“A COMPARATIVE STUDY TO ASSESS THE LEVEL OF KNOWLEDGE

REGARDING EARLY CHILDHOOD CARIES AMONG WORKING AND

NON WORKING MOTHERS OF 1-5 YEARS OF CHILDREN IN

SELECTED AREAS,BANGALORE WITH A VIEW TO DEVELOP AN

INFORMATION BOOKLET”.

By
MS. CHINCHU JOSEPH

Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In Partial fulfillment
of the requirements for the degree of
Master of Science in Nursing
In
Child Health Nursing

Under the guidance of

MRS.R. RAMALAKSHMI MSc (N)
Asst. Professor
Dept of Child Health Nursing
T. John College of Nursing
Gottigere, Bangalore-83.

2013

i
 Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation/thesis entitled “A COMPARATIVE STUDY TO

ASSESS THE LEVEL OF KNOWLEDGE REGARDING EARLY CHILDHOOD

CARIES AMONG WORKING AND NON WORKING MOTHERS OF 1-5 YEARS

OF CHILDREN IN SELECTED AREAS, BANGALORE WITH A VIEW TO

DEVELOP AN INFORMATION BOOKLET” is a bonafide and genuine research

work carried out by me under the guidance of Mrs. R.Ramalakshmi Asst. Professor

Dept of Child Health Nursing, T. John College of Nursing, Gottigere, Bangalore.

Date: Signature of the Candidate

Place: Bangalore Ms. Chinchu Joseph

ii
 ENDORSEMENT BY THE HOD, PRINCIPAL /
HEAD OF THE INSTITUTION.

This is to certify that the dissertation entitled “A COMPARATIVE STUDYTO

ASSESS THE LEVEL OF KNOWLEDGE REGARDING EARLY CHILDHOOD

CARIES AMONG WORKING AND NON WORKING MOTHERS OF 1-5 YEARS

OF CHILDREN IN SELECTED AREAS, BANGALORE WITH A VIEW TO

DEVELOP INFORMATION BOOKLET” is a bonafide research work done by Ms.

Chinchu Joseph, under the guidance of Mrs. R Ramalakhsmi Asst. Professor, Dept

of Child Health Nursing, T. John College of Nursing, Bangalore.

Mrs. R. Ramalakshmi Mrs. P. Neelavathi

Head of the Department Principal
Dept. Of Child Health Nursing T. John college of nursing
T. John college of nursing Bangalore. Bangalore

Date: Date:
Place: Bangalore Place: Bangalore

iii
 CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A COMPARATIVE STUDYTO

ASSESS THE LEVEL OF KNOWLEDGE REGARDING EARLY CHILDHOOD

CARIES AMONG WORKING AND NON WORKING MOTHERS OF 1-5 YEARS

OF CHILDREN IN SELECTED AREAS, BANGALORE WITH A VIEW TO

DEVELOP INFORMATION BOOKLET” is a bonafide research work done by Ms.

Chinchu Joseph in partial fulfillment of the requirements for the degree of Master of

Science in Child Health Nursing.

Date: Signature of the Guide

Place: Bangalore Mrs. R Ramalakshmi

Asst. Professor
T. John College of nursing
Bangalore

iv
 COPY RIGHT

Declaration by the candidate

I hereby declare that the Rajiv Gandhi University of Health sciences,

Karnataka shall have the rights to preserve, use and disseminate this dissertation/ thesis

in print or electronic format for academic/research purpose.

Date: Signature of the candidate

Place: Bangalore. Ms. Chinchu Joseph

© Rajiv Gandhi University of Health Sciences, Karnataka

v
 ACKNOWLEDGEMENT

“This is the lord’s doing; it is marvelous in our eyes.”

(Psalms -118.23)

First and foremost I thank and praise the God Almighty for giving all wisdom,

strength and guidance to complete this study successfully.

I am extremely thankful to Dr. Thomas. P. John, Chairman, T. John Group of

Institutions for giving me an opportunity to pursue my post graduation course in this

esteemed institution.

I would like to express my heartfelt gratitude and regard to Prof. Mrs. P.

Neelavathi, Principal, T. John college of Nursing for her valuable guidance and support

to carry out the dissertation work successfully.

I am profoundly indebted to Mrs.R Ramalakshmi,Guide and HOD Dept of Child

Health Nursing for her guidance and encouragement in every steps of the study.

I express my sincere thanks to Mrs. Umamaheswari, Lecturer, T John College of

Nursing, for her continuous encouragement

Heartfelt thanks to all the MSc faculties of T John College of Nursing for their

valuable guidance and practical advices.

Thanks to all librarians and all non teaching staffs, T. John College of nursing,

for providing all the facilities for the completion of the study.

vi
 I extend my sincere thanks to Mr Shaji Thomas, English Lecturer for editing

my thesis.

It is my pleasure and privilege to express my deep sense of gratitude to Mr.Bilby

Baby John, for the constant guidance, highly instructive suggestions, precious advice,

inspiration and encouragement at each and every step of the study.

My special thanks to all the subject experts who spent their valuable time for

validating my tool.

I extend my hearty thanks to Dr.Latha Murthy AMO of Begur Primary health

centre for permitting me to conduct the study in begur and for their cooperation

throughout the study.

My sincere thanks to all the participants for their cooperation with out which the

study will be impossible.

I would like to thank Mr.Suchatha Suresh, Assistant professor in Biostatics for

her guidance and support in the statistical analysis.

I am very much grateful to my beloved parents T J Joseph and Thankamma

Joseph, brother Ajish joseph, for their support, constant encouragement, timely help and

inspiration which boosted up my morale during the course of this study.

Deepest thanks are extended to my classmates and friends for their inestimable

helps and inspiration rendered at every steps of the study.

I owe a special thanks to nuns of Amal Jyothi Study House, Gottigere for their

prayer and support throughout the study period.

vii
 I would like to thank SiCE Computers, Gottigere for their prompt service.

Finally I wish to acknowledge each and everyone who have directly and indirectly

helped me to complete this thesis successfully.

Date: Signature of the Candidate

Place: Chinchu Joseph

viii
 LIST OF ABBREVIATIONS USED

Ecc Early childhood caries

Deft Number of decayed extracted filled teeth in person mouth

df Degrees of freedom

dmft Decayed missing filled teeth

dmfs Decayed missing filled tooth surfaces

NS Not Significant.

% Percentage.

S-ecc Severe early childhood caries

SD Standard Deviation.

WHO World Health Organization.

X2 Chi-Square.

ix
 ABSTRACT

A study entitled “ A comparative study to assess the level of knowledge regarding

early childhood caries among working and non working mothers of 1-5 years of children
in selected areas, Bangalore with a view to develop an information booklet”.

Background of the study

Early childhood caries (ECC) is defined as the presence of 1 or more decayed,

missing or filled tooth surfaces in any primary tooth in a child 71 months or younger.

ECC is the most common chronic disease in young children and may develop as soon as

teeth erupt. It is a significant public health problem and certain segments of society, such

as the socially disadvantaged have the highest burden of disease. A number of risk factors

are associated with ECC, which can be broadly classified into biological and social risk

factors. Biological risk factors include nutritional variables, feeding habits and early

colonization of cariogenic micro-organisms.Social risk factors comprise low parental

education, low socio-economic status and lack of awareness about dental disease. ECC

affects the quality of life of families and their affected children due to dental pain and

subsequent tooth loss resulting in difficulty in eating, speaking, sleeping and socializing

The earliest form of prevention can be achieved by educating parents and

primary caregivers about ECC. Preventive guidelines towards ECC are found in many

countries and most have their own individualized programs which aim at training parents

to recognize ECC early and seek treatment. Oral health literacy is the degree to which

individuals have the capacity to obtain, process, and understand basic oral health

information and services needed to make appropriatehealth decisions . Parents’ literacy in

oral health is an important factor contributing to the overall health of children. Caregivers

of children with ECC were more likely to believe that caries could not affect a child’s

x
health while those who believed primary teeth are important had children with

significantly less decay. Parental knowledge about infant oral health was found to be

lacking in the study. The factors associated with decreased knowledge among primary

caregivers of children include low socioeconomic status, lack of further education, high

caries status in the children. However, oral health specific self efficacy and knowledge

measures are potentially modifiable cognitions and interventions can lead to healthy

dental habits.

Objectives

1. To assess the level of knowledge of working and non working mothers of 1-5 years

of children.

2. To compare the level of knowledge of working and non working mothers of 1-5

years of children.

3. To associate the level of knowledge of working and nonworking mothers of 1-5

years of children with their selected demographic variables.

4. To develop information booklet based on findings.

Method

A descriptive design with quantitative approach was used for the study. The

sample consisted of 60 working mothers and 60 non working mothers are selected by

convenient sampling method. Data collection was done in selected areas of

Begur,Bangalore. Data were collected by questionnaire. The collected data were analyzed

by using descriptive and inferential statistics

xi
Result

Among the samples, 41.7% of working mothers and 43.3% of non working

mothers belong to the age group of 21-30 years , 28.3% of the working mothers are

undergraduate and 38.3% have secondary education .41.7% of working mothers belongs

to joint family 45% of non working mothers belong to nuclear family. 45% of working

and non working mothers have the monthly family income less than 10,000 rs.31.7% of

working mothers belongs to hindu religion and 30% of non working mothers were from

muslim religion. Majority of children of working mothers were belong to age group of 2-

3yrs and 38.3% of non working mothers children’s are in the age group of 3-4 years . In

regard to tooth-brush habits, 71% of working mothers and 80% of non working mothers

children has the habit of brushing once in a day.76.7% of children of working mothers

and 53.3% of non working mothers need assistance for brushing. 60% of working

mothers and 65% of non working mothers were not taken their children for dental

checkup.56.7% of non working mothers children have early childhood caries and 65% of

working mothers children doesn’t have early childhood caries.

98.3% of working and non working mothers have moderate knowledge about

early childhood caries.1.7% of working mothers have adequate knowledge where as 1.7%

non working mothers have inadequate knowledge.

57.82% of working mothers and 47.82%of non working mothers have adequate

knowledge about early childhood caries.

The result shows that there is a significant association between the working

mothers level of knowledge with selected demographic variables such as age x2= 5.00(s);

xii
type of family x2=7.88; monthly family income x2=7.85; limitation of sweet consumption

x2= 5.65 and there is no significant association between the non working mothers level of

knowledge with demographic variables.

Interpretation and Conclusion

Finding of the study showed that working mothers have more knowledge than non

working mothers and the study result shows that, there is a significant association found

between the working mothers knowledge score and selected demographic variables such

as age, type of family, monthly family income, limitation of sweet consumption and there

is no association found between the non working mothers knowledge score and

demographic variables.

Keywords

Early childhood caries, Working mothers, Non working mothers, Information booklet.

xiii
 TABLE OF CONTENTS

SL.NO CONTENT PAGE NO

1-6
1. Introduction

7-11
2. Objectives

12-30
3. Review of Literature

31-42
4. Methodology

43-76
5. Results

77-81
6. Discussion

82-85
7. Conclusion

86-89
8. Summary

90-96
9. Bibliography

10. Annexure 97-131

xiv
 LIST OF TABLES
TABLE TITLE PAGE NO

NO

Frequency and distribution of demographic variables among 45

1(a)
working and non working mothers of 1-5 years of children

Frequency and distribution of demographic variables among 46

1(b)
working and non working mothers of 1-5 years of children

Frequency and distribution of demographic variables among 47

1(c)
working and non working mothers of 1-5 years of children

Frequency and distribution of demographic variables among 48

1(d)
working and non working mothers of 1-5 years of children

Frequency and distribution of demographic variables among 49

1(e)
working and non working mothers of 1-5 years of children

Frequency and distribution of demographic variables among 50

1(f)
working and non working mothers of 1-5 years of children
Description of level of knowledge of working and non working 65
2
mothers of 1-5 years of children

Comparison of level of knowledge of working and non 67

3
working mothers of 1-5 years of children
Association of level of knowledge of working mothers of 1-5 69-72
4 years of children with demographic variables

Association of level of knowledge of non working mothers of 72-75

4(a)
1-5 years of children with demographic variables

xv
 LIST OF FIGURES

SL FIGURES PAGE NO

NO

1. Schematic presentation of conceptual frame work based on

11
modified General system model (From Roy C and Andrews H A)

2. Schematic representation of Research study 41

3. Bar diagram showing percentage distribution of mother’s age in

51
years.

4. Cylindrical diagram showing percentage distribution of mother’s

52
education status

5. Pyramidal diagram showing percentage distribution of type of

53
family

6. Pyramidal diagram showing percentage distribution of area of

54
residence

7. Pyramidal diagram showing percentage distribution of monthly

55
income of the family

8. Cylindrical diagram showing percentage distribution of religion 56

9. Bar diagram showing percentage distribution of age of the child 57

10. Pyramidal diagram showing percentage distribution of brushing

58
habits of their children

11. Cylindrical diagram showing percentage distribution of parental

59
assistance in brushing

xvi
12. Bar diagram showing percentage distribution of date of last dental
60
appointment

13. Pyramidal diagram showing percentage distribution of limitation

61
of sweet consumption

14. Pyramidal diagram showing percentage distribution of children

62
with early childhood caries.

15. Cylindrical diagram showing percentage distribution of previous

63
knowledge about early childhood caries

16. Pyramidal diagram showing percentage distribution of source of

64
information about early childhood caries

17. Cylindrical diagram showing percentage distribution of level of

knowledge about early childhood caries among working and non 66

working mothers

18. Cylindrical diagram showing percentage distribution of

comparison between the level of knowledge among working and 68

non working mothers of 1-5 years of children.

xvii
 LIST OF ANNEXURES

Sl. no. Annexure Page

No

1.
Letter seeking and granting permission to conduct research study. 97-98

2. Letter seeking expert’s opinion to establish content validity of the 99-100

tool and Information booklet.

3. Acceptance form for tool and Information booklet validation. 101

Content validation certificate.

4. 102

5. Evaluation criteria checklist for validation of tool. 103

6. Evaluation criteria checklist for validation of Information 104-105

booklet.

7. Consent form – English. 106

8. Tool used for the study – English. 107-129

-Kannada.

List of Validators.
9. 130

10. List of formulas used. 131

xviii
xix
 1. INTRODUCTION

Pediatric oral health is steadily declining due to cognitive and environmental

factors that create poor oral health behaviors. While the oral health of the nation as a

whole is improving, tooth decay among children between the ages of 1 to 5 is increasing.

Early Childhood Caries (ECC), is the most common chronic disease of childhood, five

times more likely than asthma and seven times more likely than hay fever (U.S.

Department of Health and Human Services [USDHHS], 2007)1.

