Motivational interviewing in improving oral health of preschool children : a randomized controlled trial

Abstract

Introduction: Dental caries (tooth decay) is highly prevalent and is largely determined by one’s behaviors, such as diet and oral hygiene. Prevailing health education (PE), focusing on information/advice giving and direct persuasion, often fails to elicit sustainable changes in health behaviors. Motivational interviewing (MI) has demonstrated great potential in changing health related behaviors. An interactive caries risk assessment (RA) tool might facilitate MI in certain ways.

Objective: This single-blinded randomized controlled trial aimed to compare the effectiveness of PE, PE+MI, and PE+MI+RA in eliciting dentally healthy behaviors and preventing dental caries in preschool children.

Methods: This study targeted children aged 3-4 years with unfavorable oral health behaviors (brushing teeth less often than twice per day and/or snacking three times or more often per day). A total of 692 parent-child dyads were recruited and randomly allocated into three groups. In Group I (n=231), oral health pamphlets were provided to parents; In Group II (n=231), in addition to the pamphlets, parent of each child joined a one-to-one MI session with a dental hygienist; In Group III (n=230), besides pamphlets and MI, interactive RA was incorporated into MI. A questionnaire was completed by parents at baseline and after 6, 12, and 24 months to collect information on parental efficacy for protecting children’s oral health and children’s oral health behaviors. Dental caries and oral hygiene status of children were recorded by a blinded examiner at baseline, 12 and 24 months. Intention-to-treat analysis was performed. Logistic regression and general linear model were used to compare the effectiveness of the interventions.

Results: Children’s socio-demographic background, parental efficacy, oral health behaviors, and oral health status were comparable among three groups at baseline (all p>0.05). After 24 months, 632 (91.3%) parent-child dyads were followed up. Significantly greater improvements were found in parental efficacy and children’s oral health behaviors (snacking and brushing frequency) in Group II and Group III than in Group I (all p<0.05). Compared with Group I, the reduction in plaque score (△plaque score) was greater in Group II (β=-0.080, 95% CI: -0.133, -0.028; p=0.003) and Group III (β=-0.083, 95% CI: -0.135, -0.030; p=0.002). When Group I was taken as a reference, the caries increment (dmft) in Group II and Group III was significantly lower [β (95% CI): -0.670 (-1.067, -0.273) and -0.696 (-1.093, -0.298) respectively; both p=0.001]. The likelihood of developing new caries was significantly lower in Group II and Group III, as compared with Group I [OR (95% CI): 0.434 (0.298, 0.633) and 0.490 (0.337, 0.713) for Group II and Group III, respectively; both p<0.001]. There was no significant difference between Group II and Group III across all outcome measures (all p>0.05). Similar trends were found at 6 and 12 months.

Conclusions: MI combined with PE was more effective than PE alone in enhancing parental efficacy, improving children’s oral health behaviors, and preventing dental caries in preschool children. The incorporation of RA did not improve the effectiveness of MI in protecting preschool children’s oral health.