Tooth brushing habits and prevalence of early childhood caries: a prospective cohort study

The role of AMY1 gene copy number variation in dental caries susceptibility: insights from a Turkish population

OBJECTIVE

Dental caries is a multifactorial disease influenced by environmental, behavioral, and genetic factors. Recent studies suggest that variations in the AMY1 gene, which encodes salivary amylase, may contribute to caries susceptibility. This study investigates the relationship between AMY1 gene copy number variation (CNV) and dental caries in a Turkish population.

METHOD

A total of 154 participants (63% female; mean age 19.6 ± 1.4 years) were included. Epithelial cells in inner cheek tissues were collected from volunteers using swabs, and the collected samples were preserved and stored in a DNA stabilization solution. The demographic characteristics of the volunteers were recorded, and DMFT and DMFS index scores were documented on the provided forms. The AMY1 gene CNVs were determined using a Real-time polymerase reaction device. The TaqMan chemistry, which comprises quantitative real-time PCR reactions utilizing a dual TaqMan kit, was utilized in this analysis process. Statistical analyses included the Kruskal-Wallis and Mann-Whitney U tests for group comparisons, Spearman's correlation analysis, and binomial logistic regression to evaluate associations between AMY1 CNVs and dental caries indices.

RESULTS

No statistically significant differences were observed between AMY1 CNVs and DMFT or DMFS indices (p > 0.05). However, significant associations were found between daily tooth brushing frequency and caries indices (Cramer's V = 0.219, p < 0.05), as well as between preferred beverage consumption and caries indices (Cramer's V = 0.219, p < 0.05). Other factors, including gender, dental floss and mouthwash use, and tongue brushing, did not show statistically significant associations (p > 0.05).

CONCLUSION

Although AMY1 CNVs were not significantly associated with caries indices, the findings highlight the complex interplay of genetic, behavioral, and dietary factors in caries development. This study emphasizes the critical role of oral hygiene and dietary habits in caries prevention and underscores the need for further research on genetic contributions to oral health.

CLINICAL TRIAL NUMBER

Not applicable.

Using a polyurea resin-bonded mounted wheel, dental resin composites and porcelain are polished precisely

BackgroundThe success of dental restorations depends on achieving adequate surface integrity. However, grinding and polishing are generally ineffective because of the special physical and chemical compositions and properties of the composites. Polyurea resin is an elastomer with high elasticity, abrasion resistance, heat resistance, and toughness. When it is used as a bond, grinding wheels with high grain grip strength can be fabricated.ObjectiveWe fabricated a mounted wheel with a polyurea resin as the bond and used it to polish a composite resin and porcelain under clinical polishing conditions. The effects of the approach on the polished surface roughness and morphology were evaluated with respect to the type of mounted wheel, initial surface roughness, abrasive particle size, and polishing time.MethodsThis study fabricates a mounted wheel with polyurea resin as the bond and uses it to polish composite resin and porcelain under clinical polishing conditions. The effects of the approach on the polished surface roughness and morphology are evaluated against the type of mounted wheel, initial surface roughness, abrasive particle size, and polishing time.ResultsAmong single-crystal diamond, siliconcon carbide (GC), and alumina (WA) abrasive grains, diamond abrasive grains produced the best finish for most tested resin composites. However, WA abrasive grains are effective for polishing Estenia (it has the highest filler content). The polishing performance of the porcelain varied with the initial surface roughness and abrasive particle diameter.ConclusionThis study provides guidance for improving and developing mounted wheels for clinical applications.

Iranian early childhood dental caries: a comprehensive systematic review and meta-analysis of prevalence and associated risk factors

OBJECTIVES

Early childhood dental caries (ECC) is a prevalent dental condition affecting infants and young children, characterized by one or more carious lesions in primary teeth. ECC risk factors include malnutrition, genetic predisposition, specific dietary habits, lack of fluoride, and prolonged bottle feeding. A comprehensive prevalence estimate is crucial for understanding the extent of dental caries in the population. So, this study aimed to determine the prevalence of ECC and its associated risk factors in Iranian children.

METHODS

A comprehensive literature search was conducted in Scopus, Web of Science, PubMed, Google Scholar, ACECR Scientific Information Database ( www.ACECRScientific Information Database.ir ), and Magiran research databases. Eligible English and Persian studies published between 2006 and 2024 were reviewed and analyzed. The studies on ECC prevalence were identified and included in the meta-analysis. Random effect models were utilized to calculate the pooled prevalence, and meta-regression and sensitivity analyses were conducted to assess sources of heterogeneity in the systematic review of risk factors.

RESULTS

The meta-analysis encompassed thirty eligible studies, providing the prevalence of ECC in Iran, with an estimated prevalence of 61.7%. Meta-regression analysis indicated a non-statistically significant increase in ECC prevalence with age and a substantial slight decrease over time. Additionally, 68 Studies evaluated categories such as age, gender, sociodemographic factors, microbial flora, oral hygiene, breast/bottle feeding, and dietary. Significant ECC-related factors identified included parents' education and occupation, breastfeeding, and oral hygiene.

CONCLUSION

The overall prevalence of ECC in Iran was estimated at 61.7%, with notable heterogeneity. Most of the studies extensively evaluated sociodemographic factors as risk factors.

Changes in Toothbrushing Behaviors Following a Child Dental Care Reform in Israel

(1) Background: Toothbrushing behavior in children and adolescents is shaped by national dental health policies and sociodemographic and psychological factors. In 2010, child dental care was incorporated into Israel's National Health Insurance Law (NHIL). This study explored toothbrushing behavior and its predictors before and after this reform. (2) Methods: Data from 36,755 students in grades 6-10 were analyzed from the Health Behaviour in School-Aged Children study conducted pre-reform (1998, 2002, 2006) and post-reform (2010, 2013, 2016). The dependent variable was toothbrushing behavior, while the independent variables included sociodemographic and psychological characteristics. Chi-squared tests compared proportions of compliant toothbrushing behaviors, and logistic regression identified significant predictors. (3) Results: According to recommendations, 59-64% of children brushed their teeth before the reform. This proportion increased significantly post-reform, reaching 73% in 2018. Predictors of compliance included being female, younger, Jewish, and non-observant, having a higher socioeconomic status, and having a better psychological status. These predictors were consistent in pre- and post-reform regression models. (4) Conclusions: The dental care reform positively influenced toothbrushing habits among children and adolescents. However, disparities remain among specific communities. Interventions tailored to address sociodemographic and psychological factors are recommended to enhance regular toothbrushing habits across all populations.

Exploring the potential of a school brushing program using a connected brush in underserved areas: a feasibility cluster randomised trial

BACKGROUND

The main aim of this cluster randomised controlled trial is to explore the feasibility of a school-based brushing program utilising a smart, connected brush in children.

METHODS

Students aged 8 to 11 years in 6 primary schools across Manchester, UK were approached for this study. All children received a smart, connected toothbrush which captured information on coverage, duration and frequency of brushing. Teachers had access to class-level digital dashboards summarising brushing habits to set challenges for the students. Additionally, children in schools randomised to the toothbrush plus text messaging trial arm received text message support (delivered to their parents' mobile phones). Outcomes included: (a) consent rate, (b) recruitment rate recorded as the number of participants who completed at least one of the study surveys post-consents, and (c) acceptability of the interventions on schools and parents through a mixed methods approach.

RESULTS

Average age of parents was 39.8 years (SD5.94) while the average age of children was 9.7 years (SD1.56). Most parents and children came from households in the most deprived decile based on their Index of Multiple Deprivation (IMD) scores with 77 households (52.4%) scoring 1 (most deprived). Out of 753 eligible participants across all 6 schools, 409 were consented (54.3% consent rate) with 148 participants completing baseline measurements (36.8%). During the study, there was only 1 drop out. In terms of acceptability, parents found the study very enjoyable (average score of 8.9/10), and found the brush and app easy to use (average score of 8.7/10). Those parents who additionally received the text messages found them easy to understand and useful (average score of 8.9/10). In total, 91.6% of parents would recommend the brush and the intervention to family and friends. Three key facilitators ((a) enhancing children's self-reliance, (b) increased engagement through the use of visual cues and (c) increased motivation (due to gamification) potentially supported children's engagement with the brush and app.

CONCLUSIONS

Low dropout rates and very positive feedback highlight the potential of this intervention. Future studies should consider how to quantify changes in children's oral health, address loss of questionnaire completion and harness the opportunities this study provided.

TRIAL REGISTRATION

The study was registered at ISRCTN registration number ISRCTN77803149 on the 28th December 2023.

Development of Chatbot-Based Oral Health Care for Young Children and Evaluation of its Effectiveness, Usability, and Acceptability: Mixed Methods Study

Background

Chatbots are increasingly accepted in public health for their ability to replicate human-like communication and provide scalable, 24/7 services. The high prevalence of dental caries in children underscores the need for early and effective intervention.

Objective

This study aimed to develop the 30-Day FunDee chatbot and evaluate its effectiveness, usability, and acceptability in delivering oral health education to caregivers of children aged 6 to 36 months.

Methods

The chatbot was created using the artificial intelligence (AI) chatbot behavior change model, integrating behavioral change theories into content designed for 3-5 minutes of daily use over 30 days. A pre-post experimental study was conducted from December 2021 to February 2022 in Hat Yai District, Songkhla Province, and Maelan District, Pattani Province, Thailand. Fifty-eight caregivers completed a web-based structured questionnaire at baseline and 2 months post baseline to evaluate knowledge, protection motivation theory-based perceptions, and tooth-brushing practices. Usability was assessed via chatbot logfiles and a web-based questionnaire at 2 months post baseline. Acceptability was evaluated through three methods: (1) open-ended chatbot interactions on day 30, (2) a web-based structured questionnaire at 2 months post baseline, and (3) semistructured telephone interviews with 15 participants 2 weeks post intervention. Participants for interviews were stratified by adherence levels and randomly selected from Hatyai and Maelan districts. All self-reported variables were measured on a 5-point Likert scale (1=lowest, 5=highest).

