Background: Maintaining optimal oral hygiene in children is a critical component of overall health and well-being. Despite widespread awareness of preventive measures, parents face numerous challenges in enforcing good oral hygiene practices among children. Behavioural, cultural and socioeconomic factors contribute to these challenges.
Methods: A narrative review of existing literature was conducted to identify common parental difficulties, underlying determinants and strategies related to paediatric oral hygiene practices.
Results: The review revealed that child resistance, inadequate parental knowledge, cultural beliefs, time constraints and limited access to dental care are major barriers. Socioeconomic disparities further influence parental capacity to supervise oral hygiene increasing risk of dental caries and other oral diseases in children.
Conclusion: Parental challenges in maintaining children's oral hygiene are multifactorial. Targeted educational interventions and improved access to preventive dental services are essential to strengthen oral health practices and improve long-term paediatric oral health outcomes preventing oral diseases.
Children's dental health affects their quality of life and is a crucial component of their general health. The incidence of caries has decreased in France as a result of regular public preventative initiatives and the participation of paediatric dentists and dental surgeons. However, among certain at-risk groups, particularly very young children, oral hygiene recommendations are not always followed. As a result, early childhood caries (ECC), a surge in caries incidence, has been noted in children under the age of six.
Any primary tooth in a kid under six years old that has at least one rotted surface (with or without cavitation), a tooth missing because of decay, or a filled tooth surface is considered to have ECC. ECC has a number of negative effects, including chronic pain, behavioural and sleep difficulties, school absenteeism, and the quality of life of children.
Maintaining a high level of ECC is facilitated by parents' ignorance and incapacity to alter family routines, apply proper toothbrushing practices, or feed their children.
The primary goal of this study was to assess how parents perceive dental disease and the primary challenges they face when trying to maintain oral hygiene for children younger than 6 years old. To achieve this, a qualitative research study was conducted in Nashik district, utilizing semi-structured interviews with parents of children in this age group.
The secondary goal was to propose solutions that could assist parents in altering their family habits, aiming to establish educational practices and behaviours that would lead to an enhancement of their children's oral health.
Study Design and Sampling Strategy: This research adheres to the Standards for Reporting Qualitative Research (SRQR). To allow parents to freely share their thoughts on children's oral health and preventive measures such as tooth brushing and dietary habits, individual semi-structured interviews were conducted following a survey form, addressing relevant topics through open-ended questions and prompts for an effective approach in identifying specific challenges in their daily routines. Each google survey form was distributed to parents with below 6-year kids. In the course of the survey, no guidance was provided since the focus was solely on understanding the parents' knowledge of oral health. As a result, the parents were required to articulate their everyday challenges across various areas on oral hygiene routines for their children.
Ethical Considerations: Participants were made aware of the objectives of this research and the format of the interviews. The interviews were recorded. Participants were also informed about the confidentiality of their responses and were entitled to withdraw from the study at any time. Prior to each survey form being distributed, participants were required to give written informed consent. The confidentiality of the data, including audio recordings and transcripts, was assured, and the study received approval from the institutional ethics committee.
Data saturation was achieved after interviewing 385 parents. Only 10 parents declined to participate in the study, stating that they had no interest. The participants reported that their children required dental consultations, with some needing only routine check-ups.
The majority of the parents were married, and approximately one-third of the mothers were stay-at-home or unemployed. A considerable proportion of the children (300 out of 385) were classified as having a high caries risk. About half of the children brushed their teeth daily, while more than fifty percent consumed soft drinks and had daily snacking habits, indicating potential risk factors for dental caries.
Key Findings:
• Brushing frequency: 56.6% of children brushed once daily; 42.6% brushed twice daily; only 0.8% brushed thrice daily
• Child cooperation: 39.2% of parents reported lack of co-operation from their child during brushing
• Toothpaste type: Fluoride toothpaste used by 45.2%; herbal toothpaste by 16.4%; flavoured kids toothpaste by 32.2%
• Brushing duration: 53.0% brushed for 30 seconds to 1 minute; only 3.9% brushed more than 2 minutes
• Statistical significance: Highly significant differences (p<0.01) were found between age groups (1–3 years vs 4–6 years) for parental assistance during brushing and child cooperation. Significant differences (p<0.05) were found for toothpaste type selection between age groups.
Research on how parents' psychosocial characteristics affect their kids' dental health behaviour is comparatively lacking. A few cross-sectional studies have discovered a relationship between children's oral health behaviour and their parents' oral health knowledge, attitudes, and beliefs. Therefore, the current study was designed to better understand the challenges parents face when cleaning their children's teeth at home.
Reversing the unfavourable trends is even more urgent when we take into account the increased expense of dental health services overall, the limited availability of clinical dental preventive treatments, and potential harm to children's oral health from the COVID-19 pandemic. In addition to their preschool-aged children's usage of dental care services, parents and other caregivers are crucial in monitoring home-based caries prevention (good eating habits, oral hygiene practices).
Key challenges identified include:
1. Behavioural Resistance from Children: Children often perceive tooth brushing as an unpleasant or unnecessary task. Resistance may include crying, tantrums, or refusal to cooperate. Short attention spans make consistent daily brushing difficult.
2. Lack of Knowledge and Awareness: Some parents underestimate the importance of primary teeth. Limited understanding of preventive dentistry, fluoride use, and diet–caries relationship.
3. Time Constraints and Busy Schedules: Dual-working parents often struggle to dedicate time for supervising brushing. Morning routines before school are rushed, leading to skipped brushing.
4. Socioeconomic Barriers: Financial constraints limit access to dental care products. In low-income households, dental visits are often delayed until problems arise.
5. Cultural and Lifestyle Factors: Dietary practices high in sugar consumption are often normalized. Traditional beliefs may replace evidence-based dental care.
Strategies to Overcome Challenges: The study proposes parental education programs, behavioural techniques including positive reinforcement, healthcare professional support through regular dental checkups, and policy-level interventions such as school-based oral health programs.
Parental enforcement of child oral hygiene is influenced by a complex interplay of behavioural, socioeconomic, cultural, and personal factors. While parents are the primary gatekeepers of their child's oral health, challenges often limit their ability to ensure consistent hygiene practices.
Addressing these challenges requires a multifaceted approach involving education, behavioural strategies, community support, and policy-level interventions. By empowering parents and creating supportive environments, it is possible to significantly improve paediatric oral health outcomes.
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