Journal of Dental Research and Review

: 2019  |  Volume : 6  |  Issue : 2  |  Page : 39--43

Knowledge, attitude, and practice about oral health among mothers of children with special needs – A cross-sectional study

Lakshmi Krishnan, Gothai Prabha, Parangimali Diwakar Madankumar 
 Department of Public Health Dentistry, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India

Correspondence Address:
Lakshmi Krishnan
SH109, ECR, Uthandi, Chennai - 600 119, Tamil Nadu


Background: Oral health of children with special needs is dependent on their parent's knowledge and attitude towards dental care. Thus this study aimed to assess the knowledge, attitude and practice of mothers of children with special needs. Methodology: A cross-sectional questionnaire study was conducted for a period of 4 months among caregivers of 3 to 17 year old children with special needs who visited a tertiary care center (NIEPMD) at Chennai city from February 2018 to June 2018. The data were analyzed using SPSS version 20 (Inc., Chicago, IL, USA). Descriptive statistics was carried out to calculate responses for each question. One way ANOVA was computed to compare means of knowledge, attitude and Practice with Age, Education and Income. Normality of the data was tested using Shaprowilk test. Results: A poor knowledge was seen among the mothers. Education, income and age were found have a statistical significance (p=0.00*) on mean knowledge, attitude and practice scores. Conclusion: More studies exploring the same issue need to be conducted on larger samples covering different populations so as to evaluate, which strategies will be effective and efficient in bringing about a behavior change in mother/parents.

How to cite this article:
Krishnan L, Prabha G, Madankumar PD. Knowledge, attitude, and practice about oral health among mothers of children with special needs – A cross-sectional study.J Dent Res Rev 2019;6:39-43

How to cite this URL:
Krishnan L, Prabha G, Madankumar PD. Knowledge, attitude, and practice about oral health among mothers of children with special needs – A cross-sectional study. J Dent Res Rev [serial online] 2019 [cited 2023 Apr 2 ];6:39-43
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Oral health is a reflection of general health. In general, oral health practices of younger children are influenced by their mother/caregiver's knowledge and belief. A good knowledge and positive attitude toward oral health care play a vital role in preventive cycle. Decision-making process of the parents creates a huge impact on their children's oral and general health.[1] The dental health-care services adopted by the parents for their children are of utmost importance, as it influences not only the current oral health status of the child but also acts as a backbone for the attitudes and practices. These practices developed by the child at this age are carried forward to his or her adulthood. Improvement in children's oral health depends on parent's awareness and knowledge. Studies have proven that practicing good oral health at early childhood is essential so that dental norms are formed and then maintained into future.[2]

Children with disabilities present increased oral pathologies, which could be because of poor knowledge among the parents/caretakers, which, in turn, results in deterioration of the children's oral health. These children have some developmental anomalies such as congenitally missing teeth, malocclusion, and delayed eruption; some oral habits such as lip biting, tongue thrusting, and mouth breathing; and also some self-injurious habits such as stripping of gingiva, and frenal thrusting; all of these factors add up for overall decrease in oral health in disabled children.[3]

Since these children depend on their caregivers for maintenance of their oral health, poor knowledge among the caregivers acts as a prominent barrier in proper maintenance of oral health for these children.[4] Even though individuals with disability are exposed to similar standards of healthcare as the general population, these children and their families undergo various barriers to the utilization of their basic health facilities and to their inclusion in society. In addition, this stigma deepens the impact of economic poverty and further perpetuates discriminatory attitudes toward these groups.

Although there are many studies to analyze the barriers of utilization of dental services among disabled children,[5],[6],[7] there are hardly any reports which depict the awareness and knowledge about oral health practices among caregivers of children with special health-care needs. It is evident from the previous studies that mothers play a vital role in their child's life. Their health beliefs and attitude toward oral healthcare act as strong predictor for the children's oral health care.[1],[2],[8] With this background, this study was formulated with an aim to assess the knowledge, practice, and attitude of caregivers/mothers of children with special needs.


To assess the knowledge among caregivers on oral diseases and methods to prevent themTo understand the level of awareness among the caregivers on influence of bad oral health on general well-being.

 Materials and Methods

A cross-sectional questionnaire study was conducted for a period of 4 months among caregivers of 3–17-year-old children with special needs who visited a tertiary care center (NIEPMD) at Chennai city from February 2018 to June 2018. The study was conducted in accordance to the Declaration of Helsinki with a proper ethical clearance from the Institutional Review Board. Before the start of the study, a written informed consent was obtained.

Mothers of children with special care needs aged between 6 and 17 years, who spent more than 8 h with their children were included in the study. A single interviewer used a structured questionnaire to collect data from the participants. A content validation and reliability analysis were done for the questionnaire. A Crohnbach's alpha value of 0.6 was obtained.

The questionnaire consisted of two parts: the first part had demographic details and the second part consisted of 21 questions, in which nine questions were related to knowledge about oral health, seven on attitude, and four on practices of oral hygiene. For attitude and practice questions had option as: (1) agree, (2) uncertain, and (3) disagree.[1]

The pro forma was in English, which was translated into Tamil by a Tamil scholar, who was fluent in both English and Tamil. The Tamil version was then backtranslated into English by an expert, who is well versed in both Tamil and English. A face validation of the questionnaire was done among 20 participants to check the understanding of the questions, and these people were not considered for the final evaluation. After the face validation, the word “fluoride” was modified as “substance helping to reduce caries.” The sample size for the study was calculated using G power software. Version 3.0.10. Germany based on the previous study, which showed the prevalence of knowledge about oral health as 15% (0.15),[1] and the power of the study was kept as 0.80 and alpha value as 0.05; a total of 120 was obtained.

