Recent epidemiological investigations on dental health among Iranian children revealed that the issue of dental caries is prevalent [1-4]. A recent study among 4,701 preschool children in urban areas of Iran showed that the total caries prevalence is 68.1% with an overall mean score for Decayed, Missing, and Filled Teeth (DMFT) of 3.167±3.003 [4].
In addition, research has revealed that the dental health of children is associated with factors such as socio-economic background and parental dental knowledge [2-5]. In addition, other studies have found a significant relationship between parental knowledge and their children’s dental health status [6-9]. Mothers play a key role in their children’s health behaviours. A good understanding of mothers’ knowledge regarding children’s dental health is essential for the effective implementation of oral health promotion efforts aimed at improving the dental health of children [6].
According to research in Iran, the general level of dental health, especially among children, is still unsatisfactory. Moreover, about 50% of the children were found to be affected by dental caries [1,8,9].
However, there are some studies among Iranian urban mothers regarding their children’s dental health [1-4], but the current study is the first study conducted among rural women aimed to explore the mothers’ knowledge about their children’s dental health.
Materials and Methods
The sampling frame for this cross-sectional study comprised mothers of children aged <6 years, attending the rural divisions of the Qazvin province of Iran. The study sample of participants was selected using a convenience sampling technique. The mothers attending the Rural Health House (RHH) for regular Mother-Child Care (MCH) were invited to participate in the study. The sample size (n=200) was calculated with following formula:
n=z2pq/d2The Iranian Primary Health Care (PHC) system was established to improve access to health care for the disadvantages and reduce the gap between health outcomes in urban and rural areas. To improve access in remote areas in the face of shortages of human and capital resources, the system has relied on three main components: (1) establishing health houses in remote and sparsely populated villages; (2) staffing the health houses with health workers, known as ‘behvarzan’, recruited from local communities; and (3) developing a simple but well-integrated health information system [1,8].
Approval to conduct the study was taken from the Ethical Board of Qazvin University of Medical Sciences Ethics Code: (IR.QUMS.REC.1394.188). Informed consent was received from all participants.
A 25-item self-administered questionnaire in the local language including socio-demographic characteristics (5-items) and knowledge about children’s dental health (20-items) was used for gathering data. The questionnaire was pretested by conducting a pilot study among 20 participants to assess the clarity of the language and the level of information in the questionnaire. The content validity and reliability of the questionnaire were assessed in order to establish the instrument’s psychometric properties. A panel of 10 experts (Dentists, Oral Health Practitioners) reviewed the questionnaire in order to determine its content and face validity. Test-retest reliability was assessed based on a sample of 20 participants (Cronbach’s alpha=0.81). The questionnaires were distributed to the participants during their attendance at RHH from June to October 2016.
The mothers were requested to respond to the questions by indicating a suitable option, which was expressed as scores of a, b, and c for the options. They scored one point for each knowledge question answered “a” and zero for “b” or “c” answers. A knowledge score was calculated from the number of correct (option “a”) answers. The maximum score was 20.
Statistical Analysis
All collected data were entered in SPSS (v. 16.0) software and descriptive statistics were obtained. The percentage frequency distributions of responses to the questions as well as the mean, standard deviation, and proportion were used to quantify the study and outcome variables. To observe the association between two categorical variables, the chi-square test was used.
Results
A total of 200 mothers enrolled in this study. Their mean and standard deviation of age was 30.8±2.5 years. Regarding the source of health information, RHH, television and radio were the main sources for about 160 (80%) of the mothers. The mean and standard deviation of the mothers’ knowledge was 14.2±2.0 and the minimum score was 7.0, while the maximum score was 18.0.
The distribution of the mothers’ responses to the questions related to knowledge about children’s dental health is presented in [Table/Fig-1]. More than 50% of the mothers answered the first eight questions on knowledge correctly. The minimum (11%) and maximum (87%) rates of true answers were related to questions 17 and 6, respectively.
