Feeding and oral hygiene habits of children attending ...

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Original Research Feeding and oral hygiene habits of children attending daycare centres in Bangalore and their caretakers oral health knowledge, attitude and practices Vinay S, Naveen N, Naganandini N Department of Public Health Dentistry, VS Dental College and Hospital, Bangalore, India

ABSTRACT

Received : 11-11-10 Review completed : 02-12-10 Accepted : 21-12-10

Aim: Caretakers in day-care centers play a significant role in imparting good oral hygiene practices and also extend a working relationship with parents with regard to their children’s oral health. As a result of this, caregiver’s dental knowledge, attitudes, beliefs and practices affect the child’s oral condition. Settings and Design: A descriptive cross-sectional study involved caretakers working in daycare centers of Bangalore. Fifty-two day-care centers were randomly selected from the different zones of Bangalore city, from which 246 caretakers provided consent for participation. Materials and Methods: A comprehensive, closed-ended, self-administered questionnaire was employed which was designed to collect the sociodemographic details and to evaluate the oral health knowledge, attitudes, practice of caretakers. The institutional review committee approved the study. Data were entered using SPSS 13.01. Results: Seventy-nine percent of the subjects had good knowledge of child’s tooth eruption time, clinical presentation of dental caries and the role of fluoride in caries prevention. Yet, half of the subjects found routine dental examination after all the milk teeth have erupted in the oral cavity insignificant and 41% strongly agreed that dentist should be consulted only when the child has a toothache. In spite of the good knowledge, 77% preferred to use pacifier dipped in honey/sugar if the children acted troublesome. Analogous to this, 45% gave milk/juice with sugar before the child’s nap time. Conclusions: The results of this study indicate that caretaker’s attitude toward oral health care needs is far from acceptable standards to mirror any positive impact on the children. Key words: Attitude, day care, dental caries, oral health, oral hygiene

Oral bacteria thrive in an environment with available dietary carbohydrates. So, parents must be taught to manage the infant/preschool children’s diet and their oral hygiene habits.[1] As it was conceived long ago, children are an important target group for oral health education and thus agreed among health educators. Dental health education given to mothers and aimed at children is more Address for correspondence: Dr. Vinay S E-mail: [email protected] Access this article online Quick Response Code:

Website: www.ijdr.in PMID: *** DOI: 10.4103/0970-9290.90298

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concerned with forming habits, rather than trying to manage established routines. This concept has yet another advantage when it comes to intervention. Behavior learnt during the child’s first year becomes deeply ingrained and resistant to change.[2,3] Intervention that requires behavioral change at a later stage is more difficult to implement and the chances of it benefiting dental health are less.[4] Children at this tender age inherit health practices from their parents, but in this workaholic era children often find themselves under the care of caretakers in places such as day-care centers. Day care is care of a child during the day by a person other than the child’s parents or legal guardians.[5] Bangalore has seen a recent escalation in the number of these day-care centers due to the economic and industrial boom in the previous decades. Bangalore is the capital of the Indian state of Karnataka. Located on the Deccan Plateau in the south-eastern part of Karnataka, Bangalore is India’s third most populous city and fifth most populous urban agglomeration.[6] Today, as a large city and growing metropolis, Bangalore is a demographically Indian Journal of Dental Research, 22(4), 2011


Vinay, et al.

Feeding and oral hygiene practices in daycare centres

diverse city, and a major economic and cultural hub in India.[7] Bangalore is known as the Silicon Valley of India because of its position as the nation’s leading information technology (IT) exporter as it contributed 33% of India’s IT exports in 2006-2007.[8-10] Bangalore is also not behind in the field of biotechnology. This industry comprises around 47% of the 265 biotechnology companies located in India.[11,12]

