How oral health literacy and parental behavior during the meals relate to dental caries in children

This cross-sectional study aimed to verify the influence of parental behavior on the development of dental caries in children by assessing parents' behavior during their children's meals and their parental level of oral health literacy. This study was conducted with children aged 2 to 4 in Diadema, Sao Paulo, Brazil. Six hundred and thirty children were examined to assess the prevalence of dental caries (dmft index). Parents answered a questionnaire related to socio-demographic conditions, oral health literacy (OHL), and the parents' behavior during the meal - Parent Mealtime Action Scale - (PMAS). The analysis fitted zero-inflated negative binomial regression (ZINB) models to assess unadjusted and adjusted associations between the study outcome and covariates. In the unadjusted analysis, the child's age, the number of siblings, household crowding, family income, socioeconomic status and OHL were associated with the outcome (p <0.05). In the adjusted model, dental caries was more prevalent among 3- (PR: 1.85, 95%CI: 1.19-2.87) and 4-year-old children (PR: 2.43, 95%CI: 1.60-3.71), those with at least one sibling (PR: 1.66, 95%CI:1.18-2.33). Poor children were more likely to have dental caries (PR: 0.66, 95%CI: 0.48-0.91); the Use of Rewards dimension of the PMAS was associated positively with dental caries severity (RR: 0.90, 95%CI: 0.84-0.97). Although OHL was not associated with caries, parents' mealtime behaviors were related to dental caries. This suggested that communication between parents and children related to good eating practices could play a protective role against dental caries in children.