Influence of Tooth Brushing and Previous Dental Visits on Dental Caries Status among Saudi Arabian Children

**Background:** Dental caries is one of the most common chronic diseases in early childhood and a severe public health problem globally. In Saudi Arabia, high caries prevalence among preschool children has been reported, but data on the influence of specific behavioral factors such as tooth brushing frequency and previous dental visits on caries status remain limited. This study aimed to evaluate dental caries prevalence and its association with tooth brushing frequency and previous dental visits among Saudi Arabian children with primary dentition.

**Methods:** This cross-sectional study was conducted from October 2020 to December 2021 at the College of Dentistry, Majmaah University, AlZulfi, Saudi Arabia, and followed STROBE guidelines. The study included 268 healthy Saudi children with primary dentition (mean age 4.6 ± 1.1 years; 66.4% male, 33.6% female). A structured, self-administered parental questionnaire collected data on child's name, gender, age (<3 years, 3.1–6 years, >6 years), tooth brushing frequency (once/twice/rarely/never), and previous dental visits (yes/no). Dental caries was diagnosed at the cavitation level through visual inspection per WHO (2013) criteria by a single experienced examiner (Kappa score 0.9). Mean dmft scores were calculated and compared across groups using t-tests, ANOVA, and multivariate linear regression. The desired sample size was 252, calculated using a single proportion formula (95% confidence level, 80% expected prevalence, 0.05 precision).

**Key Results:** Caries prevalence was 78.8%, with a mean dmft of 5.82 ± 4.48. Mean scores for decayed, missing, and filled components were 3.903 ± 3.69, 1.18 ± 1.69, and 0.73 ± 1.35, respectively. Females had significantly higher mean dmft scores (7.51 ± 4.18) than males (4.97 ± 4.39) (p < 0.001). By age group, mean dmft was 1.74 for <3 years, 6.58 for 3.1–6 years, and 4.58 for >6 years (p < 0.001). Only 50.7% of children brushed once daily, 15.7% twice daily, 11.2% rarely, and 22.4% never. Children who brushed twice daily had the lowest dmft (3.09 ± 4.07), while those who never brushed had the highest (7.5 ± 4.56) (p < 0.001). Only 32.5% of children had visited a dentist before; these children had higher dmft scores (8.14 ± 3.12) compared to first-time visitors (4.71 ± 4.61) (p < 0.001). Tooth-based analysis showed mandibular right second molars (tooth 85) were most commonly decayed, while mandibular central incisors (teeth 71, 81) were least affected. Multivariate regression analysis revealed that only age and previous dental visits had a significant independent effect on mean dmft scores (p < 0.05), while sex and tooth brushing frequency did not (p > 0.05).

**Clinical Implications:** The very high caries prevalence (78.8%) among Saudi preschool children highlights an urgent need for early preventive interventions. While bivariate analysis showed tooth brushing frequency was associated with lower dmft scores, multivariate analysis indicated that age and dental visit history were the only independent predictors. The finding that children with prior dental visits had higher dmft scores likely reflects treatment-seeking behavior rather than a causal relationship. The study reinforces the importance of establishing regular dental visits from the time of first tooth eruption, as recommended by the American Association of Pediatric Dentistry. Targeted oral health education for parents and children, promotion of twice-daily brushing with fluoridated toothpaste, and early professional fluoride applications are needed. Policymakers should prioritize early intervention programs for preschool children to reduce the caries burden in Saudi Arabia.