Changing smiles and minds—a community-based trial on parental knowledge impact on early childhood caries

Abstract

This community-based trial aimed to explore a change in levels of parental understanding of factors that could contribute to early childhood caries (ECC) following educational visits with community health workers (CHWs). This intervention was aided through the utilisation of a behavioural education programme; the named example within this study is MySmileBuddy. Children met with their parents and CHWs over the period of a year, to discuss goals that would aim to increase parent education about caries, to establish good habits and behaviours that could contribute to a reduction in the child’s future caries risk. They met at least 3 times during the year in person, and subsequent follow up was completed via a multitude of communication methods e.g. telephone call. At each visit, an electronic survey was completed evaluating agreement or disagreement with statements about factors that could contribute to caries development. This study was carried out in New York City over a period of twelve months for each child. 1207 children from 977 families, with clinically diagnosed ECC, were recruited. Inclusion criteria included children that had at least one filled or decayed primary tooth surface and were aged between 2 years to 6 years. Exclusion criteria included children that may have conditions that would have prevented the provision of oral hygiene habits or moderation of diet, for example children with severe autism. Families were recruited from local specialist residency programmes within the city or by direct referral from local CHWs. Evaluation of the parental education was established through use of electronic surveys at baseline level and follow up following CHWs’ intervention. The data was collected between 2015 and 2017 and required follow up appointments that were completed via telephone and other remote methods. Data collection separated caries risk factors into six domains with 26 factions across the pre- and post-intervention period. These addressed both parental knowledge of the aetiology of caries and factors that can contribute to this. Domains included titles such as saliva factors, hygiene, diet, severity/susceptibility, and outcome expectations. Parents were asked to note their agreement with the statements using a four-point scale (Strongly Agree, Agree, Disagree and Strongly Disagree). The survey was made up of statements including themes of caries risk factors, and behavioural science that can contribute to caries development. Examples include ‘drinking juice can cause tooth decay’ and ‘all kids get tooth decay’. Correct answers would be given as part of the targeted advice and education given by the CHWs at subsequent visits. Data was collected from a total of 669 parents of 977 taking part in the study. Analysis focussed on the trend of changing knowledge of parents from baseline to follow up. The analysis also assessed features of the participants including the parents’ first language, education level, country of birth, average age of the children and their insurance status – this was then assessed to see if this influenced the parents’ beliefs and associations. Results found there was an improvement in the parental knowledge of salivary risks for caries, hygiene input and dietary effect post intervention. The only differing result was the statement that ‘tooth decay is very common’ – this showed a reduced change. The study concluded that the MySmileBuddy programme did improve parental education on Early Childhood Caries and factors influencing the risk of this, though acknowledges that there should be further exploration in the clinical impact that this education would have on the patients’ caries status from the CHW input.