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Pediatric Dental Journal

journal homepage: www.elsevier .com/locate /pdj

Original Article

Knowledge of preventive child oral healthcare amongexpectant mothers in Port Harcourt, Nigeria

Joycelyn Odegua Eigbobo*, Elfleda Angelina Aikins, Chukwudi Ochi Onyeaso

Department of Child Dental Health, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, EasteWest Road,

Choba Port Harcourt 500001, Nigeria

a r t i c l e i n f o

Article history:

Received 10 January 2012

Received in revised form

18 September 2012

Accepted 5 October 2012

Available online 6 May 2013

Keywords:

Preventive oral health

Dental visits

Mothers’ perception

* Corresponding author.E-mail address: odegwabobo@yahoo.com

0917-2394/$ e see front matter ª 2013 The Jahttp://dx.doi.org/10.1016/j.pdj.2013.03.002

a b s t r a c t

This study was carried out to assess the perception of preventive oral care in children

among expecting mothers at the antenatal clinic of University of Port Harcourt Teaching

Hospital, Nigeria. Women who already had one or more children were selected; partici-

pants were drawn from among them by consent and a structured questionnaire was

administered. Information obtained included sociodemographic information (age, educa-

tional level, employment status, and the parity of the women) and participants’ perception

of child dental care. Data collection spanned a period of four weeks. Three hundred and

eighty two respondents participated and they had a mean age of 30.6 (�4.3 SD) years. The

majority of the participants were 26e35 years old (76%) and were primiparous (49.5%) with

tertiary education (67%). Toothache was their reported reason for a child’s first visit to the

dentist (47.4%) while routine dental check-up accounted for (42.7%). A third (35.3%) of the

participants agreed that tooth cleaning should begin as soon as the first tooth erupts; 20.7%

opined that soft toothbrush and toothpaste are choice materials for cleaning. There were

statistically significant associations between parity and (i) child’s visit to the dental clinic

( p ¼ 0.00); and (ii) the material used in cleaning the baby’s teeth ( p ¼ 0.00). Also, educa-

tional status and knowledge of routine dental check-ups were significantly associated

( p ¼ 0.04). The perceptions of dental visits, cleaning of teeth, and commencement of un-

assisted tooth brushing in children were poor. Pediatric oral health education should be

incorporated into ante- and post-natal clinics.

ª 2013 The Japanese Society of Pediatric Dentistry. Published by Elsevier Ltd. All rights reserved.

1. Introduction smiling [3]. Early childhood caries is still a problem that per-

Oral healthcare is an important aspect of general healthcare

that has an impact on the quality of life and health outcomes

in infants and children [1]. In children, it is a major factor in

the prevention of dental caries, which is the most common

childhood dental problem [2]. Dental caries has an impact on

various oral functions including eating, speaking, and even

(J.O. Eigbobo).panese Society of Pediatric

sists in many parts of the world especially in developing na-

tions such as Nigeria [4e6]. It has been associated with low

income [7e9], fewer dental visits [10e12], lower educational

levels of mothers [13], and low levels of knowledge of oral

healthcare among mothers [14].

Mothers are a primary source of early education in children

with regard to good hygiene and healthy nutritional practices

Dentistry. Published by Elsevier Ltd. All rights reserved.

Table 1 e Sociodemographic characteristics of the

p e d i a t r i c d e n t a l j o u r n a l 2 3 ( 2 0 1 3 ) 1e72

[1].Thus,pediatricoralhealthcareshouldbegin ideallywithpre-

natal oral health counseling for parents, especially mothers

who usually spend more time with the children. The first oral

examination is recommended at the time of the eruption of the

first tooth and no later than 12 months of age [15]. Pre-natal

counseling ideally should be provided by all health pro-

fessionals (dentalandnon-dental)becauseearly involvementof

parents will form the foundation on which positive behavior

patterns can be built. There is increasing evidence suggesting

that to be successful in preventing dental disease, preventive

interventionsmust begin within the first year of life [16,17].

