A mixed methods study of parental and family factors associated with children's home toothbrushing frequency

A significant number of young children in the United Kingdom experience dental caries, often resulting in a diminished quality of life. Brushing children’s teeth twice a day with fluoride toothpaste significantly reduces their risk of caries, but not all parents adhere to these guidelines. Previous behaviour change interventions in oral health have been largely unsuccessful and criticised for a narrow focus on education with no wider theoretical underpinnings. However, little is known about the factors that influence parents’ decisions about when and how often to brush their child’s teeth at home. The aim of the current project was to understand the wider social, environmental and cognitive factors that influence parents’ decisions about brushing children’s teeth, to inform future advice and interventions. Three studies were conducted, focused on parents of children aged between 3-6 years old, resident in deprived communities in Wales. In-depth interviews (n=15) suggested that parents only took brushing guidelines seriously if they believed other parents did so, that toothbrushing patterns were influenced by the home environment and day-to-day routines, and that parents often saw toothbrushing as having largely short-term benefits. These themes informed the development of a questionnaire survey (n=297), which showed that parents’ perceptions of the norm for brushing were significantly associated with how often they brushed their own child’s teeth. Parents tended to brush their child’s teeth more often when brushing was automatic or ‘habitual’ and saw different benefits in brushing a child’s teeth in the morning and evening. Finally, an experimental study (n=121) showed that parents’ judgements about what constitutes a healthy number of times to brush a child’s teeth were relative rather than absolute, and predicted by Range-Frequency Theory. The findings have implications for re-considering oral health advice offered to parents, and suggest novel theoretical framewo