Parental Knowledge, Attitudes, and Practices and Their Association with Dental Caries in Children Aged 5–9 Years: A Cross-Sectional Study in Rural Ecuador
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Ethical Considerations
2.2. Study Variables
- No obvious decay (codes 0 to 3): Includes healthy teeth or teeth with initial lesions without cavitation.
- Obvious decay (codes 4 to 6): Corresponds to cavitated lesions involving dentin, with direct clinical involvement.
- Knowledge:
- b.
- Attitude:
- c.
- Practices:
2.3. Inclusion and Exclusion Criteria
- Children aged 5–9 years enrolled in school.
- Informed consent signed by caregivers.
- ▪
- Children with severe systemic diseases (e.g., congenital heart disease, immune disorders, uncontrolled diabetes, or ongoing cancer treatment).
- ▪
- Children undergoing specialized or ongoing dental treatment (orthodontics, endodontics, or post-surgical care).
- ▪
- Absence of informed consent.
2.4. Population and Sample
2.5. Calibration of Examiners and Data Collection Protocol
2.6. Data Collection Procedures
2.7. Data Management and Analysis
3. Results
3.1. Sample Distribution by Age and Sex
3.2. Classification of Dental Caries Severity According to ICDAS Grouping
3.3. KAP Survey Instrument (Knowledge, Attitudes, and Practices)
3.4. Bubble Plot of Logistic Regression Coefficients for Caregivers’ Knowledge Items Associated with Obvious Decay in Children (ICDAS 4–6)
3.5. Association Between Caregivers’ Attitude Toward Oral Health and the Presence of Obvious Decay
3.6. Frequency and Association of Children’s Oral Health Practices (N = 229)
3.7. Forest Plot—Multivariate Model (KAPs → Advance)
4. Discussion
4.1. Comparison of Results
4.2. Instruments and Methodology
4.3. Limitations and Biases
4.4. Study Contributions
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
ICDAS | International Caries Detection and Assessment System. |
KAPS | Knowledge, Attitudes, and Practices. |
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Age (Years) | Male N (%) | Female N (%) | Total N (%) |
---|---|---|---|
5 | 3 (1.3%) | 3 (1.3%) | 6 (2.6%) |
6 | 14 (6.1%) | 9 (3.9%) | 23 (10.0%) |
7 | 38 (16.6%) | 43 (18.8%) | 81 (35.4%) |
8 | 37 (16.2%) | 26 (11.4%) | 63 (27.5%) |
9 | 28 (12.2%) | 28 (12.2%) | 56 (24.5%) |
Total | 120 (52.4%) | 109 (47.6%) | 229 (100%) |
ICDAS Code Range | Decay Classification | N | % |
---|---|---|---|
0–3 | No obvious decay | 61 | 26.6 |
4–6 | Obvious decay | 168 | 73.4 |
Total | 229 | 100 |
KAP Category | Variable | Response Category | % |
---|---|---|---|
Attitude | Attitude toward dental health | Important | 21.0 |
Less important | 0.4 | ||
Very important | 73.8 | ||
Neutral | 4.8 | ||
Practice | Child’s feeling when brushing teeth | Happy | 90.8 |
Neutral | 0.4 | ||
Resistant | 7.9 | ||
Sad | 0.9 | ||
Child brushes the tongue | No | 13.5 | |
I don’t know | 19.2 | ||
Yes | 67.2 | ||
Knowledge | Foods that cause cavities | Chocolate | 52.0 |
Fruits | 4.8 | ||
Cookies | 29.3 | ||
Cakes | 14.0 | ||
Prolonged breastfeeding causes cavities | Agree | 26.6 | |
Disagree | 21.4 | ||
I don’t know | 52.0 | ||
Amount of toothpaste used | Full length of brush | 65.5 | |
It doesn’t matter | 3.5 | ||
Pea size | 31.0 | ||
Excess sugar causes cavities | Agree | 85.6 | |
Disagree | 2.2 | ||
