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This study examined the content and general readability of pediatric oral health education materials for parents of young children.
Methods

Twenty-seven pediatric oral health pamphlets or brochures from government, industry, and private sources nonprofit were analyzed for general reading according to several parameters: readability, (Flesch-Kincaid grade level, Flesch readability and grade level Smog) thoroughness, (inclusion of issues important to young children’s oral health); textual framework (frequency of complex sentences, using pictures, diagrams, and bulleted text within materials) and terminology (frequency of difficult words and dental jargon).
Results

Readability of written texts ranged from 2 nd to 9 th grade. The average Flesch-Kincaid level of government publications was equivalent to a grade 4 reading level (4.73, range, 2.4 – 6.6); FK degrees, trade publications for an average of 8.1 (range, 6 , 9 – 8.9) and industry published materials read an average Flesch-Kincaid grade of 7.4 (range, 4.7 – 9.3). Smog readability analysis, based on a count of polysyllabic words, consistently rated materials 2 to 3 degrees higher than the Flesch-Kincaid analysis. Government sources were significantly lower compared with the commercial and industry sources for Flesch-Kincaid readability level of analysis and smog. Content analysis found materials trade and industry sources more complex than government-sponsored publications, whereas commercial sources were more in-depth coverage of pediatric oral health topics. Different materials often conflicting information.
Conclusion

The Pediatric oral health care materials are readily available, but its quality and readability are very diverse. In general, government publications are more readable than their commercial counterparts and industry. Usability criteria and the results of the analyzes presented in this article may be used by consumers of dental educational materials to ensure that their choices are well adapted to their specific patient population.
Background

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In the U.S., dental care is the most prevalent unmet health need of children.Despite the recent decline in childhood dental caries, is the increase in children ages 2 to 5 years. Oral health disparities in the U.S. still exist, especially for children from poor and culturally different backgrounds. Among children ages 2 to 5 years, 75% of dental caries found in 8% of the population. If left untreated, childhood caries can lead to problems with eating, speaking, and learning. As quoted in Maternal and Child Health fact sheet, “Oral health and learning: when children’s oral health suffers, so does their ability to learn,” the effects of dental pain may be misinterpreted by teachers as a behavior problem.

Infancy and childhood are the most dynamic period of dental growth, so that educate parents on children’s dental care is critical during these periods. Both the American Academy of Pediatrics (AAP) and the American Association of Pediatric Dentists (AAPD) recommends that children visit a dentist for oral health risk assessment within 6 months of birth and establish a dental “home” for children less than 1.

The creation of good dental habits is the result of a communication chain from supplier to the parents for the pediatric patient. Parents and guardians, and other caregiving adults, have the primary responsibility for daily care and prevention services and monitors are to create, maintain, and passing along a good oral health routine their children. This requires an understanding of dental development and how to maintain good oral health. A dentist by profession and its primary commercial subsidiaries serve on the education of parents. To help parents understand the value of early dental care and home oral hygiene, educational messages should be easy to understand and relevant. Materials to communicate oral health information in writing should be created to maximize readability and understanding and in full recognition that many U.S. adults, including parents, have limited literacy.

It is estimated that in USA at least 40 million adults have below average literacy (<5 th grade reading level), and may be unable to read or understand written basic information that most people take for granted . It is likely, given the specific context of the nature of health and technical jargon, an individual’s health literacy lags behind the general level of literacy. In fact, the Institute of Medicine recently reported that ninety million American adults have difficulty understanding health information and following treatment plans. Consequently, millions of Americans, including millions of parents, may not be able to fully comprehend basic pediatric health information.

A recent report from the Agency for Healthcare Research and Quality (AHRQ) (2004) reviewed the studies of the impact of low health literacy in health and health care utilization. The authors found low literacy is associated with greater use of expensive care, emergency services, and increased hospitalization rates. Similarly, a report by the National Working Group (NWG) devoted to literacy and health (1998) concluded that “(1) poor reading skills are associated with poor health and high use and costs of health services, 2) reading of at least 1 quarter of the U.S. adult population are so limited that written communication with this group may not be effective, 3) when written materials are essential, must be generally grade 5 or less, and (physicians should ensure that patients understand the medical information provided to them.

