Toothbrushing Behaviour Research Articles

Oral symptoms and oral hygiene behaviours among patients with type 2 diabetes at a hospital in Japan: A cross-sectional study.

Effective daily oral hygiene behaviour will prevent periodontal disease. This study aimed to examine the oral symptoms, oral hygiene behaviours and factors contributing to oral hygiene behaviours among patients with type 2 diabetes in a hospital in Japan. A cross-sectional survey was conducted with 198 patients with type 2 diabetes. Oral symptoms were assessed using a dichotomous scale based on clinical guidelines. Oral hygiene behaviours were assessed based on the frequency of daily tooth brushing and the use of interdental cleaning aids. Chi-square tests and logistic regression analyses were also performed. Overall, 71.2% of the participants had oral symptoms. Of the participants, 80.3% performed twice daily tooth brushing and 61.1% did not perform interdental cleaning on a daily basis. Logistic regression analysis revealed that tooth brushing behaviour was negatively associated with male patients (odds ratio [OR]=0.45, 95% confidence interval [CI]: 0.25-0.80), difficulty with mastication (OR=0.63, CI: 0.43-0.92) and tooth loss (OR=0.68, CI: 0.46-1.00) and positively associated with periodontal disease (OR=1.73, CI: 1.10-2.72). There were no significant variables related to the use of interdental cleaning aids. Patients need to learn about the necessity for regular oral hygiene behaviours and the appropriate way. In particular, support for male patients, those who have difficulty with mastication, those who have experienced natural tooth loss, and those who have not been diagnosed with periodontal disease are needed.

Parent-reported toothbrushing behaviour in the Portuguese preschool population.

Study toothbrushing behaviours and associated factors in a Portuguese preschool population. The study population was the parents of children attending Portuguese kindergartens. The data on sociodemographic and toothbrushing behaviours, at home and at school, were collected by an online questionnaire. The data analysis was performed using Chi-square, Fisher, Mann-Whitney and Kruskal-Wallis tests (α = 0.05). The sample included 711 parents. Most of the children brushed their teeth at home at least twice-a-day (65.3%), with the help of an adult (62.9%). The majority of the children did not brush their teeth at school (71.2%); however, only 9.9% of the parents reported that they don't/wouldn't authorise it. Considering both toothbrushing, at home and at school, 75% of the children brushed their teeth twice-a-day. However, only 7.8% of the children performed all the correct toothbrushing related procedures. Toothbrushing at school was more frequent in private kindergartens (p < 0.001). A higher level of education was associated with non-authorisation of toothbrushing at school (p = 0.019) and with performing the correct toothbrushing related procedures (p = 0.007). Attending an oral health professional appointment was also associated with performing the correct toothbrushing related procedures (p = 0.005). Toothbrushing twice-a-day was frequent in the studied population, however, the percentage of children who brushed at school was low, as well as the percentage of children who performed all the correct toothbrushing related procedures. Toothbrushing at school was more likely in private kindergartens. Performing correct toothbrushing related procedures was more frequent in children who had a previous oral health appointment and whose parents had a higher education level.

Socioeconomic inequalities in toothbrushing behaviours in young children: a children's lifestyle survey in a representative population of A city, Okinawa prefecture, Japan.

We have less understanding of which socioeconomic status (SES) indicators may be reflective of latent socioeconomic inequalities in toothbrushing behaviours, especially finishing-toothbrushing by parents in young children. The aim of this study was to reveal the socioeconomic inequalities in children's toothbrushing and finishing-toothbrushing by parents and if it varies by SES indicators. We used data from 'Survey on Children's Life' conducted by A city of Okinawa Prefecture, Japan. The multiple imputed data of 902 (boys, 453) included self-reported children's toothbrushing behaviour and finishing-toothbrushing by parents in three-to six-year-old children. SES was assessed using self-reported household income and parental educational attainment. Absolute and relative inequalities in toothbrushing behaviours were quantified using the slope index of inequality (SII) and relative index of inequality (RII), respectively. There were significant absolute and relative inequalities of children's toothbrushing for household income (SII and RII were 0.241 and 2.73, respectively), of finishing-toothbrushing by parents for household income (SII and RII were 0.133 and 3.28, respectively), and educational attainment (SII and RII were 0.166 and 5.55, respectively). The same inequality trends were observed after adjusting for covariates (child's age and sex, family structure, breakfast and dinner frequency, and sleep duration). Socioeconomic inequalities in children's toothbrushing and finishing-toothbrushing by parents varied according to SES indicators.

