Psychosocial factors and early childhood caries among low-income African-American children in Detroit

Objectives: This study sought to advance knowledge of the social determinants of oral health, by examining how several specific maternal health beliefs, behaviors, and psychosocial factors relate to young children's early childhood caries (ECC) status in a lower-income African-American population. Methods: Data were collected by the Detroit Dental Health Project (NIDCR grant), a population-based study of 1021 African-American families with at least one child under 6 years of age and living in 39 low-income Census tracts in Detroit, Michigan. Analyses were limited to 719 children aged 1-5 years and their biological mothers, and conducted in SUDAAN to account for the complex sampling design. Survey data included health belief scales on mothers' self-efficacy, feelings of fatalism, knowledge about appropriate bottle use and children's oral hygiene needs, brushing habits, psychosocial measures of depressive symptoms (CES-D), parenting stress, and availability of instrumental social support. The child's age, dental insurance status, dental visit history, and 1-week brushing frequency were also included in the model. Children's ECC status, based on a dental examination, was the main outcome. The dental team used the International Caries Detection and Assessment System (ICDAS) criteria for caries detection. Each child was classified as either caries-free or having ECC or severe ECC (S-ECC) based on the case definition of ECC proposed by an expert panel for research purposes with preschool-aged children. Results: The dental team followed a specific examination protocol and established reliable and consistent ratings of ECC based on the ICDAS criteria. The inter-rater reliability kappa was 0.83 overall, and the intra-rater reliability kappa was 0.74 overall. One-third of the children had ECC, and 20% had severe ECC. Age of the child and lower parenting stress scores were each positively associated with ECC, while higher education and income were protective. Maternal oral health fatalism and knowledge of children's hygiene needs were associated with ECC among preschool-aged children. ECC was higher among younger children who had past restorative care. Conclusions: These findings call attention to the high prevalence of ECC in this population and the need to consider psychosocial as well as traditional risk factors in developing interventions to reduce oral health disparities.