Purpose: To determine the latent class and heterogeneous associations of oral health behaviors (OHB) with caries in preschool children aged 3-6 years, and to develop effective oral health interventions for improving their health status.

Methods: Latent class analysis(LCA) was applied to classify eight OHBs in three dimensions: oral hygiene, dietary habits, and preventive protection in 595 preschool children. Optimal classes were determined using model fitting and explanatory metrics, and marginal effects were estimated using bivariate association and multivariate regression models. The correlation between OHBs and caries was explored using Chi-square and correspondence analysis with SPSS 27.0 software package.

Results: Among 595 preschool children, caries prevalence was 54%, and OHBs were classified into two latent classes: favorable (88%) and unfavorable (12%). Unfavorable OHBs were associated with higher caries prevalence (58% vs. 52%), poorer caries status (mean dmft: 3.52 vs. 2.44), and lower regular examination experience (63% vs. 66%) compared to favorable OHBs. The difference in caries severity distribution between the two classes was statistically significant (P<0.05).

Conclusions: Oral health behaviors in preschool children are heterogeneous and associated with caries. Effective interventions for improving OHBs in preschool children should be tailored according to this heterogeneity.

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