|Year : 2020 | Volume
| Issue : 2 | Page : 183-188
Knowledge and attitude of school teachers toward thumb-sucking habit in children
Vinod Birra1, Mathai Thomas2, Kranti Kiran Reddy Ealla3, Vinod Kumar4, Sowmya Marri5, Durga Prasad Mudrakola6, Veena Shivanna7
1 Department of Dentistry, Government Medical College, Srikakulam, Andhra Pradesh, India
2 Department of Periodontics, PSM College of Dental Sciences and Research, Akkikavu, Trichur, Kerala, India
3 Department of Oral Maxillofacial Pathology, Malla Reddy Institute of Dental Sciences, Suraram, Hyderabad, Telangana, India
4 Department of Pedodontics and Preventive Dentistry, Navodaya Dental College and Hospital, Raichur, Karnataka, India
5 Department of Public Health, WKU, USA
6 Department of Public Health, Faculty of Dentistry, AIMST University, Bedong, Kedah, Malaysia
7 Department of Pedodontics and Preventive Dentistry, Sri Hasanamba Dental College and Hospital, Hassan, Karnataka, India
|Date of Submission||25-Apr-2019|
|Date of Decision||08-Jun-2019|
|Date of Acceptance||16-Jul-2019|
|Date of Web Publication||22-Jul-2020|
Kranti Kiran Reddy Ealla
Department of Oral Maxillofacial Pathology, Malla Reddy Institute of Dental Sciences, Suraram, Hyderabad, Telangana
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Thumb sucking is the most prevalent oral habits among toddlers infants and children. Children spend considerable amount of time in school. Hence, school teachers, especially primary school teachers can play an important role in developing health habits in their students. There are lack of studies on the assessment of teacher's knowledge and attitude about thumb-sucking habit. Aim: The study was undertaken to determine the knowledge and attitude of school teachers toward thumb-sucking habit in children. Methodology: Pretested questionnaires that involved paper and pen were distributed to the study participants in person and the filled questionnaires were collected on the same day. Then, the completely filled questionnaires were statistically analyzed using descriptive statistics (percentage). Results: Many respondents were unaware of thumb-sucking habit. High percentage of the study participants adopted similar methods to stop thumb-sucking habit in school children. Many teachers indicated that the Internet was the leading source of information about thumb-sucking habit. Furthermore, many teachers were willing to learn more about the prevention and management of the thumb-sucking habit. Most of the study participants felt that counseling of parents and child is very important to stop the habit. Large percentages of teachers were unaware of the role of the dentist in the management of thumb-sucking habit and its associated malocclusion. Conclusion: In this study, the primary school teachers lack the knowledge about thumb-sucking habit in children and their attitude was also found to be unsatisfactory. They need educational programs and symposiums to update their knowledge about the pernicious oral habits.
Keywords: Attitude, knowledge, oral habits, teachers, thumb sucking
|How to cite this article:|
Birra V, Thomas M, Reddy Ealla KK, Kumar V, Marri S, Mudrakola DP, Shivanna V. Knowledge and attitude of school teachers toward thumb-sucking habit in children. J Nat Sc Biol Med 2020;11:183-8
|How to cite this URL:|
Birra V, Thomas M, Reddy Ealla KK, Kumar V, Marri S, Mudrakola DP, Shivanna V. Knowledge and attitude of school teachers toward thumb-sucking habit in children. J Nat Sc Biol Med [serial online] 2020 [cited 2020 Aug 4];11:183-8. Available from: http://www.jnsbm.org/text.asp?2020/11/2/183/290477
| Introduction|| |
Some oral habits are part of the behavior of small children. However, they may become harmful or damaging when occurring extensively or inappropriately. Thumb sucking, pacifier, bottle, and mouth breathing, among others, are considered nonphysiological, therefore, deleterious or parafunctional habits. Thumb sucking is not just a simple habit, but it should be considered as an activity that serves as an adaptive function for infants and toddlers by providing stimulation or self-soothing. Thumb-sucking habit is more prevalent and considered as a normal phenomenon in the first 2 years with a reported prevalence of 20%–30%.,
Children spend considerable amount of time in school, especially during the age when their habits are being formed. Hence, school teachers, especially primary school teachers, can play an important role in developing healthy habits in their students., It is now a well-established fact that school teachers have an internationally recognized potential role in school-based dental education and considerable importance has, therefore, been attributed to their dental knowledge.
