aged children. Early childhood caries (ECC) is associated with significant adverse physical,
functional, and behavioural consequences that can greatly impair quality of life2.
The prevalence of ECC is estimated to range from 1% to 12% in pre-schoolers of developed countries and from 50% to 80% in high-risk groups.The prevalence of ECC and associated risk factors was estimated to be 27.5 % in pre-school children of urban Bangalore1.
Today’s parents are busier than those in past decades. Mothers extend a helping hand financially, but because of stress at work, find less time to look after their children in regard to their health, oral hygiene and food they consume3. A relationship between caregiver stress and ECC seems promising ,especially since oral health practices for infants and toddlers are the responsibility of the caregiver during the developmental period before the child masters his or her own self-care skills.4
Although a possible relation between parental stress and ECC have been proven, very few studies have been done in this field, especially in India.
Hence this study aims to assess the influence of parental stress on early childhood caries (ECC) among preschool children in Bangalore.
6.2ReviewofLiterature: A study was conducted among 150 caregiver child pairs in an inner city health centre that serves as a minority and lower socioeconomic population in USA to examine the relationships between parenting stress and ECC while controlling the behavioural and biological factors in a high risk population. It showed that total parental stress was related significantly to ECC-1[(Presence or absence of caries) p<0.05] while the parent child dysfunctional interaction variable was related significantly to ECC-2[(total number of carious teeth) p<0.05].Oral hygiene duration was also related significantly to ECC-1(p =0.01) and ECC-2(p =0.01). The study observed the bivariate relationships between total parental stress and parent child dysfunctional interaction to caries.4
A cross sectional study was conducted to examine the association between parenting stress and early childhood caries (ECC) in 97 children of 4-5 years of age attending preschools in the North Brisbane Health Region, Australia.. Clinical examinations were conducted to evaluate the caries status of each child. Two questionnaires were given to caregivers soliciting demographic details, oral health behaviour information and information on parenting stress. The study demonstrated a significant bivariate association between parenting stress and ECC experience as measured by dmft.6
A study was conducted among 1021 caregiver child pairs to examine about several specific maternal health beliefs, behaviours, and psychosocial factors relate to young children’s early childhood caries (ECC) status in a lower-income African–American population in Detroit Michigan. The study showed that one-third of the children had ECC, and 20% had severe ECC. Age of the child and lower parenting stress scores were each positively associated with ECC, while higher education and income were protective. Maternal oral health fatalism and knowledge of children’s hygiene needs were associated with ECC among preschool-aged children2
A study was conducted among 514 children less than 4 years old in, Beijing, China, to assess risk factors for severe ECC. A questionnaire was designed to collect background information, feeding habits and oral hygiene practices .Dental plaque samples were collected to test acidogenic ability of bacteria. The study showed that a lower maternal education level ,poor knowledge of oral hygiene, night feeding, and excessive sugar intake were important contributors to the development of severe ECC.7
A cross sectional study was done in Bangalore city, India, among 1,500 children aged between 8 and 48 months. The status of dental caries was recorded according to the World
Health Organization (WHO) criteria. A structured questionnaire was given to mothers to obtain data on demographic details, oral hygiene practices, feeding habits and socio-economic status. The prevalence of ECC was found to be 27.5% among pre-school children in Bangalore.1
A case-control study was conducted among 800 preschool children [400 cases (caries active) and 400 controls (caries free)] aged 4-5 years along with their parents to assess parental stress as a risk indicator to early childhood caries(ECC). In this study using the Parental Stress Index-Short Form (PSI ⁄ SF), the stress of primary caregivers of young children were determined and dentition status and treatment needs of children were assessed using the WHO Oral Health Surveys criteria. Student’s t-test, Pearson’s correlation and linear regression were used for statistical analysis. An overall mean parenting stress index was found to be 193.48 ± 59.63. Significantly higher mean stress scores were obtained among cases than controls. This study provides data to suggest that parental stress is one of the best predictors of ECC and has a pervasive impact on the children’s oral health.3
6.3 Objectives of the study:
To assess prevalence of early childhood caries among preschool children.
