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 Table of Contents  
ORIGINAL RESEARCH
Year : 2022  |  Volume : 14  |  Issue : 6  |  Page : 582-596

Effect of oral health education on the parents knowledge, attitudes, and practice regarding dietary habits in 4- to 6-year-old children and its relation to dental caries incidence: A prospective study


1 Department of Dental Surgery, Indian Naval Hospital Ship Sanjivani, Kochi, Kerala, India
2 Department of Pedodontics, DAPMRV Dental College, Bengaluru, Karnataka, India

Date of Submission30-Jan-2022
Date of Acceptance10-Oct-2022
Date of Web Publication30-Dec-2022

Correspondence Address:
Dr. Dempsy Chengappa Mandepanda Mandanna
Department of Dental Surgery, INHS Sanjivani, Naval Base, Kochi 682004, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jioh.jioh_36_22

Rights and Permissions
  Abstract 

Aim: Four- to six-year-old children were examined to evaluate dental caries incidence in relation to knowledge, attitude, and practice (KAP) toward oral health and dietary practices among their parents, and improvements achieved through targeted oral health educational interventions. Materials and Methods: This was a longitudinal study over 1 year, with interventions at baseline and 6 months followed by evaluation at 1 year on children of two schools located at Bengaluru. The calculation of sample size was based on percentage of knowledge according to a pilot study = 66.87%, precision (%) = 5, desired confidence level (%) = 95, and sample size (n) = 340 samples were included. A 25-item KAP questionnaire on diet and dental caries was administered to parents along with an audio-visual intervention at baseline and oral health education booklet at 6 months. The children were examined at baseline and divided into two groups: Group A (caries free) and Group B (caries active). They were examined again at 1 year to evaluate impact of interventions on KAP of their parents, data recorded on modified World Health Organization (WHO) form, statistical analysis was done. Results: Group A showed higher mean scores for KAP with P value of (P < 0.001) being statistically significant. Z-test for proportions to evaluate deterioration in attitudes and practices among parents showed difference in proportion of samples with worsening in Groups A and B not statistically significant (P > 0.05, respectively). Conclusion: Diet is an important determinant in incidence of caries in the community, KAP toward dietary practices of caregivers of children impacts caries incidence.

Keywords: Dental Caries, Dental Health Education, Dietary Habits, Oral Health Knowledge, Parents Education


How to cite this article:
Mandepanda Mandanna DC, Prasanna P, Athimuthu A, Ramakrishna S, Venkataraghavan K, Shankarappa PR. Effect of oral health education on the parents knowledge, attitudes, and practice regarding dietary habits in 4- to 6-year-old children and its relation to dental caries incidence: A prospective study. J Int Oral Health 2022;14:582-96

How to cite this URL:
Mandepanda Mandanna DC, Prasanna P, Athimuthu A, Ramakrishna S, Venkataraghavan K, Shankarappa PR. Effect of oral health education on the parents knowledge, attitudes, and practice regarding dietary habits in 4- to 6-year-old children and its relation to dental caries incidence: A prospective study. J Int Oral Health [serial online] 2022 [cited 2023 Jan 31];14:582-96. Available from: https://www.jioh.org/text.asp?2022/14/6/582/366434




  Introduction Top


Oral health is an integral part of a child’s general health. In developing countries, a substantial number of children are afflicted by tooth decay and other oral diseases. However, due to lack of awareness, attitude toward health care, inadequate access, and unaffordability these children do not receive adequate dental care.[1]

Dental caries is a diet-dependent, infectious, and transmissible disease often established during the early years of life and is one of the most prevalent chronic diseases during childhood. Untreated dental caries can lead to tooth ache, facial abscesses, and impeded growth.[2]

As per World Health Organization (WHO)’s “Oral Health in India: A Report of the Multicentric Study,” 2003, it was found that approximately 75% of children and 50% of adults had never visited a dental health facility, dental caries prevalence was approximately 50% in children and 80% in adults. There is a paucity of studies in India on dietary practices and its relation to oral health of children; also very little data are available on parental awareness of their children’s dietary practices and its effect on oral health.[3]

