Usefulness of a psychometric questionnaire in exploring parental attitudes in children's dental care

In this methodological study we investigated the usefulness and reliability of a questionnaire designed to capture 4 aspects of parental dental attitudes: dental knowledge, child oral health behavior, perceived importance of dental related aims, and parental responsibility. The study was undertaken in a group of 140 parents of schoolchildren aged 8-12 years from four comprehensive schools in Sweden. Test-retest reliability, quantified by the intraclass correlation coefficient (ICC) or by Cohen's kappa, varied from acceptable to excellent for different aspects of the questionnaire. The knowledge and responsibility-taking sections were also answered by a group of dental experts who showed a high level of internal agreement. Expert profiles, to which the parental assessments could be compared, were created. Exploration of the 4 aspects showed that this group of parents commonly had a multifocal view on the etiology and prevention of caries. Correlations between their knowledge assessments and the assessments made by the expert group varied from moderately negative to strongly positive. The parents revealed a high degree of dental-related motivation and responsibility, particularly according to oral health behaviors. In conclusion, the results indicate that this 4-part psychometric questionnaire might be a suitable instrument in investigations of priority and responsibility-taking as new aspects of parental dental attitudes, along with dental knowledge and child oral health behaviors.     

Attitudes to dental care among parents of uncooperative vs. cooperative child dental patients

The aim of this cross-sectional questionnaire study was to investigate four aspects of parents' attitudes to dental care (knowledge, child's oral health behavior, priorities and responsibility). One study group (n = 50) of parents of uncooperative child dental patients (aged 8-12 yr) was compared to a reference group (n = 113) of parents of ordinary child dental patients of similar age, and to a second study group (n = 36) of parents of uncooperative younger child patients (aged 4-7 yr). Study group parents had significantly lower socio-economic status and a higher level of dental fear as compared to parents of ordinary child patients. We found indications of a poorer dental knowledge and a differing responsibility-taking profile among study group parents. Their children also had sweets more often. As compared to parents of younger children, the older study group parents had lower socio-economic status and showed a lower responsibility-taking related to the child's treatment refusal. In conclusion, parents of uncooperative children differ from parents of ordinary child dental patients, not only in socio-economic status and dental fear, but also in aspects such as dental knowledge and responsibility-taking. These differences were partly related to the child's age.     

Caries prevalence and bottle-feeding practices in 2-year-old children with cleft lip, cleft palate, or both in Taiwan.

OBJECTIVE: The purposes of this study were to investigate the caries prevalence in cleft lip, cleft palate, or both in children under the age of 2 years and to evaluate parental attitudes toward bottle-feeding, dental care, and their relationship to baby bottle tooth decay (BBTD) in Taiwan. DESIGN: Randomized and prospective study. SETTING: Institutional setting. PATIENTS AND METHODS: One hundred twenty-three 2-year-old children (68 boys and 55 girls) with cleft lip, cleft palate, or both were selected for this study. A questionnaire that asked questions about knowledge of oral health, knowledge and beliefs about BBTD, children's feeding habits, children's dental care, and parenting attitudes toward children with clefts was completed by the parents or caretakers. Children were divided into bottle-feeding and non-bottle-feeding groups according to the questionnaire responses of parents or caretakers. Each child was examined with a dental mirror and explorer under focused flashlight using defs index to determine the presence of BBTD. RESULTS: Thirty-nine percent (48) subjects reported a bottle-feeding habit; the overall prevalence of BBTD was 15.4%. The habit of bottle-feeding was significantly related to BBTD (p = .019). The defs score for children who were bottle-fed was significantly higher than children who were not bottle-fed (p = .045). Parents or caretakers of both bottle-feeding and non-bottle-feeding children showed no significant differences in their attitudes toward bottle-feeding and feeding habits (p > .05). However, parents of non-bottle-fed children had significantly better dental care than parents of bottle-fed children in brushing frequency (p < .001) and brushing before bed (p < .001). CONCLUSIONS: Children with clefts who took a bottle to bed showed an increased risk of developing BBTD. The parents or caretakers of bottle-fed children also showed a lack of motivation to perform regular preventive dental home care for their children. This suggests that oral health promotion programs should begin in infancy for children with clefts and their parents.     

