Dental caries and vitamin D status in children in Asia

The Role of Serum Vitamin D Levels and Vitamin D Receptor (VDR) Gene Variants on Dental Caries

BACKGROUND/OBJECTIVES

Vitamin D helps the mineralization of bone, teeth, and other calcified tissues by regulating calcium-phosphate metabolism. The nuclear activation of the vitamin D receptor (VDR) gene is essential for the effectiveness of vitamin D. The main objective of this study is to determine the role of vitamin D levels and VDR gene variants in dental caries.

METHODS

This study included 128 3-6-year-old children who were divided into 64 caries-free and 64 carious children. Blood samples were taken, and serum 25-hydroxyvitamin D levels were measured. Intraoral examinations were performed to record dmft index values. Genetic testing was performed on 26 children to examine VDR gene variations. Relevant gene regions were amplified using PCR and sequenced via Sanger sequencing in a total of 13 caries-free and 13 carious children. Stats analyses included chi-square/trend tests to compare count data; Student's T/Mann-Whitney U tests for two-group normally/non-normally distributed data; and the Kruskal-Wallis test for 3+ groups with non-normal data.

RESULTS

The results showed that vitamin D levels were relatively low in the caries group, but no statistically significant relationship was found between vitamin D levels and caries. No mutations were detected in the VDR gene in either group, and there was no significant difference observed in terms of the number of ApaI, TaqI, and FokI polymorphisms. Based on these findings, the use of prophylactic vitamin D supplements to prevent caries formation or development cannot be recommended.

CONCLUSIONS

This study provides important insights into the relationship between vitamin D and dental caries and can contribute to the development of effective preventive strategies for oral and dental health.

From Pain to Progress: Comprehensive Analysis of Musculoskeletal Disorders Worldwide

Objective

Comprehensive analyses of the burden of musculoskeletal disorders (MSDs) are crucial for deepening our understanding of their impact on population health and for evaluating progress toward achieving international health goals.

Study Design

A comprehensive analysis was performed using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021.

Methods

We gathered data on the number of prevalent cases, incidences, deaths, and disability-adjusted life years (DALYs) for MSDs from 1990 to 2021. Subsequently, crude indicators, age-standardized rates (ASRs) and estimated annual percentage change (EAPC) were calculated for MSDs from 1990 to 2021 at the global, regional, national, age and gender levels. Finally, decomposition analysis, frontier analysis, and EAPC cluster analysis were employed to examine changes in the indicators and the factors influencing them.

Results

In 2021, there were 367,193,430 incident cases and 1,686,561,517 prevalent cases of MSDs globally. Between 1990 and 2021, the age-standardized incidence rates (ASIR) declined marginally from 4641.5 to 4351.79 cases per 100,000 population [EAPC: -0.16 (-0.19 to -0.13)], while the age-standardized DALY rates (ASDR) increased from 1886.2 to 1908.87 per 100,000 population [EAPC: 0.09 (0.07 to 0.11)]. The ASRs were markedly elevated in the high SDI regions in comparison to the remaining SDI regions. The EAPC and its phase clustering analyses indicated a notable upward trajectory in the burden of MSDs in the low and middle SDI regions, particularly in Central Asia. The prevalence of MSDs is highest among individuals aged 50-59 years and among women. At the global level, the burden of MSDs is 1.43 to 2.30 times higher for women than for men.

Conclusion

From 1990 to 2021, the burden of MSDs has been concentrated in high SDI regions, with a gradual shift towards low and middle SDI regions.

