Stepwise prediction of dental caries in children up to 3.5 years of age

Factors Associated with Pre-Dental Students' Intention and Willingness to Serve in the Underserved Community and Vulnerable Population

A potential solution to the problem of how to increase access to dental care for the underserved and vulnerable populations is to establish an early pipeline of underrepresented and minority college students for a career in dentistry. This study aims to explore factors associated with such pre-dental students' future intentions to serve. A cross-sectional design was utilized with 144 participants completing the questionnaire with four sections, including participants' demographics, experience in access to dental care, psychosocial factors, and intention to serve the underserved and vulnerable populations. Descriptive statistics, chi-squared test, and logistic regression were used for statistical analyses. A positive attitude (OR = 12.03) and higher confidence towards addressing access to dental care issues (OR = 10.43) were found to be the strongest factor for higher intention to serve the underserved and vulnerable populations. Higher knowledge on the prevalence of dental caries among children (OR = 3.18) and participants who experienced difficulty in getting a dental appointment, or finding an available dentist when needed (OR = 3.43), were also associated with higher intention. Identifying key factors associated with higher intention to serve the underserved and vulnerable populations as a future dentist may facilitate workforce recruitment in the Health Profession Shortage Areas (HPSAs).

Development of dental caries and risk factors between 1 and 7 years of age in areas of high risk for dental caries in Stockholm, Sweden

Purpose

To explore caries predictors at age 1 year and caries development at ages 5 and 7 years in two groups of children following different fluoride-based preventive programs.

Methods

We conducted a prospective cluster-randomized controlled intervention trial with two parallel arms comparing two prevention programs: one program included fluoride varnish applications every 6 months, the other did not; otherwise, the programs were the same. Participants were 1- and 3-year-old children enrolled at 23 dental clinics in high-risk areas in Stockholm, Sweden. The baseline examination included structured interviews. Caries data were extracted from dental records. The primary outcome measures were ICDAS 1–6 > 0 at baseline (age 1 year) and defs > 0 at ages 2, 3, 5, and 7 years. The secondary outcome measure at age 7 was DFS > 0.

Results

Continuous caries development occurred: defs > 0 in 23% at 5 years and in 42% at 7 years. We found no difference in caries development between children who had or had not received fluoride varnish as toddlers. At age 1-year, significant predictors for dental caries in later preschool years were immigrant background, family income, and sweets consumption. Fluoride toothpaste > once a day at 1 year had an OR < 1 for defs > 0 at 5- and 7 years.

Conclusions

For toddlers, fluoride varnish does not seem to be an adequate prevention tool. Brushing with fluoride toothpaste from 1 year of age could not arrest caries development. Immigrant background was the strongest predictor. A new toolbox as well as collaborative upstream actions for reducing free-sugar intake are needed.

Early childhood caries risk assessment in 1-year-olds evaluated at 6-years of age

OBJECTIVES

The aim was to identify caries risk factors in 1-year-olds predicting dentine caries in 6-year-olds.

MATERIALS AND METHODS

Caries risk assessment was performed in 804 one-year-olds. Their parents answered a questionnaire, regarding family factors, general health, food habits and oral hygiene. Clinical examinations and caries risk assessments at 1, 3 and 6 years of age were performed. Simple and multiple regression analyses were used for identification of caries-associated factors.

RESULTS

Caries risk was found in 5% of the 1-year-olds, and 12% of the 3-year-olds. Dentine caries was found in 3% of the 3-year-olds and in 16% of the 6-year-olds. Caries risk assessment was associated with caries at 6 years of age (OR = 5.1, p < .001). Multiple logistic regression analysis found the following variables associated with caries at 6 years of age: Caries in sibling (OR = 2.1, p = .012), Beverage other than water (OR = 2.1, p < .001), Night meal (OR = 1.9, p = .002), Presence of mutans streptococci (MS) (OR = 1.6, p = .033) and Male gender (OR = 1.5, p = .053). An overall caries risk assessment was more reliable than any single caries risk factor.

CONCLUSIONS

Caries risk assessment for 1-year-olds in a region with low caries prevalence has limited accuracy to predict dental caries at 6 years of age. Caries risk often changes over time and should be reassessed on a regularly basis. The presence of MS in 1-year-olds did not increase the prognostic accuracy at 6 years of age.

Children's detailed non-water beverage consumption habits and longitudinal early childhood caries experiences

OBJECTIVES

Sugar-sweetened beverages and dental caries are prevalent among children. Measurement choices could explain their inconsistent relationships. This study evaluated associations between detailed baseline non-water beverage consumption (NWBC) behaviors and longitudinal early childhood caries (ECC) experiences in young, high-caries risk children.

METHODS

Researchers followed poor, rural, African Americans, recruited at 8-18 months old from Uniontown, Alabama, through convenience sampling, annually for 5 years (N = 66). Baseline questionnaires obtained demographics, oral hygiene, and daily dietary histories, including beverage types, frequencies, and NWBC behaviors of intake speed (intermittent/rapid), container (bottles/non-bottles), and bedtime beverages (yes/no). Dentists conducted examinations annually to determine decayed, missing, filled (carious) surfaces (dmfs) scores, producing increments (dmfs_final - dmfs_initial ). Age-adjusted logistic regressions estimated odds ratios (OR) and 95% confidence intervals (95% CI) for ECC (carious: incidence >0 versus caries-free: incidence = 0) with NWBC behavior then NWBC frequency, individually and conditional on NWBC behaviors, exposures.

RESULTS

NWBC behaviors were not associated with ECC; juice was significant (OR: 2.0, 95% CI: 1.0, 4.2). Adjusting for intake speed, juice persisted as a risk factor (OR: 2.1, 95% CI: 1.0, 4.3), remaining suggestive after controlling for container or bedtime beverages (OR: 2.0, 95% CI: 0.9, 4.3; OR: 1.9, 95% CI: 0.9, 4.0, respectively). Container could be an effect modifier (OR_bottle : 3.5, 95% CI: 0.8, 16.2 vs. OR_non-bottle : 1.5, 95% CI: 0.6, 3.7). Milk was not associated with ECC.

CONCLUSIONS

Independently, NWBC behaviors are insufficient in evaluating NWBC/ECC relationships; beverage type, frequency, and consumption behaviors, collectively, can better evaluate associations.

Plaque Fluoride Levels as a Predictor of Caries Development in Early Childhood with High Sugar Exposure - A Preliminary Study

Objective

This longitudinal study aimed to investigate if the plaque fluoride (PF) concentration can predict the early childhood caries onset. Design: As part of a larger study, 188 preschoolers were clinically evaluated for early childhood caries diagnosis, at baseline and after 1-year follow-up. After that, the final sample comprised: 1. children who had already caries at baseline (decayed, missing or filled surfaces, as well as white chalky white spot lesions adjacent to gingival margins) and developed at least one more cavitation after one year (n=16), and 2. children who never had or developed any caries lesions, including active white spots lesions (n=15). Before the clinical examinations, dental plaque was collected. PF concentration was determined with an ion-specific electrode. A chart was used to estimate the mean daily sugar exposure. The results were statistically analyzed by Spearman correlation and logistic regression analyses (α=0.05).

