title: Developmental delays and dental caries in low-income preschoolers in the USA: a pilot cross-sectional study and preliminary explanatory model.
abstract: BACKGROUND
  Anecdotal evidence suggests that low-income preschoolers with developmental delays are at increased risk for dental caries and poor oral health, but there are no published studies based on empirical data. The purpose of this pilot study was two-fold: to examine the relationship between developmental delays and dental caries in low-income preschoolers and to present a preliminary explanatory model on the determinants of caries for enrollees in Head Start, a U.S. school readiness program for low-income preschool-aged children.
  
  
  METHODS
  Data were collected on preschoolers ages 3-5 years at two Head Start centers in Washington, USA (N = 115). The predictor variable was developmental delay status (no/yes). The outcome variable was the prevalence of decayed, missing, and filled surfaces (dmfs) on primary teeth. We used multiple variable Poisson regression models to test the hypothesis that within a population of low-income preschoolers, those with developmental delays would have increased dmfs prevalence than those without developmental delays.
  
  
  RESULTS
  Seventeen percent of preschoolers had a developmental delay and 51.3% of preschoolers had ≥1 dmfs. Preschoolers with developmental delays had a dmfs prevalence ratio that was 1.26 times as high as preschoolers without developmental delays (95% CI: 1.01, 1.58; P < .04). Other factors associated with increased dmfs prevalence ratios included: not having a dental home (P = .01); low caregiver education (P < .001); and living in a non-fluoridated community (P < .001).
  
  
  CONCLUSIONS
  Our pilot data suggest that developmental delays among low-income preschoolers are associated with increased primary tooth dmfs. Additional research is needed to further examine this relationship. Future interventions and policies should focus on caries prevention strategies within settings like Head Start classrooms that serve low-income preschool-aged children with additional targeted home- and community-based interventions for those with developmental delays.
authors.affiliation: University of Washington, Box 357475, Seattle 98195, WA, USA. dchi@uw.edu.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Chi
authors.forename: Katharine C
authors.initials: KC
authors.lastname: Rossitch
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Beeles
mesh_terms: D017028:Caregivers / Q000193:education; D016009:Chi-Square Distribution; D002675:Child, Preschool; D003147:Communication Disorders / Q000150:complications; D003430:Cross-Sectional Studies; D004245:DMF Index; D019140:Dental Care for Children; D003731:Dental Caries / Q000150:complications* / Q000453:epidemiology*; D002658:Developmental Disabilities / Q000150:complications* / Q000453:epidemiology*; D018479:Early Intervention, Educational; D004522:Educational Status; D005457:Fluoridation; D006801:Humans; D018803:Models, Economic; D010865:Pilot Projects; D016012:Poisson Distribution; D011203:Poverty; D015995:Prevalence; D012044:Regression Analysis; D018709:Statistics, Nonparametric; D014094:Tooth, Deciduous; D014481:United States / Q000453:epidemiology; D014861:Washington / Q000453:epidemiology