The role of family functioning in childhood dental caries

The Relationship Between Manual Dexterity and Toothbrushing Efficiency in Preschool Children: A Crossover Study

AIM

The aim of this study was to evaluate the relationship between oral hygiene (OH) efficiency and manual dexterity skills in Spanish five-year-old children using two fine motor tests.

METHODS

A cross-sectional study with a pre-post evaluation was designed. The children's OH was measured according to the Silness and Löe plaque index (PI) before toothbrushing upon arrival at school (pre) and after supervised toothbrushing (post). Motor skills (children's dexterity) were determined with the Visual Motor Skills and Resistance to Fatigue test (VMSRF test) and the scale for the Behavioural Assessment of Preschool Skills (BAPS scale). Data were analysed with the SPSS® statistics software with a 95% confidence interval and bilateral significance.

RESULTS

One hundred and twenty-nine children were evaluated. The mean PI was 2.5, indicating generally poor OH in the sample. No difference in OH was observed between genders or in the brushing frequency categories. No significant differences in OH or the PI were found between right- and left-handed children either (p > 0.05). Significant differences were found between the OH category pre and post toothbrushing in the total sample, as well as in the various sextants and surfaces evaluated. The results of the VMSRF and BAPS tests indicate moderate visuomotor skills and fatigue resistance and a poor average skill level. A statistically significant improvement in the PI was found in children with higher scores in the VMSRF and BAPS tests.

CONCLUSIONS

A significantly higher OH efficacy was found in children with better motor skills, although five-year-old children showed moderate visuomotor skills and fatigue resistance and a poor average preschool skill level.

Psychosocial determinants of oral health outcomes in young children

Objective

To examine the social determinants of early childhood caries (ECC), one of the greatest public health risks affecting children, and examine alternative pathways of influence.

Methods

A physically healthy, socio-demographically high-risk sample of initially caries-free children, aged 1-4 years, was prospectively studied for 2 years. At 6-month intervals, assessments were made of caries presence from a standard dental exam; oral microbiology was assayed from saliva samples; oral hygiene behaviors and psychological and psychosocial risk exposure were derived from interviews and questionnaires.

Results

189 children were enrolled; ECC onset occurred in 48 children over the 2-year study period. A composite measure of psychosocial risk was significantly associated with ECC onset over the course of the study (1.57, 95% CI 1.12-2.20, p < .001) and significantly associated with multiple risks for ECC, including poor diet/feeding (.92; 95% CI. 22-1.61, p < .01), poor oral hygiene (.39; 95% CI .09-.68), p < .05), and higher concentrations Lactobacilli (.96; 95% CI .43-1.49, p < .001). Multivariable regression analyses provided indirect support for the hypothesis that psychosocial risk exposure predicts ECC onset via behavioral and oral hygiene pathways.

Conclusions

The study provides novel evidence that psychosocial factors influence many of the purported risks for ECC and strong evidence that there are social and psychological determinants of ECC onset.

Impact of the COVID-19 lockdown on the oral health behaviour of young children

AIM

Children up to the age of 10 are dependant primarily on their caregivers for oral care; COVID-19 lockdowns may have disrupted this care. We therefore assessed whether the COVID-19 lockdown affected routine parental oral care for their children.

METHODS

A short online survey regarding oral health behaviour and changes in the home setting during the COVID-19 lockdown was emailed to parents (n = 782, response 15%) participating in an existing study 'Healthy Teeth All Aboard (HTAA)'.

RESULTS

During the lockdown, 29% of parents reported that they skipped their children's toothbrushing more often than before the lockdown, and 49% of the children were allowed to consume sugary snacks or drinks more often. These behaviours were not significantly associated with socio-economic status, country of birth of the mother, work situation of the parents, school attendance patterns or HTAA participation status.

CONCLUSION

The COVID-19 lockdown affected the daily oral hygiene routines of children, potentially increasing caries risk.

CLINICAL RELEVANCE

Dental professionals should be aware of the potential impacts on oral health in children in the circumstance of a new lockdown. Parents should be made aware of the oral health consequences of a lockdown.

Family-related risk indicators and dental attendance in association with dental caries in preschool children

BACKGROUND

Determining risk indicators behind dental caries is important for identifying children in need of enhanced dental care. The aim of this register-based study was to investigate the association of family-related risk indicators and dental attendance in the development of dental caries in preschool children.

METHODS

The data for this study were collected from the medical records of 206 randomly chosen preschool children who lived in the city of Oulu, Finland, during 2014-2020. Data on challenges in family life, missing appointments and utilization of oral health care were collected. Sum functions were formed of risk indicators. Analyses were carried out for three age groups (1- to 2-, 3- to 4- and 5- to 6-year-olds) born between 2014 and 2018.

RESULTS

There was a significant association between the number of family-related risk indicators and the prevalence of manifested caries lesions in the age group of 5- to 6-year-olds. All family-related risk indicators and information about health care utilization were associated with dental caries risk. Challenges in a child's family life were present among 20.3% of the 5- to 6-year-olds. In all age groups, the most common challenges in family life were parental exhaustion and problems in the parents' relationship or divorce.

CONCLUSION

Family-related risk indicators and dental attendance should be considered when determining caries risk. The caries risk indicators investigated here are associated with each other.

Some young adults can maintain good oral health despite socioeconomic challenges

The association between dental caries experience and socioeconomic status, as reflected in income and educational level, is well known. However, some individuals maintain good health despite socioeconomic disadvantage. The aim of this qualitative study was to explore salutogenic (health-promoting) factors among healthy caries-free young adults of low socioeconomic status. Seventeen participants (11 women), 19-23 years of age, who were caries-free and of low socioeconomic status were interviewed in-depth. The interviews were transcribed verbatim and analysed using qualitative content analysis with an inductive approach. The theme revealed was 'Building trust and shifting responsibility from parent to child throughout children's development lays the salutogenic foundation for oral health', comprising three categories: (i) a basis for health; (ii) creating one's own path by testing wings; and (iii) developing resources for health. A feeling of trust was expressed, participants were confident in the unconditional support of their caregivers, and caregivers were trusting participants to be able to take control over their own oral health. Health-promotive factors were established not only by instilling healthy habits during childhood, but also by parental guidance through adolescence, enabling young adults to develop resources and assets to take control over their own health independently.

Factors influencing the oral health behaviour of Dutch adolescents with mild to borderline intellectual disabilities living in residential care: A qualitative study

BACKGROUND

Toothbrushing, limiting intake frequency, and scheduled visits to an oral healthcare professional (OHP) are key for good oral health. We aimed to explore factors influencing these oral health behaviours in Dutch adolescents with mild to borderline intellectual disabilities (MBID) in residential care.

METHOD

Using a qualitative, descriptive approach, we conducted focus groups and interviews with 12 adolescents, 9 counsellors, and 6 OHPs. Thematic analysis mapped factors influencing adolescents' knowledge, attitude, planning, and execution of oral health behaviours to oral care stakeholders.

RESULTS

Of nine identified influencing factors, three were pivotal: Structure (influencing toothbrushing and intake frequency), Anxiety (impeding dental visits), and Support (provided by counsellors).

CONCLUSIONS

Counsellors should provide structured daily guidance on oral hygiene and diet for adolescents with MBID, while respecting the adolescents' autonomy. As intermediaries between adolescents and OHPs, counsellors are key in reducing dental anxiety. Counsellors need clear oral health policies within care facilities to address competing priorities.

Impact of Syrian Conflict on the Oral Health of Adolescents: A Cross-Sectional Study

BACKGROUND

The Syrian conflict has had a negative impact on the psychological and overall health of adolescents. However, little is known about the oral health of those who are internally displaced.

AIMS

The purpose of this study was to investigate the relationship between mental health state and self-reported oral health and habits in Syrian adolescents.