Early childhood caries(ECC) is a syndrome characterized by severe decay in the

teeth of infants or young children which is also known as baby bottle caries, baby bottle

tooth decay and bottle rot.2 Early childhood caries is a very common bacterial infections

caused by frequent, long exposure to liquids containing sugars. More often, the upper

four teeth are affected. This problem is caused by the baby or the child falling asleep

while drinking a bottle or while breast feeding. The sugar liquid from the milk or juice

pools around the teeth and reacts with the bacteria in the child’s mouth causing tooth

decay. 3

Four factors are involved in caries development . They are tooth, time, bacteria

and carbohydrates. When all four are present, the tooth decays. Demineralization occurs

when fermentable carbohydrates, usually sucrose, are digested on the tooth surface by

bacteria, most commonly streptococcus mutans.4 These bacteria produce potent lactic

acids that lower the normal salivary oral pH between 6.0 and 7.4 to a level below 5.5. At

this acidic level, the rate of enamel decalcification exceeds that of remineralization and

enamel erosion occurs. Dentin’s network of tubules is used to deliver nutrients and

remove waste, but also creates an ideal passage way for bacteria to infect deeper dental

1
tissues. If an acidic environment persists, as in frequent prolonged periods of milk or

juice in the oral cavity, damage to the dental pulp may cause ischemic death of the

pediatric tooth5.

A tooth can begin the process of decaying as soon as it has erupted. This means

that a child as young as one year old can start having cavities. The first sign of Early

Childhood Caries (ECC) appears as white chalky marks on the four upper front teeth. If

these teeth are left untreated, unsightly and painful cavities Poor eating habit, speech

problems, low self-esteem, social problems, low weight, slowed growth, irritability

develops . These baby teeth are important for chewing and biting food, having a nice

smile and speaking properly. The most important function of baby teeth, however, is that

they hold space in the mouth for the upcoming permanent teeth4. With children under the

age of 5, a history of previous dental decay will classify a child as highest risk for future

decay6.

Prevention strategies are integral to improving the oral health for young

children. For such to be effective, it is important to understand the social value that

parents and caregivers ascribe to primary teeth.7.Mother should be aware about certain

tips such as;

• During the day, to calm or comfort your baby, don't give a bottle filled with

sugary liquids or milk; instead, give plain water or substitute a pacifier.

• At anytime, don't dip your baby's pacifier in sugar, honey, or any sugary liquid.

• At bedtime, don't put your baby to bed with a bottle filled with sugary liquids

(watered-down fruit juice or milk still increases the risk of decay). Give plain

water.

2
 • Don't allow your baby to nurse continuously throughout the night while sleeping

since human breast milk can cause decay. Use a pacifier or give a bottle filled

with plain water instead.

• Don't add sugar to your child's food.

• Use a wet cloth or gauze to wipe your child's teeth and gums after each feeding.

This helps remove any bacteria-forming plaque and excess sugar that have built

up on the teeth and gums.

• Ask your dentist about your baby's fluoride needs. If your drinking water is not

fluoridated, fluoride supplements or fluoride treatments may be needed.

• Teach your baby to drink from a cup by his or her first birthday. Moving to a

"sippy cup" reduces the teeth's exposure to sugars; however, constant sipping

from the cup can still result in decay unless it is filled with water.8

NEED FOR THE STUDY

“Although dental problems don't command the instant fears associated with low

birth weight, fetal death or cholera, they do have the consequence of wearing down the

stamina of children and defeating their ambitions. Bleeding gums, impacted teeth and

rotting teeth are routine matters for the children...Children get used to feeling constant

pain. They go to sleep with it. They go to school with it...Children live for months with

pain that grown-ups would find unendurable. The gradual attrition of accepted pain

erodes their energy and aspirations...To me, most shocking is to see a child with an

abscess that has been inflamed for weeks and that he has simply lived with and accepts as

part of the routine of life. Many teachers in the urban schools have seen this. It is almost

commonplace.” (Jonathan Kozol -- Savage Inequalities: Children in America's Schools)9.

3
 Evidence from around the globe reveals that ECC is a growing public health

problem. The prevalence of ECC has been reported for children from many developed

and developing regions of the world including North America, South America, Europe,

Asia, the Middle East, and Australia. Severe early childhood caries (S‐ECC) is a specific

subtype of ECC that is both age and pattern specific10. In India a prevalence of 44% has

been reported for caries in 8-48 months old. A study was conducted in Udupi and

Davengere (Karnataka)has reported nursing caries prevalence of 19.44% and 19.2%

respectively11. In the US its rate is highest in minority and rural population at times

infects over 70% of children.

ECC is all too common in many groups. Groups of young children that are at an

increased risk of developing caries including Aboriginal children, immigrants and

refugees, those from low‐income families, and those residing in rural regions of where

access to regular dental care may be limited. Higher rates of dental disease are often

exhibited among at‐risk populations, particularly those who are economically challenged.

It is common for many children to develop a cavity before their sixth birthday.13

A study was conducted on prevalence of early childhood caries among preschool

children of low socioeconomic status in Bangalore city, India. A sample of 566, 24-59

months children attending various Anganwadi centers had taken. Result shows that

prevalence of Early Childhood Caries (ECC) was 37.3% with a mean deft of 1.90 ± 3.38

ranging from 0 to 17 teeth. Out of 211 children with ECC, 94.3% had severe early

Childhood Caries (s-ECC) with a mean deft score of 5.35 ± 3.77. All of the deft was due

to untreated caries. Mean caries experience of 36-47 months age group was significantly

4
higher than other groups (P = 0.024).There is a need for preventive and curative oral

health programmes in the society.14

A study was conducted on the influence of severe early childhood caries and

its management on growth parameters and quality of life of preschool children from low

socioeconomic status families in India. A sample of 100 preschool children had taken.

Result shows that 46% of children with sECC had weigth below 3rd percentile

(underweight; mean 15.49 ± 1.87Kg) which was less than the controls (mean weight

16.34 ± 1.46kg). They also complained of pain (40%), avoidance of hard food (24%),

noticed weight loss (18%) and sleep disturbances (12%). After 6 months of dental

rehabilitation, there was a significant improvement in their weight (P= 0.002) and quality

of life. Awareness, education of parents and facilitation of oral health services may help

to improve the weight and quality of life.15

A study was conducted on the prevalence of early childhood caries in 1-2 years

old in semi-urban areas of Srilanka. A sample of 422 children had taken. Result shows

high prevalence and severity of ECC among 1-2 years old children in four selected MOH

areas of Colombo district and caries in most of the children with ECC (95%) were

untreated. Results reveal an urgent need to increase awareness among the public about

ECC and institute preventive stratergies.16

A study was conducted on the relationship between the infant nursing bottle

caries and the feeding patterns, oral health behavior and parent’s oral health information

in China. A sample of 300 infants aged 6, 7, 12, 18 months had taken. Results shows

early childhood caries correlated obviously with the habits of sleeping with nursing

5
bottle. After feeding food, more parents feed their infants with little plain boiled water

than clean the infant oral cavity with finger cap wet carbasus.56.7% of parents had no

acknowledge of danger of early childhood caries.17

A study was conducted on identifying certain factors that influence the

development of ECC among children under 6 years of age in Samsun, Turkey. A sample

of 226 children aged 3-6 years had taken. Result shows ECC was diagnosed in 46.9% of

children. The mean dmf-t was 2.87. Significant associations were found between ECC

prevalence and bottle feeding while sleeping and between ECC and the mother's level of

education (p<0.05). The caries rate increased with the addition of sugar-containing

substances to bottles; however, the increase was not statistically significant (p>0.05).

There were no correlations observed between ECC and the mother's oral health

knowledge or attitude (p>0.05).18

As per the above mentioned observations and studies, Investigator feels that

there is a need to assess the level of knowledge regarding early childhood caries among

working and non working mothers of 1-5 years of children in selected areas, Bangalore

with a view to develop an information booklet.

6
 2.OBJECTIVES

Research objectives are what the investigator proposes to accomplish in

research. That is specific measurable short term goals to be met19.

Statement of the problem:

A comparative study to assess the level of knowledge regarding early

childhood caries among working and non working mothers of 1-5 years of children in

selected areas, Bangalore with a view to develop an information booklet.

Objectives of the study:

1. To assess the level of knowledge of working and non working mothers of 1-5

years of children.

2. To compare the level of knowledge of working and non working mothers of 1-5

years of children.

3. To associate the level of knowledge of working and nonworking mothers of 1-5

years of children with their selected demographic variables.

4. To develop an information booklet based on findings.

Operational definitions:

1. Assess: It is an act to measure the level of knowledge.

2. Knowledge: It refers to the process of acquiring information regarding early

childhood caries.

3. Early childhood caries: Dental caries of the maxillary primary teeth caused

by the oral retention of milk or formula in the oral cavity.

4. Working mothers: Working mothers refers to the women who are mothers

and who work outside the home for income in addition to the work they perform at

home in raising their children.

7
 5. Non working mothers: Not engaged in payed employment.

Assumptions:

The study assumes that,

1. Working and non working mothers may have previous knowledge about early

childhood caries.

2. Working mothers may have more knowledge than non working mothers.

3. Knowledge level of working and non working mothers may vary from person to

person based on the level of education.

Conceptual Frame Work

Conceptual Frame Work means interrelated concepts or abstractions that are

assembled together in some rational scheme by virtue of their relevance to a common

theme. A conceptual Frame Work is a group of concepts and set of proportions that

spell out the relationship between them. Conceptual framework plays several

interrelated roles in the progress of science. The overall purpose is to make scientific

findings meaningful and generalizable.20 The development of nursing theory requires

a systemic process of inquiry; components of that process include concept analogies,

construction of theoretical relationships and practical validation of theory.

Tree and treece (1986) stated that “conceptualization is process of forming

ideas, designs and plan”. It is the process of moving from an abstract to a concrete

proposal19. A conceptual framework is a group of concepts and a set of prepositions

that spell out the relationship between them. The overall purpose is to make scientific

findings meaningful and generalise. Concepts mean those words describing mental

images of phenomena. Concepts are the building blocks of the theory.

8
 Conceptual framework refers to interrelated concepts or abstraction that is

assembled together in some rational scheme by virtue of their relevance to a common

theme. They serve as a springboard for the generation of hypothesis to be tested.21

Conceptual framework will act as a building block for the research study.

The overall purpose of framework is to make scientific finding meaningful and

generalized. It provides a certain framework of reference for clinical practice,

education and research. Framework can guide the researcher’s undertaking of not only

‘What’ of natural phenomena but also ‘why’ of their occurrence. They also give

direction for relevant questions to practical problems.19

From the review of literature several concepts and information were

collected and conceptual frame work was developed for the present study.

Polit and Hungler (1995), states that conceptual frame work is inter-

related concepts or abstractions that are assembled together in some rationale scheme

by virtue of relevance to a common thing, the device that helps to stimulate research

and the extension of knowledge of providing both direction and impetus.20

It is a frame work which provides the investigator the guidelines to

proceed in attaining the objectives of the study based on theory. It is a scientific

representation of the steps, activities and outcome of the study.19

The present study was aimed at assessing the level of knowledge

regarding early childhood caries among working and non working mothers of 1-5

years of children in selected areas,Bangalore. The conceptual frame work of the

present study is based on system model (from Roy C and Andrews H A 1991). It

consists of three steps that are input, process and output.

9
INPUT:

In the present study input refers to the target group (working and non

working mothers) with their existing knowledge about early childhood caries.

Working and non working mothers are the target group with certain demographic

variables and existing knowledge.

PROCESS:

In the present study the process refers to the development and validation of

structured questionnaire regarding early childhood caries. The investigator framed the

questions and assessed the level of knowledge regarding early childhood caries.

OUTPUT:

In the present study output measures the knowledge scores and compared

the level of knowledge of working and non working mothers.

10
The conceptual framework of the present study is depicted in fig.1

Working and non working mothers (

INPUT demographic variables)

Development and validation of Adequate

structured questionnaire regarding level of
early childhood caries knowledge
PROCESS for both
working and
Assess the level of knowledge non working
regarding early childhood caries mothers

In adequate
Evaluating the level of knowledge level of
OUTPUT of working and non working knowledge
mothers for both
working and
non working
mothers

Figure 1.Schematic presentation of conceptual frame work based on modified

General system model (From Roy C and Andrews H A)

11
 3.REVIEW OF LITERATURE

Review of literature refers to an extensive, exhaustive and systematic

examination of publications relevant to the project.19 A literature review early in the

reports provides readers with a background for current knowledge on a topic and

illuminates the significance of the new study.20

The literature can be reviewed under following headings:

1. Literature related to early childhood caries

2. Literature related to mothers knowledge regarding early childhood caries.

3. Literature related to comparing the working and non working mothers

knowledge.

1. Literature related to early childhood caries.

A study was conducted on the prevalence and related risk factors of ECC in

preschool children of urban Bangalore (India). A random sample of 1,500 children aged

between 8 and 48 months were selected from various parts of urban Bangalore. The

status of dental caries was recorded according to the World Health Organization (WHO)

criteria. Information regarding oral hygiene practices, feeding habits, socio-economic

status, birth weight, and educational status of the mother was obtained through a

structured questionnaire given to mothers of preschool children. The result shows that

prevalence of ECC in preschool children was 27.5%, while the mean deft was 0.854.

ECC increased significantly with age. Children whose mothers had no schooling and

those who belonged to low socioeconomic group showed higher caries prevalence. A

12
significant increase in caries prevalence was found in children accustomed to the practice

of on-demand breast feeding and bottle feeding at night. Caries also increased

significantly when snacks were consumed between meals.22

A study was conducted on prevalence of early childhood caries among

preschool children of low socioeconomic status in Bangalore city,India. A sample of

566,24-59 months old children attending various anganwadi centers are selected via

cluster sampling. Result shows that prevalence of Early Childhood Caries (ECC) was

37.3% with a mean deft of 1.90 ± 3.38 ranging from 0 to 17 teeth. Out of 211 children

with ECC, 94.3% had severe Early Childhood Caries (s-ECC) with a mean deft score of

5.35 ± 3.77. All of the deft was due to untreated caries. Mean caries experience of 36-47

months age group was significantly higher than other groups (P = 0.024)23.

A study was conducted on the prevalence of early childhood caries among

preschool children Hubli, Karnataka. A sample of 1500 children between the age group

of 3-5 years had taken. Result shows the prevalence was 54.1%. In 3 year olds 42.6% had

one or more carious lesions and in 4 and 5 year olds 50.7% and 60.9% respectively had

one or more carious lesions. The difference in the carious prevalence was significant

(<0.05) between the age groups of 3-4 years and 4 and 5 years, and highly significant

(<0.001) between the age groups of 3 and 5 years. The confidence interval for the

surveyed group with respect to prevalence of caries varied from 38-48%, 45-57% and 57-

64% for age groups 3, 4 and 5 years respectively. The attitude of mothers towards

children’s oral health made a statistical difference in the mean level.24

13
 A study was conducted on the prevalence of early childhood caries in Davengere

young children and its relationship with feeding practices and socioeconomic status of the

family. A sample of 813 children aged 2-6 years from kindergarten schools each from

Government, Government aided and private had taken. Result shows the prevalence

of nursing caries was 19.2% in Davangere preschool population and duration of breast

feeding increases the number of children with early childhood caries. There is a strong

and significant relationship between the severity of caries and the degree of feeding abuse

and low socioeconomic status.25

A study was conducted on early childhood caries lesions in preschool children in

Kerala, India. A sample of 530 children aged from 8 to 48 months are selected and the

caregiver of each child then completed by a structured questionnaire. Result shows that

among the group of 252 girls and 278 boys, 56% of the children being caries-lesion free.

