Caesarean Section Does Not Increase the Risk of Caries in Swedish Children

A systematic review of caries risk in children <6 years of age

BACKGROUND

For caries risk assessment (CRA) tools for young children to be evidence-based, it is important to systematically review the literature to identify factors associated with the onset of early childhood caries (ECC).

AIM

This updated systematic review aimed to identify current evidence on caries risk in young children.

DESIGN

A comprehensive and systematic literature search of relevant databases was conducted to update a previous systematic review and identify risk factors associated with ECC. Potential risk factors were identified based on strength of association using odds ratios, hazard ratios, relative risk, etc. GRADE was used for rating quality evidence through consensus.

RESULTS

Twenty-two studies met inclusion criteria for the search from mid-2017 to 2021. Twenty-five publications from the prior systematic review, from 1997 to mid-2017, were also included. Several socioeconomic, behavioral, and clinical variables were identified as ECC risk factors. Factors included the following: age, socioeconomic status, frequency of and supervised toothbrushing, fluoride exposure, breast- and bottle-feeding, feeding habits, absence of a dental home, past caries experience, active non-cavitated lesions, visible plaque, enamel defects, and microbiome.

CONCLUSION

This study provides updated evidence of risk factors for ECC that could be included in CRA tools.

Caesarean-section delivery and caries risk of 3-year-old Chinese children: a retrospective cohort study

BACKGROUND

Caesarean-section (C-section) may influence children's long-term health by affecting bacterial colonization. However, few studies have focused on the association between C-section delivery (CSD) and dental caries, and previous conclusions have been conflicting. This study aimed to explore whether CSD would increase the risk of early childhood caries (ECC) in preschool children in China.

METHODS

This study was a retrospective cohort study. Three-year-old children with full primary dentition were included through the medical records system. Children in the nonexposure group were vaginally delivered (VD), while children in the exposure group were delivered through C-section. The outcome was the occurrence of ECC. After agreeing to participate in this study, guardians of included children completed a structured questionnaire on maternal sociodemographic factors, children's oral hygiene and feeding habits. The chi-square test was used to determine differences in the prevalence and severity of ECC between the CSD and VD groups and to analyse the prevalence of ECC according to sample characteristics. Subsequently, potential risk factors for ECC were preliminarily identified through univariate analysis, and the adjusted odds ratios (ORs) were further calculated through multiple logistic regression analysis after controlling for confounding factors.

RESULTS

The VD group included 2115 participants while CSD group included 2996 participants. The prevalence of ECC was higher in CSD children than in VD children (27.6% vs. 20.9%, P < 0.05), and the severity of ECC in CSD children was higher (mean number of decayed, missing, and filled teeth, dmft: 2.1 vs. 1.7, P < 0.05). CSD was a risk factor for ECC in 3-year-old children (OR = 1.43, 95% CI = 1.10-2.83). In addition, irregular tooth brushing and always prechewing children's food were risk factors for ECC (P < 0.05). Low maternal educational attainment (high school or below) or socioeconomic status (SES-5) may also increase the prevalence of ECC in preschool children and CSD children (P < 0.05).

CONCLUSIONS

CSD would increase the risk of ECC in 3-year-old Chinese children. Paediatric dentists should devote more attention to the development of caries in CSD children. Obstetricians should also prevent excessive and unnecessary CSD.

A preliminarily Investigation on Oral Colonization and Counts of Streptococcus mutans and Streptococcus mitis in a Group of Predentate Infants in Relation to Some Maternal and Infant Factors (A Longitudinal Observational study)

Aim

Bacterial colonization of infants' oral cavities is a key factor for future caries risk. This study sought to longitudinally assess oral bacterial colonization in a group of predentate infants in relation to some mother and infant factors.

Materials and methods

A total of 50 mother-infant pairs were enrolled. When infants were 3-month-old, data were collected about some infant and mother factors; additionally, maternal Decayed, Missing, and Filled Teeth (DMFT) scores and salivary samples of mothers and infants were obtained. At 6 months of infant's age, another infants' salivary samples were obtained. Saliva was cultured to detect and quantify Streptococcus mutans (S. mutans) and Streptococcus mitis (S. mitis).

Results

Streptococcus mitis (S. mitis) was detected in all infants at 3 months. 74 and 96% of infants acquired S. mutans at 3 and 6 months, respectively. S. mutans detection was significantly higher with higher maternal DMFT scores, salivary S. mutans counts, and lower S. mitis counts, as well as when infants were given sugar-containing complementary foods/drinks. At 3-6 months, infants' S. mutans counts were significantly positively correlated with maternal S. mutans counts and DMFT scores and negatively correlated with maternal S. mitis counts. The opposite was evident for infants' S. mitis counts. Regression analysis showed that increased maternal DMFT scores and S. mutans counts, and Cesarean delivery were strong predictors for increased infant's S. mutans counts. While increased DMFT scores and maternal S. mutans counts were strong predictors for reduced infant's S. mitis counts.

