Exploring the association of dental caries with social factors and nutritional status in Brazilian preschool children

Association among chronotype, dietary behaviours, and caries experience in Brazilian adolescents: Is there a behavioural pattern?

BACKGROUND

Dental caries (DC) remains a public health issue. Chronotype, diet, and oral hygiene may influence its development.

OBJECTIVE

To investigate the association of chronotype, diet, oral hygiene, and DC among 12-year-olds.

METHODS

A cross-sectional study with 245 adolescents was conducted in public and private schools in southeast Brazil. Sociodemographics, dietary and oral hygiene habits were collected through a self-reported questionnaire. Chronotype was assessed using the Portuguese version of the Puberty and Phase Preference Scale (PPPS). Subjects were examined for DC (WHO criteria). Bivariate and multivariate analyses were performed (P < 0.05).

RESULTS

DC was present in 42.0% of the sample. In the bivariate analysis, a higher DMFT was associated with living in rural areas (P = 0.006), parents'/caregivers' lower schooling (P = 0.008), and a not daily intake of vegetables (P = 0.033). Chronotype was not associated with DMFT scores. The Poisson regression model showed that adolescents who did not have breakfast regularly (PR = 1.55; 95% CI = 1.17-2.08; P = 0.003), lived in rural areas (PR = 2.20; 95% CI = 1.59-3.04; P < 0.001) and did not consume vegetables daily (PR = 1.55; 95% CI = 1.11-2.17; P = 0.009) were more likely to present a higher DMFT.

CONCLUSIONS

DC is associated to living in rural areas and dietary habits, such as not having breakfast regularly and lack of daily intake of vegetables.

Dental caries and anthropometric measures in a sample of 5- to 9-year-old children in Dhaka, Bangladesh

AIM

This study aimed to assess associations between dental caries and anthropometric measures among a sample of children aged 5-9 years in Dhaka, Bangladesh.

METHODS

A cross-sectional observational study was conducted among 5- to 9-year-old children in Dhaka, Bangladesh. Data were collected from children and their parents attending the Dhaka Dental College Hospital and from three nearby primary schools. The outcome measures were as follows: age and sex adjusted height-z-scores (HAZ), weight-z-scores (WAZ) and BMI-z-scores (BAZ). Multiple linear regressions were used to assess the associations between caries and anthropometric measures, adjusted for maternal education, family income, study setting, birth weight and childhood diseases as potential confounders.

RESULTS

The final sample comprised 788 children, and the overall response rate was 96.7%. The majority (73.2%) had experience of dental caries. The mean dmft + DMFT score was 2.84 (95% CI 2.64, 3.03) and 35.8% experienced dental sepsis. Dental caries and sepsis were negatively associated with HAZ, WAZ and BAZ scores. After adjustment for potential confounders, children with severe levels of caries had lower HAZ scores (coefficient: -0.40; 95% CI -0.69, -0.10), lower WAZ scores (coefficient: -0.59; 95% CI -0.94, -0.24) and lower BAZ scores (coefficient: -0.50; 95% CI -0.87, -0.13) than those who were caries free. Children with moderate levels of caries also had lower WAZ scores (coefficient: -0.43; 95% CI -0.72, -0.15) and lower BAZ scores (coefficient: -0.43; 95% CI -0.72, -0.13) than caries-free children. Children with dental sepsis had lower HAZ (coefficient: -0.23; 95% CI -0.42, -0.03), WAZ (coefficient: -0.33; 95% CI -0.56, -0.10) and BAZ scores (coefficient: -0.29; 95% CI -0.53, -0.05) than dental sepsis-free children.

CONCLUSIONS

Dental caries was associated with lower height, weight and BMI among this sample of Bangladeshi children, even after adjusting for age and sex and a number of potential confounders.

Dental caries and their association with socioeconomic characteristics, oral hygiene practices and eating habits among preschool children in Abu Dhabi, United Arab Emirates - the NOPLAS project

Background

Dental caries are a global public health problem and influence the overall health of children. The risk factors for caries include biological, socio-behavioral and environmental factors. This cross-sectional study assessed dental caries and their associations with socioeconomic factors, oral hygiene practices and eating habits among Emirati and non-Emirati children in Abu Dhabi, United Arab Emirates (UAE).

Methods

The stratified sample comprised children aged 18 months to 4 years recruited from 7 nurseries. The World Health Organization (WHO) decayed, missing and filled teeth index (dmft) was used to analyze the dental status of the children. Parents completed a questionnaire regarding demographics, food consumption and oral habits. The study was approved by the Research Ethics Committee at Zayed University, UAE (ZU15_029_F).

Results

A total of 186 children with a mean age of 2.46 years, of which 46.2% were Emirati, participated. Overall, 41% of the children had dental caries. The mean dmft±SD was 1.70 ± 2.81 with a mean ± SD decayed component (dt) of 1.68 ± 2.80 and mean ± SD filled component (ft) of 0.02 ± 0.19. Emirati children showed higher mean dmft, Plaque Index and Significant Carries Index values than non-Emirati children (P < 0.000). Low maternal education, rural nursery location, infrequent tooth-brushing, frequent consumption of high-sugar food items and Emirati nationality were factors significantly associated with dental caries.

Conclusions

In this study, 4 out of 10 nursery children were found to have dental caries. Sociodemographic factors, dietary and oral health habits were associated with dental caries. Effective oral health interventions tailored to improve eating habits and the dental screening of children in this age group are imperative to mitigate these concerns.

Electronic supplementary material

The online version of this article (10.1186/s12903-018-0557-8) contains supplementary material, which is available to authorized users.

Oral health self-perception, dental caries, and pain: the role of dental fear underlying this association

BACKGROUND

Oral health perception has multidimensional nature and can be influenced not only by clinical conditions but also by psychosocial characteristics.

HYPOTHESIS

Dental fear could modify the association between dental caries and dental pain and the perception of negative impact.

DESIGN

A cross-sectional study was conducted with (n = 1,196) children aged 8-12 years attending public and private schools in Pelotas/Brazil. Children were interviewed and examined. Oral health perception was assessed using a global oral health impact item. Crude and adjusted multivariable regression models were built and effect modification of dental fear in the association between clinical indicators and perception of impact was tested.

RESULTS

Compared with children without fear and caries, children with fear and dental caries presented a 1.45 higher prevalence of negative impact (95% CI: 1.18-1.79) while those without fear and with dental caries had a 1.31 higher prevalence (95% CI: 1.11-1.54) after adjustments. Also, the prevalence of negative perception was higher for children with fear and dental pain (PR: 2.95; 95% CI: 1.59-2.39) and for children without fear and with pain (PR: 1.53; 95% CI: 1.29-1.80), compared to children without fear and pain.

CONCLUSION

The presence of fear increased the effect of pain and caries on children's oral health perception.

