DENTINO
JURNAL KEDOKTERAN GIGI Vol VII. No 2. September 2022
THE RELATIONSHIP BETWEEN KNOWLEDGE AND ATTITUDE OF MOTHERS TOWARDS THEIR TODDLERS DENTAL HEALTH CARE
Ari Tri Wanodyo Handayani1), Roedy Budirahardjo2), Filky Nanda Mafilda 3)
1)Department of Dental Public Health, Faculty of Dentistry Jember University
2)Department of Pedodontic, Faculty of Dentistry Jember University
3)Faculty of Dentistry Jember University ABSTRACT
Background: Caries are one of the dental and oral health problems that are still the highest sequence today. The prevalence of caries in Indonesia gets 90% in the toddler population. A mother's knowledge about dental health will determine the mother's attitude towards children's dental health care, and low maternal knowledge is associated with high caries prevalence. The working area of the Bangsalsari Public Health Center is one of the areas in Jember that have a relatively high number of caries cases in toddlers, which is more than half of the number of toddlers experiencing caries. The study aims to analyse the relationship between knowledge and attitudes of mothers in the maintenance of dental health of toddlers in the work area of the Bangsalsari Public Health Center, Jember.
Methods: This type of research is analytic observational with a cross-sectional approach. The research subjects were selected by a total sampling technique and obtained by as many as 126 mothers of toddlers. Data were collected using a knowledge and attitude questionnaire each containing 10 questions. The research data that have been obtained are then carried out with a nonparametric Spearman correlation test. Results: Spearman test shows a significant value of 0.000 (p<0.05), the correlation value obtained is r = 0.824 with a positive value. Conclusion:
There is a significant relationship between knowledge and attitudes of mothers in dental health care for toddlers, and both variables have a unidirectional relationship with a very strong correlation level.
Keywords : Attitudes of mothers, Dental health care, Knowledge, Toddlers
Correspondence: Ari Tri Wanodyo Handayani, Department of Dental Public Health, Faculty of Dentistry Jember University, Jl. Kalimantan, No. 37 Kampus Tegalboto, Jember, e-mail: [email protected]
INTRODUCTION
Dental and oral health plays an important role in maintaining the balance of body functions.
Dental and oral health problems are health problems that need to be addressed comprehensively because they have a very broad impact. Dental and oral health problems that are still in the highest order today are dental caries.1
The prevalence of dental caries in Indonesia is still quite high. Based on the results of the National Basic Health Research in 2018, the prevalence of the population with dental caries in Indonesia increased by 57.6% from 53.2% in 2013 and the prevalence of dental caries reached 90% of the toddler population.2 The prevalence of dental caries in East Java, there was an increase, which was 54.22% in 2018.3 Suryani (2019) stated that 9 out of 10 toddlers had tooth
decay and each child had an average of 7 teeth affected by caries.4
The highest prevalence of caries in toddlers is associated with the low ability of toddlers to clean teeth effectively, the habit of using a bottle mouth, and the habit of consuming cariogenic foods.5 Mother's awareness of the importance of maintaining dental health can be seen from the mother's knowledge about dental health.6 Mother's knowledge about dental health will determine the mother's attitude in maintaining the dental health of toddlers, and low maternal knowledge is associated with a high prevalence of dental caries.7 Keumala (2018) states that A mother's knowledge is very important in shaping behaviour that supports or does not support the maintenance of a toddler's dental health. Mothers who have lower knowledge will produce attitudes and behaviours that neglect their toddler's dental and
oral hygiene, which can increase the occurrence of caries in toddlers.8
Knowledge can be defined as everything that is known that comes from individual experience.
Knowledge will increase according to the process of experience experienced by the individual.9 Individual knowledge is influenced by several factors, namely the level of education, the amount of information obtained, environmental conditions, experience, age, and economic status.7 Attitude is a person's closed response to certain stimuli or objects that involve a person's emotional factors, such as agreeing or disagreeing, happy or not happy, good or not good.10
Jember Regency is one of the areas in East Java Province. Jember Regency is administratively divided into 31 sub-districts, one of which is Bangsalsari District. Based on the report data on dental and oral diseases in Jember Regency, dental caries in the working area of the Bangsalsari Health Center experienced a significant increase from 334 people in 2019 to 723 people in 2020. The working area of the Bangsalsari Public Health Center shows the highest number of dental caries case visits from 50 Public Health Center areas spread across the Jember district, namely 1,282 people who experienced dental caries in 2020-2021. The dentist at the Bangsalsari Health Center said that from every Integrated Services Post, almost all toddlers had dental caries. Based on data obtained from the Bangsalsari Health Center as much as 2,497 of the 4,799 toddlers examined for dental caries in 2020- 2021.
