Exploring the Link Between Screen Time and Severity of Early Childhood Caries in Primary Molars: A Cross-Sectional Study

Exploring the Link Between Screen Time and Severity of Early Childhood Caries in Primary Molars: A Cross-Sectional Study | 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 Exploring the Link Between Screen Time and Severity of Early Childhood Caries in Primary Molars: A Cross-Sectional Study Dhanraj Kalaivanan, Meenakshi Lakshmanan, Meghana Das, Sumaiyya Saleem, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5940590/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Jul, 2025 Read the published version in BMC Oral Health → Version 1 posted 9 You are reading this latest preprint version Abstract Background Early Childhood Caries (ECC) is a significant yet often overlooked paediatric health concern, particularly in India. Previous studies have linked excessive screen exposure, known as Problematic Screen Exposure (PSE), with caries in children. However, the association between PSE and the severity of ECC in terms of cavitated and non-cavitated lesions remains unexplored. This study investigates the prevalence of PSE among ECC-affected preschool children and examines its correlation with ECC severity. Methods A cross-sectional observational study was conducted among 100 children aged 36–71 months diagnosed with ECC. Data on screen exposure were collected using the "Seven-in-Seven Screen Exposure Questionnaire," validated per American Academy of Paediatrics guidelines. Clinical examinations classified caries severity using the International Caries Detection and Assessment System (ICDAS-II). Statistical analyses, including the Mann-Whitney U test and Spearman’s correlation, assessed relationships between PSE, sociodemographic factors, and ECC severity. Results Fifty-seven percent of participants exhibited high PSE scores. A majority of children (75%) had cavitated lesions. High PSE was associated with higher mean ICDAS scores for molars (p=0.025), although the correlation between PSE and ECC severity was very weak and not statistically significant (r=0.042, p=0.680). Sociodemographic factors, including family size and parental education, were also analysed, with families having three or more children showing elevated ICDAS scores. Oral hygiene practices and dietary habits partially influenced caries severity, with children using non-fluoridated toothpaste exhibiting higher ICDAS scores. Conclusions High PSE may contribute to the progression of ECC, as evidenced by a higher prevalence of cavitated lesions among children with elevated PSE scores. Preventive strategies focusing on reducing PSE and promoting healthy oral hygiene practices may mitigate ECC severity. . Further longitudinal studies are necessary to establish causality and inform targeted prevention strategies. Early Childhood Caries Problematic Screen Exposure ICDAS Preschool Children Oral Health Screen Time Paediatric Dentistry Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction A child’s initial interactions with screens are pivotal as the patterns of exposure and utilisation are conducive to habit formation and are known to influence behaviours into adulthood [ 1 ]. With the ubiquity of digital media and screens in everyday life, toddlers and preschoolers are increasingly exposed to various media gadgets (i.e., television, computers, tablets and phones) from an early age [ 2 ]. Excessive screen time may adversely impact paediatric health, influencing cariogenic bacterial proliferation, host defence development, nutrition-related behaviours and oral habits [ 2 , 3 ]. Excessive screen time correlates with higher intake of sugary foods and increased snacking, both of which lead to dental caries and periodontal disease [ 4 ]. Early childhood caries (ECC) is a specific manifestation of dental caries that predominantly affects infants, toddlers and preschool-age children. ECC is one of the most frequently overlooked health conditions among Indian children [ 5 ]. Numerous investigations have systematically assessed and classified the risk determinants of ECC. These encompass sociodemographic variables, dietary influences, oral hygiene practices and factors pertaining to oral bacterial ecosystems and modes of feeding, whether breastfeeding or bottle feeding [ 6 , 7 ]. A study has reported that inadequate sleep and increased media use may also be associated with an increased prevalence of caries in children [ 8 ]. Research indicates prolonged digital device usage in children was correlated with distracted eating, increased intake of unhealthy foods, and diminished parental oversight of dental hygiene [ 9 , 10 ]. Moreover, children overexposed to digital devices exhibit poorer dietary habits, characterized by increased energy intake, frequent fast food and sweets consumption, and reduced fibre, vegetable, fruit, and fish intake [ 11 , 12 ]. Hence, both parental and child lifestyle choices considerably influence caries development during childhood. Nonetheless, the extent to which various risk determinants are correlated with ECC is ambiguous. Hence, it is critical to analyse such lifestyle-related risk factors that may also contribute to ECC. Studies have demonstrated an association between media use, specifically television and gaming, and dental caries prevalence in school-aged children and adolescents [ 8 , 13 ]. Also, children with low sedentary screen times exhibited greater microbial diversity in their salivary microbiota compared to those with high sedentary screen times favouring caries activity [ 14 ]. Also, higher screen time have been linked to changes in salivary extracellular miRNA molecules indicating inflammatory activity [ 15 ]. Increased screen time have been shown to reduce sleep, which in turn alters the circadian rhythm resulting in disruption of oral microbiome and salivary production favouring more oral health problems [ 16 ]. In addition, Yilmaz et al. and Mustuloğlu et al. have reported a link between daily screen exposure and oral health in preschool children [ 17 , 18 ]. Most previous studies have linked the presence and absence of caries to Problematic Screen Exposure (PSE). However, to date, no research has investigated the association between PSE and the severity of ECC in terms of cavitated and non-cavitated lesions. Hence, our proposed null hypothesis stated that there was no association between screen time and the severity of ECC. This study aimed to determine the prevalence of PSE in ECC-affected children and assess the presence of a link between PSE and the severity of ECC. Methodology Study approval This study employed an observational cross-sectional analytical design and adhered to the STROBE guidelines for observational studies [ 19 ]. The Institutional Review and Ethics Board (Protocol Reference: 366-IRB-IBSEC/SIST) (Committee: EC/NEW/INST/2020/1397) granted ethical approval for the study conducted by the Department of Paediatric and Preventive Dentistry. Study population A purposive sampling method was utilised to select 100 healthy children aged 36–71 months diagnosed with ECC limited to posterior teeth. Participants were recruited from the institution’s outpatient department and an affiliated private clinic from June 2024 to December 2024. Children with systemic illnesses or special needs, involvement of decay in anterior teeth or lack of parental consent were excluded. Parents were thoroughly briefed about the study objectives, and informed consent and child assent were obtained (documented in the Appendix). Data collection Screen time exposure was evaluated using the ‘Seven-in-Seven Screen Exposure Questionnaire’, a validated tool aligned with the AAP guidelines [ 20 ]. In order to ascertain the validity and applicability of the tool within the Indian context, we adhered to a systematic methodology for linguistic and cultural adaptation. Initially, the instrument was translated into the regional language utilizing a forward- and backward-translation framework executed by bilingual professionals. Subsequently, a panel of subject matter experts evaluated the translations to ensure conceptual equivalence. A pilot study was conducted with a heterogeneous sample of participants to evaluate clarity, comprehension, and cultural relevance. Essential modifications were implemented based on participant feedback to enhance contextual appropriateness while preserving the integrity of the original instrument. Ultimately, the adapted version underwent validation through psychometric analysis, encompassing reliability testing and assessment of construct validity. This questionnaire comprises seven items categorised into screen exposure rules, exposure during daily routines and conditions of exposure. The tool captures metrics such as daily screen time, co-viewing with parents, screen usage during meals and bedtime, initiation age and screen content. The average daily screen time was calculated as follows: [(TV weekday + ‘Other Screens’ weekday) × 5 + (TV weekend + ‘Other Screens’ weekend) × 2]/7 and scored as the overall average screen time; 0: 2 hours. The overall PSE score (0–13) was computed by aggregating the scores from the three aforementioned categories. The cumulative scores were categorised as follows: low (< 7) and high (≥ 7). Data were collected before the clinical examination, and closed -ended questionnaires were completed in person and online by the parents. Additional demographic data, including age, occupation or parental income, dietary habits and oral hygiene practices, were obtained using a pre-validated tool [ 21 , 22 ]. A double-entry approach was utilized, to mitigate data entry inaccuracies allowing for the comparison of two independent entries to identify inconsistencies. Clinical examination The assessments were conducted to evaluate the baseline status at the child’s first visit without any prior influence or guidance to ensure the objectivity and validity of the findings. The parents were informed about ECC after the examination. No prophylactic recommendations were provided to participants prior to the assessment. All assessments were conducted to capture the baseline health status without prior intervention. Recommendations, if any, were made post-assessment in line with clinical indications. Intraoral examinations of included children were conducted under illuminated dental chairs performed by two junior residents (ML and MD), who were blinded to PSE scores to reduce the risk of bias during clinical examination. These were supervised and confirmed by senior paediatric dentists with > 5 years of experience (DK and SS). The two junior residents (ML and MD) were trained in the ICDAS-II assessment tool [ 23 ] and calibrated it using a pilot sample of 10 children not included in the study before the examination of subjects. Intra- and inter-examiner consistency reliability was established using Cohen’s Kappa statistic (κ = 0.8). Dental caries was diagnosed using WHO standards, with lesions categorised using ICDAS-II codes into cavitated (ICDAS > 3) and non-cavitated (ICDAS < 3) using a dental mirror and a ball-ended explorer (WHO 973/80-Martin). Each tooth was dried with a compressed air syringe, and a code was assigned to reflect the highest surface score. The mean ICDAS-II score for four posterior teeth per child was used for statistical analysis. A STROBE flow chart for the methodology is depicted in Fig. 1. Sample size estimation and statistical analysis The required sample size was calculated using Open Epi (Version 3.0) with the following formula: n = [DEFF*Np(1-p)]/ [d2/Z21-α/2*(N-1) + p*(1-p)] considering a 95% confidence interval and 80% power, based on ECC prevalence in India (49%) [ 5 ] and screen exposure prevalence in schoolchildren (52%) [ 24 ]. The estimated sample size was 80, and 100 participants were included in the study. Statistical analysis Data were analysed using SPSS (Version 25.0). All collected data were coded and entered into Microsoft Excel sheets (Microsoft, Windows 11). The Shapiro–Wilk test evaluated data normality. Descriptive statistics summarised participant characteristics and