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WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City

DENTAL CARE: KNOWLEDGE AND PRACTICES OF PRIMARY CAREGIVERS OF PRESCHOOLERS IN A SELECTED MUNICIPALITY Francis James S. Cordova Jeahly M. Maquilang Kreazel A. Nueza Jailene P. Pelaez Gieda G. Tagolimot Janine Marie L. Teodosio

Chapter 1 Introduction to the Study Chapter One consists of five parts, namely: (1) Background and Theoretical Framework of the Study, (2) Statement of the Problem and the Hypotheses, (3) Significance of the Study, (4) Definition of Terms, and (5) Delimitation of the Study. Background and Theoretical Framework of the Study Oral hygiene includes all the processes for keeping the mouth clean and healthy. It is fundamental to overall health, well-being, and quality of life. A healthy mouth enables people to eat, speak and socialize without pain,

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discomfort or embarrassment. Good oral hygiene is necessary for the prevention of dental caries, periodontal diseases, bad breath, and other dental problems. Dental caries (tooth decay) and periodontal diseases (gum diseases) are the two most common oral health diseases affecting the Filipinos. According to the 1998 National Monitoring and Epidemiological Dental Survey (NMEDS), about nine out of 10 (92.4%) Filipinos have tooth decay and about four out of five (78%) have gum diseases. Tooth decay ranks first and outranges the combined rates of other diseases in the country. The 2006 Nationwide Oral Health Survey (NOHS) reveals that 97.1 percent of six-year old Filipino school children have poor dental habits. About four out of five (84.7%) show symptoms of dental infection with a mean number of decayed, missed or filled permanent teeth (DMFT) of 0.7 and a mean DMFT of 8.4 for the primary dentition. A majority (78.0%) of 12-year-old children suffer from dental caries and almost half (49.7%) of the same age group manifested symptoms of dentinogenic infections. The NOHS, which was conducted from November 2005 to February 2006, used a random sample from 2,030 six-year old students and 2,022

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twelve-year old students from the 17 regions in the Philippines. Further, the NOHS 2006 also indicated that on the average, one dentist is responsible for the oral health of 22,300 students. Out of the dental workforce consisting of 8,500 to 17,500 dentists, only 1,750 dentists are employed in the public health care system. It is estimated that majority (77.0%) of the Philippine population has never, in their life, been to a dentist despite a huge treatment need. These statistics indicate that despite the fact that measures to control oral diseases are available, there has not been an improvement in oral health among children for the last decades, especially those living in the urban areas. This implies that indeed dental and oral diseases create a silent epidemic, placing a heavy burden on Filipino school children. The school is the best place to institutionalize healthy oral habits. Day care centers provide the ideal supportive environment for promoting oral health. In order to be taught lifelong oral health behaviors, beliefs and attitudes, the day care years are very influential stages

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in a childs life where said learning is established (Live Learn Laugh Batang May K, 2010).

It is in this light that the researchers conducted this study since oral health diseases are still considered in the Philippines as a nationwide health epidemic. This quantitative study is anchored on the Nola J. Penders Health Promotion Model. The model predicts overall health-promoting lifestyles and specific behaviors. According to Pender, There are complex bio-psychosocial processes that motivate individuals to engage in behaviors directed toward the enhancement of health. In one of the theorys assertions, Persons are more likely to commit to and engage in health-promoting behaviors when significant others model the behaviors, expect the behavior to occur, and provide assistance and support to enable the behavior (Tomey et al., 2002). In this study, the researchers assumed that the knowledge and practices of the primary caregivers influenced the dental practices of the child. The behaviors practiced by the caregiver motivate the child to engage in behaviors directed toward the enhancement of health. Parents are the light of the home. The oral health of their children is important, so there is a need to make

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sure that their parental obligations of ensuring that their children receive the best oral health care is met. Many factors can affect the childs risk of developing oral dental problems, such as their feeding habits, exposure to fluoride, oral hygiene practices, age, environment, socioeconomic status and others. With correct knowledge and practice, come the prevention and treatment strategies that can be implemented to improve the childs over-all oral health (Lopez, 2011). Pender posited that health-seeking behavior has several modifying factors including demographic characteristics, biological characteristics, interpersonal influences, situational factors and behavioral factors. Health-promoting behavior is brought about by a plan of action that is affected by behavior-specific cognitions (e.g. perceived benefits of action, perceived barriers to action, interpersonal influences and situational influences). In turn, this originated from a prior related behavior and biological, psychological, and socio-cultural personal factor. This study determined the factors that are associated with the dental care-related knowledge and practices of

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


primary caregivers of preschoolers in a selected municipality. Figure 1 shows the interplay of the variables of the study.

Antecedent Variables Type of Residence Age Sex Educational Attainment Monthly Income Civil Status

Independent Variable

Dependent Variable

Knowledge on Dental Care

Desirability of Dental Care Practices

Figure 1. Knowledge and desirability of dental care practices among primary caregivers of preschoolers in a

selected municipality as influenced by personal factors.

Statement of the Problem and the Hypothesis This study aimed to investigate the relationship between the dental care-related knowledge and practices of primary caregivers of preschoolers in Leganes, Iloilo. Specifically, this study aimed to:

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1. describe the profile of primary caregivers of preschoolers in Leganes, Iloilo; 2. identify the level of knowledge on dental care among primary caregivers of preschoolers when taken as an entire group and when classified according to (a) type of

residence, (b) age, (c) sex, (d) educational attainment, (e) monthly income, and (f) civil status; 3. determine the desirability of the dental care practices among primary caregivers of preschoolers when taken as an entire group and when classified according to

(a) type of residence, (b) age, (c) sex, (d) educational attainment, (e) monthly income, and (f) civil status; 4. identify the dental care practices of primary caregivers of preschoolers; 5. ascertain the significance of the differences in the level of knowledge on dental care among primary caregivers of preschoolers when classified according to (a) type of residence, (b) age, (c) sex, (d) educational attainment, (e) monthly income, and (f) civil status; 6. determine the significance of the differences in the desirability of dental care practices among primary caregivers of preschoolers when classified according to

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


(a) type of residence, (b) age, (c) sex, (d) educational attainment, (e) monthly income, and (f) civil status; and 7. determine the significance of the relationship between the primary caregivers level of knowledge and desirability of dental care practices. Based on the preceding problems, the following hypotheses were advanced: 1. There are no significant differences in the level of knowledge on dental care among primary caregivers of preschoolers when classified according to (a) type of residence, (b) age, (c) sex, (d) educational attainment, (e) monthly income, and (f) civil status. 2. There are no significant differences in the desirability of dental care practices among primary caregivers of preschoolers when classified according to (a) type of residence, (b) age, (c) sex, (d) educational attainment, (e) monthly income, and (f) civil status. 3. There is no significant relationship between the level of knowledge and desirability of dental care practices among primary caregivers of preschoolers.

Significance of the Study

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


This study is a significant endeavor in determining the knowledge and dental practices of primary caregivers of preschoolers in a selected municipality. This study will be beneficial to primary caregivers of preschoolers, educational facilities, preschoolers, West Visayas State University College of Nursing, Department of Health (DOH), Department of Education (DepEd) and future researchers. To the primary caregivers of preschoolers, the study will serve as an evaluative tool for them so that they will be able to appraise their dental care-related knowledge and practices. To the educational facilities, specifically the teachers since it can help them identify needed information regarding dental health knowledge and practices. Thus, they can inculcate appropriate knowledge and satisfactory practices in educating their preschoolers. To the preschoolers, since they will indirectly benefit from the study. They will be the recipients of the improved dental health knowledge and practices that will be gained by their respective primary caregivers. The latter can serve as a role model whose appropriate practices will be imitated by the child.

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To the WVSU College of Nursing, since the results can

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serve as baseline data regarding the existing knowledge and practices of the primary caregivers of preschoolers in Leganes, Iloilo. The findings can provide useful information for the faculty and students of WVSU College of Nursing when planning interventions for the promotion of oral health care and prevention of periodontal diseases in the locality. To the DOH, since the data gathered will be added to the pool of information used by the department as basis for policy-making and interventions in the community. To the DepEd, since it will provide data about the current trends regarding the dental care-related knowledge and practices of primary caregivers of preschoolers in Leganes, Iloilo. To the future researchers, for them to make use of the results of this study as related literature for researches with similar or related variables or methodology.

Definition of Terms For a better understanding of this research, the following terms are defined using their conceptual and operational definitions:

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Dental-related to or belonging to teeth (MerriamWebster Dictionary, 2011).

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Care--to be interested in or concerned about something (Encarta Dictionaries, 2008). In this study, dental care referred to being interested in or concerned about dental health. Knowledge--the fact or condition of knowing something with familiarity gained through experience or association (Merriam-Webster Dictionary, 2011). In this study, knowledge referred to the degree of understanding and knowing on caring for the teeth by the primary caregivers of preschoolers. It was measured using a 20-item questionnaire checklist consisting of items about general knowledge on dental care, tooth brushing, dietary practice and parental roles/dental consultation/government programs. Dental-related knowledge, in this study, was described as high (score of 13.36-20.00), average (score of 6.68-13.35) and low (score of 0.00-6.67). Practice--to do or perform often, customarily, or habitually (Merriam-Webster Dictionary, 2011). In this study, practice referred to the way the primary caregivers rendered care for their own teeth and how they rendered care or assisted their children or wards

12 in the care of their teeth. It was measured using a 20-item questionnaire checklist that included questions to determine the desirability of the personal dental practices of the primary caregiver, as well as the desirability of dental practices done by the primary caregiver to the preschooler. It was described as very satisfactory (mean of 2.36-3.00), satisfactory (mean of 1.68-2.35), and unsatisfactory (mean of 1.00-1.67). Primary--of first rank, importance, or value (MerriamWebster Dictionary, 2011). Caregiver--a person who provides direct care as for children, elderly people, or the chronically ill (MerriamWebster Dictionary, 2011). In this study, primary caregiver referred to the person who was directly responsible for the childs care for most of the time during the last three months. They were the childs parents, relatives, or baby-sitter. They were the participants of the study. Preschoolers--a unit of pupils of similar age or ability taught together at school (Merriam-Webster Dictionary, 2011).

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City

13 In this study, preschoolers referred to children three to six years of age who were enrolled in Day Care Centers in Leganes, Iloilo during Academic Year 2012-2013. Municipality--a city, town or area that has its own local government (Merriam-Webster Dictionary, 2011). In this study, it referred to the municipality of Leganes, Iloilo. It is a fourth-class municipality, which is, about 11 kilometers north from the capital Iloilo City. It served as the locale of the study.

