Knowledge, Attitude and Perception of Oral Health Among Parents of Children at Risk of Infective Endocarditis Attending Pediatric Cardiology Center Of King Fahad Medical City

Lama Almashham* 

King Fahad Medical City, Kingdom of Saudi Arabia 

^*Corresponding author: Lama Almashham, King Fahad Medical City, Kingdom of Saudi Arabia
 
Citation: Almashham L. (2022) Knowledge, Attitude and Perception of Oral Health Among Parents of Children at Risk of Infective Endocarditis Attending Pediatric Cardiology Center Of King Fahad Medical City. J Oral Med and Dent Res. 3(2):1-27.
Received: December 13, 2022 | Published: December 23, 2022

Copyright^© 2022 by Almashham L, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 

Abstract

Infective endocarditis is known to be a serious complication, mostly in patients who are susceptible of cardiac conditions. It is well established that there is a relationship between oral microorganisms and the development of infective endocarditis.

Objectives: The objective of this study is to determine the knowledge of the parents of children at risk for infective endocarditis, the preventive behaviours practiced, and the oral health status of the children.

Materials and Methods: A questionnaire will be distributed to parents (n = 107) of children with known cardiac diseases using selective non-random sampling, with an age ranging from 0-12 years.

Results: Although the parents' knowledge of oral health was adequate, their attitudes regarding it were not. The parents in this study agreed that maintaining good dental health was crucial for overall body health.

Conclusion: Based on these results we can conclude that attitudes toward dental care and oral health among both parents and children need to be modified.

Keywords

Infective Endocarditis; Oral hygiene; Dental caries
 

Introduction

Infective Endocarditis (IE) is known to be a serious complication, mostly in patients who are susceptible of cardiac conditions (Cowper et al., 1996), such as those with congenital heart disease, valve replacements, cardiac implantable electronic devices, chronic rheumatic heart disease, nosocomial infection and poor oral hygiene (Süzük et al., 2016). It is well established that there is a relationship between oral microorganisms and the development of infective endocarditis. The causative microorganisms for infective endocarditis in most of the cases of patients with positive haemoculture are streptococci (Bayliss et al., 1983), with S. Viridans representing 50% of this group. Even under normal physiological conditions, poor oral hygiene can result in bacterima, which increases the likelihood of getting the disease permanently (Smith & Adams et al., 1993). Therefore, individuals who are at risk are highly encouraged to establish and maintain the most meticulous oral health habits in order to reduce the potential sources of bacteremias (Guntheroth, 1984; Wilson et al., 2008). There are scarce resources in the literature regarding children’s oral health with pre-existing congenital heart disease. However, some studies have shown that these children suffer poorer oral health compared with a control group (Berger, 1978; Franco et al., 1996; Hallett et al., 1992). Some reasons include their frequent consumption of sugared medicines, increased susceptibility of developmental enamel defects (Hallett et al., 1992), and negligence of oral hygiene as their worry of their cardiac condition outweighs care for meticulous oral hygiene (Berger, 1978; Franco et al., 1996; Gould & Picton, 1960; Hallett et al., 1992).

Considering all these aspects, the importance of evaluating oral health conditions of children at risk for infective endocarditis is obviously overlooked, so there is a rising demand to assess the current knowledge, attitude, and perception of their parents’ awareness. Therefore, the objective of this study is to determine the knowledge of the parents of children at risk for infective endocarditis, the preventive behaviours practiced, and the oral health status of the children.

Materials and Methods

In this cross-sectional study, a total of 112 parents of children with known cardiac diseases included in The American Heart Association (AHA) conditions that have a risk of IE, with an age ranging from infancy to 12 years of age and are attending the paediatric outpatient clinics at King Fahad Medical City (KFMC) during a period of six to eight weeks using selective non-random sampling. This study was approved by the Institutional Review Board (IRB) of King Salman Heart Center, Saudi Arabia (IRB Log No. 22-482). 

A self-constructed questionnaire composed of 16 multiple choice questions that were written in Arabic language was distributed to parents/caregivers. Two questions were related to participants’ demographic information (sex and age group), the remaining fourteen questions were divided into four different categories covering oral hygiene habits, awareness of gingival health and plaque, knowledge and awareness of dental and general health, and attitudes towards professional dental care. Assessments of oral hygiene habits included brushing frequency and role of parents’ supervision.

Data were analyzed using IBM SPSS Statistical software for Windows version 26.0 (IBM Corp., Armonk, N.Y., USA). Descriptive statistics (frequencies and percentages) were used to describe the categorical variables. A nonparametric Pearson’s chi-square fitness of test was used to observe the statistical significance of observed categorical responses of 8 items of knowledge and 4 items of attitudes towards oral hygiene. A p-value of ≤ 0.05 was used to report the statistical significance of results [1-15].

Results

A total of 112 parents had responded to this study which assesses their knowledge and attitudes towards oral hygiene. Out of 112 parents, 60 (53.6%) of them answered for their male child, while the remaining 52 answered for their female child. Distribution regarding the age was the following: the smallest group was a minimum of 0 to 12 months (7.1%), while the most prevalent group were 9 to 12 years (29.5%). Regarding oral hygiene maintenance, about 50% of them had responded that their children do not brush their teeth, while only 12.5% of them were brushing their teeth twice a day. Regarding the role of parents in supervision of oral hygiene, 62.5% of them were only advising but do not watch their child brush their teeth, while 27.7% neither advice nor watch. Only 9.8% are attentive to their children by advising and watching them brush (Table 1).

Table 1: Distribution of children’s age, gender and items related to oral hygiene (n=112).

Regarding their knowledge of oral hygiene and awareness of gingival health, 34.8% of parents answered that plaque is soft deposits on teeth that can be removed by manual brushing, which is significantly higher than other two options of responses (p=0.002). 66.1% of them said that gingivitis could be prevented by brushing the teeth and using dental floss, which is significantly higher than other three responses (p<0.0001). Regarding the knowledge of dental and general health, when asked about the effect of sweets on dental health, 97.3% replied in agreement, which is highly statistically significant (p<0.0001), while 2.7% had responded with denial. For the awareness of oral health effect on the cardiac condition, 91.1% were aware of the significance, whereases 8.9% had no clue about the association between them (Table 2).

Table 2: Distribution and comparison of parent’s responses related to the items of their knowledge towards oral hygiene.

On the assessment of the attitude towards professional dental care, 64.3% responded that they visit the dentist only when in pain, which is statistically significantly higher than the other two responses (regularly and occasionally or never) (p<0.0001). Concomitantly, pain happens to be the primary reason for their last visit to the dentist in 75.9% of the respondents. Regarding the reasons of not visiting the dentist, most of them justified it with the high cost (36.6%) among the five other reasons, which is highly statistically significant (p<0.0001). When the parents were asked about their interest in receiving more education about oral health and its impact on overall well-being, 58% of them responded affirmatively, while 22.3% of them were not interested, and 19.7% were neutral (Table 3).

Table 3: Distribution and comparison of parent’s responses related to the items of their Attitude towards oral hygiene.

Discussion

Conclusion

References