Influence of Microflora, Cortisol And Parental Stress on ECC Onset

Objectives: To examine the association between several risk factors for Early Childhood Caries (ECC) and ECC onset in initially caries-free preschool children over a 2-year study period.
Methods: This is an analysis of the first 50 children followed for 24 months in a 2-year longitudinal study of 200 children. Saliva samples were evaluated for Streptococcus mutans (SM), Lactobacilli (LB), and Candida species using Mitis Salivarius agar and bacitracin (MSB), Rogosa, and CHROMagar respectively. Salivary cortisol samples were analyzed using ELISA. ECC was assessed using the ICDAS index and dental plaque was assessed using the Silness-Loe index. The Penn State Worry Questionnaire was used to assess the level of parent/primary caregiver worry. The Center for Epidemiologic Studies Depression Scale was used to assess the level of depression in the parent/primary caregiver.
Results: Analysis of 50 initially caries-free children, using the Kaplan-Meier method to estimate the probability distribution of time to ECC onset, indicated that 14% of the children experienced ECC onset at 6 months, 22% of the children at 12 months, 38% of the children at 18 months and 44% of the children at 24 months post-baseline. Preliminary estimation using the Cox Proportional Hazard regression model indicated that children who had higher levels of salivary SM (>10⁵ CFU/ml) (HR=3.26), higher levels of salivary LB (>10⁴ CFU/ml) (HR=1.27), carried Candida species (HR=1.81), had higher levels of salivary cortisol (HR=1.23) and whose parent/primary caregiver had a high level of worry (HR=2.49) were more likely to experience ECC onset.
Conclusions: After 2 years, 44% of the initial sample of 50 preschool children experienced ECC onset. Focusing attention on the relationships between the microbiological, psychosocial and stress related risk factors might lead to a greater understanding of the complex interaction of factors that influence increased risk for ECC.
Supported by R01 DE024985