Parental and individual determinants of dental trust in children: a path analysis of a conceptual model

Effective communication between a child and a dentist is fundamental to pediatric dental practice [1], impacting treatment outcomes and the overall dental experience [2]. In pediatric dentistry, where child cooperation and comfort are crucial, a dentist’s ability to establish clear, empathetic, trust-based communication is essential [3]. Trust encourages children to be more receptive to dental procedures and follow oral health recommendations [4]. A strong trust relationship alleviates anxiety, fosters security, and enhances the child’s participation in oral health care [5]. Emphasizing trust and effective communication is critical for ensuring productive dental visits, leading to better oral health outcomes and long-term child satisfaction [6].

Children’s dental trust is shaped by various factors [7]. The impact of the interaction between children and their families on their dental trust is significant [8]. Understanding how both children’s and families’ oral and dental characteristics influence trust is crucial for developing effective strategies to enhance it. Therefore, a thorough examination of these factors is essential to foster stronger dental trust in children [9]. This highlights the need for a comprehensive conceptual framework to systematically examine these factors and their impact on dental trust in children.

Oral health literacy (OHL) plays a key role in communication between dentists and patients [10]. Higher OHL levels in parents and children lead to better understanding and cooperation during dental visits [11]. Parental oral health behaviors (OHBs) shape how children perceive and engage with dental care, fostering open and effective communication with dentists [12]. Likewise, a child’s OHB, influenced by their parents, directly impacts their ability to follow dental advice and engage meaningfully with dentists [11].

Children’s oral health-related quality of life (OHRQoL) is closely related to their comfort and confidence in dental settings [2], which can either facilitate or impede communication with the dentist [9]. Dental anxiety is also crucial, as elevated anxiety levels can create communication barriers [13], making it challenging for dentists to explain procedures and for children to express concerns or discomfort [14]. Conversely, high levels of dental trust can significantly enhance communication [9].

Trust in children plays a clinically significant role in pediatric dentistry and dental research [1, 4, 8, 15, 16]. Understanding how various determinants interact with dental trust is essential for designing effective interventions that enhance trust and improve children’s dental care experiences. However, research applying these models in the context of pediatric dental trust is limited. This study proposes a conceptual model that outlines the relationships between dental trust in children and endogenous variables (e.g., children’s OHBs, parental OHBs, child dental anxiety, and child OHRQoL) and exogenous variables (e.g., oral health literacy). Path analysis is a statistical technique used to examine directed relationships among a set of variables, allowing researchers to test complex models by evaluating both direct and indirect effects. It provides insights into how variables influence one another within a conceptual framework, highlighting the pathways through which certain factors impact outcomes. This study aimed to develop and test a conceptual model to explore the pathways linking parental and individual determinants of dental trust in children. Additionally, this study aimed to identify which parental and individual variables were most strongly associated with dental trust among children.

Overall, 312 participants completed the forms; however, 45 were excluded because of incomplete data. Consequently, 267 children aged 7 to 12 years (mean age 9.14 ± 1.63) were included in the final analysis. A positive correlation was observed between age and total dental trust scores, although this was not significant (r = 0.083, p = 0.175). Of the children included in the study, 142 were girls (53.2%). There was no significant difference in total dental trust scores between the sexes (p = 0.800).

This study developed and tested a conceptual model to understand the relationship between dental trust in children and several variables, including children’s OHBs, dental anxiety, OHRQoL, and parental oral health literacy. These findings confirmed the hypothesized pathways, showing that improved parental oral health literacy positively influences parental and child OHBs, which, in turn, enhances dental trust in children. Additionally, lower levels of dental anxiety and better OHRQoL in children were associated with higher dental trust scores.

One of the major strengths of this study was its methodological design. SEM and path analysis allowed for the simultaneous assessment of multiple relationships within the conceptual model, providing a comprehensive understanding of the complex interactions between variables [20]. Another advantage of using SEM in this study is its ability to account for measurement error, which enhances the accuracy of the estimated relationships between variables. This feature is particularly valuable when analyzing complex models, as it provides more reliable and nuanced insights into how factors like oral health literacy and dental anxiety influence trust in pediatric dentistry. The model’s fit indices indicated strong alignment with the theoretical constructions, suggesting that the model was well-suited for testing the proposed hypotheses. Path analysis offers advantages over correlation analysis, particularly because correlation does not allow for examining the mediating role of a third variable in the relationship between two variables [19].

This study had some limitations. First, the cross-sectional design limited the ability to infer causality between variables. However, this study focused on exploring the relationships between the variables rather than their prevalence, with the strength of the analyses grounded in statistical assumptions regarding the distribution of the variables. Second, using self-reported measures to assess OHBs and literacy could introduce a response bias. Another limitation is the inclusion of several individual variables, excluding parental and environmental factors. Additionally, the study was conducted in a single geographic location within a specific cultural context, which may limit the generalizability of the findings to other populations. Future research should consider longitudinal designs and diverse samples.