Conclusion

Poor maternal oral health, early introduction of sugars in the diet, and probably Cesarean delivery can negatively impact infants' oral bacterial colonization and possibly future caries risk.

Clinical significance

Understanding factors associated with oral colonization of both caries-producing and protective flora in infants of different populations is important for caries prevention. This, in turn, can aid tailoring oral health promotion programs for expectant mothers.

How to cite this article

Wassel MO, Salman NS, Metwalli NE. A preliminarily Investigation on Oral Colonization and Counts of Streptococcus mutans and Streptococcus mitis in a Group of Predentate Infants in Relation to some Maternal and Infant Factors (A Longitudinal Observational study). Int J Clin Pediatr Dent 2023;16(1):79-86.

RISK PREDICTORS OF EARLY CHILDHOOD CARIES INCREMENT-A SYSTEMATIC REVIEW AND META-ANALYSIS

This systematic review aimed to investigate the risk predictors of caries in primary teeth and evaluate their association with the increment of Early Childhood Caries (ECC) among preschool children. This systematic review included only cohort or case-control studies of at least 2 years duration, over 300 participants and with English full-text. Potentially eligible studies were retrieved from 4 electronic databases (Ovid Embase, Ovid MEDLINE; PubMed, Web of Science) from inception to March 1, 2021. Independent screening and data extraction by 2 reviewers to identify factors associated with ECC increment, including family and socioeconomic factors, dietary and oral health-related habits, and clinical parameters. A total of 18 studies from 163 potential reports were included, involving 1,159,226 preschool children. Lower parental education attainment was found associated with ECC increment (WMD:0.87; 95% CI 0.52, 1.21); whereas immigration status (WMD:-0.38; 95% CI -1.09, 0.34), gender (WMD:-0.02; 95% CI -0.28, 0.24), and dental service utilization (WMD:0.35; 95% CI -0.10, 0.79) were not significant factors for ECC increment. All included studies consistently suggested positive correlations between ECC increment and baseline caries experience, plaque level, cariogenic microorganisms, and prenatal and passive smoking, while mixed findings were detected between ECC increment with dietary and oral hygiene practices. Preschool children whose parents have low education level are more likely to have greater increment of ECC over 2 years. Existing caries lesions, increased dental plaque level, cariogenic microorganisms, prenatal or passive smoking were also consistently identified as risk factors for ECC in all reviewed studies. This systematic review highlights specific risk factors to target for the prevention of ECC and supports implementing more oral health promotion for preschool children with parents of lower educational attainment.

Is the mode of childbirth delivery linked to the prevalence of early childhood caries? A systematic review and meta-analysis

Aim

The mode of childbirth delivery can influence the child’s future health and the aim of this study was to explore the association between the delivery mode and the prevalence of early childhood caries.

Methods

We searched the PubMed, Google Scholar and Cochrane databases up to September 15, 2020. Two independent reviewers screened the papers for relevance, extracted data and assessed the risk of bias with the Newcastle–Ottawa Scale. We performed a random effects meta-analysis to pool the prevalence of early childhood caries according to the mode of delivery.

Results

The authors included 11 studies in the review, comprising 47,688 children with vaginal delivery and 10,994 with caesarean section (C-section). The publication years ranged from 1997 to 2020 and included birth cohorts, cross-sectional, register-based and case–control studies. We assessed three publications with low or moderate risk of bias. The median caries prevalence in the C-section group was 56.4% compared to 45.9% in the vaginal group and this difference was statistically significant (p < 0.05). The pooled overall odds ratio was 1.48 (95% CI 1.07–2.05) indicating a weak but statistically significant trend towards a higher caries occurrence among children delivered with C-section. The certainty of this finding was low due to heterogeneity and inconsistencies across the studies.

Conclusion

We found a weak but inconsistent association between the mode of delivery and the prevalence of early childhood caries. Further studies based on representative, prospective cohorts reporting a standardized core outcome set are required to answer the research question with higher certainty.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40368-021-00621-6.

Caesarean delivery and early childhood caries: Estimation with marginal structural models in Brazilian pre-schoolers

OBJECTIVE

This study analysed the association between caesarean section and early childhood caries (ECC), estimating the effects using regression and causal inference models.

METHODS

This was a historical cohort study of 697 mother-child dyads, conducted in São Luís, Brazil. The caesarean section was the exposure, and the severity of ECC (dmft) was the outcome. Covariates household income, maternal schooling, maternal hypertension, maternal obesity and birth weight were adjusted for in the models. The effects were estimated by Poisson regression (Means Ratio-MR) and causal inference using a marginal structural model (MSM) (MR and Average Treatment Effect-ATE coefficients), weighted by the inverse probability (IPW) of exposure.

RESULTS

Caesarean section was protective against caries in the bivariate (MR 0.81; CI 0.70-0.94; P = 0.005) and multivariate (MR 0.78; CI 0.67-0.91; P = 0.002) models. In MSM analyses, the caesarean section had no effect on ECC (ATE = -0.35; P = 0.107), controlling for IPW of exposure.

