Fahd Sijari
V year, group 13Parent’s behaviour and attitude toward children’s oral health
Master’s ThesisSupervisor
Dr. Sandra Petrauskienė
LITHUANIAN UNIVERSITY OF HEALTH SCIENCES MEDICAL ACADEMY
FACULTY OF ODONTOLOGY
CLINIC FOR PREVENTIVE AND PEDIATRIC DENTISTRY
Parent’s behaviour and attitude toward children’s oral health Master’s Thesis
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Compliance with MT requirements and evaluation Yes Partially No 1 Summary (0.5 point)
Is summary informative and in compliance with the
thesis content and requirements? 0.3 0.1 0
2 Are keywords in compliance with the thesis essence? 0.2 0.1 0
3
Introduc-tion, aim and tasks
(1 point)
Are the novelty, relevance and significance of the
work justified in the introduction of the thesis? 0.4 0.2 0
4 Are the problem, hypothesis, aim and tasks formed clearly and properly? 0.4 0.2 0
5 Are the aim and tasks interrelated? 0.2 0.1 0
6
Review of literature (1.5 points)
Is the author’s familiarization with the works of other
authors sufficient? 0.4 0.2 0
7
Have the most relevant researches of the scientists discussed properly and are the most important results and conclusions presented?
0.6 0.3 0
8 Is the reviewed scientific literature related enough to the topic analysed in the thesis? 0.2 0.1 0
9 Is the author’s ability to analyse and systemize the scientific literature sufficient? 0.3 0.1 0
10
Material and methods (2 points)
IS the research methodology explained comprehensively? Is it suitable to achieve the set aim?
0.6 0.3 0
11
Are the samples and groups of respondents formed and described properly? Were the selection criteria suitable?
12
Are other research materials and tools (questionnaires, drugs, reagents, equipment, etc.)
described properly? 0.4 0.2 0
13
Are the statistical programmes used to analyse data, the formulas and criteria used to assess the level of
statistical reliability described properly? 0.4 0.2 0
14
Results (2 points)
Do the research results answer to the set aim and
tasks comprehensively? 0.4 0.2 0
15 Does presentation of tables and pictures satisfy the requirements? 0.4 0.2 0
16 Does information repeat in the tables, picture and text? 0 0.2 0.4 17 Is the statistical significance of data indicated? 0.4 0.2 0 18 Has the statistical analysis of data been carried out properly? 0.4 0.2 0
19
Discussion (1.5 points)
Were the received results (their importance, drawbacks) and reliability of received results assessed properly?
0.4 0.2 0
20
Was the relation of the received results with the latest
data of other researchers assessed properly? 0.4 0.2 0
21 Does author present the interpretation of results? 0.4 0.2 0 22 Do the data presented in other sections (introduction, review of literature, results) repeat? 0 0.2 0.3
23
Conclu-sions (0.5 points)
Do the conclusions reflect the topic, aim and tasks of
the Master’s thesis? 0.2 0.1 0
24
Are the conclusions based on the analysed material?
Do they correspond to the research results? 0.2 0.1 0
25 Are the conclusions clear and laconic? 0.1 0.1 0
26 References (1 point)
Is the references list formed according to the
27
Are the links of the references to the text correct? Are
the literature sources cited correctly and precisely? 0.2 0.1 0
28 Is the scientific level of references suitable for Master’s thesis? 0.2 0.1 0
29
Do the cited sources not older than 10 years old form at least 70% of sources, and the not older than 5 years
– at least 40%? 0.2 0.1 0
Additional sections, which may increase the collected number of points
30 Annexes Do the presented annexes help to understand the analysed topic? +0.2 +0.1 0
31
Practical
recommen-dations
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they related to the received results? +0.4 +0.2 0
General requirements, non-compliance with which reduce the number of points
32
General
require-ments
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annexes)? 15-20 pages
(-2 points)
<15 pages (-5 points)
33 Is the thesis volume increased artificially? -2 points -1 point
34 Does the thesis structure satisfy the requirements of Master’s thesis? -1 point -2 points
35 Is the thesis written in correct language, scientifically, logically and laconically? -0.5 point -1 points
36 Are there any grammatical, style or computer literacy-related mistakes? -2 points -1 points
37
Is text consistent, integral, and are the
volumes of its structural parts balanced? -0.2 point -0.5 points
38 Amount of plagiarism in the thesis. >20%
39
Is the content (names of sections and sub-sections and enumeration of pages) in compliance with the thesis structure and aims?