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City

Delimitation of the Study This descriptive correlational study aimed to investigate the relationship between the dental carerelated knowledge and practices of primary caregivers of preschoolers in Leganes, Iloilo. This study was conducted on June-August 2012 among 175 randomly selected primary caregivers of preschoolers in Leganes, Iloilo. Five rural barangays and five urban barangays in the municipality, which were pre-determined at random through lottery technique, served as the study locale. The participants of the study were 175 primary caregivers of preschoolers enrolled in Day Care Centers for Academic Year 2012-2013 in the pre-determined barangays.

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


They were chosen through stratified random sampling technique. The data needed for this investigation were gathered using a researcher-made questionnaire checklist, which was duly-validated and pre-tested for reliability.

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The mean, standard deviation, t-test, One Way Analysis of Variance (ANOVA), and Pearsons r Moment Coefficient of Correlation were employed as statistical tools. Computations were processed via the Statistical Package for Social Sciences (SPSS) software for windows. All levels of significance for inferential statistics were set at .05 alpha. The study was only limited to determining the dentalcare related knowledge and practices of primary caregivers of preschoolers. The oral health status of the caregivers and the preschoolers was not within the scope of the study. Further, caregivers of preschoolers who were not enrolled in Day Care Centers in Leganes, Iloilo during the conduct of the study were not taken as participants.

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Chapter 2 Review of Related Literature and Studies

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This chapter includes a discussion on: (1) the Municipality of Leganes, (2) Prevalence of Oral Diseases, (3) Dental-Care Promotive and Preventive Practices, (4) Studies Related to Dental Care, (5) Factors Affecting Dental and Oral Health, and (6) Summary. Oral health is not just the absence of disease. The

very first developmental stage of childhood according to Sigmund Freud is called the oral stage since most of an infants and a toddlers world is explored and learned through the mouth. Much of his or her waking time is spent eating or chewing, and thereby growing. Parents are the child's primary teachers of healthy habits, thus, frequent interactions within the family can have a major impact on oral health. It is important to

observe how dental health is being promoted and practiced by the parents with their children in order to provide cues as to learning strategies, potential behaviors, and difficulties.

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Municipality of Leganes The Municipality of Leganes is one of the 19 coastal towns of the Province of Iloilo. It is the only coastal municipality that shares a common border with Iloilo City,

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which is the provincial capital and regional administration center of Western Visayas in Region VI. The distance from the municipality to the capital city is only 11 miles. It is a 4th class municipality. According to the 2007 Iloilo Population Census released by the National Statistics Office, it has a population of 27,357 with an average household of five members per family. The main livelihood of Leganes is agricultural and rice is their primary commodity (http://www.iloilo.gov.ph/, retrieved 21 March 2012). Leganes has a total land area of 3,220 hectares. It ranks as the third smallest town of the 42 municipalities and one component city of the province of Iloilo. There are 18 barangays in Leganes, six of which are considered urban (Buntatala, Cagamutan Sur, Guihaman, Guinobatan and Poblacion), while the remaining 12 are rural communities (Bigke, Cagamutan Norte, Calaboa, Camangay, Cari Mayor, Gua-an, Guintas, Lapayon, M.C. Hechanova, Nabitasan, Napnud and San Vicente).

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Prevalence of Oral Diseases Tooth decay is one of the most common of all

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disorders, second only to common cold. It usually occurs in children and young adults but can affect any person. It is an erosive process that begins with the action of bacteria on fermentable carbohydrates in the mouth which produces acid that dissolves tooth enamel, ultimately causing the loss of the tooth (Smeltzer et al., 2010). Oral disease is still a major public health problem in high income countries and the burden of oral disease is growing in many low and middle income countries. Significant numbers of people around the globe suffer from illness and pain related to the mouth. The disadvantaged and poor people suffer most and they often do not receive appropriate oral health care. In addition, disease prevention and oral health promotion are widely neglected areas in public health. This is particularly the case in middle and low income countries (World Health Organization, 2003). Dental-related problems are very prevalent world-wide. Australia reported in the 2002 Child Dental Health Survey that four out of 10 five year old children had one or more decayed or missing teeth and 10 percent of those children

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examined were found to have more than seven decayed teeth. Australia is not the only country facing that problem. In

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the United Kingdom, successive national child dental health surveys have shown little change in caries prevalence in five-year-old children over the last 20 years (Armfield et al., 1999). In the Philippines, it has been noted that 97.1% of 6year-old Filipino children suffer from dental decay. Poor oral health affects not only the physical appearance and emotions of a person but his overall health as well. According to the Academy of General Dentistry, there is a relationship between gum diseases and health complication. Poor oral health can lead to other health problems like heart diseases, heart attacks, strokes and respiratory illnesses. Other researches show that 90 percent of systemic diseases show oral manifestations. Common oral problems such as gum disease, cavities, and other infections, if not addressed at an early stage, can lead to other medical problems such as ulcers, rheumatoid arthritis, appendicitis, heart disease, diabetes, osteoporosis, blood pressure, kidney problem, and even Alzheimers disease.

19 The results of the Significant Caries Index as seen in the National Oral Health Survey conducted in 2006 revealed that six-year olds have a high mean (PUFA) index (3.4) which involves pulpal involvement, ulceration caused by dislocated tooth fragments, fistula and abscess. This indicates the severity of tooth decay. Further, it was found out that six year old children residing in the rural areas of Region VI had a significant Caries Index of 1.6 and a PUFA index of 3.0. These indices are comparatively higher than the significant Caries Index (0.8) and PUFA index (2.6) of the same age group residing in urban areas. A care index of 0.0 percent worryingly indicates that, of the 4050 children examined, none had received any treatment. In a research conducted in La Trinidad, Benguet, out of the 1,200 respondents aged six to 12 years old, 71.7 percent had the prevalence of primary dentition, while that of permanent dentition was 68.2 percent. (Yabao et al., 2005). In Iloilo alone, the Head of Iloilo Dental Division of the City Health Office (CHO) alerted that almost all of the children enrolled in day care centers in this city have oral health problems, which is alarming. This is mostly

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20 attributed to the lack of awareness on the parents part on programs dealing with dental health in the city or simply because that dental health is not placed as a high priority.

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City

Other common oral diseases are: Gingivitis--is the mildest form of periodontal (gum) disease. Gingivitis is often caused by inadequate oral hygiene, which leads to plaque build-up. Periodontitis--is inflammation and infection of the ligaments and bones that support the teeth.

Dental Care Promotive and Preventive Practices The importance of improving oral health care at the earliest age possible should not be underestimated. If prevention is to be maximized, initial examinations and the education of parents in preventative oral health should begin during the first year of life. Parents should be advised that very young children may have difficulty managing their own oral care due to problems with dexterity. The primary caregivers must be present to brush or supervise tooth brushing.

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Dental Promotive Practices. The primary action needed for dental promotion is health education. Oral health promotion on an individual level is effective for reducing plaque levels. However, there is strong evidence that the changes achieved are short term and are not sustained. Interventions designed to improve oral hygiene are

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effective even when very simple direct instruction is used. Familial education is essential to reduce risk for bacterial growth. The parents must supervise the hygiene of their children as long as they have not yet showed efficiency and independency. Emphasis must be given on the diet, the dental care practices and dental consultations. Healthy eating advice should routinely be given to clients to promote good oral and general health. There should be a focused on dietary habits, including frequency of snacking, ingestion of carcinogenic food and beverages, proper oral hygiene and use of fluoride products (Brent, 2009). The frequency and amount of sugars should be reduced and restricted to mealtimes. Foods and drinks with added sugars should be limited to a maximum of four times a day. (British Association for the Study of Community Dentistry, 2005).

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Dentists recommend that brushing teeth two times per day is the ideal setting and that spending at least two minutes diligently scrubbing them is enough to kill most bacteria. There is no evidence to support the claims that swallowing toothpaste is effective in killing bacteria;

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rinsing the mouth out after brushing the teeth ensures that the harmful plaque and particles have been washed out. When it comes to toothbrushes, preschoolers should use a toothbrush that has medium to soft bristles. Using one with tough, firm bristles can be detrimental to the health of their sensitive gums, causing damage or recession. Oral health experts suggest that toothbrush should be replaced every 3 months. It is also encouraged to consume a healthy balanced diet containing foods from all the major food groups. Parents should reinforce the inclusion of fruit and vegetables, starchy staple foods such as whole meal bread and whole grain cereals, protein-rich foods such as lean meat, fish, eggs and lentils, and some dairy foods in the diet. Furthermore, they should also encourage intake of vitamins and minerals that would fortify the dental health of the child such as vitamin D and fluoride.

23 Many parents assume that all of the primary teeth need to be present in the mouth before bringing their children to see the dentist for the first time; however the American Academy of Pediatric Dentistry recommends that child's first dental visit should occur around the time their first tooth appears. A survey of primary caregivers, however, revealed that for those children who had seen a dentist, the average age at the initial visit was 2.6 years (Deltadental, 2010). Dental experts claim that an average person should visit a dentist two times per year for a cleaning and checkup. This is important because a dentist can easily spot problems that are occurring in the mouth. Dentists typically take x-rays to check for root problems and cavities. A dental hygienist starts the visit off by giving the teeth a deep cleaning and polishing, preventing and removing plaque buildup. Letting plaque build on the teeth for a long period of time will cause major or even permanent damage. The Philippine national government, alongside with the Department of Health, is primarily tasked to develop policies and guidelines for proper oral and dental hygiene for local government units.

