Bacterial, behavioral and environmental factors associated with early childhood caries

The goals of this cross-sectional study were to characterize and compare demographic, behavioral, and envi-ronmental factors potentially associated with early childhood caries (ECC) and to assess salivary levels of mutans streptococci (MS) and lactobacilli (LB) in underserved, predominantly Hispanic children. One hun-dred forty-six children aged 3 to 55 months with a range of caries experience were identified and examined. ECC was primarily associated with the presence of MS and lack of access to dental care. Salivary MS levels among young children with ECC were higher than would be expected in a dentally healthy population, but lower than levels reported among older children at high risk for caries.After adjustment for age, children with log10 MS ≥ 3.0 or log10 LB ≥ 1.5 were about five times as likely (OR=4.9, 95%CI=2.0,12.0) to have ECC than those with lower bacterial levels. This study demonstrated a significant association between relatively low cariogenic bacterial levels and dental caries in infants and toddlers.Antibiotic use, exposure to lead, and anemia were not significantly associated with the number of decayed and filled surfaces or decayed and filled teeth. ECC correlated significantly with child’s age and lack of dental insurance of the children, as well as inversely with both family income and the educational level of the mother of the child.

1. Vargas CM, Crall JJ, Schneider DA. Sociodemographic distribu-tion of pediatric dental caries: NHANES III, 1988–1994. J Am Dent Assoc 129: 1229–1238, 1998.

2. Ripa LW. Nursing caries: a comprehensive review. Pediatric Dent 10: 268–282, 1998.

3. Kaste L, Marianos D, Chang R, Phipps KR. The assessment of nursing caries and its relationship to high caries in permanent dentition. J Public Health Dent 52: 64–68, 1992.

4. Greenwell AL, Johnsen D, DiSantis TA, Gerstenmajer J, Limbert N. Longitudinal evaluation of caries patterns from the primary to the mixed dentition. Pediatr Dent 12: 278–282, 1990.

5. Acs O, Lodolini U, Kaminsky S, Cisneros GJ. Effect of nursing caries on body weight in a pediatric population. Pediatr Dent 14: 302–305, 1992.

6. Kaste LM, Drury TF, Horowitz AM, Beltran E. An evaluation of NHANES III estimates of early childhood caries. J Public Health Dent 59: 198–200, 1999.

7. Ramos-Gomez FJ, Tomar SL, Ellison J, Artiga N, Sintes J, Vicuna G. Assessment of early childhood caries and dietary habits in a population of migrant Hispanic children in Stockton, California. J Dent Child 66: 395–403, 1999.

8. Davies GN. Early childhood caries—a synopsis. Community Dent Oral Epidemiol 26 (Suppl 1): 106–116, 1998.

9. Horowitz HS. Research issues in early childhood caries. Commu-nity Dent Oral Epidemiol 26 (Suppl 1): 67–81, 1998.

10. Drury TF, Horowitz AM, Ismail AI, Maertens MP, Rozier RG, Sel-witz RH. Diagnosing and reporting early childhood caries for research purposes. A report of a workshop sponsored by the National Institute of Dental and Craniofacial Research, the Health Resources and Services Administration, and the Health Care Financing Administration. J Public Health Dent 59: 192–197, 1999.

11. Syed SA, Loesche WJ. Survival of human dental plaque flora in various transport media. Appl Microbiol 27: 961–979, 1972.

12. Hoover CI, Newbrun E, Mettraux U, Graf H. Microflora and chemical composition of plaque from patients with hereditary fructose intolerance. Infect Immun 28: 853–859, 1980.

13. Gold OG, Jordan HV, van Houte J.A selective medium for Strep-tococcus mutans. Arch Oral Biol 18: 1357–1364, 1973.

14. Hoover CI, Newbrun E. Survival of bacteria from human dental plaque under various transport conditions. J Clin Microbiol 6: 212–218, 1997.

15. Newbrun E, Matsukubo T, Hoover CI, Graves RC, Brown AT, Disney JA, Bohannan HM. Comparison of two screening tests for Streptococcus mutans and evaluation of their suitability for mass screening and private practice. Community Dent Oral Epi-demiol 12: 325–331, 1984.

16. Rogosa M, Mitchell JA,Wiseman RF. A selective medium for the isolation and enumeration of oral lactobacilli. J Dent Res30: 682–689, 1951.