-0.2 point -0.5 points
40
Are the names of the thesis parts in compliance with the text? Are the titles of sections and sub-sections distinguished logically and correctly?
-0.2 point -0.5 points
41 Was the permit of the Bioethical Committee received (if necessary)? -1 point
42 Are there explanations of the key terms and abbreviations (if needed)? -0.2 point -0.5 points
43
Is the quality of the thesis typography (quality of printing, visual aids, binding)
good? -0.2 point -0.5 points
*In total (maximum 10 points):
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Reviewer’s comments: ___________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _________________________________________ ___________________________
TABLE OF CONTENTS
ABBREVIATIONS ... 8
SUMMARY ………..………9
INTRODUCTION ... 10-11 1. ERUFRRLTIL FIREEIVER ……… 12-13 2. AEIREFE MLE ALARIETAML ... 14
2.1 SUBJECTS ………. 14 2.2 THE QUESTIONNAIRE ……….………… 14-15 2.3 STATISTICAL ANALYSIS ……… 15 3. ERMV IML ... 16-21 4. AFMSVMMFT L ... 22-23 5. ST S VMFT ML ... 24
6. SEESIFSE LERSTAAR AEIFT ML ……….24
7. ESD TR RACR...24
8. ST I FSIMLTILF IRERMI...24 9. ERIRER SRML ... 25-29 10. ANNEXES ... 30-34
8
ABBREVIATIONS
AAPD: American Association of Pediatric Dentistry EAPD: the European Academy of Paediatric Dentistry IADR: International Association for Dental Research FDI: World Dental Federation
WHO: World Health Organization FDA: Food and Drug Administration ECC: early childhood caries
S-ECC: Severe-early childhood caries GNP: Ghassan Najeeb Pharaon
LSMU: Lithuanian University of Health Sciences. dmft: decay,missing,filling index
OR: Odd ratio
CI: confidence interval SES: social economic status SSB: sugar-sweetened beverages U.S: United States
9
Parent’s behaviour and attitude toward children’s oral health.
SUMMARY
Aim of the study: To evaluate parental behavior attitudes towards their children’s oral health. Material and methods: A cross-sectional study of 114 participants (age mean 37.12 (10.10)) was conducted in Saudi Arabia-Jeddah city, in the dentistry department of private GNP hospital during December -January of 2018/2019 year. The anonymous self-administered questionnaires were given to parents with children aged 3-15 years (age mean 7.81 (3.01)) prior to consultation with the pediatric dentist. The questionnaire covered background characteristics, parental smoking habits, oral hygiene habits of parents and child, attitude toward child’s oral health. The study was approved by the Bioethics Center of the LSMU (No BEC-OF-14). Statistical data analysis was performed using SPSS 22 version. To establish relationships between categorical variables, the Pearson (χ2) test was used. P-value ≤0.05 was set to indicate statistically significant differences. The logistic regression analysis evaluated the probability of an event given a certain risk indicator/s, including the odds ratio (OR) and its confidence interval (95%CI).
Results: Considering the relation to the child, 50.9% were mothers, and 48.2% were fathers. A majority of participants (78.9%) was with university education. 76.3% of participants were non-smokers. Associations were found among non-smoking (OR =2.672[1.040-6.868]) (p=0.041)), child’s tooth brushing day (OR=4.013[1.472-10.941](p=0.007)) and parental tooth bushing twice-a-day, respectively. Associations were found between self-reported oral health status of child (OR =3.402[1.333-8.684]) (p=0.008)), child’s self-image (OR=3.497[1.494-8.186] (p=0.007)) and child’s tooth bushing twice-a-day, respectively.
Conclusions: A significant relationship was found between parental attitude toward oral hygiene and oral behavior. The parents brushing their teeth brushing regarding recommendations cleaned their child’s teeth likewise. Furthermore, self-reported oral health status and child’s self-image were strongly associated with the child’s tooth brushing habits.
10
INTRODUCTION
Dental caries is a multifactorial disease; biological, psychosocial and behavioral factors have an impact on dental caries development [1-3]. However, the main etiological factor of dental caries is dental plaque [4].
Despite dental caries is preventable, this disease remains among the most common chronic oral
diseases during childhood with a prevalence ranged from 1.0% to 94.0% in preschool-aged children in the world [5-8]. In Saudi Arabia, different studies revealed high caries prevalence among children, and it varied from 63% to 80% in primary dentition, while from 56.7% to 70% in permanent dentition [9-11].
