A Multifactorial Evaluation of Parental Oral Health Literacy, Attitudinal Construct, and Clinical Oral Disease Burden in Children and Youth With Special Health Care Need (CYSHCN) in India.
TL;DR
Oral health disparities in children with special care needs are multifactorial, rooted in parental knowledge gaps, attitudinal barriers, and suboptimal oral hygiene behaviors, cumulatively contributing to increased clinical oral disease burden.
Abstract
Objective
To evaluate the association between parental oral health literacy, attitudinal constructs, and the clinical oral disease burden in children and youth with special health care needs (CYSHCN), in comparison with age-matched healthy paediatric controls.
Methods
A quantitative, cross-sectional comparative study included 116 children and youth with Special health care need (CYSHCN) (age 10-20 years) and 336 age-matched healthy controls drawn from five special schools. Parental oral health knowledge and attitudes were assessed using a rigorously developed, validated, and pilot-tested questionnaire, translated and culturally adapted to Hindi. Clinical oral health examinations employed World Health Organization (WHO) 2013 standardized criteria for dental caries, periodontal status, dental fluorosis, erosion, and trauma conducted on-site by a calibrated examiner under natural daylight conditions. Data were analyzed via descriptive, bivariate, and multivariate statistics including Chi-square tests and logistic regression, with significance set at p ≤ 0.05.
Results
The study included 116 children with intellectual disabilities (mean age 14.11 ± 3.55 years; 75.9% male). Parental sociodemographic data showed a majority of fathers engaged in unskilled labor (33.6%) and mothers predominantly unemployed (84.5%), with limited education (one-third completed middle school). Parental oral health literacy revealed strengths, as 94% correctly identified sugary foods as cariogenic, but only 51.7% acknowledged the risks of chronic liquid medication. Child oral hygiene was often inadequate; less than half (46.6%) brushed independently, and 58.6% consumed sugary foods unrestrictedly. Dental caries prevalence was strikingly high in CYSHCN (70.7%) compared to healthy controls (35.3%), with a significantly elevated mean DMFT (2.59 ± 2.84 vs. 0.82 ± 1.47; p < 0.001). Periodontal disease was prevalent but not significantly different (p = 0.239). Logistic regression demonstrated that children of parents with moderate oral literacy had higher caries odds (OR = 2.24; p = 0.056) and those with low literacy had a fourfold increased risk (OR = 4.07; p = 0.008). Structural equation modeling revealed that socioeconomic status positively influenced parental literacy (β = 0.21; p = 0.007), which in turn positively impacted oral health behaviors (β = 0.39; p = 0.006) and protected against oral disease burden (β = -0.33; p = 0.008). Caregiver attitudes also improved behaviors (β = 0.27; p = 0.03) and correlated with literacy (r = 0.29; p = 0.006) but showed no direct effect on disease. These findings underscore the critical role of caregiver literacy and behavior, shaped by socioeconomic factors, in mitigating oral health disparities among CYSHCN.
Conclusion
Oral health disparities in children with special care needs are multifactorial, rooted in parental knowledge gaps, attitudinal barriers, and suboptimal oral hygiene behaviors, cumulatively contributing to increased clinical oral disease burden. This underscores the critical need for integrative, targeted oral health education and preventive interventions tailored for caregivers within this vulnerable demographic.