This study is nested within a cohort of pregnant women, mothers, and their children included in the Curitiba Maternal and Child Health Cohort (COOSMIC), conducted by the Pontifical Catholic University of Paraná (PUCPR), in partnership with the Municipal Health Secretariat of Curitiba [13]. The cohort population includes pregnant women at any gestational stage, aged 16 years or older, residing in Curitiba and receiving care through the “Rede Mãe Curitibana” health network. Participants are followed from pregnancy until the child reaches 2 years of age. The cohort sample consists of 1046 participants, with a mean age of 27.95 years.

This is a qualitative, exploratory study design based on the analysis of secondary data derived from text messages within a WhatsApp group. WhatsApp is a real-time messaging platform that allows for text-based communication and the exchange of various media formats, including photos, videos, documents, and location data [14]. This group was created by the cohort to provide maternal and child health guidance to participants, with an average of 85 members, including mothers and the health care professional (HP) team.

Data were collected by exporting the WhatsApp group conversations to a text file, which exclusively contained text-based interactions between participating mothers and HPs. The selection of messages was conducted through manual reading, allowing for a comprehensive evaluation of the content shared in the group and ensuring that no relevant themes were missed. Additionally, the search function for specific terms (eg, tooth, mouth, and pain) within the text file was used to complement the manual reading. Only messages addressing doubts related to infant oral health were selected. Messages that did not specifically address this theme were excluded, ensuring that the corpus remained focused on the research’s central topic. In addition to this criterion, only data referring to the years 2020 and 2021 were analyzed.

Data interpretation was conducted using the content analysis method, as proposed by Bardin [15]. Through an exhaustive reading of the material, core meanings related to the investigated topic were identified. Initially, all dialogues were organized in a spreadsheet, where each row contained a question and its corresponding responses, preserving the original interaction flow. The material was reviewed repeatedly to identify recurring patterns in the mothers’ questions. Based on these patterns, dialogues addressing similar themes were grouped, allowing thematic categories to emerge inductively from the data. These categories subsequently served as the coding framework for data organization. The final count of dialogues was performed manually after the complete tabulation of all interactions. The coding and thematic categorization process was performed by the primary researcher (NGV) and subsequently reviewed and validated by a senior supervisor (RIW). Any disagreements or uncertainties regarding the definitions of the categories were resolved through consensus meetings between the researcher and the supervisor.

Data collected from the WhatsApp group were organized based on the doubts presented by the mothers. Each dialogue was defined as a single doubt (question), accompanied by one or more responses or interactions from other participants and HPs. Accordingly, dialogues were counted based on each new doubt sent to the group. A single mother could initiate more than one dialogue throughout the analyzed period; thus, the individual participant did not determine the number of dialogues. Cases where a question received no response were also recorded as initiated dialogues, even without subsequent interaction. In addition to dialogues related to infant oral health, a second thematic axis regarding “valuing the group as a support space” was analyzed. In these instances, dialogues were defined by spontaneous messages containing feedback from mothers about their experience in the group.

To facilitate visualization, consecutive messages sent by the same participant within a single dialogue were transcribed on a single line, separated by a forward slash (/). The dialogues were initially analyzed in Portuguese, maintaining the original spelling and informal language to preserve the authenticity of the interactions. For the purposes of this publication, the dialogues were translated into English. This process involved linguistic adaptations designed to ensure clarity and comprehension for the audience while carefully maintaining the informal tone and original intent of the participants’ messages.

For the analysis, a standardized nomenclature was adopted to identify participants. Mothers who initiated dialogues with questions or doubts were identified as “Mother A,” while those who participated in the interactions by responding were identified as “Mother B.” Responses from the HPs linked to the project were identified as “HP”. In addition to this classification, each participant was assigned a sequential number corresponding to the chronological order of their first intervention in the group. This numerical identification was maintained consistently throughout the entire analysis, regardless of whether the participant initiated new dialogues or interacted in dialogues started by others.

The use of this nomenclature and sequential numbering was adopted to preserve the identity of the participants, protecting personal information such as names and phone numbers. Beyond ensuring data confidentiality, this strategy facilitated the organization and visualization of the dialogues during the analytical process. All identifiers were removed, and quotes were deidentified before analysis to ensure the protection of participant information.

The COOSMIC project was submitted to and approved by the Research Ethics Committees of the PUCPR (approval numbers 4.819.028 and 2.672.385), and the Municipal Health Secretariat of Curitiba (approval number 4.859.861). The current analysis used secondary data from the COOSMIC cohort. At the time of inclusion in the cohort, participants provided informed consent authorizing the collection, storage, and future use of the data for research purposes. All data extracted from the WhatsApp interactions were completely anonymized before analysis and were used with authorization from the COOSMIC coordination team.

