Table of Contents  
Year : 2014  |  Volume : 6  |  Issue : 1  |  Page : 53-57

Early childhood caries and its correlation with maternal education level and socio-economic status

1 Department of Pedodontics and Preventive Dentistry, Budhera, Gurgaon, Haryana, India
2 Department of Periodontics, SGT Dental College, Budhera, Gurgaon, Haryana, India

Date of Web Publication15-May-2014

Correspondence Address:
Amit Bhardwaj
House No. 1010, Sector 4, Gurgaon - 122 001, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-8844.132582

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Objectives: This study was carried out to correlate the relationship between early childhood caries and maternal education level and socio-economic status (SES). Materials and Methods: The study was conducted on 500 pairs of children of ≤6 years age and their mothers, who reported to the private dental clinic in Gurgaon, Haryana, India. The association between mother's educational level and SES of the family were estimated through a self-structured questionnaire. Caries status of the children was estimated using deft index (World Health Organization criteria). Results: Collected data was statistically analyzed. There was an inverse relationship between the education level of mothers and caries status of their children. There was no relationship between the SES of mothers and caries status of their children. Conclusion: It was concluded that, mothers are responsible for their children primary oral health.

Keywords: Early childhood caries, prevention, socio-economic status

How to cite this article:
Bhardwaj SV, Bhardwaj A. Early childhood caries and its correlation with maternal education level and socio-economic status. J Orofac Sci 2014;6:53-7

How to cite this URL:
Bhardwaj SV, Bhardwaj A. Early childhood caries and its correlation with maternal education level and socio-economic status. J Orofac Sci [serial online] 2014 [cited 2023 Jun 9];6:53-7. Available from:

  Introduction Top

Early childhood caries (ECC) is defined as "the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a child 71 months of age or younger. [1] Childhood caries is a public health problem that affects infants and preschoolers throughout the world, leading to pain, chewing difficulties, speech problems, general health disorders, psychological problems and lower quality-of-life. [2] Further, decay of primary teeth can affect children's growth, leading to malocclusion by adversely affecting the correct guidance of the permanent dentition.

The centers for disease control and prevention reported that caries is perhaps the most prevalent of infectious diseases among children. This disease affects the general population but is more likely to occur in infants who are of low socio-economic status (SES), whose mothers have low education level and who consume sugary foods. [3] Caries experience in recent years, especially in developing countries, demonstrates that a significant proportion of infants and preschoolers are still affected by the disease with a strong polarization. [2] Children under the age of 5 years spend most of their time with their parents and guardians. Dietary habits and healthy behaviors established as norms in the home and are dependent on the knowledge and behavior of parents. Without basic knowledge of caries risk factors, importance of the deciduous teeth and oral maintenance, it is difficult to employ effective disease preventive strategies. [4] In most of the developing countries in South East Asia, children have a high prevalence of dental caries in the primary dentition, often in contrast to the situation in the permanent dentition. The reasons for this difference are not obvious, but may be linked to differences in diet. In developing countries, the prevalence of dental caries seems to be increasing with the increase in sugar intake, while it stays low in countries where a poor economy restricts sugar intake. The prevalence of dental caries has been found to be variable as follows: 70%, 53%, 25%, 50.8%, 51.6% and 68.7% in the age group of 5-6 years in Bangalore (Urban), Davengere (Urban), Davengere (Rural), Kerala (Rural) and Gurgaon (Urban) respectively. [5]

Mother's behavior is correlated with children's oral health. The tooth-brushing and dietary habits of the mother are associated directly with those of her child. Children's dietary habits vary according to their mothers' educational level, resulting in low income families consuming diets higher in added sugars than diets of higher income families. [6] Despite having good knowledge, many mothers are using nursing bottle at bed time. [4] Cariogenic or decay-causing bacteria are typically transmitted from the mother or care-giver to child by behaviors that directly pass saliva, such as sharing a spoon when tasting baby food, cleaning a dropped pacifier by mouth, or wiping the baby's mouth with saliva. [2] Daily sugar consumption is an independent risk factor for ECC and that supervised tooth-brushing with a fluoridated dentifrice is a proven intervention to reduce ECC. [6] Hence, the present study, was undertaken with the aims to determine the relationship of dental caries of children with mother's educational level (as obtained from the questionnaire) and to determine the relationship of dental caries of children with mother's SES (as obtained from questionnaire).