METHODS

A total of 99 adolescents living in Syria were included in the study. The participants were given four questionnaires: the International Trauma Questionnaire (ITQ), the Depression Anxiety Stress Scale-21 (DASS-21), the Epworth Sleepiness Scale (ESS), and the World Health Organization (WHO) Oral Health Questionnaire for Children (2013). The relationship between self-reported oral and mental health was evaluated.

RESULTS

Adolescents with symptoms of mental disturbances or abnormal sleep conditions were statistically more likely to self-report the health of their teeth and gums as below average, less likely to brush their teeth regularly, and reported more frequent smoking (p<0.05). Moreover, symptoms of mental disturbances and abnormal sleep conditions were statistically more likely in adolescents living in rural areas and whose parents' education did not exceed secondary school (p<0.05).

CONCLUSION

Syrian adolescents reported mental disturbances, which were reflected in their poor oral health and habits. These findings confirm the need for psychiatric and oral health care programs for Syrians who remain in areas of conflict.

The relationship between overprotective parenting, toothbrushing practices and children's behaviour during dental treatments in 4 to 11-year-old Dutch children: a cross sectional study

PURPOSE

Overprotective parenting and its impact on child development has gained increasing public attention. This study explored the association between overprotective parenting and behaviour during dental treatments and toothbrushing behaviour of 4 to 11-year-old-children.

METHODS

In this cross-sectional study, caregivers of 4-to-11-year-old children who visited a referral practice for dental treatment in Leiden, The Netherlands, completed a questionnaire about overprotective parenting, using the Parental Overprotection Measure (POM), and children's toothbrushing behaviour. The dentist and dental assistant used the Venham scale to assess children's behaviour during dental treatments. Associations between the POM and the Venham scale and toothbrushing variables, were analysed using multiple ordered logistic regression.

RESULTS

The sample included 96 children (mean age: 7.3 ± 2.1 years, 59 boys). Overprotective parenting (higher POM scores) was significantly associated with more disruptive behaviour of children during dental treatments (higher Venham categories) (OR: 1.08 (95% CI 1.04; 1.13)) and lower caregiver self-efficacy regarding toothbrushing (OR 0.96 (95% CI 0.93; 0.99)), after adjustment for confounders. No associations between overprotective parenting and toothbrushing frequency or skipping toothbrushing were found.

CONCLUSIONS

Overprotective parenting has been associated with children's negative behaviour during dental treatments and lower caregiver self-efficacy regarding toothbrushing in primary school children who are treated in a referral practice for paediatric dental care.

Family functioning and preschool children's oral health-related quality of life

INTRODUCTION

Identifying which aspects of how a family functions are relevant to child oral health provides opportunities for interventions targeting the family context. The aim of this study was to investigate the associations of general and domain-specific family functioning with oral health-related quality of life (OHRQoL) of 3-4-year-old children.

METHODS

Cross-sectional data from 740 parent-child dyads from East London were analysed. Family functioning was assessed with the 60-item Family Assessment Device that yields scores for general functioning and six domains (roles, behaviour control, communication, affective involvement, affective responsiveness and problem solving). Children's OHRQoL was measured using the Early Childhood Oral Health Impact Scale (ECOHIS), which measures the lifetime impacts of children's oral conditions on the child (child impact section, CIS) and family (family impact section, FIS). The associations of family functioning with the ECOHIS total, CIS and FIS scores were assessed in negative binomial regression models (rate ratios [RR] and 95% confidence intervals [95% CI] were calculated), adjusting for parental sociodemographic factors and child demographic factors and caries experience.

RESULTS

Children in families with unhealthy general functioning had 1.45 (95% CI: 0.87-2.43), 1.24 (95% CI: 0.73-2.13) and 2.19 (95% CI: 1.20-3.99) times greater ECOHIS total, CIS and FIS scores, respectively, than those in families with healthy general functioning after adjustment for confounders. Unhealthy functioning in the roles domain was associated with greater ECOHIS total and FIS scores. Unhealthy functioning in the problem solving, roles and affective involvement domains were also associated with greater FIS scores.

CONCLUSIONS

Unhealthy family functioning was associated with worse child OHRQoL, especially in terms of disrupting family life. Effective assignment and undertaking of roles should be further explored as a target for intervention.

Necessity and relevance of qualitative research in pediatric dentistry. A literature review

Objectives

This review aims to understand the essence and relevance of qualitative research in pediatric dentistry and summarizes the most important information needed for a pediatric dentist before conducting a qualitative study.

Methods

An electronic search was conducted on studies published from December 2019 until December 2021 using PubMed, Scopus, and King Abdulaziz University Digital library. Several keywords were used to identify the studies for this review.

Results

Thirty-three studies involving qualitative methods in pediatric dentistry have been conducted on parents and dentists. Qualitative studies in pediatric dentistry are used to explore the perceptions of mothers and their children and to understand their behavior in different areas related to pediatric dentistry. Barriers to conducting qualitative studies with children include credibility, the influence of others on children's opinions, and differences that influence children's behavior while conducting the study.

Conclusion

Qualitative methods in pediatric dentistry have been conducted on parents and dentists; however, little is known about the credibility and trustworthiness of conducting qualitative research with children. Future studies are needed to investigate effective interview techniques with children and more research should be conducted to evaluate the credibility and trustfulness of using children as a source to collect data in qualitative research.

Planning, implementation, and evaluation of educational intervention based on PRECEDE-PROCEED model for mothers about oral health promotion on children aged 3-6 years

BACKGROUND

Mothers play an important role in oral health of children. The present study was planned, implemented, and evaluated to determine the impact of mothers' educational program based on PRECEDE-PROCEED model on oral health promotion of Rafsanjan 3-6-year-old children, in 2020.

MATERIALS AND METHODS

This quasi-experimental study was conducted on 100 mothers with children aged 3-6 years divided into two groups. The research tool was developed and approved based on the model phases in the form of demographic information, predisposing, enabling, and reinforcing factors. At phase five, intervention planning was conducted and the program was implemented in four sessions (45 min each) in 30 days. Follow-up was done 2 months after the last training session. The data were analyzed by SPSS18, using Chi-square, paired t-test, and independent t-test at the significance level of 0.05.

RESULTS

After implementing the program, a significant difference was observed between predisposing, enabling, and reinforcing factors, as well as oral health-related behaviors of the two groups (P < 0.05). Finally, 30.4% of the changes in oral health-related behavior resulted from the implementation of the designed educational program.

CONCLUSION

Considering the importance of planning to promote children's oral health and hygiene, it is recommended that the PRECEDE-PROCEED model be used to design, implement, and evaluate health evidence-based interventions.

Effects of early preventive dental visits and its associations with dental caries experience: a cross-sectional study

Objectives

Limited information is known about preventive dental visits (PDVs) before seven years of age among children in China. This study aimed to examine the early PDV rate, identify the impact of PDV on dental caries and untreated dental caries, and explore the factors related to PDV among Chinese sampled children under seven years old.

Methods

A cross-sectional survey was conducted in five selected primary health care facilities in Chengdu, China, from May to August 2021. Parent–child dyads during regular systematic medical management were recruited to participate. Children's dental caries were identified through dental examinations and documented as decayed, missing and filled teeth index (dmft) by trained primary care physicians. Dental-related information was collected through a questionnaire. Zero-inflated negative binomial (ZINB) regression was used to test the effect of early PDV on the dmft value, and logistic regression was used to analyse impact factors on the early PDV.

