Family history and oral health: findings from the Dunedin Study

Association of Demographic Disparities in Maternal Oral Hygiene Status, Caries Experience, and Oral Health Behavior Toward Children in Chengalpattu District, India: A Cross-Sectional Study

BACKGROUND AND OBJECTIVE

 Mothers are the primary caregivers throughout early childhood, playing a vital role in developing their child's oral health behavior, as oral conditions in primary teeth can have a considerable negative impact on the child's growth. This study aims to assess the association between maternal oral hygiene status, caries experience, and oral health behavior (OHB) toward their children.

METHODOLOGY

A cross-sectional study was conducted among 226 mothers of children aged nine months to three years visiting the primary health centers (PHCs) in urban (n = 113) and rural (n = 113) areas of Chengalpattu district, India. A 24-item questionnaire assessed and compared their OHB toward child oral health. Maternal oral hygiene status and caries experience were also assessed. Mann-Whitney-U test was used to compare the OHB scores between mothers from rural and urban areas, and Spearman's rank correlation (rho) was used to find the relationship between OHB with oral hygiene and the caries experience of the participants.

RESULTS

 The results showed significant differences in OHB scores between mothers from rural (mean rank: 86.78) and urban (mean rank: 140.22) backgrounds (p <0.001). Urban respondents had significantly higher knowledge (mean rank: 161.09 vs 65.91 for rural) and better oral health practices (mean rank: 132.00 vs 95.00 for rural) compared to their rural counterparts. However, rural respondents significantly showed more positive attitudes than urban respondents (mean rank: 124.80 vs. 102.20 for urban). A strong negative correlation (Spearman's rho of -0.83) was observed between knowledge, attitude, and practice (KAP) scores and Oral Hygiene Index-Simplified (OHI-S) in urban participants, and a moderately negative correlation (-0.683) was observed in rural participants.

CONCLUSION

Maternal oral hygiene has a significant influence on the OHB toward their children. This study highlights the critical influence of maternal oral health and demographic factors on the OHB of their children, underscoring the need for targeted public health interventions to address these disparities arising out of rural-urban differences and improve the oral health outcomes for both mothers and children. Mothers can thus explicitly play an indispensable role in fostering positive attitudes and healthy habits toward dental health care in children, regardless of the sociodemographic variations.

Parental Knowledge, Attitudes, and Practices Regarding Early Childhood Caries in Bihor, Romania: A Cross-Sectional Study

BACKGROUND/OBJECTIVES

Early childhood caries (ECC) is a significant global health issue, particularly affecting deciduous teeth in young children. ECC is prevalent in Romania, where nearly half of children experience dental caries. This study aimed to assess the influence of gender, age, and living environment on parents' knowledge, attitudes, and practices (KAP) regarding ECC in Bihor County, Romania, using a KAP-type questionnaire.

METHODS

A cross-sectional study was conducted between March and September 2024, utilizing an online KAP questionnaire distributed via social networks. The sample comprised 419 parents of children under six years old. Respondents provided socio-demographic data and answered questions regarding their knowledge, attitudes, and practices concerning ECC prevention, treatment, and oral health. Statistical analysis was conducted using Chi-square tests to assess associations between demographic factors and parental KAP. A p-value of less than 0.05 was considered statistically significant.

RESULTS

Of the 419 respondents, 83.1% were female, and 62.5% were between the ages of 31 and 40. Significant gender-based differences were found in knowledge about pain from caries (93.7% of female participants vs. 81.7% of male participants, p = 0.004) and the importance of brushing twice daily (93.7% of female respondents vs. 80.3% of male respondents, p = 0.010). Younger parents (aged 18-30) were more likely to affirm the effectiveness of fluoride (65.4%) compared to those aged 31-40 (53.1%, p = 0.02). Urban parents were more likely to correctly identify the timing of tooth eruption (59.1% vs. 52.6% of rural parents, p = 0.021).

CONCLUSIONS

The study highlights gender, age, and urban-rural disparities in parental knowledge and attitudes towards ECC. These findings underscore the need for targeted educational interventions to improve oral health outcomes and reduce ECC prevalence in the Bihor region. Tailored public health strategies addressing demographic factors could enhance preventive oral health behaviors and reduce the healthcare burden associated with untreated dental caries.

Knowledge, attitudes, and practice related to tooth loss and dentures among patients with dental arch deficiencies

BACKGROUND

Tooth loss is a common problem that affects many people worldwide. Exploring knowledge, attitude, and practice (KAP) among patients can identify barriers and challenges in following recommended practices, providing valuable insights for dental healthcare providers, policymakers, and researchers. This study aimed to explore the KAP of patients with dental arch deficiencies regarding tooth loss and dentures.

METHODS

This web-based, cross-sectional study was conducted among patients with dental arch deficiencies using a self-designed questionnaire.

