Research Article: Oral health behavior of children and guardians’ beliefs about children’s dental caries in Vientiane, Lao People’s Democratic Republic (Lao PDR)

Date Published: January 25, 2019

Publisher: Public Library of Science

Author(s): Somphone Phanthavong, Daisuke Nonaka, Thongsavanh Phonaphone, Kyoko Kanda, Phouphachanh Sombouaphan, Norie Wake, Sangvane Sayavong, Toshiyuki Nakasone, Khampe Phongsavath, Akira Arasaki, Jean-San Chia.


Dental caries is considered a major health problem among schoolchildren in Lao People’s Democratic Republic (Lao PDR). According to Health Belief Model (HBM)-based research, children’s oral health behavior can be determined by their guardians’ beliefs. This study aimed to describe children’s oral health behavior and its association with childhood dental caries, as well as to assess associations between children’s tooth-brushing behavior and guardians’ beliefs in an urban area of Lao PDR, using HBM. Data were collected from ten primary schools in the Sisattanak district, the Vientiane capital, between 2013 and 2014. Ten dentists with the help of dental hygienists and schoolteachers conducted dental health check-ups at the schools that diagnosed dental caries based on visual inspection. They also conducted a questionnaire-based survey with the schoolchildren’s guardians to collect data including socio-economic and demographic information, their children’s oral health behavior, and guardians’ beliefs derived from HBM, including perceived susceptibility to and perceived severity of child dental caries, perceived benefit of and perceived barrier to child’s tooth brushing, and self-efficacy in making their children brush their teeth twice daily. A mixed-effects logistic regression model assessed the association between dental caries and children’s oral health behavior and between children’s tooth-brushing behavior and guardians’ beliefs. Data from 1161 of 1304 (89.0%) children registered at the schools were used. The prevalence of dental caries was 82%. Children who brushed their teeth ≥ twice/day were significantly less likely to have dental caries than those brushing once or seldom (OR: 0.64, 95% CI: 0.45 to 0.91). The number of children who brushed twice daily also significantly increased with the increased level of guardians’ self-efficacy (OR: 2.14, 95% CI: 1.91 to 2.41). In conclusion, childhood dental caries was associated with daily tooth brushing. Children’s tooth-brushing behavior was associated with guardians’ self-efficacy in making their children brush twice daily.

Partial Text

The Lao People’s Democratic Republic (Lao PDR) is a lower-middle-income country situated in Southeast Asia. Among Lao schoolchildren, dental caries was associated with impairments of daily life activities, such as eating and sleeping, and toothache was one of the major reasons for school absenteeism [1, 2]. The National School Health Policy of the Lao PDR, which was established in 2006, includes dental caries as one of the target diseases that should be addressed through school-based strategies. Promoting appropriate oral health behavior is key to preventing dental caries. According to the World Health Organization [3], primary schoolchildren should be educated to be able to 1) practice proper oral hygiene care, 2) restrict the amount and frequency of sugar intake, and 3) adopt a regular check-up routine. In Lao PDR, however, little has been reported about how common schoolchildren practice these health behaviors and what the determinants of these behaviors actually are.

The present study showed that children who brushed their teeth twice or more per day were significantly less likely to have dental caries than children who brushed once per day or less often. This finding is reasonable because a previous systematic review with meta-analysis showed that there was a significant difference in the incidence of caries between frequent brushers (i.e., twice or more per day) and infrequent brushers (i.e., once or less than once per day) [17].

The presence of childhood dental caries was significantly associated both with twice or more daily tooth brushing and with the daily consumption of sugary snacks/drinks. Children’s tooth-brushing behavior was significantly associated with guardians’ self-efficacy in their ability to make their children brush their teeth.




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