UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2024.e4040
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Braz Dent Sci 2024 Apr/June;27 (2): e4040
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Knowledge level of children with Down Syndrome’s parents before
and after reading electronic book “Tooth Injuries in Children with
Down Syndrome”
Nível de conhecimento dos pais de crianças com Síndrome de Down antes e depois da leitura do livro eletrônico
“Traumatismos Dentários em Crianças com Síndrome de Down”
Ivan SURIJA1 , Eva FAUZIAH1 , Heriandi SUTADI1
1 - Universitas Indonesia, Pediatric Dentistry. Jakarta, Indonesia.
How to cite: SURIJA I, FAUZIAH E, SUTADI H. Knowledge level of children with Down Syndrome’s parents before and after reading electronic
book “Tooth Injuries in Children with Down Syndrome”. Braz Dent Sci. 2024;27(2):e4040. https://doi.org/10.4322/bds.2024.e4040
ABSTRACT
Objective: To analyse the knowledge level before and after reading electronic book “Tooth Injuries in Children
with Down Syndrome” through children with Down syndrome’s Parents. Material and Methods: This study
was conducted at three special need school type C (designed to the mentally disabled children) in Jakarta and
POTADS Foundation, with 37 eligible parents. Book and questionnaire used were developed and modied from
the guidelines of tooth injuries on typical children, with special consideration of children with Down syndrome.
Validity and reliability were tested through discussion with experts, dentists, and children with Down syndrome’s
parents. Knowledge was measured twice, before and after reading electronic book for 10 minutes each step using
same questionnaire. The total scores were categorized as follows: good (12-15), fair (9-11), and poor (0-8).
Difference knowledge scores were statistically tested. Results: Mean of total score before and after reading
were 6.62 (poor); 10.51 (fair), respectively. Difference score was statistically signicant (p=0,001) using paired
T-test. Conclusion: The electronic book “Tooth Injuries in Children with Down Syndrome” was developed and
modied by authors and needs to be evaluated by measuring the knowledge level of parents of children with
Down syndrome. The measurement conducted showed that there is a difference in the level of knowledge of
parents before and after reading the electronic book “Tooth Injuries in Children with Down Syndrome.”
KEYWORDS
Books; Down Syndrome; Parents; Tooth Injuries.
RESUMO
Objetivo: Analisar o nível de conhecimento dos pais de crianças com Síndrome de Down antes e depois de lerem
o livro eletrônico “Traumatismos Dentários em Crianças com Síndrome de Down”. Material e Métodos: Este
estudo foi conduzido em três escolas de necessidades especiais tipo C (destinadas a crianças com deciência
mental) em Jacarta e na Fundação POTADS, com 37 pais elegíveis. O livro e o questionário utilizados foram
desenvolvidos e modicados a partir das diretrizes sobre lesões dentárias em crianças típicas, com consideração
especial para crianças com Síndrome de Down. A validade e a conabilidade foram testadas por meio de
discussões com especialistas, dentistas e pais de crianças com Síndrome de Down. O conhecimento foi medido
duas vezes, antes e depois da leitura do livro eletrônico por 10 minutos em cada etapa, utilizando o mesmo
questionário. As pontuações totais foram categorizadas da seguinte forma: bom (12-15), razoável (9-11) e
ruim (0-8). A diferença nas pontuações de conhecimento foi testada estatisticamente. Resultados: A média da
pontuação total antes e depois da leitura foi de 6,62 (ruim) e 10,51 (razoável), respectivamente. A diferença na
pontuação foi estatisticamente signicativa (p=0,001) usando o teste T pareado. Conclusão: O livro eletrônico
“Traumatismos Dentários em Crianças com Síndrome de Down” foi desenvolvido e modicado pelos autores e
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Braz Dent Sci 2024 Apr/June;27 (2): e4040
Surija I et al.
Knowledge level of children with Down Syndrome’s parents before and after reading electronic book “Tooth Injuries in Children with Down Syndrome”
Surija I et al. Knowledge level of children with Down Syndrome’s parents
before and after reading electronic book “Tooth Injuries in
Children with Down Syndrome”
INTRODUCTION
Tooth injuries refers to injuries caused
by impact to the teeth and/or hard and soft
tissues inside and surrounding oral cavity [1].
