NORCAL Publications

Research Article

Behavior Factors and Temperament in Children with and without Early Childhood Caries: A Comparative Study

Fabiana Sodré de Oliveira¹, Jillian Stefanie DM de AT Curtt e Silva², Laysla Sabriene de Fátima Mendes², Danielly Cunha Araújo Ferreira^1*, Marcelo Tavares³ and Alessandra de Maia de Castro¹

¹Professor of Pediatric Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil

²Graduate in Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil

³Professor of Department of Applied Statistics, Faculty of Mathematics, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil

^*Corresponding author: Danielly Cunha Araújo Ferreira, Department of Pediatric Dentistry, School of Dentistry, Federal University of Uberlândia, Av. Pará, s/n, Campus Umuarama, Uberlândia, Minas Gerais, Brazil, Tel: +55 3432258146; E-mail: danielly@ufu.br

Citation: de Oliveira FS, de Arruda Curtt e Silva JSDM, de Fátima Mendes LS, Ferreira DCA, Tavares M, et al. (2017) Behavior Factors and Temperament in Children with and without Early Childhood Caries: A Comparative Study. J Dent Sci Res Ther 2017: 30-36. doi:https://doi.org/10.29199/2637-7055/DSRT.101014                  

Received: 09 September 2017; Accepted: 07 November 2017; Published: 22 November 2017

Abstract

The aims of this study were to evaluate and to compare the behavioral risk factors (diet and oral hygiene habits) and temperament of children with and without early childhood caries assisted by public health service. A cross-sectional study was carried out with a convenience sample composed of 120 children of both gender aged two to five years and their respective mothers, divided into two groups. Two researches applied a questionnaire in order to obtain data about mother, family and child. Child temperament was classified according mother’s perception, six choices of temperament were given to mothers and was asked to choose the most applicable to child: (1) calm; (2) fussy; (3) crying; (4) demanding; (5) stubborn; (6) other. Clinical examinations were carried out for the diagnosis of dental caries by the same trained and calibrated examiner for all subjects; the criteria of the World Health Organization were used for the diagnosis of dental caries. The presence of visible dental biofilm was evaluated on the vestibular surface of four upper incisors, without disclosing. The logistic regression (p<0.05) between children without caries and with early childhood caries showed that factors as the child age (OR = 1.480), the frequency of sugar intake between meals (OR = 2.343), use of fluoridated paste (OR = 2.763), lack of brushing after dinner (OR = 0.539) and unsatisfactory oral hygiene (OR = 3.449) were associated to early childhood caries. There was no difference regarding the temperament of children with and without caries. Behavioral risk factors (dietary habits and oral hygiene) were associated with the presence of early childhood caries.

Keywords: Child; Dental Caries; Preschool: Risk Factors; Temperament

Introduction

Early Childhood Caries (ECC) is a common chronic disease of childhood, represents a significant public health problem [1] and has a negative impact on the oral health-related quality of life of preschool children, their parents [2,3] and the health system [4]. The incidence of ECC is not uniformly distributed in a child population. It is confined to a subset of the total population of children. Therefore, identifying those at risk for developing the disease is a sound public health and private practice strategy [5]. ECC has a complex etiology with biological, behavioural, and sociodemographic influences [6] and is resulting from an imbalance of multiple risk and protective factors over time [1]. Especially in young children, the list of factors that may directly or indirectly influence caries risk is extensive [7]. In a systematic review [8], 106 risk factors were found to be significantly related to the prevalence or incidence of dental caries in young children. In the last years, several risk factors for ECC have been extensively studied [9-24] and many studies have shown that behavioral risk factors (dietary habits and oral hygiene) are strongly associated to ECC [9-14,17-22]. Another risk factor that may have behavioral manifestations is the child temperament, since those considered of difficult temperament present a greater risk for the development of ECC [25-30]. Few studies have evaluated the relationship between child temperament as a risk factor for early childhood caries [25-32]. According with one study, the temperament of children with ECC was less sociable, energetic, rhytimic and highly distracted as compared to children without ECC [30]. Another study showed that [25], shyness, a subscale of Emotionality, Sociability, Activity (EAS) Temperament Survey for Children, and duration of feeding habit together were associated with ECC. The results of study by Aminabadi et al., [29] showed that in children with ECC, six aspects of temperament among 18 evaluated were significantly higher compared with children without ECC. Evidence suggests that child temperament reported by mothers may be related to important ECC risk factors [26]. Therefore, the objectives of this study were to evaluate and to compare the behavioral risk factors (diet and oral hygiene habits) and temperament of children with and without ECC assisted by public health service.

