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Table of Contents
Year : 2021  |  Volume : 22  |  Issue : 1  |  Page : 39-43

Knowledge and practice of rural mothers on oral hygiene for children

1 Tutor, Department of Nursing, Chitkara School of Health Sciences, Chitkara University, Patiala, Punjab, India
2 B.Sc Nursing Student, Department of Nursing, Chitkara School of Health Sciences, Chitkara University, Patiala, Punjab, India

Date of Submission07-Mar-2020
Date of Decision04-Jun-2020
Date of Acceptance25-Jan-2021
Date of Web Publication07-Jul-2021

Correspondence Address:
Ms. Blessy Mohandass
Department of Nursing, Chitkara School of Health Sciences, Chitkara University, Patiala, Punjab
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJCN.IJCN_7_20

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Oral health is a condition in which the mouth and the teeth are healthy and free from any diseases. Improper maintenance of hygiene of the mouth is one of the risk factors for oral diseases. Researches showed that parents are responsible for inculcating good oral hygiene habits in children and mothers are considered to be the most accountable in educating the children about proper oral hygiene. This study was undertaken to explore the knowledge and practice of mothers regarding the importance of oral hygiene for children. A non-experimental descriptive research design was used, and 100 mothers of under-five children were randomly selected from the rural areas of Rajpura in Patiala District, Punjab. A self-structured knowledge questionnaire and practice checklist was used to collect the data. Analysis and interpretation of the data was done according to the objectives of the study using descriptive and inferential statistics. The present study revealed that 58 (58%) respondents had good knowledge and 57 (57%) mothers had average practices regarding the importance of oral hygiene for children. No significant relationship was observed between knowledge and practice scores. There was no significant association between the level of knowledge and the level of practice and socio-demographic variables. The study concluded that there is a lack of knowledge and practice regarding the importance of oral hygiene for children amongst the mothers residing in rural areas.

Keywords: Dental hygiene, knowledge, mothers, practice

How to cite this article:
Mohandass B, Chaudhary H, Pal GK, Kaur S. Knowledge and practice of rural mothers on oral hygiene for children. Indian J Cont Nsg Edn 2021;22:39-43

How to cite this URL:
Mohandass B, Chaudhary H, Pal GK, Kaur S. Knowledge and practice of rural mothers on oral hygiene for children. Indian J Cont Nsg Edn [serial online] 2021 [cited 2021 Dec 1];22:39-43. Available from: https://www.ijcne.org/text.asp?2021/22/1/39/320818

  Introduction Top

'Oral health is a condition in which the mouth and the teeth are healthy and free from any diseases, such as oral cancer, dental caries, tooth loss, cleft lip and palate and many others that attack the oral cavity'. Dental caries is the major dental health problem affecting people of all ages worldwide, but it continues to be predominant in preschool and school children around the globe.[1] Improper hygienic techniques of the mouth, consumption of substances such as tobacco and alcohol, along with an unhealthy diet are the risk factors for oral diseases. Oral health affects also the people's ability to function, speak, and grow. The ability to socialise is also affected by oral health. Thus, oral health affects people's physical as well as psychological dimensions.[2] Continuous periodical supervision of oral health is important as it is concerned with health promotion and disease prevention for achieving health and well-being of people.[3] Research states that good parents are responsible for good oral hygiene habits in children and mothers are the most accountable in educating the children about proper oral hygiene.[4] Parents are the primary caregivers of the children in early childhood, hence they play a vital role in their development and the parents with higher educational status give more guidance on their children's health behaviour compared with parents with low educational status.[5]

The years of 'primary socialisation', in which the under-five child acquires all the habits and routines, are mostly spent with their parents and guardians.[6] As parents are the primary caregivers of children under 3 years and children in the preschool period, their role is relevant in the maintenance and promotion of good oral health of a child, like teaching good eating and drinking habits. These habits are instituted as rules and regulations in the home and they are shaped according to the competence of the parents.[7] Other than the role of the parents, some other factors affect the oral health of their children, such as the mother's educational status, employment of the mother and her knowledge about oral hygiene.[6]

The classification of the risk factors for oral diseases is chiefly categorized into two types: biological and social.[8] Poor education of the parents, low socio-economic position and lack of awareness concerning oral and dental diseases are the social risk factors for oral diseases.[9] The first 2 years of life are crucial for the development of healthy oral hygiene habits, as the structure for healthy permanent teeth in children is set during the 1st years of life. Bad habits such as poor diet, poor habits of food intake and inadequate toothbrushing habits during the first 2 years of life cause tooth decay in children, according to several studies. If the child develops caries in the primary teeth, then the permanent teeth are more at risk of developing caries.[10]

