Early childhood caries and feeding practices in ...

Q U I N T E S S E N C E I N T E R N AT I O N A L

Early childhood caries and feeding practices in kindergarten children (IBMJC2BESJ 1I% "CEVM/PVSBMMBI 1I%3/ $ISJTUJBO)4QMJFUI %%4 1I%1

Objective: 5PEFUFSNJOFUIFQSFWBMFODFBOETFWFSJUZPGFBSMZDIJMEIPPEDBSJFT &$$ BOE JUTSFMBUJPOUPGFFEJOHQSBDUJDFTJO4ZSJBMethod and Materials: "UPUBMPGDIJMESFO BHFEUPZFBST NFBOBHF4% XFSFTDSFFOFEGSPNSBOEPNMZTFMFDUFE LJOEFSHBSUFOTJO-BUBLJB 4ZSJB%FOUBMFYBNJOBUJPOTXFSFDBSSJFEPVUCZBTQFDJBMJTUJO QFEJBUSJDEFOUJTUSZVTJOHENGUBOEENGTJOEJDFTBOEBO&$$TDPSJOHTZTUFN*OGPSNBUJPO SFHBSEJOHGFFEJOHQSBDUJDFTEVSJOHFBSMZDIJMEIPPEXBTBMTPDPMMFDUFEResults: Caries XBTTFFOJOPGUIFDIJMESFO XJUIBUPUBMNFBOENGUWBMVFPGQFSDIJME5IF NFBOWBMVFTJODSFBTFEGSPNENGUBUBHFUPBUBHF BOEENGT SFTQFDUJWFMZ "HFBOEGFFEJOHQSBDUJDFTTIPXFETUBUJTUJDBMMZ TJHOJGJDBOUBTTPDJBUJPOTXJUIDBSJFT P 5IFNFBOENGUJOUIFCPUUMFGFEDIJMESFO XBTDPNQBSFEXJUIPOMZJOQSFEPNJOBOUMZCSFBTUGFEDIJMESFO'PSUZ FJHIUQFSDFOUPGUIFDIJMESFOIBE&$$ BOETIPXFEBTFWFSFEFHSFFXJUIDBSJPVT EFGFDUTBOEPQFODBSJFTMFTJPOT"TJHOJGJDBOUMZIJHIFSQSFWBMFODFBOETFWFSJUZPG&$$ XBTPCTFSWFEJODIJMESFOXIPXFSFCPUUMFGFE [TUBUJTUJD oP DPNQBSFEXJUI CSFBTUGFEDIJMESFOConclusion:*OBEEJUJPOUPBIJHIQSFWBMFODFPGDBSJFTBOE&$$JO QSFTDIPPMDIJMESFO CPUUMFGFFEJOHMFEUPFWFOIJHIFSDBSJFTSBUFTJO4ZSJB4JODFUIFDBSJFT XBTMBSHFMZVOUSFBUFE QSFWFOUJWFBOESFTUPSBUJWFEFOUBMQSPHSBNTTIPVMECFJNQMFNFOUFE (Quintessence Int 2012;43:503–510)

