搜索结果：Caries research

Evidence-based caries management emphasises identification of disease drivers and causal, preventive, and behaviour-oriented care. However, limited evidence is available on how such care is documented for adults with high caries activity in routine public dental care. This study examined documentation of caries treatment and preventive measures consistent with evidence-based caries management, and whether documented care addressed underlying causes of caries disease. This retrospective observational record-review study included 418 adults aged 25-65 years from 19 Public Dental Service clinics in Region Västra Götaland, Sweden. High caries activity was defined as ≥ 4 manifest caries lesions at a complete oral examination in 2015 or 2016. Documented caries-related treatment, preventive measures, causal investigations, and counselling content were extracted from electronic dental records between the index examination and the subsequent complete oral examination. Descriptive statistics summarised documentation patterns. Sex-related differences were analysed using Fisher's exact test and Mann-Whitney U-test, and associations with age and sex were explored using logistic regression. The sample comprised 185 women (44.2%) and 233 men (55.7%). Overall, 330 patients (78.9%) had at least one documented preventive and/or treatment measure, whereas 88 patients (21.1%) had none. Oral hygiene advice (43.5%; 95% CI 38.7-48.4) and fluoride advice (40.9%; 95% CI 36.2-45.8) were the most frequently documented preventive measures. Dietary enquiry was documented more often than dietary advice (34.4% vs. 16.3%). Professionally applied fluoride treatment was documented for 15.6%. No record contained documentation indicating a theory-based behaviour change approach or salivary secretion measurement. In exploratory analyses, no statistically significant sex-related difference was observed, whereas increasing age was associated with a higher likelihood of documentation. Among highly caries-active adults in routine public dental care, documentation showed partial alignment with guideline-relevant preventive domains but limited evidence of causal, intensified, and behaviour-oriented caries management. The findings indicate a documentation and implementation gap in adult caries care and provide a baseline for evaluating guideline-aligned preventive practice.

Dental caries remains one of the most prevalent noncommunicable diseases worldwide despite decades of clinical and behavioural interventions. Persistently high prevalence suggests that current approaches are better organised for ongoing disease management than for preventing new disease occurrence. This commentary examines whether an elimination framework could provide a more coherent and outcome-oriented direction for oral health policy and practice. We apply the Dahlem Framework to assess whether dental caries meets established criteria for disease eradication. We then position caries within the classical continuum of control, elimination, and eradication, drawing on current evidence on caries aetiology, fluoride exposure, dietary environments, primary care integration, surveillance, and the social and commercial determinants of oral health. Dental caries does not meet the criteria for eradication. It has no single causal agent, no interruptible transmission cycle, no immunising intervention, and no global surveillance architecture capable of detecting incidence. Eradication is therefore conceptually impossible. Elimination, however, defined as the stable disappearance of dental caries as a public health problem within a defined population, is biologically plausible and operationally achievable. An elimination frame shifts expectations from managing recurrence to preventing occurrence and reframes caries as a system outcome rather than solely an individual behavioural or clinical problem. Caries elimination is not the promise of biological absence, but a realistic and measurable population health objective. Adopting an elimination framework could strengthen policy coherence, surveillance, implementation research, professional education, and accountability, while reorienting oral health systems toward prevention, equity, and sustained population-level impact.

