Association among early childhood caries, microbiological composition of dental biofilm, diet, oral hygiene and socioeconomic factors in preschoolers aging 36 to 48 months / Associação entre carie precoce da infancia, composição microbiologica do filme dentario, dieta, higiene bucal e fatores socio-economicos em pre-escolares de 36 a 48 meses

Thais Manzano Parisotto

The prevalence of early childhood caries (ECC) in Brazil is high and its severity increases with age. This way, sensitive methods for the early caries diagnosis and risk indicators identification are important for the disease control. This thesis, comprised by three manuscripts, aimed: (1) to undertake a systematic review of studies which have evidenced the association between mutans streptococci (MS) levels and the prevalence and progression of the ECC; (2) to investigate the increase of caries prevalence in young children after the inclusion of early caries lesions (ECL) to WHO thresholds caries detection and the influence of these lesions in the epidemiological profile of the studied population; (3) to identify the main risk indicators of the ECC, with regards to the microbiological, dietary and social factors, as well as oral hygiene habits, considering the development stages of dental caries. In the review, Pubmed, Scopus and Cochrane Library databases were searched for papers (1951-2007). In studies two and three the sample comprised 351 and 169 children, respectively. These preschoolers, aging 36 to 48 months, from both genders, attended public nurseries and preschools in the city of Itatiba-SP. The clinical examinations for caries index determination were performed using gauze, probe and mirror under artificial light. In the third study, the children were divided in three experimental groups (caries free, ECL and cavitated lesions). A chart was employed for the diet evaluation whereas oral hygiene, family income, ethnicity and education level were assessed by a questionnaire. Dental biofilm was collected from all buccal and lingual surfaces with a sterilized handle (1 µl) in order to standardize the amount removed. Quantitative microbiological culture techniques were performed to determine the number of mutans streptococci (MS) colonies and total microorganisms (TM) and lactobacilli (LB) counts. The review data were appraised trough qualitative analyses; the data from studies two and three were statistically analyzed by paired t-test and multiple logistic regression, respectively (_=0.05). Out of the 119 articles yielded in the review, 16 were appraised and only one article has achieved high value as evidence. In study two, the caries index has significantly increased (p<0.05) when the ECL were included; these ECL were the predominant caries lesion in the majority of the teeth, particularly on smooth surfaces. In the third study, among all risk indicators studied, the statistically significant indicators associated with ECL development were: high levels of MS (OR=2.3, CI=1.01-5.14), high daily frequency of total sugar consumption (OR=5.4, CI=1.42-20.88) and biofilm presence on maxillary incisors (OR=2.3, CI=1.01-5.14). The significant factors associated with ECC progression were: high levels of TM (OR=4.6, CI=1.56-13.74) and lactobacilli presence (OR=20.3, CI=4.03-102.51). From the review it was concluded that MS levels are a strong risk indicator for early childhood caries; however, longitudinal studies with high levels of scientific evidence are required to point out MS levels as a remarkable ECC risk factor. From studies two and three it was concluded that the inclusion of ECL in the caries diagnosis allowed the earlier identification of caries risk preschoolers and targeting of preventive measures.

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