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

OBJECTIVES: 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. METHOD: 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. RESULTS: 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. CONCLUSIONS: 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).

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

OBJECTIVES: 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. METHODS: A secondary analysis of a data set from the Japan Environment and Children's Study was performed. A total of 104 062 fetuses were enrolled after obtaining informed written parental consent, in which 84 533 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. RESULTS: 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). CONCLUSION: Maternal mental health provides valuable screening information for children with lower toothbrushing frequency for the purpose of preventing ECC.

Factors related to children's tooth-brushing at different ages: an application of the theory of planned behavior.

Tooth-brushing is one of the most important health behaviors to teach children considering potentially serious ramifications of poor dental health. However, children's tooth-brushing behavior is affected by various developmental factors. The aim of this cross-sectional study was to investigate factors related to the tooth-brushing behavior of children adopting the Theory of Planned Behavior. A preliminary elicitation study with 33 primary school students identified underlying beliefs related to tooth-brushing intentions. This data was analysed, synthesized, and incorporated into the development of survey items for three age-appropriate, closed-ended questionnaires administered to 709 primary public school students. Path analyses using structural equation modelling were used to discover the structural relationships among the direct and indirect determinants of tooth-brushing behaviors, and path estimates and the model fit were calculated. Social recognition, peer influence, self-motivating strategies, and cognitive aspects of tooth-brushing were found to become more influential in facilitating behavioral intention with age. In the path models, the tooth-brushing behavioral intention was significantly related to perceived behavioral control rather than behavioral beliefs and normative beliefs. Subjective norms were found to become more significant as children matured. This result suggests that education to improve children's tooth-brushing behavior needs be appropriate to the developmental stage of children.

Oral hygiene effects verbal and nonverbal displays of confidence.

Although oral hygiene is known to impact self-confidence and self-esteem, little is known about how it influences our interpersonal behavior. Using a wearable, multi-sensor device, we examined differences in consumers' individual and interpersonal confidence after they had or had not brushed their teeth. Students (N = 140) completed nine one-to-one, 3-minute "speed dating" interactions while wearing a device that records verbal, nonverbal, and mimicry behavior. Half of the participants brushed their teeth using Close-Up toothpaste (Unilever) prior to the interactions, whilst the other half abstained from brushing that morning. Compared to those who had not brushed their teeth, participants who had brushed were more verbally confident (i.e., spoke louder, over-talked more), showed less nonverbal nervousness (i.e., fidgeted less), and were more often perceived as being "someone similar to me." These effects were moderated by attractiveness but not by self-esteem or self-monitoring.

The complexity of tooth brushing among older adults with intellectual disabilities: Findings from a nationally representative survey.

BACKGROUND: Adults with Intellectual and Developmental Disabilities (IDD) have poor oral-hygiene and oral health. A better understanding of their oral-hygiene behaviours will inform interventions to improve personal and population health. OBJECTIVE/HYPOTHESIS: To identify the oral hygiene behaviours undertaken by and on behalf of older people with IDD. METHODS: Cross-sectional survey from the third wave of the Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA) undertaken 2016-2017. Frequency of oral hygiene, level of support, type of brush used and for a subsample, brushing technique are reported. Bivariate analyses adopted Pearson's Chi Square test of independence. RESULTS: The sample (N = 609) had a mean age of 59.7 years (SD = 8.8); 88.4% (n = 536) reported tooth cleaning at least daily. The majority who had teeth to clean reported using standard toothbrushes (75.9%), with a minority using electric (9.6%) or modified toothbrushes (5.9%). Of the 505 who reported cleaning teeth, 285 (48.5%) did not report any assistance, 127 (25.2%) were totally dependent on another person and 133 (26.3%) reported assisted cleaning, of whom 40.0% (n = 52) were Supervised, reminded or encouraged, 27.7% (n = 36) reported Hand-on-Hand and 23.8% (n = 31) reported Brush-after-Brush techniques. An association was detected between assistance and type of toothbrush used (p < 0.001). None was detected between assistance and frequency-of-brushing (p > 0.05). CONCLUSIONS: Older adults with IDD present with a complex mix of supports, toothbrushes and techniques. This highlights the complexity of oral-hygiene behaviour for this population and indicates the need for bespoke individual care plans and complexity in interventions to improve population oral-hygiene.