Caries risk begins early in life, yet few studies use intraoral cameras to assess risk in toddlers or examine multiple contributing factors. This study aimed to address this gap and conduct intraoral camera-based assessment of caries and evaluate multiple toddler risk factors, including microbial profiles, oral hygiene practices, and potential maternal transmission. Cross-sectional data from 21 maternal-child dyads included intraoral camera assessments coded with an adapted International Caries Detection and Assessment System, saliva-based microbial tests for Streptococcus mutans (SM) and Lactobacillus (LB), and validated surveys of hygiene practices. Among toddlers (N = 21; mean age 3.9 years), intraoral camera use was well tolerated and produced images adequate for assessment. Reliability was good for sound teeth [Intraclass correlation coefficient (ICC) = 0.80], moderate for initial caries (ICC = 0.72), and poor for moderate-to-severe caries (ICC = 0.13). Most teeth were sound (89.0%), with 9.8% mild and 1.1% moderate decay. SM was detected in 9/20 (45.0%) and LB in 4/21 (19.0%) of toddlers. While 81% brushed twice daily, few flossed (14.3%) or used mouthwash (19%); 42.1% consumed soda at least weekly and 19% ate fast food weekly. More frequent brushing was associated with lower SM (Cramer's V = 0.54; p = .02) and LB (V = 0.48; p = .043). Mothers (N = 21; mean age 32.1) had 38.0% of teeth coded as sound, 45.0% with initial caries, and 14.0% with moderate-to-severe decay; 9/21 (42.9%) tested positive for LB and the same proportion tested positive for SM. Most brushed twice daily (81%), with 47.6% flossing and 38.1% using mouthwash. Maternal and toddler brushing frequency (V = 0.68; p = .02), fast-food intake (V = 0.56; p = .01), and microbial positivity (SM: V = 0.93; p = .001; LB: V = 0.54; p = .02) were strongly related. Intraoral cameras with adapted ICDAS scoring were feasible for assessing caries risk in toddlers. Significant concordance between maternal and child microbial profiles suggests a potential maternal influence on early caries risk. Larger longitudinal studies are needed to clarify transmission pathways and inform prevention strategies.

Emerging evidence suggests that higher physical activity and physical fitness are associated with fewer decayed teeth (DT). This study investigates whether salivary immunoglobulin A (SIgA) mediates the association between physical activity or fitness and DT, and whether dentine caries is associated with salivary and systemic immunoglobulin levels in adults. Data were derived from the 46-year follow-up of the Northern Finland Birth Cohort 1966. Participants (N = 1,589) underwent clinical oral examinations using ICDAS criteria. SIgA and serum immunoglobulins (IgA, IgG, IgM) were analysed from saliva and fasting blood samples using a chemiluminescence immunoassay. Physical activity was measured objectively using wrist-worn accelerometers, and physical fitness by step testing and heart rate recovery. Mediation analyses examined whether SIgA mediated associations between physical activity or fitness and DT. Associations between immunoglobulins and DT were analysed using adjusted negative binomial regression. Descriptive analyses indicated higher SIgA levels among participants with greater dentine caries burden. No significant indirect effects of physical activity or fitness on caries through SIgA were observed. In adjusted models, higher SIgA concentrations were associated with increased DT (Exp(β) = 1.282, p = 0.001), whereas serum IgA, IgG, and IgM were not associated with caries. No evidence was found that SIgA statistically mediated the association between physical activity or fitness and dentine caries in this dataset. Higher SIgA levels are associated with greater caries burden, suggesting a reactive rather than protective role. Salivary SIgA may reflect immune activation in response to dentine caries rather than protection against disease, highlighting the potential role of local immunity in caries progression.

Dental caries arises from an ecological imbalance within a complex community. How chronic social context relates to ecological heterogeneity and dysbiosis-associated microbial shifts in school-age children remains unclear. To investigate the associations of left-behind status and caries burden with the salivary microbiome and to explore a two-hit ecological framework linking social context to caries-associated microbial shifts. In this cross-sectional study, 127 rural children were classified using a 2 × 2 framework based on left-behind status and caries burden. Saliva samples underwent shotgun metagenomic sequencing. Ecological analyses and covariate-adjusted multivariable models were performed. Alpha diversity did not differ across groups. Global community centroids were similar, whereas within-group dispersion was higher in left-behind children, suggesting greater ecological heterogeneity. After covariate adjustment, no genus-level associations remained significant, whereas several KEGG level 3 pathways related to translation and carbohydrate utilization were positively associated with dmft. Stratified analyses showed concordant caries-related enrichment of Streptococcus, Veillonella, and carbohydrate-utilization pathways across social strata. Ecological subtyping identified Neisseria- and Veillonella-anchored community types. The findings are consistent with a two-hit ecological framework in which social context is associated with greater ecological heterogeneity and cariogenic pressure is associated with reproducible functional shifts. Given the cross-sectional design, this framework should be considered hypothesis-generating. A two-hit ecological framework links social context to caries-associated microbiome shifts.Left-behind status was associated with greater ecological dispersion and heterogeneity.Caries burden showed concordant taxonomic and functional patterns across social strata.Covariate-adjusted models linked caries burden more consistently to functional pathway shifts.Exploratory subtyping supported a Neisseria- to Veillonella-anchored gradient.

