Environmental, maternal, and child factors which contribute to early childhood caries: a unifying conceptual model.

OBJECTIVES: Although the general pathways connecting the external social environment and child risk factors of early childhood caries (ECC) have been previously identified, the maternal and other links to ECC are not well understood. The aim of this paper is to propose a unifying conceptual model that ties together the broad social environmental, maternal, and child factors that are commonly associated with ECC.
METHODS: The aetiological factors of ECC are first reviewed individually to demonstrate their connections with ECC risk followed by presentation of the unifying conceptual model.
RESULTS: In severe ECC cases, there is usually a background of social disadvantage associated with low socioeconomic status, ethnicity or immigrant status, and low maternal educational level. These factors are commonly associated with economic and familial stresses which may in turn result in maternal psychological distress. The distress may be compounded by difficult temperaments of the children and can lead to dysfunctional parenting behaviours that place a child at risk for ECC.
CONCLUSIONS: The proposed conceptual model provides a framework that connects the social, psychological, and behavioural mediating factors involved in ECC. It demonstrates that the causative pathways involved are best explored using a combination of quantitative and qualitative research.