Results

The chatbot was successfully developed based on the 4 components of the AI chatbot behavior change model. Participants had a mean age of 34.5 (SD 8.6) years. The frequency of tooth brushing among caregivers significantly improved, increasing from 72.4% at baseline to 93.1% two months post baseline (P=.006). Protection motivation theory-based perceptions also showed significant improvement, with mean scores rising from 4.0 (SD 0.6) at baseline to 4.5 (SD 0.6) two months post baseline (P<.001). The chatbot received high ratings for satisfaction (4.7/5, SD 0.6) and usability (4.7/5, SD 0.5). Participants engaged with the chatbot for an average of 24.7 (SD 7.2) days out of 30. Caregivers praised the chatbot's content quality, empathetic communication, and multimedia design, but noted the intervention's lengthy duration and messaging system as limitations.

Conclusions

The 30-Day FunDee chatbot effectively enhanced caregivers' perceptions of oral health care and improved tooth-brushing practices for children aged 6-36 months. High user satisfaction and engagement demonstrate its potential as an innovative tool for oral health education. These findings warrant further validation through large-scale, randomized controlled trials.

Testing a multi-behavioral intervention to improve oral health behaviors in the pediatric dental surgery population: protocol for the PROTECT trial

Severe early childhood caries (S-ECC) is a common disease within marginalized pediatric populations. S-ECC is often treated under general anesthesia to facilitate extensive treatment in young children, but treatment does not address etiology of an infectious disease that is rooted in health behaviors. Without behavior changes related to toothbrushing and sugar consumption, many children experience recurrent disease, and some require subsequent surgeries. To improve post-surgery oral health, we developed PROTECT (Preventing Recurrent Operations Targeting Early Childhood Caries Treatment), a community health worker (CHW)-delivered behavioral intervention for caregivers that focuses on children's oral health behaviors. This study aims to test the efficacy of the PROTECT intervention compared to Usual Care (UC), to improve behavioral oral health outcomes. We will conduct a randomized clinical trial to test the efficacy of PROTECT (n = 210) compared to UC (n = 210) in the pediatric DGA (dental surgery under general anesthesia) population. We developed PROTECT through an iterative process, incorporating feedback from caregivers, dentists, and community health workers and through a small pilot trial. Caregivers will be recruited at their dental clinic and then will engage in a 10-session intervention with a community health worker. Topics covered will include education about toothbrushing and sugar consumption, behavioral strategies (e.g., goal setting, problem solving, self-monitoring), positive parenting and stress management and maintenance. Our two primary outcomes are parental assisted toothbrushing (twice/day, 2 min each time) and reduced added sugar consumption (less than 10% of overall daily caloric intake). Proposed mechanisms of change are self-efficacy and positive parenting. The ultimate goal of PROTECT is to prevent subsequent surgical events for children presenting with S-ECC to prevent further chronic disease and reduce costs and stress for families who already experience high levels of systemic barriers to their health.

Investigating the association between Candida albicans and early childhood dental caries: A comprehensive systematic review and meta-analysis

BACKGROUND

Early childhood caries (ECC) is a significant public health concern affecting children globally. Recent studies suggest a potential association between the presence of Candida albicans (C. albicans) in the oral cavity and the risk of ECC, but findings have been inconsistent. This systematic review and meta-analysis aimed to investigate the association between C. albicans and ECC.

METHODS

A comprehensive literature search was conducted across databases including PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Embase, Google Scholar, and Scopus. Studies were included if they examined the presence of C. albicans and the occurrence or severity of dental caries in children. Data extraction and quality assessment were performed independently by two reviewers. Statistical analyses, including pooled odds ratios (OR) and 95% confidence intervals (CI), were conducted to synthesize the findings.

RESULTS

A total of 22 studies, involving 3301 participants, were included in the meta-analysis. The findings revealed a significant association between the presence of C. albicans and an increased likelihood of ECC, with a pooled odds ratio (OR) of 4.42 (95% CI: 3.14-6.24, p < 0.001). Subgroup analyses showed that factors such as geographic region, study design, and detection methods influenced the strength of this association. Studies conducted in Europe reported a stronger association (OR: 10.13, 95% CI: 6.01-17.09) compared to those in Asia (OR: 3.62, 95% CI: 2.53-5.20) and the Americas (OR: 3.98, 95% CI: 1.14-13.87). Case-control studies had a higher pooled OR (5.30, 95% CI: 1.72-16.31) compared to cross-sectional studies (4.30, 95% CI: 2.92-6.33). The odds of ECC in children with C. albicans were 4.08 (95% CI: 2.65-6.27) in dental plaque samples, 9.55 (95% CI: 2.17-42.01) in oral swab samples, and 4.70 (95% CI: 2.44-9.09) in saliva samples. No publication bias was observed based on Begg's test (P-value = 0.612) and Egger's test (P-value = 0.250).

CONCLUSIONS

The findings provide support for the hypothesis that C. albicans plays a role in the development of ECC. Moving forward, it is essential for future research to concentrate on comprehending the mechanisms that underlie this relationship and to develop specific strategies for prevention.

Twelve-Year Changes in Pre-Schoolers' Oral Health and Parental Involvement in Children's Dental Care: Results from Two Repeated Cross-Sectional Surveys in Lithuania

BACKGROUND AND OBJECTIVES

The role of parents and the family in promoting children's oral health is increasingly acknowledged in the dental literature. This study aimed to investigate twelve-year changes in pre-schoolers' oral health and parental involvement in children's dental care using data from two repeated cross-sectional surveys. The objectives were (1) to assess the temporal changes in children's dental health status and oral health-related behaviours, (2) to examine temporal changes in parental attitudes toward their children's oral health care, and (3) to analyze the associations between observed changes.

MATERIALS AND METHODS

Two identical cross-sectional surveys were conducted in 2010/2011 (n = 294) and 2023 (n = 304). In both surveys, parents answered questions regarding their children's oral health care and completed the 38-item 'Parental Attitudes toward Children's Oral Health' (PACOH) scale, while the dental health of their 3-7-year-old children was clinically assessed. Changes in the examined characteristics were analyzed using general linear models.

RESULTS

Significant positive changes (p < 0.001) were observed when comparing the surveys: the dmf-t (decayed, missing, filled teeth) score for deciduous teeth decreased from 5.56 to 3.31; the Silness-Löe Plaque Index decreased from 1.45 to 1.15; the percentage of children brushing their teeth regularly increased from 33.0% to 55.3%; the percentage of parents assisting their child with tooth brushing increased from 19.2% to 85.1%; and regular visits to a children's dentist increased from 36.4% to 85.1%. Moreover, the study revealed better parental attitudes toward their children's oral health care, as reflected by a change in the total score of the PACOH scale from 112 to 122.

CONCLUSIONS

It was concluded that changes in parental attitudes played a crucial role in driving positive trends in oral health-related behaviours, which likely contributed to the improvement of dental health in children. Therefore, understanding and influencing parental attitudes can be essential for promoting good oral health skills and good oral health in young children.

Socio-behavioural associates of Early Childhood Caries among preschool children aged three to four years in Gampaha district, Sri Lanka: a cross sectional study

BACKGROUND

Early Childhood Caries (ECC) is a highly prevalent disease among preschoolers in Sri Lanka, with stagnated prevalence over the decades. Therefore, it is important to determine the socio-behavioural associations of ECC among preschoolers to reduce the country's ECC burden.

METHODS

A cross-sectional study with a multistage cluster sampling technique was used to select 3 to 4 year-old preschoolers/mothers dyads in Gampaha district in 2019. Preschoolers who completed third birthday and had not completed fifth birthday on the day of data collection were selected. The dependent variable was the presence (dmft ≥ 1) or absence (dmft = 0) of ECC. Independent variables were sex, monthly family income, mother's educational and occupational status, child's birth order, family type, frequency of consumption of sweets and sweetened drinks, time of sweet consumption during the last 24 h, toothbrushing frequency, supervision of toothbrushing, dental visit, and maternal dental caries. A pre-tested validated questionnaire was used. Multiple logistic regression analysis was used.

RESULTS

Total of 1038 preschoolers were selected. There were 529 females (51.0%) and 509 males (49.0%). The prevalence of ECC was 56.3% (95% CI: 53.1-59.3). Consuming sweets between meals had a higher odds ratio than consuming sweets after main meals (OR = 1.72, 95% CI:1.25-2.35), consumption of sweets every day had a higher odds ratio than consumption of sweets several times a week or less (OR = 2.89, 95% CI: 2.02-4.13), consumption of sweetened drinks every day had a higher odds ratio than consumption of sweetened drinks several times a week or less (OR = 1.73, 95% CI: 1.07-2.79), and the presence of maternal caries had a higher odds ratio than the absence of maternal caries (OR = 1.74, 95% CI: 1.12-2.69). The use of adult fluoridated toothpaste than not using adult fluoridated toothpaste (OR = 0.64, 95% CI:0.48-0.85), tooth brushing twice per day than not brushing twice per day (OR = 0.67, 95% CI:0.51-0.89), and supervised toothbrushing than unsupervised toothbrushing (OR = 0.61, 95% CI: 0.41-0.93) was negatively associated with ECC.

CONCLUSIONS

ECC is highly associated with sweet consumption and oral hygiene behaviours among preschoolers in Gampaha District. Interventions should focus on the oral health behaviours of preschoolers to reduce ECC burden.

Caregiver, community health worker, and dentist feedback on a behavioral intervention for caregivers of children with severe early childhood caries

Introduction

Severe early childhood caries (S-ECC) is a common disease within marginalized pediatric populations. S-ECC is often treated under general anesthesia to facilitate extensive treatment in young children, but treatment does not address etiology of an infectious disease that is rooted in health behaviors. Without behavior changes related to toothbrushing and sugar consumption, many children experience recurrent disease and some require subsequent surgeries. To improve post-surgery oral health, we developed PROTECT (Preventing Recurrent Operations Targeting Early Childhood Caries Treatment), a community health worker (CHW)-delivered behavioral intervention for caregivers that focuses on children's oral health behaviors. The purpose of this study was to use qualitative research methods to receive feedback on the planned protocol for a pilot study of PROTECT, a six-month intervention initiated at the time of a child's surgery to treat severe early childhood caries.

Methods

Study participants included caregivers of children presenting for surgery [n = 12], CHWs [n = 8] and dentists [n = 8] in a series of audio-video recorded semi-structured interviews. Five coders used Braun and Clarke's six-phase framework for data analysis.