questionnaire responses. Continuous variables, such as age and caries status, were presented as means and standard deviations, whereas categorical data were represented as frequencies and percentages. Statistical comparisons were performed using the Kruskal–Wallis, Mann–Whitney U and chi-square tests, with correlation analysis conducted using Spearman’s method. Statistical significance was determined at a p-value of ≤ 0.05. Results Boys comprised the major proportion of the study sample of 100 children, and most children were aged > 5 years. Based on the ICDAS-II criteria, 75% of the participants had cavitated lesions. Most of the children belonged to nuclear families with well-educated parents. Furthermore, most children behaved well and were rated positive in the first dental visit. A significant portion of the participants (57%) exhibited a high PSE score, indicating that most children used more than one electronic gadget daily, with 71% of the parents permitting their children to access these devices. (Table 1 ) (Fig. 2 and Fig. 3) Table 1 Distribution of frequency and percentage of Demographic characteristics of study participants Variable Categories Frequency Percentage Age (Mean = 4.53 ± 0.993) 3 years 19 19.0 4 years 25 25.0 5 years 39 39.0 6 years 17 17.0 Gender Female 40 40.0 Male 60 60.0 Interpretation of ICDAS (Mean = 3.981 ± 1.401) Cavitated 75 75.0 Non-Cavitated 25 25.0 Frankel’s Behaviour 2 41 41.0 3 57 57.0 4 2 2.0 PSE Score High 57 57.0 Low 43 43.0 Total 100 100.0 Sweet Score Excellent 23 23.0 Good 20 20.0 Watch out zone 57 57.0 Education of Father Graduate 72 72.0 High school certificate 9 9.0 Intermediate or diploma 6 6.0 Middle school certificate 3 3.0 Professors or honors 10 10.0 Education of mother Graduate 64 64.0 High school certificate 15 15.0 Intermediate or diploma 8 8.0 Middle school certificate 4 4.0 Professors or honors 9 9.0 Family Income > 47657 43 43.0 11914–17870 7 7.0 17871–23828 11 11.0 23829–47656 36 36.0 7148–11913 3 3.0 Mother’s Age 25–35 82 82.0 less than 25 6 6.0 more than 25 1 1.0 more than 35 11 11.0 Working status of mother not working 58 58.0 working 42 42.0 No of children 3 or more 9 9.0 less than 2 91 91.0 Type of family joint family 20 20.0 nuclear family 78 78.0 single parent 2 2.0 No of gadgets 0 10 10.0 2 47 47.0 3 43 43.0 Access for using gadgets no 29 29.0 yes 71 71.0 The screen time spent by children on television was mostly one hour or less (50%) and less than an hour on other screen devices (92%) on weekdays. However, the time exceeded upto 2–3 hours on weekends in watching television as reported by parents. The overall screen time was reported to be more than 2 hours (79%) with the initiation of screen exposure primarily occurring prior to the age of three, especially during meals and bedtime routines. Cartoons was the most common genre watched (64%) followed by educational content (11%) and rhymes and movies. Most of the parents agreed that they tend to share their screen experiences sometimes (44%) and they set screen time limits (77%) adhered by the children (Table 2 ). Table 2 Distribution of frequency and percentage of question responses related to screen exposure and oral hygiene and dietary habits Question Categories Frequency Percentage Time spent by child in a weekday looking at TV 1-2hr 35 35.0 Less than or 1 hr 50 50.0 More than 2 h 15 15.0 Time spent by child in a weekday looking at other screen devices Less than 1 hour 92 92.0 1hour or more 5 5.0 2hours or more 1 1.0 3hours or more 2 2.0 Time spent by child in a weekend looking at TV 4hrs 12 12.0 2–3 hrs 40 40.0 3-4hrs 21 21.0 Nil 1 1.0 Time spent by child in a weekend looking at other screen devices Less than an hour 91 91.0 1 hour or more 4 4.0 2 hours or more 3 3.0 3hours or more 1 1.0 More than 4 hours 1 1.0 Average over all daily screen time 2 hours 79 79.0 Age at which child started using screen devices 3yrs 34 34.0 Use of screen device during meals No, he/she does not 23 23.0 Yes, he/she does 77 77.0 Use of screen device at least one hour before bedtime No, he/she does not 32 32.0 Yes, he/she does 68 68.0 Setting screen limits I do not set screen limits 17 17.0 I set screen limits and my child obeys these limits 77 77.0 I set screen limits but my child does not obey these limits 6 6.0 At what age did your child start tooth brushing? 18 months 83 83.0 no response 2 2.0 Which tooth paste does your child use? Any other 47 47.0 Fluoridated paste (eg.Colgate Kids,Pediflor)) 52 52 No response 1 1.0 How often does your child usually brush his/her teeth in a day? after every meal 8 8.0 occasionally 1 1.0 once daily 63 63.0 twice daily 28 28.0 Do you floss your child’s teeth? after every meal 5 5.0 never 54 54.0 no response 12 12.0 Yes, occasionally 29 29.0 What is the frequency of snack consumption of your child per day? > 5 times per day 7 7.0 1–2 times per day 59 59.0 3–4 times per day 27 27.0 never or seldom 1 1.0 occasionally 6 6.0 Does your child rinse or brush teeth after eating snacks? always 12 12.0 never or seldom 24 24.0 no response 1 1.0 sometimes 63 63.0 Does your child sleep without brushing after eating snacks? always 27 27.0 never or seldom 21 21.0 no response 4 4.0 sometimes 48 48.0 Most parents reported that they initiated brushing their child’s teeth after 18 months, with the frequency of once daily with fluoridated toothpaste. Data revealed that most children brushed independently, receiving infrequent assistance, and did not utilize floss. However, several parents acknowledged that their children had snack consumption of twice daily and reported that most of them occasionally went to bed after snacking without proper oral hygiene practices (Table 2 ). Children presented with higher PES scores had higher mean ICDAS scores than those with lower PES scores, and the difference between the groups was statistically significant (p < 0.05, p = 0.025). Thus, children exposed more to devices had more cavitated ECC in molars than those with a lower exposure. However, the age at which screen viewing was initiated and the number of gadgets in the house did not significantly affect the mean ICDAS scores of molars. Children not obeying screen limits set by parents exhibited higher ICDAS scores than those in other categories, but the difference was not statistically significant (Table 3 ) (Fig. 4). Table 3 Comparison of the mean ICDAS scores of molars with children’s sociodemographic factors, oral hygiene practices, dietary habits, and screen exposure characteristics. Variables Categories Mean ICDAS score of primary molars SD p-value PSE ┼ High 4.257 1.2465 0.025* Low 3.615 1.5220 Frankel’s Behaviour rating ┼┼ 2 4.155 1.4483 0.397 3 3.829 1.3769 4 4.750 .7778 Sweet score ┼┼ Excellent 3.465 1.4705 0.117 Good 4.375 1.3002 Watch out zone 4.051 1.3708 Education of father ┼┼ Graduate 3.979 1.3820 0.114 High school certificate 4.833 1.0332 Intermediate or diploma 3.917 2.0104 Middle school certificate 4.533 1.1015 Professors or honors 3.100 1.1731 Education of mother ┼┼ Graduate 4.037 1.4272 0.062 High school certificate 4.020 1.4163 Intermediate or diploma 4.012 1.1981 Middle school certificate 5.225 .9946 Professors or honors 2.939 1.0487 Family income ┼┼ 11914–17870 4.743 .8404 0.255 17871–23828 3.518 1.7532 23829–47656 4.264 1.3559 7148–11913 4.133 1.1504 > 47657 3.728 1.3829 Mother’s age ┼┼ 25–35 3.968 1.3977 0.531 less than 25 4.400 1.0526 more than 25 2.000 0.0012 more than 35 4.027 1.6007 Type of family ┼┼ joint family 3.882 1.3118 0.669 nuclear family 3.985 1.4365 single parent 4.800 1.1314 No. of gadgets ┼┼ 1 3.515 1.4985 0.164 2 4.243 1.4084 3 3.803 1.3471 Working status of mother ┼ Not working 4.030 1.4583 0.622 Working 3.913 1.3331 No. of children ┼ 3 or more 4.933 .7399 0.042* less than 2 3.887 1.4184 Age of initiation of screen device usage ┼ 3 years 4.176 1.3144 Use of screen device during meals ┼ no, he/she does not 3.961 1.4766 0.977 yes, he/she does 3.987 1.3881 Setting screen limits ┼┼ I do not set screen limits 3.888 1.4730 0.577 I set screen limits and my child obeys these limits 3.960 1.3982 I set screen limits but my child does not obey these limits 4.517 1.3571 Age of initiation of tooth brushing ┼┼ 18 months 3.884 1.3984 No response 4.350 .3536 Tooth paste type being used ┼┼ Non -fluoridated 4.359 1.3196 0.014* Cheerio gel 4.133 1.1911 Colgate kids 3.757 1.4644 Kidodent 3.828 1.6319 No response 5.800 0.0032 Pediflur 2.986 1.0135 Frequency of brushing by child everyday ┼┼ after every meal 2.931 0.8276 0.129 occasionally 4.400 0.0089 once daily 4.048 1.4438 twice daily 4.114 1.3689 Frequency of snack consumption ┼┼ 1–2 times per day 4.034 1.3759 0.341 3–4 times per day 3.822 1.5187 > 5 times per day 4.771 1.0012 never or seldom 2.000 0.0002 occasionally 3.583 1.3075 * Statistically significant ┼┼ Kruskal-Wallis test ┼ MannWhitney U-test Other risk factors, such as the parent’s education, occupation, family income and working status of the mother, did not significantly affect the mean ICDAS score of molars. Nevertheless, the number of siblings in the family affected the mean ICDAS score of the children under consideration. Families with ≥ 3 children caused the ICDAS score to elevate compared to those with ≤ 2 children. Considering oral hygiene practices, a statistically significant difference was perceived between ICDAS scores based on the type of toothpaste used (p < 0.05) (Table 3 ). The mean ICDAS score of molars displayed a weak positive correlation with the PSE score (r = 0.042). However, the correlation was not statistically significant (p = 0.680) (Table 4 ) indicating the relationship between the variables is considered to be effectively non-existent. As screen time exposure may influence child behaviour, analysis of Frankel’s behaviour rating with screen time showed that children with high PSE scores had more positive ratings of behaviour at the first visit, not being statistically significant (p = 0.330) (Table 5 ). Table 4 Comparison of Frankel’s behaviour rating of children with PSE score Frankel’s behaviour PSE score P value High Low 0.330 * Negative 25 16 Positive 30 27 Definitely positive 2 0 * Chi-square test Table 5 Association between the mean ICDAS scores and mean PSE scores using Spearman's correlation. Spearman's Correlation ICDAS PSE ICDAS Correlation Coefficient 1.000 .042 p-value .680 N 100 100 PSE Correlation Coefficient .042 1.000 p-value .680 . N 100 100 Discussion ECC adversely affects children’s lives, causing pain when consuming hot or cold drinks, difficulties with chewing and biting, reduced appetite, weight loss, sleep disturbances, behavioural changes such as irritability and low self-esteem and diminished academic performance [ 25 ]. Problematic media use in children refers to excessive engagement that disrupts daily functioning and may lead to addictive behaviours that extend beyond the mere amount of time spent on screens (e.g., exhibiting strong resistance to limits on media use) [ 26 ]. The association between parafunctional habits and PSE and its link to dental carries has been investigated [ 18 ]. Children with high PSE often exhibit problematic eating behaviours, which may indirectly contribute to the progression of dental caries [ 27 ]. Consequently, high PSE was hypothesised to be associated with a greater prevalence of posterior ECC lesions. To the best of our knowledge, this is the first study to examine the relationship between the severity of ECC (in molars) and PSE in Indian preschool children. This study employed the children of age 36–71 months with only posterior lesions to avoid the confounding effect of feeding practices on the severity of ECC. This study employed the ‘Seven-in-Seven Screen Exposure Questionnaire’, a tool designed to evaluate PSE among Turkish preschool children based on recommendations from the AAP [ 20 ]. This questionnaire was translated into a local vernacular language, back-translated and validated for use in the Indian context to avoid bias due to linguistic and cultural domains. A previous study has established that children with high PSE tend to have poorer oral hygiene, a higher prevalence of poor oral health and a greater mean number of