Mothers’ knowledge about children’s dental health.
| No. | Items | N | (%) |
|---|
| 1 | Prolonged bottle feeding causes dental carries.a) Trueb) Falsec) Don’t know | 1124543 | 56.022.521.5 |
| 2 | Excesses intake of sugary food for infants can cause cavities.a) Trueb) Falsec) Don’t know | 1572518 | 78.512.59.0 |
| 3 | Milk teeth do not require good care as it is going to fall anywaya) Trueb) Falsec) Don’t know | 1245719 | 62.028.59.5 |
| 4 | With the eruption of the first baby teeth, parents can begin to clean them with a piece of gauze or clean washcloth.a) Trueb) Falsec) Don’t know | 1016534 | 50.532.517.0 |
| 5 | Can irregularly placed teeth be aligned in the correct position?a) Yesb) Noc) Don’t know | 1222652 | 61.013.026.0 |
| 6 | What type of brush is best for a young child?a) Smallb) Largec) Doesn’t matter | 1751114 | 87.55.57.0 |
| 7 | How much tooth paste should be placed on the brush?a) Small pea-sizeb) Full lengthc) Doesn’t matter | 1422929 | 71.014.514.5 |
| 8 | Which of the following foods cause most decay in children?a) Chocolateb) Biscuitsc) No difference | 1184339 | 59.021.519.5 |
| 9 | That it harms a baby’s tooth to let him/her sleep all night with a milk bottle in its mouth.a) Trueb) Falsec) Don’t know | 988220 | 49.041.010.0 |
| 10 | Bacteria from mom’s cavities can infect baby’s tooth if mom uses the same spoon when feeding the baby.a) Trueb) Falsec) Don’t know | 687359 | 34.036.529.5 |
| 11 | It is necessary to take the child for regular dental visits.a) Trueb) Falsec) Don’t know | 957936 | 47.539.518.0 |
| 12 | Cleaning of the child’s teeth should be done by mothers.a) Trueb) Falsec) Don’t know | 784577 | 39.022.538.5 |
| 13 | Does the tooth paste contain fluoride?a) Yesb) Noc) Don’t know | 684686 | 34.023.043.0 |
| 14 | When is it best to give sugary food and drinks to young children?a) At mealsb) Between mealsc) When child demands | 596576 | 29.532.538.0 |
| 15 | How often should a child’s teeth be brushed?a) Once a dayb) Twice a dayc) After every meals | 943571 | 47.017.535.5 |
| 16 | What is the role of the fluoride in the tooth paste?a) Prevent tooth decayb) Prevent gum problemsc) Don’t know | 724385 | 36.021.542.5 |
| 17 | How much fluoride should the paste contain?a) 1000 ppmb) 500 ppmc) Don’t know | 2219159 | 11.09.579.5 |
| 18 | How should you brush your child’s teeth?a) Standing behind the childb) Standing in front of the childc) Don’t know | 497279 | 24.536.039.5 |
| 19 | At what time babies should have their first time visit?a) At the time when the first tooth eruptsb) 1-yearc) When you see decay in tooth | 397596 | 19.537.548.0 |
| 20 | How many milk teeth are there in a child’s mouth?a) 20b) 32c) Don’t know | 486983 | 24.034.541.5 |
Most respondents (58.0%) scored unsatisfactorily at 16 or less. The associations between knowledge score and demographic items are shown in [Table/Fig-2]. A statistically significant association between the total score of knowledge and demographic characteristics exists (p<0.05).
