BMC Oral Health 2011,
11:22
doi:10.1186/1472-6831-11-22
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| Published: |
3 September 2011 |
Background
Information bias can occur in epidemiological studies and compromise
scientific outcomes, especially when evaluating information given by a
patient regarding their own health. The oral habits of children reported
by their mothers are commonly used to evaluate tooth brushing practices
and to estimate fluoride intake by children. The aim of the present
study was to compare observed tooth-brushing habits of young children
using fluoridated toothpaste with those reported by mothers.
Methods
A sample of 201 mothers and their children (aged 24-48 months) from
Montes Claros, Brazil, took part in a cross-sectional study. At day-care
centres, the mothers answered a self-administered questionnaire on
their child's tooth-brushing habits. The structured questionnaire had
six items with two to three possible answers. An appointment was then
made with each mother/child pair at day-care centres. The participants
were asked to demonstrate the tooth-brushing practice as usually
performed at home. A trained examiner observed and documented the
procedure. Observed tooth brushing and that reported by mothers were
compared for overall agreement using Cohen's Kappa coefficient and the
McNemar test.
Results
Cohen's Kappa values comparing mothers' reports and tooth brushing
observed by the examiner ranged from poor-to-good (0.00-0.75). There
were statistically significant differences between observed tooth
brushing habits and those reported by mothers (p < 0.001). When
observed by the examiner, the frequencies of dentifrice dispersed on all
bristles (35.9%), children who brushed their teeth alone (33.8%) and
those who did not rinse their mouths during brushing (42.0%) were higher
than those reported by the mothers (12.1%, 18.9% and 6.5%,
respectively; p < 0.001).
Conclusions
In general, there was low agreement between observed tooth brushing
and mothers' reports. Moreover, the different methods of estimation
resulted in differences in the frequencies of tooth brushing habits,
indicative of reporting bias. Data regarding children's tooth-brushing
habits as reported by mothers should be considered with caution in
epidemiological surveys on fluoridated dentifrice use and the risk of
dental fluorosis.
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