Acessibilidade / Reportar erro

Differences in Early Childhood Caries Status on Parental Stress Levels and Socioeconomic Status in Makassar City, Indonesia, During the COVID-19 Pandemic

Abstract

Objective:

To analyze the differences in early childhood caries status on parental stress levels and socioeconomic status in Makassar City, Indonesia, during the COVID-19 pandemic.

Material and Methods:

This type of analytical observational study with a cross-sectional design was conducted in North Rantepao, Toraja City, South Sulawesi Province, Indonesia. The research subjects of this study were parents who met the criteria, were willing to participate in the study, and had children aged 6-17 years. The questionnaire instrument with the criteria for assessing children's dental and oral health was assessed based on parents' perceptions. Each item is rated on a scale from 1 (never) to 5 (always). Then the total score was divided into three categories, namely low (score 3-6), moderate (score 7-10), and high (score 11-15). Comparative test analysis using Chi-Square test.

Results:

Parents with high-stress levels had more children with poor oral health. There is a significant difference according to the level of stress and socioeconomic status of the parents.

Conclusion:

There is a significant difference between caries status in early childhood based on socioeconomic status and parental stress level.

Keywords:
Dental Care for Children; Parent-Child Relations; Stress, Psychological; Socioeconomic Factors

Introduction

Early childhood caries (ECC) is defined as the presence of one or more carious, missing (due to caries) or filling tooth surfaces in primary teeth in children 71 months of age or younger [11 Anil S, Anand PS. Early childhood caries: prevalence, risk factors, and prevention. Front Pediatr 2017; 5:157. https://doi.org/10.3389/fped.2017.00157
https://doi.org/10.3389/fped.2017.00157...
,22 Percival T, Edwards J, Barclay S, Sa B, Majumder MAA. Early childhood caries in 3 to 5 year old children in Trinidad and Tobago. Dent J 2019; 7(1):16. https://doi.org/10.3390/dj7010016
https://doi.org/10.3390/dj7010016...
]. According to the 2015 FDI World Dental Federation, risk factors that influence the development of ECC include individual, family, and environmental factors [33 Ivančević V, Tušek I, Tušek J, Knežević M, Elheshk S, Luković I. Using association rule mining to identify risk factors for early childhood caries. Comput Methods Programs Biomed 2015; 122(2):175-81. https://doi.org/10.1016/j.cmpb.2015.07.008
https://doi.org/10.1016/j.cmpb.2015.07.0...
].

ECC is associated with other health problems, ranging from localized pain, infection, abscess, difficulty chewing, malnutrition, gastrointestinal disturbances, and difficulty sleeping [22 Percival T, Edwards J, Barclay S, Sa B, Majumder MAA. Early childhood caries in 3 to 5 year old children in Trinidad and Tobago. Dent J 2019; 7(1):16. https://doi.org/10.3390/dj7010016
https://doi.org/10.3390/dj7010016...
]. Dental caries in populations with higher burdens is not evenly distributed in lower socioeconomic groups. Several attempts have been made to allocate resources to those who need them most; there is a need for an approach to caries risk monitoring [44 Strömberg U, Holmn A, Magnusson K, Twetman S. Geo-mapping of time trends in childhood caries risk--a method for assessment of preventive care. BMC Oral Health 2012; 12:9. https://doi.org/10. 1186/1472-6831-12-9
https://doi.org/10. 1186/1472-6831-12-9...
].

Dental and oral diseases are included in the top 10 list of diseases that most Indonesian people complain about [55 Fatmasari M, Widodo W, Adhani R. Hubungan Antara Tingkat Sosial Ekonomi Orang Tua dengan Indeks Karies Gigi Pelajar SMPN di Kecamatan Banjarmasin Selatan. Dentin 2019; 1(1):62-67. [In Indonesian].]. The main problem in dental and oral health is dental caries. These problems are caused by poor oral health. Therefore, monitoring the development of oral disease is very important for children's health [66 Zhang K, Li J, Lu Z. The prevalence of dental caries in primary dentition in 3- to 5-year-old preschool children in northern China. Biomed Res Int 2020; 2020:5315236. https://doi.org/10.1155/2020/5315236
https://doi.org/10.1155/2020/5315236...
].

