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Vitiello F, Bourgeois D, Orilisi G, Orsini G, Carrouel F. Non-Cariogenic Effect of Milk and Dairy Products on Oral Health in Children and Adolescents: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:149. [PMID: 38397261 PMCID: PMC10887650 DOI: 10.3390/children11020149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024]
Abstract
Diet plays an important role in the etiopathology of dental caries. Milk and dairy products (DPs), especially in children and adolescents, are important sources of protein, calcium and phosphorus and could have an effect on dental and oral health. The aim of this scoping review was to analyze the scientific literature on the non-cariogenic effect of milk and DPs, with a focus on their potential to prevent dental caries in children and adolescents. PubMed, EMBASE, and Web of Science were searched for publications relevant to our topic from January 2013 to 30 September 2023. Thirty-eight studies were included in the qualitative analysis. The included studies highlight the properties of milk and DPs that contribute to enamel remineralization, exhibit antibacterial action, inhibit the growth of cariogenic bacteria, and promote a balanced oral microbiome. With regard to the addition of probiotics (PBs) and fluoride (F) to DPs, the mixed results of the studies analyzed did not allow a clear statement to be made about their non-cariogenic effects. However, several studies show that the addition of PBs can reduce cariogenic bacteria, create a protective barrier against pathogens and support the host's natural defense mechanisms. Further long-term and high-quality studies are needed to understand the impact of milk and its constituents on oral health in order to promote effective caries prevention strategies in children and adolescents.
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Affiliation(s)
- Flavia Vitiello
- Laboratory “Health, Systemic, Process” (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, 69008 Lyon, France; (F.V.); (D.B.)
- Department of Clinical Sciences and Stomatology (DISCO), Università Politecnica delle Marche, 60126 Ancona, Italy; (G.O.)
| | - Denis Bourgeois
- Laboratory “Health, Systemic, Process” (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, 69008 Lyon, France; (F.V.); (D.B.)
| | - Giulia Orilisi
- Department of Clinical Sciences and Stomatology (DISCO), Università Politecnica delle Marche, 60126 Ancona, Italy; (G.O.)
| | - Giovanna Orsini
- Department of Clinical Sciences and Stomatology (DISCO), Università Politecnica delle Marche, 60126 Ancona, Italy; (G.O.)
| | - Florence Carrouel
- Laboratory “Health, Systemic, Process” (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, 69008 Lyon, France; (F.V.); (D.B.)
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Vitamin D Supplementation, Characteristics of Mastication, and Parent-Supervised Toothbrushing as Crucial Factors in the Prevention of Caries in 12- to 36-Month-Old Children. Nutrients 2022; 14:nu14204358. [PMID: 36297042 PMCID: PMC9607142 DOI: 10.3390/nu14204358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/08/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022] Open
Abstract
Severe early childhood caries (S-ECC), defined as any sign of smooth-surface caries in a child younger than three years of age, remains a serious health issue. The aim of this study was to indicate oral health behaviours related to S-ECC. The study surveyed parents (socio-economic and medical factors, oral health behaviours) and clinically examined children including non-cavitated d1,2/cavitated d ≥ 3 lesions. %S-ECC, and caries indices (d1,2 d ≥ 3 mft and d1,2 d ≥ 3 mfs) were calculated. Spearman’s correlation and simple and multiple logistic regression were used to assess the relationships between various factors and S-ECC. A total of 496 children were examined. S-ECC occurred in 44.8%: d1,2 d ≥ 3 mft = 2.62 ± 3.88, d1,2 d ≥ 3 mfs = 4.46 ± 8.42. S-ECC was correlated with socio-economic factors, vitamin D supplementation, breastfeeding and using formula after the 18th month, and toothbrushing. Supplementation of vitamin D and toothbrushing tended to decrease the odds of S-ECC (OR = 0.49 (0.27−0.87); p = 0.016, OR = 0.46 (0.24−0.86) p = 0.015, respectively). Feeding exclusively with formula was observed to increase the odds of S-ECC (OR = 2.20 (1.29−3.76); p = 0.004). Consuming > three snacks daily (OR = 1.39 (0.97−1.98); p = 0.072) and the reluctance to eat resilient foods (OR = 1.63 (1.05−2.51); p = 0.028) were nullified by the confounding factors. Vitamin D supplementation, mastication of resilient food, breastfeeding in the first six months of a baby’s life, and parent-supervised toothbrushing are factors in the prevention of caries in toddlers. Breast- and bottle-feeding after the 18th month of life, the reluctance to eat solids, lack of vitamin D supplementation, hygienic neglect, and delay in introducing oral health behaviours may contribute to the development of caries in toddlers.