decayed teeth [ 18 ]. However, most investigations have not explored the prevalence of cavitated and non-cavitated lesions in preschool children with high PSE. Hence, this study attempted to examine the severity of ECC in posterior teeth using the ICDAS classification (cavitated and non-cavitated) and its relationship with PSE. Of the 100 children examined in this study, 57 exhibited high PSE scores, with the majority hailing from families with graduate parents and non-working mothers (58%) and having a good socioeconomic status. These findings are aligned with a previous study that linked high PSE scores to factors such as non-working mothers and families with ≥ 2 children [ 20 ]. Another noteworthy observation is that most children with high PSE (57%) had higher sugar consumption, as reflected by their sweet scores. Moreover, 60% of the parents stated that their children started screen viewing before the age of 3 years, consistent with an earlier finding [ 28 ]. In this research, children with high PSE had more cavitated than non-cavitated lesions in posterior teeth. These results emphasise that PSE may be a risk factor for the progression of ECC. One possible explanation for the more positive behaviour ratings observed in high PSE children could be the influence of audiovisual distraction, which may have temporarily enhanced engagement or compliance. However, this interpretation remains speculative and should be explored further in future research. Increased screen exposure has been linked to emotional overeating, heightened thirst, slow eating, satiety responsiveness, food fussiness and emotional undereating [ 24 ]. Problematic eating habits may exacerbate caries progression as children with such behaviours often retain food in their mouths for extended periods, which promotes ECC [ 27 ]. In addition, Elina et al. [ 14 ] observed that children with high sedentary screen time displayed lower microbiota diversity and altered composition, potentially leading to ECC progression as seen in our children. Although this study did not establish a significant positive correlation between PSE and ECC severity (in posterior teeth) using the ICDAS classification, its value lies in being the first to investigate this association. While our findings suggest a potential association between PSE and ECC progression, the cross-sectional design precludes causal conclusions, and longitudinal studies are needed to further explore this relationship. Consequently, preventive strategies for ECC in preschoolers should involve family-based interventions to reduce PSE and promote appropriate screen time to enhance oral health outcomes in children. Limitations Although it is the first study to explore PSE and ECC severity, our study had its own limitations. A temporal relationship between PSE and ECC severity could not be established because of its cross-sectional design. Although data on sugar consumption and oral hygiene habits were collected, information on sugar consumption during media usage was not obtained. This omission might have contributed to the insignificant relationship between the sweet score and PES. There could be a possibility of lack of clinical calibration over time among could have affected consistency in caries assessment among the examiners, which needs to be acknowledged in such studies. In addition, data were gathered from parents at a single time point, which may have introduced reporting bias and resulted in an insignificant correlation between ICDAS molar and sweet scores. Also, the possibility of social desirability bias could not be excluded in such self-reported assessment of screen and dietary behaviours. As ECC is a multifactorial disease, the lack of adjustment for influencing factors such as socioeconomic status, oral hygiene practices, and dietary patterns may limit the strength of the associations observed. Future studies employing longitudinal designs and multivariate analyses are needed to explore these relationships more robustly. Given India’s diverse food habits, cultural practices and social norms, further studies should be conducted across different regions with larger sample sizes. Such investigations could explore the causality of ECC risk factors and their severity among preschool children, enabling targeted preventive practices. Conclusion Fifty-seven per cent of preschoolers exhibited high PSE and had a higher number of cavitated lesions than non-cavitated ones. Seventy -five percent of preschoolers had higher average overall screen time of more than 2 hours. Although no significant correlation was observed between PSE and ECC severity, high PSE in preschoolers may contribute to the severity and progression of ECC, as suggested by the findings of this study. Therefore, fostering positive child–parent relationships, enforcing screen-use rules and effectively managing screen time can help prevent ECC and enhance preschoolers’ quality of life. These findings underscore the importance of interdisciplinary collaboration among paediatric dentists, paediatricians, and caregivers to mitigate modifiable lifestyle factors that influence ECC progression. Abbreviations AAP - American Academy of Paediatrics WHO - World Health Organization ECC -Early Childhood Caries PSE -Problematic Screen Exposure SEQ – Screen Exposure Questionnaire ICDAS-II – International Caries Detection and Assessment System-II Declarations Author for correspondence: Dr. Dhanraj Kalaivanan Correspondence Email: [email protected] Acknowledgements We acknowledge all the participants and their parents for their support for our research. Our sincere acknowledgements to Dr. Rajalakshmi and Dr. Sathyapriya for the language editing and statistical knowledge transfer respectively. Funding The authors declare that no funds, grants, or other forms of support were received during the preparation of this manuscript. Clinical trial number : not applicable to the study Authors contributions The authors (DK and SS) conceptualized the study, designed the methodology, and oversaw data collection. The authors (ML and MD) contributed to data collection and preparation of manuscript. The authors (SAKR and ML) contributed to statistical analysis, interpreted results, and contributed to manuscript writing and preparation of figures and tables. The authors (SS and SA) conducted literature review, refined methodology, and assisted in manuscript editing. The authors (DK and VC) contributed to s upervising the research process, reviewed the final manuscript, and provided critical revisions. All authors have read and approved the final manuscript. Availability of data and materials The data that support the findings of this study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate The research protocol was approved by the Ethics Committee of Sathyabama Institute of Science and Technology (Protocol Approval Code: 366-IRB-IBSEC/SIST; dated April 16,2024) The study was conducted ethically following the World Medical Association Declaration of Helsinki. * Informed consent was obtained from the parent and/or legal guardian for all study participants prior to data collection and clinical examination. Only children with a signed parental consent who also provided verbal assent were included in the study. The rights of all subjects were protected, and all data were kept confidential. Consent for publication : Not applicable. References Ponti M. Screen time and preschool children: Promoting health and development in a digital world. 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Yilmaz N, Avci G. Exposure to screen time and dental neglect. J Paediatr Child Health. 2022;58(10):1855–61. Mustuloğlu Ş, Tezol Ö, Yalcın SS. Problematic screen exposure and oral health in preschool children: a comparison study. BMC Oral Health. 2024 Oct 9;24(1):1200. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007 Oct 20;335(7624):806-8. Yalçin SS, Tezol Ö, Çaylan N, et al. Evaluation of problematic screen exposure in pre-schoolers using a unique tool called ‘seven-in-seven screen exposure questionnaire’: cross-sectional study. BMC Pediatr.2021;21(1):472. Dabawala S, Suprabha BS, Shenoy R, Rao A, Shah N. Parenting style and oral health practices in early childhood caries: a case-control study. Int J Paediatr Dent. 2017 Mar;27(2):135-144. Folayan MO, Kolawole KA, Oziegbe EO, Oyedele T, Oshomoji OV, Chukwumah NM, Onyejaka N. Prevalence or early childhood caries risk indicators in preschool children in suburban Nigeria. BMC Oral Health. 2015 Jun 30;15:72. Pitts NB, Ekstrand KR, ICDAS Foundation. International Caries Detection and Assessment System (ICDAS) and its International Caries Classification and Management System (ICCMS) – methods for staging of the caries process and enabling dentists to manage caries. Community Dent Oral Epidemiol. 2013;41: e41–52. Semar R, Bakshi N. Correlation of Screen Time with Eating Behavior Among School-Going Children Aged 8 to 10 Years in East Delhi, India. Journal of Indian Association for Child and Adolescent Mental Health. 2022;18(4):283-289. Singh N, Dubey N, Rathore M, Pandey P. Impact of early childhood caries on quality of life: Child and parent perspectives. J Oral Biol Craniofac Res. 2020 Apr-Jun;10(2):83-86 Domoff SE, Borgen AL, Radesky JS. Interactional theory of childhood problematic media use. Hum Behav Emerg Technol. 2020;2(4):343–53 Anandakrishna L, Bhargav N, Hegde A, Chandra P, Gaviappa D, Shetty AK. Problematic eating and its association with early childhood caries among 46-71-month-old children using Children's Eating Behavior Questionnaire (CEBQ): A cross sectional study. Indian J Dent Res 2014;25:602-6. Shah RR, Fahey NM, Soni AV, Phatak AG, Nimbalkar SM. Screen time usage among preschoolers aged 2-6 in rural Western India: A cross-sectional study. J Family Med Prim Care. 2019 Jun;8(6):1999-2002. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 16 Jul, 2025 Read the published version in BMC Oral Health → Version 1 posted Editorial decision: Revision requested 05 May, 2025 Editor assigned by journal 05 May, 2025 Reviews received at journal 25 Apr, 2025 Reviews received at journal 15 Apr, 2025 Reviewers agreed at journal 14 Apr, 2025 Reviewers agreed at journal 11 Apr, 2025 Reviewers invited by journal 11 Apr, 2025 Submission checks completed at journal 11 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. