Cited by 864Dental Health and Care UtilizationOral microbiology and periodontitis researchChild and Adolescent Health

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Influences on children’s oral health: A conceptual model

Fisher-Owens, Susan A., Gansky, Stuart A., Platt, Larry J., Weintraub, Jane A., Soobader, Mah-J, Bramlett, Matthew D., Newacheck, Paul W.·2007·Pediatrics

DOI 10.1542/peds.2006-3084

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Abstract

OBJECTIVES. Despite marked improvements over the past century, oral health in America is a significant problem: caries is the most common chronic disease of childhood. Much oral health research examines influences primarily in the oral cavity or focuses on a limited number of individual-level factors. The purpose of this article was to present a more encompassing conceptual model of the influences on children's oral health. METHODS. The conceptual model presented here was derived from the population health and social epidemiology fields, which have moved toward multilevel, holistic approaches to analyze the complex and interactive causes of children's health problems. It is based on a comprehensive review of major population and oral health literatures. RESULTS. A multilevel conceptual model is described, with the individual, family, and community levels of influence on oral health outcomes. This model incorporates the 5 key domains of determinants of health as identified in the population health literature: genetic and biological factors, the social environment, the physical environment, health behaviors, and dental and medical care. The model recognizes the presence of a complex interplay of causal factors. Last, the model incorporates the aspect of time, recognizing the evolution of oral health diseases (eg, caries) and influences on the child-host over time. CONCLUSIONS. This conceptual model represents a starting point for thinking about children's oral health. The model incorporates many of the important breakthroughs by social epidemiologists over the past 25 years by including a broad range of genetic, social, and environmental risk factors; multiple pathways by which they operate; a time dimension; the notion of differential susceptibility and resilience; and a multilevel approach. The study of children's oral health from a global perspective remains largely in its infancy and is poised for additional development. This work can help inform how best to approach and improve children's oral health.

