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Le Luyer M, Boll ME, Lemmers SAM, Stoll SJ, Hoffnagle AG, Smith ADAC, Dunn EC. How well do parents identify their child's baby teeth? Engagement and accuracy of parent-reported information on a tooth checklist survey. Community Dent Oral Epidemiol 2024. [PMID: 38680025 DOI: 10.1111/cdoe.12971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 04/05/2024] [Accepted: 04/18/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES Naturally exfoliated primary teeth are being increasingly collected in child development studies. Most of these odontological collections and tooth biobanks use parent-reported information from questionnaires or tooth checklists to collect data on offspring teeth. To the best of the authors' knowledge, no studies have assessed parental engagement in tooth checklists, nor parental accuracy in identifying their child's baby tooth. This study aimed to evaluate these dimensions by analysing data from the about this tooth checklist returned with donated primary teeth in a natural experimental study called STRONG (the Stories Teeth Record of Newborn Growth). METHODS Parental self-reported information were analysed on checklists returned with 825 primary teeth belonging to 199 children. The percentage of blank answers was calculated for each question. The accuracy of parents-reported tooth identification was evaluated by comparing parental ratings to researchers' ratings. Reliability of researchers' tooth identification was first evaluated by calculating intra-observer and inter-observer agreements, as well as Cohen's Kappa values. The percentage of accuracy of parents' tooth identification (relative to researcher's) was then calculated, and logistic regressions were used to evaluate if time elapsed between when exfoliation occurred and the checklist was completed associated with parental accuracy in tooth identification. RESULTS Parents returned 98.4% of the checklists and completed 74.9% to 97.7% of the questions. Excellent reliability was demonstrated for researchers' intra- and inter-rater tooth identification (agreement percentages >90%; Cohen's Kappa values >.83). Moderate accuracy of parents-reported tooth identifications was found, with parents correctly identifying 49.5% of the donated tooth. Better parental accuracies were highlighted for partial identifications (87.1% of correct jaw, 75.6% of correct tooth type, and 65.8% of correct lateralization). Logistic regressions showed the odds of correct parental identifications decreased on average by 1.8% every 30 days of distance between tooth exfoliation and checklist completion. CONCLUSIONS While parental engagement is high, parents-reported tooth identifications have moderate accuracy, which decreases over time. High accuracy is however found for partial identifications. Parent-reported information on the accompanying questionnaire of naturally exfoliated primary teeth collection or tooth biobanks, even when filled in a long time after exfoliation took place, should be encouraged. However, expert identifications of teeth should remain best practice.
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Affiliation(s)
- Mona Le Luyer
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Molly E Boll
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Simone A M Lemmers
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Samantha J Stoll
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alison G Hoffnagle
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrew D A C Smith
- Mathematics and Statistics Research Group, University of the West of England, Bristol, UK
| | - Erin C Dunn
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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2
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Smith SR, Kroon J, Schwarzer R, Hamilton K. Promoting regular parental supervised toothbrushing: An additive intervention design adopting the Health Action Process Approach. Appl Psychol Health Well Being 2024; 16:315-337. [PMID: 37712357 DOI: 10.1111/aphw.12489] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/24/2023] [Indexed: 09/16/2023]
Abstract
The study aimed to test the efficacy of the core elements of the Health Action Process Approach (HAPA) in an intervention among parents to promote regular supervised toothbrushing of preschool-aged children. The pre-registered study (https://osf.io/fyzh3/) tested the effects of an intervention employing information provision, behavioural instruction, implementation intention and mental imagery techniques, adopting a randomised controlled design in a sample of Australian parents of preschoolers (N = 254). The intervention used an additive design with four conditions-education, self-efficacy, planning and action control-progressively layered to show the cumulative impact of incorporating self-efficacy, planning and action control strategies with a foundational education component. The intervention was delivered online, and participants completed self-report measures of parental supervised toothbrushing and HAPA-based social cognition constructs pre-intervention and 4 weeks post-intervention. Although no significant intervention effects on behaviour were observed, mixed-model analyses of variance (ANOVAs) revealed an increase in intention and task self-efficacy within the action control condition and an increase in action planning in both the action control and planning conditions from pre-intervention to follow-up. Despite no anticipated changes in behaviour, these findings endorse the use of theory- and evidence-based behaviour change strategies to inspire change in HAPA-based determinants of parental supervised toothbrushing: intention, action planning and task self-efficacy.