Usually, trauma occurs suddenly, indirectly,
and unexpectedly, often requiring immediate
and accurate emergency treatment to improve
the success rate [1,2]. The oral cavity is one of
the most commonly affected by physical injuries
in children, accounting for approximately 18%
of injuries, right after skin and soft tissues.
Worldwide, studies show that the prevalence
of dental trauma to deciduous (baby) teeth is
around 21%, and to permanent teeth is around
15% [3]. Research conducted on Jakarta children
aged 8-12 years found that 11.4% experienced
trauma to permanent teeth [4].
Several causes ot tooth injuries are from
sports, falling, vehicle accidents, physical
collisions, violence, lack of protective devices, and
behavioral issues [5]. Certain populations are at
a higher risk of tooth injuries, especially the one
who develop behavioral issues, such as children
with special health care needs (CSHCN) [6].
One of this group is Down syndrome or trisomy
21, which is the most common chromosomal
abnormality, with a prevalence of 1:600-
2000 live births worldwide [7]. In Indonesia,
Down syndrome ranks rst among congenital
disabilities and have shown an increasing trend
based on data from the Basic Health Research
(Riskesdas) on children aged 24-59 months in
2010, 2013, and 2018, with prevalence rates of
0.12%, 0.13%, and 0.21%, respectively [8].
The prevalence of tooth injuries in all
types of CSHCN ranges from 8.7% to 23.1% in
various countries [9–11]. However, tooth injuries
prevalence among CSHCN, including Down
syndrome, have not been researched and reported
in Indonesia. The prevalence of tooth injuries
in individuals with Down syndrome compared
to typical children is 24.73%; 4.95% [12]. This
higher risk can be attributed to medical and dental
conditions, as well as factors such as intellectual
and behavioural disorders, physical limitations,
coordination, and mobility impairments [3,10].
Those limitations or impairments lead individuals
with Down syndrome to depend on assistance
from others to carry out daily activities, including
emergency dental care after trauma [13].
Various consequences that can result from
tooth injuries including crown discoloration,
pulp necrosis, inflammatory or replacement
resorption, and rooth obliteration. Another
sequels can also affect replacement teeth,
leading to changes in enamel opacity, enamel
growth defects, crown or root dilaceration,
and ectopic eruption [14,15]. Reviewing the
high prevalence of the sequelae necessitates
appropriate and timely prompt treatment to
reduce the occurence [15]. In addition, education
and strategies for preventing tooth injuries are
crucial for parents, caregivers, teachers, and
sports coaches [2,13].
Tooth injuries in CSHCN, including Down
syndrome, has not received adequate dental care.
The proportion of children receiving post-tooth
injuries care is only 23.1% in Saudi Arabia, 50%
in Brazil, and 27.7% in Jordan [10,11,16]. One of
the most frequently mentioned causes is the low
attitudes, awareness, and dental health literacy
of parents or caregivers [2,10,11].
Various media and platforms have been
developed as means of preventive education and
emergency management of tooth injuries [2].
The widespread use of smartphones in this era
of industry 4.0 can be utilized for educational
purposes [17]. Research in Indonesia shows
that 55.4% of mothers prefer internet as a
source of information for parenting over other
sources (seminars, family, or neighbours) [18].
Emergency education media are recommended to
utilize computerized technology to reach a wider
population, be easily accessible and readable,
especially when accidents occur at home or in
school environments [19].
In Indonesia, studies on rst aid education for
tooth injuries among various groups such as parents
precisa ser avaliado medindo o nível de conhecimento dos pais de crianças com Síndrome de Down. A medição
realizada mostrou que há uma diferença no nível de conhecimento dos pais antes e depois de lerem o livro
eletrônico “Traumatismos Dentários em Crianças com Síndrome de Down”.
PALAVRAS-CHAVE
Livros; Síndrome de Down; Pais; Traumatismos dentários.
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Braz Dent Sci 2024 Apr/June;27 (2): e4040
Surija I et al.
Knowledge level of children with Down Syndrome’s parents before and after reading electronic book “Tooth Injuries in Children with Down Syndrome”
Surija I et al. Knowledge level of children with Down Syndrome’s parents
before and after reading electronic book “Tooth Injuries in
Children with Down Syndrome”
and elementary school teachers have proven effective
in improving knowledge through interventions such
as animated videos and educational posters [20,21].
