A case-control study of risk factors of early childhood caries

Current understanding of risk factors of Early Childhood Caries (ECC) remains incomplete, and few well-controlled studies of ECC are available.

Objectives: The aim of this case-control study was to investigate dental, microbiological, socioeconomic (SES) and maternal psychological risk factors for ECC in an Australian population.

Methods: ECC children aged 0-4 years were randomly recruited from public hospitals, private specialist clinics, and child care facilities. Non-ECC case controls were randomly recruited from child care facilities. Children were examined for caries experience, enamel hypoplasia, visible plaque and assessed for infection with mutans streptococci (MS) using a chairside microbiological kit. Mothers of ECC and control children were also examined to determine caries experience, gingival health and presence of MS. Validated questionnaires were used to assess social, familial, medical, dental, dietary and toothbrushing histories. Mothers were also tested with regard to psychological adjustment, parenting style, parenting confidence, health locus of control, and perception of child behaviour using standard psychological questionnaires.

Results: A total of 617 children were recruited (391 non-ECC controls and 152 children with ECC). Risk factors present in all ECC children (95% Confidence Interval) were: visible plaque (OR=8.7), mutans streptococci infection (OR=7.7), enamel hypoplasia (OR=4.2), consumption of sweetened drinks (OR=4.0) or sugar-containing snacks (OR=2.7), eating before bedtime (OR=1.5) and taking a bottle of sweet fluids to sleep (OR=1.3). Maternal depression (OR=4.3) or anxiety (OR=5.1) and maternal presence of mutans streptococci (OR=8.1) were significant contributory factors. For children from private specialist practices (high SES), enamel hypoplasia was the strongest ECC risk factor.

Conclusions: Maternal depression and anxiety are significant contributory risk factors for ECC in addition to MS infection, visible plaque, lack of toothbrushing, enamel hypoplasia and frequent consumption of sugar.

Supported by Health Promotion Queensland (Research Grant #HPQ00.01-010) and Queensland Health