|Year : 2021 | Volume
| Issue : 2 | Page : 63-67
The Association Between Parenting Styles and Feeding Styles on Early Childhood Caries
Nirmala Sari1, Rosa Amalia2, Aloysia Supartinah3
1 Master of Dental Science in Prevention and Promotion of Dental Health, Universitas Gadjah Mada, Yogyakarta, Indonesia
2 Department of Preventive and Community Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
3 Department of Pediatrics Dentistry, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
|Date of Submission||16-Oct-2020|
|Date of Decision||05-Feb-2021|
|Date of Acceptance||17-Apr-2021|
|Date of Web Publication||23-Jun-2021|
Department of Preventive and Community Dentistry, Faculty of Dentistry, Universitas Gadjah Mada, Jl. Denta 1, Sekip Utara, Yogyakarta.
Source of Support: None, Conflict of Interest: None
Background: A parenting style (authoritarian, authoritative, and permissive) refers to a set of activities that parents perform to raise a child. A certain feeding style is influenced by a parenting style. The high intake of foods containing sugar without parental control can increase the incidence of early childhood caries (ECC). Objective: The Objective of this article is to analyze the association of parenting styles and feeding styles on the occurrence of ECC among children aged 3–5. Methods: The research was an analytical cross-sectional study. Data were collected from 105 pairs of mothers and children, selected through the purposive sampling technique in Yogyakarta. Type of parenting and feeding styles was obtained through questionnaires given to mothers, whereas intra-oral examination was used to detect the ECC in children using the decay-missing-filling-teeth (dmf-t) index. Data were collected and analyzed using multinominal logistic regression with a statistical significance at P < 0.05. Results: The prevalence of ECC and dmf-t among children with permissive parents was highest (63.84%; 7.51+5.97) when compared with those with authoritarian parents (26.21%; 3.09+4.23). Those with authoritative parents was lowest (9.95%; 1.17+1.65). Authoritative parenting is associated with less consumption of cariogenic foods and low occurrence of ECC (P < 0.05). Conclusion: Parenting styles have a direct association with feeding styles and ECC. Children with authoritative parents have a highest benefit on lowest risk of ECC when compared with other counterparts.
Keywords: Cariogenic food, children, ECC, feeding style, parenting style, Yogyakarta
|How to cite this article:|
Sari N, Amalia R, Supartinah A. The Association Between Parenting Styles and Feeding Styles on Early Childhood Caries. Sci Dent J 2021;5:63-7
|How to cite this URL:|
Sari N, Amalia R, Supartinah A. The Association Between Parenting Styles and Feeding Styles on Early Childhood Caries. Sci Dent J [serial online] 2021 [cited 2022 Oct 4];5:63-7. Available from: https://www.scidentj.com/text.asp?2021/5/2/63/319049
| Background|| |
Dental caries is a common oral problem among children around the world, especially in Indonesia. In 2013, the prevalence of dental caries among children aged 3–5 in Indonesia was approximately 76.7%. In 2018, this increased by about 88.7%. Only 28.9% are free from dental caries. Like any other form of dental caries, early childhood caries (ECC) is the result of a time-specific interaction of microorganisms and sugar on a tooth surface. ECC is the presence of one or more decayed, missing due to caries, or filled tooth surfaces in any primary tooth in children under 6 years.
The development of ECC is related to bottle-feeding during bedtime, bad dietary habits, and the composition of food consumed every day. It is indisputable that the consumption of cariogenic food imposes a risk on children’s teeth. To avoid ECC, parental participation is needed to control the intake of children’s food. This can be challenging, as each parent has a unique parenting pattern and set of dietary habits. Food-related factors involving the release of sugar are the frequency of cariogenic consumption, drinking and chewing habits, and the presence of cariogenic dental caries. Early lesion of caries is developed first by the transmission of cariogenic bacteria usually from adults who have a daily contact with children (ex. mothers). A frequent supply of substrate (sucrose) to the plaque fermented by cariogenic bacteria further led to the formation of ECC.
The frequency of fermentable carbohydrate and sugar consumption is closely related to the occurrence of ECC. Extended periods of oral exposure to a fermentable carbohydrate can lead to a greater risk of demineralization and less opportunity for teeth to remineralize. Frequent consumption of sugary snacks such as candy, chips, cookies, chocolate, cereal, milk, biscuit, donut, cupcake, and bread, compounded with a decline of consumption of dairy products, can also lead to ECC.
