Pathways between parental and individual determinants of dental caries and dental visit behaviours among children: Validation of a new conceptual model

Conceptual modelling of the factors affecting parental acceptance of silver diamine fluoride

BACKGROUND

It is important to delineate how different factors relate to parental acceptance of silver diamine fluoride (SDF).

AIM

To develop and validate a conceptual model evaluating the factors affecting parental acceptance of SDF.

DESIGN

Data were collected from 414 preschool children and their parents, and a path model was created to analyse the associations between variables affecting parental acceptability of SDF. The model comprised endogenous and exogenous variables from both parents and children. The psychometric evaluation of a Turkish version of the Parental Perceptions of Silver Diamine Fluoride Dental Colour Changes Questionnaire was also conducted.

RESULTS

Parental and child oral health behaviours and the psychosocial impact of dental aesthetics had the greatest indirect effect on parental acceptability of SDF. There were significant associations between parental education level and socioeconomic status, parental socioeconomic status and oral health literacy, parental and children's oral health behaviours, children's oral health behaviours and oral health-related quality of life (OHRQoL), and the psychosocial effects of dental aesthetics and OHRQoL.

CONCLUSIONS

This study demonstrated a valid pathway of association between parental and child-related factors and parental acceptance of SDF. Furthermore, the Turkish version of the questionnaire was shown to be both reliable and valid for use.

The effect of different parenting styles on the child behavior during the dental visit: observational longitudinal study

BACKGROUND

It is widely recognized that parental influence significantly shapes children's emotional health and behavioral patterns. The current study aims to evaluate the effect of different parenting styles on the child's behavior during the dental visit.

METHODS

Sixty healthy children age ranging from 4 to 6 years old who needed class I restoration in one of their primary molars were selected from the outpatient clinic of the Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Alexandria University, Egypt. Both parents signed a consent form to participate in the research and filled out the study questionnaires. Two questionnaires were used in this study: the Parenting Styles and Dimensions Questionnaire (PSDQ) and the demographic questionnaire to determine the parents' socioeconomic status. The Frankl rating scale was used to evaluate the children's behavior during the initial examination visit and the subsequent restorative visit. The procedure time was assessed from the videotaped restorative visit.

RESULTS

The overall child behavior during the examination visit and the second restorative visit showed that children of authoritative parents demonstrated significantly positive behavior (Frankl rating 3) compared to the negative behavior in children of both authoritarian and permissive parents (Frankl rating 2) (P = 0.002, P = 0.004). The authoritative parenting style showed significantly less operative time than the authoritarian and permissive groups (P = 0.001, 0.008, respectively).

CONCLUSION

Children of authoritative parenting style showed significantly positive child behavior on the dental chair than those of permissive and authoritarian parenting styles.

Understanding and reducing delayed dental care for early childhood caries: a structural equation model approach

OBJECTIVE

This study aimed to examine the factors that affect treatment delay in early childhood caries (ECC), guided by a modern medical model. This study attempted to analyze the pathways influenced by these factors and provide a theoretical foundation for designing targeted intervention programs.

METHODS

Data were collected from young children who visited the department of stomatology at a tertiary hospital from January to December 2023. Data were collected via a general information survey questionnaire, the Scale of Oral Health Outcomes for 5-year-old Children (SOHO-5), the Children's Fear Survey Schedule-Dental Subscale-Chinese (CFSS-DS-C), the Parental Caregiver Perceptions Questionnaire-8 (P-CPQ-8), the Family Impact Scale (FIS-8), and the Perceived Barriers to Health Care-Seeking Decision-Chinese (PBHSD-C). The data in this study were analyzed using a variety of statistical tests, including the Kruskal-Wallis and Mann-Whitney tests, correlation analysis, multiple stepwise regression analysis, and structural equation modeling (SEM).

RESULTS

The treatment delay score of early childhood caries was 36.77 ± 10.11, indicating that the state of early childhood caries was currently at a moderate level of delay. The SOHO-5 score was 6.41 ± 1.78, the CFSS-DS-C score was 23.60 ± 6.91, the P-CPQ-8 score was 18.43 ± 4.33, and the FIS-8 score was 18.66 ± 4.28. Multi-factor analysis revealed key factors affecting treatment delay, including permanent residence, medical insurance type, oral health habits, reasons for visit, first symptoms, the time of first discovery of oral problems, brushing teeth before bedtime every day, a genetic history of dental caries and the staging of dental caries. A positive correlation existed between oral health, children's dental fear and treatment delay, whereas social support was negatively correlated with treatment delay. The SEM, which is based on the modern medical model, revealed that children's dental fear plays a mediating role in the relationships among social support, oral health, and treatment delay.

CONCLUSION

The present study developed a novel model to study the ECC treatment delay, elucidated the causal links between the identified variables, and proposed potential intervention strategies to enhance oral health awareness, knowledge, and skills among young children and their parents. These strategies can help improve children's dental visiting behavior and reduce treatment delay.

Parental and individual determinants of dental trust in children: a path analysis of a conceptual model

BACKGROUND

Understanding the interactions among predictors of dental trust in children is important for designing effective interventions in pediatric dental care.

AIM

This study aimed to develop and validate a conceptual model to evaluate factors influencing dental trust in children.

DESIGN

This cross-sectional study included 267 parent-child dyads. Data collection tools included a sociodemographic data form, the Turkish Oral Health Literacy Assessment Task (TOHLAT-P), the Dental Trust Scale (DTS), the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), and the Early Childhood Oral Health Impact Scale (ECOHIS). The conceptual model explored the factors influencing dental trust in children by incorporating endogenous and exogenous variables. Path analysis was conducted to test model fit.

RESULTS

Dental trust was significantly associated with parental oral health literacy (β = -0.20; P < 0.001), dental anxiety (β = -0.18; P < 0.001), and oral health-related quality of life (β = -0.15; P < 0.001). The path analysis confirmed the validity of the proposed model, showing significant pathways between these variables and dental trust in children.

CONCLUSIONS

This study presents a validated model illustrating the relationships between parental and child-related factors and dental trust in children. These findings underscore the importance of addressing these factors in clinical strategies to enhance dental trust and improve pediatric dental outcomes.

Psychosocial determinants of oral health outcomes in young children

Objective

To examine the social determinants of early childhood caries (ECC), one of the greatest public health risks affecting children, and examine alternative pathways of influence.

Methods

A physically healthy, socio-demographically high-risk sample of initially caries-free children, aged 1-4 years, was prospectively studied for 2 years. At 6-month intervals, assessments were made of caries presence from a standard dental exam; oral microbiology was assayed from saliva samples; oral hygiene behaviors and psychological and psychosocial risk exposure were derived from interviews and questionnaires.

