RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE KARNATAKA BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidate and address (in block letters)

JORLEY GEORGECITY COLLEGE OF NURSINGCITY ENCLAVESHAKTHINAGARMANGALORE.575016

2. Name of the Institution CITY COLLEGE OF NURSINGCITY ENCLAVESHAKTHINAGARMANGALORE.575016

3. Course of Study and Subject M. Sc. NURSINGPAEDIATRIC NURSING

4. Date of Admission to the Course 4.6.2008

5. Title of the study

ASSESSMENT OF KNOWLEDGE AND PRACTICE OF

MOTHERS ON PREVENTION OF DENTAL CARIES AMONG

CHILDREN IN A SELECTED URBAN COMMUNITY AT

MANGALORE WITH THE VIEW TO DISTRIBUTE A

PAMPHLET.

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6. Brief resume of the intended work6.1 Introduction

Early childhood caries (ECC) is still a major health problem in developing countries1. Dental caries has been recorded since times immemorial. It has been mentioned in ‘sushruta samhita’ under disorders of mouth ‘mugha roga.’ The term caries means decay of animal tissue. It has affected the teeth of all nations irrespective of geographic and bio-cultural difference. It may affect the primary dentition as soon as infant teeth erupt. Approximately one-quarter of children and adolescents experience more extensive caries that extends to the less susceptible smooth surface of the teeth. The 25% of children who experience this pattern of decay account for 80% of the total number of permanent teeth affected by caries2. It is crucial to control the disease process by assessing and rendering the treatment required along with the spreading awareness regarding prevention3. Prevention and management of dental caries are dependent on a clear understanding of the dynamics of the multifaceted variables that determine not only the initiation of the disease but also its course over an extended period of time.4

6.2 The need for the studyThe prevalence of caries is increasing rapidly in developing nations, which is

of concern because dental caries is mostly a childhood disease and 80% of the world’s children live in the developing countries. The most likely reasons for this increase in developing countries is a combination of poor nutrition and poor oral hygienic practices.2

The Child Dental Health Survey (CDHS) of Western Australia indicated that children as young as five years of age could have high levels of caries. Dental caries was the fifth most common cause of hospitalisation among preschool children aged 1-5 years5. The U.S. National Health and Nutrition Examination Survey (NHANES) found that 41% of children aged 2–11 years had dental caries of their primary teeth and 21% of children had untreated dental caries 42% of children aged 6–19 years had dental caries of their permanent teeth and 14% of children had untreated dental caries. World oral health reported that 18% of children aged 2-4 years had dental caries.6

Children constitute 40% of total population in India and of these 270 million are suffering from dental caries. In India incidence of dental caries is very high among children and the problems of dental caries has been increasing during the last four decades, both in terms of incidence and severity9. Presently the prevalence rate of dental caries is above 80% with five decayed teeth per child.7

Dental caries is an infectious disease is primarily due to the colonisation of oral bacteria. The main risk factors of dental caries are late age to begin tooth brushing, lack or infrequent visits to the dentists, infrequent and short duration

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of tooth brushing. Infants or children who are breastfed for more than six months or who are bottle-fed with bottles that contains sweetened milk or fruit juice appear to be at increased risk for dental caries8.

Parental and other family characteristics influence children’s health-related behaviour and health. Children’s poor oral health has been found to be associated with low socioeconomic status of the family and parents’ poor oral health-related behaviours. In addition, parents’ health-related attitudes, knowledge and health have been found to influence children’s oral health behaviour and oral health. Carious primary teeth are a well recognised source of pain and discomfort, and when it strikes, it is distressing for the child and is disruptive for other family members10

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Prevention of dental caries can be achieved by the education of prospective and new parents by teaching good oral hygienic practices11.

A cross-sectional study was conducted to investigate the prevalence and severity of dental caries and their association with demographic and socioeconomic variables in Brazilian preschoolers. The study population comprised of 1487, 0- to 5-year-old children attending government nurseries in Canoas, southern Brazil. Questionnaires regarding baseline characteristics were completed by the parents. Clinical examinations were carried out by five trained examiners and results were expressed using the deft index (World Health Organisation criteria), including white spots. The results showed that 40% of the children presented dental caries [mean deft (SD): 1.53 (2.75)]. Deft increased with age (P < 0.001) and was significantly higher in children of mothers with low educational level (P = 0.001) and low family income (P = 0.001). The greatest increase in caries prevalence and severity occurred between age groups of 1 and 2 years. These findings indicate the need for preventive programmes, which should begin in the first year of life, with special attention given to families with mothers presenting low education levels12.

