All ETDs from UAB

Advisory Committee Chair

Gerald McGwin Jr

Advisory Committee Members

Noel K Childers

Russell L Griffin

Emily B Levitan

Leann Long

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Public Health


Researchers assume caries progress constantly, all crowned/extracted tooth surfaces are carious, and non-water beverage consumption (NWBC) habits are similar by relying on increments, dmfs scoring, and consumption frequencies, respectively. These assumptions are likely inaccurate. The purpose of this research was to evaluate and modify the use of 1) longitudinal caries disease assessment, 2) the dmfs score and 3) NWBC variables to more accurately estimate disease and identify risk factors. To investigate, young (8-18 months at baseline), healthy, poor, rural, African American, Alabamian children were observed annually for five years. Three calibrated dentists performed oral examinations (without radiographs), calculating the number of carious decayed, missing, filled surfaces (dmfs) score, at each visit. The traditional increment (dmfs increment = dmfs5yr – dmfsbaseline, N = 66) and newly-proposed average area under the dmfs curve (dmfsaAUC = summations of trapezoidal areas under dmfs trajectories, N = 85) measures were calculated to obtain longitudinal caries experiences. The two measures (N = 66) were compared visually, quantitatively, and statistically (paired t-test, p ≤ .05). Dental records obtained from the treating (non-study) dentists were reviewed to determine the number of carious surfaces of crowned/extracted teeth at treatment time to create more accurate dmfs scores. Assumed and chart-reviewed caries scores (N = 19; 53 teeth) were compared with a sign test (p ≤ 0.05). Legal guardians completed baseline questionnaires, providing demographic, dietary, and oral hygiene care data. In addition to beverage type and frequency, NWBC behaviors of how (intermittent vs. rapid intake), container (bottle vs. non-bottle), and bedtime use (yes vs. no) were reported. Associations between NWBC frequencies and caries, also adjusting for NWBC behaviors, were investigated with logistic regression (caries vs. caries-free, N = 66) models, producing odds ratios (95% confidence intervals). Equal incremental values resulted from unequal dmfs trajectories. Standardized dmfsaAUC values were greater than standardized increments. For crowns/extractions, chart-reviewed caries scores were significantly lower (2 – 3 surfaces) than assumed estimates (p < 0.0001). Adjustment for NWBC behaviors maintained/suggested juice/caries associations (OR ~2.0, 95% CI ~0.9, 4.3). In conclusion, precise caries and NWBC measurement in children can better describe early childhood caries epidemiology, potentially reducing disease burdens.

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