Protocol for assessing maternal, environmental and epigenetic risk factors for dental caries in children

The prevalence of dental caries and its associated factors among preschool children in Huizhou, China: a cross-sectional study

Background

Dental caries among preschool children were prevalent worldwide and had a significant impact on children and their families. Understanding its prevalence and risk factors helps to optimize the delivery of oral health care to the target population and promote their oral health ultimately. This cross-sectional study aimed to examine the prevalence of dental caries and its associated factors among 3- to 5-year-old children in Huizhou, Guangdong Province, China.

Method

We recruited children from 21 kindergartens adopting multistage sampling method. Two examiners performed oral examination. They assessed children's dental caries experience following the World Health Organization criteria. Children's dental caries activity, malocclusion, tonsil size and pH value of saliva were evaluated. Parental questionnaires collected child's sociodemographic background and oral-health-related behaviors. Data were analyzed by univariate analysis and logistic regression using SPSS.

Results

This study invited 1,485 children and recruited 1,348 (53.2% boys) (response rate: 90.8%). Dental caries prevalence rate was 58.2% for 3-, 70.7% for 4-, 80.5% for 5-year-old and 72.9% for all recruited children. The mean dmft score (±SD) was 3.38 (±4.26) for 3-, 4.75 (±4.96) for 4-, 5.81 (±5.71) for 5-year-old and 4.99 (±5.02) for all children. Age, family status (singleton or not), monthly family income, mother and father's education level, tonsil grading score, spacing in dentition, Cariostat score (reflecting the caries activity), dental plaque index, duration of breastfeeding, dental visit experience, tooth brushing habits and sugary snacking before sleeping were statistically related to the prevalence of dental caries (p < 0.050) in univariate analysis. These factors were further analyzed in the regression model. The results of the final model indicated dental caries were associated with age (p < 0.001), Cariostat score (p < 0.001), spacing (p < 0.001), tonsil grading score (p = 0.013), singleton or not (p = 0.002), sugary snacking habit before bed (p < 0.001) and breast-feeding duration (p = 0.050).

Conclusion

Dental caries was prevalent among 3-to 5-year-old preschool children in Huizhou, China. Children's age, caries activity, tonsil size, malocclusion, family background, sugary snacking habit and breast-feeding habit were related to the prevalence of dental caries. More emphasis should be placed on prevention targeting the risk factors from early life.

Risk factors for dental caries in Latin American and Caribbean countries

Identifying the risk factors for dental caries is vital in epidemiology and clinical practices for developing effective preventive strategies, both, at the individual and collective levels. Different causality/determination models have been proposed to understand the development process of dental caries. In the present review, we designed a model inspired by the world-known social determinants models proposed in the 90s and more recently in the 10s, wherein the contextual factors are placed more externally and encompass the individual factors. The contextual factors included those related to the cultural and societal values, as well as the social and health government policies. The individual factors were classified into the following categories: socioeconomic (social class, occupation, income, and education level), demographic characteristics (age, sex, and ethnicity), behavioral factors (non-use of fluoride dentifrice, sugar consumption, poor oral hygiene, and lack of preventive dental care), and biological factors (recent caries experience/active caries lesions, biofilm retentive factors, developmental defects of the enamel, disabilities, saliva amount and quality, cariogenic biofilm). Each of these variables was addressed, while focusing on the current evidence from studies conducted in Latin American and Caribbean countries (LACC). Based on the proposed model, educational aspects were addressed, and individual caries risk assessment and management decisions were proposed; further, implications for public health policies and clinical practice were described. The identification of modifiable risk factors for dental caries should be the basis for multi-strategy actions that consider the diversity of Latin American communities.

Impact of Epigenetic Alterations in the Development of Oral Diseases

BACKGROUND

Epigenetic mechanisms alter gene expression and regulate vital cellular processes that contribute to the onset and progression of major dental diseases. Their reversible character may prove beneficial for therapeutic targeting. This review aims to provide an update on the main epigenetic changes that contribute to the pathogenesis of Oral Squamous Cell Carcinoma (OSCC), pulpitis and periodontitis as well as dental caries and congenital orofacial malformations, in an effort to identify potential therapeutic targets.

METHODS

We undertook a structured search of bibliographic databases (PubMed and MEDLINE) for peer-reviewed epigenetic research studies focused on oral diseases in the last ten years. A qualitative content analysis was performed in screened papers and a critical discussion of main findings is provided.

RESULTS

Several epigenetic modifications have been associated with OSCC pathogenesis, including promoter methylation of genes involved in DNA repair, cell cycle regulation and proliferation leading to malignant transformation. Additionally, epigenetic inactivation of tumor suppressor genes, overexpression of histone chaperones and several microRNAs are implicated in OSCC aggressiveness. Changes in the methylation patterns of IFN-γ and trimethylation of histone Η3Κ27 have been detected in pulpitis, along with an aberrant expression of several microRNAs, mainly affecting cytokine production. Chronic periodontal disease has been associated with modifications in the methylation patterns of Toll-Like Receptor 2, Prostaglandin synthase 2, E-cadherin and some inflammatory cytokines, along with the overexpression of miR-146a and miR155. Furthermore, DNA methylation was found to regulate amelogenesis and has been implicated in the pathogenesis of dental caries as well as in several congenital orofacial malformations.

