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Published in: BMC Oral Health 1/2020

Open Access 01-12-2020 | Caries | Research article

Assessment of risk factors for early childhood caries at different ages in Shandong, China and reflections on oral health education: a cross-sectional study

Authors: Meng Zhang, Xinyue Zhang, Yuan Zhang, Yanan Li, Chunchun Shao, Shijiang Xiong, Jing Lan, Zhifeng Wang

Published in: BMC Oral Health | Issue 1/2020

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Abstract

Background

The high prevalence of early childhood caries (ECC) is widespread around the world, and oral health education (OHE) plays a vital role in preventing ECC. Numerous studies on ECC risk factor assessment have assisted us in enriching the content of OHE. The objective of this study was to further assess independent risk factors for ECC at different ages to provide evidence and insights for OHE.

Methods

Children aged 3–5 years old (N = 1301) in Shandong Province were enrolled in this cross-sectional study. Data about oral health status and caregivers’ oral health knowledge, attitude, and practice (KAP) were extracted from the 4th National Oral Health Survey of China. The associations between ECC prevalence and various KAP variables were tested with chi-square tests, bivariate analysis and multivariable logistic regression analyses.

Results

The ECC prevalence in Shandong Province was 64.6%, and the dmft mean was 3.15. The independent variables with an increased risk for ECC were age, feeding method within 6 months of birth, bedtime sugar frequency, experience of toothache over the past year and dental visits (P < 0.05, chi-square tests). Complete breastfeeding within 6 months of birth primarily contributed to the high ECC risk of the 3-year-old group (OR: 3.39, 95% CI: 1.41–8.17), while high frequency bedtime sweet consumption mainly contributed to that of the 5-year-old group (OR: 3.22, 95% CI: 1.03–10.06; logistic regression analysis). Tooth brushing was not associated with ECC in this study, and some positive knowledge and attitude variables were positively correlated with a high risk of ECC.

