|Year : 2023 | Volume
| Issue : 1 | Page : 28-32
Parental knowledge, attitude, and perception toward dental treatment during COVID-19 pandemic: A cross-sectional survey
C H Chandana Krishna Shree, Priya Nagar, HR Pooja, Andrea Natalia Mascarenhas
Department of Paediatric and Preventive Dentistry, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India
|Date of Submission||27-Dec-2022|
|Date of Decision||08-Feb-2023|
|Date of Acceptance||09-Feb-2023|
|Date of Web Publication||18-Mar-2023|
Dr. C H Chandana Krishna Shree
Department of Pediatric and Preventive Dentistry, Krishnadevaraya College of Dental Sciences, Hunasamaranahalli, Bengaluru - 562 157, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Dental caries in pediatric dentistry is considered very alarming to parents considering its impact on the permanent dentition. Knowledge regarding caries in primary teeth and its impact on permanent dentition is limited. Aim: The aim was to evaluate the knowledge and perception of parents toward pediatric dental treatment during covid era and to check if there is a change in practices pertaining to the COVID-19 outbreak. Materials and Methodology: One hundred and twenty copies of the questionnaire were distributed through a Google Form to parents in the general Indian population. The questionnaire consisted of 16 questions. The first segment of the survey was about the knowledge of parents regarding caries and their consequences. The second segment was about the influence of COVID on the dental treatment of children. The third segment was about the influence of COVID on the preventive dental care of children. The results obtained were tabulated and analyzed using SPSS software. Results: Results suggest that 80%–95% of parents have good knowledge about tooth decay in the pediatric population and feel COVID is a barrier to visiting the dentist and feel the availability of the COVID vaccine to children would increase confidence to break this barrier. Conclusions: COVID pandemic has been a barricade for neglecting dental treatment. If adequate information about the etiology and consequences of tooth decay along with the availability of the COVID vaccine, no barrier can be seen between the dentist and the child's dental treatment.
Keywords: COVID vaccine, COVID-19, dental caries, dental neglect, pediatric lifestyle
|How to cite this article:|
Krishna Shree C H, Nagar P, Pooja H R, Mascarenhas AN. Parental knowledge, attitude, and perception toward dental treatment during COVID-19 pandemic: A cross-sectional survey. SRM J Res Dent Sci 2023;14:28-32
|How to cite this URL:|
Krishna Shree C H, Nagar P, Pooja H R, Mascarenhas AN. Parental knowledge, attitude, and perception toward dental treatment during COVID-19 pandemic: A cross-sectional survey. SRM J Res Dent Sci [serial online] 2023 [cited 2023 Mar 24];14:28-32. Available from: https://www.srmjrds.in/text.asp?2023/14/1/28/372004
| Introduction|| |
Dental treatment in the pediatric sector is mostly attributed to dental caries which has a multifactorial origin. Various factors, such as dietary habits and carriage of caries-prone organisms, play a major role in its etiology. Various other risk factors such as lack of oral hygiene, socioeconomic status of the child, social and cultural factors and intake of fluoride, and genetic factors, were also noted to be associated with the etiology.
The COVID-19 pandemic has changed the routine of both parents and children, which negatively modified these risk factors. The restrictions imposed due to the COVID-19 pandemic exposed children to altered behavior and changed lifestyle.
Lockdown restrictions, self- isolation and financial stability caused negative effect on overall health [Physical, mental as well as oral health] of an individual. This in-turn impeded individuals form performing day to day activities.
An extended stay at home due to lockdown restrictions has led to inactive lifestyle habits, restricted physical activities, and change in habits which is more inclined toward increased intake in the frequency of junk food alongside increased screen time. Commercials of junk food and drinks attract children in consuming more junk food than normal due to increased screen time. Several studies associated these factors with being associated with the increased frequency of obesity and caries in children.
The present study was done to assess the various barriers to accepting dental treatment during the COVID era besides the general knowledge of parents toward dental treatment and also aims to gauge any misconception regarding the treatment.
| Materials and Methodology|| |
The present study conducted was a cross-sectional survey.
After taking approval from the Ethical Committee and Review Board of the institution on 06.06.2022 (Ref: KCDS/Ethical Comm/37/2022-2023), 120 copies of the structured questionnaire in a Google format in a randomized manner with 16 questions were distributed to parents/guardians in general Indian population.