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


In 2007, the Department of Health formulated the

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Guidelines in the Implementation of Oral Health Program for Public Health Services. The programs aims are to reduce the prevalence rate of dental caries to 85 percent and periodontal disease to 60 percent by the end of 2016 by providing preventive, curative, and promotive dental health care to Filipinos through a lifecycle approach (http://www .doh.gov.ph/node/1066, retrieved 12 March 2012). School children, or those falling under the ages six to 12, are made to undergo oral examination, supervising tooth brushing drills, topical fluoride therapy, pits and fissure sealant application, oral prophylaxis and permanent fillings. The program Batang May K is one of the most recent projects under the Live. Learn. Laugh (Global Program of the FDI World Dental Association). Its aim is to establish a simple, yet neglected health habit among Filipinos: tooth brushing. Each day care student will be issued a new toothbrush with toothpaste available in the classroom (http://www.batangmayk.com, retrieved 9 March 2012). In Iloilo, the Office Dental Division of the City Health

launched its own annual program last 2011 dubbed as

Balik Eskwela Ngipin ay Masigla, which offers free dental

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procedures, including yearly supply of toothbrush and

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toothpaste, oral examination, fluoride varnish, a traumatic restorative treatment, and pits and fissure sealants with an initial of 510 Grade 1 pupils from Apolinario Mabini Elementary School and Iloilo Central Elementary School receiving their dental supplies (http://balita.ph/2011/ 07/06/grade-1-pupils-to-benefit-from-citys-dental-program/, retrieved 10 March 2012). The Iloilo City Health Office (CHO) announced that the city has its own Comprehensive Dental Health Program, a complete package of dental health care delivery targeting day care pupils, preschoolers, all Grade One pupils from public schools in the city, and pregnant mothers. Every year, they will be giving out free toothbrush and toothpaste to Grade One and day care pupils and preschoolers numbering about 9,000 (http://balita.ph/2011/ 02/11/majority-of-pre-schoolers-in-iloilo-city-with-oralhealth-problems/, retrieved 10 March 2012). Dental Preventive Practices. Dental care preventive practices are important after education. Preschoolers are still not capable of practicing what was taught to them in a capable manner, therefore it is very relevant for the caregivers to emphasize the teachings.

26 The World Health Organization (WHO) and the Fdration Dentaire Internationale (FDI) World Dental Federation clearly state that prevention of tooth decay by using fluoride is the most realistic way of reducing the burden of tooth decay in populations (World Health Organization, Beijing Declaration, 2007). Teeth should be brushed twice daily. After the eruption of the first tooth within the first six months of life, dentition should be cleaned with an appropriate size, soft-bristle toothbrush, and a pea-sized layer of fluoridated toothpaste should be used and excessive toothpaste should be wiped off with a damp cloth. The toothpaste should be spit out after brushing to avoid accidental swallowing. The American Dental Hygienists Association (2011) outlined the steps for proper brushing of teeth: (1) bristles should be in 45-degree angle. It should contact both the teeth and gum line; (2) slowly brush two to three teeth in a back and forth rolling motion; (3) do the same with inner tooth surfaces; (4) tilt brush vertically behind front teeth and make the same strokes; and, (5) place teeth in the biting surface and gently scrub teeth to remove odor-producing bacteria.

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WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


Brushing time should be at least two minutes. It is recommended to remove 26 percent of plaques. Furthermore, flossing is an integral part of the whole cleaning process

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since there are plaques between teeth and gum line, an area where most periodontal disease start. Mouthwash is highly recommended to wash out bacteria and other fragments left with the first two processes. Monitoring of oral care is beneficial since it is a determinant of the childs future dental practice. The caregiver should be able to clean plaques to reduce opportunity for bacterial growth. Studies indicate that the timing of bacterial colonization is associated with caries development. The practice of borrowing utensils, cups and sharing of food between caregivers and the child must be discouraged since this would allow bacterial transmission. The best food choices for the health of the preschoolers mouth include cheeses, chicken or other meats, nuts, and milk. These foods are thought to protect tooth enamel by providing the calcium and phosphorus needed to remineralize teeth. Foods with high water content such as apples and watermelon dilute the effects of the sugars they contain, and stimulate the flow of saliva are also recommended.

28 It is better for the teeth and general health if meals are limited three times a day than have an unlimited snack supply. Studies Related to Dental Care Oral health is fundamental to a childs health and well-being. A healthy mouth enables people to eat, speak and socialize without pain, discomfort or embarrassment. In the United States of America, half of the population believed that children should see a dentist between two and four years of age. The role of bacteria in the etiology of caries was acknowledged by 33 and 35 percent of Romanian and Chinese mothers, respectively. Only 42 and 39 percent of mothers knew that dental caries is caused by sugar in Wuhan, Republic of China, and Romania. A relatively few mothers knew the effect of sugary drinks like tea, coffee and milk. Elsewhere, nearly eight out of 10 (78%) knew that

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sugary foods and drinks should be limited to meal-times, but only 7 percent could select the four foods and drinks that supply children with the bulk of their added sugar intake (Aziz et al., 2010). The study also cited, 74 percent of mothers thought that dental decay in milk teeth were very important, but

29 only about 47 percent wanted carious teeth filled, while 15 percent wanted them to be left and 28 percent wanted them extracted. Jackson et al. (2005) found that supervised tooth brushing reduces dental caries in primary school children aged five to six years in England when performed tooth brushing once a day at school compared with children from the same community who did not receive this intervention in primary school children. Teachers can also be role models for pre-school age children. A study conducted by Fisher-Owens et al. (2007) presented research evidence on early childhood caries with the suggestion that disease initiation depended on an interaction between family and community factors. Al-Omiri et al. (2006) wrote that in their study conducted in North Jordan, it was found out that out of 557 students within the age bracket of 10-16, most of their parents role in daily oral care was reported to be mainly related to giving advice on the importance of brushing. About a quarter of the subjects (26%) reported being advised and watched by parents during brushing. Only 15% of the study sample reported that their parents never watched their brushing technique nor gave them advice on brushing.

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


In addition, the research also revealed that

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approximately seven out of 10 (68%) of the study population indicated that they did not know what treatment is required for toothache although the same number of participants (60%) admitted the importance of such knowledge. Most of the students were aware that sweets and soft drinks have a negative impact on dental health. Four out of five (81%) of the respondents also showed awareness of the importance of tooth brushing for caries prevention, and 77 percent have knowledge on the positive effects of fluoride on the care of the oral cavity. In 2008, Plutzer et al. tested the efficacy of an oral health promotion program for the parents of infants, starting during the pregnancy. Of 649 women enrolled in

the program, more than half (441) had their children examined and follow up. Throughout the study, women in the

test group received three rounds of printed information applied in the form of anticipatory guidance. Findings

demonstrated that an oral health promotion program provided in the form of anticipatory guidance significantly reduced the incidence of severe early childhood caries in these very young children.

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In the aforementioned research conducted in Benguet, seven out of 10 respondents had regular tooth-brushing exercises. Yet, less than half (42.5%) of them visit their dentist only when necessary. In addition, their major source of dietary sugar intake was hard candies (89%), banana cue (84.9%), camote cue (84.9%), and soft drinks (84.4%). In contrary, there was no significant correlation

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between sugar intake and dental caries (Yabao et al., 2005). In a different study held in certain areas in northern Philippines, it was found out that mixed and bottle-feeding practices were the norm and most of the children were weaned at two years of age. Most of the children had tooth brushing practices beginning at same age but without appropriate parental guidance. Among three to four-year-old children, those who started brushing at a later age, had frequent snacks, and had a dental visit for emergency reasons showed increase in caries level. For children aged five to six years, those who went for emergency visits also had significantly more caries (Cario, 2003).

Factors Affecting Dental and Oral Health There are many factors that can impact a persons health, such as residence, age, sex, educational

32 attainment, monthly income, and civil status. These factors can affect the impact of dental and oral health in a person. According to McGrath et al. (2004), three-fourths (1132) of 1778 respondents from the United Kingdom perceived oral health as being important to quality of life. Another investigation headed by Chen et al. (1996) described and analyzed the oral health status and oral quality of life among children aged 12-13 and adults aged 35-44 and 65-74 years old in New Zealand. Results revealed that the majority have experienced at least one dental symptom in the past year. Some of them perceive poor oral health and also dislike the way their teeth or dentures look. The investigators concluded that oral health status is closely associated with oral quality of life for both adults and children. Age. Age was also found to be associated with dental health. LaValle et al. (2011) cited that lower level ages of caregivers predicted poorer oral health on children ages five to 12 years old. Further, it was found out that children would not likely return on time for their next scheduled dental visit.

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


In contrast, in a study by Sufia et al. (2009), the

33

younger the mothers age was, the more significant role was the practice of tooth brushing by the child. Type of Residence. A study by Vargas et al. in 2003, found out that a greater percentage of rural (7.5%) than urban (5.6%) children reported unmet dental needs. Urban children were more likely than rural children to have visited the dentist in the past year and were also more likely to be regular users of dental care. Sex. Astrom et al. (1996) asserted that there is no significant gender interaction in the association between same- or different-sex parent-child dyads. These indicate that parents function as social models for their children with regard to several dental health behaviors. In another study, females, in comparison to males, significantly gave good attention to their oral health, by using medium strength toothbrush. They also brushed teeth more than once daily, visited the dentist and chose toothpaste following dentist recommendations (Azodo et al., 2012). In Indonesia, Kumar (2011) concluded that among other factors, the parents gender, specifically the female, significantly influenced their childs oral health related

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


quality of life. It was found out that the female population was generally more concerned about their oral care than their counterparts. In the same manner, Fisher-Owens et al. (2007) also found that gender is associated with other factors and directly impacts the timing growth of the secondary teeth. Educational Attainment. According to Pakpour et al. (2011), a significant direct relationship exists between high decayed, missing, filled teeth (DMFT) scores. Williams et al. (2002) also remarked that parents or

34

caregivers with a further lack of education had less chance of scoring high levels for dental knowledge and a positive dental attitude. Chinese students with highly educated parents more often reported having dental visits within the last 12 months compared with those of low-education backgrounds. In addition, students with highly educated parents tend more often to have personal oral and general hygiene practices, and they often claimed to have healthy dietary habits and to engage in vigorous physical activity. Furthermore, the consumption of sugary foods and/or drinks was more frequent among these students than among those with parents of lower education (Petersen et al., 2007).

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


Monthly income. Social economic status also had an

35

effect on dental care problems. Out of 566 24-59 months old children in Bangalore City, India, seven out of 10 of their parents worked as laborers with a below average per capita income (Priyadarshini et al., 2011). In the above study, nine out of 10 of the 24-39 month age group had caries that were not treated. This is indicative of a total lack of awareness about oral health care among parents, lack of accessibility, and affordability for oral health care in this section of people. Civil status. Dental attendance patterns are affected by the civil status of participants in a research conducted in Lithuania in 2009. In the research, it was found out that married couples were prone to visit the dentist every six months compared to those who are single, divorced or widowed. Single women appear to be the most influential factor of all marital statuses. A report in a Kuwait college by Al-Ansari et al. (2003) stated that single students have a significantly higher level of knowledge regarding periodontal health compared to their married classmates. Jagadeesan et al. (2003) also found in their study in India

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


that married women were more prone to developing periodontal diseases than unmarried women. Marital interaction unquestionably alters symptom

36

expression in a number of chronic conditions. Men and women reporting lower marital quality indicates increased risk of periodontal disease and dental cavities (Marcenes and Sheiham, 1996).