Results

A total of 2028 out of 2377 parent–child dyads were qualified for analysis. Half of the children (50.4%) were male, with a mean age of 4.8 years. Among all the children, 12.1% had their first dental visit for preventive purposes, 34.4% had their first dental visit for symptomatic purposes, and more than half had never visited a dentist. The results showed that a lower dmft value (adjusted OR: 0.69, 95% CI: 0.48–0.84), a higher rate of caries-free (aOR: 6.5, 95% CI: 3.93–10.58), and a lower rate of untreated dental caries (aOR: 0.40, 95% CI: 0.21–0.76) were associated with early PDV utilization. Children who had a higher rate of PDV were positively associated with living in a family with better parental behaviours (aOR: 2.30, 95% CI: 1.71–3.08), better parental oral health perception (aOR: 1.23, 95% CI: 1.06–1.32), fathers who had no untreated caries (aOR: 0.68, 95% CI: 0.47–0.97), families with higher socioeconomic status (aOR: 1.09, 95% CI: 1.04–1.16), and dental health advice received from well-child care physicians (aOR: 1.47, 95% CI: 1.08–2.00).

Conclusions

Early PDV was associated with a lower rate of dental caries prevalence and untreated dental caries among sampled children younger than seven in Western China. Underutilization and social inequities existed in PDV utilization. Public health strategies should be developed to increase preventive dental visits and eliminate social disparities that prevent dental care utilization.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02190-6.

The Role of Parenting Practices on the Parent Perceived Impact of Child Oral Health on Family Wellbeing

BACKGROUND

Family characteristics and parenting practices could significantly influence child oral health and the impact of child oral health on family wellbeing.

AIM

To determine the association between parenting practices and parent-perceived impact of children's oral health condition on family wellbeing.

DESIGN

A cross-sectional survey was conducted among 1539 school children in India. Parents answered the short form of FIS (Family Impact Scale), and PCRQ (parent-child relationship questionnaire) to assess the impact of the child's oral health on family and parenting practices, respectively. Two factors emerged on factor analysis of PCRQ: 'Positive parenting' and 'Power assertive parenting'. The intra-oral examination was conducted for children to assess their dental caries experience and gingival health status. Unadjusted linear regression and hierarchical multiple regression analysis were used to determine the influence of parenting practices on FIS.

RESULTS

An increase in power assertion (B = 1.16) parenting was associated with increased FIS scores indicating a higher adverse impact of the child's oral health on family wellbeing when parents used more power assertive parenting practices. On the other hand, an increase in positive parenting (B = -1.27) was associated with decreased FIS scores, indicating a lesser impact of child's oral health on family wellbeing when parents used more positive parenting practices.

CONCLUSIONS

Parenting practices were associated with parents' perceptions of the effect of children's oral health on family wellbeing.

Parenting practices and oral health behaviors of children in rural Egypt: gender differences in a household survey

Background

Parenting practices influence children’s health and development. The current study aimed at assessing gender differences in children’s perception of the parenting practices of both parents, and in the association between children’s oral health behaviors and parenting practices.

Methods

A cross-sectional household survey of 6–12 year old children was conducted in a rural area in Northwestern Egypt in 2019. Clinical examination assessed caries and gingivitis. The Alabama Parenting Questionnaire assessed parenting practices in five domains (positive parenting, involvement, inconsistent disciplining, poor monitoring and corporal punishment) and the World Health Organization questionnaire assessed oral health behaviors including sugar consumption and daily toothbrushing. Sugar consumption was the dependent variable in linear regression and daily toothbrushing was the dependent variable in logistic regression. Parenting practices were the explanatory variables adjusting for confounders. Effect modification by child gender was assessed.

Results

The response rate was 94.1% (n = 433), mean age = 9.9 years, 44.1% boys, 17.8% with daily toothbrushing and mean sugar consumption score = 3.4/8. Girls perceived more mothers’ positive parenting than boys (mean = 14.15 and 13.46) and boys perceived more poor monitoring and corporal punishment. Boys and girls differed in the association between sugar consumption and fathers’ inconsistent disciplining, poor monitoring (P = 0.004 and 0.02) and mothers’ corporal punishment (P = 0.02), and also daily toothbrushing and mothers’ involvement, positive parenting (P = 0.05 and 0.02), fathers’ positive parenting (P = 0.02), mothers’ inconsistent discipling and poor monitoring (P = 0.01 and 0.04).

Conclusions

There were differences between boys and girls in perceiving mothers’ and fathers’ parenting practices and in the association between these parenting practices and toothbrushing and sugar consumption.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02054-z.

Family structure, sociodemographic factors and type of dental service associated with oral health literacy in the early adolescence

The aim of this study was to evaluate associations between oral health literacy and family, sociodemographic and dental service characteristics in early adolescents. A cross-sectional study was conducted with 740 schoolchildren. The following variables were investigated using validated questionnaires: oral health literary (BREALD-30), sociodemographic characteristics, type of dental service and family functioning (FACES III). Associations were tested using robust Poisson regression analysis (α=5%). Higher oral health literacy was associated with the female sex (RR=1.09; 95%CI: 1.03-1.14), connected type of family cohesion (RR=1.12; 95%CI: 1.05-1.20), rigid (RR=1.14; 95%CI: 1.04-1.25) and structured (RR=1.11; 95%CI: 1.04-1.20) types of family adaptability, more than eight years of mother's schooling (RR=1.16; 95%CI: 1.10-1.22), age of caregiver more than 38 years (RR=1.07; 95%CI: 1.02-1.13) and the use of private dental services (RR=1.06; 95%CI: 1.01-1.12). The level of oral health literacy in early adolescents was associated with sex, family structure, mother's schooling, caregiver's age and type of dental service used.

Impact of school closures on the health and well-being of primary school children in Wales UK: a routine data linkage study using the HAPPEN Survey (2018-2020)

OBJECTIVES

This study aimed to explore the relationship between initial school closures and children's health by comparing health and well-being outcomes collected during school closures (April-June 2020) via HAPPEN (the Health and Attainment of Pupils in a Primary Education Network) with data from the same period in 2019 and 2018 via the HAPPEN Survey.

SETTING

The study was conducted online with 161 primary schools across Wales involved in the 'HAPPEN At Home' Survey.

PARTICIPANTS

Data were collected via the 'HAPPEN At Home' Survey capturing the typical health behaviours of children aged 8-11 years from 1333 participants across Wales. These data were compared with data in 2018 and 2019 also collected between April and June, from HAPPEN (2019 (n=1150) and 2018 (n=475)).

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcomes included validated measures of physical activity, screen time, diet and dental health, as well as well-being, competency and autonomy. Free school meal (FSM) status was used as a proxy for socioeconomic deprivation. Analyses were repeated stratifying by FSM.

RESULTS

Comparing responses between April-June in 2020 (n=1068), 2019 (n=1150) and 2018 (n=475), there were improvements in physical activity levels, sleep time, happiness and general well-being for children during school closures compared with previous years. However, children on FSM ate fewer fruits and vegetables (21% less at five or more portions of fruits and vegetables (95% CI: 5.7% to 37%)) and had lower self-assessed school competence compared with 2019. Compared with those not on FSM, they also spent less time doing physical activity (13.03%, 95% CI: 3.3% to 21.7%) and consumed more takeaways (16.3%, 95% CI: 2% to 30%) during school closures.

CONCLUSIONS

This study suggests that schools are important in reducing inequalities in physical health. The physical health (eg, physical activity and diet) of children eligible for FSM may be affected by prolonged school closures.

Family functioning and dental caries among preschool children

OBJECTIVES

To investigate the relationship of family functioning with dental caries among 3-4-year-olds and the role of family functioning in explaining the relationship of family socioeconomic status (SES) with childhood dental caries.

METHODS

Data from 761 parent-child dyads who took part in the East London Oral Health Inequalities study were analyzed. Family functioning was assessed using the 60-item family assessment device that yielded scores on general functioning and six domains (roles, communication, problem-solving, affective involvement, affective responsiveness, and behavior control). Children were clinically examined at home for dental caries. The association of family functioning and family SES (education and socioeconomic classification) with dental caries (dmft and dt scores) was tested using negative binominal regression while adjusting for child and parental demographic factors.

