This study examined risk factors for children having new cavitated caries between 5 and 9 years old.
Subjects were Iowa Fluoride Study cohort children(mostly Caucasian and of relatively high socioeconomic status) with both primary and mixed dentition caries exams and at least 2 diet diaries recorded between 5 and 8 years old (N=198). Using surface-specific transitions, combined counts of new cavitated caries (d2-3f and/or D2-3F) were determined from 4 primary second molars, 8 permanent incisors, and 4 permanent molars. Food and beverage intake frequencies were abstracted. Other factors were assessed using periodic questionnaires. Logistic regression identified predictors of new cavitated caries.
Thirty-seven percent had new cavitated caries. The mean new cavitated caries count for all children was 1.17 surfaces (±2.28 SD). In multivariable logistic regression, the following were significantly associated (
Results suggested that increased tooth-brushing frequency and reduced consumption of processed starches as snacks may reduce caries incidence in younger school-aged children.
Dental caries remains a major public health problem for US children. The National Health and Nutrition Examination Survey 1999–2002 reported a national prevalence of 49% of children with dental caries experience in the primary teeth and 20% of children with caries experience in the permanent teeth
Most studies have assessed risk factors for dental caries in the mixed dentition cross-sectionally. Since the dental caries process takes time to develop into clinically detectable lesions, risk factors for dental caries should be assessed by examining factors that occur before and during the time of clinical caries detection. There are a limited number of nonexperimental studies, however, that have assessed caries incidence/increment in the transition period from primary to mixed dentition.
Associations between previous cavitated caries and new cavitated caries in primary school-age children have been investigated.
The objective of the analyses described in this paper was to examine modifiable and nonmodifiable risk factors for children having new cavitated caries from 5 to 9 years old. The frequencies of dietary intake of specific food and beverage categories and other caries-related factors were compared between 5- to 9-year-olds with and without new cavitated caries.
The data used in this analysis are part of the ongoing, longitudinal Iowa Fluoride Study (
Subjects with both primary dentition (~5 years old) and mixed dentition (~9 years old) caries exams and at least 2 diet diaries, including at least 1 from 5 to 6.5 years old and 1 from 7 to 8.5 years old (to ensure at least 1 diary before starting school and at least 1 after) were included in these analyses (N=198).
The food and beverage intakes for 2 weekdays and 1 weekend day were recorded by parents using 3-day diaries that were sent every 1.5 to 6 months (1.5 months to 8.5 years old).
Food and beverage intake frequencies were estimated from the diaries
Foods and beverages were then classified into categories. Beverages were categorized by type of beverage and included: milk; 100% juices; juice drinks; powder-sugared beverages; regular (sugared) soda pop; diet soda pop; sports drinks; and water. Foods were categorized based on sugar and/or starch content and included: sugar-based desserts (jelly, pudding, etc); candy; added sugar (table sugar, honey, brown sugar, etc); baked starch with sugar (cookies, cake, etc); unsweetened cereals; presweetened cereals; unprocessed starches (boiled potato, bread, rice, etc); and processed starches (potato chips, etc). The intake frequency of each food and beverage category was counted and averaged for each child across the 3 days for each annual diary (at 5, 6, 7, or 8 years old). Results at 5 and/or 6 years old and at 7 and/or 8 years old were averaged separately, and these 2 means were subsequently averaged to form an overall measure for each child. The dietary variables were presented in order by percentage of children with some intake (5–8 years old) at snacking occasions in each of the beverage, sugar-based, and starch-based food groups.
Daily tooth-brushing frequency and composite water fluoride intakes were determined based on data from IFS questionnaires that were sent to parents at the same time as the diaries. Composite water fluoride levels were determined from all sources, including available public water documentation and an assay of multiple sources of water (ie, home/school, bottled/filtered/tap water) at each time point for each individual child.
Three categories of SES were created based on family income and mother’s education data from baseline questionnaires (completed at birth). The high SES category included children from families with incomes from $30,000 to $49,999 a year whose mothers had a graduate/professional degree, or from families with incomes of more than $50,000/year (regardless of the mother’s educational level). Children from families with incomes less than $30,000 a year whose mother had 2 years or less in college were categorized as low SES. All other children were placed in the middle SES category.
