“Addressing Childhood Obesity in the Dental

Office: Examining the Parental Acceptance of
a Wellness Report Card”




















Kathryn Hawn
UCLA Department of Pediatric Dentistry

BACKGROUND
The number of children affected by obesity has risen substantially in the past
few decades. According to 2007-08 NHANES (National Health and Nutrition
Examination Survey) data, approximately 32% of U.S. children and
adolescents 2-19 years of age are classified as overweight (>85
th
BMI
percentile), and approximately 17% are obese (>95
th
BMI percentile).
i
In
industrialized countries like the US, children from lower socioeconomic
groups are at increased risk for obesity.
ii

There are also disparities amongst different racial groups and ethnicities. For
example, according to the 2007-08 NHANES data, Hispanic boys were 1.6
times more likely to be overweight and 1.80 times more likely to be obese
than non-Hispanic white boys.
Error! Bookmark not defined.
Similarly, non-Hispanic
black girls were 1.58 times more likely to be overweight and 1.7 times more
likely to be obese than non-Hispanic white girls.
Error! Bookmark not defined.
The
trends in childhood obesity are especially alarming when the health risks of
childhood obesity are considered.
A serious public health threat, obesity puts children at increased risk for a
multitude of medical conditions including obstructive sleep apnea, asthma,
obesity-linked hypoventilation syndrome, hypertension, insulin resistance,
type 2 diabetes, dyslipidemia, non-alcoholic fatty liver disease, and
menstruation abnormalities.
Error! Bookmark not defined.
Furthermore, obese children
are 2 to 6.5 times more likely to be obese in adulthood.
iii
Along with these
medical conditions linked to childhood obesity, adult obesity carries increased
risk for coronary heart disease, stroke, gallbladder disease, arthritis, and
cancer.
iv
In the US, adult obesity is responsible for approximately 112,000
deaths annually.
v

Mirroring the physical health risks, obese children may also face mental
health problems and impaired socialization. Social stigma often begins early
in life, with children assigning negative characteristics such as laziness,
meanness, or dirtiness to their obese peers.
Error! Bookmark not defined.
This stigma
continues to impact obese young adults, who may face discrimination in
renting apartments or applying to college.
Error! Bookmark not defined.
In adulthood,
obesity has been linked to lower levels of education and income.
Error! Bookmark
not defined.
Associations between obesity and mental health conditions have been
difficult to establish, presumably because many factors impact an individual’s
body satisfaction, self esteem, levels of anxiety, and propensity toward
depression. At the same time, the perception of overweight and obesity often
differs depending upon the child’s gender and ethnicity.
Error! Bookmark not defined.

Considering the complexity of mental health, it is not surprising that some
studies demonstrate associations between obesity and depression or anxiety,
while others show no association.
Error! Bookmark not defined.

Beyond the toll on children’s health, the economic burden is substantial.
Hospital costs related to childhood obesity from 1997-99 were $127 million,
accounting for approximately 1.7% of total US hospital costs.
vi
These costs
have more than tripled when compared to hospital cost estimates taken just
two decades from 1979-81.
Error! Bookmark not defined.
Moreover, the cost of adult
obesity is staggering, estimated by the World Health Organization in 1990 to
account directly for approximately $458,000 million in the US, or 6.8% of
total US health costs.
Error! Bookmark not defined.
In a more recent study from the
Centers for Disease Control and Prevention (CDC) and the Research Triangle
Institute, the annual US cost of obesity had reached as high as $147 billion in
2008, accounting for 9.1% of total US health costs.
vii
This enormous rate of
increase in spending will be difficult to sustain and has the potential to
exacerbate the already-out-of-control national health budget.
This past year the Surgeon General encouraged all healthcare providers to
recognize and treat obesity during routine visits.
viii
As an integral part of the
healthcare team, dentists can and should play a role in screening, dietary
counseling, and referrals for childhood obesity.
ix,x,xi
Based on findings from
the 2000-2002 Medical Expenditure Panel Survey (MEPS), children ages 6-12
visit their physician for well-child examinations approximately 0.44 times
each year.
xii
According to the 2003 MEPS, children ages 2-11 who had at least
one dental visit in 2003 averaged 2.0 dental visits annually.
xiii
As a result,
among school-aged children with an established dental home, their dentist
may be the first healthcare provider to detect overweight and obesity.
In addition to positively influencing the overall health of their patients,
screening for childhood overweight and obesity provides dentists an
opportunity for more effective caries prevention and dental treatment. In a
recent review of the topic, Bimstein and Katz underscored that many of the
risk factors for obesity are the same risk factors for caries.
Error! Bookmark not
defined.
Examples include frequent sugar exposures, frequent snacking, soda
consumption, juice consumption, and low socioecomonic status. While studies
linking caries and obesity have mixed results, reducing risk for childhood
obesity and reducing risk for caries involves many of the same behavior
modifications.
In addition to the potential link with caries, studies show that obesity also
impacts dental development.
xiv
For example, patients who are overweight or
obese often present with an accelerated dental age.
Error! Bookmark not defined.
This
is particularly critical for early orthodontic interventions, such as serial
extractions, which need to occur earlier for a patient with a higher BMI.
Error!
Bookmark not defined.
Therefore, tracking a patient’s BMI provides additional
information to gauge the appropriate time for referral to an orthodontist.
Error!
Bookmark not defined.

