March 2012

‘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. Objectives: This study aimed to further characterize the impact of parental ‘tooth worm’ belief on their children’s caries experience and its psychobehavioural mechanisms. Basic Research Design: analytic observational study. Setting: Thirteen randomly selected kindergartens in Singapore. Participants: 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. Key words: health belief, health behaviour, culture, oral health, oral hygiene