RESULTS

Children from families with unhealthy general functioning had 1.49 (95% CI: 1.01-2.20) and 1.84 (95% CI: 1.20-2.82) times greater dmft and dt, respectively, than those from families with healthy functioning after adjustment for confounders. The estimates for the associations of parental education and socioeconomic classification with dmft and dt were attenuated by around 12%-18% after adjusting for family functioning. Of the six family functioning domains assessed, only unhealthy behavior control in the family was associated with greater numbers of decayed teeth after adjustments.

CONCLUSIONS

This study showed that unhealthy family functioning was associated with dental caries among young children. Family functioning partly explained the relationship between family SES and childhood dental caries.

Role of family functioning and health-related quality of life in pre-school children with dental caries: a cross-sectional study

BACKGROUND

The aim of this cross-sectional study was to evaluate the effect of family functioning on oral health related quality of life (OHRQoL) and dental caries status among 4- to 6-year-old Chinese pre-school children in Malaysia.

METHODOLOGY

This study was approved by the institutional Joint Research and Ethics Committee, International Medical University, Malaysia (number 373/2016); consisted of 180 eligible pre-school children from a private school. Study tools included demographic, clinical oral health data form, the Early Childhood Oral Health Impact Scale (ECOHIS) and family functioning-12-item general functioning subscale. Written consent was sought prior to data collection. Data were analysed by SPSS v.22.0; descriptive statistics for socio-demographic details, clinical information, HRQoL and FAD scores. The parametric tests included independent sample t test and ANOVA to evaluate the associations between the dependent variable. Binary logistic regression models were applied to assess the impacts on OHRQoL (P value < 0.05).

RESULTS

A response rate of 80.5% was achieved. Sample means for FAD-GF12 scores ranged < 2, indicating normal family functioning. The ECOHIS scores mean was 0.52 (SD = 0.68). In the children impact section the highest score of impacts 20 was noted followed by family impact section with the score of 12. It was observed that children with dental caries had a significant (P = 0.014) negative impact on OHRQoL (mean 0.72, SD = 0.50) as compared to children with no caries (mean 0.34 SD = 0.39). The bivariate regression analysis after getting adjusted indicated three predictors associated to poor HRQoL: having two or more siblings (OR = 4.73, P = 0.013), relationship (mother) of the respondent to the child (OR = 2.86, P = 0.013) and having dental caries (OR = 8.12, P ≤ 0.001).

CONCLUSION

Findings of this study indicates that number of siblings, relationship of the respondent to the child and dental caries status are independently associated with health-related quality of life. However, family functioning does not mediate poor HRQoL in association to dental caries.

Facilitators and barriers to home-based toothbrushing practices by parents of young children to reduce tooth decay: a systematic review

OBJECTIVES

Parental supervised toothbrushing (PSB) is a collection of behaviours recommended by national guidance to improve oral health. This systematic review aimed to identify the barriers and facilitators to PSB.

MATERIALS AND METHODS

Studies investigating parental involvement in home-based toothbrushing in children under 8 years old and the impact on tooth decay were included. Electronic databases, references and unpublished literature databases were searched. The Theoretical Domains Framework (TDF) was used to code barriers/facilitators to PSB.

RESULTS

Of the 10,176 articles retrieved, 68 articles were included. Barriers and facilitators were found across all 12 TDF domains. Barriers included an inadequate toothbrushing environment and resources, knowledge of what PSB entails and child behaviour management. Facilitators were increased oral health knowledge, the adaption of the social environment to facilitate PSB and positive attitudes towards oral health. When only high-quality articles were synthesized, knowledge was not a common barrier/facilitator.

CONCLUSIONS

There are a comprehensive range of barriers/facilitators to PSB acting across all domains and at multiple levels of influence. This review identifies the most popular domains, thus informing the focus for supporting resources to supplement oral health conversations.

CLINICAL RELEVANCE

PSB is a complex behaviour. Practitioners need to understand and be able to explore the wide range of potential barriers and have practical suggestions to enable PSB. This review provides pragmatic examples of different barriers and facilitators and emphasises the importance of listening to parents and exploring their story to identify the barriers and solutions that are relevant to each family.

Organizational Barriers to Oral Health Conversations Between Health Visitors and Parents of Children Aged 9-12 Months Old

Background: Dental caries is the most prevalent preventable childhood disease and a major public health priority. Local authorities in England have a statutory responsibility to improve child health, including oral health, through the “Healthy Child Programme.” The “Healthy Child Programme,” which includes the provision of oral health advice is delivered by health visitors to parents of young children. To date, research has mainly concentrated on individual interactions between health visitors and parents, with less attention given to the broader context in which these oral health conversations between health visitor and parents take place.

Objective: Our study explored the organizational factors that obstruct health visitors from engaging in meaningful conversations with parents about young children's oral health.

Methods: Qualitative interviews and focus groups were held with health visiting teams (n = 18) conducting home visits with parents of 9–12-month olds in a deprived, urban area in England.

Results: The study revealed the wide variation in what and how oral health advice is delivered to parents at home visits. Several barriers were identified and grouped into four key themes: (1) Priority of topics discussed in the home visits; (2) Finance cuts and limited resources; (3) Oral health knowledge and skills; and (4) Collaborative working with other professionals. It was evident that organizational factors in current public health policy and service provision play an important role in shaping oral health practices and opportunities for behavior change.

Conclusion: Organizational practices and procedures play an important role in creating interaction patterns between health visiting teams and parents of young children. They often limit effective engagement with and positive change in oral health. For future oral health interventions to be effective, awareness of these barriers is essential alongside them being founded on evidence-based advice and underpinned by appropriate theory.

Evaluation of a national complex oral health improvement programme: a population data linkage cohort study in Scotland

OBJECTIVES

Child dental caries is a global public health challenge with high prevalence and wide inequalities. A complex public health programme (Childsmile) was established. We aimed to evaluate the reach of the programme and its impact on child oral health.

SETTING

Education, health and community settings, Scotland-wide.

INTERVENTIONS

Childsmile (national oral health improvement programme) interventions: nursery-based fluoride varnish applications (FVAs) and supervised daily toothbrushing, community-based Dental Health Support Worker (DHSW) contacts and primary care dental practice visits-delivered to the population via a proportionate universal approach.

PARTICIPANTS

50 379 children (mean age=5.5 years, SD=0.3) attending local authority schools (2014/2015).

DESIGN

Population-based individual child-level data on four Childsmile interventions linked to dental inspection survey data to form a longitudinal cohort. Logistic regression assessed intervention reach and the independent impact of each intervention on caries experience, adjusting for age, sex and area-based Scottish Index of Multiple Deprivation (SIMD).

OUTCOME MEASURES

Reach of the programme is defined as the percentage of children receiving each intervention at least once by SIMD fifth. Obvious dental caries experience (presence/absence) is defined as the presence of decay (into dentine), missing (extracted) due to decay or filled deciduous teeth.

RESULTS

15 032 (29.8%) children had caries experience. The universal interventions had high population reach: nursery toothbrushing (89.1%), dental practice visits (70.5%). The targeted interventions strongly favoured children from the most deprived areas: DHSW contacts (SIMD 1: 29.5% vs SIMD 5: 7.7%), nursery FVAs (SIMD 1: 75.2% vs SIMD 5: 23.2%). Odds of caries experience were markedly lower among children participating in nursery toothbrushing (>3 years, adjusted OR (aOR)=0.60; 95% CI 0.55 to 0.66) and attending dental practice (≥6 visits, aOR=0.55; 95% CI 0.50 to 0.61). The findings were less clear for DHSW contacts. Nursery FVAs were not independently associated with caries experience.

