Changes in Parental Perceptions of Their Care of Their Children's Oral Health From Age 1 to 4 Years.

INTRODUCTION: In this 3-year longitudinal study, parent/child attended 3 dental visits and in between, parents were called every 4 months and asked if their child had visited the dentist and if fluoride varnish had been applied. METHODS: Objectives were to assess changes in parents' perceptions of how well they do in taking care of their children's teeth and/or gums across these 3 time points (at age 1, 2.5, and 4 years), assess differences in parents' perceptions of how well they do taking care of their children's teeth and/or gums versus taking care of their children's medical health, and determine factors associated with parental perceptions of how well they do in taking care of the children's teeth and/or gums longitudinally. RESULTS: Participant pairs (1325) were enrolled and over time there was a significant improvement in parental perceptions of their job taking care of their children's teeth and/or gums, increasing from 86% perceiving it to be excellent/very good/good at their child's 1 year of age to 92% at child's age 4 years. The estimated odds of parents perceiving they provided excellent/very good/good versus fair/poor care for the children's teeth and/or gums were higher for those who cleaned and checked inside the children's mouth and/or gums daily (odds ratio 4.74) or took their children to the dentist yearly or twice yearly (odds ratio; 2.73). CONCLUSIONS: Parents' perceptions of the care of their children's teeth and/or gums improved over time. Parents consistently perceived that they provided better medical care than dental care for their child.

USA dental health providers' role in HPV vaccine communication and HPV-OPC protection: a systematic review.

Background. Improving human papilloma virus (HPV) vaccination coverage in the US will require healthcare providers to recommend the vaccine more effectively. To inform quality improvement efforts, we systematically reviewed studies of dental provider communication about HPV vaccination. Methods. We searched MEDLINE, CINAHL, ScienceDirect, PsycINFO and JSTOR in August 2018 to identify studies of dental provider knowledge, perceived role and communication about HPV, HPV vaccination and HPV-associated oropharyngeal cancer (HPV-OPC). Results. We identified 10 qualitative and quantitative studies. Results of the primarily descriptive studies showed that although there were some deficiencies in knowledge about HPV-related outcomes and its effect on the male population, most providers understand HPV as a sexually transmitted infection and know the HPV vaccine is available, yet many are not discussing the HPV-OPC link or recommending vaccination. Providers were less often to recommend HPV vaccination if they were uncomfortable discussing sex, perceived parents as hesitant, or believed patients to be low risk. Studies reported mixed results on providers' perceived role in expanded HPV vaccination and HPV-OPC education, but indicated support for the role of professional organizations in promoting awareness. Conclusion. Interventions are needed to help dental providers perceive their role to deliver effective recommendations within the complex communication environment surrounding HPV vaccination and HPV-OPC education.

Midwestern Latino caregivers' knowledge, attitudes and sense making of the oral health etiology, prevention and barriers that inhibit their children's oral health: a CBPR approach.

BACKGROUND: Using community-based participatory research, the Health Protection Model was used to understand the cultural experiences, attitudes, knowledge and behaviors surrounding caries etiology, its prevention and barriers to accessing oral health care for children of Latino parents residing in Central Indiana. METHODS: A community reference group (CBPR) was established and bi-lingual community research associates were used to conduct focus groups comprised of Latino caregivers. Transcripts were analyzed for thematic content using inductive thematic analysis. RESULTS: Results indicated significant gaps in parental knowledge regarding caries etiology and prevention, with cultural underlays. Most parents believed the etiology of caries was related to the child's ingestion of certain foods containing high amounts of carbohydrates. Fewer parents believed either genetics/biological inheritance or bacteria was the primary causative factor. Fatalism negatively impacted preventive practices, and a clear separation existed concerning the perceived responsibilities of mothers and fathers to provide for the oral needs of their children. Females were more likely to report they were primarily responsible for brushing their children's teeth, overseeing the child's diet and seeking dental care for the child. Fathers believed they were primarily responsible for providing the means to pay for professional care. Perceived barriers to care were related to finances and communication difficulties, especially communicating with providers and completing insurance forms. CONCLUSION: The main study implication is the demonstration of how the CBPR model provided enhanced understanding of Latino caregivers' experiences to inform improvements in oral prevention and treatment of their children. Current efforts continue to employ CBPR to implement programs to address the needs of this vulnerable population.

