The associations between social factors and suboptimal use of paediatric dental services (Tiny Teeth): a mixed method study (Hann, Palit, 2019)

Background: Dental decay is the leading reason for hospital admission of children aged 5-9 years. Prevalence of dental decay is strongly associated with deprivation, decreased maternal education, and ethnicity. This study aimed to investigate social and parental factors that prevent timely and regular use of dental services in Haringey and Enfield (London, UK), and to address the suitability of the emergency department (ED) as a site of opportunistic oral health education, using a dental intervention (DI). Method(s): The study was undertaken at the North Middlesex University Hospital's paediatric ED in North London, UK. It was a mixed method study with cross-sectional surveys, a brief DI, and qualitative interviews. Parents of children aged 10 years and younger in the ED were invited to participate in the study. Informed written consent was obtained from 101 participants. Data collection was from Jan 31, 2019, to March 13, 2019. Questionnaires collected background social and medical data, and assessed each caregiver's oral health literacy. The Big Bites and Pearly Whites DI provided parents with up-to-date information about teeth cleaning practices, dentistry, and diet. A post-intervention questionnaire assessed changes in parental knowledge. Adjusted logistic regressions explored associations between social factors and child dental registration. Seven semistructured interviews were conducted, collecting data on barriers faced to the use of paediatric dental services. Finding(s): Black British, Caribbean, and African children had an odds ratio of 0.158 (95% CI 0.037-0.679) for dental registration compared with their white counterparts, after adjusting for age of child and sibling number. The DI led to a significant difference between pre and post intervention median knowledge scores (Wilcoxon signed rank test; p=0.009) with a small effect size (r=0.2). Qualitative interviews exposed that current oral health advice, from dentists alone, is inconsistent and not universally delivered, resulting in late, suboptimal, and problem-based attendance. Interpretation(s): To maximise and reinforce early and universal parental receipt of oral health messages, collaboration and coordination is needed between educational, dental, and general health providers. Disparities in health-seeking behaviour due to ethnicity and knowledge should be accounted for when planning service engagement programmes. The study supports the ED as a site to opportunistically make every contact count by reinforcing preventive oral health messages. The major limitations of the study are its size and cross-sectional design. Funding(s): None.Copyright © 2019 Elsevier Ltd