| Abstract|| |
Context: Early Childhood Caries (ECC) is the most virulent form of caries, which requires early intervention. Pediatricians are health professionals who first examine the child, and must be able to educate parents about basic preventive dental care, early diagnosis of pathological changes in the oral cavity and appropriate referrals for the children. Aims: To assess the awareness, attitude, and practice among pediatricians regarding ECC and Infant Oral Healthcare (IOHC) in Puducherry. Settings and Design: Setting: Study was conducted among pediatricians of Puducherry. Design: Observational Cross-sectional study. Methods and Material: After obtaining consent from Pediatricians, a prevalidated questionnaire was distributed and collected from them regarding their awareness, attitude, and practices toward ECC and IOHC. Statistical Analysis Used: Percentage. Results: Out of 85% Pediatricians who responded, 57% of them were aware of initial white spot lesions, and 39% of them were aware of maternally-derived Streptococcus mutans disease. 100% of them were willing to avail information, training on IOHC. Conclusions: It is clear from the study that Pediatricians in Puducherry had limited awareness regarding the prevention of oral diseases. It is essential to provide sufficient knowledge to them by incorporating a module on ECC and infant oral health care in their curriculum.
Keywords: Early childhood caries, infant oral healthcare, pediatrician
|How to cite this article:|
Prathima G S, Kavitha M, Kayalvizhi G, Sanguida A, Suganya M, Arumugam S. Awareness, attitude, and practice of pediatricians regarding early childhood caries and infant oral healthcare of children in Puducherry- A cross-sectional survey. Indian J Dent Res 2020;31:439-43
|How to cite this URL:|
Prathima G S, Kavitha M, Kayalvizhi G, Sanguida A, Suganya M, Arumugam S. Awareness, attitude, and practice of pediatricians regarding early childhood caries and infant oral healthcare of children in Puducherry- A cross-sectional survey. Indian J Dent Res [serial online] 2020 [cited 2020 Sep 23];31:439-43. Available from: http://www.ijdr.in/text.asp?2020/31/3/439/291476
| Introduction|| |
Early childhood caries (ECC) is the most virulent form of caries, which starts soon after tooth eruption. It develops on smooth surfaces and progresses rapidly, causing a detrimental impact on the dentition.,
Infant oral health (IOH) is one of the foundations on which dental care and preventive education must be built to allow a lifetime opportunity free from preventable oral diseases., Pediatricians are the one who examine the infant soon after birth and several times during their routine health check-up. In all “well-baby check up” it is essential that the pediatricians educate mothers on oral hygiene and infant oral health practices. The American Academy of Pediatric Dentistry (AAPD) encourages health care providers to use all recommended preventive strategies to prevent ECC, and implementation of these strategies should begin at the Pediatrician's office. American Academy of Paediatrics (AAP) also emphasizes that pediatric health care professionals should be trained to perform an oral health risk assessment on all children beginning at 6 months of age.,
However due to lack of awareness pediatricians do not address the dental issue in the children nor refer them to a pedodontist. This leads to a lack of dental awareness among parents, and therefore, inability to provide comprehensive care for children that involves the coordination of services between medical and dental health care professionals.,
According to the literature search, few studies have been conducted in Canada, Italy, Turkey, Virginia, Nigeria, Iran, and in different parts of India,,,,,, to assess the awareness, attitude, and practices of pediatricians and medical professionals regarding ECC and Infant Oral Health, but there are no studies conducted in Puducherry. Hence, this survey was planned to assess the awareness, attitude, and practices of pediatricians regarding ECC and IOHC.
| Subjects and Methods|| |
A cross-sectional questionnaire-based survey was conducted among pediatricians residing in Puducherry. The study protocol was approved by the Institutional Review Board, and Ethical clearance was obtained from the Institutional Ethical Committee (IGIDSRID2017 NRP08PGKMPPD).
A comprehensive questionnaire containing 25 items was prepared from the previous research.,,, The survey questions were divided into 4 domains such as Individual details including name age, sex, and medical background; Awareness questionnaire item to assess the awareness regarding early childhood caries, infant oral health care and its preventive strategies; Attitude questionnaire item to assess the attitude of pediatricians regarding early childhood caries and infant oral health care practices; and Practice questionnaire item includes the oral health-related activities carried out during baby visits by pediatricians. In the present study, we used both closed-ended questions and open-ended questions to explore pediatrician's awareness, practice, and attitude to achieve a detailed response.
The questionnaire was pre-validated before administration. The test-retest reliability of the questions was assessed. The Cronbach's alpha value was 0.82, which implied good internal consistency.
After obtaining pediatricians consent, the questionnaire was administered to them in their respective clinics and hospital. Sufficient time was given for filling the questionnaire, and it was collected on the same day. The results obtained were tabulated and analyzed on a percentage basis.
| Results|| |
In a convenient sample of 110, pediatricians were selected. Their consent was obtained for participation in the questionnaire survey, giving a response rate of 85%, whereas the remaining 15% were not available during the visit to their clinic/hospital.
