|Year : 2013 | Volume
| Issue : 2 | Page : 75-78
Knowledge of early childhood caries among anganwadi workers in davangere city, India
Srinidhi Palagatti Basavaraj, Sakeenabi Basha, Pavagouda Gopalakrishna Naveen Kumar, Prashant Goudar Manjunath, Sushanth Veerabhadraiah Hirekalmath, Mohammad Imranulla
Department of Preventive and Community Dentistry, College of Dental Sciences, Davangere, Karnataka, India
|Date of Web Publication||4-Jul-2014|
Department of Community Dentistry, College of Dental Sciences, Davangere - 577 004, Karnataka
Source of Support: None, Conflict of Interest: None
Aim: An Anganwadi worker (AW) can be a vital link in the health care delivery system as she provides a package of services to mothers and children. Oral health knowledge among these workers is an integral component of preventing early childhood caries (ECC). The present study aimed to assess the existing knowledge of early childhood oral health-related factors among AWs. Materials and Methods: A questionnaire-based survey was conducted among AWs in Davangere city, India. The study involved face-to-face interviews and recording the response to a pretested 12-item questionnaire. Of the 80 participants, 74 participants responded to the questionnaire. Results: Of the 74 respondents, 34.3% agreed that a mother's diet during pregnancy affects the development of the infant's teeth, while 47.6% disagreed. Sixty-four percent of the participants agreed that problem with babies' teeth affect the adult teeth, and 85% of the participants agreed that breastfeeding is important for the health of the child's teeth. Ninety-two percent of the participants agreed that untreated tooth decay affects the general health of the child, and 47.3% agreed that bacteria that cause decay can spread from mother to child. Conclusion: Our study concluded that AWs showed some degree of knowledge about certain aspects of ECC. The knowledge however appeared to be inconsistent. We recommend that AWs need to be educated by conducting periodic oral health education programs, which will increase their awareness about ECC.
Keywords: Anganwadi worker, early childhood caries, knowledge
|How to cite this article:|
Basavaraj SP, Basha S, Naveen Kumar PG, Manjunath PG, Hirekalmath SV, Imranulla M. Knowledge of early childhood caries among anganwadi workers in davangere city, India. Int J Oral Health Sci 2013;3:75-8
|How to cite this URL:|
Basavaraj SP, Basha S, Naveen Kumar PG, Manjunath PG, Hirekalmath SV, Imranulla M. Knowledge of early childhood caries among anganwadi workers in davangere city, India. Int J Oral Health Sci [serial online] 2013 [cited 2017 Mar 23];3:75-8. Available from: http://www.ijohsjournal.org/text.asp?2013/3/2/75/135976
| Introduction|| |
Early childhood caries (ECC) is defined as the presence of one or more decayed, missing or filled tooth surfaces in any primary tooth in a child 71 months or younger.  ECC is a chronic, transmissible, infectious disease with a complex and multifactorial etiology,  and it is a significant public health problem in both developing and industrialized countries, which continues to affect babies and preschool children worldwide. ,,,, Researchers have shed much light on the etiology and the impacts of ECC on general health and quality of life. ,,,,, This knowledge has now enabled the dental profession to provide effective prevention of the disease.  ECC prevalence varies from population to population; however, children of disadvantaged subpopulations, regardless of race, ethnicity or culture, have been found to be most vulnerable.  Some of the published studies showed an ECC prevalence of 19-54% in the Indian population. ,,
The Anganwadi worker (AW) is the principal worker in the Integrated Child Development Services (ICDS) project in India. She provides a package of basic health services like supplementary nutrition, immunization, health check-up, referral, health education and nonformal education services to nursing mothers, other women (15-45 years) and children below 6 years of age.  Increasing the oral health knowledge of the AWs provides an opportunity to educate an important segment of the public that has access to a large population of young people. The present study aimed to assess the existing knowledge of early childhood oral health-related factors among AWs of Davangere city, Karnataka state, India.
| Materials and Method|| |
Davanagere is a city in the Indian state of Karnataka, lying in western South India. It has an area of 72 km 2 (28 sq mi). There were about 85 Anganwadis in Davangere city (2011 data). All the required and relevant information about the number and location of Anganwadis was obtained from the Taluk health office, Davangere. A total of 80 available AWs were interviewed at their official monthly meetings in the month of November 2011. The purpose of the study was explained to them and informed consent was obtained from all AWs. A 12-item close-ended questionnaire addressing knowledge of early childhood oral health-related factors was designed jointly by the research group, which included a pediatric dentist and community dental health specialist. All aspects of early childhood oral health, including oral development, nursing habits, oral hygiene habits, fluoride, transmissibility of oral bacteria and the importance of primary teeth were addressed in the questionnaire. The scoring in the knowledge domain included Agree/Disagree/Don't know. A section for socio-demographic data was included at the beginning of the questionnaire to assess the years of experience, marital status and educational level of the AWs. The questionnaire was constructed in English and later translated into Kannada, the local language, and back-translated to English. The study involved face-to-face interviews and recording the response to the pretested questionnaire (pilot study on 5 AW for clarity in understanding questions and frank response). The reliability of the questionnaire was assessed by asking 20 subjects to complete it through a face-to-face interview. Cronbach alfa was used as a measure of reliability (α = 0.75). Ethical clearance was obtained from the College of Dental Sciences, Davangere. Analysis was performed using the Statistical Package for Social Science version 17 (SPSS INC., Chicago, IL, USA).