The growth of industrial sectors has presented the city with unique circumstances, which were never seen before, wherein lately, a number of mothers are employed outside their homes in order to improve their family living conditions. As a result, young children spend a considerable amount of time in day-care centers under the custody of caretakers. Caretakers in day-care centers play a significant role in imparting good oral hygiene practices and also extend a working relationship with parents with regard to child’s oral health. As a result of this, a young child’s dental environment becomes complex because his/her mother’s and/or caregiver’s dental knowledge, attitudes, beliefs and practices affect the child’s oral condition.[13,14] Despite this situation, majority of the studies have only focused on parents’, school teachers’[15] and even school children’s[16] oral health knowledge, attitudes and practices, and no study has been undertaken focusing the role of such caretakers in promoting oral health of young children under their care in day-care centers. Hence, this study was undertaken to assess oral health knowledge, attitude and practices of caretakers and the feeding and oral hygiene habits of the children visiting their baby day-care centers of Bangalore.

MATERIALS AND METHODS This descriptive cross-sectional study that was done using a self-administered questionnaire involved caretakers working in all the day-care centers of Bangalore. From a total of 327 day-care centers listed in the updated telephone directory[17] of Bangalore, 52 day-care centers, which are scattered throughout Bangalore city and are divided geographically into five zones [Appendix 1], were randomly selected by the investigators (see Appendix 2 for details of the sampling strategy). In a total of 52 day-care centers employing 260 caretakers, 246 provided consent for participation after the purpose and the nature of the study was explained to them. The response rate for the study was 94.6%. The common reason to refuse participation was time constraint. A comprehensive, closed-ended, self-administered questionnaire was employed which was designed to gather the sociodemographic details and to evaluate the oral health knowledge, attitudes, and practice of caretakers. This questionnaire was printed in both English and Kannada Indian Journal of Dental Research, 22(4), 2011

(regional language) for ease in understanding. It had 38 items, 15 each in the knowledge and practice components and 8 in the attitude components. The scoring for attitude was based on 5-point Likert scale,[18,19] while scoring for knowledge included true/false/don’t know responses and for practice included frequent/sometimes/never responses. The questionnaire was pilot tested on 10% of the study subjects and was assessed for the uniformity of interpretation. No major corrections were necessary. Hence, the data gathered during the pilot survey were also included in the study. The questionnaire took about 25 minutes to complete. The institutional review committee approved the study. Written consent was signed by every subject participating in the study. Data were entered using SPSS 13.01.[20]

RESULTS The sociodemographic characteristics of the caretakers are shown in Table 1. Majority of the caretakers were females and most of the caretakers were graduates. Majority of the caretakers had received some sort of training in caretaking of children. The number of children under each caretaker varied from 2 to 8, and the duration of the stay of these caretakers was determined by the working hours of the child’s parents. Table 2 shows the response of the caretakers for questions based on infant oral health knowledge. Seventy-nine percent of subjects had good knowledge of child’s tooth eruption time, 85% of the subjects correctly identified the clinical presentation of dental caries and 50% of the subjects acknowledged the role of fluoride in caries prevention. In Table 1: Sociodemographic characteristics of the subjects (N = 246) Variables Age Mean : 32.6 ± 14 years Gender Males Females Educational level Illiterate Up to SSLC Diploma holders Graduates/postgraduates Manpower Trained Untrained Mothers Grandparents Maids/helpers Number of children under care in their day-care center 1-5 6-10 11-15 16-20 >20

n (%) 23 (9.35) 223 (90.65) 12 (4.87) 26 (10.56) 49 (19.91) 159 (64.63) 139 (56.5) 81 (32.93) 8 (3.25) 18 (7.32) 68 (27.64) 107 (43.49) 48 (19.51) 14 (5.69) 9 (3.65) 562


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spite of this, 65% of the subjects ignored the importance of brushing baby’s teeth in maintaining oral health. Half of the subjects found routine dental examination after all the milk teeth have erupted in the oral cavity insignificant. The caretakers’ attitude toward infant oral health is shown in Figure 1. About 41% strongly agreed that dentist should be consulted only when the child has a toothache. Likewise, 25% agreed that removal of the tooth in case of toothache is the best solution. All sorts of dental treatments are expensive according to 63% of subjects.