CONCLUSIONS

The universal interventions, nursery toothbrushing and regular dental practice visits were independently and most strongly associated with reduced odds of caries experience in the cohort, with nursery toothbrushing having the greatest impact among children in areas of high deprivation.

Impact of Lifestyle Variables on Oral Diseases and Oral Health-Related Quality of Life in Children of Milan (Italy)

A large part of the Italian population doesn’t receive adequate information and support on how to maintain oral health. In this observational, cross-sectional, pilot study, we investigated how some lifestyle-related variables affect oral diseases and oral health-related quality of life (OHRQoL) of children attending public-school summer services in Milan. A survey that included questions on children’s oral disease, OHRQoL and lifestyle-related factors (feeding habits, oral hygiene protective behaviors, dental coaching and socio-economic and educational status), was administered to the children’s caregivers. Data from 296 surveys were analyzed to assess the protective/negative effect of each variable on oral disease and OHRQoL. With respect to disease, the “never” consumption of fruit juice, the use of fluoride toothpaste, higher educational qualification and ISEE (equivalent family income) of those who filled out the form, resulted protective factors. Regarding OHRQoL, the “never” assumption/use of tea bottle, sugared pacifier and fruit juice as well as the use of fluoride toothpaste, a higher educational qualification and ISEE of those who filled out the form, resulted to have protective effects. In conclusion, protective behaviors and socio-economic status affect oral disease and OHRQoL in children of Milan.

Parenting and child behaviour as predictors of toothbrushing difficulties in young children

BACKGROUND

Oral disease is one of the most prevalent chronic health conditions affecting children. Twice-daily toothbrushing is recommended to promote good oral health; however, a large proportion of Australian families are not meeting this recommendation.

AIM

This study aimed to identify important barriers to regular toothbrushing for young children.

DESIGN

In this study, 239 parents of 0- to 4-year-old children completed an online survey that investigated child, family, and parent factors associated with child toothbrushing. Hierarchical linear regression was used to identify predictors of toothbrushing frequency in children and perceived difficulty of the task by parents.

RESULTS

We found that parent factors, specifically oral health knowledge, were the most significant predictors of toothbrushing frequency. Conversely, parent factors did not contribute significantly to the prediction of perceived difficulty of toothbrushing once family and child factors were taken into account. Oral health knowledge and use of routines were identified as the most important predictors of toothbrushing frequency, whereas resistant child behaviour and household organisation were found to be the most important predictors of perceived difficulty of regular toothbrushing.

CONCLUSIONS

The findings of the study have implications for behavioural interventions to support parents, as well as directions for future research.

Dental Health Status and Oral Health Care in Nursery School-Aged Children and their Parents Living in Poznan (Poland)

OBJECTIVES

The aim of this study was to evaluate the dental health status of nursery age children and parents. The use of dental services was assessed.

SUBJECTS AND METHODS

The study was performed in nursery schools located in Poznan, Western Poland. Clinical examination was carried out in 157 children (48.41% males and 51.59% females), aged 10-42 months. Dental health status (the number of teeth with caries, fillings and extracted) of their parents was determined on the basis of data obtained from a questionnaire. The questions also concerned information on child's and parents' dental check-ups and opinion on their predisposition to dental caries.

RESULTS

Clinical examination revealed that 21.05% of boys and 18.51% of girls had dental caries. Most mothers had from 1 to 5 either carious and/or filled teeth (47.13%) or extracted teeth due to carious process (61.15%); the fathers' values were similar at 46.50 and 66.24%, respectively. More mothers (84.71%) than fathers (72.62%) had regular dental check-ups (p = 0.02). The analysis of mother-father-child triads showed that when both parents visited the dentist regularly, more children were free of caries (56.68%) in comparison to those with the disease (13.38%; p < 0.001).

CONCLUSIONS

This study showed that the dental health status, as well as oral care of nursery school children and their parents, is unsatisfactory. Therefore, there is a need to introduce an intensive dental educational program focusing on dental prophylaxis for nursery age children and their parents or caregivers.

Developmental enamel defects are associated with early childhood caries: Case-control study

BACKGROUND

Knowledge on the association between developmental enamel defects (DED) and early childhood caries (ECC) has importance for the drafting of prevention measures and oral healthcare planning.

AIM

To compare the frequency of ECC in children with and without DED and verify their association with sociodemographic factors.

DESIGN

This case-control study was carried out with Brazilian children aged one to five years. The case group made up of 98 children with ECC and the control group was made up of 98 children without ECC. DED were classified in diffuse opacity, demarcated opacity and enamel hypoplasia (Developmental Defects of Enamel Index). Sociodemographic data were collected by a questionnaire answered by parents. Statistical analysis used McNemar's test and logistic regression analyses.

RESULTS

In the bivariate analysis, ECC was more frequent among children from families with poorer socioeconomic conditions (lower monthly household income [P ≤ .001] and lower maternal schooling [P = .001]) and among those with DED (P ≤ .001). The final logistical model showed that children with DED (OR: 1.94) and a monthly household income less than two Brazilian minimum salaries (OR: 2.24) were more likely to have ECC.

CONCLUSIONS

The occurrence of DED and lower household income were pre-disposing factors for the occurrence of ECC.

Promoting parenting strategies to improve tooth brushing in children: design of a non-randomised cluster-controlled trial

Background

Tooth brushing with fluoride toothpaste is a key recommendation in evidence-based guidelines for caries prevention. Parents generally have sufficient knowledge to practice tooth brushing for their child, yet many experience barriers to actually implement the behaviour. Common barriers are associated with difficult child behaviour, stress, poor family organisation and management of routines. These underlying determinants of tooth brushing behaviour should be addressed in caries-preventive interventions.

The ‘Uitblinkers’ intervention is a semi-structured interview method developed for oral healthcare professionals (OHPs), with the aim to improve the practice of twice daily tooth brushing in children. The interview method focusses on ¹⁾ identifying parents’ barriers to tooth brushing, and ²⁾ promoting parenting strategies (related to tooth brushing) to tackle the identified barriers. The intervention applies principles from learning theory, including stimulus control, operant conditioning and authoritative parenting. This paper describes a study protocol to evaluate the effect of the intervention.

Methods

This non-randomised cluster-controlled trial will be conducted in 40 general dental practices in The Netherlands. Intervention practices will implement the intervention in addition to care as usual, while control practices will only provide care as usual. From each dental practice, a random sample of 3 to 4-year-old children will be recruited. The intervention consists of three sessions between an OHP and parent, in which parenting strategies for identified barriers are discussed. The primary study outcome is children’s dental caries experience after 24 months. Secondary outcomes include parents’ self-efficacy in brushing their children’s teeth, tooth brushing frequency in children and children’s dental plaque scores. Differences in outcomes between the intervention and control group will be assessed using logistic and negative binomial regression. The feasibility of the intervention will be assessed through process evaluation.

Discussion

Findings of this study will ascertain whether promoting parenting strategies is a successful method to improve tooth brushing in children and to prevent childhood dental caries in a clinical dental setting.

Trial registration

This trial is registered with the Netherlands National Trial Register (registration date: 7 September 2018; trial registration number: NTR7469).

Electronic supplementary material

The online version of this article (10.1186/s12903-019-0902-6) contains supplementary material, which is available to authorized users.

Apps for oral hygiene in children 4 to 7 years: Fun and effectiveness

Background

Nowadays apps in preschool age are largely used in learning improvement. The aim of this work was to test effectiveness of apps in improving oral hygiene in children patients aged from 4 to 7 years and evaluating correlation between parents educational attainment and children oral hygiene.