Summary Oral hygiene includes all the processes for keeping the mouth clean and healthy. Healthy teeth do not only make it possible to eat and speak properly, but more importantly, they enable feeling and looking good. Good oral health is important to a persons overall wellbeing. Good oral hygiene is necessary for the prevention of dental caries, periodontal diseases, bad breath and other dental problems. It is important to learn how to maintain

good dental hygiene from early childhood. Parents and guardians should teach their children and wards the proper use of oral hygiene products. Oral disease is one of the most prevalent health care problems in the world due to the lack of proper oral care and decreased awareness of the importance of oral hygiene.

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


There is widespread neglect of dental care promotion and prevention worldwide, leading to increased probability of developing dental or orthodontic problems and its

37

complications well into adulthood. In addition, there is an alarming increase in need of understanding the significance of appropriate oral care in the Philippines. The primary method of prevention of dental caries and other dental-related problems is health promotion, beginning in the first year of life and continuing thereafter. Parental guidance is advised in supervising their children in performing dental care. Proper health teachings regarding oral care must be emphasized to caregiver and child, particularly brushing teeth at least twice a day, minimizing sugary foods and visiting the dentist every six months. There are many factors affecting dental care. Among them are age, residence, age, sex, educational attainment, monthly income, and civil status. Various researches have spawned conflicting results regarding these factors. One of the significant factors identified was correct dental carerelated knowledge and practices passed on by a caregiver to his/her child.

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


Chapter 3 Methodology Chapter Three consists of three parts, namely: (1) Purpose of the Study and Research Design, (2) Methods and (3) Statistical Data Analysis Procedure.

38

Purpose of the Study and Research Design This study aimed to determine the relationship between the knowledge and the dental practices of primary caregivers of preschoolers in Leganes. Further, it ascertained how dental care-related knowledge and practice may be associated with type of residence, age, educational attainment, monthly income and civil status. This study utilized the descriptive-correlational design. Descriptive-correlational research describes the relationship among variables rather than to infer causeand-effect relationships (Polit & Beck, 2004). The goal of this research design is to identify any patterns of relationship that exist between the variables and to measure the strength of the relationship.

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


Methods Participants. The target population of the study was

39

the primary caregivers of preschoolers enrolled in Academic Year 2012-2013 in Leganes, Iloilo. The primary caregiver is a parent, family member, relative or baby sitter who mostly cared for and attended the needs of the preschooler during the last three months. The researchers chose the municipality of Leganes, Iloilo to be the venue of the study because it is the adopted community of the West Visayas State University (WVSU) College of Nursing and since nursing students have their Related Learning Experience in Community Health Nursing in the municipality. Thus, the results of the study can provide valuable data that can be used as basis for future community health programs and activities. Five rural and five urban barangays were predetermined at random through lottery technique at the start of the study.

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


The sample size of the study was determined using the formula below: N n = 1 + N(e)2

40

where: n = sample size N = population size E = sampling error (set at 0.5 alpha level)

The 175 participants of the study were chosen through stratified random sampling technique. The Day Care Centers in the 10 barangays were used as basis for stratification. The proportionate number of preschoolers per stratum was determined. The list of preschoolers enrolled in the Day Care Center during Academic Year 2012-2013 served as the sampling frame of the study. Then, the simple random technique specifically the lottery method without replacement was used to identify the preschoolers in each center. Subsequently, the primary caregivers of these preschoolers were taken as participants of the study. The participants were grouped according to type of residence, educational attainment, monthly income, age,

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


sex, and civil status. The type of residence referred to the particular

41

place, where the participant lived for a specific period of time. In this study, the urban barangays included: Buntatala, Cagamutan Sur, Cari Minor, Guihaman, Guinobatan, and Poblacion. The rural communities consisted of Bigke, Cagamutan Norte, Calaboa, Camangay, Cari Mayor, Gua-an, Guintas, Lapayon, M.V. Hechanova, Nabitasan, Napnud and San Vicente. Educational attainment referred to the highest degree of education attained. The participants were classified into low (unschooled, had enrolled in or had graduated from elementary but have not enrolled in high school), average (had enrolled in or had graduated from high school), and high (had at least enrolled in college). Monthly income referred to the amount of money or its equivalent received during a period of time in exchange for labor or services, from the sale of goods or property, or as profit from financial investments. In this study, income refers to the aggregate monthly income of the family members presented in terms of money as a currency. It was classified as: low (those with monthly family income of Php 7,000 and below), average (those with monthly family income

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


of Php 7,001 to Php 14,000), and high (those with monthly family income of Php 14,001 and above.) Age referred to the number of years of existence from birth up to the last birthday. The participants were categorized as younger (35 years old and below) and older (36 years old and above). Sex referred to the participants biological characteristics as to being female or male.

42

Civil status referred to the position or standing of a person in relation to marriage or the married state. In this study, the participants were grouped as to: single, separated, married, and widowed. Table 1 shows the data.

Data gathering instruments. The data needed were gathered through the use of a self-administered questionnaire-checklist that was purposely designed and constructed for this study. It was composed of three parts. Part One, Demographic Info, determined the participants name (optional), address, gender, civil status, birthday, highest educational attainment, and monthly income.

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City

43

Table 1 Distribution of Participants Category


A. Entire Group

f 175 80 95 111 64 143 32 8 87 80 120 37 18 26 133 8 8

% 100.00 45.71 54.28 63.40 36.60 81.71 18.29 4.57 49.71 45.71 68.57 21.14 10.29 14.86 76.00 4.57 4.57

B. Residence Urban Rural C. Age Young Old D. Sex Female Male E. Educational attainment Low Average High F. Monthly income Low Average High G. Civil status Single Married Separated Widowed

44 Part Two, Knowledge on Dental Care, was composed of 20 questions about general knowledge on dental care, tooth brushing, dietary practice and parental roles/dental consultation/government programs. The participants were asked to place a check (/) on the box that best corresponds to their answer, either True or False. For statistical interpretation, all correct answers were given a score of one and all incorrect answers were given a score of zero. For scoring purposes, the following scores and its corresponding description was utilized: Scale of Scores 13.36 - 20.00 6.68 - 13.35 0.00 6.67 Description High Average Low

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City

High means that the participants had very adequate or very sufficient knowledge on dental care. Average means that the participants had adequate or sufficient knowledge on dental care. Low means that the participants had inadequate or insufficient knowledge on dental care. Part Three was a 20-item checklist entitled, Dental Practice. The questions included in the questionnaire pertained to (a) personal dental practices of the primary

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


caregiver, and (b) dental practices done by the caregiver to the preschooler. The participants were asked to choose from three responses: Always, Sometimes, and Never. Always means that the participant practiced the item at all times. Sometimes means that the participant practiced the item every now and then. Never means that the participant did not practice the item at all. For the purpose of scoring, the following numerical weights were assigned to the responses for items number 1, 2, 3, 4, 5, 6, 7 , 8, 9 (personal dental practices of the primary caregiver) and items number 1, 2, 3, 6, 7, 9, 10 (dental practices done by the primary caregiver to the preschooler): Response Always Sometimes Never Weight 3 2 1

45

For scoring purposes, the following weights were assigned to items number 10 (personal dental practices of the primary caregiver) and items number 4, 5, 8 (dental practices done by the primary caregiver to the preschooler):

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


Response Always Sometimes Never Weight 1 2 3

46

The desirability of the dental practices of the participants was interpreted using the scale of means and its corresponding description below: Scale of Means 2.36 - 3.00 1.68 - 2.35 1.00 - 1.67 Description Very satisfactory Satisfactory Unsatisfactory

Very Satisfactory means that the participant had very desirable dental practices on his/her self and towards the preschooler. Satisfactory means that the participant had desirable dental practices on his/her self and towards the preschooler. Unsatisfactory means that the participant did not have desirable dental practices on his/her self and towards the preschooler. The research instrument was submitted for content and face evaluation to a panel of four jurors composed of a public dental health officer, a public dentist, a

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


researcher, and a grammarian. Their comments and suggestions were incorporated in the final form of the instrument. The English instrument was then translated to the local dialect by a university professor for better comprehension of the participants. The original and the translated versions were compared and questionable items were revised. Reliability testing was done among the primary caregivers of preschoolers in Buntatala Day Care Center in Leganes. Barangay Buntatala did not belong to the predetermined barangay which served as the locale of the study. The pre-testing revealed a computed Cronbach alpha of .80, which indicates the reliability of the instrument. Data-gathering procedure. Prior to the implementation of the study, a formal letter asking for permission to

47

conduct the study noted by the college dean was sent to the Mayor and the Barangay Captains of the randomly selected barangays in Leganes, Iloilo. Preceding the actual data-gathering process, the researchers and two research assistants discussed about data collection, administration of research instruments and maintenance of confidentiality. The team agreed on ways of

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


observing uniformity during data collection to ensure that the data gathered were free from biases. The survey was conducted on a center to center basis. Informed consent was secured after the participants understand the purpose of the study. They were given 30 minutes to accomplish the instrument. For participants who cannot read and write (three out of 175), the researchers read the items to and recorded the participants responses on the questionnaire. Upon retrieval of the accomplished instrument, it was reviewed for completeness of data. The responses were tabulated and computer-processed using the Statistical Package for Social Science (SPSS) software for Windows and interpreted.

48

Data Analysis Procedure The data gathered for this investigation were subjected to descriptive and inferential statistics. Mean. The obtained mean scores were used to ascertain the level of knowledge and desirability of the dental practices of the primary caregivers of preschoolers. Rank. It was used to identify the top dental practices of primary caregivers of preschoolers.

49 Standard Deviation. The standard deviation was used to determine the dispersion of means, to determine the homogeneity or heterogeneity of the data. t-test for Independent Samples. For the knowledge on dental care, the t-test was used to determine the significance of the differences in two-level category of the variable such as age and sex. The level of significance was set at .05 alpha. One-way Analysis of Variance (ANOVA). The ANOVA set at .05 alpha level of significance, was used to determine the significance of the differences in more than two levels of categories such as educational attainment, monthly income, and civil status. Pearson Product Moment Coefficient of Correlation. The Pearsons r, set at .05 level of significance, was used to determine the significance of the relationship between the level of knowledge and desirability of dental practices of the primary caregivers of preschoolers.

