|Year : 2019 | Volume
| Issue : 2 | Page : 44-48
Pediatrician's knowledge and practice of early childhood caries and infant oral health in southern Saudi Arabia
Shreyas Tikare1, Alezi Braimoh Eroje1, Rafi Ahmed Togoo2, Saeed Mohammad Marzoq3, Saad Mohammad Alkhammah3, Mashhour Mohammad Alshahrani3, Ahmad Awad Alshahrani3, KS Ravi2
1 Department of Periodontics and Community Dental Sciences, Division of Community Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
2 Department of Pedodontics and Orthodontic Dental Sciences, Division of Pedodontics, College of Dentistry, King Khalid University, Abha, Saudi Arabia
3 Practicing Dentist, Ministry of Health Polyclinic, Asir, Saudi Arabia
|Date of Submission||03-Sep-2019|
|Date of Acceptance||16-Oct-2019|
|Date of Web Publication||8-Nov-2019|
Department of Periodontics and Community Dental Sciences, Division of Community Dentistry, College of Dentistry, King Khalid University, Abha
Source of Support: None, Conflict of Interest: None
Background: It is already known that infants and children are more vulnerable to oral and dental problems. Published literature has shown a high prevalence of early childhood caries (ECC) worldwide, including Saudi Arabia. Aim: This study aims to assess pediatrician's knowledge and practice about ECC and infant oral health in Abha-Khamis. Methodology: This cross-sectional study used a structured and pretested questionnaire. The study population included all the pediatricians practicing in the city of Abha-Khamis. Results: A total of 61 pediatricians completed the questionnaire. Most pediatricians (80%) were in agreement that white spots/lines on tooth surface were the first signs of tooth decay. Only 21% of the pediatricians agreed that only bottled-fed babies are affected by ECC while 72% disagrees, and 6.6% were not sure. Nearly half of the respondents (55%) were aware of the recommended age for prescribing fluoridated toothpaste. Most pediatricians (75%) had correct knowledge regarding the recommended child's first dental visit. The results suggest that most pediatricians (95%) performed routine visual examination of the oral cavity, 75% reported to have routinely conducted parental counseling regarding diet and oral hygiene practices, and majority of the practitioners (93%) often make referrals to dental clinics. Conclusions: Pediatricians in Abha-Khamis have good knowledge regarding ECC and infant oral health. Majority of the pediatricians had no formal training regarding oral health in the medical curriculum yet they conducted a routine oral examination and made dental referrals in their practice. Coordinated efforts between the dentists and pediatricians can effectively address oral health issues among the children.
Keywords: Oral health, pediatrics, qualitative study
|How to cite this article:|
Tikare S, Eroje AB, Togoo RA, Marzoq SM, Alkhammah SM, Alshahrani MM, Alshahrani AA, Ravi K S. Pediatrician's knowledge and practice of early childhood caries and infant oral health in southern Saudi Arabia. J Dent Res Rev 2019;6:44-8
|How to cite this URL:|
Tikare S, Eroje AB, Togoo RA, Marzoq SM, Alkhammah SM, Alshahrani MM, Alshahrani AA, Ravi K S. Pediatrician's knowledge and practice of early childhood caries and infant oral health in southern Saudi Arabia. J Dent Res Rev [serial online] 2019 [cited 2020 Oct 22];6:44-8. Available from: https://www.jdrr.org/text.asp?2019/6/2/44/270650
| Introduction|| |
A newborn child is called an infant from birth till the completion of the 1st year of life. Although an oral cavity of a newborn just has gum pads with primary teeth erupting only after 6 months, they may be affected with few oral problems such as oral thrush, teething, and natal teeth.,, Pediatricians can play a vital role in early detection of most oral health issues during infancy and early childhood. Awareness about oral health conditions among pediatricians could be critical to achieve optimal oral health in children.
Early childhood caries (ECC) is the presence of one or more decayed (noncavitated or cavitated lesions), missing teeth (due to caries), or filled tooth surfaces in any primary tooth in a child under the age of 6 years. In children younger than 3 years of age, any sign of smooth-surface caries is indicative of severe ECC (S-ECC). ECC typically involves primary maxillary incisors followed by primary maxillary and mandibular molars, maxillary canines and occasionally mandibular canines. The severe form of ECC involves many teeth with a more rapidly progressive trait which may even affect newly erupted teeth and surfaces with low risk for caries development. Caries initially begin on the cervical third of the teeth as dull, white demineralized enamel and later into yellow or brown cavitated area leading to complete destruction of the crown.