Material and Methods

100 patients aged from 4 to 7 years were randomly assigned by an external office in the study group (SG: 32 females, 18 males) and in the control group (CG: 28 females and 22 males). Plaque index (PI) and carious lesions localisation were detected. At baseline all patients and one of the parents were instructed at chair-side about the proper oral hygiene techniques. SG patients were also given app as an aid in oral hygiene practice. Follow-up was 12 months. Measurements were made every three months at chair-side visits. Information about children compliance in oral hygiene and educational level of parents were obtained by questionnaires at t0 and after 12 months.

Results

SG patients showed stronger oral hygiene and PI lower than those in CG. Questionnaire showed higher compliance of SG patients and parents educational level seemed to affect children oral hygiene.

Conclusions

Apps in children allowed achieving encouraging results with improvement of oral hygiene and health. Key words:Apps, oral hygiene compliance, children oral hygiene, motivation, educational attainment.

A qualitative study of the multi-level influences on oral hygiene practices for young children in an Early Head Start program

BACKGROUND

Individual child-level risk factors for Early Childhood Caries (ECC) have been studied, but broader family- and community-level influences on child oral hygiene behaviors are less well understood. This study explored multiple levels of influence on oral hygiene behaviors for young children in Early Head Start (EHS) to inform a future behavioral intervention targeting children from low-income families.

METHODS

Twenty-four semi-structured interviews were conducted with mothers of children under 4 years old, enrolled in the home visitor (HV) component of one EHS program in Los Angeles, CA, who participated in the BEhavioral EConomics for Oral health iNnovation pilot study (BEECON) in 2016-7. Audio-recordings of interviews were translated if needed, and transcribed in English, and coding and analysis was facilitated by Dedoose qualitative software. This investigation used general thematic analysis guided by the Fisher-Owens child oral health conceptual framework to identify influences on oral hygiene behaviors for the young children.

RESULTS

Many mothers reported brushing their children's teeth twice/day, and concern that most children frequently resisted brushing. They identified children being sick or tired/asleep after outings as times when brushing was skipped. Several child-, family-, and community-level themes were identified as influences on child oral hygiene behaviors. At the child-level, the child's developmental stage and desire for independence was perceived as a negative influence. Family-level influences included the mother's own oral hygiene behaviors, other family role models, the mother's knowledge and attitudes about child oral health, and mothers' coping skills and strategies for overcoming challenges with brushing her child's teeth. Overall, mothers in the EHS-HV program were highly knowledgeable about ECC risk factors, including the roles of bacteria and sugar consumption, which motivated regular hygiene behavior. At the community-level, mothers discussed opportunities to connect with other EHS-HV families during parent meetings and playgroups that HV coordinated. A few mothers noted that EHS-HV playgroups included brushing children's teeth after snacking, which can be a potential positive influence on children's hygiene practices.

CONCLUSION

Child-, family- and community-level factors are important to consider to inform the development of tailored oral health preventive care programs for families in EHS-HV programs.

Self-Reported Oral Health Related Behaviour and Gum Bleeding of Adolescents in Slovakia in Relation to Socioeconomic Status of Their Parents: Cross-Sectional Study Based on Representative Data Collection

BACKGROUND

Oral health strongly affects overall health and is related to many factors. The aim of our study was to analyse oral health related behaviours (OHRBs) and gum bleeding among Slovak adolescents and assess the effect of socioeconomic factors on the outcomes.

METHODS

Data from the Health Behaviour in School-aged Children study (HBSC) were used (N = 8896, age range = 10-16 years, M = 13.4; SD = 1.4; 50.9% boys). Sociodemographic and socioeconomic indicators and frequency of OHRBs (dental hygiene, toothbrush changing, preventive check-up) and gum bleeding were collected. Effects of sociodemographic and socioeconomic variables on outcome variables were analysed by binary logistic regression.

RESULTS

We found that prevalence of OHRBs slightly decreases with age, and worse outcomes were reported by boys compared to girls (OHRB odds ratio range 0.45-0.75, (95% C.I. range 0.40-0.91), gum bleeding 1.38 (95% C.I. 1.19-1.61), p < 0.05). OHRBs were in most cases significantly associated with socioeconomic variables, lower affluence predicts worse outcomes (odds ratio range 0.76-0.88 (95% C.I. range 0.68-0.96), p < 0.05).

CONCLUSION

Our study provides representative findings on ORHBs in Slovakia and shows important associations of socioeconomic factors related to adolescents' oral health issues.

Impact of social support on oral health among immigrants and ethnic minorities: A systematic review

Objective

Adaptation to social life changes after migration may be beneficial or detrimental to migrants’ oral health outcomes and related behaviors. This systematic review aims to synthesize the scientific literature on the impact of social support on immigrants’ and ethnic minorities’ oral health status and/or behaviors.

Methods

A comprehensive electronic search, up to November 2018, was conducted using five electronic databases. We included cross-sectional and longitudinal quantitative studies that examine associations between social support and oral health outcomes among immigrants and ethnic minorities. Study selection, data extraction, and risk of bias assessment were completed in duplicate and the Newcastle-Ottawa checklist was used to appraise the methodological quality of the quantitative studies.

Results

A total of 26 studies met the eligibility criteria. Included studies examined multiple oral health outcomes such as dental care utilization, oral health behaviors, oral health problems, self-rated oral health, oral health knowledge, and oral health-related quality of life among immigrants and ethnic minorities. The social support level is assessed either by social support indicators or by adapting certain scales. Overall, social support was found to be positively associated with dental care utilization, number of carious teeth, periodontal disease, oral health behaviors, oral health knowledge, oral health-related quality of life, and self-rated oral health.

Conclusion

Although immigrants and ethnic minorities encounter several challenges after migration to a new country that could affect their oral health, social support from their surrounding environment in the form of structural or functional support plays an important role in improving their oral health outcomes.

'I didn't want to pass that on to my child, being afraid to go to the dentist': making sense of oral health through narratives of connectedness over the life course

While previous sociological research on oral health has identified the relevance of personal relationships, there is more scope to analyse the mouth through a lens of connectedness. Recent qualitative interviews with 43 older people (65+) in England and Scotland found that participants constructed relational narratives to make sense of their oral health practices. By drawing on ideas of family practices, family display and personal life, we illustrate how the mouth can be understood relationally. Participants presented their own embodied experiences as connected to the actions of their parents. Narratives also reflected how, as parents and grandparents themselves, participants tried to shape the experiences of others. In this way, oral health practices were conceptualised as being about family. This can be seen in self-narratives that demonstrated how participants located themselves as embedded in webs of ongoing relationships. We highlight the importance of narrated practices of thinking and feeling, whereby participants imagined doing oral health, and indeed family, in different ways. We thereby demonstrate how oral health practices are constituted through family connectedness and at the same time how these practices contribute to the constitution of family. Policy should therefore pay attention to family relations when promoting improvements in oral health practices.

Dental caries and externalizing behaviour problems in a high-risk child population

The aim of this study was to assess the association between externalizing behaviour problems and dental caries in children. A further objective was to explore direct and indirect pathways between sociodemographic factors, family functioning and parenting factors, oral health behaviours, externalizing behaviour problems, and dental caries using structural equation modelling. Cross-sectional data were collected on 251, 5- to 8-yr-old children from a paediatric dental practice in the Netherlands. Children's decayed, missing, and filled primary teeth (dmft) scores were obtained from their dental records. Validated self-report questionnaires were used to collect sociodemographic, behavioural, and family-related data. Externalizing problem behaviour was significantly associated with a higher dmft score [incidence risk ratio (IRR) = 1.19; 95% CI: 1.06-1.34], but this association did not remain significant after adjustment for sociodemographic factors (IRR = 1.11; 95% CI: 0.99-1.26). A valid path model was presented after applying some modifications. Findings from the model suggest that it is plausible that child behaviour problems are directly associated with dental caries via toothbrushing behaviour. The model also provided support that maternal education level, the restrictiveness and warmth of parenting, and the communication of the family, play an indirect role in the association between children's externalizing behavioural problems and dental caries experience.

