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ORIGINAL ARTICLE
Year : 2022  |  Volume : 20  |  Issue : 1  |  Page : 36-42

Relationship between sense of coherence and knowledge on early childhood caries among pregnant women in Bangalore Rural and Urban District


Department of Pediatric and Preventive Dentistry, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India

Date of Submission15-Mar-2021
Date of Decision06-Jul-2021
Date of Acceptance08-Nov-2021
Date of Web Publication25-Feb-2022

Correspondence Address:
Gopika Krishnan
Department of Pedodontics and Preventive Dentistry, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bengaluru - 560 054, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_39_21

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  Abstract 


Context: Sense of coherence (SOC), as stated, is a global orientation that views life as comprehensible, structural, manageable, and coherent. Pregnancy is considered as a crucial time period where an individual experiences increased stress and apprehension which could indirectly affect the child's Quality of Life. Hence, it is important to assess the SOC during this phase of life. Aims: This study aimed to assess the SOC and knowledge about early childhood caries (ECC) among pregnant women and to correlate SOC, level of education, and oral health status of the pregnant women. Materials and Methods: A questionnaire-based cross-sectional study was conducted on pregnant women. The oral health status of the pregnant women was assessed using ICDAS II index and the education status of the participants was also obtained. Statistical Analysis Used: Chi-square test was used for intergroup comparison. Mann–Whitney U-test and Pearson's correlations were done to compare the variables between urban and rural population. Simple linear regression analysis and binary logistic regression were done to determine if SOC varied with change in other variables. Results: The mean SOC among rural and urban population were 33.64 and 41.01, respectively. It was seen that urban pregnant women had more knowledge regarding ECC and less Decayed Missing Filled Teeth (DMFT) as compared to rural pregnant women. There was an inverse relation of knowledge on ECC and SOC with DMFT among urban and rural pregnant women and a direct correlation between knowledge on ECC and SOC with education. Conclusions: This study concludes that SOC and knowledge on ECC are low among rural pregnant women. Furthermore, the SOC correlates with the level of education and oral health status of pregnant women in urban and rural districts of Bangalore, Karnataka.

Keywords: Early childhood caries, pregnant women, sense of coherence


How to cite this article:
Krishnan G, Dhananjaya G. Relationship between sense of coherence and knowledge on early childhood caries among pregnant women in Bangalore Rural and Urban District. J Indian Assoc Public Health Dent 2022;20:36-42

How to cite this URL:
Krishnan G, Dhananjaya G. Relationship between sense of coherence and knowledge on early childhood caries among pregnant women in Bangalore Rural and Urban District. J Indian Assoc Public Health Dent [serial online] 2022 [cited 2022 May 20];20:36-42. Available from: https://www.jiaphd.org/text.asp?2022/20/1/36/338517




  Introduction Top


In recent decades, public health research has increased its focus on social determinants of health and illness which has led to the emergence of theoretical approaches that stress on the social context and its interaction with biological and psychological factors,[1] one of them being salutogenesis. Salutogenesis is social medicine that focuses on factors that support human health and well-being rather than on the factors that cause diseases. The salutogenic model is mainly based on two concepts, namely general resistance resources and sense of coherence (SOC).[2]

SOC, as stated, is a global orientation that views life as comprehensible, structural, manageable, and coherent.[3] It is a way of thinking and acting that helps to distinguish usable and re-usable resources. A person with a stronger SOC is more likely to define stimuli as nonstressors or to appraise them as benign or irrelevant, and they tend to have a greater variety of coping strategies to cope appropriately with various stressors.[4]

It concentrates mostly on factors promoting health rather than those causing a particular disease.[4] Hence, SOC is a major determinant of people's position on the health ease/disease continuum and influences the movement toward the healthy end.[3] Some of the factors that greatly influence the SOC in an individual's life are old age, stress, certain setbacks in life, and pregnancy.

Amongst these phases of life, pregnancy is considered as one of the most crucial time periods where an individual experiences increased stress and apprehension which could indirectly affect the child's Quality of Life (QoL). Hence, it is important to assess the SOC during this phase of life. The SOC and QoL can have a direct or indirect effect on the general and oral health of an individual.

