Brazilian Journal of Oral Sciences Piracicaba Dental School - UNICAMP EISSN: 1677-3225 Vol. 4, Num. 14, 2005, pp. 778-782

Brazilian Journal of Oral Sciences, Vol. 4, No. 14, July/Sept. 2005, pp. 778-782

Oral hygiene practices, parents’education level and dental caries pattern in 0 to 5 years-old children

Suzely Adas Saliba Moimaz¹ Ronald Jefferson Martins² Franklin Delano Soares Forte³ Nemre Adas Saliba⁴

¹PhD Assistant Professor at the Department of Child and Social Dentistry of the Dental School of Araçatuba- Paulista State University ²Master’s Degree Candidate in Preventive and Social Dentistry at the Dental School of Araçatuba- Paulista State University ³Doctor’s Degree Candidate in Preventive and Social Dentistry at the Dental School of Araçatuba- Paulista State University ⁴Full Professor at the Department of Child and Social Dentistry of the Dental School of Araçatuba- Paulista State University

Correspondence to:Suzely Adas Saliba Moimaz Programa de Pós-Graduação em Odontologia Preventiva e Social da Faculdade de Odontologia de Araçatuba –UNESP, Rua: José Bonifácio, 1193, Vila Mendonça, Araçatuba São Paulo - CEP:16015-050 E-mail: rojema@terra.com.br

Received for publication: January 27, 2005
Accepted: March 01, 2005

Code Number: os05026

Abstract

Understanding that dental caries has multifactorial aspects, we attempted to verify the influence of food habits, oral hygiene practices, and parents’ education level in the occurrence of this disease in children. One-hundred-thirty children, aged 0 to 60 months, both male and female, were examined in the municipality of Bilac- São Paulo- Brazil. The examination was carried out on the day of National Multivaccination Campaign, using the DMFT index, with the codes and criteria established by WHO. A questionnaire with open and closed questions about children’s food and hygiene habits and parents’/ tutors’ level of education was applied to parents/tutors. The data were processed using Epi-Info 6.04 software, having been considered significant at p<0.05. It was verified that 83% of the children were bottle fed at night. Of these, 79.6% had the contents of the bottle added with sugar, and this factor was associated with dental caries (p=0.01; OR=1.2; CI=0.2 – 2.3). Oral hygiene had been started before one year of age in 54.6% of the children, and it was carried out twice a day in 46.1% of the cases. Regarding the education level of parents, 51.5% of the mothers and 53.8% of the fathers had more than eight years of education. There was no relationship between the parents’ level of education and the presence of dental caries.

Key Words:dental caries, oral health, oral hygiene

Introduction

Due to a greater understanding of dental caries, as well as because of its great relevance to public dental health, many studies have been carried out on the factors involved in the development of this disease. Since the 1970’s a decrease in dental caries has been observed in the industrialized countries. This may be partly attributed to the implementation of preventive measures, such as the rational fluoridation of public water supplies and, in Brazil in the late 1980’s, the introduction of fluoride in toothpastes¹ and alterations in the health system with the implementation of the Unified Health System (SUS). In some other countries, caries decrease is a result of an improvement in the people’s living standards and modification in sugar consumption^2-3_.

Caries lesions may be measured as signs and symptoms. They have a cumulative nature and may increase as time goes by, if there is no interference⁴. The diet is among the factors associated to its development and it plays an important role. The habit of feeding children with a night bottle, associated to lack of hygiene, was related to early development of caries in children younger than 5 years of age^5-8.

The child’s dietary pattern is an important factor in the etiology and progression of caries, as well as in the determination of the future diet, acting as a risk predictor of development of the disease^5-8. It has been demonstrated that food habits in childhood acts as a good indicator of sugar consumption by the family and of the risk of caries in deciduous and permanent teeth of young children^5,9. Early introduction of sugar in babies’diet, in the first year of life, has been verified¹⁰.

Studies have related the level of education of the parents to oral hygiene and to the presence of dental caries in children^5,11.

Information on the patterns of development of the disease in the population is important because it acts as foundation for the planning of public oral health policies¹².

Thus, understanding that dental caries has multifactorial aspects, the present research was carried out in an attempt to investigate food habits of children, oral hygiene and the education level of parents in relation to the occurrence of the disease in children in the municipality of Bilac - State of São Paulo- Brazil.

This study was approved by the Committee on Ethics in Research on Humans of the Dental School of Araçatuba/ Paulista State University and by the Municipal Education and Health Departments. An informed consent form was presented to every parent and/or tutor, informing them about the study.