Barriers and opportunities to oral health in Dutch-Moroccan children in the Netherlands: a narrative report

Introduction

Previous studies showed that 5-year-old Dutch-Moroccan children had significantly higher dmft scores compared to Dutch children of the same age, even after correction for socio-economic status. The mechanisms underlying this difference are little understood.

Aim

To explore cultural factors involved in poorer oral health of Dutch-Moroccan children by identifying knowledge, attitudes and behaviour of their mothers concerning their children’s oral health.

Methods

In 2012 mothers of Dutch-Moroccan preschool children in two cities in the Netherlands were interviewed in two focus groups (n = 16) or individual semi-structured interviews (n = 13). Semi structured interviews were also c onducted with three oral health professionals, working with Dutch-Moroccan children, and one physician from an under-five-clinic. All interviews were voice recorded, transcribed and inductively coded. MAXQDA software was used for data analysis.

Results

All mothers mentioned pain complaints, swelling and black front teeth as oral health problems in their children. Although mothers were aware that brushing teeth and reducing sugary snacks are effective preventative strategies, they did not sufficiently implement these measures. This was due to lack of brushing skills, insufficient awareness of the daily sugar intake of their children and their childrearing concerning these measures. Most mothers indicated they felt empowered in making dental care decisions.

Conclusions

This research revealed the presence of knowledge on preventive strategies regarding their children’s oral health in Dutch-Moroccan mothers, but an inadequate implementation of these measures in their daily lives. Additional qualitative research is needed to gain deeper insight for broader exposure of values, knowledge and culture.

[Therapeutic education in pediatric dentistry: analysis of obstacles and levers to the development of programmes in France in 2016]

OBJECTIVE

Over recent years, therapeutic patient education has become part of dental medicine. Management of early childhood caries, known to be a very common chronic disease, has evolved to include an educational dimension. The objective of this study was to identify the levers and barriers to the development of formalized therapeutic education programmes and alternatives.

METHODS

A comprehensive exploratory qualitative study was conducted between November 2015 and June 2016 on a targeted sample of 15 people aware of the problem of TPE in dentistry.

RESULTS

The study showed that TPE training in dentistry is underdeveloped, despite its numerous benefits: change of the healthcare professional's approach, implementation of structured educational programmes, development of research, etc. There are many obstacles to the development of TPE programmes: insufficient resources, rigid legislation or lack of knowledge of TPE practices. The dental profession is an obstacle itself because of its lack of understanding and variable degrees of integration the medical community. There are multiple levers, but the main ones are changing attitudes of the profession and the provision of resources to develop TPE. Although alternatives to TPE programmes exist (accompanying measures, short educational strategies, connected health), they cannot replace TPE.

CONCLUSION

More educational strategies must be developed in the field of dentistry. However, the framework of TPE must be adapted to the profession to ensure good uptake.

Parents' Experiences of Toothbrushing with Children: A Qualitative Study

Globally, dental caries is one of the most prevalent diseases and is more common in children living in deprived areas. Dental caries is preventable, and guidance in the United Kingdom recommends parental supervised brushing (PSB): a collection of behaviors-including twice-daily toothbrushing with fluoridated toothpaste-that should begin upon eruption of the first tooth (approximately 6 to 12 mo of age) and for which children need to be helped or supervised by an adult until at least 7 y of age. The aim of this study was to explore parents' experiences of toothbrushing with their young children and to establish barriers and facilitators to PSB at individual, interpersonal, and environmental levels according to the theoretical domains framework. Qualitative semistructured interviews guided by the framework were conducted with 27 parents of young children (<7 y) in 2 deprived areas of the United Kingdom. Framework analysis was used. Parents were not aware of national guidance concerning their active involvement in toothbrushing; however, they did have detailed knowledge of toothbrushing practices for children, and their intentions were to brush their children's teeth themselves twice every day as part of a family routine. Nonetheless, parents' difficulties experienced in managing their children's challenging behavior and the environmental context of their stressful lives meant that many parents adopted a role of simply reminding their children to brush or watching them brush. As such, the main barriers to PSB among parents living in deprived areas were skills in managing their children's behavior and environmental influences on family life. The results of our study have clear implications for the development of appropriate interventions to address the modifiable barriers to improve parental adoption of PSB. Knowledge Transfer Statement: The results of this study will be used to develop a behavior change intervention to encourage parental supervised brushing. The intervention-which is likely to be delivered through health practitioners rather than dental teams-will be developed to reduce dental caries among young children and will require evaluation in terms of its clinical and cost effectiveness.

Correlation between siblings in caries in Norway. A quantitative study

BACKGROUND

The role of the family for caries between siblings has been a focus for researchers for almost 100 years. However, the contribution of the family to the variation in caries has not been determined.

OBJECTIVES

To estimate the correlation between siblings in caries, and to investigate whether this varied according to number of siblings, mother's level of education, marital status and country of birth.

METHODS

The population included families with two or more siblings, altogether 409 766 children and adolescents aged 6-18 years, and 181 551 mothers. Data on caries were from electronic dental journals, which were merged with data from Statistics Norway about the characteristics of the mothers. The analyses were performed using random-effects regression, in which separate regressions were run for the extent of the carious lesion. Caries was scored for permanent teeth only. Mothers were used to identify siblings within families. The correlation between siblings in caries was measured using the intraclass correlation coefficient.

RESULTS

The proportion of the variance in the outcome measures that was due to between-family variability was in the range 13-29%. The intraclass correlation coefficients from the analyses of the subpopulations that described the characteristics of the mothers were fairly similar to the ICCs as estimated on the whole population.

CONCLUSION

We identified a fairly strong family effect, which confirms that the family is an important arena in which the dental health of the children is formed. An improvement in dental health for one of the siblings was associated with a positive effect on the dental health of the other sibling, and vice versa.

Impact of parent-related factors on dental caries in the permanent dentition of 6-12-year-old children: A systematic review

OBJECTIVE

To synthesise data from the literature on the effects of various parent-related characteristics (socio-demographic, behavioural and family environment) on dental caries in the permanent dentition of children.

DATA

Available studies in which the effects of parent-related characteristics on dental caries experience in the permanent dentition of children aged 6-12 years were evaluated.

SOURCES

PubMed, Medline via OVID and CINAHL Plus via EBSCO, restricted to scientific articles, were searched in April 2015. English language and time filters (articles published from 2000) were used.

STUDY SELECTION

A total of 4162 titles were retrieved, of which 2578 remained after duplicates were removed. After review of titles and their abstracts by two independent reviewers, 114 articles were considered relevant for full text review. Of these, 48 were considered for final inclusion. Data extraction was performed by two authors using piloted data extraction sheets.

CONCLUSIONS

Most of the literature on determinants of dental caries has been limited to socio-economic and behavioural aspects: we found few studies evaluating the effects of family environment and parental oral hygiene behaviour. Children belonging to lower socio-economic classes experienced more caries. In more than half the studies, children of highly educated, professional and high income parents were at lower risk for dental caries. There were conflicting results from studies on the effect of variables related to family environment, parents' oral hygiene behaviour and parent's disease status on dental caries in their children.

Establishing oral health promoting behaviours in children - parents' views on barriers, facilitators and professional support: a qualitative study

Background

The prevention of childhood dental caries relies on adherence to key behaviours, including twice daily tooth brushing with fluoride toothpaste and reducing the consumption of sugary foods and drinks. The aim of this qualitative study was to explore parents’ perceptions of barriers and facilitators that influence these oral health behaviours in children. A further objective was to explore parents’ views on limitations and opportunities for professional support to promote children’s oral health.