Imparting oral health education in schools alone has not proven to be a highly effective tool in prevention of dental caries. This may be due to influence of parents and caregivers on food and dietary choices and the attitude toward their child’s oral health. A multilevel approach with multiple interventions periodically toward oral health awareness involving the children, parents or caregivers and the school has been shown to produce better results.[4]

Dental health education should be provided at a time when the child is still at a formative stage and is in the process of establishing regular day to day routines. The child’s mother plays a pivotal role during this developmental stage and helps in imparting good oral health habits to her children. These positive changes at a younger age can help reduce the caries risk.[5]

The dissemination of information through oral health campaigns needs to target high risk populations with information on oral diseases, risk factors and measures that can be adopted to prevent them. Such campaigns should typically aim not only to impart knowledge, but also to improve attitudes regarding oral health, and facilitate transformation of these attitudes into practice.[6]

The aim of this study was to inculcate healthy lifestyle practices which will last a lifetime through effective educational interventions among schoolchildren. These interventions are dependent on factors such as source of information, dental experience, and parental attitudes.[7]

Unlike existing educational materials use of audiovisual aids along with educational pamphlets, helps provide anticipatory guidance through a comprehensive, self-directed, evidence-based approach to promotion of oral health. Widespread application of this prevention protocol has the potential to result in greater awareness, increased use of dental services and reduced incidence of preventable oral disease in target populations.[8]

Primary schools also have a great potential to influence children’s oral health habit formation due to the considerable time spent by children in school.[9]

This study endeavors to evaluate levels of knowledge, attitude, and practice (KAP) toward oral health among parents regarding dietary practices of their children and its relation to dental caries incidence. The age group of 4–6 years shows the transition from primary to early mixed dentition and is the stage when children are vulnerable to develop dental caries. Of the few studies available in literature, majority have highlighted an insufficient knowledge about relationship of dietary practices and oral diseases.[10] This study attempts to introduce oral health awareness aimed at improving attitudes and practices of parents toward their children’s oral health through an alternate approach.


  Materials and Methods Top


Study design

This was a prospective case-control study.

Study period

The study was conducted between July 2019 and August 2020.

Study setting

The study was conducted in two schools situated in Bengaluru city. Children along with their parents from nursery to upper kindergarten classes participated in the study. The principals and the administrative authorities of the schools were informed about aims and objectives of the study. Institutional ethical committee clearance was obtained vide letter no 15965/54th/9/2016/DGAFMS/DG-3B dated June 1, 2019 (Annexure I). Informed consent from parents was obtained (Annexure III). A simple random sampling method was used.

Study population

A study population comprising of 285 children and their parents. The children in the age range of 4–6 years were selected out of a total sample size of 340 children. There were 55 dropouts.

The children were grouped as follows:

  • Age Group 1––Children aged 4 years


  • Age Group 2––Children aged between 4 and 5 years


  • Age Group 3––Children aged between 5 and 6 years


Method of collection of data

Inclusion criteria for selection:

  • (i) School children aged between 4 and 6 years


Exclusion criteria:

  • (i) Medically compromised children.


  • (ii) Children with physical and mental disabilities.


  • (iii) Uncooperative children or children without parental consent.


Sample size calculation

Based on percentage of knowledge which was 66.87% according to the pilot study the sample size was calculated with 5% margin of error or 95% confidence as follows:

Expected percentage of knowledge = 66.87%, precision (%) = 5, desired confidence level (%) = 95, and sample size (n) = 340 samples were included.

Dropouts were catered to in the sample calculation by using the formula 1 minus the dropout rate to get the adjusted sample size (N), that is, N = n / (1–(z/100)).

Data collection

The data collection was done from the selected sample and following components of oral health were recorded on the WHO oral health assessment form.

  • a) Dentition status


  • b) Dental Caries


  • c) White Spot Lesions


Data collection tool––knowledge, attitude, and practice questionnaire

To assess KAP regarding the oral health of their children a questionnaire was prepared for the parents. The parents KAP were recorded at baseline and after the administration of an educational module.

