Background <p>Parental awareness regarding antibiotics might influence pediatric oral health. This study aimed to assess parents’ knowledge of antibiotic use and its relationship with their children’s oral health.</p> Methods <p>This study included 805 children (ages 3–14&#xa0;years) and their parents. A face-to-face questionnaire with 45 items was used to assess parental knowledge and attitudes using the PAPA (Parental Perceptions on Antibiotics) scale. Children’s oral health was clinically evaluated using DMFT (decayed, missing, and filled teeth) and PUFA (pulpal involvement, ulceration, fistula, and abscess) indices. Statistical analyses included the Mann–Whitney U test, Kruskal–Wallis test, independent samples T-test, Spearman’s rank correlation, and negative binomial regression.</p> Results <p>There were significant negative correlations between parents’ PAPA scores and their children’s decayed teeth, DMFT, pulpal involvement, fistula formation, abscess, and PUFA scores (<i>p</i> &lt; 0.05). Children with previous antibiotic use for dental pain had significantly higher missing teeth, DMFT, pulpal involvement, fistula formation, abscess, and PUFA scores (<i>p</i> &lt; 0.05). Parents who sought professional care after symptoms in their children had subsided following antibiotic use had higher PAPA scores and better oral health outcomes in their children (<i>p</i> &lt; 0.05).</p> Conclusions <p>Increased parental knowledge and positive attitudes toward antibiotic use were associated with improved oral health outcomes in their children.</p> Trial registration <p>The trial protocol was registered under ClinicalTrials.gov (ID: NCT07112079) on August 7, 2025. Retrospectively registered.</p>