The etiology of ECC is multifactorial and is frequently associated with poor diet rich in carbohydrates, host, and bad oral health habits such as prolonged ad libitum bottle feeding with sugar-containing fluids, especially before sleep and delayed weaning.Streptococcus mutans and Streptococcus sobrinus are the main cariogenic microorganisms implicated. Epidemiological studies have also documented low socioeconomic status, minority status, low birth weight, transfers of microbes from mother to child through the sharing of spoons, and soothers as ECC risk factors.
ECC has been considered at epidemic proportions in developing countries. The current standard of care for treating ECC usually necessitates general anesthesia with all its potential complications because of the level of co-operative behavior in babies and preschool children is less than ideal. Consequently, this treatment procedure leads to a heavy cost to the family and the health-care system. The average cost of treating one child with ECC in Canada ranges from $700 to $3,000, and the total cost is even higher if indirect costs such as medical evacuations from small communities to larger centers are included.
Contact of a child with a pediatrician typically occurs earlier than a child's first visit to a dental care provider. On average, children are seen 11 times for a well visit with a pediatrician by the age of 3 years. Guidelines by the American Academy of Pediatrics (AAP) advise the primary health-care providers to counsel families on teething and dental care and to recommend the timing of the first dental visit., Several studies in Saudi Arabia show a high prevalence of ECC ranging from 73% to 83.6%.,,, However, little is known about the preventive dental care practices among pediatricians in Saudi Arabia. Therefore, the purpose of the present study was to assess pediatrician's knowledge and practice about ECC and infant oral health in Abha-Khamis city of Southern Saudi Arabia.
Approval for the proposed study was obtained from the Institutional Review Board, King Khalid University, College of Dentistry, Saudi Arabia. A draft questionnaire was developed with 18 items to collect information on the pediatrician's knowledge of ECC and infant oral health. The first sections of the questionnaire contained 11 structured questions pertaining to a child's first dental visit, prevalence, etiology, clinical signs, management, and prevention of ECC. The second section contained 6 structured questions pertaining to the pediatricians' oral health practices regarding visual oral examination and referrals, counseling on oral health, professional training in oral health, as well as the perceived importance of their role in promoting oral health in children. The questionnaire was designed to take minimum time to complete. The responses for the items in the first section were from a three-point Likert scale (agree, disagree, and not sure), while the second section contained dichotomized response (Yes or No). The questionnaire was verified for face validity by the faculty members of the Division of Dental Public Health, King Khalid University.
The study population included all the pediatricians practicing in the city of Abha and Khamis. A list of all hospitals in the place was obtained, and prior appointments with the practicing pediatricians were taken. The pediatricians were made aware of the study purpose and assured confidentiality regarding the information to be gathered. The completed questionnaires were then collected, and the data were subjected for statistical analysis.
| Results|| |
A total of 61 pediatricians completed the questionnaire giving an overall response rate of 100%. The majority (88.5%) of pediatricians agreed to the fact that dental caries among children is highly prevalent in Saudi Arabia. Majority (98.4%) of respondents were aware of the effect of untreated dental caries on the general health of the child. About 91.8% of pediatricians were aware of the terminology “ECC.” Most respondents (83.6%) agreed that primary teeth are important even if they are bound to shed sometime later. There was a mixed response regarding “transmission of bacteria from mother to child” that may cause tooth decay with majority of pediatricians (47.5%) who disagreed with the statement. Most pediatricians (80.4%) were in agreement that white spots/lines on tooth surface were the first signs of tooth decay. Only 21.3% of the pediatricians agreed that only bottled-fed babies are affected by ECC while 72.1% disagree and 6.6% were not sure. Nearly half of the respondents (55.7%) were aware of the recommended age for prescribing fluoridated toothpaste. Most pediatricians (75.4%) had correct knowledge regarding the recommended child's first dental visit. All most all respondents believed that early treatment of dental caries is preferred and also that pediatricians have a significant role in the prevention of dental caries among children and promotion of oral health in infants and toddlers (98.4%) [Table 1].
Our results found 95.1% pediatricians conducted routine oral examination in their practice and 75.4% pediatricians frequently noticed dental caries among their patients. Majority practitioners (93.4%) said that they referred children with dental caries to dental clinics. A large number of pediatricians (86.9%) reported that they routinely conducted parental counseling regarding diet and oral hygiene practices. It was found that 63.9% of the pediatricians did not have oral health education as part of their curriculum in medical training, and 75.4% of the pediatricians had never attended any training sessions/seminars on oral health education [Graph 1].
| Discussion|| |
Our questionnaire had simple items to gather information regarding the term “ECC,” etiology, management, and prevention aspects of the condition followed by the practice aspects of pediatricians during routine clinical examination. The results of the present survey reflect that pediatricians have a relatively high level of oral health knowledge and favorable practices regarding oral health promotion. Majority of pediatricians were aware of the terminology of “ECC” and also were quite aware of its high prevalence in society. Importantly, the pediatricians believed that they have a significant role in preventing dental caries. Similar observations were made from a national survey in the United States of America.
