Responsiveness of parents towards their children’s prime dental visit – a cross sectional study

INTRODUCTION

Oral health of the child is very important to sustain the general health of the children. There are 2 types of dentition in humans, primary dentition and permanent dentition. Parents will be neglecting primary teeth as they are going to exfoliate and permanent teeth erupt. Primary teeth are also important as permanent teeth and primary teeth maintain arch length, helps in mastication, speech and aesthetics. Primary teeth start erupting at the age of six to nine months and once the teeth start erupting, dental plaque starts to adhere to the tooth structure which leads to caries. One of the major tasks of the parents is to take care of their children’s teeth as quickly as they erupt into the oral cavity. As the child at that age lacks the knowledge and does not have the capacity to sustain the necessary oral health. The majority of the parents presume pain as a predictor for the first dental visit for their children.¹ the literature stated that who visited the dentist under the age of 4 years revealed that 51.9% of them were due to injuries and 25.4% for preventive measures. However, in the U.S epidemiological studies stated that a noteworthy reduction in the overall prevalence of caries.^2,3

According to American Dental Association first dental visit should be within the first year of life,^4,5 The American Academy of Paediatrics recommends oral health risk assessment by 6 months of age and instituting of Dental Home for all infants by 12 months.⁶ An early dental visit, before completion of 12 months of age, will help the dentist to detect early lesions; estimate craniofacial and dental development; deliver anticipatory guidance, parent counselling, and diet counselling; and motivate parents towards prevention-oriented interventions.⁷

Parents have a vital responsibility in preserving their children’s oral health of dental disease.⁷ Evidence suggests that children who had an early preventive dental visit were more likely to use subsequent preventive services and experience lower dentally related costs.^8,9

Regular visits to a dentist provide a useful opportunity in regards to the prevention of oral diseases. This first dental visit should be a strategy to establish primary prevention for parents as well as an early intervention for harmful effects. Over the past several years, much discussion has centred on the age at which a child without identified dental problems should first visit a dentist.^1,2 Several dental professional organizations have offered a strong rationale for making that first visit by age.^1,3 A visit by age one year may provide the opportunity to evaluate craniofacial and dental development, assess risk for common dental conditions, and counsel parents and caregivers on primary prevention interventions before disease progresses, poor habits become well established, or irreversible harm occurs.¹⁰

MATERIALS AND METHODS

After obtaining Institutional ethical clearance, a cross-sectional descriptive study was conducted to an adult patient who was reporting to the paediatric dentistry department along with their children for the treatment. After validation of the questionnaire, it’s a combination of 12 open and closed-end questions, distributed and collected by a receptionist in the same visit. Questionnaires were given separately to the parents to reduce the bias. Data was collected and analysed using SPSS 11.0 and results were expressed as absolute values and percentages. Appropriate tests were carried out when necessary and were considered significant at the 0.05 level.

RESULTS

Half of the parents belong to 31-40 years of age group (47.3%) and the majority being mothers (56.6%) and their children age was above 4years (57%). Mother’s education level was up to high school.

Very few parents (2.7%) known that recommended time for first dental visit and 48.2% of them opined best time for first dental visit is at the age of 6 years. Around 40.5% were unaware and 60.4% of them expressed that first dental visit is not very important.

Varied opinions were expressed by the parents regarding the reasons for not seeing the dentist, 34.7% of respondents claimed that children were uncooperative in the first year, teeth are not yet complete and not affected by disease (28.4%), my economic status was not allowed these kinds of visits (18.9%), teeth are not yet erupted and no benefit from visiting dentist (18%).

Around 64.4% of the parents disagree with the use of behaviour guidance in the first dental visit, however, 35.6% agreed with it. The motivation was the best approach (70.3%) in bringing the child to the dental clinic, 17.6% not to tell the child, whereas 21.2% opined force the child.

Regarding if there is no pain in the first dental visit, what the dentist should do, 36.9% states that what parents want, 25.2% expressed preventive education and they do not visit a dentist by the same percentage of parents. However, 12.6% appeared to have behaviour guidance only without any treatment. Most of the respondents expressed emergency was the reason for visiting a dentist (77%) and followed by routine dental check-up (23%). When the parents were asked, if chief complaint was treated there was no need to visit a dentist, 69.4% agreed with it whereas 30.6% did not agree. (Table 1)

DISCUSSION

Mothers play a very important role regarding first dental visit of a child which is considered to be one of the preventive measures for dental caries. Infant oral health care begins with oral health counselling in the first dental visit.

