ORIGINAL Liang ARTICLE et al
Experience of Early Childhood Caries May Positively Correlate with Psychomotor Development Chen-Yi Lianga/Yen-Chun Liub/Tien-Yu Shiehc/Jia-Rong Lind/Yi-Chun Tsenge/ Andy Yen-Tung Tengf Purpose: To examine the as yet unknown relationship between dental caries and the child’s psychomotor development. Materials and Methods: A cross-sectional study was designed by screening the kindergartens from urban areas of two cities in southern Taiwan. Besides the personal, demographic and dietary information, the common measures for caries (dmft) and the amended comprehensive scales (CCDI) for psychomotor development were used to assess their relationship(s). A power analysis showed that 334 subjects would be required. One-way ANOVA vs multiple linear regression analysis were used to compare the differences of variables between gender, age and dmft scales, vs the relationship among all variables tested, respectively. Results: A total of 433 children completed the study. The results demonstrated that there was a positive relationship between higher (i.e. dmft ≥ 4 and 5) but not lower or extremely high caries experience and aspects of psychomotor development (i.e. personal-social and expressive language) in children aged 4 to 6 years. Conclusion: The present results are important for paediatric dentists, as they suggest a positive correlation between caries experience (dmft 3 to 6) and psychomotor development in pre-school children and that such a correlation may occur more significantly as an attribute of the most affected teeth (incisors and molars) during the critical stage of personal-social and expressive language development (speech-communication). Key words: Chinese Child Development Inventory (CCDI), dental caries, pre-school children, psychomotor development, universal health insurance programme Oral Health Prev Dent 2015;13:365-375 doi: 10.3290/j.ohpd.a32992
D
Submitted for publication: 05.01.13; accepted for publication: 08.08.13
ental caries is one of the most common preventable chronic illnesses in children, which continues on into adulthood and can ultimately result in tooth loss (Selwitz et al, 2007). It is clear that the risk factors for developing caries include poor oral hygiene, lack of fluoride supplements or oral hy-
giene products, as well as nutritional and environmental factors (Bayo et al, 2001; Touger-Decker and van Loveren, 2003; Dugmore and Rock, 2004; Selwitz et al, 2007; Meurman and Pienihakkinen, 2010). Other risk factors include: 1) high consumption of sugared/carbonated drinks, 2) overweight by
a
e
Instructor, Department of Childhood Education and Nursery, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
f
Professor, Graduate Institute of Dental Sciences and Dept. of Dental Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Centre for Osteoimmunology and Biotechnology Research, School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Laboratory of Molecular Microbial Immunity, Eastman Institute for Oral Health, Department of Microbiology and Immunology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA.
Instructor, Graduate Institute of Dental Sciences and Dept. of Dental Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Childhood Education and Nursery, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
b
Assistant Professor, Graduate Institute of Dental Sciences and Dept. of Dental Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Centre for Osteoimmunology and Biotechnology Research, School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
c
Professor, Graduate Institute of Dental Sciences and Dept. of Dental Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Centre for Osteoimmunology and Biotechnology Research, School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
d
Associate Professor, Department of Childhood Education and Nursery, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
Vol 13, No 4, 2015
Correspondence: Professor Andy Yen-Tung Teng, Centre for Osteoimmunology and Biotechnology Research, College of Dental Medicine, Kaohsiung Medical University, and University Hospital (KMUH), Kaohsiung, Taiwan; Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA. Tel: +886-0928547161 (or +886073121101 Ext-x2156x52). Email: [email protected]
365
Liang et al
age, 3) limited access to oral health care/treatment, 4) high levels of existing or past caries in children and caregivers, 5) dental fatalism and 6) low socioeconomic status (Ismail et al, 2009). It is generally accepted that a child’s general and oral-health–related well being can affect their personal development, including communicationspeech capability, social interactions and expectations as well as mental or psychological status (Funakoshi et al, 1987, Martin et al, 2007). There are four domains involved in a child’s development that are generally categorised as: physical development – an individual’s rate of growth, physical fitness, gross and fine motor skills and self-care abilities; cognitive development – intellectual progress in analytical skills, problem solving, memory and early mathematical abilities; linguistic development – babbling, pointing and gesturing in infancy; socioemotional development – a child’s relationships with caregivers and learning how much they trust the surroundings to meet their needs (Davies, 2010). Studies have shown that caries in children results