  Materials and methods Top


The questionnaire-based study was conducted on a sample of 500 pairs of children of ≤6 years age and their mothers, who reported to the private dental clinic in Gurgaon, Haryana, India. The duration of the study was 3 months. The aims and procedure of the study was explained to the mothers and the informed consent was obtained from them prior to the study.

Inclusion criteria

  1. Children of ≤6 years of age
  2. Mothers who gave informed consent.

Exclusion criteria

  1. Children of ≤6 years of age who lost their mothers or whose mothers were not residing with them
  2. Physically or mentally handicapped or medically compromised children
  3. Marked intra-oral soft tissue pathology
  4. Children using oral appliance.

Study design

The correlation between mother's educational levels, SES of the family was estimated through a self-structured questionnaire [Annexures 1 and 2]. [7] The local language was used for collecting all the required and relevant information from the mothers. All the data was collected by a single trained examiner.

Clinical examination

All the dental examinations were performed by single trained dentist using World Health Organization (WHO) criteria. Each child underwent intra-oral examination for dental caries status. Examination was done in artificial light with mouth mirror and probe. Dental caries was recorded for children with primary dentition using def index (decayed, indicated for extraction, filled index, Gruebbel AO, 1944). [8]

  Results Top

Data was entered in spreadsheets and was analyzed using software, Statistical Package for the Social Sciences (SPSS version 19.0, IBM Corp. Released 2010. IBM SPSS Statistics for Windows, Version 19.0 Armonk, NY: IBM Corp).

Evaluation of influence of education level of mothers on caries status of children

Mean deft of children with illiterate, primary to middle school, high school to intermediate and graduate to professional mothers were 8.3, 8.6, 9.2 and 5.7 respectively [Table 1]. There was statistically significant difference between graduate to the professional group with high school to intermediate group and primary to the middle group with P < 0.002 and P < 0.021 respectively [Table 2]. There was no significant difference between illiterate group and any other groups.

Evaluation of relationship of child's caries status with the SES of the family

Evaluation of relationship of child's caries status with the SES of the family was done on the basis of their monthly income as : b0 elow the poverty line (monthly income below Rs. 500), poor (Rs. 500-1499), lower middle (Rs. 1500-2999), upper middle (Rs. 3000-4999), high (Rs. 5000-9,999) and upper high (Rs. 10,000 and above).

As there was no mother below the poverty line so this class of SES was not included in statistical analysis. Mean deft values for poor, lower middle, upper middle, high and upper high are 7.0, 8.6, 8.7, 8.8 and 9.2 respectively. It was found that there was no statistical significance found between the groups [Table 3] and [Table 4].
Table 1: Mean deft of children according to the education level of their mothers

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Table 2: Multiple comparisons between various groups according to education level

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Table 3: Mean deft of children according to the socio-economic status of their mothers

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Table 4: Multiple comparisons between various groups according to socio-economic status

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  Discussion Top

In the present study, a total 500 pairs of children of ≤6 years age were screened for deft according to WHO criteria. One objective of the present study was to determine the relationship between the children dental caries status with their mother's education level. Mean deft of children with illiterate, primary to middle school, high school to intermediate and postgraduate to professional mothers were 8.3, 8.6, 9.2 and 5.7 respectively [Table 1] and [Table 2]. These results showed an inverse relationship between mothers' education level and children deft values.

Elena and Petr [9] concluded that mothers with background of high education have more positive dental knowledge and attitudes, whereas Ersin et al. [10] and Qin et al. [11] concluded in their study that a lower maternal education level, poor knowledge of oral hygiene, night-feeding and excessive sugar intake were important contributors to the development of ECC in young children. In the present study, it was found that low education level of mothers was significantly related to the occurrence of caries, which is consistent with other studies.

Other objective of the present study was to determine the relationship between children dental caries level with their mother's SES. In the present study, there was no correlation found between the SES of mothers and dental caries status of their children [Table 3] and [Table 4]. These results are in accordance with the results of the study by Savara and Suher, [12] who found no association between dental caries of children and income of parents. Reisine and Psoter [13] in a systematic review summarized the association between the incidence and prevalence of dental caries and various variables: SES, tooth-brushing and the use of the baby bottle. It was concluded that children in families of low SES had a higher prevalence of caries as compared to children in high SES families. Ismail et al. [14] and Tyagi [15] have also concluded that ECC are highly prevalent in low-income groups. ur Rehman et al. [16] adopted similar criteria in his study to find the relationship between caries and oral health status of children with extra oral or demographic factors and found that is the inverse relationship between SES and decayed/missing/filled teeth (DMFT) in children, whereas strongly correlated with frequency of sugar intake and frequency of snacking in-between meals.