Scoring system

A scoring system was developed as follows to assess the responses for the questionnaire.[1]

Good knowledge – score >7, fair: 4–6, and poor: <3; Good attitude – score >4, fair: 3–4, and poor: <2; and Good practices – score >4, and fair: 2–3, poor: <1.

Statistical analysis

The data were entered into Microsoft Excel 2010 version, and the statistical analysis was computed using SPSS Inc. Released 2011.IBM SPSS Statistics for Windows, version 20.0 Armonk, NY: IBM Corp. Descriptive statistics were computed to calculate responses for each question. One-way ANOVA was computed to compare means of knowledge, attitude, and practice with age, education, and income. Normality of the data was tested using Shapiro–Wilks test.


Demographic information

A total sample of 120 participants were included for the study. The mean age of the study population was 32.4 ± 1.2 years. When education status was assessed, 47.8% were not educated, and only 2.6% of them had a graduation degree. On assessing the income, 77.3% of the respondents had an annual income < Rs. 20,000/-, and 22.3% of them had annual income > Rs. 20,000/-.

Among the children assessed, a heterogeneous group of disabilities was seen. Majority (40.5%) of them had learning disabilities such as autism and attention deficit hyperactivity disorder, 28.9% of them had cerebral palsy with intellectual disability, and remaining children had hearing (15.7%) and visual impairment (14.9%).

Overall knowledge, attitude, and practice

Majority (94%) of the mothers had fair knowledge, 53.0% exhibited good attitude, and 13.7% showed good practices. The present study had hardly any participants in the good knowledge category.

About 51% of the mothers who had responded rated their child's oral health as fair, and 7.6% reported poor oral health. Responses of the mothers regarding their child's oral health, questions related to the causes of tooth decay, gum disease, and methods to prevent it are tabulated in [Table 1].{Table 1}

Mothers in the age group of 20–30 years and 41–50 years showed higher mean knowledge (4.8 ± 1.5) scores compared to other age group (P = 0.005) [Table 2]. Mothers with educational qualification of graduates and postgraduates had better knowledge (5.9 ± 0.25), attitude (6.00 ± 0.00), and practice (4.18 ± 0.63) scores when compared to those mothers with less educational qualification (P = 0.000) [Table 3]. Similarly, participants with higher income had better knowledge (3.36 ± 1.69), attitude (4.96 ± 1.0), and practices (4.27 ± 0.76) than those of low-income status [Table 4]. A positive correlation between knowledge and attitude as well as practice scores were seen among the study population [Table 5].{Table 2}{Table 3}{Table 4}{Table 5}


This cross-sectional study carried out among 120 mothers of children with special needs gave us insight about the knowledge, attitude, and practices of oral health. This study also revealed that despite a compromised general health seen among these disabled children, the mothers were trying hard to maintain the oral hygiene of these children.

The results of the present study were in line with the studies conducted by where majority of the mothers (80.2%) reported sticky foods such as chocolate can cause dental caries.[9],[10],[11] However, an reduced awareness on various forms of sugary items and time of consumption of sugars which are harmful to the teeth were seen in the current study, which was further justified by Moulana et al. in 2012 and Chan et al. in 2002.[9],[12] Whereas Blinkhorn et al. had stated in his study that 78% of mothers had awareness about dietary instructions.[13]

This highlights a presence of lacunae present in the knowledge on relationship between the different forms of sugars and time consumption with dental caries. In addition to this, knowledge on prevention of various oral conditions was also low in this study.[8]

Majority of the mothers agreed that it is essential to make regular dental visits for their children, which was similar to the results produced by Moulana et al., 2012 and Chan et al., 2002.[9],[12] However, in contrast to the above finding, only a very few reported to follow it. The reasons attributed for the same were apprehensive attitude toward dental care, high costs, accessibility, or lack of knowledge on good oral health care.

Participants had inadequate knowledge on the deciduous tooth management. Most of them (72.9%) cared least about their child's primary teeth, which was similar to the study done by Suresh et al., 2010.[8]

Majority of the caregivers (80%) used finger for cleaning their child's teeth. This is because of the fact that majority of our sample consisted of children with autism, who have aversion for using toothbrush for toothbrushing.[14]

Mothers with higher education and income had better knowledge and attitude regarding the oral hygiene practices which is similar to a Polish study.[15] This could be because of the fact that parents with higher level of education would have appropriate access to accurate source of information and have a complete and comprehensive understanding of the information. Furthermore, parents with higher education will exhibit more positive health attitudes and render greater attention to the general and oral health of their child.[16]

The present study findings are suggestive of poor knowledge about oral health among mothers of special needs children. This suggests a call for appropriate and effective oral health education program among them. With increasing change in trends of oral health maintenance, it is the need of the hour to hatch an appropriate oral health program targeting these disadvantaged populations. Emphasis should focus on improving their knowledge, as it is directly related to their oral health-care behavior.


The current study presented findings that mothers of children with special needs had poor knowledge and attitude toward oral health of their children.


The results of the present study cannot be extrapolated, as the sample of the study was a convenient one and not a representative in nature. Further, large sample studies in multicenter need to be conducted to extrapolate the results.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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