Children's Oral Health Behaviors Research Articles

Pengaruh Pengetahuan dan Sikap Ibu yang Bekerja Dari Rumah Selama Work Form Home Terhadap Perilaku Anak Dalam Menjaga Kebersihan Rongga Mulut dimasa Pandemi Covid-19

The covid-19 pandemic is hitting the world including Indonesia. Work from home (WFH) is one of the Indonesian goverment's policy to prevent the spread of covid-19. The mother’s knowledge, attitude, and practice regarding oral health are the important indicator that reflect their children's oral health behaviour. Objective: to analyse the relationship of mother's knowledge and practice to the children's oral health behaviour during WFH in the covid-19 era. Method: This is a cross-sectional study used the purposive sampling techniques. Thirty respondents were selected by the following criterias: women; have children aged 12 months until 12 years; work outside the home as employees; and willing to participated in this study. Respondents were instructed to fill the self-administered questionnaire through the Google Form application. Data of the mother's knowledge, practice and the children's behaviour were collected, then analysed by computerizing system. Results: Good knowledge and positive practice about oral health was represented by each 73,3% respondents. Approximately 76,7% of the children had satisfaction behaviour and only 23,3% had unsatisfaction of oral health behaviour. The study shows a statistical significant relationship of mothers’ knowledge level (p=0,003) and mother's practices (p=0,044) to their children's behavior toward oral health care. Conclusion: There is a significant relationship between mother's knowledge and practices to the children's oral health behaviour. Good knowledge and positive attitude of mothers determined the satisfaction of children's behaviour in the oral health care, especially int the covid-19 era.

Pathways between parental and individual determinants of dental caries and dental visit behaviours among children: Validation of a new conceptual model.

To delineate the pathways between the parental and individual determinants of dental caries and dental visit behaviours among children, using path analysis. The study employed an observational design; the study sample consisted of 583 parent-child dyads. Data were collected using a sociodemographic and oral health behaviour form, the Parenting Styles and Dimensions Questionnaire, the Corah Dental Anxiety Scale and the Children's Fear Survey Schedule-Dental Subscale. A conceptual model was developed, and it consisted of four endogenous variables (dental caries, children's oral health, dental visit behaviours and children's dental anxiety) and four exogenous ones (parental socioeconomic status, parental dental anxiety, parental oral health behaviours and parenting style). Path analysis was used to test the compatibility of the conceptual model, with a statistical significance at P<.001. 49.1% of participants (n=286) were male. The mean age of participants was 8.3 (SD=2.1). The mean DMFT score was 6.0 (SD=3.0) and the mean Frankl behaviour score 3.0 (SD=1.0). Parental socioeconomic status showed the strongest association with dental caries (β=.276; P<.001), and children's dental anxiety had the strongest association with dental visit behaviours (β=-.414; P<.001). Parental socioeconomic status and oral health behaviours were directly associated with dental caries (P<.001), and parental socioeconomic status had the most association. Parenting style and parental and children's dental anxiety were associated with dental visit behaviours (P<.001). Further, while all parental variables except prior exposure to training about oral and dental health were significantly correlated with dental caries, only educational level and coverage by health insurance were significantly associated with Frankl behaviour scale score. This study developed and validated a conceptual model that delineates the pathways between the parental and individual determinants of children's oral health and dental visit behaviours. The model should help us to understand these pathways to lower the incidence of dental caries and improve dental visit behaviours among children.

Improving parent oral health literacy in Head Start programs.

