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

Childhood dental caries remains a critical public health issue in rural areas, where caregivers' knowledge, attitudes, and practices (KAP) significantly influence oral health outcomes. This study assessed the association between parental KAP and the prevalence and severity of caries in children aged 5-9 years in Cayambe, Ecuador.

Methods: A cross-sectional study was conducted with 229 schoolchildren and their caregivers, using a validated questionnaire and clinical examinations (ICDAS criteria). Caries severity was categorized as "obvious decay" (ICDAS 4-6) or "no obvious decay" (ICDAS 0-3).

Results: Advanced dental caries affected 73.4% of children (ICDAS 4-6). While parental knowledge and attitudes showed no significant association, brushing teeth ≥2 times/day significantly reduced caries severity (p < 0.05). Sociodemographic factors, such as parental education, were not significant predictors.

Conclusion: Oral hygiene practices-particularly frequent toothbrushing-were the key protective factor against severe caries, highlighting the need for behavior-focused interventions promoting daily habits. Future research should evaluate long-term preventive strategies.

Keywords: Ecuador; ICDAS; caregiver practices; childhood oral health; cross-sectional study; dental caries; health promotion; oral hygiene.

Figure 1

Bubble plot of logistic regression coefficients for caregivers’ knowledge items associated with obvious decay in children (ICDAS 4–6). Note: Bubble plot representing β coefficients from logistic regression models examining the association between caregivers’ knowledge responses and the presence of obvious decay (ICDAS codes 4–6) in children. Each bubble represents a unique response category. The vertical axis shows the survey item number and theme, and the horizontal axis shows the response options. The color indicates the direction of association (blue = negative, red = positive), and the bubble size reflects the statistical significance (larger size = lower p-value).

Figure 2

Forest plot—multivariate model (KAPs → advance). Notes: The results of this study reject the null hypothesis, demonstrating a statistically significant association between caregivers’ oral hygiene practices—specifically, the frequency of tooth brushing—and the presence of obvious decay ICDAS 4–6 in children. In contrast, no significant associations were found between the severity of cavities and caregivers’ knowledge or attitudes. These findings highlight the predominant role of behavioral practices in determining oral health outcomes in early childhood, even when general knowledge and attitudes toward oral health are favorable.