|Year : 2014 | Volume
| Issue : 1 | Page : 53-57
Early childhood caries and its correlation with maternal education level and socio-economic status
Shalu Verma Bhardwaj1, Amit Bhardwaj2
1 Department of Pedodontics and Preventive Dentistry, Budhera, Gurgaon, Haryana, India
2 Department of Periodontics, SGT Dental College, Budhera, Gurgaon, Haryana, India
|Date of Web Publication||15-May-2014|
House No. 1010, Sector 4, Gurgaon - 122 001, Haryana
Source of Support: None, Conflict of Interest: None
Objectives: This study was carried out to correlate the relationship between early childhood caries and maternal education level and socio-economic status (SES). Materials and Methods: The study was conducted on 500 pairs of children of ≤6 years age and their mothers, who reported to the private dental clinic in Gurgaon, Haryana, India. The association between mother's educational level and SES of the family were estimated through a self-structured questionnaire. Caries status of the children was estimated using deft index (World Health Organization criteria). Results: Collected data was statistically analyzed. There was an inverse relationship between the education level of mothers and caries status of their children. There was no relationship between the SES of mothers and caries status of their children. Conclusion: It was concluded that, mothers are responsible for their children primary oral health.
Keywords: Early childhood caries, prevention, socio-economic status
|How to cite this article:|
Bhardwaj SV, Bhardwaj A. Early childhood caries and its correlation with maternal education level and socio-economic status. J Orofac Sci 2014;6:53-7
|How to cite this URL:|
Bhardwaj SV, Bhardwaj A. Early childhood caries and its correlation with maternal education level and socio-economic status. J Orofac Sci [serial online] 2014 [cited 2021 Jun 16];6:53-7. Available from: https://www.jofs.in/text.asp?2014/6/1/53/132582
| Introduction|| |
Early childhood caries (ECC) is defined as "the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a child 71 months of age or younger.  Childhood caries is a public health problem that affects infants and preschoolers throughout the world, leading to pain, chewing difficulties, speech problems, general health disorders, psychological problems and lower quality-of-life.  Further, decay of primary teeth can affect children's growth, leading to malocclusion by adversely affecting the correct guidance of the permanent dentition.
The centers for disease control and prevention reported that caries is perhaps the most prevalent of infectious diseases among children. This disease affects the general population but is more likely to occur in infants who are of low socio-economic status (SES), whose mothers have low education level and who consume sugary foods.  Caries experience in recent years, especially in developing countries, demonstrates that a significant proportion of infants and preschoolers are still affected by the disease with a strong polarization.  Children under the age of 5 years spend most of their time with their parents and guardians. Dietary habits and healthy behaviors established as norms in the home and are dependent on the knowledge and behavior of parents. Without basic knowledge of caries risk factors, importance of the deciduous teeth and oral maintenance, it is difficult to employ effective disease preventive strategies.  In most of the developing countries in South East Asia, children have a high prevalence of dental caries in the primary dentition, often in contrast to the situation in the permanent dentition. The reasons for this difference are not obvious, but may be linked to differences in diet. In developing countries, the prevalence of dental caries seems to be increasing with the increase in sugar intake, while it stays low in countries where a poor economy restricts sugar intake. The prevalence of dental caries has been found to be variable as follows: 70%, 53%, 25%, 50.8%, 51.6% and 68.7% in the age group of 5-6 years in Bangalore (Urban), Davengere (Urban), Davengere (Rural), Kerala (Rural) and Gurgaon (Urban) respectively. 
Mother's behavior is correlated with children's oral health. The tooth-brushing and dietary habits of the mother are associated directly with those of her child. Children's dietary habits vary according to their mothers' educational level, resulting in low income families consuming diets higher in added sugars than diets of higher income families.  Despite having good knowledge, many mothers are using nursing bottle at bed time.  Cariogenic or decay-causing bacteria are typically transmitted from the mother or care-giver to child by behaviors that directly pass saliva, such as sharing a spoon when tasting baby food, cleaning a dropped pacifier by mouth, or wiping the baby's mouth with saliva.  Daily sugar consumption is an independent risk factor for ECC and that supervised tooth-brushing with a fluoridated dentifrice is a proven intervention to reduce ECC.  Hence, the present study, was undertaken with the aims to determine the relationship of dental caries of children with mother's educational level (as obtained from the questionnaire) and to determine the relationship of dental caries of children with mother's SES (as obtained from questionnaire).
| Materials and methods|| |
The questionnaire-based study was conducted on a sample of 500 pairs of children of ≤6 years age and their mothers, who reported to the private dental clinic in Gurgaon, Haryana, India. The duration of the study was 3 months. The aims and procedure of the study was explained to the mothers and the informed consent was obtained from them prior to the study.