Methodology

Ethical procedures

The study was submitted and approved by the Research Ethics Committee of the Federal University of Uberlândia (Register number 735.009). The goals of the study were explained to the parents or primary caregivers and their written informed consent was taken.

Study design and population

A cross-sectional study was carried out with a convenience sample composed of 120 children of both gender aged two to five years and their respective mothers, divided into two groups, Group 1:60 children without ECC and Group 2:60 children with ECC. The children were selected among the patients attending the same Children’s Dental Clinic in a public health service, who presented as following inclusion criteria: gestational age ≥ 37 weeks; birth weight ≥ 2.500; children who were born and lived in the city since birth; complete mental and physical health, and mothers with similar age (≥ 24 years), educational and socioeconomic levels.

Data collection

Two researchers applied a questionnaire in order to obtain data about mother (status marital and employment), family (parents live together, monthly household income and number of people in residence) and child (age, number of siblings, birth position, diet and oral hygiene habits, use of dental floss and temperament).

Mother’s perception of child temperament

Six choices of temperament were given to mothers and was asked to choose the most applicable to child: (1) calm; (2) fussy; (3) crying; (4) demanding; (5) stubborn; (6) other. The temperament of the child was classified as easy if the mother chose the option (1) calm or difficult if she chose the options (2) fussy, (3) crying, (4) demanding and (5) stubborn. When the mother’s choice was (6) other, the children was classified by the researcher’s judgment. For example, if a mother answered happy, she was classified as easy. On the other hand, is a mother answered grumpy, she was classified as difficult [26].

Clinical examination

All clinical examinations were carried out with a dental mirror and an explorer by the same trained and calibrated examiner for all subjects (k = 0.98). Oral hygiene quality was evaluated based on presence of visible dental biofilm on the vestibular surface of four upper incisors, without disclosing. The criteria of the World Health Organization [33] were used for the diagnosis of dental caries.

The dependent variable and the exposures of interest

The dependent variable was the presence of ECC and the exhibition of interest was the temperament of the child.

Statistical analysis

The data were tabulated and analysed by using SPSS Statistics (IBM, Inc, Chicago, Illinois, USA) version 17. Associations between ECC and independent variables were determined using the multiple logistic regression model. The dependent variable was the absent and presence of ECC. Odds Ratio (O.R.) for each of the variables was calculated and the confidence interval was set at 95% and the value of p<0.05.

Results

ECC experience was expressed as absent or present. Relations between variables related to mother, to the family and to the child, diet and oral hygiene habits and mother’s perception of child temperament and absent and presence of ECC were showed in (Tables 1-4) respectively. The mean (DMFT) value was 2.95. The mean ages of children without caries and who presented caries were respectively, 2.75 years (standard desviation: 2.82 years) and 3.35 years (standard desviation = 2.12 years) Table 1.

 

 

 

 

ECC was significantly associated with age (p = 0.035), intake of sugar with and after main meals (p = 0.003), use of dentifrice fluoride (p = 0.013), person that brushing after dinner (0.047) and presence of visible dental biofilm (p = 0.001). Older children, who did not use fluoridated toothpaste, with high frequency of sugar intake with and after main meals, showed an increase in 2.763 and 2.342 times more likely to have ECC, respectively. The lack of brushing after dinner increased the chance of the child showed ECC in 0.539 times and the unsatisfactory oral hygiene increased the probability of a child presenting ECC in 3.449 times (Table 5).