Conclusion

These data provide evidence to suggest that the ECC-related risk factors at different ages are inconsistent, which provides some insights for OHE. We should highlight the effects of feeding methods in the early stages of deciduous dentition and sugar habits in the late stages of deciduous dentition on ECC, as well as encourage preventive dental visit and supplemental training for oral health practices.
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Literature
1.
go back to reference Kassebaum NJ, Smith AGC, Bernabé E, Fleming TD, Reynolds AE, Vos T, Murray CJL, Marcenes W, and GBD 2015 Oral Health Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017; 390(10100):1211–59. Kassebaum NJ, Smith AGC, Bernabé E, Fleming TD, Reynolds AE, Vos T, Murray CJL, Marcenes W, and GBD 2015 Oral Health Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017; 390(10100):1211–59.
2.
go back to reference Casamassimo PS, Thikkurissy S, Edelstein BL, Maiorini E. Beyond the dmft: the human and economic cost of early childhood caries. J Am Dent Assoc. 2009;140:650–7.PubMedCrossRef Casamassimo PS, Thikkurissy S, Edelstein BL, Maiorini E. Beyond the dmft: the human and economic cost of early childhood caries. J Am Dent Assoc. 2009;140:650–7.PubMedCrossRef
3.
go back to reference Peres M, Macpherson L, Weyant R, Daly B, Venturelli R, Mathur M, et al. Oral diseases: a global public health challenge. Lancet. 2019;394:249–60.CrossRefPubMed Peres M, Macpherson L, Weyant R, Daly B, Venturelli R, Mathur M, et al. Oral diseases: a global public health challenge. Lancet. 2019;394:249–60.CrossRefPubMed
4.
go back to reference Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F, et al. Dental caries. Nature Reviews Disease Primers. 2017;3:17030.PubMedCrossRef Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F, et al. Dental caries. Nature Reviews Disease Primers. 2017;3:17030.PubMedCrossRef
6.
go back to reference Tanaka S, Shinzawa M, Tokumasu H, Seto K, Tanaka S, Kawakami K. Secondhand smoke and incidence of dental caries in deciduous teeth among children in Japan: population based retrospective cohort study. BMJ. 2015;351:h5397.PubMedPubMedCentralCrossRef Tanaka S, Shinzawa M, Tokumasu H, Seto K, Tanaka S, Kawakami K. Secondhand smoke and incidence of dental caries in deciduous teeth among children in Japan: population based retrospective cohort study. BMJ. 2015;351:h5397.PubMedPubMedCentralCrossRef
10.
go back to reference Iida H, Auinger P, Billings RJ, Weitzman M. Association between infant breastfeeding and early childhood caries in the United States. Pediatrics. 2007;120:e944–52.PubMedCrossRef Iida H, Auinger P, Billings RJ, Weitzman M. Association between infant breastfeeding and early childhood caries in the United States. Pediatrics. 2007;120:e944–52.PubMedCrossRef
11.
go back to reference Darmawikarta D, Chen Y, Carsley S, Birken CS, Parkin PC, Schroth RJ, et al. Factors associated with dental care utilization in early childhood. Pediatrics. 2014;133:e1594–600.PubMedCrossRef Darmawikarta D, Chen Y, Carsley S, Birken CS, Parkin PC, Schroth RJ, et al. Factors associated with dental care utilization in early childhood. Pediatrics. 2014;133:e1594–600.PubMedCrossRef
12.
go back to reference Peres MA, Ju X, Mittinty M, Spencer AJ, Do LG. Modifiable factors explain socioeconomic inequalities in Children's dental caries. J Dent Res. 2019;98:1211–8.PubMedCrossRef Peres MA, Ju X, Mittinty M, Spencer AJ, Do LG. Modifiable factors explain socioeconomic inequalities in Children's dental caries. J Dent Res. 2019;98:1211–8.PubMedCrossRef
13.
go back to reference Shang X, Li D, Huang Y, Chen H, Sun R. Prevalence of dental caries among preschool children in Shanghe County of Shandong Province and relevant prevention and treatment strategies. Chin Med J. 2008;121:2246–9.PubMedCrossRef Shang X, Li D, Huang Y, Chen H, Sun R. Prevalence of dental caries among preschool children in Shanghe County of Shandong Province and relevant prevention and treatment strategies. Chin Med J. 2008;121:2246–9.PubMedCrossRef
14.
go back to reference Du MQ, Li Z, Jiang H, Wang X, Feng XP, Hu Y, et al. Dental caries status and its associated factors among 3- to 5-year-old children in China: a National Survey. Clin J Dent Res. 2018;21:167–79. Du MQ, Li Z, Jiang H, Wang X, Feng XP, Hu Y, et al. Dental caries status and its associated factors among 3- to 5-year-old children in China: a National Survey. Clin J Dent Res. 2018;21:167–79.
15.
go back to reference Petersen PE, Baez RJ, Organization WH. Oral health surveys: basic methods. 5th ed. Geneva: World Health Organization; 2013. Petersen PE, Baez RJ, Organization WH. Oral health surveys: basic methods. 5th ed. Geneva: World Health Organization; 2013.
