title: Observed child and parent toothbrushing behaviors and child oral health.
abstract: BACKGROUND
  Parent-led toothbrushing effectively reduces early childhood caries. Research on the strategies that parents use to promote this behavior is, however, lacking.
  
  
  OBJECTIVE
  To examine associations between parent-child toothbrushing interactions and child oral health using a newly developed measure, the Toothbrushing Observation System (TBOS).
  
  
  METHODS
  One hundred children ages 18-60 months and their parents were video-recorded during toothbrushing interactions. Using these recordings, six raters coded parent and child behaviors and the duration of toothbrushing. We examined the reliability of the coding system and associations between observed parent and child behaviors and three indices of oral health: caries, gingival health, and history of dental procedures requiring general anesthesia.
  
  
  RESULTS
  Reliabilities were moderate to strong for TBOS child and parent scores. Parent TBOS scores and longer duration of parent-led toothbrushing were associated with fewer decayed, missing or filled tooth surfaces and lower incidence of gingivitis and procedures requiring general anesthesia. Associations between child TBOS scores and dental outcomes were modest, suggesting the relative importance of parent versus child behaviors at this early age.
  
  
  CONCLUSIONS
  Parents' child behavior management skills and the duration of parent-led toothbrushing were associated with better child oral health. These findings suggest that parenting skills are an important target for future behavioral oral health interventions.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.|Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA.
authors.forename: Brent R
authors.initials: BR
authors.lastname: Collett
authors.affiliation: Department of Health Services, University of Washington, Seattle, WA, USA.
authors.forename: Colleen E
authors.initials: CE
authors.lastname: Huebner
authors.affiliation: School of Dentistry, University of Washington, Seattle, WA, USA.
authors.forename: Ana Lucia
authors.initials: AL
authors.lastname: Seminario
authors.affiliation: Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Wallace
authors.affiliation: Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA.
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Gray
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.|Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Speltz
mesh_terms: D000328:Adult; D002675:Child, Preschool; D003731:Dental Caries / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009909:Oral Health; D010287:Parent-Child Relations; D010290:Parents; D015203:Reproducibility of Results; D014099:Toothbrushing