Table 3 shows the response to oral hygiene practices. About 77% preferred to use pacifier dipped in honey/sugar if the children acted troublesome. Analogous to this, 45% gave milk/juice with sugar before the child’s nap time. Oral hygiene measures like rinsing the children’s mouths with water after every meal were practiced by 52% of the respondants. In the same way, 22% of the respondents frequently carried out tooth brushing in their day-care centers, whereas none of these oral hygiene measures were supervised by the caretakers according to 50% of the respondents.

Table 2: Oral health knowledge of infants among the subjects (N = 246)

Table 3: Subjects’ practices of infant’s oral hygiene measures and feeding practices (N = 246)

Questions

Questions

First tooth starts to appear in the mouth of child at the age of 6 months Tooth decay is observed as brown discoloration/hole Child’s first dental visit should be scheduled at the age of 1 year Brushing child’s teeth with fluoride toothpaste is important to prevent caries Using more than the necessary amount (peasized) of toothpaste is good for child’s teeth

True n (%) 195 (79.27)

False n (%) 18 (7.32)

Don’t know n (%) 33 (13.41)

210 (85.37)

22 (8.94)

14 (5.69)

40 (16.26)

123 (50.00)

83 (33.74)

124 (50.41)

35 (14.23)

87 (35.36)

23 (9.35)

141 (57.32)

82 (33.33)

Do you give milk/juice with sugar before the child’s nap time? Do you use pacifier dipped in honey/sugar if children acted troublesome? Do you make the children rinse their mouths with plain water after every meal? How often do you make children brush their teeth in the day-care center? How often do you assist or supervise the children during their oral hygiene practices?

A denst should be consulted only when the child has a toothache.

0

Removal of the tooth in case of toothache is the best soluon.

8

Frequent eang sweets and chocolates cause no harm to child’s teeth.

Agree

33

Don’t know

Never n (%)

111 (45.12)

57 (23.17)

78 (31.70)

190 (77.24)

38 (15.45)

18 (7.32)

127 (51.63)

14 (5.69)

105 (42.68)

53 (21.54)

85 (34.55)

108 (43.90)

89 (36.17)

35 (14.22)

122 (49.59)

26

2

54

34 51

105 122 40%

15

108

18

20%

49

142

20

6 32 7 0%

Strongly agree

88

14

Child’s teeth lost/removed for any reason need not be replaced.

Sometimes n (%)

105

51

All sorts of dental treatments are expensive.

Frequent n (%)

61 79

60%

Strongly disagree

80%

100%

Disagree

Figure 1: Subjects’ attitudes toward the oral health of infants (N = 246) 563

Indian Journal of Dental Research, 22(4), 2011



Vinay, et al.

This study presents a comprehensive overview of the oral health practices, knowledge, and attitudes of caretakers in day-care centers, and to the best of our knowledge, represents the first study of its kind in Bangalore city to explore these issues.

diseases. The first visit is non-threatening and requires minimal manipulation of the infant, but necessitates spending sufficient time with the parents for them to gather oral hygiene information and also to demonstrate appropriate home care procedures to the parents. A dentist, especially a pedodontist, is best qualified to perform this service.

Despite reductions in the prevalence of dental caries in many countries, children from disadvantaged communities continue to experience higher disease levels. However, in some countries, it appears that the underlying relationship relates to poverty, educational attainment and acculturation.[21] Parents or the caretakers of these children are held responsible for their oral hygiene and dietary practices, and in turn, the dental caries experience.

The driving factor behind visiting a dentist was toothache as reported by 41% of the subjects in the present study. A similar situation was noted by Chan et al.,[22] who noted 34% of the subjects reporting the same, and by Martignon et al.[23] who reported an alarming 60% for the same, reflecting the negligence shown toward routine dental examinations and also may be due to the false parents’ perception that no dental problem exists in their children.