Open Mouth, Open Mind: Expanding the Role of Primary Care Nurse Practitioners.

Oral health is essential to overall health at any age, although in children it is particularly important because poor oral health can have a deleterious effect on deciduous and permanent dentition. For decades, oral health providers have urged primary care providers to incorporate oral health assessment, risk factor identification, parent education, and preventive therapy into routine well-child visits. Despite recommendations from various professional associations and governmental organizations, the incidence of dental disease in young children remains relatively unchanged. Although the literature has clearly demonstrated that preventive care treatments, such as the application of fluoride varnish performed in the primary care setting, improve oral health in children, very few primary care providers include oral health services in their well-child visits. The purpose of this article is to reduce the barriers and knowledge gaps identified in recent pediatric oral health research and educate primary care nurse practitioners on the application of fluoride varnish to reduce the risk of the development of dental caries in young children.

Factors Associated With Parents' Perceptions of Their Infants' Oral Health Care.

INTRODUCTION: Parents have an important role ensuring their infants receive oral and medical health care. Their decisions affect the well-being of their children. METHODS: This study used data collected from a longitudinal, prospective study with the aim of developing and validating a caries risk assessment tool. The objectives of this study are to (a) compare parents' perceptions of how well they do in taking care of the infants' teeth and/or gums versus how well they do in taking care of the infants' medical health and (b) determine factors associated with parental perceptions of how well they do in taking care of the infants' teeth and/or gums. RESULTS: A total of 1323 parent/infant pairs were enrolled in the study at Duke University, Indiana University, and the University of Iowa. Through a survey, 283 (21%) of the parents perceived they did an excellent job of both taking care of both the infant's oral and medical health, while 861 (65%) perceived the care of their infant's medical health was better than their care of the teeth and/or gums. In the multivariable model, parents who perceived they provided excellent/very good/good care for the infants' teeth and/or gums were more likely to brush the infant's teeth daily, use toothpaste daily, clean inside the infant's mouth and/or gums daily, and not let the infant have something other than water after brushing and prior to bedtime. Also, those with infants having Medicaid or State Insurance, parents not eating sugary snacks frequently, and parents getting dental checkups at least annually were likely to perceive that they provided excellent/very good/good care for their infant's teeth and/or gums. CONCLUSIONS: Parents who provide good infant oral health care are more likely to perceive they provide good care and more likely to have better personal dental health behaviors. This agrees with previous studies concerning older children.

The Importance of Developing Communication Skills: Perceptions of Dental Hygiene Students.

Purpose: The purpose of this study was to gather data from first- and second-year dental hygiene students concerning their perceptions of the benefits and possible impediments to effective patient communication. Additionally, the students were asked to theorize as to the impact emerging communication technologies could have on oral health promotion, practice administration and patient/provider communication.Methods: A self-administered questionnaire of 6 open-ended queries was employed. Thematic analysis was conducted to reveal themes related to their perceived ability to effectively communicate, perceived barriers to communication, possible solutions to lessen or eliminate these barriers, and the impact of emerging technologies on interpersonal communication.Results: The questionnaire was completed by 63 of 68 students (93%). Patient apathy and patient unwillingness to change detrimental health-related habits were the most frequently cited barriers to effective communication. Of the students having patient contact, many stated that they were less sure of their ability to communicate effectively if the patient differed from themselves, such as being elderly or being from another culture. While most of the students believed their fundamental communication skills were good, many noted that improving their higher-order skills, such as conveying empathy or displaying a nonjudgmental attitude, were essential to being more effective communicators. Many students felt emerging technologies such as universal translators could potentially assist them in overcoming some of their perceived deficiencies.Conclusion: While perceived inadequacies will likely diminish as the students gain more experience in school and later in private practice, dental hygiene programs may wish to consider implementing additional structured educational experiences to better prepare students to address patient apathy and to effectively convey a sense of personal compassion. Promoting student involvement in community outreach activities and providing a variety of service learning opportunities, including foreign travel, may broaden student experiences and deepen their awareness and appreciation of verbal and nonverbal communications displayed by differing cultures.