Z(1−α) =1.96 (for 95% confidence interval)
P = 0.50
Based on the probability, that 50% of the study participants have adequate knowledge on caries impact on primary dentition with δ (margin of error) =0.10, the sample size was calculated as 96.04. Adding a 20% contingency for the probability of missing data, the sample size will be inflated to 120.
The present survey was assessed in the general Indian population. Parents/guardians of children between the ages of 3 and 14 years were only included in the study.
The present study was framed based on the CHERRIES checklist. The demographic details (name and age along with email ID) were collected, along with the informed consent to participate in the survey was taken way before the questionnaire section. The demographic details were concealed to ensure the confidentiality and privacy of participants.
The questionnaire consists of three segments which are as follows:
- The first segment of the survey will be done to assess the knowledge of parents regarding caries and its consequences, with six segments about the terminology and causes and effect of caries
- The second segment of the survey will be done to assess the influence of COVID on the dental treatment of children with five segments regarding the shift in attitude from the pre-COVID scenario to the present scenario and regarding the availability of vaccine, and preventive strategies in the COVID era
- The third segment of the survey will be done to assess the influence of COVID on preventive dental care of children with four questions regarding changes in preventive care from the pre-COVID scenario to the present situation.
The results obtained were tabulated and analyzed using SPSS software.
Statistical Package for Social Sciences [SPSS] for Windows, Version 22.0. (Released in 2013. Armonk, NY: IBM Corp) was used to perform statistical analyses. The Chi-square goodness-of-fit test was used to compare the distribution of responses to the questionnaire by the study participants. The Chi-square test was used to compare the fear of COVID among the parents in delaying dental visits for children. The level of significance (P value) was set at P < 0.05.
| Results|| |
The majority of the respondents were in the age group of 30–42 years of age who belonged to the general Indian population, with most of the respondents being females.
When asked regarding the knowledge of caries' impact on primary dentition, 90.2% of respondents knew about the impact, while 82% knew about the causative factors, in which 64.8% knew that caries affects erupting permanent tooth bud and 59% knew it leads to malalignment of teeth [Table 1].
|Table 1: Comparison of responses to the knowledge-based questions regarding caries impact on primary dentition using the Chi-square goodness-of-fit test|
Click here to view
When attitude-based questions regarding COVID impact on dental visits, 79.5% thought that it was easier to visit the dentist before the COVID era. 49.2% of the respondents agreed that they would delay the child's treatment because of the risk of exposure to COVID [Figure 1].
|Figure 1: Responses to Attitude based questions regarding COVID impact on dental visits among children - Part 1|
Click here to view
When further asked about the possible reasons to avoid a child's dental visit, 49.2% opted for ignorance due to milk teeth as the primary reason, followed by the cost of dental treatment and the absence of dental insurance. They also stressed that they would be more confident to send a child to the dentist if the COVID vaccine was available to children. About 63.1% of the respondents preferred direct consultation over the concept of teledentistry, maybe because of the nonfamiliarity of the concept [Figure 2].
|Figure 2: Responses to Attitude based questions regarding COVID impact on dental visits among children - Part 2|
Click here to view
When attitude-based questions regarding home care and oral behavior among children during COVID, 77.9% preferred to take more measures to avoid dental visits. About 84.4% of respondents felt the COVID pandemic led to increased snacking between meals in children. 91% of respondents felt that the COVID pandemic changed the routine of the children, which led to 86.9% of respondents agreeing to the same fact that the maintenance of oral hygiene is difficult in kids [Table 2].
|Table 2: Comparison of responses to the attitude-based questions regarding home care and oral behavior among children during COVID using the Chi-square goodness-of-fit test|
Click here to view
| Discussion|| |
Dental caries in children is the most challenging issue in pediatric dentistry. Its multifactorial etiology and the change in lifestyle in children lead to an increase in various risk factors, which leads to an increased incidence of caries. Alongside these risk factors, COVID-19 pandemic and its lockdown restrictions have added to an increase in the incidence of caries in children. The importance of routine in life is missed due to the lockdown restrictions, which led to irregular brushing of teeth, Increased snacking due to the availability of snacks at arm's distance, increased intake of sweets, and absence of school, making it interruption of timely and proportionate eating, absence of playtime, increased screen time which led to sedentary life which in turn led to the above-mentioned risk factors.
