Feeding and smoking habits as cumulative risk factors for early childhood caries in toddlers, after adjustment for several behavioral determinants: a retrospective study

BMC Pediatrics

Guglielmo Campus³  Laura Strohmenger¹  Giulio Conti²  Francesca Amadori⁴  Elena Bardellini⁴  Maria Grazia Cagetti¹  Alessandra Majorana⁴ 

[1]Department of Health Science, WHO Collaborating Center of Milan for Epidemiology and Community Dentistry, University of Milan, Milan, Italy

[2]IRCCS Ca’Granda University of Milan, Milan, Italy

[3]Department of Surgery, Microsurgery and Medicine Sciences – Dental School, University of Sassari, I-07100 Sassari, Italy

[4]Dental School, Department of Pediatric Dentistry, University of Brescia, Brescia, Italy

关键词: Socio-Economic Status;    Smoking exposure;    Feeding practice;    Toddler;    Early childhood caries;   

Others  :  1139007
DOI  :  10.1186/1471-2431-14-45

 received in 2012-12-11, accepted in 2014-02-11,  发布年份 2014

【 摘 要 】

Background

Several maternal health determinants during the first period of life of the child, as feeding practice, smoking habit and socio-economic level, are involved in early childhood health problems, as caries development. The potential associations among early childhood caries, feeding practices, maternal and environmental smoking exposure, Socio-Economic Status (SES) and several behavioral determinants were investigated.

Methods

Italian toddlers (n = 2395) aged 24–30 months were recruited and information on feeding practices, sweet dietary habit, maternal smoking habit, SES, and fluoride supplementation in the first year of life was obtained throughout a questionnaire administered to mothers. Caries lesions in toddlers were identified in visual/tactile examinations and classified using the International Caries Detection and Assessment System (ICDAS). Associations between toddlers’ caries data and mothers’ questionnaire data were assessed using chi-squared test. Ordinal logistic regression was used to analyze associations among caries severity level (ICDAS score), behavioral factors and SES (using mean housing price per square meter as a proxy).

Results

Caries prevalence and severity levels were significantly lower in toddlers who were exclusively breastfed and those who received mixed feeding with a moderate–high breast milk component, compared with toddlers who received low mixed feeding and those exclusively fed with formula (p < 0.01). No moderate and high caries severity levels were observed in an exclusively breastfed children. High caries severity levels were significantly associated with sweet beverages (p < 0.04) and SES (p < 0.01). Toddlers whose mothers smoked five or more cigarettes/day during pregnancy showed a higher caries severity level (p < 0.01) respect to those whose mothers did not smoke. Environmental exposure to smoke during the first year of life was also significantly associated with caries severity (odds ratio =7.14, 95% confidence interval = 6.07-7.28). No association was observed between caries severity level and fluoride supplementation. More than 50% of toddlers belonging to families with a low SES, showed moderate or high severity caries levels (p < 0.01).

Conclusions

Higher caries severity levels were observed in toddlers fed with infant formula and exposed to smoke during pregnancy living in area with a low mean housing price per square meter.

