Association of parental oral health literacy, early childhood oral health behaviors, and caries severity with oral health-related quality of life among preschool children

To investigate the relationship between parental oral health literacy (OHL), children’s oral health behaviors and status, and oral health-related quality of life (OHRQoL) in preschool children, and to identify factors associated with OHRQoL. A convenience sampling method was used to survey 221 pairs of preschool children and their parents who visited the pediatric dentistry department from September 2023 to May 2024. Data were collected through questionnaires, clinical examinations, and validated scales—including the Chinese version of the short-form Health Literacy Dental Scale (HeLD-14) for OHL and the Early Childhood Oral Health Impact Scale (ECOHIS) for OHRQoL—to analyze relationships between sociodemographic characteristics, parental OHL, children’s oral health behaviors, oral health status, and dental caries severity with OHRQoL. Bivariate analysis, multiple stepwise linear regression, and hierarchical regression were performed to identify factors associated with preschool children’s OHRQoL. Data from 206 children were analyzed. Parental OHL, children’s oral health behaviors, and oral health status were all significantly associated with OHRQoL in preschool children. Multiple stepwise regression analysis identified several independent factors associated with OHRQoL (P < 0.05), including parental OHL (β = -0.206, P = 0.001), age of starting toothbrushing (β = 0.164, P = 0.008), frequency of sweet food intake (β = 0.152, P = 0.013), caries severity (β = 0.199, P = 0.002), and history of toothache (β = 0.276, P < 0.001). Collectively, these factors accounted for 26.2% of the total variance in OHRQoL. OHRQoL in preschool children is associated with comprehensive factors, including family factors (parental OHL), oral health behaviors (age of starting toothbrushing, frequency of sweet food intake), and oral health status (caries severity, history of toothache). These findings suggest that strengthening parental OHL, implementing early oral hygiene interventions and limiting sugar consumption may be key strategies for improving OHRQoL among preschool children.