Original Article

Knowledge of preventive child oral healthcare among

expectant mothers in Port Harcourt, Nigeria
Joycelyn Odegua Eigbobo*, Eleda 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
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 childs rst 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 rst tooth erupts; 20.7%
opined that soft toothbrush and toothpaste are choice materials for cleaning. There were
statistically signicant associations between parity and (i) childs visit to the dental clinic
( p 0.00); and (ii) the material used in cleaning the babys teeth ( p 0.00). Also, educa-
tional status and knowledge of routine dental check-ups were signicantly associated
( p 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.
2013 The Japanese Society of Pediatric Dentistry. Published by Elsevier Ltd. All rights reserved.
1. Introduction
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
smiling [3]. Early childhood caries is still a problem that per-
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
* Corresponding author.
E-mail address: odegwabobo@yahoo.com (J.O. Eigbobo).
Available online at www.sciencedirect.com
Pediatric Dental Journal
j ournal homepage: www. el sevi er. com/ l ocat e/ pdj
p e d i a t r i c d e nt a l j our na l 2 3 ( 2 0 1 3 ) 1 e7
0917-2394/$ e see front matter 2013 The Japanese Society of Pediatric Dentistry. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.pdj.2013.03.002
[1]. Thus, pediatricoral healthcareshouldbeginideallywithpre-
natal oral health counseling for parents, especially mothers
who usually spend more time with the children. The rst oral
examination is recommended at the time of the eruption of the
rst tooth and no later than 12 months of age [15]. Pre-natal
counseling ideally should be provided by all health pro-
fessionals(dental andnon-dental) becauseearlyinvolvement of
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
interventions must begin within the rst 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.
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 clari-
cations to subjects.
The questionnaire had two sections: the rst involved de-
mographic information such as age as at last birthday,
educational level, and employment status. The age was
further grouped into 1 <20 years, 2 21e25 years, 3 26e30
years, 4 31e35 years, 5 36e40 years and 6 >40 years. The
parity of the mothers was noted. The second sectionpertained
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 rst
visit a dentist and for what reason a dental visit is deemed
necessary. Also, when their childrens 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 signicance 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 1 e Sociodemographic characteristics of the
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)
p e d i a t r i c d e nt a l j o ur na l 2 3 ( 2 0 1 3 ) 1 e7 2
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 childs rst visit to the dentist
should be due to toothache (47.4%). A fth (20.7%) of the par-
ticipants indicated that soft toothbrushand toothpaste should
be used to clean childrens 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 rst tooth erupts (35.3%)
or when all the milk (primary) teeth have erupted (35.9%)
while about half of the mothers (49.2%) thought that ve years
was the correct age for childrento start brushing their teethby
themselves (Table 2).
There was a statistically signicant association ( p < 0.05)
between the number of children and (i) the visit to the dental
clinic ( p 0.00), and (ii) the material used in cleaning the
babys teeth ( p 0.00) as shown in Table 3. Also, there was a
statistically signicant association between the educational
status and mothers knowledge of (i) the frequency of routine
dental check-ups ( p 0.04), and (ii) the importance of dental
visits ( p 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 study was conducted in a public hospital and thereby was
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-
nicant positive correlation between level of education and
perception of importance of preventive dental visits for chil-
dren. Interestingly, this was not reected 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 childs rst tooth, typically around six months
but no later than one year [15,20]. Family oral health educa-
tion, examination, anticipatory guidance, uoride 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 childs rst visit to the dentist should be when the rst
tooth erupts. Rather, 47.4% of participants believed that the
rst dental visit should be when the child has toothache. This
observation is similar to studies in Malaysians [4], Indians [22],
Americans [23], and Bulgarians [24]. Half the participants of
the Americanstudy believed that childrenshould see a dentist
between2 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 rst dental visit between the age of
6 and 12 years. Also, the Bulgarian [24] study reported that the
majority of children making their rst 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 rst dental visits have been re-
ported [21] to have a signicant 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 fth 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 2 e Mothers perception of preventive oral health
practices 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 dont know 70 (18.3)
When should your child go for the rst visit to the dentist?