The main concern is the increasing number of people suffering from caries, an increasing number of caries in children, and at an early age [44 Strömberg U, Holmn A, Magnusson K, Twetman S. Geo-mapping of time trends in childhood caries risk--a method for assessment of preventive care. BMC Oral Health 2012; 12:9. https://doi.org/10. 1186/1472-6831-12-9
https://doi.org/10. 1186/1472-6831-12-9...
]. The main concern is the increasing number of people suffering from caries, an increasing number of caries in children, as well as at an early age. Dental caries in primary teeth is one of childhood's most common oral diseases [77 Azizi Z. The prevalence of dental caries in primary dentition in 4- to 5-year-old preschool children in northern palestine. Int J Dent 2014; 2014:839419. https://doi.org/10.1155/2014/839419
https://doi.org/10.1155/2014/839419...
].

The problem of high caries rates in children is strongly influenced by the role of parents, such as income and parental education. These factors affect health status because meeting the needs of life and getting the desired health service place. Therefore, it occurs more often in groups with high income and education compared to groups with low income and education [88 Suryani L. Hubungan Tingkat Pendidikan dan Penghasilan Kepala Keluarga dengan Karies Gigi Anak pada Masyarakat Desa Seubun Ayon Kecamatan Lhoknga Aceh Besar Tahun 2019. Jurnal Aceh Medika 2020; 4(1):85-93. [In Indonesian].].

Healthy living behavior can be influenced by a person's socioeconomic status (PES). Several factors that influence PES are employment, education, income, and the number of family members. Work determines PES status because, from the job, all needs will be fulfilled. The family is the initial basis for building a wider PES life for the better, where the family's active role in the development of a child is needed in providing basic education, attitudes, and basic skills, complying with regulations, and instilling habits [99 Purwati DE, Almujadi A, Suyatmi D. Efek Pendapatan Keluarga Terhadap Jumlah Karies Gigi Pada Anak Sekolah Dasar. J Oral Health Care 2018; 6(2):49-53. https://doi.org/10.29238/ohc.v6i2.334 [In Indonesian].
https://doi.org/10.29238/ohc.v6i2.334...
,1010 Ngantung RA, Pangemanan DH, Gunawan PN. Pengaruh tingkat sosial ekonomi orang tua terhadap karies anak di TK Hang Tuah Bitung. e-GiGi 2015; 3(2). https://doi.org/10.35790/eg.3.2.2015.10319 [In Indonesian].
https://doi.org/10.35790/eg.3.2.2015.103...
].

Based on Basic Health Research (Riskesdas) in Indonesia, the Indonesian population with dental and oral health problems in 2013 and 2018 increased from 25.9% to 57.6% [88 Suryani L. Hubungan Tingkat Pendidikan dan Penghasilan Kepala Keluarga dengan Karies Gigi Anak pada Masyarakat Desa Seubun Ayon Kecamatan Lhoknga Aceh Besar Tahun 2019. Jurnal Aceh Medika 2020; 4(1):85-93. [In Indonesian]., 99 Purwati DE, Almujadi A, Suyatmi D. Efek Pendapatan Keluarga Terhadap Jumlah Karies Gigi Pada Anak Sekolah Dasar. J Oral Health Care 2018; 6(2):49-53. https://doi.org/10.29238/ohc.v6i2.334 [In Indonesian].
https://doi.org/10.29238/ohc.v6i2.334...
, 1010 Ngantung RA, Pangemanan DH, Gunawan PN. Pengaruh tingkat sosial ekonomi orang tua terhadap karies anak di TK Hang Tuah Bitung. e-GiGi 2015; 3(2). https://doi.org/10.35790/eg.3.2.2015.10319 [In Indonesian].
https://doi.org/10.35790/eg.3.2.2015.103...
, 1111 Ningsi SW, Salmah U, Noor N, Maidin A. Risk factors of the occurrence of diarrhea in children under five years old in Indonesia (Riskesdas 2013 and 2018 Data Analysis). Indian J Public Health Res Dev 2022; 13(1):385-94. https://doi.org/10.37506/ijphrd.v13i1.17379
https://doi.org/10.37506/ijphrd.v13i1.17...
]. In addition, the pattern of visits to the dentist is also consistent with socioeconomic status, even with access to the same dental care. Several studies have assessed the role of parental psychosocial factors in the oral health of children and adolescents [1212 Gazzaz AZ, Carpiano RM, Aleksejuniene J. Parenting stress as a mediator in the oral health of children and adolescents: A stress process model. Community Dent Oral Epidemiol 2020; 48(4):288-95. https://doi.org/10.1111/cdoe.12531
https://doi.org/10.1111/cdoe.12531...
].

