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| ORIGINAL ARTICLE |
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| Year : 2017 | Volume
: 7
| Issue : 1 | Page : 27-31 |
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Paediatricians' knowledge, attitude and awareness towards infant oral health care and treatment needs: A cross-sectional survey
Smit Sikligar, Seema Bargale, Bhavna Dave, Anshula Deshpande, Swara Shah, Nikhil Patel
Department of Pedodontics and Preventive Dentistry, K.M. Shah Dental College and Hospital, Sumandeep Vidhyapeeth, Vadodara, Gujarat, India
| Date of Web Publication | 6-Feb-2017 |
Correspondence Address:
Nikhil Patel
Department of Pedodontics and Preventive Dentistry, K.M. Shah Dental College and Hospital, Sumandeep Vidhyapeeth, Vadodara, Gujarat
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/AIHB.AIHB_37_16
Introduction: Paediatricians examine infants several times during the 1st and 2nd years of life. Parents usually seek paediatricians' guidance in securing their child's normal growth and development. If proper counsel regarding the child's development and eruption of teeth as well as guidance for the prevention of various oral diseases is rendered at this age, better oral health can be attained for these children. Aims: This study aimed to determine and assess the knowledge and treatment needs of paediatricians for infant oral health care (OHC) in Vadodara, Gujarat. Materials and Methods: One hundred paediatricians practicing in Vadodara City, registered in the Indian Medical Association, were randomly selected for the study. They were requested to fill an objective questionnaire without providing any infant oral health information. Filled questionnaire pro forma was collected by principle investigator. The descriptive analysis was done for the data. Results: Out of the 100 paediatricians, ninety returned the questionnaire, with the response rate of 90%. Knowledge regarding infant OHC was found to be poor in 60% and average in 40% and attitude regarding the same was found to be poor in 20%, average in 60% and good in 20% of the responders. Awareness regarding infant OHC was found to be good in 80% and average in 20% of the paediatricians. Conclusion: Paediatricians need to update themselves on recent recommendations regarding infant oral health to ensure that all their patients receive timely preventive and restorative dental care. This study showed that there is a need for more communication between the paediatricians and pedodontists so as to deliver better child OHC. Keywords: Awareness, infant oral health care, paediatrician
How to cite this article:
Sikligar S, Bargale S, Dave B, Deshpande A, Shah S, Patel N. Paediatricians' knowledge, attitude and awareness towards infant oral health care and treatment needs: A cross-sectional survey. Adv Hum Biol 2017;7:27-31 |
How to cite this URL:
Sikligar S, Bargale S, Dave B, Deshpande A, Shah S, Patel N. Paediatricians' knowledge, attitude and awareness towards infant oral health care and treatment needs: A cross-sectional survey. Adv Hum Biol [serial online] 2017 [cited 2023 Mar 27];7:27-31. Available from: https://www.aihbonline.com/text.asp?2017/7/1/27/199533 |
| Introduction | |  |
The American Academy of Pediatric Dentistry emphasises the importance of prevention, diagnosis and treatment necessary to restore and maintain the oral health of infants, children and adolescents.[1]
Paediatricians examine infants several times during their 1st and 2nd years of life. Parents usually seek paediatricians' advice in securing their child's normal growth and development. If proper counsel regarding the child's development and eruption of teeth as well as guidance for the prevention of various oral diseases is rendered at this age, better oral health can be attained for these children. To achieve this, paediatricians must have proper knowledge in addition to time and inclination to educate the parents. These visits are considered 'well-baby' or 'check-up' examinations to note the developmental progress of the child, provide necessary immunisations, give the parents guidance concerning nutrition and discuss cognitive development. Thus, paediatricians are considered to be in a unique position to provide preventive oral information and to diagnose oral diseases in their patients.[2]
Regular dental check-ups for toddlers and young children are not organised in most countries. However, paediatricians regularly examine most children, at least in their early years. Paediatricians could therefore be the ideal vehicle for advice to parents about the prevention of dental disease. Paediatricians might also be confronted with dental emergencies such as acute pain or trauma.