Toothache 181 (47.4)
Tooth decay 40 (10.5)
When the rst (milk) tooth erupts 89 (23.3)
Dont know 72 (15.5)
When should you start cleaning your childs 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)
Dont 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)
Dont know 5 (1.3)
What should be used in cleaning a babys 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. Dont know 6 (1.6)
p e d i a t r i c d e nt a l j our na l 2 3 ( 2 0 1 3 ) 1 e7 3
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 reects 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 intensied 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 childrens teeth from when they rst erupt
[15,20]. Damp face towels or wash cloth wrapped around a
nger [29] or a very soft toothbrush may be used to remove
plaque [20,29]. Also, it is benecial 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 rst 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 ve 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 childrens 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.
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)
Dont know 37 (19.6) 21 (19.8) 81 (5.7) 3 (11.5) 1 (10)
c
2
7.232, p 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)
Dont know 34 (18.0) 26 (24.5) 7 (13.7) 4 (15.4) 1 (10)
c
2
19.505, p 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)
c
2
20.183, p 0.00
When should you start cleaning your childs 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)
Dont know 27 (14.3) 18 (17.0) 17 (13.7) 3 (11.5) 1 (10)
c
2
10.817, p 0.82
*What should be used in cleaning the babys teeth?
1 Cotton wool & salt 31 (16.4) 22 (20.8) 12 (23.5) 6 (23.1) 1 (10)
2 Face towel and water 65 (34.4) 32 (30.2) 20 (39.2) 10 (38.5) 5 (50)
3 Soft toothbrush and toothpaste 47 (24.9) 27 (25.5) 3 (5.9) 1 (3.8) 1 (10)
4 Face towel and mild soap 5 (2.6) 1 (0.9) 3 (5.9) 0 (0) 0 (0)
5 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)
Dont know 3 (1.6) 2 (1.9) 0 (0) 0 (0) 1 (10)
c
2
96.874, p 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)
Dont know 4 (2.1) 0 (0) 0 (0) 0 (0) 1 (10)
c
2
17.248, p 0.37
*Signicant p 0.05.
p e d i a t r i c d e nt a l j o ur na l 2 3 ( 2 0 1 3 ) 1 e7 4
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)
Dont know 0 (0) 0 (0) 20 (16.7) 47 (19.0)
c
2
77.65, p 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)
Dont know 0 (0) 1 (12.5) 22 (18.3) 46 (18.5)
c
2
5.831, p 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)
c
2
3.391, p 0.34
When should you start cleaning your childs 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)
Dont know 0 (0) 0 (0) 22 (18.3) 33 (13.3)
c
2
11.263, p 0.51
What should be used in cleaning the babys teeth?
1 Cotton wool & salt 0 (0) 2 (25.0) 23 (19.2) 47 (19.0)
2 Face towel and water 0 (0) 3 (37.5) 41 (34.2) 86 (34.7)
3 Soft Toothbrush and toothpaste 0 (0) 2 (25) 21 (17.5) 56 (22.6)
4 Face towel and mild soap 0 (0) 0 (0) 3 (2.5) 5 (2.0)
5 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)
Dont know 0 (0) 0 (0) 1 (0.8) 3 (1.2)
c
2
33.817, p 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)
Dont know 0 (0) 0 (0) 3 (2.5) 2 (0.8)
c
2
6.289, p 0.90
*p value is signicant p < 0.05.
Fig. 1 e Are dental visits important? ,, No; -, Yes.
p e d i a t r i c d e nt a l j our na l 2 3 ( 2 0 1 3 ) 1 e7 5
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 conicts of interest that should
be disclosed.
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Fig. 3 e If your children have visited the dental clinic, what
was done? Bar represents purpose of visit.
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