|Year : 2021 | Volume
| Issue : 1 | Page : 1-6
Effectiveness of a lecture-based educational module for parental knowledge regarding infant oral health care
Gauri Shailesh Lele1, Dipti Gholap2
1 Department of Preventive Dentistry, College of Dentistry, King Faisal University, Al Ahsa, Saudi Arabia
2 Department of Pediatric and Preventive Dentistry, Dr. DY Patil Vidyapeeth, Pune, Maharashtra, India
|Date of Submission||04-Aug-2020|
|Date of Decision||21-Oct-2020|
|Date of Acceptance||22-Oct-2021|
|Date of Web Publication||25-Feb-2021|
Gauri Shailesh Lele
Office No. 1056, College of Dentistry, King Faisal University, PO Box 400, Al Ahsa, 31982
Source of Support: None, Conflict of Interest: None
Context: As parents are primarily responsible for their infant's oral health, it is dependent on their beliefs, attitude, and knowledge. Thus, educating parents by providing anticipatory guidance could help in improving the oral health of infants. Aim: To test the effectiveness of a lecture-based educational module in the improvement and retention of parental knowledge regarding infant oral health care. Setting and Design: This interventional study, with the inclusion of 110 parents of infants, was carried out in the Departments of Pediatric Dentistry, Pediatrics, and Gynaecology. Subjects and Methods: An educational module in the form of a brief lecture using a power-point presentation was prepared. This included the key features of anticipatory guidance such as the importance of healthy pregnancy, diet and nutrition, oral hygiene maintenance, feeding practices, development of teeth, causes and sequelae of early childhood caries, importance of early and regular dental visits, and treatment of carious primary teeth. Parental knowledge regarding infant oral health was assessed before and after the intervention, and later at a 3-month interval, based on their responses to a validated questionnaire. Statistical Analysis Used: Percentage analysis was used to observe the change in, and retention of parents' knowledge. Results: There is a lack of basic knowledge among parents regarding infant oral health care. The lecture-based educational module was found to be effective in improving parental knowledge and in its retention over a 3-month period. Conclusions: The lecture-based education module was found to be an effective tool in providing anticipatory guidance to parents regarding infant oral health.
Keywords: Education module, infant oral health care, parental awareness
|How to cite this article:|
Lele GS, Gholap D. Effectiveness of a lecture-based educational module for parental knowledge regarding infant oral health care. J Dent Res Rev 2021;8:1-6
|How to cite this URL:|
Lele GS, Gholap D. Effectiveness of a lecture-based educational module for parental knowledge regarding infant oral health care. J Dent Res Rev [serial online] 2021 [cited 2022 Jun 26];8:1-6. Available from: https://www.jdrr.org/text.asp?2021/8/1/1/310185
| Introduction|| |
Children's overall health and well-being are significantly influenced by their oral health status. Primary dentition, if affected by dental caries, can adversely affect the growth and development of the child.
The role of parents in maintaining their children's oral health during infancy, their knowledge of risk factors, and implementation of healthy practices at home from birth brings down future risks of dental caries and other oral health-related problems., For this, parents need to be made aware of the importance of the early preventive visit to the dentist and the concept of anticipatory guidance.
Parental knowledge and attitude about the oral health of infants in India is markedly inadequate.,, Thus educating parents about this important health-related concern becomes imperative.
Various methods that could be used as such educational intervention to help parents learn and understand the importance of oral health care of their infants include use of charts and models, lectures, audio-visual aids, videos, workshops, etc. An oral presentation, in the form of a lecture using PowerPoint presentation, could be considered as an effective method for educating a small group of parents.
Hence, this study was aimed at developing and testing the effectiveness of a lecture-based educational module to estimate the change in, and retention of parental knowledge regarding infant oral health care. The objectives were to develop a lecture-based educational module using a PowerPoint presentation for parents of to evaluate the knowledge of parents regarding infant oral health care, to evaluate the effectiveness of the educational module in changing their knowledge, and to check for retention of parental knowledge over a period of 3 months.
| Subjects and Methods|| |
This interventional study was carried out in the Department of Pedodontics and Preventive Dentistry, and Departments of Paediatrics and Gynaecology, after obtaining permission from the University Scientific and Ethics committee.