The oral health of children is greatly dependent on the awareness and knowledge of their caretakers on oral health. Early childhood caries (ECC) occur majorly due to lack of awareness and neglect of the caretaker toward the child's oral health. Bernabe´ et al. in 2010 conducted a study where the author presented a significant association between SOC and dental caries. Individuals with lower SOC were more likely to have a higher number of decayed teeth than individuals with higher SOC.[5]

The SOC in pregnant women and their knowledge on ECC have not been substantiated, particularly among those with a low socioeconomic status.

This study aimed to assess the SOC and the knowledge about ECC among pregnant women in Bangalore urban and rural districts and to correlate SOC, level of education, and oral health status of the pregnant women.


  Material and Methods Top


A questionnaire-based cross-sectional study was conducted in the Department of Obstetrics and Gynecology, Ramaiah Teaching Hospital, Bangalore, and Primary Health Center, Kaiwara, Karnataka, between March and November 2020. The study was approved by the institutional ethics committee. All the participants read and signed an informed consent form.

Pregnant women reporting at the Department of Obstetrics and Gynecology, Ramaiah Teaching Hospital, and Primary Health Center, Kaiwara, were included in the study, and those with any systemic illness that may contribute to dental caries were excluded from the study.

Sample size calculation was done considering the prevalence as per previous studies as 70%. The calculated sample size was n = 325 and above. To compensate for any confounding error that could occur during sample collection, 10% was increased and the final sample size obtained was 352 for urban and 341 for rural population.

Pregnant women fulfilling the inclusion criteria were approached by the investigator and informed consent to participate in the study was sought. The questionnaire about SOC and the knowledge about ECC was given to each pregnant woman and asked to fill the responses in an interviewer-based approach [Figure 1].
Figure 1: (a) Early Childhood Caries Questionnaire (b) Questionnaire Sense of Coherence (options in 5-point Likert scale from strongly disagree to strongly agree)

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A training and calibration of the investigator on ICDAS II for assessing caries experience was conducted with ten patients from the outpatient department. The procedure was repeated on the same patients later. The intra-examiner reliability was calculated and was found to be 0.82.

The oral health status of the pregnant women was assessed using ICDAS II index by the calibrated examiner and was classified as suffering or not suffering from dental caries.

The education status of the participants was also obtained and was graded as below primary, primary, secondary, higher secondary, and graduate.

Statistical analysis

The data were entered into an Excel spreadsheet and analyzed using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. (Armonk, NY: IBM Corp.). Descriptive statistics were calculated for each question in urban and rural population. Chi-square test was used for intergroup comparison. The significance level was set at 0.05 (95% Confidence Interval [CI]). Mann–Whitney U-test and Pearson's correlations were done to compare the variables between urban and rural populations. Simple linear regression analysis and binary logistic regression were done to determine if SOC varied with a change in other variables (P < 0.05 – significant, CI = 95%).


  Results Top


The mean SOC among rural population was 33.64 and the mean SOC among urban population was 41.01 [Table 1].
Table 1: Mean sense of coherence among pregnant women of urban and rural districts

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For questions 1, 2, and 5, majority of the rural participants opted option 3 and urban participants chose option 5. For questions 3, 8, 10, 11, and 12, majority of rural and urban population opted option 2. For question 4, majority of rural population opted for option 1 and urban opted option 2. For question 6 and 13, majority of rural population chose option 3 and urban chose option 2. For question 7, majority of urban and rural population chose option 4. For question 9, majority of rural and urban population chose option 2 and 5, respectively. All the responses were statistically significant (P ≤ 0.05) [Figure 2]. Thus, it was found that urban pregnant women had more SOC as compared to rural pregnant women and this was statistically significant (P ≤ 0.05).
Figure 2: Comparison between rural and urban response to Sense of Coherence questionnaire (Question 1–4) (b) Comparison between rural and urban response to Sense of Coherence questionnaire (Question 5–8) (c) Comparison between rural and urban response to Sense of Coherence questionnaire (Question 9–13)

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[Table 2] shows the comparison between rural and urban responses to knowledge on ECC questionnaire.
Table 2: Comparison between rural and urban responses to knowledge on Early Childhood Caries Questionnaire

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In the present scenario, both rural and urban population had awareness and knowledge about the causative factors of ECC such as consumption of sweet food and bottle or breastfeeding and how it is affecting the children below 2 years age. They were also well aware of the fact when to wean off the kid from bottle feeding to sippy cups, cleaning the gums after feeding and how important it is to brush the teeth of children. Furthermore, they were aware of the impact of oral health on general health and the importance of visiting the dentist before 2 years of age. However, in comparison to the rural population, urban population is more aware and educated about the same. Thus, it was seen that urban pregnant women had more knowledge as compared to rural pregnant women regarding ECC.