However, paediatricians' knowledge of dental topics is not up to date or sufficient.[2] The prevention and education are the best ways of promoting oral health collectively with health professionals such as paediatricians and pedodontists, by the contact that they establish with their patients since the 1st year of life.[3]
Above all, the paediatrician as an educator has to understand and motivate parents about the necessity of oral health since they are the professionals who first interact with the family. The oral health promotion is essential; it is evident that a multidisciplinary care and guidance involving paediatricians is indispensable so that not only parents' education is reached, but also especially with relation to promotion and maintenance of their children's oral health.[4]
Infant oral health is the foundation upon which dental health must be built. It is recommended that the first dental visit should occur within 6 months and no later than 12 months of age. The American Academy of Pediatrics previously recommended the first dental visit by age 3, but changed the guideline in 2003 to establishing a dental home by age 1 for children with caries risk. The concept of the dental home is to establish an early relationship between a family and a dental practitioner from whom the family will receive preventive instruction, dental care, counselling and anticipatory guidance. The establishment of a dental home for children in their 1st year of life is important for promoting the early detection of high-risk individuals and the prevention of dental disease, thereby decreasing the incidence of early childhood caries.[5]
The need of the study is to assess the knowledge regarding infant oral health in paediatricians and to make aware about the preventive oral health care (OHC) needs for the infants to their parents. Hence, there is a need for increased infant OHC education in the medical communities.
| Materials and Methods | | |
The paediatricians practicing in Vadodara City registered under the Indian Medical Association were selected for the study. A total of 100 paediatricians participated in the study; they had a Postgraduate Diploma (DCH) or a Master's Degree (MD) or both, DNB and other degree in paediatrics. For the study purpose, objective questionnaires were distributed among the paediatricians and asked to fill the pro forma. Prior appointment and the schedule for the study were obtained from the respective paediatricians. The questionnaire included both multiple choice and close-ended questions in infant OHC. They were requested to fill an objective questionnaire without providing any oral health information.
The questionnaire pro forma was self-prepared. Validation of the questionnaire was done. To validate the questionnaire, two types of validity tests were done such as content validity and concurrent validity. A table with the collected data was created in Excel and the data were statistically analysed using Chi-square test and non-parametric statistical tests (Kruskal–Wallis and Mann–Whitney U-tests).
| Results | | |
A cross-sectional questionnaire survey was conducted. Among the 100 paediatricians, ninety returned the questionnaire, in which the minimum age was 26 years and maximum age was 49 years, with the mean deviation showing paediatricians' age at 35 years.
Out of the ninety paediatricians, 68.9% were males and 31.1% were females. In relation to qualification, 58.9% had a MD, 4.4% had both MD and DNB, 28.9% had a Diploma (DCH) and 7.8% had other degree.
Distribution of knowledge, attitude and awareness among paediatricians for infant oral health care
Paediatricians' knowledge regarding infant OHC was found to be poor in 60% and average in 40% of the responders. Paediatricians' attitude regarding the same was found to be poor in 20%, average in 60% and good in 20% of the responders while paediatricians' awareness regarding infant OHC was found to be good in 80% and average in 20% as shown in [Figure 1]. | Figure 1: Distribution of paediatricians' knowledge, attitude and awareness.
Click here to view |
Paediatricians' knowledge towards infant oral health care
Eighty paediatricians knew that oral cavity is not free from bacteria whereas 20% of the paediatricians knew that it is free from bacteria. Nearly 80% of the responders knew that dental caries is not transmissible from mother while 20% said it is transmissible from mother. All paediatricians said that prolonged breastfeeding cannot cause dental caries and the first tooth erupts with birth. All paediatricians said that the 1st tooth erupts at 6 months of age. Treatment of natal or neonatal teeth was extraction according to 80% of the paediatricians and waits and watches according to 20% of the paediatricians. Almost 80% of the paediatricians said that milk teeth have an effect on alignment of permanent teeth while 20% disagreed.
In relation to the knowledge of paediatricians, 60% of paediatricians had poor knowledge and 40% had average knowledge regarding infant OHC according to their qualification and years of practice. Among the paediatricians with MD degree, 52.80% had poor knowledge whereas 47.20% had average knowledge. Among those with MD and DNB degrees, 100% had poor knowledge. Among those with DCH degree, 61.50% had poor knowledge whereas 38.50% had average knowledge. Among those with other degree, 85.70% had poor knowledge whereas 14.30% had average knowledge. In all, 60% had poor knowledge whereas 40% had average knowledge.
In relation to the knowledge of paediatricians according to the years of practice, among the paediatricians with experience of <10 years, 62.50% had poor knowledge whereas 37.50% had average knowledge. Among those with experience of 10–25 years, 50% had poor knowledge whereas 50% had average knowledge. In all, 60% had poor knowledge whereas 40% had average knowledge.
