Severe early childhood caries and behavioural risk indicators among young children in Ajman, United Arab Emirates.
AIM: To estimate the prevalence of severe early childhood caries
(s-ECC) in the primary dentition of young children in Ajman, UAE, and
investigate its association with child and family characteristics,
dietary habits, oral hygiene practices and dental services utilisation.
METHODS: A one-stage cluster sample was used to randomly select children
aged five or six years old who were enrolled in public or private
schools in Ajman, UAE. Clinical examinations for caries were conducted
by a single examiner using WHO criteria. Parents completed
questionnaires seeking information on child and family characteristics,
dietary habits, oral hygiene, and dental service utilisation. Bivariate
and multivariate analyses were used to identify risk markers and risk
indicators for s-ECC experience. RESULTS: The total number of children
sampled was 1297. Dental examination and questionnaire data were
obtained for 1036 (79.9%), of whom 50.0% were female. The overall
prevalence of s-ECC was 31.1% (95% CI, 23.6, 38.9). The prevalence of
s-ECC was higher among children of low-income families, those who had a
high snack consumption level, and those who utilised dental services
only when they had a problem. CONCLUSIONS: The prevalence of s-ECC in
young children in Ajman is high, and socio-economic characteristics,
dietary habits, and dental utilisation are important determinants of
their dental caries experience. There is an urgent need for oral health
programs targeted at the treatment and underlying causes of dental
caries in these children.
Key words: Severe early childhood caries, children, UAE.
|Publication:||Name: European Archives of Paediatric Dentistry Publisher: European Academy of Paediatric Dentistry Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 European Academy of Paediatric Dentistry ISSN: 1818-6300|
|Issue:||Date: August, 2011 Source Volume: 12 Source Issue: 4|
|Topic:||Canadian Subject Form: Child behaviour|
|Geographic:||Geographic Scope: United Arab Emirates Geographic Code: 7UNIT United Arab Emirates|
Severe early childhood caries (s-ECC) may have an impact on children's oral health status throughout life. Children who have caries in their primary teeth are more likely to develop dental caries in their permanent dentition [Horowitz, 2000]. Premature loss of primary teeth may predispose to malocclusion in the permanent dentition [Thomson et al., 2004]. The severe form of ECC may require treatment under general anesthesia. The cost of the treatment is high [Peressini et al., 2004].
S-ECC is rampant caries affecting the primary dentition. Investigators have used a multitude of different definitions and diagnostic criteria in studying this disease; for example: one or more lesions (defined as decalcified lesions, decay, and fillings) in the maxillary incisors (all surfaces) [Lopez et al., 1998]; one or more carious labial or palatal surfaces of maxilary primary incisors using the WHO criteria (cavitation) [Wyne et al., 1995]; two or more decayed maxillary anterior teeth; defined as visible evidence of a cavity that was thought by the examiner to involve dentine [Harrison et al., 1997]. s-ECC has not previously been studied in the United Arab Emirates.
The aim of the study was to estimate the prevalence of s-ECC in the primary dentition of young children in Ajman, UAE, and to investigate its association with child and family characteristics, dietary habits, oral hygiene practices and dental services utilisation.
Ethical approval for the study was obtained from both the Ministry of Health in UAE and the ethics committee of Otago University (New Zealand). There are a total of 22 urban and rural schools (kindergartens) in the Emirate of Ajman. A one-stage cluster sample was used, with the school (kindergarten) selected as the primary sampling unit. The main reason for selecting 5-6 year-olds was to compare their dental caries status with estimates from findings published previously (Al-Mughery et al., 1991; Al-Hossani and Rugg-Gunn, 1998; Naqvi et al., 1999). In addition, studying the caries experience of older children can be problematic because of their being in the mixed dentition stage.
Half of the UAE schools were selected randomly from updated lists obtained from the Ministry of Education, using a computer program for generation of random numbers. All of the students in each sampled school were selected. A questionnaire was used to elicit information on age, sex, level of parental educational attainment and parental income. Information was also collected on dietary habits, oral hygiene practices and their utilisation of dental services. The questionnaire was sent to the parents and written consent was obtained before each child was dentally examined. The questionnaire was pre-tested before use in the field, in order to examine the extent to which parents could easily understand its content. As the questionnaires appeared to be easily understood, no changes were made. No formal examination of the validity and reliability of questionnaires responses were undertaken.
