Examination of the Occurrence of Dental Caries and Contributing Factors in School-Aged Left-Behind Children in Rural Regions of Western China

Examination of the Occurrence of Dental Caries and Contributing Factors in School-Aged Left-Behind Children in Rural Regions of Western China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Examination of the Occurrence of Dental Caries and Contributing Factors in School-Aged Left-Behind Children in Rural Regions of Western China Ran Duan, Yang Xiao, luoyan Tang, Yujing Tan, Junjun Jiang, Hua Li, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5675491/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Purpose Gaining insight into the dental caries conditions and contributing factors affecting school-aged left-behind children in rural China lays the groundwork and offers theoretical backing for future studies focused on preventing and treating dental caries in these children, as well as for early interventions in their oral health. Method A cluster random stratified sampling approach was utilized to carry out oral health assessments and survey questionnaires among 1,613 school-aged children, both left-behind and non-left-behind, in rural western China. The research aimed to compare the rates of dental caries between these two groups of children and used chi-square tests and logistic regression analysis to investigate the factors that affect the development of dental caries in children. Result The research findings indicate that the overall rate of dental caries in the studied population is 93.37%. Specifically, the prevalence among left-behind children is 94.97%, compared to 91.73% for non-left-behind children. This difference is statistically significant, with left-behind children showing a notably higher rate of dental caries (χ 2 = 6.83, P = 0.009). The total filling rate stands at 8.76%, with left-behind children having a rate of 7.36% and non-left-behind children at 10.25%. A comparison of the filling rates between these two groups reveals a statistically significant difference (χ 2 = 3.906, P = 0.048). The overall sealant rate is 3.72%, with left-behind children at 2.09% and non-left-behind children at 5.39%. Similarly, the comparison of sealant rates between the two groups also indicates a statistically significant difference (χ 2 = 12.279, P < 0.001).The findings from the multi-factor logistic analysis indicate that being female (OR = 2.933, 95% CI: 1.253–6.862) and not using fluoride toothpaste (OR = 3.416, 95% CI: 1.062–10.992) are associated with an increased risk of dental caries in left-behind children ( P < 0.05). Conversely, irregular fluoride use (OR = 0.334, 95% CI: 0.132–0.847), regular fluoride use (OR = 0.032, 95% CI: 0.010–0.097), and maintaining a consistent brushing schedule (OR = 0.195, 95% CI: 0.045–0.836) serve as protective factors against dental caries in this population ( P < 0.05). Conclusion In rural western China, left-behind children experience a notably high rate of dental caries, and the current prevention and control measures are inadequate. The rates of cavity fillings and the application of pit and fissure sealants are low, highlighting the urgent need to improve dental caries prevention among these children. It is essential to create targeted intervention strategies, conduct regular oral health check-ups for children, and educate caregivers about oral health. These efforts will aid children in developing proper oral hygiene practices, increase their awareness of oral health, and ultimately decrease the prevalence of dental caries. Rural school-age left-behind children dental caries dental caries filling pit and fissure sealing health influencing factors Figures Figure 1 Figure 2 Figure 3 Introduction Since the 1980s, the rapid urbanization and industrialization in our country have led to a significant migration of surplus young and middle-aged workers from rural areas to urban centers, resulting in more frequent population movements within the country.As global population movement increases, immigration has slowly emerged as a key global phenomenon of the 21st century [ 1 ] .By 2021, the population of rural migrant workers surpassed 171 million, and this number is anticipated to keep increasing in the years ahead [ 2 ] .The extensive migration of people has resulted in the issue of "left-behind children," garnering considerable interest from the government, society, and researchers. As many rural inhabitants move to urban centers, the population of left-behind children in rural regions keeps increasing. By 2015, the count of left-behind children in China's urban areas had reached 28.26 million, representing 41.1% of the overall number of left-behind children in the nation [ 3 ] .The phenomenon of left-behind children has increasingly emerged as a significant concern in Chinese society, with the count of rural left-behind children reaching 41.77 million by the year 2020 [ 4 ] . Parents significantly influence both the physical and mental growth of their children, and their presence is crucial for children's overall happiness [ 5 ] .Data from the Ministry of Civil Affairs of China indicates that the number of left-behind children in rural regions rose from 6.97 million at the end of 2018 to 11.99 million by the end of 2021 [ 6 ] .The percentage of children left behind in rural Guangxi is significantly elevated. This situation primarily arises because one or both parents seek employment elsewhere, and due to financial constraints and the high living expenses in urban areas, they cannot take their children with them. Consequently, the children are left at home in the countryside, where they are cared for by grandparents or other family members.Children raised in such unique circumstances often experience a deficiency of parental affection and support, which can lead to psychological challenges like loneliness, anxiety, and depression [ 7 , 8 ] . These mental health issues can hinder their personal growth and may also have negative effects on their physical well-being. Additionally, left-behind children, who do not receive adequate parental care or proper guidance on oral hygiene, may struggle to establish good dental habits, increasing their risk of developing cavities. Cavities are a multifactorial chronic disease caused by cariogenic microorganisms [ 9 ] , resulting from the interaction between susceptible hosts and cariogenic diets, leading to an imbalance in the oral microbiome [ 10 ] .Cavities represent a major global health concern that impacts individuals of all ages around the world [ 11 ] .Childhood cavities are recognized as one of the three primary non-communicable diseases that negatively impact the health of children in school.The findings from the fourth oral health survey in our country indicate that the prevalence of dental caries in permanent teeth among 12-year-old schoolchildren is 34.5% [ 12 ] . Research has indicated that the prevalence of dental cavities in children from the Jinhua region of Zhejiang is 67.86% [ 13 ] ; in Shanghai, the prevalence of dental cavities in preschool-aged children is 51.0% [ 14 ] ; and in Xingtai City, the prevalence of dental caries in children between the ages of 3 and 6 is 59.8% [ 15 ] .The oral health of rural children in China is critically poor, with a significant occurrence of dental caries. This problem is especially pronounced among school-aged left-behind children, largely linked to their living conditions and oral hygiene practices. China is a significant user of sugar, with sugar crops primarily categorized into two types: sugarcane and sugar beet. These crops exhibit unique regional characteristics in their distribution throughout the country.The southern area primarily concentrates on sugarcane cultivation, with Guangxi emerging as the largest sugarcane growing region in China, thanks to its favorable climate and geographical benefits [ 16 ] .From an archaeological standpoint, evidence suggests that as far back as the early Neolithic period, people in the Guangxi area showed indications of dental caries, with a notable frequency of cavities. This suggests that the high rate of dental caries in Guangxi is linked not only to contemporary lifestyle choices but may also be influenced by genetic factors [ 17 ] . Consequently, this research focuses on school-age children in the Linggui District of Guangxi Province, China, to examine the dental caries prevalence among both left-behind and non-left-behind children. The findings will serve as a foundation and theoretical framework for future efforts in preventing and treating dental caries in left-behind children, as well as for early intervention studies related to their oral health. 1 Materials and Methods 1.1 Research Subjects In April 2023, a cluster random stratified sampling technique was employed to choose grades 2–4 from seven primary schools located in rural Guangxi Zhuang Autonomous Region for a cross-sectional study. Following approval from the hospital's ethics committee, informed consent was secured from parents and guardians, who signed the necessary consent forms. Inclusion criteria: All participants in the survey are school-aged children enrolled in primary school; they are in good health without significant illnesses, and their parents are willing to take part in the questionnaire survey; at least one parent works outside the home for over six months each year, and the children are cared for by one parent, grandparents, or other relatives. Exclusion criteria: Children with mental health issues or systemic diseases. 1.2 Methods 1.2.1 Oral Examination: The "Children's Oral Health Survey Oral Examination Record Form" was created based on the "Fourth National Oral Health Epidemiological Sampling Survey Plan" [ 13 ] . Four qualified physicians, each holding at least a bachelor's degree and possessing over five years of clinical experience in dentistry, performed oral examinations on children. These examinations were conducted under standardized artificial lighting using portable dental chairs and disposable instruments for visual and tactile assessments of the oral cavity. Key oral health indicators assessed included the presence of dental caries, the existence of fillings, and any missing teeth due to caries, among others. Only those four doctors who achieved a Kappa value exceeding 0.80 (with a Kappa value above 0.75 indicating good consistency) after receiving training in oral medicine theory and examination techniques were permitted to carry out the examinations, ensuring reliable results. 