רפואת הפה והשיניים - עיתון ההסתדרות לרפואת שיניים בישראל - כרך ל"ז, גיליון מס' 2 אייר תש"פ

and no fluoridated toothpaste should be used for brushing of children under the age of two years unless otherwise recommended by a dentist (19). The correct concentration of fluoride in toothpastes is of great importance with regards to caries prevention and safety (i.e. fluorosis), especially when toddlers are concerned (14, 20). Therefore, the lack of knowledge presented by the mothers regarding this important issue may have a debilitating effect on their children’s oral health. The minority of the mothers (35.8%) knew that consuming baby formulas at night had a cariogenic effect and even a lower percentage of them (13.5%) realized that nursing at night might have a cariogenic effect. The American Academy of Pediatric Dentistry (AAPD) encourages avoiding Ad libitum breast-feeding after the first primary tooth begins to erupt and other dietary carbohydrates are introduced. In addition, infants should not be put to sleep with a bottle filled with milk or liquids containing sugars (21). Both the World Health Organization (WHO) and the AAPD recognize breast feeding as an appropriate food to infants after the age of 6 months with complementary foods after the age of 6 months (22, 23). Therefore, it is necessary to educate mothers about the association between caries and ad libitum breast feeding or formula drinking at night. Diet plays a major role in caries development. Food items that contain carbohydrates, such as sucrose, glucose or fructose, are rapidly fermented by acidogenic micro-organisms and cause a decrease in pH and demineralization of the teeth 247). The preferable time to consume sugary food items is in proximity to meals (25). In our study, most of the mothers were not aware that the synchronization of consuming sugary food items is important and only 4.7% of the mothers answered correctly that the best time to consume sweet snacks is in proximity to the meals. In addition, half of the mothers stated that they use to taste their child’s food from her spoon to check that it was at the right temperature. That behavior has been also common among Jewish mothers

in Israel (two thirds of them) (16). And it has been associated with an early transmission of the cariogenic bacteria Streptococcus Mutans, which increases the risk of developing ECC in young ages (26). As for ranking the cariogenic food items, most of the mothers significantly ranked toffee as the most cariogenic food item (p=0.01). Interestingly, cereals and salty snacks were ranked as the least cariogenic food items, clarifying the poor awareness of the mothers to their sugary contents and their sticky properties that increase their cariogenicity. We found in the study that mothers who used to visit the dentist on a regular basis, demonstrated higher KOH and got a significantly higher score in the questionnaire than those who did not (p=0.001). This result emphasizes the crucial role of dentists in educating and influence mothers behaviors regarding dental health issues. Since only 5.3% of the mothers knew that, the recommended time for a first dental visit is within six months of the eruption of the first tooth and no later than 12 months of age (21). It may be difficult for the dentists to educate this population at young ages and establish a dental home. Therefore, the role of health providers and educators is to increase the awareness of mothers of toddlers to visit the dentist in the early development stages of the child. Conclusions The findings of this study demonstrated that mothers from the Arab minority living in a rural region in Israel had shown poor knowledge towards oral health. Maternal KOH was directly influenced by the mother’s level of education. Therefore, a matter of high priority is to develop a long- term community health education program and health promotional activities held by dentists and general practitioners targeted especially for this population.

Funding The study received no funding Conflict of interest None

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The Journal of the Israel Dental Association, vol. 37, No. 2, April 2020.