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Antibacterial Effect of Azadirachta Indica (Neem Extract) and Antibacterial Effect of Azadirachta Indica (Neem Extract) and Chlorhexidine as Cavity Disinfectants in Primary Teeth in a Group Chlorhexidine as Cavity Disinfectants in Primary Teeth in a Group of Egyptian Children (A Randomized Clinical Trial)
elhabbak, M., Dokky, N. E., ElSheikh, M., & Alaa, E. (2021) · Future Dental Journal · doi:10.54623/fdj.7025 · Cited by 2
Improving the Oral Health of Pregnant People: The Need for a Health Care-Public Health Partnership
Kumar, J., & Samelson, R. (2022) · Journal of the California Dental Association · doi:10.1080/19424396.2022.12220700 · Cited by 2
The differential predictive utility of two caregiver-targeted self-efficacy measures to promote oral health of underserved children.
Hevel, D. J., Henshaw, M., Endrighi, R., Adams, W. G., Heeren, T., Jankowski, A., & Borrelli, B. (2023) · Health Psychology · doi:10.1037/hea0001308 · Cited by 2
A Systematic Review of The Relationship Between Parental Stress and Early Childhood Caries
Kalmadka, S. (2023) · Journal of Dentistry and Oral Sciences · doi:10.37191/mapsci-2582-3736-5(2)-151 · Cited by 2
Feasibility of community-based silver diamine fluoride (SDF) initiatives for dental caries control: An Indian perspective
Sultan, A., Juneja, A., Siddiqui, M., & Kaur, G. (2023) · Archives of Dental Research · doi:10.18231/j.adr.2023.015 · Cited by 2
Adverse childhood experiences, dental insurance, and developmental disability: Association with unmet dental needs in Ohio
Horter, L., Richardson, C., Paul, M., & Meyer, B. D. (2024) · Journal of Public Health Dentistry · doi:10.1111/jphd.12605 · Cited by 2
Neighborhood and family social capital and oral health status of children in Iowa
Reynolds, J. C. (2013) · doi:10.17077/etd.9msmmfp0 · Cited by 2
Community dental clinics in British Columbia
Wallace, B. B. (2012) · cIRcle (University of British Columbia) · doi:10.14288/1.0073290 · Cited by 2
Oral Health Equity for Minority Populations in the United States
Northridge, M. E. (2018) · doi:10.1093/obo/9780199756797-0172 · Cited by 2
Editorial: Impact of parental education and socio-economic status on children’s oral health behaviors
Mansur, E. K. M., Rothen, M. L., & Gao, S. S. (2025) · Frontiers in Oral Health · doi:10.3389/froh.2025.1755103 · Cited by 2
Oral health: Epidemiology and concordance in Australian children and parents
Stormon, N., Clifford, S. A., Lange, K., Mangoyana, C., Ford, P. J., Wake, M. A., & Lalloo, R. (2021) · Community Dentistry And Oral Epidemiology · doi:10.1111/cdoe.12662 · Cited by 1
A scoping review of intervention components of school‐based oral health‐related behavioural interventions using the Theoretical Domains Framework
Wang, M., Wu, J., & Shih, W.-Y. (2021) · European Journal Of Oral Sciences · doi:10.1111/eos.12841 · Cited by 1
Daily Toothbrushing Frequency and the Association with Parental Report of Dental Pain and Discomfort in Preschool Children
Menoncin, B. L. V., Felipak, P. K., Fraiz, F. C., de Souza, J. F., & de Menezes, J. V. N. B. (2022) · Pesquisa Brasileira em Odontopediatria e Clínica Integrada · doi:10.1590/pboci.2022.022 · Cited by 1
Dental radiographic changes in individuals with COVID-19: a controlled retrospective study
YİĞİT, M. K., Akyol, R., YALVAÇ, B., & Etöz, M. (2023) · Oral Radiology · doi:10.1007/s11282-023-00713-7 · Cited by 1
“They stated that the possible reasons for this could be the policy measures to control the COVID-19 epidemic and its transmission and, accordingly, the change in the family environment, which is an important determinant of pediatric dental caries [63].”
User requirement gathering for online oral health education module development: Exploring parental perspective
Sundram, M. B., Kuppusamy, E., Yazid, F., & Rani, H. (2023) · Digital Health · doi:10.1177/20552076231203949 · Cited by 1
Assessing Oral Health in U.S. Children and Its Impact on Disparities of Overall Health and Health Expenditures: An Application Using Two-Stage Clustering
Rosenberg, M. A., Yun, S., & Kim, K. (2024) · North American Actuarial Journal · doi:10.1080/10920277.2023.2291042 · Cited by 1
“Children are selected as the target group in our study, because oral health issues in children are generally preventable with inexpensive care, as compared to when the disease spreads (Fisher-Owens et al. 2007).”
Applying Community-Based Participatory Research Principles to Global Oral Health: A Case Study from Costa Rica
Danesh, D. O., Lisann, R., Faerron-Guzman, C. A., Mora, G. A. B., Bejarano-Palacios, D., & Bejarano-Bejarano, M. (2024) · Journal of the California Dental Association · doi:10.1080/19424396.2024.2330558 · Cited by 1
Application of principles learned in a prevention‐focused pediatric dental residency curriculum to professional practice
Ramos‐Gomez, F., Kinsler, J. J., Wang, Y., Parkinson, S., & Pike, N. A. (2024) · Journal of Dental Education · doi:10.1002/jdd.13670 · Cited by 1
Motivational interviewing at home
Cartes‐Velásquez, R., & Machuca, L. H. L. (2024) · The Journal of the American Dental Association · doi:10.1016/j.adaj.2024.09.012 · Cited by 1
Oral health skills framework for pregnant women: a professional consensus