However, health education programs focused on
parents of children with Down syndrome (CDS)
are still limited in Indonesia. Education regarding
dental and oral health to Down Syndrome Parents
and Children Association (POTADS) has been
conducted through animated videos, webinars, and
online personal consultations as community service.
However, this education does not yet include topics
on preventing tooth injuries and its emergency
management. Therefore, research is needed to
assess the improvement in knowledge of parents
with Down syndrome regarding tooth injuries.
In this study, we created and developed
an educational electronic book titled “Tooth
Injuries in Children with Down Syndrome” which
includes risk factors, emergency management, and
prevention strategies. These topics have not been
previously addressed. The aim of this study was
to evaluate the effectiveness of this new electronic
book by examining the differences in knowledge
levels of parents of CDS before and after reading it.
MATERIAL AND METHODS
Subjects
This experimental research was started and
ended in November 2022 at the Centre for Down
Syndrome Parents and Children Association
(POTADS) and three special needs schools type
C (designed to the mentally disabled children) in
Jakarta. The research participants were parents
of CDS who lived in Jakarta. The subjects were
selected using purposive sampling, considering
inclusion and exclusion criteria.
Inclusion criteria for respondents were
as follows: having a smart mobile device for
communication and internet access to ll out
questionnaires and access electronic books.
Respondents who had received education related
to dental and oral trauma in children, individuals
with special needs who had difficulties in
receiving visual information, and those with
an educational or occupational background in
dentistry were excluded from the study.
Sample size calculation
The minimum sample needed in this study
to ensure the intervention effect was detected,
based on previous study [22], and calculated
using correlation formula. The result from this
formula with zα=5% (type I error of 5%), zβ=5%
(type II error of power 95%), S=2.1, and 𝑥1−
𝑥2=1.4 was 32 individuals.
Electronic book
The authors created and developed the
electronic book “Tooth Injuries in Children with
Down Syndrome” and the questionnaire for
parents. These materials were prepared based
on the guidelines for tooth injuries in typical
children, which were then modied to consider
the limitation ability of CDS. This new electronic
book needs to be evaluated rst before being
made available to the public. The content validity
was validated through discussions with experts
and 10 dentists, and face validity was conducted
with 10 parents of children with Down syndrome
(outside the research subjects). These parents
for validity test did not participated in the nal
sample.
After the validation process, the electronic
book consists of 9 pages with coloured illustrations.
The topics about tooth injuries in CDS includes
prevalence, risk factors, emergency management,
and prevention (Figure 1).
Questionnaire
A self-administered questionnaire consisting
of several sections about demographic data,
experience, and knowledge regarding tooth
injuries in CDS was used in this study.
The knowledge section related to the book’s
content was modified from several previous
studies [20,23,24], and based on discussions with
expert panels. After evaluation and improvements
were made, the questionnaire’s reliability was
tested using the Kuder Richardson-20 (KR-20)
on a minimum of 30 parents of CDS (outside
the research subjects). Questionnaire consisted
of 15 multiple choices questions with a scoring
system of 0 for incorrect answers and 1 for
correct answers. The total range of score was
0-15. The categories for total scores are dened
as follows: good (12-15), fair (9-11), and poor
(0-8).
Education method
During the initial knowledge assessment,
respondents were asked to ll out the questionnaire
via Google Form, with a maximum duration of
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Surija I et al.
Knowledge level of children with Down Syndrome’s parents before and after reading electronic book “Tooth Injuries in Children with Down Syndrome”
Surija I et al. Knowledge level of children with Down Syndrome’s parents
before and after reading electronic book “Tooth Injuries in
Children with Down Syndrome”
10 minutes for completion. Subsequently, the
respondents were allowed to carefully read the
electronic book “Tooth Injuries in Children with
Down Syndrome” for 10 minutes. After that,
the measurement was repeated using the same
questionnaire and duration.
Statistical analysis
Statistical Package for Social Studies (SPSS)
version 22.0 (IBM Corporation, Chicago, IL,
USA) was used for data entry, coding, descriptive
statistics, and analyse data. The normality data
of lled questionnaire were statistically analysed
using Shapiro-Wilk. Paired parametric numerical
comparative test of two groups (Paired T-test)
was used to analyse the difference of knowledge
total score of respondents before and after reading
electronic book “Tooth Injuries in Children with
Down Syndrome”. A p-value <0.05 was used and
considered signicant.
