Socio-demographic correlates of early childhood caries prevalence and severity in a developing country--South Africa.

OBJECTIVES: To describe Early Childhood Caries (ECC) severity in South Africa and examine the association between ECC and socio-demographic factors, area-based measures of sugar consumption and water fluoride levels. METHODS: Children, aged 36-71 months, were examined during the 1999/2002 South African National Children's Oral Health Survey (n=5822). ECC severity was described using Wyne's ECC classification (adapted) and the Significant Caries Index (SIC). Socio-demographic factors, area-based fluoride levels in water supplies, and the area-based per capita sugar expenditure obtained from the 2000 Household Expenditure Survey were examined using bivariate and multivariate analyses. RESULTS: The mean population SiC was 7.6 and 32% presented with the severe forms of ECC. Increased per capita sugar expenditure and decreasing water fluoride levels, were significantly associated with an increased risk for any ECC, but was not significantly associated with the severe forms of ECC. Compared to blacks, being of mixed race and white were respectively associated with an increased and a decreased risk for ECC. Unemployment increased the risk for the severe forms of ECC. CONCLUSIONS: The study findings support the implementation of an integrated primary oral health care strategy in order to address the underlying socio-economic determinants of ECC in South Africa.