Behavioral and social determinants of early childhood caries among Palestinian preschoolers in Jerusalem area: a cross-sectional study

Abstract

Background This study came to determine the prevalence of Early Childhood Carries (ECC) among preschoolers in a marginalized population and describe the influence of behavioral and social determinants on the development of ECC. Methods This is a cross-sectional study that was carried out in four random preschools in the Jerusalem Governorate of the Occupied Palestinian Territories. All children aged 3–5 years old in the selected schools were screened for ECC using the decayed, missing, and filled teeth index (dmft). Data on children’s socio-economic, feeding habits, hygiene habits, access to care, parental level of stress, social support, and locus of control were collected by a validated questionnaire sent to the children’s main caregivers. Descriptive statistics were generated and bivariable and multivariable analyses were used to explain the influence of different behavioral and social determinants on ECC levels. Results Four hundred and fifty-seven preschoolers completed the questionnaire and the clinical screening. Ninety-seven percent (n = 447) had experienced dental decay, with an average dmft score of 6.6 ± 4.3. After accounting for potential confounding, parents’ internal locus of control was associated with lower dental caries among children (IRR = 0.97, 95% CI = 0.97, 0.98). Having routine, preventive visits versus never seeing a dentist were associated with lower dmft scores (IRR = 0.42, 95% CI = 0.33, 0.52). Night feeding habits (putting things other than water in the baby bottle at night, having children sleep while being breastfed at night) were positively associated with children’s dental caries (IRR = 1.06, 95% CI = 1.04, 1.09: IRR = 1.15, 95% CI = 1.03, 1.29, respectively). Not adding sugar to the bottle was negatively associated with children’s dental caries (IRR = 0.86, 95% CI = 0.74, 1.00). Conclusions Preschoolers in this study suffered from high dental caries experience. Although infant feeding habits were key factors in explaining the elevated level of the disease, system and socio-psychological factors were also detrimental to ECC prevalence. Policies and interventions to alleviate the burden of ECC need to address socioeconomic determinants of health in addition to feeding and hygiene practices.

A scoping review of the links between early childhood caries and clean water and sanitation: the Sustainable Development Goal 6

“…The nine included studies were conducted in Chile [ 33 , 35 ], Africa namely Uganda/Tanzania [ 32 ], Switzerland [ 29 , 31 ], and India [ 28 ], Palestine [ 30 ], one study included data from UK, Ireland and Canada [ 34 ], and one study included global data by country [ 15 , 22 , 36 ].…”

“…Publication details are included in Table 1 . The study designs ranged from ecological [ 15 ] to cross-sectional [ 28 ]; [ 30 , 32 , 33 , 35 ], longitudinal [ 29 ], qualitative study nestled within a clinical trial [ 31 ] and a systematic review [ 34 ].…”

“…The single study on the link between ECC and access to clean water and sanitation mediated through poverty was an ecological study that indicated that access to water and sanitation had an inverse relationship with the prevalence of ECC [ 15 , 22 , 36 ]. The four studies on the link between ECC and access to clean water and sanitation mediated through feeding practices indicated that the children who consumed alternatives such as sugar-sweetened beverage [ 28 , 31 ], juice [ 28 ], milk [ 28 ] and breastmilk throughout the night [ 30 ] increased the risk for ECC. In addition, the four studies on the link between ECC and access to clean water and sanitation mediated through fluoridation of water indicated that access to fluoridated water was associated with lower prevalence of ECC [ 32 – 35 ]…”

“…al 2011 [ 29 ] Switzer-land Longitudi-nal n = 366 Age: 18 months -5 years To identify the early determinants of risk for dental caries to use in its primary prevention Question-naires & Interview & clinical examina-tions • The oral health of a child is strongly related to the lifestyle and the oral health habits of the caretakers during the first years • Socioeconomic status of the family seems to be closely related to the oral health habits and oral health • Use of thirst quenchers other than water was significantly correlated with the child’s caries increment Kateeb et. al 2023 [ 30 ] Occupied Palesti-nian Territories Cross-sectional n = 457 Age: 3–5 years To determine the prevalence of ECC among preschoolers in a marginalized population and describe the influence of behavioral and social determinants on the development of ECC Question-naires & clinical examina-tions • By age 5, 97% had experienced tooth decay, and night feeding habits (putting things other than water in the baby bottle at night and/or having children sleep while being breastfed at night) were positively associated with the child developing caries • Late introduction of fluoride toothpaste after age 3, along with the poor feeding habits could explain the elevated level of disease among the sample Poirier et. al 2022 [ 31 ] Australia Qualitative study nestled within an Randomized Clinical Trial n = 226 Age: 0–3 years To collate parental experiences and generate an understanding of facilitators for indigenous childhood oral health Qualita-tive evaluation of indige-nous parents’ interviews • Child level facilitators of childhood oral health included oral health routines and regular water consumption • Many parents identified the importance of water for their child’s health, especially in reducing sugar-sweetened beverage consumption Water fluoridation Masumo et.…”

Polish pregnant women’s knowledge on early childhood caries prevention and oral hygiene in children

“…Research emphasises that financial situation not only affects the knowledge level, but is also a factor that significantly influences a child’s oral health [ 31 ]. In addition, studies indicate that mothers’ education level directly determines their knowledge of ECC and affects the prevalence and severity of ECC [ 32 ]. Mothers with higher education and those who were economically active showed higher levels of knowledge of ECC prevention and were more involved in preventive measures for their children [ 33 ].…”