Abstract

Malocclusion is a prevalent oral health problem in children associated with oral bad habits, yet the extent to which parental and child knowledge, attitudes, and practices (KAP) influence orthodontic status remains insufficiently understood. This cross-sectional study investigated relationships between parental and child KAP, oral habits, and malocclusion in school-aged children, involving 67 child–parent pairs from an elementary school in Surabaya, Indonesia. Parental and child KAP as well as child-reported oral habits were assessed using a validated questionnaire. Children subsequently underwent standardized clinical orthodontic examinations, including alginate jaw impressions to produce dental study models, which were evaluated using the Index of Complexity, Outcome, and Need (ICON) to determine malocclusion severity and the need for orthodontic treatment. Parents demonstrated higher levels of knowledge than children. Statistical differences were found between parent- and child-reported habits for lip biting (p-value = 0.008) and tongue thrusting (p-value = 0.025). Although parental intervention was common, it was not significantly associated with overall child-reported oral habit scores. The median ICON score was 41, and 46.3% of children required orthodontic treatment. Child attitude was significantly associated with malocclusion severity (p-value <0.001), orthodontic treatment need (p-value = 0.005), and ICON score (r = 0.432, p-value <0.001), whereas parental knowledge showed no significant association with orthodontic outcomes. These findings highlight the relevance of child-related factors, particularly attitudes, in orthodontic outcomes and support integrating child-centered oral health education, parental guidance, and objective orthodontic assessment for early identification and prevention of malocclusion.

References

1. Lombardo G, Vena F, Negri P, et al. Worldwide prevalence of malocclusion in the different stages of dentition: A systematic review and meta-analysis. Eur J Paediatr Dent. 2020; 21 (2): 115-122. DOI: 10.23804/ejpd.2020.21.02.05.

2. Chen H, Lin L, Chen J, et al. Prevalence of Malocclusion Traits in Primary Dentition, 2010–2024: A Systematic Review.Healthcare. 2024; 12 (13): 1321. DOI: 10.3390/healthcare12131321.

3. Sá-Pinto AC, Rego TM, Marques LS, et al. Association between malocclusion and dental caries in adolescents: A systematic review and meta-analysis. Eur Arch Paediatr Dent. 2018; 19 (2): 73–82. DOI: 10.1007/s40368-018-0333-0.

4. Singh A, Purohit B. Is malocclusion associated with dental caries among children and adolescents in the permanent dentition? A systematic review. Community Dent Health. 2021; 38 (3): 172–177. DOI: 10.1922/CDH_00340Singh06.

5. Achmad H, Halid S, Fatimah I, et al. Analysis of the correlation between malocclusion, bad oral habits, and the caries rate in adolescents: A systematic review. J Popul Ther ClinPharmacol. 2023; 30 (8): 485–496. DOI: 10.47750/jptcp.2023.30.08.052.

6. Paolantonio EG, Ludovici N, Saccomanno S, et al. Association between oral habits, mouth breathing and malocclusion in Italian preschoolers. Eur J Paediatr Dent. 2019; 20 (3): 204–208; DOI: 10.23804/ejpd.2019.20.03.07.

7. Triwardhani A, Winoto ER, Pramusita A, et al. Prevalence of malocclusion and craniofacial morphological variations among 7-13-year-old children in Elementary School, Kediri.Indonesian J Dent Med. 2024; 7 (2): 60–63. DOI: 10.20473/ijdm.v7i2.2024.60-63.

8. Putri VAV, Triwardhani A, Nugraha AP. Orthodontic treatment needs and malocclusion prevalence according to index of complexity, outcome and need in Kediri, Indonesian 7-to-13 years-old children. J Int Dent Med Res. 2024; 17 (2): 764–768.

9. Ayu KV, Budijanana IDG, Hidajah N, et al. Correlation of Mouth Breathing Habits to Dental Malocclusions. Interdent J Kedokteran Gigi. 2023; 19 (1): 17–21. DOI: 10.46862/interdental.v19i1.6318.

10. Liu D, Li H. Knowledge, attitude, and practice of adolescents and parents toward malocclusion and orthodontic treatment. Sci Rep. 2024; 14: 26553. DOI: 10.1038/s41598-024-77474-8. 11.Zhou X, Wang J, Gou Q, et al. Parental knowledge, attitudes, and practices regarding malocclusion in preschool children.Sci Rep. 2025; 15: 15567. DOI: 10.1038/s41598-025-99314-z.

12. Zhang N, Guo J, Yang B, et al. Parents’ knowledge, attitudes, and practices regarding the impact of children’s oral habits on the development of the orofacial system. BMC Public Health. 2025; 25: 4396. DOI: 10.1186/s12889-025-25705-6.

13. Kaushik M, Sood S. A systematic review of parents’ knowledge of children’s oral health. Cureus. 2023; 15 (7): e41485. DOI: 10.7759/cureus.41485.

14. Bittlingmayer U, Islertas Z, Sahrai E, et al. Health Literacy from a Health Ethnology Perspective: An Analysis of Everyday Health Practices of Migrant Youth and Families. Wiesbaden: Springer; 2023. DOI: 10.1007/978-3-658-42348-3.