These interventions encourage healthy dietary habits,

facilitate proper monitoring of the developing dentition and

occlusion, prevent dentofacial accidental injuries, and iden-

tify oral habits that may be detrimental to occlusal develop-

ment and general health of the oral tissues [11,15]. Hence, the

level of knowledge of pediatric oral healthcare of mothers will

determine their ability to enforce and enhance such practices

in their children.

Although few studies have been carried out on knowledge

or perceptions of ante-natal women on pediatric oral health in

the south west region of Nigeria [12,18], there is paucity of

information on the commencement/timing of preventive oral

healthcare in children [18]. Meanwhile, there has been no

such study in the South-South region of Nigeria. Residents in

the South-South region of Nigeria have relatively poor dental

awareness [11]. With the presence of a new dental school in

the University of Port Harcourt, there is a need to increase

dental awareness as well as documentation of basic data for

future research efforts. Therefore, the aim of our study was to

assess mothers on their knowledge of preventive oral

healthcare in the pediatric population.

respondents.

Sociodemographic information N (%)

Age (years)

<20 5 (1.3)

21e25 34 (8.9)

26e30 163 (43.5)

31e35 124 (32.5)

36e40 49 (12.8)

>40 4 (1)

Level of education

Uneducated 1 (0.3%)

Primary 8 (2.1%)

Secondary 120 (31.4%)

Tertiary 253 (66.2)

Occupation

Artisan 14 (3.7)

Civil servant 93 (24.4)

Trader 138 (36.1)

Applicant/full time house wife 86 (22.5)

Professional 13 (3.4)

Student 38 (9.9)

Employment status

Employed 126 (33)

Unemployed 256 (67)

Number of children

One 189 (49.5)

Two 106 (27.7)

Three 51 (13.4)

Four 26 (6.8)

More than four 10 (2.6)

2. Methods

The study involved antenatal attendees at University of Port

Harcourt Teaching Hospital, Port Harcourt (UPTH) who

already had one or more children. They were recruited over a

period of four weeks. Informed consent was another criterion

for inclusion. An anonymous structured questionnaire was

administered to all participants and one of the investigators

(JOE) was available throughout to make any required clarifi-

cations to subjects.

The questionnaire had two sections: the first involved de-

mographic information such as age as at last birthday,

educational level, and employment status. The age was

further grouped into 1 ¼ <20 years, 2¼ 21e25 years, 3¼ 26e30

years, 4¼ 31e35 years, 5 ¼ 36e40 years and 6¼>40 years. The

parity of themotherswas noted. The second section pertained

to information about their perception of dental care for their

children. The section included, but was not limited to, such

questions as when they thought their children should first

visit a dentist and for what reason a dental visit is deemed

necessary. Also, when their children’s teeth should be

cleaned, what should be used in cleaning, and when the child

should start cleaning their teeth themselves? They were also

asked the importance of dental visits for their children and

whether any of their children had visited a dentist before,

purpose of visit, and the treatment administered.

3. Data analysis

Data processing and analysis were carried out with the SPSS

statistical package (Statistical Package for the Social Sciences

Version 17.0 for Windows 2009, SPSS, Inc., Chicago, IL, USA).

Descriptive statistics were performed. Chi-square test was

used to test association between parity and perception of

pediatric oral care with statistical significance set at p < 0.05.

4. Results

4.1. Sociodemographic characteristics

There were 382 respondents with an age range of 17e42 years

and mean age of 30.6 (SD � 4.3) years. The majority (76%) of

the participants were 26e35 years old and 49.5% had only one

child. Most of the mothers were highly educated, only 2.4%

had primary education or less. About two-thirds (67%) had

tertiary education while 33% of the respondents were

employed with details shown in Table 1.

