Knowledge and behaviours regarding the infant oral health visit among dental nurses and dental hygienists in Ireland

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Methods This cross-sectional, mixed-methods study assessed the knowledge and behaviours of Irish DN and DH knowledge and behaviours regarding infant oral health visits. Quantitative survey data was analysed using SPSS, while qualitative focus group discussion was thematically analysed to explore barriers and practices in early oral health promotion. Results The overall response rate was 38% (122 respondents). Results indicate that parental education was the most common procedure performed (22.3%) and fluoride interventions were least commonly performed. Lack of parental requests (32.5%) was identified as the primary barrier. RDN were significantly more likely to treat paediatric patients (74.5%) than DH (40%). Those receiving both theoretical and clinical training were significantly more likely to provide care to infants (78.9%). Public DN and DH treated significantly more children (89.7%) than private (44.2%). Older graduates (1960–1979) were more aware of the recommended first dental visit (83.3%). Conclusion This study highlights significant gaps in the knowledge and behaviours of DH and DN regarding infant oral health in Ireland, with inconsistencies in education, limited clinical exposure, and low parental awareness serving as key barriers. Variability in training and practice settings, particularly the greater involvement of public-sector DN in infant care, underscores disparities in service delivery. Additionally, inconsistent fluoride varnish application and a lack of consensus on the ideal age for a first dental visit further hinder early preventive care. Addressing these challenges through evidence-based education for DN and DH will ensure equitable access to preventive care for all infants. Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction A recent study in Ireland highlighted that a child’s first dental visit by 12 months of age should be a key priority on the health agenda in Ireland (Duane et al. 2017 ). Early childhood caries (ECC) is the most prevalent chronic disease affecting young children representing a global public health concern, occurring at a rate five times higher than asthma (Duque et al. 2022 ; Duane et al. 2017 ). Another study found that dental caries prevalence increased from 8% at 18 months to 23% at 36 months of age, underscoring the need for early intervention (Gussy et al. 2016 ). Prevention of ECC is therefore critical, and DH and DN in Ireland play a key role in shaping early oral health practices. According to Irish Dental Council Guidelines, the role of the DH involves providing guidance on oral health, organising oral health promotion programs, smoking cessation advice, providing plaque control strategies and conducting dietary analysis to prevent dental caries (Irish Dental Council Guidelines 2022). Similarly, DN are involved in providing patients with relevant health promotion guidance, empowering individuals to take greater control of their health and, in turn, improve their overall well-being (World Health Organisation 2025). The guideline of the first dental visit before age 1 or when the child’s first tooth erupts has been adopted by numerous professional bodies (Bhaskar et al. 2014 ; FDI 2020).The rationale for the infant oral health visit is manifold: early prevention, parental education, establishing a dental home, and reducing future treatment needs (Weber-Gasparoni 2019 ). However, among dental professionals, there is a clear discrepancy in when they believe the timing of the first visit should be. A recent Irish study (Djokic et al. 2018 ) found that only 58% of non-paediatric dentists were aware of the guideline, echoing findings from Canada (Canadian Dental Association 2025 ). It is evident that health education should begin at an early age to track a child's development and prevent potential health issues (Saccomanno et al. 2023 ). However, studies have identified knowledge gaps in dental practitioners' understanding and prevention of dental caries in infants, and consequently highlighting the need for improvement (Alrowaili 2021 ). Moreover, discrepancies between knowledge and behaviour persist, with studies highlighting differences in dentists’ perceived effectiveness of preventive methods, like fluoride and sealants, compared to their actual practices (Lin et al. 2010 ). These studies, despite relying on self-reported data, highlight the global need for targeted training among dental professionals to close knowledge gaps and provide consistent, effective preventive care for infant oral health. In relation to DH, the literature reveals clear variations in knowledge and behaviours. One study found widespread confidence in conducting caries risk assessments, yet identified limited use of standardized tools and significant knowledge gaps (Francisco et al. 2013 ). This need to address the lack of knowledge on infant oral health among DH is similarly underscored in various other studies (Manski and Parker 2010 ; Ruiz et al. 2014 ). While extensive research has examined dentists' knowledge and behaviours regarding infant oral health, little attention has been given to DHs, and notably, no studies have assessed DNs’ knowledge or practices. With the growing emphasis on preventive dentistry (Garcia and Sohn 2012 ), the role of DHs and DNs in educating parents and caregivers is becoming increasingly important. This study will be the first of its kind in Ireland to examine both DNs and DHs, addressing a significant gap in the literature. Existing literature often overlooks the critical role these professionals play in patient education, guidance, and early intervention. This study aims to assess DHs’ and DNs’ knowledge and behaviours regarding infant oral health, identify barriers to care, and explore how they perceive and implement best practices. Additionally, it will investigate how training methods, years of experience, and practice settings influence the incorporation of infant oral health visits into routine care. Data will be collected via an online survey of DHs and DNs in Ireland, followed by a focus group discussion. By evaluating current knowledge and practices, this study seeks to enhance education, standardize preventive strategies, and ultimately contribute to improved early childhood oral health outcomes in Ireland. Methods This study, approved by the Trinity College Dublin Research Ethics Committee on 29th January 2025, employed a cross-sectional, mixed-methods design to assess the knowledge and behaviours of oral healthcare workers in Ireland regarding infant oral health visits. A mixed-methods approach was chosen to provide a more comprehensive understanding by combining quantitative survey data with qualitative insights from focus groups. A convenience sampling method was used, targeting DN and DH registered with the Irish Dental Nurses Association(IDNA) and the Irish Dental Hygienists Association(IDHA), along with oral healthcare workers in dental practices across Ireland. Questionnaire: A 12-item questionnaire developed using a validated published source (Djokic et al. 2018 ) was employed to gather quantitative data on participants' knowledge, attitudes, and practices related to infant oral health visits. This questionnaire was adapted for DH and DN. The survey was conducted over four weeks using Qualtrics and consisted of multiple-choice and open-ended questions. It was distributed via email to IDNA and IDHA members and dental practices across Ireland(by emailing dental practices on the 2025 Dental Council of Ireland Register), with follow-up through telephone contact to encourage participation. Participant selection included participants working in dental clinics in Ireland, with at least one year of experience (Table 1). Two gatekeepers were involved-the president of the IDNA and Employment and Website Officer for the IDHA. Participants were provided with detailed information about the study's objectives, and written informed consent was obtained for both stages of the study. They were provided with a Qualtrics web link and were assured of anonymity and confidentiality, with the option to withdraw at any stage. The data was stored for a month after the survey in compliance with GDPR. Incomplete or unsubmitted responses were excluded from analysis. Focus group: A follow-up focus group was offered