Parental risk attitudes and caries-related behaviours among immigrant and western native children in Oslo

OBJECTIVES: Immigrant children make up a large proportion of the school populations in many western cities. It is likely that their parents have different attitudes and knowledge of dental health than resident populations, and thus provide a challenge to public dental services. This study sought to map existing disparities in oral health among immigrant and western native children in Oslo and to identify differences in parental, cultural and ethnic beliefs and attitudes towards oral health and caries-related behaviours. METHODS: Caries was recorded of 735 children (3- and 5-year olds), supplemented with radiographs among 5-year olds. Their parents responded to a questionnaire. RESULTS: Immigrant background, consumption of sweet drinks at bed and social status were the dominant caries risk indicators among the 3-year olds. Among the 5-year olds, the caries risk indicators were immigrant background, parental indulgence, attitude to diet, attitude to oral hygiene, social status and age starting toothbrushing. Being an immigrant was closely associated with higher caries prevalence and experience. Parental attitudes to oral hygiene, diet and indulgence, and caries-related behaviours distinguished immigrants from western natives. CONCLUSIONS: The results suggest that immigrant groups in western societies require different information packages, modified strategies for forming oral hygiene habits and attitudes related to dental care of children, and encouragement to exercise discipline on factors known to be risks for oral health. These strategies must recognize that immigrants and western natives attach different levels of importance to oral health and dental parameters. It should be paid extra attention to some caries high-risk subgroups.     

深圳市3~ 6岁儿童家长对儿童牙颌面畸形早期矫治的知识信念行为现状

目的了解深圳市3~ 6岁儿童家长对牙颌面畸形早期矫治的知识、信念及行为情况,为进一步有针对性地开展口腔宣教和保健工作提供理论依据,以提高早期口腔预防水平。 方法于2019年3—5月采取多阶段分层整群抽样的方法,对深圳市5所幼儿园3~ 6岁儿童家长886人进行问卷调查,采用两组独立样本Mann-Whitney秩和检验、多样本Kruskal-Wallis检验及多因素逐步回归分析的方法对问卷进行统计学分析。 结果共获得有效问卷860份,知识、信念、行为三部分的得分率分别为68.5%、68.0%、69.2%。单因素分析结果显示：家长年龄、父母角色、独生子女与否、家长学历、家长职业及家庭收入对知识得分有影响（检验值分别为17.13、3.13、2.45、91.66、38.24、11.16,P<0.05）;孩子年龄、家长年龄、父母角色、独生子女与否、家长学历、家长职业及家庭收入对信念得分有影响（检验值为11.42、17.52、3.17、3.59、74.49、25.25、43.18,P<0.05）;家长学历及家庭收入对行为得分有影响（检验值为8.12、17.25,P<0.05）;多因素逐步回归分析结果显示：家长学历、父母角色影响知识得分（P<0.05）,家长学历、父母角色、家庭收入影响信念得分（P<0.05）,家庭收入影响行为得分（P<0.05）。 结论儿童家长对牙颌面畸形早期矫治的知识、信念、行为方面存在不足,应结合人口学特征进一步有针对性地加强儿童牙颌面畸形早期矫治的口腔宣教及保健工作。     

Diabetes and oral health promotion: a survey of disease prevention behaviors

BACKGROUND: Diabetes is a chronic metabolic disease known to affect oral disease progression. The authors surveyed health behaviors essential for preventing dental and periodontal diseases and maintaining oral health is a population of adult patients with type 1 (insulin-dependent) diabetes. The goals of this study were to assess these patients' oral health behaviors, access to dental care and need for improved health education. METHODS: As part of a dental and periodontal examination, 406 subjects with type 1 diabetes completed a questionnaire regarding their oral health attitudes, behaviors and knowledge. The authors also evaluated 203 age-matched nondiabetic control subjects. RESULTS: The authors found that diabetic subjects' tobacco use and oral hygiene behaviors were similar to those of the nondiabetic control subjects. Diabetic subjects, however, more frequently reported the cost of dental care as a reason for avoiding routine visits. Most of these subjects were unaware of the oral health complications of their disease and the need for proper preventive care. CONCLUSIONS: Patients with diabetes appear to lack important knowledge about the oral health complications of their disease. The results of this survey did not indicate improved prevention behaviors among the subjects with diabetes compared with nondiabetic control subjects. CLINICAL IMPLICATIONS: Dentists have an opportunity and the responsibility to promote good oral health behaviors such as regular dental examinations, proper oral hygiene and smoking cessation that may significantly affect the oral health of their diabetic patients.     

