Effect of Dental Health Education on the Knowledge and Attitude Among Expectant Mothers: A Questionnaire Study.

BACKGROUND: Although dental caries levels have declined and stabilized the world over, the problem of early childhood caries has remained persistent in many areas of the world affecting certain segments of society, especially the socially deprived, who remain at high risk to this disease. Parents have an essential role in mediating between their children and environment for which prenatal period is the best time for health interventions. This mediation is done through preventive services they provide to their children such as dietary habits supervision, oral hygiene performance, and other practices that can be enhanced by prenatal dental health education.
PURPOSE: The purpose of the study was to evaluate, by means of a questionnaire, the expectant mother's knowledge and attitude toward dental health and to test the effectiveness of the health education tool.
MATERIALS AND METHODS: The baseline questionnaire consisted of 27 questions, which was distributed to 138 participants. Subsequently, provision for dental health education was made in batches of 20. After 3 weeks, 10 questions were randomly selected from the first questionnaire for reassessment session. Paired t test was used for statistical analysis.
RESULTS: The mean overall knowledge improved from 67.4% to 97.32% and attitude improved from 75.83% to 99.22%.
CONCLUSION: Knowledge and attitude of mothers was found to increase on provision of dental health education, which were retained even after a period of 3 weeks.

INTRODUCTION

Oral health forms a predominant part of overall health. Good oral health contributes to overall physical, mental, and social well-being of infants. Prevention of oral diseases among infants should begin early to ensure a successful oral health. Research shows that parents play a vital role for maintaining a good oral hygiene among their infants and toddlers. Expectant mothers are more prone to periodontal diseases and dental caries.

The level of education and socioeconomic status is significantly associated with oral health attitude and practice. A cross-sectional study conducted by Chaitra et al.[1] revealed that the knowledge of pregnant women of rural group about association of oral health and adverse pregnancy outcome was poor. Dental health education in pregnancy can lead to improved oral health and hence improved pregnancy outcomes. Insufficient knowledge in maintaining a good oral health and nutritional status can lead to complications such as preterm and low birth weight deliveries.[2] It can even adversely affect the infant oral health by increasing risks of developmental dental defects and caries. Oral diseases may affect the health of an expectant mother and the unborn child.

The purpose of oral health education program is to improve access to knowledge regarding anticipatory guidance to mothers during pregnancy. Because mothers play an important role in establishing positive attitudes, knowledge, and awareness to their children, an attempt was made to assess the knowledge and attitude toward oral health among expectant mothers.

AIM OF THE STUDY

The aims of this study were to assess the knowledge and attitude toward oral health among expectant women, and to evaluate the level of awareness after providing dental health education.

METHODS AND SUBJECTS

A cross-sectional survey was conducted at government primary health centers after obtaining the ethical approval from the institutional ethical committee. Written informed consent was obtained individually from all the participants who were willing to participate in the questionnaire survey. The subjects were asked to fill their personnel data regarding age, standard of education, order of pregnancy, and socioeconomic status of the individuals. The expectant mothers selected were between the age of 22 and 35 years, from low socioeconomic status, and were categorized based on their level of education as primary, middle school, high school, and higher secondary. A total of 197 subjects were selected for this study, of which 138 agreed to participate.

Data collection

The baseline questionnaire consisted of 27 questions based on a five-point Likert scale ranging from strongly agree to strongly disagree. The questionnaire was prechecked for construct validity and content validity with the coauthors of the study. All contents in the questionnaire were initially prepared in English followed by translation into the local language.

The baseline data were obtained based on questions pertaining to knowledge on nutrition and oral health, diet and dental caries, facts on oral health, dental visit, and preventive strategies. The other contents included their attitude toward oral hygiene and dental visit. The time allotted for the questionnaire survey was 20 min for each participant. After answering all the questions in the written format, provision for dental health education using audiovisual aids was carried out in batches of 20 and the time allotted for each session was 15 min. This presentation was an interactive one where the subjects were allowed to ask questions and any clarifications regarding the dental health education were cleared.

The same subjects were reassessed after 3 weeks. For this 10 questions were randomly picked from the first questionnaire. A total of 15 subjects withdrew from the study after which the total participants present were 123. While filling the reassessment questionnaire, women were not permitted to clarify any doubts and they were given 7 min for reassessment.

Statistical analysis

Students paired t test was used for statistical analysis with a P value set at 0.005.

RESULTS

Results of paired t test showed most of them had a good baseline knowledge toward nutrition and dental health, which even improved on provision of dental health education [Table 1]. The baseline data showed that knowledge on nutrition and dental health was 72.76%, which increased to 96.59% on provision of dental health education. The knowledge on facts of oral health improved from 69.43% to 98.86%. Participants showed an improved knowledge on diet and dental caries from 62.70% to 96.69%. The overall knowledge on teething, eruption, and malocclusion increased from 65.15% to 97.89%. The results of knowledge on preventive strategies improved from 66.96% to 96.56% and showed highly significant statistical values.