A descriptive survey was conducted to identify the attitude of mothers towards their children’s oral health behaviour and prevalence of dental caries among children in the age group of 3-5 years residing in municipality limits of Hubli, Karnataka. The sample consisted of 1500 children and 200 mothers selected by using simple random sampling technique. Caries was recorded on the basis of dmft (decayed, missed or filled teeth) index. Mothers’ response was recorded based on the structured questionnaire; 47.5% mothers showed interest in their children’s oral health and 52.5% were not showing any interest. The result showed that overall prevalence of dental caries was 54.1%. The difference in the carious prevalence was significant (P<0.05) between the age group of 3, 4, and 5 years and highly significant (P < 0.001) between the age group of 3 and 5 years. The researcher concluded that the percentage of missing and filled teeth increased with advancing age and mother’s attitude had an impact on child’s oral health and hence they play a key role in inculcating healthy oral habits.15

On extensive review of literature and community field experience the

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investigator found that there is need to assess the existing knowledge and practice of mothers towards prevention of dental caries, with a view to identify the areas of knowledge and practice deficit and to strengthen those area by establishing appropriate measures.

6.2 Review of literatureA retrospective study was conducted to determine the dental status of 3 year

children and identify the principal determinants of early childhood caries in the community of Carman. Children and their mothers were selected by using convenient random sampling technique. Mothers were interviewed regarding feeding methods, oral hygiene, and frequency of snacking, child’s dental history, family characteristics and demographics. Early childhood caries (ECC) were determined using dmft index adopted by American Academy of Paediatrics. The result showed that the prevalence of ECC was 44%, while the mean dmft was 2±3.3. Increased caries activity and ECC were associated with lower maternal level of education (p<0.01). Family size was associated with dmft scores (P=0.03) while the presence of debris was also associated with ECC (p<0.05). The researcher concluded that the factors most associated with increased caries activity included low maternal education and increased family size.14

A cross sectional study was conducted to identify the relationship between dental caries and dental plaque among 12-36 month old children in Tehran. Five hundred and four children aged 1-3 years were selected by using stratified random sampling technique. Mothers were first interviewed with a pre-tested structured questionnaire and after that children were examined according to the WHO criteria. The result showed that the prevalence of ECC in younger age group (12-15 months) was 3%, being 9% for 16-19, and 14% for 26-36 months old (p<0.001). Dental plaque was visible on at least one index tooth for 65-75% of the children (p<0.001). It shows that the lack of oral health care for this age group. The researcher concluded that ECC was more prevalent in children with more dental plaque, especially in the children of low educated parents3

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A study was conducted to assess the parent’s knowledge and attitude towards prevention of dental caries in their children in Al-Ahsa region Saudi. Nine hundred and fifty-two parents were selected by using non-random sampling method and questionnaires were used to collect the data. The results showed that 74.6% male and 73.9% of female parents carried out tooth brushing for their children to prevent dental caries while more than 50% of both parents practiced sugar reduction and dental education. Dental visits were not regarded as an effective method (12.0%) in reducing dental caries. Significant differences were observed between the parents based on their educational level except in dental education to the children. Chi-square tests showed P < 0.0001 for brushing, P < 0.041 for sugar reduction and P<0.002 for dental visits. The family income significantly influenced only the tooth brushing habits (P=0.003). Based on the results, the researcher concluded that dental

knowledge and attitudes were influenced by level of education and family income

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but not by age or sex13.

A cross-sectional study was conducted to assess the dental caries experience of preschool children in Italy. 2-6 year old children were randomly selected for the study. WHO diagnostic criteria for dental caries were adopted, dmft and SIC Indices were used to measure the severity of the disease. The result shows that ECC prevalence and mean deft by age were: 3 years 13.28% and 0.53 (SD±1.83), 4 years 18.95% and 0.83 (SD±2.24); 5 years 26.9% and 1.34 (SD±2.8), SIC index values were 1.6 at 3 years, 2.4 at 4 years, 4 at 5 years. The researcher concluded that the prevalence of dental caries increased with age and the percentage of children affected by caries doubled between 3 and 5 years.17

6.3 Statement of the problemAssessment of knowledge and practice of mothers on prevention of dental

caries among children in a selected urban community at Mangalore with the view to distribute a pamphlet.

6.4 Objectives of the study1. To determine the level of knowledge among mothers on prevention of dental

caries among children as measured by structured knowledge questionnaire.

2. To identify the practice among mothers on prevention of dental caries among children as measured by rating scale.

3. To find the correlation between knowledge and practice of mothers on prevention of dental caries.

4. To find the association between the knowledge and practice scores of the mothers with the selected demographic variables.

6.5 Operational definitions1. Knowledge: It refers to the right responses given by mothers to the questions

asked by the investigator during the interview regarding prevention of dental caries.

2. Practice: It refers to the measures taken by the mother to prevent dental caries in their children as expressed by them in terms of scores on a practice questionnaire related to brushing technique, oral hygienic practices, dietary pattern and dental check up.

3. Prevention of dental caries: In this study prevention of dental caries refers to measures taken by the mother on factors that place a child at high risk for the development of dental caries.

4. Pamphlet: A pamphlet is a visual teaching aid that consists of information related to prevention of dental caries with regards to oral hygienic practices,

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brushing technique, dietary patterns and dental check up.

