Factors underlying the polarization of early childhood caries within a high-risk population

BACKGROUND Early childhood caries (ECC) are particularly prevalent in disadvantaged populations, and socioeconomic factors are associated with the polarization of disease. A previous study showed that even within a homogenous low-income population disease is polarized, indicating that other factors apart from income may contribute to disease susceptibility. METHODS This study used a hierarchical approach to identify factors associated with polarization of ECC in low-income subjects. This cross-sectional study was conducted retrospectively using a cohort of 244 children (aged 48-72 months) with family incomes not exceeding double the minimum wage (U.S. $8,208.00/year), living in neighborhoods on the outskirts of São Luís, Maranhão, Brazil. The sample was divided into three groups based on the Significant Caries (SiC) Index: no caries group, few caries group (mean 1.38 lesions), and a high caries group (mean 3.82 lesions). Hierarchical multinomial logistic regression analyses were performed based on a theoretical model. RESULTS Twenty-eight (11.5%) of the 244 children presented with high caries. Age (p = 0.026; prevalence ratio (PR) = 1.10; 95% confidence interval (CI) 1.01-1.20) and frequency of sucrose consumption - p = 0.001; PR 4.65 (95% CI 1.83-11.84) were associated with increased risk of ECC. CONCLUSIONS In the high caries group, greater consumption of sucrose between main meals may explain why, in a group of children with homogenous social and health conditions, some had more caries than others.