Perceptions and Practices of Oral Health Care Professionals in Preventing and Managing Childhood Obesity
Abstract
:1. Introduction
2. Methods
2.1. Study Background
2.2. Study Design
2.3. Sampling
2.4. Semi-Structured Interviews
2.5. Data Analysis
2.6. Rigor
2.7. Ethical Considerations
3. Results
3.1. Theme 1: Obesity Prevention and Management in Dental Practice
3.1.1. Perceived Link of Oral Health and General Health
“Gum disease and diabetes or tooth decay and obesity, they are definitely linked. It’s one of the things that I talk about a lot in the clinic, as well as going on about how to brush your teeth. I explain that it’s important and healthy teeth are also part of a healthy body.”
“For any food, the first direct contact is inside the mouth. So, most patients who are obese, they have a high intake of cariogenic (high sugar) diet. And because of that, they have a higher rate of incidence of dental caries. Usually, I find that patients with obesity have a high risk of getting dental caries than others that are not obese.”
3.1.2. Understanding of the Common Risk Factors
“These days there’s a lot of junk food and high sugar foods and beverages that contribute to weight gain, and same goes for caries. So, we do see more children having decayed teeth if they are exposed to more sugar and junk food. As a result, kids put on the weight from eating these foods.”
“It’s just the food that is common, there is definitely a link between obesity and caries. It is more the foods that these children are eating that is contributing to both obesity and caries, at similar rates and linking more to caries. With obesity, we can definitely say there is a link there, but there are other factors that we have to account for, like exercise and genetics.”
“Part of it is the socioeconomic in the area that you’re in. Some of them tend to snack a lot on chips and chocolate because the sweet junk food is so cheap. Slurpee is one dollar, and you go to the movies, a bottle of water is five dollars. The sweet drinks are way cheaper than water. They should put limits on how much they charge for water really everywhere.”
“The local health district I’m working, a lot of people are low socioeconomic. So, it’s very hard to get them to change their diet. Because anything that is healthy is more expensive than fat foods. Especially in our region, as they are all low socioeconomic, the choice for them is not much. They’re more happy to get junk food than to get healthy foods.”
3.1.3. Current Prevention and Management Practices
“I usually ask the mom first, how is their diet? Are they fussy eater? I direct my talk on what the patient needs. If the patient is fussy then guiding the parents to incorporate a little bit of veggies, keep the treats and fruit juices to a minimum. I use that sugar chart on the sweet beverages and breakfast food, and snacks.”
“We talk about the Australian Dietary Guidelines, making sure they’re having their fruits, two fruits and five veggies a day or sampling size. Basically, water over sugary drinks, in particular tap water because of the fluorides. We do talk about diet, when it comes to sugary snacks and foods, we try to find some healthy alternative to snacks, cheese, fruit sticks, hummus dips, if they’re not allergic. So, just looking at healthier alternatives.”
“I tell them that because of obesity, and the diet that the patient is having, it is causing a little problem with our health. If you can cut down the diet, then you have less decay, you’ll be less overweight. So, there is a win-win situation, when you control this sort of thing.”
“We do try and be a little bit more understanding. We try to explain when the best time is to have something sweet, like during a mealtime. And if they do have things like juice, we recommend watering it down so it’s not as concentrated, and to have it with a straw. So, we do give them like tips like that.”
“Unfortunately, our appointments are not as long as we wish they would be. If there was a patient that had some issue with their weight, I would suggest reducing sugar, reducing portion size, and increasing water. But if there is a big issue, I recommend a referral to a dietitian or the general practitioner.”
“So, I have referred a patient who was overweight to a GP or dietitian because I don’t really know of any other places that that they can go to.”
3.2. Theme 2: Barriers and Enablers to Obesity Prevention and Management in Dental Settings
3.2.1. Barriers for Oral Health Professionals
“It is 40 min ideally for a first appointment. If you have a child that’s in the chair that is crying, mom just wants to get out of there. Even if you have a topic that is of concern and want to talk about that, some parents just want to leave, because the child is acting up or they have got some other commitments.”