This study investigated the relevant factors influencing the caries increment among schoolchildren in Liaoning Province and constructed a structural equation model to analyze the complex interrelationships among these factors. Baseline data of 7,904 schoolchildren were collected through clinical oral examinations and questionnaire surveys in 2024 and oral examinations for the cohort were collected in 2025. The prevalence of dental caries was 31.1% in 2024, with a mean DMFT/dmft of 0.84 ± 1.57, which increased to 50.6% and 1.63 ± 2.24, respectively, in 2025. A total of 2,865 individuals showed caries increment (defined as △DMFT/dmft ≥ 1), corresponding to an incidence of 36.2%. The results of the multivariate logistic regression analysis indicated that socioeconomic region, grade, gender, weight status, and deliberate exclusion from or isolation in group activities were significantly associated with the caries increment. Structural Equation Modeling analysis (SEM) converged to identify socioeconomic factors as a factor associated with caries incidence, showing both direct associations and indirect associations mediated by poorer dietary habits, although the observational one-year design precludes strong causal clclaims. Notably, the model also indicated a protective association with higher weight status, a finding that merits further investigation. While conventional factors such as socioeconomic status, dietary habits, and weight status are well-established influencers of caries increment in schoolchildren aged 9-12, our findings highlight that psychological factors, such as experiences of social isolation, constitute a significant determinant. This dimension merits particular attention in both future research and preventive strategies.

The diagnostic accuracy of caries detection on bitewing radiographs varies among dentists and is strongly influenced by lesion severity. Improving the detection of initial and extensive carious lesions remains clinically important for appropriate treatment planning. This study evaluated the diagnostic performance of a deep learning-based detection model and compared its performance with that of general dentists in detecting caries on bitewing radiographs of primary teeth, applying lesion severity criteria relevant to clinical caries management. A total of 1,427 bitewing radiographs was included, with 1,180 allocated for training and validation, and 247 for testing. As the reference dataset, two experienced dentists annotated carious lesions according to six depth categories based on the International Caries Classification and Management System (ICCMS™). The diagnostic performance of YOLOv8 and the general dentists were compared using recall, precision, F1-score, average precision (AP), and mean average precision (mAP) at an intersection over union (IoU) threshold of 50%. YOLOv8 outperformed the general dentists in recall (0.51 vs. 0.29), precision (0.41 vs. 0.31), F1-score (0.44 vs. 0.29), and mAP (0.41 vs. 0.22). Both YOLOv8 and the general dentists demonstrated greater diagnostic accuracy for extensive carious lesions than for initial lesions. Based on the pattern of mispredictions, YOLOv8 tended to underestimate lesion severity, predicting shallower depths than those annotated in the reference dataset, whereas the general dentists exhibited a tendency to overestimate lesion depth. The deep learning-based model demonstrated superior performance to the general dentists across all evaluated metrics and lesion classes. These findings support the potential role of deep learning as an adjunctive tool for radiographic caries assessment on bitewing radiographs of primary teeth.

Scarce evidence is available in how clinicians process the management of high-risk individuals in real-world scenarios. The purpose of the present study is to discern the degree to which graduates apply explicit risk analysis skillsets in practice over time, and how graduates prioritize risk factors for caries and periodontitis. The importance of risk factors for caries and periodontitis and management of low/high risk private practice patients were surveyed among dental graduates within the last ten years. Surveys were sent from August 2025 through October 2025. Data patterns were observed with statistics as support. A total of 73 surveys were obtained. For 75% of respondents, risk level influenced treatment planning. For caries-affected patients, respondents ranked risk from highest to lowest with all being considered worthy: oral hygiene, current disease level, patient compliance, sugared beverages, xerostomia, prognosis, no treatment/monitor conditions for up to 5 years, dental literacy, fluoride exposure, social barriers, and general health. For periodontitis, respondents' rankings were similar with smoking and diabetes also ranking high. Most respondents (71%) stated that they adapted ideas from dental school to practice and were more likely to score low risk patients with a more optimistic prognosis than high risk patients. Dental graduates take risk factors into account in making patient decisions in practice. Similarities in the thought process was noted in determining risk for caries- and periodontitis-affected patients. Oral hygiene, current disease level, and patient compliance are risk factors with consistent high ratings for both caries and periodontitis, indicating the importance of engaging the patient to improve health.