Parents have an important role in maintaining children's dental health. The results of a study suggest that parental psychosocial factors that have been shown to impact children's oral health negatively include maternal depression and stressful parents. Parents' concern for children's dental health can be seen through their attitude and concern for children's dental health [1313 Hapka M, Susi S, Fransiska A. Hubungan Perilaku Orang Tua dengan Early Childhood Caries Pada Anak Usia 2-3 Tahun di Kota Padang. Andalas Dent J 2021; 9(1):29-37. https://doi.org/10.25077/adj.v9i1.99 [In Indonesian].
https://doi.org/10.25077/adj.v9i1.99...
].

Stress levels in the elderly have been implicated as a predictor of oral health. However, these studies have focused more on young children and understanding how parental stress levels might affect children's oral health [1414 Nelson S, Lee W, Albert JM, Singer LT. Early maternal psychosocial factors are predictors for adolescent caries. J Dent Res 2012; 91(9):859-64. https://doi.org/10.1177/0022034512454434
https://doi.org/10.1177/0022034512454434...
]. The level of stress on parents may affect the oral health condition of children through various channels. For example, this may affect the pattern of parenting which, in turn, will change the child's behavior [1515 Masterson EE, Sabbah W. Maternal allostatic load, caretaking behaviors, and child dental caries experience: a cross-sectional evaluation of linked mother-child data from the third national health and nutrition examination survey. Am J Public Health 2015; 105(11):2306-11. https://doi.org/10.2105/AJPH.2015.302729
https://doi.org/10.2105/AJPH.2015.302729...
].

The purpose of the study was to determine the parents' perception of their children's dental and oral health status based on their children's socioeconomic status and to determine the parents' perceptions of their children's dental and oral health status based on the parents' stress level.

Material and Methods

Study Design

This type of research is analytic observational with a cross-sectional design. This research was conducted in July 2020 in North Rantepao Toraja City, South Sulawesi Province, Indonesia.

Sample and Data Collection

The subjects of this research are parents with children who meet the criteria, namely, those Willing to participate in the study, and respondents are parents who have children aged 6-17 years. The research instrument used was a questionnaire. The criteria for assessing children's oral health were evaluated in this study based on the parent's perception of seeing directly and assessing how good their child's dental and oral health was. The child's parental reported oral health was measured on a five-response scale, i.e., 0 (very poor) to 4 (very good) for the question 'In general, how would you describe the condition of your child's teeth?'. Then the total score is divided into two categories: bad (very bad, bad, and moderate) and good (good and very good).

Socioeconomic status indicators are seen from the number of children, insurance, income, education, and visits to the dentist. Family income is based on the Regional Minimum Wage (RMW) of the area with one question 'how much is the family income in one month?'. Parental education was assessed as the highest level of education achieved by anyone in the family with one question 'highest level of education achieved in the family?', 'less than high school, high school, and more than high school'. Controlling factors that can affect children's oral health: number of children 6-17 years old in the family (one child compared to two or more children covered by child health insurance (without coverage and insurance). And preventive dental visits in the past year were assessed with one question 'During the past 12 months, how many times did your child visit the dentist for preventive dental care such as a dental check-up and cleaning? No preventive dental visits and one or more preventive dental visits.

