Abstract
BackgroundEarly childhood caries (ECC) are particularly prevalent in disadvantaged populations, and socioeconomic factors are associated with the polarization of disease. A previous study showed that even within a homogenous low-income population disease is polarized, indicating that other factors apart from income may contribute to disease susceptibility.MethodsThis study used a hierarchical approach to identify factors associated with polarization of ECC in low-income subjects. This cross-sectional study was conducted retrospectively using a cohort of 244 children (aged 48–72 months) with family incomes not exceeding double the minimum wage (U.S. $8,208.00/year), living in neighborhoods on the outskirts of São Luís, Maranhão, Brazil. The sample was divided into three groups based on the Significant Caries (SiC) Index: no caries group, few caries group (mean 1.38 lesions), and a high caries group (mean 3.82 lesions). Hierarchical multinomial logistic regression analyses were performed based on a theoretical model.ResultsTwenty-eight (11.5%) of the 244 children presented with high caries. Age (p = 0.026; prevalence ratio (PR) = 1.10; 95% confidence interval (CI) 1.01–1.20) and frequency of sucrose consumption - p = 0.001; PR 4.65 (95% CI 1.83–11.84) were associated with increased risk of ECC.ConclusionsIn the high caries group, greater consumption of sucrose between main meals may explain why, in a group of children with homogenous social and health conditions, some had more caries than others.
Highlights
Childhood caries (ECC) are prevalent in disadvantaged populations, and socioeconomic factors are associated with the polarization of disease
Study design This was a cross-sectional study nested within a cohort study of preschool children aged from 18 to 42-months, in which was evidenced caries polarization [19]
Exclusion criteria included the presence of debilitating systemic diseases, malnutrition, and antibiotic use that could interfere with colonization of Streptococcus mutans (SM) 30 days prior to the onset of the study
Summary
Childhood caries (ECC) are prevalent in disadvantaged populations, and socioeconomic factors are associated with the polarization of disease. Higher prevalence in non-developed countries [5,6] and in socioeconomically disadvantaged groups living in low, middle [2,3,4] and high-income countries [7,8] have been documented. Increased concentration of ECC within a specific group signifies a polarizing phenomenon, defined as a greater number of cases within a small segment of the population [9,10,11]. Polarization of ECC is well documented; the majority of young children are caries-free, and most carious lesions are concentrated in a small number of children [14,15,16]. Polarization of caries disease has been documented among Brazilian adolescents [10,18] associated with skin color and the presence of tooth pain in the previous half year [10]
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