The present study demonstrated that parents were lacking in oral health knowledge regarding both their child’s oral health and the child’s first dental visit. In the current heath system, oral health advice is given mostly by oral health providers and Plunket nurses. Oral health information provided repeatedly by different health care providers may possibly improve parents’ awareness of oral health issues and in turn oral health literacy. Therefore, child’s primary health care provider giving priority to children’s oral health by educating the parents may improve parents’ oral health literacy. Parents’ level of oral health literacy will then be reflected in the oral health status of children. It is important parents are educated on the link between oral health and general health, by combining the general and oral health services.
The Ministry of Health’s strategic vision for oral health in New Zealand states that building linkages between primary health care providers and oral health services are one of the most important actions to improve oral health in children and adolescents (Ministry of Health,
2007). Hence, recommendations are presented for health care providers, including midwives, primary health providers, Plunket nurses and oral health providers. Silk (2010) suggested various stages of approaching parents for intervention for better oral health in children. These consisted of six stages before the child reaches five years of age. By following these stages, the oral health information needed at each stage of the child’s life would be provided in order to improve parents’ oral health knowledge regarding the child’s oral health. The health care providers whom parents have a high chance of meeting at each stage are recommended as the ones able to increase the oral health knowledge relevant to that stage. The information provided to the parents at different stages may be in the form of brochures; by motivational interviewing; or by simple advice. This could be provided to the parents by any method, but the primary aim would be to reduce the parental risk related behaviours regarding the child’s oral health and to improve parents’ knowledge of preventing oral health diseases.
In the next section, I outline some of the ways in which the types of recommendations I suggested in the discussion section might be implemented. These recommendations are not intended to be exhaustive, but perhaps suggest a model for carving up different types of oral health literacy programmes, and different types of education providers. Immediately below is one possible plan for providing a range of oral health literacy strategies, organised on a chronological basis (ante-natal to school age). Following this is a short discussion on the ways in which each of the key players: Government, policy makers, education providers and media, could take responsibility for a defined, measurable part of the oral health literacy programme.
1.2 Prenatal Intervention
(Midwife)
As noted before, the advice given to pregnant women about good oral health habits is likely to be passed on to their children. Our results suggested that a few parents lack basic oral health knowledge which is required for interpreting and understanding information regarding the child’s oral health. Hence, parents’ basic knowledge would be improved by providing pictograms or brochures during pregnancy. Parents can be advised by the mid-wife or by the obstetrician to have regular dental visits during pregnancy to avoid transmission of cavity causing bacteria to their child later.
1.3 One week, 1 month, 2 months
Mid-wives, Plunket nurses, GPs and oral health providers (if the child is enrolled in the oral health services)
At this stage parents have many chances to meet the mid-wife (recovering from pregnancy), the Plunket nurse (well-baby visits), and the GP (vaccinations). Hence, it is recommended that those health care providers provide the parents with the necessary oral health information.
The results demonstrated that only a few parents were aware of cleaning the child’s gum after feeding, so this knowledge and the effect of using bottles at bed time can be provided at this stage. From the results, many parents were also not aware of pacifier use and the transmission of micro-organisms from mother to child. Hence, health care providers would be able to give information about using pacifiers and the effect of sharing or pretesting food. Parents could be informed about healthy soothing habits because in the current study 20% of parents were not aware of the caries causing effect on using a bottle at bed time. Low weight babies may be
referred to oral health services at an early stage by the paediatrician or mid-wife, as low birth weight babies have many oral health issues including poor enamel (Silk, 2010).
1.4 Four months
GPs, Plunket nurses and oral health providers (if the child is enrolled in the oral health services)
In the current study, few parents were not aware of effect of sugar in causing cavities. Parents could be informed about healthy dietary habits at this stage as teeth may soon be erupting. Also parents could be reminded of the cariogenic effect of using a bottle and sipper during bed time. The results of the current study imply that the majority of parents were confused about managing teething. As teeth may start to erupt at this stage, information about teething and managing teething problems can be given at this stage. Parents would be encouraged to monitor teething by providing some special calendar with the general time of eruption indicated in it. As most of the parents in the current study were not aware of the relationship between systemic diseases and delayed eruption of teeth, monitoring teething might help in the diagnosis of systemic diseases at an early stage.
1.5 Six months, 9 months
Plunket nurses, GPs and oral health providers (if the child is enrolled in the oral health services)
As using a bottle in preschool aged children has proved to be a major cause of early childhood caries, it is useful for health care providers to find out whether bottles are used in the bed. The child’s sugar exposure is identified and parents advised to reduce sugar rich juices and encouraged to use water instead. As a prevention measure, those mothers who are breast
feeding can be advised not to use bottles and the child can go straight to a cup. In the current study, the majority of parents had less knowledge regarding brushing in preschool aged children which implies that parents needed more information regarding this. Hence, parents are advised to start brushing as soon as the teeth erupt, with bed time brushing insisted on owing to the decrease in the protective effect of saliva at night. Parents may be advised to make brushing a part of bedtime rituals: Bath, Bottle/cup, Brush, Book, and Bed (Silk, 2010). A dental visit is advised as soon as the child turns one and if the child is not enrolled in the oral health services, parents may be encouraged by GPs and Plunket nurses to enrol before the child’s first birthday.
1.6 12 months to 3 years
(Oral health care Providers)
Parents could be advised to completely stop the bottle and start using cups. Advice on sugar- free diets can be provided and correct brushing techniques taught by oral health providers during dental visits. Depending on the fluoride status of the home town’s water supply, advice about the effect and amount of topical fluorides used could be given. In the current study the majority of parents were not aware of the percentage of fluoride in children’s tooth paste and the amount of fluoride toothpaste that should be used for children. Parents can be informed about the percentage of fluoride in children’s tooth paste to avoid using adult’s toothpaste for a child. Parents could be advised to use a smear of a child’s fluoridated toothpaste. Children with a high caries risk are identified and additional fluoride supplements prescribed. If needed, dental sealant can be applied. Parents are advised to end the pacifier use and support to end the habit can be given to the parents.
1.7 Three years- Five years
(Oral health care providers)
Sugar-free and fibre rich foods should be encouraged. Twice daily tooth brushing under parental supervision (until the child turns 8) is preferable as being ideal. Compulsory dental referrals would be advised to identify and treat dental caries at an early stage to avoid their spread to other teeth.
Health care providers including Plunket nurses, doctors and mid-wives could be educated to provide the above oral health information for clients using short online courses. Also health care providers including oral health providers could be educated about oral health literacy because it is considered an emerging concept.