The influence of enamel defects on the development of early childhood caries in a population with low socioeconomic status: A longitudinal study

The purpose of this study was to evaluate the influence of enamel defects in the development of dental caries and their association with feeding practices and oral health behaviors in a cohort study of low-socioeconomic children from birth to 36 months of age in northeastern Brazil. Subjects were registered at birth and examined from 12 to 36 months of age. At baseline, 246 children were examined and at follow-up 228. The teeth were clinically examined and dried with gauze under natural light. Enamel defects were determined using the Developmental Defects of Enamel (DDE) index. Dental caries was determined using WHO criteria. Data were analyzed using descriptive and analytical techniques. At 36 months 78.9% infants presented at least one tooth with enamel defects and 25% of the children had at least one decayed tooth. A total of 16.9% teeth with enamel defects had become decayed (p = 0.0001). Opacity with enamel hypoplasia was the defect most frequently associated with dental caries (p = 0.001). Only 0.9% of the teeth without enamel defects developed caries. Multivariate analyses revealed that enamel defects, night breast-feeding and poor oral hygiene habits were predictors of dental caries at 18 and 24 months (p < 0.05). Considering the risk factors evaluated at 30 months of age, the presence of enamel defects was the single predictor of caries development at 36 months (p = 0.0001). Enamel defects are strongly associated with early childhood caries and, therefore, this correlation must be considered when focussing on low-socioeconomic communities.