“Time would be an issue given the time constraints. Especially if they’ve come in for a pain appointment and you have to do the height and weight measurement. And you might not have enough time to treat their pain if it goes into depth with the talk about the diet.”
“In case someone comes with weight issues, I don’t refer them to specialists because I don’t know how to. I would just tell them you go to your GP, who will answer all your questions. Usually, GPs have dietician and nutritionist in their practice so we can incorporate them.”
“There will have to be referrals in place. If there is an issue, you can bring it up and they can correspond with a letter saying when and what treatment they’ve provided the patient with. If there’s something more serious, the specialists would be the one to go and then they would probably refer to someone that can help with the preventative side of things.”
“We give dietary advice but don’t know what the Australian Dietary Guidelines recommend. The advice that we give currently is just based on experience. And it probably stemmed from guidelines. I would have had some knowledge and just not realise it’s on the guidelines.”
“I don’t want to give false information. I need to do some study to see what proper dietary guideline is. At the moment, I’m not too sure what the best advice is for the patient. I’d like to read the whole guideline and see what it is for specific age group.”
“I would like to know more because I don’t know much about BMI and obesity. All I know is that a high BMI means they could be overweight. But I don’t know about the cut-off points and when it is normal. I need to know everything from scratch.”
“I don’t know the cut-off points for obese or overweight. There is a chart on this, I don’t know enough for the ages though. BMI should be different for adult and children and depending on the age. The different charts, the different ways BMI is measured, I definitely want to learn that. I’m not doing the charting of the BMI at the moment.”
“Sometimes you feel a bit uncomfortable measuring the height, weight and waist because we’ve got other health professionals that might be more qualified, like dietitians and GPs. Especially with children, we weren’t so focused on their height or weight, and more focused on their teeth, diet, and oral hygiene habits.”
“When you’re working in the clinic, you want to do everything to the best of your ability. But when you’re in private practice, there’s also financial backing that you need to consider. Diet advice or oral hygiene don’t necessarily attract a dollar figure. I think that’s a barrier for a clinician to provide that service. Even if there was an item code that attracted a dollar figure, you can’t guarantee that they’ve done diet advice or taken weight or height.”
“You get worried if you say something that might offend the mother or the child. Maybe somebody before you hasn’t picked up on anything, then, parents might think why a dental practitioner is worried about the weight or the height, having gone to a nurse or another health care professional.”
“We have to explain to them that obesity and the weight have a big impact on oral health. They’re not comfortable, especially with the initial appointment, but probably by second or third appointment, they would be more comfortable. You need a very good explanation on the first appointment to let them know what these measurements are for.”
3.2.2. Barriers for Children and Their Families
“A lot of parents are unaware how much or how little sugar they need for their kids to develop decay. You have to wait for a hole to form before you can make the point. If patient education is not there, they’re going to think, why are you talking about my kids’ weight when we’re here for the teeth. When the knowledge improves, it becomes easier for us to include it in our clinics. If patients just think oral health is separate to general health, which a lot of them do, it becomes tricky.”
“When I explain to the parents about how much sugar there is in natural juice, they’re horrified because they don’t associate fruit with sugar. They associate fruit as something really healthy for you. So, they need to be educated that an orange might have at least two teaspoons of natural sugar in there. And then they realise that juice is not such a great thing to have all the time. A glass of juice is almost as bad as a glass of coke.”
“From experience, I can’t imagine patients or even parents of the children accepting that, if I was to tell one of my patient’s moms, your daughter is a little bit overweight, she should start exercising. I don’t think that the public view oral and overall health as together. I’m giving them that kind of advice, they will say what’s that got to do with the teeth.”
“Telling a family that your child is above the average weight, they might be a little bit guilty and not happy. But we can say, if you want any more help, we can refer you to a dietician. But whether the parents will take that that’s another thing. And we’re not a doctor, you’re only a dentist or dental therapist, you only work with the teeth. Why should you be telling me about the weight? So, that’s the other issue.”
