title: Modelling community, family, and individual determinants of childhood dental caries.
abstract: This cross-sectional study empirically tested a theoretical model of pathways and inter-relationships among community, family, and individual determinants of childhood dental caries in a sample of 630, 6-year-old children from the Netherlands. Children's decayed, missing, and filled teeth (dmft) scores were extracted from dental records. A validated parental questionnaire was used to collect data on sociodemographic characteristics, psychosocial factors, and oral hygiene behaviours. Data on neighbourhood quality were obtained from the Dutch Central Bureau of Statistics. Structural equation modelling indicated that the model was valid after applying a few modifications. In the revised model, lower maternal education level was related to poorer family organization, lower levels of social support, lower dental self-efficacy, and an external dental health locus of control. These, in turn, were associated with poorer oral hygiene behaviours, which were linked to higher levels of childhood dental caries. In addition, lower maternal education level and poorer neighbourhood quality were directly associated with higher caries levels in children. This model advances our understanding of determinants of childhood dental caries and the pathways in which they operate. Conception of these pathways is essential for guiding the development of caries-preventive programmes for children. Clues for further development of the model are suggested.
authors: Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, the Netherlands.
authors: Denise
authors: D
authors: Duijster
authors: Cor
authors: C
authors: van Loveren
authors: Elise
authors: E
authors: Dusseldorp
authors: Gijsbert H W
authors: GH
authors: Verrips
mesh_terms: D002648:Child; D003430:Cross-Sectional Studies; D004245:DMF Index; D003731:Dental Caries / Q000209:etiology*; D004522:Educational Status; D005006:Ethnicity; D005190:Family; D005260:Female; D015438:Health Behavior; D006801:Humans; D007206:Individuality; D007389:Internal-External Control; D008297:Male; D008962:Models, Theoretical; D009035:Mothers / Q000193:education; D009426:Netherlands; D009910:Oral Hygiene; D015203:Reproducibility of Results; D012111:Residence Characteristics; D012189:Retrospective Studies; D020377:Self Efficacy; D012923:Social Class; D064890:Social Determinants of Health; D012931:Social Environment; D012944:Social Support; D014099:Toothbrushing
keywords: child oral health; dental caries; determinants; psychosocial factors; structural equation modeling