Understanding Oral Habits and Malocclusion in School-Aged Children: Insights from Parental and Child Knowledge, Attitudes, and Practices

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.