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ORIGINAL ARTICLE
1 (
1
); 11-18
doi:
10.25259/DJIGIMS_20220101_11

EVALUATION OF AWARENESS, KNOWLEDGE AND ATTITUDE OF CLINICAL NURSES TOWARDS PRIMARY ORAL HEALTH CARE OF CHILDREN.

Dept. of Pedo. & Prev. Dent., VDCW, Tiruchengode, TN
Dept. of Pedo. & Prev. Dent., KSRIDS, TN
VS Dental and implant centre, Thudiyalur, Coimbatore, Tamil Nadu
Corresponding author : Dr. Mohanraj Kamatchi
Licence
This open access article is licensed under Creative Commons Attribution 4.0 International (CC BY 4.0). http://creativecommons.org/licenses/by/4.0
Disclaimer:
This article was originally published by Indira Gandhi Institute of Medical Science and was migrated to Scientific Scholar after the change of Publisher.

Abstract

Background & objectives:

Most of the toddlers and early childhood children in developing and under developing countries do not visit dental clinics for oral examinations earlier than three years of age though they often visit primary health care providers for regular medical checkups. Health care providers like nurses are easily available and are in frequent contact with expecting mothers and children for routine check ups. This provides an opportunity to join in oral health promotion and care into health care. Nurses play a major as well as prominent role in providing health services, along with the general physicians. Yet, the nurses can be efficiently employed to promote oral health awareness among the community level. The oral health should have greater importance in the nurse for identification and diagnosis of dental and oral diseases. The aim of this study was to study the awareness, knowledge and attitude towards primary oral health care of children among clinical nurses.

Methods:

A total of 200 clinical nurses received a questionnaire that included demographic data, questions to assess the oral knowledge, oral awareness and attitude towards primary oral health care of the children. Data was collected, tabulated and statistically analysed.

Results:

The result showed that most nursing students (80%) are unaware about primary oral health care disease and the importance of primary teeth are also not known by both the private and government college nursing students.

Interpretation & conclusion:

Primary health care nurses lack knowledge and awareness in oral and dental health care. Nurses have positive attitude and willingness to obtain more information for appropriate oral health care. Training and encouragement for the nurses helps to promote oral health and prevent dental diseases in children.

Keywords

Attitude
Awareness
Knowledge
Nurses
Oral Health Care.

INTRODUCTION:

Healthy mouth is a priceless and unique treasure. Maintaining a good oral health is regarded as a good overall general health1. Oral health is a significant characteristic of general health in infants and children and influences the quality of life and health outcomes2. Early childhood caries (ECC) is an important major public health problem which develops in children as early as ten months of age3. ECC needs implementation of preventive practices to decrease a child risk of further progression. Risk factors of ECC is multifactorial which include the low economic status, lack of parent education, fewer dental visits, inadequate oral hygiene, high cariogenic diet and absence of oral health knowledge4.

Nursing is a significant paramedical course which is also considered as an essential supplementary branch of medicine. Nurses play an important as well as prominent role in providing health services, along with the general physicians5. Mother being the primary educator of the child should be aware of such problems to create awareness. Nurses play an important role in such situations by shaping and changing the community, Such an attitude and knowledge is very important as they are in frequent contact with expectant mothers and new mothers. This is one such way of creating awareness on oral hygiene and health as mouth is the mirror of the body.

According to the American Academy of Pediatric Dentistry (AAPD), all health professionals are encouraged to participate in preventing ECC by providing services that includes risk assessment, health promotion, care coordination, oral screening, nutritional counseling, preventive interventions, fluoride varnish application, and referral for pediatric dental care6. The primary aim of dentist is to impart positive oral health knowledge, awareness, attitude and behavior towards an individual along with society and creating an environment friendly relationship to shift the responsibility of publics oral health from the shoulders of health professionals to the individual's own hand for an overall good general health7.

Clinical nurses are easily reachable and are in regular contact with expectant mothers and children who visit hospitals for routine checkups and this provides an eye-opener to integrate oral health promotion and care into health care.8 There is a study that reveals pediatricians and general doctors aren't advising parents to see a dentist by one year of child's age, this point tells the need for increasing education about this topic in the medical groups9. According to Yousef Al- Matalan et al training of nurses and physicians in oral health has been limited, which is most probably related to the poorly focused education on oral health issues10. So, the purpose of our study was to evaluate the knowledge, attitude and practice of nurses towards primary oral health care of children.