1.2.2 Survey: In alignment with the oral health survey questionnaire standards outlined in the "Fourth National Oral Health Epidemiological Survey Plan" [ 13 ] , the "Children's Oral Health Survey Questionnaire" was created to meet the goals of this study. The questionnaire was organized by healthcare professionals and class teachers for the participating children and their parents to complete. It covers topics such as family environmental factors, children's oral health care practices, and their understanding of oral health. The questionnaires were distributed and collected on-site, resulting in a total of 1,613 completed "Children's Oral Health Survey Questionnaires" from both left-behind and non-left-behind children, achieving a 100% response rate. 1.3 Data Entry and Statistical Analysis This research utilized SPSS 27.0 software for conducting statistical analyses. The univariate analysis involved the Chi-square test, while multiple logistic regression was used to assess the factors influencing dental caries. A p-value of less than 0.05 was deemed statistically significant. The statistical analysis aimed to investigate the hypothesis that parents working away from home may impact the oral health behaviors and caries status of children left behind. Chi-square tests and non-parametric single-factor analysis were employed to compare the oral health behaviors and caries status between left-behind children and those who were not. Following this, multi-factor logistic regression analysis was performed to explore the connection between parents' employment situations and the oral health behaviors and caries status of left-behind children. A p-value below 0.05 was considered statistically significant, with the results presented in Table 1 . Table 1 Research Factors and Value Assignment Table Factors assignment Whether suffering from dental caries 1 = Yes, 0 = No gender 1 = man, 2 = woman Household per capita monthly income 1 = Within 1000, 2 = 1000ཞ2999, 3 = 3000ཞ4999, 4 = 5000 and above Number of times to brush teeth each day 1 = 2 times or more, 2 = 1 time, 3 = Not every day Brushing duration 1 = Less than 1 minute, 2 = 1 to 2 minutes, 3 = More than 2 to 3 minutes, 4 = Not clear. Whether to use fluoride toothpaste 1 = Yes, 2 = No, 3 = Don't know Frequency of consuming sweets daily 1 = Once or less, 2 = 1–2 times, 3 = 3times or more Whether to regularly visit a hospital or clinic for dental check-ups 1 = Never, 2 = Irregularly, 3 = Regularly Whether to regularly apply fluoride 1 = Never, 2 = Irregularly, 3 = Regularly Whether there has been orthodontic treatment 1 = Currently undergoing, 2 = Have done in the past, 3 = Never done Tooth brushing method 1 = Vertical brushing, 2 = Horizontal brushing, 3 = Circular brushing What is the opinion on the effect of fluoride toothpaste on teeth 1 = Beneficial, 2 = No benefit, no harm, 3 = Harmful, 4 = Don't know What is the opinion on gum bleeding 1 = Normal phenomenon, 2 = Gum inflammation, 3 = Brushing too hard, 4 = Don't know The effect of pit and fissure sealants on teeth 1 = Beneficial, 2 = No benefit, no harm, 3 = Harmful, 4 = Don't know Whether regular dental check-ups are necessary 1 = Necessary, 2 = Not necessary, 3 = Don't know What is the opinion on "the quality of teeth is innate and unrelated to personal care" 1 = True, 2 = False, 3 = Don't know Which type of food is harmful to teeth 1 = Milk, 2 = Fruit, 3 = Vegetables, 4 = Biscuits, cakes, and other desserts 2 Results 2.1 The Frequency of Dental Cavities in School-Aged Children Living in Rural Regions of Western China A study was conducted on 1,613 children in rural western China, revealing that 1,506 of them had dental caries, leading to an overall caries rate of 93.37% (1,506 out of 1,613). Among the left-behind children, 774 were affected by dental caries, resulting in a caries rate of 94.97% (774 out of 815). In contrast, 732 non-left-behind children had dental caries, with a caries rate of 91.98% (732 out of 798). The caries rate for left-behind children was significantly higher than that of non-left-behind children, with a statistically significant difference (χ²=6.83, P = 0.009), as indicated in Table 2 . Table 2 The prevalence of dental caries among school-age children in rural areas of western China. Non-left-behind group Cavity condition Caries rate/% χ 2 value P value Caries present No caries Left-behind group 815 774 41 94.97% 6.83 0.009 Non-left-behind group 798 732 64 91.98% Total 1613 1506 105 93.37% 2.2 The Status of Dental Cavities in Primary and Permanent Teeth Among School-Aged Children in Rural Regions of Western China A total of 1,613 children who received oral health assessments had an average decayed primary teeth (DPT) score of 5.328, with a primary tooth decay rate of 90.57% and a filling rate of 1.780%. Among these children, those classified as left-behind had an average DPT score of 5.39, a primary tooth decay rate of 91.04%, and a filling rate of 1.092%. In contrast, non-left-behind children had an average DPT score of 5.27, a primary tooth decay rate of 90.10%, and a filling rate of 2.50%. For permanent teeth, the average dental caries score was 0.942, with a caries prevalence rate of 47.61% and a filling rate of 4.728%. Left-behind children had an average dental caries score of 0.989, a caries prevalence rate of 49.07%, and a filling rate of 6.080%. Non-left-behind children had an average dental caries score of 0.895, with a caries prevalence rate of 46.12%. 2.3 Distribution of Deciduous and Permanent Teeth in School-Aged Children in Rural Areas of Western China Cavities in the primary teeth of school-aged children are most frequently observed in the lower first primary molars, followed by the upper first primary molars, and then the lower and upper second primary molars. Among left-behind children, lower first primary molars represented 19.85% of the total decayed teeth (1032 out of 5198), while upper first primary molars made up 17.70% (920 out of 5198), lower second primary molars accounted for 16.85% (876 out of 5198), and upper second primary molars comprised 13.58% (706 out of 5198). In the non-left-behind group, lower first primary molars constituted 20.75% of the total decayed teeth (1020 out of 4916), upper first primary molars represented 17.96% (883 out of 4916), lower second primary molars accounted for 16.83% (875 out of 5198), and upper second primary molars made up 14.06% (731 out of 5198). There was no significant difference in the distribution of decayed primary teeth between the two groups of children ( P > 0.05). Refer to Fig. 1 A. Cavities in the permanent teeth of school-aged children are most frequently observed in the lower first molars, followed by the upper first molars, and then the lower and upper second molars. Since many of the second molars in the children we studied had not yet erupted, we did not conduct any statistical analysis for them. In the group of left-behind children, lower first molars made up 10.00% of the total decayed teeth (520 out of 5198), while upper first molars represented 4.77% (248 out of 5198). In the non-left-behind group, lower first molars accounted for 9.80% of the total decayed teeth (482 out of 4916), and upper first molars accounted for 4.07% (200 out of 4916). There was no significant difference in the distribution of decayed permanent teeth between the two groups of children ( P > 0.05). See Fig. 1 B. 2.4 Dental Filling Conditions Among School-Aged Children with Cavities in Rural Western China In a study involving 1,613 children, there were 10,114 cavities identified, of which 225 were treated with fillings, leading to a filling rate of 2.225% (225 out of 10,114). For left-behind children, 97 cavities were filled, resulting in a filling rate of 1.867% (97 out of 5,198), while non-left-behind children had 128 cavities filled, yielding a filling rate of 2.604% (128 out of 4,916). A comparison of the filling rates between the two groups revealed a statistically significant difference (χ²=6.320, P = 0.012), as illustrated in Table 3 . Table 3 The Condition of Dental Fillings for School-Aged Children Due to Cavities in Rural Areas of Western China Number of teeth filled due to cavities. Filling rate/% χ2 value P value Left-behind group 97 1.867 6.320 0.012 Non-left-behind group 128 2.604 Total 225 2.225 2.5 The Status of Pit and Fissure Sealants Among School-Aged Children in Rural Regions of Western China Out of 1,613 children, 60 were given pit and fissure sealants, leading to an overall sealing rate of 3.72% (60/1613). Among the left-behind children, 17 received sealants, resulting in a sealing rate of 2.09% (17/815), while 43 non-left-behind children received sealants, yielding a sealing rate of 5.39% (43/798). A comparison of the sealing rates between the two groups revealed a statistically significant difference (χ²=12.279, P < 0.001), as illustrated in Table 4 . Table 4 The Situation of Pit and Fissure Sealing for School-Aged Children in Rural Areas of Western China Number of people Fissure sealant (example) Fissure sealant rate / % χ2 value P value Left-behind group 815 17 2.09 12.279 < 0.001 Non-left-behind group 798 43 5.39 Total 1613 60 3.72 2.6 Analysis of Dental Caries in School-Aged Left-Behind Children in Rural Western China Using a Single Factor Approach The findings from the univariate analysis indicate that several factors are associated with the risk of dental caries in left-behind children. These factors include gender, the family's monthly per capita income, the use of fluoride toothpaste, daily sweet consumption frequency, regular dental check-ups, fluoride usage, routine visits to dental clinics or hospitals, consistent fluoride application, tooth brushing duration, knowledge about the effects of fluoride toothpaste on teeth, and awareness of gum bleeding ( P < 0.05). See Table 5 and Fig. 2 . Table 5 Single Factor Analysis of Dental Caries in School-Aged Left-Behind Children in Rural Areas of Western China [n (%)]. Factors Caries group (n = 774) Non-caries group (n = 41) χ2 value P value Household per capita monthly income 1 = Within 1000 183(23.6) 8(19.5) 10.564 0.014 2 = 1000ཞ2999 382(49.4) 15(36.6) 3 = 3000ཞ4999 157(20.3) 10(24.4) 4 = 5000 and above 52(6.7) 8(19.5) Whether to use fluoride toothpaste 1 = Yes 305(39.4) 28(68.3) 14.342 < 0.001 2 = No 264(34.1) 5(12.2) 3 = Don't know 205(26.5) 8(19.5) Frequency of consuming sweets daily 1 = Once or less 367(47.4) 11(26.8) 7.169 0.028 2 = 1ཞ2 times 306(39.5) 21(51.2) 3 = 3 times or more 101(13.0) 9(22.0) Whether to regularly visit a hospital or clinic for dental check-ups 1 = Never 383(49.4) 11(26.8) 8.180 0.017 2 = Irregularly 338(43.7) 25(61.0) 3 = Regularly 54(7.0) 5(12.2) What is the opinion on gum bleeding 1 = Normal phenomenon 146(18.9) 1(2.4) 11.818 0.008 2 = Gum inflammation 382(49.4) 29(70.7) 3 = Brushing too hard 142(18.3) 9(22.0) 4 = Don't know 104(13.4) 2(4.9) 2.7 Comprehensive Analysis of Dental Caries Among School-Aged Left-Behind Children in Rural Western China Dental caries served as the dependent variable, while the independent variables that demonstrated statistical significance in the univariate analysis were incorporated into the multifactorial logistic regression analysis, as detailed in Table 1 . The findings from the logistic regression analysis reveal that gender, the use of fluoride toothpaste, fluoride treatments, and the length of time spent brushing are significant factors affecting dental caries in left-behind children ( P < 0.05), as illustrated in Fig. 3 . 