Table 5 Key Focus Group Themes with Parents’ Responses

Perception of incidence of tooth color of their child

• “…when they have … discolored teeth more than typically, more maybe like black, dark gray, black and the tooth’s death or missing teeth”

• “I think of white teeth…No nasty yucky stuff that you sometimes see…For my kids, to make sure they do not have yellow”

• “The teeth are not necessarily white in order to have good oral health. The white idea is a new definition of attractive”

• “You have to teach them... I put eggs in coffee and soda. So the egg turned dark. So I told him: ‘Do you want this kind of teeth or do you want this kind of teeth?’ I showed him the two eggs. One was brown and the other one was white. ‘If you don’t brush your teeth, this is the way they will look. You are going to smile and they are going to be brown. If you smiled this way, look, they are going to be white’.”

• “I also see children with black teeth”

Perception of their child’s dental appearance

• “You look at someone with really crooked teeth; I always think, why didn’t your parent do something to help you?”

• “I think even if your teeth are crooked, it is good oral health. It is still healthy. You know. Your teeth are good. They are going to last you for the rest of your life. I think that knowledge is the key; to have people to be informed and with techniques so that they can have good oral health instead of bad oral health”

• “What comes to my mind when I hear the term ‘poor oral health’? I think of crooked teeth.”

Perception of the overall dental appearance

• “I think it is about keeping them clean. And, yes, straighten them and whatever if it is affecting other teeth but I think our aesthetics has gotten in the way of actual health. Do you know what I mean?”

• “I think…big smiling; white”

• “Just for the development, so that they would have a nice smile, good teeth.”

• “For good oral care, maybe that was part of it, but the main thing was so that they had nice teeth: you know. That is all.”

• “Beautiful teeth; beautiful smile”

Perception of frequency of child’s bad breath

• “I think of bad breath…in the back of your throat.”

• “When I think of poor oral health, I say when they have bad breath.”

• “Something we always tell our kids: ‘That is why you have to brush your teeth and your tongue if you do not want to have bad breath’; because when you talk to people, you know, socially… being older, again, you kind of step away and move away from people who have bad breath or do not have good oral health.”

Perception of child’s fear of dental treatment

• “I had three daughters. They were always afraid because my parents always kept saying if you don’t brush your teeth, (you are) going to go to the doctor and (it) is going to hurt you. So they didn’t want to go to the dentist because they were afraid of the treatment that could be painful. And in reality, it is painful.”

• “I am honest with my kids. I told them, it is going to hurt but is not going to kill you. That is the experience with the kids. I made a rule; I am not going to lie to you. It is going to hurt but it is not going to kill you. Each child is different based on the level of fear.”

• “My son does not have a fear of the dentist. He has a fear of needles…I think he is motivated from not wanting to go and get fillings or having the shots.”

Perception of child’s worry over dental problem

• “If you do not have a good oral health as an adult, you will get cavities, your teeth will fall out. You would have periodontal disease. I mean, those are the things that I worry about if they do not access. I do believe that if I take good care of her teeth, up ‘til 18, which is when most of her teeth were growing and forming, and we are good on their teeth, I am hoping that would give them consideration that will last for a lifetime because they will have good set of starting points. Growing adult teeth are going to be (a) higher quality of enamel and not have cavities because again from my experience that was true for me.”

• “You have to spend time as an adult to take care it all, and if I can give them the luxury of not having to worry about it and not having to take care of it, why wouldn’t I?”

• “Well, I took mine when he was 2 years; the other one was 3 years. My main purpose was not for their teeth at that time. It was so that they would have no fear. So that they would be happy and perceive it as a positive. That was very important to me; that they not be afraid to go to the dentist or be afraid of the dentist because we still, me and my husband, are still afraid. Me, my husband, my sisters have a big fear.”

Attitude toward the importance of child’s oral health to overall health

• “I have heard, too. Actually, one of my coworkers told me, and it stuck to my head that if you do not clean your teeth, you get sicker faster because more germs build up. I kind of took that seriously. He is kind of right. Now, has this been proven, studied? I do not know, but I truly believe that if you take care of your teeth, you do not get sick as often as most people do.”

• “When I hear oral health what comes to mind for me is the whole body.”

• “At 13–14 years old, I did not have a good oral health and I have cavities in my adult teeth; we all end up dealing with that as an adult. And I am not even talking about cardiovascular disease.”

Attitude toward the impact of their care for child’s oral health on longevity

• “I took a class in college…I remember them saying that if you do not take care of your teeth, it takes off—I do not remember the number— like 5 or 6 years from your life. I remember that affecting my idea of taking care of my teeth.”

Attitude toward oral health maintenance and life chances.

• “I look at it as an investment. Until they are 18, I am investing in their teeth, because I am hoping that their teeth are much more healthy than mine.”

Attitude toward their capacity for support of their child’s oral health prevention

• “I agree but it seems like, they say that plaque builds up even if you brush every day. It builds up within a period of 6-month. So, if you do not go to the dentist every 6 months, you are not getting that extra build up taken off. So, it does not matter how much you are brushing your teeth. That can add up.”

• “If you are maintaining a structured situation at home with your kids, making sure that they are brushing and flossing on a regular basis, it will not be that costly. There will just be cleanings, and maintenance to make sure they are okay, but if they are not brushing and flossing, that is when you get into caries, cavities, fillings, and other issues. That can be costly as a result of not having home discipline.”

• “My mother had dentures in her 20s because she had a gum disease called pyorrhea. So, for me, I am on it because I do not want it to happen to me or my children because of laziness or for being unaware of the details or of all the things that have to be taken care of as far as we said. Things such as scraping your tongue, flossing, brushing, and making that a routine. This is very important in my house.”

• “Setting a schedule. Being available to make the time to stand there. Say, hey, go brush your teeth and leave it up to the kid. If you know that you have a child that will not do it on their own, you have to make the time to stand there and either do it for them, do it with them or instruct them how to do it.”

• “Also, maybe the kids need to see the parents do it. Sometimes kids don’t do what we tell them. They do what they see. You know what I mean. If they see their parents brushing their teeth; that may mean that you have to do it four times instead of two. Parents need to do it at different time frames so that when the kids see you, they would say, mommy is doing it, maybe I’ll do it”

• “It also has to do with the way you are raising your kids in terms of cleanliness. I only have one child. We are always telling her to brush her teeth in the morning and in the evening. Now, because we pushed her since she was small, I do not have to push her to wash with the mouthwash. It becomes a good habit. In order for this to become a good habit, we have to teach them to do it.”

• “Do they floss as often as they would like? No. Do they brush twice a day? Yes. Do they do a good job? Uh. So, relatively speaking, yes. The reason why I take them to the dentist every 6 months is so that even if they do a good job as far as brushing their teeth twice a day... So, you know. Do they do it on their own if I do not remind them? My 10 year-old, no.; my 12 year-old, yes. He has a better attitude. As she gets older, maybe the fact (that) when the peers smile and she notices.”

Parent’s capacity to influence their child’s oral hygiene behavior

• “Well yeah, over the years, I have done different things with my kids, like my son: I have to put little notes up on the mirror to remind him what to do, they share a bathroom so I would buy both mouthwash so they have their”

• “I make sure he brushes his teeth before he goes to bed, after taking a shower every night.”

• “You just have to remind them. I never brush his teeth. As a toddler, I did. He has always done it, but if I do not remind him, he probably won’t do it. It is about reminding him and making the dental appointments.”