Association between tooth brushing behavior and diabetes mellitus occurrence in Indonesia

Diabetes mellitus (DM) is a disease that is characterized by hyperglycemia, a condition where blood glucose level is higher than normal. Recent researches have shown that tooth brushing frequency is a potential risk factor for DM. Indonesian Basic Health Research (Riskesdas) collected the data of tooth brushing behavior of Indonesian people in 2018 according to the time of the tooth brushing. The data showed that the majority of Indonesian people brushed their teeth every day, but only 2.8 % of them did it at the right time. This problem might have an association with DM occurrence in Indonesia. This study aimed to analyze the tooth brushing behavior and DM occurrence association in Indonesia using the Indonesian Basic Health Research 2018 data. This cross-sectional study used a total of 455,040 interviewed respondents aged 30-80 years old that had complete data of their daily tooth brushing behavior. Tooth brushing behavior was the main independent variable. Other independent variables were age, sex, sweet drinks consumption, sweet foods consumption, fatty foods consumption, fruits and vegetables consumption, physical activity, and obesity. The dependent variable was the occurrence of DM based on diagnosis by doctor.

Oral community health worker-led interventions in households with average levels of psychosocial factors.

IntroductionHousehold-level psychosocial stress levels have been linked to child tooth brushing behaviors. Community health worker (CHW) interventions that target psychosocial factors in high-risk communities have been associated with changes in health behaviors.AimObserve changes in psychosocial factors over time and an association between psychosocial factors and CHW intervention dose amongst urban Chicago families.Patients and methodsParticipants (N = 420 families) were recruited from 10 community clinics and 10 Women, Infants, or Children (WIC) centers in Cook County, Illinois to participate in a clinical trial. Research staff collected participant-reported psychosocial factors (family functioning and caregiver reports of depression, anxiety, support, and social functioning) and characteristics of CHW-led oral health intervention visits (number, content, child engagement) at 0, 6, and 12 months. CHWs recorded field observations after home visits on household environment, social circumstances, stressors, and supports.ResultsParticipants across the cohort reported levels of psychosocial factors consistent with average levels for the general population for nearly all measures. Psychosocial factors did not vary over time. Social functioning was the only measure reported at low levels [32.0 (6.9); 32.1 (6.7); 32.7 (6.9); mean = 50 (standard deviation)] at 0, 6, and 12 months. We did not observe a meaningful difference in social functioning scores over time by exposure to CHW-led intervention visits (control arm, 0, 1, 2, 3, and 4 visits). Field observations made by CHWs described a range of psychosocial stress related to poverty, language barriers, and immigration status.ConclusionThe unexpectedly average and unchanging psychosocial factors over time, in the context of field observations of stress related to poverty, lack of support, immigration status, and language barriers, suggests that our study did not adequately capture the social determinants of health related to oral health behaviors or that measurement biases precluded accurate assessment. Future studies will assess psychosocial factors using a variety of instruments in an attempt to better measure psychosocial factors including social support, depression, anxiety, functioning, trauma and resilience within our urban population. We will also look at neighborhood-level factors of community distress and resilience to better apply the social ecologic model to child oral health behaviors.

