Mother’s education and family relations protect children from dental caries experience: a salutogenic approach

PAULA, Janice Simpson de; RODRIGUES, Priscila Almeida; MATTOS, Flávio Freitas; ABREU, Mauro Henrique Nogueira Guimarães de; CHALUB, Loliza Luiz Figueiredo Houri; ZINA, Lívia Guimarães

doi:10.1590/1807-3107bor-2022.vol36.0111

Brasil

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Original research • Braz. oral. res. 36 • 2022 • https://doi.org/10.1590/1807-3107bor-2022.vol36.0111 linkcopy

Mother’s education and family relations protect children from dental caries experience: a salutogenic approach

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The objective of this study was to identify dental caries-protective factors among 5-year-old children using the salutogenic theory. A cross-sectional study was conducted in a small-sized municipality in the Southeast region of Brazil, with a representative sample of 247 children registered in preschool and their respective mothers. The data were collected through questionnaires administered to the mothers about the socioeconomic, behavioral, and biological aspects of the mother and children. Additionally, the collections included validated instruments concerning psychosocial aspects, such as a sense of coherence, resilience, family cohesion and religiosity, and intraoral examinations of the children through the decayed-missing-filled primary teeth (dmft) index. All examinations were performed by a trained and calibrated examiner. The non-adjusted and adjusted odds ratios (OR) and their respective confidence intervals (CI) were estimated using multiple logistic regression with a hierarchical model. Among the examined children, 41.7% were caries-free. In the final model, the chances of the absence of dental caries experience (dmft = 0) were greater in children with mothers who had higher education levels (> 8 years of study) (OR = 2.55 [95%CIi:1.42–4.59]) and those who lived in an environment of high family cohesion (OR = 3.66 [95%CI: 1.19–11.29]). The results indicated that mothers’ level of education and family relationships are protective factors against dental caries in 5-year-old children, which overlapped with behavioral and biological factors.

Dental Caries; Child, Preschool; Protective Factors; Socioeconomic Factors

Variable	n	%
Socioeconomic factors
Household income
Up to US$374.00	187	75.7
More than US$374.00	37	15.0
No information	23	9.3
Mother’s level of education
Up to 8 years	98	39.7
More than 8 years	142	57.5
No information	7	2.8
Mother’s remunerated work
No	130	52.6
Yes	95	38.5
No information	22	8.9
Indoor bathroom
No	49	19.8
Yes	197	79.8
No information	1	0.4
Adequate residence
No	104	42.1
Yes	121	49.0
No information	22	8.9
Mother’s age when the child was born
Up to 18 years	48	19.4
Over 18 years	182	73.7
No information	17	6.9
Marital status
Not married	94	38.1
Married or living together	148	59.9
No information	5	2.0
Number of siblings
Two or more siblings	102	41.3
Up to one sibling	140	56.7
No information	5	2.0
Psychological factors
Participation in groups
No	123	49.8
Yes	97	39.3
No information	27	10.9
Sense of coherence
Weak	114	46.2
Strong	110	44.5
No information	23	9.3
Resilience
Low	113	45.7
High	110	44.5
No information	24	9.7
Family cohesion
Low cohesion	37	15.0
Moderate cohesion	165	10.9
High cohesion	27	66.8
No information	18	7.3
Organizational religiosity
Low	168	68.0
High	56	22.7
No information	23	9.3
Non-organizational religiosity
Low	157	63.6
High	66	26.7
No information	24	9.7
Intrinsic religiosity
Low	78	31.6
High	142	57.5
No information	27	10.9
Biological and behavioral factors
Child’s sex
Female	125	50.6
Male	122	49.4
Mother’s self-reported skin color
Non-white	205	83.0
White	42	17.0
Type of delivery
Cesarean	113	45.7
Vaginal	127	51.4
No information	7	2.8
Mother’s frequency of toothbrushing
Sometimes	42	17.0
Everyday	197	79.8
No information	8	3.2
Mother’s use of toothpaste
No	82	33.2
Yes	161	65.2
No information	4	1.6
Mother’s nightly oral hygiene
No	58	23.5
Yes	185	74.9
No information	4	1.6
Breastfeeding
Complementary/artificial	121	49.0
Exclusive	120	48.6
No information	6	2.4
Sugar addition in the baby bottle
Yes	84	34.0
No	157	63.6
No information	6	2.4
Use of pacifier
Yes	67	27.1
No	173	70.0
No information	7	2.8
Finger sucking
Yes	21	8.5
No	218	88.3
No information	8	3.2
Child performing oral hygiene
No one/Without supervision	56	22.7
With supervision	189	76.5
No information	2	0.8
Frequency of child’s daily toothbrushing
< 2 times a day	42	17.0
≥ 2 times a day	200	81.0
No information	5	2.0
Frequency with which the child sleeps without brushing his/her teeth
Sometimes/Frequently/Always	151	61.1
Never/Rarely	91	36.8
No information	5	2.0
Use of dental floss
No	145	58.7
Yes	97	39.3
No information	5	2.0

