Oral Health Knowledge and Practices of Child Care Providers

Sona Gill, DDS; Donna Kritz-Silverstein PhD; Clarice Law, DMD

Section of Pediatric Dentistry, University of California School of Dentistry, Los Angeles, CA
Table 2. Attitudes Towards Oral Health of Respondents.

Early childhood caries is the most common chronic disease of childhood, and is the most severe amongst young children. By the time they begin kindergarten, 40% of US children have dental caries. To improve this situation, it is imperative that the oral health needs of infants and young children are addressed as early as possible. In the US in 2005, 61% of children ages 0-6 who were not yet in kindergarten received some form of child care on a regular basis from someone other than their parents. Child care providers can directly impact the oral hygiene and dietary habits of the children they care for in an effort to reduce the dental caries risk within this population. Therefore, it is vital for child care providers to possess appropriate oral health knowledge. However, regulations enforced by states on the oral health education of child care providers and the requirements for compliance with oral health practices in child care centers is rather lax. In California in particular, regulations do not make enforceable any particular oral health practices within centers.

Table 1. Sample characteristics of respondents (n=72)

Junior High Master's Degree 3% 8% Unspecified 14% High School 16%

With OH education How interested are you in learning more about oral health? How comfortable are you talking about dental issues with parents? How willing are you to counsel parents regarding dental health issues? How important do you consider your own dental health? 6.0 5.4 5.5 6.6

Without OH education 5.6 5.4 5.3 6.1

p-value 0.066 0.480 0.230 0.053

Bachelor's Degree 43%

Associate's Degree 16%

Figure 1. Highest level of education of respondents. The mean scores on the oral health
assessment showed no difference according to the level of education.

Responses are based on a 7 point Likert scale, with 1 being, not at all important, and 7 being, very important. Those with and without previous oral health (OH) education believed their own dental health was important, were willing to learn more about oral health, and were somewhat comfortable and willing to counsel parents on oral health issues.

The purpose of this study is to evaluate the oral health knowledge and practices of childcare providers in West Los Angeles to determine whether or not they can effectively partner with the dental workforce to effect change in the caries risk of the children they care for.
45% 40%

The majority of respondents were female. There was a relatively even distribution of ages, with the group of 40-49 year olds being the least represented. The predominant ethnicity of the respondents was Latino or Hispanic.

With 37%

Without 63%

Table Child care providers can potentially be powerful contributors to the dental 1: Stage 4 proximal lesion influence on outcome by treatment type (P=.001) workforce. Results of this study indicate that child care providers in West Los Angeles could help prevent caries in the children they care for if they were to improve their compliance with effective oral health practices within their centers; there is also room for improvement in terms of avoidance of caries-promoting behaviors, such as giving milk or juice as part of a nap-time routine. While providers who reported previous oral health education performed better than those without oral health education on the knowledge portion of the survey, neither group had passing average scores, demonstrating the need for more and better oral health education of child care providers. There was no significant difference between the groups with and without previous oral health education in attitudes towards oral health promotion.

Figure 2. % of respondents with and without oral health education and/or training. The
respondents answered the question: About how many hours in your training to become a child care provider were dedicated to oral health? The answers ranged from 1-20 hours.

Subjects: Subjects included 72 child care providers in West Los Angeles attending workshops for the Connections for Children child care referral service, or working in a UCLA Early Care and Education Center.

35% 30% 25%

Providers with oral health education

15

Survey Instrument: A survey designed by the research group assessed oral health knowledge with true/false and multiple choice items, and attitudes and behaviors related to oral health using Likert scales; Sociodemographic characteristics of the providers were also obtained
Survey administration: Surveys were administered at the Connections for Children child care referral site during workshops held for the child care providers, and at classrooms of all 3 sites of the UCLA Early Care and Education Centers.
Stage 2: inner enamel #L-distal Stage 3: dentinoenamel junction

20% 15% 10% 5% 0% Give milk/juice as Make the children Make the children Assist or supervise part of nap-time rinse with plain brush their teeth the children routine water after a meal during their oral or snack hygiene practices
0 Providers with oral health Providers without oral education health education

Providers without oral health education

10

Although child care providers are willing to assist the dental workforce, in order to do so they will require more training in oral health knowledge and practices.

Kranz, AM., Rozier, G. Oral Health Content of Early Education and Child Care Regulations and Standards. Journal of Public Health Dent. 2011. Spring; 71(2): 81-90. Oral health promotion in child care [Internet] Media (PA): Healthy Child Care Pennsylvania, The Early Childhood Education Linkage System, PA Chapter American Academy of Pediatrics; [updated 2008; cited 2010 April]. Overturf Johnson J. Current Population Reports. Washington (DC): U.S. Census Bureau; 2005. Whos minding the kids? Child care arrangements: Winter 2002; pp. P70101. 2010 regulations training for family child care providers [Internet] Boston (MA): Massachusetts Department of Early Education and Care; [updated 2009; cited 2010 Apr]. Federal Interagency Forum on Child and Family Statistics. Americas children: Key national indicators of well-being. Washington (DC): U.S. Government Printing Office; 2007. Mani, SA; Aziz, AA; John, J; Ismail, NM. Knowledge, attitude and practice of oral health promoting factors among caretakers of children attending day-care centers in Kubang Kerian, Malaysia: a preliminary study. Journal of the Indian Society of Pedodontic Preventice Dentistry. 2010 Apr-Jun; 28(2):78-83. American Academy of Pediatric Dentistry. Policy on Oral Health in Child Care Centers. Pediatr Dent 2012; :33-34

Statistical Analysis: t-tests and chi-squared analyses were conducted using VassarStats.

Figure 4. Oral Health Behaviors of Respondents. The y-axis

is the percent of total respondents who performed the respective practices within each group, with previous oral health education and without previous oral health education. Approximately 30-40% of respondents participate in preventive oral health practices within their centers. Approximately 20-25% of respondents participate in caries promoting practices in their centers.

Figure 3. Number correct out of 15 on oral health knowledge test. The mean score on the
oral health knowledge portion of the assessment for the group with previous oral health education and the group without previous oral health education was 10.2 (68%) and 7.7 (51%), respectively. The difference is statistically significant, p<0.0001.

Approval: This study was approved by the Institutional Review Board of the University of California, Los Angeles.
Stage 4: outer dentin; #B-mesial