1

Introduction

Dental health is a crucial aspect of overall health [ ]. ECC is defined as “the presence of one or more decayed (non-cavitated or cavitated lesions), missing teeth (due to caries), or filled tooth surfaces in any primary tooth in a child 72 of months age or younger. In children younger than 3 years of age, any sign of smooth-surface caries is indicative of severe early childhood caries (S-ECC). From ages 3 through 5, one or more cavitated, missing teeth (due to caries), or filled smooth surfaces in primary maxillary anterior teeth, or decayed, missing, or filled score of ≥4 (age 3), ≥5 (age 4), or ≥6 (age 5) surfaces constitutes S-ECC. Early childhood caries (ECC) is a dental health issue that occurs during primary dentition due to an imbalance between protective and risk factors [ ]. There are significant differences in the prevalence of ECC reported in children in the primary dentition period. In international studies, it is observed that the prevalence of ECC is approximately 3–6% in developed countries, whereas this rate may increase up to 90% in developing countries [ ]. Even within the same country, prevalence values may be different due to various risk factors. It is observed that ECC rates are higher in children in populations with low socioeconomic status [ ]. Factors such as race, culture, socioeconomic status, lifestyle, dietary habits and oral hygiene habits may affect the prevalence of ECC [ ]. ECC in primary teeth raises the risk of future caries in permanent teeth. Primary teeth serve several functions in children, including facilitating nutrition, aiding speech, acting as space maintainers until permanent teeth emerge, and guiding the eruption of permanent teeth [ ]. The dental health of children during the primary dentition period is significantly influenced by their parents’ knowledge and attitudes towards dentistry, awareness of nutrition, oral hygiene habits, dental visits, and level of knowledge about primary teeth [ , ].

Studies have generally looked at the level of knowledge of parents about children’s oral health and dental care [ ]. Evaluating parents’ knowledge only about their children’s dental care or level of health may lead to ignoring the underlying problem in this issue. Parents’ knowledge about the importance of their children’s primary teeth will change their approach to situations. Thus, it is important to assess their level of knowledge about the importance of primary teeth. Therefore, this study brings a new perspective to the subject. The aim of this study was to examine parents’ knowledge and perspectives on the importance of primary teeth, as well as to evaluate the relationship between ECC and parental knowledge, perspectives, and factors affecting their knowledge. The null hypothesis is that there is no relationship between parents’ knowledge and ECC.

2

Methods

The study retrospectively examined children aged 0–6 years who attended the Zonguldak Bulent Ecevit University Faculty of Dentistry, Department of Pedodontics Clinic and underwent routine dental examinations. The study was conducted in Turkey. The questionnaire was administered in Turkish, the language spoken and written by the participants. The study was conducted after obtaining approval from the Zonguldak Bulent Ecevit University Clinical Research Ethics Committee (decision dated April 21, 2021, numbered 2021/08-05). In the study, the examination forms of 2000 patients who applied to the Zonguldak Bulent Ecevit University Faculty of Dentistry, Department of Pedodontics Clinic and were examined were evaluated. A study questionnaire was presented to the parents of the patients eligible for the study. of these children to investigate the relationship between parents’ knowledge levels and perspectives on the importance of primary teeth and early childhood caries. Oral health information of the patients is recorded on the examination forms as a result of the examination of the pediatric dentists. Examinations are performed in the dental unit under halogen reflector illumination with the help of a dental mirror and probe. The study only included parents of patients who did not have any systemic disease, were not on regular medication, and did not have any dental anomalies. The child’s records were reviewed and the date of birth, sex, medical history, DMFT scores, and dental treatment plan were recorded.

According to Chhabra and Chhabra’s [ ] study, the sample size consisted of 389 participants with a 95% confidence level (1-α) and 95% test power (1-β). Out of the 2000 examination forms, 740 parents of patients who met at least one of the exclusion criteria were excluded from the study. Of the remaining 1260 parents, 992 were contacted, with 492 declining to participate. Ultimately, the study involved a total of 500 parents. The study protocol was explained to the parents of the participants, and verbal and informed consent were obtained and documented through signature. If there were any questions that were not understood during the completion of the questionnaires, the necessary explanations were made by the researcher at a certain distance.

The first part of the study collected demographic data, including the child’s date of birth, the sex of both the parent and child, the family’s address and place of residence, the number of children in the family, the mother’s age at the child’s birth, the education level and occupation of the parents, the total monthly family income, and whether the parent believes they have sufficient information about primary teeth and their sources of information. The second part of the questionnaire was prepared by evaluating similar studies in the literature [ ]. The second section of the questionnaire consisted of 27 statements assessing parents’ knowledge and perspectives on the importance of primary teeth. Parents were asked to indicate the accuracy of each statement as either ‘Yes’, ‘No’, or ‘I don’t know’. Each correct answer was awarded one point, while ‘I don’t know’ was considered an incorrect answer and received no points.

