Socio-Economic Status May Associate Different Risk(s) with Early Childhood Caries (ECC) That Can Cause the Development of Psychomotor Deficiency in Preschool Children Aged 3–6 Years Old: The Results of Preliminary Analysis from a Cohort Study

Abstract

Background: We have recently shown that there is a positive correlation between severe caries and developing psychomotor deficiency in preschool children. To fully re-assess such a relationship, we embarked on a 3-year longitudinal follow-up study of kindergarteners, where we aimed to: (i) confirm whether early childhood caries is causally related to the development of psychomotor deficiency as proposed, and (ii) address any significant role or contribution of socio-economic status associated with caries–psychomotor interactions in the preschooler family cohorts studied, over time. Methods: A longitudinal study was designed where the total sum of 159 kindergarteners aged 3–6 from the central and southern regions of Taiwan were randomly selected and recruited for clinical examination of caries, together with questionnaires for personal, demographic and dietary information, socio-economic status, and the children’s psychomotor development scales which were collected and analyzed over time. Student’s t test, chi-squared test, correlation coefficients, and multiple linear regression analysis with R2 determinants were employed to assess any attributable differences (of 0~1) between SES vs. psychomotor manifests and caries measured among all variables computed. Results: The results of our preliminary analyses show that: (i) there was likely a causal relationship between caries activities and aspects of general development scale via the Chinese Child Development Inventory over time (4.01 ± 3.47 vs. 5.88 ± 2.58, respectively) in the 3–6-year-old preschoolers, and (ii) there was significantly more attributable influence (via higher R-squared values) from SES and psychomotor manifests than that of caries and the Chinese Child Development Inventory counterparts, as detected over time. Conclusion: Collectively, the resulting analyses support our previous findings and confirm that there is likely a causal relationship between severe caries and psychomotor deficiency in growing preschoolers; the resulting analyses revealed that such causally related interactions may be attributably explainable by a content-reliant association via socio-economic status analyzed in the kindergartener family cohorts studied. Thus, the socio-economic status or its constituents/factors will have a much broader influence not only associated with developing early childhood caries (a biologic trait), but also for psychomotor deficiency (a social trait) in vulnerable children at risk.

Early Childhood Caries Is Causally Attributed to Developing Psychomotor Deficiency in Pre-School Children: The Resultant Covariate and Confounder Analyses in a Longitudinal Cohort Study

“…However, others in the field have shown that SES has long been considered one of the risk factors, or even a predictor, for ECC development and/or progression in children, including levels of family income, parental education and occupation, and access to medical/dental healthcare facilities, etc., all of which may be attributed to the equity issue of caries distribution in the population studied [ 15 , 16 , 17 , 19 , 20 , 22 , 23 , 24 , 25 , 32 ]. Interestingly, such intricate causal interactions between ECC and developing the psychomotor deficiency described above are found to be further implicated by other non-biologic risks/determinants, including SES (especially maternal educations), family-income level, and the frequency of dental visits, which have all been reported in our recent preliminary analyses [ 21 ].…”

“…To study the causal interactions addressed above, we have designed a three-year longitudinal study via the random recruitment of children aged three to six years old, whose baseline vs. follow-up caries activities and their growth-and-development aspects were collected via standardized protocols from randomly selected central and southern regions of Taiwan. Based on our recent reports [ 13 , 14 ], the protocols employed for the current study were directed via the same measures and criteria previously established [ 18 , 21 ], which are described below regarding their capacity to achieve the objectives stated above. After obtaining legal consent, the caries/dmft measures, as independent variables; the demographic data of age, gender, and BMI (height/weight); and the amended comprehensive scales (CCDI-aspects as the dependent variable) regarding psychomotor development, parental educations vs. occupations, and dietary information by categories were collected for the calculation of their inter-relationships.…”

“…Additional factors may also include the following: behavioral, circumstantial and lifestyle, medical/dental healthcare issues, etc. [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. Modern research has also provided further evidence that the non-dental risks on caries/ECC may generally involve those with lower levels of socio-economic status (SES), vulnerable (sub)populations with disparities, and certain minority/ethnical vs. racial groups, etc.…”

“…Some risk factors or predictors have been considered for developing ECC, including equity distributions in the (sub)populations studied [ 1 , 2 , 4 , 15 , 19 , 20 , 22 ]. In parallel, SES may act as a factor in biological or behavioral vs. conceptual access to oral healthcare in ECC-susceptible children [ 1 , 2 , 3 , 4 , 15 , 16 , 17 , 19 , 20 , 21 , 22 , 24 ], whose particular risks may be associated with specific oral biofilm-species, improper feeding and dietary behaviors, and environmental and self-image attributes, as well as some ill-defined underlying parental socio-mental/psyche distress or stresses. [ 2 , 4 , 23 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ].…”

“…in normal/regular classes of kindergarteners (i.e., without any developmentally delayed children involved), randomly selected from the country-wide regions via longitudinal designs for follow-up measures and statistical analyses [ 13 , 14 , 18 ]. Meanwhile, such likely causal interactions may be attributable by a content-reliant association through SES analyzed in kindergartener-family cohorts, whose influence was not only significantly associated with ECC progression (a biologic trait), but also with psychomotor deficiency (a social trait) in vulnerable children [ 21 ].…”