The children whose parents signed the informed consent form were examined. These comprised a total of 130 children, male and female, ranging from 0 to 60 months old, which represented 32.5% of the population of the municipality in that age group, according to data from the Brazilian Institute of Geography and Statistics - IGBE (1998). The clinical examination was carried out on the National Vaccination Day, by a single examinator, with the aid of a note taker, under natural illumination, in the patio of the Basic Healthcare Unit of Bilac – São Paulo, using a plane dental mirror, sterilized gauze to dry the teeth and clinical tweezers. Bilac is a municipality of about 6,000 inhabitants, with non-fluoridated water supply.

The examinator was previously calibrated by an experienced epidemiologist. Intra-examinator error was situated under 5%, with optimum Kappa index (K= 0.98). The DMFT index was used, with codes and criteria established by the WHO Manual of Epidemiological Surveys - 4^th edition¹³.

This methodology was used systematically for all children examined. With regards to biosafety, a white lab coat, a medical cap, a disposable medical mask, and latex examination gloves were used. Data were analyzed by Epi-Info 6.04 software and considered significant at p< 0.05.

A questionnaire developed for this research, with open and closed questions about food and hygiene habits and education level, was applied to the children’s parents.

It was observed that only 23.8% of the children had dental caries. Oral hygiene was started before the first year of life in 54.6% of the children and the frequency reported by the parents/tutors was, most of the time, twice a day (46.1%). The parents were responsible for the hygiene in 50% of the cases and in 27.6%, the parents were responsible in conjunction with the child. The toothbrush was the tool most frequently used (80.7%). Fluoride toothpaste was used in 87.6% of the children. (Table 1)

With regards to form and time of milk feeding, most children were observed to be artificially fed, and the most frequent time of feeding was before bedtime (31.5%) or when going to sleep (41.5%). Sugar was added to the contents of the bottle in most cases (79.6%). (Table 2)

Regarding the education level of the parents, 53.8% of the fathers and 51.5% of the mothers had studied for more than eight years. (Table 3)

In this study a statistically significant correlation between artificial feeding and the presence of dental caries was not verified, which corroborates Fraiz and Walter’s⁵ findings, maybe due to the low prevalence of caries in the population studied. A high percentage of caries-free children was found (76.1%).

The low prevalence of dental caries may be attributed to the conjunction of toothbrushing with the use of fluoride toothpaste, once the water supply of city in which the research was carried out is not fluoridated. Children’s teeth are brushed mostly twice a day (46.1%), which leads to a disorganization of the dental biofilm.

Cow milk presents lower cariogenicity when compared to human milk¹⁴. The addition of sugar to the contents of bottles given to non-breast-fed babies was verified. Milk added with sugar has been evidenced to present a higher cariogenic potential and the prevalence of caries is higher in children fed at night, when going to sleep or already asleep^10,15-17. In this study, most children were artificially fed at night. Similar reports were made by several authors^18-20.

Feldens et al.²¹ when studying the oral hygiene patterns and toothpaste use by the children population of Porto Alegre, observed that 100% of the children used the toothbrush before the first year of life, a result higher than the one found in this research (54.6%). Parents are responsible for the oral hygiene of their children and dental surgeons are responsible for the adequate orientation of parents, stimulating the practice as daily routine²². Newbrun²³ recommended active participation of parents in the daily toothbrushing, due to the children’s lack of motor skills to perform the adequate movements to brush their teeth appropriately. In this study, it was verified that in most cases the parents were responsible for toothbrushing (50%), followed by the parents in conjunction with the child (27.6%), in accordance with the findings of Feldens et al.²¹.

There is currently a greater concern about fluoride sources and its exposition to young children, as it may be a factor causing dental fluorosis²⁴. It was observed in this study that the great majority of children used fluoride toothpaste more than twice a day. Orientation is needed regarding the correct use of fluoride toothpaste, as for example, the technique of disposing the toothpaste transversely on the toothbrush^23,25. There was no statistically significant correlation between the education level of parents and the presence of dental caries. In the study of Fraiz and Walter⁵ a correlation was verified regarding the fathers’education level. However, that was not observed concerning the mothers. Maas et al.¹¹ emphasized that social class and parents’ level of education do not interfere with the children’s oral hygiene.

Early attention is needed to provide parents with information about oral health, even during pregnancy, especially because the expectant mother is more susceptible to acquire healthy habits that will consequently be passed on to the child²⁶. Studies verified a reduction in the dental caries index and risk reversion when attention to this is given early^27-28. The results of this study are important for the Municipal Health Department to plan oral health policies and to carry out further assessments.

The authors thank the dental surgeons Claudia Letícia Vendrame dos Santos and Antônio Carlos Pacheco Filho (Nino), the employee of the Department of Child and Social Dentistry of FOA- UNESP Nilton César Sousa, Mrs Edivete Aparecida Silva Martins, the parents and children that took part in the survey and also Municipal Health Department.

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