Results

189 children were enrolled; ECC onset occurred in 48 children over the 2-year study period. A composite measure of psychosocial risk was significantly associated with ECC onset over the course of the study (1.57, 95% CI 1.12-2.20, p < .001) and significantly associated with multiple risks for ECC, including poor diet/feeding (.92; 95% CI. 22-1.61, p < .01), poor oral hygiene (.39; 95% CI .09-.68), p < .05), and higher concentrations Lactobacilli (.96; 95% CI .43-1.49, p < .001). Multivariable regression analyses provided indirect support for the hypothesis that psychosocial risk exposure predicts ECC onset via behavioral and oral hygiene pathways.

Conclusions

The study provides novel evidence that psychosocial factors influence many of the purported risks for ECC and strong evidence that there are social and psychological determinants of ECC onset.

The influence of parents' oral health literacy and behavior on oral health of preschool children aged 3-6 years- evidence from China

BACKGROUND

Direct and indirect associations have been identified among health literacy, health behavior, and health status. Thus, we aimed to investigate the influence of oral health literacy and behaviors in parents on their children's oral health status. Moreover, we aimed to analyze the mentioned mediating effects through oral health behavior management.

METHODS

Oral health information of 1,102 preschool children aged 3 to 6 years was collected from five primary schools in Jinjiang District, Chengdu City, Sichuan Province, China. The decay-missing-filled teeth (DMFT) index and soft scale plaque index (PI) were used by professional dentists aided by school teachers to assess caries and periodontal health among the children. Simultaneously, we conducted a questionnaire-based survey among the parents to determine their oral health literacy and health behavior and their children's oral health behavior. The probit model, instrumental variables, and mediation effect model were used to evaluate the association of parents' oral health literacy and behavior with their children's oral health status.

RESULTS

The DFMT index was 1.58 among the children, with zero caries in 646 (58.6%) children. The PI was 0.68, with zero gum disease in 517 (46.9%). The univariate analysis suggested that the parents' health literacy and behavior were correlated with their children's oral health status (P < 0.01). Parents' oral health behavior significantly affected their children's oral health status. Simultaneously, a stronger correlation was observed upon using parents' health literacy as an instrumental variable to assess the endogeneity, indicating endogeneity problems. Parents' health-related behaviors exerted a mediating effect on children's oral health, with parents helping children brush their teeth demonstrating the strongest effect.

CONCLUSION

Parents' oral health-related behaviors can affect their children's oral health status. We recommend enhancing parents' oral health literacy to improve children's oral health status.

How well do parents identify their child's baby teeth? Engagement and accuracy of parent-reported information on a tooth checklist survey

OBJECTIVES

Naturally exfoliated primary teeth are being increasingly collected in child development studies. Most of these odontological collections and tooth biobanks use parent-reported information from questionnaires or tooth checklists to collect data on offspring teeth. To the best of the authors' knowledge, no studies have assessed parental engagement in tooth checklists, nor parental accuracy in identifying their child's baby tooth. This study aimed to evaluate these dimensions by analysing data from the about this tooth checklist returned with donated primary teeth in a natural experimental study called STRONG (the Stories Teeth Record of Newborn Growth).

METHODS

Parental self-reported information were analysed on checklists returned with 825 primary teeth belonging to 199 children. The percentage of blank answers was calculated for each question. The accuracy of parents-reported tooth identification was evaluated by comparing parental ratings to researchers' ratings. Reliability of researchers' tooth identification was first evaluated by calculating intra-observer and inter-observer agreements, as well as Cohen's Kappa values. The percentage of accuracy of parents' tooth identification (relative to researcher's) was then calculated, and logistic regressions were used to evaluate if time elapsed between when exfoliation occurred and the checklist was completed associated with parental accuracy in tooth identification.

RESULTS

Parents returned 98.4% of the checklists and completed 74.9% to 97.7% of the questions. Excellent reliability was demonstrated for researchers' intra- and inter-rater tooth identification (agreement percentages >90%; Cohen's Kappa values >.83). Moderate accuracy of parents-reported tooth identifications was found, with parents correctly identifying 49.5% of the donated tooth. Better parental accuracies were highlighted for partial identifications (87.1% of correct jaw, 75.6% of correct tooth type, and 65.8% of correct lateralization). Logistic regressions showed the odds of correct parental identifications decreased on average by 1.8% every 30 days of distance between tooth exfoliation and checklist completion.

CONCLUSIONS

While parental engagement is high, parents-reported tooth identifications have moderate accuracy, which decreases over time. High accuracy is however found for partial identifications. Parent-reported information on the accompanying questionnaire of naturally exfoliated primary teeth collection or tooth biobanks, even when filled in a long time after exfoliation took place, should be encouraged. However, expert identifications of teeth should remain best practice.

Risk Factors Associated with Children's Behavior in Dental Clinics: A Cross-Sectional Study

One of the most crucial tasks of pediatric dentists is to control children's negative behaviors. This study aimed to assess dental behavior and the associated risk factors among children aged 4-12. This cross-sectional study recruited healthy, unaffected children aged 4 to 12 years. Parents were interviewed regarding the sociodemographic details and characteristics of their children's dental visits. Two collaborative dentists examined the children for dental caries (DMFT/DMFT) and behavioral status (Frankl's behavior rating scale). This study included 439 children: 27.3% exhibited uncooperative behavior, and the mean DMFT/dmft was 8.46 ± 3.530. Uncooperative behavior significantly increased when the dental visit was scheduled as an emergency treatment (p = 0.134; Adjusted Odds Ratio (AOR): 1.530) and when there was an elevated DMFT/DMFT ratio (p < 0.001; AOR: 1.308). This study revealed a significant association between children's uncooperative behavior and their first dental visit, emphasizing the need for tailored strategies to address behavioral challenges when scheduling pediatric dental care. The proactive measures included controlling caries and avoiding emergencies.

Efficacy of music therapy on stress and anxiety prior to dental treatment: a systematic review and meta-analysis of randomized clinical trials

Introduction

Stress and anxiety are emotional states that often accompany patients who have to receive dental treatments, leading them to postpone or avoid treatments with the consequent deterioration of their oral health and, hence, their general condition. Music therapy has been shown to be an alternative to other treatments that are invasive and not without danger, such as anxiolytics or sedation. This systematic review and meta-analysis evaluated the effect of music therapy on anxiety and stress prior to dental treatments.

Methods

Studies published in PubMed (through Medline), Web of Science (WOS), Embase, and Cochrane Library databases were consulted up to October 2023. The inclusion criteria were established for intervention studies (randomized controlled trials, RCTs) according to the PICOS (population, intervention, comparison, outcomes, and study) strategy in subjects with dental stress and anxiety (participants) treated with music therapy (intervention) in comparison with patients without music therapy (control) and evaluating the response to treatment (outcomes).