16.
go back to reference Srisilapanan P, Nirunsittirat A, Roseman J. Trends over time in dental caries status in urban and rural Thai children. J Clin Exp Dent. 2017;9:e1201–e6.PubMedPubMedCentralCrossRef Srisilapanan P, Nirunsittirat A, Roseman J. Trends over time in dental caries status in urban and rural Thai children. J Clin Exp Dent. 2017;9:e1201–e6.PubMedPubMedCentralCrossRef
18.
19.
go back to reference Morita A, Matsuyama Y, Isumi A, Doi S, Ochi M, Fujiwara T. Association between grandparent co-residence, socioeconomic status and dental caries among early school-aged children in Japan: a population-based prospective study. Sci Rep. 2019;9:11345.PubMedPubMedCentralCrossRef Morita A, Matsuyama Y, Isumi A, Doi S, Ochi M, Fujiwara T. Association between grandparent co-residence, socioeconomic status and dental caries among early school-aged children in Japan: a population-based prospective study. Sci Rep. 2019;9:11345.PubMedPubMedCentralCrossRef
20.
go back to reference Gao X, Hsu C, Loh T, Koh D, Hwamg H, Xu Y. Dental caries prevalence and distribution among preschoolers in Singapore. Community Dent Health. 2009;26:12–7.PubMed Gao X, Hsu C, Loh T, Koh D, Hwamg H, Xu Y. Dental caries prevalence and distribution among preschoolers in Singapore. Community Dent Health. 2009;26:12–7.PubMed
21.
go back to reference Tinanoff N, Baez RJ, Diaz Guillory C, Donly KJ, Feldens CA, McGrath C, et al. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective. Int J Paediatr Dent. 2019;29:238–48.PubMedCrossRef Tinanoff N, Baez RJ, Diaz Guillory C, Donly KJ, Feldens CA, McGrath C, et al. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective. Int J Paediatr Dent. 2019;29:238–48.PubMedCrossRef
22.
go back to reference Hobdell M, Petersen PE, Clarkson J, Johnson N. Global goals for oral health 2020. Int Dent J. 2003;53:285–8.PubMedCrossRef Hobdell M, Petersen PE, Clarkson J, Johnson N. Global goals for oral health 2020. Int Dent J. 2003;53:285–8.PubMedCrossRef
23.
go back to reference Feldens CA, Rodrigues PH, de Anastacio G, Vitolo MR, Chaffee BW. Feeding frequency in infancy and dental caries in childhood: a prospective cohort study. Int Dent J. 2018;68:113–21.PubMedCrossRef Feldens CA, Rodrigues PH, de Anastacio G, Vitolo MR, Chaffee BW. Feeding frequency in infancy and dental caries in childhood: a prospective cohort study. Int Dent J. 2018;68:113–21.PubMedCrossRef
25.
go back to reference van Palenstein Helderman WH, Soe W. Van 't Hof MA. Risk factors of early childhood caries in a southeast Asian population. J Dent Res. 2006;85:85–8.PubMedCrossRef van Palenstein Helderman WH, Soe W. Van 't Hof MA. Risk factors of early childhood caries in a southeast Asian population. J Dent Res. 2006;85:85–8.PubMedCrossRef
26.
go back to reference Sun X, Bernabe E, Liu X, Gallagher JE, Zheng S. Early life factors and dental caries in 5-year-old children in China. J Dent. 2017;64:73–9.PubMedCrossRef Sun X, Bernabe E, Liu X, Gallagher JE, Zheng S. Early life factors and dental caries in 5-year-old children in China. J Dent. 2017;64:73–9.PubMedCrossRef
27.
go back to reference Avila WM, Pordeus IA, Paiva SM, Martins CC. Breast and bottle feeding as risk factors for dental caries: a systematic review and meta-analysis. PLoS One. 2015;10:e0142922.PubMedPubMedCentralCrossRef Avila WM, Pordeus IA, Paiva SM, Martins CC. Breast and bottle feeding as risk factors for dental caries: a systematic review and meta-analysis. PLoS One. 2015;10:e0142922.PubMedPubMedCentralCrossRef
28.
go back to reference Ha DH, Spencer AJ, Peres KG, Rugg-Gunn AJ, Scott JA, Do LG. Fluoridated water modifies the effect of breastfeeding on dental caries. J Dent Res. 2019;98:755–62.PubMedCrossRef Ha DH, Spencer AJ, Peres KG, Rugg-Gunn AJ, Scott JA, Do LG. Fluoridated water modifies the effect of breastfeeding on dental caries. J Dent Res. 2019;98:755–62.PubMedCrossRef
29.
go back to reference Fontana M, Jackson R, Eckert G, Swigonski N, Chin J, Zandona AF, et al. Identification of caries risk factors in toddlers. J Dent Res. 2011;90:209–14.PubMedPubMedCentralCrossRef Fontana M, Jackson R, Eckert G, Swigonski N, Chin J, Zandona AF, et al. Identification of caries risk factors in toddlers. J Dent Res. 2011;90:209–14.PubMedPubMedCentralCrossRef
30.
go back to reference Chen KJ, Gao SS, Duangthip D, Li SKY, Lo ECM, Chu CH. Dental caries status and its associated factors among 5-year-old Hong Kong children: a cross-sectional study. BMC Oral Health. 2017;17:121.PubMedPubMedCentralCrossRef Chen KJ, Gao SS, Duangthip D, Li SKY, Lo ECM, Chu CH. Dental caries status and its associated factors among 5-year-old Hong Kong children: a cross-sectional study. BMC Oral Health. 2017;17:121.PubMedPubMedCentralCrossRef
