*Iwona Soika1, Anna Turska-Szybka1, Małgorzata Dudek1, Dariusz Gozdowski2, Dorota Olczak-Kowalczyk1
Dental awareness and health seeking behaviours among parents of 3-year-old children based on a survey conducted in the Mazovia Province
Świadomość stomatologiczna oraz zachowania prozdrowotne rodziców dzieci 3-letnich na podstawie badania ankietowego, przeprowadzonego na terenie województwa mazowieckiego
1Department of Paediatric Dentistry, Medical University of Warsaw
Head of Department: Professor Dorota Olczak-Kowalczyk, MD, PhD
2Department of Experimental Design and Bioinformatics, Faculty of Agriculture and Biology, Warsaw University of Life Sciences
Head of Department: Professor Wiesław Mądry, PhD
Streszczenie
Wstęp. Edukacja prozdrowotna, szczególnie w stomatologii dziecięcej, jest bardzo ważnym elementem, na którym opiera się większość programów profilaktycznych. Znajomość zasad higieny jamy ustnej oraz nawyki dietetyczne rodziców mają istotny wpływ na wdrażanie właściwych zachowań u dzieci.
Cel pracy. Ocena świadomości stomatologicznej oraz zachowań prozdrowotnych rodziców dzieci 3-letnich na podstawie badania ankietowego, przeprowadzonego na terenie województwa mazowieckiego.
Materiał i metody. Badanie ankietowe przeprowadzono wśród rodziców dzieci 3-letnich uczęszczających do wybranych drogą losowania przedszkoli województwa mazowieckiego w ramach Ogólnopolskiego Monitoringu Stanu Zdrowia Jamy Ustnej. Ankieta zawierała 38 pytań dotyczących nawyków higienicznych i dietetycznych, wizyt stomatologicznych oraz profilaktyki choroby próchnicowej.
Wyniki. Ankietę wypełniło 253 rodziców dzieci 3-letnich: 164 ze środowiska miejskiego i 89 z wiejskiego, w tym 123 dziewcząt i 130 chłopców. Ponad 80% rodziców uważa, że posiada wiedzę stomatologiczną na poziomie wystarczającym. Zaledwie 54,9% dzieci 3-letnich ma czyszczone zęby co najmniej 2 razy dziennie i tylko 52,2% ankietowanych nakłada na szczoteczkę odpowiednią do wieku ilość pasty. 34,4% 3-latków ma podawane przed snem po ukończeniu 6. miesiąca życia napoje zawierające cukier lub miód, a zaledwie 37,2% wyłącznie wodę. Blisko połowa dzieci (49,8%) dotychczas nie była u dentysty.
Wnioski. Wiedza stomatologiczna rodziców dzieci 3-letnich dotycząca próchnicy wczesnego dzieciństwa wydaje się niewystarczająca. Połowa rodziców nie zgłosiła się jeszcze ze swoim dzieckiem do lekarza dentysty, a zaledwie co drugie dziecko ma szczotkowane zęby 2 razy dziennie. Ponad 1/3 rodziców przedłuża karmienie dzieci piersią/butelką powyżej rekomendowanego 12. miesiąca życia.
Summary
Introduction. Health education, especially in paediatric dentistry, is a very important element on which most preventive programs are based. Parental knowledge of oral hygiene principles and dietary habits have a significant impact on the implementation of appropriate behaviour in children.
Aim. Assessment of dental awareness and health-related behaviours of parents of 3-year-old children based on a survey conducted in the Mazovia Province.
Material and methods. The survey was conducted among parents of 3-year-old children attending kindergartens in the Mazovia Province. The institutions were selected randomly. The study was conducted as a part of a project known as “Monitoring of Oral Health Status among the Polish Population in the years 2013-2015”. The questionnaire contained 38 questions on hygienic and dietary habits, dental visits and caries prophylaxis.
Results. The questionnaire was completed by 253 parents of 3-year-olds (123 girls and 130 boys), including 164 respondents from urban environment and 89 respondents from rural regions. More than 80% of parents believe that their dental knowledge is sufficient. Only 54.9% of 3-year-olds have their teeth cleaned at least 2 times a day and only 52.2% of respondents apply a toothpaste dose that is suitable for age. A total of 34.4% of 3-year-olds are given beverages containing sugar or honey before bedtime after 6 months of age, and only 37.2% are given water only. Nearly half of children (49.8%) have never been to the dentist.
Conclusions. Dental knowledge among parents of 3-year-old children on early childhood caries seems insufficient. Half of the parents have not reported their child to a dentist yet, and only every second child has their teeth brushed twice a day. Over one third of parents prolong bottle or breast-feeding over the recommended age of 12 months.
Introduction
The study conducted in 2015 as a part of a project known as Monitoring of Oral Health Status in 3-old children in the Mazovia Province showed caries incidence of 51.8% and mean DMFT of 2.45 ± 3.68 (1). Preventing caries in children requires multidirectional measures as oral health in preschool children mainly depends on the health-related awareness, attitudes and behaviours of parents, who are responsible for the care of their child. The lack of appropriate parental knowledge on proper oral hygiene and hygiene habits may lead not only to caries, but also to periodontal pathologies, abnormal masticatory development, as well as systemic diseases associated with primary infection in the oral cavity.