Proper oral hygiene is the key to maintain good oral health status. The major aim of oral hygiene is to control a microbial dental plaque which is the primary etiological of dental caries [12]. Cleaning of child’s oral cavity should start from the first day of birth, and as soon as the first tooth erupts, brushing without toothpaste should be performed [13].
Various associations are their confirmed recommended guidelines regarding oral health and hygiene. Thus, the U.S. Food and Drug Administration (FDA) has guided that pea-sized amount of fluoride toothpaste would be used for children younger than 6 years of old, but the amount of toothpaste for a child younger than 2-year-old should be recommended by dentist [14]. Meanwhile, the European Academy of Paediatric Dentistry (EAPD) suggested the usage of fluoride must be balanced between the assessment of caries risks and the possible risks for toxic effects of the fluorides. Consequently, the use of appropriate fluoride toothpaste in conjunction with good oral hygiene to be the basic fluoride regimen and children aged 6 years and over should brush twice a day with a 1-2 cm amount of toothpaste containing 1450ppm fluoride [15]. Additionally, the American Association of Pediatric Dentistry (AAPD) recommended for parents to start the oral hygiene measures for their children not later than the time of eruption of the first primary tooth, and the tooth brushing should be performed for children by a parent twice daily by using a soft toothbrush of age-appropriate size [16]. Parents
supervise their children twice daily tooth brushing with fluoridated toothpaste is a simple way and highly effective to prevent early childhood caries (ECC) [17,18].
The child‘s oral health-related behaviors are directly affected by the environment provided by parents and their tooth brushing practices [19,20]. Therefore, proper knowledge provided to the children by their families will positively support the development of correct oral health-related behaviors [12]. Children tend to adopt the attitudes of their parents [21]. Mothers are more likely to teach their children about tooth brushing behaviors [22].
11 Parental habits such as smoking and diet plan provided to the child can have impactions on the child’s dental caries development [1,23,24].
Providing proper diet plan is part of the parent's responsibility toward their children. The parents’ ability to withhold cariogenic snacks such as sweets, starchy foods, beverages, and added sugar products which contain fermentable carbohydrates is also a factor associated with dental caries, since carbohydrate will be fermented by microorganisms in the mouth, leading to decrease the pH level in the saliva to 5.5 or less which promote formation of caries [24,25].
Child’s oral health status in primary dentition can reflect the oral status in permanent dentition period as well [26,27]. Studies have revealed a relation between primary dentition status and permanent dentition status; children who manifest caries in their primary dentition were three times more likely to develop caries in their permanent dentition than those children were free of caries previously [26]. Moreover, the following factors age, gender, race, habits, systemic condition such as cardiovascular disorders, diabetes mellitus, bone/ joint disorders can affect oral and dental health [28,29]. In addition, the social economic status of the parents such as the level of education and family size can have an impaction on the child’ oral status [30,31]. Family status can also have an impact on the oral hygiene status of the child since it was reported that children living in single-parent families had poorer oral hygiene status than those living in other types of families [32].
Untreated dental caries lead to functional impairments of individuals, deteriorated aesthetics due missing, discolored or damaged teeth, weight loss, poor growth in young children and lowered quality of life [33,34].
This study hypothesized that parents with higher education level reported better oral hygiene behaviours and who had an absence of bad habits such as smoking will report about the better oral health status of the child.
Aim of the study was to evaluate parental behavior attitudes towards their children’s oral health. Objectives:
1.
To analyse the data about parental behaviour and attitude toward their children’s oral health.2.
To determine the most important parental behaviour factors related to their children oral healthstatus.
12
1. REVIEW OF LITERATURE
World Dental Federation (FDI), World Health Organization (WHO) and International Association for Dental Research (IADR) published ‘‘Global Goals for Oral Health 2020’’; and provided guidance for local, regional, and national planners and policy makers to improve the oral health status of their populations [35]. The current pattern of oral diseases reflects different risk profiles across countries related to lifestyles, living conditions and environmental factors, and the implementation of preventive oral health program [36].
Numerous studies showed that the social economic status of the family plays an important role in many aspects related to the oral health status of both children and adults. Thus, Kumar et al. reported that the social economic status (SES) of the family had a significant effect on the children oral hygiene
practices and status, children of higher family SES were demonstrating better oral hygiene practices and status (P=0.005) [32]. Additionally, another study carried out Lithuania demonstrated that parents with sufficient family income reported that their child's and their own health significantly better than those reporting insufficient-family income (P < 0.001) [37]. Moreover, Kraljevic et al. found a significant relationship between the geographic origin of mothers and early childhood caries severity level, it was reported that children of non-European origin mothers had significantly higher dmft (10.38) than children of European origin mothers dmft (9.6) in Switzerland (P<0.05) [38].
