Parental Knowledge, Attitude, and Practice Regarding Children's Dental Health

Parent-targeted oral health awareness campaigns should place a strong emphasis on issues like the value of deciduous teeth and how to treat them, frequent dental checkups, and dietary habits. The current study's objective is to evaluate parents' knowledge, behaviors, and attitudes regarding their children's oral health and how those factors affect the prevalence of dental caries in 5-to 10-year-old children in Riyadh, Saudi Arabia. Parents of school-aged children aged 5 to 10 who came to our hospital were the subjects of a cross-sectional questionnaire survey. The study included 209 children in all, together with their parents. Utilizing DMFT and the deft index, clinical examinations


INTRODUCTION
Tooth decay, sometimes referred to as caries, is one of the most prevalent chronic disorders affecting children. Untreated cavities may result in pain and infections that make it difficult to eat, speak, play, or learn. Children with poor dental health may skip more school days and score lower than their peers. More than half of children between the ages of 6 and 8 have at least one cavity in the (primary) tooth. More than half of teenagers between 12 and 19 years have at least one cavity in a permanent tooth. When compared to children from higher-income households (11%), children aged 5 to 19 from low-income families have a double risk (25%) of having cavities [1].
A range of risk factors, including dietary practices, oral hygiene routines, nutritional deficiencies, imbalances in salivary flow and composition, usage of fluorides, etc. are linked to dental caries, a complex illness. The likelihood of dental caries is also influenced by parental education, socioeconomic level, poverty, and lack of knowledge about dental problems [2]. Children's oral health behaviors are significantly influenced by their mothers as well as by the rest of the family [3]. Parents can have a significant impact on preventing oral illnesses in children by being directly accountable for the dental health of their children [4]. The majority of their choices about the health of their children are influenced by their understanding of health, especially oral health [5].
When it comes to their children's health and healthcare, parents make the decisions. Because this influences the dental care that children receive at home and their access to professional dental services, it is crucial to investigate their knowledge, attitude, and habits. Oral health awareness initiatives may target young children and their mothers as a key target audience for oral health education [6].
One of the major contributors to dental caries transmission is the bad hygiene practiced by the parents or the caregivers [7]. So in the current study we are trying to emphasize this wrong knowledge, attitude and behaviors which are frequently practiced by parents or child caretakers.

METHODOLOGY
Parents of children aged 5 to 10 who visited KSMC Dental Hospital in Riyadh, Saudi Arabia, participated in a cross-sectional questionnaire survey for 3 months. The Institutional Review Board granted ethical approval, and the parents provided their informed permission. The study included 209 children in all, together with their parents. Children's dental caries status was evaluated clinically utilizing the DMFT and DFT index. Prior to the trial, the recording assistant and examiner were taught and calibrated to minimize intra-examiner variability [Kappa coefficient = 0.81].
Parents were given a self-made questionnaire to evaluate their understanding of, attitudes, and practices regarding their children's dental health. The questionnaire has two parts: a section with demographic information and another with 15 multiple-choice, closed-ended questions about knowledge (six), attitude (five), and habits (four) relevant to children's dental health. The questionnaire's reliability was pretested and determined to be acceptable [Kappa coefficient = 0.89]. The study did not include any surveys that were not completely filled out.
A score system was created to evaluate the questionnaire results. Scores were based on how many parents provided accurate or favorable Less than or = 2 3 More than or = 4 Knowledge Less than or = 2 3-4 More than or = 5 Practice Less than 2 2 More than or = 3 Overall (K+A+P) Less than or = 6 7-10 More than or = 11 answers. A value of 1 is assigned to the right or favorable response, while a value of 0 is assigned to the wrong or unfavorable response. KAP score was calculated by adding the scores for each component of the Knowledge, Attitude, and Practice (KAP) test. This was illustrated in Table 1.
With the aid of the DMFT Index for permanent teeth and the deft Index for primary teeth, clinical examination for the existence of carious lesions was conducted. SPSS v24 was used for the statistical analysis. A p-value of 0.05 or less was regarded as statistically significant when using the ANOVA test to examine the relationship between dental caries status and KAP.
Research was approved by Saudi Arabia ministry of health under IRB number (H1RI-07-Aug22-03). All information were kept confidential and no personal information was exposed, our team only can access the data and information. Informed consent was obtained from each participant.

RESULTS
The study included 209 children aged 5 to 10 and their parents, of which 115 (or 55%) were males and 94 (or 44.9%) were females.

