RESEARCH ARTICLE Research article - Knowledge, attitude and practices of pediatricians KNOWLEDGE, ATTITUDE AND PRACTICES OF PEDIATRICIANS REGARDING PREVENTION OF DENTAL CARIES Faizal C.Peedikayil, Soni Kottayi and Vaibhav Kenchamba Department of Pedodontics and Preventive Dentistry Kannur Dental College, Kannur Kerala State, India Correspondence to: drfaizalcp@gmail.com Abstract Dental caries is a common and chronic disease process with significant consequences. As healthcare professionals responsible for the overall health of children, pediatricians frequently confront morbidity associated with dental caries, and hence, they have an opportunity to prevent, intervene, and manage this condition in collaboration with their dental colleagues. This study was aimed at assessing the knowledge, attitude, and practices of pediatricians from the Kannur district of Kerala regarding the prevention of dental caries. Key words: Dental Caries, Pediatricians, preventive dentistry Introduction Dental caries is the single most common chronic disease affecting children 1. It is 5 times more common than asthma, and its prevalence is high among children from families with income below poverty level. 2 This disease not only causes damage to the tooth but is also responsible for several morbid conditions of the oral cavity and other bodily systems. 2,3 Health Sciences 2013;2(2):JS002 1 An Open Access Peer Reviewed E-Journal
The involvement of pediatricians in oral health prevention during child care visits in early childhood may play an important role in the diagnosis and prevention of the dental health of their patients. Generally, children are taken to the dentist only if there is a problem with the teeth; by this time, most of the teeth are carious because of poor oral hygiene. A pediatrician who is familiar with the science of dental caries, capable of assessing caries risk, knowledgeable about preventive strategies, and connected with dental resources can contribute to the oral health of his or her patients. 4,5 The American Academy of Pediatrics emphasizes that pediatric healthcare professionals should be trained to perform an oral health risk assessment on all children over 6 months of age. 6 However, the extent of pediatricians knowledge about preventive oral health and their contribution therein and to the assessment of oral health remains to be determined. Moreover, little is known about the incidence of dental problems in pediatric practice and whether pediatricians perceive barriers to their patients receiving professional dental care. Finally, it is important to know how pediatricians value the promotion of oral health and whether they would be willing to take on additional activities in the field. Limited literature is available on the extent of pediatricians participation, specifically, with regard to their knowledge, attitudes, and practices with regard to oral health preventive programs. Various studies have shown that the oral health competency and practice level of some pediatricians are less than adequate. 5,7,8,9,10 These results seem important because the attitude and knowledge of pediatricians may enhance or impede the implementation and eventual success of a preventive program. Therefore, the purpose of this survey was to evaluate the knowledge, attitude, and current practices regarding the prevention of dental caries among pediatricians in Kannur. Materials and Methods This survey was undertaken among the pediatricians in Kannur district, Kerala, as listed in the Indian Academy of Pediatrics, Kannur chapter. A complete, anonymous, self-administered questionnaire was personally handed over to all pediatricians by the interns of Kannur Dental College and collected after 2 days. The questionnaire was divided into 5 sections and comprised a series of questions pertaining to personal and demographic characteristics; knowledge regarding the risk factors of dental caries; attitude towards the prevention of oral diseases; management practices regarding preventive measures for oral diseases; and information regarding their knowledge about oral diseases. Health Sciences 2013;2(2):JS002 2 An Open Access Peer Reviewed E-Journal
The demographic and practice section of the instrument included questions on the gender of the pediatrician, number of years in clinical practice, type of post-graduate course completed (PG diploma/ degree), and number of patients seen in a typical workday. For assessing the knowledge of the main risk factors of dental caries, the respondents were asked a series of questions regarding their level of agreement or disagreement, with responses graded on a 2- point scale. With regard to attitude towards the prevention of oral diseases, responses were sought at a 3-point Likert scale (rating scale from 1 to 3; 1, agree and 3, disagree) for a limited number of questions exploring pediatrician agreement/disagreement to the following