Parenting

This chapter discusses the literature related to the study. A lot of literature has been written on Knowledge, Attitude and Practice of Jordanian Mothers toward their Children’s Oral Health. The aim of this chapter is to examine the viewpoints of the various authors concerning the various aspects of children’s oral health.

According to Alkhtib & Morawala (2018 pg. 98) parenting refers to the upbringing of children based on skills, knowledge, attitudes, and practices. This aims at developing good physical, social, emotional, physiological, and psychological appearance in children. The parents’ attitudes and knowledge help maintain the oral health of young children. This study on parenting was performed on 200 parents whereby self-administered questionnaires were used to address the aspects of knowledge, attitudes, and oral health practices. Fluoridated kinds of toothpaste help to avoid Early Childhood caries (ECC). From the study, very few parents were aware of the benefits of toothpaste after night meals (1). However, Arora, et al (2012) identifies that the level of parental awareness and knowledge about milk teeth, dental visits, and oral health awareness are important for children’s oral health. Healthy permanent teeth are determined by the oral health practices in young children, and this can be enhanced by a more positive attitude of the parents towards dentistry. To acquire optimal oral health into adulthood and childhood, the mother must foster dental care and preventive education of the infant’s oral health. This provides the basis to understand the practices and beliefs of the parents towards the oral health care of their children. The literature available is insufficient about parents’ attitudes towards oral healthcare in developing countries such as Jordan (2). Therefore, this study assesses Jordan mothers’ knowledge, attitudes, and practices towards their children’s oral health.

Brecher & Lewis (2018) point out that the knowledge of mothers about the oral cavity of their children depends on the parent’s education level, interest, access to necessary information. These capacities depend on the parental awareness, knowledge, and their socioeconomic status, among other characteristics. The mother identifies the child as a high risk to develop ECC whereby he or she is taken for a dentistry visit for diet counseling, oral hygiene, fluorides as preventive agents, and education on decay by promoting healthy feeding habits (3). According to the AAPD advice, a dental home has to be established the first six months after the first tooth has sprouted to train parents to prevent the development of dental caries (3). Studies show that mothers have greater impacts on their children’s oral health as they spend most of their time with children up to 12 years; therefore, they have a better understanding of the oral cavity of the children.

Knowledge of Mothers about Their Children’s Oral Cavity

According to Buzalaf (2011), mothers, the primary caregivers, need to have basic knowledge about ECC and milk teeth for their children’s oral health care. Infants and children are greatly affected by dental caries, which is a chronic disease. It results from the colonization of bacteria in the oral cavities of children after the eruption of the primary teeth (4). This is indicated by decayed or filled teeth surface for children of 2 years, as reported by Renkonen and Alaluusua. Mothers lacking the education on prevention measures for dental caries have a high burden for the disease, as indicated by the scientific literature leading to poor oral health for their children (5). This study intends to provide the basic Knowledge for Jordan mothers that could otherwise reduce the burden of ECC through the assessment of the knowledge of the mothers through questionnaires for evaluation of the knowledge about infant oral care

 Casanova-Rosado et al., (2013) depict that the oral health of children affects the overall well-being and health of children. Understanding the mothers about this relationship helps maintain good health for their children (6). Mothers the family cornerstones; therefore, their knowledge about oral hygiene and care practices can serve to prevent ECC. Mothers need to have knowledge of cleaning teeth, proper hygiene, dental care visits, and dietary habits to prevent oral diseases. Studies by the WHO have shown that the prevalence of dental caries is higher in developing than developed countries (7) Education of the mothers in developing countries has to be done about diet, hygiene procedures, and use of fluorides, preventive care programs, and awareness of dental health. Children below 12 years spend most of their time with their mothers; proper knowledge of the mothers greatly impacts the children’s oral health. Studies indicate that many mothers have poor knowledge concerning their children’s oral and general health (8). This study intends to explore the knowledge to be equipped and aware of improving their children’s health.

