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

Oral Health Behaviors for Young Low-Income Urban Children during the COVID-19 Pandemic: A Mixed Methods Analysis

This research assessed oral health behaviors changes in urban families with young children during the stay-at-home period of the COVID-19 pandemic (Nov 2020-August 2021). Survey data on oral health behaviors were collected in homes at three points before COVID-19, and via phone during COVID-19. A subset of parents and key informants from clinics and social service agencies completed in-depth interviews via video/phone. Of the 387 parents invited, 254 completed surveys in English or Spanish (65.6%) during COVID-19. Fifteen key informant interviews (25 participants) and 21 family interviews were conducted. The mean child age was 4.3 years. Children identified as mainly Hispanic (57%) and Black race (38%). Parents reported increased child tooth brushing frequency during the pandemic. Family interviews highlighted changes in family routines that impacted oral health behaviors and eating patterns, suggesting less optimal brushing and nutrition. This was linked to changed home routines and social presentability. Key informants described major disruptions in oral health services, family fear, and stress. In conclusion, the stay-at-home period of the COVID-19 pandemic was a time of extreme routine change and stress for families. Oral health interventions that target family routines and social presentability are important for families during times of extreme crisis.

Oral health behaviors for young low-income urban children during the COVID-19 pandemic: a mixed methods analysis

This research assessed oral health behaviors changes in urban families with young children during the stay-at-home period of the COVID-19 pandemic. Survey data on oral health behaviors were collected in homes at three points over one year before COVID-19, and then via phone during COVID-19. Multivariate logistic regression was used to model tooth brushing frequency. A subset of parents completed in-depth interviews via video/phone that expanded on oral health and COVID-19. Key informant interviews via video/phone were also conducted with leadership from 20 clinics and social service agencies. Interview data were transcribed and coded, and themes were extracted. COVID-19 data collection went from Nov 2020 - August 2021. Of the 387 parents invited, 254 completed surveys in English or Spanish (65.6%) during COVID-19. Fifteen key informant (25 participants) and 21 parent interviews were conducted. The mean child age was approximately 4.3 years. Children identified as mainly Hispanic (57%) and Black race (38%). Parents reported increased child tooth brushing frequency during the pandemic. Parent interviews highlighted significant changes in family routines that impacted oral health behaviors and eating patterns, suggesting less optimal brushing and nutrition. This was linked to changed home routines and social presentability. Key informants described major disruptions in their oral health services and significant family fear and stress. In conclusion, the stay-at-home period of the COVID-19 pandemic was a time of extreme routine change and stress for families. Oral health interventions that target family routines and social presentability are important for families during times of extreme crisis.

Socioeconomic inequalities in toothbrushing behaviours in young children: a children's lifestyle survey in a representative population of A city, Okinawa prefecture, Japan

PURPOSE

We have less understanding of which socioeconomic status (SES) indicators may be reflective of latent socioeconomic inequalities in toothbrushing behaviours, especially finishing-toothbrushing by parents in young children. The aim of this study was to reveal the socioeconomic inequalities in children's toothbrushing and finishing-toothbrushing by parents and if it varies by SES indicators.

METHODS

We used data from 'Survey on Children's Life' conducted by A city of Okinawa Prefecture, Japan. The multiple imputed data of 902 (boys, 453) included self-reported children's toothbrushing behaviour and finishing-toothbrushing by parents in three-to six-year-old children. SES was assessed using self-reported household income and parental educational attainment. Absolute and relative inequalities in toothbrushing behaviours were quantified using the slope index of inequality (SII) and relative index of inequality (RII), respectively.

RESULTS

There were significant absolute and relative inequalities of children's toothbrushing for household income (SII and RII were 0.241 and 2.73, respectively), of finishing-toothbrushing by parents for household income (SII and RII were 0.133 and 3.28, respectively), and educational attainment (SII and RII were 0.166 and 5.55, respectively). The same inequality trends were observed after adjusting for covariates (child's age and sex, family structure, breakfast and dinner frequency, and sleep duration).

CONCLUSION

Socioeconomic inequalities in children's toothbrushing and finishing-toothbrushing by parents varied according to SES indicators.

