Academic Edi o : Ziad D. Baghdadi
Recei ed: 28 May 2025
Re ised: 18 June 2025
Accep ed: 19 June 2025
Published: 23 June 2025
Ci a ion: Pé ez de Mo a, E.;
Ba e a-Mo a, J.M.; A enas-González,
M.; Mendoza-Mendoza, A.;
Ribas-Pé ez, D. Impac o Pa en al
Knowledge on P e en ion Risk o
Ca ies in Se ille Child en Be ween 6
and 14 Yea s Old, Applying he
CAMBRA P o ocol. Child en 2025,12,
824. h ps://doi.o g/10.3390/
child en12070824
Copy igh : © 2025 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
This a icle is an open access a icle
dis ibu ed unde he e ms and
condi ions o he C ea i e Commons
A ibu ion (CC BY) license
(h ps://c ea i ecommons.o g/
licenses/by/4.0/).
A icle
Impac o Pa en al Knowledge on P e en ion Risk o Ca ies in
Se ille Child en Be ween 6 and 14 Yea s Old, Applying he
CAMBRA P o ocol
Es he Pé ez de Mo a 1, José Ma ía Ba e a-Mo a 2, Ma cela A enas-González 3,* ,
Asunción Mendoza-Mendoza 3and Da id Ribas-Pé ez 3
1Paedia ic Den is y, Facul y o Den is y, Complu ense Uni e si y o Mad id, 28040 Mad id, Spain;
[email p o ec ed]
2O hodon ics, Facul y o Den is y, Uni e si y o Se ille, 41009 Se ille, Spain; [email p o ec ed]
3Paedia ic Den is y, Facul y o Den is y, Uni e si y o Se ille, 41009 Se ille, Spain;
[email p o ec ed] (A.M.-M.); [email p o ec ed] (D.R.-P.)
*Co espondence: ma [email p o ec ed]
Abs ac
Backg ound/Objec i es: To explo e he associa ion be ween pa en al knowledge on den al
ca ies p e en ion and he isk o ca ies in pedia ic pa ien s aged 6 o 14 yea s who eside
in he p o ince o Se ille, using he CAMBRA p e en i e p o ocol as an assessmen ool.
Me hods: A e he app o al g an ed by he E hics Commi ee, a desc ip i e and analy ical
obse a ional s udy was conduc ed. Ca ies isk was es ablished using he CAMBRA
Ques ionnai e, pH measu emen , and sali a y low a e. To assess he socioeconomic
backg ound o he pa ien s and hei hygiene and die a y habi s, pa en s comple ed wo
su eys: he i s abou he quali y o he pa ien ’s die , and he second di ec ly ela ed o
he CAMBRA ques ionnai e used and alida ed by he Uni e si y o Se ille. Resul s: The
inal s udy sample consis ed o 300 pedia ic pa ien s, aged 6 o 14 yea s, o whom 54%
we e boys and 46% we e gi ls. The ca ies isk dis ibu ion was as ollows: 33% low, 7%
mode a e, 48.6% high, and 11.3%. A o al o 61.7% o he pa icipan s li e in u ban a eas,
while 38.3% a e om pe i-u ban egions. The e is a s a is ically signi ican associa ion
be ween socioeconomic s a us and amily ci cums ances in child en wi h a isk o ca ies.
Fu he mo e, an associa ion was es ablished be ween ca ies isk, die a y habi s, and o al
hygiene. Conclusions: Pa en al knowledge abou den al ca ies p e en ion and ca ies isk
in child en was ound o ha e a s ong associa ion wi h educed ca ies isk in child en.
Keywo ds: CAMBRA; den al ca ies; en i onmen ; pa en s; pH; p e en ion; isk o den al
ca ies; sialome y
1. In oduc ion
His o ically, ca ies has been conside ed an in ec ious, ch onic, ansmissible, and
dynamic disease caused by mic oo ganisms. I is loca ed in he ha d issues o he ee h and
begins wi h demine aliza ion o he enamel, caused by o ganic acids p oduced by ce ain
o al bac e ia when ca bohyd a es a e me abolized in ou die . Howe e , oday, he concep
o ca ies encompasses bo h he disease i sel and i s clinical mani es a ions. This condi ion
in ol es dysbiosis in he no mal o al bio ilm, which eac s dynamically o suga - ich die s,
gene a ing acids ha cause ca ies lesions [1–3].
Child en 2025,12, 824 h ps://doi.o g/10.3390/child en12070824
Child en 2025,12, 824 2 o 20
Den al ca ies is, he e o e, a mic obial disease ha a ises om an imbalance in he
o al mic obiome. This imbalance esul s in a shi in bac e ial species, a o ing hose ha
p oduce o ole a e acids, inc easing he isk and ac i i y o ca ies. The cu en de ini ion
o ca ies es ablishes ha i is a dynamic, ch onic, non-communicable p ocess media ed by
bac e ia and in luenced by die , which mani es s clinically as he loss o mine als in he
ha d issues o he oo h [4–6].
P e en i e s a egies ocus on add essing each o he ac o s in ol ed in he e iology o
ca ies: he agen , he hos , and he subs a e. The den is mus selec he mos app op ia e
p e en i e measu es o each si ua ion, wi h he goal o p e en ing he de elopmen o
ca ies and i s po en ial consequences [1,4].