Results

Participant feedback on the pilot study protocol yielded the following themes: (1) right time, population, and type of support; (2) flexible intervention delivery and content; (3) inclusion of other social determinants of health; and (4) cultural considerations. Implementing a behavioral intervention for caregivers in the immediate time during a child's surgery for treating dental caries was widely deemed important and timely in order to affect post-surgical behavioral and clinical outcomes. Flexibility in content, timing, and communication were all named as facilitators to participant engagement and study retention. Caregivers and CHWs emphasized the relevance of addressing other social determinants of health. CHWs emphasized the importance of training in becoming aware of culture and practicing with understanding and humility, given the influence on health beliefs, behaviors, and family dynamics. Cultural considerations in intervention delivery were deemed an important factor for participant retention and engagement.

Discussion

Participant feedback led to critical modifications of the pilot study protocol, specifically in intervention content and CHW-led delivery.

SmilesUp text message intervention for early childhood dental caries prevention: A protocol for a randomised controlled trial

INTRODUCTION

Despite improvements in health outcomes for children, early childhood dental caries (ECC) remains a chronic lifestyle-mediated disease that affects an estimated 600 million children worldwide. Parental influence on oral health-promoting behaviours is pivotal in preventing ECC. The latest WHO publications Ending Early Childhood Dental Caries and Mobile Technologies for Oral Health highlights the opportunity for mobile Health programs (including text message programs) to improve oral health behaviours and oral health self-efficacy. In response, our team of parents, oral health professionals (academics and health promotion experts), and IT specialists co-designed a 12-week, behavioural theory-informed text message program (called SmilesUp) to address behavioural risk factors specific to ECC. This randomised trial aims to assess whether the SmilesUp program improves parents' oral health promoting behaviours (like tooth brushing twice a day with toothpaste) and oral health self-efficacy for their children compared to usual care.

METHODS AND ANALYSIS

A randomised controlled trial with a 1:1 parallel design will be conducted among 150 parents with children diagnosed with ECC and accessing public dental care in NSW, Australia. Patients will be stratified by hospital site, and modality of care (Dental General Anaesthetic (DGA) or not) and then randomly assigned to either immediately receive the SMILESup text messaging intervention or receive the program at the end of the study period. The primary outcome at 12 weeks is twice daily brushing with fluoride toothpaste. Secondary outcomes include changes in the intake frequency of sugared drinks and foods, oral health promoting bedtime routines and oral health self-efficacy. The primary analysis will follow an intention-to-treat principle. In addition, a process evaluation will examine barriers, enablers, and opportunities to scale the program.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from the Western Sydney Local Health District Human Research Ethics Committee 2022/ETH01920. Study results will be disseminated via peer-reviewed publications and presentations at conferences.

TRIAL REGISTRATION

Trial registration number: This clinical trial has been prospectively registered on the ANZCTR from the 27th of March 2023. Registration number: ACTRN12623000325606.

Relationship between Maternal Prenatal Vitamin D Status and Early Childhood Caries in Their Children: A Cross-sectional Survey

Background

Vitamin D deficiency in expectant mothers is very common in India. As a consequence, the possibility of hypoplasia of teeth and resultant propensity for faster progression of early childhood caries (ECC) is expected to be higher in Indian children.

Aim

This study aimed to determine the relationship between prenatal vitamin D intake of mothers and dental caries experience in their preschool children, and whether vitamin D deficiency in mothers could be a risk factor for tooth decay in their children.

Design

This cross-sectional study included 120 mothers of children aged up to 71 months with dental caries attending the Department of Pediatric Dentistry in India. Mothers were surveyed about their prenatal vitamin D intake and their practices regarding vitamin D and sunlight exposure. Children were clinically examined, and their caries status was recorded using the decayed, extracted, filled teeth (deft) index.

Results

Data were analyzed descriptively and correlated using an independent t-test. Binary logistic regression was employed to predict the effects of the duration of sun exposure and vitamin D deficiency on dental decay. The correlation of mothers' prenatal vitamin D intake was significantly associated weekly with children's caries experience. Their sun exposure (p = 0.002) and practices adopted (p = 0.0001) regarding vitamin D levels were statistically significant for children's caries status. Improper brushing frequency was also significantly associated with higher deft scores.

Conclusion

The association between mothers' prenatal vitamin D intake and health practices related to vitamin D with dental caries was not confirmed. Subjects with vitamin D deficiency and their children had significantly higher odds of developing dental decay. However, our findings suggest that 25-hydroxyvitamin D insufficiency may be a risk factor for developing dental caries in children.

How to cite this article

Kalra G, Kumar Y, Langpoklakpam C, et al. Relationship between Maternal Prenatal Vitamin D Status and Early Childhood Caries in Their Children: A Cross-sectional Survey. Int J Clin Pediatr Dent 2024;17(8):860-863.

Early Childhood Caries-Prevalence, Associated Factors, and Severity: A Hospital-Based Study in Riyadh, Saudi Arabia

Early childhood caries (ECC) is not merely a problem of the tooth; rather, it has negative impacts on the child's growth and development and oral health-related quality of life. The prevalence of ECC varies widely, and more variance is observed between countries than continents, and it changes over time. The current cross-sectional study aimed to determine ECC's prevalence, associated factors, and severity. This study was conducted in the Dental Clinic Complex, North Riyadh, KSA. The study sample included 306 participants between 36 and 71 months of age. A questionnaire was developed to collect information from participants. The decaying and filled teeth (DMFT) index was used to estimate the prevalence of caries. The study results revealed the prevalence of ECC to be 76% among 36- to 71-month-old children in North Riyadh. ECC is influenced by socioeconomic factors like maternal occupation, education, oral hygiene habits, and dietary patterns. Also, it was found that exclusively breastfed children have lower ECC odds (68.1% vs. 83.6%, p = 0.001), while the intake of more than three between-meal sugar-containing snacks/beverages per day increases the likelihood of ECC (63.5% vs. 79.8%, p = 0.006). The researchers recommend encouraging breastfeeding as it correlates with lower ECC prevalence, in addition to establishing effective oral hygiene practices for preschool children.

Maternal perceptions of assisting preschool-aged children with toothbrushing

BACKGROUND

Parent-led toothbrushing with fluoride toothpaste is part of an evidence-based strategy to prevent caries in children. There is a gap in the literature regarding perceptions of how and when to assist a child with toothbrushing from the maternal perspective.

METHODS

A qualitative cross-sectional study was conducted with participants in North and North Central Appalachia to examine maternal perceptions of when and how to assist with toothbrushing. From 2018 through 2022, 301 mothers of children aged 3 through 5 years volunteered to participate in semistructured interviews from a more extensive parent study (Center for Oral Health Research in Appalachia cohort). The qualitative data were transcribed, coded, and analyzed using Nvivo software, Version 12 (QSR International). The data were analyzed using grounded theory, constant comparative method, and template analysis.

RESULTS

A total of 301 mothers were interviewed for this study; 156 (52%) lived in West Virginia and 145 (48%) lived in Pittsburgh, Pennsylvania. Four main themes emerged: (1) assisting with child toothbrushing, (2) ceasing to provide assistance with child toothbrushing, (3) lacking recommendations from dental care professionals on child toothbrushing, and (4) adhering to recommendations from dental care professionals on child toothbrushing assistance.

CONCLUSIONS

Understanding the factors that influence how parents brush their children's teeth and the information they receive to guide daily dental hygiene behavior for children is essential in developing effective interventions for preventing caries in children.

PRACTICAL IMPLICATIONS

These insights can improve child toothbrushing quality through improved oral hygiene education, recommendations, terminology, and policies from the dental community.

Should We Wait to Brush Our Teeth? A Scoping Review Regarding Dental Caries and Erosive Tooth Wear

BACKGROUND

Tooth brushing is a universal recommendation. However, the recommendations related to the time of its execution are conflicting, especially when dealing with patients at risk of erosive tooth wear (ETW) or dental caries.

SUMMARY

Our objective was to summarize the evidence on the timing of brushing with fluoridated toothpaste in relation to ETW and cariogenic dietary challenges. We conducted a scoping review following the PRISMA-ScR checklist, using three databases searching for in vivo, in situ, or in vitro studies involving human teeth exposed to either a cariogenic or an erosive challenge. Only models including human saliva and fluoride were assessed. Data selection, extraction, and risk of bias analysis were done in duplicate and independently. From 1,545 identified studies, 17 (16 related to ETW and 1 to dental caries) were included. Most evidence (n = 10) supported that brushing with a fluoride-containing product does not increase ETW, independent of the moment of brushing. Delaying tooth brushing up to 1 h (n = 4) or individualized recommendations based on the patient's problem (n = 2) were less frequent. Only one study reported that brushing pre- or post-meal does not affect Streptococcus mutans counts. Most data were in situ (n = 13), and the overall study quality was judged as sufficient/low risk of bias.

KEY MESSAGES

Although the available evidence lacked robust clinical studies, tooth brushing using fluoridated products immediately after an erosive challenge does not increase the risk of ETW and can be recommended, which is in line with recommendations for dental caries prevention. Furthermore, we suggest updating the international guidelines to promote individualized recommendations based on risk factors to prevent either ETW or dental caries.

Dental caries status and related factors among 5-year-old children in Shanghai

BACKGROUND

Dental caries in young children is a difficult global oral health problem. In the last decade, China has put a great deal of effort into reducing the prevalence of dental caries. This study, which is part of the China Population Chronic Disease and Nutrition Surveillance 2021, aimed to investigate the prevalence of dental caries among children aged 5 in Shanghai, China, and its associated factors.

METHODS

A total of 1281 children aged 5 years from 6 districts in Shanghai were selected by a stratified sampling method. The survey consisted of an oral health questionnaire and an oral health examination. The questionnaire included questions on oral health knowledge, attitudes, and behaviours. The oral health examination used WHO standards. After screening, the data were input and analysed. Chi-square tests and logistic regression analyses were used to study the relevant factors affecting dental caries.

