
==== Front
BMC Oral Health
BMC Oral Health
BMC Oral Health
1472-6831
BioMed Central London

39300481
4818
10.1186/s12903-024-04818-1
Research
Oral health care among children in Saudi Arabia: a cross-sectional study
http://orcid.org/0000-0002-9788-0379
Sabbagh Heba Jafar hsabbagh@kau.edu.sa

Alzain Ibtesam Omar
https://ror.org/02ma4wv74 grid.412125.1 0000 0001 0619 1117 Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, P.O. Box: 80200, Jeddah, 21589 Saudi Arabia
19 9 2024
19 9 2024
2024
24 111813 3 2024
27 8 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Background

Oral health is crucial for caries prevention. Research reported variations in oral health practices among countries and individuals. Therefore, this study aims to examine and compare oral hygiene practices among children aged 3 to 11 years old across five areas of Saudi Arabia.

Methods

This cross-sectional study includes healthy children aged 3 to 11 from five areas/regions of Saudi Arabia. A self-administered, validated parental questionnaire was constructed according to the WHO Oral Health Questionnaire for children, which inquires about the child’s socio-demographic factors, oral health evaluation, and oral hygiene practice.

Results

Out of the 1516 parents who participated, 21.2% reported their children brushing twice a day. Regression analysis found that the first-born children and those who visited a dentist displayed a significantly higher adjusted odds ratio (AOR) for parents reporting that their child practices oral health care compared to only children (AOR: 2.837; P = 0.016) and to those who did not visit a dentist in the last 12 months (AOR: 2.989; P < 0.001).

Conclusion

This study highlights that only 21.2% of parents reported their children practicing excellent oral hygiene by brushing twice a day. This underscores the importance of early dental visits, customized interventions, and prevention programs that account for regional and demographic factors, such as birth order, to effectively promote oral health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-024-04818-1.

Keywords

Child order
Children
Oral health care
Oral hygiene practice
Practice
Saudi Arabia
issue-copyright-statement© BioMed Central Ltd., part of Springer Nature 2024
==== Body
pmcBackground

Dental caries is the prevailing oral health concern among school children [1]. This issue is compounded by the potential ramifications of untreated severely damaged teeth, manifesting as pain and discomfort that adversely affect various aspects of children’s quality of life. The research underscores its impact on essential domains such as sleep patterns, school attendance [2–4], dietary habits, growth, nutritional status, and overall body weight [5–7]. Moreover, studies by Nalliah et al. (2010) and Naidu et al. (2005) highlight odontogenic infections arising from untreated dental decay as a cause of pediatric hospitalizations [8], significantly impairing both the general health and quality of life of affected children [9].

Establishing good oral health habits early in life is essential to prevent oral disease. Moreover, since dental caries is preventable, the American Academy of Pediatric Dentistry (AAPD) recommends that the first dental visit occur no later than 12 months [10]. During that time, the child’s caries risk will be assessed, prevention advice will be given, topical fluoride application will be carried out, and early diagnosis and treatment of dental caries can occur [10, 11]. Furthermore, if the dental home is established early in life, it reduces the treatment burden on the treating institutes and the child experiencing caries and their families [12].

Recently, it was found that dental caries in children in Saudi Arabia showed an increased need and demand for dental public health services [13]. Furthermore, Al Agili et al. stated in their systematic review that the prevalence of dental caries in primary dentition was alarmingly high in Saudi Arabia (80%), which warrants both immediate intervention and long-term planning from the government and dental health professionals [14]. Also, a meta-analysis conducted by Adam in 2022 concluded that the prevalence of caries in Saudi Arabia was 84% in school children aged 5–7 years old. Studies were recommended to assess the effectiveness of the ongoing dental preventive programs [15].

The Global Oral Health Goals in 2003 were developed and set by the combined efforts of the World Health Organization (WHO), the World Dental Federation, and the International Dental Research Association to be reached by 2020 [16]. The main goal was to reduce the prevalence of caries on the individual and societal level through early prevention, diagnosis, oral health care, and treatment of dental caries [17]. Research reported variation in oral health practices among countries and individuals [18, 19].

Numerous epidemiological investigations conducted in Saudi Arabia have identified various factors correlating with dental caries incidence in children, including dietary patterns, parental educational attainment, and oral hygiene practices [20–22]. Nonetheless, many of these studies are geographically limited [20, 23], with some focusing solely on male subjects. One national study conducted in Saudi Arabia, which included a population ranging from 15 to over 65 years old, reported that 71.5% of individuals brushed their teeth [24]. Given the pivotal role of oral health in preventing dental ailments among children, this study aims to assess and compare oral hygiene practices among children aged 3 to 11 years old across five areas of the Kingdom of Saudi Arabia.

Materials and methods

This cross-sectional study was approved by the Research Ethics Committee of the Faculty of Dentistry, King Abdulaziz University (Approval No. 232-03-21/30 May 2021). The research was conducted between July 2021 and June 2022, including parents of healthy children aged 3 to 11 from five areas of Saudi Arabia. These areas were delineated based on previous studies as follows [25]: Central (Riyadh, Qasim); the Western (Mecca, Medina, Jeddah); the Eastern (Dammam, Khafji, Al-Hasa); the Northern (Tabuk, Jouf, and Hail); and the Southern (Asir, Najran, Jizan), thus dividing the country into five major urban geographical sections, each offering unique insights into the diversity of the country’s culture [26].

The sample size suggested for each area was 330 parents. Elkhodary et al. [18] reported factors affecting oral health practices in multiple countries. Oral health care at least once per day was practiced by 44.7% of their sample. An odds ratio (OR) of 0.5 (relationship between parental education and children’s oral health care), 95% confidence interval, and power of 80% were entered into the OpenEpi (Version 3) [18] website. The inclusion criteria included parents of healthy children aged 3 to 11 years old living in Saudi Arabia during the study period.

