Development and validation of a dynamic nomogram for dentes cariosus in Chinese children

Development and validation of a dynamic nomogram for dentes cariosus in Chinese children | 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 Development and validation of a dynamic nomogram for dentes cariosus in Chinese children Rui Chen, Yu Zhao, Ping Hao, Yuqing Bian, Ying Min This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6300876/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Objectives: This study is to examine the factors associated with dentes cariosus in Chinese children. Furthermore, we construct a risk prediction nomogram and assess its predictive performance. Methods: A total of 450 Chinese children who visited the outpatient Department of Stomatology, General Hospital of Northern Theater Command were included in this study. The patients were divided into dental caries group (n = 340) and non-caries group (n = 110) based on the presence of dental caries at presentation. Independent predictors of dental caries were determined using univariate and multivariate logistic regression analyses combined with LASSO regression. The prediction model was established by a nomogram model based on three factors and the original dataset was also used for validation. The discriminative power was measured by the receiver operating characteristic (ROC) curve’s area under the curve (AUC), whereas calibration was assessed using calibration plots and the Hosmer-Lemeshow test. Clinical applicability was examined through decision curve analysis (DCA) and clinical impact curves (CIC). Results: The following three factors contribute to the occurrence of dental caries: liking to eat snacks, bad behavior habits and brushing teeth for less than 2 minutes. The predicted probabilities of dental caries in outpatient clinics corresponded well to the actual incidence with index of the bootstrap-corrected Harrell's concordance was 0.939 [95% CI, 0.910-0.964] and the P value of the Hosmer-Lemeshow test was 0.922. Decision curve analysis demonstrated that our predictive model offered greater net clinical benefit across threshold probabilities of 1% to 70% compared to either no intervention or universal intervention strategies. CIC displayed good predictive ability and clinical application value for the model. Conclusion: Prediction nomograms, which including a simple clinical nomogram and online dynamic nomogram, can be used to identify children susceptible to dental caries. Thus, it is better for dentists to provide individualized management and timely and effective intervention measures for children at high risk of caries. dentes cariosus nomogram prediction model risk factors Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Background According to the definition provided by the World Health Organization (WHO), quality of life refers to "individuals' perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns" (WHO, 1997). Quality of life is a subjective concept influenced by social, cultural, and environmental factors[ 1 ]. Oral health is defined as a state of comfortable and functionally normal teeth that enables individuals to fulfill their social roles and serves as a significant determinant of quality of life. Oral health-related quality of life (OHRQoL) refers to a state where oral health does not negatively impact daily functions, wellbeing, and social life, and where individuals feel confident about their dental and facial appearance[ 2 ]. Dental caries is a common dental disease among children, and its prevalence is on the rise[ 3 ]. The World Health Organization reports that the global prevalence of dental caries in school-age children ranges from 60–90%[ 4 ]. According to the Fourth National Oral Health Epidemiological Survey of China in 2015, the prevalence of dental caries among 5-year-old children was as high as 71.9%, highlighting the high incidence of dental caries in children[ 5 ]. Dental caries is a chronic infectious disease of the hard tissues of teeth caused by acid production from cariogenic bacteria and is a major focus of dental prevention and treatment[ 6 – 8 ]. Dental caries in children often leads to reduced chewing function, decreased appetite, and subsequently affects the digestive and absorptive functions of the gastrointestinal tract, resulting in malnutrition and adversely impacting children's growth and development[ 9 – 12 ]. Therefore, identifying risk factors for dental caries in children is crucial for reducing its incidence and improving prognosis. Epidemiological surveys indicate that due to differences in economic development and dietary habits, there are significant regional variations in the prevalence of dental caries[ 13 – 15 ]. Currently, there is a lack of risk scoring systems and preventive intervention recommendations specifically targeting dental caries in preschool and school-age children. This study aims to provide references and evidence for the treatment and prevention of dental caries in children. Materials and Methods Subjects This study collected retrospective case data from children who visited the dental clinic of the General Hospital of Northern Theater Command between January 2021 and June 2023. Children who met the diagnostic criteria for dental caries as outlined in Pediatric Dentistry (5th Edition) were included in the caries group (n = 340), while the remaining children were included in the non-caries group (n = 110). The inclusion criteria were children aged 1–12 years with fully erupted front teeth and diagnosed with dental caries. The exclusion criteria were as follows: (a) children who had previously undergone treatment; (b) children with congenital dental developmental disorders; (c) children or their guardians with mental illnesses; (d) children with severe bleeding tendencies, such as idiopathic thrombocytopenia or hemophilia; (e) children with congenital immune disorders, such as Sjogren's syndrome; (f) children with familial hereditary dental diseases; (g) children taking medications with dental side effects, such as tetracyclines; (h) children with other severe chronic diseases or undergoing treatments that might affect the study outcomes. This study was approved by the Ethics Committee of the General Hospital of the Northern Theater Command (Y(2024)175) and followed the 1975 Declaration of Helsinki (revised in 2013). Written informed consent was obtained from the guardians of the enrolled children before the start of the study. Collection of Information All the detailed information of the selected children was recorded, including: Basic information: name, age, gender and initial diagnosis. Dietary habits: preference for sweet foods, carbonated beverages and eating before sleep. Oral care habits: regular dental check-ups, age of first tooth brushing, tooth brushing frequency (times/day), tooth brushing duration (minutes), tooth brushing techniques, use of fluoride toothpaste, toothbrush replacement frequency (< 3 months or ≥ 3 months) and rinsing after meals. Family situation: place of residence (urban or rural), monthly family income ( 10,000 yuan), educational level of guardians (primary school or below, junior high school, senior high school, junior college, bachelor's degree or above). Statistical Analysis Measurement data are expressed as mean ± standard deviation (x̄ ± SD), and count data are presented as the number of cases (n, %). For comparisons between groups, measurement data were analyzed using the t-test, while count data were analyzed using the chi-square test or Fisher's exact test. Paired sample comparisons were performed using the Wilcoxon signed-rank test. Statistical significance was set at P < 0.05. All analyses were conducted using SPSS 29.0 (IBM Corp., Armonk, NY) or R 4.1.2 (University of Auckland, New Zealand). All variables were subjected to univariate logistic regression analysis. Variables with P < 0.10 were included in the multivariate analysis. A risk prediction model was developed using stepwise logistic regression, with statistical significance set at P < 0.05. Risk factors contributing to the high prevalence of dental caries were identified through univariate and multivariate logistic regression analyses. Risk scores were derived by dividing each regression coefficient by the smallest regression coefficient and rounding to the nearest integer. The model's discrimination performance was assessed via the concordance index (C-index), equivalent to the area under the ROC curve (AUC), along with its 95% confidence interval (CI). C-index of 0.5 indicates no predictive ability, while 1.0 indicates perfect prediction. The optimal cutoff value for identifying high-risk and low-risk children was determined using the Youden index maximization principle on the ROC curve. The LASSO feature selection was implemented using the 'glmnet' package, serving as validation for the logistic regression analysis. Variables retaining non-zero coefficients in the LASSO model were included in the final selection. Through 10-fold cross-validation applying the 1-SE rule, we identified the most suitable λ penalty parameter for