1 Department of Epidemiology and Biostatic, School of Public Health and Cancer Prevention Research Center, Isfahan University of Medical Sciences,

2 Dental Students Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran


BACKGROUND: To increase the utilization of preventive dental care, it is essential to improve
the knowledge and attitude of parents about such cares. The aim of this study was to evaluate
the knowledge, attitude, and practice of school children’s parents toward fissure sealant (FS) and
professional fluoride therapy in Isfahan.
MATERIALS AND METHODS: In this cross‑sectional study, school children’s parents (n = 637) were
selected based on proportional cluster sampling. A valid and reliable questionnaire was designed,
including demographic section, questions about parents’ experience and their knowledge and attitude
about professional fluoride and FS therapy. Data were analyzed by ANOVA, regression, Chi‑square,
and correlation coefficient tests.
RESULTS: The means of total knowledge and knowledge about fluoride therapy and FS were 5.9 ± 4.1
out of 19, 3.3 ± 2.0 out of 9 and 2.6 ± 2.7 out of 10, respectively. The mean of attitude was 33.7 ± 5.8.
The mean of knowledge toward FS therapy was significantly higher in academically educated
parents (P = 0.023). The mean of total knowledge among those who received their knowledge by their
dentist was also significantly higher than that of other resources such as mass media (P = 0.003).
Total knowledge was positively correlated with attitude (P < 0.001, coefficient = 0.5). Of participants,
10.4% (54) and 23.2% (124) had the experience of FS and fluoride therapy, respectively.
CONCLUSION: Based on the low level of knowledge regarding professional preventive care in this
study and the effectiveness of knowledge acquired through dentists and mass media consultations,
it might be effective to require them to consider such training more seriously.


