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Caregivers’ Awareness of
Early Childhood Caries(ECC)
in
TwoHospitalsof Kabul City
A Cross-Sectional Qualitative Study
by
D...
Background:
• Active and uncontrolled dental caries
• ECC _ The most common/most prevalent oral disease
• Distribution and...
In the U.S :
• 17 million children
• 4 million children
• > 25% children aged 2-5 years
• 50% aged 12-15 years
• > 51 mill...
EarlyChildhoodCaries:
• Primary teeth
• < age 71 months
• Complex
• Very common
• Chronic
• Infectious
• Transmissible
• M...
Problem Statement
• Ongoing, alarming, widespread, highly prevalent and severe
PH problems throughout the world
• Limited ...
• From birth to 71 months of age children are more prone.
• OH of children is dependent on the awareness of caregivers
• ↓...
• In developing countries ECC affects 70% of preschool children
• In developed countries is 1-12%
• In most parts includin...
ConsequencesofECCspeciallywhenleftuntreatedare:
• Severe decay,
• early loss of the primary dentition
• affecting the grow...
Therareconsequencesof untreatedECC
• sub-orbital cellulitis
• brain abscesses
• unexplained recurrent fevers
• acute otiti...
Overall Objective
• To promote dental/oral health for preschool children, to
reduce risk factors for early childhood carie...
• Do caregivers have enough awareness regarding ECC?
• Do caregivers practice oral healthy habits?
• Does the awareness of...
The dependent/outcome variable is Early Childhood Caries.
Independent variables which are assessed by means of the
questio...
Definitions
Theoretical Definitions
ECC
Stage I Stage II Stage III Stage IV
Operational Definition
diagnosed through 4 sta...
EarlyChildhood Caries StageI to IV
10-20 months
• asymptomatic
• chalky
• opaque
• demineralized
lesions
• whitish lines
•...
• Discussed extensively and changed several times
• ECC is a new term, first recommended by NIDCR in 1999
• Definition by ...
Etiology of Early Childhood Caries
Primary Risk Factors Associated Risk Factors
Primary Risk Factors
Host/Tooth
Time
Bacte...
• The frequency , the
amount of and
cariogenicity of
consumed
carbohydrates
• Oral clearance
• Food detergency
• Amount, c...
1. Inappropriate Dietary and infant feeding practices
• Prolonged on-demand breast- feeding
• Bottle-feeding or improper u...
6. Mother’s DMFS scores
7. The extent of parental KAP
8. cariogenic bacteria transmission
9. Some diseases such as,
• Maln...
Most Relevant Studies
1. Mother's knowledge about the oral health of their pre-school children in Moradabad, India
2. Pare...
Methodology
•
Dr.WazhmaHakimiMD,MPH
Inclusion/ Exclusion Criteria
Inclusion criteria:
• Parents available at the time of the study
• Parents having children l...
Instruments:
• Pretested qualitative questionnaire
• clinical dental examination
• consent forms
• Registration forms
• Pi...
Quality Assurance Plan:
• Good instrument design
• pre-testing
• training and orientation of the second data collector
• p...
Results
• 196 caregivers
• 6 months of age<children>71 months of age
• response rate was 99%
0%
23%
10%
20%8%
2%
35%
2%
Fi...
Demographic Characteristics N (196) PERCENTAGE
Q 1. Caregivers’/parents’ sex
Male 44 22
Female 152 78
Q 2. Caregivers’/par...
79.6%
n=159
20.4%
n=40
Figure 3: Percentage of children less
than 71 months of age with ECC and
without ECC
With ECC
No EC...
Table2:DISTRIBUTIONOFCHILDRENBYSTAGESOF
EARLYCHILDHOODCARIES
Number of Children with different stages of ECC in relation t...
Figure5:Thetotalawarenessofallsubjectsonthe13
questions
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
1 2 3 4 5 6 7 8 9 10 11 12 ...
Table3:PERCENTAGEDISTRIBUTIONOFCAREGIVERS’
FORAWARENESS
Section II: Awareness of caregivers/parents regarding ECC: N(196) ...
Table 4: Percentage distribution of caregivers’ individual awareness: N(196) PERCENTAGE
Q 1. Wiping child’s teeth and gums...
Q 8. Who can transmit the bacteria to the child?
1. From mother to child
2. From one child to another
3. From one family m...
Discussion
• Assessed the awareness of ECC
• Provides impo evidences
• Noble Study
• Shows a low level of parents awarenes...
Item 1
• 53%: wiping, brushing and flossing child’s teeth prevent ECC
• 47%: did not know cleaning the infant’s teeth as s...
Item 2
• 18.4%: dental cavities in 3 year old to be filled
• Similar to:
• Suresh et al
• many mothers: cavities do not ma...
Item 3
• 47%: knew putting a child to bed with a bottle containing milk or
juice can cause cavities
• Not in line with:
• ...
Item 4
• Recommended age for weaning the child from feeding bottle = age
of twelve months
• 14.3%: stop using bottle by th...
Item 5
• 6%: cleaned and brushed as soon as they erupt (by six months of age)
• Correlates to the findings of studies:
• J...