Methods

An online self-administered parental questionnaire was constructed according to the WHO Oral Health Questionnaire for children [27] that includes the following:

General information on caregivers, including demographic data and socioeconomic factors such as parental education level and area of residence.

Oral health evaluation, including the child’s oral health status described by the parents, according to the WHO Oral Health Questionnaire for Children [27], and if the child visited the dentist in the last 12 months.

Oral hygiene practice, including the frequency of brushing teeth and the method used to clean the teeth.

The questionnaire was validated by face validity (10 parents) to ensure clarity. Furthermore, the content was validated “content validity” in Arabic by five experts (content validity index (CVI) scores of 0.98). It was electronically distributed using the snowball sampling technique. A data collector was appointed for each area and was asked to distribute the questionnaire electronically using different roots to improve generalizability. Teachers, community workers, medical health care providers, and personnel with different socioeconomic statuses were requested to distribute the questionnaire. Different platforms were utilized to distribute the questionnaire, such as WhatsApp, Instagram, and X platform.

The data was analyzed using SPSS software, version 23 (IBM Corp., Armonk, NY, USA). Categorical variables were presented as frequencies and percentages and compared using the chi-square test. Binary regression analysis was conducted by calculating the adjusted odds ratio (AOR) to overcome the effect of confounders. In Saudi Arabia, maternal education, child gender, age, and whether the child had a dentist in the last 12 months were considered independent factors. The regression analysis did not include paternal education because of its high collinearity with maternal education. The significance level was set at p < 0.05.

Results

Among the five regions in Saudi Arabia, a total of 1,516 parents participated in this study.

Participant’s characteristics

Out of the total sample, 477 (31.5%) were from the Central area, 463 (30.5%) were from the Western area, 784 (51.7%) were males, and 576 (38%) had children 2 to 5 years old.

Parents reports of their children’s oral health care practices

There were 1406 (92.7%) parents reported their children practicing oral healthcare (see Table 1). Of them, 322 (21.2) reported brushing twice a day, 671 (40.7%) reported brushing once a day, and 110 (7.3%) never did. Moreover, 708 (46.7%) used toothpaste containing fluoride; on the other hand, 76 (5%) have never used any brush tool (see Table 2).

Table 1 Sample distribution according to child oral healthcare practices and parent /child characteristics (N = 1516)

Variables	Does your child practice oral healthcare?	Total	P-value	
Yes	No	
Area of residence	South	242 (17.2)	21 (19.1)	263 (17.3)	< 0.001*	
North	114 (8.1)	17 (15.5)	131 (8.6)		
East	164 (11.7)	18 (16.4)	182 (12)		
West	447 (31.8)	16 (14.5)	463 (30.5)		
Central	439 (31.2)	38 (34.5)	477 (31.5)		
Child order	1st child	281 (20)	9 (8.2)	290 (19.1)	< 0.001*	
2nd and 3rd	402 (28.6)	24 (21.8)	426 (28.1)		
4th or more	557 (39.6)	60 (54.5)	617 (40.7)		
only child	166 (11.8)	17 (15.5)	183 (12.1)		
Gender	Male	713 (50.7)	71 (64.5)	784 (51.7)	0.005*	
Female	693 (49.3)	39 (35.5)	732 (48.3)		
Child age (years)	2–5	519 (36.9)	57 (51.8)	576 (38)	0.007*	
6–8	389 (27.7)	21 (19.1)	410 (27)		
9–11	498 (35.4)	32 (29.1)	530 (35)		
Maternal education	high school or less	450 (32)	39 (35.5)	489 (32.3)	0.456	
university or more	956 (68)	71 (64.5)	1027 (67.7)		
Paternal education	high school or less	474 (33.7)	42 (38.2)	516 (34)	0.341	
university or more	932 (66.3)	68 (61.8)	1000 (66)		
Did you visit the dentist during the last 12 months	Yes	786 (55.9)	31 (28.2)	817 (53.9)	< 0.001*	
No	620 (44.1)	79 (71.8)	699 (46.1)		
Total	1406 (100)	110 (100)			
Statistically significant at 0.05

Table 2 Parents description of their children oral health care practices (1406 (92.7%))

Variables	Frequency (%)	
How often does your child brush his/her teeth?	Twice or more per day	322 (21.2)	
Once a day	617 (40.7)	
More than once a week	222 (14.6)	
Once a week	140 (9.2)	
More than once a month	105 (6.9)	
He/she never cleans it	110 (7.3)	
Does your child use any of the following to clean the teeth?	
Toothpaste that contains fluoride	Yes	708 (46.7)	
No	808 (53.3)	
Dental floss	Yes	74 (4.9)	
No	1442 (95.1)	
Toothpick	Yes	113 (7.5)	
No	1403 (92.5)	
Mouthwash	Yes	115 (7.6)	
No	1401 (92.4)	
Toothbrush	Yes	1293 (85.3)	
No	223 (14.7)	
Do not use any brush tool	Yes	76 (5)	
No	1440 (95)	

Socioeconomic factors and their effect on parental oral health care reports

Table 3 presents the regression analysis results examining the relationship between parental reports of their children’s oral health practices (yes/no) as the dependent factor and maternal education, as well as dental visit frequency as an independent factor. Compared to other areas, the Western area exhibited a significantly higher Adjusted Odds Ratio (AOR) for parents reporting that their child practices oral health care (AOR: 2.211; P = 0.011). Additionally, first-born children and those who visited a dentist displayed a significantly higher AOR for parents reporting that their child practices oral health care compared to only children (AOR: 2.837; P = 0.016) and to those who did not visit a dentist during the last 12-months (AOR: 2.989; P < 0.001). Conversely, the AOR was significantly lower for males than females (AOR: 0.540; P = 0.004).