MATERIALS AND METHODS:

Study design and study sample

The study was a cross sectional questionnaire survey. The study population covered clinical nurses working in the institutional hospital of government and private sector, who provided care for pediatric patients, new mothers and pregnant mothers. The survey was voluntary and the responses were kept anonymous. The survey was conducted among 200 participants. The questionnaire was distributed and collected from 100 nurses in government hospital and 100 nurses in private hospital.

Criteria of selection

The inclusion criteria included those who were willing to participate with free of constraints, completed questionnaire, practicing nurses available at the time of data collection. Nurses with minimum experience of 3 years and above in the study were included.

The exclusion criteria comprised incomplete questionnaire, nurses who were not willing to participate and nurses with less than 3 years of experiences.

Questionnaire details

A structured questionnaire was formulated with 20 questions in English and then the questionnaire was given to the nurses who were practising in different colleges and hospitals. The questionnaire was given to each nurse directly and explaining the purpose of the study. Subsequently the students were asked to fill the questionnaire.

Questionnaire included four sections parts A, part B, part C and part D

Part A included sociodemographic information was also collected that included age, gender, educational qualification, professional experience and working sector (Private/ Government).

Further 3 parts includes 20 questions based on

  • - Questions (1 to 10) are related to knowledge which include information acquired by the nurses through experience or education. [Part B]

  • - Questions (11 to 15) involves awareness relate to the actual responsiveness of the participants. [Part C]

  • - Questions (16 to 20) related to attitude involved awareness predilection to certain ideas and information. [Part D]

Since there were equal participants in government and private sector, the awareness, knowledge and attitude were also compared between the groups.

QUESTIONNAIRE

A. PARTICIPANTS DEMOGRAPHY

Name:

Age:

Sex:

Educational qualification:

Professional experience:

Working sector (Government/ Private):

B. ORAL HEALTH KNOWLEDGE

  • 1. The first baby tooth appears in the child's mouth by six months

    • a. True b. False c. Don't know

  • 2. Natal teeth are teeth that are present at child's birth.

    • a. True b. False c. Don't know

  • 3. A child should be seen by a Dentist by one year of age

    • a. True b. False c. Don't know

  • 4. First sign of dental decay includes white chalky patches on the teeth

    • a. True b. False c. Don't know

  • 5. Good oral health is important of good overall well­being of child.

    • a. True b. False c. Don't know

  • 6. Dental caries can be transmitted from mother to child.

    • a. True b. False c. Don't know

  • 7. Cleaning baby's mouth after each food should begin even before tooth erupts

    • a. True b. False c. Don't know

  • 8. Putting child to sleep immediately after giving milk increases risk of caries

    • a. True b. False c. Don't know

  • 9. Fluoride in tooth is important for tooth decay.

    • a. True b. False c. Don't know

  • 10. Consuming sugar containing foods can causes tooth decay.

    • a. True b. False c. Don't know

C. ORAL HEALTH AWARENESS

  • 11. Dental caries can be prevented

    • a. Agree b. Disagree c. Neither agree nor disagree

  • 12. Oral health care delivered by nurses is inefficient

    • a. Agree b. Disagree c. Neither agree nor disagree

  • 13. Nurses can examine the oral cavity of every child.

    • a. Agree b. Disagree c. Neither agree nor disagree

  • 14. Educating parents about natal tooth/teeth is/are the responsibility of nurse.

    • a. Agree b. Disagree c. Neither agree nor disagree

  • 15. Milk teeth does not require care because they will fall out.

    • a. Agree b. Disagree c. Neither agree nor disagree

D. ORAL HEALTH ATTITUDE

  • 16. Do you recommended pregnant mother for dental visit.

    • a. Always b. Sometimes c. Never

  • 17. Do you enquires about mother's dental health.

    • a. Always b. Sometimes c. Never

  • 18. Do you encourage breast feeding or bottle feeding for babies during sleep

    • a. Always b. Sometimes c. Never

  • 19. Do you counsel the patient about importance of tooth brushing

    • a. Always b. Sometimes c. Never

  • 20. If natal tooth/teeth is/are present do you clean the oral cavity of child

    • a. Always b. Sometimes c. Never

Statistical analysis:

Descriptive statistics was used. Chi square test was used to find significance. Frequency distribution was done based on number and percentage was calculated.