Parental or mother’s education is an important factor which assesses people behaviour and attitude toward children oral health status in the studies. The finding of a study conducted In Saudi Arabia showed significantly higher caries prevalence among teenagers, with low parental education level and high maternal illiteracy [39]. Consequently Saldūnaitė et al. reported in their study that children whose parents had a high educational level brushed their teeth twice a day more frequently than those of the parents with a low educational level (48.5% and 42.4%, respectively, P < 0.001) [37].
Studies confirmed that parental smoking is a habit with long-term drawback not only for their general and oral health but for offsprings as well. Goto et al. evaluated the effect of parental smoking in the children (3-6 year-old) oral health, they found that maternal smoking was significantly related to the presence of dental caries in their child (OR = 3.14, 95% CI 1.56–6.31), while paternal smoking wasn’t so great as in the maternal smoking (OR = 1.64, 95% CI 1.02–2.64) [23]. Another study found that
13 parental smoking and caries experience in preschool children a significant relation (OR = 3.36; 95% CI: 1.49–7.58) [40].
Studies revealed that a proper parental tooth brushing habit is essential to develop correct tooth brushing habits of children. Paunio reported that both mothers and fathers tooth brushing habits were significantly associated with the child’s tooth brushing habits (P< 0.0001) [41]. Furthermore, another research found that dmft index >0 among children was associated with mother’s irregular tooth brushing (OR 2.2; 95% CI 1.4-3.5) [42]. In addition, a study conducted in Saudi Arabia showed that mothers were more likely to teach their children about tooth brushing behaviours than fathers (P < 0.05) [22].
Quality of tooth brushing is not always related to the frequency of tooth brushing. Research made by Santos et al. showed that the frequency of tooth brushing was not associated with oral hygiene quality after evaluation of visible biofilm in pre schoolchildren [43].
Blinkhorn et al. revealed a low awareness of mothers about the recommended amount of toothpastes, although 71% of mothers observed their preschool children's tooth brushing, only a half of them knew about the necessary amount of toothpaste [44]. Considering the usage of toothpaste for small children, Franzman et al. found that mothers placed the toothpaste on the toothbrush in 85% cases for 9 months child, 49% cases for 3-year-old children, and 31% cases for 5-year-old children [45]. A systematic review showed that tooth brushing with fluoride toothpaste can decrease dental caries in school-aged children, but the early usage of it can associate with dental fluorosis [46].
Dietary habits play a role in children oral health status, therefore it is important to develop correct habits, Palmer et al. studied the association between the diet plan and severe early childhood caries and they found that those children with S-ECC had more of frequency consuming juices between meals (P<0.01), intake of retentive foods (P<0.001), eating frequency (P<0.005), and estimated food cariogenicity (P<0.0001) than those children with caries-free [47].
In addition, Laitala et al. evaluated the mother’s behaviours with their infants, found that 92% of mothers gave sweets to their children by the age of 2 years, 33% of mothers gave to their offsprings younger than 1-year-old; thus a frequent consumption of sugar-sweetened products start early in childhood [48]. Furthermore, a systematic review showed a relation between sugar-sweetened beverages (SSB) and weight gain in adults and children and they found that each serving per day increase in SSBs was related with an additional weight gain of 0.22 kg over 1 year [49].
14
2. MATERIAL AND METHODS
This cross-sectional study was accomplished from December of 2018 till January of 2019 in Saudi Arabia-Jeddah city, in the dentistry department of private Ghassan Najeeb Pharaon hospital (GNP). Jeddah city is the home of the largest port on the Red Sea. It is a center for commercial activity, and it is the second most populous city in Saudi Arabia, with a population predicted around 4.433 million in 2018 [50]. Ghassan Najeeb Pharaon hospital (GNP) was established in 1969.
A self-administrated anonymous questionnaire was given to the parents during the dental pediatric appointment for their child. The examiner explained to the participants the purpose of the study, written informed consent was obtained from the parents. Participation was voluntary and anonymous.
Bioethics permission approval was obtained from the ethics committee of Lithuanian University of Health Sciences (LSMU), Kaunas (BEC-OF-14)
2.1 Subjects
The study sample (N=114) was parents seeking for a dental consultation with a pediatric dentist for their children aged from 3 to 15 years old in Ghassan Najeeb Pharaon hospital (GNP) in Saudi Arabia- Jeddah.