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


Chapter 4 Results This section provides the findings of the present

50

investigation. The study primarily aimed at determining the relationship between the level of knowledge and practices on dental care of primary caregivers of preschoolers and how these are associated with their type of residence, age, sex, educational attainment, monthly income, and civil status. To gather the data needed in the study, a researchermade self-administered questionnaire was used. This chapter presents the descriptive and inferential data and their respective analyses.

Descriptive Data Analysis Utilizing the mean scores (Ms), the descriptive findings of the study showed the level of knowledge on dental care and desirability of dental care practices of primary caregivers of preschoolers. Standard deviations (SDs) were employed to determine the primary caregivers homogeneity and heterogeneity in the various areas of investigation.

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


Profile of Primary Caregivers of Preschoolers In general, the primary caregivers of preschoolers in Leganes, Iloilo resided in rural areas (54.28%), were female (82.71%), had

51

received at least secondary education

(95.42%), had low family income (68.57%), and married (76.00%). More than half of the participants (63.40%) were young. The ages of the primary caregivers ranged from 16 to 68, with the mean age of 34.75. The data are shown in Table 1. Knowledge on Dental Care among Primary Caregivers of Preschoolers This investigation sought to determine the level of knowledge on dental care among the primary caregivers of preschoolers. In the present research, means of 13.3620.00, 6.68-13.35, and 0.00-6.67 would indicate high, average and low levels of knowledge, respectively. The level of knowledge of primary caregivers in all categories was high as indicated by mean scores that ranged from 14.88-16.50. The narrow dispersion of the means as shown by standard deviations ranging from 1.67 to 2.64 indicated homogeneity among the primary caregivers of preschoolers in

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


terms of dental care-related knowledge. The data are shown in Table 2.

52

Desirability of Dental Care Practices among Primary Caregivers of Preschoolers The desirability of dental care practice scale utilized in this study was: 2.36-3.00 (very satisfactory), 1.68-2.35 (satisfactory), and 1.00-1.67 (unsatisfactory). As shown in Table 3, the primary caregivers of preschoolers in almost all categories had very satisfactory dental practices with means ranging from 2.39-2.54. Only those with low educational attainment had satisfactory dental practices as indicated by a mean score of 2.23. The standard deviations, which ranged from 0.18 to 0.34, showed the narrow variability of the means, indicating the primary caregivers homogeneity in terms of their dental practices.

Personal Dental Care Practices of Primary Caregivers of Preschoolers The top five personal dental care practices of primary caregivers of preschoolers were: ensuring that the entire mouth is cleaned, (M=2.87, rank 1), using fluoride

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


Table 2 Knowledge on Dental Care among the Primary Caregivers of Preschoolers Category A. B. Entire Group Type of Residence Urban Rural Age Young Old Sex Female Male Educational attainment Low Average High Monthly income Low Average High Civil status Single Separated Married Widowed Legend: Scale of Scores 13.36-20.00 6.68-13.35 ` Description High Average M 15.41 15.88 15.03 15.38 15.48 15.52 14.97 SD 2.25 2.06 2.34 2.36 2.06 2.26 2.18 Desc. High High High High High High High

53

C.

D.

E.

14.88 14.89 16.05 15.22 15.54 16.50 15.39 15.25

2.23 2.39 1.94 2.27 2.28 1.79

High High High High High High

F.

G.

2.59 High 1.67 High 15.36 2.22 2.64 High

High 16.13

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


0.00- 6.67 Table 3 Desirability of Dental Care Practices among Primary Caregivers of Preschoolers Category A. Entire Group B. Type of Residence Urban Rural C. Age Young Old D. Sex Female Male E. Educational attainment Low Average High F. Monthly income Low Average High G. Civil status Single Separated Married Widowed Legend: Scale of Means 2.36-3.00 1.68-2.35 VS S Description Very Satisfactory Satisfactory M 2.47 2.49 2.46 2.43 2.53 2.49 2.39 2.23 2.46 2.50 2.46 2.49 2.50 2.51 2.53 SD .25 .24 .26 .24 .26 .25 .25 .33 .26 .22 .24 .28 .29 Desc. VS VS VS VS VS VS VS S VS VS VS VS VS VS VS .25 VS Low

54

.26 .18 2.46 2.54 .34

VS

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


1.00-1.67 U Unsatisfactory

55

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


toothpaste when brushing (M=2.86, rank 2.5), brushing the teeth before sleeping (M=2.86, rank 2.5), brushing the

56

tongue (M=2.85, rank 4.5) and tooth brushing at least twice a day (M=2.85, rank 4.5). It can be noted that even if visiting the dentist was the least practiced (M=1.93, rank 10), it was still practiced satisfactorily. The data are shown on Table 4.

Dental Care Practices Done by Primary Caregivers to Preschoolers The top three dental care practices done by primary caregivers to preschoolers were: brushing of teeth at least twice a day (M=2.73, rank 1), teaching child proper oral hygiene (M=2.73, rank 2), and teaching child about the importance of proper oral hygiene (M=2.67, rank 3). It shows that although allowing tooth filling if necessary was the least practiced (M=1.67, rank 10), it was still done satisfactorily. The data are shown in Table 5.

Inferential Data Analysis The significance of the differences in the dental care knowledge and practices when the primary caregivers were grouped as to type of residence, age, sex, educational

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


Table 4 Personal Dental Care Practices of Primary Caregivers of Preschoolers Category
1.

57

M 2.87 2.86 2.86

SD .35 .42 .38

Desc. VS VS VS

Rank 1 2.5 2.5

Ensuring that the entire mouth is cleaned 2. Brushing teeth before sleeping 3. Using fluoride toothpaste when brushing 4. Including tongue when brushing teeth 5. Brushing teeth at least twice a day 6. Following the dentists advice regarding oral health 7. Avoiding sharing of eating utensils 8. Regularly attending oral health programs 9. Using mouthwash 10. Visiting the dentist every six months Total Legend: Scale of Means 2.36-3.00 1.68-2.35 1.00-1.67 VS S U

2.85 2.85 2.52

.39 .38 .57

VS VS VS

4.5 4.5 6

2.29 2.04 2.02 1.93 2.51

.73 .60 .71 .55 .25

S S S S VS

7 8 9 10

Description Very Satisfactory Satisfactory Unsatisfactory

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


Table 5 Dental Care Practices of Primary Caregivers Done to Preschoolers Category
1. Brushing teeth at least twice a day 2. Teaching child proper oral hygiene M 2.74 2.73 SD

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Desc. Rank .45 VS .52 VS 1 2 3 VS

3. Teaching child importance of proper 2.67 .57 VS oral hygiene 4. Eating a diet rich in vitamins and 2.66 .51 4 minerals 5. Including tongue and buccal area 2.50 .63 VS when brushing 6. Allowing child to sleep without 2.42 .66 VS brushing teeth 7. Not minding childs affected tooth 2.39 .67 7 if there are no complaints 8. Allowing child to drink carbonated 2.31 .59 8 drinks everyday 9. Accompanying child to the dental 2.26 .73 S clinic 10.Allowing tooth filling if necessary 1.67 .82 S Total 2.43 .32 VS

5 6 VS

9 10

Legend: Scale of Means 2.36-3.00 1.68-2.35 1.00-1.67 VS S U Description Very Satisfactory Satisfactory Unsatisfactory

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


attainment, monthly income, and civil status was ascertained by the present investigation. Further, the significance of the relationship between dental care knowledge and practice was determined. The t-test for independent means was utilized to measure the significance of the differences among the

59

primary caregivers classified as to type of residence, age, and sex. ANOVA was used to determine significant differences among the primary caregivers grouped as to educational attainment, monthly income, and civil status. To test the significance of the relationship between dental care knowledge and practices among primary caregivers of preschoolers, the Pearson r was used. The level of significance for all inferential tests was set at .05 alpha level.

Differences in the Level of Knowledge on Dental Care Among Primary Caregivers of Preschoolers The differences in the level of knowledge on dental care among primary caregivers of preschoolers were not significant when classified according to age, t(173)=-.30, p > .05, and sex, t(173)=1.25, p > .05. Regardless of sex

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


and age, the primary caregivers of preschoolers had a high level of knowledge regarding dental care. However, in terms of type of residence, there was a highly significant difference in the level of knowledge on dental care among primary caregivers as evidenced by t(173)=2.51, p .01. With 99 percent level of confidence, it can be inferred that primary caregivers who resided in urban areas were significantly more knowledgeable than those who resided in rural areas. The data are shown in Table 6. No significant differences were noted in the level of knowledge on dental care among primary caregivers of preschoolers classified as to monthly income, F(2, 172)=2.67, p > .05, and civil status, F(3, 171)=.33, p > . 05. Regardless of the monthly income and civil status, the primary caregivers of preschoolers had a high level of knowledge regarding dental care. However, as shown in Table 7, there is a highly significant difference in the level of knowledge on dental care among primary caregivers when grouped according to educational attainment, F(2, 172)=6.16, p .01. Further, Post Hoc analysis (Scheffe test) revealed that those with high educational attainment had better knowledge level

60

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


Table 6 t-test Results for the Differences in the Level of Knowledge on Dental Care Among Primary Caregivers of Preschoolers Category M t-value df

61

Sig. (two-tailed)

A.

Type of Residence Urban 15.88 2.51** Rural 15.03 15.38 -.30 Old 15.48 14.97 1.25 Female 15.52 173 .21 173 .77 173 .01

B.

Age Young

C.

Sex Male

** Significant at .01 alpha level compared to those with average educational attainment at . 01 alpha level.

Differences in the Desirability of Dental Care Practices of Primary Caregivers of Preschoolers There was no significant difference in the desirability of dental care practices among primary caregivers of preschoolers classified according to type of

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


Table 7 One-way ANOVA Results for the Differences in the Level of Knowledge among Primary Caregivers of Preschoolers Category A. Educational attainment Between Groups Within Groups Total B. Monthly income Between Groups Within Groups Total C. Civil status Between Groups Within Groups Total 5.04 887.51 882.55 3 171 174 1.68 5.13 .33
.81

62

Sum of Squares

df

Mean

Sig.