DISCUSSION

A total of 260 subjects were approached from different day-care centers in Bangalore. Subjects’ interest in participation was noted, as it was encouraging that 246 subjects participated in the study with no restrictions, with a response rate of 94%. About 79% of the subjects correctly answered that the first tooth erupts around 6 months to 1 year time; these results contradict the results of a study conducted by Chan et al.,[22] where 15% of the subjects responded correctly. This low percentage of response is attributed to the subjects not being able to recall the time when the child’s first tooth erupted in the mouth, in spite of it being a momentous event in the lifetime of the child for the parent, as noted in the present study. Brushing children’s teeth was essential according to 78% of the subjects in the present study, whereas only 40% of the subjects believed so in a similar study conducted by Chan et al.[22] These findings reflect the awareness of subjects regarding the oral condition of the children. A greater impact on knowledge was noticed when the subjects were assessed with questions like “What does a decayed tooth look like?” for which 85% of the subjects could identify a decayed tooth as a black/brown hole on the teeth. This was in context with the current understanding of the pathology and recognizing enamel lesions and further it involved parents’ and caretakers’ interest in children’s oral health by means of observing their dentition. Identification of the disease plays a crucial role as it is the first step in treating or preventing the same. Forty percent of the subjects suggested that the child’s first dental visit should be around the age of 1 year. A similar observation was recorded by Chan et al.,[22] wherein 37% subjects reported the same. Very few infants younger than 1 year have oral problems that require intervention, but almost all have an oral environment at risk for oral Indian Journal of Dental Research, 22(4), 2011

A nursing bottle at nap time may be used as a form of comforter, thus creating a habit that is subsequently difficult to break. Forty-five percent of the subjects reported the practice of feeding children at nap time; similarly, this practice was being followed by 33% of the subjects as reported by Chan et al.,[22] in his study. Information on practical ways to control the bedtime feeding practices of young children needs to be made available. These nocturnal feeding habits are well known to contribute to caries development in young children. Monitoring the frequency of foods and liquids known to lower the pH is a high priority to reduce oral disease, beginning as early as infancy and early childhood.[24] It was encouraging to find oral hygiene measures practiced in some day-care centers like rinsing the child’s mouth with plain water after every meal and even making the children brush their teeth during their stay in the day-care center. However, 49% of the children were left to clean their teeth without the supervision of adults. Even though a child’s effort may be largely ineffective, they should not be discouraged from attempting to brush their own teeth as well as taking help from their parents or caretakers in completing the purpose of tooth brushing. With respect to the amount of toothpaste used to brush their teeth, 57% indicated that using more than the recommended amount of toothpaste for tooth brushing, that is “pea-sized”, has no additional benefit. Similar results were obtained in the study done by Martignon et al.[23] in Bogota, Columbia, wherein 50% of the subjects indicated the same. Use of small, pea-sized quantities of toothpaste by young children; parental responsibility for placement of toothpaste and actual brushing, with special attention to toothpaste flavored for children that may encourage ingestion and those with high fluoride concentration; and eliminating commercial promotion of use of a full strip of toothpaste are all important components of such efforts.[25] 564


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It is necessary to promote oral health awareness amongst the caretakers to facilitate early dental check-ups for young children. Such practices help in establishing behaviors in the preschool years, which provide a foundation for improving the oral health conditions and assessing the patterns for the use of dental services later in adulthood. A day-care center based program which consists of regular oral health education sessions and supervised daily tooth brushing with fluoridated toothpaste programs will be effective in establishing good oral health habits in children, which in turn will improve oral health knowledge and attitudes of their caretakers and parents, and reduce the development of new dental caries lesions. In conclusion, the results of this study indicate that caretakers’ attitude toward oral health and dental care needs to be improved. The positive outcome of the study is that it gives us an insight into a so far unknown domain.