Results

After one year, a positive significant correlation between caries development and liquid sucrose, total sugar and total sucrose consumption increments was found (p<0.05). Moreover, the solid sugar, solid sucrose and total sugar exposure at baseline were positively correlated with the presence of dental plaque at follow-up (p<0.05). To top it all, children with PF concentrations ≤0.1 μg/mg at baseline were 10 times more likely to develop caries.

Conclusion

In conclusion, this study demonstrated for the first time in vivo that low PF concentration is a predictor of caries development in primary teeth.

Socioeconomic Determinants, Maternal Health, and Caries in Young Children

Introduction

Maternal health during pregnancy plays a part in child health, and several conditions have been associated with adverse child outcomes.

Objectives

To determine the socioeconomic determinants and maternal health factors associated with dental caries in young children.

Methods

This cross-sectional study is part of a register-based cohort study including all children who were born from 2000 to 2003 and were residing in Stockholm County, Sweden, at age 3 y (n = 73,658). The study followed the cohort until individuals were 7 y old. The final study cohort comprised all children examined at 3 and 7 y (n = 65,259). Data on socioeconomic conditions, maternal health, and maternal health behavior were extracted from Swedish national registries. The multivariate analyses used 2 outcomes: caries experience at age 3 and 7 y (deft > 0 [decayed, extracted, and filled teeth]).

Results

The results of this study show that socioeconomic and maternal health behaviors during pregnancy are important determinants of oral health in their preschool offspring. When all significant risk factors were present, the cumulative probability of being diagnosed with dental caries at age 7 y was 75%.

Conclusion

This study also showed that maternal obesity and smoking during pregnancy were predictors of dental caries in preschool children. Strategies must be developed for increasing maternal motivation and self-efficacy and providing mothers with knowledge and caries-preventive tools.

Knowledge Transfer Statement

The results of this study inform clinicians about the importance of including a more detailed history regarding maternal health and maternal health behaviors during pregnancy to assess caries risk in preschool children. Education, income, and other socioeconomic factors are difficult to modify in the short term. Therefore, strategies must be developed to increase parental motivation and self-efficacy to give parents the determination, knowledge, and tools for prevention.

Influence of the microbiological component of Cariogram® for evaluating the risk of caries in children

OBJECTIVE

To compare the risk for caries in children as determined by Cariogram^® software (CS; Stockholm, Sweden) with and without its microbiological component and by a form based on Cariogram^® (FBC).

METHODS

Children (n = 28) aged 3-9 years were included. Data were collected clinically and from anamnesis. The salivary levels of Streptococcus mutans (SM) were evaluated. A linear regression model was used to determine which variables were predictive for each type of risk analysis. Caries risk was the dependent variable and the independent variables were caries experience, related disease, plaque amount, diet frequency, salivary levels of SM, fluoride sources and clinical judgment. A paired Student t-test was used for the following comparisons: (a) CS with and without SM; (b) CS without SM and FBC; (c) CS with SM and FBC.

RESULTS

The mean dmft/DMFT was 5.56 ± 2.51. There was no difference between the methods (p < .05). Regardless of caries risk, the children presented the same levels of SM (p = .889). Caries experience, plaque amount, diet frequency and fluoride sources were predictors of caries risk in all assessment methods. Clinical judgment was a significant predictor in CS.

CONCLUSIONS

Caries experience, plaque amount, diet frequency and fluoride sources are valuable predictors of caries risk; microbiological tests are not necessary for evaluating caries risk in children, which can be assessed similarly by CS without SM and FBC.

Impact of biannual treatment with fluoride varnish on tooth-surface-level caries progression in children aged 1-3 years

OBJECTIVE

This study describes caries progression at tooth-surface level in children from 1 to 3 years of age and the impact of biannual treatment with fluoride varnish.

METHODS

Children who participated in a cluster-randomized controlled trial and had shown signs of dental caries were included in this study (n=801). International Caries Detection and Assessment System (ICDAS) was used to classify dental caries. The present study compared children receiving a standard yearly intervention to children receiving the same standard preventive intervention supplemented with an application of fluoride varnish every half year.

RESULTS

The maxillary incisors were the first teeth to develop cavitation (ICDAS 3-6) and also mostly affected. Further analyses focusing on maxillary incisors buccal surfaces showed that sound surfaces had least progression and that progression to extensive decay was more common in teeth that had exhibited moderate decay. A summarizing progression index (PI) was calculated for the buccal surfaces of the maxillary incisors. Between 1 and 2 years of age PI was 26% and between 2 and 3 years of age PI was 21%. The progression on buccal incisors and on occlusal first primary molars did not differ between intervention groups (p≤0,05).

CONCLUSION

No impact on caries progression for biannual treatment with fluoride varnish was found.

CLINICAL SIGNIFICANCE

Using fluoride varnish as a complement to standard intervention in toddlers did not add in the prevention of dental caries or its progression. The education of parents in the use fluoride toothpaste as they start brushing the teeth of their children is essential.

Dental Awareness among Parents and Oral Health of Paediatric Cancer Patients Receiving Chemotherapy

INTRODUCTION

Dental care is often overlooked by the parents of children receiving treatment for cancer including chemotherapy who are in a phase of severe immunosuppression.

AIM

(i) To study dental attitudes of parents of children receiving chemotherapy towards importance of dental care. (ii) To evaluate oral hygiene status and compare it with healthy controls.

MATERIALS AND METHODS

A questionnaire assessing the awareness towards dental care was given to the parents of 47 paediatric patients suffering from cancer receiving chemotherapy and to parents of 47 paediatric patients reporting to outpatient Department of Pedodontics at SGT Dental College. Oral examination was also carried out for both the groups and DMFT/dmft, plaque and gingival index were noted.

RESULTS

Parents had a varying opinion regarding dental health of their child. The caries status of children in the control group was greater than children in the study group. The mean plaque index of children in the control group (1.40) was greater than children in the study group (1.34) which was statistically significant according to Mann-Whitney U test. The gingival health of children in the study group was better than children in the control group which was also not statistically significant.

CONCLUSION

This study highlights need for a periodic referral of the child cancer patients to the paediatric dental clinic in hospitals for the timely dental care.

Fatores de risco para a cárie dental em crianças na primeira infância, Salvador - BA

Resumo Objetivos: identificar fatores associados a incidência de cárie na primeira infância. Métodos: realizou-se estudo de coorte prospectivo (14 meses) com 495 crianças de 4 a 30 meses de creches públicas, privadas e filantrópicas em Salvador-BA. Resultados: a média de dentes cariados foi de 0,18 (DP=0,75) no início do estudo e 0,55 (DP=1,40) ao final. A incidência em crianças livres de cárie foi 18,5% e no grupo total 22,6%. Na análise de regressão logística, consideraram-se três modelos. Com todas as crianças (N=495), prevaleceu: experiência prévia de cárie (OR=6,8; IC95%= 3,0-15,1), frequentar creche pública (OR=2,9; IC95%= 1,6-5,3), idade maior 24 meses. No segundo, de creches públicas (N=329): idade, aleitamento durante o sono (OR=1,9; IC95%= 1,1-3,2), mancha branca (OR=3,5; IC95%= 1,1-11,3), casa sem revestimento (OR=2,3; IC95%= 1,2-4,1) e experiência prévia de cárie(OR=3,9; IC95%= 1,5-10,6). No terceiro, com crianças sem cárie no início (N=495): frequentar creche pública, idade, cor da pele negra/ parda (OR=5,5; IC95%= 1,3-23,8) e aleitamento durante o sono após um ano (OR= 1,7; IC95%= 1,0-2,8). Conclusões: a vulnerabilidade social foi um forte fator de risco à cárie em crianças menores de dois anos e é necessária melhoria das condições de vida e ações de promoção de saúde bucal para redução da morbidade.

