Socio-demographic information
A total of 18 parents and caregivers participated across the three focus groups (FG1, FG2, FG3) with 5, 9 and 14 in each group respectively. These participants were mainly female (89%) with a mean age of 28 (ranging from 23 to 49 years-old). Just over two thirds (67%) were of Indian ethnicity, with the others being of African (28%) or Mixed ethnicity (5%). The majority were in manual/semi-skilled occupations or housewives, 33% and 39% respectively. Twenty eight per cent were in non-manual or professional occupations.
Perceptions of oral health
Participants had reasonably clear thoughts on what constituted good oral health, with some expressing the view that this would include healthy gums and good breath and no cavities. Along with absence of disease, some felt that good oral health included having a nice appearance that aided self confidence:
"Plenty of clean looking teeth. (FG3)"
"Gums that are not bleeding. (FG3)"
"Well umm… people with healthy teeth have no cavities and umm good breath. (FG2)"
"Helps your confidence in umm interacting with people. (FG2)"
Pain and reduced function were mentioned by participants when describing an unhealthy mouth and not paying attention to oral hygiene could cause this. Also some felt that not taking good care of the teeth when young and heeding preventive advice could result in poor oral health later in life:
"You wouldn’t be able to eat properly, with pain from sensitive teeth. (FG3)"
"Being able to chew…"
"Yes, you wouldn’t be able to chew or bite. (FG3)"
Dental care experiences
When discussing reasons for attending dental care, a recurring issue raised was that dental treatment was often unpleasant and that going to the dentist was something largely to be avoided, unless there was current pain or problems. However, some believed that this irregular attendance would result in more problems and were concerned by this happening to their child. Reasons for avoiding dental care were largely due to bad experiences, often during childhood. Fear was often related to the procedures, in particular dental extractions:
"Toothache for sure…if you have a little cavity or so and it doesn’t trouble you then you find you wouldn’t really take care of it until you start to get pain, then you know okay, yeah you ready to reach to a dentist. (FG1)"
"it’s only when problems come then you well in my case that’s only when you know, have a problem then you would find yourself going to the dentist and you of course don’t want that for your children you want them to do the right thing carry them to the dentist. (FG2)"
The environment of the dental clinic, that is, the smells, sights and sounds of the equipment and procedures were common issues of concern together with the chair-side manner of the dentist. Fear of reprimand for not doing a better job of looking after their mouth was also mentioned. Some participants described putting off taking their children for dental care due to their own negative experiences.
"…I took too long to take them….and it’s because of my own experience, the trauma that you’ve been through, you know as children going to a dentist, I mean, so I transferred that. (FG2)"
"big as I am, I would really have to make up my mind to go to that dentist. If I don’t have pain, I not going for anything. Just to hear the machines, you know that ringing, buzzing thing in your ear. (FG1)"
"they will always find something wrong to tell you. You need a filling, you not flossing, you always, so you know, its not like you have any confidence going. you going because the dentist have something to tell you not doing good enough. (FG2)"
Differences between private and public dental care were mentioned by several participants, who related this to their personal experiences and reasons for making choices as to which service to attend. In particular, some felt that private dental care would be safer and more comfortable for their child so having to pay for that was a worthwhile expense.
"I prefer to pay your money and leaving it as that. You pay your money, you get your comfort, I believe in that. (FG1)"
"I am sure they have good workers (in government clinics). I mean they are all qualified people but umm the little extra to put out you know yeah, the little extra care, the little extra smile. (FG2)"
"You would pay so much just for somebody to be nice to you. (FG3)"
"to extract a tooth for your little one and there’s a needle going into the gum to numb the gum, you want that somebody who will take that extra care with your little one, that’s your little one you know. (FG2)"
"the way they going to treat your children, the way they going to treat you when you reach you know, I think, you know, hear what, I may be safer by a private dentist. (FG2)"
Some participants felt that private dental practitioners were aware of the lack of services available in the public sector and tended to exploit the situation and also felt they had little information of the government services available:
"I guess the dentist knows that there is no other reputable treatment available for children or otherwise, so they make their money. (FG1)"
"could sometimes be unfair too. the professionals know that the health service is bad whether it be dentistry, maternity whatever so you know what. they know you’re gonna pay for it. So they call their price and they will get their patient. (FG2)"
"and I also didn’t know about the Government."