The teachers should be well-trained with good knowledge and positive approach toward the prevention of pernicious oral habits so that they can efficiently curtail the bad oral habits developing in school children. In this way, primary school teachers play a vital role in instilling positive attitude in school children.
There are many studies carried out on knowledge and attitude of mothers toward thumb-sucking habit in children, but no studies have been done on the assessment of primary school teacher's knowledge and attitude about thumb-sucking habit in school children. Hence, this study was undertaken to determine the knowledge and attitude of primary school teachers toward thumb-sucking habit in children.
| Methodology|| |
A specific questionnaire was prepared to determine the knowledge and attitude of primary school teachers about thumb-sucking habit in children. The questionnaire was tested for validity and reliability. The overall questionnaire validity was 83% and each question validity was 77%–90%, which was acceptable for the study. The reliability of the questionnaire was assessed using Cronbach's alpha, and the reliability of the questionnaire was 0.85, which was acceptable for the study. This study has been carried out in India.
The questions that were distributed to the study participants included knowledge of habit, their approach toward thumb-sucking habit in school children, etiology of habit, and their willingness to refer the affected children to dentists. Personal information was not obtained to keep the anonymity of the study participants. After informed consent, the pretested questionnaire was physically distributed to the primary school teachers who were available in schools and was collected soon after completion by respondents. The questionnaire was administered in English. If any teacher failed to comprehend the meaning of any questions due to the linguistic barrier, they were given sufficient explanation by one of our authors so that the study participants were able to respond properly. After collecting the questionnaire, each study participant was briefed about the information of thumb-sucking habits and its ill effects on dentition and a relevant handout was given to each study participant. The completely filled questionnaires were statistically analyzed using descriptive statistics (percentage). Half-filled questionnaire and incomplete filled questionnaires were discarded. The data were subjected to descriptive statistics (percentage).
| Results|| |
The number and the response rate of the study participants are presented in [Table 1]. A total of 468 study participants participated in this study and all responded to all questions; thus, the response rate was 100%. Knowledge and attitude questions and its responses are presented in [Table 2] and [Table 3].
Knowledge questions and its response [Table 2]
Of 468 study participants, only 150 (32.05%) were aware of oral habits and remaining 318 (69.94%) respondents were unaware of oral habits.
Around 190 (40.6%) of respondents were aware of thumb-sucking habit, and 278 (60%) did not know about thumb-sucking habit. Among 278 respondents who knew about thumb-sucking habit, 80 (17.40%) study participants knew about its ill effects and 110 (23.50%) respondents were unaware about its ill effects.
Among the study participants who were aware regarding various ill effects of thumb-sucking habit, 35 (7.47%) respondents expressed unsightly appearance, 20 (4.27%) indicated mal-positioning of teeth, 10 (2.13%) respondents said that it will have psychological effect and 15 (3.20%) of the study participants pointed all of the above.
About causes of thumb-sucking habit; 21 (4.48%) study participants said that its due to psychological effect, 39 (8.33%) expressed its due to inadequate parental care, 42 (8.97%) opined its habitual, and 88 (18.80%) study participants were unaware about the cause.
Regarding the treatment of thumb-sucking habit; 59 (12.60%) of the study participants do not know how to stop the habit, 54 (11.53%) said application of bandage on thumb, 41 (8.76%) study participants felt that bitter substance application can reduce thumb-sucking habit, 26 (5.55%) respondents said counseling of child will do away with the habit, and 10 (2.13%) of study population viewed that parental counseling is the right way to stop the thumb-sucking habit.
About 90 (19.23%) of study population expressed that Internet is the source of information related to thumb-sucking habit, 30 (6.41%) of the study participants said that newspaper has provided them information about thumb-sucking habit, 25 (5.34%) of study population said that electronic media is their source of information, 30 (6.41%) study participants said that health professionals have provided them relevant information, 5 (1.06%) of respondents said that they got information through social media and 10 (2.13%) of the study population received information through their colleagues.
On asking the respondents about up to what age thumb-sucking habit is acceptable? around 42 (8.9%) respondents said below 3 years, 40 (8.54%) expressed below 4 years, 49 (10.47%) opined below 5 years, 37 (7.9%) indicated below 6 years, 51 (10.9%) said that it is not acceptable at any age, and remaining 249 (53.2%) expressed that they were unaware about the age of acceptability.
Around 89 (19.01%) of respondents opined that if thumb-sucking habit is not stopped early it may lead to deeply embedded habit and later difficult to stop it, while 107 (22.86%) confidently said “no” and remaining 272 (58.11%) of the study population were unaware that if thumb-sucking habit was not contained early it causes greater damage on dentition.