the LASSO model. A nomogram was created using R's 'rms' and 'DynNom' packages (version 4.2.1). A point scoring system was created by scaling and rounding the coefficients from the multivariate logistic regression model, with total scores subsequently converted to predicted probabilities. A calibration plot was generated to examine the agreement between predicted and observed outcomes. DCA and CIC were performed using the 'rmda' package to assess clinical utility, with bootstrap validation (1000 iterations). Statistical significance was defined as p < 0.05 (two-sided). Result Univariate analysis of children's general information and influencing factors A total of 450 children were included in this study, of whom 340 (75.5%) had dental caries and 110 had no dental caries. The two groups demonstrated statistically significant differences in three oral health-related behavioral aspects: frequent snacking, insufficient toothbrushing duration (< 2 minutes), and poor oral health behaviors(P < 0.05). (Table 1 ). Univariate analysis showed that bad behavior habits, liking to eat snacks and brushing teeth for less than 2 minutes were significantly different between the two groups ( P < 0.05), (Table 2 ). Table 1 Comparison of information between the two groups non-caries group (n = 110) caries group (n = 340) P Gender 0.094 Female 43 (39.1%) 164 (48.2%) Male 67 (60.9%) 176 (51.8%) Age 6.69 ± 2.40 6.78 ± 2.20 0.723 Undesirable Behavioral Habits 8 (7.27%) 64 (18.8%) 0.004 Prefer sweets 0.249 Never 2 (1.82%) 3 (0.88%) Occasionally 71 (64.5%) 198 (58.2%) Often 37 (33.6%) 139 (40.9%) Prefer carbonated beverages 0.127 Never 41 (37.3%) 96 (28.2%) Occasionally 63 (57.3%) 212 (62.4%) Often 6 (5.45%) 32 (9.41%) Likes to eat snacks < 0.001 Never 76 (69.1%) 5 (1.47%) Occasionally 25 (22.7%) 99 (29.1%) Often 9 (8.18%) 236 (69.4%) Eat before going to bed 0.579 Never 34 (30.9%) 95 (27.9%) Occasionally 61 (55.5%) 207 (60.9%) Often 15 (13.6%) 38 (11.2%) Regular oral checkups 0.168 Never 21 (19.1%) 70 (20.6%) Occasionally 60 (54.5%) 152 (44.7%) Often 29 (26.4%) 118 (34.7%) Initial brushing age 0.429 Less than 1 year 23 (20.9%) 80 (23.5%) 1–3 years old 63 (57.3%) 204 (60.0%) Greater than 3 years old 24 (21.8%) 56 (16.5%) Brushing frequency ≥ 2 times/day 54 (49.1%) 177 (52.1%) 0.588 Brushing time < 2min 36 (32.7%) 262 (77.1%) < 0.01 Brushing method 0.473 By yourself 70 (63.6%) 229 (67.4%) Parental guidance 40 (36.4%) 111 (32.6%) Whether to use toothpaste 110 (100%) 338 (99.4%) 1.000 Whether toothpaste contains fluoride 72 (65.5%) 209 (61.5%) 0.453 Toothpaste replacement 0.832 More than 3 months 25 (22.7%) 74 (21.8%) Less than 3 months 85 (77.3%) 266 (78.2%) Rinse mouth after meals 49 (44.5%) 150 (44.1%) 1.000 Primary caregiver is parent 99 (90.0%) 320 (94.1%) 0.138 Importance of oral health education 0.808 Not important 3 (2.73%) 13 (3.82%) Emphasize 107 (97.3%) 327 (96.2%) Lectures on oral health care 27 (24.5%) 86 (25.3%) 0.900 Parents' attitude towards dental disease 0.877 Not important 15 (13.6%) 50 (14.7%) Emphasize 95 (86.4%) 290 (85.3%) Parental management after dental caries 0.476 Not accept treatment 2 (1.82%) 13 (3.82%) Receive treatment 108 (98.2%) 327 (96.2%) Education level of primary caregiver 0.856 Elementary school and below 16 (14.5%) 46 (13.5%) Middle School 5 (4.55%) 10 (2.94%) High School 10 (9.09%) 32 (9.41%) University and above 79 (71.8%) 252 (74.1%) Table 2 Logistic regression analysis of risk factors for high prevalence dental disease univariate analysis multivariate analysis OR P OR P Gender Female Male 0.69 (0.44–1.07) 0.095 Age 1.02 (0.92–1.12) 0.71 Undesirable Behavioral Habits 2.96 (1.37–6.38) 0.006 4.32 (1.07–17.41) 0.039 Prefer sweets Never Occasionally 1.86 (0.30-11.36) 0.502 Often 2.50 (0.40-15.54) 0.324 Prefer carbonated beverages Never Occasionally 1.44 (0.91–2.28) 0.123 Often 2.28 (0.88–5.86) 0.088 Likes to eat snacks Never - - Occasionally 60.19 (22.02-164.54) < 0.001 67.54 (22.25-205.02) < 0.001 Often 398.58(129.61-1225.70) < 0.001 440.48(128.89-1505.36) < 0.001 Eat before going to bed Never Occasionally 1.21 (0.75–1.97) 0.432 Often 0.91 (0.44–1.85) 0.788 Regular oral checkups Never Occasionally 0.76 (0.43–1.35) 0.347 Often 1.22 (0.65–2.30) 0.538 Initial brushing age Less than 1 year 1–3 years old 0.93 (0.54–1.60) 0.796 Greater than 3 years old 0.67 (0.34–1.31) 0.24 Brushing frequency ≥ 2 times/day 1.13 (0.73–1.73) 0.588 Brushing time < 2min 6.90 (4.31–11.07) < 0.001 6.48 (3.06–13.73) < 0.001 Brushing method By yourself Parental guidance 0.85 (0.54–1.33) 0.473 Whether to use toothpaste 0.00 (0.00-Inf) 0.983 Whether toothpaste contains fluoride 0.84 (0.54–1.32) 0.454 Toothpaste replacement 1.06 (0.63–1.77) 0.832 More than 3 months Less than 3 months Rinse mouth after meals 0.98 (0.64–1.51) 0.937 Primary caregiver is parent 1.78 (0.82–3.84) 0.143 Importance of oral health education 0.71 (0.20–2.52) 0.591 Not important Emphasize Lectures on oral health care 1.04 (0.63–1.71) 0.875 Parents' attitude towards dental disease 0.92 (0.49–1.71) 0.782 Not important Emphasize Parental management after dental caries 0.47 (0.10–2.10) 0.32 Not accept treatment Receive treatment Education level of primary caregiver Elementary school and below Middle School 0.70 (0.21–2.34) 0.558 High School 1.11 (0.45–2.76) 0.818 University and above 1.11 (0.60–2.07) 0.744 Multivariate logistic regression and LASSO regression analysis Further multivariate logistic regression analysis was used, with statistically significant factors in univariate analysis as independent variables and dental caries as dependent variables. The results showed that bad behavior habits (OR = 4.32, 95%CI: 1.07–17.41, P = 0.039), liking to eat snacks (OR = 440.48, 95%CI: 128.89–1505.36, P < 0.001) and brushing teeth for less than 2 minutes (OR = 6.48, 95%CI: 3.06–13.73, P < 0.001) were independent risk factors for dental caries in children (Table 2 ). To reinforce the variable selection, LASSO regression analysis was conducted, yielding consistent predictors with those identified in the logistic regression analysis, thus enhancing the robustness of our predictive model. (Fig. 1 ). Establishment and application of nomogram model Based on these independent predictive factors identified through logistic and LASSO regression analyses, a nomogram risk prediction model for dental caries was established. The model was shown as a nomogram and contained three significant independent risk factors: bad behavior habits, liking to eat snacks, and teeth brushing time < 2 min. Each variable corresponds to a line segment, and the scale indicates the value. Total scores, obtained through summation of all variable-specific points, are transformed into caries probability estimates (Fig. 2 ). To overcome the clinical implementation constraints of static nomograms, we designed and deployed an interactive web-based prediction platform that dynamically calculates risk probabilities (Figure. 3) ( https://namoamituofo.shinyapps.io/DynNomapp/ ). This tool simplifies the computational process and facilitates clinical decision making. Assessment and validation of the nomogram model In our study, we applied bootstrapping with 1000 replicates to validate the models we constructed. The predictive power of the nomogram was evaluated by drawing the receiver operating characteristic (ROC) curve. The AUC, which generated based on the nomogram in predicting dental caries, was 0.939(95%CI: 0.911–0.967), demonstrating excellent predictive accuracy. At the optimal probability threshold of 0.931, the model demonstrated balanced performance with 0.845 specificity and 0.924 sensitivity (Fig. 4 ). Simultaneously, the model's accuracy was verified using the Bootstrap method with 1,000 replications, yielding an AUC of 0.939 (95%CI: 0.910–0.964). The calibration curve demonstrated excellent alignment between predicted probabilities and actual clinical outcomes (Fig. 5 ). Additionally, the Hosmer-Lemeshow goodness-of-fit test was not statistically significant ( P = 0.922), confirming the model's stability. Clinical application of the nomogram model DCA was implemented to assess whether the caries risk model provided meaningful clinical advantage. The analysis showed that the model provided significant net benefit when the risk threshold was set between 0.02 and 0.98, compared to "no intervention" or "all intervention" strategies (Fig. 6 ). Through CIC assessment, we evaluated the number of high-risk children and true high-risk children at multiple thresholds, demonstrating robust predictive accuracy with strong clinical utility (Fig. 7 ). Discussion This study retrospectively analyzed the risk factors associated with dental caries in Chinese children, using clinical data from 450 participants. We identified "poor behavioral habits", "frequent snacking" and "brushing for less than 2 minutes" as independent predictors of dental caries. Based on these predictors, we developed a nomogram to predict dental caries risk and internally validated it, confirming its robust predictive capability. Modern dietary trends have led to an increase in refined foods and a decrease in fibrous content. Sweets