4.2. Perception of oral healthcare

Table 2 shows the frequencies of the questions on the

mothers’ perception of oral healthcare for their children. The

Table 2 e Mothers’ perception of preventive oral healthpractices in children.

n (%)

When should a child visit the dentist

For routine check-up once a year 78 (20.4)

For routine check-up twice a year 71 (18.6)

When there is pain 163 (42.7)

I don’t know 70 (18.3)

When should your child go for the first visit to the dentist?

Toothache 181 (47.4)

Tooth decay 40 (10.5)

When the first (milk) tooth erupts 89 (23.3)

Don’t know 72 (15.5)

When should you start cleaning your child’s teeth?

When all milk teeth erupt 137 (35.9)

When all permanent teeth erupt 52 (13.6)

When one (milk) tooth erupts 135 (35.3)

Don’t know 58 (15.2)

When should children start brushing by themselves?

Two years 141 (36.9)

Five years 188 (49.2)

Eight years 45 (11.8)

Fifteen years 3 (0.8)

Don’t know 5 (1.3)

What should be used in cleaning a baby’s teeth?

1. Cotton wool and salt 72 (18.8)

2. Cotton wool and toothpaste 56 (14.7)

3. Face towel and mild soap 9 (2.4)

4. Face towel and water 132 (34.6)

5. Soft toothbrush and toothpaste 79 (20.7)

6. Combinations of

1 � 2 � 3 � 4 � 5

28 (7.4)

7. Don’t know 6 (1.6)

p e d i a t r i c d e n t a l j o u r n a l 2 3 ( 2 0 1 3 ) 1e7 3

mothers generally seemed to perceive oral care to be for the

treatment of pain with almost equal numbers of the partici-

pants indicating that a child should visit the dentist when in

pain (42.7%) and the reason for a child’s first visit to the dentist

should be due to toothache (47.4%). A fifth (20.7%) of the par-

ticipants indicated that soft toothbrush and toothpaste should

be used to clean children’s teeth, whilst a larger percentage of

the mothers (34.6%) indicated that face towel and water

should be used. Almost equal numbers reported that tooth

brushing should begin as soon as the first tooth erupts (35.3%)

or when all the milk (primary) teeth have erupted (35.9%)

while about half of themothers (49.2%) thought that five years

was the correct age for children to start brushing their teeth by

themselves (Table 2).

There was a statistically significant association ( p < 0.05)

between the number of children and (i) the visit to the dental

clinic ( p ¼ 0.00), and (ii) the material used in cleaning the

baby’s teeth ( p ¼ 0.00) as shown in Table 3. Also, there was a

statistically significant association between the educational

status and mothers’ knowledge of (i) the frequency of routine

dental check-ups ( p ¼ 0.04), and (ii) the importance of dental

visits ( p ¼ 0.01) (Table 4).

Although 83.6% said that dental visits were important

(Fig. 1), only 8.4% of the mothers had taken their children to

visit the dentist (Fig. 2), the largest proportion (26.9%) being for

toothache (Fig. 3).

5. Discussion

This studywas conducted in a public hospital and therebywas

open to all cadres of patients irrespective of educational or

social status. However, the study sample comprises mainly

educated women as only one of the participants was unedu-

cated. This may be attributable to greater patronage of tradi-

tional birth attendants and private midwives due to lack of

awareness and low socio-economic class of uneducated

women [19]. However, in this Nigerian study there was a sig-

nificant positive correlation between level of education and

perception of importance of preventive dental visits for chil-

dren. Interestingly, this was not reflected in practice as only

8.4% of mothers had taken their children to the dentist

whether for treatment or routine check-ups.

As an effective way to begin a lifelong program of preven-

tive dentistry, the American Academy of Pediatric Dentistry

(AAPD) recommends that dental visits begin with the

appearance of a child’s first tooth, typically around sixmonths

but no later than one year [15,20]. Family oral health educa-

tion, examination, anticipatory guidance, fluoride intake

assessment, oral hygiene instruction, and risk assessment are

all part of the age-one dental visit which gradually introduces

the child to the dental environment initiating a relationship

between the child, parent, and dental care giver [11,21,22].

