Abstract
The aim of the study: Evaluation of oral health
condi-tion in 6 and 12 year-old children of Ia[i, analysis of the
health-promoting habits of children and mothers; dem-onstrating the relation between the educational level of the mother and children’s health-promoting habits, as well as their influence upon their own health condition; the differences between educators and mothers on their oral health knowledge. Materials and method: The study, performed in 5 schools of Ia[i, between 2009-2010, in-cluded 345 children (6-7 yeas, class I) and 297 children (11-12 years, class VI), being devoted to the establish-ment of their odontal status, evaluated by the DMFT in-dex, of the oral health level, evaluated with the OHI-S index and of periodontal health, appreciated with the (CPITN) index, through a clinical examination performed each year in school medicine consulting rooms, the data collected being included in the WHO files, according to some previously established criteria. Information has been collected from 523 mothers and 125 schoolmasters, by the questionnaire method, the statistical data obtained being analyzed with the SPSS 14.0 program. Results: The results obtained indicate an increased prevalence of the dental caries, of 86% for 6-7 year-old children, and of 76%, respectively, for the 11-12 year-old ones, neverthe-less lower than the values registered in previous years. The DMFT value in 6-7 year-old children was 2.9, the
DMFT value at ages of 11-12 years being of 2.8. 47% of the mothers indicated that the ”bacteria+sugar ”
associa-tion represents the main cause of dental caries, 35%
in-criminated the ”bacteria”, while 27% associate the
for-mation of caries with the consumption of sugar. The
causes of gingival bleeding were: incorrect dental brush (49%), bacterial plaque (44%), unhealthy diet (35%), gen-eral diseases (30%), heredity (9%), while 9% of the
moth-ers did not know the possible causes of gingival bleeding. It was only 1.5% of the mothers that were convinced that the oral health of their child was very good, 17% – good,
47% – satisfactory, 19% – affected; 4% of the mothers re-fused to answer. 43.7% of the 6 year-old children and 67.8% of their mothers asserted that they practice dental brush at least twice a day. 23.1% of the 6 year-old chil-dren and 88.7% of their mothers have had a
stomatologi-cal control in the last 12 months. Educated mothers tend to have more knowledge on dental health as well as regu-lar health-promoting attitudes, participating actively,
ORAL HEALTH AND THE LEVEL OF KNOWLEDGE AND ATTITUDES OF
THE CHILDREN, MOTHERS AND EDUCATORS IN IASI, ROMANIA
A. Corneag\1, I. D\nil\2, Dana Cristiana Maxim3, Carina Balco[4
1. Ph student “Gr.T.Popa” University of Medicine and Pharmacy of Ia[i, Faculty of Medical Dentistry Dept. Oro-Dental Prevention 2. Associate professor “Gr.T.Popa” University of Medicine and Pharmacy of Ia[i, Faculty of Medical Dentistry Dept. Oro-Dental Prevention 3. University professor, Dept. Pedodonty and Orthodonty and Dental-Facial Orhtopedy
4. University assistant “Gr.T.Popa” University of Medicine and Pharmacy of Ia[i, Faculty of Medical Dentistry Dept. Oro-Dental Prevention Corresponding author: Andrei Corneag\, e-mail: and_c@ymail.com
together with their children, to the realization of dental brush. Conclusions: The family is responsible for the child’s health-promoting life style, as it constitutes the first source of information on oral health. The results of the present study show that the health-promoting habits of the adults, as well as the level of their knowledge, represent important factors in the health promotion edu-cation of their children.
Keywords: oral health, health-promoting knowledge, pupils
Over the last decade, a reduced prevalence of oral diseases has been registered in the school population from the East European countries,
especially in Romania (1-4). Such a tendency is
explained by the considerable progress of pre-ventive stomatology (such as, sensible under-standing of sugar consumption, improved
prac-tices of oral hygiene, utilization of fluorine-containing tooth pastes and fluoride mouthwash solutions or topical fluoride application), along
with the development of communitary programs for the prevention of such problems (5, 6).