and snacks now dominate children's diets[ 16 – 17 ], with consumption increasing as children grow older. Our study found that children with dental caries consumed more snacks, consistent with other research findings[ 18 – 21 ]. Snacks, which are high in sugar, promote the growth of cariogenic microorganisms, particularly Streptococcus mutans . These bacteria form a sticky plaque matrix that adheres to teeth and metabolizes carbohydrates, leading to demineralization and caries development[ 22 – 24 ]. Increased snacking frequency significantly raises caries risk, with our study showing a 440-fold increase in caries incidence among frequent snackers. This is likely due to prolonged contact between snack sugars and oral bacteria, which metabolize these sugars into acids that erode tooth enamel. Primary teeth, being less resistant to acid erosion, are more susceptible to caries[ 25 – 27 ]. However, our study did not find a significant difference between groups in terms of overall sugar intake, possibly because parents categorized only obvious sweets (e.g., sugary drinks, cakes) and overlooked the sugar content in snacks[ 28 ]. The development of dental caries in children is closely related to behavioral habits[ 29 – 32 ]. Poor habits include using a pacifier before bed, finger-sucking, and night-time milk consumption. Our study found a higher prevalence of these habits in the caries group, identifying them as significant risk factors. During sleep, saliva production decreases, allowing bacteria to proliferate and increasing caries risk. Night-time bottle feeding and milk consumption further elevate caries incidence[ 30 ].Logistic regression analysis confirmed that poor behavioral habits increase caries risk by 4.32 times, consistent with findings from other researchers[ 33 – 36 ]. Low mineralization, thin enamel, and weak acid resistance of primary teeth are intrinsic factors contributing to caries. Extrinsic factors include a preference for sweets, improper brushing techniques, and inadequate oral hygiene. The combined effect of these factors promotes bacterial growth and acid production, leading to tooth tissue destruction and caries. Good oral hygiene practices, such as effective brushing and the use of fluoride toothpaste, are widely recognized as effective preventive measures[ 37 – 40 ].Our study found that brushing for less than 2 minutes increased caries risk by 6.48 times, consistent with findings from other researchers[ 41 – 43 ]. Therefore, it is essential for healthcare providers and parents to enhance oral health education for children, improving their oral health awareness and behaviors. Conclusion This study analyzed the clinical data of children with dental caries and identified snacking habits, poor behavioral habits, and brushing for less than 2 minutes as independent predictors of dental caries in children. We developed and validated prediction models, including a simple bedside prediction model and an online dynamic prediction model, to identify children at high risk of dental caries. These models enable dentists to formulate personalized management strategies for children's oral health and provide timely and effective interventions. Declarations Ethics approval and consent to participate The research protocol received ethical clearance from the Institutional Review Board of General Hospital of Northern Theater Command (Approval No. Y[2024]175) in accordance with Declaration of Helsinki principles. Written informed consent was obtained from all guardians of the children who participated in this study. Consent for publication Not applicable. Availability of data and materials The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. Competing interests The authors declare that they have no competing interests. Funding This study was supported by the Liaoning province science and technology plan joint plan (applied basic research project) , grant number 2023JH2/101700115. Authors' contributions Rui Chen: Conceptualization, Methodology, Data Curation, Writing - Original Draft, Writing - Review & Editing. Yu Zhao and Ping Hao: Software, Validation, Investigation, Resources, Visualization. Yuqing Bian: Formal analysis, Investigation, Resources, Visualization. Ying Min: Conceptualization, Data Curation, Writing - Review & Editing, Supervision, Project administration, Funding acquisition. Acknowledgements The author sincerely thanks all the colleagues in the Department of Stomatology, General Hospital of Northern Theater Command, and the dentists who participated in this study. Thanks also to the statisticians who helped with this study. References Radina ME, Stolldorf DP, Sinclair VG, et al. Development and preliminary validation of a health-related family quality of life instrument. 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Elamin A, Garemo M, Gardner A. Dental caries and their association with socioeconomic characteristics, oral hygiene practices and eating habits among preschool children in Abu Dhabi, United Arab Emirates - the NOPLAS project. BMC Oral Health. 2018;18(1):104. Published 2018 Jun 8. Quadri MFA, Shubayr MA, Hattan AH, Wafi SA, Jafer AH. Oral Hygiene Practices among Saudi Arabian Children and Its Relation to Their Dental Caries Status. Int J Dent. 2018;2018:3234970. Published 2018 Apr 16. Kramer A, Splieth C. Health promotion through structured oral hygiene and good tooth alignment. GMS Hyg Infect Control. 2022;17:Doc08. Published 2022 May 10. Worthington HV, MacDonald L, Poklepovic Pericic T, et al. Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries. Cochrane Database Syst Rev. 2019;4(4):CD012018. Published 2019 Apr 10. Mazurkiewicz D, Pustułka M, Ambrozik-Haba J, Bienkiewicz M. Dietary Habits and Oral Hygiene as Determinants of the Incidence and Intensity of Dental Caries-A Pilot Study. Nutrients. 2023;15(22):4833. Published 2023 Nov 19. Edman K, Holmlund A, Norderyd O. 'Caries disease among an elderly population-A 10-year longitudinal study'. Int J Dent Hyg. 2021;19(2):166-175. Holmes RD. Tooth brushing frequency and risk of new carious lesions. Evid Based Dent. 2016;17(4):98-99. Fernández CE, Silva-Acevedo CA, Padilla-Orellana F, Zero D, Carvalho TS, Lussi A. Should We Wait to Brush Our Teeth? A Scoping Review Regarding Dental Caries and Erosive Tooth Wear. Caries Res. 2024;58(4):454-468. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 06 May, 2025 Editor assigned by journal 29 Apr, 2025 Editor invited by journal 11 Apr, 2025 Submission checks completed at journal 09 Apr, 2025 First submitted to journal 09 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-6300876","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":453203253,"identity":"1f316624-c010-4ff2-a152-6353568205cd","order_by":0,"name":"Rui Chen","email":"","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Rui","middleName":"","lastName":"Chen","suffix":""},{"id":453203254,"identity":"f00cfaf1-e389-47e2-b8df-b4fbe51dacfa","order_by":1,"name":"Yu Zhao","email":"","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Zhao","suffix":""},{"id":453203255,"identity":"75f2e12c-ce5f-4975-aaf8-5a7d013e1a31","order_by":2,"name":"Ping Hao","email":"","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Ping","middleName":"","lastName":"Hao","suffix":""},{"id":453203258,"identity":"c8d97bb2-0c3c-458f-a4dc-b911f0a55800","order_by":3,"name":"Yuqing Bian","email":"","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Yuqing","middleName":"","lastName":"Bian","suffix":""},{"id":453203261,"identity":"c94e6eda-6de4-4a2a-8ed0-b60db168fb0a","order_by":4,"name":"Ying Min","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxUlEQVRIiWNgGAWjYDACZiBOYGDgYWNmPnDgww8StMjwsbMlHpzZQ4JlNnL8PMaHOdiIUKrbzntM4uGOWqDDeD4cZuBhkOcXO4Bfi9lhvjSJxDPHgVp4NxwusGAwnDk7gZAWHjOJxLZjEC0zeBgSDG4Tr4XnwWEeNuK11IC0MBCtxdgise0AUAubATCQJYjwy/kzhjd/ttXZy/cffvzhww8beX5pAlqAgEWCgeEwjCNBUDkIMH9gYKgjSuUoGAWjYBSMUAAAHII+Iy6oz3UAAAAASUVORK5CYII=","orcid":"","institution":"General Hospital of Northern Theater Command","correspondingAuthor":true,"prefix":"","firstName":"Ying","middleName":"","lastName":"Min","suffix":""}],"badges":[],"createdAt":"2025-03-25 06:53:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6300876/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6300876/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82359815,"identity":"9ee5b149-a295-4b16-99b1-47f2536c5812","added_by":"auto","created_at":"2025-05-09 11:33:21","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":168197,"visible":true,"origin":"","legend":"\u003cp\u003escreening of predictors of high incidence dental disease by LASSO regression\u003c/p\u003e\n\u003cp\u003e(A) LASSO coefficient distribution map for each clinical feature.\u003c/p\u003e\n\u003cp\u003e(B) Ten-fold cross-validation with 1-SE criteria identified the most parsimonious λ value for the LASSO model.\u003c/p\u003e\n\u003cp\u003eLASSO, least absolute shrinkage and selection operator; SE,standard error.