The studies were eligible for review if they matched the following inclusion criteria: 1 they evaluated a possible association between dental caries and parents' oral-health-related behaviors, and 2 the study methodology included oral clinical examination. The main search terms were "oral health", "parental attitudes", "parental knowledge", and "dental caries". Original articles, reviews, and chapters in textbooks were also considered. Oral health education programs aimed at preventive actions are needed to provide children not only with adequate oral health, but better quality of life.
Special attention should be given to the entire family, concerning their lifestyle and oral health habits. Keywords: Parental attitudes; Parental knowledge; Oral health; Dental caries. Parents' habits and knowledge about oral health have been found to influence their children's oral health status. In addition, other factors such as gender 11 and multiple levels of influence, including time or developmental dimensions, 12 have been observed.
Since oral hygiene is essential to oral health, it is wise to provide the population with adequate guidelines on children's oral health behavior and its relationship with dental caries. It is helpful to address the factors that influence children's oral health in order to develop and implement complementary public health actions focused on children and parental behaviors, in an endeavor to provide them with good oral health and better quality of life.
This literature review comprises a number of current models and scientific evidences regarding the influence of parents' oral health behaviors on their children's dental caries status.
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Data sources and study selection. The authors searched the MEDLINE database for articles published from to the end of June , supplemented by manual searching of the references from each relevant article identified. The studies were eligible for review if they matched the following inclusion criteria: 1 they evaluated a possible association between dental caries and parents' oral health related behavior, and 2 the study methodology included oral clinical examination.
Furthermore, original articles, reviews, and chapters in textbooks were also considered. Data extraction and synthesis. A total of records were originally retrieved. Two reviewers selected and reviewed the articles. First, each reviewer independently selected the articles based on their abstracts and checked their contents. Then, they looked for articles without abstracts.
A consensus was reached regarding the studies that fulfilled the inclusion criteria 13 articles , and which were included in this review. Of the 13 studies that met eligibility criteria, eight 1,2,10, related caries to parents' self-care practice, five described sugar as being responsible for caries, ,9,18 two 19,20 described the influence of parents' socioeconomic status on children's oral health; and two 3,21 associated the mothers' age with caries in their offspring.
A summary of each selected article is presented in Table 1. Parents harboring cariogenic bacteria. Negligence towards oral hygiene is widely known as the leading cause of dental caries.
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The oral cavity of a newborn is basically free of microbes. Soon after birth, numerous bacteria, including Streptococcus mutans , start to develop in their mouth. Since saliva flow is reduced during sleep, cariogenic bacteria gain prolonged access to fermentable substances, in a process that leads to dental decay. The colonization of mutans streptococci in a child's mouth is directly related to the risk of caries.
It is known that S. Maternal habits and behaviors may sometimes stimulate or increase microbial contamination in the child's oral cavity.
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The frequent contact between mother and child may cause early contamination and transmission of bacteria. Mothers are known to be the first to infect their children with cariogenic bacteria, 28 suggesting that their DMFS number of decayed, missing, and filled surfaces of permanent teeth might be a good indicator of caries experience in their children. A reduction in the number of S. This is an important aspect that should be assessed, since the earlier the child is contaminated by cariogenic microorganisms, the higher the risk of early caries development.
Colonization with mutans streptococci leads to early caries development, and should be targeted for caries prevention in clinical practice. Parents' toothbrushing habits and children's toothbrushing-related behavior. The association between parental toothbrushing and caries in children. Parents' toothbrushing habits were found to influence their children's toothbrushing behaviors. This hypothesis was confirmed by an international study involving 17 countries. Considering that regular toothbrushing and flossing eliminate cariogenic bacteria and fermentable substances from the tooth surfaces, good oral hygiene habits help prevent some oral pathologies, such as periodontal diseases and dental caries, which are considered common public health problems.