Children were examined for dental caries at 5 years old (primary dentition) and 9 years old (mixed dentition) by the same trained and calibrated examiners. The examinations were conducted using a portable chair, halogen headlight and a DenLite mirror (Welch-Allyn Medical Product, Inc, Skaneatele Falls, NY).
Combined count of new cavitated caries (d2-3f and/or D2-3F) included cavitated lesions and restored lesions from 4 primary second molars, 8 permanent incisors, and 4 permanent first molars. The counts of new cavitated caries were determined using surface-specific transitions during exams taken between 5 and 9 years old. Having new cavitated caries was used as the dependent binary variable (none vs 1 or more new lesions and/or restorations) in these analyses.
Logistic regression analyses were used to explore the relationships between having or not having new cavitated caries from 5 to 9 years old and other variables: dietary intakes; gender; SES; age at mixed dentition exam; cavitated caries experience at 5 years old; noncavitated caries experience at 5 years old; tooth-brushing frequency; and composite water fluoride level.
First, univariable logistic regression analyses were modeled separately for each dietary variable or other related factor. For dietary variables, only variables with
dietary and other variables (tooth-brushing frequency, composite water fluoride level, gender, age at mixed dentition exam, and SES) excluding previous dental caries experience; and
all variables (including previous caries experience).
For each of these model formulations, a backward elimination procedure was performed to determine the final model. Variables that did not retain significance at
There were 198 children (55% girls) who met the inclusion criteria of having both exams and a sufficient numbers of diet diaries. Mean (±SD) ages at the primary dentition and mixed dentition exams were 5.1 (± 0.4) and 9.2 (± 0.7), respectively. Most were in the middle or high SES categories (35% and 42%, respectively). The prevalences of noncavitated caries at the primary and at the mixed dentition exams were approximately 19% and 39%, respectively. Cavitated caries prevalence at the primary and at the mixed dentition exams were approximately 21% and 49%, respectively. Sixty-three percent of the children had no new cavitated caries (zero surfaces of new cavitated caries). Among the 37% of children with some new cavitated caries, more than half (20%) had only 1 to 2 surfaces of new cavitated caries, approximately one fourth (9%) had 3 to 4 surfaces of new cavitated caries, and less than one fourth (8%) had 5 or more surfaces of new cavitated caries. The overall mean new cavitated caries for all children was 1.17 surfaces (±2.28 SD; range=0–15), with a mean only among those affected of 3.2 surfaces (±2.8 SD; range=1–15).
Descriptive analyses presenting medians and 25th and 75th percentiles of food and beverage intake frequencies at meals and at snacking occasions for individuals’ intakes for each year (5–8 years old) and averaged from the 2 to 4 diaries (5–8 years old) are presented in
Medians, means, and standard deviations of other related factors at 5 to 8 years old and averages of any available data from 5 to 8 years old are presented in
The univariable logistic regression analyses of factors other than dietary variables are presented in
The multivariable logistic regression analyses are presented in
Model 1 initially considered 8 variables, including 3 dietary variables and 5 other variables (daily tooth-brushing frequency, composite water fluoride level, gender, age at mixed dentition exam, and SES), and 2 interaction terms (between gender and composite water fluoride level and between low SES and age at mixed dentition dental exam). Snacktime intake frequency of greater processed starches (OR=1.50,
Model 2 initially included 10 variables (8 variables from model 1, noncavitated caries experience at 5 years old (yes/no) and cavitated caries experience at 5 years old (yes/no), and 2 interaction terms (between gender and composite water fluoride level and between low SES and age at mixed dentition dental exam). Having noncavitated caries experience at 5 years old (OR=2.67,
Although the main analyses have focused on intake frequency data, additional analyses were conducted using quantity of intake data. These generally showed similar directions and strengths of association to the analyses using frequency data. For example, in additional univariable analyses, both greater regular soda pop intake frequency and quantity at snacking occasions tended to increase the risk of having new cavitated caries (
Although not our first emphasis, the relationship between SES and previous noncavitated caries and the relationship between processed starches intake frequency at snacking occasions and previous cavitated caries experience were explored. Thirty-three percent of children of low SES families had previous noncavitated caries experience, while only 15% of children of middle/high SES families had previous noncavitated caries experience. Additionally, 11% of children who had reported no intake frequency of processed starches at snacking occasions had previous cavitated caries experience, while 24% of children with some intake of processed starches at snacktime had previous cavitated caries experience.
