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Common risk factor approach to address socioeconomic inequality in the oral health of preschool children – a prospective cohort study

Loc G Do1*, Jane A Scott2, W Murray Thomson3, John W Stamm4, Andrew J Rugg-Gunn5, Steven M Levy6, Ching Wong1, Gemma Devenish2, Diep H Ha1 and A John Spencer1

Author Affiliations

1 Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia

2 Curtin University, Perth, Australia

3 University of Otago, Dunedin, New Zealand

4 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

5 University of Newcastle upon Tyne, Newcastle, UK

6 The University of Iowa, Iowa city, IA, USA

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BMC Public Health 2014, 14:429  doi:10.1186/1471-2458-14-429

Published: 6 May 2014



Dental caries remains the most prevalent chronic condition in children and a major contributor to poor general health. There is ample evidence of a skewed distribution of oral health, with a small proportion of children in the population bearing the majority of the burden of the disease. This minority group is comprised disproportionately of socioeconomically disadvantaged children. An in-depth longitudinal study is needed to better understand the determinants of child oral health, in order to support effective evidence-based policies and interventions in improving child oral health. The aim of the Study of Mothers’ and Infants’ Life Events Affecting Oral Health (SMILE) project is to identify and evaluate the relative importance and timing of critical factors that shape the oral health of young children and then to seek to evaluate those factors in their inter-relationship with socioeconomic influences.


This investigation will apply an observational prospective study design to a cohort of socioeconomically-diverse South Australian newborns and their mothers, intensively following these dyads as the children grow to toddler age. Mothers of newborn children will be invited to participate in the study in the early post-partum period. At enrolment, data will be collected on parental socioeconomic status, mothers’ general and dental health conditions, details of the pregnancy, infant feeding practice and parental health behaviours and practices. Data on diet and feeding practices, oral health behaviours and practices, and dental visiting patterns will be collected at 3, 6, 12 and 24 months of age. When children turn 24-30 months, the children and their mothers/primary care givers will be invited to an oral examination to record oral health status. Anthropometric assessment will also be conducted.


This prospective cohort study will examine a wide range of determinants influencing child oral health and related general conditions such as overweight. It will lead to the evaluation of the inter-relationship among main influences and their relative effect on child oral health. The study findings will provide high level evidence of pathways through which socio-environmental factors impact child oral health. It will also provide an opportunity to examine the relationship between oral health and childhood overweight.

Children; Early childhood caries; Socioeconomic inequality; Prospective cohort study