Parents' reasons for brushing or not brushing their child's teeth: a qualitative study

Dimensions of young children's toothbrushing resistance: A qualitative content analysis of discussions on the online parenting forum Mumsnet

BACKGROUND

Young children's resistant behaviour is a barrier to parental-supervised brushing. Discussions on online parenting forums offer an insight into parental experiences, behaviour and attitudes. Analysing these discussions also demonstrates how dental advice is represented and potentially resisted.

AIM

To analyse how young children's toothbrushing resistance is discussed on an online parenting forum.

DESIGN

Qualitative content analysis of threads on toothbrushing resistance retrieved from the UK parenting forum Mumsnet.

RESULTS

A search was carried out on Mumsnet in April 2022. Overall, 204 relevant threads were identified and analysed. A coding frame was developed. Posters interacted by discussing their experiences of resistance, asking for advice, making suggestions and being both supportive and critical. Thirty-seven strategies for addressing resistance were identified. Discussions reflected attitudes and concerns relating to young children and toothbrushing resistance, including the idea brushing should be 'non-negotiable'. A key issue was the acceptability of physical force or restraint to achieve adequate brushing. Posters invoked dental authority to support their views.

CONCLUSION

Understanding how toothbrushing resistance is discussed on a parenting forum helps establish what information and advice is shared, and highlights attitudes and concerns that shape how this problem is approached.

Dentist Mothers' Attitudes, Challenges and Facilitators in the Oral Health Promotion of Their Young Children

Twice daily parental supervised brushing (PSB) is recommended for the effective oral hygiene of children with toothpaste including fluoride. This cross-sectional study aimed to identify dentist mothers' attitudes, challenges, and facilitators in the oral health promotion of their young children. An online questionnaire was prepared and distributed to dentists via e-mail with a link to the form. Of all the mothers, 46.50% started brushing their children's teeth after the eruption of the first primary teeth. Nearly 50% of the mothers thought that they should brush their children's teeth until at least the age of 7-8 years old. In terms of the main barriers to toothbrushing, 52.9% said children could fall asleep at home or in the car, while 27.5% of all mothers reported being tired as the main barrier to toothbrushing. Although dentist mothers have sufficient knowledge to promote oral and dental health, they do not always have ideal attitudes and behaviors and they may encounter various barriers regarding themselves and their children in practical applications. Providing oral care for young children goes beyond 'knowledge' and is sometimes 'challenging'; however, it could be 'possible' by developing and implementing the most appropriate solution strategies suitable for each unique family and child.

An online survey of oral health behaviours and impact on young children and families in Wales

Introduction Studies outside Wales have consistently reported reduced quality of life as measured by the Early Childhood Oral Health Impact Scale. With relatively high levels of tooth decay in Wales as found through the regular dental surveys, it is important to understand different oral health-related behaviours and impact so that findings can inform oral health promotion in Wales.Methods An oral health questionnaire was made available to volunteers registered with Health Wise Wales. Parents of children (2-6 years old) participated in the study. Frequency analyses were carried out to understand the oral health-related behaviours and regression analysis was carried out to understand the predictors of reported oral health impacts.Results Overall reported oral health impact was low in this study. In total, 20% of parents reported that their child brushed their teeth less than twice a day and 23% reported toothbrushing without adult supervision. Drinking plain water twice a day or more was associated with good oral health in children.Conclusion Overall, reported oral health impact was low, which is likely to be due to under-representation of study participants from the deprived areas in Wales. There is plenty of room for improvement in oral health-related behaviours.

The Impact of the COVID-19 Pandemic on Pediatric Dentistry: Insights from an Italian Cross-Sectional Survey

BACKGROUND

The COVID-19 pandemic has had a significant impact on pediatric dentistry and also dental education. This study aimed to assess the observed changes in children's oral health by pediatric dentists and also served as an educational tool for dentistry students during the pandemic.

METHODS

Postgraduate students in pediatric dentistry prepared a survey addressed to Italian pediatric dentists. Over 5476 dentists were invited to participate, and collaboration among the students took place through virtual meetings and electronic platforms. The online questionnaire was composed of 29 questions focusing on the management of pediatric patients during and after the lockdown period. A descriptive statistic was used for data analysis, and chi-square tests were performed (p < 0.05).

RESULTS

A total of 1752 pediatric dentists participated in the survey. During the lockdown, 68.3% of dentists exclusively handled dental emergencies. In the subsequent semester, a significant decrease in the number of pediatric treatments was reported. Pediatric dentists also noted a decline in children's oral hygiene practices, a deterioration in dietary habits, and an increase in anxiety during dental procedures.

