Early Childhood Caries Experience Associated with Upper Respiratory Infection in US Children: Findings from a Retrospective Cohort Study

Abstract

Introduction: Both Early Childhood Caries (ECC) and Upper Respiratory Infection (URI) are infectious diseases. The oral cavity is considered a potential reservoir of respiratory pathogens due to the anatomical proximity between the oral cavity and respiratory system, which implies a potential association between ECC and URI. Hence, this study aimed to evaluate the association between ECC experience and URI incidence in preschool children. Methods: This retrospective cohort study collected data via electronic health records. The exposure was ECC before 3 years of age. The dependent variable was the incidence of URI between 4-6 years of age. To analyze the factors associated with the time-to-event of URI, we used log-rank tests and Cox regression models to compare the survival of URI between the ECC and Caries- Free (CF) groups, adjusting factors including demographic-socioeconomic characteristics and medical conditions. To analyze factors associated with the number of URI episodes, we used negative binomial regression models adjusting for factors mentioned above. Results: A total of 497 US preschool children were included, with 117 ECC and 380 CF children. More children with ECC (58.1%) developed URI than the CF group (47.6%) during the follow-up period (4-6 years of age) (p=0.04). The ECC children were at 1.6 times higher risk to develop URI than the CF children even after accounting for other URI risk factors (Hazard Ratio 1.57 (1.13, 2.10), p=0.007). Conclusions: Our study suggests a potential association between ECC and URI, with an inference that early life ECC experience could be used as a predictor for developing URI in preschool age. The causal relationship between ECC and URI incidence in young children needs to be investigated through future studies.

Relationship between Early Childhood Caries and Prolonged Coughing Episodes in a Cohort of Cambodian Children

“…In this sample, one in three children experienced active caries and subsequent increased risk of developing prolonged coughing episodes. This finding is consistent with a US-based study examining the relationship between ECC and Upper Respiratory Tract Infection (URI) where there was a 1.6 times greater risk [16]. Another study from Hong Kong found a similar relationship between caries among children aged 4 and suggested that the oral cavity acts as a reservoir for opportunistic pathogens of the respiratory tract [17].…”

“…Recent studies in high-income countries have found an association between dental caries and respiratory infections in early childhood [16,17]. According to the WHO Maternal Child Epidemiology Estimation in 2018, pneumonia accounted for 14% of all deaths in children under 5 years in Cambodia [18].…”