Fifty-nine (12%) were considered to have early childhood caries (ECC), based on the

criteria that smooth surface caries lesions on all 4 maxillary incisor teeth indicated severe

ECC. Breast-feeding was practiced by 99% of the mothers, and 5% did so exclusively.

Statistically significant correlations were found between caries lesions and the child's

dental condition, as perceived by the mother or caregiver (P<.0001), the dental status of

the caregiver (P=.0417), consumption of snacks (P=.0177), giving of sweets as a reward

(P<.0001), cleaning of the child's mouth (P<.0001), oral hygiene status of the child

(P<.0001) and low socioeconomic status, as measured by income (P<.0001).26

A study was conducted on early childhood caries in 2 districts of western

Uttarpradesh. A sample of 1500 between the age group of 3-5 years were selected from

both the genders and from various socioeconomic background. The results will be

14
comparing the percentage of children with decayed teeth, dmft score and mean no. of

decayed teeth and dmft score per child in the various age groups, gender, location and

oral hygiene habits. Result shows that the prevalence of the early childhood caries was

found to be 65.9%. The mean dmft score was 3.48±3.43 and found to be more among the

females (3.65±3.41) in comparison to the males (3.32±3.44).27

A study was conducted on the association of maternal risk factors with early

childhood caries in preschool children of Moradabad, India. A sample of 150 child-

mother pairs had taken. Result shows significant difference in mother’s caries cavity,

high level of s.mutans, education level, socioeconomic status, frequency of maternal

sugar consumption and their child’s caries experiences (P < 0.001)28

A study was conducted on severe early childhood caries and behavioral risk

factors among 3 year old children in Lithuania. A sample of 950 children in kindergarten

had taken. Results shows the prevalence of ECC was 50.6% with a mean dmft of 2.1 (SD,

0.1) and a mean dmfs of 3.4 (SD, 0.2). The prevalence of S-ECC was 6.5% with a mean

dmft of 7.8 (SD, 0.1) and dmfs of 18.1 (SD, 0.6). A significantly higher percentage of

children developed S-ECC when they were breast-fed for a period longer than one year,

were sleeping with a bottle containing carbohydrates during the night, or were allowed to

sip from a bottle either going to sleep or during the day. A significantly higher percentage

of mothers having caries-free children knew about risk factors of S-ECC and started tooth

brushing after the eruption of the first tooth.29

A study was conducted on prevalence of severe early childhood caries in

preschool children in Bahadurgarh, Haryana. A sample of 709 children attending the

15
department of paediatric dentistry at PDM college had taken. Result shows that

prevalence S-ECC was 42.03%. The overall mean dmfs was 5.08 +/- 5.56. The statistical

analysis highlighted insignificant relation between prevalence of S-ECC with respect to

gender and age, though in general, S-ECC (Girls) was higher than S-ECC (boys). With

respect to age distribution, higher prevalence of S-ECC was noted in the age group of 3

and 5 years.30

A study was conducted on caries related factors for preschool children in Beijing

China. A sample of 1018 children at the age of 4 and 5,204 children with dmft> or = 6

were included in caries group and 237 children in caries free group. Saliva mutans

streptococci, saliva flow rate and buffer capacity, and debris index were tested for all

children. Their mothers finished the standardized questionnaire for information about

dietary and oral hygiene habits of the children, breast and bottle feeding history and

socio-economic status.Result shows that the saliva mutans streptococci (OR = 3.019),

debris index (OR = 2.263), frequency of consumption of snacks and sweets (OR =

1.729), frequency of intake of soft drinks (OR = 1.496) and use of sweetened food

in nursing bottle (OR = 2.255) were significant factors.31

A study was conducted on the effects of prolonged breast-or bottle-

feeding on early childhood caries in Japanese children. A sample of 592 children at 18

months,2 years and 3 years of age were selected and conducted by means of a

questionnaire and clinical examination. The children were divided into three groups: 1)

children still being breast-fed at 18 months of age (n=42); 2) children still being bottle-

fed at 18 months of age (n=45); and 3) children weaned off ofbreast- or bottle-

feeding and with no nonnutritive-sucking habits at 18 months of age (n=205). Results

16
showed that breast-feeding at 18 months of age produced many significant differences to

the control children, including a higher prevalence of caries and higher number of dft.32

A study was conducted on characteristics of children under 6 years of age

treated for early childhood caries in South Africa. A survey was conducted among 140

patients who had two or more teeth. Result shows that diet, feeding and oral hygiene

habits are the most significant factors that contributed to the development of ECC in

these patients. All the children were either breast- or bottle-fed past one year of age.

93.6% of the children went to sleep with the bottle or while on the breast and 90% of

them were fed on demand during the night. On average, breastfeeding was stopped at 9

months of age compared to bottle-feeding that, on average, was stopped at a much later

mean age of 23 months. Where oral hygiene practices were concerned, 52.6% of children

brushed their own teeth without supervision. 33

A study was conducted on feeding habits as determinants of early

childhood caries in a population where prolonged breastfeeding is the norm in Finland. A

sample of 504 children have been selected and mothers were asked to give information

about their child's feeding habits, daytime sugar intake, and their family's background.

Sugar intake during the night was operationalized as separately calculated burdens of

nighttime breastfeeding and bottle-feeding. Result shows that among the children, 56%

were solely breastfed (mean duration 16.6 months; 95% CI 16.0-17.2), 42% were both

breastfed and bottle-fed, and 2% were solely bottle-fed. Mean duration of breastfeeding

for the solely breastfed 24- to 36-month olds was 22.8 months (95% CI 21.8-23.9). At

bedtime, 69% were breastfed, 11% bottle-fed, and 20% were not fed at all. With respect

to feeding during the night, 72% of children were breastfed, 12% were bottle-fed with

17
milk, 1% received a bottle with water, while 15% were not fed. Early

childhood caries (ECC) occurred in 3-26% of the children, depending on age group (P <

0.001). The burden of milk-bottle feeding at night was a clear determinant for ECC (OR

= 5.5) whereas breastfeeding, its duration, the burden of breastfeeding at night, and

daytime sugar intake were not.34

A study was conducted to investigate the relationship of age, number of teeth,

and bottle usage/content with regard to the isolation of MS in 6–24-month-old children in

Brazil. A total of 122 children from low-income families attending a nutritional

supplement program, and their mothers, participated in this study. Children were

examined for dental caries and number of erupted teeth and were sampled for MS.

Mothers were administered a questionnaire to obtain details of baby bottle use, including

what food items were put in the bottle during the last week. MS was detected in more

than one-third of the 6–24-month-olds. The finding that approximately 20% of the

children under 14 months of age were infected with MS indicates that colonization in this

sample of low-income preschool children may begin earlier than suggested by some

investigations.35

A study was conducted on 19 months old Edmonton, Alberta children about

caries rates and risk factors, A sample of 938 19-month-old Edmonton children and their

parents/caretakers were studied. Parents were interviewed and children were examined.

Specimens for a caries activity test were collected at the examination. Results shows that

25 percent of the children had moderate to high caries activity, as shown by the cariostat,

with 4.6 percent showing decalcification lesions and frank caries. Early caries (BBTD)

were found to be related to bottle feedingpractices, discomfort with allowing the child to

18
cry, and with mother being foreign-born. Foreign-born status was associated with the

above parenting practices.36

A study was conducted on prevalence of nursing caries in 18 to 60 months

old children in Qazvin. A sample of 544 children (314 boys and 230 girls) were included

in this study. Result shows that prevalence of nursing caries in girls was 23.5%, in boys

16.5% and in both sexes 19.5%. In affected children dmft was 3.8 times more than the

unaffected children and DMFT of their mothers was higher too. Bottle feeding specially

during sleep showed statistically significant increase in nursing caries and so did the

duration of feeding with mother's milk. The results agree with those obtained in similar

populations and showed that the prevalence of nursing caries is anxiously high.37

A study was conducted on caries pattern and diet in early childhood caries in

France. A sample of 68 children of both sex aged from two to 6 years consisted of 35

boys (51% of the sample) and 33 girls (49%) with the predominance of the 5-year-old

children were selected. These children were examined using a plan mouth mirror and

probes and their mothers were interviewed. Result shows that carious lesions were

distributed on all tooth surfaces but the complete coronal destruction was the most

common lesions observed and represented 25 of the lesions, followed by lesions in three

faces of the tooth (17%). The most frequently affected tooth was the association maxillar

incisors and molars and the mandibular molars (32.4%). The incisor alone represented

22.1% of the affected teeth. The children were breast-fed associated with either pap or

with hard food (52.9%). The bottle was added to this association in 32.4% of the cases

and 10% of the children were exclusively breast-fed.38

19
 A study was conducted on the effect of possible risk factors of early

childhood caries in Finland. A sample of 183 children at the age of 2 years were

registered and continued the follow up till 7 years. Result shows that consumption of

candies and lack of daily toothbrushing were the factors that had the major impact

on caries onset in both primary and permanent molars. Prolonged pacifier sucking (>or=2

years) was related only with short duration of breastfeeding. Children with prolonged use

of a nursing bottle at night also consumed candies more than once a week, did not brush

their teeth regularly, and did not use fluoride tablets.39

A study was conducted on feeding habits and severe early childhood caries in

Brazilian preschool children A sample of male and female preschool children, aged 36 to

71 months, randomly selected from a low-income population. A 24-hour recall diary was

used to assess data about infant feeding practices and dietary habits. Result shows that

SECC was observed in 36% of the children examined. Infant feeding practices showed

the association between SECC and night-time breast-feeding (P = .02) or breast-

feeding (P = .0004) in children older than 12 months of age. The use of a bottle at night

as a substitute for the pacifier and its use on demand during the day were also correlated

with SECC (P < .0001).40

A study was conducted on feeding and dietary practices of nursing caries

children in Riyadh, Saudi Arabia. . A sample of 74 nursing caries children, 34 (45.9%)

male and 40 (54.1%) female with a mean age of 55.0 (SD 20.0) months participated in

the study and, their mothers completed the questionnaire. About two-thirds of the

children (65.0%) were breast-fed before sleep and a similar percentage (60.8%)

was breast-fed during sleep. More than two-thirds (68.9%) were bottle-fed with liquids

20
such as fresh fruit juices (51.4%), packed juices (43.2%) and soft drinks (81.1%). The

mean age of starting to drink in a cup was 25.1 (SD 10.4) months. The most popular

(71.6%) drinks in a cup were fruit juices. More than two-thirds (71.6%) of the children

were taking soft drinks directly from a container and, about two-thirds (60.0%) of the

children started drinking directly from a container at or before the age of 24 months.

Almost all the children (93.2%) were taking sweets; about half (45.9%) of them taking

sweets twice or more daily41.

2. Literature related to mothers knowledge regarding early childhood caries

A study was conducted on early childhood caries as influenced by maternal and

child characteristics in pre-school children of Trivandrum. A sample of 350 children

aged 12-36 months and their mothers were studied. The mothers were first interviewed

by a structured questionnaire; then the child’s and mothers clinical examination was

carried out covering caries experience and oral hygiene status. Result shows that

prevalence of dental caries in this population was found to be 50.6%. Statistically

significant associations were found between the severity of decay and the child’s age,

female gender, frequency and type of feeding, falling asleep with nipple in mouth,

duration of breast feeding, consumption of cariogenic snacks, age of commencement of

tooth brushing, brushing frequency, DMFS scores of mothers, and oral hygiene status of

child and mother. .It is recommended to increase knowledge of parents about proper

feeding habits and oral health practices and also preschool children’s accessibility to

dental services.42

21
 A study was conducted on the effectiveness of awareness programme on oral

health given to mothers through trained community level workers and anganwadi

workers in Kerala. Sample taken in the study is the mother who is having the children

between the age group 0-6 years in selected block panchayats in Kerala. Result shows

significant increase in knowledge regarding oral hygiene habits, importance of milk teeth,

causes of dental diseases, prevention of dental diseases and treatment after post test

intervention43

A study was conducted on mother’s knowledge about preschool child’s dental

caries and oral health in Moradabad. A sample of 406 mothers of children aged between

1-4 years, attending the hospitals had taken. Result shows three hundred (73.8%) mothers

had a good knowledge about diet and dietary practices, while only 110 (27.1%) and 103

(25.4%) mothers were found to have a good knowledge about the importance of oral

hygiene practices and importance of deciduous teeth, respectively. Mothers with higher

educational qualification and information gained through dentist had a better knowledge

about child's oral health. Oral hygiene habits and dietary habits are established during

pre-school days and the parents, especially mothers, function as role models for their

children.44

A study was conducted on feeding and oral hygiene habits of preschool

children in Hong Kong and their caregiver’s dental knowledge and attitudes. A sample of

369 boys and 297 girls between the age group of 1-3 years had taken. Result shows only

7% of the children were exclusively breast feed. More than 98% of infants used a nursing

bottle for at least some drinks. Over 73% of the children continue to use a feeding bottle

22
after 2 years of age. Of the care givers 67.7% said they did not think carious primary

teeth needed to be restored.45

A study was conducted on certain risk factors for early childhood caries in

Samsun Turkey. A sample of 226 children aged 3-6 years were taken. Questionnaires

were administered to the mothers of participating children to obtain information on

infant feeding habits and the mother's level of education and oral health knowledge.

Result shows that ECC was diagnosed in 46.9% of children. The mean dmf-t was 2.87.