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Duarte ML, Dias KR, Ferreira DMTP, Fonseca-Gonçalves A. Knowledge of health professionals about breastfeeding and factors that lead the weaning: a scoping review. CIENCIA & SAUDE COLETIVA 2022; 27:441-457. [DOI: 10.1590/1413-81232022272.35672020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/07/2021] [Indexed: 11/21/2022] Open
Abstract
Abstract This review evaluated the knowledge of health professionals (HP) about breastfeeding and factors that leading the weaning. A search was performed in four electronics databases and the grey literature. The search strategy included Mesh terms and synonyms. No language or date restrictions were adopted. Studies that evaluated the knowledge of HP about breastfeeding and weaning were considered eligible. The studies retrieved by the searches were evaluated by two independently examiners. From 1,417 studies retrieved, 35 were included. Many countries and professionals from different health areas were analyzed. No studies evaluated the dentists’ knowledge. Although the included HP know the benefits of breastfeeding for health, the length of breastfeeding recommended by the World Health Organization, exclusive or not, was not aligned with all professionals’ endorsement. Information about weaning is scarce; however, HP are mindful of the main potential causes of early weaning. The knowledge of HP is conflicting about breastfeeding and unusual about weaning. Furthermore, no studies were found that presented data on the knowledge of dentists on the subject. Thus, assessments of dentists’ knowledge and education measures for HP are necessary since they are frequently questioned about these issues.
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Campos Vieira J, Cury JA, Ricomini Filho AP. Combination effect of diurnal exposure to sucrose and nocturnal exposure to lactose on enamel demineralization. Caries Res 2021; 56:47-54. [PMID: 34749362 DOI: 10.1159/000520590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 10/31/2021] [Indexed: 11/19/2022] Open
Abstract
We have hypothesized that the association between human milk and caries in breastfeeding children could be explained by the combination of a diurnal cariogenic diet with the nocturnal lactose fermentation, conditions simulated in this experimental study. Cariogenic biofilm was formed on bovine enamel slabs, which were exposed 8x/day for 3 min to a 10% sucrose solution, simulating a highly cariogenic diurnal diet, or 50 mM NaCl solution (control). Simulating the nocturnal retention of milk in mouth, biofilms were transferred to culture medium containing 0.7% lactose for 2 h, or only to culture medium (control). Four groups were designed (n=12): Ctrl, no exposure to diurnal sucrose or nocturnal lactose; Lac, only nocturnal exposure to lactose (2 h); Suc, only diurnal exposure to sucrose (8x/day); and Suc→Lac, diurnal exposure to sucrose (8x/day) followed by nocturnal exposure to lactose (2 h). The medium was changed 3x/day, at the beginning of the day, and after diurnal and nocturnal exposures. Calcium in the medium was determined as chemical indicator of partial demineralizations occurred during the diurnal and the nocturnal treatments; the medium pH was also determined. After 96 h of growth, biofilms were harvested to evaluate CFU, biomass, and extracellular polysaccharides, soluble and insoluble. The percentage of enamel surface hardness loss (%SHL) was evaluated as cumulative demineralization. Data were analyzed by one-way ANOVA, Tukey's test (α=5%). Highest %SHL (p<0.05) was found for Suc→Lac (40.6%) group when compared to Suc (32.1%), Lac (7.7%), and Ctrl (3.8%). Calcium released during the diurnal and nocturnal treatments were respectively: Suc→Lac=Suc>Lac=Ctrl and Suc→Lac=Lac>Suc=Ctrl (p<0.05). Regarding Ctr group, calcium released from nocturnal lactose fermentation by Suc→Lac group was 4-fold greater than that provoked by Lac group. The findings were supported by the pH of the media. The data suggest that the biofilm formed under diurnal exposure to sucrose enhances the cariogenicity of nocturnal exposure to lactose.
