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Abstract
BackgroundMost studies of tooth brushing behaviors rely on self-report or demonstrations of behaviors conducted in clinical settings. This study aimed to determine the feasibility of objective assessment of tooth brushing behaviors in the homes of high-risk children under three years old. We compared parent self-report to observations to determine the accuracy of self-report in this population.MethodsForty-five families were recruited from dental and medical clinics and a community social service agency. Research staff asked questions about oral health behaviors and observed tooth brushing in the homes. Brushing was also video-recorded. Video-recordings were coded for brushing behaviors by staff that did not collect the primary data; these abstracted data were compared to those directly observed in homes.ResultsMost families were Hispanic (76%) or Black (16%) race/ethnicity. The majority of parents had a high school education (42%) or less (24%). The mean age of children was 21 months. About half of parents reported brushing their child’s teeth twice a day (58%). All parents tried to have their children brush, but three children refused. For brushing duration, 70% of parents reported differently than was observed. The average duration of brushing was 62.4 s. Parent report of fluoride in toothpaste frequently did not match observations; 39% said they used toothpaste with fluoride while 71% actually did. Sixty-eight percent of parents reported using a smear of toothpaste, while 61% actually did. Brushing occurred in a variety of locations and routines varied. ed data from videos were high in agreement for some behaviors (rinse with water, floss used, brushing location, and parent involvement: Kappa 0.74–1.0). Behaviors related to type of brushing equipment (brushes and toothpaste), equipment storage, and bathroom organization and clutter had poor to no agreement.ConclusionsObservation and video-recording of brushing routines and equipment are feasible and acceptable to families. Observed behaviors are more accurate than self-report for most components of brushing and serve to highlight some of the knowledge issues facing parents, such as the role of fluoride.
Highlights
Most studies of tooth brushing behaviors rely on self-report or demonstrations of behaviors conducted in clinical settings
From 2015 to 2016, the prevalence of total dental caries in United States youth aged 2–19 years was 43.1%; almost 18% of these began before the age of six [1]
Participants were recruited from four sites: a university pediatric dental clinic in a large medical district and a community pediatric dental clinic, and a pediatric medical clinic in a large medical district and a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) center run by the Chicago Department of Public Health
Summary
Most studies of tooth brushing behaviors rely on self-report or demonstrations of behaviors conducted in clinical settings. Low-income and minority populations experience disproportionately higher caries prevalence and morbidity rates [1,2,3] These disparities are frequently attributed to inadequate dental coverage and utilization, insufficient exposure to fluoride, unhealthy dietary choices, and poor oral hygiene [4,5,6]. Preventive interventions that target these factors in very young children can potentially reduce future pain, infections, malnutrition, speech difficulties, poor school performance, cosmetic problems, and quality of life that are associated with caries [7,8,9] While some of these factors are measured using objective data sources such as insurance and billing records, most rely on self-report or demonstrations of behavior conducted in clinical settings. What do we know about what happens in the home regarding oral hygiene in these high-risk populations for very young children?
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