Prevalence and factors associated with enamel defects among preschool children from a southeastern city in Brazil

Abstract This study sought to determine the prevalence of developmental defects of enamel (DDE) among preschool children and investigate associations with sociodemographic and socioeconomic factors and weight status. A cross-sectional study was conducted with 118 children aged 3 to 5 years. Data were collected via clinical examinations and a self-administered questionnaire completed by the parents. The diagnosis of DDE was performed using the modified DDE Index. Information on socioeconomic indicators (mother's schooling, monthly income per capita), child's sex and age, and age of mother at the birth of the child were obtained by questionnaire. The children's weight status was determined based on weight-for-age at the time of the exam. Statistical analysis involved the chi-squared test and Poisson regression with robust variance. The prevalence of DDE was 50.0%. DDE were more frequent in males (p = 0.025) and children whose families were classified as being at poverty line (p = 0.040). In the Poisson model controlled for child's sex and mother's schooling, children whose families were classified as being at the poverty line had a greater prevalence rate of DDE. In conclusion, the prevalence of DDE was high in the present sample and associated with lower household income. Weight status was not associated with DDE.

Oral Hygiene Practices among Saudi Arabian Children and Its Relation to Their Dental Caries Status

Dental caries is one of the most common preventable diseases occurring among children. The aim here is to survey the oral hygiene practices that are commonly followed by Arab children and to see its relationship with their dental caries status. A cross-sectional study with multistage random sampling technique was conducted. Sociodemographic data and information on oral hygiene practices like use of toothbrush, dental floss, siwak, frequency of brushing along with number of snack between meals per day, and consumption of sugar per day was obtained. Presence of plaque on tooth surfaces was reported using plaque index, which was followed by DMFT index to determine the dental caries status. Among the sample of 500 school children, the mean plaque score in male (mean = 0.69; SD = 0.50) was slightly higher than the female (mean = 0.66; SD = 0.46). Increased frequency of snacks (P=0.05; ß=0.08; CI = -0.00, 0.09) and sugar consumption (P=0.01; ß=0.16; CI = 0.04, 0.27) per day significantly showed higher values of DMFT. Also, the odds of dental caries among the school children who were irregular in brushing their teeth was higher in contrast to the children brushing once (P=0.03; OR = 0.89; CI = 0.70, 1.12) or twice (P=0.03; OR = 0.80; CI = 0.64, 0.93) per day. It is recommended that the dental public health practitioners here should consider the effect of oral hygiene practices on oral health status in order to design the future health promotion interventions.

Effects of nutrition and hygiene education on oral health and growth among toddlers in rural Uganda: follow-up of a cluster-randomised controlled trial

OBJECTIVE

To examine the effect of a nutrition and hygiene education intervention on oral health behaviour and whether early onset of caries was related to child growth in rural Uganda.

METHODS

Follow-up study of a cluster-randomised controlled trial conducted between October 2013 and January 2015. Data were available from 399 mother/child pairs (203 in the intervention and 198 in the control group) of the original trial (78%) when the children were 36 months old. Oral health behaviour was evaluated using questionnaires. Photographs of the maxillary anterior teeth were examined for unmistakably carious lesions, and 115 water samples from the study area were analysed for fluoride concentration.

RESULTS

The frequency of cleaning of the child's teeth at 36 months was about twice as high in the intervention as in the control group (84.3% vs. 46.6%; P = 0.0001). Cavitated carious lesions occurred more frequently in the control than the intervention group (27.8% vs. 18.2%; P = 0.04). Extraction of 'false teeth' (ebiino), a painful and crude traditional operation, was profoundly reduced in the intervention group (8.9% vs. 24.7%; P = 0.001). There was no evidence of association between the occurrence of caries and child growth.

CONCLUSIONS

The education intervention improved oral hygiene practices and reduced the development and progression of caries and extraction of ebiino. Early childhood caries was not clearly associated with child growth.

[Inequalities in dental care during the life course of young people: a cohort study]

The scope of this study was to investigate dental care from the life course perspective and its determinant factors among young people in the city of Sobral, State of Ceará, Brazil. A cohort study was conducted with waves in 2000, 2006 and 2012 with 482 young people aged between 17 and 21 years. Two outcomes were investigated: immediate dental care and the lack of dental care, based on the dental trajectory in relation to restorative treatment. Socioeconomic conditions and recourse to oral health services and actions in the three waves investigated were used as independent variables. It was found that low socioeconomic status throughout life presented itself as a risk factor for lack of dental care and the inverse effect was observed with immediate dental care. Participation in groups of teenagers was also related to dental care, as well as receiving information on oral health. This study revealed the presence of inequalities in dental care throughout the life course of the population assessed.

Impact of untreated dental caries on the daily activities of children

OBJECTIVES

Untreated dental caries can compromise oral health-related quality of life (OHRQoL). However, it is not clear which specific daily activities related to OHRQoL are compromised by the presence of this problem. Therefore, the purpose of this study was to identify which specific daily activities are affected by the presence of untreated dental caries using a representative sample of Brazilian children.

METHODS

A cross-sectional study using a representative sample of Brazilian children (12 years of age) was conducted. The presence of untreated dental caries was assessed using the "decayed - D" component of the DMFT (decayed, missing, and filled teeth) index. Clinical exams were conducted by trained and calibrated dentists. The daily activities were evaluated using the survey Oral Impacts on Daily Performance (OIDP), considering items and domains. Descriptive, bivariate, and multiple analyses were conducted (α = 0.05).

RESULTS

A total of 7,247 children were included, and 39.9 percent had at least one tooth with untreated dental caries, with 33.5 percent experiencing an impact on at least one of the OIDP activities. This study identified a greater chance of the presence of untreated dental caries in children having an impact on the psychological domain (P = 0.006), as well as on the "difficulty eating" (P = 0.007), and "difficulty sleeping" (P = 0.023) items.

CONCLUSION

The presence of untreated dental caries among Brazilian children was associated with an impact on specific daily activities (difficulty eating and sleeping) and the psychological domain of OHRQoL.

Overweight, obese, underweight, and frequency of sugar consumption as risk indicators for early childhood caries in Brazilian preschool children

BACKGROUND

A possible association between being overweight or obese and early childhood caries (ECC) remains controversial.

AIM

To investigated this association in a developing country testing the confounding effects of socioeconomic factors and frequency of sugar consumption.

METHODS

Historical cohort study, 388 children (aged 24-71 months) living in São Luís, Brazil. A theoretical model adjusted according to income, birthweight, and nutritional status at twelve months and frequency of sugar consumption was generated with directed acyclic graphs to analyze this association. Caries were considered a discrete variable in the Poisson regression models; incidence density ratios (IRs) and 95% confidence intervals (95% CIs) were estimated.

RESULTS

Being overweight or obese (IR = 1.52; 95% CI: 1.03-2.22) was independently associated with ECC. Being thin or very thin (IR = 1.97; 95% CI: 1.52-2.54), a high frequency of sugar consumption (IR = 1.83; 95% CI: 1.42-2.38), and age (IR = 3.62; 95% CI: 2.58-5.08) were associated with ECC.

CONCLUSIONS

Children overweight or obese, as well as children exhibiting being thin/very thin, were associated with ECC independent of socioeconomic variables and a high frequency of sugar consumption.

