Parental knowledge and practices and associated factors of dental caries in school-age children in Debark Town, Northwest Ethiopia.

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Learn more: PMC Disclaimer | PMC Copyright Notice Sci Rep . 2026 Mar 6;16:12379. doi: 10.1038/s41598-026-42344-y Search in PMC Search in PubMed View in NLM Catalog Add to search Parental knowledge and practices and associated factors of dental caries in school-age children in Debark Town, Northwest Ethiopia Desalegn Mitiku Kidie Desalegn Mitiku Kidie 1 Department of Pediatric and Child Health Nursing, College of Health Science, Debark University, Debark, Ethiopia Find articles by Desalegn Mitiku Kidie 1, ✉ , Jenberu Mekurianew Kelkay Jenberu Mekurianew Kelkay 2 Department of Health Informatics, College of Health Sciences, Debark University, Debark, Ethiopia Find articles by Jenberu Mekurianew Kelkay 2 , Destaye Guadie Kassie Destaye Guadie Kassie 3 Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia Find articles by Destaye Guadie Kassie 3 , Nega Tezera Assimamaw Nega Tezera Assimamaw 3 Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia Find articles by Nega Tezera Assimamaw 3 Author information Article notes Copyright and License information 1 Department of Pediatric and Child Health Nursing, College of Health Science, Debark University, Debark, Ethiopia 2 Department of Health Informatics, College of Health Sciences, Debark University, Debark, Ethiopia 3 Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia ✉ Corresponding author. Received 2024 Nov 16; Accepted 2026 Feb 25; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13083841  PMID: 41792372 Abstract Dental caries is the most widespread preventable chronic disease, with long-lasting effects on children’s health throughout their lives. Although parents are primarily responsible for preventing dental caries in their offspring, there is little evidence of parental knowledge and practice of their children’s dental caries among parents who have school-age children in Ethiopia. To assess parental knowledge, practices, and associated factors related to dental caries in school-age children in Debark town, northwest Ethiopia. A community-based cross-sectional study was conducted from March to April 2023 among 634 parents of school-age children in Debark town. A multistage random sampling technique, along with a structured interview questionnaire including twelve sociodemographic questions, eight knowledge questions, and ten practice-related questions adapted from related literature and WHO guidelines, was utilized to collect data. Descriptive statistics were computed, to summarize the data. Bivariable logistic regression was performed to identify candidate variables (p-values ≤ 0.2), which were subsequently entered into a multivariable logistic regression model. Variables with p-values ≤ 0.05 were considered statistically significant. In this study, 613 participants were enrolled, with a response rate of 96.7%. While most parents’ demonstrated good knowledge regarding dental caries prevention in their children 68.8%: 95% CI: 65.85–70.32%), less than half engaged in corresponding preventive practice (47.5%; 95% CI: 44.3–48.18%). This gap between knowledge and behavior suggests that awareness alone may not lead to effective oral health practice among parents. Factors affecting parental knowledge were lack of formal education for both mothers [AOR-5.45, 95% CI: (2.33–12.75)] and fathers [AOR-2.39, 95% CI: ( 1.19–4.66)], as well as being housewife mothers [AOR-1.6, 95% CI: (1.07–2.44)]. In terms of practice both mothers and fathers with no formal education [AOR-3.15,95%CI; (1.47–6.78)], and [AOR-2.78,95%CI; (1.38–5.61)] respectively, being housewife [AOR − 1.51, 95% CI: (1.005–2.28)], and parents who had never visited a dentist [AOR-5.13, 95% CI: (2.99–8.82)] were significantly associated factors. Although over two-thirds of the parents had adequate knowledge of their children’s dental caries, less than half applied effective practices, highlighting a significant knowledge-practice gap. Parental educational level, maternal occupation, and dental visit history were main predictors of both knowledge and practices regarding their children’s dental caries. Therefore, targeted community-based oral health education and behavior-focused interventions should be implemented, for parents with low educational status and strategies promoting regular dental visits are recommended to improved parental preventive practices. Keywords: Parents, Knowledge, Practices, School-Age Children, Ethiopia Subject terms: Gastroenterology, Health care, Medical research Introduction Dental caries is a biofilm-mediated, sugar-driven, multifactorial, disease that causes progressive demineralization of dental hard tissues in both primary and permanent dentitions 1 – 3 . It is the most common chronic disease, affecting children worldwide, impacting their overall health quality throughout their lifetime 4 .Globally, approximately 60–90% of school-age children are affected by dental caries 5 .The burden is particularly high in low and middle-income countries where limited access to preventive oral health services and fluoride use contribute to higher disease rates. This disparity underscore the significant global and regional burden of dental caries, especially in resource-limited settings 6 . Children’s dental caries are influenced by both biological and social factors 7 , 8 including low parental education, low socioeconomic challenges, and low levels of parental knowledge and practice about children’s dental disease are among the social risk factors 7 , 9 . inadequate awareness about fluoride toothpastes, proper use, its benefits, and its role further contributes to high burden of dental caries