Review of the Aetiology of Early Childhood Caries

Main Article Content

Andrew Rugg-Gunn
Margaret Woodward

Abstract

Without a full understanding of the aetiology of Early Childhood Caries (ECC), it is not possible to recommend appropriate interventions to prevent ECC. The extensive literature on the aetiology of ECC has been reviewed. Potential risk factors range from those inherent in the individual, such as genetic profile, to the environment, which influences family choices and behaviour. These have been considered in ten groups: genetics, saliva, nutrition, enamel hypoplasia, oral flora, oral hygiene and dental plaque, breast-feeding, sugar in bottles, dietary sugar, and family behaviour and environment.  All of these have been shown to be related to the occurrence of ECC, although some risk factors appear to be much more important than others, and there are strong interactions and synergies between them.  Most emphasis has been put on high and frequent consumption of dietary sugars, infant feeding practices, poor removal of dental plaque, and formation of a dental plaque flora which is particularly conducive to caries development – the growth of this plaque is strongly encouraged by poor plaque control and a high sugar diet.  Reasons for these caries-inducing behaviours lie in the family – their own experiences, circumstances and lifestyles.  However, the family, or carers, are subject to strong pressures which shape belief, attitude and behaviour.  The use, or lack of use, of fluoride has not been discussed in this review.  The beneficial role of fluoride in caries prevention is well-known, and lack of use of fluoride should be seen as an important risk factor for ECC.

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1.
Rugg-Gunn A, Woodward M. Review of the Aetiology of Early Childhood Caries. Th Dent PH J [Internet]. 2018 Oct. 8 [cited 2024 Dec. 23];22(พิเศษ):14-43. Available from: https://he02.tci-thaijo.org/index.php/ThDPHJo/article/view/149511
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References

1. Conference Proceedings. Early Childhood Caries Conference. Community Dent Oral Epidemiol. 1998;26(Suppl1):5 - 119.

2. Drury TF, Horowitz AM, Ismail AI, Maertens MP, Rozier RG, Selwitz RH. Diagnosing and reporting early childhood caries for research purposes. A report of a workshop sponsored by the National Institute of Dental and Craniofacial Research, the Health Resources and Services Administration, and the Health Care Financing Administration. J Public Health Dent. 1999;59(3):192-7.

3. Ismail AI, Sohn W. A systematic review of clinical diagnostic criteria of early childhood caries. J Public Health Dent. 1999;59(3):171-91.

4. Litt MD, Reisine S, Tinanoff N. Multidimensional causal model of dental caries development in low-income preschool children. Public Health Rep. 1995;110(5):607-17.

5. Harris R, Nicoll AD, Adair PM, Pine CM. Risk factors for dental caries in young children: a systematic review of the literature. Community Dent Health. 2004;21(1 Suppl):71-85.

6. Gussy MG, Waters EG, Walsh O, Kilpatrick NM. Early childhood caries: current evidence for aetiology and prevention. J Paediatr Child Health. 2006;42(1-2):37-43.

7. Seow WK. Biological mechanisms of early childhood caries. Community Dent Oral Epidemiol. 1998;26(1 Suppl):8-27.

8. Chaffee BW, Cheng A. Global research trends on early-life feeding practices and Early Childhood Caries: a systematic review. J Oral Dis. 2014;2014:675658.

9. Fontana M. The clinical, environmental, and behavioral factors that foster Early Childhood Caries: evidence for caries risk assessment. Pediatr Dent. 2015;37(3):217-25.

10. Abbasoglu Z, Tanboga I, Kuchler EC, Deeley K, Weber M, Kaspar C, et al. Early childhood caries is associated with genetic variants in enamel formation and immune response genes. Caries Res. 2015;49(1):70-7.

11. Romanos HF, Antunes LS, Lopes LB, Saboia T de M, Tannure PN, Lips A, et al. BMP2 is associated with caries experience in primary teeth. Caries Res. 2015;49(4):425-33.

12. Fonteles CS, Guerra MH, Ribeiro TR, Mendonca DN, de Carvalho CB, Monteiro AJ, et al. Association of free amino acids with caries experience and mutans streptococci levels in whole saliva of children with early childhood caries. Arch Oral Biol. 2009;54(1):80-5.

13. Jurczak A, Koscielniak D, Papiez M, Vyhouskaya P, Krzysciak W. A study on beta-defensin-2 and histatin-5 as a diagnostic marker of early childhood caries progression. Biol Res. 2015;48:61.

14. Kumar D, Pandey RK, Agrawal D, Agrawal D. An estimation and evaluation of total antioxidant capacity of saliva in children with severe early childhood caries. Int J Paediatr Dent. 2011;21(6):459-64.

15. Mahjoub S, Ghasempour M, Gharage A, Bijani A, Masrourroudsari J. Comparison of total antioxidant capacity in saliva of children with severe early childhood caries and caries-free children. Caries Res. 2014;48(4):271-5.

16. Si Y, Ao S, Wang W, Chen F, Zheng S. Magnetic bead-based salivary peptidome profiling analysis for severe early childhood caries. Caries Res. 2015;49(1):63-9.

17. Neves AB, Lobo LA, Pinto KC, Pires ES, Requejo M, Maia LC, et al. Comparison between clinical aspects and salivary microbial profile of children with and without Early Childhood Caries: a preliminary study. J Clin Pediatr Dent. 2015;39(3):209-14.

18. Thitasomakul S, Piwat S, Thearmontree A, Chankanka O, Pithpornchaiyakul W, Madyusoh S. Risks for early childhood caries analyzed by negative binomial models. J Dent Res. 2009;88(2):137-41.

19. Schroth RJ, Pang JL, Levi JA, Martens PJ, Brownell MD. Trends in pediatric dental surgery for severe early childhood caries in Manitoba, Canada. J Can Dent Assoc. 2014;80:e65.

20. dos Santos Junior VE, de Sousa RM, Oliveira MC, de Caldas Junior AF, Rosenblatt A. Early childhood caries and its relationship with perinatal, socioeconomic and nutritional risks: a cross-sectional study. BMC Oral Health. 2014;14:47.

21. Yokomichi H, Tanaka T, Suzuki K, Akiyama T, Okinawa Child Health Study Group, Yamagata Z. Macrosomic neonates carry increased risk of dental caries in early childhood: findings from a cohort study, the Okinawa Child Health Study, Japan. PLoS One. 2015;10(7):e0133872.