Oral health behaviour, attitude towards, and knowledge of dental caries among mothers of 0- to 3-year-old children living in Kaunas, Lithuania.

OBJECTIVES: This study aimed to investigate the oral health behaviours of mothers with young children and their attitudes towards dental caries. METHODS: The survey targeted all mothers with children under 3 years attending a primary healthcare centre (Department of Family Medicine at the Lithuanian University of Health Sciences [LSMU] Hospital) in Kaunas, Lithuania. The Bioethics Centre of the LSMU approved the study (No. BEC-OF-14). Of 176 mothers, 123 (69.9%) took part in the 2016-2017 study. The self-administered questionnaire enquired about mothers' attitudes towards oral health and behaviours related to the potential transmission of oral bacteria to their children, dietary habits, tooth brushing, smoking, and background factors. The chi-squared test and univariate/multivariate logistic regression analyses served for the statistical analysis. (p values ≤ .05 indicated statistically significant differences). RESULTS: Most (76; 68.5%) of the mothers brushed their teeth twice daily, and 97 (87.4%) reported themselves as nonsmokers. We found a statistically significant association between mothers who brushed their own teeth twice daily and those who cleaned their children's teeth likewise (OR = 5.42, 95% CI [1.28-6.63]; p = .005). We observed significant associations among mothers who gave their children sugar-sweetened beverages (SSBs) daily and the mothers' college or lower education (OR = 6.51, 95% CI [1.59-27.19]; p = .01) and maternal tooth brushing less than twice daily (OR = 3.88, 95% CI [0.99-15.18]; p = .05). CONCLUSIONS: A majority of mothers who took part in this survey did not brush their children's teeth as recommended. Mothers with a lower education and who brushed their teeth less than twice daily offered their children SSBs more frequently.

A theory-based intervention delivered by an online social media platform to promote oral health among Iranian adolescents: a cluster randomized controlled trial.

Objective: Based on the Health Action Process Approach, we tested the efficacy of a theory-based program using an online social media platform (Telegram) to promote good oral hygiene behaviour among Iranian adolescents.Design: A three-arm randomized-controlled trial design was used, consisting of an adolescent only intervention group (A group; n = 253), an adolescent and mother intervention group (A + M group; n = 260), and a control group (n = 278).Main outcome measures: Psychosocial variables, toothbrushing behaviour, Visual Plaque Index, and Community Periodontal Index.Results: Increases in adolescent toothbrushing at the one- and six-month follow-ups in both intervention groups compared to the control group were observed. Adolescents in the A + M group showed significant greater improvements in their toothbrushing behaviour, Visual Plaque Index, and Community Periodontal Index scores than adolescents in the A group. Improvements to toothbrushing social cognitions were also observed.Conclusions: Current results support the use of the theory-based program delivered by Telegram in improving good oral hygiene behaviour and oral health outcomes among Iranian adolescents. Involving mothers in an intervention can confer additional benefits for adolescent oral health.

Autoestima e comportamentos de saúde bucal em adolescentes / Self-esteem and oral health behavior in adolescents

