|Year : 2020 | Volume
| Issue : 3 | Page : 1608-1613
Assessment of Saudi parent's awareness towards space maintainers at Alkharj city: A cross-sectional study
Hamad Sulaiman Alduraihim1, Sultan R Alsulami1, Saud Z Alotaibi1, Mohamed Abd-Ellatif El-Patal2, Inderjit M Gowdar3, Praveen N Chandrappa4
1 General Dentist, Riyadh, KSA
2 Department of Pedodontics and Oral Health, College of Dentistry, Al Azhar University Cairo, Egypt; Department of Preventive Dental Sciences, Prince Sattam Bin Abdul Aziz University, Alkharj, KSA
3 Department of Preventive Dental Sciences, Prince Sattam Bin Abdul Aziz University, Alkharj, KSA
4 Department of Periodontics, College of Dental Sciences, Davangere, Karnataka, India
|Date of Submission||13-Dec-2019|
|Date of Decision||05-Feb-2020|
|Date of Acceptance||12-Feb-2020|
|Date of Web Publication||26-Mar-2020|
Dr. Hamad Sulaiman Alduraihim
General Dentist, Riyadh
Source of Support: None, Conflict of Interest: None
Background: Premature extraction or loss of a tooth due in primary dentition may lead to malocclusion in permanent dentition. Space maintainers are very important to children in mixed and primary dentition for preventing problems of malocclusion. The utilization of space maintainers depends on parental knowledge and awareness about space maintainers. Aims and Objectives: To assess the of Saudi parent's awareness toward space maintainers in Alkharj city. Material and Methods: A descriptive cross-sectional questionnaire-based study was planned among Saudi parents who visited the College of Dentistry, Prince Sattam Bin Abdulaziz University. Questions related to space maintainers awareness, use, source of information, and utilization of space maintainers were asked. Results: Around 312 (82.1%) parents were not aware of space maintainers and did not receive any information about the same. About 166 (43.7%) parents did not have any personal experience of a child's missing deciduous teeth. Only 115 (30.26%) respondents received some information about space maintainers. The majority of parents 298 (78.4%) were unaware whether space maintainers aid in the eruption of permanent teeth. Similarly, 73.7% did not know when to use space maintainers. Conclusions: Knowledge of space maintainers among Saudi parents is very less. Dental professionals hence need to create awareness of interceptive orthodontics rather than curative approaches, to achieve better oral health outcomes.
Keywords: Interceptive orthodontics, malocclusion, Saudi parents, space maintainers
|How to cite this article:|
Alduraihim HS, Alsulami SR, Alotaibi SZ, El-Patal MA, Gowdar IM, Chandrappa PN. Assessment of Saudi parent's awareness towards space maintainers at Alkharj city: A cross-sectional study. J Family Med Prim Care 2020;9:1608-13
|How to cite this URL:|
Alduraihim HS, Alsulami SR, Alotaibi SZ, El-Patal MA, Gowdar IM, Chandrappa PN. Assessment of Saudi parent's awareness towards space maintainers at Alkharj city: A cross-sectional study. J Family Med Prim Care [serial online] 2020 [cited 2020 Jul 14];9:1608-13. Available from: http://www.jfmpc.com/text.asp?2020/9/3/1608/281186
| Background|| |
The primary dentition plays a very important role in the child's growth and development, not only in terms of speech, chewing, appearance, and the prevention of bad habits but also in the guidance and eruption of permanent teeth. Exfoliation of primary teeth and eruption of permanent teeth is a normal physiological process. Primary teeth serve as best space maintainers for permanent dentition. However, if premature extraction or loss of tooth is unavoidable due to extensive caries or other reasons, it may lead to mesial migration of teeth resulting in loss of the arch length which may manifest as malocclusion in permanent dentition in the form of crowding, impaction of permanent teeth, supra eruption of opposing teeth, and so on.