Dental caries is the biggest problem related to oral health amongst other different oral and dental health problems, as the World Health Organization reports that 60%–70% of schoolchildren in the world, specifically in Asia and Latin America, have suffered from dental caries.[11] Dental caries prevalence in India amongst the 2–5-year-old children has been reported to be 48.9%.[12] Dental caries is a disease that cannot be eradicated because its initiation and progression are linked with the relation of many risk factors, such as social, cultural, behavioural, nutritional and biological factors.[13] Even if is not life threatening, the disease produces pain, decreases the ability to function, thrive, and grow and can also influence the body weight. Caries in infants and young children are called the 'black teeth of the very young' or 'nursing bottle mouth'.[14] Caries are also known as the 'faciolingual pattern of decay'.[15]

Mothers have the responsibility of teaching good oral habits and routines, along with healthy dietary habits and hygiene techniques during early years of life, because a strong foundation of dental norms is important for the future dental health of the children.[16] Research has shown that mothers' awareness about dental health and diseases associated with poor dental health has a positive effect on the dental and overall dental health of their kids and practices related to dental health.[17],[18] The educational status of the parents is also associated with the incidence of dental caries in early childhood. The more the educational level of the parents, the lesser the occurrence of dental caries.[19] Children with a single parent and those with illiterate mothers are more subjected to early childhood caries.[20]

Health promotion strategy has to be according to the need of the population, thus exploring the knowledge and practice of mothers is helpful to recognise points of weakness and then change people's behaviour and habits.[21] Many clinical pieces of evidence reveal that the knowledge and practice of oral hygiene for their kids are lacking in the mothers, who are considered as the primary caregivers.[22] A small quantity of studies has been conducted in India, but their focus has mainly been on school-age children. During our in-depth review of literature, there have been limited studies assessing the oral health of preschool kids. Therefore, this study aims to evaluate the knowledge and practice of mothers regarding the importance of oral hygiene for preschool children.

  Methods Top

A quantitative approach was used as it allowed the investigators to collect and convert data into numerical form to make statistical calculations and draw conclusions. For our study, a non-experimental descriptive research design was used to assess the knowledge and practices of mothers residing in rural areas regarding the importance of oral hygiene for children in five villages in Punjab, India. The target population was all the mothers of under-five children in the selected five villages. The five villages have been adopted by the Chitkara University for providing healthcare services to the residents in collaboration with the government-run facilities. A total of 396 mothers who had children under the age of 5 years were chosen, and out of which, a sample of 100 mothers were selected using simple random sampling by lottery method. Other primary caregivers such as the fathers, grandparents, and guardians of under-five children were excluded from the study. Ethical clearance was obtained from the institutional ethical review committee, and permission from the heads of the selected villages was taken prior to the collection of data. The instrument for data collection consisted of three parts, namely demographic variables, a self-structured knowledge questionnaire, and practice checklist.

Both knowledge questionnaire and practice checklist consisted of 15 items. The questionnaire had multiple choice items assessing the basics of oral care and techniques of dental hygiene for children under the age of 5 years, for example, what plaque means, meaning of gingivitis, causes of tooth caries, first dental visit and type of brush to be used. A score of 0–3 implied poor knowledge, 4–7 average knowledge, 8–11 good knowledge, and 12–15 excellent knowledge.

The practice checklist was also a multiple-choice item wherein the participants had to place tick mark in the option best suited to them which assessed the items pertaining to the routine of the mothers while providing best oral care to the children, for example, oral hygiene methods used, frequency of changing brushes, time of oral care, number of times of oral care, duration, technique, cleaning of tongue or not and visit to the dentist. A score of 0–2 implied poor practice, 3–5 average practice, 6–8 Good practice, and 8–10 excellent practice.

The content validity index was 94 and 92 for knowledge and practice checklist questionnaire, respectively. In this study, the reliability of the knowledge questionnaire was checked by split-half method and was found to be r = 0.2 and the reliability of the practice checklist was checked by inter-rater method and was found to be r = 0.81. Informed consent was obtained from all participants. Data were collected by interview method. Analysis and interpretation of the data was done according to the objectives of the study using descriptive and inferential statistics.

  Results Top

Mothers of under-five children were selected in accordance with the inclusion and exclusion criteria using simple random sampling technique. [Table 1] reveals the frequency and percentage distribution of sample characteristics. Half (55%) of the mothers of under-five children were from 20 to 25 years of age and 7 (7%) of mothers were above 31 years of age. About half (55%) the proportion of mothers were with matriculate and 5 (5%) were with postgraduate education. Out of 100, sixty participants reported their annual income was up to Rs. 100,000 and only 2 (2%) reported to have an annual income of above Rs. 300,000.
Table 1: Frequency and percentage distribution of sample characteristics (n=100)

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Results showed that more than half (60%) of the participants belonged to joint family. It also revealed that 98% of the mothers were not employed with any jobs outside homes.

