Abstract

BackgroundTooth decay (caries) is a significant health burden in young children. There is strong evidence for the benefits of establishing appropriate home-based oral health behaviours in early childhood. Dental teams are well placed to provide this information and there is clear advice on what oral health information should be given to parents. However, research has shown that there is limited guidance, training and resources on how dental teams should deliver this advice. "Strong Teeth" is a complex oral health intervention, using evidence-based resources and training underpinned by behaviour change psychology, to support behaviour change conversations in dental practice. This early phase evaluation aims to assess the feasibility of this intervention, prior to a full-scale trial.MethodsThe study recruited 15 parents of children aged 0–2-years-old and 21 parents of children aged 3–5 years old, from five NHS dental practices across West Yorkshire. Participant demographics, self-reported brushing behaviours, dietary habits, a dental examination and three objective measures of toothbrushing were collected in a home-setting at baseline, then at 2-weeks and 2-months post-intervention. Recruitment, retention and intervention delivery were analysed as key process outcomes. Brushing habits were compared to national toothbrushing guidelines – the Delivering Better Oral Health toolkit (Public Health England).ResultsStrong Teeth was feasible to deliver in a General Dental Practice setting in 94% of cases. Feasibility of recruitment (37%) exceeded progression criterion, however retention of participants (75%) was below the progression criterion for the 0–2 age group. More than half of children recruited aged 3–5-years had caries experience (52%). Total compliance to toothbrushing guidance at baseline was low (28%) and increased after the intervention (52%), an improvement that was statistically significant. Dietary habits remained largely unchanged. Plaque scores significantly decreased in the 3–5-year-olds and toothbrushing duration increased in all age groups.Conclusion"Strong Teeth" intervention delivery and data collection in the home setting was feasible. There was a positive indication of impact on reported toothbrushing behaviours. Some amendments to study design, particularly relating to the inclusion of the 0–2-year-old group, should be considered before progression to a full trial.Trial registration ISRCTN Register: ISRCTN10709150. Registered retrospectively 24/7/2019.

Highlights

  • Tooth decay is a significant health burden in young children

  • This quantitative analysis focuses on feasibility and looks to assess process outcomes A, C and D. These relate to feasibility of undertaking the "Strong Teeth" intervention, adequate recruitment (> 25%) and adequate retention (> 85%) of participants

  • Intervention outcomes Self‐reported toothbrushing behaviours For self-reported toothbrushing habits, ‘total’ compliance to Delivering Better Oral Health (DBOH) guidelines increased substantially from 28% (n = 36) at baseline to 52% (n = 27) at two-months following the "Strong Teeth" intervention, and the difference was found to be statistically significant (95%confidence interval (CI) = 0.13, 0.42), as represented by Fig. 2

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Summary

Introduction

Tooth decay (caries) is a significant health burden in young children. There is strong evidence for the benefits of establishing appropriate home-based oral health behaviours in early childhood. "Strong Teeth" is a complex oral health intervention, using evidence-based resources and training underpinned by behaviour change psychology, to support behaviour change conversations in dental practice. This early phase evaluation aims to assess the feasibility of this intervention, prior to a full-scale trial. By the age of five, nearly a quarter of children in England have experienced caries with an average of three teeth affected [3]. In Bradford, a city in northern England, 36% of five-year-olds have caries experience, significantly higher than the national average [3]

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