The Effect of Label and Medication Package Insert Reading Habits of Parents on their Children’s Oral Dental Health

INTRODUCTION

Tooth decay has been accepted as one of the most common chronic diseases in the childhood [1]. Fermentable carbohydrates, cariogenic bacteria, improper oral hygiene and eating habits, lack of fluoride along with genetic factors influencing saliva and tooth morphology, are the possible etiological factors [1, 2] Among them, oral hygiene, eating habits, and fluoride usage can be modified in order to reduce caries prevalence in children according to the American Association Pediatric Dentistry (AAPD) [3]. Regular use of fluoride toothpaste and professional fluoride application have been proven effective in reducing caries in areas where the water fluoride level is less than 0.6ppm. According to the current guideline, a pea-size for the 3-6 age range and no more than smear or rice-size for children under the age of 3 has been advised [3]. The European Association of Pediatric Dentistry recommends 1000 ppm fluoridated toothpaste as much as rice-size for children between 6 months and 2 years of age, 1000 ppm as much as pea-size for children aged 2-6 years, 1450 ppm as much as pea-size for children aged 6 and over with high caries risk [4].

Regarding eating habits, the AAPD guideline recommends reducing sugar consumption to 5% of the total daily energy intake in order to reduce children’s weight gain and dental caries [5]. In the guideline, it has been also pointed out that both the parents and healthcare professionals should be aware about the sugar content of foods, beverages and oral liquid medications [5, 6]. For this purpose, paying attention to the content of the products is necessary. It has been reported that with the increase in the welfare of the countries, consumers have been more careful not only to the content, but also to the safety and healthiness of the products. In this regard, reading the labels containing information that identifies the product and enables this information to be conveyed to the consumer in an understandable manner is the practical way during the purchase of the product [7]. For this purpose, packaged food labels provide information related to the content, portion, calorie, and nutritional value of a product. Mandatory food labeling was introduced by The US Drug and Food Administration (FDA) in 1993 in order to promote healthy eating [8].

In addition to reading food labels, reading medical package inserts should be considered under the heading of healthy living awareness. Medical package inserts provide detailed drug information [2]. A 2007 Institute of Medicine study reported that in-hospital adverse drug reactions occur at a rate of 400,000 per year, resulting in an additional $ 3.5 billion in hospital expenses. It is thought that by increasing the comprehensibility of the medical package insert, it can be read more by the patients and thus the drug side effects and unnecessary hospital expenses can be prevented [10].

In the literature, there have been studies regarding the effect of label reading habit on general health including weight control, healthy eating and decreasing the prevalence of chronic disease [11, 12, 13]. Studies evaluating drug package reading habits have been concerned on whether read or not and intelligibility [9, 14, 15]. However, to the authors’ knowledge, no study evaluated the effect of label and/or medical package insert reading habits on oral and dental health.

Therefore, the aim of this study is to evaluate the relationship between packaged product label and medication package insert reading habits of families and oral/dental health of their children.

MATERIALS AND METHOD

RESULTS

In the study, the questionnaire was answered by 301 parents and mothers comprised 72.8% (219) of them. Among the parents, 61% of the mothers and 67% of the fathers had at least high school graduation (Table 1).

The children were between the ages of 1-14, with the mean age 8.52 ± 2.796. The percentages of girls and boys were 50.8 and 49.2, respectively. Regarding their oral hygiene habits, 76 children (25.2%) did not brush their teeth whereas 5 children did not have a toothbrush (Table 2). The percentages representing the label and medication package inserts reading of the parents were 71.4 and 88.4, respectively. In Table 2, the factors affecting the selection of the parents for toothbrush and toothpaste as well the part of the labels and drug package inserts that gather the attention of the parents were shown.

Oral examination findings of the children were given in Table 3. The average dmft, DMFT and ICDAS II were 4.12 ± 2.881, 0.93 ± 1.374 and 4.22 ± 1.885, respectively.

Paired comparisons of demographic and oral findings with reading of product labels and medication package inserts were shown in Tables 4 and 5. A significant relationship was found between reading of the packaged product labels and age of the child, the number of children in the family, toothbrushing habit of the children, fluoride knowledge of the parents, as well as dentition type, DMFT, DMFS and ICDAS II scores of the children (p<0.05, Table 4). A significant relationship was found between reading of medication package inserts and family type, mother’s education, number of children in the family, tongue brushing habit and toothbrushing frequency of the parents, presence of untreated decayed tooth of the parents, regular medication use of the parents, SLS and paraben knowledge of the parents as well as tooth brushing habit and ICDAS II values of the children (p<0.05, Table 5).

According to the logistic regression analysis, label reading increases as the age of the child and the number of children in the family increase. Label reading was found to be higher in parents with fluoride knowledge and whose child brushed his/her teeth (Table 4).

The presence of untreated caries in parents, their regular medicine usage and knowledge about SLS and paraben, nuclear families and high maternal education were found to be related to higher rate of medication package insert reading of the parents. In addition, increase of 1 point in ICDAS II resulted in the 1.410 times decrease in the rate of medication package insert reading of the parents (Table 5).