Clinical examination armamentarium [[Figure 1]]

  • (i) Disposable mouth mirror, explorer, and tweezers


  • (ii) Sterile cotton


  • (iii) Examination gloves


  • (iv) Mouth mask


  • (v) Kidney tray
Figure 1: Armamentarium

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Instrument pretesting

A pilot study was done to evaluate effectiveness of the study design and to test the reliability of the KAP questionnaire.

Inter/intra observer reliability

A pilot study was conducted over a period of 4 months to assess inter and intra examiner calibration by taking 10% of calculated 340 samples. All the three components i.e., knowledge, attitude and practice scores were recorded and noted, then inter observer reliability was calculated by using Karl Pearson’s correlation coefficient. Reliability coefficient was found to be 0.8698, 0.9857, and 0.8857, respectively, between two observers with relation to KAP scores. Similarly, the test and retest KAP scores were recorded on each observer (interns), the intra examiner calibration was done on test and retest scores by applying the Karl Pearson’s correlation coefficient and found to be 0.9867, 0.9117, and 0.9654, respectively, between test and retest KAP scores.

Preparatory phase

A parental consent form was prepared and KAP questionnaire, WHO Oral health assessment forms were printed. To ensure a uniform assessment criteria and minimum variability during the clinical examination selected interns from the Dept of Pediatric and Preventive Dentistry were trained on how to use the oral health assessment forms. The KAP questionnaire was validated by administering it to parents of 4–6-year-old children coming to the Dept of Pediatric Dentistry. Various educational materials were designed in both Hindi and English which included:

  1. Oral health education handouts.


  2. Oral health education PowerPoint presentation.


  3. Short, animated movie on oral health awareness.


As there were 55 dropouts the final sample size for this study was 285 children. This study was carried out using the following methodology.

Statistical analysis

The statistical analysis of change in KAP within Group A and B of each age category was done using the Mann–Whitney test. For level of significance if P < 0.05, the null hypothesis was rejected and alternate hypothesis was accepted. If P ≥ 0.05, the null hypothesis was accepted. For analysis of change in scores from baseline to immediate post education and at 6-month follow-up the Wilcoxson Signed Ranks test was used



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Figure 2: Examination in progress

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Figure 3: Oral health education for parents

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{Figure 13}


  Results Top


Results were compiled based on data obtained from three stages of the study, baseline, at six months and on completion of the dental health education module. The parents KAP were evaluated using a questionnaire which contained 25 questions. These questions were divided as follows:

  • Knowledge––Eight questions


  • Practice––Nine questions


  • Attitude–Six questions


  • General––Two questions


The children were examined at baseline and at 1 year and they were evaluated for any worsening in their oral health status. The final breakdown of children in the two groups was as follows:

Group A (caries free)––164 children (57.54%) (4 years––22, 4–5 years––108, 5–6 years––4) and Group B (caries active)––121 children (42.45%) (4 years––28, 4–5 years––64, 5–6 –years––29).

Results of the study were dealt under the following heads:

Analysis of knowledge score among parents of 4-year, 4–5-year, and 5–6-year age group [[Graph 1],[Graph 2]–[Graph 3]]
Graph 1: Analysis of knowledge score in 4-year age group

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Graph 2: Analysis of knowledge score in 4–5-year age group

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Graph 3: Analysis of knowledge score in 5–6-year age group

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In the 4-year age group at baseline and immediate post education a higher mean score was recorded in Group A compared to Group B, the difference between them was statistically significant (P < 0.001).

At 6 months, a higher mean score was recorded in Group A compared to Group B, the difference between them was not statistically significant (P > 0.05).

In the 4–5-year age group at baseline and immediate post education, higher mean score was recorded in Group A compared to Group B, the difference between them was statistically significant (P < 0.001).

At 6 months, higher mean score was recorded in Group A compared to Group B, the difference between them was not statistically significant (P > 0.05).