Variables	% without caries	Crude OR	p-value	Adjusted OR	p-value	Adjusted OR	p-value	Adjusted OR	p-value

		(95%CI)		(95%CI)		(95%CI)		(95%CI)

				Model 1		Model 2		Model 3
Socioeconomic factors
Household income
Up to US$374.00	35.8	1	<0.001	1	0.059	1	0,018	1	0,046
Greater than US$374.00	70.3	4.23 (1.97-9.10)	<0.001	2.44 (0.97-6.17)	0.059	2,91 (1,20 -7,07)	0,018	3,02 (1,02-8,95)	0,046
Mother’s level of education
Up to 8 years	24.5	1	<0.001	1	0.043	1	0,059	1	0,053
More than 8 years	52.8	3.45 (1.96-6.08)	<0.001	2.21 (1.03-4.77)	0.043	2,10 (0,97-4,52)	0,059	2,78 (0,98-7,87)	0,053
Mother’s remunerated work
No	50.5	1	0.012	1	0.811
Yes	33.8	0.50 (0.29-0.86)	0.012	0.92 (0.44-1.89)	0.811
Indoor bathroom
No	40.8	1	0.918	1	0.303
Yes	41.6	1.03 (0.55-1.95)	0.918	0.62 (0.25-1.56)	0.303
Adequate residence
No	32.7	1	0.008	1	0.378
Yes	50.4	2.09 (1.22-3.60)	0.008	1.39 (0.67-2.87)	0.378
Mother’s age when child was born
Up to 18 years	29.2	1	0.043	1	0.318
Over 18 years	45.6	2.04 (1.02-4.05)	0.043	1.60 (0.64-3.99)	0.318
Marital status
Single	38.3	1	0.388	1	0.857
Married/living together	43.9	1.26 (0.74-2.14)	0.388	1.60 (0.64-3.99)	0.857
Number of siblings
Two or more siblings	33.3	1	0.014	1	0.486
Up to one sibling	49.3	1.94 (1.15-3.30)	0.014	1.29 (0.63-2.65)	0.486
Psychosocial factors
Participation in groups
No	44.7	1	0,327			1	0.208	1	0.356
Yes	38.1	0.76 (0.44-1.31)	0,327			0.63 (0.31-1.30)	0.208	0.36 (0.28-1.57)
Sense of coherence
Weak	47.4	1	0.331			1	0,69
Strong	40.9	0.77 (0.45-1.31)	0.331			1.15 (0.58-2.27)	0,69
Resilience
Low	39.8	1	0.324			1	0,163	1	0.043
High	46.4	1.31 (0.77-2.22)	0.324			1.63 (0.82-3.26)	0,163	2.45 (1.03-5.81)
Family cohesion
Low cohesion	27.0	1				1		1
Moderate cohesion	44.2	2.14 (0.97-4.71)	0.058			2.48 (0.93-6.58)	0,069	5.61 (1.24-24.38)	0.021
High cohesion	63.0	4.60 (1.58-13.33)	0.005			6.40 (1.35-30.30)	0,019	29.36 (3.68-234.40)	0.011
Organizational religiosity
Low	44.6	1	0.484			1	0,379
High	39.3	0.80 (0.43-1.49)	0.484			0.66 (0.26-1.66)	0,379
Non-organizational religiosity
Low	43.9	1	0.834			1	0,361
High	42.4	0.94 (0.53-1.68)	0.834			1.46 (0.65-3.26)	0,361
Instrinsic religiosity