Performance of pit and fissure sealants according to tooth characteristics: A systematic review and meta-analysis

OBJECTIVE

Aim of this systematic review was to assess the clinical performance of sealants on various teeth in an evidence-based manner.

SOURCES

Five databases were searched from inception to February 2017.

DATA

Randomized clinical studies on humans.

METHODS

After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, Paule-Mandel random-effects meta-analyses of Relative Risks (RRs) and their 95% confidence intervals (CIs) were calculated.

RESULTS

A total of 16 randomized clinical trials with 2778 patients (male/female 49.1%/50.9%) and an average age of 8.4 years were included. No significant difference in either caries incidence of sealed teeth or sealant retention could be found according to (i) mouth side (right versus left), (ii) jaw (upper versus lower), (iii) and tooth type (1st permanent molar versus 2nd permanent molar/1st permanent molar versus 2nd deciduous molar/1st deciduous molar versus 2nd deciduous molar), based on evidence of very low to low quality. On the other side, compared to 1st permanent molars, sealed premolars were significantly less likely to develop caries (3 trials; RR=0.12; 95% CI=0.03 to 0.44; P=0.001) and less likely to experience loss of the sealant (5 trials; RR=0.33; 95% CI=0.20 to 0.54; P=0.001), both based on low to moderate quality evidence.

CONCLUSIONS

The performance of pit and fissure sealants does not seem to be negatively affected by mouth side, jaw, and tooth type, apart from the exception of a favorable retention on premolars.

CLINICAL SIGNIFICANCE

Based on existing evidence, pit and fissure sealants can be effectively applied on any deciduous or permanent posterior teeth without adverse effects on their clinical performance.

The relationship between childhood body weight and dental caries experience: an umbrella systematic review protocol

BACKGROUND

Obesity and dental caries are global public health problems which can impact in childhood and throughout the life course. In simple terms, childhood dental caries and body weight are linked via the common risk factor of diet. An association between dental caries and obesity has been described in a number of studies and reviews. However, similarly, a relationship has also been noted between low body weight and caries experience in children. This protocol will provide the framework for an umbrella review to address the following question: Does the available evidence support a relationship between dental caries experience and body weight in the child population?

METHODS

This review protocol outlines the process to carry out an umbrella systematic review which will synthesise previous reviews of childhood dental caries experience and body weight. An umbrella review methodology will be used to examine the methodological and reporting quality of existing reviews.

DISCUSSION

The final umbrella review aims to aggregate the available evidence in order to provide a summary for policymakers and to inform healthcare interventions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42016047304.

Quantitative assessment of salivary oral bacteria according to the severity of dental caries in childhood

This study aimed to assess differences in selected oral bacteria in children according to the severity of dental caries. One hundred and thirty-six children, 36-60 months old were divided into three groups according to caries status: caries-free (CF) (n=47), early childhood caries (ECC) (n=40) and severe-early childhood caries (S-ECC) (n=49). Saliva was collected for detection and quantification of selected oral streptococci, Actinomyces naeslundii, Lactobacillus spp., Bifidobacterium spp., and Scardovia wiggsiae by quantitative-polymerase chain reaction. The results showed that the detection and quantitative levels of S. mutans, S. sobrinus, Bifidobacterium spp. and S. wiggsiae were significantly higher in S-ECC children compared to CF and ECC children, while for S. salivarius were significantly higher in CF compared to ECC and S-ECC children. There was no statistical difference among the clinical groups for S. mitis, S. oralis, A. naeslundii and Lactobacillus spp. levels and detection. S-ECC children had a lower monthly family income, started tooth brushing later and were breastfeed for a longer duration compared to CF children. S. mutans levels were positively correlated with S. wiggsiae and Bifidobacterium spp. levels, lower mother's education and child bottle-feeding before sleeping and negatively correlated with S. salivarius. It was concluded that in addition to S. mutans, other bacterial species, including bifidobacteria, Scardovia wiggsiae and S. sobrinus, are associated with severity of early childhood caries, although their role in the progress of dental caries remains unclear.

Social Determinants of Pediatric Oral Health

Social determinants of health are defined as conditions in which people are born and live and the role these conditions play on health outcomes. Research indicates that risk factors and their interactions are far more complex than originally thought. This article outlines social determinant constructs and their role in understanding oral health promotion. Due to the complex interactions, oral health must be promoted using a multilevel chronic disease model or common risk factor approach. An understanding of social determinants is particularly important for the pediatric population because optimum oral health and general health in adulthood are heavily influenced by childhood.

Dental caries

Dental caries is a biofilm-mediated, sugar-driven, multifactorial, dynamic disease that results in the phasic demineralization and remineralization of dental hard tissues. Caries can occur throughout life, both in primary and permanent dentitions, and can damage the tooth crown and, in later life, exposed root surfaces. The balance between pathological and protective factors influences the initiation and progression of caries. This interplay between factors underpins the classification of individuals and groups into caries risk categories, allowing an increasingly tailored approach to care. Dental caries is an unevenly distributed, preventable disease with considerable economic and quality-of-life burdens. The daily use of fluoride toothpaste is seen as the main reason for the overall decline of caries worldwide over recent decades. This Primer aims to provide a global overview of caries, acknowledging the historical era dominated by restoration of tooth decay by surgical means, but focuses on current, progressive and more holistic long-term, patient-centred, tooth-preserving preventive care.

Bayesian Analysis of the Association between Family-Level Factors and Siblings' Dental Caries

We conducted a Bayesian analysis of the association between family-level socioeconomic status and smoking and the prevalence of dental caries among siblings (children from infant to 14 y) among children living in rural and urban Northern Appalachia using data from the Center for Oral Health Research in Appalachia (COHRA). The observed proportion of siblings sharing caries was significantly different from predicted assuming siblings' caries status was independent. Using a Bayesian hierarchical model, we found the inclusion of a household factor significantly improved the goodness of fit. Other findings showed an inverse association between parental education and siblings' caries and a positive association between households with smokers and siblings' caries. Our study strengthens existing evidence suggesting that increased parental education and decreased parental cigarette smoking are associated with reduced childhood caries in the household. Our results also demonstrate the value of a Bayesian approach, which allows us to include household as a random effect, thereby providing more accurate estimates than obtained using generalized linear mixed models.

Caretaker's caries experience and its association with early childhood caries and children's oral health-related quality of life: A prospective two-generation study

OBJECTIVES

The first objective of this study is to examine the association between caretakers' caries experience and caries experience of their children. Second, to investigate whether children's and caretaker's caries experience is associated with oral health-related quality of life (OHRQoL) of children and their families.

METHODS

This study is based on the prenatal recruitment interviews and the 5-year follow-up of 417 caretaker-children pairs from the Ugandan site of the PROMISE-EBF trial conducted in Mbale, Eastern Uganda. Face-to-face interviews were conducted with caretakers at the household level. Caries experience of caretakers (DMFT >0) and children (dmft >0) were assessed in accordance with the criteria of the World Health Organization. OHRQoL was assessed using an abbreviated version of the Early Childhood Oral Health Impact Scale (ECOHIS).

