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Background Most studies of tooth brushing behaviors rely on self-report or demonstrations of behaviors conducted in clinical settings. This study aimed to determine the feasibility of objective assessment of tooth brushing behaviors in the homes of high-risk children under three years old. We compared parent self-report to observations to determine the accuracy of self-report in this population. Methods Forty-five families were recruited from dental and medical clinics and a community social service agency. Research staff asked questions about oral health behaviors and observed tooth brushing in the homes. Brushing was also video-recorded. Video-recordings were coded for brushing behaviors by staff that did not collect the primary data; these abstracted data were compared to those directly observed in homes. Results Most families were Hispanic (76%) or Black (16%) race/ethnicity. The majority of parents had a high school education (42%) or less (24%). The mean age of children was 21 months. About half of parents reported brushing their child’s teeth twice a day (58%). All parents tried to have their children brush, but three children refused. For brushing duration, 70% of parents reported differently than was observed. The average duration of brushing was 62.4 s. Parent report of fluoride in toothpaste frequently did not match observations; 39% said they used toothpaste with fluoride while 71% actually did. Sixty-eight percent of parents reported using a smear of toothpaste, while 61% actually did. Brushing occurred in a variety of locations and routines varied. Abstracted data from videos were high in agreement for some behaviors (rinse with water, floss used, brushing location, and parent involvement: Kappa 0.74–1.0). Behaviors related to type of brushing equipment (brushes and toothpaste), equipment storage, and bathroom organization and clutter had poor to no agreement. Conclusions Observation and video-recording of brushing routines and equipment are feasible and acceptable to families. Observed behaviors are more accurate than self-report for most components of brushing and serve to highlight some of the knowledge issues facing parents, such as the role of fluoride.

Despite advances in orthodontic technology, including innovation(s) in imaging systems and software, the approaches used in diagnosis and treatment planning have not experienced similar advances during the past century. 1,2 For example, most clinicians use cephalometrics for orthodontic diagnosis and treatment planning. In 2002, 90% of orthodontists in the United States routinely obtained

Objectives: Coordinated Oral health Promotion (CO-OP) Chicago is a cluster randomized controlled trial testing the efficacy of a community health worker (CHW) intervention to improve tooth brushing in low-income children. Methods:Four hundred twenty children under 3 years old (mean 21.5 months) were recruited from 20 sites in or near Chicago, IL. Children were identified mainly as Black race (41.9%) or Hispanic ethnicity (53.8%) and most (85.2%) had Medicaid. Intervention families were offered four CHW home visits over 1 year. Brushing frequency was selfreported. Plaque score was determined from images collected in homes using disclosing solution. Analyses used GEE logistic models with variable selection at p < .05.Results: At enrolment, 45.0% of families reported twice a day or more child brushing frequency, and child plaque scores were poor (mean of 1.9, SD: 0.6). Data were obtained from 87.1% of children at 6 months and 86.2% at 12 months. In the CHW intervention arm (10 sites, N = 211), 23.7% received 4 visits, 12.8% 3 visits, 21.3% 2 visits, 23.2% 1 visit and 19% no visits from CHWs. No intervention effect was seen for brushing frequency or plaque score. Child brushing frequency improvement over time was associated with a range of child and caregiver factors. The only factor associated with a change in plaque score over time was parent involvement in brushing.Conclusions: Oral-health-specific CHW services were not associated with improved brushing behaviours in these young children. However, caregiver involvement with brushing supported more quality brushing. More robust interventions are needed to support families during this critical developmental period.