Nearly all of the mothers studied knew when their children should brush their teeth, which foods should be avoided, and how often their children needed to visit the dentist. Yet, among the 30 mothers who participated in this study, only one demonstrated genuinely good oral care practices. This finding is more than just a striking statistic. It reveals a wide gap between knowledge and actual practice, particularly among mothers who care for children with Down syndrome every day.
The study, published in the Jurnal Kedokteran Gigi Universitas Padjadjaran, Volume 37, December 2025 issue, involved a research team from the Department of Pediatric Dentistry, Faculty of Dentistry, Universitas Gadjah Mada: Bhintari Ayu Agustina, drg. Sri Kuswandari, Sp.KGA, and Prof. Dr. drg. Al. Supartinah, Sp.KGA. Their cross-sectional study addressed a seemingly simple question that has rarely been clinically explored: to what extent is maternal concern actually reflected in the oral health condition of children with Down syndrome?
Two Numbers That Tell the Whole Story
The study was conducted at the Association of Parents of Children with Down Syndrome (POTADS) in Yogyakarta and Kebumen. Thirty mother-child pairs involving children with Down syndrome aged 6 to 12 years participated in the study. Maternal concern was assessed from two dimensions: knowledge and behavior. The children’s oral health status was assessed using two standard clinical indices, namely the Gingival Index (GI), which measures the degree of gingival inflammation, and the Patient Hygiene Performance Index (PHP), which measures plaque accumulation on tooth surfaces.
The results revealed a striking contrast. A total of 43.3% of the mothers had good knowledge, while another 43.3% had a moderate level of knowledge. Only 13.3% had low knowledge. This picture sounds promising. However, when viewed from the perspective of behavior, the pattern changed dramatically: 46.7% of the mothers demonstrated poor behavior, 50% demonstrated moderate behavior, and only 3.3% demonstrated good behavior.
Statistical analysis using Spearman’s correlation test and multiple linear regression showed that maternal behavior was significantly associated with the children’s GI scores (r = 0.57; p < 0.05) and PHP scores (r = 0.74; p < 0.05). This means that the better the mothers’ behavior, the lower the children’s GI and PHP scores, indicating healthier gums and less dental plaque. The combined contribution of maternal knowledge and behavior to PHP reached R² = 0.67, or 67%.
Knowledge, on the other hand, showed only a weak association with PHP and no significant association with GI.
When Knowing Is Not Enough
Why do mothers who understand the theory not always manage to put it into practice? The researchers offered several explanations. Children with Down syndrome may have fine motor and cognitive limitations that make toothbrushing routines more than just a habit; they can become an exhausting daily negotiation. Mothers may know how to brush teeth correctly, but teaching the technique to a child who refuses, is uncooperative, or is unable to understand instructions presents an entirely different level of challenge.
“Maternal behavior carried out routinely and consistently in maintaining children’s oral and dental hygiene plays an important role in improving their oral health status,” the research team wrote in their discussion.
Other factors also come into play: parenting stress, limited time for supervision, and a lack of practical guidance applicable to children with special needs. All mothers in this study were homemakers, ranging in age from 32 to 55 years, with educational backgrounds ranging from elementary school graduates to university graduates. Although higher educational attainment was correlated with better knowledge, it did not automatically translate into more consistent behavior.
Interventions Pointed in the Wrong Direction
The implications of this study are quite significant for those designing public dental health programs. Dental health education has often focused on improving knowledge through lectures, leaflets, and counseling. This study shows that such approaches may not be sufficient, even for mothers who already possess adequate knowledge.
What is needed is not merely mothers who know what to do, but mothers who are skilled and accustomed to doing it. Behavior-based interventions, such as hands-on demonstrations, regular supervision, and simulations of toothbrushing techniques for children with special needs, may have greater potential to produce tangible improvements in children’s oral health.
Prof. Dr. drg. Al. Supartinah, Sp.KGA, who was also one of the researchers in this study, is among the figures who consistently promote community-based preventive and promotive approaches in pediatric dentistry, including for children with special needs who are often overlooked by conventional dental services.
This study does have limitations: the sample was limited to two cities and did not capture long-term dynamics. Nevertheless, its message is strong enough to be heard. The oral health of children with Down syndrome is not solely a clinical matter. It begins with the hands of mothers who accompany their children in brushing their teeth every night—a small action that turns out to carry substantial statistical weight.
Source DOI: http://10.24198/jkg.v37i3.60907
Authors: Nanda Ayu, drg. Achmad Zam Zam Aghasy, M.Kes.
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