22. Zhou Y, Yang JY, Lo EC, Lin HC. The contribution of life course determinants to early childhood caries: a 2-year cohort study. Caries Res. 2012;46(2):87-94.

23. Hong L, Ahmed A, McCunniff M, Overman P, Mathew M. Obesity and dental caries in children aged 2-6 years in the United States: National Health and Nutrition Examination Survey 1999-2002. J Public Health Dent. 2008;68(4):227-33.

24. Bhoomika W, Ramakrishna Y, Munshi AK. Relationship between severe early childhood caries and body mass index. J Clin Pediatr Dent. 2013;37(3):235-42.

25. Clarke M, Locker D, Berall G, Pencharz P, Kenny DJ, Judd P. Malnourishment in a population of young children with severe early childhood caries. Pediatr Dent. 2006;28(3):254-9.

26. Schroth RJ, Levi J, Kliewer E, Friel J, Moffatt ME. Association between iron status, iron deficiency anaemia, and severe early childhood caries: a case-control study. BMC Pediatr. 2013;13:22.

27. Schroth RJ, Levi JA, Sellers EA, Friel J, Kliewer E, Moffatt ME. Vitamin D status of children with severe early childhood caries: a case-control study. BMC Pediatr. 2013;13:174.

28. Sadeghi M, Darakhshan R, Bagherian A. Is there an association between early childhood caries and serum iron and serum ferritin levels? Dent Res J (Isfahan). 2012;9(3):294-8.

29. Hong CH, Bagramian RA, Hashim Nainar SM, Straffon LH, Shen L, Hsu CY. High caries prevalence and risk factors among young preschool children in an urban community with water fluoridation. Int J Paediatr Dent. 2014;24(1):32-42.

30. Rugg-Gunn AJ, Do L. Effectiveness of water fluoridation in caries prevention. Community Dent Oral Epidemiol. 2012;40 Suppl 2:55-64.

31. Alaluusua S. Defining developmental enamel defect-associated childhood caries: where are we now? J Dent Res. 2012;91(6):525-7.

32. Caufield PW, Li Y, Bromage TG. Hypoplasia-associated severe early childhood caries ̶ a proposed definition. J Dent Res. 2012;91(6):544-50.

33. Seow WK, Amaratunge A, Sim R, Wan A. Prevalence of caries in urban Australian aborigines aged 1-3.5 years. Pediatr Dent. 1999;21(2):91-6.

34. Plonka KA, Pukallus ML, Barnett AG, Holcombe TF, Walsh LJ, Seow WK. A longitudinal case-control study of caries development from birth to 36 months. Caries Res. 2013;47(2):117-27.

35. Narrenthran JS, Muthu MS, Renugalakshmi A. In vivo scanning electron microscope assessment of enamel permeability in primary teeth with and without early childhood caries. Caries Res. 2015;49(3):209-15.

36. Das B, Muthu MS, Farzan JM. Comparison of the chemical composition of normal enamel from exfoliated primary teeth and teeth affected with early childhood caries: an in vitro study. Int J Paediatr Dent. 2016;26(1):20-5.

37. Leong PM, Gussy MG, Barrow SY, de Silva-Sanigorski A, Waters E. A systematic review of risk factors during first year of life for early childhood caries. Int J Paediatr Dent. 2013;23(4):235-50.

38. Parisotto TM, Steiner-Oliveira C, Silva CM, Rodrigues LK, Nobre-dos-Santos M. Early childhood caries and mutans streptococci: a systematic review. Oral Health Prev Dent. 2010;8(1):59-70.

39. Hao W, Xu H, Chen X, Zhou Q, Zhang P, Chen F, et al. Changes in dental plaque microbial richness and oral behavioral habits during caries development in young Chinese children. Caries Res. 2015;49(2):116-23.

40. Chaffee BW, Gansky SA, Weintraub JA, Featherstone JD, Ramos-Gomez FJ. Maternal oral bacterial levels predict early childhood caries development. J Dent Res. 2014;93(3):238-44.

41. Mitchell SC, Ruby JD, Moser S, Momeni S, Smith A, Osgood R, et al. Maternal transmission of mutans streptococci in severe-early childhood caries. Pediatr Dent. 2009;31(3):193-201.

42. Pattanaporn K, Saraithong P, Khongkhunthian S, Aleksejuniene J, Laohapensang P, Chhun N, et al. Mode of delivery, mutans streptococci colonization, and early childhood caries in three- to five-year-old Thai children. Community Dent Oral Epidemiol. 2013;41(3):212-23.

43. Ibrahim S, Nishimura M, Matsumura S, Rodis OMM, Nishida A, Yamanaka K, et al. A longitudinal study of early childhood caries risk, dental caries, and life style. Pediatric Dental Journal. 2009;19(2):174-80.

44. van Palenstein Helderman WH, Soe W, van 't Hof MA. Risk factors of early childhood caries in a Southeast Asian population. J Dent Res. 2006;85(1):85-8.

45. Caufield PW, Cutter GR, Dasanayake AP. Initial acquisition of mutans streptococci by infants: evidence for a discrete window of infectivity. J Dent Res. 1993;72(1):37-45.

46. Tankkunnasombut S, Youcharoen K, Wisuttisak W, Vichayanrat S, Tiranathanagul S. Early colonization of mutans streptococci in 2- to 36-month-old Thai children. Pediatr Dent. 2009;31(1):47-51.

47. Ersin NK, Eronat N, Cogulu D, Uzel A, Aksit S. Association of maternal-child characteristics as a factor in early childhood caries and salivary bacterial counts. J Dent Child. 2006;73(2):105-11.

48. Ma C, Chen F, Zhang Y, Sun X, Tong P, Si Y, et al. Comparison of oral microbial profiles between children with severe early childhood caries and caries-free children using the human oral microbe identification microarray. PLoS One. 2015;10(3):e0122075.

49. Saraithong P, Pattanaporn K, Chen Z, Khongkhunthian S, Laohapensang P, Chhun N, et al. Streptococcus mutans and Streptococcus sobrinus colonization and caries experience in 3- and 5-year-old Thai children. Clin Oral Investig. 2015;19(8):1955-64.

