Reasons for low adherence to diet-diaries issued to pediatric dental patients: a collective case study

Exploring Barriers and Facilitators to Dietary Assessment and Advice in the Paediatric Population Attending Dental Clinics: A Scoping Review

OBJECTIVES

This scoping review aimed to identify barriers and facilitators, from both dental clinic staff and caregivers, to effectively providing and implementing dietary assessment and advice (for both oral and/or systemic health) in dental clinics managing paediatric patients.

METHODS

A protocol was developed a priori (Open Science Framework- https://osf.io/bp4ts.) and followed the PRISMA-ScR guidelines. Studies published in English from 1990 to December 2024 in MEDLINE, Cochrane Library, Embase and CINAHL databases were searched. Additional journal searches targeted articles on dietary assessment or advice in dental clinics treating paediatric patients (aged ≤ 18 years), exploring barriers and facilitators for caregivers and dental clinic staff.

RESULTS

Of 4736 studies identified, 32 were included, with 5 additional studies included from manual searching. Sixteen studies were quantitative, 13 were qualitative, and 8 mixed methods. Across studies, 77 barriers and 45 facilitators were identified in providing and implementing dietary assessment and advice in the paediatric population attending dental clinics. Results were mapped to the Theoretical Domains Framework. Common barriers for dental staff included time constraints and financial compensation, while caregivers cited controlling children's dietary habits as a major barrier.

CONCLUSIONS

Understanding the main barriers and facilitators in providing and implementing dietary assessment and advice in dental clinics treating paediatric patients is crucial to improving preventive healthcare.

Food for Thought: Exploring Dental Students' Perceptions of Delivering Dietary Advice to Children and Families

BACKGROUND

Delivery of dietary advice by dental professionals is an important part of national guidelines, to prevent dental disease and improve general health in children and young people. Anecdotally, dental students feel uneasy delivering dietary advice to children and their parents/carers, which may affect their ability to provide effective advice confidently. This study aimed to explore undergraduate dental students' perceptions of delivering dietary advice to children and parents/carers.

METHOD

Semi-structured qualitative interviews were held with undergraduate dental students who had experience of providing dietary advice for children and parents. Interviews were steered using a topic guide, and were recorded and transcribed verbatim. Recruitment continued until data saturation was considered to have been achieved. Two researchers undertook thematic analysis on the transcriptions independently, prior to agreeing upon the key themes and subthemes.

RESULTS

Interviews were carried out with 11 students with varied levels of experience in providing dietary advice. Managing the child-parent dyad was a key theme, with students finding it challenging to tailor age-appropriate information to engage both parties, particularly when the child's behaviour became difficult. Students found it challenging to deliver dietary advice to children and parents from diverse cultural backgrounds and were aware that families may struggle to implement the advice that they were delivering due to financial difficulties and complex childcare arrangements. Students felt their learning experience in this area was adversely affected by the pandemic.

CONCLUSION

This is the first study to explore student perceptions of delivering dietary advice, providing rich data to inform future teaching developments and research.

Implementation of a food science and nutrition module in a dental undergraduate curriculum

INTRODUCTION

To outline the development and implementation of a food science and nutrition module for dental undergraduate students that provides basic knowledge and clinical skills for improving oral health outcomes and understanding their importance for overall health.

MATERIALS AND METHODS

Interdisciplinary discussions with professionals with expertise in food science and nutrition, including dentists, dietitians and nutritionists, were held to agree on core subject areas in line with the evidence base. The module was delivered online to 2nd-year dental students due to COVID-19 restrictions. Students completed an online evaluation on completing the module. Final examination consisted of one essay question.

RESULTS

Subject areas and learning outcomes were derived from current and previous approaches to curriculum development. A total of 14 prerecorded lectures, including healthy eating guidelines, dietary assessment, specific oral effects of diet and food constituents were delivered and tutorials provided. The evaluation survey had a 90% (n = 39/43) response rate. A majority indicated that the course was "interesting," "worth doing" (59%) and "provided a good evidence base to understand nutrition and oral health" (87%). Nearly all students (92%) agreed that the course was "sufficiently structured to allow understanding of the key topics" and that "a good understanding of nutrition is important for a dentist" (95%).

CONCLUSION

A food science and nutrition module developed by a multidisciplinary team enabled dental students to gain an understanding of the role of diet in oral and overall health. The module facilitated the development of skills that enable students to utilise dietary assessment techniques and promote dietary interventions beneficial to oral health. The approach taken may act as a template for other institutions.

Online Behavioral Screener with Tailored Obesity Prevention Messages: Application to a Pediatric Clinical Setting

Obesity prevention involves promoting healthy eating and physical activity across all children. Can we leverage technology to feasibly survey children's health behaviors and deliver theory-based and user-tailored messages for brief clinical encounters? We assessed the acceptability and utility of an online pediatric-adapted liking survey (PALS) and tailored messages among children receiving non-urgent care in a pediatric emergency department (PED). Two hundred and forty-five children (average age = 10 years, racially/ethnically diverse, 34% overweight/obese from measured indices, 25% of families reporting food insecurity) and their parents/caregivers participated. Each reported the child's activity and behaviors using the online PALS and received two to three messages tailored to the responses (aligned with elaboration likelihood and transtheoretical models) to motivate behavioral improvements or reinforce healthy behaviors. Most children and parents (>90%) agreed the PALS was easy to complete, encouraging thought about their own/child's behaviors. The child's PALS responses appeared reasonable (fair-to-good child-parent intraclass correlations). Most children and parents (≥75%) reported the tailored messages to be helpful and favorable for improving or maintaining the targeted behavior. Neither message type (motivating/reinforcing) nor favorability responses varied significantly by the child's weight or family's food security status. In summary, children and parents found the PALS with tailored messages acceptable and useful. The message types and responses could help focus brief clinical encounters.

Pediatric-Adapted Liking Survey (PALS): A Diet and Activity Screener in Pediatric Care

Clinical settings need rapid yet useful methods to screen for diet and activity behaviors for brief interventions and to guide obesity prevention efforts. In an urban pediatric emergency department, these behaviors were screened in children and parents with the 33-item Pediatric-Adapted Liking Survey (PALS) to assess the reliability and validity of a Healthy Behavior Index (HBI) generated from the PALS responses. The PALS was completed by 925 children (average age = 11 ± 4 years, 55% publicly insured, 37% overweight/obese by Body Mass Index Percentile, BMI-P) and 925 parents. Child–parent dyads differed most in liking of vegetables, sweets, sweet drinks, and screen time. Across the sample, child and parent HBIs were variable, normally distributed with adequate internal reliability and construct validity, revealing two dimensions (less healthy—sweet drinks, sweets, sedentary behaviors; healthy—vegetables, fruits, proteins). The HBI showed criterion validity, detecting healthier indexes in parents vs. children, females vs. males, privately- vs. publicly-health insured, and residence in higher- vs. lower-income communities. Parent’s HBI explained some variability in child BMI percentile. Greater liking of sweets/carbohydrates partially mediated the association between low family income and higher BMI percentile. These findings support the utility of PALS as a dietary behavior and activity screener for children and their parents in a clinical setting.