Significant associations were found between ECC prevalence and bottle feeding while

sleeping and between ECC and the mother's level of education (p<0.05). The caries rate

increased with the addition of sugar-containing substances to bottles; however, the

increase was not statistically significant (p>0.05)46

A study was conducted on parents knowledge attitude and practice about

early childhood caries and its prevention in Malaysia. A sample of 120 parents of infants

and toddlers aged 6 months-2 years attending four public maternal and child health care

clinics were randomly selected and invited to participate in the study. A total of 102 out

of 120 questionnaires were returned. Result shows that majority of parents (92%) knew

when the first tooth erupted in the mouth, not that many (62%) were sure of when all the

20 teeth should be present in their child’s mouth. About half of the parents knew (49%)

that caries can affect infants below 2 years old. Almost all respondents knew the types of

food causing dental caries and the importance of brushing children’s teeth. Fewer parents

(81%) knew that children’s mouth should be cleaned before teeth erupted. About 78% of

the parents knew that weaning from the bottle should start at 1 year of age. Most parents

(85%) knew that fluoride is important for preventing tooth decay andabout half of them

23
(52%) knew that they should start using toothpaste with fluoride for cleaning their child’s

teeth when the child learns to spit. Sixty four percent knew that it is necessary to do

fillings in their baby’s teeth.47

A study was conducted on to assess the knowledge and practice of caries

prevention in mothers from Bialystok, Poland. A sample of 140 mothers of 3-4 year old

children were taken. The questionnaire used in the survey related to the knowledge of

principles of early childhood caries prevention, the sources from which mothers obtain

their knowledge and the methods of implementing oral health behavior. Result shows that

95.7% of mothers knew about the importance of regular removal of dental plaque by

brushing teeth, 85.7% knew of the role of fluoride-containing toothpaste and 82.8%

indicated avoiding the consumption of sweets. They were also aware that oral health

required regular dental visits (89.2%). Most of them (87%) knew that deciduous teeth

should be treated as permanent ones, but only 65.7% were convinced that a direct

relationship of the condition of deciduous and permanent dentition exists.48

A study was conducted on relationship between the infants nursing bottle

caries and feeding patterns, oral health behavior and parents oral health knowledge in

China. A sample of Three hundred infants aged 6, 7, 12, 18 months were enrolled in

this study, nursing bottle caries were examined and recorded. Questionnaires on infant

basic data, feeding patterns, oral health behavior, parents' oral health information were

asked and recorded in these 300 parents.Result shows that the

infant nursing bottle caries correlated obviously with the habit of sleeping with

the nursing bottle or mammary papilla in mouth, and did not correlate with the breast or

24
artificial feeding patterns. The occurrence rate of infant nursing bottle caries was

significantly lower in the infants with oral health behavior than those without oral health

behavior. After feeding food, more parents feed the infants with little plain boiled water

than clean the infant oral cavity with finger cap wet carbasus. 56.7% of parents had no

acknowledge of danger of infant nursing bottle caries.49

A study was conducted on potential role of breast feeding and other factors in

helping to reduce early childhood caries in Atlanta. A sample of 175 children, aged 1 to

5, receiving dental care were selected and personal interview is done with the mother.

Result shows that children exclusively bottle-fed for at least 1.5 years had more decayed

or filled tooth surfaces than children breast-fed part of that time but well short of a year.

No bottle at night nor juice at irregular times, the mother's brushing of her child's teeth,

and adequate dental care in the mother seemed to reduce ECC.50

A study was conducted on early childhood caries among a Bedouin community

residing in the eastern outskirts of Jerusalem. A sample of 102 children aged 12-36

months were visually examined for caries, mothers' anterior dentition was visually

subjectively appraised, demographic and health behavior data were collected by

interview. Result shows that among children, 17.6% demonstrated ECC, among mothers,

37.3% revealed "fairly bad" anterior teeth. Among children drinking bottles there was

about twice the level of ECC (20.3%) than those breast-fed (13.2%). ECC was found

only among children aged more than one year (p < 0.001); more prevalent ECC (55.6%)

was found among large (10-13 children) families than among smaller families (1-5

children: 13.5%, 6-9 children: 15.6%) (p = 0.009); ECC was more prevalent among

25
children of less educated mothers (p = 0.037); ECC was more prevalent among mothers

with "fairly poor" anterior dentition (p = 0.04). Oral hygiene practices were poor.51

A study was conducted on caregiver knowledge and attitudes of preschool oral

health and early childhood caries in Canada. Children and their main caregivers served

as the sample. Preschoolers underwent a comprehensive dental screening while

caregivers completed a questionnaire that explored knowledge and attitudes toward

preschool dental health. Result shows that a majority agreed that primary teeth were

important, that dental disease could lead to health problems and that a first dental visit

should be made by age 1. Caregivers of children with ECC were more likely to believe

that caries could not affect a child's health while those who believed primary teeth are

important had children with significantly less decay.52

A study was conducted on early feeding practices and severe early childhood

caries in 4 years old children in Brazil. A sample of 340 children under 4 years of age had

taken. The multivariable model showed a higher adjusted risk of S-ECC for the following

dietary practices at 12 months: breastfeeding ≥7 times daily (RR = 1.97; 95% CI = 1.45-

2.68), high density of sugar (RR = 1.43; 95% CI = 1.08-1.89), bottle use for liquids other

than milk (RR = 1.41; 95% CI = 1.08-1.86), as well as number of meals and snacks >8

(RR = 1.42; 95% CI = 1.02-1.97). Mother's education ≤8 years was also associated with

the outcome. The present study identified early feeding practices which represent risk

factors for caries severity in subsequent years. These findings may contribute to

developing general and oral health interventions, with special attention to families with

low maternal education.53

26
 A study was conducted on early childhood caries and a Community Trial of its

Prevention in Tehran, Iran. A sample of 12- to 36-month-olds 504 children and their

mothers attending the vaccination offices of 18 randomly selected from public health

centers. The mother was first interviewed by a structured questionnaire covering

background factors, feeding habits, daytime sugar intake, mother’s and child’s oral

cleaning habits, and mother’s perception toward her ability to maintain the child’s oral

hygiene. Result shows that the prevalence of ECC was rather high (3%-26%) in the three

age groups,. The majority of the children showed visible plaque on central upper incisors.

Oral cleaning on a daily basis was reported for just 68% of mothers and 39% of children.

The frequency of oral cleaning and good oral hygiene of the child were directly

proportional to the mother’s own tooth brushing frequency. Of the children, 98% were

solely or partly breastfed. ECC was more likely to occur among those for whom the

burden of milk-bottle feeding at night existed (OR = 4.9), while breastfeeding its

duration, and its nighttime burden were not related to ECC.54

A study was conducted on mothers' knowledge and beliefs about early childhood

caries in Brazil. A sample of 277 mothers were selected and interviewed. Result shows

that sugar intake was the most frequent mentioned cause of caries (59.2%), but the lack

of fluoride or the role of bacteria were not cited by any mother. Most mothers (66%)

believe that night-bottle feeding could be detrimental to children's oral health. Although

90% of the mothers were aware of the need to begin teeth-brushing on their children's

first year, only 55.6% recognized oral hygiene as a cause of ECC. Most mothers (68%)

were aware of the importance of the first visit to the dentist within the first year of life.

The lack of knowledge about the first visit to the dentist and about poor oral hygiene as

27
risk factors of tooth decay were associated with low income and low maternal education

(p<0.05)55.

A study was conducted on awareness and knowledge of causative factors for

early childhood caries among Saudi Parents. A sample of 125 parents were selected. The

results of the study showed that of the 80 respondents about one-third (39%) agreed that

mother's diet during pregnancy affects development of the infant's teeth while 33%

disagreed and 28% parents did not have an answer. Majority of the parents (95%)

believed that proper breast feeding was important for infant's teeth and 46%

recommended breast feeding the child before sleeping. A majority (63%) parents

assumed that night time bottle feeds don't affect the child's teeth. 85% of the 80 parents

questioned answered in the affirmative when asked whether healthy milk teeth are

important and 63% agreed that any problems with milk teeth affect the child's permanent

teeth. 80% parents did not favor bottle feeding the child before sleeping and 70% favored

the use of comforters/pacifiers while as 70% suggested giving sweetened juices to

children frequently. 46% disagreed whether infants and children should be taken to a

dentist for regular checkup even if they have no dental problems. 85% of the 80 parents

who returned the questionnaire agreed to the benefits of fluoridated tooth pastes and 94%

understood that decayed teeth affect the general health of the child.56

3. Literature related to comparing the working and non working mothers.

A study was conducted on knowledge of dental trauma among mothers in

Mangalore. A sample of 500 working and non working mothers via their children

attending primary school had taken. Result shows 72% of working mothers were aware

28
about the management of dental trauma while 65% of non working mothers were aware.

This shows that working mothers have more knowledge than non working mothers57

A study was conducted on oral health knowledge and attitude among working

and non working mothers and their children in Gujarat, to analyze the oral health habits

of school children and mother according to working status, and to find out the relation

between mother’s educational background and children’s oral health. A sample of 500

mothers had taken. Result shows there was no significant difference in school children

and mothers according to their working status as 98% of the working and non working

mothers are educated. It was clear that irrespective of whether the mother is working or

not working it was the education that mattered.58

A study was conducted on level of oral health knowledge and source of

dental information among mothers of children with own’s syndrome in Riyadh, Saudi

Arabia. A sample of Two hundred and Fifty mothers were selected and self-

administered questionnaires were distributed to the mothers of down’s syndrome children

in three institutions that provided education to children with mental disabilities of which

225 (90%) were returned. The results showed that 57.41% of the children had visited the

dentist, 61.9% had their first visit at the age of 4-6 years or earlier and nearly 72% of the

children visited the dentist only when they had pain. Mothers with university education

were found to make their childrens’ dental visit at an earlier age (P=0.03) and more of the

non-working mothers were found to make their childrens’ visits only when in pain

(P=0.025). The majority of mothers (97.8%) knew the causes of dental caries, and more

than 85% of them recognized the causes of halitosis.59

29
 A study was conducted on oral health knowledge,attitude and behavior in a

female population in Saudi Arabia. A sample of 528 mothers are selected and responded

to self administered questionnaire. The result showed that 80.6% of the mothers believed

that pregnancy had an effect on their teeth and gums. Working mothers of older age

group and higher education indicate latter attitude more frequently and 17.3 % of non

working mothers with less education considered that visit is not necessary.60

30
 4.METHODOLOGY

Research methodology is a way to systematically solve the research problem. It may

be understood as a science of studying how research is done scientifically15.

The present study aimed at assessing the level of knowledge regarding early

childhood caries among working and non working mothers of 1-5 years of children in

selected areas, Bangalore with a view to develop an information booklet”

This chapter include research approach, research design, variables, setting of the

study, population, sample size, sampling technique, sample selection criteria,

development of the tool, description of the tool, content validity, pilot study, reliability of

the tool, data collection procedure and plan for data analysis.

Research approach

Research approach indicates the basic procedure for conducting research.15 The

research approach adopted for this study was Quantitative approach.

In quantitative research the aim is to determine the relationship between one thing

(an independent variable) and another (a dependent or outcome variable) in a population.

Non experimental is a subtype of the quantitative methods helps to explain the effect of

independent variable on the dependent variable15.

Research design

The research design is the plan, structure and strategy of investigations for

answering the research question. It is the overall plan or blue-print the researchers select

to carry out their study15.

31
 In this study, Descriptive comparative design was adopted as it found to be

appropriate for assessing the level of knowledge regarding early childhood caries among

working and non working mothers of 1-5 years of children. Descriptive research design is

a scientific method which involves observing and describing the behaviour of a subject

without influencing it in any way.16This study had not included manipulation and control

group. It was carried out by convenient sampling technique.

Variables

Variables are qualities, properties or characteristics of the person, things or

situation that change or vary16.

Three types of variables were identified in the study.

• Independent variable: An independent variable is the variable that stands alive

and it is not depend on any other. It is the presumed cause of action.16 In this study

it referred to early childhood caries.

• Dependent variable: The dependent variable is the variable that the researcher

interested in understanding, explaining or predicting.16 In the present study it

referred the knowledge of working and non working mothers.

Extraneous variable: Any uncontrolled variable that influences the result of the

study is called extraneous variable16. The extraneous variable identified in the present

study include age, religion, education.

32
Setting of the Study:

Setting is the general location and condition in which data collection takes place

in the study.16

The present study was conducted in selected areas of Begur, Bangalore. The

selected settings include availability of the sample, availability of time, geographical

accessibility and the population of subjects.

Population:

Population refers to the entire aggregation of case that meets a designed set of

criteria.15

In the present study population was defined as all the working and non working

mothers of 1-5 years of children in selected areas at Bangalore.

Sample:

A sample is used in research, when it is not feasible to study the whole population

from which it is drawn. Samples are the mothers who fulfill inclusion and exclusion

criteria. The sample for the study consisted of 60 working and non working mothers of

1-5 years of children in selected areas at Bangalore.

Sampling Technique:

Sampling is the selection of the study subjects from the target population under

study.15

33
 The present study followed a convenient sampling technique for selecting

samples. Convenient sampling technique is a type of non probability sampling technique.

The selection was based on inclusion and exclusion criteria.

Sampling Criteria

Inclusion Criteria

1. Working mothers having the children between 1-5 years of age in selected areas,

Bangalore

2. Non working mothers having the children between 1-5 years of age in selected

areas Bangalore

3.Mothers those who can read and write Kannada or English

Exclusion Criteria

1. Working and non working mothers those who are not willing to

participate in this study

2. Working and non working mothers those who are not at home

during the time of data collection.

Selection and development of tool

The instrument selected in a research should as far as possible be a vehicle that

would best obtaining data for drawing conclusions, which were pertinent to the data. The

tool used in this study was closed ended questionnaire. Questionnaire consists of 2

sections; Section A and Section B. Taking into consideration the educational background

of the samples the tools were translated into English and Kannada

34
Description of the tool:

It consisted of two sections (Annexure VIII).

Section A

. Section A includes 14 demographic variables such as age, education, working

status, type of family, Area of residence, monthly family income, religion, age of the

child, tooth brush habit of the child, parental assistance during tooth brushing, date of

child’s last dental appointment, limitation of sweet consumption, history of early

childhood caries, previous knowledge about early childhood caries, source of

information,

Section B

Section B consists of questions related to meaning, causes, types, signs and

symptoms, complications, treatment and prevention of early childhood caries. It consists

of 36 questions. Each question has one correct answer and it carries one mark. Question

1- 5 related to general questions, 6-9 is related to early childhood caries,10-13 is about

the causes,14- 16 is related to types of early childhood caries, 17- 20 is about the

symptoms, 21- 23 is related to complications, 24-25 is about the treatment and 26-36 is

about the preventive measures.

The overall score interpreted as follows for the statistical convenience:

Sl.no Remarks Score Percentage

1 Adequate 27- 36 Above 75

35
2 Moderately adequate 18-26 50-75%

3 Inadequate Below 18 Below50%

Content Validity

The content validity refers to the degree to which the items in an instrument

adequately represent the universal content.15

In this study content validity of closed ended questionnaire and Information booklet

were obtained by giving it to 4 experts from Paediatric Nursing educators and two from

pedodontist and from one statistician (Annexure IX). The experts were requested to give

their opinions and suggestions regarding the appropriateness and relevance of the

questions and content (Annexure II, V and VI). There was 100% agreement on the items

and content of the Information booklet (Annexure III). The suggestions given by the

experts to modify some of the questions and Information booklet were incorporated in the

final draft. Content validity was also obtained from language experts in English and

Kannada

Reliability

The reliability refers to the accuracy or inaccuracy rate in measurement device.15

The reliability of the tool was computed by using Karl Pearson split half method.

Where r = Correlation coefficient computed on split halves.

36
The obtained value of Karl’s Pearson correlation method r = 0.70. The tool was found to

be reliable.

Development of Information booklet

An Information booklet on Early childhood caries was developed in the following

sequences:

• Development of objectives.

• Review of literature.

• Consultation with experts.

• Preparation of first draft of the content.

• Content validation of Information booklet

Preparation of the first draft of the Information booklet

An Information booklet on Early childhood caries was developed in order to attain

the set of objectives. The areas covered in the Information booklet were definition of

early childhood caries, incidence, causes, types, signs and symptoms, complications,

diagnostic evaluations, treatment and prevention of early childhood caries.