Among the 5–6-year age group at baseline and immediate post education, higher mean score was recorded in Group A compared to Group B and the difference between them was statistically significant (P < 0.001 and P < 0.05, respectively).

At 6 months, higher mean score was recorded in Group A compared to Group B, the difference between them was not statistically significant (P > 0.05).

Analysis of attitude score among parents of 4-year, 4–5-year, and 5–6-year age group [[Graph 4], [Graph 5] and [Graph 6]]
Graph 4: Analysis of attitude score in 4 years age group

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Graph 5: Analysis of attitude score in 4–5-year age group

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Graph 6: Analysis of attitude score in 5–6-year age group

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Among the 4-year age group, analysis of attitude score at baseline and immediate post education showed higher mean score in Group A compared to Group B, the difference between them was statistically significant (P < 0.001). At 6 months, higher mean score was recorded in Group A compared to Group B, the difference between them was not statistically significant (P > 0.05).

In the 4–5-year age group, at baseline a higher mean score was recorded in Group A compared to Group B and the difference between them was statistically significant (P < 0.001) however in immediate post education, slightly higher mean score was recorded in Group A compared to Group B, the difference between them was not statistically significant (P > 0.05). At 6 months, higher mean score was recorded in Group B compared to Group A, the difference between them was not statistically significant (P > 0.05).

In the 5–6-year age group at baseline, higher mean score was recorded in Group A compared to Group B and the difference between them was statistically significant (P < 0.01). Immediate post education, slightly higher mean score was recorded in Group A compared to Group B, the difference between them was not statistically significant (P > 0.05). At 6 months, higher mean score was recorded in Group B compared to Group A, the difference between them was not statistically significant (P > 0.05).

Analysis of practice score among parents of 4-year, 4–5-year, and 5–6-year age group [[Graph 7], [Graph 8] and [Graph 9]]
Graph 7: Analysis of practice score in 4 years age group

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Graph 8: Analysis of practice score in 4–5-year age group

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Graph 9: Analysis of practice score in 5–6-year age group

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In the 4-year age at baseline and immediate post education, higher mean score was recorded in Group A compared to Group B and the difference between them was statistically significant (P < 0.05). At 6 months, higher mean score was recorded in Group A compared to Group B and the difference between them was statistically significant (P < 0.01).

Among 4–5-year age group, at baseline, immediate post education and at 6 months, higher mean score was recorded in Group A compared to Group B and the difference between them was statistically significant (P < 0.001).

While in the 5–6-year age group, at baseline, immediate post education and at 6 months higher mean score was recorded in Group A compared to Group B and the difference between them was statistically significant (P < 0.001).

Analysis of change in scores––Groups A and B––4-year, 4–5-year, and 5–6-year children

This analysis was done to evaluate the change in KAP among the parents from baseline to immediate post education to six months in Group A and B in all the age groups using Wilcoxon Signed Ranks Test to ascertain effectiveness of the oral health education module.

Among parents of all age groups the results in Group A showed improvement in knowledge from baseline to immediate post education and immediate post education to 6 months in all age groups with exception of 5–6-year age group where it was not statistically significant.

Analysis of attitude scores among the parents of children of the three age groups revealed increase in scores from baseline to immediate post education and immediate post education to 6 months in all groups except for non-statistically significant scores in immediate post education to 6 months in 4-year age group.

Analysis of practice scores revealed no change in the scores from baseline to immediate post education in all three categories. However, there was a steady increase in practice scores from immediate post education to 6 months with the scores being statistically significant in all three age categories [Table 1][Table 2][Table 3].
Table 1: Analysis of the change in scores within Group A: 4-year-old children

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Table 2: Analysis of the change in scores within Group A: 4–5-year-old children

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Table 3: Analysis of the change in scores within Group A: 5–6-year-old children

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Results of this analysis done using Wilcoxon Signed Ranks Test among parents of all age groups in Group B showed improvement in knowledge and attitude scores from baseline to immediate post education and immediate post education to 6 months. The scores were statistically significant in all the age categories.