Recommendations on Topical Fluoride Usage for Caries Management in East Asia

Dental caries is a widespread oral health issue in Asia, affecting an estimated 30% to 90% of children and adults. Many caries cases remain untreated, resulting in pain and infection. In response, the Asian Academy of Preventive Dentistry (AAPD) emphasises comprehensive caries management and organised a fluoride workshop at the 15th International Conference of the AAPD in 2023. The AAPD invited a group of experts to form a fluoride working group to review existing literature and develop fluoride recommendations for stakeholders across Asian countries and regions. The working group assessed caries risk and identified commonly used topical fluoride products for home care, professional, and community settings in Asia. The working group concluded that fluoride is a safe and highly effective strategy to reduce caries prevalence and incidence. The working group provided key recommendations based on successful regional caries management practices: (1) use topical fluoride for prevention and control of dental caries; (2) encourage the use of fluoride toothpaste with a concentration of at least 1,000 ppm for effective caries reduction; (3) advise a 0.05% fluoride mouth rinse as soon as children can spit it out to prevent early childhood caries; (4) deliver professionally administered fluoride, such as 5% sodium fluoride varnish, 2% fluoride gel, or 1.23% acidulated phosphate fluoride preparations, to decrease dental caries in at-risk individuals; and (5) apply 38% silver diamine fluoride to arrest cavitated caries. These recommendations aim to help practitioners, health care providers, and parents/caregivers make informed decisions about fluoride use as part of comprehensive oral health care in the region.

The impact of vitamin D deficiency on caries, periodontitis, and oral cancer: A systematic review

Background

The relationship between vitamin D deficiency with dental caries, periodontitis and oral cancer is controversial.

Objectives

This review aimed to systematically evaluate the published literature and summarise the available evidence about the impact of vitamin D deficiency (VDD) on the oral diseases mentioned above.

Methods

PubMed, Web of Science, Scopus and ScienceDirect databases were used. The search terms included were vitamin D, caries, periodontitis, and oral cancer. All papers published between January 2017 and November 2022 were included. The PRISMA process was used for the screening and selection studies.

Results

Initially, 3001 studies were identified. However, after evaluating 46 full-text articles that explored the link between VDD and caries, periodontitis, and oral cancer, only 32 studies met the inclusion criteria for this systematic review. Among these, 15 studies focused on caries, 16 on periodontitis, and only one on oral cancer. Regarding study quality and risk of bias, 25 out of the 32 studies were deemed to have low risk. A total of 12 studies on periodontitis showed the impact of VDD.

Conclusion

The review highlights that most evidence suggests an association between VDD and periodontitis. However, findings concerning the association between VDD and dental caries were controversial. Thus, further research is required to clarify the impacts of VDD on caries and oral cancer.

A study on the relationship between cheese intake and caries occurrence based on Mendelian randomization method

Objective

The study aims to investigate the causal relationship between cheese intake and caries occurrence by a two-sample Mendelian randomization method (TSMR).

Methods

Data from a genome-wide association study (GWAS) on cheese intake as an exposure factor were collected, and dental caries was the outcome variable, appropriate SNPs were selected as instrumental variables (IVs). The TSMR was analyzed by the inverse variance weighting (IVW) method, weighted median method, MR-Egger regression method, simple model and weighted model.

Results

We identified forty-four single-nucleotide polymorphisms (SNPs) in the gene encoding group-specific component (cheese) that were associated with cheese intake, and IVW was adopted. The IVW method supported a relationship between cheese intake and the risk of dental caries occurrence[OR,1.00(95 %CI,0.99-1.00), P = 0.039 < 0.05]. There was no horizontal pleiotropy between the IVs(b = -0.0037, P = 0.39), and the sensitivity analysis using the "leave-one-out" method was robust to causal effects.

Conclusion

The results of the TSMR analysis supported that an appropriate intake of cheese could reduce the occurrence of dental caries.

Association between prenatal vitamin D deficiency with dental caries in infants and children: a systematic review and meta-analysis

Prenatal vitamin D (PVD) is a vital micronutrient for dental caries (DCs). The association between prenatal vitamin D deficiencies (PVDD) and DCs in children has been conflicting in different reports. This meta-analysis aimed to investigate the association between PVDD and DCs in children for the first time. We searched PubMed, Scopus, Web of Sciences, Embase, and Scholar databases to find relevant studies based on mesh terms from 2000 to October 2023. This study was conducted based on the 2020 version of the PRISMA checklist. Cochran's Q and I2 tests were used to evaluate heterogeneity between studies. Egger's test was used to evaluate publication bias. The effect size of the association between PVDD and DCs was reported by the odds ratio (OR) at the 95% confidence interval (95% CI).Twelve studies, including 11,021 participants, were reviewed. The pooled prevalence of PVDD was estimated at 4353 (32%). The prevalence of DCs in children of mothers with and without PVDD was 44% and 25%, respectively. PVDD was significantly associated with an increased risk of DCs in children (OR: 1.35, 95% CI (1.22, 1.47), I2 = 86.6%). The association of DCs with PVDD was different based on gestational age groups, children's age groups, and vitamin D levels. This meta-analysis showed PVDD can be associated with an increased risk of DCs in children, especially in mothers with prenatal vitamin D levels ≤ 35 nmol/L. Adequate vitamin D levels throughout pregnancy can help prevent DCs in children.