RESULTS

The prevalence of dental caries among 1281 children was 51.0%, the dmft index score was 2.46, the Significant Caries Index (SiC) score was 6.39, and the SiC10 score was 10.35. Dental caries experience was related to the frequency of sweet drink consumption, the age of starting tooth brushing, eating habits after brushing, whether the children had received an oral examination provided by the government (p < 0.05), and the mother's education level but was not related to sex, the use of fluoride toothpaste, the frequency of brushing, whether the parents assisted brushing, or the frequency of flossing (p > 0.05). Logistic regression analysis showed that the region of residence, eating after brushing and the age of starting brushing were associated with dental caries.

CONCLUSIONS

Dental caries remained prevalent among 5-year-old children in Shanghai, China. Prevention strategies that target the associated factors including region of residence, eating after brushing, and the age of starting brushing should be considered.

Early life factors and oral microbial signatures define the risk of caries in a Swedish cohort of preschool children

The oral cavity harbors complex communities comprising bacteria, archaea, fungi, protozoa, and viruses. The oral microbiota is establish at birth and develops further during childhood, with early life factors such as birth mode, feeding practices, and oral hygiene, reported to influence this development and the susceptibility to caries. We here analyzed the oral bacterial composition in saliva of 260 Swedish children at two, three and five years of age using 16S rRNA gene profiling to examine its relation to environmental factors and caries development at five years of age. We were able to assign the salivary bacterial community in each child at each time point to one of seven distinct clusters. We observed an individual dynamic in the development of the oral microbiota related to early life factors, such as being first born, born by C-section, maternal perinatal antibiotics use, with a distinct transition between three and five years of age. Different bacterial signatures depending on age were related to increased caries risk, while Peptococcus consistently linked to reduced risk of caries development.

Assessment of knowledge, attitude, and practice on early childhood caries among dental undergraduates and residents in China

BACKGROUND

Early childhood caries (ECC) causes severe, widespread oral health issues in children. Dental undergraduates and residents are expected to have a solid understanding of ECC for children's oral health promotion. This study aimed to evaluate the knowledge, attitude, and clinical practice on ECC among dental undergraduates and residents in China.

METHODS

A 23-item electronic questionnaire was distributed to 598 dental undergraduates (4th- and 5th-year undergraduates) and residents (1st-, 2nd-, and 3rd-year residents) at the School of Stomatology, Wuhan University, China (in April-May 2023). SPSS Statistics was used to analyze the data using the Chi-square test at a significance level of 0.05.

RESULTS

A total of 422 questionnaires were completed by participants (recovery rate: 70.6%) from various academic levels. Around 77.3% of participants had heard of ECC (mainly from textbooks), and only 27.5% considered themselves familiar with it. Residents (79.8%) had higher risk awareness of ECC on children's overall health than undergraduates (58.3%) (p < 0.05), but only 54.0% of participants correctly defined ECC. Most participants had a positive understanding of ECC's pathogenic factors and preventive measures, including feeding patterns (71.6%), fluoride application (93.4%), and teeth cleaning (93.1%). Furthermore, only 50.2% of participants encountered ECC cases in clinic.

CONCLUSIONS

Despite having a suboptimal level of ECC-related knowledge and practice, dental undergraduates and residents in China demonstrated a more positive attitude towards its etiology-based prevention. Strengthening ECC education, guidance, and practice may enable them to gain a better understanding of ECC learning, which would benefit children's oral health.

Nudging oral habits; application of behavioral economics in oral health promotion: a critical review

Background

Oral health disorders significantly contribute to the global incidence of chronic diseases. Nudge interventions have demonstrated effectiveness in enhancing people's decision-making and self-management capacities in a cost-efficient manner. As a result, these interventions could be valuable tools for fostering improved oral care habits. This critical review explores potential behavioral nudges applicable to promoting oral health.

Methods

A thorough electronic literature search was conducted on Scopus, Embase, and PubMed databases for papers published post-2008. The search focused on empirical evidence concerning the direct and indirect application of Nudge theory in oral health enhancement. In addition, the investigation included the nudge intervention's role in managing common non-communicable disease risk factors (tobacco, alcohol, and sugar) and their use in other health sectors.

Results and conclusion

There is a dearth of studies on behavioral economics, particularly those involving reward and reminder techniques. However, various successful nudge interventions have been identified in other sectors that aim to improve health decisions. These include strategies encouraging healthier nutritional choices, tobacco and alcohol cessation, medication compliance, routine physical activity, and regular health check-ups. Such interventions can also have direct or indirect positive impacts on oral health. Implementing these interventions within an oral care framework could promote oral health due to similar underlying cognitive mechanisms. However, different types of nudge interventions have varying degrees of effectiveness. Furthermore, factors such as the method of delivery and the characteristics of the targeted population significantly influence the outcome of the intervention. Hence, it is imperative to conduct extensive studies in diverse socioeconomic settings to fully understand the potentials, limitations, and impacts of nudge interventions in promoting oral health.

Estimated impact of the UK soft drinks industry levy on childhood hospital admissions for carious tooth extractions: interrupted time series analysis

Introduction

Tooth extraction due to dental caries is associated with socioeconomic deprivation and is a major reason for elective childhood hospital admissions in England. Consumption of sugar-sweetened beverages is a risk factor for dental caries. We examined whether the soft drinks industry levy (SDIL), announced in March 2016 and implemented in April 2018, was associated with changes in incidence rates of hospital admissions for carious tooth extraction in children, 22 months post-SDIL implementation.

Methods

Changes in incidence rates of monthly National Health Service hospital admissions for extraction of teeth due to a primary diagnosis of dental caries (International Classification of Diseases; ICD-10 code: K02) in England, between January 2012 and February 2020, were estimated using interrupted time series and compared with a counterfactual scenario where SDIL was not announced or implemented. Periodical changes in admissions, autocorrelation and population structure were accounted for. Estimates were calculated overall, by Index of Multiple Deprivation (IMD) fifths and by age group (0-4 years, 5-9 years, 10-14 years, 15-18 years).

Results

Compared with the counterfactual scenario, there was a relative reduction of 12.1% (95% CI 17.0% to 7.2%) in hospital admissions for carious tooth extractions in all children (0-18 years). Children aged 0-4 years and 5-9 years had relative reductions of 28.6% (95% CI 35.6% to 21.5%) and 5.5% (95% CI 10.5% to 0.5%), respectively; no change was observed for older children. Reductions were observed in children living in most IMD areas regardless of deprivation.

Conclusion

The UK SDIL was associated with reductions in incidence rates of childhood hospital admissions for carious tooth extractions, across most areas regardless of deprivation status and especially in younger children.

Trial registration number

ISRCTN18042742.

Prevalence and socio-behavioral determinants of early childhood caries in children 1-5- year- old in Iran

AIM

According to the World Health Organization (WHO), early childhood caries (ECC) is still considered a major global health problem despite the general improvement in oral health practice. This study aimed to assess ECC's prevalence, severity, and key social and behavioral determinants in Iranian children 1-5- years of age.

METHOD

This cross-sectional study recruited Iranian 1-5-year-olds with a three-stage stratified clustered sampling method. After providing consent, parents were interviewed using a validated questionnaire, including questions on child characteristics and behavioral factors. Each child underwent a dental examination by one of four trained and calibrated dentists. Associations between key covariates of interest and primary outcome measures were assessed by multivariable logistic regression modeling and multivariate generalized negative binomial regression modeling after weightings were applied. Statistical analysis was performed using SPSS V25 and Stata V14.2 software packages. A p-value ≤ 0.05 was considered significant.

RESULTS

The mean age of 909 participants was 41.1±1.2 months, 48.6% were male, and 38.1% lived in rural areas. The overall prevalence of ECC was 53.2% and mean dmft score was 2.7± 0.3. Key determinants associated with ECC included living rurally (p = 0.009, OR = 2.13), consuming sweet drinks, sugary snacks, or both [p-value = 0.02 (OR = 2.53), and p-value<0.001 (OR = 4.96), respectively], and visible plaque (p<0.001, OR = 3.41). Covariates associated with dmft scores included residing in rural regions (p = 0.02, IRR = 1.31), having both sugary snacks and sweet drinks (p = 0.02, IRR = 1.85) compared to those had none, and visible dental plaque (p<0.001, IRR = 2.06).

CONCLUSIONS

The prevalence of dental caries in children is high in Iran. The increase of ECC prevalence and severity from toddlers to preschoolers emphasizes on the critical importance of early interventions in toddlers. Improving access to care for rural children is essential along with the need to change dietary and self-care behaviors through multilevel efforts.

Toothbrushing and Access to Dental Services in Peruvian Children

Objective. The aim was to determine the association between access to dental services and toothbrushing in Peruvian children under 12 years old. Methods. This was a cross-sectional study with a population of 2021 database of the Demographic and Family Health Survey. Records of children under 12 years old who provided answers about their toothbrushing were included. Variables were evaluated descriptively and followed by a bivariate analysis; multivariate tests were performed using Poisson regression with a multilevel regression analysis. Results. General toothbrushing was 96.32% (n = 34 198), and daily toothbrushing was 88.05% (n = 28 444). Access to dental services was associated with general toothbrushing (aPR: 1.18; 95% CI: 1.14-1.22; P < .001), daily toothbrushing (aPR: 1.08; 95% CI: 1.04-1.12; P < .001) and minimum toothbrushing 2 times a day (aPR: 1.12; 95% CI: 1.07-1.17; P < .001). Conclusion. Access to dental services was associated with general toothbrushing, daily toothbrushing and toothbrushing at least twice a day.

Prolonged breastfeeding and dental caries in preschool children

PURPOSE

To explore breastfeeding from 6 to 18 months of age and to study the association between breastfeeding and caries prevalence at 5 years of age.

METHODS

The study included 1088 children from one Norwegian county and was based on the Norwegian Mother, Father and Child Cohort Study (MoBa). The children had clinical dental examination at 5 years of age, and parents answered a questionnaire, which included information on breastfeeding, oral health behaviour and child characteristic. Multivariate logistic regressions were performed. The study was ethically approved.

RESULTS

Of the studied children, 77% were breastfed at 6 months of age and 16% were still breastfed at 18 months of age. Few children (6%) were breastfed during night at 18 months of age, while 11% received sugary drink during night. No association was found between breastfeeding up to 18 months of age and caries prevalence at 5 years of age (p > .05). Children who at 18 months of age had their teeth brushed less than twice daily (OR 2.4, CI 1.5-3.9), consumed sugary drink once a week or more often (OR 1.7, CI 1.1-2.7) and had non-Western parents (OR 3.4, CI 1.5-8.1) were more likely to have caries experience at 5 years of age than other children.