Migration background is associated with caries in Viennese school children, even if parents have received a higher education

Background

A low level of education and the migration background of parents are associated with the development of caries in children. The aim of this study was to evaluate whether a higher educational level of parents can overcome risks for the development of caries in immigrants in Vienna, Austria.

Methods

The educational level of the parents, the school type, and the caries status of 736 randomly selected twelve-year-old children with and without migration background was determined in this cross sectional study. In children attending school in Vienna the decayed, missing, and filled teeth (DMFT) index was determined. For statistical analysis, a mixed negative-binomial-model was used.

Results

The caries status of the children with migration background was significantly worse compared to that of the native Viennese population. A significant interaction was found between migration background and the educational level of the parents (p = 0.045). No interaction was found between the school type and either the migration background (p = 0.220) or the education level of the parents (p = 0.08). In parents with a higher scholarly education level, migration background (p < 0.01) and school type (p = 0.018) showed an association with DMFT values. In parents with a low education level, however, migration background and school type had no significant association with DMFT values.

Conclusion

These data indicate that children with a migration background are at higher risk to acquire caries than other Viennese children, even when the parents have received a higher education.

Time until first dental caries for young children first seen in Federally Qualified Health Centers: a retrospective cohort study

OBJECTIVES

The study assessed the time until first dental caries for young children seen at five Federally Qualified Health Centers (FQHC) in Iowa and the relationship with the frequency and gaps (in months) of dental episodes, the number of topical fluoride treatments, and the number of dentists caring for the subject.

METHODS

Forty children were randomly selected at each FQHC (n = 200). All children were continuously enrolled in the Medicaid program and had their first dental visit prior to age 6. Dental chart findings, claims data for the child and family, and birth certificate information were merged into one dataset. Dental visits were followed for a minimum of 36 months, including dental visits external to the FQHCs. Using time until first caries as the dependent variable, the data were subject to left, interval, and right censoring and were analyzed via Weibull regression.

RESULTS

Slightly more than half of the 200 children experienced caries. Regression analysis indicated that the hazard of first dental caries increased by approximately 2% with each additional month that transpired between preventive recall examinations. In addition, children with older siblings who had a dental visit at the same center during the previous year prior to the subject's first visit were more likely to have a longer time until first dental caries.

CONCLUSIONS

Timing of dental care episodes was associated with caries experience in young children from low income families. Dental professionals should focus on regularity of dental care to prevent or delay caries experience in young children.

Caries risk assessment. A systematic review

OBJECTIVE

To assess the ability of multivariate models and single factors to correctly identify future caries development in pre-school children and schoolchildren/adolescents.

STUDY DESIGN

A systematic literature search for relevant papers was conducted with pre-determined inclusion criteria. Abstracts and full-text articles were assessed independently by two reviewers. The quality of studies was graded according to the QUADAS tool. The quality of evidence of models and single predictors was assessed using the GRADE approach.

RESULTS

Ninety original articles fulfilled the inclusion criteria. Seven studies had high quality, 35 moderate and the rest poor quality. The accuracy of multivariate models was higher for pre-school children than for schoolchildren/adolescents. However, the models had seldom been validated in independent populations, making their accuracy uncertain. Of the single predictors, baseline caries experience had moderate/good accuracy in pre-school children and limited accuracy in schoolchildren/adolescents. The period of highest risk for caries incidence in permanent teeth was the first few years after tooth eruption. In general, the quality of evidence was limited.

CONCLUSIONS

Multivariate models and baseline caries prevalence performed better in pre-school children than in schoolchildren/adolescents. Baseline caries prevalence was the most accurate single predictor in all age groups. The heterogeneity of populations, models, outcome criteria, measures and reporting hampered the synthesis of results. There is a great need to standardize study design, outcome measures and reporting of data in studies on caries risk assessment. The accuracy of prediction models should be validated in at least one independent population.

Survival of primary molar restorations in four birth cohorts-A retrospective, practice-based study

OBJECTIVE

Paediatric restorative dentistry continues being a challenge in everyday clinical practice. Practise-based survival analysis covering entire age cohorts offer an epidemiological approach to this issue in studying survival of restorations in primary teeth. The aim of this study was to compare survival of restorations in primary molars in 1985, 1990, 1995 and 2000 age cohorts associated with some population-related factors.

MATERIAL AND METHODS

Data from dental records of the entire cohorts were obtained from the Health Centre of Kemi, Finland covering the period 1989-2009. The longevity of the restorations was illustrated using the Kaplan-Meier survival curves and tested with log-rank test and Cox proportional hazards regression analysis. The retrospective caries risk definition for individuals was based on the early restorations in the first permanent molars.

RESULTS

Total number of the placed restorations was 2755. Survival of the restorations was the shortest in the 1995 cohort and the longest in the 1985 cohort (p < 0.001). The greatest deterioration was between the cohorts in 1990 and 1995. Survival was also shorter for the children at high risk for caries compared with the low risk children (p < 0.001).

CONCLUSIONS

Survival of the restorations shortened distinctly towards the younger cohorts and was also shorter for the high risk compared with the low risk children. Due to the variety of materials in paediatric dentistry, handling them carefully according to manufacturers' instructions must be emphasized to avoid failures of restorations due to technical reasons. Also, non-invasive treatment must always be given together with invasive treatment.

Population groups in dietary transition

Background

Little is known about the effects of dietary acculturation in minority groups in the Nordic countries, including immigrants from non-Western societies.

Methods

A search was performed in Medlin33e/PubMed and SweMed+ for articles published in 1990–2011.

Results

A total of 840 articles were identified, with a final 32 articles used to tabulate results which were included in the primary analysis. High rates of vitamin D deficiency (23 articles) were found in immigrants of non-Western origin; deficiency rates were very high among both pregnant and non-pregnant women, and also among children, with young children of immigrant parents showing 50 times higher risk for rickets when compared to children of indigenous parents. The risk of iron deficiency (two articles) was high among immigrant women, while the results were inconclusive regarding children. High rates of dental caries (seven articles) were found among pre-school and younger school children of immigrant origin, while the risk of caries was not as evident among older children. In a secondary analysis, including 48 articles (results not tabulated), overweight and obesity (14 articles) were seen in many immigrant groups, resulting in a high prevalence of diabetes (2 review articles from a total of 14 original articles) and incidence of coronary heart disease (CHD; seven articles). For hypertension (three articles), dyslipidemia (four articles), and dietary patterns among immigrants (10 articles), the results were contradictory.

Conclusions

Risk of vitamin D deficiency is alarmingly high in the Nordic countries among immigrants of non-Western origin, especially among women. Dental caries is high among immigrant children aged 0–7 years due to a higher intake of sugary products. Overweight and obesity, associated with a higher risk of diabetes and CHD, are prevalent in many immigrant groups and need further attention.