Prevalence of Dental Caries in Tamil Nadu State, India: A Comprehensive Umbrella Analysis

Dental caries is a major public health concern among other oral diseases in most developing and industrialized countries, particularly in those nations where preventative programs have not yet been developed. Adults and the elderly population in Tamil Nadu also face significant challenges related to dental caries beyond children and adolescents. This systematic review examined the comprehensive epidemiology of dental caries in all age groups in Tamil Nadu. The articles were collected using various electronic databases. From the 4509 initially collected articles, 22 articles were chosen for the current umbrella analysis. The collective dental caries prevalence for Tamil Nadu state, India, from 22 studies with 33,584 study participants was 42.8%, with a 95% confidence interval (CI) of 42.3-43.4%. Among the four regions of Tamil Nadu, Eastern Tamil Nadu showed the highest dental caries prevalence of 82.2%. Thus, the strategies by the government of Tamil Nadu should focus on raising awareness about improving oral hygiene practices, seeking access to timely oral healthcare treatments, and strengthening the oral healthcare infrastructure.

Dental caries in children and vitamin D deficiency: a narrative review

Dental caries represents one of the most prevalent health problems in childhood. Numerous studies have assessed that vitamin D deficiency is highly related to dental caries in primary and permanent teeth in children. The aim of this study is to elaborate a narrative review about proposed mechanisms by which vitamin D deficiency interacts with dental caries process in children. Vitamin D deficiency during pregnancy may cause intrauterine enamel defects, and through childhood is accompanied by insufficient activity of antibacterial peptides, decreased saliva secretion, and a low level of calcium in saliva.  Conclusion: In conclusion, vitamin D deficiency would increase the risk of caries in the primary and/or permanent dentition. Relationship between vitamin D deficiency and dental caries is evident enough for vitamin D deficiency to be considered as a risk factor for dental caries in children. Optimal levels of vitamin D throughout pregnancy and childhood may be considered an additional preventive measure for dental caries in the primary and permanent dentition.

The bi-directional relationship between growth stunting and early childhood caries: a rapid review

Objective

This review aims to determine the two-way relationship between stunting and ECC in developing countries worldwide.

Methods

The procedure in this study was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Rapid Review protocol. Article searches were carried out using databases Cochrane and PubMed. In addition, searches were also carried out using backward and forward snowballing techniques to identify articles that were not detected through database searches.

Results

Nine observational epidemiological articles were found in children aged six months to six years, published in 2015-2020. Five articles discussed the features of ECC in stunted children, and the other five discussed stunting in children with caries in their primary teeth.

Conclusion

Several studies found associations between severe ECC and stunting, with ECC and stunting as both independent and dependent variables, suggesting a bi-directional relationship, also supported by literature on the physiological relationship between oral health and nutrition.

Correlation between vitamin D levels in serum and the risk of dental caries in children: a systematic review and meta-analysis

BACKGROUND

Vitamin D plays a crucial role in oral health, and its deficiency is associated to significant changes in oral health diseases. We aimed to explore the relationship between levels of 25-hydroxyvitamin D (25(OH) D) and dental caries in children.

METHODS

Four electronic databases were searched by two investigators including PubMed, Embase, Web of Science, and Cochrane Library. Dental caries results were presented as either prevalence or based on the index of primary and permanent teeth/surfaces with decaying, missing, and filled areas, while vitamin D levels were determined through laboratory testing. Two researchers independently selected studies, collected information, assessed risk of bias, and evaluated the study quality. Any disagreements were resolved through discussion.