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6300876/v1/d4f43c553a862bd921299522.png"},{"id":82358552,"identity":"84a44986-06ba-4928-bd68-2b7a604bc43a","added_by":"auto","created_at":"2025-05-09 11:24:50","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":119752,"visible":true,"origin":"","legend":"\u003cp\u003eA nomogram risk model predicting dental caries in children.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6300876/v1/d0e0f313c5c8de00181ac8c1.png"},{"id":82358562,"identity":"d2116329-36b5-4f94-aeed-00b06225c4ec","added_by":"auto","created_at":"2025-05-09 11:24:50","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":185627,"visible":true,"origin":"","legend":"\u003cp\u003eWeb-based dynamic nomogram.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-6300876/v1/8ff1335611ed0ed91b9f7a06.png"},{"id":82358554,"identity":"f50fd87c-5bba-486c-bb53-93379535dbb5","added_by":"auto","created_at":"2025-05-09 11:24:50","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":115159,"visible":true,"origin":"","legend":"\u003cp\u003eThe predictive power of the nomogram was evaluated by drawing the ROC curve. ROC analysis yielded an AUC value of 0.939[95%CI: 0.911-0.967]. AUC, area under the curve.ROC, receiver operating characteristic .\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-6300876/v1/a160c8e8f39db05b35e7207b.png"},{"id":82358556,"identity":"bedb0fe5-780a-44a9-a2af-b6b34a702646","added_by":"auto","created_at":"2025-05-09 11:24:50","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":20624,"visible":true,"origin":"","legend":"\u003cp\u003eThe calibration graph illustrates predicted (X-axis) vs 0bserved probabilities (Y-axis). The 'Ideal' line marks the ideal prediction model. The blue line shows Bootstrap resampling-predicted probabilities from 1000 resamples of the original dataset. The ’Apparent’ line denotes the predicted probabilities.\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-6300876/v1/c5d7915c0e173c2f02faa82c.png"},{"id":82359778,"identity":"1c5ec7f2-6872-4c45-ad28-53498f5193ec","added_by":"auto","created_at":"2025-05-09 11:32:50","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":101616,"visible":true,"origin":"","legend":"\u003cp\u003eDCA for predictive nomogram.\u003c/p\u003e\n\u003cp\u003eX-axis: Threshold. Y-axis: Net benefit. The”None” line shows the net benefit when no children are included in the interventions. The “All” line corresponds to the net benefit when the interventions cover the entire child population. The solid red line reflects the net benefit of targeting only children who have dental caries. DCA, decision curve analysis.\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-6300876/v1/3e61b6a316a335a9aaf9524a.png"},{"id":82358559,"identity":"7d33a241-c4dc-45ee-94b7-932adae399ce","added_by":"auto","created_at":"2025-05-09 11:24:50","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":126461,"visible":true,"origin":"","legend":"\u003cp\u003eCIC of the nomogram. The two horizontal axes illustrate this relationship. The red line displays how many children are classified as high-risk across different thresholds (out of 1,000). The blue dashed line represents the actual caries cases detected in these high-risk children. CIC, Clinical Impact Curves.\u003c/p\u003e","description":"","filename":"floatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-6300876/v1/68386ca33e9b52d634c6021a.png"},{"id":82361264,"identity":"1888070f-5fbb-4b88-a8ce-9b02652e6fc4","added_by":"auto","created_at":"2025-05-09 11:48:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1774016,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6300876/v1/e5e9166d-b690-46b2-9f92-530dd99d1968.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development and validation of a dynamic nomogram for dentes cariosus in Chinese children","fulltext":[{"header":"Background","content":"\u003cp\u003eAccording to the definition provided by the World Health Organization (WHO), quality of life refers to \"individuals' perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns\" (WHO, 1997). Quality of life is a subjective concept influenced by social, cultural, and environmental factors[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Oral health is defined as a state of comfortable and functionally normal teeth that enables individuals to fulfill their social roles and serves as a significant determinant of quality of life. Oral health-related quality of life (OHRQoL) refers to a state where oral health does not negatively impact daily functions, wellbeing, and social life, and where individuals feel confident about their dental and facial appearance[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDental caries is a common dental disease among children, and its prevalence is on the rise[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The World Health Organization reports that the global prevalence of dental caries in school-age children ranges from 60\u0026ndash;90%[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. According to the Fourth National Oral Health Epidemiological Survey of China in 2015, the prevalence of dental caries among 5-year-old children was as high as 71.9%, highlighting the high incidence of dental caries in children[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Dental caries is a chronic infectious disease of the hard tissues of teeth caused by acid production from cariogenic bacteria and is a major focus of dental prevention and treatment[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Dental caries in children often leads to reduced chewing function, decreased appetite, and subsequently affects the digestive and absorptive functions of the gastrointestinal tract, resulting in malnutrition and adversely impacting children's growth and development[\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Therefore, identifying risk factors for dental caries in children is crucial for reducing its incidence and improving prognosis. Epidemiological surveys indicate that due to differences in economic development and dietary habits, there are significant regional variations in the prevalence of dental caries[\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCurrently, there is a lack of risk scoring systems and preventive intervention recommendations specifically targeting dental caries in preschool and school-age children. This study aims to provide references and evidence for the treatment and prevention of dental caries in children.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSubjects\u003c/h2\u003e \u003cp\u003eThis study collected retrospective case data from children who visited the dental clinic of the General Hospital of Northern Theater Command between January 2021 and June 2023. Children who met the diagnostic criteria for dental caries as outlined in Pediatric Dentistry (5th Edition) were included in the caries group (n\u0026thinsp;=\u0026thinsp;340), while the remaining children were included in the non-caries group (n\u0026thinsp;=\u0026thinsp;110). The inclusion criteria were children aged 1\u0026ndash;12 years with fully erupted front teeth and diagnosed with dental caries. The exclusion criteria were as follows: (a) children who had previously undergone treatment; (b) children with congenital dental developmental disorders; (c) children or their guardians with mental illnesses; (d) children with severe bleeding tendencies, such as idiopathic thrombocytopenia or hemophilia; (e) children with congenital immune disorders, such as Sjogren's syndrome; (f) children with familial hereditary dental diseases; (g) children taking medications with dental side effects, such as tetracyclines; (h) children with other severe chronic diseases or undergoing treatments that might affect the study outcomes. This study was approved by the Ethics Committee of the General Hospital of the Northern Theater Command (Y(2024)175) and followed the 1975 Declaration of Helsinki (revised in 2013). Written informed consent was obtained from the guardians of the enrolled children before the start of the study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCollection of Information\u003c/h3\u003e\n\u003cp\u003eAll the detailed information of the selected children was recorded, including:\u003c/p\u003e \u003cp\u003eBasic information: name, age, gender and initial diagnosis.\u003c/p\u003e \u003cp\u003eDietary habits: preference for sweet foods, carbonated beverages and eating before sleep.\u003c/p\u003e \u003cp\u003eOral care habits: regular dental check-ups, age of first tooth brushing, tooth brushing frequency (times/day), tooth brushing duration (minutes), tooth brushing techniques, use of fluoride toothpaste, toothbrush replacement frequency (\u0026lt;\u0026thinsp;3 months or \u0026ge;\u0026thinsp;3 months) and rinsing after meals.\u003c/p\u003e \u003cp\u003eFamily situation: place of residence (urban or rural), monthly family income (\u0026lt;\u0026thinsp;5,000 yuan, 5,000\u0026ndash;10,000 yuan, \u0026gt; 10,000 yuan), educational level of guardians (primary school or below, junior high school, senior high school, junior college, bachelor's degree or above).