to questionnaire participants, with an opt-in question at the end. Seven participants attended a 45-minute Zoom session held on a later date. A pre-prepared script guided the discussion to explore questionnaire trends in depth. Participants were assigned pseudonyms to ensure anonymity, and they were informed that they could withdraw at any time. All data were securely stored on password-protected devices, and only authorized research team members had access. Data analysis: Quantitative survey data were entered into Microsoft Excel and analysed in SPSS to compute descriptive statistics. The Chi-squared test was used due to the categorical nature of the variables in this study ( p < 0.05 was considered significant). Qualitative focus group data were transcribed from the audio recording and analysed thematically. Results Questionnaire Results: A total of 381 clinics were contacted, with 122 respondents (38% response rate). The demographic breakdown was: 30.7% DH (35), 44.7% RDs (51), and 24.6% NRDN (28). Eight responses were excluded due to incomplete surveys. Questionnaire responses are summarized in Table 2 below. Regarding clinical practice settings, 67.5% of participants (77) worked in private practice, 25.4% in public settings (29), 6.1% in both (7), and 0.9% in other roles (1). Participants graduated between 1960 and 2024, with 30.7% completing their degrees between 2020–2024. Additionally, 14% had no undergraduate training. Most respondents(103) obtained their post-registration degree in Ireland, while 11 trained abroad. In terms of workload, 57% worked full-time (≥ 31 hours per week), 25.4% worked 21–30 hours, 11.4% worked 11–20 hours, and 6.1% worked 0–10 hours. Training exhibited substantial variability, with 43.9% receiving only theoretical instruction, 34.2% both clinical and theoretical, 2.6% clinical only, and 19.3% no formal training. The most cited barrier was lack of parental requests (32.5%), followed by perceived lack of necessity (19%) and preference for specialist referrals (9%) .Less commonly cited factors included role delegation, uncertainty about interventions, financial concerns, belief that young children don’t require care, busy practice, lack of enthusiasm, excessive time commitment and personal discomfort. Additionally, 6.5% responded in relation to ‘Other’ ,with responses including working in specialized or A&E settings ( Table 2). The most frequent treatment provided by DH and DN was parental education (22.3%), followed by dietary advice (18.2%). Others included oral hygiene instructions (16.3%), assessment of normal dental development (15 .5 %), and caries examination (13.9%). Fluoride evaluation (7.1%) and varnish application (4.3%) were the least common. Additionally, 2.4% selected ‘other,’ which included emergency child exams, tongue-tie release, and acclimatizing children to the dental environment. A significant association was obtained between professional designation and treating children aged 0–36 months (P value:0.0495, at p < 0.05 level of significance). RDN were significantly more likely to treat paediatric patients (74.5%,), whereas DH were significantly less likely (40%)( Table 3 ). There is a statistically significant association between the role of an oral healthcare worker and the likelihood of seeing infants(P value: 0.022). DHs were the least likely to see children frequently, with only 6.3% seeing at least 1 child per week. RDN and NRDN were similar in their frequency of seeing children, with 26% and 23.1% respectively seeing one child a week (Fig. 1). A significant association was observed between undergraduate training type and treating children aged 0–36 months (P value: 0.015). Respondents with both theoretical and clinical training were significantly more likely to treat infants (78.9%) compared to those with theory-only training (46%), who were significantly less likely to treat paediatric patients ( Fig. 2). A significant association was found between practice setting and treating paediatric patients (P value:0.015). In private practice, 55.8% did not treat children, while 44.2% did. In contrast, a significant proportion of public practice respondents (89.7%) treated paediatric patients, with only 10.3% not providing care ( Fig. 3 ). Graduation year influenced knowledge of the recommended first dental visit. Earlier graduates were more likely to endorse a 0–12-month visit, with 83.3% of those from 1960–1979 doing so, compared to just 14.3% of 2020–2024 graduates ( Fig. 4) . Focus Group Results Focus group discussion topics were thematically organised under the following headings. Various responses within each theme were obtained. 1.Training and educational gaps Various responses were recorded in relation to the adequacy of training received. "I feel like we don’t get enough training on infant oral health. More practical experience would really help us feel more confident. " "I feel like my training adequately prepared me for my job. However, I work in a hospital and was trained in the hospital so I feel like it trained me for the job I have. Other colleagues of mine work in private and would disagree with this." 2. Clinical Exposure and Frequency of Infant Visits Participants noted that increased frequency increased their confidence in seeing infants. "The more you see infants, the more prepared you feel to talk to parents about oral health." In relation to the relevance of clinical practice setting, participants were not surprised that public saw more infants than private settings. "In public practices, we see way more young kids. It’s really just because it’s more affordable for families. In private practice, if a child needs sedation or general anaesthesia, it adds to the overall cost." 3. Routine practices in Infant Oral Health Visits Many participants emphasised the importance of education. "Education and advice are the best things for infant oral health. For example, a hygienist visited my son’s school and showed them how to brush their teeth. Afterwards, many parents started bringing their children to the dentist. It just goes to show how important education is." 4. Barriers to Providing Infant Oral Healthcare Many barriers were noted by participants ranging from embarrassment to financial reasons. "There’s an element of embarrassment. Parents feel ashamed if their child’s teeth are in bad condition." "Parents don’t care. They think deciduous teeth don’t matter since they’ll be replaced anyway." "Parents wait until the HSE sees their children in primary school. Unless there’s an emergency, they don’t bring them in earlier. Many private dentists defer infant oral health to public services." 5.Beliefs about the ideal age of the first dental visit In relation to the guideline on the first dental visit, some participants noted discrepancy in guidelines. "There's conflicting information in the literature regarding the age of the first dental visit" When asked why they believed those who graduated years ago had more experience, participants attributed it largely to continued professional development(CPD). "Those who graduated years ago have so much more experience. A big factor is that they have done a lot of CPD training. They really know everything—I’m in awe of them." 6.Recommendations Participants provided several recommendations to improve infant oral health education and practice: "I’d be interested in CPD training, but it would need to be funded by the practice. That’s why hospital-based DN tend to have more CPD than those in private practice—it’s covered for them." Other suggestions included increased clinical exposure to infants. "Clinical exposure to infants during undergraduate training would be extremely beneficial." Discussion 1.Training and Educational Gaps in Infant Oral Health The variation in responses among those with theoretical training, both theoretical and clinical training, or no training at all highlights inconsistencies in educational preparation. DH were more likely to receive theory-only training, while RDN had more comprehensive clinical and theoretical training. Notably, those trained in both modalities were significantly more likely to treat infants than those with theory-only training. The discrepancy in perceived job preparedness underscores the need to address gaps in formal education. This study aligns with prior research indicating that education enhances confidence; for example, a cross-sectional study (Calhoun et al. 2023 ) found that higher education levels predict DHs’ likelihood of providing anticipatory guidance to parents. 