Motivational interviewing to prevent early childhood caries: A randomized controlled trial

Objectives: Prevailing health education (PE) often fails to achieve sustained behavioral changes. This randomized controlled trial integrated motivational interviewing (MI) and a patient communication tool featuring interactive caries risk assessment (RA) into PE and investigated the effectiveness of PE, PE + MI, and PE + MI + RA in preventing early childhood caries.

Methods: This study targeted children aged 3-4 years with unfavorable oral health behaviors. 692 parent-child dyads were recruited, randomly assigned into three groups (PE, PE + MI, and PE + MI + RA), and received respective interventions. A questionnaire was completed at baseline and after 6 and 12 months to collect information on socio-demographic background, parental efficacy and children's oral health behaviors. Children's oral hygiene status and dental caries were recorded at baseline and after 12 months.

Results: 655 (94.7%) parent-child dyads remained in the study after 12 months. Caries increment was significantly lower in PE + MI group (β=-0.717, 95% CI: -1.035, -0.398) and PE + MI + RA group [β=-0.600, 95% CI: -0.793, -0.407] than in PE group. There was significantly greater reduction in plaque score in PE + MI group (β=-0.077, 95% CI: -0.106, -0.048) and PE + MI + RA group (β=-0.075, 95% CI: -0.113, -0.036), as compared with PE group. Significantly greater improvements were found in parental efficacy and children's oral health behaviors in PE + MI and PE + MI + RA groups than in PE group (all p < 0.05). There was no significant difference between PE + MI group and PE + MI + RA group across all outcome measures (all p > 0.05).

Conclusions: Intergration of motivational interviewing improves the effectiveness of prevailing health education in preventing early childhood caries, enhancing parental efficacy, and improving children's oral health behaviors. Incorporation of the communication tool for caries risk assessment does not further improve the effectiveness of motivational interviewing in protecting children's oral health.

Clinical significance: The findings of this study provide much needed evidence for dentists, dental auxiliary staff and public health workers to select effective intervention to empower parents for improving children's oral health behaviors and preventing early childhood caries.