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5940590","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":441847414,"identity":"a49da0b8-ef1f-4c29-b7ee-aae4c44608e1","order_by":0,"name":"Dhanraj Kalaivanan","email":"data:image/png;base64,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","orcid":"","institution":"Sathyabama Dental College and Hospital","correspondingAuthor":true,"prefix":"","firstName":"Dhanraj","middleName":"","lastName":"Kalaivanan","suffix":""},{"id":441847415,"identity":"8e119e0d-8c60-4629-9d79-d357eb4370e6","order_by":1,"name":"Meenakshi Lakshmanan","email":"","orcid":"","institution":"Sathyabama Dental College and Hopsital","correspondingAuthor":false,"prefix":"","firstName":"Meenakshi","middleName":"","lastName":"Lakshmanan","suffix":""},{"id":441847416,"identity":"9fbe63b4-a8ea-4bbf-abd1-25225028d1b8","order_by":2,"name":"Meghana Das","email":"","orcid":"","institution":"Sathyabama Dental College and Hopsital","correspondingAuthor":false,"prefix":"","firstName":"Meghana","middleName":"","lastName":"Das","suffix":""},{"id":441847417,"identity":"f76680f2-68c1-4338-83bd-b9138791a866","order_by":3,"name":"Sumaiyya Saleem","email":"","orcid":"","institution":"Sathyabama Dental College and Hopsital","correspondingAuthor":false,"prefix":"","firstName":"Sumaiyya","middleName":"","lastName":"Saleem","suffix":""},{"id":441847418,"identity":"967554b7-903c-4d22-8629-edb175f681a3","order_by":4,"name":"Santhoshpriya Appiya Krishnan Ramnathbabu","email":"","orcid":"","institution":"Sathyabama Dental College and Hopsital","correspondingAuthor":false,"prefix":"","firstName":"Santhoshpriya","middleName":"Appiya Krishnan","lastName":"Ramnathbabu","suffix":""},{"id":441847420,"identity":"81f5e0f7-3537-4eae-909e-330ef06f3720","order_by":5,"name":"Vishnu Rekha Chamarthi","email":"","orcid":"","institution":"Sathyabama Dental College and Hopsital","correspondingAuthor":false,"prefix":"","firstName":"Vishnu","middleName":"Rekha","lastName":"Chamarthi","suffix":""}],"badges":[],"createdAt":"2025-02-01 08:08:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5940590/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5940590/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12903-025-06135-7","type":"published","date":"2025-07-16T16:05:20+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":80791669,"identity":"f38702cb-def1-4479-9116-6f1e48d16390","added_by":"auto","created_at":"2025-04-17 06:51:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50993,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure1.STROBEflowdiagramforthemethodology.png","url":"https://assets-eu.researchsquare.com/files/rs-5940590/v1/a6daa760742a55f927617448.png"},{"id":80791667,"identity":"fcf82f7e-f7e1-4304-a467-2cd6ff43e4b2","added_by":"auto","created_at":"2025-04-17 06:51:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":31545,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Figure2.Piechartshowingthedistributionofcavitatedandnoncavitatedlesions.png","url":"https://assets-eu.researchsquare.com/files/rs-5940590/v1/ec2eef1011affbdf91781ee5.png"},{"id":80791671,"identity":"a4d136c8-2beb-4ef3-8827-817a7ea2b587","added_by":"auto","created_at":"2025-04-17 06:51:22","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":28885,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Figure3.PiechartillustratingthedistributionofPSEscoresamongchildren..png","url":"https://assets-eu.researchsquare.com/files/rs-5940590/v1/a21ea989e39635b0f379e98d.png"},{"id":80791676,"identity":"2839f9df-46ab-48c7-bf32-357c2c84d864","added_by":"auto","created_at":"2025-04-17 06:51:22","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":20019,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Figure4.BarchartshowingthedifferenceinmeanICDASscoresbetweenchildrenwithhighandlowPSEscores.1.png","url":"https://assets-eu.researchsquare.com/files/rs-5940590/v1/4a9ec50f6309b330caaa853e.png"},{"id":88506036,"identity":"9dcfa89a-33b7-40c8-9495-a93fed01babf","added_by":"auto","created_at":"2025-08-07 07:29:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1520756,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5940590/v1/d4acb597-98a3-4b30-a895-4baa9f727449.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eExploring the Link Between Screen Time and Severity of Early Childhood Caries in Primary Molars: A Cross-Sectional Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA child’s initial interactions with screens are pivotal as the patterns of exposure and utilisation are conducive to habit formation and are known to influence behaviours into adulthood [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. With the ubiquity of digital media and screens in everyday life, toddlers and preschoolers are increasingly exposed to various media gadgets (i.e., television, computers, tablets and phones) from an early age [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Excessive screen time may adversely impact paediatric health, influencing cariogenic bacterial proliferation, host defence development, nutrition-related behaviours and oral habits [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Excessive screen time correlates with higher intake of sugary foods and increased snacking, both of which lead to dental caries and periodontal disease [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEarly childhood caries (ECC) is a specific manifestation of dental caries that predominantly affects infants, toddlers and preschool-age children. ECC is one of the most frequently overlooked health conditions among Indian children [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Numerous investigations have systematically assessed and classified the risk determinants of ECC. These encompass sociodemographic variables, dietary influences, oral hygiene practices and factors pertaining to oral bacterial ecosystems and modes of feeding, whether breastfeeding or bottle feeding [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A study has reported that inadequate sleep and increased media use may also be associated with an increased prevalence of caries in children [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Research indicates prolonged digital device usage in children was correlated with distracted eating, increased intake of unhealthy foods, and diminished parental oversight of dental hygiene [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Moreover, children overexposed to digital devices exhibit poorer dietary habits, characterized by increased energy intake, frequent fast food and sweets consumption, and reduced fibre, vegetable, fruit, and fish intake [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Hence, both parental and child lifestyle choices considerably influence caries development during childhood. Nonetheless, the extent to which various risk determinants are correlated with ECC is ambiguous. Hence, it is critical to analyse such lifestyle-related risk factors that may also contribute to ECC.\u003c/p\u003e \u003cp\u003eStudies have demonstrated an association between media use, specifically television and gaming, and dental caries prevalence in school-aged children and adolescents [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Also, children with low sedentary screen times exhibited greater microbial diversity in their salivary microbiota compared to those with high sedentary screen times favouring caries activity [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Also, higher screen time have been linked to changes in salivary extracellular miRNA molecules indicating inflammatory activity [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Increased screen time have been shown to reduce sleep, which in turn alters the circadian rhythm resulting in disruption of oral microbiome and salivary production favouring more oral health problems [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In addition, Yilmaz et al. and Mustuloğlu et al. have reported a link between daily screen exposure and oral health in preschool children [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Most previous studies have linked the presence and absence of caries to Problematic Screen Exposure (PSE).\u003c/p\u003e \u003cp\u003eHowever, to date, no research has investigated the association between PSE and the severity of ECC in terms of cavitated and non-cavitated lesions. Hence, our proposed null hypothesis stated that there was no association between screen time and the severity of ECC. This study aimed to determine the prevalence of PSE in ECC-affected children and assess the presence of a link between PSE and the severity of ECC.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e "},{"header":"Methodology","content":"\u003cp\u003eStudy approval\u003c/p\u003e\u003cp\u003eThis study employed an observational cross-sectional analytical design and adhered to the STROBE guidelines for observational studies [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The Institutional Review and Ethics Board (Protocol Reference: 366-IRB-IBSEC/SIST) (Committee: EC/NEW/INST/2020/1397) granted ethical approval for the study conducted by the Department of Paediatric and Preventive Dentistry.\u003c/p\u003e\u003cp\u003eStudy population\u003c/p\u003e\u003cp\u003eA purposive sampling method was utilised to select 100 healthy children aged 36–71 months diagnosed with ECC limited to posterior teeth. Participants were recruited from the institution’s outpatient department and an affiliated private clinic from June 2024 to December 2024. Children with systemic illnesses or special needs, involvement of decay in anterior teeth or lack of parental consent were excluded. Parents were thoroughly briefed about the study objectives, and informed consent and child assent were obtained (documented in the Appendix).\u003c/p\u003e\u003cp\u003eData collection\u003c/p\u003e\u003cp\u003eScreen time exposure was evaluated using the ‘Seven-in-Seven Screen Exposure Questionnaire’, a validated tool aligned with the AAP guidelines [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In order to ascertain the validity and applicability of the tool within the Indian context, we adhered to a systematic methodology for linguistic and cultural adaptation. Initially, the instrument was translated into the regional language utilizing a forward- and backward-translation framework executed by bilingual professionals. Subsequently, a panel of subject matter experts evaluated the translations to ensure conceptual equivalence. A pilot study was conducted with a heterogeneous sample of participants to evaluate clarity, comprehension, and cultural relevance. Essential modifications were implemented based on participant feedback to enhance contextual appropriateness while preserving the integrity of the original instrument. Ultimately, the adapted version underwent validation through psychometric analysis, encompassing reliability testing and assessment of construct validity.\u003c/p\u003e\u003cp\u003eThis questionnaire comprises seven items categorised into screen exposure rules, exposure during daily routines and conditions of exposure. The tool captures metrics such as daily screen time, co-viewing with parents, screen usage during meals and bedtime, initiation age and screen content. The average daily screen time was calculated as follows: [(TV weekday + ‘Other Screens’ weekday) × 5 + (TV weekend + ‘Other Screens’ weekend) × 2]/7 and scored as the overall average screen time; 0: \u0026lt;1 hour; 1: 1–2 hours; 2: \u0026gt;2 hours. The overall PSE score (0–13) was computed by aggregating the scores from the three aforementioned categories. The cumulative scores were categorised as follows: low (\u0026lt; 7) and high (≥ 7).\u003c/p\u003e\u003cp\u003eData were collected before the clinical examination, and closed -ended questionnaires were completed in person and online by the parents. Additional demographic data, including age, occupation or parental income, dietary habits and oral hygiene practices, were obtained using a pre-validated tool [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. A double-entry approach was utilized, to mitigate data entry inaccuracies allowing for the comparison of two independent entries to identify inconsistencies.\u003c/p\u003e\u003cp\u003eClinical examination\u003c/p\u003e\u003cp\u003eThe assessments were conducted to evaluate the baseline status at the child’s first visit without any prior influence or guidance to ensure the objectivity and validity of the findings. The parents were informed about ECC after the examination. No prophylactic recommendations were provided to participants prior to the assessment. All assessments were conducted to capture the baseline health status without prior intervention. Recommendations, if any, were made post-assessment in line with clinical indications.\u003c/p\u003e\u003cp\u003eIntraoral examinations of included children were conducted under illuminated dental chairs performed by two junior residents (ML and MD), who were blinded to PSE scores to reduce the risk of bias during clinical examination. These were supervised and confirmed by senior paediatric dentists with \u0026gt; 5 years of experience (DK and SS). The two junior residents (ML and MD) were trained in the ICDAS-II assessment tool [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and calibrated it using a pilot sample of 10 children not included in the study before the examination of subjects. Intra- and inter-examiner consistency reliability was established using Cohen’s Kappa statistic (κ = 0.8). Dental caries was diagnosed using WHO standards, with lesions categorised using ICDAS-II codes into cavitated (ICDAS \u0026gt; 3) and non-cavitated (ICDAS \u0026lt; 3) using a dental mirror and a ball-ended explorer (WHO 973/80-Martin). Each tooth was dried with a compressed air syringe, and a code was assigned to reflect the highest surface score. The mean ICDAS-II score for four posterior teeth per child was used for statistical analysis. A STROBE flow chart for the methodology is depicted in Fig.