Key words:CSFBTUGFFEJOH DBSJFTQSFWBMFODF FBSMZDIJMEIPPEDBSJFT GFFEJOH QSBDUJDFT 4ZSJB

*OUIFQBTUEFDBEF BHFOFSBMDBSJFTEFDMJOF

followed by the involvement of the primary

has

NPMBST3BSFMZ UIFNBOEJCVMBSJODJTPSTBSF

been

observed

in

the

permanent

EFOUJUJPO PG DIJMESFO BOE ZPVOH BEVMUT

JOWPMWFE 5IF DPOEJUJPO IBT CFFO BTTPDJ-

)PXFWFS UIJTIBTOPUCFFOUIFDBTFJOUIF

BUFEXJUICSFBTUGFFEJOH TXFFUFOFEQBDJGJFS

Middle East.3–5 3FDFOU FQJEFNJPMPHJD EBUB

VTF GSFRVFOU VTF PG TXFFUFOFE NFEJDB-

JO4ZSJBTIPXSFMBUJWFMZIJHIEFDBZFE NJTT-

UJPOT PS ESJOLJOH MJRVJET DPOUBJOJOH TVHBST

JOH PS GJMMFE UFFUI ENGU WBMVFT GPS WBSJPVT

from a bottle.9

BHF HSPVQT XIJDI EPFT OPU TFFN UP IBWF DIBOHFEJOUIFQBTUUXPEFDBEFT *O DPOUSBTU UP UIF QFSNBOFOU EFOUJUJPO

&$$SFQSFTFOUTBNBKPSIFBMUIQSPCMFN QBSUJDVMBSMZ JO MPXJODPNF QPQVMBUJPOT *O HFOFSBM DPOWFOUJPOBM SFTUPSBUJWF USFBU-

UIF TJUVBUJPO JO QSJNBSZ UFFUI IBT OPU CFFO

NFOUJTEJGGJDVMUBOEUJNFDPOTVNJOH BOEJU

FYBNJOFEBTUIPSPVHIMZ FTQFDJBMMZGPSFBSMZ

PGUFOSFRVJSFTHFOFSBMBOFTUIFTJB

DIJMEIPPE DBSJFT &$$ &$$ PGUFO QSF

$VSSFOUMZ PSBM IFBMUI JO ZPVOH DIJMESFO

sents as white spots along the gingival

JTTUSPOHMZUISFBUFOFECZEFOUBMDBSJFT BOE

NBSHJO JO UIF QSJNBSZ NBYJMMBSZ JODJTPS 8

&$$ DPOUJOVFT UP CF B DIBMMFOHF JO DBSJFT prevention. 3FDFOU FQJEFNJPMPHJD EBUB TIPX UIBU UIF NPTU FGGFDUJWF BQQSPBDI GPS

1

Department of Preventive and Pediatric Dentistry, Ernst Moritz Arndt University, Greifswald, Germany.

UIF DPOUSPM PG &$$ JT CBTFE PO QSFWFOUJPO OPU SFTUPSBUJWF USFBUNFOU14 Despite

2

Pediatric Dentistry Unit, Al-Hada Military Hospital, Saudi Arabia.

3

Department of Pediatric Dentistry, Tishreen University, Latakia, Syria.

Correspondence: Prof Dr Christian H. Splieth, Präventive Zahnmedizin und Kinderzahnheilkunde, Rotgerberstr 8 D-17487 Greifswald, Germany. Email: [email protected]

VOLUME 43 t /6.#&36 t +6/& 2012

UIF NBOZ FEVDBUJPOBM PSBM IFBMUI BOE QSFWFOUJWF QSPHSBNT JOTUJUVUFE JO UIF QSJNBSZ TDIPPMT PG 4ZSJB BT QBSU PG UIF GPSNBM DVSSJDVMVN 15NBOZDIJMESFOTUJMMTVGGFSGSPNDBSJFTBOEJUTBEWFSTFFGGFDUTBUBOFBSMZBHF16

503

Q U I N T E S S E N C E I N T E R N AT I O N A L Qadri et al

*OGBOU GFFEJOH IBCJUT IBWF GSFRVFOUMZ

XFSF FYDMVEFE GSPN UIF TUVEZ JG UIFZ XFSF

been identified as having an important

6 years of age or older or if they had perma-

SPMF JO EFWFMPQJOH &$$ )PXFWFS DPOUSP-

nent anterior teeth present.