50. Qiu R, Li W, Lin Y, Yu D, Zhao W. Genotypic diversity and cariogenicity of Candida albicans from children with early childhood caries and caries-free children. BMC Oral Health. 2015;15(1):144.

51. Tao Y, Zhou Y, Ouyang Y, Lin H. Dynamics of oral microbial community profiling during severe early childhood caries development monitored by PCR-DGGE. Arch Oral Biol. 2013;58(9):1129-38.

52. Tanner AC, Kent RL, Jr., Holgerson PL, Hughes CV, Loo CY, Kanasi E, et al. Microbiota of severe early childhood caries before and after therapy. J Dent Res. 2011;90(11):1298-305.

53. Niji R, Arita K, Abe Y, Lucas ME, Nishino M, Mitome M. Maternal age at birth and other risk factors in early childhood caries. Pediatr Dent. 2010;32(7):493-8.

54. Turton B, Durward C, Manton D, Bach K, Yos C. Socio-behavioural risk factors for early childhood caries (ECC) in Cambodian preschool children: a pilot study. Eur Arch Paediatr Dent. 2016;17(2):97-105.

55. Aminabadi NA, Ghoreishizadeh A, Ghoreishizadeh M, Oskouei SG, Ghojazadeh M. Can child temperament be related to early childhood caries? Caries Res. 2014;48(1):3-12.

56. Wong MCM, Lu HX, Lo ECM. Caries increment over 2 years in preschool children: a life course approach. Int J Paediatr Dent. 2012;22(2):77-84.

57. Carino KM, Shinada K, Kawaguchi Y. Early childhood caries in northern Philippines. Community Dent Oral Epidemiol. 2003;31(2):81-9.

58. Al-Malik MI, Holt RD, Bedi R. The relationship between erosion, caries and rampant caries and dietary habits in preschool children in Saudi Arabia. Int J Paediatr Dent. 2001;11(6):430-9.

59. Winter J, Glaser M, Heinzel-Gutenbrunner M, Pieper K. Association of caries increment in preschool children with nutritional and preventive variables. Clin Oral Investig. 2015;19(8):1913-9.

60. Bissar A, Schiller P, Wolff A, Niekusch U, Schulte AG. Factors contributing to severe early childhood caries in south-west Germany. Clin Oral Investig. 2014;18(5):1411-8.

61. Senesombath S, Nakornchai S, Banditsing P, Lexomboon D. Early childhood caries and related factors in Vientiane, Lao PDR. Southeast Asian J Trop Med Public Health. 2010;41(3):717-25.

62. Carvalho JC, Silva EF, Vieira EO, Pollaris A, Guillet A, Mestrinho HD. Oral health determinants and caries outcome among non-privileged children. Caries Res. 2014;48(6):515-23.

63. Nunes AM, da Silva AA, Alves CM, Hugo FN, Ribeiro CC. Factors underlying the polarization of early childhood caries within a high-risk population. BMC Public Health. 2014;14:988.

64. Subramaniam P, Prashanth P. Prevalence of early childhood caries in 8 - 48 month old preschool children of Bangalore city, South India. Contemp Clin Dent. 2012;3(1):15-21.

65. Campus G, Lumbau A, Sanna AM, Solinas G, Luglie P, Castiglia P. Oral health condition in an Italian preschool population. Eur J Paediatr Dent. 2004;5(2):86-91.

66. Huntington NL, Kim IJ, Hughes CV. Caries-risk factors for Hispanic children affected by early childhood caries. Pediatr Dent. 2002;24(6):536-42.

67. Hsieh HJ, Huang ST, Tsai CC, Hsiao SY. Toothbrushing habits and risk indicators of severe early childhood caries among aboriginal Taiwanese. Asia Pac J Public Health. 2014;26(3):238-47.

68. Stecksén -Blicks C, Holm AK. Dental caries, tooth trauma, malocclusion, fluoride usage, toothbrushing and dietary habits in 4-year-old Swedish children: changes between 1967 and 1992. Int J Paediatr Dent. 1995;5(3):143-8.

69. Masson LF, Blackburn A, Sheehy C, Craig LC, Macdiarmid JI, Holmes BA, et al. Sugar intake and dental decay: results from a national survey of children in Scotland. Br J Nutr. 2010;104(10):1555-64.

70. Majorana A, Cagetti MG, Bardellini E, Amadori F, Conti G, Strohmenger L, et al. Feeding and smoking habits as cumulative risk factors for early childhood caries in toddlers, after adjustment for several behavioral determinants: a retrospective study. BMC Pediatr. 2014;14:45.

71. Olatosi OO, Sote EO. Association of Early Childhood Caries with breastfeeding and bottle feeding in southwestern Nigerian children of preschool age. J West Afr Coll Surg. 2014;4(1):31-53.

72. Nobile CG, Fortunato L, Bianco A, Pileggi C, Pavia M. Pattern and severity of early childhood caries in Southern Italy: a preschool-based cross-sectional study. BMC Public Health. 2014;14:206.

73. Tanaka K, Miyake Y, Sasaki S, Hirota Y. Infant feeding practices and risk of dental caries in Japan: the Osaka Maternal And Child Health Study. Pediatr Dent. 2013;35(3):267-71.

74. Jain M, Namdev R, Bodh M, Dutta S, Singhal P, Kumar A. Social and behavioral determinants for Early Childhood Caries among preschool children in India. J Dent Res Dent Clin Dent Prospects. 2015;9(2):115-20.

75. Perera PJ, Fernando MP, Warnakulasooriya TD, Ranathunga N. Effect of feeding practices on dental caries among preschool children: a hospital based analytical cross sectional study. Asia Pac J Clin Nutr. 2014;23(2):272-7.

76. Tham R, Bowatte G, Dharmage SC, Tan DJ, Lau MX, Dai X, et al. Breastfeeding and the risk of dental caries: a systematic review and meta-analysis. Acta Paediatr. 2015;104(467):62-84.

77. Prakash P, Subramaniam P, Durgesh BH, Konde S. Prevalence of early childhood caries and associated risk factors in preschool children of urban Bangalore, India: a cross-sectional study. Eur J Dent. 2012;6(2):141-52.

78. Ozer S, Sen Tunc E, Bayrak S, Egilmez T. Evaluation of certain risk factors for early childhood caries in Samsun, Turkey. Eur J Paediatr Dent. 2011;12(2):103-6.