RESULTS

A total of 13 studies were included, comprising 5 cross-sectional studies, 5 cohort studies, 3 case-control studies, all of which had high methodological quality. Our meta-analysis showed that children with vitamin D deficiency had a 22% higher risk of dental caries than those with normal vitamin D levels, with a relative risk (RR) of 1.22 and a 95% confidence interval (CI) of 1.18 to 1. 25. Further subgroup analysis according to the three types of studies showed that the risk of dental caries in children with vitamin D deficiency was higher than that in normal vitamin D level group (cohort studies: 62%; cross-sectional studies, 19%; and case-control studies, 5%). Additionally, according to age, subgroup analysis also showed that the risk of dental caries in children with vitamin D deficiency was higher than that in normal vitamin D level group (permanent teeth studies, 28%; deciduous teeth studies, 68%; and mixed dentition studies 8%).

CONCLUSIONS

Levels of 25 (OH) D have been found negatively associated with dental caries in children, indicating that low vitamin D levels may be considered a potential risk factor to this dental disease.

A certain protective effect of vitamin D against dental caries in US children and youth: A cross-sectional study

OBJECTIVES

Recent studies reported that evidence of the association between caries and vitamin D was inconclusive. We investigated the relationship between dental caries and serum vitamin D levels in US children and youth aged 5-19 years through the National Health and Nutrition Examination Survey (NHANES). The purpose of this study was to analyze the relations between serum 25-hydroxyvitamin-D [25(OH)D] level and dental caries in children and youth.

METHODS

Data were collected from the NHANES dataset performed in 2011-2018. A total of 8896 subjects completed the examination was enrolled. Serum 25(OH)D was determined by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). All teeth examined and caries assessment was conducted by licensed dentists. Statistical analyses included complex samples Chi-square tests, analysis of variance, logistic regression analyses, and restricted cubic splines conducted by R software.

RESULTS

There was a nonlinear relation between dental caries and age in youth. Vitamin D showed a relatively stable protective effect when the concentration exceeded 60 nmol/L. There was a dose-effect relation that a 10 nmol/L increase in serum 25(OH)D concentrations was associated with a decreased caries odd by 10%.

CONCLUSIONS

Our findings suggested that vitamin D sufficiency may be a protective factor for dental caries.

Examining Myeloperoxidase (MPO) biomarker in the saliva of patients with Lactobacillus-associated caries in Hilla City

This study aimed to evaluate the levels of myeloperoxidase (MPO) biomarkers in the saliva of individuals with Lactobacillus spp.-related caries in Hilla City. A total of 115 samples were collected, including 90 (78.26%) from patients with severe dental caries and 25 (21.74%) from healthy subjects as a control group. The age range was between 20 and 45 years, with a mean age of 33.76±2.01 for patients with severe dental caries and 24.15±0.44 for healthy subjects. Female participants constituted the majority of the study sample, with 77 (85.5%) females and 13 (14.5%) males. Pathogenic bacteria were isolated and identified using gram staining, biochemical tests, and the VITEK 2 compact system. Of the 90 clinical samples, 65 (72.2%) showed positive bacterial culture, while 25 (27.7%) samples had no bacterial growth. Lactobacillus spp. accounted for 25/65 (38.4%) of the total isolates, making it the predominant etiological agent compared to other types of bacteria, constituting 40/65 (61.5%). There was a significant decrease (p≤0.05) in myeloperoxidase levels in patients with severe dental caries and positive Lactobacillus culture compared to the control group.

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.

Effect of serum vitamin D on metabolic associated fatty liver disease: a large population-based study

BACKGROUND

Several studies have revealed that serum vitamin D is an important factor for metabolic associated fatty liver disease (MAFLD), but there had been no consistent conclusion.

METHODS

Of 427,507 subjects who underwent health examination, 83,625 who met the inclusion criteria were included in a cross-sectional analysis. Clinical and laboratory data were collected for analysis. MAFLD was diagnosed by abdominal imaging.

