Perception of Saudi parents towards the problems related to primary dentition of their children residing in Riyadh city.

BACKGROUND: The parental awareness and perceptions help in early recognition of problems in deciduous dentition, which will help us plan better preventive measures. Hence, the present study was conducted to evaluate the perceptions of Saudi parents residing in Riyadh towards the problems related to primary dentition of their children.
MATERIALS AND METHODS: A cross-sectional study was conducted on the patients attending private dental institution in Riyadh city. Information about demographic details, questions related to maintenance of primary teeth, and future implications of poor primary dentition health were collected. Descriptive statistics and Chi-square test were used for the analysis. The level of significance was set at P < 0.05.
RESULTS: A total of 1773 male and females filled up the survey form, which comprised of 28% males and 72% females, and maximum parents (68%) were university graduates. Overall better responses were in females and parents having more children.
CONCLUSION: Over all mothers had a higher level of knowledge and positive attitude towards their children's oral health as compared to fathers. Developing and strengthening optimistic outlook among parents towards oral health especially primary dentition is utmost important. Copyright:

Introduction

In developing and maintaining the fundamental life functions of the child-like phonetics and eating, an essential role is played by primary dentition. Regardless of its well-established importance, in majority of the population, the care of deciduous teeth is not considered crucial owing to the belief that primary teeth will eventually shed off with no harm to permanent dentition. Recently, there has been an increase in the incidence of dental caries in primary dentition termed as early childhood caries. This might result in pain, decline in food intake, and consequently extend to malnutrition.[12]

A child might also suffer from oral problems like pernicious habits of thumb sucking, tongue thrusting, and bruxism. These destructive habits if not stopped after certain time lead to malocclusion and might necessitate orthodontic management along with employment of habit breaking appliances.[2]

Another problem related to primary dentition is majority of the parents are unaware of the correct protocol that should be followed if their children face dental trauma. The trauma to primary dentition might lead to disturbances with eruption, enamel hypoplasia, white spots, intrusion, and extrusion in permanent teeth.[34]

Being dependent on the awareness, comprehension and the mind-set of the parents, the oral health of children might be compromised.[56] There are evidences in the literature that least interest is given to dental problems and furthermore the primary dentition is additionally ignored.[7] In growth and development of the child, parents especially mother plays a critical part since they are the chief decision makers of to their children's health. Thus, their awareness about dental health is important so that they can be guided and instructed to prevent the development of various oral problems.[8] A major disparity between medical opposed to oral health provision is that the caregivers usually offer access to medical services by taking the child to a professional, however for oral health, in addition to seeking professional aid; there is also partaking by parents during tooth brushing and ensuring that there is no excess intake of sugary foods.[9]

However, in this workaholic era of the 21st century, most of the parents do not get sufficient time to dedicate to their family care.[10] Several studies have taken place in order to measure the level of knowledge and attitude of parents towards the problems related to their children's dentition and not much research is done in this area in Saudi Arabia.[1112] The parental awareness and perceptions help in early recognition of problems in deciduous dentition which will help us plan better preventive and interceptive orthodontics or other dental treatment modalities so as reduce or avoid adult oral problems, the time required for treatment, and thus decrease the economic burden which parents face for such treatments and improves the overall quality of life of the child.[7]

Literature reveals that the attitude towards oral habits varies among different ethnic groups since they differ in culture, beliefs and awareness, as well as socioeconomic development and caring level and not much research is conducted in Saudi.[8] Hence, the present study was conducted to evaluate the perceptions of Saudi parents residing in Riyadh towards the problems related to primary dentition of their children.

Materials and Methods

A cross-sectional study was conducted on the patients attending private dental institution in Riyadh city. A pilot study was conducted on 50 patients for the determination of sample size. These patients did not participate in the main study. The sample size was calculated with the help of Epi Info software, and it was found to be 1500. The nonresponse rate was assumed to be 15%, and the final sample size was adjusted by the formula: final sample size = effective sample size/(1-nonresponse rate anticipated), which gave the figure of 1764, keeping in mind the outliers the survey was conducted on 1773 participants.

The questionnaire was first prepared in the English and then translated to local language and again back translated to English for checking language reliability by a person expert in both languages. Analysis revealed that reliability and content validity of the questionnaire was acceptable (Cohen's kappa statistics = 0.82 and Aiken's V index = 0.83, respectively).

Permission for conducting the study was obtained from the Institutional ethical committee The study proposal was submitted to the research Centre of Riyadh Elm University ethical approval was obtained from Institutional Review Board [RC/IRB/2019/262] on 02-10-2019. The study procedure was explained to each participant and written informed consent was acquired. All the patients who have at present or had in past 2 years child/children of ≤5 years were included.

Parents were provided with a self-administered, close-ended questionnaire consisting of information about their demographic details, questions related to primary dentition, maintenance of oral health, oral habits of the child, parental experience of trauma management, and future implications of poor primary dentition health.

