Early childhood caries and its association with socio-behavioural and parental factors among 2-6 year old children

Doctoral Thesis / Dissertation, 2016

222 Pages



1 Introduction

2 Aim & Objectives

3 Review of Literature

4 Materials and Method

5 Results

6 Discussion

7 Summary and Conclusion

8 Recommendations

9 References

10 Annexures


Oral health is related to general health and quality of life, which emphasizes the importance of retaining good functional dentition.1 It is associated with development of healthy personality, perception and enables an individual to speak, eat and socialize without active disease and discomfort.2 The role of nutrition is also related to poor oral health affecting growth and cognitive development that leads to medical complications of untreated diseases, and result in poor social outcomes.3

Despite the great improvement in oral health, many countries still encounter oral diseases which are widely prevalent, more so in the developing countries like India.4 Dental diseases, such as Dental caries, Periodontal disease and Oral mucosal lesions, are the major public health problem throughout the world with the high prevalence due to altered life style and eating habits.5 The burden of Oral disease is particularly high for the disadvantageous and poor population groups in both developing and developed countries.6

Dental caries is an epidemic disease affecting humans of all ages in regions of most common disease of children. Among all the dental diseases, the prevalence of dental caries in India is increasing referred as “Disease of civilization.”7 According to Centre for Disease Control & Prevention, dental caries is perhaps the most prevalent infectious disease. Although it is well understood and preventable but still a global problem among children and young adults. More than 40% of children have caries by the time they reach kindergarten.8

Early childhood caries is a serious oral health problem. According to American Academy of Pediatric Dentistry ( AAPD), Early Childhood Caries is defined as is the presence of one or more decayed (noncavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a child with 71 months of age or younger.9 It also have a complex etiology and is considered to be a multi-factorial disease and these factors includes a susceptible host, fermentable carbohydrate diet, presence of dental plaque, high number of cariogenic micro-organisms such as mutans streptococci, lactobacillus and time.10

Early Childhood Caries can be a particularly virulent form of caries, beginning soon after tooth eruption, developing on smooth surfaces, progressing rapidly, and having a lasting detrimental impact on the dentition.9

ECC has also been described as a social, political, behavioral, medical, psychological, economical and dental problem, because it is epidemic in disadvantaged children, regardless of race, ethnicity, or culture.10 Long term follow up reveals that children who experience ECC are more likely to develop dental problems as they grow older and the prevalence rate ranging from 1% to 12% in preschoolers of developed countries and from 50% to 80% in high-risk groups.10

Oral diseases including dental caries especially among primary teeth is considered to be a public health problem with many of these children being untreated11 and the treatment of dental caries in children alone is expected to exceed the total child health care budget, especially in the developing countries.7 In addition, to the burden of treating these diseases, pain, discomfort, sleepless nights, and limitation in eating function leads to poor nutrition and together with time taken off school for the children and work for parents, it can be detrimental to the physical and social health of both the children and their parents11,12,13,14 with 90% of pre-school children being affected and with the disease threatening to affect the well-being of millions of children, the WHO has recommended the common risk factor approach to deal with the problem.12

The variables or determinants of the disease can be based on socio-economic and demographic factors which includes - level of education (schooling), occupation, income, locality of habitation and access to amenities like health care. For example, the parent‟s socio-economic background determines the child„s socio-economic status and this reflects on the parents„ level of schooling, education and income.15 Other factors or variables of significance could be feeding habits and practices- with regard to frequency and methods used, oral health behaviour- with regard to tooth brushing and dental check- ups. In addition, in the development of early child hood caries could be oral hygiene status and the types and counts of bacteria involved in causing the disease. 15

Studies have found that the frequency of ECC is greater among children who fall asleep sipping sugar containing fluid, children in families with a larger number of siblings and those whose mothers are younger. 16

The most significant effect of nutrition on teeth is the local action of diet on the development of dental caries. 17 There is a vast amount of evidence that shows sugars (mono and disaccharides added to food by the manufacturer) are undoubtedly the most important dietary factor in the aetiology and development of dental caries.18 Oral bacteria, especially Streptococcus mutans and Lactobacilli ssp. have the ability to ferment sugar (sucrose, fructose and glucose) and produce lactic acid. This acid production reduces the pH of the oral cavity to 5.5 which is the critical pH at which demineralisation occurs.19 If this pH is maintained for a long period of time, it is capable of destroying tooth enamel and can eventually lead to tooth loss. S. mutans also has the ability to convert sucrose to an extremely adhesive substance called dextran polysaccharide which allows it to adhere to biofilm on the tooth surface.20

In addition, the frequency of sugar consumption is an important aetiological factor for caries development. Primary evidence came from the infamous Vipeholm study which showed caries development was low when sugars were consumed up to four times a day at mealtimes.21 A study in 1989 among 5 year old children in Iceland also came to the same conclusion - children who developed 3 or more carious lesions had a sugar intake of an average of 5.1 times per day as compared with 2.1 times to those who developed less than 3 carious lesions.22 The amount of sugar consumed is also an important aetiological factor. An increase in the amount of sugar consumed results in increase in dental caries.23 There is also a strong correlation between the amount and frequency of sugars consumed.24,25 The cariogenicity of sugary food is also related to dental caries. The longer it takes a food to clear the mouth, the longer the drop in pH remains. The cariogenicity of food is related to its consistency - whether it is a liquid, solid, sticky, nutrient composition, sequence of food intake, combination of food and potential to stimulate saliva.26

ECC has also being associated with demographic characteristics, parental attitude, parents with low level of formal education or insufficient knowledge regarding oral health and lower household income.27

Although there have been improvements in the oral health provision in developed countries, oral health inequalities still remains both in the developed and developing countries and is a major public health challenge because it is often lower income and socially disadvantaged sections within these societies that are affected.11 Early childhood caries is prevalent among the disadvantaged sections in all societies of the world.28,29,30

Detailed information regarding the prevalence and influencing factors of ECC provides a valuable tool in the planning, implementation and evaluation of oral health promotion programs. Despite of several studies done on ECC worldwide, there is a paucity of data on the prevalence of early childhood caries and its association with Socio-behavioral and Parental factors in Indian context, therefore an attempt is made to assess the prevalence of early childhood caries and its association with Socio-behavioral and Parental factors among 2-6 year old children in Faridabad.



- To assess the prevalence of ECC and its association with socio-behavioural and parental factors among 2-6 year old children in Faridabad, Haryana.


- To assess the prevalence and severity of ECC among 2-6 year old children in Faridabad.
- To assess the oral hygiene status among 2-6 year old children in Faridabad.
- To assess if there is any association of ECC with various socio-behavioural, and parental factors.