Mothers are dependent on their children as caretakers to maintain their oral cavity health through prevention and treatment. The knowledge of the parents, in this case, is crucial, according to the studies carried out on Chennai school children (9). The mothers’ knowledge depends on the socioeconomic status, whereby low-status mothers lack or are less informed about horal health care (10). The level of the mother’s education also determines the nature of oral care in terms of teeth brushing. Knowledge-based on the tools to be used, the fluorides, and how the brushing can be done to maintain the best health hygiene (11). Previous studies in India have indicated that insufficient knowledge of mothers regarding the age of the children to start the brushing techniques greatly influences the children’s oral health. However, they did not give clear information on how the brushing should be done (12). This study intends to give the basic skills of brushing to equip Jordanian mothers with the knowledge to give the best oral care for their children.

Knowledge of Mothers about Milk Teeth and Oral Diseases in Children

According to Ramroop, Wright & Naidu (2011), the age to start the teeth brushing practices is 3 years. This knowledge of mothers regarding brushing is very important since it helps prevent the occurrence of ECC, which is prevalent below the age of 3 years in children. The mothers’ oral status directly affects the oral health of the child (13).in India, the study conducted by NOHS indicated a high prevalence of dental caries in infants due to a lack of awareness of the mothers. This study gives the basic knowledge about the ae to start brushing in children by the Jordanian mothers, which will help to curb the prevalence of ECC in children and infants (14). This helps to form the basic health promotion for children according to the AAPD recommendations.

According to Robinson, Hunter, Pemberton & Sloan, (2018) mothers form the basis for good health behaviors that greatly influence their children’s oral health. These behaviors include how often the teeth have to be brushed for their children as they serve as role models to their children (15). Children born of mothers with poor oral health also become of poor health in adulthood than vice versa. The who recommends brushing teeth after every meal to prevent the accumulation of food particles on the surface of teeth that subsequently cause teeth decay in children and adults (16). Mothers’ knowledge regarding the frequency of brushing their children’s milk teeth in the right way prevents the prevalence of dental caries (17). Current studies have indicated that few mothers with dental knowledge who brush their children’s teeth frequently after meals show less prevalence of dental caries, unlike those with little Knowledge (18). Awareness has to be done to improve the number of knowledgeable mothers to improve children’s oral health. In general, oral hygiene help to prevent periodontal diseases and caries, which mothers have emphasized since childhood (19).

Suresh, et al,. (2010) elaborate that fluoridated kinds of toothpaste have greatly helped reduce the prevalence of dental caries globally. The studies have indicated that mothers have limited knowledge about the benefits, contents, and harms of toothpaste, mostly affecting developing countries (20). Current studies have shown fluorides to be the best fighters against the prevalence of dental caries. Today, the challenge is to provide the correct quantity of fluoride safe and reliable for kinds of toothpaste in children (21). The knowledge of the mothers on the use of fluoridated kinds of toothpaste can be enhanced through advertisements that contain scientific rationale as done in India to improve the general oral health of citizens (22).this can involve the efficacy, how to use and safety of the kinds of toothpaste and also educating the mothers and children about the preventive measures to improve oral health(23). This study intends to fill the gap in the previous studies by determining the required knowledge about the number of fluorides to be used safely.

Knowledge of Mothers about the Relationship between General and Oral Health

Vieira et al, (2015) state that the reality about the dental visits by the mothers seem to only take the children to dentists during an emergency and risky cases. In case of dental caries with no pain, the mothers may assume to take the children for dental visits according to the evidence given by the Sudanese study (24). This shows that this population of mothers has to be delivered with information about infection control (Vieira et al, (2015). The mothers’ knowledge prevents the prevalence of the ECC as the risks can be identified early enough during the dental visits and be treated. During the covid 19 pandemic in 2020, most mothers got information on social media about its infection, which affected their knowledge about dental visit practices due to fear of infections (25). A study performed in India indicated a change in the attitudes of the mother since the dental operations involve aerosols such as saliva that could enhance the spread of covid 19. A study in Brazil also indicated the same whereby a few were willing to take their children to the dental clinics due to fear and lack of basic Knowledge (26). This group comprised mothers with children in pain and emergency cases of dental caries. This study intends to equip the Jordanian mothers with knowledge about dental visits in the recommendations after analyzing the data collected (27).

Ramroop, Wright & Naidu (2011) points out that most countries have experienced a decline in mothers taking their children for the first dental visits. Mothers believed that hospitals were the most dangerous places than public areas. The previous studies have also identified statistical associations between medical clinics and dental clinic dangers in infections (28). Mothers have to be equipped with knowledge about the importance of the first dental clinics to prevent dental caries from fostering children’s oral health (29). This study intends to provide such information to Jordanian mothers for the safety of their children concerning oral health.

