In total, 48 Brazilian immigrant parents (29 mothers and 19 fathers) participated in the study. As seen in
Sample characteristics.
| Variables | Total (N=48) | Fathers (n=19) | Mothers (n=29) |
| Age, mean (SD) | 36.5 (6.6) | 39.1 (6.8) | 33.9 (6.5) |
| Race, n (%) | |||
| 15 (31.3) | 6 (31.6) | 9 (31) | |
| 5 (10.4) | 1 (5.3) | 4 (13.8) | |
| 28 (58.3) | 12 (63.1) | 16 (55.2) | |
| Marital status, n (%) | |||
| 41 (85.4) | 19 (100) | 22 (75.9) | |
| 3 (6.3) | 0 (0) | 3 (10.3) | |
| 4 (8.3) | 0 (0) | 4 (13.8) | |
| Educational attainment, n (%) | |||
| 10 (20.8) | 6 (31.6) | 4 (13.8) | |
| 23 (47.9) | 7 (36.8) | 16 (55.2) | |
| 15 (31.3) | 6 (31.6) | 9 (31) | |
| Household income per year (US $), n (%) | |||
| <45,000 | 14 (29.1) | 6 (31.6) | 8 (27.6) |
| ≥45,000 to <65,000 | 25 (52.1) | 11 (57.9) | 14 (48.3) |
| 9 (18.8) | 2 (10.5) | 7 (24.1) | |
| Number of children between 2 and 5 years old in the household, n (%) | |||
| 34 (70.8) | 9 (47.4) | 25 (86.2) | |
| 14 (29.2) | 10 (52.6) | 4 (13.8) | |
| Born in Brazil, n (%) | |||
| 48 (100) | 19 (100) | 29 (100) | |
| States of origin, n (%) | |||
| 28 (58.2) | 8 (42.1) | 20 (69) | |
| 4 (8.3) | 2 (10.5) | 2 (6.9) | |
| 5 (10.5) | 2 (10.5) | 3 (10.2) | |
| 2 (4.2) | 0 (0) | 2 (6.9) | |
| 1 (2.1) | 0 (0) | 1 (3.5) | |
| 1 (2.1) | 0 (0) | 1 (3.5) | |
| 4 (8.3) | 4 (21) | 0 (0) | |
| 1 (2.1) | 1 (5.3) | 0 (0) | |
| 1 (2.1) | 1 (5.3) | 0 (0) | |
| 1 (2.1) | 1 (5.3) | 0 (0) | |
| Years of residence in the United States, n (%) | |||
| 27 (56.3) | 13 (68.5) | 14 (48.3) | |
| 16 (33.3) | 4 (21) | 12 (41.4) | |
| 5 (10.4) | 2 (10.5) | 3 (10.3) | |
| Primary language spoken at home, n (%) | |||
| 48 (100) | 19 (100) | 29 (100) | |
| SASH | |||
| 47 (97.9) | 19 (100) | 28 (96.6) | |
| 1 (2.1) | 0 (0) | 1 (3.4) | |
| Health care insurance, n (%) | |||
| 44 (91.7) | 17 (89.5) | 27 (93.1) | |
| 4 (8.3) | 2 (10.5) | 2 (6.9) | |
| Dental care insurance, n (%) | |||
| 33 (68.7) | 17 (89.5) | 16 (55.2) | |
| 15 (31.3) | 2 (10.5) | 13 (44.8) | |
aSASH: Short Acculturation Scale for Hispanics.
The majority (n=41, 85.4%) of the participants was married or living with a partner. All participants were born in Brazil, with 58.2% (n=28) originating from the state of Minas Gerais. Over half (n=27, 56.3%) had lived in the United States for less than 5 years. Portuguese was the primary language spoken at home, and 97.9% (n=47) scored below 2.99 on the SASH scale, indicating low acculturation to the United States.
Educational attainment varied among participants, with 79.2% (n=38) having completed high school or more. About half reported an annual household income between US $45,000 and US $65,000 (n=25, 52.1%). Most parents (n=34, 70.8%) had one child aged 2 to 5 years, while 29.2% (n=14) had 2 children in that age range. The majority of participants (n=44, 91.7%) was enrolled in public or government-sponsored health insurance programs, and 68.7% (n=33) reported having dental insurance.
The analysis revealed a range of factors influencing Brazilian immigrant parents’ perspectives on early childhood oral health. These findings are organized according to the SEM. A conceptual model (
Social ecological model of influences on Brazilian immigrant parents’ perspectives on oral health in early childhood and suggested strategies for education, access, and care.
Parents identified limited knowledge and language obstacles as barriers that they and other Brazilian immigrant families face in supporting their children’s oral health. Several noted that caregivers often lack basic information about pediatric dental care. As one mother explained, “There are many mothers who are not educated on how to take care of their kids’ teeth. They don’t know what’s important
Language barriers were also widely reported, particularly among those newer to the United States. Participants spoke limited English proficiency made it difficult to understand dental recommendations, navigate insurance, or communicate with providers, undermining parents’ confidence and ability to advocate for their children. One mother shared, “I’m not fluent in English. It would help to have information in our language” (mother #7). Another parent stressed the need for organizations that support families struggling with language challenges, “There should be places that help families like ours understand things better, especially when we don’t speak the language well” (mother #14).