In relation to the knowledge of paediatricians according to gender, 54.8% of male paediatricians had poor knowledge regarding infant OHC and was found average in 45.2% of male paediatricians; 71.4% of female paediatricians had poor knowledge regarding infant OHC and was found average in 28.60% of female paediatricians according to their gender. In all, 60% had poor knowledge whereas 40% had average knowledge. P value achieved by Pearson's Chi-square test is 0.137 which is statistically insignificant.
Paediatricians' attitude towards infant oral health care
All paediatricians performed oral examination of their patients and gave oral health information. Almost 80% of paediatricians recommended cessation of bottle feeding at the age of <1 year whereas 20% of paediatricians recommended cessation of bottle feeding at the age of more than 1 year. All paediatricians suggested the first dental visit recommendation at the 1st year or above the 1st year of age of the infant. All paediatricians gave oral health information regarding infant OHC. Nearly 40% of the paediatricians recommended cleaning of gum pads of infants from birth and 60% recommended from 3 to 6 months. Almost 20% of paediatricians referred to paediatric dentist and rest all 80% referred to general dentist.
In relation to the attitude of paediatricians, 20% of the paediatricians had poor attitude, 60% had average attitude and was found to be good in 20% of paediatricians regarding infant OHC according to their qualification and years of practice. Among the paediatricians with MD degree, 24.50% had poor attitude, 52.80% had average attitude and 22.60% had good attitude. Among those with MD and DNB degrees, 0% had poor attitude, 100% had average attitude and 0% had good attitude. Among those with DCH degree, 19.20% had poor attitude, 61.50% had average attitude and 19.20 had good attitude. Among those with other degree, 0% had poor attitude, 85.70% had average attitude and 14.30 had good attitude. In all, 20% had poor attitude, 60% had average attitude and 20% had good attitude as shown in [Figure 2]. | Figure 2: Consolidated distribution of attitude according to qualification of paediatricians.
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In relation to the attitude of paediatricians according to the years of practice, among the paediatricians with experience of <10 years, 25% had poor attitude, 62.50% had average attitude and 12.50 had good attitude. Among those with experience of 10–25 years, 0% had poor attitude, 50% had average attitude and 50% had good attitude.
In relation to the awareness of paediatricians according to their gender, 29% of the male paediatricians had poor attitude regarding infant OHC, 54.8% had average attitude regarding infant OHC and was found good in 16.1% of male paediatricians; 71.4% of female paediatricians had average attitude regarding infant OHC and was found to be good in 28.6% of female paediatricians.
Paediatricians' awareness towards infant oral health care
Almost 60% of the paediatricians considered infant oral health as important and 40% considered it as extremely important. All the paediatricians were aware about cleaning of gum pads and 'teething'. All the paediatricians were aware of the paediatric dental speciality and considered lip biting and thumb sucking as normal at this age.
In relation to the awareness of paediatricians, 20% of paediatricians had average awareness regarding infant OHC and was found to be good in 80% of paediatricians according to their qualification and years of practice. Among the paediatricians with MD degree, 15.10% had average awareness and 84.90% had good awareness. Among those with MD and DNB degrees, 0% had average awareness and 100% had good awareness. Among those with DCH degree, 34.60% had average awareness and 65.40% had good awareness. Among those with other degree, 14.30% had average awareness and 85.70% had good awareness. In all, 20% had average awareness and 80% had good awareness as shown in [Figure 3]. | Figure 3: Consolidated distribution of awareness according to qualification of paediatricians.
Click here to view |
In relation to the awareness of paediatricians according to their years of practice, among the paediatricians with experience of <10 years, 12.50% had average awareness and 87.50% had good awareness. Among those with experience of 10–25 years, 50% had average awareness and 50% had good awareness. In all, 20% had average awareness and 80% had good awareness.
In relation to the awareness of paediatricians according to their gender, 17.7% of male paediatricians had average awareness regarding infant OHC and was found to be good in 82.3% of male paediatricians; 25% of female paediatricians had average awareness regarding infant OHC and was found to be good in 75% of female paediatricians.
| Discussion | | |
Comprehensive health care cannot be achieved without dental care in all health service programmes. Paediatricians establish early relationships with young children and their parents, and represent a trustworthy source of preventive information from birth.[6] The oral health promotion should be integrated into the existing preventive programmes which have been implemented by medical professionals.[7] Paediatricians are in a unique position to address dental disease in these children.[8] Tsamtsouris and White have assessed how much physicians know about the aspects of preventive dental care in children other than fluoride supplementation.[9]
In general, the medical practitioners had higher levels of dental knowledge and more positive attitudes than the caregivers. They can play an important guiding role in developing positive dental attitudes. However, in a study, the results failed to show that the medical practitioners conveyed the correct dental knowledge and positive dental attitudes to caregivers.[10]
In this study, 60% of the paediatricians showed poor knowledge about infant oral health. The findings are in agreement with a previous study by Sanchez et al.,[11] who reported that 64% of the paediatricians surveyed considered themselves to have poor-to-fair knowledge regarding paediatric preventive dental care.
