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ACTA SCIENTIFIC Dental Sciences
Volume 8 Issue 11 November 2024
Parents’ Knowledge and Attitudes in Oral Health in their Down’s Syndrome Children in Benghazi,
Libya
Fatma G Ashlak1, Fowziya M Ali1 and Ahmed Abouserwel2*
1Paediatric Dentistry, University of Benghazi, Libya
2Dental Board, Hywel Dda University, UK
*Corresponding Author: Ahmed Abouserwel, Dental Board, Hywel Dda University, UK.
Research Article
Received: October 07, 2024
Published: October 31, 2024
© All rights are reserved by
Ahmed Abouserwel., et al.
Abbreviations
Abstract
Keywords: Down Syndrome; Oral Health; Children; Parents’ Knowledge; Attitude
The primary objective was to evaluate parents' knowledge and attitudes toward oral health in their children with Down syndrome
in Benghazi.
Subjects and Methods At rehabilitation facilities that treat individuals with Down syndrome (DS), a cross-sectional study on the
parents of their children receiving services from government and non-government institutions in Benghazi was conducted. Two sec-
tions of a self-generated questionnaire with 27 questions about the patient's medical history, sociodemographic, and dental health
treatment were utilized to gather data. The University of Benghazi’s Research Committee at the Faculty of Dentistry provided ethical
approval (reference number 086). Before the study began, all parents signed a consent form.
Results: Of the 102 questionnaires given to participating parents/caregivers of children with DS, 35 (34.3%) were female and 67
(65.7%) were male. Of the 60 individuals with DS, 58.8% were boys and 41.2% were girls. Of the total participants, 52.9 percent
were from the government sector and 47.1 percent were from the non-government sector for rehabilitative and educational services.
27.5%, third 13.7%, and higher 39% 21.6 had thyroid gland problems, 7.8 had heart disease, and 28.4 had diabetes. Of them, 62%
did not visit a hospital or obtain medical attention during the year. A daily toothbrush is used by 52% of participants once a day, 21%
irregularly, and 27.5% twice a day or more. Only 19% of them used rotating toothbrushes; most used manual ones. In a rehabilitation
institution, most people (96.1%) received education regarding oral health. In the preceding six months, 20.6% of respondents visited
a dentist, 63.7% did so once a year, and 15.7% never did. Visiting dentist to get an examination in 37.3%, trauma (22%), toothache
(23%), and tooth-decay (19%).
Conclusion: Parents of children with Down syndrome need educational programs that promote positive attitudes and increase
knowledge about oral health care. It is important to emphasize that parents should receive high-level information and guidance on
how to care for their affected children
DOI: 10.31080/ASDS.2024.08.1937
-
Introduction
autosomal chromosomal disorder, in 1866. It is one of the anoma-
lies in life that arises from the trisomy of chromosome 21. DS af-
fects different groups differently (1 in 319 to 1 in 1000 live births),
and it is more common in older mothers. In neonates with DS, up
to 50% may get CHD [1]. Since DS affects numerous systems, it is
linked to a variety of clinical disorders. Numerous manifestations
and signs are present in these people, including neurological traits,
-
[1-4]. The most anatomical feature of DS, including the facial mid-
Citation: Ahmed Abouserwel., et al. “Parents’ Knowledge and Attitudes in Oral Health in their Down’s Syndrome Children in Benghazi, Libya". Acta
Scientific Dental Sciences
84
Parents’ Knowledge and Attitudes in Oral Health in their Down’s Syndrome Children in Benghazi, Libya
third, is underdeveloped, creating a prognathic occlusal relation-
ship, producing a hypoplastic maxilla with a high, short, and nar-
and the mandibular prognathism is mild or marked relative to the
maxilla [5]. For children with Down syndrome, orofacial problems
are a major concern. Children with DS occasionally have physical,
mental, and structural abnormalities [5,6]. Neuro-behavioural and
mental issues are more prevalent in children with Down syndrome
(18% to 38%). Disorders characterized by disruptive behaviour,
hyperactivity disorder (6.1%), conduct/oppositional disorder
(5.4%), or aggressive behaviour (6.5%), are the most common is-
sues. Over 25% of individuals with DS suffer from a mental illness,
with major depressive disorder (6.1%) and violent behaviour
(6.1%) being the most common. Of children with DS, 7% have an
autism or autism spectrum disorder diagnosis [7]. Epilepsy is seen
in 8% of children with DS, with 40% occurring in infancy and of-
ten presenting as infantile spasms. Alzheimer’s disease which is
associated with DS appears later in life, not in childhood [8]. Ad-
ditionally, it is crucial to provide children with DS with ongoing
medical evaluations and screenings throughout their lives [9]. In
because it stimulates the development of the oral motor system.