1. S Saravanan, I Madivanan, B Subashini, JW Felix (2005)33 conducted a study to assess the pattern of prevalence of dental caries in the primary dentition among 5 year old children of urban Pondicherry. The study population consisted of 1009 school children of both sexes (527 boys and 482 girls). A simple random sampling method was used to select the schools. Dental caries was assessed by the Dentition status and Treatment Need (WHO 1997). Statistical analysis was done using the Proportion test. Results showed that the prevalence of caries was 44.4% among the study population, being higher in the boys (P < 0.05); In Mandibular arch in both the sexes (boys P < 0.05, girls P < 0.01); in posterior teeth (both sex wise & arch wise). Comparison of caries among anterior teeth (Boys vs Girls) and posterior teeth (upper vs. lower) revealed higher caries prevalence in Maxillary anterior teeth (P < 0.001) and Mandibular posterior teeth (P < 0.001). In both the sexes and arches, primary second molars showed higher caries prevalence.

2. Azevedo T, Bezzera A, Toledo O (2005) 34 carried out a study to analyse the association between the feeding practice and presence or absence of severe early childhood caries (SECC) in low socio-cultural Brazilian preschool children. A total of 369 children were included in the study with an age range of 36 to 71 months, randomly selected at public health centres. An interview guided by a questionnaire about the culture, socioeconomic status, occupation of the parents and family income followed by oral examination was conducted. Results showed that 95% of the children had been breastfed for at least one month. Breastfeeding at night was observed in 72% and the authors noted that this practice was statistically associated with SECC. The mean length of time for breastfeeding was 17 months, and showed a significant association of breastfeeding in children older than 12 months and presence of SECC. Based on the findings of this study, the authors concluded that breast feeding at night and beyond 12 months of age are associated with SECC and SECC is positively associated with a night time bottle use as a pacifier substitute and bottle used on demand during the day.

3. Yonezu T, Ushida N, Yakushiji M (2006) 35 performed a longitudinal study to assess the effects of prolonged breast- or bottle feeding on dental caries in Japanese children. This study involved a questionnaire and clinical examination of 592 children at 18 months, 2 years and 3 years of age. Three groups were formed 1) children still being breastfed at 18 months (n=42), 2) children still being bottle fed at 18 months (n=45) and 3) children weaned off breast- or bottle feeding and no non-nutritive sucking habits at 18 months of age (n=205). The results showed that at 18 months, 5 (11.9%) of the 42 breastfed children had caries compared to 4 (2%) of the 205 not breast- or bottle fed. At 24 months, 6 (14.3%) of the 42 breastfed children had caries compared with 11 (5.4%) of those non bottle or breastfed children. The authors thus concluded that the children who were breastfed at 18 months of age were 3 times more likely to have dental caries at 2 years of age than those who had been weaned before 18 months of age. They also noted that those children who were prolonged breastfed were more likely to have dental caries than those prolonged bottle fed.

4. Hallett KB, O Rourke PK (2006) 36 carried out a study to investigate the association between selected social and behavioural variables and the pattern and severity of early childhood caries (ECC) within a community Australian child population. A cross-sectional sample of 2515 children aged 4-5 years were examined in a preschool setting using decayed, missing, filled teeth/surface (dmft/dmfs) indices and a self-administered questionnaire was used to obtain information regarding social, demographic, birth, infant feeding, oral and general health attitudes. Children with caries (847) were divided into anterior or posterior caries pattern groups and severe (dmfs score >6) or non-severe (dmfs score <6) caries groups. The data were analysed using a chi-square test and modelled using a logistic regression procedure. Significant variables associated with anterior ECC pattern were ethnicity other than Caucasian, sipping from the bottle during the day, male gender and sleeping with a bottle at night (OR ¼ 1.5, 95% CI ¼ 1.1-2.2). Significant variables associated with severe ECC form were sipping from the bottle during the day (OR ¼ 2, 95% CI ¼ 1.4-2.8), maternal age at birth ≤ 24 years (OR ¼ 1.8, 95% CI ¼ 1.3-2.7), ethnicity other than Caucasian (OR ¼ 1.6, 95% CI ¼ 1.1-2.5) and sleeping with a bottle at night (OR ¼ 1.5, 95% CI ¼ 1.1-2.2) and finally authors concluded that infant bottle-feeding habits (either allowing a child to sip from a bottle during the day or put to sleep at night) and ethnicity other than Caucasian were significant determinants for both anterior caries pattern and severity of ECC in 4-5-year-old.

5. Yonezu T, Yotsuya K, Yakushiji M (2006) 37 conducted a study to investigate characteristics and risk factors of prolonged breast feeding in Japanese infants. A total of 105 children aged 18 months were recruited for the study. These children underwent a comprehensive examination which involved diet history, tooth brushing habits and oral hygiene. Again examinations were performed at 24 months for recording initial and manifested dental caries followed by questionnaire that had to be filled by the parents. The results showed that 9 (8.6%) of the 105 still breastfed children had caries at 18 months and 20 (19%) at 24 months. Authors also noted that bedtime breastfeeding was a statistically significant factor in caries formation. Authors thus concluded that reducing the frequency of feeding, early establishment of good oral hygiene habits and regular visits to the dentist are essential in preventing nursing caries in prolonged breast fed children.

6. Schroth R, Brothwell D, Moffatt M (2007) 38 did a cross sectional study including a retrospective interview with caregivers to assess the relationship between caregiver knowledge and attitudes of preschool oral health and early childhood caries (ECC) from 4 communities in Manitoba. Children and their main caregivers served as the sample. Preschoolers underwent a comprehensive dental screening while caregivers completed a questionnaire that explored knowledge and attitudes toward preschool dental health. Caregiver responses were matched with findings from each child’s examination. Results showed that a majority agreed that primary teeth were important, that dental disease could lead to health problems and that a first dental visit should be made by age one. Caregivers of children with ECC were more likely to believe that caries could not affect a child’s health while those who believed primary teeth are important had children with significantly less decay. Finally authors concluded that most caregivers believed that primary teeth are important and correctly responded to inquiries about knowledge and attitudes toward oral health. Attitudes on the importance of baby teeth and bottle feeding after one year of age, the effect of rotten teeth on childhood health and night-time nursing emerged as variables most associated with the absence/presence of ECC and deft rates. Incorporating such questioning into caries risk assessments may be a useful means to determine a child’s risk for ECC.

7. Iida H, Auinger P, Billings R, Weitzman M (2007) 39 performed a study to investigate the association between infant breastfeeding and ECC in the US. Data was taken from the 1999-2002 National Health and Nutrition Examination Survey (NHANES). This cross sectional survey is conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention. Data on infant feeding and oral health was analysed for 1576 children aged between 2 and 5 years. The data showed that 27.5% had ECC and 10% had SECC. Around 60% of children had been breastfed. However those children breastfed for ≥ 1 year were more likely to experience ECC than children who were breastfed for < 1 year. The authors thus concluded that the infant breastfeeding and its duration, whether overall, full or exclusive, is not associated with any increased risk for ECC or SECC. In this particular study factors such as maternal smoking and decreased family income were found to be independently associated with an increased risk.