Item 6
• Surprisingly, 85.7%: bacteria and germs
• almost equal to Voronina L.Mckinney.
Item 7
• 36.7%: caries producing b...
Item 8
• 67.3%: did not know that caries producing bacteria can be
transmitted in saliva from one person to the other
• 32...
Item 9• 55.10%: did not know that caries producing bacteria can be transmitted through
sharing utensils such as spoon and ...
Item 10
• 20.4%: knew that caregivers who have untreated dental
cavities pass caries producing bacteria to their children
...
Item 11
• 2%: within 6 months of eruption of the 1st primary tooth and no later
than 12 months of age due to
• the importa...
Item 11
• 26.5%: when they are around 7 years old.
• urged that:
• permanent teeth are erupted
• so keep them safe and hea...
Item 11
• These statistics indicates:
• caregivers do not know that the earlier a child visits the dentist, the greater
wo...
Item 12
• 65.3%: check their children’s teeth for the signs of ECC
• Other: had never checked their children’s teeth
• The...
Item 13
• 81.6%: No training, no counseling, dissatisfied
• In accordance to:
• In Pakistan by Iqbal et al
• 60%: no educa...
Item 13• Jain et al.,in Mumbai, mothers get OH information
• 45%, newspapers and TV
• 19.2%, dentists
• 12.8%, pediatricia...
The result of the table 2 shows that:
• Overtime, more children became affected by ECC
• It indicates that the prevalence ...
Conclusion
Purpose: to assess the awareness of ECC among caregivers who
were receiving services in two Kabul’s governmenta...
• Increase in the development and severity of ECC with age
suggests:
• that this sample of children is at high risk for fu...
Limitations
• Only in two governmental hospitals
• Private hospitals are not included in this study
1. Therefore, the pare...
Recommendations
Recommendations are given to:
• elevate awareness and knowledge of ECC
• to manage and prevent ECC
1. OH p...
6. Different methods
• to find the prevalence of ECC in Kabul city
• to examine the cause and effect relationship between ...
Prevention of Early Childhood Caries
The prevention of ECC has three main aims:
• Early identification of those who are at...
Any Question?
Dr.WazhmaHakimiMD,MPH
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Caregivers’ Awareness of Early Childhood Caries

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This is the first and noble study on Early Childhood Caries conducted in 2015 - 2016 by Dr. Wazhma Hakimi. MD/MPH in Kabul, Afghanistan with surprising findings and results.

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Caregivers’ Awareness of Early Childhood Caries

  1. 1. Caregivers’ Awareness of Early Childhood Caries(ECC) in TwoHospitalsof Kabul City A Cross-Sectional Qualitative Study by Dr. Wazhma Hakimi Dr.WazhmaHakimiMD,MPH
  2. 2. Background: • Active and uncontrolled dental caries • ECC _ The most common/most prevalent oral disease • Distribution and severity varies • Asian country • African country • Most industrialized country • 60-90% of school children • Nearly 100% of adults • 30% people aged 65-74 • 4th most expensive disease • Poor and disadvantaged population Dr.WazhmaHakimiMD,MPH
  3. 3. In the U.S : • 17 million children • 4 million children • > 25% children aged 2-5 years • 50% aged 12-15 years • > 51 million school hours/yr • 164 million work hours/yr • Only 1.5% of 1 year olds • Nearly 43% In Canada: • 57% aged 6-11 years and 59% adolescents • 2.26 million school days • 4.15 million work days • About 19.000 < 6 years Dr.WazhmaHakimiMD,MPH
  4. 4. EarlyChildhoodCaries: • Primary teeth • < age 71 months • Complex • Very common • Chronic • Infectious • Transmissible • Multifactorial • Diet-dependent • Severe • Rampant • Begins immediately after tooth eruption • Progress • Deterioration Dr.WazhmaHakimiMD,MPH
  5. 5. Problem Statement • Ongoing, alarming, widespread, highly prevalent and severe PH problems throughout the world • Limited access to OH care in developing countries → ↑, untreated/extracted • → short term and long term serious consequences • In Afghanistan no study is conducted on ECC • OH of preschool children has not been documented to the same extent as school children because: • Primary teeth are not considered to be as important as permanent teeth • Children going to school are easier to identify and include in OH surveys Dr.WazhmaHakimiMD,MPH
  6. 6. • From birth to 71 months of age children are more prone. • OH of children is dependent on the awareness of caregivers • ↓ awareness → big proportion of children getting ECC • Awareness is important in preventing ECC but counseling is given a low priority. • To support the planning, implementation and evaluation of early prevention of ECC • This study is valuable because: • It explores parents’ awareness and its effect • can be used for timely introduction of effective OH programs • can be used in the future as a reference for other studies Problem Statement Dr.WazhmaHakimiMD,MPH
  7. 7. • In developing countries ECC affects 70% of preschool children • In developed countries is 1-12% • In most parts including Afghanistan remains untreated and is neglected • Little knowledge, therefore this study will provide informative evidences • The result of the study will help • developing and revising effective programs and strategies on elevating parent’s awareness, education and advocacy to prevent ECC, to reduce its risk factors and to promote oral health for preschool children. • Consequences Study Rationale Dr.WazhmaHakimiMD,MPH