This study sample was predominantly Caucasian, of relatively high SES, and had low-moderate caries risk. More than one third, however, had new caries in the 4-year period and nearly 10% had an average of more than 1 new surface per year. Even in a low-moderate-risk population, caries in school-age children is still a public health problem.
Infection by cariogenic bacteria and the demineralization process on tooth surfaces are part of the true dental caries disease processes, but noncavitated caries and cavitated caries are signs of the chronic disease that can be more reliably assessed clinically. Routine assessments of dynamic changes in bacteria and/or tooth demineralization that can be reversed or remineralized in a short time are not feasible clinically. Thus, the present study assessed signs of dental caries (clinical exam) and used them in determining the outcome variable of new cavitated caries.
From the descriptive analyses of the dietary variables, more than three-fourths of these children consumed regular soda pop, and approximately one-fourth consumed diet soda pop. Diet soda pop has been available in the United States for more than 50 years. The results, however, reveal that many more children consumed regular vs diet soda pop. In addition, consumption of presweetened cereal was more common among children than consumption of unsweetened cereals.
Several other studies found a strong association between previous caries experience of the primary dentition and new caries of the mixed dentition.
The present analyses did not use a traditional 5% significance level but instead used a 10% significance level. The univariable results showed strong relationships between caries incidence and previous caries experience and weaker relationships between caries incidence and certain other explanatory factors, such as SES and processed starches intake at snacking occasions. In the multivariable logistic regression analyses, when a 0.05 significance level was used in the backward elimination procedure, dietary variables were not retained in the final multivariable model. Because previous caries experience and the dental caries outcome is the same disease, it is possible that they share the same risk factors. Thus, we further explored the relationship between these factors and previous noncavitated and cavitated caries experiences. The results indicate associations between: SES and noncavitated caries experiences; and frequency of snacktime intake of processed starches and cavitated caries experience. Because of these relationships, the simultaneous inclusion of previous caries experience in a multivariable model containing the other explanatory factors reduced the contribution of the other factors. Therefore, the dietary variables which had weaker relationships with caries incidence would have been dropped out from the model with the traditional
A study by Leroy et al.,
To show how explanatory variables affected each other in the model, we developed 2 separate models. Model 1 initially included all potential variables other than previous caries experience. In the backward elimination procedure, the results of using a level of significance of 0.05 or 0.10 were identical. In the final model, 3 modifiable factors, daily tooth-brushing frequency, composite water fluoride level, and frequency of snacktime intake of processed starches were significantly associated with having new cavitated caries. SES was also significant in the final model.
Model 2, which initially included all potential variables, including previous caries experience, showed that both previous caries experience variables (noncavitated and cavitated) and daily tooth-brushing frequency were significantly associated with new caries. Processed starch intake frequency at snacking occasions and composite water fluoride level are the 2 variables in the final model that had
Processed starches are common snacks in developed countries. The association between caries incidence and processed starches is not surprising. No studies, however, have found this association in early school-aged children. Possibly there are no other studies that have detailed information on dietary intake at this level. Also, processed starch intake frequency at snacking occasions might be counted with other snack intakes in other studies. Thus, the effect of processed starch exposures on new caries might be part of the association between a combined dietary variable such as frequency of snack intake and new cavitated caries. Developmentally, children in this age group still need to have snacks. Thus, the defined findings of which snacks would increase the chances of having new caries can be very useful for making recommendations.
Daily tooth-brushing frequency is a strong preventive factor in this group of children. This confirmed the finding of other studies.
In model 2, there was a statistically significant interaction effect between gender and composite water fluoride level. Specifically, increased composite water fluoride level showed a significant protective effect in girls, but not in boys. Additional studies are needed to confirm and explain these findings.