in pain, reduced food intake, loss of weight and sleep and subsequently a poorer quality of life (Chauncey et al, 1984; Low et al, 1999). A previous study measuring the kindergarten children’s bite forces, masticatory efficiency and their intelligence observed a significant correlation between the bite forces and the child’s IQ scores on a geometric design test (Funakoshi et al, 1987). Other reports found a positive relationship between masticatory ability and nerve conduction, which increased brain activity and metabolism (Inoue et al, 1989). A recent study also suggested that dietary fatty acids may be associated with hyperactivity in children with specific learning disabilities (Stevenson, 2006). Interestingly, a gender (male)-specific association between lead exposure and caries affecting the primary dentition was reported (Martin et al, 2007). It is worth noting that the health status of ‘socially vulnerable’ children was characterised by a higher prevalence of caries and these children may present more psychomotor disorders than their less ‘socially vulnerable’ counterparts (Davies, 2010). Although it is still largely unclear how and to what extent the aetiology and risks described have an overall impact on the child’s psychological development (Marlowe et al, 1985), we were interested in studying whether there is any relationship between them in young children. If any such relationships exists, further understanding of their underlying interactions and/or effects in the children will be important in the future. Thus, the purpose of
366
this cross-sectional study was to examine the as yet unknown relationship between caries and psychomotor development in pre-school children aged 4–6 in urban Taiwanese communities.
MATERIALS AND METHODS This cross-sectional study was designed to determine whether correlations exist between caries experience and the factors related to physical and psychological development. The levels of caries measured were grouped for multiple comparisons, as we found that the underlying correlation between caries and psychological development may be complex. To this end, a sequence of analyses was employed to classify the severity of caries (i.e. dmft index) where the results indicated positive correlations between high caries experience (dmft index ≥ 4–5) and psychomotor development in pre-school children aged 4–6 in urban Taiwanese communities.
Subject selection The study was approved by the Kaohsiung Medical University ethics committee. Informed consent was obtained after the study was explained to the parents and/or legal guardians by calibrated interviewers. The sample size required for such a study was estimated at ≥ 334 to reach statistical significance, based on the set criteria where α = 0.05, SD = 5.5, power = 0.9 and a 30% drop-out rate. We employed purposive sampling to select four kindergartens from Kaohsiung and Tainan, the two major cities in southern Taiwan, where 581 children aged 4–6 years were originally recruited based on convenience and availability. 433 of them completed the study with a survey participation rate of 74.5%. Data were subsequently collected on gender, age, parental education levels and occupations, dmft, BMI, dietary status and the children’s psychomotor development.
Caries examination All clinical examinations were performed based on the WHO guidelines for oral health surveys (WHO, 1997). Each study participant received the oral examination on the same day by the same two calibrated dentists. The diagnostic reproducibility was estimated at κ = 0.80–0.84 using the results of Oral Health & Preventive Dentistry
Liang et al
testing 12 randomly selected children based on the same WHO guidelines. The oral examination included the number of decayed, extracted and filled primary teeth. Then, the sum of decayed, filled and missing teeth was computed for the dmft index.
Body mass index determination Body Mass Index (BMI) is a measure of weight by height that the WHO recommends and is commonly used to classify underweight, overweight and obesity. It is defined as the weight in kilograms divided by the square of the height in meters (kg/m2). The average normal BMI for 4-, 5- and 6-year-old children was defined by the Ministry of Health and Welfare, Executive Yuan in Taiwan, R.O.C. Weights and heights of all participating children were measured using one and the same electronic meter.
does not reveal the overall mean scores of normal development for Chinese children in general, it was logical and reasonable to apply CCDI to our present study as did other authors (Chen et al, 2005). The scales employed in CCDI included a total of 320 items on the checklist over 7 developmental areas for study (i.e. gross motor, fine motor, expressive language, comprehension concept, situation comprehension, self-help, personal-social) and one summary scale (for general development). Thus, it is suitable for children 6 months to 6 years old, and includes a questionnaire completed by the child’s caretaker. It has been frequently used to assess children that may have developmental delays in healthcare facilities or hospital settings (Hsu et al, 2004, Chen et al, 2005). It is estimated that the correlation of various CCDI scales with the Draw a Person (DAP) test is as high as 0.70 and with the Chinese version of the Denver Developmental Screening Test is higher than 0.70 (Hsu et al, 1978).
