Motivational interviewing effects on caries prevention in children differ by income: A randomized cluster trial

Abstract

Objectives:This study aimed to investigate the differential preventive effect of motivational interviewing (MI) on early childhood caries (ECC) according to socioeconomic variables, using a community-based trial in a public healthcare setting. Methods:A cluster-randomized, double-blind study with two parallel groups in healthcare clinical settings (HCCs) comparing conventional oral health education (CE) and MI aimed at mothers of children born in 2013 and 2014. The oral health team of 6 of the 12 HCCs were trained in MI. This training was intensive for active learning of the basic MI principles, conducted by a psychologist who is a PhD in psychiatry and has extensive experience in conducting MI training workshops. It was held in an experiential format divided into two 4-hour shifts, with a 1-week interval. Children who attended at least one dental visit in the first year of life at their HCC were clinically evaluated by trained examiners and parents responded to a questionnaire. The effect of MI on the caries outcome compared with CE was evaluated in different subgroups: family income, mother's education and skin colour. Results:One hundred and eighty-six were included in the CE group and 228 in the MI group. The caries rate per 100 surface-year was 1.29 (95%CI: 0.92-1.80) in the CE group and 0.46 (95%CI: 0.29-0.73) in the MI group. The effect of MI was statistically significant in the lower-income category (P = .03); MI prevented 57% of carious lesions (IRR = 0.43, 95% CI 0.22-0.83) and reduced the occurrence of the disease on more than one surface per 100 followed surface-year in this same category in the equivalent income subgroup (IRD = −1.37, P = .04). Conclusions:Motivational interviewing had a greater preventive effect against caries in children whose families are of lower income.

Home‐based toothbrushing interventions for parents of young children to reduce dental caries: A systematic review

“…In terms of a specific theoretical framework being applied to the intervention development and evaluation, only 18 interventions explicitly stated that they were based on psychological theory and that this was used to inform intervention delivery and measures 20,22‐38 …”

“…Twenty‐nine studies explored the impact of their intervention on caries. Of these, 19 studies showed significant reductions in caries experience 28‐30,38,40‐43,45,47,48,53‐60 . Again, however, one study found these improvements across both intervention and control groups, 54 another only identified small changes in caries experience, 56 and although there was a significant reduction in dentine caries, enamel caries was still highly prevalent in the intervention group of Villena, Pesaressi, Frencken, 59 suggesting a slowed, but not halted rate of caries progression in the intervention group post‐intervention.…”

“…These educational programmes tended to be communicated through health professionals, predominantly dental care practitioners, via lectures, counselling/discussion sessions, leaflets, and videos, with further support being provided through follow‐up phone calls/text messages and home visits in some instances 22,24,27,31,34,39,45,56,57 . There were some exceptions to this format, for example, several studies employed motivational interviewing to discuss with parents dental outcomes for their children 20,22,28‐30,33,36,38 ; or interventions included additions to this format, for example, by further enhancing toothbrushing skills through demonstrations/practice of appropriate brushing techniques; 23,31,47,49‐51 though this was not always an obligatory element of the intervention 51 . Two studies, however, used completely novel delivery methods for their intervention, with one utilizing a smartphone app (‘ToothSense’) 35 and the other taking the form of a storybook (‘Kitten's First Tooth’) to be read by parents and children together 37 .…”

Evaluation of the Level of Salivary sHLA-G in Children Aged 3–5 Years with or without Dental Caries

“…Since early childhood caries (ECC) is a major disease in the public health, understanding the factors that influence oral health such as biologic factors, parents' behaviours and economy situation [ 8 , 9 , 35 ], data on diet, and preventive behaviour [ 36 ] are important for the development of strategies to prevent dental caries and promote oral health. Among biologic factors, the microorganisms, particularly S .…”

“…ECC is a multifactorial infectious disease that results from the interaction of both genetic and environmental factors [ 7 ]. The usual risk factors of ECC include poor oral hygiene, diet, low socioeconomic status [ 8 , 9 ], and host salivary constituents. Dietary practices such as poor dietary habits and food preferences, frequent exposure to sweet beverages, and night-time meals or drinks promote the proliferation of cariogenic bacteria [ 10 , 11 ].…”