RESULTS

Multivariate linear regression models discovered a negative association between serum vitamin D and MAFLD (OR: 0.92, 95% CI: 0.90 to 0.94, p = .001), after adjusting for other well-identified risk factors. The same result was found when serum vitamin D was handled as a categorical variable (quartile, Q1-Q4) (Q4 vs. Q1, OR: 0.82, 95% CI: 0.77 to 0.87, p < .001), and a significant linear trend was observed (p for trend <.001). After analysis, a nonlinear relationship was detected between serum vitamin D and MAFLD, with an inflection point of 2.23 (44.6 nmol/L or 17.84 ng/mL). The effect sizes and the confidence intervals on the left and right sides of the inflection point were 1.16 (1.06 to 1.28) and 0.89 (0.86 to 0.91), respectively. All interactions with MAFLD were not significant for age, sex, diabetes, hypertension, smoking and body mass index (p for interaction = .110, .558, .335, .195, .616 and .401, respectively).

CONCLUSIONS

There was a nonlinear relationship between serum vitamin D and MAFLD. When the serum vitamin D level was ≥44.6 nmol/L (17.84 ng/mL), a negative correlation between serum vitamin D and MAFLD was detected. Below this level, serum vitamin D might promote the progression of MAFLD.

Low Maternal Serum 25-Hydroxyvitamin D Concentration Is Associated With Postpartum Hemorrhage: A Retrospective Observational Study

OBJECTIVE

The primary aim of this study is to investigate the relationship between vitamin D serum level and the incidence of postpartum hemorrhage (PPH). The secondary objective is to determine the relative risk of low vitamin D associated with PPH.

METHODS

This was a retrospective observational study. A total of 600 women who had delivered their babies in a single tertiary teaching hospital were enrolled. Serum blood test for 25(OH)D was performed at 35 + 0 to 36 + 6 weeks of pregnancy to measure vitamin D. A 25(OH)D level < 20 ng/mL was defined as vitamin D deficient, and a level 21-29 ng/mL as insufficient.

RESULTS

Vitamin D levels were deficient in 145 (24.1%) and insufficient in 254 (42.3%) of the women tested. Women with deficient and insufficient vitamin D levels were significantly younger than those with sufficient vitamin D levels (p < 0.001). The overall rates of PPH in the deficient and insufficient groups were 6.9% (10/145) and 6.7% (17/254), respectively, and were significantly higher than the rate of the normal vitamin D group (1.5%, p = 0.009). Women with sufficient vitamin D levels had significantly higher hemoglobin levels than those with low vitamin D levels. Higher vitamin D levels were associated with a significantly low risk of PPH (AOR: 0.93, CI: 0.89-0.98, p = 0.006).

CONCLUSION

Our results suggest that a low vitamin D level is a risk factor for PPH. Low vitamin D also related to high risk of low hemoglobin before delivery. Thus, antepartum care should include vitamin D supplements for all women if possible.

Association between Vitamin D and Dental Caries in a Sample of Canadian and American Preschool-Aged Children

Background: Inadequate vitamin D levels may increase the risk of caries during childhood. The purpose of this study was to investigate the association between 25-hydroxyvitamin D (25(OH)D) status and severe early childhood caries (S-ECC) in preschool children. Methods: Data were obtained from children <72 months of age in two case–control studies in Winnipeg, Manitoba and Richmond, Virginia. Serum analysis assessed 25(OH)D, calcium and parathyroid concentrations. Data on demographics, dental history and oral hygiene were obtained via questionnaires. Bivariate and multiple logistic regression analyses were performed to assess the relationships between demographic and biological variables and S-ECC. A p-value of ≤0.05 was significant. Results: Data were available for 200 children with S-ECC and 144 caries-free controls. Children with S-ECC had significantly lower 25(OH)D levels than those who were caries-free (p < 0.001), and children with deficient 25(OH)D levels were 10 times more likely to have S-ECC (p < 0.001). Multiple logistic regression revealed that having higher 25(OH)D and calcium concentrations (p = 0.019 and p < 0.0001, respectively), as well as being breastfed in infancy (p < 0.001), were significantly and independently associated with lower odds of S-ECC, while dental insurance (p = 0.006) was associated with higher odds of S-ECC. Conclusions: This study provides additional evidence of an association between nutritional status, specifically vitamin D and calcium levels, and S-ECC.

