A multifactorial analysis of tooth-brushing barriers among mentally challenged children

Abstract

Objectives: To identify tooth-brushing barriers among mentally challenged preschool children. Methods: Participants were 333 mentally challenged children aged 2 to 6 years old, 70% were males. Questionnaires regarding children's demographic information and barriers to oral health care were completed by children's caregivers. The proposed barriers were categorized into three groups, including: i) children-related barriers (intellectual functioning and adaptive skills); ii) caregivers- related barriers (access to dental knowledge, financial burden, time and efforts); iii) dental products-related barriers (design of the commercially available dental products). Bivariate analysis and binary regression model were used to determine the potential factors that impacted on children's behavior towards their daily tooth-brushing task. Results: Tooth-brushing was reported to be a difficult task for 206 (61.9%) children, and the top three reasons provided by parents were i) children's inappropriate behaviors during tooth-brushing (improper swallow/unable to keep still, 59.2%); the complexity of tooth-brushing procedure (58.3%); and iii) children's emotional resistance towards tooth-brushing (56.3%). More than a quarter of parents reported that the commercially available toothbrushes could not meet the additional needs of their children. Although all three groups of barriers had been revealed, only parents-related barriers (lack of time and efforts) and children-related barriers (lower adaptive skills) had been identified through bivariate analysis. By adjusting the social-economic status, the final regression model indicated that the strongest barrier was originated from children's practical skills (p <0.001). When comparing with children who had average or high practical skills, children presented with limited practical skills (OR = 3.20, p = 0.005), or low practical skills (OR= 5.23, p< 0.001) were more likely to show non-compliance toward daily tooth-brushing. Conclusions: Although three groups of barriers had been recognized during daily tooth-brushing performance among mentally challenged preschool children, limitation in children's practical skill was the most important barrier to daily performance of tooth-brushing.