The p ima y objec i e o any ca ies in e en ion is o p ese e heal hy ee h and
p e en he disease om de eloping; ha is, o achie e p ima y p e en ion in he
p epa hogenic phase o he disease. Howe e , his is no always possible due o he
high p e alence o ca ies and he nume ous sequelae associa ed wi h his pa hology. The e-
o e, i is essen ial o de elop guidelines o global isk assessmen [
7
,
8
]. Risk ac o s play
a c ucial ole in he e iology o ca ies; hei p esence di ec ly inc eases he likelihood o
disease de elopmen , while hei absence o elimina ion dec eases his p obabili y [7,9].
The diagnosis o den al ca ies in child en in ol es no only he iden i ica ion and
moni o ing o ca ious lesions bu also a a ie y o ac o s. This includes assessing ca ies
isk, analyzing he na u al his o y o ca ies p og ession, assessing and eassessing disease
ac i i y, e alua ing he esul s o p e ious ea men s, and pa en al expec a ions and p e e -
ences. Mul iple ools ha e been de eloped o assess ca ies isk, including he CAMBRA
p o ocol, he subjec o his s udy [7,10].
The CAMBRA p o ocol, p omo ed by he Cali o nia Den al Associa ion (CDA) in
2002, is a p ocedu e ha analyzes a pa ien ’s ca ies isk based on hei age, assessing he
ype and amoun o den al plaque p esen . The o iginal model includes ou isk le els:
low, mode a e, high, and ex emely high. This ques ionnai e assesses he ca ies lesion and
p oposes ac ion p o ocols based on isk le el [7,10,11].
CAMBRA allows pa ien s o be classi ied acco ding o hei isk assessmen , consid-
e ing ca ies p e alence, and es ablishes ea men p o ocols ha o e an indi idualized
app oach o each isk g oup. This acili a es ea men ocused on ca ies- ela ed p o-
ec i e ac o s. Addi ionally, i plays a p e en i e and in e cep i e ole in he disease,
co e ing he en i e popula ion; e en hose conside ed low- isk can bene i om p e en ion
ecommenda ions [7,10–12].
Howe e , he e ec i eness o hese indi idualized p e en i e s a egies is closely
ela ed o beha io s es ablished wi hin he amily en i onmen . The ca ies isk ou come
ob ained h ough he CAMBRA p o ocol in pedia ic pa ien s la gely depends on he daily
habi s p omo ed a home [13–15].
Pa en s play a c ucial ole in he beha io o a child in he pedia ic den is [
13
–
15
].
Recen ly, di e en pa en ing s yles ha e gained g ea in e es since pa en s, as p ima y
ca egi e s, exe a signi ican in luence on he de elopmen o hei child en’s p esen
and u u e emo ional heal h, pe sonali y, cha ac e , well-being, social and cogni i e de-
elopmen , and academic pe o mance. This is ans e ed o he den al o ice, a ec ing
he in e ac ion wi h he den is [
13
]. Pa en ing s yles also in luence child en’s heal h.
Childhood obesi y and suga consump ion a e inc easing among child en, and his is a
conce n o child en’s o al and gene al heal h [
13
,
14
]. The e o e, unde s anding he le el
o knowledge and he p ac ices o pa en s and ca egi e s plays an impo an ole in he
ad ancemen o in e en ion p og ams aimed a modi ying beha io and p omo ing he
imp o emen o o al heal h o child pa ien s [14,15].
Child en 2025,12, 824 3 o 20
P e en ion and ea men o childhood ca ies equi e a comp ehensi e app oach
ha combines indi idualized clinical s a egies, such as he CAMBRA p o ocol, wi h he
essen ial ole o he amily in adop ing heal hy habi s and shaping beha io s ha p omo e
good o al heal h om he ea ly yea s [7,10,14,15].
2. Ma e ials and Me hods
2.1. S udy Type and Se ings
This c oss-sec ional, obse a ional, and analy ical s udy was app o ed by he Resea ch
E hics Commi ee o he Uni e si y o Se ille. The sample consis ed o 300 child en who
had no known alle gies o any o he p oduc s used in he s udy. The sample size was
calcula ed based on a isk o e o (
α
) wi h a 95% con idence in e al (CI) and a isk o
e o (
β
). Pa ien s who unde wen o hodon ic ea men , sys emic pa hologies, o daily
medica ion we e excluded. The gua dians consen ed o he use o hei eco ds and pe sonal
da a o scien i ic pu poses. Va ious ypes o da a we e collec ed.
2.2. CAMBRA Assessmen Ques ionnai e
Fi s , CAMBRA ques ionnai es we e applied o ob ain he ca ies isk o pedia ic
pa ien s acco ding o he CAMBRA p o ocol. Sali a samples we e aken o measu e pH,
bu e ing capaci y, and sali a y low a e. The ou o iginal le els o ca ies isk (low,
mode a e, high, and ex eme) we e conside ed, and based on hese da a, a den al educa ion
p og am on o al hygiene was implemen ed, and a die analysis was pe o med o make he
necessa y ecommenda ions abou he oods ha could p omo e he appea ance o ca ies a
a young age [7].