Table 3 Regression analysis for the relationship between parental reports of their children’s oral health practice (dependent factor), their socioeconomic status factors, and their dental visit

Parameter	p value	AOR	95% Wald Confidence Interval	
Lower	Upper	
Area of residence	South	0.945	1.020	0.578	1.801	
North	0.045	0.526	0.280	0.987	
East	0.273	0.713	0.389	1.306	
West	0.011*	2.211	1.203	4.061	
Central	.	1	.	.	
Child order	1st child	0.016*	2.834	1.218	6.591	
2nd and 3rd	0.268	1.459	0.747	2.849	
4th or more	0.734	0.902	0.499	1.631	
only child	.	1	.	.	
Did you visit the dentist during the last 12 months	Yes	< 0.001*	2.989	1.931	4.625	
No	.	1	.	.	
Gender	Male	0.004*	0.540	0.356	0.819	
Female	.	1	.	.	
Maternal education	high school or less	0.815	0.950	0.619	1.459	
university or more	.	1	.	.	
AOR: Adjusted Odds Ratio

Statistically significant at 0.05

Discussion

Oral health practices during childhood play a pivotal role in long-term dental well-being. This study, involving 1516 parents, sheds light on possible relationships between children’s oral health practices and socioeconomic background. The demographic distribution, children’s gender, and birth order provide some understanding of the study population. Most parents reported their children engaging in oral healthcare, yet nuances exist, such as varying brushing frequencies. Residency disparities, first-born status, and dental visit history emerged as significant influencers on oral health practices. Recognizing these patterns is essential for tailoring effective interventions and policies promoting consistent and comprehensive oral health practices among children.

Tooth brushing habits are strongly associated with reducing dental caries [22, 28]. Moreover, Regular brushing twice daily is strongly associated with lower plaque formation and caries [29]. Furthermore, Alhabdan et al., 2018 found that higher dental caries prevalence was more likely to occur in children who acquired good oral habits later in life and those who brushed their teeth irregularly [30]. Moreover, it was documented in the literature that parental awareness, especially mothers’ oral health, dramatically reduces the experience of caries and the burden on their children [19, 31].

In this study, the method used for collecting the information was through parents’ reports. However, direct observation is the gold standard for assessing children’s brushing habits [32]. This is considered technically challenging when collecting information from a larger sample on a national level. Thus, parents’ reports on their children’s oral habits have been a commonly adopted and accepted method of evaluation and assessment [32].

This study showed more parental reports from the central area followed by the western area. This may be because these two areas are more populated (General Authority for Statistics) (supplementary Fig. 1). Furthermore, the high number (92.7%) of parents reporting that their children brush their teeth is a good indicator that the awareness of oral health is established [33–36]. As for toothbrushing frequency, results show that brushing once daily was the most frequent habit in children, which agrees with previous studies [22, 28].

In addition, 1406 (92.7%) parents reported that their children practice oral healthcare, a finding similar to that of Alghamdi et al. (2022), who reported that 95% of children practice oral healthcare in the central region [28]. Another study on 6-12-year-olds in the central region reported that 74% of male schoolchildren used a toothbrush [23]. They also found that only 2.2% were aware of dental floss, which was lower than our finding of 4.9%. These slight discrepancies could be attributed to differences in study design and the variable settings of the different studies.

On the other hand, when looking at the frequency of brushing, 40.7% of children reported by their parents to brush their teeth once daily, whereas only 21.2% brushed twice daily. This is similar to the former finding for the central region [22]. Nevertheless, a study conducted in the Eastern region revealed similar findings, reporting that 24.5% of the students brushing their teeth twice or more per day [20]. Previous studies show that tooth brushing frequency varies globally, as national surveys show. In the U.S., 60.5% of children were found to brush twice daily [37]; New Zealand revealed 63% [38], while 78.8% of children in France brushed at the same frequency [39]. A global study across 23 countries found that 45.9% of schoolchildren and 77.7% of dental patients brushed twice daily [40]. These variations highlight the influence of cultural practices, dental health awareness, access to dental care, socioeconomic factors, and education programs on oral hygiene habits. Understanding these nuances is crucial for tailoring effective public health initiatives and dental care education specific to each country’s context.

Regarding the birth order of children, results found that the oldest child tends to have better brushing habits, which agrees with the literature [41]. Researchers found that second or later children tend to have a higher rate of caries than first children [42]. In addition, Poutanen et al. 2006 found that children with siblings had a healthier lifestyle than an only child [43]. Results also showed that the odds ratio of brushing in an only child is significantly worse than in an older child, second or more childbirth order. On the other hand, Shaghaghian et al. and Zhang et al. reported that children without siblings were more likely to brush their teeth twice a day than children with siblings [44, 45]. These results may not agree with our findings, which may be attributed to the different populations studied (Chinese, Shaghaghian, and Zeraatkar populations). The family environment primarily contributes to children’s knowledge, habits, and attitudes. Moreover, the conflicting outcomes make sense since family practices are influenced by the surrounding cultures and way of life [46, 47].

The findings of this study also showed that most of the sample had not visited the dentist in the past 12 months, which agrees with several other studies in Saudi Arabia [23, 30, 48, 49]. This finding warrant concern. While dental home and oral healthcare practices at home are essential in preventing oral disease, it is as important to visit the dentist routinely, at least twice a year, for routine checkups, prevention, early treatment according to individual patient needs, and anticipatory guidance [10]. Among the factors contributing to the infrequency of children’s dental visits, maternal fear of dentistry emerges as a significant concern. Interestingly, these apprehensive mothers often prioritize enforcing meticulous brushing habits in their children to avert unwelcome dental visits. However, this seemingly protective behavior inadvertently hinders optimal oral health practices. By avoiding dental visits, crucial opportunities for professional preventive measures, oral health education from dental professionals, and early intervention for oral health issues are postponed, as emphasized in the research conducted by Kino [50].

