Can a naughty monkey prevent children's dental plaque?

How do you ensure that young children brush their teeth more often and better? In any case, the dry brochure texts that are in the brochure rack in many dental practices do not seem to appeal to children. Communication scientists from VU University Amsterdam and Radboud University Nijmegen investigated whether a story about a mischievous orange monkey with poor oral hygiene does.

Caries (cavities) is a common chronic condition in children. Brushing your teeth is one of the most important preventative measures. It is therefore imperative that health communication encourages children to brush their teeth better. ‘In oral care, the didactic method is the default’, says researcher Enny Das. ‘If you don't brush, you will get cavities! We know that those kinds of tactics - scaring people - don't work.’ Research among adults showed that storytelling can promote healthy behaviour. Is that also the case with children?

Naughty monkey

In an experiment among 94 children, aged 4 to 10, communication scientists Enny Das of Radboud University Nijmegen and Katalin Bálint of VU University Amsterdam investigated the influence of a funny toothbrush story about an orange monkey, Johnny Joker, on brushing behaviour in children. ‘Johnny does all kinds of stupid things in the story’, Das summarizes. ‘He brushes his teeth with chocolate, for example. Children find that very funny. But it is not a moralistic story. Johnny's friends point out that he stinks, but he is not punished for his actions.’

The children, patients at a dental practice in Rosmalen, The Netherlands, were followed for a month. Their plaque score was measured in the dental practice at the beginning of the experiment. Then half of the children took home the brochure of the Ivory Cross and the other half the funny book about Johnny Joker. Parents had to make sure their child read the leaflet or story every other day. The children were asked about their experience of the brochure or booklet and the dental plaque score was again determined by the dentist at the end of the month. ‘That is really special about this research, because dental plaque score is a very objective measure to measure the effect of the type of health communication’, says Das.

Crucial

The first finding is that children find the story about Johnny more fun to read than the brochure. ‘That seems obvious, but it is an important finding in health communication’, says Das. ‘If you want to educate children, you first have to get them interested.’ But the next question is: does reading pleasure also translate into (positive) health outcomes? The answer is not straightforward: liking a story does not automatically ensure that the brushing process is improved. Das: ‘What is crucial is that children realize that Johnny is naughty. If so, the booklet will result in a reduced dental plaque score. But just finding the story funny doesn't make a positive difference. It can even backfire. Children might think: I'm going to brush my teeth with chocolate too!’

Reading with pleasure is a prerequisite for attracting attention, but the combination of humour and ‘naughty’ behaviour of a story character appears to be a risky strategy. Das: ‘I think there is a lot to be gained in oral care, but it is very important that you know what you are doing. My suggestion for this form of information is to provide a clear conclusion at the end: brushing your teeth is important. It is more boring, but also safer.’

This research was supported by the CZ Fund. The creator of the Johnny Joker book series is Marnix Hoppener, also a research associate at Enny Das's Persuasive Communication research group.