For this reason, breastfeeding should be encouraged [10]. [More-
over, individuals with DS have unique oral health needs that are
critical to their overall health and well-being due to a variety of
physiological and medical characteristics. Dental health is direct-
ly impacted by many medical and physiological elements of DS,
which can impact the quality of life for individuals with the condi-
tion and those who provide care for them [11]. However, because
of their impaired oral motor function, children with DS can have
problems with drinking, swallowing, and chewing. Overweight and
overnutrition deserve serious attention in children with DS [12].
Modeer., et al. -
mation, periodontal pockets (5 mm), supra- and subgingival calcu-
lus, and alveolar bone loss was measured in children (10-19 years
old) with DS in comparison to an age- and sex-matched 39 con-
trol group and of the 71 children with DS participated in a clinical
and radiological evaluation. Alveolar bone loss was noted around
distance between the cementoenamel junction and the alveolar
crest exceeded 2.0 mm. Alveolar bone loss was found in 39% of
the children [13]. According to their mothers’ children with DS
could have a variety of issues, including Mothers reporting that
their children’s overall mood was impacted by the painful behav-
iours they saw in them. Some moms claimed that their children
cried out stopped laughing, and got furious, which was thought to
be an indication that their children were experiencing tooth pain.
Some moms mentioned that their infants were dribbling or drool-
ing, while others said that their children’s tongues were compara-
tively large or protruding when they were younger. Mothers stated
that because of the early functional therapy interventions they re-
ceived, these issues seemed to lessen as their child grew older and,
in several cases, were nearly resolved [14]. A study on dental caries
in individuals with DS found that only approximately 31% of the
participants had parental assistance when brushing their teeth and
that roughly 50% of people with caries and the other half are free of
caries. Although 91% of persons experience physical and/or cogni-
tive impairments when following the recommended dental hygiene
procedures [15,16]. In contrast, periodontal disease is prone to
being particularly aggressive in a patient with DS [11,16]. A com-
prehensive analysis of the evidence implies reduced caries in indi-
viduals with DS. Furthermore, gingivitis and periodontitis are more
frequent in people with DS and are strongly associated. Oral func-
tion in DS is also affected resulting in speech, breathing, and eating
intervention protocols, for the younger generations of individuals
with DS, their families, and caregivers [17]. Previous studies have
indicated that the parents did not have enough knowledge about
the importance of regular dental examinations on oral and dental
health (Kalyoncu, 2018). Furthermore, the oral hygiene of children
with DS and the oral hygiene knowledge of their parents showed
a notable and robust inverse association. Dental hygiene practices
[18].