THE EFFECT OF DENTAL HEALTH EDUCATION USING THE DEMONSTRATION METHOD ON THE BEHAVIOR OF DENTAL BRUSHING IN CLASS V SCHOOL AGE CHILDREN AT SDN 1 PAGAR AIR DISTRICT WANTS TO JAYA DISTRICT BIG ACEH

Dental and oral health counseling to elementary school students is one of the efforts to improve the degree of dental health in children in promotive and preventive aspects. The selection of demonstration methods in dental and oral health education supports increasing children's understanding, by practicing directly how to brush their teeth correctly. From the results of interviews with 10 students, it is known that 7 students do not know how to brush their teeth properly and correctly. This study aims to determine the effect of dental health education using the demonstration method on tooth brushing behavior in fifth grade school-aged children at SDN 1 Pagar Air, Want Jaya District, Aceh Besar District. The type of research used in this study is a Quasi Experiment using a pretest and posttest design which was carried out on January 21-22 2022 at SDN 1 Pagar Air, Aceh Besar District. The sampling technique was Total Sampling, which consisted of 60 students. Analysis of the data in this study is quantitative data using parametric statistical test Paired Sample T-test. The results showed that there was an effect of dental health education using the demonstration method on tooth brushing behavior in fifth grade school-aged children at SDN 1 Pagar Air with a significant value of P =. p=0.000. It can be concluded that there is an effect of dental health education using the demonstration method on the behavior of brushing teeth in fifth grade school-aged children at SDN 1 Pagar Air. It is suggested to the students of SDN 1 Pagar Air, Sub-District of Want Jaya to apply good and correct brushing techniques.

Designing Reinforcement Learning Algorithms for Digital Interventions: Pre-Implementation Guidelines.

Online reinforcement learning (RL) algorithms are increasingly used to personalize digital interventions in the fields of mobile health and online education. Common challenges in designing and testing an RL algorithm in these settings include ensuring the RL algorithm can learn and run stably under real-time constraints, and accounting for the complexity of the environment, e.g., a lack of accurate mechanistic models for the user dynamics. To guide how one can tackle these challenges, we extend the PCS (predictability, computability, stability) framework, a data science framework that incorporates best practices from machine learning and statistics in supervised learning to the design of RL algorithms for the digital interventions setting. Furthermore, we provide guidelines on how to design simulation environments, a crucial tool for evaluating RL candidate algorithms using the PCS framework. We show how we used the PCS framework to design an RL algorithm for Oralytics, a mobile health study aiming to improve users' tooth-brushing behaviors through the personalized delivery of intervention messages. Oralytics will go into the field in late 2022.

Effect of Mozart's music on the learning of toothbrushing behavior in children with high and low dental anxiety levels.

The aim of this study was to evaluate the effectiveness of Mozart's music on the learning of toothbrushing behavior in children with high and low dental anxiety levels. A randomized, controlled, single-blinded, and observational study was conducted with 60 children, aged 8-12, who were recruited to high dental anxiety level (HDAL) and low dental anxiety level (LDAL) groups. Both groups were divided into two equal subgroups (with or without Mozart's music). In the Mozart's music subgroups, children were exposed to Mozart's Sonata for 7min and toothbrushing training was given accompanied by music. The training was instructed to the second subgroup without listening to Mozart's music. The periodontal measurements were repeated after 15days. Three-factor variance analysis was used to analyze the data. There was a statistically significant decrease in plaque index (PI) and gingival index (GI) scores in the follow-up visits for all groups (p < 0.05). A statistically significant decrease was found in PI values between groups with or without music in those with HDAL (p < 0.001). However, no statistically significant differences were found between groups with or without music in those with LDAL (p = 0.07). Listening to Mozart's music before toothbrushing training had a significant effect on plaque removal in children with high dental anxiety, while Mozart's music did not have a positive effect in the group with low dental anxiety. The use of Mozart's music may be beneficial in oral hygiene education for children with high dental anxiety levels.

Habit and goal-related constructs in determining toothbrushing behavior: Two sensor-based longitudinal studies.

