Dental RECUR Randomized Trial to Prevent Caries Recurrence in Children.

The purpose of this study was to determine the efficacy of a dental nurse-delivered intervention-the Dental RECUR Brief Negotiated Interview for Oral Health (DR-BNI)-in reducing the recurrence of dental caries in children who have a primary tooth extracted. It was based on a 2-arm multicenter randomized controlled trial with blinded outcome assessment. Participants were 5- to 7-y-old children (n = 241) scheduled to have primary teeth extracted in 12 UK centers. Test intervention parents (n = 119) received DR-BNI led by trained dental nurses. DR-BNI is a 30-min structured conversation informed by motivational interviewing with a forward focus to prevent future caries. Preventive goals are agreed, and a review appointment is made with child's general dental practitioner, who is advised to treat the child as being at high caries risk. The control intervention (n = 122) was a parent-nurse conversation about child's future tooth eruption, with advice given to visit a general dental practitioner as usual. At baseline, the DR-BNI group's mean dmft was 6.8, and the control group's was 6.3. A median of 5 teeth were extracted, mainly under general anesthesia. Final dental assessments were conducted by a single examiner visiting 189 schools 2 y after intervention; 193 (80%) of 241 children were examined. In the control group, 62% developed new caries in teeth that were caries-free or unerupted at baseline, as compared with 44% in the test group, a significant reduction (P = 0.021). The odds of new caries experience occurring were reduced by 51% in the DR-BNI group as compared with control. There was a 29% decrease in the relative risk of new caries experience in the DR-BNI group as compared with control. This single low-cost, low-intensity intervention was successful in significantly reducing the risk of recurrence of dental caries in children. This trial has implications for changing pediatric dental practice internationally. Training in and implementation of a motivational interviewing-informed brief intervention provides opportunities for dental nurses to facilitate behavior change improving the oral health of children at high caries risk (ISRCTN 24958829).

Analysis of health behaviour change interventions for preventing dental caries delivered in primary schools.

To improve oral health in children, the key behaviours (tooth brushing and sugar control) responsible for development of dental caries need to be better understood, as well as how to promote these behaviours effectively so they become habitual; and, the specific, optimal techniques to use in interventions. The aim of this paper is to describe and analyse the behaviour change techniques that have been used in primary school-based interventions to prevent dental caries (utilizing a Cochrane systematic review that we have undertaken) and to identify opportunities for improving future interventions by incorporating a comprehensive range of behaviour change techniques. Papers of five interventions were reviewed and data were independently extracted. Results indicate that behaviour change techniques were limited to information-behaviour links, information on consequences, instruction and demonstration of behaviours. None of the interventions were based on behaviour change theory. We conclude that behaviour change techniques used in school interventions to reduce dental caries were limited and focused around providing information about how behaviour impacts on health and the consequences of not developing the correct health behaviours as well as providing oral hygiene instruction. Establishing which techniques are effective is difficult due to poor reporting of interventions in studies. Future design of oral health promotion interventions using behaviour change theory for development and evaluation (and reporting results in academic journals) could strengthen the potential for efficacy and provide a framework to use a much wider range of behaviour change techniques. Future studies should include development and publication of intervention manuals which is becoming standard practice in other health promoting programmes.

Family relationships as an explanatory variable in childhood dental caries: a systematic review of measures.

It is widely acknowledged that parental beliefs (self-efficacy) about oral health and parental oral health-related behaviours play a fundamental role in the establishment of preventative behaviours that will mitigate against the development of childhood dental caries. However, little attention has been given to the wider perspective of family functioning and family relationships on child oral health. For oral health researchers, exploration of this association requires the use of reliable, valid and appropriate assessment tools to measure family relationships. In order to promote methodologically sound research in oral health, this systematic review aims to provide a guide on self-report psychometric measures of family functioning that may be suitable to utilize when exploring childhood dental caries. This systematic review has identified 29 self-report measures of family functioning and evaluated them in terms of their psychometric support, constructs measured and potential utility for oral health research. The majority of the measures reported adequate levels of reliability and construct validity. Construct evaluation of the measures identified five core domains of family functioning, namely 'communication', 'cohesion/engagement', 'control', 'involvement' and 'authoritative/rigid parenting style'. The constructs were subsequently evaluated with respect to their potential relevance to child oral health. Herewith this review provides a framework to guide future research to explore family functioning in furthering our understanding of the development of childhood dental caries.