APPENDIX 2 Sampling methodology

Bangalore is divided into five zones: north, east, south, west and central. This is geographic division is based on the location of major residential zones, population and the public amenities available surrounding these residential zones. Maternity and child care centers, schools and pre-schools, and day-care centers are located in all major residential zones and are easily accessed by public transport. Of the 327 day-care centers operating in Bangalore, a sample of 10 centers in each zone was randomly selected by the investigators from those in each zone. Bangalore-zones North East South West Central

No. of day-care centers sampled 10 10 12 10 10

APPENDIX 1 Bangalore zones North Murphy Town Old Madras Rd P and T Colony Periyar Nagar Pottery Town Queen’s Rd R R Mohan Roy Rd R T Nagar Main Rd Rabindra Nath Tagore Nagar RBI Colony Residency Rd Richards Town Richmond Rd Sagaya Puram Shivaji Nagar Sindhi Colony Someshwara Pura St Marks Rd Sultan Palya Taj Residency Taskar Town Trinity Church Rd Ulsoor Venkatesh Pura

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East Benson Town Binna Mangala Brigade Rd Cantonment Station Cavalry Rd Chandni Chowk Rd Church Street Cleveland Town CMH RD Commercial Street Cookes Town Cox Town Cubbon Rd Cunningham Rd Defence Colony Devara Jeevan Halli Dickenson Rd Doddi Gonta Domlur Village Frazer Town Gowtama Pura Gupta Layout H A L Rd Hanumantha Pura HMT Layout Indira Nagar Indiranagar 100 ft RD Indiranagar Double RD Infantry Rd Jayamahal Extn Jeevan Halli Kanteerava Stadium Kasturba Rd Kausalya Nagar Lakshmi Puram Lavelle Rd Lido Lingaraj Puram M G Rd Maciver Town

South Ashoka Pillar Avala Halli Azad Nagar Banashankari Bank Colony Bugle Rock Rd Bull Temple Byatrayana Pura Chamarajpet Chandra Layout Deepanjali Nagar GiriNagar Hanumantha Nagar Jayanagar K R Rd Kalasipalyam Karithimmana Halli Kempegowda Nagar Kumara Swamy layout Lalbagh Gardens Lalbagh West Gate Mysore Bank Colony N R Colony Nagasandra Sarakki Layout Shankara Puram South End Rd Srinagar Srinivasa Nagar Thyagaraj Nagar Valmiki Nagar Vani Vilas Rd Vidyapeetha Vishveshwarapuram Vittal Nagar

West Mamulpet Margosa Rd Mariyappan Palya Mekhri Circle Nagarthpet Navrang Rd Palace Rd Pipeline Rd Prakash Nagar Rajaji Nagar Rajmahal Vilas Extn Ramachandra Puram Raman Research Inst RPC Layout S J P Rd Sachidananda Nagar Sadashiv Nagar Sampige Rd Sanjay Nagar Sankey Tank Rd Sheshadripuram Sri Ramanamaharshi Rd Srirampuram Subash Nagar Subramanya Nagar Thimmenahalli Tumkur Rd Victoria Hospital Vidyaranya Nagar Vijayanagar Vyalikaval West of Chord Road Windsor Manor

Central Akkipet Anand Rao Circle Ashoka Hotel Ashwathnarayan puram Avenue Rd B V K Iyengar Rd Balepet Basaveshwar Nagar Bellary Rd Binny Layout Binnypet Blore City Railway St Chickpet Cottonpet Cubbonpet Dattatreya Temple Rd East of Chord Road Gandhi Nagar Gayathri Nagar Gopal Puram Goragunte Palya Govt Soap Factory High Grounds HosaHalli Extn IISc Industrial Town J C Rd K G Rd Keshav Nagar Krishnanand Nagar Kumarapark East Kumarapark West LIC Bhima Jyothi Nagar Lower Palace Orchards M S R Ind Estate M S Ramiah Hospital Madhav Nagar Magadi Rd MahaLaxmi Layout



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REFERENCES 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14.

