This study investigated caries predictors in 378 children remaining from a birth cohort of 1,052 at 7 y and compared the efficacy of home visits (HVs) and telephone contacts (TCs) for early childhood caries (ECC) prevention.
Methods:
The HVs or TCs were made at ages 6, 12, 18, 30, and 42 mo with annual dental clinic examinations at ages 2 to 7 y. At every visit, the parents completed validated questionnaires regarding the children’s family, medical, dental, and dietary histories.
Results:
The caries prevalence increased from 2% and 6% at ages 2 and 3 y to 15%, 33%, 42%, and 52% at ages 4 to 7 y. The mean caries experience (decayed, missing, and teeth extracted due to caries) of the total cohort increased from 0.1 ± 0.5 at age 2 y to 0.2 ± 1.1 at 3 y, 0.5 ± 1.6 at 4 y, 1.1 ± 2.4 at 5 y, 1.6 ± 2.6 at 6 y, and 2.0 ± 2.7 at 7 y. The prevalence of mutans streptococci (MS) in the total cohort at years 2 to 7 was 22%, 36%, 42%, 42%, 39%, and 44%, respectively. MS was strongly correlated with caries prevalence for all years (all P < 0.001). Statistical modeling employing the generalized estimating equations identified caries predictors as holding a Health Care Card (low socioeconomic status) (P = 0.009; odds ratio [OR] = 2.05; confidence interval [CI]: 1.20–3.52), developmental defects of enamel (DDEs) (P < 0.001; OR = 1.09; CI: 1.05–1.14), and MS counts ≤105/mL (P = 0.001; OR = 1.63; CI: 1.24–2.14). By contrast, HVs were more protective than TCs for caries (P = 0.008; OR = 0.42; CI: 0.22–0.80).
Conclusions:
This study provides prospective, clinical evidence that MS, DDEs, and low socioeconomic status are strongly correlated with early childhood caries and that HVs are more efficacious than TCs in ECC prevention.
Knowledge Transfer Statement:
This 7-y birth cohort study provides longitudinal clinical evidence that mutans streptococci, developmental defects of enamel, and low socioeconomic status are key risk indicators of early childhood caries.
AdamsonJCockayneSPufferSTorgersonDJ. 2006. Review of randomised trials using the post-randomised consent (Zelen’s) design. Contemporary Clin Trials. 27(4):305–319.
2.
AlaluusuaSRenkonenOV. 1983. Streptococcus mutans establishment and dental caries experience in children from 2 to 4 years old. Scand J Dent Res. 91(6):453–457.
3.
AlbinoJTiwariT.2016. Preventing childhood caries: a review of recent behavioral research. J Dent Res. 95(1):35–42.
4.
AvasareTWarrenJQianFMarshallTWeber-GasparoniKDrakeD.2017. Longitudinal study assessing factors associated with mutans streptococci acquisition in infants and toddlers. Oral Health Prev Dent. 15(6):543–548.
5.
BernabéEBallantyneHLongbottomCPittsNB. 2020. Early introduction of sugar-sweetened beverages and caries trajectories from age 12 to 48 months. J Dent Res. 99(8):898–906.
6.
CaufieldPWCutterGRDasanayakeAP. 1993. Initial acquisition of mutans streptococci by infants: evidence for a discrete window of infectivity. J Dent Res. 72(1):37–45.
7.
ClarksonJO’MullaneD.1989. A modified DDE index for use in epidemiological studies of enamel defects. J Dent Res. 68(3):445–450.
8.
FanCCWangWHXuTZhengSG. 2019. Risk factors of early childhood caries (ECC) among children in Beijing—a prospective cohort study. BMC Oral Health. 19(1):34.
9.
FeldensCAGiuglianiERJDuncanBBDrachlerMLVıtoloMR. 2010. Long-term effectiveness of a nutritional program in reducing early childhood caries: a randomized trial. Community Dent Oral Epidemiol. 38:324–332.
10.
FinlaysonTLSiefertKIsmailAISohnW.2007. Psychosocial factors and early childhood caries among low-income African-American children in Detroit. CommunityDent Oral Epidemiol. 35(6):439–448.
11.
GhazalTSLevySMChildersNKCarterKDCaplanDJWarrenJJCavanaughJEKolkerJ.2018. Mutans streptococci and dental caries: a new statistical modeling approach. Caries Res. 52(3):246–252.
12.
HaDHDoLGSpencerAJThomsonWMGolleyRKRugg-GunnAJLevySMScottJA.2017. Factors influencing early feeding of foods and drinks containing free sugars—a birth cohort study. Int J Environ Res Pub Health. 14(10):1270.
13.
HanleyJANegassaAEdwardesMDForresterJE. 2003. Statistical analysis of correlated data using generalized estimating equations: an orientation. Am J Epidemiol. 157(4):364–375.
14.
HarrisonRLVeronneauJLerouxB.2012. Effectiveness of maternal counseling in reducing caries in Cree children. J Dent Res. 91(11):1032–1037.
15.
KatoHTanakaKShimizuKNagataCFurukawaSArakawaMMiyakeY.2017. Parental occupations, educational levels, and income and prevalence of dental caries in 3-year-old Japanese children. Environ Health Prev Med. 22(1):80.
16.
KohRPukallusMKularatnaSGordonLGBarnettAGWalshLJSeowWK. 2015. Relative cost-effectiveness of home visits and telephone contacts in preventing early childhood caries. Community Dent Oral Epidemiol. 43(6):560–568.
17.
