# Feeding Practices, Prenatal Oral Health Information, and Early Childhood Caries in Toddlers Born Before and During the COVID-19 Pandemic: A Cross-Sectional Study from Hungary

## TL;DR

This study compares tooth decay in Hungarian toddlers born before and during the pandemic, finding a slight decrease in caries but no benefit from prenatal oral health information.

## Contribution

The study reveals that pandemic-related changes may have reduced educational disparities in oral health outcomes among toddlers.

## Key findings

- Caries prevalence decreased slightly from 15.46% in 2019 to 13.87% in 2024.
- Prenatal oral health information did not affect caries rates or feeding habits.
- Parental education had less influence on caries in the 2024 cohort compared to 2019.

## Abstract

Objectives: Early childhood caries (ECC) remains a significant global health issue. COVID-19 disrupted protective factors such as in-office parental support and routine dental screenings. This study investigates caries prevalence and severity in Hungarian toddlers (<3 years) born during the lockdown, compared with pre-pandemic data from 2019. Methods: A serial cross-sectional study was conducted through nursery-based dental screenings and a parental questionnaire. Key indices (caries prevalence; average number of decayed, missing, and filled tooth—dmf-t index; Significant Caries Index—SiC-index; and Restorative Index—RI) were calculated and analyzed in relation to parental education and knowledge of caries etiology. The results were compared to 2019 data. Results: A total of 636 children were examined; 274 (mean age: 29.37 ± 4.56 months) were part of the 2024 cohort. Caries prevalence decreased from 15.46% in 2019 to 13.87%. The mean dmf-t index also declined significantly (0.685 ± 2.20 vs. 0.383 ± 1.29; p = 0.025). Initial feeding practices, such as exclusive breastfeeding, were positively linked to later liquid intake habits (p < 0.01). Prenatal information did not affect caries rates or cariogenic liquid consumption. While parental education level was significantly related to caries prevalence and feeding practices in 2019, its influence was less marked in the 2024 cohort. Conclusions: ECC prevalence declined slightly among children born during the pandemic but remains high. Prenatal education did not promote healthier feeding-related oral health behaviors or outcomes. The reduced impact of parental education post-lockdown may suggest that heightened general health awareness during the pandemic lessened education-based disparities.