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 Table of Contents  
Year : 2021  |  Volume : 12  |  Issue : 3  |  Page : 132-135

Parental knowledge, attitude and practice of oral hygiene of special children in Bangalore

Department of Pedodontics and Preventive Dentistry, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India

Date of Submission27-Nov-2020
Date of Acceptance28-Jul-2021
Date of Web Publication17-Sep-2021

Correspondence Address:
Dr. Anagha Saseendran
Post Graduate, Department of Pedodontics, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/srmjrds.srmjrds_126_20

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Background: Oral hygiene of special children is directly related to their disability, and parents play a key role in a child's oral hygiene maintenance which would influence their general health condition. Aim: The aim of this study was to evaluate the knowledge and attitude of parents of special children toward oral hygiene maintenance and to correlate the same with educational and socioeconomic status. Materials and Methods: A cross-sectional study was conducted among the mothers of children from special schools in Bangalore. The survey included questions related to knowledge and attitude of parents and practice of oral hygiene maintenance for their children. The results were tabulated and subjected to statistical analysis using Chi-square test. P < 0.05 was considered to be statistically significant. Results: The parents of the special children had sufficient knowledge on the maintenance of oral hygiene, and the educational status of the parent had a positive impact on the child's oral health. Conclusion: Oral hygiene maintenance of special children is extremely important as primary teeth serve as the milestone in orofacial growth and development.

Keywords: Attitude of parents, knowledge, oral hygiene, primary teeth, special children

How to cite this article:
Saseendran A, Nagar P, Nameeda K S, Nihala K F. Parental knowledge, attitude and practice of oral hygiene of special children in Bangalore. SRM J Res Dent Sci 2021;12:132-5

How to cite this URL:
Saseendran A, Nagar P, Nameeda K S, Nihala K F. Parental knowledge, attitude and practice of oral hygiene of special children in Bangalore. SRM J Res Dent Sci [serial online] 2021 [cited 2023 Feb 4];12:132-5. Available from:

  Introduction Top

Oral health is a key indicator of overall health, and oral hygiene maintenance is crucial in the prevention of dental caries.[1] Oral health has been ignored in every part of the globe, especially among special children, which was directly related to their physical and mental health condition.[2],[3],[4] Parents should be educated about the oral health care, which in turn influences the general health of their children.[5],[6],[7] Special children also have substantial limitations in performing day-to-day activities which also required parental assistance for toothbrushing. Special children generally have increased dental caries due to the lack of oral hygiene maintenance. Compromised gingival and periodontal health occur due to impaired immune system and connective tissue disorders which indirectly affect the oral health condition of special children. Attrition of the enamel due to bruxism is commonly seen in children with cerebral palsy. Hypotonic muscles and uncoordinated chewing tends to accumulate more food in the mouth in children with cerebral palsy and thus harbors microorganisms which causes dental caries.[8],[9] This study was conducted to evaluate the knowledge and attitude of parents of special children toward oral hygiene maintenance and to correlate the same with educational and socioeconomic status. Health professionals should take an initiative to identify the individuals at high risk, provide anticipatory guidance, and refer to pedodontists for making efficient preventive oral health care and necessary treatments including fluoride application and implement adequate knowledge of maintenance of oral hygiene in special children.

  Methods Top

Ethical clearance was obtained from the Institutional Review Board (Reference ID: KCDS/165/2018-2019). A cross-sectional survey was conducted among 93 mothers of special children (both boys and girls) from special schools of Bangalore aged 3–9 years with autism, Down syndrome, hearing impairment, mentally challenged, attention deficit hyperactivity disorder, and cerebral palsy. Written consent was obtained from the mothers aged between 27 and 48 years, and all the participants were asked in person to answer the questionnaire, the first part of which included their demographic data, educational qualification and the age of the child. Questions related to knowledge, attitude of parents and practice of oral hygiene maintenance for their children was included in the questionnaire.

Statistical analysis was done using IBM SPSS version 23 (IBM Corporation, Armonk, NY, USA). Chi-square test was done to compare the categorical variables. P < 0.05 was considered to be statistically significant.

  Results Top

Sixty-eight percent of the parents were undergraduates/postgraduates [Table 1]. 89.2% thought that consumption of sugar would cause detrimental effects on the dentition. 30% of the parents visited the dentist frequently to know the oral health status of their child. 26.9% depended on media, dentist, and peer suggestion as a source of oral health information. 36.6% preferred combined use of brushing and mouthwash as an appropriate method of cleaning the oral cavity. It is evident that majority of the parents knew that sugar could be the arch criminal and only 10% were unaware about it and the P value was 0.001 which was considered statistically significant. 60% preferred to give equal importance to both primary and mixed dentition while 35% preferred only permanent dentition. 17% visited a dentist once in 3 months and 49% visited once in 6 months, with a P value difference of 0.001 which was statistically significant. 72% of the parents made the child brush twice daily and 22% of the parents did brushing once in their children. 78.5% of the parents reported that their child brushes teeth without assistance.
Table 1: Parental knowledge, attitude, and practice scores of oral hygiene of special children in Bangalore

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  Discussion Top

Maintenance of primary teeth is considered to be an important factor for the oral and general development of the child and is indirectly associated with oral hygiene maintenance.[10] Untreated primary teeth cause serious complications such as space infections and alterations in growth and development and also leads to malnourishment of the child.[11],[12],[13],[14] Premature loss of teeth can lead to malocclusion and hamper the speaking skill.[15]

