Psychosocial and environmental factors implicated in the development of dental disease are not well understood, including parenting stress, social support, beliefs, caregiver perceived self-efficacy, and executive function.  The association between stress and chronic illness is well established in the medical literature.  However, the relationship between stress and dental caries is equivocal.  Social support also has received considerable attention in the general health literature, with social support reducing the adverse effects of many health conditions and contributing to positive well-being, improved quality of life and greater longevity.  Social support has received less attention in the oral health literature and relatively little in studies of ECC.  Reports from the Detroit Dental Health Project, a longitudinal study of low-income African American children and their caregivers, consistently demonstrate the importance of individual level, as well as neighborhood level, social support on reducing caries risk and in predicting caries progression among young children.

Theories of self-efficacy postulate that a person’s belief or confidence in their ability to perform certain actions influences the decision to perform these actions.  Self-efficacy has been found to be strongly associated with people’s decision to engage in a broad range of health behaviors.  The study of low income African American caregivers in Detroit investigated the effects of perceived self-efficacy about tooth brushing and perceived fatalism about children developing tooth decay.  Self-efficacy were fairly high indicating strong caregivers’ beliefs in their ability to brush their children’s teeth.

Ethnic minorities and new immigrants experience oral health disparities for many reasons beyond ability to pay for care.  A recent review of health disparities in the Veterans Affairs Health System suggests that the underlying problems are, in part, cultural differences in how health care providers interact with ethnic minority patients, levels of patient trust, how patients think about the etiology, course and outcomes of disease as well as access to social resources.