Validity of single-item parental ratings of child oral health

Is Parental Rating of Child's Oral Health Associated with Caries Experience in Children? A Cross-Sectional Study

Aim

The Parents' view to the oral health of their children is a significant factor that can impact oral health practices and behaviors. The aim of this research was to investigate how parental assessment of their child's oral health associates with caries experience in children receiving dental treatment at the hospital of Taibah University Dental College.

Materials and Methods

This cross-sectional study enrolled 127 children who underwent dental treatment at Taibah University Dental College and Hospital during 2020-2021. Dental caries experience was assessed using the dmft/DMFT index, and parental rating of oral health was obtained through a questionnaire. Three logistic regression models were used to assess the correlation between dental caries experience and parental rating of oral health while controlling for sociodemographic and behavioral factors.

Results

Most parents rated the oral health of their child as good (60.4%), followed by excellent (18.8%) and very good (15.6%). The mean dmft/DMFT score was 3.47 ± 3.46, with 43.8% of children having high/very high dental caries experience. Logistic regression analysis showed that children whose parents rated their oral health as poor were more likely to have high/very high dental caries experience compared to those rated as excellent/very good/good/fair (adjusted odds ratio = 4.45, 95% confidence interval 1.23-16.07).

Conclusion

This study suggests a link between parental assessment of their child's oral health and an elevated prevalence of dental caries in children. The study found that children whose parents rated their oral health as suboptimal had higher odds of having high dental caries experience. These findings emphasize the significance of parental perception of their child's oral health and suggest a necessity for customized interventions to enhance parental knowledge and practices concerning children's oral health.

Is childhood oral health the 'canary in the coal mine' for poor adult general health? Findings from two New Zealand birth cohort studies

OBJECTIVES

This study aimed to investigate whether childhood dental caries was associated with self-reported general health in midlife.

METHODS

We used data on childhood oral health (caries experience) and adult self-reported general health from two New Zealand longitudinal birth cohorts, the Dunedin Multidisciplinary Health and Development Study (n = 922 and n = 931 at ages 5 and 45 years, respectively), and the Christchurch Health and Development Study (n = 1048 and n = 904 at ages 5 and 40 years, respectively). We used generalized estimating equations to examine associations between age-5 dental caries and self-rated general health and the number of self-reported physical health conditions at ages 45/40 (diagnosed by a doctor or health professional, n = 14 conditions among both cohorts). Covariates included known risk factors for poor health (SES, IQ, perinatal complications), and personality style, which is known to affect subjective health ratings.

RESULTS

Incidence rate ratios for 'Excellent' self-rated health were lower among those who had high experience of dental caries as children than those who had not in both, the Dunedin (IRR, 0.76; 95% CI, 0.50, 1.14) and Christchurch studies (IRR, 0.69; 95% CI, 0.47, 1.00). Childhood dental caries was not associated with the number of self-reported physical health conditions in midlife, in either cohort. Dunedin Study members who at age 5 were not caries-free or whose parents rated their own or their child's oral health as poor were less likely to report 'Excellent' self-rated general health at age 45 than those who were caries-free and whose parents did not give a 'poor' rating (IRR, 0.69; 95% CI, 0.49, 0.97).

CONCLUSIONS

Five-year-olds with greater caries experience were more likely to have poorer self-rated general health by midlife. Beyond this longitudinal association, future research should examine whether childhood dental caries is associated with objective/biological markers of physical health and whether it may have utility as an early indicator for poor general health in adulthood.

Water fluoridation, dental caries and parental ratings of child oral health

OBJECTIVES

Previous studies have identified many demographic, socioeconomic, behavioural and clinical variables associated with subjective parental ratings of child oral health. This study investigated associations between children's lifetime exposure to fluoridated drinking water (LEFW) and dental caries prevalence and parental ratings.

METHODS

Australia's National Child Oral Health Study 2012-2014 conducted oral epidemiological examinations for 24 664 children aged 5-14 and investigated risk factors for child oral health and disease through questionnaires. Parents also subjectively rated their child's oral health. This cross-sectional study estimated prevalence ratios for associations between LEFW and prevalence of dental caries in the primary and permanent dentitions and parental oral health ratings for 5-8 year old and 9-14 year old children. E-value sensitivity analyses helped assess whether observed effect sizes may have arisen through unmeasured confounding.

