Oral health promotion strategies and benefits

Dental Health Program for Low-Income Children

Oral Health Promotion

A child's socioeconomic status and gender are significant predictors of susceptibility to life-long dental disease (Broadbent, Thomson, Boyens, and Poulton, 2011). Male children and children from low-income households are less likely to brush daily, floss, or visit the dentist as adults, despite suffering from more prevalent and severe dental disease (p < 0.001 for all associations). When the bulk of the 81.5 billion-plus yearly oral health care burden in the United States consists of restorative dental services provided by dentist (Baelum, Van Palenstein Helderman, Hugoson, Yee, and Fejerskov, 2007, p. 878), any program that encourages daily plaque removal in young children would therefore tend to lower oral health care costs over the long-term.

Dental disease during childhood also has an impact on the child's immediate overall health. The pain and discomfort associated with tooth decay can lead to malnutrition, low body weight, poor diet quality, and sleep and behavioral problems (Baelum, Van Palenstein Helderman, Hugoson, Yee, and Fejerskov, 2007, p. 886). Establishing good oral hygiene habits during childhood will therefore improve the health of a child overall and lead to good oral hygiene habits that they can then pass onto their kids.

Childhood Caries Intervention Program

Dental care should begin early in a child's life. The first visit to a dentist should occur by 12 months of age (Committee on Clinical and Scientific Affairs, 2010), which means pediatricians should play an important role in motivating parents to seek dental care for their infant (Gussy, Waters, Walsh, and Kilpatrick, 2006). This first visit also presents the best and most important opportunity to provide parents with the information and motivation they need to help their child grow up relatively free of dental disease.

Motivational interviewing (MI) has been shown to provide a significant positive benefit for a number of behavioral health problems, including substance abuse, obesity, and medical self-efficacy (Ismail, Ondersma, Willem, Little, and Lepkowski, 2011). When parents were provided with an informational DVD on early childhood oral health, the inclusion of a 40 minute MI session had a significant positive impact six months later on whether the parent checked for precavities (OR = 3.57, p < 0.01) and had the child visit the dentist every six months (OR = 2.04, p = 0.05). In addition, the habit ensuring the child brushed twice per day approached statistical significance (OR = 1.72, p = 0.06). Two years after the intervention MI group parents were significantly more likely to check for precavities only (OR = 2.71, p = 0.03), while the habit of having the child visit the dentist every six months had ended (OR = 1.23, p = 0.67). Two years after the MI-based intervention the prevalence of tooth decay was not significantly different between the two groups, but this could be due to an dramatic self-reported decline in the quality of the diet being provided to the child by MI group parents (OR = 0.25, p = 0.06).

The proposed early childhood oral health program would be built upon the foundation provided by the above study. In addition to providing an information DVD and a pamphlet containing the same information (in case a DVD player is not available to the parent), toothbrush, toothpaste, floss, and an embossed printout of oral health goals the parent and interviewer agreed upon will also be provided. Topics covered with the parent and child would include: how and when to brush and floss, improving diet quality with limited income, checking for caries, and the importance of regular visits to the dentist.