Epidemiological surveys commonly use the oral habits of children as reported by their mothers to evaluate tooth-brushing practices and to estimate fluoride intake. A cross-sectional study compared the observed tooth-brushing habits of childern (aged 24 to 48 months) using fluoridated toothpaste with those reported by their mothers. At day care centers in Montes Claros, Brazil, the 201 mothers answered a self-administered questionnaire on their children's tooth-brushing habits. Subsequently, an appointment was made with each mother/child pair at day care centers, where the participants were asked to demonstrate the tooth-brushing practice as usually performed at home. A trained examiner observed and documented the procedure. Observed tooth brushing and that reported by mothers were compared for overall agreement. Cohen's kappa values comparing mothers' reports and tooth brushing observed by the examiner ranged from poor to good. There were statistically significant differences between the reports given by the examiners and the mothers. When observed by the examiner, the frequencies of dentifrice dispersed on all bristles (35.9%), children who brushed their teeth alone (33.8%), and those who did not rinse their mouths during brushing (42.0%) were higher than those reported by the mothers (12.1%, 18.9%, and 6.5%, respectively). The study concludes that there was generally a low agreement between observed tooth brushing and mothers' reports. Moreover, the different methods of estimation resulted in differences in the frequencies of tooth brushing habits, indicative of reporting bias. Data regarding children's tooth-brushing habits as reported by mothers should be considered with caution in epidemiological surveys on fluoridated dentifrice use and the risk of dental fluorosis.

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(Source: BMC Oral Health; doi:10.1186/1472-6831-11-22; published September 3, 2011)

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