Psychosocial associated factors of early childhood caries and oral health-related quality of life: Structural equation model approach

• Published in: Journal of dentistry Vol. 133; p. 104506
• Main Authors: Bittencourt, Jéssica Madeira, Martins, Letícia Pereira, Paiva, Saul Martins, Pordeus, Isabela Almeida, Bendo, Cristiane Baccin
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-06-2023
• Subjects: Child; Child, Preschool; Cross-Sectional Studies; Dental caries; Dental Caries - epidemiology; Dental Caries - etiology; Dental Caries - psychology; Dental Caries Susceptibility; Dietary Sugars; Early childhood caries; Humans; Oral Health; Psychological resilience; Quality of Life; Structural equation modeling; Child, Preschool; Dental caries; Structural equation modeling; Psychological resilience; Early childhood caries; Quality of life
• ISSN: 0300-5712; 1879-176X
• DOI: 10.1016/j.jdent.2023.104506

•Low parental resilience is an indirect associated factor of ECC.•Low socioeconomic status is a direct associated factor of ECC.•Higher frequency of free sugar consumption is a direct associated factor of ECC.•ECC negatively affects the OHRQoL of children and their families.•SEM allows the analysis of different dependence relationships between the variables.
To identify a structural model for the identification of psychosocial associated factors of early childhood caries (ECC) and oral health-related quality of life (OHRQoL) in preschool children and their families.
A population-based cross-sectional study was conducted with 533 preschool children from 4 to 6 years-old public and private preschools, from Ribeirão das Neves, MG. Parents/caregivers self-completed the Brazilian versions of the Early Childhood Oral Health Impact Scale (B-ECOHIS) and Resilience Scale as well as a structured questionnaire addressing socioeconomic status and child's oral health behavior. Two dentists who had undergone training and calibration exercises for ICDAS‑epi and pufa index (Kappa≥0.95) performed the examinations for ECC. Stages of ECC were classified as free of visible carious lesion, initial caries, moderate caries, extensive caries without pulp consequences and extensive caries with pulp consequences. Data were analyzed using structural equation modeling, using Mplus version 8.6.
Lower socioeconomic status (b=-0.250; p<0.001) and higher frequency of free sugar consumption (b = 0.122; p = 0.033) were directly associated with a more severe stage of ECC. Lower parental resilience had an indirect impact on more severe stage of ECC which was mediated by the variable ‘frequency of free sugar consumption’ (b=-0.089; p = 0.048). ECC was associated with lower child's OHRQoL (b = 0.587; p<0.001) and lower family's OHRQoL (b = 0.506; p<0.001).
Structural modeling revealed that the severity of ECC negatively impacted the OHRQoL of preschoolers and their families. The main associated factors of the severity of ECC were lower socioeconomic status, higher frequency of free sugar consumption and lower parental resilience.
T The findings indicate that psychosocial and behavior variables can be associated with the severity of ECC, and ECC can be associated with negative impact on wellbeing and ability to perform daily activities of preschoolers and their families.