RESEARCH ARTICLE

https://doi.org/10.5005/jp-journals-10005-2411
International Journal of Clinical Pediatric Dentistry
Volume 15 | Issue 4 | Year 2022

Effectiveness of Parental Participation in a Dental Health Program on the Oral Health Status of 8–10-year-old School Children

Sowmiya Sree RA1, Joe Louis C2, Senthil Eagappan AR3https://orcid.org/0000-0003-2933-6272, Daya Srinivasan4https://orcid.org/0000-0001-5453-4380, Divya Natarajan5https://orcid.org/0000-0002-2345-2179, Dhanalakshmi V6

1-6Department of Pediatric and Preventive Dentistry, Chettinad Dental College & Research Institute, Kelambakkam, Tamil Nadu, India

Corresponding Author: Senthil Eagappan AR, Department of Pediatric and Preventive Dentistry, Chettinad Dental College & Research Institute, Kelambakkam, Tamil Nadu, India, Phone: +91 9894212394, e-mail: dr.eaga_ars@yahoo.com

ABSTRACT

Aim: Prevention-focused school dental health program (SDHP) is a cost-effective intervention that countries can use to lessen the problem of dental diseases by educating on oral health. The current study aims to assess the effectiveness of parental participation in an SDHP held at periodic intervals on the oral health status (OHS) of children aged 8–10 years attending a local school in Southern India.

Materials and methods: The longitudinal study was scheduled between September 2018 and June 2019 (36 weeks) in 120 participants who were healthy school children aged 8–10 years at a private school in Kelambakkam. This 36-week duration study assessed the effectiveness of school dental health education program with and without parents at every 12 weeks interval. The OHS of subjects was assessed using the standard indices [i.e., Decayed, Missing and Filled permanent teeth (DMFT), decayed, extracted, and filled primary teeth (deft), and Simplified Oral Hygiene Index (OHI-S)]. Friedman’s test and Mann–Whitney U test were used for analyzing the data as indicated.

Results: In postintervention visits, children with parental participation had significantly lower caries increments than children without parental participation. While the oral hygiene index scores have improved significantly in both groups over time, the improvement in the parental participation group was greater.

Conclusion: It can be concluded that the SDHP is an educational driver that showed a constructive impression on the oral health of children. The participation of the child’s parents in SDHP has significantly improved the OHS of children.

How to cite this article: Sowmiya Sree RA, Joe Louis C, Senthil Eagappan AR, et al. Effectiveness of Parental Participation in a Dental Health Program on the Oral Health Status of 8–10-year-old School Children. Int J Clin Pediatr Dent 2022;15(4):417-421.

Source of support: Nil

Conflict of interest: None

Keywords: Dental health education, Oral health status, Parents, School dental program.

INTRODUCTION

Oral disease, particularly dental caries, poses a major health burden in children and can have an impact on their life, inflicting pain, discomfort, and disfigurement. Dental caries is multifactorial in nature and affects the entire population regardless of gender, age, or socioeconomic status.1 According to WHO data, the frequency of occurrence of dental caries in a child ranges from 49 to 83.4% in primary dentition and from 41.9 to 69.4% in permanent dentition across different countries.2 The pooled prevalence in Indian children is reported to be 58.3% between 2012 and 2016.1 This indicates a fairly greater prevalence (of dental caries) as compared to the target advocated by WHO for the year 2000 (i.e., half of those in the age group of 5–6 years must be caries-free).3 The negligence of dental health among Indians is the conjoint reason for the increasing prevalence and caries severity.4 The gaps in knowledge and awareness of good oral hygiene practices, fear of dental treatment, and affordability are some other attributable causes of increased dental caries in the Indian subcontinent.5

Regular dental care is based on specific treatments, and rehabilitation showed only a limited impact on the oral health of the population. India’s large population size and limited manpower make this approach impractical and questionable in terms of effectiveness. Instead, addressing these issues at the primary level of prevention would be efficient and cost-effective, reducing the need for remedial treatment and requiring limited manpower and materials.6

A school-based dental health education program is a preventive strategy aimed at improving oral/dental health status during the school years, and motivating to maintain best practices even after schooling. Appropriate guidance on oral hygiene is vital for growing children and schools are the best centers for effective implementation of dental health promotion programs because they are easily accessible to children.7 Furthermore, children are more receptive and information on health promotion can be delivered and nurtured, thereby allowing them to develop good dental health behaviors that last a lifetime.8

