title: Factors contributing to severe early childhood caries in south-west Germany.
abstract: OBJECTIVE
  The purpose of this study is to investigate the contribution of selected variables to the occurrence of severe early childhood caries (S-ECC) in 3- to 5-year-old kindergarten children.
  
  
  METHODS
  A cross-sectional study was conducted in 2010 in 30 randomly selected kindergartens in the German Rhein-Neckar district. After informed consent, parents were asked to complete a questionnaire. The oral examinations took place in the selected kindergartens and the WHO methods as well as the criteria proposed by the American Academy of Pediatric Dentistry were followed. Logistic regression was applied to explore the main factors contributing to S-ECC in a multivariate model.
  
  
  RESULTS
  In all, 1,007 children aged 3 to 5 years with an average age of 4.1 (SD = 0.8) years were examined. Five variables were associated significantly with the occurrence of S-ECC: breastfeeding for more than 12 months (OR = 3.27), use of the nursing bottle in bed (OR = 3.08), start of tooth brushing after the first anniversary (OR = 2.42), regular visits at the dentists (OR = 0.14) and mother with immigration background (OR = 4.05). Prevalence rate of S-ECC was 9.5 %. The mean d(3+4)mft values were 5.69 (S-ECC group) and 0.23 (non-S-ECC group).
  
  
  CONCLUSIONS
  These results show that occurrence of S-ECC is a complex interaction between socioeconomic, psychological and behavioural factors of parents. New and specific ways to provide preventive dental care for toddlers and infants of caries risk groups have to be developed.
  
  
  CONCLUSIONS
  Parents of newborn children have to receive information about timely start of tooth brushing and adequate use of nursing bottles.
authors.affiliation: Department of Conservative Dentistry, University of Heidelberg, Heidelberg, Germany, Abdul-razak.bissar@med.uni-heidelberg.de.
authors.forename: A
authors.initials: A
authors.lastname: Bissar
authors.forename: P
authors.initials: P
authors.lastname: Schiller
authors.forename: A
authors.initials: A
authors.lastname: Wolff
authors.forename: U
authors.initials: U
authors.lastname: Niekusch
authors.forename: A G
authors.initials: AG
authors.lastname: Schulte
mesh_terms: D003430:Cross-Sectional Studies; D003731:Dental Caries / Q000209:etiology*; D005858:Germany; D049691:History, Medieval; D006801:Humans; D012307:Risk Factors; D012720:Severity of Illness Index