A comparison of perceived and actual dental needs of a select group of children in Texas.

Dental caries (DMFS) evaluations were made for 150 children in Grades 2 to 7. Three months later, a trained interviewer questioned 120 children from 100 families to determine atitudes toward oral hygiene and dental health on the part of (a) the child, (b) the parent, along with (c) the child's perception of the parent's attitude, and (d) the parent's perception of the child's attitude. Evaluation of the perceived attitudes toward oral hygiene revealed a statistically significant correlation between the child's attitude and the degree of dental health as well as between the attitudes of child and parent. Conclusions were: (1) parents were not accurate in their perception of the dental health habits of their children, (2) children were not performing acceptable routine oral hygiene procedures, (3) children accurately perceived the attitudes of their parents toward dental health, and (4) children's actual dental health behavior as manifested by dental health status was related to the attitudes of their parents.     

Views and experiences of parents and siblings of adults with Down Syndrome regarding oral healthcare: a qualitative and quantitative study

AIMS: To investigate experiences and expectations of parents/siblings of adults with Down Syndrome (DS) regarding oral healthcare, and explore factors impacting on access and experience of dental care for this group. DESIGN: A two phase qualitative and quantitative study using in-depth interviews with a convenience sample of six parents/siblings, and a postal questionnaire of 200 parents/siblings of adults with DS who are members of the Down Syndrome Association. RESULTS: The main themes elicited from the qualitative interviews related to concern, experiences, parents'/siblings' attitudes, preferences and information. The response rate from the postal questionnaire was 63.5%. Adults with DS attended the dentist regularly but received little restorative treatment. Experience of oral healthcare was influenced by the attitudes and skills of dental health professionals; stigma; and relatives' expectations of dentists, their oral health beliefs, information and support received, knowledge and priorities. Parents/siblings wanted dentists to be proactive in providing more information on oral health issues in collaboration with other health and social care professionals. CONCLUSIONS: Whilst most adults with DS visited the dentist regularly, relatively little treatment had been provided. Parents highlighted a need for appropriate and timely oral health information early in their child's life, and access to dentists who were sympathetic, good communicators and well-informed about DS.     

Oral health habits amongst children in the United Kingdom in 2003

BACKGROUND: The 2003 Children's Dental Health Survey is the fourth in a series of decennial national children's dental health surveys. AIMS: This paper presents data on parental attitudes towards the care of children's teeth and gums, reported oral hygiene behaviours and clinical measures of hygiene and periodontal health in 2003 and highlights trends since previous surveys. METHOD: A total of 10,381 children were examined in schools by trained and calibrated examiners. Four measures of hygiene and periodontal health were recorded as part of the clinical examination. In addition, 3,342 questionnaires were completed by parents of a sub-sample of these children. The questionnaire enabled information to be collected about reported oral health behaviours and parental attitudes. RESULTS: About three quarters of children across all age groups are reported to brush their teeth twice daily. A range of oral health products was reported as being used in addition to toothbrushes and toothpaste. There is a trend in parental preferences towards restoration of teeth rather than extractions and towards a better understanding of dental caries prevention. Although overall a higher proportion of children in this survey appeared to have gingival inflammation, plaque and calculus than 10 and 20 years ago, there was no change in the proportion of older children with gingivitis. CONCLUSIONS: Dental practitioners have a role to play in reinforcing these positive attitudes and encouraging appropriate and effective oral hygiene behaviours in their child patients.     

Validity of single-item parental ratings of child oral health

Objective. The aim of this study was to assess the validity of single-item parental ratings of child oral heath. Methods. Data were collected during a study to assess the impacts of dental injury. Clinical examinations of children aged 11–14 years were undertaken that included measures of trauma, decay, treatment needs, and fluorosis. Children with trauma and a group of trauma-free children were followed-up. Parents were mailed a questionnaire along with a questionnaire for the child that contained a short form of the Child Perceptions Questionnaire 11–14 (CPQ11–14). Bivariate analyses examined associations between parents’ ratings of their child's oral health, measures of dental disease, clinically defined treatment needs, and scores on the CPQ11–14. Logistic regression was used to see if the associations observed remained after controlling for access to dental care variables. Results. Complete data were collected from 370 children and their parents. Parental ratings showed significant associations with most of the clinical indicators used and CPQ11–14 scores. Similar results were obtained when the data were analysed for subgroups defined by household income and mother's education. These associations remained after controlling for access to dental services. Conclusion. The data suggest that single-item parental ratings of child oral health have adequate construct validity.     