developing countries among school-age children 10 . Using fluoride toothpaste enhances enamel resistance through fluorapatite formation during demineralization; therefore, adequate parental knowledge and consistent twice-daily application play a crucial preventive role 11 . Despite widespread recognition of the important of oral hygiene, studies have demonstrated a consistent gap between parental knowledge and actual preventive practice 7 , 12 . A study in the United Arab Emirates (UAE) nearly half of parents had a relatively good knowledge score of 58.2%, yet only 20% implemented effective practices to prevent dental caries among their children’s 13 . Similarly, in Morocco, 60.9% of parents possessed good knowledge, but just 22.9% demonstrated effective practices 14 .Several factors influence these outcomes, including, age of mother, parents’ education level, family income, access to dental care service, children’s prior dental care experience 15 , as well as mother’s occupation 16 . These factors not only shaping parental behavior but also determine the overall prevalence and consequence of dental caries among children 17 , which can result in dental pain, tooth loss, infection, sepsis, decreased educational concentration, and worsening chronic diseases 18 , 19 . The impact of dental caries extends beyond health implication to impose a considerable, economic burden on both families and communities 20 .It estimate that globally, dental caries contributed to for approximately $442 billion annually in treatment costs and productivity losses 21 . In high-income countries, it consumes 5–10% of a total healthcare expenditures, leads to a high rate of hospitalization 13 , while in developing nations, despite ongoing efforts, a significant proportion of dental caries remains untreated 21 . For this reason, the World Health Organization (WHO) has implemented strategies in the African region to addressing the root causes of dental caries through school based oral health promotion targeting cariogenic diets and poor oral hygiene practices. However, despite this initiatives, the burden of dental caries among school age children remains a major public health challenge 22 . To effectively implement these strategies, parental oral health knowledge and practice play a vigorous role in the prevention of children’s dental caries since they are the primary responsible body for matters affecting their children’s health care 12 .Community health workers can support these efforts by implementing health education programs that promote proper oral hygiene, effects of sweet foods consumption, consistent use of fluoride toothpaste and behavior in daily care practices 23 . Parental dental behaviors may also be investigated using the Health Belief Model, which proposes that health actions are influenced by individuals’ beliefs about susceptibility, severity, benefits, and challenges, as well as cues to action. Parents with a higher level of knowledge and awareness are more likely to understand the risk of dental caries and the benefits of preventative measures like using fluoride toothpaste. In contrast, limited education and socioeconomic status could hinder their participation in beneficial dental health practices. This framework offers a theoretical foundation for understanding how parental characteristics affect children’s dental health outcomes 24 , 25 (Fig. 1 ). Fig. 1. Open in a new tab Conceptual framework of parental knowledge and practices and associated factors of dental caries in school-age children in Debark Town, Northwest Ethiopia. However, rapid urbanization and growing sugar consumption have further contributed to an increased prevalence of dental caries in recent years, and these trends may continue 26 . To lessen the burden of pediatric dental disease, parents have a vital deciding role in issues impacting their children’s dental health. Understanding the level of parental knowledge and practices, as well as factors that influence them, is essential for designing effective strategies. Despite the importance of parental influence, no prior study has assessed parental knowledge and practice regarding children’s dental caries in Ethiopia. Therefore, this study aimed to assess parental knowledge, practices, and their associated factors towards their school-age children’s dental caries by using data from a sample of parents who have school-age children in a Debark town community-based cross-sectional study. This theoretical framework demonstrates how parental knowledge, attitudes, and actions influence the prevalence of dental caries among school-age children, inspired by the health belief model. Methods Study design and setting A community-based cross-sectional study was conducted from March 1 to April 1, 2023, in Debark town. Located in the Amhara region of Northwest Ethiopia. According to estimates from the zonal health office, the total population of the study area is around 32,858, of whom 14,011 are children below 15 years old. According to the administrative units, the town is divided into three kebeles (administrative divisions), each containing four ketenas, and the smallest administrative units. In terms of healthcare services, the community is supported by two governmental health centers, two private medium clinics, four private primary clinics, six private pharmacies, and one general government hospital that serves both residents and the surrounding areas 27 . Study population and sampling The source population comprised all parents of school-age children resides in Debark town. The study population included parents of school-age children who had lived in Debark town for at least six months and were available during the data collection period. Inclusion and Exclusion Criteria. All parents or primary caregivers (including legal guardians) of school-age children residing in Debark town were eligible for inclusion. Parents who had lived in Debark town for less than six months, those who were critically ill during data collection, parents who were unable to communicate or had hearing impairments, and parents who were younger than 18 years old were excluded from the study. Sample size determination The sample size was calculated using the single population proportion formula, based on the assumptions of a 95% confidence interval, a 5% margin of error, and a proportion (P) of 50% due to absence of prior similar studies in Ethiopia. A design effect of 1.5 was applied to account for multistage sampling technique, and a 10% non-response rate was considered. Accordingly, the final sample size was 634 parents with school-age children. Sampling Multistage random sampling was employed to select the study subjects by clustering the town into kebeles at the beginning. Debark town has three kebele administrations, each consisting of four lower-level ketena administrations. Stage 1 One kebele was randomly selected from the three using the lottery method. Stage 2 All four ketenas within the selected kebele were included without further sampling. Stage 3 The sample size was allocated proportionally based on the number of children in each selected ketene. Then, a systematic sampling technique was used with a list of school-age children (used as the sampling frame) obtained from the local health extension workers, who had updated records of children in each household as part of their routine community health outreach and registration system. This list was considered complete and reliable for sampling purposes. Using this list, households were selected at a fixed interval (K), and one parent or guardian of each selected child was included in the study. The sampling procedure is outlined below (Fig. 2 ). Fig. 2. Open in a new tab Sampling procedure and sampling allocation to assess parental knowledge, practices, and their associated factors of their school-age children’s dental caries in Debark town, northwest Ethiopia. Variables of the study Parental knowledge and practice were dependent variables while child-related factors (age and sex), parental characteristics (age, sex, marital status, educational status, and occupational status) and socio-demographic elements (religion, ethnicity, number of children in the family, family size, dentists visit history, use of traditional oral health methods including (herbal remedies or teeth extraction)were treated as independent variables. Parental knowledge and practice were classified as good and poor a 50% of cut-off, as adopted from previous studies 16 , 28 . Data collection tool and procedure Structured interview questionnaires were adapted and modified from related literature and WHO guidelines to gather data on parental knowledge and practices towards their school-age children’s dental caries. This included twelve socio-demographic questions, eight questions assessing parental knowledge of their Children’s dental caries, and ten practical knowledge-based questions assessing their level of practice regarding children’s dental caries and factors affecting their knowledge and practice towards their children’s dental caries 29 – 32 . The data was collected through a face-to-face interview by four trained nurses, supervised by one degree-holding nurse. To ensure data quality, the adapted English questionnaire was initially translated into Amharic local language, by a professional Amharic language expert and then back translated into English by a separate English language expert to verify consistency. However, translation alone does not guarantee validity. To assess content validity, the questionnaire was assessed by a dental professional with subject matter expertise to evaluate the relevance, clarity, and appropriateness of each item in the local context. Data collectors were recruited based on prior experience in health-related surveys and received comprehensive training two day before data collection by principal investigators on the study’s objectives, the confidentiality of information, the relevance of the study, respondents’ rights, informed consent, and interview techniques for two days using lectures, discussion and role plays exercises. Inter-observer reliability was assessed during training and pilot test by having multiple data collectors independently administer the questioner to the same participants. Their response were compared, and discrepancy were discussed and resolved to standardized data collection procedure. Regular supervision and spot checks were conducted throughout the data collection period to ensure consistency among data collectors. The questionnaire was pretested on a sample of 5%( n = 32) from the Dabat district, which had similar characteristics, before the actual data collection to evaluate its internal consistency and cultural appropriateness. Feedback from pilot study was used to refine the items, ensuring they were understandable, relevant and culturally appropriate. The reliability of the data was assessed using Cronbach’s alpha test, yielding a reliability score of 0.821 for knowledge section and 0.799 for practice section. In addition, the investigator rigorously monitored data quality at various stages, including before data coding, during entry, and throughout the data analysis process. Data processing and analysis The collected data were double-checked and reviewed for accuracy and completeness, then coded and entered into EpiData software version 7.2.1 for processing. Subsequent analysis was performed using SPSS version 25, where descriptive statistics, including frequency tables, ratios, and percentages, were calculated to present the variables