versy still exists as to whether the dietary

5IVT B UPUBM PG DIJMESFO BHFE UP

QSBDUJDFTPGJOGBOUTDPOUSJCVUFUPUIFEFWFM-

ZFBST XFSF TFMFDUFE SBOEPNMZ GSPN

opment of ECC.10 5IF FWJEFODF PG B SFMB-

EJGGFSFOU LJOEFSHBSUFOT BDDPSEJOH UP TBN-

UJPOTIJQCFUXFFOCPUUMFVTFBOEDBSJFTSJTL

QMF TJ[F DBMDVMBUJPOT 14 4PGUXBSF 24

JTXFBL BOEJUJTNPSFMJLFMZUIBUUIFSJTLPG

CBTFE PO DPNQBSJOH UXP QSPQPSUJPOT UP

DBSJFTNBZCFEVFUPUIFJOUFSBDUJPOPGNVM-

EFUFDUBEJGGFSFODFJOQSFWBMFODF4

UJQMFGBDUPST JODMVEJOHEJFUBSZQSBDUJDFT 0OUIFPUIFSIBOE TFWFSBMTUVEJFTIBWF TIPXO UIBU CSFBTUGFFEJOH PS FWFO FYDMV-

1SJPS UP UIF EFOUBM FYBNJOBUJPO QSJODJQBMTBOETUBGGNFNCFSTPGUIFLJOEFSHBSUFOT XFSF CSJFGFE BCPVU UIF SFTFBSDI QSPKFDU

TJWF CSFBTUGFFEJOH DBO DBVTF DBSJFT JO

EVSJOH B QFSTPOBM WJTJU 5IF TUVEZ QSPUPDPM

UIF NBYJMMBSZ JODJTPST TJNJMBS UP UIF DMBTTJD

XBT BQQSPWFE CZ UIF &UIJDT $PNNJUUFF BU

pattern of the ECC in bottlefeeding. A

UIF6OJWFSTJUZPG5JTISFFO -BUBLJB 4ZSJB

TZTUFNBUJDSFWJFXPGUIFEJGGFSFOUNPEFTPG JOGBOU GFFEJOH GPVOE UIF FYJTUJOH MJUFSBUVSF

Clinical examination

UPCFPGJOTVGGJDJFOUBOEQPPSNFUIPEPMPHJD

"GUFS JOGPSNFE DPOTFOU XBT PCUBJOFE QBS-

RVBMJUZ 5IFSFGPSF UIF FWJEFODF PG CFO-

ents were interviewed regarding feeding

FGJDJBM PS IBSNGVM FGGFDUT PG CSFBTUGFFEJOH

QSBDUJDFT HJWFO EVSJOH UIFJS DIJMET JOGBO-

XBTGPVOEUPCFJODPODMVTJWF23

DZ QSFEPNJOBOUMZ CSFBTU PS CPUUMFGFE

*O BEEJUJPO EJFUBSZ IBCJUT NBZ EJGGFS JO

&YBNJOBUJPOT BOE SFDPSET XFSF QFSGPSNFE

FBDIQPQVMBUJPOEVFUPDVMUVSBM TPDJBM BOE

CZ B XFMMUSBJOFE BOE DBMJCSBUFE QFEJBUSJD

FDPOPNJDEJGGFSFODFT215IVT JUJTFTTFOUJBM

EFOUJTUGPMMPXJOH8PSME)FBMUI0SHBOJ[BUJPO

GPS FGGFDUJWF IFBMUI QSPNPUJPO TUSBUFHJFT UP

8)0 EJBHOPTUJD DSJUFSJB HVJEFMJOFT BOE

GJSTUDPOEVDUBUIPSPVHIJOWFTUJHBUJPOPGUIF

ENGUEFDBZFE NJTTJOH PS GJMMFE TVSGBDFT

QSFWBMFODF TQFDJGJD FUJPMPHZ BOE QBUUFSOT

ENGT JOEJDFT25

PG &$$ 5IJT DSPTTTFDUJPOBM DPIPSU TUVEZ

"GUFS DMFBOJOH UIF UFFUI XJUI TUFSJMF

BJNFE UP EFUFSNJOF UIF QSFWBMFODF BOE

HBV[F B EFOUBM FYBNJOBUJPO XBT DPOEVDU-

TFWFSJUZPG&$$JOQSFTDIPPMDIJMESFOBHFE

FE VOEFS OBUVSBM CVU JOEJSFDU MJHIU VTJOH

UP ZFBST JO 4ZSJB BT XFMM BT BTTFTT JUT

EFOUBMNJSSPSTBOECBMMFOEFEQSPCFT $1*

BTTPDJBUJPOXJUIEJGGFSFOUGFFEJOHQSBDUJDFT

"MM FYBNJOBUJPOT XFSF DPOEVDUFE XJUI UIF DIJMESFOJOVQSJHIUQPTJUJPOTXJUIUIFJSIFBET UJMUFECBDL 5IFENGUBOEENGTJOEJDFTXFSFSFDPSE-