\u0026nbsp;1.\u003c/p\u003e\u003cp\u003eSample size estimation and statistical analysis\u003c/p\u003e\u003cp\u003eThe required sample size was calculated using Open Epi (Version 3.0) with the following formula: n = [DEFF*Np(1-p)]/ [d2/Z21-α/2*(N-1) + p*(1-p)] considering a 95% confidence interval and 80% power, based on ECC prevalence in India (49%) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and screen exposure prevalence in schoolchildren (52%) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The estimated sample size was 80, and 100 participants were included in the study.\u003c/p\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eData were analysed using SPSS (Version 25.0). All collected data were coded and entered into Microsoft Excel sheets (Microsoft, Windows 11). The Shapiro–Wilk test evaluated data normality. Descriptive statistics summarised participant characteristics and questionnaire responses. Continuous variables, such as age and caries status, were presented as means and standard deviations, whereas categorical data were represented as frequencies and percentages. Statistical comparisons were performed using the Kruskal–Wallis, Mann–Whitney U and chi-square tests, with correlation analysis conducted using Spearman’s method. Statistical significance was determined at a p-value of ≤ 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eBoys comprised the major proportion of the study sample of 100 children, and most children were aged\u0026thinsp;\u0026gt;\u0026thinsp;5 years. Based on the ICDAS-II criteria, 75% of the participants had cavitated lesions. Most of the children belonged to nuclear families with well-educated parents. Furthermore, most children behaved well and were rated positive in the first dental visit. A significant portion of the participants (57%) exhibited a high PSE score, indicating that most children used more than one electronic gadget daily, with 71% of the parents permitting their children to access these devices. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) (Fig.\u0026nbsp;2 and Fig.\u0026nbsp;3)\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\u003eDistribution of frequency and percentage of Demographic characteristics of study participants\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 \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;=\u0026thinsp;4.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.993)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInterpretation of ICDAS\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;=\u0026thinsp;3.981\u0026thinsp;\u0026plusmn;\u0026thinsp;1.401)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCavitated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Cavitated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFrankel\u0026rsquo;s Behaviour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePSE Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSweet Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWatch out zone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eEducation of Father\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e72.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school certificate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntermediate or diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle school certificate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfessors or honors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eEducation of mother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school certificate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntermediate or diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle school certificate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfessors or honors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eFamily Income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;47657\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11914\u0026ndash;17870\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17871\u0026ndash;23828\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23829\u0026ndash;47656\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7148\u0026ndash;11913\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMother\u0026rsquo;s Age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eless than 25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emore than 25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emore than 35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWorking status of mother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enot working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eworking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNo of children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eless than 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e91.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eType of family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ejoint family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enuclear family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e78.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esingle parent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNo of gadgets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAccess for using gadgets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e71.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe screen time spent by children on television was mostly one hour or less (50%) and less than an hour on other screen devices (92%) on weekdays. However, the time exceeded upto 2\u0026ndash;3 hours on weekends in watching television as reported by parents. The overall screen time was reported to be more than 2 hours (79%) with the initiation of screen exposure primarily occurring prior to the age of three, especially during meals and bedtime routines. Cartoons was the most common genre watched (64%) followed by educational content (11%) and rhymes and movies. Most of the parents agreed that they tend to share their screen experiences sometimes (44%) and they set screen time limits (77%) adhered by the children (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\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\u003eDistribution of frequency and percentage of question responses related to screen exposure and oral hygiene and dietary habits\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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTime spent by child in a weekday looking at TV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1-2hr\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than or 1 hr\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than 2 h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eTime spent by child in a weekday looking at other screen devices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than 1 hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1hour or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2hours or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3hours or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eTime spent by child in a weekend looking at TV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2 hrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;4hrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;3 hrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3-4hrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eTime spent by child in a weekend looking at other screen devices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than an hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 hour or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 hours or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3hours or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than 4 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAverage over all daily screen time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge at which child started using screen devices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eUse of screen device during meals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo, he/she does not\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes, he/she does\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eUse of screen device at least one hour before bedtime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo, he/she does not\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes, he/she does\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSetting screen limits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI do not set screen limits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI set screen limits and my child obeys these limits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI set screen limits but my child does not obey these limits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAt what age did your child start tooth brushing?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;18 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;18 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eWhich tooth paste does your child use?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAny other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFluoridated paste (eg.Colgate Kids,Pediflor))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eHow often does your child usually brush his/her teeth in a day?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eafter every meal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eoccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eonce daily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etwice daily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDo you floss your child\u0026rsquo;s teeth?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eafter every meal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes, occasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eWhat is the frequency of snack consumption of your child per day?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 times per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2 times per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;4 times per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enever or seldom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eoccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDoes your child rinse or brush teeth after eating snacks?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ealways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enever or seldom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDoes your child sleep without brushing after eating snacks?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ealways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enever or seldom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMost parents reported that they initiated brushing their child\u0026rsquo;s teeth after 18 months, with the frequency of once daily with fluoridated toothpaste. Data revealed that most children brushed independently, receiving infrequent assistance, and did not utilize floss. However, several parents acknowledged that their children had snack consumption of twice daily and reported that most of them occasionally went to bed after snacking without proper oral hygiene practices (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Children presented with higher PES scores had higher mean ICDAS scores than those with lower PES scores, and the difference between the groups was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, p\u0026thinsp;=\u0026thinsp;0.025). Thus, children exposed more to devices had more cavitated ECC in molars than those with a lower exposure. However, the age at which screen viewing was initiated and the number of gadgets in the house did not significantly affect the mean ICDAS scores of molars. Children not obeying screen limits set by parents exhibited higher ICDAS scores than those in other categories, but the difference was not statistically significant (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) (Fig.