Motivational interviewing for preventing early childhood caries: A systematic review and meta-analysis

Impact of Oral Health Chatbot With and Without Toothbrushing Training on Childhood Caries

OBJECTIVES

Standalone oral health chatbots targeting young children's oral health are rare. The aim of this research was to compare the effectiveness of a standalone chatbot and a combination chatbot with in-person toothbrushing training for caregivers in improving young children's oral health.

METHODS

A randomised, parallel, 2-group pretest-posttest design was employed with 320 caregiver-child pairs (aged 6-42 months). Group I (160 pairs) used the 21-Day FunDee (modified) chatbot along with in-person toothbrushing training, whilst Group II (160 pairs) used only the 21-Day FunDee Plus chatbot. Oral examination assessed plaque levels and caries, whilst a self-administered questionnaire evaluated oral hygiene care, dietary practices, and oral health perceptions based on the protection motivation theory (PMT). Data were analysed using 2-way repeated-measures analysis of variance, a t test, and chi-square measures for group comparisons.

RESULTS

The majority of caregivers were Muslim mothers. No significant differences were observed between groups at the baseline, 3-month, and 6-month follow-ups in mean dmft (Group I: 4.16, 4.64, and 5.30 vs Group II: 4.30, 5.54, and 5.82), mean plaque scores (Group I: 0.72, 0.53, and 0.55 vs Group II (0.84, 0.52, and 0.59), and most dietary habits. However, significant improvements were found within groups from baseline to follow-ups in plaque reduction, toothbrushing practices, overall knowledge score, PMT perceptions, proper tooth brushing, fluoride toothpaste usage, and dietary behaviours (frequency of bottle feeding, frequency of nocturnal bottle feeding, proportion of children who went to bed without consuming anything after cleaning their teeth before bedtime). The significant differences between groups were found in self-efficacy at all time points, but only at the 6-month evaluation for percentage of fluoride toothpaste and overall PMT perceptions.

CONCLUSIONS

Both interventions were comparable in preventing caries, reducing plaque, improving feeding practices, increasing parental involvement in tooth brushing, and enhancing knowledge. The standalone chatbot 21-Day FunDee Plus presents a viable alternative for promoting oral health in young children.

Why Is Caries Prevention in Children So Difficult? A Narrative Opinion

Caries is among the most common non-communicable diseases worldwide, yet it is commonly described as preventable. Caries prevention is, however, difficult and complex, since the disease has strong social, parental, behavioral, political, medical/genetic, and psychological elements, and the payment models are targeted at traditional conservative care. The aim of this paper is to discuss some key issues that make caries prevention in children be perceived as "difficult": i) the communication gap between researchers and clinicians, creating unrealistic expectations of intervention efficacy; ii) the skewed distribution of caries and the problem of reaching children with the highest need; iii) limited access to care, which is a threat to oral health, in particular in low-socioeconomic-status, underserviced, and remote communities; and iv) the need to adopt behavior change models to affect the modifiable risk factors that are shared with other non-communicable diseases. Dentists cannot simply rely on fluoride exposure; proper education and training in caries risk assessment, behavior change models targeted at oral hygiene and sugar intake, and collaboration with primary healthcare and local school authorities are avenues that aid in caries prevention and reduce the uneven burden of the disease. Online education and mobile apps may help to promote oral health in areas with shortages of dental work force.

Caries indicators in relation to healthcare access and hygienic-dietary habits in Spanish preschoolers

INTRODUCTION

Dental caries continues to be a public healthcare problem due to its high prevalence and morbidity. It was proposed to evaluate caries indicators in relation to healthcare access and hygienic-dietary habits in Spanish preschoolers.

MATERIALS AND METHODS

A cross-sectional study was carried out on a random sample consisting of 343 patients ranging from 3 to 5 years of age in the primary care setting, the main measurements were: dental care access, hygienic-dietary habits, and caries registration according to WHO criteria.

RESULTS

The prevalence of caries was 35.3% and mean ± standard deviation (SD) dft was 1.51 ± 2.93. Preschoolers who had ever visited the dentist had a higher dft occurrence than those who had never attended the dentist. The lower prevalence of caries was significantly associated with the frequency of two daily brushings versus non-daily brushing (p = 0.007; 25.3% vs. 47.1%) and was 10.7% lower in patients who had the habit of night brushing (p = 0.041). The consumption of sugary liquids between meals implied a higher dft index.