The relationship between socio-demographic characteristics and dental health knowledge and attitudes of parents with young children

OBJECTIVE: To determine if parental socio-demographic characteristics are associated with dental knowledge and attitude. DESIGN: A questionnaire survey of 500 consecutive parents with children aged approximately 8-months, attending clinics in 1999/2000, in Burnley, Pendle and Rossendale, for health visitor distraction-hearing tests. OUTCOME MEASURES: Scores were obtained for dental knowledge and attitudes. The socio-demographic variables of parental ethnicity, age, education and area of residence were used to determine any associations. RESULTS: Parental age ranged between 16-46 years. Child age ranged between 7-11 months. Significant differences were detected for parental dental knowledge according to ethnicity (P = 0.003), educational status (P = 0.000), and area of residence (P = 0.016). Significant differences were also found in dental attitudes; ethnicity (P = 0.000), educational status (P = 0.004) and area of residence (P = 0.005). Parental age was not significant for either knowledge or attitude. CONCLUSIONS: Lack of further education, being Asian and living in a deprived area means parents have less chances of high dental knowledge and positive dental attitudes.     

上海市残障儿童及家长口腔健康知、信、行调查分析

目的: 调查分析上海市残障儿童口腔健康行为及家长的口腔健康知识、态度,为设计针对残障儿童的口腔公共卫生服务项目和制订有关政策提供依据。方法: 采用分层整群抽样方法,对上海市1 381名残障儿童家长进行相关问卷调查。数据采用SPSS 21.0软件包进行处理。结果: 残障儿童家长口腔健康知识知晓率为67.21%,78.98%的残障儿童家长对口腔健康持积极态度。13.61%的残障儿童经常在睡前吃甜食,只有45.98%的残障儿童每天刷牙2次及以上,42.65%的残障儿童使用含氟牙膏,88.12%的残障儿童从未使用过牙线,49.75%的残障儿童从未看过牙。结论: 上海市残障儿童口腔健康行为有待改善,家长口腔健康知识水平较低,应对家长开展个性化口腔健康教育,并加强郊区口腔健康宣教工作。     

Modeling the theory of planned behavior for intention to improve oral health behaviors: the impact of attitudes, knowledge, and current behavior

The aim of this study was to test the efficiency of an extended model of the theory of planned behavior (TPB) in predicting intention to improve oral health behaviors. The participants in this cross-sectional study were 153 first-year medical students (mean age 20.16, 50 males and 103 females) who completed a questionnaire assessing intentions, attitudes, subjective norms, perceived behavioral control, oral health knowledge, and current oral hygiene behaviors. Attitudes toward oral health behaviors and perceived behavioral control contributed to the model for predicting intention, whereas subjective norms did not. Attitudes toward oral health behaviors were slightly more important than perceived behavioral control in predicting intention. Oral health knowledge significantly affected affective and cognitive attitudes, while current behavior was not a significant predictor of intention to improve oral health behavior. The model had a slightly better fit among females than among males, but was similar for home and professional dental health care. Our findings revealed that attitude, perceived behavioral control, and oral health knowledge are predictors of intention to improve oral health behaviors. These findings may help both dentists and dental hygienists in educating patients in oral health and changing patients' oral hygiene habits.     

