NUTRITION AND TOOTH DECAY IN CHILDREN: A QUALITATIVE STUDY OF CAREGIVER EXPERIENCES AND PERSPECTIVES

Introduction: Tooth decay is the most common chronic disease in children. According to the Canadian Health Measures Survey (CHMS), 56.8% of Canadian children (six to 11 years old) have had dental caries. Many factors can cause tooth decay including diet, poor oral hygiene (brushing, flossing), and social determinants of health. Foods can be labeled as: cariogenic (promotes tooth decay; e.g., sugary foods) and cariostatic (inhibits tooth decay; e.g., milk, cheese). Cariogenic foods that are consumed frequently are especially harmful. To date, there is little known about parent/caregiver perspectives regarding nutrition and tooth decay, especially in Canada and Saskatchewan. Objectives: The purpose of this study is to investigate the parents/caregivers´ perspective as it relates to the role of nutrition in tooth decay in children. Specifically, this study will explore the knowledge, experiences, and attitudes regarding tooth decay and nutrition, including nutrition care, in parents/caregivers of children who have recently experienced this disease. Methods: Saskatchewan parents/caregivers of children ≤12 years of age diagnosed with tooth decay in the past 2 years by an oral health professional were recruited using community-based advertising (e.g., online advertisements) to complete a semi-structured interview. All interviews (in-person; telephone) were audio-recorded and transcribed. Data were managed using NVIVO version 12 (QSR International, Doncaster, Australia) software and analyzed using Interpretive Description methods. Results: A total of 21 parents/caregivers (17 females; 4 males) participated in interviews ranging from 22 to 71 minutes. A total of 26 children (15 boys; 11 girls) experienced tooth decay and they were 2 to 12 years (mean age: 7.7 years) at the time of the interview. They had different types of tooth decay treatment (e.g., fillings, root canal, crowns, and tooth extractions). Three major themes emerged from the research findings (1) Parents/Caregivers: Knowledge, Beliefs and Practices; (2) Getting Help; and (3) Moving Forward- Advice for the future. For the first theme, parents/caregivers seemed to have a general understanding about the causes of tooth decay since they mentioned diet; oral hygiene and genetics as causes. Variable eating behaviors were found in children, but a high consumption of sugary foods/beverages especially during breakfast, snacks and at bedtime was reported. Most of parents/caregivers did not report making any dietary changes following tooth decay diagnosis. In the cases where dietary changes were made, the changes were limited, and often focused on one or a few foods that were high in sugar. For the second theme, most parents/caregivers did not receive any explanation for their child’s tooth decay and limited/no advice on future prevention, especially related to nutrition. No caregivers were referred to or consulted a dietitian regarding tooth decay, and none of them reported having had an in-depth conversation with an oral health professional about nutrition and prevention of tooth decay. For the third theme, caregivers were very interested in learning more about nutrition and tooth decay and wanted more education on this topic. Parents/caregivers indicated they would welcome increased dietitian involvement, new policies towards food labeling, and more information from the health professionals that they already attend for regular visits including oral health professionals, public health nurses, and family physicians. Conclusions: Parents/caregivers reported receiving little/no information about nutrition and tooth decay, and none received dietitian assistance on this topic. They wanted to learn more about nutrition to decrease the risk of tooth decay. More information on nutrition and tooth decay needs to be spread throughout the community using diverse channels. Dietitians have an important role regarding many of the suggestions to help to provide more assistance to parents/caregivers regarding this topic. Significance: Nutrition and tooth decay is an emerging practice area for dietitians. Dietitians have an important role in working collaboratively with other health professionals to decrease the burden of tooth decay. Parent/caregiver suggestions can help to guide development of nutrition interventions to prevent tooth decay in the future