Resumo Este estudo investigou a mediação da autoestima nos comportamentos de saúde bucal dos adolescentes. Para avaliar a autoestima usou-se a escala de Rosenberg, já as características sociodemográficas e comportamentais foram analisadas por questões validadas em outros inquéritos. Com exceção da alimentação, a maior proporção dos adolescentes possuía bons comportamentos de saúde bucal. O número de adolescentes com alto nível de autoestima foi relevantemente menor que aqueles com baixa autoestima. A utilização dos serviços odontológicos, embora associado ao alto nível de autoestima, perdeu significância após ajustado pelo sexo, idade e escovação dos dentes. Porém, a análise de regressão logística múltipla, através das estimativas não-ajustadas e ajustadas com seus respectivos Intervalos de Confiança de 95%, evidenciou associação da autoestima com idade (p-valor=0,001) e frequência de escovação (p-valor=0,019). Independente do sexo, escolares maiores de 16 anos e com autoestima elevada, escovam seus dentes com maior frequência, adquirindo, possivelmente, melhor saúde bucal. Isto confirma a modulação da autoestima sobre os comportamentos de saúde bucal, e atesta a necessidade de implementar a análise e o exercício desse fator psicossocial na assistência à saúde bucal dos jovens.

Abstract This study investigated the mediation of self-esteem in adolescents' oral health behaviors. The Rosenberg self-esteem scale was used to assess self-esteem, whereas data from socio-demographic and behavior characteristics were analyzed by questions validated in previous surveys. The teenagers had good oral health behavior, except unhealthy diet. The number of adolescents with high self-esteem was a lot smaller than those with low self-esteem. The use of dental services, even when associated with high self-esteem, lost significance after being adjusted by sex, age and tooth brushing frequency. Nevertheless, multiple logistic regression analysis, using unadjusted estimates and adjusted with their respective Confidence Intervals of 95%, showed a relationship of self-esteem with age (p-value=0.001) and tooth brushing frequency (p-value=0.019). Regardless of the sex, students over 16 years old with high self-esteem brush their teeth more often, having probably better oral health. These results confirm the modulation of self-esteem in oral health, and then it is necessary the analysis and the use of these psychosocial factors in the young oral health care.

Self-esteem and oral health behavior in adolescents. / Autoestima e comportamentos de saúde bucal em adolescentes.

This study investigated the mediation of self-esteem in adolescents' oral health behaviors. The Rosenberg self-esteem scale was used to assess self-esteem, whereas data from socio-demographic and behavior characteristics were analyzed by questions validated in previous surveys. The teenagers had good oral health behavior, except unhealthy diet. The number of adolescents with high self-esteem was a lot smaller than those with low self-esteem. The use of dental services, even when associated with high self-esteem, lost significance after being adjusted by sex, age and tooth brushing frequency. Nevertheless, multiple logistic regression analysis, using unadjusted estimates and adjusted with their respective Confidence Intervals of 95%, showed a relationship of self-esteem with age (p-value=0.001) and tooth brushing frequency (p-value=0.019). Regardless of the sex, students over 16 years old with high self-esteem brush their teeth more often, having probably better oral health. These results confirm the modulation of self-esteem in oral health, and then it is necessary the analysis and the use of these psychosocial factors in the young oral health care.

Este estudo investigou a mediação da autoestima nos comportamentos de saúde bucal dos adolescentes. Para avaliar a autoestima usou-se a escala de Rosenberg, já as características sociodemográficas e comportamentais foram analisadas por questões validadas em outros inquéritos. Com exceção da alimentação, a maior proporção dos adolescentes possuía bons comportamentos de saúde bucal. O número de adolescentes com alto nível de autoestima foi relevantemente menor que aqueles com baixa autoestima. A utilização dos serviços odontológicos, embora associado ao alto nível de autoestima, perdeu significância após ajustado pelo sexo, idade e escovação dos dentes. Porém, a análise de regressão logística múltipla, através das estimativas não-ajustadas e ajustadas com seus respectivos Intervalos de Confiança de 95%, evidenciou associação da autoestima com idade (p-valor=0,001) e frequência de escovação (p-valor=0,019). Independente do sexo, escolares maiores de 16 anos e com autoestima elevada, escovam seus dentes com maior frequência, adquirindo, possivelmente, melhor saúde bucal. Isto confirma a modulação da autoestima sobre os comportamentos de saúde bucal, e atesta a necessidade de implementar a análise e o exercício desse fator psicossocial na assistência à saúde bucal dos jovens.