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Affiliation(s)
- Stephanie R Smith
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Jeroen Kroon
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Ralf Schwarzer
- Division of Health Psychology, Freie Universität Berlin, Berlin, Germany
- Faculty of Psychology, SWPS University, Wroclaw, Poland
| | - Kyra Hamilton
- School of Applied Psychology, Griffith University, Brisbane, Australia
- Health Sciences Research Institute, University of California, Merced, California, USA
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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3
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Sudradjat H, Meyer F, Fandrich P, Schulze Zur Wiesche E, Limeback H, Enax J. Doses of fluoride toothpaste for children up to 24 months. BDJ Open 2024; 10:7. [PMID: 38296947 PMCID: PMC10831090 DOI: 10.1038/s41405-024-00187-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 02/02/2024] Open
Abstract
AIM The aim of this study was to test the dose of fluoride toothpaste by parents for their children aged up to 24 months. METHODS Parents who use fluoride toothpastes for their children were asked to dose two commercially available toothpastes (A and B) with 1000 ppm fluoride each for their children as they would normally do at home. The toothpaste amounts were weighed, and as reference, the weight of an 'optimal' grain of rice-size amount of each toothpaste was used. RESULTS 61 parents dosed a mean of 0.263 ± 0.172 g toothpaste A and 0.281 ± 0.145 g toothpaste B. The parents' mean doses were 5.9 times higher for toothpaste A and 7.2 times higher for toothpaste B than an 'optimal' grain of rice-size amount (the reference dose as recommended). The difference between parent's and reference dose was statistically significant (p < 0.001). Moreover, 39.3% of parents were not aware about conditions of use and warnings that have to be printed on the package of fluoride toothpastes. CONCLUSION In this study, parents significantly overdosed the toothpaste for their children. To avoid fluoride intake from toothpaste, parents can choose fluoride-free alternatives for the oral care of their infants and toddlers.
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Affiliation(s)
- Henny Sudradjat
- Dr. Kurt Wolff GmbH & Co. KG, Research Department, Johanneswerkstr. 34-36, 33611, Bielefeld, Germany
- Private dental practice, Braunschweig, Germany
| | - Frederic Meyer
- Dr. Kurt Wolff GmbH & Co. KG, Research Department, Johanneswerkstr. 34-36, 33611, Bielefeld, Germany
| | - Pascal Fandrich
- Dr. Kurt Wolff GmbH & Co. KG, Research Department, Johanneswerkstr. 34-36, 33611, Bielefeld, Germany
| | - Erik Schulze Zur Wiesche
- Dr. Kurt Wolff GmbH & Co. KG, Research Department, Johanneswerkstr. 34-36, 33611, Bielefeld, Germany
| | - Hardy Limeback
- Faculty of Dentistry, University of Toronto, Toronto, ON, M5G 1G6, Canada
| | - Joachim Enax
- Dr. Kurt Wolff GmbH & Co. KG, Research Department, Johanneswerkstr. 34-36, 33611, Bielefeld, Germany.
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Nascimento EB, Rodrigues R, Manso MC. Prevalence of dental floss use in deciduous dentition: A systematic review and meta-analysis. Int J Dent Hyg 2023; 21:116-127. [PMID: 35924390 DOI: 10.1111/idh.12611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/28/2022] [Accepted: 07/31/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Adherence to the daily use of dental floss in childhood is recommended by various international health institutions/organizations. This systematic review (PROSPERO number CRD42020205232) aims to evaluate the prevalence of dental floss use in deciduous dentition. MATERIALS AND METHODS A systematic review was conducted in six databases (B-on, Cochrane Library, PubMed, Scielo, Science Direct and Web of Science) up to December 2020. The CoCoPop mnemonic allowed for obtaining 2333 articles and resulted in the inclusion of 7 observational studies that evaluated the prevalence of dental floss use (primary outcome) in children up to 6 years old. The Joanna Briggs Institute critical appraisal checklist was used to evaluate the risk of bias, showing that most articles presented good quality. Meta-analyses were performed using the proportion of dental floss use (yes or once/day) and the random effects model. RESULTS The meta-analysis showed a prevalence of dental floss use of only 12.60% (95% CI: 7.69%-18.52%) based on studies with high heterogeneity of results (I2 = 94.75%; 95% CI: 91.44%-96.78%). Six of the seven studies showed that more than 70% of children never used dental floss. CONCLUSIONS A low prevalence of dental floss use was observed in children up to 6 years old. Given the diversity of evaluating the use of dental floss, different options should be the target of standardization in future studies.