In the coding stage for the theme “infant oral health,” conducted in a Microsoft Excel spreadsheet, the selected material was reorganized and categorized, giving rise to the following themes: eruption of primary teeth, medication for children, bruxism in children, children’s oral hygiene, pacifier use in childhood, children’s products related to oral health, and questions about children’s oral health. Additionally, in a second spreadsheet, dialogues referring to valuing the group as a support space were arranged, in which spontaneous reports from participants praising the team and the group’s operation were observed. After defining the analysis corpus, the data were organized in a Microsoft Excel spreadsheet, totaling 36 dialogues: 28 related to oral health and 8 to the group’s impact.

The most recurrent themes related to “infant oral health” were eruption of primary teeth (mentioned 12 times) and bruxism in children (mentioned 5 times). Additionally, “valuing the group as a support space” was mentioned 8 times. The frequency of mentions of each theme by the participants is represented in Figure 1.

From these data, it was possible to identify the most recurrent themes in the dialogues, as well as the frequency with which they were mentioned by the participants.

Based on this information, the second stage of the research proceeded, aiming to deeply comprehend the core meanings generated by the mothers regarding the themes discussed.

During the analysis, doubts raised by participants related to infant oral health were observed; however, these did not have continuity in the dialogue, whether due to a lack of response or a lack of interaction. These records nevertheless highlight mothers’ active and recurrent efforts to seek information related to their children’s oral health:

The excerpt below reveals a series of important elements related to the barriers faced by mothers during the COVID-19 pandemic:

The situation described by the mother highlights the difficulties faced in accessing in-person dental care, especially when caring for children with special needs during the health crisis. In this scenario, the group was configured as an accessible support tool given the limitations imposed by the pandemic.

Reports shared by the mothers reveal the importance attributed to the group as a support space during motherhood. Participants highlight the exchange of experiences and support as differentiators in the maternal experience:

Finally, the mothers expressed their appreciation for and satisfaction with the group, highlighting positive aspects such as the opportunity to participate in this space, the possibility of clarifying doubts, the support received, and the strengthening of the support network. In addition, they expressed gratitude for the support provided by the HPs.

This study contributes to the understanding of health education delivered through WhatsApp, highlighting mothers’ proactive interest in seeking information about children’s oral health. Health guidance provided by HPs through the platform was associated with positive outcomes, facilitating the resolution of mothers’ questions while strengthening a peer support network. Our findings further reinforce the idea that the active involvement of HPs is essential to ensure the reliability of oral health information disseminated and shared through digital platforms.

The findings of this study reveal that mothers actively seek information related to their children’s oral health through WhatsApp. This behavior reflects their interest in expanding their knowledge and clarifying doubts, as observed in Dialogue 1 and Dialogue 11 and in the Unanswered Questions. These findings are consistent with the literature, which indicates a growing trend among mothers to use social media as a source of information on child health [9,11].

Beyond information seeking, interactions within the group revealed other relevant behaviors. Among these, the search for opinions, observed in Dialogue 14, stands out. Previous studies have also shown that mothers use digital platforms to support decision-making regarding childcare, attributing considerable value to these spaces as sources of information [11]. Another identified aspect was the exchange of experiences, advice, and suggestions among participants. This pattern, observed in Dialogue 3, Dialogue 4, Dialogue 14, and Dialogue 15, reinforces collective support and highlights a frequent need for connection and validation of motherhood experiences [11].

In this context, the group extends beyond its role as a space for clarifying doubts and functions as a peer support network, providing an environment in which participants share experiences, recognize common situations, and establish social bonds. This environment is valued by mothers for promoting mutual validation, reassurance, and support, as reported in the findings of this study. Similar findings have been reported in previous studies, which indicate that digital platforms can contribute to mothers’ emotional well-being [11] by fostering support, information sharing, and a stronger sense of connection among participants [12].

This study also demonstrates that WhatsApp can be used as a strategy for health promotion. Across several dialogues, HPs play a key role by providing guidance that promotes maternal autonomy. This is illustrated in Dialogue 4, in which the mother is advised to monitor her infant’s tooth eruption, and in Dialogue 6 and the Grouped Dialogues, where HPs help clarify questions and improve participants’ understanding. These findings highlight the potential of social media as a strategic tool for health education [16]. Furthermore, they underscore the importance of professional guidance, as clear explanations enable mothers to correctly understand and independently apply health information, as illustrated in Dialogue 18.

In this context, WhatsApp facilitates communication between HPs and mothers. This practice has also been described in previous studies, in which HPs use digital technologies to provide health guidance and information [17,18], reflecting the field of teledentistry, which refers to the use of technologies, such as mobile communication devices, to deliver dental services and health education activities [19]. In Dialogue 13, the HP’s suggestion to continue the conversation privately illustrates the delivery of health education through remote care, characterizing a teledentistry practice. This approach has emerged as an alternative for providing health guidance while strengthening the relationship between HPs and patients [18]. Similarly, another study identified a similar scenario, highlighting teledentistry as a tool that can be used by HPs for oral health promotion, particularly through text messages and mobile apps [20].