METHOD AND MATERIALS

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*O4ZSJB DIJMESFOHFOFSBMMZTUBSUTDIPPMBUUIF

DBSJPVT EFGFDU &$$ XBT EJBHOPTFE JG B

BHF PG ZFBST BOE LJOEFSHBSUFOT QSPWJEF

DIJME IBE POF PS NPSF UFFUI XJUI EFDBZFE

B PS ZFBS QSFTDIPPM QSPHSBN -BUBLJB

NJTTJOH SFTVMUJOH GSPN DBSJFT

PS GJMMFE

JT POF PG UIF MBSHFTU 4ZSJBO DJUJFT MPDBUFE

UPPUI TVSGBDFT JO BOZ QSJNBSZ UPPUI26 Initial

øLJMPNFUFSTOPSUIXFTUPG%BNBTDVT XJUI

DBSJFT MFTJPOT XFSF BMTP JODMVEFE BT QSP-

BQPQVMBUJPOPGBQQSPYJNBUFMZ 5IF

QPTFE JO UIF *OUFSOBUJPOBM $BSJFT %FUFDUJPO

ESJOLJOH XBUFS TVQQMJFT PG UIF DJUZ IBWF B

BOE"TTFTTNFOU4ZTUFN *$%"4 and the

OBUVSBMGMVPSJEFMFWFMPGQQN

EJBHOPTUJDDSJUFSJBCZ/ZWBEFUBM28

'PS DPMMFDUJPO PG UIF TBNQMFT UIF DJUZ XBT EJWJEFE JOUP GPVS RVBESBOUT 'JWF LJO-

"MM DIJMESFO XFSF JOEFQFOEFOUMZ TDPSFE GPS&$$ GSPNUP VTJOHBNPEJGJFETDPS-

EFSHBSUFOT XFSF SBOEPNMZ DIPTFO GSPN

JOH TZTUFN CBTFE PO DBSJFT QSPHSFTTJPO

FBDI RVBESBOU VTJOH B TUSBUJGJFE SBOEPN

OP DBSJFT JOJUJBM DBSJFT MFTJPOT PO UIF

sampling

CVDDBMPSPSBMTVSGBDFTPGUIFNBYJMMBSZJODJ-

method.

The

sampling

frame

DPOTJTUFE PG BMM UIF DIJMESFO GSPN UIF

TPSTPS DBSJPVTEFGFDUTXJUINBDSPTDPQJD

BTTJHOFE LJOEFSHBSUFOT BHFE UP ZFBST

CSFBLEPXOBOEPQFODBWJUBUJPOPOUIFCVD-

BUUIFUJNFPGDMJOJDBMFYBNJOBUJPO$IJMESFO

DBMPSPSBMTVSGBDFTPGUIFNBYJMMBSZJODJTPST

504

VOLUME 43 t /6.#&36 t +6/& 2012


Table 1

Caries data (mean ± SD) for children from 3 to 5 years of age

Age (y) (n)

MT

FT

FS

dmfs

DT

dmft

DS

MS

4% TUBOEBSEEFWJBUJPO%5 EFDBZFEUPPUI.5 NJTTJOHUPPUI'5 GJMMFEUPPUIENGU EFDBZFE NJTTJOH PSGJMMFEUFFUI%4 EFDBZFETVSGBDF.4 NJTTJOHTVSGBDF'4 GJMMFETVSGBDFENGT EFDBZFE NJTTJOH PSGJMMFETVSGBDF.BOO8IJUOFZUFTU P < .05.

Table 2

No. (%) of Syrian kindergarten children with different ECC scores by age ECC grades

Age (y)

Score 0 (No ECC)

Score 1 (Initial lesion)

Score 2 (Open cavitations)