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Affiliation(s)
| | - Rita Rodrigues
- Faculty of Health Sciences, FP-I3ID, FP-BHS, University Fernando Pessoa, Porto, Portugal
| | - Maria Conceição Manso
- Faculty of Health Sciences, FP-I3ID, FP-BHS, University Fernando Pessoa, Porto, Portugal.,FP-ENAS - UFP Energy, Environment and Health Research Unit, University Fernando Pessoa, Porto, Portugal.,LAQV, REQUIMTE, University of Porto, Porto, Portugal
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Garcés-Elías MC, Beltrán JA, Del Castillo-López CE, Agudelo-Suárez AA, León-Manco RA. Peruvian children toothbrushing during the COVID-19 pandemic. F1000Res 2022; 11:760. [PMID: 36474998 PMCID: PMC9692047 DOI: 10.12688/f1000research.122504.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/01/2023] Open
Abstract
Background: Toothbrushing is a convenient, inexpensive, widespread and culturally accepted method, resulting in an ideal public health outcome. This study aimed to determine the impact of the COVID-19 pandemic on toothbrushing in Peruvian children. Methods: This was a cross-sectional study conducted using a database of children aged 0 to 11 years, with a final sample of 39,124 participants, 15,974 in 2019 (62.03%) and 7088 in 2020 (55.54%). General toothbrushing, daily toothbrushing and minimum frequency of two times a day were dependent variables; the year was considered as the independent variable. In addition, other covariates such as geographical landscape, area of residence, place of residence, altitude, wealth index, health insurance cover, sex and age. Descriptive, bivariate and multivariate statistical analyses were applied. Results: General toothbrushing was 96.19% (n=51 013), daily toothbrushing was 87.47% (n=42 246) and minimum toothbrushing two times a day was 84.53% (n=33 957). In multivariate form, the year presented a negative association with daily toothbrushing (RPa: 0.97; CI95%: 0.96-0.98; p<0.001) and minimum toothbrushing two times a day (RPa: 0.97; CI95%: 0.95-0.98; p<0.001), adjusted for the previously associated co-variables. Conclusions: The year 2020 of the COVID-19 pandemic negatively impacted daily toothbrushing and minimum twice-daily toothbrushing of Peruvian children.
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Affiliation(s)
| | - Jorge A Beltrán
- Facultad de Estomatología, Universidad Peruana Cayetano Heredia, Lima, Peru
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Retrospective Cohort Study on Potential Risk Factors for Repeated Need of Dental Rehabilitation under General Anesthesia in a Private Pediatric Dental Practice. CHILDREN 2022; 9:children9060855. [PMID: 35740792 PMCID: PMC9221647 DOI: 10.3390/children9060855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 12/02/2022]
Abstract
The need for dental rehabilitations under general anesthesia (DRGAs) is continuously increasing, particularly for dental treatment of children. The present retrospective cohort study aimed to investigate potential risk factors for repeated need of DRGA in a cohort of patients from a private pediatric dental practice. Demographic and anamnestic data, dental status, and treatments performed during DRGA were retrospectively analyzed from the electronic dental charts of 1155 children that received at least one DRGA between October 2016 and December 2021. The median age of all children was 5 years at time of their first DRGA. The rate of repeated DRGAs was 9%. Patients with repeated need of DRGA were significantly younger at time of their first DRGA and revealed significantly more often a history of preterm birth and current use of a baby bottle as compared to patients with only one DRGA. There were significantly fewer treatments (regardless of type) in the second DRGA than at the first. Within the limitations of this study, young age at first DRGA, a history of preterm birth, and current use of a baby bottle may be risk factors for repeated need of DRGA. The search for effective strategies to minimize the repeated need for DRGA in children remains critical.
