1. Introduction
Oral diseases constitute a public health problem because they can negatively affect people throughout their growth and development, causing pain, discomfort, loss of function, and reducing their quality of life [
1,
2]. These diseases affect approximately 3.5 billion people worldwide. It has also been reported that dental caries in permanent teeth is the most frequent disorder, and it is estimated that approximately 2000 million people suffer from it. On the other hand, it has been reported that 514 million children worldwide suffer from caries in deciduous teeth [
3]. In Peru, the prevalence of carious lesions in enamel and dentin was reported to be 91.2% in 3-year-old children living in Lima [
4].
The postpartum period, also known as puerperium, is a stage of maternal anatomical and physiological changes that begins with the production of breast milk and the physiological recovery of various organs and systems. This period is divided into three phases: Acute or immediate phase that occurs up to the first 24 h postpartum, intermediate or early phase from the 2nd to the 7th postpartum day, and late or remote phase up to 6 weeks postpartum to 6 months [
5]. The puerperium or postpartum period is a key moment for health education since women are interested in information about the care and well-being of their newborns. It is therefore important to provide them with basic notions about preventive measures such as the recommended frequency of brushing, correct use of fluoride toothpaste, use of pacifiers, improper use of bottles, breastfeeding, and type of feeding, among others [
6,
7,
8,
9].
In this regard, the World Health Organization [
3] has considered it essential to work on the prevention and control of oral diseases with specific actions during the preconception, prenatal and postnatal periods, implementing the promotion of self-care, community actions, and preventive activities due to the vulnerability of newborns [
10,
11]. Therefore, it is important to consider gestation, puerperium, and the first two years of life as stages of opportunities to promote health and foster healthy growth and development. To achieve this, the mother is a key factor in guiding good health behavior if she acquires good oral hygiene practices and healthy eating habits. This would make it possible to maintain oral health throughout the life cycle, since habits acquired at an early age are more likely to be preserved uninterrupted into adulthood [
10,
12,
13,
14]. However, the modulation of these habits can be influenced by some factors such as the level of knowledge about oral health, age, socioeconomic status, or educational level, among others [
2,
3,
15,
16].
Several studies have been conducted to determine the level of knowledge of pregnant women in order to adopt governmental policies and carry out educational interventions to improve their quality of life and that of their future babies, taking into account that both are considered vulnerable populations due to their greater exposure to risk factors [
8,
11,
17,
18]. However, in the last five years (2018 to 2022) there is only one study that evaluates the knowledge of early postpartum women about oral health in infants [
19].
Therefore, the present study aimed to evaluate the sociodemographic factors associated with the level of knowledge of early postpartum women about oral health prevention in infants aged 0 to 2 years. The present study considers as a null hypothesis that there are no sociodemographic factors significantly associated with the level of knowledge of early postpartum women about oral health prevention in infants aged 0 to 2 years.
4. Discussion
The high prevalence of oral diseases [
26] makes it necessary to promote and prevent oral health from early childhood to reduce the impact on future generations. This becomes even more relevant if we take into account that women during the gestation and postpartum stages are more predisposed to make changes in their habits, assimilating more easily the information that can benefit their health and that of their babies. Therefore, these stages become crucial to instruct mothers about oral health care so that they can be transmitters of healthy attitudes and practices to their children [
8,
9,
26]. In Peru, 12.6 out of every 100 adolescents are pregnant or are already mothers according to the Demographic and Family Health Survey in 2018 [
27]. Adolescents between 12 and 17 years of age represent 10.8% of the population in Peru. Of this total, adolescent pregnancies registered 10.1% in urban areas and 22.7% in rural areas [
27]. Likewise, between 34% and 43% of patients in public hospitals have been reported with inadequate health literacy, being age, level of education, and unemployment are some of the factors that influence this problem [
28]. For this reason, the National Concerted Health Plan 2007–2020 in Peru included as part of its health objective the inclusion of pregnant women in preventive dental care [
29]. In view of the above, the present study aimed to determine the factors associated with the level of knowledge of early postpartum women about oral health prevention in infants aged 0 to 2 years old. The null hypothesis was rejected since academic level and age were identified as risk factors for having a poor level of knowledge about this topic. Taking into account the findings, it would be advisable for health authorities to pay more attention to this vulnerable population, focusing specifically on young women with low academic levels, encouraging their self-care and helping them to be guides for their children in the acquisition of healthy habits [
7]. Furthermore, taking into account that maternal oral health is recognized as a risk factor for early childhood caries, preventive oral care, and educational sessions should be addressed before pregnancy and as part of prenatal and postnatal check-ups [
30,
31,
32].
