title: The use of diet diaries in clinical dentistry
Creators: name: Arheiam, A
Publisher: name: University of Liverpool Repository
Year: 2017

description: Background: Recently, there has been renewed interest in the importance of reducing sugar intake to control dental caries both in the UK and internationally. Although diet advice to promote oral as well as general health is recommended for all dental patients, those at high risk of dental caries are particularly in need of additional professional support tailored to their needs. For this reason, diet diaries have been recommended as a dietary assessment tool that enables the tailoring of effective dietary advice for individual patients in dental practice (Watt et al., 2003). However, despite the recognised merits of diet diaries as dietary assessment and self-monitoring tools in the general literature (Thompson and Subar, 2013), an early search of literature revealed that very little empirical work had been devoted to this topic in the dental context. The overall aim of this research is to explore the use of diet diaries in the dental clinical setting. It offers some important insights into the possible barriers and facilitators of their use to support dietary advice. Methods Four studies were undertaken to meet the general aim and the objectives of the thesis. A range of qualitative and quantitative research methods were used. Dentists’ current practices and perceived influences of diet diaries usage in dental practice were investigated using a postal questionnaire survey to general dental practitioners (GDPs) (Study I). A case-vignette based on a diet diary was incorporated into this questionnaire to deepen understanding about how dentists interpret and use diet diaries to formulate dietary advice (Study II). A retrospective study was carried out to estimate the return rate of diet diaries and its associated factors among paediatric dental patients in a teaching dental hospital (Study III) - a different setting where dental remuneration is less of an issue. Finally, a qualitative case study was conducted to investigate factors associated with patients’ adherence to diet diaries issued to paediatric dental patients in a teaching dental hospital setting (Study IV). Findings Study I found that the majority of English GDPs did not use diet diaries to collect diet information (62%), mainly because of constraints related to finance and time. Other barriers identified were poor patient compliance and a perceived lack of necessary skill relating to dietary counselling. Diet diaries were more likely to be used in children than in adults, and for patients with high levels of caries. Study II demonstrated that GDPs rely upon a strategy of intelligent selection to filter complex dietary information in order to generate dietary advice. Challenged with a large field of information, they select what they see as a subset of either the most useful or the easiest information for patients to understand and implement. Study III found that the return rate of diet diaries by children and their families in a dental hospital setting was low (34%). Return rate was associated with patients’ demographic and oral health maintenance habits. Content analysis of returned diet diaries showed that diet diaries did not consistently capture the full range of complexities of dietary aspects relevant to oral health. Information on sugar amount, consumption context, sequence of intake within meals, prolonged contact with teeth and sugars consumed near bedtime – all were partially or completely missing from the returned diaries. Study IV concluded that adherence to diet diaries is a multi-contextual phenomenon associated with interacting factors which are generally related to the patient (parent/child), the dentist and the diet diary itself. Conclusions Diet diaries were not frequently used by dental practitioners, nor were they frequently returned or adequately completed by patients and their families. The use of diet diaries as a dietary assessment and monitoring tool is complicated by many factors related to the dentist, patients and the diet diaries itself. Therefore, multifaceted interventions targeted at patients, providers and the healthcare system are required if the use of diet diaries is to be enhanced. A motivated patient, a time-efficient tool as well as appropriate support from health care system appear to be necessary for the successful use of diet diaries.