RESULTS

Adjusted negative binomial regression analysis revealed that caretaker's caries experience was positively associated with early childhood caries of their offspring (IRR 2.0, 95% confidence interval (CI) 1.3-3.0). Children's caries experience (IRR 1.8, 95% CI 1.2-3.0), but not caries experience of caretakers, was associated with worse OHRQoL of children and their families. Caretakers who perceived good child oral health were less likely to report OHRQoL impacts (IRR 0.20, 95% CI 0.12-0.35).

CONCLUSION

Improving caretaker's caries experience and her perception of child's oral health status could improve children's caries experience and the OHRQoL of children and family. Such knowledge is important and should inform public oral health programs for young children.

Does dental health of 6-year-olds reflect the reform of the Israeli dental care system?

Background

The National health insurance law enacted in 1995 did not include dental care in its basket of services. Dental care for children was first included in 2010, initially up till 8 years of age. The eligibility age rose to 12 years in 2013.

The dental survey of 6 year-olds in 2007 found that the average of decayed, missing and filled teeth index (dmft) was 3.31 and 35 % of children were caries free. The current cross sectional survey of dental health for 6 year-olds was conducted as a comparison to the pre-reform status.

Methods

Twenty-three local authorities were randomly selected nationwide. Two Grade 1 classes were randomly chosen in each. The city of Jerusalem was also included in the survey because of its size. The children were examined according to the WHO Oral Health Survey Methods 4th ed protocol. The dental caries index for deciduous teeth (dmft: decayed, missing, filled teeth) was calculated.

Results

One thousand two hundred ten children were examined. 61.7 % of the children suffered from dental decay and only 38.3 % were caries free. The mean dmft was 2.56; d = 1.41 (teeth with untreated caries), f = 1.15 (teeth damaged by decay and restored), virtually none were missing due to caries. Dental caries prevalence was rather consistent, an average of over 2 teeth affected per child. Although there is no major change in comparison to former surveys, there is more treated than untreated disease. In the present survey the f component is higher than in the past, especially in the Jewish sector where it is the main component. It is still lower in the Arab sector.

Conclusions

Although the level of dental disease remained rather constant, an increase in the treatment component was observed. In order to reduce caries prevalence, preventive measures such as school dental services and drinking water fluoridation should be extended and continued. Primary preventive dental services should be established for children from birth, with an emphasis on primary health care and educational settings, such as family health centers and kindergartens.

Higher body mass index associated with severe early childhood caries

BACKGROUND

Severe Early Childhood Caries (S-ECC) is an aggressive form of tooth decay in preschool children affecting quality of life and nutritional status. The purpose was to determine whether there is an association between Body Mass Index (BMI) and S-ECC.

METHODS

Children with S-ECC were recruited on the day of their slated dental surgery under general anesthesia. Age-matched, caries-free controls were recruited from the community. All children were participating in a larger study on nutrition and S-ECC. Analysis was restricted to children ≥ 24 months of age. Parents completed a questionnaire and heights and weights were recorded. BMI scores and age and gender adjusted BMI z-scores and percentiles were calculated. A p-value ≤ 0.05 was significant.

RESULTS

Two hundred thirty-five children were included (141 with S-ECC and 94 caries-free). The mean age was 43.3 ± 12.8 months and 50.2 % were male. Overall, 34.4 % of participants were overweight or obese. Significantly more children with S-ECC were classified as overweight or obese when compared to caries-free children (p = 0.038) and had significantly higher mean BMI z-scores than caries-free children (0.78 ± 1.26 vs. 0.22 ± 1.36, p = 0.002). Those with S-ECC also had significantly higher BMI percentiles (69.0 % ± 29.2 vs. 56.8 % ± 31.7, p = 0.003). Multiple linear regression analyses revealed that BMI z-scores were significantly and independently associated with S-ECC and annual household income as were BMI percentiles.

CONCLUSIONS

Children with S-ECC in our sample had significantly higher BMI z-scores than caries-free peers.

Oral health education program among pre-school children: an application of health-promoting schools approach

Background: Preschool children have a limit ability to take care of their teeth. The aim of this study was to determine the effect of an intervention based on Albanian’s Health Promoting Schools Model (Albanian’s HPSM) on the oral health behaviors among a group of Iranian female preschool (5-6 years old) children.

Methods: In this quasi-experimental study, 120 children in seventh district of Tehran, Iran were randomly recruited and assigned to either the intervention or the control groups. A scale was designed and validated to assess the oral health behaviors among the children and knowledge,attitude, self-efficacy beliefs, perceived barriers and oral health behaviors among the parents and the schoolteachers. An expert panel approved the content validity of the scale (CVR = 0.89,CVI = 0.90). The reliability was also approved applying intraclass correlation coefficient (range,0.83–0.92) and Cronbach alpha (range, 0.83–0.96). Based on the preliminary data, a 6-week intervention was designed and conducted to the intervention group. One month following the intervention, both groups were followed-up. The data were analyzed using covariance and paired t tests.

Results: Following the intervention, significant differences were found in the oral health behaviors of the children in the intervention group (P < 0.05) and knowledge, attitude, oral health behaviors, self-efficacy, and perceived barriers of their parents and the schoolteachers (P < 0.05).

Conclusion: Using Albanian’s health-promoting schools (HPSs) approach was useful in improving the oral hygiene behaviors among the preschool children.

Dental caries is negatively correlated with body mass index among 7-9 years old children in Guangzhou, China

BACKGROUND

Evidence linking caries in primary dentition and children's anthropometric measures is contradictory. We aimed to evaluate the prevalence of primary dental caries and its relationship with body mass index (BMI) among 7-9 years old school children in urban Guangzhou, China.

METHODS

This cross-sectional study enrolled 32,461 pupils (14,778 girls and 17,683 boys) aged 7-9 years from 65 elementary schools in Guangzhou. Dental caries was detected according to criteria recommended by the World Health Organization (WHO). The total mean decayed, missing or filled teeth (dmft) of primary dentition were assessed. Weight and height were measured and BMI was calculated. Children were classified into underweight, normal weight, overweight and obesity groups by BMI based on Chinese criteria. Z-score of BMI-for-age (BAZ) was calculated by WHO standardized procedure. Multivariable odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated using logistic regression. Restricted cubic spline regression was applied to evaluate the shape of the relationship between BAZ and primary dental caries.

RESULTS

The prevalence of primary dental caries was 30.7 % in total sample. Regarding dmft values, the mean ± standard deviation (SD) in the combined sample were 1.03 ± 2.05 in boys and 0.93 ± 1.92 in girls. Both indices decreased by age. Compared with normal BMI group, children in overweight and obesity groups have 27 % (OR = 0.73, 95 % CI: 0.66-0.81, P < 0.0001) and 34 % (OR = 0.66, 95 % CI: 0.59-0.74, P < 0.0001) lower odds for the presence of primary dental caries after adjustment for age and gender, respectively. Although in general, increased BAZ was associated with decreased risk of dental caries, full-range BAZ was associated with dental caries in an A-shaped manner with a zenith at around -1.4.

