Theses Doctoral

The Diet and Early Childhood Caries (DECC) Study: Validation of a Novel ECC Risk Assessment Tool and Investigation of Diet-Related ECC Risk Factors

Custodio-Lumsden, Christie Lauren

Early Childhood Caries (ECC) is a highly prevalent disease afflicting approximately 28 percent of children in the U.S. under the age of 6 years (Bruce A Dye et al., 2007). ECC is a serious condition that can have profound health implications, including altered physical appearance, impaired ability to chew and speak, diminished quality of life, and increased risk for both oral and systemic health conditions (Colares and Feitosa, 2003; B. L. Edelstein, Vargas, and D, 2006; Norman Tinanoff and Reisine, 2009). Early identification of risk and prompt, targeted intervention is essential to overcoming the rising rates of ECC. The Diet and Early Childhood Caries (DECC) study was designed to evaluate a novel risk assessment tool, MySmileBuddy (MSB), in a predominantly Spanish speaking, low income, urban population. MSB serves as an interactive platform for education and goal setting for ECC prevention and a comprehensive ECC risk assessment tool that incorporates questions evaluating diet, feeding practices, general attitudes and beliefs, fluoride use, and family history. A large component of the MSB tool is devoted to the assessment of dietary risk factors related to ECC via inclusion of a modified 24-hour dietary recall. A primary aim of the DECC study was to establish concurrent criterion validity by evaluating if MSB diet and comprehensive scores were associated with physical evidence of risk (i.e., oral mutans levels, decalcifications, visible plaque, and ECC status). Additionally the DECC study aimed to examine associations between physical evidence of caries risk and overall frequency of oral exposures, length of exposure time, and body mass index-for-age (BMI/age). Lastly, the DECC study was designed to assess the preliminary impact of the MSB intervention on recollection of stated goals and progress toward achievement of targeted ECC-related behavior changes one month post-intervention. In 108 parent/child (caregiver/child) dyads, the MSB diet risk scores were found to be significantly associated with early stage indicators of caries risk, specifically oral mutans levels (p less than 0.05), and borderline associated (p less than 0.1) with visible plaque levels. The MSB comprehensive risk score was also found to be significantly associated with both oral mutans and visible plaque (p less than 0.05). Children with high MSB risk scores (diet and comprehensive) were more likely to have higher levels of oral mutans, and more likely to have higher levels of visible plaque compared to children with lower scores. Physical indicators of caries risk were not associated with other factors included in the DECC study (i.e., frequency of oral exposures and intake of individual food/beverage categories, length of oral exposure time, and BMI/age weight status). Preliminary data from the one-month follow-up suggests that the majority of parents/caregivers were able to recall their MSB goal and were beginning to initiate diet- and other dental-related changes at home. Overall, these findings suggest that the MSB tool may be a valid tool for predicting known physical precursors to caries and may be an effective avenue for behavior change. While these preliminary findings are encouraging, larger and longer-term studies will be necessary to determine the ultimate utility of MSB in predicting the ECC experience in children.


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More About This Work

Academic Units
Behavioral Nutrition
Thesis Advisors
Wolf, Randi
Ph.D., Columbia University
Published Here
May 14, 2013