2.2 The questionnaire
This questionnaire was designed to evaluate parental behaviour and attitudes toward the child’s oral health. An anonymous self-administered questionnaire was prepared in English, and later it was translated into the Arabic language. Subsequently, the Arabic version was translated into English to compare the correctness of the translation.
An anonymous self-administered questionnaire consisted of 23 questions and covered background characteristics of parents and their child, parental level of education, smoking habits, oral hygiene attitudes of both parents and child, the self-evaluation of child’s oral health status and the self-image, attendance of dentist, dietary habits of child and necessity of primary teeth treatment.
The question about parental education level had three options: none, primary/middle/high school, and bachelor’s degree or higher. Later these options were dichotomised into≤ high school and university. The question about the frequency of parental tooth brushing had four options: never, less than daily, once a day, two or more times a day. Later these options were regrouped into the following groups: ≤Once a day and ≥Twice a day.
15 Answers of questions regarding self-reported child’s oral health status and the self-image had the followed options (very satisfied, satisfied, dissatisfied, very dissatisfied) and later they were dichotomised into two groups (satisfied or unsatisfied groups).
The question about the reason for the previous dental visit of the child had several options (regular check-up, toothache, dental trauma, preventive treatment, and other reasons ) Later all answers were classified into four main groups: regular check-up (check-up and dental prevention procedures), toothache, dental trauma and other reasons ( like root canal treatment and extraction).
Questions about the dietary habits of the child asked about frequency of meals consumed per day and the possible option of answers were (2 meals per day, 3 meals per day, 4 meals per day and >4 meals per day) Meanwhile, two options (less than daily and daily) of vegetables, fruits, sweets, candies and beverages (tea, soda, juice) consumption frequency were analysed.
The questionnaire included an open question regarding the participants’ opinion about the necessity of treating the primary teeth, answers were grouped into four main groups: functional purposes (including chewing purposes and space maintainers answers), health purposes (including avoiding dental caries exacerbations –outcomes- answers ), esthetic purposes (including self-confidence reasons) and no opinion group.
2.3 Statistical analysis
The Statistical Package for Social Sciences (SPSS version 22) was used for analysis. Statistical evaluation included Chi-squared tests for differences between mothers’ background characteristics, smoking habits, own health behaviour and oral health behaviour towards their children. The data were analysed using the t-test. A p-value ≤0.05 was set to indicate statistically significant differences. The logistic regression analysis evaluated the probability of an event given a certain risk indicator/s, including the odds ratio (OR) and its confidence interval (95%CI).
16
3. RESULTS
Overall, 114 participants were enrolled in the study and the age mean of the parent’ was 37.12(10.10) years. Considering the relation to the child, 50.9% were mothers, and 48.2% were fathers. A majority of mothers was Saudi mothers (61.4%), while only (35.6%) of participants reported that mothers were Non-Saudi origin (Table 1).
A majority of participants (78.9%) was with university education. Considering the smoking habits, (76.3%) of participants were non-smokers. According to the number of children in the family, families with 3-4 children prevailed (43.0%), while families with 1-2 children were less prevalent (38.6%), respectively (Table 1).
Table 1. Demographic characteristics of participants.
Variable N %
Relation to the child ( Missing N= 1 )
Father 55 48.2 Mother 58 50.9 Mother’s Origin Saudi 70 61.4 Non-Saudi 44 38.6 Parental education ≤ High school 24 21.1 University 90 78.9
Smoking habits ( Missing N= 1 )
Yes 26 22.8
No 87 76.3
Children in family
1-2 children 44 38.6
3-4 children 49 43.0
More than 4 children 21 18.4
Gender of the child ( missing N=1 )
Boy 58 50.9
17 Participants reported that 50.9 % of children were boys and 48.9% were girls, respectively. The age mean of the child was 7.81(3.01).
The study showed that significantly more fathers (38.9%) than mothers (6.9%) were smokers
(P<0.001) (Table 2). There is a statistically significant relationship between frequency of parental tooth brushing and smoking habits; more non-smoking parents (82.89%) used to brush their teeth at least twice a day than smokers (64.86%) (P=0.033) (Table 2).
Table 2. Parents’ (N=114) smoking habits and behaviour towards their child by education and parental tooth brushing frequency.
