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The prevention of caries – or cavities, as they are more commonly known – in children will require a greater focus on interventions aimed at supporting parents and strengthening the family environment. Denise Duijster is advocating these measures on the basis of her doctoral research, for which she will receive her doctorate from the University of Amsterdam on 6 February.

Girl is brushing her teeth
Photo: Flickr CC / Patrick

Duijster assessed the parental and family-related psychosocial factors that affect the occurrence of caries in children, and the extent to which these factors could potentially explain the social and economic differences in children's oral health.

‘Caries is still the most common chronic children's disease throughout the world, despite considerable investments in research and healthcare,’ Duijster explains. ‘We know that children's oral health is related to their parents' social and economic status. However, we still know little about the factors underlying this phenomenon.’

Functioning of the family environment

According to Duijster's research, children from families that function effectively in terms of communication, organisation and responsiveness and have a large social network have significantly less caries than children from less effective family environments. The amount of organisation, routine and structure proved to be especially important in this regard. Poorer functioning of the family environment is also associated with less frequent brushing, the start of brushing at a later age and less parental involvement in children's tooth brushing habits.

Positive involvement

Duijster also concludes that more effective parenting strategies based around positive involvement (showing interest and warmth), positive affirmation (stimulating and complimenting) and problem-solving ability are more commonly found in the parents of children without caries than the parents of children that do suffer from caries. An excessively strict disciplinarian attitude in combination with a lack of warmth in parent-child relationships also proved to be a strong indicator for the occurrence of caries in children.

Parental self-confidence

The self-confidence of parents also proves to play an important role. Duijster: ‘Parents that are less confident about their own “ability” to interact with their children in a healthy way are more likely to have children with caries. The same applies to parents with an external locus of control – defined as the belief that caries are the result of bad genes, chance or bad luck – whereby responsibility is externalised.’


D. Duijster, Family Matters: The Role of Parental and Family-related Psychosocial Factors in Childhood Dental Caries. Supervisors: Prof. G.H.W. Verrips and Prof. C. van Loveren.  

Time and location

The PhD defence ceremony will take place on Friday, 6 February at 13.00.
Location: Aula van de UvA, Singel 411, Amsterdam.