CONCLUSION

Higher BMI was associated with lower odds of caries; overweight and obese children were more likely to be primary dental caries free among 7-9 years in Guangzhou, China.

Disparities in the experience and treatment of dental caries among children aged 9-18 years: the cross-sectional study of Korean National Health and Nutrition Examination Survey (2012-2013)

BACKGROUND

The aim of this study is to examine the association between parental socioeconomic status (SES) and the experience as well as treatment of dental caries among children aged 9 to 18 years.

METHODS

Data from 1253 children aged 9-18 years from the Korean National Health and Nutrition Examination Survey (2012-2013) were analyzed. Parental socioeconomic status was measured using household income level and maternal educational level. The decayed, missing, and filled teeth (DMFT) index was used to measure experience of dental caries (DMFT ≥ 1). Non-treatment of dental caries was measured according to whether the participants who experienced dental caries used a dental service at a dental clinic to treat caries during the previous year. Logistic regression was used to investigate the association between parental socioeconomic status and the experience of dental caries as well as the association between parental socioeconomic status and the non-treatment of dental caries among children that have experienced caries.

RESULTS

A total of 808 subjects (64.5 %) experienced dental caries among 1253 participants, and 582 of these 808 subjects (72.0 %) did not receive treatment among those having experience of dental caries. Parental socioeconomic status was not associated with experience of dental caries. However, those from low- and middle-income households were less likely to receive treatment than those from high-income households (odds ratio [OR] 2.11 [95 % confidence interval (CI) 1.16-3.86], OR 2.14 [95 % CI 1.27-3.62]). In particular, those from low- and middle-income households who had regular dental checkups were more likely to have untreated caries than those from high-income households (OR 3.58 [95 % CI 1.25-10.24]).

CONCLUSIONS

This study demonstrates the parental household income-related disparities in children's dental health treatment. Efforts should be made to lower financial barriers to dental health services, particularly among those from low-income households, in order to reduce dental health disparities in the treatment of caries in children.

Antimicrobial peptides in saliva of children with severe early childhood caries

OBJECTIVE

Controversies exist regarding the relationship between the concentrations of antimicrobial peptides (AMPs) and presence of dental caries in children. Thus, the aim of this study was to examine levels of AMPs in saliva of caries-free (CF), early childhood caries (ECC) and severe early childhood caries (S-ECC) children to determine if the levels of these salivary peptides individually or in combinations were related to caries severity and mutans streptococci levels.

DESIGN

36 to 60 month-old children were selected to participate in this study. Children were grouped into CF group (n=29), ECC group (n=25) and S-ECC group (n=29). Saliva was collected from children for microbiological analysis by culture. Salivary concentrations of cathelicidin LL-37, human β-defensin 2 (hBD-2), human β-defensin 3 (hBD-3) and histatin-5 (HTN-5) were determined by ELISA.

RESULTS

Salivary concentrations of AMPs did not differ among CF, ECC and S-ECC groups. Data showed positive correlations between mutans streptococci levels and salivary hBD-2 or HTN-5. Positive correlations were found between hBD-2, hBD-3, LL-37 and HTN-5. Combinations among AMPs, mainly LL-37, were positively associated with caries levels.

CONCLUSIONS

Salivary concentrations of AMPs individually were not associated with the severity of early childhood caries. The stimulus of caries appears to trigger a biological response, however, with a combination of these peptides.

Relationship between the IgA antibody response against Streptococcus mutans GbpB and severity of dental caries in childhood

OBJECTIVE

Explore the associations between the severity of dental caries in childhood, mutans streptococci (MS) levels and IgA antibody response against Streptococcus mutans GbpB. Moreover, other caries-related etiological factors were also investigated.

DESIGN

36-60 month-old children were grouped into Caries-Free (CF, n=19), Early Childhood Caries (ECC, n=17) and Severe Early Childhood Caries (S-ECC, n=21). Data from socio-economic-cultural status, oral hygiene habits and dietary patterns were obtained from a questionnaire and a food-frequency diary filled out by parents. Saliva was collected from children for microbiological analysis and detection of salivary IgA antibody reactive with S. mutans GbpB in western blot.

RESULTS

S-ECC children had reduced family income compared to those with ECC and CF. There was difference between CF and caries groups (ECC and S-ECC) in MS counts. Positive correlations between salivary IgA antibody response against GbpB and MS counts were found when the entire population was evaluated. When children with high MS counts were compared, S-ECC group showed significantly lower IgA antibody levels to GbpB compared to CF group. This finding was not observed for the ECC group.

CONCLUSIONS

This study suggests that children with S-ECC have reduced salivary IgA immune responses to S. mutans GbpB, potentially compromising their ability to modify MS infection and its cariogenic potential. Furthermore, a reduced family income and high levels of MS were also associated with S-ECC.

Association between Dental Caries and Socioeconomic Factors in Schoolchildren - A Multilevel Analysis

Abstract This study aimed to assess the association between dental caries, socioeconomic individual and contextual factors in 12-years-old children. A representative sample of 1,134 children enrolled in public schools from Santa Maria, RS, Brazil, was obtained from a multistage random sampling. Four calibrated dentists examined participants at schools. Data about dental caries (DMF-T index) and dental plaque (present or absent) were assessed. Children's parents or guardians answered questions regarding their demographics and socioeconomic status. Context variables were also collected from official publications of the city. Data analyses were performed using multilevel logistic regression models. Caries prevalence in this sample (DMF-T≥1) was 49.9% (95%CI: 45.05% - 54.77%), and mean DMF-T was 1.15 (95%CI: 1.01-1.29) with 0.068 standard error. Children of the 3rd and 2nd tertile of income represented by the rich and intermediate categories, showed, respectively, a 50% (OR 0.50: CI95 % 0.35-0.71) and 39% (OR 0.61: CI95% 0.45-0.82) lower chance to present untreated caries compared with the poorest portion of the sample represented by the 1st tertile of income. Regarding the context covariates, children from lower income neighborhood presented a higher chance for having untreated dental caries compared with their counterpart (OR 1.70: CI95% 1.19 to 2.43). Inequalities in the distribution of dental caries continue affecting children from poorer socioeconomic profiles. There is need for planning public interventions for oral health promotion that take into account individual and contextual socioeconomic characteristics.

Protocol for assessing maternal, environmental and epigenetic risk factors for dental caries in children

Background

Expenditure on dental and oral health services in Australia is $3.4 billion AUD annually. This is the sixth highest health cost and accounts for 7 % of total national health expenditure. Approximately 49 % of Australian children aged 6 years have caries experience in their deciduous teeth and this is rising. The aetiology of dental caries involves a complex interplay of individual, behavioural, social, economic, political and environmental conditions, and there is increasing interest in genetic predisposition and epigenetic modification.

