Pathways Linking Socioeconomic Circumstances to Childhood Dental Caries: The Mediating Role of Parenting and Oral Health Behaviours Before and After Childsmile Implementation.

OBJECTIVES

To determine the extent that parenting styles and oral health behaviours mediate the relationship between socioeconomic circumstances (SEC) and childhood dental caries experience: pre-/post-national roll-out in 2011 of Childsmile, the child oral health improvement programme for Scotland.

METHODS

A longitudinal design linked 2798 participants from Birth Cohort-1 (following from age 10 months in 2005/06 to age 5 years in 2009/10) and 3015 from Birth Cohort-2 (following from age 10 months in 2011 to age 5 years in 2015) of the Growing Up in Scotland study with caries experience at age five from the National Dental Inspection Programme. Two Structural Equation Models (Birth Cohort-1 and 2) tested an a priori framework to explain the social gradient (SEC: Income Poverty, Area-based Deprivation, Household Education, Household Employment) in caries experience, considering proximal behaviours (toothbrushing, cariogenic diet, regular dental attendance) before introducing validated parenting styles (Parental Responsiveness/Demandingness).

RESULTS

Models for both the pre-/post-Childsmile cohorts illustrated similar pathways. Dental attendance and parenting had no direct effect on caries experience. Responsiveness partially mediated the SEC-toothbrushing relationship, while demandingness partially mediated the SEC-diet relationship. Cariogenic diet directly increased caries experience prevalence (β = 0.33/0.24), while increased toothbrushing persistently decreased caries (β = -0.18/-0.13). Total mediated effect of SEC decreased from 58.8% to 39.1%, with the largest relative decrease being directly via toothbrushing (9.5%/4.0%). The effect mediated through parenting pathways remained minimal (4.8%/3.5%).

CONCLUSIONS

Pathways between SEC and childhood caries were unchanged after Childsmile roll-out, with minimal effects from parenting styles. The diminishing SEC effects via toothbrushing may be positively attributed to Childsmile interventions. The persistent unexplained effect of SEC on caries experience highlights the need for equity-focused structural approaches that address broader socioeconomic inequalities.