Tenenbaum, A., Yazdanbakhsh, M., CERDAN, I., Omiya, J., de Andrade, V., Maurice, A., Marquillier, T., Margat, A., Lombrail, P., Gagnayre, R., et al. (2026) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-026-09331-7 · Cited by 1
Conhecimento, atitudes e práticas maternas em relação a saúde bucal na infância
Erckmann, M. C., Guanabara, V. O., dos Santos, V. V., da Rosa, C. G., & Masiero, A. V. (2024) · Cuadernos de Educación y Desarrollo · doi:10.55905/cuadv16n13-049 · Cited by 1
Exploring Migrant Mothers' Utilisation of Oral Health‐Related Information: A Qualitative Interview Study in the Swedish Context
Shmarina, E., Stensson, M., & Jacobsson, B. (2024) · International Journal of Dental Hygiene · doi:10.1111/idh.12901 · Cited by 1
Retrospective Evaluation of Fluoride Varnish Application Programs and Their Impact on Early Childhood Caries
Vaval, V., Mondal, A., Tiwari, R., Dubey, R., Priyadarshini, S., Gupta, S. K., Sharma, N., & Managutti, A. M. (2025) · Journal of Pharmacy And Bioallied Sciences · doi:10.4103/jpbs.jpbs_673_24 · Cited by 1
“[5] The application of fluoride varnish programs varies greatly between various healthcare settings and populations, despite its shown efficacy.”
EFFECTIVENESS OF ASSISTED TOOTHBRUSHING ON PRESCHOOLERS’ ORAL HYGIENE: A CAREGIVER-INTERVENTION APPROACH
Limo, L., Ayala-Mendívil, R. E., & Martins, J. G. (2025) · Journal of Evidence Based Dental Practice · doi:10.1016/j.jebdp.2025.102138 · Cited by 4
A cross-sectional study of mothers’ oral health literacy on oral health status of children
Nourian, A., Tapak, L., Daneshyar, F., & Afshari, M. (2025) · Community Dental Health · doi:10.1177/0265539x251355305 · Cited by 1
“In our study, we utilized the WHO ’ s pathway model tailored for oral health (Watt and Sheiham, 2012), and the conceptual framework of Fisher-Owens et al. (2007).”
Adverse childhood experiences from birth to age 6 years and changes in dental caries experience from age 7 to 10 years
Jawad, N., Golkari, A., & Bernabé, E. (2025) · Journal of Dentistry · doi:10.1016/j.jdent.2025.105966 · Cited by 1
Inanspruchnahme und Kosten zahnärztlicher Leistungen zur Versorgung und Prävention im Kindes‑, Jugend- und jungen Erwachsenenalter: Eine Querschnittanalyse anhand von Routinedaten aus Deutschland
Grochtdreis, T., Kayser, M., Bergmann, A., Bergmann, N., Bock, F. D., Boutmans, C., Petrakakis, P., König, H., Dams, J., & Alayli, A. (2025) · Prävention und Gesundheitsförderung · doi:10.1007/s11553-025-01237-0 · Cited by 1
Can the duration of breastfeeding affect oral health on adulthood?
Buali, D., & DELGADO-ANGULO, E. K. (2025) · Community Dental Health · doi:10.1177/0265539x251365727 · Cited by 1
“Oneofthe most prevalent oral health issues is dental caries (GBD 2019 Diseases and Injuries Collaborators, 2023), a complex and multifactorial infectious disease, in ﬂ uenced by various biological, environmental, and behavioural factors (Fisher-Owens et al., 2007).”
Evaluation of socioeconomic inequalities in dental caries levels in Chilean children aged 6 years, 2008–2023
Celis, A., Meleda, M., Pérez, A., Celis-Dooner, J., & Ortuño, D. (2025) · Community Dental Health · doi:10.1177/0265539x251369459 · Cited by 1
“Socioeconomic status (SES) has been identi ﬁ ed as one of the most critical determinants of oral health (Fisher-Owens et al., 2007).”
A cross-sectional study on factors associated with oral health behaviors in lower primary school students using social cognitive theory
Wang, Q., Lin, J., Shi, X., Zhang, S. Y., Tian, Z., Liu, Y., Shi, H., & Wang, J. (2025) · BMC Oral Health · doi:10.1186/s12903-025-07305-3 · Cited by 1
“Children’s healthy behavior habits are often formed in the family environment, the family is an important place for children to acquire oral health knowledge and behavioral norms, and parents’ behavior patterns can significantly associate children’s healthy behavior habits [14, 15, 43].”
Intergenerational Oral Conditions’ Relationships: The Role of Sugar Intake
Kiuchi, S., Schuch, H. S., Matsuyama, Y., Osaka, K., Aida, J., Do, L., & Ha, D. H. (2025) · JDR Clinical & Translational Research · doi:10.1177/23800844251390461 · Cited by 1
“Sharing similar eating habits, unfavorable oral care habits, and lack of access to dental care have been reported as mechanisms of oral health relationships between mothers and children (Fisher-Owens et al 2007; Shearer and Thomson 2010; Scaglioni et al 2011; Goettems et al 2018).”
G-Computation Quantifying Caries Reduction by World Health Organization Sugar Limits in Children
Dao, A. T. M., Do, L., Stormon, N., Nguyen, H. V., & Ha, D. H. (2026) · Journal of Dental Research · doi:10.1177/00220345251406559 · Cited by 1
“…by integrating stages of translational science (Nazarian 2023), building on evidence that SES is a fundamental driver of dental health inequalities (Fisher-Owens et al 2007; Do et al 2022) and that FSI is a key mediator linking SES to ECC (Dao et al 2025b), our study advances to estimate the…”
Conceptual modeling of child temperament, emotional and behavioral problems, and parenting style in relation to children’s oral health and dental visit behavior
Önsüren, A. S., & Arslan, S. C. (2026) · Scientific Reports · doi:10.1038/s41598-025-25243-6 · Cited by 1
“Fisher-Owens et al. 3 acknowledged the challenges associated with applying theoretical models to real-world practice.”

