Level of Knowledge about Oral Health of Parents and its Relationship with Oral Hygiene Habits of their Children from 8 to 10 Years Old.

Objective: To determine the relationship between the level of knowledge in oral health of parents with the oral hygiene habits of their children from 8 to 10 years old. Material and methods: This cross-sectional study was applied to a sample of 200 parents (70% male and 70% 24-40 years old) and their respective children (52.5 male; 44% 8 years old) from two private schools in Lima. in 2021. Two questionnaires were applied, one of 20 oral health knowledge items addressed to parents and another of 4 oral hygiene items applied to their children. Statistical analysis was performed using the Mann-Whitney U or Kruskal Wallis tests with a significance level of P<0.05. Results: Most presented a regular level of oral hygiene habits (59%) and knowledge of oral health (53%). Age of the child was related to the frequency of daily brushing (P=0.004) and oral hygiene items (P=0.0024), while the level of education of the parents was related to the level of oral health knowledge (P=0.000). Higher levels of parental knowledge were associated with higher levels of oral hygiene over weekly tooth brushing frequency (P=0.012).

Conclusion: Both oral hygiene and the level of knowledge in oral health were regular, showing a positive relationship with a higher frequency of weekly brushing.

Keywords: Oral health; Oral hygiene; oral health surveys; Knowledge.

Oral diseases are related to the roles of parents, in addition to knowledge, beliefs, culture and education, since these are transmitted to their children. Adequate understanding of the disease by the father is important in its prevention. Quality of life and socioeconomic level are also considered important factors in the development of diseases, since having a low income leads to not having access to a good health service, as well as limited access to information on health. prevention [1-3].

The level of knowledge about oral health is related to the education that parents have. It corresponds to the ability to understand and use correct information and guidelines related to oral health. These include the identification of risk and factors that affect oral health, in addition to the knowledge and application of oral hygiene measures [4].

Knowledge is studied from certain points of view through disciplines such as logic, psychology, anthropology or philosophy. However, it is agreed that, in general terms, knowledge is a human relationship of truth with known reality. All people throughout their lives acquire it in different ways, whether through sensations, experiences or studies [5].

As people’s educational level increases, so does their knowledge about oral health. Everyone has the capacity to transmit them and this has been demonstrated in adults where knowledge about oral health is associated with educational level and certain oral hygiene habits [6].

It is important to establish oral hygiene habits as a preventive measure against oral diseases. The close relationship that exists between family attitudes regarding oral hygiene has been demonstrated, observing that children follow the habits and behaviors of their parents [7,8].

A stage where these habits can be better established and reinforced is between 8 and 10 years old. In this age range, the transitions of fundamental motor skills are more refined, presenting greater motor development and the acquisition of gross and fine motor skills due to the progressive maturity of the central nervous system. However, the literature is scarce when relating this age to oral hygiene practices or habits. In contrast, in preschool children, oral health practices have been shown to be strongly influenced by parents, especially mothers [9,10].

It is of interest to have a clear perspective of the relationship between parents’ oral health knowledge and their children’s oral hygiene habits in this age range. A similar study carried out in the San Miguel district in Lima has not been found. Therefore, this study aimed to determine the relationship between the level of oral health knowledge of parents and the oral hygiene habits of their children aged 8 to 10 years in Lima-Peru.

The design of this study was prospective cross-sectional. The study was approved by the Institutional Research Ethics Committee of the Universidad Cientifica del Sur (N°166-CIEI-CIENTÍFICA-2022). The study was carried out in accordance with the requirements of the Declaration of Helsinki. Informed consent and assent were obtained physically from the study participants.

The population was 414 parents and their respective children aged 8 to 10 from two private schools (n1=200 and n2=214) in the district of San Miguel (located west of Lima andmedium/medium-high socioeconomic level). A non-probabilistic sample was selected from 200 parents and their respective 200 children enrolled in the 3rd, 4th and 5th grade of primary school in 2021. The exclusion criteria were: children with illnesses or who took medications because they could alter habits., children with deficiencies in psychomotor skills, cognitive alterations, incomplete questionnaires or those filled out incorrectly according to the instructions provided, parents with more than one child in the same age range.

The questionnaire directed towards parents was taken from the study ofCoupé-Araujo and García-Rupaya11 where there were 20 knowledge questions about the oral health of their children distributed in four dimensions (prevention, dental caries and diet), and four alternatives with only one correct answer (1 point each). The total score from 0 to 20 points was categorized into: poor (0-10 points), regular (11-14 points), good (15-17 points) and very good (18-20 points)11 (Ministry of Education of the Peru).

