Association of socioeconomic status on parental knowledge, attitudes, and practices regarding dental fluorosis in Salem, Tamil Nadu: a cross-sectional study

Dental fluorosis is a significant public health burden in endemic regions like Salem, Tamil Nadu. While environmental fluoride levels are the primary cause, the severity of the condition is often mediated by parental awareness and preventive practices. Socioeconomic status (SES) plays a critical role in determining health literacy and access to resources, yet its specific association with fluorosis-related behaviour remains underexplored in this region. This study aimed to evaluate and compare the knowledge, attitudes, and practices (KAP) of parents from different socioeconomic classes regarding dental fluorosis. A cross-sectional KAP survey was conducted among 160 parents of schoolchildren using a stratified convenience sampling technique. Participants were categorized into five socioeconomic classes based on the Modified Kuppuswamy Scale 2024. Data were collected using a self-administered questionnaire containing 20 dichotomous questions; while content and face validity were established via expert review and piloting, formal reliability testing was not conducted. Statistical associations were analysed using the Chi-square test ( p < 0.05). Socioeconomic status (SES) was significantly associated with key awareness and practice domains. The sample distribution included upper lower ( n = 54), upper middle ( n = 45), lower middle ( n = 26), upper ( n = 18), and lower ( n = 17) socioeconomic classes. Parents from higher SES groups demonstrated significantly ( p < 0.05) higher awareness of fluoride in drinking water and a more positive attitude toward the necessity of treatment compared to lower SES groups. Furthermore, specific oral hygiene practices varied significantly by SES; most notably, children in the lower class had 16 times higher odds of ingesting toothpaste compared to the upper-class reference group (94.1% vs. 50.0%; OR = 16.0; 95% CI: 1.74–147.2; p < 0.001).Clinically, this indicates a substantially elevated risk of excessive systemic fluoride exposure and subsequent fluorosis severity among lower SES children due to high-risk brushing behaviours. The findings suggest that significant socioeconomic disparities exist in parental KAP regarding dental fluorosis, with lower SES groups exhibiting critical gaps in preventive practices. Current awareness programs appear insufficient. Public health policies could benefit from shifting from generalized information to targeted behavioural change interventions, including clearer guidance on age-appropriate toothpaste and the integration of oral health education into school curricula across all socioeconomic strata. However, it should be noted that these findings reflect self-reported data drawn from a convenience sample, which may introduce selection bias, and require future clinical correlation with actual disease severity.