Risk factors for caries-free time: longitudinal study in early childhood

Cabral, Maria Beatriz Barreto de Sousa; Mota, Eduardo Luiz Andrade; Cangussu, Maria Cristina Teixeira; Vianna, Maria Isabel Pereira; Floriano, Fabiana Raynal

doi:10.11606/S1518-8787.2017051006558

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Sumário

Original Articles • Rev. Saúde Pública 51 • 2017 • https://doi.org/10.11606/S1518-8787.2017051006558 copy

Risk factors for caries-free time: longitudinal study in early childhood

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To estimate time in days from the beginning of follow-up up to the development of dental caries in children under 30 months and to assess risk factors potentially affecting the development of the disease.

METHODS

The study population of the cohort study were children attending public, private, and charitable day care centers in Salvador, Northeastern Brazil, followed up for fourteen months. We used the multivariate Cox regression to estimate risk and Kaplan-Meier method to estimate the caries-free time.

RESULTS

Of the 495 children studied, 112 developed caries (22.6%). Mean caries-free time was 248.6 (SD = 96.2) days. The comparasion of curves by age group (> 24 months) and children attending public day care showed more caries in a shorter period (p < 0.00). The following variables were important risk factors for increased rate of caries: district of origin (HR = 1.88, 95%CI 1.27–2.77), category of day care (HR = 3.88, 95%CI 2.04–7.38), age (HR = 1.77, 95%CI 1.15–2.74), bottle-feeding before sleep time after the age of 12 months (HR = 1.62, 95%CI 1.04–2.51), presence of active white spots (HR = 2.70, 95%CI 1.07–6.80), and living in non-masonry house (HR = 1.68, 95%CI 1.02–2.76). The highest hazard ratio (HR = 4.60, 95%CI 2.80–7.42) was found for previous caries experience.

CONCLUSIONS

Social variables were considered as of high risk for the development of dental caries.

Infant; Child, Preschool; Dental Caries, epidemiology; Risk Factors; Cohort Studies

Exposure factors	n	Time under risk (days)	Observed Events (n)	Expected events (n)	p^a	Hazard ratio^b	95%CI
Age
≤ 24 months	277	69.01	42	62.01		1,0
> 24 months	218	54.05	70	49.92	0.000	2.07	1.41–3.03
Race
White	64	15.85	3	13.84		1.0
Black/Biracial	431	107.22	109	98.22	0.005	5.11	1.62–16.12
District of origin
Barra-Rio Vermelho	305	78.99	58	74.71		1.0
Cabula-Beiru	190	44.07	54	37.33	0.001	1.93	1.31–2.84
Category of day care
Private/Charitable	166	41.86	22	38.72		1.0
Public	329	81.21	90	73.34	0.001	2.17	1.36–3.47
Schooling of the mother^c
≥ High school/University	254	64.04	42	60.71		1.0
< High school/University	236	57.57	70	51.22	0.000	1.98	1.35–2.91
Schooling of the father^c
≥ High school/University	205	52.59	29	47.13		1.0
< High school/University	246	59.43	68	49.93	0.000	2.23	1.44–3.45
Occupation of the mother^c
Upper or average level CBO	82	21.61	4	20.35		1.0
Low CBO or unemployed	410	100.811	108	91.77	0.000	6.04	2.22–16.4
Occupation of the father^c
Upper or average level CBO	99	26.00	9	25.39		1.0
Low CBO or unemployed	335	81.14	91	74.75	0.000	3.49	1.75–6.95
Family income (minimum wage)
≤ 0.38–7.75	179	46.36	29	44.42		1.0
< 0.06–0.37	290	70.46	81	65.56	0.003	1.89	1.24–2.90
Masonry house
Yes	338	100.14	80	92.23		1.0
No	187	22.92	32	19.87	0.003	1.87	1.24–2.84
Bottle-feeding
≤ 24 months	426	105.37	85	95.32		1.0
> 24 months	69	17.69	27	16.74	0.007	1.81	1.17–2.79
Bottle-feeding before bedtime
≤ 24 months	325	80.85	57	73.11		1.0
> 24 months	170	42.21	55	38.92	0.002	1.81	1.25–2.62
Bottle-feeding during sleep time
≤ 12 months	267	65.73	46	59.64		1.0
> 12 months	228	57.34	66	52.43	0.011	1.63	1.12–2.38
Use of sugar
No	60	14.52	4	12.76		1.0
Yes	435	108.54	108	99.34	0.015	3.46	1.27–9.38
Active white spots
No	468	117.32	98	107.57		1.0
Yes	27	5.74	14	4.51	0.000	3.45	1.96–6.07
Frequent use of drugs
No	334	94.89	80	89.31		1.0
Yes	204	28.17	32	22.62	0.028	1.59	1.05–2.41
Presence of visible plaque
No	103	27.01	6	25.53		1.0
Yes	392	96.05	106	86.51	0.000	5.32	2.33–12.13
Previous experience of caries
No	455	114.91	84	105.70		1.0
Yes	40	8.15	28	6.30	0.000	5.81	3.75–8.99

Exposure factors	HR*	95%CI	p
Model 1
Cabula-Beiru district	2.04	1.27–3.26	0.003
Public day care	3.88	2.04–7.38	< 0.001
Age > 24 months	1.77	1.15–2.74	0.010
Active white spots	2.70	1.07–6.80	0.035
Bottle-feeding during sleep time after 12 months of age	1.62	1.04–2.51	0.032
Non-masonry house	1.68	1.02–2.76	0.040
Model 2
Cabula-Beiru district	1.88	1.13–3.13	0.015
Age > 24 months	1.83	1.15–2.92	0.010
Active white spots	2.96	1.05–8.31	0.039
Bottle-feeding during sleep time after 12 months of age	1.65	1.03–2.66	0.038
Non-masonry house	2.06	1.22–3.47	0.006
Model 3
Cabula-Beiru district	1.88	1.27–2.77	0.002
Public day care	2.80	1.73–4.51	< 0.001
Age > 24 months	1.70	1.14–2.55	0.010
Active white spots	1.88	1.01–3.49	0.045
Previous experience of caries	4.60	2.80–7.42	< 0.001

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence: Maria Beatriz Barreto de Sousa Cabral. Rua Araújo Pinho 62 6º Andar Canela. 40110-150 Salvador, BA, Brasil. E-mail: mbcabral@ufba.br