Spanish-speaking Mexican-American parents' experiences while navigating the dental care system for their children.

OBJECTIVES: The purpose of this study is to describe Mexican-American parents' experiences navigating the dental care system for their children. METHODS: Thirty in-depth qualitative interviews were conducted with Spanish-speaking caregivers of young children in an urban county of Northern California, asking about their experiences navigating dental care for their children. Interviews were digitally recorded, translated, transcribed, coded, and analyzed using standard qualitative procedures. RESULTS: Caregivers reported challenges that highlight how various aspects of navigating the health care system are elemental to oral health literacy. These included making appointments, finding a provider they trust, using their dental insurance, and communicating with the dental care provider. CONCLUSIONS: When addressing oral health literacy, it is important to consider the navigational components to improve children's oral health literacy.

Importance of Content and Format of Oral Health Instruction to Low-income Mexican Immigrant Parents: A Qualitative Study.

PURPOSE: This study's purpose was to explore how content and format of children's oral health instruction in the dental clinic is perceived by parents and might affect parents' knowledge and behaviors. METHODS: Thirty low-income Mexican immigrant parents of children age five years and under were recruited from dental clinics in 2015 to 2016. In-person qualitative interviews in Spanish about their children's and their own experiences of dental care and home oral hygiene practices were conducted, digitally recorded, translated, and transcribed. Data analysis involved iteratively reading text data and developing and refining codes to find common themes. RESULTS: Twenty-five of 30 parents recalled receiving oral hygiene instruction, and 18 recalled receiving nutrition instruction and were included in analyses. The format and effectiveness of instruction varied. More engaging educational approaches were recalled and described in more detail than less engaging educational approaches. As a result of oral hygiene and nutritional instruction, most parents reported changing their oral hygiene home behaviors for their children; half aimed to reduce purchasing sugary foods and drinks. CONCLUSIONS: Most parents recalled receiving oral hygiene and nutrition instruction as part of their child's dental visit and reported incorporating the instruction and recommendations they received into their children's home routine.

Integrating a Nurse-Midwife-Led Oral Health Intervention Into CenteringPregnancy Prenatal Care: Results of a Pilot Study.

INTRODUCTION: National and professional organizations recommend oral health promotion in prenatal care to improve women's oral health. However, few prenatal programs include education about oral health promotion. The objective of this study was to determine if women receiving a brief, low-cost, and sustainable educational intervention entitled CenteringPregnancy Oral Health Promotion had clinically improved oral health compared to women receiving standard CenteringPregnancy care. METHODS: Women attending CenteringPregnancy, a group prenatal care model, at 4 health centers in the San Francisco Bay Area, participated in this nonrandomized controlled pilot study in 2010 to 2011. The intervention arm received the CenteringPregnancy Oral Health Promotion intervention consisting of two 15-minute skills-based educational modules addressing maternal and infant oral health, each module presented in a separate CenteringPregnancy prenatal care session. The present analysis focused on the maternal module that included facilitated discussions and skills-building activities including proper tooth brushing. The control arm received standard CenteringPregnancy prenatal care. Dental examinations and questionnaires were administered prior to and approximately 9 weeks postintervention. Primary outcomes included the Plaque Index, percent bleeding on probing, and percent of gingival pocket depths 4 mm or greater. Secondary outcomes were self-reported oral health knowledge, attitudes (importance and self-efficacy), and behaviors (tooth brushing and flossing). Regression models tested whether pre to post changes in outcomes differed between the intervention versus the control arms. RESULTS: One hundred and one women participated in the study; 49 were in the intervention arm, and 52 were in the control arm. The control and intervention arms did not vary significantly at baseline. Significant pre to post differences were noted between the arms with significant improvements in the intervention arm for the Plaque Index, bleeding on probing, and pocket depths 4 mm or greater. DISCUSSION: Providing brief oral health education and skills-building activities within prenatal care may be effective in improving women's oral health during pregnancy. These findings provide support for developing a full-scale randomized clinical trial of the CenteringPregnancy Oral Health Promotion intervention.

Sociodemographic disparities and behavioral factors in clinical oral health status during pregnancy.