Most other studies of caries incidence and diet collected dietary information at only one point (either at the beginning or the end of this period) and related it to the new caries. This study collected the dietary information longitudinally to evaluate the relationship between the dietary intake during the period between the 2 dental examinations and cavitated caries incidence, which is a major strength of the present study. There were limitations to this study, however, including a relatively small sample size, a predominance of subjects with high SES, and a low to moderate disease level in the cohort. Thus, results should be interpreted in light of these limitations. This study did not assess cariogenic bacteria. Thus, the results of this study did not control for differences in the cariogenic bacteria among individuals. Additionally, no analyses considered duration of exposures to foods and beverages.
For practicality, future research should focus more on modifiable factors. Moreover, it should assess risk factors at a detailed level that could lead to practical preventive measures.
Based on this study’s results, the following conclusions can be made:
Snacktime intake of processed starches, tooth-brushing, and socioeconomic status are variables associated with caries, consistent with other studies in preschool and school-age children.
In school-age children, many of those associations with modifiable factors are absent from multivariable models, which include previous caries experience. Studies concerning risk factors for dental caries should be focused to include and emphasize modifiable factors.
Results suggested that tooth-brushing with fluoridated toothpaste and dietary counseling could help decrease the risk of new cavitated caries in young school-aged children.
The Iowa Fluoride Study was supported by NIH grants M01-RR00059, R01-DE09551, and R01-DE12101, CDC grants TS-0652 and TS-1329, and Dr. Levy’s Wright-Bush-Shreves Endowed Research Professorship. The contents of this paper are the responsibility of the authors and do not necessarily reflect the official views of the granting organizations.
DESCRIPTIVE ANALYSIS OF DIETARY VARIABLES
| Variable | Median (25th, 75th percentile) | Children with some intake (%) | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| 5–8 ys old (N=198) | 5 ys old (N=171) | 6 ys old (N=173) | 7 ys old (N=164) | 8 ys old (N=150) | 5–8 ys old (N=198) | 5 ys old (N=171) | 6 ys old (N=173) | 7 ys old (N=164) | 8 ys old (N=150) | ||
| Milk | Snack | 0.2 (0.1, 0.4) | 0.3 (0, 0.7) | 0.3 (0, 0.7) | 0 (0, 0.3) | 0 (0, 0.3) | 80 | 56 | 55 | 40 | 37 |
| Meal | 1.6 (1.2, 1.8) | 1.7 (1.0, 2.0) | 1.5 (1.0, 2.0) | 1.3 (1.0, 2.0) | 1.7 (1.0, 2.0) | 99 | 94 | 97 | 96 | 95 | |
| 100% juice | Snack | 0.1 (0, 0.3) | 0 (0, 0.3) | 0 (0, 0.3) | 0 (0, 0) | 0 (0, 0) | 65 | 47 | 33 | 23 | 17 |
| Meal | 0.3 (0.1, 0.6) | 0.3 (0, 0.7) | 0.3 (0, 0.7) | 0 (0, 0.7) | 0 (0, 0.7) | 80 | 58 | 52 | 48 | 41 | |
| Regular soda pop | Snack | 0.1 (0, 0.3) | 0 (0, 0.3) | 0 (0, 0.3) | 0 (0, 0.3) | 0 (0, 0.3) | 65 | 30 | 34 | 32 | 30 |
