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Year : 2021  |  Volume : 14  |  Issue : 1  |  Page : 40-44  

Knowledge attitude and practices of parents towards oral health maintenance among their children and correlation with dental caries experience- A cross-sectional study

1 Department of Pedodontics, Nanded Rural Dental College and Research Centre, Nanded, Maharashtra, India
2 Department of Pedodontics, MGV's KBH Dental College and Hospital, Nashik, Maharashtra, India
3 Private Practioner

Date of Submission05-Jun-2020
Date of Decision30-Jul-2020
Date of Acceptance14-Aug-2020
Date of Web Publication22-Jan-2021

Correspondence Address:
Anand Nanasaheb Patil
Nanded Rural Dental College and Research Centre, Nanded, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_310_20

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Aim: The aim of this study is to assess parent's knowledge, attitude, and practice (KAP) regarding their children's oral health maintenance and its correlation with dental caries experience. Methodology: A cross-sectional study was conducted among 504 parents of children aged 5–10 years between September 2013 and November 2014. A self-designed pretested 15-item questionnaire was used to assess the KAP. Dental caries experience was recorded as Decayed, Missing, Filled, Teeth (DMFT) and decayed-extracted-filled teeth among the children. Results: Dental caries prevalence among children was 61.1%. Good KAP was reported among 23% of the parents, 64% had fair, whereas 11.5% had poor KAP. One-way ANOVA showed a significant difference (P = 0.04) in deft scores among parents having good, fair, and poor KAP. The highest deft score was found among children of parents with poor KAP. The DMFT scores did not show a significant difference between the KAP categories (P = 0.76). Conclusion: Better knowledge, positive attitude, and good oral health practices followed for children by the parents will reflect the good dental health status of their children.

Keywords: Attitudes, child, dental caries, health knowledge, parents, practice

How to cite this article:
Patil AN, Karkare SR, Jadhav HS, Sirikonda S, Suryawanshi VB, Patil SN. Knowledge attitude and practices of parents towards oral health maintenance among their children and correlation with dental caries experience- A cross-sectional study. Med J DY Patil Vidyapeeth 2021;14:40-4

How to cite this URL:
Patil AN, Karkare SR, Jadhav HS, Sirikonda S, Suryawanshi VB, Patil SN. Knowledge attitude and practices of parents towards oral health maintenance among their children and correlation with dental caries experience- A cross-sectional study. Med J DY Patil Vidyapeeth [serial online] 2021 [cited 2021 Feb 27];14:40-4. Available from: https://www.mjdrdypv.org/text.asp?2021/14/1/40/307677

  Introduction Top

The mouth is regarded as the mirror of the body and a gateway to good health.[1] Oral health is an important aspect of general health in children as it impacts the quality of life and health outcomes.[2] The National Health Survey[3] presented dental caries of 51.9%, 58.3%, and 63.1% among 5, 12, and 15 years children, respectively, indicating oral health burden. Challenge comes in treating these children because of the dental procedures fear, making them uncooperative. This fear and anxiety among children tend them to delay the dental treatment in every possible way, thereby deteriorating their own oral health.[4] The damage later drives beyond oral health and starts affecting daily activities of life, creating a negative psychosocial impact.[4] Awareness among children can help tackle this issue at a very young age.[5] Early the habits inculcated better would be the foundation for healthy permanent dentition.[6] However, growing children need proper guidance for their healthy growth and oral hygiene maintenance.[5] Preventive dental care should start early in infancy during the first year of child's life to ensure a successful outcome.[7]

Howeverwithout basic knowledge regarding dental health, it is difficult to employ effective disease preventive strategies.[8] The study reports that around 77% of caregivers preferred using pacifier dipped in sugar for children, while another 45% gave milk or juice containing sugar just before nap time. These poor attitudes and practices of caregivers toward the oral health of children presented with increased caries prevalence among children.[9] Parents are directly responsible for the dental health of their offspring and can play an important role in preventing oral diseases in children.[10] Parents guide children in tooth brushing, promote healthy dietary habits in them and also seek professional dental care. Thus, an attempt was made to assess the knowledge, attitude, and practice (KAP) of parents regarding oral health maintenance of their children and correlate it with the dental caries experience.

  Methodology Top

After obtaining ethical clearance from Institutional Ethics committee (MGV/KBHDC/814/2012) and taking written informed consent, a cross-sectional questionnaire study was conducted among parents of 504 school children of age 5–10 years visiting M.G.V.'s K.B.H. Dental College and Hospital, Nashik, Maharashtra from September 2013 to November 2014. The sample size of 504 (with 5% alpha error) was estimated based on the pilot study giving KAP prevalence of 32% among parents. Illiterate parents, grandparents, or relatives were excluded. A specially designed self-administered questionnaire was designed to collect the data regarding the KAP of parents on oral health maintenance.

Designing of the questionnaire

  1. Questionnaire development - A conceptual framework was prepared based on the literature search, which helped in framing 21 questions that underwent face and content validity. The content validity ratio (CVR) was obtained for each question by distributing the questionnaire to five experts in the field. Questions with a CVR ratio of 0.99 or more were retained. As six questions could not meet these criteria, they were removed, bringing the final count to 15 with 6 questions on knowledge, 5 on attitude, and 4 on practices
  2. Translation and back translation of the questionnaire - The structured questionnaire Pro forma was designed in English and then translated into local language Marathi by two dentists fluent in English and Marathi. The Marathi version was then back-translated into English by another two people fluent in both languages. The final version of the questionnaire was then given to parents to assess their KAP.

Oral examination of children was conducted to record Decayed, Missing, Filled, Teeth (DMFT), and decayed-extracted-filled teeth (deft) index.[11] For the purpose of analysis, each correct answer was given a score of 1. To obtain the overall KAP score, all the scores of correct answers were added. KAP was considered as good if the combined scores were >11, fair if in the range was 7–10 and poor if the score was <6.