Teledentistry gained particular prominence during the COVID-19 pandemic [21], when limited access to in-person dental care led digital technologies to become an accessible resource for addressing health-related concerns [8,18]. In the Unanswered Questions section, mothers sought guidance regarding their children’s oral health during this period, using the group as one of the available sources of professional support. This finding further reinforces the potential of WhatsApp as a tool for delivering health guidance and information.

However, these digital interactions also reveal potential risks and limitations. In Dialogue 9, 1 mother compares her experience of bruxism in adulthood with another mother’s report of bruxism in her child during infancy. This example illustrates the risk of sharing inaccurate information that is not supported by scientific evidence. This is particularly important because bruxism is considered a common finding in early childhood [22], whereas in adults it is associated with different etiologies [23].

Another example is observed in Dialogue 17, in which a mother recommends applying gentian violet to the infant’s mouth. Information shared by individuals without health care training may contribute to the phenomenon known as an infodemic, characterized by an overabundance of information, often including unreliable content, that can compromise health promotion [24]. A similar situation is observed in Dialogue 12, where a participant states that soft teething rings should not be used because they could interfere with breastfeeding. This recommendation contradicts current evidence supporting the use of soft, flexible teething rings because of their significant soothing effect during tooth eruption [25]. Therefore, unreliable information may circulate within the group, highlighting the importance of HPs in providing accurate, evidence-based guidance [24].

Taken together, these findings emphasize the importance of the presence and active mediation of HPs. Their involvement is essential to provide technical clarification, prevent the dissemination of inaccurate information, and promote access to reliable health information. Conversely, the absence of such active mediation may increase maternal uncertainty and contribute to the spread of misinformation [24].

Although inaccurate information was shared by some participants within the group, the findings also identified mothers who demonstrated knowledge related to children’s oral health. In Dialogue 5, for example, 1 mother critically assessed the situation by suggesting that tooth eruption could be the cause of her infant’s discomfort, demonstrating a higher level of oral HL. This ability reflects critical appraisal skills [4,5], as she associated a clinical sign—irritability, which is commonly related to the eruption of primary teeth [17]—with the timing of tooth eruption.

In Dialogue 7 and Dialogue 10, mothers sought information regarding the appropriate use of medications and oral hygiene practices for their children, suggesting more advanced HL skills by demonstrating the ability to seek, understand, and apply health information—competencies typically associated with individuals who are better able to manage health-related situations, as described in the literature [5]. These HL skills were also evident in other situations, including mothers’ vigilance regarding their children’s oral health, as observed in Dialogue 13, and their confidence in discussing bruxism and recognizing the importance of early dental care, as illustrated in Dialogue 16.

Conversely, Dialogue 8 illustrates HL skills that were still developing. The mother’s uncertainty regarding the correct administration of the medication, even after receiving guidance, suggests difficulties in understanding and applying health information in practice. This dialogue reflects competencies consistent with more basic levels of HL, in which health information is applied with less autonomy than in more advanced manifestations of HL [5].

Taken together, these findings indicate predominantly advanced manifestations of HL among the participating mothers, reflected in a more proactive attitude and a greater understanding of children’s oral health information. This familiarity with the topic was demonstrated not only through the ability to interpret health information but also through the ability to share it with others, thereby contributing to collective knowledge [5]. Furthermore, greater attention to children’s oral health care was observed, consistent with previous studies which show that higher levels of maternal HL are associated with increased attention to child health care [6,26].

This study presents some limitations. First, the number of text messages collected for the analysis of infant oral health is small, which restricts the analysis and may not reflect the diversity of experiences among mothers. Second, as this research is based exclusively on text messages, it was not possible to directly evaluate the impact of the information on mothers’ daily lives, which limited understanding of the effectiveness of digital technologies within health education processes. To address this, complementary data, such as interviews, observations, or objective outcome measures, would be necessary. Given these limitations, it is recommended that future studies use mixed methods, integrate impact measures, and include longitudinal evaluations, in order to deepen the understanding of the effectiveness of digital technologies in mothers’ health education processes.

WhatsApp proved to be a useful tool for mothers seeking guidance related to infant oral health. Participants reported positive impacts resulting from the guidance received from HPs, as well as the peer support built within the group. Furthermore, the study allowed for the identification of a diverse range of patterns related to the competencies and limitations in infant oral HL within the studied population, such as empowerment, autonomy, insecurity, knowledge gaps, and misinformation.