8. Ismail AI, Lim S, Sohn W, Willem JM (2008) 40 evaluated the association between early childhood caries (ECC) and severe ECC (S-ECC) and social, dietary, and behavioural risk factors on a representative sample of low-income ≤ 5-year-old children residing in Detroit, Mich. These children and their primary caregivers were selected using a multi-stage sampling strategy. A total of 1,021 child and caregiver dyads were interviewed and examined at the Dental Assessment Centre, Detroit. The combined screening and interviewing response rate was 74% in wave. From a total of 1,021 children who completed an interview and examination in wave 1, 77% (N=790) were interviewed and examined during wave 2. Two children could not be examined. Hence, the sample size included in this analysis is 788 children. The sampled children were examined by a team of 4 dentists in waves 1 and 2 using the International Caries Detection and Assessment System (ICDAS)—a new caries classification system. The data regarding caregivers’ sociodemographic characteristics, children’s demographic information, caregivers’ psychosocial factors potentially influencing oral health, children’s consumption of sugary foods and oral hygiene related factors were collected through interviews. Caregivers’ sociodemographic characteristics included age, annual household income, the highest education level and caregivers’ relationship to children. To measure children’s consumption of sugary foods, the Block Kids Food Frequency Questionnaire was used. In addition, to capture various aspects of caregivers’ oral hygiene knowledge and self-efficacy, three belief scores were constructed. Two sets of logistic regression models were developed to investigate the relationship between the independent variables and ECC-only or S-ECC status. The results of the study showed that in wave 1, 1-year-old children had a higher mean number of cavitated or dentinal carious lesions than non-cavitated lesions. The difference, however, was not statistically significant. Among children who participated in both waves, the mean number of new non-cavitated carious tooth surfaces was significantly higher than the mean number of cavitated tooth surfaces among 3 to 5 year old children. Approximately one fifth (21%) of the children had no signs of clinical caries in waves 1 and 2, while 14% and 21% of all children developed ECC-only or S-ECC, respectively, between waves 1 and 2 but had no caries in wave 1. The older age of the child and caregiver and the number of times the family had moved during the last 5 years were significantly associated with increased odds of developing ECC only. Religiosity was associated with lower odds of progressing to ECC only and SECC. According to regression analysis, authors found that the age of the child and caregiver, gender of the child, and fatalistic belief and religiosity of the caregivers were significant predictors of ECC and S-ECC and consumption of soft drinks was associated with development of S-ECC.

9. Qin M, Li J, Zhang S, Wenli Ma (2008) 41 carried out a study to assess the risk factors for Severe Early Childhood Caries in children younger than 4 years old in Beijing, China. The purpose of this study was to compare cariogenic factors and acidogenic ability of bacteria between severe early childhood caries (S-ECC) and caries-free children. The study consisted of 117 S-ECC children and 129 caries-free children < 4 years old. A questionnaire was designed to collect background information, feeding habits, and oral hygiene practices. Dental plaque samples were collected to test acidogenic ability of bacteria. Results showed that compared with the mothers of caries-free children, those of S-ECC children had a lower education level and poorer knowledge of oral hygiene (P<.05). Night-feeding and eating sweets several times a day were significantly more common in S-ECC children than in caries-free children (P<.001). Forty-six S-ECC children but only 2 caries-free children received prechewed food (P<.001). The results of the Cariostat test showed that the majority of the caries-free children (81%) were at a low risk level, and most of the S-ECC children (78%) were at a high risk level (P<0.001). Authors from the results concluded that there was strong relationship between high acidogenic ability of bacteria and S-ECC. A lower maternal education level, poor knowledge of oral hygiene, night-feeding, and excessive sugar intake were important contributors to the development of S-ECC.

10. Li Y, Zhang Y , Yang R, Zhang Q, Zou J, Kang D (2011) 42 carried out a survey among 1523 children of Xiamen city China to analyse the associated social and behavioural determinants with ECC using a stratified random sampling technique. Clinical examinations were performed to record caries at the surface level. Parents filled the questionnaire containing sixteen variable, covering six aspects of the studied subjects including age, gender, eating habits, family status, child care provider and oral intervention. Chi Square test was used to determine whether a factor was related to caries by comparing the caries distribution in its subcategories. The Kruskal Wallis test was used for the comparison of age, sweet food, carbonated drink, bedtime eating, milk or dietary product, parents health knowledge and education, number of children in the family, household income, age of initial brushing, brushing frequency and tooth paste type. The Mann Whitney test was used for gender, residence, location, childcare facility and topical fluoride. A stepwise forward logistic regression analysis was performed to establish the prediction model and potential two-way interactions were explored throughout the modeling process. The variance inflation factor was used to test multicollinearity of independent variables and Hosmer-Lemeshow test was used to assess the model. The authors concluded that the prevalence of ECC in their study population was 56.7-78.31% with an increasing tendency with age. Early childhood caries in children living in Xiamen city was found to be strongly associated with eating habits, family, childcare related factors and tooth brushing.

11. Masumo R, Bardsen A, Mashoto K, Nordrehaug A (2012) 43 performed a cross- sectional survey to assess the prevalence, socio-behavioural correlates of ECC, and feeding habits among 6-36 months old children in Uganda and Tanzania . A total of 1221 and 816 child - caretaker pairs attending health care facilities for growth monitoring participated in Manyara and Kampala, respectively. Information regarding child’s age, sex, sugar consumption, teething, breast feeding along with dental awareness was collected through face to face interviews with caretaker. Children underwent oral clinical examination whereby ECC and Enamel hypoplasia were recorded using the dmft (WHO 1997) and the DDE index (FDI 1992). The prevalence of ECC was 3.7% in Manyara and 17.6% in Kampala. According to multiple logistic regression analyses, lack of oral health information from health worker was found to be the strongest determinant of ECC in Manyara, adjusted OR 0.3 (95% CI 0.09 - 0.93). Visible plaque, high sugar intake and presence of Enamel hypoplasia were found to be associated with ECC among Kampala study population, adjusted ORs 2.8 (95% CI 1.61- 4.95), 3.0 (95% CI 1.39 - 6.34) and 2.3(95% CI 1.36 - 3.95). Hence, results revealed that lack of information from health workers; high sugary food and beverage intake, presence of visible plaque and presence of enamel hypoplasia were risk factors for ECC.