Parental stress levels were assessed based on three of the four Aggregation items on the Parenting Scale. This scale is derived from the parental stress index and the childbirth scale. Using the following three things: How often in the past month did the parents feel; (a) that their child is much more difficult to care for than children of the same age, (b) is much distracted by the things their child does, and (c) is angry with their child. Each item is rated on a scale from 1 (never), 2 (never), 3 (sometimes), 4 (often), to 5 (always). Then the total score was divided into three categories, namely low (score 3-6), moderate (score 7-10), and high (score 11-15).

Data Analysis

Data processing was performed using SPSS Version 22 for windows (IBM Corp., Armonk, NY, USA). This analysis proceeds in several steps. First, descriptive statistics were calculated for all variables. Second, perform a comparative test analysis using the Chi-Square test, with the significance level set at 5%.

Ethical Clearance

This study was approved by the Ethics Committee of the Faculty of Dentistry, Hasanuddin University, based on Attachment Number: 0140/PL.09/KEPK FKG-RSGM UNHAS/2021.

Results

Table 1 is a univariate analysis based on the characteristics of respondents, totaling 364 people. Most of the respondents in this study have two or more children, have private insurance, and have a higher education background. For income and the number of visits to the dentist, the distribution of respondents is almost evenly distributed between those with incomes less than the minimum wage and more than the minimum wage.

Table 1
Descriptive analysis of socioeconomic variables.

Socioeconomic factors can contribute to causing differences in parental perceptions of the oral health status of children (Table 2). Children of parents with more than one child with private insurance, an income of more than RMW, and higher education are more likely to be judged to have good oral health by their parents.

Table 2
Comparative test of oral health by socioeconomic characteristics.

It was found that the variables of insurance, income, education and the number of visits to the dentist all showed significant values. There are significant differences in parents' perceptions of the oral health status of their children between parents with and without insurance coverage. Similar results were also observed between parents with income group less and more than RMW and those with less and more education from high school and never or once or more visited the dentist. However, there was no significant difference in parents' perceptions of the oral health status of children between parents with one or more children.

Table 3 shows the results of a comparative oral health test based on stress levels. Oral health variables were categorized into bad and good. Meanwhile, the stress level variable is categorized into low, medium, and high. Most parents have moderate stress levels. It was observed that parents with low-stress levels had more children rated as having good oral health and moderate stress levels. However, parents with high-stress levels found that more children were judged to have poor oral health. From the results of the statistical significance test, it was found that there was a significant difference in oral health according to stress levels.

Table 3
Comparative test of oral health based on stress level.

Discussion

This study is research conducted to obtain parental perceptions of the dental and oral health status of children aged 6-17 years based on socioeconomic status and parental stress levels. The first variable in socioeconomic status is the number of children in the family. The results of the comparison test showed that there was no significant difference in oral health based on the number of children. Previous studies have found that the number of siblings is negatively related to a child's health [1616 Liu H. The quality-quantity trade-off: evidence from the relaxation of China’s one-child policy. J Popul Econ 2014; 27(2):565-602. https://doi.org/10.1007/s00148-013-0478-4
https://doi.org/10.1007/s00148-013-0478-...
,1717 Hatton TJ, Martin RM. Fertility decline and the heights of children in Britain, 1886–1938. Explor Econ Hist 2010; 47(4):505-19. https://doi.org/10.1016/j.eeh.2010.05.003
https://doi.org/10.1016/j.eeh.2010.05.00...
] and spending on health [1818 Simo Fotso A. Child disability and siblings' healthcare expenditures in a context of child fostering. Soc Sci Med 2017; 182:89-96. https://doi.org/10.1016/j.socscimed.2017.04.016
https://doi.org/10.1016/j.socscimed.2017...
].