  8. 8. ConsequencesofECCspeciallywhenleftuntreatedare: • Severe decay, • early loss of the primary dentition • affecting the growth and maturation of the secondary dentition • new lesions • acute and chronic odontogenic pain • systemic infection, abscesses, cellulitis • tooth loss and malocclusion • Malnutrition • gastrointestinal disorders • more widespread health issues including hospitalizations and emergency treatments and room visits • interference with the child’s speech and communication, chewing, eating(poor appetite), sleeping, behavior, proper growth and development • loss of school dayswith restricted activity • diminished ability to learn and concentrate • diminished OHRQoL • low self-esteem • Increased expenses • compromise of general health • impact on children’s and their families’ productivity and QoL • threat to child welfare and even death due to sepsis and anesthesia Dr.WazhmaHakimiMD,MPH
  9. 9. Therareconsequencesof untreatedECC • sub-orbital cellulitis • brain abscesses • unexplained recurrent fevers • acute otitis media • exacerbates the conditions of children with SHCN such as seizure disorders or severe emotional disturbances • complicates the organ and bone marrow transplants • infection of a defective heart valve These unfortunate situations need increased attention in Afghanistan. Dr.WazhmaHakimiMD,MPH
  10. 10. Overall Objective • To promote dental/oral health for preschool children, to reduce risk factors for early childhood caries and to prevent early childhood caries. Specific Objective/s • To explore and assess the awareness of ECC among caregivers who are receiving services through Indira Gandhi Child hospital (IGCH) and Stomatology Curative hospital. • To identify the role of caregiver’s awareness of ECC in the development of ECC. • To observe the oral health status of children who are less than 71 months of age in the above two hospitals. Objectives Dr.WazhmaHakimiMD,MPH
  11. 11. • Do caregivers have enough awareness regarding ECC? • Do caregivers practice oral healthy habits? • Does the awareness of parents/caregivers influence the development of ECC? • Is the low awareness of caregiver’s a risk factor for ECC? • What type of ECC is more prevalent among babies and preschool children? • Do caregivers have important role in prevention of ECC? • Does the age of children related to ECC development & severity? Research Questions Dr.WazhmaHakimiMD,MPH
  12. 12. The dependent/outcome variable is Early Childhood Caries. Independent variables which are assessed by means of the questionnaire are: • Caregivers’/parents’ education level and gender • Child’s age • parental awareness of : • Oral health practices(bottle feeding ) • Importance of deciduous teeth(check up and first dental visit, filling the cavities) • Oral hygiene habits (teeth cleaning, tooth brushing, using toothpaste, flossing) • Transmissibility of caries • Oral/Dental health training attendance Research Variables Dr.WazhmaHakimiMD,MPH
  13. 13. Definitions Theoretical Definitions ECC Stage I Stage II Stage III Stage IV Operational Definition diagnosed through 4 stages Awareness PCG Dr.WazhmaHakimiMD,MPH
  14. 14. EarlyChildhood Caries StageI to IV 10-20 months • asymptomatic • chalky • opaque • demineralized lesions • whitish lines • reversible but not recognizable • air spray or cotton 16-24 months • develop rapidly • destructed enamel • Cavities/holes • Affected/exposed dentine • appears soft and yellow • symptomatic • great sensitivity to cold • Recognizable • maxillary primary molars are in stage I 20-36 months • large and deep lesions • Affected pulp with irritation and spontaneous pain during the night • pain during chewing and brushing • ↑primary molars in stage II • ↓primary molars and ↑ canines are in stage I 30-48 months • Fractured crowns • Necrotized maxillary incisors • unable to sleep and eat and complain • ↑ primary molars are at stage III • secondary molars and ↑ canines and the first ↓ molars are at stage II Dr.WazhmaHakimiMD,MPH
  15. 15. • Discussed extensively and changed several times • ECC is a new term, first recommended by NIDCR in 1999 • Definition by AAPD, ADA , CDA, NIDCR and NIH • Old names such as: • baby bottle-fed tooth decay (BBTD) • Baby bottle caries • Bottle rot • Bottle mouth caries • Bottle caries • nursing caries/nursing caries lesions • night bottle mouth • Nursing bottle caries, nursing/baby bottle syndrome • nursing bottle mouth • milk bottle syndrome • breast milk tooth decay • maxillary anterior caries lesions • facio-lingual pattern of decay • rampant caries lesions • labial caries lesions • maxillary anterior caries lesions • comforter caries • early childhood tooth/dental decay (ECTD) • and most recently, ECC lesions Literature Review Definitions Dr.WazhmaHakimiMD,MPH
  16. 16. Etiology of Early Childhood Caries Primary Risk Factors Associated Risk Factors Primary Risk Factors Host/Tooth Time Bacteria Diet Caries Dr.WazhmaHakimiMD,MPH