In addition, it has been reported that children who visited the dentist in the last year were more likely to brush their teeth twice a day than children who have not visited the dentist lately [51]. Moreover, this may be attributed either to the educational input from the dental professional team or because those who visited the dentist were more likely to be keen on their oral health. Interestingly, a national survey of adults in Saudi Arabia in 2016 reported that only 11% of adults visited their dentists routinely for checkups. The cumulative results from the studies above suggest that irregular dental visit behaviors initiate at a younger age and persist into adulthood. Consequently, actions, measures, and policies must consider this when modifying such behaviors [48].

As for gender differences, our results showed that girls brush their teeth more than boys. This finding agrees with previous studies [50–52]. A study conducted in 32 European countries consistently found that females brush their teeth more than boys, even after adjusting the parental occupation and wealth to reduce the confounding factors [53]. The reason behind this may be attributed to the fact that females are more self-conscious about appearances, aesthetics, and personal hygiene and have more positive health-directed attitudes and behaviors than boys [54].

Results showed that more than half of the sample (53.3%) did not use fluoridated toothpaste, which is close to findings of AlHumaid in 2018, which was 52% [48]. Moreover, these figures are alarming. It is well documented through more than half a century of research that the topical application of fluoride through toothpaste is one of the most imperative preventative modalities [55]. Moreover, studies from other countries have higher percentages of fluoride toothpaste usage, ranging from 71% [56] to 79.9% [38].

In the regression analysis, the mother’s education was chosen over the father’s to assess its relationship or effect on children’s brushing habits since mothers spend more time interacting, childbearing, and parenting their children than fathers [57]. Furthermore, the literature has documented a significant relationship between mothers’ oral-related habits and their children’s oral health [21, 58].

Our results found no relationship between the mother’s education level and the frequency of brushing in children, which does not agree with other studies on other populations [20, 43, 51, 59, 60]. However, this result agreed with a study by Khalid et al. in 2021 conducted on Saudi families, which found no relationship between parents’ level of education and attitudes, knowledge, or oral health-related practices [31].

Limitations of this study include reporting bias. Also, the study cannot be generalized to the population because of sampling bias. However, we overcame this by distributing the sample through different population groups among the five residency areas. Also, the sample distribution according to residency and gender is similar to that of the general population [61] (see supplementary Table 1).

This study recommends targeted educational programs for regions with lower reported engagement and focused initiatives for parents of only children and those who last visited a dentist in the last 12 months.

Conclusion

This study highlights that only 21.2% of parents reported their children practicing excellent oral health care practices through brushing twice a day. This finding emphasizes the importance of early dental visits, tailored interventions, and prevention programs that consider regional and demographic factors such as child order to promote oral health effectively. Future research on the effectiveness of oral health programs and the extent to which oral health care providers adequately deliver anticipatory guidance to parents through studies that include clinical examination is recommended.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Supplementary Material 2

Author contributions

HJS designed and constructed the idea of the study, acquired ethical approval, constructed the methodology and executed data collection, participated in the writing of the original draft as well as in the review and editing of the final draft of the manuscript. IOA participated in the writing of the original draft and in the review and editing of the final draft of the manuscript.

Funding

This study was not funded by any institutions.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate and for publication

Ethical approval was issued by the Research Ethics Committee of the Faculty of Dentistry, King Abdulaziz University (Approval No. 232-03-21/30 May 2021). Informed consent for participation and publication was obtained from the parents before they could continue with the study participation.

Competing interests

The authors declare no competing interests.