The best way to promote oral hygiene in young children is through an SDHP which includes a close association between teachers, parents, and dental professionals. These programs may help to increase school teachers’ knowledge of oral health, and they can collaborate with dental professionals to promote oral health concepts and good hygienic skills in children. This, in turn, can enhance their dental health and general wellness.9

Young children are greatly influenced by their parents. Therefore, improving parents’ oral health knowledge through an SDHP can minimize their children’s risk of dental caries. Ideally, parents’ tutoring should go hand in hand with children’s training pertaining to the importance of dental health and best oral hygiene practices. This way parents can learn to improve their oral health and simultaneously educate their own children.10

This current study is aimed to assess the effectiveness of an SDHP given at periodic intermissions and the effect of parental participation on the dental health status of children aged 8–10 years attending local schools in Southern India.

MATERIALS AND METHODS

A longitudinal study was implemented from September 2018 to June 2019 (36 weeks). The study was permitted to be conducted by the Ethics Committee of Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu (Reference number: 347/IHEC/10-17). The school was selected on the criteria of proximity. Official approval from the in-charges of the school was taken after explaining the objectives of the study. Healthy school children, 8–10 years of age of both genders were included in this study. Children with chronic illness, on long-term medications, children using orthodontic appliances, siblings already enrolled in the study, and children with disability were excluded. Written Informed consent was acquired from the parents before the commencement of the study.

The sample comprised 120 healthy children from the fourth and fifth grades. Each grade had two sections and one section of each grade was randomly assigned to group I (n = 60), in which only the children participated in the dental health education program. The other section of each grade was included in group II (n = 60) where parents participated in the program along with their children. The baseline clinical examination was done in the school by a well-trained, calibrated child dental specialist, from the parent institute. The dental caries status and oral hygiene status of each child were recorded in the proforma.

After baseline examination, dental health education was provided to the participants of both groups, teachers of all the classes, and parents of group II through audio-visual aids. This included an interactive session for 30 minutes focusing on a wide range of topics, including, functions of teeth, types of dentition and their significance, common oral diseases and their clinical manifestations, dietary instructions, oral hygiene instructions, injurious oral habits, prevention of dental diseases, treatment modalities, and importance of visiting dentists regularly. Also, the correct brushing technique was demonstrated with the help of typodont models, and children were encouraged to practice on the models. Similar toothbrushes (soft) and fluoride toothpastes were distributed to all the children and they were asked to use the same throughout the study. Teachers were encouraged to demonstrate the brushing technique to children once every fortnight in both groups. In group II, parents were asked to help their children with their new oral hygiene habits at home. Instruction booklets comprising dietary instructions, oral hygienic practices, and brushing technique was handed over to both teachers and parents for reference. This dental health education program was repeated at the 12th, 24th, and 36th weeks’ follow-up visits to all the study participants, and children were examined for their caries status and oral hygiene status. Data obtained during these consequent visits were recorded and analyzed using the Friedman’s test (longitudinal analysis) and Mann–Whitney U test (intergroup comparisons).

RESULTS

The present study was conducted on 120 school children between the age of 8 and 10 years and their demographic details are depicted in Table 1. The changes in the DMFT index scores from baseline to weeks 12, 24, and 36 for both groups are shown in Table 2. There was a considerable increase in the DMFT index from baseline to the 36th week (0.27 ± 0.686 initially to 0.57 ± 0.81 by 36 weeks; p < 0.001) in group I. However, in group II, the baseline mean DMFT was 0.25 ± 0.680 which remained unchanged until the 24th week, then raised to 0.30 ± 0.696 by the 36th week [the changes were significant (p = 0.029)].

Table 1: Demographic data
Group I Without parents (N = 60) Group II With parents (N = 60)
Male:female ratio 50:50 50:50
Age (range) 8.75 ± 0.571 (8–10) 8.82 ± 0.431 (8–10)
Table 2: Comparison of mean DMFT score between baseline and after dental health education
Groups Weeks Mean rank Mean SD p-value
Group I (without parents) DMFT baseline 2.21 0.27 0.686 <0.001*
DMFT 12thweek 2.31 0.32 0.725
DMFT 24th week 2.68 0.50 0.813
DMFT 36th week 2.81 0.57 0.810
Group II (with parents) DMFT baseline 2.48 0.25 0.680 0.029*
DMFT 12th week 2.48 0.25 0.680
DMFT 24th week 2.48 0.25 0.680
DMFT 36th week 2.58 0.30 0.696

*Statistically significant

The differences in the deft index scores from baseline to weeks 12, 24, and 36 for both groups are shown in Table 3. The baseline mean deft index score for group I was 1.80 ± 2.114, which statistically significantly raised to 2.53 ± 2.054 by the 36th week (p < 0.001). The mean deft index score in group II also showed a statistically noteworthy change from 1.23 ± 1.430 at baseline to 1.52 ± 1.513 by the 36th week (p < 0.001).