RESULT

3166 valid questionnaires were included. Participants' mean KAP scores were 6.84 ± 2.27 (possible range: 0 ~ 12), 39.4 ± 3.72 (possible range: 9 ~ 45), and 27.7 ± 4.36 (possible range: 8 ~ 40), respectively. Multivariable logistic regression analysis showed that knowledge (OR = 1.383), employed (OR = 1.805), family history (OR = 2.158), and treatment (OR = 1.683) were independently associated with attitude. Moreover, knowledge (OR = 1.239), attitude (OR = 1.250), female (OR = 0.619), age (OR = 0.967), college/bachelor (OR = 0.373), and master and above degree (OR = 0.418), employed (OR = 0.554) or student (OR = 0.434), with 10,001-20,000 Yuan household income per month (OR = 0.492), have been married (OR = 0.609), smoking (OR = 0.595), drinking (OR = 0.397), disease duration (OR = 0.972), with family history (OR = 1.676), and with treatment (OR = 3.492) were independently associated with practice (all P < 0.05).

CONCLUSION

Patients with dental arch deficiencies have insufficient knowledge, positive attitudes, and moderate practice toward tooth loss and dentures, which might be affected by multiple demographic factors.

A Right to Health-Based Approach to Dental Caries: Toward a Comprehensive Control Strategy

BACKGROUND

Health is a matter of human rights, and dental caries is the most common noncommunicable disease globally. Consequently, dental caries is a matter of human rights and its control, particularly prevention, must be a priority. Although largely preventable, this is too often neglected, both in the literature of human rights and health law, and in dental research. The right to oral health has recently been acknowledged by the World Health Organization (WHO), but it is insufficiently clear what this right entails.

SUMMARY

This article introduces a right to health-based narrative in the context of dental caries. The right to health is stipulated in human rights treaties, including the International Covenant on Economic, Social and Cultural Rights (ICESCR) and the Convention on the Rights of the Child (CRC). States that are parties to these treaties, which are virtually all States globally, are mandated to ensure the enjoyment of individuals' right to the highest attainable standard of health, including oral health.

KEY MESSAGES

Dental caries is a matter of human rights. States have binding obligations to address dental caries: they require the regulation of the healthcare system, i.e., the traditional focus on operative care, but also put the regulation of other risk factors on an equal footing, such as the regulation of the living environment and access to fluoride. A right to health-based approach to dental caries thus offers a comprehensive approach to dental caries control, particularly prevention.

Control of Dental Caries in Children and Adolescents Using Fluoride: An Overview of Community-Level Fluoridation Methods

The maintenance of oral health is a crucial aspect of general well-being; however, a significant proportion of the worldwide population experiences a range of oral diseases. Dental caries is a highly prevalent non-communicable disease globally, especially in children and adolescents. Fluoride is involved in the control of dental caries, primarily by decreasing the critical pH for dental hard tissue dissolution and decreasing enamel solubility. Due to the substantial data supporting the efficacy of fluoride in controlling dental caries, many community-level fluoridation initiatives have been devised and executed as global public health preventive interventions. These initiatives encompass the fluoridation of water, salt, and milk. Water fluoridation is considered safe and effective when fluoride levels are maintained within the recommended range (0.6 to 1.1 mg/L). Salt fluoridation has a cariostatic potential similar to that of water fluoridation, and a fluoride concentration of 250 micrograms per gram in salt is not associated with an increased risk of developing dental fluorosis. However, there is currently an effort to reduce the consumption of table salt in order to mitigate the harmful effects of excessive salt consumption. It has been hypothesized that fluoride food supplementation, such as fluoridated milk, is associated with a decrease in caries experience in permanent teeth; however, the effect is not clear in primary teeth. Public-level fluoride interventions are more cost-effective than the operative care of caries lesions and limit the burden of care. The administration of fluorides should be conducted using safe methods, limiting ingestion, and adhering to the guidelines set by international and national health agencies in each country. This is particularly important when considering children with developing dentitions. Fluoride is an important tool in the control of dental caries, but it is crucial to combine it with good oral hygiene, a healthy diet, and regular visits to a dental professional to maintain long-term oral health.

Oral Health Knowledge, Attitudes, Practices, and Literacy of Pregnant Women: A Scoping Review

PURPOSE

Pregnancy is a state particularly sensitive to oral pathologies (periodontal and decay). The oral health status of pregnant women can have an impact on the outcome of the pregnancy and the oral health of the child to come. As in the general population, the oral health of pregnant women is socially determined and dependent on psychosocial factors, including factors related to health behaviours. Research into the determinants of oral health in pregnant women will allow a better understanding of the mechanisms of action specific to this period of perinatality.

MATERIALS AND METHODS

The methodology of a scoping review was selected with the objective of investigating the contribution of knowledge, attitudes, practices (KAP) and oral health literacy on pregnant women's oral health.

RESULTS

Of the 67 articles selected, 52 studied the 'knowledge' component, 27 the 'attitude' (including the perception and beliefs concerning health), and 54 the 'practice' component, while 6 articles examined literacy. The KAP components were studied in relation to socioeconomic determinants, oral health status, healthcare utilisation and oral health literacy. The level of oral health literacy of pregnant women is strongly related to their living environment and socioprofessional level which influences their attitudes and practices. Woman's oral health practices before pregnancy can be a predictor of her practices during pregnancy.

CONCLUSION

The complex nature of the attitude component (locus of control, sense of self-efficacy, perceived importance) is little discussed. The heterogeneity and exhaustiveness of topics related to KAP raises the question of how to more accurately assess KAP in pregnant women in a valid, reproducible, and transferable manner and the need to build a structured oral health consensus body of work. This review is a first step towards identifying the psychosocial factors that are essential for developing a model of educational intervention in oral health that combines the process of behavioural change and decision making while taking into account the concept of empowerment, and with the aim of reducing social inequalities in health.