\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eMeasurement data are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x̄ \u0026plusmn; SD), and count data are presented as the number of cases (n, %). For comparisons between groups, measurement data were analyzed using the t-test, while count data were analyzed using the chi-square test or Fisher's exact test. Paired sample comparisons were performed using the Wilcoxon signed-rank test. Statistical significance was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05. All analyses were conducted using SPSS 29.0 (IBM Corp., Armonk, NY) or R 4.1.2 (University of Auckland, New Zealand).\u003c/p\u003e \u003cp\u003eAll variables were subjected to univariate logistic regression analysis. Variables with \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.10 were included in the multivariate analysis. A risk prediction model was developed using stepwise logistic regression, with statistical significance set at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Risk factors contributing to the high prevalence of dental caries were identified through univariate and multivariate logistic regression analyses. Risk scores were derived by dividing each regression coefficient by the smallest regression coefficient and rounding to the nearest integer. The model's discrimination performance was assessed via the concordance index (C-index), equivalent to the area under the ROC curve (AUC), along with its 95% confidence interval (CI). C-index of 0.5 indicates no predictive ability, while 1.0 indicates perfect prediction. The optimal cutoff value for identifying high-risk and low-risk children was determined using the Youden index maximization principle on the ROC curve. The LASSO feature selection was implemented using the 'glmnet' package, serving as validation for the logistic regression analysis. Variables retaining non-zero coefficients in the LASSO model were included in the final selection. Through 10-fold cross-validation applying the 1-SE rule, we identified the most suitable λ penalty parameter for the LASSO model. A nomogram was created using R's 'rms' and 'DynNom' packages (version 4.2.1). A point scoring system was created by scaling and rounding the coefficients from the multivariate logistic regression model, with total scores subsequently converted to predicted probabilities. A calibration plot was generated to examine the agreement between predicted and observed outcomes. DCA and CIC were performed using the 'rmda' package to assess clinical utility, with bootstrap validation (1000 iterations). Statistical significance was defined as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (two-sided).\u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eUnivariate analysis of children's general information and influencing factors\u003c/h2\u003e \u003cp\u003eA total of 450 children were included in this study, of whom 340 (75.5%) had dental caries and 110 had no dental caries. The two groups demonstrated statistically significant differences in three oral health-related behavioral aspects: frequent snacking, insufficient toothbrushing duration (\u0026lt;\u0026thinsp;2 minutes), and poor oral health behaviors(P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Univariate analysis showed that bad behavior habits, liking to eat snacks and brushing teeth for less than 2 minutes were significantly different between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\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\u003eComparison of information between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003enon-caries group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;110)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ecaries group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;340)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (39.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e164 (48.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (60.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e176 (51.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.69\u0026thinsp;\u0026plusmn;\u0026thinsp;2.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.78\u0026thinsp;\u0026plusmn;\u0026thinsp;2.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.723\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUndesirable Behavioral Habits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (7.27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64 (18.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrefer sweets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.249\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (0.88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (64.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e198 (58.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (33.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e139 (40.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrefer carbonated beverages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (37.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96 (28.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (57.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e212 (62.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (5.45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (9.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLikes to eat snacks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76 (69.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (1.47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (22.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e99 (29.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (8.18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e236 (69.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEat before going to bed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.579\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (30.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95 (27.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61 (55.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e207 (60.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38 (11.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegular oral checkups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.168\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (19.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70 (20.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (54.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e152 (44.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (26.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e118 (34.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInitial brushing age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.429\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (20.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80 (23.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;3 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (57.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e204 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGreater than 3 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (21.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56 (16.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrushing frequency\u0026thinsp;\u0026ge;\u0026thinsp;2 times/day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (49.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e177 (52.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.588\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrushing time\u0026thinsp;\u0026lt;\u0026thinsp;2min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (32.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e262 (77.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrushing method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.473\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBy yourself\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (63.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e229 (67.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParental guidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (36.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e111 (32.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhether to use toothpaste\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e338 (99.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhether toothpaste contains fluoride\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72 (65.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e209 (61.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.453\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eToothpaste replacement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.832\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (22.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74 (21.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85 (77.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e266 (78.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRinse mouth after meals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (44.