KohlerBAndreenI.1994. Influence of caries preventive measures in mothers on cariogenic bacteria and caries experience in their children. Arch Oral Biol. 39(10):907–911.
18.
KowashMBToumbaKJCurzonME. 2006. Cost-effectiveness of a long-term dental health education program for the prevention of early childhood caries. Eur Arch Paediatr Dent. 7(3):130–135.
19.
LandisJRKochGG. 1977. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics. 33(2):363–374.
20.
OliveiraAFBChavesAMBRosenblattA. 2006. The influence of enamel defects on the development of early childhood caries in a population with low socioeconomic status: a longitudinal study. Caries Res. 40(4):296–302.
21.
PeresKGThomsonWMChaffeeBWPeresMABirungiNDoLGFeldensCAFontanaMMarshallTAPitiphatW, et al. 2020. Oral health birth cohort studies: achievements, challenges, and potential. J Dent Res. 99(12):1321–1331.
22.
PittsNBBaezRJDiaz-GuilloryCDonlyKJFeldensCAMcGrathCPhantumvanitPSeowWKSharkovNSongpaisanY, et al. 2019. Early childhood caries: IAPD Bangkok declaration. J Dent Child. 86(2):72–72.
23.
PlonkaKAPukallusMLBarnettAHolcombeTFWalshLJSeowWK. 2013a. A controlled, longitudinal study of home visits compared to telephone contacts to prevent early childhood caries. Int J Paediatr Dent. 23(1):23–31.
24.
PlonkaKAPukallusMLBarnettAGHolcombeTFWalshLJSeowWK. 2013b. A longitudinal case-control study of caries development from birth to 36 months. Caries Res. 47(2):117–127.
25.
PlonkaKAPukallusMLBarnettAGWalshLJHolcombeTFSeowWK. 2012a. A longitudinal study comparing mutans streptococci and lactobacilli colonisation in dentate children aged 6 to 24 months. Caries Res. 46(4):385–393.
26.
PlonkaKAPukallusMLBarnettAGWalshLJHolcombeTHSeowWK. 2012b. Mutans streptococci and lactobacilli colonization in predentate children from the neonatal period to seven months of age. Caries Res. 46(3):213–220.
27.
PlonkaKAPukallusMLHolcombeTFBarnettAGWalshLJSeowWK. 2013. Randomized controlled trial: A randomized controlled clinical trial comparing a remineralizing paste with an antibacterial gel to prevent early childhood caries. Pediatr Dent. 35(1):8-12.
28.
PlutzerKSpencerAJ. 2008. Efficacy of an oral health promotion intervention in the prevention of early childhood caries. Community Dent Oral Epidemiol. 36(4):335–346.
29.
PukallusMPlonkaKBarnettAGWalshLHolcombeTSeowW.2013. A randomised, controlled clinical trial comparing chlorhexidine gel and low-dose fluoride toothpaste to prevent early childhood caries. Int J Paediatr Dent. 23(3):216–24.
30.
SaraithongPPattanapornKChenZKhongkhunthianSLaohapensangPChhunNPattanapornWGawHYLiY.2015. Streptococcus mutans and Streptococcus sobrinus colonization and caries experience in 3- and 5-year-old Thai children. Clin Oral Invest. 19(8):1955–1964.
31.
SeowWKLeishmanSJPalmerJEWalshLJPukallusMBarnettAG. 2016. A longitudinal observational study of developmental defects of enamel from birth to 6 years of age. JDR Clin Transl Res. 1(3):285–291.
32.
SladeGDCaplanDJ. 1999. Methodological issues in longitudinal epidemiologic studies of dental caries. Community Dent Oral Epidemiol. 27(4):236–248.
33.
TanabeYParkJHTinanoffNTurngBFLilliHMinahGH. 2006. Comparison of chairside microbiological screening systems and conventional selective media in children with and without visible dental caries. Pediatr Dent. 28(4):363–368.
34.
TanakaKMiyakeYSasakiSHirotaY.2013. Socioeconomic status and risk of dental caries in Japanese preschool children: the Osaka maternal and child health study. J Public Health Dent. 73(3):217–223.
35.
ThitasomakulSThearmontreeAPiwatSChankankaOPithpornchaiyakulWTeanpaisanRMadyusohS.2006. A longitudinal study of early childhood caries in 9- to 18-month-old Thai infants. Community Dent Oral Epidemiol. 34(6):429–436.
36.
VollmerSBommerCKrishnaAHarttgenKSubramanianSV. 2016. The association of parental education with childhood undernutrition in low- and middle-income countries: comparing the role of paternal and maternal education. Int J Epidemiol. 46(1):312–323.
37.
WagnerYHeinrich-WeltzienR.2017. Evaluation of a regional German interdisciplinary oral health programme for children from birth to 5 years of age. Clin Oral Invest. 21(1):225–235.
38.
WanAKSeowWKPurdieDMBirdPSWalshLJTudehopeDI. 2001. Oral colonization of streptococcus mutans in six-month-old predentate infants. J Dent Res. 80(12):2060–2065.
39.
WanAKSeowWKPurdieDMBirdPSWalshLJTudehopeDI. 2003. A longitudinal study of Streptococcus mutans colonization in infants after tooth eruption. J Dent Res. 82(7):504–508.
40.
WilsonARMulvahillMJTiwariT.2017. The impact of maternal self-efficacy and oral health beliefs on early childhood caries in Latino children. Frontiers Pub Health. 5:228.
41.
World Health Organization. 2013. Oral health surveys: basic methods. 5th ed. Geneva (Switzerland): WHO; pp 42–47.
