The Influence of the First Thousand Days of Life on Establishing Determinant Behaviors for Dental Caries in Childhood

ABSTRACT

Objective:

To study the influence of the first thousand days of life on establishing determinant behaviors for dental caries in childhood.

Material and Methods:

Longitudinal retrospective study involving 664 children born in 2009 living in a southern Brazilian municipality was carried out. Data was collected through interviews with mothers and through child’s health card. Dependent variables were 1) tooth brushing onset after two years of age; 2) absent tooth brushing or once a day; 3) tooth brushing without adult supervision; 4) not having gone to the dentist until the age of 6; and 5) seek for dental services due to toothache at 6 years of age, over the last 30 days. Bivariate and multivariate analyses were performed using Poisson Regression to estimate relative risks (RR) and respective confidence intervals at the 95% accuracy level.

Results:

Mothers with lower schooling at child’s birth presented a higher risk of “child’s tooth brushing onset only after two years of age”, “brushing the teeth once a day only or not brushing” and with “child not having gone to the dentist until the age of 6”. Mothers who did not have a job when the child was born were associated with “not having gone to the dentist until the age 6”. Children with gastroesophageal reflux who underwent hospitalization for more than 2 days under age 2 were associated with “seeking dental services because of pain at 6 years of age over the last 30 days”.

Conclusion:

Higher risks of some determinant behaviors related to dental caries were associated with variables of the period of the first thousand days of life.

Keywords:
Infant Behavior; Child Behavior; Oral Health; Cohort Studies

Introduction

Dental caries is a chronic multifactorial disease with a slow progression in the majority of cases. It is considered the most common disease among Latin American children [¹]. It causes suffering and pain [²], impacting children’s and families’ quality of life [³]. High costs of treatment and existing preventive measures are factors that contribute to be considered this aggravation as a public health problem [²]. Data from the Brazilian National Oral Health Survey [⁴] showed that Brazilian children at age 5 presented 2.43 teeth attacked by caries in 2010. This figure was 2.80 in 2003, which represented a reduction of only 13.9% of number of decayed, missed or restored deciduous teeth.

Dental caries is determined by hygiene and feeding habits, as well as by the pattern of usage of health services [⁵]. Considering that dental caries and other chronic diseases have complex etiologies and long periods of time, proper understanding of their development should involve the study of the influence of the first stages of life [⁶,⁷]. Thus, longitudinal studies have an appropriate design to investigate life-course events, allowing the exploration of the interaction between biological aspects, social environment and behavioral aspects involved in the development of chronic diseases [⁸]. Thus, Life Course Theory [⁶] is a possible pathway to a better understanding on the determination of dental caries. It is based on the accumulation of risks during life, both biological and psychosocial factors at different critical stages of life, especially in childhood. Growth in bad conditions in early childhood and low birth weight are examples of possible influence on health-related behaviors in the future life [⁹] concerning biological factors. Therefore, if harmful expositions to health are numerous and accumulated during life, the risk of developing chronic diseases increases [⁶,¹⁰].

It can be admitted, therefore, that aspects related to unfavorable environments at birth and in the early stages of childhood are accumulated in the course of life and can reduce the chances of healthy habits and behaviors as well as patterns of use of services that, taken as a whole, can increase the risk of disease in adulthood [⁹]. In the present study, these aspects were incorporated by socioeconomic status at when the child was born and those related to the first thousand days of life: variables related to pregnancy and related to children up to two years old. So, knowledge about the early stages of life is very important to understand the way an individual's health condition will be in the future [¹⁰]. Hence, this study aimed to analyze the influence of the first thousand days of life on selected determinant behaviors for dental caries in 6-year-old children.

Material and Methods

Ethical Clearance

The research project was submitted to and approved by the Ethics Committee on Research with Human Beings of Universidade do Sul de Santa Catarina under the protocol CAAE 38240114.0.0000.5369.

