Oral Health Birth Cohort Studies: Achievements, Challenges, and Potential

The value-for money of preventing and managing periodontitis: Opportunities and challenges

This article gives an overview of the societal and economic aspects of periodontitis and periodontal care. Despite its largely preventable nature, periodontitis is highly prevalent worldwide and imposes a substantial health and economic burden on individuals and society as a whole. The worldwide estimated direct treatment costs and productivity losses due to periodontitis (including for periodontitis-related tooth loss) amounted to US$ 186 billion and US$ 142 billion in 2019, respectively. The burden of periodontitis is particularly evident in low and disadvantaged populations. Smoking, dietary habits, and presence of systemic diseases along with social and commercial determinants are considered as risk factors for the periodontal diseases. The cost-effectiveness of preventing and managing periodontitis has been explored in several studies but it has been highlighted that there is scope for improvement in defining the methodology and quality of reporting of such studies. A recent report by The Economist Intelligence Unit examined the cost-effectiveness of interventions to prevent and manage periodontal diseases, suggesting that prevention of periodontitis through prevention of gingivitis by means of individual home care would be more cost-efficient than four other examined approaches. Future research in this field is recommended to further decipher the economic burden of periodontitis to society and to assess the value for money of alternative approaches to address periodontitis with particular emphasis on public health preventive strategies and intersectoral care approaches that address the common risk factors of periodontitis and other non-communicable diseases simultaneously.

Ankyloglossia and Breastfeeding Duration: A Multicenter Birth Cohort Study

Background and Objective: The prevalence of ankyloglossia and its impact on breastfeeding practices may be overestimated, leading to surgical overtreatment in newborns. The study was conducted to estimate the prevalence of ankyloglossia in the first year of life and investigate the association with exclusive and total breastfeeding duration in different regions of Brazil. Materials and Methods: This multicenter prospective cohort study involved the recruitment of mother-infant pairs soon after childbirth in public hospitals in three state capitals in Brazil. Interviews were held with the mothers after birth, at 6 and 12 months to collect sociodemographic variables and data on exclusive and total breastfeeding duration. At 12 months of age, the children were submitted to a dental examination for classification of the lingual frenulum using the Bristol Tongue Assessment Tool. Data analysis involved Poisson regression with robust variance, with the calculation of unadjusted and adjusted relative risk (RR). Results: The final sample was composed of 293 children. The prevalence of defined and suspected ankyloglossia was 1% and 4.8%, respectively, totaling 5.8% (confidence interval [95% CI]: 3.1-8.5). No significant difference was found in the prevalence of exclusive and total breastfeeding at 1, 4, and 6 months between children with defined/suspected ankyloglossia and those without ankyloglossia. The multivariable analysis showed that the probability of the child achieving 6 months of breastfeeding did not differ between groups (RR = 0.98; 95% CI: 0.79-1.23; p = 0.907). Conclusion: The prevalence of defined ankyloglossia was very low and defined/suspected ankyloglossia was not associated with exclusive or total breastfeeding duration. Clinical Trial Registration: Registered with clinicaltrials.gov (n° NCT03841123).

Prediction Model Development and Validation of 12-Year Incident Edentulism of Older Adults in the United States

INTRODUCTION

Edentulism affects health and quality of life.

OBJECTIVES

Identify factors that predict older adults becoming edentulous over 12 y in the US Health and Retirement Study (HRS) by developing and validating a prediction model.