The life course and oral health in old age

Alongside a marked increase in the population of older New Zealanders has been an increase in tooth retention: more and more older adults now have at least some of their own teeth. Understanding their oral health demands consideration of their journey along the life course. The common clinical oral conditions - dental caries ('tooth decay') and periodontitis ('gum disease') - are both chronic and cumulative, and highly socially patterned in their occurrence, being more prevalent and severe in those of lower socio-economic position. Those who have ended up with 'good oral health' in old age are those who have had the wherewithal to adapt successfully to their oral disease burden as it has accumulated over the years. In this paper, I consider the utility of the life course approach for interpreting and understanding data, and I apply its principles to a number of important observations on older people's oral health.

Oral Health Behaviours, Knowledge, and Literacy of Expectant Mothers: A Cross-Sectional Study among Maternity Ward Patients

Maternal knowledge, literacy, and behaviours in the area of oral health may greatly influence the risk of caries and the oral health status of children from the youngest age. Thus, the aim of the study was to investigate paediatric oral health knowledge and literacy as well as maternal oral health behaviours and outcomes among expectant mothers. A cross-sectional study was undertaken among 400 pregnant inpatients aged 17-48 years (mean age 29.5 ± 5.3 years) in 31 public maternity wards in the Wielkopolska region, Poland. An anonymous, self-designed questionnaire was prepared on the basis of current oral health recommendations. Pregnancy complications were reported by 195 (48.8%), and permanent tooth extractions by 158 (39.5%) women. Knowledge and literacy scores were associated with, among other things, maternal education, selected oral hygiene practices, and reported extractions of permanent teeth. Although participants had some correct information regarding oral health, they had insufficient awareness of caries as an infectious disease and of the appropriate timing for the child's first dental visit. Their self-assessment of oral health status and belief that they were under dental care tended to be overly optimistic, given their self-reported outcomes. These aspects should be considered in future health education efforts among expectant women.

Oral health: Epidemiology and concordance in Australian children and parents

INTRODUCTION

Studying parent-child pair health provides the opportunity to identify risk factors and opportunities for oral health prevention and intervention focusing on the family context. The aim of this study was to describe the oral health of children aged 11-12 years and their parents in a national sample of parent-child dyads in Australia.

METHODS

The Child Health CheckPoint is a study of 11 to 12-year-old children and one parent nested within the Longitudinal Study of Australian Children, a nationally representative cohort study. In 2015-16, the study collected two-dimensional photographic intra-oral images and was scored using visual assessments of the teeth, oral hygiene and malocclusion.

RESULTS

Of the 1874 CheckPoint families, 1396 biological parent-child pairs had at least one oral health measure recorded. Over two-thirds of children had moderate to severe gingival inflammation (69.7%, 95%CI 64.7-74.9). Parents had a lower proportion of poor oral hygiene (2.1%, 95% CI 1.4-3.0) than children (13.0%, 95% CI 11.3-14.9). High concordance was seen in the Modified Gingival Index correlation coefficient 0.49 (95%CI 0.44-0.53).

CONCLUSION

The high concordance in gingival health between child-parent pairs supports the familial and behavioural links established in previous studies. Children had poorer oral hygiene but fewer visible dental caries lesions than their parents. As dental caries is a chronic and cumulative disease, preventive interventions targeting children's oral hygiene are needed.

Age at first childbirth in relation to oral health later in life

OBJECTIVE

This study aimed to examine the relationship between age at first childbirth and oral health. The mediation effect of body mass index (BMI) on this relationship was also determined.

METHODS

This study analyzed data of 2,506 parous postmenopausal women aged 50 or older from the Korea National Health and Nutrition Examination Survey 2013-2015. Chewing inconvenience was investigated by an oral interview. Periodontitis and dental caries were determined through dental examinations. Multivariable logistic regression analysis was performed to examine the relationship between age at first childbirth and oral health, and mediation analysis was performed to examine the contribution of BMI on the relationship between age at first childbirth and oral health.

RESULTS

Women who underwent their first delivery between the age of 26 and 46 years had significantly decreased odds of chewing inconvenience (odds ratio [OR] = 0.72, 95% confidence interval [95% CI] = 0.56-0.93, P = 0.010) compared with the odds of those women whose first delivery was between at the age of 15 and 22 years. We also found a significant linear relationships between age at first childbirth and odds of chewing inconvenience (OR = 0.83, 95% CI = 0.74-0.95, P = 0.017) and dental caries (OR = 0.84, 95% CI = 0.74-0.96, P = 0.025). BMI accounted for 12.9% of the relationship between age at first childbirth and dental caries. Age at first childbirth was only indirectly associated with periodontitis through BMI (OR = 0.98, 95% CI = 0.96-0.99, P = 0.003).

CONCLUSIONS

Women whose first delivery occurred at a young age had significantly increased odds of chewing inconvenience and dental caries. BMI mediated the relationships between age at first childbirth and periodontitis and dental caries.

