Volume 9, Issue 8, August – 2024 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24AUG1629

Knowledge and Attitude of Dentists towards

Teething and Essential Treatment for Teething
Toddlers: A Questionnaire Study
1
Dr. Deepak Raj K; 2Dr. Sowmya B Shetty; 3Dr. Kiran Raj; 4Dr. Pusa Jagdish; 5Dr. Guzlan Lubin P; 6 Dr. Akshita A Shetty
1
Postgraduate, Pediatric and Preventive Dentistry, AJ Institute of dental sciences, Mangalore, India
2
Professor and Head, Pediatric and Preventive Dentistry, AJ Institute of dental sciences, Mangalore, India
3
Reader, Pediatric and Preventive Dentistry, AJ Institute of dental sciences, Mangalore, India
4
Postgraduate,Pediatric and Preventive Dentistry, AJ Institute of dental sciences, Mangalore, India
5
Postgraduate, Pediatric and Preventive Dentistry, AJ Institute of dental sciences, Mangalore, India
6
Postgraduate, Pediatric and Preventive Dentistry, AJ Institute of dental sciences, Mangalore, India

Abstract:- I. INTRODUCTION

 Introduction Each infant, upon birth, is inevitably progressing

Tooth eruption is the physiological process of through a developmental milestone (whether typical or
movement of teeth from inside the jaw to their position atypical) in order to adapt to the ecological shifts in the
in functional occlusion in the oral cavity. This process surroundings. The development of infants includes physical,
starts on average at 6 months of age and can cause local emotional, physiological, and social functions. Objective
inflammatory symptoms, as well as signs and symptoms and readily observable to oneself and others, physical
in the general health of babies and children. development is very measurable. A physiologically
significant component of physical development is the
 Methodology process of teething.1
The purpose of the cross-sectional questionnaire
study was to assess the knowledge and attitude of Teething is an inherent and prominent stage in a child's
dentists toward teething and essential treatment for growth, usually taking place between six months to three
toddlers. Validated questionnaire on google forms was years of age. Although considered typical, this procedure
circulated among the participants via social media. Data can cause discomfort and behavioral changes in young
from Google forms was entered into excel sheets and children, which may urge caregivers to seek advice on
SPSS 23 software was used for inferential analysis. effective management techniques.2,3 Indications of teething
include restlessness, excessive saliva and drooling, facial
 Results flushing, fever, inflamed/irritated gingiva, loss of appetite,
Of the 301 dentists assessed, the study included malaise, malodorous urine, otitis media, painful
54.5% females and 45.5% males, mostly general gingiva/mouth, perioral rash, primary herpetic
practitioners aged 26-30 years. Of the participants, 99% gingivostomatitis, respiratory problems (including runny
were aware of teething, with 89.7% encountering nose, congestion, throat infection), restlessness, severe
patients. Common symptoms were chewing objects crying, skin rash, sleep disturbance, vomiting, wakefulness,
(80.4%) and swollen gums (77.1%). Teething occurs at 4- and weight loss.1
7 months for 7-8 days. 84.7% recognized eruption
problems. 73.4% considered hematoma self-limiting. Dentists, as primary oral health care professionals, play
82.1% knew pharmacological and non-pharmacological a critical role in teaching parents about teething, its related
methods. Advice included teething rings (80.7%) and symptoms, and suitable treatment options. However, there is
distraction (77.1%). 96% recommended regular dental a paucity of comprehensive studies investigating dentists'
check-ups. 97.7% felt CDE was needed, and 99.3% knowledge and attitudes concerning teething and the critical
wanted better parental guidance on teething therapies they recommend for toddlers.4
management.
Understanding the knowledge and attitudes of dentists
 Conclusion around teething is crucial for improving pediatric dental
The results of the present study help conclude that treatment. Previous study indicates that many dental
included dentists had good level of knowledge and practitioners may feel unprepared to diagnose and manage
attitude toward teething of toddlers. dental discomfort in children, which might influence their
capacity to deliver good care during teething episodes. 5
Keywords:- Dental Health Services, Diet counseling, Infant, Furthermore, the knowledge gap among parents regarding
Knowledge. Pregnancy. oral health practices for their children might worsen the