described through numbers, tables, or figures. The model’s goodness of fit was assessed using the Hosmer-Lemeshow test to ensure its appropriateness of fit. Bivariate logistic regression was fitted to screen candidate variables with a p -value of 0.2 after confirming the multi-collinearity by VIF (1.042–3.111) for each independent variable. The backward stepwise method was used to fit all variables into the multivariable logistic regression, which became significant with a p-value of 0.2 in the binary logistic regression model to adjust for confounders. To evaluate the strength of the association between dependent and independent variables, an AOR with 95% CI was generated. Multivariable analysis’s p-value cutoff of 0.05 was used to determine which variables were statistically significant to the outcome variable. The results were then presented in tables and figures with the necessary summary statistics. Ethical consideration Ethical clearance was issued from the School of Nursing Research ethical review committee on behalf of the University of Gondar (Ref.No:-S/N/164/7/2014) and further permission was obtained from Debark town Health Bureau and from selected kebele administrative which described the objectives of the study and then it was delivered to selected ketena administrators and the importance of the study was explained for each participant. Data was collected after full informed verbal consent and assent was obtained from parents before the interview based on Declaration of Helsinki. Confidentiality of the information was maintained throughout the study by excluding names as identification in the questionnaire and keeping their privacy during interviews. Result Socio-demographic characteristics of study participants A total of 613 participants were enrolled in this survey, yielding a response rate of 96.7%. The mean ages of the parents and children were 37.74 years (SD ± 8.205) and 9.94 years (SD ± 2.4), respectively. Parents’ age ranges from 24 to 72 years, while children’s age ranges from 6 to14 years. The majority of respondents were mothers (71.5%), and nearly half of mothers (45.7%) were housewives. Regarding mothers’ educational attainment, 33.6% of mothers had completed primary school, 22.3% had finished secondary education, and 18.6% had attained a college degree or higher. In comparison, among fathers, 32.3% of fathers had completed primary school, 21.2% had finished secondary education, and 32.5% had reached college level and beyond (Table 1 ). Table 1. Socio-demographic characteristics of study participants in Debark Town, Northwest, Ethiopia. Socio-demographic characteristics Frequency Percentage Sex of children Male 329 53.7 Female 284 46.3 Sex of parents Male 175 28.5 Female 438 71.5 The age group of children 6–10 years 375 61.2 11–14 years 238 38.8 Age group of parents 25-34years 233 38 35-44years 284 46.3 Above 45 years 96 15.7 Marital status Single 43 7.0 Married 369 60.2 Divorced 125 20.4 Widowed 76 12.4 Maternal educational status No formal education 156 25.4 Primary education 206 33.6 Secondary education 137 22.3 college and above 114 18.6 Father educational status No formal education 86 14.0 Primary education 198 32.3 Secondary education 130 21.2 College and above 199 32.5 Maternal occupation Housewife 280 45.7 Merchant 178 29.0 Governmental worker 112 18.3 Non-Governmental worker 22 3.6 Laborer worker 21 3.4 Father occupation Unemployed 40 6.5 Merchant 96 15.7 Governmental worker 213 34.7 Non-Governmental worker 112 18.3 labor worker 152 24.8 No of children in the family Only one child 66 10.8 Two children 166 27.1 Three children 158 25.8 > Three children 223 36.4 Ethnicity Amhara 585 95.4 Oromo 3 0.5% Tigray 9 1.5 Kimant 16 2.6 Religion Orthodox 382 62.3 Muslim 224 36.5 Protestant 7 1.1 Open in a new tab This table presents the demographic profile of participating parents and their children, including age gender, educational level, occupation, and other background variables related to the study population. Parental knowledge of their children’s dental caries According to this survey, about two third of parents (68.8%) of parents demonstrated sufficient knowledge about their school-age children’s dental caries [95% CI (65.85–70.32%)]. Most parents (88%) identified the importance of basic preventive measures such as rinsing the oral cavity after a meal and daily teeth brushing and a large proportion (77.8%) were aware also that excessive consumption of sugary food contribute to dental caries. A majority of parents (74, 7%) recognized that dental caries is preventable condition and 72.9% were aware that brushing with fluoride toothpaste contributes to its prevention. Nevertheless, nearly half of the study participants were unaware of the importance of brushing before bedtime, the underlying causes of tooth decay, and the need to avoid sweet snacks between meals (Table 2 ). Table 2. Parental knowledge of their children’s dental caries in Debark Town, Northwest, Ethiopia. Knowledge items questions Yes (%) No (%) Tooth decay can be prevented by rinsing the oral cavity after a meal or by daily teeth brushing 539 (87.9%) 74 (12.1%) Tooth decay is caused by a lack of tooth brushing 537 (87.6%) 76 (12.4%) Dental caries can be caused by the frequent use of sweet foods 477 (77.8%) 136 (22.2%) Is it possible to prevent or control dental caries 458 (74.7%) 155 (25.3%) Tooth decay can be prevented by brushing with toothpaste 447 (72.9%) 166 (27.1%) Teeth brushing at night is the right time to prevent childhood dental caries 301 (49.1%) 312 (50.9%) Tooth decay is caused by bacteria 295 (48.1%) 318 (51.9%) Avoiding the frequent use of sweet snacks can prevent dental caries 286 (46.7%) 327 (53.3%) Total score of knowledge item questions Good 422 (68.8%) Poor 191 (31.2%) Open in a new tab This