Comparative assessment of plaque removal and motivation between a manual toothbrush and an interactive power toothbrush in adolescents with fixed orthodontic appliances: A single-center, examiner-blind randomized controlled trial.

INTRODUCTION: The objective of this 2-arm parallel trial was to determine the plaque removal efficacy (main outcome) and the motivation assessment (secondary outcome) comparing a manual versus an interactive power toothbrush in orthodontic patients. METHODS: Sixty adolescents with fixed orthodontic appliances in both arches were randomized in a 1:1 ratio in this parallel, randomized, examiner-blind controlled clinical trial. Eligibility criteria included at least 16 natural teeth, 1-6 "focus care areas," plaque score of ≥1.75, no severe caries, gingivitis and periodontitis, no dental prophylaxis, no smoking, no antibiotics, and no chlorhexidine mouth rinse. Subjects were to brush unsupervised with either an interactive power toothbrush (Oral-B Professional Care 6000, D36/EB20) with Bluetooth technology or a regular manual toothbrush (Oral-B Indicator 35 soft). Focus care areas were each brushed for 10 additional seconds. Plaque removal was assessed with the use of the Turesky Modification of the Quigley-Hein Plaque Index (TMQHPI) to determine change from baseline at 2 and 6 weeks. Supervised brushing at screening and post-treatment visits recorded actual brushing times. Subject-reported motivational aspects were recorded at screening and week 6. RESULTS: Fifty-nine subjects aged 13-17 years completed the study. The interactive power toothbrush provided significantly (P <0.001) greater plaque reduction versus the manual toothbrush at 2 and 6 weeks according to the whole-mouth TMQHPI. The treatment difference in adjusted mean plaque change from baseline was 0.777 (95% CI 0.614-0.940) at week 2 and 0.834 (0.686-0.981) at week 6. Mean reductions in the number of focus care areas were also significantly greater (P <0.001) in the power brush group at weeks 2 and 6. Brushing times increased significantly at weeks 2 and 6 (P ≤0.013) versus baseline in the interactive power brush group only. Subject-reported motivation was significantly increased in the interactive power brush group at week 6 versus screening (P ≤0.005). CONCLUSIONS: An interactive power toothbrush generated increased brushing times and significantly greater plaque removal versus a manual brush.

Knowledge, attitude, and practical behavior of parents regarding their child's oral health in New Delhi.

OBJECTIVE: The objective of this study was to determine the knowledge, attitude, and practical behavior of parents regarding their children's oral health in New Delhi. METHODOLOGY: A cross-sectional study was conducted among 500 parents who reported in outpatient department in the Department of General Medicine at Maulana Azad Medical College and in the Department of Pedodontics and Preventive Dentistry at Maulana Azad Institute of Dental Sciences, New Delhi. Data were collected through a self-administered questionnaire. The statistical analysis was performed using the Statistical Package for Social Sciences software (21.0 version; Inc., Chicago IL, USA) for descriptive and multivariate analysis, and the level of statistical significance used in this study was chosen at P < 0.005. RESULTS: The results of this explorative research showed that the sample selected had a relatively good knowledge regarding the importance of the primary teeth, the fact that problems in primary teeth can affect the permanent teeth, brushing frequency on daily basis, and brushing aids. Participants were aware about the effect of prolonged bottle feeding and sticky foods on the dentition. On the other hand, the majority of participants failed to recognize the ideal time of first dental visit. Parents showed positive attitudes regarding the importance of regular dental visit and their role in their children's daily oral hygiene habits. CONCLUSION: In New Delhi, parental awareness and attitudes regarding their children's oral health are relatively good. However, the high dental caries prevalence in children in Central New Delhi contradict the study findings, which prove the fact that changing parental behavior and attitudes toward their children's oral health is far more important than increasing their knowledge only.

Oral Health Behaviours of Preschool Children with Autism Spectrum Disorders and Their Barriers to Dental Care.

