Trend on dental caries status and its risk indicators in children aged 12 years in China: a multilevel analysis based on the repeated national cross-sectional surveys in 2005 and 2015

Dental Caries and Associated Factors in Tibetan School-Age Children in Gannan, China

OBJECTIVES

Data on the oral health status in the Qinghai-Tibetan Plateau are limited. This study aimed to investigate the dental caries status and identify associated risk factors among 8- to 12-year-old children in Gannan, a Tibetan Autonomous Prefecture in Northwest China.

METHODS

The study population was recruited using a multistage stratified random sampling procedure. Caries status was assessed by clinical oral examination and indicated by the decayed, missing, and filled teeth (DMFT/dmft) index. Information on sociodemographic characteristics, oral hygiene behaviours, and dietary habits was collected using a comprehensive structured questionnaire. Statistical analyses, including the chi-square test and a two-level logistic regression model, were conducted to examine the risk factors associated with dental caries.

RESULTS

A total of 1024 Tibetan children were examined, revealing a dental caries prevalence rate of 89.55%, with a mean DMFT/dmft index of 4.25 ± 3.27. The two-level logistic regression model showed that initiating tooth brushing at four to 5 years old (OR = 2.295, 95% CI 1.053-5.002) and frequent dessert and candy intake (OR = 2.655, 95% CI 1.216-5.794) were risk factors for dental caries. Conversely, being 11 years (OR = 0.399, 95% CI 0.177-0.904) or 12 years old (OR = 0.396, 95% CI 0.163-0.961) and if the father's education level was high school or above (OR = 0.311, 95% CI 0.098-0.986) were indicated to be protective factors against dental caries.

CONCLUSIONS

The prevalence of dental caries was high in Tibetan children aged 8 to 12year-old in Gannan. Therefore, it is imperative to prioritize comprehensive home- and school-based interventions to improve the oral health of this population.

Cross-sectional survey on dental caries among preschool children in Guangzhou city in 2022

OBJECTIVE

To investigate the prevalence of deciduous dental caries in preschool children aged 36-71 months as well as the eruption and caries status of permanent teeth in children aged 60-71 months in Guangzhou city, providing references for oral health work.

DESIGN

This study was a cross-sectional study design.

SETTING

The study was conducted in 34 kindergartens in the central and non-central urban areas of Guangzhou city.

PARTICIPANTS

14 883 preschool children aged 36-71 months in Guangzhou city were included in the ultimate analysis.

MAIN OUTCOME MEASURES

The prevalence of dental caries and other indicators of deciduous teeth, eruption and caries status of permanent teeth in children aged 60-71 months.

RESULTS

The prevalence of dental caries in children aged 36-47 months, 48-59 months and 60-71 months were 41.6% (95% CI: 40.1%, 43.1%), 57.1% (95% CI: 55.8%, 58.5%) and 65.2% (95% CI: 64.0%, 66.4%), respectively. Mean decayed-missing-filled teeth increased with age, with differences between genders and areas. The percentage of permanent first molars and central incisors eruption in children aged 60-71 months differed, and caries conditions varied.

CONCLUSION

The problem of early childhood caries in preschool children in Guangzhou city is prominent. Prevention should be strengthened from early life, and oral health education and publicity enhanced to narrow regional oral health gaps.

The influence factors on pit and fissure sealing behavior of 12-year-old children: a cross-sectional study in Zhejiang, China

BACKGROUND

In the 21st century, dental caries remains a global burden, particularly severely affecting the growth and quality of life of 12-year-old children. Fortunately, pit and fissure sealing (PFS) procedures can effectively prevent molars from caries. Hence, this study focused on the relationship between PFS and oral epidemiological factors in 12-year-old children.

METHODS

A cross-sectional survey was conducted in 12-year-old children from 11 cities in Zhejiang Province. Their dental conditions were collected through questionnaires, as well as basic information such as relevant family information, oral health knowledge and behavior. Then, logistic regression analysis was used to identify the influencing factors associated with PFS.