An important sometimes overlooked issue relates to the fact that obesity can
reduce the safety and efficacy of sedation in the dental office.
Error! Bookmark not
defined.,xv
Obese patients may be overdosed if dentists use the maximum dosage
for their weight.
Error! Bookmark not defined.
While it is advisable to reduce the
maximum dosage to accommodate for an obese patient, this may result in a
less effective sedation.
Error! Bookmark not defined.
Furthermore, when sedated for
dental procedures, obese patients face increased risk of respiratory
complications, hypertension, gastric regurgitation, and aspiration
pneumonia.
Error! Bookmark not defined.
Respiration is further compromised by the
use of opioids or chloral hydrate, so extra care is needed when selecting oral
sedative drugs.
Error! Bookmark not defined.
By screening for childhood overweight
and obesity, dentists will be aware of these factors prior to planning for
sedation.
To detect childhood overweight and obesity, dentists must effectively screen
for it. Methods used to identify overweight and obesity in children include
skinfold thickness measurements, waist circumference percentiles, and BMI
percentiles.
xvi
Because of the ease of collection, acceptable sensitivity,
specificity, and accuracy, BMI percentiles are the most commonly used metric
to determine weight status in childhood.
Error! Bookmark not defined.
Children are
accustomed to having their height and weight measured when visiting their
physician, and the BMI (kg/m
2
) is easily calculated from these measurements.
To make the BMI calculation convenient and easy, the CDC provides an
online calculator at http://apps.nccd.cdc.gov/dnpabmi/Calculator.aspx.
xvii
This
online link also determines the BMI percentile, using CDC BMI-for-age
growth charts, which account for age and sex.
Error! Bookmark not defined.
If
computer access is not readily available in the dental office, SmartPhone
applications can also provide this service.
After obtaining the BMI percentile, children can be classified as either
underweight, normal weight, overweight, or obese. A normal weight is
considered to be between the 5
th
percentile and the 84
th
percentiles.
xviii

Childhood underweight is defined as a BMI less than the 5
th
percentile.
Error!
Bookmark not defined.
Overweight is defined as a BMI at or above the 85
th

percentile, and childhood obesity is defined as a BMI at or above the 95
th

percentile.
Error! Bookmark not defined.,xix

Recently Tseng et al. suggested guidelines for overweight and obesity
screening, subsequent treatment, and referral.
Error! Bookmark not defined.
These
involve determining the BMI and BMI percentile at least annually for all
pediatric patients ages 2 and older.
Error! Bookmark not defined.
Findings are
explained to parents, which may easily provide an opening for obesity-related
dietary counseling, should the dental practitioner feel confident in its
provision.
Error! Bookmark not defined.
Based on the BMI percentile,
recommendations are then made to the patient and his or her parents. For
patients at a healthy weight (BMI >5÷84°), dentists should provide positive
reinforcement, as well as guidance and encouragement to continue
maintaining a healthy weight.
Error! Bookmark not defined.
For both underweight
patients (BMI <5%) and overweight patients (BMI >85÷94°), a referral
should be made to a pediatrician or family physician.
Error! Bookmark not defined.