Parental low oral health literacy is thought to contribute to child oral health disparities. Few large-scale interventions can improve oral health literacy for diverse, high-risk populations. We sought to determine whether an oral health literacy intervention aimed at parents of children attending Head Start programs improved oral health literacy and behaviors. Staff from 29 Head Start agencies across the country were trained to deliver a parent oral health literacy intervention. Parent surveys were conducted at baseline and approximately 6 months later, following intervention completion. Surveys measured parent and child demographics, oral health knowledge, behaviors, information sources, and health care utilization. Paired t tests and mixed-effects regression models controlling for agency, child age, and race/ethnicity evaluated whether measures improved after the intervention. In addition, at follow-up, agency staff were asked to complete an open-ended survey reporting how the intervention impacted their site. Responses were coded using a grounded theory approach. A total of 2,011 (87%) parents completed both the baseline and follow-up surveys. All oral health knowledge and behaviors improved significantly from baseline to follow-up. In addition, parents reported using more oral health information sources, using more preventative oral health care, and less emergency room (ER) use for child dental problems. Head Start staff perceived that the intervention increased parental oral health literacy, enhanced parental oral health engagement, improved child oral health behaviors, and facilitated health communication with parents. Findings suggest that this intervention successfully improved oral health literacy for diverse parents of children at high risk for dental caries.

Maternal Dental Health Knowledge and Its Relation to the Dental Caries Experience of Their Children in Mamyzawa Camp of Refugees in Erbil, Iraq.

This study aimed to evaluate the mothers' dental health knowledge and its relation to their children's oral health behavior and practice in a camp of refugees. This descriptive cross-sectional observational study was conducted in Mamyzawa refugee camp in Erbil City, Iraq, in November 2017. Seventy-nine preschoolers (43 aged 4 years and 36 aged 5 years) and their mothers (79) were chosen for this study. The study was accomplished in two days. The first day the mothers' oral health knowledge, children's behavior towards oral hygiene, eating behaviors of their children and their use of dental services were assessed by a questionnaire. The day after, examinations of the dental health status of the children were performed. SPSS statistics software was used to analyze the collected data. Mothers' knowledge of oral health was low, and 63% of the children had dental caries. Five-year old children had more dental caries (77.8%) than the four-year old (51.20 %). Frequency of sweet consumption, brushing assistance, and irregular use of dental services were the main factors that had relation to the high dental caries in those children. The mothers living in Mamyzawa refugee camp do not have enough knowledge of oral health, which was led to high caries prevalence among their children, indicating that an intensive education program is required for the mothers and oral health care for their children.

What Child Oral Health-Related Behaviors Can First-time Mothers Actualize? A Pragmatic Prospective Study.

First-time pregnant women are considered to be receptive to health information, rendering the prenatal period an opportune time to provide helpful information on the importance of child-related oral health. However, little is known about pregnant women's knowledge of child oral health-related behaviors (COHBs) during pregnancy and their implementation after birth. We sought to address this knowledge gap by a prospective investigation of intended and actualized oral health behaviors among first-time pregnant women. We examined relationships between intended and actualized COHBs and their correlations with changes in oral health knowledge, health literacy, general self-efficacy, and dental neglect in a cohort of first-time pregnant clients at Women, Infants, and Children sites in North Carolina-participants of a large community-based study. The COHBs were related to diet (i.e., frequency of fruit juice and sweet snacks consumption and nighttime bottle-feeding) and oral hygiene practices (e.g., performance of daily oral hygiene and use of fluoridated toothpaste). Analyses relied on descriptive statistics and bivariate tests (Student's t and McNemar's). Data were collected from 48 participants (White, 44%; African American, 40%; Native American, 17%) at baseline and again at least 12 months after the birth of their first child. On average, most mothers actualized 3 of 5 COHBs (range, 1 to 4). Significant differences between before and after birth were noted for frequency of sweet snacks consumption and putting the baby in bed with a bottle. No correlation was found between knowledge, literacy, self-efficacy, neglect, and sociodemographic characteristics and COHB actualization. Our findings suggest that first-time mothers in the studied population are likely to implement some but not all positive intended COHBs during pregnancy. Interventions are needed to assist women in implementing these practices. We support that, for prenatal interventional efforts to reap positive benefits, messaging should be personalized and include specific guidance on how to implement these recommendations. A knowledge gap exists in our understanding of the relationship between first-time mothers' intended and actualized child oral health behaviors, with implications in the optimal timing of infant and early childhood oral health messaging. Our findings suggest that first-time mothers are likely to implement some but not all positive behaviors that they intended to adopt during pregnancy. Interventions are needed to assist women in implementing these practices.

