|Year : 2020 | Volume
| Issue : 4 | Page : 338-343
Mothers’ knowledge about signs, symptoms, and management of teething and its relation to their educational level in Egypt: A Cross-sectional Study
Gehan G Allam
Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Ain Shams University, Abbasya, Cairo, Egypt
|Date of Submission||07-Nov-2019|
|Date of Decision||04-Jan-2020|
|Date of Acceptance||07-Jan-2020|
|Date of Web Publication||20-Aug-2020|
Dr. Gehan G Allam
Department of Pediatric and Dental Public Health, Faculty of Dentistry, Ain Shams University, El-Khalyfa El-Mamoun Street, Abbasya, Cairo.
Source of Support: None, Conflict of Interest: None
Aim: Many physical disturbances have been related to teething. Inappropriate knowledge of mothers and their misconceptions about teething may intervene with the prompt diagnosis and management of severe illnesses. The aim of this study was to evaluate the knowledge of mothers about teething, to determine how they used to manage its problems, and to investigate the association between the education status of mothers and their management of teething problems. Materials and Methods: A cross-sectional survey was performed using a self-administered questionnaire conducted on mothers of children aged 1–3 years, recruited from the outpatient clinic. The questionnaire consisted of four sections. Results: The needed sample size was derived to be 120 mothers. All mothers revealed that their children had at least one of the symptoms that were presented in the questionnaire. Response to teething was wrongly accompanied with fever (76%), diarrhea (80%), and sleep disturbances (86%). The mothers in the age-group 20–24 years showed significantly higher level of knowledge than those in other age-groups. Regarding mother’s education, university and diploma groups had significantly higher level of knowledge than others. Conclusion: Among 120 mothers, 50.8% and 35.8% had poor and moderate level of knowledge about teething, respectively. Furthermore, only 13.3% had good level of knowledge regarding teething.
Keywords: Education, Eruption, Survey, Symptoms, Teething
|How to cite this article:|
Allam GG. Mothers’ knowledge about signs, symptoms, and management of teething and its relation to their educational level in Egypt: A Cross-sectional Study. J Int Oral Health 2020;12:338-43
|How to cite this URL:|
Allam GG. Mothers’ knowledge about signs, symptoms, and management of teething and its relation to their educational level in Egypt: A Cross-sectional Study. J Int Oral Health [serial online] 2020 [cited 2022 Aug 17];12:338-43. Available from: https://www.jioh.org/text.asp?2020/12/4/338/292756
| Introduction|| |
Eruption is defined as the normal physiological process by which tooth breaks through the alveolar bone until it reaches an antagonist. Tooth eruption begins approximately by 4–10 months after birth. Eruption of full set of primary teeth is nearly completed by approximately 3 years of age. Many physical disturbances have been related to teething, which include pain, gingival inflammation overlying the tooth, irritability, inappropriate sleep, increase salivation, bowel upset, loss of appetite, and ear rubbing on the same side of the erupting tooth.
Many mothers in previous studies were convinced that teething could cause severe health problems.,,, In an Australian survey for parents, Wake et al. found parents related pain (85%), irritability (82%), sleep disturbance (78%), mouthing or biting (78%), drooling (77%), red cheeks (75%), fever (70%), nappy rash (50%), and infections (48%) to teething.
Cultural and social differences had a critical role in the mothers’ psychological responses to and awareness of the child’s illness, utilization of dental health services, and seeking the help of health professionals. It could be argued that any factor that influences women’s educational progress (e.g., early pregnancy accompanied by low socioeconomic status) may affect the child’s health.
Mother’s wrong beliefs may interfere with the prompt diagnosis and management of severe illnesses. Despite this, a search of literature displayed lack of studies performed in Egypt to evaluate mothers’ knowledge, practices, and how they used to manage their children’s teething troubles. Hence, this study aimed to evaluate mothers’ knowledge about teething signs and symptoms in Egypt, to assess the ways they used to manage teething troubles, and to find if there is an association between the educational status and the knowledge of mother about how to manage teething problems.
It is believable that the results of our study will help internationally or at least at the regional level in the design of educational programs to improve mothers’ knowledge about teething and their practices for managing teething troubles.
| Materials and Methods|| |
Study setting and population
A cross-sectional study was conducted in our department. Ethical approval was obtained from the ethical committee of dental research (FDASU-REC M109501) before the beginning of the study, and a written informed consent was obtained from mothers who agreed to participate.
The sample size estimation was obtained from the following formula:
According to Kish, with an expected prevalence of 5.5% and an expected precision (or margin of error) d = 4% with 95% confidence interval, the needed sample size was derived to be 100 mothers.
All mothers who had children aged 1–3 years, who visited the Department in May 2018, and who agreed to participate were surveyed.