2. Clinical Exposure and Frequency of Infant Visits The study found significant differences in clinical exposure, with RDNs seeing more infant patients than DH. Infant visit frequency also varied, with few DH seeing one child per week. Those working more than 31 hours per week were more likely to treat children than those working only 10 hours per week (Table 2). Frequent exposure correlated with increased confidence in educating parents. Practice setting also influenced patient demographics. DH and DN in public practice treated more infants than those in private practice, aligning with research showing public services handle most paediatric dental care due to limited private options (Auld 2023 ). The disparity between public and private practice highlights the need for standardized formal teaching on infant oral health. 3. Routine Practices in Infant Oral Health Visits This study underscores the complementary roles of DH and DN in infant oral health, particularly in parent education and preventive care to support the dentist’s role. As poor oral hygiene is a significant risk factor for ECC (Kirthiga et al. 2019 ), parental education on prevention is critical. However, fluoride varnish application—a critical preventive measure—remains underutilized. This aligns with previous studies (Djokic et al. 2018 ; Manski and Parker 2010 ) reporting inconsistent fluoride varnish application rates. This study also revealed significant variations in knowledge and consistency related to routine dental practices. This aligns with previous research which examined the consistency of caries prevention recommendations and found that while two-thirds of professionals prioritized oral hygiene education, only 18% emphasized dietary advice (Løken et al. 2016 ). 4. Barriers to Providing Infant Oral Healthcare The primary barrier to infant oral healthcare identified was the lack of parental initiative in requesting appointments, often due to a lack of awareness, concern, or even embarrassment. This aligns with a recent Irish study in which 41% of non-paediatric dentists identified parental unawareness as a major obstacle (Djokic et al. 2018 ). Most parents rely on HSE referrals unless there is an emergency, mirroring a systematic review showing infants are usually seen only for problems, not prevention (Bhaskar et al. 2014 ). This is underscored in a recent Irish study (Duane et al. 2017 ) that found while the HSE provides dental services up to age 16, non-emergency cases often experience delays. Routine school referrals typically occur between ages 6 and 8 so often infants are not seen until then. Other less frequently cited barriers; such as financial constraints also align with previous research, as well as uncertainty about what to expect or do at a 12-month dental visit (Schroth et al. 2015 ; Ruiz et al. 2014 ). 5. Beliefs About the Ideal Age for a First Dental Visit The variation in recommended ages for a child’s first dental visit highlights inconsistencies in professional knowledge and adherence to guidelines, emphasizing the need for clearer recommendations. This study found significant differences in beliefs about the ideal timing. International research indicates that while DH often prioritize topics like diet and pacifier use, fewer (48%) emphasize the importance of a 12-month visit (Calhoun et al. 2023 ). Findings from this study indicate this discrepancy may be influenced by experience levels, as findings indicate that graduation year was linked to knowledge, with those graduating between 1990 and 1999 more likely to recommend early visits. Findings of this study attribute this to extensive clinical expertise and advanced standing. This aligns with studies showing that greater experience correlates with higher knowledge scores( Alrowaili 2021 ; Manski and Parker 2010 ). Respondents also noted inconsistencies in professional guidelines, reinforcing the need for improved quality guidelines (Verdugo-Paiva et al. 2024 ). This is reinforced in the literature with another study noting that online sources do not always align with professional advice (Bhaskar et al. 2014 ). 6.Recommendations This study highlights the need for enhanced knowledge among DH and DN research. This study found that additional education through dental curricula and continuing education would be well received, consistent with prior research which found that approximately 90% of DH would be interested in CPD (Manski and Parker 2010 ; Clovis et al. 2012 ). Another recommendation was for NRDN to complete a short foundational course before starting work as a DN to ensure they acquire essential knowledge. Furthermore, incorporating practical training in infant oral health into undergraduate curricula could better prepare future professionals. This importance of obtaining both theory and clinical training is highlighted in the literature (Ruiz et al. 2014 ). Limitations This study has several limitations, primarily stemming from biases associated with self-reported data, including self-selection and recall bias, which may affect the reliability of findings. Response bias may have occurred due to non-participation, potentially leading to an overrepresentation of certain perspectives. Additionally, the use of convenience sampling limits the generalisability of results. Time constraints further posed a challenge to data collection due to the delay in the ethics form approval. The web-based survey also faced obstacles, such as reluctance from DH associations to distribute the link, technical difficulties, and some respondents lacking the necessary technical skills. Furthermore, there was a lack of clarity associated with some survey questions. Question 7 on undergraduate training may have led to overreporting, as NRDN likely had no formal training. Also participants may have overreported treatments they provide, particularly procedures like tongue-tie releases and emergency exams, which fall outside the scope of practice for dental nurses and hygienists as per Irish Dental Council guidelines. Ambiguities in terminology, such as the definition of “children” (0–36 months) and distinctions between age categories (e.g.,0–12 months vs. 1 year), also contributed to confusion. Additionally, multiple-choice questions (Q10 and Q11) made it challenging to categorize responses accurately. Conclusion This study highlights critical gaps in the knowledge and behaviours of DH and DN regarding infant oral health visits in Ireland. The willingness of these professionals to see paediatric patients was significantly influenced by their practice setting, training modality, and professional role. Notably, those who received both theoretical and clinical training exhibited greater confidence and engagement, underscoring the importance of a structured curriculum that includes hands-on experience. Findings also revealed that public-sector DN were more engaged with young patients than their private-sector counterparts, emphasizing the need for standardized training across all settings. Barriers such as low parental awareness further hinder early dental visits, reinforcing the necessity of targeted public education and improved dissemination of clinical guidelines. Despite efforts in parental education, preventive measures like fluoride varnish remain underutilized, highlighting inconsistencies in guideline adherence. The absence of consensus on the recommended age for a first dental visit further underscores the need for clearer, standardized guidelines. Expanding access and funding for CPD courses would enhance professional development and strengthen infant oral health services. Addressing knowledge gaps and increasing clinical exposure for DH and DN will contribute to a paradigm shift in infant oral healthcare, ultimately improving long-term outcomes. Standardized, evidence-based interventions are essential to ensure timely and equitable care for all infants, reaffirming the crucial role of oral health professionals in early prevention. Declarations Author Contribution M.B. wrote the manuscript and conducted the data analysis. All authors contributed to data collection and read and approved the final manuscript. References Alrowaili EF. Self-reported knowledge about dental caries at young age and variations between dental practitioners in the Ministry of Health in Bahrain. BDJ Open . 