Variable
Relation to the child* N (%) Parental education** N (%) Frequency of parental tooth brushing*** N (%) P-value
Father Mother ≤High school University ≤Once a day ≥Twice a day Smoking missing (N=1) Yes 21(38.9) 4(6.9) 3(12.5) 23(25.84) 13(35.13) 13(17.10) <0.001* 0.33** 0.033*** No 33(61.1) 54(93.1) 21(87.5) 66(74.15) 24(64.86) 63(82.89) Total 54(100.0) 58(100.0) 24(100.0) 89(100.0) 37(100.0) 76(100.0) Frequency of child tooth brushing
<Twice a day 36(65.45) 39(67.24) 16(66.66) 59(65.55) 32(84.2) 43(56.6) 0.841* 0.919** 0.003*** ≥Twice a day 19(34.54) 19(32.75) 8(33.3) 31(34.4) 6(15.8) 33(43.42) Total 55(100.0) 58(100.0) 24(100.0) 90(100.0) 38(100.0) 76(100.0)
Parental help to brush the child’s teeth
Yes 24(43.6) 22(37.9) 7(29.2) 40(44.4) 16(42.10) 31(40.78) 0.403* 0.177** 0.893*** No 31(56.4) 36(62.1) 17(70.8) 50(55.6) 22(57.89) 45(59.21)
Total 55(100.0) 58(100.0) 24(100.0) 90(100.0) 38(100.0) 76(100.0) P*-comparison between relation to the child; Chi-square test
P**-comparison between parental education; Chi-square test
P***-comparison between the frequency of parental tooth brushing; Chi-square test
The results revealed that significant relation between frequency of parental tooth brushing and
18 child’s teeth likewise, while only 15.8% of parents brushing once a day reported that children teeth are brushed at least two times a day (P=0.003) (Table 2). In addition, associations were found among parental tooth bushing twice-a-day and non-smoking (OR =2.672[1.040-6.868]) (P=0.041)), besides child’s tooth brushing twice-a-day (OR=4.013[1.472-10.941](P=0.007)), respectively (Table 3).
Table.3 Factors explaining parental tooth brushing at least twice a day, as assessed by means of a multivariate logistic regression model of the parent-child pairs (N=114) visiting Ghassan Najeeb Pharaon (GNP) Hospital.
Variable OR 95%CI P-value
Smoking
Yes 1
0.041
No 2.672 1.040-6.868
Twice a day child’s tooth brushing
Yes 4.013 1.472-10.941
0.007
No 1
OR- odd ratio
CI- confidence interval
Overall, a higher share (56.1%) of participants reported not helping to brush teeth for the child. In addition, no statistically significant differences were found between the help of child’s toothbrushing and gender, education level and frequency of parental toothbrushing (P>0.05), respectively (Table.2).
The self-reported oral health status of the child was related to the habits of child’ toothbrushing
(P=0.008). 82.1% of children brushing their teeth at least twice a day were satisfied in their oral health status as their parents reported. (Table.4). Significantly more children brushing teeth at least twice a day were satisfied with their self-image (P=0.003).
Subsequently, the relation between a satisfied self-reported oral health status of the child and a positive child self-image was statistically significant (P<0.001). The study revealed associations between the reported oral health status of the child (OR =3.402[1.333-8.684]) (P=0.008)), the child‘s self-image (OR=3.497[1.494-8.186] (P=0.007)) and child’s tooth bushing twice-a-day, respectively (Table 4).
19 Table.4 Factors explaining the frequency of child tooth brushing, as assessed by means of a univariate logistic regression model of the parent-child pairs (N=114) visiting Ghassan Najeeb Pharaon (GNP) Hospital.
Variable Frequency of child’s tooth brushing OR 95%CI P-value <twice a day ≥twice a day
Oral health status of the child
Satisfactory 43(57.3) 32(82.1) 3.402 1.333-8.684 0.008 Unsatisfactory 32(42.7) 7(17.9) 1 Total 75(100.0) 39(100.0) Child’s self-image Satisfied 34(45.3) 29(74.4) 3.497 1.494- 8.186 0.003 Unsatisfied 41(54.7) 10(25.6) 1 Total 75(100.0) 39(100.0) OR- odd ratio
CI- confidence interval
Frequency of child‘s meal‘s consumption per day is presented in figure 1, the majority of children (66%) had 3 meals a day.
Fig.1 Frequency of children meal’s consumption per day.
Moreover, 81.57% of children used to eat fruits and vegetables less than daily as reported by their parents. Additionally, 42.98% of children ate the sweets and candies daily, and 23.68% consumed
12%
66% 19%
3%
2 meals per day 3 meals per day 4 meals per day > 4 meals per day
20 sugar-sweetened beverages as their parents reported (Figure 2). Associations were found among Saudi mother’s origin (OR =2.922[1.195-7.147]) (P=0.019)) and children’ daily consumption of sugar-sweetened beverages, respectively.
