The Validity Gap and Premature Autonomy: Reframing Pediatric Oral Health in Latin America

Resumen

Background: Early Childhood Caries (ECC) remains a persistent public health problem in Latin America, affecting a majority of preschool children despite high levels of parental awareness regarding oral hygiene. This paradox highlights limitations of traditional prevention strategies that rely primarily on information delivery. Problem Analysis: This perspective synthesizes evidence from pediatric dentistry, behavioral science, and preventive medicine to identify two underrecognized barriers to effective ECC prevention. First, the “Validity Gap” refers to the discrepancy between caregiver-reported oral hygiene practices and objectively observed behaviors, largely driven by social desirability bias and misinterpretation of technical competence. Second, “Premature Autonomy” describes the widespread developmental misconception that young children possess the fine motor skills required for effective biofilm disruption, leading to early withdrawal of parental assistance. Conceptual Proposal: Reframing pediatric oral health as a core component of puericulture, we argue for a shift from passive advice toward active coaching and objective verification within primary pediatric care. Drawing on existing evidence, we outline a conceptual framework that emphasizes visual assessment tools (e.g., plaque disclosing agents), early clinical surveillance (“lift-the-lip” examinations), assisted brushing aligned with neurodevelopmental readiness (the “7-Year Rule”), and simulation-based caregiver education. Conclusion: Addressing ECC requires moving beyond knowledge transmission to focus on behavioral execution and developmental capacity. Integrating oral health into routine pediatric surveillance and adopting coaching-based preventive strategies may help bridge the translational gap between parental intent and effective home practice, positioning the oral cavity as a meaningful indicator of systemic child health.