Food expenditures, cariogenic dietary practices and childhood dental caries in southern Brazil

Family expenditures on food for children may represent an important barrier to the adoption of healthy feeding practices in populations of low socioeconomic status. The aim of this study was to explore the relationship between cariogenic feeding practices, expenditures on food for children and dental caries. This cross-sectional study included 329 four-year-old children from São Leopoldo in southern Brazil. Cariogenic dietary practices were assessed at 4 years of age using two 24-hour recalls conducted with the children's mothers. Expenditures on food for children were estimated based on all reported food items and the respective amounts ingested. Early childhood caries and severe early childhood caries were assessed by clinical examination at 4 years of age. Cariogenic dietary habits were not associated with lower food expenditures. On the contrary, in multivariable regression analysis, the intake of chocolate (p = 0.007), soft drinks (p = 0.027) and a higher number of meals and snacks per day (p < 0.001) was associated with greater expenditures on food for children. No statistically significant differences were observed in food expenditures or in the proportion of household income spent on feeding children between caries-free children, those with early childhood caries and those with severe early childhood caries. In conclusion, keeping children free of dental caries does not necessarily increase food expenditures or the proportion of household income spent on feeding children in low-socioeconomic status populations. Some cariogenic dietary practices were associated with greater expenditures on child feeding.

Influence of a low xylitol-dose on mutans streptococci colonisation and caries development in preschool children

AIM

To evaluate the effect of xylitol-containing tablets on mutans streptococci colonisation and caries development in preschool children.

STUDY DESIGN

Randomised single-blind prospective design.

METHODS

The material consisted of 132 healthy 2-year-old children, 71 boys and 61 girls and they were assigned to a xylitol tablet (test) group or a non-intervention control group. The mean age was 2 years + 1 month in both groups. The drop-out rate was 10.6% during the 2-year trial. The test group was given 1-2 xylitol tablets (0.5-1g) per day during 1.5 years. Mutans streptococci (MS) enumeration was performed at baseline and semi-annually in the children and at baseline or shortly after in the mothers with a chair-side technique. Caries prevalence was scored at baseline and the age of 4 years.

RESULTS

No statistically significant differences in MS colonisation were disclosed between the test and control groups at baseline or any of the designated follow-ups. A statistically significant positive relationship was found between the maternal salivary MS levels and the colonisation of the children in the control group at 2.5 years, 3 years and 3.5 years (r=0.39, r=0.35; r=0.30; p<0.01, p<0.01 and p<0.05) but not in the xylitol tablet group (p<0.05). The mean caries prevalence was lower in the test group compared with the control group at 4 years of age (dmfs 0.38 +/-1.05 vs. 0.80 +/-2.60) but the difference was not statistically significant.

CONCLUSION

The findings do not support a low-dose xylitol tablet program for caries prevention in preschool children.

Caries prevalence in Danish pre-school children delivered vaginally and by caesarean section

OBJECTIVE

The mode of delivery may significantly influence the diversity and composition of the oral microflora and facilitate early acquisition of mutans streptococci. The aim was to compare caries prevalence and experience in 3-year-old children delivered vaginally and by caesarean section (C-section).

MATERIALS AND METHODS

The study had an observational cohort protocol based on extracted information from governmental databases and nationwide registers concerning birth, social and educational levels and dental status. Children born at the Copenhagen University Hospital in 2005 were eligible and the final study group with complete information consisted of 594 children, 443 delivered vaginally and 151 by C-section.

RESULTS

The total caries prevalence was 8% and no significant difference was displayed between the groups. When only the children with caries (dmfs > 0) were compared, those delivered by C-section had a higher mean value in comparison with those delivered vaginally (dmfs 6.8 vs 3.2), but the difference was not statistically significant. There was a significant relationship between caries prevalence and low family income in the total study group (OR = 5.8, p < 0.05).

CONCLUSIONS

Within the limitations of this observational cohort study, caries prevalence in 3-year-old children was not related to the mode of delivery. However, the tendency of more severe caries in the C-section group justifies further studies, preferably with a prospective design.

Mother and youth access (MAYA) maternal chlorhexidine, counselling and paediatric fluoride varnish randomized clinical trial to prevent early childhood caries

BACKGROUND

Mexican-American children have a higher caries prevalence than the U.S. average. The Mothers and Youth Access (MAYA) study was a randomized clinical trial initiated to address this problem.

AIM

Comparison of the efficacy of two prevention interventions in reducing early childhood caries (ECC).

DESIGN

All 361 randomized mother-child dyads received oral health counselling. Beginning at 4 months postpartum, intervention mothers received chlorhexidine (CHX) mouthrinse for 3 months beginning 4 months postpartum and children received fluoride varnish (FV) every 6 months from age 12-36 months. Control group children received FV if precavitated lesions developed. Salivary mutans streptococci (MS) and lactobacilli were assessed.

RESULTS

No significant difference in children's 36-month caries incidence between groups; 34% in each group developed caries [(d(2+) fs) > 0]. About half of control group developed precavitated lesions and received therapeutic FV. Maternal MS levels declined during CHX use, but increased when discontinued.

CONCLUSIONS

Maternal postpartum CHX regimen, oral health counselling and preventive child FV applications were not more efficacious than maternal counselling with child therapeutic FV for precavitated lesions for ECC prevention. FV for young children with brief maternal CHX use and oral health counselling may need to be combined with additional or longer-term therapies to significantly reduce ECC in high-risk populations.

The influence of social status on pre-school children's eating habits, caries experience and caries prevention behavior

OBJECTIVES

To assess the prevalence of Early Childhood Caries (ECC) in a county in Northern Hesse and to correlate this parameter to various independent variables. Additionally to investigate the relationship between preventive measures and the socioeconomic status (SES).

METHODS

In spring 2006, 1,082 preschool children were examined. According to WHO-criteria d(3+4)mft scores were recorded. Information about eating habits and preventive measures were collected by structured questionnaires. To compare the mean caries scores and preventive measures of various subgroups, non-parametric tests were performed. Variables associated with caries were included in a binary stepwise backward logistic regression analysis.

RESULTS

The mean d(3+4)mft score amounted to 1.88. Children with high SES had significantly less caries than children with low SES. Significant positive and negative associations of feeding practices and preventive measures to d(3+4)mft scores were observed. Differences between feeding practices and preventive measures were dependent on SES.

CONCLUSIONS

Long-term use of baby bottles at night is the most important factor of ECC. Differences in feeding practices and preventive measures in the various SES groups are evident but not that significant as supposed.

Risk factors for early childhood caries in disadvantaged populations

Early childhood caries is a significant international public health problem. The aim of this paper was to review the current evidence of the risk factors for dental caries in disadvantaged children under 6 years of age. Medline, Cochrane, and PubMed database searches were conducted. Systematic reviews were used where available, or meta-analyses; randomized, controlled trials; and cohort, case-control, and cross-sectional studies (in that order). Studies were restricted to those published in English from 1990 to October 2010. Early childhood caries has a complex etiology with biological, behavioral, and sociodemographic influences. Evidence suggests that young children are most likely to develop caries if Streptococcus mutans is acquired at an early age, although this is influenced by other factors, such as oral hygiene, fluoride, diet, dental visit patterns, socioeconomic status, ethnicity, and health literacy. Etiological pathways should be taken into consideration when designing interventions to prevent dental caries in disadvantaged preschool children.