According to Vollay, (2018), knowing the schedule of dental visits is important to mothers to prevent the prevalence of ECC despite basic home routines such as diet, brushing practices, and fluorides. This information helps identify possible dangers in the children’s oral cavity health that would otherwise affect the well-being of the children if not attended to medically (30). Children are colonized by the s. mutants from their mothers at the age of two years; therefore, dental visits help prevent the development of dental caries (31). The AAP recommends mothers to be assessed about their knowledge about the importance of the dental visits, whether there is pain or not, to establish awareness programs to encourage such visits.

Knowledge of Mothers Regarding Teeth Brushing

Wagner & Heinrich-Weltzien (2017) state that teeth decay is caused by dietary habits influenced directly by the mothers’ knowledge. Mothers provide food such as sugary and sticky, which enhance the prophylaxis of teeth decay in children, thus affecting the children’s oral health. Studies have indicated a correlation between the knowledge and health literacy of the mother and the early childhood health of their children (32). Here, highly educated mothers have better oral health knowledge than low educated ones, which greatly affects children between 6 to 10 years (33). The study indicated that early guidance from parents leads to fewer incidences of dental caries.

 Mothers need to know the importance of breastfeeding and the use of nocturnal bottles to prevent the development of diseases. Previous studies indicated that bottle-fed children had a high caries prevalence (33). They identify that breastfeeding prevents dental caries in children. Mothers have to be equipped with knowledge about the importance of breastfeeding their children exclusively for the first six months before weaning (33). Disagreement between the bottle-feeding causing dental caries calls for further studies to clarify the existing association.

Sugary and sticky foodstuffs contribute immensely to the development of caries if proper hygiene is not practiced in children. Children prefer sugary foods to those with less sugar that are more nutritious (34). Studies carried out indicated the mothers’ knowledge about the choices of food but did not correlate to the prevalence of caries in children (35).

According to Gezgin et al, (2018), mothers are the direct caregivers of their children; therefore, they have the general responsibility of developing the schedule for oral health care for their children to avoid the occurrence of ECC and irregular teeth. Oral health determines children’s overall well-being and health (35). Mothers have to be equipped with basic knowledge about the causes of irregularities in teeth development for their children. This can help enhance the basic oral care for their children, such as hygiene brushing, and dental visits. Improving the mothers’ knowledge greatly impacts positively on the oral health of the children (36). However, the kind of knowledge to be equipped is missing in such studies. Therefore, this study intends to provide the type of knowledge to be offered to the mothers to improve their children’s oral health by identifying the causes of teeth that are irregular.

 The mother’s attitudes on when to visit the dentist greatly determine the children’s oral health. According to the current studies, most mothers with low education levels and low economic status believe that the dentist can only be visited in case of problems or pain (37). This indicated that their children’s oral health is greatly affected by the ECC. Some of the schooled mothers do not care to visit nor the development of caries as long as there is no pain in their children’s teeth. A small percentage of such women visit the dentist after the six months of the eruption of their children’s milk teeth; therefore, prevention of the development of ECC is fostered (38). However, the studies did not give a specific calendar of how the mothers have to visit the dentist. This study intends to provide the basis of when and how frequently the mothers have to take their children to the dentist for checkups despite not having pains or decay(39).

Age of Starting Teeth Brushing

 Mothers are the role models to their children in terms of knowledge, attitudes, and practices that involve oral health from brushing, diet, and other health practices that improve the children’s oral health. In socially disadvantaged groups, mothers do not value the need to practice teeth brushing for their children, unlike in high social class, whereby the parents are involved in guiding their children about oral health through brushing of teeth to prevent ECC (40). These groups of women visit the dentist frequently to check the children’s health, unlike the other great percentage that visits oy when there is a pain to be guided in how to brush and what products to use to brush teeth (41). To maintain better oral health, the children and mothers have to work together by commencing prevention measures such as brushing at young ages (42). This study assesses the attitudes of the Jordanian mothers to help analyze the measures to be put in place for the brushing to be fostered in children.