Decrease in posterior occlusal support area can accelerate tooth loss: The Suita study

Purpose A decrease in posterior occlusal support is considered to increase the load on remaining teeth and thus accelerate tooth loss. Therefore, a follow-up study was carried out to perform a longitudinal analysis of the association between the posterior occlusal support region and tooth loss.Methods The participants of the study were 806 Suita Study participants who underwent physical health checkups both at baseline and at follow-up. The participants were classified into three groups by posterior occlusal support area (POSA) using the Eichner Index at baseline: Perfect POSA group, Eichner A; Decreased POSA group, Eichner B1-3; and Lost POSA group, Eichner B4 and Eichner C1-2. Participants were also classified into two groups according to whether they had tooth loss during the follow-up period. Tooth loss risk factors were investigated through the construction of logistic regression models with tooth loss as the dependent variable and posterior occlusal support, sex, age, periodontal disease, stimulated salivary flow rate, smoking habit, drinking habit, denture wearing, utilization of dental services, brushing habits, diabetes mellitus, osteoporosis and number of years of follow-up as independent variables.Results In the results of the logistic regression model, the adjusted odds ratio (95%CI) for tooth loss with the Perfect POSA group as the reference was 3.19 (1.98-5.14) for the Decreased POSA group and 4.57 (1.97-10.62) for the Lost POSA group.Conclusions This study showed that decreased POSA accelerated tooth loss in the general urban population.

Validation of Cariogram in Caries Prediction in Women and Their Children 4 Years After Pregnancy - Longitudinal Study

BACKGROUND

Cariogram®, an algorithm-based software model, for predicting caries risk has been used to assess the caries risk profile of many different groups. The aims of the study were to evaluate Cariogram caries risk assessment during pregnancy with DMFT/dmft incidence in mothers and their children 4 years after pregnancy and to check if there is an association between children's caries risk profiles using Cariogram and caries risk profiles (by Cariogram) of their mothers during pregnancy.

METHODS

The study population consisted of 96 pregnant women (average age 27.4±7.2 years at baseline) who completed clinical baseline examination and salivary tests. The follow-up study was initiated 4 years later and the 80 pairs of mother and children (from that pregnancy) were re-examined using the same procedure at baseline. An individual caries risk profile and DMFT/dmft incidence were made for each woman and child. The prediction of the Cariogram was compared to the actual dental experience in 4 years. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for two cut-offs were calculated to express the outcome.

RESULTS

The results showed a strong association between the risk categories of pregnant women and their offspring as well as between caries development in offspring and the Cariogram risk categories of pregnant women. Sensitivity and PPV for new DMFT (ΔDMFT>0) 4 years after for women were  high (>80%) for those participants assessed with 0-60% "chance to avoid caries", as well as diagnostic accuracy (74.00%). High specificity (91.00%), very high PPV (95.00%) and clinically useful values according to Youden's index (0.53) were obtained for moderate-risk and two lowest-risk groups for dmft in children.

CONCLUSION

Cariogram was valid in the authors' sample only and highly predictive in caries risk assessment in investigated children based on caries risk assessment of their mothers in pregnancy.

Oral health behaviour, attitude towards, and knowledge of dental caries among mothers of 0- to 3-year-old children living in Kaunas, Lithuania

OBJECTIVES

This study aimed to investigate the oral health behaviours of mothers with young children and their attitudes towards dental caries.

METHODS

The survey targeted all mothers with children under 3 years attending a primary healthcare centre (Department of Family Medicine at the Lithuanian University of Health Sciences [LSMU] Hospital) in Kaunas, Lithuania. The Bioethics Centre of the LSMU approved the study (No. BEC-OF-14). Of 176 mothers, 123 (69.9%) took part in the 2016-2017 study. The self-administered questionnaire enquired about mothers' attitudes towards oral health and behaviours related to the potential transmission of oral bacteria to their children, dietary habits, tooth brushing, smoking, and background factors. The chi-squared test and univariate/multivariate logistic regression analyses served for the statistical analysis. (p values ≤ .05 indicated statistically significant differences).

RESULTS

Most (76; 68.5%) of the mothers brushed their teeth twice daily, and 97 (87.4%) reported themselves as nonsmokers. We found a statistically significant association between mothers who brushed their own teeth twice daily and those who cleaned their children's teeth likewise (OR = 5.42, 95% CI [1.28-6.63]; p = .005). We observed significant associations among mothers who gave their children sugar-sweetened beverages (SSBs) daily and the mothers' college or lower education (OR = 6.51, 95% CI [1.59-27.19]; p = .01) and maternal tooth brushing less than twice daily (OR = 3.88, 95% CI [0.99-15.18]; p = .05).

CONCLUSIONS

A majority of mothers who took part in this survey did not brush their children's teeth as recommended. Mothers with a lower education and who brushed their teeth less than twice daily offered their children SSBs more frequently.

Community-level predictors of Australian children's dental caries and injury

BACKGROUND

Social determinants of oral health are complex and have been described by conceptual frameworks. A widely embraced model of children's oral health was published by Fisher-Owens et al. (2007), identifying theoretical constructs influencing oral health. The current study aimed to investigate community-level constructs described in the conceptual model.

METHODS

The Longitudinal Study of Australian Children is a cross-sequential dual cohort study, with a representative sample (n = 10090) of Australian children. Generalized estimating equations were applied to model seven waves of carer-reported oral health and community measures.