Dietary status Statistical analyses Food intake was surveyed via the questionnaires filled out by the parents and kindergarten teachers to assess and document the subjects’ dietary status. The questionnaires were derived from the standardised questionnaire of the Nutrition and Health Survey, Taiwan (NAHSIT) and included frequency of food intake, food type, etc (Wu et al, 2005). Based on all 33 items categorised in the NAHSIT, four new items were added: fried foods, high-fat snacks, high-sugar snacks and sweetened beverages. Subsequently, data from the parents’ questionnaire were pooled with the those of the kindergartens regarding the subjects’ timing for food intake each day (Cronbach α = 0.854). Accordingly, eight categories were used for the assessment, including three nutrient categories (calcium, protein and carbohydrates) and five food categories (vegetables and fruit, sweetened beverages, nonsweetened beverages, candy and fried food).
Psychomotor development The Chinese Child Development Inventory (CCDI) modified by Hsu et al (1978) after adaptation from the Minnesota Child Development Inventory (MCDI) (Hsu et al, 1978; Chen et al, 2005) has been frequently used to screen or assess children’s and infants’ physical and mental development in Taiwan (Hsu et al, 1978, Chen et al, 2005). Since CCDI
Vol 13, No 4, 2015
The data were analysed using SAS 8.2 (SAS Institute; Cary, NC, USA). The level of statistical significance was set at p < 0.05. Student’s t-test was employed to compare variables among gender and various dmft scales (i.e. ≤ 3 vs ≥4) and one-way ANOVA was used to compare variables among different age groups. A multiple linear regression model was used to analyse the relationship between all variables studied.
RESULTS A total of 433 kindergarten children (203 females [46.88%] and 230 males [53.12%]) were included in this study and divided into three groups by age: 4-, 5- and 6-year-olds (n = 179: 41.34%, n = 209: 48.27% and n = 45: 10.39%, respectively). Their mean height was 110.30 ± 6.29 cm and mean weight 18.78 ± 3.81 kg. Based on BMI scores, there were 124 (28.64%) overweight, 250 (57.74%) normal weight and 59 (13.63%) underweight children. The mean caries score (dmft) was 4.07 ± 4.25 and the average number of decayed, extracted and filled teeth was 2.20 ± 3.18, 0.02 ± 0.17, and 1.85 ± 2.70, respectively. Caries prevalence in the study cohort was 67.90% (data not shown), which was slightly lower than that of a recent national survey (Hsiao et al, 2007), and other 32.10% were car-
367
Liang et al
Table 1 Caries, CCDI, dietary status, height, weight and BMI of different gender and age groups Sex
Age (years)
Male (n = 230) Female (n = 203) (Mean ± SD) (Mean ± SD) Caries (dmft)
4.33 ± 4.21
3.78 ± 4.29
p
4 (n = 179) (Mean ± SD)
5 (n = 209) (Mean ± SD)
6 (n = 45) (Mean ± SD)
p
0.1811
3.36 ± 4.10
4.48 ± 4.19
4.98 ± 4.77
0.0105*
Chinese Child Development Inventory (%) Gross motor Fine motor Expressive language Comprehension concept
79.52 ± 16.15
79.88 ± 16.34
0.8389
83.17 ± 11.54
0.1181
113.62 ± 15.05
99.32 ± 11.59
0.1432
104.48 ± 12.19 94.64 ± 10.25 92.16 ± 14.75
118.78 ± 14.32 120.47 ± 13.64
0.2896
130.75 ± 13.55
0.0003*
104.85 ± 14.71 93.21 ± 13.21 83.38 ± 15.18
Experience of Early Childhood Caries May Positively Correlate with Psychomotor Development Chen-Yi Lianga/Yen-Chun Liub/Tien-Yu Shiehc/Jia-Rong Lind/Yi-Chun Tsenge/ Andy Yen-Tung Tengf Purpose: To examine the as yet unknown relationship between dental caries and the child’s psychomotor development. Materials and Methods: A cross-sectional study was designed by screening the kindergartens from urban areas of two cities in southern Taiwan. Besides the personal, demographic and dietary information, the common measures for caries (dmft) and the amended comprehensive scales (CCDI) for psychomotor development were used to assess their relationship(s). A power analysis showed that 334 subjects would be required. One-way ANOVA vs multiple linear regression analysis were used to compare the differences of variables between gender, age and dmft scales, vs the relationship among all variables tested, respectively. Results: A total of 433 children completed the study. The results demonstrated that there was a positive relationship between higher (i.e. dmft ≥ 4 and 5) but not lower or extremely high caries experience and aspects of psychomotor development (i.e. personal-social and expressive language) in children aged 4 to 6 years. Conclusion: The present results are important for paediatric dentists, as they suggest a positive correlation between caries experience (dmft 3 to 6) and psychomotor development in pre-school children and that such a correlation may occur more significantly as an attribute of the most affected teeth (incisors and molars) during the critical stage of personal-social and expressive language development (speech-communication). Key words: Chinese Child Development Inventory (CCDI), dental caries, pre-school children, psychomotor development, universal health insurance programme Oral Health Prev Dent 2015;13:365-375 doi: 10.3290/j.ohpd.a32992