Results

A total of 154 results were obtained, with 14 studies finally selected. The risk of bias and the methodological quality were assessed using the Cochrane Risk of Bias Tool and the Jadad scale, respectively. A random-effects meta-analysis was used to quantify the results of the pooled studies, while a fixed-effects meta-analysis was used for studies in the pediatric population. The meta-analysis of pooled studies found statistical significance in the subgroups of anxiety and anxiety-stress (p = 0.03 and p = 0.05, respectively), with an overall effect in favor of the intervention group (p = 0.005). Meta-analysis of the studies in the pediatric population showed considerable statistical significance for the experimental group (p < 0.00001).

Conclusion

Music therapy as a treatment for stress and anxiety, prior to dental treatment, proved to be effective in both children and adults although more well-designed randomized clinical studies are needed to validate its efficacy.

Systematic review registration

INPLASY, identifier 202312000.

The Role of Family Factors in the Development of Dental Anxiety in Children

Background and Objectives: In the literature, the influence of parents who suffer from dental anxiety and a previous unpleasant experience at the dentist are cited as the two most common causes of dental anxiety in children. The aim of this study is to investigate the relationship between socioeconomic factors and the development of dental anxiety in children aged 9 to 12 years. Materials and Methods: A total of 131 children and their accompanying parents/guardians participated in the cross-sectional study. The children were divided into an experimental group, which visited a specialised office for paediatric and preventive dentistry for the examination, and a control group, which visited a primary care dental office. During the visit, the children completed questionnaires on dental anxiety (CFSS-DS). Parents completed a socioeconomic questionnaire and a dental anxiety questionnaire for adults (CDAS). Results: The results showed a statistically significant positive predictor: parental dental anxiety as measured by the CDAS. In addition, the t-test showed that children who visited a specialised dental office did not show a statistically significant increase in dental anxiety compared to children who visited a primary care dental office. Conclusions: With this study, we confirm the influence of parental dental anxiety on the development of dental anxiety in children. The socioeconomic status of the family and the type of dental office do not play a statistically significant role in the development of dental anxiety in children.

Efficacy of Virtual Reality Distraction in Reduction of Pain and Anxiety of Pediatric Dental Patients in an Iranian Population: A Split-Mouth Randomized Crossover Clinical Trial

Materials and Methods

This crossover clinical trial was conducted with eligible 6-8-year-old children requiring bilateral mandibular molar pulpotomy. At the first treatment visit, pulpotomy was performed for 15 children using VR glasses distraction while the other 15 children received a pulpotomy without any VR glasses; this trend was reversed at the second session and pulpotomy was performed for the contralateral tooth. Pulse rate (PR) and Modified Child Dental Anxiety Scale (MCDAS) measured the anxiety levels. Wong-Baker Faces Pain Scale (WBFP) assessed the pain perception before and after the intervention. Data were analyzed by Statistical Package for the Social Sciences version 25 using the Mann-Whitney and χ2 tests.

Results

The mean PR was not significantly different between the two groups. However, the test group showed significantly lower scores of MCDAS (P value = 0.02) and WBFP (P value = 0.001) compared with the control group.

Conclusion

The present results suggest that VR headsets can decrease the level of pain and anxiety of patients during primary mandibular pulpotomy. This trial is registered with IRCT20200315046782N1.

Interrelationship Between Intelligence Quotient and Space Maintainers Among Children: A Cross-Sectional Comparative Study

Introduction Intelligence quotient (IQ) is an indicator to measure a child's cognitive ability to learn or understand and to deal with new situations with their logical and analytical skills. Children with better IQ exhibit increased cooperation when undergoing dental treatments, leading to a positive attitude toward dental care. The primary aim of the study was to assess the interrelationship between the IQ of children, space maintainer therapy, and the behavior of children aged 6-10 years. Materials and methods A total of 104 children were divided into two groups: group 1 included children undergoing space maintainer therapy and group 2 included children who did not undergo space maintainer therapy. Their IQ scores were assessed using Raven's Coloured Progressive Matrices and behavior and the Frankl behavior rating scale. The data were analyzed by SPSS Version 23 (IBM Corp., Armonk, NY). Independent t-tests were used to evaluate the differences between IQ and children with space maintainers, and Mann-Whitney U tests were used to assess the differences between behavior and space maintainers. Results The mean age of the participants was approximately 8.28 years. The mean IQ score of the group of children undergoing the space maintainer therapy was 90.69 ± 7.65 and that of the control group was 105.59±10.71. Based on the Frankl behavior rating scale, the mean score in the space maintainer group was 35.44 and that of the control group was 69.56. There was a significant association between IQ, behavior, and the presence of space maintainers. Conclusion The group of children undergoing space maintainer therapy demonstrated comparatively lesser IQ, and the majority of children exhibited negative behavior. Also, children wearing space maintainers had undergone one or multiple extractions, which is traumatic for children and may lead to them likely exhibiting a negative behavior than children in the control group. Hence, it may be concluded that intelligence, behavior, and space maintainers are all significantly associated with each other.

Is Parental Rating of Child's Oral Health Associated with Caries Experience in Children? A Cross-Sectional Study

Aim

The Parents' view to the oral health of their children is a significant factor that can impact oral health practices and behaviors. The aim of this research was to investigate how parental assessment of their child's oral health associates with caries experience in children receiving dental treatment at the hospital of Taibah University Dental College.

Materials and Methods

This cross-sectional study enrolled 127 children who underwent dental treatment at Taibah University Dental College and Hospital during 2020-2021. Dental caries experience was assessed using the dmft/DMFT index, and parental rating of oral health was obtained through a questionnaire. Three logistic regression models were used to assess the correlation between dental caries experience and parental rating of oral health while controlling for sociodemographic and behavioral factors.

Results

Most parents rated the oral health of their child as good (60.4%), followed by excellent (18.8%) and very good (15.6%). The mean dmft/DMFT score was 3.47 ± 3.46, with 43.8% of children having high/very high dental caries experience. Logistic regression analysis showed that children whose parents rated their oral health as poor were more likely to have high/very high dental caries experience compared to those rated as excellent/very good/good/fair (adjusted odds ratio = 4.45, 95% confidence interval 1.23-16.07).

Conclusion

This study suggests a link between parental assessment of their child's oral health and an elevated prevalence of dental caries in children. The study found that children whose parents rated their oral health as suboptimal had higher odds of having high dental caries experience. These findings emphasize the significance of parental perception of their child's oral health and suggest a necessity for customized interventions to enhance parental knowledge and practices concerning children's oral health.