3 Discussion A survey carried out in rural regions of western China revealed that more than ninety percent of school-aged children have dental caries.In comparison to the dental caries prevalence rates of school-age children in Shenzhen (41.15%) [ 18 ] and Hangzhou (52.78%) [ 19 ] , the rates among school-age children in rural western China are considerably greater.The findings suggest that the prevalence of dental caries in school-aged children living in rural regions of western China is quite high. This could be attributed to Guangxi's position in a low latitude area, characterized by a subtropical monsoon climate, which features extended hours of sunlight and plentiful rainfall, creating favorable conditions for sugarcane cultivation.According to a report by the Food and Agriculture Organization of the United Nations, China is the third largest producer of sugarcane, following Brazil and India. In China, sugarcane is the main sugar crop, accounting for over 90% of the country's sugar production [ 20 , 21 ] .Guangxi is the primary sugarcane production base in China, and its sugarcane output has consistently ranked among the top in the country.Sucrose is a primary contributor to the development of cavities [ 22 ] .Excessive intake of foods high in sugar can lead to the metabolism of sugar by microorganisms in dental plaque, producing acids that demineralize tooth enamel and result in cavities [ 23 ] .While the natural salts in saliva can neutralize the acids generated by the microbial breakdown of sugars, regularly eating foods high in sugar can diminish saliva's effectiveness in fighting these acids, which raises the likelihood of tooth decay [ 24 ] .Moreover, sucrose has strong adhesive qualities, allowing it to easily adhere to tooth surfaces, making them hard to clean and raising the likelihood of cavities. It is important to highlight that the prevalence of dental caries in school-aged left-behind children in rural western China (94.97%) is greater than that in non-left-behind children (91.73%), with a statistically significant difference ( P = 0.009). This suggests that dental caries among left-behind children has become a significant child health concern, with parental migration for work being a key risk factor. Society should pay more attention to the dental health of left-behind children. Since their parents are away for work, these children are primarily cared for by their grandparents, who often lack adequate knowledge and awareness of oral health care, which may impede their ability to effectively support left-behind children in maintaining proper oral hygiene. Pit and fissure sealing is a commonly utilized, non-invasive, and painless method for preventing and treating dental caries in children within clinical settings [ 25 ] .The rate of dental caries fillings serves as a key measure of a region's oral health. According to this survey, the overall filling rate for dental caries is 8.76% (132 out of 1506), with left-behind children having a filling rate of 7.36% (57 out of 774) compared to 10.25% (75 out of 732) for non-left-behind children. This indicates that left-behind children have a lower filling rate than their non-left-behind counterparts. Additionally, the pit and fissure sealing rate is 3.72% (60 out of 1613), with left-behind children at 2.09% (17 out of 815) and non-left-behind children at 5.39% (43 out of 798), further demonstrating that left-behind children have a lower sealing rate as well. This disparity may be linked to the generally lower economic conditions of families with left-behind children, leading to fewer dental care resources [ 26 ] . Fluoride toothpaste is the most widely used and effective way to prevent dental caries locally, and using it regularly can decrease the occurrence of cavities by approximately 25% [ 27 ] .Fluoride therapy for teeth is presently a successful approach for preventing and treating tooth decay [ 28 ] .The research revealed that the absence of fluoride toothpaste increases the risk of dental caries in left-behind children, whereas both consistent and inconsistent use of fluoride can help protect against these cavities. It is widely recognized that fluoride strengthens teeth's resistance to caries, a fact supported by studies from both national and international scholars [ 29 ] .Fluoride can prevent bacteria from growing on tooth surfaces, which decreases the acid they generate and consequently lowers the chances of tooth demineralization [ 30 , 31 ] .Furthermore, fluoride can aid in the remineralization of tooth surfaces, improving their hardness and resistance to acid [ 32 ] .This research indicates that among left-behind children, girls are more susceptible to dental caries, mainly due to their greater inclination towards sweets than boys. One key method for preventing cavities is regular tooth brushing, and the study highlights that the length of time spent brushing also affects the likelihood of developing dental caries. Brushing helps to physically eliminate dental plaque and food particles, which diminishes the harmful impact of acidic substances on teeth, thus helping to prevent cavities. In comparison to other developed regions, the prevalence of dental fillings and sealants among school-aged children in rural western China is notably low. This suggests that both schools and families in these areas are overlooking the importance of preventive and treatment measures for children's oral health, as well as lacking awareness about its significance. There is a need to enhance efforts aimed at preventing and treating dental caries. To address this, oral health education and awareness initiatives can be implemented in schools, communities, and other organizations to raise awareness among left-behind children and their caregivers, encouraging the development of good oral hygiene practices. Additionally, health authorities should regularly perform oral health screenings to facilitate the early identification and treatment of dental issues, ultimately decreasing the rate of dental caries among left-behind children. 4 Conclusion In conclusion, children living in rural regions of western China are facing a significant issue with dental caries and a low rate of dental fillings, highlighting a serious dental health problem. It is essential to create targeted intervention programs to encourage proper oral hygiene practices and raise awareness about oral health among left-behind children. National and relevant government agencies should implement comprehensive prevention and control strategies, developing integrated approaches tailored to our country that aim to decrease children's consumption of sugary foods, thus helping to prevent dental caries. Declarations Ethics declarations Ethical Approval and Informed Consent The study design and protocol were approved by the Ethics Committee of the Second Affiliated Hospital of Guilin Medical University (NO.WSSY-2022012), and written informed consent was obtained from the children's guardians. Clinical trial number: not applicable Conflict of Interest The authors declare that they have no competing interests. Funding This study was supported by the Guangxi Medical and Health Appropriate Technology Development and Promotion Application Project (No. S2022151). Author Contribution Ran Duan and QiuzhongLi designed the study. QiuzhongLi was responsible for training and supervising the project investigators.Yang Xiao , Junjun Jiang , Hua Li , Luoyan Tang, and Yujing Tan conducted the research and were responsible for data collection and entry. Ran Duan and Yang Xiao were responsible for data analysis, interpretation, and manuscript preparation. All authors read and approved the final manuscript. Acknowledgements The study was supported by the Guangxi Medical and Health Appropriate Technology Development and Promotion Application Project (No. S2022151). We would like to thank the administrators, teachers, and public health officials of the schools involved in the study, as well as the children for their cooperation. The funders had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation. The authors declare no conflicts of interest related to this study. Data Availability Data is provided within the manuscript or supplementary information files References International Organization of Migration. World migration report 2020. 2020; https://publications.iom.int/system/files/pdf/wmr_2020.pdf National Bureau of Statistics of China. The 2021 Statistical Communique on National Economic and Social Development. 2022 Feb 28 [cited 20 July 2022]. 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Dental caries status and related factors among 5-year-old children in Shanghai. BMC Oral Health. 2024;24(1):459. Published 2024 Apr 16. 10.1186/s12903-024-04185-x Xu H, Ma X, Wang J, Chen X, Zou Q, Ban J. Exploring the state and influential factors of dental caries in preschool children aged 3–6 years in Xingtai City. BMC Oral Health. 