Parental Adherence to At-Home Fluoride Varnish Application for Their Children in Southeast Iran: A feasibility study

Document Type : Original Article

Authors

1 Department of Community Dentistry, Faculty of Dentistry, Kerman University of Medical Sciences, Kerman, Iran

2 Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

3 Private Practice, Kerman, Iran

Abstract

Background: Fluoride varnish (FV) is applied to tooth surfaces to prevent dental caries. Thus, this study aimed to experimentally assess parental adherence to FV application for their children at home.
Methods: This acceptability study was conducted in two phases. The first phase was to create an acceptability questionnaire asking questions about applying FV, including self-efficacy, perceived effectiveness, and intervention coherence. The content validity index and content validity ratio were used to evaluate the questionnaire’s content validity, while test-retest and internal consistency procedures were used to examine its reliability. The second part of the study examined adherence to the intervention following an educational session, where parents of children aged three to fourteen years in the Kerman Province cities of Bardsir and Mahan were given FV packets to apply to their children’s teeth at home.
Results: A 13-item survey was developed during the first phase. The content validity index and validity ratio scores were satisfactory for all items except one. The reliability calculation, which yielded acceptable results (Cronbach’s α = 0.78, Cohen’s kappa = 0.44), included 11 items. Phase two included delivering the varnish kits and accompanying education to 3,205 parents. A total of 91.3% of parents followed the treatment plan—78.5% after the first follow-up and 12.8% after the second. Parents with higher education levels were more likely to adhere to the treatment (P = 0.001), and over 75% of mothers reported that they could apply the varnish independently.
Conclusion: Based on the results, over 90% of parents successfully applied FV, indicating that this method could effectively increase FV coverage in the target population.