Predictors of Parental Acceptance towards Contemporary Behavior Management Techniques Used in Pediatric Dentistry: A Preliminary Study on Turkish Population

BACKGROUND

Parents, who make the final decision regarding their child's treatment, play a significant role in their dental care. Parental approval is important for each stage of treatment and may affect the physician's approach to the treatment. Therefore, it is essential for pediatric dentists to comprehend which behavior management techniques (BMTs) are acceptable to parents and to identify the factors that influence their acceptability.

METHODS

Parents who were bringing their children for dental treatment answered a survey on the acceptance of twenty contemporary BMTs. The sociodemographic data of the parents and the age, gender, and Frankl behavior rating scale (Frankl) scores of their children were recorded. Parents were asked to indicate their level of acceptance of each BMT. Binary logistic regression analysis was designed to see the predictors of "accepted" and "declined" answers.

RESULTS

According to acceptance frequencies, the most accepted technique was communication and communicative guidance. The most declined technique was parental absence. The child's age, gender, Frankl score, parental educational status, and parent type predict the acceptability of some BMTs.

CONCLUSION

This study revealed that pediatric dentists must consider parent and child factors when selecting BMTs for children. We believe that this study can provide a basis for determining which factors pediatric dentists should consider when selecting individualized BMTs.

The Impact of Child Dental Caries and the Associated Factors on Child and Family Quality of Life

Introduction

Dental caries are considered as common health hazards and a serious lifelong threat to general health and quality of life. The present study aimed at identifying the impact of child dental caries and the associated factors on both child and family quality of life (QoL). Material and Methods. In this cross-sectional study, preschool children were selected randomly through clustered sampling from five educational districts in Tabriz, Iran, 2016. To assess the QoL related to oral health, the Early Childhood Oral Health Impact Scale (ECOHIS) was used. Clinical oral examination was performed to assess the presence of caries through the index of decayed, missing, and filled teeth (dmft). Descriptive and analytic statistical methods were used. To assess the underlying predictors of ECOHIS as a whole scale and the dimensions as a linear regression model were used as univariate and multivariate.

Results

: Out of 756 children under 7 years old, 51.5% boys, mean (M) standard deviation (SD) of age 5.76 (0.78). About 85% of children had dental caries. The predictors of suboptimal ECOHIS related to both general and child dimensions were child age 6 year and above: r (756) = 2.43, and P ≤ 0.001, low-socioeconomic status: r (756) = 3.36 and P < 0.001 and high dmft: r (756) = 9.10 and P < 0.001. The predictors of suboptimal ECOHIS related to family domain were sex (girl): r (756) = 0.39 and P = 0.047; mother education (under12): r (756) = -0.92 and P < 0.001; mother job (employed) as univariate: r (756) = 0.71 and P = 0.002); and dmft: r (756) = -0.58 and P = 0.035.

Conclusion

Adverse oral health of children imposes adverse effects on the QoL of children and families. Children's age, family socioeconomic level, presence of dental caries, child's gender, and mother's educational level were associated with the impact on QoL.

Children's Dental Fear: Occurrence Mechanism and Prevention Guidance

Children's dental fear (CDF) has become one of the main reasons affecting the quality of dental treatment. In order to reduce the incidence of CDF in China before and after children's dental visits, this review applies literature analysis and empirical summary methods to analyze and summarize academic discussions on this topic, including occurrence mechanism, prevention guidance, and the conclusion that the occurrence and prevention of CDF is closely related with children's internal characteristics and external influences. In the end, we propose a breakthrough of combining the CFSS-DS scale and three-grade prevention theory together in the future to provide new ideas and hypotheses for the prevention of CDF.

Association between different behavioral factors and dental caries among children attending the dental clinics in a sample from Saudi Arabia

BACKGROUND

This study aimed to assess the association between different behavioral factors and the prevalence of dental caries among children attending the dental clinic in a sample from the Hail and Tabuk regions, Saudi Arabia.

METHOD

A cross-sectional study design was employed to determine the burden of dental caries in teeth and key associated factors among 6-12-year-old children who attended different dental clinics. The data was recruited from Hail and Tabuk districts, Saudi Arabia. The study included only Saudi nationals, whose parents could fill out the self-administered questionnaire and provide informed consent for their child's dental examination at clinics. Children underwent a simple dental examination based on the World Health Organization diagnostic criteria for oral health surveys. The Decayed, Missed, Filled Tooth (DMFT) index developed by the World Health Organization (WHO) was utilized to assess dental caries. Descriptive statistics were performed to describe categorical variables. The mean DMFT was compared between girls' and boys' and the children from Hail and Tabuk regions using the Mann-Whitney U-test. The chi-square test was used to examine the association between different behavioral factors and the prevalence of dental caries.

RESULTS

Of the total 399 children examined, 203 (50.9%) were boys, whilst 196 (49.1%) were girls. The prevalence of dental caries was correlated with the cleaning tool, parental educational level, dental visits, and sugar consumption (p < 0.05). However, brushing frequency failed to demonstrate a correlation with the prevalence of dental caries (p > 0.05). The total mean DMFT for the studied sample was 7.81 (SD ± 1.9). Caries' experience was made up mainly of decayed teeth. Decayed teeth made up an average of 3.30 (SD ± 1.07). The total mean of missing and filling teeth was 2.51 (SD ± 0.99) and 1.99 (SD ± 1.26) respectively. There was no statistically significant difference in the mean DMFT and gender or between Hail and Tabuk (p < 0.05).

CONCLUSION

Saudi Arabia continues to have a high prevalence of dental caries compared to the global norm.

Reliability and validity of the Turkish version of the Oral Health Literacy Assessment Task: Pathways between parental oral health literacy and oral health consequences in children

BACKGROUND

Parental oral health literacy (OHL) is a determinant of oral health behavior and oral health status of children.

AIM

To delineate the pathways between parental OHL and oral health consequences in children and to validate the Turkish version of the Oral Health Literacy Assessment Task (TOHLAT-P).

DESIGN

This cross-sectional study was conducted with 315 parent-child dyads. The TOHLAT-P was psychometrically evaluated. Item analysis was performed to determine the reliability of the TOHLAT-P. Construct validity was tested by comparing a commonly used instrument using Pearson's product-moment correlation coefficients. A path model was developed to evaluate associations between parental OHL and oral health consequences in children. The model consisted of five endogenous variables (parental oral health behaviors, children's oral health behaviors, children's dental anxiety, dental caries, and oral health-related quality of life [OHRQoL]) and one exogenous variable (parental OHL). A path analysis was used to test the compatibility of the conceptual model, with a statistical significance of p < .001.

RESULTS

There was a statistically significant association between parental oral health behaviors and children's oral health behaviors, and between dental caries and OHRQoL. The variable most directly affected by parental OHL was parental oral health behaviors, whereas the variable most indirectly affected by parental OHL was children's oral health behaviors.