Fluoride content of infant foods.

Excessive fluoride consumption during the first 2 years of life is associated with an increased risk of dental fluorosis. Estimates of fluoride intake from various sources may aid in determining a child's risk for developing fluorosis. This study sought to assess the fluoride content of commercially available foods for infants, and to guide dentists who are advising parents of young children about fluoride intake. Three samples each of 20 different foods (including fruits and vegetables, as well as chicken, turkey, beef/ham, and vegetarian dinners) from 3 manufacturers were analyzed (in duplicate) for their fluoride content. Among the 360 samples tested, fluoride concentration ranged from 0.007-4.13 µg fluoride/g food. All foods tested had detectable amounts of fluoride. Chicken products had the highest mean levels of fluoride, followed by turkey products. Consuming >1 serving per day of the high fluoride concentration products in this study would place children over the recommended daily fluoride intake. Fluoride from infant foods should be taken into account when determining total daily fluoride intake.

Introduction of health literacy into the allied dental curriculum: first steps and plans for the future.

In 2003, the U.S. Department of Education's National Center for Education Statistics conducted the National Assessment of Adult Literacy (NAAL). The NAAL reported that over 90 million adults were functionally or marginally illiterate. When these individuals encounter the health care system, they often have difficulties with reading and understanding basic text and, as a result, have difficulty managing their disease or using medications. The purpose of this article is to describe our initial efforts to educate our students concerning health literacy, its consequences, and our assessment. As part of a new segment of the allied health curriculum, second-year dental hygiene students received a lecture concerning the prevalence of poor literacy in America and the possible consequences of poor literacy on their patients' ability to maintain oral health. To provide clinical experience with assessing health literacy, the students were instructed in the administration of a validated medical health literacy tool. This clinical exercise had two functions: 1) to familiarize students with assessing health literacy as part of their clinical experience and 2) to continue to gather preliminary data concerning the level of health literacy of adult patients at Indiana University School of Dentistry using a standardized methodology, the Short Test of Functional Health Literacy in Adults (S-TOFHLA). The results indicated that 13 percent of those assessed had "inadequate" or "marginal" literacy as measured by the S-TOFHLA. As a result, we plan to continue to expand our educational efforts and develop a larger investigation of the prevalence in our dental school population. With these data, we hope to develop effective educational programs and experiences for our students, faculty, and staff to improve their awareness and communication skills and ultimately improve the oral health of our patients.

Comparison of a dietary survey and the duplicate plate method for determining dietary fluoride ingested by young children: a pilot study.

BACKGROUND: Investigators have attempted to establish the diet's contribution to the total body burden of fluoride in response to a reported trend towards an increase in fluoride intake. AIM: The aim of this study was to compare the suitability of two methods to collect dietary data for fluoride intake assessment. DESIGN: Assessments were made in 12 children using the duplicate plate and dietary diary methods following a randomized cross-over design. Foods and beverages were analysed for fluoride, and total fluoride intake per day was calculated. Results from each method were compared. RESULTS: Mean beverage fluoride intake was estimated at 316 +/- 120 and 422 +/- 195 microg/day utilizing the diary and duplicate plate methods, respectively. Mean food fluoride intake was estimated at 188 +/- 48 microg/day using the diary, whereas it was 130 +/- 41 microg using the duplicate plate method. Total fluoride intake was 504 +/- 138 and 552 +/- 192 microg/day utilizing the diary and duplicate methods. Large variations in daily fluoride intake from both beverages and food were observed between and within children. CONCLUSIONS: Both methods had inherent shortcomings and sources of error. The duplicate method was more labour intensive and costly; however, the diary method required a large number of assumptions. A combination of both methods seems to be most suitable to obtain reliable data.