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e150 (44.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary caregiver is parent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99 (90.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e320 (94.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.138\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImportance of oral health education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.808\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot important\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2.73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (3.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmphasize\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107 (97.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e327 (96.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLectures on oral health care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (24.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86 (25.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.900\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParents' attitude towards dental disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.877\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot important\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50 (14.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmphasize\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95 (86.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e290 (85.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParental management after dental caries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.476\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot accept treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (3.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceive treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108 (98.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e327 (96.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level of primary caregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.856\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElementary school and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (14.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46 (13.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (4.55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (2.94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (9.09%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (9.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (71.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e252 (74.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\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\u003eLogistic regression analysis of risk factors for high prevalence dental disease\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eunivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003emultivariate analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.69 (0.44\u0026ndash;1.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.095\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.02 (0.92\u0026ndash;1.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.71\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUndesirable Behavioral Habits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.96 (1.37\u0026ndash;6.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.32 (1.07\u0026ndash;17.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrefer sweets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.86 (0.30-11.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.502\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.50 (0.40-15.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.324\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrefer carbonated beverages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.44 (0.91\u0026ndash;2.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.123\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.28 (0.88\u0026ndash;5.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.088\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLikes to eat snacks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.19 (22.02-164.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67.54 (22.25-205.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e398.58(129.61-1225.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e440.48(128.89-1505.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEat before going to bed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.21 (0.75\u0026ndash;1.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.432\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.91 (0.44\u0026ndash;1.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.788\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegular oral checkups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.76 (0.43\u0026ndash;1.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.347\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.22 (0.65\u0026ndash;2.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.538\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInitial brushing age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;3 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.93 (0.54\u0026ndash;1.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.796\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGreater than 3 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.67 (0.34\u0026ndash;1.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.24\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrushing frequency\u0026thinsp;\u0026ge;\u0026thinsp;2 times/day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.13 (0.73\u0026ndash;1.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.588\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrushing time\u0026thinsp;\u0026lt;\u0026thinsp;2min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.90 (4.31\u0026ndash;11.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.48 (3.06\u0026ndash;13.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrushing method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBy yourself\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParental guidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.85 (0.54\u0026ndash;1.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.473\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhether to use toothpaste\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.00 (0.00-Inf)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.983\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhether toothpaste contains fluoride\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.84 (0.54\u0026ndash;1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.454\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eToothpaste replacement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.06 (0.63\u0026ndash;1.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.832\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRinse mouth after meals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.98 (0.64\u0026ndash;1.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.937\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary caregiver is parent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.78 (0.82\u0026ndash;3.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.143\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImportance of oral health education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.71 (0.20\u0026ndash;2.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.591\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot important\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmphasize\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLectures on oral health care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.04 (0.63\u0026ndash;1.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.875\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParents' attitude towards dental disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.92 (0.49\u0026ndash;1.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.782\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot important\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmphasize\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParental management after dental caries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.47 (0.10\u0026ndash;2.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.32\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot accept treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceive treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level of primary caregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElementary school and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.70 (0.21\u0026ndash;2.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.558\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.11 (0.45\u0026ndash;2.