CONCLUSIONS

This survey shed light on the diverse effects of the pandemic on children's oral health and also provided valuable educational insights.

Cytotoxic effects of different detergent containing children's toothpastes on human gingival epithelial cells

Background

This study aimed to evaluate possible cytotoxic effects to gingival epithelial cells exposed to children toothpastes containing different detergent.

Methods

Tissues required for the isolation of human gingival epithelial cells were obtained by biopsy during the extraction of the impacted third molar tooth. Toothpaste solutions of different concentrations were prepared from five different children’s toothpastes with different detergent contents. Isolated gingival epithelial cells were stimulated with experimental groups consisting of toothpaste solutions (Colgate, Sensodyne, Splat, Nenedent, Perlodent) at different concentrations and a control group consisting of complete Dulbecco’s modified eagle medium. After the experiments, cell viability was evaluated using flow cytometry. 2 Way ANOVA was used to see the interaction effect of the main effects of toothpaste solution and concentration factors. Pairwise comparisons were made by Tukey post hoc tests. In the study, the significance level was taken as 0.05.

Results

As a result of the analysis, it was seen that the toothpaste solution and concentration factors and the interactions of these 2 factors were effective on the viable, early apoptotic, late apoptotic and necrotic cell rates. The statistically highest live cell ratios were detected in Splat’s toothpaste solutions (90.14% at 0.4% concentration) after the control group (90.82%) and the group with the lowest viability values was determined in Colgate group (75.74% at 0.4% concentration) (p < 0.05).

Conclusions

According to the results of the study, it was observed that toothpastes containing SLS affected the viability of cells more negatively than toothpastes with other detergent contents.

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.

Is toothbrushing behaviour habitual? Cues, context, motivators and patient narratives

OBJECTIVES

Toothbrushing is generally considered as a key self-care behaviour necessary for maintaining good oral health. Although twice-daily brushing is widely recommended as beneficial since this provides both biofilm removal and a regular application of fluoride, some people such as those with low socio-economic (SES) backgrounds often brush less regularly. Habit theory identifies that behaviours become habitual when they are undertaken repeatedly in response to a particular cue within a stable context. Once behaviour becomes automatic, long-term maintenance is more likely even if motivation wanes. Establishing toothbrushing as a habitual behaviour is therefore an intervention strategy which may help reduce health inequalities. Therefore, the objective was to more fully understand the nature of toothbrushing behaviour in adults and what prompts its instigation and execution in the morning and evening, in order to inform the design of interventions in this area.

METHODS

Twenty-nine semi-structured interviews were undertaken in an urgent dental care centre in a deprived area of North West England. Thematic analysis using a framework method was used to code the data into theoretically derived categories.

RESULTS

Morning toothbrushing was found to be strongly integrated into cleansing routines and was identified as a behaviour predominantly initiated in response to visual cues. Some toothbrushing behaviour was prompted by internal cues, expressed as strong feelings or urges. These were more related to night-time toothbrushing habits. Common morning motivators were aesthetics and social acceptability. Evening motivators were relatively idiosyncratic. Cleaning of the mouth following a hard, manual working day emerged as a strong driver for low SES males.

CONCLUSION

Understanding the nature of habitual morning and evening toothbrushing is important for the design of effective behavioural interventions, especially those aiming to achieve sustainable improvement in the frequency of night-time toothbrushing.

Can children's oral hygiene and sleep routines be compromised during the COVID-19 pandemic?

BACKGROUND

During COVID-19 pandemic, children are confined at home, with changes in family routines.

AIM

Evaluate sleep disorders among Brazilian and Portuguese children during social distancing, and its association with parental perception of child's oral hygiene.

DESIGN

In this cross-sectional study, Portuguese and Brazilian parents/caregivers of 3- to 15-year-old children, practicing social distancing due to COVID-19 pandemic, answered an online questionnaire, from April 24-26, 2020, evaluating sociodemographic characteristics, child's school activities online, child's sleep quality during social distancing. Two questions from the questionnaire, developed based on previous studies, evaluated the parental perception of child's oral hygiene quality and routine changes during social distancing. Parents/caregivers answered five domains of the Portuguese-language version of the Sleep Disturbances Scale for Children, evaluating sleep-breathing disorders, disorders of arousal, sleep-wake transition disorders, disorders of excessive somnolence and sleep hyperhidrosis. Descriptive, Linear-by-linear association, Kruskal-Wallis and post hoc analysis were performed (P ≤ .05).