2024;24(1):951. Published 2024 Aug 16. 10.1186/s12903-024-04663-2 Zhang M, Govindaraju M. ‘Sugarcane Production in China’. Sugarcane - Technology and Research, InTech, 16 May 2018. Crossref, 10.5772/intechopen.73113 Peiqi ZHANG, Fajun LI. Minghui,.Analysis of dental caries and diet of the Neolithic population at the Dingsishan site. South China[J] ACTA ANTHROPOLOGICA SINICA. 2018;37(03):393–405. 10.16359/j.cnki.cn11-1963/q.2018.0016 . Cheng YH, Liao Y, Chen DY, Wang Y, Wu Y. Prevalence of dental caries and its association with body mass index among school-age children in Shenzhen, China. BMC Oral Health. 2019;19(1):270. 10.1186/s12903-019-0950-y . Published 2019 Dec 4. Chen Z, Zhu J, Zhao J et al. Dental caries status and its associated factors among schoolchildren aged 6–8 years in Hangzhou, China: a cross-sectional study. BMC Oral Health. 2023;23(1):94. Published 2023 Feb 14. 10.1186/s12903-023-02795-5 Wang M. Research on Sugarcane Field Recognition Method Based on Support Vector Machine. Master’s Thesis, Guangxi Normal University, Nanning, China, 2020. Deng SQ. Sugarcane Cultivation area Extraction and Growth Monitoring Based on NDVI Time Series. Master’s Thesis, Guilin University of Technology, Guilin, China, 2022. Tungare S, Paranjpe AG. Diet and Nutrition to Prevent Dental Problems. StatPearls. Treasure Island (FL). Volume 10. StatPearls Publishing; 2023. Tudoroniu C, Popa M, Iacob SM, Pop AL, Năsui BA. Correlation of Caries Prevalence, Oral Health Behavior and Sweets Nutritional Habits among 10 to 19-Year-Old Cluj-Napoca Romanian Adolescents. Int J Environ Res Public Health. 2020;17(18):6923. 10.3390/ijerph17186923 . PMID: 32971957; PMCID: PMC7558728. Skinner J, Byun R, Blinkhorn A, Johnson G. Sugary drink consumption and dental caries in New South Wales teenagers. Aust Dent J. 2015;60(2):169–75. 10.1111/adj.12310 . Epub 2015 May 19. PMID: 25988969. Liu W, Xiong L, Li J, Guo C, Fan W, Huang S. The anticaries effects of pit and fissure sealant in the first permanent molars of school-age children from Guangzhou: a population-based cohort study. BMC Oral Health. 2019;19(1):156. Published 2019 Jul 16. 10.1186/s12903-019-0846-x Gokhale N, Nuvvula S. Influence of socioeconomic and working status of the parents on the incidence of their children's dental caries. J Nat Sci Biol Med. 2016 Jul-Dec;7(2):127–9. 10.4103/0976-9668.184697 . PMID: 27433061; PMCID: PMC4934100. Creeth J, Zero D, Mau M, Bosma ML, Butler A. The effect of dentifrice quantity and toothbrushing behaviour on oral delivery and retention of fluoride in vivo. Int Dent J. 2013;63(2):14–24. 10.1111/idj.12075 . Hu W, Featherstone JD. Prevention of enamel demineralization: an in-vitro study using light-cured filled sealant. Am J Orthod Dentofac Orthop. 2005;128(5):592–670. 10.1016/j.ajodo.2004.07.046 . Schlueter N, Ganss C, Mueller U, Klimek J. Effect of titanium tetrafluoride and sodium fluoride on erosion progression in enamel and dentine in vitro. Caries Res. 2007;41(2):141–5. 10.1159/000098048 . Featherstone JD. Prevention and reversal of dental caries: role of low level fluoride. Community Dent Oral Epidemiol. 1999;27(1):31–40. 10.1111/j.1600-0528.1999.tb01989 . Lynch RJ, Navada R, Walia R. Low-levels of fluoride in plaque and saliva and their effects on the demineralisation and remineralisation of enamel; role of fluoride toothpastes. Int Dent J. 2004;54(5 Suppl 1):304–9. 10.1111/j.1875-595x.2004.tb00003.x . Ten Cate JM, Buzalaf MAR. Fluoride Mode of Action: Once There Was an Observant Dentist. J Dent Res. 2019;98(7):725–30. 10.1177/0022034519831604 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5675491","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":396124850,"identity":"d813f437-27b2-47a1-a00f-ce4275fc407c","order_by":0,"name":"Ran Duan","email":"","orcid":"","institution":"Guangxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ran","middleName":"","lastName":"Duan","suffix":""},{"id":396124851,"identity":"afb9f034-e47d-488b-86ea-83c5321df49c","order_by":1,"name":"Yang Xiao","email":"","orcid":"","institution":"Guangxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Xiao","suffix":""},{"id":396124852,"identity":"d53615be-8475-4d42-b07e-7c0a3d2a9319","order_by":2,"name":"luoyan Tang","email":"","orcid":"","institution":"The Second Affiliated Hospital of Guilin Medical University，No","correspondingAuthor":false,"prefix":"","firstName":"luoyan","middleName":"","lastName":"Tang","suffix":""},{"id":396124853,"identity":"82e29a32-8ae0-476f-ba2b-9365565c75bb","order_by":3,"name":"Yujing Tan","email":"","orcid":"","institution":"The Second Affiliated Hospital of Guilin Medical University，No","correspondingAuthor":false,"prefix":"","firstName":"Yujing","middleName":"","lastName":"Tan","suffix":""},{"id":396124854,"identity":"2dc4ee7b-7673-47e3-af3e-c7d2ecfd1682","order_by":4,"name":"Junjun Jiang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYBACxmYQyQNkNDAwPoAKGhCthRmmFL8WZMAmQZQW5nbmZw+/yBzOY56Re6zya9u2xAb25m0SDDV38DiMzdxYhudwMeOMvLTbMmduJzbwHCuTYDj2DJ9fzKQleA4nNs7IMbstUQHUIpFjJsHYcBiPFvZvcC3FEgZALfJvCGnhMZP8ANXC+AFsCw9BLWXSDDzpiY09b4ylGc7cNm7jSSu2SDiGW4th//Ftkj97rBM3tucYfvzZdlu2n/3wxhsfavBoaQAGNG8PlAGMUgY2kHACTg0MDPIgx/34AWPgUTkKRsEoGAUjFwAALstVLK4EcjYAAAAASUVORK5CYII=","orcid":"","institution":"Guangxi Medical University","correspondingAuthor":true,"prefix":"","firstName":"Junjun","middleName":"","lastName":"Jiang","suffix":""},{"id":396124855,"identity":"3e2c9b74-a30f-428c-a5b4-8b0d0cf420d6","order_by":5,"name":"Hua Li","email":"","orcid":"","institution":"Guangxi Medical University College of Stomatology","correspondingAuthor":false,"prefix":"","firstName":"Hua","middleName":"","lastName":"Li","suffix":""},{"id":396124856,"identity":"67bc6f61-8c7c-4d6a-af54-6760c77313c3","order_by":6,"name":"Qiuzhong li","email":"","orcid":"","institution":"The Second Affiliated Hospital of Guilin Medical University，No","correspondingAuthor":false,"prefix":"","firstName":"Qiuzhong","middleName":"","lastName":"li","suffix":""}],"badges":[],"createdAt":"2024-12-19 09:38:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5675491/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5675491/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":72739842,"identity":"1b7ab349-b17a-438b-aa89-48d6fec176b7","added_by":"auto","created_at":"2025-01-01 09:26:31","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":64908,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of dental caries in primary and permanent teeth among \u0026nbsp;school-age left-behind children and non-left-behind children in rural areas of \u0026nbsp;western China.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5675491/v1/09b682ec9cde1ba8d0ddc2e2.jpg"},{"id":72740728,"identity":"2b35feda-ab51-4bba-bc08-cf8a6b529aa1","added_by":"auto","created_at":"2025-01-01 09:34:31","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":96143,"visible":true,"origin":"","legend":"\u003cp\u003eLogistic univariate analysis of dental caries in school-age left-behind children in rural areas of western China.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5675491/v1/47b2d57a7a5c150910abea98.jpg"},{"id":72740729,"identity":"c16672f5-ff11-4aa6-8e2b-4343710789ee","added_by":"auto","created_at":"2025-01-01 09:34:31","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":26956,"visible":true,"origin":"","legend":"\u003cp\u003eLogistic Multivariate Analysis of Dental Caries in School-Aged Left-Behind Children in Rural Areas of Western China\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-5675491/v1/d7bd886037d46de37885bf17.png"},{"id":72741315,"identity":"94bb56f1-7790-45b5-b552-a6771debf2b5","added_by":"auto","created_at":"2025-01-01 09:42:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":935175,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5675491/v1/35334e06-d9b1-4abe-86a1-504c78dac37e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Examination of the Occurrence of Dental Caries and Contributing Factors in School-Aged Left-Behind Children in Rural Regions of Western China","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSince the 1980s, the rapid urbanization and industrialization in our country have led to a significant migration of surplus young and middle-aged workers from rural areas to urban centers, resulting in more frequent population movements within the country.As global population movement increases, immigration has slowly emerged as a key global phenomenon of the 21st century\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e.By 2021, the population of rural migrant workers surpassed 171\u0026nbsp;million, and this number is anticipated to keep increasing in the years ahead\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e.The extensive migration of people has resulted in the issue of \"left-behind children,\" garnering considerable interest from the government, society, and researchers. As many rural inhabitants move to urban centers, the population of left-behind children in rural regions keeps increasing. By 2015, the count of left-behind children in China's urban areas had reached 28.26\u0026nbsp;million, representing 41.1% of the overall number of left-behind children in the nation\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.The phenomenon of left-behind children has increasingly emerged as a significant concern in Chinese society, with the count of rural left-behind children reaching 41.77\u0026nbsp;million by the year 2020\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eParents significantly influence both the physical and mental growth of their children, and their presence is crucial for children's overall happiness\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.Data from the Ministry of Civil Affairs of China indicates that the number of left-behind children in rural regions rose from 6.97\u0026nbsp;million at the end of 2018 to 11.99\u0026nbsp;million by the end of 2021\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e.The percentage of children left behind in rural Guangxi is significantly elevated. This situation primarily arises because one or both parents seek employment elsewhere, and due to financial constraints and the high living expenses in urban areas, they cannot take their children with them. Consequently, the children are left at home in the countryside, where they are cared for by grandparents or other family members.Children raised in such unique circumstances often experience a deficiency of parental affection and support, which can lead to psychological challenges like loneliness, anxiety, and depression\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. These mental health issues can hinder their personal growth and may also have negative effects on their physical well-being. Additionally, left-behind children, who do not receive adequate parental care or proper guidance on oral hygiene, may struggle to establish good dental habits, increasing their risk of developing cavities.