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 Table of Contents  
ORIGINAL RESEARCH
Year : 2022  |  Volume : 14  |  Issue : 6  |  Page : 574-581

Oral health status and sociofamiliar aspects among 12-year-old schoolchildren: A correlational study


1 Faculty of Natural Resources, Escuela Superior Politécnica de Chimborazo, Riobamba, Ecuador; Faculty of Health Sciences, School of Dentistry, Universidad Nacional de Chimborazo, Riobamba, Ecuador
2 Faculty of Health Sciences, School of Dentistry, Universidad Nacional de Chimborazo, Riobamba, Ecuador
3 Faculty of Mechanics, School of Industrial Maintenance and Automotive, Escuela Superior Politécnica de Chimborazo, Riobamba, Ecuador

Date of Submission23-Mar-2021
Date of Acceptance10-Oct-2022
Date of Web Publication30-Dec-2022

Correspondence Address:
Prof. Dennys V Tenelanda López
Faculty of Natural Resources, Escuela Superior Politécnica de Chimborazo/ Faculty of Health Sciences, School of Dentistry, Universidad Nacional de Chimborazo, Riobamba
Ecuador
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jioh.jioh_66_21

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  Abstract 

Aim: The relationship between children and parents significantly influences several aspects of child growth, including the oral health status. The research was carried out to analyze the oral health status and sociofamiliar characteristics among 12-year-old schoolchildren. Materials and Methods: The design of this study was descriptive, observational, and cross-sectional, with a quantitative approach; as well as the type of research was correlational. The population of this study involved 34,107 elementary school students, of which 380 12-year-old students were chosen through a random probabilistic sampling and a statistical formula. This research was conducted in Riobamba City, Chimborazo Province, Ecuador. Observational and surveys were used as techniques to collect data; their instruments included the Dental Clinical History and the Health Behavior in School-aged Children 2014—Spain questionnaire. The Kruskal–Wallis test for independent samples, the Spearman rho test, and Pearson’s correlation were applied for the statistical analysis. Results: The results showed a statistically significant relationship between toothbrushing frequency and the number of Decayed, Missing due to caries, and Filled Teeth in the permanent teeth (DMFT) index (P = 0.023), as well as the mother’s profession and their children’s DMFT index (P = 0.044), and the father’s educational level with their children’s toothbrushing frequency (P = 0.035). Conclusions: It was concluded that brushing teeth more than once a day is not enough to maintain optimal oral health status; other important indicators must complement this procedure. The parents’ educational level directly affected their children’s oral health status.

Keywords: DMFT Index, Educational Status, Employment, Toothbrushing


How to cite this article:
Tenelanda López DV, Alban Hurtado CA, Castelo Reyna MA, Vinueza OF. Oral health status and sociofamiliar aspects among 12-year-old schoolchildren: A correlational study. J Int Oral Health 2022;14:574-81

How to cite this URL:
Tenelanda López DV, Alban Hurtado CA, Castelo Reyna MA, Vinueza OF. Oral health status and sociofamiliar aspects among 12-year-old schoolchildren: A correlational study. J Int Oral Health [serial online] 2022 [cited 2023 Feb 1];14:574-81. Available from: https://www.jioh.org/text.asp?2022/14/6/574/366436




  Introduction Top


World Health Organization (WHO)[1] states oral health as the absence of periodontal diseases, decay, orofacial pain, infections and mouth sores, mouth or throat cancer, and tooth loss, including disorders that might limit the person to achieve the functions of the stomatognathic system such as mastication, deglutition, smiling, and speech. The abovementioned means that optimal oral health is essential for a good quality of life.

According to Ortega et al.,[2] WHO and World Dental Federation (WDF) had projected for 2020 that the prevalence of dental caries corresponded to no more than three teeth maximum in children under 12 years of age. That is why the governments of all countries in the world have tried to regulate, control, and improve the oral health status of their population. Therefore, the mission of the Ministry of Public Health of Ecuador (MPHE) is to encourage accurate proposals for oral health promotion according to the lifestyles of its citizens.[3]

Many risk factors can contribute to the development of early caries in children or adolescents, such as excessive consumption of sugars, eating certain foods at night, inadequate toothbrushing, a lack of knowledge of children and parents about oral hygiene, inappropriate toothbrushing frequency, and a lack of visits to the dentist.[4]

According to the University of Virginia,[5] people with higher levels of educational instruction have longer and healthier lives than those ones with fewer years of academic instruction. Education is essential in preventing and controlling diseases because this is the basis for the behavior of the patient facing a health problem.[6] These arguments support the close and indispensable relationship between education and health.