RESULTS

A total of 1204 children were included, with 252 in the PFS group and 952 in the non-PFS group. There were significant differences between the two groups in terms of decayed, missing and filled teeth (DMFT) score, first permanent molar DMFT score, residential area, educational level of parents, tooth-brushing frequency, use of dental floss, oral examination in a medical institution, having taken courses on oral health care, as well as having knowledge that tooth brushing could effectively prevent gingival inflammation, PFS could protect teeth, and oral disease may affect general health. According to further logistic regression analysis, the independent factors influencing PFS included use of dental floss [odds ratios (OR) = 1.672, 95% confidence intervals (CI) = 1.235-2.263, P = 0.001], having taken courses on oral health care (OR = 0.713, 95% CI = 0.515-0.988, P = 0.042), having knowledge that tooth brushing is effective in preventing gingival inflammation (OR = 0.627, 95% CI = 0.389-0.987, P = 0.044) and having knowledge that PFS can protect teeth (OR = 0.589, 95% CI = 0.438-0.791, P < 0.001).

CONCLUSION

PFS can reduce the mean DMFT score of 12-year-old children. Independent influencing factors of PFS consist of use of dental floss, having taken courses on oral health care, oral health behavior and knowledge level.

Child dental neglect and legal protections: a compendium of briefs from policy reviews in 26 countries and a special administrative region of China

Background

Child neglect is a public health, human rights, and social problem, with potentially devastating and costly consequences. The aim of this study was to: (1) summarize the oral health profile of children across the globe; (2) provide a brief overview of legal instruments that can offer children protection from dental neglect; and (3) discuss the effectiveness of these legal instruments.

Methods

We summarized and highlighted the caries profile and status of implementation of legislation on child dental neglect for 26 countries representing the World Health Organization regions: five countries in Africa (Nigeria, South Africa, Sudan, Tanzania, Zimbabwe), eight in the Americas (Argentina, Brazil, Canada, Chile, Mexico, Peru, Unites States of America, Uruguay), six in the Eastern Mediterranean (Egypt, Iran, Libya, Jordan, Qatar, Saudi Arabia), four in Europe (Italy, Latvia, Serbia, United Kingdom), two in South-East Asia (India and Indonesia) and one country (China) with its special administrative region (Hong Kong) in the Western Pacific.

Results

Twenty-five of the 26 countries have legal instruments to address child neglect. Only two (8.0%) of these 25 countries had specific legal instruments on child dental neglect. Although child neglect laws can be interpreted to establish a case of child dental neglect, the latter may be difficult to establish in countries where governments have not addressed barriers that limit children's access to oral healthcare. Where there are specific legal instruments to address child dental neglect, a supportive social ecosystem has also been built to facilitate children's access to oral healthcare. A supportive legal environment, however, does not seem to confer extra protection against risks for untreated dental caries.

Conclusions

The institution of specific country-level legislation on child dental neglect may not significantly reduce the national prevalence of untreated caries in children. It, however, increases the prospect for building a social ecosystem that may reduce the risk of untreated caries at the individual level. Social ecosystems to mitigate child dental neglect can be built when there is specific legislation against child dental neglect. It may be more effective to combine public health and human rights-based approaches, inclusive of an efficient criminal justice system to deal with child dental neglect.

Association of oral health knowledge, self-efficacy and behaviours with oral health-related quality of life in Chinese primary school children: a cross-sectional study

OBJECTIVE

Achieving good oral health-related quality of life (OHRQOL) is of particular concern in children. The inter-relations among oral health knowledge, self-efficacy, behaviours and OHRQOL in children groups remain unclear. This study aimed to explore the inter-relations between these oral health behaviour-related factors and OHRQOL in primary school children.

METHODS

In this cross-sectional study, 651 children in grades 2 and 3 were recruited in October 2020 from two primary schools in Minhang District, Shanghai, China. Data were collected through self-reported questionnaires, consisting of demographic characteristics, oral health knowledge, self-efficacy, oral health behaviours and OHRQOL. Pearson's correlation analyses were used to analyse the relationship between study variables. Structural equation models were used to test the inter-relations between OHRQOL and oral health behaviour-related factors.

