Structural equation modeling to identify social and physical risk indicators of early childhood caries in suburban Nigerian population

Background Early Childhood Caries (ECC) is a growing public health problem in low and middle-income countries like Nigeria. This study aimed to identify the social and physical risk indicators of ECC among children in the Ile-Ife Central Local Government Area of Nigeria. Methods A cross-sectional study was conducted among 895 mother-child dyads aged 0–60 months between December 2024 and January 2025. The outcome variable was ECC experience. The latent variable s were socioeconomic status (SES), maternal oral health knowledge (MOHK), oral hygiene status (OHS), and household dietary sugar exposure (HDSE). Child age and maternal time availability for breastfeeding were included as observed covariates. Diagonally Weighted Least Squares Structural Equation Modelling (DWLS-SEM) was utilized to fit the model, with bootstrap estimation (1,000 resamples) for indirect and total effects. Results Among 895 mother-child dyads, 66 children (7.4%) had ECC and 1.5% had PUFA ≥ 1. The model demonstrated good fit (CFI = 0.959, TLI = 0.952, RMSEA = 0.045). There was a significant positive association between SES and maternal knowledge ( β  =  + 0.47, p  < 0.001), and negative associations between SES and oral hygiene status ( β  = −0.17, p  = 0.004) and ECC ( β  = −0.15, p  = 0.034). Oral hygiene status showed the strongest direct association with ECC ( β  =  + 0.32, p  = 0.008). Child age had a significant indirect effect on ECC via oral hygiene ( β  =  + 0.10) but no significant direct effect. Higher maternal knowledge was paradoxically associated with poorer oral hygiene ( β  =  + 0.13, p  = 0.010). Limited maternal time for breastfeeding was positively associated with ECC ( β  =  + 0.10, p  = 0.020). Dietary sugar exposure showed a small but marginal significant model-level association ( β  = +0.13, p  = 0.08). The total effect of SES on ECC ( β  = −0.19) exceeded its direct effect, with oral hygiene mediating the largest indirect pathway. Conclusion The findings highlight that ECC in this population is primarily structured by socioeconomic position rather than knowledge alone, underscoring the need for interventions addressing structural inequalities and resource constraints alongside behavior change strategies.