CONCLUSION

Breastfeeding up to 18 months of age was not associated with caries development during preschool age.

A comparative evaluation of the learning outcome of toothbrushing in preschoolers by a novel cartoon-based education aid with conventional toothbrushing model education technique: A randomized controlled trial

BACKGROUND

The recommendation of toothbrushing which is twice daily for 2 min is well known, but for most parents, getting their children to brush is a stressful task. The barriers are numerous. In this study, we focused on imparting knowledge and motivation to toothbrushing while making it into a playful activity for the child as well as their parents.

AIM

The aim of this study was to comparatively evaluate the learning outcome of toothbrushing by a novel cartoon-based education aid with conventional toothbrushing model education technique in preschoolers.

MATERIALS AND METHODS

The study included 43 children aged between 3 and 5 years randomly allocated into two groups: Group A received toothbrushing instruction through play with a novel cartoon-based education aid and Group B received instructions through an acrylic brushing model. Both the groups were recalled on the 8th day, and the glass index was used to assess for plaque estimation. The intergroup comparison was done by unpaired t-test and the intragroup analysis by paired t-test.

RESULTS

The comparison of the mean plaque scores in both the groups at the 8th day was not significant statistically (P = 0.965). The intragroup analysis, from baseline to the 8th day, in Group A, with mean difference (0.277 ± 0.751), was not statistically significant (P = 0.135), whereas in Group B, the mean difference (0.400 ± 0.598) was statistically significant (P = 0.008).

CONCLUSIONS

The reduced mean of plaque scores proves that both the techniques had a positive impact on reducing the plaque scores; however, the comparison between the two groups was not statistically significant.

Carious status and socio-behavioral risk factors among 12 year-old children in South-Central region in Romania

BACKGROUND

Regular screenings at children population level are necessary in order to assess communities' need for education, prevention, as well as early detection and intervention programs The study aims to assess dental caries experience and oral health-related behaviors among Romania children from the South and Central region.

METHODS

The cross-sectional study conducted in 2019-2020 is part of the national survey "Romanian Oral Health Survey", under the endorsement of the World Health Organization (WHO). The stratified, randomized and representative sample included 98 children of 12 years of age. The assessment included a clinical examination, using International Caries Detection and Assessment System (ICDAS) and the Oral Health Questionnaire for Children recommended by the World Health Organization.

RESULTS

Results revealed that the frequency of caries-free children among 12 year-olds was 36.7% and the mean DMFT was 2.89. Regarding the oral health-related habits, 38.8% of children brushed twice daily; the consumption of sugary foods multiple times per day has been frequently met and 11.2% at the age of 12 never visited the dental office.

CONCLUSIONS

The findings revealed that caries prevalence was high and behaviors negatively influence oral health. The presented data are of utmost importance for Romanian policy makers to promote oral health education among children, to support consistent preventive oral health campaigns and to stimulate dental attendance, irrespective of children' living areas or gender.

Partial Pulpotomy in Young Permanent Teeth: A Systematic Review and Meta-Analysis

The aim of the present systematic review was to evaluate the clinical and radiographic success of partial pulpotomies in deep caries processes or post-eruptive defects in young, vital permanent teeth. Four electronic databases, PubMed, Scopus, Embase, and Google Scholar, were searched, followed by a manual search in the reference lists. Randomized controlled trials evaluating partial pulpotomy with a follow-up period of ≥12 months were included. A meta-analysis using a random effects model was performed. A total of 3127 articles were retrieved, and after duplicate removal, 2642 were screened by title and abstract; 1 additional article was found during the manual search, and 79 were identified. Finally, six papers were included in the review. Regardless of the partial pulpotomy modalities or material used, there were no significant differences between clinical and radiographic success rates (cumulative success rate 91.8-92.3%). Five studies were included in the meta-analysis that did not indicate any statistically significant differences in success rates when mineral trioxide aggregate was compared to other materials (95% confidence interval: 0.239 to 1.016; p = 0.055). The present research systematically evaluates the evidence and summarizes the available data on partial pulpotomy in young permanent teeth. Given its high clinical and radiographic success rate, partial pulpotomy should be considered when vital pulpal therapy needs to be performed in highly damaged young permanent teeth, as this procedure provides a biological benefit and allows more invasive endodontic treatments to be postponed.

Oral health profile and periodontal diseases awareness and knowledge among the jordanian population: a cross-sectional study

OBJECTIVE

To explore the oral health profile and periodontal diseases awareness and knowledge among the Jordanian population. In addition, we aimed to identify predictors of good knowledge of periodontal diseases.

METHOD

This was an online cross-sectional survey study that was conducted in Jordan between January and May 2022. A total of 13 item from the world health organisation (WHO) oral health questionnaire for adults were used to examine the oral health profile of our study participants. In addition, a previously developed questionnaire by Abdulbaqi et al. were adapted and used to examine participants' knowledge about periodontal diseases. Binary logistic regression analysis was used to identify predictors of better knowledge of periodontal diseases.

RESULTS

This study involved 1,099 participants in total. More than half of them (61.1%) claimed that throughout the previous 12 months, they had experienced pain or discomfort in their mouths or teeth. Nearly half of the participants said their teeth and gums were in good or very good condition. 70.7% said they brush their teeth once or more per day. The vast majority of them (93.0%) claimed to brush their teeth using toothpaste that contained 61.9% fluoride. The most frequent cited cause for dental visits was pain or difficulty with teeth, gums, or mouth (36.3%), according to almost one-third of study participants who said they had visited a dentist during the previous six months. The most commonly reported problems that occurs frequently due to the state of the participants' teeth or mouth were avoiding smiling because of teeth, feeling embarrassed due to appearance of teeth, and having difficulty in biting foods with 11.0%, 10.2%, and 9.0%, respectively. Tea with sugar (16.5%) was the most frequently reported beverage as being consumed frequently on a daily basis. The most popular tobacco product to be smoked often on a daily basis was cigarettes (21.6%). For periodontitis knowledge questions, the percentage of accurate responses ranged from 32.3 to 55.8%. The majority of participants (55.8%) were able to recognize that poor oral hygiene is one of the most frequent causes of malodor, whereas the least number of participants (32.3%) were able to recognize that improper teeth brushing is a frequent cause of gingival recession.

CONCLUSION

The average degree of periodontitis knowledge among Jordanians was moderate. Along with it, there were modest oral hygiene practices. In order to prevent further oral complications that have a detrimental influence on patients' quality of life, educational campaigns are required to increase public awareness of knowledge and practices in terms of proper oral hygiene and periodontitis.

Relationship between vitamin D status and caries experience in a group of Egyptian children: a cross-sectional study

BACKGROUND

Dental caries is one of the most common diseases of childhood. Evidence suggests that malnutrition and vitamin deficiency may increase the risk to dental caries.

AIM

This study aimed to determine the relationship between vitamin D and dental caries experience in children and whether vitamin D deficiency is a risk factor for tooth decay.

PARTICIPANTS AND METHODS

A cross-sectional study was performed on 51 Egyptian children, aged from three to five years and diagnosed from Abo El-Resh Children's Hospital as 'Sufficient', 'Insufficient' or 'Deficient' in vitamin D. Children were divided into 3 equal groups. A structured questionnaire, formed of four sections, was answered by the parents. Dental examination was performed under natural daylight. Caries index (dmf), for each group, was calculated then compared. The study was conducted from July 2019 to January 2020. Associations between dmf and different variables were assessed using independent t-test. Correlation between age and dmf was assessed using Spearman's rank order correlation coefficient. Multiple linear regression model was used to study the effect of different variables on caries.

RESULTS

There was a weak positive correlation between age and dmf scores (β = 2.00; 95%CI, 0.73:3.26). Children playing outside experienced higher dmf (β = 1.29; 95%CI, -0.35:2.94) than those with no outside play. Children with 25(OH) D below 20 ng / ml had the highest dmfs (β = 1.01; 95%CI, -0.74:2.76). There was a significant association with teeth brushing; children not brushing their teeth showed significantly higher dmf (β = -2.21; 95%CI, -4.14:-0.28) than their counterparts. There were no significant associations of sex (β = -1.05; 95%CI, -2.68:0.59), fluoride tablets intake (β = 2.19; 95%CI, -1.25:5.63), dental visits (β = -1.43; 95%CI, -3.09:0.23), mothers' vitamin D intake during pregnancy (β = 0.71; 95%CI, -1.13:2.56), snacking (β = -1.18; 95%CI, -4.62:2.26) and parental education (β = 0.62; 95%CI, -1.18:2.42) with caries experience among the study population.

CONCLUSION

Vitamin D deficiency does not seem to be associated with dental caries experience of 3-5 years old Egyptian children. Out of the indicator variables, age and tooth brushing contributed significantly to the occurrence of dental caries among the study population.

Tooth brushing practice in Ethiopia: a systematic review and meta-analysis

Oral hygiene refers to taking care and maintaining the cleanness of gum and teeth; a good oral hygiene practice promotes better oral health in general. Oral hygiene is the top public health concern of the population. Tooth brushing is a technique to keep oral hygiene from related complications. Therefore, this study provides the pooled prevalence of tooth brushing practice in Ethiopia. Databases searched for articles systematically across PubMed, Google Scholar, Hinari, EMBASE, and African Journals Online. Two reviewers independently conducted the selection, screening, reviewing, and data extraction using a Microsoft Excel spreadsheet and used the Joanna Briggs Institute prevalence critical appraisal tools to assess the quality of evidence. All studies conducted in Ethiopia from 2010 to 2020, reporting tooth-brushing practices extracted for and imported into the Comprehensive meta-analysis version 3.0 for further analysis. Beggs and Eggers's tests evaluated for publication bias with Higgins's method evaluated for heterogeneity. A random-effects meta-analysis model with a 95% confidence interval was computed to estimate the pooled effect size (prevalence). Furthermore, the authors employed subgroup analysis based on the study area and sample size. After reviewing 36, 10 articles fulfilled the inclusion criteria, and were included in the meta-analysis. The pooled prevalence of tooth brushing practice was 12.2% (95% CI 7.6-19.2%). The review reported a lower level of tooth-brushing practice in Ethiopia. We recommended that special attention should be given to the oral hygiene of the Ethiopian people.