The data provided by extended polls devoted to oral health, performed both in România and
in the neighbouring countries, have
demon-strated that approximately 100% of the adults
and 90% of the children had and still have cari-ous and periodontal lesions.
At present, the main steps taken are oriented towards finding of some efficient modalities for combating such pathologies, and of the
economic support necessary for reaching the
ob-jectives had in view.
In România, up to now, several programs for improving oral health have been implemented, most of them being intrerrupted by the lack of funds necessary for their devleopment at na-tional level (7, 8).
education supported by private companies pro-ducing oral hygiene products, along with meet-ings with parents and educators, the main fac-tors responsible for the health-promoting behaviour of the child.
The objectives of the present study were to
collect data on the oral health condition of
chil-dren with ages between 6 and 12 years of Iasi;
to analyze the health-promoting habits of both children and mothers, on evidencing the rela-tion between mother’s educarela-tional level and the health-promoting habits of her children, and the influence upon her own’s health status; to dif-ferentiate the level of oral health knowledge among educators and mothers.
MATERIALS AND METHOD
The epidemiological study was realized in 5 schools of the Iasi city. To attain the objectives of the study, 345 children with ages of 6-7 years (class I) and 297 children with ages of 11-12 years (class VI) were investigated in the school year 2009-2010, on following the odontal status, evaluated by the DMFT (Decayed, Missing, Filed Teeth) index, the oral health status, evaluated by the OHI (Oral Hygiene Index) index and the periodontal condition, evaluated by the CPITN (Community Periodontal Index Treatment Needs) index.
The data were obtained from annual clinical examinations performed in the medical school consulting rooms by specialized staff. Data re-cording was made acre-cording to the WHO crite-ria in force.
In a parallel action, information from 523 mothers and 125 educators was collected by the questionnaire method, the obtained data being analyzed with the SPSS 14.0 program.
The questionnaire for mothers included ques-tions on their knowledge oforal health, on their attitude for preventing oral diseases, the health-promoting behaviour of both mother and child, the parental support for child’s health-promot-ing attitudes, self-evaluation of oral health and the necessary treatment for the child, the source of information on oral health and mother’s edu-cation level. The same questionnaire was filled in by educators.
RESULTS
The results provided by the clinical exams indicate a higher prevalence of the dental caries, comparatively with the WHO objectives for the year 2010, for both groups of age, of 86% for the 6-7 year-old children and of 76%, respectively, for the 11-12 year-old ones, yet lower than in the previous years. The dmft values of the 6-7 year-old children were of 2.9, with a percent ratio of 4.2 % among the children with caries free teeth, while the DMFT ratio at ages of 11-12 years was of 2.8, with 23% of the children with caries free
teeth(table 1).
Table 1. dmft and DMFT values and percentage of caries free children
dmft caries free children
(%)
DMFT caries free children
(%) 6-7 years
(345)
2.9 4.2 0.8
11-12 years (297)
0.9 2.8 23
As to the oral hygiene status (OHI-S) and peri-odontal condition (CPITN), higher values are registered for both groups of age (table 2).
Table 2. Oral hygiene level and periodontal status on age groups
Age OHI –S CPITN
6-7 years (345)
1.8 0.7
11-12 years (297)
2.7 0.3
47% of the mothers indicated that the
“bacteria+ sugar ” association is the cause of
dental caries, 35% replied that the cause was
re-presented by “bacteria”, while 27% of them
as-sociate the occurrence of caries with the con-sumption of “sugar”.
When asked about the noxious influence of
some food products, 83% of the mothers indi-cated the negative effect of sugar and 85% of
them – the negative effect of candies. Mothers
an-swers to the prevention of the oral diseases of their children.
