ORAL HEALTH AND THE LEVEL OF KNOWLEDGE AND ATTITUDES OF THE CHILDREN, MOTHERS AND EDUCATORS IN IASI, ROMANIA

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1 Prophylaxis ORAL HEALTH AND THE LEVEL OF KNOWLEDGE AND ATTITUDES OF A. Corneag\ 1, I. D\nil\ 2, Dana Cristiana Maxim 3, Carina Balco[ 4 1. Ph student Gr.T.Popa University of Medicine and Pharmacy of Ia[i, Faculty of Medical Dentistry Dept. Oro-Dental Prevention 2. Associate professor Gr.T.Popa University of Medicine and Pharmacy of Ia[i, Faculty of Medical Dentistry Dept. Oro-Dental Prevention 3. University professor, Dept. Pedodonty and Orthodonty and Dental-Facial Orhtopedy 4. University assistant Gr.T.Popa University of Medicine and Pharmacy of Ia[i, Faculty of Medical Dentistry Dept. Oro-Dental Prevention Corresponding author: Andrei Corneag\, and_c@ymail.com Abstract The aim of the study: Evaluation of oral health condition in 6 and 12 year-old children of Ia[i, analysis of the health-promoting habits of children and mothers; demonstrating the relation between the al level of the mother and children s health-promoting habits, as well as their influence upon their own health condition; the differences between educators and mothers on their oral health knowledge. Materials and method: The study, performed in 5 schools of Ia[i, between , included 345 children (6-7 yeas, class I) and 297 children (11-12 years, class VI), being devoted to the establishment of their odontal status, evaluated by the DMFT index, of the oral health level, evaluated with the OHI-S index and of periodontal health, appreciated with the (CPITN) index, through a clinical examination performed each year in school medicine consulting rooms, the data collected being included in the WHO files, according to some previously established criteria. Information has been collected from 5 mothers and 125 schoolmasters, by the questionnaire method, the statistical data obtained being analyzed with the SPSS 14.0 program. Results: The results obtained indicate an increased prevalence of the dental caries, of 86 for 6-7 year-old children, and of 76, respectively, for the year-old ones, nevertheless lower than the values registered in previous years. The DMFT value in 6-7 year-old children was 2.9, the DMFT value at ages of years being of of the mothers indicated that the bacteria+sugar association represents the main cause of dental caries, 35 incriminated the bacteria, while 27 associate the formation of caries with the consumption of sugar. The causes of gingival bleeding were: incorrect dental brush (49), bacterial plaque (44), unhealthy diet (35), general diseases (30), heredity (9), while 9 of the mothers did not know the possible causes of gingival bleeding. It was only 1.5 of the mothers that were convinced that the oral health of their child was very good, 17 good, 47 satisfactory, 19 affected; 4 of the mothers refused to answer of the 6 year-old children and 67.8 of their mothers asserted that they practice dental brush at least twice a day..1 of the 6 year-old children and 88.7 of their mothers have had a stomatological control in the last 12 months. Educated mothers tend to have more knowledge on dental health as well as regular health-promoting attitudes, participating actively, together with their children, to the realization of dental brush. Conclusions: The family is responsible for the child s health-promoting life style, as it constitutes the first source of information on oral health. The results of the present study show that the health-promoting habits of the adults, as well as the level of their knowledge, represent important factors in the health promotion of their children. Keywords: oral health, health-promoting knowledge, pupils Over the last decade, a reduced prevalence of oral diseases has been registered in the school population from the East European countries, especially in Romania (1-4). Such a tendency is explained by the considerable progress of preventive stomatology (such as, sensible understanding of sugar consumption, improved practices of oral hygiene, utilization of fluorinecontaining tooth pastes and fluoride mouthwash solutions or topical fluoride application), along with the development of communitary programs for the prevention of such problems (5, 6). The data provided by extended polls devoted to oral health, performed both in România and in the neighbouring countries, have demonstrated that approximately 100 of the adults and 90 of the children had and still have carious and periodontal lesions. At present, the main steps taken are oriented towards finding of some efficient modalities for combating such pathologies, and of the economic support necessary for reaching the objectives had in view. In România, up to now, several programs for improving oral health have been implemented, most of them being intrerrupted by the lack of funds necessary for their devleopment at national level (7, 8). Nowadays, developed in the kindergartens and schools of Iasi are only programs of sanitary International Journal of Medical Dentistry 341

