Early Childhood Caries (ECC) refers to an infectious and chronic oral disease that is prevalent in young children, and it is common among minority and poor populations. Some public health programs that have been implemented following increased cases of ECC include fluoride therapy, intensive patient counseling, modification of diets, and antimicrobial interventions (Fan, Wang, Xu, & Zheng, 2016). Javed, Feng, and Kopycka-Kedzierawski (2016) pointed out that there have been a lot of concerns regarding the increase in the prevalence of ECC among the poor and minority populations. Chu (2006) pointed out that there are a number of causal factors of ECC that play a significant role in the increased rate of ECC prevalence among young children from minority and poor populations. In spite of this, numerous researchers and scholars have expressed concerns over the role of caretakers and parents in the prevention of early childhood caries (Ezer, Swoboda, & Farkouh, 2010; Javed et al., 2016).
In support of this, Ezer et al. (2010) noted that there is an information gap regarding the risk and causal factors of early childhood caries as well as its prevention among caregivers. Such a situation has led to children being exposed to diets that can lead to the development of dental caries. Javed et al. (2016) pointed out that parents and guardians should be equipped with the necessary oral health knowledge to ensure that they keep their children free from ECC. As such, this study will focus on the examination of the subject of early childhood caries, with a specific focus on the investigation of the relationship between ECC and caregiver dental knowledge.
Many children suffer from early childhood caries due to poor dietary habits and lack of concern among the parents on their children’s oral health. This is attributable to the lack of ECC awareness and dental care knowledge among parents. Ignoring and neglecting this problem at early stages would lead to further decay of the affected surface, which would spread to the other primary teeth thereby, destroying the individual’s primary dentition. To reduce as well as prevent dental caries in children, parents need to be aware of the recommended feeding, breastfeeding practices and knowledge on dental care and the causal factors of ECC.
Several research objectives and questions have been identified for this research study. However, the study will focus on one question in order to deliver meaningful findings. The targeted research question is presented below.
- Is there a significant relationship between the dental knowledge among guardians/parents and the prevalence rate of ECC among young children?
Goals and Objectives
The primary goal of this study is to provide awareness of early childhood caries particularly on the role of parents in the prevention of early childhood caries.
The specific objective of this study include:
- To establish whether or not there is a significant relationship between the parents’ dental knowledge and increased prevalence rate of ECC among young children.
The rate of early childhood carries among children is high (54%) (Berkowitz, 2003; Ezer et al., 2010). The problem of early childhood caries is considered to be a virulent type of dental caries, which features extremely infectious challenge, with a close relation to dietary habits. During the initial stages of ECC, the affected individual experiences smooth surface carious lesions, which tend to occur on the primary maxillary incisors. However, the progression of the disease is manifested by decay of the first molars’ occlusal surface. If not prevented at this stage, the decay has the ability of spreading to the other primary teeth thereby, destroying the individual’s primary dentition. Even though early childhood caries is a common problem to preschool children and babies, its prevalence is higher among disadvantaged children. This section provides an overview of the literature that will be used in the study on early childhood caries.
The preferred main literature focuses on causes of ECC, its treatment and prevention. In his qualitative review to examine the causes, treatment and prevention of early childhood caries, Berkowitz (2003) provides a comprehensive coverage of the concept of early childhood caries focusing on the primary causes and how it can be prevented as well as treated. Microbial studies on the causal factors of early childhood have indicated that infants suffering from ECC have more than 30% of Streptococcus mutans in comparison to the plague flora.
According to Berkowitz (2003), recent reports on the incidence of ECC among disadvantaged children have indicated that the prevalence is high. In support of this, Chu (2006) asserted that there are numerous factors that influence the occurrence of ECC hence, increasing the rate of early childhood caries among young children especially those from minority and poor backgrounds. The natural history of early childhood caries is associated with the acquisition of Streptococcus mutans at early stages of growth. The availability of excess Streptococcus mutans, according to Berkowitz (2003), leads to loss of minerals in the tooth structure of the affected individual. Treating early childhood caries is quite expensive as it involves restoring carious teeth or removing them. However, parents are advised to consider their children’s feeding habits, alongside the adoption of antimicrobial therapy as ways of preventing the occurrence of ECC (Berkowitz, 2003). This article is very useful in providing background on the causal factors, treatment and prevention of ECC.
Tickle et al. (2016) carried out a study primarily to measure the impacts and costs of composite fluoride intervention implemented for the purpose of preventing dental caries in young children. This study found out that even though there is a high prevalence of ECC, dental knowledge among parents is minimal and forms one of the factors responsible for the increased number of children suffering from dental caries (Tickle et al., 2016). However, the study indicated that a number of preventive and curative measures have been adopted to reduce the prevalence rate of early childhood caries. According to the results of this study, it was evident that the teeth of the children under composite fluoride intervention became caries active. In addition, for the children put under the composite fluoride intervention, only a small number of their tooth surfaces were affected by caries (Tickle et al., 2016). Nevertheless, the cost of the composite fluoride intervention was quite high, which explains why many parents are reluctant to adopt such interventions.
Javed et al. (2016) examined the incidence of early childhood caries by systematically reviewing available literature. The study focused on five studies, whereby two were randomized clinical trials. It was evident that the incidence level of childhood caries is high among children with baseline caries in comparison to caries-free children.
In another study, Fan et al. (2016) focused on identifying the risk factors that have a close association with dental caries. In this study, it was evident that the rate at which children visited a dentist for examination was a factor in the occurrence of dental caries. Children who had frequent visits to dentists were less likely to have dental carries. On the other hand, a high level of Streptococci mutans played a significant role in most cases of high prevalence of dental caries in children (Fan et al., 2016). Such findings align with the assertions of Berkowitz (2003) that one of the risk factors of early childhood caries is plaque Streptococci mutans, especially at high levels.
