title: Early childhood caries and access to dental care among children of Portuguese-speaking immigrants in the city of Toronto.
abstract: OBJECTIVE
  To determine the influence of accessibility of dental services and other factors on the development of early childhood caries (ECC) among Toronto children 48 months of age or younger with at least one Portuguese-speaking immigrant parent.
  
  
  METHODS
  This population-based case-control study involved 52 ECC cases and 52 controls (i.e., without ECC) identified from community centres, churches and drop-in centres by a process of network sampling. Caries status (dmft/s) was assessed by clinical examination. Access to dental care and risk factors for ECC were determined through a structured interview with the Portuguese-speaking parent.
  
  
  RESULTS
  Forty (77%) of the children with ECC but only 28 (54%) of controls had never visited a dentist. Thirty (58%) mothers of children with ECC but only 13 (25%) mothers of controls had not visited a dentist in the previous year. Bivariate analyses revealed that low family income, no family dentist, no dental insurance, breastfeeding, increased frequency of daily snacks and low parental knowledge about harmful child feeding habits were associated with ECC. Non-European-born parents and parents who had immigrated in their 20s or at an older age were 2 to 4 times more likely to have a child with ECC than European parents and those who had immigrated at a younger age. Lack of insurance, no family dentist and frequency of snacks were factors remaining in the final logistic regression model for ECC.
  
  
  CONCLUSIONS
  The strongest predictors of ECC in this immigrant population, after adjustment for frequent snack consumption, were lack of dental care and lack of dental insurance. These findings support targeting resources to the prevention of ECC in children of new immigrants, who appear to experience barriers to accessing private dental care and who are exposed to many of the determinants of oral disease.
authors.affiliation: Health and Biological Sciences Centre, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.
authors.forename: Renata I
authors.initials: RI
authors.lastname: Werneck
authors.forename: Herenia P
authors.initials: HP
authors.lastname: Lawrence
authors.forename: Gajanan V
authors.initials: GV
authors.lastname: Kulkarni
authors.forename: David
authors.initials: D
authors.lastname: Locker
mesh_terms: D000328:Adult; D000810:Angola / Q000208:ethnology; D001394:Azores / Q000208:ethnology; D001903:Bottle Feeding / Q000706:statistics & numerical data; D001938:Brazil / Q000208:ethnology; D016022:Case-Control Studies; D002675:Child, Preschool; D003144:Communication Barriers; D004245:DMF Index; D003731:Dental Caries / Q000453:epidemiology*; D003752:Dental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D004037:Diet, Cariogenic; D054242:Emigrants and Immigrants; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007347:Insurance, Dental; D007802:Language; D016015:Logistic Models; D008297:Male; D009864:Ontario / Q000453:epidemiology; D011174:Portugal / Q000208:ethnology