CONCLUSIONS

The high prevalence of early childhood caries and the dental care access associated with poor oral health suggest the need to implement a multidisciplinary oral healthcare program that involves both healthcare and dental healthcare professionals in Primary Health Care Units without forgetting the participation of the community and local administrations.

Two years outcome of an individualized oral health preventive program for preschool children with neurodevelopmental disorders

AIMS

Limited data exist on the effectiveness of oral health preventive programs in children with Neurodevelopmental Disorders (NDD). The aim of this study was to evaluate the effectiveness of an individualized preventive oral health program for preschool children with NDD at a rehabilitation center, over a two years period.

METHODS AND RESULTS

In this study, 102 preschool children with NDD were assessed for caries (dmft), oral hygiene status (Green & Vermillion Index) and presence of developmental dental defects. An individualized preventive program was applied based on caries risk and children were followed for two years. Effectiveness of the program was assessed for caries and dental plaque change and explanatory individual factors were used in multivariate models. After two years prospective, dmft increased significantly from 1.1 (SD = 2.7) to 2.04 (SD = 3.6), while GVPI was reduced significantly from 1.8 (SD = 0.9) to 1.4 (SD = 0.9). Children in the moderate and high-risk groups missed significantly more follow-ups compared to the low caries risk group (p < .001) while older maternal age (OR = 1.38, 95%CI = 1.057-1.808) and consumption of more than three sugary snacks/day (OR = 0.005, 95%CI = 0-0.0794) were significantly correlated with dental caries.

CONCLUSION

The individualized preventive program for preschool children with NDD was effective in improving oral hygiene but not dental caries status.

Does oral health goal setting during medical visits improve parents' oral health behaviors?

OBJECTIVES

The Rocky Mountain Network for Oral Health (RoMoNOH) promotes the delivery of preventive oral health services (POHS) to children receiving care at community health centers (CHCs) in Arizona, Colorado, Montana, and Wyoming. One POHS is oral health goal setting (OHGS). This study aimed to evaluate the effect of OHGS during medical visits on parent/caregiver-reported oral health behaviors (OHBs).

METHODS

The RoMoNOH implementation team trained CHC healthcare providers in POHS, including caries risk assessment, oral health education, fluoride varnish application, dental referrals, and parent/caregiver oral health engagement. To promote parents' oral health engagement, healthcare providers were trained in motivational interviewing (MI) with OHGS at medical visits. To evaluate the impact of MI with OHGS on parent/caregiver OHBs, a healthcare team member invited parents/caregivers to complete a baseline survey after their medical visits. The evaluation team sent a follow-up survey after 10-14 days. The surveys measured parents/caregivers' goals, confidence in goal attainment, OHBs, and sociodemographics; the follow-up survey also measured OHGS attainment. Improvement in parent/caregiver-reported OHBs was tested with a paired t-test and unadjusted and adjusted multiple linear regression.

RESULTS

In total, 426 parents/caregivers completed the baseline survey; 184 completed both surveys. OHBs, including toothbrushing frequency, stopping bed bottles, drinking tap water, and brushing with fluoride toothpaste improved over the evaluation interval. After adjusting for covariates, brushing with fluoride toothpaste (p = 0.01), drinking tap water (p = 0.03), and removing bed bottles (p = 0.03) improved significantly.

CONCLUSION

MI with OHGS with parents/caregivers during medical visits has potential to improve OHBs on behalf of their children.

Motivational interviewing for preventing oral morbidities in adults: Systematic review and meta-analysis

OBJECTIVE

This systematic review with meta-analysis was performed to assess whether motivational interviewing (MI) effectively prevents oral morbidities in adults.

METHODS

Studies considered were randomized controlled trials, cluster-randomized controlled trials and community-based randomized trials assessing interventions based on MI or indicating that a counselling technique based on the principles developed by Miller and Rollnick was used. Controls were any type of oral health education or negative controls. Participants were 18-60 years old. The main outcome was any oral morbidity. From 602 studies identified in MEDLINE, Scopus, Web of Science and LILACS databases, seven studies were included in the synthesis.