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Ricomini Filho AP, de Assis ACM, Costa Oliveira BE, Cury JA. Cariogenic Potential of Human and Bovine Milk on Enamel Demineralization. Caries Res 2021; 55:260-267. [PMID: 34130289 DOI: 10.1159/000516090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/21/2021] [Indexed: 11/19/2022] Open
Abstract
The higher cariogenicity of human milk when compared with bovine milk is still a debatable subject. Therefore, we evaluated the effect of human or bovine milk exposure on biofilm composition and enamel demineralization using a validated cariogenic biofilm model. Streptococcus mutans UA159 biofilms (n = 8) were grown on human saliva-coated bovine enamel slabs of known surface hardness. The biofilms were exposed 8×/day to 0.9% NaCl (negative control), human milk, bovine milk, 7.0% lactose (active human milk control), 4.5% lactose (active bovine milk control), or 10% sucrose (positive control). The culture medium was changed twice daily, and the pH was analyzed as an indicator of biofilm acidogenicity. After 120 h of growth, biofilms were harvested to evaluate viable cells, and soluble and insoluble extracellular polysaccharides (EPS). Enamel demineralization was assessed by the percentage of surface hardness loss (%SHL). Data were analyzed by one-way ANOVA/Tukey's test (α = 5%). In terms of %SHL, negative control (7.7 ± 3.1), human milk control (13.3 ± 7.5), bovine milk control (15.3 ± 8.2), human milk (7.5 ± 5.0), and bovine milk (8.7 ± 6.3) did not differ among them (p > 0.05) but differed (p < 0.05) from sucrose (55.1 ± 5.4). The findings of enamel demineralization (%SHL) were statistically supported by the data of biofilm acidogenicity, bacterial counts and EPS biofilm composition. This experimental study suggests that human and bovine milk have low cariogenic potential to provoke caries lesions in enamel.
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Affiliation(s)
| | | | - Bárbara E Costa Oliveira
- Piracicaba Dental School, UNICAMP, Piracicaba, Brazil.,Ceuma University, UNICEUMA, São Luís, Brazil
| | - Jaime A Cury
- Piracicaba Dental School, UNICAMP, Piracicaba, Brazil
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Holve S, Braun P, Irvine JD, Nadeau K, Schroth RJ. Early Childhood Caries in Indigenous Communities. Pediatrics 2021; 147:peds.2021-051481. [PMID: 34001640 PMCID: PMC8893228 DOI: 10.1542/peds.2021-051481] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The oral health of Indigenous children of Canada (First Nations, Inuit, and Métis) and the United States (American Indian and Alaska native) is a major child health disparity when compared with the general population of both countries. Early childhood caries (ECC) occurs in Indigenous children at an earlier age, with a higher prevalence, and at much greater severity than in the general population. ECC results in adverse oral health, affecting childhood health and well-being, and may result in high rates of costly surgical treatment under general anesthesia. ECC is an infectious disease that is influenced by multiple factors, but the social determinants of health are particularly important. This policy statement includes recommendations for preventive and clinical oral health care for infants, toddlers, preschool-aged children, and pregnant women by primary health care providers. It also addresses community-based health-promotion initiatives and access to dental care for Indigenous children. This policy statement encourages oral health interventions at early ages in Indigenous children, including referral to dental care for the use of sealants, interim therapeutic restorations, and silver diamine fluoride. Further community-based research on the microbiology, epidemiology, prevention, and management of ECC in Indigenous communities is also needed to reduce the dismally high rate of caries in this population.
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Affiliation(s)
- Steve Holve
- Tuba City Regional Health Care Corporation, Tuba City, Arizona;
| | - Patricia Braun
- Denver Health and Hospital, Denver, Colorado,Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | | | - Kristen Nadeau
- Mentored Scholarly Activity Longitudinal Research Course and Colorado Clinical and Translational Sciences Institute Scientific Advisory and Review Committee, Anschutz Medical Campus, University of Colorado and Children’s Hospital Colorado, Aurora, Colorado
| | - Robert J. Schroth
- Departments of Preventive Dental Science, Pediatrics and Child Health, and Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada,Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada,Section of Pediatric Dentistry, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
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In vitro comparison of biofilm formation and acidogenicity between human breast milk and other milk formulas. PEDIATRIC DENTAL JOURNAL 2020. [DOI: 10.1016/j.pdj.2020.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Menezes CRSD, Pereira ALA, Ribeiro CCC, Chaves CO, Guerra RNM, Thomaz ÉBAF, Monteiro-Neto V, Alves CMC. Is there association between chronic kidney disease and dental caries? A case-controlled study. Med Oral Patol Oral Cir Bucal 2019; 24:e211-e216. [PMID: 30818314 PMCID: PMC6441594 DOI: 10.4317/medoral.22737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 12/28/2018] [Indexed: 12/04/2022] Open
Abstract
Background The purpose of this study was to assess the association between chronic kidney diseases (CKD) and dental caries. Material and Methods 107 patients with CKD and 107 with no systemic alteration were randomly included. DMFT (decayed, missing, and filled teeth), plaque index, colony-forming units (CFU) of Streptococcus mutans and salivary composition (IgA total, IgA anti- Streptococcus mutans, calcium and urea) were evaluated. McNemar and Wilcoxon tests were used to compare test and control groups. Spearman test was used to correlate time of hemodialysis and variables studied. Associations between variables were evaluated by logistic regression analysis. Results The number of filled teeth, the amount of IgA anti-Streptococcus mutans, salivary urea, education level, monthly income and the amount of CFU of Streptococcus mutans were statistically different between groups. There was a positive correlation between the duration of hemodialysis (Hd) and the amount of IgA anti-Streptococcus mutans, urea in saliva, and the number of CFU of Streptococcus mutans. In the adjusted model, a higher incidence of CFU mutans streptococci, elevated salivary urea, smaller number of filled teeth, lower DMFT, and less calcium salivary were associated with CKD. Conclusions Programs to prevent and treat oral problems and regular follow-up at the beginning of dialysis are necessary to increase patients’ awareness of their condition. Key words:Renal disease, chronic, dental caries, renal dialysis.
