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Table of Contents
Year : 2020  |  Volume : 7  |  Issue : 3  |  Page : 43-45

Influence of family structure on dental caries experience of preschool children: A cross-sectional study

1 Senior Lecturer, Department of Pedodontics and Preventive Dentistry, Mahe Institute of Dental Sciences and Hospital, Chalakara, Mahe, Union Territory of Puducherry, India
2 Assistant Professor, College of Dentistry, King Faisal University, Al Ahsa, Kingdom of Saudi Arabia

Date of Submission17-Aug-2020
Date of Acceptance06-Sep-2020
Date of Web Publication29-Sep-2020

Correspondence Address:
Dr. Binoy Mathews Nedumgottil
College of Dentistry, King Faisal University, Al Ahsa
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/INPC.INPC_36_20

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Introduction: Dental caries is the most common oral disease affecting preschoolers. Despite the improvement in oral hygiene practices and dietary habits, no evident decline in their decayed, missing, and filled teeth levels was observed, which shifts away the focus of understanding its etiology from primarily a dietary-induced bacterial infection to a rather complex disease with multiple contributing factors.
Aim: The aim is to explore the impact of parental characteristics and family structure on dental caries experience of preschoolers.
Subjects and Methods: Dental caries status of 200 children, aged 3–5 years in Chidambaram was assessed using the WHO standard criteria for primary teeth and informations on family structure were obtained from parents using questionnaire.
Results: Family size, birth rank, age difference between the subject and siblings, parent's age, and educational status of parents were found to be associated with the dental caries experience of the preschoolers at bivariate level. In a stepwise multiple linear regression analysis family size, birth rank, and mother's educational status remained statistically significant.
Conclusion: Family structure might significantly affect the caries experience of preschool children.

Keywords: Birth rank, dental caries, family size, maternal education

How to cite this article:
Sam S, Nedumgottil BM. Influence of family structure on dental caries experience of preschool children: A cross-sectional study. Int J Prev Clin Dent Res 2020;7:43-5

How to cite this URL:
Sam S, Nedumgottil BM. Influence of family structure on dental caries experience of preschool children: A cross-sectional study. Int J Prev Clin Dent Res [serial online] 2020 [cited 2021 Jun 15];7:43-5. Available from: https://www.ijpcdr.org/text.asp?2020/7/3/43/296543

  Introduction Top

Dental caries is an oral disease with frequent initial onset of occurrence in infants, preschoolers, elementary school children and adolescents,[1] affecting their general health and growth pattern.[2] Early childhood caries (ECC) being a disease with complex nature and multifactorial contribution, factors such as social, behavioral, psychological, and biological factors were initially included in the prediction of its occurrence,[3] which was later expanded, resulting in a recent multilevel conceptual model of children's oral health as proposed by Fisher-Owens et al. which incorporates influences exerted at the individual, family, and community levels.[4] Variables such as parent's educational level,[5] socioeconomic status,[6] family size, birth rank, and age difference between the subject and next oldest sibling and parent's age at birth of the subject were reported to have influence on the dental caries experience of the preschool children.[7]

Besides these studies, there is a paucity of information regarding the collective and individual effect of family structural characteristics in determining ECC in child population of Chidambaram, Tamil Nadu. The purpose of this study, therefore, was to investigate the association between selected variables related to family structure and ECC in 3–5-year-old children in Chidambaram.

  Subjects and Methods Top

Study population

The study was done in 200 children aged 3–5 years from Chidambaram, Tamil Nadu, India. Necessary permission from the school administration was obtained for participation in the study. The children with the presence of systemic illnesses, child without both parents, children from reconstituted families, and adopted children were excluded from the study.

Data collection

Questionnaire with self-structured, closed-ended questions in local language, to gather informations regarding the parental characteristics and family structure such as family size (number of children in the family), birth rank, age difference between the child included in the study and siblings, age of mother at birth of the subject, family annual income, and parent's educational status were handed to the children, filled by the parents and were collected from the children at school, the next day.

Dental caries assessment (Type III oral examination) was carried out by single pediatric dentist using decayed, missing, and filled teeth (dmft) index (decayed, extracted, filled teeth score) with basic oral examination instruments under daylight. Caries was diagnosed and recorded using visual and tactile methods according to the WHO criteria for primary teeth. Children requiring further evaluation and management of caries were referred to the tertiary health center.

Data analysis

Collected data were subjected to descriptive analysis using the SPSS 13 version. Student's test was employed and risk factor association with ECC was investigated using a stepwise multiple linear regression analysis with P < 0.05 considered statistically significant.