“We do get a lot of cases where the parents explain to us that they really cannot afford it. I’ve had this connection with parents over the years where a lot of them are struggling to pay for dental and different services for their children. So, if it was covered through Medicare, it would make things a lot easier and more accessible.”
“We recommend all these little things that we can do for them. But in the end, if we are unsuccessful, the only option would be to tell them they have to go privately. If the parent provides with a lot of information in regard to their financial hardship, then I have gone out of my way to try and seek special approval for that. And sometimes it has gone through if the management says that the parents are experiencing financial hardship.”
“I don’t feel confident enough with their defiance, if the patients are uncooperative, if they show prejudice, like we’re oral health clinician and it’s not our area. None of your business, just do my teeth, you can have patients like that. So, patients that have that mentality, we can’t push this because there’s no point. It’s just like a waste of time as well.”
“The obstacles we did face was when the child didn’t want to stand on the scale or didn’t want to have their height measured. The parent would really try for the child to participate. But if it’s unsuccessful, they say is this necessary? And we just say don’t worry about this.”
“A lot of the occasions it was because the child has never been in such a setting. It’s like a first exposure maybe to a dental setting or maybe they’ve just got some trauma from previous experience. So, they’ve come in thinking we’re going to give them an injection.”
“So, if a child is uncooperative, I usually recommend another appointment, and use that appointment just to establish some rapport with the child, try to make it as friendly as possible, not worry on the treatment side. If the child is really anxious, crying in the chair, I would probably bring them back for another appointment.”
3.2.3. Enablers to Healthy Weight Status
“I studied over 30 years ago, so we had nothing about diet and obesity, it was just diet and teeth. If we have training, and if we’re given information on where these people can seek help, that will help us a big deal to help them as well. Extra training in the BMI thing, and the average height, weights, and then if you have a face-to-face, you can ask questions.”
“I think offering courses with CPD points. I know there’s already some courses running about diet and nutrition, but that’s more about gut health. So, this could be something that’s made into those courses currently running, so then talk about overall health and obesity.”
“We can recommend a 24-h diet diary or a weekend diary to note down cariogenic or obesogenic foods and even protective foods like cheese and dairy, to look at the quantity and quality of the foods that the kids are having. This would help us assess their diet in a comprehensive manner.”
“Small changes all the time, like maintaining a diet diary and using it as a tool to track changes could be useful. Some kids are eating lollies every day after school, so I would say, can you try and change that to maybe every third day after school. I would explain why it’s healthier. And when they come back for the next recall, we can have a look at the diet diary and see if it works.”
“The parents would like to get the children off iPads and watching TV. But now you see a child and then you don’t see the child for another three or six months. You get on a waiting list and in between the time, every advice to promote something that you’ve given just go waste. If we send them reminder messages every week or fortnight, that would be great.”
“Behaviour is very hard to change. Parents, because their mind is set, so I normally talk about children’s health and oral health. As soon as I mention it’s for child’s health benefit, they normally listen. Rather than that, if you just say you have to do this and you have to do that, they don’t like being told as they are parents.”
“Simple pictorial pamphlets for the parents that’s got the average heights, weight and waist measurement, and where we can mark where your child fits in, and where you can get some extra help. We can say you can access these people, and I’m happy to make a referral.”
“Instead of having the normal channels on a TV, we can have oral health information screened in the waiting room, even mentioning the link between caries and obesity. Although the patients are here for a toothache or a preventative service, they’re getting more information. They’re likely seek information from other health professionals or even ask when they are in the dental setting.”
“Maybe we could refer to the schools if there’s some connection with the canteens and maybe the teachers as well. So, if there is a child that has specific concerns, they can engage them in more exercise or develop a program for them. I guess schools for the young kids, but if there are some older ones that are interested in some exercise outside of school, then maybe contacting those centres and working with them as well.”
“I’ve told some parents that there’s a healthy children’s website under the government listings. You can look at that and there’s another school holiday programme, where they help with the exercising with the kids.”