RESULTS

Studies included only evaluated periodontal outcomes, no studies were found for other oral morbidities. Patients' mean age was 43.7 years, and the follow-up time after MI or MI-based intervention varied between 1 month and 1 year. The total study population was 272 people with moderate-to-severe periodontitis; other groups analysed were pregnant women (n = 112) and patients with mental disorders and alcohol problems (n = 60). Meta-analysis for the plaque index (four studies, n = 267), bleeding on probing (two studies, n = 177) and gingival index (two studies, n = 166) were carried out. The summary effects for the random-effects model were estimated respectively as -3.59 percentage points (CI: [-11.44; 4.25] for plaque index, -6.41 percentage points (CI: [-12.18, -0.65]) for bleeding on probing and -0.70 (CI: [-1.87; 0.48]) for gingival index, marginally favouring the MI group. The reduced number of studies, the non-disclosure of some aspects of the data and the heterogeneity among them undermine the precision of the estimates.

CONCLUSION

The current evidence available is limited to periodontal outcomes, and it is not possible to determine whether MI effectively prevents oral morbidities in adults.

Community health worker intervention to improve tooth brushing in young children: Results from a cluster randomized controlled trial

OBJECTIVES

Coordinated Oral health Promotion (CO-OP) Chicago is a cluster randomized controlled trial testing the efficacy of a community health worker (CHW) intervention to improve tooth brushing in low-income children.

METHODS

Four hundred twenty children under 3 years old (mean 21.5 months) were recruited from 20 sites in or near Chicago, IL. Children were identified mainly as Black race (41.9%) or Hispanic ethnicity (53.8%) and most (85.2%) had Medicaid. Intervention families were offered four CHW home visits over 1 year. Brushing frequency was self-reported. Plaque score was determined from images collected in homes using disclosing solution. Analyses used GEE logistic models with variable selection at p < .05.

RESULTS

At enrolment, 45.0% of families reported twice a day or more child brushing frequency, and child plaque scores were poor (mean of 1.9, SD: 0.6). Data were obtained from 87.1% of children at 6 months and 86.2% at 12 months. In the CHW intervention arm (10 sites, N = 211), 23.7% received 4 visits, 12.8% 3 visits, 21.3% 2 visits, 23.2% 1 visit and 19% no visits from CHWs. No intervention effect was seen for brushing frequency or plaque score. Child brushing frequency improvement over time was associated with a range of child and caregiver factors. The only factor associated with a change in plaque score over time was parent involvement in brushing.

CONCLUSIONS

Oral-health-specific CHW services were not associated with improved brushing behaviours in these young children. However, caregiver involvement with brushing supported more quality brushing. More robust interventions are needed to support families during this critical developmental period.

Motivational Interviewing and Childhood Caries: A Randomised Controlled Trial

BACKGROUND

This study tested the occurrence of early childhood caries (ECC) and changes in potential mediators of ECC after an early childhood oral health promotion intervention.

METHODS

Consenting parent/child dyads in Western Australia were randomised into test [motivational interviewing (MI) + anticipatory guidance (AG)] or control (lift the lip assessments by child health nurses). A questionnaire at baseline and follow-ups (at 18, 36 and 60 months) evaluated the parental factors and the children clinically examined. Data were analysed using parametric and non-parametric tests for two groups and paired comparisons. Multivariable analysis used negative binomial regression with robust standard errors for over-dispersed count data and effect estimates presented as incidence rate ratios.

RESULTS

Nine hundred and seventeen parent/child dyads were randomised (test n = 456; control n = 461). The parental attitude toward a child's oral hygiene needs improved among the test group at the first follow-up (n = 377; baseline 1.8, SD 2.2, follow-up 1.5, SD 1.9, p = 0.005). Living in a non-fluoridated area and parents holding a fatalistic belief increased the risk of caries (IRR = 4.2, 95% CI 1.8-10.2 and IRR = 3.5, 95% CI 1.7-7.3), respectively, but MI/AG did not reduce the incidence of dental caries.

CONCLUSION

The brief MI/AG oral health promotion intervention improved parental attitude but did not reduce ECC.

A randomized controlled trial of 6-month dental home visits on 24-month caries incidence in preschool children

OBJECTIVES

This paper reports on the effect of 6-month dental home visits compared to no dental home visits on 24-month caries incidence in 5- to 6-year-olds.