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Volume 9, Issue 8, August – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24AUG1629

issues associated with teething, underscoring the need for III. RESULTS
increased communication and education from dental
experts.6,7 The demographic details of the included participants
from Figure 1 to 4 showed that it included 54.50% female
This study aims to analyze the knowledge and attitudes participants and 45.50% males with most of them belonging
of dentists about teething and the treatments they believe to the age group between 26-30 years (34.88%) followed by
vital for children during this developmental stage. By 20-25 years (21.92%). The participants included mostly of
adopting a structured questionnaire, the research will gather general practitioners (66.80%) when compared to post
insights into dentists' perspectives, uncover potential graduates (33.20%) and of the postgraduates included, most
misconceptions, and evaluate their readiness to treat belonged to the department of pediatric and preventive
teething-related concerns. The findings will not only dentistry (17.70%), orthodontics and dentofacial orthopedics
contribute to the current research but also inform (11%), conservative dentistry and endodontics (10.60%)
educational activities targeted at boosting the quality of care followed by other departments.
offered to young patients and their families. In summary, the
present study intends to overcome the information gap in The results associated with the knowledge of the
pediatric dentistry surrounding teething, thereby participants from table 1 showed that 99% of the
encouraging better oral health outcomes for children during participants were aware of teething among toddlers, while
this key period of development. 77.4% recall the management of teething being taught
during their undergraduate degree and 89.7% of participants
II. MATERIALS AND METHODS had come across patients with symptoms of teething. The
most common symptoms encountered were chewing objects
The study was conducted after obtaining clearance (80.4%) followed by swollen gingivae (77.1%), irritability
from the Institutional ethics committee (76.1%), fever (64.5%) and others in smaller proportions.
(SRB/PEDO24/09/V1). The cross-sectional questionnaire When asked about the first incidence of teething, most of the
survey was conducted to evaluate the knowledge and participants answered that it is usually seen between 4-7
attitude of dentists toward teething and essential treatment months of age (84.4%) and lasts for 7-8 days (55.8%).
for toddlers from January 2024 to March 2024. Dentists
practicing in Mangalore city were included in the present When asked about the different teething problems
study. encountered, 84.7% of participants answered that the
conditions observed were eruption hematoma, eruption
The questionnaire was prepared using goggle forms sequestrum, and ectopic eruption. When participants were
and circulated among the participants via social media enquired on the management of a case of eruption
(WhatsApp). The present study included dentists residing in hematoma, 73.4% of the participants considered eruption
Mangalore city who consented to participate in the study. hematoma to be a self-limiting condition. Participants
Participants who refused to provide informed consent and answered that permanent 1st molar (56.1%) is the tooth most
who did not fill out the questionnaire completely were commonly associated with eruption sequestrum. When
excluded from the study. managing teething, 82.1% of participants were aware of
pharmacological, non-pharmacological, and alternative
Sample size was calculated by using G* software at holistic methods in the management of teething among
95% confidence and 5% margin of error with a p value of toddlers. The participants were asked on what the employed
0.90 based on the previous literature by Panda A et al in pharmacological strategies achieved and they responded that
2022 wherein the knowledge and awareness of teething and a combination of analgesia, anesthesia and sedation was
its management was present in 90% of the dentists8, a achieved (68.4%). When asked about the different advice
sample size of 300 participants was calculated. provided by them to manage the teething related symptoms,
most of the participants preferred advice for symptom
The questionnaire was circulated among dentists in management which included teething rings (80.7%),
Mangalore and response was obtained from 301 dentists. distraction/comfort (77.1%), and rubbing gums (74.4%)
After explaining the purpose of the study, the participants
were requested to complete and submit the questionnaire. Responses to attitude related questions from table 2
The questionnaire was assessed for content validity by 2 revealed that when asked about what advice was to be
subject experts in the field of pedodontics and the provided to parents regarding to the dental care of the
questionnaire contents were considered valid to proceed toddler, most of the participants considered regular check
with the study. Demographic data of study participants were ups to be the most important (96%) followed by oral
obtained using a proforma. Complete anonymity of the hygiene practices (91.4%), nutritional guidance (83.1%) and
participants was maintained at every step of the study. Each fluoride and water (71.8%). Most participants (97.7%)
and every piece of information was kept confidential and believed that there was a need for continuing dental
was only reported as group data without any personal education (CDE) on this topic among dental professionals
information. All information was stored in a safe place, while also believing that there is a need for better guidance
accessible only to individuals actively working on the study. for parents on the management of teething (99.3%).
Data from Google forms was entered into excel sheets and
SPSS 23 software was used for inferential analysis.