2.3. Clinical Examina ion
As pa o he clinical assessmen , he p esence o bac e ial plaque on den al su aces
was examined o de e mine he s a e o o al hygiene. The p esence o absence o bac e ial
plaque on den al su aces was e alua ed using he modi ied Quigley–Hein plaque index
as a e e ence. The measu emen ocused on he hi d gingi al laye o he buccal and
lingual den al su aces o all e up ed ee h [
6
]. The a e age index was ob ained by di iding
he sum o he o al su ace sco e by he numbe o su aces examined. A sco e o 0 o 1
co esponded o low amoun s o bac e ial plaque, and 2 o mo e was associa ed wi h high
plaque sco es [16].
2.4. Sali a Analysis
To e alua e he sali a y cha ac e is ics o he pa ien s, speci ic es s we e pe o med o
measu e sali a y low a e and pH. A sialome y es was pe o med by s imula ion wi h
pa a in chewing gum o measu e sali a y low a e (SFV) in pa ien s [
17
]. The esul o his
collec ion was exp essed as millili e s pe minu e and was ob ained by di iding he sali a y
olume by he numbe o minu es elapsed. A sali a y low a e o less han 1 mL/min in
5 min was conside ed hyposali a ion [
17
,
18
]. Rega ding sali a y pH measu emen , he
pH scale was aken in o accoun , which includes alues be ween 0 and 14, h ough which
he acidi y o alkalini y o sali a was es ima ed. In he case o he sali a y sample s udied,
which is composed o 99% wa e and 1% o ganic and ino ganic molecules, he no mal pH
has a alue be ween 6.7 and 7.4. Tha is, i is ela i ely neu al [
18
–
20
]. The alue legend
included in he GC Eu ope Sali a Check Bu e pack, which was he se pu chased o
sialome y and sali a y pH measu emen , was used as a e e ence.
Child en 2025,12, 824 4 o 20
2.5. Socioeconomic Da a Collec ion
To assess pa en s’ knowledge and child en’s socioeconomic backg ound on den al
ca ies p e en ion, pa en s comple ed wo su eys. The i s was o assess die a y habi s
using he Die Quali y Ques ionnai e o he Spanish Socie y o Die e ics and Food Sciences
(SEDCA), which has been alida ed and used in p e ious s udies wi h he Spanish pedia ic
popula ion (Appendix A). This ques ionnai e has good in e nal consis ency and sensi i i y
o iden i y die a y pa e ns ha could in luence o al heal h. This su ey is alida ed o he
Spanish child popula ion and can p oduce h ee possible esul s: a good die , a die wi h
oom o imp o emen , and a poo die [21].
The second su ey was conduc ed o analyze knowledge and p ac ices ela ed o o al
hygiene habi s o p e en den al ca ies. This ques ionnai e was adap ed om he CAMBRA
p o ocol, bu i unde wen an addi ional alida ion p ocess ha included a pilo es wi h a
ep esen a i e sample o pa en s o assess he cla i y o he ques ions. The ques ionnai es
we e adminis e ed by he same in e iewe o minimize bias and ensu e uni o mi y in
da a collec ion. Rega ding socioeconomic backg ound, da a we e collec ed on: age, gende ,
educa ional le el, and na ionali y o pa en s, whe he he child pa ien s selec ed o he
s udy we e only child en o no , whe he hei pa en s we e sepa a ed, and whe he he
pedia ic pa ien s li ed in an u ban o pe i-u ban en i onmen . In addi ion, 14 ques ions
we e included in hei knowledge o den al ca ies p e en ion (Appendix B).
2.6. Radiog aphic Exam
All pa ien examina ion adiog aphs we e ob ained digi ally ollowing s anda d-
o -ca e p ocedu es. I is he s anda d o ca e o ob ain ca ies de ec ion adiog aphs i
no diagnos ic-quali y adiog aphs ha e been a ailable in he pas yea , acco ding o he
AAPD [
22
]. The p incipal in es iga o clinically and adiog aphically e alua ed he pa ien s,
classi ying he a ious pa hology in o di e en ypes: enamel ca ies, den in ca ies, and
pulpal ca ies.
The gold s anda d o in e -ope a o ag eemen was D . Asunción Mendoza-Mendoza,
P o esso o Pedia ic Den is y a he Uni e si y o Se ille, who has ex ensi e expe ience
in conduc ing s udies o his na u e.
2.7. S a is ical Analysis and Valida ion
Rega ding he da abase, a da a collec ion shee was used using Mic oso Excel, in
which pa ien codes, ull names, and alues o he a iables analyzed we e eco ded. To
ensu e he anonymi y o he pa ien s included in he s udy, each was assigned a nume ical
code. Only he p incipal in es iga o o his s udy had access o hese da a. A able was
designed o eco d all da a using SPSS . 29 o analysis. To alida e he collec ed da a,
a de ailed e i ica ion p ocess was conduc ed o ensu e ha all en ies we e co ec ly
coded and ha he in o ma ion was comple e and consis en . Incomple e o inco ec
da a we e iden i ied and emo ed om he da abase o a oid po en ial biases in he
esul s. Subsequen ly, a comp ehensi e desc ip i e analysis was pe o med o cha ac e ize
he sample based on he main sociodemog aphic and clinical a iables. In addi ion, a
mo e in-dep h analysis was pe o med, including he applica ion o mul i a ia e models
o iden i y signi ican associa ions be ween he a iables s udied and he isk o ca ies.