【 授权许可】

   
2014 Majorana et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Indicators for assessing infant and young child feeding practices, part 1: definitions. http://www.who.int/maternal_child_adolescent/documents/9789241596664/en/index.html webcite
• [2]Bharati SR: Socio-economic dimensions of breast-feeding-a study in Hyderabad. Health Popul Perspect Issues 2000, 23:144-159.
• [3]van Rossem L, Oenema A, Steegers EAP MD, Moll HA, Jaddoe VWV, Hofman A, Mackenbach JP, Raat H: Are starting and continuing breastfeeding related to educational background? the generation R study. Pediatr 2009, 123:e1017-e1027.
• [4]Becker GE, Remmington S, Remmington T: Early additional food and fluids for healthy breastfed full-term infants. Cochrane Database Syst Rev 2011., 7CD006462
• [5]Donath SM, Amir LH: The relationship between maternal smoking and breastfeeding duration after adjustment for maternal infant feeding intention. Acta Paediatr 2004, 93:1514-1518.
• [6]Inoue M, Binns CW, Otsuka K, Jimba M, Matsubara M: Infant feeding practices and breastfeeding duration in Japan: a review. Int Breastfeed J 2012, 25:7-15.
• [7]Letson GW, Rosenberg KD, Wu L: Association between smoking during pregnancy and breastfeeding at about 2 weeks of age. J Hum Lact 2002, 18:368-372.
• [8]Iida H, Auinger P, Billings RJ, Weitzman M: Association between infant breastfeeding and early childhood caries in the United States. Pediatrics 2007, 120:944-952.
• [9]Tanaka K, Miyake Y, Sasaki S: The effect of maternal smoking during pregnancy and postnatal household smoking on dental caries in young children. J Pediatr 2009, 155:410-415.
• [10]Hanioka T, Nakamura E, Ojima M, Tanaka K, Aoyama H: Dental caries in 3-year-old children and smoking status of parents. Paediatr Perinat Epidemiol 2008, 22:546-550.
• [11]Shenkin JD, Broffitt B, Levy SM, Warren JJ: The association between environmental tobacco smoke and primary tooth caries. J Public Health Dent 2004, 64:184-186.
• [12]Petersen PE: Global policy for improvement of oral health in the 21st century--implications to oral health research of world health assembly 2007, world health organization. Community Dent Oral Epidemiol 2009, 37:1-8.
• [13]Campus G, Solinas G, Strohmenger L, Cagetti MG, Senna A, Minelli L, Majori S, Montagna MT, Reali D: Castiglia P and collaborating study group: national pathfinder survey on children’s oral health in Italy: pattern and severity of caries disease in 4-year-olds. Caries Res 2009, 43:155-162.
• [14]Congiu G, Campus G, Sale S, Spano G, Cagetti MG, Lugliè PF: Early childhood caries and associated determinants: a cross-sectional study on Italian preschool children. J Public Health Dent 2013.
• [15]Misra S, Tahmassebi JF, Brosnan M: Early childhood caries–a review. Dent Update 2007, 34:556-564.
• [16]Vadiakas G: Case definition, aetiology and risk assessment of early childhood caries (ECC): a revisited review. Eur Arch Paediatr Dent 2008, 9:114-125.
• [17]Psoter WJ, Zhang H, Pendrys DG, Morse DE, Mayne ST: Classification of dental caries patterns in the primary dentition: a multidimensional scaling analysis. Community Dent Oral Epidemiol 2003, 31:231-238.
• [18]Thitasomakul S, Piwat S, Thearmontree A, Chankanka O, Pithpornchaiyakul W, Madyusoh S: Risks for early childhood caries analyzed by negative binomial models. J Dent Res 2009, 88:137-141.
• [19]Mohebbi SZ, Virtanen JI, Vahid-Golpayegani M, Vehkalahti MM: Feeding habits as determinants of early childhood caries in a population where prolonged breastfeeding is the norm. Community Dent Oral Epidemiol 2008, 36:363-369.
• [20]Ribeiro NME, Ribeiro MAS: Breastfeeding and early childhood caries: a critical review. J Pediatr 2004, 80:199-210.
• [21]Aimutis WR: Bioactive properties of milk proteins with particular focus on anticariogenesis. J Nutr 2004, 134:989S-995S.
• [22]Petti S, Simonetti R, Simonetti D’Arca A: The effect of milk and sucrose consumption on caries in 6-to-11-year-old Italian schoolchildren. Eur J Epidemiol 1997, 13:659-664.
• [23]Scariati PD, Grummer-Strawn LM, Beck Fein S: A longitudinal analysis of infant morbidity and the extent of breastfeeding in the United States. Pediatrics 1997, 99(6):E5.
• [24]Brambilla E, Felloni A, Gagliani M, Malerba A, García-Godoy F, Strohmenger L: Caries prevention during pregnancy: results of a 30-month study. J Am Dent Assoc 1998, 129:871-877.
• [25]Geronimus AT, Bound J: Use of census-based aggregate variables to proxy for socioeconomic group: evidence from national samples. Am J Epidemiol 1998, 148:475-486.
• [26]Campus G, Cagetti MG, Senna A, Spano G, Benedicenti S, Sacco G: Differences in oral health among Italian adolescents related to the type of secondary school attended. Oral Health Prev Dent 2009, 7:323-330.
• [27]Castiglia P, Campus G, Solinas G, Maida C, Strohmenger L: Children’s oral health in Italy: training and clinical calibration of examiners for the National Pathfinder about caries disease. Oral Health Prev Dent 2007, 5:255-261.
• [28]Braga MM, Ekstrand KR, Martignon S, Imparato JCP, Ricketts DNJ, Mendes FM: Clinical performance of Two visual scoring systems in detecting and assessing activity status of occlusal caries in primary teeth. Caries Res 2010, 44:300-308.
• [29]Honkala E, Runnel R, Honkala S, Olak J, Vahlberg T, Saag M, Mäkinen KK: Measuring dental caries in the mixed dentition by ICDAS. Int J Dent 2011, 1504:24.
• [30]Hanley GE, Morgan S: On the validity of area-based income measures to proxy household income. BMC Health Serv Res 2008, 8:79. BioMed Central Full Text
• [31]Bollen KA, Jackman RW: Regression diagnostics: an expository treatment of outliers and influential cases. SMR 1985, 13:510-542.
• [32]Yngve A, Kylberg E, Sjöström M: Breast-feeding in europe–rationale and prevalence, challenges and possibilities for promotion. Public Health Nutr 2001, 4:1353-1355.
• [33]Conn JA, Davies MJ, Walker RB, Moore VM: Food and nutrient intakes of 9-month-old infants in Adelaide, Australia. Public Health Nutr 2009, 12:2448-2456.
• [34]Chan SC, Tsai JS, King NM: Feeding and oral hygiene habits of preschool children in Hong Kong and their caregivers’ dental knowledge and attitudes. Int J Paediatr Dent 2002, 12:322-331.
• [35]Mobley C, Marshall TA, Milgrom P, Coldwell SE: The contribution of dietary factors to dental caries and disparities in caries. Acad Pediatr 2009, 9:410-414.
• [36]Heck KE, Braveman P, Cubbin C, Chávez GF, Kiely JL: Socioeconomic status and breastfeeding initiation among california mothers. Public Health Rep 2006, 121:51-59.
• [37]Sá Roriz Fonteles C, Zero DT, Moss ME, Fu J: Fluoride concentrations in enamel and dentin of primary teeth after pre- and postnatal fluoride exposure. Caries Res 2005, 39:505-508.
• [38]Marinho VC, Higgins JP, Logan S, Sheiham A: Topical fluoride (toothpastes, mouthrinses, gels or varnishes) for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2003., 4CD002782
• [39]Italian national guidelines on oral health in children. http://www.salute.gov.it/portale/documentazione/p6_2_2_1.jsp?lingua=italiano&id=2073 webcite
• [40]Hood E: Dwelling disparities: how poor housing leads to poor health. Environ Health Perspect 2005, 113:A310-A317.