Risk Factors Associated With non-Cavitated and Cavitated Carious Lesions in pre-School Children

Objectives: To evaluate the risk factors associated with the development of non-cavitated and cavitated lesions among preschool children in Hong Kong.
Methods: A cross-sectional analysis of baseline data from a randomized controlled clinical trial was performed among 3-4 years old preschool children from 25 kindergartens in Hong Kong. Diagnosis of caries was done using ICDAS criteria. Children were grouped as Caries-free (ICDAS score=0), children with non-cavitated carious lesions (ICDAS score 2), and children with cavitated carious lesion (ICDAS score 3-6). Oral hygiene was evaluated using Visible Plaque Index (VPI) on 6 deciduous index teeth. A structured questionnaire provided family socio-demographic background, parental oral health knowledge and practices of children. The backward stepwise selection method was used to study the significant variables by using multinominal logistic regression analysis.
Results: 741 children (mean 3.9 years) participated in the study with the prevalence of non-cavitated and cavitated carious lesions as 216 (29.1%), and 366 (49.4%), respectively. VPI was a significant factor to predict non-cavitated as well as cavitated lesions in the final regression model. Children with poorer oral hygiene were at a higher risk of developing both non-cavitated (OR:1.06, 95% CI:1.03-1.08, p<0.001) and cavitated lesions (OR:1.08, 95% CI:1.05-1.10, p<0.001). Children who snacked once/less than once a day (OR:0.53, 95% CI:0.33-0.83, p=0.006) and whose parents had higher mean oral health knowledge score (OR:0.74, 95% CI 0.61-0.89, p=0.002) had lower odds of developing cavitated lesions. In addition, children from lower household income families had higher odds of developing cavitated lesions (OR:2.84, 95% CI:1.35-5.96, p=0.006).
Conclusions: Poor oral hygiene could be a strong predictor of caries initiation. Snacking frequency, family income and parental oral health knowledge are risk factors associated with the development of cavitated carious lesion.