The Burden of Early Childhood Caries in Children under 5 Years Old in the European Union and Associated Risk Factors: An Ecological Study

Abstract

The associations among early childhood caries (ECC), socioeconomic status, and sugar consumption are of the utmost importance, due to their potential policy implications. The purpose of this study was to identify trends in ECC burden in children under 5 years old among European Union (EU) member states over time and to evaluate the relationship with its risk factors. Global Burden of Disease 2019 data were analyzed to estimate the burden of ECC over time, specifically incidence, prevalence, and years lived with disability (YLDs) for children under 5 years old. Four ecological variables with a potential effect on YLDs for ECC were used to investigate the association between 2014 and 2017. The YLDs rate was consistently higher among Eastern EU countries over time. Univariate models showed a positive significant association between at-risk-of-poverty rate and YLDs rate, while GDP per capita and urbanization were inversely associated with YLDs rate. In the multivariate analysis, sugar consumption, GDP per capita and urbanization showed significant association with YLDs rate. After stratification by region, association remained significant only in the Eastern EU countries between GDP, urbanization, and YLDs rate, while sugar consumption and at-risk-of-poverty rate had no significant impact on YLDs rates. This study found increasing ECC burden in the EU. The complexity of the problem indicates the need for innovative and personalized policy approaches to tackle the disease.

Clinical Consequences of Dental Caries, Parents’ Perception of Child’s Oral Health and Attitudes towards Dental Visits in a Population of 7-Year-Old Children

“…Primary teeth caries rates in Poland are lower than in developing countries but higher than in more economically developed parts of European Union [ 27 ]. In 2016, national oral health monitoring revealed that 89.4% of 7-year-old children were affected by dental caries with a mean dmft index equal to 5.61 [ 28 ].…”

Socio-Economic Status May Associate Different Risk(s) with Early Childhood Caries (ECC) That Can Cause the Development of Psychomotor Deficiency in Preschool Children Aged 3–6 Years Old: The Results of Preliminary Analysis from a Cohort Study

“…Modern research on caries has indicated that the non-dental risks of ECC may include a low level of SES, other vulnerable sub-populations with disparities, and/or certain minority ethnical vs. racial groups, etc. [13][14][15][16][17][18][19][20][21][22][23][24][25]. Therefore, there is an urgent need to identify the critical risks of ECC and also target the high-risk sub-populations on prevention and effective protocols for subsequent proper treatments vs. managements.…”

“…The ECC-psychomotor axial interactions are complex, where the causal factors, risks, confounding variable(s), or interference may be intertwined [10][11][12][13][14][15][16][17]. Notably, there were three distinct characteristics in our present cohorts analyzed (Table 1): (i) there were insignificant healthcare inequity issues involved, due to the national healthcare insurance program available; (ii) the kindergartener family cohorts had annual income levels of the middle class, based on the SES gradients of the regions addressed; and (iii) the kindergarteners recruited and enrolled for the study all came from the regular/normal classes of preschoolers without any special or disabled children involved.…”

“…in regular/normal classes of kindergarteners (i.e., no developmentally delayed children involved) analyzed via a crosssectional bi-township design [10][11][12]. Furthermore, other studies in the field have shown that the socio-economic status (SES) has long been considered one of the risk factors or even a predictor for ECC development and/or progress in children, including the levels of family/household incomes, parental education and occupation, access to medical/dental healthcare facilities, etc., all of which may be attributed to the equity issue of caries distribution in the population studied [13][14][15][16][17][18][19][20][21][22][23]. Likewise, SES may also be a domain for the oral health behavior and conceptual access to dental healthcare of the parents and/or caregivers in preschoolers [14][15][16][17].…”

“…Furthermore, other studies in the field have shown that the socio-economic status (SES) has long been considered one of the risk factors or even a predictor for ECC development and/or progress in children, including the levels of family/household incomes, parental education and occupation, access to medical/dental healthcare facilities, etc., all of which may be attributed to the equity issue of caries distribution in the population studied [13][14][15][16][17][18][19][20][21][22][23]. Likewise, SES may also be a domain for the oral health behavior and conceptual access to dental healthcare of the parents and/or caregivers in preschoolers [14][15][16][17]. However, additional risks suggested for ECC may include biofilmassociated microbial species, improper feeding, dietary or food practices, ethnicity/race, poverty-income classes, environmental/salivary vs. self-image attributes, and maternal psychosocial (i.e., sense of coherence) distress or parental stresses, etc.…”