Barriers and strategies in parental toothbrushing supervision: insights from a qualitative study in Kuala Muda, Kedah, Malaysia

Background: Early childhood caries (ECC) remains a persistent challenge in Malaysia despite nationwide preventive programs. Parental supervision during toothbrushing is essential for the prevention of ECC, but little is known about parents’ practices, perceptions, and experiences in fulfilling this role. This qualitative study explores the barriers faced by parents and the mitigating strategies used when supervising their toothbrushing among their 5- to 6-year-old children. Methods: Parents were recruited through snowball sampling from kindergartens in the Kuala Muda district. Semi-structured interviews were conducted either face-to-face or via an online platform. The sessions were audio-recorded and transcribed using automated software (Plaud AI). Data were analyzed using the Framework Method with both deductive and inductive coding, supported by ATLAS.ti. Results: Eight parents participated in the study, after which data saturation was reached, with no new themes emerging. Parents described practical and psychosocial barriers that hindered effective supervision, including time constraints and competing responsibilities; child resistance or difficult temperament; limited awareness and confidence regarding optimal brushing practices; inconsistent routines and practical limitations; and a perceived lack of institutional support from schools or community programs. Despite these challenges, parents reported using a range of strategies to reinforce supervision. These include hands-on brushing followed by gradual autonomy, establishing fixed morning and night routines, motivating children through praise and positive reinforcement, using calm behaviour management, adapting practices after professional advice, introducing brushing from infancy, and relying on school or community activities to reinforce home practices. Conclusions: The selected parents in Kuala Muda were highly motivated to supervise their children’s toothbrushing but remained constrained by structural, behavioral, and contextual barriers. Their adaptive strategies provide valuable insights for the development of brief, practical behavioral guidance tailored to Malaysian families.

Early childhood caries; Toothbrushing; Child; Preschool; Parents; Qualitative research; Malaysia

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