METHODS

5- to 6-year-olds attending kindergartens were randomized to receive either 6-month dental home visits and education leaflets (Intervention group) or education leaflets alone (Control group) over 24 months. To detect a 15% difference in caries incidence with a significance level of 5% and power of 80%, 88 children were calculated to be needed in the Intervention group and 88 in the Control. Baseline clinical data included oral examinations at the kindergartens. Follow-up visits were made on the 6th, 12th and 18th month. At the end of the 24 months, both the Intervention and Control groups were visited for oral examinations. The primary outcome was caries incidence, measured by the number and proportion of children who developed new caries in the primary molars after 24 months. The secondary outcome was the number of primary molars that developed new caries (d-pms). Frequency distributions of participants by baseline socio-demographic characteristics and caries experience were calculated. The chi-square test was used to test differences between the caries experience in the Intervention and Control groups. The t test was used to compare the mean number of primary molars developing new caries between the Intervention Group and the Control Group. The number of children needed to treat (NNT) was also calculated.

RESULTS

At the 24-month follow-up, 19 (14.4%) developed new caries in the Intervention Group, compared to 60 (60.0%) in the Control Group (p = .001). On average, 0.2 (95% CI = 0.1-0.3) tooth per child in the Intervention Group was observed to have developed new caries compared to 1.1 (95% CI = 0.8-1.3) tooth per child in the Control Group (p = .001). The number of children needed to treat (NNT) to prevent one child from developing new caries was 2.2.

CONCLUSIONS

The present study has demonstrated that 6-month home visits to families of 5- to 6-year-olds are effective in caries prevention in 5- to 6-year-olds of low-income families in a middle-income country where access to health services, including oral health promotion services, is limited.

Effectiveness of brief motivational interviewing on perceived importance, interest and self-efficacy of oral health behaviors: A randomized clinical trial

Objective

To investigate periodontal patients' perceived importance, interest and self-efficacy of oral hygiene (OH) behaviors.

Methods

Secondary outcomes from a randomized single-site examiner-blinded clinical trial investigated the control group (traditional oral hygiene instructions) and the test group (brief motivational interviewing) over four time points. Analyses were performed using R version 4.1.1.

Results

Sixty participants were eligible, and 58 completed the pre and post questionnaires for a 97% response rate. Importance was higher in the test group for good oral health and daily oral self-care (4.86 vs. 4.80). Interest in taking care of teeth and gums and changing a homecare routine was higher in the test group (4.89). Self-efficacy was higher in the test group for taking care of teeth and gums (4.18 vs. 4.07), making a change to improve oral health (4.29 vs. 4.27), and maintaining a change long-term (4.32 vs. 4.17). Statistical significance for self-efficacy was achieved for maintaining an OH behavior long-term.

Conclusion

A brief motivational interviewing intervention was superior to enhance perceived importance, interest and self-efficacy of oral hygiene behaviors.

Innovation

Contrary to previous motivational interviewing research, this study used a novel approach to evaluate MI-fidelity to determine the most effective MI strategies to support self-efficacy.

Health professionals delivering oral health interventions in early childhood: A scoping review of Australian and New Zealand literature

ISSUE ADDRESSED

Dental caries is highly prevalent in very young Australian and New Zealand children. Health professionals other than registered dental professionals can help prevent early childhood caries, promoting oral health to assist families establish preventative oral health habits at a child's early age. This review identifies oral health promotion (OHP) delivered by nondental health professionals in Australia and New Zealand involving very young children.

METHODS

Databases (MEDLINE, CINAHL, Embase, Emcare, Web of Science, Scopus, ProQuest, Google Scholar, TROVE) and digital libraries were searched between 2001 and 2021 for eligible studies and grey literature. Studies with a focus on preventative oral health strategies in a primary health care context were included.

RESULTS

The review identified 76 studies. Seven met the inclusion criteria, and were conducted in Australia across metropolitan, rural, and remote settings. Studies that successfully engaged nondental health professionals to promote oral health to families reported a positive change in oral health practices among very young children. Delivering OHP during a child's early life stage positively influenced their oral health outcomes.

CONCLUSIONS

Integration of dental and primary health care increased access to oral health care and advanced positive oral health outcomes for children. With adequate training, resources, and support mechanisms, nondental health professionals can deliver oral health strategies that facilitate behaviour change in parents to improve children's oral health. So What? Health promotion generates enabling conditions that support and empower families to improve and maintain their oral health. Nondental health professionals can play a crucial role promoting oral health for very young children and improving equitable access to preventative oral health care.