Inmates are recognized as a vulnerable population with limited access to healthcare and generally poorer oral health than the wider community, warranting focused investigation. This study, conducted at Takuapa District Prison, Thailand, aimed to assess oral health status and oral health-related quality of life (OHRQoL) among inmates and to examine factors associated with dental service utilization. A total of 535 inmates underwent oral examinations and completed questionnaires, and descriptive statistics were used for this entire sample. Subsequently, logistic regression analysis was performed only on the 418 inmates who also completed the Oral Impacts on Daily Performance (OIDP) index. Dental caries was present in 94.6% of inmates, with a mean DMFT score of 10.05 ± 7.23. Untreated caries affected 90.5% of participants (mean DT = 6.22 ± 5.50), while 58.9% presented with complications of untreated caries, with a mean PUFA score of 2.41 ± 3.61. Five inmates were edentulous, and among dentate inmates, 63.6% had periodontitis (CPI scores 3-4). Overall, 50.7% of inmates reported impaired OHRQoL, as assessed using the OIDP index, which was significantly associated with complications of untreated caries (PUFA). In addition, 48.6% of inmates reported access to dental services, which was also significantly associated with impaired OHRQoL. Inmates exhibit a high burden of untreated dental caries and periodontitis, which, along with limited healthcare access, significantly impairs their oral health-related quality of life. Implementing targeted oral health services and preventive programs within prisons is urgently needed to improve their well-being.

Dental caries is defined as a chronic, multifactorial disease characterized by the demineralization of dental hard tissues resulting from the acid production by oral microbial communities metabolizing dietary sugars. The ingestion of sugars is a pivotal ecological factor in the progression of caries, with mechanisms that extend beyond merely providing substrates for cariogenic bacteria. This review explores the influence of sugars on the metabolism, adhesion, biofilm formation, and interspecies interactions of oral microorganisms, with a particular focus on species such as Streptococcus mutans, Lactobacilli, Actinomyces, and Candida albicans. The disruption of the oral microbiome balance by these sugars initiates and promotes the process of caries. The review comprehensively summarizes contemporary public health strategies for caries prevention based on microbial ecological theories, including the limitations of sugar intake, fluoride application, probiotics, and ecological management, assessing their effectiveness and challenges. The objective of this study is to establish a theoretical framework and practical guidelines for the precise prevention of dental caries.

Dental caries is a chronic biofilm-mediated disease that is caused by the interplay of plaque dysbiosis, persistent acid generation by cariogenic bacteria and host-associated environmental influences. Accordingly, current anti-caries measures increasingly focus on broader interventions targeting bacterial adhesion and colonization, biofilm formation, extracellular polysaccharide (EPS) production, and the local oral microecological equilibrium. Funoran, a sulfated polysaccharide derived from red algae, has become a promising natural marine bioactive, because it has desirable biocompatibility, interfacial activity, and potential anti-adhesive and antibiofilm properties. Current evidence suggests that funoran can reduce the adhesion of oral streptococci to tooth-relevant surfaces and may improve biofilm inhibition when combined with agents such as xylitol. Studies on structurally related algal polysaccharides further support the potential of marine polysaccharides in antibacterial, antibiofilm, anti-inflammatory, and oral delivery applications. Nevertheless, the development of funoran for caries prevention is still constrained by limited direct evidence, unclear mechanisms, non-standardized evaluation systems, and insufficient clinical research. Future studies should emphasize structural characterization, mechanistic investigation, standardized biological evaluation, and local delivery design to accelerate its translation into precision caries prevention.