Association between the mothers’ knowledge score and demographic figures.
| Variables | Score | p-value |
|---|
| <16 (n=116; 58%) | ≥16 (n=84; 42%) |
|---|
| Age (year) |
| ≤30 | 60 (30.0%) | 38 (19.0%) | 0.042* |
| >30 | 56 (28.0%) | 46 (23.0%) |
| Education |
| None | 34 (17.0%) | 21 (10.5%) | 0.034* |
| Under diploma | 47 (23.5%) | 45 (22.5%) |
| University | 35 (17.5%) | 18 (9.0%) |
| No. of children | | | |
| 1 | 69 (34.5%) | 35 (17.5%) | 0.021* |
| ≥2 | 47 (23.5%) | 49 (24.5%) |
| Attending health education classes |
| Yes | 73 (36.5%) | 38 (19.0%) | 0.023* |
| No | 43 (21.5%) | 46 (23.0%) |
| Source of health information |
| TV and radio | 45 (22.5%) | 31 (15.5%) | 0.049* |
| RHH | 36 (18.0%) | 29 (14.5%) |
| Others | 35 (17.5%) | 24 (12.0%) |
*Chi-square test shows significant differences
Discussion
This study was conducted in rural areas of the Qazvin province, Iran, to explore the knowledge of mothers regarding the dental health of their children under age six and to assess the associated maternal factors. To authors knowledge, there are very few Iranian studies involving mothers of children in this age group.
The results of this study revealed that the mean knowledge of the mothers, which was just below the cut-off score, was an indication of an unsatisfactory level. In addition, the mothers’ knowledge score was significantly associated with demographic characteristics, such as age, education, number of children, attending health education classes, and source of information.
However, there are more studies for and against these findings, and it is noteworthy that there are no similar studies among Iranian rural women. A study by Shaghaghian S et al., showed that about 60% of mothers had satisfactory knowledge about their children’s dental health [9]. In a similar study conducted by Ibrahim, the mean knowledge score was 25 (out of 40), and the minimum score was 14, while the maximum score was 36. Moreover, 218 (58.4%) scored more than the cut-off point [10]. In addition, Shetty RM et al., and Reang T and found that most mothers in their studies were aware of the dental health risk factors of children [6,11].
In contrast with these studies, Suresh BS et al., found that the average mothers’ knowledge regarding children’s dental health, including brushing and knowledge about fluoride, was unsatisfactory, as nearly 73% of the mothers had inadequate or partial knowledge [12]. In addition, Akpabio A et al., aimed to explore mothers’ knowledge about children’s oral health and discovered that just up to 35% of the sample was aware of brushing and dental care [13].
These differences might be because the study population was situated in rural areas where the literacy was likely to be less than that in urban areas. In addition, if we reduce the cut-off point for the knowledge score, the results might be similar to these studies. Moreover, these differences might be due to the variation in the data collection instruments that the researchers used in their studies.
In parallel with the present findings, regarding the association between the mothers’ knowledge score about children’s dental health and their demographic characteristics, similar studies revealed a significant association between parents’ knowledge and their educational level [9,14], occupation, number of children [13], source of information [13,15], age, and attendance of health education classes [16-18].
Results of a systematic review to illustrate the effects of the family environment on children’s oral health by Castilho AR et al., showed an association between children’s dental health and parental dental health practices and awareness [19]. Another systematic review by Kumar S et al., to investigate the effect of parental socio-economic status on children’s Oral Health-Related Quality of Life (OHRQoL) revealed that parents with higher income levels and education had better OHRQoL. In addition, the mothers’ age and family structure were two significant predictors of children’s dental health [20]. Rad M et al., in a cross-sectional study among 1,554 school children, explored the vigorous association among mothers’ educations and jobs with children’s dental health [21].
Limitation
The present study has some limitation. Authors did not gather the information about family diet and oral health of children. Another limatation is the small sample size regarded to numerous villages in Qazvin province. Cross-sectional nature of this study, did not allow to assess the cause and effect relationship between mothers knowledge and children oral health.
Conclusion
In the present study, mothers had unsatisfactory knowledge of children’s dental health. Rural parents, especially mothers, need to be educated about their key position as role models for their children and be encouraged to improve their children’s dental health. Since this study was conducted in the rural areas of Qazvin province, Iran, conclusions cannot be applied to the entire population; thus, further studies with larger samples are recommended.
*Chi-square test shows significant differences