Conceptual modelling of the factors affecting oral health-related quality of life in children: A path analysis.

It is important to understand the interaction of various predictors with oral health-related quality of life (OHRQoL) to better design effective interventions to improve OHRQoL. The aim of this study was to develop and validate a conceptual model evaluating the factors affecting the OHRQoL in children. The study group consisted of 754 parent-child dyads. The data collection tools were a socio-demographic data form, the Early Childhood Oral Health Impact Scale (ECOHIS), Corah Dental Anxiety Scale (C-DAS), Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), and an oral and dental health examination form. A conceptual model was developed to examine the factors affecting OHRQoL in children consisting of four endogenous and four exogenous variables. Path analysis was used to test the compatibility of the conceptual model. OHRQoL was associated with parental socio-economic status (β=-0.12; P<.001), dental anxiety (β=-0.15; P<.001), and oral health behaviours (β=-0.13; P<.001). Although parental dental anxiety had the strongest direct effect on OHRQoL, children's oral health behaviours had the strongest indirect effect. This study revealed a valid demonstrable path of association between parental socio-economic status, dental anxiety, childhood dental anxiety, oral health behaviours, and OHRQoL.

Oral health behavior of children and guardians’ beliefs about children’s dental caries in Vientiane, Lao People’s Democratic Republic (Lao PDR)

Dental caries is considered a major health problem among schoolchildren in Lao People’s Democratic Republic (Lao PDR). According to Health Belief Model (HBM)-based research, children’s oral health behavior can be determined by their guardians’ beliefs. This study aimed to describe children’s oral health behavior and its association with childhood dental caries, as well as to assess associations between children’s tooth-brushing behavior and guardians’ beliefs in an urban area of Lao PDR, using HBM. Data were collected from ten primary schools in the Sisattanak district, the Vientiane capital, between 2013 and 2014. Ten dentists with the help of dental hygienists and schoolteachers conducted dental health check-ups at the schools that diagnosed dental caries based on visual inspection. They also conducted a questionnaire-based survey with the schoolchildren’s guardians to collect data including socio-economic and demographic information, their children’s oral health behavior, and guardians’ beliefs derived from HBM, including perceived susceptibility to and perceived severity of child dental caries, perceived benefit of and perceived barrier to child’s tooth brushing, and self-efficacy in making their children brush their teeth twice daily. A mixed-effects logistic regression model assessed the association between dental caries and children’s oral health behavior and between children’s tooth-brushing behavior and guardians’ beliefs. Data from 1161 of 1304 (89.0%) children registered at the schools were used. The prevalence of dental caries was 82%. Children who brushed their teeth ≥ twice/day were significantly less likely to have dental caries than those brushing once or seldom (OR: 0.64, 95% CI: 0.45 to 0.91). The number of children who brushed twice daily also significantly increased with the increased level of guardians’ self-efficacy (OR: 2.14, 95% CI: 1.91 to 2.41). In conclusion, childhood dental caries was associated with daily tooth brushing. Children’s tooth-brushing behavior was associated with guardians’ self-efficacy in making their children brush twice daily.

Correlations of Mothers’ Oral Health Knowledge and Verbal Oral Health Literacy with Children's Oral Health Behaviors in a Daycare Center

Correlations of Mothers’ Oral Health Knowledge and Verbal Oral Health Literacy with Children's Oral Health Behaviors in a Daycare Center

Autism Spectrum Disorder: Patients’ Oral Health Behaviors and Barriers in Oral Care from Parents’ Perspectives