Knowledge
The

Attitude
In the entire survey population, 89% of parents said they wanted their children' teeth to be free of decay. According to 51% of parents, deciduous teeth are necessary for eating, speaking, and maintaining the mouth space until permanent teeth grow. Almost 31% of parents are unaware of the significance of baby teeth. Only 4.9% of participants don't think dental care is as important as other medical illnesses, compared to 89.4% of parents who gave dental care and other medical illnesses the same weight. Parents reported that they would follow a pedodontist's advice if they encountered oral disorders in about 50.5% of cases. Parents said that ordinary dentists can also treat youngsters in around 12.4% of cases. About 31.5% of parents are unaware about pedodontists and dental care.

Practice
Out of 209, 49% of the parents had never been to the dentist, compared to 51% of the parents who have. Only 34.2% of parents took their children to the dentist on a regular basis, as opposed to 65.8% of parents who did not. In the research population, 69.1% of parents provide their children chips, candy, soda, and sweets.

Clinically
According to the DMFT index, 59.2% of the permanent tooth had dental cavities. The prevalence of dental caries was the same in both boys and girls. Children aged 9 and younger had the highest prevalence of DMFT (79.4%).
According to the Deft Index, 95.9% of the primary teeth had dental caries. Boys had somewhat higher dental cavities in their primary teeth (97%) than females (96%) did. The frequency of dexterity was high across all age groups.

DISCUSSION
The majority of a child's time is spent at home with their parents or other adult guardians. Instilling healthy oral habits in children is largely the responsibility of their parents. If parents are properly motivated and educated, oral illness, especially dental caries in young children, can be greatly avoided. Several research have shown a favorable correlation between parental knowledge and children's dental caries status [8,9]. However, there is still a significant lack of parental knowledge regarding these baby teeth in poor nations like India [10].
The initiative taken by Saudi parents to provide their children with preventive dental treatment is not well documented. The aim of this study was to check the parents of 5-to 10-year-old children enrolled at KSMC dental hospital with regard to their knowledge, attitudes, and practices regarding oral health and to determine the impact of these factors on children dental caries level. 209 parents and their children, who are all between the ages of 5 and 10, were included in the current cross-sectional study. 43.9% of parents said that children should get help brushing their teeth not far away from to Kaur, [11] (57%) and Dikshit et al. [12] (77%) finding that the majority of parents help their children wash their teeth. Children under the age of six may not be capable of brushing their own teeth due to a lack of physical dexterity. Therefore, it is advised that parents direct and watch over their children when they clean their teeth. According to Gokhale N, [6], children whose parents helped them brush their teeth found considerably less carious teeth (6).
78.6% of parents in the current study agreed that children should wash their teeth twice a day. These findings accord with other studies' findings that 70.5% [13], 71% [14], 78.5% [15], and 80.5% [16] of parents said children should brush their teeth twice a day. The fact which may be attributed to the parents' greater educational background-the majority of whom were educated in the current research. According to our data, 84.5% of parents believe that brushing and toothpaste should be used to clean teeth. In other research, toothbrushes and toothpaste were used by 56.5% [12], 82% [17], and 93% of participants. Compared to children who used toothbrushes and toothpaste in cleaning teeth, children who did not had 1.56 odds of getting dental caries [3].
According to our study 51% knew the value of deciduous teeth which is high percent if compared to other studies such as Nagaveni, [10] (18%) and Gokhale & Nuvvula, [6] (22.6%). According to Shetty et al. [16], (71.7%)] of parents agreed that deciduous teeth need to be taken care of even though they will fall out. According to Suma & Anisha, ]3], children whose parents did not value their deciduous teeth had 1.67 times the likelihood of developing dental caries as compared to other children.
According to the DMFT index, dental caries prevalence in the research population's permanent teeth was 59.2%, which was lower than the study conducted by Casanova-Rosado et al. [18] (82%) [18]. According to the deft index, dental caries prevalence in the study population's primary teeth was 95.9, which was comparable to the study conducted by Begzati et al. [19] (94.4%), as well as Casanova et al. [18] (90.2%) [18,19]. The mean deft in our study was greater than the mean deft in the study by Joshi et al. [20]. The current investigation revealed that primary teeth had a greater caries prevalence than permanent teeth. This might be explained by the permanent teeth's decreased susceptibility to dental caries.

CONCLUSION
The participants in the current study had a reasonable KAP on their children' oral health. No significant association between KAP and DMFT or KAP and DEFT was detected. Poor dental caries status in the children's primary teeth was a reflection of inadequacy in various aspects of oral health awareness. The significance of deciduous teeth and their treatment, frequent dental appointments, and dietary behaviors are among the knowledge gaps in oral health.

CONSENT
As per international standard or university standard, parental's written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
As per international standard or university standard written ethical approval has been collected and preserved by the author(s).