Two longitudinal studies were conducted to examine how habits and goal-related constructs determine toothbrushing behavior from a dual-process perspective. We aimed to describe the variations of habit strength, intention, and attitude and to test their associations with actual behavior at both inter- and intraindividual levels. In addition, toothbrushing behavior was measured both by self-report and sensors with the goal to compare these measures. In Study 1, 40 young adults were instructed to brush their teeth twice a day, and their behaviors were measured by accelerometers for 3 weeks. Participants also self-reported their instrumental and affective attitude, habit strength, and behavior frequency weekly. Effects of interest were estimated using structural equation modeling. Study 2 replicated Study 1 with a larger and more diverse sample (N = 79), adding a measure of behavioral intention. Supporting the dual-process account, habit strength predicted future behavior in addition to goal-related constructs. Habit strength also attenuated the influences of goal-related constructs on behavior, but this pattern only emerged interindividually and for self-reported behavior. In addition, toothbrushing behavior was more strongly driven by affective rather than instrumental attitude. In both studies, associations among variables were weaker within-person and when sensor-measured behavior was modeled. The partial support for the dual-process account suggests the need of using habit-based interventions to complement intention-based interventions when attempting to change oral health routines. Our findings also highlight the importance of affective aspects of toothbrushing behavior and the potential to incorporate sensor-based objective measures in research and interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Socioeconomic factors related to tooth brushing behavior among adults in Korea: analysis with 2019 Community Health Survey data

Socioeconomic factors related to tooth brushing behavior among adults in Korea: analysis with 2019 Community Health Survey data

The Effect of Pop Up Book Media on Increasing Dental Health Knowledge in Elementary School Children

Background: Children are a very large group of people and have a high prevalence of dental caries. This is related to the correct tooth brushing behavior data which is 2.8% every day. Dental health promotion is an effort to increase children's knowledge whose success cannot be separated from the method of education and the role of the media. Pop-up book is one of the three-dimensional visual media that can be an alternative as a learning medium. Objective: This study aims to analyze the effect of pop up book media on increasing dental health knowledge of elementary school children. Methods: Pre-experimental research with pretest-posttest control group design. The sampling technique was purposive sampling as many as 64 children, consisting of 32 children in the intervention group and 32 children in the control group. The study was conducted at SDN 03 Cilandak Timur, South Jakarta from September to October 2021. The variable influence on the intervention group was pop up book media and the control group was flipchart media while the affected variable was dental health knowledge. The research instrument used a questionnaire about dental health. Data analysis used the SPSS program with the Paired Sample Test to compare the knowledge scores before and after the intervention and the independent t-test to compare the difference in knowledge scores between the intervention group and the control group. Results: The results of the Paired Sample Test on knowledge in the intervention group obtained p = 0.000 and in the control group was p = 0.182. The results of the independent t-test were obtained p = 0.000. Conclusion: Pop up book media is effective in increasing the dental health knowledge of elementary school children.&#x0D; &#x0D;

The effectiveness of the application of the mentoring module on brushing teeth by parents on the behavior of brushing teeth in early childhood

Background: Ability and good habits in maintaining dental health must be trained from an early age. In early childhood, there are deciduous teeth that must be maintained and maintained in order to stay healthy and support children to grow and develop optimally. At the age of 6 years will begin to grow permanent teeth that will be used for life. Therefore, children need to be equipped with knowledge and skills in maintaining oral health independently. Parents, especially mothers, are the closest people to children who will provide assistance and guidance to early childhood children in carrying out dental health maintenance, in connection with children who are not yet able to do it themselves. Objective: This study aims to analyze the effectiveness of the application of the brushing mentoring module on improving tooth brushing behavior in early childhood. Methods: this study used a quasi-experimental with a pretest and posttest with one group design. This research was conducted at Pertiwi VI Kindergarten Pondok Labu. The independent variable: the application of the brushing mentoring module and the dependent variable: knowledge, early childhood tooth brushing skills, knowledge and attitudes of parents. Data were tested using Wilcoxon. Result: the application of the mentoring module on brushing teeth was proven to be significantly (p&lt;0.001) effective in increasing the knowledge and skills of brushing teeth for early childhood as well as increasing the knowledge and attitudes of parents. Conclusion: the brushing teeth mentoring module is effective in increasing tooth brushing behavior in early childhood.&#x0D; Keywords: Brushing mentoring module, behavior, early childhood.