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.818\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 \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.11 (0.60\u0026ndash;2.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.744\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/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eMultivariate logistic regression and LASSO regression analysis\u003c/h2\u003e \u003cp\u003eFurther multivariate logistic regression analysis was used, with statistically significant factors in univariate analysis as independent variables and dental caries as dependent variables. The results showed that bad behavior habits (OR\u0026thinsp;=\u0026thinsp;4.32, 95%CI: 1.07\u0026ndash;17.41, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.039), liking to eat snacks (OR\u0026thinsp;=\u0026thinsp;440.48, 95%CI: 128.89\u0026ndash;1505.36, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and brushing teeth for less than 2 minutes (OR\u0026thinsp;=\u0026thinsp;6.48, 95%CI: 3.06\u0026ndash;13.73, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were independent risk factors for dental caries in children (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). To reinforce the variable selection, LASSO regression analysis was conducted, yielding consistent predictors with those identified in the logistic regression analysis, thus enhancing the robustness of our predictive model. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEstablishment and application of nomogram model\u003c/h3\u003e\n\u003cp\u003eBased on these independent predictive factors identified through logistic and LASSO regression analyses, a nomogram risk prediction model for dental caries was established. The model was shown as a nomogram and contained three significant independent risk factors: bad behavior habits, liking to eat snacks, and teeth brushing time\u0026thinsp;\u0026lt;\u0026thinsp;2 min. Each variable corresponds to a line segment, and the scale indicates the value. Total scores, obtained through summation of all variable-specific points, are transformed into caries probability estimates (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e). To overcome the clinical implementation constraints of static nomograms, we designed and deployed an interactive web-based prediction platform that dynamically calculates risk probabilities (Figure. 3) (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://namoamituofo.shinyapps.io/DynNomapp/\u003c/span\u003e\u003cspan address=\"https://namoamituofo.shinyapps.io/DynNomapp/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). This tool simplifies the computational process and facilitates clinical decision making.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eAssessment and validation of the nomogram model\u003c/h3\u003e\n\u003cp\u003eIn our study, we applied bootstrapping with 1000 replicates to validate the models we constructed. The predictive power of the nomogram was evaluated by drawing the receiver operating characteristic (ROC) curve. The AUC, which generated based on the nomogram in predicting dental caries, was 0.939(95%CI: 0.911\u0026ndash;0.967), demonstrating excellent predictive accuracy. At the optimal probability threshold of 0.931, the model demonstrated balanced performance with 0.845 specificity and 0.924 sensitivity (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Simultaneously, the model's accuracy was verified using the Bootstrap method with 1,000 replications, yielding an AUC of 0.939 (95%CI: 0.910\u0026ndash;0.964). The calibration curve demonstrated excellent alignment between predicted probabilities and actual clinical outcomes (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Additionally, the Hosmer-Lemeshow goodness-of-fit test was not statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.922), confirming the model's stability.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eClinical application of the nomogram model\u003c/h2\u003e \u003cp\u003eDCA was implemented to assess whether the caries risk model provided meaningful clinical advantage. The analysis showed that the model provided significant net benefit when the risk threshold was set between 0.02 and 0.98, compared to \"no intervention\" or \"all intervention\" strategies (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). Through CIC assessment, we evaluated the number of high-risk children and true high-risk children at multiple thresholds, demonstrating robust predictive accuracy with strong clinical utility (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study retrospectively analyzed the risk factors associated with dental caries in Chinese children, using clinical data from 450 participants. We identified \"poor behavioral habits\", \"frequent snacking\" and \"brushing for less than 2 minutes\" as independent predictors of dental caries. Based on these predictors, we developed a nomogram to predict dental caries risk and internally validated it, confirming its robust predictive capability.\u003c/p\u003e \u003cp\u003eModern dietary trends have led to an increase in refined foods and a decrease in fibrous content. Sweets and snacks now dominate children's diets[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], with consumption increasing as children grow older. Our study found that children with dental caries consumed more snacks, consistent with other research findings[\u003cspan additionalcitationids=\"CR19 CR20\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Snacks, which are high in sugar, promote the growth of cariogenic microorganisms, particularly \u003cem\u003eStreptococcus mutans\u003c/em\u003e. These bacteria form a sticky plaque matrix that adheres to teeth and metabolizes carbohydrates, leading to demineralization and caries development[\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Increased snacking frequency significantly raises caries risk, with our study showing a 440-fold increase in caries incidence among frequent snackers. This is likely due to prolonged contact between snack sugars and oral bacteria, which metabolize these sugars into acids that erode tooth enamel. Primary teeth, being less resistant to acid erosion, are more susceptible to caries[\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, our study did not find a significant difference between groups in terms of overall sugar intake, possibly because parents categorized only obvious sweets (e.g., sugary drinks, cakes) and overlooked the sugar content in snacks[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe development of dental caries in children is closely related to behavioral habits[\u003cspan additionalcitationids=\"CR30 CR31\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Poor habits include using a pacifier before bed, finger-sucking, and night-time milk consumption. Our study found a higher prevalence of these habits in the caries group, identifying them as significant risk factors. During sleep, saliva production decreases, allowing bacteria to proliferate and increasing caries risk. Night-time bottle feeding and milk consumption further elevate caries incidence[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].Logistic regression analysis confirmed that poor behavioral habits increase caries risk by 4.32 times, consistent with findings from other researchers[\u003cspan additionalcitationids=\"CR34 CR35\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLow mineralization, thin enamel, and weak acid resistance of primary teeth are intrinsic factors contributing to caries. Extrinsic factors include a preference for sweets, improper brushing techniques, and inadequate oral hygiene. The combined effect of these factors promotes bacterial growth and acid production, leading to tooth tissue destruction and caries. Good oral hygiene practices, such as effective brushing and the use of fluoride toothpaste, are widely recognized as effective preventive measures[\u003cspan additionalcitationids=\"CR38 CR39\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].Our study found that brushing for less than 2 minutes increased caries risk by 6.48 times, consistent with findings from other researchers[\u003cspan additionalcitationids=\"CR42\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTherefore, it is essential for healthcare providers and parents to enhance oral health education for children, improving their oral health awareness and behaviors.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study analyzed the clinical data of children with dental caries and identified snacking habits, poor behavioral habits, and brushing for less than 2 minutes as independent predictors of dental caries in children. We developed and validated prediction models, including a simple bedside prediction model and an online dynamic prediction model, to identify children at high risk of dental caries. These models enable dentists to formulate personalized management strategies for children's oral health and provide timely and effective interventions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe research protocol received ethical clearance from the Institutional Review Board of General Hospital of Northern Theater Command (Approval No. Y[2024]175) in accordance with Declaration of Helsinki principles. Written informed consent was obtained from all guardians of the children who participated in this study.