The prevalence and severity of dental caries in pre-school children can be quite high as demonstrated by several studies (6
). Thus, it is of great importance to begin preventive efforts at very young ages in vulnerable populations; however, information has been somewhat lacking concerning individual risk or specific factors to address in preventive programs for the very young. The results of this study suggest that two relatively easily-identified risk factors in 1-year-olds, presence of mutans streptococci and sugar-sweetened beverage consumption, are predictive of frank (d2-3f) caries in the middle pre-school years.
The identification of such risk factors early in life may allow tailored interventions for individual children including nutritional counselling and antimicrobial therapy or other appropriate prevention. Similarly, on a larger scale, the results of the study suggest that approaches to early childhood caries prevention may require more emphasis on behavioral change in regard to dietary practices and on antimicrobial agents as first-line preventive agents in young children. Thus, it appears that further studies of behavioral change methods (e.g., motivational interviewing, self-determination theory) are justified, and studies of antimicrobial agents including chlorhexidine, iodine and other agents are warranted.
Overall, the risk factors identified in the present study are similar to those identified in other studies (6
), including two longitudinal studies of older children (24
). In the study by Grindefjord et al (24
), presence of SM and consumption of sugar-containing beverages at baseline were associated with caries development during the succeeding 1-year period, and the odds ratios for these two risk factors were 4.5 and 2.1, respectively – similar to the findings of the present study. However, unlike the present study, these odds ratios were based on bivariate analyses that weren’t adjusted for age, and in these analyses several other risk factors were identified (e.g., immigrant status, low education level of mothers) so that it is not clear which risk factors were most germane to caries development. Moreover, the children in this study were at least 2 ½ years old and 11% of them had frank caries at baseline so that the findings may not apply to younger children.
While a strength of the present study was its longitudinal assessment of very young children, there were limitations. These included somewhat self-selected samples who remained in the study over an 18-month period, and who were from a limited geographic area. In addition, while Caucasian and Hispanic populations were well-represented in the sample, other groups were not. Taken together, the study sample cannot be considered representative of any population, so that extrapolation of study results should be done with caution. In addition, the study did not fully assess some potential risk factors including organisms other than MS; fluoride exposures other than water or dentifrice; parental health, health knowledge or beliefs, or other, non-beverage sugar exposures. Given that the study was conducted in a WIC clinic, it may not have allowed for enough variation in socio-economic status to identify SES as a caries risk factor. Moreover, sample size limited logistic modeling such that it was not possible to jointly consider all important risk factors in a single model. In addition, the sample size did not allow separate analyses based on narrower age ranges. Nonetheless, as a longitudinal study of children who were 1-year-olds at baseline, the study is unique and provides valuable insights into the initiation of caries in early childhood.
In conclusion, the results suggest that consumption of sugar-sweetened beverages in children up to 24 months of age is a strong and identifiable predictor of early childhood caries development in this population. Consistent with earlier studies, results also suggest that presence of mutans streptococci at an early age is strongly associated with ECC development. Health care providers should be alerted to substantially increased risk for ECC among infants and toddlers who consume sugar-sweetened beverages on a regular basis. Moreover, preventive strategies for very young children should include interventions to address SM as well as reduced sugar-sweetened beverage consumption.