This study compared oral health behaviours and barriers to dental care among preschool children with and without ASD, and evaluated dental knowledge and attitudes of their parents. 257 preschoolers with ASD and an age- and gender-matched control sample were recruited. Children with ASD had less frequently performed tooth-brushing and used toothpaste, but more often required parental assistance in tooth-brushing (p < .05). Barriers to dental care were more frequently reported among children with ASD (p < .001). Parents of children with ASD had higher scores in dental knowledge and attitudes than those without ASD. Differences in oral health behaviours and barriers to dental care existed between preschool children with and without ASD. Parents of children with ASD had better dental knowledge and attitudes.

A comparative assessment of plaque removal and toothbrushing compliance between a manual and an interactive power toothbrush among adolescents: a single-center, single-blind randomized controlled trial.

BACKGROUND: Many adolescents have poor plaque control and sub-optimal toothbrushing behavior. Therefore, we compared the efficacy of an interactive power toothbrush (IPT) to a manual toothbrush (MT) for reducing dental plaque and improving toothbrushing compliance. METHODS: In this randomized, parallel single-blind clinical study, adolescents brushed twice daily with either a MT (Oral-B® Indicator soft manual toothbrush) or an IPT (Oral-B® ProfessionalCare 6000 with Bluetooth). Subjects brushed for 2 min, plus an additional 10 s for each 'Focus Care Area'. At screening and Week 2, afternoon pre-brushing plaque was assessed via the Turesky Modification of the Quigley-Hein Plaque Index (TMQHPI), and supervised brushing duration was measured. RESULTS: Sixty subjects were randomized; 98% completed. At Week 2, the mean reduction in whole mouth plaque relative to baseline was 34% (p < 0.001) for the IPT versus 1.7% (p = 0.231) for the MT. For Focus Care Areas, the IPT yielded a 38.1% mean TMQHPI reduction (p < 0.001) versus 6.2% for the MT (p < 0.001). Mean brushing time versus baseline increased 34 s in the IPT group (p < 0.001) while remaining flat in the MT group (p = 1.0). CONCLUSIONS: Over 2 weeks, adolescents using an IPT experienced superior plaque reduction and increased overall brushing time versus those using a MT. TRIAL REGISTRATION: This trial was retrospectively registered ( ISRCTN10112852 ) on the 18th, June 2018.

Dental caries and externalizing behaviour problems in a high-risk child population.

The aim of this study was to assess the association between externalizing behaviour problems and dental caries in children. A further objective was to explore direct and indirect pathways between sociodemographic factors, family functioning and parenting factors, oral health behaviours, externalizing behaviour problems, and dental caries using structural equation modelling. Cross-sectional data were collected on 251, 5- to 8-yr-old children from a paediatric dental practice in the Netherlands. Children's decayed, missing, and filled primary teeth (dmft) scores were obtained from their dental records. Validated self-report questionnaires were used to collect sociodemographic, behavioural, and family-related data. Externalizing problem behaviour was significantly associated with a higher dmft score [incidence risk ratio (IRR) = 1.19; 95% CI: 1.06-1.34], but this association did not remain significant after adjustment for sociodemographic factors (IRR = 1.11; 95% CI: 0.99-1.26). A valid path model was presented after applying some modifications. Findings from the model suggest that it is plausible that child behaviour problems are directly associated with dental caries via toothbrushing behaviour. The model also provided support that maternal education level, the restrictiveness and warmth of parenting, and the communication of the family, play an indirect role in the association between children's externalizing behavioural problems and dental caries experience.

Self-control and dental caries among elementary school children in Japan.