Because 13 variables were used in this study to elicit information about the frequency of consumption of snacks and drinks containing sugar, the variables were combined in two ways. First, the items for chocolate, sweets/candies and jelly beans were combined to form a single variable for confectionery; those for sweet biscuits and sweet pastries were combined to form the variable called sweet baked goods; those for ice-cream and ice-muncher were combined to form a variable called frozen confectionery; and that for dates was retained. The variables for drinks were combined in a similar way. Second, a principal components analysis was undertaken using all 13 of those variables (excluding milk), as described by Hashim et al. . This enabled representation of the overall consumption of sugary snacks using a single variable, labelled 'snack consumption', which was a summated scale computed by adding the frequency scores for the 13 variables. This was then divided into three ordinal categories using half a standard deviation above and below the mean score as the cut off points. Those categories were designated 'low', 'moderate' and 'high' snack consumption. The association between these variables and s-ECC was examined.
Dental examinations were carried out using a disposable mouth mirror. Children were examined at the school health clinic while sitting on an ordinary chair. Natural daylight was used for illumination, and no radiographs were taken. The World Health Organisation criteria were used [WHO, 1997], and caries was diagnosed at the cavitation stage. In this study, the case definition for s-ECC was one or more decayed, missing (due to caries) or filled smooth surfaces in the primary maxillary anterior teeth [AAPD, 2010-11].
The reliability of the dental examining process was assured by using (a) initial calibration with the research supervisor, and (b) assembling a replicate data-set by examining 97 participants (approximately 10%). The examination and re-examination were separated by at least one day. In the calibration session (where 10 children were examined), the intra-class
correlation coefficient for dmfs scores was 1.00.
In the replicate data-set, the intra-class correlation coefficient for dmfs was 0.99.
Because schools (rather than individuals) were the primary sampling unit, the data were analysed using the 'survey' commands in Stata (Stata version 9.0). The data from each school were weighted using post-hoc weights to account for the different response rates within each school. Statistical tests were used to determine whether the association between the dependent variable and the overall effect of the explanatory variable was statistically significant; p<0.05 was regarded as statistical significance. Results are presented for bivariate associations, or associations adjusted for background factors (age, sex, maternal education and family income). Logistic regression was used where s-ECC was the dependent variable. No adjustment was made for multiple testing.
The total number of children approached to take part in this study was 1,297 (from 11 schools). Dental examinations and questionnaires were completed for 1,036 individuals, giving an overall participation rate of 79.9%. s-ECC was observed in 31.3% (95% CI 23.6, 38.9) of the children examined. Estimates of the association between the s-ECC and the background factors in the form of Odds Ratios (OR) and (95% CI) are shown in Table 1. There were socio-economic gradients apparent in caries prevalence, whereby children from the poorest households had higher prevalence of s-ECC than those from households with the highest incomes, and children of university-educated mothers had lower prevalence of s-ECC than children of mothers with only a primary-school education.
The association of dietary factors and the prevalence of s-ECC are presented in Table 2. Because only 755 of the parents answered all eight questions about snacks, the analysis was based on the responses of the 912 respondents who completed at least 6 of the questions and who also had complete data for maternal education and family income. While all the questions about specific drinks were completed by 823 parents, the analysis for drinks was based on the 920 respondents who completed at least five questions and had complete data for maternal education and family income. The only dietary variable associated with s-ECC was that related to snack consumption level and derived from the principal component analysis. The odds ratio for children who had a high level of snack consumption was 1.93 (1.38, 2.70), using children with low level of snack consumption as the reference category. The overall effect of this variable was statistically significant. The odds ratio was reduced to 1.84 (1.31, 2.57) after adjusting for background factors.
