Socioeconomic, Nutritional and Behavioral Factors Associated with Severe Childhood Caries in Children Aged 18-36 Months

Elizabeth Lima Costa, Paulo Vitor Campos Ferreira, Bárbara Emanoele Costa Oliveira, Renata Portela Portugal, Vandilson Pinheiro Rodrigues, José Ferreira Costa


Objective: To relate the occurrence of severe childhood caries with nutritional, socioeconomic and behavioral factors among preschool children. Material and Methods: This cross-sectional study included 111 children aged 18-36 months who sought dental care in basic health units of São Luis, Brazil. The oral health status was measured by the DMFT index (number of decayed, missing and filled teeth), IPV/ISG. Socioeconomic, nutritional and behavioral data were collected through a questionnaire applied to parents. Caries Group was defined as DMFT ≥ 1. Data were analyzed using the Chi-square test and Fisher exact test. Poisson regression models and incidence rate ratio (IRR) were used for multivariate analysis, adopting significance level of 5% and confidence interval (CI) of 95%. Results: It was observed that 61 children (55%) were free from caries and 50 (45%) had the disease. In the Caries Group, 38 (76%) had white spot lesions, 70% had the habit of consuming sweets between meals (p=0.04) and the sucrose intake frequency was considered high (3x daily). After multivariate analysis, age (IRR=1.05, 95%CI=1.03 to 1.07, p <0.001) and consumption of sweets (IRR=1.46, 95%CI=1.11 to 1.92 p=0.006) were associated with increased incidence of caries. Conclusion: The findings of this study suggest that frequent exposure to sugars in the form of sweets between meals, lack of guidance of mothers on oral hygiene and increased age were determining factors for the occurrence of severe childhood caries.

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American Academy of Pediatric Dentistry. Clinical Affairs Committee--Infant Oral Health Subcommittee. Guideline on infant oral health care. Pediatr Dent 2012; 34(5):148-52.

American Academy of Pediatric Dentistry. 2008-9. Definition, oral health policies and clinical guidelines.

Ferreira SH, Béria JU, Kramer PF, Feldens EG, Feldens CA. Dental caries in 0- to 5-year-old Brazilian children: prevalence, severity, and associated factors. Int J Paediatr Dent 2007; 17(4):289-96.

Fejerskov O. Changing paradigms in concepts on dental caries: consequences for oral health care. Caries Res 2004; 38(3):182-91.

Feldens CA, Hommerding LP, Santos BZ, Feldens EG, Vitolo MR. Cariogenic feeding habits and associated in children from the southern Brazil. Pesq Bras Odontoped Clin Integr 2010; 10(2):201-7.

Brasil. Ministério da Saúde. Secretaria de atenção à saúde. Departamento de Atenção Básica. Projeto SB Brasil 2003: condições de saúde bucal da população brasileira 2002-2003. Coordenação de Saúde Bucal - Brasília: Ministério da Saúde; 2004. p. 11-7, 20-33.

Ribeiro AG, Oliveira AF, Rosenblatt A. [Early childhood caries: prevalence and risk factors in 4-year-old preschoolers in João Pessoa, Paraíba, Brazil]. Cad Saúde Pública 2005, 21(6):1695-1700.

ABEP. Associação Brasileira de Empresas de Pesquisa. 2003. Available from:

Martello RP, Junqueira TP, Leite ICG. [Dental caries and factors associated in children aged three years enrolled in Family Health Units in the Municipality of Rondonopolis, Mato Grosso, Brazil]. Rev Epidemiol Serv Saúde 2012; 21(1):99-108.

Mattos-Graner RO, Rontani RM, Gavião MB, Bocatto HA. Caries prevalence in 6-36-month-old Brazilian children. Community Dent Health 1996; 13(2):96-8.

Bönecker M, Marcenes W, Sheiham A. Caries reductions between 1995, 1997 and 1999 in preschool children in Diadema, Brazil. Int J Paediatr Dent 2002; 12(3):183-8.