Shetty and Dixit in their study reported 76% of the paediatricians' knowledge regarding dental and oral health in children.[2] Regular dental check-ups for toddlers and young children are not organised in most countries. Clinical experience and literature show that a dentist does not see young children unless there are urgent problems. However, paediatricians' knowledge of dental topics is not up to date or sufficient.[12]
About 23.7% of the paediatricians and 24.9% of the family physicians agreed that dental caries is infectious and transmissible from mother to child as reported by Preeti et al. which is showing similar results i.e., 20% of paediatricians in this study.[13],[14]
Paediatricians have a fair understanding about their importance in infant oral health maintenance but they routinely do not advise it and the advice given is often inadequate. These findings agree with a study by Di Giuseppe et al. who reported the awareness of 89% of paediatricians as compared to 80% in this study.[12]
In dentistry, there is an assumption that breastfeeding on demand, especially at night with prolonged duration, produces caries. Chung et al. in 2006 stated that 18.4% of medical students gave the answer for cessation of demand feeding when the first tooth erupts.[15] These results agree with the results of this study, in which 80% of paediatricians agree in cessation of breastfeeding <1 year of age. Majority of the respondents felt the need of antenatal counselling on feeding and weaning habits in infants as compared to 60% of respondents in a study done by Shivaprakash et al.[16] Prenatal education becomes the key to the dental care of the infants because mothers should serve as models for their children to provide a successful environment for good oral health. Most of the respondents knew that putting a child to bed with a bottle of fruit juice or milk is harmful as studied by Kumari et al.[17]
Effective prevention strategies are integral to improve the oral health and quality of life for the very young. The overall awareness on preventive strategies was comparatively good, wherein 79.4% of the respondents agreed that gum pads should be cleaned, however only 25% of them agreed in a study by Shivaprakash et al. and 32% in a study by Kumari et al.[17] As compared to earlier studies mentioned, in this study, 100% of the paediatricians recommended cleaning of gum pads. Nearly 40% of the paediatricians recommended cleaning of gum pads from birth and 60% recommended cleaning of gum pads from 3 to 6 months.
About 65.2% of the paediatricians recommended the 1st dental visit in 6 months to 1 year as compared to 40% by Kumari et al., 52.5% by Shivaprakash et al. and only 2.7% of paediatricians and family physicians agreed in the study done by Preeti et al.[13],[18] As compared to the above-mentioned studies, in this study, all paediatricians recommended the 1st dental visit in 6 months.
In a study by Rabiei et al., physicians had generally positive attitudes towards OHC and believed that they should be more knowledgeable in this field.[18] Among the physicians, 77% were willing to carry out preventive measures, which is comparable to the findings of Preeti et al. where 80% of the participants were willing to perform oral health promotion activities.[13] These findings were similar to this study where attitude was average in the paediatricians.
Evidence increasingly suggests that for successful prevention of caries, preventive interactions must begin within the 1st year of life. The attitude for prevention of dental caries was positive in almost everybody in a study done by Murthy and Mohandas whereas it was average in this study.[19]
More communication between medical and dental societies are needed to improve the status of infant OHC.[20] Deshpande et al.,[21] have done a study on gynaecologists with impact of perinatal OHC education and concluded that there is a need for provision of education and awareness to the primary healthcare providers which would help in improving pregnant women and infant's oral health status along with the establishment of dental home. Continuing dental education programmes for paediatricians and gynaecologists have to be done on regular intervals. These measures have to be taken into account so that as a family we can improve the quality of oral health in children.
| Conclusion | | |
This study has identified that there is a need to increase the knowledge of medical students through effective strategies. Medical professionals require adequate training in infant oral health in medical colleges and in continuing medical education courses. Paediatricians should also be encouraged to actively participate in continuing dental education programmes and courses specifically related to infant oral health.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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