Research Article | | Volume 14 Special Issue 2 (July to August, 2025) | Pages 96 - 101

The Smile Starts at Home: Parental Impact on Paediatric Oral Health in Saudi Arabia: A Cross-Sectional Study

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1
General Dentistry Program, Batterjee Medical College, Jeddah, Saudi Arabia
Under a Creative Commons license
Open Access
Received
July 20, 2025
Revised
Aug. 22, 2025
Accepted
Aug. 29, 2025
Published
Sept. 5, 2025

Abstract

Early Childhood Caries (ECC) remains a highly prevalent and preventable oral condition worldwide, including in Saudi Arabia. Parental knowledge, attitudes and practices (KAP) strongly influence children’s oral health outcomes. This study assessed parental KAP regarding children’s oral health in Jeddah and explored sociodemographic factors influencing these practices. Methods: A cross-sectional survey was conducted among 257 parents of children aged 0-12 years in three districts of Jeddah. A validated bilingual questionnaire (Arabic/English) assessed demographics, knowledge, attitudes and practices. Stratified random sampling across schools, clinics and community centres was employed. Data were analysed using Chi-square tests, with p<0.05 considered significant. Results: Most parents recognized dental caries as a major childhood condition (75.5%) and identified its causes (86.8%). However, knowledge of preventive strategies such as dental sealants (26.5%) and recommended first dental visit (26.5%) was limited. Mothers, Saudi nationals and those with higher education and income demonstrated significantly better knowledge (p<0.05). Although 93.4% of children brushed daily, only 47.1% brushed for 2-3 minutes, 17.1% used dental floss and 39.7% attended regular dental checkups. Attitudinal assessment revealed that 68.2% of parents considered primary teeth important, yet 42.5% delayed the first visit until problems arose. Conclusion: While parents in Jeddah showed adequate general awareness, significant gaps persist in preventive knowledge, early dental visits and flossing. Targeted, culturally tailored education programs are essential to improve preventive practices and reduce ECC prevalence.

Keywords
Early Childhood Caries, Parental Knowledge, Attitudes, Oral Health Practices, Saudi Arabia

INTRODUCTION

Children’s oral health is a vital component of general health and well-being, closely influenced by parental knowledge, attitudes and behaviours. Among the most prevalent dental diseases in early childhood is Early Childhood Caries (ECC), a preventable condition that poses a significant public health challenge worldwide, particularly in low- and middle-income countries [1]. In Saudi Arabia, ECC remains highly prevalent and continues to affect the quality of life and development of young children [2-4]. ECC is characterized by the presence of one or more decayed, missing or filled tooth surfaces in any primary tooth in children under six years of age. Despite being largely preventable through proper oral hygiene practices and timely dental visits, ECC persists at alarmingly high rates [5,6].

 

Parental education, socioeconomic status and cultural beliefs have been consistently identified as key determinants of children’s oral health. Studies from across the region and internationally support this association. In Kuwait, Alyahya found that higher levels of parental education correlated with improved oral hygiene behaviours in children [7]. In Saudi Arabia, Alshammari et al. reported moderate parental awareness in Dammam, with clear disparities based on socioeconomic status [8], while in Riyadh, Ansari et al. highlighted cultural misconceptions surrounding the perceived insignificance of primary teeth as a cause for delayed dental visits [9]. Globally, the American Academy of Paediatric Dentistry (AAPD, 2018) recommends the first dental visit to occur by the child’s first birthday [10]. However, adherence to this guideline remains low in Saudi Arabia, where dental visits are often reactionary rather than preventive. In Saudi Arabia it was reported by Sabbagh and Alzain that many parents in Riyadh only sought dental care when their child was already experiencing dental problems, resulting in more advanced and difficult-to-treat cases [11]. These findings align with international literature, which emphasized the critical role of early preventive measures in managing ECC [12,13]. Cultural beliefs and socioeconomic conditions significantly shape oral health behaviours and access to care. Studies show that misconceptions about the value of preventive care, such as flossing or regular check-ups, are prevalent in many provinces in Saudi Arabia [14-16]. ECC is defined as the presence of one or more decayed, missing or filled primary tooth surfaces in children under six years [5]. However, older children remain relevant when exploring parental practices, as oral hygiene behaviours established in early years extend into later childhood [6]. In Saudi Arabia, ECC prevalence remains high, with studies reporting rates between 62-80% among preschoolers [2-4]. Despite national initiatives, preventive care remains underutilized.