To evaluate diagnostic performance of artificial intelligence (AI) models in detecting proximal caries across different radiographic modalities. We systematically searched in five electronic databases: Web of Science, PubMed, IEEE Xplore, ScienceDirect and CNKI. Essential study characteristics, AI models and their accuracy metrics for proximal caries detection were extracted. Methodological quality of eligible studies was assessed with QUADAS-2. Studies judged to be of adequate quality were retained for meta-analysis. Twenty studies were included: fifteen employed bitewing radiographs, three utilized panoramic radiographs, and two adopted periapical radiographs. AI accuracy ranged from 28.5% to 100%. Due to the unavailability of essential 2 × 2 contingency data, only ten studies (six bitewing, three panoramic, and one periapical) were eligible for meta-analysis, yielding a pooled sensitivity of 76% (95% CI: 70%-80%), specificity of 94% (95% CI: 90%-96%), and Summary Receiver Operating Characteristic (SROC) AUC of 0.90 (95% CI: 0.87-0.92). Substantial heterogeneity was observed. AI models show promising diagnostic accuracy for proximal caries, with bitewing radiographs yielding slightly better performance than panoramic views. While AI holds potential as a clinical decision-support tool, high heterogeneity and limited external validation remain significant barriers to clinical translation. Future work should prioritize prospective, multicenter validation and open datasets to support clinical translation. This systematic review covers studies up to October 2025, simultaneously evaluate AI performance of different modalities, enabling direct cross-modal comparison. By stratifying analyses by task type, dataset size, and imaging modality, this study identifies specific sources of performance heterogeneity that have previously confounded pooled estimates in the field. This review also establishes evidence thresholds for clinical implementation, serving as a methodological checkpoint to guide future research.

This in vitro study evaluated the diagnostic accuracy of visual and radiographic assessments for secondary caries (ICDAS-merged) on posterior permanent teeth. Teeth were obtained from a university tooth bank and selected based on the presence of occlusal or proximal restorations. Two trained examiners assessed 296 restored surfaces using ICDAS-merged secondary caries criteria, grouping scores into sound (0), initial (1-2), moderate (3-4), and extensive (5-6). Scores were validated against a histological gold standard using three diagnostic thresholds: (1) sound vs. initial+moderate+extensive; (2) sound+initial vs. moderate+extensive; and (3) sound+initial+moderate vs. extensive. Analyses included Spearman correlation, weighted kappa, and calculation of sensitivity, specificity, and accuracy. After sample evaluation included 129 premolar surfaces and 167 molar surfaces, restored either with amalgam (n = 194) or composite resin (n = 102). Both methods showed substantial inter- and intra-examiner reproducibility (kappa: 0.70-0.80). Correlation with histology was substantial for both visual (=0.73) and radiographic (=0.70) assessments. At the threshold of sound vs. initial+moderate+extensive, specificity was high (visual: 0.85; radiographic: 0.93), while sensitivity was higher for visual (0.80) than for radiographic criteria (0.68). Overall accuracy was high for both methods (visual: 0.83; radiographic: 0.81). Across restorative materials, visual assessment showed consistent accuracy for amalgam and composite restorations. In contrast, radiographic assessment showed lower sensitivity for amalgam (0.61) and composite (0.64) restorations at the same threshold. ICDAS-merged visual criteria demonstrated strong accuracy and reproducibility for detecting secondary caries in restored permanent teeth, regardless of restorative material. Radiographic criteria exhibited high specificity but lower sensitivity, particularly for early lesions, highlighting the value of visual inspection as a reliable method for detecting secondary caries in clinical settings.

Early childhood caries remains a significant public health concern globally. Caries risk assessment (CRA) tools are essential for early identification and prevention, yet comparative evidence in young children is limited. To compare three CRA tools - American Academy of Pediatric Dentistry (AAPD), American Dental Association (ADA) and Caries Management by Risk Assessment (CAMBRA) - in children aged 1-6 years. Cross-sectional study at a tertiary care dental hospital in South India. One hundred and nineteen children (61 males, 58 females; mean age 2.8 &#xb1; 0.9 years) were examined. All three CRA tools were applied simultaneously by a single calibrated examiner. Risk categories were compared across age groups (<3 years vs. &#x2265;3 years) and gender. Cohen's kappa coefficient assessed inter-tool agreement. Chi-square and Fisher's exact tests compared distribution (P < 0.05). AAPD identified significantly more high-risk children (4.2%) than ADA and CAMBRA (0.8% each), most pronounced in children under 3 years (5.1% vs. 0%). ADA and CAMBRA showed almost perfect agreement (&#x3ba; = 0.885, 98.3%), while AAPD showed moderate agreement with ADA (&#x3ba; = 0.596) and CAMBRA (&#x3ba; = 0.520). No significant differences were observed across age groups or gender (p > 0.05). All three tools are effective for pediatric CRA with varying sensitivity. AAPD may be more sensitive for early risk detection in toddlers, while ADA and CAMBRA demonstrate higher concordance. Tool selection should be guided by clinical context and whether sensitivity or specificity is prioritized.