Exclusion criteria included mothers of children of age >3 years, who had refused to participate in the study for any reason. Their refusal did not affect the health-care services delivered to them by any means.
The total sample size was chosen to be 110 mothers.
An Arabic form of the questionnaire was created by the researcher based on the review of relevant literature. Its content and clarity were validated by a jury of 15 academic staffs (5 public health, 5 pediatric nursing, and 5 pediatric dentists).
The questionnaire, which consisted of four parts, underwent pilot testing and was modified before administration.
Part A: Consisted of eight questions to assess mothers’ and children’s demographic characteristics.
Part B: Consisted of four questions to assess mothers’ knowledge about teething and other conditions related to child.
Part C: Consisted of 14 questions that assessed mothers’ knowledge about signs and symptoms of teething.
Part D: Consisted of six questions that investigated how the mothers used to manage teething troubles.,,,
Responses to part A, B, and C were structured using “agree,” “disagree,” and “don’t know” options, and responses to part D were structured using “yes” or “no” options.
The questionnaire form was conducted by face-to-face interview technique.
Data management and analysis: The reliability of the questionnaire was tested using Cronbach α coefficient (0.86).
Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 21.0. Variables were described as number and percent. In categorical variables, χ2 test and unadjusted odds ratio (OR) were used for comparison between groups. Significant predictors of good knowledge in bivariate analysis were entered into a logistic regression using the forward Wald method, and adjusted OR was calculated. P ≤ 0.05 was considered statistically significant.
For calculation of knowledge score, each knowledge item obtained a score of “1” for the correct answer and “0” for wrong or do not know answers. A total score was calculated, and then for calculating the percent, the total score of each knowledge items was divided into: poor score (<50%), moderate score (50–<65), and satisfactory score (≥65).
| Results|| |
The sample size was derived to 116 mothers, although 130 mothers were asked to participate in the survey to compensate for nonresponders.
Response rate was 92.3%, as 120 mothers agreed to participate in our study.
Demographic profile of the study population is presented in [Table 1]. The mothers in the age-group 25–30 years represented majority (42%) of the participants. A total of 37% of mothers were having diploma degree and 65% were unskilled workers; 81% of the children were breastfed.
|Table 1: Descriptive statistic of mothers’ and children’s demographic characteristics|
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Degree of mothers’ knowledge about signs and symptoms of teething [Table 2] and about management of teething problems [Figure 1] was calculated and together with the total score of mothers’ knowledge about teething are shown in [Table 3].
|Table 2: Mothers’ knowledge about signs and symptoms accompanied with teething in percentage|
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|Table 3: Distribution of mothers’ group according to their knowledge about teething|
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Chi-square value in [Table 4] was used to correlate between the total score of mothers’ knowledge about teething and their demographic characteristics; poor knowledge was significant among mothers aged 31–35 years or more than that among mothers in the age-group 20–24 and 25–30 years with P = 0.0001. Regarding mother’s education, poor knowledge was significant among mothers with diploma degree (P = 0.0001) and unskilled workers (P = 0.001).
|Table 4: Correlation between total score of mothers’ knowledge about teething and their demographic and basic characteristics|
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Logistic regression analysis in [Table 5] revealed the significant independent predictors of satisfactory knowledge; the model showed that the age-group 20–24 years was significantly higher by OR = 2.98 than the age-group >35 years, also the age-group 25–30 years showed significant increase in knowledge more than the age-group >35 years by OR = 2.55, whereas the age-group 31–35 years showed insignificant difference than the age-group >35 years.
|Table 5: Multivariate logistic regression analysis of significant independent predictors of good knowledge about teething|
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Regarding mother’s education, university and diploma groups were significantly higher in level of knowledge than the secondary and less than secondary groups by OR, 3.01 and 2.2, respectively, while the secondary group showed insignificant difference than less than secondary group. Considering mother’s occupation, the skilled workers were significantly higher than the housewives by OR = 2.85, but the unskilled workers showed insignificant difference than the housewives. Whereas the number of siblings showed insignificant effect in logistic regression analysis.
| Discussion|| |
Mother is always the first person who notices any slight change in the child’s normal appearance, behavior, or health. They usually have more influence and responsibilities than father for the everyday duties of their children; hence, she is the one from where we can get our information.
We chose mothers having children aged from 1 to 3 years because at 1 year of age, the mothers had experienced the eruption of the first primary tooth of her child and at 3 years, the child was expected to have full set of erupted primary teeth, and also to minimize any recall bias.