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Affiliation(s)
- C-R-S-D Menezes
- Departamento de Odontologia II, Faculdade de Odontologia, Campus Universitário do Bacanga, Avenida dos Portugueses, 1966 São Luís-MA, Brazil, CEP: 65080-805,
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Signori C, Hartwig AD, Silva-Júnior IFD, Correa MB, Azevedo MS, Cenci MS. The role of human milk and sucrose on cariogenicity of microcosm biofilms. Braz Oral Res 2018; 32:e109. [PMID: 30328901 DOI: 10.1590/1807-3107bor-2018.vol32.0109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/03/2018] [Indexed: 11/22/2022] Open
Abstract
This study investigated the effect of human milk, alone and associated with sucrose, in the cariogenicity of biofilms in a microcosm biofilm model and compared with the cariogenicity of sucrose and bovine milk. Microcosm biofilms were grown in enamel discs in 24-well plates. Six growth conditions were studied: DMM (chemically defined artificial saliva - negative control), DMM with 1% of sucrose (DMM+s) (positive control), human milk with DMM, human milk with DMM+s, bovine milk with DMM, and bovine milk with DMM+s. After 5 days, the outcome variables surface hardness change (%SHC), microbiological composition of biofilms, and pH of supernatant were analyzed. All groups had significantly lower hardness loss compared to the DMM group with 1% of sucrose. Human and bovine milk associated with sucrose showed higher hardness loss. The supernatant pH values after 6 hours of different treatments were similar for the groups sucrose and human milk associated with sucrose (p>0.05). After 18 hours at rest in pure DMM, an increase in the pH of the supernatant was observed. Higher values of total microorganisms count were found for sucrose and bovine milk groups compared to the group supplemented only by DMM. Bovine milk group showed greater amount of total aciduric microorganisms in comparison to human milk group. Within the limits of this study, it can be infered that both human and cow milks have some cariogenic potential, although differing from sucrose in terms of mineral loss.
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Affiliation(s)
- Cácia Signori
- Universidade Federal de Pelotas - UFPel, School of Dentistry, Graduate Program in Dentistry, Pelotas, RS, Brazil
| | - Andréia Drawanz Hartwig
- Universidade Federal de Pelotas - UFPel, School of Dentistry, Graduate Program in Dentistry, Pelotas, RS, Brazil
| | - Ivam Freire da Silva-Júnior
- Universidade Federal de Pelotas - UFPel, School of Dentistry, Graduate Program in Dentistry, Pelotas, RS, Brazil
| | - Marcos Britto Correa
- Universidade Federal de Pelotas - UFPel, School of Dentistry, Graduate Program in Dentistry, Pelotas, RS, Brazil
| | - Marina Sousa Azevedo
- Universidade Federal de Pelotas - UFPel, School of Dentistry, Graduate Program in Dentistry, Pelotas, RS, Brazil
| | - Maximiliano Sérgio Cenci
- Universidade Federal de Pelotas - UFPel, School of Dentistry, Graduate Program in Dentistry, Pelotas, RS, Brazil
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Abstract
Early childhood caries (ECC) is a common childhood disease with highest prevalence found in poor, socially disadvantaged, and minority groups. The main risk factors for ECC are frequent sugar consumption, lack of tooth brushing, and enamel hypoplasia. Contributory factors include environmental and psychosocial stresses that modify caregiver behaviors. Strategies for prevention include preventing mutans streptococci transmission, restricting dietary sugars, tooth brushing, topical fluoride applications, and early dental examinations. This article provides an overview of ECC based on current understanding of its cause, prevention, and management.
