## 4 Discussion
This finding could be explained by the fact that adjacent primary molars usually undergo operative procedures simultaneously, and therefore, the mean of the filled adjacent surfaces of these molars was similar in our study. The linear correlation between different surface conditions of the first and second primary molars showed that similar adjacent surfaces were highly correlated. The sound, decayed, and filled distal surfaces of the first primary molars were correlated with similar adjacent mesial surfaces of the second primary molars. The correlation observed in our study was similar to a study by [PERSON] et al., in which the researchers measured the effects of adjacent teeth on the prevalence of caries; they found a strong association between the caries status of a tooth and the caries status of its adjacent teeth [17]. The results of our study showed a significant relationship between children's cooperation and the presence of caries on the proximal surfaces of the primary molars. This finding is in accordance with another study that supports the fact that children's cooperation has an immense impact on their oral health [18]. Patient non-cooperation has been associated with dental fear and anxiety in the literature. The American Academy of Pediatric Dentistry uses the term \"behavior guidance\" in reference to modifying patient behavior, which includes anxiety and fear, in the dental setting [25]. The aim of behavior guidance is to maintain communication, build children's confidence to overcome their fear of the dental chair, improve parental awareness, and provide the best possible oral healthcare in a comfortable and effective way [25]. A cross-sectional study completed in Saudi Arabia found that fearful children were more likely to have a minimum of one untreated dental decay compared to cooperative children [26]. Another study among Saudi children found similar results with regard to dental fear and caries. In that study, children with dental fear had more carious teeth and fewer sound permanent teeth [27]. Children's negative behaviors can lead to treatment termination or incomplete dental therapy, resulting in fewer restorative treatments, and hence a lower association with filled surfaces [19]. Alternative behavioral management options, such as computerized local anesthesia, oral sedation, and general anesthesia, although effective in managing patient behavior, tend to be costly and are associated with a possible relapse of oral health issues [28; 29; 30; 31; 32; 33]. Children who undergo dental treatment under general anesthesia were more likely to experience poor oral health and recurrent early childhood caries after 19-24 months [31]. Thus, it is highly important to educate parents, dental students, and clinical practitioners about the influence of children's behaviors on oral health outcomes to improve oral health status and reduce the progression of dental caries. The implementation of community-based programs for schoolchildren to desensitize undesired behaviors, and encourage good cooperation, is also recommended. This could be accomplished by developing oral health education platforms for parents to raise their awareness regarding oral health and oral hygiene practices. On the other hand, it is also recommended that children with severe caries receive greater attention and are provided specific behavior management techniques based on their age to reduce the incidence of dental fear and anxiety [18]. Our study had several limitations. Since this was a retrospective study that extracted patient information from medical records, it was not possible to obtain additional information. These limitations could have been improved by the inclusion of additional patient factors that are known to influence caries patterns, such as the frequency of consumption of cariogenic foods, brushing practices, fluoride exposure, and parental socioeconomic background. According to the AAPD, socioeconomic status is considered a risk factor for developing caries [34]. [PERSON] et al.