The number of children affected by malocclusion due to premature loss of primary teeth has increased significantly and is considered one of the most common dental problems together with dental caries, gingival disease, and dental fluorosis.,
Treatment of malocclusion comprises corrective as well as interceptive measures. Interceptive measures are done in the primary or early mixed dentition when the first signs of occlusal maldevelopment are recognized. A space maintainer is the most commonly used tools of interceptive measures. Space maintainers are very important to children in mixed and primary dentition for preventing problems of malocclusion.
Early detection and appropriate referral of cases requiring preventive and interceptive orthodontic treatments are necessary. It will eliminate or reduce the severity of a developing malocclusion, the complexity of treatment, and overall treatment time and cost. It will also improve the self-esteem of the subject and parental satisfaction., Among the preventive measures “space maintenance” using certain appliances called “space maintainers”, which are fixed or removable appliances are used to preserve arch length following the premature loss or elective extraction of the primary tooth. Space maintenance is a critical process in developing dentition. The loss of arch length may lead to multiple problems such as crowding, ectopic eruption, dental impaction, crossbite formation, and dental centerline discrepancies. Thus, the use of space maintainers often affects the future dental needs of a complex orthodontic treatment as it may potentially obviate the need for later extractions.
The utilization of interceptive orthodontics is dependent on the knowledge of parents about space maintainers. Parents are usually educated in a nursing home or hospital during their routine visit to the physician for their child's checkup where they will get information about vaccination, diet and nutrition, and prevention of injuries and accidents, whereas in case of oral health the attitude is entirely different which make them visit the dentist at a later stage of caries progression or malocclusion, and so on.
Many a times, people responsible for the oral care of children feel or believe that since primary teeth will any way shed, it is not worth their while to spend time/money on providing good oral health to children. Even in developed nations, most parents still take their children to the dentist for curative and not for preventive treatments.
The American Academy of Pediatric Dentistry (AAPD) emphasizes the importance of prevention, diagnosis, and treatment necessary to restore and maintain the oral health of infants, children, and adolescents. Comprehensive healthcare cannot be achieved unless dental care is a strong priority in all health service programs.
With consideration to all the aspects, a study was designed to evaluate the level of awareness of Saudi parents toward space maintainers in Alkharj city.
| Aim of The Study|| |
To evaluate the level of Saudi parent's awareness toward space maintainers in Alkharj city.
Objectives of the study
To evaluate the level of awareness of Saudi parents toward space maintainers in Alkharj city.
To enhance the awareness of using space maintainers for Saudi children in Alkharj city.
Question of the research
How is the level of awareness of Saudi parents towards space maintainers in Alkharj city?
The level of awareness of Saudi parents towards space maintainers is low.
No difference in the level of awareness of Saudi parents towards space maintainers.
| Material and Methods|| |
Descriptive cross-sectional study.
Saudi parents who live in Alkharj city.
Ethical clearance was obtained by the institution review board.
A descriptive cross-sectional questionnaire-based study was planned among Saudi parents who visited the College of Dentistry, Prince Sattam Bin Abdulaziz University.
The sample size was calculated by using the formula
Where, Z = Standard score corresponding to a given confidence level. Example, at 95% confidence level (CI) or 5% level of significance (a = 0.05), Z = 1.96.
P = Prevalence of awareness about space maintainers among parents 40% = 0.40
q = (1 – p) 100-40 = 60% = 0.6
d = Precision limit or proportion of sampling error which is usually a 5% confidence limit. = 0.05
After substituting the values required sample size was found to be 374.7 which was rounded to 380.
A total of 380 parents (both gender) were randomly selected for the study during the period from June 2018 to December 2018.
The sampling technique considered as systematic sampling technique with every 5th parent included for the study. Those parents who will give written consent were included and the parents not willing to participate were excluded from the study.
Parents were requested to fill out an objective type of anonymous questionnaire without providing any oral health information. Questions related to personal information (age and educational status), previous loss of primary tooth and space maintainers, awareness toward the uses and maintenance of space maintainers, source of information and utilization of space maintainers were asked. Educational status was considered as up to secondary schooling, diploma graduate, degree graduate, and master's degree graduate.
Validation of a questionnaire
Initially, questions were prepared in the English language and then translated to the Arabic language again back-translated to English to validate the questionnaire.