 

Parental influence is central to shaping oral health outcomes [7-9]. Mothers, in particular, play a pivotal role in establishing hygiene routines, dietary control and dental attendance. However, cultural misconceptions, such as the belief that primary teeth are unimportant or that dental care is necessary only when problems arise, remain barriers to prevention in Saudi Arabia [10-12].

 

While studies have been conducted in Riyadh, Dammam and Taif, limited evidence exists for Jeddah, a city characterized by socioeconomic and cultural diversity. This study therefore sought to evaluate parental knowledge, attitudes and practices (KAP) regarding children’s oral health in Jeddah, while identifying demographic factors influencing these domains.

METHODS

Study Design and Setting

A cross-sectional study was conducted between January and April 2024 in Jeddah districts (Al-Safa, Al-Faisaliyah and Al-Nahda). Participants were recruited from community health centres, public dental clinics, primary schools and through online distribution.

 

Participants

 

  • Inclusion criteria: Parents/guardians of children aged 0-12 years, residents of selected districts and those providing informed consent
  • Exclusion criteria: Non-residents, individuals without children in the specified age group or those unwilling to consent

 

Sampling

Stratified convenience sampling was used to ensure inclusion across districts and facilities. Although power analysis indicated a minimum of 250 participants (medium effect size, α = 0.05, power = 80%), the final sample included 257 respondents.

 

Data Collection Tool

A structured, validated bilingual (Arabic/English) questionnaire was administered. It assessed: (1) sociodemographic details, (2) knowledge of oral health, (3) attitudes toward preventive care and (4) practices. Internal consistency was confirmed (Cronbach’s α = 0.82). Pilot testing was conducted on 20 parents and minor modifications were incorporated.

 

Statistical Analysis

Data were analysed using SPSS v26.0. Descriptive statistics (frequency, percentage) summarized responses. Associations between KAP scores and sociodemographic variables were tested using Chi-square and Fisher’s Exact Tests. A p-value<0.05 was considered statistically significant.

RESULTS

Sociodemographic Characteristics

Out of 257 participants, most were Saudi nationals (75.9%) and mothers (70.0%). The majority were between 26-45 years (61.5%) and resided in urban areas (98.1%). Over half had university education (61.1%), middle income (73.5%) and no chronic illness (71.2%) (Table 1).

 

Table 1: Sociodemographic characteristics of the participants

Parameters

Variable

N

%

Nationality

Saudi

195

75.9

Not Saudi

62

24.1

Parent

Father

77

30.0

The mom

180

70.0

Age of the parent

15-25 year

53

20.6

26-35 year

81

31.5

36-45 year

77

30.0

46-55 year

27

10.5

> 55 years

19

7.4

Residence

Urban‎/city

252

98.1

Rural‎/village

5

1.9

Educational level

No primary education

5

1.9

Primary

12

4.7

Middle

18

7.0

Secondary

65

25.3

University

157

61.1

Employment

Employed

128

49.8

Student

47

18.3

Other

82

31.9

Marital status

Married

185

72.0

Divorced

22

8.6

Widow‎/widower

50

19.5

Income

Low

33

12.8

Middle

189

73.5

High

35

13.6

Number children

1

83

32.3

2

60

23.3

3

57

22.2

4

57

22.2

Chronic disease

Nothing

183

71.2

Diabetes Mellites

29

11.3

Hypertension

20

7.8

Other

25

9.7

Is this first child

No

131

51.0

Yes

126

49.0

 

Knowledge

Most parents knew caries is the most common dental disease (75.5%) and could identify causes (86.8%). However, only 26.5% knew about dental sealants and the correct timing for the first dental visit. Fluoride knowledge was moderate (57.6%). Overall knowledge levels: 44.1% good, 35.0% fair, 20.9% poor (Figure 1, Table 2-3).

 

Figure 1: Knowledge level of the participants

 

Table 2: Knowledge about Dental Health

Question

Response

n (%)

Do you know that tooth decay is the most common dental disease among children?

Yes

194 (75.5%)

No

63 (24.5%)

Do you know the benefits of primary prevention for teeth?

Yes

194 (75.5%)

No

63 (24.5%)

Are tooth decay and gum diseases hereditary or acquired?

Acquired

214 (83.3%)

Hereditary

43 (16.7%)

Do you know the factors that cause tooth decay?

Yes

223 (86.8%)

No

34 (13.2%)

Do you understand the importance of monitoring your child's diet, including the type and quantity of sugar intake?

Yes

186 (72.4%)

No

71 (27.6%)

Do you know what dental sealants are and why they are important for children?

Yes

68 (26.5%)

No

189 (73.5%)

Do you know how to properly clean teeth with a toothbrush?