According to a study by Liu et al. 2020 and Wu et al. 2020, three-fourths of the respondents did not visit the dentist for any dental ailment, which indicates a lack of knowledge about early dental check-ups in children. However, in our study, 80%–95% of parents have good knowledge about tooth decay in the pediatric population and felt COVID was a barrier to visiting the dentist and felt the availability of the COVID vaccine to children would increase confidence to break this barrier, Patient's parents have inadequate knowledge on consequences of tooth decay, teledentistry, and importance of milk teeth which could be the main barrier for neglecting dental treatment. The COVID pandemic is just an additional barrier. If adequate information was available for the parent, no barrier can be seen between the dentist and the child's dental treatment.
In a study conducted by Sharma et al. findings revealed that 72% admitted that the COVID-19 pandemic has increased their knowledge about maintaining oral hygiene to avoid dental visits. About 84% felt routine dental check-ups and appointments are not necessary, thereby avoiding dental treatment during COVID-19 and 47% agreed that this neglect is due to the dental environment, which could be a source of infection to children. However, in our study, the main reason for dental neglect could be the COVID and the lack of availability of vaccines for children, which acts as the main barrier.
During the COVID-19 pandemic, it is necessary to make a detailed note about the change in lifestyle habits and oral health habits and their impact on the oral as well as general health of the children. For children who are assessed as high risk, pediatric dentists should advise preventive measures to prevent the occurrence of further dental-related problems. However, pediatric dentists should emphasize more on motivational training pertaining to their habits which changed due to lockdown restrictions.
With long-term closures of schools and childcare centers, parents are also worried about changes in the routine of the child and increased snacking, which might lead to an increase in dental caries. After a gap of over 2 years, schools are functioning like before. It's time for pedodontists to wake up and start fresh and conduct various school dental health camps, which will help us in properly estimating decay-missing-filled teeth scores and can help in taking the proper first step in building caries-free, ever-smiling younger generations. These camps also help us to increase awareness in children regarding the intake of caries-inducing food and its impact on future dentition and guide them in a proper way to create a healthy lifestyle.
| Conclusions|| |
The pandemic is a barrier for many parents to consider dental treatment for children. Proper available knowledge about caries, its sequel, and preventive strategies will help elaborate the priority to take treatment with precautions without neglecting it. The availability of the COVID vaccine will bring confidence to all parents. As pediatric dentists, we have a crucial role in enlightening parents to give importance to the treatment at earlier stages instead of neglecting it and letting the child lose his precious smile with caries, pain, and lack of function.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Babu TA, Selvapandiyan J. The psychological effects of COVID-19 pandemic related lockdown in children. Indian Pediatr 2020;57:1087.
Campagnaro R, Collet GO, Andrade MP, Salles JP, Calvo Fracasso ML, Scheffel DL, et al.
COVID-19 pandemic and pediatric dentistry: Fear, eating habits and parent's oral health perceptions. Child Youth Serv Rev 2020;118:105469.
Pietrobelli A, Pecoraro L, Ferruzzi A, Heo M, Faith M, Zoller T, et al.
Effects of COVID-19 lockdown on lifestyle behaviors in children with obesity living in Verona, Italy: A longitudinal study. Obesity (Silver Spring) 2020;28:1382-5.
Kim K, Han K, Yang S. Association between overweight, obesity and incidence of advanced dental caries in South Korean adults: A 10-year nationwide population-based observational study. PLoS One 2020;15:e0229572.
Liu W, Zhang Q, Chen J, Xiang R, Song H, Shu S, et al.
Detection of COVID-19 in children in early January 2020 in Wuhan, China. N Engl J Med 2020;382:1370-1.
Wu F, Zhao S, Yu B, Chen YM, Wang W, Song ZG, et al
. A new coronavirus associated with human respiratory disease in China. Nature 2020;579:265-9.
Sharma P, Dhawan P, Rajpal S, Bhat A. Knowledge, attitudes, and perception of parents toward dental treatment of children during the COVID-19 outbreak. Int J Clin Pediatr Dent 2021;14:693-9.
Gotler M, Oren L, Spierer S, Yarom N, Ashkenazi M. The impact of COVID-19 lockdown on maintenance of children's dental health: A questionnaire-based survey. J Am Dent Assoc 2022;153:440-9.
[Figure 1], [Figure 2]
[Table 1], [Table 2]