Key words:
Behavior - children - dental caries - dental visit - parents
INTRODUCTION
Contrary to earlier misconception, when people, undermining importance of the oral
health, used to go to dentists for the treatment of their ailing teeth only at the
time they could not bear the pain, it is now realized and accepted universally that
oral health is an essential part of the general health of any age group be it adults
or children.[1] Nevertheless, it has been unfortunate to find that children get victimized to dental
caries at the budding stage of their life as early as 12 months of age.[2]
Over and above difficulty in eating, sleeping, altered growth, psychological effect,
and also the increased risk of developing dental caries in permanent teeth, pain is
the main problem associated with early childhood caries.[3]
[4] Hence, the prevention of dental caries in children is of greater importance during
the early phase of their life so that they are not incapacitated at all to do all
the essential activities of their developing life in a healthy manner and to the maximum
required degree.
In several previous studies, oral health status of children has been found associated
with attitude and practice of their parents toward providing necessary dental treatment
to their wards: children whose parents have positive approach and seriousness in treating
them possess better oral health.[5]
[6] In previous studies, many risk factors such as prolonged breastfeeding, frequent
nocturnal bottle feeding, number of family members, oral hygiene practices, diet,
timing, and reason for the first visit of a child to the dentist have been documented
as prominent causes for the development of caries in early childhood stage.[7]
A previous study conducted among parents of Saudi Arabia revealed low level of knowledge
among parents regarding the appropriate timing for children’s first dental visit.[8]
It goes beyond describing that the parents play a major role in imparting education
to their children so that they realize the need of being quite aware about the healthy
measures and all the related facts. Only in this way, the parents can influence and
shape their children’s views in a positive way which would ultimately lead to good
present and future oral health status of their children. Thus, it is an established
fact that the oral and general health of children is significantly affected due to
their parents’ conception, attitude, and practice toward fully grooming/upbringing
of their children to have sound oral health as an essentially integral ingredient
of good overall/general health.[9]
The factors such as appropriate timing of the first dental visit, knowledge of parents
regarding oral health of their children, and past dental experience and behavior of
dentist have been considered to be very important as far as optimum delivery/utilization
of oral health care is concerned. Furthermore, it is found that a child’s behavior
during the first dental visit is very importantly decisive since it considerably impacts
the future recall visits.[10]
Hence, in light of the aforementioned facts and observations, a cross-sectional questionnaire-based
study was planned and undertaken in order to adequately assess knowledge and attitude
of parents/guardians in Abha, Saudi Arabia, toward the timing of their children’s
first dental visit and other associated factors.
MATERIALS AND METHODS
A cross-sectional questionnaire-based study was conducted among parents/guardians
of children attending the Outpatient Department of King Khalid University College
of dentistry, Abha. Ethical approval was taken from the Scientific Research Committee,
King Khalid University, Abha, before conducting the study. A convenient sample of
320 participants was included in the study. All the parents (mother or father)/ guardians
willing to participate in the study and whose children visiting the dentist for the
first time were included in the study. Those parents/guardians whose children suffered
from any mental/physical disability were excluded from the study. A self-administered
10-item questionnaire [Appendix 1] was translated into local (Arabic) language for
ease in understanding of the participants. The internal validity of the questionnaire
was assessed by Cronbach’s alpha which was found to be acceptable (α = 0.7). The questionnaire
included questions related to age at the first dental visit of child, the person accompanying
the child to dentist, reasons for the first dental visit, selection of place of treatment,
children’s behavior during the first visit to dentist, the overall experience and
treatment offered at the first visit, and reasons to attend/miss the recall dental
visits.
Children’s behavior was assessed using Frankl’s scale [Appendix 2] ranging from definitely
negative to definitely positive.[11] The participants were assured that their responses would not be disclosed so as
to maintain the confidentiality. The questionnaires were collected after half an hour
from the participants. Out of total 320 respondents, 300 respondents had filled the
questionnaire completely. Hence, data received from the duly filled 300 questionnaires
were put to statistical analysis.
RESULTS
Majority (29%) of the children visited the dentist for the first time at the age of
3–6 years while the least percentage (8%) visited the dentist for the first time at
age 0–1 year. A statistically significant difference was found between the responses
(P < 0.05). Majority (72.67%) of children were being accompanied by parents during their
first dental visit. Majority (40.33%) of the parents said that overall experience
of the first visit of their children was good. About 39.67% of the children had positive
behavior as per Frankl’s scale, during their first dental visit. About 53.67% of the
participants said that they might return for the next appointment for their children,
while 28.67% were not sure about their coming for recall visit [Table 1]. About 47.33% of the participants believed that they would miss the next appointment
for their children at dentist because they do not require further dental treatment
[Table 2]. Majority (37.33%) of the participants said that pain was the main reason for them
to get their children to dentist [Graph 1].