2 A. Corneag\, I. D\nil\, Dana Cristiana Maxim, Carina Balco[ supported by private companies producing oral hygiene products, along with meetings with parents and educators, the main factors responsible for the health-promoting behaviour of the child. The objectives of the present study were to collect data on the oral health condition of children with ages between 6 and 12 years of Iasi; to analyze the health-promoting habits of both children and mothers, on evidencing the relation between mother s al level and the health-promoting habits of her children, and the influence upon her own s health status; to differentiate the level of oral health knowledge among educators and mothers. MATERIALS AND METHOD The epidemiological study was realized in 5 schools of the Iasi city. To attain the objectives of the study, 345 children with ages of 6-7 years (class I) and 297 children with ages of years (class VI) were investigated in the school year , on following the odontal status, evaluated by the DMFT (Decayed, Missing, Filed Teeth) index, the oral health status, evaluated by the OHI (Oral Hygiene Index) index and the periodontal condition, evaluated by the CPITN (Community Periodontal Index Treatment Needs) index. The data were obtained from annual clinical examinations performed in the medical school consulting rooms by specialized staff. Data recording was made according to the WHO criteria in force. In a parallel action, information from 5 mothers and 125 educators was collected by the questionnaire method, the obtained data being analyzed with the SPSS 14.0 program. The questionnaire for mothers included questions on their knowledge oforal health, on their attitude for preventing oral diseases, the healthpromoting behaviour of both mother and child, the parental support for child s health-promoting attitudes, self-evaluation of oral health and the necessary treatment for the child, the source of information on oral health and mother s level. The same questionnaire was filled in by educators. RESULTS The results provided by the clinical exams indicate a higher prevalence of the dental caries, comparatively with the WHO objectives for the year 2010, for both groups of age, of 86 for the 6-7 year-old children and of 76, respectively, for the year-old ones, yet lower than in the previous years. The dmft values of the 6-7 yearold children were of 2.9, with a percent ratio of 4.2 among the children with caries free teeth, while the DMFT ratio at ages of years was of 2.8, with of the children with caries free teeth (table 1). Table 1. dmft and DMFT values and percentage of caries free children 6-7 years (345) years (297) dmft DMFT caries free children () caries free children () As to the oral hygiene status (OHI-S) and periodontal condition (CPITN), higher values are registered for both groups of age (table 2). Table 2. Oral hygiene level and periodontal status on age groups Age OHI S CPITN 6-7 years (345) years (297) volume 1 issue 4 October / December of the mothers indicated that the bacteria+ sugar association is the cause of dental caries, 35 replied that the cause was represented by bacteria, while 27 of them associate the occurrence of caries with the consumption of sugar. When asked about the noxious influence of some food products, 83 of the mothers indicated the negative effect of sugar and 85 of them the negative effect of candies. Mothers also reported that beverages have a lower risk of causing caries. Only 1.2 of the mothers consider that fruit (apples) might affect teeth (fig. 1). Figure 2 shows the distribution of mothers anpp

3 ORAL HEALTH AND THE LEVEL OF KNOWLEDGE AND ATTITUDES OF swers to the prevention of the oral diseases of their children. Other causes of dental caries invoked by the mothers participating to the study were heredity (38), general diseases (28) and pregnancy (24). 