Assessing Risk for ECC in Child Care Settings: Policy and Program Implications

NHANES findings of increasing Early Childhood Caries (ECC) prevalence compels further investigation into correlates of ECC and methods to identify affected children. In a series of three caries risk studies involving parental, environmental, and biological risk factors among 2-to-6 year-olds attending Mississippi Delta childcare centers (n=764) 38.4% had ECC, 20.7% had severe-ECC, and 10.4% had urgent treatment needs. As expected, caries prevalence correlated with minority status (black versus other), plaque, mutans in saliva, and increasing age (4.4% at age 2, 13.9% at 3, 31.3% at 4, and 30.7% at 5; caries increments of 1.2 teeth per year among 72 children seen in at least 2 waves). Socioeconomic factors (parent education and Medicaid eligibility as proxy for low income) were weak correlates of caries - predictive in only the first wave - perhaps because sample size decreased with each wave. Similarly, parental consumption of sugar drinks and flossing were predictive in only the first wave. Surprisingly, parental history of having had a dental abscess was consistently predictive of caries. In logistic regression analyses using pooled data, age, minority race, and history of parent abscess predicted ECC and age, minority race, lower parent education, no or occasional flossing, and history of parent abscess predicted severe ECC. These findings point toward development of a reliable caries risk profile for young children and the potential for non-examination factors to help identify children with current dental treatment needs.