3

4

5

NFBOBHF

&$$ FBSMZDIJMEIPPEDBSJFT$IJTRVBSFUFTUGPSJOEFQFOEFODFP = .059

Statistical analysis

RESULTS

"MM EBUB XFSF FOUFSFE JO .JDSPTPGU &YDFM .JDSPTPGU BOE UIFO USBOTGFSSFE UP 4144

"MM DIJMESFO BUUFOEJOH UIF TFMFDUFE LJOEFS-

*#. GPS GVSUIFS TUBUJTUJDBM BOBMZTJT

gartens on the day of the examination were

%FTDSJQUJWF TUBUJTUJDT JODMVEJOH UIF NFBO

JODMVEFE JO UIF TUVEZ TBNQMF TJODF UIFSF

TUBOEBSE EFWJBUJPO 4%

BOE SBOHF XFSF

XBTOPQBSFOUBMSFGVTBM"UPUBMPGDIJM-

VTFE GPS UIF EJGGFSFOU BHFT BOE GFFEJOH

ESFO HJSMT BOE CPZT XJUI BO BHF

QSBDUJDF IBCJUT 'PS UIF BOBMZUJD TUBUJTUJDT

SBOHFGSPNUPZFBST NFBO

BOE EVF UP UIF GBDU UIBU UIF EJTUSJCVUJPO

XFSFTDSFFOFEGPSUIFQSFTFODFPG&$$

PG DBSJFT BNPOH DIJMESFO XBT QPTJUJWFMZ TLFXFE OPOQBSBNFUSJD UFTUT BOE BOBMZ-

5IF DBSJFT JOEJDFT JODSFBTFE TJHOJGJDBOUMZXJUIBHF 5BCMF CZBCPVUUFFUI

TFT XFSF VTFE 5IF EJGGFSFODFT PG ENGUT

PSTVSGBDFTQFSZFBS SFBDIJOHBNFBOPG

WBMVFT CFUXFFO EJGGFSFOU HSPVQT XFSF

TVSGBDFTBGGFDUFEBUUIFBHFPGZFBST

BOBMZ[FE VTJOH UIF .BOO8IJUOFZ BOE

.PSF UIBO XFSF PQFO DBSJFT MFTJPOT

,SVTLBM8BMMJT UFTUT GPS JOEFQFOEFOU TBN-

GSBOL DBWJUJFT 5IF NFBO OVNCFS PG GJMMFE

QMFT 5IF DIJTRVBSF UFTU XBT VTFE UP

UFFUIPSTVSGBDFTSFNBJOFETUBCMFPOBMPX

BTTFTT UIF TUBUJTUJDBM TJHOJGJDBODF PG UIF

MFWFM XIJMF FYUSBDUJPOT TFFNFE UP CF UIF

EJGGFSFODFT JO DBSJFT TUBUVT GPVOE CFUXFFO

predominant therapy.

HSPVQT 5IF MFWFM PG TUBUJTUJDBM TJHOJGJDBODF for all tests was set at P < .05. -PHJTUJD SFHSFTTJPO BOBMZTFT XFSF DPOEVDUFE GPS ENGU BOE &$$ PVUDPNFT BOE

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CPZTBOEPGBMMHJSMTXFSFGPVOEXJUI

DBMDVMBUFE"HF TFY BOEEJFUBSZQSBDUJDFT

DBSJPVT EFGFDUT 5IJT EJGGFSFODF XBT OPU

XFSFJODMVEFEJOUIFNPEFMTBTDPWBSJBUFT

TUBUJTUJDBMMZ TJHOJGJDBOU DIJTRVBSF TUBUJTUJD

" MFWFM PG DPOGJEFODF XBT VTFE GPS

P 5IF UPUBM NFBO ENGU XBT

testing.

QFSDIJME

VOLUME 43 t /6.#&36 t +6/& 2012

505


Table 3

Logistic regression analyses estimating the association between caries status (dmft/ECC) and other predictor’s variables dmft

ECC

P value

OR (95% CI)

P value

OR (95% CI)

%JFUBSZQSBDUJDFT DSVEFNPEFMT

.048*

o

< .001

o

Age

.036*

o

.018

o

%JFUBSZQSBDUJDFT GVMMZBEKVTUFE

.038*

o

< .001*

o

Age

.030*

o

o

4FY

o

.451

o

Variables

a

a

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-PHJTUJDSFHSFTTJPOBOBMZTJTP < .05.

3FHBSEJOH &$$ DIJMESFO PG UIF UPUBM TUVEZ TBNQMF XFSF EJBHOPTFE XJUI

"HFIBEUIFTUSPOHFTUBOENPTUDPOTJTUFOU SFMBUJPOTIJQXJUIBMMUIFPVUDPNFT

&$$ XJUIBQSFWBMFODFSBUFPG)BMGPG

$POGJEFODF JOUFSWBMT $*T BCPVU UIF

UIFTF DIJMESFO FYIJCJUFE UIF TFWFSF

PEET SBUJPT 03T TVHHFTUFE UIBU UIF SJTL

GPSNPG&$$XJUIPQFODBWJUBUJPOT TDPSF

UIBUBHFQSFTFOUFEGPSDBSJFTTUBUVTPS&$$

5BCMF 5IF OVNCFS PG DIJMESFO XJUI B

may have been as great as 2.3. Dietary

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QSBDUJDFT XFSF BMTP TFFO DPOTJTUFOUMZ BT