Study Design and Sampling

It was a longitudinal retrospective study involving children enrolled in public and private schools of the municipality of Palhoça/SC, Brazil. The study population consisted of children who were born in 2009 and their families [¹¹]. The minimum sample size was determined using the following parameters: total children population of 1,756; 95% confidence level; unknown prevalence of studied dependent variables (p = 50%); 3% relative error. Thus, the total sample was 664 children and their families. The sample size was calculated in the OpenEpi 3.03a [¹²].

Data Collection

Data collection was performed through interviews and children’s health cards analysis. Interviews were conducted with mothers or, in her absence, the main child’s caregiver at home. Through the direction of schools, letters containing the free and informed consent terms were sent to the parents, with the objectives and the importance of the research, inviting them to participate in the study. To carry out the interviews, a specific instrument was elaborated by the researchers. A workshop composed of six meetings was held involving researchers, Ph.D. and MSc students [¹¹]. The interviews were developed by the team of researchers and Community Health Agents from the municipality of Palhoça/SC. The team was formally trained in 30 hours of activity.

The dependent variables were selected determinant behaviors for dental caries: i- tooth brushing onset after two years of age; ii. absent tooth brushing or once a day; iii- tooth brushing without adult supervision; iv- not having gone to the dentist until the age of 6; v- seek for dental services due to toothache at 6 years of age, over the last 30 days. The independent variables were socioeconomic status at when the child was born and those related to the first thousand days of life: variables related to pregnancy and related to children up to two years old.

Data Analysis

Data were inserted in Excel spreadsheets and then exported to the IBM SPSS^® 18.0 software (IBM Corp., Armonk, NY, USA) and then analyzed. Descriptive statistics were performed through distribution and frequency tables. Multivariate analyses were performed to identify independent relationship among the several studied variables. They were also used to identify confounding variables, adjusting the analysis models. These models were composed by variables whose values p≤0.20 [¹³] were observed in the bivariate analysis. The bivariate and multivariate analyses were performed using Poisson Regression to estimate relative risks (RR) and respective confidence intervals at the 95% accuracy level.

Results

Regarding oral hygiene, lower mother schooling was independently associated with inadequate habits. Mothers that had finished eight years or fewer of study at child’s birth presented 81% higher and independent risk (RR = 1.81; 95% CI = 1.02-3.21; p=0.041) of “child’s tooth brushing onset only after two years of age” (Table 1). This variable was also independently associated with the habit of “brushing the teeth once a day only or not brushing” (RR = 2.05; 95% CI = 1.01-4.17; p=0.049) (Table 2). Another oral hygiene habit, “dental brushing without any adult supervision”, was not associated with factors related to the first thousand days.

Table 1
Association factors related to the first thousand days of life and the variable “tooth brushing onset after two years of age”.