The purpose of this study was to analyse the relationship between knowledge and attitudes of mothers in the maintenance of dental health for toddlers in the work area of the Bangsalsari Public Health Center, Jember.
MATERIALS AND METHODS
Category n %
Positive 60 47,6
Negative 66 52,4
Total 126 100
This research has obtained a research permit and ethical feasibility issued by the Health Research Ethics Commission, Faculty of Dentistry, Jember University No. 1447/UN25.8/KEPK/DL/2022. This type of research is analytic observational with a cross-sectional approach. The subjects in this study were 126 mothers of toddlers, the research subjects were selected using a total sampling technique. This research was carried out in February 2022 in three
Integrated Services Posts located in Bangsalsari Village, Petung Village, and Langkap Village. Data was collected using a questionnaire and filled in by mothers of toddlers who came to Integrated Services Post activities, then continued with interviews. Data on the level of knowledge of mothers about the maintenance of dental health for toddlers were obtained by filling out a questionnaire totaling 10 questions. The value of the questionnaire in this study was divided into 3 categories, namely good knowledge (score 8-10), sufficient (score 6-7), and less (score <6). Mother's attitude data in maintaining the dental health of toddlers was obtained by filling out a questionnaire totaling 10 statements. The value of the questionnaire in this study was divided into 2 categories obtained from the calculation of the T score and the mean T value with a mean T value of 50, namely the category of positive attitude if T score
≥50 and negative attitude if T scores <50.
RESULTS
Research on the relationship between knowledge and attitudes of mothers in maintaining the dental health of toddlers in the work area of the Bangsalsari Health Center was conducted in February 2022. Characteristics of respondents based on education can be seen in Table 1.
Table 1. Characteristics of Respondents in the Working Area of the Bangsalsari Jember Health Center Based on Education
Education n %
No school 4 3,2
Did not pass elementary school 3 2,4 Graduated from elementary
school
37 29,4 Graduated Middle School 31 24,6
High school graduate 43 34,1
College Graduate 8 6,3
Profession
Housewife 115 91,3
Private employees 4 3,2
Farmer 2 1,6
Entrepreneur 5 4,0
Total 126 100
The results showed that most of the respondents were high school graduates, as many as 43 respondents (34,1%). Characteristics of respondents by profession in Table 1 shows that most of the respondents are housewives, which are 115 respondents (91,3%), 4 respondents (3,2%) work as
private employees, 2 respondents (1,6%) as farmers, and 5 respondents (4,0%) as entrepreneurs.
Table 2. Distribution of Respondents Based on Knowledge Levels of Toddler Dental Health Maintenance
Category n %
Good 21 16,7
moderate 52 41,3
Less 53 42,0
Total 126 100
Table 2 shows that the mother's knowledge about the maintenance of dental health for toddlers is mostly less knowledge, with as many as 53 respondents (42,1%).
Table 3. Distribution of Respondents Based on Attitudes in Caring for Toddler Dental Health Table 3 shows that the attitude of mothers toward maintaining dental health for toddlers is mostly negative, with as many as 66 respondents (52,4%).