OBJECTIVES: Children's self-control is associated with various behaviour-related health problems in childhood and later in life. However, studies on self-control and dental caries, strongly associated with toothbrushing or drinking and eating behaviour, are limited. We investigated the association between self-control and the number of decayed or filled primary teeth (dft) among first-grade children (6-7 years old) in Japan and evaluated the mediation effect of oral health behaviour on this association. METHODS: A cross-sectional study of all first-grade elementary school children and their caregivers in Adachi ward (Tokyo) was conducted in 2015. Clinically determined dft status among children and caregiver-administered questionnaires on self-control was linked (n = 4291; valid response rate = 80.1%). Self-control was assessed by the following single question: "in the last month, was your child able to give up on things they want or do things that they do not like to do for better future outcomes?" Poisson regression analysis was conducted adjusting for age in months, sex, parental educational attainment and household income. Mediation analysis was performed to evaluate the mediation effects of toothbrushing frequency, frequency of drinking sugar-sweetened beverages and snack-eating habits on the association. RESULTS: Lower self-control was associated with higher dft after adjusting for all covariates (mean ratio = 1.09; 95% CI: 1.06, 1.12). Toothbrushing frequency, frequency of drinking sugar-sweetened beverages and snack-eating habits mediated 18.1%, 36.1% and 38.3% of the association between self-control and dft, respectively. CONCLUSIONS: Strengthening children's self-control might decrease their dental caries by improving their oral health behaviour.

FDI-Unilever Brush Day & Night partnership: 12†years of improving behaviour for better oral health.

Twelve years ago, FDI World Dental Federation and Unilever Oral Care began a partnership to raise awareness of oral health globally. This aim reflects FDI's mission to "lead the world to optimal oral health", and one of the goals set by the Unilever Sustainable Living Plan "to improve health and well-being for more than 1 billion" by 2020. This partnership has developed a series of public health programmes to improve the brushing habits of targeted populations through health promotion and educational campaigns worldwide. Building on the success of the first two phases of the partnership, the third phase (Phase III), named Brush Day & Night, aimed to educate children in brushing twice-daily with fluoride toothpaste via a 21 Day school programme. This article reports the main outcomes of the past 12 years of this partnership, in particular the key outreach and figures of Phase III evaluation. School programmes were implemented in 10 countries, where local teams collected data from children aged between 2 and 12 years to monitor their oral health behaviours using specific indicators. In addition to the school programme, the World Oral Health Day was used as a vehicle to convey oral health awareness to influential governing bodies and the public. As a result, over 4 million people were directly reached by the programme in 2016.

Parental supervision for their children's toothbrushing: Mediating effects of planning, self-efficacy, and action control.

OBJECTIVES: With 60-90% of children worldwide reportedly experiencing dental caries, poor oral health in the younger years is a major public health issue. As parents are important to children's oral hygiene practices, we examined the key self-regulatory behaviours of parents for supervising their children's toothbrushing using the health action process approach. DESIGN AND METHOD: Participants (N = 281, 197 mothers) comprised Australian parents of 2- to 5-year-olds. A longitudinal design was used to investigate the sequential mediation chain for the effect of intention (Time 1) on parental supervision for their youngest child's toothbrushing (Time 3), via self-efficacy and planning (Time 2), and action control (Time 3). RESULTS: A latent-variable structural equation model, controlling for baseline behaviour and habit, revealed significant indirect effects from intention via self-efficacy and action control and intention via planning and action control, on parental supervision behaviour. The model was a good fit to the data, explaining 74% of the variance in parents' supervising behaviour for their children's toothbrushing. CONCLUSION: While national recommendations are provided to guide parents in promoting good oral hygiene practices with their children, current results show the importance of going beyond simple knowledge transmission to support parents' intentions to supervise their children's toothbrushing actually materialize. Current findings make a significant contribution to the cumulative empirical evidence regarding self-regulatory components in health behaviour change and can inform intervention development to increase parents' participation in childhood oral hygiene practices, thus helping to curb rising oral health conditions and diseases. Statement of contribution What is already known on this subject? Self-regulatory skills are important to translate intentions into behaviour. Self-efficacy, planning, and action control are key self-regulatory skills for behaviour change. What does this study add? Self-regulatory skills are needed for parents to supervise their children's toothbrushings. Self-efficacy, planning, and action control are important self-regulatory skills in this context. Future interventions should map these self-regulatory predictors onto behaviour change techniques.