Methods

The Oral Health Sub-study; a cross sectional study of a birth cohort began in November 2012 by examining mothers and their children who were six years old by the time of initiation of the study, which is ongoing. Data from detailed questionnaires of families from birth onwards and data on mothers’ knowledge, attitudes and practices towards oral health collected at the time of clinical examination are used. Subjects’ height, weight and mid-waist circumference are taken and Body Mass Index (BMI) computed, using an electronic Bio-Impedance balance. Dental caries experience is scored using the International Caries Detection and Assessment System (ICDAS). Saliva is collected for physiological measures. Salivary Deoxyribose Nucleic Acid (DNA) is extracted for genetic studies including epigenetics using the SeqCap Epi Enrichment Kit. Targets of interest are being confirmed by pyrosequencing to identify potential epigenetic markers of caries risk.

Discussion

This study will examine a wide range of potential determinants for childhood dental caries and evaluate inter-relationships amongst them. The findings will provide an evidence base to plan and implement improved preventive strategies.

Weighing in on pediatric obesity: Weight screening at the dental visit

BACKGROUND AND OVERVIEW

Pediatric obesity is a public health concern requiring an interprofessional approach to care. Weight screening in the dental office can promote healthy behaviors to improve weight and oral health status and reduce systemic and oral health risks.

CONCLUSIONS

Oral health care professionals can perform weight screenings quickly. Routine weight screening of pediatric patients and early intervention through education and referral of patients to a registered dietitian nutritionist and a physician for more in-depth evaluation may help reduce disease risk.

PRACTICAL IMPLICATIONS

Oral health care professionals can measure a patient's height and weight and can easily calculate body mass index percentile according to a patient's age and sex to detect weight status that does not fall within the normal range. Oral health care professionals should refer patients who are underweight, overweight, or obese to a registered dietitian nutritionist and the patient's physician for follow-up.

Early Childhood Caries, Mouth Pain, and Nutritional Threats in Vietnam

OBJECTIVES

We investigated the relationships among early childhood caries (ECC), mouth pain, and nutritional status in children aged 1 to 6 years in Southern and Central Vietnam.

METHODS

A total of 593 parent-child pairs were recruited from 5 kindergartens or preschools in Ho-Chi Minh City and Da Nang. Parents completed surveys about dietary habits, oral health practices, and children's mouth pain experience; children received anthropometric assessment and dental examinations.

RESULTS

There was a high prevalence of dental caries (74.4%), mostly untreated, and mouth pain (47.1%). Moderate correlations were found between parents' and children's consumption of soda (ρ = 0.361; P < .001) and salty snacks (ρ = 0.292; P < .001). Severity of ECC was associated with decreased weight- and body mass index-for-age z-scores. Presence of pulp-involved caries was associated with strikingly lower height-for-age (mean difference = 0.66; P = .001), weight-for-age (mean difference = 1.17; P < .001), and body mass index-for-age (mean difference = 1.18; P < .001) z-scores. Mouth pain was associated with lower body mass index-for-age z-scores (mean difference = 0.29; P = .013).

CONCLUSIONS

ECC might negatively affect children's nutritional status, which might be mediated by the depth of decay, chronic inflammation, and mouth pain. Family-based and prevention-oriented nutrition and oral health programs are needed and should start during pregnancy and infancy.

Nutritional status, tooth wear and quality of life in Brazilian schoolchildren

OBJECTIVE

To evaluate the correlation among nutritional status, tooth wear and quality of life in Brazilian schoolchildren.

DESIGN

The study followed a cross-sectional design. Nutritional status was measured via anthropometry using BMI and tooth wear was measured using the Dental Wear Index; both these assessments were carried out by a trained recorder according to standard criteria. A modified version of the Child Oral Impacts on Daily Performances was used to assess quality of life.

SETTING

City of Bauru, in Brazil.

SUBJECTS

A cluster sample of 396 schoolchildren (194 boys and 202 girls) aged 7-10 years.

RESULTS

The anthropometric assessment showed similar situations for both sexes regarding underweight (31·40 % in boys and 30·20 % in girls) and overweight/obesity (33·96 % in boys and 33·17 % in girls). The underweight children showed a greater severity of tooth wear in the primary teeth (OR=0·72; CI 0·36, 1·42), although in the permanent dentition the obese children had a greater severity of tooth wear (OR=1·42; 95 % CI 0·31, 6·55). The tooth wear was correlated with age for both dentitions.

CONCLUSIONS

Tooth wear in the primary and permanent dentition may be related to nutritional status. Tooth wear and obesity did not have a significant impact on the schoolchildren's perception of quality of life.

Epidemiological study of traumatic dental injuries in 5- to 6-year-old Brazilian children

Monitoring traumatic dental injury (TDI) in primary teeth through epidemiological cross-sectional surveys provides descriptive information relevant to the development of public policies focused on the prevention of such injuries for the target population. The aim of this study was to assess the prevalence of TDI in 5- to 6-year-old Brazilian children and its association with biological and socioeconomic factors. A total of 684 children aged 5 to 6 years old, from 11 public schools in the city of Barueri (Brazil) were evaluated. Clinical examinations were carried out in the schools, by two trained and calibrated examiners. Gauze and a mouth mirror were used for the examinations. The reported TDIs were classified according to the Andreasen (2007) criteria for primary teeth. The results showed that 52.3% of the children had TDI. Enamel fracture (63.4%) was the most frequently observed sign of TDI, and the most affected teeth were the primary maxillary central incisors (26.9% maxillary right central incisor and 24% maxillary left central incisor). There was no association between the presence of TDI and biological or socioeconomic factors. In conclusion, the prevalence of TDI was high and had no statistically significant association with biological and socioeconomic factors.

[Is the severity of caries associated with malnutrition in preschool children?]

An analysis was conducted to evaluate if the severity of caries is associated with protein-calorie malnutrition in preschool children. The cross-sectional study was performed on a retrospective cohort of 625 children aged 24-71 months attending daycare centers in São Luís, Maranhão. A hierarchical model was evaluated at five levels: 1.) Socio-economic variables (economic group, mother's educational level and skin color); 2) Access variables; 3) Low birth weight (LBW) and exclusive breastfeeding; 4) Weight per height at 12 months; and 5) Severity of caries and albumin (Alb) levels. The outcome was protein-calorie malnourishment (weight per height z score < -2). The prevalence of outcome was 5.0% and the prevalence of caries was 32%. At the first level, the variables were not associated with the outcome, but the economic group was maintained until the final model. The variables in the second and third levels were not significant. At the fourth level, weight for height at 12 months was not significant, but was maintained until the final model. In the last level, severity of caries was positively associated with malnourishment. The association between severity of caries and malnourishment suggest that oral health should be integrated with public health care policies for children.