2021; 7: 18. Auld D. Is there a need for private paediatric dentistry in the UK? BDJ In Pract 2023; 36: 12-13. Bhaskar V, McGraw KA, Divaris K. The importance of preventive dental visits from a young age: systematic review and current perspectives. 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World Health Organization. First global conference on health promotion.2025.Online information available at https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference (accessed January 2025). Tables Tables 1 to 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files tables.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 22 Oct, 2025 Reviews received at journal 24 Aug, 2025 Reviewers agreed at journal 11 Aug, 2025 Reviewers invited by journal 11 Aug, 2025 Editor assigned by journal 31 Jul, 2025 Submission checks completed at journal 31 Jul, 2025 First submitted to journal 30 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Darius","middleName":"","lastName":"Sagheri","suffix":""},{"id":498962944,"identity":"3282b0ab-af51-421c-8a1d-78b70dbbd3d4","order_by":9,"name":"Maria Van Harten","email":"","orcid":"","institution":"Dublin Dental University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"Van","lastName":"Harten","suffix":""}],"badges":[],"createdAt":"2025-07-30 14:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7253855/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7253855/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89397358,"identity":"5c73e4dc-ce86-481c-9c28-fc3168ef537f","added_by":"auto","created_at":"2025-08-19 13:46:56","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":367519,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"floatimage6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7253855/v1/086722d68fea0e244ebc12ac.jpeg"},{"id":89398831,"identity":"6fb96d05-262c-427d-aad9-48587cbfffb3","added_by":"auto","created_at":"2025-08-19 13:54:56","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":325270,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"floatimage7.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7253855/v1/c58f4b567dc566c5917d39e3.jpeg"},{"id":89398840,"identity":"fae501ff-dc94-4c66-b5c2-fee14e3e9ebe","added_by":"auto","created_at":"2025-08-19 13:54:56","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":366664,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"floatimage8.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7253855/v1/7d278e14a3fab0cb09ca897c.jpeg"},{"id":89397367,"identity":"4e07b755-ae74-416f-8489-fc6f5b17b90d","added_by":"auto","created_at":"2025-08-19 13:46:56","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":298910,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"floatimage9.png","url":"https://assets-eu.researchsquare.com/files/rs-7253855/v1/c814f7112e9780d6b929d8f0.png"},{"id":89400650,"identity":"c3318814-03b1-4f14-9341-3fba88e99a58","added_by":"auto","created_at":"2025-08-19 14:11:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1958609,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7253855/v1/c4346e16-2253-4a88-b6a8-34ebaf511781.pdf"},{"id":89398829,"identity":"442e122f-96f9-41b9-b173-52f07aa5871c","added_by":"auto","created_at":"2025-08-19 13:54:56","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":877318,"visible":true,"origin":"","legend":"","description":"","filename":"tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-7253855/v1/1d166273254f1f5138df110a.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Knowledge and behaviours regarding the infant oral health visit among dental nurses and dental hygienists in Ireland","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA recent study in Ireland highlighted that a child’s first dental visit by 12 months of age should be a key priority on the health agenda in Ireland (Duane et al. \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Early childhood caries (ECC) is the most prevalent chronic disease affecting young children representing a global public health concern, occurring at a rate five times higher than asthma (Duque et al. \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Duane et al. \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Another study found that dental caries prevalence increased from 8% at 18 months to 23% at 36 months of age, underscoring the need for early intervention (Gussy et al. \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePrevention of ECC is therefore critical, and DH and DN in Ireland play a key role in shaping early oral health practices. According to Irish Dental Council Guidelines, the role of the DH involves providing guidance on oral health, organising oral health promotion programs, smoking cessation advice, providing plaque control strategies and conducting dietary analysis to prevent dental caries (Irish Dental Council Guidelines 2022). Similarly, DN are involved in providing patients with relevant health promotion guidance, empowering individuals to take greater control of their health and, in turn, improve their overall well-being (World Health Organisation 2025).\u003c/p\u003e\u003cp\u003e The guideline of the first dental visit before age 1 or when the child’s first tooth erupts has been adopted by numerous professional bodies (Bhaskar et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; FDI 2020).The rationale for the infant oral health visit is manifold: early prevention, parental education, establishing a dental home, and reducing future treatment needs (Weber-Gasparoni \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). However, among dental professionals, there is a clear discrepancy in when they believe the timing of the first visit should be. A recent Irish study (Djokic et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) found that only 58% of non-paediatric dentists were aware of the guideline, echoing findings from Canada (Canadian Dental Association \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIt is evident that health education should begin at an early age to track a child's development and prevent potential health issues (Saccomanno et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). However, studies have identified knowledge gaps in dental practitioners' understanding and prevention of dental caries in infants, and consequently highlighting the need for improvement (Alrowaili \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Moreover, discrepancies between knowledge and behaviour persist, with studies highlighting differences in dentists’ perceived effectiveness of preventive methods, like fluoride and sealants, compared to their actual practices (Lin et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). These studies, despite relying on self-reported data, highlight the global need for targeted training among dental professionals to close knowledge gaps and provide consistent, effective preventive care for infant oral health.\u003c/p\u003e\u003cp\u003eIn relation to DH, the literature reveals clear variations in knowledge and behaviours. One study found widespread confidence in conducting caries risk assessments, yet identified limited use of standardized tools and significant knowledge gaps (Francisco et al. \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). This need to address the lack of knowledge on infant oral health among DH is similarly underscored in various other studies (Manski and Parker \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Ruiz et al. \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhile extensive research has examined dentists' knowledge and behaviours regarding infant oral health, little attention has been given to DHs, and notably, no studies have assessed DNs’ knowledge or practices. With the growing emphasis on preventive dentistry (Garcia and Sohn \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), the role of DHs and DNs in educating parents and caregivers is becoming increasingly important.\u003c/p\u003e\u003cp\u003eThis study will be the first of its kind in Ireland to examine both DNs and DHs, addressing a significant gap in the literature. Existing literature often overlooks the critical role these professionals play in patient education, guidance, and early intervention. This study aims to assess DHs’ and DNs’ knowledge and behaviours regarding infant oral health, identify barriers to care, and explore how they perceive and implement best practices. Additionally, it will investigate how training methods, years of experience, and practice settings influence the incorporation of infant oral health visits into routine care. Data will be collected via an online survey of DHs and DNs in Ireland, followed by a focus group discussion.