[Table 3] describes the comparison of mean Decayed Missing Filled Teeth (DMFT) among rural and urban pregnant women. The mean DMFT among rural and urban pregnant women were 0.6070 ± 0.48 and 0.2170 ± 0.41, respectively. The U-value derived was 11.23 and it was found to be statistically significant, which suggests that urban population had less DMFT as compared to rural population.
Table 3: Comparison of mean Decayed Missing Filled Teeth among rural and urban pregnant women

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[Table 4] describes the correlation between knowledge on ECC and DMFT among urban and rural pregnant women. It is evident from the table that the r-value obtained was −0.59 for urban and −0.74 for rural women which was found to be statistically significant. Thus, there was an inverse relation of knowledge on ECC and DMFT among urban and rural pregnant women, which suggests that with increase in knowledge of ECC, the DMFT decreased.
Table 4: Correlation between knowledge on early childhood caries and Decayed Missing Filled Teeth among urban and rural pregnant women

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[Table 5] describes the correlation between knowledge on ECC and level of education among urban and rural pregnant women. It is evident from the table that the r-value obtained was 0.89 for urban and 0.48 for rural women, which was found to be statistically significant. This suggests that there was a direct correlation between knowledge on ECC and education, which infers that with increase in education, the ECC knowledge also increased.
Table 5: Correlation between knowledge on early childhood caries and level of education among urban pregnant women

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[Table 6] describes the correlation between SOC and DMFT among rural and urban pregnant women. It is evident from the table that the r-value derived was − 0.34, which suggests that there is an inverse correlation between SOC and DMFT, i.e., with increase in SOC the DMFT decreased.
Table 6: Correlation between sense of coherence and Decayed Missing Filled Teeth among rural and urban pregnant women

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[Table 7] describes the correlation between SOC and education among rural and urban pregnant women. It is found that the r-value derived was 0.45, which was statistically significant, this suggests that there was a direct correlation between SOC and education, i.e., with increase in educational score the SOC increased.
Table 7: Correlation between sense of coherence and education among rural and urban pregnant women

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  • Equation for determination of SOC (rural): 34.75 + (1.265 × education of rural pregnant women) + (−4.418 × DMFT of rural children)
  • Equation for determination of SOC (urban): 34.75 + (1.265 × education of urban pregnant women) + (−4.418 × DMFT of urban children).


[Table 8] determines the SOC from oral health status and education level among rural and urban pregnant women. It was found that the SOC obtained through the filled questionnaire was 33.64 ± 7.08 and 41.01 ± 7.90, respectively, for rural and urban pregnant women.A simple linear regression analysis was applied on the education and the oral health status to determine whether a change in these factors would affect the overall SOC. After applying the simple linear regression analysis the outcomes obtained were, 35.59 ± 3.17, and 39.10 ± 2.29 for rural and urban pregnant women respectively. This regression outcome was found to be statistically significant. Thus, this suggest that there was a direct relation of education to sense of coherence which in turn has an affect on DMFT among rural and urban pregnant women.
Table 8: Determination of sense of coherence among pregnant women according to oral health status and level of education

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[Table 9] describes the outcome of DMFT among rural and urban pregnant women with knowledge of ECC. It was found that the beta value (constant) was −0.337 with a standard error of 0.077 and this was found to be statistically significant. The odds ratio thus derived was 0.68 which suggests that with lesser the knowledge among rural pregnant women, there are 68.6 odds of increased DMFT as compared to urban pregnant women.
Table 9: Determination of the outcome of Decayed Missing Filled Teeth among rural and urban population with knowledge on early childhood caries

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[Table 10] describes the outcome of DMFT among rural and urban pregnant women with SOC. It was found that the beta value (constant) was −0.078 with a standard error of 0.017, this was found to be statistically significant. The odds ratio thus derived was 0.925, which suggests that with lesser the SOC among rural pregnant women, there are 92.5 odds of increased DMFT as compared to urban pregnant women.
Table 10: Determination of the outcome of Decayed Missing Filled Teeth among rural and urban population with sense of coherence