Statistical analysis

KAP scores were transferred into a Microsoft Excel Spreadsheet-2000. Correlation of DMFT and deft scores was done with the three categories of KAP (good, fair, and poor) using One-way ANOVA on EPI INFO version 6.04 with the level of significance fixed at P < 0.05.

  Results Top

Out of 504 children, 326 (64.7%) were boys and 178 (35.3%) were girls with dental caries prevalence of 61.1%.

[Table 1] shows the knowledge category. More than 50% of the parents answered that children should brush their teeth themselves twice a day using toothbrush and toothpaste. About 15.6% of parents answered correctly that dental visits should be scheduled as soon as the first tooth erupts. About 52.2% of them were aware about dental caries, while only 24.4% knew about primary dentition treatment.
Table 1: Responses of parents to the knowledge questions on oral hygiene maintenance (n=504)

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[Table 2] shows the attitude category. The majority of parents wanted cavity-free teeth for children with 49% responding to primary teeth as essential. Oral and general health treatment was scored for equal importance. Parents preferred Pedodontist's and believed that Pedodontist can do a better treatment.
Table 2: Responses of parents to the attitude questions on oral hygiene maintenance (n=504)

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[Table 3] shows the practice category. 50% of the parents never took their child for a dental visit, with only 35.7% going for regular check-ups. Moreover, 70.4% of parents themselves offered sweets to their children and proper practice of tooth brushing was followed by 81.2%.
Table 3: Responses of parents to the practice questions on oral hygiene maintenance (n=504)

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Overall KAP was found good in 23.6% parents, fair in 64.9% and poor in 11.5%. Children of the parents having good, fair and poor KAP had 1.56, 1.63, 1.72 DMFT and 6.09, 6.77, and 7.41 deft, respectively, with the significant difference found only for deft between the KAP categories [Table 4].
Table 4: Correlation of Decayed, Missing, Filled, Teeth and deft with respect to knowledge, attitude and practice categories

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  Discussion Top

Parents are the ones who take care of their children; hence, a good understanding of parental knowledge, attitude, and awareness regarding oral health are essential for the effectiveness of oral health promotion efforts aimed at improving the dental health of young children. In the present study, 57.3% reported that children should brush their teeth, which was alike with sudies[5],[12],[13] believing, children need assistance until 10 years of age. Studies with younger age groups may tend to give a lesser percentage for self-driven toothbrushing.

Majority of parents were aware about brushing twice a day, which was in consensus[14] and contrast[15] with the past studies. Parents in the present study presented importance towards toothbrush and toothpaste, which is also recommended by American Dental Association (ADA) based on child's age. 51.8% parents made the first visit to the dentist after child's toothache[1] while it was 15.4% being aware about exact schedule of the visits. The variation can be related to parent's belief about primary teeth ultimately getting replaced by permanent teeth. Amercan Academy of Pediatric Dentistry (AAPD)[16] recommends children 1st dental visit at the age of 1 or within 6 months of first erupted tooth. Though parent's in the present study were aware about dental caries, they showcased poor knowledge regarding primary dentition treatment similar to Al-Omiri et al.[17] suggesting a need to educate parents regarding the importance of deciduous dentition treatment.

Though 96% of parents wanted cavity-free teeth <50% responded correctly for the importance of milk teeth. These responses were still better than past studies.[8],[18] Dental caries in primary dentition have its effect on permanent dentition too, thus stressing the importance of milk teeth.[13] To our surprise, 93.8% of parents considered dental and other health treatments equally important similar to other reported studies[12],[19],[20] who strongly expressed the belief that oral health is integral to overall health while contrast was observed in few studies[21],[22] thus becoming a hindrance in planning and implementing preventive programs for children.

The majority of the parents believed that a Pedodontist can do a better treatment of children, which was alike with the study[23] with only 20% visiting Pedodontist and few even unaware about pediatric dentist.[18] The pediatric dentist is a one who informs parents about their child's tooth development, causes and prevention of oral diseases, and appropriate diet, including home dental care.[24] In this study, 50% of the parents never visited a dentist while only 35.7% took their children for regular dental check-ups, which was in agreement with lietarure[17],[25] whilealike with few studies[1],[26],[27] reflecting the need of spreading awareness regarding the importance of dental visits by dentists. The majority of parents offered sweets to their children similar[28] and contrasting[29] with studies. Parents need to be educated and advised to follow a strict diet when it comes to sugar intake for children. Abou 81.2% of parents practiced to clean teeth by wetting the toothbrush and applying toothpaste on it. The same was practiced in Hans et al.[30] but not in Joshi et al.[28] study. This method ensures that the bristles become soft and less abrasive.

Only 23.6% of parents had good KAP regarding oral health maintenance thus7.41 deft was noted among children of parents with poor KAP. This suggests that correct knowledge; positive attitude, and good practices have an impact on children's oral health, which was in consistent with a study.[31] Better knowledge and attitude of parents prove to be a major factor for inculcating good practices among children which helps to maintain teeth with low dental caries and has also been supported by the presence of inverse relationship[32] between dental caries of children and KAP of parents. The reason for no significant difference with respect to KAP on dental caries in permanent dentition maybe because of the age group of the children included. The newly erupted teeth are most likely to report low DMFT in the present study.

  Conclusion Top

The study revealed that correct knowledge and positive attitude of parent's toward oral health maintenance results in the better oral health of their children. Majority of parents having only fair KAPs stresses on conducting educational programs directed toward parents. It can be recommended that preventive programs in schools, along with the coordinated efforts of pediatric dentist, school teachers, and parents can help cultivate awareness among them and improve children's oral health.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3], [Table 4]


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