\u003c/p\u003e\u003cp\u003eBy evaluating current knowledge and practices, this study seeks to enhance education, standardize preventive strategies, and ultimately contribute to improved early childhood oral health outcomes in Ireland.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e This study, approved by the Trinity College Dublin Research Ethics Committee on 29th January 2025, employed a cross-sectional, mixed-methods design to assess the knowledge and behaviours of oral healthcare workers in Ireland regarding infant oral health visits. A mixed-methods approach was chosen to provide a more comprehensive understanding by combining quantitative survey data with qualitative insights from focus groups. A convenience sampling method was used, targeting DN and DH registered with the Irish Dental Nurses Association(IDNA) and the Irish Dental Hygienists Association(IDHA), along with oral healthcare workers in dental practices across Ireland.\u003c/p\u003e\u003cp\u003eQuestionnaire:\u003c/p\u003e\u003cp\u003eA 12-item questionnaire developed using a validated published source (Djokic et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) was employed to gather quantitative data on participants' knowledge, attitudes, and practices related to infant oral health visits. This questionnaire was adapted for DH and DN. The survey was conducted over four weeks using Qualtrics and consisted of multiple-choice and open-ended questions. It was distributed via email to IDNA and IDHA members and dental practices across Ireland(by emailing dental practices on the 2025 Dental Council of Ireland Register), with follow-up through telephone contact to encourage participation. Participant selection included participants working in dental clinics in Ireland, with at least one year of experience \u003cem\u003e(Table\u0026nbsp;1).\u003c/em\u003e Two gatekeepers were involved-the president of the IDNA and Employment and Website Officer for the IDHA. Participants were provided with detailed information about the study's objectives, and written informed consent was obtained for both stages of the study. They were provided with a Qualtrics web link and were assured of anonymity and confidentiality, with the option to withdraw at any stage. The data was stored for a month after the survey in compliance with GDPR. Incomplete or unsubmitted responses were excluded from analysis.\u003c/p\u003e\u003cp\u003eFocus group:\u003c/p\u003e\u003cp\u003eA follow-up focus group was offered to questionnaire participants, with an opt-in question at the end. Seven participants attended a 45-minute Zoom session held on a later date. A pre-prepared script guided the discussion to explore questionnaire trends in depth. Participants were assigned pseudonyms to ensure anonymity, and they were informed that they could withdraw at any time. All data were securely stored on password-protected devices, and only authorized research team members had access.\u003c/p\u003e\u003ch2\u003eData analysis:\u003c/h2\u003e\u003cp\u003eQuantitative survey data were entered into Microsoft Excel and analysed in SPSS to compute descriptive statistics. The Chi-squared test was used due to the categorical nature of the variables in this study (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05 was considered significant). Qualitative focus group data were transcribed from the audio recording and analysed thematically.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eQuestionnaire Results:\u003c/p\u003e\u003cp\u003eA total of 381 clinics were contacted, with 122 respondents (38% response rate). The demographic breakdown was: 30.7% DH (35), 44.7% RDs (51), and 24.6% NRDN (28). Eight responses were excluded due to incomplete surveys. Questionnaire responses are summarized in \u003cem\u003eTable\u0026nbsp;2\u003c/em\u003e below.\u003c/p\u003e\u003cp\u003eRegarding clinical practice settings, 67.5% of participants (77) worked in private practice, 25.4% in public settings (29), 6.1% in both (7), and 0.9% in other roles (1).\u003c/p\u003e\u003cp\u003eParticipants graduated between 1960 and 2024, with 30.7% completing their degrees between 2020\u0026ndash;2024. Additionally, 14% had no undergraduate training. Most respondents(103) obtained their post-registration degree in Ireland, while 11 trained abroad.\u003c/p\u003e\u003cp\u003eIn terms of workload, 57% worked full-time (\u0026ge;\u0026thinsp;31 hours per week), 25.4% worked 21\u0026ndash;30 hours, 11.4% worked 11\u0026ndash;20 hours, and 6.1% worked 0\u0026ndash;10 hours. Training exhibited substantial variability, with 43.9% receiving only theoretical instruction, 34.2% both clinical and theoretical, 2.6% clinical only, and 19.3% no formal training.\u003c/p\u003e\u003cp\u003e The most cited barrier was lack of parental requests (32.5%), followed by perceived lack of necessity (19%) and preference for specialist referrals (9%) .Less commonly cited factors included role delegation, uncertainty about interventions, financial concerns, belief that young children don\u0026rsquo;t require care, busy practice, lack of enthusiasm, excessive time commitment and personal discomfort. Additionally, 6.5% responded in relation to \u0026lsquo;Other\u0026rsquo; ,with responses including working in specialized or A\u0026amp;E settings (\u003cem\u003eTable\u0026nbsp;2).\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe most frequent treatment provided by DH and DN was parental education (22.3%), followed by dietary advice (18.2%). Others included oral hygiene instructions (16.3%), assessment of normal dental development (15\u003cem\u003e.5\u003c/em\u003e%), and caries examination (13.9%). Fluoride evaluation (7.1%) and varnish application (4.3%) were the least common. Additionally, 2.4% selected \u0026lsquo;other,\u0026rsquo; which included emergency child exams, tongue-tie release, and acclimatizing children to the dental environment.\u003c/p\u003e\u003cp\u003eA significant association was obtained between professional designation and treating children aged 0\u0026ndash;36 months (P value:0.0495, at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 level of significance). RDN were significantly more likely to treat paediatric patients (74.5%,), whereas DH were significantly less likely (40%)(\u003cem\u003eTable\u0026nbsp;3\u003c/em\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThere is a statistically significant association between the role of an oral healthcare worker and the likelihood of seeing infants(P value: 0.022). DHs were the least likely to see children frequently, with only 6.3% seeing at least 1 child per week. RDN and NRDN were similar in their frequency of seeing children, with 26% and 23.1% respectively seeing one child a week\u003cem\u003e(Fig.\u0026nbsp;1).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eA significant association was observed between undergraduate training type and treating children aged 0\u0026ndash;36 months (P value: 0.015). Respondents with both theoretical and clinical training were significantly more likely to treat infants (78.9%) compared to those with theory-only training (46%), who were significantly less likely to treat paediatric patients (\u003cem\u003eFig.\u0026nbsp;2).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eA significant association was found between practice setting and treating paediatric patients (P value:0.015). In private practice, 55.8% did not treat children, while 44.2% did. In contrast, a significant proportion of public practice respondents (89.7%) treated paediatric patients, with only 10.3% not providing care (\u003cem\u003eFig.\u0026nbsp;3\u003c/em\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eGraduation year influenced knowledge of the recommended first dental visit. Earlier graduates were more likely to endorse a 0\u0026ndash;12-month visit, with 83.3% of those from 1960\u0026ndash;1979 doing so, compared to just 14.3% of 2020\u0026ndash;2024 graduates (\u003cem\u003eFig.\u0026nbsp;4)\u003c/em\u003e.\u003c/p\u003e\u003cp\u003eFocus Group Results\u003c/p\u003e\u003cp\u003eFocus group discussion topics were thematically organised under the following headings. Various responses within each theme were obtained.