Parents were contacted in the available free time in the outpatient department and explained the nature and purpose of the study. The questionnaire was distributed without giving any information. Sufficient time was given to fill the questionnaire and a filled questionnaire was collected back on the same day.
Descriptive statistics were computed and data were statistically analyzed using the Chi-square test. All analyses were made with a 95% CI and a P value < 0.05 considered as statistically significant.
| Results|| |
[Table 1] shows mean age of study subjects according to gender there were 231 males with a mean age of 38.18 ± 10.02 and 149 females with a mean age of 38.76 ± 9.01 the mean age was statistically nonsignificant according to gender.
[Table 2] shows the distribution of study subjects based on educational status. The majority of parents had a graduation level of education (32.7%); education according to gender was statistically nonsignificant.
[Table 3] shows the distribution of study subjects based on working status. The majority of parents were working (60.0%); working status according to gender was statistically nonsignificant.
[Table 4] shows the awareness of parents about space maintainers. Around 312 (82.1%) parents were not aware of space maintainers and did not receive any information about the same. About 166 (43.7%) parents did not have any personal experience of a child's missing deciduous teeth. Only 115 (30.26%) of respondents have received some information about space maintainers. The majority of parents 298 (78.4%) did not know whether space maintainers aid in the eruption of permanent teeth. Similarly, 73.7% did not know when to use space maintainers.
[Table 5] shows that only 26 (6.8%) parents correctly answered the question related to the type of space maintainers. Nearly 299 (78.7%) parents were not aware of the purpose of space maintainers. Moreover, 270 (71.1%) parents told they did not know what actions are to be taken in case space maintainers are broken.
[Table 6] shows 360 (94.7%) parents never used any space maintainers. Around 349 (91.8%) respondents never interacted with medical or dental experts regarding deciduous tooth loss and space maintenance. About 330 (86.8%) parents were unaware of the eruption sequence of permanent teeth. About 303 (79.7%) parents did not know about treatment options available if deciduous teeth were lost. Again the responses were statistically nonsignificant according to gender with a P value >0.05.
| Discussion|| |
Parents have a unique position to address dental disease in children. The result of the present study suggests that more than 50% of the parents were having a personal experience of child's missing tooth. This study is first of its kind to assess parent's knowledge towards space maintainers. There is very limited literature assessing parents' awareness toward the management of early loss of primary teeth and the use of space maintainers. The present study suggests the overall awareness about space maintainers among parents is very low (17.9%) this is in accordance with the study by Amal I Linjawi et al. and Ahad Fahad Alshammari et al. wherein the authors have observed a very limited knowledge among parents of Saudi Arabia.
Borrie et al. in Scotland reported that the greatest obstacle in supplying interceptive orthodontic care was the specialists' absence of positive self-image in their selected treatment strategy.
The use and choice of preventive measures by dental practitioners can differ between countries and among individual dentists, with the ultimate common goal of improving oral health. The differences are perhaps, due to oral healthcare legislation, acceptance, and appreciation of preventive approaches by patients and by the dental community, availability of preventive agents, and workload of restorative care, as well as dentists' location of practice, years in practice, age, and income.,
A gap seems, however, to exist between what is known about preventing oral diseases and what is provided in private practice, public clinics, dental schools, and community-based programs in many countries.
Public knowledge of oral diseases and their prevention is assessed in several studies, with a gap between the general public and current scientific knowledge of the prevention of dental diseases., In general, people are aware of the importance of oral hygiene for the prevention of oral diseases. The results are similar in our study.
A lower educational level is consistently associated with a low level of knowledge  This is also reflected in the present study.
In a study conducted to know the caries-preventive knowledge and reported behavior among Japanese parents resident in London showed their knowledge and behavior to be generally lower than those reported by English parents. This difference was also seen among British expatriates in Tokyo compared to the Japanese, the former knowing more about dental caries. The result in the present study also reflects in the same way wherein less than 20% of parents were aware about space maintainers.
