What compels parents to act on signs of kids’ tooth decay?

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What compels parents to act on signs of kids’ tooth decay?

UW collaborates on study to discern how best to raise dental red flags
Samantha Sauer

If tooth decay is largely preventable, why is it the most common chronic disease in children? 

The disconnect, experts say, lies with parents and caregivers who may not understand how to prevent tooth decay or who mistakenly believe dental care is unimportant for baby teeth because they fall out anyway. 

Through a new behavioral intervention, researchers at the University of Washington Northwest Center to Reduce Oral Health Disparities and Case Western Reserve University hope to change parents’ misconceptions of children’s dental needs. Ultimately the researchers hope to develop a model to improve children’s oral health nationwide. 

In the early morning dark, Dr. Joana Cunha-Cruz, left, and dental assistant Mary Hagstrom load a van at UW with supplies to take to Longview.
picture of Dr. Joana Cunha-Cruz and UW dental assistant Mary Hagstrom loading dental supplies into a van

School-based intervention 
At 4:30 a.m. on Nov. 30, 2015, Marilynn Rothen and her team began loading a van with dental supplies. The team needed an early start to get to a Longview, Washington, elementary school and set up three portable units before students arrived.

Over the next two days, Rothen and the UW team from the Institute of Translational Health Sciences’ Dental Clinical Research Center provided dental exams. 

The exams are part of a 2.5-year study being conducted in rural Washington and urban communities in Cleveland, Ohio. The study will evaluate the effectiveness of a behavioral intervention to educate parents about the importance of keeping baby teeth cavity-free.  

Two dentistry professors, Peter Milgrom at the UW and Suchitra Nelson at Case Western, are leading the study. Milgrom has partnered with the ITHS to conduct the exams and research for the 350 to 400 children to be enrolled in Washington.

Parents’ crucial role 
Dentists have seen persistent numbers of young children with dental decay with children from lower socioeconomic groups experiencing issues at significantly higher rates. Some experts estimate that 80 percent of tooth decay is experienced by only 20 to 25 percent of the population.

UW dental pair
Dental hygienist Marilynn Rothen, left, and dentist Peter Milgrom are the UW's leads on the child dental decay study.
pictures of UW dental hygienist Marilynn Rothen, left, and dentist Peter Milgrom

Many parents either don’t understand how to prevent decay or mistakenly believe that decay “is just inevitable,” Milgrom explained. “They don’t see it as a preventable disease, a bacterial disease. They don’t see any solution to it.”

And that can lead to parents not bringing their children to the dentist, even when a cavity has been found. 

Currently 12 states require or provide for dental exam for a child’s school entry. However these laws typically don’t require or track referrals for further care. Parents are told if children have cavities, and it is up to parents to act on that information.

“Parents receive letters saying their children need care, but often there is no follow up,” said Rothen, a registered dental hygienist who is leading ITHS’ role in the study.

At the center: communication
The research team is studying whether changing the format and wording of those letters – top-lining the implications of decay and including contact info for local dentists – will prompt more action from parents.

Children in the study receive either the standard letter or one of four iterations drafted by the researchers. The variations will help pinpoint what version spurs action. 

In the spring, the dental team will return to the schools for follow-up exams to track whether additional care was sought. “If the cavity didn’t get fixed, we presume the child didn’t get care,” Milgrom said. 

The researchers hope they can use the study findings to create an evidence-based approach to encouraging parents to take their children to the dentist. “Our goal is to change practice. That’s the business we are in. Marilynn and I have been at this way too long to do studies just for the fun of doing studies,” Milgrom said, laughing.