Preparation of the final draft of the Information booklet

The final draft of Information booklet was prepared with necessary corrections

and suggestions from the experts. (Annexure VI)

37
Pilot Study

A pilot study is a small scale replication of the main study and covers the entire

process of research.15

The Pilot study was conducted from 7/12/2012 to 14/12/2012 by selecting 6

working and 6 non working mothers who is residing in Chikkbegur, Bangalore. After

explaining the purpose of pilot study the questionnaire with selected demographic

variables and questions were distributed to the working and non working mothers of 1-5

years of children. The collected data were coded numerically and tabulated and entered

into a spread sheet by key board entry. The data were analyzed using descriptive and

inferential statistics. The study was found to be feasible, practicable and acceptable. Few

modifications were made in section A of the tool. It was found that the language and

comprehension were clear and all the items in the tool were clearly understood by the

subjects without ambiguity. Hence the tool was found to be feasible and practicable for

the study.

Method of data collection

As a first step in the data collection procedure, the investigator met the Assistant

Medical Officer in order to establish support and cooperation to conduct study

successfully. The formal permission was taken from the authorized personnel of primary

health center Begur. The data collection extended from 03/01/2013 to 03/02/2013.

After obtaining the permission, the investigator met the subjects and establishes

rapport with them after ensuring the physical comforts. A written informed consent was

38
taken separately from each subject. Appropriate orientation was given to the subjects

about the aims of the study. Adequate care was taken for protecting the subjects from the

potential risks including maintaining confidentiality, security and identity. Structured

questionnaire was used to collect the data. After data collection Information booklets

were given to them

Procedure of data collection

Permission was obtained from the concerned authority.

Written informed consent was obtained from all participant of the study after explaining

the purpose and other details.

The subjects were asked to maintain confidentiality.

The subjects were informed that their participation was voluntary, had freedom to

dropout research work at any time

Plan for Data Analysis

In order to achieve the stated objectives of the study, the data obtained from the

subjects were coded numerically and tabulated. After tabulation and coding,the data was

entered into a spread sheet by the keyboard. The responses on tool were analyzed with

descriptive and inferential statistical measures.

• Descriptive statistics

Frequency and percentage was used to assess the demographic characteristics of working

and non working mothers of 1-5 years of children. Mean, standard deviation and range

39
are used to assess the knowledge regarding early childhood caries in working and non

working mothers of 1-5 years of children.

• Inferential statistics:

Unpaired t test are used to compare mean score of knowledge regarding early

childhood caries among working and non working mothers of 1-5 years of children

Chi-square test and correlation are used to find association between the level of

knowledge of working and non working mothers of 1-5 years of children with their

selected demographic variables.

The analysis data was presented in following sections:

Section 1: Description and distribution of demographic variables of working mothers of

1-5 years of children

Section 2: Description and distribution of demographic variables of non working mothers

of 1-5 years of children

Section 3: comparing the knowledge level of working and non working mothers of 1-5

years of children.

Section 4: Association of level of knowledge of working and non working mothers of 1-5

years of children with selected demographic variables.

40
Figure 2 Schematic representation of Research study

41
Summary

This chapter dealt with research methodology adopted for the study. It includes

research approach, research design, population, samples, sampling technique, research

setting, plan for development of tool and Information booklet, pilot study, data collection

procedure and plan for data analysis. The analysis and interpretation of the results have

been presented in following chapter.

42
 5.RESULTS

The description of results is the heart of a research project. It is the communication

of facts, measurements and observations gathered by the researcher. For achieving the

research results, the collected data must be processed and analyzed in an orderly coherent

fashion.

Analysis refers to the computation of certain measures along with researching for

the pattern of relationship that exists among data groups.16 Thus, in the process of

analysis relationships or differences supporting or conflicting with original or new

hypothesis should be subjected to statistical tests of significance to determine with what

validity data can be said to indicate any conclusions.

The collected information was organized, tabulated, analyzed and interpreted using

descriptive and inferential statistics. The findings were organized and presented in two

parts with tables and figures.

Objectives of the study:

1. To assess the level of knowledge of working and non working mothers of 1-5 years

of children.

2. To compare the level of knowledge of working and non working mothers of 1-5

years of children.

3. To associate the level of knowledge of working and nonworking mothers of 1-5

years of children with their selected demographic variables.

4. To develop information booklet based on findings.

43
Hypothesis of the study

H1: There will be significant difference in the mean knowledge regarding early childhood

caries among working and non working mothers of 1-5 years of children.

H2: There will be significant association between the knowledge of working and

nonworking mothers of 1-5 years of children with their selected demographic variables.

Organization of the study findings

Presentation of Data

The analysis data has been organized and presented in the following sections:

Section 1: Distribution and description of demographic variables of working and non

working mothers of 1-5 years of children.

Section 2: Description of level of knowledge of working and non working mothers of 1-5

years of children.

Section 3: Comparison between the level of knowledge among working and non working

mothers of 1-5 years of children.

Section 4: Association of the level of knowledge among working and non working

mothers of 1-5 years of children with selected demographic variables.

44
 Section I: Distribution and description of demographic variables of working and

non working mothers of 1-5 years of children.

Table 1 (a): Frequency and Distribution of demographic variables among working

and non working mothers of 1-5 years of children.

Sl no Demographic variables Working mothers Non working mothers

Frequency Percentage Frequency Percentage

1 Age of the 21-30years

mother 25 41.7% 26 43.3%

31-40years
26 43.3% 23 38.3%
41-50years 9 15.0% 11 18.3 %

2 Education Primary 9 15.0% 14

education 23.3%

Secondary
education 8 13.3% 23 38.3%

PUC 14 23.3% 15 25.0%

Under- 17 28.3% 8 13.3%

graduate

Post
12 20.0% 0 0.0%
-graduate

3 Working working 60 100% 0 0%

status
Non-working
0 0% 60 100%

45
Table 1(b): Frequency and Distribution of demographic variables among working

and non working mothers of 1-5 years of children.

Sl no Demographic Working mothers

Non working mothers
variables
Frequency Percentage Frequency Percentag
e
4 Type of
Nuclear 22 36.7% 27 45.0%
family

Joint 25 41.7% 23 38.3%

Extende
13 21.7% 10 16.7%
d

5 Area of Rural
1 1.7% 0 0%
residen

ce urban
59 98.3% 60 100%

6 Monthl Less

y than 45% 27 45%

27
family 10,000

income Rs
10,001-
19 31.7% 19 31.6%
15,000

Rs
15,001- 14 23.3% 14 23.3%
20,000

46
 Table 1(c): Frequency and Distribution of demographic variables among working

and non working mothers of 1-5 years of children.

Working mothers Nonworking mothers

Sl no Demographic variables

Frequency Percentage Frequency Percentage

7 Religion Hindu
19 31.7% 16 26.7%

Muslim
14 23.3 % 18 30.0%

Christian 12 20% 11 18.3 %

others
15 25 % 15 25%

8 Age of the child 1-2 years

14 23.3% 11 18.3%

2-3 years
16 26.7 % 15 25%

3-4 years
15 25% 23 38.3 %

4-5 years
15 25% 11 18.3%

47
 Table 1(d): Frequency and Distribution of demographic variables among working

and non working mothers of 1-5 years of children.

Demographic variables Nonworking mothers

Working mothers
Sl no
Frequency Percentage Frequency Percentage

9 Once in a
43 71.7% 48 80 %
day

Twice in a
17 28.3% 12 20%
Toothbrush
day
habit
Thrice in a
0 0% 0 0
day

Never
0 0% 0 0%

10 Parental Yes
46 76.7% 32 53.3%
Assistance
No
4 6.7% 13 21.7%

Occassionly
10 16.7% 15 25%

11 During last 6
4 6.7% 2 3.3%
months

During last
Date of 1 1.7% 0 0%
7-12 months
appointment One year ago 19 31.7% 19 31.7%

Never
36 60% 39 65%

48
 Table 1(e): Frequency and Distribution of demographic variables among working

and non working mothers of 1-5 years of children.

Working mothers Nonworking mothers

Sl no Demographic variables

Frequency Percentage Frequency Percentage

12 Limitation of Yes
23 38.3% 20 33.3%
sweet

No
37 61.7% 40 66.7%

13 Child having Yes

21 35% 34 56.7%
ECC

No
39 65% 26 43.3%

14 Previous Yes

knowledge 47 78.3% 44 73.3%

about ECC

No
13 21.7% 16 26.7%

49
 Table 1(f): Frequency and Distribution of demographic variables among working

and non working mothers of 1-5 years of children.

Sl no

Working mothers Non working mothers

Demographic variables
Frequency Percentage Frequency Percentage

15 Source of Parents and

8 13.33% 12 20.%
information relatives

Friends and
3 5% 19 31.6%
neighbours

Mass media 23 38.3% 19 31.6%

Health
26 43.3% 10 16.6%
professionals

50
Figure 3: Bar diagram showing percentage distribution of mother’s age in years.

The data presented in fig. 3 shows that 43.3% of non working mothers were in

the age group 21-30 years,whereas 43.3% of working mothers in 31-41 years.

51
 Figure 4: Cylindrical diagram showing percentage distribution of mother’s

education status

The data presented in fig. 4 shows that 28.3% of working mothers are

undergraduate and 38.3% of non working mothers are having secondary education.

52
 Figure 5: Pyramidal diagram showing percentage distribution of type of family

The data presented in fig. 5 shows that 41.7% of working mothers from joint

family and 45% of non working mothers from nuclear family.

53
 Figure 6: Pyramidal diagram showing percentage distribution of area of

residence

The data presented in fig 6 shows that 1.7% of working mothers were from rural

area and 100% non working mothers from urban area.

54
Figure 7: Pyramidal diagram showing percentage distribution of monthly income of

the family

The data presented in fig7 shows that 45% of working mothers and non

working mothers family is having the monthly income less than 10000.

55
 Figure 8: Cylindrical diagram showing percentage distribution of religion

The data presented in fig 8 shows that 31.7% of working mothers belongs to

hindu religion and 30% of non working mothers are from muslim religion

56
 Figure 9: Bar diagram showing percentage distribution of age of the child

The data presented in fig 9 shows that 26.7% of working mothers having 2-3

years old children and 38.3% non working mothers having 3-4 years of children

57
Figure 10: Pyramidal diagram showing percentage distribution of brushing habits

of their children

The data presented in fig 10 shows that 71.7% of working mothers children

and 80% of non working mothers children brushes their teeth once in a day.

58
 Figure 11: Cylindrical diagram showing percentage distribution of parental

assistance in brushing

The data presented in fig 11 shows that 76.7% of working mothers assist their

children in brushing whereas 53.3% of non working mothers assist their children.

59
Figure 12: Bar diagram showing percentage distribution of date of last dental

appointment

The data presented in fig 12 shows that 60% of working mothers and 65% of

non working mothers were not taken their children for dental checkup

60
Figure 13: Pyramidal diagram showing percentage distribution of limitation of

sweet consumption

The data presented in fig 13 shows that 66.7% of non working mothers and

61.7 % of working mothers were limiting the sweet consumption

61
Figure 14: Pyramidal diagram showing percentage distribution of children with

early childhood caries.

The data presented in fig 14 shows that 56.7% of non working mothers children

have early childhood caries and 65% of working mothers children doesn’t have

early childhood caries

62
Figure 15: Cylindrical diagram showing percentage distribution of previous

knowledge about early childhood caries

The data presented in fig 15 shows that 78.3% of working mothers and

73.3% of non working mothers have previous knowledge about early childhood

caries

63
Figure 16: Pyramidal diagram showing percentage distribution of source of

information about early childhood caries

The data presented in fig 16 shows that 43.3% of working mothers got the

informations from health professionals and 31.6% of non working mothers have the

information about early childhood caries from friends and mass media.

64
Section 2: Description of level of knowledge of working and non working mothers of

1-5 years of children.

Table 2. Description of level of knowledge of working and non working mothers of

1-5 years of children.

Level of knowledge

Group Level of knowledge Frequency Percentage

Working mothers Adequate 1 1.7

Moderate 59 98.3

Total 60 100.0

Non working mothers Adequate 59 98.3

1 1.7

60 100.0

65
Figure 17. Cylindrical diagram showing percentage distribution of level of

knowledge about early childhood caries among working and non working mothers

The data presented in fig 17 shows that 98.3% of working and non working

mothers have moderate knowledge about early childhood caries.1.7% of working

mothers have adequate knowledge where as 1.7% non working mothers have

inadequate knowledge.

66
 Section 3: Comparison between the level of knowledge among working and non

working mothers of 1-5 years of children.

Table 3 Comparison between the level of knowledge among working and non

working mothers of 1-5 years of children.

Group N Minimum Maximum Maximum mean Standard Median Stand Mean

possible deviation ard %

score error

Working 60 17 25 36 20.82 1.918 21.00 .248 57.82

mothers

Non 60 12 23 36 17.27 2.357 17.00 .304 47.96

working

mothers

Combined 120 12 25 36 19.04 2.785 19.00 .254 52.89

67
Figure 18. Cylindrical diagram showing percentage distribution of comparison

between the level of knowledge among working and non working mothers of 1-5

years of children.

The data presented in fig 18 shows that 57.82% of working mothers and 47.82%of

non working mothers have adequate knowledge about early childhood caries

68
Section 4: Association of the level of knowledge among working and non working

mothers of 1-5 years of children with selected demographic variables.