To assess the oral health behaviors of children with Autism Spectrum Disorder (ASD) and explore attitudes and barriers in providing oral care by their parents. A cross-sectional, mixed method study design, which comprised of quantitative and qualitative sections was conducted. The quantitative part assessed the oral health behavior through a parent-proxy report questionnaire whilst the qualitative part assessed parents’ overall perspective on maintenance of oral health in children with ASD through an in-depth interview using semi-structured questions. All children below the age of 16 who have been clinically diagnosed with ASD and registered at the Pediatric Dental Clinic were included. The sample consisted of twenty children with ASD. Most of the sample were male and between 5-8 years old. Majority had good oral health behaviors but some exhibited self-injurious behaviors that may affect oral health. Severe characteristics of ASD, co-morbid conditions and incompetent health professionals were reported as barriers in oral care by parents of these children. Despite having good oral health behaviors, several barriers and challenges were expressed by these parents with ASD when providing home oral care or bringing them for dental appointment. Continuous support for parents with ASD child by dental professionals is essential to help overcome the real challenges and barriers in providing oral care among these parents.

Oral health behaviour of children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends.

Oral health behaviour plays a key role in the prevention of caries and periodontitis. This article describes the prevalence, determinants and trends of tooth brushing frequency and utilization of dental check-ups. The analyses are based on the data from the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017). The results show that around 80% of children and adolescents meet the recommended tooth brushing frequency and utilization of dental check-ups. Around one fifth of children and adolescents do not meet the recommendations. 14- to 17-year-old adolescents, as well as those with low socioeconomic status and a migration background are groups which are particularly at risk. Compared to the KiGGS baseline study (2003-2006), tooth brushing frequency and utilization of dental check-ups has improved. While this positive development is apparent for nearly all the population groups analysed, the same risk groups that were identified by the baseline study are also evident in the KiGGS Wave 2 results. Targeted measures directed at specific target groups to promote oral health behaviour at younger ages should therefore be maintained and expanded, respectively.

Early Life Professional and Layperson Support Reduce Poor Oral Hygiene Habits in Toddlers-A Prospective Birth Cohort Study.

Oral health behaviours of children are formulated from a very young age. Formation of those behaviours among very young children is dependent on their mothers/caregivers who may themselves require support from the health profession or laypersons. The study aimed to investigate if early life visits for check-up and dental advice and perceived support improved oral health behaviours as practiced by mothers of toddlers aged 24–30 months old. Data from a population-base birth cohort study in South Australia was used. The study recruited and followed mothers of newborn children from birth to age 24–30 months. Parental questionnaires collected information about socioeconomic factors, dental visiting patterns, and oral health behaviours as practiced by the mothers for their child. Self-reported putting a child to bed with a bottle and brushing a child’s teeth were the outcome variables. The two main exposures of this study were (1) early visiting for a dental advice, and (2) layperson support that a mother received in the first two years of having the child. Data were analysed progressively from bivariate to multivariable regression models. A total of 1183 mother/child dyads had complete data. The retained sample was representative of the population. Approximately 36% of mothers put their child to bed with a bottle and 26% of mothers did not brush their child’s teeth the night before. Around 29% of children had a visit for dental check-up and 80% of mothers reported having lay support. There were gradients in the outcome variables by socioeconomic factors and the main exposures. Multivariable regression models reported that having no dental visit for advice and having no lay support were associated with 1.30 and 1.21 imes higher rates of putting a child to bed with a bottle, respectively. Having no dental visit for advice was associated with a 1.37-times higher rate of not brushing a child’s teeth, controlling for other factors. This population-based birth cohort study confirmed importance of early life dental visit for check-up and support for mothers of young children in establishing oral health behaviours of young children.

Parental Attitudes and Beliefs About Preschooler Preventive Oral Health Behaviors: Implications for Health Promotion.

Dental caries affects 60-90% of school-aged children, with non-Hispanic Black children among those disproportionately affected. This study seeks to examine the attitudes, beliefs, and behaviors of Black parents about preventive measures against caries for their preschool children (3-5 years). Parents of Black preschool children in Miami-Dade County (n = 192) completed an oral health survey measuring oral health attitudes, beliefs, and behaviors. Descriptive statistics were used to analyze attitudes, beliefs and favorable oral health behaviors. Logistic regression was used to examine the relationship between parental oral health attitudes and beliefs and their children's oral health behaviors. Most of the parents reported positive attitudes with regards to sugar snacking (81%), brushing child's teeth (88%), attitude to prevention (85%), and perceived seriousness of decay (91%). Parental oral health attitudes were independently associated with children's preventive oral health behaviors (p < 0.05). Parental education should be included in interventions geared towards improving children's oral health.