RESULTS

Children aged 5-8 with 0%-10% or 11%-89% LEFW are respectively 1.5 (95% CI 1.2-1.8) and 1.5 (95% CI 1.1-2.0) times more likely than children with 90%-100% LEFW to receive a fair or poor parental oral health rating. Children aged 9-14 with 0%-10% or 11%-89% LEFW are 1.2 (95% CI 1.0-1.4) times more likely than children with 90%-100% LEFW to receive a fair or poor parental oral health rating. Children aged 5-8 with 0%-10% or 11%-89% LEFW are respectively 1.4 (1.3-1.6) and 1.3 (95% CI 1.1-1.4) times more likely than children with 90%-100% LEFW to experience caries in their primary teeth. Children aged 9-14 with 0%-10% or 11%-89% LEFW are respectively 1.4 (95% CI 1.3-1.5) and 1.1 (95% CI 1.0-1.2) times more likely than children with 90%-100% LEFW to experience caries in their permanent teeth.

CONCLUSIONS

Longer lifetime exposure to fluoridated drinking water is causally associated with a lower childhood dental caries prevalence and more positive parental ratings of child oral health. The associations are stronger for younger children.

Parenting stress as a mediator in the oral health of children and adolescents: A stress process model

OBJECTIVES

We tested hypotheses regarding socioeconomic status (SES) disparities in oral health amongst children and adolescents and the extent to which such SES disparities may be mediated by parenting stress.

METHODS

We analysed data from the 2011/2012 US National Survey of Children's Health for ages 6-11 years (n = 21 596) and 12-17 years (n = 23 584). Our models estimated associations between SES indicators (family income and parental education) and parenting stress with two oral health outcomes: parent-reported child oral health and preventive dental visits.

RESULTS

For both age groups, SES was positively associated with both oral health outcomes. Parenting stress mediated the relationship between SES and child oral health, not preventive dental visits-such that lower SES was associated with worse oral health via higher parenting stress. Amongst children, the indirect effect of parenting stress was observed for parental education and family income, whilst amongst adolescents, no indirect effect of parenting stress was observed.

CONCLUSION

Parenting stress was an important determinant of children's oral health and partially explained the SES-related oral health disparities in children. Future research is needed to explore the causal pathways in this association.

A Causative Approach to Demographic and Socioeconomic Factors Affecting Parental Ratings of Child Oral Health

INTRODUCTION

Many studies have investigated associations between demographic, socioeconomic status (SES), behavioral, and clinical factors and parental ratings of child oral health. Caries experience, pain, missing teeth, malocclusions, and conditions and treatments likely to negatively affect the child or family in the future have been consistently associated with poorer parental ratings. In contrast, effect sizes for associations between demographic and SES indicators (race/ethnicity, country of birth, family structure, household income, employment status, and parental education levels) and parental ratings vary greatly.

OBJECTIVES

The primary objectives of this study were to estimate effect sizes for associations between demographic and SES variables and parental ratings of child oral health and then to consider possible causal implications.

METHODS

This article uses a nationally representative data set from 24,664 Australian children aged 5 to 14 y, regression analyses guided by a directed acyclic graph causal model, and sensitivity analyses to investigate effects of demographic and SES factors on parental ratings of oral health.

RESULTS

One in 8 children had oral health rated as fair or poor by a parent. Indigenous children, older boys, young children with a migrant parent, children from single-parent families, low-income households and families where no parent worked full-time, and children whose parents had lower education levels were much more likely to receive a fair or poor parental oral health rating in crude and adjusted models.

CONCLUSION

This cross-sectional study helps to clarify inconsistent findings from previous research and shows many demographic and SES variables to be strong determinants of parental ratings of child oral health, consistent with the effects of these variables on other health outcomes. Sensitivity analyses and consideration of the potential for chance and bias to have affected these findings suggest that many of these associations may be causal.

KNOWLEDGE TRANSFER STATEMENT

Based on regression analyses driven by a directed acyclic graph causal model, this research shows a strong impact of demographic and socioeconomic determinants on parental ratings of child oral health, consistent with associations between these variables and other oral and general health outcomes. Many of these associations may be causal. We demonstrate the value of causal models and causal thinking when analyzing complex multilevel observational data.

The Impact of Policy Modifiable Factors on Inequalities in Rates of Child Dental Caries in Australia

Background: Poor oral health in childhood can lead to adverse impacts later in life. We aimed to estimate the prevalence and population distribution of childhood dental caries in Australia and investigate factors that might ameliorate inequalities. Methods: Data from the nationally representative birth cohort Longitudinal Study of Australian Children (N = 5107), using questions assessing: The experience of dental caries during each biennial follow-up period (2–3 years to 10–11 years), socioeconomic position (SEP), and policy modifiable oral health factors. Results: The odds of dental caries were higher for children with lowest vs. highest SEP (adjusted OR (adjOR) 1.92, 95% CI 1.49–2.46), and lower where water was fluoridated to recommended levels (adjOR 0.53, 95% CI 0.43–0.64). There was no evidence of an association between caries experience and either reported sugary diet or tooth brushing. When SEP and fluoridation were considered in conjunction, compared to the highest SEP group with water fluoridation children in the lowest SEP with fluoridation had adjOR 1.54 for caries, (95% CI 1.14–2.07), and children in the lowest SEP without fluoridation had adjOR 4.06 (95% CI 2.88–5.42). For patterns of service use: The highest SEP group reported a greater percentage of service use in the absence of caries. Conclusions: Dental caries appears prevalent and is socially distributed in Australia. Policy efforts should consider how to ensure that children with dental caries receive adequate prevention and early care with equitable uptake.