Yes

231 (89.9%)

No

26 (10.1%)

Do you know the correct timing and frequency recommended for brushing teeth?

Yes

204 (79.4%)

No

53 (20.6%)

Do you know the importance of fluoride for children?

Yes

148 (57.6%)

No

109 (42.4%)

When should children first visit a dentist?

When teeth emerge

68 (26.5%)

After one year

53 (20.6%)

Do not know

136 (52.9%)

Table 3: Knowledge Level by Demographic Variables

Parameter

Variable

Knowledge Level

P-value

Poor n (%)

Fair n (%)

Good n (%)

Nationality

Saudi

36 (18.5%)

73 (37.4%)

86 (44.1%)

<0.001

Non-Saudi

30 (48.4%)

17 (27.4%)

15 (24.2%)

Parent

Father

28 (36.4%)

22 (28.6%)

27 (35.1%)

0.035

Mother

38 (21.1%)

68 (37.8%)

74 (41.1%)

Age (years)

15-25

11 (20.8%)

20 (37.7%)

22 (41.5%)

0.184

26-35

23 (28.4%)

24 (29.6%)

34 (42.0%)

36-45

18 (23.4%)

29 (37.7%)

30 (39.0%)

46-55

12 (44.4%)

10 (37.0%)

5 (18.5%)

>55

2 (10.5%)

7 (36.8%)

10 (52.6%)

Residence

Urban/city

63 (25.0%)

88 (34.9%)

101 (40.1%)

0.112

Rural/village

3 (60.0%)

2 (40.0%)

0 (0.0%)

Educational level

No education

0 (0.0%)

4 (80.0%)

1 (20.0%)

<0.001

Primary

11 (91.7%)

1 (8.3%)

0 (0.0%)

Middle

12 (66.7%)

4 (22.2%)

2 (11.1%)

Secondary

18 (27.7%)

28 (43.1%)

19 (29.2%)

University

25 (15.9%)

53 (33.8%)

79 (50.3%)

Employment

Employed

39 (30.5%)

42 (32.8%)

47 (36.7%)

0.489

Student

10 (21.3%)

16 (34.0%)

21 (44.7%)

Other

17 (20.7%)

32 (39.0%)

33 (40.2%)

Marital status

Married

52 (28.1%)

60 (32.4%)

73 (39.5%)

0.349

Divorced

3 (13.6%)

8 (36.4%)

11 (50.0%)

Widowed

11 (22.0%)

22 (44.0%)

17 (34.0%)

Income

Low

17 (51.5%)

10 (30.3%)

6 (18.2%)

0.001

Middle

46 (24.3%)

68 (36.0%)

75 (39.7%)

High

3 (8.6%)

12 (34.3%)

20 (57.1%)

Number of children

1

24 (28.9%)

32 (38.6%)

27 (32.5%)

0.404

2

18 (30.0%)

21 (35.0%)

21 (35.0%)

3

12 (21.1%)

16 (28.1%)

29 (50.9%)

4

12 (21.1%)

21 (36.8%)

24 (42.1%)

First child

No

37 (28.2%)

48 (36.6%)

46 (35.1%)

0.354

Yes

29 (23.0%)

42 (33.3%)

55 (43.7%)

 

Attitudes

 

  • 2% agreed that primary teeth are important
  • 5% believed dental visits were only needed when problems occur
  • 1% accepted sweets as unavoidable in children’s diets

 

Practices Although 93.4% reported regular brushing, only 47.1% of children brushed for 2-3 minutes and 17.1% used dental floss. Only 39.7% attended routine dental checkups every 3-6 months (Table 4-6).

 

Table 4: Practices related to Dental Hygiene and Care

Question

Response

n (%)

Have you visited a dentist before?

Yes

251 (97.7%)

No

6 (2.3%)

Do you regularly take your child for a dental checkup every 3-6 months?

Yes

102 (39.7%)

No

155 (60.3%)

Do you replace your child’s toothbrush every three months?

Yes

152 (59.1%)

No

105 (40.9%)

Did you consult a dentist when your child's first tooth appeared?

Yes

93 (36.2%)

No

164 (63.8%)

Did you take care to clean your child's gums before their teeth appeared?

Yes

120 (46.7%)

No

137 (53.3%)

Do you regularly check your child's teeth at home?

Yes

95 (37.0%)

No

90 (35.0%)

Not Sure

72 (28.0%)

 

Table 5: Child’s Oral Health Behaviours and Habits

Question

Response

n (%)

Does your child brush his/her teeth regularly?

Yes

240 (93.4%)

No

17 (6.6%)

What type of toothbrush does your child use?