This app oach allowed o mo e obus esul s and allowed o adjus men o po en ial
con ounding ac o s.
3. Resul s
Wi hin he sample, 162 pa ien s we e boys (54%) and 138 gi ls (46%). The age dis i-
bu ion shows a ai ly uni o m sp ead ac oss he ange om 6 o 14 yea s old, wi h sligh
Child en 2025,12, 824 5 o 20
a ia ions be ween gende s. In pa icula , younge age g oups (6 o 8 yea s) had a highe
p opo ion o boys compa ed o gi ls, while in some middle age g oups (9 o 11 yea s),
he p opo ion o gi ls was sligh ly highe o simila o boys. In olde age g oups (12 o
14 yea s),
he numbe s end o le el ou again, wi h small di e ences be ween boys and
gi ls. O e all, he da a sugges ha he e was no signi ican gende skew in he sample
ac oss he age ange s udied, indica ing a balanced ep esen a ion o u he analysis.
To de e mine whe he he quan i a i e a iables me he no mali y c i e ia, he
Kolmogo o –Smi no es wi h Lillie o s co ec ion was pe o med; he assump ion o no -
mali y was ejec ed based on he esul s ob ained. Medians, pe cen iles, and in e qua ile
anges o all hese a iables we e calcula ed, p oducing a median o 9 o age, wi h an
in e qua ile ange o 4. Fo s imula ed sali a y low, he median was 8, wi h an in e qua -
ile ange o 4. Fo sali a y pH, he median was 7, wi h an in e qua ile ange o 0.4. The
equencies and pe cen ages o all he quan i a i e a iables collec ed in he s udy we e
calcula ed (Tables 1–4). The a iables we e di ided in o 4 ables, based on he g ouping
selec ed o each one.
Table 1. F equencies and pe cen ages o quali a i e a iables ela ed o he isk o ca ies in child en.
Va iable Boys Gi ls To al
F equency (%) F equency (%) F equency (%)
Gende 162 (54) 138 (46) 300 (100)
Risk o ca ies
CAMBRA
Low 52 (32.1) 47 (34.1) 99 (33)
Mode a e 11 (6.8) 10 (7.2) 21 (7)
High 81 (50) 65 (12.3) 146 (48.7)
Ex eme 17 (10.5) 17 (5.7) 34 (11.3)
Modi ied
Quigley–Hein
plaque index
0 22 (13.6) 30 (21.7) 52 (119)
1 60 (37) 59 (42.8) 119 (39.7)
2 62 (38.3) 40 (29) 102 (34)
3 18 (11.1) 9 (6.5) 27 (9)
4 0 (0) 0 (0) 0 (0)
5 0 (0) 0 (0) 0 (0)
Die Quali y
Su ey
Good 61 (37.7) 56 (40.6) 117 (39)
Imp o able 93 (57.7) 79 (57.2) 172 (54.3)
Bad 8 (4.9) 3 (2.2) 11 (3.7)
Suga
consump ion
mo e han
3 imes/day
Yes 116 (71.6) 99 (71.7) 215 (71.7)
No 46 (28.4) 39 (28.3) 85 (28.3)
The Table 1shows he quali a i e a iables ela ed o he isk o ca ies in he pa ien s
selec ed o he s udy. The able p esen s in o ma ion on he ollowing a iables: ca ies isk
de e mined by he CAMBRA ques ionnai e, he modi ied Quigley–Hein plaque index, die
quali y, and suga consump ion mo e han h ee imes a day. These esul s a e di ided in
he able by gende o he selec ed sample (Table 1).
Six y pe cen o child en a e a high o ex eme isk o ca ies. Simila esul s we e
ob ained o he a iables used o de e mine he isk o ca ies, de e mined by CAMBRA.
Almos 83% o child en ha e some le el o den al plaque. Al hough only 3.7% ha e a
“poo ” die , 54.3% ha e a die ha could be imp o ed. Mo e han 70% o he child en
consumed excessi e suga (Table 1).
Child en 2025,12, 824 6 o 20
Table 2. F equencies and pe cen ages o a iables on he amily si ua ion o he en i onmen
o child en.
Va iable Boys Gi ls To al
F equency (%)
Yes/No
F equency (%)
Yes/No
F equency (%)
Yes/No
F equency (%)
Yes/No
Single child 33 (20.4) 29 (21) 62 (20.7) 300 (100)
129 (79.6) 109 (79) 238 (79.3)
Sepa a ed
pa en s
18 (11) 10 (7.2) 28 (9.3) 300 (100)
144 (88.9) 128 (92.8) 272 (90.7)
Place o
esidence
92 (56.8) 93 (67.4) 185 (61.7) 300 (100)
70 (43.2) 45 (32.6) 115 (38.3)
Table 3. F equencies and pe cen ages o a iables in he su ey o de e mine he knowledge o
child en’s pa en s abou den al ca ies p e en ion.
Va iable Boys Gi ls To al
F equency (%)
Yes/No
F equency (%)
Yes/No
F equency (%)
Yes/No
F equency (%)
Yes/No
1. Has he mo he o
p ima y ca egi e had
ca i ies in he pas yea ?