RESULTS
The reliability testing of the questionnaire
using KR-20 yielded a value of 0.72, which can
be interpreted as both the electronic book and the
knowledge questionnaire being valid and reliable.
Out of the 43 samples of parents of CDS present
during the measurement, 37 parents met the
criteria and agreed to participate as respondents.
The distribution of respondent characteristics in
this study was predominantly female (86.5%),
aged between 46-65 years (73%), with a basic
to intermediate education level (59.5%), and
unemployed or housewife (78.3%) (Table I).
Figure 1 - Cover electronic book “Tooth Injuries in Children with Down Syndrome”.
Table I - Demographic details of respondents
Variables Frequencies
(N)
Percentage
(%)
Sex
Male 5 13.5
Female 32 86.5
Age Group (years)
Adult (26-45) 10 27.0
Elderly (46-65) 27 73.0
Education Level
Basic-Intermediate
(Primary, Secondary Education) 22 59.5
Advanced
(Bachelor, Master, Doctorate Education) 15 40.5
Working Status
Employed 8 21.6
Unemployed 29 78.3
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Surija I et al.
Knowledge level of children with Down Syndrome’s parents before and after reading electronic book “Tooth Injuries in Children with Down Syndrome”
Surija I et al. Knowledge level of children with Down Syndrome’s parents
before and after reading electronic book “Tooth Injuries in
Children with Down Syndrome”
The results of the normality test for the
data using Shapiro-Wilk on parental knowledge
before and after reading the electronic book
consecutively were 0.067 and 0.116 (p>0.05),
indicating a normal distribution. The mean
knowledge scores of parents before and after
reading the electronic book were 6.62 (poor)
and 10.51 (fair), respectively (Figure 2).The
total difference in knowledge scores was tested
using the Paired T-test, and the obtained p-value
was 0.001 (Table II). Thus, it can be concluded
that there is a statistically signicant difference
(p<0.05) between the knowledge scores of
parents of CDS before and after reading the
electronic book “Tooth Injuries in Children with
Down Syndrome.”
DISCUSSION
The background for selecting this topic
is based on several recent studies regarding
Down syndrome and its relationship with tooth
injuries [7,10,12]. According to a meta-analysis
study, three studies showed that the prevalence
of tooth injuries in the Down syndrome group
was signicantly higher compared to the control
group, with percentages of 24.73%:4.95%,
88.7%:3.2%, and 8.7%:4.1% [12]. The odd
ratios for tooth injuries in Down syndrome and
control group ranged from 6.18 to 69.95. It also
mentioned that further research should focus on
the development of prevention efforts aimed to
avoid factors related to tooth injuries and Down
syndrome, as well as reducing the impact of tooth
injuries [12].
The parents of CDS were chosen as respondents
is considered due to the limitations and dependence
of CDS on other helps in daily living. Parents are
the closest individuals, facilitators, and caregivers
who hold the main authority and responsibility
for making decisions related to the behaviour and
healthcare of their children [25]. The proportion of
children who experience tooth injuries and receive
dental care afterward remains low, ranging from
23.1% to 27.7% [10,11,16]. The most common
reasons disclosed for this are the low knowledge,
awareness, and attitude of parents towards dental
trauma management [2,10,11]. Through direct
education to parents, it is hoped that knowledge
and awareness regarding the management and
prevention of dental trauma in CDS can be
improved.
The research was taken place at POTADS and
several special needs schools type C at Jakarta
was mainly refers to previous dental and oral
health education in CDS research on conducted
in several similar places [26]. By taking samples
from various locations, a diverse background of
parents was expected to obtain. There are no
restrictions on the sociodemographic background
of the respondents because it is expected that this
electronic book can be understood by all parents
of CDS. In this study, the differences in parental
sociodemographic characteristics concerning
knowledge improvement were tested and
Table II - Comparison of total knowledge scores before and after reading electronic book
Total Knowledge Score n Mean (SD) Knowledge Level p Value
Before 37 6.62 (0.34) Poor *0.001
After 37 10.51 (0.48) Fair
*Parametric Paired T-test, sig. level p ≤ 0.05.