  Results Top

At bivariate level, analysis illustrated statistically significant difference (P = 0.001) in caries experience, with increased risk among children from families with >2 children than from families with <2 children. Birth rank of the child in the family was found to have significant (P = 0.001) influence on the dmft score, with second born having high caries experience. Relative frequency of caries was found to be highest in subjects whose parents had low educational level. Among the study population, caries experience was more in children when age spacing between the siblings was <2 years than in children with >2 years of age spacing (P = 0.001) [Table 1].
Table 1: Mean decayed, missing, and filled teeth of preschool children by age, gender, and family characteristics

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To identify the strongest determinants of ECC presence, all variables were then subjected to stepwise multiple linear regression analysis. Of all the variables analyzed only family size, birth rank, and mother's educational status were found to be significantly associated with the caries experience of the preschool children [Table 1].

  Discussion Top

Children below 2 years of age were excluded from the study, as it was not easy to get cluster of the sample. In the representative sample, there was positively skewed distribution of the dmft score.[8] No significant association was observed between the caries experience and age as well as gender.[8] Reason for equal distribution of caries would be their younger age, to develop gender difference as well as the dietary and oral hygiene practices being mostly controlled by parents.[8]

The present study illustrated, high caries experience in children from increased family size,[5],[7] based on the effort and amount of time invested by the parents depending on the family size.[5],[7] Birth rank of the child was found to have significant (P = 0.001) influence on the dmft score, with second born having high caries experience,[7],[9] which may be due to less stern monitoring of their dietary and oral habits and also, there might be a possibility of natural inclination toward the first born rendering them more attention.[7]

Stepwise multiple linear regression analysis showed, strong association only between the mother's educational level and caries experience among their children and not with father's educational level[10] which suggested that, it might be due to the difference in parental role in dental care of their children and improved awareness among the educated mothers regarding dental health practices, role of dietary sugar in dental health and general well-being of the child.

This study is however, limited only to evaluating only few variables in the family structure. Although efforts were made to ensure internal consistency of the questionnaire, both memory bias as well as socially accepted answers were anticipated to have its effect on the final result. As this study was conducted in a convenience sample, utilizing the evidences gathered from this study is limited only to take informed decisions on the development of dental health-care strategies only within this community. Future research with large sample size nested in a national cross-sectional study is needed to corroborate the present findings.

  Conclusion Top

Few potential risk factors identified through this survey, can be used to identify and target high risk social groups on promoting awareness, introducing population-based screening measure at the level of preschool and also in establishing a framework for the formulation of preventive oral health-care protocol between the dental and general health-care personnel, based on the information that are routinely collected about the families while rendering general health-care services.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Ryu K, Jeong S, Kim J, Choi Y, Song K. Effect of mother's oral health behaviour and knowledge on dental caries in their preschool children. J Korean Acad Dent Health 2004;28:105-15.  Back to cited text no. 1
Hamila A. Early childhood caries and certain risk factors in a sample of children 1-3.5 Years in Tanta. Dentistry 2013;4:1.  Back to cited text no. 2
Reisine S, Douglass JM. Psychological and behavioral issues in early childhood caries. Community Dent Oral Epidemiol 1998;Suppl 1:32-44.  Back to cited text no. 3
Fisher-Owens SA, Gansky SA, Platt LJ, Weintraub JA, Soobader MJ, Bramlett MD, et al. Influences on children's oral health: A conceptual model. Pediatrics 2007;120:e510-20.  Back to cited text no. 4
Sujlana A, Pannu PK. Family related factors associated with caries prevalence in the primary dentition of five-year-old children. J Indian Soc Pedod Prev Dent 2015;33:83-7.  Back to cited text no. 5
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Cianetti S, Lombardo G, Lupatelli E, Rossi G, Abraha I, Pagano S, et al. Dental caries, parents educational level, family income and dental service attendance among children in Italy. Eur J Paediatr Dent 2017;18:15-8.  Back to cited text no. 6
Wellappuli NA, Amarasena NB. Influence of family structure on dental caries experience of preschool children in Sri Lanka. Caries Res 2012;46:208-12.  Back to cited text no. 7
Suchithra MS, Sreedharan S, Thomas V, Nayar BR. Dental caries experience in preschool children of Thiruvananthapuram, Kerala: Is it related to the socio-demographic factors? IOSR J Dent Med Sci 2018;17:49-56.  Back to cited text no. 8
Tiberia MJ, Milnes AR, Feigal RJ, Morley KR, Richardson DS, Croft WG, et al. Risk factors for early childhood caries in Canadian preschool children seeking care. Pediatr Dent 2007;29:201-8.  Back to cited text no. 9
Vargas-Ferreira F, Piovesan C, Praetzel JR, Mendes FM, Allison PJ, Ardenghi TM. Tooth erosion with low severity does not impact child oral health-related quality of life. Caries Res 2010;44:531-9.  Back to cited text no. 10


  [Table 1]


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