Study of Dental Caries and PTH Gene

Parathyroid hormone (PTH) is essential for calcium and phosphate homeostasis in odontogenesis-related cells. Therefore, the present study aimed to investigate the association between single nucleotide polymorphisms in the gene encoding PTH, and dental caries in Brazilian children. Three hundred and fifty-three children (170 boys and 183 girls, age ranging from 8 to 11 years old) were included in this study. The International System for Detection and Assessment of Carious Lesions (ICDAS) was used for diagnosis of dental caries. Visible biofilm was also evaluated during the clinical examination. Genomic DNA was extracted from saliva for real-time PCR to evaluate the single nucleotide polymorphisms rs6256, rs307247 and rs694 in PTH gene. Dental caries was classified in ICDAS0 vs. ICDAS1−6 or ICDAS1−2 vs. ICDAS3−6. Chi-square test, binary logistic regression adjusted by biofilm and haplotype analyses were performed (p &lt; 0.05). Biofilm was associated with dental caries (p &lt; 0.05). There were no associations between dental caries and rs6256, rs307247, rs694 in none of the analyses performed (p &gt; 0.05). In conclusion, the present study supports that the single nucleotide polymorphisms rs6256, rs307247, and rs694 in the PTH-encoding gene are not associated with dental caries in Brazilian children.

Interventions to improve vitamin D status in at-risk ethnic groups during pregnancy and early childhood: a systematic review

OBJECTIVE

To systematically review the literature with the primary aim of identifying behavioural interventions to improve vitamin D stores in children from at-risk ethnic groups.

DESIGN

Review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PROSPERO registration number: CRD42017080932. Health Behaviour Model and Behaviour Change Wheel framework constructs used to underpin evaluation of interventions. Methodological quality evaluated using Cochrane Risk of Bias, Cochrane ROBINS-I and NHLBI tools.

SETTING

Databases Cochrane Library, MEDLINE, EMBASE, CINAHL with secondary search of Google Scholar. No country limits set. Papers between January 1990 and February 2018, published in English included. Anticipating study heterogeneity, outcome measures not pre-specified and identified from individual full papers. Updated literature search November 2020.

PARTICIPANTS

Patient or population including pregnant women, newborns and children aged under 18 years, from Asian or African ethnic groups.

RESULTS

Of 10 690 articles screened, 298 underwent full-text review, with 24 ultimately included for data extraction. All identified studies conducted a vitamin D pharmacological supplementation intervention, with two also incorporating a behavioural intervention strategy. No study explicitly defined a primary aim of evaluating a behavioural intervention, undertaken to study its effect on vitamin D supplement uptake.

CONCLUSIONS

There is a need to address the paucity of data in ethnic at-risk children on how behavioural interventions ideally developed and co-produced with the community under study, affect and help improve vitamin D uptake, within the antenatal and pregnancy phase as well as during childhood.

Vitamin D Status Is Associated with Modifiable Lifestyle Factors in Pre-Adolescent Children Living in Urban Kuala Lumpur, Malaysia

Studies on vitamin D status and its determinants in growing children in countries with ample sunshine such as Malaysia have been limited. The aim of our study was to determine factors associated with serum 25(OH)D concentrations such as lifestyle, dietary intake, anthropometry, and body composition in 243 pre-adolescent Malaysian children from low-income families living in Kuala Lumpur. This cross-sectional study measured bone density and body composition using dual-energy X-ray absorptiometry (DXA), while serum 25(OH)D was measured using LC-MS/MS. Time spent outdoors, body surface area exposed to sunlight, dietary intake, and physical activity level were assessed using questionnaires. Multiple linear regression and stepwise analysis were performed to identify significant predictors for serum 25(OH)D. About 69.4% had 25(OH)D < 50 nmol/L, and 18.9% were vitamin-D-deficient with 25(OH)D < 30 nmol/L. Girls had a nine-fold higher prevalence of vitamin D deficiency than boys. Body surface area exposed to sunlight, Sun Index, and fat mass were significant predictors of 25(OH)D concentrations in this population. Modifiable lifestyle factors such as sun exposure and reducing obesity are important public health guidance to ensure optimal vitamin D status in these children.

