Experience of maintaining tooth brushing for children born with a cleft lip and/or palate

BackgroundChildren with a Cleft Lip and/or Palate (CL/P) have been reported to have poorer oral health than those without the condition. The consequences for these children can be particularly problematic due to implications for future treatments. Tooth brushing is an important behaviour contributing to children’s oral health, but is under researched in the CL/P population. The aim of the study is to explore the experience of maintaining tooth brushing among children in the United Kingdom (UK) with a CL/P and their parents.MethodsSemi-structured interviews were carried out with twenty-two parents and sixteen children with a CL/P (5-11 years), recruited at a cleft centre in the UK. Thematic analysis was used for data analysis.ResultsThree key themes were drawn from the qualitative data: first, parents of children with a CL/P generally had strong motivation to look after their children’s teeth but children’s motivation was inconsistent. Second, parents were primary enablers of children’s tooth brushing behaviour, often employing approaches adapted to their child’s characteristics to encourage tooth brushing. Third, a range of obstacles were encountered by parents and children in maintaining regular tooth brushing behaviours. They reported obstacles such as issues related to CL/P, ‘forgetting’ and childhood illness.ConclusionsThe paper suggests that parents of children with a CL/P need support to enact their intention to maintain regular tooth brushing and prioritise tooth brushing within the context of demanding and dynamic family life.

[1]  R. Aunger Tooth brushing as routine behaviour , 2007 .

[2]  S. Gilbert,et al.  Dental Caries, Oral Hygiene, and Oral Clearance in Children with Craniofacial Disorders , 2004, Journal of dental research.

[3]  R. Redett,et al.  Cleft Lip and Palate , 2013, Eplasty.

[4]  Mahmoud Al-Dajani,et al.  Comparison of Dental Caries Prevalence in Patients with Cleft Lip and/or Palate and Their Sibling Controls , 2009, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[5]  K. Britton,et al.  Dental caries prevalence in children with cleft lip/palate aged between 6 months and 6 years in the West of Scotland , 2010, European archives of paediatric dentistry : official journal of the European Academy of Paediatric Dentistry.

[6]  J. Malley,et al.  Younger Adults' Understanding of Questions for a Service User Experience Survey. Funded/commissioned by: The Health and Social Care Information Centre , 2006 .

[7]  E. Waters,et al.  An exploration of the views of Australian mothers on promoting child oral health. , 2016, Australian dental journal.

[8]  M. Wells Review suggests that cleft lip and palate patients have more caries , 2014, Evidence-Based Dentistry.

[9]  A. Hugoson,et al.  Sociodemographic conditions, knowledge of dental diseases, dental care, and dietary habits. , 2015, Journal of public health dentistry.

[10]  Lisa Gibbs,et al.  Breaking down the barriers: a qualitative study to understand child oral health in refugee and migrant communities in Australia , 2015, Ethnicity & health.

[11]  K. Vehkalahti,et al.  Oral health behaviors and bacterial transmission from mother to child: an explorative study , 2015, BMC oral health.

[12]  P. Gollwitzer Implementation intentions: Strong effects of simple plans. , 1999 .

[13]  E. Goffman The Presentation of Self in Everyday Life , 1959 .

[14]  P. Callery,et al.  Parents’ and children's knowledge of oral health: a qualitative study of children with cleft palate , 2017, International journal of paediatric dentistry.

[15]  R. Tesch Qualitative Research: Analysis Types and Software , 1990 .

[16]  C. Pine,et al.  Analysis of Health Behaviour Change Interventions for Preventing Dental Caries Delivered in Primary Schools , 2013, Caries Research.

[17]  C. Pine,et al.  Primary school-based behavioural interventions for preventing caries. , 2013, The Cochrane database of systematic reviews.

[18]  V. Braun,et al.  Using thematic analysis in psychology , 2006 .

[19]  S. Asokan,et al.  Dental Caries and the Associated Factors Influencing It in Tribal, Suburban and Urban School Children of Tamil Nadu, India: A Cross Sectional Study , 2015, Journal of public health research.

[20]  B. Collett,et al.  Observed child and parent toothbrushing behaviors and child oral health. , 2016, International journal of paediatric dentistry.

[21]  James A. Holstein,et al.  Ethnomethodological Analyses of Interviews , 2003 .

[22]  A. Hemprich,et al.  Investigation of caries prevalence in children with cleft lip, alveolus, and palate. , 2004, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[23]  J. Murray Gene/environment causes of cleft lip and/or palate , 2002, Clinical genetics.

[24]  K. Buetow,et al.  Clinical and epidemiologic studies of cleft lip and palate in the Philippines. , 1997, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[25]  Rosaline S Barbour,et al.  Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? , 2001, BMJ : British Medical Journal.

[26]  M. Makou,et al.  Oral health status and behaviour of Greek patients with cleft lip and palate , 2009, European archives of paediatric dentistry : official journal of the European Academy of Paediatric Dentistry.

[27]  L. Levin,et al.  Improving oral hygiene skills among children undergoing treatment at the haemato-oncology department - an interventional programme. , 2015, International dental journal.

[28]  H. Garfinkel Studies in Ethnomethodology , 1968 .

[29]  P. Sheeran Intention—Behavior Relations: A Conceptual and Empirical Review , 2002 .

[30]  K. Kavvadia,et al.  Oral Hygiene Facilitators and Barriers in Greek 10 Years Old Schoolchildren , 2015, International journal of clinical pediatric dentistry.

[31]  G. Antonarakis,et al.  Caries Prevalence in Non-Syndromic Patients with Cleft Lip and/or Palate: A Meta-Analysis , 2013, Caries Research.

[32]  C. Currie,et al.  Adolescent toothbrushing and the home environment: sociodemographic factors, family relationships and mealtime routines and disorganisation. , 2010, Community dentistry and oral epidemiology.

[33]  E. Waters,et al.  Teeth Tales: a community-based child oral health promotion trial with migrant families in Australia , 2015, BMJ Open.

[34]  Renata Tesch,et al.  Qualitative research : analysis types and software tools , 1990 .

[35]  A. Glenny,et al.  'Doing the "right" thing': how parents experience and manage decision-making for children's 'normalising' surgeries. , 2012, Social science & medicine.

[36]  A P Vanderas,et al.  Incidence of cleft lip, cleft palate, and cleft lip and palate among races: a review. , 1987, The Cleft palate journal.