Life course approach: caries risk factors

The life course approach looks back at an individual or groups’ life experiences or generations looking for influences on current patterns of health and disease. It also recognises that past and present experiences are influenced by wider social, economic and cultural background.

The aim of this review was to summarise studies that use the life course approach to evaluate the association between factors experienced in early life and throughout the lifetime and the development of dental caries in children and adolescents.

Methods

Searches were conducted in the PubMed, Embase, Scopus and Web of Science databases. Studies using a life course approach to examine factors associated with the development of dental caries in children and adolescents (0-18 yrs) were considered. Two reviewers independently selected studies and abstracted data with study quality being assessed using the Newcastle-Ottawa scale. A narrative summary of the findings was presented

Results

11 studies (7 cohort, 4 cross-sectional) were included.
6 of the cohort studies and 3 of the cross-sectional studies were considered to be of high quality.
A statistically significant association was found between the following life course factors, with the development of dental caries among children and adolescents.
Demographic and socio-economic factors
- Level of parental schooling <8 -9yr
- Household income at the child’s birth
- Lower household income was associated with high rates of dental caries in adolescents.
- Caries was significantly higher among adolescents who were born in a non-brick house
- Single-parent families, those living with more than two children in the family, and those who spent less time with their mothers on a school day, also had higher rates of dental caries.
Biological factors
- Adolescents who were born with a low birth weight , were the second or later child, and had a higher body weight, were more likely to have high DMFT scores
Psychological factors
- Adolescents who experienced high levels of paternal punishment had an increased risk of higher rates of caries
- Individuals with lower self- esteem were also more likely to have higher rates of dental caries
Oral health-related behaviors
- Snack intake once or more
- Consumption of sweets at least once a day
- History of bottle-feeding
- Brushed for the first time after 12 months of age
- Brushed their teeth less than once a day
- Those who did not attend preschool
Dental status of mothers, children, and adolescents
- Children whose mothers were edentulous, and
- Mother with more visible plaque and higher levels of Streptococcus mutans
- Adolescents with a higher DMFT index in childhood and those with high levels of gingival bleeding
- Adolescents who had more dental visits between 15 and 18 yr of age had a higher DMFT index at age 18

Conclusions

The authors concluded:

Different life course factors were associated with the development of dental caries among children and adolescents, including sociodemographic, biological, psychological, and oral health behaviors, as well as the dental status of mothers, children, and adolescents.

Comments

Many of the risk factors identified in this review will be familiar to readers but this review brings together many of the different facts involved in the development of caries. A greater understanding of the interaction of these factors can aid the development of effective action to address the underlying causes of disease. This helps guide research policy making and resource allocation to improve oral health.