|Year : 2022 | Volume
| Issue : 3 | Page : 268-272
Parental perceptions, attitudes, and practices regarding their children's oral health in Kerala, India – A cross-Sectional study
Pooja Latti1, Deepa Ramesan1, Subramaniam Ramanarayanan2
1 Department of Public Health Dentistry, Annoor Dental College and Hospital, Muvattupuzha, India
2 Department of Public Health Dentistry, Indira Gandhi Institute of Dental Sciences, Kothamangalam, Kerala, India
|Date of Submission||13-Feb-2022|
|Date of Decision||06-Apr-2022|
|Date of Acceptance||18-Apr-2022|
|Date of Web Publication||08-Jul-2022|
Department of Public Health Dentistry, Annoor Dental College and Hospital, Muvattupuzha - 686 673, Kerala
Source of Support: None, Conflict of Interest: None
Introduction: Oral diseases in children, if left untreated can frequently lead to significant pain, interference with talking, eating, loss of school hours, and general health problems. Parents have an important role to play in the initiation and reinforcement of oral health-related behaviors for preventing and controlling oral diseases. Parental attitudes and perceptions have a direct influence on their children's oral health. The survey was conducted to investigate the parental perceptions, attitudes, and practices regarding their child's oral health. Methodology: A cross-sectional questionnaire-based survey was conducted among parents of primary school students (two government and two private) in Paravur town of Ernakulam district, Kerala. Data collection was done during the Parents–Teachers Association meeting. The prevalidated questionnaire, translated into local language Malayalam, consisted of 12 questions assessing the parental attitude and practice toward oral health and dental treatment. The data were tabulated and analyzed with Chi-square test. Results: The final sample comprised 414 parents; 105 men and 309 women. Less than 30% of the participants had taken their child for a dental visit in the past year. Over 43% had visited the dentist for treatment of decayed teeth. More than 53% of the parents reported that their children brushed their teeth twice daily. More than 93% agreed to supervise their child's brushing. About 30% of the parents are willing for routine dental checkups for their children more than three times a year. About 30% select the toothpaste and toothbrush as per recommendations from the dentist. Over 78% considered consulting a dentist as the first response to a dental complaint of the child. Conclusions: The study showed a positive attitude and perception of parents regarding the oral health of children in terms of money, time, and dental clinic visits.
Keywords: Oral health, parents, perception
|How to cite this article:|
Latti P, Ramesan D, Ramanarayanan S. Parental perceptions, attitudes, and practices regarding their children's oral health in Kerala, India – A cross-Sectional study. J Nat Sci Med 2022;5:268-72
|How to cite this URL:|
Latti P, Ramesan D, Ramanarayanan S. Parental perceptions, attitudes, and practices regarding their children's oral health in Kerala, India – A cross-Sectional study. J Nat Sci Med [serial online] 2022 [cited 2022 Aug 17];5:268-72. Available from: https://www.jnsmonline.org/text.asp?2022/5/3/268/350301
| Introduction|| |
Dental caries is one of the most prevalent dental diseases affecting children. According to the National Oral Health Survey and Fluoride Mapping of India, conducted in 2002, the prevalence of dental caries in India was 51.9%, 53.8%, and 63.1% at ages 5, 12, and 15 years, respectively. Oral diseases in children, if untreated, can result in general health problems, pain, and suffering, interference with functioning such as eating and talking and reduction in productive school hours. This can further continue into adulthood and lead to poor oral health-related quality of life, affecting the economic productivity.
Parents have an important role to play in the initiation and reinforcement of oral health-related behaviors, such as tooth brushing two times a day, with fluoridated toothpaste and providing a noncariogenic diet, for prevention or controlling of dental caries. It is the responsibility of the parents to inculcate healthy oral hygiene practices, food habits, and promote regular dental visits among children. Therefore, the characteristics, perceptions, and attitudes of parents can directly influence their children's utilization of dental services, as children need to depend on their parents to visit the dentist.