RESULTS:

200 questionnaires were distributed, collected back from the participants and statistically analysed. Table 1 shows that females participated more than males in the study. Table 2 shows professional experience among the nurses, which has a statistical difference. Questions number 1, 3, 5, 6 and 8 shows statistical difference among the private and government hospitals working nurses (table 3 and 4). In awareness related questions (table 5), questions 11 and 12 got the significant difference values among the responses given by the nurses. Table 6 shows the attitude related questionnaire in which 16th and 17th questions has significant difference in the responses.

Table: 1 - Gender comparison among nurses participated
Nursing College Gender TotalSig. (2-sided)
Male Female
Private 25 75 100 .498#
Government 20 80 100
Total 45 155 200

#Non-significant (p>0.05)

Table: 2 - Professional experience association with nursing college
Nursing College Professional experience Total Sig. (2-sided)
3 Year Experience 5 Year Experience
Private 70 30 100 .000**
Government 35 65 100
Total 105 95 200

**Highly Significant (p<0.01), *Significant (p<0.05)

Table: 3 - Knowledge related questionnaire (Part A)
S. No Questions Nursing College Response Sig.(2-sided)
True False Don't Know
1 The first baby tooth appears in the child's mouth by six months Private 6 90 04 0.00**
Government 92 6 02
Total 98 96 06
2 Natal teeth are teeth that present at child's birth Private 18 66 16 0.70#
Government 20 68 12
Total 38 134 28
3 A child should be seen by a Dentist by one year of age Private 32 6 62 0.00**
Government 30 64 06
Total 62 70 68
4 First sign of dental decay includes white chalky patches on the teeth Private 62 20 18 0.10#
Government 72 20 08
Total 134 40 26
5 Good oral health is important of good overall well-being of child. Private 52 44 04 0.01*
Government 40 42 18
Total 92 86 22
Table: 4 - Knowledge related questionnaire (Part B)
S. No Questions Nursing College Response Sig.(2-sided)
True False Don't Know
6 Dental caries can be transmitted from mother to child Private 20 50 30 0.00**
Government 36 54 10
Total 56 104 40
7 Cleaning the baby's mouth after each food should begin even before tooth erupts. Private 44 40 16 0.33#
Government 52 30 18
Total 96 70 34
8 Putting child to sleep immediately after giving milk increases the risk of caries Private 20 36 44 0.00**
Government 44 40 16
Total 64 76 60
9 Fluoride in tooth isimportant for tooth decay Private 38 42 20 0.93#
Government 38 44 18
Total 76 86 38
10 Consuming sugar containing foods can causes tooth decay Private 72 20 08 0.43#
Government 72 24 04
Total 144 44 12

**Highly Significant (p<0.01), *Significant (p<0.05), #non-significant (p>0.05)

Table: 5 - Awareness related questionnaire
S. No Questions Nursing College Response Sig.(2-sided)
True False Neither agree nor disagree
11 Dental caries can be prevented Private 48 14 38 .001*
Government 68 18 14
Total 116 32 52
12 Oral health care delivered by nurses is inefficient Private 44 22 34 .008*
Government 62 22 16
Total 106 44 50
13 Nurses can examine the oral cavity of every child Private 26 116 58 .932#
Government 18 58 24
Total 38 114 48
14 Educating parents about natal tooth/teeth is /are responsibility of the nurses Private 10 50 40 .836#
Government 10 46 44
Total 20 96 84
15 Milk teeth does not required care because they will fall out Private 08 58 34 .062#
Government 18 58 24
Total

**Highly Significant (p<0.01), *Significant (p<0.05), #non-significant (p>0.05)

Table: 6 - Attitude related questionnaire
S. No Questions Nursing College Response Sig.(2-sided)
True False Never
16 Do you recommend pregnant mother for dental visit Private 32 62 06 0.041*
Government 22 62 16
Total 54 124 22
17 Do you enquire about mother's dental health Private 22 54 24 0.940#
Government 22 56 22
Total 44 110 46
18 Do you encourage breast feeding or bottle feeding for babies during sleep Private 44 50 06 0.143#
Government 44 42 14
Total 88 90 20
19 Do you counsel the patient on importance about tooth brushing Private 36 26 38 0.987#
Government 37 26 37
Total 73 52 73
20 If natal tooth/teeth is/are present, do you clean the oral cavity of child Private 40 20 40 0.009*
Government 22 18 60
Total 62 38 100

**Highly Significant (p<0.01), *Significant (p<0.05), #non-significant (p>0.05)

DISCUSSION:

Profession with frequent contact with the expecting mothers, new mother and new born are the nurses. The key aspect is that nurse is change leaders. Clinical nurse is in the best situation to identify needed change and determine potential improvements. Engaging them and performing the work each day will have the greatest improved outcome. Oral disease is one of the major public health problems, since nursing staff and students reach out to many unreserved areas of the country, they are expected to have positive behavior towards oral health and its disease.