| Results|| |
A total of 74 out of 80 AWs responded to the questionnaire (response rate of 92.5%). The demographic data of the respondents are presented in [Table 1]. There were about 63.51% of AWs in between 31 and 45 years of age, and the majority of them had ≥10 years of experience. Ninety-one percent had secondary education and 72.97% were married. [Table 2] presents the response of AWs to the questionnaires. Of the 74 respondents, 34.3% agreed that a mother's diet during pregnancy affects the development of the infant's teeth while 47.6% disagreed. Sixty-four percent of the participants agreed that problems with babies' teeth affect the adult teeth, and 85% of the participants agreed that breastfeeding is important for the health of the child's teeth. Ninety-two percent of the participants agreed that untreated tooth decay affects the general health of the child, and 47.3% agreed that bacteria that cause decay can spread from mother to child. Seventy-one percent of the participants agreed that fluoride helps to prevent tooth decay.
| Discussion|| |
The present study was undertaken to assess the existing knowledge of early childhood oral health-related factors among AWs so that effective pediatric oral health measures can be provided, thereby safeguarding the growth and development of young children. Oral disease, predominantly caries, in young children can be prevented to a great extent if AWs are sufficiently educated and motivated, who in turn educate and motivate mothers to provide the best oral care for their children. Oral health literacy is one of the important factors affecting oral health.
According to the response to this study, 34.3% agreed that a mother's diet during pregnancy affects the development of the infant's teeth, while 47.6% disagreed. This indicates a lack of knowledge about the relationship between the mother's health and oral health of the unborn child. Proper nutrition and good oral health of the mother and the caregiver are important factors as far as the oral health status of the infant is concerned. The majority of AWs believed that baby teeth are important, although they do not last as long as permanent teeth, child's first teeth play an important role in his development. While they are in place, these primary teeth help a child to speak, smile and chew properly. In response to question number three, 31.1% of the workers disagreed that problems with baby teeth will affect adult teeth. Tooth decay can occur as soon as the teeth appear in the baby's mouth. AWs may wonder why there is concern about baby teeth becoming decayed, as they will be replaced by permanent teeth. But, there is cause for concern: Decay in primary teeth may damage the hidden permanent teeth that are forming inside the gums. The studies have shown that the children who develop caries at an early age run a high risk of further caries development in the primary dentition, and are more likely to develop caries in the permanent dentition. ,
In response to question number four, 47.3% agreed that babies without teeth need mouths cleaned, and 41.8% thought that a baby's teeth should be cleaned after teeth eruption. Cleaning a child's mouth should begin before teeth erupt, and tooth brushing is recommended when the first tooth erupts at least once daily till 2 years, and subsequently twice daily.  About 41.9% of AWs think that babies should be put to bed with bottles. When babies fall asleep while sucking on a bottle, the liquid will pool around teeth as they sleep, which can cause cavities. This happens because the bacteria in the mouth change the sugars in milk, juice, formula and breast milk into acids that can dissolve tooth enamel. This is most often a problem for the front four upper teeth because babies hold the nipple against them with the tongue. AWs' responses to the question of whether bottle feeding beyond 12 months of age may pose harm to the primary dentition may be helpful in identifying children at increased risk for caries. For instance, those who disagreed with the practice may have been speaking from first-hand knowledge of the effects this behavioral practice may have. Breastfeeding the infant helps the child maintain positive jaw growth patterns, maintain good oral hygiene and maintain a cavity-free environment from the very start. The sucking mechanism used during bottle feeding differs from that used during breastfeeding. The different sucking mechanisms have the potential to predispose a bottle-fed infant to the development of poor jaw growth patterns. The study of the Urban Mexican American and immigrant Latino mothers rarely recognized cariogenic food beyond candy, and demonstrated uncertainty as to how exactly bottle feeding is detrimental to oral health. 
About 29.7% of workers disagreed that children should see a dentist or dental therapist by the first birthday. To prevent dental problems, a child should see a pediatric dentist when the first tooth appears, usually between 6 and 12 months of age, certainly no later than his/her first birthday. In this study, 91.9% workers agreed that untreated dental decay could affect the general health of the child. Dental caries has a number of impacts on the daily activities of the children as it might impair their ability to eat or affect the quality of their sleep. Many studies found that caries experience affects growth, specifically body weight and height of the children, in an adverse manner. ,
In this study, 43% workers disagreed bacteria that cause decay can spread from mother to child. Transmission of cavity-causing bacteria from mom to baby have been published for 30 years. ,,,, The primary culprit is Streptococcus mutans, a bacteria that can pass from person to person through the transfer of saliva, such as sharing utensils, blowing on food and, yes, even kissing that sweet little bundle of joy on the mouth.  Our study showed that 71% of AWs knew that fluoride in toothpaste is important for preventing caries in teeth.