Hence, for preventing caries in children, willingness of parents to invest effort, money, and time is important. “Willingness To Pay” is a method used in the field of health economics for measuring health benefits in monetary terms., It is a method, in which the parents are questioned regarding how much money they are hypothetically willing to pay for improved health, or for a health program concerning their child. Understanding parents' perceptions of their children's oral health and factors that motivate these perceptions can help the dentist overcome barriers that parents encounter in accessing dental care for their children., This survey was conducted with the objective of assessing the parental perceptions, attitude, and practices regarding their child's oral health.
| Methodology|| |
A cross-sectional survey was conducted among parents of 5–12 years old children, belonging to two government and two private schools, randomly selected from the list of schools in Paravur town of Ernakulam district, Kerala. Ethical clearance was obtained from the Institutional ethics committee before the start of the study (IEC approval No. 019-B/09 dated 19.11.2019). The study was conducted as per the guidelines of Declaration of Helsinki.
Prior permission was obtained from the concerned school authorities for conducting the study. Voluntary informed consent was obtained from the parents before the start of the study. Data collection was done during the Parent–Teacher Association (PTA) meeting. A prevalidated questionnaire based on existing literature, translated into the local language Malayalam, consisted of 12 questions assessing the parental attitude and practice toward oral health and dental treatment. Parents/guardians were briefed regarding the objectives of the study. Parents who gave a voluntary informed consent to participate in the study were included in the study. About 450 parents were contacted, of whom 414 agreed to participate in the study (response rate of 92%). The sampling technique used to select the parents was convenience sampling. Parents reporting to the PTA meeting were approached for participating in the study. The data were collected by the principal investigator. The questionnaire was distributed to the study participants and the study participants were asked to submit their response within 5 min duration.
All statistical analyses were performed using IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. Descriptive analysis of all variables was performed. Chi-square test was used to investigate the relation between parent's factors with independent variables. P < 0.05 was considered statistically significant.
| Results|| |
The final sample of 414 parents comprised 25.36% (n = 105) men and 74.64% (n = 309) women. About 16% (n = 66) of the parents had one child, 72.46% (n = 300) had 2 children, and 11.59% (n = 48) had 3 or more children. About 40% of the parents sent their children to a government school and the rest to a private school. About 47% (n = 198) of the parents had a qualification of high school or lower, 24.60% (n = 102) had higher secondary/pre-degree qualification, 21.30% (n = 88) were graduates, and the rest 6.30% (n = 26) were post graduates)
[Table 1] outlines the responses to practice-based questions, and [Table 2] outlines the responses to attitude-based questions, assessing the parental perceptions regarding their child's oral health. Less than 30% (n = 123) of the respondents had taken their child for a dental visit in the past 1 year. Over 43% (n = 53) had visited the dentist for treatment of decayed tooth. Among 70% who did not visit a dentist past 1 year, the most common reason was the lack of treatment need (n = 265). About 36% (n = 149) of the respondents were willing to spend more than one thousand rupees per month for their child's dental treatment. There was a significant difference in the willingness to spend on child's dental treatment between the parents of children in government and private schools. The latter were willing to pay more (P = 0.01). Over 60% (n = 249) of the participants were willing to invest for buying dental products every 1–3 months. A significant increase in willingness to invest in buying dental products was seen in parents of children attending primary school (P = 0.03) More than 53% (n = 220) of the parents reported that their children brushed their teeth twice daily. More than 93% (n = 385) agreed to supervising their child's brushing. About 60% (n = 248) reported a duration of more than 3 min for brushing. Majority (71.3%) of the parents were willing to visit a dentist for a regular checkup at least once a year and the results were statistically significant (P = 0.02) with respect to private and government school parents. The private school parents were willing for more frequent dental visits for their children. About 30% (n = 119) of parents are willing for a routine dental checkup for their children more than three times a year. About 30% (n = 121) select the toothpaste and toothbrush as per recommendations from a dentist. Over 78% (n = 323) considered consulting dentist as the first response to dental complaints of the child. The response was significantly better in parents with 1 or 2 children compared to parents with three or more children.
| Discussion|| |
Poor dental health can affect a child's functional, social, psychological as well as physical dimensions of well-being. Oral pain due to dental caries has shown to have devastating effects on children's health as well, including sleep loss, poor growth, behavioral problems, and poor learning. Furthermore, dental health problems are associated with a substantial reduction in school attendance, economic burden, and loss of parental working days, all of which affects the whole family. Oral health is not prioritized as general health and there are no stand-alone dental insurances or public health financing available in India, and therefore, oral health gets neglected.