I don’t know | 12.2 | ||
Sleeping with bottle causes cavities | Agree | 45.0 | |
Disagree | 5.7 | ||
I don’t know | 49.3 | ||
Age of first tooth eruption | 10–16 months | 18.8 | |
6–10 months | 71.6 | ||
I don’t know | 9.6 | ||
Cleaning baby teeth with gauze | Agree | 68.1 | |
Disagree | 6.6 | ||
I don’t know | 25.3 | ||
Best time to give sweets/cold drinks | After meals | 53.3 | |
Between meals | 12.7 | ||
None | 0.4 | ||
I don’t know | 33.2 | ||
Evening | 0.4 | ||
Brushing method | Forward/backward | 16.6 | |
Up/down | 39.7 | ||
Circulars | 37.6 | ||
It doesn’t matter | 6.1 | ||
Transmission of bacteria from mother to child | Agree | 58.1 | |
Disagree | 9.6 | ||
I don’t know | 32.3 | ||
Use of fluoride toothpaste | Agree | 54.1 | |
Disagree | 5.2 | ||
I don’t know | 40.6 | ||
Toothbrush replacement frequency | Every 3 months | 77.3 | |
Every 6 months | 16.6 | ||
When they open | 3.9 | ||
I don’t know | 2.2 | ||
Brushing frequency | After every meal | 17.9 | |
Twice | 16.2 | ||
Thrice | 63.3 | ||
Once | 2.6 | ||
What to do if child has toothache | Analgesic | 10.0 | |
Salt water | 9.6 | ||
Take to the dentist | 76.4 | ||
I don’t know | 1.7 | ||
Eat elsewhere | 2.2 |
Attitude Toward Oral Health | Frequency | Percentage (%) | OR | p-Value |
---|---|---|---|---|
Very Important | 169 | 73.8 | 1.32 | 0.363 |
Important | 48 | 21.0 | ||
Neutral | 11 | 4.8 | ||
Less Important | 1 | 0.4 |
Variable | Response | Frequency | Percentage (%) | OR (95% CI) | p-Value |
---|---|---|---|---|---|
Child’s feeling when brushing teeth | Happy | 209 | 91.3% | 0.30 (0.07–1.35) | 0.117 |
Neutral | 0 | 0.0% | |||
Resistant | 18 | 7.9% | |||
Sad | 2 | 0.9% | |||
Child brushes the tongue | Yes | 154 | 67.2% | 0.81 (0.42–1.54) | 0.519 |
I don’t know | 44 | 19.2% | |||
No | 31 | 13.5% |
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Saquicela-Pulla, M.; Dávila-Arcentales, M.; Vélez-León, E.; Armas-Vega, A.; Melo, M. Parental Knowledge, Attitudes, and Practices and Their Association with Dental Caries in Children Aged 5–9 Years: A Cross-Sectional Study in Rural Ecuador. Int. J. Environ. Res. Public Health 2025, 22, 953. https://doi.org/10.3390/ijerph22060953
Saquicela-Pulla M, Dávila-Arcentales M, Vélez-León E, Armas-Vega A, Melo M. Parental Knowledge, Attitudes, and Practices and Their Association with Dental Caries in Children Aged 5–9 Years: A Cross-Sectional Study in Rural Ecuador. International Journal of Environmental Research and Public Health. 2025; 22(6):953. https://doi.org/10.3390/ijerph22060953
Chicago/Turabian StyleSaquicela-Pulla, María, Mónica Dávila-Arcentales, Eleonor Vélez-León, Ana Armas-Vega, and María Melo. 2025. "Parental Knowledge, Attitudes, and Practices and Their Association with Dental Caries in Children Aged 5–9 Years: A Cross-Sectional Study in Rural Ecuador" International Journal of Environmental Research and Public Health 22, no. 6: 953. https://doi.org/10.3390/ijerph22060953
APA StyleSaquicela-Pulla, M., Dávila-Arcentales, M., Vélez-León, E., Armas-Vega, A., & Melo, M. (2025). Parental Knowledge, Attitudes, and Practices and Their Association with Dental Caries in Children Aged 5–9 Years: A Cross-Sectional Study in Rural Ecuador. International Journal of Environmental Research and Public Health, 22(6), 953. https://doi.org/10.3390/ijerph22060953