Dental researchers are increasingly focusing on how psychological factors affect oral health, especially when it comes to cracking the code on the causes of early childhood caries.
A recent study conducted by Richard Heyman, PhD, and Amy Smith Slep, PhD, co-directors of the Family Translational Research Group at the New York University College of Dentistry (NYUCD), is part of an ongoing effort at the school to understand how mental health impacts oral health. The researchers found that the more verbal or physical aggression that occurred between parents, the more oral health problems a child in the home had.
"Behavior seen in parents correlated to the child's decay rate," Mark Wolff, DDS, PhD, a professor and the chair of the NYUCD Department of Cariology and Comprehensive Care and the associate dean for predoctoral clinical education, told DrBicuspid.com. "We found that poor oral health was related to lax parenting -- not a big surprise -- but the permissive parent had high decay."
Interestingly, lax parenting may be more likely to lead to tooth decay than a child witnessing violent behavior from the parent.
"This was tagged to something that we could dissect out -- it also turned out not to be socioeconomic," said Dr. Wolff, noting that even well-educated parents can be guilty of allowing their children to have a high-sugar diet.
Fundamental behavior issues
While the connection may seem obvious, the relationship between oral health and family dynamics has not been explored systematically, according to Heyman and Slep.
— Mark Wolff, DDS, PhD, New York
University College of Dentistry
"Very likely that the next big gain in oral health will be associated with how we manage patient behaviors," Dr. Wolff said. "One of the things as a cariologist that has struck me is that we've developed different means of affecting decay, such as fluoride, but there still a huge population that has it. Part of the process is understanding the fundamental behavior issues responsible."
Previous research had shown that couples' conflict can lead to increases in blood pressure, lower immunological functioning, and slower wound healing. Heyman, Slep, and their group had collected data on how family and environmental factors affect children's and adults' physical and psychological health, and they felt it wasn't a stretch to ask whether these factors would also impact oral health. In 2009, the team was awarded a $1 million grant from the National Institutes of Health (NIH) to conduct a study.
"Professors Slep and Heyman had been doing family violence research and had this cohort of families on hand," Dr. Wolff said. "Could we study certain parameters, like amount of decay, inflammation, periodontal disease ... does it correlate to something we can assess in them?"
For the study, the researchers gathered data on nearly 150 families, using blood and saliva samples, physical exams, and questionnaires, and found a correlation between the amount of oral health problems a child had and how much verbal or physical aggression took place between parents. They presented their preliminary data to the National Institute of Dental and Craniofacial Research (NIDCR) Council, a part of the NIH, in September 2011.
"This does not include child abuse," Dr. Wolff explained. "The parents are not beating the child, but the study notes appropriate or inappropriate behavior such as a child yelled at by a parent, undisciplined raising, or arguing in front of the child. It all goes on a scale classified as family violence."
There were other interesting results. "Family violence was directly related to the amount of decay in the male parent, but not in the female parent," Dr. Wolff said.
Two hypotheses, future research
There are two hypotheses regarding parental discord and oral health, according to Heyman. The first is that lax supervision -- an outgrowth of discord -- affects the dietary habits of children, who favor sugary foods, and whether they brush their teeth. The second is that family conflict and stress, which has been shown to affect the immune system, is eliciting a biological response from children.
With an improved understanding of the psychological causation of tooth decay, the researchers are now trying to prevent it.
"What we're doing now is interventions," Dr. Wolff explained. "Can we train folks out of this to make them want to maintain their oral health, or remove them from the environment of permissive behaviors?"
With funding from a NIDCR clinical trial planning grant, the team has embarked on a new study to learn how early education can reduce the likelihood of decay and periodontal disease in at-risk children. The study is focusing on new parents, since the birth of a new baby is a good time to intervene with families, a time when couples are the most open to changes in their relationship, Heyman noted.
The researchers are recruiting up to 30 families from maternity wards at Bellevue Hospital Center and Stony Brook University Hospital, seeking families whose newborn children are in low-income households, have parents with no more than a high school education, and have at least one non-European-American parent. Participating couples will view DVD segments on conflict resolution and healthy parenting. A coach will guide them to improved conflict-resolution and parenting skills. In addition, they'll complete a workbook that reinforces those messages with exercises.
The intervention consists of eight sessions planned around the developmental stages of their child, from age 3 months to 12 months, covering the period of tooth eruption and transition to recommended dental visits. Then the children will have dental exams at 15 months.
The researchers will be looking for early childhood caries and contributing factors such as bacteria and saliva hormones related to stress.