For the obese children (BMI >95°), a referral to a pediatrician or family
physician is necessary, and referral to a registered dietitian (RD) should also
be considered.
Error! Bookmark not defined.

In a recent pilot study
xx
, two community dental clinics adopted a protocol
similar to the guidelines advocated by Tseng et al.
Error! Bookmark not defined.
In
addition, the protocol called for individualized report cards and
recommendations for each patient.
Error! Bookmark not defined.
The dental hygienists
involved in the study found that the protocol was feasible, not a burden to the
providers, and acceptable to both patients and parents.
Error! Bookmark not defined.
As one dimension of this pilot study, a parent survey was distributed. Of
parents participating in the study, 59% believed that the dental office was a
good place to record their child’s weight and height measurements, and 65%
of parents believed that the report card program helped them to make healthy
changes.
Error! Bookmark not defined.

The aforementioned pilot study did not report the race and ethnicity of the
study participants, which may affect parental attitudes toward obesity-related
dietary counseling. In Nevada, a survey was administered to overweight
preschool children and their mothers, who were participants in a Nevada
Special Supplemental Nutritional Program for Women, Infants, and Children
(WIC).
xxi
Nearly 90% of the study participants were Hispanic. 61.5% of
mothers did not perceive their child as overweight, and 50% had not
attempted to control their child’s diet because they perceived no problem with
the current weight.
Error! Bookmark not defined.
The findings of this study suggest
that Hispanic mothers may be less likely to perceive overweight as a problem,
and thus may be less accepting of obesity interventions, including such
programs in the dental office setting.
In addition to parental receptiveness, the attitudes of dentists toward obesity-
related dietary counseling must also be considered. In a recent survey of
pediatric dentists in North Carolina, all respondents believed overweight to be
a health problem and 84% felt that obesity-related dietary counseling in the
dental office would benefit patients.
xxii
Even so, less than 25% provided
obesity-related dietary counseling in their offices and 81% had never referred
a child to another healthcare provider for weight management.
Error! Bookmark not
defined.
Two-thirds of respondents did not obtain weight measurements
routinely and only 6% of respondents routinely obtained height
measurements.
Error! Bookmark not defined.
Respondents who received general
nutrition training during residency were more likely to offer obesity-related
dietary counseling.
Error! Bookmark not defined.
Other characteristics that increased
the likelihood of respondents’ providing counseling included knowledge,
confidence in providing counseling, increased practice experience (more than
ten years), and respondents’ gender (female).
Error! Bookmark not defined.

Respondents cited lack of trained staff (60%) and lack of knowledge (47%) as
barriers to implementing obesity-related dietary counseling in their
practices.
Error! Bookmark not defined.
In a more recent 2010 study of nearly 3000 dentists across the US, only 4.8%
of dentists were currently providing obesity-related screening or counseling in
their practices, but 50.5% were interested in doing so.
xxiii
The barriers cited for
not currently providing these services included fear of offending parents or
patients (53.8%), fear of appearing judgmental of parents or patients (52%),

lack of trained staff (46.3%), and a patient population not accepting of
obesity-related interventions provided by a dentist (45.7%). In this study,
pediatric dentists were more likely to note fear or offending patients or parents
and fear of appearing judgmental than general dentists.
Without a user-friendly practice-ready protocol, dentists may feel that
attempting to implement their own obesity-related dietary counseling would
be cumbersome, beyond their knowledge base, beyond their comfort level,
potentially offensive to parents or patients, and possibly detrimental to
practice productivity. In contrast, when given a protocol in a pilot study,
dental practitioners were able to incorporate it successfully into hygiene
appointments.
Error! Bookmark not defined.
Therefore, a potential way to empower
private dental practitioners to screen for childhood overweight and obesity
would be the availability of an easy, efficient, and effective screening tool or
instrument.



MATERIALS AND METHODS

Two sites participated in the study, the Children’s Dental Center in Los
Angeles, California and the Fort Bend Family Health Care Center in
Stafford, Texas. Subjects were recruited from patients ages 2-14
presenting for oral health maintenance visits at these clinics from May
2012 through July 2012. All children who obtained parental consent
received a Wellness Report Card, available in English or Spanish (WRC –
see Appendix). Children whose parents consented to participate in the
study received the same treatment (dental exam, radiographs as needed,
dental prophylaxis, and fluoride treatment) as children whose parents
decline to participate in the study.