The oral health knowledge questionnaire was validated in the previous study [11] by expert judgment (pediatric dentists and research methodology specialists), showing content validation with Aiken’s V=0.95 (acceptable) and construct validation with factor analysis whose Item analysis ranged from 0.36 to 0.77. Test-retest reproducibility of 0.89 (very good) and Cronbach’s alpha reliability of 0.64 (fair).

The questionnaire aimed at children aged 8 to 10 years was taken from the study on oral health behavior by Karamehmedovic et al. [1]. where four questions related to oral hygiene habits were selected (frequency of daily and weekly brushing, brushing time and oral hygiene elements used), with unique responses that indicated levels of ordinal habits (from 2 to 5 points). The total score from 0 to 20 points was categorized into: poor (0-10 points), fair (11-14 points), good (15-17 points) and very good (18-20 points).

The researchers previously received training from a primary school teacher to ask the questions to children in a simple and understandable way. Likewise, they received training for behavioral management in children. The application of the questionnaire to children was carried out in school environments, while the questionnaire to parents was sent to parents through notices from classroom teachers to be returned completed if they accepted participation in the study.

The data was analyzed with the statistical software IBM SPSS Statistics (Statistical Package for Social Sciences). The variables were presented with descriptive statistics. The tests applied to compare levels of habits or knowledge against dichotomous variables were analyzed withU of Mann Whitney and against polytomous variables with Kruskal Wallis. The P<0.05 indicated statistically significant differences.

The child participants (n=200) were distributed similarly by sex (52.5% males and 47.5% females) and age (44% 8 years old; 23.5 9 years old; and 32.5% 10 years). The level of oral hygiene habits in children was mostly regular (59%) followed by good (21%). Age was related to habits in the items on the frequency of daily brushing (P=0.004) and the oral hygiene elements used (P=0.0024), with a higher level of oral hygiene habits being observed at older ages [ Table 1].

Table 1. Oral hygiene habits in children between the ages of 8 years (n=88), 9 years (n=47) and 10 years (n=65).

The sex of the children was not associated with oral hygiene habits (P≥0.05) [Table 2].

Table 2. Oral hygiene habits in children among women (n=95) and men (n=105).

The majority of parent participants (n=200) were male (70%), aged 24 to 40 years (70%), and had a higher/technical educational level (63%). The level of knowledge of parents about predominant oral health was regular (53%) followed by good (39.5%). Only the demographic variable level of education was related to the level of parents’ knowledge about oral health, showing that a higher level was found in parents with a higher/technical degree than compared to those in secondary school (P=0.000) [Table 3].

Table 3. Parents’ level of knowledge about oral health according to age, level of education and sex.

Oral hygiene habits predominated in tooth brushing two to three times a day (65%), every day of the week (73.5%), 30 to 1 minute (75%), and using a toothbrush and toothpaste. dental (81%). Parents’ knowledge levels were associated with children’s oral hygiene habits only in the weekly tooth brushing frequency item, showing a higher brushing frequency associated with higher levels of their parents’ knowledge about oral health (P=0.012). [Table 4].

Table 4. Parents’ level of knowledge about oral health according to their children’s oral hygiene habits.

In this study, a relationship was found between the level of knowledge about oral health of theparents with the frequency of weekly tooth brushing of their children aged 8 to 10 years, but not with respect to frequency, time and elements used for brushing. A study also carried out in Lima by Ruiz and Campos [12] found a relationship between the level of oral health knowledge of mothers and their children aged 3 to 5 years. However, this relationship would not be completely seen at older ages as in this study, since younger children are more dependent on their parents with respect to the development of their habits.

Another study with which we do not agree was the one carried out bySosiawan et al. [13] who found a significant relationship between parents’ oral hygiene knowledge and children’s oral hygiene. Nadazdyova et al. [14] also found the influence of parents’ knowledge on inappropriate hygienic behaviors of children aged 7 to 13 years. In this sense, it is feasible to establish a certain relationship between the level of knowledge of the parents and the oral hygiene habits of their children, emphasizing that when there is a higher educational level of the parents, fewer oral health difficulties develop [15].

It is important to consider what Ghattas et al. [16] stated, who indicate that good oral hygiene habits should be instituted at an early age. However, it has been shown that children between 8 and 10 years old are capable of acquiring knowledge efficiently, and they also acquire a sense of responsibility while developing their independence [17].

Regarding the relationship between children’s oral hygiene habits and sex, the present study did not coincide with a research carried out in Spain, wherefound that the group with the highest risk of suffering from oral diseases was men [20].

The present study did not find differences between the level of knowledge of parents about oral health and their age. However, there was a greater participation of young parents (24 to 40 years old) in the surveys carried out and with a good level of knowledge about oral health. In contrast to the study by Moriyama et al. [21], who determined that mothers aged less than or equal to 30 years had adequate oral health literacy, this may be due to the greater mastery of young parents with technology and the digital world.