statements: dental caries may be prevented; the pediatrician has an important role in the prevention of oral diseases; the pediatrician should conduct an oral health examination; and oral hygiene and routine dental visit are effective in prevention. The fourth set of questions assessed the management practices by questions enquiring about whether pediatricians perform oral health examination during child care visits; when do they advice tooth brushing for infants; whether they provide patient counseling regarding the prevention of dental problems; and when do they refer children to dentists. The next section evaluated the pediatricians level of knowledge about oral diseases acquired by the pediatricians during their post-graduate course and their sources of information about the prevention of oral diseases. Results Of the 58 questionnaires distributed, 38 were returned completed, giving a response rate of 65.52%. Demographic information of survey recipients and their practices are summarized in table 1. Table 1. Characteristics of Respondents Characteristics Respondents Percentage Total no of respondents-38 Gender Male 26 68.42 Female 12 31.58 Years of practice after postgraduate degree/ diploma (13.68±9.39)* Less than 10 years 15 39.47 Health Sciences 2013;2(2):JS002 3 An Open Access Peer Reviewed E-Journal
11-20 years 15 39.47 More than 20years 08 21.06 Qualification Diploma 22 57.89 Degree 16 42.11 No. of patients seen in a work day less than 20 03 07.89 20-30 10 26.33 30-40 12 31.58 more than 40 13 34.21 *Mean and standard deviation The respondents had been in practice for a mean of 13.68 years. More than 65% of the pediatricians saw more than 30 patients a day. Data regarding the pediatricians knowledge regarding dental caries are given in figure 1. While a majority of the respondents were aware of the major risk factors, only 22% of the respondents knew that caries is transmitted from mother to child. Figure 1: Knowledge regarding the risk factors of dental caries % 100 80 60 40 20 0 Frequent intake of sugar Night feeding Poor oral hygeine Risk factors Malposed teeth Transmission from mother Health Sciences 2013;2(2):JS002 4 An Open Access Peer Reviewed E-Journal
Table 2 pertains to the attitude of the pediatricians regarding their role in the dental care of the patients; it indicates that almost all the pediatricians agree with and know the role of the pediatrician in the prevention of dental caries. Table 2. Attitude of Pediatricians regarding oral health Agree Dental caries may be prevented 100% Oral hygiene is important in preventing dental caries 100% Pediatrician should provide an oral cavity health 94.7% Pediatrician have a role in promoting oral health 100% Routine dental visit is important in preventing oral diseases 100% The data on the practices of pediatricians in relation to the prevention of dental caries are summarized in Table 3. Table 3. Practices of Pediatricians No. of respondents Percentage Do you perform oral health assessment during physical examination? 1 Routinely for all patients - 15 39.47 2. Only in presence of a complaint - 21 55.27 3 Not at all - 02 05.26 When do you advice brushing for children? Before tooth erupts 02 05.26 After 1 tooth erupts 34 89.48 After a few teeth erupts 02 05.26 Do you counsel on prevention of dental problems? Yes 22 57.89 No 13 34.22 Sometimes 03 07.89 When do you refer a patient to a dentist? At 6 months of age 02 05.26 Health Sciences 2013;2(2):JS002 5 An Open Access Peer Reviewed E-Journal
At 1 year of age 06 15.79 When there is a problem 30 78.95 Only 39.47% of the pediatricians performed oral health assessment during physical examination, whereas 51.27% of pediatricians perform oral health examination only in the presence of a relevant complaint. Among the pediatricians, 89.48% advice tooth brushing after the first tooth erupts. Counseling of patients regarding dental caries was provided only by 57.89% of the pediatricians. The survey also indicated that 78.95% of pediatricians refer patients to dentists only when there is a dental problem. The results of the self-assessment of pediatricians regarding oral health education are shown in figure 2. The results indicate that 73.68% of the pediatricians believe that their oral health education is inadequate. Figure 2. Self-assessment of pediatricians regarding oral health education Knowledge regarding oral health 80 73.68 70 60 50 % 40 30 20 10 26.32 Not adequate 0 1 2 Adequate Health Sciences 2013;2(2):JS002 6 An Open Access Peer Reviewed E-Journal
