MULTIDIMENSIONAL CAUSAL MODEL OF DENTAL-CARIES DEVELOPMENT IN LOW-INCOME PRESCHOOL-CHILDREN

DESPITE THE DECLINE in the incidence of dental caries in the United St ates over the past several years, the condition remains a significant problem for the nation's poor children. Efforts to identify the factor s responsible for caries development in samples of children of low soc ioeconomic status have primarily focused on a limited number of variab les, and those have been predominantly biological (mutans streptococci , for example). Resulting models of caries development have usually sh own good sensitivity but poor specificity. They have had limited impli cations for treatment. In an effort to produce a comprehensive model o f caries development, 184 low-income preschool children were clinicall y assessed for mutans streptococci and for decayed, missing, or filled surfaces of deciduous teeth twice, first at age 4 years (baseline) an d again a year later (year 1 assessment). As the clinical assessments were being done, caretakers were being interviewed to obtain data from five domains: demographics, social status, dental health behaviors, c ognitive factors such as self-efficacy (self-confidence) and controlla bility, and perceived life stress. Data were analyzed using a structur al equations modeling approach in which variables from all domains, pl us baseline decayed missing and filled surfaces and baseline mutans, w ere used together to create a model of caries development in the year 1 assessment. Results confirmed earlier work that suggested that carie s development at a 1-year followup was strongly dependent on earlier c aries development. Early caries development in this sample was determi ned in part by mutans levels and by dental health behaviors. These beh aviors themselves were accounted for partly by a cognitive factor. The results support the advantages of employing multidimensional models a nd provide some direction for intervention to reduce caries incidence.