Objective: The aim of this study was to examine Latino immigrant caregivers' explanatory models of the causes of early childhood caries (ECC).
Methods: In a rural area, we conducted 71 open-ended qualitative interviews with 26 Mexican immigrant and 12 Salvadoran immigrant caregivers of children under 6 about the causes of ECC. Two researchers independently read each interview and classified each interviewee's response.
Results: Caregivers mentioned three biomedical causes of oral disease (sweets, poor oral hygiene, and bottle-feeding) and two lay or popular causes (lack of milk consumption and "bad" genes). Although caregivers were aware that the consumption of sweet foods causes decay they expressed particular confusion about how bottle-feeding causes decay. Nineteen caregivers attributed decay specifically to bottle-feeding, yet 14 believed the cause of decay was the bottle's nipple. Seven Mexican immigrant caregivers attributed their children's decay specifically to a lack of calcium, and six immigrant caregivers to "bad teeth genes."
Conclusions: Conceptions of oral disease derived from the caregivers' own dental experiences, their conceptions of the body, and interactions with dental professionals. The fact that biomedical explanations dominate the list of causes of caries for both groups indicates that the caregivers' explanatory models of oral disease are powerfully shaped by interactions with health professionals. Immigrant caregivers' mistaking of the baby bottle's nipple as the source of decay indicates the need for more effective oral health promotion. Yet the Mexican immigrants' conceptions of a lack of calcium as a major factor in their children's decay may illustrate a strong cultural link between teeth and milk.