_applied sciences_  
_Apticle_  
_Does the Behavior of Pediatric Patients towards Dental Treatment Influence the Pattern of Adjacent (Sound, Decayed, and Filled) Proximal Surfaces in Primary Molars?_  
[PERSON] 1,*(c), [PERSON] 2, [PERSON] 2, [PERSON] 2, [PERSON] 2  
1 Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; kalkhal  
approximately 80% of individuals in developing countries, and approximately 90% of those caries are left untreated [2; 3; 4; 5]. In Saudi Arabia, despite the free dental services provided by the government, the prevalence of dental caries remains high [2]. During the last decade, the prevalence of caries in individuals with primary dentition in Saudi Arabia was reported to reach 95% [6]. In addition, previous studies in Riyadh, Jeddah, and Al-Hassa reported an average (decayed, missing, filled primary teeth) dmft score of approximately six [7; 8; 9; 10; 11]. This high prevalence and incidence of dental caries in children could be related to increased sugar consumption, dietary habits, and reduced awareness of oral health and diseases [4]. In fact, most Saudi children are at high risk for dental caries [5] despite the efforts of the Ministry of Health to provide dental care programs, such as the National Initiative, \"Prevent Tooth Caries\", that embraces the existing partnership between the Saudi Ministry of Health and the Ministry of Education [12].  
Proximal caries is a category of dental caries that develops between two adjacent teeth. It is crucial to detect proximal caries early in the development of primary dentition due to the rapid progression of caries between the adjacent surfaces of the teeth [13]. In comparison to permanent teeth, primary teeth have thinner enamel and dentine, a lesser degree of remineralization, and wider dental tubules [13]. The early detection of proximal caries in these teeth is a fundamental component of minimally invasive dentistry because the prevention of caries' progression to adjacent teeth is less destructive to tooth structures [14]. One method to define proximal caries in clinical studies is the use of the term caries adjacent to restoration (CAR) [15]. In one study, caries was significantly more prevalent in intact proximal surfaces next to recently placed composite posterior proximal restorations than on the contralateral control surface that did not have a restoration in contact (OR = 2.6, CI = 1.2-5.3) [16]. Caries adjacent to caries (CAC) is another method to define proximal caries in clinical studies [17]. A strong association has been reported between the caries status of a tooth and the caries status of adjacent teeth in 3-5-year-old children [17].  
Children's behaviors during dental treatment have a considerable impact on their oral health and the severity of dental caries [18]. They affect the distribution of caries, treatment outcomes, and their oral and systemic health status [19]. There are several factors that influence children's behaviors, such as their cognitive skills, family, and society, which consequently affect their oral health [20]. Treatment administration during pediatric dental visits can be terminated or interrupted due to children's negative behaviors, which results in poor oral health outcomes [21]. The influence of children's behaviors towards dental treatment on the relationship between the adjacent proximal surfaces (sound, decayed, or filled) in primary molars has not been well studied. This study will assist clinical practitioners in the improved management and prevention of the progression of dental caries to achieve more favorable dental treatment outcomes. Therefore, the present study aimed to investigate the influence of pediatric patient behavior on the presence of the adjacent proximal surfaces (sound, decayed, or filled) in the primary molars.