CONCLUSIONS

The path analysis revealed significant associations between parental and children's oral health behaviors, and between dental caries and OHRQoL. Understanding these pathways is necessary to establish strategies to improve children's oral health. The TOHLAT-P will be useful for future assessments of Turkish children.

Diagnostic accuracy, available treatment, and diagnostic methods of dental caries in practice: a meta-analysis

Background

Diagnosis of dental caries and identification of patients with dental caries is the biggest challenge in dentistry. For this diagnostic accuracy, several methods are studied. The present study attempts to re-study the published data in the last 50 years, between 1960 and 2020.

Main body

Based on designed keywords, we made a thorough search of 4 different databases and found 3887 articles after removing the duplicate. The included database was PubMed, Ovid, Web of Science, and Cochrane library. On keen screening of the articles, we included 19 articles in the review. All the articles were analyzed based on the Cochrane risk assessment method. Maximum studies of up to 80% of caries management are based on children from 1 to 10 years of age. About 47% of articles were found based on reported use of drugs against dental caries, whereas 52.6% of articles were based on the behavioral and socio-demographic study of the mother and caretakers. We found that attentive parents and caretakers of the children can help in reducing the prevention of caries. Frese et al. (Sci Rep. 8(1):16991, 2018.10.1038/s41598-018-34777-x), Liu et al. (PLoS ONE 8(11):e78723, 2013.10.1371/journal.pone.0078723), and Innes et al. J Dent Res 99(1):36–43, 2020.10.1177/0022034519888882) were the studied articles with high quality and low bias risk. These methods were based on the use of stannous fluoride for dental caries, the study of the effect of smoking on older adults, by checking the anxiety level of the participants.

Short conclusions

Tooth decay is a common condition in the general population and affects mostly children. The method with high accuracy and low risk can be recommended for routine treatment.

The Influence of Parenting Styles on Eating Behavior and Caries in Their Children: A Cross-Sectional Study

The type of parenting style influences the way children cope with problems and can create states of anxiety that can even alter their eating habits, which can cause problems in their oral health. The present study aimed to find out which parenting style is more favorable for the oral health of their children. In this cross-sectional study, 186 children (aged 8-15 years) were examined to assess the mean Decayed/Missing/Filled teeth (DMFT + dmft) index, and they were asked to complete the State-Trait Anxiety Inventory, the Parenting Style Scale, and questions about their oral hygiene habits. On the other hand, their parents answered the Parental Feeding Style Questionnaire and the Children's Eating Behavior Questionnaire. Results showed that a worse oral health status was associated with a higher state of anxiety, more overeating, more emotional eating, and higher psychological control. A higher rate of missing teeth was associated with increased undereating and overeating. Emotional eating was positively related to psychological control. State of anxiety, overeating, and parental psychological control predicted 24.6% of DMFT + dmft. In addition, emotional eating had a moderating effect in DMFT + dfmt only in those with low levels of affection and communication. In conclusion, high psychological control and low levels of parental affection and communication will increase the state of anxiety in children, influencing their caries rate.

Cross Sectional Study on the Association between Dental Caries and Life Habits in School Age Italian Children

Dental caries is still a major public health issue and influences the overall health of children. The risk factors for caries include biological, socio-behavioral, and environmental factors. Our aim is to assess the association between dental caries and the life habits of children and their parents. A cross-sectional study was conducted in Rome (Italy) among primary school children aged 5 to 11. Parents completed the anamnestic questionnaire, and a dental clinical examination was performed on 333 children. Caries prevalence was 38.7% overall, 47% in males and 31.9% in females. The association between bottle night-time feeding and caries was statistically significant (43.2%; p = 0.013). Usage of a honeyed pacifier was also significantly associated with the presence of caries (72.7%; p = 0.027). Finally, higher caries prevalence was found among male children (47% vs. 31.9%; p = 0.005). The present study shows that the percentage of caries is still high in the paediatric population, and caries prevalence is associated with life habits. Our results highlight the importance of oral health education programs at primary school that involve teachers and parents to contribute to improving lifestyles.

The Relationship between Dental Fear and Anxiety, General Anxiety/Fear, Sensory Over-Responsivity, and Oral Health Behaviors and Outcomes: A Conceptual Model

Dental fear and anxiety (DFA) is common across the lifespan and represents a barrier to proper oral health behaviors and outcomes. The aim of this study is to present a conceptual model of the relationships between DFA, general anxiety/fear, sensory over-responsivity (SOR), and/or oral health behaviors and outcomes. Two rounds of literature searches were performed using the PubMed database. Included articles examined DFA, general anxiety/fear, SOR, catastrophizing, and/or oral health behaviors and outcomes in typically developing populations across the lifespan. The relationships between the constructs were recorded and organized into a conceptual model. A total of 188 articles were included. The results provided supporting evidence for relationships between DFA and all other constructs included in the model (general anxiety/fear, SOR, poor oral health, irregular dental attendance, dental behavior management problems [DBMP], and need for treatment with pharmacological methods). Additionally, SOR was associated with general anxiety/fear and DBMP; general anxiety/fear was linked to poor oral health, irregular attendance, and DBMP. This model provides a comprehensive view of the relationships between person factors (e.g., general anxiety/fear, SOR, and DFA) and oral health behaviors and outcomes. This is valuable in order to highlight connections between constructs that may be targeted in the development of new interventions to improve oral health behaviors and outcomes as well as the experience of DFA.

Evaluation of the knowledge and attitudes about dental practices of Turkish parents who visited the pedodontics clinic in Tokat Gaziosmanpaşa University, during the COVID-19 pandemic

PURPOSE

This study aimed to evaluate parents' knowledge and attitudes about dental practices who visited a pedodontics clinic during the COVID-19 pandemic.

METHODS

In the present work, data were collected via questionnaires from 475 parents who brought their children (between 0 and 14 years old) to our clinic for routine pedodontic examinations. The data obtained were analyzed using Microsoft Excel. Frequency and percentage values of answers to questions were obtained.

RESULTS

The majority of the participants (67.9%) indicated sufficient knowledge about COVID-19. Although 75% of parents were fearful and worried about the possibility of contracting virus during admission to the hospital, it was observed that 92% of them highly counted on the measures taken by their dentists and 72% did not hesitate to take their children to dentists during the pandemic.

CONCLUSION

Within the limitations of the present study, it has been shown that despite the increased level of parents' knowledge about the pandemic, it was evident that anxiety and fear were present when visiting hospitals/clinics as a result of the possible transmission due to the high number of COVID-19 cases. Therefore, it is necessary to conduct further studies on how to increase public awareness of the transmission routes of aerosols released during dental treatments.