Variables	RRc	CI 95%	p-value	RRa	CI 95%	p-value
Socioeconomic Status
Mother’s Schooling When the Child was Born			0.001			0.041
> 8 Years	1.00			1.00
≤ 8 Years	2.54	1.61-4.02		1.81	1.02-3.21
Father’s Schooling When the Child was Born			0.007
> 8 Years	1.00
≤ 8 Years	1.98	1.20-3.25		*
Mother’s Occupation When the Child was Born			0.075			0.754
With Income	1.00			1.00
Without Income	1.49	0.96-2.33		1.09	0.62-1.92
Father’s Occupation When the Child was Born			0.061
With Income	1.00
Without Income	2.10	0.96-4.57
Steady Partner When the Child was Born
Yes	1.00			*
No	1.02	0.44-2.34	0.962
Related to Pregnancy
Teenage Pregnancy			0.780
≥ 20 Years Old	1.00
10 to 19 Years Old	1.08	0.61-1.89
Prenatal Consultation			0.236
Yes	1.00
No	2.01	0.63-6.36
Number of Prenatal Consultations			0.276
≥ 6	1.00
< 5	1.90	0.59-6.05
Use of Alcohol While Pregnant			0.003			0.534
No	1.00			1.00
Yes	2.55	1.38-4.71		1.35	0.52-3.49
Smoking While Pregnant			0.081			0.747
No	1.00			1.00
Yes	1.61	0.94-2.75		1.08	0.41-1.86
Use of Illicit Drugs While Pregnant			0.036			0.127
No	1.00			1.00
Yes	2.93	1.07-8.01		3.19	0.71-14.21
Infectious Diseases While Pregnant			0.786
No	1.00
Yes	1.06	0.66-1.70
Gestational Age			0.658
37 to 41 Weeks	1.00
< 37 or ≥ 42 Weeks	1.13	0.64-1.98
Route of Delivery			0.221
Vaginal	1.00
Cesarean	1.34	0.83-2.14
Related to Children up to 2 Years Old
Child’s Gender			0.041			0.060
Female	1.00			1.00
Male	1.65	1.02-2.69		1.74	0.97-3.09
Birth Weight			0.386
≥ 2500g	1.00
< 2499g	1.86	0.45-7.60
Apgar 1st Minute			0.466
≥ 8	1.00
< 7	0.73	0.31-1.70
Gastroesophageal Reflux			0.250
No	1.00
Yes	1.53	0.74-3.18
Infectious Diseases			0.064			0.311
No	1.00			1.00
Yes	2.20	0.95-5.09		1.56	0.65-3.74
Use of Antibiotics			0.370
No	1.00
Yes	1.23	0.77-1.97
Use of Medication for more than 30 Consecutive Days			0.397
No	1.00
Yes	1.26	0.73-2.19
Hospitalization for More Than 2 Days			0.974
No	1.00
Yes	1.01	0.55-1.82
Hospitalization During the First 29 Days of Life			0.988
Yes	1.01	0.40-2.50
No	1.00
Nursery Frequency			0.529
No	1,00
Yes	1,16	0.72-1.86

• RR_c= Crude Relative Risk; RR_a= Adjusted Relative Risk; CI 95% = Confidence interval 95%; *The variable "Mother’s schooling when the child was born" showed some collinearity with the variable "Father´s schooling when the child was born" (p=0.001) along with "Father’s occupation when the child was born" (p=0.032). "Mother’s schooling when the child was born" was maintained and the others were removed.

Table 2
Association factors related to the first thousand days of life and the variable “absent tooth brushing or once a day”.

Variables	RRc	CI 95%	p-value	RRa	CI 95%	p-value
Socioeconomic Status
Mother’s Schooling When the Child was Born			0.008			0.049
>8 Years	1.00			1.00
≤ 8 Years	2.02	1.19-3.41		2.05	1.01-4.17
Father’s Schooling When the Child was Born			0.013
>8 Years	1.00
≤ 8 Years	2.09	1.17-3.75		*
Mother’s Occupation When the Child was Born			0.234
With Income	1.00
Without Income	1.35	0.82-2.23
Father’s Occupation When the Child was Born			0.437
With Income	1.00
Without Income	1.49	0.54-4.12
Steady Partner When the Child was Born			0.150			0.550
Yes	1.00			1.00
No	1.72	0.82-3.61		1.39	0.47-4.13
Related to Pregnancy
Teenage Pregnancy			0.220
≥ 20 Years Old	1.00
10 to 19 Years Old	1.55	0.76-3.14
Prenatal Consultation			0.843
Yes	1.00
No	1.22	0.16-8.80
Number of Prenatal Consultations			0.095
≥ 6	1.00
< 5	1.89	0.89-4.00		*
Use of Alcohol While Pregnant			0.052			0.298
No	1.00			1.00
Yes	2.08	0.99-4.37		1.76	0.60-1.13
Smoking While Pregnant			0.550
No	1.00
Yes	1.22	0.63-2.33
Use of Illicit Drugs While Pregnant			0.926
No	1.00
Yes	1.09	0.15-7.91
Infectious Diseases While Pregnant			0.382
No	1.00
Yes	1.26	0.74-2.12
Gestational Age			0.436
37 to 41 Weeks	1.00
< 37 or ≥ 42 Weeks	1.26	0.70-2.27
Route of Delivery			0.038			0.042
Vaginal	1.00			1.00
Cesarean	0.89	0.70-0.97		0.42	0.18-0.97
Related to Children up to 2 Years Old
Child’s Gender			0.147
Female	1.00
Male	1.50	0.86-2.62		*
Birth Weight			0.161
≥ 2500 g	1.00
< 2499 g	1.93	0.76-4.87
Apgar 1st Minute			0.484
≥ 8	1.00
< 7	1.66	0.40-6.87
Gastroesophageal Reflux			0.364
No	1.00
Yes	1.33	0.71-2.50
Infectious Diseases			0.036			0.165
No	1.00			1.00
Yes	3.47	1.08-11.12		2.77	0.66-11.6
Use of Antibiotics			0.551
No	1.00
Yes	1.17	0.69-1.98
Use of Medication for More than 30 Consecutive Days			0.889
No	1.00
Yes	1.04	0.54-2.00
Hospitalization for More than 2 Days			0.117			0.968
No	1.00			1.00
Yes	1.58	0.89-2.83		1.01	0.41-2.52
Hospitalization During the First 29 Days of Life			0.177
Yes	3.91	0.54-28.32
No	1.00
Nursery Frequency			0.799
No	1.00
Yes	1.07	0.62-1.82