17. Leverett DH, Proskin HM, Featherstone JD, Adair SM, Eisen-berg AD, Mundorff-Shrestha SA, Shields CP, Shaffer CL, Billings RJ. Caries risk assessment in a longitudinal discrimination study. J Dent Res 72: 538–543, 1993.

18. Helfenstein U, Marcel S. The use of logistic discrimination and receiver operating characteristic (ROC) analysis in dentistry. Community Dent Health 11: 142–146, 1994.

19. Caufield PW, Cutter GR, Dasanayake AP. Initial acquisition of mutans streptococci by infants: evidence for a discrete window of infectivity. J Dent Res 72: 37–45, 1993.

20. Milgrom P, Riedy CA, Weinstein P, Tanner AC, Manibusan L, Bruss J. Dental caries and its relationship to bacterial infection, hypoplasia, diet, and oral hygiene in 6- to 36-month-old children. Community Dent Oral Epidemiol 28: 295–306, 2000.

21. Berkowitz R. Etiology of nursing caries: A microbiologic per-spective. J PubI Health Dent 56: 51–54, 1996.

22. Buttner M. [What physicians should currently observe in the area of dental health]. Gesundheitswesen 57: 741–743, 1995.

23. Alaluusua S, Matto J, Gronroos L, Innila S, Innila S, Torkko H, Asikainen S, Jousimies-Somer H, Saarela M. Oral colonization by more than one clonal type of mutans streptococcus in children with nursing-bottle dental caries. Arch Oral Biol 4: 167–173, 1996.

24. Antony U, Munshi AK. Sibling versus maternal S. mutans levels as related to dental caries. J Clin Pediatr Dent 21: 145–150, 1997.

25. Emanuelsson IR, Li Y, Bratthall D. Genotyping shows different strains of mutans streptococci between father and child and within parental pairs in Swedish families. Oral Microbiol Immunol 13: 271–277, 1998.

26. Brambilla F, Felloni A, Gagliani M, Malerba A, Garcia-Godoy F, Strohmenger L. Caries prevention during pregnancy: results of a 30- month study. J Am Dent Assoc 129: 871–877, 1998.

27. Karn TA, O’Sullivan DM, Tinanoff N. Colonization of mutans streptococci in 8- to 15-month-old children. Public Health Dent 58: 248–249, 1998.

28. Seow WK. Biological mechanisms of early childhood caries. Community Dent Oral Epidemiol 26 (Suppl 1): 8–27, 1998.

29. Bowen WH. Response to Seow: Biological mechanisms of early childhood caries Community Dent Oral Epidemiol 26 (Suppl 1): 28–31, 1998.

30. Mattila ML, Rautava P, Sillanpaa M, Paunio P. Caries in five-year-old children and associations with family-related factors. J Dent Res 79: 875–881, 2000.

31. Weinstein P, Domoto P,Wohlers K, Koday M. Mexican-American parents with children at risk for baby bottle tooth decay: Pilot study at a migrant farm workers clinic. J Dent Child 59: 376–383, 1992.

32. Ramos-Gomez FJ, Shepard DS. Cost-effectiveness model for prevention of early childhood caries. J Cal Dent Assoc 26: 539–544, 1999.

33. Watson MR, Horowitz AM, Garcia I, Canto MT. Caries condi-tions among 2–5-year-old immigrant Latino children related to parents’ oral health knowledge, opinions and practices. Commu-nity Dent Oral Epidemiol 27: 8–15, 1999.

34. Kaste LM, Gift HC. Inappropriate infant bottle feeding. Status of the Healthy People 2000 objective. Arch Pediatr Adolesc Med 149: 786–791, 1995.

35. Ismail AI. The role of early dietary habits in dental caries devel-opment. Spec Care Dentist 18: 40–45, 1998.

36. Tinanoff N, Kaste LM, Corbin SB. Early childhood caries: a pos-itive beginning. Community Dent Oral Epidemiol 26 (Suppl 1): 117–119, 1998.

37. Ismail AI. Prevention of early childhood caries. Community Dent Oral Epidemiol 26 (Suppl 1): 49–61, 1998.

38. Tinanoff N, Daley NS, O’Sullivan DM, Douglass JM. Failure of intensive preventive efforts to arrest early childhood and ram-pant caries: three case reports. Pediatr Dent 21: 160–163, 1999.