RESULTS

Participated in the study 253 parents/caregivers, 50.2% from Brazil. Most parents (72.2%) reported changes in child's routine during social distancing. Sleep breathing disorders (P = .019), sleep-wake transition disorders (P = .022), and disorders of excessive somnolence (P < .001) were associated with poor oral hygiene during social distancing.

CONCLUSION

Sleep disorders are associated with poor oral hygiene during social distancing.

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.

Dental Plaque Disclosing as an Auxiliary Method for Professional Dental Prophylaxis in Early Childhood

Aim

This study aimed to clarify whether dental plaque disclosing before professional prophylaxis would improve the visualization of dental plaque, therefore optimizing the procedure.

Materials and methods

The sample comprised both the smooth and occlusal surfaces of the teeth of 25 children from 18 to 36 months. A randomized crossover clinical trial was conducted with two groups: GI—with disclosing and GII—without disclosing (washout/1 month). The teeth were stained with 1% malachite green solution to assess the amount of dental plaque on smooth and occlusal surfaces.

Results

Dental plaque removal was more effective and statistically faster (391.27 seconds ±142.2) in GI. The plaque index and the prophylaxis duration were inversely related in GI. The child's behavior did not affect the plaque removal effectiveness, regardless of plaque disclosure (p > 0.05).

Conclusion

Dental plaque disclosing in young children is an effective and less time-consuming method that improves the quality of the professional dental prophylaxis.

Clinical significance

Biofilm control is important for the success of programs for prevention of early childhood caries (ECC) and considering the particularities inherent to the dental care of infants, it is necessary that periodic professional prophylaxis is effective in eliminating the oral biofilm, ideally reducing chair time. Although dental plaque disclosing has been traditionally performed on educational basis during oral hygiene instruction, this resource can be safely employed to help professional prophylaxis in infants.

How to cite this article

de Alencar CRB, de Oliveira GC, et al. Dental Plaque Disclosing as an Auxiliary Method for Professional Dental Prophylaxis in Early Childhood. Int J Clin Pediatr Dent 2019;12(3):189–193.

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.

Parental supervision for their children's toothbrushing: Mediating effects of planning, self-efficacy, and action control

OBJECTIVES

With 60-90% of children worldwide reportedly experiencing dental caries, poor oral health in the younger years is a major public health issue. As parents are important to children's oral hygiene practices, we examined the key self-regulatory behaviours of parents for supervising their children's toothbrushing using the health action process approach.

DESIGN AND METHOD

Participants (N = 281, 197 mothers) comprised Australian parents of 2- to 5-year-olds. A longitudinal design was used to investigate the sequential mediation chain for the effect of intention (Time 1) on parental supervision for their youngest child's toothbrushing (Time 3), via self-efficacy and planning (Time 2), and action control (Time 3).

RESULTS

A latent-variable structural equation model, controlling for baseline behaviour and habit, revealed significant indirect effects from intention via self-efficacy and action control and intention via planning and action control, on parental supervision behaviour. The model was a good fit to the data, explaining 74% of the variance in parents' supervising behaviour for their children's toothbrushing.

CONCLUSION

While national recommendations are provided to guide parents in promoting good oral hygiene practices with their children, current results show the importance of going beyond simple knowledge transmission to support parents' intentions to supervise their children's toothbrushing actually materialize. Current findings make a significant contribution to the cumulative empirical evidence regarding self-regulatory components in health behaviour change and can inform intervention development to increase parents' participation in childhood oral hygiene practices, thus helping to curb rising oral health conditions and diseases. Statement of contribution What is already known on this subject? Self-regulatory skills are important to translate intentions into behaviour. Self-efficacy, planning, and action control are key self-regulatory skills for behaviour change. What does this study add? Self-regulatory skills are needed for parents to supervise their children's toothbrushings. Self-efficacy, planning, and action control are important self-regulatory skills in this context. Future interventions should map these self-regulatory predictors onto behaviour change techniques.

Development of an implementation intention-based intervention to change children's and parent-carers' behaviour

Background

Implementation intentions enable individuals to translate good intentions into action. Parents and children can find maintaining oral health difficult, as evidenced by the presence of tooth decay. This is a common condition in children in spite of being preventable through the use of regular tooth brushing, fluoride protection and avoiding sugar intake. Even when parents and children are positive about looking after the teeth, they can face challenges in maintaining consistent habits. The aim of this paper is to describe the design of a video animation to teach parents and children how to use implementation intentions to establish new habits to improve oral health, applied in this case, to parents and children with cleft lip and/or palate (CLP).

