Effectiveness of family-centered oral health promotion on infant oral health

Abstract

Introduction: Although dental caries is preventable, and upstream preventive strategies are considered effective for reducing the risk of ECC development, the early childhood caries (ECC) is prevalent in Hong Kong preschool children. American AAPD suggests perinatal oral health education (OHE) starting at pregnancy and establishment of a dental home by one-year-old. So far, no study is available about the effectiveness of family-centered OHE targeting pregnant women, their husbands and infants on infant oral health.

Aim of the study: To evaluate the effectiveness of a family-centered oral health program on parental toothbrushing practices, proper dietary and feeding habits, oral health knowledge, attitude and self-efficacy, and oral health status in infants.

Methods: At baseline, first-time expectant parents were recruited at public hospitals and health centers in Hong Kong and randomly allocated into two groups. In the test group, individualized OHE and an infant oral health pamphlet were provided to pregnant women and their husbands. Pregnant women in the control group received only the pamphlet. When the infants were one-year-old, oral examinations and biological sample collections were conducted on the infants and their mothers. The mothers also completed a questionnaire on dietary and feeding habits and oral hygiene practices. Changes in oral health behavior and status were evaluated when infants were two years old.

Result: In total, 580 families were recruited at baseline and 416 families (test: 211, control: 205) were followed up when the infants were at age 1 and 2 (follow-up rate:70.6%). At age 1, no significant differences were found between the two groups for any dietary or feeding habits (p>0.05). However, at age 2, there was a significant improvement in night-time milk-feeding, falling asleep during feeding milk, the use of nursing bottles and daily consumption of snacks in the test groups only (p<0.05). Regarding oral hygiene practices, test group infants at both ages had better parental toothbrushing than the control group infants. Particularly, twice-daily toothbrushing practice was better-adapted by the parents in the test group when the infants were at age 2 than those in the control group. Also, at ages 1 and 2, the proportion of infants with visible plaque, WSL and S.mutans in the test group was significantly lower than that in the control group (Visible plaque at age 1 18.5% vs 55.1%, p<0.001; at age 2: 38.9% vs 68.8%, p<0.001; WSL at age 1 6.6% vs 12.7%, at age 2: 12.3% vs 24.9%; S.mutans at age 1: 0.23% vs 0.68%, at age 2: 5.85% vs 11.46%, All p<0.001). At age 1 and 2, the positive correlation between dental plaque and WSL in infants, the level of S.mutans were found. Infants who were in the test group or who had parental toothbrushing were less likely to have the presence of visible plaque, WSL and S.mutans at age 1 and 2. Conclusion: The family-centered oral health promotion program improved reported feeding habits, oral hygiene practices, as well as infants’ oral health status at age 2. However, no significant improvements in sugar consumption were found.