3.3. Theme 3: Role of Oral Health Professionals in Promoting Healthy Weight Status
3.3.1. Role of Oral Health Professionals: Oral Health Therapists, Dental Therapists, Dentists, Paediatric Dentists
“I don’t think it’s hard to take someone’s height, weight and waist measurements. Advising patients about their diet, that works well into a dental appointment. Part of the appointment is diet advice and you talk about sticky foods, carbs, and sugars. So, I think it ties in well because it’s part of our role, its within our scope. It’s what we’re supposed to do, promote healthy eating and obesity prevention or management.”
“I think every oral health professional should have some idea of providing advice about healthy eating, because for a patient, they don’t really see a GP often unless they get sick. So, I think all oral health professionals should give some advice in terms of diet and weight.”
3.3.2. Bridging the Gap in Public–Private Dental Services
“In a private practice, where the parent had to pay out of their pocket for obesity screening and management, they’re more less likely to use it. Whereas, in the public, if Medicare was to cover it for free, then it would be an easy option for them”.
“Public is a lot easier to refer because they have a dietitian or nutritionist who works there. In private practice, nutritionists and dietitians aren’t closely engaged with oral health professionals. Bridging that gap between public and private, the nutritionist, the dietician referrals, is a huge factor. So, creating a database where nutritionists and dietitians can engage with oral health professionals might be a good idea.”
4. Discussion
4.1. Limitations
4.2. Implication for Practice, Policy and Future Research
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Themes | Subthemes |
---|---|
Theme 1: Obesity prevention and management in dental practice | Perceived link of oral health and general health |
Understanding of the common risk factors | |
Diet | |
Socioeconomic status | |
Current prevention and management practices | |
Diet assessment | |
Patient education | |
Providing referrals to dietitians and general practitioners | |
Theme 2: Barriers and enablers to obesity prevention and management in dental settings | Barriers for oral health professionals |
Time | |
Referral pathways | |
Limited knowledge on dietary guidelines recommendations | |
Limited knowledge on Body Mass Index (BMI), BMI for age chart, and obesity | |
Scope of practice | |
Communicating advice to children and families | |
Barriers for children and their families | |
Limited health awareness | |
Guilt due to difficult conversations | |
Access and costs of health care | |
Uncertainty on scope in dental settings | |
Fear of dental environment for children | |
Enablers to healthy weight status | |
Education and training | |
Diet diaries as a tool | |
Family-centred approaches to achieve goals | |
Patient education resources | |
School- and government-run programs | |
Theme 3: Role of oral health professionals in promoting healthy weight status | Role of oral health professionals: oral health therapists, dental therapists, dentists, paediatric dentists |
Bridging the gap in public–private dental services |
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Arora, A.; Rana, K.; Manohar, N.; Li, L.; Bhole, S.; Chimoriya, R. Perceptions and Practices of Oral Health Care Professionals in Preventing and Managing Childhood Obesity. Nutrients 2022, 14, 1809. https://doi.org/10.3390/nu14091809
Arora A, Rana K, Manohar N, Li L, Bhole S, Chimoriya R. Perceptions and Practices of Oral Health Care Professionals in Preventing and Managing Childhood Obesity. Nutrients. 2022; 14(9):1809. https://doi.org/10.3390/nu14091809
Chicago/Turabian StyleArora, Amit, Kritika Rana, Narendar Manohar, Li Li, Sameer Bhole, and Ritesh Chimoriya. 2022. "Perceptions and Practices of Oral Health Care Professionals in Preventing and Managing Childhood Obesity" Nutrients 14, no. 9: 1809. https://doi.org/10.3390/nu14091809
APA StyleArora, A., Rana, K., Manohar, N., Li, L., Bhole, S., & Chimoriya, R. (2022). Perceptions and Practices of Oral Health Care Professionals in Preventing and Managing Childhood Obesity. Nutrients, 14(9), 1809. https://doi.org/10.3390/nu14091809