In this study, less than a quarter of the respondents knew

that a child’s first visit to the dentist should be when the first

tooth erupts. Rather, 47.4% of participants believed that the

first dental visit should be when the child has toothache. This

observation is similar to studies inMalaysians [4], Indians [22],

Americans [23], and Bulgarians [24]. Half the participants of

the American study believed that children should see a dentist

between 2 and 4 years of age [23] and 58.8% of caregivers in the

Malaysian [4] study did not believe that children should see a

dentist before 2 years of age. In the retrospective study in In-

dians by Meera et al. [22], 42% presented with pain and the

majority (59.1%) had their first dental visit between the age of

6 and 12 years. Also, the Bulgarian [24] study reported that the

majority of children making their first dental visit were 3e6-

year-olds (51.9%) and the least attendance was in the children

younger than one year (1.73%). On the contrary, a study in four

communities within Manitoba, Canada reported 74.7% of the

caregivers (guardian and majority being mothers) favored a

dental visit by the age of one year [25].

Most importantly, early first dental visits have been re-

ported [21] to have a significant positive effect on dentally

related expenditure, with the average dentally related costs

being lower for children who received earlier preventive care.

Also, children that had a preventive dental visit by age one

were likely to have subsequent preventive visits rather than

subsequent restorative or emergency visits compared to those

who did not [21].

Although over 80% of mothers acknowledged the impor-

tance of routine dental visits, less than a fifth acknowledged

that routine visits should be twice a year. Furthermore, 42.7%

of the mothers in this study indicated that their children

should visit the dentist when in pain. Among the 8.4% of the

women that took their children to the dental clinic, only 23.1%

of these went for routine dental check-ups. Hence, the

Table 3 e The association between mothers’ parity and knowledge of pediatric oral care.

1 Child 2 Children 3 Children 4 Children >4 Children

How often should a child visit the dentist?

Once a year 42 (22.2) 23 (21.7) 7 (13.7) 4 (15.4) 2 (20)

Twice a year 36 (19.0) 16 (15.1) 12 (23.5) 6 (23.1) 1 (10)

When there is pain 74 (39.2) 46 (43.4) 24 (47.1) 13 (50) 6 (60)

Don’t know 37 (19.6) 21 (19.8) 81 (5.7) 3 (11.5) 1 (10)

c2 ¼ 7.232, p ¼ 0.84

When should children have their 1st visit to dentist?

Toothache 87 (46.0) 52 (49.1) 21 (41.2) 15 (57.7) 6 (60)

Tooth decay 17 (9.0) 6 (5.7) 12 (23.5) 3 (11.5) 2 (20)

1st milk tooth erupts 51 (27.0) 22 (20.8) 11 (21.6) 4 (15.4) 1 (10)

Don’t know 34 (18.0) 26 (24.5) 7 (13.7) 4 (15.4) 1 (10)

c2 ¼ 19.505, p ¼ 0.08

*Has/have your child/children visited the dental clinic?

Yes 6 (3.2) 12 (11.3) 6 (11.8) 7 (26.9) 1 (10)

No 189 (96.8) 94 (88.7) 45 (88.2) 19 (73.1) 9 (90)

c2 ¼ 20.183, p ¼ 0.00

When should you start cleaning your child’s teeth?

When all milk teeth erupt 70 (37.0) 43 (40.6) 12 (23.5) 8 (30.8) 4 (40)

When the permanent teeth erupt 23 (12.2) 12 (11.3) 11 (21.6) 4 (15.4) 2 (20)

When one milk tooth erupts 67 (35.4) 33 (31.1) 21 (41.2) 11 (42.3) 3 (30)

Don’t know 27 (14.3) 18 (17.0) 17 (13.7) 3 (11.5) 1 (10)

c2 ¼ 10.817, p ¼ 0.82

*What should be used in cleaning the baby’s teeth?