Graph 1: Frequency distribution of participants based on the reasons for the first dental
visit of their children
Table 1:
Frequency distribution of different aspects at the first dental visit
|
Age of the child at the time of first visit
|
Person accompanying the child at the time of first visit
|
Overall experience of first dental visit
|
|
Age
|
n (%)
|
Person
|
n (%)
|
Experience
|
n (%)
|
|
*Highly significant P<0.0001
|
|
0-1 year
|
24 (8.00)
|
Parent
|
218 (72.67)
|
Very good
|
102 (34.00)
|
|
1+-3 years
|
51 (17.00)
|
Sibling
|
26 (8.67)
|
Good
|
121 (40.33)
|
|
3+-6 years
|
87 (29.00)
|
Grand parent
|
27 (9.00)
|
Satisfactory
|
43 (14.33)
|
|
6+-9 years
|
86 (28.67)
|
Guardian
|
29 (9.67)
|
Bad
|
24 (8.00)
|
|
<9 years
|
52 (17.33)
|
Alone
|
0 (0.00)
|
Very bad
|
10 (3.33)
|
|
χ2 (df)
|
47.433 (4)*
|
χ2 (df)
|
529.500 (4)*
|
χ2 (df)
|
159.500 (4)*
|
|
Child’s behavior during first dental visit
|
Are you likely to return for next appointment?
|
What treatment was provided at the first time of the visit?
|
|
Definitely positive
|
96 (32.00)
|
Definitely yes
|
34 (11.33)
|
Problem for visit was treated
|
121 (40.33)
|
|
Positive
|
119 (39.67)
|
Probably no
|
86 (28.67)
|
Only oral examination/X-ray done
|
74 (24.67)
|
|
Negative
|
54 (18.00)
|
Definitely no
|
19 (6.33)
|
Only medication prescribed
|
48 (16.00)
|
|
Definitely negative
|
31 (10.33)
|
Probably yes
|
161 (53.67)
|
Only advice provided
|
57 (19.00)
|
|
χ2 (df)
|
63.387 (3)*
|
χ2 (df)
|
164.453 (3)*
|
χ2 (df)
|
42.267 (3)*
|
Table 2:
Frequency distribution of participants as per responses to Q4, Q9, and Q10
|
Reason for selecting the place of treatment
|
What would be the main reason for you to keep your next appointment?
|
What would be the reason for you to miss your next appointment?
|
|
Reason
|
n (%)
|
Next appointment kept reason
|
n (%)
|
Next appointment miss reason
|
n (%)
|
|
*Highly significant P<0.0001
|
|
Quality of treatment
|
82 (27.33)
|
The treatment provided relieved my problem
|
80 (26.67)
|
Treatment did not provided relieve
|
49 (16.33)
|
|
Advice from friends/relatives
|
70 (23.33)
|
Behavior of dental professionals
|
49 (16.33)
|
Dentist behavior of was not good
|
46 (15.33)
|
|
Previous personal experience
|
99 (33.00)
|
Importance of dental treatment
|
74 (24.67)
|
Further treatment not required
|
142 (47.33)
|
|
Distance from home
|
35 (11.67)
|
For completing my treatment
|
76 (25.33)
|
Any other
|
63 (21.00)
|
|
Other
|
14 (4.67)
|
Any other
|
21 (7.00)
|
|
|
|
χ2 (df)
|
80.767 (4)*
|
χ2 (df)
|
41.567 (4)*
|
χ2 (df)
|
82.000 (3)*
|
DISCUSSION
It is very distressing to find that dental caries takes toll of health of a child
of an age of <3 years which is the budding phase of his life growth. As a matter of
fact, owing thereto, preventive measures taken at the early stages hold great significance
since it has been observed that incidence of dental caries is high among those who
are infected before the age of 3 years.[12]
[13]
In comparison to lower prevalence rates found in most of the developed countries,
the prevalence of nursing dental caries was found as to be 27.3% in a previous study
conducted in Riyadh, Saudi Arabia, by Wyne et al. in 2001[14]
[15] causing huge concern for the parents; the various deleterious effects of nursing
dental caries range from pain to devastating psychological issues of a child.[16]
Over and above other common preventive measures, the important factors facilitative
to establishing the oral health of children are proper oral hygiene and balanced diet,
awareness about appropriate timing of children’s first dental visit, recall visits,
behavior of children in dental clinic, and the positive attitude of parents/guardians.