Access to information on oral hygiene and mothers' practices of children with microcephaly caused by Zika virus

OBJECTIVE

To verify whether access to information about oral hygiene influenced the practices of caregivers of children with microcephaly caused by Zika virus (ZIKV).

METHODS

A case series study was developed at the Mens Sana Rehabilitation Center, in the municipality of Arcoverde, Pernambuco, Brazil. The study universe included the mothers of 32 children with microcephaly caused by Zika virus. Data collection took place in the month of June 2018 and was carried out through a structured questionnaire. The variables studied comprised socioeconomic issues, habits, diet and knowledge about oral hygiene. Fisher's Exact and Pearson's Chi-square tests were used with a significance level of 5%.

RESULTS

Out of 32 individuals eligible to participate in the study, only 27 were selected. Most mothers reported receiving information about oral hygiene from their infants (63.0%). Fisher's Exact and Pearson's Chi-square tests showed that access to oral hygiene information was associated with mother's education, family income, regular visits to the dentist, frequency of tooth brushing, age at which the infant started brushing, and brushing time (p < 0.05).

CONCLUSION

Access to information about oral hygiene positively influenced the oral health care of mothers with their children with microcephaly caused by ZIKV.

Evaluation of Children Caries Risk Factors: A Narrative Review of Nutritional Aspects, Oral Hygiene Habits, and Bacterial Alterations

Dental caries is one of the most common diseases—both in adults and children—that occurs due to the demineralization of enamel and dentine by the organic acids formed from bacteria present in dental plaques through anaerobic metabolism of dietary sugars. The aim of this article is to provide a guideline to assess the risk of caries by looking for the main factors involved. Literature research was performed for studies that analyzed the factors most involved in the development of child caries, such as poor oral hygiene, bad eating habits (or food disorders), and an alteration of the oral bacterial flora—with an increase of Streptococci spp., Lactobacilli spp., Candida albicans, Cryptococcus neoformans, and Candida sake. It is therefore essential to assess the risk of caries in children, based on the assessment of risk factors, in order to be able to establish preventive and/or therapeutic approaches that will reduce or stop the development of dental caries. The use of fluoride products, products made from casein phosphopeptide-amorphous calcium phosphate, substituted zinc biomimetic hydroxyapatite products, or products containing self-assembling oligopeptide SAP-P₁₁-4 are useful. In terms of the clinical approach, a communicative approach should be added to learn about the eating habits and the oral hygiene habits of the child and parents; in addition, the use of a simple method to frame the factors involved, and subsequently establish the risk of carious lesions in the child, allows the reduction of the DMFT (Decayed Missing Filled Teeth) or ICDAS (International Caries Detection and Assessment System) index on large scales.

Influence of maternal postpartum depression on children's toothbrushing frequency

OBJECTIVES

Daily toothbrushing behaviour is very effective for the prevention of early childhood dental caries (ECC), but is mostly dependent upon parental management. Intrapersonal association between lower toothbrushing frequency and depression is well known; however, the impact of maternal postpartum depression on child toothbrushing behaviour within the mother-child dyad remains unknown. The aim of this study was to determine the association between the prevalence of maternal postpartum depression and lower toothbrushing frequency in children aged two years.

METHODS

A secondary analysis of a data set from the Japan Environment and Children's Study was performed. A total of 104 062 fetuses were enrolled after obtaining informed written parental consent, in which 84 533 mother-infant pairs were included after applying exclusion criteria. The Edinburgh Postpartum Depression Scale (EPDS) was used to evaluate maternal postpartum depression (a total score of ≥9 in EPDS) at one and six months postpartum. Indeed, the participants were classified based on the persistence of postpartum depression: 'Resilient' (no prevalence); 'Improving' (prevalence only at one month postpartum); 'Emergent' (prevalence only at six months postpartum); and 'Chronic' (prevalence at both time points). The association between postpartum depression and a toothbrushing frequency in children (the reference group: more than once per day, the low group: once per day, and the very-low group: less than once per day) was examined using Poisson regression models with adjustments for maternal and child characteristics after multiple imputations for missing data.