Despite the current medical research on health literacy, few studies have examined oral health literacy. The scope of the problem of low oral health literacy levels among parents of pediatric patients is presented by Jackson

who suggests several methods to improve patient-provider communication, including the use of grade-level analysis as a means for dentists to assess pediatric education materials . One such study by Alexander  analyzed the readability of the 24 general dental educational publications. We found that 41.7 percent of the materials were written at grade level higher than grade 8. A similar study by Kang et al used Alexander’s readabililty framework for analysis and investigated the readability of pediatric oral health-specific educational materials. We are extending this research in addition to evaluation of readability and thoroughness, textual framework and terminology of 27 publications from a diverse group of sources: the ADA, government health sources, and commercial organizations. Our analysis of the differences in readability of source documents (ie, commercial, industrial and government) is similar to that of Harrison and Harwood tested the readability of orthodontic patient information leaflets. Our approach provides a framework for selecting the most readable and comprehensive pediatric oral health materials based on multiple parameters. The results presented here provide dentists and other providers of oral health services with an analysis of the materials available today.

The frame itself can be used today and in the future to select materials that are highly readable and comprehensive in content.
Methods
Pediatric Dentistry educational materials

Twenty leaflets and brochures have been examined in this study. Most materials are readily and publicly available at no cost, those with a cost attached could be previewed in PDF format or obtained by mail. They were obtained from various sources, including local pediatric dental practices, online web sites from commercial sources (ie Crest, Oral B and Colgate), government and industry sources. Many of the publications available online in PDF format. Most government publications were mailed to the study author (RLH) by request, samples of each publication in this study were available at no cost. Nine publications are available in languages ​​other than English. Of the materials included in the sample, 22% were from commercial sources, 44% came from government sources and 33% came from industry sources. The source of each publication is provided in Table 1 below.
Usability Analysis

Our analysis of “usability” of these educational materials considered 3 sets of attributes: form, content and reading level. The review of format included physical characteristics of the material (ie, number of pages and how the document), the public, the use of instructional pictures or drawings, cartoons and text. The review of content assessed the thoroughness of the prospectus or brochure that provides information on 11 topics relevant to the oral health of infants, toddlers and preschoolers. The review of readability assessed the reading level of text and dental jargon.
Format

The criteria for our analysis of format are presented in Table 1 and, in turn, are defined below.
Thoroughness

Judgments about the thoroughness of the brochures and pamphlets are based on the presence of about 11 oral health topics. The topics are listed in Table 2 and, in turn, are defined below.
Text reading level and use of professional jargon

The reading level of each document is determined using three widely used measures: Flesch-Kincaid grade level, Flesch Reading Ease, Reading and grade level smog. In addition, we examined each of the documents for the use of professional jargon. Readability measures are presented in Table 3 and are defined below.
Data Analysis

Tests for differences of origin of the publication were examined by the following characteristics: format (% bulleted text), content (number of topics covered of 11 in total) and readability (FK grade level and smog). Tests were one-way analysis of variance followed by Tamhane’s T2 test (not assuming equal variance) to identify significant pairwise differences between means.
Results
Format

Twenty-seven publications were reviewed, 21 were available free of charge and 6 were available for a fee. Materials range from a single page handouts, sometimes tri-booklets, 10 – and 12 – page booklets. Six used no bulleted text and 6 bulleted text in all pages. On average, the proportion of pages with bulleted text was .65 (SD = .38) for materials from government sources, .25 (SD = .23) for materials from commercial sources, and .26 (SD = .28) materials for industry. The test of mean differences in the proportion of pages with bulleted text was statistically significant (F (2,24) = 5.13, p = .01), official publications contained a significantly higher number of pages of bulleted text made from commercial sources (p = .04) and more industry-sponsored publications (p = .04).
Content Analysis