Supervisors info:
Γκιζάνη Σωτηρία, Αναπληρώτρια Καθηγήτρια, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Αγουρόπουλος Ανδρέας, Επίκουρος Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Παπαϊωάννου Βασίλειος, Αναπληρωτής Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Summary:
Introduction:
Dental caries in primary dentition is the 10th most common human disease, affecting 621 million children worldwide. Treatment of primary teeth involves a wide range of invasive pulp treatments and crown restoration procedures, to minimally invasive approaches. Silver diamine fluoride treatment is a simple, painless, and rapid procedure that arrests carious lesions without the need for tooth tissue removal. However, the black discoloration of the tooth after application is the main drawback of its use.
Parents, as legal guardians, are responsible for deciding and consenting to any dental treatment. Their knowledge and perceptions of oral health have a major impact on the oral health status of their children. To date, there is limited data on parental knowledge of children's oral health and their preferences for treatment management of primary dentition, especially in European countries.
Aim:
The aim of the present study is to assess the knowledge and attitudes of parents/guardians regarding their children's oral health and their preferences regarding the type of treatment for primary teeth.
Material and Methods:
This is a descriptive, cross-sectional study conducted through the completion of a questionnaire by the parents/guardians of pediatric patients. The sample consisted of 264 parents/guardians of children attending the undergraduate and postgraduate clinics of the Department of Pediatric Dentistry, School of Dentistry, NKUA, between January and April of 2023. Selection criteria included parents/guardians of healthy children aged between 2 and 12 years, who could read and understand the Greek language. Participants' children should have primary or mixed dentition and require or have received restorative dental treatment on their primary teeth. Protocol was approved by the Ethics Committee of the School of Dentistry, NKUA. The questionnaire was self-administered and consisted of 35 questions related to family demographics, oral hygiene, dietary habits, caries experience and dental treatment of children, and parental priorities and preferences for ‘traditional’ and SDF treatment of primary teeth using three clinical scenarios with colored clinical photographs. Prior to data collection, the questionnaire was piloted on a random sample of 20 parents/guardians. Data were analyzed using Chi-Square and Fisher's exact tests. Statistical significance was set at p≤0.05.
Results:
Of the 264 parents/guardians who responded to the questionnaire, 73% were female, 81% were married, and most of them and their partners were over 40 years old (62%). Regarding education, 6% of parents had primary education, 59% had secondary education and 35% had higher education. Half of the children were boys (50%) and their ages ranged from 3 to 12 years, with a mean age of 8.09 years (s.d. 0.14).
Most children (48%) brushed their teeth twice daily, 40% brushed once daily, and 12% brushed less often. Tooth brushing was supervised or supported by parents in 44% of children, especially at younger ages (p=0.02). Almost half of the parents (52%) didn't know the fluoride concentration of their children's toothpaste and the majority used only a manual toothbrush (65%). Thirty-eight percent of the parents reported that their children consumed sugary products on a daily basis, especially when parents had primaty educational level (p=0.01).
Parents rated their children's oral health as moderate in 48%, good in 36% and poor in 16%, while 82% believed that oral health affected general health and 72% assessed primary teeth as very important. The higher the education of the parents, the more important they thought primary teeth were (p=0.033).
According to the parents, 53% of children had caries, 56% had a toothache, 31% had taken pain medication or antibiotics for toothache, and 11% had missed school because of toothache. Answers distribution on the etiology of dental caries was: 6% poor tooth brushing, 21% frequent sweets, 13% dental development problems, 51% all the above and 9% don't know.
In terms of treatment, parents prioritize their child's cooperation (53%) and pain (32%). Length of appointment, time to exfoliation of the treated tooth, cost of treatment, and esthetics were influenced by parental demographic and socioeconomic characteristics. In this sample, 79% of parents reported that they would immediately accept the treatment recommended by their dentist, 6% would seek a second opinion, and 15% would discuss with him/her other alternatives.
In the case of the asymptomatic tooth case, 94% of parents would like to restore the tooth. Older parents refused treatment because it was a primary tooth compared to younger parents (p=0.05). In the case of the symptomatic tooth, acceptance of treatment increased to 98%. The preferred type of treatment was pulp therapy and SSC for 58% of the respondents and extraction and space maintenance for 42%. No statistical significance was found between the two options. In most cases (63%), the reason for their choice was the child's cooperation. Finally, 56% of the parents accepted SDF treatment, while 43% preferred resin composite restoration. Parents of boys were statistically more positive about SDF treatment than parents of girls (p=0.013). Respectively, higher parental education level was correlated with greater acceptance of SDF (p=0.057).
Conclusion:
Age, parental education level, and marital status are not correlated with children's oral hygiene habits, frequency, and reasons for visiting the dentist and decision to treat cavitated/non-cavitated primary teeth. The importance of primary teeth and the lower frequency of consumption of sugary foods was associated with a higher level of parental education. Acceptance of SDF treatment was higher among highly educated parents and parents of boys.