51 (17)/111 (37) 56 (18.7)/82 (27.3) 107 (35.7)/193 (64.7) 300 (100)
2. Has you child had
illings in he pas yea ? 61 (20.3)/101 (33.7) 62 (20.7)/76 (25.3) 123 (41)/177 (59) 300 (100)
3. Has you child had
den al isi s in he
las yea ?
138 (46)/24 (8) 120 (40)/18 (6) 258 (86) 42 (14) 300 (100)
4. Does you child ea
snacks o d ink suga y
d inks be ween meals mo e
han h ee imes a day?
25 (8.3)/136 (45.3) 25 (8.3)/113 (37.7) 50 (16.6)/249 (83) 299 (100)
5. Does you child egula ly
d ink o he be e ages
han wa e ?
55 (18.3)/107 (35.7) 38 (12.7)/100 (33.3) 93 (31)/207 (69) 300 (100)
6. Does you child sleep in
wi h a bo le o b eas eed
on demand while sleeping
be ween he ages o 2
and 6?
3 (1)/159 (53) 2 (0.7)/136 (45.3) 5 (1.7)/295 (98.3) 300 (100)
7. Do you know he
pu pose o luo ide? 118 (39.3)/44 (14.7) 104 (34.7)/34 (11.3) 222 (26)/78 (74) 300 (100)
8. Does you child b ush
hei ee h wi h 1450 ppm
luo ide oo hpas e daily?
131 (43.7)/31 (10.3) 115 (38.3)/23 (7.7) 246 (82)/54 (18) 300 (100)
9. Does you child b ush
hei ee h h ee imes
a day?
44 (14.7)/118 (39.3) 44 (14.7)/94 (31.3) 88 (29.3)/212 (70.7) 300 (100)
10. Did you child b ush
hei ee h h ee imes a day
be o e he age o 6?
38 (12.7)/124 (41.3) 38 (12.7)/100 (33.3) 76 (25.3)/224 (74.7) 300 (100)
Child en 2025,12, 824 7 o 20
Table 3. Con .
Va iable Boys Gi ls To al
F equency (%)
Yes/No
F equency (%)
Yes/No
F equency (%)
Yes/No
F equency (%)
Yes/No
11. Do you check you
child’s b ushing a leas
once a day?
87 (29)/75 (25) 63 (21)/75 (25) 150 (50)/150 (50) 300 (100)
12. Did you check you
child’s b ushing a leas
once a day be o e age 6?
58 (19.3)/104 (34.7) 42 (14)/96 (32) 100 (33.3)/200 (66.7) 300 (100)
13. Does you child use
luo ide mou hwash
o inse?
44 (14.7)/118 (39.3) 39 (13)/99 (33) 83 (27.7)/217 (72.3) 300 (100)
14. Does you child use a
manual oo hb ush? 128 (42.7)/34 (11.3) 112 (37.3)/26 (8.7) 240 (80)/60 (20) 300 (100)
Table 4. Chi-squa e analysis e alua ing he associa ion be ween pa en al knowledge o p e en ion
(based on su ey da a) and quali a i e a iables ela ed o child en’s ca ies isk.
Ques ion
Modi ied
Quigley–Hein
Plaque Index
Ca ies Risk
CAMBRA Die Quali y Su ey
Suga Consump ion
G ea e Than
3 Times/Day
1. Has he mo he o
p ima y ca egi e had
ca i ies in he pas yea ?
0.155 0.003 * 0.001 * 0.001 *
2. Has you child had
illings in he pas yea ? 0.001 * 0.001 * 0.016 * 0.005 *
3. Has you child had
den al isi s in he
las yea ?
0.148 0.027 * 0.001 * 0.001 *
4. Does you child ea
snacks o ha e suga y
d inks be ween meals
mo e han h ee imes
a day?
0.214 0.002 * 0.001 * 0.013 *
5. Does you child
egula ly d ink o he
be e ages han wa e ?
0.001 * 0.003 * 0.001 * 0.001 *
7. Do you know he
pu pose o luo ide? 0.538 0.001 * 0.132 0.038 *
8. Does you child b ush
hei ee h wi h 1450 ppm
luo ide oo hpas e daily?
0.162 0.015 * 0.003 * 0.015 *
11. Do you check you
child’s b ushing a leas
once a day?
0.299 0.009 * 0.305 0.898
*p alue < 0.05 means s a is ical signi icance.
The ollowing able p esen s in o ma ion on he amily si ua ion o en i onmen o
he child en included in he s udy. The quali a i e a iables selec ed we e as ollows:
whe he o no hey we e single child en, he pa en s’ ma i al s a us (whe he he pa en s
Child en 2025,12, 824 8 o 20
we e sepa a ed o no ), and he child en’s p ima y esidence.,Se ille, an u ban a ea, o a
pe iu ban a ea (Table 2).
The as majo i y, 79.3%, o he child en had siblings. The e o e, 20.7% o he child en
we e single child en. Only 9.3% o he child en had sepa a ed pa en s. 61.7% li ed in he
ci y o Se ille, while 38.3% li ed in pe i-u ban a eas (Table 2).