The data were analysed using IBM SPSS V23. Compliance with normal distribution was assessed using the Kolmogorov-Smirnov and Shapiro-Wilk tests. The Mann-Whitney U test was used to compare non-normally distributed data between binary groups. The Kruskall-Wallis H test was used to compare non-normally distributed data between groups of three or more, and multiple comparisons were analysed using Dunn’s test. Spearman’s rho correlation coefficient was used to analyse the relationship between non-normally distributed quantitative data. The results were presented as median, minimum-maximum, and mean ± standard deviation for quantitative data, and frequency and percentage for categorical data. The significance level was set at p < 0.05.

3

Results

The study included 309 mothers and 191 fathers as participants. The gender distribution of the children was 274 girls and 226 boys. The average age of the children was 4.52 years. Table 1 presents the sociodemographic data obtained from the first part of the questionnaire.

The results of the second part of the questionnaire indicate that 43.2% of parents answered ‘Yes’ and 56.8% answered ‘No’ to the question ‘Do you think you have enough information about primary teeth?’. When asked about their sources of information on primary teeth, 28.6% of parents answered ‘Internet’, 27.8% answered ‘No information’, 26.8% answered ‘Pediatric dentist’, 11% answered ‘Dentist’, 4.4% answered ‘Television’, and 1.4% answered ‘Other physicians’. To assess parents’ understanding of the significance of primary teeth, we presented 27 statements to them and recorded their responses in Table 2 .

Table 2

Parents’ questionnaire responses.

	Frequency (n)	Percentage (%)
1.Primary teeth are not important because they will fall out after a certain amount of time.
Yes	153	30.6
No	279	55.8
I don’t know	68	13.6
2. Children have 20 primary teeth.
Yes	190	38.0
No	31	6.2
I don’t know	279	55.8
3. The mandibular incisors are the first teeth to erupt into the oral cavity.
Yes	341	68.2
No	18	3.6
I don’t know	141	28.2
4. Babies are usually expected to grow their first baby tooth at 6 months.
Yes	437	87.4
No	32	6.4
I don’t know	31	6.2
5. Permanent first molars erupt around the age of 6 years.
Yes	190	38.0
No	66	13.2
I don’t know	244	48.8
6. The eruption of primary teeth is completed around 2 – 3 years of age.
Yes	331	66.2
No	55	11.0
I don’t know	114	22.8
7. Itching of the gums and increased saliva are seen in infants during teething.
Yes	470	94.0
No	7	1.4
I don’t know	23	4.6
8. Babies cannot be born with teeth.
Yes	381	76.2
No	84	16.8
I don’t know	35	7.0
9. Problems with primary teeth do not affect permanent teeth.
Yes	209	41.8
No	178	35.6
I don’t know	113	22.6
10. Primary teeth do not need to be treated because they will fall out anyway.
Yes	64	12.8
No	385	77.0
I don’t know	51	10.2
11. There is no need to make a space maintainer in the early loss of primary teeth for any reason.
https://cevirsozluk.com/
Yes	122	24.4
No	200	40.0
I don’t know	178	35.6
12. Bacteria that cause caries come from parents and can be transmitted to children.
Yes	152	30.4
No	228	45.6
I don’t know	120	24.0
13. Frequent exposure to sweet and sticky foods negatively affects dental health.
Yes	477	95.4
No	14	2.8
I don’t know	9	1.8
14. Sugary foods should be consumed between meals to prevent dental caries.
Yes	273	54.6
No	140	28.0
I don’t know	87	17.4
15. Putting babies to sleep at night with a bottle full of sweetened milk and long-term bottle use does not affect dental health.
Yes	59	11.8
No	382	76.4
I don’t know	59	11.8
16. Applying sugary foods such as honey and molasses to the pacifier does not cause caries formation.
Yes	64	12.8
No	396	79.2
I don’t know	40	8.0
17. Primary teeth do not need to be brushed.	0
Yes	16	3.2
No	472	94.4
I don’t know	12	2.4
18. Tooth brushing in children should be started with the eruption of the first primary tooth.
Yes	197	39.4
No	245	49.0
I don’t know	58	11.6
19. Children’s teeth should be brushed twice a day.
Yes	473	94.6
No	17	3.4
I don’t know	10	2.0
20. The gums of babies should be wiped before the eruption of their teeth to prevent dental caries.
Yes	125	25.0
No	98	19.6
I don’t know	277	55.4
21. Fluoride does not prevent tooth decay and for this reason, fluoride application is unnecessary.
Yes	94	18.8
No	161	32.2
I don’t know	245	49.0
22. The role of parents in guiding their child’s oral hygiene is important.
Yes	474	94.8
No	3	0.6
I don’t know	23	4.6
23. Parents should help children up to 8 years old to brush teeth.
Yes	375	75.0
No	106	21.2
I don’t know	19	3.8
24. A child’s first dentist visit should be from when the first primary tooth erupts, between 6 – 12 months.
Yes	216	43.2
No	94	18.8
I don’t know	190	38.0
25. There is no need to visit the dentist regularly. Children should be taken to the dentist when their teeth hurt.
Yes	84	16.8
No	403	80.6
I don’t know	13	2.6
26. Bottle use in children should be discontinued between 12 – 18 months and children should be taught to drink water from a glass from age 1 year.
Yes	332	66.4
No	32	6.4
I don’t know	136	27.2
27. Primary teeth guide the eruption of permanent teeth.
Yes	341	68.2
No	28	5.6
I don’t know	131	26.2

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