The results of this review showed a reduced ECC incidence in preschool children whose mothers received prenatal oral health care. ECC is a multifactorial disease with complex socioeconomic, genetic, oral hygiene behaviors, and bacterial and diet factors that affect its risk (30, 31). Streptococcus mutans and more recently, candida species have been implicated as potential major etiological microorganisms that may be involved in the initiation and development of ECC (32, 33).
This study focused on maternal level knowledge regarding oral health, especially since mothers play crucial roles in educating their preschool children. However, an attempt was also made to increase the awareness of not only mothers but also health professionals regarding the importance of the early prevention of dental and oral diseases in children. Through pre and postnatal health education, mothers’ education level had a direct effect on children's oral health (13) and attempts at improving the knowledge and attitude in parents have a substantial impact on improving the oral health of next generation (15).
In the reviewed studies, we found that text messaging and phone connect intervention was able to increase flossing behavior and oral health knowledge. Additionally, among participants from a private practice, using this method increased the use of mouthrinse. Mothers’ behaviors with respect to their children also changed; more text group mothers than control group mothers reported trying to improve their child’s oral health behaviors and decreasing their child’s candy, and sugary snack intake. The use of mobile technology (text messages, video messages, voice calling, and the Internet) to provide health care (mHealth) has been applied to improve the practicality, rapidity, and precision of diagnostic tests; monitor specific medical conditions; improve medication adherence; send appointment reminders; and deliver medical test results (22).
The dental environment of a young child is affected by a complexity of factors that include the mother’s and/or caregiver’s dental knowledge, attitudes, beliefs and practices, all of which affect the child’s oral condition (34). Feeding habits are said to be of primary importance in the etiology of dental caries at any age, but even more so among preschool children (35).
Participants who received MI (Motivational Interviewing) showed improved knowledge across a wider range of knowledge items (correct amount of toothpaste, supervised brushing position, fluoride varnish, and safest time to give sugary foods and drinks) compared to those who received traditional dental health education DHE. Importantly knowledge of the importance of fluoride varnish application also has practical implications for preventive strategies as this clinical intervention is effective in reducing ECC separately and in combination with fluoride toothpaste (36, 37). The reduction in prevalence of early childhood caries (ECC) following an MI intervention reported in Asian families in Canada, was largely attributed to a greater uptake of fluoride varnish by those families (38) possibly due to the parents attaching greater value to professional preventive care. Mother’s education level additionally indicates knowledge of oral health. In other words, mother’s oral health knowledge was correlated with their education level. For instance, the dietary choice for children could be affected if their mothers knew about the role of bacteria and sugar in dental caries. Sweet food habits commence at preschool age (39).
Parents and caregivers can be considered gatekeepers for the oral healthcare of preschool children, therefore their oral health knowledge, beliefs, attitudes and behavior may directly, or indirectly, influence early childhood oral health. Traditional dental health education approaches with a main focus on improving parental oral health knowledge have not been effective in improving preschool children’s oral health (21).
Social, economic and environmental factors play a substantial role in shaping people’s behavior and translating this knowledge into positive health choices and practices (40). In addition, the results of this study highlighted some general trends that were not always statistically significant but yet are worth noting. The first was a general lack of weakness in the knowledge, attitude and practice in infant oral health-related areas such as the timing for the first dental visit, the ideal timing to initiate tooth brushing for children, as well as nighttime bottle feeding. Better infant oral health-related trends, however, were observed with younger caregivers and caregivers of children under 1 year. This is possibly due to higher educational levels among the younger group. Additionally, younger parents have generally better computer/internet literacy and would therefore have wider access to a variety of oral health-related knowledge. The second observed trend was that mothers, compared to other caregivers, were generally more knowledgeable, had better attitude, but did not necessarily have better practices (41).