European Archives of Paediatric Dentistry

, Volume 13, Issue 2, pp 70–75 | Cite as

Maternal education is an independent determinant of cariogenic feeding practices in the first year of life

  • C. A. FeldensEmail author
  • P. F. Kramer
  • M. C. Sequeira
  • P. H. Rodrigues
  • M. R. Vítolo
Scientific Article


AIM: To identify risk factors for cariogenic feeding practices in the first year of life. STUDY DESIGN: Cohort study. METHODS: 500 children born within the public health care system in São Leopoldo, Brazil, were recruited in a follow-up program. Anthropometric and demographic data were collected soon after birth; data on feeding practices were assessed at 12 months of age using a standardised questionnaire; clinical examination at 4 years of age allowed identification of cariogenic feeding practices in the first year of life and to quantify their relative risks. In the present study, the attributable risks of each child were summed, and the outcome was assessed for the upper quartile of scores for cariogenic feeding practices. STATISTICS: Adjusted relative risks for the outcome were estimated using robust Poisson regression models. RESULTS: A total of 327 children comprised the final study sample, i.e. were followed from birth to 4 years of age. Multivariate analysis showed that the risk of cariogenic feeding practices doubled in children from mothers with less than 5 years of education (RR 2.19, 95%CI 1.26–3.82) and was 70% higher in children from mothers with 5–8 years of education when compared with maternal education >8 years. The other independent variables were not associated with the outcome. CONCLUSIONS: Low maternal education is a risk factor for cariogenic feeding practices, independently of other factors. Mothers with low educational levels should be the focus of child health promotion interventions, especially those aimed at controlling dental caries.