  17. 17. • The frequency , the amount of and cariogenicity of consumed carbohydrates • Oral clearance • Food detergency • Amount, composition and frequency of diet • Bacterial load • Dental Plaque • Plaque composition • Plaque acidogenicity • Plaque acidoduricity • The time of acquisition of bacteria especially MS • Enamel resistance • morphology and genetic • Root surface exposure • Saliva • Immunological factors • Enamel defects • length of time of exposure of the teeth to sugar Time Host Dietary Substrate Cariogenic microorganisms Caries Dr.WazhmaHakimiMD,MPH
  18. 18. 1. Inappropriate Dietary and infant feeding practices • Prolonged on-demand breast- feeding • Bottle-feeding or improper use of nursing bottle • infant formula • sweetened pacifier • Fruit juices and carbonated/sweetened beverages • Poor diet of child and mother, low Mg & Vit D • Diet high in sugar 2. Previous Caries Experience 3. Demographic risk factors • Age • Child’s and Parental Gender • SES/Socioeconomic Status 4. Low parental education 5. Mother’s dental awareness and the general care of her child/Maternal general health Associatedriskfactors Dr.WazhmaHakimiMD,MPH
  19. 19. 6. Mother’s DMFS scores 7. The extent of parental KAP 8. cariogenic bacteria transmission 9. Some diseases such as, • Malnutrition • Asthma • recurrent infections • other chronic diseases • medically compromised children such as CHD 10. Premature babies, low birth-weight and malnourished infants 11. Medications especially long term medications that cause decrease in the oral salivary flow and use of flavored and sweetened Pediatric syrups 12. Insufficient fluoride intake 13. Oral hygiene of the child and mother/ Behavioral risk factors 14. Early-in-life or infant colonization by S. mutans • vertical transmission • horizontal transmission 15. Psychosocial factors 16. Nutritional transition in developing countries Dr.WazhmaHakimiMD,MPH
  20. 20. Most Relevant Studies 1. Mother's knowledge about the oral health of their pre-school children in Moradabad, India 2. Parental attitudes and tooth brushing in preschool children 3. KAP study on infant oral health in Udaipur, India 4. A KAP study among Children Aged 11-12 Years in an Urban School of Karachi 5. Dental plaque, preventive care, and tooth brushing associated with dental caries in primary teeth in schoolchildren ages 6–9 years of Leon, Nicaragua 6. THE RELATIONSHIP BETWEEN EARLY CHILDHOOD CARIES AND CAREGIVERS’ OH KNOWLEDGE AND BEHAVIOR AMONG MEDICAID-ELIGIBLE CHILDREN IN NORTH CAROLINA • No data or study available on ECC in pre-school children in Afghanistan • Limited number of studies have been conducted worldwide Dr.WazhmaHakimiMD,MPH
  21. 21. Methodology • Dr.WazhmaHakimiMD,MPH
  22. 22. Inclusion/ Exclusion Criteria Inclusion criteria: • Parents available at the time of the study • Parents having children less than 71 months of age • Parents who were willing to participate • who signed the informed consent • Children younger than 71 months of age and older than six months Exclusion criteria: • Children < six months of age, who are “not applicable (no teeth yet)” • Those who did not give consent • Subjects with any missing responses to one or more items • Subjects who refused to answer, or left the interview Dr.WazhmaHakimiMD,MPH
  23. 23. Instruments: • Pretested qualitative questionnaire • clinical dental examination • consent forms • Registration forms • Pilot Testing Data Management and Analysis plan: • Translation of questionnaires into local language: • Coding the questionnaire • Questionnaire pilot-test • Constructing the data entry Form • Finalizing the questionnaire • data collection • data entry • Developing the analysis plan(%) Ethical Consideration Dr.WazhmaHakimiMD,MPH
  24. 24. Quality Assurance Plan: • Good instrument design • pre-testing • training and orientation of the second data collector • pilot testing • Supervision • constructing and testing data entry form • double data entry The pre-test is conducted: • proper interpretation • comprehension difficulties • need to clarify some questions and answers • to check that the answers truly match the local conditions • and to identify the reactions of the respondents and potential problem questions • to check that the length of time • To be able to change certain question phrasing or even remove questions Dr.WazhmaHakimiMD,MPH
  25. 25. Results • 196 caregivers • 6 months of age<children>71 months of age • response rate was 99% 0% 23% 10% 20%8% 2% 35% 2% Figure 2: Percentage of Caregivers according to educational level Primary Secondary High school Higher education Religious school No educated Other Dr.WazhmaHakimiMD,MPH
  26. 26. Demographic Characteristics N (196) PERCENTAGE Q 1. Caregivers’/parents’ sex Male 44 22 Female 152 78 Q 2. Caregivers’/parents’ education Primary 44 22.4 Secondary 20 10.2 High school 40 20.4 Higher education 16 8.2 Religious school 4 2 No educated 68 34.7 Other 4 2 22% 78% Figure 1: Percentage of caregivers according to the sex Dr.WazhmaHakimiMD,MPH
  27. 27. 79.6% n=159 20.4% n=40 Figure 3: Percentage of children less than 71 months of age with ECC and without ECC With ECC No ECC Dr.WazhmaHakimiMD,MPH
