Social and psychological theories and their use for dental practice.

This paper discusses four major theoretical constructs that have helped broaden our understanding of oral hygiene behaviours and dental health risks, including: social class, life stress, self-efficacy and locus of control. The potential of these constructs to enhance the treatment of dental diseases is illustrated using data from a study based on a biopsychosocial model of caries risk. In two cities in Connecticut, 481 children aged 3 years were recruited from the Head Start programme. Two dentists examined the children with a mirror and explorer and collected data on dmfs. A parent or guardian of 369 of these children completed an interview with a research assistant which provided data on each child's brushing habits, dietary intake of sugar, social class indicators, stressful life events, dental health locus of control and perceived dental self efficacy. The effects of psychosocial variables on two clinical measures were assessed, the levels of S. mutans and the prevalence of decay. Analysis indicated that S. mutans was the most important predictor of caries risk. Mothers who had more external locus of control beliefs, lower income, more knowledge about tooth decay and higher stress levels had children with greater risk of having caries. Further, use of a baby bottle at night was a significant factor in caries risk. Analyses of S. mutans risk showed that socioeconomic status and ethnicity significantly differentiated those with no colonies from those with one or more colonies while attitudinal and behaviour factors predicted who would be in the group with the highest number of S. mutans colonies.