Parents shape children's behaviors, habits, and attitudes from an early age, and they make decisions for their children that can either be conducive or unfavorable for children's oral health. Hence, addressing the parental factors that have an influence on children's oral health is important to develop and implement complementary public health actions, assess the treatment needs, prioritize oral care so as to provide the children, who are the future of our country, with good oral health and also better quality of life.
The study reveals that decayed tooth (43%) and pain (26%) were the most common reason for dental visit among the parents who took their child for dental visits past 1 year. Dental caries in children is an important public health issue. Studies have shown that pooled prevalence of dental caries in Indian children is more than 50% and average dmf/DMF values are between 2 and 3 in all the age groups. Lack of awareness and nonavailability of dental services were not a concern for any of the participants. The study, although set in a semi-urban area, it reflects the oral health literacy and accessibility of dental care in the region.
The study shows that over 60% of the parents were ready to spend more than five hundred rupees a month on their child's dental treatment. The observation is in contrast with another study conducted in Bengaluru, India, where over 60% were willing to spend <200 rupees.
Over 53% reported that their children brushed teeth at least twice a day. In similar studies conducted in Kashmir in 2016, Bengaluru in 2021, and Chennai in 2017, the corresponding figures were 26%, 30%, and 36%, respectively. This reflects a comparatively higher practice among the population surveyed. It is noteworthy that over 93% of the parents reported to have supervised their child's brushing among whom, for over 74%, it was the mother who supervised the brushing. In the studies conducted in Bengaluru and Chennai, the corresponding values were 63% and 34%, respectively.
It is an important observation that about 30% of the parents were willing to take their child for regular dental checkup more than five times a year. This was in contrast to similar studies conducted in India.,, More than 78% of the parents reported that their first response to a dental complaint of their child was consulting a dentist. About 14% of the respondents would apply home remedies and only 3.4% would prefer self-medications. This observation shows a very positive attitude toward approaching dental professionals for dental complaints. In the study conducted in Kashmir, 40% of the parents preferred home remedies. The results are comparable to a study conducted in Kerala, which showed 79% of the parents would prefer a dentist for a complaint such as a toothache.
On being asked to give a self-rating regarding their priority toward their children's oral health, over 70% rated themselves 5 or more out of 10. This reflects a positive outlook of the study population toward oral health.
Oral hygiene is an important component to oral health. It is, therefore, advisable to provide adequate guidelines to the population regarding children's oral health behavior and its association with dental caries. It is helpful to address the factors influencing children's oral health to develop and implement complementary public health actions focused on children and parental behaviors, to provide them with good oral health and better quality of life.
The parental behavior toward oral health, can act as predictors for caries in their children. Hence, all aspects those are associated with the family's process of buying and investing for oral health behaviors can have a significant impact on pediatric dental health care. Shared decision-making functions as a favorable communication tool between professionals and patients in health care.
The study was conducted in four randomly selected private and government schools in a district in Kerala state of India. Larger sample size studies correlating the attitude and perception with clinical findings are recommended to further explore the impact of attitude on the child's oral health.
| Conclusions|| |
The study showed a positive attitude and perception of parents regarding oral health of children in terms of money, time, and visits to a dental clinic. Information on perceptions of parents about child's oral health and willingness to spend for oral care can be useful in planning comprehensive pediatric oral health care programs to improve their oral health status. Further studies can be carried out to assess the correlation between parental perceptions regarding oral, health and the oral health status of their children.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]