79. Begzati A, Berisha M, Meqa K. Early childhood caries in preschool children of Kosovo - a serious public health problem. BMC Public Health. 2010;10:788.

80. Qin M, Li J, Zhang S, Ma W. Risk factors for severe early childhood caries in children younger than 4 years old in Beijing, China. Pediatr Dent. 2008;30(2):122-8.

81. Shiboski CH, Gansky SA, Ramos-Gomez F, Ngo L, Isman R, Pollick HF. The association of early childhood caries and race/ethnicity among California preschool children. J Public Health Dent. 2003;63(1):38-46.

82. Ramos-Gomez FJ, Tomar SL, Ellison J, Artiga N, Sintes J, Vicuna G. Assessment of early childhood caries and dietary habits in a population of migrant Hispanic children in Stockton, California. J Dent Child. 1999;66(6):395-403, 366.

83. al Ghanim NA, Adenubi JO, Wyne AA, Khan NB. Caries prediction model in pre-school children in Riyadh, Saudi Arabia. Int J Paediatr Dent. 1998;8(2):115-22.

84. Chaffee BW, Feldens CA, Rodrigues PH, Vitolo MR. Feeding practices in infancy associated with caries incidence in early childhood. Community Dent Oral Epidemiol. 2015;43(4):338-48.

85. Avila WM, Pordeus IA, Paiva SM, Martins CC. Breast and bottle feeding as risk factors for dental caries: a systematic review and meta-analysis. PLoS One. 2015;10(11):e0142922.

86. Feldens CA, Giugliani ER, Vigo A, Vitolo MR. Early feeding practices and severe early childhood caries in four-year-old children from southern Brazil: a birth cohort study. Caries Res. 2010;44(5):445-52.

87. Peltzer K, Mongkolchati A. Severe early childhood caries and social determinants in three-year-old children from Northern Thailand: a birth cohort study. BMC Oral Health. 2015;15:108.

88. Masumo R, Bardsen A, Mashoto K, Astrom AN. Feeding practice among 6-36 months old in Tanzania and Uganda: reliability and relationship with early childhood caries, ECC. Acta Odontol Scand. 2013;71(5):1309-18.

89. Ghazal T, Levy SM, Childers NK, Broffitt B, Cutter GR, Wiener HW, et al. Factors associated with early childhood caries incidence among high caries-risk children. Community Dent Oral Epidemiol. 2015;43(4):366-74.

90. Lim S, Tellez M, Ismail AI. Dental caries development among African American children: results from a 4-year longitudinal study. Community Dent Oral Epidemiol. 2015;43(3):200-7.

91. Wigen TI, Wang NJ. Does early establishment of favorable oral health behavior influence caries experience at age 5 years? Acta Odontol Scand. 2015;73(3):182-7.

92. Meurman PK, Pienihakkinen K. Factors associated with caries increment: a longitudinal study from 18 months to 5 years of age. Caries Res. 2010;44(6):519-24.

93. Ohlund I, Holgerson PL, Backman B, Lind T, Hernell O, Johansson I. Diet intake and caries prevalence in four-year-old children living in a low-prevalence country. Caries Res. 2007;41(1):26-33.

94. Hong L, Levy SM, Warren JJ, Broffitt B. Infant breast-feeding and childhood caries: a nine-year study. Pediatr Dent. 2014;36(4):342-7.

95. Warren JJ, Weber-Gasparoni K, Marshall TA, Drake DR, Dehkordi-Vakil F, Dawson DV, et al. A longitudinal study of dental caries risk among very young low SES children. Community Dent Oral Epidemiol. 2009;37(2):116-22.

96. Maruyama S, Teramoto S, Miyazawa H. Epidemiological study of dental disease factors among young Japanese children. Pediatric Dental Journal. 2008;18(2):156-66.

97. Palmer CA, Kent R, Jr., Loo CY, Hughes CV, Stutius E, Pradhan N, et al. Diet and caries-associated bacteria in severe early childhood caries. J Dent Res. 2010;89(11):1224-9.

98. Zaki NA, Dowidar KM, Abdelaziz WE. Assessment of the Healthy Eating Index-2005 as a predictor of early childhood caries. Int J Paediatr Dent. 2015;25(6):436-43.

99. Li Y, Zhang Y, Yang R, Zhang Q, Zou J, Kang D. Associations of social and behavioural factors with early childhood caries in Xiamen city in China. Int J Paediatr Dent. 2011;21(2):103-11.

100. Kolker JL, Yuan Y, Burt BA, Sandretto AM, Sohn W, Lang SW, et al. Dental caries and dietary patterns in low-income African American children. Pediatr Dent. 2007;29(6):457-64.

101. Abdelaziz WE, Dowidar KM, El Tantawi MM. Association of healthy eating, juice consumption, and bacterial counts with Early Childhood Caries. Pediatr Dent. 2015;37(5):462-7.

102. Vargas CM, Dye BA, Kolasny CR, Buckman DW, McNeel TS, Tinanoff N, et al. Early childhood caries and intake of 100 percent fruit juice: Data from NHANES, 1999-2004. J Am Dent Assoc. 2014;145(12):1254-61.

103. Wulaerhan J, Abudureyimu A, Bao XL, Zhao J. Risk determinants associated with early childhood caries in Uygur children: a preschool-based cross-sectional study. BMC Oral Health. 2014;14:136.

104. Stecksen-Blicks C, Holm AK. Between-meal eating, toothbrushing frequency and dental caries in 4-year-old children in the north of Sweden. Int J Paediatr Dent. 1995;5(2):67-72.

105. Congiu G, Campus G, Sale S, Spano G, Cagetti MG, Luglie PF. Early childhood caries and associated determinants: a cross-sectional study on Italian preschool children. J Public Health Dent. 2014;74(2):147-52.

106. Kumarihamy SL, Subasinghe LD, Jayasekara P, Kularatna SM, Palipana PD. The prevalence of Early Childhood Caries in 1-2 yrs olds in a semi-urban area of Sri Lanka. BMC Res Notes. 2011;4:336.

107. Kiwanuka SN, Astrom AN, Trovik TA. Dental caries experience and its relationship to social and behavioural factors among 3-5-year-old children in Uganda. Int J Paediatr Dent. 2004;14(5):336-46.