American Academy of Paediatric Dentistry recommends that the first visit should be within six months of the eruption of the first primary tooth and no later than age 12 months. Further, during this time parents should receive counselling, anticipatory guidance on appropriate oral hygiene procedures, and also minimizing harmful habits feeding practices, fluorides as well as general dietary counselling related to oral health.²

A first dental visit at the age of one enables the dentist to lay a foundation on which a lifetime of preventive education and dental care can be built in order to help assure optimal oral health care into childhood.

In this study regarding timing of the first dental visit are inconsistent with the studies done by Alaa S et al., who concluded that only 12% were aware that the first dental examination should be by age 12 months.¹³ Another study done by Thakib et al., concluded that most of the parents thought to bring the children in the first year of life was inappropriate, and this finding was concurrent with our study.¹²

In the present study, 60.4% of parents claimed that first dental visit in first year is not so important and this finding correlates with previous study which concludes that mothers’ educational status is inversely related to early childhood caries.¹¹

Most of them thought that the first dental visit should occur at 3 years or 5 years of age11 and this finding is concurrent with present study. This may be due to most of the parents assumed that primary teeth are not completely erupted at 12 months of age and no need to visit a dentist at a very young age hence leads to behaviour problems of the children.

Primary teeth should be maintained healthy in children, which in turn maintains overall oral and general development. The literature stated that early childhood caries can be prevented in a very young age if children are brought as soon as the first tooth erupted in the oral cavity. The previous study which concludes that primary teeth are not completely erupted at one year of age, therefore, no disease can occur at this age and also child was uncooperative.¹¹ This finding is concurrent with the present study.This could be attributed to the education levels of the mothers where the majority was studied up to high school level as well as they belong to low socioeconomic status. So they did not have knowledge about the importance of the first dental visit.

American Academy of Paediatric Dentistry recommends behaviour guidance is a very vital step in the treatment of a child since it is coupled with fear and anxiety. Literature stated that that most of the parents preferred behaviour modification during the first dental visit. Another study done by Al-shall, concludes that a higher percentage of mothers indicated they would visit another dentist if no treatment was accomplished other than behaviour management of child at that visit and also older mothers preferred behaviour modification compared with younger parents.¹¹ This finding is inconsistent with the present study where most of the mothers preferred treatment in the first dental visit rather than behaviour guidance. This could be due to lack of knowledge regarding dental treatment, their hectic work, financial constraints, permission from school teachers and family schedules which avoid them from attending extra visits or make such appointments inconvenient.

In the present study, motivation was best approach to bring the child to dental clinic and this finding was correlating with their study.¹³ However, Stijacic et al., concluded that most of dentists are not familiar about recommendation of first dental visit this means that information regarding appropriate age of first dental visit is not reaching to parents as well as public also.⁷

According to Fayl, early behavior orientation is an important practice towards best treatment for children because the first dental visit is usually associated with fear and anxiety and hence dentist should aim to provide a friendly introduction to dental care, reduce stress for children and parents, and to establish lifetime positive attitudes towards dental health.¹⁵ In the present study only 12.6% were approved with it. Our study findings are inconsistent with other study done by Al-Shalan who reported that the mainstream of them preferred to start with behaviour modification during the first dental visit.¹¹ This may be attributed to their hectic work and family schedules, which make such appointments inconvenient.

In this study, 77% of the parents considered emergency was the main reason to visit a dentist and this finding is correlating with other studies. However, this finding is inconsistent with other studies. The difference in the findings might be due to the place of participants’ recruitment where the study was done.^1,11

Parents need to be informed about the significance of the early first dental visit. It must be emphasized to parents particularly the parents with low education must not wait for pain or dental disease to occur for a visit a dentist; rather early dental check-up must be made to prevent any dental problem. Many of the children may not be able to express any pain or discomfort in their teeth and the disease may progress to an advanced stage without being noticed by the parents. This makes an early visit even more important in children. Furthermore, an early first check-up visit (as soon as first teeth erupt or even earlier) is an opportunity for a dentist to provide dental health information (such as oral hygiene practices, dietary information, and possible use of fluoride supplements) to the parents and early intervention if a problem already exists.¹⁰

Limitations of present study are questionnaires distributed only one area which is not representative of whole community, occupation, ethnicity, household income that would possibly influence their knowledge and attitudes towards first dental visit, to overcome these drawbacks, future studies will be recommended.

CONCLUSION

Considering our obtained results, which suggests that a first dental visit should not be in the first year of age, parents disagree with behaviour guidance in the first dental visit, motivation was the best approach to bring the child, emergency was the reason for visiting a dentist and finally if chief complaint was treated there is no need to visit a dentist.