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Title Lower Levels of Caregiver Literacy and Education Increase the Child’s Risk of Developing Childhood caries
Clinical Question For pediatric patients, does the parent’s/caregiver's lower level of literacy about caries-promoting diets increase the child’s caries risk?
Clinical Bottom Line For pediatric patients, the parent's/caregiver’s lower level of literacy regarding caries-promoting diets does increase the child’s risk of developing caries. This is supported by various systematic reviews and multiple studies of parents with high and low levels of education/literacy regarding diet and overall oral health practices. There are multiple studies on how diet is related to the development of dental caries, but further research needs to be done analyzing oral health literacy of caregivers and its influence on childhood caries.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 28163858Khodadadi/2016384 Preschool-aged patients attending the pediatric dental clinicCross-Sectional Study
Key resultsThis study was based out of the dental clinic in Babol, Iran. They performed a cross-sectional study looking at parental oral health literacy and its effects on their child’s oral health. They analyzed the children’s primary dentition utilizing the DMFT index, and they also evaluated parental literacy levels through an oral health literacy adult questionnaire. They concluded that low oral health literacy led to an increased amount of dental caries and less treatment (fewer dental restorations); however, one weakness acknowledged was that their results may not represent other populations. This study emphasized that implementing methods to increase caregiver oral health literacy could help to reduce dental caries.
#2) 22842202Hooley/201255 studiesSystematic review of non-randomized trials
Key resultsThis systematic review looked at 55 articles that met the specified criteria. This review concluded that the education level of the parents is a critical socioeconomic indicator, influencing their attitudes and overall knowledge of oral health, thereby increasing the risk of childhood caries. The authors also concluded that there is a need for further research regarding parental social determinants of health and the practices influencing the development of childhood caries.
#3) 25909840Dantas/2015479 children aged 5 years in BrazilCase Control Study
Key resultsThis study looked into the specific social conditions that influenced the level of dental caries in 5-year-old children in Brazil. They obtained their data through questionnaires and exams that measured the DMFT scores for the children. The study children lived in poverty, and their lives were heavily influenced by numerous socioeconomic factors such as inadequate living conditions, caregivers with little formal education, and potentially lower income levels. The study highlighted that the families’ food choices were economically influenced and that the lack of timely education with respect to eating habits led to improper dietary choices. Another important aspect for this study was that caregivers with a lower education level typically did not seek dental treatment, leading to further development of caries.
Evidence Search ("oral health"[MeSH Terms] OR ("oral"[All Fields] AND "health"[All Fields]) OR "oral health"[All Fields]) AND ("literacy"[MeSH Terms] OR "literacy"[All Fields]) AND ("dental caries"[MeSH Terms] OR ("dental"[All Fields] AND "caries"[All Fields]) OR "dental caries"[All Fields] OR "caries"[All Fields]) ("parents"[MeSH Terms] OR "parents"[All Fields] OR "parental"[All Fields]) AND influence[All Fields] AND ("Childhood"[Journal] OR "childhood"[All Fields]) AND ("dental caries"[MeSH Terms] OR ("dental"[All Fields] AND "caries"[All Fields]) OR "dental caries"[All Fields] OR "caries"[All Fields]) ("dental caries"[MeSH Terms] OR ("dental"[All Fields] AND "caries"[All Fields]) OR "dental caries"[All Fields] OR "cavities"[All Fields]) AND ("child"[MeSH Terms] OR "child"[All Fields] OR "children"[All Fields]) AND ("diet"[MeSH Terms] OR "diet"[All Fields])
Comments on
The Evidence
Validity: The researchers conducted a thorough review initially starting with 476 articles and narrowing those down with specifically developed criteria that resulted in 55 studies, which were adequately assessed for sufficient and quality research. The authors used a ranking system to communicate level of bias across each study. A meta-analysis of articles included in this systemic review was not conducted, so it is unknown if the overall effect of caregiver health literacy is statistically significant. The case-control study (Dantas/2015) included a control group that was came from the same patient population as the case group. Both the case-control study and the cross-sectional study (Khodadadi/2016) had >80% of their participants complete the study. To further contribute to their validity, each research article used appropriate statistical analysis such as ANOVA, p-values, and confidence intervals. Lastly, In both the cross-sectional and case-control studies the authors used multivariate linear regression to 'control for' factors other than oral health literacy when calculating their results, which further enhances the data. Perspective: These particular articles are representative of the current situation regarding socioeconomic status and its influence on overall health. Although the main research was conducted in non-US countries, there are many families with children living in poverty in the United States where these findings are also relevant. Caregivers with lower levels of education are impacted by their financial situations, which can influence their ability to make better dietary choices for their children. There are several opportunities for children to learn about oral health education through school-based programs, but there are not very many options for parents to improve their knowledge regarding diet and childhood caries. If and when more effective methods are implemented to improve oral health education of caregivers, this could reduce the occurrence of childhood caries.
Applicability Childhood caries is one of the most common diseases, and it is especially prevalent in South Texas. There are families living in poverty in south Texas that have limited access to dental care and resources to prevent caries; however, more important is the lack of knowledge regarding the prevention of childhood caries. Although empowering children with the knowledge of how to protect their teeth is important, it would be even more beneficial if educational programs geared toward caregiver comprehension were to be implemented.
Specialty/Discipline (Public Health) (General Dentistry) (Pediatric Dentistry)
Keywords childhood caries, oral health literacy, diet
ID# 3150
Date of submission: 04/05/2017spacer
E-mail hrynyshyn@livemail.uthscsa.edu
Author Lauren Hrynyshyn
Co-author(s) e-mail
Faculty mentor/Co-author Moshtagh R. Farokhi, DDS, MPH
Faculty mentor/Co-author e-mail farokhi@uthscsa.edu
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