Lactotransferrin Gene Polymorphism Associated with Caries Experience

Dental caries is a common multifactorial disease, resulting from the interaction of biofilm, cariogenic diet and host response over time. Lactotransferrin (LTF) is a main salivary glycoprotein, which modulates the host immune-inflammatory and antibacterial response. Although a genetic component for caries outcome has been identified, little is known over the genetic aspects underlying its susceptibility. Thus, the aim of this study was to investigate the association between LTF polymorphisms and caries susceptibility. Six hundred seventy seven 12-year-old students were selected: 346 with (DMFT ≥ 1) and 331 without caries experience (DMFT = 0). Also, individuals concentrating higher levels of disease (polarization group, DMFT ≥ 2, n = 253) were tested against those with DMFT ≤ 1 (n = 424). Along with clinical parameters, three representative LTF tag SNPs (rs6441989, rs2073495, rs11716497) were genotyped and the results were evaluated using univariate and multivariate analyses. Allele A for tag SNP rs6441989 was found to be significantly less frequent in the polarization group, conferring a protective effect against caries experience [AA + AG × GG (OR: 0.710, 95% CI: 0.514-0.980, p = 0.045)], and remained significantly associated with caries protection in the presence of gingivitis (p = 0.020) and plaque (p = 0.035). These results might contribute to the understanding of the genetic control of caries susceptibility in humans.

Social determinants of health and oral health: An Indian perspective

Several conventional approaches have been tried in the past to resolve health inequities in India. However, achieving Universal Health Coverage (UHC) is yet to be fully realized as the benefits have been meager. The recent concept of targeting social determinants of general and oral health in order to achieve health for all has shown positive results in the developed as well as the developing nations. Based on the framework recommended by the Commission on Social Determinants of Health, several policies have been introduced and suitably backed up with the intention of providing health care even to people living in remote sections of the society. This paper intends to highlight the rationale for social determinants approach in Indian context, its application and future recommendations for the same. It is considered as a radical approach, and adequate measures have been implemented by health systems to achieve the desired targets without delay. However, in order to achieve UHC, redistribution of the available resources and converting the "normative" needs into "felt" needs of the people is going to be an uphill task to accomplish.

Association of sweet taste receptor gene polymorphisms with dental caries experience in school children

Sweet taste is a powerful factor influencing food acceptance. The peripheral taste response to sugar is mediated by the TAS1R2/TAS1R3 taste receptors. The aim of the study was to determine the relationship between TAS1R2 (rs35874116 or rs9701796) and/or TAS1R3 (rs307355) single nucleotide polymorphisms with dental caries experience in schoolchildren. A total of 184 schoolchildren aged between 7 and 12 years (101 girls, 83 boys) were included in the study. Genomic DNA was extracted from saliva samples and the genotypes were identified by qPCR. The genotype frequencies were as follows: 6.6% for homozygous wild type, 41.8% for heterozygous and 51.6% for homozygous polymorphic genotype carriers of TAS1R2 gene rs35874116; 27.8% for heterozygous and 72.2% for homozygous polymorphic genotype carriers of TAS1R2 gene rs9701796, and 83.1% for homozygous wild type and 16.9% for heterozygous genotype carriers of TAS1R3 gene rs307355 polymorphism. A significant association was observed between total caries experience (dft + DMFT - decayed filled primary teeth + decayed, missing and filled permanent teeth) and TAS1R2 rs35874116 (p = 0.008) and TAS1R3 rs307355 (p = 0.04) gene polymorphisms but not for TAS1R2 gene rs9701796 polymorphism. TAS1R3 gene rs307355 polymorphism has been found to be an independent risk factor for dental caries experience by logistic regression analysis and to have increased the risk of caries. Moderate caries experience (4-7 caries) was found to be associated with TAS1R3 rs307355 heterozygous genotype, whereas high-risk caries experience (>8 caries) was found to be associated with TAS1R2 rs35874116 homozygous polymorphic genotype.

Impact of dental caries on quality of life among preschool children: emphasis on the type of tooth and stages of progression

The aim of this cross-sectional study was to evaluate the impact of dental caries on the quality of life of preschool children and their parents/caretakers, with an emphasis on the type of tooth and stage of progression. A randomly selected sample of preschool children, 3-5 yrs of age, underwent an oral examination for the assessment of dental caries using the International Caries Detection and Assessment System II (ICDAS II) criteria. Parents/caretakers answered two questionnaires, one on the oral health-related quality of life (OHRQoL) of the child [the Early Childhood Oral Health Impact Scale (ECOHIS)], and the other on the socio-economic characteristics of the family. Statistical analyses were performed using the chi-square test, Kruskal-Wallis test, Mann-Whitney U-test, and Poisson regression. A total of 451 preschool children participated in the study. The majority of carious lesions exhibited severe decay (60.6%) and were found in both anterior (incisors/canines) and posterior (molars) teeth. The final Poisson model revealed negative impacts on quality of life from more advanced stages of dental caries, both in incisors/canines and molars. Child's age and household income were also associated with impact on quality of life. Carious lesions in more advanced stages of progression in anterior and posterior teeth were associated with a negative impact on the quality of life of preschool children.

Comparação de métodos de regressão multivariada no estudo de determinantes da cárie dentária em crianças

Objetivos: comparar resultados com modelos multivariados hierarquizados e convencionais na investigação de determinantes da cárie dentária em crianças. Métodos: analisou-se dados de um inquérito em crianças assistidas pela Estratégia Saúde da Família do Recife, Pernambuco, conduzido em 2006. A variável dependente foi a prevalência de cárie (ceo-d≥1); As variáveis independentes foram ordenadas em blocos: socioeconómico, contexto de vida/familiar, cuidado em saúde bucal. Variáveis estatisticamente associadas a ceo-d ≥1 em análises univariadas, com um nível de significância dep≤0,20, foram incluídas nos modelos multivariados. No modelo hierarquizado, a ordem de inclusão das variáveis foi orientada por um modelo conceitual multidimensional. Variáveis associadas a um nível de p≤0,10 foram mantidas no modelo final. No modelo logístico convencional as variáveis significantes nas análises univariadas foram simultaneamente incluídas e ajustadas. Variáveis associadas ao ceo-d com p≤0,10 foram mantidas. Resultados: no modelo convencional foram fatores associados ao ceo-d≥1: alta densidade domiciliar, baixa escolaridade do cuidador; estudar em escolas públicas, procurar tratamento/emergência, ingerir doces. No modelo hierarquizado, além desses fatores, foram mantidos no modelo final a ocupação do pai e a escolaridade da mãe. Conclusões: a análise hierarquizada possibilitou identificar os determinantes distais, que exerceram influências sobre os de níveis inferiores e destes sobre o desfecho, permitindo uma discussão mais contextualizada do problema.

Factors underlying the polarization of early childhood caries within a high-risk population

BACKGROUND

Early childhood caries (ECC) are particularly prevalent in disadvantaged populations, and socioeconomic factors are associated with the polarization of disease. A previous study showed that even within a homogenous low-income population disease is polarized, indicating that other factors apart from income may contribute to disease susceptibility.

METHODS

This study used a hierarchical approach to identify factors associated with polarization of ECC in low-income subjects. This cross-sectional study was conducted retrospectively using a cohort of 244 children (aged 48-72 months) with family incomes not exceeding double the minimum wage (U.S. $8,208.00/year), living in neighborhoods on the outskirts of São Luís, Maranhão, Brazil. The sample was divided into three groups based on the Significant Caries (SiC) Index: no caries group, few caries group (mean 1.38 lesions), and a high caries group (mean 3.82 lesions). Hierarchical multinomial logistic regression analyses were performed based on a theoretical model.

