Parental socioeconomic status, education, and oral health knowledge as determinants of early childhood caries in 36–72-month-old children in Lucknow City

BACKGROUND: Early childhood caries (ECC) is a multifactorial disease, in which socioeconomic factors, parental knowledge, and oral health-related behaviors play critical roles in determining disease severity. AIM: The aim of the study was to evaluate the determinants of severity of ECC among preschool children diagnosed with ECC and to explore the direct and indirect pathways influencing caries severity. MATERIALS AND METHODS: This descriptive cross-sectional analytical study included 770 preschool children with ECC aged 36-72 months. Sociodemographic details, parental oral health knowledge, and oral health behaviors were assessed using a structured questionnaire. The severity of caries was recorded using the decayed, missing, and filled teeth (dmft) index according to the World Health Organization criteria. Descriptive statistics, Chi-squared tests, Pearson's correlation, multiple linear regression, and multiple logistic regression were used. Structural equation modeling was employed to assess the mediation pathways. Statistical significance was set at P < 0.05. RESULTS: Higher dmft scores were significantly associated with increasing age, lower socioeconomic status (SES), lower maternal education, poor parental knowledge, infrequent tooth brushing, absence of dental visits, and higher sugar exposure ( P < 0.001). Multiple linear regression analysis showed that maternal education and SES were the strongest predictors of dmft scores. Logistic regression revealed that children from lower socioeconomic strata had more than threefold higher odds of severe ECC. Mediation analysis demonstrated that approximately 30% of the socioeconomic effect on caries severity was indirectly mediated by parental knowledge and oral health behaviors. CONCLUSION: ECC severity is strongly influenced by socioeconomic disadvantages, with parental knowledge and behaviors acting as important modifiable mediators.