RESULTS

In the final model, children living in Queensland had a 1.48 (CI 1.35-1.62) increased odds of dental caries over time. Children in low socio-economic status (SES) areas (OR 1.32 CI 1.20-1.44) had an increased odds of caries. The state of Queensland (OR 1.24 CI 1.05-1.46) and poor neighbourhood liveability (OR 1.17 CI 1.05-1.31) were predictors of dental injury.

CONCLUSION

By modelling available community measures, this study found SES and rurality were predictors of caries over childhood. Our results highlight the difficulty of applying conceptual models to oral health. The use of qualitative studies and realist reviews should be considered to complement statistical models to provide contextualized insights into funding, policy and service delivery on children's oral health.

Socioeconomic Factors and Caries in People between 19 and 60 Years of Age: An Update of a Systematic Review and Meta-Analysis of Observational Studies

This study is aimed to perform an update of a systematic review and meta-regression to evaluate the effect modification of the socioeconomic indicators on caries in adults. We included studies that associated social determinants with caries, with no restriction of year and language. The Newcastle-Ottawa Scale was used to evaluate the risk of bias. With regard to the meta-analysis, statistical heterogeneity was evaluated by I², and the random effect model was used when it was high. A subgroup analysis was conducted for socioeconomic indicators, and a meta-regression was performed. Publication bias was assessed through Egger's test. Sixty-one studies were included in the systematic review and 25 were included in the meta-analysis. All of the studies were published between 1975 and 2016. The most frequent socioeconomic indicators were schooling, income, and socioeconomic status (SES). In the quantitative analysis, the DMFT (decayed, missing, filled teeth) variation was attributed to the studies' heterogeneity. The increase of 10.35 units in the proportion of people with lower SES was associated with an increase of one unit in DMFT, p = 0.050. The findings provide evidence that populations with the highest proportions of people with low SES are associated with a greater severity of caries. The results suggest the need for actions to reduce the inequalities in oral health (PROSPERO [CRD42017074434]).

WITHDRAWN: Community-based population-level interventions for promoting child oral health

BACKGROUND

Dental caries and gingival and periodontal disease are commonly occurring, preventable chronic conditions. Even though much is known about how to treat oral disease, currently we do not know which community-based population-level interventions are most effective and equitable in preventing poor oral health.

OBJECTIVES

Primary • To determine the effectiveness of community-based population-level oral health promotion interventions in preventing dental caries and gingival and periodontal disease among children from birth to 18 years of age. Secondary • To determine the most effective types of interventions (environmental, social, community and multi-component) and guiding theoretical frameworks.• To identify interventions that reduce inequality in oral health outcomes.• To examine the influence of context in the design, delivery and outcomes of interventions.

SEARCH METHODS

We searched the following databases from January 1996 to April 2014: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resource Information Center (ERIC), BIOSIS Previews, Web of Science, the Database of Abstracts of Reviews of Effects (DARE), ScienceDirect, Sociological Abstracts, Social Science Citation Index, PsycINFO, SCOPUS, ProQuest Dissertations & Theses and Conference Proceedings Citation Index - Science.

SELECTION CRITERIA

Included studies were individual- and cluster-randomised controlled trials (RCTs), controlled before-and-after studies and quasi-experimental and interrupted time series. To be included, interventions had to target the primary outcomes: dental caries (measured as decayed, missing and filled deciduous teeth/surfaces, dmft/s; Decayed, Missing and Filled permanent teeth/surfaces, DMFT/S) and gingival or periodontal disease among children from birth to 18 years of age. Studies had to report on one or more of the primary outcomes at baseline and post intervention, or had to provide change scores for both intervention and control groups. Interventions were excluded if they were solely of a chemical nature (e.g. chlorhexidine, fluoride varnish), were delivered primarily in a dental clinical setting or comprised solely fluoridation.

DATA COLLECTION AND ANALYSIS

Two review authors independently performed screening, data extraction and assessment of risk of bias of included studies (a team of six review authors - four review authors and two research assistants - assessed all studies). We calculated mean differences with 95% confidence intervals for continuous data. When data permitted, we undertook meta-analysis of primary outcome measures using a fixed-effect model to summarise results across studies. We used the I2 statistic as a measure of statistical heterogeneity.