Analysis of practice scores revealed no change from baseline to immediate post education in all three categories. However, there was a steady statistically significant increase in practice scores from immediate post education to 6 months in all age categories [Table 4][Table 5][Table 6].
Table 4: Analysis of the change in scores within Group B: 4-year-old children

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Table 5: Analysis of the change in scores within Group B: 4–5-year-old children

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Table 6: Analysis of the change in scores within Group B: 5–6-year-old children

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Analysis for comparison of worsening of oral health status from base line to 1-year follow-up [[Table 7]]
Table 7: Comparison of changes between the groups: (Z test for proportions)

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This analysis was done to evaluate the no of cases where worsening in parental attitudes and practices toward the dietary practices of their children adversely affecting the oral health status was seen during the study. This analysis was done using the Z-test for proportions. In 4-year and 4–5-year age group, the difference in proportion of samples with worsening in Group A and Group B was not statistically significant (P > 0.05, respectively).


  Discussion Top


The overall health, well-being, education and development of children, families and communities can be affected by oral health. Even though there has been a marked improvement in oral health of children over the past few decades, dental caries has remained one of the most prevalent oral health problems in children worldwide.[11],[12]

Developing countries such as India face many challenges in rendering oral health needs of pre-school children, especially in rural populations. The oral health of pre-school children is affected by parental knowledge, attitudes, practices, cultural beliefs, awareness about infant diet and feeding practices, oral hygiene habits, regular preventive dental visits, care of primary teeth and concern for oral health[13]

Even though oral health of preschool children improved considerably in most industrialized countries over the past decades, dental caries remains an important childhood disease affecting a considerable proportion of young children in developing countries like India.[14],[15],[16] In the present study the caries prevalence was found in 43.8% of the children which corresponds to other similar studies.[17]

Enhancements in knowledge and awareness are important prerequisites for behavioural change, including behaviour related to health and disease prevention[18],[19],[20],[21]

A sound understanding of parental knowledge, attitudes, beliefs, and awareness regarding oral health is essential for oral health promotion efforts aimed at improving the dental health of young children.[22],[23],[24],[25],[27]It has been found that more positive the parents’ attitude towards dentistry, the better will be the dental health status of their children.[26]

This study was undertaken with the objective to evaluate the effect of oral health education on parents’ KAP regarding dietary habits in 4-6 yrs. old children and its relation to dental caries incidence. Studies have shown that the overall nutritional knowledge related to oral health is insufficient among the broader population.[27],[28],[29]

In the present study, children were examined at baseline and at 1-year duration to evaluate whether the education module given to parents in the form of an audio-visual presentation at baseline and an educational booklet at 6 months had any effect on dental health of the children. Evaluation of the parents’ KAP was done using a questionnaire consisting of 25 questions.

Immediately after introduction of the education module, the mean knowledge score was found to increase in both groups. It was higher in Group A than Group B and the difference between the two groups was found to be statistically significant. At 6-months, a higher mean score was recorded in Group A as compared to Group B but the difference between them was not found to be statistically significant.

The mean scores for attitude and practice also showed increase in both groups, however the improvement in practice seen in Group B was gradual and did not show immediate improvement after the introduction of the education module. The practice scores of Group B improved significantly after second education module was introduced at 6 months. As seen in recent studies on maternal knowledge of preschool children’s oral health it is conclusively brought out that reinforcement of knowledge of parents and caregivers on a regular basis will improve dietary attitudes and practices and aid in reducing caries incidence.[26],[30] The resulting effect on the null hypothesis was that there was no significant improvement in KAP or significant difference in KAP between different age groups at 6 months interval. However, repeated reinforcements over longer duration of time would be more beneficial along with larger sample size and this could be endeavoured in future studies. As the data collected in the present study was by self – reporting by parents who were administered a questionnaire a limitation of the study may be related to how honestly the parents assessed their child’s dietary practices.[31] A longer period of follow up with a greater number of oral health education interventions would be helpful to bring about more significant changes. Interventions related to dietary practices to help improve oral health of children can be considered for implementation as a structured program in schools to help improve not only oral health but also general health.