Abbreviations

AAPD American Academy of Pediatric Dentistry

WHO World Health Organization

CVI Content validity index

AOR Adjusted odds ratio

OC Only child

NOC Non-only child

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
==== Refs
References

1. Petersen PE The world oral health report 2003: continuous improvement of oral health in the 21st century–the approach of the WHO Global Oral Health Programme Community Dent Oral Epidemiol 2003 31 Suppl 1 3 23 10.1046/j..2003.com122.x 15015736
Petersen P PE. The world oral health report 2003: continuous improvement of oral health in the 21st century–the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol. 2003;31(Suppl 1):3–23.15015736
2. Agaku IT Olutola BG Adisa AO Obadan EM Vardavas CI Association between unmet dental needs and school absenteeism because of illness or injury among U.S. school children and adolescents aged 6–17 years, 2011–2012 Prev Med 2015 72 83 8 10.1016/j.ypmed.2014.12.037 25575801
Agaku IT, Olutola BG, Adisa AO, Obadan EM, Vardavas CI. Association between unmet dental needs and school absenteeism because of illness or injury among U.S. school children and adolescents aged 6–17 years, 2011–2012. Prev Med. 2015;72:83–8.25575801
3. Leal SC Bronkhorst EM Fan M Frencken JE Untreated cavitated dentine lesions: impact on children’s quality of life Caries Res 2012 46 2 102 6 10.1159/000336387 22398411
Leal SC, Bronkhorst EM, Fan M, Frencken JE. Untreated cavitated dentine lesions: impact on children’s quality of life. Caries Res. 2012;46(2):102–6.22398411
4. Seirawan H Faust S Mulligan R The impact of oral health on the academic performance of disadvantaged children Am J Public Health 2012 102 9 1729 34 10.2105/AJPH.2011.300478 22813093
Seirawan H, Faust S, Mulligan R. The impact of oral health on the academic performance of disadvantaged children. Am J Public Health. 2012;102(9):1729–34.22813093
5. Benzian H Monse B Heinrich-Weltzien R Hobdell M Mulder J van Palenstein Helderman W Untreated severe dental decay: a neglected determinant of low body Mass Index in 12-year-old Filipino children BMC Public Health 2011 11 558 10.1186/1471-2458-11-558 21752286
Benzian H, Monse B, Heinrich-Weltzien R, Hobdell M, Mulder J, van Palenstein Helderman W. Untreated severe dental decay: a neglected determinant of low body Mass Index in 12-year-old Filipino children. BMC Public Health. 2011;11:558.21752286
6. Duijster D Sheiham A Hobdell MH Itchon G Monse B Associations between oral health-related impacts and rate of weight gain after extraction of pulpally involved teeth in underweight preschool Filipino children BMC Public Health 2013 13 533 10.1186/1471-2458-13-533 23731717
Duijster D, Sheiham A, Hobdell MH, Itchon G, Monse B. Associations between oral health-related impacts and rate of weight gain after extraction of pulpally involved teeth in underweight preschool Filipino children. BMC Public Health. 2013;13:533.23731717
7. Heinrich-Weltzien R Monse B Benzian H Heinrich J Kromeyer-Hauschild K Association of dental caries and weight status in 6- to 7-year-old Filipino children Clin Oral Investig 2013 17 6 1515 23 10.1007/s00784-012-0849-3 23053701
Heinrich-Weltzien R, Monse B, Benzian H, Heinrich J, Kromeyer-Hauschild K. Association of dental caries and weight status in 6- to 7-year-old Filipino children. Clin Oral Investig. 2013;17(6):1515–23.23053701
8. Nalliah RP Allareddy V Elangovan S Karimbux N Allareddy V Hospital based emergency department visits attributed to dental caries in the United States in 2006 J Evid Based Dent Pract 2010 10 4 212 22 10.1016/j.jebdp.2010.09.013 21093802
Nalliah RP, Allareddy V, Elangovan S, Karimbux N, Allareddy V. Hospital based emergency department visits attributed to dental caries in the United States in 2006. J Evid Based Dent Pract. 2010;10(4):212–22.21093802
9. Ramos-Jorge J Pordeus IA Ramos-Jorge ML Marques LS Paiva SM Impact of untreated dental caries on quality of life of preschool children: different stages and activity Community Dent Oral Epidemiol 2014 42 4 311 22 10.1111/cdoe.12086 24266653
Ramos-Jorge J, Pordeus IA, Ramos-Jorge ML, Marques LS, Paiva SM. Impact of untreated dental caries on quality of life of preschool children: different stages and activity. Community Dent Oral Epidemiol. 2014;42(4):311–22.24266653
10. American Academy of Pediatric Dentistry Periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents The reference Manual of Pediatric Dentistry 2023 Chicago, Ill American Academy of Pediatric Dentistry
American Academy of Pediatric Dentistry. Periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents. The reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2023.
11. Beil H Rozier RG Preisser JS Stearns SC Lee JY Effects of early dental office visits on dental caries experience Am J Public Health 2014 104 10 1979 85 10.2105/AJPH.2013.301325 24134364
Beil H, Rozier RG, Preisser JS, Stearns SC, Lee JY. Effects of early dental office visits on dental caries experience. Am J Public Health. 2014;104(10):1979–85.24134364
12. Kassebaum NJ Smith AGC Bernabé E Fleming TD Reynolds AE Vos T Global, Regional, and National Prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990–2015: a systematic analysis for the Global Burden of Diseases, injuries, and risk factors J Dent Res 2017 96 4 380 7 10.1177/0022034517693566 28792274
Kassebaum NJ, Smith AGC, Bernabé E, Fleming TD, Reynolds AE, Vos T, et al. Global, Regional, and National Prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990–2015: a systematic analysis for the Global Burden of Diseases, injuries, and risk factors. J Dent Res. 2017;96(4):380–7.28792274