Authors: Fisher-Owens, S. A., Gansky, S. A., Platt, L. J., Weintraub, J. A., Soobader, M.-J., Bramlett, M. D., & Newacheck, P. W.
Affiliations: Department of Pediatrics
University of California, San Francisco (US)
Statworks, Boston, Massachusetts
Centers for Disease Control and Prevention (US)
ORCID: Gansky, Stuart A.
Weintraub, Jane A.
Venue: Pediatrics
Publisher: American Academy of Pediatrics (AAP)
Published: 2007-09-01
Volume: 120
Issue: 3
Pages: e510-e520
ISSN: 0031-4005 (ISSN-L)
1098-4275
DOI: 10.1542/peds.2006-3084
OpenAlex: W2039971937
Semantic Scholar: 26d7508015c25539bc2679c72746d3458dd6f669
Cited by: 864
References: 134
Citations by year: 2026: 50 · 2025: 58 · 2024: 79 · 2023: 57 · 2022: 83 · 2021: 77 · 2020: 63 · 2019: 57 · 2018: 39 · 2017: 53 · 2016: 35 · 2015: 58 · 2014: 35 · 2013: 37 · 2012: 36
FWCI: 9.76
Type: journal article
Language: en
Open access: closed
Locations: PEDIATRICS (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health
National Institute of Dental and Craniofacial Research (R03 DE165701, R03DE016571, U54DE014251)
Topics: Health Sciences › Dentistry › General Dentistry › Dental Health and Care Utilization
Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Child and Adolescent Health
Keywords: children's oral health, dental caries, conceptual model, multilevel analysis, social determinants of health, family and community influence, social environment, physical environment, health behavior, access to dental care, health care, differential susceptibility, resilience, temporal dimension
MeSH terms: Anthropometry, Child, Child Development, Disease Susceptibility, Family, Humans, Insurance, Dental, Health Knowledge, Attitudes, Practice, Models, Biological, Oral Health, Oral Hygiene, Patient Acceptance of Health Care, Risk Factors, Sex Factors, Social Environment, Socioeconomic Factors, Health Behavior, Dental Care for Children, Racial Groups

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Influences on children’s oral health: A conceptual model

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