 0.006). With respect to Group 3, Class III demonstrated a significant difference between Class II (P = 0.02) and Class IV (P = 0.01) [Table 2]. Pearson's correlation test to assess the correlation between child and parent responses in different age groups and SES classes shows that there is a weak correlation in Class III SES among the age group of 7–10 years old and strong correlation in Class I SES among 11–13-year-old children [Table 3]. Multiple comparison of mean difference in total child awareness scores in Class I SES demonstrated that 3–6-year age group showed a significant difference as compared with 7–10-year age group (P < 0.001) and 11–13-year age group (P = 0.003). In Class II, 3–6-year age group showed a greater awareness as compared to 7–10-year age group, which was statistically significant (P = 0.02) [Graph 2]. Multiple comparison of mean difference in total parent awareness scores in Class III and Class V demonstrated that 3–6-year age group a showed significant differences with 7–10-year age group and 11–13-year age group [Graph 3].
Table 1: Comparison of mean total awareness scores of children between socioeconomic strata classes in each group using one-way ANOVA test

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Table 2: Comparison of mean total awareness scores of parents of study children between socioeconomic strata classes for each age group using one-way ANOVA test

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Table 3: Pearson's correlation test to assess the correlation between child and parent responses in different age groups and socioeconomic strata classes

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  Discussion Top


Toothbrushing is a simple routine which everyone follows. The importance of toothbrushing is very significant in the oral hygiene and health of every individual. The awareness and importance of night brushing is a crucial yet much underrated and an often neglected. This study is an attempt to evaluate the same and encourage further research in this regard. The study pointed out significant findings regarding the effect of awareness on night brushing among various SES had in the society. It pointed out that not every sample in the SES was particularly rated as informed and oriented to the topic of interest or completely ignorant of the same. We could find out from the study that children in all three age groups from the middle SES were more aware compared to other SES. Furthermore, the trend was more in the mid-SES rather than both the poles. Surprisingly, the parents from lower SES were more aware than all other groups, though it cannot be generalized. This study also showed that children who were in the age group of 7–10 years were more aware than the other two groups, but when it comes to parents, those of smaller age group of children were more aware.

Various studies have been done on toothbrushing habits of children and their parents and caregivers, their awareness about the importance of oral hygiene in oral health, but the importance of night brushing, sadly, is an unturned stone. The results similar to our study regarding the difference in the awareness among various SES were also noted in the study conducted by Mishra et al. They inferred that, along with socioeconomic status, other factors that determine a person's attitude toward oral hygiene are lack of awareness, lack of availability of dentist nearby, and fear and anxiety also play an important role.[6]

Parents from low SES have to be educated more in the aspect of their role in the importance of oral health of their children, and it seems to agree with the reports of the study by Abed A-H Hamasha et al.[7] and partially agrees with the results of the study done by Kumar Chandan Srivastava where the parents from higher SES are more aware than those from low SES.[8] Similar to our study, not among all the age groups and all SES, there was correlation between parent's awareness and oral hygiene of their children as seen in a study on the relationship between children's dental health and parental knowledge about oral hygiene by Omargal et al.[9]

Demographic and socioeconomic factors influence the awareness levels and feasibility to dental awareness to reap the advantages of the same. As seen in the present study, the awareness level varies in the various SES among parents and their children. This result is seen in line with the findings of Casanova Rosado AJ et al., who found that different variables (sociodemographic, socioeconomic, and dental) may influence the frequency of toothbrushing. Furthermore, family size (a proxy for socioeconomic status) may indicate certain oral health inequities in this population, which can influence oral self-care behaviors in populations.[10] Peer influence is a crucial factor that determines the awareness level about the activities and thoughts of school-going children. Koerber et al. studied the covariates of toothbrushing frequency in low-income African Americans from Grades 5–8 and reported that peer influence is an important factor in toothbrushing behavior in metropolitan African American preadolescent children. Furthermore, this indicates that schools may be the best place to promote oral health behaviors since, by the fifth grade; parental influence is not the only factor. The methods used to promote oral health in schools should appeal to the children's need, peer acceptance, and should promote children's physical self-esteem. It is also not clear that increasing knowledge of oral health issues would have any effect on brushing behavior.[11]