| Meal | 0.3 (0.1, 0.4) | 0.3 (0, 0.5) | 0 (0, 0.3) | 0.3 (0, 0.3) | 0 (0, 0.5) | 80 | 55 | 47 | 57 | 49 | |
| Juice drinks | Snack | 0.1 (0, 0.2) | 0 (0, 0.3) | 0 (0, 0) | 0 (0, 0.2) | 0 (0, 0) | 57 | 26 | 23 | 25 | 23 |
| Meal | 0.2 (0, 0.3) | 0 (0, 0.3) | 0 (0, 0.3) | 0 (0, 0.3) | 0 (0, 0.3) | 69 | 32 | 36 | 37 | 36 | |
| Powder-sugared beverages | Snack | 0 (0, 0.1) | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 41 | 18 | 15 | 17 | 12 |
| Meal | 0 (0, 0.1) | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 39 | 18 | 17 | 13 | 12 | |
| Sport drinks | Snack | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 8 | 2 | 2 | 1 | 2 |
| Meal | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 5 | 4 | 2 | 2 | 5 | |
| Diet soda pop | Snack | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 19 | 6 | 8 | 8 | 6 |
| Meal | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 23 | 5 | 8 | 9 | 11 | |
| Water | Snack | 0.8 (0.3, 1.5) | 0.7 (0, 1.3) | 0.7 (0, 1.3) | 0.7 (0, 1.7) | 0.7 (0, 1.7) | 93 | 71 | 73 | 74 | 73 |
| Meal | 0.2 (0, 0.3) | 0 (0, 0.3) | 0 (0, 0.3) | 0 (0, 0.3) | 0 (0, 0.3) | 62 | 39 | 38 | 40 | 39 | |
| Sugar-based desserts | Snack | 0.3 (0.1, 0.5) | 0.3 (0, 0.5) | 0.3 (0, 0.7) | 0.3 (0, 0.7) | 0 (0, 0.3) | 86 | 55 | 61 | 51 | 48 |
| Meal | 0.2 (0.1, 0.3) | 0 (0, 0.3) | 0 (0, 0.3) | 0 (0, 0.3) | 0 (0, 0.3) | 78 | 42 | 47 | 39 | 42 | |
| Candy | Snack | 0.3 (0.1, 0.5) | 0 (0, 0.3) | 0.3 (0, 0.7) | 0.3 (0, 0.7) | 0 (0, 0.3) | 81 | 46 | 51 | 55 | 48 |
| Meal | 0.04 (0, 0.2) | 0 (0, 0) | 0 (0, 0) | 0 (0, 0.3) | 0 (0, 0) | 50 | 22 | 23 | 27 | 19 | |
| Added sugars | Snack | 0 (0, 0.2) | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 46 | 19 | 21 | 14 | 15 |
| Meal | 0.3 (0.2, 0.6) | 0.3 (0, 0.7) | 0.3 (0, 0.7) | 0.3 (0, 0.7) | 0.3 (0, 0.7) | 86 | 58 | 65 | 60 | 55 | |
| Baked starches with sugar | Snack | 0.5 (0.3, 0.8) | 0.7 (0.3, 1.0) | 0.7 (0.3, 1.0) | 0.3 (0, 0.7) | 0.4 (0, 0.7) | 96 | 80 | 77 | 69 | 69 |
| Meal | 0.5 (0.3, 0.7) | 0.3 (0, 0.7) | 0.3 (0.3, 0.7) | 0.6 (0.3, 0.8) | 0.6 (0.3, 0.7) | 95 | 64 | 75 | 79 | 77 | |
| Processed starches | Snack | 0.3 (0.1, 0.4) | 0 (0, 0.3) | 0.3 (0, 0.3) | 0 (0, 0.3) | 0 (0, 0.3) | 81 | 45 | 52 | 43 | 45 |
| Meal | 0.3 (0.2, 0.5) | 0.3 (0, 0.7) | 0.3 (0, 0.7) | 0.3 (0, 0.7) | 0.3 (0, 0.7) | 95 | 65 | 69 | 68 | 64 | |
| Unprocessed starches | Snack | 0.2 (0.1, 0.3) | 0 (0, 0.3) | 0 (0, 0.3) | 0 (0, 0.3) | 0 (0, 0.3) | 81 | 44 | 44 | 39 | 42 |
| Meal | 2.5 (2.3, 2.8) | 2.3 (2.0, 3.0) | 2.5 (2.0, 3.0) | 2.7 (2.0, 3.0) | 2.7 (2.3, 3.0) | 100 | 100 | 99 | 100 | 99 | |
| Presweetened cereals | Snack | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 24 | 8 | 9 | 9 | 7 |
| Meal | 0.3 (0.2, 0.5) | 0.3 (0, 0.7) | 0.3 (0, 0.7) | 0.3 (0, 0.7) | 0.3 (0, 0.5) | 87 | 56 | 61 | 59 | 56 | |
| Unsweetened cereals | Snack | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 16 | 6 | 6 | 5 | 2 |
| Meal | 0.1 (0, 0.2) | 0 (0, 0.3) | 0 (0, 0.3) | 0 (0, 0) | 0 (0, 0.3) | 55 | 29 | 22 | 23 | 23 | |
To compute these measures, mean dietary intakes from 5 and/or 6 years old and 7 and/or 8 years old were calculated, and these 2 means were subsequently averaged.
