Exploring the association between nutritional status and early childhood caries while understanding the effect of nutritional and dental interventions

Abstract

Early Childhood Caries (ECC) is a common multifactorial chronic disease affecting 71.3% of preschool children in Malaysia and 514 million children worldwide. ECC has relation to child’s growth and development. Currently, there are many studies relating ECC to nutritional status but yielding conflicting results. This study aimed to determine the association between nutritional status and early childhood caries and further understand its relation to salivary alpha-amylase (sAA) levels. This mixed method study is divided into two phases. Preschool children were conveniently recruited from Paediatric Dental Clinic, UKM between January 2022 till April 2023. In the first phase, children were divided into 3 groups which were caries free (CF), ECC and severe early childhood caries (SECC) groups based on the decayed, missing and filled teeth index (dmft index). Data was collected from a questionnaire, three-day diet diary, anthropometric measurements, and saliva samples. In the second phase, only SECC children were recruited and divided into two groups. Both groups underwent comprehensive dental treatment and basic dietary advice for caries prevention, while only the intervention group had personalised nutritional intervention. Data was recollected after three months post completion of dental treatment. All saliva samples were processed using Enzyme-linked Immunosorbent Assay (ELISA) to obtain sAA levels. Of the 95 children recruited in the first phase, the majority were boys (54.7%) with mean age of 4.7 years old. Most children were of Malay ethnicity (86.3%) and from middle-income group family (46.3%). About 91.4% of children with SECC had high food fussiness. sAA concentration significantly increased with caries severity as seen in caries free (5.24μg/ml), ECC (10.65μg/ml) and SECC children (12.39μg/ml). There was a significant reduction in sAA concentration 3 months after completion of dental treatment by 3.32μg/ml. In conclusion, there was a significant association between nutritional status and caries status when referring to BAZ score. Age, race, parent’s education level, presence of parental assistance during toothbrushing, type of fluoridated toothpaste, food fussiness, and sAA concentration were factors significantly associated with caries status. Understanding this multifactorial association, allows not only prevention of caries but improvement of children’s overall health and well-being.