Data on the association of brushing habits with s-ECC prevalence are presented in Table 3. In the bivariate analysis, the odds ratio for those who brushed once per day was 0.64 (0.43, 0.93), using those who brush less than daily as the reference group. There were no significant associations between s-ECC prevalence and assistance with brushing or the skipping of brushing.
Data on the association of dental utilisation with s-ECC prevalence are presented in Table 4. The odds ratio for children who had visited the dentist because of a problem was 1.81 (1.38, 2.37) higher than those who never visited the dentist in the previous year using the latter as reference group. Adjusting for background factors showed (Table 4) that dental visiting was independently associated with s-ECC prevalence; the odds ratio for those visited a dentist because of a problem was 1.92 (1.49, 2.49), a higher rate than for those who had not visited the dentist in the previous year.
The multivariate model describing the association between child and family characteristics, snacking between meals per day, consumption level of snack, frequency of the child's brushing and s-ECC is shown in Table 5. The associations between s-ECC and monthly income were statistically significant; the odds ratio for children from low-income families was 1.43 (1.11, 1.85), using children from high-income families as the reference group. The odds ratio for children with a high level of snack consumption was 1.80 (1.26, 2.58), using children with a low level of snack consumption as the reference category.
The majority of studies on dental caries in young children in the Middle East have considered only one factor or a relatively small number of factors [Al-Malik et al., 2001; Sayegh et al., 2005]. The present study investigated the associations between oral health (in terms of s-ECC) and a wide range of factors, such as child and family characteristics, dietary habits, oral hygiene practices and dental service utilisation. It showed that the prevalence of s-ECC was higher among children of low-income families, those who had a high snack consumption level, and those who utilised dental services only when they had a problem.
Before discussing the findings, it is appropriate to examine the weaknesses and strengths of the study. A cross-sectional design was employed and putative risk factors were recorded at the same time as the disease outcome under study. It is not possible, therefore, to infer a direct cause-and-effect association between putative risk factors and concurrent dental status in this study. Conducting a longitudinal study would have provided stronger evidence on the temporal relationship between these factors and severe early childhood caries. A potential criticism of the study is that we included 6 year-olds in our identification of cases of s-ECC, notwithstanding the AAPD's strict criteria for the condition which specifically mention only children aged up to 5 years old. We chose to do this because of the nature of the disease in question: dental caries is a cumulative, progressive condition; its manifestation in the primary anterior teeth of 6 year-olds is as likely (as that seen in 5 year-olds) to have arisen as a result of early childhood caries. Arbitrarily classifying children who are one year older as not having the condition is to miss an important opportunity to further understand its occurrence and aetiology, and so we chose to include 6 year-olds in our analyses. The strengths of the study include the representative sample, a participation rate which is satisfactory by modern standards [Locker, 2000], and the size of the sample.
The 31.3% prevalence of s-ECC observed in the current study is much higher than that seen in children of an equivalent age in the UK and Australia [O'Brien, 1994; Plutzer and Spencer, 2008] but similar to that seen in at least two recent studies from the Middle East [Al-Malik et al., 2001; Sayegh et al., 2005]. In Jeddah (Saudi Arabia), the prevalence of s-ECC was around 34% [Al-Malik et al., 2001] while, in Amman (Jordan), the prevalence of s-ECC was 31% [Sayegh et al., 2005]. This may indicate common determinants of disease in countries with similar cultures.
The findings of this study showed a clear association between maternal education and s-ECC, with children of primary-educated mothers having higher s-ECC prevalence than those of university-educated mothers. This finding demonstrates the importance of social factors in the development of caries in children, and is consistent with findings from numerous other investigations in Arab countries, such as in Jordan [Hamdan and Rock, 1993; Sayegh et al., 2002a; Rajab and Hamdan, 2002], Saudi Arabia [Al-Malik et al., 2001; Al-Mohammadi et al., 1997] and in other countries [Postma et al., 2008; Traebert et al., 2009]. The universality of the social gradient indicates the overriding influence of the social environment on health [Watt, 2007]. Our finding showed that children of low-income families had higher s-ECC experience than children of high-income families. Some of this difference might be attributed to the fact that children of low-income families tended to brush their teeth less frequently than the children of high-income families. Many studies have shown that ECC or s-ECC are more prevalent among children from low-income families [Rajab and Hamdan, 2002; Ismail et al., 2008].