METHODS

The HRS includes data on a representative sample of US adults aged >50 y. Selection criteria included participants in 2006 and 2018 who answered, "Have you lost all of your upper and lower natural permanent teeth?" Persons who answered "no" in 2006 and "yes" in 2018 experienced incident edentulism. Excluding 2006 edentulous, the data set (n = 4,288) was split into selection (70%, n = 3,002) and test data (30%, n = 1,286), and Monte Carlo cross-validation was applied to 500 random partitions of the selection data into training (n = 1,716) and validation (n = 1,286) data sets. Fitted logistic models from the training data sets were applied to the validation data sets to obtain area under the curve (AUC) for 32 candidate models. Six variables were included in all models (age, race/ethnicity, gender, education, smoking, last dental visit) while all combinations of 5 variables (income, alcohol use, self-rated health, loneliness, cognitive status) were considered for inclusion. The best parsimonious model based on highest mean AUC was fitted to the selection data set to obtain a final prediction equation. It was applied to the test data to estimate AUC and 95% confidence interval using 1,000 bootstrap samples.

RESULTS

From 2006 to 2018, 9.7% of older adults became edentulous. The 2006 mean (SD) age was 66.7 (8.7) for newly edentulous and 66.3 (8.4) for dentate (P = 0.31). The baseline 6-variable model mean AUC was 0.740. The 7-variable model with cognition had AUC = 0.749 and test data AUC = 0.748 (95% confidence interval, 0.715-0.781), modestly improving prediction. Negligible improvement was gained from adding more variables.

CONCLUSION

Cognition information improved the 12-y prediction of becoming edentulous beyond the modifiable risk factors of smoking and dental care use, as well as nonmodifiable demographic factors.

KNOWLEDGE TRANSFER STATEMENT

This prediction modeling and validation study identifies cognition as well as modifiable (dental care use, smoking) and nonmodifiable factors (race, ethnicity, gender, age, education) associated with incident complete tooth loss in the United States. This information is useful for the public, dental care providers, and health policy makers in improving approaches to preventive care, oral and general health, and quality of life for older adults.

Parental recall bias in observational studies: Child dental service use

BACKGROUND

Parents are frequently used to recall events of exposure and disease as a proxy for their children in observational health research.

AIM

To assess the validity of parental recall of children's utilisation of dental services.

DESIGN

Parents in the Longitudinal Study of Australian Children (LSAC) were asked to recall their children's overall dental service use in the previous year and whether the study child had received fillings or extractions due to decay in the previous 2 years. True positives were identified through parents who correctly recalled child dental service utilisation with actual dental treatment received in a linked dataset.

RESULTS

Of the 10 090 participants from the LSAC, 1290 study children had linked dental treatment data eligible for inclusion in this study. The absolute true-positive rate for parental recall of dental service use in the previous year was 82% (n = 1263). Overall true-positive percentages were lower for recall of fillings (40%) and extractions (7%) in the previous 2 years. Increasing number of recall days was associated with the rate of true-positive recall adjusted for other factors in all three models.

CONCLUSION

Accuracy of parental recall for tooth fillings and extractions was low. The use of parental recall for specific dental treatment over a time span of 2 years in further research is not recommended.

Consumption of ultraprocessed food is associated with higher blood pressure among 6-year-old children from southern Brazil

Ultraprocessed foods (UPF) consumption plays a critical role in the development of chronic diseases, but evidence of their effect on children's health is limited. We hypothesized that the consumption of UPF can influence blood pressure levels in 6-year-old children. This study is a secondary analysis of a randomized field trial in Brazil that is registered at clinicaltrial.gov (NCT00635453). Dietary intake was obtained using 2 multiple-pass 24-hour recalls when 305 children were 3 and 6 years old. We classified foods according to the NOVA system and determined the percentage of total energy intake derived from ultraprocessed foods. We collected anthropometric measures from and evaluated systolic and diastolic blood pressures of 6-year-old children. Linear regression analysis was used to assess the association between UPF consumption and blood pressure levels. UPF represented 40.3% (interquartile range, 34.1-48.5) of the total energy intake at 3 years and 45.2% (interquartile range, 41.5-53.2) at 6 years. The adjusted linear regression analyses showed that systolic blood pressure was associated with UPF consumption at 6 years (P = .05), birth weight (P = .02), waist circumference (P < .01), and physical activity (P = .04), whereas diastolic blood pressure was associated with UPF consumption at 3 and 6 years (P = .01 and P < .01, respectively), birth weight (P = .05), and waist circumference (P < .01). Our data suggest that UPF consumption played a role in increasing 6-year-old children's blood pressure. These results reinforce the importance of effective strategies to prevent the excessive consumption of UPF in childhood.