Methods

Six focus group interviews were conducted, including a total of 39 parents of 7-year old children, who were recruited from paediatric dental centres in The Netherlands. Interviews were held with Dutch parents of low and high socioeconomic status and parents from Turkish and Moroccan origin. Focus group interviews were conducted on the basis of a pre-tested semi-structured interview guide and topic list. Content analysis was employed to analyse the data.

Results

Analysis of interview transcripts identified many influences on children’s oral health behaviours, operating at child, family and community levels. Perceived influences on children’s tooth brushing behaviour were primarily located within the direct family environment, including parental knowledge, perceived importance and parental confidence in tooth brushing, locus of control, role modelling, parental monitoring and supervision, parenting strategies and tooth brushing routines and habituation. The consumption of sugary foods and drinks was influenced by both the direct family environment and factors external to the family, including the school, the social environment, commercials and television, supermarkets and affordability of foods. Parents raised several suggestions for professional oral health support, which included the provision of clear and consistent oral health information using a positive approach, dietary regulations at school and a multidisciplinary approach among dental professionals, child health centres and other institutions in providing parental support.

Conclusion

In conclusion, this qualitative study provided detail regarding parental views on the influences on children oral health behaviours and their opinions on what further support is needed to promote children’s dental health. Parents’ suggestions for professional oral health support can guide the development or improvement of caries preventive interventions.

Body mass index and dental caries in children aged 5 to 8 years attending a dental paediatric referral practice in the Netherlands

Background

Obesity and dental caries are widely-recognised problems that affect general health. The prevention of both dental caries and obesity have proven very difficult: children and their parents may need professional support to achieve behaviour change. To find out whether both dental caries and overweight in childhood can be targeted using a common risk factor approach, it is necessary to establish whether the two diseases are indeed linked. The aim of the present study was therefore to use anthropometric data obtained professionally to investigate the association between Body Mass Index and dental caries experience in children aged 5–8 years receiving treatment in a referral centre for paediatric dental care in the Netherlands.

Methods

Children’s dmft and dmfs scores were calculated using dental records and sociodemographic data were also extracted from these records. Dentists were trained to measure standing height and weight in a standardised way. Body Mass Index was calculated by dividing kilograms by height squared (kg/m²). Extended International (International Obesity Task Force) body mass index cut-offs were used to define ‘no overweight’ and ‘overweight’ (with the latter category including obesity).

Results

No statistically significant differences were found between the mean dmft or dmfs scores of the two groups (overweight and non-overweight), even after correction for the effect of the potential confounders sex, socio-economic status and ethnicity. The percentage of caries-active children in the non-overweight group was almost the same as in the overweight group. No statistically significant differences were found.

Conclusions

We hypothesised to find a positive association between body mass index and dental caries experience in children aged 5–8 years attending our practice. However, this study did not find a relationship of this kind. A common risk factor approach for the prevention of caries and overweight is therefore not supported by our study.

Neighborhood and family social capital and parent-reported oral health of children in Iowa

OBJECTIVES

A growing body of evidence supports the impact of social factors on oral health disparities in children in the United States. The goal of this study was to examine the relationship between two types of social capital-family and neighborhood-and the parent-reported oral health of Iowa's children.

METHODS

We analyzed results from a 2010 cross-sectional statewide health survey. The outcome was parent-reported child oral health status, and the five primary independent variables were neighborhood social capital and four separate indicators of family social capital. Data were analyzed using a mixed-effects linear regression with a random effect for zip code.

RESULTS

Significant positive associations were found between child oral health status and neighborhood social capital (P = 0.005) and one indicator of family social capital, family frequency of eating meals together (P = 0.02), after adjusting for covariates.

CONCLUSIONS

This study adds to the growing body of literature around the social determinants of oral health. Our findings indicate that the oral health of children may be influenced by broad social factors such as neighborhood and family social capital.

Oral Health in a Sample of Pregnant Women from Northern Appalachia (2011-2015)

Background. Chronic poor oral health has a high prevalence in Appalachia, a large region in the eastern USA. The Center for Oral Health Research in Appalachia (COHRA) has been enrolling pregnant women and their babies since 2011 in the COHRA2 study of genetic, microbial, and environmental factors involved in oral health in Northern Appalachia. Methods. The COHRA2 protocol is presented in detail, including inclusion criteria (healthy, adult, pregnant, US Caucasian, English speaking, and nonimmunocompromised women), recruiting (two sites: Pittsburgh, Pennsylvania, and West Virginia, USA), assessments (demographic, medical, dental, psychosocial/behavioral, and oral microbial samples and DNA), timelines (longitudinal from pregnancy to young childhood), quality control, and retention rates. Results. Preliminary oral health and demographic data are presented in 727 pregnant women, half from the greater Pittsburgh region and half from West Virginia. Despite similar tooth brushing and flossing habits, COHRA2 women in West Virginia have significantly worse oral health than the Pittsburgh sample. Women from Pittsburgh are older and more educated and have less unemployment than the West Virginia sample. Conclusions. We observed different prevalence of oral health and demographic variables between pregnant women from West Virginia (primarily rural) and Pittsburgh (primarily urban). These observations suggest site-specific differences within Northern Appalachia that warrant future studies.

Association between early childhood caries and maternal caries status: A cross-section study in São Luís, Maranhão, Brazil

OBJECTIVE

This study aims to evaluate the association between early childhood caries (ECC) and maternal caries status, and the maternal perception of ECC risk factors.

MATERIALS AND METHODS

A cross-sectional study was carried out with 77 mother-child pairs, the children ranging from 12 to 36 months of age and their mothers, who were seeking dental care at a health center in São Luís, Maranhão, Brazil. Data collection was conducted using a specific questionnaire for mothers. Oral clinical examination of the mother-child binomial to assess caries incidence, gingival bleeding (GB) and visible plaque was done. Home visits were performed in 10% of the sample in order to observe the environmental conditions, dietary habits and dental hygiene practices.

RESULTS

The findings showed that the caries prevalence in children was 22.5 times higher in the mother who had decayed tooth (prevalence ratio [PR] = 22.5, confidence interval [CI] 95% = 3.2-156.6, P < 0.001). GB also was observed in 14 mothers and children, the PR in pair was 12.2 (CI95% = 1.6-88.9, P < 0.001). The variables are related for the mother-child binomial in regression linear analysis.

CONCLUSION

The maternal caries status was associated with ECC.

Parental and family-related influences on dental caries in children of Dutch, Moroccan and Turkish origin

OBJECTIVES

The aim of this cross-sectional study was to investigate the relationship between parental and family-related factors and childhood dental caries in a sample of 5- to 6-year-old children of Dutch, Moroccan and Turkish origin. Furthermore, the relationship of parental and family-related factors with social class and ethnicity was examined.

METHODS

The study sample included 92 parent-child dyads (46 cases and 46 controls), which were recruited from a large paediatric dental centre in The Hague, the Netherlands. Cases were children with four or more decayed, missing or filled teeth, and controls were caries free. Validated questionnaires were used to collect data on sociodemographic characteristics, oral health behaviours, parents' dental self-efficacy and locus of control (LoC), parenting practices and family functioning. Parenting practices were also assessed using structured video observations of parent-child interactions.

RESULTS

Parents of controls had a more internal LoC, and they were more likely to show positive (observed) parenting in terms of positive involvement, encouragement and problem-solving, compared to cases (P < 0.05). Lower social class was significantly associated with a lower dental self-efficacy, a more external LoC and poorer parenting practices. Furthermore, LoC was more external in Moroccan and Turkish parents, compared to Dutch parents.

CONCLUSION

Parents' internal LoC and observed positive parenting practices on the dimensions positive involvement, encouragement and problem-solving were important indicators of dental health in children of Dutch, Moroccan and Turkish origin. Findings suggest that these parental factors are potential mediators of socioeconomic inequalities in children's dental health.