Table 3: Comparison of mean deft score between baseline and after dental health education
Groups Weeks Mean rank Mean SD p-value
Group I (without parents) deft baseline 1.71 1.80 2.114 <0.001*
deft 12thweek 2.03 1.97 2.147
deft 24th week 3.12 2.52 2.071
deft 36th week 3.15 2.53 2.054
Group II (with parents) deft baseline 2.26 1.23 1.430 <0.001*
deft 12th week 2.26 1.23 1.430
deft 24th week 2.68 1.45 1.443
deft 36th week 2.80 1.52 1.513

*Statistically significant

Table 4 shows that the mean value of the OHI-S index was 1.265 ± 0.642 at baseline and 1.082 ± 0.338 at the end of the 36th week in group I. the corresponding scores for group II were 1.405 ± 0.635 at baseline and 0.537 ± 0.370 at the end of 36th week. Oral hygiene index scores significantly improved over the time period in both groups (p < 0.001).

Table 4: Comparison of OHI-S index score between baseline and after dental health education
Groups Weeks Mean rank Mean SD p-value
Group I (without parents) OHI-S baseline 3.34 1.265 0.642 <0.001*
OHI-S 12th week 1.28 0.658 0.328
OHI-S 24th week 2.41 0.972 0.341
OHI-S 36th week 2.98 1.082 0.338
Group II (with parents) OHI-S baseline 3.93 1.405 0.635 <0.001*
OHI-S 12th week 1.57 0.408 0.304
OHI-S 24th week 2.18 0.517 0.338
OHI-S 36thweek 2.33 0.537 0.370

*Statistically significant

Intergroup analysis (Table 5) performed via the Mann–Whitney U test did not show statistically signifying variations (p > 0.05) for the DMFT, deft, and OHI-S scores at the baseline. The DMFT and deft scores of group II were noted to be considerably inferior to those of group I at the 24th and 36th weeks’ follow-up visits (p < 0.05). Mean OHI-S scores in group II were significantly lower than those of group I at the 12th, 24th, and 36th weeks’ follow-up visits.

Table 5: Intergroup comparison of mean DMFT, deft, and OHI-S index scores
Variables Group I (without parents) Group II (with parents) “z” statistic p-value
Mean SD Mean SD
DMFT baseline 0.27 0.686 0.25 0.680 –0.23 0.815
DMFT 12th week 0.32 0.725 0.25 0.680 –0.69 0.485
DMFT 24th week 0.50 0.813 0.25 0.680 –0.24 0.013*
DMFT 36th week 0.57 0.810 0.30 0.696 –3.10 0.002*
deft baseline 1.80 2.114 1.23 1.430 –1.24 0.213
deft 12th week 1.97 2.147 1.23 1.430 –1.85 0.064
deft 24th week 2.52 2.071 1.45 1.443 –2.96 0.003*
deft 36th week 2.53 2.054 1.52 1.513 –2.85 0.004*
OHI-S baseline 1.265 0.642 1.405 0.635 –0.38 0.700
OHI-S 12th week 0.658 0.328 0.408 0.304 –4.06 <0.001*
OHI-S 24th week 0.972 0.341 0.517 0.338 –6.27 <0.001*
OHI-S 36th week 1.082 0.338 0.537 0.370 –6.89 <0.001*

*Statistically significant

The difference in the DMFT, deft, and OHI-S index values from baseline to 36th week was calculated and was compared for intergroup variations (Table 6). Comparing groups I and II, group I reported a greater increase in carious lesions than group II, whereas group II experienced a considerably better improvement in OHI-S scores.

