Preschool Children’s Taste Acceptance of Highly Concentrated Fluoride Compounds: Effects on Nonverbal Behavior

Objective: The aim of this video-based study was to examine the taste acceptance of children between the ages of 2 and 5 years regarding highly concentrated fluoride preparations in kindergarten-based preventive programs. Study design: The fluoride preparation Duraphat was applied to 16 children, Elmex fluid to 15 children, and Fluoridin N5 to 14 children. The procedure was conducted according to a standardized protocol and videotaped. Three raters evaluated the children's nonverbal behavior as a measure of taste acceptance on the Frankl Behavior Rating Scale. The interrater reliability (intraclass correlation coefficient; ICC) was .86. In an interview, children indicated the taste of the fluoride preparations on a three-point “smiley” rating scale. The interviewer used a hand puppet during the survey to establish confidence between the children and examiners. Results: Children's nonverbal behavior was significantly more positive after Fluoridin N5 and Duraphat were applied compared to the application of Elmex fluid. The same trend was found during the smiley assessment. The response of children who displayed cooperative positive behavior before the application of fluoride preparations was significantly more positive than those who displayed uncooperative negative behavior. Conclusion: To achieve a high acceptance of the application of fluoride preparations among preschool children, flavorful preparations should be used.

Fluorides; Taste; Nonverbal behavior; Behavior management; Early childhood caries; Taste acceptance

1. American Academy on Pediatric Dentistry; American Academy of Pedi-atrics. Policy on Early childhood caries (ECC): Classifications, conse-quences, and preventive strategies. Pediatr Dent 30(7): 40-43, 2008-2009.

2. Schroth R, Dahl P, Haque M, Kliewer E. Early childhood caries among Hutterite preschool children in Manitoba, Canada. Rural Remote Health 10(4): 1535, 2010.

3. Iida H, Auinger P, Billings RJ, Weitzman M. Association between infant breastfeeding and early childhood caries in the United States. Pediatrics 120(4): 944-952, 2007.

4. Pitts N, Harker R. Obvious decay experience- Survey of children’s dental Health in the United Kingdom 2003. Children’s dental health in the United Kingdom 2003. London: Office of National Statistics; 2004:1-48.

5. Stecksen-Blicks C, Sunnegardh K, Borssen E, Stecksen-Blicks C, Sunneg-ardh K, Borssen E. Caries experience and background factors in 4-year-old children: time trends 1967-2002. Caries Res 38: 149-155, 2004.

6. Guidelines on prevention of early childhood caries: An EAPD policy docu-ment. Dublin, Ireland: European Academy of Pediatric Dentistry; 2008.

7. Grant JS, Roberts MW, Brown WD, Quinoñez RB. Integrating dental screening and fluoride varnish application into a pediatric residency outpa-tient program: clinical and financial implications. J Clin Pediatr Dent 31(3): 175-178, 2007.

8. Weintraub JA, Ramos-Gomez F, Jue B, Shain S, Hoover CI, Featherstone JD, Gansky SA. Fluoride varnish efficacy in preventing early childhood caries. J Dent Res 85: 172–176, 2006.

9. Weinstein P, Spiekerman C, Milgrom P. Randomized equivalence trial of intensive and semiannual applications of fluoride varnish in the primary dentition. Caries Res 43(6): 484-490, 2009.

10. Ramos-Gomez FJ, Gansky SA, Featherstone JD et al. Mother and youth access (MAYA) maternal chlorhexidine, counselling and paediatric fluoride varnish randomized clinical trial to prevent Early childhood caries. Int J Paediatr Dent 22(3): 169-179, 2012.

11. Van der Zeypen E. Gustatorische Sinnessysteme. In: Graumann W, Sasse D, eds. CompactLehrbuch Anatomie, Sinnessysteme, Haut, ZNS, periphere Leitungsbahnen. Stuttgart: Schattauer; 2005:157.

12. Birch LL, Anzman-Frasca S. Learning to prefer the familiar in obesogenic environments. Nestle Nutr Workshop Ser Pediatr Program 68: 187-196, 2011.

13. Ventura AK, Mennella JA. Innate and learned preferences for sweet taste during childhood. Curr Opin Clin Nutr Metab Care 14(4): 379-384, 2011.

14. Beauchamp GK, Mennella JA. Early flavor learning and its impact on later feeding behavior. J Pediatr Gastroenterol Nutr 48(1): 25–30, 2009.

15. Rozin P. The selection of food by rats, humans and other animals. In: Rosenblatt J, Hinde RA, Beer C, Shaw E, eds. Advances in the study of behavior. New York, NY: Academic Press; 1976:21-76.

16. Dovey TM, Staples PA, Gibson EL, Halford JC. Food neophobia and ‘picky/fussy’ eating in children: A review. Appetite 50(2-3): 181-193, 2008.

17. MacIntyre C. Understanding children’s development in the early years: Questions practitioners frequently ask. New York, NY: Routledge; 2007.

18. Mennella JA, Forestell CF, Morgan L, Beauchamp GK. Early milk feeding influences taste acceptance and liking during infancy. Am J Clin Nutr 90(3): 780- 788, 2009.

19. Forestell CA, Mennella JA. Early determinants of fruit and vegetable acceptance. Pediatrics 120(6): 1247-1254, 2007.

20. Beauchamp GK, Mennella JA. Flavor perception in human Infants: Devel-opment and functional significance. Digestion 83(1): 1–6, 2011.

21. Ellrott K, Guo JT, Olman V, Xu Y. Improvement in protein sequence-struc-ture alignment using insertion/deletion frequency arrays. Comput Syst Bioinformatics Conf 6: 335-342, 2007.