Snacking between meals appears to be a common practice among Arab children, reflecting the high accessibility of these foods. A study of Saudi Arabian children aged 4-6 years-old found that a high percentage (88.2%) regularly consumed sweet snacks [Wyne and Khan, 1995]. In line with this finding, Sayegh and co-researchers [2002b] reported that confectionery was eaten regularly by 76% of Jordanian 4-5 year-olds.
Data from surveys carried out in Arab countries have shown a change in the dietary patterns of mothers and children, with a trend (following that seen elsewhere) towards the consumption of foods rich in fat, cholesterol, salt and sugar [Musaiger, 1996]. These changes are likely to have had an effect on oral health. In the UAE, for example, traditional dietary habits and practices have continued, but food and drinks typical of westernised diets are now cheap and readily available, particularly in major cities. The impact of this relatively sudden transition from the traditional way of feeding and preparing children's meals to a new style of living and eating might be another reason for ECC development in young children in the Emirates.
To date, few studies have reported on the cariogenicity of human breast milk. Osman and El-Sabban  studied infant feeding practices in Al-Ain (UAE), and showed that breast-feeding was practiced by less than a third of all (375) mothers, and usually discontinued after 12 months.
In the current study, children who had visited the dentist during the last year for a problem had higher prevalence of s-ECC than those who never visited the dentist. It is clear that these children had attended due to pain or symptoms, rather than because of any greater dental awareness of their parents. Considering the small number of restorations observed (data not presented), it appears reasonable to suggest that most instances of dental treatment that took place were tooth extractions as a result of symptomatic dental visits. The high level of untreated decay observed in the survey offers further support for this interpretation. The same observation has been noted by Wong and co-researchers  among 5-6 year-olds in China. Parents may have been unaware of the need for treatment, or perhaps felt that their child was too young to attend a dental clinic, and he/she was not taken to the dental clinic until pain was experienced.
Regular asymptomatic dental visits have a cumulative effect and may also act to prevent development of dental anxiety. In this way, children learn to associate positive or neutral effects with asymptomatic dental visiting. For clinical prevention to work in practice, regular attendance by children is necessary; dentists should be adequately remunerated for undertaking this time-consuming work. Preventive interventions (such as the topical application of fluoride) are advocated for children with active caries [Fayle et al., 2001] and such non-invasive approaches should do much to build confidence in anxious children and their parents.
The prevalence of s-ECC was higher among children from low-income UAE families, those who had a high snack consumption level, and those who utilised dental services only when they had a problem. It is important to note that the UAE is a country with a diverse mix of nationalities, religions, languages, and origins. Caries among preschool children is determined by a complex interplay of social, familial, community, government, and work policies, and work is needed to promote changes at all of these levels. Health-promoting approaches recognise that health is linked to social and economic conditions outside the control of the individual. Oral health promotion aims to increase people's control over their own health and includes actions to tackle the social, political and environmental determinants of oral health are needed.
The prevalence of s-ECC in young children in Ajman is high, and socio-economic characteristics, dietary habits, and dental utilisation are important determinants of their dental caries experience. There is an urgent need for oral health programs targeted at the treatment and underlying causes of dental caries in these children.
AAPD American Academy of Pediatric Dentistry. Reference manual, Policy on ECC Classification and preventive strategies. 2010-2011 vol.32, p41-44.
Al-Hossani E, Rugg-Gunn A. Combination of low parental educational attainment and high parental income related to high caries experience in pre-school children in Abu Dhabi. Community Dent Oral Epidemiol 1998; 26: 31-36.
Al-Malik MI, Holt RD, Bedi R. The relationship between erosion, caries and rampant caries and dietary habits in preschool children in Saudi Arabia. Int J Paediatr Dent 2001; 11:430-439.