The target participants for this study were parents of infants and were selected based on the following inclusion criteria:
- Parents of infants who reported to the Department of Pedodontics and Preventive Dentistry and Departments of Paediatrics and Obstetrics and Gynaecology
- Parents who were willing to participate in the study.
A total of 110 parents participated in the study. They were provided detailed information about the proposed study, and a written informed consent was taken from them in a language of their choice from amongst Marathi, Hindi, and English.
The educational module was prepared in the form of a lecture of 15–20 min duration using a PowerPoint presentation. Validation of the educational module was done by teaching staff from the Departments of Pedodontics and Preventive Dentistry and Dental Education.
The educational module comprised comprehensive anticipatory guidance grouped under few key areas or domains related to the infant oral health care and included information related to the importance of healthy pregnancy, diet and nutrition, oral hygiene maintenance, acquisition of oral micro-organisms, feeding practices, development of teeth, causes and sequelae of early childhood caries (ECCs), with emphasis on the importance of early and regular dental visits and treatment of carious primary teeth. Pilot testing of the educational module was done by presenting it to a few parents who reported to the Department of Pedodontics and Preventive Dentistry. After a final evaluation, this was considered ready to be used for the study.
The educational module was presented to parents in small groups of eight to ten in simple Marathi or Hindi languages as per their preference. English language was not preferred by any parent. At the end of the presentation, the parents were asked if they had any doubts or queries, which if present, were clarified.
The prevalidated questionnaire, which was in English, comprised of simple questions, with multiple-choice formats for responses, with an additional response “I don't know” provided to assess lack of knowledge and discourage guessing. It was translated into Marathi and Hindi language by two independent bilingual translators and minor discrepancies were resolved with the help of another professional bilingual translator not involved in the previous translations. Then, the translation was independently back-translated to ensure the accuracy of the translation.
The questions asked were based on the following domains: Importance of healthy pregnancy, maternal oral health, the eruption of the deciduous dentition and it's care, causative and behavioral factors for ECCs, and importance of early and regular dental visits and treatment of carious primary teeth. The parents were requested to fill in the same questionnaire, in a language of their preference, at three-time intervals A, B, and C as follows:
- A – Baseline: before the intervention-education module
- B – Immediate: right after the delivery of the education module
- C – Retention: after 3 months.
Parental responses at each of the three-time intervals were scored based on the number of correct responses for each question. For every right answer, “one” mark was awarded and for every wrong answer “zero” mark was given. Based on the number of correct responses, the data was grouped and tabulated for statistical analysis. The scores were tabulated in the form of percentage at three different time intervals A, B, and C: at baseline, immediately after educational module and at follow-up of 3 months.
| Results|| |
[Table 1] shows that based on the educational qualifications of the parents, there was a marked variation in the average percentage of correct responses at baseline: A. However, these values increased significantly across all categories of educational qualifications, with similar higher retention rates of knowledge at the end of 3 months.
|Table 1: Percentage of correct responses based on educational qualification of parents|
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The average percentage of correct responses at baseline: A was 49.81%, with a marked improvement in knowledge immediately after the presentation of the education module: B with 93.15% of correct responses. The retention of this knowledge after a 3-month interval: C was also high, with an average of 92.84%, as seen in [Table 2].
There was similarity in the average percentage of correct responses immediately after the presentation of the education module: B in females and males (98% and 97.22%, respectively). However, the retention of knowledge after a 3-month interval: C was higher in females, with an average of 93.7% [Table 3].
[Table 4] shows that the average percentage of correct responses related to maternal oral health showed a marked increase to 94.54% and 95.45% immediately after the presentation of the education module (B). Parents showed a high percentage of retention of this knowledge at 97.27% and 96.36% (C).
|Table 4: Percentage of correct responses for the domain based on maternal oral health|
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The average percentage of correct responses at baseline: A related to the initiation of brushing was very low at 18.18%, with a marked improvement in knowledge immediately after the presentation of the education module: B (94.54%). The retention of this knowledge after a 3-month interval: C was also high, with an average of 93.63%, as seen in [Table 5].
|Table 5: Percentage of correct responses regarding primary dentition and it's hygiene|
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With respect to the causative and behavioral factors for ECC, parental knowledge regarding foods causing dental caries, based on the average percentage of correct responses at baseline: A was 84.54%, while immediately after the presentation of the education module: B it was 100% and continued have an average of 100% at time interval C, showing excellent retention [Table 6].