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Mamat N, Mani SA, Danaee M. T-shaped toothbrush for plaque removal and gingival health in children: a randomized controlled trial. BMC Oral Health 2022; 22:113. [PMID: 35392881 PMCID: PMC8991571 DOI: 10.1186/s12903-022-02137-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/22/2022] [Indexed: 11/22/2022] Open
Abstract
Background To evaluate an experimental T-shaped toothbrush for plaque removal and gingival health when compared to a conventional toothbrush among children. Methods This single blind parallel randomized controlled trial was conducted on 8–10-year-old healthy schoolchildren with no history of recent antibiotic intake, proximal caries or more than 3 missing teeth per quadrant. A computer-generated randomization list allocated child to the 2 groups. Each child received detailed instructions for tooth brushing. Gingival health and plaque scores were recorded in school at baseline, 2 weeks, 1 month and 3 months in a portable dental chair by an examiner who was blind to the allocated toothbrush. A general feedback on the use of the T-shaped toothbrush was obtained at 3 months. Data was analyzed using two-way repeated measure ANOVA, Generalized estimating equation and Bonferroni test. Results A total of 195 eligible children were invited, 110 parents gave consent and 100 children completed the study; 50 in each group. There were statistically significant reductions in mean gingival and plaque scores at each visit when compared to baseline for both toothbrushes (p < 0.05). There were no statistically significant differences between scores for the two toothbrushes at each visit (p > 0.05). Majority of participants gave positive feedback regarding the T-shaped toothbrush. Conclusions Both toothbrushes had similar efficacy in removing plaque and improving gingival health among children. The T-shaped toothbrush is an alternative to the conventional toothbrush for oral hygiene in children. Trial registration Retrospectively registered at ClinicalTrials.gov Registry—NCT03989479 18/06/2019.
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Affiliation(s)
- Noraida Mamat
- Unit of Paediatric Dentistry, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia.,Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Shani Ann Mani
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Mahmoud Danaee
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
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Pullishery F, Abuzenada BM, Alrushnudi NM, Alsafri MM, Alkhaibari WM, Alharbi MF, Aladani JA, Mohammed Z. Comparison of Efficacy of Different Supervision Methods of Toothbrushing on Dental Plaque Scores in 7-9-year-old Children. Int J Clin Pediatr Dent 2021; 14:263-268. [PMID: 34413604 PMCID: PMC8343690 DOI: 10.5005/jp-journals-10005-1927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and objectives The efficiency of mechanical plaque control in children not only depends on the type of oral aids they use but also on the instructions, training, and motivation given to them. To compare the efficiency of different methods of personal supervision of toothbrushing in reducing the dental plaque levels in 7-9-year-old schoolchildren. Materials and methods A parallel designed double-blinded randomized study was conducted in a private school in Jeddah, Saudi Arabia from September 2018 to December 2018. The children were allocated randomly into two groups based on the type of supervision given. Plaque scores examination was carried out at four intervals as baseline, 7th day, 14th day, and 90th day. Results Plaque scores reduced after 7 days in all groups, even though there was no statistically significant difference observed. At the final examination of plaque scores (90th day), there was a highly statistically significant reduction observed in group I and II compared to group III where the reduction was less evident. Conclusion Supervision of toothbrushing in the correct way was effective in reducing the plaque scores. Our study benefited both parents and children in understanding the correct method of brushing and the importance of plaque control. How to cite this article Pullishery F, Abuzenada BM, Alrushnudi NM, et al. Comparison of Efficacy of Different Supervision Methods of Toothbrushing on Dental Plaque Scores in 7-9-year-old Children. Int J Clin Pediatr Dent 2021;14(2):263-268.