D
Submitted for publication: 05.01.13; accepted for publication: 08.08.13
ental caries is one of the most common preventable chronic illnesses in children, which continues on into adulthood and can ultimately result in tooth loss (Selwitz et al, 2007). It is clear that the risk factors for developing caries include poor oral hygiene, lack of fluoride supplements or oral hy-
giene products, as well as nutritional and environmental factors (Bayo et al, 2001; Touger-Decker and van Loveren, 2003; Dugmore and Rock, 2004; Selwitz et al, 2007; Meurman and Pienihakkinen, 2010). Other risk factors include: 1) high consumption of sugared/carbonated drinks, 2) overweight by
a
e
Instructor, Department of Childhood Education and Nursery, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
f
Professor, Graduate Institute of Dental Sciences and Dept. of Dental Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Centre for Osteoimmunology and Biotechnology Research, School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Laboratory of Molecular Microbial Immunity, Eastman Institute for Oral Health, Department of Microbiology and Immunology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA.
Instructor, Graduate Institute of Dental Sciences and Dept. of Dental Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Childhood Education and Nursery, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
b
Assistant Professor, Graduate Institute of Dental Sciences and Dept. of Dental Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Centre for Osteoimmunology and Biotechnology Research, School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
c
Professor, Graduate Institute of Dental Sciences and Dept. of Dental Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Centre for Osteoimmunology and Biotechnology Research, School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
d
Associate Professor, Department of Childhood Education and Nursery, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
Vol 13, No 4, 2015
Correspondence: Professor Andy Yen-Tung Teng, Centre for Osteoimmunology and Biotechnology Research, College of Dental Medicine, Kaohsiung Medical University, and University Hospital (KMUH), Kaohsiung, Taiwan; Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA. Tel: +886-0928547161 (or +886073121101 Ext-x2156x52). Email: [email protected]
365
Liang et al
age, 3) limited access to oral health care/treatment, 4) high levels of existing or past caries in children and caregivers, 5) dental fatalism and 6) low socioeconomic status (Ismail et al, 2009). It is generally accepted that a child’s general and oral-health–related well being can affect their personal development, including communicationspeech capability, social interactions and expectations as well as mental or psychological status (Funakoshi et al, 1987, Martin et al, 2007). There are four domains involved in a child’s development that are generally categorised as: physical development – an individual’s rate of growth, physical fitness, gross and fine motor skills and self-care abilities; cognitive development – intellectual progress in analytical skills, problem solving, memory and early mathematical abilities; linguistic development – babbling, pointing and gesturing in infancy; socioemotional development – a child’s relationships with caregivers and learning how much they trust the surroundings to meet their needs (Davies, 2010). Studies have shown that caries in children results in pain, reduced food intake, loss of weight and sleep and subsequently a poorer quality of life (Chauncey et al, 1984; Low et al, 1999). A previous study measuring the kindergarten children’s bite forces, masticatory efficiency and their intelligence observed a significant correlation between the bite forces and the child’s IQ scores on a geometric design test (Funakoshi et al, 1987). Other reports found a positive relationship between masticatory ability and nerve conduction, which increased brain activity and metabolism (Inoue et al, 1989). A recent study also suggested that dietary fatty acids may be associated with hyperactivity in children with specific learning disabilities (Stevenson, 2006). Interestingly, a gender (male)-specific association between lead exposure and caries affecting the primary dentition was reported (Martin et al, 2007). It is worth noting that the health status of ‘socially vulnerable’ children was characterised by a higher prevalence of caries and these children may present more psychomotor disorders than their less ‘socially vulnerable’ counterparts (Davies, 2010). Although it is still largely unclear how and to what extent the aetiology and risks described have an overall impact on the child’s psychological development (Marlowe et al, 1985), we were interested in studying whether there is any relationship between them in young children. If any such relationships exists, further understanding of their underlying interactions and/or effects in the children will be important in the future. Thus, the purpose of
366
this cross-sectional study was to examine the as yet unknown relationship between caries and psychomotor development in pre-school children aged 4–6 in urban Taiwanese communities.
MATERIALS AND METHODS This cross-sectional study was designed to determine whether correlations exist between caries experience and the factors related to physical and psychological development. The levels of caries measured were grouped for multiple comparisons, as we found that the underlying correlation between caries and psychological development may be complex. To this end, a sequence of analyses was employed to classify the severity of caries (i.e. dmft index) where the results indicated positive correlations between high caries experience (dmft index ≥ 4–5) and psychomotor development in pre-school children aged 4–6 in urban Taiwanese communities.
Subject selection The study was approved by the Kaohsiung Medical University ethics committee. Informed consent was obtained after the study was explained to the parents and/or legal guardians by calibrated interviewers. The sample size required for such a study was estimated at ≥ 334 to reach statistical significance, based on the set criteria where α = 0.05, SD = 5.5, power = 0.9 and a 30% drop-out rate. We employed purposive sampling to select four kindergartens from Kaohsiung and Tainan, the two major cities in southern Taiwan, where 581 children aged 4–6 years were originally recruited based on convenience and availability. 433 of them completed the study with a survey participation rate of 74.5%. Data were subsequently collected on gender, age, parental education levels and occupations, dmft, BMI, dietary status and the children’s psychomotor development.
Caries examination All clinical examinations were performed based on the WHO guidelines for oral health surveys (WHO, 1997). Each study participant received the oral examination on the same day by the same two calibrated dentists. The diagnostic reproducibility was estimated at κ = 0.80–0.84 using the results of Oral Health & Preventive Dentistry
Liang et al
testing 12 randomly selected children based on the same WHO guidelines. The oral examination included the number of decayed, extracted and filled primary teeth. Then, the sum of decayed, filled and missing teeth was computed for the dmft index.
Body mass index determination Body Mass Index (BMI) is a measure of weight by height that the WHO recommends and is commonly used to classify underweight, overweight and obesity. It is defined as the weight in kilograms divided by the square of the height in meters (kg/m2). The average normal BMI for 4-, 5- and 6-year-old children was defined by the Ministry of Health and Welfare, Executive Yuan in Taiwan, R.O.C. Weights and heights of all participating children were measured using one and the same electronic meter.
does not reveal the overall mean scores of normal development for Chinese children in general, it was logical and reasonable to apply CCDI to our present study as did other authors (Chen et al, 2005). The scales employed in CCDI included a total of 320 items on the checklist over 7 developmental areas for study (i.e. gross motor, fine motor, expressive language, comprehension concept, situation comprehension, self-help, personal-social) and one summary scale (for general development). Thus, it is suitable for children 6 months to 6 years old, and includes a questionnaire completed by the child’s caretaker. It has been frequently used to assess children that may have developmental delays in healthcare facilities or hospital settings (Hsu et al, 2004, Chen et al, 2005). It is estimated that the correlation of various CCDI scales with the Draw a Person (DAP) test is as high as 0.70 and with the Chinese version of the Denver Developmental Screening Test is higher than 0.70 (Hsu et al, 1978).
