Life course dental caries determinants and predictors in children aged 12 years: a population-based birth cohort

To investigate the main dental caries life course determinants and predictors of dental caries at age 12.

This study was nested in a population-based birth cohort started in 1993 in Pelotas, Brazil. A sample of 359 children was followed-up. Dental examinations and interviews were performed at 6 and at 12 years old. Dental caries (DMFT) at 12 years old was the outcome. Exploratory variables included socioeconomic and demographic variables at birth, children's nutritional and development characteristics, primary dental caries, oral health related behaviors and dental service use at age 6 and 12. Poisson regression was used in order to provide relative risk ratio estimates. Attributable risk or etiology fraction and population attributable risk for both main early life variables were calculated. Dental caries prediction (DMFT >or= 1) at 12 years old was tested using logistic regression analyses.

Children who presented height-for-age deficit at 12 months (RR 1.50 CI: 95%=1.03-2.18), children who showed a DMFT of 1-3 and 4-19 at 6 years (RR=2.01; CI: 95%=1.33-3.03, and RR=2.66; CI: 95%=1.81-2.53, respectively) and those children aged 12 in the highest tertile of proportion of teeth experiencing gingival bleeding (RR=1.58; CI: 95%=1.11-2.24) presented a higher level of dental caries at age 12. Attributable risk for dental caries at age 12 were 79.1% and 74.2% for deficit in height for age at 12 months and for primary dental caries at age 6 years respectively; population attributable risk for dental caries at age 12 were 3.1% for deficit in height for age at 12 months and 64.9% for primary dental caries at age 6. The level of accuracy in predicting dental caries at age 12 by using life course socioeconomic, behavioral and clinical data was modest.

The results of this study support the hypothesis linking social, biological and behavioral exposures and dental caries at 12 years old. In addition, the findings reinforce the lack of accuracy of dental caries predictors therefore limiting the individuals high-risk approach as a public health strategy.