12. Prakash P, Subramania P, Durgesh BH, Konde S (2012) 16 conducted a cross sectional survey to assess the prevalence and related risk factors of ECC in preschool children of urban Bangalore (India).A random sample of 1,500 children aged between 8 and 48 months were selected from various parts of urban Bangalore. The status of dental caries was recorded according to the World Health Organization (WHO) criteria. Information regarding oral hygiene practices, feeding habits, socio-economic status, birth weight, and educational status of the mother was obtained through a structured questionnaire given to mothers of preschool children. Clinical examinations were performed for detecting carious lesion (WHO criteria 1997) using CPI probe. Children were examined with assistance of their mother by means of the ―knee to knee‖ examination. Bivariate test was performed using Chi-Square test of association. Results revealed that the prevalence of ECC in preschool children was 27.5%, while the mean deft was 0.854. The authors of this study concluded that ECC increased significantly with age. Children whose mothers had no schooling and those who belonged to low socioeconomic group showed higher caries prevalence. A significant increase in caries prevalence was found in children accustomed to the practice of on demand breast feeding and bottle feeding at night. Caries also increased significantly when snacks were consumed between meals However, increased frequency of tooth brushing, parental supervision, use of a baby toothbrush, and fluoridated dentifrice significantly decreased caries prevalence.

13. Ashkanani F & Al-Sane M (2012) 44 conducted a study to assess the knowledge, attitudes and practices of caregivers in relation to oral health of preschool children. Questionnaires with multiple-choice questions were distributed to 334 caregivers of children under the age of 6 years attending vaccination centers in Kuwait. For each question, one of the multiple-choice answers was consistent with the consensus in the pediatric dental literature in relation to early childhood caries prevention, and was considered to be correct. The Chi square test, Independent t test, ANOVA, and stepwise linear regression were used to assess the associations between the variables in question and p < 0.05 was accepted as statistically significant. Results showed that of the 334 participants, 234 (70%) were between 20 and 40 years of age with a high school diploma or higher degree and had between 2 and 5 children. The mean knowledge score was 4.68 ± 1.87, the mean attitude score was 4.34 ±0.88 and the mean practice score was 2.45 ±0.99. Major weaknesses were reported in infant oral health related concepts. Mothers had better knowledge than other caregivers (p < 0.001). Higher education was significantly associated with better knowledge (p = 0.003) and better practices (p = 0.017). In addition, knowledge, attitude and level of education were positively and significantly associated with practices (p <0.005). Thus authors concluded that caregivers had weak knowledge and practice in relation to the oral health of preschool children. Mothers and caregivers with higher education had better knowledge and practices. Education and attitude appeared to be favorable indicators of the caregiver’s practices with regard to the oral health of their preschool children.

14. Singh S, N. Vijayakumar, H. R. Priyadarshini, Shobha M (2012)45 conducted a cross-sectional to find out the prevalence of Early Childhood Caries among 3-5 year old pre-schoolers in schools of Marathahalli, Bangalore. Study was conducted on 717 pre-schoolers in 6 schools of Marathahalli. Clinical examination was performed and deft index was recorded using Gruebell's criteria. Early Childhood Caries was diagnosed using Early Childhood Caries Diagnostic Criteria, consistent with the NIDCR workshop statement. Data was analysed using SPSS 15.0 and descriptive statistics was applied. Chi-square test was used to find out the significant differences. The level of significance was taken at P value < 0.05. Results of this study showed that prevalence of early childhood caries was 40% with a mean deft of 1.89 (3.3) and Significant Caries Index score was 5.51. 44.8% of 3 year old had Early Childhood Caries, 35% of 4 year old children and 41% of 5 year old had Early Childhood Caries. Almost, all of deft was due to untreated caries. Thus authors concluded that there is a need to focus on pre-schooler’s oral health and parental education for prevention and early detection of Early Childhood Caries.

15. Menon I, Nagarajappa R, Ramesh G, Tak M (2013)46 conducted a case-control study among 800 preschool children [400 cases (caries active) and 400 controls (caries free)] aged 4-5 years along with their parents in Moradabad city, India to investigate the association of parental stress as a predictor of early childhood caries among preschool children. The study population was randomly selected from 25 preschools of Moradabad city. Equal number of cases and controls were selected from each school. Subjects were then evaluated for dental caries using mouth mirror and CPI probe by a calibrated examiner. Dentition Status and Treatment Needs was recorded on all subjects using the WHO Oral Health Surveys criteria. If the patients exhibited no caries history or no current decay, they were included into the control (caries free, CF) group. Questionnaire (also designed in Hindi script-local language) along with the consent form were distributed to parent of the child aged 4-5 years visiting the school on the parents-teachers meeting day. They also completed a brief questionnaire regarding demographic information (Parent’s age, gender, education, socioeconomic status, child’s gender, and number of siblings in house). Socioeconomic status was recorded according to Prasad’s Classification based on that it was stratified into five categories, viz, Upper High, High, Upper Middle, Lower Middle, and Poor. The relationship between parental stress and ECC was clearly demonstrated in this study. Stress scores increased with increasing number of carious teeth and children with most carious teeth had the highest PSI scores. The high prevalence of ECC in this population is associated with significant adverse physical, functional, and behavioural consequences that can greatly impair quality of life. The assessment of these influences can help clinicians and researchers in their attempt to improve oral health outcomes for young children. The mean dmft in the case group was 2.17 ± 0.75. The prevalence of children with poor oral hygiene status was higher among the case group (48.5%) when compared to control group (34.5%). An overall mean parenting stress index was found to be 193.48 ± 59.63. A statistically significant strong correlation was observed between caries and parenting distress (r = 0.78, P = 0.03); between caries and DC (r = 0.89, P = 0.02) and between caries and total parenting stress index (r = 0.80, P = 0.05)

16. Carol CF, Priego M (2013)47 conducted a study to assess the prevalence of Early Childhood Caries (ECC) in 1-3 year old children and association of risk factors with ECC in Ica-Peru. In this study three kindergarten schools in Ica were included and data of 231 children of age group (1 -3) years was collected. A structured questionnaire was sent to the parents before conducting the study. A prior consent was taken from parents for dental examination. Caries status, oral hygiene status and salivary pH was evaluated. Risk factors evaluated were: consumption sugary foods, professional fluoride application, and degree of training of the mother, degree improper oral hygiene and salivary pH. Chi square tests were applied for evaluation of risk factors. Results of the study stated that the prevalence of ECC was found out to be 65.8%. A statistically significant relationship was found between dental caries and children with improper oral hygiene, with frequent consumption of sugary foods, without professional fluoride application and acid salivary pH (p< 0.0001).

17. Faria PC, Júnior PA, Andrade RG, Marques LS, Ramos-Jorge ML (2013)48 conducted a cross sectional survey to assess the prevalence of early childhood caries (ECC) among Brazilian pre-schoolers and to investigate the influence of sociodemographic variables, quality of oral hygiene and child-related aspects on ECC. A cross-sectional study was carried out with 593 children aged 3 -5 years. Data were collected through oral clinical examinations, anthropometric measures and interview with parents Interviews with parents of the children were conducted to acquire information on age, children in the family, place of residence bottle feeding, and sociodemographic aspects including monthly household income and parental schooling harmful oral habits. Clinical examination was done for the diagnosis of dental caries and oral hygiene quality using WHO criteria and presence of visible plaque respectively. Association between ECC and independent variables were determined using Chi-Square test. Poisson regression with robust variance was performed for the analysis of factors associated with ECC. Results revealed that the prevalence of ECC was found to be 53.6% and its occurrence was greater among children with unsatisfactory oral hygiene and those from a family with a lower monthly household income. In conclusion, unsatisfactory oral hygiene and monthly income exerted an influence on the occurrence of ECC among pre-schoolers.