59.02 823.53 882.55

2 172 174

29.51 4.79

6.16**.01

26.49 856.06 882.55

2 172 174

13.25 4.98

2.67

.07

** Significant at .01 alpha level residence t(173)=.85, p > .05. The type of residence was not associated with the primary caregivers desirability of dental care practices. However, there were significant differences in the desirability of dental care practices among primary

63 caregivers grouped as to age, t(173)=2.56, p .01 and sex, t(173)=2.10, p < .05. With 99 percent level of confidence, it can be concluded that older primary caregivers exhibited significantly more desirable dental practices than the younger primary caregivers. In addition, dental care practices of female primary caregivers were significantly more desirable than their male counterparts. The data are shown in Table 8. The differences in the desirability of dental care practices were not significant when grouped as to monthly income, F(2, 172)=.28, p >.05, and civil status, F(3, 171)=.74, p > .05. Heedless of monthly income and civil status, the primary caregivers of preschoolers had very satisfactory dental care practices. However, a significant difference was noted in the desirability of dental care practices among primary caregivers grouped according to educational attainment, F(2, 172)=4.54, p .01. Post Hoc analysis (Scheffe test) revealed that those with high educational attainment practiced more desirable dental care than those with average educational attainment at .01 alpha level. The data are shown in Table 9.

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


Table 8 t-test Results for the Desirability of Dental Care Practices of Primary Caregivers of Preschoolers Category M t-value df

64

Sig. (two-tailed)

A.

Type of Residence Urban 2.49 .85 Rural 2.46 2.43 2.56** Old 2.53 2.49 2.10* Male 2.39 173 .04 173 .01 173 .40

B.

Age Young

C.

Sex Female

** Significant at .01 alpha level * Significant at .05 alpha level Relationship between the Level of Knowledge and Desirability of Dental Care Practices of Primary Caregivers of Preschoolers There is no significant relationship between the level of knowledge and desirability of dental care practices of primary caregivers of preschoolers as indicated by r=.113, p > .05. The data are shown in Table 10.

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


It can be inferred that the primary caregivers knowledge on dental care is not associated with the desirabilityof their dental care practices.

65

Table 9 One-way ANOVA Results for the Differences in the Desirability of Dental Care Practices of Primary Caregivers of Preschoolers Category
Sum of Squares df Mean F Sig.

A.

Educational attainment Between Groups Within Groups Total .56 10.52 11.08 2 172 174 .2 .06 4.54** .01

B.

Monthly income Between Groups Within Groups Total .04 11.41 11.08 2 172 174 .02 .06 .28 .76

C.

Civil status Between Groups Within Groups Total .14 10.94 11.08 3 171 174 .05 .06 .74 .53

** Significant at .01 alpha level

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


Table 10 Pearson r Result for the Relationship between the Level of Knowledge and Desirability of Dental Care Practices of Primary Caregivers of Preschoolers Level of Knowledge r Sig. .113 .137

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N Desirability of Dental Care Practices 175

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Chapter 5 Summary, Conclusions, Implications and Recommendations

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Chapter Five is made up of four parts, namely: (1) Summary, (2) Conclusions, (3) Implications, and (4) Recommendations.

Summary of the Problem, Method and Findings This descriptive-correlational study aimed to investigate the relationship between dental care-related knowledge and practices of primary caregivers of preschoolers in Leganes, Iloilo. Specifically, this study aimed to: 1. describe the profile of primary caregivers of

preschoolers in Leganes, Iloilo; 2. identify the level of knowledge on dental care

among primary caregivers of preschoolers when taken as an entire group and when classified according to (a) type of

residence, (b) age, (c) sex, (d) educational attainment, (e) monthly income, and (f) civil status; 3. determine the desirability of the dental care

practices among primary caregivers of preschoolers when taken as an entire group and when classified according to

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(a) type of residence, (b) age, (c) sex, (d) educational attainment, (e) monthly income, and (f) civil status; 4. identify the dental care practices of primary

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caregivers of preschoolers; 5. ascertain the significance of the differences in

the level of knowledge on dental care among primary caregivers of preschoolers when classified according to (a) type of residence, (b) age, (c) sex, (d) educational attainment, (e) monthly income and (f) civil status; 6. determine the significance of the differences in

the desirability of dental care practices among primary caregivers of preschoolers when classified according to (a) residence, (b) age, (c) sex, (d) educational attainment, (e) monthly income and (f) civil status; and 7. determine the significance of the relationship

between the primary caregivers level of knowledge and desirability of dental care practices. Based on the preceding problems, the following hypotheses were advanced: 1. There are no significant differences in the level

of knowledge on dental care among primary caregivers of preschoolers when classified according to (a) type of

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residence, (b) age, (c) sex, (d) educational attainment, (e) monthly income, and (f) civil status. 2. There are no significant differences in the

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desirability of dental care practices among primary caregivers of preschoolers when classified according to (a) types of residence, (b) age, (c) sex, (d) educational attainment, (e) monthly income and (f) civil status. 3. There is no significant relationship between the

level of knowledge and desirability of dental care practices among primary caregivers of preschoolers. The participants of the study were the 175 randomly selected primary caregivers of preschoolers enrolled in Day Care Centers for Academic Year 2012-2013 in 10 predetermined barangays of Leganes, Iloilo. Using stratified-random sampling technique, they were chosen from a total population of 310 through lottery technique. Data were gathered using a research-made self-administered questionnaire that was duly validated and pre-tested for reliability. The descriptive statistics used were the means, standard deviations and rank. For inferential analysis, the t-Test for independent means, the One-Way Analysis of

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Variance, and Pearsons Product Moment Correlation were employed. The findings of this investigation were: 1. Over all, the primary caregivers of preschoolers

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in Leganes, Iloilo, were females, young, resided in rural areas, had received at least secondary education, had low family income, and married. 2. The level of knowledge on dental care among

primary caregivers in all categories was high. 3. The primary caregivers of preschoolers in almost

all categories had very satisfactory dental practices, except for those with low educational attainment who had satisfactory dental practices. 4. The most common dental care practices of the

primary caregivers were: ensuring that the entire mouth is cleaned, using fluoride toothpaste when brushing, and brushing the teeth before sleeping. The top three dental

care practices done by primary caregivers to preschoolers were: brushing of teeth at least twice a day, teaching the child proper oral hygiene, and teaching child about the importance of proper oral hygiene. 5. Only the type of residence and educational

attainment significantly influenced dental care-related

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knowledge. Those who resided in urban areas were

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significantly more knowledgeable than those who resided in rural areas. Those with high educational attainment had

better knowledge level compared to those with average educational attainment. Knowledge was not associated with age, sex, monthly income, and civil status. 6. Significant differences were noted in the

desirability of dental practices of the primary caregivers grouped as to age, sex, and educational attainment. Older

and female primary caregivers significantly exhibited more desirable dental practices than their younger and male counterparts. Those with higher educational attainment had

better dental practices than those who have not enrolled in college. Type of residence, monthly income, and civil

status made no significant difference on the primary caregivers dental practices. 7. There is no significant relationship between

knowledge and desirability of dental care practices among primary caregivers.

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Conclusions

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In view of the findings, the following conclusions are drawn. 1. Predictably, a vast majority of primary

caregivers of preschoolers were females since it has been a universal role for a woman to support, guide and take care of her family. Also, they take greater responsibility for routine childcare than their male partners. The primary caregivers in this study were mostly young, literate, and educated. Leganes, Iloilo, in spite of its proximity to The

the City of Iloilo, is a fourth class municipality. main source of living is agricultural in nature.

This may

explain why most of the primary caregivers in the study belong to low-income families. 2. The primary caregivers high level of knowledge

indicates that they have very adequate understanding of dental health. This may also be reflective of the increasing public awareness about the importance of dental health. This can also be attributed to the nationwide

advocacy on dental health promotion, especially the Oral Health Month celebration during the month of February. Exposure to media through television, radio, and print media has also contributed.

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3. The primary caregivers had very desirable dental

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practices. They observe healthy dental care practices and these are passed on to the preschoolers. 4. Predominantly, the dental practices of the

primary caregivers focus on the care of the mouth and the teeth. Likewise, Al-Omiri et al. (2006) stated that parents role in daily oral care was reported to be mainly related to giving advice on the importance of brushing of teeth. 5. The type of residence and educational attainment

affected the dental-care knowledge of the primary caregivers. Those who lived in urban areas may have more

access to dental health care services and programs in the city proper. Likewise, they may have more exposure to

health promotion campaigns via various types of informational media from the television, radio and print media. Further, those with higher education had better knowledge than those who had lower educational attainment. Similarly, Williams et al. (2002) remarked that caregivers with lack of education had less chance of scoring high levels for dental knowledge. On the other hand, age, sex,

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monthly income, and civil status made no significant difference in the primary caregivers knowledge level. 6. Older primary caregivers had healthier dental practices compared to younger ones. This is supported by

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LaValle et al. (2011) who reported that lower level ages of caregivers predicted poor oral health on children ages five to 12 years old. Further, females had more desirable In the same manner, Azodo et al.

practices than males.

(2012) mentioned that females in comparison to males significantly gave good attention to their oral health. Furthermore in Indonesia, Kumar (2011) concluded that among other factors, the parents gender, specifically the female, significantly influenced their childs oral health related quality of life. It was found out that the female population was generally more concerned about their oral care than their counterparts. In addition, Fisher-Owens et al. (2007) also found that gender is associated with other factors and directly impacts the timing of growth of the secondary teeth. 7. A high level of dental care-related knowledge

does not necessarily indicate that the individual exhibits good dental care practices, and vice versa. On the other hand, there could be other factors that could influence the

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relationship of knowledge and desirability of dental care practices.

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Implications The findings of the present study led to certain implications for theory and practice in relation to the dental care knowledge and practices of primary caregivers of preschoolers of Iloilo. For Theory. The Health Promotion Model posits that multi-faceted nature of persons correlating with their interpersonal nature and interacting with their interpersonal and physical environments trail towards health promotion. This implies that individual characteristics and experiences could affect ones behavior regarding health care. Pender (1996) said that personal factors and prior experiences of individual affect the health-seeking behavior. The study identified personal factors that are predictive of desirability of dental care practices, specifically age and educational attainment. The desirability of dental practice of the primary caregivers

76 may be attributed to other variables which were not covered in this study such as frequency of dental visits and diet. The primary caregivers in the study had high level of knowledge and desirable dental practices. Based on Penders model, it can be inferred that the primary caregivers can be a good source of interpersonal influence that can increase or decrease the childs commitment to and engagement in desirable dental practices. According to Peterson et al. (2009), Penders model is useful to the nurses because it helps expand their role to promote good health as opposed to just decreasing their risk for becoming ill. Moreover, the nurses goals are now aimed at strengthening resources, potentials, and capabilities for each patient and providing resources and education to promote improved health and a better quality of life. Thus, this model allows the patient and the nurse to work together towards a goal of a better quality of life though application of this theory is varied and substantive on its own.