  28. 28. Table2:DISTRIBUTIONOFCHILDRENBYSTAGESOF EARLYCHILDHOODCARIES Number of Children with different stages of ECC in relation to the age Variable N With Caries Stage I Stage II Stage III Stage IV N % N % N % N % N % 1. Child's age < 24 months 40 12 6.10% 12 6.10% 0 0% 0 0% 0 0% 24-36 months 24 20 10.2% 0 0.00% 0 0% 12 6.1% 8 4.1% 36-71 months 132 124 63.30% 0 0% 0 0% 28 14.30% 96 49% Dr.WazhmaHakimiMD,MPH
  29. 29. Figure5:Thetotalawarenessofallsubjectsonthe13 questions 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 1 2 3 4 5 6 7 8 9 10 11 12 13 Percentage Questions Figure 5: Percentage of Correct Responses Dr.WazhmaHakimiMD,MPH
  30. 30. Table3:PERCENTAGEDISTRIBUTIONOFCAREGIVERS’ FORAWARENESS Section II: Awareness of caregivers/parents regarding ECC: N(196) PERCENTAGE Q 1. Wiping child’s teeth and gums or brushing and flossing child’s teeth regularly can prevent dental caries. 104 53% Q 2. Cavities in three year olds’ teeth need to be filled. 36 18.40% Q 3. Putting a child to bed with a bottle containing milk or juice can cause cavities in the teeth. 92 47% Q 4. Children should stop using a bottle by their first birthday. 28 14.30% Q 5. At what age child’s teeth should be brushed regularly? 12 6% Q 6. Bacteria and germs on the teeth help to produce cavities. 168 85.70% Q 7. Do you know that caries producing bacteria can be transmitted in saliva? 72 36.70% Q 8. Who can transmit the bacteria to the child? 64 32.65% Q 9. Bacteria can be transmitted from caregiver to child in saliva through: 88 45% Q 10. Caregivers who have untreated cavities are more likely to pass bacteria to their children through their saliva. 40 20.40% Q 11. At what age should children start going to the dentist? 4 2% Q 12. Have you ever checked your child’s teeth for signs of Early Childhood Caries? 128 65.30% Q 13. Have you ever received any training regarding your and your children’s oral health? 36 18.40% Dr.WazhmaHakimiMD,MPH
  31. 31. Table 4: Percentage distribution of caregivers’ individual awareness: N(196) PERCENTAGE Q 1. Wiping child’s teeth and gums or brushing and flossing child’s teeth regularly can prevent dental caries. 1. Know 2. Do not know 3. Not sure 104 12 80 53% 6% 41% Q 2. Cavities in three year olds’ teeth need to be filled. 1. Know 2. Do not know 3. Not sure 36 140 20 18.4% 71.4% 10.2% Q 3. Putting a child to bed with a bottle containing milk or juice can cause cavities in the teeth. 1. Know 2. Do not know 3. Not sure 92 60 44 47% 30.6% 22.4% Q 4. Children should stop using a bottle by their first birthday. 1. Know 2. Do not know (16.3%=2yrs, 10.2%=2 and half, 2%=3yrs) 3. Not sure 28 136 32 14.3% 69.3% 16.3% Q 5. At what age child’s teeth should be brushed regularly? 1. As soon as the child has teeth/six months of age 2. at age 2-5 years 3. at age 6-8 years 4. at age eight 5. > eight 12 88 60 28 8 6% 44.89% 30.6% 14.28% 4.08% Q 6. Bacteria and germs on the teeth help to produce cavities. 1. Know 2. Do not know 3. Not sure 168 24 4 85.70% 12.2% 2% Q 7. Do you know that caries producing bacteria can be transmitted in saliva? 1. Yes 2. No 72 124 36.7% 63.3%
  32. 32. Q 8. Who can transmit the bacteria to the child? 1. From mother to child 2. From one child to another 3. From one family member to others 4. All of the above 5. None of the above 32 8 20 64 72 16.3% 4% 10.2% 32.65% 36.7% Q 9. Bacteria can be transmitted from caregiver to child in saliva through: 1. sharing eating utensils such as spoon or glass 2. sharing food 3. pre-chewing food for the baby 4. cleaning off a baby bottle nipple or a pacifier with their mouth 5. sharing your toothbrush with your child 6. All of the above 7. None of the above 4 0 8 8 12 88 76 2% 0% 4% 4% 6% 45% 39% Q 10. Caregivers who have untreated cavities are more likely to pass bacteria to their children through their saliva. 1. Know 2. Do not know 3. Not sure 40 128 28 20.4% 65.3% 14.3% Q 11. At what age should children start going to the dentist? 1. Between the ages of 0-1 years 2. Between the ages of 1-3 years 3. Between the ages of 4-5 years 4. Between the ages of 6-8 years 5. Older than 8 years 47% (n=92)=pain 4 0 28 52 20 2% 0% 14.3% 26.5% 10.2% Q 12. Have you ever checked your child’s teeth for signs of Early Childhood Caries? 1. Yes 2. No 128 68 65.3% 34.7% Q 13. Have you ever received any training regarding your and your children’s oral health? 1. Yes 36 18.4%
  33. 33. Discussion • Assessed the awareness of ECC • Provides impo evidences • Noble Study • Shows a low level of parents awareness on all but 3 of the 13 awareness items • lower education • lower knowledge • no accessibility to trainings and educational programs • Similar results of poor knowledge of IOH care in studies by: • Ramesh Nagarajappa et al., in Udaipur India • Jain et al., in Mumbai • Werneck et al in Toranto • Dogra S et al in Udaipur • Opposite findings in study done by: • Voronina L.Mckinney in North Carolina Dr.WazhmaHakimiMD,MPH
  34. 34. Item 1 • 53%: wiping, brushing and flossing child’s teeth prevent ECC • 47%: did not know cleaning the infant’s teeth as soon as they erupt with a washcloth or soft toothbrush helps to reduce bacterial colonization • in line with Suresh et al., and Publishery et al., • unsatisfactory knowledge about OH practices • In contrast with • Voronina L.Mckinney: • 93%: wiped or brushed their child’s teeth. • Jain et al and Dogra et al: • respectively 76.5% and 76% of the mothers knew that cleaning child’s teeth after every meal is necessary even before teeth have erupted Dr.WazhmaHakimiMD,MPH