Figu e 1shows in o ma ion on he socioeconomic backg ound o he 300 pa icipan s,
de e mined by he age, educa ional le el, and na ionali y o he pa en s. Mos o he a he s
we e o e 35 yea s old, wi h an almos equal dis ibu ion be ween he 35–45 age g oups
(45.7%) and hose o e 45 yea s old (46%). Rega ding he mo he s o he pa ien s, mos
we e be ween 35 and 45 yea s o age (52.7%), sligh ly younge han he a he s on a e age.
Rega ding he educa ional le el, 54% o a he s and 55% o mo he s had highe educa ion.
Child en 2025, 12, x FOR PEER REVIEW 6 o 23
The as majo i y, 79.3%, o he child en had siblings. The e o e, 20.7% o he child en
we e single child en. Only 9.3% o he child en had sepa a ed pa en s. 61.7% li ed in he
ci y o Se ille, while 38.3% li ed in pe i-u ban a eas (Table 2).
Table 2. F equencies and pe cen ages o a iables on he amily si ua ion o he en i onmen o
child en.
Va iable Boys Gi ls To al
F equency (%)
Yes/No
F equency (%)
Yes/No
F equency (%)
Yes/No
F equency (%)
Yes/No
Single child 33 (20.4) 29 (21) 62 (20.7) 300 (100)
129 (79.6) 109 (79) 238 (79.3)
Sepa a ed pa en s 18 (11) 10 (7.2) 28 (9.3) 300 (100)
144 (88.9) 128 (92.8) 272 (90.7)
Place o esidence 92 (56.8) 93 (67.4) 185 (61.7) 300 (100)
70 (43.2) 45 (32.6) 115 (38.3)
Figu e 1 shows in o ma ion on he socioeconomic backg ound o he 300 pa icipan s,
de e mined by he age, educa ional le el, and na ionali y o he pa en s. Mos o he a-
he s we e o e 35 yea s old, wi h an almos equal dis ibu ion be ween he 35–45 age
g oups (45.7%) and hose o e 45 yea s old (46%). Rega ding he mo he s o he pa ien s,
mos we e be ween 35 and 45 yea s o age (52.7%), sligh ly younge han he a he s on
a e age. Rega ding he educa ional le el, 54% o a he s and 55% o mo he s had highe
educa ion.
Figu e 1. F equencies and pe cen ages o ele an quali a i e a iables e e ing o he socioeco-
nomic en i onmen o child en.
Howe e , a small pe cen age o mo he s had p ima y educa ion (14.3%). Rega ding
he na ionali y o he pa en s, mos o he wo sexes we e Spanish (app oxima ely 90%).
Figu e 1. F equencies and pe cen ages o ele an quali a i e a iables e e ing o he socioeconomic
en i onmen o child en.
Howe e , a small pe cen age o mo he s had p ima y educa ion (14.3%). Rega ding
he na ionali y o he pa en s, mos o he wo sexes we e Spanish (app oxima ely 90%).
The ollowing able shows he equencies and pe cen ages o esponses ha we e
included, as p e iously men ioned, in he su ey o pa en s o de e mine hei knowledge
abou den al ca ies p e en ion habi s (Appendix B) (Table 3).
In gene al, high a es o a i ma i e esponses we e ob ained, such as in Ques ion
3 (86%) and Ques ion 14 (80%). I should be no ed ha in Ques ion 6, he majo i y o
pa en s esponded “No,” wi h 98.3%. In Ques ion 11, he esponses we e spli exac ly 50/50
(Table 3).
In gene al, he p opo ion o esponses does no a y signi ican ly be ween boys and
gi ls. Howe e , we no e ha in Ques ion 5, mo e pa en s o boys answe ed “Yes” (18.3%)
compa ed o pa en s o gi ls (12.7%). Howe e , in Ques ion 12, he di e ence is also no able:
Mo e pa en s o boys (19.3%) answe ed “Yes” compa ed o pa en s o gi ls (14%) (Table 3).
Pea son’s chi-squa e es was pe o med o es he signi icance among ca ego ical
a iables. Subsequen ly, we desc ibe he signi icance o each ca ego ical independen
a iable ela i e o he o he ca ego ical dependen a iables. Ca ies isk (CAMBRA) is
Child en 2025,12, 824 9 o 20
obse ed o be he indica o wi h he mos s a is ically signi ican associa ions, especially
wi h a his o y o ca i ies in ca egi e s, he p esence o ca i ies in he child, he equency o
den al isi s, equen suga consump ion, and luo ide use, indica ing ha hese ac o s a e
key de e minan s o ca ies isk. Daily suga consump ion also shows signi ican associa ions
wi h mos a iables ela ed o die and luo ide use. In con as , he plaque index was only
signi ican ly associa ed wi h he consump ion o be e ages o he han wa e (Table 4).
The emaining esul s ob ained om he Chi-squa e es o he independen a iables
did no show any signi ican associa ion wi h he dependen a iables. In he ollowing, we
de ail he signi icance o he associa ion be ween each ca ego ical dependen a iable and
he o he ca ego ical dependen a iables. The educa ional le el o bo h pa en s, a he , and
mo he , is he sociodemog aphic ac o wi h he highes numbe o s a is ically signi ican
associa ions wi h child en’s o al heal h habi s. I is p ima ily ela ed o equen suga
consump ion, knowledge o luo ide, and he use o luo ide oo hpas e. Some signi ican
associa ions a e also obse ed wi h he pa en s’ na ionali y and, o a lesse ex en , wi h
hei age, especially in aspec s such as supe ising oo h b ushing and he consump ion o
suga y d inks (Tables 5and 6).