Randomized Trial of Motivational Interviewing to Prevent Early Childhood Caries in Public Housing.

Caries experience among preschool-age children has remained relatively unchanged for the past 2 decades, despite recently documented decreases in untreated decay. In a community-based cluster-randomized controlled trial, a motivational interviewing (MI) intervention administered to primary caregivers was hypothesized to reduce caries increment over 2 y as compared with controls, among children aged 0 to 5 y at baseline living in public housing. Public housing residents, who served as interventionists, were trained in MI with a focus on early childhood caries prevention. All 26 eligible public housing developments were randomized to either control (quarterly clinical examinations, fluoride varnish applications, toothbrush/toothpaste, and educational brochures) or intervention (same procedures as control plus MI counseling). Quarterly MI sessions were delivered in English or Spanish over 2 y, audio recorded, and assessed for treatment fidelity. The primary outcome was the increment in dmfs (decayed, missing, and filled tooth surfaces) as assessed by clinical examination at baseline, 12 mo, and 24 mo. Secondary outcomes included caregiver oral health knowledge and child oral health behaviors (child toothbrushing and sugar-sweetened beverage intake). Baseline characteristics were compared between groups and adjusted for housing-site clusters. Longitudinal outcomes were analyzed with mixed models. A total of 1,065 children (49% female, 55% non-White, 61% Hispanic, 89% below poverty level, n = 686 control) and their caregivers were enrolled. During 2 y of follow-up, the mean dmfs increment increased in both groups; however, there were no statistically significant group differences at 24 mo or group × time interactions. The mean increase in intervention caregivers' knowledge was significantly greater than that of control, F(2, 1,593) = 3.48, P = 0.0310, but there were no significant intervention effects on caregiver-reported child sugar-sweetened beverage intake or child toothbrushing. MI counseling plus intensive caries prevention activities resulted in knowledge increases but did not improve oral health behaviors or caries increment (ClinicalTrials.gov NCT01205971). When viewed in light of the findings from the companion Pine Ridge study and other recent MI studies, the results of this study suggest that when the complex disease of early childhood caries is addressed in high-risk populations, MI is not effective, and alternative approaches are warranted.

Hubungan Jenjang Pendidikan terhadap Perilaku Menjaga Kesehatan Gigi dan Mulut Anak Tunagrahita di SLB Kota Sidoarjo

Intellectual disability is a child who suffers from intellectual ability below average and tends to have retardation in intelligence, physical, emotional, and social. They are not independent enough in keeping their own health especially oral hygiene, it can affect their oral health behavior. Education that is one of external factors influences health behavior. Education and knowledge influence each other so that people are expected to have high education in order to be knowledgeable especially in terms of maintaining health. The purpose of this study was to analyze the correlation between education level and oral health behavior of children suffering from intellectual disability. This research was an observational analytic research with cross sectional approach. The subjects of this study were a number of children of SDLB, SMPLB and SMALB in SLB Sidoarjo, with total sampling as many as 115 students. The subjects were asked to fill out a questionnaire of knowledge and attitude how to brush teeth and performed the action as well. The collected data were analyzed by using spearman correlation test. The result of this research showed that correlation coefficient for education level with knowledge, attitude and behavior was &gt; 0,05, so there was no relation between those variables. Meanwhile, the result of correlation coefficient of education with action was &lt; 0.05, so there was correlation between those two. The conclusion of this research is there is no correlation between the level of education and oral health behavior of intellectual disability children in SLB Sidoarjo.&#x0D; Keywords: Mental retarded, dental health behavior, education level&#x0D;

Effectiveness of oral health education intervention among female primary school children in Riyadh, Saudi Arabia