CONCLUSION

The apparent association between caesarean section and ECC severity seems spurious, as it did not persist after employing a superior approach to estimating causality.

U-shaped association between maternal age at delivery and dental caries in offspring

OBJECTIVE

To determine the association between maternal age at delivery and caries in offspring.

MATERIALS AND METHODS

This registry-based cohort study included all children born between 2000 and 2003 and who were residing in Stockholm County, Sweden, at 7 years of age. Between 2007 and 2010, the cohort (n = 65,259) was examined to determine caries experience (deft scores) at 7 years of age. Age of mother at childbirth was retrieved from the patient histories. Data were analysed using linear regressions.

RESULTS

The lowest mean deft occurred in children born to mothers aged 25-34 years. The final model - adjusted for sex, income, educational level, migration background, family situation, smoking, obesity, small for gestational age, and number of siblings - found that young mothers and older mothers were significant risk indicators for caries experience at 7 years of age.

CONCLUSIONS

The present study found a U-shaped relationship between maternal age at childbirth and caries experience in the offspring at age 7 years. The offspring of mothers under 25 or over 34 years of age are at greater risk of having more teeth with caries experience.

[Perinatal risk factors of the early childhood caries]

THE AIM

Of the study was to find possible correlations between early childhood caries (ECC) prevalence and intensity and perinatal factors, such as pregnancy and birth adverse events, terms and mode of delivery, child's weight at birth.

MATERIALS AND METHODS

The study comprised 165 3-6 years old healthy children (80 boys and 85 girls) examined in Khimki nurseries. Perinatal background data were collected through validated questionnaires.

RESULTS

ECC prevalence and dmft median were 41.2% and 1.2 teeth, correspondingly, in 3-years-olds and values growth up to 64.8% and 3.5 teeth was seen in 6-years-olds. Exact Fisher test showed significant positive correlation between adverse pregnancy events and caries risk, as ECC had 8.6 and 51.7% of children born from complicated and non-complicated pregnancies, correspondingly (p<0.05). In children born by cesarean section ECC was detected more often, than in born via vaginal delivery (62.8 vs 49.6%, correspondingly). The correlation became statistically significant by the age of 6 (p=0.02). In 6-years-olds we also noted significant correlation between mode of delivery and dmft numbers (p<0.05).

CONCLUSION

Adverse pregnancy events and cesarean section are ECC risk factor affecting the intensity of the disease.

Adverse birth outcomes and the risk of dental caries at age 3 years

BACKGROUND

Since birth outcome is associated with maternal and newborn health, it can be a predictor of the future health of the child.

AIM

To investigate the association between adverse birth outcomes and dental caries.

DESIGN

The present registry-based cohort study included all children born in 2000-2003, residing in Stockholm County, Sweden and who received a dental examination at the age of 3 years (n = 74 748). National registries supplied data on socioeconomic conditions, maternal health, maternal health behavior, and birth outcomes. Forward stepwise binary logistic regression was performed to determine predictors of caries experience in the 3-year-olds.

RESULTS

Of the subjects, 6.0% had caries experience (decayed, extracted, and filled teeth [deft] ≥ 1), 5.6% were born preterm (<37 weeks); 2.2% were born small (SGA) and 3.7% large (LGA) for gestational age. Of the studied adverse birth outcomes, only SGA was significantly associated with caries experience at 3 years of age, and only for mothers who had refrained from smoking during pregnancy.

CONCLUSIONS

SGA is associated with caries experience in 3-year-old children; however, this relationship occurs only in mothers who did not smoke during pregnancy.

Influence of mode of delivery, family and nursing determinants on early childhood caries development: a prospective cohort study

INTRODUCTION

Conflicting results exist regarding mode of delivery and caries. We investigated the influence of the mode of delivery and selected family- and nursing factors during the first 2 years of life on the prevalence of dental caries at 5 years.

MATERIALS AND METHODS

551 infants were invited to a prospective medical study with focus on growth and overweight prevention. The parents of 346 infants (179 boys and 167 girls) accepted this invitation and at the age of 2-years, 336 of them agreed to dental check-ups and salivary samplings. At the ages of three and five years, 302 (90%) and 292 children (87%) could be re-examined with respect to caries by one of two calibrated examiners. All stages of caries lesions were scored on tooth and surface level. Background maternal and nursing data were collected semiannually through validated questionnaires and interviews.

RESULTS

The caries prevalence (initial + cavitated lesions) was 5.6% at 3 years of age and 18.9% at 5 years. The 5-year-olds delivered with caesarian section displayed a significantly elevated risk of having caries (relative risk [RR] 2.2; 95% confidence interval (CI) 1.4-3.6; p < .05). Parental smoking and siblings with caries were the most influential family determinants (p < .05) while drinking juice to meals at 2 years of age (p < .05) was most outstanding among the nursing factors (p < .05).

CONCLUSIONS

In this cohort, the mode of delivery (caesarian section) had a significant impact on the risk of early childhood caries (ECC) but also other family and infant nursing determinants were related to the development of the disease.

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.