table presents the level of parental awareness regarding the cause, prevention, and risk factors of dental caries among their school age children. Parental practices regarding their children’s dental caries In this study, the overall parental practice scores regarding their children’s dental caries was below average at 47.5% [95% CI (44.3–48.18%)]. The majority of parents reported positeve oral hygiene bahaviors such as encouring theire childerm to rinse their mouths after every meal, limit giving sugary foods to their children for fear of dental caries, and seek dental care when they experienced a toothache. Furthermore, more than half also reported brushing their child’s teeth regularly. However, in practical engagement in sveral key areas remained low. Most parents were less consisttent in assessing their children’s dental health, providing toothpaste to their children, assisting with brushing, and ensuring regular visiting a dentist for their children’s dental care (Table 3 ). Table 3. Parental practice of their children’s dental caries in Debark Town, Northwest, Ethiopia. Knowledge-based practical items Yes (%) No (%) Have you ever noticed your child’s teeth status? 264 (43.1%) 349 (56.9%) Did you give sweet food to your children regularly by yourself? 413 (67.4%) 200 (32.6%) Does your child often brush his/her teeth regularly? 354 (57.7%) 259 (42.3%) Did you assist your child when he brushes his/her teeth? 136 (22.2%) 477 (77.8%) Do you provide your child with toothpaste to brush their teeth regularly? 142 (23.2%) 471 (76.8%) Do you supervise your child to limit the intake of sweetened food? 370 (60.4%) 243 (39.6%) Did you discuss which diet is healthy for their teeth with your children 183 (29.9%) 426 (70.1%) Did you order your child to rinse their mouth after eating/drinking or before schooling 459 (74.9%) 154 (25.1%) Did you have a consultation (visit) dentist to check your child’s teeth regularly Yes, every 6 months 40 (6.5%) 495 (80.8%) Yes, every year 65 (10.6%) Yes, every two years 13 (2.1%) What will you do when your children have a toothache or pain, or signs of caries Go to a health institution 406 (66.2%) Extract culturally 136 (22.2%) Use herbal drugs 45 (7.3%) leave alone 26 (4.2%) Total score of knowledge-based practical items Good 291 (47.5%) Poor 322 (52.5) Open in a new tab This table summarizes the behaviors and actions of parents, including oral hygiene supervision, provision of toothpaste, dietary control, and regular dental visits for their children. Determinant factors of parental knowledge regarding their children’s dental caries In bivariable regression analysis, significant factors affecting parents’ knowledge of their children’s dental caries were the educational status of mothers and fathers, being housewives, and the number of children in the family. In multivariable regression, mothers and fathers without formal education and who were housewives were significantly associated with lower parental knowledge regarding their children’s dental caries. The odds of mothers with no formal education having good knowledge of their children’s dental caries were 5.5 times lower [AOR = 5.45, 95% CI (2.33–12.75)] compared to those with a diploma or higher. Similarly, fathers without formal education are 2.3 times less likely [AOR = 2.35, 95% CI (1.19–4.66)] to have good awareness than their diploma-educated counterparts. Additionally, a significant factor affecting parental knowledge is the mother’s occupation; being a housewife is 1.6 times less likely [AOR = 1.62, 95% CI (1.07–2.44)] to have a good understanding of their children’s dental caries compared to employed mothers. In contrast, no significant associations were identified between knowledge and factors such as parents’ age, children’s age, father’s occupation, family size, or parental marital status. These result indicate that higher parental education and employment status are positively associated with better knowledge of children’s dental caries, while lack of formal education and being a housewife are negatively associated (Table 4 ). Table 4. Bivariable and multivariable analysis of factors associated with parental knowledge of their children’s dental caries in Debark Town, Northwest, and Ethiopia. Independent variables Knowledge COR 95%CI AOR with 95% C. I Poor Good Mothers’ occupation Housewife 120 160 2.77 (1.94–3.94) * 1.62 (1.07–2.44) ** Worker 71 262 1 1 Refe Mothers’ educational status No formal education 83 73 10.6 (5.3-21.37) * 5.45 (2.33–12.75) ** Primary education 62 144 4.03 (2.02–8.03) * 2.54 (1.15–5.58) ** Secondary education 35 102 3.21 (1.55–6.67) * 2.67 (1.27–5.62) ** Diploma and above 11 103 1 1 Refe Fathers’ educational status No formal education 46 40 5.39 (3.08–9.43) * 2.35 (1.19–4.66) ** Primary education 69 129 2.51 (1.57-4.00) * 1.23 (0.68–2.21) Secondary education 41 89 2.16 (1.28–3.63) * 1.51 (0.85–2.66) Diploma & above 35 164 1 1 Refe N o children in the family 1–2 Children 58 174 1 1 Refe 3–4 Children 95 193 1.48 (1.04–2.17) * 0.75 (0.44–1.31) > 4 children 38 55 2.07 (1.25–3.45) * 1.15 (0.67–1.96) Open in a new tab This table presents the relationships between socio-demographic and other relevant factors and parental knowledge levels, highlighting variables with significant positive or negatively associated. COR, Unadjusted odds ratio; AOR, Adjusted odds ratio; CI, Confidence interval, p -value < 0.05, ** significantly associated. Determinant factors of parental practices regarding their children’s dental caries Maternal occupation, parents’ educational status, number of children in the family, and history of dentist visits were identified as determining factors for parental practices regarding their children’s dental caries in bivariate regression. After adjusting for confounding variables, both