Oral Hygiene Practices and Prevalence of Early Childhood Caries in Low-Income Communities of Karachi, Lahore, and Peshawar.

Abstract

Background:
Early childhood caries (ECC) is one of the most common chronic diseases affecting young children, disproportionately impacting those from socioeconomically disadvantaged communities. In Pakistan, limited data exist comparing oral hygiene practices and ECC prevalence across major urban centers, despite evidence of widespread oral health disparities.

Objective:
To assess the association between oral hygiene practices, feeding behaviors, and the prevalence of ECC among children aged 2–6 years in low-income communities of Karachi, Lahore, and Peshawar.

Methods:
A cross-sectional study was conducted among 425 children and their caregivers using a multistage random sampling approach. Clinical dental examinations were performed according to World Health Organization (WHO) criteria, and ECC was measured using the decayed, missing, and filled teeth (dmft) index. Oral hygiene status was evaluated using the Simplified Oral Hygiene Index (OHI-S). A validated caregiver questionnaire captured data on demographics, hygiene routines, and dietary practices. Data were analyzed using IBM SPSS version 26.0, employing t-tests, chi-square tests, and multivariate regression. Ethical approval was obtained from the Institutional Review Board of Dow University of Health Sciences (Ref: IRB-2025/DUHS/0349).

Results:
The overall prevalence of ECC was 51.8%, with the highest rates in Karachi (56.4%). Mean dmft score was 2.46 ± 1.78. Infrequent tooth brushing (<1/day) and absence of fluoride toothpaste use were associated with significantly higher dmft scores (p < 0.001). Frequent sugary snacking and night-time feeding also increased ECC risk (OR = 2.17; 95% CI: 1.48–3.12). Maternal education and household income were inversely related to ECC prevalence.

Conclusion:
ECC remains highly prevalent among children in Pakistan’s low-income urban populations. Modifiable behaviors—such as oral hygiene frequency, fluoride exposure, and feeding practices—play a critical role. Community-based preventive programs focusing on caregiver education and early oral health promotion are essential to mitigate this burden.

Keywords:
Caregivers, Child, Dental Caries, Feeding Behavior, Oral Health, Oral Hygiene, Pakistan