Parents play an important role in shaping children’s eating behaviors through a combination of feeding styles and parenting styles. A parenting style refers to a set of activities that parents perform to raise a child. There are three parenting styles originally proposed by Baumrind: authoritative parenting, authoritarian parenting, and permissive parenting. The high involvement among parents to ensure good dietary habits, including regular meal patterns and feeding patterns, is also associated with healthier dietary behavior among children. High intake of sugar-containing foods without parental control can increase the incidence of ECC.
Yogyakarta is one of the regions in Indonesia that has a high risk of caries due to the high consumption of foods and drinks that contain sugar. Research related to the risk factors for ECC in children aged 4–6 years found that the prevalence of ECC in preschool children was 76.7%. Based on these data, efforts should be taken to prevent the continuing high incidence of caries, especially by involving parents taken into account their parenting style. To address this gap, this study intends to probe the association of parenting style and dietary habits with the occurrence of ECC in Yogyakarta.
| Materials and Methods|| |
Study design and sample
The study design employed an analytic survey with a cross-sectional study. Exclusion criteria were children who have a history of systemic/chronic diseases such as xerostomia, diabetes mellitus, kidney disease, or other systemic diseases that have received a certain diet or special treatment was excluded. The sampling method was a purposive sampling technique by recruiting 105 pairs (each of parenting style was consisted of 35 pairs) of mothers and children aged 3–5 in several selected kindergartens. The sampling formula was based on sampling calculation for the correlation research. This research is located in Depok Sleman Yogyakarta, which is a densely populated area with diverse economic backgrounds.
There were three sets of data collected in this study: parenting style, feeding styles, and ECC. Data on parenting style and feeding style were obtained through a questionnaire distributed to mothers. A set of 19 questions from a modified parenting styles and dimensions questionnaire (PSDQ) was used to determine parenting style: authoritarian (five items), authoritative (six items), and permissive (eight items). Mothers report how often they display the behaviors listed in the questionnaire using a five-point Likert scale ranging from 1 = never to 5 = always. The total score is obtained by calculating the score for each parenting style subscale and then dividing by the number of questions from each parenting style. The subscale with the highest score reflects the type of mother’s parenting style.
To obtain data on feeding styles, the record of the child’s food diary within 3 × 24 h reported by mothers was collected. All types of foods and drinks reported were then categorized into two categories: cariogenic and non-cariogenic. The overall frequency of food and beverage consumption based on the cariogenic level is then categorized as low, moderate, and high.
The data on ECC were obtained by examining the teeth using the decay-missing-filling-teeth (dmf-t) index, following the WHO guideline. The child was accompanied by a teacher during the examination of the oral cavity. The examination was conducted under sufficient lighting using a mouth mirror and periodontal probe. The children were asked to gargle first before the examination of the oral cavity. If debris was found, the teeth were cleaned first. Written informed consent was obtained from the mothers, and the ethical clearance was approved by the Dental Research Ethics Committee of the Faculty of Dentistry Gadjah Mada University number 00391/KKEP/FKG-UGM/EC/2020.
The data were analyzed using multinominal logistic regression to observe the direct and indirect correlations between variables with a statistical significance at P < 0.05. The statistical analysis was performed using SPSS software (version 25; SPSS Inc., Chicago IL, USA).
| Results|| |
[Table 1] shows the distribution of the participants according to parenting styles. Among the children, 55 children were males and 50 children were females with the mean age of 4.39 ± 0.69 years. The differences in parenting styles as crossed to cariogenic food consumption can be seen in [Table 2]. Mixed findings were identified for the feeding style. Most parents with authoritarian (74.29%) and authoritative (60%) styles were protective against the risk of ECC. Unfortunately, children whose parents with permissive style tended to consume more cariogenic food. The data revealed that children of permissive parents consumed cariogenic foods in average 7.42 times a day, those of authoritarian parents 6.82 times a day, and those of authoritative parents 6.72 times a day.
[Table 3] summarizes the prevalence of dmf-t according to parenting styles. The prevalence of ECC among children with permissive parents was 63.84%, compared with that with authoritarian parents of 26.21% and with authoritative parents of 9.95%, which means that children with authoritative parenting having lowest ECC occurrence. Based on [Table 3], children who had the highest prevalence of ECC are those with permissive parents, with an average per child of 7.51+5.97. This number is higher than the prevalence of ECC among children of authoritative parents, with a mean dmf-t of 1.17+1.65. The mean dmf-t of children of authoritarian parents was 3.09+4.23.