\u003c/p\u003e\n\u003ch3\u003e1.Training and educational gaps\u003c/h3\u003e\n\u003cp\u003eVarious responses were recorded in relation to the adequacy of training received.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I feel like we don\u0026rsquo;t get enough training on infant oral health. More practical experience would really help us feel more confident. \"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I feel like my training adequately prepared me for my job. However, I work in a hospital and was trained in the hospital so I feel like it trained me for the job I have. Other colleagues of mine work in private and would disagree with this.\"\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003e2. Clinical Exposure and Frequency of Infant Visits\u003c/h3\u003e\n\u003cp\u003eParticipants noted that increased frequency increased their confidence in seeing infants.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"The more you see infants, the more prepared you feel to talk to parents about oral health.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003eIn relation to the relevance of clinical practice setting, participants were not surprised that public saw more infants than private settings.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"In public practices, we see way more young kids. It\u0026rsquo;s really just because it\u0026rsquo;s more affordable for families. In private practice, if a child needs sedation or general anaesthesia, it adds to the overall cost.\"\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003e3. Routine practices in Infant Oral Health Visits\u003c/h3\u003e\n\u003cp\u003eMany participants emphasised the importance of education.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Education and advice are the best things for infant oral health. For example, a hygienist visited my son\u0026rsquo;s school and showed them how to brush their teeth. Afterwards, many parents started bringing their children to the dentist. It just goes to show how important education is.\"\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003e4. Barriers to Providing Infant Oral Healthcare \u003c/h3\u003e\n\u003cp\u003eMany barriers were noted by participants ranging from embarrassment to financial reasons.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"There\u0026rsquo;s an element of embarrassment. Parents feel ashamed if their child\u0026rsquo;s teeth are in bad condition.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Parents don\u0026rsquo;t care. They think deciduous teeth don\u0026rsquo;t matter since they\u0026rsquo;ll be replaced anyway.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Parents wait until the HSE sees their children in primary school. Unless there\u0026rsquo;s an emergency, they don\u0026rsquo;t bring them in earlier. Many private dentists defer infant oral health to public services.\"\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003e5.Beliefs about the ideal age of the first dental visit\u003c/h3\u003e\n\u003cp\u003e In relation to the guideline on the first dental visit, some participants noted discrepancy in guidelines.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"There's conflicting information in the literature regarding the age of the first dental visit\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003eWhen asked why they believed those who graduated years ago had more experience, participants attributed it largely to continued professional development(CPD).\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Those who graduated years ago have so much more experience. A big factor is that they have done a lot of CPD training. They really know everything\u0026mdash;I\u0026rsquo;m in awe of them.\"\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003e6.Recommendations \u003c/h3\u003e\n\u003cp\u003eParticipants provided several recommendations to improve infant oral health education and practice:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I\u0026rsquo;d be interested in CPD training, but it would need to be funded by the practice. That\u0026rsquo;s why hospital-based DN tend to have more CPD than those in private practice\u0026mdash;it\u0026rsquo;s covered for them.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003eOther suggestions included increased clinical exposure to infants.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Clinical exposure to infants during undergraduate training would be extremely beneficial.\"\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\n\u003ch3\u003e1.Training and Educational Gaps in Infant Oral Health\u003c/h3\u003e\n\u003cp\u003eThe variation in responses among those with theoretical training, both theoretical and clinical training, or no training at all highlights inconsistencies in educational preparation. DH were more likely to receive theory-only training, while RDN had more comprehensive clinical and theoretical training. Notably, those trained in both modalities were significantly more likely to treat infants than those with theory-only training.\u003c/p\u003e\u003cp\u003eThe discrepancy in perceived job preparedness underscores the need to address gaps in formal education. This study aligns with prior research indicating that education enhances confidence; for example, a cross-sectional study (Calhoun et al. \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) found that higher education levels predict DHs\u0026rsquo; likelihood of providing anticipatory guidance to parents.\u003c/p\u003e\n\u003ch3\u003e2. Clinical Exposure and Frequency of Infant Visits\u003c/h3\u003e\n\u003cp\u003eThe study found significant differences in clinical exposure, with RDNs seeing more infant patients than DH. Infant visit frequency also varied, with few DH seeing one child per week. Those working more than 31 hours per week were more likely to treat children than those working only 10 hours per week \u003cem\u003e(Table\u0026nbsp;2).\u003c/em\u003e Frequent exposure correlated with increased confidence in educating parents.\u003c/p\u003e\u003cp\u003ePractice setting also influenced patient demographics. DH and DN in public practice treated more infants than those in private practice, aligning with research showing public services handle most paediatric dental care due to limited private options (Auld \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The disparity between public and private practice highlights the need for standardized formal teaching on infant oral health.\u003c/p\u003e\n\u003ch3\u003e3. Routine Practices in Infant Oral Health Visits\u003c/h3\u003e\n\u003cp\u003eThis study underscores the complementary roles of DH and DN in infant oral health, particularly in parent education and preventive care to support the dentist\u0026rsquo;s role. As poor oral hygiene is a significant risk factor for ECC (Kirthiga et al. \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), parental education on prevention is critical.\u003c/p\u003e\u003cp\u003eHowever, fluoride varnish application\u0026mdash;a critical preventive measure\u0026mdash;remains underutilized. This aligns with previous studies (Djokic et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Manski and Parker \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) reporting inconsistent fluoride varnish application rates.\u003c/p\u003e\u003cp\u003eThis study also revealed significant variations in knowledge and consistency related to routine dental practices. This aligns with previous research which examined the consistency of caries prevention recommendations and found that while two-thirds of professionals prioritized oral hygiene education, only 18% emphasized dietary advice (L\u0026oslash;ken et al. \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003e4. Barriers to Providing Infant Oral Healthcare\u003c/h3\u003e\n\u003cp\u003eThe primary barrier to infant oral healthcare identified was the lack of parental initiative in requesting appointments, often due to a lack of awareness, concern, or even embarrassment. This aligns with a recent Irish study in which 41% of non-paediatric dentists identified parental unawareness as a major obstacle (Djokic et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e Most parents rely on HSE referrals unless there is an emergency, mirroring a systematic review showing infants are usually seen only for problems, not prevention (Bhaskar et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis is underscored in a recent Irish study (Duane et al. \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) that found while the HSE provides dental services up to age 16, non-emergency cases often experience delays. Routine school referrals typically occur between ages 6 and 8 so often infants are not seen until then.