CONCLUSION

Strong evidence indicates that epigenetic changes participate in the pathogenesis of oral diseases and epigenetic targeting may be considered as a complementary therapeutic scheme to the current management of oral health.

Indicators of Risk for Dental Caries in Children: A Holistic Approach

BACKGROUND

Dental caries in children is a major public health problem worldwide, with a multitude of determinants acting upon children to different degrees in different communities. The objective of this study was to determine maternal, environmental, and intraoral indicators of dental caries experience in a sample of 6- to 7-y-old children in South East Queensland, Australia.

METHODS

A total of 174 mother-child dyads were recruited for this cross-sectional study from the Griffith University Environments for Healthy Living birth cohort study. Maternal education, employment status, and prepregnancy body mass index were maternal indicators, and annual household income was taken as a proxy for environmental indicators. These were collected as baseline data of the study. Clinical data on children's dental caries experience, saliva characteristics of buffering capacity, stimulated flow rate, and colony-forming units per milliliter of salivary mutans streptococci were collected for the oral health substudy. Univariate analysis was performed with 1-way analysis of variance and chi-square tests. Caries experience was the outcome, which was classified into 4 categories based on the number of carious tooth surfaces. Ordinal logistic regression was used to explore the association of risk indicators with caries experience.

RESULTS

Age (P = 0.021), low salivary buffering capacity (P = 0.001), reduced levels of salivary flow rate (P = 0.011), past caries experience (P = 0.001), low annual household income; <$30,000 (P = 0.050) and <$60,000 (P = 0.033) and maternal employment status (P = 0.043) were associated with high levels of dental caries.

CONCLUSION

These data support the evidence of associations between maternal, environmental, and children's intraoral characteristics and caries experience among children in a typical Western industrialized country. All of these need to be considered in preventative strategies within families and communities.

KNOWLEDGE TRANSFER STATEMENT

The results of this study can be used by clinicians, epidemiologists, and policy makers to identify children who are at risk of developing dental caries. With consideration of costs for treatment for the disease, this information could be used to plan cost-effective and patient-centered preventive care.

Children's untreated decay is positively associated with past caries experience and with current salivary loads of mutans Streptococci; negatively with self-reported maternal iron supplements during pregnancy: a multifactorial analysis

OBJECTIVES

This study explored the association of children's salivary characteristics, past caries experience, birth weight, and reported maternal prenatal vitamin and mineral supplementation with the dental untreated decay of the child.

METHODS

This cross-sectional study, a sub-study of Griffith University Environments for Healthy Living birth cohort study, was conducted on 174 mother-child dyads. Mother's prenatal usage of vitamin and mineral supplements; child's birthweight; salivary pH, buffering capacity, and levels of salivary MS and LB were explored as risk indicators. Dental caries experience was assessed using International Caries Detection and Assessment System criteria. Path analysis was conducted to evaluate the association of risk indicators with children's current and past dental caries experience.

RESULTS

Children's past caries experience (β = 0.332, p = 0.018), and salivary MS counts (β = 0.215, p = 0.032) were positively associated with untreated decay at time of examination. With a trend towards significance, children whose mothers had reported taking iron supplements during pregnancy experienced lower levels of past caries (β = -0.137, p = 0.068) and untreated dental caries (β = -0.046, p = 0.051).

CONCLUSIONS

This study confirms that a child's levels of untreated decay is positively associated with their past caries, and that it correlates with current levels of salivary MS. Children of mothers who reported to have taken iron supplements during pregnancy experienced less caries throughout their lives. These observations confirm the importance to offspring of monitoring maternal health throughout pregnancy and of early monitoring of children's oral health in preventing future dental disease.

[Association between the dental caries and the human leucocyte antigen DQB1 allele polymorphisms among the Uygur and Han children in Xinjiang]

OBJECTIVE

This study aims to investigate the association between human leucocyte antigen (HLA)-DQB1 allele polymorphisms and the presence dental caries among the Uygur and Han children in Xinjiang.

METHODS

HLA-DQB1 allele in the Uygur and Han children with dental caries and healthy control in Xinjiang was tested (n=40) using the polymerase chain reaction-sequence specific primer (PCR-SSP) DNA parting technology.

RESULTS

A total of five specific loci were detected in the HLA-DQB1 locus among the Uygur and Han children. The frequency of the HLA-DQB1*02 allele in the Han group with severe caries (12.5%) was significantly lower than in the control group (32.5%) (P<0.05, OR=0.297). Moreover, the frequency of the HLA-DQB1*05 allele in the Uygur group with severe caries (37.5%) was significantly higher than in the control group (17.5%) (P<0.05, OR=2.829).

CONCLUSIONS

Caries susceptibility among the Uygur and Han children in Xinjiang is related to the HLA-DQB1 allele. The HLA-DQB1*02 allele may protect against caries among the Han children, whereas the HLA-DQB1*05 allele may be responsible for the susceptibility of the Uygur children to caries.