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Affiliation(s)
- Wan Kim Seow
- School of Dentistry, The University of Queensland, 288 Herston Road, Herston, Queensland 4006, Australia.
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Peres KG, Chaffee BW, Feldens CA, Flores-Mir C, Moynihan P, Rugg-Gunn A. Breastfeeding and Oral Health: Evidence and Methodological Challenges. J Dent Res 2017; 97:251-258. [PMID: 29108500 DOI: 10.1177/0022034517738925] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Breastfeeding is a powerful health-promoting behavior. A 2016 Lancet global collaboration to review the health implications of breastfeeding was among the first to consider oral health outcomes. While a role was suggested for breastfeeding in preventing malocclusion, caries was the only included disease condition unfavorably associated with breastfeeding. The present critical review examines the evidence connecting breastfeeding practices to these outcomes and discusses the methodological challenges inherent in reaching causal conclusions. Published systematic reviews show some evidence of a protective effect of breastfeeding against primary dentition malocclusion but no supportive evidence for mixed dentition and permanent dentition malocclusions. Regarding caries, well-conducted studies report a benefit with breastfeeding up to 12 mo but a positive association between caries and breastfeeding of longer duration, at times that vary between 12 and 24 mo, as well as nocturnal feeding. Future studies would be methodologically stronger if focused on specific malocclusion traits that are plausibly associated with sucking movements rather than using general malocclusion indices. Studies should use detailed and consistent terminology for breastfeeding definition, including frequency, intensity, and timing. Analytical studies should be carried out to distinguish between confounders (e.g., prematurity) and mediators (e.g., use of pacifier). Regarding a link to caries, standard terminology for exposures (e.g., nocturnal feeding) is recommended. Statistical analyses must account for known confounding factors (e.g., socioeconomic conditions) but avoid inappropriate adjustment for variables on a causal path between exposure and outcome or for variables not associated with breastfeeding (e.g., tooth brushing), as can be guided using tools such as direct acyclic graphs. For dental practice, the potential caries risk of long-duration breastfeeding should be part of individual patient counseling that incorporates patient values and circumstances. Given the unquestioned overall health benefits of breastfeeding, the dental community should support World Health Organization guidelines that encourage and promote breastfeeding.
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Affiliation(s)
- K G Peres
- 1 Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Australia
| | - B W Chaffee
- 2 Department of Preventive and Restorative Dental Sciences, Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, San Francisco, CA, USA
| | - C A Feldens
- 3 Department of Pediatric Dentistry, Universidade Luterana do Brasil, Canoas, Brazil
| | - C Flores-Mir
- 4 Division of Orthodontics, School of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - P Moynihan
- 5 School of Dental Sciences, Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
| | - A Rugg-Gunn
- 6 Newcastle University, Newcastle upon Tyne, UK
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ElKarmi R, Hassona Y, Taimeh D, Scully C. YouTube as a source for parents' education on early childhood caries. Int J Paediatr Dent 2017; 27:437-443. [PMID: 27882621 DOI: 10.1111/ipd.12277] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patients can and do search the Internet for information on various health-related topics. YouTube™ is one popular website they may consult. AIM To examine the quality of information offered by YouTube™ for patients seeking information on early childhood caries (ECC). DESIGN YouTube™ was searched for videos on ECC. The usefulness of selected videos in providing adequate information about ECC was evaluated using a 13-point usefulness score. The guidelines of the American Academy of Pediatric Dentistry were used for benchmarking. RESULTS Most videos were uploaded by healthcare professionals (60%, n = 18). Videos had generally low usefulness scores (mean: 5.1 ± 2.9; range: 1-11). An average YouTube™ video on ECC was viewed two times/day (range: 0.07-34.4 views/day). Less useful videos ranked early on the viewing list, and viewer's interactions with videos were not affected significantly by their usefulness. CONCLUSION YouTube™ should not be used as a trusted site for educating patients on ECC.
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Affiliation(s)
- Rawan ElKarmi
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, The University of Jordan, Amman, Jordan.,Department of Dentistry, The University of Jordan Hospital, Amman, Jordan
| | - Yazan Hassona
- Department of Dentistry, The University of Jordan Hospital, Amman, Jordan.,Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, School of Dentistry, The University of Jordan, Amman, Jordan
| | - Dina Taimeh
- Department of Dentistry, The University of Jordan Hospital, Amman, Jordan
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