title: Promoting positive health behaviours--'tooth worm' phenomenon and its implications.
abstract: 'Tooth worm' is a traditional belief about the pathogen of dental caries (tooth decay). Nevertheless, in our previous study, parental 'tooth worm' belief was linked to a reduced caries risk of their children.
  
  
  OBJECTIVE
  This study aimed to further characterize the impact of parental 'tooth worm' belief on their children's caries experience and its psychobehavioural mechanisms.
  
  
  METHODS
  analytic observational study.
  
  
  METHODS
  Thirteen randomly selected kindergartens in Singapore.
  
  
  METHODS
  1,782 preschoolers aged 3-6 years.
  
  
  METHODS
  Each child received an oral examination and microbiological tests. Parents completed a self-administered questionnaire on their socio-demographic background, oral health knowledge/attitude and child's oral health habits.
  
  
  RESULTS
  Multivariate analysis confirmed a reduced chance of 'high caries rate' (number of affected teeth > 2) among children whose parents held the 'tooth worm' belief (Odds Ratio = 0.41; 95% Confidence Interval = 0.19-0.89). With such perception among parents, children brushed their teeth more frequently (p = 0.042). Since no difference in oral hygiene was observed, the health benefit of the "tooth worm" perception may be acquired through the delivery of fluoride (an agent with proven anti-caries effect) during frequent toothbrushing episodes.
  
  
  CONCLUSIONS
  This study revealed a 'tooth worm' phenomenon, indicating that parental 'tooth worm' belief is associated with early establishment of regular toothbrushing habit and reduction of dental caries in children. This phenomenon and its psychobehavioural mechanisms, enriching our understanding of oral health behaviours, have implications for effective health education.
authors.affiliation: Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong. gaoxl@hkucc.hku.hk
authors.forename: X L
authors.initials: XL
authors.lastname: Gao
authors.forename: C Y S
authors.initials: CY
authors.lastname: Hsu
authors.forename: Y C
authors.initials: YC
authors.lastname: Xu
authors.forename: T
authors.initials: T
authors.lastname: Loh
authors.forename: D
authors.initials: D
authors.lastname: Koh
authors.forename: H B
authors.initials: HB
authors.lastname: Hwarng
mesh_terms: D001294:Attitude to Health; D002327:Cariostatic Agents / Q000627:therapeutic use; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D003469:Culture; D004245:DMF Index; D003731:Dental Caries / Q000209:etiology* / Q000382:microbiology; D003774:Dental Plaque Index; D004522:Educational Status; D005247:Feeding Behavior; D005248:Feeding Methods; D005459:Fluorides / Q000627:therapeutic use; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006798:Housing; D006801:Humans; D007778:Lactobacillus / Q000302:isolation & purification; D008519:Medicine, Traditional; D009911:Oral Hygiene Index; D010290:Parents / Q000193:education / Q000523:psychology; D057566:Self Report; D012846:Singapore; D012923:Social Class; D013295:Streptococcus mutans / Q000302:isolation & purification; D011795:Surveys and Questionnaires; D014099:Toothbrushing
chemical_list: D002327:Cariostatic Agents; D005459:Fluorides