Multilevel modeling (MLM) is increasingly applied in oral health research to reflect the hierarchical structure of dental data, in which teeth are nested within individuals and individuals are embedded within social and environmental contexts. By partitioning both within- and between-individual variability, MLM improves estimate precision, reduces bias, and strengthens causal interpretation, thereby enhancing the evidence base for preventive strategies, clinical practice, and public health policy. This review synthesizes recent methodological developments and ongoing challenges in the application of MLM to oral health research, with particular emphasis on causal inference. Key issues include reciprocal relationships between individual- and contextual-level factors, establishing temporality, collinearity among contextual variables, population mobility, and the selection of appropriate geographic or institutional levels. We also highlight methodological advances, such as integrating propensity score weighting within multilevel frameworks, which offer promising approaches to improving causal assessment in observational studies. Accumulating evidence demonstrates the importance of contextual determinants, such as school and neighborhood environments, in shaping oral health outcomes across the life course. However, causal inference regarding these distal exposures remains underdeveloped. Persistent threats to validity include measurement error in contextual indicators, unmeasured multilevel confounding, and limited consideration of cross-level interactions. Using a school-based example, we illustrate how food insecurity mediates the association between household income and active dental caries, highlighting the value of analytical approaches that jointly address individual- and contextual-level determinants. Overall, MLM provides a robust framework for clarifying causal pathways, improving analytical rigor, and guiding interventions that target both behavioral and structural drivers of oral health inequalities.

Dental caries, a chronic disease resulting from bacterial demineralization of dental hard tissues, poses a significant global health challenge. Remineralization therapy presents a promising strategy to arrest caries progression and restore tissue integrity. However, simultaneously achieving stable, efficient remineralization and effectively combating plaque biofilm formation remains a critical hurdle. Inspired by the hierarchical "brick-and-mortar" architecture of nacre and the adhesive functionality of mussel foot proteins (Mfps), a novel nanoarchitectonic system was developed via a layer-by-layer biomimetic assembly. This multifunctional system comprises amorphous calcium phosphate (ACP) as a mineral ion reservoir, tannic acid (TA) as a bridging and crystallization-regulating layer mimicking the catechol chemistry of Mfps, and hydroxypropyltrimethyl ammonium chloride chitosan (HACC) as a functional antibacterial outer layer. This bioinspired design yields a stable platform capable of sustained release of calcium and phosphate ions for remineralization while providing long-lasting antibacterial activity against cariogenic biofilms. The system not only forms a durable protective barrier on the enamel surface but also facilitates effective biomimetic remineralization of early carious lesions. This nature-inspired strategy provides a comprehensive and clinically translational approach for hard tissue regeneration and synergistic caries management.

The participation of patient in this task can be done with the help of certain indicators such as the oral health related quality of life (OHRQOL). This indicator helps to measure the extent to which oral health conditions impact on a patient's behavior and social functioning. Oral health-related quality of life (OHRQOL) serves as a measure to assess the impact of oral health on the overall well-being of individuals. Good oral health improves quality of life, necessary to improve an individual productivity in life. Therefore the aim of this study was to evaluate the effect of dental caries on OHRQOL in adults in Ebolowa, Cameroon. This cross&#x2011;sectional study was conducted in people aged over 15 years living in Ebolowa, South of Cameroon. Data collection was conducted from October 2022 to May 2023. Patients and their attendees (e.g., patients' family members and relatives) visiting the outpatient department of the dental unit were selected. Patients who were fifteen years old or more, and were residents of Ebolowa and its surroundings were included in the study. A simple random sampling technique was adopted for the current study. The majority of participants (54.37%) were found to be in the 'High' risk category, 17.48% in the 'moderate' category and only 28.16% in the 'low' risk category. Concerning dental caries, 17.15% of the study population had a score equal to or above the SiC index. Dental caries affects OHRQOL in adults. Using OHRQoL as an assessment tool, along with a dental clinical indicator, can be beneficial in planning oral health programs.