1. Khan H, Rehman K, Rasool G. Awareness of parents about
dental disease and their prevention in children. Pak Oral Dent J
2. National Center for Health Statistics, Centers for Disease Control
and Prevention. National Health and Nutrition Examination
Surveys 1999‑2004. Available from:
data/databriefs/db53.pdf . [Last accessed on 2017 Oct 15].
3. Acevedo AM, Ray MV, Socorro M, Rojas‑Sánchez F. Frequency
and distribution of mutans streptococci in dental plaque from
caries‑free and caries‑affected Venezuelan children. Acta Odontol
Latinoam 2009;22:15‑20.
4. Yekaninejad MS, Eshraghian MR, Nourijelyani K, Mohammad K,
Foroushani AR, Zayeri F, et al. Effect of a school‑based oral
health‑education program on Iranian children: Results from a
group randomized trial. Eur J Oral Sci 2012;120:429‑37.
5. Merghache D, Bellout B, Merghache S, Boucherit‑Atmani Z.
Fluoride levels in commercial dentifrices and drinking water in
Algeria. Odontostomatol Trop 2011;34:20‑8.
6. Recommendations for using fluoride to prevent and control
dental caries in the united states. Centers for disease control and
prevention. MMWR Recomm Rep 2001;50:1‑42.
7. Mc Donald RE, Avery DR, Stookey GK. Dental caries in the child
and adolescent. In: Mc Donald RE, Avery DR, editors. Dentistry
for the Child and Adolescent. 7th ed. St. Louis: Mosby; 2000.
p. 209‑46.
8. Ahovuo‑Saloranta A, Forss H, Hiiri A, Nordblad A, Mäkelä M.
Pit and fissure sealants versus fluoride varnishes for preventing
dental decay in the permanent teeth of children and adolescents.
Cochrane Database Syst Rev 2016 Jan 18;(1): CD003067.
9. Jafari A, Amir Soltani M, Golestan B, Bahrami N. Evaluation
of knowledge, attitude and practice of students’ parents about
fissure sealant therapy. J Dent Med Tehran Univ Med Sci
10. Beauchamp J, Caufield PW, Crall JJ, Donly K, Feigal R, Gooch B,
et al. Evidence‑based clinical recommendations for the use
of pit‑and‑fissure sealants: A report of the American Dental
Association Council on Scientific Affairs. J Am Dent Assoc
11. Bhuridej P, Damiano PC, Kuthy RA, Flach SD, Kanellis MJ,
Heller KE, et al. Natural history of treatment outcomes of
permanent first molars: A study of sealant effectiveness. J Am
Dent Assoc 2005;136:1265‑72.
12. Centers for Disease Control and Prevention. Oral Health:
Preventing Cavities, Gum Disease, and Tooth Loss; 2007.
Available from:
aag/oh.htm. [Last accessed on 2017 Oct 08].
13. Behnaz H, Shafagh A. Dental Anatomy and Morphology. 9th ed.
Iran: Jahad Publishing; 1997. p. 143‑55.
14. Gill DS, Lee RT, Tredwin CJ. Treatment planning for the loss of
first permanent molars. Dent Update 2001;28:304‑8.
15. Baradaran Nakhjavani Y. Mothers knowledge about fluoride
therapy and fissure sealants. J Oral Health Oral Epidemiol
16. Marinho VC, Worthington HV, Walsh T, Clarkson JE. Fluoride
varnishes for preventing dental caries in children and adolescents.
Cochrane Database Syst Rev 2013 11;(7):CD002279.
17. Skorupskas E. American Academy of Pediatric Dentistry. Fast
Facts 2013. Available from:
FastFacts. [Last accessed on 2017 Oct 15].
18. Welbury R, Raadal M, Lygidakis NA, European Academy of
Paediatric Dentistry. EAPD guidelines for the use of pit and fissure
sealants. Eur J Paediatr Dent 2004;5:179‑84.
19. Mani SA. Evidence‑based clinical recommendations for fluoride
use: A review. Arch Orofac Sci 2009;4:1‑6.20. European Academy of Paediatric Dentistry. Guidelines on the
use of fluoride in children: An EAPD policy document. Eur Arch
Paediatr Dent 2009;10:129‑35.
21. American Academy of Pediatric Dentistry. Guideline on fluoride
therapy. Pediatr Dent 2013;35:E165‑8.
22. Mafeni JO, Messer LB. Parental knowledge and attitudes towards
pit and fissure sealants. Aust Dent J 1994;39:172‑80.
23. Al Agili DE, Niazy HA, Pass MA. Prevalence and socioeconomic
determinants of dental sealant use among schoolchildren in
Saudi Arabia. East Mediterr Health J 2012;18:1209‑16.
24. Lam A. Increase in utilization of dental sealants. J Contemp Dent
Pract 2008;9:81‑7.
25. Kazemi Z. The Effect of family variables on information rate of
guidance school female students about maturity health. J Fam
Res 2012;8:319‑35.
26. Kay E, Locker D. A systematic review of the effectiveness of
health promotion aimed at improving oral health. Community
Dent Health 1998;15:132‑44.
27. Mårtensson C, Söderfeldt B, Andersson P, Halling A, Renvert S.
Factors behind change in knowledge after a mass media campaign
targeting periodontitis. Int J Dent Hyg 2006;4:8‑14.
28. Gholami M, Pakdaman A, Montazeri A, Jafari A, Virtanen JI.
Assessment of periodontal knowledge following a mass media
oral health promotion campaign: A population‑based study. BMC
Oral Health 2014;14:31.
29. Kay EJ, Locker D. Is dental health education effective? A
systematic review of current evidence. Community Dent Oral
Epidemiol 1996;24:231‑5.
30. AL‑Shalan TA. Saudi parents’ knowledge of and attitude
toward the prevention of dental caries. Saudi Dent J
31. Tahani B, Khoshnevisan MH, Yazdani S, Ebn Ahmady A,
Dugdale P. Stewardship of national oral health system in Iran:
Its strengths and weaknesses. Arch Iran Med 2013;16:717‑24.
32. Stella Kwan S, Petersen PE. Oral Health Promotion: An Essential
Element of a Health‑Promoting School. WHO Information Series
on School Health – Document Eleven World Health Organization.
Available from:
doc11/en/. [Last accessed on 2017 Oct 01].
33. Jürgensen N, Petersen PE. Promoting oral health of children
through schools – Results from a WHO global survey 2012.
Community Dent Health 2013;30:204‑18.