18. Pullishery F, Panchmal G, Shenoy R (2013)49 conducted a study to aseess the to assess the tooth brushing habits of preschool children and to determine the role and amount of supervision given to them by parents. A pretested self-designed questionnaire was used to collect information from parents of 130 preschool children in Anganwadi and Kindergarten in Mangalore. Statistical analysis was done using Chi-square test. Results showed that tooth brushing habits in these children was started at a mean age of 22.4 months (SD 8.4).62% of the preschool children used toothbrush and toothpaste for cleaning teeth and brushing habits were mainly (84%) introduced by mothers. Seventy-one percent of the children were cooperative when they were introduced to tooth brushing. Thus authors concluded that preschool children of Mangalore were introduced to tooth brushing at a mean age of 22.4 months and mothers played a vital role in introducing and teaching the child how to brush. In children less than 10 months of age tooth brushing was not started at all.

19. Hamila N (2013)50 conducted a study to assess the prevalence of early childhood caries and its associated risk factors in a sample of children aged 1-3.5 Years in Tanta. The sample population of this study comprised of 560 toddlers (222 girls, 338 boys) aged (1-3.5) years and their mothers attending for Public Maternal Health Centers and centers for immunization in Gharbeia governorate, Tanta city, Egypt. The study was conducted from January 2013 till August 2013. Questionnaires were administered to the mothers of participating children to obtain socio-demographic information as: name, sex, birth date, and position of the child in the family, mother’s level of education and employment status. Also, biologic risk factors as feeding habits of the children and oral health practices for both mothers and children were also recorded. Mothers own oral cleaning was assessed in terms of the frequency of their own tooth brushing. Clinical diagnosis of ECC was based on intraoral examinations conducted by the same examiner according to WHO guidelines. The dental caries status was assessed using the dmft index. Questionnaires were fulfilled by the author through direct interview with the participating mothers of children. Chi-square was used to identify factors with significant association with dental caries. Results of this study showed that the ECC was diagnosed in 69.6% of children. The mean dmft ranged from (2.1-7.6). Males were significantly affected more than females. Education level, employment status, oral hygiene practice for the mothers, position of child in the family, type of feeding and oral hygiene practice were dependently associated with the disease. Authors thus concluded that mother’s education and attitude in maintaining oral hygiene of their children is very important determinant of early childhood caries.

20. Naidu R, Nunn J, Kelly A (2013)51 conducted a cross sectional oral health survey to assess the prevalence and severity of ECC among 3-5 years old preschool children in the Caroni region of Central Trinidad. Oral health examinations were conducted for children for whom parental consent was given, using WHO criteria (visual diagnosis/cavitation at d3). A self-reported questionnaire was distributed to all parents and care givers. Questionnaire variable included Parent/ caregiver age, sex, ethnicity, occupation of head of household, level of education, rating of child’s dental health, oral health knowledge beliefs and practices, child age, ethnicity, sex, health and development. Clinical variables included Dentition status and treatment needs and need for urgent care or referral based on WHO 1997 criteria. Pearson Chi Square test were used for bivariate analysis of categorical variables. Poision generalized linear mixed models (GLMN) and logistic GLMN were used for multiple variate analysis. The results of the study were based on the findings of 251 children from 9 preschools and were found that the prevalence of ECC was 29% and the prevalence of severe ECC was 17.5%. Out of the subjects, 29.9% of children had some treatment need whereas 12% of children were in a need of urgent care referral. Results revealed that the prevalence and severity of ECC in Central Trinidad was related to oral health behaviour and access to dental care.

21. Wulaerhan J, Bao XL, Zhao J (2014)52 conducted a preschool-based cross- sectional study to assess the Risk determinants associated with early childhood caries in Uygur children. The study population of children ranging in age from 3 to 5 years was invited using a three stage stratified sampling in Kashgar, the westernmost city in China. The ―dmft‖ index was used to assess dental caries. The diagnosis of ECC or severe ECC was based on the oral health diagnostic criteria defined by the American Academy of Pediatric Dentistry. A questionnaire was completed by the children’s caregivers. The survey included questions concerning the children’s sociodemographic background; feeding and eating habits, particularly frequency of sweet beverage and food consumption; dental hygiene-related behaviors; the general oral health knowledge of caregivers; and the dental healthcare experience of caregivers and their children. Result showed that a total of 670 Uygur children underwent complete dental caries examination. Most of the children (74.2%) had ECC, with a mean dmft ± SD of 3.95 ± 3.84. The prevalence of severe ECC was 40.1% (N =269), with a mean dmft of 7.72 ± 3.14. More than 99% of caries were untreated. Statistically significant correlations were found between higher ECC prevalence and increased age and lower socioeconomic background, while greater dental health knowledge of the caregiver and positive oral hygiene behaviors were found to be protective.

22. Santos V, Sousa RM, Oliveira MC, Caldas AF, Rosenblatt A (2014)53 A cross sectional study was conducted by authors in which 320 children were examined according to the criteria established by the World Health Organization. A validated questionnaire was used to obtain information from parents and guardians about family income, gestational age and birth weight. To check the nutritional risk, we used the criteria provided by the CDC (Center for Disease Control). For Statistics, Pearson’s, chi-square and the multivariate Poisson analyses were used to determine the association among variables. Results of the study showed that approximately 20% of children had ECC, and the Poisson multivariate analyses indicated that family income (p = 0.009), birth weight (p < 0.001) and infant obesity (p < 0.001) were related to the increase of ECC, and gestational age was not significantly associated with ECC (p = 0.149).

23. Bissar A, Schiller P, Wolff A, Niekusch U, Schulte AG (2014)54 conducted a study to assess the factors contributing to severe early childhood caries in 3- to 5year-old kindergarten children south-west Germany. A cross-sectional study was conducted in 2010 in 30 randomly selected kindergartens in the German RheinNeckar district. After informed consent, parents were asked to complete a questionnaire. The oral examinations took place in the selected kindergartens and the WHO methods as well as the criteria proposed by the American Academy of Pediatric Dentistry were followed. Logistic regression was applied to explore the main factors contributing to S-ECC in a multivariate model. In all, 1,007 children aged 3 to 5 years with an average age of 4.1 (SD=0.8) years were examined. Five variables were associated significantly with the occurrence of S-ECC: breastfeeding for more than 12 months (OR=3.27), use of the nursing bottle in bed (OR=3.08), start of tooth brushing after the first anniversary (OR=2.42), regular visits at the dentists (OR=0.14) and mother with immigration background (OR= 4.05). Results showed that the Prevalence rate of S-ECC was 9.5%. The mean dmft values were 5.69 (S-ECC group) and 0.23 (non-S-ECC group). These results show that occurrence of S-ECC is a complex interaction between socioeconomic, psychological and behavioural factors of parents. New and specific ways to provide preventive dental care for toddlers and infants of caries risk groups have to be developed.