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Volume 9, Issue 8, August – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24AUG1629

IV. DISCUSSION teething rings, hug therapy and stroking the gums were more
helpful than others. However, none of the strategies was
The study aims to analyze the knowledge and totally helpful in dealing with all the teething difficulties that
management strategies surrounding child teething symptoms was reviewed.14
among dentists residing in the city of Mangalore, Karnataka.
Previous evidence suggests that despite teething being a Responses on the management the teething symptoms
natural phase of newborn development, there is surprisingly showed that it included teething rings, distraction/comfort,
little known about the causes and management of teething and rubbing gums. Teething rings and stroking the gums
signs and symptoms even though teething is considered as a reduced gingival inflammation and finger sucking. The
discomforting process for the child.9,10 pressure created by biting teething rings or pacifiers and
gingival massage may alleviate pain by overwhelming the
The demographic details showed that most of the sensory receptors. Biting or sucking cold or frozen objects
participants belonged to the age group between 26-30 years such fruits, vegetables or other foods promotes localized
(34.88%) followed by 20-25 years (21.92%) which showed vasoconstriction and minimizes inflammation; in addition,
that the study included a majority of dentists in the early the pressure on the gums lessens discomfort. However, it is
stages of their career. indicated that these therapies should be utilized only for
youngsters who are able to ingest solid foods. Also, foods
Results associated with knowledge showed that almost that are excessively firm should not be utilized, to avoid
all participants were aware of teething among toddlers with pain caused by bruising the gum. Moreover, parental
more than three quarters recalling the teething management attention is important to prevent choking on little pieces of
taught during their undergraduate degree and 89.7% of food.11,12,15
participants had come across patients with symptoms of
teething. An older study reported that most participants The results from the knowledge-related questions
(76%) could not recall teething being taught in their indicate a high level of awareness and experience among
undergraduate studies which is dissimilar to that observed in participants regarding teething in toddlers. A questionnaire-
the present study.11 This variation can be explained by the based study on Paediatric Dentists' knowledge of teething
different populations included in the two studies. signs, symptoms and management indicated that while most
pediatric dentists in the UK were aware of common teething
Common symptoms encountered included chewing symptoms, there were gaps in their knowledge regarding
objects, swollen gingivae, irritability, fever followed by accessible professional resources and guidance. This
other symptoms in smaller proportions. This contrasted the coincides with the current study's purpose to analyze
results of a previous study wherein symptoms such as dentists' knowledge and attitudes concerning teething and
irritability, increased salivation, runny nose, loss of appetite, critical therapies.16
diarrhoea, rash, sleep disturbance and gum rubbing were
most apparent among teething toddlers.12 This divergence Attitude related responses showed that most of the
can be explained by McDonald et al. who described tooth participants considered regular checkups, oral hygiene
eruption as a natural process, which does not support its practices, nutritional guidance and fluoride water to be the
relationship with fever and systemic diseases. Fever and most important step in the dental care of the child. Most
respiratory tract infections in this period of life may arise at participants also believed that there was a need for
the same time as eruption but are not connected with it. 13 continuing dental education (CDE) on this topic among
dental professionals with parents needing better guidance on
With regard to the first incidence of teething, most the management of teething. The attitude-related questions
participants answered that it is usually seen between 4-7 demonstrate a broad consensus on the need of dental care
months of age and lasts for 7-8 days which was an accurate and education surrounding teething. Previous study has
answer. Eruption hematoma, eruption sequestrum, and revealed that there was a lack of understanding regarding
ectopic eruption were the most common condition current rules on teething, yet these standards do not offer
associated with teething encountered with most of them clear information to help decision-making. Creation and
answering that it is a self-limiting condition. Most extensive dissemination of guidelines on teething is
participants answered that permanent 1st molar is the tooth recommended.11
most commonly associated with eruption sequestrum.
Participants were aware of pharmacological, non- The drawbacks of the present study include the lack of
pharmacological, and alternative holistic methods in the association of responses to variables that could help in
managing teething among toddlers with pharmacological assessing the different ways that the knowledge of the dental
strategies achieving a combination of analgesia, anesthesia professional could be increased. The advantages of the
and sedation. Memarpour et al, in their previously conducted present study included the huge sample size that can provide
study; provided two main techniques - pharmacological and responses from a wide range of professionals to ensure
nonpharmacological - which have been recommended as better results. The results of the present study help us infer
treatments during tooth eruption. Non-pharmacological that dental professionals are very knowledgeable on the
therapies were employed because of the parents’ views different signs, symptoms and management of teething
towards employing cures which do not risk their child’s among infants which should translate to better outcomes
health. According to their results, some approaches such as when diagnosis and treatment of children who present with