Other causes of dental caries invoked by the
mothers participating to the study were heredity (38%), general diseases (28%) and preg-nancy (24%). 4.2% of the mothers could not
an-swer. The distribution of the answers to the ques-tion about the causes of gingival bleeding was
the following: an incorrectly-applied dental brush (49%), bacterial plaque (44%), unhealthy diet (35%), general diseases (30%), heredity (9%); 9% of the mothers could not give an explanation
to gingival bleeding.
SELF-EVALUATION OF THE ORAL HEALTH CONDITION
Only 1.5% of the mothers were sure that the
oral health of their children was very good, 17%
declared that the teeth were good,
47% men-tioned the satisfactory condition of the oral
status, 19% recognized that their children had affected teeth and 4% of them could not answer. As to the necessity of dental controls, 66% of the mothers said that their child
needs one or more stomatological treatments,
28% reported no need for stomatological treat-ments, while 5% of them did not answer. When
asked to evaluate their own health condition,
24% of the mothers mentioned that they had
good teeth, needing no stomatological
treat-ments, and 57% of them declared to have poor
teeth, which require stomatological intervention.
48.9 4.5 97.4
45 40
98.3 23 0.7
60 88 2.5
49.2 3.2 98.6
23 91
la pte indulcit la pte ne indulcit za ha rul ca fe a ua ce a iul dulciuri fuma tul fructe le
ma memothers i nvata toriteachers
fruits
smoking
sweets
tea
coffee
sugar
sugar free MILK
Milk with sugar
Fig. 1.
Percentage of mothers and teachers that have identified the factors which can affect teeth
Fluorides protect teeth against dental caries
Parents must control sweets consumption
High level of sweet consum ption causes dental caries
tooth brushing prevents dental caries and bleeding
Assisted tooth brushing
Regular dental visit
teachers m others
Fig. 2.
Distribution of answers on the oro-prevention attitudes in mothers and teachers
Table 3. Practices of oral health in the children and mothers of Iassy
Children, % Mothers,%
Tooth brushing 2 times/day 43.7 67.8 Tooth brushing after breakfast 78.9 92.3 Annual evaluation of the dentist 23.1 88.7
Table 3, synthesizing the health-promoting
attitudes of the children and mothers of Ia[i,
shows that 43.7% of the 6 year-old children and 67.8% of their mothers practice dental brushing at least twice a day. Dental brush after breakfast was reported only for 78.9% of children and
92.3% of mothers. Distribution of answers to the question on the annual stomatological control
was the following: 23.1% of the 6 year-old chil-dren and 88.7% of the mothers participating to
the study made stomatological visits in the last 12 months.
Table 4 lists the results of bivariate analysis
on the health-promoting knowledge and
atti-tudes, self-evaluation of the necessary dental care and the practices of oral health of children,
comparatively with the frequency of the stoma-tological controls of the mothers taking part
in the study. Data on the frequency of
hydro-carbons consumption in 6 year-old children (provided by their mothers) are listed in table 5.
The results of the analysis on the health-pro-moting knowledge, attitudes and practices of
mothers, according to the level of their sanitary
education, are listed in table 6. One may observe
health-promoting attitudes and participate actively, to-gether with their children, to dental brush, while attempting at reducing the consumption of sugar.