4.2 of the mothers could not answer. The distribution of the answers to the question about the causes of gingival bleeding was the following: an incorrectly-applied dental brush (49), bacterial plaque (44), unhealthy diet (35), general diseases (30), heredity (9); 9 of the mothers could not give an explanation to gingival bleeding. SELF-EVALUATION OF THE ORAL HEALTH CONDITION Only 1.5 of the mothers were sure that the oral health of their children was very good, 17 declared that the teeth were good, 47 mentioned the satisfactory condition of the oral status, 19 recognized that their children had affected teeth and 4 of them could not answer. As to the necessity of dental controls, 66 of the mothers said that their child needs one or more stomatological treatments, 28 reported no need for stomatological treatments, while 5 of them did not answer. When asked to evaluate their own health condition, 24 of the mothers mentioned that they had good teeth, needing no stomatological treatments, and 57 of them declared to have poor teeth, which require stomatological intervention. teachers invata tori mothers ma me fruits fructele fuma tul smoking dulciuri cea iul tea coffee ca fea ua 88 sugar za ha rul MILK lasugar pte free neindulcit la pte indulcit Fig. 1. Percentage of mothers and teachers that have identified the factors which can affect teeth International Journal of Medical Dentistry mothers teachers Fluorides protect teeth against dental caries Parents must control consumption High level of sweet consumption causes dental caries tooth brushing prevents dental caries and bleeding Assisted tooth brushing Regular dental visit Fig. 2. Distribution of answers on the oro-prevention attitudes in mothers and teachers Table 3. Practices of oral health in the children and mothers of Iassy Tooth brushing 2 times/day Tooth brushing after breakfast Annual evaluation of the dentist Children, Mothers, Table 3, synthesizing the health-promoting attitudes of the children and mothers of Ia[i, shows that 43.7 of the 6 year-old children and 67.8 of their mothers practice dental brushing at least twice a day. Dental brush after breakfast was reported only for 78.9 of children and 92.3 of mothers. Distribution of answers to the question on the annual stomatological control was the following:.1 of the 6 year-old children and 88.7 of the mothers participating to the study made stomatological visits in the last 12 months. Table 4 lists the results of bivariate analysis on the health-promoting knowledge and attitudes, self-evaluation of the necessary dental care and the practices of oral health of children, comparatively with the frequency of the stomatological controls of the mothers taking part in the study. Data on the frequency of hydrocarbons consumption in 6 year-old children (provided by their mothers) are listed in table 5. The results of the analysis on the health-promoting knowledge, attitudes and practices of mothers, according to the level of their sanitary, are listed in table 6. One may observe that high-graduated mothers are better informed as to dental knowledge, have habitual health- 343

4 A. Corneag\, I. D\nil\, Dana Cristiana Maxim, Carina Balco[ promoting attitudes and participate actively, together with their children, to dental brush, while attempting at reducing the consumption of sugar. the dental caries were, for example, heredity (48), pregnancy (27) or the general pathologies (27). Tabel 4. Percentage of mothers that have reported dental visits Table 6. Distribution of the results on healthpromoting knowledge, attitudes and practices of mothers, according to the level of knowledge in oral health atattitudes an Question Mothers with regular dental evaluations Mothers with irregular dental evaluations Bacteria and that produce dental caries The child eats a lot of 6.4 I brush my child s teeth daily 4,2 Bacteria and that produce dental caries Healthy teeth are necessary for a good oral health It is possible to prevent dental caries I use the toothbrush and the toothpaste daily Food/beverages At least 1/daily Several times a day Soda drinks Fruit juices Sweets at breakfast Candies Gum with sugar Ice-cream Always/randomly 344 High level of I check child s teeth after every brush I know how many destroyed teeth has my child Healthy teeth are necessary for a good oral health As to the question on the causes of gingival bleeding, the following risk factors have been selected: an incorrectly realized brushing (66), the bacterial plaque (61), general diseases (51), unhealthy diet (45), heredity (20), consumption of warm and cold aliments (16), while 3.3 of the didactic staff do not know which are the causes of gingival bleeding. Table 7. Percent distribution of teachers answers to the factors producing dental caries Health-promoting knowledge and attitudes in schoolmasters 59 of the educators consider that the bacteria + sugar association was the cause of the dental caries, 55 declared that responsible are exclusively the bacteria, while 36 of them asserted that carious lesions are caused by sugar. In spite of this, the negative effects of sugar were reported by 98 of the educators, and those of candies by 91 of them (table 7). Also, 2.5 of the teaching staff declared that fruit (apples) and beverages may have negative effects. Other invoked causes of Medium level of 43.3 I use the toothbrush and the toothpaste daily Table 5. Frequency of