High stress levels can make parents pay attention or not pay attention to the needs of their children, which may be reflected differently in seeking the use of their child's dental care [1212 Gazzaz AZ, Carpiano RM, Aleksejuniene J. Parenting stress as a mediator in the oral health of children and adolescents: A stress process model. Community Dent Oral Epidemiol 2020; 48(4):288-95. https://doi.org/10.1111/cdoe.12531
https://doi.org/10.1111/cdoe.12531...
]. In addition, several studies found that in mothers, the number of children was more associated with social isolation and relationship problems with partners [1919 Skreden M, Skari H, Malt UF, Pripp AH, Björk MD, Faugli A, et al. Parenting stress and emotional wellbeing in mothers and fathers of preschool children. Scand J Public Health 2012; 40(7):596-604. https://doi.org/10.1177/1403494812460347
https://doi.org/10.1177/1403494812460347...
]. These things may cause the same results are not reflected in this study.

Insurance can have a mediating effect on other sociodemographic variables and access to care. However, the presence of insurance alone does not guarantee it because the insurance you have may not be accepted at health facilities that are easily accessible [2020 Cortés DE, Réategui-Sharpe L, Spiro Iii A, García RI. Factors affecting children's oral health: perceptions among Latino parents. J Public Health Dent 2012; 72(1):82-9. https://doi.org/10.1111/j.1752-7325.2011.00287.x
https://doi.org/10.1111/j.1752-7325.2011...
,2121 Northridge ME, Schrimshaw EW, Estrada I, Greenblatt AP, Metcalf SS, Kunzel C. Intergenerational and social interventions to improve children's oral health. Dent Clin North Am 2017; 61(3):533-48. https://doi.org/10.1016/j.cden.2017.02.003
https://doi.org/10.1016/j.cden.2017.02.0...
]. A report published in Care Without Coverage concluded that health insurance is associated with better physical and mental health outcomes for working-age Americans and that adults who do not have health insurance suffer from decreased health and life expectancy [2222 Jewers M, Ku L. Noncitizen children face higher health harms compared with their siblings who have US Citizen status: study compares citizen and noncitizen siblings living in mixed-status families to determine differences in health insurance coverage and access to medical care. Health Affairs 2021; 40(7):1084-9. https://doi.org/10.1377/hlthaff.2021.00065
https://doi.org/10.1377/hlthaff.2021.000...
,2323 Byrd T, Pasupathy R. Public Health in Your Practice: Sex and Gender Considerations in Intimate Partner Violence, Access to Healthcare, and Immunizations. In: Jenkins M, Newman C. How Sex and Gender Impact Clinical Practice: Elsevier; 2020. p. 277-87. https://doi.org/10.1016/B978-0-12-816569-0.00013-9
https://doi.org/10.1016/B978-0-12-816569...
].

The findings of Schwendicke et al. [2424 Schwendicke F, Dörfer CE, Schlattmann P, Foster Page L, Thomson WM, Paris S. Socioeconomic inequality and caries: a systematic review and meta-analysis. J Dent Res 2015; 94(1):10-8. https://doi.org/10.1177/0022034514557546
https://doi.org/10.1177/0022034514557546...
] and Chen et al. [2525 Chen L, Hong J, Xiong D, Zhang L, Li Y, Huang S, et al. Are parents' education levels associated with either their oral health knowledge or their children's oral health behaviors? A survey of 8446 families in Wuhan. BMC Oral Health 2020; 20(1):203. https://doi.org/10.1186/s12903-020-01186-4
https://doi.org/10.1186/s12903-020-01186...
] that children with lower levels of parental education will have poorer health literacy, poorer dietary behavior and oral health, this study found that parents with lower academic backgrounds had poorer oral health knowledge, which in turn ultimately lead to poorer dental and oral health behaviors. A study on dental caries shows that the mother's education level is the most important index that influences dental caries from household income and parents' occupation [2626 Van den Branden S, Van den Broucke S, Leroy R, Declerck D, Hoppenbrouwers K. Oral health and oral health-related behaviour in preschool children: evidence for a social gradient. Eur J Pediatr 2013; 172(2):231-7. https://doi.org/10.1007/s00431-012-1874-6
https://doi.org/10.1007/s00431-012-1874-...
].