The oral health behaviours and fluid consumption practices of young urban Aboriginal preschool children in south-western Sydney, New South Wales, Australia

ISSUE ADDRESSED

Australian Aboriginal children have a higher risk of dental caries yet there is limited focus on oral health risk factors for urban Aboriginal preschool children. This study examined the oral health behaviours and fluid consumption practices of young children from an urban Aboriginal community in south-western Sydney, Australia.

METHODS

In total, 157 Aboriginal children who were recruited to the "Gudaga" longitudinal birth cohort participated in this study. A survey design was employed and parents responded to the oral health questions when their child was between 18 and 60 months.

RESULTS

Few parents (20%) were concerned about their child's oral health across the time period. By 60 months, only 20% of children had seen a dentist while 80% were brushing their teeth at least once daily. High levels of bottle use were seen up to 30 months. Consumption of sugary drinks was also very high in the early years, although this was replaced by water by 36 months.

CONCLUSIONS

While there are some encouraging findings, such as the rates of tooth brushing and increasing rates of water consumption, the findings do highlight the poor uptake of dental services and high levels of bottle usage among urban aboriginal children during their early years. SO WHAT?: Targeted oral health promotional programs are needed in the urban Aboriginal community to better support parents understanding of good oral health practices in the early years and engagement with dental health services.

Qualitative methods in the development of a parent survey of children's oral health status

Background

Parents’ perceptions of their 8–17-year-old children’s oral health status were assessed using a sample from diverse dental clinics in Greater Los Angeles County to identify constructs for a survey instrument.

Methods

Focus groups with 29 parents or guardians were conducted to identify themes that informed development of survey items. The draft items were administered to a different group of 32 parents or guardians in cognitive interviews, and revised for subsequent field-testing.

Results

Thematic and narrative analyses were performed after the focus groups and key lay-oriented dimensions were uncovered, notably the relationship between oral health, systemic health and the life course. In the cognitive interviews, parents entered multiple responses to questions related to the look of their child’s teeth, and their overall perception of tooth color. Parents also assessed their child’s fear or discomfort with the dental experience, and other social and psychological concerns related to oral health status. The temporal dimensions of certain items were specified; for example, oral pain and mood items were revised to include duration of the symptom or mood state. As parents tended to confuse oral health maintenance and prevention, these two related concepts were separated into two items. Based on the qualitative work, we revised items in preparation for a field test.

Conclusions

As a PRO measurement study, qualitative research informed a field test survey to assess factors associated with oral health status and the individual’s perceptions and subjective views of these constructs for eventual item development for epidemiological and clinical use.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Impact of traumatic dental injury on the quality-of-life of children and adolescents: a case-control study

OBJECTIVE

To evaluate the quality-of-life of students in Nova Friburgo, Rio de Janeiro, who suffered traumatic dental injury.

MATERIALS AND METHODS

A case-control study was carried out by means of structured questionnaire for traumatic dental injury evaluation, clinical oral examination and application of a quality-of-life questionnaire (CPQ11-14), validated in the Portuguese version. This study consisted of 50 children/adolescents (17 cases of traumatic dental injury and 33 controls). Psychometric properties, like internal consistency (Cronbach's Alpha) and test-re-test reliability (ICC), were evaluated. The independent variables were collected for being of interest to the study (dental trauma) or for acting as potential confounding factors (malocclusion, caries). Descriptive and univariate analyses were performed.

RESULTS

The Cronbach's Alpha was 0.90 for case and 0.77 for controls. ICC was 0.99. When the groups were compared, confounding factors showed no statistical difference (p > 0.05). Among the cases CPQ11-14 mean score was 17.59 (SD = 14.01), median = 17.00, whereas among the controls it was 3.09 (SD = 4.42), median = 1.00 (p < 0.01, Mann-Whitney test). When the groups were compared, there was statistical difference frequencies between CPQ11-14 total scale and sub-scales (p < 0.05). The functional limitation and emotional well-being were the sub-scales most affected. The TDI impact was related to 'delay and difficulty in chewing', 'embarrassed or ashamed' and 'caring about what others were thinking of appearance'.

CONCLUSIONS

One can observe a relationship between traumatic dental injury and its impact on quality-of-life. Children and adolescents who suffered traumatic dental injury showed negative experiences and greater functional and emotional impact.