MAIN RESULTS

This review includes findings from 38 studies (total n = 119,789 children, including one national study of 99,071 children, which contributed 80% of total participants) on community-based oral health promotion interventions delivered in a variety of settings and incorporating a range of health promotion strategies (e.g. policy, educational activities, professional oral health care, supervised toothbrushing programmes, motivational interviewing). We categorised interventions as dietary interventions (n = 3), oral health education (OHE) alone (n = 17), OHE in combination with supervised toothbrushing with fluoridated toothpaste (n = 8) and OHE in combination with a variety of other interventions (including professional preventive oral health care, n = 10). Interventions generally were implemented for less than one year (n = 26), and only 11 studies were RCTs. We graded the evidence as having moderate to very low quality.We conducted meta-analyses examining impact on dental caries of each intervention type, although not all studies provided sufficient data to allow pooling of effects across similar interventions. Meta-analyses of the effects of OHE alone on caries may show little or no effect on DMFT (two studies, mean difference (MD) 0.12, 95% confidence interval (CI) -0.11 to 0.36, low-quality evidence), dmft (three studies, MD -0.3, 95% CI -1.11 to 0.52, low-quality evidence) and DMFS (one study, MD -0.01, 95% CI -0.24 to 0.22, very low-quality evidence). Analysis of studies testing OHE in combination with supervised toothbrushing with fluoridated toothpaste may show a beneficial effect on dmfs (three studies, MD -1.59, 95% CI -2.67 to -0.52, low-quality evidence) and dmft (two studies, MD -0.97, 95% CI -1.06 to -0.89, low-quality evidence) but may show little effect on DMFS (two studies, MD -0.02, 95% CI -0.13 to 0.10, low-quality evidence) and DMFT (three studies, MD -0.02, 95% CI -0.11 to 0.07, moderate-quality evidence). Meta-analyses of two studies of OHE in an educational setting combined with professional preventive oral care in a dental clinic setting probably show a very small effect on DMFT (-0.09 weighted mean difference (WMD), 95% CI -0.1 to -0.08, moderate-quality evidence). Data were inadequate for meta-analyses on gingival health, although positive impact was reported.

AUTHORS' CONCLUSIONS

This review provides evidence of low certainty suggesting that community-based oral health promotion interventions that combine oral health education with supervised toothbrushing or professional preventive oral care can reduce dental caries in children. Other interventions, such as those that aim to promote access to fluoride, improve children's diets or provide oral health education alone, show only limited impact. We found no clear indication of when is the most effective time to intervene during childhood. Cost-effectiveness, long-term sustainability and equity of impacts and adverse outcomes were not widely reported by study authors, limiting our ability to make inferences on these aspects. More rigorous measurement and reporting of study results would improve the quality of the evidence.

Community-based population-level interventions for promoting child oral health

BACKGROUND

Dental caries and gingival and periodontal disease are commonly occurring, preventable chronic conditions. Even though much is known about how to treat oral disease, currently we do not know which community-based population-level interventions are most effective and equitable in preventing poor oral health.

OBJECTIVES

Primary • To determine the effectiveness of community-based population-level oral health promotion interventions in preventing dental caries and gingival and periodontal disease among children from birth to 18 years of age. Secondary • To determine the most effective types of interventions (environmental, social, community and multi-component) and guiding theoretical frameworks.• To identify interventions that reduce inequality in oral health outcomes.• To examine the influence of context in the design, delivery and outcomes of interventions.

SEARCH METHODS

We searched the following databases from January 1996 to April 2014: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resource Information Center (ERIC), BIOSIS Previews, Web of Science, the Database of Abstracts of Reviews of Effects (DARE), ScienceDirect, Sociological Abstracts, Social Science Citation Index, PsycINFO, SCOPUS, ProQuest Dissertations & Theses and Conference Proceedings Citation Index - Science.

SELECTION CRITERIA

Included studies were individual- and cluster-randomised controlled trials (RCTs), controlled before-and-after studies and quasi-experimental and interrupted time series. To be included, interventions had to target the primary outcomes: dental caries (measured as decayed, missing and filled deciduous teeth/surfaces, dmft/s; Decayed, Missing and Filled permanent teeth/surfaces, DMFT/S) and gingival or periodontal disease among children from birth to 18 years of age. Studies had to report on one or more of the primary outcomes at baseline and post intervention, or had to provide change scores for both intervention and control groups. Interventions were excluded if they were solely of a chemical nature (e.g. chlorhexidine, fluoride varnish), were delivered primarily in a dental clinical setting or comprised solely fluoridation.

DATA COLLECTION AND ANALYSIS

Two review authors independently performed screening, data extraction and assessment of risk of bias of included studies (a team of six review authors - four review authors and two research assistants - assessed all studies). We calculated mean differences with 95% confidence intervals for continuous data. When data permitted, we undertook meta-analysis of primary outcome measures using a fixed-effect model to summarise results across studies. We used the I2 statistic as a measure of statistical heterogeneity.

MAIN RESULTS

This review includes findings from 38 studies (total n = 119,789 children, including one national study of 99,071 children, which contributed 80% of total participants) on community-based oral health promotion interventions delivered in a variety of settings and incorporating a range of health promotion strategies (e.g. policy, educational activities, professional oral health care, supervised toothbrushing programmes, motivational interviewing). We categorised interventions as dietary interventions (n = 3), oral health education (OHE) alone (n = 17), OHE in combination with supervised toothbrushing with fluoridated toothpaste (n = 8) and OHE in combination with a variety of other interventions (including professional preventive oral health care, n = 10). Interventions generally were implemented for less than one year (n = 26), and only 11 studies were RCTs. We graded the evidence as having moderate to very low quality.We conducted meta-analyses examining impact on dental caries of each intervention type, although not all studies provided sufficient data to allow pooling of effects across similar interventions. Meta-analyses of the effects of OHE alone on caries may show little or no effect on DMFT (two studies, mean difference (MD) 0.12, 95% confidence interval (CI) -0.11 to 0.36, low-quality evidence), dmft (three studies, MD -0.3, 95% CI -1.11 to 0.52, low-quality evidence) and DMFS (one study, MD -0.01, 95% CI -0.24 to 0.22, very low-quality evidence). Analysis of studies testing OHE in combination with supervised toothbrushing with fluoridated toothpaste may show a beneficial effect on dmfs (three studies, MD -1.59, 95% CI -2.67 to -0.52, low-quality evidence) and dmft (two studies, MD -0.97, 95% CI -1.06 to -0.89, low-quality evidence) but may show little effect on DMFS (two studies, MD -0.02, 95% CI -0.13 to 0.10, low-quality evidence) and DMFT (three studies, MD -0.02, 95% CI -0.11 to 0.07, moderate-quality evidence). Meta-analyses of two studies of OHE in an educational setting combined with professional preventive oral care in a dental clinic setting probably show a very small effect on DMFT (-0.09 weighted mean difference (WMD), 95% CI -0.1 to -0.08, moderate-quality evidence). Data were inadequate for meta-analyses on gingival health, although positive impact was reported.