BHF XIJMFUIFTFWFSJUZPGMFTJPOTJODSFBTFE

having an independent and strong relation-

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TIJQ XJUI DBSJFT TUBUVT BOE &$$ 5IF DPO-

EFSMJOF TJHOJGJDBODF CFUXFFO EJGGFSFOU BHF

GJEFODFJOUFSWBMTBCPVUUIF03TTVHHFTUFE

HSPVQT P 'PSEJFUBSZQSBDUJDFT DBSJFTMFWFMTXFSF TJHOJGJDBOUMZIJHIFSJOUIFDIJMESFOXIPXFSF

UIBU UIF EJFUBSZ QSBDUJDFT SJTL PO DBSJFT TUBUVTPS&$$NBZIBWFCFFOBTIJHIBT BOEGPSCPUIPVUDPNFT

CPUUMFGFE NFBO ENGU UIBO JO DIJMESFOXIPXFSFQSFEPNJOBOUMZCSFBTUGFE NFBO ENGU 5IJT GJOEJOH XBT IJHIMZTUBUJTUJDBMMZTJHOJGJDBOU P

DISCUSSION

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BOE CSFBTUGFFEJOH PDDVSSFE JO DIJM-

5IJT QBQFS EPDVNFOUT B UIPSPVHI DMJOJ-

ESFO 5IFSF XBT BO JODSFBTF JO UIF NFBO

DBM FYBNJOBUJPO GPS &$$ EJBHOPTJT JO POF

ENGUJOUIFDIJMESFOXIPXFSFNPTUMZCPUUMF-

PG UIF MBSHFTU DJUJFT JO 4ZSJB 5IF DVMUVSBM

GFE DPNQBSFE XJUI DIJMESFO

BOESFMJHJPVTCBDLHSPVOEPG4ZSJB BOEUIF

XIP XFSF OPU 5IF OVNCFS PG

.JEEMF &BTU JO HFOFSBM IBT B EJSFDU FGGFDU

UFFUI BGGFDUFE XBT BMTP TJHOJGJDBOUMZ IJHIFS

POUIFEJFUBSZBOEPSBMIZHJFOFQSBDUJDFTPG

JO QSFEPNJOBOUMZ CPUUMFGFE DIJMESFO XJUI

JUT QPQVMBUJPO *O HFOFSBM CSFBTUGFFEJOH JT

&$$ DPNQBSFE XJUI DIJMESFO XIP XFSF

IJHIMZFODPVSBHFEBOEDPOTJEFSFEBCBTJD

CSFBTUGFE [TUBUJTUJD o P

IBCJUGPS4ZSJBONPUIFST

0O CBTJD MPHJTUJD SFHSFTTJPO NPEFMT DSVEF EJFUBSZQSBDUJDFTBOEBHFWBSJBCMFT

)PXFWFS UIF FGGFDUT PG HMPCBMJ[BUJPO JODSFBTFE VSCBOJ[BUJPO BOE B NPEFSO MJGF-

XFSFTJHOJGJDBOUMZSFMBUFEUPENGUBOE&$$

TUZMF PWFS UIF QBTU EFDBEFT IBWF MFE UP

SFTQFDUJWFMZ P P "HF TFY

TFSJPVT CFIBWJPSBM DIBOHFT JO UIFTF DPN-

BOEEJFUBSZQSBDUJDFT CPUUMFWTCSFBTUGFFE-

NVOJUJFTXJUITFWFSFDPOTFRVFODFTPGDBS-

JOH XFSF BEKVTUFE JO UIF NPEFM 5BCMF

ies levels.29

506

VOLUME 43 t /6.#&36 t +6/& 2012


%FOUBM DBSJFT XBT TFFO JO PG UIF

three teeth. o5IFSFGPSF UIFIJHIQSFWB-

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XIJDI JT JO UIF SBOHF PG UIF EBUB GPVOE

CF BUUSJCVUFE UP UIF TFOTJUJWF EJBHOPTUJD

JO %BNBTDVT BOE JO BOE

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XJUI DBWJUBUFE DBSJPVT EFGFDUT PS GJMMJOHT

UIJT TUVEZ DBO CF DPOTJEFSFE SFQSFTFOUB-

JO UIFTF QSFTDIPPM DIJMESFO JT DPOTJEFSFE

UJWF PG UIF VSCBO 4ZSJBO QPQVMBUJPO XIJDI

IJHI CVU DPNQBSBCMF UP UIF TUVEJFT NFO-

DPNQSJTFT BCPVU IBMG PG UIF DPVOUSZT UPUBM

tioned above.