RESULTS

Four hypothetical structural equation models were tested and one of them was selected as the most appropriate model, which explained 15.0% of the variance in OHRQOL. This selected model showed that oral health behaviours were directly related to OHRQOL. Oral health knowledge was indirectly associated with OHRQOL through both self-efficacy and oral health behaviours. Self-efficacy was directly associated with OHRQOL or was indirectly associated with OHRQOL through oral health behaviours.

CONCLUSION

This study revealed a pathway of association between children's oral health knowledge and their OHRQOL, in which children's oral health self-efficacy and behaviours had indirect effects. This provides a basis for understanding the mechanism of oral health promotion interventions to improve children's OHRQOL and helps to identify direct or indirect intervention targets.

Subgroup detection-based dental caries status and inequalities trend exploration: A nationwide, 10-year-repeated cross-sectional study

Background

The goal of this study was to identify potentially important factors for the dental health though heterogeneous effects of risk factors within Chinese adolescent populations with different characteristics by analyzing the repeated cross-sectional data collected in the 3rd (2005) and 4th (2015) National Oral Health Survey.

Methods

We studied the relationships between the decayed, missing and filled permanent teeth (DMFT) score, which was a discrete value, with the caries risk factors (region, census type, gender, only child or not, parents' education level, tooth bushing, dentist visit history, knowledge score, sugar intake, and pit-and-fissure sealants status), though the Poisson mixture regression model, which could identify subgroups among the full population and estimate the heterogeneous effects of risk factors simultaneously. We performed a series of tests and trend analysis based on the model fitting results to explore the primary causes for the dental caries issue clearly and intuitively.

Results

A total of 39,049 teenagers aged 12 years were involved in the analysis. The Poisson mixture regression model clustered all individuals into three subgroups, where the mean values (standard deviations) of DMFT were 0.18 (0.56), 1.31 (1.49), and 2.91 (1.89), respectively. Model fitting results indicated that the heterogeneous effects of the involved risk factors were significant. In addition, we also found significant differences in the distributions and trends of DMFT within different categories of selected risk factors (region, census type, gender and dentist visiting history) from the projection analysis results. The estimated and projected proportions showed that the proportion of high caries risk population in the southwestern region increased by 31.8%, and will become even more severe as it will be the major component of high caries risk population in 2025.

Conclusions

We found that the trends for the developments and changes of dental caries within populations with different characteristics were inequality. The regional difference is the primary factor for diversified changes in DMFT. The findings in this study provide support for intervention and prevention policies for the deterioration of dental caries risk within different adolescent populations.

Caries prevalence of the first permanent molar and associated factors among second-grade students in Xiangyun of Yunnan, China: A cross-sectional study

PURPOSE

This study aimed to explore the caries prevalence of the first permanent molar (FPM) and the associated factors among second-grade students in Xiangyun of Yunnan, China.

MATERIALS AND METHODS

A cross-sectional survey was conducted in Xiangcheng Town, Xiangyun County, China, from September to November 2020. The methodology recommended by WHO was used for the dental examination. All the parents were required to complete a questionnaire to collect information on children's family background, dietary habits, oral health behaviors and parental oral health-related knowledge. The tests of significance used were the chi-square test. The association between dental caries prevalence and its associated factors was investigated using logistic regression analysis. Statistical significance was set at P < 0.05.

RESULTS

Data of 1,295 second graders consisting of 665 males and 630 females were analyzed. The caries prevalence of FPM was 47.6%, and the mean DMFT was 1.11 ± 1.394 in this sample. Among all the children with caries, the filling rate is meager, 2.6%. There were statistically significant differences in the caries prevalence of FPM among age groups. No significant difference existed between the sexes. Logistic regression analysis showed that the most significantly associated factors were: consuming desserts at least once a day, no fluoride varnish application experience, worse parental perception of children's oral health status, and incorrect parental knowledge of whether decayed primary teeth need treatment.

CONCLUSION

Caries prevalence of FPM among second-grade schoolchildren in Xiangyun was considerably higher than the average prevalence nationwide in China. As China aims to reduce dental caries to <25% of 12-year-old children in 2030, the local government of remote regions like Xiangyun needs to do much more to achieve this goal. Results of this study could provide a framework for ongoing and future public oral health programs and policy planning in Xiangyun, with particular attention to early preventive and therapeutic measures.