Identification of Early Childhood Caries Risk Determinants in Underprivileged Children

Objectives: Early childhood caries (ECC) is a highly prevalent, multifactorial disease. It is one of the most common unmet healthcare needs of underprivileged children. Data indicates that there is no significant reduction in caries status of Hong Kong preschoolers over the past decades. Moreover, caries polarization may become more prominent and geographic influences are yet to be further investigated. This study aimed to identify caries risk determinants amongst underprivileged children.
Methods: Two kindergartens from two districts in Hong Kong, Tin Shui Wai (TSW) and Sham Shui Po (SSP), were recruited for this preliminary study. Following informed consent, primary caregivers completed questionnaires collecting sociodemographic, behavioural, environmental and health data. In addition to a series of health assessments, oral examinations were performed in 157 preschoolers to determine their oral hygiene and ECC status. Negative binomial regression was performed to identify the risk factors leading to the onset and progression of ECC.
Results: Caries lesions were observed in 45% of the preschoolers. Children from SSP presented a higher caries prevalence (66.7%) and plaque index compared to their TSW peers (p<0.05). Significant differences were also observed for different aspects of toothbrushing (starting age, frequency, and assistance) and caregivers’ perceptions (importance of milk teeth, child’s oral health, cariogenic bacteria, and caries treatment). Motor performance/lung function test scores and weekday sleep duration were individual factors affecting the child’s dmft. Multivariable regression analysis consistently showed child’s age and paternal education level to be associated with ECC (p<0.05).
Conclusions: Dental caries was prevalent among the Hong Kong preschoolers. Different ecological and geographical contexts not only influence parental beliefs/behaviors and childhood growth/development, but also the early onset and progression of ECC. Further identification of early-life factors will provide important insights into more proactive public health preventive programs for underprivileged children and their families.