Consumo de dentifrício e fatores associados em um grupo populacional brasileiro

Este estudo transversal avaliou o consumo de dentifrício fluoretado e fatores associados em Passo Fundo, Rio Grande do Sul, Brasil. Seiscentos e oitenta e oito domicílios foram selecionados. Um questionário estruturado foi respondido pela mãe para obter dados demográficos, hábitos e consumo de dentifrício. O consumo foi avaliado por intermédio da duração de um tubo de dentifrício e considerado baixo (duração > 1 mês) e alto (duração < 1 mês). Modelos de regressão logística avaliaram a associação do consumo com variáveis independentes. Foi observado que 61,2% dos domicílios apresentaram alto consumo de dentifrício. No modelo multivariado, idade da mãe > 50 anos (OR = 1.62; IC95% 1,02-2,61), frequência de escovação da mãe (OR = 2,53; IC95%: 1,53-4,16), número de moradores que utilizam escova (OR = 5,69; IC95%: 3,68-8,81) e motivo cosmético para escolha do dentifrício (OR = 1,64; IC95%:1,03-2,61) representaram maior chance de alto consumo de dentifrício. Conclui-se que a maioria dos domicílios apresenta consumo elevado de dentifrício, associado com idade e frequência de escovação da mãe, número de moradores e motivos de escolha.

Identification of caries risk factors in toddlers

The purpose of this study was to identify risk factors to predict caries progression in toddlers in primary-healthcare settings for the cost-effective targeting of preventive and referral strategies. We examined 329 children (26 ± 6 mos old) twice, one year apart, in Indiana, USA. A 107-item structured interview was used to collect information from the primary caregiver and child on factors/beliefs/perceptions/behaviors that could affect caries development, transmission of bacteria, medical-dental health, and access to care. Bacterial levels, gingivitis, dental plaque, and caries experience were assessed. Multiple-variable logistic regression models of caries progression toward cavitation included family caries experience, transmission-related behaviors, dietary factors, health beliefs, and lower income, but differed in selected predictors/predictive power by race/ethnicity. Addition of clinical variables did not significantly improve the prediction.

Family characteristics and caries experience in preschool children. A longitudinal study from pregnancy to 5 years of age

OBJECTIVE

The purpose of the study was to explore associations between family status, family income, family size, mother's age at child birth, mother's education and parents' national background and caries experience in 5-year-old children.

METHOD

This study is based on data from the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health and the Public Dental Services. A total of 1348 children were followed from pregnancy to the age of 5 years. Questionnaires were completed by mothers twice during pregnancy and when the children were 3 and 5 years of age. Clinical and radiographic examination of the children was performed at the age of 5 years.

RESULTS

Caries experience in the 5-year-old children was low; 89% had no caries experience (d(3-5) mft = 0). In multiple logistic regression having one or both parents of non-western origin (OR 3.4, CI 1.6-7.3), having had a change in family status from pregnancy to 5 years of age (OR 2.0, CI 1.1-3.4) and having mother with low education (OR 1.9, CI 1.3-2.8) were statistically significant risk indicators for having caries experience at the age of five.

CONCLUSION

Family characteristics in pregnancy and early life were associated with caries experience in 5-year-old children. Primary care personnel meeting young children with one or several of these characteristics should consider referring the child to dental personnel to enable early initiation of health-promoting activities.

Migration background: a risk factor for caries development during adolescence

The influence of child and parental migration background on the risk of approximal caries increment in Swedish adolescents was investigated. This retrospective longitudinal register-based cohort study included all 13-yr-old adolescents (n = 18,142) who were resident in the County of Stockholm, Sweden, in 2000, and followed them up to 19 yr of age. At follow-up, 15,538 subjects were examined. Caries data [decayed, missing, and filled teeth/surfaces (DMFT/S)], were collected from a dental database. Socio-demographic determinants were collected from Swedish National Registers. After adjustments for socio-demographic confounders, logistic regression analysis revealed that adolescents with foreign-born parents, irrespective of whether the child was born in Sweden or abroad, exhibited a significantly elevated risk for approximal caries increment (DMFSa > 0), and developed, on average, 0.53 and 1.14 more approximal caries lesions, respectively, compared with their counterparts with Swedish-born parents. Furthermore, adolescents born in eastern Europe exhibited an increased risk for approximal caries increment (DMFSa > 0) and developed, on average, 1.06 more approximal caries lesions compared with Swedish-born adolescents. In conclusion, parental migration background must be considered as a risk factor for caries development during adolescence, irrespective of whether or not the adolescent was born in Sweden.

Sociodemographic variation of caries risk factors in toddlers and caregivers

Objectives. Dental caries is the most common chronic childhood disease, with numerous identified risk factors. Risk factor differences could indicate the need to target caregiver/patient education/preventive care intervention strategies based on population and/or individual characteristics. The purpose of this study was to evaluate caries risk factors differences by race/ethnicity, income, and education. Methods. We enrolled 396 caregiver-toddler pairs and administered a 105-item questionnaire addressing demographics, access to care, oral bacteria transmission, caregiver's/toddler's dental and medical health practices, caregiver's dental beliefs, and caregiver's/toddler's snacking/drinking habits. Logistic regressions and ANOVAs were used to evaluate the associations of questionnaire responses with caregiver's race/ethnicity, income, and education. Results. Caregivers self-identified as Non-Hispanic African-American (44%), Non-Hispanic White (36%), Hispanic (19%), and "other" (1%). Differences related to race/ethnicity, income, and education were found in all risk factor categories. Conclusions. Planning of caregiver/patient education/preventive care intervention strategies should be undertaken with these caries risk factor differences kept in mind.

Diet and caries-associated bacteria in severe early childhood caries

Frequent consumption of cariogenic foods and bacterial infection are risk factors for early childhood caries (ECC). This study hypothesized that a short diet survey focused on frequency of foods, categorized by putative cariogenicity, would differentiate severe ECC (S-ECC) from caries-free children. Children's diets were obtained by survey and plaque bacteria detected by PCR from 72 S-ECC and 38 caries-free children. S-ECC children had higher scores for between-meal juice (p < 0.01), solid-retentive foods (p < 0.001), eating frequency (p < 0.005), and estimated food cariogenicity (p < 0.0001) than caries-free children. S-ECC children with lesion recurrence ate fewer putative caries-protective foods than children without new lesions. Streptococcus mutans (p < 0.005), Streptococcus sobrinus (p < 0.005), and Bifidobacteria (p < 0.0001) were associated with S-ECC, and S. mutans with S. sobrinus was associated with lesion recurrence (p < 0.05). S. mutans-positive children had higher food cariogenicity scores. Food frequency, putative cariogenicity, and S. mutans were associated with S-ECC individually and in combination.