Oral health behaviour of schoolchildren and parents in Jordan

Summary. Objectives. The objectives of the study were: (i) to assess the level of dental knowledge and attitudes towards child dental care among parents in Jordan, (ii) to analyse the oral health care habits of schoolchildren and parents, and (iii) to evaluate the oral hygiene habits and use of professional dental services of children in relation to socio‐demographic conditions. Design. Cross‐sectional, self‐administered questionnaires for parents. Sample and methods. National representative sample of 6–16‐year‐olds living in urban areas (n = 1556, children and parents, response rate 92%, 48·7% boys, 51·3% girls). Results. In all, 80% of the parents knew about the harmful effect of sugar and 79% thought that poor oral hygiene may induce dental caries. In addition to proper oral hygiene (79%) and restriction of sugar/sweets (42%), 36% of the parents emphasized regular dental visits for the prevention of dental disease in children. However, most children saw a dentist for symptomatic reasons only (86%), while 11% attended for dental check‐ups. At their last visit to the dentist, 49% of the children had tooth extraction and only 8% had preventive services (fissure sealing). Toothbrushing at least twice a day was reported for 31% of the children; 14% of children aged 6–9 years had assistance from adults in brushing. Dental care habits of children were highly affected by dental visiting habits of parents, and variations by level of education of parents were also found. Conclusions. The discrepancy between dental knowledge and attitudes of parents and oral health care practices indicate the need for oral health education. School‐based oral health promotion programmes should be established in Jordan to influence the oral health behaviour of children and parents and to avoid further deterioration in their oral health.     

Oral healthcare of preschool children in Trinidad: a qualitative study of parents and caregivers

ABSTRACT: BACKGROUND: Little is known about oral health in early childhood in the West Indies or the views and experiences of caregivers about preventive oral care and dental attendance The aims of this study were to explore and understand parents and caregivers experience of oral healthcare for their preschool aged child and how, within their own social context, this may have shaped their oral health attitudes and behaviours. These data can be used to inform oral health promotion strategies for this age group. METHOD: After ethical approval, a qualitative study was undertaken using a focus group approach with a purposive sample of parents and caregivers of preschool children in central Trinidad. Group discussions were initiated by use of a topic guide. Audio recording and field notes from the three focus groups, with a total of 17 participants, were transcribed and analysed using a thematic approach. RESULTS: Despite some ambivalence toward the importance of the primary teeth, the role of fluoride and confusion about when to take a child for their first dental visit, most participants understood the need to ensure good oral hygiene and dietary habits for their child. Problems expressed included, overcoming their own negative experiences of dental care, along with finding affordable and suitable dental care for their child. There was difficulty in establishing good brushing routines and controlling sweet snacking in the face of many other responsibilities at home. Lack of availability of paediatric dental services locally and information on oral health care were also highlighted. Many expressed a need for more contact with dental professionals in non-clinic settings, for oral health care advice and guidance. CONCLUSION: Parents and caregivers in this qualitative study showed generally positive attitudes towards oral health but appear to have encountered several barriers and challenges to achieving ideal preventive care for their child, with respect to healthy diet, good oral, hygiene and dental attendance. Oral health promotion should include effective dissemination of oral health information, more practical health advice and greater access to dental care for families with preschool children. KEYWORDS: Preschool children, oral health, parents, caregivers, qualitative, focus groups, West Indies.     

Oral health investigations of indigenous participants in remote settings: a methods paper describing the dental component of wave III of an Australian Aboriginal birth cohort study

Background

Exploring the stability of self-reports over time in observational studies may give valuable information for the planning of future interventions. The aims of the present study were: 1) to explore the consistency of parental self-reports of oral health habits, beliefs and attitudes towards child oral health care over a two-year period; 2) to evaluate possible differences in item scores and consistency between parents with different immigrant status; and 3) to assess the construct validity of items measuring parental beliefs and attitudes towards child oral health care.

Methods

The sample (S1, n = 304) included parents of 3-year-old children in Oslo, Norway; 273 mothers of western origin (WN-group) and 31 of non-western origin (IM-group). They were surveyed in 2002 (child age 3 years) and in 2004 (child age 5 years). Two additional samples of parents were also included; one with 5-year old children in 2002 (S2, n = 382) and one with 3-year-old children in 2004 (S3, n = 427). The questionnaire included items measuring child oral health habits and parental beliefs and attitudes towards child oral health care.

Results

In 2002, 76.8% of the parents reported that they started to brush their child's teeth before the age of 1 year. Eighty-five percent of them reported the same in 2004; 87.0% of the WN-group and 33.3% of the IM-group (P < 0.001). For 17 of 39 items measuring beliefs and attitudes the responses were more positive for the WN-compared to the IM-group. Parents of caries-free children in 2004 reported significantly more positive beliefs and attitudes towards child oral health care in 2002 compared to parents of children with caries in 2004 (P < 0.05, P < 0.01 and P < 0.001). No differences in mean item scores were found between the three samples S1, S2 and S3.