Köro ̆glu et al.[7] mention that toothbrushing is the classic and primary method used in oral hygiene, which must be done at least twice a day using a suitable fluoride toothpaste and toothbrush in order to keep an adequate cleaning of the stomatognathic system. In addition, they say that the surface properties and color stability of interim crown materials may differ depending on the toothbrushing technique. Before the 20th century, waste disposal in the teeth was made using wooden sticks or a form of barbed teeth after meals. After this period, the concept of dental brushing evolved, considering further the proper technique execution, combined with the oral hygiene kit mentioned by Gunjan et al.[8] to remove plaque from tooth surfaces without damaging soft surfaces.

Universities should look for educative and research proposals to contribute to achieving the goals of the WHO and the WDF concerning the prevention of caries.[9] It is crucial to identify the lifestyles of children or teenagers in order to create oral health educational programs involving all members of their socioeducational community, such as teachers, parents, students, and professors at schools of dentistry.

The number of decayed, missing due to caries, and filled teeth in the permanent teeth is known as the number of Decayed, Missing due to caries, and Filled Teeth in the permanent teeth (DMFT) index; one of the WHO’s indicator ages used to calculate it is 12 years old. A few studies specifically believe this age group, for example, the ones conducted by Patel et al.[10] and Prabakar et al.,[11] which associated even age with the DMFT index. So, this research is essential in terms of providing the current caries level associated with one of its factors, such as eating habits in people of a third-world country, studying the age group recommended by WHO.[12],[13]

Based on the aforementioned, this research aims to analyze the oral health status and sociofamiliar aspects among 12-year-old schoolchildren through the Dental History Form[14] and the questionnaire “Health Behavior in School-aged Children (HBSC).”[15]


  Materials and Methods Top


Type of study

The methodological design of this study was descriptive, observational, and cross-sectional, with a quantitative approach; as well as the type of research was correlational.

Participants, eligibility criteria, and setting

The population of this research involved 34,107 students of Riobamba City, Chimborazo Province, Ecuador, who studied from 2019 to 2020. The statistical formula proposed by Hernández et al.[16] was used to calculate the representative sample size, obtaining 380 12-year-old school children; they were chosen through a random probabilistic sample. There were some selection criteria issues that the students had to fulfill to be a part of this study, such as being registered in public educative institutions in Riobamba City, being 12-years-old, having informed consent signed by their parents, knowing enough personal information about their parents, having permanent teeth, avoiding potable water intake, and preferring bottled/boiled water intake. The student’s parents signed informed consent for the voluntary opening of the Dental History Form and the questionnaire application to their children. Additionally, the Education District of the Riobamba City of Ecuador gave the corresponding permission to carry out some stages of this research.

Data collection and selection techniques

Observational and survey techniques were used by applying the following instruments to collect data, the Dental Clinical Form approved by the MPHE[14] and the questionnaire HBSC.[15] The first instrument was applied by students in the final year of the School of Dentistry of the National University of Chimborazo to determine the DMFT index (the number of decayed, missing, and filled teeth) through an intraoral examination.[12],[17] This index determined the study population’s high-, medium-, or low-caries risk. The DMFT community index was calculated considering the total number (2460) of all decayed (1744), missing (144), and filled (572) teeth pieces divided by the number of individuals examined (380) in this research. The second instrument was applied to obtain information related to students’ oral hygiene habits and parents’ educational level and work status. Three experts analyzed the questionnaire’s content validity, which was determined as good, Item Objective Congruence (IOC = 0.85); this instrument was applied to 200 people as pilot testing; after that, Cronbach’s alpha was used to determine reliability, which was excellent (α = 0.89). So, it was shown that the questionnaire could be applied to Ecuadorian students.

Statistical analysis

The collected data were processed through the statistical program Statistical Package for the Social Sciences Software (SPSS) 17.0 edition (Version 24, IBM Corp., NY, USA). The Kruskal–Wallis test for independent sample was used to check whether there was an association between the toothbrushing variable and DMFT index levels. On the other hand, the Spearman-rho test was used to check whether there was an association between the occupation of students’ parents and the DMFT index levels of these children.[18] Finally, Pearson’s correlation was also used to check whether there was an association between the parent’s educational level and children’s toothbrushing frequency.[19] In the three statistical tests mentioned above, results with a P value of more than 0.050 were considered not significant.