Understanding dental caries as a non-communicable and behavioral disease: Management implications

New paradigms in caries conceptualization have emerged during the last decades, leading to intense debate and discussion on how to approach the disease, both from a preventive and a therapeutic perspective. Among many new ideas, research discoveries and technologies, one major concept can be highlighted that created a deep frontier between the old and the new paradigm in caries conceptualization; the non-communicable nature of the disease, firmly associated with behaviors and lifestyles. This article synthetizes the conceptual construction of dental caries as a non-communicable disease (NCD) based on the current evidence and discusses the appropriate management of the disease in this context. Dental caries has shifted from being considered transmissible and infectious to an ecological and non-communicable disease. Environmental factors such as frequent sugars intake, disrupt the symbiosis of the dental biofilm leading to a dysbiosis, which favors caries lesion initiation and progression. As an NCD, dental caries shares characteristics with other NCDs such as cardiovascular and chronic respiratory diseases, cancer and diabetes, including long duration and slow progression, not being transmissible from person-to-person, being strongly related to modifiable behavioral risk factors, and affecting preferentially disadvantaged populations with a strong inequality gradient. Given the high prevalence of dental caries, and its consequences on people's health and quality of life, a recognizable conceptual view of caries as a NCD is required to target an effective management. Current understanding of dental caries supports prevention through acting on the modifiable risk factors (behaviors) and involves management based on an interdisciplinary approach. Communicating these modern concepts among researchers, clinicians and policymakers is needed to decrease the global high burden of the disease.

Motivational interviewing versus conventional caries prevention strategies in high-caries-risk children and families: a non-randomised trial

Background This study compared the effectiveness of motivational interviewing (MI) and conventional caries prevention (CCP) for primary (caries increment) and secondary outcomes (caries intensity, gingival health, caregiver-reported oral health-related knowledge, behaviours and attitudes) over 12 months.Methods High-caries-risk children and caregivers received CCP or MI with comprehensive dental care. Fidelity was monitored using MI treatment integrity code 4.2.1. Caries increment, intensity and gingival health were measured at baseline, six and twelve months. Readiness Assessment of Parents Concerning Infant Dental Decay questionnaires recorded oral health-related knowledge, behaviours and attitudes.Results In total, 86 caregiver-child dyads (CCP = 51; MI = 35) were recruited. The mean difference (95% confidence interval [CI]) in caries increment (ΔdICDAS1-6mfs + DICDAS1-6MFS) was significantly higher with MI compared to CCP at six (MI 2.3 [1.2, 3.5] vs CCP 0.6 [0.1, 1.0]; p <0.001) and twelve (MI 4.3 [2.5, 6.0] vs CCP 1.2 [0.6, 1.8]; p <0.001) months. Multivariate analysis with CCP as reference group, odds ratio (95% CI) for new/progressed caries (Δdecayed, missing and filled surface score [permanent] + decayed, missing and filled surface score [primary] >0) at six and twelve months were 18.2 (4.0, 81.7); p <0.001 and 12.6 (3.3, 47.8); p <0.001, respectively. The MI group reported positive behaviours and attitudes.Conclusions CCP was more effective in reducing caries increment when behaviour change technique was incorporated into the preventative strategies as per current paediatric dentistry guidelines.

Caries Experience and Increment in Children Attending Kindergartens with an Early Childhood Caries Preventive Program Compared to Basic Prophylaxis Measures-A Retrospective Cohort Study

Dental caries constitutes a public health challenge. As preventive strategies are desirable, this retrospective cohort study aimed to assess the caries experience and increment in children attending kindergartens with an early childhood caries (ECC) preventive program (intervention group, IG) compared to basic prophylaxis measures (control group, CG) located in areas of different socioeconomic status (SES) within Marburg (Germany). The long-term caries experience (2009−2019) of these 3−5-year-old kindergarten children was evaluated. For the caries increment, dental records of 2019 were screened for the availability of a minimum of two dental examinations at least 8 months apart. Caries was scored according to the WHO criteria (dmf−t). The data were split by observation period (300−550 and >550 days). Overall, 135 children (Ø 3.7 years) attended IG, and 132 children (Ø 3.6 years) attended CG. After 300−550 days, no significant differences were found between both groups regarding mean caries increment and experience (p > 0.05). After >550 days, IG with low SES exhibited a high caries experience. Fluoride varnish applications could not reduce the caries increment compared to CG in the short-term but slightly decreased the long-term caries experience. Comprehensive ECC prevention measures actively involving parents are needed to overcome the caries burden.