Table 4: Association of the level of knowledge of working mothers of 1-5 years

children with demographic variables

Level of Knowledge
N Chi
Demographic variables % < Median (21) ≥ Median(21)
o square
No % No %

1. Age (In Years)

a. 21-30 yrs 25 41.7 8 32 17 68

5.004*
b. 31-40 yrs 26 43.3 11 42.3 15 57.7
1df S
c. 41-50 yrs 9 15 6 66.7 3 33.3

2. Education

a. Primary Education 9 15 4 20 3 8.5

9.46689
b. Secondary Education 8 13.3 3 12 5 14.2
1
c. PUC 14 23.3 2 12 12 34.2
4df
d. Under graduate 17 28.3 11 44 6 17
NS
e. Post graduate 12 20 3 12 9 25.7

3. Type of family

a. Nuclear 22 36.7 4 1802 18 81.8

7.899*
b. Joint family 25 41.7 14 56 11 44
2df S
c. Extended 13 21.7 7 53.8 6 46.2

4. Area of residence

a. Rural 1 1.7 0 0 1 2.8 0.72639

69
 2
b.Urban 59 25 34
98.3 100 97 1df Ns

5. Monthly Family
Income

57.1428
a. Less than 10,000 27
45 7 28 20 6 7.85592
6
b. 10000-150000 31.4285
19 31.7 8 32 11 7 3df

11.4285 S*
c. 15000-20000 14
23.3 10 40 4 7

6. Religion

a.Hindu 19 31.7 8 42.1 11 57.9

1.388
b. Muslim 14 23.3 5 35.7 9 64.3
3df
c.Christian 12 20 4 33.3 8 66.7
Ns
D. others 15 25 8 53.3 7 46.7

7.Age of the child

17.1428
1-2yrs 14
23.3 7 28 7 6
3.06197
31.4285 8
2-3yrs 16
26.7 5 20 11 7
3df
31.4285
3-4yrs 15 NS
25 5 20 10 7

4-5yrs 15 25 8 32 7 20

8. Tooth Brush Habit

74.2857 0.73469
Once in a day 43
71.7 17 64 26 1 4

1df
Twice in a day 17
28.3 9 36 8 25.7142
70
 9 NS

Thrice in a day 0 0 0 0 0 0

Never 0 0 0 0 0 0

9. parental Assistance

74.2857
Yes 46
76.7 19 76 27 1 1.25714
3
11.4285
No 4
6.7 1 4 3 7 2df

14.2857 NS
Occasionally 10
16.7 5 20 5 1

10.Date of Appointment

2.85714
During last 6 months 4
6.7 2 8 2 3
2.39609
Last 7 – 12 months 1 1.7 1 4 0 0 8
31.4285 3df
One year ago 19
31.7 8 32 11 7
NS
65.7142
Never 36
60 14 56 22 9

11. Limitation of Sweets

Yes 23 38.3 14 60.9 9 39.1 5.659*

No 37 61.7 11 29.7 26 70.3 1df S

12. Child having ECC

Yes 21 35 7 33.3 14 66.7 .923

No 39 65 18 46.2 21 53.8 1df Ns

13. Previous Knowledge

about ECC

Yes 47 78.3 21 44.7 26 55.3 .339

71
No 13 21.7 4 30.8 9 69.2 1df Ns

14.Source Of
Information

8.57142
Parents & Relatives 8
13.33 5 20 3 9

8.57142 5.88647
Friends and Neighbours 3 9
5 0 0 3 9

31.4285 3df
Mass media 23
38.33 12 48 11 7 NS
51.4285
Health Professionals 26
43.33 8 32 18 7

Note: S- significant at 5% level (ie., p<0.05); NS- not significant at 5% level (ie.,p>0.05).

72
Table 4(a): Association of the level of knowledge of non working mothers of 1-5

years children with demographic variables.

Level of Knowledge
Chi
Demographic variables No % < Median (21) ≥ Median(21)
square
No % No %

1. Age (In Years)

a. 21-30 yrs 26 43.3 9 34.6 17 65.4

.448
b. 31-40 yrs 23 38.3 8 34.8 15 65.2
2df Ns
c. 41-50 yrs 11 18.3 5 45.5 6 65.2

2. Education

a. Primary Education 14 23.3 5 22.727 9 23.684

b. Secondary Education 23 38.3 7 31.818 16 42.105

0.82
c. PUC 15 25 6 31.818 9 23.684
3df NS
d. Under graduate 8 13.3 4 13.636 4 10.526

e. Post graduate 0 0 0 0 0 0

4. Type of family

a. Nuclear 27 45 8 29.6 19 70.4

1.083
b. Joint family 23 38.3 10 43.5 13 56.5
2df Ns
c. Extended 10 16.7 4 40 6 60

5. Area of residence

a. Rural 0 0 0 0 0 0 0

b.Urban 60 100 22 100 38 100 1df Ns

6. Monthly Family
Income

a. Less than 10,000 27 45 10 45.455 17 44.737 0.444412

73
 2df Ns``
b. 10000-150000
19 31.6 6 27.273 13 34.211

c. 15000-20000 14 23.3 6 27.273 8 21.053

7. Religion

a.Hindu 16 26.7 6 37.5 10 62.5

b. Muslim 18 30 6 33.3 12 66.7 .163

c.Christian 11 18.3 4 36.4 7 63.6 3df Ns

D. others 15 25 6 40 9 60

8.Age of the child

1-2yrs 11 18.3 6 27.273 5 15.789

2.322749
2-3yrs 15 25 4 18.182 11 31.579
3df
3-4yrs 23 38.3 7 31.818 16 36.842
NS
4-5yrs 11 18.3 5 22.727 6 15.789

9. Tooth Brush Habit

Once in a day 48 80 18 81.818 30 78.947

0.07177
Twice in a day 12 20 4 18.182 8 21.053
1df
Thrice in a day 0 0 0 0 0 0
NS
Never 0 0 0 0 0 0

10. parental Assistance

Yes 32 53.3 11 50 21 55.263 0.648003

No 13 21.7 6 27.273 7 18.421 2df

Occasionally 15 25 5 22.727 10 26.316 NS

11.Date of Appointment

During last 6 months 2 3.3 0 0 2 5.2632 1.688782

Last 7 – 12 months 0 0 0 0 0 0 3df

74
 One year ago 19 31.7 6 27.273 13 34.211 NS

Never 39 65 16 72.727 23 60.526

12. Limitation of Sweets

Yes 20 33.3 6 30 14 70 0.574

No 40 66.7 16 40 24 60 1df Ns

13. Child having ECC

Yes 34 56.7 13 38.2 21 61.8 0.083

No 26 43.3 9 34.6 17 65.4 1df Ns

14. Previous Knowledge

about ECC

Yes 44 73.3 16 36.4 28 63.6 0.007

No 16 26.7 6 37.5 10 62.5 1df Ns

15.Source Of Information

Parents & Relatives 12 20 5 22.727 7 18.421

0.774364
Friends and Neighbours 19 31.667 6 27.273 13 34.211
3df
Mass media 19 31.667 8 36.364 11 28.947
NS
Health Professionals 10 16.667 3 13.636 7 18.421

Note: S- significant at 5% level (ie., p<0.05); NS- not significant at 5% level (ie.,p>0.05).

75
Summary

This chapter dealt with analysis and interpretation of the study. The data were analyzed

by using descriptive and inferential statistics. The analysis had been organized and

presented under various sections like distribution and description of demographic

variables of working and non working mothers of 1-5 years of children. Description of

level of knowledge of working and non working mothers of 1-5 years of children.

Comparison between the level of knowledge among working and non working mothers of

1-5 years of children and association of the level of knowledge among working and non

working mothers of 1-5 years of children with selected demographic variables.

76
 6. DISCUSSION

This chapter discusses the major findings of the study and the perspectives of the

study can be discussed with reference to the research problem, conceptual framework,

objectives and assumptions of the study and with the findings of other studies.

The aim of the present study was to assess the level of knowledge of mothers of 1-

5 years older children regarding early childhood caries. The present study was conducted

at Begur village,Bangalore. The study made use of an descriptive comparative approach.

By using convenient sampling technique, 120 mothers were selected as study samples.

Through a structured questionnaire schedule the knowledge was assessed among both

working and nonworking mothers of Bangalore.

The obtained data was analyzed by using descriptive and inferential statistics such

as mean, percentage, standard deviation, paired‘t’ test and chi-square test.

The findings of the study are discussed under the following headings.

1. Demographic variable

2. Assessment regarding level of knowledge.

3. Comparison of level of knowledge between working and non-working mothers

4. Association of level of knowledge of working and non working mothers with

selected demographic variables.

5. Development of an information booklet based on the findings

77
Description of demographic variable of working and non-working mothers of 1-5

years of children

Among the samples, 41.7% of working mothers and 43.3% of non working

mothers belong to the age group of 21-30 years , 28.3% of the working mothers are

undergraduate and 38.3% have secondary education .41.7% of working mothers belongs

to joint family 45% of non working mothers belong to nuclear family. 45% of working

and non working mothers have the monthly family income less than 10,000 rs.31.7% of

working mothers belongs to hindu religion and 30% of non working mothers were from

muslim religion. Majority of children of working mothers were belong to age group of 2-

3yrs and 38.3% of non working mothers children’s are in the age group of 3-4 years . In

regard to tooth-brush habits, 71% of working mothers and 80% of non working mothers

children has the habit of brushing once in a day.76.7% of children of working mothers

and 53.3% of non working mothers need assistance for brushing. 60% of working

mothers and 65% of non working mothers were not taken their children for dental

checkup.56.7% of non working mothers children have early childhood caries and 65% of

working mothers children doesn’t have early childhood caries.

The above findings was supported by a study conducted on the prevalence of

early childhood caries among preschool children Hubli, Karnataka. A sample of 1500

children between the age group of 3-5 years was taken. Result shows that the prevalence

was 54.1%. The difference in the carious prevalence was significant (<0.05) between the

age groups of 3-4 years and 4 and 5 years, and highly significant (<0.001) between the

age groups of 3 and 5 years. The confidence interval for the surveyed group with respect

to prevalence of caries varied from 38-48%, 45-57% and 57-64% for age groups 3, 4 and

78
5 years respectively. The attitude of mothers towards children’s oral health made a

statistical difference in the mean level.19

Objective 1: To assess the level of knowledge of working and non working mothers of

1-5 years of children.

98.3% of working and non working mothers have moderate knowledge about early

childhood caries.1.7% of working mothers have adequate knowledge where as 1.7% non

working mothers have inadequate knowledge.

The above findings was supported by a study conducted on mother’s knowledge

about preschool child’s dental caries and oral health in Moradabad. A sample of 406

mothers of children aged between 1-4 years, attending the hospitals had taken. Result

shows three hundred (73.8%) mothers had a good knowledge about diet and dietary

practices, while only 110 (27.1%) and 103 (25.4%) mothers were found to have a good

knowledge about the importance of oral hygiene practices and importance of deciduous

teeth, respectively. Mothers with higher educational qualification and information gained

through dentist had a better knowledge about child's oral health. Oral hygiene habits and

dietary habits are established during pre-school days and the parents, especially mothers,

function as role models for their children.23

Objective 2. To compare the level of knowledge of working and non working mothers of

1-5 years of children.

57.82% of working mothers and 47.82%of non working mothers have adequate

knowledge about early childhood caries

79
 The above findings was supported by a study conducted on knowledge of dental

trauma among mothers in Mangalore. A sample of 500 working and non working

mothers via their children attending primary school had taken. Result shows 72% of

working mothers were aware about the management of dental trauma while 65% of non

working mothers were aware. This shows that working mothers have more knowledge

than non working mothers.

Objective 3: To associate the level of knowledge of working and nonworking mothers

of 1-5 years of children with their selected demographic variables.

The result shows that there is a significant association between the working

mothers level of knowledge with selected demographic variables such as age x2= 5.00(s);

type of family x2=7.88; monthly family income x2=7.85; limitation of sweet consumption

x2= 5.65 at 0.001 level and there is no significant association between the non working

mothers level of knowledge with demographic variables.

A study was conducted on early childhood caries lesions in preschool children in

Kerala, India. A sample of 530 children aged from 8 to 48 months are selected and the

caregiver of each child then completed by a structured questionnaire. Result shows that

among the group of 252 girls and 278 boys, 56% of the children being caries-lesion free.

Fifty-nine (12%) were considered to have early childhood caries (ECC), based on the

criteria that smooth surface caries lesions on all 4 maxillary incisor teeth indicated severe

ECC. Breast-feeding was practiced by 99% of the mothers, and 5% did exclusively.

Statistically significant correlations were found between caries lesions and the child's

dental condition, as perceived by the mother or caregiver (P <.0001), the dental status of

80
the caregiver (P =.0417), consumption of snacks (P =.0177), giving of sweets as a reward

(P< .0001), cleaning of the child's mouth (P< .0001), oral hygiene status of the child (P<.

0001) and low socioeconomic status, as measured by income (P<.0001).21

Objective 4: To develop an information booklet based on findings.

In view of the nature of the present study and to accomplish the objectives

of the study an Information booklet was prepared on definition of early childhood caries,

incidence, causes, types, signs and symptoms, complications, diagnostic evaluations,

treatment and prevention of early childhood caries.

Summary

This chapter dealt with the discussion of major findings of the study like

assessment of level of knowledge, comparison of working and non working mothers level

of knowledge, association of level of knowledge with selected demographic variables.

81
82
 7. CONCLUSION

This chapter dealt with the conclusion, implications of the study, limitations of the

study, suggestions and recommendations.

The present study was “A comparative study to assess the level of knowledge

regarding early childhood caries among working and non working mothers of 1-5 years

of children in selected areas, Bangalore with a view to develop an information booklet.”

In this study 60 working and non working mothers each are selected from different areas

of Begur by using convenient sampling technique. The data was collected and interpreted

by suitable and appropriate statistical methods.

The following conclusions were drawn based on the data analysis.

Among the samples, 41.7% of working mothers and 43.3% of non working

mothers belong to the age group of 21-30 years , 28.3% of the working mothers are

undergraduate and 38.3% have secondary education .41.7% of working mothers belongs

to joint family 45% of non working mothers belong to nuclear family. 45% of working

and non working mothers have the monthly family income less than 10,000 rs.31.7% of

working mothers belongs to hindu religion and 30% of non working mothers were from

muslim religion. Majority of children of working mothers were belong to age group of 2-

3yrs and 38.3% of non working mothers children’s are in the age group of 3-4 years . In

regard to tooth-brush habits, 71% of working mothers and 80% of non working mothers

children has the habit of brushing once in a day.76.7% of children of working mothers

and 53.3% of non working mothers need assistance for brushing. 60% of working

mothers and 65% of non working mothers were not taken their children for dental

82
checkup.56.7% of non working mothers children have early childhood caries and 65% of

working mothers children doesn’t have early childhood caries.

98.3% of working and non working mothers have moderate knowledge about

early childhood caries.1.7% of working mothers have adequate knowledge where as 1.7%

non working mothers have inadequate knowledge.

57.82% of working mothers and 47.82%of non working mothers have adequate

knowledge about early childhood caries.

The result shows that there is a significant association between the working

mothers level of knowledge with selected demographic variables such as age x2= 5.00(s);

type of family x2=7.88; monthly family income x2=7.85; limitation of sweet consumption

x2= 5.65 at 0.001 level and there is no significant association between the non working

mothers level of knowledge with demographic variables

Implications of the study

The finding of the study has implications in nursing education, nursing practice,

nursing administration and nursing research.

Nursing Education

Nursing profession present and future require qualified nurses to meet the

challenges and deliver health care in all setting. The student nurses are the growing buds

of our nursing profession. The nursing curriculum should include the contemporary

approach for care of children with caries. It should also emphasis on proper assessment of

children for identification of caries and for its prevention.

83
Nursing practice

Nursing personnel need to be aware of complications for early childhood

caries. Nurses also need to give more attention to diagnose the early childhood caries at

initial stage.Nurses should improve awareness among the mothers regarding the

prevention of early childhood caries in their children.

Nursing Administration

The functions of administrator is not only plays their role in hospital setting

but also they are the right person to develop the protocol for health awareness

programmes. The nurse administrator can mobilize the available resources and personnel

towards the health education for mothers whose children are with early childhood caries.

Planning and organization of educational programmes requires efficient team work in

planning for man power, money, material and methods to conduct successful educational

programme both in hospital and in the PHC’s. He/she must also encourage and depute

nurses to participate in such programmes conducted by other organizations.

Nursing Research

Nurse researchers can encourage nurses to apply the research findings in

their daily nursing care. This help the future nurse researcher to develop appropriate

health education tool for educating the mothers and general public about early childhood

caries. This will increase thirst for the evidence based practice and effective research

approaches in health promotion.

