title: Facilitators and barriers to twice daily tooth brushing among children with special health care needs.
abstract: OBJECTIVE
  The oral hygiene routines of preschool-age children with special health care needs (CSHCN) were examined to identify caregiver behaviors and beliefs associated with twice daily tooth brushing.
  
  
  METHODS
  Ninety caregivers of CSHCN, ages 23 to 62 months, were interviewed to determine supports or barriers to tooth brushing.
  
  
  RESULTS
  Ninety-eight percent of caregivers had begun brushing their child's teeth and half reported brushing twice daily. Caregivers' brushing skills and the availability of child-friendly supplies were associated with twice daily versus less frequent brushing (p = .02).
  
  
  CONCLUSIONS
  This study adds insight into the challenges of establishing daily oral health care for children who must rely on others for their care. The facilitators and barriers to tooth brushing by caregivers of CSHCN are similar to those noted previously among parents of typically developing children. Efforts to improve all caregivers' oral hygiene skills are needed. For caregivers of CSHCN, oral health teaching opportunities may exist among professionals who provide ongoing medical care, special services and therapies.
authors.affiliation: Graduate, Health Services and Maternal and Child Health, University of Washington, Seattle, WA, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Campanaro
authors.forename: Colleen E
authors.initials: CE
authors.lastname: Huebner
authors.forename: Beth Ellen
authors.initials: BE
authors.lastname: Davis
mesh_terms: D002648:Child; D019988:Children with Disabilities; D019983:Guideline Adherence; D006801:Humans; D014099:Toothbrushing
keywords: children; children with disabilities; interviews; oral health; oral hygiene; preschool; toothbrushing