Breastfeeding Protects from Overjet in Adolescence by Reducing Pacifier Use: A Birth Cohort Study

Increased dental overjet in adolescence is a clinically relevant outcome associated with the complexity and high cost of treatment, indicating the need for prevention strategies. We investigated the long-term impact of breastfeeding and pacifier use on increased overjet (IOVJ) in permanent dentition. A prospective cohort nested in a randomized controlled trial was conducted from birth to 12 years of age (n = 214). Breastfeeding and pacifier use were recorded monthly until 12 months. Overjet was assessed at age 12 years. We employed a causal mediation analysis using parametric regression models assuming no interaction between breastfeeding and pacifier usage. We found a total protective effect of breastfeeding on IOVJ (OR 0.49; 95% CI 0.28-0.96), where 63.1% were mediated by pacifier use (OR 0.61; 95% CI 0.44-0.87). Breastfeeding directly decreased the odds of IOVJ by 20%; however, the confidence interval included the null estimate (OR 0.81; 95% CI 0.41-1.60). In conclusion, breastfeeding protects by half of the IOVJ in adolescence through reducing pacifier use. Oral and general health professionals should collaborate to support WHO breastfeeding guidelines during individual patient counseling. Guidelines for practice, policy or public information require messages that include a common risk approach to oral and general health.

Oral and craniofacial research in the Generation R study: an executive summary

OBJECTIVES

Oral conditions are of high prevalence and chronic character within the general population. Identifying the risk factors and determinants of oral disease is important, not only to reduce the burden of oral diseases, but also to improve (equal access to) oral health care systems, and to develop effective oral health promotion programs. Longitudinal population-based (birth-)cohort studies are very suitable to study risk factors on common oral diseases and have the potential to emphasize the importance of a healthy start for oral health. In this paper, we provide an overview of the comprehensive oral and craniofacial dataset that has been collected in the Generation R study: a population-based prospective birth cohort in the Netherlands that was designed to identify causes of health from fetal life until adulthood.

METHODS

Within the multidisciplinary context of the Generation R study, oral and craniofacial data has been collected from the age of 3 years onwards, and continued at the age of six, nine, and thirteen. Data collection is continuing in 17-year-old participants.

RESEARCH OUTCOMES

In total, the cohort population comprised 9749 children at birth, and 7405 eligible participants at the age of seventeen. Based on questionnaires, the dataset contains information on oral hygiene, dental visits, oral habits, oral health-related quality of life, orthodontic treatment, and obstructive sleep apnea. Based on direct measurements, the dataset contains information on dental caries, developmental defects of enamel, objective orthodontic treatment need, dental development, craniofacial characteristics, mandibular cortical thickness, and 3D facial measurements.

CONCLUSIONS

Several research lines have been set up using the oral and craniofacial data linked with the extensive data collection that exists within the Generation R study.

CLINICAL RELEVANCE

Being embedded in a multidisciplinary and longitudinal birth cohort study allows researchers to study several determinants of oral and craniofacial health, and to provide answers and insight into unknown etiologies and oral health problems in the general population.