The study samples was categorized according to various criteria such as age, gender, years of practice, hours of practice, and type of practice. Among the respondents, the majority of them were males 66% and female around 34%. With respect to age, 65% were in the age group of 25–35 years, 20% in the age group of 35–45 years, 8% in the age group of 45–55 years, and 17% of them in the age group of >55 years.
According to their qualification, 55% pediatricians had a Masters Degree and 45% had a Diploma Degree. Among them, 72% of participants were Private practitioners, 10% of them were in Government practice and 17.3% were both in Private and Government practice.
With respect to the clinical experience, 40% had the clinical experience of 10–20 years, 36.5% had 1–10 years experience, and 23.5% had experience of 20–45 years. In total, 88.2% of the pediatricians practice for 5–10 h, 3.6% of them practice for 3–5 h, and 8.2% of them practice for 10–20 h. On the basis of their patient inflow in a day 44% of them examined at least 10–20 patients, 25.4% examined 40–150 patients per day, 24.5% of them examined 20–40 patients, and only 18.1% examined 6–10 patients per day.
In the present study, majority of pediatricians were aware about their role in the prevention of oral disease. Approximately, 39.1% knew that cavity causing bacteria can be transmitted from mother to child. Their knowledge regarding the age at which first primary teeth erupts was 46.9% [Table 1].
|Table 1: Awareness about early childhood caries and infant oral health care|
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Regarding tooth brush recommendations, 39.1% of them advised tooth brushing when the first primary teeth erupted, but mostly, 51.8% of pediatricians advised tooth brushing after all the primary teeth erupted.
Diet and Nutritional Counseling plays an important role in the prevention of dental caries and also to address nutritional deficiencies in children. Approximately, 79% of them considered that reducing high sugar drink and high sugar snacks and recommending food rich in mineral and vitamins could prevent ECC [Graph 1].
Fifty percent of pediatricians discussed about the ill effects of early childhood caries with their parents and 70% of them believed that untreated dental caries could affect the general health of a child. In the present study, 86.4% of the pediatricians performed oral health examination of their patients, 80.9% of pediatricians recommended regular oral health examination for special children, and 95.5% of them referred a suspected case of ECC to a General Dentist, On the contrary, only 10.9% of pediatricians referred them to a Pedodontist [Table 2] and Graph 2]. Approximately, 12.7% of the pediatricians strongly believe that first signs of tooth decay are the presence of white spots on tooth surface [Table 1].
|Table 2: Practice about early childhood caries and infant oral health care|
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Although 89.1% of the pediatricians do not advise bottle feeding for infants, 25.5% of them disagreed that bottle feeding at night leads to dental caries and only 42.8% of them agreed that prolonged and “at will” breastfeeding leads to dental caries. Besides 44.5% of the pediatricians advised parents regarding the use of the fluoridated tooth paste, only 20.9% of pediatricians knew about the role of fluoride in caries prevention.
In the present study, 35% of the practitioners reported that they received information about Infant Oral Health Care and Early Childhood Caries from continuing medical/dental educational courses, colleagues, through associations and from other sources. Almost all pediatricians were willing to avail information and training about the prevention of oral diseases and infant oral health care [Graph 3].
| Discussion|| |
In spite of the pronounced improvement in oral health, caries is still a common disease affecting the children. One of the factors that affect the performance of preventive dentistry is the knowledge and involvement of the medical profession. Hence, this study was planned to evaluate the awareness, attitude, and practice of pediatricians in Puducherry, and at the same time to create awareness of ECC and infant oral health care among them.
Pediatricians are health professionals who supervise the process of growth and development of children from birth. They should be able to educate parents about basic preventive dental care, diagnose pathological changes in the oral cavity, and make appropriate referrals for the children. In the present study, majority of the pediatricians believed that they have a role in the prevention of oral diseases, which correlates with the study done by Giuseppe et al. among pediatricians in Italy.
Although AAPD, AAP, and ADA insist on an early dental visit to improve infant oral health care and prevention of ECC, it can be achieved only with the help of allied health professional and pediatricians. Additional fraternization is needed between dental and medical community to prevent oral diseases.
According to AAPD, the first dental visit of a child is recommended at the time of the eruption of the first primary tooth and no later than 12 months of age. AAP recommended that Dental home similar to the medical home should be established by age one for those children at caries risk. In the present study, only 12.7% of pediatricians recommended 1st dental visit by 6 months of age, which correlated with the study done among Canadian pediatricians. While 43.7% reported that first dental visit of a child should be at their first birthday, in contrast, Douglass et al. in his study reported that only 28% of study participants referred children by the first birthday. A recent survey of American pediatricians and Family physicians reported that only 19% of Family physicians and 14% of pediatricians would recommend an early dental visit for a child with a low caries risk.
