The Longitudinal Reciprocal Relationships of Tooth Brushing Behaviors between Underserved Children and their Caregivers

Background: Tooth brushing is an effective strategy for preventing early childhood caries. However, it is unclear how children’s and caregiver’s tooth brushing are reciprocally related.

Purpose: The current study investigated whether the longitudinal relationships between children and caregiver tooth brushing are moderated by a caregiver-targeted child oral health intervention and caregiver depression.

Methods: This is a secondary analysis of a randomized clinical trial which tested whether caregiver-targeted oral health text messages (OHT) outperformed child wellness text messages (CWT) on pediatric dental caries and oral health behaviors (n=754, Mchild age=2.9, 56.2% Black, 68.3% <poverty level). Tooth brushing behaviors were self-reported by caregivers using a time-line follow-back method at baseline and 4-, 12-, and 24-months later. Caregiver depressive symptoms were self-reported at baseline. A multi-group Random-Intercept Cross-Lagged Panel Model examined relationships between caregiver and child tooth brushing for four post-hoc groupings of condition: OHT vs. CWT, and caregiver depressive symptoms: high vs. low.

Results: Within-participants analyses revealed that caregiver tooth brushing at months 4 and 12 positively predicted their child’s tooth brushing at month 12 and 24 for caregivers in the OHT condition with low depressive symptoms (i.e., moderation by depressive symptoms and condition). Similarly, children’s tooth brushing at month 4 positively predicted caregiver tooth brushing at month 12 for caregivers in the OHT condition with low depressive symptoms. There were no significant associations among participants in the CWT condition, regardless of depressive symptoms.

Conclusions: Child and caregiver tooth brushing have reciprocal influences, but only for those in the OHT condition with low depressive symptoms.