The data were entered into an MS Excel sheet. Descriptive statistics and Chi-square test were used for the analysis. The level of significance was set at P < 0.05. SPSS version 19 (IBM, Chicago, IL, USA) software was used to perform the statistical analysis.

Results

A total of 1773 male and females filled up the survey form, which comprised of 28% (n = 495) males and 72% (n = 1278) females, and maximum parents (n = 1199; 68%) were university graduates and from age group of 18–30 years (n = 827; 47%) with 38% (n = 665) having 1–3 children and 56% (n = 977) have moderate income [Table 1].

Table 1

Demographic distribution of study participants

Demographic variables	Number	Percentage
Gender
Male	1277	72
Female	496	28
Education level
≤Primary	89	5
High school	479	27
University	1206	68
Age group (in years)
>18	53	3
18-30	408	23
31-45	833	47
>45	496	28
Number of children
1-3	674	38
4-5	550	31
>6	230	13
None	337	19
Income
Low	780	44
Moderate	993	56
High	0	0

The distribution of responses with respect to gender showed slightly better responses in females than males related to health of primary dentition, e.g., 24 females and 22 males had visited to dentist for fissure sealant. After the early loss of primary tooth, it should be replaced by space maintainer was rightly answered by 24 females and 18 males. Similarly, when parents were compared in terms of number of children, better responses were found in those who had more children compared to others [Table 2]

Table 2

(a) Comparison of the study participants based on gender and number of children

Item					M	F	P		1-3	3-5	>6	P
When should you start maintaining the oral hygiene for your child	Right after birth				7	1	0.184		8	10	7	0.001*
	When first tooth erupts				56	52		60	47	42
	After first dental caries				37	47		32	43	51
How many teeth there are in primary dentition	10				41	27	0.001*		31	24	26	0.001*
	16				28	32		32	34	28
	20				25	30		30	28	36
	32				62	11		7	9	8
Maintenance of primary dentition is less important than permanent dentition	Definitely Yes				29	20	0.001*		20	24	28	0.030*
	Maybe				38	35		36	35	32
	Definitely No				33	45		44	41	40
Frequency of tooth brushing by your child?	Does not brush				14	11	0.001*		12	9	12	0.001*
	Once a day				42	51		51	53	49
	Twice a day				27	30		32	28	28
	Do not know				17	8		5	10	11
Do you resist when your child asks for sweets and snacks?	Yes				9	11	0.001*		12	11	6	0.003*
	No				29	20		19	21	25
	Sometimes				62	69		69	68	69
Do you need more information about maintaining primary dentition?	Yes				90	84	0.001*		86	85	82	0.177
If your child lost a primary tooth early what of the following is important to do?	Brushing of the space				9	10	0.073		9	9	11	0.476
	Space maintainer device				18	24		21	24	21
	Do nothing				73	66		70	67	68
If your child has a trauma on his teeth what you do?	Wash the teeth with clean water				16	17	0.009*		19	16	12	0.062
	Wash it with salted water				20	27		22	27	27
	Go to dentist				64	56		59	57	61
What do you usually do when a child’s teeth start to be lose?	Extract at home				49	56	0.001*		48	61	64	0.001*
	Visit a dentist				29	20		25	17	17
	Do nothing				22	24		27	22	19
Have you ever heard about the fissure sealant?	No, I have not heard about it				66	62	0.393		65	60	63	0.204
	Yes, I visited the doctor for it				22	24		21	28	25
	Yes, I did not visit the doctor for it				12	14		14	12	12
(b): Comparison of the study participants based on gender and number of children
Item		M	F	P		1-3		3-5		>6		P
Have you received instructions from dentist about maintaining health of primary dentition of your children?	Yes	43	51	0.002*		48		54		53		0.001*
	No	38	30			23		28		28
	Do not know	19	19			29		18		19
Has a family member/friend advised you to maintain health of primary dentition?	Yes	57	57	0.299		58		60		60		0.001*
	No	30	28			30		27		25
	Do not know	13	15			12		13		15
Poor health of primary dentition may affect permanent dentition in future?	Yes	65	74	0.002*		71		75		74		0.002*
	No	7	6		6		5		9
	Do not know	28	20			23		20		17
Spaces in teeth due to primary teeth shedding are important factor in determining future dental health.	Yes	46	54	0.003*		46		56		62		0.001*
	No	8	5			5		5		4
	Do not know	54	41			49		41		34
Abnormal oral habits like (thumb sucking and nail biting, etc.) may affect permanent dentition in future?	Yes	72	84	0.001*		80		83		84		0.004*
	No	10	6			7		5		4
	Do not know	18	10		13		12		12

