How oral health literacy and parental behavior during the meals relate to dental caries in children

MORIYAMA, Caroline Moraes; VELASCO, Sofia Rafaela Maito; BUTINI, Luciane; ABANTO, Jenny; ANTUNES, José Leopoldo Ferreira; BÖNECKER, Marcelo

doi:10.1590/1807-3107bor-2022.vol36.0131

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Original Research, Community Dental Healt • Braz. oral. res. 36 • 2022 • https://doi.org/10.1590/1807-3107bor-2022.vol36.0131 linkcopy

How oral health literacy and parental behavior during the meals relate to dental caries in children

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Abstract

This cross-sectional study aimed to verify the influence of parental behavior on the development of dental caries in children by assessing parents’ behavior during their children’s meals and their parental level of oral health literacy. This study was conducted with children aged 2 to 4 in Diadema, São Paulo, Brazil. Six hundred and thirty children were examined to assess the prevalence of dental caries (dmft index). Parents answered a questionnaire related to socio-demographic conditions, oral health literacy (OHL), and the parents’ behavior during the meal - Parent Mealtime Action Scale - (PMAS). The analysis fitted zero-inflated negative binomial regression (ZINB) models to assess unadjusted and adjusted associations between the study outcome and covariates. In the unadjusted analysis, the child’s age, the number of siblings, household crowding, family income, socioeconomic status and OHL were associated with the outcome (p <0.05). In the adjusted model, dental caries was more prevalent among 3- (PR: 1.85, 95%CI: 1.19–2.87) and 4-year-old children (PR: 2.43, 95%CI: 1.60–3.71), those with at least one sibling (PR: 1.66, 95%CI:1.18–2.33). Poor children were more likely to have dental caries (PR: 0.66, 95%CI: 0.48–0.91); the Use of Rewards dimension of the PMAS was associated positively with dental caries severity (RR: 0.90, 95%CI: 0.84–0.97). Although OHL was not associated with caries, parents’ mealtime behaviors were related to dental caries. This suggested that communication between parents and children related to good eating practices could play a protective role against dental caries in children.

Pediatric Dentistry; Behavior; Education, Dental; Dental Caries

Demographic characteristics	n (%)
Age
2 years	213 (33.81)
3 years	213 (33.81)
4 years	204 (32.38)
Sex
Female	298 (47.30)
Male	332 (52.70)
Number of siblings
None	272 (43.17)
1 or more	343 (54.44)
Socioeconomic status
Mother’s level of education
≤ 10 years of schooling	219 (34.76)
> 10 years of schooling	401 (63.65)
Mother’s age	312 (49.68)
≤ 30 years	314 (50.00)
> 30 years
Father’s age	198 (31.43)
≤ 30 years	382 (60.63)
> 30 years
School frequency
Yes	452 (71.75)
No	154 (24.44)
Family income
Up to 2 minimum wage	315 (50.00)
≥ 2 minimum wage	296 (46.98)
Socioeconomic stratum
A1+A2+B1	200 (31.75)
B2+C1+C2+D-E	429 (68.10)
Household crowding (mean ± sd)	1.14 (0.024)
< 1	355 (56.35)
> 1	244 (38.73)
Oral health characteristics
Frequency of sugar consumption
< 3 times a day	260 (41.27)
> 3 times a day	365 (57.94)
Tooth brushing
≥ 2 a day	509 (80.79)
< 2 a day	106 (16.83)
Untreated caries experience
Absence	479 (76.04)
Presence	151 (23.97)
BREALD
Low	90 (14.29)
Ideal	538 (85.40)
(mean ± sd)	19.27 (0.26)