24. Munevveroglu A , Koruyucu M, Seymen F (2014)55 conducted a study to assess the risk factors for early childhood caries (ECC) in 2-5 years old children living in different areas of Istanbul, Turkey. The aim of this study was to determine the association of dietary habits and socioeconomic status with early childhood caries (ECC). A total of 200 children were examined for gender, dmft, dmfs, dietary and brushing habits, duration and contents of bottle feeding, number of family individuals, educational level, occupation of parents and socioeconomic status.

Statistical analysis was performed by using one-way ANOVA, tukey test, t-test, chi-square test were performed between the groups. According to the results, 62.7% of the children had a history of bottle-feeding. Gender, number of main meal and drinking milk before sleeping were positively and total income was negatively associated with bottle feeding (p=0.031, p=0.017, p=0.038, p=0.0001 respectively). For children which were using bottle, the mean average of dmf and dmfs scores were 9.88, 15.5 respectively. Statistically significant differences were found between dmfs scores and bottle feeding (p=0.0001). Only breast feeding, only feeding bottle and bottle with breast feeding were significantly associated with dmf and dmfs scores (p=0.0001). Anterior caries pattern was significantly high for bottle feeeding than only breast and bottle feeding and only breast feeding (p=0.0001). Socioeconomic status was found significantly associated with dmf and dmfs scores (p=0.004, p=0.036). Hence authors concluded that ECC was more prevalent in preschool children especially who were in low socioeconomic status. It was concluded that night-time breast-feeding in children, using of a bottle at night and during the day correlated with the etiology of ECC

25. Han D, Kim D, Kim M, Kim J, Jung-Choi K, &Bae K (2014)56 did a study to examine the relationship of ECC with preschool children’s oral health behavior and caregiver’s oral health in Ulsan, Korea. In 2006 authors conducted a cross-sectional survey of 1214 children under 6 years old and their care givers were surveyed. Two dentists examined according to the WHO criteria. Outcome variable was ECC, and explanatory variables were preschool children’s oral health behavior and caregivers’ oral health. The chi-square test and multiple log-binomial regression models were performed. Results showed that the prevalence of simple ECC was 47.5% and that of severe ECC was 34.8%. In bivariate analysis, ECC prevalence was increased according to children’s age, caregiver’s age, and type of housing. In multiple log-binomial regression models, preschool children’s irregular oral checkup [prevalence ratio (PR): 1.7 for simple ECC and 1.8 for severe ECC] and frequent snack and soda drinking (PR: 1.2 for simple ECC, and 1.6 for severe ECC) were significant factors. Thus authors concluded that prevalence of ECC was high among Korean children. To promote oral health of children, not only the improvement of diet pattern of children but motivation of caregivers for the early visit of their offsprings is also needed.

26. Zhang S, Liu J, Lo CM, Chu CH (2014)57 carried out a survey to assess the dental caries status of 5 year old Bulang children in Yunnan. Study population was collected using a multi-stage cluster sampling method. One trained dentist examined the children using dental mirrors with intra-oral LED light and CPI probes. Caries experience was measured according to the dmft index. Oral hygiene status was recorded according to the Visible Plaque index (VPI). Out of 775 children 723 joined the survey. Parents who brought the children were asked to complete the questionnaire that included demographic information and oral health related behaviours. Results were based on the findings of 723 children. Caries prevalence was 85%, and 38% of them had caries involved in pulp. The mean dmft and dt score were 5.8 ± 4.9 and 5.6 ± 4.8, respectively. Visible plaque was found on 636 children (88%). Multi-factor ANCOVA analysis found that higher dmft scores were found among the children who snacked on sweets daily, had visited a dentist within the last year and had higher VPI scores. A Chi square test was used to compare the caries prevalence between anterior and posterior teeth and between maxillary and mandibular teeth. The author concluded that the caries prevalence and experience among 5-year-old Bulang children in Yunnan was high, and most of the caries were left untreated and the caries experience was associated with snacking habits, dental visit habits and oral hygiene.

27. Nobile C, Fortunato L, Bianco A, Pileggi C, Pavia M (2014)58 conducted a cross

sectional study to assess the pattern and severity of early childhood caries among preschoolers of Southern Italy. The study population (children aged 36-71 months) attending thirteen kindergartens was randomly selected through a two-stage cluster sampling procedure. Parents/guardians of all eligible children were invited to participate in the study. Parents were asked to fill structured self-administered questionnaire, and after having returned the informed consent form an oral examination of the child was performed at school. The questionnaire included information on: socio-demographics about parents/guardians and child, pregnancy and newborn characteristics, oral hygiene habits of child, eating habits particularly on consumption of sweets, access to dental services, and infant feeding practices. The WHO caries diagnostic criteria was used for recording dental caries Univariate and multiple logistic regression analyses were conducted to evaluate statistical associations of social demographics, infant feeding practices, oral hygiene habits, and access to dental services to ECC, S-ECC, dmft and dmfs. Results showed that 515 children participated in the study. 19% had experienced ECC, and 2.7% had SECC, with a mean dmft and dmfs scores of 0.51 and 0.99, respectively. Mean dmft was 2.68 in ECC subjects, and 6.86 in S-ECC subjects. Statistical analysis showed that prevalence of ECC significantly increased with age (OR = 1.95; 95% CI = 1.3- 2.91) and duration of breastfeeding (OR = 1.26; 95% CI = 1.01-1.57), whereas it was significantly lower in children of more educated mothers (OR = 0.64; 95% CI = 0.42-0.96), and higher in those who had been visited by a dentist in the previous year (OR = 3.29; 95% CI = 1.72-6.33). Authors thus concluded that even in Western countries ECC and S-ECC represent a significant burden in preschool children, particularly in those disadvantaged, and that most of the known modifiable associated factors regarding feeding practices and oral hygiene are still highly prevalent in the population.