\u003c/p\u003e\u003cp\u003eOther less frequently cited barriers; such as financial constraints also align with previous research, as well as uncertainty about what to expect or do at a 12-month dental visit (Schroth et al. \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Ruiz et al. \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003e5. Beliefs About the Ideal Age for a First Dental Visit\u003c/h3\u003e\n\u003cp\u003e The variation in recommended ages for a child\u0026rsquo;s first dental visit highlights inconsistencies in professional knowledge and adherence to guidelines, emphasizing the need for clearer recommendations. This study found significant differences in beliefs about the ideal timing. International research indicates that while DH often prioritize topics like diet and pacifier use, fewer (48%) emphasize the importance of a 12-month visit (Calhoun et al. \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFindings from this study indicate this discrepancy may be influenced by experience levels, as findings indicate that graduation year was linked to knowledge, with those graduating between 1990 and 1999 more likely to recommend early visits. Findings of this study attribute this to extensive clinical expertise and advanced standing. This aligns with studies showing that greater experience correlates with higher knowledge scores( Alrowaili \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Manski and Parker \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e Respondents also noted inconsistencies in professional guidelines, reinforcing the need for improved quality guidelines (Verdugo-Paiva et al. \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This is reinforced in the literature with another study noting that online sources do not always align with professional advice (Bhaskar et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003e6.Recommendations\u003c/h3\u003e\n\u003cp\u003eThis study highlights the need for enhanced knowledge among DH and DN research. This study found that additional education through dental curricula and continuing education would be well received, consistent with prior research which found that approximately 90% of DH would be interested in CPD (Manski and Parker \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Clovis et al. \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Another recommendation was for NRDN to complete a short foundational course before starting work as a DN to ensure they acquire essential knowledge.\u003c/p\u003e\u003cp\u003eFurthermore, incorporating practical training in infant oral health into undergraduate curricula could better prepare future professionals. This importance of obtaining both theory and clinical training is highlighted in the literature (Ruiz et al. \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eLimitations\u003c/p\u003e\u003cp\u003eThis study has several limitations, primarily stemming from biases associated with self-reported data, including self-selection and recall bias, which may affect the reliability of findings. Response bias may have occurred due to non-participation, potentially leading to an overrepresentation of certain perspectives. Additionally, the use of convenience sampling limits the generalisability of results. Time constraints further posed a challenge to data collection due to the delay in the ethics form approval.\u003c/p\u003e\u003cp\u003eThe web-based survey also faced obstacles, such as reluctance from DH associations to distribute the link, technical difficulties, and some respondents lacking the necessary technical skills.\u003c/p\u003e\u003cp\u003eFurthermore, there was a lack of clarity associated with some survey questions. Question 7 on undergraduate training may have led to overreporting, as NRDN likely had no formal training. Also participants may have overreported treatments they provide, particularly procedures like tongue-tie releases and emergency exams, which fall outside the scope of practice for dental nurses and hygienists as per Irish Dental Council guidelines.\u003c/p\u003e\u003cp\u003eAmbiguities in terminology, such as the definition of \u0026ldquo;children\u0026rdquo; (0\u0026ndash;36 months) and distinctions between age categories (e.g.,0\u0026ndash;12 months vs. 1 year), also contributed to confusion. Additionally, multiple-choice questions (Q10 and Q11) made it challenging to categorize responses accurately.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights critical gaps in the knowledge and behaviours of DH and DN regarding infant oral health visits in Ireland. The willingness of these professionals to see paediatric patients was significantly influenced by their practice setting, training modality, and professional role. Notably, those who received both theoretical and clinical training exhibited greater confidence and engagement, underscoring the importance of a structured curriculum that includes hands-on experience.\u003c/p\u003e\u003cp\u003eFindings also revealed that public-sector DN were more engaged with young patients than their private-sector counterparts, emphasizing the need for standardized training across all settings. Barriers such as low parental awareness further hinder early dental visits, reinforcing the necessity of targeted public education and improved dissemination of clinical guidelines. Despite efforts in parental education, preventive measures like fluoride varnish remain underutilized, highlighting inconsistencies in guideline adherence.\u003c/p\u003e\u003cp\u003e The absence of consensus on the recommended age for a first dental visit further underscores the need for clearer, standardized guidelines. Expanding access and funding for CPD courses would enhance professional development and strengthen infant oral health services. Addressing knowledge gaps and increasing clinical exposure for DH and DN will contribute to a paradigm shift in infant oral healthcare, ultimately improving long-term outcomes. Standardized, evidence-based interventions are essential to ensure timely and equitable care for all infants, reaffirming the crucial role of oral health professionals in early prevention.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eM.B. wrote the manuscript and conducted the data analysis. All authors contributed to data collection and read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlrowaili EF. Self-reported knowledge about dental caries at young age and variations between dental practitioners in the Ministry of Health in Bahrain. \u003cem\u003eBDJ Open\u003c/em\u003e. 2021; 7: 18. \u003c/li\u003e\n\u003cli\u003eAuld D. Is there a need for private paediatric dentistry in the UK? \u003cem\u003eBDJ In Pract\u003c/em\u003e 2023; 36: 12-13. \u003c/li\u003e\n\u003cli\u003eBhaskar V, McGraw KA, Divaris K. The importance of preventive dental visits from a young age: systematic review and current perspectives. \u003cem\u003eClin Cosmet Investig Dent\u003c/em\u003e 2014; 6: 21-27. \u003c/li\u003e\n\u003cli\u003eCalhoun ME, Smilyanski I, Boyd LD, Vineyard J. Dental Hygienists\u0026rsquo; Intentions to Provide Anticipatory Guidance Recommendations: Application of the Theory of Planned Behavior\u003cem\u003e. The Internet Journal of Allied Health Sciences and Practice\u003c/em\u003e. 2023 Jun 29;21(3), Article 10. \u003c/li\u003e\n\u003cli\u003eCanadian Dental Association. First dental visit. 2025. Online information available at https://www.cda-adc.ca/en/oral_health/cfyt/dental_care_children/first_visit.asp (accessed January 2025).\u003c/li\u003e\n\u003cli\u003eClovis JB, Horowitz AM, Kleinman DV, Wang MQ, Massey M. Maryland dental hygienists\u0026apos; knowledge, opinions and practices regarding dental caries prevention and early detection\u003cem\u003e. J Dent Hyg 2012\u003c/em\u003e; 86(4): 292-305.\u003c/li\u003e\n\u003cli\u003eDental Council of Ireland. Scope of practice for each member of the dental team.2022. Online information available at https://www.dentalcouncil.ie/patient-information/scope-of-practice-for-each-member-of-the-dental-team (accessed January 2025).