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  Discussion Top


Health is overseen by the social, physical, economic, and cultural environment in which people work and live. The “victim blaming” orientation of lifestyle approach is fundamentally defective strategy and had been a point of criticism by experts. The effect of positive aspects of an individual's personality has been recently being considered by the experts. Considering the determinants of health promotion or health behavior, an individual responsibility is analyzed differently. With the introduction of concepts such as salutogenesis and SOC, there has been a shift of focus.[3]

A trait of personality developed during early adolescence and stabilized around 30 years of age is known as SOC. A more recent analysis aimed at assessing the validity and reliability of the SOC and found that it is not fully stable, as SOC tends to increase with age and the scale is multidimensional.

Sjöström et al. discovered that SOC was a good predictor of women's well-being during pregnancy and childbirth, while sociodemographic history was not. The authors found no changes in SOC over time and concluded that during the childbearing era, SOC becomes constant.[6] Other scholars, on the other hand, have emphasized the importance of external feedback, such as counseling.[5]

The three sociodemographic variables of economic status, educational level, and gender were found to be strongly correlated with SOC in a study by ShifraSagy. Educational attainment was also linked to family coping resources, a strong belief system, a sense of worth, and self-assurance.[7]

In the present study, it was found that level of education is highly correlated with the SOC of the pregnant women. This could be because of the ability to understand and use the available resources in the most appropriate manner and having less dependency on others for their self needs.

Oral health literacy refers to a person's ability to acquire, process, and comprehend essential oral health knowledge and resources to make informed health decisions.[8] The oral health literacy of parents is a significant factor in children's overall health.[9]

Caregivers of children with ECC were more likely to conclude that caries had little impact on the child's health, while those who felt primary teeth were relevant had children with slightly less decay.[10] In several studies, their knowledge of child oral health was also found to be lacking.[11-13]

The factors associated with poor attitudes and decreased knowledge among these caregivers include low socioeconomic status,[14] lack of further education,[15] high caries status in the children,[15] and difficult past dental experience[16] among others.

In other research, urban Mexican–American and immigrant Latino mothers were unable to identify cariogenic foods other than candy and expressed skepticism about the extent to which bottle feeding is harmful to oral health.[17] While Schroth et al., 2007, stated that 98% of children had juice in bottles or sippy cups. Bottle feeding was also common in the study, with the majority of children receiving the bottle at naptime. Parents of children with ECC were more likely to disagree that night-time nursing was healthy, suggesting that parental awareness is high but not reflected in their children's dental health.[10]

In Wuhan, China, and Romania, however, only 42% and 39% of mothers, respectively, recognized that sugar was the source of dental caries. In certain research, only a small percentage of participants were able to classify the sugary diet.[17],[18]

In the present study, majority of the population were aware of the ill effects of poor diet and lack of oral hygiene on oral health.

Poor awareness was expressed by 12%–37% of pregnant women in rural south India in a study by Pentapati et al. The number of pregnancies and educational status had a significant relationship with caries knowledge.[19]

Three research looked at mothers/parents SOC in relation to dental caries in preschoolers.[2],[20],[21] According to Bonanato et al., 2009, mothers with lower SOC had a greater risk of their children developing dental caries, including caries involving pulp and filled teeth.[2] Parents of caries-free children had higher SOC scores than parents of children with dental caries, according to Albino et al., 2014.[2]

Our study noted a significant correlation between SOC and dental caries, suggesting that an increased SOC denoted a decreased mean DMFT among pregnant women in both urban and rural districts.

A study by Suma Sogi et al. noted an overall mean knowledge on ECC of 69.5% among parents in Belagavi, Karnataka. They also noticed that the knowledge on ECC increased with the level of education of these parents.[22]

In the present study, we found a statistically significant association between level of education and knowledge about ECC among pregnant women in rural and urban districts of Bangalore. The limitation of the study is that the correlation between SOC and knowledge on ECC among pregnant women has not been established and the study cannot be generalized due to the low sample size.


  Conclusions Top


This study concludes that SOC and knowledge on ECC are low among rural pregnant women. Furthermore, the SOC correlates with the level of education and oral health status of pregnant women in urban and rural districts of Bangalore, Karnataka.