During the dental appointment, children had their height and weight
recorded. Next, the BMI and BMI percentile were calculated using a
Smartphone application. The WRC was then be filled out using this
information and the information from the patient’s clinical exam. A brief
explanation of the data was provided, and questions from the parents
were addressed, provided the questions were within the scope of a dental
practitioner. For more complex questions, parents were encouraged to
ask their physician.

Following the receipt of the WRCs, to gauge their attitude toward the
WRC program, parents of subjects participating in the study completed a
short anonymous survey (see Appendix), available in English or Spanish.
This survey was adapted from a similar investigation by Tavares et al.
20

To maintain anonymity thereby encouraging honest feedback, parents
folded their surveys and placed them in a designated box.











RESULTS

30 surveys were collected from the California site, and 20 were collected from the
Texas site. Of the study participants, 31 of the parents were English-speaking
parents and 19 of the parents were Spanish-speaking. Due to an unfortunate
mistranslation on the Spanish version of the survey, only question number 9 could
be compared between the English-speaking parents and the Spanish-speaking
parents. Analysis of questions 1 through 8 will be presented using only the English-
speaking surveys.

Question 2 in the survey was designed to determine whether parents viewed the
WRC as too lengthy or inconvenient. Overall, parents strongly disagreed that
receiving a WRC made the child’s visit take too long (median 1 out of 5). As Figure 2
shows, 58% strongly disagreed (score 1 out of 5), 25.8% disagreed (score 2 out of 5),
6.5% were neutral (3 out of 5) and 9.7% agreed (score 4 out of 5). None of the
parents strongly agreed (score 5 out of 5) that it made their child’s visit take too
long.

Questions 3, 4, and 5 were asked to determine the child’s level of comfort with the
WRC process. As figure 3 demonstrates, 76.7% of parents strongly agreed (scored 5
out of 5) that their child was comfortable having their height and weight measured
at the dental office, 20% agreed (scored 4 out of 5). 3.3% disagreed (scored 2 out of
5). None of the parents were neutral or strongly disagreed.

As noted in Figure 4, 83.9% of parents strongly agreed (scored 5 out of 5) that their
child was comfortable getting his or her weight and BMI results at the dental office,
12.9% agreed (scored 4 out of 5), and 3.2% felt neutral (scored 3 out of 5). None of
the parents disagreed or strongly disagreed that their child was comfortable getting
his or her weight and BMI results at the dental office.

Question 5 received the same response as Question 4, as evidenced by Figures 4 and
5. 83.9% of parents strongly agreed (scored 5 out of 5) that their child was
comfortable having their WRC completed at the dental office, 12.9% agreed (scored
4 out of 5), and 3.2% felt neutral (scored 3 out of 5). None of the parents disagreed
or strongly disagreed that their child was comfortable having their WRC completed
at the dental office.

Questions 6 and 7 addressed whether parents felt that the dental office was a good
place to conduct obesity screening. As figure 6 shows, 80.6% of parents strongly
agreed (scored 5 out of 5) that the dental office is a good place to get their child’s
height and weight measured, 12.9% agreed (scored 4 out of 5), and 6.5% were
neutral (scored 3 out of 5). None of the parents disagreed or strongly disagreed that
the dental office was a good place to get their child’s height and weight measured.

As figure 7 demonstrates, 61.3% of parents strongly agreed (scored 5 out of 5) that
the dental office is a good place to receive and discuss their child’s weight and BMI
status. 61.3%, 19.4% agreed (scored 4 out of 5), and 19.4% felt neutral (scored 3 out
of 5). None of the parents disagreed or strongly disagreed that the dental office was
a good place to receive and discuss their child’s weight and BMI status.

Questions 1 and 8 were designed to determine whether parents view the WRC as a
helpful tool. Question 1 was the most divided question in the survey, with 48.3% of
parents strongly agreeing (scoring 5 out of 5) that the information in the WRC was
new to them, 10.3% agreeing (scoring 4 out of 5) that the information in the WRC
was new to them, 13.8% claiming to be neutral (scoring 3 out of 5), 13.8%
disagreeing (scoring 2 out of 5), and 13.8% strongly disagreeing (scoring 1 out of 5).
Figure 1 illustrates this point.