- Children of ≤6 years of age
- Mothers who gave informed consent.
- Children of ≤6 years of age who lost their mothers or whose mothers were not residing with them
- Physically or mentally handicapped or medically compromised children
- Marked intra-oral soft tissue pathology
- Children using oral appliance.
The correlation between mother's educational levels, SES of the family was estimated through a self-structured questionnaire [Annexures 1 and 2].  The local language was used for collecting all the required and relevant information from the mothers. All the data was collected by a single trained examiner.
All the dental examinations were performed by single trained dentist using World Health Organization (WHO) criteria. Each child underwent intra-oral examination for dental caries status. Examination was done in artificial light with mouth mirror and probe. Dental caries was recorded for children with primary dentition using def index (decayed, indicated for extraction, filled index, Gruebbel AO, 1944). 
| Results|| |
Data was entered in spreadsheets and was analyzed using software, Statistical Package for the Social Sciences (SPSS version 19.0, IBM Corp. Released 2010. IBM SPSS Statistics for Windows, Version 19.0 Armonk, NY: IBM Corp).
Evaluation of influence of education level of mothers on caries status of children
Mean deft of children with illiterate, primary to middle school, high school to intermediate and graduate to professional mothers were 8.3, 8.6, 9.2 and 5.7 respectively [Table 1]. There was statistically significant difference between graduate to the professional group with high school to intermediate group and primary to the middle group with P < 0.002 and P < 0.021 respectively [Table 2]. There was no significant difference between illiterate group and any other groups.
Evaluation of relationship of child's caries status with the SES of the family
Evaluation of relationship of child's caries status with the SES of the family was done on the basis of their monthly income as : b0 elow the poverty line (monthly income below Rs. 500), poor (Rs. 500-1499), lower middle (Rs. 1500-2999), upper middle (Rs. 3000-4999), high (Rs. 5000-9,999) and upper high (Rs. 10,000 and above).
As there was no mother below the poverty line so this class of SES was not included in statistical analysis. Mean deft values for poor, lower middle, upper middle, high and upper high are 7.0, 8.6, 8.7, 8.8 and 9.2 respectively. It was found that there was no statistical significance found between the groups [Table 3] and [Table 4].
|Table 1: Mean deft of children according to the education level of their mothers|
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|Table 2: Multiple comparisons between various groups according to education level|
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|Table 3: Mean deft of children according to the socio-economic status of their mothers|
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|Table 4: Multiple comparisons between various groups according to socio-economic status|
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| Discussion|| |
In the present study, a total 500 pairs of children of ≤6 years age were screened for deft according to WHO criteria. One objective of the present study was to determine the relationship between the children dental caries status with their mother's education level. Mean deft of children with illiterate, primary to middle school, high school to intermediate and postgraduate to professional mothers were 8.3, 8.6, 9.2 and 5.7 respectively [Table 1] and [Table 2]. These results showed an inverse relationship between mothers' education level and children deft values.
Elena and Petr  concluded that mothers with background of high education have more positive dental knowledge and attitudes, whereas Ersin et al.  and Qin et al.  concluded in their study that a lower maternal education level, poor knowledge of oral hygiene, night-feeding and excessive sugar intake were important contributors to the development of ECC in young children. In the present study, it was found that low education level of mothers was significantly related to the occurrence of caries, which is consistent with other studies.
Other objective of the present study was to determine the relationship between children dental caries level with their mother's SES. In the present study, there was no correlation found between the SES of mothers and dental caries status of their children [Table 3] and [Table 4]. These results are in accordance with the results of the study by Savara and Suher,  who found no association between dental caries of children and income of parents. Reisine and Psoter  in a systematic review summarized the association between the incidence and prevalence of dental caries and various variables: SES, tooth-brushing and the use of the baby bottle. It was concluded that children in families of low SES had a higher prevalence of caries as compared to children in high SES families. Ismail et al.  and Tyagi  have also concluded that ECC are highly prevalent in low-income groups. ur Rehman et al.  adopted similar criteria in his study to find the relationship between caries and oral health status of children with extra oral or demographic factors and found that is the inverse relationship between SES and decayed/missing/filled teeth (DMFT) in children, whereas strongly correlated with frequency of sugar intake and frequency of snacking in-between meals.
| Conclusion|| |
It can be concluded that, mothers are responsible for their child's life-style, behavior and habits and represents the primary information about oral health. Hence, pre and postnatal counseling of mothers about oral health will help in increasing the oral health awareness of their children. If oral health promotion efforts are to be effective in improving the oral health of young children, it is essential that there be a good understanding of parental knowledge and attitudes. Such strategies may help to guide and modify current and future oral health prevention activities.
| References|| |
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[Table 1], [Table 2], [Table 3], [Table 4]
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