AUTHORS' CONCLUSIONS

This review provides evidence of low certainty suggesting that community-based oral health promotion interventions that combine oral health education with supervised toothbrushing or professional preventive oral care can reduce dental caries in children. Other interventions, such as those that aim to promote access to fluoride, improve children's diets or provide oral health education alone, show only limited impact. We found no clear indication of when is the most effective time to intervene during childhood. Cost-effectiveness, long-term sustainability and equity of impacts and adverse outcomes were not widely reported by study authors, limiting our ability to make inferences on these aspects. More rigorous measurement and reporting of study results would improve the quality of the evidence.

Correlation between siblings in caries in Norway. A quantitative study

BACKGROUND

The role of the family for caries between siblings has been a focus for researchers for almost 100 years. However, the contribution of the family to the variation in caries has not been determined.

OBJECTIVES

To estimate the correlation between siblings in caries, and to investigate whether this varied according to number of siblings, mother's level of education, marital status and country of birth.

METHODS

The population included families with two or more siblings, altogether 409 766 children and adolescents aged 6-18 years, and 181 551 mothers. Data on caries were from electronic dental journals, which were merged with data from Statistics Norway about the characteristics of the mothers. The analyses were performed using random-effects regression, in which separate regressions were run for the extent of the carious lesion. Caries was scored for permanent teeth only. Mothers were used to identify siblings within families. The correlation between siblings in caries was measured using the intraclass correlation coefficient.

RESULTS

The proportion of the variance in the outcome measures that was due to between-family variability was in the range 13-29%. The intraclass correlation coefficients from the analyses of the subpopulations that described the characteristics of the mothers were fairly similar to the ICCs as estimated on the whole population.

CONCLUSION

We identified a fairly strong family effect, which confirms that the family is an important arena in which the dental health of the children is formed. An improvement in dental health for one of the siblings was associated with a positive effect on the dental health of the other sibling, and vice versa.

Association between early childhood caries and maternal caries status: A cross-section study in São Luís, Maranhão, Brazil

OBJECTIVE

This study aims to evaluate the association between early childhood caries (ECC) and maternal caries status, and the maternal perception of ECC risk factors.

MATERIALS AND METHODS

A cross-sectional study was carried out with 77 mother-child pairs, the children ranging from 12 to 36 months of age and their mothers, who were seeking dental care at a health center in São Luís, Maranhão, Brazil. Data collection was conducted using a specific questionnaire for mothers. Oral clinical examination of the mother-child binomial to assess caries incidence, gingival bleeding (GB) and visible plaque was done. Home visits were performed in 10% of the sample in order to observe the environmental conditions, dietary habits and dental hygiene practices.

RESULTS

The findings showed that the caries prevalence in children was 22.5 times higher in the mother who had decayed tooth (prevalence ratio [PR] = 22.5, confidence interval [CI] 95% = 3.2-156.6, P < 0.001). GB also was observed in 14 mothers and children, the PR in pair was 12.2 (CI95% = 1.6-88.9, P < 0.001). The variables are related for the mother-child binomial in regression linear analysis.

CONCLUSION

The maternal caries status was associated with ECC.

Which life course model better explains the association between socioeconomic position and periodontal health?

AIM

To assess whether the relationship between socioeconomic position (SEP) and periodontal health fitted the Critical Period or the Social Mobility life course models.

METHODS

A nationally representative sample of 5570 Korean adults from KNHANES IV study. Log-binomial regression models adjusting for adulthood or childhood socioeconomic (SES) variables was used to assess independent effects of socioeconomic differences for childhood, adulthood and period of transition from child to adult in periodontal health.

RESULTS

In the Critical Period model, poorer periodontal status was associated with SES disadvantage in adulthood and not predicted by SES disadvantage in childhood. For the intergenerational Social Mobility model, prevalence of current periodontal disease was only different for females aged 30-39 and 40-49 years, after adjustment. Prevalence of periodontal disease in females was highest in the downwardly mobile group.

CONCLUSIONS

The Critical Period model was better at explaining association between socioeconomic position and periodontal health, such as the adulthood socioeconomic variables (SEP), had a stronger effect than childhood factors on periodontal disease. The Social Mobility model explained more of the variation in the association between SEP and periodontal health among women than among men.

Early life conditions, adverse life events, and chewing ability at middle and later adulthood

OBJECTIVES

We sought to determine the extent to which early life conditions and adverse life events impact chewing ability in middle and later adulthood.

