Schmitz, Mark F.; Tellez Merchán, Marisol; Bhoopathi, Vinodh (Temple University. Libraries, 2017)
      Background: Early Childhood Caries (ECC) is one of the most common chronic illnesses among young children, affecting around 23% of children 2-5 years old, leading to pain, discomfort, and poor quality of life. It is a multi-factorial disease that develops through the combined effects of bacteria, tooth morphology, fermentable carbohydrates, time, and various social factors. Several studies have investigated the associations between dental caries and non-traditional factors acquired during the first years of life including; mode of delivery, breastfeeding, and Environmental Tobacco Smoke (ETS). However, the literature on these associations has been inconsistent. Objective: To investigate the unadjusted and adjusted associations between the presence of Early Childhood Caries (ECC) and Severe-ECC (S-ECC), and three non-traditional factors: breastfeeding, mode of delivery, and ETS, among children 1-5 years old. Methods: A cross-sectional design was employed, and a sample of 112 caregiver/ child dyads was recruited from the ongoing flow of patients at Temple University Maurice H. Kornberg School of Dentistry (TUKSoD). After consent, subjects completed a questionnaire and received a standard intra-oral examination and the American Academy of Pediatric Dentistry (AAPD) Caries-risk Assessment Tool (CAT) by a student doctor. The study was approved by the Temple University Institutional Review Board (Protocol # 23885). Chi-square tests, two-sample t-tests and bivariate logistic regressions were used to assess the unadjusted associations. Two multivariable logistic models were developed for ECC and S-ECC and included demographics, overall CRA, and the three non-traditional risk factors. Results: The prevalence of ECC and S-ECC were 61% and 30%, respectively. The following variables were significant in the unadjusted analysis for both ECC and S-ECC: child’s age, maternal educational attainment, overall AAPD CAT classification, sugary snacks per day, presence of plaque on child’s teeth and ETS. Exposure to ETS was associated with an increased adjusted odds ratio for ECC (aOR=5.39 [95% CI: 1.14-25.33], P=0.033), but not for S-ECC. Furthermore, C-section birth was associated with a decreased adjusted odds ratio for both ECC and S-ECC, respectively (ECC: aOR=0.132 [95% CI: 0.02-0.72], P=0.02; S-ECC: aOR=0.141 [95% CI: 0.026-0.748], P=0.021). With inclusion of the AAPD CAT, demographics, and the three non-traditional factors, the overall model accuracy at predicting ECC was 82.2%. Conclusions and Clinical Relevance: In this study of urban, predominantly African American, and low income children, ECC was found associated with two non-traditional factors, ETS and mode of delivery, suggesting that including them in CRA may improve prediction of future dental caries, and aid in the prevention and treatment of disease. Results from this study support the notion that ECC is a multi-factorial disease, and highlights the importance of adopting oral health education among caregivers.