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Liaoning province science and technology plan joint plan (applied basic research project) , grant number 2023JH2/101700115.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eRui Chen: Conceptualization, Methodology, Data Curation, Writing - Original Draft, Writing - Review \u0026amp; Editing. Yu Zhao and Ping Hao: Software, Validation, Investigation, Resources, Visualization. Yuqing Bian: Formal analysis, Investigation, Resources, Visualization. Ying Min: Conceptualization, Data Curation, Writing - Review \u0026amp; Editing, Supervision, Project administration, Funding acquisition.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe author sincerely thanks all the colleagues in the Department of Stomatology, General Hospital of Northern Theater Command, and the dentists who participated in this study. Thanks also to the statisticians who helped with this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRadina ME, Stolldorf DP, Sinclair VG, et al. Development and preliminary validation of a health-related family quality of life instrument. Health Care Women Int. 2024;45(6):657-677. \u003c/li\u003e\n\u003cli\u003eSischo L, Broder HL. Oral health-related quality of life: what, why, how, and future implications. 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Narrative Review on Role of Streptococcus mutans in Dental Caries and Homoeopathic Intervention. Sustainability, Agri, Food and Environmental Research. (2023): n. pag.\u003c/li\u003e\n\u003cli\u003eZhang L, Liu Y, Chu R, et al. Current Status and Family Factors Influencing Caries in the Deciduous Teeth of Children 3-6 Years of Age in Families Residing in Rural Heishanzui Township. Oral Health Prev Dent. 2024;22:145-150. Published 2024 Apr 23. \u003c/li\u003e\n\u003cli\u003eZeng L, Zeng Y, Zhou Y, et al. Diet and lifestyle habits associated with caries in deciduous teeth among 3- to 5-year-old preschool children in Jiangxi province, China. BMC Oral Health. 2018;18(1):224. Published 2018 Dec 20. \u003c/li\u003e\n\u003cli\u003eYousaf M, Aslam T, Saeed S, Sarfraz A, Sarfraz Z, Cherrez-Ojeda I. Individual, Family, and Socioeconomic Contributors to Dental Caries in Children from Low- and Middle-Income Countries. Int J Environ Res Public Health. 2022;19(12):7114. 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Int Dent J. 2019;69(3):214-222. \u003c/li\u003e\n\u003cli\u003eGuan M, Nada OA, Wu JJ, et al. Dental Caries and Associated Factors in 3-5-Year-Old Children in Guizhou Province, China: An Epidemiological Survey (2015-2016). Front Public Health. 2021;9:747371. Published 2021 Sep 30. \u003c/li\u003e\n\u003cli\u003eHong, M. Risk Factors Affecting Dental Caries in Children. The Korea Academia-Industrial cooperation Society, 2020;21:320-326. https://doi.org/10.5762/KAIS.2020.21.5.320.\u003c/li\u003e\n\u003cli\u003eAlhabdan YA, Albeshr AG, Yenugadhati N, Jradi H. Prevalence of dental caries and associated factors among primary school children: a population-based cross-sectional study in Riyadh, Saudi Arabia. Environ Health Prev Med. 2018;23(1):60. Published 2018 Nov 30. \u003c/li\u003e\n\u003cli\u003eCirib\u0026egrave; M, Galeotti A, Dolci C, et al. Cross Sectional Study on the Association between Dental Caries and Life Habits in School Age Italian Children. Healthcare (Basel). 2022;10(4):607. Published 2022 Mar 24. \u003c/li\u003e\n\u003cli\u003eElamin A, Garemo M, Gardner A. Dental caries and their association with socioeconomic characteristics, oral hygiene practices and eating habits among preschool children in Abu Dhabi, United Arab Emirates - the NOPLAS project. BMC Oral Health. 2018;18(1):104. Published 2018 Jun 8. \u003c/li\u003e\n\u003cli\u003eQuadri MFA, Shubayr MA, Hattan AH, Wafi SA, Jafer AH. Oral Hygiene Practices among Saudi Arabian Children and Its Relation to Their Dental Caries Status. Int J Dent. 2018;2018:3234970. Published 2018 Apr 16. \u003c/li\u003e\n\u003cli\u003eKramer A, Splieth C. Health promotion through structured oral hygiene and good tooth alignment. GMS Hyg Infect Control. 2022;17:Doc08. Published 2022 May 10. \u003c/li\u003e\n\u003cli\u003eWorthington HV, MacDonald L, Poklepovic Pericic T, et al. Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries. Cochrane Database Syst Rev. 2019;4(4):CD012018. Published 2019 Apr 10. \u003c/li\u003e\n\u003cli\u003eMazurkiewicz D, Pustułka M, Ambrozik-Haba J, Bienkiewicz M. Dietary Habits and Oral Hygiene as Determinants of the Incidence and Intensity of Dental Caries-A Pilot Study. Nutrients. 2023;15(22):4833. Published 2023 Nov 19. \u003c/li\u003e\n\u003cli\u003eEdman K, Holmlund A, Norderyd O. \u0026apos;Caries disease among an elderly population-A 10-year longitudinal study\u0026apos;. Int J Dent Hyg. 2021;19(2):166-175. \u003c/li\u003e\n\u003cli\u003eHolmes RD. Tooth brushing frequency and risk of new carious lesions. Evid Based Dent. 2016;17(4):98-99. \u003c/li\u003e\n\u003cli\u003eFern\u0026aacute;ndez CE, Silva-Acevedo CA, Padilla-Orellana F, Zero D, Carvalho TS, Lussi A. Should We Wait to Brush Our Teeth? A Scoping Review Regarding Dental Caries and Erosive Tooth Wear. Caries Res. 2024;58(4):454-468.\u003c/li\u003e\n\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":"dentes cariosus, nomogram, prediction model, risk factors","lastPublishedDoi":"10.21203/rs.3.rs-6300876/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6300876/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives: \u003c/strong\u003eThis study is to examine the factors associated with dentes cariosus in Chinese children. Furthermore, we construct a risk prediction nomogram and assess its predictive performance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A total of 450 Chinese children who visited the outpatient Department of Stomatology, General Hospital of Northern Theater Command were included in this study. The patients were divided into dental caries group (n = 340) and non-caries group (n = 110) based on the presence of dental caries at presentation. Independent predictors of dental caries were determined using univariate and multivariate logistic regression analyses combined with LASSO regression. The prediction model was established by a nomogram model based on three factors and the original dataset was also used for validation. The discriminative power was measured by the receiver operating characteristic (ROC) curve’s area under the curve (AUC), whereas calibration was assessed using calibration plots and the Hosmer-Lemeshow test. Clinical applicability was examined through decision curve analysis (DCA) and clinical impact curves (CIC).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The following three factors contribute to the occurrence of dental caries: liking to eat snacks, bad behavior habits and brushing teeth for less than 2 minutes. The predicted probabilities of dental caries in outpatient clinics corresponded well to the actual incidence with index of the bootstrap-corrected Harrell's concordance was 0.939 [95% CI, 0.910-0.964] and the \u003cem\u003eP\u003c/em\u003e value of the Hosmer-Lemeshow test was 0.922. Decision curve analysis demonstrated that our predictive model offered greater net clinical benefit across threshold probabilities of 1% to 70% compared to either no intervention or universal intervention strategies. CIC displayed good predictive ability and clinical application value for the model.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Prediction nomograms, which including a simple clinical nomogram and online dynamic nomogram, can be used to identify children susceptible to dental caries. Thus, it is better for dentists to provide individualized management and timely and effective intervention measures for children at high risk of caries.\u003c/p\u003e","manuscriptTitle":"Development and validation of a dynamic nomogram for dentes cariosus in Chinese children","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-09 11:24:45","doi":"10.21203/rs.3.rs-6300876/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-05-06T05:37:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-29T16:43:08+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-11T06:45:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-09T11:48:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2025-04-09T11:47:40+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":"6b476c96-e2f5-4e2d-acd3-aba47a432199","owner":[],"postedDate":"May 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-05-09T11:24:45+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-09 11:24:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6300876","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6300876","identity":"rs-6300876","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}