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UP PS FWFO JO ,VXBJU BOE 4BVEJ

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UP UIF TMJHIUMZ IJHIFS QSFWBMFODF GPS ZFBS

%FOUBM DBSJFT JO HFOFSBM TFFNT UP IBWF

PME DIJMESFO UIF TFWFSJUZ JODSFBTFE NPSF

BOBTTPDJBUJPOXJUIUIFEFWFMPQNFOUMFWFMPG

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FBDIOBUJPO%FOUBMDBSJFTDPVMECFBTJHOJG-

GVSUIFSDBSJFTBDUJWJUZBOEQSPHSFTTJPO

JDBOU IFBMUI QSPCMFN JO TFWFSBM EFWFMPQJOH

5IF NFBO OVNCFS PG UFFUI XJUI &$$

DPVOUSJFT CVU UIF SFWFSTF TJUVBUJPO JT TFFO

XBT BMTP IJHI JO UIF QSFTFOU

JO UIF EFWFMPQFE DPVOUSJFT31 *O DPOUSBTU UP

TUVEZ XIJDI JT JO BHSFFNFOU XJUI PUIFS

UIFEFDMJOJOHDBSJFTSBUFTJONBOZJOEVTUSJBM-

&$$ TUVEJFT JO XIJDI UP UFFUI XFSF

J[FE DPVOUSJFT NBOZ EFWFMPQJOH DPVOUSJFT

BGGFDUFE 5IJT IJHI OVNCFS PG BGGFDUFE

FYIJCJU JODSFBTJOH WBMVFT XJUI QSFWBMFODF

UFFUI PGUFO SFGMFDUT B TFWFSF EFHSFF PG

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EFOUBM EFTUSVDUJPO UIBU DBOOPU CF USFBUFE

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FSBMEFOUBMQSBDUJUJPOFS0GUFO QSJNBSZUFFUI

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et al33 BOE 3BNF[BOJ FU BM reported the

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VOLUME 43 t /6.#&36 t +6/& 2012


JO DBSJFT JODJEFODF JO SFMBUJPOTIJQ UP FJUIFS

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breast- or bottlefeeding.

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CONCLUSION

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health benefits of breastfeeding and the

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as this is not a well-established habit in this

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inappropriate feeding patterns in infants. 5IJT DBO CF BTTPDJBUFE XJUI UIF FYDFTTJWF VTF PG CPUUMFGFFEJOH FTQFDJBMMZ XIFO UIF JOGBOU GPSNVMB JT FOSJDIFE XJUI BEEJ-

ACKNOWLEDGMENTS

UJPOBMTVHBS XIJDIJTOPUUIBUVODPNNPOJO "SBCJBO DPVOUSJFT )PXFWFS JU DBO CF BMTP DBVTFECZCSFBTUGFFEJOHQBUUFSOT TVDIBT GSFRVFOU54 and prolonged feeding after the

The staff of the kindergartens in Latakia, Syria, the children, and their parents are thanked for their kind assistance and cooperation in the present study.

UFFUI IBWF FSVQUFE XIJDI JT VODPNNPO JOUIFTF*TMBNJDDPNNVOJUJFT 6OEFSOPSNBMEJFUBSZDPOEJUJPOT IVNBO NJMLJTOPUBDBSJPHFOJDBHFOU CVUXJUIGSFRVFOUBOEQSPMPOHFEFYQPTVSF JUNBZMFBE UPBESPQJOUIFQMBRVFQ)56%VSJOHCSFBTUGFFEJOH UIF NJML EPFT OPU QPPM BSPVOE UIF UFFUI3BUIFS JUJTTVDLFEJOUPUIFQPTUFSJPS QBSU PG UIF TPGU QBMBUF VOMJLF GFFEJOH GSPN a bottle. It has also been reported that the

508

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