However, fewer practitioners were lacking adequate knowledge regarding oral health issues among children. It is a well-established fact that the bacteria that cause decay can spread from mother to child.,, Nearly, only half of our respondents knew that the bacteria causing caries can be transmitted from the mother to the infant. Furthermore, nearly half of the respondents were either not aware or not sure regarding the recommended age for the use of fluoridated toothpastes. There are studies which suggest that the oral health competency and practice level of some pediatricians is less than adequate.,,, The AAP policy on oral health risk assessment timing and establishment of the dental home encourages pediatricians to play an important role in the oral health of children. There are several publications to provide information on children's oral health in the pediatric journals.,,, The mere access to information perhaps is inadequate for pediatricians to fulfill the role in children's oral health as suggested by the AAP. The professional boundary apparent between a pediatrician and dentist could also be a barrier for some pediatricians in assuming oral health-related roles. Furthermore, the time factor might be critical for many pediatric practitioners to incorporate new issues and screening into the visits. Even if such barriers are overcome, the key challenge will be the attitudes of pediatricians toward incorporating oral health into their daily practice.
The majority of the pediatricians in this study did not have common oral health issues in children as part of their medical curriculum and did not attend any continuing education sessions on the topic. In spite of the lack of professional training, pediatricians performed routine visual examinations of the teeth and oral cavity and made referrals to dentists if required. The pediatricians very frequently counseled the parents regarding the significance of good oral hygiene practices in children. The literature findings suggest that some pediatricians elsewhere do practice oral health examination for their patients and engage in parent counseling., However, the knowledge regarding oral health information conveyed to the parents is believed to be derived from general knowledge and their practical experiences.
The following recommendations could be possible opportunities to bridge the gap between the two professional societies; continuing dental education on preventive dentistry topics should be incorporated in continuing medical education programs, appropriate measures need to be taken to include dentists as a part of well-child care clinic to encourage group practice, the graduating pediatric practitioners need to have certain competencies in oral health as a part of curriculum and preventive dentistry articles to be published in pediatric journals regularly.
Limitations of our study include the use of dichotomous response options as either “Yes” or “No” for practice-based questions. This response design was deliberately used to help respondents in completing the questionnaire with minimum time due to their busy work schedule. Further studies are needed to explore in-depth analysis regarding pediatrician's knowledge of various other oral health conditions and their related practices.
| Conclusions|| |
Overall, the results of the study suggest that pediatricians in Abha-Khamis have good knowledge regarding ECC and infant oral health. Although majority of pediatricians had no formal training, they conducted a routine oral examination and made dental referrals if necessary in their practice. There is an increased need for continuing education programs on relevant topics among pediatricians to bridge the knowledge gaps. Such a coordinated effort between professional disciplines makes our approach more holistic in promoting oral health.
The authors would like to thank all the pediatricians for their participation, valuable feedback, and time. We are also grateful to the various hospital managements for their kind cooperation, thereby making this study a success.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest
| References|| |
Soares IMV, Silva AMRB, Moura LFAD, Lima MDM, Nétto OBS, Moura MS, et al
. Conduct of pediatricians in relation to the oral health of children. Revista de Odontologia da UNESP. 2013;42:266-72. Doi: doi.org/10.1590/S1807-25772013000400006.
Colak H, Dülgergil CT, Dalli M, Hamidi MM. Early childhood caries update: A review of causes, diagnoses, and treatments. J Nat Sci Biol Med 2013;4:29-38.
Drury TF, Horowitz AM, Ismail AI, Maertens MP, Rozier RG, Selwitz RH, et al.
Diagnosing and reporting early childhood caries for research purposes. A report of a workshop sponsored by the national institute of dental and craniofacial research, the health resources and services administration, and the health care financing administration. J Public Health Dent 1999;59:192-7.
Ramazani N, Poureslami HR, Ahmadi R, Ramazani M. Early childhood caries and the role of pediatricians in its prevention. Iran J Pediatr Soc 2010;2:47-52.
McDonald RE, Avery DR, Dean JA. Dentistry for the Child and Adolescent. 9th
ed. St. Louis: Mosby; 2011. p. 1-3, 181-3, 196-8.
