Psychosocial determinants of oral health outcomes in young children

Dorota T Kopycka-Kedzierawski; Patricia G Ragusa; Changyong Feng; Kim Flint; Gene E Watson; Cynthia L Wong; Steven R Gill; Ronald J Billings; Thomas G O'Connor

doi:10.3389/fped.2024.1478302

Psychosocial determinants of oral health outcomes in young children

Front Pediatr. 2024 Dec 6:12:1478302. doi: 10.3389/fped.2024.1478302. eCollection 2024.

Authors

Dorota T Kopycka-Kedzierawski¹, Patricia G Ragusa¹, Changyong Feng², Kim Flint¹, Gene E Watson¹, Cynthia L Wong¹, Steven R Gill³, Ronald J Billings¹, Thomas G O'Connor⁴

Affiliations

¹ Department of Oral and Craniofacial Sciences, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, United States.
² Department of Biostatistics and Computational Biology and Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, NY, United States.
³ Department of Immunology and Microbiology, University of Rochester, Rochester, NY, United States.
⁴ Departments of Psychiatry, Neuroscience, and Obstetrics and Gynecology, University of Rochester, Rochester, NY, United States.

Abstract

Objective: To examine the social determinants of early childhood caries (ECC), one of the greatest public health risks affecting children, and examine alternative pathways of influence.

Methods: A physically healthy, socio-demographically high-risk sample of initially caries-free children, aged 1-4 years, was prospectively studied for 2 years. At 6-month intervals, assessments were made of caries presence from a standard dental exam; oral microbiology was assayed from saliva samples; oral hygiene behaviors and psychological and psychosocial risk exposure were derived from interviews and questionnaires.

Results: 189 children were enrolled; ECC onset occurred in 48 children over the 2-year study period. A composite measure of psychosocial risk was significantly associated with ECC onset over the course of the study (1.57, 95% CI 1.12-2.20, p < .001) and significantly associated with multiple risks for ECC, including poor diet/feeding (.92; 95% CI. 22-1.61, p < .01), poor oral hygiene (.39; 95% CI .09-.68), p < .05), and higher concentrations Lactobacilli (.96; 95% CI .43-1.49, p < .001). Multivariable regression analyses provided indirect support for the hypothesis that psychosocial risk exposure predicts ECC onset via behavioral and oral hygiene pathways.

Conclusions: The study provides novel evidence that psychosocial factors influence many of the purported risks for ECC and strong evidence that there are social and psychological determinants of ECC onset.

Keywords: International Caries Detection and Assessment System (ICDAS); early childhood caries; oral health; social conditions; social determinants of health.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. Funding was provided by NIH DE024985; the NIH had no role in the design and conduct of the study.