  Conclusion Top

It can be concluded that, mothers are responsible for their child's life-style, behavior and habits and represents the primary information about oral health. Hence, pre and postnatal counseling of mothers about oral health will help in increasing the oral health awareness of their children. If oral health promotion efforts are to be effective in improving the oral health of young children, it is essential that there be a good understanding of parental knowledge and attitudes. Such strategies may help to guide and modify current and future oral health prevention activities.

  References Top

1.American Academy of Pediatric Dentistry. Definition of early childhood caries (ECC). Pediatr Dent 2008;25:15.  Back to cited text no. 1
2.Agarwal V, Nagarajappa R, Keshavappa SB, Lingesha RT. Association of maternal risk factors with early childhood caries in schoolchildren of Moradabad, India. Int J Paediatr Dent 2011;21:382-8.  Back to cited text no. 2
3.American Academy of Pediatric Dentistry. Guideline on infant oral health care. Pediatr Dent 2009;30:90-3.  Back to cited text no. 3
4.Suresh BS, Ravishankar TL, Chaitra TR, Mohapatra AK, Gupta V. Mother's knowledge about pre-school child's oral health. J Indian Soc Pedod Prev Dent 2010;28:282-7.  Back to cited text no. 4
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5.Kalra G, Bansal K, Sultan A. Prevalence of early childhood caries and assessment of its associated risk factors in preschool children of urban Gurgaon, Haryana. Indian J Dent Sci 2011;3:12-6.  Back to cited text no. 5
6.Dye BA, Vargas CM, Lee JJ, Magder L, Tinanoff N. Assessing the relationship between children's oral health status and that of their mothers. J Am Dent Assoc 2011;142:173-83.  Back to cited text no. 6
7.Agarwal A. Social classification: The need to update in the present scenario. Indian J Community Med 2008;33:50-1.  Back to cited text no. 7
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8.Soben P. Indices used in dental epidemiology. Essentials of Preventive and Community Dentistry. 1 st ed. New Delhi: Arya (Medi) Publishing House; 1999. p. 456-552.  Back to cited text no. 8
9.Elena B, Petr L. Oral health and children attitudes among mothers and school teachers in Belarus. Stomatolgija, Baltic Dental Maxillofacial Journal 2004;6:40-3.  Back to cited text no. 9
10.Ersin NK, Kocabas EH, Alpoz AR, Uzel A. Transmission of Streptococcus mutans in a group of Turkish families. Oral Microbiol Immunol 2004;19:408-10.  Back to cited text no. 10
11.Qin M, Li J, Zhang S, Ma W. Risk factors for severe early childhood caries in children younger than 4 years old in Beijing, China. Pediatr Dent 2008;30:122-8.  Back to cited text no. 11
12.Savara BS, Suher T. Dental caries in children one to six years of age as related to socioeconomic level, food habits, and toothbrushing. J Dent Res 1955;34:870-5.  Back to cited text no. 12
13.Reisine ST, Psoter W. Socioeconomic status and selected behavioral determinants as risk factors for dental caries. J Dent Educ 2001;65:1009-16.  Back to cited text no. 13
14.Ismail AI, Lim S, Sohn W, Willem JM. Determinants of early childhood caries in low-income African American young children. Pediatr Dent 2008;30:289-96.  Back to cited text no. 14
15.Tyagi R. The prevalence of nursing caries in Davangere preschool children and its relationship with feeding practices and socioeconomic status of the family. J Indian Soc Pedod Prev Dent 2008;26:153-7.  Back to cited text no. 15
[PUBMED]  Medknow Journal  
16.ur Rehman MM, Mahmood N, ur Rehman B. The relationship of caries with oral hygiene status and extra-oral risk factors. J Ayub Med Coll Abbottabad 2008;20:103-8.  Back to cited text no. 16


  [Table 1], [Table 2], [Table 3], [Table 4]

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