Abstract
Twice-daily caregiver-supervised toothbrushing with fluoridated toothpaste is an effective and widely recommended strategy to prevent tooth decay in children. Qualitative research suggests that low-income caregivers know the recommendation but would benefit from toothbrushing supplies and advice about how to introduce this health behavior especially as the child becomes older and asserts autonomy to do it "myself." Our objective is to assess consumer satisfaction with the evidence-based theory-informed campaign and usefulness of materials that were home delivered. The focus of the evaluation was families with children <36 months of age because of the high incidence of disease in this population. A dental care organization designed and implemented Everybody Brush! in three counties of Central Oregon. Participants were families of Medicaid-insured children <21 years of age. Participants were randomly assigned to one of the three study groups: test (supplies, voice/printed messages, telephone support), active (supplies), and a waitlist control. Program materials were in English and Spanish. Caregivers of children <36 months were interviewed at the beginning and end of the program. A total of 83,148 toothbrushing kits were mailed to 21,743 families. In addition, 93,766 printed messages and 110,367 recorded messages were sent to half of the families. Caregivers were highly satisfied. On a global rating scale from 0 to 10 (worst to best program possible), they rated the program 9.5 on average (median: 10, SD 0.9). On a scale from 0 to 10 (not at all to very useful), mean ratings for usefulness of the toothbrushing supplies was 9.5 (SD = 1.5), for the printed postcard messages was 7.2 (SD 3.6), and for the voice telephone messages was 6.5 (SD 3.9). A dental care organization carried out a complex community intervention designed to address excess tooth decay among low-income children. Caregivers were highly satisfied with the Everybody Brush! program and toothbrushing supplies were considered the most useful, followed by printed messages. Voice telephone messages were rated least useful. Further evaluation of the impact of the program on toothbrushing behavior and dental-care utilization is underway.
Highlights
Widespread availability of fluoridated toothpaste is one reason the U.S has seen a decline in tooth decay over the past several decades
Regular brushing with fluoridated toothpaste maintains a low level of fluoride in the saliva
Evidence of the benefits of twice-daily brushing of children’s teeth with fluoridated toothpaste [2] has led the American Academy of Pediatric Dentistry and other professional organizations to endorse this practice with children of all ages [3]
Summary
Widespread availability of fluoridated toothpaste is one reason the U.S has seen a decline in tooth decay over the past several decades. Evidence of the benefits of twice-daily brushing of children’s teeth with fluoridated toothpaste [2] has led the American Academy of Pediatric Dentistry and other professional organizations to endorse this practice with children of all ages [3]. The general public is aware of the recommendation to brush twice a day [4], not all vulnerable children benefit from this relatively simple health behavior. In a study of 1,021 African-American families in inner city Detroit, preschool children brushed their teeth about half as much as recommended [5]. An international study of over 2,800 parents and their children found that the single best predictor of a child being caries free at age 4 was parents’ perceived skill at regularly brushing their child’s teeth [1, 6]
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