Variables	Prevalence		Severity

	PR (95% CI)	p-value	RR (95% CI)	p-value
Demographic characteristics
Child’s age
2 years	Ref.
3 years	1.80 (1.16–2.80)	0.008	0.80 (0.48–1.35)	0.412
4 years	2.49 (1.64–3.79)	< 0.001	1.11 (0.68–1.82)	0.660
Child’s sex
Male	Ref.		0.97 (0.67–1.40)
Female	1.02 (0.75–1.39)	0.894	0.97 (0.67–1.40)	0.865
Number of siblings
None	Ref.
One or more	1.74 (1.24–2.44)	0.001	1.17 (0.79–1.73)	0.426
Socioeconomic characteristics
Mother’s level of education
≤ 10 years of schooling	Ref.
> 10 years of schooling	0.801 (0.58–1.11)	0.187	0.77 (0.53–1.13)	0.193
Mother’s age
≤ 30 years	Ref.
> 30 years	0.98 (0.72–1.33)	0.904	1.03 (0.71–1.49)	0.877
Father’s age
≤ 30 years	Ref.
> 30 years	1.23 (0.87–1.76)	0.23	1.16 (0.76–1.77)	0.489
School frequency
Yes	Ref.
No	0.75 (0.51–1.11)	0.149	1.21 (0.77–1.89)	0.409
Household crowding
Up to one	Ref.
More than one	1.40 (1.01–1.92)	0.039	1.13 (0.77–1.65)	0.541
Brazilian minimum wage
< 2 BMW	Ref.
≥ 2 BMW	0.73 (0.53–0.99)	0.049	0.74 (0.51–1.08)	0.126
SES classification
A – B1	Ref.
B2 - E	1.50 (1.05–2.17)	0.027	1.43 (0.92–2.22)	0.114
Health literacy
BREALD-30
Low	Ref.
Ideal	0.65 (0.43–0.97)	0.035	1.03 (0.63–1.67)	0.903
Behavioral characteristics
Frequency at school
No	Ref.
Yes	0.75 (0.50–1.10)	0.149	0.52 (–0.02–1.05)	0.06
Tooth brushing frequency
≥ 2	Ref.		Ref.
< 2	0.75 (0.50–1.10)	0.149	1.17 (0.75–1.83)	0.479
Daily sugar intake
≤ 3	Ref.		Ref.
> 3	1.02 (0.75–1.40)	0.875	0.92 (0.63–1.34)	0.659
PMAS
Daily fruits and vegetables	1.03 (0.92–1.16)	0.531	1.01 (0.87–1.15)	0.936
Snack modelling	1.11 (0.99–1.23)	0.063	0.99 (0.88–1.11)	0.872
Use of rewards	1.00 (0.93–1.08)	0.935	0.90 (0.84–0.97)	0.005
Many food choices	1.01 (0.93–1.10)	0.767	0.92 (0.84–1)	0.059
Fat reduction	0.94 (0.86–1.03)	0.215	0.98 (0.88–1.09)	0.701
Special meals	1.05 (0.94–1.18)	0.381	0.89 (0.78–1.01)	0.072
Snack limits	0.99 (0.91–1.07)	0.767	1.01 (0.91–1.12)	0.800
Positive persuasion	0.95 (0.89–1.02)	0.138	1.02 (0.93–1.12)	0.650
Insistence on rating	0.98 (0.91–1.05)	0.535	1.04 (0.95–1.13)	0.361

Variables	Prevalence		Severity

	PR (95% CI)	p-value	RR (95% CI)	p-value
Demographic characteristics
Child’s age (years)
2	Ref.		**
3	1.85 (1.19–2.87)	0.006
4	2.43 (1.60–3.71)	< 0.001
Number of siblings
None	Ref.		**
One or more	1.66 (1.18–2.33)	0.003
Socioeconomic characteristics
Brazilian minimum wage
< 2 BMW	Ref.		**
≥ 2 BMW	0.66 (0.48–0.91)	0.011
Behavioral characteristics
PMAS
Daily fruits and vegetables
Snack modelling	1.11 (0.99–1.23)	0.055
Use of rewards			0.90 (0.84–0.97)	0.005
Many food choices
Fat reduction
Special meals
Snack limits
Positive persuasion
Insistence on eating

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[TFN1] Number of missing subjects: number of siblings: 15; mother’s level of education: 10; mother’s age: 4; father’s age: 50; school frequency: 24; family income: 19; socioeconomic stratum: 1; household crowding: 31; frequency of consumption of sugar: 5; tooth brushing: 15; BREALD: 2.