Kelly M, Bruerd B. The prevalence of baby bottle tooth decay among two native American populations. J Public Health Dent 1987;47:94-7.
Milnes AR, Rubin CW, Karpa M, Tate R. A retrospective analysis of the costs associated with the treatment of nursing caries in a remote Canadian aboriginal preschool population. Community Dent Oral Epidemiol 1993;21:253-60.
Nurelhuda NM, Al-Haroni M, Trovik TA, Bakken V. Caries experience and quantification of streptococcus mutans and streptococcus sobrinus in saliva of sudanese schoolchildren. Caries Res 2010;44:402-7.
Fitzsimons D, Dwyer JT, Palmer C, Boyd LD. Nutrition and oral health guidelines for pregnant women, infants, and children. J Am Diet Assoc 1998;98:182-6, 189.
Douglass JM, Douglass AB, Silk H. Infant oral health knowledge and training of medical health professionals. Pediatr Dent 2003;25:179.
Panagiotou L, Rourke LL, Rourke JT, Wakefield JG, Winfield D. Evidence-based well-baby care. Part 1: Overview of the next generation of the rourke baby record. Can Fam Physician 1998;44:558-67.
American Academy of Pediatrics. Recommendations for preventive pediatric health care. Pediatrics 2000;105:645-6.
Al-Malik MI, Holt RD, Bedi R. Erosion, caries and rampant caries in preschool children in Jeddah, Saudi Arabia. Community Dent Oral Epidemiol 2002;30:16-23.
Khan NB, Al Ghannam NA, Al Shammary AR, Wyne AH. Caries in primary school children: Prevalence, severity and pattern in Al-Ahsa, Saudi Arabia. Saudi Dent J 2001;13:71-4.
Wyne A, Darwish S, Adenubi J, Battata S, Khan N. The prevalence and pattern of nursing caries in Saudi preschool children. Int J Paediatr Dent 2001;11:361-4.
Alshehri A. Social and behavioral determinants of early childhood caries in the aseer region of Saudi Arabia. Pediatr Dent Care 2016;1:114.
Lewis CW, Grossman DC, Domoto PK, Deyo RA. The role of the pediatrician in the oral health of children: A national survey. Pediatrics 2000;106:E84.
Berkowitz RJ, Jones P. Mouth-to-mouth transmission of the bacterium streptococcus mutans between mother and child. Arch Oral Biol 1985;30:377-9.
Li Y, Caufield PW. The fidelity of initial acquisition of mutans streptococci by infants from their mothers. J Dent Res 1995;74:681-5.
Slavkin HC. First encounters: Transmission of infectious oral diseases from mother to child. J Am Dent Assoc 1997;128:773-8.
Gift HC, Hoerman KC. Attitudes of dentists and physicians toward the use of dietary fluoride supplements. ASDC J Dent Child 1985;52:265-8.
Koranyi K, Rasnake LK, Tarnowski KJ. Nursing bottle weaning and prevention of dental caries: A survey of pediatricians. Pediatr Dent 1991;13:32-4.
Kuthy RA, McTigue DJ. Fluoride prescription practices of ohio physicians. J Public Health Dent 1987;47:172-6.
Rigilano JC, Friedler EM, Ehemann LJ. Fluoride prescribing patterns among primary care physicians. J Fam Pract 1985;21:381-5.
Hale KJ, American Academy of Pediatrics Section on Pediatric Dentistry. Oral health risk assessment timing and establishment of the dental home. Pediatrics 2003;111:1113-6.
Johnson RL, Charney E, Cheng TL, Kittredge D, Nazarian LF, Chesney RW, et al.
Final report of the FOPE II education of the pediatrician workgroup. Pediatrics 2000;106:1175-98.
Martof A. Consultation with the specialist: Dental care. Pediatr Rev 2001;22:13-5.
Krol DM. Dental caries, oral health, and pediatricians. Curr Probl Pediatr Adolesc Health Care 2003;33:253-70.
Edelstein BL. Public and clinical policy considerations in maximizing children's oral health. Pediatr Clin North Am 2000;47:1177-89, vii.
Krol DM. Educating pediatricians on children's oral health: Past, present, and future. Pediatrics 2004;113:e487-92.
Sánchez OM, Childers NK, Fox L, Bradley E. Physicians' views on pediatric preventive dental care. Pediatr Dent 1997;19:377-83.
Nwhator SO, Olojede CO, Ijarogbe O, Agbaje MO. Self-assessed dental health knowledge of nigerian doctors. East Afr Med J 2013;90:147-55.