Parent's self-reported tooth brushing and use of fluoridated toothpaste: Associations with their one-year-old child's preventive oral health behaviour

OBJECTIVE

The aim of the study was to examine if the tooth brushing frequency and use of fluoridated toothpaste of the mother and father were associated with the tooth brushing frequency and use of fluoridated toothpaste for their 1-year-old child.

METHODS

This cross-sectional study is part of the FinnBrain Birth Cohort Study. Questionnaire data were obtained from 1672 mothers and 867 fathers on tooth brushing and use of fluoridated toothpaste, age, education, number of siblings and parity (when the child was 1-year-old). For 763 families (mother and father), data from both parents were available. Tooth brushing was dichotomized to at least twice daily (2× day) and less than 2× day, and use of fluoridated toothpaste for child to at least once daily and less than once daily. The association between brushing of child's teeth (both parents less than 2× day) and use of fluoridated toothpaste for the child (both parents less than once daily) with parent's own tooth brushing was modelled with logistic regression analyses adjusted for family-related variables (parents' age and education, number of older siblings) using odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

Families in which both parents brushed their own teeth less than 2× day were more likely to brush their child's teeth less than 2× day than families in which both parents brushed their own teeth 2× day (OR = 9.23; 95%CI = 5.42-15.69). The likelihood of not brushing the child's teeth 2× day was less strong when at least one of the parents brushed his/her own teeth 2× day (mother 2× day: OR = 1.97; 95%CI = 1.25-3.10; father 2× day: OR = 2.85; 95%CI = 1.51-5.40).

CONCLUSIONS

Less frequent tooth brushing of both mothers and fathers was strongly associated with less frequent tooth brushing of their child. When educating parents on child oral home care, parents' own home care and inclusion of fathers also need more attention.

Childhood dental caries experience in northern Spain: a cross-sectional study

PURPOSE

This study aimed to describe the caries experience in primary and permanent dentition of schoolchildren from a sample taken in public schools in Bilbao, to identify the most vulnerable child population, and compare them with the findings obtained by the Children's Dental Care Programme in the region of the Basque Country (Spain).

METHODS

A cross-sectional study was conducted using a representative sample (n = 1682) of children from 5-year-old early childhood education classes and the first- and second-year elementary classes in public schools in Bilbao. The dependent variable was the caries experience determined through oral examinations carried out by a single dentist. On the other hand, independent variables were measured through questionnaires completed by families, with help from teachers as appropriate. In the statistical analysis, Mann-Whitney and Kruskal-Wallis nonparametric tests, as well as two logistic regressions, were performed, and the significance level was set at α = 0.05 for decision making.

RESULTS

The mean (SD) values of dft, DMFT, DMFS and DMFT of first permanent molars scores were 1.25 ± 2.20, 0.16 ± 0.61, 0.20 ± 0.90 and 0.15 ± 0.57, respectively. Compared to the findings in the most recent PADI report, the schoolchildren in our sample had slightly greater experience of dental caries in primary dentition and much greater experience in permanent dentition.

CONCLUSION

The dft index of the primary dentition for the current sample is 1.25, while the DMFT index for the permanent dentition is 0.16. Among pupils in early childhood and elementary education in public schools in Bilbao, children from families with low socioeconomic status and educational attainment are most vulnerable to developing caries.

Current knowledge about early childhood caries in the gulf cooperation council with worldwide reflection: Scoping review of the scientific literature (2010-2021)

Early childhood caries (ECC) is one of the most prevalent chronic childhood diseases affecting the primary teeth of children younger than 6 years of age. The disease etiology is complex and includes social, biological, and dietary factors. This review aims to explore the knowledge of ECC prevalence globally and locally within the Gulf Cooperation Council (GCC) countries during the years 2010-2021. Another aim is to explore oral health promotion programs with more focus on the GCC region. A search was conducted in PubMed, Medline, Scopus, the Cochrane Collaboration database, and Google Scholar to identify relevant studies published between 2010 and 2021 using specific keywords. Studies that utilized both the World Health Organization criteria and International Caries Detection and Assessment System for dental caries assessment were included. The included studies indicated considerable variation in the reported prevalence of ECC. While developed countries show low prevalence, countries in the GCC and other Arab countries show a high prevalence of ECC. Many oral health promotion programs were identified globally including oral health education, nutritional programs, the use of fluoride and pit-and-fissure sealants, and inter-professional population-based oral health promotion and prevention programs such as school-based oral health programs, motivational interviewing, and anticipatory guidance. ECC remains a significant problem in many parts of the world including the GCC region. Oral health prevention programs have been established within the GCC region. Nevertheless, the GCC region has some unique characteristics that need to be investigated to contextualize the western model of the dynamics of ECC prevention and promotion programs locally.

Childhood caries and dental surgery under general anesthesia: an overview of a global disease and its impact on anesthesiology

Children’s oral health is influenced, negatively and positively, but modifiable social determinants. For high-risk populations, severe disease burden leads to dental treatment under general anesthesia (DGA), which represents a costly and futile use of scarce resources. These clinical events, at the intersection of medicine and dentistry, often involve anesthesiologists to facilitate care. However, clinical interventions do not address the etiology of disease, which are largely rooted in health behaviors. In this review, we will summarize the scope of severe disease on a global scale and its impact on individual and population health and health systems. We will also provide insight into factors that influence DGA utilization from perspectives of families, providers, health systems, policy, and community-level environment. A child’s need for DGA may represent missed prevention opportunities at several levels. However, the surgical period may serve as a prime window to change a family’s oral health behaviors and reduce chance of recurrent disease amongst the highest risk families.

Trends in social inequalities in early childhood caries using population‐based clinical data

OBJECTIVE

To assess the longitudinal trends in social inequalities in early childhood caries (ECC) using collected population-based data.

METHODS

Clinical data on children were routinely collected from 2008 to 2019 in Victoria, Australia. ECC prevalence and severity (dmft) were quantified according to Indigenous status, culturally and linguistically diverse (CALD) status, concession cardholder status, geographic remoteness and area deprivation. The inverse probability weighting was used to quantify social inequalities in ECC. The weighted prevalence differences, and the ratio between the weighted prevalence of ECC and mean dmft and their 95% confidence interval, were then plotted.

RESULTS

Absolute inequalities in ECC prevalence increased for children by 7% for CALD status and cardholder status between 2008 and 2019. Likewise, absolute inequalities in ECC severity in this time period increased by 0.6 for CALD status and by 0.4 for cardholder status. Relative inequalities in ECC increased by CALD (ratio: 1.3 to 2.0), cardholder status (1.3 to 2.0) and area deprivation (1.1 to 1.3). Relative inequalities in severity increased by CALD (1.5 to 2.8), cardholder (1.4 to 2.5) or area deprivation (1.3 to 1.5). Although children with Indigenous status experienced inequalities in ECC prevalence and severity, these did not increase on the absolute (ECC: 0.1-0.1 Severity: 1.0-0.1) or relative scale (ECC ratio: 1.3-1.3 Severity ratio: 1.6-1.1).

CONCLUSIONS

Trends in inequalities in ECC were different according to sociodemographic measures. Oral health policies and interventions must be evaluated on the basis of reducing the prevalence of oral diseases and oral health inequalities between population sub-groups.

Unemployment and expenditure on health and education as mediators of the association between toothbrushing and global income inequalities

Objective

The study assessed the association of country-level income inequalities with the percentage of schoolchildren toothbrushing-at-least-twice-daily; and the mediating effect of country-level unemployment rate and governmental expenditure on health and education (EH&E).

Methods

This was an ecological study. The dependent variable was country-level toothbrushing-at-least-twice-daily among 11-15-year-old schoolchildren. Data for the period 2009 to 2019 were extracted from two global surveys about schoolchildren’s health and from manuscripts identified through a systematic search of three databases. The independent variable was country-level income inequalities measured by the Gini coefficient (GC) extracted from the Sustainable Development Report 2021. The mediators were the unemployment rate and EH&E. We stratified the sample by the level of GC and assessed the correlation between the dependent and independent variables in each stratum. Linear regression was used to assess the relations between the dependent and independent variables, and mediation path analysis was used to quantify the direct, indirect, and total effects.

Results

Data were available for 127 countries. The mean (SD) percentage of children who brushed-at-least-twice-daily was 67.3 (16.1), the mean (SD) GC = 41.4 (8.2), unemployment rate = 7.5 (4.7) and EH&E = 8.4 (3.3). The percentage of children brushing at-least-twice-daily had weak and non-significant correlation with GC that was positive in countries with the least inequality and negative for countries with higher levels of inequality. A greater percentage of schoolchildren brushing-at-least-twice-daily was significantly associated with higher GC (B = 0.76, 95%CI: 0.33, 1.18), greater EH&E (B = 1.67, 95%CI: 0.69, 2.64) and lower unemployment rate (B=-1.03, 95%CI: -1.71, -0.35). GC had a significant direct positive effect (B = 0.76, 95%CI: 0.33, 1.18), a significant indirect negative effect through unemployment and EH&E (B=-0.47, 95%CI: -0.79, -0.24) and a non-significant total positive effect (B = 0.29, 95%CI: -0.09, 0.67) on the percentage of schoolchildren brushing-at-least-twice-daily.

Conclusion

Unemployment and EH&E mediated the association between income inequality and toothbrushing. Country-level factors may indirectly impact toothbrushing.

