摘要：Objectives. We sought to determine Maryland adults’ knowledge, understanding, opinions, and practices with respect to prevention and early detection of dental caries. Methods. We conducted a statewide random-digit-dialing, computer-assisted telephone survey in 2010 among 770 adults who had a child aged 6 years or younger living in their home. A traditional random-digit sample and a targeted low-income sample were included. Analyses included frequencies, percentages, the χ2 test, and multivariate logistic regression. Results. Respondents’ overall level of knowledge about preventing dental caries was low. Those with higher levels of education were more likely to have correct information regarding prevention and early detection of dental caries. Nearly all respondents (97.9%) reported that they were aware of fluoride, but only 57.8% knew its purpose. More than one third (35.1%) of the respondents were not aware of dental sealants. Those with lower levels of education were significantly less likely to drink tap water, as were their children, and significantly less likely to have had a dental appointment in the preceding past 12 months. Conclusions. Our results demonstrate the need to increase oral health literacy regarding caries prevention and early detection. Having an understanding of disease symptoms and preventive measures is essential to acting appropriately to prevent disease. Information has been available for decades on how to prevent dental caries through appropriately using fluorides and pit and fissure sealants and reducing the frequency of consumption of refined carbohydrates. 1,2 Yet poor oral health in US children prevails, causing children needless pain and suffering and affecting their ability to speak, eat, and learn; in some cases, untreated dental disease can even result in death. 3 Between the period 1988 through 1999 and 1999 through 2004, the National Health and Nutrition Examination Survey demonstrated a rise in dental caries among 2- to 5-year-old children for the first time in 40 years. 4 It is estimated that 28% of children in this age group have dental caries. The survey also revealed the significant prevalence of dental decay among children enrolled in Medicaid, showing that 1 in 3 had untreated tooth decay and that 1 in 9 had untreated decay in 3 or more teeth. Nationally, low-income populations and communities of color disproportionately experience worse health outcomes than their counterparts across a broad spectrum of diseases and conditions, including dental disease. 4 Furthermore, according to the US Government Accountability Office, the extent to which children in these groups experience dental disease has not decreased. 5 Maryland data from 2005–2006 show that 31% of children in kindergarten and 3rd grade in the state had untreated decay in their primary teeth. 6 In 2006, only 29% of children in Maryland’s Medicaid program (7.9% of children aged 0–3 years and 37.2% of those aged 4-5 years) had at least one dental visit. 7 These national and state findings are extremely disturbing in light of science-based knowledge on preventing this disease. One factor that may contribute to this situation is limited health literacy. Health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”8(p32) Numerous studies have shown that limited health literacy contributes to decreased use of preventive health practices and increased use of emergency services. 8 Millions of US adults have difficulty performing basic health-related tasks such as determining when and how to take their medication or determining whether they are eligible for Medicaid. Studies focusing on oral health have shown that low health literacy affects frequency of dental visits, severity of dental caries, and oral health knowledge. 9–12 We are fortunate to have evidence on the pathogenesis and prevention of dental caries and knowledge regarding how to reverse the earliest symptoms of this disease. Research has clearly indicated that clinically detected noncavitated lesions (frequently referred to as “white spot lesions”) can be reversed or remineralized through appropriate use of fluorides. 13 This remineralization can occur only when both caregivers and health professionals understand and value the prevention of oral disease and have the understanding and skills necessary to do so. For example, if a mother does not understand how to inspect her infant’s mouth, does not know how to recognize “white spots” and reverse them, and does not have the necessary supplies (toothbrushes and fluoride toothpaste), she is not likely to engage in these activities. A recent national study of caregivers of children aged 0 to 11 years reported that 36% of respondents admitted their children brushed their teeth less than once a day, and two thirds of the respondents indicated that their child’s first visit to the dentist occurred at approximately 2.5 years of age. 14 With respect to the latter finding, the recommendation of the American Dental Association and the American Academy of Pediatric Dentistry is that the first dental visit occur at the age of 1 year or 6 months after the eruption of an infant’s first tooth. Individuals report that they obtain most of their dental health information from their dentist or dental staff members, and they tend to believe the best way to prevent caries is to brush their teeth (without mentioning use of fluoride-containing dentifrice). 15–17 However, studies have shown that, in many cases, neither dental hygienists nor dentists have complete, current knowledge regarding caries prevention regimens. 18,19 Collectively, these factors may contribute to increases in dental caries, especially among lower income children. In March and April 2010, we conducted a random-digit-dialing telephone survey to determine knowledge, opinions, and practices related to caries prevention among Maryland adults who had a child aged 6 years or younger in the home. This telephone survey was part of a needs assessment to be used in developing a state health literacy model regarding caries prevention and early detection; the ultimate goal is to decrease dental disparities among Maryland’s children by increasing oral health literacy.