Conclusion

The results showed a fair to good consistency of parental self-reports from 2002 to 2004. They also indicate that parents with different cultural backgrounds should be evaluated separately and in a cultural context.     

Dental attitudes: proximal basis for oral health disparities in adults

OBJECTIVES: Behavioral science postulates that underlying characteristics of populations, rather than sociodemographic groupings, are more proximal causes of oral health disparities through differing oral health behaviors. To our knowledge this is the first report in the literature that examines longitudinal correlates of oral health and dental care using groups of persons holding similar attitudes and beliefs. METHODS: The subjects were 873 participants in the Florida Dental Care Study, a longitudinal study of oral health among dentate adults. Hierarchical cluster analysis identified four groups with similar dental attitudes that were labeled 'favorable attitudes about dental care', 'frustrated believers in dental care', 'negative attitudes and cost concerns', 'pessimistic about personal and professional oral care'. RESULTS: The attitudinal groups cut across race, sex, and age with race and educational status the best discriminators among sociodemographic and economic variables. The negative attitude group reported the least preventive care and the largest oral health decrements on clinical examination at baseline and 24 months. The group with favorable attitudes about dental care reported the highest number of preventive and restorative visits and the lowest point-prevalence of toothache pain, temperature sensitivity, and painful gums. The frustrated believers have access to dental care equivalent to the favorable attitude group, but may delay seeking dental care until oral disease becomes more severe, based on their pattern of preventive, restorative, and dental extraction visits. Additional group differences on oral health and dental care are reported. CONCLUSION: This study takes a novel approach to examining oral healthy disparities. Differences in oral health behaviors support the validity of the groups.     

Dental knowledge and attitudes among Arab schoolteachers in northern Israel

A representative random sample of 597 Arab school-teachers in northern Israel, was surveyed regarding sources and levels of knowledge and attitudes about dental caries prevention. Data were measured according to a self-administered questionnaire from a 91.4 per cent response rate. When ranking the effectiveness of different caries preventive measures teachers on average listed optimal water fluoridation as a lower priority compared to toothbrushing, dental visits, fluoride mouthrinses and eating fewer sweet products. Placing of fissure sealants was ranked as the second least effective caries preventive measure, with 39.6 per cent not knowing the effectiveness. Only 68.5 per cent of the school-teachers were aware of the anti-bacterial role of fluoride, and only a small minority knew of fluoride's potential in healing incipient caries. Teachers seemed less motivated to being involved in dental health school programmes which involved dedicating school time and their active involvement, such as fissure sealant programmes at school, supervision of brushing and flossing, and school mouthrinsing programmes. They revealed positive attitudes towards: informing parents about the importance of oral hygiene and teaching children about preventive dentistry. Teachers' main reported source of knowledge was the dental office. It is the responsibility of the dental profession to ensure that updated knowledge is correctly conveyed to schoolteachers, who are an important and potentially influential sector of dental health consumers and health education agents.     

An investigation of the oral status and reported oral care of children with heart and heart-lung transplants

Aim . To investigate the oral health status and oral microflora of children who have received heart and heart-lung transplants. Parental knowledge and current practice of oral health procedures by the child were also investigated.
Sample and method . Thirty-five children attending the Cardio-Thoracic Transplant Unit, Great Ormond Street Hospital for Children were included. Measurements were compared with children matched by age and gender attending the trauma clinic at the Department of Paediatric Dentistry, Eastman Dental Hospital. Teeth were examined for the presence or absence of caries or enamel defects. Plaque deposition, gingivitis, gingival bleeding and gingival enlargement were measured and a swab was taken to look at the oral microbial flora. A questionnaire was used to assess parental knowledge of dental health procedures and the current practice of these.
Results . There were no significant differences between transplant and control children in caries experience, plaque or gingivitis. Children with heart or heart-lung transplants had significantly greater numbers of enamel defects and more gingival enlargement than control children, children in the heart transplant group had significantly more gingival bleeding. There was little difference in the dental knowledge and reported behaviour of the transplant group compared to the control group.
Conclusion . The dental needs of heart and heart-lung transplant patients treated at the Great Ormond Street Hospital for Children were similar to those of the control group in this study, however further improvement could be made in educating parents and children on the importance of caries prevention and good oral hygiene.