OR=odds ratio; CI=confidence interval.
Note: There were 22% additional abstracted dietary diary responses at ages 5½, 6½, 7½, and 8½ that are not included in the year-specific data, but are included as substitutes when 5- to 8-year-olds were missing.
Percentage of children with some intake from diaries (among 2–4 annual time points per child).
DESCRIPTIVE ANALYSIS OF OTHER RELATED FACTORS
| Variable | Median | Mean±(SD) | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 5–8 ys old (N=198) | 5 ys old (N=171) | 6 ys old (N=173) | 7 ys old (N=164) (N=150) | 8 ys old | 5–8 ys old (N=198) | 5 ys old (N=171) | 6 ys old (N=173) | 7 ys old (N=164) | 8 ys old (N=150) | |
| Daily tooth-brushing frequency | 1.50 | 1.0 | 1.0 | 2.0 | 2.0 | 1.5±0.5 | 1.4±0.6 | 1.5±0.6 | 1.5±0.6 | 1.5±0.6 |
| Composite water fluoride level (ppm) | 0.93 | 0.94 | 0.95 | 0.98 | 0.94 | 0.8±0.4 | 0.8±0.4 | 0.8±0.4 | 0.8±0.3 | 0.8±0.4 |
UNIVARIABLE LOGISTIC REGRESSION MODELS USING DIETARY VARIABLES TO PREDICT OCCURRENCE OF NEW CAVITATED CARIES FROM 5 TO 9 YEARS OLD
| Variable | Odds ratio (95% confidence interval) | ||
|---|---|---|---|
| Milk | Snack | 1.29 (0.64, 2.62) | .48 |
| Meal | 0.87 (0.52, 1.46) | .60 | |
| 100% juice | Snack | 0.90 (0.19, 4.40) | .90 |
| Meal | 0.79 (0.35, 1.78) | .57 | |
| Regular soda pop | Snack | 5.15 (1.003, 26.43) | <.05 |
| Meal | 1.75 (0.52, 5.94) | .37 | |
| Juice drinks | Snack | 1.09 (0.28, 4.19) | .90 |
| Meal | 0.53 (0.16, 1.78) | .31 | |
| Powder-sugared beverages | Snack | 2.04 (0.47, 8.89) | .35 |
| Meal | 0.44 (0.04, 5.14) | .51 | |
| Diet soda pop | Snack | 0.48 (0.03, 7.03) | .60 |
| Meal | 1.92 (0.05, 70.26) | .72 | |
| Water | Snack | 1.03 (0.75, 1.41) | .18 |
| Meal | 1.30 (0.56, 3.04) | .34 | |
| Sugar-based desserts | Snack | 1.33 (0.48, 3.72) | .59 |
| Meal | 0.38 (0.08, 1.76) | .22 | |
| Candy | Snack | 0.77 (0.31, 1.95) | .59 |
| Meal | 0.54 (0.07, 4.14) | .56 | |
| Added sugar | Snack | 4.42 (0.42, 47.10) | .22 |
| Meal | 0.50 (0.19, 1.34) | .17 | |
| Baked starch with sugar | Snack | 0.91 (0.38, 2.18) | .83 |
| Meal | 0.79 (0.31, 2.03) | .63 | |
| Processed starches | Snack | 2.85 (0.83, 9.83) | .10 |
| Meal | 0.79 (0.25, 2.49) | .69 | |
| Unprocessed starches | Snack | 3.16 (0.76, 13.15) | .12 |
| Meal | 1.16 (0.62, 2.18) | .64 | |
| Presweetened cereals | Snack | 0.43 (0.01, 23.54) | .68 |
| Meal | 1.72 (0.56, 5.28) | .35 | |
Cavitated caries from exam at approximately 9 years old that was not present at 5 years old.
Note: Each line of this table represents a separate regression model.
P<.15 used as a criterion to screen dietary variables for multivariable logistic regression.