Vitamin D Supplementation, Characteristics of Mastication, and Parent-Supervised Toothbrushing as Crucial Factors in the Prevention of Caries in 12- to 36-Month-Old Children

Severe early childhood caries (S-ECC), defined as any sign of smooth-surface caries in a child younger than three years of age, remains a serious health issue. The aim of this study was to indicate oral health behaviours related to S-ECC. The study surveyed parents (socio-economic and medical factors, oral health behaviours) and clinically examined children including non-cavitated d1,2/cavitated d ≥ 3 lesions. %S-ECC, and caries indices (d1,2 d ≥ 3 mft and d1,2 d ≥ 3 mfs) were calculated. Spearman’s correlation and simple and multiple logistic regression were used to assess the relationships between various factors and S-ECC. A total of 496 children were examined. S-ECC occurred in 44.8%: d1,2 d ≥ 3 mft = 2.62 ± 3.88, d1,2 d ≥ 3 mfs = 4.46 ± 8.42. S-ECC was correlated with socio-economic factors, vitamin D supplementation, breastfeeding and using formula after the 18th month, and toothbrushing. Supplementation of vitamin D and toothbrushing tended to decrease the odds of S-ECC (OR = 0.49 (0.27−0.87); p = 0.016, OR = 0.46 (0.24−0.86) p = 0.015, respectively). Feeding exclusively with formula was observed to increase the odds of S-ECC (OR = 2.20 (1.29−3.76); p = 0.004). Consuming > three snacks daily (OR = 1.39 (0.97−1.98); p = 0.072) and the reluctance to eat resilient foods (OR = 1.63 (1.05−2.51); p = 0.028) were nullified by the confounding factors. Vitamin D supplementation, mastication of resilient food, breastfeeding in the first six months of a baby’s life, and parent-supervised toothbrushing are factors in the prevention of caries in toddlers. Breast- and bottle-feeding after the 18th month of life, the reluctance to eat solids, lack of vitamin D supplementation, hygienic neglect, and delay in introducing oral health behaviours may contribute to the development of caries in toddlers.

Using Chatbot as an Alternative Approach for In-Person Tooth Brushing Training During the COVID-19 Pandemic

Background

It is recommended that caregivers receive oral health education and in-person training to improve toothbrushing for young children. To strengthen oral health education before COVID-19, the 21-Day FunDee chatbot with in-person toothbrushing training for caregivers was used. During the pandemic, practical experience was difficult to implement. Therefore, the 30-Day FunDee chatbot was created to extend the coverage of chatbots from 21 days to 30 days by incorporating more videos on toothbrushing demonstrations and dialogue. This was a secondary data comparison of 2 chatbots in similar rural areas of Pattani province: Maikan district (Study I) and Maelan district (Study II).

Objective

This study aimed to evaluate the effectiveness and usability of 2 chatbots, 21-Day FunDee (Study I) and 30-Day FunDee (Study II), based on the protection motivation theory (PMT). This study explored the feasibility of using the 30-Day FunDee chatbot to increase toothbrushing behaviors for caregivers in oral hygiene care for children aged 6 months to 36 months without in-person training during the COVID-19 pandemic.

Methods

A pre-post design was used in both studies. The effectiveness was evaluated among caregivers in terms of oral hygiene practices, knowledge, and oral health care perceptions based on PMT. In Study I, participants received in-person training and a 21-day chatbot course during October 2018 to February 2019. In Study II, participants received only daily chatbot programming for 30 days during December 2021 to February 2022. Data were gathered at baseline of each study and at 30 days and 60 days after the start of Study I and Study II, respectively. After completing their interventions, the chatbot's usability was assessed using open-ended questions. Study I evaluated the plaque score, whereas Study II included an in-depth interview. The 2 studies were compared to determine the feasibility of using the 30-Day FunDee chatbot as an alternative to in-person training.

Results

There were 71 pairs of participants: 37 in Study I and 34 in Study II. Both chatbots significantly improved overall knowledge (Study I: P<.001; Study II: P=.001), overall oral health care perceptions based on PMT (Study I: P<.001; Study II: P<.001), and toothbrushing for children by caregivers (Study I: P=.02; Study II: P=.04). Only Study I had statistically significant differences in toothbrushing at least twice a day (P=.002) and perceived vulnerability (P=.003). The highest overall chatbot satisfaction was 9.2 (SD 0.9) in Study I and 8.6 (SD 1.2) in Study II. In Study I, plaque levels differed significantly (P<.001).

Conclusions

This was the first study using a chatbot in oral health education. We established the effectiveness and usability of 2 chatbot programs for promoting oral hygiene care of young children by caregivers. The 30-Day FunDee chatbot showed the possibility of improving toothbrushing skills without requiring in-person training.

Trial Registration

Thai Clinical Trials Registry TCTR20191223005; http://www.thaiclinicaltrials.org/show/TCTR20191223005 and TCTR20210927004; https://www.thaiclinicaltrials.org/show/TCTR20210927004

Free sugars and early childhood caries development: a prospective cohort study

PURPOSE

To investigate the impact of giving children younger than 2 years foods and beverages with free sugars on the prevalence of early childhood caries at 5 years.

MATERIALS AND METHODS

The study group consisted of 208 children (105 boys and 103 girls) with a complete set of data on nursing, diet and caries from birth to 5 years. We collected feeding habits and dietary data through structured questionnaires at 6, 12, 18 and 24 months and the presence of decayed (d), missed (m) and filled (f) teeth was scored according to the WHO criteria at five years of age. We processed data with chi-square tests and expressed as relative risk (RR) with 95% confidence intervals.

RESULTS

At the age of 5 years, 22% of the children had caries. Intake of fruit juice with meals (RR 2.3) and cookies or biscuits at 24 months of age (RR 2.4), as well as fast food consumption at least once every week (RR 2.9), more than doubled the risk for early childhood caries (p < 0.05).

CONCLUSIONS

Within the limitations of the present study, we found a relationship between consumption of free sugars early in life and dental caries prevalence at 5 years. It therefore seems important to embrace and emphasise the current sugar recommendations in primary and dental care to educate caregivers to avoid serving free sugars to their children before the age of 2 years.

Influence of digital media in the oral health education of mother-child pairs: study protocol of a parallel double-blind randomized clinical trial

BACKGROUND

Dental caries is the most common non transmissible chronic disease in childhood and the control of dental biofilm in children is one of the greatest challenges in oral disease prevention. Digital media applications can help patients in improving their oral hygiene performance and reducing the number of appointments due to pain and discomfort reasons. This study aims to investigate the use of an smartphone application (WhatsApp) to deliver oral health education to mother-child pairs, with the ultimate goal of controlling dental biofilm and caries through digital activities focused on oral hygiene.

METHODS

This study was designed as a randomized, double-blind, parallel clinical trial involving 100 pairs of mothers and children (6-12 years old). The mothers and children will be randomly allocated to the control group (n = 50 pairs), who will receive a single visit conventional oral health education, or to the experimental group (n = 50 pairs), who will receive both a single visit conventional oral health education and educational videos through WhatsApp Messenger, twice a week. Before randomization of the groups and after the intervention, pairs will be evaluated regarding to plaque index (VPI), gingival bleeding index (GBI), and number of decayed, missing and filled permanent or primary teeth (DMF-T) modified by the inclusion of active non-cavitated carious lesions (Nyvad criteria). Socioeconomic data, dental history, and oral health literacy will obtained using questionnaires (Oral Health Literacy Assessment Task for Paediatric Dentistry; BOHLAT-P). Chi-square, Student's t-test, paired Student's t-test, Mann-Whitney, and Friedman tests will be used with a 5% significance level.

DISCUSSION

This intervention proposal is designed to motivate behavioral change in mother-child pairs. We hypothesize that adding digital media to traditional oral health programs will provoke improvements in oral hygiene behavior and health outcomes. To our knowledge, this is the first study evaluating the effect of educational videos communicated by digital media (WhatsApp) on the oral health of mother-child pairs evaluated by long-term dental examinations. In addition, we will assess the maternal level of comprehension of the provided information via a literacy assessment tool. The clinical trial is registered at the Brazilian Registry of Clinical Trials (No. RBR-7s8bw6m).

The Assessment of Early Server Childhood Caries Status in Abandoned Institutionalized Children

Oral health is a critical indicator of children’s quality of life, which at this early age, depends exclusively on the attention, involvement, and guidance of parents or caregivers. Assessing carious damage and measuring the prevalence of early severe tooth decay in temporary teeth in children is obtained by calculating the dmft index, giving the sum of an individual’s decayed, missing, and filled teeth. The aim of our study was to conduct a clinical examination of the oral status of institutionalized children from Romania. We selected and included in the study 144 children, both boys and girls in equal number, with ages of five or six years old, from which 110 were eligible for the study and met the inclusion criteria. Of all children, 20.90% were five years old girls, 27.27% five years old boys, 26.36% six years old girls, and 25.46% six years old boys. Of all, 10,45% had more than three incisors presenting decays, equally affected by gender. Of the boys’ group, 20% of age six had more de two canines affected, and 26.7% of five years old girls had more than three affected canines. Of the five years boys’ group, 24.3% had more than three affected temporary molars, 44.9% of six years boys had more than five. Of the five years old girls, 33.3% had more than four temporary molars affected and, 56.6% of the six years old girls’ group had more than five molars presenting carious lesions. The dental status and dmft values were similar for five years old and six years old children and similar boys and girls. Due to the vulnerability of young children that consists not only in their inability to identify, express, and address their own needs but also the lack of parental support, lack of an optimal diet for age, and proper hygiene, they reach adolescence with an impaired dental status, inappropriate for their age.

Peruvian children toothbrushing during the COVID-19 pandemic

Background: Toothbrushing is a convenient, inexpensive, widespread and culturally accepted method, resulting in an ideal public health outcome. This study aimed to determine the impact of the COVID-19 pandemic on toothbrushing in Peruvian children. Methods: This was a cross-sectional study conducted using a database of children aged 0 to 11 years, with a final sample of 39,124 participants, 15,974 in 2019 (62.03%) and 7088 in 2020 (55.54%). General toothbrushing, daily toothbrushing and minimum frequency of two times a day were dependent variables; the year was considered as the independent variable. In addition, other covariates such as geographical landscape, area of residence, place of residence, altitude, wealth index, health insurance cover, sex and age. Descriptive, bivariate and multivariate statistical analyses were applied. Results: General toothbrushing was 96.19% (n=51 013), daily toothbrushing was 87.47% (n=42 246) and minimum toothbrushing two times a day was 84.53% (n=33 957). In multivariate form, the year presented a negative association with daily toothbrushing (RPa: 0.97; CI95%: 0.96-0.98; p<0.001) and minimum toothbrushing two times a day (RPa: 0.97; CI95%: 0.95-0.98; p<0.001), adjusted for the previously associated co-variables. Conclusions: The year 2020 of the COVID-19 pandemic negatively impacted daily toothbrushing and minimum twice-daily toothbrushing of Peruvian children.