At different ages in childhood, toothbrushing habits should be introduced to children by their parents or care-givers, and practiced on a daily basis. Importance of interventions to improve parental toothbrushing. Parents' oral health behaviors have a direct influence on the number of decayed teeth of their children, indicating that oral health strategies should be focused not only on children but also on their parents.
In fact, the higher the parents' education level, the more favorable the oral self-care of their children. Maternal oral health habits undoubtedly influence her children's oral selfcare, emphasizing the mothers' role in the oral health of their offspring; therefore, oral health educational programs focusing on these aspects should be developed. However, the caries index observed for children and the oral health status of their mothers imply that this epidemiological approach has failed to assess the oral health of those attending the educational programs aimed to prevent oral diseases.
Castilho et al. However, a caries index mean DMFT: 5. According to Finlayson et al. Interestingly, parental self-efficacy is associated with insecurity about correct toothbrushing techniques, but mostly, to a self-reported oversensitivity to the child's desires for some particular foods or not liking to brush.
Favorable oral habits are more often reported by girls. Therefore, more attention should be given to parents, since they influence their children's behaviors in a general way. Parental knowledge, attitudes, and socioeconomic status. Widely investigated parental characteristics such as knowledge, attitudes, and socioeconomic status influence children's oral health behaviors. Cultural norms and practices influence a large variety of social factors, such as values, beliefs, and customs, affecting children's oral health.
Culture comprises religion, health beliefs, language, diet, family structure, and medical and dental preventive approaches. The association between children's poor oral health and low socio-economic status of the family is clear. The fact that mothers of children in ethnic minority groups often receive only a few years of education results in poor communication skills, and consequently poor dental health.
Based on several studies, the key elements that showed particular impact on children's oral health behavior and oral health status were: parents' oral health-related attitudes, general knowledge, and health status. Although parental factors are known to influence children's dental health, there are differences between study models for boys and girls.
Boys were influenced by their father's occupational level, while girls were influenced by their father's knowledge and behavior. Taking these findings into consideration, school health educational interventions involving the entire family are needed to provide children with more adequate preventive guidelines in order to ensure the success of their oral health. It is remarkable that the day-to-day life of families is largely influenced by social, cultural, environmental, and economic conditions.
These social aspects play key roles in oral health, with positive or negative influence on the adoption of particular oral health attitudes and behaviors. Early education and implementation of preventive measures at home. Clearly, family environments encourage healthy choices and lifestyles. Although parents play the most important role in the oral health of their children, schoolteachers are also important and should be involved in children's oral health education.
Early oral health education and preventive measures help reduce the need for future surgical interventions. However, the parents must be able to assimilate the information, understand the instructions provided, and implement them as part of the child's preventive oral health routine. Unfortunately, many adults are only partially literate, and consequently, have more difficulty in understanding the instructions on dental caries prevention.
In summary, parents' dental hygiene habits, educational backgrounds, and child-rearing abilities have a favorable effect on their children's dental health status. Contextual aspects related to a family's capacity to develop and maintain good dental health behaviors are relevant in pediatric dentistry, since parents with poor dental health behaviors indicate caries risk in their children. Recommendations on children's oral health care. A better understanding of social, economic, belief, behavioral, and attitudinal factors is crucial in studies with the goal of oral health promotion.
A central model based on oral health promotion efforts ss was developed to provide the population with substantial knowledge and guidelines on oral health-related behaviors. A wider outlook involving multiple determinants of oral health 53 is needed to encourage individuals from different backgrounds to adopt a healthy lifestyle. Socioeconomic disparities account for part of the oral health behaviors involving the whole family. Oral health policies designed to change behaviors are unlikely to completely eliminate disparities in oral health.
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The entire family should take responsibility for their dental hygiene. Health-influencing factors are addressed at individual, family, and community levels. Children live in families; families are included in communities. Therefore, effective community initiatives, such as oral health promotion and public approaches are related to children's oral health.
Communities that value oral health lead to children with better oral health. Oral health is correlated with general health. Consequently, any approach to children's oral health must be based on a multilevel outlook as a means to achieve long-term effects.