Rugg-Gunn AJ, Roberts GJ, Wright WG. Effect of human milk on plaque pH in situ and enamel dissolution in vitro compared with bovine milk, lactose and sucrose. Caries Res 1985;19:327-34. Blinkhorn AS. Dental preventive advice for pregnant and nursing mothers-sociological implications. Int Dent J 1981;31:14-21. Petersen PE. Oral health behaviour of 6-year-old Danish children. Acta Odontol Scand 1992;50:57-64. Baric L, Blinkhorn AS, MacArthur C. A health education approach to nutrition and dental health education. Health Educ J 1974;33:79-90. Available from: http://en.wikipedia.org/wiki/Day_care [Last accessed on 2007 July 21]. India: largest cities and towns and statistics of their population. World Gazetteer. India’s 10 fastest growing cities. Rediff News. 2008-02-06. [Last accessed on 2007-04-07]. Bangalore: Growth opportunities in the Silicon Valley of India. Internationalisation Advisory. [Last accessed on 2007-08-20]. Location Roadmap for IT-BPO Growth. NASSCOM. [Last accessed on 2007-08-20]. Karnataka IT exports up by 52%. SiliconIndia.com. [Last accessed on 2007-08-20]. Jairam Ramesh. IT in India: Big successes, large gaps to be filled. Online Edition of the Business Standard dated 2007-09-30. [Last accessed on 2007-10-04]. Chatterjee, Sumeet. Biocon in drug development talks with Bayer. Online webpage of Reuters, dated 2007-10-04. [Last accessed on 2007-10-04]. Grytten J, Rossow I, Holst D, Steele L. Longitudinal study of dental health behaviours and other caries predictors in early childhood. Community Dent Oral Epidemiol 1988;16:356-9. Crawford AN, Lennon MA. Dental attendance patterns among mothers and their children in an area of social deprivation. Community Dent Health 1992;9:289-94.


15. Liu M, Zhu L, Zhang B, Petersen PE. Changing use and knowledge of fluoride toothpaste by school children, parents and school teachers in Beijing, China. Int Dent J 2007;57:187-94. 16. Al-Omiri MK, Al-Wahadni AM, Saeed KN. Oral health attitudes, knowledge, and behaviour among school children in North Jordan. J Dent Educ 2006;70:179-87. 17. Info media India limited, Info media Yellow pages, Bangalore, 2007-2008. 18. Skaggs EB, Grossman S, Krueger L, Krueger CF. Further studies of the reading-recitation process in learning. Vol. 1. Archives Of psychology. New York: Columbia University; 1930. p. 114. 19. William MR. Likert Scaling. Research methods knowledge base, 2nd ed. [Last updated on 2006 Oct 20]. [Last accessed on 2007 Apr 30]. 20. SPSS Inc. SPSS 13.0 for Windows. Chicago: SPSS Inc; 2005. 21. Crall JJ. Delivery systems for preschool children. Dent Clin North Am 1995;39:897-907. 22. Chan SC, Tsai JS, King NM. Feeding and oral hygiene habits of preschool children in Hong Kong and their caregivers’ dental knowledge and attitudes. Int J Paediatr Dent 2002;12:322-31. 23. Martignon S, Gonzalez MC, Santamaria RM, Jacome-lievano S, Munoz Y, Moreno P. Oral health workshop targeted at 0-5 yr old deprived children’s parents and caregivers: Effect on knowledge and practices. J Clin Pediatr Dent 2006;31:104-8. 24. Koranyi K, Rasnaka LK, Tarnowski KJ. Nursing bottle weaning and prevention of dental caries: A survey of paediatricians. Pediatr Dent 1991;13:32-4. 25. Levy SM, Kohout FJ, Kiritsy MC, Heilman JR, Wefel JS. Infants’ fluoride ingestion from water, supplements and dentifrice. J Am Dent Assoc 1995;126:1625-32. How to cite this article: Vinay S, Naveen N, Naganandini N. Feeding and oral hygiene habits of children attending daycare centres in Bangalore and their caretakers oral health knowledge, attitude and practices. Indian J Dent Res 2011;22:561-6. Source of Support: Nil, Conflict of Interest: None declared.

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