carbohydrates consumption in 6 year-old school children Low level of 38.7 It is possible to prevent dental caries I know how many destroyed teeth has my child Irregular visits to the dentist 37.9 I brush my child s teeth daily Regular visits to the dentist The child eats a lot of I check the child s teeth after every brush Chocolate Question Teachers Milk without sugar Sugar Coffee without sugar Coffee with sugar Tea without sugar Tea with sugar Sweets/candies Smoking Apples DISCUSSION The epidemiological studies developed up to now in Romania show beyond any doubt that the problem of the dental caries, especially in 6 year-old children, is far from being eradicated; on the contrary, the DMFT indices register high values, possible explanations being related to: modification of the life style of a population, absence of medical assistance, lack of family s volume 1 issue 4 October / December 2011 pp

5 ORAL HEALTH AND THE LEVEL OF KNOWLEDGE AND ATTITUDES OF support for children s oral, a higher frequency of carbohydrate consumption, an incomplete knowledge on the effects of fluorine contained in the tooth paste, etc. The study was based on questionnaires addressed to adults mothers and educators who are mainly responsible for child s health-promoting life style, both at present and in the future. The answers provided by both categories evidence the necessity of additional information on the main causes provoking dental caries. Mothers answer to the question of how to avoid dental caries was, in most cases, related to dental brushing. The level of knowledge on the negative effects of sugar was quite high, in both mothers and educators, differences being nevertheless recorded between it and the health-promoting practices. The level of health-promoting of mothers and educators influences the oro-dental health condition of children, as actually shown by the literature of the field (9-14). CONCLUSIONS The family is responsible for the health-promoting life style of the child, as it constitutes the first source of information on oral health. A modality for increasing the interest of the child for oral health is that of providing permanently-updated information, continuous and motivation from the part of the parents. At the same time, school represents an important potential for the establishment of health-promoting habits, due to the considerable time the children spend in this place. The results of the present study show that the health-promoting habits of the adults, as well as the level of knowledge are important factors in the health-promoting of children. References 1. Downer MC. The improving oral health of United Kingdom adults and prospects for the future. Br Dent J 1991; : O Mullane D, editor. Efficiency in oral health care the evaluation of oral health systems in Europe. Cork: UE Biomed Consortium report, Marthaler T, O Mullane DM, Vbric V. The prevalence of dental caries in Europe Caries Res 1996; 39: Kaivusilta L, Honkala S, Honkala E, Rimpela A. Tooth brushing as a part of the adolescents lifestyle predicts al level. J Dent Res 2003; 82(5): D\nila I., Bârlean L., S\veanu I., Mihailovici L. Knowledge and attitudes towards oral health among parents and teachers in Iasi, Romania. The 12 th Annual Conference of the European Association of Dental Public Health: Poster Presentation Sessions,September Danila I., Evghenikos Adina, Petersen PE, S\l\v\stru C, Stan A, Oral Health teachers behavior change a major factor of progress, The Journal of Preventive Medicine 2005; 13(1-2):3-4 pg I. D\nil\, Teodora Timi[. The effectiveness of the National Caries Preventive Program in Romanian schoolchildren , (2006) (The 11-th Annual Conference of the European Association for Dental Public Health, Prague, sept.) Community Dental Health 2006; (3): Kunzel W. Trends in coronal caries prevalence in Eastern Europe: Poland, Hungary, Czechoslovakia, Slovakia, Romania, Bulgaria and the former States of the USSR. Int Dent J 1996; 46 (Suppl): Petersen PE. Effectiveness of oral health care some Danish experiences. Proc Finn Dent Soc. 1992; 88: Petersen PE. Guttman scale analysis of dental attitudes and knowledge. Community Dent Oral Epidemiol 1989; 17: Petersen PE, Holst D. Utilization of dental health services. In: Cohen L, Gift HC, editors. Disease prevention and oral health promotion. Copenhagen: Munksgaard, Petersen PE, Tanase M. Oral health status of an industrial population in Romania. Int Dent J. 1997; 47: Rajab LD, Petersen PE, Bakaeen G, Hamdan MI. Oral health behaviour of schoolchildren and parents in Jordan. Intern J Paediatr Dent 2002, 12(3): Taani DS, Wahadni AM, al Omari M. The effect of frequency of toothbrushing on oral health of year old. J Int Assoc Dent Child 2003, 49(1): International Journal of Medical Dentistry 345