\u003c/p\u003e \u003cp\u003eCavities are a multifactorial chronic disease caused by cariogenic microorganisms\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e, resulting from the interaction between susceptible hosts and cariogenic diets, leading to an imbalance in the oral microbiome\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.Cavities represent a major global health concern that impacts individuals of all ages around the world\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e.Childhood cavities are recognized as one of the three primary non-communicable diseases that negatively impact the health of children in school.The findings from the fourth oral health survey in our country indicate that the prevalence of dental caries in permanent teeth among 12-year-old schoolchildren is 34.5%\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Research has indicated that the prevalence of dental cavities in children from the Jinhua region of Zhejiang is 67.86%\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e; in Shanghai, the prevalence of dental cavities in preschool-aged children is 51.0%\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e; and in Xingtai City, the prevalence of dental caries in children between the ages of 3 and 6 is 59.8%\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e.The oral health of rural children in China is critically poor, with a significant occurrence of dental caries. This problem is especially pronounced among school-aged left-behind children, largely linked to their living conditions and oral hygiene practices.\u003c/p\u003e \u003cp\u003eChina is a significant user of sugar, with sugar crops primarily categorized into two types: sugarcane and sugar beet. These crops exhibit unique regional characteristics in their distribution throughout the country.The southern area primarily concentrates on sugarcane cultivation, with Guangxi emerging as the largest sugarcane growing region in China, thanks to its favorable climate and geographical benefits\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e.From an archaeological standpoint, evidence suggests that as far back as the early Neolithic period, people in the Guangxi area showed indications of dental caries, with a notable frequency of cavities. This suggests that the high rate of dental caries in Guangxi is linked not only to contemporary lifestyle choices but may also be influenced by genetic factors \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eConsequently, this research focuses on school-age children in the Linggui District of Guangxi Province, China, to examine the dental caries prevalence among both left-behind and non-left-behind children. The findings will serve as a foundation and theoretical framework for future efforts in preventing and treating dental caries in left-behind children, as well as for early intervention studies related to their oral health.\u003c/p\u003e"},{"header":"1 Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Research Subjects\u003c/h2\u003e \u003cp\u003eIn April 2023, a cluster random stratified sampling technique was employed to choose grades 2–4 from seven primary schools located in rural Guangxi Zhuang Autonomous Region for a cross-sectional study. Following approval from the hospital's ethics committee, informed consent was secured from parents and guardians, who signed the necessary consent forms.\u003c/p\u003e \u003cp\u003eInclusion criteria: All participants in the survey are school-aged children enrolled in primary school; they are in good health without significant illnesses, and their parents are willing to take part in the questionnaire survey; at least one parent works outside the home for over six months each year, and the children are cared for by one parent, grandparents, or other relatives.\u003c/p\u003e \u003cp\u003eExclusion criteria: Children with mental health issues or systemic diseases.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e1.2 Methods\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e1.2.1\u003c/h2\u003e \u003cp\u003eOral Examination: The \"Children's Oral Health Survey Oral Examination Record Form\" was created based on the \"Fourth National Oral Health Epidemiological Sampling Survey Plan\" \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Four qualified physicians, each holding at least a bachelor's degree and possessing over five years of clinical experience in dentistry, performed oral examinations on children. These examinations were conducted under standardized artificial lighting using portable dental chairs and disposable instruments for visual and tactile assessments of the oral cavity. Key oral health indicators assessed included the presence of dental caries, the existence of fillings, and any missing teeth due to caries, among others. Only those four doctors who achieved a Kappa value exceeding 0.80 (with a Kappa value above 0.75 indicating good consistency) after receiving training in oral medicine theory and examination techniques were permitted to carry out the examinations, ensuring reliable results.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e1.2.2\u003c/h3\u003e\n\u003cp\u003eSurvey: In alignment with the oral health survey questionnaire standards outlined in the \"Fourth National Oral Health Epidemiological Survey Plan\" \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, the \"Children's Oral Health Survey Questionnaire\" was created to meet the goals of this study. The questionnaire was organized by healthcare professionals and class teachers for the participating children and their parents to complete. It covers topics such as family environmental factors, children's oral health care practices, and their understanding of oral health. The questionnaires were distributed and collected on-site, resulting in a total of 1,613 completed \"Children's Oral Health Survey Questionnaires\" from both left-behind and non-left-behind children, achieving a 100% response rate.\u003c/p\u003e\n\u003ch3\u003e1.3 Data Entry and Statistical Analysis\u003c/h3\u003e\n\u003cp\u003e \u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003eThis research utilized SPSS 27.0 software for conducting statistical analyses. The univariate analysis involved the Chi-square test, while multiple logistic regression was used to assess the factors influencing dental caries. A p-value of less than 0.05 was deemed statistically significant.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003eThe statistical analysis aimed to investigate the hypothesis that parents working away from home may impact the oral health behaviors and caries status of children left behind. Chi-square tests and non-parametric single-factor analysis were employed to compare the oral health behaviors and caries status between left-behind children and those who were not. Following this, multi-factor logistic regression analysis was performed to explore the connection between parents' employment situations and the oral health behaviors and caries status of left-behind children. A p-value below 0.05 was considered statistically significant, with the results presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResearch Factors and Value Assignment Table\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eassignment\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhether suffering from dental caries\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = Yes, 0 = No\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003egender\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = man, 2 = woman\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold per capita monthly income\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = Within 1000, 2 = 1000ཞ2999,\u003c/p\u003e \u003cp\u003e3 = 3000ཞ4999, 4 = 5000 and above\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of times to brush teeth each day\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = 2 times or more, 2 = 1 time,\u003c/p\u003e \u003cp\u003e3 = Not every day\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrushing duration\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = Less than 1 minute,\u003c/p\u003e \u003cp\u003e2 = 1 to 2 minutes,\u003c/p\u003e \u003cp\u003e3 = More than 2 to 3 minutes,\u003c/p\u003e \u003cp\u003e4 = Not clear.