Using the International Classification of Functioning, Disability and Health (ICF) to describe children referred to special care or paediatric dental services

Children in dentistry are traditionally described in terms of medical diagnosis and prevalence of oral disease. This approach gives little information regarding a child’s capacity to maintain oral health or regarding the social determinants of oral health. The biopsychosocial approach, embodied in the International Classification of Functioning, Disability and Health - Child and Youth version (ICF-CY) (WHO), provides a wider picture of a child’s real-life experience, but practical tools for the application of this model are lacking. This article describes the preliminary empirical study necessary for development of such a tool - an ICF-CY Core Set for Oral Health. An ICF-CY questionnaire was used to identify the medical, functional, social and environmental context of 218 children and adolescents referred to special care or paediatric dental services in France, Sweden, Argentina and Ireland (mean age 8 years ±3.6yrs). International Classification of Disease (ICD-10) diagnoses included disorders of the nervous system (26.1%), Down syndrome (22.0%), mental retardation (17.0%), autistic disorders (16.1%), and dental anxiety alone (11.0%). The most frequently impaired items in the ICF Body functions domain were ‘Intellectual functions’, ‘High-level cognitive functions’, and ‘Attention functions’. In the Activities and Participation domain, participation restriction was frequently reported for 25 items including ‘Handling stress’, ‘Caring for body parts’, ‘Looking after one’s health’ and ‘Speaking’. In the Environment domain, facilitating items included ‘Support of friends’, ‘Attitude of friends’ and ‘Support of immediate family’. One item was reported as an environmental barrier – ‘Societal attitudes’. The ICF-CY can be used to highlight common profiles of functioning, activities, participation and environment shared by children in relation to oral health, despite widely differing medical, social and geographical contexts. The results of this empirical study might be used to develop an ICF-CY Core Set for Oral Health - a holistic but practical tool for clinical and epidemiological use.

Impacto do traumatismo dentário na qualidade de vida de crianças e adolescentes: revisão crítica e instrumentos de medida

O traumatismo dentário constitui-se em um problema de saúde pública com elevada prevalência, tanto em crianças como em adolescentes brasileiros. Aliado a isso, essa injúria pode ocasionar perdas dentais irreparáveis, o que torna importante avaliar o impacto dessa condição por meio de instrumentos de qualidade de vida relacionada à saúde bucal (QVRSB). Baseado nisso, a presente revisão de literatura, teve o propósito de expor índices existentes que possam avaliar a Qualidade de Vida (QV) em crianças e adolescentes brasileiros com traumatismo dentário, bem como apresentar o estado da arte dos trabalhos dessa condição na QVRSB dos mesmos e, em seguida, discutir a problematização sobre a produção encontrada a respeito do tema. Para tanto, priorizaram-se os artigos publicados de 1980 a junho/2011, pesquisados em bases de dados (Pubmed, BVS, Google Scholar) ou manualmente nas referências das publicações selecionadas. A partir deste trabalho, pôde ser constatado que não há instrumento específico para traumatismo dentário, sendo necessário utilizar índices voltados para avaliação da QVRSB em crianças e adolescentes presentes na literatura. Através deles, questões ainda não elucidadas sobre o impacto de traumatismos dentários na QVRSB poderão ser respondidas.

A literature review of aesthetic perceptions of dental fluorosis and relationships with psychosocial aspects/oral health-related quality of life

Aesthetic perceptions and oral health-related quality of life concerning dental fluorosis have been assessed in several studies during the past two decades. However, no comprehensive review article summarizing the studies investigating this issue has been published.

OBJECTIVE

To assess the relationships between perceptions of dental appearance/oral health-related quality of life (OHRQoL) and dental fluorosis.

METHODS

The PubMed database was searched using the Medical Subject Headings (MeSH) for English-language studies from 1985 to March 2009. Thirty-five articles qualified for inclusion and then were classified into three categories based on the type of study approach: (i) respondent review of photographs and assessment concerning satisfaction/acceptance, (ii) respondent assessment of study subject's teeth concerning satisfaction/acceptance, and (iii) respondent assessments of the psychosocial/OHRQoL impact.

RESULTS

There were varied results from earlier studies focused on satisfaction/acceptance of very mild to mild fluorosis. More recent studies with methodological improvements to assess impact on quality of life clearly showed that mild fluorosis was not a concern. Furthermore, mild fluorosis was sometimes associated with improved OHRQoL. Severe fluorosis was consistently reported to have negative effects on OHRQoL.

CONCLUSION

Because dental fluorosis in the United States and other nations without high levels of naturally-occurring fluoride is mild or very mild, with little impact on OHRQoL, dental professionals should emphasize the appropriate use of fluorides for caries prevention and preventing moderate/severe fluorosis.