The a iables in which s a is ically signi ican esul s we e ob ained ha e been in-
cluded in Tables 4–6. I is highligh ed, o example, ha he e we e no ele an esul s
ega ding he ype o b ush used by he pa ien s.
Because he sample did no ha e a no mal dis ibu ion, nonpa ame ic s a is ical es s
we e applied, in his case, he Wilcoxon es o ela ed samples. In he ollowing, we de ail
he signi icance o he nume ical independen a iable (age) wi h he o he nume ically
dependen a iables (s imula ed sali a y low and sali a y pH). Bo h esul s showed a
s a is ically signi ican ela ionship (p= 0.001). The e was a signi ican associa ion be ween
he nume ically dependen a iables since he p alue was less han 0.05 (p= 0.026).
Logis ic eg ession analysis was used o iden i y a iables signi ican ly associa ed wi h
he likelihood o he e en o in e es . This app oach allows explo ing how di e en ac o s
con ibu e o he occu ence o he phenomenon s udied, acili a ing a be e unde s anding
o he collec ed da a. The nume ical a iables we e g ouped in o h ee g oups: age,
di ided in o h ee g oups acco ding o he ype o den i ion (young child en wi h mixed
den i ion, phase 1: be ween 6 and 9 yea s; middle-aged child en wi h mixed den i ion,
phase 2: be ween 10 and 12 yea s; olde child en wi h pe manen den i ion: be ween 13
and
14 yea s).
Rega ding he sali a y pH a iable, alues we e g ouped in o wo in e als
based on he ype o pH (acidic pH, be ween 6.2 and 7; basic pH, be ween 7.2 and 7.8).
Rega ding he alues o he s imula ed sali a y low a iable, hey ha e been g ouped in o
wo anges: alues less han 5 mL/min a e associa ed wi h hyposali a ion, while alues
g ea e han 5 mL/min a e associa ed wi h no mal sali a ion.
In he ollowing, wi h espec o age, using he oldes g oup (13–14 yea s) as a e e ence,
signi ican associa ions we e obse ed wi h he educa ional le el o he a he (seconda y
and high school) and wi h he esponses o he p e en i e knowledge ques ions
(ques ions 1
and 7) in he 6- o 9-yea -old g oup. Fo child en aged 10–12 yea s, signi ican associa ions
we e ound wi h he educa ional le el o he a he (seconda y and highe educa ion), he
age o he mo he (26–35 yea s), and he esponses o ques ion 9 on b ush equency.
Sali a y pH, aking he basic pH g oup as a e e ence, wi h he o he ca ego ical
a iables showed signi icance wi h he pa ien ’s gende (p= 0.039 and OR = 0.560), he
modi ied Quigley–Hein plaque index, a iable 0 (p= 0.044 and OR = 0.082), he Pa ien ’s
Die Quali y Su ey, good (p< 0.001 and OR = 2.065
×
10
−9
) and place o esidence
(p= 0.024 and OR = 2.019).
Child en 2025,12, 824 16 o 20
E.P.d.M.; in es iga ion, E.P.d.M.; esou ces, E.P.d.M.; da a cu a ion, E.P.d.M., D.R.-P.; w i ing—
o iginal d a p epa a ion, E.P.d.M.; w i ing— e iew and edi ing, E.P.d.M., M.A.-G.; isualiza ion,
E.P.d.M., A.M.-M., D.R.-P.; supe ision, A.M.-M.; p ojec adminis a ion, E.P.d.M., J.M.B.-M.; unding
acquisi ion, E.P.d.M. All au ho s ha e ead and ag eed o he published e sion o he manusc ip .
Funding: This esea ch did no ecei e ex e nal unding.
Ins i u ional Re iew Boa d S a emen : The s udy was ca ied ou in acco dance wi h he Decla a ion
o Helsinki and app o ed by he E hics Commi ee o UNIVERSIDAD DE SEVILLA (p o ocol code
0930-N23 and da e o 31 Janua y 2024).
In o med Consen S a emen : In o med consen was ob ained om all subjec s in ol ed in
he s udy.
Da a A ailabili y S a emen : O iginal con ibu ions p esen ed in his s udy a e included in he a icle
and Supplemen a y Ma e ials. Fu he inqui ies can be di ec ed o he co esponding au ho .
Con lic s o In e es : The au ho s decla e ha hey ha e no con lic s o in e es .
Appendix A. Valida ed Su ey on Die Quali y by he Spanish Socie y o
Die e ics and Food Sciences
DIET QUALITY SURVEY (SEDCA)
QUESTION YES NO
1. Do you consume a leas 2 o 3 se ings o esh ui
e e y day?
2. Do you egula ly include a ull se ing o ege ables and
g eens in bo h lunch and dinne (making up abou 1/3 o
1/2 o he pla e)?
3. Do you consume a leas 2–3 se ings o legumes
pe week?
4. Do you egula ly include aw o oas ed (no ied o
sal ed) nu s o aw o oas ed seeds (such as chia, laxseed,
sesame, sun lowe , pumpkin. . .) in you die se e al imes
a week?
5. When you ea b eak as ce eals, b ead, pas a, o lou
p oduc s, do you choose whole g ain e sions ins ead o
whi e o e ined ones?
