RESEARCH ARTICLE Open AccessComparison between observed children’s toothbrushing habits and those reported by mothersCarolina C Martins 1 , Maria J Oliveira 2 , Isabela A Pordeus 1 and Saul M Paiva 1*AbstractBackground: Information bias can occur in epidemiological studies and compromise scientific outcomes,especially when evaluating information given by a patient regarding their own health. The oral habits of childrenreported by their mothers are commonly used to evaluate tooth brushing practices and to estimate fluoride intakeby children. The aim of the present study was to compare observed tooth-brushing habits of young children usingfluoridated toothpaste with those reported by mothers.Methods: A sample of 201 mothers and their children (aged 24-48 months) from Montes Claros, Brazil, took part ina cross-sectional study. At day-care centres, the mothers answered a self-administered questionnaire on their child’stooth-brushing habits. The structured questionnaire had six items with two to three possible answers. Anappointment was then made with each mother/child pair at day-care centres. The participants were asked todemonstrate the tooth-brushing practice as usually performed at home. A trained examiner observed anddocumented the procedure. Observed tooth brushing and that reported by mothers were compared for overallagreement using Cohen’s Kappa coefficient and the McNemar test.Results: Cohen’s Kappa values comparing mothers’ reports and tooth brushing observed by the examiner rangedfrom poor-to-good (0.00-0.75). There were statistically significant differences between observed tooth brushinghabits and those reported by mothers (p < 0.001). When observed by the examiner, the frequencies of dentifricedispersed on all bristles (35.9%), children who brushed their teeth alone (33.8%) and those who did not rinse theirmouths during brushing (42.0%) were higher than those reported by the mothers (12.1%, 18.9% and 6.5%,respectively; p < 0.001).Conclusions: In general, there was low agreement between observed tooth brushing and mothers’ reports.Moreover, the different methods of estimation resulted in differences in the frequencies of tooth brushing habits,indicative of reporting bias. Data regarding children’s tooth-brushing habits as reported by mothers should beconsidered with caution in epidemiological surveys on fluoridated dentifrice use and the risk of dental fluorosis.BackgroundInformation bias can occur in epidemiological studiesand compromise the scientific outcome, especially whenevaluating patient self-report regarding their own health.The aim of the study design is to obtain the most accu-rate results to represent reality. In paediatric dentistry, anumber of studies have evaluated fluoride intake amongchildren either from dietary sources or from tooth-brushing with fluoridated dentifrice [1-4]. The currentmethod used to evaluate fluoride intake from diet is theduplicate plate method [1]. A comparison between theduplicate plate method and dietary logs provided by par-ents’ suggest differences in fluoride intake by childrenbetween methods, with the dietary log reporting signifi-cantly higher fluoride intake from food than the dupli-cate plate method [5]. However, the few other studiescomparing methodologies for food and beverage con-sumption on the part of young children focus on therisk of obesity [6,7].To estimate the risk of dental fluorosis in young chil-dren, fluoride intake also considers tooth brushing withfluoridated dentifrices. Young children often ingest alarge proportion of the dentifrice dispersed on thetoothbrush, thereby increasing the risk of developing* Correspondence: smpaiva@uol.com.br1 Department Pediatric Dentistry and Orthodontics, School of Dentistry,Federal University of Minas Gerais, Belo Horizonte, BrazilFull list of author information is available at the end of the articleMartins et al. BMC Oral Health 2011, 11:22http://www.biomedcentral.com/1472-6831/11/22© 2011 Martins et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.