Al-Mohammadi SM, Rugg-Gunn AJ, Butler TJ. Caries prevalence in boys aged 2, 4 and 6 years according to socio-economic status in Riyadh, Saudi Arabia. Community Dent Oral Epidemiol 1997; 25:184-186.
Al-Mughery AS, Attwood D, Blinkhorn A. Dental health of 5 year-old children in Abu Dhabi, United Arab Emirates. Community Dent Oral Epidemiol. 1991; 19:308-309.
Fayle SA, Welbury RR, Roberts JF. British Society of Paediatric Dentistry. A policy document on management of caries in the primary dentition. Int J Paediatr Dent 2001; 11:153-157.
Hamdan MAM Rock WP. Dental caries experience in Jordanian and English school children. Community Dent Health 1993; 10:151-157.
Harrison RL, Wong T, Ewan C et al. Feeding practices and dental caries in an urban Canadian population of Vietnamese preschool children. J Dent Children 1997; 64:112-117.
Hashim R, Williams S, Thomson WM. Diet and caries experience among preschool children in Ajman, United Arab Emirates. Eur J Oral Sci 2009; 117: 734-740.
Horowitz HS. Decision-making for national programs of community fluoride use. Community Dent Oral Epidemiol 2000; 28: 321-329.
Ismail AI, Lim S, Sohn W et al. Determinants of early childhood caries in low-income African American young children. Pediatr Dent 2008; 30:289-96.
Locker D. Response and non-response bias in oral health surveys. J Public Health Dent 2000; 60:72-81.
Lopez D-VL, Velazquez-Quintana Y, Weinstein P et al. Early childhood caries and risk factors in rural Puerto Rican children. J Dent Children 1998; 65:132-135.
Musaiger AO. Food habits of mothers and children in two regions of Oman. Nutr Health 1996; 11:29-48.
Naqvi A, Othman SA, Thabit MG. Baseline oral conditions in preschool children in Al-Ain Medical District. Dental News. 1999; 6:17-21.
O'Brien M. Children's dental health in the United Kingdom 1993. Office of Population Censuses and Survey. London: HMSO; 1994.
Osman NA, El-Sabban FF. Infant-feeding practices in Al-Ain, UAE. East Mediterr Health J. 1999; 5:103-110.
Peressini S, Leake JL, Mayhall JT et al. Prevelance of early childhood caries among First nations children, District of Manitoulin, Ontario. Int J Paediatr Dent 2004; 14:101-110.
Plutzer K, Spencer AJ. Efficacy of an oral health promotion intervention in the prevention of early childhood caries. Community Dent Oral Epidemiol 2008; 36:335-346.
Postma TC, Ayo-Yusuf OA, van Wyk PJ. Socio-demographic correlates of early childhood caries prevalence and severity in a developing country-South Africa. Int Dent J 2008; 58:91-7.
Rajab LD, Hamdan MAM. Early childhood caries and risk factors in Jordan. Community Dent Health 2002; 19:224-229.
Sayegh A, Dini EL, Holt RD et al. Caries prevalence and patterns and their relationship to social class, infant feeding and oral hygiene in 4- 5-year-old children in Amman, Jordan. Community Dent Health 2002a; 19:144-151.
Sayegh A, Dini EL, Holt RD et al. Food and drink consumption, sociodemographic factors and dental caries in 4-5 year-old children in Amman, Jordan. Br Dent J 2002b; 193:37-42.
Sayegh A, Dini EL, Holt RD et al. Oral health, sociodemographic factors, dietary and oral hygiene practices in Jordanian children. J Dent 2005; 33:379-388.
Thomson WM, Poulton R, Milne BJ et al. Socio-economic inequalities in oral health in childhood and adulthood in a birth cohort. Community Dent Oral Epidemiol 2004; 32: 345-353.
Traebert J, Guimaraes Ldo A, Durante EZ et al. Low maternal schooling and severity of dental caries in Brazilian preschool children. Oral Health Prev Dent 2009; 7:39-45.
Watt RG. From victim blaming to upstream action: tackling the social determinants of oral health inequalities. Community Dent Oral Epidemiol 2007, 35:1-11.