As figure 8 demonstrates, 77.4% of parents strongly agreed (scored 5 out of 5) that
the WRC was a helpful tool to receive at the dental visit, 19.4% agreed (score 4 out
of 5), and 3.2% were neutral (scored 3 out of 5). None of the parents disagreed or
strongly disagreed that the WRC was a helpful tool to receive at the dental visit.

Question 9 asked parents if a health care provider had discussed your child’s BMI or
weight in the past. 43% of all parents indicated that a health care provider had
previously discussed BMI or weight. This question was able to be compared
between English-speaking and Spanish-speaking parents. 61% of English-speaking
parents had previously discussed BMI or weight with a health care provider, which
was considerably more than indicated by Spanish-speaking parents (17%). This
difference was statistically significant (p<.01).

If patients had been informed, most (76.5%) had been notified within the past year.
As figure 9 shows, 41,2% had been notified within the past 0-6 months, 35.3%
within the past 6-12 months, 5.9% within the past 1-2 years, 11.8% within the past
2-3 years, and 5.9% had been notified over 3 years ago.

None of the questions revealed a statistically significant difference between parents
in Texas and parents in California.




DISCUSSION

In this study, most parents felt that the dental office was be a good place for obesity
screening, believed that their child was comfortable with the WRC protocol, and
identified the WRC as a helpful tool.

39% of English-speaking parents and 83% of Spanish-speaking parents did not
remember hearing this information from a health care provider previously.

This study was conducted in two very different states. Texas is considered to be a
more conservative state than California, and its population struggles more with
obesity (Texas ranks 12
th
in the nation in obesity, while California ranks 40
th
.)
Interestingly, no statistically significant differences were found between these two
groups of subjects. This finding may be explained by the fact that both settings serve
mainly individuals of a lower socioeconomic status, who are more at risk for obesity
and may for that reason be more receptive. In addition, individuals of a lower
socioeconomic status may be less easily offended than individuals of a higher
socioeconomic status.

One limitation of the study is the setting in which it was conducted. The subjects
participating were enrolled as patients in either a university setting (California) or a
comprehensive community health clinic (Texas), and as such, may be more tolerant
of longer appointments and public health related interventions. In addition, these
settings serve mostly individuals of a lower socioeconomic status. Therefore, the
results may not be generalizable to other settings, such as private practice dental
offices.


CONCLUSION

Because 43% of the parents surveyed were unaware of their child’s weight status,
the Wellness Report Card (WRC) could make a difference in addressing childhood
obesity. According to survey responses received, the WRC is acceptable to parents,
with 96.8% of parents either agreeing or strongly agreeing that it is a helpful tool to
receive at their child’s dental visit.













REFERENCES

i. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM: Prevalence of high body
mass index in US children and adolescents, 2007-2008. JAMA 303: 242-249, 2010.
ii. Lobstein T, Baur L, Uauy R: Obesity in children and young people: a crisis in public
health. Obesity Reviews, 5: 4-85, 2004.
iii. Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T: Do obese
children become obese adults? A review of literature. Preventive Medicine. 22: 167-177,
1993.
iv. Clinical guidelines on the identification, evaluation, and treatment of overweight and
obesity in adults – the evidence report. National Institutes of Health. Obes Res. 2:51S-
209S, 1998.
v. Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with
underweight, overweight, and obesity. JAMA. 293: 1861-1867, 2005.
vi. Wang G, Dietz WH: Economic burden of obesity in youths aged 6 to 17 years: 1979-
1999. Pediatrics 109: E81-1, 2002.
vii. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending
attributable to obesity: payer- and service-specific estimates. Health Affairs. 28: w822-
831, 2009.
viii. US Department of Health and Human Services. The Surgeon General’s Vision for a
Healthy and Fit Nation. Rockville, MD: US Department of Health and Human Services,
Office of the Surgeon General, January 2010.