The level of knowledge of parents about oral health was related to the level of education where there was a higher percentage of parents with a higher/technical degree. Higher educational levels such as higher education leads to a greater understanding of oral hygiene instructions, coinciding withBogovska and Kabaktchieva [23]. On the other hand, Elamin, et al. [24] found that parents with lower levels of education reported less favorable oral hygiene behaviors, as did Dahlan, et al. [25].

This study presented limitations such as some variables that were not evaluated: living conditions, sociodemographic characteristics and socioeconomic level. However, we chose to focus the study on the level of knowledge. Parents and children may have already received training sessions before conducting the study; this could have altered the results. The study was carried out only in an urban area and in three levels of parental education: primary, secondary and higher education.

The survey technique could have affected the result obtained by not performing a clinical evaluation. In addition,The instrument chosen for parents was created for oral health of preschoolers, which differed with the age range evaluated. This study began its application in 2020, so the data collection technique had to be adapted to the COVID-19 restrictions established by the country. However, these results are considered reliable since, at ages 8 to 10, children show greater parental independence in discerning their responses.

The results of this study contribute to focusing oral health promotion campaigns comprehensively on both minors and parents, since evidence has been found of the influence of parents’ hygiene habits. towards children at an early age. We toastFuture research data that will allow parents to evaluate oral health problems and their impact on their children’s quality of life through the analysis of sociodemographic and cultural factors.

Appendix 1. Consistency matrix.

Appendix 2. Variable operationalization table.

Annex 3. Instrument used in the research.

Quiz for Children

General Information

Hello, I am Alex Jair Clavijo Valladares, student of the Stomatology Department at the Scientific University of the South. I am studying: Stomatology, which is why I thank you for the 5 minutes it will take you to complete the following questionnaire, which has two parts: The first is to collect your data and the second deals with questions about your oral hygiene habits.

Before starting you must accept the following informed assent.

I, ………………………………………… ………………………………………….. …………………………………….. I agree to be part of the study by answering the questions about my oral hygiene habits. They have told me that this data will not be shared with anyone (Law 29733). If I have questions, they will gladly answer me.

Below, you will find questions and we ask for your collaboration by answering as you feel.

Variable: Children’s oral hygiene habits

This quiz includes 4 questions. To answer, choose a single answer for each question and mark with an X. You must answer all questions.

QUESTIONNAIRE

Surnames and names: _________________________________________________

Sex: ☐Child ☐Little girl

How old are you?

1. a) 8 years
2. b) 9 years
3. c) 10 years

• Circle the answer that you consider most appropriate.

1. How many times do you brush your teeth a day?
2. I don’t brush
3. Once a day
4. Two or three times a day
5. More than three times a day
6. How many times do you brush your teeth a week?
7. I don’t brush
8. Once a week
9. Two or three times a week
10. Every day of the week
11. How long do you brush your teeth?
12. I don’t brush
13. 30 seconds
14. 1 minute
15. More than 1 minute
16. What do you use to brush your teeth?
17. I don’t brush
18. toothbrush only
19. Toothbrush and toothpaste
20. Toothbrush, toothpaste and dental floss

THANK YOU VERY MUCH FOR YOUR HELP

Questionnaire for Parents

General Information

Hello, I am Alex Jair Clavijo Valladares, a student of the Stomatology Department at the Scientific University of the South, which is why I thank you for the 15 minutes it will take you to complete the following survey that has four groups of questions about knowledge about oral health of your children. Below you will find statements in relation to what was explained. We ask for your collaboration by answering as you feel, that is, the one you think best fits your answer. There are no good or bad questions. What is interesting is your opinion on the topics mentioned. It is important that you provide a single answer to all questions and do not leave alternatives unchecked. The results of this questionnaire are strictly confidential, in no case accessible to other people and the protection of your data in the study is guaranteed.

Date: _________

Your child’s age:

1. a) 8 years
2. b) 9 years
3. c) 10 years

Who answers the questionnaire?

1. a) Father
2. b) Mother

Age of informant: __________

Father’s educational level:

1. a) None
2. b) Primary Education

c)Secondary Education

1. d) Technical and/or Higher Education

Level of knowledge about oral health of parents

This quiz includes 20 questions. To answer, choose a single answer for each question and mark with an X. You must answer all questions.

DENTAL CARIES

1.- What is dental caries?

a.- It is a disease that appears in malnourished children.

b.- It is not a disease

c.- It is a disease caused by lack of oral hygiene and consumption of sugars.

d.- It is a disease caused by lack of oral hygiene and consumption of fried foods.

2.- The microorganisms that cause dental caries can be transmitted by

1. a) Share utensils
2. b) Share toothbrushes
3. c) Kisses on the mouth
4. d) All of the above

3.- What is dental plaque?

a.- It is a hard layer that forms on the surface of the teeth

b.- It is a soft plaque that forms on the surface of the teeth

c.- It is the tartar that forms on the teeth

d.- It is a mass that is only found in the teeth of adults

4.- Are baby teeth important?

