Independent contributions of nuclear and extended families to risk of early childhood caries among children from low socioeconomic status in India

Objective: The family is a fundamental unit of society and provides care to the needs of its members. This study aims to assess the independent contributions of nuclear and extended families through direct and indirect pathways towards the risk of early childhood caries among 5-year-old children from low socio-economic status families in Central India. Methods: Cross-sectional study with two-stage sampling of 313 randomly selected school children. The American Association of Pediatric Dentistry criteria were used for diagnosing early childhood caries (ECC) and severe early childhood caries (S-ECC). It was hypothesised that the type of family would impact ECC and S-ECC by acting on individual-level variables such as frequency of cleaning teeth, dietary patterns, and utilisation of dental services. Examiner-administered interviews collected information about demographic details and oral hygiene practices. Generalized structural equation modelling (GSEM) examined the relationship between exogenous variables, including nuclear and extended families with ECC and SECC. Path coefficients and the standard error with a 95% confidence interval were reported. Results: ECC and SECC were present among 186 (59.4%) and 47 (15%) children. Nuclear families, more frequent between meal sugar consumption and lower utilization of dental care were associated with ECC (odds ratios of 2.43, 2.78, and 8.65, respectively (p< 0.001)). Nuclear families were also associated with SECC. Type of family directly (p< 0.001) and indirectly (p< 0.05) predicted ECC via three or more times sugar consumption and lower utilization of dental services. Conclusions: Nuclear families were associated with ECC and SECC among children. Health professionals need to understand the influence of the type of family and the associated pathway to tackle and reduce the burden of ECC. Keywords: risk factors, dental caries, oral health promotion, access to health care