Wong MCM, Lo ECM, Schwarz E et al. Oral health status and oral health behaviors in Chinese children. J Dent Res 2001; 80:1459-1465.
World Health Organisation. Oral Health Surveys. Basic Methods. 4th ed. Geneva: World Health Organisation; 1997.
Wyne AH, Khan N. Use of sweet snacks, soft drinks and fruit juices, tooth brushing and first dental visit in high DMFT 4-6 years old of Riyadh region. Indian J Dent Res 1995; 6:21-24.
Wyne AH, Adenubi JO, Shalan T et al. Feeding and socioeconomic characteristics of nursing caries children in a Saudi population. Pediatr Dent 1995; 17:451-454.
R. Hashim *, S. Williams **, W.M. Thomson **
* Ajman University of Science & Technology, Emirate of Ajman, United Arab Emirates, ** University of Otago, Dunedin, New Zealand
Postal address: Dr. R. Hashim, Growth and Development Department, Ajman University, P.O.Box 346 Ajman, UAE.
Table 1. Prevalence of severe Early Childhood Caries and odds ratio (95% CI), by child and family characteristics. N (%) Prevalence Unadjusted p odds ratio Age (95% CI) 5 years 495 (50.5) 30.1 1.00 0.444 6 years 486 (49.5) 32.1 1.11 (0.80, 1.55) Sex Male 488 (49.7) 33.0 1.00 0.286 Female 493 (50.3) 29.7 0.89 (0.69, 1.16) Mother's education University 253 (25.8) 27.8 1.00 0.062 High school 467 (47.6) 29.2 1.05 (0.64, 1.72) Primary school 261 (26.6) 38.2 1.60 (0.97, 2.66) Monthly income >Dhs 7000 384 (39.1) 25.9 1.00 0.020 Dhs 3001-7000 329 (33.5) 32.9 1.45 (1.05, 2.01) Dhs 1000-3000 268 (27.4) 36.5 1.73 (1.25, 2.39) Adjusted odds ratio p (95% CI) Age 5 years 1.00 0.895 6 years 1.02 (0.76, 1.36) Sex Male 1.00 0.344 Female 0.88 (0.67, 1.16) Mother's education University 1.00 0.154 High school 1.00 (0.63, 1.60) Primary school 1.43 (0.85, 2.42) Monthly income >Dhs 7000 1.00 0.058 Dhs 3001-7000 1.35 (1.03, 1.87) Dhs 1000-3000 1.53 (1.08, 2.27) Dhs = Dirham, is the currency of the United Arab Emirates. Currently 1 [euro] =5.37 Dhs. Table 2. Prevalence of severe Early Childhood Caries and odds ratio (95% CI), by dietary factors. N (%) Prevalence Unadjusted odds ratio Frequency of eating/day (95% CI) 1-2 times 148 (15.3) 35.8 1.00 3-4 times 632 (65.2) 29.0 0.73 (0.44, 1.19) 5+ times 190 (19.5) 35.9 1.00 (0.59, 1.68) Snacks between meals/day Once 369 (37.8) 28.4 1.00 Twice 389 (39.9) 33.1 1.20 (0.92, 1.56) Three or more217 (22.3) 32.3 1.25 (0.97, 1.60) Eat/drink before bedtime No 569 (58.0) 30.5 1.00 Yes 412 (42.0) 32.2 1.09 (0.75, 1.55) Frequency of drinking/day 1-2 times 621 (63.4) 30.0 1.00 3-4 times 260 (26.6) 30.2 1.00 (0.71, 1.31) 5+ times 98 (10.0) 36.4 1.28 (0.65, 2.51) Snack consumption level Low 297 (33.7) 25.7 1.00 Moderate 363 (41.2) 29.4 1.20 (0.81,1.77) High 221 (25.1) 40.2 1.93 (1.38, 2.70) p Adjusted p odds ratio Frequency of eating/d (95% CI) 1-2 times 0.211 1.00 0.226 3-4 times 0.75 (0.44, 1.26) 5+ times 1.01 (0.59, 1.77) Snacks between