RESULTS

The prevalence of maternal postpartum depression at one and six months postpartum was 13.9% and 11.4%, respectively; the proportions of each persistence group were 81.1% ('Resilient'), 7.5% ('Improving'), 5.0% ('Emergent') and 6.4% ('Chronic'). Concerning children's toothbrushing frequency, 51.6% and 0.5% of participants self-reported frequencies of once per day and less than once per day, respectively. The association of maternal postpartum depression with a lower toothbrushing frequency in children consistently had higher relative risks (RRs). However, these associations were weakened when adjusting for whether the child could self-perform toothbrushing or whether this was done under parental supervision. A key result is that participants with persistent postpartum depression at both one and six month(s) postpartum showed the highest adjusted RRs (95% CI) for lower toothbrushing frequency in children (1.08 [1.04-1.12] with a decrease in children's toothbrushing frequency).

CONCLUSION

Maternal mental health provides valuable screening information for children with lower toothbrushing frequency for the purpose of preventing ECC.

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.

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.

Toothbrushing behavior in children - an observational study of toothbrushing performance in 12 year olds

Background

Many countries offer systematic group prevention programs in kindergarten and school in order to promote children’s oral health. Little is known, however, about the actual toothbrushing abilities of children when group prevention programs end.

Methods

In Germany, all children take advantage from a nationwide group prevention program (called “Gruppenprophylaxe”) lasting from kindergarten up to sixth grade (12 years of age). Standardized recommendations are given concerning brushing systematics and brushing movements. N = 174 children at the age of 12 were thus randomly selected from two German towns and were asked to perform toothbrushing to the best of their abilities in front of a mirror which also served as a camera. Brushing behavior was analyzed by video analysis.

Results

Children brushed their teeth for an average of 200 s ± 80.48 s (mean ± SD). Still, more than 55% missed at least one sextant when brushing inner surfaces, 16% missed them all. Only 7.5% of the children brushed both inner and outer surfaces by the intended movements (vertical movements on the inner surfaces and circular movements on the outer surfaces) for at least 90% of the respective brushing time. Instead, horizontal brushing was very common on the lateral surfaces.

Conclusions

The present analysis indicates that children have low efficiency to adopt the tooth-brushing recommendations given in prevention programs. This is surprising as great endeavors are made to help children internalize the recommendations. Future research is needed to better understand which factors impede adoption of toothbrushing recommendations in children and which efforts are necessary to improve their toothbrushing abilities.

Electronic supplementary material

The online version of this article (10.1186/s12903-019-0755-z) contains supplementary material, which is available to authorized users.

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.

Toothbrushing frequency among 4-6-year-old Iranian children and associated maternal attitude and sociobehavioral factors

Background:

Toothbrushing is an important aspect of children's oral health self-care. This study aimed to explore toothbrushing frequency among 4–6-year-old Iranian children and associated maternal attitude and sociobehavioral factors.

Materials and Methods:

This cross-sectional study was conducted on 407 mother–child (aged 4–6 years) pairs through stratified random sampling in Tabriz, Iran. Data were collected using self-reported questionnaires including demographic characteristic, maternal attitude, and toothbrushing frequency of both mothers and children. Logistic regression was used to determine the predicators of children's toothbrushing. Statistical significance was set at P < 0.05 for all tests.

Results:

The mean ages were 32.6 ± 4.8 and 5.3 ± 1.1 years for mothers and children respectively. Twice-daily toothbrushing was observed at a relative frequency of 12.8% in children and 18.4% in mothers. About 43.7% of children brushed their teeth once daily. Nearly 38.7% of children started toothbrushing behavior regularly at 4 years of age, and 41% had dental visits. Multiple logistic regression analysis indicated that children's toothbrushing (once daily or more) was associated with maternal brushing frequency (odds ratio [OR] =2.0, 95% confidence interval [CI] =1.53–2.86), maternal attitude toward oral health (OR = 1.15, CI = 1.08–1.22), and children's age (OR = 1.21, 95% CI = 1.02–1.77).

Conclusion:

The descriptive results indicated that maternal and children toothbrushing behaviors are unfavorable. Furthermore, maternal toothbrushing behavior is a strong predicator of children's brushing behavior. Health promotional activities seem necessary for mothers to enhance oral health behavior of their 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.