Normal

230 (89.5%)

Electric

27 (10.5%)

Does your child know how to brush his/her teeth correctly?

Yes

229 (89.1%)

No

28 (10.9%)

Have you taught your child the correct method of brushing teeth?

Yes

225 (87.5%)

No

32 (12.5%)

Do you reward or praise your child during tooth brushing?

Yes

138 (53.7%)

No

119 (46.3%)

Does your child brush his/her teeth for 2-3 minutes?

Yes

121 (47.1%)

No

136 (52.9%)

Does your child use dental floss?

Yes

44 (17.1%)

No

213 (82.9%)

Does your child brush his/her teeth more than once a day?

Yes

165 (64.2%)

No

92 (35.8%)

Table 6: Dietary Habits and Oral Health Issues

Question

Response

n (%)

Does your child consume sugary food or drinks with meals or between meals?

Between meals

171 (66.5%)

During meals

86 (33.5%)

Have you noticed any abnormalities or deformities in your child's mouth?

Yes

56 (21.8%)

No

201 (78.2%)

Has your child complained about pain or discomfort in the mouth or gums?

Yes

149 (58.0%)

No

108 (42.0%)

Does your child have other oral habits (e.g., thumb sucking, nail-biting)?

Yes

93 (36.2%)

No

164 (63.8%)

Does your child receive an adequate amount of fluoride?

Yes

171 (66.5%)

No

86 (33.5%)

What is the source of fluoride your child receives?

Toothpaste

151 (58.8%)

Water

55 (21.4%)

Topical application

17 (6.6%)

Other

34 (13.2%)

DISCUSSION

The findings of this study reveal encouraging levels of general awareness among parents in Jeddah regarding children's oral health, particularly in relation to the causes and prevention of tooth decay. A significant proportion of respondents (75.5%) identified dental caries as the most common childhood oral disease and demonstrated a solid understanding of primary preventive measures. This aligns with findings from a study in India by Mishra et al., which also reported high parental recognition of caries and its preventability [19]. Furthermore, a majority of participants (83.3%) correctly believed that dental caries and gum diseases are acquired conditions rather than hereditary, which is consistent with the health education principles promoted by the American Academy of Paediatric Dentistry [20]. Similarly, the high proportion (86.8%) who understood the contributing factors of tooth decay supports the findings of a systematic review and recent meta-analysis by Khan et al. [21] done in Saudi Arabia, who stressed that parental knowledge of sugar consumption and oral hygiene practices significantly correlated with lower caries prevalence.

 

Knowledge about practical oral hygiene techniques was also strong, with 89.9% of participants indicating they knew how to brush properly and 79.4% correctly identifying the recommended frequency and timing of brushing. These results are comparable to those reported by AlShammari et al. in Dammam, where parents showed moderate to high awareness of oral hygiene routines [8]. However, the findings also revealed critical knowledge gaps. About 26.5% of parents were aware of the role and importance of dental sealants, which is a preventive intervention shown to be effective in reducing caries incidence, especially in molars as demonstrated by multiple studies [22-24]. This mirrors findings from Al-Agili et al. in Saudi Arabia, where parental knowledge of dental sealants was found to be very low, suggesting an ongoing need for targeted public education on preventive dental treatments. Furthermore, while 57.6% recognized the benefits of fluoride for children, this remains lower than ideal. In contrast, a study by Timms and colleagues exploring the experiences of parents in the UK and USA found that while the majority of parents in Sheffield (73%) and Colorado (72%) were willing to accept fluoride treatment for their children’s posterior teeth, acceptance dropped to 58% for anterior teeth in both groups. Parental concerns about dental aesthetics significantly influenced acceptability, particularly for anterior teeth and also affected acceptance of posterior teeth in the UK sample, highlighting the aesthetic barrier to broader use of fluoride [26]. Perhaps the most concerning finding was that over half of the participants (52.9%) were unaware of the recommended timing for the child’s first dental visit, with only 26.5% correctly identifying it as when the first tooth erupts. This gap is consistent with previous studies in Eastern Province and Riyadh province of Saudi Arabia, which also highlighted poor parental knowledge regarding early dental visits [18,27]. International guidelines, such as those by the AAPD, recommend the first dental visit by age one [10] and studies in countries like Latvia and Lithuania have shown higher parental compliance with these recommendations, particularly when early dental education is emphasized [28,29].