DISCUSSION

With the increasing demand on the packaged products in all over the world, marketing process of these products has been evolving continuously. In this regard, package of the products is considered as an important factor to gather the attention of the consumers. The effect of the labels of the packages on this issue is controversial as there has been a wide variation regarding the percentage of label reading among the countries [19, 20, 21]. In a study conducted in an African country, Malawi, the percentage of label reading was found to be as 29.1 [21]. In South Africa, however, the percentage is higher (55%) [20]. In studies conducted in European countries the percentages were quite higher with 52% in England, 65% in Ireland, 50% in Sweden and 63% in France [22]. It was reported that 78% of the consumers read labels in the United States [23]. Within the limits of aforementioned studies, it would be reasonable to suggest a relationship between label reading habits and the country where the study was performed.

Mandatory food labeling, was introduced by the FDA in 1993 and in 1997 Food Codex regulations came into force in Turkey [24]. Considering the studies and laws published around the world for about 20-25 years, it can be thought that people’s behavior and attitudes on this issue may have changed over the years. Thus, higher label reading levels reported in recent studies indicate the increasing interest of the consumers to the labels [13, 19, 25]. In accordance with the recent suggestion, label reading percentage of the parents in our study was found to be 71.4. similar to that of Chopera et al which was reported as 77.2% [15].

In the present study, the expiration date (87%) and the production date (70.1%) of the products were the most cared items on the labels. Similar to that finding, in a study conducted in six different countries in Europe, it was reported that consumers mostly paid attention to expiration date, production date, calorie and sugar amounts of the products [26]. The consumers stated that they also pay attention to the brand of the product (63.5%), as well [26]. In a study conducted in France, 24% of the consumers stated that they had purchased the products depending on the brands [27].

In studies aimed to determine the parameters having an impact on label reading the variables including education, gender, obesity, nutritional knowledge level was investigated [19, 28, 29, 30, 31]. It has been reported that gender may play role in label reading as women read more labels than men [30, 31]. In our study, no such difference was found between men and women. However, this insignificant relationship may be caused by the low number of fathers compared to that of the mothers answered the questionnaire (27.2%).

In the literature, although there have been many studies evaluating the relationship between food label reading and healthy living /obesity, no study has been focused on the relationship between label reading and dental caries [26, 28, 29, 32]. In the present research, according to the logistic regression analysis, increase of 1 point in ICDAS II resulted in the 1.410 times decrease in the rate of medication package insert reading of the parents. As there has been no such study in the literature, the obtained result could not be compared. However, the higher level of reading medical inserts along with lower level of caries might have been related to the higher social and/or education level of the parents as we have documented some data which might be regarded as a proof supporting the hypothesis.

In some studies, it was stated that reading labels is related to healthy eating desire and understanding the information on the label is affected by the level of education [13, 33, 34, 35, 36]. In our study, no significant relationship was found between parent education and label reading. However, a positive correlation was found between the of mothers’ education and medical package inserts reading. The reason for the lack of a similar relationship with the fathers may be due to the inadequate number of fathers in the study as great majority of the parents consisted of mothers (72.8%).

The results of the present study indicated an increase in the label reading of the parent with the increase in their fluoride knowledge and with the toothbrushing habit of the child. This result indicates that the parents aware of tooth brushing and fluoride are also aware of reading labels. However, the results could not be compared as there has been no such study evaluated the relationship between label reading of the parents and tooth brushing habit of their children.

In our study, it was also found that the rate of food label reading of the parents increased 1.015 times as the age of the child increased by 1 month. This result may be interpreted as the increasing awareness of the parents both with the increasing age of them and their children. However, further studies are needed to support the suggestion.

Health literacy is a wide field that requires the individual to be able to define his / her own health / illness and to make appropriate decisions regarding his / her health. Package insert information such as the content and directions for use of the medicine as well as fluoride content of toothpastes are within the extent of this subject [37]. However, there has been no study evaluated the effect of reading of medication package inserts on dental health. The studies concerned medical package inserts focused on ability to understand and interpret medical terms [37, 38]. Therefore, the present study can be considered as the first study investigating the effect of medication package insert reading habits of the parents on their children’s oral health. The percentage of reading medication package inserts reading was 88.4, higher than that of label reading (71.4%) indicating that the parents payed more attention to medications.

In the current study there have been few limitations. The first one can be regarded as the small sample size because of the Covid 19 pandemic and which resulted in an enormously decreased referral of patients to the dental clinics. The other limitation of the study is the lack of a standard questionnaire on this subject in the literature. The third limitation is the likelihood of the parents answering the questions with the perception of reading the labels as a positive behavior.

CONCLUSION

Reading labels and medical package inserts may be regarded as effective tools for healthy living. It would be reasonable to conclude that improving the rate of label and medical package insert reading would be effective in preventing dental caries and improving oral health. Therefore, increasing the awareness of the society and further investigations on this issue are needed.