Around 26 (5.55%) of the study participants expressed that sudden stoppage of thumb-sucking habit leads to tongue thrusting habit, whereas 152 (32.4%) said no and remaining 290 (61.9%) of study population were unaware about it.
Almost 206 (44%) study participants were aware that thumb-sucking habit causes malocclusion, whereas 140 (29.9%) study participants said “no” and remaining 122 (26%) respondents expressed that they do not know about it.
Among the study participants who knew about thumb-sucking habit causing malocclusion at various ages; around 20 (4.27%) of the study population said that thumb-sucking habit causes malocclusion below 3 years of age, 26 (5.55%) said below 4 years, 36 (7.69%) said below 5 years, 33 (7.05%) felt below 6 years, 35 (7.47%) viewed below 7 years, and remaining 56 (11.96%) of respondents indicated that it can cause malocclusion at any age [Table 2].
Attitude questions and its response [Table 3]
Around 158 (33.76%) of the study population noticed thumb-sucking habit in children whereas 310 (66.23%) did not notice habit. Among the respondents who noticed thumb-sucking habit in school children, 26 (5.55%) of respondents counseled the parents to give adequate care to child, 30 (6.41%) of study participants counseled the child to stop the habit, 39 (8.33%) of respondents applied bitter substance on finger to stop the habit, 38 (8.11%) applied bandage on the finger, and 25 (5.34%) study participants advised long sleeves for thumb-sucking child.
On asking about observation of abnormal oral features in thumb-sucking child; 248 (52.99%) of the study participants said that they noticed abnormal oral structures in thumb-sucking child, and 220 (47%) study population did not notice any abnormal oral structures in thumb-sucking child. Among the respondents who noticed abnormal oral structures; 43 (9.18%) noticed deep palate, 58 (12.39%) found forward placement of teeth, 49 (10.47%) found gap in teeth, 50 (10.68%) observed mal-alignment of teeth, and 48 (10.25%) of respondents found all of the above abnormal oral features.
Almost 297 (62.66%) of the study population noticed abnormal features on thumb of thumb-sucking child and remaining 171 (37.33%) did not observe anything. Among the study participants who had observed abnormal features on thumb; 54 (11.53%) observed clear finger, 50 (10.68%) found reddened finger, 56 (11.79%) observed chapped finger, 53 (11.32%) saw callus on superior part of finger, 46 (9.82%) observed short nail on finger, and remaining 38 (8.11%) found all of the above abnormalities on the finger.
Only 191 (40.81%) of the study population advised parents to counsel dentist for the treatment of thumb-sucking habit and its associated malocclusion, whereas large percentage 277 (59.18%) of respondents did not advise parents to consult dentist.
Only 195 (41.66%) of the study population felt that thumb-sucking habit should be referred to dentist for the better management of thumb-sucking child and majority, 273 (58.33%) of the study participants felt not to refer to dentist. Among the school teachers who felt thumb-sucking child to be referred to dentist; 47 (10.04%) referred to thumb-sucking child to dentist all the times, 54 (11.53%) referred most of the times, 48 (10.25%) rarely referred to dentist and remaining 46 (9.82%) of the study participants so far not referred to any dentist.
Large majority, 445 (95.08%) of respondents wanted to learn more about thumb-sucking habits, its prevention and management, whereas only 23 (4.91%) of study populations are not interested to learn more about thumb-sucking habit.
Overwhelming majority 459 (98.07%) of the study participants felt that more information should be provided about thumb-sucking habit and only 9 (1.92%) of the study population said that the information available about thumb-sucking habit is enough [Table 3].
| Discussion|| |
Primary school teachers can play an essential role in imparting health education at schools. The assessment of knowledge and attitude of primary school teachers is important because they have tremendous influence on school children in promoting oral health.
There are several negative outcomes associated with thumb-sucking habit. The most frequent concern related to chronic thumb-sucking habit is development of malocclusion, increased overjet, cross bite, and anterior open bite. These problems may not self-correct if thumb sucking persists beyond 4 years of age.
The relationship of pernicious oral habits of children with adverse effects has been well-confirmed by various studies; thus, it is very important for school teachers to be aware of risk factors for the timely intervention and prevention. In our finding most of the school teachers, adopted similar methods in trying to terminate the thumb-sucking habit in children.
The study indicated that most of the school teachers did not accept the thumb-sucking habit; these findings are in agreement with the study done by Alfayeez et al., in which around 70% of participants indicated that thumb-sucking habit is an unacceptable habit.
