Early Childhood Caries Risk Factors and Contributing Factors

With the high volume of children with Early Childhood Caries (ECC), some researchers have looked at certain risk factors contributing to the development of ECC. Low family socioeconomic status (SES) almost invariably emerges as a significant risk factor for ECC, documented in studies from countries including Australia (Plutzer & Keirse, 2011), Brazil (Feitosa, Colares, & Pinkham, 2005; Oliveira, Sheiham, & Bonecker, 2008), and Malaysia (Masood, Yusof, Ibrahim, Hassan, & Jaafar, 2012), as well as the U.S. (Bugis, 2012). Both Brazilian studies reported an association between low family income, poor nutrition, and heightened risk for dental caries among young children (Feitosa et al., 2005; Oliveira et al., 2008). In addition, Feitosa et al. (2005) found a family history of dental caries to be a key predictor of ECC. Low parental education, often linked with low-income status, is also an independent risk factor for ECC (Masood et al., 2012; Oliveira et al., 2008). Limited access to preventive dental care is an additional major contributor to the development of dental caries (Edelstein & Chinn, 2009).

A higher prevalence of ECC has been observed in the children of single parents, particularly single mothers, compared to their peers from two-parent homes (Plutzer & Keirse, 2011). Single mothers are often overburdened financially and emotionally. They may find it difficult to adopt a program of good oral hygiene at home, and dental visits are often neglected. Plutzer and Keirse (2011) found that an oral health promotion program designed to prevent ECC was especially effective in decreasing ECC among children in single-parent families. At the same time, the program still did not close the gap in the risk for ECC. Early intervention with AAPD dental screening tools is particularly important in view of evidence that the presence of dental caries in the permanent teeth of six-year-old children is a strong predictor of dental caries in early adolescence (Masood et al., 2012).  

Parental smoking has been linked with the presence of dental caries in children. Most studies tend to focus on mothers; however, Hanioka, Nakamura, Ojima, Tanaka, and Aoyama (2008) examined the smoking behavior of both parents, with special attention to fathers. Records from 711 three-year-old children confirmed an association between parental smoking and ECC. The effect of paternal smoking was not as pronounced as maternal smoking, but it was significant, nonetheless. Two potential mechanisms have been proposed. One possibility is that environmental tobacco smoke contributes to a bacterial infection that leads to dental caries. Alternately, parents who smoke may have poorer oral hygiene habits than non-smoking parents, and thus may be less diligent regarding their children’s dental health.

Parental education was not a factor, as in Japan, smokers tend to be more educated than non-smokers (Hanioka et al., 2008). The study did not investigate SES.  Biological, social, environmental, and behavioral factors all interact in contributing to the prevalence of dental caries in children and adults (Plutzer & Keirse, 2011). The complex interplay of these factors in the etiology of dental caries is still unfolding with ongoing research. 

References

Hanioka, T., Nakamura, E., Ojima, M., Tanaka, K., & Aoyama, H. (2008). Dental caries in 3-year-old children and smoking status of parents. Paediatric and Perinatal Epidemiology, 22, 546-550. doi:10.1111/j.1365-3016.2008.00950.x

Oliveira, L. B., Sheiham, A., & Bonecker, M. (2008). Exploring the association of dental caries with social factors and nutritional status in Brazilian preschool children. European Journal of Oral Sciences, 116, 37-43. doi:10.1111/j.1600-0722.2007.00507.x

Plutzer, K., & Keirse, M. J. N. C. (2011). Incidence and prevention of early childhood caries in one- and two-parent families. Child: Care, Health and Development, 37, 5-10. doi:10.1111/j.1365-2214.2010.01114.x