15. Sudrik SS, Shashikiran ND, Gaonkar N, et al. Management of Persistent Thumb-Sucking Habit Using a Modified Thumb Guard Appliance: A Case Report. Cureus. 2026; 18 (6): e111565. DOI: 10.7759/cureus.111565.

16. Rodas-Fernandez K, Ortiz-Pizarro M, Julca-Levano J-C, et al. Effectiveness of Motivational Interviewing in Parents to Modify Knowledge About Children Sucking Habits. J Int Dent Med Res. 2025; 18 (1): 197–203.

17. Irawan A, Marsyama’ah. The detrimental effects of oral bad habits on children’s oral health and dental development. Crown J Dent Health Res. 2023; 1 (2): 56–62. DOI: 10.59345/crown.v1i2.87.

18. Sikorska A, Cudziło D, Matthews-Kozanecka M, et al. Impact of incorrect oral habits on mastication anomalies in children and adolescents—literature review and own observations. Dev Period Med. 2016; 20 (4): 325–327.

19. Galán-González AF, Domínguez-Reyes A, Cabrera-Domínguez ME. Influence of bad oral habits upon the development of posterior crossbite in a preschool population. BMC Oral Health. 2023; 23: 923. DOI: 10.1186/s12903-023-03572-0.

20. Katib HS, Aljashash AA, Albishri AF, et al. Influence of oral habits on pediatric malocclusion: Etiology and preventive approaches. Cureus. 2024; 16 (11): e72995. DOI: 10.7759/cureus.72995.

21. Almugairin S, Alwably A, Alayed N, et al. Parental knowledge, awareness, and attitudes towards children’s oral habits: A descriptive cross-sectional study. Acta Odontol Scand. 2025; 84: 42643. DOI: 10.2340/aos.v84.42643.

22. Thomes CR, de Arruda TQ, Monteiro NMG, et al. Factors Associated with Deleterious Sucking Habits in Childhood: Integrative Literature Review. Saúde Coletiva. 2026; 17 (104): 18964–18971. DOI: 10.36489/saudecoletiva.2026v17i104p18964-18971.

23. Paiva CR, Alves Filho A de O, Medina PO, et al. Agreement Between Reports of Parents and Children About Children’s Oral Health-Related Quality of Life. Pesqui Bras Odontopediatria Clin Integr. 2019; 19: e4759. DOI: 10.4034/PBOCI.2019.191.124.

24. Mansur EKM, Thomson WM, Buzaribah KSH, et al. Concordance between Libyan child and parent self-reports of oral-health-related quality of life. J Indian Assoc Public Health Dent. 2021; 19 (2): 144–151. DOI: 10.4103/jiaphd.jiaphd_186_20.

25. Bunta O, Filip I, Garba C, et al. Tongue behavior in anterior open bite—a narrative review. Diagnostics. 2025; 15 (6): 724. DOI: 10.3390/diagnostics15060724.

26. Sahil S, Soni S, Kaur G. Challenging Malocclusion in Orthodontics: The Open Bite. Int J Health Sci. 2021; 5 (S2): 125–134. DOI: 10.53730/ijhs.v5nS2.5581.

27. Nasim VS, Nasim R, Nayak S, et al. Oral Habits and Their Impact on Developing Dentofacial Structures: A Cross-Sectional Study in Children Aged 4-12. Bull Stomatol Maxillofac Surg. 2025; 21: 490–496. DOI: 10.58240/1829006X-2025.21.10-490.

28. Gutierrez DS, Daley SF, Carugno P. Thumb Sucking and Other Nonnutritive Sucking Habits in Children. Saint Petersburg, FL: StatPearls Publishing; 2026.

29. Lin L, Zhao T, Qin D, et al. The impact of mouth breathing on dentofacial development: A concise review. Front Public Health. 2022; 10: 929165. DOI: 10.3389/fpubh.2022.929165.

30. Bradshaw S, Bem D, Shaw K, et al. Improving health, wellbeing and parenting skills in parents of children with special health care needs and medical complexity–a scoping review. BMC Pediatr. 2019; 19: 301. DOI: 10.1186/s12887-019-1648-7.

31. Khairinisa S, Setiawati F, Maharani DA, et al. Validity of mother-child self-perceived oral health for the assessment of 5 years old children’s oral health in Indonesia. BMC Oral Health. 2023; 23: 172. DOI: 10.1186/s12903-023-02876-5.

32. Rosalien R, Saragih FAI, Agustanti A, et al. Validity of self-perceived and clinically diagnosed Gingival Status among 12–15-year-old children in Indonesia. Asian Pac Isl Nurs J. 2019; 4 (2): 72–76. DOI: 10.31372/20190402.1033.

33. Maharani DA, Adiatman M, Rahardjo A, et al. An assessment of the impacts of child oral health in Indonesia and associations with self-esteem, school performance and perceived employability. BMC Oral Health. 2017; 17: 65. DOI: 10.1186/s12903-017-0358-5

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