Predicting Caries Risk in Underserved Toddlers

Objective: To develop a questionnaire to identify toddlers at risk of developing early childhood caries. Methods: 328 children (26.5±5.6 months-of-age) were examined for plaque, Streptococcus mutans, gingivitis, and caries incidence (facial of 4 upper incisors and occlusal of all 1^st molars) over 12 months using the International Caries Detection and Assessment System (ICDAS) criteria. Their primary caregivers were examined for caries, salivary mutans streptococci and lactobacilli. A range of cultural, socio-demographic, dietary and biological factors, health beliefs and perceptions that may affect caries transmission and development, general-dental health, and access to care were collected through a structured interview. In the multivariate analysis, predictors (p<0.30) of change in total ICDAS score were identified and combined into a single model, with only predictors significant at p<0.05 retained in the final model. Results: The children's total ICDAS score was 5.5±0.6(mean±SE) at one year vs. 2.9±0.5 at baseline. The multivariate model had an R²=0.29 for all races/ethnicities; R²=0.04 for Non-Hispanic-African-Americans (predictors of worse change: baseline ICDAS and child drinks from bottle), R²=0.58 for Non-Hispanic-Caucasians (predictors: baseline ICDAS, not using city water, difficulty talking to doctor/dentist, caregiver not helping the child brush teeth, child drinks from bottle, child snacks on chips, child drinks juice between meals, caregiver does not know if toothpaste has fluoride, caregiver snacks on cake, caregiver does not drink sugar-free drinks), and R²=0.74 for Hispanics (predictors: baseline ICDAS, caregiver not born in US, child uses a pacifier, sharing food or drinks from the same plate/glass, not very satisfied with child doctor, child drinks from bottle, caregiver does not snack on crackers, caregiver drinks regular soda between meals, caregiver drinks milk between meals). Conclusion: Several perceptions, behaviors and socioeconomic variables were associated with caries incidence, and the prediction model varied by race/ethnicity. This study was supported by NIH-R21-DE16451-01.