This cross-sectional survey was chosen to be performed in Egypt as the results of the previous studies, showed that understanding of teething is different from one area to another. But our results revealed that Egyptian mothers related many common symptoms of their children’s diseases to teething, which was in association with many previous studies.,
This study revealed that the desire for biting, thumb sucking, and drooling were the most frequent local symptoms associated with teething.
Higher percentage of mothers in our study wrongly believed that diarrhea (80%) and fever (76%) were due to teething. Others falsely accompanied symptoms may be vomiting (6%), cough (48%), and disturbed sleep (86%). The most commonly assumed symptom recorded by mothers associated with teething was diarrhea (80%), whereas Wake et al., Owais et al., and Feldens et al. revealed less percentage than ours.
Most of the Egyptian mothers had wrong belief that their child’s diarrhea at this age was due to eruption, although diarrhea might be due to many other reasons as the children at this age used to explore the surrounding by placing any infected items in their oral cavity.
Diarrhea may accompanied in this age group with teething or without teething as in both situations; the child is liable to dehydration.,
Our investigations showed that 76% of mothers incorrectly related fever to teething; this was in agreement with a study conducted by Elbur et al., in which parents reported that teething causes fever and other signs and symptoms such as pain, irritability, sleep disturbance, and increased salivation. The percentage of mothers with these incorrect beliefs in our study exceeded to what was reported in a study by Feldens et al. (38.9%).
Many children at this age are liable to infection because of the reduction in circulating maternal humeral immunity and the establishment of the child’s own humeral immunity, which coincides with the time of eruption of the primary incisors (6–12 months). Hence, fever is a common symptom at that time, also fever may be accompanied by irritability, facial rash, and loss of appetite, and this may be due to the infection with the human herpes simplex virus, which is widespread among children of that age.
Among 100 mothers, 32%, 60%, and 8% had poor, moderate, and good level of knowledge about management of teething problems, and this seems logical as the number of children increases the mother gains more experience.
In this study, when mothers were asked about what they used to provide relief to the local discomfort associated with their child’s primary teeth eruption, 66% of them reported that they let the child bite on a teething object, 62% of them used local teething gel, which was approximately equal to the result of a study by Wake et al., which showed that 55% of mothers applied teething gels and 56% of mothers used to let the child bite on a cold object, which did not go with a study conducted by Kakatkar et al., who showed that only 33.8% of mothers allowed their children to bite on cold objects.
Only 34% of mothers used systemic analgesics to provide relief for the discomfort from teething, which was contrary to a study conducted by Wake et al., which showed that approximately 76% of mothers used systemic analgesics such as paracetamol, and in a study performed by Kakatkar et al., 62.7% of mothers also gave systemic analgesics to their children.
The mothers in the age-group 20–24 years showed significantly higher level of knowledge than those in the age-group >35 years, also the mothers in the age-group 25–30 years showed a significant increase in knowledge more than those in the age-group >35 years, whereas the mothers in the age-group 31–35 years showed insignificant difference than those in the age-group >35 years. This result was not in association with the Indian study performed by Fernandes et al.
Regarding mother’s education, university and diploma groups were significantly higher in the level of knowledge than the less than secondary group, whereas the secondary group showed insignificant difference than the less than secondary group, this result agreed with that of a study by Kakatkar et al., which showed statistically significant association between the education of mothers and knowledge about signs and symptoms of teething and the management of teething problems, although it did not agree with that of a study by Adam and Abhulimhen-Iyoha.
Considering the mother’s occupation, skilled workers were significantly higher than the housewives, but the unskilled workers showed insignificant difference than the housewives.
Number of sibling showed insignificant effect in logistic regression analysis, and the results agreed with those of a study by Fernandes et al.
Poor knowledge about teething is a common dental public health problem and is highly related to the improper health education; hence, it is essential to design educational programs to improve mothers’ knowledge about normal signs and symptoms of teething and to give them proper instructions about how to manage teething troubles, taking into consideration the views of mothers and the common belief related to “teething.” It is equally essential to stress that some symptoms should not be related to teething as children might be having a serious underlying cause.
One of the limitations of this research was the small sample size, which shows the necessity of the survey to be applied on larger population size and to include multiple geographical areas. Also the importance of evaluating the awareness of pediatricians regarding the oral health of children is essential in future research.
Among 120 mothers, 50.8% and 35.8% had poor and moderate level of knowledge about teething. Furthermore, only 13.3% had good level of knowledge regarding teething.
I would like to thank all mothers and their children who participated in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
Ethical policy and Institutional Review board statement
Patient declaration of consent
An informed written consent from guardians and/or mothers were taken for participation in the study and publication of the data for research and educational purposes. Participants were given freedom to withdraw from the study at any point. Regular care was also ensured in such cases.
Data availability statement
Data can be obtained on valid request to corresponding author mail ([email protected])
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]