\u003c/li\u003e\n\u003cli\u003eDjokic J, Bowen A, Singh Dooa J, et al. Knowledge, attitudes, and behaviour regarding the infant oral health visit: are dentists in Ireland aware of the recommendation for a first visit to the dentist by age 1 year? \u003cem\u003eEur Arch Paediatr Dent\u003c/em\u003e. 2018; 19: 365-371. \u003c/li\u003e\n\u003cli\u003eDuane B, FitzGerald K, McGovern E, N\u0026iacute; Chaolla\u0026iacute; A. First tooth, first visit, zero cavities: a review of the evidence as it applies to Ireland. \u003cem\u003eJ Ir Dent Assoc\u003c/em\u003e. 2017; 63(2): 105\u0026ndash;11.\u003c/li\u003e\n\u003cli\u003eDuque C, Chrisostomo DA, Souza ACA, et al. Understanding the predictive potential of the oral microbiome in the development and progression of early childhood caries. \u003cem\u003eJ Dent Res.\u003c/em\u003e 2022; 101(12): 1390-1397.\u003c/li\u003e\n\u003cli\u003eFDI World Dental Federation. FDI policy statement on perinatal and infant oral health. \u003cem\u003eInt Dent J 2020\u003c/em\u003e; 64(6): 287-288.\u003c/li\u003e\n\u003cli\u003eFrancisco EM, Johnson TL, Freudenthal JJ, Louis G. Dental hygienists\u0026apos; knowledge, attitudes and practice behaviors regarding caries risk assessment and management. \u003cem\u003eJ Dent Hyg\u003c/em\u003e 2013;87(6).\u003c/li\u003e\n\u003cli\u003eGarcia R I, Sohn W. The paradigm shift to prevention and its relationship to dental education. \u003cem\u003eJ Dent Educ\u003c/em\u003e. 2012 Jan;76(1):36-45.\u003c/li\u003e\n\u003cli\u003eGussy, M., Ashbolt, R., Carpenter, L., Virgo-Milton, M., Calache, H., Dashper, S., et al. Natural history of dental caries in very young Australian children. \u003cem\u003eInt J Paediatr Dent\u003c/em\u003e 2016; 26 (3): 173-183.\u003c/li\u003e\n\u003cli\u003eKirthiga M, Murugan M, Saikia A, Kirubakaran R. Risk factors for caries: A systematic review and meta-analysis of case control and cohort studies. \u003cem\u003ePediatr Dent.\u003c/em\u003e 2019;41(2):95-106.E18-E23.\u003c/li\u003e\n\u003cli\u003eLin T-H, Hsieh T-Y, Horowitz AM, Chen K-K, Lin S-S, Lai Y-J, Hsiao F-Y, Chang C-S. Knowledge and practices of caries prevention among Taiwanese dentists attending a national conference. \u003cem\u003eJ Dent Sci\u003c/em\u003e 2010;5(4):229-236.\u003c/li\u003e\n\u003cli\u003eL\u0026oslash;ken S, Wang N, Wigen T. Caries-preventive self-care for children. Consistent oral health messages to the public? \u003cem\u003eInt J Dent Hyg\u003c/em\u003e 2016;15(2):142-148\u003c/li\u003e\n\u003cli\u003eManski MC, Parker ME. Early childhood caries: Knowledge, attitudes, and practice behaviours of Maryland dental hygienists.\u003cem\u003e J Dent Hyg\u003c/em\u003e. 2010;84(4):6.\u003c/li\u003e\n\u003cli\u003eRuiz V R, Quinonez R B, Wilder R S, Phillips C. Infant and toddler oral health: attitudes and practice behaviors of North Carolina dental hygienists. \u003cem\u003eJ Dent Educ\u003c/em\u003e 2014; 78: 146-156.\u003c/li\u003e\n\u003cli\u003eSaccomanno S, De Luca M, Saran S, Petricca MT, Caramaschi E, Mastrapasqua RF, Messina G, Gallusi G. The importance of promoting oral health in schools: a pilot study. \u003cem\u003eEur J Transl Myol\u003c/em\u003e 2023;33(1):11158.\u003c/li\u003e\n\u003cli\u003eSchroth RJ, Qui\u0026ntilde;onez RB, Yaffe AB, Bertone MF, Hardwick FK, Harrison RL. WHAT ARE CANADIAN DENTAL PROFESSIONAL STUDENTS TAUGHT ABOUT INFANT, TODDLER AND PRENATAL ORAL HEALTH. \u003cem\u003eJ Can Dent Assoc. \u003c/em\u003e2015;81:f15. \u003c/li\u003e\n\u003cli\u003eVerdugo-Paiva F, Rojas-G\u0026oacute;mez AM, Wielandt V, Pe\u0026ntilde;a J, Silva-Ruz I, Novillo F, \u0026Aacute;vila-Oliver C, Bonfill-Cosp X, Glick M, Carrasco-Labra A. Evidence-informed guidelines in oral health: insights from a systematic survey. \u003cem\u003eBMC Oral Health\u003c/em\u003e 2024; 24: 746.\u003c/li\u003e\n\u003cli\u003eWeber-Gasparoni K. Examination, Diagnosis, and Treatment Planning of the Infant and Toddler. \u003cem\u003ePediatr Dent\u003c/em\u003e 2019; 200-215.e1.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. First global conference on health promotion.2025.Online information available at https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference (accessed January 2025).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-archives-of-paediatric-dentistry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EAPD","sideBox":"Learn more about [European Archives of Paediatric Dentistry](https://link.springer.com/journal/40368)","snPcode":"40368","submissionUrl":"https://submission.springernature.com/new-submission/40368/3","title":"European Archives of Paediatric Dentistry","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7253855/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7253855/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAims\u003c/h2\u003e\u003cp\u003eTo explore the knowledge and behaviours regarding the infant oral health visit among dental nurses(DN) including registered(RDN) and non-registered(NRDN) and dental hygienists(DH) in Ireland.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis cross-sectional, mixed-methods study assessed the knowledge and behaviours of Irish DN and DH knowledge and behaviours regarding infant oral health visits. Quantitative survey data was analysed using SPSS, while qualitative focus group discussion was thematically analysed to explore barriers and practices in early oral health promotion.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe overall response rate was 38% (122 respondents). Results indicate that parental education was the most common procedure performed (22.3%) and fluoride interventions were least commonly performed. Lack of parental requests (32.5%) was identified as the primary barrier. RDN were significantly more likely to treat paediatric patients (74.5%) than DH (40%). Those receiving both theoretical and clinical training were significantly more likely to provide care to infants (78.9%). Public DN and DH treated significantly more children (89.7%) than private (44.2%). Older graduates (1960\u0026ndash;1979) were more aware of the recommended first dental visit (83.3%).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis study highlights significant gaps in the knowledge and behaviours of DH and DN regarding infant oral health in Ireland, with inconsistencies in education, limited clinical exposure, and low parental awareness serving as key barriers. Variability in training and practice settings, particularly the greater involvement of public-sector DN in infant care, underscores disparities in service delivery. Additionally, inconsistent fluoride varnish application and a lack of consensus on the ideal age for a first dental visit further hinder early preventive care. Addressing these challenges through evidence-based education for DN and DH will ensure equitable access to preventive care for all infants.\u003c/p\u003e","manuscriptTitle":"Knowledge and behaviours regarding the infant oral health visit among dental nurses and dental hygienists in Ireland","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-19 13:46:51","doi":"10.21203/rs.3.rs-7253855/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-22T12:49:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-24T22:20:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"185550617783295847003469307050258793193","date":"2025-08-11T17:52:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-11T16:53:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-31T06:18:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-31T06:17:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Archives of Paediatric Dentistry","date":"2025-07-30T14:07:13+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-archives-of-paediatric-dentistry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EAPD","sideBox":"Learn more about [European Archives of Paediatric Dentistry](https://link.springer.com/journal/40368)","snPcode":"40368","submissionUrl":"https://submission.springernature.com/new-submission/40368/3","title":"European Archives of Paediatric Dentistry","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"25037e9e-5c7c-48ba-9f12-9916b7dfb837","owner":[],"postedDate":"August 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-07T11:24:05+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-19 13:46:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7253855","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7253855","identity":"rs-7253855","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}