meals/day Once 0.139 1.00 0.168 Twice 1.14 (0.86, 1.51) Three or more 1.24 (0.99, 1.59) Eat/drink before bedtime No 0.636 1.00 0.176 Yes 1.04 (0.73, 1.49) Frequency of drinking/day 1-2 times 0.709 1.00 0.849 3-4 times 0.95 (0.69, 1.31) 5+ times 1.15 (0.59, 2.21) Snack consumption level Low 0.002 1.00 0.003 Moderate 1.18 (0.78, 1.77) High 1.84 (1.31, 2.57) Table 3. Prevalence of severe Early Childhood Caries and odds ratio (95% CI), by children's brushing characteristics. N (%) Prevalence Unadjusted p odds ratio (95% CI) Frequency of child's brushing Less than daily 265 (27.0) 38.4 1.00 0.068 Once 308 (31.4) 28.4 0.64 (0.43, 0.93) Twice or more 407 (41.6) 28.7 0.65 (0.44, 0.94) Who helps with brushing? No-one 354 (36.4) 30.5 1.00 0.081 Mother 559 (57.5) 29.8 0.96 (0.71, 1.31) Others 60 (6.1) 43.7 1.77 (0.92, 3.38) Does child skip brushing? Never 402 (41.2) 32.0 1.00 0.061 Occasionally 266 (27.2) 27.1 0.78 (0.65, 0.94) > once/month 309 (31.6) 33.2 1.05 (0.77, 1.42) Adjusted p odds ratio (95% CI) Frequency of child's brushing Less than daily 1.00 0.091 Once 0.64 (0.43, 0.95) Twice or more 0.61 (0.47, 0.98) Who helps with brushing? No-one 1.00 0.221 Mother 1.05 (0.81, 1.41) Others 1.76 (0.89, 3.46) Does child skip brushing? Never 1.00 0.098 Occasionally 0.81 (0.67, 0.98) > once/month 1.09 (0.84, 1.43) Table 4. Prevalence of severe Early Childhood Caries and odds ratio (95% CI), by reason for dental visiting. N (%) Prevalence Unadjusted p odds ratio (95% CI) Dental visit in previous year Never 660 (67.5) 28.6 1.00 0.003 Check-up 68 (6.9) 15.8 0.47 (0.24, 0.90) Problem 250 (25.6) 42.1 1.81 (1.38, 2.37) Adjusted p odds ratio (95% CI) Dental visit in previous year Never 1.00 0.001 Check-up 0.48 (0.24, 0.94) Problem 1.92 (1.49, 2.49) Table 5. Multivariate model, odds ratio (95%CI) for the association between s-ECC and other variables. s-ECC N (%) Adjusted p odds ratio (95% CI) Age 5 years 445 (50.9) 1.00 0.943 6 years 429 (49.1) 1.01 (0.71, 1.42) Sex Male 431 (49.3) 1.00 0.553 Female 443 (50.7) 0.92 (0.68, 1.23) Mother's education University 224 (25.6) 1.00 0.301 High school 419 (47.9) 0.97 (0.61, 1.52) Primary school 231 (26.5) 1.21 (0.79, 1.85) Monthly income >Dhs 7000 341 (39.0) 1.00 0.040 Dhs 3001-7000 297 (34.0) 1.34 (0.98, 1.86) Dhs 1000-3000 236 (27.0) 1.43 (1.11, 1.85) Snacks between meals/day Once 331 (37.8) 1.00 0.837 Twice 353 (40.4) 1.07 (0.81, 1.42) Three or more 190 (21.8) 1.03 (0.73, 1.45) Snack consumption level Low 294 (33.6) 1.00 0.004 Moderate 362 (41.4) 1.19 (0.78, 1.80) High 218 (25.0) 1.80 (1.26, 2.58) Frequency of child's brushing Less than daily 237 (27.1) 1.00 0.275 Once 277 (31.7) 0.73 (0.50, 1.07) Twice or more 360 (41.2) 0.78 (0.51, 1.18) Dhs = Dirham, is the currency of the United Arab Emirates. Currently 1 [euro]=5.37 Dhs.
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