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhether to use fluoride toothpaste\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = Yes, 2 = No, 3 = Don't know\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of consuming sweets daily\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = Once or less, 2 = 1–2 times,\u003c/p\u003e \u003cp\u003e3 = 3times or more\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhether to regularly visit a hospital or clinic for dental check-ups\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = Never, 2 = Irregularly,\u003c/p\u003e \u003cp\u003e3 = Regularly\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhether to regularly apply fluoride\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = Never, 2 = Irregularly,\u003c/p\u003e \u003cp\u003e3 = Regularly\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhether there has been orthodontic treatment\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = Currently undergoing,\u003c/p\u003e \u003cp\u003e2 = Have done in the past,\u003c/p\u003e \u003cp\u003e3 = Never done\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTooth brushing method\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = Vertical brushing,\u003c/p\u003e \u003cp\u003e2 = Horizontal brushing,\u003c/p\u003e \u003cp\u003e3 = Circular brushing\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat is the opinion on the effect of fluoride toothpaste on teeth\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = Beneficial,\u003c/p\u003e \u003cp\u003e2 = No benefit, no harm, 3 = Harmful, 4 = Don't know\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat is the opinion on gum bleeding\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = Normal phenomenon,\u003c/p\u003e \u003cp\u003e2 = Gum inflammation,\u003c/p\u003e \u003cp\u003e3 = Brushing too hard,\u003c/p\u003e \u003cp\u003e4 = Don't know\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe effect of pit and fissure sealants on teeth\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = Beneficial,\u003c/p\u003e \u003cp\u003e2 = No benefit, no harm, 3 = Harmful, 4 = Don't know\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhether regular dental check-ups are necessary\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = Necessary, 2 = Not necessary,\u003c/p\u003e \u003cp\u003e3 = Don't know\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat is the opinion on \"the quality of teeth is innate and unrelated to personal care\"\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = True, 2 = False, 3 = Don't know\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhich type of food is harmful to teeth\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = Milk, 2 = Fruit, 3 = Vegetables,\u003c/p\u003e \u003cp\u003e4 = Biscuits, cakes, and other desserts\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\n \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\n \u003cp\u003e \u003c/p\u003e "},{"header":"2 Results","content":"\u003cp\u003e \u003cb\u003e2.1 The Frequency of Dental Cavities in School-Aged Children Living in Rural Regions of Western China\u003c/b\u003e \u003c/p\u003e\u003cp\u003eA study was conducted on 1,613 children in rural western China, revealing that 1,506 of them had dental caries, leading to an overall caries rate of 93.37% (1,506 out of 1,613). Among the left-behind children, 774 were affected by dental caries, resulting in a caries rate of 94.97% (774 out of 815). In contrast, 732 non-left-behind children had dental caries, with a caries rate of 91.98% (732 out of 798). The caries rate for left-behind children was significantly higher than that of non-left-behind children, with a statistically significant difference (χ²=6.83, \u003cem\u003eP\u003c/em\u003e = 0.009), as indicated in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe prevalence of dental caries among school-age children in rural areas of western China.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNon-left-behind group\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eCavity condition\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCaries rate/%\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e value\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCaries present\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo caries\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft-behind group\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e815\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e774\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.97%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e6.83\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-left-behind group\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e798\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e732\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e91.98%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1613\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1506\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93.37%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e \u003cb\u003e2.2 The Status of Dental Cavities in Primary and Permanent Teeth Among School-Aged Children in Rural Regions of Western China\u003c/b\u003e \u003c/p\u003e\u003cp\u003eA total of 1,613 children who received oral health assessments had an average decayed primary teeth (DPT) score of 5.328, with a primary tooth decay rate of 90.57% and a filling rate of 1.780%. Among these children, those classified as left-behind had an average DPT score of 5.39, a primary tooth decay rate of 91.04%, and a filling rate of 1.092%. In contrast, non-left-behind children had an average DPT score of 5.27, a primary tooth decay rate of 90.10%, and a filling rate of 2.50%.\u003c/p\u003e\u003cp\u003eFor permanent teeth, the average dental caries score was 0.942, with a caries prevalence rate of 47.61% and a filling rate of 4.728%. Left-behind children had an average dental caries score of 0.989, a caries prevalence rate of 49.07%, and a filling rate of 6.080%. Non-left-behind children had an average dental caries score of 0.895, with a caries prevalence rate of 46.12%.\u003c/p\u003e\u003cp\u003e \u003cb\u003e2.3 Distribution of Deciduous and Permanent Teeth in School-Aged Children in Rural Areas of Western China\u003c/b\u003e \u003c/p\u003e\u003cp\u003eCavities in the primary teeth of school-aged children are most frequently observed in the lower first primary molars, followed by the upper first primary molars, and then the lower and upper second primary molars. Among left-behind children, lower first primary molars represented 19.85% of the total decayed teeth (1032 out of 5198), while upper first primary molars made up 17.70% (920 out of 5198), lower second primary molars accounted for 16.85% (876 out of 5198), and upper second primary molars comprised 13.58% (706 out of 5198). In the non-left-behind group, lower first primary molars constituted 20.75% of the total decayed teeth (1020 out of 4916), upper first primary molars represented 17.96% (883 out of 4916), lower second primary molars accounted for 16.83% (875 out of 5198), and upper second primary molars made up 14.06% (731 out of 5198). There was no significant difference in the distribution of decayed primary teeth between the two groups of children (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05). Refer to Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA.\u003c/p\u003e\u003cp\u003eCavities in the permanent teeth of school-aged children are most frequently observed in the lower first molars, followed by the upper first molars, and then the lower and upper second molars. Since many of the second molars in the children we studied had not yet erupted, we did not conduct any statistical analysis for them. In the group of left-behind children, lower first molars made up 10.00% of the total decayed teeth (520 out of 5198), while upper first molars represented 4.77% (248 out of 5198). In the non-left-behind group, lower first molars accounted for 9.80% of the total decayed teeth (482 out of 4916), and upper first molars accounted for 4.07% (200 out of 4916). There was no significant difference in the distribution of decayed permanent teeth between the two groups of children (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05). See Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB.\u003c/p\u003e\u003ch3\u003e2.4 Dental Filling Conditions Among School-Aged Children with Cavities in Rural Western China\u003c/h3\u003e\u003cp\u003eIn a study involving 1,613 children, there were 10,114 cavities identified, of which 225 were treated with fillings, leading to a filling rate of 2.225% (225 out of 10,114). For left-behind children, 97 cavities were filled, resulting in a filling rate of 1.867% (97 out of 5,198), while non-left-behind children had 128 cavities filled, yielding a filling rate of 2.604% (128 out of 4,916). A comparison of the filling rates between the two groups revealed a statistically significant difference (χ²=6.320, \u003cem\u003eP\u003c/em\u003e = 0.012), as illustrated in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe Condition of Dental Fillings for School-Aged Children Due to Cavities in Rural Areas of Western China\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of teeth filled due to cavities.\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFilling rate/%\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ2 value\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft-behind group\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.867\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e6.320\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-left-behind group\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.604\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.225\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e \u003cb\u003e2.5 The Status of Pit and Fissure Sealants Among School-Aged Children in Rural Regions of Western China\u003c/b\u003e \u003c/p\u003e\u003cp\u003eOut of 1,613 children, 60 were given pit and fissure sealants, leading to an overall sealing rate of 3.72% (60/1613). Among the left-behind children, 17 received sealants, resulting in a sealing rate of 2.09% (17/815), while 43 non-left-behind children received sealants, yielding a sealing rate of 5.39% (43/798). A comparison of the sealing rates between the two groups revealed a statistically significant difference (χ²=12.279, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001), as illustrated in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe Situation of Pit and Fissure Sealing for School-Aged Children in Rural Areas of Western China\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of people\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFissure sealant (example)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFissure sealant rate / %\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ2 value\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft-behind group\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e815\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.09\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e12.279\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-left-behind group\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e798\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.39\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1613\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.72\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003cb\u003e2.6 Analysis of Dental Caries in School-Aged Left-Behind Children in Rural Western China Using a Single Factor Approach\u003c/b\u003e \u003c/p\u003e\u003cp\u003eThe findings from the univariate analysis indicate that several factors are associated with the risk of dental caries in left-behind children. These factors include gender, the family's monthly per capita income, the use of fluoride toothpaste, daily sweet consumption frequency, regular dental check-ups, fluoride usage, routine visits to dental clinics or hospitals, consistent fluoride application, tooth brushing duration, knowledge about the effects of fluoride toothpaste on teeth, and awareness of gum bleeding (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05). See Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSingle Factor Analysis of Dental Caries in School-Aged Left-Behind Children in Rural Areas of Western China [n (%)].