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Affiliation(s)
- Fawaz Pullishery
- Division of Community Dental Practice, Faculty of Dentistry, Batterjee Medical College, North Obhur, Jeddah, Kingdom of Saudi Arabia
| | - Basem M Abuzenada
- Division of Operative Dentistry, King Abdulaziz University and Batterjee Medical College, Jeddah, Kingdom of Saudi Arabia
| | - Nawal M Alrushnudi
- Dentistry Program, Batterjee Medical College, Jeddah, Kingdom of Saudi Arabia
| | - Maram M Alsafri
- Dentistry Program, Batterjee Medical College, Jeddah, Kingdom of Saudi Arabia
| | - Wafa M Alkhaibari
- Dentistry Program, Batterjee Medical College, Jeddah, Kingdom of Saudi Arabia
| | - Mawadda F Alharbi
- Dentistry Program, Batterjee Medical College, Jeddah, Kingdom of Saudi Arabia
| | - Jaidaa As Aladani
- Dentistry Program, Batterjee Medical College, Jeddah, Kingdom of Saudi Arabia
| | - Zahra Mohammed
- Dentistry Program, Batterjee Medical College, Jeddah, Kingdom of Saudi Arabia
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Khan IM, Mani SA, Doss JG, Danaee M, Kong LYL. Pre-schoolers' tooth brushing behaviour and association with their oral health: a cross sectional study. BMC Oral Health 2021; 21:283. [PMID: 34078349 PMCID: PMC8173819 DOI: 10.1186/s12903-021-01643-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/22/2021] [Indexed: 01/04/2023] Open
Abstract
Background Toothbrushing is an important yet neglected behaviour that affects the oral health of preschool children. Little is reported on parental supervision, an essential aspect of routine effective toothbrushing in this age group. The aim of this study was to evaluate pre-schoolers’ toothbrushing behaviour including parental involvement and its association with their oral health. Methods This was a cross-sectional study. A total of 92 preschool children (4–6 years) were invited to participate with their parents/guardians. Nine parameters of toothbrushing behaviour were assessed from parental responses (questionnaire) and observation of child and parents/guardians (video recording). Oral examination included recording plaque, gingival and dental caries indices. BORIS software was used to assess toothbrushing parameters and Smart PLS was used to perform association with a second-generation multivariate analysis to create models with and without confounding factors. Results Girls were slightly more (53%) than boys (47%). Children aged 4 years were slightly more in number (38%), followed by 6-year-olds and 5-year-olds. Nearly, 90% parents had tertiary education and 46% had more than 2 children. Differences were recorded in the reported and observed behaviour. Thirty-five percent parents/guardians reported using pea-size toothpaste amount but only 28% were observed. Forty percent reported to brush for 30 s–1 min, however 51% were observed to brush for 1–2 min. Half the children were observed to use fluoridated toothpaste (F < 1000 ppm) under parental supervision (11%). The mean (SD) plaque score reduction after toothbrushing was 10.80 (2.46), mean pre-brushing plaque score was 90.3 (10.2), mean gingival index was 0.89 (0.65) and mean dental caries status (ICDAS(1–6)) was 18.87 (12.39). Toothbrushing behaviour in terms of toothbrushing technique, duration, pattern and frequency, toothbrush type and grip type, toothpaste type and amount, post-brushing mouth rinsing and parental involvement contributed significantly to plaque score change (86%), dental caries status (73%), gingival index (66%) and pre-brushing plaque score (31%). The significant confounding variables had a small influence on oral health of preschool children. Conclusions Preschool children’s toothbrushing behaviour was inadequate while their oral health was poor, with a significant association between the two parameters.
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Affiliation(s)
- Iqra Muhammad Khan
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Shani Ann Mani
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Jennifer Geraldine Doss
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mahmoud Danaee
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Lydia Yi Li Kong
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Simancas-Pallares MA, Ginnis J, Vann WF, Ferreira Zandoná AG, Shrestha P, Preisser JS, Divaris K. Children's oral health-related behaviours and early childhood caries: A latent class analysis. Community Dent Oral Epidemiol 2021; 50:147-155. [PMID: 33987840 DOI: 10.1111/cdoe.12645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/03/2021] [Accepted: 03/25/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE In this cross-sectional study in a large community-based sample of preschool-age children, we sought to identify distinct clusters of modifiable early childhood oral health-related behaviours (OHBs) and quantify their association with clinical and parent-reported measures of early childhood oral health. METHODS We relied upon a questionnaire (n = 8033; 11% in Spanish) and clinical oral health data (n = 6404; early childhood caries [ECC] prevalence = 54%] collected in the context of an epidemiologic study of early childhood oral health among 3- to 5-year-old children in North Carolina. Latent class analysis was used to identify clusters of modifiable OHBs based on parents' responses to 6 questionnaire items pertaining to their children's oral hygiene, diet and dental home. The optimal number of clusters was determined based on measures of model fit and interpretability. We examined associations of OHB clusters with clinical and parent-reported child oral health status (ie, ECC prevalence, severity and proportion with untreated disease) using bivariate association tests and multivariable regression modelling with marginal effects estimation accounting for clustered data. We used Mplus v.8.6 (Muthén & Muthén, Los Angeles, CA, USA) and Stata v.16.1 (StataCorp, College Station, TX, USA) for data analyses. RESULTS We identified 2 OHB clusters, a favourable (74%) and an unfavourable (26%) one. Children in the favourable OHB cluster had better oral hygiene practices (ie, tooth brushing frequency and fluoridated toothpaste use), lower consumption frequency of sugar-containing snacks and beverages, less frequent reports of night-time bottle-feeding history and a higher likelihood of a dental home. Children in the unfavourable cluster had significantly higher ECC prevalence (57% vs 53%), caries burden (mean dmfs = 9.3 vs 7.6), untreated disease (43% vs 33%) and worse parent-reported oral health status than the favourable cluster. CONCLUSIONS Our findings demonstrate the importance and utility of clustering common, modifiable ECC risk factors in population studies - health promotion efforts may centre on groups of people rather than individual behavioural risk factors.