Parents' Oral and Dental Health Behavior as Predictors of Children's Oral and Dental Health Status

Parents are considered to have the knowledge to teach their children basic things about maintaining a healthy body. The cultivation of oral health behavior should start at an early age and start from the family environment. Childhood is the beginning of behavior formation, therefore parents are expected to be able to educate their children to behave properly to maintain healthy teeth and mouth. The purpose of this study was to determine the oral health behavior of parents to determine the oral health status of children in the pedodontics department of the Baiturrahmah University Dental Hospital. This research type is quantitative with analytic survey method with cross sectional research design. The population was pediatric patients who took care at the Paedodonti Department of the Baiturrahmah Hospital in July 2020. The results showed that the educational status, tooth brushing behavior, eating sweet eating behavior, the habit of bringing children to the dentist and complaints in the oral cavity of the parents gave a picture. predictions for their children about oral health. Parents' behavior will have an effect on their children because indirectly the habits of parents will be imitated and made an example for their children

What characterizes effective tooth brushing of daily users of powered versus manual toothbrushes?

BackgroundRecent data show comparable deficits in oral cleanliness after tooth brushing in habitual users of powered toothbrushes (PT) and manual toothbrushes (MT). The present analysis explores the origin of these deficits by relating aspects of the observed tooth brushing behaviour to plaque after tooth brushing.MethodsUsers of rotating-oscillating PT (N = 48) and of MT (N = 52) brushed their teeth the best they could while being filmed. Video analyses assessed brushing time, number of sextants brushed sufficiently long (7.5 s per surface; NSBSL), brushing of outer surfaces with closed jaws, and brushing movements. Correlation analyses examined the relationship between these parameters and plaque after brushing (Marginal Plaque Index (MPI); Turesky modification of Quigley Hein Index (TQHI)) and gingivitis (Papillary Bleeding Index (PBI)).ResultsIn PT users, correlations between behaviour and MPI-scores were significant for the NSBSL (outer surfaces: rho = − 0.249; inner surfaces: rho = − 0.510) and brushing duration (outer surfaces: rho = − 0.399; inner surfaces: rho = − 0.509). In MT users, vertical movements on the outer surfaces were positively related to MPI (rho = 0.299). In contrast, circular movements correlated negatively with MPI in those who brushed all outer sextants sufficiently long (n = 47: rho = − 0.294). In both groups, PBI-scores on the inner surfaces were negatively correlated to NSBSL and brushing duration (rho = − 0.327 − rho = − 0.246).ConclusionNSBSL and brushing duration appear to play an important role for brushing effectiveness and gingival health in PT and MT users. Whether PT users apply brushing movements or not apparently does not affect the result. In MT users, circular movements seem to be more efficient than vertical movements on the outer surfaces.

Poor tooth brushing behavior is associated with high risk of cardiovascular events: A prospective observational study

BackgroundsPoor oral care is associated with cardiovascular disease. The aim of this study was to determine the impact of tooth brushing behavior on the incidences of future cardiovascular events in a general population including patients with cardiovascular disease. MethodsThis was a prospective observational study which included 692 participants (437 men and 255 women, mean age, 63 ± 16 years). The participants were divided into three groups according to the frequency and duration of tooth brushing: low frequency and short duration group (<twice/day and <2 min/procedure), low frequency or short duration group (<twice/day or <2 min/procedure), and non-low frequency and non-short duration group (≥twice/day and ≥2 min/procedure). We assessed the associations of tooth brushing behavior with major adverse cardiovascular events (MACEs) including death from cardiovascular causes, acute myocardial infarction, hospitalization for heart failure, and stroke. ResultsDuring a median follow-up period of 28.5 (15.4–35.1) months, 32 events occurred (10 deaths from cardiovascular causes, one acute myocardial infarction, 13 hospitalizations for heart failure, and eight strokes). Kaplan-Meier curves for MACEs among the groups were significantly different (P = 0.001). After adjustment for cardiovascular risk factors, the combination of low frequency and short duration of tooth brushing was significantly associated with high incidences of MACEs compared with the incidences of MACEs for the combination of non-low frequency and non-short duration of tooth brushing (hazard ratio, 3.06; 95% confidence interval, 1.24–7.63; P = 0.02). ConclusionsThe combination of decreased frequency and duration of tooth brushing is associated with a higher risk of cardiovascular events.Clinical Trial Registration Information: URL for Clinical Trial: http://UMIN; Registration Number for Clinical Trial: UMIN000003409.

