Bridging oral health and youth health care A novel approach to early oral health prevention in Dutch well-baby clinics

This thesis examines early oral health promotion in well-baby clinics, focusing on the global issue of early childhood caries (ECC) affecting approximately one-third of Dutch five-year-olds, predominantly from lower socio-economic backgrounds. It examines the challenges Dutch oral health professionals face in providing early oral health prevention. The thesis finds that although over 90% of children under four get preventive care at these clinics, oral health promotion often gets less attention due to other health issues being prioritised. It also looks into how willing parents are to invest in their children’s oral health, noting less willingness among those from lower socio-economic groups. These findings indicate a gap in early oral health promotion and stress the need for more awareness and education on preventing oral health issues from the start.
To address these challenges, this thesis introduces the Toddler Oral Health Intervention (TOHI), implemented in well-baby clinics. This starts oral health promotion as soon as the first tooth appears. TOHI involves sessions with trained oral health coaches for children up to 48 months old, focusing on caries risk assessment and tailored oral health promotion, incorporating the Non-Operative Caries Treatment and Prevention program, Health Action Process Approach, and Motivational Interviewing (MI). The intervention's impact on children’s oral health and behaviour was evaluated in a pragmatic randomised controlled trial at age four, demonstrating a reduction in caries incidence and improved oral health behaviour in the intervention group. Additionally, an observational study on MI's application in TOHI revealed varying levels of proficiency among coaches, emphasising the importance of ongoing training and monitoring.