The total analysis of the results from the present study shows that among the three age groups of children studied those who belong to the 7–10-year age group had more awareness compared to both the other groups. It can also be noted that the children from the middle SES had more awareness. In the lower age group, the comparison of awareness among parents between various SES showed higher awareness in middle and higher SES. Comparison of awareness among parents between age groups showed the highest level of awareness in parents of younger age group (3–6 years) and least among parents of 11–13-year-old children. Night brushing hence turns out to be a highly underrated and ignored aspect of the discussion. People though aware about night brushing are not concerned about its importance or the consequences of not following the same. Further researches and studies with a higher sample size stretching over a larger geographic area should be conducted on the caries incidence and progression rates in children who follow night brushing with who do not follow night brushing so as to clinically evaluate, quantify, and signify the magnitude of importance and necessity about the same. Increased awareness in the younger age group shows that younger children (preschool) are getting more information about toothbrushing compared to older children. This may be attributed to parents of younger age group children being more aware as we found in this study. In these preschools, children are educated and given orientation toward personal hygiene and toothbrushing through rhymes and action songs which probably has helped them to be better aware than older children who have missed out on this new curriculum. As the awareness of lower SES about night brushing is less as compared to middle and higher SES, the importance of oral health and care among lower SES group has to be stressed more by parent education programs and community dental health programs.


  Conclusion Top


To conclude from the present study, the extent of awareness varies in different SES among the various age groups of children and their parents. This study shows that both parent and the child are aware of the fact that they have to practice toothbrushing twice daily, but the extent of practicing night brushing in their daily life is questionable. The significance and consequences of not practicing night brushing should be aggressively emphasized and stressed by the dentist because when it comes to practicing the habit, the percentage of people who does is very low and that is something that has to be addressed. Results of our study showed only 47.6% of children and 53% of parents have been practicing night brushing. The incidence and prevalence of caries and periodontal diseases should be evaluated to get a clinical picture and severity of the end result of not practicing night brushing. This study was only an initial step toward evaluation of awareness regarding the importance of night brushing and so including a larger population covering more of geographical area should be mandated.

Acknowledgment

The authors would like to thank and acknowledge Dr. Santhosh for helping us with statistical analyses.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Al-Hussaini R, Al-Kandari M, Hamadi T, Al-Mutawa A, Honkala S, Memon A. Dental health knowledge, attitudes and behaviour among students at the Kuwait University Health Sciences Centre. Med Princ Pract 2003;12:260-5.  Back to cited text no. 1
    
2.
Reang T, Bhattacharjya H. Mother's knowledge and practice regarding oral hygiene and challenges in the prevention of dental caries of under-five children in an urban resettlement colony. Int J Med Sci Public Health 2014;3:76-80.  Back to cited text no. 2
    
3.
Ashkanani F, Al-Sane M. Knowledge, attitudes and practices of caregivers in relation to oral health of preschool children. Med Princ Pract 2013;22:167-72.  Back to cited text no. 3
    
4.
Mishra P, Solanki J, Choudhary R, Sharma C, Sharma P, Shah D. Attitude towards oral hygiene among different socio-economic groups in Jaipur city, Rajasthan. Med Pharm Rep 2019;92:79-82.  Back to cited text no. 4
    
5.
Pandey VK, Aggarwal P, Kakkar R. Modified BG Prasad socioeconomic classification, update – 2019. Indian J Comm Health 2019;31:123-5.  Back to cited text no. 5
    
6.
Mishra P, Solanki J, Choudhary R, Sharma C, Sharma P, Shah D. Attitude towards oral hygiene among different socio-economic groups in Jaipur city, Rajasthan. Med Pharm Rep 2019;92:79-82.  Back to cited text no. 6
    
7.
Hamasha AA, Rasheed SJ, Aldosari MM, Rajion Z. Parents knowledge and awareness of their children's oral health in Riyadh, Saudi Arabia. The Open Dentistry J 2019;13.  Back to cited text no. 7
    
8.
Srivastava KC. Differential pattern of awareness about oral health and its hygiene practices among rural and urban schoolchildren of two index age groups in Al Qassim Region, Saudi Arabia. J Int Oral Health 2019;11:153.  Back to cited text no. 8
  [Full text]  
9.
Omargali A, Uraz R, Campbell P. Relationship between children's dental health and parental knowledge about oral hygiene. Available from: http://elib.zkgmu.kz/xmlui/handle/123456789/778. [Last accessed on 2019 Jul 26].  Back to cited text no. 9
    
10.
Casanova-Rosado AJ, Medina-Solís CE, Casanova-Rosado JF, Vallejos-Sánchez AA, Minaya-Sánchez M, Mendoza-Rodríguez M, et al. Tooth brushing frequency in Mexican schoolchildren and associated socio-demographic, socioeconomic, and dental variables. Med Sci Monit 2014;20:938-44.  Back to cited text no. 10
    
11.
Koerber A, Graumlich S, Punwani IC, Berbaum ML, Burns JL, Levy SR, et al. Covariates of tooth-brushing frequency in low-income African Americans from grades 5-8. Pediatri Dent 2006;28:524-30.  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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