Methods

Evidence from a qualitative study of parents’ and children’s knowledge, beliefs and behaviour informed the design of an animation forming part of an intervention for children and parents using implementation intentions. The user views generated a set of guiding principles to determine the style and content of a teaching video, whilst an animation designer translated the key messages of implementation intention into images and characters appealing and meaningful to the target audience of children and parents.

Results

A team of researchers, an animation designer and a script writer designed a 2-min video as a teaching tool for children and parents. The team drafted and iteratively refined the content and visuals, with guidance from an advisory group and informal discussions with children in the target age group and their parents. Planning, consulting, designing and production of the animation spanned a total of 20 weeks. The video explains how to formulate ‘if-then’ plans using the voices of a boy and his mother in a conversation, with examples from oral health to illustrate how to enact intentions. It is available via digital media and designed to be delivered by dental care practitioners. The effectiveness of the intervention will be evaluated as part of a feasibility study.

Conclusion

The current study describes the development of an intervention mediated through an animation tutorial that enables children and parents to devise ‘if-then’ plans to improve oral health as a collaborative endeavour between parents and children. The animation uses examples from oral health, but we believe there is scope for exploring application of the intervention to other areas of behaviour.

Parents' and children's knowledge of oral health: a qualitative study of children with cleft palate

BACKGROUND

Children with cleft lip and/or palate (CLP) are prone to poorer oral health outcomes than their peers, with serious implications for treatment. Little is known of the knowledge and practice of children with CLP in caring for teeth and how these contribute to oral health.

AIM

To investigate (i) parents' and children's knowledge of oral health, (ii) how knowledge is acquired, and (iii) how knowledge is implemented.

DESIGN

A qualitative design was used to investigate knowledge, beliefs, and practices reported by parents and children, age 5-11 years with CLP. Data were collected from 22 parents and 16 children and analysed using thematic analysis.

RESULTS

Four themes were derived as follows: (i) implicit knowledge: children express simple knowledge underpinned by basic rationales, (ii) situated knowledge: children gain skills as part of everyday childhood routines, (iii) maintaining good practice in oral health: parents take a lead role in motivating, monitoring, and maintaining children's toothbrushing, and (iv) learning opportunities: pivotal moments provide opportunities for children to extend their knowledge.

CONCLUSION

Developers of oral health education interventions should take account of children's implicit knowledge and the transmission of beliefs between generations that influence toothbrushing behaviours. This could enhance interventions to support parents and children's practice.

Effectiveness of Chewable Tooth Brush in Children-A Prospective Clinical Study

INTRODUCTION

Dental plaque is one of the aetiological factors in causation of dental caries. Effective removal of plaque can reduce the incidence of caries. Various agents for removing plaque has been introduced, of which, chewable brush is a recent advance. There is limited evidence assessing the effectiveness of using chewable brush in children.

AIM

The aim of this study was to evaluate the effectiveness of chewable brush in relation to efficiency in plaque removal and reduction in S.mutans counts in saliva.

MATERIALS AND METHODS

Ten children of six-nine years with their first molars erupted were included in the study and the children were supervised for their normal brushing for 7 days. The baseline Oral Hygiene Index-Simplified (OHI-S), Plaque Index (PI) and Decay, Missing Filled Tooth Index (DMFT-I) were noted and the saliva sample was collected from the children. The sample was sent for microbiological examination of S.mutans count and the pH of the saliva was also determined. The children were advised to brush their teeth twice daily for seven days using chewable brush. On the seventh day, the indices were noted again and the saliva sample was collected and sent for microbiological examination. Statistical analysis was done using paired t-test to compare the pre and post-brushing index scores, S. mutans count and salivary pH.

RESULTS

There was a significant reduction in the debris index (p<0.001), oral hygiene index (p<0.000), plaque index (p<0.001), pH of the saliva (p<0.037) and S. mutans level (p<0.006) before and after brushing with chewable brush. However, the calculus index remained unchanged (p=0.168).

CONCLUSION

Chewable brush can be used as an effective alternative to manual brushing in children.

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.

The effect of motivational interviewing on oral healthcare knowledge, attitudes and behaviour of parents and caregivers of preschool children: an exploratory cluster randomised controlled study

Background

Motivational Interviewing (MI) has been used across primary healthcare and been shown to be effective in reducing the prevalence of early childhood caries (ECC) in preschool children. This study aimed to compare the effect of MI, in contrast to traditional dental health education (DHE), on oral health knowledge, attitudes, beliefs and behaviours among parents and caregivers of preschool children in Trinidad.