"I didn’t know, cause if I knew that, I think I would have taken my children there. (FG1)"
Dental care for children
Participants were clear in knowing what they would like the dental visit for their child to be like. The personality of the dental care provider was the focus, with several stating that they would want someone who could put the child and ease and communicate well with them. The environment of the clinic was important to most participants and making it less intimidating and ‘child-friendly’ by reducing the clinical sounds and smells and having tokens and rewards for the child was seen as very helpful.
"Somebody pleasant who would make them feel comfortable and not amm not put them down too much even though they have cavities, you know explain to them how they get the cavities but how they could also help prevent it you know and take care of their teeth, some encouragement you know. (FG1)"
"A room that is ..not scary...not too sterile, a room that is fun like .. (FG2)"
"It could be sterile clean but not smell you know the scary smell that you get in the hospital…there should be some brightly coloured pictures (FG2) they should never ever hear that…’.zzzzzzzzz’…that sound, that sound alone is scary (FG2)"
"Friendly, yes, friendly person…not just come out and say ‘Your turn’ you know."
"Somebody to talk to the child . talk to the child and be friendly (FG3)"
The first dental visit
There was not much awareness of when to take a child for the first dental visit (other than if there were pain or problems in need of attention). Getting them checked around the time the child would have a full set of primary teeth or preschool age seemed to be the general view:
"I’m going to take her for the first dental check-up, she will be four. I don’t know if that is right but you know. (FG2)"
"My son was probably about five or six, but they didn’t really do anything major, they just looked at his mouth. (FG3)"
"My dentist is so warm and so nice that I even told her okay my baby girl is going to come here, right because next month she is going to be four you know you tell me when, what age is good, and I want her to come (FG1)"
Importance of “baby” teeth
There were mixed opinions about the importance of the primary teeth. Several participants felt that as the teeth were temporary they were not too concerned about them getting cavities and would focus more on the permanent teeth once they came in. However others believed that problems with the primary teeth could affect the permanent successors and were worried about decay or infections causing pain and problems.
Although aware of their temporary nature, some participants felt that the primary teeth could help the child to enjoy their food allowing variety in their diet and also provide an opportunity to learn good oral hygiene habits.
"I not too worried about because I know the teeth will fall out as is baby teeth and they would get the adult teeth and you know. (FG1)"
"I don’t think they so important, because I find they just drop off then you get adult teeth you know. (FG2)"
"I feel I have more concern about the permanent teeth.well I mean after that baby teeth come out it’s the permanent teeth coming in and when that come out no other teeth coming in so you wanna protect them. (FG3)"
"Well I think if this teeth, the first set of teeth bad, it will affect the next one not so, the new ones? That is what I always thought it was like that. (FG3)"
"is like their trial teeth you teach them to brush and take care of it you know and show them if they get that little bit of pain in that set, you could imagine in the permanent set how much more the pain could be. (FG3)"
Diet and food choices
With respect to healthy diets for their children, participants were aware of the risk posed by sweets and chocolates but also conscious of providing a generally nutritious diet. In terms of preventing cavities, more emphasis was given to brushing than the diet.
"you have to kind of teach them from early and groom them into what you want them to get into, good eating habits, good hygiene, you know you start them from now. (FG3)"
"they have to eat everything to get all the proteins and calcium and all these things, its just to brush. (FG1)"
"I think brushing is more important. (FG1)"
Use of the bottle and breast feeding
Participants felt bottle feeding before bed-time had a role to play in providing comfort for the child and aided in getting them