6. Do you consume a leas 3–4 se ings o ish pe week
(including canned ish), wi h some o hem being oily ish?
7. Do you egula ly ea suga y b eak as ce eals, cookies,
pas ies, o swee s (mo e han 3 imes a week on a e age)?
8. Do you d ink so d inks, whe he suga y o in hei
ligh /ze o e sions, se e al imes a week (mo e han 2 so
d inks pe week)?
9. When buying packaged oods, do you ead he nu i ion
label o choose he bes op ions (no added suga s, quali y
a s, lowe in sal , whole g ain lou s. . .)?
10. Do you consume mo e han 4–5 se ings o mea and
p ocessed mea p oduc s (cold cu s, sausages, mea
p epa a ions. . .) pe week?
Child en 2025,12, 824 17 o 20
DIET QUALITY SURVEY (SEDCA)
QUESTION YES NO
11. Do you b eak as s usually include suga y ce eals,
cookies, comme cial jams, swee ened cocoa powde , suga ,
pas ies. . .?
12. Do you usually add suga o oods such as co ee o
yogu , o choose hei p e-swee ened e sions?
13. Do you o en use e ined oils (such as sun lowe , palm,
palm ke nel. . .) o cooking o equen ly buy p oduc s ha
con ain hose (p ecooked meals, cookies, b eak as
ce eals. . .)?
14. Do you o en skip meals o educe you calo ie in ake,
ea as li le as possible, o ollow e y es ic i e die s o he
poin o eeling e y hung y a he nex meal, expe iencing
ood anxie y, o eeling unwell?
15. Do you skip meals o snack on any hing be ween meals
o a oid aking a b eak a wo k o due o a lack o ime o
p epa e p ope meals?
16. Do you o en eso o quick dinne s made wi h
low-nu i ional-quali y p ocessed oods, o de as ood, o
ea cold cu s, cookies wi h milk, o simila (2 o mo e imes
pe week)?
I you sco e is:
•
Be ween 11 and 16 poin s: The quali y o he die is qui e good. I is impo an o
suppo an ac i e li es yle and exe cise.
•
Be ween 6 and 10 poin s: The quali y o he die could be imp o ed. Some o he
poin s should be e iewed o imp o emen , and al e na i es should be sough o
imp o e hem.
•
Be ween 0 and 5 poin s: The quali y o he die needs o be imp o ed. I is impo an
o e iew he ecommenda ions ha a e no being ollowed and o y o g adually
in oduce imp o emen s o he die .
Appendix B. Valida ed Su ey on Daily Die a y Habi s o
Pedia ic Pa ien s
PARENTAL SURVEY ON ORAL HEALTH PREVENTION
This su ey is a esponse o esea ch being conduc ed a he Uni e si y o Se ille o
de e mine he knowledge o pa en s o pedia ic pa ien s ega ding hygiene and ca ies
p e en ion measu es.
Age o 1s pa en :
◦Unde 25 yea s old
◦Be ween 25 and 35 yea s old
◦Be ween 35 and 45 yea s old
◦O e 45 yea s old
Age o 2nd pa en :
◦Unde 25 yea s old
◦Be ween 25 and 35 yea s old
◦Be ween 35 and 45 yea s old
◦O e 45 yea s old
Child en 2025,12, 824 18 o 20
PARENTAL SURVEY ON ORAL HEALTH PREVENTION
Gende o 1s pa en :
◦Female
◦Male
◦O he
Gende o 2nd pa en :
◦Female
◦Male
◦O he
Educa ional le el o 1s pa en :
◦P ima y educa ion
◦Seconda y educa ion
◦Highe educa ion
◦Don’ know, no answe (DK/NA)
Educa ional le el o 2nd pa en :
◦P ima y educa ion
◦Seconda y educa ion
◦Highe educa ion
◦Don’ know, no answe (DK/NA)
Na ionali y o 1s pa en : Na ionali y o 2nd pa en :
Is he pa ien an single child? NO YES
A e he pa ien ’s pa en s sepa a ed/di o ced? NO YES
Does he pa ien li e in an u ban se ing? NO YES
1. Has he mo he o p ima y ca egi e had ca i ies in he pas yea ? NO YES
2. Has you child had illings in he pas yea ? NO YES
3. Has you child isi ed he den is in he pas yea ? NO YES
4. Does you child ea snacks o suga y d inks be ween meals mo e han h ee imes a day?
NO YES
5. Does you child egula ly d ink o he be e ages han wa e ? NO YES
6. Does you child sleep wi h a bo le o b eas eed on demand while sleeping be ween he
ages o 2 and 6? NO YES
7. Do you know he pu pose o luo ide? NO YES
8. Does you child b ush hei ee h wi h 1450 ppm luo ide oo hpas e daily? NO YES
9. Does you child b ush hei ee h h ee imes a day? NO YES
10. Did you child b ush hei ee h h ee imes a day be o e he age o 6? NO YES
11. Do you e iew you child’s b ushing habi s a leas once a day? NO YES
12. Did you e iew you child’s b ushing habi s a leas once a day be o e age 6? NO YES
13. Does you child use luo ide- ee mou hwash o inse? NO YES
14. Does you child use a manual oo hb ush? NO YES
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