  35. 35. Item 2 • 18.4%: dental cavities in 3 year old to be filled • Similar to: • Suresh et al • many mothers: cavities do not matter. • Vakani F et al in Karachi Pakistan • a huge gap left in oral diseases treatment • 90% of the dental cavities never get treated • < Voronina L.Mckinney • 50%: dental cavities in 3 year old to be filled • Study conducted among Muslim parents in Udaipur of Rajasthan • 39%: ignored treating • 17%: extraction Dr.WazhmaHakimiMD,MPH
  36. 36. Item 3 • 47%: knew putting a child to bed with a bottle containing milk or juice can cause cavities • Not in line with: • Voronina L.Mckinney • 79% and 85% respectively _ milk & juice. • Dogra S et al • 65%: knew that sweetened liquid/juice in bottle at night is harmful. • 30.6% and 22.4%: did not know or were not sure that putting a child to bed with a bottle containing milk or juice can cause cavities • CGs reported putting child to bed with nursing bottle • contrary to the MCHN recommendation • Ramesh Negarajappa in Udaipur, India • 45.1%: did not know that bottle feeding can cause ECC. . Dr.WazhmaHakimiMD,MPH
  37. 37. Item 4 • Recommended age for weaning the child from feeding bottle = age of twelve months • 14.3%: stop using bottle by their 1st birthday or by completing 1 year of age. • 2%: feed from bottle till age of three • 10.2%: by two and half (30 months ) • 16.3%: by two years • Two and half year of age_ Islam _ breast feeding Vs. bottle feeding • Not in line with: • < Voronina L.Mckinney and Dogra S et al • 75% and 62% respectively: by 1st birthday (12 months of age) Dr.WazhmaHakimiMD,MPH
  38. 38. Item 5 • 6%: cleaned and brushed as soon as they erupt (by six months of age) • Correlates to the findings of studies: • Jain et al., • 21.1% mothers, soon after first milk tooth eruption • Arora R., • 19% parents, soon after first milk tooth eruption • Publishery et al., in Mangalore • Introduced to tooth brushing at mean age of 16 months • < 10 months of age tooth brushing was not started at all • 30.6%: cleaned and brushed when all their primary teeth are erupted. • Correlates with the findings of: • Suresh et al: most of the parents , should not be cleaned before the deciduous teeth erupts • Ramesh Nagarajappa: most of the parents, should not be cleaned before the deciduous teeth erupts • Contrary to • Study in rural Australia • 95%: start brushing child’s teeth when the first tooth erupts Dr.WazhmaHakimiMD,MPH
  39. 39. Item 6 • Surprisingly, 85.7%: bacteria and germs • almost equal to Voronina L.Mckinney. Item 7 • 36.7%: caries producing bacteria can be transmitted in saliva. • 63.3%: sure that it is impossible, had doubt • lack of awareness • information is not disseminated • comprehending. • Same results in the study: • conducted among Muslim parents in Udaipur, India by Arora R • 64% males and 92% females did not know about the transmissibility of caries. Dr.WazhmaHakimiMD,MPH
  40. 40. Item 8 • 67.3%: did not know that caries producing bacteria can be transmitted in saliva from one person to the other • 32.6%: correctly answered • In accordance to: • the study conducted among Muslim parents in Udaipur India by Arora R • largely unaware • only 17% aware • 16.3%: can be transmitted only from mothers to the child • but no enough awareness on how this bacteria is transmitted Dr.WazhmaHakimiMD,MPH
  41. 41. Item 9• 55.10%: did not know that caries producing bacteria can be transmitted through sharing utensils such as spoon and glass, sharing food, giving pre-chewing food to the child, cleaning the nipple of the feeding bottle with mouth and sharing tooth brushes. • 45%: through all of the above means • 2%: by sharing feeding utensils • In accordance with the study: • Ramesh Nagarajappa et al • half of the parents disagreed sharing feeding utensils • 4%: chewed food to their children may cause ECC because implantation of MS occurs • In line with: • Ramesh Nagarajappa et al • 30% of the parents did not knew that bitten food may cause ECC. • Suresh et al reported: • majority of the mothers had lower knowledge regarding the transmission of caries producing bacteria by sharing of utensils, especially feeding spoon. • Oppositely, Dogra S et al.,reported: • 68% of the mothers knew that some feeding practices such as pre-chewing children’s food help in transmitting caries producing bacteria. Dr.WazhmaHakimiMD,MPH
  42. 42. Item 10 • 20.4%: knew that caregivers who have untreated dental cavities pass caries producing bacteria to their children • Nearly similar to Voronina L.Mckinney in North Carolina • 19% of the caregivers knew Item 11 • 47%: taken to the dentist when they have pain • unaware _ even if they do not have any complaint • when they have toothache • In line to the findings: • Jain et al., • 54.7%_only during problems. • 14.3%: between 4-5 years • The rationale: more manageable, differs their right and left hand. • in accordance to: • Ramesh Nagarajappa., • 33.6% of the parents disagreed of visiting a dentist before the child is two years old. Dr.WazhmaHakimiMD,MPH