Since appropriate hygienic and dietary habits should be introduced already in the first month of life, not only dental professionals, but also family physicians, parents, paediatricians, gynaecologists, midwives and primary care nurses should be engaged in educational activities (2). The oral health of pregnant women and young mothers is also important. Caries is an infectious disease, therefore it is important to delay transmission of cariogenic bacteria to infants as much as possible as well as to prevent caries already in the prenatal period. It was demonstrated that the severity of caries depends on the age of infection with cariogenic bacteria as well as their numbers in dental plaque and saliva (3). The incidence of mother-to-child transmission is several times higher in mothers with high salivary levels of Streptococcus mutans (> 105 CFU/mL). Reduced maternal salivary levels of cariogenic bacteria prevented or delayed infection in the child (3, 4).
Aim
The aim of the study was to assess dental awareness and health-related behaviours among parents of 3-year-old children based on a survey conducted in the Mazovia Province.
Material and methods
The questionnaire was conducted among parents of 3-year-olds attending randomly selected kindergartens in the Mazovia Province, as a part of the Monitoring of Oral Health Status among the Polish Population (Contract No. 11/1/2015/1210/421 of 18th August 2015). The questionnaire included 38 closed questions regarding hygiene and dietary habits, dental visits and caries prevention. The data were analysed statistically using the chi-square test and Spearman’s correlation coefficient at a significance level of p < 0.05.
The study was approved by the Bioethics Committee of the Warsaw Medical University (KB/216/2015).
Results
The questionnaire was completed by 253 parents of 3-year-old children (123 girls and 130 boys), including 164 respondents from urban and 89 respondents from rural areas. Respondents described oral health expenses as medium (56.5%), low (22.5%) or high (20.9%).
Dental awareness among parents of 3-year-olds
Most respondents (81.4%) considered their knowledge on oral health to be sufficient. Respondents from rural settings more often described their dental knowledge as limited (tab. 1).
Tab. 1. Self-assessment of dental knowledge among respondents in the study population depending on the place of residence (urban/rural setting) and gender
| Parental knowledge | Urban | Rural | Females | Males | Total |
| limited (poor) | 8 (4.9%) | 10 (11.2%) | 12 (6.2%) | 6 (10.0%) | 18 (7.1%) |
| fully sufficient (very good) | 22 (13.4%) | 7 (7.9%) | 24 (12.4%) | 5 (8.3%) | 29 (11.5%) |
| sufficient | 134 (81.7%) | 72 (80.9%) | 157 (81.3%) | 49 (81.7%) | 206 (81.4%) |
The rates of correct answers to questions assessing general parental knowledge on the causes of caries are presented in table 2. The lowest rates of correct answers were reported for questions on parent-to-child and deciduous-to-permanent teeth transmission of cariogenic bacteria.
Tab. 2. Questions evaluating general knowledge of respondents on the aetiology of caries (correct answers are in *)
| No | Statement (question no. in the questionnaire) | Yes | No | Not sure |
| N (%) |
| 1 | Children should have regular dental visits | 247*
(97.6%) | 2 (0.8%) | 4 (1.6%) |
| 2 | Frequent snacking between meals promotes caries | 205*
(81%) | 13 (5.1%) | 35 (13.8%) |
| 3 | High sugar consumption causes caries | 243*
(96%) | 1 (0.4%) | 9 (3.6%) |
| 4 | Children should be assisted by their parents when brushing their teeth until the age of 7-8 years | 172*
(68%) | 55
(21.7%) | 26
(10.3%) |
| 5 | Fluoride-containing products help protect teeth against caries | 222*
(87.7%) | 6 (2.4%) | 25 (9.9%) |
| 6 | Deciduous teeth do not require the same care as permanent teeth as they will soon fall out | 12
(4.7%) | 232*
(91.7%) | 9 (3.6%) |
| 7 | Deciduous caries attacks permanent teeth | 195*
(77.1%) | 8 (3.2%) | 50
(19.8%) |
| 8 | Cariogenic bacteria can be transmitted from e.g. mother to child’s mouth | 160*
(63.2%) | 25
(9.9%) | 68
(26.9%) |
Hygiene habits
Analysis of oral hygiene behaviours among 3-year-olds demonstrated that although 99.9% of children have their teeth brushed, only 54.9% have their teeth brushed at least twice daily, 38.7% – once daily, 5.5% – 1 to 3 times a week, and 0.8% – occasionally or never. Teeth cleaning was performed after breakfast and supper in only 45.0% and after every meal in 2.4% of children who had their teeth brushed. A total of 46.3% of children had their teeth cleaned only after one meal in a day, while 6.4% had their teeth brushed only before breakfast. Most children (99.6%) used a toothbrush and toothpaste. No significant differences were found between teeth cleaning in relation to meals or agents used in relation to place of residence or gender.
A total of 15.5% of parents had no knowledge on fluoride content in toothpaste. Fluoride-containing toothpaste was used in 64.5% and fluoride-free toothpaste was used in 19.9% of children. Unfortunately, only 52.2% of parents applied an amount of toothpaste that was adequate for child’s age (pea-sized). Exceeded amount of toothpaste used was reported by 37.4% of parents, and was more common among rural (40.4%) rather than urban (35.8%) inhabitants. Unfortunately, 25.9% of 3-year-olds who have their teeth cleaned are rarely assisted or unassisted when brushing their teeth. Of 231 children assisted during tooth brushing, only 44.6% are helped by an adult.
Dietary habits
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