• RR_c= Crude Relative Risk; RR_a= Adjusted Relative Risk; CI 95% = Confidence interval 95%; *The variable "Mother’s schooling when the child was born" showed some collinearity with the variable "father’s schooling when the child was born" (p=0.001) along with "number of prenatal exams" (p=0.031) and birth weight" (p=0.046); "Mother´s schooling when the child was born" was maintained and the others were removed.

Regarding access to dental services, lower mother schooling was also independently associated with “child not having gone to the dentist until the age of 6” (RR = 1.69; 95% CI = 1.05- 2.72; p=0.028) and with mother’s occupation when the child was born. Children whose mothers had no income (who did not have a job) presented a relative risk of 1.75 (95% CI = 1.08-2.82; p=0.021) of “not having gone to the dentist until the age 6” (Table 3).

Table 3
Association factors related to the first thousand days of life and the variable “not having gone to the dentist until the age of 6”.

Variables	RRc	CI 95%	p-value	RRa	CI 95%	p-value
Socioeconomic Status
Mother’s Schooling When the Child was Born			< 0.001			0.028
> 8 Years	1.00			1.00
≤ 8 Years	2.19	1.57-3.06		1.69	1.05-2.72
Father’s Schooling When the Child was Born			0.283
>8 Years	1.00
≤ 8 Years	1.22	0.84-1.77
Mother’s Occupation When the Child was Born			0.005			0.021
With Income	1.00			1.00
Without Income	1.61	1.15-2.25		1.75	1.08-2.82
Father’s Occupation When the Child was Born			0.735
With Income	1.00
Without Income	1.14	0.53-2.43
Steady Partner When the Child was Born			0.040			0.339
Yes	1.00			1.00
No	1.67	1.02-2.74		1.47	0.66-3.27
Related to Pregnancy
Teenage Pregnancy			0.297
≥ 20 Years Old	1.00
10 to 19 Years Old	1.22	0.83-1.78
Prenatal Consultation			0.454
Yes	1.00
No	1.46	0.54-3.94
Number of Prenatal Consultations			0.600
≥ 6	1.00
< 5	1.19	0.60-2.35
Use of Alcohol While Pregnant			0.005			0.204
No	1.00			1.00
Yes	2.04	1.24-3.34		1.57	0.78-3.17
Smoking While Pregnant			0.096			0.230
No	1.00			1.00
Yes	1.41	0.94-2.11		1.41	0.80-2.50
Use of Illicit Drugs While Pregnant			0.128			0.786
No	1.00			1.00
Yes	1.99	0.82-4.87		1.32	0.17-9.89
Infectious Diseases While Pregnant			0.147			0.644
No	1.00			1.00
Yes	1.28	0.91-1.79		1.11	0.69-1.78
Gestational Age			0.761
37 to 41 Weeks	1.00
< 37 or ≥ 42 Weeks	1.07	0.68-1.67
Route of Delivery			0.707
Vaginal	1.00
Cesarean	1.07	0.74-1.54
Related to Children up to 2 Years Old
Child’s Gender			0.905
Female	1.00
Male	1.02	0.71-1.46
Birth Weight			0.494
≥ 2500 g	1.00
< 2499 g	1.28	0.62-2.63
Apgar 1st Minute			0.010			0.059
≥ 8	1.00			1.00
< 7	0.48	0.28-0.83		0.54	0.29-1.02
Gastroesophageal Reflux			0.750
No	1.00
Yes	1.08	0.67-1.73
Infectious Diseases			0.316
No	1.00
Yes	1.29	0.77-2.16
Use of Antibiotics			0.127			0.422
No	1.00			1.00
Yes	1.29	0.92-1.80		1.21	0.75-1.94
Use of Medication for More than 30 Consecutive Days			0.270
No	1.00
Yes	1.25	0.83-1.88
Hospitalization for More than 2 Days			0.350
No	1.00
Yes	1.21	0.80-1.83
Hospitalization During the First 29 Days of Life			0.590
No	1.00
Yes	1.23	0.57-2.64
Nursery Frequency			0.442
No	1.00
Yes	1.15	0.80-1.65