Acknowledgment

I thank Dr. Naveen for guiding me with the statistical analysis, also my sincere thanks to the Primary Health Centre, Kaiwara, and Ramaiah Teaching Hospital, for allowing me to conduct the survey in their institutions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Newton JT, Bower EJ. The social determinants of oral health: New approaches to conceptualizing and researching complex causal networks. Community Dent Oral Epidemiol 2005;33:25-34.  Back to cited text no. 1
    
2.
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Antonovsky A. Unraveling the mystery of health: How people manage stress and stay well. Jossey-bass; 1987.  Back to cited text no. 3
    
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Bernabé E, Watt RG, Sheiham A, Suominen-Taipale AL, Uutela A, Vehkalahti MM, et al. Sense of coherence and oral health in dentate adults: Findings from the Finnish Health 2000 survey. J Clin Periodontol 2010;37:981-7.  Back to cited text no. 5
    
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Sjöström H, Langius-Eklöf A, Hjertberg R. Well-being and sense of coherence during pregnancy. Acta Obstet Gynecol Scand 2004;83:1112-8.  Back to cited text no. 6
    
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Sagy S, Antonovsky H. The development of the sense of coherence: A retrospective study of early life experiences in the family. Int J Aging Hum Dev 2000;51:155-66.  Back to cited text no. 7
    
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Schroth RJ, Cheba V. Determining the prevalence and risk factors for early childhood caries in a community dental health clinic. Pediatr Dent 2007;29:387-96.  Back to cited text no. 10
    
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Blinkhorn AS, Wainwright-Stringer YM, Holloway PJ. Dental health knowledge and attitudes of regularly attending mothers of high-risk, pre-school children. Int Dent J 2001;51:435-8.  Back to cited text no. 11
    
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Orenuga OO, Sofola OO. A survey of the knowledge, attitude and practices of antenatal mothers in Lagos, Nigeria about the primary teeth. Afr J Med Med Sci 2005;34:285-91.  Back to cited text no. 13
    
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Finlayson TL, Siefert K, Ismail AI, Sohn W. Psychosocial factors and early childhood caries among low-income African-American children in Detroit. Community Dent Oral Epidemiol 2007;35:439-48.  Back to cited text no. 14
    
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Szatko F, Wierzbicka M, Dybizbanska E, Struzycka I, Iwanicka-Frankowska E. Oral health of Polish three-year-olds and mothers' oral health-related knowledge. Community Dent Health 2004;21:175-80.  Back to cited text no. 15
    
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Tickle M, Milsom KM, Humphris GM, Blinkhorn AS. Parental attitudes to the care of the carious primary dentition. Br Dent J 2003;195:451-5.  Back to cited text no. 16
    
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Horton S, Barker JC. Rural Latino immigrant caregivers' conceptions of their children's oral disease. J Public Health Dent 2008;68:22-9.  Back to cited text no. 17
    
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Petersen PE, Danila I, Samoila A. Oral health behavior, knowledge, and attitudes of children, mothers, and schoolteachers in Romania in 1993. Acta Odontol Scand 1995;53:363-8.  Back to cited text no. 18
    
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Pentapati KC, Acharya S, Bhat M, Rao SK, Singh S. Knowledge of dental decay and associated factors among pregnant women: A study from rural India. Oral Health Prev Dent 2013;11:161-8.  Back to cited text no. 19
    
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Albino J, Tiwari T, Henderson WG, Thomas J, Bryant LL, Batliner TS, et al. Learning from caries-free children in a high-caries American Indian population. J Public Health Dent 2014;74:293-300.  Back to cited text no. 20
    
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Sá-Pinto AC, Coelho VS, Barbosa IF, Menezes-Silva R, Ramos-Jorge ML. Relationship between mother's sense of coherence and oral health of babies aged 6-36 months: A Pilot study. Pesqui Bras Odontopediatria Clín Integr 2016;16:185-93.  Back to cited text no. 21
    
22.
Suma Sogi HP, Hugar SM, Nalawade TM, Sinha A, Hugar S, Mallikarjuna RM. Knowledge, attitude, and practices of oral health care in prevention of early childhood caries among parents of children in Belagavi city: A Questionnaire study. J Family Med Prim Care 2016;5:286-90.  Back to cited text no. 22
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]



 

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