title: Factors underlying the polarization of early childhood caries within a high-risk population.
abstract: BACKGROUND
  Early childhood caries (ECC) are particularly prevalent in disadvantaged populations, and socioeconomic factors are associated with the polarization of disease. A previous study showed that even within a homogenous low-income population disease is polarized, indicating that other factors apart from income may contribute to disease susceptibility.
  
  
  METHODS
  This study used a hierarchical approach to identify factors associated with polarization of ECC in low-income subjects. This cross-sectional study was conducted retrospectively using a cohort of 244 children (aged 48-72 months) with family incomes not exceeding double the minimum wage (U.S. $8,208.00/year), living in neighborhoods on the outskirts of São Luís, Maranhão, Brazil. The sample was divided into three groups based on the Significant Caries (SiC) Index: no caries group, few caries group (mean 1.38 lesions), and a high caries group (mean 3.82 lesions). Hierarchical multinomial logistic regression analyses were performed based on a theoretical model.
  
  
  RESULTS
  Twenty-eight (11.5%) of the 244 children presented with high caries. Age (p = 0.026; prevalence ratio (PR) = 1.10; 95% confidence interval (CI) 1.01-1.20) and frequency of sucrose consumption - p = 0.001; PR 4.65 (95% CI 1.83-11.84) were associated with increased risk of ECC.
  
  
  CONCLUSIONS
  In the high caries group, greater consumption of sucrose between main meals may explain why, in a group of children with homogenous social and health conditions, some had more caries than others.
authors.forename: Ana Margarida Melo
authors.initials: AM
authors.lastname: Nunes
authors.forename: Antônio Augusto Moura
authors.initials: AA
authors.lastname: da Silva
authors.forename: Claudia Maria Coelho
authors.initials: CM
authors.lastname: Alves
authors.forename: Fernando Neves
authors.initials: FN
authors.lastname: Hugo
authors.affiliation: Federal University of Maranhão, Jupiter Street 12, apartment 1101, Ed, José Gonçalo, Renascença II, São Luis, Ma, Brasil. cecilia_ribeiro@hotmail.com.
authors.forename: Cecilia Claudia Costa
authors.initials: CC
authors.lastname: Ribeiro
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003729:Dental Care; D003731:Dental Caries / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009910:Oral Hygiene; D011203:Poverty / Q000706:statistics & numerical data*; D015995:Prevalence; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013395:Sucrose / Q000008:administration & dosage*
chemical_list: D013395:Sucrose