  Results Top


In this descriptive and cross-sectional study, the DMFT index corresponded to 6.47 (high level). A total of 380 12-year-old schoolchildren participated, both men (54.2%; n = 206) and women (45.8%; n = 174). Regarding the place of residence, it is verified that the group with the greatest representation is the urban sector (70%; n = 266). It is determined that most schoolchildren (73.3%; n = 280) brush their teeth more than once a day, followed by once a day (20.8%; n = 79). Finally, it is verified that most of the students analyzed present a high level of DMFT index (40.8%; n = 155), followed by a low level (32.1%; n = 122), and only the remaining 27.1% (n = 103) have a medium level [Table 1].
Table 1: Sociodemographic variables

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The results showed that there were 206 males (54.2%) and 174 females (45.8%) of the total 380 of the study population about gender. It was determined that most students (73.68%) brushed their teeth more than once a day; however, 120 students (42.9%) showed a high risk of caries according to the DMFT index, and only four students representing 1.05% never brushed their teeth, so they also had a high-level range according to the index mentioned above [Table 2].
Table 2: DMFT index, gender, and toothbrushing frequency

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Concerning the parents’ educational level, the data showed that the majority of their fathers (76.1%) and mothers (84.7%) had studied at the basic level of formal academic instruction, followed by a representative group of 74 fathers and 34 mothers who completed their university studies representing 19.5% and 8.9%, respectively. There were only 16 fathers (4.2%) and 21 mothers (5.5%) who had never formally studied in an educative institution [Table 3].
Table 3: Level of academic instruction of parents

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Data collected about the profession of parents showed that most of them worked in positions that did not require specific academic training, including the prevailing professions of fathers were merchant (12.6%), livestock farmer (1.8%), slaughter (0.5%), cook (1.3%), mechanic (7.1%), driver (22.9%), and others (27.1%). Concerning professions requiring a formal educational background, the results showed that architects were 22.9%. On the other hand, data from mothers showed that they worked as merchant (4.2%), livestock farmer (0.8%), slaughter (0.5%), cook (4.2%), housemaid (3.9%), seamstress (3.4%), waitress (1.3%), driver (1.1%), hairdresser (3.7%), laundress (0.5%), and the most frequent profession was the housewife (45.0%). Regarding the professions needing specific academic training, there were only four, such as teacher, doctor, accountant, and secretary, with 4.2%, 2.4%, 1.1%, and 0.8%, respectively [Table 4].
Table 4: Parents’ professions

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Each of the jobs of the fathers and mothers was correlated with the DMFT index of their children; the studies of parents were correlated with the toothbrushing frequency of their children. Considering that caries is a multifactorial pathology, the results showed that there was only a low and negative relationship between the mother’s job and the children’s DMFT index with a P value equal to 0.044. Concerning the father’s educational level and the toothbrushing frequency of their children, there was evidence of a low and positive correlation, showing that the higher the level of education of parents, the higher toothbrushing of their children with a P value equal to 0.035. The father’s job or the mother’s educational level showed no relationship with the DMFT index and toothbrushing frequency, respectively. All the P values mentioned before considered 95% confidence [Table 5].
Table 5: Parent’s educational level and profession

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According to the Kruskal–Wallis test for independent samples, it was shown that the distribution of the DMFT index was the same between the categories of toothbrushing frequency, reflecting a P value equal to 0.023. That was why H0 was rejected, and H1 was accepted [Table 6].
Table 6: Hypothesis testing

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  Discussion Top


Ecuador has an outdated national plan for oral health, dating from 2009,[20] which generates constraints for implementing appropriate promotional programs for oral health. The population of this study showed a high level according to the DMFT index,[21] a result very similar to the one obtained by Medinal et al.[22] in a population of the Ecuadorian Amazon region and consistent with the report given by the WDF[23]; this organization scored Ecuador a high level of caries. The Ecuadorian level of caries is higher than the ones obtained in another research conducted by Mittal et al.,[24] Reddy et al.,[25] Al-Samadani et al.,[26] Narbutatite et al.,[27] and Padilla.[28]

Toothbrushing is vital to maintain good oral hygiene; the standard norm recommends brushing teeth twice daily.[29] Frequent toothbrushing could help prevent dental cavities, as well as other oral pathologies such as gingivitis and periodontitis.[30],[31] In this research, most students brushed their teeth more than once a day; however, their community DMFT index was high, showing a statistical association between the DMFT index and toothbrushing frequency. The toothbrushing frequency in our study was very similar to the investigation carried out by López[32] and Trubey et al.,[33] because their population brushed their teeth more than once a day. They even added that there was a tendency to do it more in the morning than at night and that the children’s parents also controlled the toothbrushing more in the morning than at night. On the other hand, the results obtained in our research related to toothbrushing frequency contrasted with the ones found by Kumar et al.,[29] who stated that weekly brushing frequency was low in their study. In their research, education was directly provided by the dentist in most cases, but teachers also had a fundamental role. The last ones knew the importance and responsibility of instilling good oral hygiene habits.

