12. Determinants of Brushing Young Children’s Teeth: Implications for Anticipatory Brushing Guidance

Background: The roles played by health beliefs and norms, standards, and perceived self-efficacy have been largely untapped in studies of tooth-brushing behavior. Rural parents with limited incomes are more likely to be young and geographically isolated than their urban counterparts, and thus these rural parents might be less knowledgeable about where to turn for advice about oral health or to obtain oral health services. Moreover, even if parents are aware of and have access to resources for their children, rural parents might avoid using them, preferring to “get by” on their own or with the help of family members. Utilization data show that, overall, rural children are less likely than children living in other areas to use dental services overall and that rural parents are more likely to report the purpose of the last dental visit as something “bothering or hurting” their children.

Methods: Researchers from the University of Washington included parents and community-based health professionals in each step of the study design and data collection. Parents were interviewed as expert informants to elucidate a diverse set of viewpoints regarding the value and ease of brushing young children’s teeth. Study protocols and the interview guide were reviewed, revised, and approved by a steering committee consisting of seven community residents, including five professionals in early childhood health or education and two low-income mothers with young children. Interviews were conducted by three paid community residents trained by the study investigators.

Results: Just under two-thirds (26 of 41) of the parents who reported the age at which they began brushing their child’s teeth said it was before the child’s first birthday. No single explanation emerged as a majority reason for initiating brushing. The most common reason was an external cue, such as the eruption of the child’s first tooth. Other common reasons reflected health beliefs, followed by normative expectations, including advice from early childhood educators, health professionals, or peers.

Nearly all parents (91%) thought the recommendation to brush a child’s teeth twice a day was realistic. However, only slightly more than half (55%) reported achieving this goal. Parents who achieved twice-daily brushing were more likely than those who did not achieve this standard to accurately discuss milestones in child development, children’s oral health needs, and specific skills to engage the child’s cooperation. The most common barriers to brushing, cited by 89% of all parents, were lack of time and an uncooperative child.

In summary, the study found that determinants of parents brushing their children’s teeth vary. For this reason, rural children would benefit from simple interventions to encourage an early and regular habit of tooth brushing by their parents. Guidance given to parents about the oral health of their children should include discussion of ways to overcome the challenges identified in the study.

Comments: Because parents participated in the advisory board as expert informants on tooth brushing and served as study designers, data collectors, and study participants, new knowledge was generated.

Applications of Principles of Community Engagement: Principle 6 emphasizes that all aspects of community engagement must recognize and respect community diversity; this research project demonstrates this principle by acknowledging that the determinants of brushing the teeth of one’s children vary. By going into the community and learning about the community’s norms and values, the researchers were also demonstrating Principle 2.