Vitamin D Status and Its Influence on the Health of Preschool Children in Hangzhou

Objective: Vitamin D deficiency and insufficiency in children are global public health problems. However, few studies have focused on vitamin D status in healthy preschool children, especially in Asia. This study aimed to investigate vitamin D status and host-related factors in healthy preschool children in Hangzhou to analyze the impact of low vitamin D levels (<30 ng/mL) on health outcomes (obesity, early childhood caries, and respiratory tract infections).

Methods: A total of 1,510 healthy children aged 24–72 months from 15 kindergartens in Hangzhou were included. Data on the children's gender, age, body mass index (BMI), caries, and blood samples available for vitamin D analysis were collected from June to August 2018. A total of 325 children aged 36–48 months took part in a survey on the frequency of respiratory tract infections in the last year.

Results: The children's mean 25(OH)D level was 28.01 ± 7.29 ng/mL. A total of 11.4% of the children had vitamin D deficiency, and 52.6% had vitamin D insufficiency. Only 36.0% had vitamin D sufficiency. No significant difference was found by gender or BMI group. However, children in the obesity group had the highest prevalence of vitamin D deficiency and the lowest 25(OH)D levels. A significant negative correlation was found between the 25(OH)D level and child age (r = −0.144, p < 0.001). Regression analysis showed that the children’s 25(OH)D levels decreased by 0.17 ng/mL per month with age. In addition, children with low vitamin D levels might increase the risk of obesity and early childhood caries. Multiple linear regression indicated that the number of caries in children increased by 0.08 per 1-ng/mL decrease in the 25(OH)D level (β = −0.08, p < 0.001).

Conclusion: Vitamin D deficiency/insufficiency is a serious problem among healthy preschool children in Hangzhou. Public health policies or interventions should be implemented to ensure that preschool children have adequate vitamin D to reduce the risk of related diseases.

Association of parental-reported vitamin D supplementation with dental caries of 3-year-old children in Poland: a cross-sectional study

OBJECTIVE

The study aimed to assess the association between parental-reported vitamin D supplementation and caries in a national sample of 3-year-olds in Poland.

MATERIALS AND METHODS

A total of 1900 children, representing all provinces of Poland, were invited. The questionnaires concerned vitamin D supplementation, socio-demographics, and oral health behaviours. Based on dental examination, caries scores (dmft/dmfs), prevalence of early childhood caries (ECC) and severe ECC (S-ECC) were calculated. The Spearman's correlation, linear regression and logistic regression were used to assess the association between various factors and caries (p < 0.05).

RESULTS

A total of 1638 children were tested. Of this number, 99.1% infants were supplemented with vitamin D. Supplementation had been continued seasonally in 55.2% children. ECC/S-ECC prevalence were significantly lower in children receiving vitamin D (ECC 38.3% vs. 44.7%, OR = 0.77; S-ECC 20.5% vs. 27.1%, OR = 0.69; p < 0.05). Mean dmft/dmfs were lower in those with supplementation (1.54 ± 2.72 vs. 2.24 ± 3.55; 2.40 ± 5.56 vs. 3.72 ± 7.56, respectively; p < 0.001). After controlling for confounding factors, supplementation was not significantly associated with caries; only dt/ds were still associated. Maternal education, sweetened beverages before bedtime, bottle use were significantly associated with S-ECC.

CONCLUSIONS

Lower caries prevalence was observed in those with vitamin D supplementation. The association between parental-reported vitamin D and ECC/S-ECC was not significant in Polish children. Decayed teeth and supplementation were still associated. Dietary habits can modify the association with caries.

CLINICAL RELEVANCE

There may be an association between vitamin D supplementation and lower caries in children. Parents should supplement their children during periods of significant growth and development.