Parents who had lived in the United States for fewer than 5 years more frequently reported these difficulties. This highlights how language barriers and cultural unfamiliarity compounded challenges in accessing timely and appropriate dental care.
To address key gaps, parents emphasized the importance of parents and children being provided culturally tailored oral health education especially in Portuguese, when their children are very young to build knowledge and support home-based routines, such as brushing, limiting sugary snacks, and modeling good habits. One mother explained, “Children need encouragement, so that in the future they don’t end up spending money fixing dental problems—if they take care of their teeth consistently” (mother #11).
Parents felt that community-based programs were the most likely to be effective. Parents called for “more educational programs” (mother #19), and one father described the need for initiatives “showing the importance of oral health for children and families, and the damage of not taking care of your mouth and teeth” (father #10). These programs were viewed as particularly important for families new (<5 years) to the United States.
Digital and visual learning tools were widely recommended to improve accessibility and engagement. Suggestions included “videos” (father #6), “podcasts” (father #8), “mobile brushing games” (father #14), and “cartoons for children” (mother #18). Mothers generally expressed a stronger preference for visual and interactive materials that they could use together with their children, reflecting their more active roles in day-to-day child care. In contrast, fathers preferred digital formats they could access on their own during commutes or work breaks.
Language remained a significant barrier, particularly for newer immigrants. Participants with lower English proficiency and shorter US residence were more likely to report difficulties related to language and cultural challenges when accessing dental services. Many stressed the need for materials and support in Portuguese to boost their confidence and ability to care for their children’s oral health. As one father said, “If I had information in Portuguese, I’d feel more confident taking care of my kids’ teeth” (father #9), while another noted, “You trust more when someone speaks your language and understands where you come from” (father #5).
At the interpersonal level, parents described how their relationships with their children, peers, and broader social networks influence oral health behaviors. Key themes included the role of peer modeling and school-based learning in shaping children’s habits, the challenges parents face in modeling oral health behaviors due to limited knowledge, and the importance of informal social networks, particularly within immigrant communities, for sharing information and accessing support.
Many parents noted that children learn by observing and often mimic what they see at school or from peers. For example, one mother said, “When this is taught at school, kids come home wanting to do it. When it’s only from parents, it doesn’t always work” (mother #20). Similarly, a father shared, “Children like to imitate” (father #12), highlighting the strong influence of peer behavior on home routines.
While parents tried to serve as educators, several noted that a lack of oral health knowledge among other adults undermined their ability to model good habits. One mother explained, “... Because there are many mothers who are not educated on how to take care of their kids’ teeth. They don’t know what’s important” (mother #12).
Parents often shared oral health experiences and information within informal community groups. One mother emphasized the role of peer support: “I usually hear about new things from other moms—like which toothpaste is best or when to take my child to the dentist. We really learn from each other” (mother #13). Another highlighted the need for greater connection among parents, stating, “… programs that bring parents together and help us support each other with our children’s daily oral health care” (mother #6).
Parents who had recently arrived in the United States and those with lower household incomes or without dental insurance more frequently emphasized the need for accessible, no-cost community resources. For these families, support through free cleanings, oral hygiene kits, and multilingual education was seen not just as helpful but essential. These parents also described a greater reliance on informal community networks, such as churches or local nonprofits, to meet health-related needs, further underscoring the importance of community-based resources.
To overcome these interpersonal challenges, parents suggested strengthening culturally grounded, community-based programs that engage both families and peer groups. These programs could reinforce positive oral health behaviors by providing education and support within trusted social networks. As one mother expressed, “Programs that support us, helping with our children’s daily oral health care” (mother #19), underscoring the importance of accessible, community-rooted resources.
Parents felt that offering no-cost or low-cost services, oral hygiene kits, and multilingual educational materials through informal networks, such as churches and community centers, could improve access and engagement, especially for recent immigrants and lower-income families. As a father noted about trusted community venues,
Parents also valued school-based initiatives, seeing them as a way to promote healthy behaviors that children could bring home, helping to bridge gaps in parental knowledge and role modeling. As one mother reflected, “At my daughter’s daycare, they brush her teeth after lunch. They asked me if I wanted them to do it” (mother #8), highlighting the power of early education settings in shaping habits.
At the organizational level, parents highlighted the important role of institutions, such as schools, daycare centers, clinics, and pediatric offices, in shaping children’s oral health. However, parents also identified challenges and missed opportunities. Many parents noted missed opportunities in health care settings where oral health promotion and education could be better integrated. For example, some felt that dental health was overlooked during medical visits. One mother mentioned, “Sometimes when I take my child to the doctor, they only check the general health, and nobody asks about their teeth. It feels like dental health is forgotten” (mother #3). Additionally, unfamiliarity and a lack of culturally welcoming environments made navigating health care systems particularly difficult for immigrant families. One mother expressed, “First is information, for sure, but also being welcomed. That’s very important. One of the hardest things when you arrive here is not knowing where to go for help” (mother #10).