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Affiliation(s)
- Miguel A Simancas-Pallares
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeannie Ginnis
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - William F Vann
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Poojan Shrestha
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John S Preisser
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kimon Divaris
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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11
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Ramos-Gomez F, White JS, Lindau HE, Lin TK, Finlayson TL, Liu JX, Gansky SA. Family monetary incentives as a value-based care model for oral hygiene: rationale and design of the BEhavioral EConomics for Oral health iNnovation (BEECON) trial. J Public Health Dent 2020; 80:10.1111/jphd.12406. [PMID: 33090505 PMCID: PMC8761083 DOI: 10.1111/jphd.12406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/24/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Effective prevention-focused, value-based strategies are needed to improve oral health. Despite evidence that monetary incentives can motivate healthy behavior, well-powered studies have yet to examine incentives for improving children's oral hygiene. AIM Describe the rationale and design of the BEhavioral EConomics for Oral health iNnovation (BEECON) trial, which tests lottery-based monetary incentives as a consumer-oriented, value-based care model for improving children's oral hygiene. DESIGN Phase II, stratified, permuted block randomized, controlled, two-arm, parallel groups, prevention trial. SETTING Study visits occur at three Los Angeles, CA health clinics. PARTICIPANTS Two hundred and forty-four parent-child dyads with a child aged 6-48 months. INTERVENTIONS Eligible dyads were randomized in equal allocation to one of two groups: lottery incentive group or waitlist (delayed incentive) control group. Weekly lottery incentives were offered for 6 months based on Bluetooth-recorded toothbrushing frequency. Both groups received weekly text message feedback on toothbrushing performance. OUTCOMES The primary outcome was toothbrushing performance from baseline to 6 months, measured as the mean number of qualifying half-day Bluetooth-recorded episodes per week when the child's teeth were brushed. Secondary outcomes included toothbrushing performance sustainability through 12 months and dental caries status. CONCLUSIONS BEECON offers a consumer-oriented approach to promoting value-based oral health care. We hypothesize that lottery-based incentives can improve oral hygiene in young children. Study results will inform programming efforts to enhance oral disease prevention in young children. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT03576326.
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Affiliation(s)
- Francisco Ramos-Gomez
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, CA, USA
- Section of Pediatric Dentistry, School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA
- UCLA Center for Children’s Oral Health (UCCOH), University of California Los Angeles, Los Angeles, California, USA
| | - Justin S. White
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, CA, USA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, University of California San Francisco, San Francisco, California, USA
| | - Helen E. Lindau
- Section of Pediatric Dentistry, School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA
| | - Tracy K. Lin
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Tracy L. Finlayson
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, CA, USA
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Jenny X. Liu
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, CA, USA
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Stuart A. Gansky
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, CA, USA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, CA, USA
- Bakar Computational Health Sciences Institute, University of California San Francisco, University of California San Francisco, San Francisco, California, USA
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12
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White JS, Ramos-Gomez F, Liu JX, Jue B, Finlayson TL, Garza JR, Crawford AH, Helman S, Santo W, Cheng J, Kahn JG, Gansky SA. Monetary incentives for improving smartphone-measured oral hygiene behaviors in young children: A randomized pilot trial. PLoS One 2020; 15:e0236692. [PMID: 32730310 PMCID: PMC7392266 DOI: 10.1371/journal.pone.0236692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/10/2020] [Indexed: 11/19/2022] Open
Abstract