1 ¼ Cotton wool & salt 31 (16.4) 22 (20.8) 12 (23.5) 6 (23.1) 1 (10)

2 ¼ Face towel and water 65 (34.4) 32 (30.2) 20 (39.2) 10 (38.5) 5 (50)

3 ¼ Soft toothbrush and toothpaste 47 (24.9) 27 (25.5) 3 (5.9) 1 (3.8) 1 (10)

4 ¼ Face towel and mild soap 5 (2.6) 1 (0.9) 3 (5.9) 0 (0) 0 (0)

5 ¼ Cotton wool and toothpaste 29 (15.3) 14 (13.2) 8 (15.7) 4 (15.4) 1 (10)

Combination of 1 � 2 � 3 � 4 � 5 9 (4.8) 22 (20.8) 5 (9.8) 5 (19.2) 1 (10)

Don’t know 3 (1.6) 2 (1.9) 0 (0) 0 (0) ‘1 (10)

c2 ¼ 96.874, p ¼ 0.00

When should children start brushing by themselves?

2 years 60 (31.7) 45 (42.5) 21 (41.2) 11 (42.3) 4 (40)

5 years 102 (54.0) 50 (47.2) 22 (43.1) 10 (38.5) 4 (40)

8 years 22 (11.6) 10 (9.4) 7 (13.7) 5 (19.2) 1 (10)

15 years 1 (0.5) 1 (0.9) 5 (19.2) 0 (0) 0 (0)

Don’t know 4 (2.1) 0 (0) 0 (0) 0 (0) 1 (10)

c2 ¼ 17.248, p ¼ 0.37

*Significant p � 0.05.

p e d i a t r i c d e n t a l j o u r n a l 2 3 ( 2 0 1 3 ) 1e74

practice of routine dental check-ups among these mothers is

poor. This corroborates the earlier observations among

Nigerians [11,12], where a small proportion (7.97% and 4.1%,

respectively) of children had been to dental clinics for routine

dental check-ups. Also, this reflects mothers’ behaviors who

attend dental clinics only when in pain as reported by Adeniyi

et al. [26].

Previous studies [27,28] in Ibadan, Nigeria have shown the

need for intensified dental education to reduce the incidence

and prevalence of some malocclusal traits among Nigerian

children. In one of those studies [27], Onyeaso and Onyeaso

found that over half of the children studied needed one form

of preventive/interceptive intervention or other to promote

occlusal development in children.

Good oral hygiene practices are formed as soon as the child

is born; the oral cavity is regularly cleaned even before tooth

eruption. The AAPD recommends that parents should begin

cleaning the children’s teeth from when they first erupt

[15,20]. Damp face towels or wash cloth wrapped around a

finger [29] or a very soft toothbrush may be used to remove

plaque [20,29]. Also, it is beneficial for an adult to assist tooth

brushing until the child has the dexterity to remove plaque

effectively by themselves and this is when the child is about

8e10 years old [29,30]. In this study, almost equal numbers of

the mothers believed that tooth cleaning should begin when

the first milk tooth erupts (35.3%) or when all the milk teeth

have erupted (35.9%). About half of the mothers (49.2%) indi-

cated that the preferred age for the children to start brushing

their teeth without any assistance was five years, whilst 36.9%

stated two years as the ideal age, and only a tenth of the

women indicated eight years. While a face towel and water

were preferred by a third of the respondents (34.6%) for teeth

cleaning, only 20.7% chose to use a soft brush and toothpaste.

This was higher than the 8% of the women who used a

toothbrush and toothpaste to clean their children’s teeth re-

ported by Orenuga and Sofola [12]. The mothers did not have

adequate knowledge of oral healthcare as depicted by their

oral care practices.

Fig. 2 e Has any of your children visited the dental clinic?

,, No; -, Yes.

Table 4 e The association between mothers’ educational level and knowledge of pediatric oral care.

No education Primary Secondary Tertiary

*How often should a child visit the dentist?

