Early Childhood Caries (ECC) is a significant clinical and public health challenge that the world and the Singapore population are facing. This study seeks to test the effectiveness of technology-enabled anticipatory guidance and peer support in empowering parents to establish proper childcare practices and prevent ECC.
The study design is a two-arm, parallel group, assessor-blinded, randomised controlled trial. The hypothesis is that technology-enabled anticipatory guidance and peer support is more effective than conventional oral health education in enhancing parental efficacy, establishing proper childcare practices (dietary, feeding and toothbrushing), and preventing ECC. Up to 600 mother-child dyads will be recruited and randomly assigned to receive conventional oral health education (control), and technology-enabled anticipatory guidance and peer support (intervention), respectively. For the intervention arm, anticipatory guidance and peer support will be delivered through 4 unique online sessions for mothers, when each child turns 3, 6, 12, and 18 months, to match the developmental milestones and parental needs for childcare support. Outcomes will be assessed through a questionnaire and food diary (at 12, 24 and 36 months of child's age) and a dental examination for the child (at 24 and 36 months of age). The effectiveness of the intervention will be evaluated using psychological outcomes (parental efficacy), behavioral outcomes (dietary, feeding and oral hygiene practices), and clinical outcomes (oral hygiene and ECC), and quality of life outcomes. Process evaluation and cost-effectiveness analysis will be included. Data will be analyzed on an intention-to-treat basis, including with the last observation carried forward method. Descriptive statistics on socio-demographic backgrounds, parental efficacy, childcare practices, child's oral health status, and oral health related quality of life will be reported. Chi-square test and two-sample t-test, or their non-parametric equivalents, will be used as appropriate to compare proportions and means between the control and intervention groups. Effect sizes and number needed to be treated will be presented to provide an estimate of the number of parents needed to be intervened in order to avoid one child with new dental caries. Multivariable analyses will be performed to evaluate the effectiveness of the intervention.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
The intervention includes 4 online sessions led by an oral health therapist (OHT) or dentist, as well as push notifications and information delivered to participants via a mobile/web app.
Participants on this arm will receive conventional child oral health education materials at 4 time points.
National University Hospital
Singapore, Singapore
RECRUITINGIncidence of early childhood caries
Number of new surfaces with coronal caries
Time frame: 24 and 36 months of age for children
Toothbrushing behaviours
Using a questionnaire, toothbrushing behaviours will be categorised as: 1. Favourable (frequency of brushing \>=2times/day) 2. Unfavourable (frequency of brushing \<2times/day)
Time frame: 12, 24 and 36 months of age for children
Dietary and feeding practices (favourable/unfavourable)
Self-reported frequency of snack, sweet/dessert and sugary drink intake
Time frame: 12, 24 and 36 months of age for children
Dental Utilisation
Self-reported frequency of dental visits
Time frame: 12, 24 and 36 months of age for children
Dental Costs
Sum of direct costs from dental treatment and indirect costs due to time taken off work by parents to attend dental visits, and loss of productivity. Costs will be captured in Singapore dollars (SGD).
Time frame: 12, 24 and 36 months of age for children
Parental efficacy in managing oral health of child
Measured using the self-efficacy scale for maternal oral care (SESMO). Response options ("Yes" and "No"). A score of 1 is given for an answer with higher self-efficacy and 0 for lower self-efficacy. Minimum score is 0 and maximum score is 16 for the 16 questions. Higher scores indicate better outcomes.
Time frame: 12, 24 and 36 months of age for children
Plaque score
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Purpose
PREVENTION
Masking
SINGLE
Enrollment
600
Plaque score based on the index recommended by Ramjford and modified for primary dentition. The plaque score is coded as following: 2 = visible plaque without use of probe, 1 = no visible plaque but a probe skimmed over the tooth surface reveals plaque, 0 = no plaque. Scoring is done at three sites (interproximal, buccal and palatal/lingual) on the index teeth (#54, #61, #64, #74, #81, #84).
Time frame: 24 and 36 months of age for children
Breastfeeding rate
Duration of breastfeeding (in months)
Time frame: 12 and 24 months of age for children