Methods: Data were obtained from a program where trained senior nursing students examine children for oral hygiene and apply fluoride varnish. The program is currently being implemented in pre-schools in Northwest Arkansas where a high percentage of children qualify for free and reduced school meals. Data collected from the program include a parent-completed permission form with yes or no questions regarding tooth-brushing frequency, sugar intake, familial dental problems, and whether the child is being seen by a dentist. The second data set is completed by student nurses and includes the presence of tooth decay and/or fillings, visible plaque, enamel defects, white spot lesions, swelling, complaints of pain, whether the child was referred to a dentist for urgent care. Based on the data, student nurses assign a tooth decay risk score. During the study period (Spring, 2018), a total of 456 three and four year old children were assessed for oral health and 436 children had fluoride applied to their teeth by the student nurses. Ninety children, 21%, were referred to the dentist for further evaluation and treatment.
Results:
Ninety-two percent of the parents reported brushing their child’s teeth at least once a day using toothpaste with fluoride; 60% reported that their child drinks fluoridated water; 77% reported that their child drinks juice or sweetened drinks between meals or eats sugary snacks; and 8% reported that their child sleeps with a bottle filled with milk or drinks other than water. Seventy-one percent reported that their child was being seen by a dentist.
A bivariate analysis with a Chi-square value was applied to compare the presence of tooth decay with each independent variable reported by the parents. There was a statistically significant difference in the presence of tooth decay between children whose teeth were brushed at least once a day using toothpaste with fluoride and those whose were not and between children whose parents reported that they slept with a bottle filled with milk or drinks other than water and those who did not.
A multiple regression analysis was conducted to predict the overall tooth decay risk from the student nurse performed oral assessment. Overall, 9% of the children were assessed to be at high risk for tooth decay, 26% at moderate risk, and 66% at low risk. Results of this analysis indicate that the physical assessment measures accounted for a significant amount of the risk variability, R2 = .50, F(4, 354) = 88.558, p <.001. A second analysis was conducted to evaluate whether the parent report measures predicted tooth decay risk over and above the assessment, R2 change = .015, F(6, 348) = 1,772, p = .104. These results suggest the parent reports offer little additional predictive power beyond that contributed by the screening.
Conclusion:
Results indicate that screening of children’s teeth and mouth that enables early detection and referral to the dental team for detailed examination and treatment can be effectively carried out by trained nursing students. New laws, such as Arkansas ACT 90 of 2011, that allow nurses to apply fluoride varnish, increase childrens’ access to preventive dental care. Many elementary schools participate in visual and hearing assessments for children. Adding dental screening with fluoride application can result in improved oral health for children.
Results also indicate that oral health education programs are needed. While most of the parents reported brushing their children’s teeth at least once a day, the majority reported that their children consumed sugary food and drinks and 40% reported that their child did not drink fluoridated water. Educational programs should include information about the cariogenic effects of sugar and the importance of fluoride as well as emphasizing parenting skills and strategies to promote healthy oral hygiene habits in children.