Table 3 shows that not much difference was found when parents were compared based on education level. For few items, response was better in graduates like importance of health of primary teeth, maximum correct answer was given by graduates (n = 73), followed by high school pass out (n = 67), and least by those were in those who educated till primary (n = 64), and this difference was significant responses were seen in compared to other (P < 0.05)

Table 3

(a) Comparison of the study participants based on education

Item			<Primary	<High school	Graduate	P
When should you start maintaining the oral hygiene for your child	Right after birth		9	8	8	0.001*
	When first tooth erupts		38	47	57
	After first dental caries		53	45	35
How many teeth there are in primary dentition	10		32	33	29	0.321
	16		27	27	33
	20		27	30	29
	32		14	10	9
Maintenance of primary dentition is less important than permanent dentition	Definitely Yes		34	28	20	0.001*
	Maybe		35	38	35
	Definitely No		31	34	45
Frequency of tooth brushing by your child?	Does not brush		11	12	11	0.955
	Once a day		49	49	49
	Twice a day		31	28	29
	Do not know		9	11	11
Do you resist when your child asks for sweets and snacks?	Yes		11	10	11	0.831
	No		22	21	23
	Sometimes		67	69	66
Do you need more information about maintaining primary dentition?	Yes		90	88	85	0.104
If your child lost a primary tooth early what of the following is important to do?	Brushing of the space		12	10	9	0.51
	Space maintainer device		20	20	24
	Do nothing		68	70	67
If your child has a trauma on his teeth what you do?	Wash the teeth with clean water		17	17	16	0.502
	Wash it with salted water		20	28	25
	Go to dentist		63	55	59
What do you usually do when a child’s teeth start to be lose?	Extract at home		63	57	52	0.136
	Visit a dentist		20	24	23
	Do nothing		17	19	24
Have you ever heard about the fissure sealant?	No, I have not heard about it		63	63	63	0.297
	Yes, I visited the doctor for it		30	22	24
	Yes, I did not visit the doctor for it		7	15	13
(b): Comparison of the study participants based on education
Item		<Primary	<High school	Graduate		P
Have you received instructions from dentist about maintaining health of primary dentition of your children?	Yes	53	45	50		0.118
	No	23	33	31
	Do not know	24	22	19
Has a family member/friend advised you to maintain health of primary dentition?	Yes	64	59	56		0.404
	No	22	26	30
	Do not know	14	15	14
Poor health of primary dentition may affect permanent dentition in future?	Yes	64	67	73		0.027*
	No	8	8	5
	Do not know	28	25	22
Spaces in teeth due to primary teeth shedding are important factor in determining future dental health.	Yes	54	50	52		0.730
	No	3	7	5
	Do not know	43	43	43
Abnormal oral habits like (thumb sucking and nail biting, etc.) may affect permanent dentition in future?	Yes	74	74	83		0.001*
	No	7	10	6
	Do not know	19	16	11

Discussion

This study aimed to assess the Saudi parents’ knowledge about their children's primary dentition and related problems. Untreated primary teeth can cause various complications such as pain, infections, alterations in growth and development, problems in eating and sleeping, and malnutrition.

The gender comparison showed that overall results were better in females compared to males. This showed a positive knowledge and attitude level of mothers as compared to the fathers. Similar findings were reported by studies conducted by Rajab et al. and Chhabra & Chhabra.[1314] This could be attributed to the fact that in general the primary caregiver of the child is mother compared to father who plays part more in the financial support.[15]

Furthermore, comparison on the basis of number of children showed that the parents having six or more children showed better knowledge than other parents. Other studies have supported the fact that having more children leads to a better attitude and knowledge towards the health of primary dentition of the children.[16] The possible explanation for this could be the experience from previous child/children might have lead to the better understanding of importance of maintaining of health of primary teeth.

Educational levels have a great deal of effect on the oral health of people themselves as well as their children. Low educational groups have demonstrated a poor quality of oral health among the families.[12] However, we did not find many significant comparisons when compared the survey responses on the basis of educational levels. Such inconsistencies in our results might be due to fact that study was conducted on parents attending dental institution and such parents might be better oriented towards oral health, thus diminishing the actual influence of socioeconomic status.

Although the validity and reliability of the questionnaire was tested, in-built limitations of the questionnaire studies should be based in mind and these results should be considered as preliminary. The homogenous sample of parents reporting to dental institutions only might have resulted in bias in the final outcomes and warrants further researches with more heterogeneous population.

Conclusions

Overall mothers had a higher level of knowledge and positive attitude towards their children's oral health as compared to fathers. Parents are ultimately responsible for their children's health care, including oral health. Promoting and strengthening optimistic outlook among parents towards oral health especially primary dentition is utmost important. There should be development of programs for parents oriented towards child oral health with active parental participation and by integrating even medical professionals in which information about importance of primary teeth and preventive care of these teeth should be conveyed.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.