Fig.2 Dietary habits of the children.
Concerning the reason for the previous dental visit, toothache was the most common answer (64.60%), while only 15.9% of parents reported preventive procedures as a reason for previous visit (Figure 3). Fig. 3 Reasons for the child’s previous dental visit
0.0% 25.0% 50.0% 75.0% 100.0% Vegetables and fruits
Sweet and candies sugar sweetened beverages
Less than daily Daily
15.90%
64.60% 7.10%
4.40%
8.00%
Regular check up Toothache Dental trauma Other reasons No previous visit
21 Regarding the necessity of treatment of primary dentition, half of the parents did not have an opinion. Consequently, 31.60% answered that treatment of primary teeth is necessary due to health purposes (Figure.4).
Fig.4 Parental attitude toward reasons for primary teeth treatment necessity
12.30% 7%
31.60% 49.10%
Easthetic reasons Functional reasons Health reasons Have no opinion
22
4. DISCUSSION
This study revealed that parental education, smoking habits, frequency of parental tooth brushing and the origin of mothers have an impact on the self-reported children oral health status.
In this study parent brushing teeth according to recommendations and non-smokers tended to maintain the habit that their children teeth should be brushed twice a day. Moreover, a better self-reported child’s oral health status and child’s self-image were associated with twice a day child tooth brushing.
Studies found that parents’ habits and knowledge about oral health can influence their children’s oral health status [51]. Parental level of education was found to be a major role in the children oral health status in many previous studies [37,39]. However, this relation was not statistically significant in our results.
This study showed a significant relationship between parental smoking habit and frequency of parental tooth brushing. Similarly, a study performed in Finland found that daily man-smokers brushed their teeth less often than non-smokers (P<0.001) [52]. In addition, another research made by Honkala et al. revealed that smoking and frequency of tooth brushing were strongly associated with each other [53]. However, the smoking habit can have an impaction on the child’ oral health status in the long-term. A Study carried out in Japan evaluated the effect of smoker householder on the children caries prevalence and found that the exposure to maternal and paternal smoking was significantly associated with dental caries of their children which will lead to worsening the oral status of the child [23].
Our data show a significant relationship between the frequency of parental tooth brushing and frequency of child tooth brushing. Subsequently, this finding was reported by several authors. They reported that parent’s and children’s oral hygiene practice is positively associated with each other and children usually follow their parent’s tooth brushing behaviours [19,22]. the Systemic review made by Holmes in 2016 concluded that individuals brushing their teeth infrequently were at greater risk for the incidence or increment of new carious lesions than those brushing more frequently and the effect is more pronounced in the deciduous than in the permanent dentition [54]. However, oral hygiene frequency is not always associated with oral hygiene quality [43].
In our study, parental help in the child’s tooth brushing was quite not prevalent. In contrast, a study made by Hamilton in 2018 showed, that parental supervising their children during tooth brushing can significantly contribute to the cumulative empirical evidence regarding self-regulatory components in
23 health behaviour change, and can inform intervention development to increase parents’ participation in childhood oral hygiene practices [55].
Our results showed significantly more children brushing teeth at least twice a day were satisfied with their self-image; however, dental health is important not only in self-image satisfaction, but it is also associated with speech development, eating ability, and overall health in young children [56].
Origin of mothers can have an impaction on the oral health status of the child. This study showed that Saudi mothers tended to give sugar-sweetened beverages daily than non-Saudi mothers. Elamin et al. showed in their study, that intake of sugary products is strongly associated with dmft score. Children with dental caries (dmft> 0) consumed sugar-sweetened products more frequently than those who were caries free (P = 0.003) [57]. Another research done by Van Loveren approved that frequency of sugar-sweetened products consumption is more related to dental caries prevalence than the amount of sugar consumption [58].
ECC has an impact on the quality of life of both children and parents due to deteriorated sleep patterns and issues of food consumption in children [59].
The main limitation of our study was the small sample size, and it could be the reason why the first hypothesis of this study which supposed a relationship between the parental level of education and children oral status was rejected. However, the second hypothesis which assumed that parental absence of bad habit would report better child oral health status was confirmed according to our study results. And due to the study limitation, it could explain the reason why some relations were not significant in our study while in other studies they report them as substantial risk factors.
24
5. CONCLUSIONS
A significant relationship was found between parental attitude toward oral hygiene and oral behavior to the self-reported children oral health status. The parents brushing their teeth brushing regarding
recommendations cleaned their child’s teeth likewise. Furthermore, self-reported oral health status and child’s self-image were strongly associated with the child’s tooth brushing habits. The mother’s origin influenced the routine diet mode of their child.