Subjects and Methods
The current study was planned to assess parental knowledge
and attitudes toward oral health in their children with DS in Beng-
hazi. A cross-sectional survey using a questionnaire for data col-
lection of parents concerning the oral health status of DS children
in Benghazi City. The current study’s population consists of the
government and non-government DS Association of parents in
Benghazi city. Approval from authorities from Benghazi Univer-
sity was provided, and permission for participation was delivered
to clinic principals. There were two sections to the questionnaire
created for this study. The respondent’s background information
age group, income, and employment of their parents. The second
section of the questionnaire, which covers oral and dental hygiene
practices, is the primary portion. It aims to ascertain respondents’
overall knowledge and attitude toward oral health care. Version 25
of (SPSS) was used to analyse the data. Descriptive statistics were
Citation: Ahmed Abouserwel., et al. “Parents’ Knowledge and Attitudes in Oral Health in their Down’s Syndrome Children in Benghazi, Libya". Acta
Scientific Dental Sciences
85
Parents’ Knowledge and Attitudes in Oral Health in their Down’s Syndrome Children in Benghazi, Libya
recorded through frequency and percentages. The chi-square test
was used to compare differences in proportions with parents’
knowledge and attitudes.
Results
Table 1 displays that the majority (59.8%) of DS children in the
survey were from the age group (10-14 years). However, the mi-
Variables Numbers Percentage
Age Child Less than 5 8 7.8
5-9 12 11.8
10-14 61 59.8
15 or More 21 20.6
Total 102 100.0%
Male 60 58.8
Female 42 41.2
Total 102 100.0%
Child Order First 21 20.6
Second 28 27.5
Third 14 13.7
More 39 38.2
Total 102 100.0
Table 1: Sociodemographic characteristics of DS children.
nority (7.8%) of children with DS are in the age group (less than
females. According to the order of children with DS in the family,
38.2% of children were of order more than the third, followed by
-
tively. In contrast, the minority of the children (13.7%) were of the
third order in their families.
According to Table 2, more than half of the participants (52.9%,
54 out of 102) were from the public sector, whereas, (47.1%, 48
out of 102) were from the private sector. Table 1 also shows that
most respondents (65.7%) were males, compared to 34.3% of fe-
males. The majority (71.6%) of respondents participating in the
survey were aged less than 60 years. Regarding the income level,
the majority (82.4%) have a moderate-income level, and the rest
(17.6%) have a low-income level. the most frequent father occupa-
tion was an employee (43.1%), followed by free business (29.4%),
while 27.2% were retired. Concerning the mothers’ occupation,
52% of the respondents were housewives; 32.4% were found to
be teachers, while 15.7% were employed. Regarding the father’s
education, 32.4% of parents have secondary level education, and
27.5% of parents have either preparatory or university level edu-
cation, whereas, the respondents with primary level education
were 12.7%, the minority of respondents participating in the sur-
vey. However, most mothers (37.3%) have a university education
level, followed by 30.4% who have a secondary education level,
while the rest of the respondents have preparatory and primary
education levels, which were the minority of respondents partici-
pating in the survey.
The majority of children (57.8%) have health problems, (Table
3). The majority of parents 62.7% reported that they had not been
referred to a hospital in the preceding year, whereas 37.3% said
they had.
The age group of the parents who were brushing the children’s
< 0.05). Compared to parents in other age groups, parents 60 years
of age or older were less likely to be supporting their children.
However, the vast majority of them (52.9%) did not encourage or
assist with their youngsters’ tooth brushing. (Table 4).
-
ents’ age group and the number of times they took their kids to
age range were more likely than those in other age groups to take
their children to the dentist. About taking their children to the den-
tist, the parents said that within six months, 20.6%, 63.7% within a
year, and 15.7% never took them. In (Table 5).