ObjectiveThis study aimed to examine the effectiveness of oral health intervention on the improvement in knowledge and self-reported oral health behavior among 6–8 year old female primary school children in Riyadh, Saudi Arabia. Materials and methodsThe sample consisted of 1661 girls in primary schools who are 6 to 8-year-olds (first, second and third graders). The children’s level of knowledge was assessed by a self-administered questionnaire that was formulated for this specific age and divided into two parts; oral health knowledge and self-reported oral health behavior. There were seven multiple choice questions and one true/false question with five underlying parts in the questionnaire which contained basic information about oral health knowledge, oral hygiene practices and certain habits that affect teeth. The questionnaires were distributed before and six weeks after implementation of the oral health educational program to measure the level improvement of knowledge regarding oral health among these children. ResultsAll the questions showed statistically significant improvement in knowledge and self-reported behavior in the post intervention group. There was a significant increase in the level of knowledge by 11.24% and level of self-reported behavior by 25% after intervention (P < 0.001). The highest net change in the knowledge due to intervention was noted among third graders (13.3%), whereas for self-reported oral health behavior, it was noted among first graders (28.3%). ConclusionThe results of this study showed that an easy-to-organize and inexpensive school-based intervention can, on a short-term basis, be effective in improving the knowledge and self-reported oral health behavior of children.

The effectiveness of the Brush Day and Night programme in improving children’s toothbrushing knowledge and behaviour

Regular twice-daily toothbrushing with a fluoridated toothpaste is widely recommended for schoolchildren. The '21-day Brush Day and Night (BDN) programme' includes an educational approach for children and school staff, with a consistent practice of toothbrushing at school for 3 weeks. This study aims to evaluate the improvement in oral hygiene knowledge and behaviour in schoolchildren involved in BDN, the sustainability of this after 6-12 months, and if any particular age group was more receptive to it than others. Ten countries and 7,991 children, 2-12 years old, participated in this longitudinal study, with two BDN interventions at the beginning and 6-12 months afterward. Data were collected via a self-reported questionnaire at baseline/first intervention (T0), 21 days after first intervention (T0D21), at the second intervention (T1), and 21 days after second intervention (T1D21). Improvement in knowledge and behaviour was compared using the chi-square test with an alpha level of 5%. The final data sample of 5,148 schoolchildren was evaluated, and the analysis revealed that 25% more of the schoolchildren brushed their teeth twice a day after the first intervention. The programme was more effective among the 7-9 years age group. The BDN intervention increased brushing-frequency in children at the first intervention, and this was sustained after 6-12 months. Therefore, this programme illustrated a sustainable approach to improve children's oral health knowledge and behaviour.

Risk Factors of Early Childhood Caries among Young Children in Hong Kong: A Cross-Sectional Study.

Early childhood caries (ECC) was prevalent in Hong Kong. Children with ECC risk should be identified early for prevention. This study aimed to identify common risk factors of ECC in Hong Kong 3-year-old children. Sample size calculation showed at least 6,321 of 3-year-old children should be invited in this study. A consent form and a questionnaire enquiring the children's oral health behaviours and social-economic background were distributed to their parents. Children with parental consent were examined by a trained dentist. Caries status was recorded in dmft index. Chi-square test and logistic regression analysis were performed to identify the risk factors of ECC. A total of 5,167 children from the 6,331 children invited were examined. Among them, 1,130 children (22%) had ECC (dmft>0). Logistic regression analysis found age of starting tooth brushing, snack-intake frequency, dental visit experience, birthplace, family monthly income, primary caretaker, and mother's education level were factors associated with ECC of the children. Children who started tooth brushing later, had higher snack-intake frequency, were not born in Hong Kong, and whose family monthly income was lower, mother's education level was lower, primary caretaker was not domestic helper, had a statistically significant higher chance of having ECC.

Oral health behaviours of parents and young children in a practice-based caries prevention trial in Northern Ireland.