\u0026nbsp;4).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the mean ICDAS scores of molars with children\u0026rsquo;s sociodemographic factors, oral hygiene practices, dietary habits, and screen exposure characteristics.\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=\"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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean ICDAS score of primary molars\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePSE\u003c/b\u003e\u003csup\u003e\u003cb\u003e┼\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.2465\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.025*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.615\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.5220\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eFrankel\u0026rsquo;s Behaviour rating\u003c/b\u003e\u003csup\u003e\u003cb\u003e┼┼\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.4483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.397\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.829\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3769\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.750\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.7778\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eSweet score\u003c/b\u003e\u003csup\u003e\u003cb\u003e┼┼\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.465\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.4705\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.117\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWatch out zone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3708\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eEducation of father\u003c/b\u003e\u003csup\u003e\u003cb\u003e┼┼\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.979\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3820\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.114\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school certificate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.833\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0332\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntermediate or diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.917\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.0104\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle school certificate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.533\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.1015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfessors or honors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.1731\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eEducation of mother\u003c/b\u003e\u003csup\u003e\u003cb\u003e┼┼\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.4272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school certificate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.4163\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntermediate or diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.1981\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle school certificate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.9946\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfessors or honors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.939\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0487\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eFamily income\u003c/b\u003e\u003csup\u003e\u003cb\u003e┼┼\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11914\u0026ndash;17870\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.743\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.8404\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.255\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17871\u0026ndash;23828\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.518\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.7532\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23829\u0026ndash;47656\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3559\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7148\u0026ndash;11913\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.1504\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;47657\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.728\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3829\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eMother\u0026rsquo;s age\u003c/b\u003e\u003csup\u003e\u003cb\u003e┼┼\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.968\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3977\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.531\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eless than 25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0526\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emore than 25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emore than 35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.6007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eType of family\u003c/b\u003e\u003csup\u003e\u003cb\u003e┼┼\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ejoint family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.882\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.669\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enuclear family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.985\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.4365\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esingle parent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.1314\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eNo. of gadgets\u003c/b\u003e\u003csup\u003e\u003cb\u003e┼┼\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.515\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.4985\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.164\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.4084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.803\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3471\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eWorking status of mother\u003c/b\u003e\u003csup\u003e\u003cb\u003e┼\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.4583\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.622\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.913\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3331\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eNo. of children\u003c/b\u003e\u003csup\u003e\u003cb\u003e┼\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.933\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.7399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.042*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eless than 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.887\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.4184\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAge of initiation of screen device usage\u003c/b\u003e\u003csup\u003e\u003cb\u003e┼\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.880\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.4434\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.356\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eUse of screen device during meals\u003c/b\u003e\u003csup\u003e\u003cb\u003e┼\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno, he/she does not\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.961\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.4766\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.977\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes, he/she does\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.987\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3881\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eSetting screen limits\u003c/b\u003e\u003csup\u003e\u003cb\u003e┼┼\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI do not set screen limits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.888\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.4730\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.577\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI set screen limits and my child obeys these limits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.960\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3982\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI set screen limits but my child does not obey these limits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3571\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eAge of initiation of tooth brushing\u003c/b\u003e\u003csup\u003e\u003cb\u003e┼┼\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;18 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.467\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.4481\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.277\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;18 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.884\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3984\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.350\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.3536\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eTooth paste type being used\u003c/b\u003e\u003csup\u003e\u003cb\u003e┼┼\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon -fluoridated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.359\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003e0.014*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCheerio gel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.1911\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eColgate kids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.757\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.4644\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKidodent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.828\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.6319\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePediflur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.986\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0135\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eFrequency of brushing by child everyday\u003c/b\u003e\u003csup\u003e\u003cb\u003e┼┼\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eafter every meal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.931\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.8276\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.129\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eoccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0089\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eonce daily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.4438\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etwice daily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3689\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eFrequency of snack consumption\u003c/b\u003e\u003csup\u003e\u003cb\u003e┼┼\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2 times per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.341\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;4 times per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.822\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.5187\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 times per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.771\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enever or seldom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eoccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.583\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e*\u003c/sup\u003e\u003cb\u003eStatistically significant\u003c/b\u003e \u003csup\u003e\u003cb\u003e┼┼\u003c/b\u003e\u003c/sup\u003e\u003cb\u003eKruskal-Wallis test\u003c/b\u003e \u003csup\u003e\u003cb\u003e┼\u003c/b\u003e\u003c/sup\u003e\u003cb\u003eMannWhitney