When assessing for the knowledge regarding dental hygiene, 58% of the respondents revealed good knowledge, 27% had average knowledge, 14% had excellent knowledge and only 1% had poor knowledge. The study also revealed that 57% of the mothers were following good practices, 37% were following average oral hygiene practices, 5% of the mothers were having excellent practice and only 1% of the mothers included in the study were having poor practice of oral hygiene on their children [Figure 1]. The values in [Table 2] show that the mean knowledge score and standard deviation (SD) was 8.87 + 2.343 and the mean practice score and SD was 6.06 + 1.47. There was a weak positive correlation (r = 0.119) between knowledge and practice which was not significant.
Table 2: Association between level of knowledge and practice scores (n=100)

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Figure 1: Distribution of mothers according to levels of knowledge and practice

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Socio-demographic variables, i.e., mothers' age, level of mothers' education, household income, type of family and occupational status, did not have any significant association with knowledge or practice of mothers of under-five children regarding oral hygiene. This study also revealed that most of the mothers were able to answer correctly the cause of tooth caries (96%), best type of brush (89%), foods that cause most tooth decay in children (84%) as compared to questions like meaning of gingivitis (35%), importance of oral hygiene for children (34%) and time for the baby's first dental visit (23%) which is even less than the percentage of mothers who responded correctly for the correct age at which a child can start brushing on his own (48%). Regarding the practice, visiting the dentist was done by only 19% and correct technique of brushing was done by only 10% of the mothers.

  Discussion Top

The study findings are different from a descriptive study conducted on the same lines to assess the knowledge relating to the oral health of 100 parents of preschool children who visited the outpatient department of a district hospital.[2] The results obtained showed that out of 100, the majority (81%) had moderate knowledge, 15% had poor knowledge and only 4% had good knowledge concerning oral hygiene of their children. A significant difference in knowledge was found amongst variables such as educational status, educational level and past experience about oral disorders in this study. On the other hand, the present study showed that out of 100 mothers, majority (58%) of the respondents had good knowledge and 1% had poor knowledge. However, no significant association was found between knowledge and any of the demographic variables in this study.

A study conducted by Mubeen and Nisar amongst mothers of children (aged 1–5 years) in civil hospital, Karachi, showed that of 281 mothers, most of the mothers (91.1%) had inadequate knowledge. Approximately 55% of the mothers had positive perspectives and 65% of the mothers had improper practices.[23] On the other hand, in the present study, it was found that the majority (57%) of the mothers were following average practices and only 5% of the mothers had good practice. Mubeen and Nisar found that the percentages of inadequate knowledge amongst illiterate mothers were eight times greater as compared to literate mothers. Many other factors were studied in accordance with the level of knowledge and practices regarding oral hygiene, such as the negative attitude of mothers, household income (<10,000 Pakistani rupees) and the inadequate practice of divorced/separated mothers as compared to married women which were found to be significantly associated in the study.[23]

The Karachi study concluded that mothers of children below 5 years of age had improper knowledge, negative perspective and improper practice of oral hygiene and the association between some socio-demographic variables and level of knowledge and practice is significant, whereas the present study results show that there is no significant association between selected socio-demographic variables and level of knowledge or practice. The number of demographic variables included was limited to age, educational status, occupation and family income in this study which could have contributed to this result. Meanwhile, there were also studies[24],[25],[26] in which there was no association between knowledge and any socio-demographic variable like the present study in which no significant association was seen either between knowledge and selected socio-demographic variables or between practice and selected socio-demographic variables. Furthermore, the said studies reported that the mothers scored higher on the aspects that are covered usually in marketing campaign of toothpaste brands such as cause of tooth caries, best type of brush, foods that cause most tooth decay in children, time at which parents can begin cleaning their children's teeth, best technique to clean teeth and importance of fluoride in toothpaste. In addition to this, it was also observed that they had good practice skills in providing oral hygiene, choosing the best method, time and duration of brushing teeth.

  Conclusion Top

From the above-sited discussion, it can be concluded that there is an overall lack of knowledge and adequate practice regarding oral hygiene adopted by the mothers of under-five children and mainly it can be associated to the mother's educational level for the majority of all the above-discussed studies. It can be said that if there is an improvement in the knowledge, then the practice will also improve. However, in the present study and in other studies, it was frequently seen that there is no relationship between knowledge score and practice score, as even if the mother is having good knowledge, her practice with her child regarding oral hygiene can be poor. It was observed in the current study that many mothers were unaware of the importance of oral hygiene for children even after improved health facilities, child and maternal health programs, easy access to mass media and improved literacy in women. Therefore, it is necessary to educate mothers about good oral hygiene-related practices to be followed on their children, as well as the oral hygiene associated risks and diseases.

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Conflicts of interest

There are no conflicts of interest.

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  [Figure 1]

  [Table 1], [Table 2]


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