Dietary status Statistical analyses Food intake was surveyed via the questionnaires filled out by the parents and kindergarten teachers to assess and document the subjects’ dietary status. The questionnaires were derived from the standardised questionnaire of the Nutrition and Health Survey, Taiwan (NAHSIT) and included frequency of food intake, food type, etc (Wu et al, 2005). Based on all 33 items categorised in the NAHSIT, four new items were added: fried foods, high-fat snacks, high-sugar snacks and sweetened beverages. Subsequently, data from the parents’ questionnaire were pooled with the those of the kindergartens regarding the subjects’ timing for food intake each day (Cronbach α = 0.854). Accordingly, eight categories were used for the assessment, including three nutrient categories (calcium, protein and carbohydrates) and five food categories (vegetables and fruit, sweetened beverages, nonsweetened beverages, candy and fried food).
Psychomotor development The Chinese Child Development Inventory (CCDI) modified by Hsu et al (1978) after adaptation from the Minnesota Child Development Inventory (MCDI) (Hsu et al, 1978; Chen et al, 2005) has been frequently used to screen or assess children’s and infants’ physical and mental development in Taiwan (Hsu et al, 1978, Chen et al, 2005). Since CCDI
Vol 13, No 4, 2015
The data were analysed using SAS 8.2 (SAS Institute; Cary, NC, USA). The level of statistical significance was set at p < 0.05. Student’s t-test was employed to compare variables among gender and various dmft scales (i.e. ≤ 3 vs ≥4) and one-way ANOVA was used to compare variables among different age groups. A multiple linear regression model was used to analyse the relationship between all variables studied.
RESULTS A total of 433 kindergarten children (203 females [46.88%] and 230 males [53.12%]) were included in this study and divided into three groups by age: 4-, 5- and 6-year-olds (n = 179: 41.34%, n = 209: 48.27% and n = 45: 10.39%, respectively). Their mean height was 110.30 ± 6.29 cm and mean weight 18.78 ± 3.81 kg. Based on BMI scores, there were 124 (28.64%) overweight, 250 (57.74%) normal weight and 59 (13.63%) underweight children. The mean caries score (dmft) was 4.07 ± 4.25 and the average number of decayed, extracted and filled teeth was 2.20 ± 3.18, 0.02 ± 0.17, and 1.85 ± 2.70, respectively. Caries prevalence in the study cohort was 67.90% (data not shown), which was slightly lower than that of a recent national survey (Hsiao et al, 2007), and other 32.10% were car-
367
Liang et al
Table 1 Caries, CCDI, dietary status, height, weight and BMI of different gender and age groups Sex
Age (years)
Male (n = 230) Female (n = 203) (Mean ± SD) (Mean ± SD) Caries (dmft)
4.33 ± 4.21
3.78 ± 4.29
p
4 (n = 179) (Mean ± SD)
5 (n = 209) (Mean ± SD)
6 (n = 45) (Mean ± SD)
p
0.1811
3.36 ± 4.10
4.48 ± 4.19
4.98 ± 4.77
0.0105*
Chinese Child Development Inventory (%) Gross motor Fine motor Expressive language Comprehension concept
79.52 ± 16.15
79.88 ± 16.34
0.8389
83.17 ± 11.54
0.1181
113.62 ± 15.05
99.32 ± 11.59
0.1432
104.48 ± 12.19 94.64 ± 10.25 92.16 ± 14.75
118.78 ± 14.32 120.47 ± 13.64
0.2896
130.75 ± 13.55
0.0003*
104.85 ± 14.71 93.21 ± 13.21 83.38 ± 15.18
