Parental knowledge, attitudes and perceptions of dental caries and dental sealants as a preventive strategy of dental caries.

Abstract

Introduction: Children’s oral health care should be a public health priority and parental knowledge, attitudes and perceptions (KAPs) are likely to play a role in achieving and maintaining a desired level of oral health in children. Aims and Objectives: The aim of the study was to understand parents role and the use of dental sealants in Grade 1 learners’ oral preventive health in the Chatsworth Circuit of the uMlazi District, KwaZulu-Natal. The objectives of the study were to establish parental knowledge, attitudes and perceptions of Grade 1 learners towards dental caries through the use of a self-administered questionnaire, to determine parental self-oral health care practices (and consequent influence on the child) through the use of a self-administered questionnaire, to assess parental knowledge, attitudes and perceptions towards dental sealants as a preventive strategy for dental caries through the use of a questionnaire and group focus discussions, to determine the relationship between gender, parental age, level of education and socio-economic status on knowledge, attitudes and perceptions towards dental sealants and dental caries through statistical tests of association and compared to the literature review, and lastly to determine the current oral health promotive strategies implemented by the KwaZulu-Natal (KZN) Department of Health through a review of the available policy documents and statistical records. Methods: The study participants were the parents (ɳ=295) of grade one learners aged between five and six years old who attended schools in the Chatsworth Circuit of the uMlazi education district. From a sample population of 50 schools, twelve schools were selected from an ordered list, using systematic sampling technique. Information was obtained using a self-administered questionnaire that included questions on demographic data, oral health behaviour and knowledge patterns, income and education status, and knowledge of oral health prevention practices. Further data was obtained by conducting focus group interviews at five schools with 10 participants in each group. Ethical approval was obtained from the Humanities and Social Sciences Research Ethics Committee at the University of KwaZulu-Natal (Reference: HSS/0327/013M) and gatekeeper permission was obtained from the relevant sections in the Department of Education and the Department of Health in the eThekwini District, KwaZulu-Natal. All participants were assured of confidentiality. Privacy and confidentiality were maintained and participant anonymity was guaranteed through the use of codes. Results: Although the majority of respondents understood the role of diet and self-care practices such as tooth-brushing in the prevention of dental caries, almost 80% of these respondents did not floss or use a mouthwash (70%). Similar scores were reported by respondents for their children’s oral health care practices. The study participants (74%) did not perceive dental caries in deciduous teeth as being important precursors for caries in adult teeth. The results indicate that 65% of respondents were aware of dental sealants. However only 67% of participants were willing to have sealant placements performed on their children. A significant number (33%) of respondents were uncertain or unwilling to have this procedure done. The association between the participants’ level of education and the child’s self-care practice was of statistical significance (p=0.002). Almost two-thirds of the respondents (77%) had at most a high school education and about 43% of the respondents were dependent on the social welfare system (p=.003). The results indicate that extractions is the most frequent clinical procedure with almost 192 722 procedures carried out in the eThekwini District, KwaZulu-Natal in 2011. The results further indicate that 75% (ɳ=295) of the participants experienced difficulties in accessing facility-based oral health care due to transport problems. Discussion: The results of this study reveal gaps in parents’ knowledge, attitudes and perceptions towards dental caries, oral hygiene practices, diet and nutrition, and dental sealants. The study findings further reiterate that parental attitudes and perceptions does appear to influence children’s attitudes and perceptions towards oral health self- care. This is reflected in the statistical significance between the participant’s level of education and the child’s self-care practice. Income also appears to play a role in determining attitudes towards oral health self-care practices. More research needs to be conducted to unravel the reasons for parents not wanting to have sealant placements done on their children despite knowledge of its known benefits. This study thus supports the premise that perceived parental knowledge of oral health self-care does not necessarily translate into practice. It is also important to note that oral health service delivery in the public sector is still curative driven with very little focus on prevention and promotion of optimal oral health care. The low number of dental sealant placements provides further evidence that there is a mismatch between oral health policy priorities and oral health service delivery. Conclusion: The study therefore concludes that parental knowledge, attitudes and perceptions towards dental caries could be influenced by education and income. Knowledge and awareness of the value of dental sealants did not necessarily translate into support for this procedure as a preventive strategy for dental caries. The literature provides supportive evidence for parental involvement in oral health promotion decision-making but the factors that influence this decision making, must be considered. More research needs to be conducted to further investigate strategies to improve parental involvement in oral health promotion decision making, specifically in the area of children’s oral health care.