Health promotion in developing country like India is limited due to the factors like economic, social, geographic and political leading to inadequate health care resources. Collection of such data's help us in carrying out various planes and train some important group of manpower and utilize their service in the field of oral health7. According to Tetuan et al and Spielman et al oral health assessment should be a part of nursing curriculum11,12. An oral health promotion module for primary health care nursing course can enhance nurse about skill, awareness and knowledge about oral health13. Formicola et al quoted that oral health care would require dental school in collaboration with the health care team so the quality of life of an individual can be improved by improving the oral health in terms of general health14. A literature by Gallagher et al stated that the role of community nurse is to improve the oral health in the society, particularly among the less likely access area of the dental service15.

ECC is a significant problem among the primary dentition which is often ignored or not taken under care. ECC is preventable and treatable if untreated it leads to further problems like pain, alteration to growth and development, speech problems, tooth loss, aesthetic problems, negative effect on the proceeding successor, bacteremia, and lack of self­confidence. A small change in the day-to-day life can create a change in the health of oral cavity like encouraging the expecting parents and parents to visit the dentist for their own oral health thereby decreasing the mutant level in mothers may decreases the risk of child developing ECC, discouraging of liquid sugar intake at bedtime or naptime before bed, reduction of nocturnal breastfeeding after first tooth eruption, encouraging of cup drinking soon after first birthday, periodic cleaning of tooth after every meal or medication and balanced diet intake for good nutrition.

Corbella et al completed meta-analysis in17,053 subjects from 22 studies concluded that pre term and low birth weight are risk of women with periodontitis16. In a cross-sectional study with 1206 subject at post-partum follow up accounted that maternal periodontitis was responsible in decreased low and very low birth weight with decreased mean weight17. Maternal oral health has connection with dental caries in children this statement is supported by several authors.

Gestational diabetes mellitus (GDM) is in strong evidence with periodontitis which is the reason for maternal and fetal pregnancy complication.[18]. Surgeon general in America used 'silent epidemic' in a report on oral health to depict dental caries stating the dental caries is most prevalent and preventable disease in childhood19. Leong et al and his coworkers highlighted pregnancy and neonatal period are the time to identify children for high risk and early oral health examination in maternal have potential to reduce the likelihood early onset dental caries in children20.

Boggers et al in 2008 supported the statement saying that oral health of the mother has significant effect on child oral health21. Pregnant and non pregnant women of childbearing age don't visit dentist which is multifactorial like financial barrier, socio demographic and perception22. Many public and private health plans do not include dental benefits along with lack of insurance are some factors which dental services are not in reach for pregnant and pregnancy planning women. Oliveira et al studied period of 10 years among dentists reported that reasons for not treating women during pregnancy were related to unsafe of x- rays, medications, administration of local anesthesia was also unsafe for treatments23.

In a population-based survey done by Marchi et al in California for duration of five years among postpartum women specified that primary reason women reported not using dental care during pregnancy was a lack of perceived need followed secondarily by financial barriers24. Medications and anesthetics used in dental practices fall under Category B in FDA and have not been a risk to the fetus25. Ismail et al concluded that prevention of ECC can be achieved by accomplishment of joining networks like health professional, community workers and national organizations serving children26.

A successive prevention of ECC is by motivation of expecting mothers, mothers of infants and toddlers, care givers and health care providers27. Improving the educational level sector, oral health policies, positive instruction of feeding practice among mothers and care givers might improve community to overcome the silent epidemic.

CONCLUSION:

This study contrasted the awareness, knowledge and attitude of medical nurses towards primary oral health care of children in private and government sector. Subsequently the oral health knowledge, awareness is not necessarily be implemented only by the dentist. Joining hands with such auxiliaries and training them in correct pathway can also be used to progress the knowledge and awareness to the public on oral health.

Conflicts of interest:

Nil

Financial support:

Nil

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