Orphaned children face heightened vulnerability due to the absence of parental care and limited access to preventive services. Evidence linking oral health knowledge, attitudes, and practice (KAP) with clinical outcomes in this population remains limited. This study aimed to assess oral health KAP among orphaned children in Karaj, Iran, and examine their associations with clinical indicators of dental caries, gingival status, and oral hygiene. In this cross-sectional study, 72 children aged 6-12 years residing in four government-run quasi-family centers in Karaj were examined between October 2024 and January 2025 through a census sampling approach. Inclusion required age eligibility and informed consent, whereas children with systemic or developmental disorders or those receiving orthodontic treatment were excluded. Data were collected using a structured, validated questionnaire (&#x3b1;&#x2009;=&#x2009;0.83) to assess KAP and demographic factors. Clinical examinations were performed by a calibrated examiner (ZJ) (Kappa&#x2009;=&#x2009;87.68%) using the CAST, GI, and OHI-s indices. Logistic and linear regression models were used to examine predictor variables of KAP and oral health outcomes. The mean scores of knowledge, attitude, and practice were 3.16&#x2009;&#xb1;&#x2009;1.60 (out of 7), 33.52&#x2009;&#xb1;&#x2009;4.36 (out of 50), and 10.26&#x2009;&#xb1;&#x2009;2.72 (out of 20), respectively. Overall, 62.5% of children demonstrated fair oral hygiene (OHI-s&#x2009;=&#x2009;1.75&#x2009;&#xb1;&#x2009;1.58) with mild gingival inflammation. CAST assessment indicated that fewer than one-third of primary molars were sound, while more than half of permanent first molars showed enamel caries. Regression analyses showed that frequent toothbrushing (p&#x2009;=&#x2009;0.015, OR=0.52, 95% CI: 0.30-0.88) and more positive attitudes toward oral health (p&#x2009;=&#x2009;0.013, OR=0.70, 95% CI: 0.53-0.93) were significant predictors of improved oral status, whereas knowledge and self-reported practice were not consistent predictors. Orphaned children in Karaj demonstrated moderate oral hygiene, a high prevalence of untreated dental caries, and limited awareness of oral health. Addressing these behavioral and systemic gaps through targeted, evidence-based interventions-particularly oral health education, caregiver involvement, and routine dental monitoring-may help improve oral health outcomes in this vulnerable population.

Early Childhood Caries (ECC) is a highly prevalent chronic condition that disproportionately affects children from low-income and marginalised communities. Globally, approximately 500&#xa0;million children have untreated caries in their primary teeth. ECC affects approximately 49% of the global population and up to 90% of the population in some Low- and Middle-Income countries (LMICs), compared with 30-50% in high-income countries. Behavioural science frameworks offer structured approaches to diagnosing behavioural determinants. This study aimed to explore the determinants, barriers, and facilitators of ECC-preventive behaviours among mothers and caregivers of 1-3-year-old children in urban underserved settlements (USS). A qualitative study with five focus group discussions (FGDs) with mothers and caregivers of children aged 1-3 years with ECC and 11 key informant interviews (KIIs) with health professionals and community stakeholders was conducted in the USS of Colombo City. Reporting was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Audio-recorded data were transcribed, translated, and analysed using a framework analysis. The coding was primarily deductive. Behavioural diagnosis was guided by the Behaviour Change Wheel (BCW), with the COM-B model and the Theoretical Domains Framework (TDF) used to map the determinants. Thirty-four caregivers and 11 professionals participated. The caregivers' mean age was 29.3 years and the informants' mean age was 43.7 years. Twelve themes from FGDs and 18 from KIIs were mapped to the COM-B components. Capability barriers included limited tooth brushing skills, inadequate ECC knowledge, and low prioritisation of oral health. Opportunity barriers included social norms, intergenerational practices, restricted or constrained services and economic hardship. The motivational factors included beliefs, fear, guilt, low perceived severity, competing priorities, and unsupported intentions to improve child oral health. Nevertheless, the participants exhibited clear motivation, readiness, and intention to enhance their oral health practices. The BCW, COM-B, and TDF frameworks identified key deficits in capability, opportunity, and motivation that sustain ECC risk despite mother or caregiver concerns, informing targeted, context-specific interventions to improve early childhood oral health and reduce urban inequities.