Exploring child and family-level influences on oral hygiene practices (OHP)-a qualitative study from South India

Early childhood caries (ECC) is an oral health concern prevalent globally, and can be effectively prevented via improved oral health literacy and practices. Parental beliefs, attitudes and cultural factors widely influence children's adoption of oral hygiene practices (OHP). Recent literature has demonstrated a knowledge gap in parents and caregivers regarding these practices. This qualitative study explored the traditional oral health beliefs, perspectives and practices among parents and caregivers of children aged 0-3 years, both with and without ECC via 24 semi-structured interviews and 2 focus group discussions. Moreover, information was collected regarding oral health practices and oral health-seeking behaviours to obtain in-depth insights into this phenomenon. The research process was guided by the Fisher-Owen's model focusing on child- and family-level influences. The audio recordings were entered into the NVivo software and analysed using the thematic analytical approach. The analysis unveiled two main themes under child-level and three under family-level influences. The findings revealed that child- and family-level determinants, such as the tender age of the child and poor cooperation in complying with OHP coupled with poor parental awareness of the importance of oral hygiene, specifically tooth brushing methods, use of toothpaste, the role of fluoride in the prevention of ECC, nighttime brushing and poor self-efficacy contributed to its inadequate practice. Preventing ECC requires an attitudinal and behavioural change among parents and caregivers. These observations indicate the lack of knowledge about oral health and OHP amongst parents and underscore the need for enhanced parental awareness and understanding of OHP via educational programs, and the development of effective oral health policies to improve oral health outcomes in young children.