• RR_c= Crude Relative Risk; RR_a= Adjusted Relative Risk; CI 95% = Confidence Interval 95%.

Table 4 shows statistically independent and significant associations of two variables with "seek for dental services because of pain at 6 years of age over the last 30 days". Children with gastroesophageal reflux under the age 2 showed a relative risk of 2.00 (95% CI = 1.01-3.98; p=0.046), and children who were undergone hospitalization for more than 2 days under age 2 presented a relative risk of 1.98 (95% CI = 1.03- 3.96; p=0.044).

Table 4
Association factors related to the first thousand days of life and the variable “seek for dental services due to toothache at age 6, over the last 30 days”.

Variables	RRc	CI 95%	p-value	RRa	CI 95%	p-value
Socioeconomic Status
Mother’s Schooling When the Child was Born			0.068
> 8 Years	1.00
≤ 8 Years	1.36	0.97-1.90		*
Father’s Schooling When the Child was Born			0.306
> 8 Years	1.00
≤ 8 Years	1.17	0.86-1.58
Mother’s Occupation When the Child was Born			0.024			0.051
With Income	1.00			1.00
Without Income	1.37	1.04-1.80		1.41	0.98-2.01
Father’s Occupation When the Child was Born			0.335
With Income	1.00
Without Income	1.44	0.68-3.07
Steady Partner When the Child was Born			0.357
Yes	1.00
No	1.34	0.71-2.54
Related to Pregnancy
Teenage Pregnancy			0.930
≥ 20 Years Old	1.00
10 to 19 Years Old	1.01	0.72-1.43
Prenatal Consultation			0.281
Yes	1.00
No	1.56	0.69-3.51
Number of Prenatal Consultations			0.260
≥ 6	1.00
< 5	1.41	0.77-2.60
Use of Alcohol While Pregnant			0.441
No	1.00
Yes	1.32	0.65-2.67
Smoking While Pregnant			0.317
No	1.00
Yes	1.24	0.81-1.89
Use of Illicit Drugs While Pregnant			0.802
No	1.00
Yes	1.15	0.37-3.61
Infectious Diseases While Pregnant			0.224
No	1.00
Yes	1.19	0.89-1.59
Gestational Age			0.096			0.202
37 to 41 Weeks	1.00			1.00
< 37 or ≥ 42 Weeks	1.43	0.93-2.20		1.34	0.85-2.11
Route of Delivery			0.973
Vaginal	1.00
Cesarean	1.00	0.73-1.38
Related to Children up to 2 Years Old
Child’s Gender			0.818
Female	1.00
Male	1.03	0.75-1.42
Birth Weight			0.363
≥ 2500 g	1.00
< 2499 g	1.51	0.62-3.68
Apgar 1st Minute			0.439
≥ 8	1.00
< 7	0.77	0.40-1.47
Gastroesophageal Reflux			0.098			0.046
No	1.00			1.00
Yes	1.33	0.94-1.88		2.00	1.01-3.98
Infectious Diseases			0.089			0.462
No	1.00			1.00
Yes	1.33	0.95-1.86		1.17	0.76-1.82
Use of Antibiotics			0.533
No	1.00
Yes	1.09	0.82-1.45
Use of Medication for More than 30 Consecutive Days			0.883
No	1.00
Yes	1.02	0.71-1.48
Hospitalization for More than 2 Days			0.041			0.044
No	1.00			1.00
Yes	1.60	1.02-2.50		1.98	1.03-3.96
Hospitalization During the First 29 Days of Life			0.455
No	1.00
Sim	1.29	0.65-2.53
Nursery Frequency			0.105
No	1.00
Yes	1.27	0.95-1.71		*