|Table 6: Percentage of correct responses for the causative and behavioral factors for early childhood caries|
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As shown in [Table 7], even though the parents' knowledge regarding their infant's first visit was low, with an average percentage of only 25.45 at baseline, this increased to 95.45% immediately after the presentation of the education module: B, with 91.81% of correct responses at the end of 3 months.
|Table 7: Percentage of correct responses regarding importance of primary teeth|
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| Discussion|| |
The foundation for preventive education and dental care must be built in infancy through infant oral health to increase the opportunity to lead a life free from preventable oral diseases American Academy of Pediatric Dentistry (AAPD). The involvement of parents in maintaining their children's oral health during infancy, identification of risk factors and implementation of healthy practices at home from birth brings down future risks of dental caries and other oral health-related problems., Hence, in the present study parents of infants were targeted for oral health education. Furthermore, parental involvement should start when they are approachable towards health information and education, even in the prenatal or early postnatal time period., Thus, the parents of infants reporting to the Departments Paediatrics and Obstetrics and Gynaecology were also included in the study.
The educational module developed and used in the study was a lecture of 15–20 minutes duration, using images and illustrations in a PowerPoint presentation specifically focused on providing information about the preventive factors and possible risks that influence the oral health of infants. It was conducted for small groups of about eight to ten parents at a time to improve participation and encourage questions, if any. The effectiveness of 30 minutes PowerPoint and video presentation has been demonstrated in other studies, in improving the parental knowledge regarding the oral health of infants, wherein most of the parents had “found the presentation to be helpful and it had changed their ways toward baby's oral health care at home.”
The average increase in knowledge immediately after the intervention to 93.15% [Table 2] from baseline average of 49.81% indicates the interest generated and information gained by the parents about their infant's oral health. These results were similar to those observed by Vikesh et al., in a study conducted to test the effectiveness of an audio-visual aid for improving parental awareness regarding children's oral health care. It is also indicative of the effectiveness of the lecture using power point presentation as an educational module. The retention of knowledge by 92.84% at the end of a 3 months period indicates that parents are often interested in knowing about their children's oral health but misconceptions about “milk teeth,” lack of resources, or difficulty in accessing those might be the challenges faced by them. This reiterates the need for parental education in a manner that is easily accessible, easy to comprehend, and interesting.,,
[Table 3] depicts that the participation of mothers (69.09%) was greater in the study and that their knowledge at baseline: A was 56% compared to fathers (30.11%). The increase in knowledge at B, and retention C, was also higher, similar to the study by Vikesh et al. This could be explained on the basis that conventionally, Indian mothers have a greater role in rearing children and their overall health. Mothers' beliefs regarding the value of preventive health measures and positive feelings about the sources of healthcare have been found to be associated with preventive actions taken on behalf of their children.
Parents lacked knowledge regarding healthy pregnancy (39.09%), as shown in [Table 4]. The role of regular check-ups during pregnancy, taking medications with physician's consent, harmful effects of smoking and drinking, and beneficial effects of nutritious, healthy and regular meals on the oral development of the fetus was explained in the lecture. The increase in knowledge, with 97.27% of right responses at the 3 months follow-up, indicates a high retention rate, similar to observations made by Vikesh et al. This may be due to the motivation of parents to read more or gather additional information to improve their knowledge about healthy pregnancy or maybe because a greater number of participants in both the studies were mothers (69%), as mothers have a positive attitude toward their infant oral health care.,
In this study, many parents (82.72%) were aware that microbes causing dental caries are spread from mother to child when the oral hygiene of the mother is poor. This finding is contrary to other study wherein the awareness at baseline was 28%. This could be attributed to the difference in the educational qualifications of parents. While 74.54% of parents in this study had completed high school, graduation, or postgraduation [Table 1] only 22.5% of parents had a similar qualification in the other study. This implies that the education of parents plays a vital role regarding the attitude, knowledge, and practice of oral health in their children.