13. Aqeeli A, Alsharif AT, Tennant M, Kruger E. School Dental services Theoretical Model-based on Geographic Information System in Al-Madinah, Saudi Arabia. Child (Basel). 2023;10(2).
14. Al Agili DE A systematic review of population-based dental caries studies among children in Saudi Arabia Saudi Dent J 2013 25 1 3 11 10.1016/j.sdentj.2012.10.002 23960549
Al Agili DE. A systematic review of population-based dental caries studies among children in Saudi Arabia. Saudi Dent J. 2013;25(1):3–11.23960549
15. Adam TR Al-Sharif AI Tonouhewa A AlKheraif AA Prevalence of Caries among School Children in Saudi Arabia: a Meta-analysis Adv Prev Med 2022 2022 7132681 10.1155/2022/7132681 36105432
Adam TR, Al-Sharif AI, Tonouhewa A, AlKheraif AA. Prevalence of Caries among School Children in Saudi Arabia: a Meta-analysis. Adv Prev Med. 2022;2022:7132681.36105432
16. World Health Organization. WHO expert consultation on public health intervention against early childhood caries: Report of a Meeting, Thailand, 26–28. January 2016. 2017. https://www.who.int/publications/i/item/who-expert-consultation-on-public-health-intervention-against-early-childhood-caries. Accessed 5 March 2024.
17. Hobdell M Petersen PE Clarkson J Johnson N Global goals for oral health 2020 Int Dent J 2003 53 5 285 8 10.1111/j.1875-595X.2003.tb00761.x 14560802
Hobdell M, Petersen PE, Clarkson J, Johnson N. Global goals for oral health 2020. Int Dent J. 2003;53(5):285–8.14560802
18. Elkhodary HM Abdelnabi MH Swelem AA Sabbagh HJ El Meligy O Talaat IM Individual, familial and country-level factors associated with oral hygiene practices in children: an international survey BMC Oral Health 2023 23 1 50 10.1186/s12903-023-02746-0 36710323
Elkhodary HM, Abdelnabi MH, Swelem AA, Sabbagh HJ, El Meligy O, Talaat IM, et al. Individual, familial and country-level factors associated with oral hygiene practices in children: an international survey. BMC Oral Health. 2023;23(1):50.36710323
19. Sabbagh HJ, Albeladi NH, Altabsh NZ, Bamashmous NO. Risk factors Associated with Children receiving treatment at Emergency Dental clinics: a case-control study. Int J Environ Res Public Health. 2023;20(2).
20. Amin TT Al-Abad BM Oral hygiene practices, dental knowledge, dietary habits and their relation to caries among male primary school children in Al Hassa, Saudi Arabia Int J Dent Hyg 2008 6 4 361 70 10.1111/j.1601-5037.2008.00310.x 19138188
Amin TT, Al-Abad BM. Oral hygiene practices, dental knowledge, dietary habits and their relation to caries among male primary school children in Al Hassa, Saudi Arabia. Int J Dent Hyg. 2008;6(4):361–70.19138188
21. Ellakany P, Madi M, Fouda SM, Ibrahim M, AlHumaid J. The effect of parental education and socioeconomic status on Dental Caries among Saudi Children. Int J Environ Res Public Health. 2021;18(22).
22. Mallineni SK, Alassaf A, Almulhim B, Alghamdi S. Influence of tooth brushing and previous Dental visits on Dental Caries Status among Saudi Arabian children. Child (Basel). 2023;10(3).
23. Kannan SP Alfahaid SF Alharbi AS Almutairi BS Alanazi AH Alsaab FA Oral Hygiene Behavior of School Children in Saudi Arabia: a descriptive cross-sectional survey Int J Clin Pediatr Dent 2020 13 1 66 71 10.5005/jp-journals-10005-1710 32581483
Kannan SP, Alfahaid SF, Alharbi AS, Almutairi BS, Alanazi AH, Alsaab FA, et al. Oral Hygiene Behavior of School Children in Saudi Arabia: a descriptive cross-sectional survey. Int J Clin Pediatr Dent. 2020;13(1):66–71.32581483
24. El Bcheraoui C Tuffaha M Daoud F Kravitz H AlMazroa MA Al Saeedi M Use of dental clinics and oral hygiene practices in the Kingdom of Saudi Arabia, 2013 Int Dent J 2016 66 2 99 104 10.1111/idj.12210 26749526
El Bcheraoui C, Tuffaha M, Daoud F, Kravitz H, AlMazroa MA, Al Saeedi M, et al. Use of dental clinics and oral hygiene practices in the Kingdom of Saudi Arabia, 2013. Int Dent J. 2016;66(2):99–104.26749526
25. Farrag MA Hamed ME Amer HM Almajhdi FN Epidemiology of respiratory viruses in Saudi Arabia: toward a complete picture Arch Virol 2019 164 8 1981 96 10.1007/s00705-019-04300-2 31139937
Farrag MA, Hamed ME, Amer HM, Almajhdi FN. Epidemiology of respiratory viruses in Saudi Arabia: toward a complete picture. Arch Virol. 2019;164(8):1981–96.31139937
26. Long DE Culture and custons of Saudi Arabia 2005 Bloomsburry Bloomsburry Publishing
Long DE. Culture and custons of Saudi Arabia. Bloomsburry: Bloomsburry Publishing; 2005.
27. World Health Organization. Oral health surveys: basic methods – 5th edition. 2013. https://www.who.int/publications/i/item/9789241548649. Accessed 11 April 2022.
28. Alghamdi SA, Aljohar A, Almulhim B, Alassaf A, Bhardwaj SS, Thomas JT et al. Correlation between BMI and Oral Health Status (DMFT, PI, mSBI, and Salivary 1,5-AG) among the Pediatric Population in Saudi Arabia: A Clinico-Biochemical Study. Children (Basel). 2022;9(7).
29. Quadri MFA Shubayr MA Hattan AH Wafi SA Jafer AH Oral Hygiene practices among Saudi Arabian children and its relation to their Dental Caries Status Int J Dent 2018 2018 3234970 10.1155/2018/3234970 29849636
Quadri MFA, Shubayr MA, Hattan AH, Wafi SA, Jafer AH. Oral Hygiene practices among Saudi Arabian children and its relation to their Dental Caries Status. Int J Dent. 2018;2018:3234970.29849636
30. Alhabdan YA Albeshr AG Yenugadhati N Jradi H Prevalence of dental caries and associated factors among primary school children: a population-based cross-sectional study in Riyadh, Saudi Arabia Environ Health Prev Med 2018 23 1 60 10.1186/s12199-018-0750-z 30497366
Alhabdan YA, Albeshr AG, Yenugadhati N, Jradi H. Prevalence of dental caries and associated factors among primary school children: a population-based cross-sectional study in Riyadh, Saudi Arabia. Environ Health Prev Med. 2018;23(1):60.30497366