Differential Unmet Needs and Experience of Restorative Dental Care in Trajectories of Dental Caries Experience: A Birth Cohort Study

Dental caries is a chronic and cumulative disease but little has been reported on the continuity of the disease and its treatment through life. Group-based multi-trajectory modeling was used to identify developmental trajectories of untreated carious tooth surfaces (DS), restored tooth surfaces (FS), and teeth extracted due to caries (MT) from ages 9 to 45 years in a New Zealand longitudinal birth cohort, the Dunedin Multidisciplinary Health and Development Study (n = 975). Associations between early-life risk factors and trajectory group membership were examined by specifying the probability of group membership according to a multinomial logit model. Six trajectory groups were identified and labeled: "low caries rate"; "moderate caries rate, maintained"; "moderate caries rate, unmaintained"; "high caries rate, restored"; "high caries rate, tooth loss"; and "high caries rate, untreated caries". The two moderate-caries-rate groups differed in count of FS. The three high-caries-rate groups differed in the relative proportion of accumulated DS, FS, and MT. Early childhood risk factors associated with less favorable trajectories included higher dmfs scores at age 5, lack of exposure to community water fluoridation during the first 5 years of life, lower childhood IQ, and low childhood socioeconomic status. Parent self-ratings of their own or their child's oral health as "poor" were associated with less favorable caries experience trajectories. Children who had clinical signs of dental caries together with a parent rating of child's oral health as poor were more likely to follow a less favorable caries trajectory. Higher deciduous dentition caries experience at age 5 years was associated with less favorable caries trajectories, as were children whose parents gave "poor" ratings of their own or their child's oral health. These findings highlight the considerable intergenerational continuity in dental caries experience from early childhood to midlife. Subjective measures of child oral health are informative and might aid as predictors of adult caries experience in cases where childhood dental clinical data were not available.

Reflections on oral health inequalities: Theories, pathways and next steps for research priorities

Health inequalities, including those in oral health, are a critical problem of social injustice worldwide, while the COVID-19 pandemic has magnified previously existing inequalities and created new ones. This commentary offers a summary of the main frameworks used in the literature of oral health inequalities, reviews the evidence and discusses the potential role of different pathways/mechanisms to explain inequalities. Research in this area needs now to move from documenting oral health inequalities, towards explaining them, understanding the complex mechanisms underlying their production and reproduction and looking at interventions to tackle them. In particular, the importance of interdisciplinary theory-driven research, intersectionality frameworks and the use of the best available analytical methodologies including qualitative research is discussed. Further research on understanding the role of structural determinants on creating and shaping inequalities in oral health is needed, such as a focus on political economy analysis. The co-design of interventions to reduce oral health inequalities is an area of priority and can highlight the critical role of context and inform decision-making. The evaluation of such interventions needs to consider their public health impact and employ the wider range of methodological tools available rather than focus entirely on the traditional approach, based primarily on randomized controlled trials. Civil society engagement and various advocacy strategies are also necessary to make progress in the field.

Sodium Intake Tracked from Infancy and Salt Taste Preference during Adolescence: Follow-up of a Randomized Controlled Field Trial in Brazil

Background

Effective interventions to promote healthy sodium intakes require understanding factors driving liking for salt taste.

Objectives

To examine effects of an early feeding intervention among low-income mothers on their children's energy and sodium intake and salt taste preferences at 12 years; and to identify age-related changes in dietary sodium sources.

Methods

Secondary analyses were conducted on dietary intake and taste preference data collected from children in a longitudinal trial (NCT00629629). Mothers randomized to the intervention group received counseling on healthy eating practices for 1 year postpartum; the control group received no counseling. Two-day dietary recalls were obtained at 1 year (intervention end) and at 4-, 8-, and 12-year follow-up visits, from which foods were categorized as unprocessed, processed, or ultra-processed. At the 12-year visit, children's most preferred concentration of salt was measured using a validated, forced-choice, paired-comparison tracking method, and pubertal stage was self-assessed.

Results

The intervention group had reduced energy intake compared with controls in all food categories at 1 year (P = 0.04) but not at the other time points. Sodium intake from processed foods increased from 4 to 12 years and from ultra-processed foods from 1 to 4; intake from unprocessed foods decreased from 1 to 8 year (all P < 0.01). At 12 years, children in early stages of puberty (Tanner stages 1-3; P = 0.04) or in the ≥75th percentile of sodium intake (P < 0.01) preferred significantly higher concentrations of salt than the other children.

