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.
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.
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,
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.