parents’ educational status, history of dentist visits, and mothers’ occupation remained significantly associated with parental practices. The odds of good parental practices among those who had never visited a dentist were 5.4 times lower [AOR-5.135, 95% CI (2.99–8.817)] compared to those who had. Additionally, mothers without formal education were 3.2 times less likely [AOR-3.16, 95% CI (1.47–6.78)] to provide practical dental care for their children compared to parents with a diploma or higher. Fathers without formal education were 2.8 times less likely [AOR-2.78, 95% CI (1.38–5.61)] to demonstrate good parental practices compared to those with a diploma or higher. Lastly, housewife mothers were 1.5 times less likely [AOR − 1.54, 95% CI (1.04–2.29)] to provide good dental care for their children compared to employed mothers. These findings suggest that educational level, occupational status, and prior exposure to dental services play key roles in shaping parental practices, underscoring the importance of improving oral health literacy and access to dental care within families (Table 5 ). Table 5. Bivariable and multivariable regression of factors associated with the parental practices of their children’s dental caries in Northwest, Ethiopia. Independent variables Practices COR 95% CI AOR 95% CI Poor Good Mothers’ educational status Not formal education 122 34 11.6 (6.5-20.55) * 3.16 (1.47–6.78) ** Primary education 120 86 4.49 (2.69–7.51) * 1.34 0.696-2.575 Secondary education 53 84 2.03 (1.17–3.53) * 1.19 0.653-2.198 Diploma & above 27 87 1 1 Refe Fathers’ educational status Not formal education 63 23 7.54 (4.26–13.4) * 2.79 (1.38–5.61) ** primary education 136 62 6.04 (3.91–9.33) * 2.71 (1.56–4.72) ** Secondary education 70 60 3.21 (2.02–5.13) * 2.04 (1.21–3.46) ** Diploma & above 53 146 1 1 Refe Maternal occupation Housewife 188 92 3.04 (2.18–4.24) * 1.51 (1.01–2.28) ** Employed 134 199 1 1 Refe Dentist visiting Yes 22 103 1 1 Refe No 300 188 7.47 4.554–12.258 5.14 (2.99–8.82) ** N o children in the family 1–2 Children 116 116 1 1 Refe 3–4 Children 147 141 1.04 (0.74–1.47) 1.02 (0.68–1.52) > 4children 59 34 1.74 (1.06–2.85*) 0.54 (0.53–1.68) Open in a new tab This table presents the relationships between socio-demographic and other relevant factors and parental oral health practice, highlighting variables with significant positive or negative effects. COR, Unadjusted odds ratio; AOR, Adjusted odds ratio; CI, Confidence interval, p -value < 0.05, ** significant association. Discussion This study examined parental knowledge and practice regarding dental caries and their association with its occurrence among school-age children in Debark town. The findings demonstrate that parental knowledge and preventive practice were not optimal, indicating meaningful gaps in awareness and routine oral health behaviors within households. These shortcoming may contribute to the persistence of dental caries among children and highlight the critical role of parents in influencing oral health outcomes. The level of parental knowledge observed in this study is comparable to findings reported in South Africa 29 and in Malaysia 33 , where parental awareness of dental caries has also been described as moderate. However, it was lower than the study observed in Egypt 34 and in India 32 ,where higher level of parental knowledge have been documented. The possible reason for this difference in parental knowledge may be related to varying educational attainment among participants. In setting Egypt, and India, higher level of parental education and stronger public health engagement in child oral health promotion may contribute to greater awareness of dental caries prevention. Public health campaigns, school-based oral health programs, and broader access to dental service in these context could further enhance parental knowledge. In contrast, the level of parental knowledge present in our study is higher than those reported in Morocco 14 and Tanzania 35 .This disparity may be attributable to the study site, as community-based studies, like the current one, often provide a more accurate reflection of public knowledge than institutional or school-based studies, owing to variations in participants and access to oral health education. In terms of specific knowledge areas, most participants recognized that lack of tooth brushing and frequent consumption of sugary food contribute to dental caries, and they understood that regular brushing with fluoride toothpaste can effectively prevent dental caries among school-age children. These findings are consistent with a similar study conducted in Ethiopia, Nigeria, and Qatar, which also reported strong awareness of basic dental caries prevention measures 8 , 36 , 37 . The study revealed that while parents had a moderate level of knowledge about their children dental caries, their actual practice were considerably lower, indicates that awareness alone does not always in appropriate behavior. This discrepancy highlight that cultural belief, limited access to dental services or resources, and competing parental responsibility can all impede the translation of knowledge into actual practice. Thus, interventions should not only increasing awareness but also address systematic, cultural, and behavioral barriers 38 – 40 . It is critical to note that causality cannot be inferred from this cross-sectional study. Although parents demonstrated moderate knowledge of dental caries, and their preventive practice were notably lower, and no clear relationship between knowledge and behavior was observed. This knowledge-practice gap emphasizes the need for school-based oral health programs and integration of oral health promotion into primary care, addressing socioeconomic, cultural and structural barriers. These