Fidelity of motivational interviewing in an oral health intervention with caregivers of young children

The aim of this study was to assess the fidelity of a motivational interviewing (MI) intervention with caregivers of young children in primary healthcare in Southern Brazil. Seven trained interventionists conducted one MI session with each caregiver at their home. The sessions were audio-recorded and a randomly selected subset (n = 109) was coded by a single reviewer using the Motivational Interviewing Treatment Integrity 3.1.1. criteria (MITI 3.1.1.). This instrument establishes parameters of MI proficiency for beginners and experts measuring the global ratings of five MI principles (evocation, collaboration, autonomy/support, direction and empathy), the global MI spirit score, and the behavior counts of MI basic skills: to inform, to ask, and to listen. The mean global MI spirit rating was 4.0 (95%CI 3.9-4.1). Mean MI principle scores ranged from 3.8 (95%CI 3.7-3.9) to 4.3 (95%CI 4.2-4.4). The overall reflection-to-question ratio was 0.9 (95 CI 0.8-1.0), % open questions was 76.3 (95%CI 73.1-79.6), % complex reflections was 66.1 (95%CI 63.1-69.1), and % MI-adherent information was 94.1 (95%CI 93.5-94.5). Interventionists with higher scores conducted more and longer sessions than those with lower scores (p = 0.012). Those with beginner proficiency had a higher proportion of caregivers changing their oral health knowledge (p = 0.005). In conclusion, a good degree of MI fidelity was found, with higher fidelity among interventionists who conducted more interviews and spent more time talking with caregivers.

Digital surveillance: Monitoring the activity of Internet users searching for information related to early childhood caries

This study evaluated the behavior of Internet users from seven countries through the analysis of the monthly variation of the Relative Search Volume (RSV) for queries related to early childhood caries (ECC), retrieved by Google Trends application programming interface between January 2004 to December 2020. The association of RSV with years lived with disability (YLDs) for untreated dental caries in deciduous teeth and Internet penetration were tested by regression models. Forecasting models were developed to predict the interests until December 2021. Relevant topics linked to searches were assessed qualitatively. Increasing levels of interests were observed in most countries, regarding the comparison of periods 2004-2012 and 2013-2021, without influence of seasonality. These results were associated with YLDs only in France and with the Internet penetration in Mexico and France. Searches were mostly related to the definition, risk factors, and preventive care of ECC. The interests of Internet users in ECC-related information increased in the last years in all seven countries, although it was maintained low over time. It might indicate a lack of awareness about the negative consequences of the disease in the early stages of life. Specific policies should be developed toward the dissemination of oral health information and the prevention of the disease.

Nonrestorative Management of Dental Caries

The World Dental Federation (FDI) policy statement in 2016 advocated evidence-based caries-control measures for managing dental caries. The caries management philosophy has shifted from the traditional surgical manners to minimal intervention dentistry. Minimal intervention dentistry aims to extend the longevity of natural teeth. It places the nonrestorative approaches as a priority. The nonrestorative approaches for caries management aim to tackle the etiological factors of dental caries. Caries can be prevented or reversed by restricting the sugar intake and its frequency in the diet, improving oral hygiene practices, and using fluoride toothpaste. This article aims to present strategies for the nonrestorative management of dental caries, which are divided into four components to address the different etiological factors of dental caries. The first component is controlling dental plaque. Strategies for plaque control include oral hygiene instruction, motivational interviewing, mechanical plaque control, and chemical plaque control. The second component for nonrestorative management is reducing the risk of caries by identifying caries risk factors and protective factors, assessing personal caries risk, and customizing a treatment plan. Evidence-based measures for caries prevention include using fluoride, and dental sealants should be provided. The third component includes topical treatment to remineralise early carious lesions. The last component is long-term follow-up. Appropriate strategy adoption for the nonrestorative management of dental caries prolongs the life span of the teeth and sustains the good oral health of patients.