UNIVARIABLE LOGISTIC REGRESSION MODELS USING DEMOGRAPHIC VARIABLES AND OTHER VARIABLES TO PREDICT OCCURRENCE OF NEW CAVITATED CARIES FROM 5 TO 9 YEARS OLD
| Variable | Odds ratio (95% confidence interval) | |
|---|---|---|
|
| ||
| Gender | ||
| • Boys | 1.01 (0.59, 1.89) | .85 |
| • Girls | ||
|
| ||
| Age at mixed dentition dental exam (year) | 1.24 (0.83, 1.85) | .29 |
|
| ||
| Age interval between 1st and 2nd exam (year) | 1.20 (0.82, 1.74) | .35 |
|
| ||
| Socioeconomic status | ||
| • Low | 2.07 (1.04, 4.13) | .04 |
| • Middle/high | ||
|
| ||
| Daily tooth-brushing frequency from 5-years old (time/day) | 0.37 (0.20, 0.69) | .002 |
|
| ||
| Composite water fluoride level (ppm) from 5–8 years old | 0.91 (0.40, 2.04) | .81 |
|
| ||
| Non-cavitated caries experience at 5 years old | ||
| • Yes | 4.00 (1.91, 8.39) | <.001 |
| • No | ||
|
| ||
| Cavitated caries experience at 5 years old | ||
| • Yes | 4.44 (2.16, 9.12) | <.001 |
| • No | ||
Cavitated caries from exam at approximately 9 years old that was not present at 5 years old.
Note: Each line of this table represents a separate regression model.
MULTIVARIABLE LOGISTIC REGRESSION MODELS TO PREDICT OCCURRENCE OF NEW CAVITATED CARIES FROM 5 TO 9 YEARS OLD
| Models | Estimate | Odds ratio (95% confidence interval) | |
|---|---|---|---|
|
| |||
|
| |||
| Intercept | |||
| • Girls | 2.77 | ||
| • Boys | 0.38 | ||
|
| |||
| Snacktime intake of processed starches | 1.50 | 4.48 (1.14, 17.70) | .04 |
|
| |||
| Daily tooth-brushing frequency among 5- to 8-year-olds (time/day) | −1.15 | 0.32 (0.16, 0.63) | <.001 |
|
| |||
| Socioeconomic status | |||
| • Low | 0.41 | 2.27 (1.08, 4.80) | .04 |
| • Middle/high (Reference category) | |||
|
| |||
| Composite water fluoride level (0.1 ppm) among 5- to 8-year-olds | |||
| • Girls | −0.16 | 0.86 (0.75, 0.98) | .03 |
| • Boys | 0.06 | 1.06 (0.93, 1.20) | .39 |
|
| |||
|
| |||
| Intercept | |||
| • Girls | 1.91 | ||
| • Boys | −3.79 | ||
|
| |||
| Snacktime intake of processed starches | 1.35 | 3.87 (0.93, 16.16) | .07 |
|
| |||
| Daily tooth-brushing frequency among 5- to 8-year-olds (time/day) | −1.29 | 0.28 (0.13, 0.59) | .001 |
|
| |||
| Non-cavitated caries experience among 5-year-olds | |||
| • Yes | 0.49 | 2.67 (1.11, 6.42) | .03 |
| • No (Reference category) | |||
|
| |||
| Cavitated caries experience among 5-year-olds | |||
| • Yes | 0.61 | 3.39 (1.48, 7.78) | .004 |
| • No (Reference category) | |||
|
| |||
| Age at mixed dentition exam (year) | 0.52 | 1.68 (1.04, 2.73) | .04 |
|
| |||
| Composite water fluoride l (0.1 ppm) among 5- to 8-year-olds | |||
| • Girls | −0.13 | 0.88 (0.76, 1.01) | .08 |
| • Boys | 0.05 | 1.05 0.93, 1.20) | .44 |
Cavitated caries from exam at approximately 9 years old that was not present at 5 years old. Note: The other variables initially considered for inclusion (not shown in the table) were removed in the backward elimination (P<0.10 to remain).
All variables excluding caries experience: snacktime intake of regular soda pop; snacktime intake of processed starches; snacktime intake of unprocessed starches; tooth-brushing frequency; composite water fluoride level; gender; age at mixed dentition exam; and socioeconomic status
All variables: snacktime intake of regular soda pop; snacktime intake of processed starches; snacktime intake of unprocessed starches; tooth-brushing frequency; composite water fluoride level; gender; age at mixed dentition exam; socioeconomic status; previous noncavitated caries; and previous cavitated caries