Conclusions

Both dietary intake of sodium and early puberty were associated with preferences for higher salt concentrations. Childhood and adolescence are important periods for understanding how experience and growth shape diet by changing salt taste.

Clinical Trial Registration

This manuscript reports secondary analysis of data collected in trial NCT00629629 (2001-3) and follow-up [https://clinicaltrials.gov/ct2/show/NCT00629629?term=NCT00629629&draw=2&rank=1].

Investigating the impact of oral health on pregnancy and offspring outcomes: protocol for the Lifetime Impact of ORal heAlth (LIORA) cohort study

INTRODUCTION

Oral health is a fundamental component of well-being, and is closely associated with overall health and quality of life. Oral health may also affect the next generation. The children of mothers with poor oral health are likely to also have poor oral health as they go through life. We aim to investigate associations between maternal oral health and general health, pregnancy outcomes, offspring oral health and offspring general health.

METHODS AND ANALYSIS

The Lifetime Impact of Oral Health study is a prospective, observational cohort study being done at a single centre in Chongqing, China. A total of 1000 pregnant women will be recruited in their first trimester (11-14 weeks gestation). After obtaining informed consent, general and oral health assessments will be undertaken. Maternal lifestyle, demographic data and biospecimens (blood, hair, urine, nail clippings, saliva, dental plaque, buccal, vaginal and anal swabs) will be collected. Pregnancy outcomes will be recorded at the time of delivery. Cord blood and placenta samples will be collected. The offspring will be followed up for general and oral health examinations, neurodevelopmental assessments and biospecimen (dental plaque, saliva, buccal swabs, exfoliated primary dentition, urine, hair, nail clippings) collection until they are 15 years old. Biological samples will undergo comprehensive metabolomic, microbiome and epigenome analyses. Associations between maternal oral health and general health, pregnancy outcomes, offspring oral health and offspring general health will be investigated and the underlying mechanisms explored.

ETHICS AND DISSEMINATION

This project has been approved by the Research Ethics Committee of the Affiliated Hospital of Stomatology of Chongqing Medical University (CQHS-REC-2021 LSNo.23). Participants will be required to provide informed consent to participate in the study. Dissemination of findings will take the form of publications in peer-reviewed journals and presentations at national and international conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2100046898.

Pattern of caries lesions and oral health-related quality of life throughout early childhood: A birth cohort study

The aim of this study was to evaluate the impact of different patterns of dental caries on oral health-related quality of life (OHRQoL) throughout early childhood. This birth cohort study followed 277 children from southern Brazil for 6 years. Demographic and socioeconomic variables were collected at birth. At age 3 years, children's dental caries experience was quantified by the decayed, missing, or filled teeth (dmft) index. At age 6 years, parents answered the Early Childhood Oral Health Impact Scale (ECOHIS). Poisson regression models were used to estimate associations between caries experience and later OHRQoL, presented as the ratio of ECOHIS scores between the groups. The prevalence of dental caries at 3 years of age was 37.5%. In children with caries, lesions only in anterior teeth, only in posterior teeth, and in both dental segments at age 3 were associated with age 6 ECOHIS scores that were 2.7, 7.8, and 6.2 times higher, respectively, than in children without dental caries experience. OHRQoL was worse among children with higher dmft scores. Dental caries lesions in posterior teeth by age 3 years was strongly predictive of adverse impacts on later OHRQoL, presumably as an indicator of continued disease experience in the intervening years.