Trend on dental caries status and its risk indicators in children aged 12 years in China: a multilevel analysis based on the repeated national cross-sectional surveys in 2005 and 2015

Background

This study aimed to explore the trend and risk indicators for dental caries of children aged 12 years in China based on national oral health survey data in 2005 and 2015.

Methods

Research data were from the two latest national oral health surveys conducted in mainland China, including 30 and 31 provinces, autonomous regions, and municipalities in 2005 and 2015, respectively. Children aged 12 years were clinically examined for dental caries and dental fluorosis according to the World Health Organization criteria. Sociodemographic characteristics and oral health-related behaviours were collected using questionnaires. Multilevel zero-inflated negative binomial regression model was used to investigate the association between dental caries severity and dental fluorosis, sociodemographic characteristics, and oral health-related behaviours.

Results

The final analyses included 12,350 and 27,818 children surveyed in 2005 and 2015, respectively. The standardized prevalence of dental caries increased from 27.05% (95% confidence interval [CI], 24.25-28.85) in 2005 to 37.92% (95% CI, 34.94-40.90) in 2015, and the respective standardized mean decayed, missing, filled teeth (DMFT) index scores increased from 0.50 (standard deviation [SD], 1.04) to 0.83 (SD, 1.45) (P < 0.001). Fujian province had the highest increase in dental caries, followed by Liaoning, Heilongjiang, Hainan, and Yunnan. Results revealed that children who were girls, more frequently experienced dental pain, and had more recent dental visits, had significantly higher DMFT scores after adjusting for the survey year and other variables (all P < 0.05).

Conclusions

Dental caries of 12-year-old children in China deteriorated from 2005 to 2015, particularly in the northeast and southwest regions. Dental caries was associated with sex, dental pain, and dental service utilization.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12262-x.

The Effect of Parental Education and Socioeconomic Status on Dental Caries among Saudi Children

Parental attitudes toward the importance of oral hygiene have an impact on the formation of their children’s oral habits and the prevalence of oral diseases. Our aim was to assess the association between parents’ education and socioeconomic status and their children’s oral health. A cross-sectional study was conducted between the years of 2018 and 2020 in the eastern province of Saudi Arabia among primary school children. Two pre-calibrated dentists performed the clinical examination of the children, and a self-administered validated questionnaire was obtained from their parents. Clinical examination was performed on 589 children with an age range of 3 to 14 years, where 47% were males and 53% were females, 70% with dental caries. Both parents with higher education and a high monthly income were significantly associated with lower prevalence of decayed teeth in their children, respectively. Mother’s education, age, gender and application of sealant were found significantly associated with the high prevalence of caries. High prevalence of tooth decay was reported among school children in the eastern province of Saudi Arabia. A high educational level of parents and high income were correlated with a lower prevalence of decayed teeth, similarly to the situation in the case of presence of medical insurance.

The Meaning and Purpose of Primary Tooth Disposal Rituals: Implications for Pediatric Dental Professionals

Rituals for disposing of exfoliated primary teeth exist in virtually all cultures around the globe, suggesting an important psychological and social function for young children and parents. Despite the importance of these rituals, and the role they may play in children's interactions with dental professionals, the meaning and purpose of primary tooth disposal traditions has not yet received adequate attention in pediatric dentistry. The overarching goal of this perspective was to draw attention to the meaning and purpose of primary tooth disposal rituals and show how, with a greater understanding of these rituals, dental professionals could improve the interactions they have with their young patients. To achieve this goal, we first summarize findings from prior research on how primary tooth disposal rituals are primarily practiced as a rite-of-passage to ease the transition from early to later childhood, to counteract anxiety, trauma, or pain experienced by children of tooth-shedding age, and to honor spiritual or religious beliefs that are thought to protect the child and aid their healthy development. Second, we articulate how, by understanding the significance and diversity of these traditions, practitioners can potentially improve their ability to prevent dental anxiety, increase their cultural competence to engage with increasingly diverse pediatric patient populations, and ensure more timely primary oral care. Finally, we provide a two-pronged approach, centered around the pillars of Education and Communication, to improve overall patient care built on knowledge of these rituals and cultural practices.

Which determinants should be considered to reduce social inequalities in paediatric dental care access? A cross-sectional study in France

Better access to dental care through systemic and educational strategies is needed to lessen the burden of disease due to severe early caries. Our study aims to describe family characteristics associated with severe early caries: parental knowledge, attitudes, practices in oral health and socio-demographic factors. For this cross-sectional study, 102 parents of children aged under 6 years with severe early caries and attending paediatric dentistry service in France completed a questionnaire during face-to-face interviews. Caries were diagnosed clinically by calibrated investigators, using the American Academy of Paediatric Dentistry criteria, and dental status was recorded using the decayed, missing, and filled teeth index. The majority of children were from underprivileged backgrounds and had poor oral health status, with a median dmft index of 10. Parents highlighted the difficulty of finding suitable dental care in private practices. Parents appeared to have good oral health knowledge and engaged in adapted behaviours but showed a low sense of self-efficacy. They perceived the severity of early caries as important but the susceptibility of their child as moderate. The study affirmed the importance of improving the accessibility of paediatric dental care and developing educational strategies to enhance the knowledge, skills, and oral health practices of families.

Relationship Between Maternal Dental Anxiety and Children's Dental Caries in the Eastern Province of Saudi Arabia

Purpose

Dental anxiety is a barrier to dental care utilization and is associated with poor oral health outcomes. The aim of the study was to assess the relationship between dental anxiety of mothers and dental caries of their children in the Eastern Province, Saudi Arabia.

Methodology

A cross-sectional study was conducted on a sample of mother-child pairs (N= 199) in Dammam, AlKhobar, and Dhahran, Saudi Arabia. Dental caries experience among children was determined using dmft/DMFT indexes following the World Health Organization's guidelines. Maternal dental anxiety was assessed by using the Modified Dental Anxiety Scale (MDAS).

Results

The mean ages of mothers and children were 33.98 ± 5.41 and 6.74 ± 2.29 years, respectively. The mean dmft score was 4.3 ± 3.99 in primary dentition and the mean maternal dental anxiety score was 13.89 ± 5.33. Ninety-two percent of mothers had low to extreme dental anxiety and only 8% reported no dental anxiety. Dental caries experience in primary teeth was higher in children of dentally anxious mothers (mean dmft 4.45 ± 3.92) than the children of mothers who were non-anxious (mean dmft 2.56 ± 4.59) (P=0.07). The mean maternal anxiety score was significantly higher in children with untreated decay in primary dentition (14.49 ± 5.08) than those with sound primary dentition (12.24 ± 5.67) (P = 0.008). The study also found a statistically significant correlation between maternal dental anxiety and untreated decay in the primary dentition (Pearson's r =0.171, P = 0.015).