Relationship between Dental Caries Risk Factors and Quality of Life in Elementary School Children

The prevalence of dental caries among children in Indonesia is still high. Riskesdas data in 2018 shows that children aged 8-12 years are vulnerable to dental caries problems. Dental caries have an impact on children's quality of life. The purpose of this study was to determine the relationship between risk factors for dental caries and children's quality of life and the magnitude of the influence of each risk factor. This type of research is analytic observational with a cross-sectional design. The population is elementary school children in the area of Banyuraden, Gamping, Sleman, Yogyakarta. The time of the study was from March 2021 to August 2021. The sampling technique was carried out by purposive sampling; the number of samples was 200 children. The influence variable is the risk factor for dental caries, and the affected variable is the child's quality of life. The research instrument is a questionnaire consisting of 30 statement items. Assessment of dental caries risk factors includes knowledge of caries, tooth brushing behavior, and cariogenic food eating habits. In contrast, assessing children's quality of life is seen from oral cavity complaints, functional complaints, psychological complaints, and limitations of social interaction. Data were analyzed by univariate, bivariate, and chi-square tests. The results showed more children with low quality of life (67.0%) than children with high quality of life (33.0%). The chi-square correlation test results showed a significant relationship between knowledge about dental caries and children's quality of life (p=0.002; OR=2.77), between tooth brushing behavior and children's quality of life (p=0.012; OR=2.14). as well as between the habit of eating cariogenic foods with the quality of life of children (p=0.020; OR=2.03). This study concludes a significant relationship between knowledge, behavior, and eating habits with children's quality of life.

The influence of family socioeconomic status on toothbrushing practices in Australian children.

To assess the relationship between toothbrushing behavior and socio-demographic characteristics in Australian children. Data were collected through the 2012-2014 Australian National Child Oral Health Survey (NCOHS). NCOHS was a cross-sectional survey of representative school children aged 5-14 years of Australia with a total sample size of 24,664 children. Two-thirds (69%) of Australian children brushed twice or more times a day and the mean age of starting toothbrushing with fluoridated toothpaste was 24 months. Males were less consistent with toothbrushing than females (OR=0.85; 95% CI: 0.74-0.97) and the likelihood of brushing twice or more a day improved with the increase in age (OR=1.05; 95% CI: 1.02-1.08). Children with university educated (OR=1.80; 95% CI: 1.44-2.26), vocational trained parents'/guardians' (OR=1.45, 95% CI 1.11-1.90), living in families with an income of >AU$120,000 (OR=1.42; 95% CI: 1.08-1.89) and having an overseas born parent (OR=1.30; 95% CI: 1.07-1.58) were more likely to brush their teeth twice or more a day than their comparative counterparts. Children in households with two children (OR=1.33; 95% CI: 1.07-1.64) were more likely to brush twice or more than single-child households. Children with a health welfare card tended to delay the start of toothbrushing by 1.4months in comparison to those without a welfare card. Children with one of the caregivers born overseas started brushing later than those with Australia born caregivers (B= 1.04; SE=0.46). Children living in high income and educated families and households with two or more children tended to start toothbrushing at an earlier age. Several family socio-demographic factors influenced toothbrushing habits in Australian children.