METHODS

Secondary analyses were conducted based on data from waves 2 and 3 of the Survey of Health, Ageing, and Retirement in Europe (SHARE), collected in the years 2006 to 2009 and encompassing information on current chewing ability and the life history of persons aged 50 years or older from 13 European countries. Logistic regression models were estimated with sequential inclusion of explanatory variables representing living conditions in childhood and adverse life events.

RESULTS

After controlling for current determinants of chewing ability at age 50 years or older, certain childhood and later life course socioeconomic, behavioral, and cognitive factors became evident as correlates of chewing ability at age 50 years or older. Specifically, childhood financial hardship was identified as an early life predictor of chewing ability at age 50 years or older (odds ratio = 1.58; 95% confidence interval = 1.22, 2.06).

CONCLUSIONS

Findings suggest a potential enduring impact of early life conditions and adverse life events on oral health in middle and later adulthood and are relevant for public health decision-makers who design strategies for optimal oral health.

A systematic review of dental late effects in survivors of childhood cancer

Survivors of childhood cancer are at risk for dental late effects. This systematic review summarizes associations between treatment exposures and dental late effects among survivors of childhood cancer. We included investigations with at least 20 study participants conducted for 2 or more years after completion of childhood, adolescent, or young adult cancer therapy. This review suggests both independent and additive effects of radiotherapy and chemotherapy on dental complications, and identifies vulnerable groups with specific host and treatment characteristics. This summary provides information that will assist clinicians to prevent, detect, and facilitate early intervention for dental late effects.

Maternal oral bacterial levels predict early childhood caries development

OBJECTIVE

To calculate the association of maternal salivary bacterial challenge (mutans streptococci [MS] and lactobacilli [LB]) from pregnancy through 24 months' postpartum with child caries incidence (≥1 cavitated or restored teeth) at 36 months.

MATERIALS & METHODS

Dental, salivary bacterial, sociodemographic, and behavioral measures were collected at three- to six-month intervals from a birth cohort of low-income Hispanic mother-child dyads (N = 243). We calculated the relative child caries incidence, adjusted for confounding, following higher maternal challenge of MS (>4500 colony-forming units per milliliter of saliva [CFU/mL]) and LB (>50 CFU/mL) based on multivariable models.

RESULTS

Salivary MS and LB levels were greater among mothers of caries-affected children versus caries-free children. Mothers with higher salivary MS challenge were more likely to have MS-positive children (>0 CFU/mL), but maternal LB challenge was not a statistically significant predictor of child LB-positive status. Adjusting for sociodemographics, feeding and care practices, and maternal dental status, higher maternal salivary challenge of both MS and LB over the study period predicted nearly double the child caries incidence versus lower MS and LB (cumulative incidence ratio: 1.9; 95% confidence interval: 1.1, 3.8).

CONCLUSION

Maternal salivary bacterial challenge not only is associated with oral infection among children but also predicts increased early childhood caries occurrence.

Oral health care in children with haemophilia in Helsinki, Finland

BACKGROUND

The bleeding tendency and fear of bleeds may have a negative effect on preventive dental care of patients with haemophilia both at home and at dental appointments.

AIM

To describe the clinical practice of dental care in children with haemophilia in Helsinki, Finland.

METHODS

This study evaluated retrospectively the medical records of 28 paediatric patients with haemophilia (aged 5.3-17.4 years) from dental visits during 2009-2010. Decayed, missing and filled teeth in the primary (dmft) and permanent dentition (DMFT), Community Periodontal Index (CPI), signs of developmental dental defects in enamel and the number of preventive and restorative procedures were gathered. Dmft + DMFT scores were compared with those of 17,079 non-haemophiliac boys. The Mann-Whitney U-test was used to compare the data between the groups of different severity of haemophilia.

RESULTS

The median number of dental visits per patient was three (range 1-11). Twenty-two patients (79 %) had dmft + DMFT-scores within the 95 % reference range for age. None of the children had a CPI >2. Twelve (43 %) patients had developmental enamel defects. Half had received restorative dental care and three out of four preventive procedures.

CONCLUSIONS

Dental care during hospital visits in children with haemophilia may enhance confidence in the preventive dental care and help minimise bleeding during dental procedures.

A systematic review of socioeconomic indicators and dental caries in adults

Increasing evidence suggests that socioeconomic factors may be associated with an increased risk of dental caries. To provide better evidence of the association between dental caries in adults and socioeconomic indicators, we evaluated the relation between these two conditions in a thorough review of the literature. Seven databases were systematically searched: Pubmed, Cochrane, Web of Science, Bireme, Controlled Trials, Clinical Trials and the National Institute for Health and Clinical Excellence. No restrictions were placed on the language or year of publication. The search yielded 41 studies for systematic review. Two independent reviewers screened the studies for inclusion, extracted data and evaluated quality using the Newcastle-Ottawa scale. The following socioeconomic indicators were found: educational level, income, occupation, socio-economic status and the community index. These indicators were significantly associated with a greater occurrence of dental caries: the subject's education, subject's income, subject's occupation and the Gini coefficient. A high degree of heterogeneity was found among the methods. Quality varied across studies. The criteria employed for socioeconomic indicators and dental caries should be standardized in future studies. The scientific evidence reveals that educational level, income, occupation and the Gini coefficient are associated with dental caries.