6. PRACTICAL RECOMMENDATIONS
The further investigations should be continued to assess the relationship between the oral health status and oral hygiene condition, not only the self-reported evaluation.
Improvement of parental knowledge toward the child’s oral health should be implemented by organizing lectures and seminars.
7. ACKNOWLEDGMENTS
I dedicate this master thesis to my beloved Mother, Father, Brothers Dr.Ziad Sijari and Dr.Basel Sijari, and Dr.Sherin Bahrou, pharmacist Reham Saijari and the babies Lara and koko sijari for their
encouragements and constant, unwavering faith in me. I would like to say a special thank you to my father Ammar Sijari and mother Nahed raef said for their enormous support, always inspiring me to follow my dreams. This journey would not have been possible without the support and encouragements of my family, friends, professors and university stuff.
I also thank the GNP hospital in Jeddah and in top of them Dr. Montaser Istanbuli.
Finally, I would like to extend my thanks to my supervisor Sandra Petrauskienė for her guidance throughout this research project.
8. CONFLICTS OF INTEREST
The author reports that he has no competing interests.25
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10. ANNEXES
31 INFORMATION SHEET FORM FOR RESEARCH PARTICIPANT
A student Fahd Ammar Sijari of LSMU Faculty of Odontology is conducting master thesis, which is aimed to evaluate the parent’s behaviour and attitude toward children’s oral health.
The research participants are parents of children seeking for dental consultation for their child in GNP - Ghassan Najeeb Pharaon- hospital , in Saudi Arabia-Jeddah
The research data collected from the anonymous questionnaires will be used systematized only for scientific purposes and confidentiality is guaranteed.
If you have any questions please contact:
Fahd Sijari (Faculty of Odontology, V year, group 13) Tel. No: +370 (636) 93981, email: fahd_a_1@hotmail.com
Sandra Žemgulytė (scientific supervisor), LSMU, MA Clinic for Preventive and Pediatric Dentistry, adress: J. Lukšos-Daumanto g. 6, LT-50106, Kaunas, Lithuania, e-mail: sandra.zemgulyte@lsmuni.lt
The Supervisor of Research: Dr.Sandra Žemgulytė
32 CONSENT SHEET FORM OF RESEARCH PARTICIPANT
I understand all information provided me in the information sheet and agree to participate in research “ Parent’s behaviors and attitude toward children’s oral health ” aimed to to determine the risk indicators and their correlation to parent’s behaviours toward their children oral health.
Signature _____________________ Date ____________
33 Parent’s behaviour and attitude toward children’s oral health
1. Relation to child? Father Mother
2. How many children are in your family? 1–2 child 3–4 child more than 4
3. Mother’s origin?
Saudi non-Saudi from Arabic countries non-Saudi from foreign countries 4. How old are you?... years
5. What is your education level ?
None primary/middle/high school bachelor’s degree and higher 6. How often do you brush your teeth?
Never less often than daily once a day two or more times a day
7. Do you smoke? YES NO
8. How old is the child? ...years 9. Gender of child: Boy Girl
10. How often teeth of child are brushed?
Never less often than daily once a day two or more times a day
11. Does the child is getting help during teeth brushing? YES NO 12. How long does your child brush teeth? > 1min 1-2 min < 2 min
13. Which kind of toothpaste does your child use?
Fluoridated toothpaste Non-fluoridated toothpaste I DON’T KNOW 14. What auxiliary measures your child use?
Dental floss Mouth wash Inter-dental brush None
15. How do you rate the health status of your children’s mouth and teeth? Very good Satisfactory Dissatisfactory Very dissatisfactory 16. Are you satisfied with your child’s teeth appearance?
34
17. Has your child visited a dentist before? YES NO
18. If YES, why did your child visit the dental clinic?
Regular check-ups toothache accident/trauma
Preventive treatment to reduce caries others (please specify)……….
Please choose most suitable answer of the following questions. (Eating habits and attitude of children)
1. How many meals consumption does the child eat per day?
Two meals/day three meals/day four meals/day more than 4 meals/ day 2. How often does your child eat vegetables and fruits per week?
Daily consumption Less than daily consumption
3. How often does your child eat sweets and candies per week?
Daily consumption Less than daily consumption
4. How often does your child drink sugared drinks per week? (Tea,soda,juice)?
Daily consumption Less than daily consumption