  43. 43. Item 11 • 2%: within 6 months of eruption of the 1st primary tooth and no later than 12 months of age due to • the importance of early interventions as recommended by AAPD • to ensure a successful outcome • oral care advice for preventing ECC • Same to our results: • in Mumbai, India by Jain et al., • 57.6%: not taken their children to the dentist yet • 16.8%: child’s first dental visit was 6 months after birth. • in Udaipur, India by Arora R • 64% male and 68% female parents were unaware of dental visit within six months of eruption of the first primary tooth • Another study conducted among 6th grade students of two local schools in Mardan Pakistan • 75% of them never visited a dentist • 18% of them did not consider it important • 12% answered that they did not go to the dentist because they self-medicate • In contrast, • Dogra S et al., in Udaipur • 62% of the mothers agreed that it was essential to visit the dentist before one year of age. Dr.WazhmaHakimiMD,MPH
  44. 44. Item 11 • 26.5%: when they are around 7 years old. • urged that: • permanent teeth are erupted • so keep them safe and healthy • primary teeth are not important and not require good care because they will fall off. • 10.2%: when they are older than eight years old • According to Bhavneet Kaur • same common misconception in India that primary teeth will exfoliate • lack of dental awareness regarding the importance of milk teeth • Lack of dental visits in Indian society • In contrast, • 85% in Udaipur city of Rajasthan India agreed that primary teeth need dental care like permanent teeth • 15% of the parents believed that milk teeth do not hold any importance because they will fall anyway. Dr.WazhmaHakimiMD,MPH
  45. 45. Item 11 • These statistics indicates: • caregivers do not know that the earlier a child visits the dentist, the greater would be his likelihood of being caries free, • low awareness on the importance of deciduous teeth • In accordance with: • Jain et al • Iqbal et al., • OH is given less importance in Pakistan • Adversely, • Voronina L.Mckinney • 76%: knew that children should start going to the dentists between 1-3 years. • 1%: children start going to the dentist between the ages of 6-8 years, • <1% older than eight years • The barriers for later child visit to the dentist can be: • high costs or economic problems • lack of motivation • less accessibility • fear of children • carelessness and unsuitable behavior of dentists. • parents do not perceive that dental problem might exist in their children. • Cultural and economic factors • These barriers need to be explored and evaluated by further studies. Dr.WazhmaHakimiMD,MPH
  46. 46. Item 12 • 65.3%: check their children’s teeth for the signs of ECC • Other: had never checked their children’s teeth • Their reason: • do not have time • do not think that milk teeth are important. • Similar Results: • Jain et al.,in Mumbai, India • 43.6%: do not require good care as they fall off any way. • Conversely, • Jain et al., • most mothers checked their child’s teeth, because they had reported the number of decayed teeth and the alignment of teeth in their children’s mouth. • 20.1% and 28.9% of the mothers were not aware about the number of decayed teeth and teeth alignment, respectively. It means that they had not checked their baby’s mouth. Dr.WazhmaHakimiMD,MPH
  47. 47. Item 13 • 81.6%: No training, no counseling, dissatisfied • In accordance to: • In Pakistan by Iqbal et al • 60%: no education on OH • Source of information of 6th grade regarding OH practices • 3%: dentists • 58%: parents • In Udaipur India by Arora R, • 81%: no education on dental health • In contrast, • Suresh et al., and Jain et al • 34.2% of the Saudi population got the OH information from dentist followed by media. Dr.WazhmaHakimiMD,MPH
  48. 48. Item 13• Jain et al.,in Mumbai, mothers get OH information • 45%, newspapers and TV • 19.2%, dentists • 12.8%, pediatricians • 20.1%, all four sources • While in Afghanistan • no pediatricians • in the present study very few subjects got the information from the dentist. • This is due to: • low utilization of dental services • inefficiency of the dentist in educating patients and public • Training and counseling on OH especially ECC is given a low priority in pediatrics and professional training of physicians and nurses • skill building and counseling are the most effective interventions for increasing awareness and behavior change. • Werneck et al: • parents who had received information regarding preventive dental care through attending trainings or from family physician were less likely to have a child with ECC. • RCT study in UK showed: • visits to a dentist increased the knowledge of parents and improved the attitude toward dental health of their off springs. • This indicates the urgent need to motivate dentist and other health professionals to incorporate OH education in order to prevent ECC in their clinics. Dr.WazhmaHakimiMD,MPH