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For Practice. Being a health educator is an essential role of nurses. Health promotion is the key responsibility

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for primary prevention. In this regard, nurses must commend the dental practices of primary caregivers. Community health nursing is an avenue for preventing health deficits. Community health workers, including nurses, can focus their health education by targeting groups who had exhibited less desirable dental care practices.

Recommendations In view of the aforementioned findings and conclusions, the following recommendations are advanced: 1. The primary caregivers of preschoolers in Leganes

are further encouraged to continue their desirable dental care practices and to teach the younger generation how to care for their teeth. 2. Health workers, including student nurses, can

organize a dental health education package targeting preschoolers and their primary caregivers, wherein attention can be given to young, male, lowly-educated caregivers who reside in the rural area.

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3. Day Care Centers should continue to integrate

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dental health promotion activities into their lessons as part of their campaign to fight against early oral health problems. 4. Government agencies such as the Department of

Health, Department of Education, Rural Health Unit and nongovernment agencies should work hand in hand in monitoring trends regarding the dental health status of the children in the community. 5. The West Visayas State University College of

Nursing can incorporate dental health promotion in their Community Health Nursing (CHN) activities. This should not be limited to children but should also include family members as well. 6. Similar investigations on this topic are highly

suggested for wider range, larger coverage of participants including those who are not enrolled in Day Care Centers, larger sample size, wider scope and inclusion of other variables that may influence dental health. 7. Further studies may be conducted to determine if

dental care-related knowledge and dental care practices can affect health status.

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issn=09704388;year=2010;volume=28;issue= 2;spage=78;epage=83;aulast=Mani;aid=JIndianSocPedod PrevDent_2010_28_2_78_66741 Marcenes W.S., & Sheiham A., (1996). The relationship between work stress and oral health status. Department of Epidemiology and Public Health. Retrieved 1 September 2012 from http://www.ncbi.nlm.nih.gov/ 1485198 Marinho, V., Wong M.C., Clarkson J., & Glenny A.M., (2003). Cochrane reviews on the benefits/risks of fluoride toothpastes. Journal on Dental Research. Retrieved 12

March 2012 from http://adr.sagepub.com/ content/20/1/3.extract McGrath C., & Bedi R., (2004). A study of the impact of oral health on the quality of life of older people in the UK-findings from a national survey. National Center for Biotechnology Information. Retrieved 1 September 2012 from http:www.ncbi.nlm.nih.gov/pubmeb/ 10530183

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Petersen, E. (2007).Diet, nutrition and the prevention of dental diseases. WHO Collaborating Centre for Nutrition and Oral Health. Doi:10.1079/PHN2003589 Peterson, S. & Bredow T. (2009). Middle range theories: application to nursing. Theoretical Framework in Nursing Research. Retrieved 12 March 2012 from http://www.studymode.com/essays/TheoreticalFrameworkIn-Nursing-Process-954720.html

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Pakpour A.H., Hidarnia A., Hajizadeh E., Kumar S., & Harrison A.P., (2011). The status of dental caries and related factors in a sample of Iranian adolescents. Department of Health Education, School of Medical Sciences. Retrieved 1 September 2012 from http://www.ncbi.nlm.nih.gov/pubmed/21196852 Plutzer, K., & Spencer ,A.J. (August 2008). Efficacy of an oral health promotion intervention in the prevention of early childhood caries. National Center for Biotechnology Information. Retrieved 12 March 2012 from http://www.ncbi.nlm.nih.gov/pubmed/19145720 Priyadarshini, H.R., Hiremath, S.S., Puranik M., Rudresh, S.M., & Nagaratnamma, T. (2011). Prevalence of early childhood caries among preschool children of low socioeconomic status in Bangalore city, India. Journal

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Dentistry, 1(1), pp. 27-30. Retrieved on 12 March 2012 from http://www.jispcd.org/article.asp? issn=22310762: year=2011;volume=1;issue=1;spage=27;epage=30;aulast= Priyadarshini Province of Iloilo, Official Website. (2009). Municipal Profile of Leganes. Iloilo City. Retrieved on 21 March 2012 from http://www.iloilo.gov.ph/ Smeltzer, S., Bare. B., Hinle, J. & Cheever, K. (2010). Brunner and suddarths textbook of medical-surgical nursing. 12th ed. Philadelphia: Lippincott Williams and Wilkins. Sufia, S., Ayyaz, A.K., & Chaudhry, S., (2009). Maternal factors and childs dental health. Journal of Oral Health and Community Dentistry. Retrieved 1 September 2012 from http://www.johcd.org/pdf/JOHCD-Maternal %20Factors%20and%20Child%20Dental%20Health.pdf Tomey, A.M. & Alligood, M.R. (2002).Nursing theorists and their work. 5th ed. Missouri: Mosby. Vargas, C.M., Ronzio, C.R., & Hayes, K.L. (2003). Oral health status of children and adolescents by rural residence, United States. US National Library of Medicine National Institutes of Health. Retrieved 12

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March 2012 from http://www.ncbi.nlm.nih.gov/pubmed/12839134 World Health Organization (2003). The world oral health

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report 2003: Continuous improvement of oral health in the 21st century. Retrieved 12 March 2012 from http://www2.paho.org/hq/dmdocuments/2009/OH_st_WHO.pdf World Health Organization (2007). Beijing declaration on food safety. Retrieved on on 14 March 2012 from http://www.who.int/foodsafety/fs_management/meetings/B eijing_decl.pdf Williams, K., Fildes, D., Grootemaat, P., Marosszeky, N., & Magee, N. (September 2008). Updates to the catalogue of evidence-based strategies for childrens health and wellbeing: Part 1. Centre for Health Service Development, University of Wollongong. Retrieved on 14 March 2012 from http://www.eduweb.vic.gov.au/ edulibrary/public/earlychildhood/healthwellbeing/catal ogueupdates-dec08.pdf Yabao R.N., Duante C.A., Velandria F.V., Lucas M., Kassu A., Nakamori M., & Yamamoto S., (December 2005). Prevalence of dental caries and sugar consumption among 6-12-yr-old schoolchildren in La Trinidad, Benguet, Philippines. National Center for

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Biotechnology Information. Retrieved 12 March 2012 from http://www.ncbi.nlm.nih.gov/pubmed/16118653

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APPENDICES

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APPENDIX A LETTERS TO VALIDATORS

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_______DATE _______ ___________________ ___________________ ___________________ Madam/Sir, Greetings!

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As a requirement for graduation from the Bachelor of Science in Nursing Curriculum, we, the Group 10 of Third Year Section C, will conduct a research study entitled Dental Care: Knowledge and Practices of Primary Caregivers of Preschoolers in a Selected Municipality. In this connection, we would like to ask for your assistance in the validation of our research instrument as to the following criteria: a. Relevance if the item is relevant or not in relation to the objectives of the study b. Clarity if the item is specific or not We would appreciate it very much if you could make necessary corrections and suggestions. We are hoping for your positive response to this request. Truly yours, SGD. FRANCIS JAMES C. CORDOVA Leader, BSN 3-C Group 10 Noted: SGD. SHEILA A. BELIRAN, R.N., M.A.N. Research Adviser SGD. DAISY C. VILLAROSA, R.N., M.S.N. Dean, College of Nursing

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APPENDIX B LETTER TO MAYOR

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June 20, 2012 HON. ENRIQUE M. ROJAS Municipal Mayor Leganes, Iloilo Dear Hon. Rojas,

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As a requirement of the course Bachelor of Science in Nursing, we, the members of the Research Group 10, will conduct a research study entitled, Dental Care: Knowledge and Practices of Primary Caregivers of Preschoolers in a Selected Municipality. In this connection, we would like to ask permission from your good office to conduct the said study in your municipality on July-August 2012. The respondents of this study are the primary caregivers of children between the ages 3-6 years old in selected daycare centers. The data that will be generated by the research study will be very useful to the nursing students from our school who are assigned in your Rural Health Unit and those who have their Community Health Nursing related learning experience in your municipality. The findings of this study can be used as basis in designing health programs to promote the dental health of children in Leganes, Iloilo. Your favorable action regarding this matter will be appreciated. Truly yours, SGD. FRANCIS JAMES S. CORDOVA Leader, Research Group 10 Noted: SGD. SHEILA P. BELIRAN, R.N., M.A.N. Research Adviser SGD. MARIA REBECCA A. BUSCAR, R.N Chair, Division of Professional Nursing SGD. DAISY C. VILLAROSA, R.N., M.S.N. Dean, College of Nursing

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APPENDIX C LETTER TO BARANGAY CAPTAINS

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August 1, 2012 ________________ Barangay Captain Barangay _______ Leganes, Iloilo Dear _________________, Greetings!

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As a requirement for graduation from the Bachelor of Science in Nursing Curriculum, we, the Group 10 of Fourth Year Section A, will conduct a research study entitled Dental Care: Knowledge and Practices of Primary Caregivers of Preschoolers in a Selected Municipality. In this connection, we would like to ask permission from your good office to conduct the pre-test in your barangay on August ___, 2012. The respondents of this study are the primary caregivers of children between the ages 3-6 years old in selected daycare centers as part of our informative requirement. The questionnaires will be given at their most convenient time. Thank you very much and more power! Truly yours,
SGD. FRANCIS JAMES S. CORDOVA Leader, Research Group 10

Noted:
SGD. SHEILA P. BELIRAN, R.N., M.A.N. Research Adviser SGD. MARIA REBECCA A. BUSCAR, R.N Chair, Division of Professional Nursing SGD. DAISY C. VILLAROSA, R.N., M.S.N. Dean, College of Nursing

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APPENDIX D LETTER TO PARTICIPANTS AND INFORMED CONSENT

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99 August 22, 2012

Dear Participant, Greetings! As a requirement for the degree Bachelor of Science in Nursing, we, the members of Research Group 10 of Fourth Year Section A, will conduct a research study entitled Dental Care: Knowledge and Practices of Primary Caregivers of Preschoolers in a Selected Municipality. The group would like to solicit your assistance by being one of our respondents. You are in the best position to supply the data needed in this investigation. Please answer each item sincerely and truthfully as you can. Please do not leave any item unanswered. All answers will be kept confidential. Thank you very much and more power! Truly yours, Francis James S. Cordova Jeahly M. Maquilang Kreazel A. Nueza Jailene P. Pelaez Gieda G. Tagolimot Janine Marie L. Teodosio

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CONSENT

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I do hereby consent to be a participant in the research entitled, Dental Care: Knowledge and Practices of Primary Caregivers of Preschoolers in a Selected Municipality. I have been made aware and assured that my confidentiality and privacy as a participant shall be highly maintained and that the results of this study will be used for research purposes only. Should I choose to withdraw, I have the right to discontinue my participation. __________________________ Signature over Printed Name __________________________ Date and Time

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APPENDIX E RESEARCH INSTRUMENT (ENGLISH)

102 Dental Care: Knowledge and Practices of Primary Caregivers of Preschoolers in a Selected Municipality I. PERSONAL DATA a. b. c. d. e. f. g. No _ h. Monthly Family Income Income per Month (In Pesos) Name Address: Gender: Civil Status: [ Birthday: Highest Educational Attainment: Is there a dental clinic in your barangay? Yes _ [ [ ] Male ] Single [ [ ] Female ] Married (Optional):____________________________________ ___________________________________________

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] Separated[

] Widowed

__________________________________________ ____________________

Name of Working Family Members

Total Monthly Family Income

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II. KNOWLEDGE ON DENTAL CARE Direction: Please indicate your answer on each item by

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placing a check (/) on the column that best corresponds to your choice. Check TRUE if you think the statement is correct. Check FALSE if you think the statement is wrong.