The multinomial logistic regression analysis [Figure 1] revealed that there was a significant association between parenting styles and ECC occurrence (P < 0.0001) and parenting styles and feeding styles (P < 0.0001). However, there was no significant association between feeding styles and ECC (P = 0.625). Goodness of fit was P = 0.48 and pseudo R2 Negelkerke was 0.41.
|Figure 1: Significance value of relationships between variables using multinominal logistic regression analysis. Significant relationship (P <0.05)|
Click here to view
| Discussion|| |
This study showed that parenting style has a significant impact on the occurrence of ECC. Children with permissive parents unfortunately had a highest dmf-t index and highest prevalence of ECC. Otherwise, children with authoritative parents had a lowest dmf-t index and lowest prevalence of ECC. The results of the statistical analysis showed a significant relationship between parenting styles and ECC occurrence. These results are consistent with a research which found that children of authoritative parents had lower caries than children with authoritarian and permissive parents. Authoritarian parents are restrictive of their child, authoritative parents support children’s behavior and encourage independence, and permissive parents do not control the choices of the children.
The result of a previous study revealed that permissive parents gave a little guidance on the benefits of a healthy food in children so as to allow children to prefer snacks and sugary drinks that contain sugar. Permissive parents prioritize comfort and give children freedom in choosing foods they like. However, all parents should realize that meeting daily nutritional needs is recommended but parents should supervise their children on eating regularly three times a day and also snack between meals. It should be noticed that children who consume sugary foods and drinks containing sugar with a frequency of more than four times a day have higher dental caries than children who consume foods and drinks containing sugar less than four times a day.
Feeding styles exhibit no significant relationship with ECC. This can happen when children’s oral hygiene conditions are not considered. This means that even though children do not consume snacks, if their oral hygiene is not maintained, it will certainly have an impact on the occurrence of ECC. Even though children consume cariogenic snacks, if they can maintain proper dental behavior, they are less likely to experience ECC. Besides, factors that contribute to the occurrence of ECC can be found at multiple levels such as biological and genetic factors and use of health services. On a familial level, social support factors, parental health status, socio-economic status, sociodemographic status, culture of the family, and health behavior can contribute to ECC occurrence.,
Feeding styles and nutrients play a role in dental caries. Some foods are not cariogenic and offer protection to teeth, for instance, fibrous foods (vegetables and fruits) and hard cheese. Nutrients have topical and systemic effects that can prevent the development of dental caries. Parents should determine acceptable cariogenic foods and drinks while making sure that the bulk of their children’s diet is made up of non-cariogenic foods. Parents also should recognize that it is important for children to explore food. The ability of choosing healthy food is generally developed during childhood and reflects the family’s lifestyle and its ethnic or cultural, social, religious, geographical, economic, and psychological components. All these factors influence a child’s attitudes, feelings, and beliefs about food. However, cultural and economic factors typically have the greatest influence on feeding styles.
Parental attitudes and food preferences, eating habits, and food choices are influential factors in a child’s food preferences. When a kind of food is disliked by one or both parents, it will not be served often or may not be served at all. The key influence on the quality of a child’s diet is the quality of the primary caregiver’s feeding styles. Children model their parents and tend to enjoy foods preferred by their parents. Providing fruits for snacks and serving vegetables at mealtime affect a preschooler’s feeding styles for life.
The parental attitudes, food preferences, eating habits, sociocultural, and socioeconomic backgrounds of parents can serve as risk factors that can contribute to a higher occurrence of ECC in children., Parents should be motivated to take care of the primary dentition to prevent ECC. Almost all risk factors for ECC are modifiable including the choice of food. They can be grouped according to individual, family, and community levels. Parents should teach their children about the importance of establishing good eating habits, along with proper brushing habits, especially since the first tooth appears in childhood. Parents are expected to pay attention to their children’s dental health, educate their children, and provide knowledge to their children about oral and dental health by means of proper care. If parents take an active part by controlling sugar consumption, ECC in children is likely to be prevented from an early age. Practicing good life habits at an early stage can prevent and reduce the number of tooth and mouth pain and can lead us to a healthy child free of caries.
| Conclusion|| |
The study showed parenting styles have a direct association with feeding styles and ECC. Children with authoritative parenting have a lower risk of ECC compared with children with authoritarian and permissive parenting.
