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.
Excerpt: 4. Discussion
Tooth decay could adversely affect children’s health, quality of life, psychosocial well-being, and education [19,20]. The present study evaluated the effect of parental education and income on their children’s oral health.
The results showed a high prevalence (70%) of tooth decay among children. Similar findings were reported in previous studies among gulf countries [21,22,23,24]. This might explain the high incidence of dental caries disease among the community despite an improvement in educational and financial status of citizens and elaborating the need for applying oral health awareness programs among parents and children .
Additionally, only 11% of the parents reported that their children brush their teeth and 26% reported the use of fluoridated toothpaste. However, no significant association between both factors or independently and the prevalence of dental caries was observed. This may reflect other tooth brushing-related factors, such as the frequency, amount and duration of tooth brushing, that have a greater effect on tooth decay rather than the type of toothpaste used alone [26,27]. Additionally, the use of fluoridated toothpaste was not sufficient to prevent tooth decay, rather than the parents’ awareness of their children brushing habits. This is in agreement with previous studies that showed an enhanced anti-cariogenic effect of fluoridated toothpastes when compared to a placebo in supervising tooth brushing procedure [28,29]. Thus, parents need to be aware about the major role of brushing habits and soft drink intake in dental caries progression and prevention.
The study hypothesis was partially rejected as the results showed that parents with higher educational level and income were associated with lower prevalence of dental caries. In line with our findings, previous studies reported reduced prevalence of dental caries and improved oral health of children whose parents had high education and income [30,31,32]. This could be explained by the lack of knowledge about the importance of oral hygiene and preventive measures among less educated parents in comparison to higher ones [33,34].
In studying the role of each parent independently, it was found that higher maternal education was significantly associated with higher caries prevalence, unlike father’s educational impact, which agrees with other studies [35,36]. This might be due to the employment status of mothers who would not have enough time to develop proper oral hygiene and health dietary habits regime with their children . An alternative explanation might be that highly educated mothers with a high socioeconomic level in KSA are used to intaking meals including more soda and sugar-sweetened beverages  and fast food . However, specific data on the employment status and the dietary composition of family meals were not collected in the current study. On the other hand, educated mothers can easily detect the suitable healthy lifestyle by merging sports with healthy food when weight gain is noticed among their children [33,40]. The socioeconomic status affects the eating habits, which in turn are correlated with caries prevalence, particularly the high sugar intake [34,41].
Our findings showed that age was highly linked to caries prevalence where elder children exhibited more caries than younger ones. This is in agreement with Youssefi et al.’s  study, where a lack of knowledge about the methods of oral healthcare towards primary teeth may be the causative factor for higher caries prevalence, as is also parental belief regarding the importance of retaining the primary teeth in the oral cavity as they are exchangeable with permanent teeth so they are of minimal importance [43,44,45], since early shedding of primary teeth would expose permanent teeth early to cariogenic factors [46,47,48,49,50]. Additionally, anxiety and fear from dental treatment was seen increasing in older age .
Gender also showed significant association, where females were more prone to caries in the current study than males, which is in a line with several other studies [52,53]. Girls usually exhibit earlier eruption of teeth than boys which subject them to higher caries incidence . Additionally, dental fear was reported to be higher among girls than boys, which might hinder girls from going to dental visits and performing needed dental treatment [55,56]. On the other hand, boys in the Arabic culture are not raised to express their own fears as this represents a point of weakness on their personalities if they did .
The present study showed that lack of medical insurance had a significant effect on the prevalence of decayed/caries teeth. The reason for that could be financial problem due to the high cost of dental treatments, living in rural areas away from pediatric dentists with difficulty in transportation [57,58], where dental treatment exhibits a higher financial barrier than medical treatment .
Children’s oral health requires more attention by developing more public preventive healthcare programs that would serve children and reduce the incidence of caries . Parental dental education is also of great importance in order to provide their children with healthy dietary products and perform frequent dental follow ups according to the scheduled dental visits. Therefore, prevention of dental problems could have a positive impact on the children’s education and quality of life .
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