Keywords

Main Subjects


1. Baik A, Alamoudi N, El-Housseiny A, Altuwirqi A. Fluoride
varnishes for preventing occlusal dental caries: a review. Dent
J (Basel). 2021;9(6):64. doi: 10.3390/dj9060064.
2. Garcia RI, Gregorich SE, Ramos-Gomez F, Braun PA, Wilson
A, Albino J, et al. Absence of fluoride varnish-related adverse
events in caries prevention trials in young children, United
States. Prev Chronic Dis. 2017;14:E17. doi: 10.5888/
pcd14.160372.
3. Utomo AI, Murti B, Pamungkasari EP. Meta-analysis the
effectiveness of fluoride varnish use to prevent deciduous dental
caries in children. J Epidemiol Public Health. 2023;8(2):205-
12. doi: 10.26911/jepublichealth.2023.08.02.05.
4. Bonetti D, Clarkson JE. Fluoride varnish for caries prevention:
efficacy and implementation. Caries Res. 2016;50 Suppl 1:45-
9. doi: 10.1159/000444268.
5. World Health Organization (WHO). Global Data on Dental
Caries Prevalence ( DMFT) in Children Aged 12 Years /
Global Oral Data Bank, Oral Health/Area Profile Programme.
Geneva: WHO; 2000. Available from: https://apps.who.int/iris/
handle/10665/66520?show = full. Accessed February 2, 2021.
6. Gilchrist F, Marshman Z, Deery C, Rodd HD. The impact of
dental caries on children and young people: what they have
to say? Int J Paediatr Dent. 2015;25(5):327-38. doi: 10.1111/
ipd.12186.
7. Shoaee S, Saeedi Moghaddam S, Masinaei M, Sofi-Mahmudi
A, Hessari H, Heydari MH, et al. Trends in dental caries of
deciduous teeth in Iran: a systematic analysis of the national
and sub-national data from 1990 to 2017. BMC Oral Health.
2022;22(1):634. doi: 10.1186/s12903-022-02634-z.
8. Shoaee S, Masinaei M, Saeedi Moghaddam S, Sofi-
Mahmudi A, Hessari H, Shamsoddin E, et al. National and
subnational trend of dental caries of permanent teeth in Iran,
1990-2017. Int Dent J. 2024;74(1):129-37. doi: 10.1016/j.
identj.2023.07.012.
9. Khami MR, Haghparast Ghomsheh A, Hessari H, Shati M.
Knowledge of the health personnel involved in the fluoride
varnish therapy programs of primary schools in Tehran, Iran.
BMC Oral Health. 2024;24(1):649. doi: 10.1186/s12903-024-
04390-8.
10. Goff SL, Gilson CF, DeCou E, Dick AW, Geissler KH, Dalal
M, et al. Barriers and facilitators to optimal fluoride varnish
application. Acad Pediatr. 2024;24(5):755-64. doi: 10.1016/j.
acap.2023.09.018.
11. Lienhart G, Elsa M, Farge P, Schott AM, Thivichon-Prince B,
Chanelière M. Factors perceived by health professionals to
be barriers or facilitators to caries prevention in children: a
systematic review. BMC Oral Health. 2023;23(1):767. doi:
10.1186/s12903-023-03458-1.
12. Marinho VC, Higgins JP, Sheiham A, Logan S. One
topical fluoride (toothpastes, or mouthrinses, or gels, or
varnishes) versus another for preventing dental caries
in children and adolescents. Cochrane Database Syst
Rev. 2004;2004(1):CD002780. doi: 10.1002/14651858.
CD002780.pub2.
13. Gaunt F, Brough L. Fluoride application in paediatric patients
attending general anaesthetic in Carlisle and Eden. Int J Paediatr
Dent. 2022;32(Suppl 1):76-8. doi: 10.1111/ipd.13020.
14. Skinner J, Dimitropoulos Y, Sohn W, Holden A, Rambaldini
B, Spallek H, et al. Child fluoride varnish programs
implementation: a consensus workshop and actions to increase
scale-up in Australia. Healthcare (Basel). 2021;9(8):1029. doi:
10.3390/healthcare9081029.
15. Mascarenhas AK. Is fluoride varnish safe?: Validating the safety
of fluoride varnish. J Am Dent Assoc. 2021;152(5):364-8. doi:
10.1016/j.adaj.2021.01.013.
16. Rahaei Z, Zare-Bidoki M, Fotouhi-Ardakani F, Jambarsang S.
Improving the participation of preschool children’s mothers
in fluoride varnish program: an educational intervention. J
Educ Community Health. 2023;10(1):43-8. doi: 10.34172/
jech.2023.A-10-1131-2.
17. Mohebbi SZ, Razeghi S, Chinipardaz Z, Soleimannejad H,
Kharazifard MJ. Performance of preschoolers’ mothers and
senior dental students after receiving training on fluoride
varnish administration. J Dent (Tehran). 2017;14(4):237-45.
18. Jafari A, Zangooei M, Aslani S, Shamshiri A, Hesari H. The role
of trained mothers in varnish fluoride therapy program. Iran J
Pediatr Dent. 2013;9(1):59-66. doi: 10.29252/ijpd.9.1.59.
19. Morgan-Trimmer S, Chadwick BL, Hutchings S, Scoble C,
Lisles C, Drew CJ, et al. The acceptability of fluoride varnish
and fissure sealant treatments in children aged 6-9 delivered
in a school setting. Community Dent Health 2019;36(1):33-8.
doi: 10.1922/CDH_4263Morgan-Trimmer06.
20. Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare
interventions: an overview of reviews and development of a
theoretical framework. BMC Health Serv Res. 2017;17(1):88.
doi: 10.1186/s12913-017-2031-8.
21. Boateng GO, Neilands TB, Frongillo EA, Melgar-Quiñonez HR,
Young SL. Best practices for developing and validating scales
for health, social, and behavioral research: a primer. Front
Public Health. 2018;6:149. doi: 10.3389/fpubh.2018.00149.
22. Nurdin MF, Mohd Yusof ZY. Facilitators and barriers to the
implementation of preschool oral healthcare programme
in Malaysia from the perspective of dental therapists: a
qualitative study. Children (Basel). 2020;7(12):266. doi:
10.3390/children7120266.
23. Tahani B, Yadegarfar G, Ahmadi A. Knowledge, attitude, and
practice of parents of 7-12-year-old children regarding fissure
sealant therapy and professional fluoride therapy. J Educ
Health Promot. 2017;6:106. doi: 10.4103/jehp.jehp_17_17.
24. Almehmadi AH, Bannan A, Ahmad A, Alqadi R, Alhindi
A. Parental knowledge and awareness of fluoride varnish
application on their children - a cross-sectional study. Int J
Gen Med. 2022;15:7435-42. doi: 10.2147/ijgm.S378194.
25. Naderifar M, Ghaljaei F, Akbarizadeh MR. Determination of
the mothers’ practice about orodental health of their children
up to six years old. Zahedan J Res Med Sci. 2010;12(4):43-8.
26. Lawrence HP, Binguis D, Douglas J, McKeown L, Switzer
B, Figueiredo R, et al. A 2-year community-randomized
controlled trial of fluoride varnish to prevent early childhood
caries in Aboriginal children. Community Dent Oral Epidemiol.
2008;36(6):503-16. doi: 10.1111/j.1600-0528.2008.00427.x.
27. Slade GD, Bailie RS, Roberts-Thomson K, Leach AJ, Raye I,
Endean C, et al. Effect of health promotion and fluoride varnish
on dental caries among Australian Aboriginal children: results
from a community-randomized controlled trial. Community
Dent Oral Epidemiol. 2011;39(1):29-43. doi: 10.1111/j.1600-
0528.2010.00561.x.
28. American Academy of Pediatric Dentistry. Guideline on
periodicity of examination, preventive dental services,
anticipatory guidance/counseling, and oral treatment
for infants, children, and adolescents. Pediatr Dent.
2013;35(5):E148-56.
29. Hendaus MA, Jama HA, Siddiqui FJ, Elsiddig SA, Alhammadi
AH. Parental preference for fluoride varnish: a new concept
in a rapidly developing nation. Patient Prefer Adherence.
2016;10:1227-33. doi: 10.2147/ppa.S109269.
30. Stearns SC, Rozier RG, Kranz AM, Pahel BT, Quiñonez RB. Costeffectiveness
of preventive oral health care in medical offices
for young Medicaid enrollees. Arch Pediatr Adolesc Med.
2012;166(10):945-51. doi: 10.1001/archpediatrics.2012.797.
31. Chhabra N, Chhabra A. Parental knowledge, attitudes and
cultural beliefs regarding oral health and dental care of
preschool children in an Indian population: a quantitative
study. Eur Arch Paediatr Dent. 2012;13(2):76-82. doi: 10.1007/
bf03262848.
32. Chi DL. Parent refusal of topical fluoride for their children:
clinical strategies and future research priorities to improve
evidence-based pediatric dental practice. Dent Clin North
Am. 2017;61(3):607-17. doi: 10.1016/j.cden.2017.03.002.
33. Davoodi-Lahijan J, Farrokh-Eslamlou HR, Shariat-Torbaghan
K, Nouraei-Motlagh S, Alinia C, Yusefzadeh H. Economic
evaluation of fluoride varnish application in Iranian schools. J
Oral Health Oral Epidemiol. 2021;10(2):64-71. doi: 10.22122/
johoe.v10i2.1146.
34. Khodadadi E, Gharekhani S, Esmaeili B, Karampour N, Bijani
A. Evaluation of the effect of various types of fluoride varnishes
on color stability of a composite resin. J Oral Health Oral
Epidemiol. 2017;6(1):22-6.