Trajectories of Sugar Consumption and Dental Caries in Early Childhood

This study verifies the association between the trajectory of sugar consumption and dental caries in the 2015 Pelotas Birth Cohort in Pelotas, Brazil. It was conducted with data from the follow-ups at 3, 12, 24, and 48 mo from the 2015 Birth Cohort, which included 4,275 children born alive in hospitals in Pelotas. Data collection included standardized questionnaires for first caregivers applied by trained interviewers at all follow-ups. Exposure was the trajectory of sugar consumption from 3 to 48 mo (always low, always intermediate, increasing, and always high), obtained by group-based trajectory modeling. The outcome of this study was dental caries, obtained through clinical examination performed by calibrated dentists at 48 mo of age. Socioeconomic conditions and oral health instruction from a health professional during the first 4 y of life were included in the analysis as potential confounders. Prevalence ratios and their 95% confidence intervals were provided from generalized estimating equations with a log-Poisson with robust variance specification. In total, 3,654 (91.1%) children participated in the survey at 48 mo, and 2,806 children had complete data for the analyzes performed. Of these, 1,012 (36.1%; 95% confidence interval [CI], 34.3-37.8) experienced caries, and 723 (25.8%; 95% CI, 24.2-27.4) had cavitated caries. Regarding cavitated caries, the prevalence was 1.48 times higher in the group with increasing sugar consumption than children with always low consumption. There is an association between the trajectory of sugar consumption and dental caries at 48 mo. Children with increasing and always high sugar consumption have the highest prevalence of caries.

Scoping Review of Oral Health-Related Birth Cohort Studies: Toward a Global Consortium

The multidisciplinary nature and long duration of birth cohort studies allow investigation of the relationship between general and oral health and indicate the most appropriate stages in life to intervene. To date, the worldwide distribution of oral health-related birth cohort studies (OHRBCSs) has not been mapped, and a synthesis of information on methodological characteristics and outcomes is not available. We mapped published literature on OHRBCSs, describing their oral health-related data and methodological aspects. A 3-step search strategy was adopted to identify published studies using PubMed, Embase, Web of Science, and OVID databases. Studies with baseline data collection during pregnancy or within the first year of life or linked future oral health data to exposures during either of these 2 life stages were included. Studies examining only mothers' oral health and specific populations were excluded. In total, 1,721 articles were suitable for initial screening of titles and abstracts, and 528 articles were included in the review, identifying 120 unique OHRBCSs from 34 countries in all continents. The review comprised literature from the mid-1940s to the 21st century. Fifty-four percent of the OHRBCSs started from 2000 onward, and 75% of the cohorts were from high-income and only 2 from low-income countries. The participation rate between the baseline and the last oral health follow-up varied between 7% and 93%. Ten cohorts that included interventions were mostly from 2000 and with fewer than 1,000 participants. Seven data-linkage cohorts focused mostly on upstream characteristics and biological aspects. The most frequent clinical assessment was dental caries, widely presented as decayed, missing, and filled teeth (DMFT/dmft). Periodontal conditions were primarily applied as isolated outcomes or as part of a classification system. Socioeconomic classification, ethnicity, and country- or language-specific assessment tools varied across countries. Harmonizing definitions will allow combining data from different studies, adding considerable strength to data analyses; this will be facilitated by forming a global consortium.

Patients' Perspective on Their Experience of Dental Treatments Covered by Public Health Insurance in Romania-A Pilot Study

Although the aims of any public health coverage are prevention, diagnosis, treatment, rehabilitation, and maintenance, dental services are hardly ever included in services. The goal of our pilot study is to assess the perspective of a group of adult patients on their covered dental treatments. The present cross-sectional study was conducted on 140 patients who reported their perception by filling in a questionnaire. All the collected data were statistically analyzed using IBM SPSS Statistics 25. Most of the subjects (40.7%, n = 57) were treatment oriented, visiting the dentist only in an emergency situation. A total of 40.7% (n = 57) of the participants stated that all the dental treatments had coverage and 22.8% (n = 13) had to split their treatment plan because of the insurance budget limit. The subjects who had chosen covered dental services because they considered it was a right they should benefit from (53.7%, n = 22) and those who had chosen covered dental services because of financial reasons (29.3%, n = 12) were more frequently unsatisfied with the types of covered dental services. The reduced level of satisfaction was associated mainly with the list of dental procedures accepted for coverage and also with younger and highly educated patients. For a more accurate description, the present study should be completed by future studies not only on a representative population at national level, but also by assessing the perspective of dental professionals.