Update on early childhood caries since the Surgeon General's Report

The 2000 Surgeon General's Report on Oral Health included a limited discussion of the condition known as early childhood caries. Because of its high prevalence, its impact on young children's quality of life and potential for increasing their risk of caries in the permanent dentition, early childhood caries is arguably one of the most serious and costly health conditions among young children. A necessary first step in preventing dental caries in preschool children is understanding and evaluating the child's caries risk factors. Previous caries experience and white spot lesions should automatically classify a preschool child as high risk for caries. Microbial factors, such as presence of visible plaque and tests that identify a child as having high levels of mutans streptococci, also predict caries in young children. Frequency of sugar consumption, enamel developmental defects, social factors such as socioeconomic status, psychosocial factors, and being an ethnic minority also have shown to be relevant in determining caries risk. On the basis of this knowledge of specific risk factors for an individual, different preventive strategies and different intensities of preventive therapies can be implemented. Caries preventive strategies in preschool children include fluoride therapy, such as supervised tooth brushing with a fluoridated dentifrice, systemic fluoride supplement to children who live in a nonfluoridated area and who are at risk for caries, and professional topical fluoride with fluoride varnish. There is emerging evidence that intensive patient counseling or motivational interviews with parents to change specific behaviors may reduce caries prevalence in their children. Findings regarding antimicrobial interventions, efforts to modify diets, and traditional dental health education are less consistent.

Dental caries in 3-year-old children is associated more with child-rearing behaviors than mother-related health behaviors

OBJECTIVE

We assessed whether child- or mother-related health behaviors were associated more strongly with dental caries in 3-year-old children.

METHODS

Multiple logistic regression analyses were performed on dental caries' presence as the dependent variable with independent variables from the results of examination and a self-administered questionnaire of 396 mother-child pairs.

RESULT

Dental caries of 3-year-old children was more strongly associated with child-related health behavior than mother-related health behavior. Of the child-related variables, "a habit of feeding in bed" [OR (odds ratio) 10.14; 95 percent class interval (CI) 1.80-56.97], "eating between meals three times a day or more" (OR 3.33; 95 percent CI 1.56-7.10), "consuming a sports drink three times a week or more" (OR 4.47; 95 percent CI 1.60-12.49), "having both home and professional preventive dental care" (OR 3.02; 95 percent CI 1.44-6.32), and "having professional preventive dental care" (OR 3.79; 95 percent CI 1.75-8.21) were significantly associated with dental caries in children. Of the mother-related variables, "brushing teeth once a day or less" (OR 2.72; 95 percent CI 1.19-6.20) and "drinking alcohol three times a week or more" (OR 0.38; 95 percent CI 0.16-0.93) had significant effects.

CONCLUSION

Dental caries of 3-year-old children was more strongly associated with child-related health behavior than mother-related health behavior. The results of this study suggest that encouraging good child-rearing behavior among mothers could result in better dental health among their children regardless of the mother's dental health status.

Roles of parents in preventing dental caries in the primary dentition among preschool children in Thailand

This study aimed to identify important roles of parents in preventing caries in primary dentition among preschool children in Thailand. A total of 664 preschool children aged 3 to 4 years and their parents were sampled from representative provinces of the 5 regions of Thailand. Dental examination to assess dental caries in preschool children was conducted. Questionnaires investigating roles of parents in caring for their children's teeth were used to interview parents. Preschool children were more likely to have at least 1 carious tooth if parents did not always clean their teeth every time they bathed them, did not always examine the cleanliness of children's teeth regularly, and always allowed children to consume snacks more than 3 times a day. Thai parents must be motivated to consistently spend the time required to take care of the primary dentition of their children by regular cleaning and controlling the snacking behavior of children.

Knowledge and attitude of parents or caretakers regarding transmissibility of caries disease

Dental caries is a transmissible infectious disease in which mutans streptococci are generally considered to be the main etiological agents. Although the transmissibility of dental caries is relatively well established in the literature, little is known whether information regarding this issue is correctly provided to the population. The present study aimed at evaluating, by means of a questionnaire, the knowledge and usual attitude of 640 parents and caretakers regarding the transmissibility of caries disease. Most interviewed adults did not know the concept of dental caries being an infectious and transmissible disease, and reported the habit of blowing and tasting food, sharing utensils and kissing the children on their mouth. 372 (58.1%) adults reported that their children had already been seen by a dentist, 264 (41.3%) answered that their children had never gone to a dentist, and 4 (0.6%) did not know. When the adults were asked whether their children had already had dental caries, 107 (16.7%) answered yes, 489 (76.4%) answered no, and 44 (6.9%) did not know. Taken together, these data reinforce the need to provide the population with some important information regarding the transmission of dental caries in order to facilitate a more comprehensive approach towards the prevention of the disease.

Strategies for caries risk assessment in children and adolescents at public dental clinics in a Swedish county

BACKGROUND

Since caries prevalence has decreased and become polarized, high-risk preventive strategies have been widely adopted. The underlying factors leading to assessment and management of caries risk are poorly understood.

AIM

The aim of this study was to identify the factors forming the basis for dentist's caries risk assessment in dental care for children and adolescents.

DESIGN

From all 3372 children in a Swedish county identified as at high risk for developing caries, a sample of dental records from 432 children, aged 3-19 years, were randomly selected to be analysed in the study. Information about medical and social history, dental status, dietary habits, oral hygiene, and salivary data was obtained from the records.

RESULTS

The results show that the only data registered in the majority of the dental records were dental status from the clinical examination and bitewing radiographs. In approximately half of the dental records, medical history and data concerning oral hygiene were registered. Dental history and dietary habits were noted in approximately 25% of the dental records, whereas other risk factors/indicators were occasionally registered.

CONCLUSIONS

Dentists mainly base their caries risk assessments on past caries experience, a reliable risk indicator for assessing the risk of being affected by caries again. In children with no experience of caries, knowledge of other risk factors/indicators needs to be available to perform a caries risk assessment. In this study, documentation of such knowledge was strongly limited.

Case definition, aetiology and risk assessment of early childhood caries (ECC): a revisited review

AIM

To provide a review of the existing literature on early childhood caries (ECC) with particular reference on the nomenclature, case definition, epidemiology, etiology and risk assessment.

METHODS

An electronic search was used to identify and critically review papers that have been published and are pertinent to the above issues, evaluate and compile the reported evidence.

RESULTS

The term ECC has been adopted to more accurately describe dental caries that affects primary dentitions, replacing previously used terminology that associated the disease with the nursing habit. Suggested ECC case definition uses caries patterns as defining criteria, however, further refinement to include different clinical expressions of a varying severity is necessary. Significant percentages of preschool child populations are affected by ECC today, with the disease concentrating disproportionately in deprived families. Early colonization by mutans streptococci (MS) is associated with increased ECC development, with bacteria being transmitted in both vertical and horizontal ways. Dietary factors related to sugar consumption predispose to early MS colonization and establishment and increase the risk for ECC development, being part of the causal chain. Inappropriate bottle and breast-feeding behaviors also increase the risk, without showing a direct causal relationship. High risk children belong to ethnic minority groups and to low income families with poor parental behaviors and attitudes.

CONCLUSIONS

Further high-quality studies are needed to explore the role bacteria other than MS may play in caries initiation and progression, elucidate the interaction of the saliva immune defence system with a potentially defective tooth, and investigate the effect distant behavioral factors have on the causal chain that leads to ECC development.