84
Suggestions

1.Awareness programme can be conduct among public regarding early childhood caries.

2.Free dental check up should be conduct on schools for early identification of early

childhood caries

3.Guidance and counselling facilities could be provided by the experts for the mothers

who need them

Recommendations:

The following recommendation are drawn

(1) The study can be replicated on a large sample.

(2) The study can be replicated on the samples with different demographic

characteristics

(3) The study can be replicated as a longitudinal study with follow up.

(4) A similar study can be conducted to assess the knowledge attitude and

practice among mothers residing in rural and urban areas.

(5) The same study can conducted with qualitative approach.

Limitations of the study

The limitations of the present study include:

1. The finding of the study could not be generalized in view of small sample size

and limited area of setting.

2.The study also limits with available data collection period

85
86
 8. SUMMARY

Statement of the problem:

A comparative study to assess the level of knowledge regarding early

childhood caries among working and non working mothers of 1-5 years of children in

selected areas, Bangalore with a view to develop an information booklet.

Objectives of the study:

1. To assess the level of knowledge of working and non working mothers of 1-5 years

of children.

2. To compare the level of knowledge of working and non working mothers of 1-5

years of children.

3. To associate the level of knowledge of working and nonworking mothers of 1-5

years of children with their selected demographic variables.

4. To develop an information booklet based on findings.

Methodology

The aim of the present study was to assess the level of knowledge of mothers of

1-5 years older children regarding early childhood caries carries. The present study was

conducted at Begur village, Bangalore. A formal written permission was obtained from

the higher authorities. The present study was descriptive in nature, conducted over a

period of 4 weeks from 3rd Jan 2013 to 3rd Feb 2013. The conceptual framework used for

the study was based on modified general system model . Convenient sampling technique

was used to select 60 samples each from working and non working mothers.

86
 The instrument used for the data collection was closed ended questionnaire.

Questionnaire consists of 2 sections; Section A and Section B. Section A includes 14

demographic variables such as age, education, working status, type of family, area of

residence, monthly family income, religion, age of the child, tooth brush habit of the

child, parental assistance during tooth brushing, date of child’s last dental appointment,

limitation of sweet consumption, history of early childhood caries, previous knowledge

about early childhood caries, source of information and Section B consists of questions

related to meaning, causes, types, signs and symptoms, complications, treatment and

prevention of early childhood caries.

The prepared tool was validated by subject experts and the reliability of tool was

tested. The reliability of the tool was computed by using Karl Pearson split half method.

The tool was found to be reliable. The Pilot study was conducted from 7/12/2012 to

14/12/2012 by selecting 6 mothers each from working and non working mothers who

were residing in Chikkabegur Bangalore. The data obtained were analyzed and

interpreted in terms of the objective of the study. Descriptive and inferential statistics

were used for data analysis.

Examining the Hypothesis

Formulated Hypothesis:

H1: There will be significant difference in the mean knowledge regarding early

childhood caries among working and non working mothers of 1-5 years of children.

The result shows that 57.82% of working mothers and 47.82%of non working

mothers have adequate knowledge about early childhood caries. So it indicate that the

research hypothesis is accepted.

87
 H2: There will be significant association between the knowledge of working and

nonworking mothers of 1-5 years of children with their selected demographic

variables.

The result shows that there is a significant association between the working

mothers level of knowledge with selected demographic variables such as age x2= 5.00(s);

type of family x2=7.88; monthly family income x2=7.85; limitation of sweet consumption

x2= 5.65 at 0.001 level so that the research hypothesis is accepted and there is no

significant association between the non working mothers level of knowledge with

demographic variables and the reseaech hypothesis is rejected.

The findings are summarized as follows.

1.Findings related to demographic variables

Among the samples, 41.7% of working mothers and 43.3% of non working

mothers belong to the age group of 21-30 years , 28.3% of the working mothers are

undergraduate and 38.3% have secondary education .41.7% of working mothers belongs

to joint family 45% of non working mothers belong to nuclear family. 45% of working

and non working mothers have the monthly family income less than 10,000 rs.31.7% of

working mothers belongs to hindu religion and 30% of non working mothers were from

muslim religion. Majority of children of working mothers were belong to age group of 2-

3yrs and 38.3% of non working mothers children’s are in the age group of 3-4 years . In

regard to tooth-brush habits, 71% of working mothers and 80% of non working mothers

children has the habit of brushing once in a day.76.7% of children of working mothers

and 53.3% of non working mothers need assistance for brushing. 60% of working

88
mothers and 65% of non working mothers were not taken their children for dental

checkup.56.7% of non working mothers children have early childhood caries and 65% of

working mothers children doesn’t have early childhood caries.

2.Finding related to level of knowledge of mothers about early childhood caries in

children

98.3% of working and non working mothers have moderate knowledge about

early childhood caries.1.7% of working mothers have adequate knowledge and non

working mothers have inadequate knowledge

3. Findings related to comparison of level of knowledge between working and non-

working mothers

57.82% of working mothers and 47.82%of non working mothers have adequate

knowledge about early childhood caries

4.Findings related to association of level of knowledge of working and non working

mothers with selected demographic variables.

The result shows that there is a significant association between the working

mothers level of knowledge with selected demographic variables such as age x2= 5.00(s);

type of family x2=7.88; monthly family income x2=7.85; limitation of sweet consumption

x2= 5.65 at 0.001 level and there is no significant association between the non working

mothers level of knowledge with demographic variables.

89
90
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 58. Amitha Hedge. Oral health knowledge and attitude among working and non working

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96
 ANNEXURE –I

Letter granting permission to conduct the Pilot study

97
 ANNEXURE –I(a)

Letter granting permission to conduct the Main study

98
 ANNEXURE –II
LETTER REQUESTING THE OPINION OF EXPERTS ON CONTENT
VALIDITY OF THE TOOL AND INFORMATION BOOKLET.

From,
Ms. Chinchu Joseph
2nd year Msc (N) student
T. John College Of Nursing
To,
…………………………
…………………………
Forwarded through
Principal
T. John College Of Nursing
Respected sir/Madam
Sub: Requisition for expert opinion and suggestion for content validity of the tool.
I Ms. Chinchu Joseph a student of Msc Nursing IInd year in T. John College Of
Nursing affiliated to Rajiv Gandhi University of health sciences Bangalore. As a partial
fulfillment of Msc Nursing program, I am conducting a study on “ A COMPARATIVE
STUDY TO ASSESS THE LEVEL OF KNOWLEDGE REGARDING EARLY
CHILDHOOD CARIES AMONG WORKING AND NON WORKING MOTHERS
OF 1-5 YEARS OF CHILDREN IN SELECTED AREAS, BANGALORE WITH A
VIEW TO DEVELOP AN INFORMATION BOOKLET”. Tool for my project has to
be validated by experts. I request you to kindly go through the content of tool and
information Booklet, and give your valuable opinion on the same. I also request you to
kindly sign the certificate stating that you have validated the tool. Please suggest
modifications where ever possible.

Thanking you in anticipation

99
Here I am enclosing the copy of
a) Objectives of the study
b) Information booklet
c) Structured questionnaire
d) Criteria checklist
e) Validity certificate
Yours faithfully
( Chinchu Joseph)

Signature of principal

PRINCIPAL

T. John College Of Nursing

100
 ANNEXURE –III
ACCEPTANCE FORM FOR TOOL VALIDATION

NAME:

DESIGNATION:

NAME OF THE COLLEGE/HOSPITAL

Statement of acceptance or non-acceptance

I gave my acceptance or non acceptance to validate tool.

“ A COMPARATIVE STUDY TO ASSESS THE LEVEL OF KNOWLEDGE

REGARDING EARLY CHILDHOOD CARIES AMONG WORKING AND NON
WORKING MOTHERS OF 1-5 YEARS OF CHILDREN IN SELECTED AREAS,
BANGALORE WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET”

Place

Date Signature

101
 ANNEXURE –IV
CONTENT AND TOOL VALIDATION CERTIFICATE

I hereby certify that I have validated the tool and information booklet of Ms. Chinchu
Joseph IInd year M.sc (N) student, T. John College Of Nursing who is undertaking the
following study.

“ A COMPARATIVE STUDY TO ASSESS THE LEVEL OF KNOWLEDGE

REGARDING EARLY CHILDHOOD CARIES AMONG WORKING AND NON
WORKING MOTHERS OF 1-5 YEARS OF CHILDREN IN SELECTED AREAS,
BANGALORE WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET”

Place Signature of expert

Date Designation and Address

102
 ANNEXURE –V
EVALUATION CRITERIA CHECKLIST

Dear sir/Madam

Kindly go through the content and place right mark against questions in the
following columns ranging from relevant to not relevant, whether need modification,
kindly give your opinion in the remark column.

SECTION I

DEMOGRAPHIC DATA

SL NO ITEMS RELEVANT NEED NOT REMARKS

MODIFICATION RELEVANT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Signature of the
Evaluator

Name and designation

Suggestions:

103
 ANNEXURE –VI
EVALUATION CRITERIA CHECK LIST (Information booklet)

Respected Sir/Madam,

Kindly go through the content and rate the content in the appropriate column and your
expert opinion and suggestion in the remark column if found not relevant or needs
modification.

SL CONTENT RELEVANT NEED NOT REMARKS

NO MODIFICATION RELEVANT
1 Objectives
• Respond
oriented
• Realistic to
achieve
2 Selection of
content
• Adequate
content
Objectives
• According
to the
participant
cognitive
level
• Aims at
high level of
wellness
• Continuing
of the
content
observed
3 Organisation of
content
• Arrange in
logical
sequence
• Integration
of the
content
from simple
to complex

104
4 Language
• Simple
comprehend
• Clear to
perceive the
• Meaning of
the content
5 Visual image used
• Relevant to
the content
• Represents
adequate to
the concept
of content
• Clear and
understanda
ble
6 Fesibility and
practicability of
information
booklet
• Permits self
learning
• Interesting
and useful
to Staff
Nurses

Comments:………………………………………………………

……………………………………………………………………

……………………………………………………………………

………………………………………………………………….....

Date: Name

Place Signature of Expert

105
 ANNEXURE –VII

CONSENT FORM (ENGLISH)

I am M.Sc Nursing student of T. John College of nursing. I have selected a study,

“ A COMPARATIVE STUDY TO ASSESS THE LEVEL OF KNOWLEDGE

REGARDING EARLY CHILDHOOD CARIES AMONG WORKING AND NON

WORKING MOTHERS OF 1-5 YEARS OF CHILDREN IN SELECTED AREAS,

BANGALORE WITH A VIEW TO DEVELOP AN INFORMATION

BOOKLET”.I request you to participate in my study. You will be required to answer the

questions honestly. The information finished by you will be kept confidential and will be

used only for the study purpose.

Place:

Signature of the participant

Date:

106
 ANNEXURE –VIII

TOOL USED FOR THE STUDY (ENGLISH)

QUESTIONNAIRE FOR ASSESSING THE KNOWLEDGE OF

MOTHER’S HAVING 1-5 YEARS OLD CHILDREN REGARDING

EARLY CHILDHOOD CARIES

SECTION A

Baseline Data:-

Instruction: Please read the following question and put tick mark against
the appropriate response.

Sample no:……………………..
Date:……………………………

Demographic variables

1) Age of the mother

a) 21-30 years [ ]
b) 31-40 years [ ]
c) 41-50 years [ ]

107
2) Education
a) Primary education [ ]
b) Secondary education [ ]
c) PUC [ ]
d) Under graduate [ ]
e) Postgraduate [ ]

3) Working status
a) Working [ ]
b) Not working [ ]

4) Type of family
a) Nuclear [ ]
b) Joint [ ]
c) Extended [ ]

5) Area of residence
a) Rural area [ ]
b) Urban are [ ]

6) Monthly family income

a) Less than Rs 10,000 [ ]
b) Rs 10,001-15,000 [ ]
c) Rs 15,001- 20,000 [ ]
d) Rs 20,001 and above [ ]

108
7) Religion
a) Hindu [ ]
b) Muslim [ ]
c) Christian [ ]
d) Other (specify)…….. [ ]

8) Age of your child

a) 1-2 years [ ]
b) 2- 3 years [ ]
c) 3-4 years [ ]
d) 4-5 years [ ]

9) Tooth brush habit in child

a) Once in day [ ]
b) Twice in a day [ ]
c) Thrice in a day [ ]
d) Never [ ]

10) Parental assistance during tooth brushing

a) Yes [ ]
b) No [ ]
c) Occasionally [ ]

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11) Date of child’s last dental appointment
a) During last 6 months [ ]
b) During last 7-12 months [ ]
c) One year ago [ ]
d) Never [ ]

12) Limitation of sweet consumption

a) Yes [ ]
b) No [ ]

13) The child is having early childhood caries

a) Yes [ ]
b) No [ ]

14) Previous knowledge about early childhood caries

a) Yes [ ]
b) No [ ]
If yes Sources of information are
a) Parents and relatives [ ]
b) Friends and neighbours [ ]
c) Mass media [ ]
d) Health professionals [ ]

110
 SECTION B

Instructions: Three alternatives are given for each question. The respondent
is requested to place a tick mark against the correct answer. Each correct
answer carries one score. There is only one correct answer.