In the current study, as many as 29% of the children are reported to have visited
the dentist for the first time at the age of 3-6 years, while the least percentage
of 8% visited the dentist for the first time at the age of 0-1 year. This finding
corroborates with various previous studies conducted in Saudi Arabia, wherein the
parents/guardians exposed their children to dentist at 3-6 years of age.[17]
[18] The underlying reason is their misconception, whereby they do not require to take
their children to dentists/pedodontists unless any problem arises, especially before
the age of 1 year.
It is really astonishing to know that in various previous researches[19]
[20] carried out in other parts of the world, the age of 7-11 years and 6-12 years was
being reported as the age for the first dental visit for their children. In a yet
another study conducted in Bulgaria, the researchers noted that the study participants
did not take their children to dentist earlier of the age of 1 year and they only
visited the dentist in case their children suffered from dental caries or its complication.[21] Such findings are quite indicative of the unawareness among parents regarding the
appropriate age of their children for visiting the dentist for the first time. The
recommended age by the American Academy of Pediatrics[22] is the period between 6 months of age and the eruption of the first tooth.
The significance of early dental visits has been justified on the basis of various
reasons such as prevention of early childhood caries, detection of incipient dental
caries lesion at its earliest stages so as to prevent further progression of the same,
and evaluation of dental and craniofacial growth. Moreover, other factors include
counseling of parents regarding appropriate and effective oral hygiene habits, healthy
dietary habits, use of fluoride, balanced diet, and motivating parents toward timely
preventive measures for attaining good oral health among their children.[22]
The findings of the present study show that majority of the children (72.67%) were
accompanied by parents during their first dental visit. It is evident that parents,
especially mothers being overprotective, prefer to be with their children while undergoing
treatment at dentist. Parents’ role and attitude have been documented in previous
studies as having an essential impact on children’s behavior as well as their apprehension
toward dental treatment which eventually lays considerable impact on oral health of
children.[23]
[24]
About 39.67% of the children were found to have positive behavior during their first
dental visit. This finding was similar to previous study in Riyadh, Saudi Arabia,
wherein majority of the participants are reported to have behaved positively during
their first dental visit.[25] The reasons thereof might be the fact that they were provided with conducive environment
while undergoing treatment. Moreover, majority of the children aged 3-6 years were
found more cooperative.
To measure the child’s behavior, Frankl’s scale was being used which has been reported
to be the most reliable scale to assess the behavior of children in clinics.[26] This scale assists in predicting the future appointments of pediatric patients.[10] Results of the present study show that owing to the positive behavior of their children
while undergoing dental treatment, majority of the parents (40.33%) felt good as far
as their overall experience of their children’s first dental visit was concerned.
As a good percentage of children (26.67%) in the present study are reported having
been relieved of the problem for which they were brought to dentist, so their parents
were satisfied with overall experience of the first dental visit of their children.
When, as recorded in the present study, the parents were inquired about the reasons
for them to get their children to dentist for the first time, bulk of them assigned
the reason to the dental pain (37.33%) followed by dental caries (21%). These results
were in accordance with previous studies, wherein the main reasons of children’s first
dental visit were pain and dental caries.[19]
[27]
Such findings confirm the lack of awareness among masses about visiting dentists for
regular dental checkups of their children so as to prevent the occurrence of ailments
such as dental caries and its associated complications.
Around 47.33% of the participants are reported to believe that they would not turn
up for the next appointment for their children at dentist, as according to them, it
was not needed. This finding calls attention of all the dental professionals, pediatric
dentists, public health dentists, and other health workers to work efficiently and
collaboratively so as to create awareness among the populace regarding regular dental
examination and importance of recall visits. The dental professionals, during in-office
hours while undertaking the dental treatment of their children, need to adequately
educate the parents/guardians. Furthermore, the oral health education should be emphasized
upon at community and school levels during various health awareness programs.
CONCLUSION
It is fairly concluded that bulk of the parents were unaware about the appropriate
age of their children’s first dental visit. Most of the parents brought their children
to dentist after their children experienced pain or suffered from dental caries. There
is ample need to raise awareness among masses regarding the importance of taking oral
health care of their children quite seriously at the earliest budding stage of their
life.
Financial support and sponsorship
Nil.