Question answer N % Toddler
toothbrush use
Own one Alternate
Not used to brushing my teeth
100 11 15
79,4 8,7 11,9 Type of
toothbrush used by toddlers
Child Mature
Not used to brushing my teeth
106 5 15
84,1 4,0 11,9 Frequency
of brushing toddler's teeth
1x (morning shower)
2x (morning and evening shower) 2x (after breakfast + evening)
3x (shower + night) 3x (morning, afternoon, evening) Not used to brushing my teeth
2 87
8 9 5 15
1,6 69,0
6,3 7,1 4,0 12,0 Toddler
teeth habits at night before bed
Yes No Sometimes
Not used to brushing my teeth
21 81 9 15
16,7 64,3 7,1 12,0 Toddler
brushing technique
Vertical Horizontal Roll
Combination
18 36 5 1
30,0 60,0 8,3 1,7
Mother's attitude in inviting toddlers to visit the dental clinic
Yes No
3 123
2,4 97,6
Mother's attitude in seeking treatment when a toddler has a toothache
Buying medicine at the shop/pharmacy Dentist/Public health center (if severe)
Midwife Do Nothing
79 37
2 8
62,7 29,4
1,6 6,3 Frequency
of
replacement of toddler toothbrushes in a year
<3 Months 3-4 Months If it's broken If lost
Not used to brushing my teeth
15 29 62 5 15
11,9 23,0 49,2 4,0 11,9
Total 126 100
Table 4. Interview Results of Respondents in the Working Area of the Bangsalsari Health Center
Based on Table 4, the results of interviews with respondents in the working area of the Bangsalsari Health Center show that most of the respondents answered that toddlers had their toothbrushes, as many as 100 respondents (79,4%), most of the toddlers used a special toothbrush for toddlers, as many as 106 respondents (84,1%), most of the respondents brush their teeth twice a day while bathing in the morning and evening, as many as 87 respondents (69,0%). Based on the habit of brushing their toddler's teeth at night before going to bed, most of the respondents answered that they had not gotten used to their toddlers brushing their teeth, as many as 81 respondents (64,3%). Based on the technique of brushing the teeth of toddlers, most the respondents answered that toddlers brushed their teeth with the horizontal technique as much as 36 respondents (60,0%). Based on the attitude of mothers in inviting their toddlers to visit the dental clinic, most of the mothers answered that they never invited their toddlers to go to the dental clinic, as many as 123 respondents (97,6%), while the attitude of mothers in seeking treatment when their toddler had a toothache, most of them answered that they would buy medicine at a shop/pharmacy, as many as 79 respondents (62,7%). Based on the frequency of changing toddler toothbrushes in a year, most of the respondents answered that they replaced their toothbrush when the bristles were damaged, as many as 62 respondents (49,2%).
Table 5. Relationship between Knowledge and Attitude of Mothers in Caring for Toddler Dental Health in the working area of the Bangsalsari Health Center
Knowled ge
Attitude Tota l (%)
p r Positiv
e (%)
Negativ e (%)
Good 16,7 0 16,7
Moderate 30,9 10,3 41,3 0,00 0
0,82 4
Less 0 42,1 42,1
Total 47,6 52,4 100
Table 5 shows the results of the cross tabulation of the relationship between knowledge and attitudes of mothers in maintaining dental health in toddlers, most of the respondents have less knowledge with negative attitudes as many as 42.1%
respondents, 10.3% respondents have sufficient knowledge with negative attitude, 30.9% respondents had sufficient knowledge with a positive attitude, and 16.7% respondents had good knowledge with a positive attitude. Based on the results of the correlation of mother's knowledge and attitudes using the Spearman rank correlation statistical test, a significant value of 0.000 (p <0.05) was obtained, meaning that there was a significant relationship between mother's knowledge and attitudes in maintaining dental health in toddlers, while the correlation value obtained was r = 0.824 with a positive value so it can be concluded that the two variables have a significant relationship.
DISCUSSION
Table 1 shows the characteristics of respondents in the working area of the Bangsalsari Health Center based on the mother's education. The characteristics of respondents based on education are mostly high school graduates, but there are still many respondents who have junior high school education and even elementary school graduates, this may be due to family economic limitations that cause respondents to be unable to continue their education to a higher level. Characteristics of respondents by profession, most of the respondents are housewives, this may be because housewives have more free time, so they can participate in Integrated Services Post activities compared to working mothers.