  49. 49. The result of the table 2 shows that: • Overtime, more children became affected by ECC • It indicates that the prevalence of dental caries increases as the child ages. • child’s age is related to ECC • has a significant effect because as the age ↑ its severity also ↑ • Similar results: • Al-Jewair et al., • Del et al., • Voronina L.Mckinney., • Awooda et al, in Khartoum Sudan the % of children affected by ECC : • 3, 4 and 5 years was 10%, 33.5% and 56.6% • This is because that, • once dental cavities have occurred they are irreversible • new lesions develop with increasing age • In Kabul, dental cavities are not treated in these ages, because • parents do not think that primary teeth are important • dentists neglect to fill and provide proper care for them. Dr.WazhmaHakimiMD,MPH
  50. 50. Conclusion Purpose: to assess the awareness of ECC among caregivers who were receiving services in two Kabul’s governmental hospitals It is Concluded: • ↓ level of awareness regarding ECC in Afghan families • ↓ level of importance on primary teeth • indicates that caregiver’s knowledge on ECC will be inadequate • Most of the children in Afghanistan suffer from: • ECC and the effects of neglected dental treatment • Awareness of OH practices, oral hygiene habits and transmissibility of caries producing bacteria was not good. • Mostly-brush-when their permanent teeth erupt • Mostly-take to dentist-pain at a later age. • No attendance in OH educating trainings • Very low rate of receiving counseling from dentists. Dr.WazhmaHakimiMD,MPH
  51. 51. • Increase in the development and severity of ECC with age suggests: • that this sample of children is at high risk for future dental caries in primary and permanent teeth, • so they should be targeted of preventive efforts. • The results of this study indicate the need for future effective OH education programs which should focus on the awareness of ECC. • Also the reasons for low awareness of ECC should be clearly defined, e.g., • why children are not taken to the dentist earlier • why dentists neglect provision of necessary treatment and counseling to patients • Fortunately, ECC is preventable and manageable with: • implementing effective programs and strategies to increase the awareness and prevent ECC Dr.WazhmaHakimiMD,MPH
  52. 52. Limitations • Only in two governmental hospitals • Private hospitals are not included in this study 1. Therefore, the parents with higher education who usually belong to middle and high level income families may be excluded • the sample size was small • included only those caregivers and their children who were receiving services in two governmental hospitals. 2. The results of this study cannot be generalized because: • cross-sectional design 3. so does not demonstrate the cause-effect relationship between ECC and KAP of caregivers Dr.WazhmaHakimiMD,MPH
  53. 53. Recommendations Recommendations are given to: • elevate awareness and knowledge of ECC • to manage and prevent ECC 1. OH programs targeted • treatment and prevention of ECC • high priority should be given to include expectant and new mothers 2. After and during programs, • studies on the effectiveness of such programs 3. On larger samples and various populations • to provide evidences for OH policies, strategies and programs to prevent ECC. 4. Anticipatory guidelines • for parents, schools and community • for prevention of ECC and increasing awareness. 5. Similar in private hospitals • to identify the awareness • to compare the awareness and knowledge of parents between private and governmental hospitals • between low, middle, and high income families Dr.WazhmaHakimiMD,MPH
  54. 54. 6. Different methods • to find the prevalence of ECC in Kabul city • to examine the cause and effect relationship between ECC and its risk factors. 7. The barriers for later child visit need to be explored and evaluated by further studies. 8. The government of Afghanistan should offer all children free dental care and dental health services, including preventive care. 9. Food and drug legislators should declare the source of fermentable sugars in products such as syrups, lozenges and teething jellies, so that parents and other consumers may be made aware of their caries promoting potential. 10. Preventive OH care should be started in infancy because at this age: • Many risk factors for ECC can be identified such as • improper feeding practices and poor oral hygiene • can be halted by appropriate interventions. Parents can be educated to maintain good oral health. • Impact of ECC can be decreased or avoided such as dental pain, poor nutrition, future caries and unaesthetic appearance. Dr.WazhmaHakimiMD,MPH
  55. 55. Prevention of Early Childhood Caries The prevention of ECC has three main aims: • Early identification of those who are at risk of ECC • Preventing the progression of ECC • Preventing the recurrence of dental caries in children who have been diagnosed with ECC. • multi-factorial approach due to its various etiological factors • organized and planned through different ways and strategies. Three approaches are recommended to prevent ECC: • Community- based approaches • Professional- based approaches • Home-based approaches All these three approaches include training/educating the caregivers Dr.WazhmaHakimiMD,MPH
  56. 56. Any Question? Dr.WazhmaHakimiMD,MPH

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