Discussion Results based on self-reported data are considered valid when the recall is restricted to a short period of time and anonymity is ensured 11. This survey met both these criteria. The response rate was 63%, which is consistent with that observed in similar surveys 5,10. The attitude of pediatricians regarding their participation in the prevention of dental caries was found to be excellent. Our results emphasize the pediatricians responsibility and positive attitude towards the prevention of oral diseases. This survey revealed that the majority of pediatricians acknowledged the fact that frequent intake of sugar, night feeding, poor oral hygiene, and malposed teeth are possible risk factors of dental caries. However, only 20% of pediatricians were aware of the transmission of the disease from mother to the child. Caries is a transmittable infectious disease that the child can acquire from the mother 12. Various surveys have shown that pediatricians awareness regarding the transmission of dental caries is poor despite the publication of reports over 2 decades back 13. The majority of the pediatricians do not perform oral health assessment routinely during physical examination. Oral health assessment should be a part of general examination. In the United States, 98.9% of the pediatricians frequently or occasionally examine a child for signs of dental caries 5. By routine examination of the oral cavity during physical examination, pediatricians can diagnose early caries formation, and the child can be referred to a dental surgeon for preventive dental treatment. 14,15 Most pediatricians who participated in this study referred patients to dentists only when there was an explicit dental complaint. This indicated that the pediatricians may not be aware of American Association of Pediatric Dentistry (AAPD) guideline, endorsed by the American association of pediatricians (AAP), which states that the first examination is recommended at the time of the eruption of the first tooth and no later than 12 months of age. 6,16 Pediatricians are caregivers who are mainly responsible for the supply of information to patients since they have multiple opportunities to intervene with respect to a child s oral health. 17,18 Although the US guidelines recommend that all pediatricians provide anticipatory guidance, only 57% of the pediatricians in our study provided counseling regarding dental problems. Noncounseling may also send wrong signals to parents that the prevention of oral health is not of high value. Counseling regarding dental diseases should be a part of preventive pediatrics. Information concerning the impact of diet on oral health and counseling with regard to oral hygiene should be shared with parents. Infant oral hygiene counseling should include instructions to brush twice daily, use of pea-sized amount of toothpaste Health Sciences 2013;2(2):JS002 7 An Open Access Peer Reviewed E-Journal
and flossing as soon as the adjacent teeth are in contact. 16,19,20 The majority of pediatricians feel that their knowledge regarding oral health is not adequate. Others surveys indicate that the knowledge imparted in medical schools is inadequate with regard to oral health. 15,21 Measures to educate pediatricians need to be included in the PG curriculum and at each level of medical graduate curriculum. Literature regarding dental subjects in medical journals, pedodontists participation in continuing medical education programmes, and pedodontist and pediatrician interactions would be worthwhile to improve pediatricians knowledge and practice. Limitations In interpreting the findings of this study, it is important to acknowledge the limitations of this study. First, this study could not determine whether the reported practices reflect actual clinical practices. This study design did not allow investigation of the possible links between the level of knowledge of the pediatricians and their attitude to the best practice. Conclusion Since children visit the pediatrician more often than the dentist, it is critical that pediatricians be knowledgeable about dental caries, prevention of the disease, and interventions available to the pediatrician and the family. This survey indicates that pediatricians overwhelmingly believe that they have an important role to play in the promotion of oral health. Lack of familiarity with oral health issues makes it difficult for pediatricians to promote oral health, and this suggests the need for improvement in the curriculum and formal training and standards for preventive oral health counseling and care. References 1. Fejerskov O. Changing paradigms in concepts on dental caries: consequences for oral health care. Caries Res 2004;38:182 191. 2. Newacheck P, Hughes DC, Hung YY, Wong S, Stoddard JJ. The unmet health needs of America s children. Pediatrics 2000;105:989 997. 3. Chakraborthy M, Saha JB, Bhattacharya RN, Roy A, Ram R. Epidemiological correlates of dental caries in an urban slum of West Bengal. Indian J Public Health 1997;41:56-60. 4. Schulte JR. Early childhood tooth decay-pediatric interventions. Clin Pediatr 1992;31:727-30. 5. Lewis CW, Grossman DC, Domoto PK, Deyo RA. The role of the Health Sciences 2013;2(2):JS002 8 An Open Access Peer Reviewed E-Journal
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