Parental knowledge regarding the eruption of the first baby tooth (77.27%) was better than their knowledge of all primary teeth (40%) at baseline [Table 5], since most parents have an idea about when the first tooth is seen in the baby's mouth, as observed in another study (85.6% correct responses). The development of baby teeth, with their eruption pattern and timing, was explained in the educational module. 73.63% of parents responded correctly regarding the cleaning of gums of infants at baseline. Infant oral hygiene practices were well demonstrated in the presentation, resulting in retention of 96.36%. In the present study, only 18.18% parents were aware that the child's teeth should be brushed immediately after the eruption of the first tooth. The majority of the parents did not brush the teeth of their children till they were 2 years old, similar Suresh et al., who found that most of the parents started brushing their children's teeth when all the primary teeth had erupted. Since the importance of brushing was emphasized in the educational module, the retention of knowledge regarding this was above 90%.
About 84.54% of participants were aware of the role of frequent intake of sweets and sticky food products in causing decay and all the parents answered correctly (100%) immediately after the lecture and at retention period after 3 months [Table 6]. These results were similar to the ones observed by Suresh et al. and Lin et al.
In this study, only 27.27% of parents were aware of the transfer of bacteria causing caries from mother to child and 25.45% via sharing of food, causing an increased risk and caries severity. Habits like blowing on and tasting of food, kissing children on their mouth and sharing utensils lead to the transmission of the streptococcus mutans.,, Therefore, the knowledge of infectious pathophysiology and associated risk factors of dental caries in very young children should be delivered to the primary health care provider, enabling them to take appropriate, timely decisions and effective interventions.,
It was found that most of the parents were unaware regarding the adverse effects of improper feeding practices, with only 40% and 16% of correct responses at baseline A. This revealed parental ignorance and lack of adequate dental education, similar to observation by Hallonsten et al., The child's future health and well-being can be achieved through proper maternal nutrition during pregnancy, exclusive breastfeeding, and appropriate weaning practice. The responses of half of the parents regarding timing of weaning was correct at baseline in the present study [Table 6], similar to those observed by Katepa-Bwalya et al. However, knowledge gained about feeding practices and weaning showed high retention (90.90% and 87.27%, respectively).
Only 25.45% parents were aware about the first dental visit before the educational module [Table 7]. Similar results were obtained in a study wherein only 18% of working professional mothers knew about the first dental visit. Unfortunately, most of the parents believed that the first dental visit should be when teeth were carious or after the entire primary dentition erupts. Immediately after the educational module at time B, 95.45% of parents responded correctly regarding the first dental visit of child, with a retention of 91.81%.
Around 65.5% of the parents were aware of getting the treatment done for their children's decayed milk teeth [Table 7] but most parents thought that milk teeth remained in the mouth for only a short duration and would be replaced eventually. This deficient knowledge could result due to deep-rooted belief that “baby teeth are going to fall out anyway” and therefore decay in the primary dentition does not require any treatment.,
The initiative for regular preventive dental examinations and treatment of infants is taken by either their parents or dentist in developed countries, while such an effort is predominantly missing in Indian children. Parents do not feel the need for the routine dental check-up of their infants, as they do regarding the medical check-up., The reason for neglecting dental check-up or treatment was mainly attributed to the negative attitude of parents to routine dental treatment, as suggested by Chhabra and Chhabra. The increase in parental awareness of the importance of early and regular dental visits increased from 78.18 at baseline to 99.09% at time B and was at 99.09% at the end of 3 months, proving the effectiveness of this educational module.
Limitations of the study and future scope
On the basis of this study, a lecture-based educational module using PowerPoint presentation was found to be effective in improving the knowledge of parents of infants. However, findings of the present study cannot be generalized to the whole Indian population. Ethnic/religious differences in beliefs could also have an impact on infant oral health, and those factors have not been considered in this study. Further quantitative and qualitative research on larger sample size and for an extended period of time would help in gaining a better understanding of the knowledge, attitudes, and awareness of parents about infant oral health, and also the various factors influencing them.
| Conclusions|| |
There is a lack of basic knowledge amongst parents regarding infant oral health care. The lecture-based education module using PowerPoint was found to be an effective tool in providing anticipatory guidance for infant oral health in the target populations. It was observed to be an appropriate means to aid in the retention of knowledge provided to parents over a 3-month period of time.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mouradian WE. The face of a child: Children's oral health and dental education. J Dent Educ 2001;65:821-31.