108. Khanh LN, Ivey SL, Sokal-Gutierrez K, Barkan H, Ngo KM, Hoang HT, et al. Early Childhood Caries, mouth pain, and nutritional threats in Vietnam. Am J Public Health. 2015;105(12):2510-7.

109. Seow WK. Environmental, maternal, and child factors which contribute to early childhood caries: a unifying conceptual model. Int J Paediatr Dent. 2012;22(3):157-68.

110. Baggio S, Abarca M, Bodenmann P, Gehri M, Madrid C. Early childhood caries in Switzerland: a marker of social inequalities. BMC Oral Health. 2015;15:82.

111. Stecksén -Blicks C, Hasslof P, Kieri C, Widman K. Caries and background factors in Swedish 4-year-old children with special reference to immigrant status. Acta Odontol Scand. 2014;72(8):852-8.

112. Putnam SP, Gartstein MA, Rothbert MK. Measurement of fine-grained aspects of toddler temperament: Early Childhood Behavior questionnaire. Infant behav Dev. 2006;29:386-401.

113. Williamson R, Oueis H, Casamassimo PS, Thikkurissy S. Association between early childhood caries and behavior as measured by the Child Behavior Checklist. Pediatr Dent. 2008;30(6):505-9.

114. Shantinath SD, Breiger D, Williams BJ, Hasazi JE. The relationship of sleep problems and sleep-associated feeding to nursing caries. Pediatr Dent. 1996;18(5):375-8.

115. Menon I, Nagarajappa R, Ramesh G, Tak M. Parental stress as a predictor of early childhood caries among preschool children in India. Int J Paediatr Dent. 2013;23(3):160-5.

116. Seow WK, Clifford H, Battistutta D, Morawska A, Holcombe T. Case-control study of early childhood caries in Australia. Caries Res. 2009;43(1):25-35.

117. Finlayson TL, Siefert K, Ismail AI, Sohn W. Psychosocial factors and early childhood caries among low-income African-American children in Detroit. Community Dent Oral Epidemiol. 2007;35(6):439-48.

118. Tang C, Quinonez RB, Hallett K, Lee JY, Whitt JK. Examining the association between parenting stress and the development of early childhood caries. Community Dent Oral Epidemiol. 2005;33(6):454-60.

119. Duijster D, Verrips GH, van Loveren C. The role of family functioning in childhood dental caries. Community Dent Oral Epidemiol. 2014;42(3):193-205.

120. Ismail AI, Lim S, Sohn W, Willem JM. Determinants of early childhood caries in low-income African American young children. Pediatr Dent. 2008;30(4):289-96.

121. de Souza PM, Mello Proenca MA, Franco MM, Rodrigues VP, Costa JF, Costa EL. Association between early childhood caries and maternal caries status: A cross-section study in Sao Luis, Maranhao, Brazil. Eur J Dent. 2015;9(1):122-6.

122. Camacho MEI, Pérez LS, Pérez ÁG, Zepeda MAZ. Relationship between Severe Early Childhood Caries, mother's oral health and mutans streptococci in a low-income group: changes from 1996 to 2007. J Clin Pediatr Dent. 2009;33(3):241-6.

123. Tsai AI, Johnsen DC, Lin YH, Hsu KH. A study of risk factors associated with nursing caries in Taiwanese children aged 24-48 months. Int J Paediatr Dent. 2001;11(2):147-9.

124. Nakayama Y, Mori M. Association of environmental tobacco smoke and snacking habits with the risk of early childhood caries among 3-year-old Japanese children. J Public Health Dent. 2015;75(2):157-62.

125. Iida H, Auinger P, Billings RJ, Weitzman M. Association between infant breastfeeding and early childhood caries in the United States. Pediatrics. 2007;120(4):e944-52.

126. Birungi N, Fadnes LT, Okullo I, Kasangaki A, Nankabirwa V, Ndeezi G, et al. Effect of breastfeeding promotion on Early Childhood Caries and breastfeeding duration among 5 year old children in eastern Uganda: a cluster randomized trial. PLoS One. 2015;10(5):e0125352.

127. Correa-Faria P, Paixao-Goncalves S, Paiva SM, Pordeus IA, Marques LS, Ramos-Jorge ML. Association between developmental defects of enamel and early childhood caries: a cross-sectional study. Int J Paediatr Dent. 2015;25(2):103-9.

128. Folayan MO, Kolawole KA, Oziegbe EO, Oyedele T, Oshomoji OV, Chukwumah NM, et al. Prevalence, and early childhood caries risk indicators in preschool children in suburban Nigeria. BMC Oral Health. 2015;15:72.

129. Kato T, Yorifuji T, Yamakawa M, Inoue S, Saito K, Doi H, et al. Association of breast feeding with early childhood dental caries: Japanese population-based study. BMJ Open. 2015;5(3):e006982.

130. Liang CY, Liu YC, Shieh TY, Lin JR, Tseng YC, Teng AY. Experience of Early Childhood Caries may positively correlate with psychomotor development. Oral Health Prev Dent. 2015;13(4):365-75.

131. Nakayama Y, Mori M. Association between nocturnal breastfeeding and snacking habits and the risk of early childhood caries in 18- to 23-month-old Japanese children. J Epidemiol. 2015;25(2):142-7.

132. Paglia L. Does breastfeeding increase risk of early childhood caries? Eur J Paediatr Dent. 2015;16(3):173.

133. Albino J, Tiwari T, Henderson WG, Thomas J, Bryant LL, Batliner TS, et al. Learning from caries-free children in a high-caries American Indian population. J Public Health Dent. 2014;74(4):293-300.

134. Batliner T, Wilson AR, Tiwari T, Glueck D, Henderson W, Thomas J, et al. Oral health status in Navajo Nation Head Start children. J Public Health Dent. 2014;74(4):317-25.

135. Chaffee BW, Feldens CA, Vitolo MR. Association of long-duration breastfeeding and dental caries estimated with marginal structural models. Ann Epidemiol. 2014;24(6):448-54.

136. Congiu G, Campus G, Luglie PF. Early Childhood Caries (ECC) prevalence and background factors: a review. Oral Health Prev Dent. 2014;12(1):71-6.

137. Gao X, Hsu CY, Loh T, Hwarng B, Koh D. Role of microbiological factors in predicting early childhood caries. Pediatr Dent. 2014;36(4):348-54.