In the current study, majority of the study participants were well aware that consumption of sugar would result in detrimental effects to the oral cavity of their children. This can be due to the increased literacy rate among the parents. The knowledge about the fluoridated pastes implies the educational status and awareness of the parents which is in favor of the study. Gurunathan and Shanmugaavel conducted a cross-sectional survey among 478 parents of children aged 3–12 years and carried out PUFA and decayed, missing, filled teeth index and concluded that neglect of oral hygiene maintenance was more prevalent in the suburban population.[16] Maintenance of oral health in special children requires the active participation of both parents and caregivers, and the attitude of the parent was governed by financial restraints.[10]

Mouthwash and brushing was the preferred method of maintenance of oral hygiene among 36.8%, and they also practiced flossing for their children. This could be because of the higher educational level and socioeconomic status of the parent population. 60.2% of the total population reported that they gave equal importance to the primary dentition also. A similar result was reported by Magoo et al.[5] in which majority of the parents gave importance to milk teeth.

From the survey, a bit more than half of the total parents reported that oral health maintenance was important and would affect the appearance and overall health of the child. Nearly two-third of the participants agreed that reduced sugar intake, frequent dental visits, supervision, and toothbrushing assistance would be the appropriate way to maintain good oral hygiene. From the current survey, it was concluded that majority of the children practiced the traditional method of cleansing the tooth, since mechanical cleaning was difficult for few of the special children.[5] Janhvi and Geo reported that parents with higher literacy status had better awareness and efficient way of oral hygiene practice in special children which was similar to our results.[17]

Nearly half of the study groups visited dentists once in 6 months and very few in once in 3 months. This clearly defines the awareness about oral hygiene among the parents. Magoo et al. reported that 69% of the special children used additional oral hygiene aid which was similar to our study. 35.5% reported that they do not practice any other oral health-care needs other than manual brushing.[5] Some populations of the society were least bothered about primary dentition maintenance and the treatment.[18]

Maintenance of oral health in special children requires active participation of both parents and caregivers, and the attitude of the parent was governed by financial restraints. It is the responsibility of each parent to up bring a child with a healthy dental attitude. Since 68% of the parents were educated, they had comparatively better knowledge about various aspects and importance of oral hygiene maintenance. Inadequate knowledge about the various advanced dental aids for brushing can be one of the reasons for the improper maintenance of oral hygiene among the special children. Lahti et al. suggested that the preschool population were given less priority than adults.[19] Schroth et al. concluded that attitude of the parent populations was positively related to oral health of the child and was similar to our study.[20]

Three-sided manual toothbrush, chewing brushes with tufts all around, and powered toothbrushes help in efficient plaque removal and thus maintain the oral health which indirectly effects a child's physical and mental health. Each and every consequence of the neglect of oral health should be taught to the parents and caregivers in order to implement a positive dental attitude for future.

Nocturnal feeding, deficiencies in nutrition, and improper oral hygiene were found to be the major problems of occurrence of early childhood caries.[12] Better management of early childhood caries can be achieved by creating awareness among parents and changing their attitude toward the maintenance of oral hygiene.[21] In countries like India, where there is a lack of dental professionals in a rural area, general physicians with adequate knowledge on oral hygiene maintenance can render effective preventive measures to the public.[22],[23],[24] Parental awareness and knowledge has led direct impact on the maintenance of oral hygiene in their children. It is necessary to instill a positive dental attitude in the parents and public to create awareness about the importance of maintenance of oral hygiene in primary teeth. The etiological agents for nursing caries should be made aware among the parent populations. A child with good oral hygiene not only has the advantage of caries-free mouth but also helps him to increase his confidence and help him to behave well in the society. As a part of preventive approach, pedodontists should make worthwhile attempts to conduct regular camps among the special care schools and centers in order to establish a society who could understand the importance of prevention of dental caries among children and the deleterious effect of it on the dentition. To achieve optimal oral health care in these patients, it is the responsibility of pedodontists to render effective treatment and preventive approach in a beneficial manner for a healthy society in future.

  Conclusion Top

Even though parents were educated and had better knowledge, they failed to incorporate healthy dental practices. Majority of the parents were unaware of the anticariogenic effect of fluoride and associated supplements. Effective preventive programs and anticipatory guidance should be implemented by the health professionals and guide the parents of the special children who are at high-risk categories of dental caries.

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Conflicts of interest

There are no conflicts of interest.

  References Top

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Selvaraj S, Naing NN, Wan-Arfah N, Nogueira Guimarães de Abreu MH. Demographic and Habitual Factors of Periodontal Disease among South Indian Adults. International Journal of Environmental Research and Public Health 2021;18:7910.  Back to cited text no. 2
Siddharthan S, Naing NN, Arfah NW. Periodontal disease and COVID 19. J Pharm Res Int 32:88-91.  Back to cited text no. 3
American Academy of Pediatric Dentistry. Definition of special health care needs. Pediatr Dent 2013;34:16.  Back to cited text no. 4
Magoo J, Shetty AK, Chandra P, Anandkrishna L, Kamath P, Iyengar U. Knowledge, attitude and practice towards oral health care among parents of autism spectrum disorder children. J Adv Clin Res Insights 2015;1:1-5.  Back to cited text no. 5
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Schroth RJ, Levi J, Kliewer E, Friel J, Moffatt ME. Association between iron status, iron deficiency anaemia, and severe early childhood caries: A case-control study. BMC Pediatr 2013;13:22.  Back to cited text no. 14
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