RESULTS

Twenty-eight (11.5%) of the 244 children presented with high caries. Age (p = 0.026; prevalence ratio (PR) = 1.10; 95% confidence interval (CI) 1.01-1.20) and frequency of sucrose consumption - p = 0.001; PR 4.65 (95% CI 1.83-11.84) were associated with increased risk of ECC.

CONCLUSIONS

In the high caries group, greater consumption of sucrose between main meals may explain why, in a group of children with homogenous social and health conditions, some had more caries than others.

Social aspects of dental caries in the context of mother-child pairs

The relationship between mother and child in the context of oral health has traditionally been exposed by the scientific literature in microbiology, which lacks a broad and necessary discussion of health and illness seen as processes, both biological and social.

Early childhood caries and its relationship with perinatal, socioeconomic and nutritional risks: a cross-sectional study

Background

Socioeconomic, perinatal and other life cycle events can be important determinants of the health status of the individual and populations. This study aimed to assess the prevalence of early childhood caries (ECC), perinatal factors (gestational age, teenage pregnancy and birth weight), family income and nutritional risk in children.

Methods

A cross-sectional study in which 320 children were examined according to the criteria established by the World Health Organization. A previously validated questionnaire was used to obtain information from parents and guardians about family income, gestational age and birth weight. To check the nutritional risk, we used the criteria provided by the CDC (Center for Disease Control). For Statistics, Pearson’s, chi-square and the multivariate Poisson analyses were used to determine the association among variables.

Results

Approximately 20% of children had ECC, and the Poisson multivariate analyses indicated that family income (p = 0.009), birth weight (p < 0.001) and infant obesity (p < 0.001) were related to the increase of ECC, and gestational age was not significantly associated with ECC (p = 0.149). Pregnancy in adolescence was not included in the regression analyses model because it was not statistically significant in the chi-square test (p > 0.05).

Conclusion

The prevalence of ECC was related to low family income, premature birth and infant obesity.

Impact of low birthweight on early childhood caries in 6-36 months old infants in Uganda: A cross-sectional study

OBJECTIVE

Focusing on 6-36 months old infants, this study assessed (1) whether socio-economic status, current anthropometric status, presence of enamel hypoplasia, number of erupted teeth, oral hygiene and consumption of sugared snacks varied between children with normal birthweight (NBW) and low birthweight (LBW) and (2) the association between ECC and birthweight whilst adjusting for covariates of ECC, such as current anthropometric status.

METHOD

A cross-sectional study was conducted in Kampala in 2007, involving 816 child/caretaker pairs. All caretakers completed face-to-face interviews. Children were examined for ECC and enamel defects using WHO (1997) criteria and the developmental defects of enamel (DDE) index. Weight at birth was obtained from hospital records and current anthropometric status was assessed using z-scores for weight-for-length (WLZ), length-for-age (LAZ) and weight-for-age (WAZ).

RESULTS

Prevalence of LBW (< 2500 g) and ECC were estimated to 11.5% and 18.1%, respectively. Children with LBW and those with ECC presented with more visible plaque, higher sugar consumption and more current underweight (WAZ < -2) than children with normal birth weight (NBW) and no caries; 26.7% of LBW vs 17.3% (p < 0.001) of NBW children presented with ECC. Enamel defects (OR = 2.8, 95% CI = 1.6-4.8) and presence of visible plaque (OR = 2.4, 95% CI = 1.3-4.1), but not LBW, were associated with ECC in multiple variable logistic regression analyses.

CONCLUSION

Both LBW and ECC were associated with poor oral hygiene, high intake of sugars and current underweight. Enamel defects were associated with ECC. Adjusting for covariates there were no clear association between LBW and ECC. Studies using a prospective study design are needed for further investigation.

Dental caries and growth in school-age children

BACKGROUND AND OBJECTIVE

Dental caries in young children is commonly untreated and represents a public health problem. Dental caries in children is reported to affect their anthropometric outcomes, but the evidence is conflicting. Some studies found no association, whereas others found that caries was associated with underweight or overweight. The objective was to assess the relationship between dental caries status and height and weight in 6- to 8-year-old Saudi children with high caries prevalence.

METHODS

This study was a cross-sectional survey in schoolchildren aged 6 to 8 years attending military primary schools in Jeddah, Saudi Arabia. Caries status was assessed by using the dmft (decayed, missing, filled, teeth [primary teeth]) index. Height and weight were assessed by using z scores of height-for-age (HAZ), weight-for-age (WAZ), and BMI-for-age (BAZ) calculated by World Health Organization standardized procedures. Relationships between caries and HAZ, WAZ, and BAZ were assessed by using regression models.

RESULTS

A total of 417 of the 436 eligible schoolchildren with complete data were included, with a response rate of 95.6%. Their mean dmft index was 5.7 ± 4.2. There was an inverse linear relationship between caries status and children's HAZ, WAZ, and BAZ and significantly lower anthropometric outcomes for children at each consecutive group with higher levels of caries. The associations remained significant after adjusting for dental, social, and demographic variables.

CONCLUSIONS

The inverse linear association between dental caries and all anthropometric outcomes suggests that higher levels of untreated caries are associated with poorer growth in Saudi schoolchildren.

The relationship between caregiver functional oral health literacy and child oral health status

OBJECTIVE

To describe the relationship between caregivers' oral health literacy (OHL) and the oral health status of their children in an Asian population.

METHODS

A random sample of 301 child/caregiver dyads was recruited from kindergartens in Hong Kong. Two locally-developed and validated OHL assessment tasks were administered to caregivers with Hong Kong Rapid Estimate of Adult Literacy in Dentistry-30 (HKREALD-30) assessing word recognition and Hong Kong Oral Health Literacy Assessment Task for Paediatric Dentistry (HKOHLAT-P) assessing comprehension. Their children's oral health status was assessed [dental caries experience - decayed, missing, filled teeth index - (dmft) and oral hygiene status - Visible Plaque Index (VPI)].

RESULTS

Caregivers' literacy was associated with children's oral health status. The HKOHLAT-P had a stronger association with children's oral health than HKREALD-30. HKOHLAT-P and HKREALD-30 remained associated with dmft in the adjusted negative binomial regression models (accounting for socio-demographics), Incidence Rate Ratio (IRR) 0.97, p=0.02, and 0.96, p=0.03, respectively. In the adjusted model, HKOHLAT-P was associated with VPI (IRR 0.90, p<0.05), but no association between HKREALD-30 and VPI was evident.

CONCLUSION

The main conclusion of this study was that caregiver oral health literacy was associated with their child's oral health status. A comprehension instrument had a more robust association with children's oral status than a word recognition instrument.

PRACTICE IMPLICATIONS

This study has implications for general public health education for designing community-level interventions.