Tabel 4. Percentage of mothers that have reported dental visits
Question Mothers with
regular dental evaluations
Mothers with irregular
dental evaluations
Bacteria and sweets that
produce dental caries 48.5 37.9
The child eats a lot of
sweets 6.4 7.2
I brush my child’s teeth
daily 4,2 3.8
I check the child’s teeth
after every brush 14.3 8.9
I know how many destroyed
teeth has my child 69.9 63.4 Healthy teeth are necessary
for a good oral health 87.6 63
It is possible to prevent
dental caries 76 57
I use the toothbrush and the
toothpaste daily 17.5 8.5
Table 5. Frequency of carbohydrates consumption in 6 year-old school children
At least 1/daily
Several times a day
Always/randomly Food/beverages
% % %
Milk with sugar Soda drinks Fruit juices Sweets at breakfast Candies
Chocolate Gum with sugar Ice-cream
7.8 3.1 23 5.2 15.8
4 1.8 8.1
8.2 15.9 31.3 12.2 31.8 19.2 9.7 33.9
83.9 81 45.9 82.4 51.2 76.7 88.4 57.9
Health-promoting knowledge and attitudes
in schoolmasters 59% of the educators consider that the “bacteria + sugar” association was the
cause of the dental caries, 55% declared that
responsible are exclusively the ”bacteria”, while 36% of them asserted that carious lesions are caused by “sugar”. In spite of this, the negative effects of sugar were reported by 98% of the edu-cators, and those of candies – by 91% of them (table 7). Also, 2.5% of the teaching staff declared that fruit (apples) and beverages may
have negative effects. Other invoked causes of
the dental caries were, for example, heredity
(48%), pregnancy (27%) or the general patho-logies (27%).
Table 6. Distribution of the results on health-promoting knowledge, attitudes and practices of
mothers, according to the level of knowledge in oral health education atattitudes an
Question Regular visits to the dentist
Irregular visits to the dentist
Low level of education
Medium level of education
High level of education
Bacteria and sweets that
produce dental caries 48.5 37.9 43.3 45 51.5
The child eats a lot of
sweets 44.6 38.7 16 5.8 7.2
I brush my child’s teeth
daily 4.2 3.8 10 4.3 3.8
I check child’s teeth after
every brush 14.3 8.9 10 12.7 15.3
I know how many destroyed
teeth has my child 69.6 63.4 70 71.7 66.2
Healthy teeth are necessary
for a good oral health 87.6 63 46.7 84 90
It is possible to prevent
dental caries 76 57 53.3 72.2 77
I use the toothbrush and the
toothpaste daily 17.5 8.5 13.3 64.5 92.6
As to the question on the causes of gingival bleeding, the following risk factors have been selected: an incorrectly realized brushing
(66%), the bacterial plaque (61%), general dis-eases (51%), unhealthy diet (45%), heredity
(20%), consumption of warm and cold aliments
(16%), while 3.3% of the didactic staff do not know which are the causes of gingival bleeding.
Table 7. Percent distribution of teachers answers to the factors producing dental caries
Teachers
Milk with sugar Milk without sugar Sugar
Coffee without sugar Coffee with sugar Tea without sugar Tea with sugar Sweets/candies Smoking Apples
49.7 3.2 98.6 28.7 66 6.6 60 91 88 2.5
DISCUSSION
support for children’s oral education, a higher frequency of carbohydrate consumption, an in-complete knowledge on the effects of fluorine contained in the tooth paste, etc.
The study was based on questionnaires ad-dressed to adults – mothers and educators – who are mainly responsible for child’s health-pro-moting life style, both at present and in the fu-ture. The answers provided by both categories evidence the necessity of additional information on the main causes provoking dental caries. Mothers’ answer to the question of how to avoid dental caries was, in most cases, related to den-tal brushing. The level of knowledge on the negative effects of sugar was quite high, in both mothers and educators, differences being never-theless recorded between it and the health-pro-moting practices.
The level of health-promoting education of mothers and educators influences the oro-dental health condition of children, as actually shown by the literature of the field (9-14).
CONCLUSIONS
The family is responsible for the health-pro-moting life style of the child, as it constitutes the first source of information on oral health. A mo-dality for increasing the interest of the child for oral health is that of providing permanently-up-dated information, continuous education and motivation from the part of the parents. At the same time, school represents an important po-tential for the establishment of health-promot-ing habits, due to the considerable time the chil-dren spend in this place. The results of the present study show that the health-promoting habits of the adults, as well as the level of knowl-edge are important factors in the health-promot-ing education of children.
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