  Conclusion Top


There is a direct influence of the parent’s knowledge, attitudes, and practices regarding dietary habits of their children on the dental caries incidence. The oral health education module on dietary practices of the children was effectively implemented among the parents in two schools in Bengaluru. The parent’s KAP regarding dietary habits of their children and its influence on the incidence of dental caries improved. This was evident from improvement in oral health status which was visualized as remineralization of white spot lesions and restoration of decayed teeth in children from baseline to 1 year of age.

However regular reinforcement to convey the message and to motivate parents to improve dietary habits of their children to positively impact their health is essential. There is a need to have longer periods of follow-up and a greater number of modules for reinforcement to enhance efficiency of this program. Additional parameters such as skill of children in using oral hygiene aids and role of parents in maintenance of oral hygiene may need to be incorporated in future studies. As brought out through this study it has the potential to be an effective tool in improving dietary habits among schoolchildren thereby helping to reduce caries incidence.

Acknowledgement

None.

Financial support and sponsorship

Nil.

Conflict of interest

The authors declare no conflict of interest.

Authors contributions

DCMM: Concepts, design, definition of intellectual content, literature search, data acquisition, data analysis, statistical analysis, manuscript preparation, manuscript editing, and manuscript review.

PP: Concepts, design, definition of intellectual content, literature search, and manuscript review.

AA, SR, KV, and PS: Manuscript review.

Ethical policy and institutional review board statement

Institutional ethical committee clearance was obtained vide letter no 15965/54th/9/2016/DGAFMS/DG-3B dated June 1, 2019 (Annexure I).

Patient declaration of consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Data availability statement

Not applicable.


  Annexure i Top





  Annexure ii Top


PATIENT INFORMATION SHEET

YOU ARE REQUESTED TO TAKE PART IN A STUDY ENTITLED “Effect of oral health education on the Parent’s Knowledge, Attitudes and Practice regarding dietary habits of 4 to 6 year-old children and its relation to Dental Caries incidence.”

THE STUDY AIMS TO EVALUATE THE KNOWLEDGE,ATTITUDES AND PRACTICE REGARDING DIETARY PRACTICES OF PARENTS AND CHILDREN OF 4 TO 6 YEARS AND ITS INFLUENCE ON THE CHILD’S DENTAL CARIES EXPERIENCE AS WELL AS INTRODUCE A DENTAL HEALTH EDUCATION MODULE.

VOLUNTARY PARTICIPATION

YOUR PARTICIPATION IN THE PROJECT IS VOLUNTARY. YOU CAN WITHDRAW FROM THE PROJECT AT ANY TIME AND THIS WILL NOT AFFECT YOUR SUBSEQUENT TREATMENT OR RELATIONSHIP WITH THE TREATING DOCTOR.

RISK (IF ANY) TO THE SUBJECTS

NIL


  Annexure iii Top


CONSENT FORM

I, ……………………………………………… HAVE BEEN PROVIDED BY Dr……………………………….. WITH A COPY OF THE PATIENT INFORMATION SHEET FOR TAKING PART IN THE PROJECT ENTITLED “Effect of oral health education on the Parent’s Knowledge, Attitudes and Practice regarding dietary habits of 4 to 6 year-old children and its relation to dental caries incidence”. AND ALSO BEEN EXPLAINED TO MY SATISFACTION IN THE LANGUAGE KNOWN TO ME.

I HEREBY GIVE CONSENT TO BE ENROLLED IN THE STUDY.

SIGNATURE AND NAME SIGNATURE OF THE

OF THE PARENT/GUARDIAN INVESTIGATOR

SIGNATURE OF THE WITNESS DATE


  Annexure iv Top





  Annexure v Top


KAP QUESTIONNAIRE

Name of Child

Name of Parent

Occupation

Educational status

Q1. What type of food do you eat?

  • a. Vegetarian


  • b. Non vegetarian


  • c. Mixed


Q2. In your opinion what is a balanced diet?

  • a. A diet with equal proportions of cereals, vegetables and fruits.