Based on Table 2, the level of knowledge of mothers about dental health care for toddlers in the working area of the Bangsalsari Health Center is mostly at the know level and is included in the poor category, this shows that the respondents have a poor understanding of the maintenance of the dental health of toddlers. The respondent's low knowledge may be
due to the mother's education. Most of the respondents have a high school education, but there are still many respondents who have junior high school education and even elementary school education. The level of education is very influential on the mother's knowledge about the maintenance of the dental health of the toddler. The low level of maternal education is one of the factors in the failure to prevent dental caries. Mothers with low education tend to be less aware of how to pay attention, prevent, and take good care of their toddler's teeth.11
Based on Table 2, most toddlers already have their toothbrushes and use a special toothbrush for children, but there are still some toddlers who use toothbrushes interchangeably with other family members and use adult toothbrushes. Toothbrushes for toddlers should have several criteria, namely a small size with a handle that is easy for children to grip, soft bristles with a narrow and flat brush head tip so that it can reach the back of the teeth, whereas a toothbrush with coarse bristles and a large brush head cannot reach the back of the teeth and can result in injury to the teeth and gums. Toothbrushes that are shared with other family members can be a cause of transmission of dental and oral diseases because they allow the transfer of microorganisms.12,13
Most respondents do not understand the right time to brush their toddler's teeth. Many respondents answered that toddlers brush their teeth twice a day in the morning and evening, and respondents do not get used to brushing their teeth before going to bed at night. These results are in line with the research of Noaman et al (2019) which showed that mothers know that brushing their teeth is one way of maintaining dental health, but they do not know the right time to brush their teeth.13 The right time to brush your teeth is in the morning after breakfast which aims to clean up leftover food and at night before going to bed because the saliva flow is not as active as during the day making it easier for bacteria to multiply from food scraps.15
Most of the respondents accompanied and helped brush their toddler's teeth with back-and-forth movements (horizontal technique) for all tooth surfaces. Wijayanti (2018) explained that brushing teeth with a horizontal technique is more effective in reducing plaque compared to other techniques. This technique is a fairly simple method, according to the anatomy of the occlusal surface of the teeth, it can enter the interdental sulcus so that it can clean the plaque around the interdental sulcus, easy for children to do and imitate.16
Table 3 shows that the attitude of mothers in maintaining the dental health of toddlers in the work area of the Bangsalsari Health Center is mostly in the negative category. Most of the respondents took their
toddlers to the dentist only when the dental disease was severe, most of the respondents explained that they never took their toddlers to the dentist, dental clinic, or health center because the toddler had never had a toothache, besides that the mother preferred to buy pain reliever medicine at the shop/pharmacy.
This result is in line with the results of the National Basic Health Research (2018) which states that 95.5% of Indonesians have never visited a dentist.
check with the doctor at least once every 6 months is highly recommended to find out which dental problems must be treated as early as possible.17
The attitude of mothers who do not take care of their toddler's teeth is also evident from the results of the interviews, most of the mothers replace their toddler's toothbrushes when the bristles are damaged.
The frequency of using a toothbrush in a year is one of the factors that need to be considered because after 3 months of use the bristles will look more blooming or irregular again, causing injury to the gums, and the toothbrush will lose its ability to clean plaque and can be a gathering place for bacteria. 17,18
The attitude of mothers who are lacking in maintaining the dental health of toddlers can be caused by the lack of information and knowledge of mothers about dental care, as well as the lack of enthusiasm of mothers in maintain the dental health of toddlers. Liza & Diba (2020) explained that the lack of information about toddler dental care can cause the mother's attitude to be wrong in responding to dental problems. Mothers will assume that toothache is a natural thing experienced by toddlers and is underestimated because it is not dangerous.19
Based on the Spearman rank correlation statistical test, it was found that there was a significant relationship between mothers' knowledge and attitudes in maintaining the dental health of toddlers in the working area of the Bangsalsari Health Center. The correlation coefficient is positive, which means that the two variables have a unidirectional relationship, namely the better the mother's level of knowledge about dental health maintenance, the more positive the mother's attitude towards the maintenance of the dental health of toddlers and vice versa with a very strong correlation level. This may be due to the mother's knowledge of dental health care playing an important role in the underlying formation of children's dental health care attitudes. Notoatmodjo (2018) states that knowledge is one of the predisposing factors for the formation of a complete attitude (total attitude) so low knowledge will support the formation of a negative attitude. Liza
& Diba (2020) explain that individual knowledge about an object consists of 2 aspects, namely positive and negative aspects. This aspect of knowledge will determine the individual's attitude, the more
dominant the positive aspect and the more objects that are known, the more positive the individual's attitude will be.19
Based on the results of the study, it can be concluded that there is a significant relationship between the knowledge and attitudes of mothers in maintaining dental health in toddlers, and these two variables have a direct relationship with a very strong correlation level. The suggestion from this research is that parents are expected to be more active in seeking information about maintaining the health of their children's teeth and mouth to avoid dental and oral problems. There is a need for counseling on the importance of maintaining dental and oral health for mothers by dentists and medical professionals so that mothers better understand and pay attention to the dental and oral health of toddlers.
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