Figure 2 - The difference of total score of samples before and after reading electronic book.
6.62
10.51
0
4
8
12
Before After
poor
fair
good
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Braz Dent Sci 2024 Apr/June;27 (2): e4040
Surija I et al.
Knowledge level of children with Down Syndrome’s parents before and after reading electronic book “Tooth Injuries in Children with Down Syndrome”
Surija I et al. Knowledge level of children with Down Syndrome’s parents
before and after reading electronic book “Tooth Injuries in
Children with Down Syndrome”
showed no signicant differences in education
level, employment status, and age. This is in line
with previous research that age, employment
status (whether working or staying at home),
and education are not significantly related
to knowledge, attitudes, and concern about
their children’s dental health [27]. Knowledge
improvement can be achieved not only through
formal education but also through non-formal
education and other sources of information such
as television, social media, and others [28].
We choose visual educational media through
books in this study is considered based on
previous studies that have shown an improvement
in knowledge about oral health and dental
trauma in parents or teachers through visual
educational media such as posters, online videos,
and leaets [20,23]. According to experts, visual
perception is the dominant sense in conveying
knowledge to the brain (75-87%), followed by
hearing (13%), and other senses (12%) [29].
The advantage of visual media is that education
can be presented in a more concrete, engaging,
meaningful, and effective manner. The use
of images and illustrations can help visualize
educational concepts more realistically and
concretely [30].
There are some drawbacks of printed visual
media, such as the materials being easily torn
or lost, printing costs depending on quality and
quantity, and limited information availability
in certain locations [2,20]. To address these
limitations, education in this research is developed
in digital, one of which is an electronic book.
Teaching and education about emergency are
better utilized through technology, computerized,
and internet connectivity to broaden the target
audience, reduce printing costs, facilitate regular
topic updates, and provide access from various
places and times [19].
The content of this electronic book on
emergency management of tooth injuries
refers to the guidelines for dental trauma by
International Association of Dental Traumatology
(IADT), International Association of Paediatric
Dentistry (IAPD), and health departments of
several countries for typical children [31-34].
Modifications are made based on discussions
with experts to specically formulate for CDS.
Material on the prevention of tooth injuries
is organized both generally and specifically.
General prevention follows the guidelines for
injury prevention in paediatric dentistry, such
as the use of safety equipment and trauma
prevention tools (helmets, mouthguards),
creating a safe home environment, and using
a car seat [33,34]. Specic prevention material
for CDS is developed based on their specic risk
factors for trauma, including improving motor
coordination and balance through physical
therapy, using specialized footwear, hearing
and visual aids, and regular visits to a paediatric
dentist, especially for those with malocclusion,
mouth-breathing habits, and incompetent
lips [35-37]. Proper use of car seat, according to
the child’s weight and specically designed for
CDS, is essential to protect them from head, neck,
and spinal injuries due to their reduced muscle
tone and neck instability [38].
The questionnaire was adapted from several
previous studies related to tooth injuries in
children [20,23,24]. Then, modications were
made to make the questions more specific in
measuring knowledge about tooth injuries in
CDS, and it covered all the topics from the
electronic book that had been prepared. Content
validity is highly recommended when developing
a new instrument involving literature review and
evaluation by experts. Meanwhile, face validity
focuses on whether the measurement instrument
is relevant, logical, not ambiguous, and clear or
easy to understand [39]. In this study, content
validity was conducted for both the electronic
book and the knowledge questionnaire, where
the researchers and experts discussed the content,
text, and illustrations of the electronic book, as
well as the 15 knowledge questions along with
their answer choices. Face validity was assessed
by 10 dentists and 10 parents of CDS (other than
research respondents).
The reliability of the questionnaire
measurement tool can be assessed based on
the aspect of internal consistency. Consistency
or internal reliability evaluates to what extent
responses to each question have the same
concept characteristics or correlate with each
other. The reliability of the questionnaire with
binary answer types in this study was tested using
the KR-20 test [40]. This test was conducted
on 30 parents of CDS (excluding the research
respondents from Jakarta) who had not received
any educational intervention previously, and the
KR-20 correlation result was 0.72. Based on the
reliability index category, the KR-20 result in
this study has good reliability criteria. Through
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Surija I et al.