138. Gilbert K, Joseph R, Vo A, Patel T, Chaudhry S, Nguyen U, et al. Children with severe early childhood caries: streptococci genetic strains within carious and white spot lesions. J Oral Microbiol. 2014;6:25805.

139. Han DH, Kim DH, Kim MJ, Kim JB, Jung-Choi K, Bae KH. Regular dental checkup and snack-soda drink consumption of preschool children are associated with early childhood caries in Korean caregiver/preschool children dyads. Community Dent Oral Epidemiol. 2014;42(1):70-8.

140. Jabin Z, Chaudhary S. Association of child temperament with early childhood caries. J Clin Diagn Res. 2014;8(12):ZC21-4.

141. Koo H, Bowen WH. Candida albicans and Streptococcus mutans: a potential synergistic alliance to cause virulent tooth decay in children. Future Microbiol. 2014;9(12):1295-7.

142. Krisdapong S, Somkotra T, Kueakulpipat W. Disparities in early childhood caries and its impact on oral health-related quality of life of preschool children. Asia Pac J Public Health. 2014;26(3):285-94.

143. Li W, Yu D, Gao S, Lin J, Chen Z, Zhao W. Role of Candida albicans-secreted aspartyl proteinases (Saps) in severe early childhood caries. Int J Mol Sci. 2014;15(6):10766-79.

144. Masumo R, Birungi N, Bardsen A, Fadnes LT, Astrom AN. Impact of low birthweight on early childhood caries in 6-36 months old infants in Uganda: A cross-sectional study. Acta Odontol Scand. 2014;72(4):312-20.

145. Peng SM, Wong HM, King NM, McGrath C. Is dental caries experience associated with adiposity status in preschool children? Int J Paediatr Dent. 2014;24(2):122-30.

146. Piovesan C, Tomazoni F, Del Fabro J, Buzzati BC, Mendes FM, Antunes JL, et al. Inequality in dental caries distribution at noncavitated and cavitated thresholds in preschool children. J Public Health Dent. 2014;74(2):120-6.

147. Reyes-Perez E, Borrell LN, Katz RV, Gebrian BJ, Prophete S, Psoter WJ. Effect of early childhood protein-energy malnutrition on permanent dentition dental caries. J Public Health Dent. 2014;74(3):181-7.

148. Schroth RJ, Lavelle C, Tate R, Bruce S, Billings RJ, Moffatt ME. Prenatal vitamin D and dental caries in infants. Pediatrics. 2014;133(5):e1277-84.

149. Torriani DD, Ferro RL, Bonow ML, Santos IS, Matijasevich A, Barros AJ, et al. Dental caries is associated with dental fear in childhood: findings from a birth cohort study. Caries Res. 2014;48(4):263-70.

150. Xu H, Hao W, Zhou Q, Wang W, Xia Z, Liu C, et al. Plaque bacterial microbiome diversity in children younger than 30 months with or without caries prior to eruption of second primary molars. PLoS One. 2014;9(2):e89269.

151. American Academy of Pediatric Dentistry. Council on Clinical Affairs. Policy on early childhood caries (ECC): classifications and consequences, and preventive strategies. Oral Health Policies. 2013/14;35 (6):50 - 2.

152. American Academy of Pediatric Dentistry. Council on Clinical Affairs. Policy on early childhood caries (ECC): unique challenges and treatment options. Oral Health Policies. 2013/14;35(6):53 - 5.

153. Alanzi A, Minah G, Romberg E, Catalanotto F, Bartoshuk L, Tinanoff N. Mothers' taste perceptions and their preschool children's dental caries experiences. Pediatr Dent. 2013;35(7):510-4.

154. Feldens CA, Rodrigues PH, Rauber F, Chaffee BW, Vitolo MR. Food expenditures, cariogenic dietary practices and childhood dental caries in southern Brazil. Caries Res. 2013;47(5):373-81.

155. Naidu R, Nunn J, Kelly A. Socio-behavioural factors and early childhood caries: a cross-sectional study of preschool children in central Trinidad. BMC Oral Health. 2013;13:30.

156. O'Keefe E. Early childhood caries. Evid Based Dent. 2013;14(2):40-1.

157. Pani SC, Abuthuraya D, AlShammery HM, AlShammery D, AlShehri H. Salivary cortisol as a biomarker to explore the role of maternal stress in early childhood caries. Int J Dent. 2013;2013:565102.

158. Smith GA, Riedford K. Epidemiology of early childhood caries: clinical application. J Pediatr Nurs. 2013;28(4):369-73.

159. Whitney-Evans EW, Hayes C, Palmer CA, Bermudez OI, Cohen SA, Must A. Dietary intake and severe early childhood caries in low-income, young children. J Acad Nutr Diet. 2013;113(8):1057-61.

160. Hughes CV, Dahlan M, Papadopolou E, Loo CY, Pradhan NS, Lu SC, et al. Aciduric microbiota and mutans streptococci in severe and recurrent severe early childhood caries. Pediatr Dent. 2012;34(2):e16-23.

161. Masumo R, Bardsen A, Mashoto K, Astrom AN. Prevalence and socio-behavioral influence of early childhood caries, ECC, and feeding habits among 6-36 months old children in Uganda and Tanzania. BMC Oral Health. 2012;12:24.

162. Nunes AM, Alves CM, Borba de Araujo F, Ortiz TM, Ribeiro MR, Silva AA, et al. Association between prolonged breast-feeding and early childhood caries: a hierarchical approach. Community Dent Oral Epidemiol. 2012;40(6):542-9.

163. Plutzer K, Keirse MJ. Influence of first-time mothers' early employment on severe early childhood caries in their child. Int J Pediatr. 2012;2012:820680.

164. Qadri G, Nourallah A, Splieth CH. Early childhood caries and feeding practices in kindergarten children. Quintessence Int. 2012;43(6):503-10.

165. Yang XQ, Zhang Q, Lu LY, Yang R, Liu Y, Zou J. Genotypic distribution of Candida albicans in dental biofilm of Chinese children associated with severe early childhood caries. Arch Oral Biol. 2012;57(8):1048-53.

166. Zhang XH, Zhou Y, Zhi QH, Tao Y, Lin HC. Genetic polymorphisms of the sortase A gene and early childhood caries in two-year-old children. Arch Oral Biol. 2012;57(7):948-53.