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


ITEMS Dental caries are caused by plaques that are made of bacteria, acid, food debris, and saliva. Tooth decay will not get better by itself. Dental cavities can cause tooth loss. Dental caries can affect a childs performance in school. Proper dental care should start at home and not in school. Brushing alone can prevent the development of dental cavities. It is alright not to spit out the tooth paste after tooth brushing. Mouthwash is gargled and swallowed. Brushing of teeth must be done every after meal. Use of fluoride toothpaste while brushing teeth will not prevent tooth decay. The tongue, the buccal area and the back of the teeth should be included when brushing the teeth. Oral hygiene starts during breastfeeding. Carbonated drinks and candies increase the risks for dental cavities. Diet rich in vitamins and minerals can help prevent occurrence of dental cavities. Drinking water after eating sweets is not advisable. ITEMS Sticky foods cause lower risks of dental cavities than non-sticky foods. Children with dental cavities usually experience tooth pain and an achy feeling after drinking cold or hot drinks. Drinking non- fluoridated water doesnt affect ones teeth. Dental check-ups should be done every six months. Dental consultations are only advisable when experiencing tooth and gums problems. TRUE

104 FALSE

1.

2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

TRUE

FALSE

16. 17. 18. 19. 20.

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


III. DENTAL PRACTICE Direction: Please indicate your answer on each item by

105

placing a check (/) on the column that best corresponds to your choice. ALWAYS if you practice the item at all times. SOMETIMES if you practice the item every now and then. NEVER if you are not practicing the item at all. III.A. Personal Dental Practice of the Primary Caregiver
SOME TIMES

ITEMS 1. I brush my teeth at least twice a day. 2. My family and I use fluoride toothpaste when brushing our teeth. 3. I include my tongue when I brush my teeth. 4. I make sure that all accessible surfaces of my mouth are cleaned when brushing. 5. I go to the dentist every six months. 6. I use the mouthwash. ITEMS 7. I brush my teeth before I sleep. 8. I attend oral health programs. 9. I follow the advice of the dentist regarding proper oral dental care. 10.I share eating utensils at home with the child.

ALWAYS

NEVER

ALWAYS

SOME TIMES

NEVER

III.B. Dental Practices Done by the Caregiver to the Child ITEMS


ALWAYS SOME TIMES NEVER

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


1. I brush his/her teeth twice a day. 2. I ensure that he/she includes his/her tongue and buccal area when brushing his/her teeth. 3. I make sure that he/she eats food rich in vitamins and minerals to prevent oral cavities. 4. I allow him/her not to brush his/her teeth in the evening. 5. I allow him/her to drink carbonated drinks every day. 6. I teach him/her proper oral hygiene. 7. I explain to him/her the importance of proper oral hygiene. 8. I dont mind his/her affected tooth especially when he/she does not complain of pain. 9. I accompany him/her to the dental clinic when his/her baby teeth are already infected with cavities which cause his/her cheeks to swell. 10.I let his/her dentist perform tooth filling if necessary.

106

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City

107

APPENDIX F RESEARCH INSTRUMENT (HILIGAYNON)

108 Dental Care: Knowledge and Practices of Primary Caregivers of Preschoolers in a Selected Municipality

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City

I. PERSONAL NGA MGA IMPORMASYON a. Pangalan(Pwede kag indi pwede isulat): ____________________________________________________ b. Address:__________________________________________ c. Pagkatawo: [ ] Lalaki [ [ Balo e. Kaadlawan o Birth date: ___________________________ f. Pinakamata-as nga natapusan sa buluthu-an: ________ g. May ara bala klinika nga naga panggabot sang ngipon sa inyo barangay? Huo__Wala__ h. Ano kalayo ang dental clinic sa inyo balay? ________
i.

]Babaye ] Separado [ ]

d. Estado Sibil: [

] Wala sang bana/asawa ] Kasado [

Kita sang pamilya kada bulan. Kita sa Kada Bulan (Php) may Ubra

Ngalan sang Miyembro sang Pamilya nga

Kabilugannga Kita sang Pamilyasa KadaBulan

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


II. NAHIBALU-AN NAHANUNGOD SA PAG-ATIPAN SANG NGIPON

109

Pagtudlo: Palihogsabat sang mgapamangkotpaagisapag tsek (/) sang imonapili-an ngasabatsa may column. Tsekanang MATU-OD kungsapamatyagmongaang ginapahayag insakto. Tsekan ang INDI MATU-OD kung sapamatyagmongaang ginapahayagwala sang kamatu-oran. INDI MATU-OD

ITEMA 1. Tumalagsahon lang ang pagkagu-ab sang ngipon sang mga bata nga naga pangedaron anum katu-ig pa-idalum. 2. Indi mag-ayo ang gu-ab kung ini gina pabay-an lang. 3. Ang aguting ukon gu-ab mahimo mangin rason sang pagka-ungab ukon pagkabingaw sang ngipon. 4. Maapektohan ang pag-eskwela sang isa ka bata kung ini may gu-ab. 5. Ang husto nga pag-atipan sang ngipon naga sugod sa pinamalay kag indi sa eskwelahan. 6. Malikawan ang pagtubokagpagdamu sang gu-absapagpanipilyo lang. 7. Kungmagpanipilyo, pwedengaindi pagiduplaang toothpaste. 8. Ang mouthwash ginapangalimogkag gina tulon. 9. Dapatmagpanipilyokadataposkaon. 10. Angpaggamit sang toothpaste nga may fluoride indimakapugong sangpagkaguba sang ngipon. ITEMA 11. Dapatginasipilyuhan manangdila

MATU-OD

MATU-OD

INDI MATU-OD

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kaganglikod sang ngipon kung magpanipilyo. Nagasugodangpag-atipan sang baba sa pag-umpisapa langsapagpasuso. Angmgasoftdrinkskagdulsi nagapadako sang tsansangamagubaang ngipon. Angmgapagkaonngapuno sang bitaminakag mineral makabuligsa pagpugong sang pagkaguba sang ngipon. Walaginapanugyonangpag-inum sang tubigpagkatapos mag-kaon sang matam-is napagkaon. Angmgamapilitngapagkaonnaga panubo sangtsansangamagubaang ngiponkomparasamgaindimapilit ngapagkaon. Angmgabatanga may gu-abkagguba angngiponmakabatyag sang sakit sang ngiponpagkatapos mag-inom sang malamig kagmainitngatubig. Indi maka-apektosangiponangpaginom sang tubignga wala sang fluoride. Angpag-palantaw sang ngipondapat ginaubrakadaanumkabulan. Mahimo langnamagpakonsulta sang ngipon kun may problemalangdirikag sa imo ngislo.

110

12. 13.

14.

15.

16.

17.

18. 19. 20.

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City


III.

111

DENTAL PRACTICE

Pagtudlo: Palihog sabat sang mga pamangkot paagi sa pag tsek (/) sang imo napili-an nga sabat sa may column. PERMI kung gina ubra mo ang itema nga ini sang masunsun. KON KAISA kung gina ubra mo ang nga adlaw. WALA GUID kung wala mo gina ubra ang itema nga A. Makinaugalingon nga Dental Practice sang Mayor nga Taga-atipan ITEMA 1. Gapanipilyo ako sang akon ngipon indi mag-nubo sa isa ka bes kada adlaw. 2. Ang akon pamilya naga gamit sang toothpaste nga may fluoride kung gapanipilyo. 3. Gina dala ko limpyo ang akon nga dila kung magpanipilyo. 4. Gina sigurado ko nga malimpyuhan ang bilog ko nga baba kung mag sipilyo. 5. Gakadto ako sa dentist kada anum ka bulan. 6. Nagagamit ako sang mouthwash mag panipilyo. 7. Gapanipilyo ako bag-o mag tulog. 8. Nagatambong ako sa mga programa tuhoy sa oral health. 9. Gina sunod ko ang mga ginatudlo sang dentist tuhoy sa sakto nga pagtatap sang ngipon. 10. Gahulamanay kami sang tinidor, kutsara kag baso kung magkaon kami sang akon bata. PERMI KON KAISA WALA GUID ini. itema nga ini sa iban

112 III. B. Kinaugalingon nga Dental Practice sang Mayor nga Taga-atipan sa Iya nga Bata KON KAISA WALA GUID

WEST VISAYAS STATE UNIVERSITY COLLEGE OF NURSING Iloilo City

ITEMA 1. Gina sipilyuhan ko ang iya ngipon maka isa sa isa ka adlaw. 2. Gina sigurado ko nga ginadala nya ang iya nga dila kag buccal area kung siya mag panipilyo. 3. Gina sigurado ko nga nagakaon siya sang masustansya nga pagkaon para makalikaw sa mga problema sa ngipon. 4. Gina pasugtan ko siya nga indi magpanipilyo kon gab-i. 5. Gina pasugtan ko siya nga maginom sang softdrinks adlawadlaw. 6. Gina tudlu-an ko siya sang insakto nga pagtatap sang iya baba. 7. Gina paathag ko sa iya ang importansya sang insakto nga pagtatap sang baba kag ngipon. 8. Ginapabay-an ko lang ang iya guab kung wala man lang siya gareklamo nga nagasakit. 9. Gina-updan ko siya sa dental clinic kung ang iya nga ngipon nga bag-o lang nagtubo ang may ara gu-ab nga gapa banog sang iya guya. 10. Gina pahanugutan ko ang iya dentist nga pastahan ang iya nga ngipon nga may gu-ab kung kinahanglan.

PERMI