AIMS To assess feasibility, acceptability, and early efficacy of monetary incentive-based interventions on fostering oral hygiene in young children measured with a Bluetooth-enabled toothbrush and smartphone application. DESIGN A stratified, parallel-group, three-arm individually randomized controlled pilot trial. SETTING Two Los Angeles area Early Head Start (EHS) sites. PARTICIPANTS 36 parent-child dyads enrolled in an EHS home visit program for 0-3 year olds. INTERVENTIONS Eligible dyads, within strata and permuted blocks, were randomized in equal allocation to one of three groups: waitlist (delayed monetary incentive) control group, fixed monetary incentive package, or lottery monetary incentive package. The intervention lasted 8 weeks. OUTCOMES Primary outcomes were a) toothbrushing performance: mean number of Bluetooth-recorded half-day episodes per week when the child's teeth were brushed, and b) dental visit by the 2-month follow-up among children with no prior dental visit. The a priori milestone of 20% more frequent toothbrushing identified the intervention for a subsequent trial. Feasibility and acceptability measures were also assessed, including frequency of parents syncing the Bluetooth-enabled toothbrush to the smartphone application and plaque measurement from digital photographs. FINDINGS Digital monitoring of toothbrushing was feasible. Mean number of weekly toothbrushing episodes over 8 weeks was 3.9 in the control group, 4.1 in the fixed incentive group, and 6.0 in the lottery incentive group. The lottery group had 53% more frequent toothbrushing than the control group and 47% more frequent toothbrushing than the fixed group. Exploratory analyses showed effects concentrated among children ≤24 months. Follow-up dental visit attendance was similar across groups. iPhone 7 more reliably captured evaluable images than Photomed Cannon G16. CONCLUSIONS Trial protocol and outcome measures were deemed feasible and acceptable. Results informed the study protocol for a fully powered trial of lottery incentives versus a delayed control using the smart toothbrush and remote digital incentive program administration. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT03862443.
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Affiliation(s)
- Justin S. White
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
| | - Francisco Ramos-Gomez
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- Section of Pediatric Dentistry, School of Dentistry, University of California Los Angeles, Los Angeles, California, United States of America
| | - Jenny X. Liu
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- Institute for Health and Aging, University of California San Francisco, San Francisco, California, United States of America
| | - Bonnie Jue
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Tracy L. Finlayson
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- School of Public Health, San Diego State University, San Diego, California, United States of America
| | - Jeremiah R. Garza
- Section of Pediatric Dentistry, School of Dentistry, University of California Los Angeles, Los Angeles, California, United States of America
| | - Alexandra H. Crawford
- California Protons Cancer Therapy Center, University of California San Diego Health, San Diego, California, United States of America
| | - Sarit Helman
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - William Santo
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Jing Cheng
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - James G. Kahn
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America
| | - Stuart A. Gansky
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, United States of America
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, United States of America
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13
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Lee HH, Ochoa N, Moragne-O'Neal N, Rosales GF, Pugach O, Shadamoro A, Martin MA. Can an Instrument Validated to Assess Parent-Child Interactions in the Laboratory Setting Be Applied to Home-Based Observations? Front Pediatr 2020; 8:550922. [PMID: 33520881 PMCID: PMC7845142 DOI: 10.3389/fped.2020.550922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The Toothbrushing Observations Scale (TBOS) was developed in a laboratory setting to measure child and parent behaviors during toothbrushing. However, we required an instrument to assess home based behaviors. We assessed the feasibility of applying TBOS to observations of parents and their child (<3 years of age) in urban homes. Methods: Sample consisted of 36 families recruited from university and community pediatric dental/medical clinics and a Women, Infants, and Children center in Chicago as part of a pilot study for a larger clinical trial. The average age of children in our sample was 20.7 months. Most of the parent participants were mothers (90%), and 75% of the parents identified as Hispanic. Parent-child dyads were video-recorded during home-based toothbrushing activities and footage was reviewed by two independent TBOS coders. Results: The TBOS instrument consists of 12 parent and 18 child items. We were able to code five parent and ten child items. Conclusion: The feasibility of applying the TBOS measure to our study population was somewhat limited by factors related to home-based observations and the young age of children in our study. Instruments need to be validated across natural settings, such as the home, to increase the quality and accuracy of human behavioral data.