ix. Bimstein E, Katz J: Obesity in children: a challenge that pediatric dentistry should not
ignore – review of the literature. J Clinical Pediatric Dentistry 34: 103-106, 2009.
x. Vann WF, Jr., Bouwens TJ, Braithwaite AS, Lee JY. The childhood obesity epidemic:
a role for pediatric dentists? Pediatric Dentistry. 27: 271-276, 2005.
xi. Tseng R, Vann WF, Jr., Perrin EM. Addressing childhood overweight and obesity in
the dental office: rationale and practical guidelines. Pediatric Dentistry 32: 417-423, 2010.
xii. Selden TM. Compliance with well-child visit recommendations: evidence from the
medical expenditure panel survey, 2000-2002. Pediatrics. 118: 1766-1778, 2006.
xiii. Brown E, Jr. Children’s Dental Visits and Expenses, US, 2003. Statistical Brief #117.
Agency for Healthcare Research and Quality. Rockville, MD: March 2006.

xiv. Hilgers KK, Akridge M, Scheetz JP, Kinane DE. “Childhood obesity and dental
development.” Pediatric Dentistry 28: 18-22, 2006.
xv. Baker S, Yagiela JA. Obesity: a complicating factor for sedation in children. Pediatric
Dentistry. 28: 487-493, 2006.
xvi. Krebs NF, Himes JH, Jacobson D, Nicklas TA, Guilday P, Styne D. Assessment of
child and adolescent overweight and obesity. Pediatrics. 120: S193-S228, 2007.
xvii. Centers for Disease Control and Prevention. BMI percentile calculator for child and
teen: English version. Available at: http://apps.nccd.cdc.gov/dnpabmi/Calculator.aspx.
Accessed January 1, 2011.
xviii. Centers for Disease Control and Prevention. Child and Teen – About BMI.
Available at:
http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.ht
ml. Accessed January 1, 2011.
xix. Ogden CL, Flegal KM. Changes in terminology for childhood overweight and
obesity. National Health Stat Report. 25: 1-5, 2010.
xx. Tavares M, Chomitz V. A healthy weight intervention for children in a dental setting:
a pilot study. JADA. 140: 313-316, 2009.
xxi. Hackie M, Bowles CL. Maternal perception of their overweight children. Public
Health Nursing. 24(6): 538-546, 2007.


xxii. Braithwaite AS, Vann WF Jr., Switzer Br, Boyd KL, Lee JY. Nutritional counseling
practices: how do North Carolina dentists weight in? Pediatric Dentistry. 30: 488-495,
2008.
xxii
Curran AE, Caplan DJ, Lee JY, Paynter L, Cizlice Z, Champagne C, Ammerman AS,
Agans R. Dentists’ attitudes about their role in addressing obesity in patients: A
national survey. JADA. 141(11): 1307-1316, 2010.








WELLNESS REPORT CARD

Plaque Level: Low Medium High
The Plaque Level tells us how clean the teeth are today. Plaque is a sticky film of
made up of bacteria that causes gingivitis (inflammation of the gums) and tooth
decay.
Number of Cavities Today: ________
One of our goals is for your child to have a cavity-free check-up.
If cavities were found today, please schedule an appointment for treatment. Also,
please consider the following modification(s) to improve your child’s oral health
and his or her chances of a cavity-free check-up at the next dental exam visit:
__________________________________________________________________
Weight: _____ pounds Height: ______ inches
We are checking your child’s weight and height today for several reasons. First
and foremost, we strive to promote the overall health and wellbeing of our patients.
In addition, these measurements can be useful in the dental office. For example, a
child’s weight allows us to calculate how much medicine we can give when teeth
are numbed for fillings. Tracking your child’s weight and height also helps with
the timing of orthodontic treatment.
Body Mass Index (BMI): _______
BMI Percentile for Age and Gender: ________
The BMI is calculated using height and weight. The BMI estimates the amount of
body fat. If you would like, we’ll be happy to discuss with you what your child’s
BMI score means and address any questions you may have. Further information
and educational activities are available at the websites below. If you’d like
additional information about where to obtain help with nutritional planning, please
ask Dr. ________________________.


Here are a few sources of information to help keep your child healthy:

Interactive BMI calculator that you and your child can use together:
http://apps.nccd.cdc.gov/dnpabmi/
Error! Bookmark not defined.


Healthy meal ideas and guidelines:
http://mypyramid.gov/kids/
xxii

Call 1-888-779-7264 (8am to 3pm Eastern time, Mon-Fri, closed Federal holidays)



Thank you!