High number of cases of early childhood caries has led to the adoption of various initiatives to reduce as well as prevent the occurrence of ECC. As Javed et al. (2016) noted, a number of public health programs have been implemented to prevent early childhood caries. For example, the fluoride therapy is used to ensure that there is no loss of minerals in the teeth. In addition, fluoride is used to re-mineralize early carious lesions hence, reducing the severity of dental caries. This can be attributable to the fact that the application of fluoride on teeth allows the formation of calcium fluoride globules for the purpose of reserving minerals that are used in the prevention of demineralization.
Another health program that is common in the fight against dental caries is intensive patient counseling, where individuals are provided with in-depth knowledge about dental care. In addition, modifications of diets and antimicrobial interventions have also been adopted as measures towards prevention and reduction of the prevalence rates of early childhood caries. Memarpour, Dadaein, Fakhraei, and Vossoughi (2016) carried out a comparative analysis of the significance of oral health education and the use of fluoride intervention. The results of this study indicated that both methods were effective in the reduction of dental caries, and that there was a need to implement both simultaneously. Ezer et al. (2010) asserted that the increase in the number of cases of early childhood caries can be attributed largely to the existence of an information gap as far as the risk and causal factors of early childhood caries, as well as its prevention is concerned.
From the foregoing, it is evident that the prevalence rate of ECC is high. While, there are various factors that lead to high cases of dental caries among young children, the literature review has showed that the dental knowledge on the risk factors of ECC, its prevention and treatment among parents and guardians has put a lot of children at vulnerable positions, where they are highly likely to have dental caries. The implication is that there is a need for parents and guardians to be aware of the factors that contribute to the occurrence of early childhood caries, as well as the available resources to deal with this problem.
The study on the relationship between parents’ dental knowledge and early childhood caries will focus on what is known about the problem of dental caries in children and hence, the experimental design will be used. The primary sources of data will be used to provide insights into the study phenomenon. The primary sources of data will include several respondents. The target population for this study is young children between the ages of 0 and 5 years who have dental caries. Simple random sampling technique will be used to get the required sample size after which, structured questionnaires will be conducted to assess the state of childhood caries, risk and prevention among the selected children and thus, nominal and interval scales of data will be used in this study.
The decision to use the simple random sampling technique is based on the fact that such a sampling method is inclusive and hence, suitable for obtaining a highly representative sample as it gives all units in a sample frame equal chance of inclusion to the sample. In addition, it is free from human bias and avoids the classification of errors. For this reason, the simple random sampling technique will be instrumental in ensuring that all the children selected for the study are representative of the population of the study in terms of the major characteristics such as age, and availability of dental caries.
Therefore, the study will be cross-sectional as this approach is quiet and simple to carry out. As such, through the use of the simple random sampling technique will target a sample size of 50 children aged between 0 and 5 years and have dental caries, alongside their parents or guardians. The selected children and their parents or guardians will be used to provide responses on a few aspects of dental caries. Since the study focuses on the risk factors of childhood carries, treatment, and its prevention, the selected parents’ knowledge and children’s oral health status will be assessed. This will include observing the behaviors of the parents as far as the management of their children’s dental issues. In addition, the dental conditions of the children in the sample will be investigated for the purpose of examining the role of dental knowledge on the prevention or even elimination of dental caries.
The study will also focus on understanding the knowledge and performance of the parents as far as dental care is concerned. As such, the relevant information such as parental education, their dental care knowledge, the family socioeconomic background, as well as breastfeeding practices will be collected. In addition, emphasis will be put on examining the dietary practices of the children in order to examine the possibility of being subjected to sugary diets that can lead to the occurrence of early childhood caries.
All the collected data will be synthesized for a chance to establish whether or not there is a significant relationship between the parents’ dental knowledge and increased prevalence rate of ECC among young children. As such, given that the study will focus on low SES, stratifying the study based on low and high SES will be instrumental in examining the parents’ knowledge regarding dental care and hence, establish whether or not there is any significant difference between the two groups.
Berkowitz, R. (2003). Causes, treatment and prevention of early childhood caries: A Microbiologic Perspective. Journal of the Canadian Dental Association, 69(5), 304-307.
Chu, S. (2006). Review – Early childhood caries: Risk and prevention in underserved populations. Los Angeles, LA: University of California Press.
Ezer, M. S., Swoboda, N. A., & Farkouh, D. R. (2010). Early childhood caries: The dental disease of infants. Oral Health Journal, 1(1), 1-7.
Fan, C., Wang, W., Xu, T., & Zheng, S. (2016). Risk factors of early childhood caries among children in Beijing: a case-control study. BMC Oral Health, 16(1), 23-46.
Javed, F., Feng, C., & Kopycka-Kedzierawski, D. (2016). Incidence of early childhood caries: A systematic review and meta-analysis. Journal Of Investigative And Clinical Dentistry, 2(3), 19.
Memarpour, M., Dadaein, S., Fakhraei, E., & Vossoughi, M. (2016). Comparison of oral health education and fluoride varnish to prevent early childhood caries: A randomized clinical trial. Caries Research, 50(5), 433-442.
Tickle, M., O’Neill, C., Donaldson, M., Birch, S., Noble, S., Killough, S., …Worthington, V. (2016). A randomized controlled trial to measure the effects and costs of a dental caries prevention regime for young children attending primary care dental services: The Northern Ireland Caries Prevention in Practice (NIC-PIP) trial. Health Technology Assessment, 20(71), 1-96.