Development of a standardisation device for photographic assessment of dental fluorosis in field studies.

PURPOSE: This study evaluated the agreement between clinical and photographic assessment of dental fluorosis (DF) in 73 children during a field study, using portable equipment and a standardising device. MATERIALS AND METHODS: A dental exam was performed using the Tooth Surface Index of Fluorosis (TSIF). Photographs of the facial aspects of front teeth and from the occlusal aspect of the mandibular posterior teeth were taken. All photographs were taken following a standard operating procedure. Photographs of anterior and posterior teeth were coded and assigned a random study number. Examiners scored photographs as fluorosis cases or non-cases. RESULTS: Agreement among the clinical examiners ranged from good to excellent. Agreement was also good for the repeated photographic evaluations. In total, 22% of the children were diagnosed with DF during a clinical exam, and 19% were diagnosed with DF using the photographs. CONCLUSIONS: Development of this method aided in the photographic assessment of DF. The photographs obtained were a useful tool for documenting DF, to re-train examiners, and to determine intra- and inter-examiner agreement.

Health literacy in an adult dental research population: a pilot study.

OBJECTIVE: The purpose of this investigation was to gather data concerning the level of health literacy in adults who frequently volunteer for our clinical research programs. METHODS: A convenience sample of 99 adults was recruited from our database of subjects taking part in an ongoing series of investigations. Health literacy was measured using the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Additional demographic and socioeconomic data were collected by means of a questionnaire. RESULTS: The results indicated that 13 percent of the cohort of subjects scored in the "inadequate" or "marginal" categories as described by the criteria of the S-TOFHLA. Inadequate or marginal health literacy was associated with race, gender, and age. Unfortunately, the sample size was too small to determine the interaction of these variables. CONCLUSIONS: Dental faculty conducting clinical research investigations should be cognizant of the fact that a portion of adults, especially older adults, may have difficulty reading written instructions, informational letters of consent, prescriptions, and other documents. Researchers should make every effort to ensure that information provided in text form is provided in a manner that is easily understandable to the reader. Technical terminology and jargon should be avoided or if used, it should be explained in plain, simple language. If a potential subject is having difficulty, the investigator is obligated to take the additional time to educate the potential subject using alternative methods.

The fluoride content of foods and beverages from negligibly and optimally fluoridated communities.

In the spring of 1996, foods and beverages most commonly consumed by adolescents were analyzed for fluoride as part of a larger investigation. These foods were selected by interviewing 711 adolescents, 12-14 years of age, who were long-time residents of either an optimally or negligibly fluoridated community. The brand names of the identified foods and beverages most commonly purchased were determined by interviews with the parents. A total of 441 brand-name food and beverage items were purchased from both communities and were individually analyzed for fluoride. These analyses were done in order to estimate the fluoride content of various kinds of foods and beverages and to determine whether or not there was a significant difference between the two communities in the amount of fluoride ingested from these dietary sources. The food and beverage items were classified into dietary groups based on US Department of Agriculture (USDA) guidelines. Overall, the fluoride content of the sampled foods and beverages was low. In addition, there was no significant difference in the fluoride content of the same pre-packaged or ready-to-eat food or beverage items purchased in the two communities. However, a significant difference was found between the two communities in the fluoride content of fountain beverages and in cooked or reconstituted foods prepared using local water from the respective communities. Based on these results, we have estimated the mean daily, dietary fluoride intake for 3-5-year-old children who are more susceptible to developing dental fluorosis.