Citation: Ahmed Abouserwel., et al. “Parents’ Knowledge and Attitudes in Oral Health in their Down’s Syndrome Children in Benghazi, Libya". Acta
Scientific Dental Sciences
86
Parents’ Knowledge and Attitudes in Oral Health in their Down’s Syndrome Children in Benghazi, Libya
Variables Numbers of respondents Percentage
Sector type
Public 54 52.9
Private 48 47.1
Total 102 100.0%
Male 67 65.7
Female 35 34.3
Total 102 100.0%
Age groups
40-49 years 36 35.3
50-59 years 37 36.3
60 years or more 29 28.4
Total 102 100.0%
Income level Low 18 17.6
Moderate 84 82.4
Total 102 100.0%
Father occupation
Free Business 30 29.4
Employee 44 43.1
Retired 28 27.5
Total 102 100.0
Mother Occupation
Housewife 53 52.0
Teacher 33 32.4
Employee 16 15.7
Total 102 100.0%
Father’s education level
Primary 13 12.7
Preparatory 28 27.5
Secondary 33 32.4
University 28 27.5
Total 102 100.0
Mother’s education level
Primary 17 16.7
Preparatory 16 15.7
Secondary 31 30.4
University 38 37.3
Total 102 100.0
Table 2: Shows the distribution of DS child parents by age, gender, and socioeconomic level.
Variables Numbers Percentage
Referring to hospital
Take any medications
Yes
No
38
64
37.3
62.7
Total 102 100.0%
Yes 59 57.8
No 43 42.2
Total 102 100.0%
Type of associated disease Diabetes 29 28.4%
Thyroid gland
Heart disease
22
8
21.6%
7.8%
Total 59 58.4%
Table 3: Description of the samples according to the Down syndrome children’s health.
Citation: Ahmed Abouserwel., et al. “Parents’ Knowledge and Attitudes in Oral Health in their Down’s Syndrome Children in Benghazi, Libya". Acta
Scientific Dental Sciences
87
Parents’ Knowledge and Attitudes in Oral Health in their Down’s Syndrome Children in Benghazi, Libya
The age group of parents Every day More than once/week One or less a week Never Total
40-49 9 5 5 17 36
25.0% 13.9% 13.9% 47.2% 100.0%
50-59 9 10 2 16 37
24.3% 27.0% 5.4% 43.2% 100.0%
60 or more 2 3 3 21 29
6.9% 10.3% 10.3% 72.4% 100.0%
Total 20 18 10 54 102
19.6% 17.6% 9.8% 52.9% 100.0%
p-value = 0.046 df = 6 CC = 0.370 2χ = 10.66
Table 4: Association between age groups of parents/ caregivers and supporting a child’s tooth brushing children.
Age group Within six months Within a year Never Total
40-49 8 19 9 54
22.2% 52.8% 25.0% 100.0%
50-59 7 29 1 48
18.9% 78.4% 2.7% 100.0%
60 or more 6 17 6 27
20.7% 58.6% 20.7% 100.0%
Total 21 65 16 102
20.6%63.7% 15.7% 100.0%
p-value = 0.043 df = 4 CC = 0.280 2χ = 8.57
Table 5
parents’ age group and the dental health care facility they got (p-
health care was more likely to result in favourable outcomes than
other forms of dental car
helped their kids brush their teeth (p-value> 0.05). However, par-
-
ents, half (50.7%) of the male respondents chose to “involve the
than the female responses (Figure 2).
The relationship between fathers’ education levels and taking
(p-value < 0.05). Fathers who completed secondary school and
university had higher education levels associated with taking their
children to the dentist than other fathers. However, there was no
-
ther’s educational attainment and his assistance in brushing their
children’s teeth (Figure 3).
The mother’s occupation and the oral health care facility their
and most of them sought public health care (Figure 4).
Citation: Ahmed Abouserwel., et al. “Parents’ Knowledge and Attitudes in Oral Health in their Down’s Syndrome Children in Benghazi, Libya". Acta
Scientific Dental Sciences
Figure 1: Association between age groups of parents and
received dental health care facility.
88
Parents’ Knowledge and Attitudes in Oral Health in their Down’s Syndrome Children in Benghazi, Libya
Figure 2: Association between the most important features of the
dentists they prefer and the gender of parents.
Figure 3: Association between the father's education level and
taking their children to a dentist.
Figure 4: Association between mother's occupation and received
dental health care facility for their children.