Method

The design of this exploratory study included a cluster randomised controlled trial and semi-structured focus groups. Six preschools (79 parents and caregivers) in Eastern Trinidad were randomly assigned to a test or control group (3 preschools in each group). Parents and caregivers in the test-group (n = 25) received a talk on dental health using an MI approach and the control-group (n = 54) received a talk using traditional DHE. Both groups received additional, written dental health information. The MI group also received two telephone call follow-ups as part of the MI protocol. Both groups were given questionnaires before the talks and four months later. Question items included oral health knowledge, beliefs, attitudes, brushing behaviour, oral health self-efficacy, oral health fatalism and a specific instrument to asses ‘readiness for change’, the Readiness Assessment of Parents Concerning Infant Dental Decay (RAPIDD). Participants in the test-group were also invited to take part in a focus group to share their views on the dental health talk.

Results

At four month follow-up, knowledge items on fluoride use, tooth brushing, dietary practice and dental attendance increased in both the test (DHE + MI) and control (DHE) groups ((p < 0.05, Chi Square test). In the test-group there were increases in mean child tooth brushing frequency and reduction in oral health fatalism (p < 0.05 t-test). Findings from a thematic analysis of the focus group suggested that the MI talk and telephone follow-up were well accepted and helpful in supporting parent and caregiver efforts to improve oral health practices for their preschool children.

Conclusion

In this exploratory controlled study there was some evidence that using an MI approach when delivering oral health information had a positive effect on parent/ caregiver oral health knowledge, attitudes and behaviours compared to traditional DHE. There is need for further research involving the use of brief-counselling techniques in this Caribbean population.

Children's toothbrushing frequency: the influence of parents' rationale for brushing, habits and family routines

OBJECTIVES

To assess the relationship between parental and family factors and children's toothbrushing frequency at different times of day.

METHODS

A cross-sectional questionnaire survey of predominantly low-socio-economic status parents of children aged 3-6 years (n = 296) in South Wales, UK. Data were collected on the child's weekly toothbrushing frequency (morning and evening), the parents' rationale for brushing their child's teeth in the morning and evening, the strength of a parent's habit for brushing a child's teeth in the morning and evening, and the extent to which the family's daily routines were stable from day to day. Socio-demographic details were also collected.

RESULTS

Reported weekly brushing frequency was significantly (p < 0.001) higher in the morning (mean ± SD: 6.57 ± 1.37) than the evening (mean ± SD: 5.99 ± 2.15). Parents had significantly (p < 0.001) more interest in the cosmetic benefits of toothbrushing in the morning compared to the evening. Multivariate analysis showed that an increasing focus on the cosmetic benefits of toothbrushing was associated with significantly (p < 0.05) less weekly brushing in the evening. The extent to which brushing a child's teeth was 'habitual' was significantly (p < 0.001) associated with weekly toothbrushing frequency at both times of day.

CONCLUSIONS

Parents' rationale for brushing their children's teeth can vary at both an individual level and at different times of day. Understanding these variations is important in designing interventions to improve brushing frequency for at-risk children. The results also demonstrate habituation as being an important factor in understanding toothbrushing frequency. Further research is required to understand the mechanisms involved in habit formation and maintenance with children's oral hygiene behaviour.

Caries and background factors in Swedish 4-year-old children with special reference to immigrant status

OBJECTIVE

This study assesses the prevalence of caries and some background factors in 4-year-old children in the city of Umeå, northern Sweden, and compares this with data from earlier studies to reveal changes over time.

MATERIALS AND METHODS

Children from the catchment areas of three Public Dental Health Service clinics in Umeå (n = 224) born during the third quarter of 2008 were invited to undergo a clinical dental examination. Decayed surfaces (including both dentine and enamel, except for enamel lesions on buccal and lingual surfaces), missing and filled surfaces (dmfs) were recorded using the same methods and criteria as in a series of earlier studies performed between 1980-2007. Background data were collected in a case-history and a questionnaire. Results. The proportion of children with caries significantly decreased from 2007 (38%) to 2012 (22%) (p < 0.05). In addition, the distribution of dmfs differed significantly between these years (p < 0.05). More immigrant children had caries (42%) than non-immigrant children (15%) (p < 0.05). For children with caries, there were no significant changes in the distribution of dmfs between 1980-2012 (p > 0.05). An immigrant background was associated with a lower frequency of tooth brushing and a higher intake of ice cream, sweets and chocolate drinks (p < 0.05).

CONCLUSION

Although the proportion of children with caries declined between 2007-2012, this decline was limited to non-immigrant children. Since 1980 the distribution of dmfs remained unchanged among children with caries. More research on interventions for changing oral health behaviours is needed, specifically for immigrant children.