Changes in Oral Health Behaviors Associated With a Nursing Intervention in Primary Care

Abstract

Objective . To describe changes in oral health behaviors following implementation of a nursing intervention targeting children at risk for early childhood caries at an urban 2-site primary care practice. Methods . Nurses used a proprietary Nursing Caries Assessment Tool (N-CAT) to identify behaviors associated with early childhood caries risk, then provided brief focused dental education, fluoride varnish applications, and dental referrals to children without a dental home. We used generalized estimating equation logistic regression models, adjusted for age at visit, to analyze changes in oral health behaviors over time including the following: (1) tooth brushing frequency, (2) use of fluoride toothpaste, and (3) adult help with brushing among children younger than 5 years of age who had at least 2 N-CATs documented during well care visits between April 2013 and June 2015. We also evaluated dietary habits including going to bed with a bottle or sippy cup and sugar-sweetened beverage consumption, as secondary study outcomes during the same time frame. Results. A total of 2097 children with a mean age of 15.8 (SD 7.6) months at the initial visit were included in the analysis; 51% were boys; 28% were black, 36% Hispanic/Latino, 5% white, 2% Asian, and 19% other; 75% were publicly insured. During the study period, significant ( P < .05) improvements were noted across the 3 oral health behaviors studied among children younger than 18 months. Conclusion. Nursing interventions show promise for promoting preventive dental care in primary care settings and deserve further study.

Interventions Targeting Bottle and Formula Feeding in the Prevention and Treatment of Early Childhood Caries, Overweight and Obesity: An Integrative Review

“…Eighteen studies were targeted at populations with a specific vulnerability to increased overweight or obesity through infant formula use, dental caries from prolonged infant bottle use, or both: five studies targeted parents or carers in the USA WIC program [ 28 , 29 , 30 , 31 , 32 , 33 ]; four studies targeted American, Australian and Canadian First Nations communities [ 34 , 35 , 36 , 37 , 38 , 39 , 40 ]; four studies were undertaken in communities with social deprivation [ 41 , 42 , 43 , 44 ] and five studies were undertaken with cultural groups that report high prevalence of ECC [ 45 , 46 , 47 , 48 , 49 ]. The remaining nine studies targeted parents or carers of infants fed with formula [ 50 , 51 , 52 ], general populations attending well-child checks [ 53 , 54 , 55 ] or communities where the prevalence of ECC was reported to be increasing [ 56 , 57 , 58 ].…”

“…Infants and young children as the focus populations of interventions ranged from prenatal parental education [ 34 , 38 , 39 , 40 ] to 5 years of age [ 47 ]. Most interventions targeted parents as the primary carer [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 53 , 54 , 55 , 56 , 57 , 58 ]. Five interventions included extended caretakers, such as grandparents, siblings and babysitters [ 34 , 35 , 36 , 37 , 47 , 49 ].…”

“…Five WIC-based interventions were implemented during well-child visits or nutrition education classes [ 28 , 29 , 30 , 31 , 32 , 33 ]. Fourteen studies were undertaken during well-child visits, health visits or vaccination clinics, with physicians, nurses, health visitor (a registered nurse or midwife qualified in public health nursing in the UK [ 59 ]), dental healthcare providers and community health workers as interventionists [ 34 , 41 , 42 , 43 , 45 , 46 , 48 , 49 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ]. The Bottle it up—take a cup!…”

“…All interventions focused on educating carers during primary healthcare or as health promotion in community programs. The topics encompassed dental caries and oral health [ 28 , 30 , 31 , 38 , 39 , 40 , 41 , 48 , 49 , 54 , 55 , 56 , 58 ]; safe infant formula feeding practices [ 50 , 51 ]; infant bottle cessation, transitioning from bottle use to cup use, limiting bottle use and avoiding bottle use at bedtime [ 29 , 32 , 38 , 39 , 40 , 41 , 42 , 43 , 45 , 46 , 48 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ]; dietary behaviours, including choosing water as a drink, limiting intake and exposure to cariogenic foods and beverages [ 30 , 31 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 49 , 57 , 58 ]; healthy weight or growth [ 28 , 50 ]; infant satiety [ 32 ]; responsive infant formula feeding [ …”

“…Infants and young children as the focus populations of interventions ranged from prenatal parental education [34,[38][39][40] to 5 years of age [47]. Most interventions targeted parents as the primary carer [53][54][55][56][57][58]. Five interventions included extended caretakers, such as grandparents, siblings and babysitters [34][35][36][37]47,49].…”