A large number of dentist visits, especially preventive visits, reduces the need for preventive care later because preventable conditions have been prevented earlier during preventive visits, thereby improving oral health [2727 Sen B, Blackburn J, Morrisey MA, Kilgore ML, Becker DJ, Caldwell C, et al. Effectiveness of preventive dental visits in reducing nonpreventive dental visits and expenditures. Pediatrics 2013; 131(6):1107-13. https://doi.org/10.1542/peds.2012-2586
https://doi.org/10.1542/peds.2012-2586...
]. It was also found that children who frequently visited the dentist had a high caries rate. However, because of the awareness to carry out this treatment, the health of the oral cavity will improve again because all problems in the oral cavity have been overcome [2828 Lebrun-Harris LA, Canto MT, Vodicka P. Preventive oral health care use and oral health status among US children: 2016 National Survey of Children's Health. J Am Dent Assoc 2019; 150(4):246-58. https://doi.org/10.1016/j.adaj.2018.11.023
https://doi.org/10.1016/j.adaj.2018.11.0...
].

Table 3 shows significant differences in oral health based on parental stress levels. Ultimately, family stress levels can influence a child's behavior through changes in the child's stress response, which can compromise oral health. In addition, it is possible that parents with high-stress levels will be too distracted or busy thinking about other factors that make them stressed rather than taking preventive measures to maintain their child's dental health, such as regular dental visits [1212 Gazzaz AZ, Carpiano RM, Aleksejuniene J. Parenting stress as a mediator in the oral health of children and adolescents: A stress process model. Community Dent Oral Epidemiol 2020; 48(4):288-95. https://doi.org/10.1111/cdoe.12531
https://doi.org/10.1111/cdoe.12531...
].

Conclusion

There is a significant comparison of parents' perceptions of their children's dental and oral health based on the socioeconomic status of parents in the group of parents who have insurance and have a high income, high parental education, and the number of visits to the dentist. In addition, there are significant differences in children's oral health based on the stress level of parents.

  • Data Availability
    The data used to support the findings of this study can be made available upon request to the corresponding author.

