Only 45 percent of Medicaid-enrolled children in West Virginia received dental care in 2017, according to the West Virginia Kids Count Data Book. When visits to the dentist office are few and far between, dental professionals strive even harder to maximize the effects of each appointment, especially when it comes to preventing kids’ cavities.
Daniel McNeil, a researcher in the West Virginia University School of Dentistry, studies the social determinants of oral health outcomes. Recently, he and his colleagues investigated the relation between how much social support mothers felt they had, and how many cavities dentists identified in their children’s teeth. The higher a mother scored on a measure of appraisal support—defined as “the perceived availability of someone to talk to about problems”—the less likely her child was to have a lot of cavities. The results of their study appeared in the journal Pediatric Dentistry.
'There’s a person attached to the mouth'
“One of the things we do in educating students in dentistry and dental hygiene is to encourage them to look beyond the oral cavity,” said McNeil, a clinical professor in the Department of Dental Practice and Rural Health and a professor of clinical psychology in the Department of Psychology. “There’s a person attached to the mouth, and there’s a broader life circumstance that that person is in.”
McNeil’s research approach is similarly holistic. He and his team wanted to know if perceived social support among mothers with high amounts of tooth decay was associated with the number of cavities their children had.
To find out, the researchers interviewed 250 mothers who had a considerable amount of tooth decay, based on a dental exam, and whose children were under the age of six. Specifically, they guided the mothers through the Interpersonal Support Evaluation List, a 40-question assessment of the social resources people feel they have. In addition, the children had their own dental exam.
All of the participants visited dentist offices between 2002 and 2009 in one of five counties: Nicholas and Webster counties in West Virginia, and Allegheny, McKean and Washington counties in Pennsylvania. “These counties were selected because they were representative of north central Appalachia broadly,” McNeil said.
Overall, 27 percent of the children who participated in the study had what the researchers deemed a high number of cavities. The odds of children having a high number of cavities was lower by 7 percent for every one-point change on the 30-point ISEL appraisal score.
Information, validation and empowerment
Why does this correlation exist? McNeil has a hunch. “If the mother of a young child has social support—somebody to talk to outside of that immediate family, or even another adult within the immediate family—then there are lots of things that happen, including the giving of information. For example, the mother might say, ‘I think my son is drinking too much soda,’ and the person who’s providing social support might say, ‘Yeah, my son did that, too, and I just told him he could only have one a week.’”
He also suspects the emotional validation that social support provides may indirectly improve children’s oral health outcomes as well. “It’s a wonderful challenge, raising children,” he said. “If I have somebody to talk to about that, I may feel more empowered, more sure of myself. I may have better self-esteem, better self-appraisal. I think that can translate into my being an even more effective parent in terms of managing my kids’ health behaviors.”
Not just warnings about sugary drinks
The project was part of the Center for Oral Health Research in Appalachia, a collaboration among researchers at WVU, the University of Pittsburgh and the University of Michigan. Since its launch in 2000, COHRA has explored factors that contribute to the burden of dental problems and oral health disparities in West Virginia and across Appalachia. The National Institute of Dental and Craniofacial Research—a division of the National Institutes of Health—funds the initiative.
“The WVU School of Dentistry is the only dental school in West Virginia,” said Fotinos Panagakos, the associate dean of research for the School of Dentistry. “We play a critical role in delivering necessary dental care to those in need within the state through our Rural Dental Clinic Network. Our students spend six weeks treating patients in these clinics, delivering care that would otherwise not happen. Our focus is to improve the oral health of the patient, which will have a positive cascading effect by improving overall wellness and well-being.”
McNeil’s findings may influence how dentists and dental hygienists interact with their patients. “I think what this study might do is to encourage them to think, not only about diet and tooth brushing, but more broadly about how things are going for their patients at home,” he said. If the situation warrants, dental professionals could refer patients to other services, such as support groups for parents.
“You might think, ‘Well, is that a dental recommendation?’ Absolutely,” he said. “I think the findings would suggest that we need to look beyond the tooth—to look at the social support that our patients have.”
Just as dental professionals can look “beyond the tooth” to consider how a patient’s quality of life—including her social support network—affects her oral health, researchers can reflect on the ways poor oral health can affect someone’s quality of life.
“The importance of oral health goes well beyond one’s mouth,” said Lindsay Allen, an assistant professor in the School of Public Health whose research informed the West Virginia Kids Count Data Book. “In addition to physical health, untreated oral disease has economic consequences, often causing patients to miss school or work. There are also social consequences: research has found links between poor dental health and self-esteem in adolescents. Dr. McNeil’s study offers insight about what types of policies might help improve rates of dental care among children.”
Research reported in this publication was supported by the National Institute of Dental and Craniofacial Research, a division of the National Institutes of Health under Award Number R01DE014899, and by the West Virginia Clinical and Translational Science Institute. WVCTSI is funded by an IDeA Clinical and Translational grant from the National Institute of General Medical Sciences, under Award Number U54GM104942, to support the mission of building clinical and translational research infrastructure and capacity to impact health disparities in West Virginia. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH or CTSI.
Title: Mother’s perceived social support and children’s dental caries in Northern Appalachia