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Affiliation(s)
- Helen H Lee
- Department of Anesthesiology, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States.,Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States
| | - Nadia Ochoa
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States
| | - Nia Moragne-O'Neal
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States
| | - Genesis F Rosales
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States
| | - Oksana Pugach
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States.,Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
| | | | - Molly A Martin
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States.,Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
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Tull K, Gray-Burrows KA, Bhatti A, Owen J, Rutter L, Zoltie T, Purdy J, Giles E, Paige C, Patel M, Marshman Z, West R, Pavitt S, Day PF. "Strong Teeth"-a study protocol for an early-phase feasibility trial of a complex oral health intervention delivered by dental teams to parents of young children. Pilot Feasibility Stud 2019; 5:100. [PMID: 31413863 PMCID: PMC6691530 DOI: 10.1186/s40814-019-0483-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background Dental attendance provides an important opportunity for dental teams to explore with parents the oral health behaviours they undertake for their young children (0–5 years old). For these discussions to be effective, dental professionals need to be skilled in behaviour change conversations. The current evidence suggests that dental teams need further support, training and resources in this area. Therefore, the University of Leeds and Oral-B (Procter & Gamble Company) have worked with the local community and dental professionals to co-develop “Strong Teeth” (an oral health intervention), which is delivered in a general dental practice setting by the whole dental team. The protocol for this early phase study will explore the feasibility and acceptability of the Strong Teeth intervention to parents and the dental team, as well as explore short-term changes in oral health behaviour. Methods Forty parents (20 of children aged 0–2 years old, and 20 of children aged 3–5 years old) who are about to attend the dentist for their child’s regular dental check-up will be recruited to the study. Parents and children will be recruited from 4 to 8 different dental practices. In the home setting, consent and baseline oral health behaviour data will be collected. The researchers will ask parents questions about their child’s oral health behaviours, including toothbrushing and diet. Three different proxy objective measures of toothbrushing will be collected and compared with self-report measures of parental supervised toothbrushing (PSB). Discussion The parent and child will then attend their dental visit and receive the Strong Teeth intervention, delivered by the dental team. This intervention should take 5–15 min to be delivered, in addition to the routine dental check-up. Furthermore, children aged 0–2 years old will receive an Oral-B manual children’s toothbrush, and children aged 3–5 years old will receive an Oral-B electric rechargeable children’s toothbrush. At 2 weeks and 2–3 months following the Strong Teeth intervention, further self-report and objective measures will be collected in the parent/child’s home. This data will be supplemented with purposively sampled qualitative interviews with parents (approximately 3 months following the intervention) and dental team members (following delivery of the intervention). Trial registration ISRCTN Register, (ISRCTN10709150) Electronic supplementary material The online version of this article (10.1186/s40814-019-0483-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kerina Tull
- 1University of Leeds, Leeds Institute of Health Sciences, Clarendon Way, Leeds, LS2 9NL UK
| | | | - Amrit Bhatti
- 2University of Leeds, School of Dentistry, Clarendon Way, Leeds, LS2 9LU UK
| | - Jenny Owen
- 2University of Leeds, School of Dentistry, Clarendon Way, Leeds, LS2 9LU UK
| | - Lucy Rutter
- 2University of Leeds, School of Dentistry, Clarendon Way, Leeds, LS2 9LU UK
| | - Timothy Zoltie
- 2University of Leeds, School of Dentistry, Clarendon Way, Leeds, LS2 9LU UK
| | - Jayne Purdy
- 2University of Leeds, School of Dentistry, Clarendon Way, Leeds, LS2 9LU UK
| | - Erin Giles
- 2University of Leeds, School of Dentistry, Clarendon Way, Leeds, LS2 9LU UK
| | - Carron Paige
- 2University of Leeds, School of Dentistry, Clarendon Way, Leeds, LS2 9LU UK
| | - Morvin Patel
- 2University of Leeds, School of Dentistry, Clarendon Way, Leeds, LS2 9LU UK
| | - Zoe Marshman
- 3University of Sheffield, School of Clinical Dentistry, Claremont Crescent, Sheffield, S10 2TA UK
| | - Robert West
- 1University of Leeds, Leeds Institute of Health Sciences, Clarendon Way, Leeds, LS2 9NL UK
| | - Sue Pavitt
- 2University of Leeds, School of Dentistry, Clarendon Way, Leeds, LS2 9LU UK
| | - Peter F Day
- 2University of Leeds, School of Dentistry, Clarendon Way, Leeds, LS2 9LU UK
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