References

  • 1
    Anil S, Anand PS. Early childhood caries: prevalence, risk factors, and prevention. Front Pediatr 2017; 5:157. https://doi.org/10.3389/fped.2017.00157
    » https://doi.org/10.3389/fped.2017.00157
  • 2
    Percival T, Edwards J, Barclay S, Sa B, Majumder MAA. Early childhood caries in 3 to 5 year old children in Trinidad and Tobago. Dent J 2019; 7(1):16. https://doi.org/10.3390/dj7010016
    » https://doi.org/10.3390/dj7010016
  • 3
    Ivančević V, Tušek I, Tušek J, Knežević M, Elheshk S, Luković I. Using association rule mining to identify risk factors for early childhood caries. Comput Methods Programs Biomed 2015; 122(2):175-81. https://doi.org/10.1016/j.cmpb.2015.07.008
    » https://doi.org/10.1016/j.cmpb.2015.07.008
  • 4
    Strömberg U, Holmn A, Magnusson K, Twetman S. Geo-mapping of time trends in childhood caries risk--a method for assessment of preventive care. BMC Oral Health 2012; 12:9. https://doi.org/10. 1186/1472-6831-12-9
    » https://doi.org/10. 1186/1472-6831-12-9
  • 5
    Fatmasari M, Widodo W, Adhani R. Hubungan Antara Tingkat Sosial Ekonomi Orang Tua dengan Indeks Karies Gigi Pelajar SMPN di Kecamatan Banjarmasin Selatan. Dentin 2019; 1(1):62-67. [In Indonesian].
  • 6
    Zhang K, Li J, Lu Z. The prevalence of dental caries in primary dentition in 3- to 5-year-old preschool children in northern China. Biomed Res Int 2020; 2020:5315236. https://doi.org/10.1155/2020/5315236
    » https://doi.org/10.1155/2020/5315236
  • 7
    Azizi Z. The prevalence of dental caries in primary dentition in 4- to 5-year-old preschool children in northern palestine. Int J Dent 2014; 2014:839419. https://doi.org/10.1155/2014/839419
    » https://doi.org/10.1155/2014/839419
  • 8
    Suryani L. Hubungan Tingkat Pendidikan dan Penghasilan Kepala Keluarga dengan Karies Gigi Anak pada Masyarakat Desa Seubun Ayon Kecamatan Lhoknga Aceh Besar Tahun 2019. Jurnal Aceh Medika 2020; 4(1):85-93. [In Indonesian].
  • 9
    Purwati DE, Almujadi A, Suyatmi D. Efek Pendapatan Keluarga Terhadap Jumlah Karies Gigi Pada Anak Sekolah Dasar. J Oral Health Care 2018; 6(2):49-53. https://doi.org/10.29238/ohc.v6i2.334 [In Indonesian].
    » https://doi.org/10.29238/ohc.v6i2.334
  • 10
    Ngantung RA, Pangemanan DH, Gunawan PN. Pengaruh tingkat sosial ekonomi orang tua terhadap karies anak di TK Hang Tuah Bitung. e-GiGi 2015; 3(2). https://doi.org/10.35790/eg.3.2.2015.10319 [In Indonesian].
    » https://doi.org/10.35790/eg.3.2.2015.10319
  • 11
    Ningsi SW, Salmah U, Noor N, Maidin A. Risk factors of the occurrence of diarrhea in children under five years old in Indonesia (Riskesdas 2013 and 2018 Data Analysis). Indian J Public Health Res Dev 2022; 13(1):385-94. https://doi.org/10.37506/ijphrd.v13i1.17379
    » https://doi.org/10.37506/ijphrd.v13i1.17379
  • 12
    Gazzaz AZ, Carpiano RM, Aleksejuniene J. Parenting stress as a mediator in the oral health of children and adolescents: A stress process model. Community Dent Oral Epidemiol 2020; 48(4):288-95. https://doi.org/10.1111/cdoe.12531
    » https://doi.org/10.1111/cdoe.12531
  • 13
    Hapka M, Susi S, Fransiska A. Hubungan Perilaku Orang Tua dengan Early Childhood Caries Pada Anak Usia 2-3 Tahun di Kota Padang. Andalas Dent J 2021; 9(1):29-37. https://doi.org/10.25077/adj.v9i1.99 [In Indonesian].
    » https://doi.org/10.25077/adj.v9i1.99
  • 14
    Nelson S, Lee W, Albert JM, Singer LT. Early maternal psychosocial factors are predictors for adolescent caries. J Dent Res 2012; 91(9):859-64. https://doi.org/10.1177/0022034512454434
    » https://doi.org/10.1177/0022034512454434
  • 15
    Masterson EE, Sabbah W. Maternal allostatic load, caretaking behaviors, and child dental caries experience: a cross-sectional evaluation of linked mother-child data from the third national health and nutrition examination survey. Am J Public Health 2015; 105(11):2306-11. https://doi.org/10.2105/AJPH.2015.302729
    » https://doi.org/10.2105/AJPH.2015.302729
  • 16
    Liu H. The quality-quantity trade-off: evidence from the relaxation of China’s one-child policy. J Popul Econ 2014; 27(2):565-602. https://doi.org/10.1007/s00148-013-0478-4
    » https://doi.org/10.1007/s00148-013-0478-4
  • 17