Does a social/behavioural gradient in dental health exist among adults? A cross-sectional study.

Objective To explore the potential presence of a social/behavioural gradient in dental health among Italian adults using a cross-sectional study. Methods Caries indices were recorded among 480 subjects (52.9% men, 47.1% women) who also completed a structured self-administered social and behavioural questionnaire. A social/behavioural gradient was generated as the sum of the worst circumstances recorded on the questionnaire (cariogenic diet, smoking, lowest occupational profile, brushing teeth < twice daily, lowest educational level, uneven dental examination attendance). Results Caries figures (DMFT) and the number of filled sound teeth (FS-T) were statistically significantly linked to the social/behavioural gradient (DMFT: χ2(9) = 20.17 p = 0.02, Z = 0.02 p = 0.99; FS-T: χ2(9) = 25.68 p < 0.01, Z = -4.31 p < 0.01). DMFT was statistically significantly associated with gender and with social and behavioural variables. FS-T was higher in women (p = 0.03) and was linked to smoking ( p < 0.01). Conclusions The proposed social/behavioural gradient demonstrated how subjects reporting the worst circumstances on the questionnaire exhibited the worst dental health. The use of the gradient demonstrates that health promotion and prevention cannot be compartmentalized.

An application of the Health Action Process Approach model to oral hygiene behaviour and dental plaque in adolescents with fixed orthodontic appliances.

BACKGROUND: The Health Action Process Approach (HAPA) model addresses health behaviours, but it has never been applied to model adolescents' oral hygiene behaviour during fixed orthodontic treatment. AIM: This study aimed to apply the HAPA model to explain adolescents' oral hygiene behaviour and dental plaque during orthodontic treatment with fixed appliances. METHODS: In this cross-sectional study, 116 adolescents with fixed appliances from an orthodontic clinic situated in Almere (the Netherlands) completed a questionnaire assessing oral health behaviours and the psychosocial factors of the HAPA model. Linear regression analyses were performed to examine the factors associated with dental plaque, toothbrushing, and the use of a proxy brush. RESULTS: Stepwise regression analysis showed that lower amounts of plaque were significantly associated with higher frequency of the use of a proxy brush (R2 = 45%), higher intention of the use of a proxy brush (R2 = 5%), female gender (R2 = 2%), and older age (R2 = 2%). The multiple regression analyses revealed that higher action self-efficacy, intention, maintenance self-efficacy, and a higher education were significantly associated with the use of a proxy brush (R2 = 45%). CONCLUSION: Decreased levels of dental plaque are mainly associated with increased use of a proxy brush that is subsequently associated with a higher intention and self-efficacy to use the proxy brush.

Friendship Network and Dental Brushing Behavior among Middle School Students: An Agent Based Modeling Approach.

By using a standard questionnaire, the level of dental brushing frequency was assessed among 201 adolescent female middle school students in Tehran. The initial assessment was repeated after 5 months, in order to observe the dynamics in dental health behavior level. Logistic Regression model was used to evaluate the correlation among individuals' dental health behavior in their social network. A significant correlation on dental brushing habits was detected among groups of friends. This correlation was further spread over the network within the 5 months period. Moreover, it was identified that the average brushing level was improved within the 5 months period. Given that there was a significant correlation between social network's nodes' in-degree value, and brushing level, it was suggested that the observed improvement was partially due to more popularity of individuals with better tooth brushing habit. Agent Based Modeling (ABM) was used to demonstrate the dynamics of dental brushing frequency within a sample of friendship network. Two models with static and dynamic assumptions for the network structure were proposed. The model with dynamic network structure successfully described the dynamics of dental health behavior. Based on this model, on average, every 43 weeks a student changes her brushing habit due to learning from her friends. Finally, three training scenarios were tested by these models in order to evaluate their effectiveness. When training more popular students, considerable improvement in total students' brushing frequency was demonstrated by simulation results.