Table 6: Descriptive statistics of the change in variables score from baseline to 36th week
Variables Group I (without parents) Group II (with parents) “z” statistic p-value
Mean SD Mean SD
DMFT (36thweek–baseline) 0.30 0.462 0.05 0.219 –4.58 <0.001*
deft (36thweek–baseline) 0.73 0.482 0.28 0.490 –4.71 <0.001*
OHI-S (baseline–36thweek) 0.18 0.488 0.868 0.508 –6.53 <0.001*

*Statistically significant

DISCUSSION

Oral diseases are very common in developing countries and are reflected to be a public health burden owing to their physical, social, emotional, and economic consequences.14 Many oral health diseases are preventable and reversible in the early stages. Nevertheless, a large number of children and their parents are not sufficiently aware of the causes and prevention of oral diseases.15 In many developed and developing countries, oral health education for school children by SDHP is shown to be effective in taming the awareness, and behaviors pertaining to oral/dental health.16-19

Health education can help improve the level of and change attitudes and beliefs. Health promotion programs provide appropriate information about dental care, including health care practices and attitudes not only to schoolchildren but also to their parents. Awakening the family’s commitment to the well-being of family members, and guiding them to lead a healthy lifestyle is reported to have a significant effect on their lives and the overall family’s OHS.20 Parents, more so, when the mother participates in an educational health care program and is encouraged to develop healthy behaviors, is reported to bring down the incidence of caries in her child.21 Organizing SDHP with parents warrants long-term welfare.

In the current study, we found that children in group I whose parents did not participate in the school dental health program had a greater increase in carious lesions during the postintervention visits than children in group II whose parents participated. While both the groups showed significant improvement in oral hygiene status after dental health education, the children with their parents in group II performed significantly better than children in group I, whose parents did not participate. This implies a positive association between parental participation in school dental health education program and OHS of children. The reason for the better OHS among children in the active parental participation group might be attributed to the parent’s better awareness of oral health behaviors and their augmented ability to supervise best dental hygiene practices among their children. Parents may act as role models or verbally encourage their ward so that it endorses positive behavioral changes propagated at school.

This finding is in line with Lee who in his study had reported that parental participation in SDHP showed considerably better enhancements in oral health.22 Likewise, another similar study conducted in Europe, had reported that a parent’s affirmative participation and backing in SDHP was correlated with lower caries experience in children.23 Similarly, a report from the United States by Howenstein et al. has reported authoritative parenting to be shielding against dental caries in children aged 3–6 years.24

On the contrary, Matsuyama et al. reported that poor contribution and absence of regulation of child’s health behaviors were correlated with the raised frequency of dental caries and deprived OHS among 6–7 years old Japanese children.25

In summary, the study reveals that the group with both the parental and children training had better oral health as compared to the group where only the children received training. Thus, parents may play a key role in establishing good oral hygiene practices in children. The basis for the founding of strong permanent teeth is laid down in the early years of life. Unhealthy dietary practices and the absence of brushing in the first 2 years of life are linked to dental caries. Furthermore, dental caries in the primary dentition raises the chance of dental caries in the succeeding teeth. Parents can play a key role in serving as a model for children to develop good oral hygiene practices and can play a vital role in making the children comprehend the importance of oral hygiene. Parents must regulate their child’s OHS by overseeing the brushing practices until the stage of changing dentition, that is, the eruption of the second molars or until they develop sufficient motor skills that allow them to appropriately perform oral hygiene maintenance self-reliantly.

The current study aimed at school children in the age range of 8–10 years. As early childhood caries can occur during the early childhood years, and oral habits and behaviors are formed during the early years of life, future studies may also target kindergarten children. As the majority of the population in India still resides in rural areas, with low maternal education and limited access to specialized dental care, it would be interesting to examine the efficiency of a parent/guardian involved in SDHP in rural areas.

CONCLUSION

This study showed that an SDHP had a constructive outcome on children’s OHS and awareness of dental hygiene practices. The benefits of such programs can be maximized with the regular involvement of school personnel, children, and their parents. Dental health education aimed at both the parents and children may show a superior enhancement in children’s OHS, as opposed to instructing health education without parental participation. Given the lack of parental awareness and lack of conjoint participation in dental health care programs in India, there is a need to include several dental awareness programs aimed specifically toward parents.

ORCID

Senthil Eagappan AR https://orcid.org/0000-0003-2933-6272

Daya Srinivasan https://orcid.org/0000-0001-5453-4380

Divya Natarajan https://orcid.org/0000-0002-2345-2179

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