Discussion
Children’s dental health can be neglected because of a disability,
a challenging illness, or restricted access to dental care. Parents
should be required to receive education about proper oral hygiene
for their children since it can greatly aid in the growth and devel-
opment of their teeth. Several factors, including age, education,
experience, economic and social status, the media, and the sur-
rounding environment, may have an impact on parents’ awareness
of and ability to maintain their children’s dental hygiene. The at-
their parent’s capacity to preserve their health. According to their
mothers, children with Down syndrome could have a variety of
issues, including Mothers reported that they saw signs of pain in
their children and that this had an impact on the child’s overall atti-
tude. Others claimed that their children cried out stopped laughing,
and got furious, which was thought to be an indication that their
children were experiencing tooth pain. Some moms mentioned that
their infants were dribbling or drooling, while others said that their
children’s tongues were comparatively large or protruding when
they were younger. Mothers stated that as their youngsters grew
older, these issues seemed to lessen and, in many situations, were
nearly resolved again as a result of the early functional therapy
[14,19]. Early professional treatment and daily care at home can
mitigate their severity and allow people with Down syndrome to
-
drome. Children experience rapid, destructive periodontal disease.
Consequently, large numbers of them lose their permanent anteri-
or teeth in their early teens. Contributing factors include poor oral
hygiene, malocclusion, bruxism, conical-shaped tooth roots, and
abnormal host response because of a compromised immune sys-
agent such as chlorhexidine. Recommend an appropriate delivery
method based on your patient’s abilities. Rinsing, for example, may
cannot expectorate. Chlorhexidine applied using a spray bottle or
-
tions has led to gingival hyperplasia, emphasize the importance
of daily oral hygiene and frequent professional cleanings. Encour-
age independence in daily oral hygiene. Ask patients to show you
brushing methods or toothbrush adaptations. Involve patients in
need help. Talk to their caregivers about daily oral hygiene. Do not
assume that all caregivers know the basics; demonstrate proper
holder can simplify oral care. Also, use your experiences with
each patient to demonstrate sitting or standing positions for the
caregiver. Emphasize that a consistent approach to oral hygiene
is important caregivers should try to use the same location, tim-
ing, and positioning. Dental caries. Children and young adults who
have Down syndrome have fewer caries than people without this
developmental disability. Several associated oral conditions may
Citation: Ahmed Abouserwel., et al. “Parents’ Knowledge and Attitudes in Oral Health in their Down’s Syndrome Children in Benghazi, Libya". Acta
Scientific Dental Sciences
89
Parents’ Knowledge and Attitudes in Oral Health in their Down’s Syndrome Children in Benghazi, Libya
teeth; missing permanent teeth; and small teeth with wider spaces
between them, which make it easier to remove plaque. Addition-
ally, the diets of many children with Down syndrome are closely
supervised to prevent obesity; this helps reduce the consump-
tion of cariogenic foods and beverages [20]. This study assessed
the views and comprehension of parents regarding the oral health
condition of their children with Down syndrome who attended a
rehabilitation centre, utilising data gathered from a sample of par-
ents in Benghazi City, resulting in a response rate of 98.3%. The
majority of fathers’ education levels were secondary (32.4%),
whereas the majority of mothers’ education levels were university
(37.3%), with the father’s occupations being employed (43.1%)
and housewife (52%). In contrast, in a study by Putri et al., 50%
of participants had higher education (bachelor’s or PhD degree),
and 50% had only had secondary education (Putri, 2018). Similar
to our study, another study reported that the majority of mothers
(71.4%) were housewives [21].
The results indicate that some of the parents in the study group
children with Down syndrome were male (58.8%), aged between
10 to 14 years (59.8%), and positioned higher than third in their
-
camps et al., where the majority were male [22]. Our study found
that the majority of children were not referred to a hospital during
the previous 12 months (62.7%). According to a related report by
Stensson., et al., (20%) of children had been referred to a hospital
in the previous 12 months [23]. Our study found that most of the
children used a manual toothbrush and more than half (52.9%)
reported never helping their teeth. According to a related report
by Schmidt., et al., (53.8%) of children with Down syndrome
younger than 18 years most frequently used manual toothbrushes,
(60.4%) stated that the children with DS in their home could brush
their teeth without help [24,25]. Additionally, our study reported
that (63.7%) of parents had taken their child to a dentist in the
last years and answered the reason for visiting the dentist almost
-
other study approximately half of the subjects from children with
DS had visited a dentist within the previous year [26].