Although the study population brushed their teeth more than once a day, they showed a high DMFT index in this research. This situation showed that tooth brushing every day is not enough to have good oral health. Other parameters must be fulfilled simultaneously with a good toothbrushing frequency, for example, a suitable brushing technique, a soft-bristle toothbrush that must be changed every 3 months, a suitable fluoride toothpaste, and adequate time of toothbrushing according to Wainwright and Sheiham[34] and Sicca et al.[35] These characteristics matched the systematic review developed by Dos Santos et al.,[36] who included the cleaning of the tongue, the amount of toothpaste fluoride, the use of flossing, mouthwash, and cleaning of the gums. It is imperative to point out the fundamental role of other professionals, such as the pediatrician in the education of children, as well as the parental supervision and guidance at the time of toothbrushing to have more adequate oral health.

Education is very important, in terms that it makes people apply adequate living oral hygiene standards in their daily. In the case of parents, they can give the example or guide their children to perform many activities related to their health properly such as good toothbrushing including all the parameters aforementioned. The knowledge acquired through formal education is the strongest and gives the person a better understanding of the world in which we live. According to the University of Virginia,[5] people with higher levels of educational instruction have longer and healthier lives than those ones with few years of academic training. Education is also a central component in the prevention and control of diseases because this is the basis for the patient’s behavior in facing a health problem.[6] These arguments demonstrate the close and vital relationship between education and health. There was a statistical association between the father’s educational level and their children’s toothbrushing frequency, having most fathers with only primary education. The level of academic training limits opportunities to find work; the majority of mothers only had basic studies and was engaged to be housewives. It was evidenced that even though they passed apparently most of the time at home, their educational level did not help in controlling and guiding their children appropriately to maintain an adequate toothbrushing frequency complemented with all indicators given by references [34],[35],[36]. There was a statistical association between the mother’s job and the DMFT index of children.

In research conducted by Duijster et al.,[37] Marques et al.,[38] Kragt et al.,[39] and Wang et al.,[40] a relationship between family functioning and childhood dental caries was found, which may have operated via oral hygiene behaviors. These results agree with the ones found in this research related to parents’ jobs and formal studies. Regarding general sociodemographic factors, other authors such as Folayan et al.[41] even showed that participants with high socioeconomic status had a significantly lower prevalence of caries compared to those with lower status.

Although caries is multifactorial,[42] the parents’ educational level could be a determining factor in the health of people in this research; these data agreed with the organization Unite for Sigh,[43] which mentions that the lack of education may reduce the ability to find, understand, and use health information properly. Thus, it can be argued that well-educated individuals are healthier and have low morbidity, mortality, and disability levels. On the other hand, people with a low educational level present more risk for infectious and chronic diseases and shorter life expectancy.

In a systematic review, Cooper et al.[44] stated that there was insufficient evidence of the effectiveness of behavioral interventions based on primary school to reduce tooth decay. There was limited evidence of the effectiveness of these interventions in plaque outcomes and in acquiring knowledge about children’s oral health. None of the included interventions were reported as based on the behavioral theory. It meant that educational programs for oral health should be more comprehensive to make a significant difference in the study population, including issues such as behavioral theory, children, parents, and teachers’ participation.


  Conclusions Top


Toothbrushing more than once daily is insufficient to maintain optimal oral health status. This must be complemented with a good technique, a soft-bristle toothbrush that must be changed every 3 months, suitable fluoride toothpaste, the appropriate brushing time, tongue cleaning, an adequate amount of fluoride toothpaste, flossing, mouthwash, and gum cleaning. Comprehensive educational programs for promoting and preventing oral health must accompany the indicators mentioned above. Parents’ educational level directly affects their children’s oral hygiene habits. Even though mothers spend most of their time at home, they do not contribute to maintaining an adequate status of their children’s stomatognathic system, probably because of the lack of knowledge about oral health.

Acknowledgement

We do express our gratitude to the School of Dentistry, Universidad Nacional de Chimborazo, Ecuador, for their invaluable research support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Authors’ contributions

DVTL carried out the study design, article correction, and formatting. The article preparation, study execution, data collection, and data analysis were done by CAAH and OFFV. Data analysis and the use of the English language were rechecked by MACR. All the authors have made substantial contributions to this study, as well as they have reviewed the final article before its submission. Finally, the four authors have approved the article for publication.

Ethical policy and institutional review board statement

All procedures were in accordance with the ethical standards of the Research Center of the Faculty of Health Sciences, Universidad Nacional de Chimborazo, Ecuador, with approval number 36-CIV-22-02-2021 (dated March 22, 2021).

Patient declaration of consent

The parents of the students signed informed consent for their children’s voluntary participation.

Data availability statement

Data will be available on request from Dennys V. Tenelanda López ([email protected]/[email protected]).



 
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