31. Khalid A Althumairy A Alturayri W Alassaf A Almulhim B Alghamdi S Assessment of Knowledge, attitude and practices regarding oral Hygiene among the parents of Pre-school children: a cross-sectional study Ann Med Health Sci Res 2021 11 82 6
Khalid A, Althumairy A, Alturayri W, Alassaf A, Almulhim B, Alghamdi S, et al. Assessment of Knowledge, attitude and practices regarding oral Hygiene among the parents of Pre-school children: a cross-sectional study. Ann Med Health Sci Res. 2021;11:82–6.
32. Martins CC Oliveira MJ Pordeus IA Paiva SM Comparison between observed children’s tooth brushing habits and those reported by mothers BMC Oral Health 2011 11 22 10.1186/1472-6831-11-22 21888664
Martins CC, Oliveira MJ, Pordeus IA, Paiva SM. Comparison between observed children’s tooth brushing habits and those reported by mothers. BMC Oral Health. 2011;11:22.21888664
33. Mehta A Bhalla S Assessing consequences of untreated carious lesions using pufa index among 5–6 years old school children in an urban Indian population Indian J Dent Res 2014 25 2 150 3 10.4103/0970-9290.135906 24992842
Mehta A, Bhalla S. Assessing consequences of untreated carious lesions using pufa index among 5–6 years old school children in an urban Indian population. Indian J Dent Res. 2014;25(2):150–3.24992842
34. Okada M Kawamura M Kaihara Y Matsuzaki Y Kuwahara S Ishidori H Influence of parents’ oral health behaviour on oral health status of their school children: an exploratory study employing a causal modelling technique Int J Paediatr Dent 2002 12 2 101 8 10.1046/j.1365-263X.2002.00338.x 11966888
Okada M, Kawamura M, Kaihara Y, Matsuzaki Y, Kuwahara S, Ishidori H, et al. Influence of parents’ oral health behaviour on oral health status of their school children: an exploratory study employing a causal modelling technique. Int J Paediatr Dent. 2002;12(2):101–8.11966888
35. Park H Walton-Moss B Parenting style, parenting stress, and children’s health-related behaviors J Dev Behav Pediatr 2012 33 6 495 503 10.1097/DBP.0b013e318258bdb8 22772823
Park H, Walton-Moss B. Parenting style, parenting stress, and children’s health-related behaviors. J Dev Behav Pediatr. 2012;33(6):495–503.22772823
36. Sabbarwal B Puranik MP Uma SR Association between Parental Behavior and Child’s oral health among 3-5-year-old children in Bengaluru City Int J Clin Pediatr Dent 2020 13 6 677 81 33976495
Sabbarwal B, Puranik MP, Uma SR. Association between Parental Behavior and Child’s oral health among 3-5-year-old children in Bengaluru City. Int J Clin Pediatr Dent. 2020;13(6):677–81.33976495
37. Thornton-Evans G Junger ML Lin M Wei L Espinoza L Beltran-Aguilar E Use of toothpaste and toothbrushing patterns among children and adolescents - United States, 2013–2016 MMWR Morb Mortal Wkly Rep 2019 68 4 87 90 10.15585/mmwr.mm6804a3 30703075
Thornton-Evans G, Junger ML, Lin M, Wei L, Espinoza L, Beltran-Aguilar E. Use of toothpaste and toothbrushing patterns among children and adolescents - United States, 2013–2016. MMWR Morb Mortal Wkly Rep. 2019;68(4):87–90.30703075
38. Hobbs M Marek L Clarke R McCarthy J Tomintz M Wade A Investigating the prevalence of non-fluoride toothpaste use in adults and children using nationally representative data from New Zealand: a cross-sectional study Br Dent J 2020 228 4 269 76 10.1038/s41415-020-1304-5 32112020
Hobbs M, Marek L, Clarke R, McCarthy J, Tomintz M, Wade A, et al. Investigating the prevalence of non-fluoride toothpaste use in adults and children using nationally representative data from New Zealand: a cross-sectional study. Br Dent J. 2020;228(4):269–76.32112020
39. Fernandez de Grado G Ehlinger V Godeau E Arnaud C Nabet C Benkirane-Jessel N Changes in tooth brushing frequency and its associated factors from 2006 to 2014 among French adolescents: results from three repeated cross sectional HBSC studies PLoS ONE 2021 16 3 e0249129 10.1371/journal.pone.0249129 33780479
Fernandez de Grado G, Ehlinger V, Godeau E, Arnaud C, Nabet C, Benkirane-Jessel N, et al. Changes in tooth brushing frequency and its associated factors from 2006 to 2014 among French adolescents: results from three repeated cross sectional HBSC studies. PLoS ONE. 2021;16(3):e0249129.33780479
40. Llodra JC Phantumvanit P Bourgeois DM Horn V LLL2: an international global level questionnaire on toothbrushing and use of fluoride toothpaste Int Dent J 2014 64 Suppl 2 20 6 10.1111/idj.12128 25209647
Llodra JC, Phantumvanit P, Bourgeois DM, Horn V. LLL2: an international global level questionnaire on toothbrushing and use of fluoride toothpaste. Int Dent J. 2014;64(Suppl 2):20–6.25209647
41. Kaplan BA Mascie-Taylor CG Boldsen J Birth order and health status in a British national sample J Biosoc Sci 1992 24 1 25 33 10.1017/S0021932000006775 1737812
Kaplan BA, Mascie-Taylor CG, Boldsen J. Birth order and health status in a British national sample. J Biosoc Sci. 1992;24(1):25–33.1737812
42. Nicolau B Marcenes W Bartley M Sheiham A A life course approach to assessing causes of dental caries experience: the relationship between biological, behavioural, socio-economic and psychological conditions and caries in adolescents Caries Res 2003 37 5 319 26 10.1159/000072162 12925821
Nicolau B, Marcenes W, Bartley M, Sheiham A. A life course approach to assessing causes of dental caries experience: the relationship between biological, behavioural, socio-economic and psychological conditions and caries in adolescents. Caries Res. 2003;37(5):319–26.12925821
43. Poutanen R Lahti S Tolvanen M Hausen H Parental influence on children’s oral health-related behavior Acta Odontol Scand 2006 64 5 286 92 10.1080/00016350600714498 16945894
Poutanen R, Lahti S, Tolvanen M, Hausen H. Parental influence on children’s oral health-related behavior. Acta Odontol Scand. 2006;64(5):286–92.16945894