\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCaries group (n = 774)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-caries\u003c/p\u003e \u003cp\u003egroup (n = 41)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ2 value\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eHousehold per capita monthly income\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = Within 1000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e183(23.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8(19.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e10.564\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 = 1000ཞ2999\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e382(49.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15(36.6)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 = 3000ཞ4999\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e157(20.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(24.4)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 = 5000 and above\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52(6.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8(19.5)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eWhether to use fluoride toothpaste\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = Yes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e305(39.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28(68.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e14.342\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 = No\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e264(34.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(12.2)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 = Don't know\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e205(26.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8(19.5)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFrequency of consuming sweets daily\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = Once or less\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e367(47.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(26.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e7.169\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 = 1ཞ2 times\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e306(39.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(51.2)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 = 3 times or more\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101(13.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(22.0)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eWhether to regularly visit a hospital or clinic for dental check-ups\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = Never\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e383(49.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(26.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e8.180\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 = Irregularly\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e338(43.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25(61.0)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 = Regularly\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54(7.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(12.2)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eWhat is the opinion on gum bleeding\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 = Normal phenomenon\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e146(18.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(2.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e11.818\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 = Gum inflammation\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e382(49.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29(70.7)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 = Brushing too hard\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e142(18.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(22.0)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 = Don't know\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104(13.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(4.9)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003ch3\u003e2.7 Comprehensive Analysis of Dental Caries Among School-Aged Left-Behind Children in Rural Western China\u003c/h3\u003e\u003cp\u003eDental caries served as the dependent variable, while the independent variables that demonstrated statistical significance in the univariate analysis were incorporated into the multifactorial logistic regression analysis, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The findings from the logistic regression analysis reveal that gender, the use of fluoride toothpaste, fluoride treatments, and the length of time spent brushing are significant factors affecting dental caries in left-behind children (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05), as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e"},{"header":"3 Discussion","content":"\u003cp\u003eA survey carried out in rural regions of western China revealed that more than ninety percent of school-aged children have dental caries.In comparison to the dental caries prevalence rates of school-age children in Shenzhen (41.15%) \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e and Hangzhou (52.78%) \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e, the rates among school-age children in rural western China are considerably greater.The findings suggest that the prevalence of dental caries in school-aged children living in rural regions of western China is quite high. This could be attributed to Guangxi's position in a low latitude area, characterized by a subtropical monsoon climate, which features extended hours of sunlight and plentiful rainfall, creating favorable conditions for sugarcane cultivation.According to a report by the Food and Agriculture Organization of the United Nations, China is the third largest producer of sugarcane, following Brazil and India. In China, sugarcane is the main sugar crop, accounting for over 90% of the country's sugar production\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e.Guangxi is the primary sugarcane production base in China, and its sugarcane output has consistently ranked among the top in the country.Sucrose is a primary contributor to the development of cavities\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e.Excessive intake of foods high in sugar can lead to the metabolism of sugar by microorganisms in dental plaque, producing acids that demineralize tooth enamel and result in cavities\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e.While the natural salts in saliva can neutralize the acids generated by the microbial breakdown of sugars, regularly eating foods high in sugar can diminish saliva's effectiveness in fighting these acids, which raises the likelihood of tooth decay\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e.Moreover, sucrose has strong adhesive qualities, allowing it to easily adhere to tooth surfaces, making them hard to clean and raising the likelihood of cavities.\u003c/p\u003e\u003cp\u003eIt is important to highlight that the prevalence of dental caries in school-aged left-behind children in rural western China (94.97%) is greater than that in non-left-behind children (91.73%), with a statistically significant difference (\u003cem\u003eP\u003c/em\u003e = 0.009). This suggests that dental caries among left-behind children has become a significant child health concern, with parental migration for work being a key risk factor. Society should pay more attention to the dental health of left-behind children. Since their parents are away for work, these children are primarily cared for by their grandparents, who often lack adequate knowledge and awareness of oral health care, which may impede their ability to effectively support left-behind children in maintaining proper oral hygiene.\u003c/p\u003e\u003cp\u003ePit and fissure sealing is a commonly utilized, non-invasive, and painless method for preventing and treating dental caries in children within clinical settings\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e.The rate of dental caries fillings serves as a key measure of a region's oral health. According to this survey, the overall filling rate for dental caries is 8.76% (132 out of 1506), with left-behind children having a filling rate of 7.36% (57 out of 774) compared to 10.25% (75 out of 732) for non-left-behind children. This indicates that left-behind children have a lower filling rate than their non-left-behind counterparts. Additionally, the pit and fissure sealing rate is 3.72% (60 out of 1613), with left-behind children at 2.09% (17 out of 815) and non-left-behind children at 5.39% (43 out of 798), further demonstrating that left-behind children have a lower sealing rate as well. This disparity may be linked to the generally lower economic conditions of families with left-behind children, leading to fewer dental care resources\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eFluoride toothpaste is the most widely used and effective way to prevent dental caries locally, and using it regularly can decrease the occurrence of cavities by approximately 25%\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e.Fluoride therapy for teeth is presently a successful approach for preventing and treating tooth decay\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e.The research revealed that the absence of fluoride toothpaste increases the risk of dental caries in left-behind children, whereas both consistent and inconsistent use of fluoride can help protect against these cavities. It is widely recognized that fluoride strengthens teeth's resistance to caries, a fact supported by studies from both national and international scholars\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e.Fluoride can prevent bacteria from growing on tooth surfaces, which decreases the acid they generate and consequently lowers the chances of tooth demineralization\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e.Furthermore, fluoride can aid in the remineralization of tooth surfaces, improving their hardness and resistance to acid\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e.This research indicates that among left-behind children, girls are more susceptible to dental caries, mainly due to their greater inclination towards sweets than boys. One key method for preventing cavities is regular tooth brushing, and the study highlights that the length of time spent brushing also affects the likelihood of developing dental caries. Brushing helps to physically eliminate dental plaque and food particles, which diminishes the harmful impact of acidic substances on teeth, thus helping to prevent cavities.