Knowledge level of children with Down Syndrome’s parents before and after reading electronic book “Tooth Injuries in Children with Down Syndrome”
Surija I et al. Knowledge level of children with Down Syndrome’s parents
before and after reading electronic book “Tooth Injuries in
Children with Down Syndrome”
this series of validity and reliability tests, it can
be concluded that the electronic book media and
the research questionnaire are valid and reliable.
Effective Speed Reading (ESR) is a
combination of the average reading speed and the
accuracy of understanding the content. Calculating
the reading speed for various educational levels
with a minimum comprehension rate of 70%,
the ESR values are as follows: elementary school
level - 140 words per minute (wpm), junior high
school - 140-175 wpm, senior high school - 175-
245 wpm, and college - 245-280 wpm [41].
In this study, the electronic book consists of a
total of 1290 words. The reading duration was
determined considering the ESR for the lowest
educational level, which is elementary school
with 140 wpm and a duration of 9.2 minutes, and
the longest reading duration during the validation
of the electronic book by parents, which was
10 minutes. Therefore, the researcher decided
that the duration for reading the electronic
book and lling out the questionnaire would be
10 minutes each.
From those 15 knowledge questions in the
questionnaire, it was found that all question
had a varied increase in the percentage of
correct answers, ranging from 5.41% to 70.27%
(Table III). The three questions with the highest
increase in the distribution of correct answers
were question numbers 4, 5, and 7. Question
number 4, which addressed the risk factors
for tooth injuries in CDS, had an increase
of 45.95% in the score of correct answers.
Question number 5, which covered emergency
management of avulsed teeth, had the highest
increase in correct answers, reaching 70.27%.
Question number 7, concerning emergency
management of fractured teeth, showed an
increase of 67.57% in the percentage of correct
answers. These ndings are in line with previous
research that showed an increase in knowledge
related to avulsed tooth management in parents
who received interventions such as posters,
pamphlets, brochures, and the “ToothSOS”
mobile application by IADT [23,42].
Emergency management for avulsed and
fractured teeth are essential topics for parents
Table III - Distribution percentage of knowledge scores before and after reading electronic book
No Questions Right Answer (%) Delta
1. What is dental and oral trauma in children? Before 16.22 43.24
After 59.46
2. Which of the following are classified as dental trauma in CDS? Before 18.92 21.62
After 40.54
3. How is the prevalence of dental and oral trauma in CDS and children without Down syndrome? Before 64.86 10.81
After 75.68
4. Which one of the following can increase the risk of CDS to dental and oral trauma? Before 21.62 45.95
After 67.57
5. What first aid treatment should be taken if tooth falls out and falls in a dirty area? Before 21.62 70.27
After 91.89
6. What is the correct way to handle a dislodged tooth to ensure the good prognosis? Before 48.65 32.42
After 81.08
7. What is the first aid treatment should be taken for broken tooth due to an impact? Before 8.11 67.57
After 75.68
8 What is the first aid treatment should be taken for bleeding lip in children? Before 64.86 16.22
After 81.08
9 When is the appropriate time to seek medical treatment when dental and oral trauma happens in CDS? Before 89.19 5.41
After 94.59
10 Where should parents seek appropriate dental help when dental and oral trauma occurs in CDS? Before 54.05 8.11
After 62.16
11 When should follow-up post-treatment dental trauma be scheduled? Before 78.38 5.41
After 83.78
12 What tool can be used to prevent dental trauma in children during physical activities? Before 56,76 24.32
After 81.08
13 Which one is NOT a prevention way of dental and oral trauma in children? Before 45.95 8.11
After 54.05
14 Which one is NOT a way to improve motor coordination and balance in CDS? Before 51.35 8.11
After 59.46
15 What is the way to create a safe condition inside the car for CDS weighing 12 kg? Before 13.51 37.84
After 51.35
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Braz Dent Sci 2024 Apr/June;27 (2): e4040
Surija I et al.