 

In our study Saudi parents had significantly better knowledge about children's oral health compared to non-Saudis (44.1% vs. 24.2%, p<0.001), a pattern that aligns with previous studies in Saudi Arabia suggesting that familiarity with local health education initiatives may contribute to increased awareness among nationals [8,30]. Mothers were also more knowledgeable than fathers (41.1% vs. 35.1%), which is consistent with global and regional literature emphasizing the central role of mothers in child health behaviours [30,31]. Educational attainment had a strong association with knowledge levels, with university-educated participants demonstrating the highest proportion of good knowledge, echoing findings by Mishra et al. and Al-Malik et al., who highlighted the positive impact of higher education on oral health awareness [19,16]. Likewise, income level significantly affected knowledge, as higher-income families exhibited better knowledge compared to lower-income groups, a trend reported in both local and international studies [13,29,32]. Interestingly, no significant associations were found between knowledge and age, residence, employment, marital status, number of children or first-child status, suggesting that socioeconomic and educational variables may be more critical predictors than basic demographic characteristics, which is in contrastto some earlier assumptions that parenting experience alone improves oral health literacy.

 

The current study findings showed that while the vast majority of participants (97.7%) had taken their child to the dentist at least once, adherence to recommended preventive dental care practices was suboptimal. Fewer than half of the parents (39.7%) scheduled regular dental checkups every 3-6 months and only 36.2% sought dental consultation upon the eruption of their child’s first tooth, reflecting poor compliance with early dental care guidelines recommended by the AAPD [10]. Additionally, less than half (46.7%) reported cleaning their child’s gums before tooth eruption and only 37.0% regularly inspected their child’s teeth at home, both of which are essential preventive measures for early detection and oral hygiene establishment. Nevertheless, a relatively higher proportion (59.1%) reported replacing their child’s toothbrush every three months, which is consistent with recommended hygiene practices. These findings indicate a gap between awareness and consistent preventive behaviour, a pattern also demonstrated in studies from other Middle Eastern settings [27,33] emphasizing the need for reinforcing practical parental engagement through structured oral health education initiatives.

 

The study revealed generally positive oral hygiene habits among children, with most brushing regularly and demonstrating proper technique, likely influenced by the high rate of parental instruction reported. These findings align with Pullishery et al., who noted that active parental involvement significantly shapes children’s oral hygiene behaviour [34]. However, less than half met the recommended brushing duration of 2-3 minutes, reflecting a common gap between routine and best practices, as similarly observed in AAPD guidelines [10]. The minimal use of dental floss parallels results from AlShalan et al., emphasizing the continued neglect of interdental cleaning in local populations [27. High consumption of sugary foods between meals remains a concern, reinforcing the established link between dietary habits and early childhood caries [35]. Compared to lower sugar intake levels reported in Canadian and European cohorts with strong parental regulation [28,32], these findings point to the need for dietary education. The presence of oral abnormalities and parafunctional habits such as thumb sucking suggests a behavioural component requiring attention through early intervention. While fluoride exposure was adequate in most children, it was primarily limited to toothpaste use, with limited contribution from water or professional applications. This differs from countries with systemic water fluoridation, where broader exposure enhances caries prevention [36].

 

This study highlights satisfactory parental awareness in Jeddah regarding general oral health but reveals significant deficiencies in preventive knowledge and practices. The low awareness of sealants (26.5%) and poor compliance with first dental visit guidelines (26.5%) are concerning. These findings align with earlier Saudi studies [8,11,25], emphasizing the gap between awareness and preventive behaviour.

 

The omission of preventive practices is critical, as fluoride and sealants significantly reduce caries incidence [22-25]. The attitudinal finding that nearly half of parents delayed dental visits until problems arose reflects a reactive care model, inconsistent with AAPD recommendations [10].

 

Sociodemographic analysis showed mothers, higher-educated and higher-income parents demonstrated superior knowledge, consistent with prior Saudi and international studies [19,30-32]. However, reliance on Chi-square testing without multivariate models limits conclusions about independent predictors.

 

Clinically, the high sugar consumption (66.5%) and low flossing rates (17.1%) indicate an urgent need for behaviour-focused education. School-based interventions and parent-focused campaigns are warranted.

CONCLUSIONS

Parental knowledge of general oral health in Jeddah is encouraging, yet preventive gaps, especially regarding sealants, early visits, flossing and brushing duration, remain pronounced. Mothers and higher socioeconomic groups exhibit better awareness, but misconceptions persist. Tailored education programs addressing cultural and behavioural barriers are essential to reduce ECC prevalence. Future studies should integrate longitudinal and interventional designs with clinical assessments.

 

Ethical Statement

Approval was obtained from the Ethics Committee of Batterjee Medical College (Approval No: BMC-REC-2024-011). Written/electronic informed consent was obtained from all participants. Confidentiality and anonymity were assured.

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