The harmful effect of thumb-sucking habit on oral structures is recognized by 53% of school teachers. Our study is in agreement with the studies done by Al-Hussyeen, Al-Jobair and Al-Emran, and Vadiakas et al.
In our findings, many teachers expressed that counseling of the parents and child is important to do away with the habit. Most of the study participants were able to notice abnormal oral features in thumb-sucking child but only 41% of school teachers referred those children to dentist for better management of thumb-sucking habit. This proves that many school teachers were unaware regarding the major role of dentists in thumb-sucking habit management and its associated malocclusion. The school teachers should encourage parents to consult dentist if the school children are practicing thumb-sucking habit beyond 4 years of age.
In our observation, around 95% of school teachers were willing to learn about the prevention and immediate management of thumb-sucking habit and 98% of the study participants felt that they need more information about the thumb-sucking habit. Our observations reveal the necessity of health education among primary school teachers. Education about oral health habits prevention must be offered to the primary school teachers in order to promote better oral health among school children.
This study sample size is small and this study has been done in India, and hence, the knowledge and attitude of Indian teachers may not reflect the attitude and knowledge of the entire world.
| Conclusion|| |
Primary school teachers lack the knowledge about thumb-sucking habit in children and their attitude was also found to be unsatisfactory. There is a definite need of education programs and symposiums to help them upgrade their knowledge about pernicious oral habits. Better knowledge and positive attitude of teachers brings positive influence on child's oral health. We recommend further studies in different countries to assess the knowledge and attitude of teachers toward thumb-sucking habit. The result of this study may be helpful for the government agencies/nongovernmental organizations in the respective countries to take adequate measures to provide good knowledge and management skills to teachers which will improve the oral health of children.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Maghalhaes LN, Rodrigues MJ, Heimer MV, Alencar AS. Prevalence of non-nutritive sucking habits and its relation with anterior open bite in children seen in the odontopediatric clinic of the university of Pernambuco. Dental Press J Orthod 2012;17:119-23.
Leite-Cavalcanti A, Medeiros-Bezerra PK, Moura C. Breast-feeding, bottle-feeding, sucking habits and malocclusion in Brazilian preschool children. Rev Salud Publica (Bogota) 2007;9:194-204.
Byrd MR, Nelson EM, Manthey LM. Oral-D thumbal habits of childhood: Thumb sucking. In: JE. Fischer, O'Donohue WT, editors. Practitioners Guide to Evidence-Based Psychology. New York: Springer Publication Co.; 2006. p. 718-25.
Bishara SE, Warren JJ, Broffitt B, Levy SM. Changes in the prevalence of nonnutritive sucking patterns in the first 8 years of life. Am J Orthod Dentofacial Orthop 2006;130:31-6.
Duncan K, McNamara C, Ireland AJ, Sandy JR. Sucking habits in childhood and the effects on the primary dentition: Findings of the Avon longitudinal study of pregnancy and childhood. Int J Paediatr Dent 2008;18:178-88.
Mota A, Oswal KC, Sajnani DA, Sajnani AK. Oral health knowledge, attitude, and approaches of pre-primary and primary school teachers in Mumbai, India. Scientifica (Cairo) 2016;2016:5967427.
Al-Tamimi S, Petersen PE. Oral health situation of schoolchildren, mothers and schoolteachers in Saudi Arabia. Int Dent J 1998;48:180-6.
Petersen PE, Esheng Z. Dental caries and oral health behaviour situation of children, mothers and schoolteachers in Wuhan, people's republic of China. Int Dent J 1998;48:210-6.
Sgan-Cohen HD, Saadi S, Weissman A. Dental knowledge and attitudes among arab schoolteachers in Northern Israel. Int Dent J 1999;49:269-74.
Alfayeez NA, Alnussyan NS. Attitude of mothers towards prolonged non-nutritive sucking habits in children in Qassim province. Int J Med Health Res 2017;12:57-62.
Al-Hussyeen AJ. Attitudes of Saudi mothers towards prolonged non-nutritive sucking habits in children. Saudi Dent J 2010;22:77-82.
Al-Jobair A, Al-Emran SE. Attitudes of Saudi Arabian mothers towards the digit-sucking habit in children. Int J Paediatr Dent 2004;14:347-54.
Vadiakas G, Oulis C, Berdouses E. Profile of non-nutritive sucking habits in relation to nursing behavior in pre-school children. J Clin Pediatr Dent 1998;22:133-6.
[Table 1], [Table 2], [Table 3]