167. Agarwal V, Nagarajappa R, Keshavappa SB, Lingesha RT. Association of maternal risk factors with early childhood caries in schoolchildren of Moradabad, India. Int J Paediatr Dent. 2011;21(5):382-8.

168. Duran-Contreras GL, Torre-Martinez HH, de la Rosa EI, Hernandez RM, de la Garza Ramos M. spaP gene of Streptococcus mutans in dental plaque and its relationship with early childhood caries. Eur J Paediatr Dent. 2011;12(4):220-4.

169. Hart TC, Corby PM, Hauskrecht M, Hee Ryu O, Pelikan R, Valko M, et al. Identification of microbial and proteomic biomarkers in early childhood caries. Int J Dent. 2011;2011:196721.

170. Kawashita Y, Kitamura M, Saito T. Early childhood caries. Int J Dent. 2011;2011:725320.

171. Lindemeyer RG, Satpute NS, Katz SH. Evaluation of bronchial asthma as risk factor for early childhood caries. N Y State Dent J. 2011;77(6):18-21.

172. Mathur A, Mathur A, Jain M, Bhandari S, Choudhary S, Prabu D, et al. Influence of feeding habits on early childhood caries (ECC) within primary dentition in India. Pediatric Dent J. 2011;21(2):101-6.

173. Zhou Y, Lin HC, Lo EC, Wong MC. Risk indicators for early childhood caries in 2-year-old children in southern China. Aust Dent J. 2011;56(1):33-9.

174. Zhou Q, Qin X, Qin MAN, Ge L. Genotypic diversity of Streptococcus mutans and Streptococcus sobrinus in 3–4-year-old children with severe caries or without caries. Int J Paediatr Dent. 2011;21(6):422-31.

175. Elfrink ME, Schuller AA, Veerkamp JS, Poorterman JH, Moll HA, ten Cate BJ. Factors increasing the caries risk of second primary molars in 5-year-old Dutch children. Int J Paediatr Dent. 2010;20(2):151-7.

176. Johansson I, Holgerson PL, Kressin NR, Nunn ME, Tanner AC. Snacking habits and caries in young children. Caries Res. 2010;44(5):421-30.

177. Kanasi E, Dewhirst FE, Chalmers NI, Kent R, Jr., Moore A, Hughes CV, et al. Clonal analysis of the microbiota of severe early childhood caries. Caries Res. 2010;44(5):485-97.

178. Parisotto TM, Steiner-Oliveira C, Duque C, Peres RC, Rodrigues LK, Nobre-dos-Santos M. Relationship among microbiological composition and presence of dental plaque, sugar exposure, social factors and different stages of early childhood caries. Arch Oral Biol. 2010;55(5):365-73.

179. Petti S. Why guidelines for early childhood caries prevention could be ineffective amongst children at high risk. J Dent. 2010;38(12):946-55.

180. Tuli A, Singh A. Early childhood caries and oral rehabilitation: a treatment quandary. Eur J Paediatr Dent. 2010;11(4):181-4.

181. Adeniyi AA, Ogunbodede EO, Jeboda SO, Folayan MO. Do maternal factors influence the dental health status of Nigerian pre-school children? Int J Paediatr Dent. 2009;19(6):448-54.

182. Alaki SM, Burt BA, Garetz SL. The association between antibiotics usage in early childhood and early childhood caries. Pediatr Dent. 2009;31(1):31-7.

183. Irigoyen-Camacho ME, Sanchez-Perez L, Garcia-Perez A, Zepeda-Zepeda MA. Relationship between severe early childhood caries, mother's oral health and mutans streptococci in a low-income group: changes from 1996 to 2007. J Clin Pediatr Dent. 2009;33(3):241-6.

184. Choi EJ, Lee SH, Kim YJ. Quantitative real-time polymerase chain reaction for Streptococcus mutans and Streptococcus sobrinus in dental plaque samples and its association with early childhood caries. Int J Paediatr Dent. 2009;19(2):141-7.

185. Jigjid B, Ueno M, Shinada K, Kawaguchi Y. Early childhood caries and related risk factors in Mongolian children. Community Dent Health. 2009;26(2):121-8.

186. Nunn ME, Braunstein NS, Krall Kaye EA, Dietrich T, Garcia RI, Henshaw MM. Healthy eating index is a predictor of early childhood caries. J Dent Res. 2009;88(4):361-6.

187. Nunn ME, Dietrich T, Singh HK, Henshaw MM, Kressin NR. Prevalence of early childhood caries among very young urban Boston children compared with US children. J Public Health Dent. 2009;69(3):156-62.

188. Uribe S. Early childhood caries ̶ risk factors. Evid Based Dent. 2009;10(2):37-8.

189. Cogulu D, Ersin NK, Uzel A, Eronat N, Aksit S. A long-term effect of caries-related factors in initially caries-free children. Int J Paediatr Dent. 2008;18(5):361-7.

190. Alaki SM, Burt BA, Garetz SL. Middle ear and respiratory infections in early childhood and their association with early childhood caries. Pediatr Dent. 2008;30(2):105-10.

191. Declerck D, Leroy R, Martens L, Lesaffre E, Garcia-Zattera MJ, Vanden Broucke S, et al. Factors associated with prevalence and severity of caries experience in preschool children. Community Dent Oral Epidemiol. 2008;36(2):168-78.

192. Mohebbi SZ, Virtanen JI, Vahid-Golpayegani M, Vehkalahti MM. Feeding habits as determinants of early childhood caries in a population where prolonged breastfeeding is the norm. Community Dent Oral Epidemiol. 2008;36(4):363-9.

193. Warren JJ, Weber-Gasparoni K, Marshall TA, Drake DR, Dehkordi-Vakil F, Kolker JL, et al. Factors associated with dental caries experience in 1-year-old children. J Publ Health Dent. 2008;68(2):70-5.

194. Du M, Luo Y, Zeng X, Alkhatib N, Bedi R. Caries in preschool children and its risk factors in 2 provinces in China. Quintessence Int. 2007;38(2):143-51.

195. Ferreira SH, Beria JU, Kramer PF, Feldens EG, Feldens CA. Dental caries in 0- to 5-year-old Brazilian children: prevalence, severity, and associated factors. Int J Paediatr Dent. 2007;17(4):289-96.