Low	47.4	1	0.400			1	0,170	1	0.646
High	41.5	0.79 (0.45-1.37)	0.400			0.61 (0.30-1.24)	0,170	0.82 (0.36-1.89)
Biological and behavioral factors
Child’s sex
Female	43.2	1	0.629					1	0.564
Male	40.2	0.88 (0.53-1.46)	0.629					0.79 (0.35-1.77)
Mother’s self-reported skin color
Non-white	38.5		0.028					1	0.060
White	57.1	2.13 (1.09-4.17)	0.028					2.66 (0.96-7.36)
Type of delivery
Cesarean	47.8	1	0.151					1	0.548
Vaginal	38.6	0.69 (0.41-1.15)	0.151					0.77 (0.34-1.77)
Mother’s frequency of toothbrushing
Sometimes	33.3	1	0.220					1	0.212
Everyday	43.7	1.55 (0.77-3.12)	0.220					0.42 (0.11-1.63)
Mother’s use of toothpaste
No	36.6	1	0.262					1	0.681
Yes	44.1	1.37 (0.79-2.36)	0.262					0.83 (0.34-2.04)
Mother’s nightly oral hygiene
No	43.1	1	0.842					1	0.788
Yes	41.6	0.94 (0.52-1.71)	0.842					0.86 (0.29-2.57)	0.788
Breastfeeding
Complementary/artificial	46.3	1	0.168					1	0.297
Exclusive	37.5	0.70 (0.42-1.17)	0.168					1.64 (0.65-4.17)	0.297
Sugar addition in the baby bottle
Yes	45.2	1	0.444					1	0.324
No	40.1	0.81 (0.47-1.39)	0.444					0.64 (0.26-1.56)	0.324
Use of pacifier
Yes	52.2	1	0.049					1	0.872
No	38.2	0.56 (0.32-1.00)	0.049					0.93 (0.37-2.34)	0.872
Finger sucking
Yes	38.1	1	0.686					1	0.294
No	42.7	1.21 (0.48-3.04)	0.686					2.27 (0.49-10.46)	0.294
Child performing oral hygiene
No one/Without supervision	44.6	1	0.653					1	0.866
With supervision	41.3	0.87 (0.48-1.59)	0.653					0.91 (0.32-2.60)	0.866
Frequency of child’s daily toothbrushing
< 2 times a day	38.1	1	0.599					1	0.777
≥ 2 times a day	42.5	1.20 (0.61-2.38)	0.599					0.84 (0.26-2.74)	0.777
Frequency with which the child sleeps without brushing his/her teeth
Sometimes/Frequently/Always	39.1	1	0.360					1	0.081
Never/Rarely	45.1	1.28 (0.75-2.17)	0.360					2.27 (0.90-5.69)	0.081
Use of dental floss
No	44.8	1	0.303					1	0.076
Yes	38.1	0.76 (0.45-1.29)	0.303					0.42 (0.16-1.09)	0.076

Variables	OR (95%CI)	p-value
Level of Education
Up to 8 years	1
More than 8 years	2.55 (1.42-4.59)	0.002
Family cohesion
Low cohesion	1
Moderate cohesion	1.85 (0.85-4.15)	0.138
High cohesion	3.66 (1.19-11.29)	0.024

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