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The idea behind motivating both the individual and community must be understood. Individuals at the highest risk of caries with the lowest motivation are the most difficult patients to work with during the practice of oral health education. The key concept of the health promotion approach is the empowerment of individuals.
Poor parental oral health behaviors are likely to be caries predictors for their children. Shared decision-making functions as a favorable communication tool between professionals and patients in health care. Caries, the most frequent oral disease, are preventable with the adoption of effective interventions in the individual's lifestyle and habits, including oral hygiene.
However, the population's cooperation is a dominant factor in every preventive approach, because knowledge and information are not enough to promote oral health. In fact, oral health promotion is highly dependent on good health behaviors. Successful preventive actions against oral diseases involve environmental modifications and development of strategies that enable people to choose a healthier lifestyle 75 by creating resources that guide them to a more active and productive life, resulting in good health status, and consequently, a satisfactory quality of life.
Reducing inequalities in oral health continues to be the greatest dental public health challenge. This social gradient is constantly associated with minor illnesses and causes of death, affecting all age groups, genders, races, and countries. According to public health studies, biological, psychosocial, behavioral, environmental, and political factors are observed to be the cause of dental diseases. Social determinants of oral health inequalities undoubtedly have some influence on oral health; however, the broader background that determines patterns of behavior must be deeply analyzed in order to create a social environment that supports good oral health habits.
The development and implementation of satisfactory public health actions at different levels local, national, and international are essential for health promotion. The adoption of consistent behavioral habits in childhood begins at home, with the parents, especially the mother, playing an important role in the child's oral health-behaviors. Parents should be informed that their dental health habits influence their children's oral health, and consequently, their quality of life.
Therefore, a more soundly based health educational program involving all family members is needed to provide parents with adequate guidance on how to maintain the oral health of their children. The authors have no conflicts of interest to declare. Will the role of family influence dental caries among seven-year-old children? Acta Odontol Scand. Familial and cultural perceptions and beliefs of oral hygiene and dietary practices among ethnically and socio-economically diverse groups.
Community Dent Health. Caries in five-year-old children and associations with family-related factors. J Dent Res. Behavioural and demographic factors during early childhood and poor dental health at 10 years of age. Caries Res. Application of the high-risk strategy to control dental caries. Community Dent Oral Epidemiol. Gibson S, Williams S. Dental caries in pre-school children: associations with social class, toothbrushing habit and consumption of sugars and sugar-containing foods.
Further analysis of data from the National Diet and Nutrition Survey of children aged 1. Petersen PE. Sociobehavioural risk factors in dental caries - international perspectives. Socio-economic effect on caries.
Incidence data among Swedish year-olds. Distribution of caries in year-old children in Sweden. Social and oral health-related behavioural patterns. Influence of parents' oral health behaviour on oral health status of their school children: an exploratory study employing a causal modelling technique. Int J Paediatr Dent. Using a "lifestyle" perspective to understand toothbrushing behaviour in Scottish schoolchildren.
Influences on children's oral health: a conceptual model. Influence of mothers' oral health knowledge and attitudes on their children's dental health. Eur Arch Paediatr Dent. Oral health behaviour of Iranian mothers and their 9-year-old children. Oral Health Prev Dent. Evaluation of oral health knowledge and oral health status in mothers and their children with cleft lip and palate. Cleft Palate Craniofac J. Gender differences in child-related and parent-related determinants of oral health-related lifestyle among to year-old Finnish schoolchildren.
LOG IN. Additional Information. Table of Contents. Cover Download Save. Contents pp. Foreword Fern Ingber pp. Preface pp. Part I. Chapter 1. Chapter 2. Basic Care and Cleaning pp. Chapter 3. The Dental Visit pp. Chapter 4. Preventing Decay and Protecting Teeth pp.
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Chapter 5. Affording Dental Care for Your Child pp. Part II. Ages and Stages. Chapter 6. Chapter 7. Infants and Toddlers Newborn to Age 4 pp.
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