196. Kramer MS, Vanilovich I, Matush L, Bogdanovich N, Zhang X, Shishko G, et al. The effect of prolonged and exclusive breast-feeding on dental caries in early school-age children: new evidence from a large randomized trial. Caries Res. 2007;41(6):484-8.

197. Olak J, Mandar R, Karjalainen S, Soderling E, Saag M. Dental health and oral mutans streptococci in 2-4-year-old Estonian children. Int J Paediatr Dent. 2007;17(2):92-7.

198. Schroth RJ, Cheba V. Determining the prevalence and risk factors for early childhood caries in a community dental health clinic. Pediatr Dent. 2007;29(5):387-96.

199. Tiberia MJ, Milnes AR, Feigal RJ, Morley KR, Richardson DS, Croft WG, et al. Risk factors for early childhood caries in Canadian preschool children seeking care. Pediatr Dent. 2007;29(3):201-8.

200. de Carvalho FG, Silva DS, Hebling J, Spolidorio LC, Spolidorio DM. Presence of mutans streptococci and Candida spp. in dental plaque/dentine of carious teeth and early childhood caries. Arch Oral Biol. 2006;51(11):1024-8.

201. Hallett KB, O'Rourke PK. Pattern and severity of early childhood caries. Community Dent Oral Epidemiol. 2006;34(1):25-35.

202. Law V, Seow WK. A longitudinal controlled study of factors associated with mutans streptococci infection and caries lesion initiation in children 21 to 72 months old. Pediatr Dent. 2006;28(1):58-65.

203. Psoter WJ, Pendrys DG, Morse DE, Zhang H, Mayne ST. Associations of ethnicity/race and socioeconomic status with early childhood caries patterns. J Public Health Dent. 2006;66(1):23-9.

204. Tsai AI, Chen CY, Li LA, Hsiang CL, Hsu KH. Risk indicators for early childhood caries in Taiwan. Community Dent Oral Epidemiol. 2006;34(6):437-45.

205. Nomura Y, Tsuge S, Hayashi M, Sasaki M, Yamauchi T, Ueda N, et al. A survey on the risk factors for the prevalence of dental caries among preschool children in Japan. Pediatr Dent J. 2004;14(1):79-85.

206. Rosenblatt A, Zarzar P. Breast-feeding and early childhood caries: an assessment among Brazilian infants. Int J Paediatr Dent. 2004;14(6):439-45.

207. Stevens A, Freeman R. The role of the mother-child interaction as a factor in nursing caries (ECC): a preliminary communication. Eur J Paediatr Dent. 2004;5(2):81-5.

208. Vachirarojpisan T, Shinada K, Kawaguchi Y, Laungwechakan P, Somkote T, Detsomboonrat P. Early childhood caries in children aged 6-19 months. Community Dent Oral Epidemiol. 2004;32(2):133-42.

209. Ismail AI. Determinants of health in children and the problem of early childhood caries. Pediatr Dent. 2003;25(4):328-33.

210. Jin BH, Ma DS, Moon HS, Paik DI, Hahn SH, Horowitz AM. Early childhood caries: prevalence and risk factors in Seoul, Korea. J Public Health Dent. 2003;63(3):183-8.

211. Jose B, King NM. Early childhood caries lesions in preschool children in Kerala, India. Pediatr Dent. 2003;25(6):594-600.

212. Chan SC, Tsai JS, King NM. Feeding and oral hygiene habits of preschool children in Hong Kong and their caregivers' dental knowledge and attitudes. Int J Paediatr Dent. 2002;12(5):322-31.

213. Rosenblatt A, Zarzar P. The prevalence of early childhood caries in 12- to 36-month-old children in Recife, Brazil. J Dent Child. 2002;69(3):319-24, 236.

214. Tinanoff N, Kanellis MJ, Vargas CM. Current understanding of the epidemiology mechanisms, and prevention of dental caries in preschool children. Pediatr Dent. 2002;24(6):543-51.

215. Maciel SM, Marcenes W, Sheiham A. The relationship between sweetness preference, levels of salivary mutans streptococci and caries experience in Brazilian pre-school children. Int J Paediatr Dent. 2001;11(2):123-30.

216. Ansai T, Tahara A, Ikeda M, Katoh Y, Miyazaki H, Takehara T. Influence of colonization with mutans streptococci on caries risk in Japanese preschool children: 24 month survival analysis. Pediatr Dent. 2000;22(5):377-80.

217. Rodrigues CS, Sheiham A. The relationships between dietary guidelines, sugar intake and caries in primary teeth in low income Brazilian 3-year-olds: a longitudinal study. Int J Paediatr Dent. 2000;10(1):47-55.

218. Tinanoff N, Palmer CA. Dietary determinants of dental caries and dietary recommendations for preschool children. J Public Health Dent. 2000;60(3):197-206; discussion 7-9.

219. Oulis CJ, Berdouses ED, Vadiakas G, Lygidakis NA. Feeding practices of Greek children with and without nursing caries. Pediatr Dent. 1999;21(7):409-16.

220. Bowen WH. Response to Seow: biological mechanisms of early childhood caries. Community Dent Oral Epidemiol. 1998;26(1 Suppl):28-31.

221. Davies GN. Early childhood caries ̶ a synopsis. Community Dent Oral Epidemiol. 1998;26(Suppl1):106-16.

222. Reisine S, Douglass JM. Psychosocial and behavioral issues in early childhood caries. Community Dent Oral Epidemiol. 1998;26(Suppl1):32-44.

223. Tinanoff N. Introduction to the Early Childhood Caries Conference: initial description and current understanding. Community Dent Oral Epidemiol. 1998;26(Suppl1):5-7.

224. Del Valle LL, Velazquez-Quintana Y, Weinstein P, Domoto P, Leroux B. Early childhood caries and risk factors in rural Puerto Rican children. J Dent Child. 1998;65(2):132-5.

225. Peretz B, Kafka I. Baby bottle tooth decay and complications during pregnancy and delivery. Pediatr Dent. 1997;19(1):34-6.

226. Tinanoff N, O'Sullivan DM. Early childhood caries: overview and recent findings. Pediatr Dent. 1997;19(1):12-6.

227. Todd RV, Durward CS, Chot C, So PK, Im P. The dental caries experience, oral hygiene and dietary practices of preschool children of factory workers in Phnom Penh, Cambodia. Int J Paediatr Dent. 1994;4(3):173-8.