1. a) Yes, because they save space for permanent teeth
2. b) No, because they do not fulfill any function
3. c) No, because in the end they are going to fall
4. d) No, because they are not permanent teeth

5.- At what age do children have all their baby teeth?

1. a) 2 years
2. b) 4 years
3. c) 6 years
4. d) 8 years

PREVENTION

6.- The first visit to the dentist is recommended from:

1. a) From 2 years old
2. b) When the first baby tooth appears
3. c) When we have adult teeth
4. d) Only when there is pain

7.- What benefits do you know of fluoride?

1. a) Strengthens teeth and prevents cavities
2. b) Heal teeth to prevent extractions
3. c) Fluoride has a whitening action in children
4. d) Strengthens the child so that he grows healthy and strong

8.- It is necessary to visit the dentist when you have healthy teeth:

1. a) Yes, for a routine clinical examination
2. b) Only if you have crooked teeth
3. c) No, since it has nothing, it is not necessary
4. d) I only go if my son has mouth discomfort

9.- If your child loses a baby tooth early because it has cavities, do you think it could affect the position of the teeth?

So

1. a) It depends, only if you lose your baby teeth
2. b) No
3. c) Baby teeth are not important

10.- What preventive measures do you know to combat dental caries?

1. a) Fluorine
2. b) Correct oral hygiene
3. c) Avoid excessive consumption of sugars
4. d) All of the above

DIET

11.- What foods do you think are best for having healthier teeth?

1. a) Fruits and vegetables
2. b) Soft drinks and fruits
3. c) Fruits and cookies
4. d) All of the above

12.- What is recommended that your child carry in the lunch box?

1. a) Cheese, quinoa, fruits, egg, bread, meat.
2. b) Sweet cookies, chocolates, cakes, boxed soft drinks.
3. c) Frugos, chocolate milk, chizitos
4. e) All of the above

13.- Regarding the consumption of sugars, check the correct ones

a.- The child should never consume sugar

b.- The child can consume sugar at various times during the day

c.- The child can consume sugar at certain times and then brush his teeth

d.- All of the above

14.- Up to what age is it recommended to breastfeed the child?

a.- Up to 15 days old

b.- Up to 3 months of age

c.- Up to 6 months of age

d.- Until the first month of birth

15.- Letting the child have a bottle with sugary liquids throughout the night, what would it cause?

a.- You will be stronger when you wake up

b.- You will be stronger and healthier

c.- You will be more exposed to cavities

d.- Nothing happens

ORAL HYGIENE

16.- How many times a day should the child brush his teeth?

a.- 1 time

b.- 2 to 3 times

c.- From 5 to more times

d.- Children should not brush their teeth

17.- From what age can you use toothpaste with fluoride?

1. a) From 2 years old
2. b) From 5 years
3. c) From adolescence
4. d) In children under 2 years of age

18.- Is brushing recommended after each meal?

year

1. b) Only before going to sleep
2. c) Just using a rinse aid is enough
3. d) Yes

19.- How often should you change your toothbrush?

1. a) Every 3 months
2. b) Every 8 months
3. c) Per year
4. d) Never

20.- Regarding tooth brushing

a.- Tooth brushing can only be done by the child himself

b.- Parents should supervise their children’s tooth brushing at this age

c.- Tooth brushing should be done in children over 3 years old.

d.- In children, tooth brushing should be done without toothpaste.

THANK YOU VERY MUCH FOR YOUR HELP

Annex 4. Validation and reliability of the knowledge questionnaire.

Results found in a previous study aimed at validating the questionnaire used in this study: Cupé-Araujo Ana Cecilia, García-Rupaya Carmen Rosa. Parents’ knowledge about the oral health of preschool children: development and validation of an instrument. Rev. Estomatol. Herediana [Internet]. 2015 Apr [cited 2023 Sep 03];25(2):112-121. Available in:

http://www.scielo.org.pe/scielo.php?pid=S1019-43552015000200004&script=sci_abstract

Annex 5. Authorization of Educational Institutions.

Annex 6. Photos of the execution.

Annex 7. Consents and informed assents approved by the Ethics Committee.

Annex 8. Ethics committee approval document

Annex 9. Directorial resolution approving the thesis project

Annex 10. Evidence of submission to magazine.

Based on the results of this study, it was concluded that A greater frequency of weekly brushing in children was related to higher levels of oral health knowledge in their parents. An older age of the children was associated with higher levels of oral hygiene regarding the frequency of daily brushing and oral hygiene elements, while a higher educational level of the parents was associated with higher levels of knowledge about oral health.