28. Folayan M, Oziegbe E, Oyedele T, Oshomoji O, Chukwumah N, Onyejaka N et al (2015)59 performed a study to assess the prevalence, and early childhood caries risk indicators in preschool children in suburban Nigeria. The data of 497 children aged 6 months to 71 months who were recruited through a household survey conducted in Ile-Ife, Nigeria was analysed for prevalence of ECC and risk indicators. Information on children’s ages, sex, socioeconomic status, tooth brushing habits, sugary snacks consumption, use of fluoridated toothpaste, birth rank, infant-feeding practices, breastfeeding practices, maternal age at childbirth, and maternal knowledge of oral health was obtained from their parents through structured questionnaire. Risk factors associated with ECC were determined using logistic regression analysis. Results of this study showed that 33 (6.6 %) children had ECC, 4 (0.8 %) had severe ECC. The four risk indicators for ECC were the child’s gender, mothers’ knowledge of oral health, consumption of sugary snacks in between meals more than three times a day, and the child’s oral hygiene status. Females (PR: −0.06; 95 % CI: −0.01- -0.01; p = 0.02), and children with mothers who had good knowledge of oral health (PR: −0.06; 95 % CI: −0.11--0.008; p = 0.02) were less likely to have ECC. Children who consumed sugary snacks in between meals three times a day or more (PR: 0.05; CI: 0.003 - 0.01; P = 0.04) and children with fair oral hygiene (PR: 0.05; 95 % CI: 0.005-0.10; p = 0.03) were more likely to have ECC. Hence in accordance with the results it was concluded that the prevalence of ECC in the study population was low. Promoting good oral hygiene practices and enhancing mothers’ knowledge of oral health may help reduce further, the risk for ECC in the study population.

29. Baggio S, Abarca M, Bodenmann P, Gehri M, Madrid C (2015)60 conducted a study titled Early childhood caries in Switzerland: a marker of social inequalities. The study took place between 2010 and 2012 in the primary care facility of Lausanne Children’s Hospital. Authors clinically screened 856 children from 36 to 71 months old for ECC, and their caregivers (parents or legal guardians) filled in a questionnaire including items on socioeconomic background (education, occupation, income, literacy and immigration status), dental care and dietary habits. Prevalence rates, prevalence ratios and logistic regressions were calculated. The overall ECC prevalence was 24.8 %. ECC was less frequent among children from higher socioeconomic backgrounds than children from lower ones (prevalence ratios ≤ 0.58). This study reported a worrying prevalence rate of ECC among children from 36 to 71 months old, living in French-speaking Switzerland. ECC appears to be a good marker of social inequalities as disadvantaged children, whether from Swiss or immigrant backgrounds, were more likely to have caries than their less disadvantaged peers.

30. Nakayama Y, Mori M (2015)61 conducted a cross-sectional study to investigate the association between nocturnal breastfeeding, snacking habits, or other risk factors and ECC among 18 to 23 month old Japanese children. In this study subjects were 1675 children aged 18 to 23 months. A self-administered questionnaire was completed by parents or guardians of the children. The survey contents included such things as number of decayed, missing, and filled teeth per child, smokers in the home, nocturnal breastfeeding habit, snack times, kinds of snacks consumed ≥4 days a week, kinds of drinks consumed ≥4 days a week, parents brushing their child’s teeth daily, and the use of fluoride toothpaste. Logistic regression analysis was performed to estimate the odds of ECC. Results showed that the average number of decayed, missing and filled teeth was 0.10, prevalence of dental caries was 3.3% and nocturnal breastfeeding habits were present in 357 subjects (21.3%). After excluding items of multicollinearity, authors found significant associations between ECC and nocturnal breastfeeding, drinking or eating sweets after dinner every day, and the intake of candy, soda and/or isotonic drinks ≥4 days a weekend concluded that nocturnal breastfeeding and snacking habits are correlated with ECC.

31. Peltzer K, Mongkolchati A (2015)62 undertaken a study to investigate the prevalence and social risk factors of severe early childhood caries in three-year-old children in Northern Thailand, using a birth-cohort study. The data utilized in this study were from the prospective cohort study of Thai children (PCTC) from the 28 to 38 weeks gestational age until the children reached the age of 36 months (N = 597) in Mueang Nan district, Northern Thailand. In this study questionnaires were administered at different time points and dental examination was conducted at the age of 3 years of the child. Authors used univariate logistic regression, followed by multivariate backward conditional logistic regression to obtain adjusted odds ratios (AOR) and associated 95 % confidence intervals. All variables with a univariate test P value ≤ 0.25 were considered for inclusion in the multiple logistic regression models. Results of the study showed that 44.1 % of the 3 year old children had SECC. In multivariate logistic regression analysis, environmental factors (the use of rain or well water as drinking water, no schooling of mother of child, being male), and risk behavior (sleeping with a bottle at 30 months) were associated with SECC. Further, in bivariate analysis, psychological distress in the mother, lack of spousal relationship support, suckle to sleep when going to bed, introduction of soft drinks at 12 months, having had more frequently sweet food, and less than daily tooth brushing before 30 months were associated with S-ECC.

32. Ghazal T, Levy SM, Childers NK, Broffitt B, Cutter GR, Wiener HW, Kempf MC, Warren J, Cavanaugh JE et al (2015)63 conducted a study to assess the relationships between different behavioral factors and Early Childhood Caries (ECC) in African-American pre-school children. In this study a total of ninety-six African-American children aged 3-22 months old at baseline were recruited from a high caries risk, non-fluoridated African-American community in Uniontown, Alabama. The children had dental examinations annually following World Health Organization (WHO) criteria at mean ages 1.1, 2.0, 3.1 and 4.0 years. All children received fluoride varnish application at each study visit and parents provided oral hygiene and dietary information semiannually by completing questionnaires. Areaunder-the-curve (AUC) with the trapezoidal rule was used to summarize longitudinal exposure data. Bivariate and multivariable relationships between ECC incidence and behavioral risk factors were assessed using logistic regression and negative binomial modeling for dichotomous and count dependent variables, respectively, with the independent variables defined at age 1, age 3 and as the AUC. Results showed that greater frequency of toothbrushing and greater AUC composite of daily frequency of consumption of 100% juices were associated with lower incidence of dental caries (P-values = 0.01 and 0.049, ORs = 0.34 and 0.37, respectively).

33. Makhdoom S, Khan MA, Qureshi Z (2015)64 carried out a cross sectional

analytical study among 2-6 years old children for the assessment of early childhood caries (ECC) and its relationship with feeding practices. They recruited 194 children with convenience purposive sampling technique. In this study children were examined on dental unit by the principal author and caries were detected by using dft index. A parent or care giver, after taking the informed consent, was asked to complete a self-designed questionnaire regarding information about the child’s pattern of feeding, mother education level, socio economics status age of starting brushing, having snack between meals and dft status. Result of the study showed the prevalence of ECC was 55.2%. In this study breastfed children were 84% and bottle-fed were 16%. Percentage of ECC in breast-fed children was 51.6%, which was less than the percentage of ECC in bottle-fed children, which was 72.25%. Those children who took bottle at nighttime had more carries (72.5%) as compared to those who did not (50%). Caries in children was 89% who took milk with sugar at night as compared to those who did not. Incident of carries was more in the children of illiterate mothers (56%) than those of educated mothers (10%). Results revealed an urgent need of increased awareness among the public about ECC and their attitude towards the importance of primary teeth. This is high time to institute preventive strategies to control ECC.