The antibacterial effects of vitamin D3 against mutans streptococci: an in vitro study

Purpose:

This study aims to evaluate the antimicrobial effects of the cholecalciferol vitamin D3 against Streptococcus sobrinus (Strep. sobrinus) and Streptococcus mutans (Strep. mutans) bacteria in vitro that is considered the main causative bacteria in dental caries development.

Materials and methods:

The antimicrobial effects of vitamin D3 were evaluated against Strep. sobrinus and Strep mutans using the agar disc diffusion method. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of vitamin D3 were determined using a microdilution method following the guidelines by the Clinical Laboratory Standards Institute (CLSI). Scanning electron microscope (SEM) was used to evaluate the morphological changes of bacterial cells following exposure to vitamin D3.

Results:

Strep. sobrinus was more sensitive to vitamin D3 compared to Strep. mutans bacteria. The MIC values of vitamin D3 against Strep. sobrinus and Strep. mutans were 60 μg/ mL and 250 μg/mL respectively whereas the MBC values were 120 μg/mL and 500 μg/mL, respectively. Moreover, significant changes in the bacterial morphology were observed in treated bacterial cells with vitamin D3 as compared to the untreated control bacteria using SEM.

Conclusion:

These findings suggested that vitamin D3 has excellent antimicrobial effects against Strep. sobrinus and Strep. mutans and may be considered as a promising compound in the prevention of dental caries in the future. Further research is recommended to elucidate the mechanism of vitamin D3 on these bacteria.

Oral manifestations of magnesium and vitamin D inadequacy

Adequate nutrition is essential for maintaining good oral health. Minerals such as magnesium, calcium, and phosphorus found in the diet constitute the main structural components of the tooth. Their inadequacy leads to absorption impairment, increased bleeding tendency, bone resorption, looseness, and premature tooth loss. Inadequacy of those essential minerals is associated with delayed tooth eruption and with enamel or dentin hypoplasia. Taking calcium without magnesium results in soft dental enamel, which cannot resist the acids causing tooth decay. In addition to magnesium, calcium, and phosphorus, adequate vitamin D is needed to maintain optimal oral health. Vitamin D exerts anti-inflammatory effects and helps in calcium absorption and bone remodeling. Moreover, adequate vitamin D status could reduce formation of dental caries by delaying its onset and progression. Here we summarize the oral manifestations of vitamin D and magnesium inadequacy.

The Burden of Early Childhood Caries in Canadian Children and Associated Risk Factors

Introduction: Early childhood caries (ECC) is any caries in the primary dentition occurring in children under the age of six. ECC is common in many population groups in Canada. Objective: The purpose of this review was to describe the burden of ECC in Canada, the prevalence and associated risk factors for ECC, and its impact on childhood health based on the existing published literature. Methods: A review was conducted to assess published Canadian studies on ECC identified through searches of electronic databases. Databased searched included PubMed, Medline, Cinahl, and the library catalog of the University of Manitoba. Known publications on ECC that were not identified by the electronic search were also considered. Only the studies that reported the prevalence of ECC or caries in preschool aged children were considered. In-depth assessments were restricted to those studies that employed logistic regression analysis to investigate relationship between ECC and risk factors or nutritional status and quality of life. Results: A total of 36 studies were identified that related to ECC in Canadian children. Overall, 27 related to prevalence and 12 reported on risk factors, four related to the association between severe ECC and nutritional health and well-being, while only one related to the oral microbiome composition. Published studies reveal that the prevalence of ECC can be as high as 98% in some parts of Canada. Commonly identified risk factors include age, sex, socio-economic status, parental beliefs, family characteristics, debris/plaque, enamel hypoplasia, and behavioral (oral health or feeding behaviors) tendencies. Conclusions: Current literature reveals that many Canadian children are affected by ECC. The development of ECC appears to be strongly associated with social determinants of health including low household income and the level of parental education or employment status. Associations were also observed between ECC and the child's age at first dental visit and parental beliefs about child's oral health. Children with enamel hypoplasia are also at significantly greater odds for experiencing caries. Future research should include assessments of developmental defects of enamel to better understand the association between enamel hypoplasia and ECC.