Pathways Between Parental Attitudes and Early Childhood Caries in Preschool Children

<b>Background/Objectives</b>: Parental attitudes play a crucial role in shaping children's oral health habits and preventing dental diseases. This study aimed to explore the theoretical pathways through which parental behavior and attitudes toward child oral health can influence the dental caries experience as measured by the dmf-t index in preschool children in Lithuania. <b>Methods</b>: A cross-sectional study was conducted involving 302 children aged 4-7 years and their parents (262 mothers). Parental attitudes were assessed using the Parental Attitudes Towards Child Oral Health (PACOH) scale. For the children, the following variables were considered: sex, age, dental caries experience (dmf-t index in the primary dentition), oral hygiene index (Silness-Löe Plaque Index), toothbrushing frequency, and parental assistance with toothbrushing. Structural Equation Modeling (SEM) was applied for the data analysis. <b>Results</b>: The main path through which parental attitudes towards child oral health influenced the dmf-t index was via toothbrushing frequency (β = -0.17) or parental assistance with toothbrushing (β = 0.24). These factors were then linked to the oral hygiene index (β = 0.20 and β = -0.47, respectively), which ultimately influenced dmf-t (β = 0.52). The parents' attitudes and toothbrushing frequency per se had no significant effect on children's dmf-t (β = -0.06 and β = -0.04, respectively). The final model met all goodness-of-fit criteria: Chi-square test <i>p</i> = 0.211, Incremental Fit Index IFI = 0.994, Tucker-Lewis Index TLI = 0.982, Comparative Fit Index CFI = 0.994, and Root Mean Square Error of Approximation RMSEA = 0.038. <b>Conclusions</b>: Findings from this study demonstrate that parents play a significant role in determining children's oral health. Regular toothbrushing, parental assistance with toothbrushing, and good oral hygiene are critical factors linking parents' oral health-related attitudes to a child's experience of early caries. Identifying the associations between dental caries risk factors helps plan interventions.