U-test\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOther risk factors, such as the parent\u0026rsquo;s education, occupation, family income and working status of the mother, did not significantly affect the mean ICDAS score of molars. Nevertheless, the number of siblings in the family affected the mean ICDAS score of the children under consideration. Families with \u0026ge;\u0026thinsp;3 children caused the ICDAS score to elevate compared to those with \u0026le;\u0026thinsp;2 children. Considering oral hygiene practices, a statistically significant difference was perceived between ICDAS scores based on the type of toothpaste used (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The mean ICDAS score of molars displayed a weak positive correlation with the PSE score (r\u0026thinsp;=\u0026thinsp;0.042). However, the correlation was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.680) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) indicating the relationship between the variables is considered to be effectively non-existent. As screen time exposure may influence child behaviour, analysis of Frankel\u0026rsquo;s behaviour rating with screen time showed that children with high PSE scores had more positive ratings of behaviour at the first visit, not being statistically significant (p\u0026thinsp;=\u0026thinsp;0.330) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Frankel\u0026rsquo;s behaviour rating of children with PSE score\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=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFrankel\u0026rsquo;s behaviour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePSE score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHigh\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.330\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDefinitely positive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e*\u003c/sup\u003eChi-square test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between the mean ICDAS scores and mean PSE scores using Spearman's correlation.\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=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSpearman's Correlation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eICDAS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePSE\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eICDAS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eCorrelation Coefficient\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.680\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eN\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ePSE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eCorrelation Coefficient\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.680\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eN\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eECC adversely affects children\u0026rsquo;s lives, causing pain when consuming hot or cold drinks, difficulties with chewing and biting, reduced appetite, weight loss, sleep disturbances, behavioural changes such as irritability and low self-esteem and diminished academic performance [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Problematic media use in children refers to excessive engagement that disrupts daily functioning and may lead to addictive behaviours that extend beyond the mere amount of time spent on screens (e.g., exhibiting strong resistance to limits on media use) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The association between parafunctional habits and PSE and its link to dental carries has been investigated [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Children with high PSE often exhibit problematic eating behaviours, which may indirectly contribute to the progression of dental caries [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Consequently, high PSE was hypothesised to be associated with a greater prevalence of posterior ECC lesions. To the best of our knowledge, this is the first study to examine the relationship between the severity of ECC (in molars) and PSE in Indian preschool children.\u003c/p\u003e \u003cp\u003eThis study employed the children of age 36\u0026ndash;71 months with only posterior lesions to avoid the confounding effect of feeding practices on the severity of ECC. This study employed the \u0026lsquo;Seven-in-Seven Screen Exposure Questionnaire\u0026rsquo;, a tool designed to evaluate PSE among Turkish preschool children based on recommendations from the AAP [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This questionnaire was translated into a local vernacular language, back-translated and validated for use in the Indian context to avoid bias due to linguistic and cultural domains. A previous study has established that children with high PSE tend to have poorer oral hygiene, a higher prevalence of poor oral health and a greater mean number of decayed teeth [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, most investigations have not explored the prevalence of cavitated and non-cavitated lesions in preschool children with high PSE. Hence, this study attempted to examine the severity of ECC in posterior teeth using the ICDAS classification (cavitated and non-cavitated) and its relationship with PSE.\u003c/p\u003e \u003cp\u003eOf the 100 children examined in this study, 57 exhibited high PSE scores, with the majority hailing from families with graduate parents and non-working mothers (58%) and having a good socioeconomic status. These findings are aligned with a previous study that linked high PSE scores to factors such as non-working mothers and families with \u0026ge;\u0026thinsp;2 children [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Another noteworthy observation is that most children with high PSE (57%) had higher sugar consumption, as reflected by their sweet scores. Moreover, 60% of the parents stated that their children started screen viewing before the age of 3 years, consistent with an earlier finding [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In this research, children with high PSE had more cavitated than non-cavitated lesions in posterior teeth. These results emphasise that PSE may be a risk factor for the progression of ECC. One possible explanation for the more positive behaviour ratings observed in high PSE children could be the influence of audiovisual distraction, which may have temporarily enhanced engagement or compliance. However, this interpretation remains speculative and should be explored further in future research.\u003c/p\u003e \u003cp\u003eIncreased screen exposure has been linked to emotional overeating, heightened thirst, slow eating, satiety responsiveness, food fussiness and emotional undereating [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Problematic eating habits may exacerbate caries progression as children with such behaviours often retain food in their mouths for extended periods, which promotes ECC [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In addition, Elina et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] observed that children with high sedentary screen time displayed lower microbiota diversity and altered composition, potentially leading to ECC progression as seen in our children.\u003c/p\u003e \u003cp\u003eAlthough this study did not establish a significant positive correlation between PSE and ECC severity (in posterior teeth) using the ICDAS classification, its value lies in being the first to investigate this association. While our findings suggest a potential association between PSE and ECC progression, the cross-sectional design precludes causal conclusions, and longitudinal studies are needed to further explore this relationship. Consequently, preventive strategies for ECC in preschoolers should involve family-based interventions to reduce PSE and promote appropriate screen time to enhance oral health outcomes in children.\u003c/p\u003e \u003cp\u003eLimitations\u003c/p\u003e \u003cp\u003eAlthough it is the first study to explore PSE and ECC severity, our study had its own limitations. A temporal relationship between PSE and ECC severity could not be established because of its cross-sectional design. Although data on sugar consumption and oral hygiene habits were collected, information on sugar consumption during media usage was not obtained. This omission might have contributed to the insignificant relationship between the sweet score and PES. There could be a possibility of lack of clinical calibration over time among could have affected consistency in caries assessment among the examiners, which needs to be acknowledged in such studies. In addition, data were gathered from parents at a single time point, which may have introduced reporting bias and resulted in an insignificant correlation between ICDAS molar and sweet scores. Also, the possibility of social desirability bias could not be excluded in such self-reported assessment of screen and dietary behaviours. As ECC is a multifactorial disease, the lack of adjustment for influencing factors such as socioeconomic status, oral hygiene practices, and dietary patterns may limit the strength of the associations observed. Future studies employing longitudinal designs and multivariate analyses are needed to explore these relationships more robustly. Given India\u0026rsquo;s diverse food habits, cultural practices and social norms, further studies should be conducted across different regions with larger sample sizes. Such investigations could explore the causality of ECC risk factors and their severity among preschool children, enabling targeted preventive practices.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eFifty-seven per cent of preschoolers exhibited high PSE and had a higher number of cavitated lesions than non-cavitated ones.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSeventy -five percent of preschoolers had higher average overall screen time of more than 2 hours.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAlthough no significant correlation was observed between PSE and ECC severity, high PSE in preschoolers may contribute to the severity and progression of ECC, as suggested by the findings of this study.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eTherefore, fostering positive child\u0026ndash;parent relationships, enforcing screen-use rules and effectively managing screen time can help prevent ECC and enhance preschoolers\u0026rsquo; quality of life. These findings underscore the importance of interdisciplinary collaboration among paediatric dentists, paediatricians, and caregivers to mitigate modifiable lifestyle factors that influence ECC progression.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003col\u003e\n \u003cli\u003eAAP - American Academy of Paediatrics\u003c/li\u003e\n \u003cli\u003eWHO - World Health Organization\u003c/li\u003e\n \u003cli\u003eECC -Early Childhood Caries\u003c/li\u003e\n \u003cli\u003ePSE -Problematic Screen Exposure\u003c/li\u003e\n \u003cli\u003eSEQ \u0026ndash; Screen Exposure Questionnaire\u003c/li\u003e\n \u003cli\u003eICDAS-II \u0026ndash; International Caries Detection and Assessment System-II\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Declarations","content":"\u003cp\u003eAuthor for correspondence: Dr. Dhanraj Kalaivanan\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCorrespondence Email: \u0026nbsp;[email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; We acknowledge all the participants and their parents for their support for our research. Our sincere acknowledgements to Dr. Rajalakshmi and Dr. Sathyapriya for the language editing and statistical knowledge transfer respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other forms of support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: not applicable to the study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors\u003cstrong\u003e\u0026nbsp;(DK and SS)\u003c/strong\u003e conceptualized the study, designed the methodology, and oversaw data collection. The authors\u003cstrong\u003e\u0026nbsp;(ML and MD)\u003c/strong\u003e contributed to data collection and preparation of manuscript. The authors\u003cstrong\u003e\u0026nbsp;(SAKR and ML)\u0026nbsp;\u003c/strong\u003econtributed to statistical analysis, interpreted results, and contributed to manuscript writing and preparation of figures and tables. The authors \u003cstrong\u003e(SS and SA)\u0026nbsp;\u003c/strong\u003econducted literature review, refined methodology, and assisted in manuscript editing. The authors \u003cstrong\u003e(DK and VC)\u0026nbsp;\u003c/strong\u003econtributed to\u003cstrong\u003e\u0026nbsp;s\u003c/strong\u003eupervising the research process, reviewed the final manuscript, and provided critical revisions. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research protocol was approved by the Ethics Committee of Sathyabama Institute of Science and Technology (Protocol Approval Code: 366-IRB-IBSEC/SIST; dated April 16,2024) The study was conducted ethically following the World Medical Association Declaration of Helsinki. * Informed consent was obtained from the parent and/or legal guardian for all study participants prior to data collection and clinical examination. Only children with a signed parental consent who also provided verbal assent were included in the study. The rights of all subjects were protected, and all data were kept confidential.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePonti M. Screen time and preschool children: Promoting health and development in a digital world. Paediatrics \u0026amp; Child Health. 2023 Jun 1;28(3):184-92.\u003c/li\u003e\n\u003cli\u003eHill D, Ameenuddin N, Reid Chassiakos YL, Cross C, Hutchinson J, Levine A, Boyd R, Mendelson R, Moreno M, Swanson WS. Media and young minds. Pediatrics. 2016 Nov 1;138(5).\u003c/li\u003e\n\u003cli\u003e.World Health Organization. Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age\u003cem\u003e. \u003c/em\u003eWorld Health Organization; 2019.\u003c/li\u003e\n\u003cli\u003eRobin A, Padmanabhan V, Swaminathan K, et al. (March 28, 2025) Association Between Screen Time, Dietary Patterns, and Oral Health Among Children: A Cross-Sectional Study. Cureus 17(3): e81348. doi:10.7759/cureus.81348\u003c/li\u003e\n\u003cli\u003eGanesh A, Muthu MS, Mohan A, Kirubakaran R. Prevalence of Early Childhood Caries in India - A Systematic Review. Indian J Pediatr. 2019 Mar;86(3):276-286.\u003c/li\u003e\n\u003cli\u003eTinanoff N, Baez RJ, Giullory CD, et al. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education or policy: Global perspective.Int J Paediatr Dent 2019;29(3):238-48.\u003c/li\u003e\n\u003cli\u003eKirthiga M, Murugan M, Saikia A, Kirubakaran R. Risk Factors for Early Childhood Caries: A Systematic Review and Meta-Analysis of Case Control and Cohort Studies. Pediatr Dent. 2019 Mar 15;41(2):95-112.\u003c/li\u003e\n\u003cli\u003eAsaka Y, Sekine M, Yamada M, Tatsuse T, Sano M. Association of short sleep duration and long media use with caries in school children. Pediatr Int. 2020;62(2):214\u0026ndash;20.\u003c/li\u003e\n\u003cli\u003eGarg N, Khatri A, Kalra N, Tyagi R. The association of screen time with intake of potentially cariogenic food and oral health of school children aged 8-14 years-a cross-sectional study. J Clin Pediatr Dent. 2023 Sep;47(5):116-123.\u003c/li\u003e\n\u003cli\u003eShqair AQ, Pauli LA, Costa VP, Cenci M, Goettems ML: Screen time, dietary patterns and intake of potentially cariogenic food in children: a systematic review. J Dent. 2019, 86:17-26. 10.1016/j.jdent.2019.06.004\u003c/li\u003e\n\u003cli\u003eTambalis, K.D.; Panagiotakos, D.B.; Psarra, G.; Sidossis, L.S. Screen time and its effect on dietary habits and lifestyle among schoolchildren. Cent. Eur. J. Public Health 2020, 28, 260\u0026ndash;266\u003c/li\u003e\n\u003cli\u003eShang, L.;Wang, J.; O\u0026rsquo;Loughlin, J.; Tremblay, A.; Mathieu, M.\u0026Egrave;.; Henderson, M.; Gray-Donald, K. Screen time is associated with dietary intake in overweight Canadian children. Prev. Med. Rep. 2015, 2, 265\u0026ndash;269.\u003c/li\u003e\n\u003cli\u003eZeng X, Sheiham A, Sabbah W. The association between dental caries and television viewing among Chinese adolescents in Guangxi. China BMC Oral Health. 2014;14:138\u003c/li\u003e\n\u003cli\u003eEngberg E, Raju SC, Figueiredo RA, Weiderpass E, Rounge TB, Viljakainen H. Saliva microbiota differs between children with low and high sedentary screen times. Human Microbiome Journal. 2021 Jun 1;20:100080.\u003c/li\u003e\n\u003cli\u003eVriens A, Provost EB, Saenen ND, De Boever P, Vrijens K, De Wever O, Plusquin M, Nawrot TS. Children\u0026apos;s screen time alters the expression of saliva extracellular miR-222 and miR-146a. Sci Rep. 2018 May 29;8(1):8209\u003c/li\u003e\n\u003cli\u003eKurtović A, Talapko J, Bekić S, \u0026Scaron;krlec I. The Relationship between Sleep, Chronotype, and Dental Caries-A Narrative Review. Clocks Sleep. 2023 May 15;5(2):295-312.\u003c/li\u003e\n\u003cli\u003eYilmaz N, Avci G. Exposure to screen time and dental neglect. J Paediatr Child Health. 2022;58(10):1855\u0026ndash;61.\u003c/li\u003e\n\u003cli\u003eMustuloğlu Ş, Tezol \u0026Ouml;, Yalcın SS. Problematic screen exposure and oral health in preschool children: a comparison study. BMC Oral Health. 2024 Oct 9;24(1):1200.\u003c/li\u003e\n\u003cli\u003evon Elm E, Altman DG, Egger M, Pocock SJ, G\u0026oslash;tzsche PC, Vandenbroucke JP; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007 Oct 20;335(7624):806-8.\u003c/li\u003e\n\u003cli\u003eYal\u0026ccedil;in SS, Tezol \u0026Ouml;, \u0026Ccedil;aylan N, et al. Evaluation of problematic screen exposure in pre-schoolers using a unique tool called \u0026lsquo;seven-in-seven screen exposure questionnaire\u0026rsquo;: cross-sectional study. BMC Pediatr.2021;21(1):472.\u003c/li\u003e\n\u003cli\u003eDabawala S, Suprabha BS, Shenoy R, Rao A, Shah N. Parenting style and oral health practices in early childhood caries: a case-control study. Int J Paediatr Dent. 2017 Mar;27(2):135-144. \u003c/li\u003e\n\u003cli\u003eFolayan MO, Kolawole KA, Oziegbe EO, Oyedele T, Oshomoji OV, Chukwumah NM, Onyejaka N. Prevalence or early childhood caries risk indicators in preschool children in suburban Nigeria. BMC Oral Health. 2015 Jun 30;15:72. \u003c/li\u003e\n\u003cli\u003ePitts NB, Ekstrand KR, ICDAS Foundation. International Caries Detection and Assessment System (ICDAS) and its International Caries Classification and Management System (ICCMS) \u0026ndash; methods for staging of the caries process and enabling dentists to manage caries. Community Dent Oral Epidemiol. 2013;41: e41\u0026ndash;52.\u003c/li\u003e\n\u003cli\u003eSemar R, Bakshi N. Correlation of Screen Time with Eating Behavior Among School-Going Children Aged 8 to 10 Years in East Delhi, India. Journal of Indian Association for Child and Adolescent Mental Health. 2022;18(4):283-289.\u003c/li\u003e\n\u003cli\u003eSingh N, Dubey N, Rathore M, Pandey P. Impact of early childhood caries on quality of life: Child and parent perspectives. J Oral Biol Craniofac Res. 2020 Apr-Jun;10(2):83-86\u003c/li\u003e\n\u003cli\u003eDomoff SE, Borgen AL, Radesky JS. Interactional theory of childhood problematic media use. Hum Behav Emerg Technol. 2020;2(4):343\u0026ndash;53\u003c/li\u003e\n\u003cli\u003eAnandakrishna L, Bhargav N, Hegde A, Chandra P, Gaviappa D, Shetty AK. Problematic eating and its association with early childhood caries among 46-71-month-old children using Children\u0026apos;s Eating Behavior Questionnaire (CEBQ): A cross sectional study. Indian J Dent Res 2014;25:602-6.\u003c/li\u003e\n\u003cli\u003eShah RR, Fahey NM, Soni AV, Phatak AG, Nimbalkar SM. Screen time usage among preschoolers aged 2-6 in rural Western India: A cross-sectional study. J Family Med Prim Care. 2019 Jun;8(6):1999-2002.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"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":"Early Childhood Caries, Problematic Screen Exposure, ICDAS, Preschool Children, Oral Health, Screen Time, Paediatric Dentistry","lastPublishedDoi":"10.21203/rs.3.rs-5940590/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5940590/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003cbr\u003e\nEarly Childhood Caries (ECC) is a significant yet often overlooked paediatric health concern, particularly in India. Previous studies have linked excessive screen exposure, known as Problematic Screen Exposure (PSE), with caries in children. However, the association between PSE and the severity of ECC in terms of cavitated and non-cavitated lesions remains unexplored. This study investigates the prevalence of PSE among ECC-affected preschool children and examines its correlation with ECC severity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003cbr\u003e\nA cross-sectional observational study was conducted among 100 children aged 36–71 months diagnosed with ECC. Data on screen exposure were collected using the \"Seven-in-Seven Screen Exposure Questionnaire,\" validated per American Academy of Paediatrics guidelines. Clinical examinations classified caries severity using the International Caries Detection and Assessment System (ICDAS-II). Statistical analyses, including the Mann-Whitney U test and Spearman’s correlation, assessed relationships between PSE, sociodemographic factors, and ECC severity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003cbr\u003e\nFifty-seven percent of participants exhibited high PSE scores. A majority of children (75%) had cavitated lesions. High PSE was associated with higher mean ICDAS scores for molars (p=0.025), although the correlation between PSE and ECC severity was very weak and not statistically significant (r=0.042, p=0.680). Sociodemographic factors, including family size and parental education, were also analysed, with families having three or more children showing elevated ICDAS scores. Oral hygiene practices and dietary habits partially influenced caries severity, with children using non-fluoridated toothpaste exhibiting higher ICDAS scores.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003cbr\u003e\nHigh PSE may contribute to the progression of ECC, as evidenced by a higher prevalence of cavitated lesions among children with elevated PSE scores. Preventive strategies focusing on reducing PSE and promoting healthy oral hygiene practices may mitigate ECC severity.\u003cdel\u003e.\u003c/del\u003e Further longitudinal studies are necessary to establish causality and inform targeted prevention strategies.\u003c/p\u003e","manuscriptTitle":"Exploring the Link Between Screen Time and Severity of Early Childhood Caries in Primary Molars: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-17 06:51:17","doi":"10.21203/rs.3.rs-5940590/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-05T07:26:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-05T07:20:44+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-25T20:18:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-15T13:01:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87211867008568813326092112059091261308","date":"2025-04-14T07:45:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"304810580309764094242041552875194910874","date":"2025-04-11T19:26:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-11T19:24:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-11T07:02:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2025-04-10T01:51:29+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":"c0129cc0-8b04-41d3-bd1b-f305f4c68b3e","owner":[],"postedDate":"April 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-07T07:10:55+00:00","versionOfRecord":{"articleIdentity":"rs-5940590","link":"https://doi.org/10.1186/s12903-025-06135-7","journal":{"identity":"bmc-oral-health","isVorOnly":false,"title":"BMC Oral Health"},"publishedOn":"2025-07-16 16:05:20","publishedOnDateReadable":"July 16th, 2025"},"versionCreatedAt":"2025-04-17 06:51:17","video":"","vorDoi":"10.1186/s12903-025-06135-7","vorDoiUrl":"https://doi.org/10.1186/s12903-025-06135-7","workflowStages":[]},"version":"v1","identity":"rs-5940590","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5940590","identity":"rs-5940590","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}