Risk factors for dental caries in Latin American and Caribbean countries

Identifying the risk factors for dental caries is vital in epidemiology and clinical practices for developing effective preventive strategies, both, at the individual and collective levels. Different causality/determination models have been proposed to understand the development process of dental caries. In the present review, we designed a model inspired by the world-known social determinants models proposed in the 90s and more recently in the 10s, wherein the contextual factors are placed more externally and encompass the individual factors. The contextual factors included those related to the cultural and societal values, as well as the social and health government policies. The individual factors were classified into the following categories: socioeconomic (social class, occupation, income, and education level), demographic characteristics (age, sex, and ethnicity), behavioral factors (non-use of fluoride dentifrice, sugar consumption, poor oral hygiene, and lack of preventive dental care), and biological factors (recent caries experience/active caries lesions, biofilm retentive factors, developmental defects of the enamel, disabilities, saliva amount and quality, cariogenic biofilm). Each of these variables was addressed, while focusing on the current evidence from studies conducted in Latin American and Caribbean countries (LACC). Based on the proposed model, educational aspects were addressed, and individual caries risk assessment and management decisions were proposed; further, implications for public health policies and clinical practice were described. The identification of modifiable risk factors for dental caries should be the basis for multi-strategy actions that consider the diversity of Latin American communities.

The Queensland Birth Cohort Study for Early Childhood Caries: Results at 7 Years

AIMS

This study investigated caries predictors in 378 children remaining from a birth cohort of 1,052 at 7 y and compared the efficacy of home visits (HVs) and telephone contacts (TCs) for early childhood caries (ECC) prevention.

METHODS

The HVs or TCs were made at ages 6, 12, 18, 30, and 42 mo with annual dental clinic examinations at ages 2 to 7 y. At every visit, the parents completed validated questionnaires regarding the children's family, medical, dental, and dietary histories.

RESULTS

The caries prevalence increased from 2% and 6% at ages 2 and 3 y to 15%, 33%, 42%, and 52% at ages 4 to 7 y. The mean caries experience (decayed, missing, and teeth extracted due to caries) of the total cohort increased from 0.1 ± 0.5 at age 2 y to 0.2 ± 1.1 at 3 y, 0.5 ± 1.6 at 4 y, 1.1 ± 2.4 at 5 y, 1.6 ± 2.6 at 6 y, and 2.0 ± 2.7 at 7 y. The prevalence of mutans streptococci (MS) in the total cohort at years 2 to 7 was 22%, 36%, 42%, 42%, 39%, and 44%, respectively. MS was strongly correlated with caries prevalence for all years (all P < 0.001). Statistical modeling employing the generalized estimating equations identified caries predictors as holding a Health Care Card (low socioeconomic status) (P = 0.009; odds ratio [OR] = 2.05; confidence interval [CI]: 1.20-3.52), developmental defects of enamel (DDEs) (P < 0.001; OR = 1.09; CI: 1.05-1.14), and MS counts ≤10⁵/mL (P = 0.001; OR = 1.63; CI: 1.24-2.14). By contrast, HVs were more protective than TCs for caries (P = 0.008; OR = 0.42; CI: 0.22-0.80).

CONCLUSIONS

This study provides prospective, clinical evidence that MS, DDEs, and low socioeconomic status are strongly correlated with early childhood caries and that HVs are more efficacious than TCs in ECC prevention.

KNOWLEDGE TRANSFER STATEMENT

This 7-y birth cohort study provides longitudinal clinical evidence that mutans streptococci, developmental defects of enamel, and low socioeconomic status are key risk indicators of early childhood caries.