5. Children: In this study children refers to those in the age group between 1 to 5 years.

6.6 Assumptions1. Mothers have some knowledge on prevention of dental caries

2. Knowledge influences the practice.

6.7 DelimitationsThe study is delimited to mothers those who are having children in the age group of 1-5 years in the selected community.

6.8 HypothesesAll hypotheses will be tested at 0.05 level of significance.

H1: There will be significant correlation between knowledge and practice scores of mothers regarding prevention of dental caries among their children.

H2: There will be significant association between knowledge and practice scores of mothers on prevention of dental caries with their selected demographic variables.

7. Material and methods7.1 Source of data

Mothers who have children in the age group of 1-5 years in a selected community at Mangalore.

7.1.1 Research designA descriptive correlative research design is adopted for the study to find out the relationship between knowledge and practice of mothers regarding prevention of dental caries.

7.1.2 SettingThe study will be conducted in a selected urban community at Mangalore.

7.1.3 PopulationPopulation under this study consists of the mothers who are having children in the age group of 1-5 years.

7.2 Methods of data collection7.2.1 Sampling procedure

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Purposive sampling technique will be adopted for this study

7.2.2 Sample sizeIn this study the sample consist of 60 mothers having children in the age group of 1-5 years.

7.2.3 Inclusion criteria for sampling Mothers who are willing to participate in the study. Mothers having children in the age group of 1-5 years. The mothers who can communicate in English or Kannada.

7.2.4 Exclusion criteria for sampling Mothers who are health professionals.

7.2.5 Instruments intended to be used A structured knowledge questionnaire will be used to determine the

knowledge of mothers regarding prevention of dental caries. Rating scale will be used to determine the practice of mothers towards the

prevention of dental caries.

7.2.6 Data collection methodMothers who have children in the age group of 1-5 years from a selected community would be selected by using purposive sampling technique. Knowledge will be assessed by using structured knowledge questionnaire and practice of mothers on prevention of dental caries will be assessed by using rating scale.

7.2.7 Data analysis planThe data will be analysed using descriptive (mean, median, SD and mean percentage). Knowledge will be tested by ‘t’-test. The association of study variable and selected demographic variables would be tested by chi-square test.

7.3 Does the study require any investigations or interventions to be conducted on patients, or other animals? If so please describe briefly.

Yes, the investigator needs to determine the knowledge and practice of the mother who are having children in the age group of 1-5 years regarding prevention of dental caries.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes, ethical clearance is obtained from the institution.

8. References1. Thongchai V, Koyoko S. The process and outcome of a programme for

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preventing early childhood caries in Thailand. Journal of Community Dental Health 2005;22:253-25

2. Caufield PW. Dental caries. Paediatric Clinics Of North America 2000 Oct;47(5):1001-5.

3. Mohebbi SZ, Virtanen JI. Early childhood caries and dental plaque among 1-3 years olds in Tehran. J Indian Soc Pedod Prev Dent 2006 Dec;177-180.

4. Dhar V, Jain A. Prevalence of dental caries and treatment needs in the school going children J Indian Soc Pedod Prevent Dent 2007 Sep;19-20.

5. Kruger E, Dyson K. Preschool child oral health in rural western Australia. Australian Dental Journal 2005;50(4):258-62.

6. Downer MC, Drugan CS, Blinkhorn AS. Dental caries experience of British children in an international context. Community Dental Health 2005;22(2):86-93.

7. The World Oral Health Report 2003. Available from: URL:http://www.who.int/oral_health/media/en/orh_report03_en.pdf.

8. Harris R, Nicoll AD, Adair PM. Risk factors for dental caries in young children. Community Dental Health 2004;21(1):71-85.

9. Harris R, Nicoll AD. Risk factors for dental caries in young children. Journal of Community Dental Health 2004;21(supplement):71-85.

10. Poutanen R, Lahti S. Family factors and child initial caries, Acta Odontologica Scandinavica 2007;(65):87-96.

11. Mobley CC. Nutrition and dental caries prevalence among preschool children. The Dental Clinics of North America 2003;47:319-36.

12. Ferreira SH , Béria JU, Kramer PF, Feldens EG, Feldens CA. Dental caries in 0-5 year old Brazilian children. Indian Journal of Paediatric Dentistry 2007;17(4):289-96.

13. Saudi parents’ knowledge and attitude towards dental caries. Available from: URL:http//www.sdsjournal.org/down.loads/taskdoc_download/gid.108

14. Schroth RJ, Moffatt MEK. ECC in a rural Manitoba community. Paediatric Dentistry 2005;27(2):114

15. Mehajabeen R, Sudha P, Kulkarni SS, Anegundi R. Dental caries prevalence among preschool children of Hubli. J Indian Soc Pedod Prev Dent 2006 Mar;19-22.

16. Milson KM, Tickle M. Dental pain and dental treatment of young children.

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British Dental Journal 2002 Mar;192(5):280-1.

17. Ferro R, Besostri A, Meneghetti B. Dental caries experience in preschool children in Veneto region Italy. Community Dental Health 2006;23:91-4.

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