OBJECTIVES: Although oral health (OH) problems are common during pregnancy, little is known about individual characteristics or behaviors relating to clinically assessed OH during pregnancy. This cross-sectional study describes the clinical OH status of a sample of pregnant women, examines relationships between sociodemographic factors and OH, behavioral factors and OH, and the influence of behavior on the relationships between sociodemographic clusters and OH. Baseline data were utilized from a pilot intervention study promoting OH during pregnancy. METHODS: Participants (n = 99), recruited from CenteringPregnancy(®) prenatal care groups completed questionnaires addressing race/ethnicity, income, education, dental insurance, oral hygiene practices, and dental care utilization; and clinical examinations for periodontal probing depths (PD), bleeding on probing (BOP), plaque assessment, and visual detection of untreated decay. Chi-squares and one-way anovas with Tukey's studentized range test of planned comparisons were conducted to examine bivariable relationships between both sociodemographic and behavioral characteristics to OH status. Multivariable logistic regression analyses tested whether the effects of sociodemographic variables on OH status might be mediated by behaviors, including self-reported oral hygiene and recent dental visits. RESULTS: Forty-five percent of the sample had untreated decay and the mean percentage of sites with BOP = 18%. Bivariable analyses of sociodemographic factors indicated that compared with Whites, Hispanic women had greater % of sites with: BOP, PD ≥5 mm plus BOP, and Plaque Index (PI) scores of ≥2, all P = 0.05; and greater untreated decay (Chi-square 13.3, P < 0.001). Lower income was related to greater untreated decay (Chi-square 7.6, P < 0.01). Compared with the highest education level, the lowest level group had higher % BOP, P < 0.05. Public dental insurance (versus private) was associated with greater % BOP, PD ≥5 mm plus BOP, both P < 0.05, and greater untreated decay (Chi-square 16.9, P < 0.001). Regarding behaviors, lacking a past 6-month dental visit was related to greater: BOP, PD ≥5 mm plus BOP, and PI ≥2 (F range 6.2-8.7, P < 0.01-0.05); and greater untreated decay (Chi-square 12.0, P < 0.001). Self-reported optimal oral hygiene was related to lower % BOP and PD ≥5 mm plus BOP (F range 4.5-6.7, both P < 0.05). Mediation analyses indicated that there were significant indirect effects of racial/ethnic differences on OH outcomes via having a recent dental visit (OR range 1.2-1.9). However, significant differences between the Hispanic and White groups remained. CONCLUSIONS: This study highlights sociodemographic disparities in clinical OH during pregnancy, the importance of dental care, and provides useful findings for tailoring interventions for expectant mothers and their infants.

Recruiting and retaining pregnant women from a community health center at the US-Mexico border for the Mothers and Youth Access clinical trial.

BACKGROUND: Recruitment and retention in clinical trials of minorities is low, particularly in rural underserved populations. This has slowed progress in addressing racial/ethnic disparities in oral health. PURPOSE: To describe factors associated with successful recruitment, and identify predictors of continued retention of pregnant women attending a community health center into a randomized controlled clinical trial to prevent early childhood caries. METHODS: The Mothers and Youth Access (MAYA) Trial recruited women in the second trimester of pregnancy. At baseline, consenting women completed an oral health questionnaire and received a dental exam and oral health counseling. Four months postpartum, women returned with their babies for randomization with follow up at 9-, 12-, 18-, 24-, 30-, and 36-month postpartum visits. To assess predictors of retention, data about respondents' demographics, and oral health-related knowledge, attitudes, and behaviors were obtained by questionnaire and analyzed by logistic and discrete time-to-event regression analyses. RESULTS: Of 556 predominantly Mexican-American women recruited at baseline, 195 (35%) were excluded after baseline for not meeting inclusion criteria; 361 (65%) continued to randomization. Factors such as race/ethnicity, annual household income, household composition, oral health-related knowledge and behaviors significantly related to retention until randomization. In multivariable models, women reporting a higher annual household income were less likely to be lost to attrition before randomization (odds ratio = 0.73, 95% confidence interval (CI) 0.60-0.89); while Mexican/Mexican-American women were less likely to be lost beyond randomization (hazard ratio = 0.53, 95% CI 0.26-1.08). LIMITATIONS: Factors not measured at baseline may have been important in predicting attrition. The MAYA Trial is expected to finish by November 2008; therefore, complete results for total retention may differ from those reported here. CONCLUSIONS: Recruitment and retention efforts for pregnant Hispanic women should place heavy emphasis on culture as ethnicity remained the only borderline significant predictor in postrandomization retention.

Giving policy some teeth: routes to reducing disparities in oral health.

Despite improvements in oral health status and clear links between oral and systemic health, oral health is not accorded the same importance in health care policy as is general health. This review of oral health disparities over the life span documents the results of this inequity. Dental concerns and unmet dental treatment needs, especially among vulnerable populations, are not well addressed in oral health policies. We offer examples of discrepancies between policy and needs and examples of successful interventions that integrate oral health care with informed policy.

Oral health status of San Francisco public school kindergarteners 2000-2005.

OBJECTIVES: To determine the prevalence of dental caries and oral health disparities in San Francisco kindergarten public school children from 2000-2005. METHODS: The San Francisco Department of Public Health in partnership with the San Francisco Dental Society and assistance from the National Dental Association, has been conducting annual dental screenings of kindergarten children enrolled in the San Francisco Unified School District since 2000. Outcomes assessed from this series of cross-sectional screenings included prevalence of caries experience, untreated caries, treatment needs, and caries severity by child's sex, race/ethnicity, residential zip code, and a proxy for socioeconomic status. RESULTS: Of 76 eligible schools, 62-72 participated, and 86-92% of enrolled children (n=3,354-3,527) were screened yearly. Although there was a small, significant decrease over the time period, in 2005, 50.1% of children had caries experience; 28.8% had untreated caries and 7.6% had urgent treatment needs. Each year caries prevalence was greatest for Asian children, those attending schools with > 50% children eligible for the free or reduced-price meal program, and children living in zip codes in and around Chinatown and San Francisco's southern border. CONCLUSIONS: Despite signs of improvement, caries remains a public health problem especially in Asian and Hispanic children, and children living in certain sections of San Francisco.