Key words

Dental caries risk factors feeding behaviour diet cariogenic 


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  1. Abanto J, Carvalho TS, Mendes FM et al. Impact of oral diseases and disorders on oral health-related quality of life of preschool children. Community Dent Oral Epidemiol 2011;39:105–14.PubMedCrossRefGoogle Scholar
  2. Birch L L. Development of food acceptance patterns in the first years of life. Proceedings of the Nutrition Society 1998; 57:617–625.PubMedCrossRefGoogle Scholar
  3. Brazil. Health Ministry. Assistência pré-natal — Manual Técnico — 2000 [document in Portuguese]. 2011 Jul 14. Available from
  4. Brazil. Health Ministry. Ten Steps for Healthy Feeding. Brasília: Health Ministry and Pan American Health Organization [document in Portuguese]. 2011 Jul 14. Available from
  5. Davies GM, Worhington HV, Ellwood RP et al. A randomised controlled trial of the effectiveness of providing free fluoride toothpaste from the age of 12 months on reducing caries in 5–6-year old children. Community Dent Health 2002; 19:131–136.PubMedGoogle Scholar
  6. Declerck D, Leroy R, Martens L et al. Factors associated with prevalence and severity of caries experience in preschool children. Community Dent Oral Epidemiol 2008; 36:168–78.PubMedCrossRefGoogle Scholar
  7. Drewnowski A. Concept of a nutritious food. toward a nutrient density score. Am J Clin Nutr 2005; 82:721–32.Google Scholar
  8. Drury TF, Horowitz AM, Ismail AI et al. Diagnosing and reporting early childhood caries for research purposes. A report of a workshop sponsored by the National Institute of Dental and Craniofacial Research, the Health Resources and Services Administration, and the Health Care Financing Administration. J Public Health Dent. 1999;59:192–7.PubMedCrossRefGoogle Scholar
  9. Feldens CA, Giugliani ERJ, Vigo A, Vítolo MR. Early Feeding Practices and Severe Early Childhood Caries in Four-Year-Old Children from Southern Brazil: A Birth Cohort Study. Caries Res 2010a; 44:445–452.PubMedCrossRefGoogle Scholar
  10. Feldens CA, Giugliani ERJ, Duncan BB, Drachler ML, Vítolo MR. Long-term effectiveness of a nutritional program in reducing early childhood caries: a randomized trial. Community Dent Oral Epidemiol. 2010b; 38:324–332.PubMedCrossRefGoogle Scholar
  11. Ferreira SH, Béria JU, Kramer PF, Feldens EG, Feldens CA. Dental caries in 0-to 5-year-old Brazilian children: prevalence, severity, and associated factors. Int J Paediatr Dent 2007;17:289–96.PubMedCrossRefGoogle Scholar
  12. Finlayson TL, Siefert K, Ismail AI, Sohn W. Psychosocial factors and early childhood caries among low-income African-American children in Detroit. Community Dent Oral Epidemiol 2007;35:439–48.PubMedCrossRefGoogle Scholar
  13. Fletcher RH, Fletcher SW. Clinical epidemiology: the essentials. 4 ed. Baltimore: Lippincott Williams & Wilkins; 2005.Google Scholar
  14. Harris R, Nicoll AD, Adair PM, Pine CM. Risk factors for dental caries in young children: a systematic review of the literature. Community Dental Health 2004; 21 Suppl:71–85.PubMedGoogle Scholar
  15. Hashim R, Williams S, Thomson WM. Severe early childhood caries and behavioural risk indicators among young children in Ajman, United Arab Emirates. Eur Arch Paediatr Dent 2011;12:205–10.PubMedCrossRefGoogle Scholar
  16. Ismail AI. Prevention of early childhood caries. Community Dent Oral Epidemiol 1998; 26:49–61.PubMedGoogle Scholar
  17. Jin BH, Ma DS, Moon HS et al. Early childhood caries: prevalence and risk factors in Seoul, Korea. J Public Health Dent 2003; 63:183–88.PubMedCrossRefGoogle Scholar
  18. Johansson I, Holgerson PL, Kressin NR, Nunn ME, Tanner AC. Snacking habits and caries in young children. Caries Res 2010;44:421–30.PubMedCrossRefGoogle Scholar
  19. Lawrence HP, Binguis D, Douglas J et al. A 2-year community-randomized controlled trial of fluoride varnish to prevent early childhood caries in Aboriginal children. Community Dent Oral Epidemiol 2008;36:503–16.PubMedCrossRefGoogle Scholar
  20. Mohebbi SZ, Virtanen JI, Vahid-Golpayegani M, Vehkalahti MM. A cluster randomised trial of effectiveness of educational intervention in primary health care on early childhood caries. Caries Res. 2009;43:110–8.PubMedCrossRefGoogle Scholar
  21. Petersen PE. Global policy for improvement of oral health in the 21st century — implications to oral health research of World Health Assembly 2007, World Health Organization. Community Dent Oral Epidemiol 2009; 37:1–8.PubMedCrossRefGoogle Scholar
  22. Pine CM, Adair PM, Nicoll AD et al. International comparisons of health inequalities in childhood dental caries. Community Dent Health 2004;21(1 Suppl):121–30.PubMedGoogle Scholar
  23. Plutzer K, Spencer AJ. Efficacy of an oral health promotion intervention in the prevention of early childhood caries. Community Dent Oral Epidemiol. 2008;36:335–46.PubMedCrossRefGoogle Scholar
  24. Reisine S, Douglass JM. Psychosocial and behavioral issues in early childhood caries. Community Dent Oral Epidemiol 1998;26 Suppl:32–44.PubMedGoogle Scholar
  25. Rossow I, Kjaernes U, Holst D. Patterns of sugar consumption in early childhood. Community Dent Health 1990; 18:12–6.CrossRefGoogle Scholar
  26. Skinner JD, Carruth BR, Wendy B, Ziegler PJ. Children’s food preferences: A longitudinal analysis. J Am Diet Assoc 2002;102:1638–47PubMedCrossRefGoogle Scholar
  27. Thitasomakul S, Piwat S, Thearmontree A et al. Risks for early childhood caries analyzed by negative binomial models. J Dent Res 2009; 88:137–41.PubMedCrossRefGoogle Scholar
  28. van Palenstein Helderman WH, Soe W, van’t Hof MA. Risk factors of early childhood caries in a Southeast Asian population. J Dent Res 2006;85:85–8.PubMedCrossRefGoogle Scholar
  29. Watt RG. Strategies and approaches in oral disease prevention and health promotion. Bull World Health Organ. 2005;83:711–718.PubMedGoogle Scholar
  30. Weinstein P, Harrison R, Benton T. Motivating mothers to prevent caries: confirming the beneficial effect of counseling. J Am Dent Assoc 2006;137:789–93.PubMedGoogle Scholar
  31. Willems S, Vanobbergen J, Martens L, De Maeseneer J. The independent impact of household and neighbourhood based social determinants on early childhood caries: a cross-sectional study of inner city children. Family and Community Health 2005; 28:168–175.PubMedCrossRefGoogle Scholar

Copyright information

© Adis International 2012

Authors and Affiliations

  • C. A. Feldens
    • 1
    Email author
  • P. F. Kramer
    • 1
  • M. C. Sequeira
    • 1
  • P. H. Rodrigues
    • 1
  • M. R. Vítolo
    • 2
  1. 1.Department of Paediatric DentistryLuterana University of Brasil (ULBRA)CanoasBrazil
  2. 2.Department of NutritionFederal University of Ciências da Saúde de Porto AlegrePorto AlegreBrazil

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