Once a year 0 (0) 0 (0) 18 (15.0) 60 (24.2)

Twice a year 0 (0) 3 (37.5) 17 (14.2) 50 (20.2)

When there is pain 1 (100) 5 (62.5) 65 (54.2) 91 (36.7)

Don’t know 0 (0) 0 (0) 20 (16.7) 47 (19.0)

c2 ¼ 77.65, p ¼ 0.04

When should children have their 1st visit to dentist?

Toothache 1 (100) 6 (75.0) 57 (47.5) 116 (46.8)

Tooth decay 0 (0) 0 (0) 16 (13.3) 23 (9.3)

1st milk tooth erupts 0 (0) 1 (12.5) 25 (20.8) 63 (25.4)

Don’t know 0 (0) 1 (12.5) 22 (18.3) 46 (18.5)

c2 ¼ 5.831, p ¼ 0.76

Has/have your child/children visited the dental clinic?

Yes 0 (0) 0 (0) 14 (11.8) 17 (6.9)

No 1 (100) 8 (100) 105 (88.2) 231 (93.1)

c2 ¼ 3.391, p ¼ 0.34

When should you start cleaning your child’s teeth?

When all milk teeth erupt 0 (0) 6 (75.0) 40 (33.3) 89 (35.9)

When the permanent teeth erupt 0 (0) 0 (0) 19 (15.8) 31 (12.5)

When one milk tooth erupts 1 (100) 2 (25.0) 38 (31.7) 94 (37.9)

Don’t know 0 (0) 0 (0) 22 (18.3) 33 (13.3)

c2 ¼ 11.263, p ¼ 0.51

What should be used in cleaning the baby’s teeth?

1 ¼ Cotton wool & salt 0 (0) 2 (25.0) 23 (19.2) 47 (19.0)

2 ¼ Face towel and water 0 (0) 3 (37.5) 41 (34.2) 86 (34.7)

3 ¼ Soft Toothbrush and toothpaste 0 (0) 2 (25) 21 (17.5) 56 (22.6)

4 ¼ Face towel and mild soap 0 (0) 0 (0) 3 (2.5) 5 (2.0)

5 ¼ Cotton wool and toothpaste 1 (100) 0 (0) 17 (14.2) 38 (15.3)

Combination of 1 � 2 � 3 � 4 � 5 0 (0) 3 (37.5) 35 (29.2) 69 (27.8)

Don’t know 0 (0) 0 (0) 1 (0.8) 3 (1.2)

c2 ¼ 33.817, p ¼ 0.89

When should children start brushing by themselves?

2 years 1 (100) 5 (62.5) 43 (35.8) 90 (36.3)

5 years 0 (0) 2 (25.0) 60 (50.0) 123 (49.6)

8 years 0 (0) 1 (12.5) 13 (10.8) 31 (12.5)

15 years 0 (0) 0 (0) 1 (0.8) 2 (0.8)

Don’t know 0 (0) 0 (0) 3 (2.5) 2 (0.8)

c2 ¼ 6.289, p ¼ 0.90

*p value is significant p < 0.05.

Fig. 1 e Are dental visits important? ,, No; -, Yes.

p e d i a t r i c d e n t a l j o u r n a l 2 3 ( 2 0 1 3 ) 1e7 5

Fig. 3 e If your children have visited the dental clinic, what

was done? Bar represents purpose of visit.

p e d i a t r i c d e n t a l j o u r n a l 2 3 ( 2 0 1 3 ) 1e76

6. Conclusion

Although a good proportion of mothers acknowledged that

dental visits were important, their perceptions of timing and

purpose of dental visits, tooth cleaning materials, and

commencement of unassisted tooth brushing in children

were poor.

7. Recommendation

We therefore recommend that pediatric oral health education

(care) be part of ante- and post-natal clinics, and that all

health workers involved with ante- and post-natal clinics

need to be educated in oral healthcare. Also, oral health

workers should be incorporated into these clinics to give oral

health education, since this is a time when the women are

open to receiving new information.

Disclosure

None of the authors have any conflicts of interest that should

be disclosed.

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