• RR_b= Total Relative Risk; RR_a= Relative Risk; CI 95% = Confidence Interval 95%; *The variable "Mother’s occupation when the child was born" showed some collinearity with the variable "mother’s schooling when the child was born" (p=0.001) along with "nursery frequency" (p=0.001); "Mother’s schooling when the child was born" was maintained and the others were removed.

Discussion

Among the different possibilities of using socioeconomic indicators, it is noticed that the level of maternal schooling is considered one of the best indicators of the child’s health, especially in underdeveloped countries. Furthermore, as mothers are the main children’s caregivers, their understanding about oral hygiene practices and habits is crucially relevant when aiming for good oral health for their children [¹⁴].

Mother’s schooling equal or fewer than eight years resulted in a greater risk of establishing inadequate child’s oral hygiene habits (dental brushing onset after two years of age and absent or only once a day brushing). An analysis directed to the social conditions of the individual is primordial to identify determining factors for the occurrence of diseases [¹⁴]. In a study conducted in Brazil, the variable "maternal schooling" was also significantly associated with caries experience [¹⁵], corroborating the results of the present study. It was also found that children of mothers who did not study had a higher incidence of caries than those with a higher average education. Thus, as provided by the literature, maternal education is one of the variables capable of influencing the levels of dental caries [¹⁶]. Mothers with lower educational attainment have a lower income, less access to dental service, less knowledge about oral health practices, and therefore are less well informed about curative and preventive measures of dental caries control, which ultimately influences the pattern of dental caries during childhood [¹⁷].

In this study, another socioeconomic variable related to the first thousand days associated with determinant behaviors for dental caries was the mother’s occupation. It was observed that children whose mothers had no formal income (who did not have a job) presented a higher risk of not having gone to the dentist until the age 6. Peres et al. [¹⁸] observed that children whose parents were unemployed when they were born presented a 7.7 higher chance of having caries and dental pain. Other studies [¹⁹,²⁰] have pointed out that parents with better education and income have better conditions and higher access to dental services.

In the present study, in the group of variables related to pregnancy, the only one associated with determinant behaviors for dental caries was the route of delivery. It is known that during the pregnancy, the mother undergoes different physiological transformations in all the organic systems since several hormones and psychological factors are involved [²⁰]. In this research, the cesarean delivery method was associated with inadequate oral hygiene habits. There are no studies reporting this relationship, but there are other associations related to the route of delivery. For example, a case-control study in Sweden demonstrated a significantly higher prevalence of certain strains, such as Streptococcus salivarius, Lactobacillus curvata, Lactobacillus salivarius, and Lactobacillus casei in children who were born by vaginal delivery compared to those born by cesarean section [²¹]. On the other hand, Thakur et al. [²²] concluded that there was no association between vaginal or cesarean delivery with a significantly higher prevalence of certain strains. They also affirmed that the socioeconomic status and the food that mothers had tried during pregnancy showed a possible initial acquisition of Streptococcus mutans in children’s oral cavity [²²].