31.
go back to reference Lin YC, Chang CS, Ho PS, Lee CH, Chen JH, Huang HL. Immigrant(−)Native Differences in Sugar-Sweetened Beverage and Snack Consumption and Preventive Behaviors Associated with Severe Early Childhood Caries: A Large-Scale Survey in Taiwan. Int Environ Res Public Health. 2019;16. https://doi.org/10.3390/ijerph16061047. Lin YC, Chang CS, Ho PS, Lee CH, Chen JH, Huang HL. Immigrant(−)Native Differences in Sugar-Sweetened Beverage and Snack Consumption and Preventive Behaviors Associated with Severe Early Childhood Caries: A Large-Scale Survey in Taiwan. Int Environ Res Public Health. 2019;16. https://​doi.​org/​10.​3390/​ijerph16061047.
32.
go back to reference Nakayama Y, Mori M. Association between nocturnal breastfeeding and snacking habits and the risk of early childhood caries in 18- to 23-month-old Japanese children. J Epidemiol. 2015;25:142–7.PubMedCrossRef Nakayama Y, Mori M. Association between nocturnal breastfeeding and snacking habits and the risk of early childhood caries in 18- to 23-month-old Japanese children. J Epidemiol. 2015;25:142–7.PubMedCrossRef
33.
go back to reference Rudney JD, Jagtap PD, Reilly CS, Chen R, Markowski TW, Higgins L, et al. Protein relative abundance patterns associated with sucrose-induced dysbiosis are conserved across taxonomically diverse oral microcosm biofilm models of dental caries. Microbiome. 2015;3:69.PubMedPubMedCentralCrossRef Rudney JD, Jagtap PD, Reilly CS, Chen R, Markowski TW, Higgins L, et al. Protein relative abundance patterns associated with sucrose-induced dysbiosis are conserved across taxonomically diverse oral microcosm biofilm models of dental caries. Microbiome. 2015;3:69.PubMedPubMedCentralCrossRef
34.
go back to reference Pitts NB, Baez RJ, Diaz-Guillory C, Donly KJ, Alberto Feldens C, McGrath C, et al. Early Childhood Caries: IAPD Bangkok Declaration. J Dent Child. 2019;86:72. Pitts NB, Baez RJ, Diaz-Guillory C, Donly KJ, Alberto Feldens C, McGrath C, et al. Early Childhood Caries: IAPD Bangkok Declaration. J Dent Child. 2019;86:72.
35.
go back to reference Leroy R, Hoppenbrouwers K, Jara A, Declerck D. Parental smoking behavior and caries experience in preschool children. Community Dent Oral Epidemiol. 2008;36:249–57.PubMedCrossRef Leroy R, Hoppenbrouwers K, Jara A, Declerck D. Parental smoking behavior and caries experience in preschool children. Community Dent Oral Epidemiol. 2008;36:249–57.PubMedCrossRef
36.
go back to reference Schluter PJ, Durward C, Cartwright S, Paterson J. Maternal self-report of oral health in 4-year-old Pacific children from South Auckland, New Zealand: findings from the Pacific Islands families study. J Public Health Dent. 2007;67:69–77.PubMedCrossRef Schluter PJ, Durward C, Cartwright S, Paterson J. Maternal self-report of oral health in 4-year-old Pacific children from South Auckland, New Zealand: findings from the Pacific Islands families study. J Public Health Dent. 2007;67:69–77.PubMedCrossRef
37.
go back to reference Aligne CA, Moss ME, Auinger P, Weitzman M. Association of pediatric dental caries with passive smoking. Jama. 2003;289:1258–64.PubMedCrossRef Aligne CA, Moss ME, Auinger P, Weitzman M. Association of pediatric dental caries with passive smoking. Jama. 2003;289:1258–64.PubMedCrossRef
38.
go back to reference Faustino-Silva DD, Colvara BC, Meyer E, Hugo FN, Celeste RK, Hilgert JB. Motivational interviewing effects on caries prevention in children differ by income: a randomized cluster trial. Community Dent Oral Epidemiol. 2019;47:477–84.PubMedCrossRef Faustino-Silva DD, Colvara BC, Meyer E, Hugo FN, Celeste RK, Hilgert JB. Motivational interviewing effects on caries prevention in children differ by income: a randomized cluster trial. Community Dent Oral Epidemiol. 2019;47:477–84.PubMedCrossRef
39.
go back to reference Aida J, Ando Y, Oosaka M, Niimi K, Morita M. Contributions of social context to inequality in dental caries: a multilevel analysis of Japanese 3-year-old children. Community Dent Oral Epidemiol. 2008;36:149–56.PubMedCrossRef Aida J, Ando Y, Oosaka M, Niimi K, Morita M. Contributions of social context to inequality in dental caries: a multilevel analysis of Japanese 3-year-old children. Community Dent Oral Epidemiol. 2008;36:149–56.PubMedCrossRef
40.
go back to reference Gao XL, Hsu CY, Xu YC, Loh T, Koh D, Hwarng HB. Behavioral pathways explaining oral health disparity in children. J Dent Res. 2010;89:985–90.PubMedCrossRef Gao XL, Hsu CY, Xu YC, Loh T, Koh D, Hwarng HB. Behavioral pathways explaining oral health disparity in children. J Dent Res. 2010;89:985–90.PubMedCrossRef