\u003c/p\u003e\u003cp\u003eIn comparison to other developed regions, the prevalence of dental fillings and sealants among school-aged children in rural western China is notably low. This suggests that both schools and families in these areas are overlooking the importance of preventive and treatment measures for children's oral health, as well as lacking awareness about its significance. There is a need to enhance efforts aimed at preventing and treating dental caries. To address this, oral health education and awareness initiatives can be implemented in schools, communities, and other organizations to raise awareness among left-behind children and their caregivers, encouraging the development of good oral hygiene practices. Additionally, health authorities should regularly perform oral health screenings to facilitate the early identification and treatment of dental issues, ultimately decreasing the rate of dental caries among left-behind children.\u003c/p\u003e"},{"header":"4 Conclusion","content":"\u003cp\u003eIn conclusion, children living in rural regions of western China are facing a significant issue with dental caries and a low rate of dental fillings, highlighting a serious dental health problem. It is essential to create targeted intervention programs to encourage proper oral hygiene practices and raise awareness about oral health among left-behind children. National and relevant government agencies should implement comprehensive prevention and control strategies, developing integrated approaches tailored to our country that aim to decrease children's consumption of sugary foods, thus helping to prevent dental caries.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval and Informed Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study design and protocol were approved by the Ethics Committee of the Second Affiliated Hospital of Guilin Medical University (NO.WSSY-2022012), and written informed consent was obtained from the children\u0026apos;s guardians.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number: not applicable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study was supported by the Guangxi Medical and Health Appropriate Technology Development and Promotion Application Project (No. S2022151).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eRan Duan and QiuzhongLi designed the study. QiuzhongLi was responsible for training and supervising the project investigators.Yang Xiao , Junjun Jiang , Hua Li , Luoyan Tang, and Yujing Tan conducted the research and were responsible for data collection and entry. Ran Duan and Yang Xiao were responsible for data analysis, interpretation, and manuscript preparation. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThe study was supported by the Guangxi Medical and Health Appropriate Technology Development and Promotion Application Project (No. S2022151). We would like to thank the administrators, teachers, and public health officials of the schools involved in the study, as well as the children for their cooperation. The funders had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation. The authors declare no conflicts of interest related to this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is provided within the manuscript or supplementary information files\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eInternational Organization of Migration. World migration report 2020. 2020; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://publications.iom.int/system/files/pdf/wmr_2020.pdf\u003c/span\u003e\u003cspan address=\"https://publications.iom.int/system/files/pdf/wmr_2020.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Bureau of Statistics of China. The 2021 Statistical Communique on National Economic and Social Development. 2022 Feb 28 [cited 20 July 2022]. 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Fluoride Mode of Action: Once There Was an Observant Dentist. J Dent Res. 2019;98(7):725\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0022034519831604\u003c/span\u003e\u003cspan address=\"10.1177/0022034519831604\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Rural school-age left-behind children, dental caries, dental caries filling, pit and fissure sealing, health influencing factors","lastPublishedDoi":"10.21203/rs.3.rs-5675491/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5675491/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eGaining insight into the dental caries conditions and contributing factors affecting school-aged left-behind children in rural China lays the groundwork and offers theoretical backing for future studies focused on preventing and treating dental caries in these children, as well as for early interventions in their oral health.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eA cluster random stratified sampling approach was utilized to carry out oral health assessments and survey questionnaires among 1,613 school-aged children, both left-behind and non-left-behind, in rural western China. The research aimed to compare the rates of dental caries between these two groups of children and used chi-square tests and logistic regression analysis to investigate the factors that affect the development of dental caries in children.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eThe research findings indicate that the overall rate of dental caries in the studied population is 93.37%. Specifically, the prevalence among left-behind children is 94.97%, compared to 91.73% for non-left-behind children. This difference is statistically significant, with left-behind children showing a notably higher rate of dental caries (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;6.83, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009). The total filling rate stands at 8.76%, with left-behind children having a rate of 7.36% and non-left-behind children at 10.25%. A comparison of the filling rates between these two groups reveals a statistically significant difference (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;3.906, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.048). The overall sealant rate is 3.72%, with left-behind children at 2.09% and non-left-behind children at 5.39%. Similarly, the comparison of sealant rates between the two groups also indicates a statistically significant difference (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;12.279, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).The findings from the multi-factor logistic analysis indicate that being female (OR\u0026thinsp;=\u0026thinsp;2.933, 95% CI: 1.253\u0026ndash;6.862) and not using fluoride toothpaste (OR\u0026thinsp;=\u0026thinsp;3.416, 95% CI: 1.062\u0026ndash;10.992) are associated with an increased risk of dental caries in left-behind children (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Conversely, irregular fluoride use (OR\u0026thinsp;=\u0026thinsp;0.334, 95% CI: 0.132\u0026ndash;0.847), regular fluoride use (OR\u0026thinsp;=\u0026thinsp;0.032, 95% CI: 0.010\u0026ndash;0.097), and maintaining a consistent brushing schedule (OR\u0026thinsp;=\u0026thinsp;0.195, 95% CI: 0.045\u0026ndash;0.836) serve as protective factors against dental caries in this population (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIn rural western China, left-behind children experience a notably high rate of dental caries, and the current prevention and control measures are inadequate. The rates of cavity fillings and the application of pit and fissure sealants are low, highlighting the urgent need to improve dental caries prevention among these children. It is essential to create targeted intervention strategies, conduct regular oral health check-ups for children, and educate caregivers about oral health. These efforts will aid children in developing proper oral hygiene practices, increase their awareness of oral health, and ultimately decrease the prevalence of dental caries.\u003c/p\u003e","manuscriptTitle":"Examination of the Occurrence of Dental Caries and Contributing Factors in School-Aged Left-Behind Children in Rural Regions of Western China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-01 09:26:26","doi":"10.21203/rs.3.rs-5675491/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-31T09:15:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-12-31T05:16:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-12-30T14:33:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2024-12-19T09:30:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fac14ce3-f5f5-4544-bf77-9b3c62f3c5e3","owner":[],"postedDate":"January 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-11T14:23:30+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-01 09:26:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5675491","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5675491","identity":"rs-5675491","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}