Objectives To assess the relationships between different behavioral factors and Early Childhood Caries (ECC) in African-American pre-school children. Methods Ninety-six African-American children aged 3 to 22 months old at baseline were recruited by word of mouth from Uniontown, Alabama, a non-fluoridated community. The children had dental examinations annually following World Health Organization (WHO) criteria at baseline, 1st, 2nd and 3rd follow-up. Parents provided detailed oral hygiene and dietary information every six months by completing questionnaires. Cumulative calculations using area-under-the-curve (AUC) were made for all the independent variables that were assessed at the follow-up questionnaires. Bivariate and multivariable relationships between ECC incidence and different behavioral risk factors were assessed using logistic regression for dichotomous dependent variables and negative binomial modeling for count dependent variables. Independent variables were defined at baseline, as the AUC and at 2nd follow-up. Results Ninety-nine percent of the children consumed sugar-added beverages by the time of the 2nd follow-up visit. Increased frequency of toothbrushing and increased AUC composite of daily frequency of consumption of 100% juices were associated with decreased incidence of dental caries (p-values=0.01 and 0.049, ORs=0.34 and 0.37, respectively). Greater AUC of daily frequency of consumption of sweetened foods and a history of a previous visit to a dentist by the 2nd follow-up visit were associated with increased incidence of ECC (p-values=0.002 and 0.03, ORs=9.22 and 4.57, respectively). Conclusion For those living in a non-fluoridated community, more frequent consumption of sweetened food, less frequent consumption of 100% juice, less frequent toothbrushing, and reporting a previous visit to a dentist were significantly associated with increased ECC incidence.

Objectives To assess the prevalence and incidence of Early Childhood Caries (ECC) in African-American children. Methods A cohort of 96 African-American children approximately one year of age at baseline was recruited in Uniontown, Alabama, by word of mouth and followed for three years. Oral examinations were conducted annually by one of three trained/calibrated dentists using portable equipment, without radiographs. Dental examinations with WHO criteria assessed surface-level dmf. Results The prevalence of dmfs was: 1.1% (all d) at approximately age 1 (n=90, six children were excluded for having no erupted teeth); 12.8% (d=10.5% & f=4.7%) at age 2 (n=86); 39.3% (d=21.4%, m=2.4% & f=22.6%) at age 3 (n=84); and 65.8% (d=28.8%, m=5.5 & f=46.6%) at age 4 (n=73). The percentages of incisors, canines, 1st molars and 2nd molars with dmfs were: 0.1%, 0.0%, 0.0% and 0.0%, at age 1; 2.4%, 0.1%, 0.8%, and 0.6% at age 2; 8.2%, 0.8%, 7.6%, and 6.3% at age 3; and 10.2%, 2.2%, 12.6% and 16.7% at age 4, respectively. The three, one-year, person-level incidence rates were 12.8% (from approximately age 1 to age 2), 38.6% (age 2 to age 3), and 56.2% (age 3 to age 4). From baseline, the two-year incidence was 39.3% and three-year incidence was 65.8%, while the two-year caries incidence from age 1 to age 3 was 66.7% (n=72). Conclusion The majority of children developed caries during the three-year follow-up, which is much higher than the 32% prevalence of caries among African-American children under age six years in National Health and Nutrition Examination Survey from 1999–2002.

This two-part study investigated the genetic diversity and transmission of Streptococcus mutans using the DiversiLab repetitive extragenic palindromic PCR (rep-PCR) approach. For children with S. mutans and participating household members, analysis for evidence of unrelated child-to-child as well as intra-familial transmission was evaluated based on commonality of genotypes. A total of 169 index children and 425 household family members from Uniontown, Alabama were evaluated for genetic diversity using rep-PCR. Thirty-four unique rep-PCR genotypes were observed for 13,906 S. mutans isolates. For transmission, 117 child and household isolates were evaluated for shared genotype (by child and by genotype cases, multiple matches possible for each child). Overall, children had 1–9 genotypes and those with multiple genotypes were 2.3 times more likely to have caries experience (decayed, missing and filled teeth/surfaces>0). Only 28% of children shared all genotypes within the household, while 72% had at least 1 genotype not shared with anyone in the household. Children had genotype(s) not shared with any household members in 155 cases. In 158 cases children and household members shared a genotype in which 55% (87/158 cases) were shared with more than one family member. Children most frequently shared genotypes with their mothers (54%; 85/158), siblings (46%; 72/158) and cousins (23%; 37/158). A reference library for S. mutans for epidemiological surveillance using the DiversiLab rep-PCR approach is detailed. The genetic diversity of S. mutans in this population demonstrated frequent commonality of genotypes. Evidence for both child-to-child and intra-familial transmission of S. mutans was observed by rep-PCR.