Dental Provider: __________________________________________Date:_____________________________


PARENT SURVEY
Dear Parent,
To evaluate and improve our Wellness Report Card program, we need your honest
feedback. Please complete the short survey below, fold, and place in the box labeled
“Parent Surveys.” All responses are anonymous.
Thank you for your honest feedback!

*Please rate the following 8 statements on a scale from 1 to 5 by circling the
corresponding number.
5 = Strongly Agree, 4 = Agree, 3 = Neutral, 2 = Disagree, 1 = Strongly Disagree
1. The information presented in
the Wellness Report Card was
new to me.
Strongly Agree 5 4 3 2 1 Strongly Disagree


2. Receiving a Wellness Report
Card made my child’s dental
care visit too long.
Strongly Agree 5 4 3 2 1 Strongly Disagree

3. My child was comfortable
getting his or her height and
weight measured at the dental
office.
Strongly Agree 5 4 3 2 1 Strongly Disagree


4. My child was comfortable
getting his or her weight and
BMI results at the dental office.
Strongly Agree 5 4 3 2 1 Strongly Disagree

5. My child was comfortable
getting the Wellness Report Card
at the dental office.
Strongly Agree 5 4 3 2 1 Strongly Disagree

6. The dental office is a good
place to get my child’s height
and weight measured.
Strongly Agree 5 4 3 2 1 Strongly Disagree


7. The dental office is a good
place to receive and discuss my
child’s weight and BMI status.
Strongly Agree 5 4 3 2 1 Strongly Disagree

8. The Wellness Report Card
was a helpful tool to receive at
my child’s dental
cleaning/checkup visit.
Strongly Agree 5 4 3 2 1 Strongly Disagree


9. Has a health care provider discussed your child’s BMI or weight with you in the past?
Please circle your answer: Yes No
10. If you answered yes to question #9, how long has it been since you had this
discussion?
Please circle your answer:
0-6 months 6-12 months 1-2 years 2-3 years more than 3 years
Please give us One Good Idea on how we can improve the Wellness Report Card:
_______________________________________________________________________
FIGURES
Figure 1 – Question 1: The information presented in the WRC was new to me.

Figure 2 – Question 2: Receiving a Wellness Report Card made my child’s dental care
visit too long.
0
5
1
0
1
5
F
r
e
q
u
e
n
c
y
0 1 2 3 4 5

Question 1









Figure 3 – Question 3: My child was comfortable getting his or her height and weight
measured at the dental office.

Figure 4 – Question 4: My child was comfortable getting his or her weight and BMI
results at the dental office.
0
5
1
0
1
5
2
0
F
r
e
q
u
e
n
c
y
1 2 3 4

Question 2
0
5
1
0
1
5
2
0
2
5
F
r
e
q
u
e
n
c
y
1 2 3 4 5

Question 3


Figure 5 – Question 5: My child was comfortable getting the Wellness Report Card at the
dental office.


Figure 6 – Question 6: The dental office is a good place to get my child’s height and
weight measured.

Figure 7 – Question 7: The dental office is a good place to receive and discuss my child’s
weight and BMI status.
0
5
1
0
1
5
2
0
2
5
F
r
e
q
u
e
n
c
y
1 2 3 4 5

Question 4
0
5
1
0
1
5
2
0
2
5
F
r
e
q
u
e
n
c
y
1 2 3 4 5

Question 5
0
5
1
0
1
5
2
0
2
5
F
r
e
q
u
e
n
c
y
1 2 3 4 5

Question 6


Figure 8 – Question 8: The Wellness Report Card was a helpful tool to receive at my
child’s dental cleaning/checkup visit.


Figure 9 – Question 10: How recently has a health care provider discussed your child’s
BMI or weight with you (if applicable)?


0
5
1
0
1
5
2
0
F
r
e
q
u
e
n
c
y
1 2 3 4 5

Question 7
0
5
1
0
1
5
2
0
2
5
F
r
e
q
u
e
n
c
y
1 2 3 4 5

Question 8
0
.
1
.
2
.
3
.
4
D
e
n
s
i
t
y
0 - 6 mo. 6-12 mo. 1-2 yr. 2-3 yr. >3 yr.

Question 10