This manuscript is of importance to primary care physicians because they are the first healthcare providers for young children. In general, physicians with adequate knowledge about early loss of deciduous teeth and their consequences can guide parents about space maintainers.
| Conclusions|| |
Knowledge of space maintainers among Saudi parents who live in Alkharj city is very less. Moreover, less than 20% of parents know about space maintainers. Hence, dental professionals need to create awareness of interceptive orthodontics rather than curative approaches, to achieve better oral health outcomes. Furthermore, this would potentially be reflected as an improvement in the oral health of the general public especially concerning the prevention of malocclusion.
To all the study participants.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Pawar BA. Maintenance of space by innovative three -dimensional-printed band and loop space maintainer. J Indian Soc Pedod Prev Dent 2019;37:205-8.
] [Full text]
Alshukairi H. Delayed tooth eruption and its pathogenesis in paediatric patient: A review. J Dent Health Oral Disord Ther 2019;10:209-12.
Setia V, Pandit IK, Srivastava N, Gugnani N, Sekhon HK. Space maintainers in dentistry: Past to present. J Clin Diagn Res 2013;7:2402-5.
Asiry MA. Occlusal status among 12-16 year-old school children in Riyadh, Saudi Arabia. J Int Oral Health 2015;7:20-3.
Dhar V, Jain A, Van Dyke TE, Kohli A. Prevalence of gingival diseases, malocclusion and fluorosis in school going children of rural areas in Udaipur district. J Indian Soc Pedod Prev Dent 2007;25:103-5.
] [Full text]
Wong ML, Che Fatimah Awang, Ng LK, Norlian D, Rashidah Dato Burhanudin, Gere MJ. Role of interceptive orthodontics in early mixed dentition. Singapore Dent J 2004;26:10-4.
Keski-Nisula K, Hernesniemi R, Heiskanen M, Keski-Nisula L, Varrela J. Orthodontic intervention in the early mixed dentition: A prospective, controlled study on the effects of the eruption guidance appliance. Am J Orthod Dentofacial Orthop 2008;133:254-60.
Green J. Mind the gap: Overview of space maintaining appliances. Dent Nurs 2015;11:24-7.
Shetty RM, Dixit UB. Paediatricians' views on dental and oral health and treatment needs in children. Oral Health Prev Dent 2011;9:315-22.
Linjawi AI, Alajlan SA, Bahammam HA, Alabbadi AM, Bahammam MA. Space maintainers: Knowledge and awareness among Saudi adult population. J Int Oral Health 2016;8:733-8. [Full text]
Alshammari AF, Al Naafa MM, Alshammari AF, Alhumaid N, Alquwayz TS, Alghrairy LA, et al
. Assessment of parental knowledge and awareness about the space maintainer in KSA. Int J Healthcare Sci 2017;5:359-65.
Borrie F, Bonetti D, Bearn D. What influences the implementation of interceptive orthodontics in primary care? Br Dent J 2014;216:687-91.
Helminen SE, Vehkalahti M, Lammi R, Ketomäki TM, Murtomaa H. Dentists' decisions as to mode of preventive treatment in adolescents and young adults in Finland. Community Dent Health 1999;16:250-5.
Helminen SK, Vehkalahti MM. Does caries prevention correspond to caries status and orthodontic care in 0- to 18-year-olds in the free public dental service? Acta Odontol Scand 2003;61:29-33.
Roberts-Thomson KF, Spencer AJ. Public knowledge of the prevention of dental decay and gum diseases. Aust Dent J 1999;44:253-8.
Mikami Y, Croucher R, Hector M. Knowledge and reported behaviour concerning the prevention of caries in children: A questionnaire survey of Japanese parents resident in London, UK. Int Dent J 1999;49:115-21.
Mikami Y, Wakai S, Croucher R, Hector MP, Nakamura Y. Children's dental health: British expatriate residents in Tokyo, Japan. Int Dent J 2003;53:280-4.
Petersen PE, Esheng Z. Dental caries and oral health behaviour situation of children, mothers and schoolteachers in Wuhan, People's Republic of China. Int Dent J 1998;48:210-6.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]