One of the key factors leading to this high rate of dental decay is inadequate toothbrushing.

There is a lot of evidence demonstrating that regular toothbrushing results in lower rates of caries yet research indicates that only 27 per cent of Australian school children, 39 per cent of preschool children and 58 per cent of infants have their teeth brushed daily.

MORE FROM MARGARET SIMS:

The Australian Dental Association recommends tooth brushing from the appearance of an infant's first tooth. Parental supervision of toothbrushing is recommended until at least eight years of age.

Using fluoride toothpaste is recommended as important in preventing dental caries. Fluoride toothpaste helps create fluorapatite crystals which promote enamel remineralisation.

Along with this is a low sugar diet, water fluoridation and regular check-ups at the dentists. In Australia, children living in rural and remote areas have a 38 per cent higher rate of dental caries than children living in metropolitan areas.

Part of the reason for this is lack of fluoridation in the water supplies, socio-economic status, a shortage of dental workers and difficulties in accessing dental treatments.

Research also suggests that regular toothbrushing is more likely when families establish a routine. Family routines are better established in stable, well functioning families. Parental knowledge also impacts on the establishment of toothbrushing routines.

A recent study reported that over half the parents involved reported they had difficulties in managing child resistance behaviours around toothbrushing. Lack of time in the mornings made this a particularly difficult time for supervising toothbrushing. Children who were normally reasonably compliant were found to demonstrate resistance to toothbrushing and this behaviour really challenged parents who were trying to establish good dental hygiene.

A recent study indicated that children were more likely to brush their teeth twice a day when their parents had a positive attitude towards water fluoridation. Children in sole parent families were less likely to brush twice a day as were children with higher levels of chocolate consumption. Children whose mothers had had a tooth removed or who had poor dental health were also less likely to brush their teeth twice a day. Families with dental health insurance were more likely to have their children brush teeth twice daily.

Despite the importance of establishing good dental hygiene habits early, there is little research that demonstrates effective parental support programmes aimed at achieving this. Many studies focus on improving knowledge of dental health, and enhancing toothbrushing skills often through demonstration of appropriate brushing techniques.

One study used a Smartphone app and other a storybook for parents and children to use together.

These studies generally demonstrated improved toothbrushing frequency and effectiveness but in terms of research rigour there remained many questions around the intensity of intervention needed, and the desire of parents to provide researchers with socially acceptable responses.

It seems we have a lot yet to learn about how to best support our parents to teach their children appropriate dental hygiene practices.