In the group of variables related to children’s health up to two years old, a significant association of the variable "hospitalization for more than two days" with "seeking for dental services due to pain" was observed. It can be explained by the marked use of medications and the difficulties of oral hygiene in children with some kind of health problems who needed hospitalization up to the age 2. In these cases, parents could be more concerned with the child’s general health than oral health, so when dental care is required, a painful dental symptomatology has already been created. A study evaluated the oral health of children who were hospitalized from 2 to 12 years old in a hospital in Imperatriz, Brazil [²³]. The authors observed that 65.2% of children with three days of hospitalization had poor oral hygiene. Regarding nocturnal oral hygiene, 76.2% of them reported that it was never done. Some factors may be related to unsatisfactory oral hygiene in hospitalized children: the age group (the youngest do not have enough motor coordination to perform adequate brushing), the condition they are in (lack of physical disposition due to the weakness), the lack of knowledge of the hospital staff about oral hygiene practices and, finally, the lack of motivation of parents and children on the benefits of oral hygiene [²³].

Gastroesophageal reflux, another variable related to under two-year-old children’s health, also showed association with the same variable "seek for dental services due to pain". The relationship between this variable and several modifications in the oral cavity is found in the literature. Oral manifestations include dental erosion, salivary alterations, halitosis, xerostomia, cancer sores, burning or itching of the oral mucosa, sour or bitter taste in the mouth, gingival alterations, lingual and dental sensitivity. In the first year of life, in addition to recurrent regurgitation and/or vomiting, gastroesophageal reflux manifestations include irritability, constant crying and refusal of food [²⁴]. To date, there is little information available on the experience of caries disease in children with gastroesophageal reflux. Although there is no direct relationship between caries and erosive erosion [²⁵], the association of caries disease with gastroesophageal reflux disease has been suggested [²⁶,²⁷]. In a study by Ersin et al. [²⁸] the salivary flow, buffer capacity and amount of Streptococos mutans, Lactobacilli and colonization yeasts of children with gastroesophageal reflux disease were investigated. The authors concluded that these children had an increased risk of developing caries disease compared to healthy ones. Similarly, Tenório et al. [²⁹] stated that low oral pH in children with gastroesophageal reflux causes enamel dissolution and transport of calcium and phosphate to the oral environment, which fosters the bacteria survival.

The results of the present study should be viewed with caution. An important limitation is related to the collection of information that occurred six years ago. However, it is believed that the main information related to pregnancy is fully remembered by the woman, in addition to the fact that all information present in the child's health card was used. Another limitation is the non-inclusion of feeding habits, which should be investigated in future studies.

Conclusion

Higher risk of some determinant behaviors related to dental caries can be associated to variables of the period of the first thousand days of life. Tooth brushing onset after two years of age was independently associated with lower mother’s schooling when the child was born. Absent tooth brushing or once a day was independently associated with lower mother’s schooling when the child was born and with vaginal route of delivery. Not having gone to the dentist until the age of 6 was independently associated with lower mother’s schooling when the child was born and with mother’s occupation without income when the child was born. Seek for dental services due to toothache at age 6, over the last 30 days was independently associated with occurrence of gastroesophageal reflux and hospitalization for more than 2 days.

• Financial Support
  Foundation for Research and Innovation of the State of Santa Catarina (Grant No. 2016TR22) and the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.
• Data Availability
  The data used to support the findings of this study can be made available upon request to the corresponding author.

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Edited by

Academic Editor: Burak Buldur

Publication Dates

• Publication in this collection
  29 Oct 2021
• Date of issue
  2021

History

• Received
  01 Oct 2020
• Reviewed
  15 Mar 2021
• Accepted
  16 Apr 2021