  • b. A diet with the right proportions of carbohydrates, proteins, fats, and vitamins


  • c. A diet consisting of fried items and sugary snacks


Q3. What is the ideal quantity of sugar that your child should consume?

  • a. 8 to 10 teaspoons


  • b. 10 to 12 teaspoons


  • c. 6 to 8 teaspoons


Q4. Sugar is good for your child’s teeth.

  • a. Strongly agree


  • b. Agree


  • c. Do not know


  • d. Disagree


  • e. Strongly disagree


Q5. How often does your child eat fresh fruit?

  • a. Never


  • b. Several times a month


  • c. Once in a week


  • d. Several times a week


  • e. Everyday


  • f. Several times in a day


Q6. How often do you give your child fruit juices?

  • a. Rarely


  • b. Once a day


  • c. Twice a day


  • d. Never


Q7. What are the fruits your child enjoys?

……………………..

…………………….

…………………….

Q8. How frequently does your child have soft drinks?

  • a. Never


  • b. Several times a month


  • c. Once in a week


  • d. Several times a week


  • e. Everyday


  • f. Several times in a day


Q9. Frequent consumption of soft drinks is harmful to the body and teeth.

  • a. Strongly agree


  • b. Agree


  • c. Do not know


  • d. Disagree


  • e. Strongly disagree


Q10. Does your child have a glass of milk before going to bed?

  • a. Yes


  • b. No


Q11. When does your child brush his\her teeth?

  • a. In the morning


  • b. Noon


  • c. Before going to bed


  • d. Any other time (please specify)


Q12. Does your child often eat snacks in between meals?

  • a. Yes


  • b. No


Q13. If yes, how often does your child have snacks during the day?

  • a. Once


  • b. Twice


  • c. Thrice


  • d. More than thrice


Q14. When does your child generally snack?

  • a. Between breakfast and lunch


  • b. Between lunch and dinner


  • c. Post- dinner


  • d. Any other (please specify)


Q15. What type of snacks does your child generally have?

  • a. Sweet syrupy snacks


  • b. Chips


  • c. Biscuits\cakes\pastries


  • d. Chocolates


  • e. Homemade Indian sweets


Q16. Do you think between-meals snacking is detrimental to your child`s health?

  • a. Yes


  • b. No


  • c. Not sure


Q17. Do you think in between meals snacking affect your child`s teeth adversely?

  • a. Yes


  • b. No


Q18. Do you ask your child to rinse his\her mouth or brush his teeth after a bout of snacking?

  • a. Yes


  • b. No


Q19. Do you consider your child`s oral health good?

  • a. Strongly Agree


  • b. Agree


  • c. Do not know


  • d. Disagree


  • e. Strongly Disagree


Q20. Does your child suffer from tooth ache, bleeding gums or bad breath?

  • a. Yes


  • b. No


  • c. Do not know


Q21. Have you taken your child to the dentist for an oral health check up?

  • a. Yes


  • b. No


Q22. Do you think your regular diet at home is a healthy balanced diet?

  • a. Strongly agree


  • b. Agree


  • c. Do not know


  • d. Disagree


  • e. Strongly Disagree


Q23. Do you consider a balanced diet and healthy snacks would contribute to healthy teeth for your child?

  • a. Strongly agree


  • b. Agree


  • c. Do not know


  • d. Disagree


  • e. Strongly disagree


Q24. Does your child tooth paste contain fluoride?

  • a. Yes


  • b. No


  • c. Do not know


Q25. Do you think your childs teeth need to be checked by a dentist periodically?

  • a. Strongly agree


  • b. Agree


  • c. Do not know


  • d. Disagree


  • e. Strongly disagree


KNOWLEDGE

In your opinion what is a balanced diet?

  • a. A diet with equal proportions of cereals, vegetables and fruits.


  • b. A diet with the right proportions of carbohydrates, proteins, fats, and vitamins


  • c. A diet consisting of fried items and sugary snacks


What is the ideal quantity of sugar that your child should consume?