Dental health indices of long-term childhood cancer survivors who had oral supervision during treatment: a case-control study

The aim of this case-control study was to compare the dental health of a group of long-term survivors of childhood cancer with that of age- and gender-matched healthy controls. All children who had been progress- and/or disease-free for at least 5 years were selected. Caries indices for permanent dentition (DMF/T) and primary dentition (dmf/t) were calculated. Past data were collected from medical and dental records and read separately by one of the authors. The mean age of the subjects at the initial diagnosis of the disease was 4.3 +/- 0.3 yr (range 0.5-14 yr). The mean time lapse from the cessation of the therapy to the present dental examination was 5.0 +/- 0.7 yr. The study group had significantly (p < .001) more carious lesions in their primary teeth than the control group. The mean dmf/t value was 5.8 +/- 0.6 in the long-term survivors compared to 3.4 +/- 0.2 in the controls. The difference in DMF/T value of those children was statistically insignificant (p > .05) compared to healthy subjects (2.1 +/- 0.6 and 1.6 +/- 0.2, respectively). There was a significant positive correlation between the presence of head and neck radiotherapy (r = 0.427, p < .05), the number of months the child had been on chemotherapy (r = 0.413, p < .01), the number of fluoride gel treatments (r = .361, p < .05), and dmf/t values, separately. Based on the results of this study, our Unit now considers a through semiannual dental examination for every child who will be or has been treated at Pediatric Oncology Department to be mandatory. The focus should be on caries prevention and include dietary counseling, oral hygiene, and fluoride applications if necessary.

Oral health in preschool children with asthma

OBJECTIVE

The aim of this study was to investigate oral health and its determinants in 3-year-old and 6-year-old children with asthma.

METHODS AND SUBJECTS

Caries and gingivitis were examined in 127 asthmatic (all children with asthma in a selected area and born during a specific time period) and 117 matched, healthy control children. The parents were interviewed regarding various oral-health-related factors.

RESULTS

The mean dfs (+/- standard deviation) in the 3-year-old with asthma was 1.4 +/- 3.2 compared with 0.5 +/- 1.2 in the controls (P < 0.05). The corresponding figures for the 6-year-old were 2.5 +/- 3.9 and 1.8 +/- 2.8. The 3-year-old asthmatic children had more gingival bleeding than the healthy controls (P < 0.05). There were no significant differences in gingivitis in the 6-year-old children. Asthmatic children reported higher consumption of sugar-containing drinks and were more frequently mouthbreathers than healthy children (P < 0.05). In 3-year-old children with asthma and immigrant background, the mean dfs was higher compared with immigrant children in the control group (P < 0.01).

CONCLUSION

The results indicate that preschool children with asthma have higher caries prevalence than healthy children. The factors discriminating for caries in asthmatic children are higher intake of sugary drinks, mouth breathing, and immigrant background.

Factores salivales asociados a prevalencia e incremento de caries dental en escolares rurales

OBJETIVO: Evaluar la asociación de la saliva y la prevalencia de caries. MÉTODOS: Estudio longitudinal de dos años, en una población de niños escolares rural de Cruz del Eje, Córdoba-Argentina, entre los años 2000 y 2002. La población de estudio comprendió la totalidad de escolares asistentes (N=196) a ocho escuelas rurales de 5 a 14 años de edad, ambos sexos. Se estudiaron tres momentos (N=46): base, 12 y 24 meses. Se evaluaron los componentes salivales y los índices CPOD y ceod. Se crearon las variables nominales, "caries" y "caries nueva" para evaluar riesgo de caries en el estudio base y en los tiempos 12 y 24 meses, respectivamente. Se aplicó el análisis de componentes principales para seleccionar factores salivales relacionados con la presencia de caries que a posterior se categorizaron según valor de la mediana como punto de corte. RESULTADOS: Se observó alta prevalencia de caries (50%-90%) en los tres momentos de estudio. El incremento de caries fue significativamente mayor a los 12 meses (p=0.000), comparado con el observado a los 24 meses. En el estudio base se observó concentración baja y homogénea de los iones fosfato y calcio, y asociación significativa (p<0.050) entre calcio y fósforo y relación Ca/P con la presencia de caries. CONCLUSIONES: Las concentraciones de iones fosfato y de la relación molar calcio/fósforo podrían ser considerados como factores de riesgo para el desarrollo de caries en poblaciones con características particulares como la estudiada.

Oral hygiene and parent-related factors during early childhood in relation to approximal caries at 15 years of age

The aim was to investigate whether oral hygiene habits and parent-related factors, recorded in early childhood, have a predictive value in relation to approximal caries experience (including initial caries lesions) at the age of 15 years (n = 568). Data were selected from examinations, interviews and questionnaires at 1 and 3 years and bitewing radiographs at 15 years. Four levels of cut-off points for the statistical analysis were used: DFa = 0, > 0, > or = 4 and > or = 8. In the final logistic regression analyses, mother's self-estimation of her oral health care being less good remained statistically significant and predicted a caries experience of DFa > 0 at 15 years. The following four variables predicted DFa > or = 4: (1) female gender, (2) plaque on maxillary incisors at 1 year, (3) mother's self-estimation of her oral health care being less good and (4) father being less satisfied with his social situation. Two variables predicted DFa > or = 8: (1) toothbrushing with fluoride toothpaste just once a day, and (2) father being less satisfied with his social situation. Furthermore, children who failed to attend the examination at 1 year of age had 6.95 +/- 5.36 (mean +/- SD) DFa at 15 years compared with 3.10 +/- 3.85 for children who were examined at 1 year of age (p < 0.01). To conclude, factors explaining good dental health at 15 years of age pertained to both children and parents. Thus, it seems that good oral hygiene habits, established in early childhood, provide a foundation for a low experience of approximal caries in adolescents.

Similarity of bacterial populations in saliva from African-American mother-child dyads

Using PCR-based denaturing gradient gel electrophoresis analyses of oral bacterial samples in 20 mother-child dyads, this study demonstrated a high degree of similarity of bacterial compositions between the mothers and their children; the two may share as much as 94% of their oral bacterial spectra, including cariogenic species.

Influences on children's oral health: a conceptual model

OBJECTIVES

Despite marked improvements over the past century, oral health in America is a significant problem: caries is the most common chronic disease of childhood. Much oral health research examines influences primarily in the oral cavity or focuses on a limited number of individual-level factors. The purpose of this article was to present a more encompassing conceptual model of the influences on children's oral health.

METHODS

The conceptual model presented here was derived from the population health and social epidemiology fields, which have moved toward multilevel, holistic approaches to analyze the complex and interactive causes of children's health problems. It is based on a comprehensive review of major population and oral health literatures.

RESULTS

A multilevel conceptual model is described, with the individual, family, and community levels of influence on oral health outcomes. This model incorporates the 5 key domains of determinants of health as identified in the population health literature: genetic and biological factors, the social environment, the physical environment, health behaviors, and dental and medical care. The model recognizes the presence of a complex interplay of causal factors. Last, the model incorporates the aspect of time, recognizing the evolution of oral health diseases (eg, caries) and influences on the child-host over time.