Table 1

Overall improvement in the knowledge of expectant mothers pre- and post-dental health education results after a waiting period of 3 weeks

			N	Mean	Standard deviation	Mean %	t	P
Knowledge	Nutrition and dental health	Pre	123	3.64	0.717	72.76	15.71	<0.001**
		Post	123	4.83	0.399	96.59
	Facts of oral health	Pre	123	3.47	0.537	69.43	27.83	<0.001**
		Post	123	4.94	0.233	98.86
	Diet and dental caries	Pre	123	3.13	0.562	62.70	29.70	<0.001**
		Post	123	4.83	0.253	96.67
	Teething, eruption, and malocclusion	Pre	123	3.26	0.679	65.15	23.60	<0.001**
		Post	123	4.89	0.380	97.89
	Preventive strategies	Pre	123	3.35	0.560	66.96	21.29	<0.001**
		Post	123	4.83	0.507	96.59
Attitude	Oral hygiene	Pre	123	4.74	0.32	94.78	8.69	<0.001**
		Post	123	4.96	0.11	99.24
	Dental visit	Pre	123	3.69	0.690	73.72	19.60	<0.001**
		Post	123	4.96	0.198	99.19

P = Level of significance. **Values are statistically highly significant on both knowledge and attitude

The baseline data on attitude obtained from their first dental visit were 73.72%, which drastically improved to 99.19%. The attitude level on oral hygiene improved from 94.78% to 99.24%. The results were found to be highly significant. The mean overall knowledge improved from 67.4% to 97.32% and attitude improved from 75.83% to 99.22%.

DISCUSSION

Tooth decay remains a substantial problem in many children. It is made even worse by the existing barriers that prevent them from obtaining proper dental care. Infancy and toddlerhood are considered as critical times in terms of risk of early childhood caries, dental injuries, and so on. Researches show that mothers play an important role in the decision-making processes regarding health care for their children.[3] A cross-sectional study conducted by Nagi et al.[4] reported that knowledge and practices of pregnant women should be improved for better pregnancy outcomes.

Identifying the indispensable role of mothers about health care for their children becomes mandatory to assess the knowledge and attitudes regarding infant oral health and educating them as they are the primary caregivers.[5]

A study by Reddy et al.[6] showed that the women were not conscious of oral cavity conditions that occur during pregnancy and the need for meticulous management of oral hygiene and treatment by a dentist.

The intention of pediatric dentists is to focus and promote on early positive aspects on oral health care. In this study a five-point Likert scale was chosen since it does not require the participant to provide a concrete yes or no answer. Moreover it allows the participants to show their level of agreement (from strongly disagree to strongly agree) with the given statement (items) on a metric scale. Here all the statements in combination revealed the specific dimension of the attitude toward the issue, hence necessarily interlinked with each other.[7]

The results of the study showed a significant increase in both the knowledge and attitude among the expectant mothers. The knowledge was imparted with regard to weaning and effects of cariogenic diet and its role on dental caries. In a questionnaire study reported by Mani et al.,[8] only 3% of the caretakers practiced the right time to start giving semisolid food for a child at the nursery and most of them (64.7%) started feeding semisolid food for a child at the nursery at the age of 1 year, thus increasing the risk factors of caries.

The knowledge on preventive strategies was very low before giving them oral health care awareness, which improved significantly with the post-questionnaire tests. The most effective level was observed with facts on oral health, which showed a significant improvement.

The attitude regarding dental visit, in the first questionnaire, was that most of the mothers felt it is not essential to visit a dentist biannually. With provision of the importance of dental visit, the posttest results showed positive outcome. These women often fail to realize that their behavior and attitude toward oral health during pregnancy can have an effect on their child’s oral health. Many of these women were not aware of the fact that tooth development takes place between sixth and eighth week in utero.

Baseline data obtained showed that the subjects in this study did not have any knowledge on the importance of deciduous teeth and its oral hygiene, the possible sequelae of caries with intake of carbohydrate diet, and when it is important to start weaning. This study investigated this issue and it was encouraging to see that these women showed positive attitude toward retaining the knowledge of prenatal dental health education imparted to them even after 3 weeks.

Most pregnancy follow-up appointments are performed on a monthly basis. Therefore, it is important to assess if this knowledge could be retained between follow-up appointments during pregnancy as an effective measure for education and reinforcement.

Cardenas LM et al.[9] demonstrated an average of 34.67% improvement in knowledge with provision of prenatal dental health education among expectant mothers. The American Academy of Pediatric Dentistry (AAPD) recently introduced guidelines on perinatal oral health care. These guidelines suggest anticipatory guideline education to the mother about prevention of dental caries through diet, oral hygiene, fluoride and delay of colonization, and professional oral health care. In the present study, knowledge was imparted on the factors recommended by the AAPD, which worked out well on these expectant mothers.[10]

Grael AMF et al. Adriana et al.[11] conducted a study to evaluate the degree of knowledge about oral health in a group of 60 pregnant women before and after providing access to an educational manual. The study concluded that there was an increase in knowledge in the expectant mothers after providing access to prenatal dental health education.

Paradis et al.[12] reported that a 15-min educational DVD of newborn about anticipatory guidance had a positive impact on parent’s knowledge about routine child care.

Prenatal education is the key to dental care of the infant, because mothers serve as models for their children and a good oral health of the infant relies on the knowledge of the parent towards oral health.[13] The results from this study showed an above average knowledge among mothers about infant oral health, and a higher number of mothers showed comparatively better knowledge and attitude with provision of dental health education. Studies of same design need to be conducted on larger samples and on different sectors of population and groups so as to evaluate the knowledge and attitude with a long-term follow-up up to their delivery, even during their nursing period.

CONCLUSIONS

Based on the results of this study, the following conclusions were arrived at:

Knowledge and attitude of mothers were found to increase on provision of dental health education.

Educating pregnant women on oral health can be beneficial and pregnant women were capable of retaining most of the information for at least 3 weeks.

Information on oral health should be included in education provided to pregnant women, especially for those of underserved backgrounds (who are at increased risk) through federal and/or state-based programs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.