Parents strongly supported embedding oral health promotion within early education settings. They praised daycare programs where children’s teeth were brushed after meals, highlighting schools and daycares as critical sites for developing positive habits. For instance, a mother shared, “At my daughter’s daycare, they brush her teeth after lunch. They asked me if I wanted them to do it” (mother #8). Others suggested distributing toothbrushes and toothpaste in schools alongside instruction on proper use. One mother stated,
Despite this enthusiasm, participants noted a lack of oral health programs in local schools. Some reflected on more robust efforts in their home country of Brazil, such as fluoride days and school visits from dentists. As 1 mother recalled, “In Brazil, we had a fluoride day and dentists visiting schools. Here, there’s nothing like that” (mother #9). Parents reiterated the value of school-based efforts not only for education but also for motivating children through peer influence.
Regarding health care environments, parents recommended integrating oral health education into routine pediatric visits and offering workshops at clinics. One mother said, “Offer workshops at the same place where children are seen by doctors. Teach mothers how to prevent diseases too” (mother #12). Continuity of care and easier access to multiple clinics were also viewed as important, with parents advocating for follow-ups similar to pediatric care and more options for dental services.
Welcoming environments were especially valued. Parents appreciated when providers gave tangible tools, such as toothbrushes and toothpaste, helping children get excited about brushing. One mother reflected, “First is information, for sure, but also being welcomed. That’s very important. One of the hardest things when you arrive here is not knowing where to go for help” (mother #10). Another added, “The dentist gave my son a toothbrush and toothpaste. He came home super excited to brush” (mother 23). Relational and culturally sensitive care settings were seen as essential for building trust and encouraging ongoing engagement.
At the community level, parents identified environmental, cultural, and informational barriers that limited their ability to support their children’s oral health. These included a lack of localized services, culturally appropriate education, and outreach in trusted spaces. Recent immigrants particularly noted difficulties finding oral health resources in their language or in places they frequented. One mother recommended, “A program that goes into the communities, offering free help. Not everyone has health care or dental insurance” (mother #15). Another parent emphasized the need for local programs: “A more accessible program so that children can get cleanings for free. Some kids don’t even have MassHealth and can’t afford cleanings” (father #7).
Parents were enthusiastic about community-based outreach efforts that could bring oral health education and services into familiar and trusted environments. Health fairs, free hygiene kits, and toothbrushing demonstrations were widely supported. “Health fairs with free kits and toothbrushing demonstrations would really help” (father #6). “The only thing that could help would be providing us with oral hygiene products” (father #3).
Trusted local institutions, such as churches and community centers, were viewed as effective platforms for education and engagement. A mother explained, “Mothers are usually responsible for health in the family. Community centers could offer this support” (mother #11). A father added, “Churches already bring families together. Adding health workshops there would be very effective” (father #9).
Parents also suggested increasing the visibility of oral health messaging through flyers, posters, and small magazines placed in culturally relevant, high-traffic areas, such as supermarkets and bus stops. “Put up posters in places Brazilians go, like supermarkets or bus stops” (father #5). Another noted,
Particularly for those newer to the United States, culturally and linguistically appropriate messaging and delivery channels were vital. In contrast, parents with longer US residency often preferred institutional sources, such as schools and clinics, for receiving health information, suggesting a need for varied community engagement strategies.
At the policy level, parents highlighted structural barriers, particularly related to insurance coverage, service availability, and systemic navigation challenges. Many families described difficulties using public insurance programs, such as MassHealth, due to bureaucratic complexity and long wait times. One mother expressed, “Sometimes you try to make an appointment, and they say, ‘There are no slots. Your insurance isn’t active. You have to call MassHealth...’” (mother #9). Another stated,
These experiences reflect what many parents described as system-level inaccessibility, referring to barriers that stem not from a lack of individual effort or community-based resources but from the way the health care system is designed and operates. These include complex insurance rules, difficulty finding providers who accept public coverage, long appointment waiting times, and limited language support within insurance and health systems. For many families, these challenges made it difficult to navigate oral health care, even the services that were technically available.
Parents proposed policy-level changes such as expanding public dental coverage, increasing provider availability, and simplifying the process of booking appointments. For example, one mother suggested, “They should provide more assistance to families, maybe even schedule appointments through the schools” (mother #24), showing support for integrated service delivery.
There were also calls for systemic reforms to improve support for immigrant communities, such as enhanced language access and outreach by state programs. Broader investments in affordable dental services, policy incentives for providers to accept public insurance, and improved transparency around insurance benefits were also suggested to reduce disparities and ensure equitable care. One father stated: “It’s hard for families like mine to get good dental care. Sometimes we don’t undertsand the forms or what the insurance covers. I wish there were programs in our language and more clinics that take public insurance (MassHealth), so everyone could get the care they need” (father #4).