    Hatton TJ, Martin RM. Fertility decline and the heights of children in Britain, 1886–1938. Explor Econ Hist 2010; 47(4):505-19. https://doi.org/10.1016/j.eeh.2010.05.003
    » https://doi.org/10.1016/j.eeh.2010.05.003
  • 18
    Simo Fotso A. Child disability and siblings' healthcare expenditures in a context of child fostering. Soc Sci Med 2017; 182:89-96. https://doi.org/10.1016/j.socscimed.2017.04.016
    » https://doi.org/10.1016/j.socscimed.2017.04.016
  • 19
    Skreden M, Skari H, Malt UF, Pripp AH, Björk MD, Faugli A, et al. Parenting stress and emotional wellbeing in mothers and fathers of preschool children. Scand J Public Health 2012; 40(7):596-604. https://doi.org/10.1177/1403494812460347
    » https://doi.org/10.1177/1403494812460347
  • 20
    Cortés DE, Réategui-Sharpe L, Spiro Iii A, García RI. Factors affecting children's oral health: perceptions among Latino parents. J Public Health Dent 2012; 72(1):82-9. https://doi.org/10.1111/j.1752-7325.2011.00287.x
    » https://doi.org/10.1111/j.1752-7325.2011.00287.x
  • 21
    Northridge ME, Schrimshaw EW, Estrada I, Greenblatt AP, Metcalf SS, Kunzel C. Intergenerational and social interventions to improve children's oral health. Dent Clin North Am 2017; 61(3):533-48. https://doi.org/10.1016/j.cden.2017.02.003
    » https://doi.org/10.1016/j.cden.2017.02.003
  • 22
    Jewers M, Ku L. Noncitizen children face higher health harms compared with their siblings who have US Citizen status: study compares citizen and noncitizen siblings living in mixed-status families to determine differences in health insurance coverage and access to medical care. Health Affairs 2021; 40(7):1084-9. https://doi.org/10.1377/hlthaff.2021.00065
    » https://doi.org/10.1377/hlthaff.2021.00065
  • 23
    Byrd T, Pasupathy R. Public Health in Your Practice: Sex and Gender Considerations in Intimate Partner Violence, Access to Healthcare, and Immunizations. In: Jenkins M, Newman C. How Sex and Gender Impact Clinical Practice: Elsevier; 2020. p. 277-87. https://doi.org/10.1016/B978-0-12-816569-0.00013-9
    » https://doi.org/10.1016/B978-0-12-816569-0.00013-9
  • 24
    Schwendicke F, Dörfer CE, Schlattmann P, Foster Page L, Thomson WM, Paris S. Socioeconomic inequality and caries: a systematic review and meta-analysis. J Dent Res 2015; 94(1):10-8. https://doi.org/10.1177/0022034514557546
    » https://doi.org/10.1177/0022034514557546
  • 25
    Chen L, Hong J, Xiong D, Zhang L, Li Y, Huang S, et al. Are parents' education levels associated with either their oral health knowledge or their children's oral health behaviors? A survey of 8446 families in Wuhan. BMC Oral Health 2020; 20(1):203. https://doi.org/10.1186/s12903-020-01186-4
    » https://doi.org/10.1186/s12903-020-01186-4
  • 26
    Van den Branden S, Van den Broucke S, Leroy R, Declerck D, Hoppenbrouwers K. Oral health and oral health-related behaviour in preschool children: evidence for a social gradient. Eur J Pediatr 2013; 172(2):231-7. https://doi.org/10.1007/s00431-012-1874-6
    » https://doi.org/10.1007/s00431-012-1874-6
  • 27
    Sen B, Blackburn J, Morrisey MA, Kilgore ML, Becker DJ, Caldwell C, et al. Effectiveness of preventive dental visits in reducing nonpreventive dental visits and expenditures. Pediatrics 2013; 131(6):1107-13. https://doi.org/10.1542/peds.2012-2586
    » https://doi.org/10.1542/peds.2012-2586
  • 28
    Lebrun-Harris LA, Canto MT, Vodicka P. Preventive oral health care use and oral health status among US children: 2016 National Survey of Children's Health. J Am Dent Assoc 2019; 150(4):246-58. https://doi.org/10.1016/j.adaj.2018.11.023
    » https://doi.org/10.1016/j.adaj.2018.11.023

Edited by

Academic Editor: Alidianne Fábia Cabral Cavalcanti

Data availability

Data Availability

The data used to support the findings of this study can be made available upon request to the corresponding author.

Publication Dates

  • Publication in this collection
    13 Mar 2023
  • Date of issue
    2022

History

  • Received
    29 Jan 2022
  • Reviewed
    02 Mar 2022
  • Accepted
    27 Mar 2022
Associação de Apoio à Pesquisa em Saúde Bucal Avenida Epitácio Pessoa, 4161 - Sala 06, Miramar, CEP: 58020-388, João Pessoa, PB - Brasil, Tel.: 55-83-98773 2150 - João Pessoa - PB - Brazil
E-mail: apesb@terra.com.br