findings are consistent with theoretical models emphasizing the impact of parental responsibilities and socioeconomic circumstances on children’s oral health practices. This study found that parents generally have a poor practices regarding their children’s dental care, indicating lower engagement in preventive behaviors and irregular dental visits. When compared it to higher level of practice; this is comparable to findings in Egypt 16 , where parent engagement in preventive behaviors is moderate, however, higher than the study conducted in Sudan 15 and Kenya 41 , where few parents follow recommended dental routine care or seeking dental regular check-ups. The difference observed with Sudan and Kenya could be due to variation in parental dental care awareness and disparities between urban and rural parents, as noted in Kenya. Based on the findings of this research, moderate awareness was observed, however, gaps in specific behaviors remain. Although most children brush their teeth regularly, few use toothpaste and receive parental assistance. At this age, supervised brushing with fluoride toothpaste is essential to ensure proper technique, minimize ingestion, and prevent dental caries among school-age children. This is supported by study done in the United Kingdom 42 , in England 43 , and a longitudinal study done in Australia 44 which highlight that parental involvement not only improves brushing effectiveness but also fosters long-term routine dental caries preventive practices. The results of this research indicate that, only a small proportion of children adhere to the recommended biannual dental check-up schedule, despite guidance from a scoping review and dental care guidelines recommending dental visits every 6–12 months beginning with the eruption of the first tooth 45 , 46 . Early preventive dental visits are associated with a lower incidence of dental caries and reduced long-term treatment costs. Therefore, improving parental adherence to the recommended dental visit schedule remains a critical focus for public health intervention. When children experience dental pain, most parents seek professional care, while some rely on cultural extractions, or herbal remedies. This pattern is consistent with the findings from Lithuania 47 , highlights how influence of parental beliefs on treatment choices and the need to promote evidence-based care. This is the fact that parental attitudes directly guide treatment decisions, with positive dental health perceptions leading to safer choices, which needs more encouragement on the choice of safer dental care practice for their school-age children. It is also encouraging that most parents require rising post-meals, aligning with best practice for reducing food residue and acid exposure. This finding is supported by a study done in Ethiopia 48 and India 49 . Rising with water after meals helps to neutralize oral PH and wash away food debris, reducing acid exposure and inhibiting bacterial growth 50 . The study demonstrate that parental educations is strongly associated with knowledge and practice regarding children’s dental health. Parents with higher education are more informed and better able to prioritize their children’s dental caries, consistent with studies from Sudan, China, in different areas of India, and Midwestern Latino populations, Nepal and Waban 51 – 56 . In contrast, parents without formal education may have limited awareness due to socioeconomic challenges such as financial instability and job insecurity. These findings highlights the importance of targeting educational intervention to improve parental knowledge and promote healthcare practice for their children’s oral health. Mother’s occupation is another factor influening parental knowledge of their children’s dental caries. Employed mothers tend to have better awareness compared to housewife. This finding is supported by studies from Morocco, the UAE, and Japan 57 – 59 . This may be due to employed mothers often have higher education levels and health information exposure from their work environments, which enabling them better understanding and management about their children’s dental conditions. However, this finding contradicts a study in Egypt where housewife mothers were 9.5 times more knowledgeable about children’s dental caries compared with counterparts 16 , which may be due to better educational coverage in that community, leading to an equal understanding of children’s dental care among mothers. Additionally, employed women may experience more work stress or burnout, which can negatively impact the mother-child relationship due to the depletion of the mother’s psychological energy. A mother’s burnout and a strained relationship may lead her to neglect her children’s dental health 60 . Furthermore, children spend the majority of the day at school during working hours, employed mothers have limited control may not devote much attention to monitoring their children’s care campaerd to housewives. Parents in this study demonstrated relatively good awareness of dental caries concerning their children; however, this awareness was not fully reflected in their practices. This finding is similar to studies conducted in India, the UAE, and Nepal 57 , 61 , 62 . This discrepancy may be due to parents’ inability to apply their knowledge in everyday situations, as well as cultural practices in the study area that remain unchanged despite the knowledge they have gained. Our study found that parents who never take their children to the dentist tend to have poor practices regarding their children’s dental caries, consistent with finding from Nigeria, Morocco, and Latinx parents 58 , 63 , 64 . A possible reason for this discrepancy could be the reinforcement of messages from dentists about the