Conclusion

Dental anxiety was highly prevalent among mothers in the present study. There was a significant relationship between maternal dental anxiety and untreated decay in the primary dentition. Awareness should be raised among dentally anxious mothers to reduce the burden of dental caries in their children.

Determinants of dental caries in children in the Middle East and North Africa region: a systematic review based on literature published from 2000 to 2019

Background

Dental caries risk factors have been expanded to not only emphasize biology, dietary and oral habits but also broader social determinants such as socioeconomic factors and the utilization of health services. The aim was to review sociobehavioural/cultural and socioeconomic determinants of dental caries in children residing in the Middle East and North Africa (MENA) region.

Methods

A search was conducted in the PubMed/Medline database and Google Scholar to identify studies published from 2000 to 2019 covering children using key search terms. In the initial stages, titles, abstracts and, if needed, full articles were screened for eligibility. In the final stage, all included articles were reassessed and read, and relevant data were extracted.

Results

Out of 600 initial articles, a total of 77 were included in this review, of which 74 were cross-sectional, 2 were longitudinal and one was a case–control study. The studies included a total of 94,491 participants in 14 countries across the MENA region. A majority used the World Health Organization scoring system to assess dental caries. The caries prevalence ranged between 17.2% and 88.8%, early childhood caries between 3% and 57% and decayed missing filled teeth (dmft) varied between 0.6 and 8.5 across the various age groups. Increased age, low maternal education, low overall socioeconomic status, decreased frequency of tooth brushing, low parental involvement, poor oral habits, infant feeding practices and sugar consumption were among the most prevalent determinants for increased risk of caries in the reviewed studies.

Conclusions

Dental caries was found to be high among children in many of the studies published from MENA. The key determinants of dental caries were found to include factors related to child characteristics, family background, oral hygiene and infant feeding and eating habits. The high dental caries prevalence emphasises the need to address the prevailing modifiable sociobehavioural and socioeconomic determinants by translating them into effective oral health prevention policies and programmes.

Dental caries and psychosocial factors: Testing a conceptual model in adolescents

OBJECTIVES

A conceptual model was designed to examine interrelations among psychosocial factors, oral health behaviour, and dental caries in a sample of adolescents.

METHODS

This cross-sectional study design of 531 Greek families included an oral examination and a survey completed by adolescents, and a survey completed by mothers. The outcome measure was dental caries experience. Additionally, dental sealants were recorded. The participants provided information which comprised the Sense of Coherence (SoC) scale and 11 psychosocial and behavioural variables that formed 6 composite variables (life-course experiences, socio-economic status, perceived parental support, perceived parental punishment, preventive measures, sugar intake frequency). The composite variables of preventive measures and sugar intake formed the latent variable of oral health behaviour. The interrelations of the above factors were included in a conceptual model and tested using a Structural Equation Modelling analysis.

RESULTS

Data fit the proposed conceptual model (χ²  = 23.338, df = 14, P = .055, RMSEA = 0.036). Among psychosocial variables, adolescent's SoC was the best predictor of both dental caries (Standardized Regression Coefficient - Std. RC ± Standard Error (SE) = -0.178 ± 0.04) and oral health behaviour (Std. RC ± SE = -0.378 ± 0.09). All psychosocial factors were associated with SoC (Std. RCs ± SE between -0.162 ± 0.04 and 0.211 ± 0.04) and via SoC with oral health behaviour (Std. RCs ± SE between -0.080 ± 0.03 and 0.061 ± 0.02).

CONCLUSIONS

A conceptual model was tested that integrated SoC with the psychosocial factors theoretically shaping it and clarified all factors' predictive abilities on dental caries via oral health behaviour.

Oral Health Status of Young People Infected with HIV in High Epidemic Area of China

Purpose

This study aimed to understand the oral hygiene habits and oral health status of young people infected with human immunodeficiency virus (HIV) in Henan province of China.

Methods

Randomized stratified cluster sampling strategy was used to select young people who were receiving highly active anti-retroviral therapy (HARRT) from 6 towns. A total of 104 participants were enrolled and divided into 2 groups, adolescence group and young adult group. By face-to-face oral interview and examination, well-trained dentists collected general information, oral hygiene habits and oral health status of the participants.

Results

Fifty-eight of them were adolescence group and 46 of them were young adult group. In two groups, most of them brushed their teeth once a day (55.20%, 67.40%), and half of them basically brushed their teeth for 2 minutes (51.7%, 50.0%). Majority of participants did not use dental floss (93.1%,91.3%) and also never visited a dentist (81%,78.3%). One-third of participants had spontaneous bleeding, and about half of them had gingival bleeding when brushed their teeth. The most frequent mucosal disease was oral ulcers. Moreover, the prevalence of caries remained very high in both groups, which was 82.76% and 84.8%, respectively. Most of the participants in both groups had low education level and received less than 9 years of education (65.5%, 63%).

Conclusion

The participants had poor oral hygiene habits. The economic and education level may associate with the awareness of oral health and care.

Family cohesion and attention deficit exert an influence on visits to the dentist in early adolescence

OBJECTIVES

To determine whether family environment, signs of attention deficit/hyperactivity disorder (ADHD) and oral health literacy (OHL) are associated with visits to the dentist in adolescents.

METHODS

A school-based cross-sectional study was conducted with a representative sample of 448 12-year-old adolescents enrolled at schools in the city of Cajazeiras, Brazil. The adolescents answered a validated questionnaire addressing family cohesion and adaptability (FACES III), an OHL measure (Brazilian Rapid Estimate of Adult Literacy in Dentistry [BREALD-30]) and a questionnaire addressing the history of visits to the dentist and previous toothache experience. The parents answered a questionnaire addressing sociodemographic characteristics. Parents and teachers answered the inattention and hyperactivity/impulsivity subscales of the Swanson, Nolan & Pelham (SNAP-IV) questionnaire for the detection of signs of ADHD. Multiple Poisson regression with robust variance was used for data analysis (α = 5%).

RESULTS

The prevalence of having visited a dentist some time in life was higher among adolescents with enmeshed (PR = 1.08; 95% CI: 1.01-1.15) and connected (PR = 1.06; 95% CI: 1.01-1.13) families and those with attention deficit according to parents' reports (PR = 1.09; 95% CI: 1.04-1.14). A family income higher than the Brazilian minimum wage (PR = 1.06; 95% CI: 1.01-1.12) and toothache in the previous six months (PR = 1.05; 95% CI: 1.01-1.11) were also associated with the outcome.