 According to Ramroop, Wright & Naidu (2011), mothers’ attitudes towards the oral health of their children determine the oral health of their children. Socially disadvantaged groups are greatly affected by ECC despite the increased awareness about preventive measures. Studies in India have indicated an increased prevalence of ECC in disadvantaged social groups due to a lack of primary oral care and assessment of oral health programs (43). However, other studies in the USA indicated a lack of knowledge about the sugary foods carcinogenicity, and the parents believed in sealing the teeth in case of pain and teeth loss at early stages. The mothers’ attitudes indicated that caries is not such a problem as they can be handled and cured (45). To achieve the best oral health outcomes in children, mothers, direct caregivers have to be equipped with basic knowledge in their children’s oral health to ensure the well-being of their babies (46). This study intends to use the Jordanian mothers to gauge the attitudes that will greatly impact the type of knowledge to such mothers to change the attitudes that negatively influence their children’s oral health.

 Pandey, et al. (2021) elaborate that after meals, food particles often remain in the teeth of children. Brushing the teeth after every meal prevents the development of ECC as the food particles are washed away immediately. In infants, the attitudes of the mother towards cleaning teeth, the kinds of toothpaste, and the frequency of cleaning determine the oral health of their children. The studies conducted using a self-administered questionnaire show that most mothers do not care about brushing their children’s teeth as long as dental caries do not develop with pain (47). In contrast, others learned with diplomas would visit the dentist for guidance. The level of education of the mother determines the children’s oral health based on the products to be used during cleaning and how frequently the brushing has to be done (48). Learned mothers teach their children about dentistry for the signs of tooth decay to be known. Therefore, this enhanced the children’s oral health of educated mothers (48). However, there was no significant difference between the toothbrush exchange intervals and dental visits frequency in this study in such studies.

Frequency of Teeth Brushing

Dental visits help the mothers understand both the oral cavity and their children’s health. The occurrence of dental caries can be realized early enough and be treated, unlike for the mothers who do not visit the dentist. In the current studies, most mothers visit the dentist when the children have problems with their oral health, while a small percentage of the mothers visit after six months of the eruption of the milk teeth (49). In another Sudanese study, the mother responded that the children do not complain of pain, which indicated that no dental visits are practiced by the mothers unless there is trouble with their children’s oral health. There is a need for creating strong awareness to mothers about the importance of dental visits and treatment for their children. Socioeconomic status also determines the number of dental visits (50). Those in low status were more affected with dental caries in childhood and adulthood, unlike those of high social classes (50). This study provides the basis of the practices of the mother on how and when to visit the dentist both on the permanent and deciduous dentition of their children, thus providing basic knowledge of oral health to parents.

Based on the views by Gavic, Maretic, Putica, & Tadin (2022) it true that oral hygiene refers to the practices that entail the general cleaning of the oral cavity of the children to enhance oral health by preventing the development of ECC in children (51). The mothers’ knowledge influences their practice as the study by Suresh in 2010 indicated that mothers start brushing their children’s teeth after all the primary teeth have erupted (52). Another study presently indicates different information as some begin brushing after the sprout of the first milk teeth, others after 4-6 teeth, and others after all the primary have erupted. These indicated a lack of oral hygiene practices among the mothers (53). In the present studies, mothers use brushes, twigs, and fingers to brush their children’s milk teeth, which greatly contribute to their oral hygiene. School-going children have greatly benefited in terms of using Fluoridated kinds of toothpaste twice a day as it is taught at schools (54). Non-school-going children are affected by the mothers’ practices as they determine the oral hygiene of the babies.

Dye et al,. (2011) state that diet determines an individual’s health from childhood to adulthood because development, growth, and metabolic activities are influenced. The diet contributes to the development of diseases such as dental caries (55). Therefore, studies about the dietary practices on children have to be done from birth and study the changes as the children grow up. Generally, children have innate rating habits as they prefer certain tastes. Mothers have to repeatedly expose the children to such a diet until acceptance is stimulated (56). Studies indicate that mothers directly influence the quality of diet and the eating habits of their children, according to Jansen. Children decide to take the food offered or not, but the determinants are the mothers. According to Kroller, the mother’s nutritional status is associated with their children’s as they directly touch the diet of their children daily (57). The available knowledge of the mother influences the practices of their children’s diet such as brushing, use of Fluoridated kinds of toothpaste, eating habits, and use of sugary foods. There was a direct correlation between the consumption of sugary foods and the occurrence of dental caries in children.

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