Of the total number of respondents, 48.86% had a poor level of knowledge. These results differ from those reported by Luengo et al. [
17] who found that 58% of the women surveyed showed fair knowledge. This discrepancy could be due to the fact that the aforementioned study was conducted on Mexican pregnant women hospitalized in a specialized women’s health care facility where there is probably greater control and dedication to pre- and postnatal care, including oral health care. The present study was carried out in a general hospital where patients referred from different health facilities are attended. Likewise, the study by Luengo et al. was carried out before the COVID-19 pandemic, unlike the present study which was conducted when Peru was in the second wave of the pandemic and may have greatly limited the oral health care of early postpartum women. In addition, the poor level of knowledge obtained in the present study could be attributed to the low awareness of many women about their oral health, since despite having symptoms or signs of disease, they do not seek or receive promotional preventive dental care. If we add to this the socioeconomic level, it becomes a barrier to disease prevention [
17,
30,
33,
34]. Another explanation for this could be that oral health care instruction for the future baby is not routinely addressed during the mother’s prenatal care either because dentists are not part of the prenatal multidisciplinary health team or because there is little interprofessional education [
30]. Furthermore, the present study was conducted in a population whose social determinants such as age and educational level may have had a negative influence on the level of knowledge [
35,
36,
37].
In the present study, early postpartum women aged 18 to 25 years were significantly two times more likely to have poor knowledge than those over 35 years, which is consistent with the study by Ben David et al. [
19] who reported that older women had greater knowledge. Likewise, Esteves et al. [
22] found that women older than 30 years had acceptable knowledge in relation to knowing when their child should visit the dentist for the first time. Likewise, our results were similar to those found by Al-Sane et al. [
21] who indicated that the age of the mother was significantly associated with a better level of knowledge about dental caries, since mothers older than 35 years had significantly better scores than younger mothers. In summary, these results could be explained by the fact that older women may want to become more skilled and acquire more experience, which may contribute to a healthier prenatal and postnatal environment [
38]. Moreover, greater maturity would allow them to engage in independent, productive, and self-serving behaviors [
39].
The early postpartum mothers in the present study who had no education, those who had only primary school, and those who had only secondary school had 11 times, 6 times, and 5 times, respectively, the probability of having poor knowledge significantly higher than those who had a university education. These results are similar to those obtained by Al-Sane et al. [
21], who indicated that mothers with higher levels of education had better levels of knowledge. Furthermore, according to Barbieri et al. [
18], a level of schooling equal to or higher than 8 years was associated with adequate knowledge about oral health. This could be explained by the fact that mothers with a higher educational level may have better discernment to choose the appropriate sources of information to adopt healthy practices. Likewise, women with a higher educational level may have better oral health literacy and a greater ability to choose a health service that is appropriate to their needs [
40,
41,
42].
Among the limitations of the present study, we can mention that it was not possible to make a comparison between the knowledge of early postpartum women who attended in public health facilities and those who attended in private health facilities. Likewise, it was not possible to compare the knowledge of early postpartum women in urban areas with those in rural areas. Another limitation was the inability to interview early postpartum women under 18 years of age because informed consent could not be obtained from their guardians. Finally, the cross-sectional design of the present study did not allow us to evaluate the variation and durability of knowledge over time.
Taking into account the results obtained, it is recommended that health authorities develop oral healthcare programs focused on the mother-child duo from the moment of conception [
10]. Likewise, it is necessary to empower professionals who work with pregnant women and postpartum women, whether primiparous or multiparous, on the need to develop promotion and prevention strategies during prenatal and postnatal control in an interdisciplinary manner with the dentist, valuing that these stages are learning opportunities that can contribute to establishing healthy habits from childhood, thus favoring the care of the mother and child throughout life [
30,
32].