Associations of toothbrushing behaviour with risks of vascular and nonvascular diseases in Chinese adults

Accumulating evidence has shown that poor oral hygiene is associated with increased risk of cardiometabolic diseases in Western populations. However, its relevance about the relationships in Chinese adults remains unclear. The China Kadoorie Biobank enrolled 512715 adults aged 30-79years in China during 2004-2008. Cox regression was used to estimate adjusted hazard ratios (HRs) for each disease associated with measures of oral hygiene. Overall 9.3% of the participants reported rarely or never brushing teeth at baseline. Participants who rarely or never brushed teeth had adjusted HR of 1.12 (95% CI: 1.09, 1.15) for MVE, with similar HRs for stroke (1.08, 1.05-1.12), intracerebral haemorrhage (1.18, 1.11-1.26) and pulmonary heart disease (1.22, 1.13-1.32) compared with those who brushed teeth regularly. Those who did not brush teeth also had increased risk of cancer (1.09, 1.04-1.14), chronic obstructive pulmonary disease (COPD) (1.12, 1.05-1.20), liver cirrhosis (1.25, 1.09-1.44) and all-cause death (1.25, 1.21-1.28) but not type 2 diabetes (0.94, 0.86-1.03) and chronic kidney disease (0.98, 0.81-1.18). Among Chinese adults, we found that poor oral hygiene is associated with higher risks of major vascular disease, cancer, COPD, liver cirrhosis and all-cause deaths, but not type 2 diabetes and chronic kidney disease.

Influence of maternal postpartum depression on children's toothbrushing frequency.

Daily toothbrushing behaviour is very effective for the prevention of early childhood dental caries (ECC), but is mostly dependent upon parental management. Intrapersonal association between lower toothbrushing frequency and depression is well known; however, the impact of maternal postpartum depression on child toothbrushing behaviour within the mother-child dyad remains unknown. The aim of this study was to determine the association between the prevalence of maternal postpartum depression and lower toothbrushing frequency in children aged two years. A secondary analysis of a data set from the Japan Environment and Children's Study was performed. A total of 104062 fetuses were enrolled after obtaining informed written parental consent, in which 84533 mother-infant pairs were included after applying exclusion criteria. The Edinburgh Postpartum Depression Scale (EPDS) was used to evaluate maternal postpartum depression (a total score of ≥9 in EPDS) at one and six months postpartum. Indeed, the participants were classified based on the persistence of postpartum depression: 'Resilient' (no prevalence); 'Improving' (prevalence only at one month postpartum); 'Emergent' (prevalence only at six months postpartum); and 'Chronic' (prevalence at both time points). The association between postpartum depression and a toothbrushing frequency in children (the reference group: more than once per day, the low group: once per day, and the very-low group: less than once per day) was examined using Poisson regression models with adjustments for maternal and child characteristics after multiple imputations for missing data. The prevalence of maternal postpartum depression at one and six months postpartum was 13.9% and 11.4%, respectively; the proportions of each persistence group were 81.1% ('Resilient'), 7.5% ('Improving'), 5.0% ('Emergent') and 6.4% ('Chronic'). Concerning children's toothbrushing frequency, 51.6% and 0.5% of participants self-reported frequencies of once per day and less than once per day, respectively. The association of maternal postpartum depression with a lower toothbrushing frequency in children consistently had higher relative risks (RRs). However, these associations were weakened when adjusting for whether the child could self-perform toothbrushing or whether this was done under parental supervision. A key result is that participants with persistent postpartum depression at both one and six month(s) postpartum showed the highest adjusted RRs (95% CI) for lower toothbrushing frequency in children (1.08 [1.04-1.12] with a decrease in children's toothbrushing frequency). Maternal mental health provides valuable screening information for children with lower toothbrushing frequency for the purpose of preventing ECC.

Pre-schoolers\u2019 tooth brushing behaviour and association with their oral health: a cross sectional study

BackgroundToothbrushing 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.MethodsThis 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.ResultsGirls 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.ConclusionsPreschool children’s toothbrushing behaviour was inadequate while their oral health was poor, with a significant association between the two parameters.