Dental caries is the most common chronic disease that can be prevented in children [3]. Previous studies reported the prevalence rate of dental caries to be 27.3-69.5% among preschool children [4, 5, 6]. Children’s dental caries not only influence their wellbeing [7] quality of life [8]and growth [9] but can be a risk factor for caries in permanent teeth [10]. As early childhood caries starts on surfaces that can be easily accessed by routine tooth brushing, oral hygiene levels may be associated with caries risk. Increased frequency and better oral hygiene levels are associated with lower caries levels in preschool children. Several studies show that increased tooth brushing frequency and parental involvement decrease carious lesions on smooth surfaces [11-15].However, a study reports that the absence of tooth brushing is not associated with a greater prevalence of incisor caries [12], while others find no relationship between tooth brushing frequency and caries[14,16]. Additionally, except for one report [12], studies investigating the age of tooth brushing demonstrate few associations with caries status [17-19]. Studies that assess plaque scores or gingival status in preschool children find a positive and significant association between gingivitis, mutans streptococci levels and caries [13, 20].Studies also declared that dental caries could be associated with oral health behavior, eating habits, and frequency of tooth brushing in children [4, 6, 21-23].

Most studies also show that dental knowledge is positively related to caries prevalence. That is, parents who have high scores on dental knowledge usually have children with high caries levels. Regardless of the anomalous finding, these studies confirm the generally agreed-upon principle that education alone is insufficient to produce behavior change [24].  More investigations should be conducted to clarify the parents’ knowledge about their children’s oral health behavior accurately and to identify what they need to improve it [25].

The present study was conducted to access the impact of dental health behaviors on the prevalence and severity of ECC among a group of Lebanese preschool children. It’s a descriptive, cross-sectional study that included various public and private pre-schools in Lebanon. Disposable plastic mirrors were used for screening after drying the area to be examined and before deciding the presence and severity of ECC. The examination was conducted in each school in a prepared room with a suitable source of light for screening, where the child was seated on an ordinary straight back chair. A total of 500 preschool children, aged 3 to 5 years were chosen with the stratified random sample technique with proportional allocation of the subjects, into different strata. Out of 500 students chosen, 409 complied and returned the questioner and hence were included in the study. The study was performed in schools distributed in different areas of Beirut. The students in these schools came from different areas in Lebanon. And hence the results obtained could be generalized on all Lebanese pre­ school children. The selected schools were three private and three public schools.

As for the private schools the students in the study sample were distributed as follows:       

The first school with 54 students.

The second school with 45 students.

The third school with 61 students.

The students in the public schools were distributed as follows:

 The fourth school with 128 students.

The fifth school with 55 students.

The sixth school with 66 students.

Intra-examiner calibration was done before starting the survey where ten children were examined under the supervision of the main supervisor in order to make sure that the investigator achieved optimally uniform examination and to minimize variations which might affect the judgment of the examiner and hence the diagnosis.

Every child was examined using a disposable plastic dental mirror with an adequate source of light. Early childhood caries was diagnosed as present when one or more decayed (non cavitated or cavitated lesions), missing (due to caries), or filled tooth surface on any primary tooth in children up to 71 months of age [1] was detected.

The severity of ECC was classified according to Whyne AH (1999) [2].

Type 1Early Childhood Caries (mild to moderate).

The existence of isolated carious lesion(s) involvi ng molars and / or incisors.

Type 2 Early Childhood Caries (moderate to severe).

Labiolingual carious lesions affecting maxillary incisors, with or without molar caries, and unaffected mandibular incisors.

Type 3 Early childhood caries (severe).

Carious lesions affect almost all the teeth including the lower incisors.

All eligible children were given a questionnaire to be filled in at home by the parents and returned by a specific date. Out of 500 students given the questionnaire, 409 returned the filled questionnaire on the specific date.

Dental health behaviors included in the questionnaire are Age, Gender, Age of commencement of tooth brushing, adult supervision of tooth brushing, Amount of toothpaste used, Application of toothpaste, Dummy use with and without sweetener, Previous visits to dentist, Selection of labels with no added sugar. Descriptive statistics were calculated in the form of frequencies and percents for qualitative variables and mean and standard deviation or medians for quantitative variables. Relation between caries severity and quantitative variables was analyzed using analysis of variance while chi square was used for analysis of association between caries severity and qualitative variables. Significant associations in these bivariate analyses were used to build an ordinal regression model to predict factors affecting caries severity. In all cases, significance was set at the 5% level. Statistical analysis was performed using SPSS version 13.

In order to study the impact of dental health behaviors on the prevalence and severity of ECC, this epidemiologic survey was conducted among 409 preschool children in Lebanon. The data were collected, tabulated and statistically analyzed, using package for social science "SPSS" version 13. And since we have a responsibility, as researchers, to insure and defend the credibility of our work, intra-examiner consistency has been assessed before collecting the data. Table 1 shows the personal characteristics of the study sample. The age of the study sample ranged from 3- 5 years with a mean 4.0 ± 0.9. About half of the sample was males (49.1%). The majority of children were in public schools (60.9%).

Table 1: Personal characteristics

Table 2 shows the relation between caries severity and oral hygiene habits. Significantly more children who brushed were caries free compared to non-brushers (30.6% and 14.8% respectively, P<0.0001). more children who started brushing  at  12 and  18 months were caries free compared to children who  started brushing  at 24 months  or later  (55.8%,  50.7%,  20.8%  and 20.3%  respectively,  P<0.0001).  No relation was observed between caries severity and parental supervision of brushing, amount of toothpaste placed on brush or who places toothpaste on tooth brush (P= 0.10, 0.06 and 0.10 respectively).

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