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Volume 9, Issue 8, August – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24AUG1629

the condition. However, further research can be encouraged [7]. Sharma A, Jain M, Vigarniya M. Parental Knowledge,
to ensure that the dentists are aware of the different Attitude, and Practices Regarding Oral Health of their
guidelines involved in the treatment of teething. Children in Nuh District of Haryana, India. Ind J Dent
Furthermore, it has been demonstrated the value of Sci. 2022;14(2):89-93. doi: 10.4103/ijds.ijds_70_21
evaluating both parental and dental professionals' [8]. Panda A, Shah R, Parmar B, Panchal J. Knowledge,
knowledge to provide comprehensive care for young Attitude and Perception about teething and its
children which includes teething as well which can be management among dental interns. The Quadrant.
studied more to design an intervention for the same.17 2022;1(1):14-16.
[9]. Wuni A, Iddrisu M, Angliengmene AA, Salia SM,
V. CONCLUSION Chanayireh L, Mohammed IS, et al. Knowledge and
management practices of infant teething symptoms
In summary, the study highlights that undergraduate among mothers in a tertiary facility in Ghana. Pan Afr
and postgraduate dentists were knowledgeable on the topic Med J. 2024;47:65. doi:
of teething among infants. However, there is a lack of 10.11604/pamj.2024.47.65.40792.
information on specific guidelines for management which [10]. Nishana E, Bhat SS, Hegde SK, Rao A, Bhat VS.
can be worked upon. The results also help understand that Knowledge, Beliefs and Practices Associated with
collaboration between pediatric dentists, general dentists, Teething Among Mothers in Mangalore Taluk, South
and pediatricians is important to provide consistent, India. AOHDR. 2018. doi: 10.21276/AOHDR.1872
evidence-based guidance to parents on this common [11]. Reeve-Brook L, Bhatia S, Al-Yaseen W, Innes N,
childhood issue Monaghan N. A questionnaire-based study of
Paediatric Dentists' knowledge of teething signs,
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Volume 9, Issue 8, August – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24AUG1629

TABLES

Table 1: Table Enumerating the Results of Knowledge Related Questions among Participants
Are you aware of teething among toddlers?
Yes 99%
No 1%
Do you recall the management of teething being taught during your undergraduate degree?
Yes 77.4%
No 22.6%
Have you come across a patient with symptoms of teething?
Yes 89.7%
No 10.3%
What are the usual symptoms of teething that you have encountered?
Fever 64.5%
Drooling 54.8%
Irritability 76.1%
Flushed cheeks 53.5%
Swollen gingivae 77.1%
Bowel disruption 44.5%
Chewing objects 80.4%
Coughing 19.9%
Others 18.3%
What is the age when teething usually is seen?
4-7 months 84.4%
10-12 months 13.3%
12-18 months 2.3%
For how many days is the teething period is seen usually?
7-8 days 55.8%
10-12 days 35.5%
14-16 days 8.6%
Teething problems include?
Eruption hematoma 10.6%
Eruption sequestrum 3.7%
Ectopic eruption 1%
All of the above 84.7%
How do you manage a case of eruption hematoma?
It is a self-limiting condition 73.4%
Management with pharmacological methods 20.3%
Management with surgical methods 6.3%
During the eruption of which teeth is eruption sequestrum seen usually?
Primary 1st molars 23.3%
Permanent 1st molars 56.1%
Primary incisors 15.3%
Permanent incisors 5.3%
Which are the different methods of managing teething that you are aware of?
Pharmacological methods 8.3%
Non pharmacological methods 8%
Alternative holistic medicine 1.7%
All of the above 82.1%
What do pharmacological strategies aim to achieve?
To achieve analgesia 26.9%
To achieve anesthesia 3.7%
To achieve sedation 1%
Combination of the above 68.4%
Which of the follow would you prefer to advise for the management of symptoms of teething?
Distraction/Comfort 77.1%
Use of a dummy 67.1%
Rubbing gums 74.4%

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Volume 9, Issue 8, August – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24AUG1629

Teething rings 80.7%

Hard food to chew 60.5%
Homeopathic teething gels/powders 29.6%
Non homeopathic teething gels 22.6%
Age appropriate dosage of oral systemic analgesia 46.8%
Other 15.6%

Table 2: Table Enumerating the Results of Attitude Related Questions among Participants
What advice should be given to parents regarding the next steps in dental care for the child?
Regular dental check ups 96%
Oral hygiene practices 91.4%
Nutritional guidance 83.1%
Fluoride and water 71.8%
Do you feel there is a need for continuing dental education (CDE) on this topic for dental professionals?
Yes 97.7%
No 2.3%
Do you feel that is there need for better guidance for parents on the management of teething?
Yes 99.3%
No 0.7%

FIGURES

Fig 1: Pie Chart Depicting the Gender Distribution

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Volume 9, Issue 8, August – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24AUG1629

Fig 2: Pie Chart Depicting the Age Distribution

Fig 3: Distribution of Different Education Levels of Dentists in the Study.

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Fig 4: Distribution of Different Speciality of Postgraduate Participants

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