Kagihara LE, Niederhauser VP, Stark M. Assessment, management, and prevention of early childhood caries. J Am Acad Nurse Pract 2009;21:1-0.
Kulkarni GV. Long-term effectiveness of parent education using the “baby oral health” model on the improvement of oral health of young children. Int J Dent 2013;2013:1-6.
Savage MF, Lee JY, Kotch JB, Vann WF Jr. Early preventive dental visits: Effects on subsequent utilization and costs. Paediatrics 2004;114:e418-23.
Gurunathan D, Moses J, Arunachalam SK. Knowledge, attitude, and practice of mothers regarding oral hygiene of primary school children in Chennai, Tamil Nadu, India. Int J Clin Pediatr Dent 2018;11:338-43.
Bano A. Knowledge and attitude of parents toward oral health maintenance and treatment modalities for their children. Int J Curr Res 2018;10:73001-5.
Chhabra N, Chhabra A. Parental knowledge, attitudes and cultural beliefs regarding oral health and dental care of preschool children in an Indian population: A quantitative study. Eur Arch Paediatr Dent 2012;13:76-82.
Vikesh S, Gauri SL, Rai TS, Shailesh ML, Rai A, Shah R. Development and testing of an audiovisual aid for parental awareness of child oral health care. Natl J Dentcom 2013;2:33-9.
Schroth RJ, Brothwell DJ, Moffatt ME. Caregiver knowledge and attitudes of preschool oral health and early childhood caries (ECC). Int J Circumpolar Health 2007;66:153-67.
Nowak AJ, Casamassimo PS. Using anticipatory guidance to provide early dental intervention. J Am Dent Assoc 1995;126:1156-63.
Rothe V, Kebriaei A, Pitner S, Balluff M, Salama F. Effectiveness of a presentation on infant oral health care for parents. Int J Paediatr Dent 2010;20:37-42.
Rathore K, Tandon S, Sharma M, Kalia G. Queries of parents related to their children's oral health in rural and Urban area of Jaipur: A clinical study. Int J Clin Pediatr Dent 2019;12:88-91.
Shinde PP, Shetiya SH, Agarwal D, Mathur A. Knowledge, attitude, and practice about infant oral hygiene care among Indian professional working mothers: A questionnaire study. J Indian Assoc Public Health Dent 2018;16:58-61. [Full text]
Suresh BS, Ravishankar TL, Chaitra TR, Mohapatra AK, Gupta V. Mother's knowledge about pre-school child's oral health. J Indian Soc Pedod Prev Dent 2010;28:282-7.
] [Full text]
Lin HC, Wong MC, Wang ZJ, Lo EC. Oral health knowledge, altitudes, and practices of Chinese adults. J Dent Res 2001;80:1466-70.
Caufield PW, Cutter GR, Dasanayake AP. Initial acquisition of mutans streptococci by infants: Evidence for a discrete window of infectivity. J Dent Res 1993;72:37-45.
Sakai VT, Oliveira TM, Silva TC, Moretti AB, Geller-Palti D, Biella VA, et al
. Knowledge and attitude of parents or caretakers regarding transmissibility of caries disease. J Appl Oral Sci 2008;16:150-4.
Hallonsten AL, Wendt LK, Mejàre I, Birkhed D, Håkansson C, Lindvall AM, et al
. Dental caries and prolonged breast-feeding in 18-month-old Swedish children. Int J Paediatr Dent 1995;5:149-55.
Bewket Zeleke L, Welday Gebremichael M, Mehretie Adinew Y, Abebe Gelaw K. Appropriate weaning practice and associated factors among infants and young children in northwest Ethiopia. J Nutr Metab 2017;2017:1-7.
Katepa-Bwalya M, Mukonka V, Kankasa C, Masaninga F, Babaniyi O, Siziya S. Infants and young children feeding practices and nutritional status in two district of Zambia. Int Breastfeed J 2015;10:5.
Moallemi ZS, Virtanen JI, Ghofranipour F, Murtoma H. Influence of mothers' oral health knowledge and attitudes on their children's dental health. Eur Arch Paediatric Dent 2008;9:79-83.
Grewal N, Kaur M. Status of oral health awareness in Indian children as compared to Western children: A thought provoking situation (a pilot study). J Indian Soc Pedod Prev Dent 2007;25:15-9.
] [Full text]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]