44. Shaghaghian S Zeraatkar M Factors affecting oral Hygiene and tooth brushing in Preschool Children, Shiraz/Iran J Dent Biomater 2017 4 2 394 402 28959771
Shaghaghian S, Zeraatkar M. Factors affecting oral Hygiene and tooth brushing in Preschool Children, Shiraz/Iran. J Dent Biomater. 2017;4(2):394–402.28959771
45. Zhang K, Li J, Lu Z. Oral health status and knowledge of only and non-only children in China. Br Dent J. 2021.
46. Helman CG The family culture: a useful concept for family practice Fam Med 1991 23 5 376 81 1884934
Helman CG. The family culture: a useful concept for family practice. Fam Med. 1991;23(5):376–81.1884934
47. Nwoke M Influence of Culturalvalue System and Home on Child-Rearing practices in the contemporary Nigerian society Open J Philos 2013 03 200 6 10.4236/ojpp.2013.31A033
Nwoke M. Influence of Culturalvalue System and Home on Child-Rearing practices in the contemporary Nigerian society. Open J Philos. 2013;03:200–6.
48. AlHumaid J El Tantawi M AlAgl A Kayal S Al Suwaiyan Z Al-Ansari A Dental visit patterns and oral Health outcomes in Saudi Children Saudi J Med Med Sci 2018 6 2 89 94 10.4103/sjmms.sjmms_103_17 30787827
AlHumaid J, El Tantawi M, AlAgl A, Kayal S, Al Suwaiyan Z, Al-Ansari A. Dental visit patterns and oral Health outcomes in Saudi Children. Saudi J Med Med Sci. 2018;6(2):89–94.30787827
49. Alshammary FL Mobarki AA Alrashidi NF Madfa AA Association between different behavioral factors and dental caries among children attending the dental clinics in a sample from Saudi Arabia BMC Oral Health 2023 23 1 198 10.1186/s12903-023-02849-8 37009869
Alshammary FL, Mobarki AA, Alrashidi NF, Madfa AA. Association between different behavioral factors and dental caries among children attending the dental clinics in a sample from Saudi Arabia. BMC Oral Health. 2023;23(1):198.37009869
50. Kino S Bernabé E Sabbah W Aukett J Relationship between family characteristics and children’s regular toothbrushing with fluoride toothpaste Community Dent Health 2015 32 3 132 6 26513846
Kino S, Bernabé E, Sabbah W, Aukett J. Relationship between family characteristics and children’s regular toothbrushing with fluoride toothpaste. Community Dent Health. 2015;32(3):132–6.26513846
51. Vallejos-Sánchez AA Medina-Solís CE Maupomé G Casanova-Rosado JF Minaya-Sánchez M Villalobos-Rodelo JJ Sociobehavioral factors influencing toothbrushing frequency among schoolchildren J Am Dent Assoc 2008 139 6 743 9 10.14219/jada.archive.2008.0256 18519998
Vallejos-Sánchez AA, Medina-Solís CE, Maupomé G, Casanova-Rosado JF, Minaya-Sánchez M, Villalobos-Rodelo JJ, et al. Sociobehavioral factors influencing toothbrushing frequency among schoolchildren. J Am Dent Assoc. 2008;139(6):743–9.18519998
52. Farsi JM Farghaly MM Farsi N Oral health knowledge, attitude and behaviour among Saudi school students in Jeddah city J Dent 2004 32 1 47 53 10.1016/j.jdent.2003.08.002 14659718
Farsi JM, Farghaly MM, Farsi N. Oral health knowledge, attitude and behaviour among Saudi school students in Jeddah city. J Dent. 2004;32(1):47–53.14659718
53. Maes L Vereecken C Vanobbergen J Honkala S Tooth brushing and social characteristics of families in 32 countries Int Dent J 2006 56 3 159 67 10.1111/j.1875-595X.2006.tb00089.x 16826883
Maes L, Vereecken C, Vanobbergen J, Honkala S. Tooth brushing and social characteristics of families in 32 countries. Int Dent J. 2006;56(3):159–67.16826883
54. King A, Wold B, Tudor-Smith C, Harel Y. The health of youth: a cross-national survey. WHO Regional Publications, European Series No. 69.; 1996.
55. Marinho VC Higgins JP Sheiham A Logan S Fluoride toothpastes for preventing dental caries in children and adolescents Cochrane Database Syst Rev 2003 2003 1 Cd002278 12535435
Marinho VC, Higgins JP, Sheiham A, Logan S. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2003;2003(1):Cd002278.12535435
56. Martin M Rosales G Sandoval A Lee H Pugach O Avenetti D What really happens in the home: a comparison of parent-reported and observed tooth brushing behaviors for young children BMC Oral Health 2019 19 1 35 10.1186/s12903-019-0725-5 30791896
Martin M, Rosales G, Sandoval A, Lee H, Pugach O, Avenetti D, et al. What really happens in the home: a comparison of parent-reported and observed tooth brushing behaviors for young children. BMC Oral Health. 2019;19(1):35.30791896
57. McBride BA Mills G A comparison of mother and father involvement with their preschool age children Early Child Res Q 1993 8 4 457 77 10.1016/S0885-2006(05)80080-8
McBride BA, Mills G. A comparison of mother and father involvement with their preschool age children. Early Child Res Q. 1993;8(4):457–77.
58. Hooley M Skouteris H Boganin C Satur J Kilpatrick N Parental influence and the development of dental caries in children aged 0–6 years: a systematic review of the literature J Dent 2012 40 11 873 85 10.1016/j.jdent.2012.07.013 22842202
Hooley M, Skouteris H, Boganin C, Satur J, Kilpatrick N. Parental influence and the development of dental caries in children aged 0–6 years: a systematic review of the literature. J Dent. 2012;40(11):873–85.22842202
59. Koçanalı B Topaloğlu AA Çoğulu D Evaluation of the Dental Caries Risk factors in children J Pediatr Res 2014 1 76 9 10.4274/jpr.46220
Koçanalı B, Topaloğlu AA, Çoğulu D. Evaluation of the Dental Caries Risk factors in children. J Pediatr Res. 2014;1:76–9.
60. Sufia S, Khan A, Khan S, Chaudhry S. Maternal Factors and Child’s Dental Health. J Oral Health Comm Dent. 2009;3.
61. General Authority for Statistics Kingdom of Saudi Arabia. Population by Gender, Age Groups and Nationality (Saudi/Non-Saudi). https://www.stats.gov.sa/en/5680. Accessed 17 September 2023.
