Randomized clinical trial: evaluation of the effectiveness of an application for mobile phones as an aid in early childhood caries control

Author(s)

Matheus Lotto de Almeida Souza

• Document type: Master's Dissertation
• Press: Bauru.
• Institution: Universidade de São Paulo (USP). Faculdade de Odontologia de Bauru (FOB/SDB)
• Defense date: 2020-07-22

Examining board members

Thiago Cruvinel da Silva; Thiago Machado Ardenghi; Maria Aparecida de Andrade Moreira Machado; Saul Martins de Paiva

• Advisor: Thiago Cruvinel da Silva

Abstract

Considering the impacts caused by early childhood caries (ECC) on the quality of life of children and their families, as well as the great diffusion and influence of digital media on people\'s health, this study was divided into two stages, aiming (1) to investigate the parental perspectives on this disease, and (2) to evaluate the effectiveness of text messages sent via cellphones to the parents or caregivers as an adjuvant method for ECC control. In first phase, three focus groups were conducted with attendees of the Clinics of Paediatric Dentistry from the Bauru School of Dentistry. The meetings were audio- and video-recorded, and the contents were transcribed verbatim. Then, textual passages were coded and qualitatively analyzes using the software NVivo 12 Plus. The participants associated the presence of dental caries lesions with negative consequences for children, such as problems for permanent dentition, discrimination, and psychological damages. Although regular oral hygiene and healthy diet were recognized as important factors for the prevention of ECC, specific doubts about feeding, toothpaste usage, oral hygiene, and dental eruption were detected among parents. Additionally, they declared that their children brush teeth alone, intake fermentable carbohydrates frequently, and sleep during breastfeeding without dental plaque removal, because uncooperativeness, permissiveness, and convenience. Despite the parents and caregivers understand the unfavorable effects of ECC on children\'s quality of life, their attitudes in disease management are inaccurate and influenced by their daily routines, doubts, and beliefs. In second phase, a single-blinded, randomized, and parallel-group study was conducted with 104 dyads of parents and children aged between 36-60 months, recruited in preschools from periphery of city of Bauru-SP. The participants were randomly allocated into two groups, control and intervention (n=52), stratified by eHealth literacy levels of parents (eHEALS), and age, gender, and oral health status of children. Every 2 weeks, text messages, with ECC control-related contents and that were produced from the first phase findings, were sent to parents of intervention group via WhatsApp. Visible plaque index, community periodontal index, and the International Caries Detection and Assessment System (ICDAS) were assessed at baseline, 3- and 6-month follow-up after professional electric toothbrushing. Also, eHEALS and dietary habits were determined at baseline and 6-month follow-up. P values <0.05 were considered significant. Despite similar scores of VPI, CPI, and ICDAS between groups, a significant increase of eHEALS scores and free-sugar sweets consumption were detected in the intervention group after 6 months, especially among those dyads with engaged parents. Therefore, mobile text messages were not effective to arrest the progression of ECC in low socioeconomic preschoolers, although they seemed beneficial to improve parental eHealth literacy levels and free-sugar sweet intake by children. (AU)

• FAPESP's process: 17/25899-7 - Randomized clinical trial: evaluation of the effectiveness of an application for mobile phones as an aid in the prevention of early childhood caries
• Grantee: Matheus Lotto de Almeida Souza
• Support Opportunities: Scholarships in Brazil - Master