To assess prevalence of stress among parents of preschoolers.
To determine possible relationship between parental stress and early childhood caries.
Materials and methods:
7.1 Source of data:
A cross sectional study will be conducted among 3-5 year old children studying in different pre-schools , selected randomly from the list obtained from Deputy Director of Public Instructions office of North and South zone Bangalore.
The data will be collected from preschool children and their parents who fulfill the inclusion criteria after obtaining necessary permissions from school authorities and parents who were explained the nature and purpose of the study.
A modified Parental Stress Index-Short Form (PSI-SF), a questionnaire, which consists of three subscales, the Parental Distress subscale, the subscale of Parent–Child Dysfunctional Interaction, the third subscale called Difficult Child will be used to assess parental stress, along with questions that include demographic information (parent’s age, gender, education, socioeconomic status, /child’s gender and number of siblings in house. Socioeconomic status will be recorded using Kuppuswamy’s Socio-Economic Status Scale.
Dentition Status and Treatment Needs of the pre-school children will be assessed using the WHO Oral Health Assessment Form (1997).
The prevalence rate was estimated using the prevalence rate of ECC in Bangalore city obtained from previous study/literature.
The sample size was calculated as 612 pre-school children but was rounded of to 700 pre-school children.
Study population –
Pre- school children within the age group of 3-5 years.
Parents and children who are willing to participate.
Children whose primary caregiver is the parent.
Parents and children who does not give consent.
More than one child per family will be excluded.
Subjects with any systemic diseases and psychological impairment will be excluded.
Children under the care of persons other than their parents.
A cross sectional study will be conducted among pre-school children from pre-schools randomly selected from the list obtained from Deputy Director of Public Instructions office North and South zone, Bangalore.
A pilot study was conducted and internal reliability coefficient (Cronbach’s alfa) obtained was 0.83.
Karl Pearson’s correlation, Chi square test and other relevant statistical tests will be used for analysis of data.
Duration of the study: 6 months
7.3 Does the study require any investigation or intervention to be conducted on patients or other Humans or Animals? If so, please describe briefly.
Yes. Type III oral examination will be conducted on pre-school children for assessment of early childhood caries.
7.4 Has ethical clearance been obtained from your institution, if yes in case of 7.3 Yes.
Ethical clearance is obtained from the institutional ethical committee and review board Vydehi Institute of Dental Sciences & Research Centre, Bangalore.
Prashanth Prakash, Priya Subramaniam, B.H.Durgesh ,Sapna Konde. Prevalence of early childhood caries and associated risk factors in preschool children of urban Bangalore, India: A cross sectional study. Eur J Dent 2012 ; 6 : 141-152.
Finlayson T, Siefert K, Ismail A, Sohn W. Psychosocial factors and early childhood caries among low income African–American children in Detroit. Community Dent Oral Epidemiol 2007; 35: 439-448.
Ipseeta Menon, Ramesh Nagarajappa, Gayathri Ramesh & Mridula Tak Parental stress as a predictor of early childhood caries among preschool children in India. Int J Paediatr Dent 2013;23: 160-165.
Quinonez R, Keels M, Vann W Jr, McIver F, Heller K, Whitt J. Early Childhood Caries: analysis of psychosocial and biological factors in a high–risk population. Caries Res 2000; 35: 376–383.
Mark D. Litt, Susan Reisine, Norman Tinanoff. Multidimensional Causal Model of Dental Caries Development in Low-Income Preschool Children. Public Health Reports 1995;110: 607-617.
Tang C, Quinonez R, Hallett K, Lee J, Kenneth Whitt J. Examining the association between parental stress and the development of early childhood caries. Community Dent Oral Epidemiol 2005; 33: 454–460
Man Qin, Jing Li, Sun Zhang, Wenil Ma.Risk factors for severe early childhood caries in children younger than 4 years old in Beijing, China. Pediatr Dent 2008;30: 122-128.