According to AAPD, ECC is an infectious and preventable disease that is vertically transmitted from mothers or other intimate caregivers to infants, which is also cited in the pediatric literature. However, in a study conducted among pediatricians of Bangalore, only 39.1% of them agreed that cavity-causing bacteria could be transmitted between mother and the child.
Among 55% of pediatricians, only 28.2% of them took their child for regular dental check-up and 9.1% of them took them to a dentist 6 months once, which correlates with the results of study among Turkish pediatricians in which 10.3% of them reported that they take their child to the dentist at intervals of <6 months. In the present study, pediatricians in spite of having noticed decay, 21.8% visited a dentist with their child when the child complained of pain.
In the present study, most of the pediatricians recommended tooth brushing for their patients and about 39.1% of them recommended tooth brushing when the first tooth erupts. In the present study, pediatrician's awareness about the role of fluoride in the prevention of caries was found to be limited. In contrast, Lewis et al. reported that American Pediatricians had good knowledge regarding fluoride varnish application and fluoride supplementation. In the present study, 58.2% of Pediatricians reported that they were aware that white spots are initial signs of caries and the results correlated with that of Sodani et al. (40%) but are contradictory to Prakash et al. study who reported only 23.5% of them being aware of initial signs of tooth decay.,
Inspection of the oral cavity of the child can be done while examining the oropharynx and nasopharynx. Similar to the findings reported by Soares et al., and Sabbagh et al. in Saudi Pediatricians,, we also observed that almost 86.4% of pediatricians routinely examined the oral cavity of their patients.,, Pediatricians regularly examined the oral cavity for identifying any systemic illness rather than finding any dental problem, which could be the reason why many reported that they examined the oral cavity regularly. In addition, 80.9% of them recommended regular oral health examination for special children.
Untreated dental caries might affect the general health of the child and lowers the quality of life. To avoid such consequences, diet and nutritional counseling and oral hygiene practices should be discussed with the parents. It was found that 70% of them believed that untreated dental caries would affect the general health of the child, whereas among them only 54% of them discussed the ill effects of ECC with the parents.
A well-known fact that diet counseling and weaning plays an important role in the prevention of ECC was agreed by 60.9% of pediatricians, thus, 70.9% of them provided nutritional counseling to prevent caries. In the present study, most of the pediatricians felt that there is a need for counseling on feeding and weaning habits in infants is similar to a study done in Bagalkot city (Karnataka), where in 60% of health professionals agreed to this concept.
Although breastfeeding is an ideal feed for infant, prolonged and “at will” breastfeeding leads to caries; this was not agreed by 31.8% of the pediatricians. However, 51.8% of the pediatricians agreed that bottle feeding could lead to dental caries. Subsequently, 89.1% of pediatricians usually did not recommend bottle feeding, which correlated with Sabbagh (2011).
Most of the Pediatricians in the present study refer the suspected case of ECC to general dentist and only 10.9% of them refer to a Pedodontist, which was observed among Chennai pediatricians.
Similar to the previous study by Sanchez et al., pediatricians in the present study reported receiving little training regarding prevention of oral diseases from Continuing Dental educational courses and colleagues, and 89% of them were not aware about specialist called Pediatric dentist.
AAP recommends the integration of health care professionals toward infant oral health care and prevention of ECC i.e. pediatricians, family practitioners, pediatric nurse practitioners, and physician assistants should be trained to perform an oral health risk assessment on all children beginning by 6 months of age to identify known risk factors for Early Childhood Caries. Pediatricians should support the concept of the identification of a dental home as ideal for all children in the early toddler years.
However, with the lack of training and unfamiliarity with oral health issues, it becomes difficult for the pediatricians to diagnose and refer suspected cases of ECC. This lacune can be solved by providing adequate knowledge during their under graduation and post graduation, adding a module in their curriculum about perinatal and infant oral health care, conducting regular continuing dental/medical education program for pediatricians and by publishing guidelines about infant oral health care in medical journals.
| Conclusion|| |
It can be concluded that most of the pediatricians avail little knowledge regarding ECC and infant oral health care during their curriculum, and majority of them were not aware about pedodontics as a speciality in Dentistry. They also reported the issue of lack of knowledge of the main risk factors for oral diseases, and they also believed that they had an important responsibility in preventing oral diseases in children. Hence, there is a need to educate health care professionals on infant oral health care by conducting health education programs and incorporating the same in medical curriculum so as to promote good oral health.
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Conflicts of interest
There are no conflicts of interest.
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Dr. Muthukrishnan Kavitha
Department of Paedodontics and Preventive Dentistry, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeth, Pillayarkuppam, Puducherry - 607 402
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2]