Knowledge level of children with Down Syndrome’s parents before and after reading electronic book “Tooth Injuries in Children with Down Syndrome”
Surija I et al. Knowledge level of children with Down Syndrome’s parents
before and after reading electronic book “Tooth Injuries in
Children with Down Syndrome”
of CDS to be understood due to the success
prognosis of dental trauma treatment largely
depends on the accuracy of the emergency
management performed by those closest to
the child. Inadequate management can lead to
early tooth loss, reduced prognosis, increased
complications, and psychological problems
in growing children [23]. From the above
analysis, it can be concluded that the electronic
book “Tooth Injuries in Children with Down
Syndrome” is able to fulfill its value as an
information and education tool for parents
regarding dental and oral trauma in CDS,
especially on the crucial topics.
The results of the Paired T-test analysis
with a p-value of 0.001 indicate that there is
a statistically signicant difference in parents’
knowledge levels before and after reading the
electronic book “Tooth Injuries in Children with
Down Syndrome.” This is consistent with other
studies that have shown an increase in parents’
knowledge in various countries after receiving
dental trauma education through printed media,
seminars, digital tools, mobile applications, or
multimodal approaches [22,23,42]. The average
knowledge level of the research respondents
before the intervention was 6.62, which was
considered inadequate. This is consistent with
the findings of other studies, which revealed
that parents’ knowledge about avulsion and
replantation of teeth before education was
inadequate [23,43].
The results of this research indicate that
the educational media of the electronic book
can increase parents’ knowledge about tooth
injuries in CDS. Therefore, it can be considered
in developing easily accessible educational
media about dental and oral trauma that are
evidence-based for parents CDS in the future.
Additionally, the inadequate knowledge of
parents of CDS about dental and oral trauma
emphasizes the importance of education for this
group, considered its high prevalence in this
population.
As this research focused on the development
of new electronic educational media, such as
an electronic book, the sample included only
the parents of CDS. However, studies targeting
other populations closely related to CDS, such as
special school teachers, and caregivers are also
needed. The design used in this study was before
and after treatment measurement. Sometimes,
it is necessary to measure the retention of new
knowledge. This can be assessed by implementing
several measurements, for example 5 days,
7 days, or 10 days after reading. High prevalence
of tooth injuries is also found in other special
needs populations, such as those with cerebral
palsy, attention defisit hyperactivity disorder
(ADHD), and autism spectrum disorder (ASD).
Educational intervention about tooth injuries may
also be developed for these populations.
CONCLUSION
There is a difference in the level of knowledge
of parents of CDS before and after reading the
electronic book “Tooth Injuries in Children with
Down Syndrome,” it can be concluded that the
electronic book is an effective educational media in
improving the knowledge of parents about dental
and oral trauma in CDS. The increase in knowledge
observed after reading the book demonstrates its
effectiveness in providing valuable and relevant
information to parents, which can positively
impact the way they handle dental and oral trauma
in their children. The electronic book has proven to
be a useful tool in enhancing knowledge of parents
to make better decisions for the tooth injuries and
oral trauma of their CDS.
Acknowledgements
The researcher would like to thank all
school principals and participants who agreed to
participate in this study.
Author’s Contributions
IS: Methodology, Software, Formal Analysis,
Investigation, Resources, Data Curation, and
Writing – Original Draft Preparation. EF:
Conceptualization, Methodology, Validation,
and Writing – Review & Editing, Supervision.
HS: Conceptualization, Validation, and Writing
– Review & Editing, Visualization.
Conict of Interest
The authors declare no conicts of interest.
Funding
HIBAH PUTI (Grant No. NKB-233/UN2.
RST/HKP.05.00/2022), Universitas Indonesia.
9
Braz Dent Sci 2024 Apr/June;27 (2): e4040
Surija I et al.
Knowledge level of children with Down Syndrome’s parents before and after reading electronic book “Tooth Injuries in Children with Down Syndrome”
Surija I et al. Knowledge level of children with Down Syndrome’s parents
before and after reading electronic book “Tooth Injuries in
Children with Down Syndrome”
Regulatory Statement
This study protocol was reviewed and approved
by Research Ethics Committee at the Faculty of
Dentistry, University of Indonesia, approval number
116/Ethical Approval/FKGUI/XI/2022.
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Eva Fauziah
(Corresponding address)
Universitas Indonesia, Pediatric Dentistry, Jakarta, Indonesia.
Email: eva.fauziah@ui.ac.id
Date submitted: 2023 Sept 14
Accept submission: 2024 June 13