CONCLUSION

Family cohesion and attention deficit according to parental reports influenced visits to the dentist among adolescents. In contrast, OHL was not associated with the outcome.

Batman or Joker? A mixed-method approach to understanding children's perceptions of dentists

It is important to understand children's perceptions of dentists in order to improve child-dentist communication. The aim of this mixed-methods study was to develop and validate a conceptual model of individual determinants of children's perceptions of dentists. A total of 1014 children completed an oral health behaviour form, a metaphor form, the Children's Fear Survey Schedule-Dental Subscale, the Dental Trust Scale, and the Early Childhood Oral Health Impact Scale. A conceptual model, which included five endogenous and two exogenous variables, was developed and validated. Qualitative (metaphor analysis) and quantitative (path analysis) analyses were conducted. The metaphors that were used to describe dentists were classified into seven conceptual categories: chaotic and unlovable; scary; artistic; protective and alleviative; restorative; scientific; and educative. Better oral health behaviours, greater trust in dentists, and lower dental anxiety were associated with positive perceptions of dentists. Oral health behaviours, trust in dentists, and dental anxiety had the strongest direct effects on perceptions of dentists, but age had the strongest indirect effect. The developed model should help dentists to understand pathways between children's individual determinants and perceptions of dentists. Coupled with behaviour management, this understanding can be an important part of improving dental visit behaviours and fostering positive post-visit attitudes among children.

Examining Parental Treatment Decisions Within a Contemporary Pediatric Dentistry Private Practice

PURPOSE

The primary objective of this study was to compare relationships between child, parent, and clinical factors with patient-level treatment decisions for early childhood caries. A secondary objective was to describe children that received silver diamine fluoride (SDF) as interim versus long-term treatment.

PATIENTS AND METHODS

Parents of 2-6-year-old children seeking care at a multi-center pediatric dentistry private practice were enrolled in this cross-sectional study. Demographic data and dental anxiety data according to the Modified Corah's Dental Anxiety Scale were collected via questionnaire. A dental visit behavior rating and decayed, missing, and filled tooth (dmft) index were recorded from the child's dental record. The primary outcome was treatment decision categorized into three groups: (1) treatment with SDF (n=25), (2) conventional restorative treatment under local anesthesia (n=32), and (3) restorative treatment under general anesthesia (n=33). Analyses included descriptive statistics, bivariate analysis, and ordered logistic regression.

RESULTS

Child age, parent education level, family income, dental insurance status, dental visit behavior rating, and dmft were significantly different across treatment groups in bivariate comparisons. However, when included in multivariable, ordered logistic regression, child dental anxiety was the only significant covariate associated with treatment decisions (Odds Ratio=5.01, 95% confidence interval: 1.51 to 16.63). In secondary analysis, two distinct subgroups were identified within the SDF group: one as long-term treatment (n=9) and one as interim treatment prior to general anesthesia (n=16). The long-term group was younger (mean=3.2 versus 3.7), had lower dmft (mean=4 versus 11.1), and had lower frequency of very high dental anxiety (0% versus 15%).

CONCLUSION

The present study identified child dental anxiety as the primary factor associated with treatment decisions at this private practice. The characterization of two subgroups of children treated with SDF has meaningful implications for studies evaluating the economic and public health impacts of SDF.

Comparison of Survival Rates of Stainless-Steel Crowns Placed with and without Pulpotomy: A Two-Year Retrospective Study

Aim. This study aimed to retrospectively compare the survival outcomes over two years between teeth with proximal dental caries that were restored with stainless-steel crowns to those that were pulpotomized and then restored with a stainless-steel crown in patients who were rehabilitated under general anesthesia. Participants and Methods. The records of 131 patients aged between two to six years who had stainless-steel crowns placed under general anesthesia and had two-year follow-up were screened. 340 teeth with moderate proximal caries on the radiograph (D2) were included in the study. Of these, 164 teeth were treated with a pulpotomy and stainless-steel crown, while 176 teeth were crowned without a pulpotomy. The type of each tooth was compared using the Chi-squared test and Kaplan–Meier survival analysis, and curves were plotted based on the two-year outcomes. Results. Treatment: the sample comprised 59 males (mean age 4.73 years, SD ± 1.4 years) and 72 females (mean age 5.2 years, SD ± 2.0 years). The Kaplan–Meier regression model showed no significant difference in survival outcomes between teeth that had been pulpotomized and those that had not ( $p$  = 0.283). Conclusion. Within the limitations of the current study, we can conclude that performing a pulpotomy does not influence the survival outcome of mild/moderate proximal caries restored with stainless-steel crowns under general anesthesia.

Impact of maternal and child dental anxiety on oral health-related quality of life of 5-6-year-old preschool children

BACKGROUND

There is a lack of evidence with regards to the association between both maternal and child dental anxiety and the mother's perception of her child's oral health-related quality of life (COHRQoL). The aim of this study was to investigate the association of maternal and child dental anxiety with COHRQoL and the effect of demographic factors as moderators in this relationship. In addition, the association between child's dental caries experience and the COHRQoL was also assessed.

METHODS

A cross-sectional study was conducted involving 1150, 5-6 year-old preschool children in Selangor, Malaysia. Mothers answered a questionnaire on socio-economic status, the Malay-Modified Dental Anxiety Scale to assess maternal dental anxiety, and the Malay-Early Childhood Oral Health Impact Scale to assess COHRQoL. Child's dental anxiety was assessed using the Malay-Modified Child Dental Anxiety Scale via a face-to-face interview prior to oral examination to assess dental caries. Data were analysed using structural equation modelling to assess the relationship between maternal and child dental anxiety and COHRQoL.

RESULTS

Overall, complete data on 842 mother-child dyads were analysed. The mean scores of total ECOHIS, the child impacts section (CIS), and the family impacts section (FIS) were 17.7 (SD = 4.9), 12.6 (SD = 3.7), and 5.1 (SD = 1.9), respectively. The mean dental anxiety scores for mothers and children were 11.8 (SD = 4.5) and 16.9 (SD = 4.3), respectively. Maternal dental anxiety was associated with the CIS (b = 0.08, p < 0.001), the FIS (b = 0.01, p = 0.001), and the total ECOHIS (b = 0.14, p < 0.001). Maternal education level, income, urban/rural location, and kindergarten type were moderators to the relationship. In addition, there was also a significant relationship between child's dental caries experience and COHRQoL (p < 0.001).

CONCLUSIONS

Maternal dental anxiety and child's dental caries experience have significantly impacted the COHRQoL, the CIS, and the FIS domains. Demographic factors such as maternal education, income, urban/rural location, and kindergarten type acted as moderators that can strengthen or weaken the relationship between maternal dental anxiety and COHRQoL of 5-6-year-old preschool children.