22. Savage JS, Fisher JO, Birch LL. Parental influence on eating behavior: Conception to adolescence. J Law Med Ethics 35(1): 22-34, 2007.

23. Baxter SD. Are elementary schools teaching children to prefer candy but not vegetables? J Sch Health 68: 111-113, 1998.

24. Hamilton A, Plunkett K, Schafer G. Infant vocabulary development assessed with a British communicative development inventory. J Child Lang 27(3): 689-705, 2000.

25. McAllister A, Brandt SK: A Comparison of Recordings of Sentences and Spontaneous Speech: Perceptual and Acoustic Measures in Preschool Chil-dren’s Voices. J Voice 26(5): 673, 2012.

26. Xia B, Wang CL, Ge LH. Factors associated with dental behaviour manage-ment problems in children aged 2-8 years in Beijing, China. Int J Paediatr Dent 21(3): 200-209, 2011.

27. Jäger R. Construction of a rating scale with smilies as symbolic labels. Diagnostica 50(1): 31-38, 2004.

28. Pothmann R. Comparison of the Visual Analog Scale (VAS) and a Smiley Analog Scale (SAS) for the evaluation of pain in children. In: Tyler DC, Krane EJ, eds. Advances in pain research and therapy: Pediatric Pain. New York, NY: Raven Press; 1990:95-104.

29. Buchanan H. Development of a computerised dental anxiety scale for chil-dren: Validation and reliability. Br Dent J 199(6): 359-362, 2005.

30. Steiner JE: Discussion paper: innate, discriminative human facial expres-sions to taste and smell stimulation. Ann N Y Acad Sci 237(0): 229-233, 1974.

31. Erickson K, Schulkin J. Facial expressions of emotion: a cognitive neuro-science perspective. Brain Cogn 52(1): 52-60, 2003.

32. Versloot J, Veerkamp JS, Hoogstraten J. Assessment of pain by the child, dentist, and independent observers. Pediatr Dent 26(5): 445-449, 2004.

33. Frankl SN, Shiere FR, Fogels HR. Should the parent remain with the child in the operatory? J Dent Child 29: 150-163, 1962.

34. Epstein I, Stevens B, McKeever P, Baruchel S, Jones H. Using puppetry to elicit children’s talk for research. Nurs Inq 15(1): 49-56, 2008.

35. Parish-Plass N. Animal-assisted therapy with children suffering from insecure attachment due to abuse and neglect: A method to lower the risk of intergenerational transmission of abuse? Clin Child Psychol Psychiatry 13(1): 7-30, 2008.

36. Fayle SA, Tahmassebi JF. Paediatric dentistry in the new millennium: 2. Behaviour management-helping children to accept dentistry. Dent Update 30(6): 294-298, 2003.

37. American Academy of Pediatric Dentistry Clinical Affairs Committee-Be-havior Management Subcommittee et al. Guideline on behavior guidance for the pediatric dental patient. Pediatr Dent 30(7): 125-133, 2008-2009.

38. Weise M. Medienbildung in der frühen Kindheit. MedienPädagogik 2008;11:1-10.

39. Escudero V, Friedlander ML, Heatherington L. Using the e-SOFTA for video training and research on alliance-related behavior. Psychotherapy (Chic) 48(2): 138-147, 2011.

40. Lapierre MA, Vaala SE, Linebarger DL. Influence of licensed spokeschar-acters and health cues on children’s ratings of cereal taste. Arch Pediatr Adolesc Med 165(3): 229-234, 2011.

41. Ablow JC, Measelle JR, Kraemer HC et al. The MacArthur three-city outcome study: Evaluating multi-informant measures of young children´s symptomatology. J Am Acad Child Adolesc Psychiatry 38(12): 1580-1590, 1999.

42. Mennella JA, Ventura AK. Early feeding: Setting the stage for healthy eating habits. Nestle Nutr Workshop Ser Pediatr Program 68: 153-163, 2011.

43. Keskitalo K, Knaapila A, Kallela M et al. Sweet taste preferences are partly genetically determined: Identification of a trait locus on chromosome 16. Am J Clin Nutr 86(1): 55-63, 2007.

44. Autio JT, Courts FJ. Acceptance of the xylitol chewing gum regimen by preschool children and teachers in a Head Start program: A pilot study. Pediatr Dent 23(1): 71-74, 2001.

45. Kohli K, Ngan P, Crout R, Linscott CC. A survey of local and topical anes-thesia use by pediatric dentists in the United States. Pediatr Dent 23(3): 265- 269, 2001.

46. Primosch RE, Rolland-Asensi G. Comparison of topical EMLA 5% oral adhesive to benzocaine 20% on the pain experienced during palatal anes-thetic infiltration in children. Pediatr Dent 23(1): 11-14, 2001.

47. Ram P, Grol R, Rethans JJ, Schouten B, van der Vleuten C, Kester A. Assessment of general practitioners by video observation of communica-tive and medical performance in daily practice: Issues of validity, reliability and feasibility. Med Educ 33(6): 447-454, 1999.

48. Zhou Y, Forbes GM, Humphris G. Camera-related behaviours of female dental nurses and nursery school children during fluoride varnish appli-cation interactions in nursery school settings. Int J Paediatr Dent 20(5): 374–381, 2010.

49. Mey G. Erzählungen in qualitativen Interviews: Konzepte, Probleme, soziale Konstruktionen. Sozialer Sinn 1(1): 135-151, 2000.

50. Naylor S, Keogh B, Downing B, Maloney J, Simon S. The Puppet Project: Using puppets to promote engagement and talk in science. In: Pinto R, Couso D, eds. Contributions from Science Education Research. Dordrecht: Springer; 2007:289-296.