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Small for gestational age and early childhood caries: the BRISA cohort study
Juliana de Kássia Braga Fernandes1,2, Francenilde Silva de Sousa3,4, Cláudia Maria Coelho Alves1,5
1Programa de Pós-graduação em Saúde Coletiva, Universidade Federal do Maranhão, São Luís, MA, Brazil.
Insights
Children born small for gestational age (SGA) show increased susceptibility to severe early childhood caries (S-ECC). The relationship is complex, influenced by diagnostic criteria and the number of erupted teeth, impacting disease risk exposure.
Area of Science:
- Pediatric Dentistry
- Public Health
- Neonatology
Background:
- Severe early childhood caries (S-ECC) is a significant public health issue.
- Children born small for gestational age (SGA) may have unique health vulnerabilities.
- Understanding the link between SGA and S-ECC is crucial for targeted prevention strategies.
Purpose of the Study:
- To investigate the hypothesis that children born small for gestational age (SGA) are more susceptible to severe early childhood caries (S-ECC).
- To analyze both direct and indirect effects of SGA on S-ECC development.
- To explore the influence of diagnostic criteria and tooth eruption status on this association.
Main Methods:
- Prospective cohort study involving 865 children aged 12-30 months in Northeast Brazil.
- S-ECC defined by the proportion of decayed tooth surfaces.
- Small for gestational age (SGA) defined using Kramer criterion and INTERGROWTH-21st standard.
- Structural equation modeling used to estimate direct and indirect effects.
Main Results:
- SGA demonstrated both direct and indirect influences on S-ECC.
- Using the Kramer criterion, a positive direct effect of SGA on S-ECC was observed in children with ≥12 erupted teeth (SFL=0.163, P=0.019).
- Using the INTERGROWTH-21st standard, a negative direct effect of SGA on S-ECC was found across all SGA children (SFL=-0.711, P<0.001).
- Age and the number of erupted teeth appear to modify the occurrence of S-ECC in SGA children.
Conclusions:
- The relationship between SGA and S-ECC is complex and influenced by the definition of SGA and the child's developmental stage (number of teeth).
- The number of erupted teeth affects exposure time to cariogenic risk factors, mediating the impact of SGA on S-ECC.
- Further research is needed to elucidate these complex interactions for effective early intervention programs.
Abstract:
This study tests the hypothesis that children 12-30 months born small for gestational age (SGA) aged are more susceptible to severe early childhood caries (S-ECC). We used data on 865 children aged 12-30 months from a prospective cohort study conducted in a city in the northeast of Brazil. The study outcome was S-ECC, defined based on the proportion of decayed tooth surfaces (cavitated or not). The main exposure variable was SGA, defined according to the Kramer criterion and the INTERGROWTH-21st standard. Direct (SGA → S-ECC) and indirect effects were estimated using structural equation modeling, calculating standardized factor loadings (SFL) and P-values (alpha = 5%). The final models showed a good fit. SGA influenced S-ECC in the direct and indirect paths. In the group of SGA children with 12 or more erupted teeth defined according to the Kramer criterion, the direct effect was positive (SFL = 0.163; P = 0.019); while among all SGA children defined according to the INTERGROWTH-21st standard, the direct effect was negative (SFL = - 0.711; P < 0.001). Age and number of erupted teeth may influence the occurrence of S-ECC in SGA children, as the number of teeth affects the time of exposure to disease risk factors.
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