Parental oral health literacy has consistently been recognized as a critical factor in shaping children’s health behaviors and outcomes [11, 12, 21]. In this study, higher oral health literacy positively influenced both parental and child OHBs, consistent with the previous studies [2, 5, 22] which reported that higher parental literacy was associated with more frequent dental visits and better oral hygiene practices in children.

These findings are also consistent with previously published models [2, 5, 23, 24] showing that parental behaviors are significant predictors of children’s oral health and anxiety levels. These studies emphasize the role of the family environment in influencing children’s responses to dental care, particularly regarding how parental attitudes and behaviors can either reduce or exacerbate dental anxiety in children. The findings of this study reinforce the critical influence of parental behavior on pediatric dental outcomes and support the idea that effective parental involvement is essential for pediatric dental care [12].

Another aspect of this study is its focus on dental trust as a distinct outcome variable, which has not been widely modeled in previous research. While previous studies have examined the impact of dental anxiety on OHBs [13, 18], few [2, 5] have specifically explored the pathways leading to trust in the dental context, especially in pediatric settings. This study has the potential to fill this gap by demonstrating that dental trust is not only influenced by child-related factors such as anxiety and OHRQoL but is also significantly shaped by parental literacy and behaviors.

The negative impact of dental anxiety on trust scores observed in this study is consistent with the previous studies which reported that higher levels of dental anxiety are linked to reduced trust in dentists [9], resulting in poorer cooperation during dental procedures [5]. This highlights the importance of addressing dental anxiety to build and maintain trust, which is essential for successful dental interventions. Furthermore, the current study extends this understanding by showing that reducing anxiety can improve OHRQoL, enhance dental trust, and emphasize the interconnectedness of these factors.

Compared with earlier models [2, 5, 25], this study introduced OHRQoL as a mediator between children’s OHBs and dental trust. Previous studies [5, 25] have reported that quality of life plays a significant role in dental settings; however, this study provides empirical evidence of its importance in developing trust in pediatric dentistry. This suggests that interventions to improve children’s overall dental experience could lead to enhanced trust and better long-term outcomes.

Children whose parents maintain regular oral hygiene and dental visit routines are more likely to adopt similar behaviors [21, 26], suggesting an intergenerational transmission of health practices. The findings support this view as they directly link these behaviors to the development of dental trust, offering a more integrated view of how family dynamics contribute to children’s dental experiences.

Overall, while this study corroborates many findings from previous research [1, 4, 6‐9, 15], it expands our understanding of pediatric dental trust by integrating multiple determinants into a comprehensive model. This approach not only validates the significance of known factors such as anxiety and oral health literacy but also introduces new variables such as OHRQoL, providing a holistic perspective on how trust is built and sustained in pediatric dental care.

Parental oral health literacy closely link to children’s OHBs. Vann et al. [22] reported that parents with higher oral health literacy tended to promote better oral hygiene practices in their children, leading to improved oral health outcomes. The current study showed that higher levels of parental oral health literacy directly enhanced both parental and child OHBs, subsequently increasing dental trust among children. Previous studies [27] have also emphasized the significant role that parental influence plays in shaping children’s OHBs. The current study found that when children consistently practiced good oral hygiene, their trust in dental professionals strengthened, likely due to the reduced incidence of negative dental experiences.

Child dental anxiety is a significant barrier to developing trust in dental care [28], and higher anxiety levels are correlated with reduced trust and increased avoidance behaviors [29]. The current study also supports previous studies showing that lower levels of dental anxiety are associated with higher dental trust scores among children [18, 24], suggesting that effective anxiety management strategies can enhance the overall dental experience of children and foster long-term trust in dental practitioners. Moreover, our findings align with the conclusions of Locker et al. [30], who reported that improvements in OHRQoL are linked to increased dental trust.

Based on the model findings, future interventions could focus on enhancing parental oral health literacy and addressing dental anxiety through targeted educational programs and anxiety-reducing strategies. Such interventions could foster greater trust in pediatric dental settings, ultimately promoting more positive oral health outcomes in children. This approach bridges our findings with actionable strategies, providing practical applications for improving pediatric dental care.

This study provides a validated model to elucidate the pathways through which parental and individual factors influence dental trust in children. The findings suggest that enhancing parental oral health literacy and addressing children’s dental anxiety could be effective in improving dental trust and, consequently, oral health outcomes in the pediatric population. The findings indicate that focusing on parental education and child anxiety management within clinical settings could strengthen dental trust, supporting more positive dental experiences and healthier oral habits in children. Future studies should explore the longitudinal effects of these interventions and apply these models to diverse populations to enhance their generalizability. The findings of this study are significant for pediatric dental practitioners, as they highlight the need for targeted educational and behavioral interventions to build and maintain dental trust in young patients.