Mohebbi SZ, Virtanen JI, Vahid-Golpayegani M, Vehkalahti MM. Feeding habits as determinants of early childhood caries in a population where prolonged breastfeeding is the norm. Community Dent Oral Epidemiol 2008; 36(4):363-9.

Parisotto M, Oliveira S, Silva MS, Almeida EC, Rodrigues KA, Santos N. The importance of feeding practices, oral hygiene and socioeconomic factors in the early childhood caries prevalence in preschool children from Itatiba - SP. Rev Odontol Bras Centr 2010;19(51):59-70.

Rosenblatt A, Zarzar P. The prevalence of early childhood caries in 12-to 36-month-old children in Recife, Brazil. ASDC J Dent Child 2002; 69(3):319-24.

Jin BH, Ma DS, Moon HS, Paik DI, Hahn SH, Horowitz AM. Early childhood caries: prevalence and risk factors in Seoul, Korea. J Public Health Dent 2003; 63 (3):183-8.

Nunes AMM, Alves CMC, Araújo FB, Ortiz TML, Ribeiro MRC, Silva AAM, Ribeiro CCC. Association between prolonged breast-feeding and early childhood caries: a hierarchical approach. Community Dent Oral Epidemiol 2012; 40(6):542-9.

Iida H, Auinger P, Billings R J, Weitzman M. Association between infant breastfeeding and early childhood caries in the United States. Pediatrics 2007; 120(4):e944-52.

Azevedo TD, Bezerra AC, de Toledo OA. Feeding habits and severe early childhood caries in Brazilian preschool children. Pediatr Dent 2005; 27(1):28-33.

Losso EM, Tavares MC, da Silva JY, Urban CA. Severe early childhood caries: an integral approach. J Pediatr 2009; 85(4):295-30.

Dini EL, Holt RD, Bedi R. Caries and its association with infant feeding and oral health related behaviors in 3-4-year-old Brazilian children. Community Dent Oral Epidemiol 2000; 28(4):241-8.

Brandão IMG, Arcieri RM, Sundefeld MLM, Moimaz SAS. Early childhood caries: the influence of socio-behavioral variables and health locus of control in a group of children from Araraquara, São Paulo, Brazil. Cad Saúde Pública 2006; 22(6):1247-56.

Prakash P, Subramaniam P, Durgesh BH, Konde S. Prevalence of early childhood caries and associated risk factors in preschool children of urban Bangalore, India: A cross-sectional study. Eur J Dent 2012; 6(2):141-52.

Baldani MH, Vasconcelos AG, Antunes JL. [Association of the DMFT index with socioeconomic and dental services indicators in the state of Paraná, Brazil]. Cad Saúde Pública 2004; 20(1):143-52.

Peres MA, Peres KG, Antunes JL, Junqueira SR, Fraz P, Narvi PC. The association between socioeconomic development at the town level and the distribution of dental caries in Brazilian children. Am J Public Health 2003; 14(3):149-57.

Melo MMDC, Souza WV, Lima MLC, Braga C. Factors associated with dental caries inpreschoolers in Recife, Pernambuco State, Brazil. Cad Saúde Pública 2011; 27(3): 471-85.

Saito K, Deccico HMU, Santos MN. [The effect of infant feeding practices and associated factors on dental caries in preschool children, ages from 18 up to 48 months]. Rev Odontol Univ São Paulo1999; 13(1):5-11.

Mattila ML, Rautava P, Sillanpaa M, Paunio P. Caries in Five-year-old children and associations with family-realted factors. J Dent Res 2000; 79(3):875-81.

Fadel CB, Kozlowski VA. Cárie precoce: uma estratégia mais ampla de prevenção. J Bras Odontopediatr Odontol Bebê 2002; 3(14):313-7.

Barros SG, Castro-Alves A, Pugliese LS, Reis SRA. [Contribution to the study of dental caries in 0-30-month-old infants]. Pesq Odontol Bras 2001; 15(3):215-22.