Peruvian children toothbrushing during the COVID-19 pandemic

Background: Toothbrushing is a convenient, inexpensive, widespread and culturally accepted method, resulting in an ideal public health outcome. This study aimed to determine the impact of the COVID-19 pandemic on toothbrushing in Peruvian children. Methods: This was a cross-sectional study conducted using a database of children aged 0 to 11 years, with a final sample of 39,124 participants, 15,974 in 2019 (62.03%) and 7088 in 2020 (55.54%). General toothbrushing, daily toothbrushing and minimum frequency of two times a day were dependent variables; the year was considered as the independent variable. In addition, other covariates such as geographical landscape, area of residence, place of residence, altitude, wealth index, health insurance cover, sex and age. Descriptive, bivariate and multivariate statistical analyses were applied. Results: General toothbrushing was 96.19% (n=51 013), daily toothbrushing was 87.47% (n=42 246) and minimum toothbrushing two times a day was 84.53% (n=33 957). In multivariate form, the year presented a negative association with daily toothbrushing (RPa: 0.97; CI95%: 0.96-0.98; p<0.001) and minimum toothbrushing two times a day (RPa: 0.97; CI95%: 0.95-0.98; p<0.001), adjusted for the previously associated co-variables. Conclusions: The year 2020 of the COVID-19 pandemic negatively impacted daily toothbrushing and minimum twice-daily toothbrushing of Peruvian children.

Using mHealth to promote parents' brushing of preschool children's teeth: a protocol for a randomized factorial trial using the Multi-phase Optimization Strategy (MOST)

BACKGROUND

Early childhood caries is a highly prevalent disease affecting young children. Parental brushing of children's teeth is recommended during preschool years. Interventions to promote parental brushing of children's teeth are assessed as a package in randomized clinical trials and the efficacy of separate components is not known.

METHODS AND ANALYSIS

The aim of this study is to develop an optimized behavior modification intervention to increase parents' brushing of their pre-school children's teeth using the multi-phase optimization strategy (MOST) guided by the Theory of Planned Behavior. Behavior change will be assessed by the percent reduction in children's dental plaque index after 6 months and parents reporting of toothbrushing frequency. Two phases of MOST will be carried out. First, the preparation phase comprises the development of a conceptual framework, identifying candidate components, conducting a feasibility pilot study to assess the acceptability and the design features of three intervention components (motivational interviewing (MI), and two mobile health (mHealth) components: oral health promotion messages and storytelling videos delivered using WhatsApp messenger) in addition to setting an optimization objective. Second, the optimization phase constitutes a factorial trial assessing the three intervention components and developing the intervention by selecting the most effective components within the optimization constraint. Each component will be set at two levels: yes (the intervention is applied) and no (the intervention is not applied). A linear regression model will be used to assess the effect of the intervention components on the percent reduction in dental plaque index (primary outcome measure). The secondary outcome measure is the change in the frequency of parents' brushing of the child's teeth. The combination of components making up the new optimized intervention will be selected.

DISCUSSION

This will be the first study to apply the MOST framework in the field of dentistry. The results of this study can guide the development of an optimized behavior modification interventions using mHealth and MI.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04923581, Registered 11 June 2021.

Dental caries severity and oral health-related quality-of-life in Brazilian preschool children

The impact of dental caries on oral health-related quality-of-life (OHRQoL) may be influenced by disease severity. This study evaluated the impact of caries severity on OHRQoL in preschool children. A school-based, cross-sectional study was conducted with 205 children (aged 2-5 years) in Southern Brazil. Parents answered the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) and provided sociodemographic information. The Caries Assessment Spectrum and Treatment criteria were used to evaluate caries severity, and Poisson regression with robust variance estimation conducted to determine the rate ratio (RR) and 95% confidence intervals (CIs) of the mean OHRQoL scores according to severity level. Most children had at least one tooth in the morbidity (37%) or pre-morbidity (35%) stages, and the prevalence of impacts on OHRQoL was 40%. Caries severity was associated with the impact scores: after adjustments, the mean B-ECOHIS scores were 6.31 (95% CI: 4.24-9.38) higher for children in the morbidity stage, and 10.84 (95% CI: 6.51-18.05) higher in the severe morbidity stage, than for healthy children [RR = 10.84 (95% CI: 6.51-18.05)]. Children with carious lesions into dentine or with pulpally-involved or abscessed teeth had poorer OHRQoL than children without such lesions.

A systematic review to inform the development of a Canadian caries risk assessment tool for use by primary healthcare providers

BACKGROUND

Caries risk assessment (CRA) tools may assist in identifying children at risk of early childhood caries.

AIM

To complete a systematic review of CRA and develop a Canadian CRA tool for preschool children for use in non-dental clinical settings.

DESIGN

Systematic searches of relevant databases were conducted. Potential variables were based on strength of associations (odd ratios, relative risk, hazard ratios, etc), frequency of occurrence, and existing CRA tools. Quality of the evidence assessments were performed by at least two review teams through consensus following GRADE.

RESULTS

Overall, 25 publications met the inclusion criteria, all prospective in design. Based on this review, variables to be considered when developing a new CRA tool for use with preschool children are as follows: age, socioeconomic status, family toothbrushing habits, fluoride exposure, infant feeding practices, dietary habits/behaviours, dental home, caries experience, visible plaque, and enamel defects. The environmental scan identified 22 CRA tools suggesting other additional variables to consider including in a CRA tool, including special healthcare needs, enamel defects, and dental attendance.

CONCLUSIONS

This review informed the development of a Canadian CRA tool for use by primary healthcare professionals, which may improve access to oral health assessments and increase interprofessional collaboration.

Dental Caries and Associated Factors in 3-5-Year-Old Children in Guizhou Province, China: An Epidemiological Survey (2015-2016)

Objective: This study aimed to explore the factors influencing dental caries among 3-5-year-old children in Guizhou Province and the interrelationship between these factors using structural equation modeling, while providing theoretical references to improve the prevention and control strategy. Materials and Methods: A total of 1,291 children aged 3-5 years in Guizhou Province were selected by a multistage stratified and whole group random sampling to examine the caries prevalence in whole-mouth deciduous teeth crowns, and parents were surveyed with questionnaires to analyze the caries-related factors. IBM SPSS Statistics v 23.0 software (IBM, Armonk, NY, USA) was used for statistical analysis. Results: The caries prevalence of children aged 3-5 years in Guizhou Province was 63.1%, the mean decayed-missing-filled teeth was 3.32, the caries filling rate was 0.5%, and there was no statistically significant difference between urban and rural areas and among genders in each age group; results of logistic regression analysis showed that the caries risk increased with the following factors: age, brushing frequency <2 times per day when parents did not take their children to the dentist, and with parents poor evaluation of the oral condition of their children. The higher the education of the parent, the lower the risk of children suffering from caries in deciduous teeth. Conclusions: With an overall poor situation about oral hygiene habits, oral healthcare attitude of the parents, and behavior transformation, the prevalence of dental caries in the deciduous teeth of children aged 3-5 years in Guizhou Province is high, and their caries status was severe, with more than 99% of the caries cases that were untreated. Therefore, prevention and treatment measures of caries in preschool children need strengthening through the improvement of public awareness and the enhancement of the management of oral health habits of their children.

Use of fluoridated dentifrices by children in Araçatuba, Brazil: factors affecting brushing habits and amount applied on the brush

PURPOSE

To evaluate the type and the amount of fluoridated dentifrice applied on children's toothbrushes by parents/guardians according to descriptions typically recommended by scientific societies, as well as to assess the influence of demographic and socioeconomic variables on dentifrice use.

METHODS

Parents/guardians of children (0-7 years old; n = 306; convenience sample) attending vaccination centres from Araçatuba (Brazil), answered to a structured questionnaire comprising items related to interviewees' education, child's age, gender, brushing habits and use of fluoridated dentifrice. The amount of toothpaste used by children during toothbrushing was estimated using a portable scale. Similarly, the interviewees were requested to apply dentifrices on toothbrushes according to eight descriptions, ranging from "smear" to "all bristles", following a random sequence. Data were submitted to Mann-Whitney's, Kruskal-Wallis' and Friedman's tests, and Spearman's correlation coefficient (p < 0.05).

RESULTS

The type of toothpaste and the amount of product used at home were not affected by the respondents' educational level or family income. However, child's age was significantly correlated with the amount of toothpaste placed on the toothbrush (r = 0.324, p < 0.001). Also, the amount of toothpaste placed on the toothbrush increased according to what would be expected from the descriptions, although wide variations were observed within each description, with large interquartile and overall ranges.

CONCLUSION

The amount and the type of dentifrice used by children were influenced by their age, while parents/caregivers' interpretation on verbal instructions regarding appropriate dentifrice quantities varied widely. This reinforces the need for educative measures on the appropriate use by dentifrices by children.

Feeding Practices and Early Childhood Caries in Korean Preschool Children

Objectives

This study aimed to investigate the association between feeding practices and early childhood caries using representative Korean national survey data.

Methods

Data of 2772 children (aged 1-3 years) from the fourth to seventh Korean National Health and Nutrition Examination Surveys (2007-2018) were analysed. Data on decayed-filled teeth (dft) were obtained, and early childhood caries was determined as dft ≥1. Chi-squared test was performed to examine the experiencing of dental caries by participant characteristics, whilst analysis of variance was performed to compare the difference in dft values amongst the 3 groups (breast-feeding, mixed-feeding, and formula-feeding groups). Logistic regression analysis was performed to evaluate the association between feeding practice and early childhood caries.

Results

Comparison of the mean dft values amongst the 3 groups showed the highest value in the breast-feeding group. Multiple logistic regression analysis results showed that the likelihood of experiencing dental caries was significantly lower in the mixed-feeding group than in the breast-feeding group, whereas no significant difference was seen between the formula-feeding and breast-feeding groups. The likelihood of early childhood caries was higher in the group that introduced weaning food at ≥6 months than that at 4- to 6-month age, whilst the introduction of cow's milk and use of nutritional supplements had no significant association with the likelihood of early childhood caries.

Conclusions

Breast-feeding and delayed introduction of weaning food were associated with a higher likelihood of early childhood caries.