Financial support and sponsorship
Conflicts of interest
The authors declare no conflicts of interest.
| References|| |
Amalia R, Chairunisa F, Alfian MF, Supartinah A. Indonesia: Epidemiological profiles of early childhood caries. Front Public Health 2019;7:210.
Borutta A, Wagner M, Kneist S. Early childhood caries: A multi-factorial disease. Oral Health Dent Manag 2010;9:1-10.
American Academy of Pediatric Dentistry. Policy on early childhood caries (ECC): Classification, consequences and preventive strategies. Pediatr Dent 2016;38:52-4.
Anil S, Anand PS. Early childhood caries: Prevalence, risk factors, and prevention. Front Pediatr 2017;5:157.
Meyer F, Enax J. Early childhood caries: Epidemiology, aetiology, and prevention. Int J Dent 2018;2018:1415873.
Sheiham A, James WP. Diet and dental caries: The pivotal role of free sugars reemphasized. J Dent Res 2015;94:1341-7.
Tinanoff N, Palmer CA. Dietary determinants of dental caries and dietary recommendations for preschool children. J Public Health Dent 2000;60:197-206; discussion 207-9.
Brooks J. The Process of Parenting. 8th ed. New York: McGraw-Hill; 2010. p. 111.
Blaine RE, Kachurak A, Davison KK, Klabunde R, Fisher JO. Food parenting and child snacking: A systematic review. Int J Behav Nutr Phys Act 2017;14:146.
Wang L, van de Gaar VM, Jansen W, Mieloo CL, van Grieken A, Raat H. Feeding styles, parenting styles and snacking behaviour in children attending primary schools in multiethnic neighbourhoods: A cross-sectional study. BMJ Open 2017;7:e015495.
Indonesia. Statistics of Yogyakarta Municipality (Badan Pusat Statistik Kota Yogyakarta). Yogyakarta City Regional Statistics. Yogyakarta: Statistics of Yogyakarta Municipality; 2018. p. 27.
Utami S, Hendrartini Y, Pramono D. Faktor-faktor yang berhubungan dengan tingkat keparahan early childhood caries (ECC) pada anak usia prasekolah di Kabupaten Sleman [thesis]. Universitas Gajah Mada, Yogyakarta, 2016.
Robinson CC, Mandleco B, Roper SO, Hart CH. The parenting styles and dimensions questionnaire (PSDQ). In: Perlmutter BF, Touliatos J, Holden GW, editors. Handbook of Family Measurement Techniques. Vol. 3. Instruments and Index. California: Sage; 2001. p. 319-21.
Radler DR, Touger-Decker R. Nutrition for oral and dental health. In: Mahan LK, Escott-Stump S, editors. Krause’s Food & Nutrition Therapy. St Louis: Saunders Elsevier; 2008.
van Loveren C. Sugar restriction for caries prevention: Amount and frequency. Which is more important? Caries Res 2019;53:168-75.
World Health Organization. Oral Health Surveys Basic Methods. 5th ed. Geneva: World Health Organization; 2013. p. 42-7.
Nayyar A, Battepati P, Tavargeri A, Trasad V. Association of parenting styles with caries status, caries risk and behaviour of children in dental set up. Int J Curr Res 2018;10:65123-6.
Hughes SO, Power TG, Papaioannou MA, Cross MB, Nicklas TA, Hall SK, et al
. Emotional climate, feeding practices, and feeding styles: An observational analysis of the dinner meal in head start families. Int J Behav Nutr Phys Act 2011;8:60.
Sheiham A, James WP. A new understanding of the relationship between sugars, dental caries and fluoride use: Implications for limits on sugars consumption. Public Health Nutr 2014;17:2176-84.
Maltz M, Jardim JJ, Alves LS. Health promotion and dental caries. Braz Oral Res 2010;24(Suppl 1):18-25.
Elamin A, Garemo M, Gardner A. Dental caries and their association with socioeconomic characteristics, oral hygiene practices and eating habits among preschool children in Abu Dhabi, United Arab Emirates—The NOPLAS project. BMC Oral Health 2018;18:104.
Ramos-Jorge J, Ramos-Jorge ML, De Paiva SM, Marques LS, Pordeus IA. Dental caries and quality of life among preschool children. IntechOpen2014;26:117-26.
Wigen TI, Wang NJ. Health behaviors and family characteristics in early childhood influence caries development. A longitudinal study based on data from Moba. Norsk Epidemiol 2014;24:91-5.
[Table 1], [Table 2], [Table 3]