10 August 2022

Parental involvement is a key factor for successful caries prevention

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By: Assoc. Prof. Dr. Nor Azlida Mohd Nor, Prof. Zamros Yuzadi Mohd. Yusof

Data from the national oral health survey in 2015 showed that 7 out of 10 children aged 5 years old had tooth decay (caries) in their milk teeth. Similar trend observed from the recent annual oral health report from the Oral Health Programme, Ministry of Health Malaysia. It is well known that dental caries has negative impacts on children’s quality of life such as pain, discomfort, difficulty in eating, problems during sleep and disturbed schooling and daily activities. Parents or caregivers of children with untreated dental caries are also affected by experiencing sleepless nights and financial implications. Despite the existence of a preschool oral healthcare programme in Malaysia over the past three decades, caries reduction among pre-schoolers declined at a much slower rate than other age groups. The main contributing factors to this problem are lack of parental and teacher’s support for children’s oral health, as well as a high workload among dental therapists who are involved in the preschool oral healthcare service. All these factors have led to poor oral health behaviours in children.

Parents or caregivers play an important role in children’s oral health because tooth decay is largely preventable. Young children are not able to look after their oral health, thus, the responsibility lies with parents or caregivers. Parents play a key role to establish early oral health practices in their child’s life. Scientific evidence shows that parental oral health beliefs and self-efficacy help determine the extent to which they will engage in oral health promoting behaviours at home. The good oral health behaviours will be further strengthened at school with support from teachers. Evidence from a local study in Perak suggests that a preschool oral health programme that includes active participation of parents is able to significantly reduce children’s dental plaque and sugary drinks intake at 6-month follow up than the oral health programme with a low parental participation.

Based on the evidence from the literature, the recommendations put forward to improve preschool children’s oral health in Malaysia are to empower parents, include teachers in oral health activities at school and strengthen the role of dental professionals in caries prevention. However, some parents still have misconceptions about their role and leave their children’s oral health care with dental professionals to solve their children’s oral health problems. Dental treatment alone does not solve the root cause of oral diseases. Therefore, in order to control dental caries and gum disease, family’s effort to improve and monitor their children’s oral health behaviours and dietary intake is important.

Prevention is even more crucial during this pandemic because oral healthcare service at school settings is limited. The following are some tips for oral hygiene practice at home for parents with young children.

boy in red and black sweater smiling

Brush together

Spend time with your child when he/she brushes teeth. Children need help and guidance from parents for effective tooth brushing. It is best to monitor them when they brush their teeth until they are 7 years old. Many studies have shown that parental supervision during toothbrushing is effective to control dental plaque and prevent dental caries.

Attractive toothbrush

Most children’s toothbrushes have attractive colours and designs. Find a toothbrush that your child finds attractive, e.g. a toothbrush with cartoon characters or a superhero to attract their attention and encourage good toothbrushing habits.

Brush twice a day for two minutes

Creating a morning and bed-time toothbrushing routine is important to make sure your child brushes his/her teeth twice daily for 2 minutes. Parents often ask how long their child should brush his/her teeth. There are several ways to do this. For example, you can use a 2-minute sand-timer in the bathroom to record the brushing time or play a fun song from YouTube when your child brushes his/her teeth.

Fluoridated toothpaste

Use a fluoridated toothpaste. Read the label on the toothpaste’s box to check for fluoride ingredients before buying a toothpaste for your child. For young children aged 3 years or below, use a smear/rice grain amount of toothpaste. For children aged 4 years and above, use a pea-size amount of toothpaste. Fluoride helps to prevent tooth decay by making the tooth more resistant to acid attack from plaque bacteria and sugars in the mouth.

Offer reward and positive feedback

Give positive feedback by praising your child after toothbrushing so that they appreciate your approval and will look forward to the next brushing session. Dentists often advise parents to use a toothbrushing calendar to monitor their child’s daily brushing routine and reward them with a star-sticker afterward. If your child develops good oral hygiene practice every day for a month, you may offer them a special prize to keep them motivated.

Yearly visit to the dental clinic

Many parents take their child to see the dentist only when the child has a toothache. This will lead to a bad experience and the child may develop dental fear and anxiety when visiting a dentist. This should be avoided in a child. Instead, visiting a dentist should be an enjoyable experience. Start bringing your child to see a dentist on his/her first birthday or as soon as the first tooth has erupted. The Ministry of Health has launched an oral health promotion campaign, i.e. “ingat hari jadi, ingat dr gigi” to encourage a yearly dental visit for children. Regular visits to the dentist help to diagnose oral disease at early stage and if treatment is needed, it will be minimal, pain-free and less invasive.


The authors are researchers at the Faculty of Dentistry, Universiti Malaya.