importance of dental care and the long-term effects of dental caries enhancing parental awareness and encourages maintaining their children’s dental hygiene. In contrast, parents who never visit a dentist may lack adequate understanding and initiative to participate in their children’s dental care. The study identifies that low maternal educational status was a determining factor in their poor practices regarding their children’s dental caries. Mothers with higher education are likely to engage in preventive practice. This is aligns with studies in Morocco, China, India, Japan, Canada, and Brazil 53 , 54 , 58 , 59 , 65 , 66 . The authors of these studies postulated that more educated mothers tend to pay more attention to their children’s health, ensuring access to dental care, serving as an important social model in imparting health skills to their children and utilized regular dental check-ups before developing condition, rather than waiting for consultation after the issue arises. Similarly, fathers with low education are less likely to engage in effective practices for managing their children’s dental caries. This finding is supported by a study in China 53 . The potential reason could be due to limited education may reduce fathers access to relevant information about children’s dental caries and its risks, making it more difficult to understand or apply effective dental care practices and often do not take steps to access dental supplies or seek out professional dental care for their children, leaving most responsibility to the mother. According to this study, maternal occupation is a factor affecting parental practice of their children’s dental caries. Housewives were less likely to provide proper dental care compared to employed mothers. This is in agreement with the studies in the UAE, Morocco, and Malaysia 57 , 58 , 67 , likely due to lower education level among housewife, reduce awareness leads to poor habits of practice. However, this finding contrasts with studies in other areas of Malaysia and India 68 , 69 . This difference may be due to the number of studies conducted in those areas regarding parents’ knowledge and practices related to their children’s oral health, which enhance housewives’ awareness and practices. Furthermore, housewife mothers spend more time with their children, allowing them closer supervision of all aspects of childcare, including dental care activities. As a result, they may devote more attention to their children’s dental health compared to employed mothers. Limitations of the study The study has certain limitations. To analyze parents’ practice of their children’s dental caries, data were collected using self-reported knowledge-based practical questions. As a result, if the parental practice is realized through observation, the outcome may differ from the study’s findings. In the case of a self-reported face-to-face interview, the data collectors were nurses, who may be susceptible to recall bias and social desirability bias. In addition, the study did not include data on family income, which could act as a potential confounding factor influencing both parental knowledge and practice. Furthermore, due to the unavailability of a relevant tool, the source of parents’ information focusing on oral health behaviors is not incorporated in this study. As a result, the scope of the study is limited to the available information, excluding an essential aspect of the broader context of oral health behaviors within the families. Conclusion and recommendation In conclusion, this study found that over half of the parents demonstrated good knowledge regarding dental caries in their children; nevertheless, their theoretical knowledge did not fully translate into effective dental care practices for their children’s teeth. Significant factors influencing this knowledge and related practices were parental educational status, mothers’ occupations, and prior history of dental visits. To improve awareness and practices related to children’s dental health, policy makers should design community targeted oral health educational programs should be implemented for parents with lower educational backgrounds and those in specific occupations, utilizing mass education, leaflets, and mass communication strategies. Encouraging early and regular dental check-ups in line with WHO recommendation can further enhance parental knowledge and practice. Additionally, community engagement initiatives can strengthen understanding and improve practices in their children’s oral health. Further research employing observational methods is recommended to accurately assess parents’ knowledge and practices regarding their children’s dental care, as the actual level of parental involvement may be lower than indicated in this study. Acknowledgements The authors are grateful for the data collectors and study participants. Abbreviations AOR Adjusted odd ratio COR Crude odd ratio CI Confidence interval LMICs Lower-middle-income countries SD Standard deviation SPSS Statistical package for social sciences UAE United Arab Emirate VIF Variance inflation factor WHO World Health Organization Author contributions Desalegn Mitiku Kidie: Conceived and designed the experiments, analyzed and interpreted the data; drafted the article, or critically revised its important intellectual content.Destaye Guadie Kassie and Nega Tezera Assimamaw **:** Conceived and designed the experiments, performed the experiments, analyzed and interpreted the data; and wrote the paper.Jenberu Mekurianew Kelkay: overall the paper assessed, edited, and give constructive feedback before sending the paper to journal. Funding There is no source of funding for this research. All costs were covered by researchers. 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