34. Rahbari M, Gold J (2015)65 carried out a pilot study to assess Knowledge and Behaviors Regarding Early Childhood Caries Among Low-Income Women in Florida. This study evaluated the oral health knowledge and behaviors in pregnant women and mothers of young children in relation to early childhood caries to assess the need for an educational oral health program. In this study, interviews were conducted from a sample of 103 Medicaid eligible participants; 56 pregnant women and 47 mothers with children under the age 6 in Florida. The data were collected using closed ended questionnaire and analyzed using SAS/STAT 9.22. Results of the study showed that overall, 79 of 101 study participants (78%) did not receive any dental care during pregnancy. There was found a significant relationship between the frequencies of mother’s tooth brushing and how frequently toddler’s teeth were brushed (p=0.04), and the mother’s self-reported oral health ratings and how frequently they brushed their toddler’s teeth (r2=0.29; p=0.03). And finally authors concluded that mother’s oral hygiene habits are significantly related to the oral hygiene habits of their children and Oral health education, during and after pregnancy, would be beneficial to promote healthier mouths for the mothers and their children.

35. Stephen A, Krishnan R, Ramesh M, Kumar VS (2015)66 conducted a cross- sectional study over a period of 10 months to assess the prevalence of early childhood caries and its risk factors in 18-72 month old children in Salem, Tamil Nadu. This cross-sectional study was conducted among 2771 children selected randomly, in the age group 18-72 months and attending playschools and primary schools in urban, semi-urban, and rural areas of Salem. A modified Winter et al. questionnaire and a proforma were used for collecting information on each child. The completed questionnaire and proformas were statistically analyzed and evaluated. The statistical analysis was done using Student’s t-test and analysis of variance (ANOVA) to obtain mean values. Results of the study showed that the prevalence of ECC in Salem was 16% with a mean dfs of 5.23 ± 1 and prevalence was high (46.5%) among the children of low socioeconomic status group and the children of working mothers, with a mean dfs of 10.47.

36. Kato T, Yorifuji T, Yamakawa M, Inoue S, Saito K, Doi H, Kawachi I et al (2015)67 performed a longitudinal survey to determine the association of breast feeding with early childhood dental caries among 30-66 months old 43383 Japanese children. Authors estimated the risk of dental caries each year according to duration of breast feeding. They controlled for set of biological factors (birth weight, sex, parity, and maternal age at delivery), and socioeconomic factors (maternal educational attainment and smoking status, marital status at delivery, family income and region of birth and residence). Baseline questionnaire was sent to all the families when the newborns reached 6 months or 7 months of age. Follow up questionnaires were sent to these families annually (at 18 months, 30 months, 42 months and so on). Birth records from Japanese vital statistics, which include birth length and weight, gestational age, sex, parental age and other information were also linked to the each child in the survey. Authors then found that infants who had been breast fed for atleast 6 or 7 months, both exclusively and partially, were at elevated risk of dental caries at the age of 30 months compared with those who had been exclusively formula fed. Adjusted odd’s ratio were 1.78 (95% CI), (1.45 to 2.17) for the exclusively breastfed group and 1.39 (1.14 to 1.70) for the partially breastfed group. However the associations became attenuated through the follow up period and were no longer statistically significant beyond the age of 42 months for the partially breastfed group and beyond the age of 54 months for the exclusively breastfed group.

37. Jain M, Namdev R, Bodh M, Dutta S, Singhal P, Kumar A et al (2015)68 conducted a study to evaluate the Social and Behavioral Determinants for Early Childhood Caries among Preschool Children in Rohtak, Haryana. The study involved a dental examination of 1400 children aged 0-71 months, recording caries using Gruebbel’s deft index and a structured questionnaire to interview parents or caretakers. In this study tabulated data was statistically analyzed using t-test and ANOVA at 5% level of significance. Results showed that the variables significantly associated with ECC were age (P<0.001), geographical location (P<0.05), duration of breast/bottle feeding (P<0.001), use of sweetened pacifiers (P<0.001), frequency of snacking (P<0.05), frequency of tooth brushing (P<0.001), the person responsible for child’s oral health care (P<0.05) and education level of parents (P<0.05). However, other variables like child’s gender, number of siblings, types of snack the child preferred and age at which tooth brushing was instituted did not have statistically significant relationship with ECC (P>0.05).

38. Kierce A, Linda D. Rainchuso L, Palmer C, Rothman A (2016)69 did a study to assess the association between the establishment of a dental home and ECC prevalence in a group of Medicaid-enrolled preschool children, and to explore feeding practices associated with an increased prevalence of ECC in Medicaid enrolled preschool children with an established dental home. A cross-sectional survey was conducted among Medicaid-enrolled children (n=132) between 2 and 5 years of age with an established dental home and no dental home to compare feeding practices, parental knowledge of caries risk factors and oral health status. Children with an established dental home had lower rates of biofilm (p<0.05), gingivitis (p<0.05) and mean decayed, missing and filled teeth (DMFT) scores (p<0.05). Children with no dental home consumed more soda and juice (p<0.05) daily, and ate more sticky fruit snacks (p<0.05) than children with an established dental home. Result concluded that establishment of a dental home had a strong protective effect on caries and DMFT index (odds ratio=0.22) in both univariate and confounding adjusted analyses and suggested that the establishment of a dental home, especially among high-risk, low income populations, decreases the prevalence of ECC and reduces the practice of cariogenic feeding behaviors.

39. Gopal S, Chandrappa V, Kadidal U, Rayala C, Vegesna M (2016)70 carried out a study to determine the prevalence and potential risk factors of ECC among 3 to 6 year old preschool children. A sample of 477 preschool children aged 3 to 6 years was randomly selected from the schools in Bhimavaram town, West Godavari district, Andhra Pradesh. In this study caries was recorded according to the WHO criteria from 1997. Information regarding demographic data, socioeconomic status, feeding habits, oral hygiene practices, birthweight and the children’s visits to the dentist was obtained through a structured questionnaire. Data were then analysed using Student’s t-test, the chi square test and Pearson’s correlation analysis. Result of the study showed that the prevalence of early childhood caries in 3- to 6-year-old preschool children was found to be 27.3% with a mean dmft of 2.36 which increased significantly with age and is more predominant in girls. And according to the results, maxillary arch was more affected than mandibular arch and children belonging to the low socioeconomic group showed higher caries prevalence than children with high socioeconomic group. Finally authors concluded that ECC is more prevalent in children accustomed to on-demand breast feeding, bottle feeding at night, between meal snacking and sweetened pacifier use. Factors such as increased frequency of toothbrushing, use of toothbrush and fluoridated dentifrice were found to be the protective factors against the risk of ECC. A strong correlation between the risk factors studied and ECC was also found.


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Early childhood caries and its association with socio-behavioural and parental factors among 2-6 year old children
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Pratibha Taneja (Author), 2016, Early childhood caries and its association with socio-behavioural and parental factors among 2-6 year old children, Munich, GRIN Verlag, https://www.grin.com/document/371909


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