  • a. 8 to 10 teaspoons


  • b. 10 to 12 teaspoons


  • c. 6 to 8 teaspoons


Frequent consumption of soft drinks is harmful to the body and teeth.

  • a. Strongly agree


  • b. Agree


  • c. Do not know


  • d. Disagree


  • e. Strongly disagree


Do you consider your child`s oral health good?

  • a. Strongly Agree


  • b. Agree


  • c. Do not know


  • d. Disagree


  • e. Strongly Disagree


Does your child suffer from tooth ache, bleeding gums or bad breath?

  • a. Yes


  • b. No


  • c. Do not know


Do you think your regular diet at home is a healthy balanced diet?

  • a. Strongly agree


  • b. Agree


  • c. Do not know


  • d. Disagree


  • e. Strongly Disagree


Does your child’s tooth paste contain fluoride?

  • a. Yes


  • b. No


  • c. Do not know


How long should your child brush his/her teeth?

  • a. One minute


  • b. Two minutes


  • c. Don’t know


ATTITUDE

Sugar is good for your child’s teeth.

  • a. Strongly agree


  • b. Agree


  • c. Do not know


  • d. Disagree


  • e. Strongly disagree


Frequent consumption of soft drinks is harmful to the body and teeth.

  • a. Strongly agree


  • b. Agree


  • c. Do not know


  • d. Disagree


  • e. Strongly disagree


Do you think between-meals snacking is detrimental to your child`s health?

  • a. Yes


  • b. No


  • c. Not sure


Do you think in between meals snacking affect your child`s teeth adversely?

  • a. Yes


  • b. No


Do you consider a balanced diet and healthy snacks would contribute to healthy teeth for your child?

  • a. Strongly agree


  • b. Agree


  • c. Do not know


  • d. Disagree


  • e. Strongly disagree


Do you think eating sugary sweet snacks between meals is bad for your child’s teeth?

  • a. Strongly agree


  • b. Agree


  • c. Do not know


  • d. Disagree


  • e. Strongly disagree


Do you think your child’s teeth need to be checked by a dentist periodically?

  • a. Strongly agree


  • b. Agree


  • c. Do not know


  • d. Disagree


  • e. Strongly disagree


PRACTICES

How often does your child eat sugary sweet snacks or candy?

  • a. Never


  • b. Several times a month


  • c. Once in a week


  • d. Several times a week


  • e. Everyday


  • f. Several times in a day


How often does your child eat fresh fruit?

  • a. Never


  • b. Several times a month


  • c. Once in a week


  • d. Several times a week


  • e. Everyday


  • f. Several times in a day


What type of food do you eat?

  • a. Vegetarian


  • b. Non vegetarian


  • c. Mixed


How often do you give your child fruit juices?

  • a. Rarely


  • b. Once a day


  • c. Twice a day


  • d. Never


How frequently does your child have soft drinks?

  • a. Never


  • b. Several times a month


  • c. Once in a week


  • d. Several times a week


  • e. Everyday


  • f. Several times in a day


Does your child have a glass of milk before going to bed?

  • a. Yes


  • b. No


When does your child brush his\her teeth?

  • a. In the morning


  • b. Noon


  • c. Before going to bed


  • d. Any other time (please specify)


Does your child often eat snacks in between meals?

  • a. Yes


  • b. No


If yes, how often does your child have snacks during the day?

  • a. Once


  • b. Twice


  • c. Thrice


  • d. More than thrice


When does your child generally snack?

  • a. Between breakfast and lunch


  • b. Between lunch and dinner


  • c. Post- dinner


  • d. Any other (please specify)


What type of snacks does your child generally have?

  • a. Sweet syrupy snacks


  • b. Chips


  • c. Biscuits\cakes\pastries


  • d. Chocolates


  • e. Homemade Indian sweets


Do you ask your child to rinse his\her mouth or brush his teeth after a bout of snacking?

  • a. Yes


  • b. No


Have you taken your child to the dentist for an oral health check up?

  • a. Yes


  • b. No




 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]



 

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Abstract
Introduction
Materials and Me...
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Annexure i
Annexure ii
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Annexure v
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