CONCLUSIONS

This conceptual model represents a starting point for thinking about children's oral health. The model incorporates many of the important breakthroughs by social epidemiologists over the past 25 years by including a broad range of genetic, social, and environmental risk factors; multiple pathways by which they operate; a time dimension; the notion of differential susceptibility and resilience; and a multilevel approach. The study of children's oral health from a global perspective remains largely in its infancy and is poised for additional development. This work can help inform how best to approach and improve children's oral health.

Dental health and oral mutans streptococci in 2-4-year-old Estonian children

OBJECTIVE

The aim of this study was to assess the dental health and presence of mutans streptococci (MS) in 2-4-year-old Estonian children.

METHODS

The dental health of 472 2-4-year-old children was examined using a mirror and a penlight in 14 daycare centres representing seven communities around Estonia. The mean (+/-SD) age of the children was 41.4+/-4.1 months (n=222). Plaque samples of 222 children were employed to determine the presence of MS using the Dentocult SM Strip mutans test.

RESULTS

Caries was diagnosed in 42% of the children, and the average (+/-SD) dmft index was 1.6+/-2.5, ranging from 1.1+/-1.2 in Tartu to 2.4+/-3.1 in Võru. The proportion of caries-free children decreased from 82% in the younger to 63% in the older group (P=0.001). Among the tested subjects, 58% were colonized with MS, and those with caries were colonized more often than children with no visible caries (80% and 51%, respectively; P=0.001).

CONCLUSIONS

The prevalence of dental caries in Estonian 2-4-year-olds is higher than in the Nordic countries, but similar to other Baltic nations. Colonization by MS was associated with dental caries.

Longitudinal study of dental caries in Brazilian children aged from 12 to 30 months

OBJECTIVE

The purpose of the present study was to investigate caries in a sample of young children in Brazil.

METHODS

A prospective longitudinal study of dental caries was carried out on a sample of 186 children aged from 12 to 30 months in Feira de Santana, Bahia, where the water supply is optimally fluoridated. The sample was composed of children accompanied by their mother or guardian and was part of a public health child care programme. After 11 months, all the mothers or guardians and children who took part in the initial examination were contacted, of whom 85.7% attended follow-up. Oral examinations for the detection of dental caries, visible plaque (VP) and white spots (WS) were performed at the beginning of the study and after one year. The statistical analysis consisted of frequency distributions, means and standard deviations, bivariate analysis, and calculation of relative risk, adopting confidence intervals of 95%.

RESULTS

The prevalence of dental caries at the initial examination was 6.4%, rising approximately threefold by 12 months. When the presence of WS also took the form of dental caries, the prevalence of the disease almost doubled. A statistically significant difference was seen between the decayed, missing and filled primary teeth (dmft) found at the initial examination and that at the end of the study. In addition, there was an increase in the dmft index during the course of the study, both for the children who presented with WS and VP, and for those without these conditions.

CONCLUSIONS

A low prevalence of dental caries was observed among the children studied at the initial examination, but around 20% of these children presented with new disease during the period of the study. Amongst children with lesions at the start, the presence of caries almost doubled between examinations.

A seven-year survival analysis of caries onset in primary second molars and permanent first molars in different caries risk groups determined at age two years

OBJECTIVE

To investigate in a group of children (n=183) the effect of possible risk factors registered at the age of 2 years on caries development in 7 years of follow-up, and to study associations between risk groups.

MATERIAL AND METHODS

Consumption of candies, use of a nursing bottle at night, use of fluorides, toothbrushing, pacifier sucking, and prolonged breastfeeding (>or=12 months) were recorded at the age of 2 years. The timing of caries onset in different groups was compared by applying a survival analysis method--the survival curves produced separately for selected teeth in different risk groups.

RESULTS

The survival curves of caries onset for both primary and permanent molars were consistently lower for children who consumed candies more than once a week, did not brush their teeth daily, were given a nursing bottle at night or a pacifier at age 2 years. The multivariate survival analysis confirmed that consumption of candies and lack of daily toothbrushing were the factors that had the major impact on caries onset in both primary and permanent molars. Prolonged pacifier sucking (>or=2 years) was related only with short duration of breastfeeding. Children with prolonged use of a nursing bottle at night also consumed candies more than once a week, did not brush their teeth regularly, and did not use fluoride tablets.

CONCLUSIONS

Consumption of candies and inadequate oral hygiene at age 2 years are important long-term risk factors for caries development in both primary and permanent molars.

Progression of dental caries and tooth loss between the third and fourth decades of life: a birth cohort study

The majority of what is known of the experience of dental caries among adults is from cross-sectional studies, and there are surprisingly few population-level longitudinal studies of dental caries among adults. Dental examinations were conducted at age 26 and again at age 32 among participants in a longstanding prospective study of a birth cohort born in Dunedin (New Zealand) in 1972/1973. Some 901 individuals (88.8%) were dentally examined at both ages. The mean number of remaining teeth and tooth surfaces fell between 26 and 32, reflecting ongoing tooth loss. The overall prevalence of caries rose from 94.9 to 96.8%, while there were greater increases in the proportion with caries-associated tooth loss (from 10.8 to 22.8%). Caries experience was greatest in the molar teeth and upper premolars, and was lowest in the lower anterior teeth. The mean crude caries increment (CCI) was 5.0 surfaces (SD 6.6); 681 (75.5%) experienced 1+ CCI, and the mean CCI among those individuals was 6.6 surfaces (SD 6.9). Substantial dental caries and tooth loss experience occur as people move from the third into the fourth decade of life.

Diet, nutrition and the prevention of dental diseases

Oral health is related to diet in many ways, for example, nutritional influences on craniofacial development, oral cancer and oral infectious diseases. Dental diseases impact considerably on self-esteem and quality of life and are expensive to treat. The objective of this paper is to review the evidence for an association between nutrition, diet and dental diseases and to present dietary recommendations for their prevention. Nutrition affects the teeth during development and malnutrition may exacerbate periodontal and oral infectious diseases. However, the most significant effect of nutrition on teeth is the local action of diet in the mouth on the development of dental caries and enamel erosion. Dental erosion is increasing and is associated with dietary acids, a major source of which is soft drinks.

Despite improved trends in levels of dental caries in developed countries, dental caries remains prevalent and is increasing in some developing countries undergoing nutrition transition. There is convincing evidence, collectively from human intervention studies, epidemiological studies, animal studies and experimental studies, for an association between the amount and frequency of free sugars intake and dental caries. Although other fermentable carbohydrates may not be totally blameless, epidemiological studies show that consumption of starchy staple foods and fresh fruit are associated with low levels of dental caries. Fluoride reduces caries risk but has not eliminated dental caries and many countries do not have adequate exposure to fluoride.

It is important that countries with a low intake of free sugars do not increase intake, as the available evidence shows that when free sugars consumption is <15–20kg/yr (~6–10% energy intake), dental caries is low. For countries with high consumption levels it is recommended that national health authorities and decision-makers formulate country-specific and community-specific goals for reducing the amount of free sugars aiming towards the recommended maximum of no more than 10% of energy intake. In addition, the frequency of consumption of foods containing free sugars should be limited to a maximum of 4 times per day. It is the responsibility of national authorities to ensure implementation of feasible fluoride programmes for their country.