The study aimed at identifying oral health determinants that are present in early childhood, are amenable to change and for which there is evidence of their modulation of the rate of caries progression in a sample of non-privileged children. The null hypothesis was that determinants associated with the child's institutional environment as evidenced by nursery policies significantly influenced the child's oral health. The sample was formed by 2,511 Brazilian 1-5-year-olds. Caries severity and activity were recorded. Parents were interviewed and nurseries answered a questionnaire. According to the case status d₁efs, the final multilevel model (generalized linear mixed model) identified significant associations with determinants such as bottle-feeding the child during the night on demand, not assisting the child in toothbrushing, ensuring visit to the dentist in case of troubles with teeth only (p < 0.0001) and intake of sugary products 2-4 times daily at nursery (p = 0.026). The likelihood of caries outcomes was associated with determinants related to nursery policies, not promoting preventive oral health care for children of mothers with 4 years of education (OR = 2.14; p < 0.0015) and <4 years of education (OR = 2.6; p = 0.0010), as well as consumption of sugary products 2-4 times daily for children of mothers with 4 years of education (OR = 3.35; p = 0.0010) and <4 years of education (OR = 4.07; p = 0.0063). In conclusion, determinants related to parental negative practices and to nursery policies significantly influenced children's oral health. Of particular interest was the identification of determinants considered amenable to change in connection with nursery policies towards oral health.

The aims were to analyse caries trends in Brazilian non- privileged preschool children from 1996 to 2006 and to test the hypothesis that a decline in caries prevalence would manifest itself as a reduction in the rate of caries progression. Subjects were 1- to 5-year-old children born in and life time residents of the Federal District of Brazil (cohort 1996 = 1,465) and (cohort 2006 = 2,511). The clinical examination determined whether the tooth surfaces were sound, presented active lesions (non cavitated and cavitated), inactive lesions (non-cavitated and cavitated), fillings, were indicated for extraction or had been extracted. Intra- and inter-examiner reliability of caries scores showed κ values ranging from 0.71–0.93. A significant increase in the percentage of children who were free from any form of untreated or treated caries was observed (p < 0.05; χ² test). Caries prevalence decreased by almost a half from 1996 to 2006. Differences in the mean caries scores at surface level, which included non-cavitated lesions, were observed for all age groups (p < 0.002; Mann-Whitney test) indicating a reduction in the rate of caries progression. In conclusion, since this population has access to fluoride and presents moderate caries prevalence, other measures to reduce the rate of caries progression are required to further improve oral health in non-privileged children.

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