The NICPIP trial evaluated the costs and effects of a caries prevention intervention delivered to 2- to 3-year-old children attending dental practices in Northern Ireland. This supplementary study explored the oral health behaviours of children and their parents to help understand the reasons for the trial's findings. A mixed methods study that included a questionnaire completed by all parents (n=1058) at the time they brought their child for the NICPIP final clinical assessment. The questionnaire collected data on frequency of toothbrushing and sugar consumption. Questionnaire data were analysed by trial group and caries status. Parents of trial participants (n=42) were invited to take part in telephone interviews. Parents were purposively sampled according to trial group and whether or not their child developed caries. The interviews explored how and why oral health behaviours happened. Interview data were audio-recorded, transcribed verbatim and analysed thematically. The questionnaire data indicated that toothbrushing and between-meal sugar snacking were common in the majority of children. The children of parents who automatically reminded their child to brush their teeth were more likely to remain caries-free (Odds Ratio 1.24; 95% CI 1.08, 1.41; P=.002). Frequency of sweet drink consumption was associated with the child developing caries (Odds Ratio 0.88; 95% CI 0.79, 0.98; P=.021). The interview data showed that parents had positive attitudes towards brushing both in terms of perceived importance and expected outcomes. Attitudes towards sugar snacking were more complex, with parents reporting difficulties in controlling this behaviour. Sugar was described as being something that was "ever present" in children's lives. Toothbrushing was widely adopted from a young age, but between-meal sugar consumption was highly prevalent. The results suggest that effective family-level and population-level interventions are needed to reduce sugar consumption if substantial improvements in caries prevention are to be achieved.

How do foster carers manage the oral health of children in foster care? A qualitative study.

This qualitative study explored how the foster family environment influenced children's oral health. It also aimed to better understand foster carers' oral health knowledge, attitudes and experiences of managing foster children's oral health behaviours and oral health care. An interpretative phenomenological analysis (IPA) study design was used to recruit a purposive sample of foster carers in Tower Hamlets, United Kingdom, from a range of backgrounds (maximum variation sampling). Participants were aged 21 years and older and provided full-time foster care for children for a minimum of 1 year. The foster carers took part in focus groups that were audio-recorded and transcribed verbatim. Data analysis followed a five-step IPA process, which included reading the transcripts, note taking, identifying emerging themes, connecting related themes and writing up the final themes. Iterative data gathering and analysis continued to reach thematic saturation. Three focus groups were conducted, involving a total of 12 foster carers. Eight of the 12 participants had fostered children for more than 10 years and they were currently fostering 22 children aged five to 18 years old. Four themes emerged from within the context of the supportive and nurturing foster family environment that described how foster carers' responded to and managed the oral health of their foster children. Foster carers had adopted an oral health caregiving role, "in loco parentis" responding to the poor oral health of their vulnerable foster children. They were hypervigilant about establishing and monitoring children's oral health routines and taking their children to see a dentist; these were seen as an integral part of being good foster carers. They were knowledgeable about the causes of children's oral ill health, gained from their own dental experiences and from looking after their own children. Foster carers had experienced tensions while adopting this oral health caregiving role with dentists who had refused to see younger children. Foster carers had also experienced tensions with teenage foster children who questioned their parental authority and legitimate right to set rules about smoking and healthy eating. This is the first study to explore foster carers' oral health perspectives and the foster family environment within the oral health context. It highlights the unrecognized and important role that foster carers have in improving the oral health of vulnerable children. Further research is needed to explore the relationship between foster carers and dentists and to support the development of health and social care interventions to improve foster children's oral health.

The family's influence on the oral health of children. A peek behind the front door

The prevention of dental caries seems fairly easy. The disease can largely be avoided by the daily removal of dental plaque using fluoride toothpaste and the control of sugary intakes. Most parents have sufficient knowledge and motivation to adhere to this prevention advice with respect to their children. Actual practice, however, proves quite difficult because parents experience barriers in implementing the advice. This article provides an overview of the most important family-related factors that influence children's oral health behaviour and dental caries experience. Factors include oral health-related attitudes of the parents, the way that parents deal with their children and communicate with them (parenting practices) and the organisation of daily life within the family (family functioning). It's important for oral health care providers to engage in conversations with parents to identify possible barriers. Tailored advice can then be given to help them improve their oral health behaviour.