Regular visits to the dentist are very important for the preven-
tion of oral diseases in disabled children and their parents for ob-
taining essential information about oral hygiene maintenance and
[23].
about the preferred dental visits and perceived obstacles to dental
care for kids with special needs and their ability to get dental care
in public dental facilities, private dentistry clinics, or specialised
of public dental health. This study aimed to characterize the dental
visitation patterns, assess accessibility, and pinpoint obstacles to
dental care for children with DS. In our study, it was observed that
most of the parents of children aged (50-59) years were statisti-
their children to the dentist within the previous “one year”. Another
study by Syama et al. found that parents of disabled children visited
the dentist more frequently (46%) in the past year than parents of
normal developing children (40%) [27]
getting an appointment was the most common perceived barrier
to dental care by parents of Down syndrome children and normal
in cooperation as a more important barrier to treatment (34.7%)
than the parents of normal children (20.3%) [27]. Another study
services for their DS child and 46.9% admitted that healthcare for
their DS child took more time [28]. In the present study, most of
the parents 52.9%) Never helped their children brush their teeth
compared to another survey, researchers discovered that nearly
59.4% of parents helped their children brush their teeth [29]. Also,
Alhaddad., et al
towards DS individuals and nearly 59.5% indicated their willing-
ness to help those with DS to lead regular lives [30]. while (95.8%)
are willing to support their children in living a normal life [31].
In our study, it was found that most parents who had better edu-
cation said that the one who trained their children in oral hygiene
was the teacher. According to a study from 2015, the majority of
information was obtained by “Dentists,” while 20% of the parents
of children with DS never received any oral hygiene advice [22].
Additionally, according to research by (Kalyoncu., et al., 2018), the
majority of families (47.5%) learned about oral hygiene through
dentists, while 18.4% did so from teachers. So it is important to
emphasize the importance of daily oral hygiene and frequent pro-
fessional cleanings. Encourage independence in daily oral hygiene.
Ask patients to show you how they brush and follow up with spe-
-
tations. Involve patients in hands-on demonstrations of brushing
about daily oral hygiene. Do not assume that all caregivers know
use your experiences with each patient to demonstrate sitting or
standing positions for the caregiver. Emphasize that a consistent
approach to oral hygiene is important caregivers should try to use
the same location, timing, and positioning. Dental caries. Children
Citation: Ahmed Abouserwel., et al. “Parents’ Knowledge and Attitudes in Oral Health in their Down’s Syndrome Children in Benghazi, Libya". Acta
Scientific Dental Sciences
90
Parents’ Knowledge and Attitudes in Oral Health in their Down’s Syndrome Children in Benghazi, Libya
Bibliography
and young adults who have Down syndrome have fewer caries
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small teeth with wider spaces between them, which make it easier
to remove plaque. Additionally, the diets of many DS children are
closely supervised to prevent obesity; this helps reduce the con-
sumption of cariogenic foods and beverages [20].
Conclusion
Parents who participated in this study had some knowledge
about the oral health of an individual with Down syndrome, but
more than half of them did not have enough general knowledge
-
ings of this study also revealed that almost all parents emphasize
that there is a need for more high-level information and guidance
and the need to improve the dental services available to individu-
als with DS. Also, parents need more attention to help their chil-
dren in terms of supervising their oral health habits and providing
dental care.
Acknowledgement
We would like to thank all parents and their children who gave
their consent to participate in this study to enhance the results and
Dr. Yousif Elgimati who assisted in the statistical analysis of this
study data.
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