GENERAL QUESTIONS:-
1) The eruption of milk teeth occur
a) Before 6 months [ ]
b) 6 months – 1 year [ ]
c) After 1 year [ ]

2) The child will have complete set of 20 milk teeth by

a) 2-3 years of age [ ]
b) 3-4 years of age [ ]
c) 4-5 years of age [ ]

3) The first permanent teeth erupt at

a) 4 years of age [ ]
b) 5 years of age [ ]
c) 6 years of age [ ]
4) For a healthy growth of teeth it is essential to have
a) Balanced diet [ ]
b) Protein rich diet [ ]

c) Calcium rich diet [ ]

111
5) Tooth decay can affect
a) Only adult [ ]
b) Only children [ ]
c) Both [ ]

EARLY CHILDHOOD CARIES

6) Early childhood caries is also known as

a) Baby bottle caries [ ]
b) Nursing bottle caries [ ]
c) Both [ ]

7) Early childhood caries is common in children aged

a) 0-5 years [ ]
b) 5-10 years [ ]
c) 10-15 years [ ]

8) Early childhood caries is common in children belong to

a) High socio-economic status [ ]
b) Low socio-economic status [ ]
c) Both [ ]
9) The most commonly affected teeth by early childhood caries are
a) Upper front four teeth [ ]
b) Lower front four teeth [ ]
c) Molars [ ]
112
 CAUSES OF EARLY CHILDHOOD CARIES
10) Early childhood caries is caused by
a) Bacteria [ ]
b) Virus [ ]
c) Fungus [ ]

11) Early childhood caries developed by

a) Bacteria and tooth [ ]
b) Bacteria, food and tooth [ ]
c) Food and tooth [ ]

12) Main type of food that can cause early childhood caries are
a) Food rich in fats [ ]
b) Food rich in proteins [ ]
c) Food rich in carbohydrates [ ]

13) Early childhood caries is caused by

a) Intake of plain water [ ]
b) Intake of sweet fluids at night [ ]
c) Consumption of vegetables [ ]

113
 TYPES OF EARLY CHILDHOOD CARIES

14) Type 1 early childhood caries is manifested by

a) Wound involving incisors [ ]
b) Wound involving canine [ ]
c) Wound involving molars [ ]

15) Type 2 early childhood caries is manifested by

a) Wound affecting maxillary incisors with or without molars [ ]

b) Wound affecting premolars with or without molars [ ]

c) Wound affecting third molars [ ]

16) Type 3 early childhood caries is manifested by

a) Wound affecting premolar [ ]
b) Wound affecting almost all teeth [ ]
c) Wound affecting incisors [ ]

SIGNS AND SYMPYOMS

17) The early sign of early childhood caries is

a) Reddish discoloration of gums [ ]
b) Whitish discoloration of gums [ ]
c) Dull white band on tooth surface [ ]

114
18) Clinical sign for early childhood caries are
a) Pink, soft and moist tissue and gums [ ]
b) Teeth that are brownish, black stamps [ ]
c) Grooved surfaces on front teeth [ ]

19) The symptoms of early childhood caries is

a) Tooth itching [ ]
b) Tooth numbness [ ]
c) Tooth ache [ ]

20) The late signs of cavity formation is

a) Gum bleeding [ ]
b) Brown or black discoloration of the teeth [ ]
c) Facial swelling [ ]

COMPLICATIONS
21) The early complication of early childhood caries is
a) Respiratory infection [ ]
b) Speech developmental problem [ ]
c) Fever [ ]

22) The late complication of early childhood caries is

a) Displacement of permanent teeth [ ]
b) Recurrent infection [ ]
c) Oral thrush [ ]
115
23) The effect of early childhood caries is
a) Oral cancer [ ]
b) Gum bleeding [ ]
c) Mal nutrition [ ]
TREATMENT

24) Early childhood caries can be treated by

a) Fluroide varnish [ ]
b) Paracetomol [ ]
c) Rantitidine [ ]

25) The severe form of early childhood caries can be treated by

a) Medicated mouth wash [ ]
b) Applying ointment [ ]
c) Tooth extraction [ ]

PREVENTION

26) The mother should check for signs of early childhood caries
a) Once in a month [ ]
b) Once in 6 months [ ]
c) Once in a year [ ]

116
27) The transmission of early childhood caries from mother to child can
be prevented by
a) Paracetomol [ ]
b) Albendazol [ ]
c) Chlorhexidine mouth wash [ ]

28) Oral care should be started soon after

a) Birth of the child [ ]
b) 6 month [ ]
c) 1 year [ ]

29) Incidence of early childhood caries can be reduced by

a) Cleaning the teeth before bed time [ ]
b) Use of bottles for giving feeds [ ]
c) Increasing the duration of breast feeding [ ]

30) Weaning from a baby bottle to sipping cup should be planned when the
child is
a) 6 months of age [ ]
b) 1 year of age [ ]
c) 2 years of age [ ]
31) The teeth should be brushed
a) Once in a day [ ]
b) Twice in a day [ ]
c) Thrice in a day [ ]

117
32) The early childhood caries can be treated by using
a) Herbal tooth paste [ ]
b) Home made tooth paste [ ]
c) Fluroide containing tooth paste [ ]

33) The amount of tooth paste used to brush the child teeth is
a) One brush full [ ]
b) Half brush full [ ]
c) Pea sized amount [ ]

34) The child who are fed frequently at night time should be protected from
early -
childhood caries by
a) Giving sweet fluid after the feed [ ]
b) Giving plain water after the feed [ ]
c) Giving salt water after the feed [ ]

35) The early childhood caries can reduced by adding

a) Sodium bicarbonate to public water [ ]
b) Chlorine to public water [ ]
c) Fluoride to public water [ ]

118
36) The first dental check up to prevent early childhood caries among
children -
should be
a) Between 6 months- 1 year [ ]
b) Between 1-2 year [ ]
c) For tooth extraction [ ]

119
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129
 ANNEXURE – IX

LIST OF VALIDATORS

1. Mrs. Babhani, Professor

Department of Child Health Nursing
The Oxford college of Nursing
Bangalore-68.
2. Mrs.Anu Mathew,Asst.Professor
Department of Child Health Nursing
Syamala Reddy College of Nursing
Bangalore.
3. Mrs.Menagha Gandhi,Asst.Professor
Department of Child Health Nursing
Chinai College of Nursing
Bangalore.
4. Mrs.Dhanalakshmi,Asst.Professor
Department of Child Health Nursing
Rajiv Gandhi College of Nursing
Bangalore.
5. Mrs.Priya, Asso Professor
Department of Child Health Nursing
Spurthy College of nursing
Bangalore.
6. Dr.Krishna Kumar
Pedodontict
Oxford college of nursing
Bangalore.
7. Dr. Jacob John
Pedodontict
KVJ Dental College
Sulliya.
8. Dr. Ruby John
Professor in Biostatistics
T John College of Nursing
Bangalore-83

130
 ANNEXURE –X

LIST OF FORMULAE USED

1. Karl Pearson’s Correlation Coefficient

2. Spearman’s Brown Prophecy formula

2r
r1 = _____________
1+ r

r = Correlation coefficient computed on split halves.

r1= The estimated reliability of the entire test.

3. Chi-square formula

N(ad - bc)2
2
X = ___________________
(a+b) (c+d) (a+c) (b+d)

4. Standard Deviation

∑ (di - d)2
Sd= ___________
n-1

_
∑(di- d)2 = ∑ di2 - (∑di)2
-----------
n

131
 INFORMATION BOOKLET
ON
EARLY CHILDHOOD CARIES

MS. CHINCHU JOSEPH

Dept of Child Health Nursing 
T. John College of Nursing 
Gottigere, Bangalore­83. 

i
INTRODUCTION
Milk teeth, otherwise known as deciduous teeth, reborner teeth, baby
teeth, temporary teeth and primary teeth, are the first set of teeth in the growth
development of humans and many other mammals. They develop during the
embryonic stage of development and erupt at the age of 6 months to 1 year. In
the deciduous dentition there are a total of twenty teeth: five per quadrant and
ten per arch. The child will have complete set of 20 milk teeth by 2-3 years of
age.

The deciduous dentition is made up of central incisors, lateral incisors,

canines, first molars, and secondary molars; there is one in each quadrant,
making a total of four of each tooth. All of these are gradually replaced with a
permanent counterpart except for the first and second molars; they are
replaced by premolars. The replacement of deciduous teeth begins around age
six. At that time, the permanent teeth start to appear in the mouth, resulting in
mixed dentition.
Keeping milk teeth clean and healthy is important. For a healthy
growth of teeth it is essential to have a balanced diet. It helps to establish life
long habits and parents play an important role model in this regard. The
importance of milk teeth are
• Healthy baby teeth are crucial in helping the baby learn how to
speak properly.
• Healthy and nice looking teeth are important in building self-
confidence and self-esteem.

ii
 • Baby teeth serve as spacers which maintain the proper spacing and
alignment of the teeth so that permanent teeth have enough room
to come in.
• Baby teeth are important in proper feeding and nutrition

Poor dental care and certain practices leads to early childhood

caries which cause teeth to fall out and bone to erode, creating major
problems for permanent teeth if and when they do come in.

DEFINITION
Early childhood caries, also known as baby bottle caries, baby bottle tooth
decay, nursing bottle caries and bottle rot, is a syndrome characterized by
severe decay in the teeth of infants or young children.
INCIDENCE
• Its common in children between 0-5 years of age
• Low socioeconomic status
• More in children of uneducated mothers
• Upper front four teeth are commonly affected

ETIOLOGY
• Bacterial infection caused by streptococcus mutans

Streptococcus mutans are present naturally in the mouth. They form a

thin, sticky bio-film on the teeth and gums in the mouth, in every individual.
These bacteria utilize the sugars and carbohydrates and produce acids. These
tend to demineralize the enamel of the tooth. Thus, after repeated frequent
attacks, the tooth decay occurs.

• Frequent intake of fluids containing fermentable

carbohydrates:

Frequent intake of fluids containing fermentable carbohydrates such as

soda, soft drinks, formula, milk, juice, etc increases the risk of tooth decay or

iii
early childhood caries. This is because of the prolonged contact between the
bacteria and sugars on the teeth. This results in acid production.

• Poor feeding practices:

Poor feeding practices or habits such as bottle feeding without any appropriate
preventive measures might lead to caries in susceptible toddlers and infants

• Frequent intake of sugary fluids at night:

During sleep due to less saliva production and high sugary content
in the mouth after the intake of sugary fluids, plaque utilizes the sugar and
generates acids which easily cause enamel decay exposing the softer inner
tissue. Ultimately, this results in caries.

• Mother to child

Mother-to-child transmission occurs through transfer of infected

saliva by kissing the baby on the mouth or, more likely, by moistening the
nipple or pacifier, or by tasting food on the baby's spoon before serving it.
Colonization by maternal organisms largely depends on inoculum size;
mothers with extensive dental caries usually have high levels of mutans
streptococci in their saliva.

• Food rich in carbohydrates

ECC usually affect the primary upper front teeth and are caused by
eating sugary and simple carbohydrate rich foods.

• Inadequate brushing.

If you don't clean child teeth soon after eating and drinking, plaque
forms quickly and the first stages of decay can begin.

iv
TYPES OF EARLY CHILDHOOD CARIES
Type I (mild to moderate) ECC

The existence of isolated carious lesion(s) involving molars and /or incisors.
The cause is usually a combination of cariogenic semi-solid or solid food and
lack of oral hygiene. The number of affected teeth usually increases as the
cariogenic challenge persists. This type of ECC is usually found in children
who are 2 to 5 years old.

Type II (moderate to severe) ECC

Labiolingual carious lesions affecting maxillary incisors, with or without

molar caries depending on the age of the child and stage of the disease, and
unaffected mandibular incisors. The cause is associated with inappropriate use
of a feeding bottle, at will breast feeding or a combination of both, with or
without poor oral hygiene. Poor oral hygiene most probably compounds the
cariogenic challenge. This type of ECC could be found soon after the first
teeth erupt. Unless controlled, it may proceed to become type III ECC.

v
 Type III (severe) ECC

Carious lesions affecting almost all teeth including lower incisors. This
condition is found between the age of 3 to 5 years. The condition is rampant
and generally involves tooth surface/s that are unaffected by caries e.g.
mandibular incisors
CLINICAL MANIFESTATIONS

• Dull white band along the gum line as a result of demineralization

• Yellow, brown or black collar around the neck of the teeth
indicative of progression to cavities
• Teeth that are brownish, black stumps as a result of advanced
cavitieS
• swelling, redness or ulcers in the mouth
• Toothache

vi
DIAGNOSTIC EVALUATION

• Dental examination
• Dental x ray

MANAGEMENT

• MI Paste (GC America), a paste consisting of casein phosphopeptide (a milk-derived

protein vehicle),
• amorphous calcium phosphate
• Fluroide varnish

Fluoride varnish is a topical treatment containing 5% sodium fluoride that is applied to

the surfaces of teeth. FVA protects the teeth for several months. It prevents new cavities
from forming and hinders developing cavities.

• Tooth extraction

PREVENTION
Although dental caries is the most prevalent chronic disease of children in the nation, it is also
the most preventable. Providers have opportunities to educate families and help prevent dental
caries. Education and preventive dental care should start during pregnancy and continue
throughout a child’s life.

• Prevention begins with good maternal dental practices during pregnancy to reduce
vertical colonization of cariogenic Streptococcus mutans from mother to infant
• Mother should instruct the use of a xylitol-based chewing gum, as xylitol has been
shown to inhibit harmful bacteria growth.
• promote good oral hygiene in mothers
• Soon after the baby is born, oral care should begin.
• Gums should be cleaned after each feeding. Wipe gums with a clean,
damp cloth or gauze pad
• You can begin brushing your child’s teeth as soon as they appear

• Brush after eating or drinking.

vii
 Brush the child teeth at least twice a day and ideally after every meal, using fluoride-
containing toothpaste. To clean between the teeth, floss or use an interdental cleaner. If can't
brush after eating, at least try to rinse the mouth with water. No more than a pea-sized amount
of fluoridated toothpaste should be used for children under six years of age

• Eat tooth-healthy food

Some foods and beverages are better for teeth than others. Avoid foods that get stuck
in grooves and pits of teeth for long periods, such as chips, candy or cookies. Instead, eat
food that protects the teeth, such as cheese, which some research shows may help prevent
cavities, as well as fresh fruits and vegetables, which increase saliva flow, and unsweetened
coffee, tea and sugar-free gum, which help wash away food particles
• Encourage early weaning from the bottle to a sipping cup at the age of
1
• Reducing consumption of fruit juice, milk at bedtime, soda pop, sports
drinks and other sugary liquids
• Increasing daytime milk consumption
• If the child is not seems tom fall asleep with bottle then give bottle
with plain water
• Provide the food in small cups after making in to small pieces
• Encourage parents to bring their children in for their first dental visits
as soon as the first tooth erupts, which usually occurs between the ages
of 6 months and a year
• Comprehensive dental care by age 1
• Fluoride supplementation when systemic fluoride exposure is
suboptimal; up to at least 16 years of age.
• Oral health screening and risk assessment
• Parent/caregiver and patient education

viii
ANTICIPATORY GUIDANCE FOR CARE GIVERS
6 to 12 months • Encourage good oral health of parent
or caregiver
• Encourage use of soft cloth to clean
mouth after feeding
• Encourage tooth cleaning after first
tooth eruption
• Review nutrition and eating habits
• Encourage napping and sleeping
without a bottle or sippy cup
• Encourage use of cup for drinking
• Discuss mouth and tooth injury
prevention
• Provide counseling for nonnutritive
oral habits (e.g. digit, pacifiers)
• Help evaluate fluoride needs
• Address speech/language development
• Refer to dentist upon first tooth
eruption and no later than 12 months of
age

12 to 24 months • Review applicable items from 6 to 12

months
• Encourage daily brushing and flossing
• Assess appropriateness of feeding
practices
• Review fluoride status, including
childcare arrangements that may affect
systemic fluoride intake

ix
 2 to 6 years • Review applicable items from previous
visits
• Encourage assisting child with tooth
brushing until child is capable of tying
his/her own shoes
• Encourage assisting child with flossing
until child is capable of writing name
in cursive
• Reinforce brushing with pea-sized
amount of fluoride tooth paste
• Reinforce injury prevention
• Help evaluate change in fluoride needs

CONCLUSION
Early childhood caries is the most prevalent chronic disease of early childhood and is a
major cause of school absenteeism, according to the US Department of Health and Human
Services.1 As a matter of fact, studies show that as many as 38% of children 1 to 2 years of age
and 56% of children 2 to 3 years of age develop ECC.2 Within certain economically
disadvantaged groups, about 80% of infants and preschoolers have been found to have
ECC.ECC an be preventable if we take measures at early stage itself.

x
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