Factors Affecting Preschool Teachers Promotion of Childrens Oral Health

Kemia Wendfeldt, D.D.S.* and Donna Kritz-Silverstein, Ph.D.

University of California Los Angeles; University of California San Diego
Background
The prevalence of caries in the primary dentition is on the rise; >40% of children have caries by the time they reach kindergarten >70% of caries in the primary dentition of 2-5 year old children remain untreated; untreated childhood dental disease can cause eating, speaking, learning and general health problems as well as lack of attendance at school A vast majority of children 5 years old use some form of child-care such as preschools Educational and referral interventions could be made by preschool teachers, who interact frequently with preschool childrens parents or caregivers, but little research exists on this topic Table 1. Characteristics of Participants (N=150)
_

N
Female Ethnicity Caucasian African-American Asian Latino Other 145 71 4 10 52 13 113 108 113 37 47 95 17 20 17

%
96.6 47.3 2.7 6.7 34.7 8.7 75.3 72.0 75.3 24.0 31.3 63.7 11.4 13.4 11.4
60

Figure 3-4 . Comparison of Preschool Teachers' Behaviors by Preschool Type and OH Education

Results
Table 1 - Most responders (75.3%) taught in private preschools, had an average of 13.2 years of experience teaching; 63.7% reported having no oral health education and only 31.3% ever made dental referral Figure 1 - Most preschool teachers are not aware of dental needs in preschool children Figure 2 - Teachers do not perform behaviors promoting preschoolers oral health such as brushing, rinsing or assisting with OH Table 2 Teachers with OH education are more likely to make dental referrals than those without OH education, although less than half the teachers with OH education made a referral; newer teachers were likelier to make a referral Figure 3-4 Public preschool teachers and teachers with OH education were likelier to promote preschoolers oral health behaviors Table 3 Preschool teachers knowledge of etiology of caries and its associated risks and preventive factors was low and did not differ by type of preschool or previous OH education

50

P=.008 P=.015 P=.018

College Education Parent (yes) Preschool type Private Public Dental Referral (yes) OH Education 0 hour (N=149) 1 hour 2-4 hours 5 hours or > Age (N=146) Years Teaching

40 Private Public

% 30

20

10

MEAN (SD)
39.9 (11.7) 13.2 (9.2)

RANGE
20-67 1-41
0 Milk/juice before nap Rinse w/ water Brush Supervise OH

Fig 1. Teacher Experiences: Preschoolers Dental Needs

120 100 80 >1 per month Once every 6 month Once per year Never 60 50

Behaviors

Purpose
To compare the behaviors, attitudes and knowledge of preschool teachers with regard to childrens oral health (OH)

P= .001
40 % 30 20 10

P= .017

% 60 40 20 0

OH Ed. No-OH Ed.

Methods
Survey assessing oral health: Behavior Attitudes Knowledge Surveyed at San Diego preschools and during local conference in September-October 2012 192 surveys distributed, 150 completed Data Analysis compared preschool teachers by type of schools and past OH education using chi square analysis and independent t-tests

Child w/ Child w/pain tooth (teeth/mouth/ decay jaws)

Trouble eating/ drinking due to dental problem

Parent concerned about child's dental issues

Child needing emergency tx due to caries

Limitations and Strengths

Milk/juice before nap Rinse w/ water Brush Supervise OH

Fig. 2. Teacher Experiences: OH Behavior

120 100 80 % 60 40 20 0 Everyday Almost every day 2-3 times per week Once per week 1-3 times per month Never

Behaviors

Limitations Relatively small sample size Self-reported data Strengths Represents new area of research, findings could impact oral health in preschoolers

Table 3.
Age 1 visit

Comparisonsa

of OH Knowledge by School Type & OH Ed

School Type Private Public 61 62 18 81 74 43 48 76 63 78 53 6 8 91 67 48 43 86 59 54** 48 5.7 OH Education Yes No 70 57 17 85 77 44 55 80 60 80 55 5.9 17 83 65 44 43 79 65 70 50 6.0

Xylitol prevents cavities Baby teeth problems affect adult teeth Fluoride disinfects water (false) More snacks, increase cavity risk Parents' cavities transmitted to children

Conclusions
Overall rates of OH promotion in preschool teachers are low even among those with education Preschool teachers with OH education are more likely to promote OH through dental referrals and healthy dental habits in their classrooms Preschool teachers are far more likely to see new mothers, infants and preschool age children; it is essential they are aware of the etiology of caries and associated risk factors, make effective educational interventions and referrals to facilitate establishment of the dental home Preschool children would benefit from increased and continuous OH training among teachers

Give milk/ juice before nap

Rinse w/ water after food

Brushing children's teeth

Assist children's OH

Decay in baby teeth can cause infections in face and body White spots are healthy indication of remineralization (false)

Table 2. Predictors of Dental Referrals

Dental Referrals
No
Years teaching (mean) School type Public (%) Private (%) 15.2 38 36 76.8 53.7

Yes
11.9 62 64 23.2 46.3

t or 2
2.1 0.0

Childs overall health does not depend on cavities (false) Knocked out baby tooth should be put back or in milk (false) Total Knowledge (Mean)

.03 1.00

OH Education No (%) Yes (%)

7.5

.006

_________________________________________________________________________
a Correct

response is true unless noted otherwise. Comparison of percent correct for each knowledge item performed with chi-square analysis; comparison of total knowledge scores performed with independent t-test *P < .05 **P< .01