| Conclusion|| |
An AW can be a vital link in the health care delivery system as she provides a package of services to mothers and children. The finding of this present study shows that the AWs showed some degree of knowledge about certain aspects of ECC. The knowledge however appeared to be inconsistent/contradictory in some aspects. We recommend that AW needed to be educated by conducting periodic oral health education programs, which will create an awareness about oral health. The topic of oral health should be included in their training curriculum. AWs should be educated about the relative benefits of preventive methods that the individuals can perform at home, like oral hygiene procedures using a fluoridated dentifrice and knowledgeable nursing habits.
| References|| |
|1.||Drury TF, Horowitz AM, Ismail AI, Maertens MP, Rozier RG, Selwitz RH. 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. |
|2.||Qin M, Li J, Zhang S, Ma W. Risk factors for severe early childhood caries in children younger than 4 years old in Beijing, China. Pediatr Dent 2008;30:122-8. |
|3.||Douglass JM, Douglass AB, Silk HJ. A practical guide to infant oral health. Am Fam Physician 2004;70:2113-20. |
|4.||Livny A, Assali R, Sgan-Cohen HD. Early childhood caries among a Bedouin community residing in the eastern outskirts of Jerusalem. BMC Public Health 2007;7:167. |
|5.||Douglass JM, Montero MJ, Thibodeau EA, Mathieu GM. Dental caries experience in a Connecticut Head Start program in 1991 and 1999. Pediatr Dent 2002;24:309-14. |
|6.||Milnes AR. Description and epidemiology of nursing caries. J Public Health Dent 1996;56:38-50. |
|7.||Saravanan S, Madivanan I, Subashini B, Felix JW. Prevalence pattern of dental caries in the primary dentition among school children. Indian J Dent Res 2005;16:140-6. |
|8.||Ismail AI. Determinants of health in children and the problem of early childhood caries. Pediatr Dent 2003;25:328-33. |
|9.||Hallett KB, O′Rourke PK. Social and behavioural determinants of early childhood caries. Aust Dent J 2003;48:27-33. |
|10.||Acs G, Lodolini G, Kaminsky S, Cisneros GJ. Effect of nursing caries on body weight in a pediatric population. Pediatr Dent 1992;14:302-5. |
|11.||Ayhan H, Suskan E, Yildirim S. The effect of nursing or rampant caries on height, body weight and head circumference. J Clin Pediatr Dent 1996;20:209-12. |
|12.||Berkowitz RJ. Causes, treatment and prevention of early childhood caries: A microbiologic perspective. J Can Dent Assoc 2003;69:304-7. |
|13.||Tyagi R. The prevalence of nursing caries in Davangere preschool children and its relationship with feeding practices and socioeconomic status of the family. J Indian Soc Pedod Prev Dent 2008;26:153-7. |
|14.||Jose B, King NM. Early childhood caries lesions in preschool children in Kerala, India. Pediatr Dent 2003;25:594-600. |
|15.||Integrated Child Development Services, Nov 1983, Central Technical Committee on health and nutrition, All India Institute of Medical Sciences, New Delhi. |
|16.||Demers M, Brodeur JM, Simard PL, Mouton C, Veilleux G, Fréchette S. Caries predictors suitable for mass-screenings in children: A literature review. Community Dent Health 1990;7:11-21. |
|17.||Li Y, Wang W. Predicting caries in permanent teeth from caries in primary teeth: An eight-year cohort study. J Dent Res 2002;81:561-6. |
|18.||Berg JH, Slayton RL. Early Childhood Oral Health. Vol. 1. Hoboken, New Jersey: Wiley-Blackwell; 2009. p. 44-5. |
|19.||Hoeft KS, Barker JC, Masterson EE. Urban Mexican-American mothers ′beliefs about caries etiology in children. Community Dent Oral Epidemiol 2010;38:244-55. |
|20.||Seow WK. Biological mechanisms of early childhood caries. Community Dent. Oral Epidemiol 1998;26(Suppl 1):8-27. |
|21.||Harris R, Nicoll AD, Adair PM, Pine CM. Risk factors for dental caries in young children: A systematic review of the literature. Community Dent Health 2004;2121(Suppl 1):71-85. |
|22.||Toi CS, Cleaton-Jones PE, Daya NP. Mutans streptococci and other caries-associated acidogenic bacteria in five-year-old children in South Africa. Oral Microbiol Immunol 1999;14:238-43. |
|23.||Mitchell SC, Ruby JD, Moser S, Momeni S, Smith A, Osgood R, et al. Maternal transmission of mutans streptococci in severe-early childhood caries. Pediatr Dent 2009;31:193-201. |
|24.||Zhan L, Tan S, Den Besten P, Featherstone JD, Hoover CI. Factors related to maternal transmission of mutans streptococci in high-risk children-pilot study. Pediatr Dent 2012;34:e86-91. |
|25.||Gussy MG, Waters EB, Riggs EM, Lo SK, Kilpatrick NM. Parental knowledge, beliefs and behaviours for oral health of toddlers residing in rural Victoria. Aust Dent J 2008;53:52-60.25. |
[Table 1], [Table 2]