41.
go back to reference Begzati A, Berisha M, Meqa K. Early childhood caries in preschool children of Kosovo - a serious public health problem. BMC Public Health. 2010;10:788.PubMedPubMedCentralCrossRef Begzati A, Berisha M, Meqa K. Early childhood caries in preschool children of Kosovo - a serious public health problem. BMC Public Health. 2010;10:788.PubMedPubMedCentralCrossRef
42.
go back to reference Zhou Y, Lin HC, Lo EC, Wong MC. Risk indicators for early childhood caries in 2-year-old children in southern China. Aust Dent J. 2011;56:33–9.PubMedCrossRef Zhou Y, Lin HC, Lo EC, Wong MC. Risk indicators for early childhood caries in 2-year-old children in southern China. Aust Dent J. 2011;56:33–9.PubMedCrossRef
43.
go back to reference Abdelaziz W, Dowidar K, El Tantawi M. Association of Healthy Eating, juice consumption, and bacterial counts with early childhood caries. Pediatr Dent. 2015;37:462–7.PubMed Abdelaziz W, Dowidar K, El Tantawi M. Association of Healthy Eating, juice consumption, and bacterial counts with early childhood caries. Pediatr Dent. 2015;37:462–7.PubMed
44.
go back to reference Jiang EM, Lo EC, Chu CH, Wong MC. Prevention of early childhood caries (ECC) through parental toothbrushing training and fluoride varnish application: a 24-month randomized controlled trial. J Dent. 2014;42:1543–50.PubMedCrossRef Jiang EM, Lo EC, Chu CH, Wong MC. Prevention of early childhood caries (ECC) through parental toothbrushing training and fluoride varnish application: a 24-month randomized controlled trial. J Dent. 2014;42:1543–50.PubMedCrossRef
46.
go back to reference George A, Sousa MS, Kong AC, Blinkhorn A, Patterson Norrie T, Foster J, et al. Effectiveness of preventive dental programs offered to mothers by non-dental professionals to control early childhood dental caries: a review. BMC Oral Health. 2019;19:172.PubMedPubMedCentralCrossRef George A, Sousa MS, Kong AC, Blinkhorn A, Patterson Norrie T, Foster J, et al. Effectiveness of preventive dental programs offered to mothers by non-dental professionals to control early childhood dental caries: a review. BMC Oral Health. 2019;19:172.PubMedPubMedCentralCrossRef
47.
go back to reference Dooley D, Moultrie NM, Heckman B, Gansky SA, Potter MB, Walsh MM. Oral Health Prevention and Toddler Well-Child Care: Routine Integration in a Safety Net System. Pediatrics. 2016;137(1):e20143532. Dooley D, Moultrie NM, Heckman B, Gansky SA, Potter MB, Walsh MM. Oral Health Prevention and Toddler Well-Child Care: Routine Integration in a Safety Net System. Pediatrics. 2016;137(1):e20143532.
48.
go back to reference Bartosova M, Svetlak M, Kukletova M, Borilova Linhartova P, Dusek L, Izakovicova HL. Emotional stimuli candidates for behavioural intervention in the prevention of early childhood caries: a pilot study. BMC Oral Health. 2019;19:33.PubMedPubMedCentralCrossRef Bartosova M, Svetlak M, Kukletova M, Borilova Linhartova P, Dusek L, Izakovicova HL. Emotional stimuli candidates for behavioural intervention in the prevention of early childhood caries: a pilot study. BMC Oral Health. 2019;19:33.PubMedPubMedCentralCrossRef
49.
go back to reference Mouradian WE, Wehr E, Crall JJ. Disparities in children's oral health and access to dental care. Jama. 2000;284:2625–31.PubMedCrossRef Mouradian WE, Wehr E, Crall JJ. Disparities in children's oral health and access to dental care. Jama. 2000;284:2625–31.PubMedCrossRef
50.
go back to reference Whelton HP, Spencer AJ, Do LG, Rugg-Gunn AJ. Fluoride revolution and dental caries: evolution of policies for global use. J Dent Res. 2019;98:837–46.PubMedCrossRef Whelton HP, Spencer AJ, Do LG, Rugg-Gunn AJ. Fluoride revolution and dental caries: evolution of policies for global use. J Dent Res. 2019;98:837–46.PubMedCrossRef
51.
go back to reference Walsh T, Worthington HV, Glenny AM, Marinho VC, Jeroncic A. Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database Syst Rev. 2019;3:Cd007868.PubMed Walsh T, Worthington HV, Glenny AM, Marinho VC, Jeroncic A. Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database Syst Rev. 2019;3:Cd007868.PubMed
Metadata
Title
Assessment of risk factors for early childhood caries at different ages in Shandong, China and reflections on oral health education: a cross-sectional study
Authors
Meng Zhang
Xinyue Zhang
Yuan Zhang
Yanan Li
Chunchun Shao
Shijiang Xiong
Jing Lan
Zhifeng Wang
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Caries
Published in
BMC Oral Health / Issue 1/2020
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-020-01104-8

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